Sample records for endoscopic sphenopalatine artery

  1. Endoscopic Cauterization of the Sphenopalatine Artery to Control Severe and Recurrent Posterior Epistaxis

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    Behrooz Gandomi


    Full Text Available Introduction: Epistaxis is one of the most common medical emergencies, making the management of posterior epistaxis a challenging problem for the ear, nose, and throat (ENT surgeon. In the cases of conservative management failure, ligation of the major arteries or percutaneous embolization of the maxillary artery is performed routinely in most units, but rates of failure and complications are high.The objective of this study was to assess the effectiveness of endoscopic sphenopalatine artery (SPA cauterization in patients with refractory posterior epistaxis.   Materials and Methods: Between April 2011 and January 2012, 27 patients (15 males and 12 females with refractory posterior epistaxis underwent endoscopic SPA cauterization in two tertiary referral hospitals in Shiraz. Three patients underwent bilateral cauterization.   Results: Four patients (from 30 arteries had new epistaxis after surgery, three experienced subsequent epistaxis requiring medical treatment, and one patient had a minor epistaxis not needing treatment.   Conclusion:  The SPA electrocoagulation technique seems to be safe, simple, fast, and effective with low rates of morbidity and complications for the management of refractory posterior epistaxis. Endoscopic SPA cauterization should be considered as an immediate second-line management when conservative treatment as first-line management fails. 

  2. The sphenopalatine foramen in man: anatomical, radiological and endoscopic study. (United States)

    El-Shaarawy, Ehab Abdel Aziz; Hassan, Sherif S


    Epistaxis is a frequent problem otorhinolaryngologists faces of in their practice. The variations of the sphenopalatine foramen and consequently the artery may be one of the major sources of such bleeding. The present work aimed at to localize the site of sphenopalatine foramen and also to illustrate its different shapes, number and any other variation. In the current study, twenty adult skulls of both sexes with total 40 half skulls were used in addition to 20 heads of adult living subjects of both sexes aged between 30-60 years examined with multislice helical CT with 3-D reconstruction of SPF. Then, examination of another ten dried skulls with endoscope. The number of the sphenopalatine foramina (SPF) is varied being single in nearly 80 % and multiple in 20 % of examined cases. The shape of the foramen also is varied; regular in 67.5 % and irregular in 32.5 % of all cases. The site of the foramen on the lateral nasal wall is placed in the superior meatus in most of examined skulls (62.5 %) while in the rest (37.5 %) they are found in the superior meatus and extending to the middle one. There are variation of the number, shape and site of the SPF, and consequently of the branches of the sphenopalatine artery, and this may explain the surgical failure in management of severe epistaxis. The data obtained from the current work support the predication of more than one sphenopalatine arteries and gives ample knowledge on the endoscopic study of the lateral nasal wall and consequently the surgical treatment of severe epistaxis.

  3. Endoscopic sphenopalatine artery ligation for acute idiopathic epistaxis. Do anatomical variation and a limited evidence base raise questions regarding its place in management? (United States)

    Ellinas, A; Jervis, P; Kenyon, G; Flood, L M


    Endoscopic sphenopalatine artery ligation is widely accepted as effective and safe for acute spontaneous epistaxis that is unresponsive to conservative management. As with many new procedures, it has been progressively adopted as common practice, despite a limited evidence base for its efficacy. Early reviews called for comparative trials to support its adoption, but subsequent literature largely consists of case series and narrative reviews. These have attempted to derive an algorithm to establish its place in management, but consensus is still lacking. Intuitively, although there are theoretical objections, an operation regarded as relatively simple, fast and safe hardly seems to demand high-level evidence of efficacy. Rhinologists may be influenced by years of personal experience and success with the technique. However, estimates of the effect size and the added contribution to traditional surgical management are lacking. If the procedure could be shown to dramatically influence outcome, it should be standard practice and indispensable for all patients requiring operative intervention. This paper systematically examined the literature, appraising the anatomical basis for such an approach and evidence for its efficacy. It questions whether any units unable to consistently offer endoscopic sphenopalatine artery ligation should be undertaking surgical management of acute epistaxis.

  4. Anatomy of the sphenopalatine artery and its implications for transnasal neurosurgery. (United States)

    Eordogh, M; Grimm, A; Gawish, I; Patonay, L; Reisch, R; Briner, H R; Baksa, G


    The knowledge of sinonasal vasculature is inevitable in transnasal neurosurgery. We performed an anatomical study on the sphenopalatine artery from the perspective of skull base procedures. To analyse the anatomical landmarks of the sphenopalatine artery, arterial skull corrosion casts (26 head halves) underwent endoscopic transnasal phantom surgery. Furthermore, we performed microsurgical dissection on formaldehyde-fixated cadavers with arterial perfusion (14 head halves) as well as studied Cone Beam CT-scans of anonymised patients and cadavers (115 head sides). In our cadaveric material, the sphenopalatine foramen is located at the transition of the superior and middle nasal meatus (95.0%) or in the superior nasal meatus (5.0%). It is the main entry point of the branches of the sphenopalatine artery into the nasal cavity. In most cadaveric cases (25.0%), at this level there are 2 branches superiorly and 1 vessel inferiorly to the ethmoid crest. An average of 2.4 vessels leave the sphenopalatine foramen superiorly to the ethmoid crest, 97.8% of them belong to the sphenopalatine arterys posterior septal branches. An average of 2.1 branches leave the sphenopalatine foramen inferiorly to the ethmoid crest; all of them belong to the posterior lateral nasal branches. There are no cases with a single artery at the plane of the sphenopalatine foramen. We describe a triangular bony structure bordering the sphenopalatine foramen anteriorly which is built up by the palatine and ethmoid bone as well as the maxilla. According to the radiographic studies, this triangular prominence is surrounded superiorly by a posterior ethmoid cell (57.4%), the sphenoid sinus (41.7%) or the orbit (0.9%) with a varying contribution of the superior nasal meatus; inferolaterally by the maxillary sinus (98.3%) or the pterygopalatine and infratemporal fossa (1.7%) and inferomedially by the middle nasal meatus. The medial vertex of the bony triangle corresponds to the ethmoid crest of the palatine

  5. Management of Hemorrhagic Pseudoaneurysmal Arteriovenous Fistula of the Sphenopalatine Artery

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    Ajeet Gordhan


    Full Text Available n-Butyl cyanoacrylate (n-BCA embolization of a hemorrhagic pseudoaneurysmal arteriovenous fistula of the sphenopalatine artery in a patient with paranasal sinus squamous cell carcinoma treated with regional surgery and radiation has, to our knowledge, not been previously reported.

  6. [Pedicle flaps based on the sphenopalatine artery: anatomical and surgical study]. (United States)

    Gras-Cabrerizo, Juan R; Gras-Albert, Juan R; Monjas-Canovas, Irene; García-Garrigós, Elena; Montserrat-Gili, Joan R; Sánchez del Campo, Francisco; Kolanczak, Katarzyna; Massegur-Solench, Humbert


    Local pedicle flaps based on the sphenopalatine artery make it possible to reconstruct large defects of the skull base (SB). From January 2008 to January 2013, 64 lesions with involvement of SB were analysed. These lesions were treated using endoscopic endonasal approach and required a pedicle flap based on the sphenopalatine artery. In addition, measurements and flexibility of the flaps were examined in 4 cadaveric nasal cavities. Surgical group. Sixty-four nasoseptal flaps (NSF) were used, in 4 cases associated with a middle turbinate flap (MTF), and in 1 case supplemented with an inferior turbinate flap (ITF). Five cerebrospinal fluid fistulas (8%) were noted. Among patients with initial lesions, 7% presented an anosmia. Cadaveric group. The length of the NSF varied between 5.2 cm and 7.7 cm and the width ranged from 3 cm to 4.5 cm. The ITF provided an anterior-posterior distance between 4.2 cm and 5 cm, with a width between 1.2 cm and 2.8 cm. The mean length of MTFs varied between 3.5 cm and 4.2 cm, with a width between 1.4 cm and 1.9 cm. The most versatile local flap for the reconstruction of skull base defects is the NSF, and flaps pedicled to the posterolateral nasal artery offer an excellent alternative. Copyright © 2013 Elsevier España, S.L. y Sociedad Española de Otorrinolaringología y Patología Cérvico-Facial. All rights reserved.

  7. Massive epistaxis due to pseudoaneurysm of the sphenopalatine artery: a rare post-operative complication of orthognathic surgery. (United States)

    Kim, Y-W; Baek, M-J; Kim, H-D; Cho, K-S


    To introduce pseudoaneurysm of the sphenopalatine artery as the possible aetiology of acute massive epistaxis in patients with a history of orthognathic surgery accompanied by Le Fort I osteotomy. Case report and literature review. This paper reports a case of acute life-threatening epistaxis following Le Fort I osteotomy. Computed tomography and angiography showed a pseudoaneurysm of the sphenopalatine artery, which was successfully treated by endovascular embolisation. Although a pseudoaneurysm of the sphenopalatine artery following Le Fort I osteotomy is extremely rare, it should be considered as the possible aetiology of acute massive epistaxis in patients with a history of orthognathic surgery accompanied by Le Fort I osteotomy.

  8. Sphenopalatine meningoencephalocele: a diagnosis and therapeutic challenge

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    Ayoub, Jimmy Ali Saadallah


    Full Text Available Introduction: Encephalocele and myelocele are deformities of easy clinical diagnosis, however, in some cases this diagnosis can be complicated for the clinical signs and complaints' absence. Objective: The present study intends to report the case of a two-year-old patient of the male sex with a trans sphenoidal meningocele without symptomatology associated to discrete alterations in the physical exam and treated through endoscopic transnasal surgery. Case Report: Trans sphenoidal meningocele' surgery treatment in a two-year-old patient, through endoscopic transnasal surgery, using bilateral septal nasal mucosa shred, pedicellate in the sphenopalatine artery. Conclusion: The meningoencephalocele approach, using septal nasal mucosa it is showed a viable and effective option in pediatric patients.

  9. Endoscopic Radial Artery Harvest for Coronary Artery Bypass Surgery

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    Kuan-Ming Chiu


    Conclusion: Endoscopic harvest of the radial artery is technically demanding, but excellent results can be achieved. The endoscopic approach can provide suitable conduits in a less invasive way than the open harvest technique.

  10. Robotically assisted totally endoscopic coronary artery bypass surgery


    Canale, Leonardo Secchin; Mick, Stephanie; Mihaljevic, Tomislav; Nair, Ravi; Bonatti, Johannes


    Robotically assisted totally endoscopic coronary artery bypass surgery has emerged as a feasible and efficient alternative to conventional full sternotomy coronary artery bypass graft surgery in selected patients. This minimally invasive approach using the daVinci robotic system allows fine intrathoracic maneuvers and excellent view of the coronary arteries. Both on-pump and off-pump operations can be performed to treat single and multivessel disease. Hybrid approaches have the potential of o...

  11. History and Current Status of Robotic Totally Endoscopic Coronary Artery Bypass

    National Research Council Canada - National Science Library

    Lee, Jeffrey D; Srivastava, Mukta; Bonatti, Johannes


    Robotic totally endoscopic coronary artery bypass (TECAB) is a minimally invasive endoscopic surgical approach using the daVinci robotic telemanipulation system to perform coronary artery bypass grafting on the arrested or beating heart...

  12. Robotically assisted totally endoscopic coronary artery bypass surgery (United States)

    Canale, Leonardo Secchin; Mick, Stephanie; Mihaljevic, Tomislav; Nair, Ravi


    Robotically assisted totally endoscopic coronary artery bypass surgery has emerged as a feasible and efficient alternative to conventional full sternotomy coronary artery bypass graft surgery in selected patients. This minimally invasive approach using the daVinci robotic system allows fine intrathoracic maneuvers and excellent view of the coronary arteries. Both on-pump and off-pump operations can be performed to treat single and multivessel disease. Hybrid approaches have the potential of offering complete revascularization with the “best of both worlds” from surgery (internal mammary artery anastomosis in less invasive fashion) and percutaneous coronary intervention (least invasive approach). In this article we review the indications, techniques, short and long term results, as well as current developments in totally endoscopic robotic coronary artery bypass operations. PMID:24251021

  13. Is totally endoscopic coronary artery bypass safe, feasible and effective? (United States)

    Acharya, Metesh Nalin; Ashrafian, Hutan; Athanasiou, Thanos; Casula, Roberto


    A best evidence topic was written according to a structured protocol. The question addressed was whether totally endoscopic coronary artery bypass (TECAB) is safe, effective and feasible. A total of 171 papers were found, of which eight represented the best evidence. The authors, date, journal, study type, population, main outcome measures and results are tabulated. The da Vinci robotic system was utilized in seven retrospective studies and one multicentre prospective trial, comprising 724 patients undergoing TECAB. Patient-related outcomes, including the incidence of major adverse cardiac events, graft patency and survival, were investigated. From the studies evaluated, TECAB appears to be safe operation with low complication rates and excellent early- and mid-term graft patencies. The incidence of internal thoracic artery injury was documented in four studies and ranged from 0 to 10%. Re-exploration for bleeding was necessary in 1-15% of patients. Conversion to open techniques was performed in 0-24% of cases. There was no in-hospital mortality in the majority of studies, but this reached 2.1% in a large series of 228 patients. Target-vessel reintervention rates varied between 0 and 12.1% according to the institutional experience. Pre- and post-discharge graft patencies were excellent at 93-100 and 92-100%, respectively. Intraoperative variables, such as time taken for internal thoracic artery harvest, anastomosis, cross-clamp, cardiopulmonary bypass (CPB) and the overall operation were as follows: internal thoracic artery harvest time (range 5-187 min), anastomosis time (range 6-82 min), cross-clamp time (range 30-223 min), CPB time (range 41-268 min) and operative time (range 84-600 min). TECAB is a technically demanding and time-consuming procedure associated with a significant learning curve. Proctoring and structured training programmes are currently supported by European and international societies to encourage wider uptake of the procedure. In conclusion

  14. Five-Year Clinical Outcome of Endoscopic Versus Open Radial Artery Harvesting: A Propensity Score Analysis. (United States)

    Bisleri, Gianluigi; Giroletti, Laura; Hrapkowicz, Tomasz; Bertuletti, Martina; Zembala, Marian; Arieti, Mario; Muneretto, Claudio


    Despite the popularity of less invasive approaches for conduits procurement in coronary artery bypass graft surgery, concerns have been raised about the potential detrimental effects of the endoscopic technique when compared with the conventional "open" technique. Among 470 patients undergoing coronary surgery with the use of a radial artery conduit, a propensity score analysis was performed among those patients assigned either to an open technique (n = 82) or to an endoscopic approach (n = 82). Endoscopic harvesting was performed with a nonsealed system. The primary endpoint was cardiac-related mortality, and secondary endpoint was survival free from major cardiac and cerebrovascular adverse events. Moreover, hand and forearm sensory discomfort and forearm wound healing were also assessed. No conversion to the open technique occurred in patients undergoing endoscopic harvesting. No patients in either group showed hand ischemia; wound infection occurred only in the open group (open 7.3% versus endoscopic 0%, p = 0.007). Wound healing (Hollander scale) was considerably better in the endoscopic group (open 3.3, endoscopic 4.7; p < 0.001) as well as paresthesia at the latest follow-up (open 19.5% versus endoscopic 3.6%, p < 0.001). Pain (visual analog scale score) was significantly reduced with the endoscopic technique (open 3.2, endoscopic 1.2; p = 0.003). At 5 years of follow-up, freedom from cardiac-related mortality (open 96.3% ± 2.1% versus endoscopic 98.1% ± 1.8%; p = 0.448) as well as survival free from major cardiac and cerebrovascular adverse events (open 93.9% ± 2.6% versus endoscopic 93% ± 3.4%; p = 0.996) were similar among the groups. Endoscopic radial artery harvesting allows for incremental benefits in the short term in terms of improved cosmesis and reduced wound and neurologic complications, without yielding detrimental effects in terms of graft-related events at 5 years of follow-up. Copyright © 2016 The Society of Thoracic Surgeons

  15. Is there a role for robotic totally endoscopic coronary artery bypass in patients with a colostomy? (United States)

    Gibber, Marc; Lehr, Eric J; Kon, Zachary N; Wehman, P Brody; Griffith, Bartley P; Bonatti, Johannes


    Preoperative colostomy presents a significant risk of sternal wound complications, mediastinitis, and ostomy injury in patients requiring coronary artery bypass grafting. Less invasive procedures in coronary surgery have a potential to reduce the risk of sternal wound healing problems. Robotic totally endoscopic coronary artery bypass grafting in patients with a colostomy has not been reported. We describe a case of completely endoscopic coronary surgery using the da Vinci Si system in a patient with a transverse colostomy. Single left internal mammary artery grafting to the left anterior coronary artery was performed successfully on the beating heart. We regard this technique as the least invasive method of surgical coronary revascularization with a potential to reduce the risk of surgical site infection and mediastinitis in patients with a colostomy.

  16. How to perform a coronary artery anastomosis in complete endoscopic fashion with robotic assistance. (United States)

    Canale, Leonardo Secchin; Bonatti, Johannes


    Current technology in robotic surgery allows us to perform myocardial revascularization procedures in a totally endoscopic fashion. We will describe the technique of choice for left internal mammary artery to left anterior descendent artery anastomosis with the use of cardiopulmonary bypass machine. The method is efficient and there is long term follow-up showing similar patency of the graft when compared to conventional methods (when performed through sternotomy).

  17. How to perform a coronary artery anastomosis in complete endoscopic fashion with robotic assistance (United States)

    Canale, Leonardo Secchin; Bonatti, Johannes


    Current technology in robotic surgery allows us to perform myocardial revascularization procedures in a totally endoscopic fashion. We will describe the technique of choice for left internal mammary artery to left anterior descendent artery anastomosis with the use of cardiopulmonary bypass machine. The method is efficient and there is long term follow-up showing similar patency of the graft when compared to conventional methods (when performed through sternotomy). PMID:25714222

  18. How to perform a coronary artery anastomosis in complete endoscopic fashion with robotic assistance

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    Leonardo Secchin Canale


    Full Text Available Current technology in robotic surgery allows us to perform myocardial revascularization procedures in a totally endoscopic fashion. We will describe the technique of choice for left internal mammary artery to left anterior descendent artery anastomosis with the use of cardiopulmonary bypass machine. The method is efficient and there is long term follow-up showing similar patency of the graft when compared to conventional methods (when performed through sternotomy.

  19. Estudo anatômico do forame esfenopalatino Anatomical study of the sphenopalatine foramen

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    Adriana Bernardini Antunes Scanavine


    Full Text Available As variações anatômicas do forame esfenopalatino podem corresponder às alterações na entrada da irrigação nasal arterial, condição relevante para o tratamento das epistaxes graves através da ligadura da artéria esfenopalatina. OBJETIVO: Estudar o forame esfenopalatino quanto à sua variação numérica e sua localização na parede lateral nasal em relação à crista etmoidal óssea do osso palatino. Material e Método: Os estudos anatômicos foram realizados em 54 hemicrânios. RESULTADOS: O forame esfenopalatino apresentou a seguinte variação numérica: único (87,0% ou 47 peças, duplo (11,1% ou 6 peças e triplo (1,9% ou uma peça; foi localizado no meato nasal superior em 81,5% ou 44 peças, 14,8% (8 peças entre os meatos nasais médio e superior e no meato nasal médio apenas em um caso (1,9%. CONCLUSÃO: Foi demonstrada a variação numérica do FEP, a sua relação com a crista etmoidal óssea, e sua localização nos meatos nasais superior, médio e em ambos.Anatomical variations of the sphenopalatine foramen may correspond to alterations at the arterial nasal irrigation input, which is a relevant condition to treat severe epistaxis through ligation of the sphenopalatine artery. AIM: To study the sphenopalatine foramen in terms of its numeric variation and its location on the lateral nasal wall in relation to the bony ethmoidal crest of the palatine bone. MATERIALS AND METHODS: The anatomical studies were carried out in 54 hemifaces. RESULTS: the sphenopalatine foramen presented the following numeric variation: single (87%, or 47 specimens, double (11,1%, or 6 specimens, and triple (1.9% or one specimen; it was located at the superior nasal meatus in 81.5%, or 44 specimens; 14.8% (8 specimens between the middle and superior nasal meatus and in the middle nasal meatus in only one case (1.9%. CONCLUSION: We have been able to show a numeric variation of the SPF, its relation with the bony ethmoidal crest and its location in

  20. Arterial Thoracic Outlet Syndrome Treated Successfully with Totally Endoscopic First Rib Resection. (United States)

    Mitsos, Sofoklis; Patrini, Davide; Velo, Sara; Antonopoulos, Achilleas; Hayward, Martin; George, Robert S; Lawrence, David; Panagiotopoulos, Nikolaos


    Thoracic outlet syndrome (TOS) is a constellation of signs and symptoms caused by compression of the neurovascular structures in the thoracic outlet. TOS may be classified as either neurogenic TOS (NTOS) or vascular TOS: venous TOS (VTOS) or arterial TOS (ATOS), depending on the specific structure being affected. The basis for the surgical treatment of TOS is resection of the first rib, and it may be combined with scalenectomy or cervical rib resection. Herein, we describe a case of arterial thoracic outlet syndrome which was successfully treated with totally endoscopic video-assisted thoracoscopic surgery (VATS) first rib resection.

  1. Segmental wall motion abnormalities during telerobotic totally endoscopic coronary artery bypass grafting. (United States)

    Mierdl, Stephan; Byhahn, Christian; Dogan, Selami; Aybek, Tayfun; Wimmer-Greinecker, Gerhard; Kessler, Paul; Meininger, Dirk; Westphal, Klaus


    In addition to single-lung ventilation (SLV), intrathoracic CO2 insufflation is mandatory for adequate exposure during totally endoscopic coronary artery bypass grafting. With transesophageal echocardiography, we investigated biventricular myocardial wall motion in 25 patients with isolated disease of the left anterior descending coronary artery who underwent totally endoscopic coronary artery bypass grafting with the "Da Vinci" robotic surgical system. At distinct time points during the operation, a cine loop of both ventricles was registered from a transgastric mid-short-axis view. Myocardial wall motion analysis was performed according to an established segmentation model of the left ventricle and to an established five-point scale for wall motion (1, normal; 5, dyskinesia). Significant alterations from preoperative baseline wall motion were visible in the septal, inferior, and anterior segments of the left ventricle at some time during the prebypass period, combined with a markedly decreased PaO2 under SLV and increased intrathoracic pressure. The same findings applied to the right ventricle; however, wall motion abnormalities were more pronounced here. After myocardial revascularization, weaning from cardiopulmonary bypass, CO2 deflation, and return to double-lung ventilation, myocardial wall motion recovered to baseline values. Clinically significant hemodynamic instability did not occur. The data suggest that robot-assisted coronary artery bypass grafting leads to significant prebypass alterations of biventricular segmental wall motion. On the basis of our data, it cannot be definitively stated whether the observed results were due to reduced oxygenation during SLV and thus "real" myocardial ischemia, intrathoracic CO2 insufflation with positive pressure leading to mechanical compromise of the heart, absolute or relative hypovolemia, or a combination of these factors. However, in this cohort, which consisted of patients with single-vessel disease and good

  2. Compromised Cardiopulmonary Exercise Capacity in Patients Early After Endoscopic Atraumatic Coronary Artery Bypass Graft: Implications for Rehabilitation


    Hansen, Dominique; Roijackers, Ruben; Jackmaert, Lore; Robic, Boris; Hendrikx, Marc; Yilmaz, Alaaddin; Frederix, Ines; Rosseel, Michael; Dendale, Paul


    Objective: The purpose of this work was to test the hypothesis that cardiopulmonary exercise tolerance is better preserved early after endoscopic atraumatic coronary artery bypass graft (endo-ACAB) surgery versus coronary artery bypass graft (CABG) surgery. Design: Twenty endo-ACAB surgery patients, 20 CABG surgery patients, and 15 healthy subjects executed a maximal cardiopulmonary exercise test, with assessment and comparison of cycling power output, O2 uptake, CO2 output, respiratory ...

  3. 56. Endoscopic vein graft harvest for coronary artery bypass surgery: Single center experience in Saudi Arabia

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    M. Algadheeb


    Full Text Available Open saphenous vein technique is the standard of care in patients undergoing coronary artery surgery (CABG worldwide and in Saudi Arabia. Endoscopic vein harvest (EVH is an innovative technique that have been recommended by the international society of minimally invasive surgery. Our aim in the current study is to review our preliminary data about endoscopic vein harvest. Would endoscopic vein harvest decrease the incidence of leg wound infections? This is a retrospective study of a single tertiary care center of 94 consecutive patients who underwent CABG with EVH. Preoperative associated risk factors were assessed. Postoperative follow up includes leg wound infection and patient satisfaction with EVH by using a telephone and/or a paper questionnaire. We had 94 consecutive patients who underwent CABG with EVH between October 2014 and October 2015, mean age was 56.7 (33–77 years, 91.5% were male, mean euro score II was 2.47%. The most common presentation was NSTEMI (39.4% followed by STEMI (26.6%, unstable angina (11.7% and stable angina (5.3%. Our cohort had the following characteristics: 85.1% were diabetic, 84% were hypertensive, 46.8% had dyslipidemia, 2.1% had CVA, 7.4% had Carotid artery disease, 2.1% had Congestive heart failure, 4.3% had any renal disease and 4.3% had previous PCI. Most of our patients received 3 grafts (44.7% followed by 4 grafts (42.6% of which only one leg was used for EVH (94.1%. Leg wound infection occurred in one patient only and in this case EVH was converted to open technique. A written and/or telephone questionnaire resulted in a high patient-satisfaction with the cosmetic outcome of EVH as well as very low grade of leg wound pain. EVH is a very promising innovative technique in patient undergoing CABG. Our patients were highly satisfied with their leg wound cosmetic outcome. In this single center experience, in Saudi Arabia, EVH is a promising innovative technique for saphenous vein harvest. It is highly

  4. Biliary Cast Syndrome: Hepatic Artery Resistance Index, Pathological Changes, Morphology and Endoscopic Therapy

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    Hu Tian


    Full Text Available Background: Biliary cast syndrome (BCS was a postoperative complication of orthotopic liver transplantation (OLT, and the reason for BSC was considered to relate with ischemic type biliary lesions. This study aimed to evaluate the relationship between BCS following OLT and the hepatic artery resistance index (HARI, and to observe pathological changes and morphology of biliary casts. Methods: Totally, 18 patients were diagnosed with BCS by cholangiography following OLT using choledochoscope or endoscopic retrograde cholangiopancreatography. In addition, 36 patients who did not present with BCS in the corresponding period had detectable postoperative HARI on weeks 1, 2, 3 shown by color Doppler flow imaging. The compositions of biliary casts were analyzed by pathological examination and scanning electron microscopy. Results: HARI values of the BCS group were significantly decreased as compared with the non-BCS group on postoperative weeks 2 and 3 (P 1 (OR = 1.300; 1.223; and 1.889, respectively. The OR of HARI 3 was statistically significant (OR = 1.889; 95% confidence interval = 1.166-7.490; P = 0.024. The compositions of biliary casts were different when bile duct stones were present. Furthermore, vascular epithelial cells were found by pathological examination in biliary casts. Conclusions: HARI may possibly serve as an independent risk factor and early predictive factor of BCS. Components and formation of biliary casts and bile duct stones are different.

  5. The surgical challenge of carotid artery and Fallopian canal dehiscence in chronic ear disease: a pitfall for endoscopic approach. (United States)

    Pauna, H F; Monsanto, R C; Schachern, P A; Costa, S S; Kwon, G; Paparella, M M; Cureoglu, S


    Endoscopic procedures are becoming common in middle ear surgery. Inflammation due to chronic ear disease can cause bony erosion of the carotid artery and Fallopian canals, making them more vulnerable during surgery. The objective of this study was to determine whether or not chronic ear disease increases dehiscence of the carotid artery and Fallopian canals. Comparative human temporal bone study. Otopathology laboratory. We selected 78 temporal bones from 55 deceased donors with chronic otitis media or cholesteatoma and then compared those two groups with a control group of 27 temporal bones from 19 deceased donors with no middle ear disease. We analysed the middle ear, carotid artery canal and Fallopian canal, looking for signs of dehiscence of its bony coverage, using light microscopy. We found an increased incidence in dehiscence of the carotid artery and Fallopian canals in temporal bones with chronic middle ear disease. The size of the carotid artery canal dehiscence was larger in the middle ear-diseased groups, and its bony coverage, when present, was also thinner compared to the control group. Dehiscence of the carotid artery canal was more frequently located closer to the promontory. The incidence of Fallopian canal dehiscence was significantly higher in temporal bones from donors older than 18 years with chronic middle ear disease. The increased incidence of the carotid artery and Fallopian canal dehiscence in temporal bones with chronic middle ear disease elevates the risk of adverse events during middle ear surgery. © 2016 John Wiley & Sons Ltd.

  6. Endoscopic endonasal nasopharyngectomy: tensor veli palatine muscle as a landmark for the parapharyngeal internal carotid artery. (United States)

    Liu, Chiung-Lin; Hsu, Ning-I; Shen, Ping-Hung


    Endoscopic endonasal nasopharyngectomy(EEN) can be a promising option for select patients with recurrent nasopharyngeal carcinoma, but serious complications can occur in terms of parapharyngeal internal carotid artery (PPICA) injury. Several landmarks have been proposed for locating the PPICA. In this study, we investigated the spatial relationship between the tensor veli palatini (TVP) muscle and the PPICA in a cadaveric model. Seven fresh cadaver heads were available for anatomic study. Eustachian tube and the levator veli palatine (LVP) muscle were partially sacrificed or truncated to maximize the surgical field, and the TVP muscle was carefully preserved. Complete dissection was defined as when the PPICA could be visualized. We then measured the distance between the posterior margin of the TVP muscle and PPICA (z-axis), and the distance from the midline of the nasopharynx to the PPICA (x-axis). Thirteen sides of the PPICA were successfully identified. The mean distance between the posterior margin of the TVP to the PPICA (z) was 20.3 mm (range, 12 to 28 mm), and the mean distance between the midline of the nasopharynx to the PPICA (x) was 19.6 mm (range, 15 to 24 mm). The PPICA was located in the same sagittal plane as the TVP muscle during dissection posteriorly. The PPICA appeared to lie around 2 cm laterally from the midline at around 2 cm in depth from the posterior margin of the TVP muscle. However, the exact position of the PPICA should be assessed using preoperative magnetic resonance imaging and intraoperative image-guided systems. © 2017 ARS-AAOA, LLC.

  7. Endoscopic Management of Epistaxis in Lumbini Medical College

    Directory of Open Access Journals (Sweden)

    Anup Acharya


    Full Text Available Introduction: Epistaxis is one of the commonest Ear Nose Throat (ENT emergency. Proper guidelines for its management are lacking; on the other hand, the management is mostly done by the junior health service providers which has invited non-standardized practice of epistaxis management. Thereby this study was much inclined towards assessment of the effectiveness of endoscopic management of epistaxis.   Methods: This prospective study included patients above 16 years who were diagnosed with idiopathic epistaxis visiting Out Patient of ENT Department or in the Emergency Department of Lumbini Medical College from 1st of July 2014 to 30th of June 2015. ENT examination was done to find the cause and site of bleeding. Thereafter different epistaxis management interventions were done depending on the bleeding condition. The data were collected, entered and then analyzed using SPSS version 21. The descriptive statistics were applied.   Results: Of the total 116 patients, 53 (45.69% were male and 63 (54.31% were female showing no gender preponderance with epistaxis in our study. Majority (49% of the patients were managed with cauterization with silver nitrate or electrocautery in out-patient clinic. Second most common (18% procedure was endoscopic sphenopalatine artery cauterization. Nasal packing was done only in three cases with zero posterior pack.   Conclusion: Endoscopic intervention of epistaxis seems to be safe, simple, fast, and effective for the management of epistaxis with low rates of morbidity and complications. Thereby it can be preferred over the conservative nasal packing and considered as immediate second-line management.

  8. Surgical problems and complex procedures: issues for operative time in robotic totally endoscopic coronary artery bypass grafting. (United States)

    Wiedemann, Dominik; Bonaros, Nikolaos; Schachner, Thomas; Weidinger, Felix; Lehr, Eric J; Vesely, Mark; Bonatti, Johannes


    Robotically assisted totally endoscopic coronary artery bypass grafting (TECAB) is a viable option for closed chest coronary surgery, but it requires learning curves and longer operative times. This study evaluated the effect of extended operation times on the outcome of patients undergoing TECAB. From 2001 to 2009, 325 patients underwent TECAB with the da Vinci telemanipulation system. Correlations between operative times and preoperative, intraoperative, and early postoperative parameters were investigated. Receiver operating characteristic analysis was used to define the threshold of the procedure duration above which intensive care unit stay and ventilation time were prolonged. Demographic data, intraoperative and postoperative parameters, and survival data were compared. Patients with prolonged operative times more often underwent multivessel revascularization (P 445 minutes and >478 minutes to predict prolonged (>48 hours) intensive care unit stay and mechanical ventilation, respectively. Patients with procedures >478 minutes had longer hospital stays and higher perioperative morbidity and mortality. Kaplan-Meier analysis revealed decreased survival among patients with operative times >478 minutes. Multivessel revascularization and conversions lead to prolonged operative times in totally endoscopic coronary artery bypass grafting. Longer operative times significantly influence early postoperative and midterm outcomes. Copyright © 2012 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

  9. Cluster headache attack remission with sphenopalatine ganglion stimulation

    DEFF Research Database (Denmark)

    Barloese, Mads C J; Jürgens, Tim P; May, Arne


    ; p = 0.2188). Post-remission headache disability (HIT-6) was significantly improved versus baseline (67.7 ± 6.0 before, 55.2 ± 11.4 after; p = 0.0118). Six of the 10 remission patients experienced clinical improvements in their preventive medication use. At 24 months post insertion headache...... in a subset of these. Some patients experiencing remission were also able to reduce or stop their preventive medication and remissions were accompanied by an improvement in headache disability.......Background: Cluster headache (CH) is a debilitating headache disorder with severe consequences for patient quality of life. On-demand neuromodulation targeting the sphenopalatine ganglion (SPG) is effective in treating the acute pain and a subgroup of patients experience a decreased frequency of CH...

  10. Endoscopic versus open radial artery harvest and mammario-radial versus aorto-radial grafting in patients undergoing coronary artery bypass surgery: protocol for the 2 × 2 factorial designed randomised NEO trial. (United States)

    Carranza, Christian L; Ballegaard, Martin; Werner, Mads U; Hasbak, Philip; Kjær, Andreas; Kofoed, Klaus F; Lindschou, Jane; Jakobsen, Janus Christian; Gluud, Christian; Olsen, Peter Skov; Steinbrüchel, Daniel A


    Coronary artery bypass grafting using the radial artery has, since the 1990s, gone through a revival. Observational studies have indicated better long-term patency when using radial arteries. Therefore, radial artery might be preferred especially in younger patients where long time patency is important. During the last 10 years different endoscopic techniques to harvest the radial artery have evolved. Endoscopic radial artery harvest only requires a small incision near the wrist in contrast to open harvest, which requires an incision from the elbow to the wrist. However, it is unknown whether the endoscopic technique results in fewer complications or a graft patency comparable to open harvest. When the radial artery has been harvested, there are two ways to use the radial artery as a graft. One way is sewing it onto the aorta and another is sewing it onto the mammary artery. It is unknown which technique is the superior revascularisation technique. The NEO Trial is a randomised clinical trial with a 2 × 2 factorial design. We plan to randomise 300 participants into four intervention groups: (1) mammario-radial endoscopic group; (2) aorto-radial endoscopic group; (3) mammario-radial open surgery group; and (4) aorto-radial open surgery group.The hand function will be assessed by a questionnaire, a clinical examination, the change in cutaneous sensibility, and the measurement of both sensory and motor nerve conduction velocity at 3 months postoperatively. All the postoperative complications will be registered, and we will evaluate muscular function, scar appearance, vascular supply to the hand, and the graft patency including the patency of the central radial artery anastomosis. A patency evaluation by multi-slice computer tomography will be done at one year postoperatively.We expect the nerve conduction studies and the standardised neurological examinations to be able to discriminate differences in hand function comparing endoscopic to open harvest of the

  11. Sphenopalatine blocks in the treatment of pain in fibromyalgia and myofascial pain syndrome. (United States)

    Janzen, V D; Scudds, R


    Sphenopalatine blocks have been used to treat pain for more than 80 years. Anecdotal support for sphenopalatine ganglion blocks has been very strong in those who believe in the technique, but the research results have been inconclusive. Therefore, a double blind, placebo-controlled study was performed on 61 patients, 42 with fibromyalgia and 19 with myofascial pain syndrome. Pain was measured using visual analogue scales prior to treatment, during treatment, and 28 days after the treatment. Headaches were evaluated in frequency and location prior to and after treatment. Sphenopalatine ganglion blocks were performed under direct vision using 4% lidocaine and sterile water as a placebo. Analysis of the results showed no statistical differences between the lidocaine and the placebo groups.

  12. Compromised Cardiopulmonary Exercise Capacity in Patients Early After Endoscopic Atraumatic Coronary Artery Bypass Graft: Implications for Rehabilitation. (United States)

    Hansen, Dominique; Roijakkers, Ruben; Jackmaert, Lore; Robic, Boris; Hendrikx, Marc; Yilmaz, Alaaddin; Frederix, Ines; Rosseel, Michael; Dendale, Paul


    The purpose of this work was to test the hypothesis that cardiopulmonary exercise tolerance is better preserved early after endoscopic atraumatic coronary artery bypass graft (endo-ACAB) surgery versus coronary artery bypass graft (CABG) surgery. Twenty endo-ACAB surgery patients, 20 CABG surgery patients, and 15 healthy subjects executed a maximal cardiopulmonary exercise test, with assessment and comparison of cycling power output, O2 uptake, CO2 output, respiratory gas exchange ratio, end-tidal O2 and CO2 pressures, equivalents for O2 uptake and CO2 output, heart rate, O2 pulse, expiratory volume, tidal volume, respiratory rate, at peak exercise and ventilatory threshold. In patients, forced expiratory volume and forced vital capacity were measured. Oxygen uptake, CO2 output, expiratory and tidal volume, equivalents for O2 uptake and CO2 output, end-tidal O2 and CO2 pressures at peak exercise (matched peak respiratory gas exchange ratio between patient groups), and ventilatory threshold were significantly worse in patients versus healthy controls (P power, >0.80). All these parameters, and lung function, were, however, comparable between CABG and endo-ACAB surgery patients (P > 0.10). Exercise tolerance and ventilatory function during exercise seems, in contrast to expectation, equally compromised early after endo-ACAB surgery as opposed to after CABG surgery. These data may signify the need for exercise-based rehabilitation intervention early after endo-ACAB surgery.

  13. Stimulation of the sphenopalatine ganglion (SPG) for cluster headache treatment. Pathway CH-1

    DEFF Research Database (Denmark)

    Schoenen, Jean; Jensen, Rigmor Højland; Lantéri-Minet, Michel


    BackgroundThe pain and autonomic symptoms of cluster headache (CH) result from activation of the trigeminal parasympathetic reflex, mediated through the sphenopalatine ganglion (SPG). We investigated the safety and efficacy of on-demand SPG stimulation for chronic CH (CCH).MethodsA multicenter, m...

  14. Sphenopalatine ganglion stimulation for the treatment of cluster headache. (United States)

    Láinez, Miguel J A; Puche, Miguel; Garcia, Ana; Gascón, Francisco


    Cluster headache is a severe, debilitating disorder with pain that ranks among the most severe known to humans. Patients with cluster headaches have few therapeutic options and further, 10-20% develop drug-resistant attacks. The often brief duration of cluster attacks makes abortive therapy a challenge, and preventive medications are almost always provided to patients, but the side effects of these preventive medications can be significant. The sphenopalatine ganglion (SPG) is believed to play a role in headache pain and cranial autonomic symptoms associated with cluster headache, which is a result of activation of the trigeminal-autonomic reflex. For over 100 years, the SPG has been a clinical target to treat primary headache disorders using pharmacologic and nonpharmacologic methods. Radiofrequency lesioning and nerve-resection therapies, while initially beneficial, are irreversible procedures, and the use of neurostimulation provides one method of interfacing with the neural pathways without causing permanent damage to neural tissue. SPG neurostimulation is both reversible and adjustable, and has recently been tested in both proof-of-concept work and in a randomized, sham-controlled trial for the treatment of cluster headache. A randomized, sham-controlled study of 32 patients was performed to evaluate further the use of SPG stimulation for the acute treatment of chronic cluster headache. Of the 32 patients, 28 completed the randomized experimental period. Overall, 68% of patients experienced an acute response, a frequency response, or both. In this study the majority of adverse events were related to the implantation procedure, which typically resolved or remained mild in nature at 3 months following the implant procedure. This and other studies highlight the promise of using SPG stimulation to treat the pain-associated cluster headache. SPG stimulation could be a safe and effective option for chronic cluster headache.

  15. Short- and long-term results of transcatheter embolization for massive arterial hemorrhage from gastroduodenal ulcers not controlled by endoscopic hemostasis (United States)

    Loffroy, Romaric; Guiu, Boris; Mezzetta, Lise; Minello, Anne; Michiels, Christophe; Jouve, Jean-Louis; Cheynel, Nicolas; Rat, Patrick; Cercueil, Jean-Pierre; Krausé, Denis


    BACKGROUND AND AIM: Severe bleeding from gastrointestinal ulcers is a life-threatening event that is difficult to manage when endoscopic treatment fails. Transcatheter embolization has been suggested as an alternative treatment in this situation. The present study reports on the efficacy and long-term outcomes of transcatheter embolization after failed endoscopic treatments were assessed in high-operative-risk patients. METHODS: A retrospective review of 60 consecutive emergency embolization procedures in hemodynamically unstable patients (41 men, 19 women; mean [±SD] age 69.4±15 years) was conducted. Patients were referred for selective angiography between 1999 and 2008 after failed endoscopic treatment of massive bleeding from gastrointestinal ulcers. Mean follow-up was 22 months. RESULTS: Embolization was feasible and successful in 57 patients. Sandwich coiling of the gastroduodenal artery was used in 34 patients, and superselective occlusion of the terminal feeding artery (with glue, coils or gelatin particles) was used in 23 patients. Early rebleeding occurred in 16 patients and was managed with endoscopy (n=8), reembolization (n=3) or surgery (n=5). No major embolization-related complications occurred. Sixteen patients died within 30 days after embolization (including three who died from rebleeding) and 11 died thereafter. No late bleeding recurrences were reported. CONCLUSIONS: Selective angiographic embolization is safe and effective for controlling life-threatening bleeding from gastroduodenal ulcers. The procedure usually obviates the need for emergency surgery in these high-risk patients. Survival depends chiefly on underlying conditions. PMID:19214287

  16. A Case of Pseudoaneurysm of the Internal Carotid Artery Following Endoscopic Endonasal Pituitary Surgery: Endovascular Treatment with Flow-Diverting Stent Implantation

    Directory of Open Access Journals (Sweden)

    Ali Karadag


    Full Text Available Internal carotid artery (ICA pseudoaneurysm is a rare complication of endoscopic endonasal surgery occurring in 0.4–1.1% of cases. Pseudoaneurysms can subsequently result in other complications, such as subarachnoid hemorrhage, epistaxis, and caroticocavernous fistula with resultant death or permanent neurologic deficit. In this case, we illustrate endovascular treatment with a flow-diverting stent for an ICA pseudoaneurysm after endoscopic endonasal surgery for a pituitary adenoma in a 56-year-old male. Surgery was complicated by excessive intraoperative bleeding and emergent CT angiography confirmed an iatrogenic pseudoaneurysm on the anteromedial surface of the ICA. The pseudoaneurysm was treated endovascularly with flow-diverting stent implantation only. Follow-up CT angiography after three months demonstrated occlusion of the pseudoaneurysm.

  17. Endoscopic versus open radial artery harvest and mammario-radial versus aorto-radial grafting in patients undergoing coronary artery bypass surgery

    DEFF Research Database (Denmark)

    Carranza, Christian L; Ballegaard, Martin; Werner, Mads U


    BACKGROUND: Coronary artery bypass grafting using the radial artery has, since the 1990s, gone through a revival. Observational studies have indicated better long-term patency when using radial arteries. Therefore, radial artery might be preferred especially in younger patients where long time pa...

  18. Sphenopalatine ganglion stimulation induces changes in cardiac autonomic regulation in cluster headache

    DEFF Research Database (Denmark)

    Barloese, MC; Petersen, Anja Sofie; Guo, Song


    -frequency stimulation, there was a greater increase in heart rate compared to sham (Pattacks were reported (six following low......INTRODUCTION: Cluster headache is characterized by attacks of severe unilateral pain accompanied by cranial and systemic autonomic changes. Our knowledge of the latter is imperfect. This study aimed to investigate the effect of low-frequency sphenopalatine ganglion stimulation on cardiac autonomic...... regulation. MATERIALS AND METHODS: In a double-blind, randomized, sham-controlled crossover design, patients received low-frequency and sham stimulation. RR intervals were recorded, and heart rate variability was analysed (time-domain, frequency-domain, nonlinear parameters). Headache characteristics...

  19. Objective Validation of Perfusion-Based Human Cadaveric Simulation Training Model for Management of Internal Carotid Artery Injury in Endoscopic Endonasal Sinus and Skull Base Surgery. (United States)

    Shen, Jasper; Hur, Kevin; Zhang, Zhipeng; Minneti, Michael; Pham, Martin; Wrobel, Bozena; Zada, Gabriel


    The emergence of minimally invasive endoscopic endonasal skull base surgery has necessitated reproducible and realistic simulators of rare vascular injuries. To assess the face and content validity of an innovative perfusion-based cadaveric model developed to simulate internal carotid artery (ICA) injury during endoscopic surgery. Otolaryngology and neurosurgery trainees attempted 3 consecutive trials of endoscopic control of a parasellar ICA injury, with standardized technical feedback. Time to hemostasis (TTH) and blood loss were trended. All participants completed validated questionnaires using a 5-point Likert scale to assess the domains of confidence gain, face validity, content validity, and curriculum applicability. Among all participants (n = 35), TTH and mean blood loss significantly decreased between first vs second attempt (P = .005), and first vs third attempt (P = .03). Following the first attempt, trainees experienced an average 63% reduction in blood loss and 59% reduction in TTH. In the quartile of most improved participants, average blood loss reduction was 1115 mL (84% reduction) and TTH of 259 s (84% reduction). There were no significant differences between trainees of varying postgraduate year or specialty. Average pre and postprocedural confidence scores were 1.38 and 3.16, respectively (P < .0001). All trainees reported model realism, which achieved mean face validity 4.82 ± 0.41 and content validity 4.88 ± 0.33. The perfusion-based human cadaveric ICA injury model achieves high ratings of face and content validity across all levels of surgical trainees, and enables safe, realistic simulation for standardized skull base simulation and future curriculum development. Objective improvements in performance metrics may translate to improved patient outcomes.

  20. Quantitative and qualitative analysis of the working area obtained by endoscope and microscope in pterional and orbitozigomatic approach to the basilar artery bifurcation using computed tomography based frameless stereotaxy: A cadaver study. (United States)

    Filipce, Venko; Ammirati, Mario


    Basilar aneurisms are one of the most complex and challenging pathologies for neurosurgeons to treat. Endoscopy is a recently rediscovered neurosurgical technique that could lend itself well to overcome some of the vascular visualization challenges associated with this pathology. The purpose of this study was to quantify and compare the basilar artery (BA) bifurcation (tip of the basilar) working area afforded by the microscope and the endoscope using different approaches and image guidance. We performed a total of 9 dissections, including pterional (PT) and orbitozygomatic (OZ) approaches bilaterally in five whole, fresh cadaver heads. We used computed tomography based image guidance for intraoperative navigation as well as for quantitative measurements. We estimated the working area of the tip of the basilar, using both a rigid endoscope and an operating microscope. Operability was qualitatively assessed by the senior authors. In microscopic exposure, the OZ approach provided greater working area (160 ± 34.3 mm(2)) compared to the PT approach (129.8 ± 37.6 mm(2)) (P > 0.05). The working area in both PT and OZ approaches using 0° and 30° endoscopes was larger than the one available using the microscope alone (P approach, both 0° and 30° endoscopes provided a working area greater than a microscopic OZ approach (P approach (P > 0.05). Integration of endoscope and microscope in both PT and OZ approaches can provide significantly greater surgical exposure of the BA bifurcation compared to that afforded by the conventional approaches alone.

  1. Long-term effectiveness of sphenopalatine ganglion stimulation for cluster headache

    DEFF Research Database (Denmark)

    Jürgens, Tim P; Barloese, Mads; May, Arne


    OBJECTIVES: The sphenopalatine ganglion (SPG) plays a pivotal role in cluster headache (CH) pathophysiology as the major efferent parasympathetic relay. We evaluated the long-term effectiveness of SPG stimulation in medically refractory, chronic CH patients. METHODS: Thirty-three patients were...... response through the 24-month evaluation. CONCLUSIONS: In the population of disabled, medically refractory chronic CH patients treated in this study, SPG stimulation is an effective acute therapy in 45% of patients, offering sustained effectiveness over 24 months of observation. In addition, a maintained...... enrolled in an open-label follow-up study of the original Pathway CH-1 study, and participated through 24 months post-insertion of a microstimulator. Response to therapy was defined as acute effectiveness in ≥ 50% of attacks or a ≥ 50% reduction in attack frequency versus baseline. RESULTS: In total, 5956...

  2. Experimental activation of the sphenopalatine ganglion provokes cluster-like attacks in humans

    DEFF Research Database (Denmark)

    Schytz, Henrik W; Barløse, Mads; Guo, Song


    BackgroundHigh frequency (HF) stimulation of the sphenopalatine ganglion (SPG) is an emerging abortive treatment for cluster headache (CH) attacks. HF SPG stimulation is thought to exert its effect by physiologically blocking parasympathetic outflow. We hypothesized that low frequency (LF) SPG...... stimulation may activate the SPG, causing increased parasympathetic outflow and thereby provoking cluster attacks in CH patients.MethodsIn a double-blind randomized cross-over study, seven CH patients implanted with an SPG neurostimulator were randomly allocated to receive HF or LF stimulation for 3 min on 2...... separate days. We recorded headache characteristics and autonomic symptoms during and after stimulation.ResultsSix patients completed the study. Three out of six patients (50%) reported ipsilateral cluster-like attacks during or within 30 min of LF SPG stimulation. These cluster-like attacks were all...

  3. Endoscopic ultrasound (United States)

    ... page: // Endoscopic ultrasound To use the sharing features on this page, please enable JavaScript. Endoscopic ultrasound is a type of imaging test. It is ...

  4. Endoscopic neck surgery

    Directory of Open Access Journals (Sweden)

    Chowbey P


    Full Text Available Endoscopic surgery in the neck was attempted in 1996 for performing parathyroidectomy. A similar surgical technique was used for performing thyroidectomy the following year. Most commonly reported endoscopic neck surgery studies in literature have been on thyroid and parathyroid glands. The approaches are divided into two types i.e., the total endoscopic approach using CO2 insufflation and the video-assisted approach without CO2 insufflation. The latter approach has been reported more often. The surgical access (port placements may vary-the common sites are the neck, anterior chest wall, axilla, and periareolar region. The limiting factors are the size of the gland and malignancy. Few reports are available on endoscopic resection for early thyroid malignancy and cervical lymph node dissection. Endoscopic neck surgery has primarily evolved due to its cosmetic benefits and it has proved to be safe and feasible in suitable patients with thyroid and parathyroid pathologies. Application of this technique for approaching other cervical organs such as the submandibular gland and carotid artery are still in the early experimental phase.

  5. Home-based application of sphenopalatine ganglion block for head and neck cancer pain management

    Directory of Open Access Journals (Sweden)

    Priti R Sanghavi


    Full Text Available Background: Head and neck cancer pain is intractable and difficult to manage. Many a times it is difficult to treat with oral opioids and adjuvants. Aim: This study aims to study the effects of transnasal sphenopalatine ganglion block (SPGB, administered using cotton swab/ear bud by patients' caretaker, at home, for pain management. Study Design: This is a prospective, single-arm observational study conducted on 100 head and neck cancer patients, from January 2014 to December 2015. Patients and caretaker were given a demonstration of the procedure using sterile cotton swab/ear buds. They were advised to repeat the procedure when their visual analog score (VAS was more than 5. They continued with the oral analgesics. They kept the records of pre- and post-procedure pain score (VAS, the frequency of repetition, ease of performance of procedure, and morphine requirement. A paired t-test (SPSS software was used for statistical analysis. Results: A significant reduction in pain was noted by a decrease in mean VAS from 8.57 ± 1.31 to 2.46 ± 1.23 (P 0.05 mg per day, at the end of 2 months. Ease of performance was observed in 88 patients. Conclusion: The home-based application of SPGB is an easy, safe, and cost-effective method to manage cancer pain. It provides excellent immediate pain relief with a minimum side effect. It can be performed bilaterally, repeatedly and even with a feeding tube in place.

  6. Hemicrania continua may respond to repetitive sphenopalatine ganglion block: A case report. (United States)

    Androulakis, X Michelle; Krebs, Kaitlin A; Ashkenazi, Avi


    Hemicrania continua (HC) is a chronic headache disorder characterized by a continuous, strictly unilateral head pain accompanied by cranial autonomic symptoms, which completely responds to indomethacin; however, few alternative treatment options exist for the patients with this disorder who cannot tolerate indomethacin. Sphenopalatine ganglion (SPG) block has been used for the treatment of various headaches, with the strongest evidence for efficacy in cluster headache. A 52-year-old woman with a 7-year history of HC was evaluated in our clinic for management of her headaches after she had stopped using indomethacin due to a bleeding gastrointestinal ulcer. After failing multiple pharmacologic therapies, she was treated with repetitive SPG blocks using bupivacaine (0.6 mL at 0.5%) twice a week for 6 weeks and followed by maintenance therapy. This treatment protocol resulted in significant improvement in her headaches, mood, and functional capacity. SPG block using a local anesthetic may be an effective treatment for patients with HC, specifically for those who cannot tolerate indomethacin, or when this drug is contraindicated. © 2016 American Headache Society.

  7. Post-endoscopic biliary sphincterotomy bleeding: an interventional radiology approach.

    LENUS (Irish Health Repository)

    Dunne, Ruth


    Endoscopic sphincterotomy is an integral component of endoscopic retrograde cholangiopancreatography. Post-sphincterotomy hemorrhage is a recognized complication. First line treatment involves a variety of endoscopic techniques performed at the time of sphincterotomy. If these are not successful, transcatheter arterial embolization or open surgical vessel ligation are therapeutic considerations.

  8. Endoscopic calcaneoplasty

    NARCIS (Netherlands)

    van Dijk, C. N.; van Dyk, G. E.; Scholten, P. E.; Kort, N. P.


    Endoscopic calcaneoplasty offers access to the retrocalcaneal space, thereby making it possible to remove inflamed retrocalcaneal bursa as well as the posterosuperior part of the calcaneus in applicable cases of painful hindfoot. In this study, endoscopic calcaneoplasty was performed in 21

  9. Endoscopic tympanoplasty

    Directory of Open Access Journals (Sweden)

    Abdulvahap Akyigit


    Full Text Available Middle ear surgery is usually performed using a surgical microscope. Initially, in otorhinolaryngology practice, endoscopes were used for paranasal sinus surgeries. It was only later that they were applied in the area of otology. In otologic surgeries, endoscopes were first used to visualize the middle ear, before being used to assist with visualization of instruments during cholesteatoma surgeries, although they are still not used alone in various otologic surgeries. As in other surgical fields, there is also a trend towards minimally invasive intervention in the field of otorhinolaryngology. Smaller incisions performed under the guidance of endoscopes are preferred over conventional large incisions. Using this approach, improved outcomes can be achieved and postoperative morbidities can be reduced. In addition, the outcomes of grafts performed using the endoscopic approach are similar to that achieved by the microscopic approach. Therefore, endoscopic ear surgery implementations are becoming increasingly popular.

  10. Endoscopic retrograde cholangiopancreatography and endoscopic ...

    African Journals Online (AJOL)

    An approach to suspected gallstone pancreatitis'based on endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy (ES) was adopted in 1976 and was followed in 29 patients. ERCp became the routine method of early biliary tract assessment when gallstone pancreatitis was suspected on ...

  11. Endoscopic retrograde cholangiopancreatography and endoscopic ...

    African Journals Online (AJOL)


    Jan 5, 1991 ... An approach to suspected gallstone pancreatitis'based on endoscopic retrograde cholangiopancreatography (ERCP) and e'ndoscopic sphincterotomy (ES) was adopted in 1976 and was followed in 29 patients. ERCp became the routine method of early biliary tract assessment when gallstone pancreatitis.

  12. Motion magnification for endoscopic surgery (United States)

    McLeod, A. Jonathan; Baxter, John S. H.; de Ribaupierre, Sandrine; Peters, Terry M.


    Endoscopic and laparoscopic surgeries are used for many minimally invasive procedures but limit the visual and haptic feedback available to the surgeon. This can make vessel sparing procedures particularly challenging to perform. Previous approaches have focused on hardware intensive intraoperative imaging or augmented reality systems that are difficult to integrate into the operating room. This paper presents a simple approach in which motion is visually enhanced in the endoscopic video to reveal pulsating arteries. This is accomplished by amplifying subtle, periodic changes in intensity coinciding with the patient's pulse. This method is then applied to two procedures to illustrate its potential. The first, endoscopic third ventriculostomy, is a neurosurgical procedure where the floor of the third ventricle must be fenestrated without injury to the basilar artery. The second, nerve-sparing robotic prostatectomy, involves removing the prostate while limiting damage to the neurovascular bundles. In both procedures, motion magnification can enhance subtle pulsation in these structures to aid in identifying and avoiding them.

  13. Computerized tomography-guided sphenopalatine ganglion pulsed radiofrequency treatment in 16 patients with refractory cluster headaches: Twelve- to 30-month follow-up evaluations. (United States)

    Fang, Luo; Jingjing, Lu; Ying, Shen; Lan, Meng; Tao, Wang; Nan, Ji


    Sphenopalatine ganglion percutaneous radiofrequency thermocoagulation treatment can improve the symptoms of cluster headaches to some extent. However, as an ablation treatment, radiofrequency thermocoagulation treatment also has side effects. To preliminarily evaluate the efficacy and safety of a non-ablative computerized tomography-guided pulsed radiofrequency treatment of sphenopalatine ganglion in patients with refractory cluster headaches. We included and analysed 16 consecutive cluster headache patients who failed to respond to conservative therapy from the Pain Management Center at the Beijing Tiantan Hospital between April 2012 and September 2013 treated with pulsed radiofrequency treatment of sphenopalatine ganglion. Eleven of 13 episodic cluster headaches patients and one of three chronic cluster headaches patient were completely relieved of the headache within an average of 6.3 ± 6.0 days following the treatment. Two episodic cluster headache patients and two chronic cluster headache patients showed no pain relief following the treatment. The mean follow-up time was 17.0 ± 5.5 months. All patients enrolled in this study showed no treatment-related side effects or complications. Our data show that patients with refractory episodic cluster headaches were quickly, effectively and safely relieved from the cluster period after computerized tomography-guided pulsed radiofrequency treatment of sphenopalatine ganglion, suggesting that it may be a therapeutic option if conservative treatments fail. © International Headache Society 2015.

  14. Alcohol percutaneous neurolysis of the sphenopalatine ganglion in the management of refractory cranio-facial pain

    Energy Technology Data Exchange (ETDEWEB)

    Kastler, Adrian [Grenoble University Hospital, Neuroradiology Department, Grenoble (France); Franche Comte University, I4S Laboratory, EA4268, IFR133, Besancon (France); Cadel, Gilles; Gory, Guillaume [Franche Comte University, I4S Laboratory, EA4268, IFR133, Besancon (France); Comte, Alexandre [University Hospital Besancon, Functional Imaging Research Department, Besancon (France); Piccand, Veronique [University Hospital Jean Minjoz, Pain Evaluation and Treatment Unit, Besancon (France); Tavernier, Laurent [Franche Comte University, I4S Laboratory, EA4268, IFR133, Besancon (France); University Hospital Jean Minjoz, Head and Neck Surgery-Otolaryngology Unit, Besancon (France); Kastler, Bruno [Franche Comte University, I4S Laboratory, EA4268, IFR133, Besancon (France); University Hospital Jean Minjoz, Interventional Pain Management Unit, Besancon (France)


    The sphenopalatine ganglion (SPN) has been proven to be involved in various types of facial pain syndromes. Management of these cranio-facial pain syndromes can be challenging, and existing specific treatments are sometimes inefficient and may fail. The purpose of this study is to describe and evaluate alcohol SPN in the management of cranio-facial pain. Forty-two patients suffering from refractory facial pain who underwent 58 consecutive SPN were included in this study between 2000 and 2013. Patients were divided into three groups: group ''cluster headache'' (CH), group ''persistent idiopathic facial pain'' (PFIP), and group ''Other''. Pain was assessed using Visual Analogue Scale scores (measured immediately before and after procedure and at regular intervals following the procedure). Alcohol SPN was considered to be effective when pain relief was equal to or greater than 50 % and lasting for at least 1 month. All procedures were realized ambulatory under CT guidance and consisted of an injection of 1 ml of absolute alcohol. Overall efficacy rate of alcohol SPN was 67.2 %, with mean pain relief duration of 10.3 months. Procedure was graded either not painful or tolerable by patients in 64.2 %. Analysis showed a higher efficacy rate in the groups CH (76.5 %) and PFIP (85.7 %) compared to the group Other (40 %). No difference was found between groups regarding the recurrence rate. Alcohol SPN under CT guidance appears as a safe and effective treatment of refractory facial pain, especially in cases of cluster headache and persistent idiopathic facial pain. (orig.)

  15. Sensitization of the sphenopalatine ganglion (SPG by periodontal inflammation: A possible etiology of sinusitis and headache in children

    Directory of Open Access Journals (Sweden)

    Haryono Utomo


    Full Text Available Sinusitis is a frequent complication of allergic rhinitis. Theoretically, sinusitis could be found in human since infancy. The prevalence of diagnosed sinusitis is 20% of ambulatory patients in daily practice. Unfortunately, a lot of sinusitis cases must be treated by surgical operation. Other cases are treated conservatively with decongestants, corticosteroids, antibiotics and diathermy. However, dental treatment approach for sinusitis management is rarely discussed. Headache, especially migraine is also a common problem in children. Sinusitis and migraine, are closely related; sinusitis sufferers often accompanied by migraine and vice versa. This phenomenon resulting in misdiagnosis of the main etiology of sinusitis and migraine; if this case happens in young children, the diagnosis should be more complicated. Dental procedures which may directly reduce the periodontal inflammation were done to children diagnosed as sinusitis by otolaryngologist and pediatrician. In a short period of time, the sinusitis and headache symptoms subsided. The objective of this case reports is to propose the possible explanation of the neurogenic switching mechanism cut off, that resulting in the instant relief of sinusitis and headache symptoms. Regarding the immediate relief of the symptoms, the role of autonomic nervous system should also be considered. Since parasympathetic innervations of nasal, sinus mucosa and maxillary periodontal tissues originated from the sphenopalatine ganglion; the conclusion is that the periodontal inflammation may sensitize the sphenopalatine ganglion which may trigger sinusitis and headache in children.

  16. Calcitonin gene-related peptide and its receptor components in the human sphenopalatine ganglion -- interaction with the sensory system

    DEFF Research Database (Denmark)

    Csati, Anett; Tajti, Janos; Tuka, Bernadett


    , but not in neurons. RAMP1 immunoreactivity was localized in many neurons and SGCs. Thus, the two CGRP receptor components together were found in the SGCs. In addition, Western blot revealed the presence of RAMP1 and CLR in rat SPG. Our results suggest a possible sensory influence in the parasympathetic cranial......Clinical studies have suggested a link between the sensory trigeminal system and the parasympathetic ganglia. Calcitonin gene-related peptide (CGRP) is a sensory neuropeptide which plays an important role in vasodilatation and pain transmission in craniocervical structures. The present study...... was designed to examine if CGRP and CGRP receptor components are present in the human sphenopalatine ganglion (SPG) in order to reveal an interaction between the sensory and parasympathetic systems. Indirect immunofluorescence technique was used for immunohistochemical demonstration of CGRP, the calcitonin...

  17. Endoscopic dacryocystorhinostomy

    Directory of Open Access Journals (Sweden)

    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.

  18. Distribution of vasoactive intestinal peptide, pituitary adenylate cyclase-activating peptide, nitric oxide synthase, and their receptors in human and rat sphenopalatine ganglion

    DEFF Research Database (Denmark)

    Csati, A; Tajti, J; Kuris, A


    Cranial parasympathetic outflow is mediated through the sphenopalatine ganglion (SPG). The present study was performed to examine the expression of the parasympathetic signaling transmitters and their receptors in human and rat SPG. Indirect immunofluorescence technique was used for the demonstra......Cranial parasympathetic outflow is mediated through the sphenopalatine ganglion (SPG). The present study was performed to examine the expression of the parasympathetic signaling transmitters and their receptors in human and rat SPG. Indirect immunofluorescence technique was used...... for the demonstration of vasoactive intestinal peptide (VIP), pituitary adenylate cyclase-activating peptide (PACAP), nitric oxide synthase (NOS), glutamine synthetase (GS), glial fibrillary acidic protein (GFAP), VIP and PACAP common receptors (VPAC1, VPAC2), and PACAP receptor (PAC1). In addition, double labeling...

  19. Endoscopic case


    Pereira, Fernando


    We present the case of a ten-year-old female patient referred to Gastroenterolgy consultation for abdominal pain and cramping, usually worse after eating, recurring diarrhoea, hypochromic and microcytic anaemia with low serum iron and ferritin levels. Moderate to severe Crohn’s disease of the terminal ileum e right colon (L3) was diagnosed, based on endoscopic image and biopsy. The patient was treated with prednisone and azathioprine, but after one year of treatment she was steroids dependent...

  20. Photo-consistency registration of a 4D cardiac motion model to endoscopic video for image guidance of robotic coronary artery bypass (United States)

    Figl, Michael; Rueckert, Daniel; Edwards, Eddie


    The aim of the work described in this paper is registration of a 4D preoperative motion model of the heart to the video view of the patient through the intraoperative endoscope. The heart motion is cyclical and can be modelled using multiple reconstructions of cardiac gated coronary CT. We propose the use of photoconsistency between the two views through the da Vinci endoscope to align to the preoperative heart surface model from CT. The temporal alignment from the video to the CT model could in principle be obtained from the ECG signal. We propose averaging of the photoconsistency over the cardiac cycle to improve the registration compared to a single view. Though there is considerable motion of the heart, after correct temporal alignment we suggest that the remaining motion should be close to rigid. Results are presented for simulated renderings and for real video of a beating heart phantom. We found much smoother sections at the minimum when using multiple phases for the registration, furthermore convergence was found to be better when more phases are used.

  1. Endoscopic Treatment of a Gastric Dieulafoy's Lesion | Ranketi ...

    African Journals Online (AJOL)

    Dieulafoy's lesion, a caliber persistent artery in the submucosa, is a rare but important cause of intermittent painless massive GI bleeding. Due to its intermittent nature, it can easily be missed and often requires multiple endoscopic evaluations. We present a case of one such patient with subsequent endoscopic findings and ...

  2. Stimulation of the sphenopalatine ganglion (SPG) for cluster headache treatment. Pathway CH-1: a randomized, sham-controlled study. (United States)

    Schoenen, Jean; Jensen, Rigmor Højland; Lantéri-Minet, Michel; Láinez, Miguel J A; Gaul, Charly; Goodman, Amy M; Caparso, Anthony; May, Arne


    The pain and autonomic symptoms of cluster headache (CH) result from activation of the trigeminal parasympathetic reflex, mediated through the sphenopalatine ganglion (SPG). We investigated the safety and efficacy of on-demand SPG stimulation for chronic CH (CCH). A multicenter, multiple CH attack study of an implantable on-demand SPG neurostimulator was conducted in patients suffering from refractory CCH. Each CH attack was randomly treated with full, sub-perception, or sham stimulation. Pain relief at 15 minutes following SPG stimulation and device- or procedure-related serious adverse events (SAEs) were evaluated. Thirty-two patients were enrolled and 28 completed the randomized experimental period. Pain relief was achieved in 67.1% of full stimulation-treated attacks compared to 7.4% of sham-treated and 7.3% of sub-perception-treated attacks ( P  < 0.0001). Nineteen of 28 (68%) patients experienced a clinically significant improvement: seven (25%) achieved pain relief in ≥50% of treated attacks, 10 (36%), a ≥50% reduction in attack frequency, and two (7%), both. Five SAEs occurred and most patients (81%) experienced transient, mild/moderate loss of sensation within distinct maxillary nerve regions; 65% of events resolved within three months. On-demand SPG stimulation using the ATI Neurostimulation System is an effective novel therapy for CCH sufferers, with dual beneficial effects, acute pain relief and observed attack prevention, and has an acceptable safety profile compared to similar surgical procedures.

  3. Pilot study of sphenopalatine injection of onabotulinumtoxinA for the treatment of intractable chronic cluster headache. (United States)

    Bratbak, Daniel Fossum; Nordgård, Ståle; Stovner, Lars Jacob; Linde, Mattias; Folvik, Mari; Bugten, Vegard; Tronvik, Erling


    The main object of this pilot study was to investigate the safety of administering onabotulinumtoxinA (BTA) towards the sphenopalatine ganglion (SPG) in intractable chronic cluster headache. Efficacy data were also collected to provide indication on whether future placebo-controlled studies should be performed. In a prospective, open-label, uncontrolled study, we performed a single injection of 25 IU (n = 5) or 50 IU BTA (n = 5) towards the SPG in 10 patients with intractable chronic cluster headache with a follow-up of 24 weeks. The primary outcome was adverse events (AEs) and the main efficacy outcome was attack frequency in weeks 3 and 4 post-treatment. A total of 11 AEs were registered. There was one severe adverse event (SAE): posterior epistaxis. The number of cluster headache attacks (main efficacy outcome) was statistically significantly reduced in the intention-to-treat analysis from 18 ± 12 per week in baseline to 11 ± 14 (p = 0.038) in weeks 3 and 4, and five out of 10 patients had at least 50% reduction of attack frequency compared to baseline. The cluster attack frequency was significantly reduced for five out of six months post-treatment. Randomised, placebo-controlled studies are warranted to establish the potential of this possible novel treatment of cluster headache. © International Headache Society 2015.

  4. Endoscopic case

    Directory of Open Access Journals (Sweden)

    Fernando Pereira


    Full Text Available We present the case of a ten-year-old female patient referred to Gastroenterolgy consultation for abdominal pain and cramping, usually worse after eating, recurring diarrhoea, hypochromic and microcytic anaemia with low serum iron and ferritin levels. Moderate to severe Crohn’s disease of the terminal ileum e right colon (L3 was diagnosed, based on endoscopic image and biopsy. The patient was treated with prednisone and azathioprine, but after one year of treatment she was steroids dependent and treatment was switched to infliximab. One year after beginning this treatment, the patient achieved remission (clinical and laboratorial parameters. A control colonoscopy showed mucosal healing with scars and deformation with stenosis of ileocecal valve (Figures 1-2. Surgical intervention will be probably necessary in near future.

  5. Endoscopic third ventriculostomy

    Directory of Open Access Journals (Sweden)

    Yad Ram Yadav


    Full Text Available Endoscopic third ventriculostomy (ETV is considered as a treatment of choice for obstructive hydrocephalus. It is indicated in hydrocephalus secondary to congenital aqueductal stenosis, posterior third ventricle tumor, cerebellar infarct, Dandy-Walker malformation, vein of Galen aneurism, syringomyelia with or without Chiari malformation type I, intraventricular hematoma, post infective, normal pressure hydrocephalus, myelomeningocele, multiloculated hydrocephalus, encephalocele, posterior fossa tumor and craniosynostosis. It is also indicated in block shunt or slit ventricle syndrome. Proper Pre-operative imaging for detailed assessment of the posterior communicating arteries distance from mid line, presence or absence of Liliequist membrane or other membranes, located in the prepontine cistern is useful. Measurement of lumbar elastance and resistance can predict patency of cranial subarachnoid space and complex hydrocephalus, which decides an ultimate outcome. Water jet dissection is an effective technique of ETV in thick floor. Ultrasonic contact probe can be useful in selected patients. Intra-operative ventriculo-stomography could help in confirming the adequacy of endoscopic procedure, thereby facilitating the need for shunt. Intraoperative observations of the patent aqueduct and prepontine cistern scarring are predictors of the risk of ETV failure. Such patients may be considered for shunt surgery. Magnetic resonance ventriculography and cine phase contrast magnetic resonance imaging are effective in assessing subarachnoid space and stoma patency after ETV. Proper case selection, post-operative care including monitoring of ICP and need for external ventricular drain, repeated lumbar puncture and CSF drainage, Ommaya reservoir in selected patients could help to increase success rate and reduce complications. Most of the complications develop in an early post-operative, but fatal complications can develop late which indicate an importance of

  6. Clinical course of patients with episodic cluster headache treated with corticosteroids inproximity to the sphenopalatine ganglion: a preliminary study of 23 patients. (United States)

    Peñarrocha-Diago, Maria; Boronat, Araceli; Peñarrocha-Oltra, David; Ata-Ali, Javier; Bagan, Jose V; Peñarrocha-Diago, Miguel


    A study is made of the clinical course of patients with episodic cluster headache following the injection of corticosteroids in the proximity of the sphenopalatine ganglion of the affected side. A retrospective observation study was made corresponding to the period between 2006 and 2010. Patients with episodic cluster headache received corticosteroid infiltrations in the vicinity of the sphenopalatine ganglion. Data were collected to assess the clinical course, quantifying pain intensity and quality of life. A total of 23 patients (11 women and 12 men) with a mean age of 50.4 years (range 25-65) were included. Forty percent of the patients had undergone dental extractions in the quadrant affected by the pain, before the development of episodic cluster headache, and 37.8% underwent extractions in the same quadrant after appearance of the headache. Most of the patients suffered 1-3 attacks a day, with a duration of pain of between 31-90 minutes. The mean pain intensity score during the attacks at the time of the first visit was 8.8 (range 6-10), versus 5.4 (range 3-9) one week after the first corticosteroid injection. On the first visit, 86.9% of the patients reported unbearable pain, versus 21.7% after one week, and a single patient after one month. The evolution of episodic cluster headache is unpredictable and variable, though corticosteroid administration clearly reduces the attacks and their duration.

  7. The experience of totally endoscopic coronary bypass grafting with the robotic system «Da Vinci» in Russia (United States)

    Efendiev, V. U.; Alsov, S. A.; Ruzmatov, T. M.; Mikheenko, I. L.; Chernyavsky, A. M.; Malakhov, E. S.


    A new technology - a thoracoscopic coronary bypass grafting with the use of Da Vinci robotic system in Russia is represented by the experience of NRICP. The technology was introduced in Russia in 2011. Overall, one hundred endoscopic coronary artery bypass procedures were performed. We have compared and analyzed results of coronary artery stenting vs minimally invasive coronary artery bypass grafting. According to the results, totally endoscopic coronary artery bypass grafting has several advantages over alternative treatment strategies.

  8. Hepatic applications of endoscopic ultrasound

    DEFF Research Database (Denmark)

    Srinivasan, Indu; Tang, Shou-Jiang; Vilmann, Andreas S


    The diagnosis and staging of various gastrointestinal malignancies have been made possible with the use of endoscopic ultrasound, which is a relatively safe procedure. The field of endoscopic ultrasound is fast expanding due to advancements in therapeutic endoscopic ultrasound. Though various...... of endoscopic ultrasound, thus not only providing an overview of utilization of endoscopic ultrasound in various liver conditions but also speculating its future role....

  9. Endoscopic ultrasound-guided endoscopic transmural drainage of pancreatic pseudocysts


    César Vivian Lopes; Christian Pesenti; Erwan Bories; Fabrice Caillol; Marc Giovannini


    BACKGROUND: Surgery is the traditional treatment for symptomatic pancreatic pseudocysts, but the morbidity is still too high. Minimally invasive endoscopic approaches have been encouraged. AIMS: To evaluate the efficacy of endoscopic ultrasound-guided endoscopic transmural drainage of pancreatic pseudocysts. METHODS: From January, 2003 to August, 2006, 31 consecutive symptomatic patients submitted to 37 procedures at the same endoscopic unit were retrospectively analysed. Chronic and acute pa...

  10. Systematic review of the safety and effectiveness of peripheral neurostimulation of the sphenopalatine ganglion for the treatment of refractory chronic cluster headache. (United States)

    Sánchez-Gómez, L M; Polo-deSantos, M; Pinel-González, A; Oreja-Guevara, C; Luengo-Matos, S


    This study aimed to assess the safety and effectiveness of peripheral neurostimulation of the sphenopalatine ganglion (SPG) in the treatment of refractory chronic cluster headache. Various medical databases were used to perform a systematic review of the scientific literature. The search for articles continued until 31 October 2016, and included clinical trials, systematic reviews and/or meta-analyses, health technology assessment reports, and clinical practice guidelines that included measurements of efficiency/effectiveness or adverse effects associated with the treatment. The review excluded cohort studies, case-control studies, case series, literature reviews, letters to the editor, opinion pieces, editorials, and studies that had been duplicated or outdated by later publications from the same institution. Regarding effectiveness, we found that SPG stimulation had positive results for pain relief, attack frequency, medication use, and patients' quality of life. In the results regarding safety, we found a significant number of adverse events in the first 30 days following the intervention. Removal of the device was necessary in some patients. Little follow-up data, and no long-term data, is available. These results are promising, despite the limited evidence available. We consider it essential for research to continue into the safety and efficacy of SPG stimulation for patients with refractory chronic cluster headache. In cases where this intervention may be indicated, treatment should be closely monitored. Copyright © 2017 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.

  11. Sterilization of endoscopic instruments. (United States)

    Sabnis, Ravindra B; Bhattu, Amit; Vijaykumar, Mohankumar


    Sterilization of endoscopic instruments is an important but often ignored topic. The purpose of this article is to review the current literature on the sterilization of endoscopic instruments and elaborate on the appropriate sterilization practices. Autoclaving is an economic and excellent method of sterilizing the instruments that are not heat sensitive. Heat sensitive instruments may get damaged with hot sterilization methods. Several new endoscopic instruments such as flexible ureteroscopes, chip on tip endoscopes, are added in urologists armamentarium. Many of these instruments are heat sensitive and hence alternative efficacious methods of sterilization are necessary. Although ethylene oxide and hydrogen peroxide are excellent methods of sterilization, they have some drawbacks. Gamma irradiation is mainly for disposable items. Various chemical agents are widely used even though they achieve high-level disinfection rather than sterilization. This article reviews various methods of endoscopic instrument sterilization with their advantages and drawbacks. If appropriate sterilization methods are adopted, then it not only will protect patients from procedure-related infections but prevent hypersensitive allergic reactions. It will also protect instruments from damage and increase its longevity.

  12. Endoscopic submucosal dissection

    DEFF Research Database (Denmark)

    Pimentel-Nunes, Pedro; Dinis-Ribeiro, Mário; Ponchon, Thierry


    UNLABELLED: This Guideline is an official statement of the European Society of Gastrointestinal Endoscopy (ESGE). The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system 1 2 was adopted to define the strength of recommendations and the quality of evidence. MAIN...... RECOMMENDATIONS: 1 ESGE recommends endoscopic en bloc resection for superficial esophageal squamous cell cancers (SCCs), excluding those with obvious submucosal involvement (strong recommendation, moderate quality evidence). Endoscopic mucosal resection (EMR) may be considered in such lesions when...... they are smaller than 10 mm if en bloc resection can be assured. However, ESGE recommends endoscopic submucosal dissection (ESD) as the first option, mainly to provide an en bloc resection with accurate pathology staging and to avoid missing important histological features (strong recommendation, moderate quality...

  13. Olecranon extrabursal endoscopic bursectomy. (United States)

    Tu, Chen G; McGuire, Duncan T; Morse, Levi P; Bain, Gregory I


    Olecranon bursitis is a common clinical problem. It is often managed conservatively because of the high rates of wound complications with the conventional open surgical technique. Conventional olecranon bursoscopy utilizes an arthroscope and an arthroscopic shaver, removing the bursa from inside-out. We describe an extrabursal endoscopic technique where the bursa is not entered but excised in its entirety under endoscopic vision. A satisfactory view is obtained with less morbidity than the open method, while still avoiding a wound over the sensitive point of the olecranon.

  14. Acute Vision Loss Following Endoscopic Sinus Surgery

    Directory of Open Access Journals (Sweden)

    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. Technicalities of endoscopic biopsy

    NARCIS (Netherlands)

    Tytgat, G. N.; Ignacio, J. G.


    Despite the wealth of biopsy forceps currently available, it is obvious that there are sufficient drawbacks and shortcomings to reconsider the overall design of the endoscopic biopsy depth, the short lifespan of reusable forceps, damage to the working channel, excessive time consumption, cleaning

  16. Robotic flexible endoscope

    NARCIS (Netherlands)

    Ruiter, Jeroen


    In flexible endoscopy a flexible tube with a steerable camera is used to inspect the internal patient tracts and to perform small surgical interventions. In current practice the physician is faced with usability problems. Often assistance is required to manipulate the flexible endoscope and the

  17. Evolving endoscopic surgery. (United States)

    Sakai, Paulo; Faintuch, Joel


    Since the days of Albukasim in medieval Spain, natural orifices have been regarded not only as a rather repugnant source of bodily odors, fluids and excreta, but also as a convenient invitation to explore and treat the inner passages of the organism. However, surgical ingenuity needed to be matched by appropriate tools and devices. Lack of technologically advanced instrumentation was a strong deterrent during almost a millennium until recent decades when a quantum jump materialized. Endoscopic surgery is currently a vibrant and growing subspecialty, which successfully handles millions of patients every year. Additional opportunities lie ahead which might benefit millions more, however, requiring even more sophisticated apparatuses, particularly in the field of robotics, artificial intelligence, and tissue repair (surgical suturing). This is a particularly exciting and worthwhile challenge, namely of larger and safer endoscopic interventions, followed by seamless and scarless recovery. In synthesis, the future is widely open for those who use together intelligence and creativity to develop new prototypes, new accessories and new techniques. Yet there are many challenges in the path of endoscopic surgery. In this new era of robotic endoscopy, one will likely need a virtual simulator to train and assess the performance of younger doctors. More evidence will be essential in multiple evolving fields, particularly to elucidate whether more ambitious and complex pathways, such as intrathoracic and intraperitoneal surgery via natural orifice transluminal endoscopic surgery (NOTES), are superior or not to conventional techniques. © 2014 Journal of Gastroenterology and Hepatology Foundation and Wiley Publishing Asia Pty Ltd.


    Directory of Open Access Journals (Sweden)

    Brigita Drnovšek Olup


    Full Text Available Background. We present our experience with transnasal endoscopic dacryocystorhinostomy.Patients and methods. We treated 95 patients with lacrimal duct insufficiency from June 2000 to February 2003. The most frequent cause of nasolacrimal duct obstruction was chronic inflammation. We inserted a light probe through the inferior canalliculus to transilluminate the area of the lacrimal sac. We anaemized the region over the lacrimal sac and the attachment of the middle nasal concha and corrected nasal septum deviation were indicated. We coagulated and removed the mucosa over the transilluminated area, the bony wall and the medial portion of the lacrimal sac. After haemostasis, we placed silicone tubes through both canalliculi and fixed its ends with metallic clips. We finally introduced a Merocel tampon in the middle nasal meatus for two days. The silicone tubes remained in place for 3 to 4 months.Results. We observed no serious complications. The silicone tubes remained in place for 3 to 4 months. Follow up period ranged from 8 to 40 months. We noticed recurrence of symptoms in seven patients.Conclusions. Transnasal endoscopic DCR is a contribution to the development of endoscopic surgery technique. Its success rate is comparable to or even better than external DCR, according to other and our own study. Transnasal endoscopic DCR is a simple and successful procedure and well tolerated by the patients.

  19. Endoscopic treatment of obesity (United States)

    Swidnicka-Siergiejko, Agnieszka; Wróblewski, Eugeniusz; Dabrowski, Andrzej


    BACKGROUND: The increasing incidence of obesity and overweight among children and adolescents will be reflected by the imminent increase in the number of obese patients who require more definitive methods of treatment. There is great interest in new, safe, simple, nonsurgical procedures for weight loss. OBJECTIVE: To provide an overview of new endoscopic methods for the treatment of obesity. METHODS: An English-language literature search on endoscopic interventions, endoscopically placed devices and patient safety was performed in the MEDLINE and Cochrane Library databases. RESULTS: The literature search yielded the following weight loss methods: space-occupying devices (widely used), gastric capacity reduction, modifying gastric motor function and malabsorptive procedures. A commercially available intragastric balloon was the most commonly used device for weight loss. In specific subgroups of patients, it improved quality of life, decreased comorbidities and served as a bridge to surgery. More evidence regarding the potential benefits and safety of other commercially available intragastric balloons is needed to clarify whether they are superior to the most commonly used one. Moreover, early experiences with transoral gastroplasty, the duodenaljejunal bypass sleeve and an adjustable, totally implantable intragastric prosthesis, indicate that they may be viable options for obesity treatment. Other agents, such as botulinum toxin and a device known as the ‘butterfly’, are currently at the experimental stage. CONCLUSION: New endoscopic methods for weight loss may be valuable in the treatment of obesity; however, more clinical experience and technical improvements are necessary before implementing their widespread use. PMID:22059171

  20. Automated endoscope reprocessors. (United States)

    Desilets, David; Kaul, Vivek; Tierney, William M; Banerjee, Subhas; Diehl, David L; Farraye, Francis A; Kethu, Sripathi R; Kwon, Richard S; Mamula, Petar; Pedrosa, Marcos C; Rodriguez, Sarah A; Wong Kee Song, Louis-Michel


    The ASGE Technology Committee provides reviews of existing, new, or emerging endoscopic technologies that have an impact on the practice of GI endoscopy. Evidence-based methodology is used, with a MEDLINE literature search to identify pertinent clinical studies on the topic and a MAUDE (U.S. Food and Drug Administration Center for Devices and Radiological Health) database search to identify the reported complications of a given technology. Both are supplemented by accessing the "related articles" feature of PubMed and by scrutinizing pertinent references cited by the identified studies. Controlled clinical trials are emphasized, but in many cases data from randomized, controlled trials are lacking. In such cases, large case series, preliminary clinical studies, and expert opinions are used. Technical data are gathered from traditional and Web-based publications, proprietary publications, and informal communications with pertinent vendors. Technology Status Evaluation Reports are drafted by 1 or 2 members of the ASGE Technology Committee, reviewed and edited by the committee as a whole, and approved by the Governing Board of the ASGE. When financial guidance is indicated, the most recent coding data and list prices at the time of publication are provided. For this review, the MEDLINE database was searched through February 2010 for articles related to automated endoscope reprocessors, using the words endoscope reprocessing, endoscope cleaning, automated endoscope reprocessors, and high-level disinfection. Technology Status Evaluation Reports are scientific reviews provided solely for educational and informational purposes. Technology Status Evaluation Reports are not rules and should not be construed as establishing a legal standard of care or as encouraging, advocating, requiring, or discouraging any particular treatment or payment for such treatment. Copyright © 2010 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.

  1. Efeitos da simpaticotomia endoscópica sobre as artérias carótidas e vertebrais na terapêutica cirúrgica da hiperidrose primária Effects of endoscopic sympathicotomy in carotid and vertebral arteries in the surgical treatment of primary hiperhidrosis

    Directory of Open Access Journals (Sweden)

    Jeancarlo F. Cavalcante


    Full Text Available OBJETIVOS: Analisar, em pacientes submetidos a simpaticotomia videotoracoscópica para tratamento da Hiperidrose Primária (HP, as conseqüências hemodinâmicas da desnervação vascular das artérias carótidas e vertebrais após a trans-secção cirúrgica da cadeia simpática torácica (simpaticotomia, através da mensuração de parâmetros ultra-sonográficos. MÉTODO: Vinte e quatro pacientes portadores de HP submetidos a quarenta e oito simpaticotomias torácicas endoscópicas foram avaliados através da mensuração da velocidade de pico sistólico (VPS, velocidade de pico diastólico (VPD, índice de pulsatibilidade (IP e índice de resistência (IR nas artérias carótidas comuns, internas e externas, além da artéria vertebral bilateralmente usando o eco-doppler duplex scan. As avaliações foram realizadas antes da intervenção cirúrgica e trinta dias após o procedimento. O teste de Wilcoxon foi usado na análise das diferenças entre as variáveis antes e depois da simpaticotomia. RESULTADOS: A simpaticotomia no nível de T3 foi a trans-secção mais realizada (95,83%, seja isoladamente (25% ou associada a T4 (62,50% ou a T2 (8,33%. Houve aumento significativo no IR e no IP da artéria carótida comum bilateralmente (pPURPOSES: Analyze, in patients with primary hyperhidrosis (PH who was undergone to videothoracoscopic sympathicotomy, the degree of vascular denervation after surgical transection of the thoracic sympathetic chain by measuring ultrasonografic parameters in carotid and vertebral arteries. METHODS: Twenty-four patients with PH underwent forty-eight endoscopic thoracic sympathicotomy and were evaluated by duplex eco-doppler measuring systolic peak velocity (SPV, diastolic peak velocity (DPV, pulsatility index (PI and resistivity index (RI in bilateral common, internal and external carotids, besides bilateral vertebral arteries. The exams were performed before operations and a month later. Wilcoxon test was used to

  2. Transaxillary Endoscopic Breast Augmentation

    Directory of Open Access Journals (Sweden)

    Hyung-Bo Sim


    Full Text Available The axillary technique is the most popular approach to breast augmentation among Korean women. Transaxillary breast augmentation is now conducted with sharp electrocautery dissection under direct endoscopic vision throughout the entire process. The aims of this method are clear: both a bloodless pocket and a sharp non-traumatic dissection. Round textured or anatomical cohesive gel implants have been used to make predictable well-defined inframammary creases because textured surface implants demonstrated a better stability attributable to tissue adherence compared with smooth surface implants. The axillary endoscopic technique has greatly evolved, and now the surgical results are comparable to those with the inframammary approach. The author feels that this technique is an excellent choice for young patients with an indistinct or absent inframammary fold, who do not want a scar in the aesthetic unit of their chest.

  3. Instrumentation: endoscopes and equipment. (United States)

    Gaab, Michael R


    The technology and instrumentation for neuroendoscopy are described: endoscopes (principles, designs, applications), light sources, instruments, accessories, holders, and navigation. Procedures for cleaning, sterilizing, and storing are included. The description is based on the author's own technical development and neuroendoscopic experience, published technology and devices, and publications on endoscopic surgery. The main work horses in neuroendoscopy are rigid glass rod endoscopes (Hopkins optics) due to the optical quality, which allows full high-definition video imaging, different angles of view, and autoclavability, which is especially important in neuroendoscopy due to the risk of Creutzfeldt-Jakob disease infection. Applications are endoscopy assistance to microsurgery, stand-alone endoscopy controlled approaches such as transnasal skull base, ventriculoscopy, and cystoscopy in the cranium. Rigid glass rod optics are also applicable in spinal endoscopy and peripheral nerve decompression using special tubes and cannulas. Rigid minifiberoptics with less resolution may be used in less complex procedures (ventriculoscopy, cystoscopy, endoscopy assistance with pen-designs) and have the advantages of smaller diameters and disposable designs. Flexible fiberoptics are usually used in combination with rigid scopes and can be steered, e.g. through the ventricles, in spinal procedures for indications including syringomyelia and multicystic hydrocephalus. Upcoming flexible chip endoscopes ("chip-in-the-tip") may replace flexible fiberoptics in the future, offering higher resolution and cold LED-illumination, and may provide for stereoscopic neuroendoscopy. Various instruments (mechanical, coagulation, laser guides, ultrasonic aspirators) and holders are available. Certified methods for cleaning and sterilization, with special requirements in neuroapplications, are important. Neuroendoscopic instrumentation is now an established technique in neurosurgical practice and

  4. Endoscopic tissue diagnosis of cholangiocarcinoma.

    LENUS (Irish Health Repository)

    Harewood, Gavin C


    The extremely poor outcome in patients with cholangiocarcinoma, in large part, reflects the late presentation of these tumors and the challenging nature of establishing a tissue diagnosis. Establishing a diagnosis of cholangiocarcinoma requires obtaining evidence of malignancy from sampling of the epithelium of the biliary tract, which has proven to be challenging. Although endoscopic ultrasound-guided fine needle aspiration performs slightly better than endoscopic retrograde cholangiopancreatography in diagnosing cholangiocarcinoma, both endoscopic approaches demonstrate disappointing performance characteristics.

  5. Endoscopic augmented reality navigation system for endonasal transsphenoidal surgery to treat pituitary tumors: technical note. (United States)

    Kawamata, Takakazu; Iseki, Hiroshi; Shibasaki, Takao; Hori, Tomokatsu


    Endoscopes have been commonly used in transsphenoidal surgery to treat pituitary tumors, to compensate for the narrow surgical field. Although many navigation systems have been introduced for neurosurgical procedures, there have been few reports of navigation systems for endoscopic operations. This report presents our recently developed, endoscopic, augmented reality (AR) navigation system. The technology is based on the principles of AR environment technology. The system consisted of a rigid endoscope with light-emitting diodes, an optical tracking system, and a controller. The operation of the optical tracking system was based on two sets of infrared light-emitting diodes, which measured the position and orientation of the endoscope relative to the patient's head. We used the system during endonasal transsphenoidal operations to treat pituitary tumors in 12 recent cases. Anatomic, "real," three-dimensional, virtual images of the tumor and nearby anatomic structures (including the internal carotid arteries, sphenoid sinuses, and optic nerves) were superimposed on real- time endoscopic live images. The system also indicated the positions and directions of the endoscope and the endoscopic beam in three-dimensional magnetic resonance imaging or computed tomographic planes. Furthermore, the colors of the wire-frame images of the tumor changed according to the distance between the tip of the endoscope and the tumor. These features were superior to those of conventional navigation systems, which are available only for operating microscopes. The endoscopic AR navigation system allows surgeons to perform accurate, safe, endoscope-assisted operations to treat pituitary tumors; it is particularly useful for reoperations, in which midline landmarks may be absent. We consider the AR navigation system to be a promising tool for safe, minimally invasive, endonasal, transsphenoidal surgery to treat pituitary tumors.

  6. Endoscopic surveillance strategy after endoscopic resection for early gastric cancer. (United States)

    Nishida, Tsutomu; Tsujii, Masahiko; Kato, Motohiko; Hayashi, Yoshito; Akasaka, Tomofumi; Iijima, Hideki; Takehara, Tetsuo


    Early detection of early gastric cancer (EGC) is important to improve the prognosis of patients with gastric cancer. Recent advances in endoscopic modalities and treatment devices, such as image-enhanced endoscopy and high-frequency generators, may make endoscopic treatment, such as endoscopic submucosal dissection, a therapeutic option for gastric intraepithelial neoplasia. Consequently, short-term outcomes of endoscopic resection (ER) for EGC have improved. Therefore, surveillance with endoscopy after ER for EGC is becoming more important, but how to perform endoscopic surveillance after ER has not been established, even though the follow-up strategy for more advanced gastric cancer has been outlined. Therefore, a surveillance strategy for patients with EGC after ER is needed.

  7. Rinsability of Orthophthalaldehyde from Endoscopes

    Directory of Open Access Journals (Sweden)

    Norman Miner


    Full Text Available Orthophthalaldehyde high level disinfectants are contraindicated for use with urological instruments such as cystoscopes due to anaphylaxis-like allergic reactions during surveillance of bladder cancer patients. Allergic reactions and mucosal injuries have also been reported following colonoscopy, laryngoscopy, and transesophageal echocardiography with devices disinfected using orthophthalaldehyde. Possibly these endoscopes were not adequately rinsed after disinfection by orthophthalaldehyde. We examined this possibility by means of a zone-of-inhibition test, and also a test to extract residues of orthophthalaldehyde with acetonitrile, from sections of endoscope insertion tube materials, to measure the presence of alkaline glutaraldehyde, or glutaraldehyde plus 20% w/w isopropanol, or ortho-phthalaldehyde that remained on the endoscope materials after exposure to these disinfectants followed by a series of rinses in water, or by aeration overnight. Zones of any size indicated the disinfectant had not been rinsed away from the endoscope material. There were no zones of inhibition surrounding endoscope materials soaked in glutaraldehyde or glutaraldehyde plus isopropanol after three serial water rinses according to manufacturers' rinsing directions. The endoscope material soaked in orthophthalaldehyde produced zones of inhibition even after fifteen serial rinses with water. Orthophthalaldehyde was extracted from the rinsed endoscope material by acetonitrile. These data, and other information, indicate that the high level disinfectant orthophthalaldehyde, also known as 1,2-benzene dialdehyde, cannot be rinsed away from flexible endoscope material with any practical number of rinses with water, or by drying overnight.

  8. Endoscopic capacity in West Africa.

    African Journals Online (AJOL)

    Abstract: Background: Levels of endoscopic demand and capacity in West Africa are unclear. Objectives: This paper aims to: 1. describe the current labor and endoscopic capacity, 2. quantify the impact of a mixed-meth- ods endoscopy course on healthcare professionals in West Africa, and 3. quantify the types of diagnoses ...

  9. Robot-assisted endoscopic surgery

    NARCIS (Netherlands)

    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,

  10. Endoscopic capacity in West Africa.

    African Journals Online (AJOL)

    edge among participants after didactics, objective data paired with subjective responses was more useful than either alone. Of 23 patients who received endoscopy, 7 required endoscopic intervention with 6 having gastric or esophageal varices. Currently the endoscopic capacity in West Africa is not sufficient. A formal GI ...

  11. Gastric ulcer bleeding from a variant left gastric artery accompanied by congenital absence of the splenic artery successfully treated with coil embolization: a case report and review of the literature. (United States)

    Namikawa, Masashi; Kakizaki, Satoru; Takakusaki, Satoshi; Saito, Shuichi; Yata, Yutaka; Mori, Masatomo


    Endoscopic hemostasis is a useful treatment modality for gastric ulcer bleeding. However, it is sometimes difficult to achieve hemostasis in cases with arterial bleeding, especially those complicated with vascular abnormalities. We describe a case with gastric ulcer bleeding from a variant left gastric artery accompanied by congenital absence of the splenic artery. A 50-year-old female was admitted to our hospital with dizziness and tarry stools. Upper gastrointestinal endoscopy revealed bleeding from a gastric ulcer, and endoscopic hemostasis by endoscopic clipping was carried out. Computed tomography and abdominal angiography revealed the variant left gastric artery running below the gastric ulcer. In spite of endoscopic hemostasis and medication, re-bleeding from the gastric ulcer occurred. A transcatheter coil embolization for the variant left gastric artery was performed and successfully achieved hemostasis. This case was accompanied by congenital absence of the splenic artery, which is an extremely rare condition. We herein describe this rare case and review previously reported cases.

  12. [Endoscopic vacuum-assisted closure]. (United States)

    Wedemeyer, J; Lankisch, T


    Anastomotic leakage in the upper and lower intestinal tract is associated with high morbidity and mortality. Within the last 10 years endoscopic treatment options have been accepted as sufficient treatment option of these surgical complications. Endoscopic vacuum assisted closure (E-VAC) is a new innovative endoscopic therapeutic option in this field. E-VAC transfers the positive effects of vacuum assisted closure (VAC) on infected cutaneous wounds to infected cavities that can only be reached endoscopically. A sponge connected to a drainage tube is endoscopically placed in the leakage and a continuous vacuum is applied. Sponge and vacuum allow removal of infected fluids and promote granulation of the leakage. This results in clean wound grounds and finally allows wound closure. Meanwhile the method was also successfully used in the treatment of necrotic pancreatitis.

  13. Epicardial ultrasound in coronary artery bypass surgery

    NARCIS (Netherlands)

    Budde, R.P.J.


    Chapter 1 Coronary artery bypass surgery (CABG) is traditionally performed via a median sternotomy approach on cardiopulmonary bypass (arrested heart). Since the mid 1990ties, beating heart, minimally invasive and even totally endoscopic CABG are (re)explored. In all approaches to CABG, the

  14. Prospective analysis of endoscopic vein harvesting. (United States)

    Patel, A N; Hebeler, R F; Hamman, B L; Hunnicutt, C; Williams, M; Liu, L; Wood, R E


    Utilization of bridging vein harvesting (BVH) of saphenous vein grafts (SVG) for coronary artery bypass grafting (CABG) results in large wounds with great potential for pain and infection. Endoscopic vein harvesting (EVH) may significantly reduce the morbidity associated with SVG harvesting. A prospective database of 200 matched patients receiving EVH and BVH was compared. The patients all underwent CABG done over a period of 4 months (April to August 2000). Patients were excluded if they had prior vein harvesting. The EVH and BVH group included 100 patients each with similar demographics. The patients in the EVH group had significantly fewer wound complications, mean days to ambulation, and total length of stay (P BVH in patients undergoing CABG.

  15. Endoscopic indocyanine green video angiography in aneurysm surgery: an innovative method for intraoperative assessment of blood flow in vasculature hidden from microscopic view. (United States)

    Nishiyama, Yoshihisa; Kinouchi, Hiroyuki; Senbokuya, Nobuo; Kato, Tatsuya; Kanemaru, Kazuya; Yoshioka, Hideyuki; Horikoshi, Toru


    Recently, intraoperative fluorescence video angiography using indocyanine green (ICG) has been widely used in aneurysm surgery. This is a simple and useful method to confirm complete occlusion of the aneurysm lumen and preservation of blood flow in the arteries around the aneurysm. However, the observation field of ICG video angiography is limited under a microscope, making it difficult to confirm the flow in the arteries behind the parent arteries or aneurysm. The authors developed a new technique of intraoperative endoscopic ICG video angiography to assess the blood flow in perforating arteries hidden by the parent arteries or aneurysm. The endoscope emits excitation light with a wavelength of approximately 800 nm, and video images were obtained through a cut filter. The authors used this ICG fluorescence endoscope in treating 3 patients with unruptured cerebral aneurysms. During clip placement, the endoscope was inserted to confirm aneurysm occlusion. Then, ICG was intravenously administered, and the fluorescence in the vessels was observed via the endoscope as well as under the microscope. The blood flow in the perforating arteries was clearly identified, and no procedural complication occurred. The authors conclude that the technique is very useful and facilitates intraoperative real-time assessment of the patency of perforating arteries behind parent arteries or aneurysms.

  16. High-quality endoscope reprocessing decreases endoscope contamination. (United States)

    Decristoforo, Petra; Kaltseis, Josef; Fritz, Andreas; Edlinger, Michael; Posch, Wilfried; Wilflingseder, Doris; Lass-Flörl, Cornelia; Orth-Höller, Dorothea


    Several outbreaks of severe infections due to contamination of gastrointestinal (GI) endoscopes, mainly duodenoscopes have been described previously. The rate of microbial endoscope contamination is varying dramatically in literature. Thus, the aim of this multicentre prospective study was to evaluate the hygiene quality of endoscopes and automated endoscope reprocessors (AERs) in Tyrol/Austria. In 2015 and 2016, a total of 463 GI endoscopes and 105 AERs from 29 endoscopy centres were analysed by a routine (R) and a combined routine and advanced (CRA) sampling procedure and investigated for microbial contamination by culture- and molecular-based analyses. The contamination rate of GI endoscopes was 1.3-4.6% according to national guideline, suggesting that 1.3-4.6 patients out of 100 could have had contacts with hygiene relevant microorganisms through an endoscopic intervention. Comparison of R and CRA sampling showed 1.8% of R versus 4.6% of CRA failing the acceptance criteria in phase I and 1.3% of R versus 3.0% of CRA samples in phase II. The most commonly identified indicator organism was Pseudomonas spp., mainly P. oleovorans. None of the tested viruses were detected in 40 samples. While AERs in phase I failed (n=9, 17.6%) mainly due to technical faults, phase II revealed lapses (n=6, 11.5%) only on account to microbial contamination of the last rinsing water, mainly with Pseudomonas spp. In the present study the contamination rate of endoscopes was low compared to results from other European countries, possibly due to high quality of endoscope reprocessing, drying and storage. Copyright © 2018 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

  17. Endoscopic egomotion computation (United States)

    Bergen, Tobias; Ruthotto, Steffen; Rupp, Stephan; Winter, Christian; Münzenmayer, Christian


    Computer assistance in Minimally Invasive Surgery is a very active field of research. Many systems designed for Computer Assisted Surgery require information about the instruments' positions and orientations. Our main focus lies on tracking a laparoscopic ultrasound probe to generate 3D ultrasound volumes. State-of-the-art tracking methods such as optical or electromagnetic tracking systems measure pose with respect to a fixed extra-body coordinate system. This causes inaccuracies of the reconstructed ultrasound volume in the case of patient motion, e.g. due to respiration. We propose attaching an endoscopic camera to the ultrasound probe and calculating the camera motion from the video sequence with respect to the organ surface. We adapt algorithms developed for solving the relative pose problem to recreate the camera path during the ultrasound sweep over the organ. By this image-based motion estimation camera motion can only be determined up to an unknown scale factor, known as the depth-speed-ambiguity. We show, how this problem can be overcome in the given scenario, exploiting the fact, that the distance of the camera to the organ surface is fixed and known. Preprocessing steps are applied to compensate for endoscopic image quality deficiencies.

  18. Selective Embolization for Post-Endoscopic Sphincterotomy Bleeding: Technical Aspects and Clinical Efficacy

    Energy Technology Data Exchange (ETDEWEB)

    So, Young Ho; Choi, Young Ho [Seoul National University Boramae Medical Center, Seoul (Korea, Republic of); Chung, Jin Wook; Jae, Hwan Jun; Park, Jae Hyung [Seoul National University Hospital, Seoul (Korea, Republic of); Song, Soon Young [Hanyang University Hospital, Seoul (Korea, Republic of)


    The objective of this study was to evaluate the technical aspects and clinical efficacy of selective embolization for post-endoscopic sphincterotomy bleeding. We reviewed the records of 10 patients (3%; M:F 6:4; mean age, 63.3 years) that underwent selective embolization for post-endoscopic sphincterotomy bleeding among 344 patients who received arteriography for nonvariceal upper gastrointestinal bleeding from 2000 to 2009. We analyzed the endoscopic procedure, onset of bleeding, underlying clinical condition, angiographic findings, interventional procedure, and outcomes in these patients. Among the 12 bleeding branches, primary success of hemostasis was achieved in 10 bleeding branches (83%). Secondary success occurred in two additional bleeding branches (100%) after repeated embolization. In 10 patients, post-endoscopic sphincterotomy bleedings were detected during the endoscopic procedure (n = 2, 20%) or later (n = 8, 80%), and the delay was from one to eight days (mean, 2.9 days; {+-} 2.3). Coagulopathy was observed in three patients. Eight patients had a single bleeding branch, whereas two patients had two branches. On the selective arteriography, bleeding branches originated from the posterior pancreaticoduodenal artery (n = 8, 67%) and anterior pancreaticoduodenal artery (n = 4, 33%), respectively. Superselection was achieved in four branches and the embolization was performed with n-butyl cyanoacrylate. The eight branches were embolized by combined use of coil, n-butyl cyanoacrylate, or Gelfoam. After the last embolization, there was no rebleeding or complication related to embolization. Selective embolization is technically feasible and an effective procedure for post-endoscopic sphincterotomy bleeding. In addition, the posterior pancreaticoduodenal artery is the main origin of the causative vessels of post-endoscopic sphincterotomy bleeding.

  19. Endoscopic ultrasound and pancreas divisum

    DEFF Research Database (Denmark)

    Rana, Surinder S; Gonen, Can; Vilmann, Peter


    cholangiopancreatography is the gold standard for its diagnosis, but is invasive and associated with significant adverse effects. Endoscopic ultrasound (EUS) allows the detailed evaluation of the pancreaticobiliary ductal system without injecting contrast in these ducts. Moreover, it provides detailed images...

  20. Sphenopalatine ganglion neuromodulation in migraine

    DEFF Research Database (Denmark)

    Khan, Sabrina; Schoenen, Jean; Ashina, Messoud


    has gained increasing interest within recent years, as current treatment strategies often fail to provide adequate relief from this debilitating headache. Common migraine symptoms include lacrimation, nasal congestion, and conjunctival injection, all parasympathetic manifestations. In addition......, studies have suggested that parasympathetic activity may also contribute to the pain of migraineurs. The SPG is the largest extracranial parasympathetic ganglion of the head, innervating the meninges, lacrimal gland, nasal mucosa, and conjunctiva, all structures involved in migraine with cephalic...

  1. Novel developments in endoscopic mucosal imaging

    NARCIS (Netherlands)

    van der Sommen, F; Curvers, W L; Nagengast, W B


    Endoscopic techniques such as High-definition and optical-chromoendoscopy have had enormous impact on endoscopy practice. Since these techniques allow assessment of most subtle morphological mucosal abnormalities, further improvements in endoscopic practice lay in increasing the detection efficacy

  2. Endoscopic Transaxillary Near Total Thyroidectomy (United States)

    Ejeh, Ijeoma Acholonu; Speights, Fredne; Rashid, Qammar N.; Ideis, Mustafa


    Background: Since first reported in 1996, endoscopic minimally invasive surgery of the cervical region has been shown to be safe and effective in the treatment of benign thyroid and parathyroid disease. The endoscopic transaxillary technique uses a remote lateral approach to the thyroid gland. Because of the perceived difficulty in accessing the contralateral anatomy of the thyroid gland, this technique has typically been reserved for patients with unilateral disease. Objectives: The present study examines the safety and feasibility of the transaxillary technique in dissecting and assessment of both thyroid lobes in performing near total thyroidectomy. Methods: Prior to this study we successfully performed endoscopic transaxillary thyroid lobectomy in 32 patients between August 2003 and August 2005. Technical feasibility in performing total thyroidectomy using this approach was accomplished first utilizing a porcine model followed by three human cadaver models prior to proceeding to human surgery. After IRB approval three female patients with histories of enlarging multinodular goiter were selected to undergo endoscopic near total thyroidectomy. Results: The average operative time for all models was 142 minutes (range 57–327 min). The three patients in this study had clinically enlarging multinodular goiters with an average size of 4 cm. The contralateral recurrent laryngeal nerve and parathyroid glands were identified in all cases. There was no post-operative bleeding, hoarseness or subcutaneous emphysema. Conclusion: Endoscopic transaxillary near total thyroidectomy is feasible and can be performed safely in human patients with bilateral thyroid disease. PMID:16882421

  3. Flexible Ultrathin Endoscope Integrated with Irrigation Suction Apparatus for Assisting Microneurosurgery. (United States)

    Otani, Naoki; Morimoto, Yuji; Fujii, Kazuya; Toyooka, Terushige; Wada, Kojiro; Mori, Kentaro


    Endoscopy can observe the anatomical components in a deeply located and/or hidden area during neurosurgical procedures under the operating microscope. We have newly developed a flexible ultrathin endoscope integrated with irrigation suction apparatus (FUEISA) to visualize deeply located and/or hidden areas for assisting microneurosurgery. The present study investigated the usefulness of the FUEISA system for direct clipping surgery of cerebral aneurysms. Twenty-one patients underwent microneurosurgery assisted with the FUEISA system for direct clipping of cerebral aneurysms. The flexible ultrathin endoscope (outer diameter 0.75mm) consists of an image guide (6000 dpi) and a light guide, integrated with the irrigation suction apparatus. This endoscopic system was inserted before and after clipping to observe the anatomical conditions surrounding the lesions. In all cases, handling and operation of the FUEISA was technically successful during the surgical procedure. The ultrathin endoscope was adequately integrated with the irrigation suction apparatus in all cases. General anatomy visualization including the lenticulostriate arteries, medial striate arteries, and/or internal carotid artery perforators was possible, and the correct clip positioning and vessel conditions were easily checked. The endoscope revealed that the clip had been positioned incorrectly in one case. No complications associated with the endoscopic system occurred. The FUEISA system can be applied with safe manipulation, which was remarkably useful for confirmation of the presence of perforators and cranial nerves behind the lesions, particularly anatomical components located in deep and/or hidden areas during clipping of cerebral aneurysms. Copyright © 2017 Elsevier Inc. All rights reserved.

  4. Risks of Endoscopic Temporal Ventriculocisternostomy for Isolated Lateral Ventricle: Anatomic Surgical Nuances. (United States)

    Hasegawa, Takatoshi; Ogiwara, Toshihiro; Nagm, Alhusain; Goto, Tetsuya; Aoyama, Tatsuro; Hongo, Kazuhiro


    Entrapment of the temporal horn, known as isolated lateral ventricle (ILV), is a rare type of noncommunicating focal hydrocephalus, and standard treatment has not been established. We report 2 cases of endoscopic surgery for ILV and highlight the anatomic surgical nuances to avoid associated surgical risks. The first patient presented with recurrent ILV following initial shunt placement for ILV, owing to shunt malfunction. In the second patient, ILV recurred secondary to choroid plexus inflammation caused by cryptococcal infection. Endoscopic temporal ventriculocisternostomy was effective in both cases. However, in the second case, the choroidal fissure was fenestrated, which led to cerebral infarction in the territory of the choroidal artery zone, attributed to damage of the branches of the choroidal segment of the anterior choroidal artery. Although endoscopic temporal ventriculocisternostomy is considered a safe and less invasive procedure for treatment of symptomatic ILV, the technique is still associated with risks. To avoid complications, it is necessary to be familiar with the anatomy of the choroidal arteries and the pertinent endoscopic intraventricular orientation. Additionally, sufficient experience is required before it can be recommended as the treatment of choice. Copyright © 2017 Elsevier Inc. All rights reserved.

  5. Endoscopic Treatment for Early Gastric Cancer


    Kim, Sang Gyun


    Endoscopic resection has been accepted as a curative modality for early gastric cancer (EGC). Since conventional endoscopic mucosal resection (EMR) has been introduced, many improvements in endoscopic accessories and techniques have been achieved. Recently, endoscopic submucosal dissection (ESD) using various electrosurgical knives has been performed for complete resection of EGC and enables complete resection of EGC, which is difficult to completely resect in the era of conventional EMR. Cur...

  6. Cholesterol atheroembolism of the colon can mimic the endoscopic features of pseudomembranous colitis. (United States)

    Lim, Geok-Hoon; Roslani, April Camilla; Pang, Brendan; Bih-Shiou, Charles Tsang


    The endoscopic features of cholesterol atheroembolism affecting the colon have not been extensively described in the literature, owing to the rarity of this entity. We report a middle-aged man who presented with hematochezia after recent coronary artery bypass graft surgery. Colonoscopy revealed ulcerative skip lesions with overlying slough resembling pseudomembranes distal to the transverse colon, inconsistent with the initial clinical impression of ischemic colitis. As a consequence of continued bleeding with hemodynamic instability, the patient underwent an extended low anterior resection with end transverse colostomy. Histology revealed cholesterol atheroembolism resulting in patchy ischemic ulceration of the colon. Colonic cholesterol atheroembolism can mimic the endoscopic features of pseudomembranous colitis.

  7. Total extraperitoneal endoscopic hernioplasty (TEP). (United States)

    Kuthe, A; Mainik, F; Flade-Kuthe, R


    One can no longer think about modern hernia surgery without mentioning endoscopic techniques. But due to their high technical demands the learning curve is comparatively long. And by technical mistakes and their consequences (pain, recurrence, complications) the benefits of the endoscopic techniques can easily be turned to drawbacks. The following text explains the steps of the total extraperitoneal endoscopic hernioplasty (TEP) technique in detail pointing out alternatives and risks. From preparation, indication and positioning, from trocar placement to extraperitoneal dissection and mesh placement, the principles of TEP are elucidated in respect of local anatomy and possible complications. The text as well as the accompanying video in the Mediathek are based on the authors' 20 years of experience in the TEP technique. Both of them may help in safe TEP application to minimise the complication rate as well as recurrences. Then patients can benefit from the advantages of this technique. Georg Thieme Verlag KG Stuttgart · New York.

  8. Endoscopic treatment of lumbar arachnoiditis. (United States)

    Warnke, J P; Mourgela, S


    The diagnosis of lumbar arachnoiditis remains complex and often inconclusive. Using the technique of lumbar subarachnoidal endoscopy (thecaloscopy), the pathology can be identified and the patient treated with long-term effects on the symptoms. Endoscopic operations were performed on 23 patients suffering from varying symptoms with an enlarged lumbar subarachnoidal space. Having confirmed the diagnosis of lumbar arachnoiditis, a number of endoscopic operations ranging from adhesiolysis to subarachno-epidurostomy were carried out. Radicular symptoms in lumbar arachnoiditis were successfully relieved by various endoscopic dissection techniques, such as restoration of the improved CSF flow by subarachno-epidurostomy along the rootlet. This has been identified as one of the causal factors of the clinical symptoms. In cases where lumbar pain persists in spite of a previous thecaloscopy, further treatment with a lumboperitoneal shunt device has proved most successful.

  9. Endoscopic Palliation for Pancreatic Cancer

    Directory of Open Access Journals (Sweden)

    Mihir Bakhru


    Full Text Available Pancreatic cancer is devastating due to its poor prognosis. Patients require a multidisciplinary approach to guide available options, mostly palliative because of advanced disease at presentation. Palliation including relief of biliary obstruction, gastric outlet obstruction, and cancer-related pain has become the focus in patients whose cancer is determined to be unresectable. Endoscopic stenting for biliary obstruction is an option for drainage to avoid the complications including jaundice, pruritus, infection, liver dysfunction and eventually failure. Enteral stents can relieve gastric obstruction and allow patients to resume oral intake. Pain is difficult to treat in cancer patients and endoscopic procedures such as pancreatic stenting and celiac plexus neurolysis can provide relief. The objective of endoscopic palliation is to primarily address symptoms as well improve quality of life.

  10. Colorectal endoscopic mucosal resection (EMR). (United States)

    Kandel, Pujan; Wallace, Michael B


    Colonoscopy has the benefit of detecting and treating precancerous adenomatous polyps and thus reduces mortality associated with CRC. Screening colonoscopy is the keystone for prevention of colorectal cancer. Over the last 20 years there has been increased in the management of large colorectal polyps from surgery to endoscopic removal techniques which is less invasive. Traditionally surgical resection was the treatment of choice for many years for larger polyps but colectomy poses significant morbidity of 14-46% and mortality of up to 7%. There are several advantages of endoscopic resection technique over surgery; it is less invasive, less expensive, has rapid recovery, and preserves the normal gut functions. In addition patient satisfaction and efficacy of EMR is higher with minor complications. Thus, this has facilitated the development of advanced resection technique for the treatment of large colorectal polyps called as endoscopic mucosal resection (EMR). Copyright © 2017 Elsevier Ltd. All rights reserved.

  11. Endoscopic brow lifts uber alles. (United States)

    Patel, Bhupendra C K


    Innumerable approaches to the ptotic brow and forehead have been described in the past. Over the last twenty-five years, we have used all these techniques in cosmetic and reconstructive patients. We have used the endoscopic brow lift technique since 1995. While no one technique is applicable to all patients, the endoscopic brow lift, with appropriate modifications for individual patients, can be used effectively for most patients with brow ptosis. We present the nuances of this technique and show several different fixation methods we have found useful.

  12. Mammary artery harvesting using the Da Vinci Si robotic system

    Directory of Open Access Journals (Sweden)

    Leonardo Secchin Canale


    Full Text Available Internal mammary artery harvesting is an essential part of any coronary artery bypass operation. Totally endoscopic coronary artery bypass graft surgery has become reality in many centers as a safe and effective alternative to conventional surgery in selected patients. Internal mammary artery harvesting is the initial part of the procedure and should be performed equally safely if one wants to achieve excellence in patency rates for the bypass. We here describe the technique for mammary harvesting with the Da Vinci Si robotic system.

  13. Mammary artery harvesting using the Da Vinci Si robotic system (United States)

    Canale, Leonardo Secchin; Bonatti, Johannes


    Internal mammary artery harvesting is an essential part of any coronary artery bypass operation. Totally endoscopic coronary artery bypass graft surgery has become reality in many centers as a safe and effective alternative to conventional surgery in selected patients. Internal mammary artery harvesting is the initial part of the procedure and should be performed equally safely if one wants to achieve excellence in patency rates for the bypass. We here describe the technique for mammary harvesting with the Da Vinci Si robotic system. PMID:24896171

  14. Endoscopic third ventriculostomy and choroid

    African Journals Online (AJOL)


    Finally, gratitude goes to my supervisors Prof. Dele, Prof. Ngoma and Dr. Nkandu for guidance and Dr. Ben. Andrews for helping with the editing of the document. REFERENCES. 1. Warf BC. Hydrocephalus in Uganda: the predominance of infectious origin and primary management with endoscopic third ventriculostomy.

  15. Complications of endoscopic variceal therapy

    African Journals Online (AJOL)


    endoscopic treatment of oesophageal and gastric varices, and consequently the incidence varies widely in reported .... and pleuritic chest pain, fever, an exudative pleural effusion and worsening encephalopathy.21,82 .... contrast, Ogle et al. found no instance of acid reflux into the oesophagus but patients who received ...

  16. Colonic perforation following endoscopic retrograde ...

    African Journals Online (AJOL)

    Case report. A 41-year-old woman with HIV infection who had not had anti- retroviral drugs presented with jaundice secondary to choledo- cholithiasis. Multiple common bile duct stones were extracted at endoscopic retrograde cholangiopancreatography (ERCP). She failed to keep appointments for laparoscopic ...

  17. Endoscopic treatment of orbital tumors. (United States)

    Signorelli, Francesco; Anile, Carmelo; Rigante, Mario; Paludetti, Gaetano; Pompucci, Angelo; Mangiola, Annunziato


    Different orbital and transcranial approaches are performed in order to manage orbital tumors, depending on the location and size of the lesion within the orbit. These approaches provide a satisfactory view of the superior and lateral aspects of the orbit and the optic canal but involve risks associated with their invasiveness because they require significant displacement of orbital structures. In addition, external approaches to intraconal lesions may also require deinsertion of extraocular muscles, with subsequent impact on extraocular mobility. Recently, minimally invasive techniques have been proposed as valid alternative to external approaches for selected orbital lesions. Among them, transnasal endoscopic approaches, "pure" or combined with external approaches, have been reported, especially for intraconal lesions located inferiorly and medially to the optic nerve. The avoidance of muscle detachment and the shortness of the surgical intraorbital trajectory makes endoscopic approach less invasive, thus minimizing tissue damage. Endoscopic surgery decreases the recovery time and improves the cosmetic outcome not requiring skin incisions. The purpose of this study is to review and discuss the current surgical techniques for orbital tumors removal, focusing on endoscopic approaches to the orbit and outlining the key anatomic principles to follow for safe tumor resection.

  18. Colonic perforation following endoscopic retrograde ...

    African Journals Online (AJOL)

    We highlight a potentially lethal complication of acute severe pancreatitis that may not be suspected in severely ill patients. A 41-year-old woman developed acute severe pancreatitis following endoscopic retrograde cholangiopancreatography (ERCP) for suspected choledocholithiasis. When her condition deteriorated ...


    African Journals Online (AJOL)

    1 1 10-5 704. African Journal of Urology. V0/. 9, NO. 1, 2003. 36-40. ENDOSCOPIC TRANSURETHRAL RESECTION OF BILHARZIAL. ULCERS OF THE URINARY BLADDER. SINGLE-CENTER ... ulcers (78% de novo and 22% recurrent ul- cers after previous open partial .... tion cf its tip is used for resection. However, it.


    African Journals Online (AJOL)

    1 1 10-5 704. African Journal of Urology. Vol. 9, NO. 1, 2003. 36-40. ENDOSCOPIC TRANSURETHRAL RESECTION OF BILHARZIAL. ULCERS OF THE URINARY BLADDER. SINGLE-CENTER ... ulcers (78% de novo and 22% recurrent ul- cers after previous open partial .... tion of its tip is used for resection. HoWever, it.


    African Journals Online (AJOL)

    Objectives To evaluate the role, safety and efficacy of endoscopic MacroplastiqueTM implants in the management of female stress incontinence. Material and Methods Between 1995 and 1999, transurethral submucosal injection of MacroplastiqueTM was performed in 68 women (mean age 58 years, range 32 — 85 years) ...

  2. Virtual endoscopy combined with intraoperative neuronavigation for planning of endoscopic surgery in patients with occlusive hydrocephalus and intracranial cysts

    Energy Technology Data Exchange (ETDEWEB)

    Krombach, G.A.; Haage, P.; Kilbinger, M. [Department of Diagnostic Radiology, University of Technology, Aachen (Germany); Rohde, V. [Department of Neurosurgery, University of Technology, Aachen (Germany); Struffert, T. [Department of Neuroradiology, University of Technology, Aachen (Germany); Department of Neuroradiology, University of Saarland, Homburg (Germany); Thron, A. [Department of Neuroradiology, University of Technology, Aachen (Germany)


    We assessed the clinical value of MR ventriculoscopy (virtual endoscopy, VE) combined with image-guided frameless stereotaxy for endoscopic surgery of occlusive hydrocephalus and intracranial cysts. VE was obtained in 20 patients with hydrocephalus and three with intracranial cysts. All surgical operations were endoscopic. The path of the rigid endoscope to the target point was planned using neuronavigation. VE was carried out along the same trajectory retrospectively in 20 cases and prospectively in three. The results were analysed for demonstration of anatomical landmarks and structures at risk. VE was successful in all patients. Possible obstacles to endoscopic access to the lamina terminalis and the basal cisterns and structures at risk, such as the basilar artery, were clearly shown in relation to the direction of the endoscope. However, the floor of the third ventricle and septum pellucidum were not clearly seen and possible abnormalities could therefore not be appreciated. VE can provide realistic simulation of endoscopic third ventriculostomy and cystostomy. The appropriate trepanation point and trajectory of the endoscope can be assessed with regard to the size of the foramen of Monro and the position of vulnerable structures. This simulated trajectory can be adapted to the field of operation by image-guided neuronavigation. This regime may potentially reduce the risk of damage to intracranial structures. (orig.)

  3. Endoscopic prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis. (United States)

    Lee, Tae Hoon; Park, Do Hyun


    Post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) is not an uncommon adverse event but may be an avoidable complication. Although pancreatitis of severe grade is reported in 0.1%-0.5% of ERCP patients, a serious clinical course may be lethal. For prevention of severe PEP, patient risk stratification, appropriate selection of patients using noninvasive diagnostic imaging methods such as magnetic resonance cholangiopancreatography or endoscopic ultrasonography (EUS), and avoidance of unnecessary invasive procedures, are important measures to be taken before any procedure. Pharmacological prevention is also commonly attempted but is usually ineffective. No ideal agent has not yet been found and the available data conflict. Currently, rectal non-steroidal anti-inflammatory drugs are used to prevent PEP in high-risk patients, but additional studies using larger numbers of subjects are necessary to confirm any prophylactic effect. In this review, we focus on endoscopic procedures seeking to prevent or decrease the severity of PEP. Among various cannulation methods, wire-guided cannulation, precut fistulotomy, and transpancreatic septostomy are reviewed. Prophylactic pancreatic stent placement, which is the best-known prophylactic method, is reviewed with reference to the ideal stent type, adequate duration of stent placement, and stent-related complications. Finally, we comment on other treatment alternatives, and make the point that further advances in EUS-guided techniques may afford useful PEP prophylaxis.

  4. Endoscopic subsurface imaging in tissues

    Energy Technology Data Exchange (ETDEWEB)

    Demos, S G; Staggs, M; Radousky, H B


    The objective of this work is to develop endoscopic subsurface optical imaging technology that will be able to image different tissue components located underneath the surface of the tissue at an imaging depth of up to 1 centimeter. This effort is based on the utilization of existing technology and components developed for medical endoscopes with the incorporation of the appropriate modifications to implement the spectral and polarization difference imaging technique. This subsurface imaging technique employs polarization and spectral light discrimination in combination with image processing to remove a large portion of the image information from the outer layers of the tissue which leads to enhancement of the contrast and image quality of subsurface tissue structures.

  5. Endoscopic approach to subepithelial lesions. (United States)

    Menon, Laila; Buscaglia, Jonathan M


    Endoscopy and endoscopic ultrasound (EUS) play a critical role in the detection and management of subepithelial lesions of the gastrointestinal tract. The most common subepithelial lesions detected by endoscopists are gastrointestinal stromal tumors (GISTs), leiomyomas, lipomas, granular cell tumors (GCTs), pancreatic rests and carcinoid tumors. These lesions can be classified based on unique histochemical staining and the gastrointestinal layer of origin. While the majority of the lesions are considered benign, some tumors such as GISTs and carcinoids have a strong propensity for malignant transformation. Therefore, appropriate endoscopic versus surgical management based on size and location is crucial in the prevention of malignant transformation and metastasis. In this review, we provide a systematic approach to the diagnosis, management and treatment of commonly encountered subepithelial lesions.

  6. Endoscopic ultrasound and pancreas divisum

    DEFF Research Database (Denmark)

    Rana, Surinder S; Gonen, Can; Vilmann, Peter


    Pancreas divisum is the most common congenital anatomic variation of the pancreatic ductal anatomy and in most of the individuals it is asymptomatic. However, in minority of individuals it is presumed to cause recurrent acute pancreatitis and chronic pancreatitis. Endoscopic retrograde cholangiop......Pancreas divisum is the most common congenital anatomic variation of the pancreatic ductal anatomy and in most of the individuals it is asymptomatic. However, in minority of individuals it is presumed to cause recurrent acute pancreatitis and chronic pancreatitis. Endoscopic retrograde...... of the parenchyma also. Therefore EUS, both radial and linear, has potential for being a minimally invasive diagnostic modality for pancreas divisum. A number of EUS criteria have been suggested for the diagnosis of pancreas divisum. These criteria have varying sensitivity and specificity and hence there is a need...

  7. Endoscopic cubital tunnel recurrence rates. (United States)

    Cobb, Tyson K; Sterbank, Patrick T; Lemke, Jon H


    Cubital tunnel syndrome is the second most common nerve entrapment in the upper extremity. There are no current publications concerning the recurrence rates after endoscopic cubital tunnel release. The purpose of this study is to evaluate the recurrence rate of endoscopic cubital tunnel release compared to published reports of recurrence following open cubital tunnel procedures. We reviewed 134 consecutive cases of endoscopic cubital tunnel release in 117 patients. There were 104 cases in 94 patients with greater than 3 months follow-up. The mean follow-up time was 736 days. They were grouped using Dellon's classification. Two literature control groups were used from published reports of recurrence rate following open cubital tunnel release. A recurrence was identified if the patient was symptom-free following surgery but had symptoms reappear 3 months or more after surgery as defined in the literature. Of the 104 cases, 92.31% had more than a 4-month follow-up. One case (0.96%) met the criteria for recurrence at 4 months postprocedure. Data were then compared to the literature control groups used from published reports of recurrence rates following open cubital tunnel release. Pooled, the combined controls had 22 of 180 cases (12.22%) with recurrences. The percentage of procedure recurrence varied significantly with p value equal to 0.0004. It is recognized that there is a lack of common classification and comparative analysis of these studies, but they do classify preoperative grading and recurrence similarly. We are 95% confident that our true recurrence rate is between 0.02% and 5.24% and that endoscopic cubital tunnel release has a recurrence rate, which is not higher than open cubital tunnel release literature controls.

  8. Endoscopic versus microscopic stapes surgery. (United States)

    Surmelioglu, Ozgur; Ozdemir, Suleyman; Tarkan, Ozgur; Tuncer, Ulku; Dagkiran, Muhammed; Cetik, Fikret


    The aim of this study to compare the outcomes and complications of endoscopic stapes surgery versus microscopic stapes surgery. This study involved patients who underwent stapedotomy at the Department of Otorhinolaryngology, Faculty of Medicine, Cukurova University between January 2012 and July 2014. The patients were divided into two groups. Patients in group I were operated with endoscope and patients in group II were operated with microscope. Pure tone audiometry was carried out in all patients preoperatively. Peroperative surgical findings, complications, and duration of surgery were noted and compared between the two groups. Air conduction and bone conduction thresholds were measured at frequencies of 500, 1000, 2000, and 4000Hz, and the mean (±SD) air-bone gap was noted. Mean preoperative air-bone gap was 36.9±6.8dB (23.3-50dB) in group I and 35.1±6dB (26.6-50dB) in group II. Mean postoperative air-bone gap was 9.3±7.1dB (0-30dB) in group I and 13.5±9.7dB (1.6-35dB) in group II. The difference in preoperative and postoperative air-bone gap between the two groups was statistically significant (p=0.023). Patients in group I did not complain of postoperative pain but this was felt in four patients in group II. The difference was statistically significant (p=0.045). Endoscopic stapes surgery has many benefits such as good visualization, and easy accessibility to the stapes, oval window niche, and facial nerve. Removal of the scutum and manipulation of the chorda tympani nerve are less frequent with the endoscopic technique. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  9. Does nasal oxygen reduce the cardiorespiratory problems experienced by elderly patients undergoing endoscopic retrograde cholangiopancreatography?


    Haines, D J; Bibbey, D; Green, J R


    Elderly patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) have an increased risk of sedation related complications during the procedure. To determine whether nasal oxygen supplementation (2 l/min) reduces these risks, half of 66 patients aged over 60 undergoing ERCP using minimal midazolam sedation alone were randomised to receive nasal oxygen. The arterial oxygen saturation and pulse rate of all patients were monitored by pulse oximetry before and during the procedure...

  10. Endoscopic Aspects of Gastric Syphilis

    Directory of Open Access Journals (Sweden)

    Mariana Souza Varella Frazão


    Full Text Available Introduction. Considered as a rare event, gastric syphilis (GS is reported as an organic form of involvement. Low incidence of GS emphasizes the importance of histopathological analysis. Objective. We aim to characterize GS endoscopic aspects in an immunocompetent patient. Case Report. A 23-year-old man presented with epigastric pain associated with nausea, anorexia, generalized malaise and 11 kg weight loss that started 1 month prior to his clinical consultation. Physical examination was normal except for mild abdominal tenderness in epigastrium. Endoscopy observed diminished gastric expandability and diffuse mucosal lesions, from cardia to pylorus. Gastric mucosa was thickened, friable, with nodular aspect, and associated with ulcers lesions. Gastric biopsies were performed, and histopathological analysis resulted in dense inflammatory infiltration rich in plasmocytes. Syphilis serologies were positive for VDRL and Treponema pallidum reagents. Immunohistochemical tests were positive for Treponema pallidum and CD138. The patient was treated with penicillin, leading to resolution of his clinical complaints and endoscopic findings. Conclusion. Diagnosis suspicion of GS is important in view of its nonspecific presentation. Patients with gastric symptoms that mimic neoplastic disease should be investigated thoroughly based on the fact that clinical, endoscopic, and histological findings can easily be mistaken for lymphoma or plastic linitis.

  11. Endoscopically removed giant submucosal lipoma

    Directory of Open Access Journals (Sweden)

    Jovanović Ivan


    Full Text Available Background. Although uncommon, giant submucosal colon lipomas merit attention as they are often presented with dramatic clinical features such as bleeding, acute bowel obstruction, perforation and sometimes may be mistaken for malignancy. There is a great debate in the literature as to how to treat them. Case report. A patient, 67-year old, was admitted to the Clinic due to a constipation over the last several months, increasing abdominal pain mainly localized in the left lower quadrant accompanied by nausea, vomiting and abdominal distension. Physical examination was unremarkable and the results of the detailed laboratory tests and carcinoembryonic antigen remained within normal limits. Colonoscopy revealed a large 10 cm long, and 4 to 5 cm in diameter, mobile lesion in his sigmoid colon. Conventional endoscopic ultrasound revealed 5 cm hyperechoic lesion of the colonic wall. Twenty MHz mini-probe examination showed that lesion was limited to the submucosa. Since polyp appeared too large for a single transaction, it was removed piecemeal. Once the largest portion of the polyp has been resected, it was relatively easy to place the opened snare loop around portions of the residual polyp. Endoscopic resection was carried out safely without complications. Histological examination revealed the common typical histological features of lipoma elsewhere. The patient remained stable and eventually discharged home. Four weeks later he suffered no recurrent symptoms. Conclusion. Colonic lipomas can be endoscopically removed safely eliminating unnecessary surgery.

  12. Compartmental endoscopic surgical anatomy of the medial intraconal orbital space. (United States)

    Bleier, Benjamin S; Healy, David Y; Chhabra, Nipun; Freitag, Suzanne


    Surgical management of intraconal pathology represents the next frontier in endoscopic endonasal surgery. Despite this, the medial intraconal space remains a relatively unexplored region, secondary to its variable and technically demanding anatomy. The purpose of this study is to define the neurovascular structures in this region and introduce a compartmentalized approach to enhance surgical planning. This study was an institutional review board (IRB)-exempt endoscopic anatomic study in 10 cadaveric orbits. After dissection of the medial intraconal space, the pattern and trajectory of the oculomotor nerve and ophthalmic arterial arborizations were analyzed. The position of all vessels as well as the length of the oculomotor trunk and branches relative to the sphenoid face were calculated. A mean of 1.5 arterial branches were identified (n = 15; range, 1-4) at a mean of 8.8 mm from the sphenoid face (range, 4-15 mm). The majority of the arteries (n = 7) inserted adjacent to the midline of medial rectus. The oculomotor nerve inserted at the level of the sphenoid face and arborized with a large proximal trunk 5.5 ± 1.1 mm in length and multiple branches extending 13.2 ± 2.7 mm from the sphenoid face. The most anterior nerve and vascular pedicle were identified at 17.0 and 15.0 mm from the sphenoid face, respectively. The neurovascular supply to the medial rectus muscle describes a varied but predictable pattern. This data allows the compartmentalization of the medial intraconal space into 3 zones relative to the neurovascular supply. These zones inform the complexity of the dissection and provide a guideline for safe medial rectus retraction relative to the fixed landmark of the sphenoid face. © 2014 ARS-AAOA, LLC.

  13. Endoscopic Management of Cavernous Carotid Surgical Complications: Evaluation of a Simulated Perfusion Model. (United States)

    Ciporen, Jeremy N; Lucke-Wold, Brandon; Mendez, Gustavo; Cameron, William E; McCartney, Shirley


    Endoscopic surgical treatment of pituitary tumors, lateral invading tumors, or aneurysms requires surgeons to operate adjacent to the cavernous sinus. During these endoscopic endonasal procedures, the carotid artery is vulnerable to surgical injury at its genu. The objective of this simulation model was to evaluate trainees regarding management of a potentially life-threatening vascular injury. Cadaveric heads were prepared in accordance with the Oregon Health & Science University body donation program. An endoscopic endonasal approach was used, and a perfusion pump with a catheter was placed in the ipsilateral common carotid artery at its origin in the neck. Learners used a muscle graft to establish vascular control and were evaluated over 3 training sessions. Simulation assessment, blood loss during sessions, and performance metric data were collected for learners. Vascular control was obtained at a mean arterial pressure of 65 mm Hg using a muscle graft correctly positioned at the arteriotomy site. Learners improved over the course of training, with senior residents (n = 4) performing better across all simulation categories (situation awareness, decision making, communications and teamwork, and leadership); the largest mean difference was in communication and teamwork. Additionally, learner performance concerning blood loss improved between sessions (t = 3.667, P management that transcend this model. Copyright © 2016 Elsevier Inc. All rights reserved.

  14. [Robot-assisted Coronary Artery Bypass Grafting]. (United States)

    Ishikawa, Norihiko; Watanabe, Go


    The application for robot-assisted coronary surgery ranges from internal thoracic artery (ITA) harvesting with hand-sewn anastomoses to totally endoscopic coronary artery bypass grafting (TECAB), either on- or off-pump. The bilateral IMA can be harvested with the aid of a surgical robot and then multivessel bypass grafting can follow. Such robot-assisted minimally invasive direct coronary artery bypass grafting is called "ThoraCAB". Surgical robots cannot only endoscopically harvest the ITA but they can also anastomose the coronary artery in TECAB. But TECAB still has the difficulties, such as narrow surgical field in Japanese patients. Both procedures have the significant advantages of minimizing surgical trauma, such as reduced comlications, faster return back to normal activities and being improved cosmesis, and which have resulted in the development of minimally invasive surgery. Robot-assisted cardiac surgery for structural heart disease has been approved by the Ministry of Health, Labour and Welfare (MHLW) since December 2015, however, robot-assisted cardiac surgery for TECAB has not been approved yet in Japan.

  15. Cost-effectiveness of stimulation of the sphenopalatine ganglion (SPG) for the treatment of chronic cluster headache: a model-based analysis based on the Pathway CH-1 study. (United States)

    Pietzsch, Jan B; Garner, Abigail; Gaul, Charly; May, Arne


    In the recent Pathway CH-1 study, on-demand stimulation of the sphenopalatine ganglion (SPG) by means of an implantable neurostimulation system was proven to be a safe and effective therapy for the treatment of chronic cluster headache. Our objective was to assess the cost-effectiveness of SPG stimulation in the German healthcare system when compared to medical management. Clinical data from the Pathway CH-1 study were used as input for a model-based projection of the cost-effectiveness of SPG stimulation through 5 years. Medical management as the comparator treatment was modeled on the basis of clinical events observed during the baseline period of CH-1. The costs of treatment were derived from a previously published cluster headache costing study and 2014 medication, neurostimulator, and procedure costs. We computed the 5-year incremental cost-effectiveness ratio (ICER) in euros per quality-adjusted life year (QALY), with costs and effects discounted at 3 % per year. SPG stimulation was projected to add 0.325 QALYs over the study period, while adding €889 in cost, resulting in a 5-year ICER of €2,736 per QALY gained. Longer follow-up periods, higher baseline attack frequency, and higher utilization of attack-aborting medications led to overall cost savings. SPG stimulation was found either cost-effective or cost-saving across all scenarios investigated in sensitivity analyses. Our model-based analysis suggests that SPG stimulation for the treatment of chronic cluster headache, under the assumption of sustained therapy effectiveness, leads to meaningful gains in health-related quality of life and is a cost-effective treatment strategy in the German healthcare system.

  16. Endoscopic versus external approach dacryocystorhinostomy: A ...

    African Journals Online (AJOL)

    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. Keywords: Dacryocystorhinostomy, endoscopic, external. Nigerian Medical Journal | Vol. 54 | Issue 3 | May-June ...

  17. Transgastric endoscopic splenectomy: is it possible? (United States)

    Kantsevoy, S V; Hu, B; Jagannath, S B; Vaughn, C A; Beitler, D M; Chung, S S C; Cotton, P B; Gostout, C J; Hawes, R H; Pasricha, P J; Magee, C A; Pipitone, L J; Talamini, M A; Kalloo, A N


    We have previously reported the feasibility of diagnostic and therapeutic peritoneoscopy including liver biopsy, gastrojejunostomy, and tubal ligation by an oral transgastric approach. We present results of per-oral transgastric splenectomy in a porcine model. The goal of this study was to determine the technical feasibility of per-oral transgastric splenectomy using a flexible endoscope. We performed acute experiments on 50-kg pigs. All animals were fed liquids for 3 days prior to procedure. The procedures were performed under general anesthesia with endotracheal intubation. The flexible endoscope was passed per orally into the stomach and puncture of the gastric wall was performed with a needle knife. The puncture was extended to create a 1.5-cm incision using a pull-type sphincterotome, and a double-channel endoscope was advanced into the peritoneal cavity. The peritoneal cavity was insufflated with air through the endoscope. The spleen was visualized. The splenic vessels were ligated with endoscopic loops and clips, and then mesentery was dissected using electrocautery. Endoscopic splenectomy was performed on six pigs. There were no complications during gastric incision and entrance into the peritoneal cavity. Visualization of the spleen and other intraperitoneal organs was very good. Ligation of the splenic vessels and mobilization of the spleen were achieved using commercially available devices and endoscopic accessories. Transgastric endoscopic splenectomy in a porcine model appears technically feasible. Additional long-term survival experiments are planned.

  18. Endoscopic cubital tunnel release: a systematic review. (United States)

    Smeraglia, Francesco; Del Buono, Angelo; Maffulli, Nicola


    Theoretical advantages of endoscopic cubital tunnel release are the short incision, lower risk of nerve damage, reduced manipulation of the nerve and possible faster recovery. We systematically searched Medline (PubMed), Web of Science and Scopus databases using the following keywords: 'endoscopic ulnar nerve', 'endoscopic cubital nerve', 'endoscopic ulnar compression' and 'endoscopic ulnar neuropathy'. Twenty-one studies were included in this review. The quality of the studies was assessed using the Coleman Methodological Score. Endoscopic release is effective for cubital tunnel entrapment and allows adequate visualization of the site of entrapment. There is a negative association between the severity of the compression and reported outcomes. Injury to the medial branch of the antebrachial cutaneous nerve is less frequent thanks to the limited dissection. The most frequent complication is the development of a hematoma. It is unclear whether ulnar nerve instability is a contraindication to simple decompression. The shorter time to return to work and the cosmetic appearance of the scar can be considered advantages of the endoscopic technique. There is a need to perform randomized clinical trials with common and validated scoring system with a longer duration of follow-up. The literature pertinent to endoscopic cubital tunnel release is lacking in the evaluation of the learning curve. Further investigations are necessary to assess the role of ulnar nerve instability. © The Author 2015. Published by Oxford University Press. All rights reserved. For permissions, please e-mail:

  19. Endoscopic third ventriculostomy in idiopathic normal pressure ...

    African Journals Online (AJOL)

    Objective: To determine the efficacy of endoscopic fenestration of the third ventricle in the treatment of idiopathic normal pressure hydrocephalus. Methods: 16 patients with idiopathic normal pressure hydrocephalus were treated by endoscopic third ventriculostomy. This study lasted three years. All patients were over 50 ...


    African Journals Online (AJOL)

    Objective:-To evaluate the safety and efficacy of povidone iodine with contrast agent as a sclerosant for the endoscopic treatment of chylurla. -. Patients and Methods: From December 1999 to October 2003, a total of 22 patients having chylurla were treated. After their baseline evaluation they were subjected to endoscopic ...

  1. Duodenal diverticular bleeding: an endoscopic challenge

    Directory of Open Access Journals (Sweden)

    Eduardo Valdivielso-Cortázar

    Full Text Available Duodenal diverticula are an uncommon cause of upper gastrointestinal bleeding. Until recently, it was primarily managed with surgery, but advances in the field of endoscopy have made management increasingly less invasive. We report a case of duodenal diverticular bleeding that was endoscopically managed, and review the literature about the various endoscopic therapies thus far described.

  2. Endoscopic third ventriculostomy in idiopathic normal pressure ...

    African Journals Online (AJOL)

    Mohammed Ahmed Eshra


    Dec 22, 2013 ... Abstract Objective: To determine the efficacy of endoscopic fenestration of the third ventricle in the treatment of idiopathic normal pressure hydrocephalus. Methods: 16 patients with idiopathic normal pressure hydrocephalus were treated by endoscopic third ventriculostomy. This study lasted three years.

  3. Clinical Outcome after Endoscopic Endonasal Resection of Tuberculum Sella Meningiomas. (United States)

    Elshazly, Khaled; Kshettry, Varun R; Farrell, Christopher J; Nyquist, Gurston; Rosen, Marc; Evans, James J


    In select cases, the endoscopic endonasal approach (EEA) has distinct advantages for resection of tuberculum sella meningiomas (TSM). To report the extent of resection (EOR), complication rates, and outcomes in a large series of TSM treated by the EEA. Twenty-five consecutive TSM cases treated by EEA from 2008 to 2016 were retrospectively reviewed. Patient history, imaging, volumetric EOR, complications, and outcomes are presented. Mean patient age was 53.9 yr, with female predominance (84%). Preoperatively, 84% of patients had vision impairment and 68% had optic canal tumor invasion. The tumor was abutting or partially encasing the anterior cerebral artery in 14 (56%) and 3 (12%) patients, respectively. The supraclinoid internal carotid artery (ICA) was partially or completely encased in 4 (16%) and 4 (16%) patients, respectively. Gross total resection (GTR) was achieved in 19/25 (76%) cases. Complete ICA encasement was the most common reason for subtotal resection. Among patients without complete ICA encasement, GTR was achieved in 19/20 (95%) patients. Optic canal invasion, tumor volume, intratumoral calcifications, and partial vascular encasement were not limiting factors for GTR. Eighty-eight percent of patients with preoperative visual impairment had improvement or normalization of vision. No patient experienced permanent visual deterioration or new permanent pituitary dysfunction. Cerebrospinal fluid leakage occurred in 2 (8%) cases. The EEA for resection of TSM provides high rates of GTR and visual improvement with a low rate of complications. Direct contact or partial encasement of the ICA and anterior cerebral artery does not limit the EOR.

  4. Integrated biophotonics in endoscopic oncology (United States)

    Muguruma, Naoki; DaCosta, Ralph S.; Wilson, Brian C.; Marcon, Norman E.


    Gastrointestinal endoscopy has made great progress during last decade. Diagnostic accuracy can be enhanced by better training, improved dye-contrast techniques method, and the development of new image processing technologies. However, diagnosis using conventional endoscopy with white-light optical imaging is essentially limited by being based on morphological changes and/or visual attribution: hue, saturation and intensity, interpretation of which depends on the endoscopist's eye and brain. In microlesions in the gastrointestinal tract, we still rely ultimately on the histopathological diagnosis from biopsy specimens. Autofluorescence imaging system has been applied for lesions which have been difficult to morphologically recognize or are indistinct with conventional endoscope, and this approach has potential application for the diagnosis of dysplastic lesions and early cancers in the gastrointestinal tract, supplementing the information from white light endoscopy. This system has an advantage that it needs no administration of a photosensitive agent, making it suitable as a screening method for the early detection of neoplastic tissues. Narrow band imaging (NBI) is a novel endoscopic technique which can distinguish neoplastic and non-neoplastic lesions without chromoendoscopy. Magnifying endoscopy in combination with NBI has an obvious advantage, namely analysis of the epithelial pit pattern and the vascular network. This new technique allows a detailed visualization in early neoplastic lesions of esophagus, stomach and colon. However, problems remain; how to combine these technologies in an optimum diagnostic strategy, how to apply them into the algorithm for therapeutic decision-making, and how to standardize several classifications surrounding them. 'Molecular imaging' is a concept representing the most novel imaging methods in medicine, although the definition of the word is still controversial. In the field of gastrointestinal endoscopy, the future of

  5. Endoscopic findings following retroperitoneal pancreas transplantation. (United States)

    Pinchuk, Alexey V; Dmitriev, Ilya V; Shmarina, Nonna V; Teterin, Yury S; Balkarov, Aslan G; Storozhev, Roman V; Anisimov, Yuri A; Gasanov, Ali M


    An evaluation of the efficacy of endoscopic methods for the diagnosis and correction of surgical and immunological complications after retroperitoneal pancreas transplantation. From October 2011 to March 2015, 27 patients underwent simultaneous retroperitoneal pancreas-kidney transplantation (SPKT). Diagnostic oesophagogastroduodenoscopy (EGD) with protocol biopsy of the donor and recipient duodenal mucosa and endoscopic retrograde pancreatography (ERP) were performed to detect possible complications. Endoscopic stenting of the main pancreatic duct with plastic stents and three-stage endoscopic hemostasis were conducted to correct the identified complications. Endoscopic methods showed high efficiency in the timely diagnosis and adequate correction of complications after retroperitoneal pancreas transplantation. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  6. Endoscopic Thyroidectomy for Differentiated Thyroid Cancer

    Directory of Open Access Journals (Sweden)

    Yi Yang


    Full Text Available Endoscopic thyroidectomy is a relatively new approach in treating differentiated thyroid cancer. Since last decades, more and more endoscopic thyroidectomies have been performed. We review the indications and contraindications, methods, and postoperational complications of this surgical procedure. Lots of surgical approaches have been developed in endoscopic thyroidectomy for differentiated thyroid cancer. Compared to conventional thyroidectomy, scarless endoscopic thyroidectomy has a superior cosmetic result. And it also reduces the incidence of hypesthesia, paresthesia, or feelings of self-consciousness. However, the outcome depends, to a large extent, on the skill of the operator and the learning curve being relatively long. With the development of surgical equipments and skills, operation time and complications will be reduced. Indications of endoscopic thyroidectomy will be widened and it will be more and more performed.

  7. Endoscopic thyroidectomy for differentiated thyroid cancer. (United States)

    Yang, Yi; Gu, Xiaodong; Wang, Xiaoxiao; Xiang, Jianbin; Chen, Zongyou


    Endoscopic thyroidectomy is a relatively new approach in treating differentiated thyroid cancer. Since last decades, more and more endoscopic thyroidectomies have been performed. We review the indications and contraindications, methods, and postoperational complications of this surgical procedure. Lots of surgical approaches have been developed in endoscopic thyroidectomy for differentiated thyroid cancer. Compared to conventional thyroidectomy, scarless endoscopic thyroidectomy has a superior cosmetic result. And it also reduces the incidence of hypesthesia, paresthesia, or feelings of self-consciousness. However, the outcome depends, to a large extent, on the skill of the operator and the learning curve being relatively long. With the development of surgical equipments and skills, operation time and complications will be reduced. Indications of endoscopic thyroidectomy will be widened and it will be more and more performed.

  8. Coronary Artery Bypass Grafting (United States)

    ... Health Topics / Coronary Artery Bypass Grafting Coronary Artery Bypass Grafting What Is Coronary artery bypass grafting (CABG) ... multiple coronary arteries during one surgery. Coronary Artery Bypass Grafting Figure A shows the location of the ...

  9. Chemotherapy-induced sclerosing cholangitis: long-term response to endoscopic therapy. (United States)

    Alazmi, Waleed M; McHenry, Lee; Watkins, James L; Fogel, Evan L; Schmidt, Suzette; Sherman, Stuart; Lehman, Glen L


    Hepatic arterial infusion of fluoropyrimidines has been widely used for the treatment of hepatic metastasis from colorectal cancer. One major complication of such treatment is biliary sclerosis resembling primary sclerosing cholangitis, which has an incidence ranging from 8% to 26%. We evaluated the efficacy and long-term outcome of endoscopic therapy in the management of chemotherapy-induced sclerosing cholangitis (CISC). With the use of an endoscopic retrograde cholangiopancreatography (ERCP) database, all patients with a diagnosis of CISC who had endoscopic therapy between March 1995 and March 2005 were identified. The indications, findings, therapies, and complications for all patients undergoing ERCP were recorded in this database. Additional information was obtained by review of medical records. Eleven patients (six men and five women) were identified. The mean age at presentation was 59.5 years (range, 36-76 years). Cholangiogram findings revealed stricture confined to the common hepatic duct in two patients, involving the hilum in seven patients, involving the right and/or left main hepatic ducts in nine patients, and extending to the intrahepatic radicals in two patients. All patients had successful endoscopic therapy to alleviate the presenting symptom. The grade and extent of biliary strictures did not change in five patients, improved in one patient, recurred in two patients, and progressed in two patients over the follow-up period of 28.2 months (range, 4-60 months). Although long-term follow-up of patients with CISC is limited by the dismal prognosis of the underlying malignancy, CISC has a recalcitrant pattern that rarely improves with endoscopic therapy. However, endoscopic therapy seems to be an effective method of palliation.

  10. Severe gastric variceal haemorrhage due to splenic artery thrombosis and consecutive arterial bypass

    Directory of Open Access Journals (Sweden)

    Wasmuth Hermann E


    Full Text Available Abstract Background Upper gastrointestinal haemorrhage is mainly caused by ulcers. Gastric varicosis due to portal hypertension can also be held responsible for upper gastrointestinal bleeding. Portal hypertension causes the development of a collateral circulation from the portal to the caval venous system resulting in development of oesophageal and gastric fundus varices. Those may also be held responsible for upper gastrointestinal haemorrhage. Case presentation In this study, we describe the case of a 69-year-old male with recurrent severe upper gastrointestinal bleeding caused by arterial submucosal collaterals due to idiopathic splenic artery thrombosis. The diagnosis was secured using endoscopic duplex ultrasound and angiography. The patient was successfully treated with a laparoscopic splenectomy and complete dissection of the short gastric arteries, resulting in the collapse of the submucosal arteries in the gastric wall. Follow-up gastroscopy was performed on the 12th postoperative week and showed no signs of bleeding and a significant reduction in the arterial blood flow within the gastric wall. Subsequent follow-up after 6 months also showed no further gastrointestinal bleeding as well as subjective good quality of life for the patient. Conclusion Submucosal arterial collaterals must be excluded by endosonography via endoscopy in case of recurrent upper gastrointestinal bleeding. Laparoscopic splenectomy provides adequate treatment in preventing any recurrent bleeding, if gastric arterial collaterals are caused by splenic artery thrombosis.

  11. On-demand endoscopic CO2 insufflation with feedback pressure regulation during natural orifice transluminal endoscopic surgery (NOTES) peritoneoscopy induces minimal hemodynamic and respiratory changes. (United States)

    Navarro-Ripoll, Ricard; Martínez-Pallí, Graciela; Guarner-Argente, Carlos; Córdova, Henry; Martínez-Zamora, Maria Angels; Comas, Jaume; Rodríguez de Miguel, Cristina; Beltrán, Mireia; Rodríguez-D'Jesús, Antonio; Hernández-Cera, Clara; Llach, Josep; Balust, Jaume; Fernández-Esparrach, Glòria


    Endoscopic insufflation has been associated with marked increase in intra-abdominal pressure (IAP) and hemodynamic and respiratory changes during transgastric surgery. To investigate the hemodynamic and respiratory effects during intraperitoneal cavity exploration through 3 different natural orifice transluminal endoscopic surgery (NOTES) access locations compared with laparoscopy. Survival experiments using 40 female pigs randomized to transgastric, transcolonic, transvaginal, and laparoscopic peritoneoscopy. On-demand endoscopic insufflation of CO(2) with feedback pressure regulation was used in NOTES with a maximum pressure of 14 mm Hg. In the laparoscopy group, the IAP was maintained at 14 mm Hg. NOTES procedures were performed by an endoscopist (with the assistance of a gynecologist in the transvaginal group and a second endoscopist in the transgastric and transrectal groups) and laparoscopy by 2 surgeons. Invasive hemodynamic and respiratory data. Blood samples were drawn for gas analyses. All experiments except one in the transrectal group were completed. The IAP was significantly lower in all NOTES groups compared with the laparoscopy group. A significant increase in mean systemic arterial blood pressure was observed in the laparoscopy group at 15 and 30 minutes of intraperitoneal cavity exploration, but it remained unchanged during all NOTES procedures. An increase in airway pressures was observed at 15 and 30 minutes of peritoneoscopy in the animals undergoing laparoscopy, whereas those parameters remained unchanged in the NOTES groups. The laparoscopy group showed a significant impairment in pulmonary gas exchange (decrease in Pao(2), increase in Paco(2), and decrease in arterial pH) after 30 minutes of peritoneoscopy, whereas only a slight increase in Paco(2) was observed in the transrectal and transvaginal groups. Healthy animal model. On-demand endoscopic insufflation of CO(2) with feedback pressure regulation can minimize the risk of hemodynamic and

  12. Novel Endoscopic Management of Obesity (United States)

    Dargent, Jerome


    Endoscopic procedures have been well-documented in the obesity field, but have not yet reached a sufficient level of evidence as stand-alone methods for treating obesity. It is unclear if they should take over. Although expanding, the array of bariatric surgical techniques does not fully meet the current needs, and there are not enough resources for increasing surgery. Surgery is avoided by a majority of patients, so that less aggressive procedures are necessary. For the time being, relevant endoscopic methods include intra-gastric balloons, gastric partitioning (Endo-plication), and the metabolic field (Endo-barrier). Surgical novelties and basic research are also important contributors owing to their potential combination with endoscopy. Conditions have been listed for implementation of bariatric endoscopy, because innovation is risky, expensive, and faces ethical challenges. A scientific background is being built (e.g., hormonal studies). Some techniques require additional study, while others are not ready but should be priorities. Steps and goals include the search for conceptual similarities and the respect of an ethical frame. Minimally invasive bariatric techniques are not ready for prime time, but they are already being successful as re-do procedures. A time-frame for step-strategies can be defined, and more investments from the industry are mandatory. PMID:26855921

  13. Coronary Arteries (United States)

    ... animations for grades K-6. The Coronary Arteries Coronary Circulation The heart muscle, like every other organ or ... the heart by its own vascular system, called coronary circulation. The aorta (the main blood supplier to the ...

  14. Cervical and retrosternal approach to the left thoracic cavity using a flexible endoscope. (United States)

    Masmoudi, Hicham; Karsenti, Alexandre; Giol, Mihaëla; Gounant, Valérie; Grunenwald, Dominique; Assouad, Jalal


    Mediastinoscopy remains the gold standard for surgical exploration of the mediastinum. The use of this approach to access the left thoracic cavity could be complicated by vascular or neurological lesion. The aim of this experimental work was to describe a new approach to the left thoracic cavity through a cervical incision and retrosternal space using a flexible endoscope as a unique instrument. We conducted an experimental work on 12 refrigerated and non-embalmed cadavers. Through a cervical incision, we dissected the retrosternal space to the level of Louis angle and then opened the left mediastinal pleura. We introduced the flexible endoscope through this pleural window into the left thoracic cavity. We defined three distances between the borders of the endoscope entry point, the phrenic nerve and the mammary artery: Distance 1: between the medial edge of the endoscope entrance point and the medial edge of the left mammary artery, Distance 2: between the top of the endoscope entrance point and the penetration of phrenic nerve in the left thoracic cavity and Distance 3: between the lateral edge of the entrance point of the endoscope and the medial edge of the phrenic nerve. To measure these distances, we performed a left postero-lateral thoracotomy. Procedure was successfully executed in 10 of the 12 studied subjects. The mean distances 1, 2 and 3 were 17.1 (range 2-40), 39.5 (17-80) and 19.1 mm (10-40), respectively. The minimal Distance 1 was in two subjects 0.2 and 0.5 mm. This approach avoids the para-aortic and supra-aortic zone; this access could be less dangerous than already described access techniques. Despite the limits of our work on cadavers, and the two failures in the application of the access, the mean distances we calculated show the potential safety of our approach concerning the phrenic nerve and the mammary artery. An experimental protocol on living animals is currently underway with the aim of confirming the safety of our approach. © The

  15. Successes rate of endoscopic dacryocystorhinostomy at KMC. (United States)

    Shrestha, S; Kafle, P K; Pokhrel, S; Maharjan, M; Toran, K C


    Nasolacrimal duct obstruction is a common problem which can be corrected by dacryocystorhinostomy (DCR). The gold standard treatment for this is DCR operation through an external approach. Development of endoscopic sinus surgery and endoscopic DCR performed through intranasal route is a major recent development in this field. The aim of this study is to find out the success rate of endoscopic dacryocystorhinostomy without silicon stent intubation within the period of six month following surgery. A prospective study was done on 26 patients with obstruction of the nasolacrimal duct referred from eye out-patient department to ENT OPD during one year period from 2008 to 2009. All the cases had undergone endoscopic DCR operation which was regularly followed up for a period of six months. Postoperative patency of ostium was checked by sac syringing and endoscopic visualisation of ostium in the nasal cavity. The success of surgery was categorised as: complete cure, partial cure and no improvement depending upon symptomatic relief and clinical examination such as sac syringing and endoscopic examination following surgery. In six months' follow-up, 22 (84.5%) out of 26 patients had achieved the complete cure and 4 patients (15.5%) continued to have persistent epiphora. Endoscopic DCR is a beneficial procedure for nasolacrimal duct obstruction with no external scar on face and less bleeding. The success rate is as good as external DCR.

  16. Endoscopic retrograde cholangiopancreatography for primary sclerosing cholangitis. (United States)

    Thosani, Nirav; Banerjee, Subhas


    Although there are no randomized, controlled trials evaluating the efficacy of endoscopic retrograde cholangiography (ERC) in primary sclerosing cholangitis (PSC) patients, substantial indirect evidence supports the effectiveness of ERC in symptomatic PSC patients with a dominant stricture. Currently, cumulative evidence supports the role of ERC with endoscopic dilation with or without additional short-term stent placement for symptomatic PSC patients with a dominant stricture. Differentiating benign dominant strictures from cholangiocarcinoma (CCA) remains difficult; however, newer endoscopic techniques and advanced cytologic techniques are likely to improve sensitivity for the diagnosis of CCA over that achieved by traditional cytology brushing alone. Copyright © 2014 Elsevier Inc. All rights reserved.

  17. Direct percutaneous endoscopic jejunostomy performed with gastroscope

    Directory of Open Access Journals (Sweden)

    Ajay P Choksi


    Full Text Available While percutaneous endoscopic gastrostomy (PEG is a well-known approach for achieving enteral feeding, direct percutaneous endoscopic jejunostomy (DPEJ is a technique that allows endoscopic placement of percutaneous/transabdominal feeding tube directly into the jejunum. It offers a non-surgical alternative for postpyloric enteral feeding for long-term nutritional support when gastric feeding is not technically possible or is inappriopriate. Conventionally DPEJ is done with pediatric colonoscope or small bowel enteroscope. Here, we report a case where DPEJ was accomplished with gastroscope.

  18. Endoscopic intervention in obstructive renal papillary necrosis

    Directory of Open Access Journals (Sweden)

    V Chandrashekar Rao


    Full Text Available To evaluate the usefulness of ultrasonography, endoscopic retrieval, and the outcome of patients with diabetes mellitus presenting with ureteric obstruction caused by necrosed renal papillae. Material And Methods: Eleven seriously ill patients with diabetes mellitus, admitted into medical wards, were found to have ureteric obstruction complicated by urinary infection. The diagnosis was made by ultrasonography alone. Prompt relief followed endoscopic extraction of the offending necrosed papillae. Results: Ten patients improved dramatically. One patient died from septicemia. Conclusions: Ultrasonography appears to be a useful diagnostic method to diagnose ureteric obstruction. It is cheap, fast, and extremely reliable. Endoscopic extraction of the obstructing papilla offers the best chance for successful outcome.

  19. Arterial stiffness

    Directory of Open Access Journals (Sweden)

    Ursula Quinn


    Full Text Available Measurements of biomechanical properties of arteries have become an important surrogate outcome used in epidemiological and interventional cardiovascular research. Structural and functional differences of vessels in the arterial tree result in a dampening of pulsatility and smoothing of blood flow as it progresses to capillary level. A loss of arterial elastic properties results a range of linked pathophysiological changes within the circulation including increased pulse pressure, left ventricular hypertrophy, subendocardial ischaemia, vessel endothelial dysfunction and cardiac fibrosis. With increased arterial stiffness, the microvasculature of brain and kidneys are exposed to wider pressure fluctuations and may lead to increased risk of stroke and renal failure. Stiffening of the aorta, as measured by the gold-standard technique of aortic Pulse Wave Velocity (aPWV, is independently associated with adverse cardiovascular outcomes across many different patient groups and in the general population. Therefore, use of aPWV has been proposed for early detection of vascular damage and individual cardiovascular risk evaluation and it seems certain that measurement of arterial stiffness will become increasingly important in future clinical care. In this review we will consider some of the pathophysiological processes that result from arterial stiffening, how it is measured and factors that may drive it as well as potential avenues for therapy. In the face of an ageing population where mortality from atheromatous cardiovascular disease is falling, pathology associated with arterial stiffening will assume ever greater importance. Therefore, understanding these concepts for all clinicians involved in care of patients with cardiovascular disease will become vital.

  20. Clinical endoscopic management and outcome of post-endoscopic sphincterotomy bleeding.

    Directory of Open Access Journals (Sweden)

    Wei-Chen Lin

    Full Text Available Post-endoscopic sphincterotomy bleeding is a common complication of biliary sphincterotomy, and the incidence varies from 1% to 48%. It can be challenging to localize the bleeder or to administer various interventions through a side-viewing endoscope. This study aimed to evaluate the risk factors of post-endoscopic sphincterotomy bleeding and the outcome of endoscopic intervention therapies. We retrospectively reviewed the records of 513 patients who underwent biliary sphincterotomy in Mackay Memorial Hospital between 2011 and 2016. The blood biochemistry, comorbidities, indication for sphincterotomy, severity of bleeding, endoscopic features of bleeder, and type of endoscopic therapy were analyzed. Post-endoscopic sphincterotomy bleeding occurred in 65 (12.6% patients. Forty-five patients had immediate bleeding and 20 patients had delayed bleeding. The multivariate analysis of risk factors associated with post-endoscopic sphincterotomy bleeding were liver cirrhosis (P = 0.029, end-stage renal disease (P = 0.038, previous antiplatelet drug use (P<0.001, and duodenal ulcer (P = 0.023. The complications of pancreatitis and cholangitis were higher in the bleeding group, with statistical significance. Delayed bleeding occurred within 1 to 7 days (mean, 2.5 days, and 60% (12/20 of the patients received endoscopic evaluation. In the delayed bleeding group, the successful hemostasis rate was 71.4% (5/7, and 65% (13/20 of the patients had ceased bleeding without endoscopic hemostasis therapy. Comparison of different therapeutic modalities showed that cholangitis was higher in patients who received epinephrine spray (P = 0.042 and pancreatitis was higher in patients who received epinephrine injection and electrocoagulation (P = 0.041 and P = 0.039 respectively. Clinically, post-endoscopic sphincterotomy bleeding and further endoscopic hemostasis therapy increase the complication rate of pancreatitis and cholangitis. Realizing the effectiveness of each

  1. Robotically-Assisted Coronary Artery Bypass Grafting

    Directory of Open Access Journals (Sweden)

    Thierry A. Folliguet


    Full Text Available Objectives. Robotic surgery enables to perform coronary surgery totally endoscopically. This report describes our experience using the da Vinci system for coronary artery bypass surgery. Methods. Patients requiring single-or-double vessel revascularization were eligible. The procedure was performed without cardiopulmonary bypass on a beating heart. Results. From April 2004 to May 2008, fifty-six patients were enrolled in the study. Twenty-four patients underwent robotic harvesting of the mammary conduit followed by minimal invasive direct coronary artery bypass (MIDCAB, and twenty-three patients had a totally endoscopic coronary artery bypass (TECAB grafting. Nine patients (16% were converted to open techniques. The mean total operating time for TECAB was 372±104 minutes and for MIDCAB was 220±69 minutes. Followup was complete for all patients up to one year. There was one hospital death following MIDCAB and two deaths at follow up. Forty-eight patients had an angiogram or CT scan revealing occlusion or anastomotic stenoses (>50% in 6 patients. Overall permeability was 92%. Conclusions. Robotic surgery can be performed with promising results.

  2. Ensuring the Safety of Your Endoscopic Procedure (United States)

    ... been a major advance in the treatment of gastrointestinal diseases. For example, the use of endoscopes allows the detection of ulcers, cancers, polyps, and sites of internal bleeding. Through endoscopy, tissue ...

  3. Endoscopic appearance of irradiated gastric mucosa

    Energy Technology Data Exchange (ETDEWEB)

    De Sagher, L.I.; Van den Heule, B.; Van Houtte, P.; Engelholm, L.; Balikdjan, D.; Bleiberg, H.


    Irradiation of the epigastric area for gastric cancer may induce actinic lesions of the stomach characterized on endoscopic examination by ulcerations, haemorrhagic gastritis, fragility of the mucosa, thickening and congestion of the gastric folds.

  4. An illumination system for endoscopic applications

    DEFF Research Database (Denmark)


    The present disclosure relates to an illumination system for endoscopic applications comprising at least one substantially monochromatic light source having a predefined central wavelength between 400 and 500 nm or between 500 and 550 nm, an optical transmission path adapted to guide light...... emanating from the light source to an endoscopic region of examination, and an optical band-rejection filter, wherein the illumination system is adapted to illuminate at least a part of the region of examination by generating autofluorescence in surrounding tissue, and the band-rejection filter is adapted...... to attenuate at least said light source wavelength to a viewer and wherein said light source is the single light source in the illumination system. A further embodiment relates to an endoscope for examining a body cavity comprising tissue, the endoscope comprising a source of light consisting...

  5. Endoscopic discovery and capture of Taenia saginata. (United States)

    Descombes, P; Dupas, J L; Capron, J P


    The authors report the first case of endoscopic finding and removal of a beef tapeworm (Taenia saginata). The parasite was discovered in the duodenal bulb of a 72-year-old woman, who complained of epigastric pain.

  6. Society of American Gastrointestinal and Endoscopic Surgeons (United States)

    ... for Minimizing Bile Duct Injuries: Adopting a Universal Culture of Safety in Cholecystectomy ... Surgeons: The New SAGES Course Endorsement System The Society of American Gastrointestinal Endoscopic Surgeons (SAGES) recognizes that ...

  7. Laparoscopic-assisted percutaneous endoscopic transgastrostomy jejunostomy

    National Research Council Canada - National Science Library

    Dimofte, Mihail-Gabriel; Porumb, Vlad; Nicolescu, Simona; Ristescu, Irina; Lunca, Sorinel


    .... The typical approach involves a percutaneous endoscopic transgastrostomy jejunostomy (PEG-J), which requires a combination of procedures designed to ensure that no organ is interposed between the abdominal wall and the gastric surface...

  8. Endoscopic and Radiologic Findings in Eosinophilic Esophagitis. (United States)

    Alexander, Jeffrey A


    Eosinophilic esophagitis (EoE) was first described by Landis in 1978. The disease is characterized by esophageal symptoms, primarily dysphagia in adult patients, and esophageal eosinophilic infiltration. The disease is associated with characteristic endoscopic findings, including edema, rings, furrows, exudates, and strictures. The typical radiographic findings of this disorder are rings, strictures, and small-caliber esophagus. The endoscopic and radiographic findings of EoE are the topic of this review. Copyright © 2017 Elsevier Inc. All rights reserved.

  9. Tracking camera control in endoscopic dacryocystorhinostomy surgery. (United States)

    Wawrzynski, J R; Smith, P; Tang, L; Hoare, T; Caputo, S; Siddiqui, A A; Tsatsos, M; Saleh, G M


    Poor camera control during endoscopic dacryocystorhinostomy (EnDCR) surgery can cause inadequate visualisation of the anatomy and suboptimal surgical outcomes. This study investigates the feasibility of using computer vision tracking in EnDCR surgery as a potential formative feedback tool for the quality of endoscope control. A prospective cohort analysis was undertaken comparing junior versus senior surgeons performing routine EnDCR surgery. Computer vision tracking was applied to endoscopic video footage of the surgery: Total number of movements, camera path length in pixels and surgical time were determined for each procedure. A Mann-Whitney U-test was used to test for a significant difference between juniors and seniors (P theatre. Ten junior surgeons (100 completed procedures). Total number of movements of the endoscope per procedure. Path length of the endoscope per procedure. Twenty videos, 10 from junior surgeons and 10 from senior surgeons were analysed. Feasibility of our tracking system was demonstrated. Mean camera path lengths were significantly different at 119,329px (juniors) versus 43,697px (seniors), P ≪ 0.05. The mean number of movements was significantly different at 9134 (juniors) versus 3690 (seniors), P ≪ 0.05. These quantifiable differences demonstrate construct validity for computer vision endoscope tracking as a measure of surgical experience. Computer vision tracking is a potentially useful structured and objective feedback tool to assist trainees in improving endoscope control. It enables juniors to examine how their pattern of endoscope control differs from that of seniors, focusing in particular on sections where they are most divergent. © 2015 John Wiley & Sons Ltd.

  10. Endoscopic Sinus Surgery for Chronic Sinusitis


    篠, 昭男; 吉原, 俊雄; Akio, SHINO; Toshio, YOSHIHARA


    Endoscopic sinus surgery (ESS) has became basic surgical treatment for chronic sinusitis instead of the Caldwell-Luc procedure. This technique is aimed at improvement of ventilation and excretion with endoscopic approach between nasal cavity and each sinus. The mucosa preservation of sinus is recognized to important as the surgery for inflammatory disease. The ostiomeatal complex (OMC) plays a significant role in the pathogenesis of sinusitis. Obstruction here predisposes to chronic sinusitis...

  11. Endoscopic intervention in obstructive renal papillary necrosis


    V Chandrashekar Rao; Bhat, Soumya S; Padmanabha Vijayan; Shankar Ramamurthy


    To evaluate the usefulness of ultrasonography, endoscopic retrieval, and the outcome of patients with diabetes mellitus presenting with ureteric obstruction caused by necrosed renal papillae. Material And Methods: Eleven seriously ill patients with diabetes mellitus, admitted into medical wards, were found to have ureteric obstruction complicated by urinary infection. The diagnosis was made by ultrasonography alone. Prompt relief followed endoscopic extraction of the offending necrosed pa...

  12. Endoscopic Management of Gastrointestinal Leaks and Fistulae. (United States)

    Willingham, Field F; Buscaglia, Jonathan M


    Gastrointestinal leaks and fistulae can be serious acute complications or chronic morbid conditions resulting from inflammatory, malignant, or postsurgical states. Endoscopic closure of gastrointestinal leaks and fistulae represents major progress in the treatment of patients with these complex presentations. The main goal of endoscopic therapy is the interruption of the flow of luminal contents across a gastrointestinal defect. In consideration of the proper endoscopic approach to luminal closure, several basic principles must be considered. Undrained cavities and fluid collections must often first be drained percutaneously, and the percutaneous drain provides an important measure of safety for subsequent endoscopic luminal manipulations. The size and exact location of the leak/fistula, as well as the viability of the surrounding tissue, must be defined. Almost all complex leaks and fistulae must be approached in a multidisciplinary manner, collaborating with colleagues in nutrition, radiology, and surgery. Currently, gastrointestinal leaks and fistulae may be managed endoscopically by using 1 or more of the following modalities: stent placement, clip closure (including through-the-scope clips and over-the-scope devices), endoscopic suturing, and the injection of tissue sealants. In this article, we discuss these modalities and review the published outcomes data regarding each approach as well as practical considerations for successful closure of luminal defects. Copyright © 2015 AGA Institute. Published by Elsevier Inc. All rights reserved.

  13. Endoscopic solutions to challenging enteral feeding problems. (United States)

    Paski, Shirley C; Dominitz, Jason A


    Enteral nutrition support is often required in patients who are unable to meet their own nutritional requirements. Endoscopists play a key role in the placement of enteral feeding catheters. This review focuses on the recently published solutions to common problems encountered during endoscopic placement of enteral feeding devices. Case reports and case series describe solutions for overcoming common problems encountered during the placement of enteral feeding devices. Transnasal techniques can simplify nasojejunal tube placement, whereas deep enteroscopy techniques provide more reliable jejunostomy placement. Endoscopic ultrasound can help when transillumination is not possible or in the setting of postsurgical anatomy like Roux-en-Y. Laparoscopic-assisted procedures are useful when endoscopic techniques have failed in adults or in select high-risk pediatric patients. The American Society for Gastrointestinal Endoscopy and the American Gastroenterology Association both published comprehensive guidelines that outline the indications, contraindications, technical aspects of feeding catheter placement, and complications. Advances in endoscopic techniques, including deep enteroscopy, endoscopic ultrasound, ultra-slim transnasal endoscopes and laparoscopic-assisted procedures, have enabled endoscopists to successfully place enteral feeding tubes in patients who previously required open procedures.

  14. Fetal endoscopic tracheal occlusion for congenital diaphragmatic hernia: indications, outcomes, and future directions. (United States)

    Ruano, Rodrigo; Ali, Raheel A; Patel, Parin; Cass, Darrell; Olutoye, Oluyinka; Belfort, Michael A


    In the present study, we review the indications, technical aspects, preliminary results, risks, and clinical implications of fetal endoscopic tracheal occlusion (FETO) for severe congenital diaphragmatic hernia (CDH) performed outside the United States and its potential future directions in this country and globally. Congenital diaphragmatic hernia occurs in approximately 1 in 2500 live births and results in high neonatal morbidity and mortality, largely associated with the severity of pulmonary hypoplasia and pulmonary arterial hypertension. With the advent of prenatal imaging, CDH can be diagnosed before birth, and in utero treatment is now available in some centers. The prognosis of CDH can be evaluated by assessing the fetal lung size, the degree of liver herniation, and the fetal pulmonary vasculature in isolated forms of CDH. These parameters help classify fetuses as having mild, moderate, severe, or extremely severe isolated CDH. Severe and extremely severe diaphragmatic hernias have poor outcomes and thus are candidates for innovative therapies such as FETO. Fetal endoscopic tracheal occlusion is usually performed between 26 and 30 weeks' gestation. In utero, an endoscope is passed through the fetal mouth and down to the carina; the balloon is deployed just above the carina. After the procedure, ultrasound surveillance every 2 weeks ensures the balloon's structural integrity and measures the fetal pulmonary response. At approximately 34 weeks' gestation, the balloon is deflated and removed. Fetal endoscopic tracheal occlusion is thought to improve outcomes by decreasing mortality and allowing more rapid neonatal stabilization. Ultimately, the goal of FETO is to minimize pulmonary hypoplasia and pulmonary arterial hypertension. Following delivery, neonates still require diaphragm repair.

  15. Augmented reality image guidance for minimally invasive coronary artery bypass (United States)

    Figl, Michael; Rueckert, Daniel; Hawkes, David; Casula, Roberto; Hu, Mingxing; Pedro, Ose; Zhang, Dong Ping; Penney, Graeme; Bello, Fernando; Edwards, Philip


    We propose a novel system for image guidance in totally endoscopic coronary artery bypass (TECAB). A key requirement is the availability of 2D-3D registration techniques that can deal with non-rigid motion and deformation. Image guidance for TECAB is mainly required before the mechanical stabilization of the heart, thus the most dominant source of non-rigid deformation is the motion of the beating heart. To augment the images in the endoscope of the da Vinci robot, we have to find the transformation from the coordinate system of the preoperative imaging modality to the system of the endoscopic cameras. In a first step we build a 4D motion model of the beating heart. Intraoperatively we can use the ECG or video processing to determine the phase of the cardiac cycle. We can then take the heart surface from the motion model and register it to the stereo-endoscopic images of the da Vinci robot using 2D-3D registration methods. We are investigating robust feature tracking and intensity-based methods for this purpose. Images of the vessels available in the preoperative coordinate system can then be transformed to the camera system and projected into the calibrated endoscope view using two video mixers with chroma keying. It is hoped that the augmented view can improve the efficiency of TECAB surgery and reduce the conversion rate to more conventional procedures.

  16. Role of endoscopic ultrasound and endoscopic resection for the treatment of gastric schwannoma. (United States)

    Hu, Jinlong; Liu, Xiang; Ge, Nan; Wang, Sheng; Guo, Jintao; Wang, Guoxin; Sun, Siyu


    Endoscopic ultrasound (EUS) and endoscopic resection play an important role in gastric submucosal tumor. However, there were few articles regarding EUS and endoscopic resection of gastric schwannomas. Our aim was to evaluate the role of EUS and endoscopic resection in treating gastric schwannomas.We retrospectively reviewed 14 patients between March 2012 and April 2016 with gastric schwannomas and who received EUS and endoscopic resection. EUS characteristics, endoscopic resection, tumor features, and follow-up were evaluated in all the patients.Fourteen patients were enrolled in the present study. The patients' ages ranged from 25 to 72 years (mean age, 52.6 years). On EUS, all tumors were originating from muscularis propria and hypoechoic. Ten tumors have the extraluminal growth patterns and 4 tumors have the intraluminal growth patterns. Marginal halos were observed in 7 lesions. No cystic change and calcification were found inside the lesions. Complete endoscopic resection was performed in all the patients with no complications occurring in any patients. No recurrence or metastases was found in all patients during the follow-up period.Gastric schwannoma has some characteristics on EUS, but it is difficult to differentiate gastric schwannoma from gastrointestinal stromal tumor. Endoscopic resection is an effective and safe treatment for gastric schwannoma with an excellent follow-up outcome.

  17. Craniovertebral junction 360°: A combined microscopic and endoscopic anatomical study. (United States)

    Jhawar, Sukhdeep Singh; Nunez, Maximiliano; Pacca, Paolo; Voscoboinik, Daniel Seclen; Truong, Huy


    Craniovertebral junction (CVJ) can be approached from various corridors depending on the location and extent of disease. A three-dimensional understanding of anatomy of CVJ is paramount for safe surgery in this region. Aim of this cadaveric study is to elucidate combined microscopic and endoscopic anatomy of critical neurovascular structures in this area in relation to bony and muscular landmarks. Eight fresh-frozen cadaveric heads injected with color silicon were used for this study. A stepwise dissection was done from anterior, posterior, and lateral sides with reference to bony and muscular landmarks. Anterior approach was done endonasal endoscopically. Posterior and lateral approaches were done with a microscope. In two specimens, both anterior and posterior approaches were done to delineate the course of vertebral artery and lower cranial nerves from ventral and dorsal aspects. CVJ can be accessed through three corridors, namely, anterior, posterior, and lateral. Access to clivus, foreman magnum, occipital cervical joint, odontoid, and atlantoaxial joint was studied anteriorly with an endoscope. Superior and inferior clival lines, supracondylar groove, hypoglossal canal, arch of atlas and body of axis, and occipitocervical joint act as useful bony landmarks whereas longus capitis and rectus capitis anterior are related muscles to this approach. In posterior approach, spinous process of axis, arch of atlas, C2 ganglion, and transverse process of atlas and axis are bony landmarks. Rectus capitis posterior major, superior oblique, inferior oblique, and rectus capitis lateralis (RCLa) are muscles related to this approach. Occipital condyles, transverse process of atlas, and jugular tubercle are main bony landmarks in lateral corridor whereas RCLa and posterior belly of digastric muscle are the main muscular landmarks. With advances in endoscopic and microscopic techniques, access to lesions and bony anomalies around CVJ is becoming easier and straightforward. A

  18. Occlusive Peripheral Arterial Disease (United States)

    ... but also to the worsening of the disease. Obstructive peripheral arterial disease most commonly develops in the arteries of the legs, including the two branches of the aorta (iliac arteries), main arteries of the thighs (femoral arteries), of ... arterial disease may also develop in the part ...

  19. Towards automated visual flexible endoscope navigation. (United States)

    van der Stap, Nanda; van der Heijden, Ferdinand; Broeders, Ivo A M J


    The design of flexible endoscopes has not changed significantly in the past 50 years. A trend is observed towards a wider application of flexible endoscopes with an increasing role in complex intraluminal therapeutic procedures. The nonintuitive and nonergonomical steering mechanism now forms a barrier in the extension of flexible endoscope applications. Automating the navigation of endoscopes could be a solution for this problem. This paper summarizes the current state of the art in image-based navigation algorithms. The objectives are to find the most promising navigation system(s) to date and to indicate fields for further research. A systematic literature search was performed using three general search terms in two medical-technological literature databases. Papers were included according to the inclusion criteria. A total of 135 papers were analyzed. Ultimately, 26 were included. Navigation often is based on visual information, which means steering the endoscope using the images that the endoscope produces. Two main techniques are described: lumen centralization and visual odometry. Although the research results are promising, no successful, commercially available automated flexible endoscopy system exists to date. Automated systems that employ conventional flexible endoscopes show the most promising prospects in terms of cost and applicability. To produce such a system, the research focus should lie on finding low-cost mechatronics and technologically robust steering algorithms. Additional functionality and increased efficiency can be obtained through software development. The first priority is to find real-time, robust steering algorithms. These algorithms need to handle bubbles, motion blur, and other image artifacts without disrupting the steering process.

  20. Endoscopic Management of Nonlifting Colon Polyps

    Directory of Open Access Journals (Sweden)

    Shai Friedland


    Full Text Available Background and Study Aims. The nonlifting polyp sign of invasive colon cancer is considered highly sensitive and specific for cancer extending beyond the mid-submucosa. However, prior interventions can cause adenomas to become nonlifting due to fibrosis. It is unclear whether nonlifting adenomas can be successfully treated endoscopically. The aim of this study was to evaluate outcomes in a referral practice incorporating a standardized protocol of attempted endoscopic resection of nonlifting lesions previously treated by biopsy, polypectomy, surgery, or tattoo placement. Patients and Methods. Retrospective review of patients undergoing colonoscopy by one endoscopist at two hospitals found to have nonlifting lesions from prior interventions. Lesions with biopsy proven invasive cancer or definite endoscopic features of invasive cancer were excluded. Lesions ≥ 8 mm were routinely injected with saline prior to attempted endoscopic resection. Polypectomy was performed using a stiff snare, followed by argon plasma coagulation (APC if necessary. Results. 26 patients each had a single nonlifting lesion with a history of prior intervention. Endoscopic resection was completed in 25 (96%. 22 required snare resection and APC. 1 patient had invasive cancer and was referred for surgery. The recurrence rate on follow-up colonoscopy was 26%. All of the recurrences were successfully treated endoscopically. There was 1 postprocedure bleed (4%, no perforations, and no other complications. Conclusions. The majority of adenomas that are nonlifting after prior interventions can be treated successfully and safely by a combination of piecemeal polypectomy and ablation. Although recurrence rates are high at 26%, these too can be successfully treated endoscopically.

  1. The endoscopic transoral approach to the craniovertebral junction: an anatomical study with a clinical example. (United States)

    Chan, Andrew K; Benet, Arnau; Ohya, Junichi; Zhang, Xin; Vogel, Todd D; Flis, Daniel W; El-Sayed, Ivan H; Mummaneni, Praveen V


    -splitting technique (velopharyngeal insufficiency) and the expanded endonasal approach (mucus crusting, sinusitis, and potential lacerum or cavernous-paraclival internal carotid artery injury). For appropriately selected lesions near the palatal line, the endoscopic transoral approach appears to be the preferred approach.

  2. Fully endoscopic supraorbital keyhole approach to the anterior cranial base: A cadaveric study

    Directory of Open Access Journals (Sweden)

    Mehmet Osman Akçakaya


    Full Text Available Introduction: The supraorbital keyhole approach for anterior cranial base lesions has been increasingly used in clinical practice. Anatomical studies focusing on the endoscopic anatomy via this approach are few, although the microscopic anatomy has been well studied. The aim of this study is to describe the anatomical features and surgical exposure provided by the endoscopic supraorbital keyhole approach using quantitative measurements. Materials and Methods: Nine formalin-fixed human cadavers from the inventory of the Anatomy department were used. A total of 18 supraorbital keyhole cranitomies were conducted. The distances between the target anatomical structures and the dura mater at the craniotomy site, and the distances between deep anatomical structures were measured with purpose-designed hooks. Results: The distance between the dura mater and optic canal was measured as 69.5 ± 6.7 mm (62-83 mm; optic chiasm as 76.2 ± 5.4 mm (67-86 mm; anterior communicating artery as 82.6 ± 6.1 mm (71-93 mm; internal carotid artery (ICA bifurcation as 74.7 ± 6.0 mm (66-84 mm and the basilar tip as 94.9 ± 7.0 mm (87-111 mm. The mean diameter of the optic canal was 7.4 ± 1.3 mm (6-11 mm, whereas the mean diameter of diaphragma sellae was measured as 8.4 ± 1.1 mm (7-10 mm. Conclusions: The results of this study showed that the anterior anda medial aspects of the anterior cranial fossa can be visualized properly. Dissection of the ipsilateral arteries of Circle of Willis can be performed easily using an endoscopic supraorbital keyhole approach.

  3. Sequelae of Endoscopic Inguinal Hernia Repair : Incidence, evaluation and management

    NARCIS (Netherlands)

    Burgmans, J.P.J.


    The endoscopic preperitoneal technique (TEP) is an appealing inguinal hernia repair technique, theoretically superior to other approaches. In practice some problems remain unsolved. Real incidences of chronic postoperative inguinal pain (CPIP) and other important sequelae of endoscopic hernia repair

  4. Is bacteriologic surveillance in endoscope reprocessing stringent enough?

    NARCIS (Netherlands)

    Kovaleva, J.; Meessen, N. E. L.; Peters, F. T. M.; Been, M. H.; Arends, J. P.; Borgers, R. P.; Degener, J. E.


    Endoscopes, including duodenoscopes, are medical devices that are frequently associated with outbreaks of nosocomial infections. We investigated an outbreak of multidrug-resistant Pseudomonos aeruginosa sepsis affecting three patients after endoscopic retrograde cholangiopancreaticography (ERCP).

  5. Transforaminal endoscopic surgery for lumbar stenosis: a systematic review

    NARCIS (Netherlands)

    Nellensteijn, J.M.; Ostelo, R.W.J.G.; Bartels, R.; Peul, W.; van Royen, B.J.; van Tulder, M.W.


    Transforaminal endoscopic techniques have become increasingly popular in surgery of patients with lumbar stenosis. The literature has not yet been systematically reviewed. A comprehensive systematic literature review up to November 2009 to assess the effectiveness of transforaminal endoscopic

  6. Laparoscopic-assisted percutaneous endoscopic transgastrostomy jejunostomy. (United States)

    Dimofte, Mihail-Gabriel; Porumb, Vlad; Nicolescu, Simona; Ristescu, Irina; Lunca, Sorinel


    New therapeutic protocols for patients with end-stage Parkinson disease include a carbidopa/levodopa combination using continuous, modulated enteral administration via a portable pump. The typical approach involves a percutaneous endoscopic transgastrostomy jejunostomy (PEG-J), which requires a combination of procedures designed to ensure that no organ is interposed between the abdominal wall and the gastric surface. Lack of transillumination in maximal endoscopic light settings is a major contraindication for PEG-J, and we decided to use a different approach to establish enteric access for long-term medication delivery via pump, using a minimally invasive procedure. In all patients, we performed a laparoscopic-assisted percutaneous transgastrostomy jejunostomy (LAPEG-J) after an unsuccessful endoscopic transillumination. Five patients with end-stage Parkinson disease were referred to our department after successful therapeutic testing with administration of levodopa/carbidopa via naso-jejunal tube. All patients failed the endoscopic transillumination during the endoscopic procedure and were considered for LAPEG-J. In all patients, the LAPEG-J procedure was uneventful. The most common reason identified for failed transillumination was a high position of the stomach, followed by interposition of the liver or colon between the stomach and anterior abdominal wall. There were no complications regarding the LAPEG-J procedure, and all patients were discharged during the second postprocedural day. LAPEG-J provides a simple and safe option for placing a jejunostomy after an unsuccessful PEG-J attempt.

  7. Extended endoscopic endonasal surgery using three-dimensional endoscopy in the intra-operative MRI suite for supra-diaphragmatic ectopic pituitary adenoma. (United States)

    Fuminari, Komatsu; Hideki, Atsumi; Manabu, Osakabe; Mitsunori, Matsumae


    We describe a supra-diaphragmatic ectopic pituitary adenoma that was safely removed using the extended endoscopic endonasal approach, and discuss the value of three-dimensional (3D) endoscopy and intra-operative magnetic resonance imaging (MRI) to this type of procedure. A 61-year-old-man with bitemporal hemianopsia was referred to our hospital, where MRI revealed an enhanced suprasellar tumor compressing the optic chiasma. The tumor extended on the planum sphenoidale and partially encased the right internal carotid artery. An endocrinological assessment indicated normal pituitary function. The extended endoscopic endonasal approach was taken using a 3D endoscope in the intraoperative MRI suite. The tumor was located above the diaphragma sellae and separated from the normal pituitary gland. The pathological findings indicated non-functioning pituitary adenoma and thus the tumor was diagnosed as a supra-diaphragmatic ectopic pituitary adenoma. Intra-operative MRI provided useful information to minimize dural opening and the supra-diaphragmatic ectopic pituitary adenoma was removed from the complex neurovascular structure via the extended endoscopic endonasal approach under 3D endoscopic guidance in the intra-operative suite. Safe and effective removal of a supra-diaphragmatic ectopic pituitary adenoma was accomplished via the extended endoscopic endonasal approach with visual information provided by 3D endoscopy and intra-operative MRI.

  8. Postoperative seizure following transforaminal percutaneous endoscopic lumbar discectomy


    Kertmen, Hayri; G?rer, Bora; YILMAZ, Erdal Resit; Sekerci, Zeki


    Endoscopic surgery for lumbar disc herniation has been available for more than 30 years. Transforaminal percutaneous endoscopic lumbar discectomy is a well-known, safe, and effective method used for the treatment of the lumbar disc herniation. The published complications of the transforaminal percutaneous endoscopic lumbar discectomy consist of infections, thrombophlebitis, dysesthesia, dural tear, vascular injury, and death. Seizure after transforaminal percutaneous endoscopic lumbar discect...

  9. Endoscopic sleeve gastroplasty: a potential endoscopic alternative to surgical sleeve gastrectomy for treatment of obesity. (United States)

    Abu Dayyeh, Barham K; Rajan, Elizabeth; Gostout, Christopher J


    Obesity and its associated conditions, including type 2 diabetes and cardiovascular disease, have reached epidemic proportions. High-efficacy, high-risk surgical approaches are unlikely to meet the increasing burden of disease. Emerging endoscopic technologies have opened the door for endoscopic approaches to reproduce many of the benefits of GI weight loss surgery and thereby contribute to the effective treatment of obesity and its associated disorders. To demonstrate the technical feasibility of transoral endoscopic gastric volume reduction with an endoscopic suturing device in a fashion similar to sleeve gastrectomy for the treatment of obesity. Single-center, pilot feasibility study. Four human subjects with obesity. Transoral sleeve gastroplasty. Technical feasibility. We successfully used an endoscopic free-hand suturing system in 4 subjects, thus demonstrating the technical feasibility of a novel technique to mimic the anatomic manipulations created by surgical sleeve gastrectomy endoscopically. Pilot feasibility study with small number of subjects. Endoscopic sleeve gastroplasty for treatment of obesity is feasible. Copyright © 2013 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.

  10. Pose Reconstruction of Flexible Instruments from Endoscopic Images using Markers

    NARCIS (Netherlands)

    Reilink, Rob; Stramigioli, Stefano; Misra, Sarthak


    A system is developed that can reconstruct the pose of flexible endoscopic instruments that are used in ad- vanced flexible endoscopes using solely the endoscopic images. Four markers are placed on the instrument, whose positions are measured in the image. These measurements are compared to a

  11. Transanal submucosal endoscopic resection (TASER) by TEO system®. (United States)

    Muñoz de Nova, José Luis; Viamontes Ugalde, Francisco Eduardo; Mendoza Jiménez-Ridruejo, Jorge


    Given the higher incidence of non-invasive colorectal tumors due to the further implementation of screening techniques, multiple endoscopic techniques have emerged for its resection. Recently described, transanal submucosal endoscopic resection (TASER) pools the concepts of endoscopic resection with the transanal surgery. We report our initial experience and reflections on this new technique.

  12. To evaluate the results of endoscopic variceal band ligation (EVBL)

    African Journals Online (AJOL)



    Apr 4, 2004 ... Lay, C.S. Tsai, Y.T. Teg, C.Y. et al. Endoscopic variceal ligation in prophylaxis of first variceal bleeding in cirrhotic patients with high-risk esophageal varices. Hepatology. 1997;. 25:346-350. 24. Stiegmann, G.V. Goff, J.S. Michaletz-Onody, P.A. et al. Endoscopic sclerotherapy as compared with endoscopic.

  13. Coccidioides immitis and Mycobacterium tuberculosis diagnosed by endoscopic ultrasound. (United States)

    Naidu, Veena G; Tammineni, Anil K; Biscopink, Ronald J; Davis, Terry L; Veerabagu, Manjakkollai P


    The use of endoscopic ultrasound in staging non-small cell lung cancer is well known. Its role in diagnosing non-malignant conditions that cause mediastinal adenopathy is still not well established. We diagnosed Coccidioides immitis and Mycobacterium tuberculosis in two patients using endoscopic ultrasound. To our knowledge this is the first case of Coccidioidomycosis to be diagnosed by endoscopic ultrasound.

  14. [12 years of endoscopic stone removal]. (United States)

    Gysi, B; Schmassmann, A; Scheurer, U; Halter, F


    All 583 attempts at endoscopic clearance of biliary calculi, performed in the Gastrointestinal Unit, Inselspital Bern, were retrospectively analyzed from 1980 until 1991. The average age of the patients was 70; 56% were female and 44% male. In 1980, 26 ERCPs for bile duct stone removal were performed, whereas in 1991 the number had increased to 90. The substantial increase in 1991 occurred after introduction of laparoscopic cholecystectomy. Over the total period of 12 years all stones were removed endoscopically after papillotomy in 82%, while the success rate in 1991 was 90%. Morbidity was 5.4% and lethality 0.2%. Total morbidity did not change markedly. However, the number of severe complications requiring surgical repair was reduced from 1.7% between 1980 and 1986 to 0% between 1987 and 1991. These results suggest that endoscopic removal of bile duct stones is increasingly performed with high success and low complication rates.

  15. Endoscopic management of pancreatic pseudocysts and necrosis. (United States)

    Law, Ryan; Baron, Todd H


    Over the last several years, there have been refinements in the understanding and nomenclature regarding the natural history of acute pancreatitis. Patients with acute pancreatitis frequently develop acute pancreatic collections that, over time, may evolve into pancreatic pseudocysts or walled-off necrosis. Endoscopic management of these local complications of acute pancreatitis continues to evolve. Treatment strategies range from simple drainage of liquefied contents to repeated direct endoscopic necrosectomy of a complex necrotic collection. In patients with chronic pancreatitis, pancreatic pseudocysts may arise as a consequence of pancreatic ductal obstruction that then leads to pancreatic ductal disruption. In this review, we focus on the indications, techniques and outcomes for endoscopic therapy of pancreatic pseudocysts and walled-off necrosis.

  16. Endoscopic anatomy of the pediatric middle ear. (United States)

    Isaacson, Glenn


    Traditionally, otologists have aimed to produce a clean, dry, safe ear with the best possible hearing result. More recently, "less invasively" has been added to this list of goals. The development of small-diameter, high-quality rigid endoscopes and high-definition video systems has made totally endoscopic, transcanal surgery a reality in adult otology and a possibility in pediatric otology. This article reviews the anatomy of the pediatric middle ear and its surrounding airspaces and structures based on the work of dozens of researchers over the past 50 years. It will focus on the developmental changes in ear anatomy from birth through the first decade, when structure and function change most rapidly. Understanding the limits and possibilities afforded by new endoscopic technologies, the pediatric otologist can strive for results matching or exceeding those achieved by more invasive surgical approaches.

  17. Diagnosis and management of iatrogenic endoscopic perforations

    DEFF Research Database (Denmark)

    Paspatis, Gregorios A; Dumonceau, Jean-Marc; Barthet, Marc


    perforation, ESGE recommends that the endoscopist reports: its size and location with a picture; endoscopic treatment that might have been possible; whether carbon dioxide or air was used for insufflation; and the standard report information. 3 ESGE recommends that symptoms or signs suggestive of iatrogenic......This Position Paper is an official statement of the European Society of Gastrointestinal Endoscopy (ESGE). It addresses the diagnosis and management of iatrogenic perforation occurring during diagnostic or therapeutic digestive endoscopic procedures. Main recommendations 1 ESGE recommends that each...

  18. Endoscopic management of acute peptic ulcer bleeding. (United States)

    Lu, Yidan; Chen, Yen-I; Barkun, Alan


    This review discusses the indications, technical aspects, and comparative effectiveness of the endoscopic treatment of upper gastrointestinal bleeding caused by peptic ulcer. Pre-endoscopic considerations, such as the use of prokinetics and timing of endoscopy, are reviewed. In addition, this article examines aspects of postendoscopic care such as the effectiveness, dosing, and duration of postendoscopic proton-pump inhibitors, Helicobacter pylori testing, and benefits of treatment in terms of preventing rebleeding; and the use of nonsteroidal anti-inflammatory drugs, antiplatelet agents, and oral anticoagulants, including direct thrombin and Xa inhibitors, following acute peptic ulcer bleeding. Copyright © 2014 Elsevier Inc. All rights reserved.

  19. An Artificial Cadaveric Leg Blood Flow System for Endoscopic Vein Harvesting Simulation. (United States)

    Karras, Constantine L; DeDonato, Emily A; DiBartola, Kaitlin K; Zhao, Jin-Cheng

    Despite being the most common training model for endoscopic vein harvesting, cadaveric legs are limited by their absence of blood flow, resulting in a faded vascular appearance. Because the saphenous vein and the surrounding tissue seem less distinguishable, dissection of the saphenous vein and bipolar coagulation of its branches becomes increasingly inefficient and difficult. An inexpensive artificial blood flow system was developed to overcome this limitation. A cadaveric leg was thawed to a soft and yielding degree, and the saphenous vein was dissected medial and proximal to the medial malleolus. An artificial blood solution was prepared by dissolving 4% protein powder, red dye, and a contrast agent-for x-ray visualization-in saline. The solution was perfused through the saphenous vein and artery. The open ends of the vessels were temporarily clamped after the perfusion had been completed. Blood flow within the vessels was confirmed via angiography and endoscopic visualization of the leg's vessels. A bleeding effect was observed when the saphenous vein was perforated or when a vascular branch was transected. Conversely, a tight seal indicated successful bipolar coagulation of a branch, providing an objective, quantifiable assessment parameter. The artificial blood flow system helps overcome the limitations of the cadaveric leg, creating a more realistic and inexpensive model for endoscopic vein harvesting simulation training.

  20. Percutaneous probe stimulation for intraoperative neuromonitoring in total endoscopic thyroidectomy: A preliminary experience. (United States)

    Zhang, Daqi; Li, Fang; Wu, Che-Wei; Liu, Xiaoli; Xin, Jingwei; Chiang, Feng-Yu; Sun, Hui


    The purpose of this study was to investigate the feasibility and value of using intraoperative neuromonitoring (IONM) performed via percutaneous probe stimulation during total endoscopic thyroidectomy. This study prospectively enrolled a series of 132 consecutive patients with 156 recurrent laryngeal nerves (RLNs) at risk who received total endoscopic thyroidectomy performed via bilateral breast approach using standardized IONM. The stimulation probe was introduced into the working space by percutaneous puncture. During lateral thyroid dissection, the proximal RLN was periodically stimulated to monitor adverse electromyography (EMG) changes. Preoperative and postoperative vocal cord mobility was routinely examined with laryngofiberoscopy. All IONMs were successfully performed via percutaneous probe stimulation with no morbidity or scarring in the neck. Twelve nerves (7.7%) showed significant changes in EMG (amplitude reduction, 50% to 90% from baseline EMG) during the lateral thyroid dissection. Compression near the inferior thyroid artery (70%) and traction near the Berry's ligament (30%) were the most common causative mechanisms, and modification of the surgical maneuver resulted in partial recovery of the EMG changes (amplitude reduction, 10% to 80% before wound closure). Of the 12 nerves with adverse EMG changes (final amplitude reduction, 65% to 80%), 8 nerves showed temporary (3 months or less) vocal cord palsy. No cases of permanent vocal cord palsy occurred in this series. Percutaneous probe stimulation is a simple, effective, and safe method of performing IONM in total endoscopic thyroidectomy when the operating space is limited. © 2017 Wiley Periodicals, Inc. Head Neck 39: 1001-1007, 2017. © 2017 Wiley Periodicals, Inc.

  1. [A novel miniature robotic endoscope design for intestinal inspection]. (United States)

    Chi, Dong-xiang; Yan, Guo-zheng; Lin, Liang-ming


    This paper makes a comparison between the traditional endoscope system and the active robotic endoscope system, discusses the human intestine-working conditions of the robotic endoscope system in detail and its design requirements. An active robotic endoscope system based on earthworn-locomotion principles is proposed here and besides, its structure and locomotion mechanism are analyzed. A new method of human intestinal intervention is brought out and it can prevent the robotic endoscope guided by a cone-shaped guide pipe from being jammed or damaged.

  2. Dehiscence following successful endoscopic closure of gastric perforation during endoscopic submucosal dissection (United States)

    Sekiguchi, Masau; Suzuki, Haruhisa; Oda, Ichiro; Yoshinaga, Shigetaka; Nonaka, Satoru; Saka, Makoto; Katai, Hitoshi; Taniguchi, Hirokazu; Kushima, Ryoji; Saito, Yutaka


    Gastric perforation is one of the most serious complications that can occur during endoscopic submucosal dissection (ESD). In terms of the treatment of such perforations, we previously reported that perforations immediately observed and successfully closed with endoclips during endoscopic resection could be managed conservatively. We now report the first case in our medical facility of a gastric perforation during ESD that was ineffectively treated conservatively even after successful endoscopic closure. In December 2006, we performed ESD on a recurrent early gastric cancer in an 81-year-old man with a medical history of laparotomy for cholelithiasis. A perforation occurred during ESD that was immediately observed and successfully closed with endoclips so that ESD could be continued resulting in an en-bloc resection. Intensive conservative management was conducted following ESD, however, an endoscopic examination five days after ESD revealed dehiscence of the perforation requiring an emergency laparotomy. PMID:22919258

  3. A New Irrigation System (Endosplash) for a Rigid Endoscope in Trans-sphenoidal Endoscopic Surgery. (United States)

    Kuroda, Rintarou; Nakajima, Takeshi; Yamaguchi, Takashi; Watanabe, Eiju


    Obstruction of the visual field by blood is a major hindrance during endonasal endoscopic surgery, and a rapid and effective method for cleaning the lens is needed. We developed a new lens-cleaning system that does not employ a sheath or an irrigation-suction system. It is a 20-mm long cylinder with side holes that is attached to the barrel of the endoscope and is connected to a syringe containing saline. When the syringe is pressed, saline flows down to the tip along the barrel and washes the lens without requiring a sheath. We report the use of the system in six cases of endonasal endoscopic surgery. The lens was wiped significantly less often than during similar surgery performed without the use of this system. The Endosplash is simple and enables the surgeon to clean the lens with a single press of a syringe, thereby greatly enhancing the efficacy of endoscopic surgery.

  4. Carotid artery surgery (United States)

    Carotid endarterectomy; CAS surgery; Carotid artery stenosis - surgery; Endarterectomy - carotid artery ... results of stenting versus endarterectomy for carotid-artery stenosis. N Engl J Med . 2016;374(11):1021- ...

  5. Carotid Artery Disease (United States)

    ... head with blood. If you have carotid artery disease, the arteries become narrow or blocked, usually because ... other substances found in the blood. Carotid artery disease is serious because it can block the blood ...

  6. Coronary artery disease (image) (United States)

    ... through these arteries is critical for the heart. Coronary artery disease usually results from the build-up of fatty material and plaque, a condition called atherosclerosis. As the coronary arteries narrow, the flow of blood to the ...

  7. Peripheral arterial line (image) (United States)

    A peripheral arterial line is a small, short plastic catheter placed through the skin into an artery of the arm or leg. The purpose of a peripheral arterial line is to allow continuous monitoring of blood pressure ...

  8. Endoscopic repair of an abdominal intercostal hernia. (United States)

    Bobbio, Antonio; Ampollini, Luca; Prinzi, Gabriele; Sarli, Leopoldo


    Abdominal viscera herniation through the chest wall is a rare condition. A case is presented of an abdominal intercostal hernia of the seventh right intercostal space; its pathogenesis and clinical features are described, and also the combined endoscopic and percutaneous surgical approach employed for its repair.

  9. Successful Endoscopic Therapy of Traumatic Bile Leaks

    Directory of Open Access Journals (Sweden)

    Matthew P. Spinn


    Full Text Available Traumatic bile leaks often result in high morbidity and prolonged hospital stay that requires multimodality management. Data on endoscopic management of traumatic bile leaks are scarce. Our study objective was to evaluate the efficacy of the endoscopic management of a traumatic bile leak. We performed a retrospective case review of patients who were referred for endoscopic retrograde cholangiopancreatography (ERCP after traumatic bile duct injury secondary to blunt (motor vehicle accident or penetrating (gunshot trauma for management of bile leaks at our tertiary academic referral center. Fourteen patients underwent ERCP for the management of a traumatic bile leak over a 5-year period. The etiology included blunt trauma from motor vehicle accident in 8 patients, motorcycle accident in 3 patients and penetrating injury from a gunshot wound in 3 patients. Liver injuries were grade III in 1 patient, grade IV in 10 patients, and grade V in 3 patients. All patients were treated by biliary stent placement, and the outcome was successful in 14 of 14 cases (100%. The mean duration of follow-up was 85.6 days (range 54-175 days. There were no ERCP-related complications. In our case review, endoscopic management with endobiliary stent placement was found to be successful and resulted in resolution of the bile leak in all 14 patients. Based on our study results, ERCP should be considered as first-line therapy in the management of traumatic bile leaks.


    African Journals Online (AJOL)

    Solapur Kidney Care and Research Center, Maharashtra, India. Objectivez-To evaluate the safety and efficacy ... Conclusion: Povidone iodine is a very safe and efficacious agent for the endoscopic treatment of chyluria by ..... ment of tilarial chyluria in Japan. J Uroi 1983,. 129:64. 10. Chang CY, Lue YB, Lapides J. Surgical ...

  11. Ethical challenges of percutaneous endoscopic gastrostomy. (United States)

    Morgenstern, L; Laquer, M; Treyzon, L


    Percutaneous endoscopic gastrostomy (PEG) is a widely used procedure for patients who cannot swallow. Although it is mostly performed for valid indications, its use in terminally ill patients is questionable. In this study, more than 30% of patients died in hospital after PEG placement and 16% died less than 30 days after placement. Strict guidelines and oversight or PEG placement are recommended.

  12. Endoscopic third ventriculostomy and choroid plexus cauterization ...

    African Journals Online (AJOL)

    Background: Endoscopic third ventriculostomy (ETV) and Choroid Plexus Cauterization (CPC) have been recommended as reliable surgical options in developing countries for childhood hydrocephalus owing to reported shunt failures in shunt dependency. Objective: To evaluate outcomes of the ETV and ETV-CPC ...

  13. Oesophageal cancer and experience with endoscopic stent ...

    African Journals Online (AJOL)

    Background: Oesophageal cancer often presents in advanced stages not amenable to surgical resection. In such patients, palliation of dysphagia remains the mainstay of management. Objectives: To determine the burden of advanced oesophageal cancer and to document the experience with endoscopic metal stent ...

  14. Esophageal Stricture Post Endoscopic Injection Sclerotherapy ...

    African Journals Online (AJOL)

    Background: Post endoscopic sclerotherapy esophageal stricture is usually not fatal but may requires several sessions of esophageal dilation as an effective palliative treatment yet has its own complications. Aim: The purpose of this study is to find out the predictors of sclerotherapy esophageal stricture. Methods: This is a ...

  15. Endoscopic management of bile leaks after laparoscopic ...

    African Journals Online (AJOL)

    Endoscopic intervention is widely accepted as the treatment of choice. This study assessed ... Seven patients had one or more complications related to the ERCP: 3 acute pancreatitis, 2 cholangitis, 2 sphincterotomy bleeds, 1 duodenal perforation and 1 impacted Dormia basket, the latter 2 requiring operative intervention.

  16. Real-time endoscopic optical properties imaging (United States)

    Angelo, Joseph P.; van de Giessen, Martijn; Gioux, Sylvain


    With almost 50% of all surgeries in the U.S. being performed as minimally invasive procedures, there is a need to develop quantitative endoscopic imaging techniques to aid surgical guidance. Recent developments in widefield optical imaging make endoscopic implementations of real-time measurement possible. In this work, we introduce a proof-of-concept endoscopic implementation of a functional widefield imaging technique called 3D single snapshot of optical properties (3D-SSOP) that provides quantitative maps of absorption and reduced scattering optical properties as well as surface topography with simple instrumentation added to a commercial endoscope. The system’s precision and accuracy is validated using tissue-mimicking phantoms, showing a max error of 0.004 mm−1, 0.05 mm−1, and 1.1 mm for absorption, reduced scattering, and sample topography, respectively. This study further demonstrates video acquisition of a moving phantom and an in vivo sample with a framerate of approximately 11 frames per second. PMID:29188107

  17. An observational study on oesophageal variceal endoscopic ...

    African Journals Online (AJOL)

    African Journal of Health Sciences ... The study site was the Centre for Clinical Research, Kenya Medical Research Institute (KEMRI). ... All the patients with portal hypertension and previous history of acute variceal blood who underwent endoscopic injection sclerotherapy between August 1998 and May 2001 in the ...

  18. Current considerations of direct percutaneous endoscopic jejunostomy. (United States)

    Zhu, Yanfei; Shi, Liping; Tang, Hao; Tao, Guoqing


    BACKGROUOND: Direct percutaneous endoscopic jejunostomy (DPEJ) is a well-known approach to deliver postpyloric enteral nutritional support to individuals who cannot tolerate gastric feeding. However, it is technically difficult, and some case series have reported significant procedural failure rates. The present article describes current indications, successes and complications of DPEJ placement. A MEDLINE database search was performed to identify relevant articles using the key words "direct percutaneous endoscopic jejunostomy", "percutaneous endoscopic gastrostomy", and "percutaneous endoscopic gastrostomy with a jejunal extension tube". Additional articles were identified by a manual search of the references cited in the key articles obtained in the primary search. DPEJ is gradually becoming more common in the treatment of patients who cannot tolerate gastric feeding. Differences in patient selection and technique modifications may contribute to the various success rates reported. Failure is most often due to inadequate transillumination or gastroduodenal obstruction. Currently, there are limited data to evaluate the safety and effectiveness of DPEJ. The clinical use of DPEJ is increasing. With appropriate care and expertise, DPEJ may prove to be reliable and safe.

  19. Current considerations in direct percutaneous endoscopic jejunostomy (United States)

    Zhu, Yanfei; Shi, Liping; Tang, Hao; Tao, Guoqing


    BACKGROUND: Direct percutaneous endoscopic jejunostomy (DPEJ) is a well-known approach to deliver postpyloric enteral nutritional support to individuals who cannot tolerate gastric feeding. However, it is technically difficult, and some case series have reported significant procedural failure rates. The present article describes current indications, successes and complications of DPEJ placement METHODS: A MEDLINE database search was performed to identify relevant articles using the key words “direct percutaneous endoscopic jejunostomy”, “percutaneous endoscopic gastrostomy”, and “percutaneous endoscopic gastrostomy with a jejunal extension tube”. Additional articles were identified by a manual search of the references cited in the key articles obtained in the primary search. RESULTS: DPEJ is gradually becoming more common in the treatment of patients who cannot tolerate gastric feeding. Differences in patient selection and technique modifications may contribute to the various success rates reported. Failure is most often due to inadequate transillumination or gastroduodenal obstruction. Currently, there are limited data to evaluate the safety and effectiveness of DPEJ. CONCLUSION: The clinical use of DPEJ is increasing. With appropriate care and expertise, DPEJ may prove to be reliable and safe. PMID:22312608

  20. Shaft-Guidance for Flexible Endoscopes

    NARCIS (Netherlands)

    Loeve, A.J.


    Flexible endoscopes (long, slender, flexible instruments with a camera and light at the distal end, having working channels to introduce flexible instruments) are used for diagnostic and therapeutic interventions inside the human digestive system and inside the abdomen. Though used for their

  1. Endoscopic management of bile leaks after laparoscopic ...

    African Journals Online (AJOL)


    Nov 4, 2013 ... abscesses, interloop and intra-abdominal sepsis and cholangitis, or the later secondary sequelae of biliary cirrhosis, portal hypertension and end-stage liver disease. There is consensus that optimal management of a bile duct injury requires multidisciplinary. Endoscopic management of bile leaks after.

  2. [Extended endoscopic endonasal approach to skull base]. (United States)

    López-Arbolay, Omar; González-González, Justo; Rojas-Manresa, Jorge Luis


    Different approaches to the skull base have been developed through the sphenoidal sinus. Traditional boundaries of the trans-sphenoidal approach can be extended in antero-posterior and lateral plane. We review our experience with extended endoscopic endonasal approach in 127 cases. We used the extended endoscopic endonasal approach in 127 patients with different lesions of the skull base. This study specifically focuses on: type of lesions, surgical approach, outcome and surgical complications. Extended endoscopic endonasal approach was used in 127 patients with following lesions: 61 invasive adenomas to cavernous sinus, 10 clival chordomas, 21 craniopharyngiomas, 26 meningiomas, 4 cerebrospinal fluid leakages, one meningoencephalocele, 2 malignan lesions and 2 thyroid ophthalmopathy. In tumoral lesions gross total resection was achieved in 82.5%, with better results in craniopharyngiomas 90.5%, followed by invasive adenomas with 85.2%, and meningiomas with 84.6%. The most frequent complications were the insipid (8.6%) diabetes, meningoencefalitis (3.9%) and the hydrocephalic (3.9%). Mortality was 3.9%. The extended endoscopic endonasal approach is a promising minimally invasive alternative for selective cases with skull base lesions. As techniques and technology advance this approach may become the procedure of choice for most lesions and should be considered an option in the management of the patients with these complex pathologies by skull base surgeon. Copyright © 2012 Sociedad Española de Neurocirugía. Published by Elsevier España. All rights reserved.

  3. Oesophageal cancer and experience with endoscopic stent ...

    African Journals Online (AJOL)

    Background: Oesophageal cancer often presents in advanced stages not amenable to surgical resection. In such patients, palliation of dysphagia remains the mainstay of management. oBjectives: To determine the burden of advanced oesophageal cancer and to document the experience with endoscopic metal stent.


    Directory of Open Access Journals (Sweden)

    Samo K. Fokter


    Full Text Available Background. Carpal tunnel syndrome (CTS is a frequent cause of hand pain, numbness and paresthesias. Clinical outcome studies have been shown that endoscopic transverse carpal ligament release is an effective operation for treating idiopathic CTS. This retrospective study was designed to determine the one- to five-year outcome of endoscopic surgery for this disease.Methods. Single portal endoscopic carpal tunnel release (ECTR was performed on 68 hands in 48 patients who had clinical signs and symptoms consistent with CTS confirmed with electrodiagnostic studies. Charts were reviewed and the following data were obtained: age, duration of symptoms, time of hospitalization and complications. 57 cases (40 patients responded to a questionnaire and follow-up nerve conduction studies were available in 44 cases (65% of the entire cohort. The data of electrodiagnostic studies before treatment and at follow-up were statistically compared.Results. In two cases symptoms persisted and open surgery was performed two months after endoscopic procedure. Majority of hands (49 out of 57; 86% were pain-free at the final follow-up. Electrodiagnostic studies confirmed significant difference in nerve conduction latencies, action potentials (p < 0.01 and sensory conduction velocities (p < 0.05.Conclusions. ECTR offers safe decompression of the median nerve. The resumption of activities of daily living is short and many patients are allowed to return to work soon.

  5. Potential capacity of endoscopic screening for gastric cancer in Japan. (United States)

    Hamashima, Chisato; Goto, Rei


    In 2016, the Japanese government decided to introduce endoscopic screening for gastric cancer as a national program. To provide endoscopic screening nationwide, we estimated the proportion of increase in the number of endoscopic examinations with the introduction of endoscopic screening, based on a national survey. The total number of endoscopic examinations has increased, particularly in clinics. Based on the national survey, the total number of participants in gastric cancer screening was 3 784 967. If 30% of the participants are switched from radiographic screening to endoscopic screening, approximately 1 million additional endoscopic examinations are needed. In Japan, the participation rates in gastric cancer screening and the number of hospitals and clinics offering upper gastrointestinal endoscopy vary among the 47 prefectures. If the participation rates are high and the numbers of hospitals and clinics are small, the proportion of increase becomes larger. Based on the same assumption, 50% of big cities can provide endoscopic screening with a 5% increase in the total number of endoscopic examinations. However, 16.7% of the medical districts are available for endoscopic screening within a 5% increase in the total number of endoscopic examinations. Despite the Japanese government's decision to introduce endoscopic screening for gastric cancer nationwide, its immediate introduction remains difficult because of insufficient medical resources in rural areas. This implies that endoscopic screening will be initially introduced to big cities. To promote endoscopic screening for gastric cancer nationwide, the disparity of medical resources must first be resolved. © 2016 The Authors. Cancer Science published by John Wiley & Sons Australia, Ltd on behalf of Japanese Cancer Association.

  6. A case of central retinal artery occlusion following embolization procedure for juvenile nasopharyngeal angiofibroma (United States)

    Ramezani, Alireza; Haghighatkhah, Hamidreza; Moghadasi, Habibollah; Taheri, Morteza S; Parsafar, Hiva


    A 23-year-old male patient with right nasal Juvenile Nasopharyngeal Angiofibroma (JNA) developed Central Retinal Artery Occlusion (CRAO) during embolization of the tumor using polyvinyl alcohol particles before endoscopic excision. Classic CRAO management was initiated by an ophthalmologist after 12 h. Retrospective evaluation of the angiograms revealed a tiny communication between the external carotid and ophthalmic arteries which had not been noticed before embolization. During endoscopic excision, the tumor was found to originate extraordinarily from midline structures. It was concluded that CRAO might be a rare complication of JNA embolization. Careful preoperative angiographic evaluations to detect communicating arteries and immediate ophthalmologic consultation in case of developing visual symptoms during the procedure are necessary. PMID:20689199

  7. A case of central retinal artery occlusion following embolization procedure for juvenile nasopharyngeal angiofibroma

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    Ramezani Alireza


    Full Text Available A 23-year-old male patient with right nasal Juvenile Nasopharyngeal Angiofibroma (JNA developed Central Retinal Artery Occlusion (CRAO during embolization of the tumor using polyvinyl alcohol particles before endoscopic excision. Classic CRAO management was initiated by an ophthalmologist after 12 h. Retrospective evaluation of the angiograms revealed a tiny communication between the external carotid and ophthalmic arteries which had not been noticed before embolization. During endoscopic excision, the tumor was found to originate extraordinarily from midline structures. It was concluded that CRAO might be a rare complication of JNA embolization. Careful preoperative angiographic evaluations to detect communicating arteries and immediate ophthalmologic consultation in case of developing visual symptoms during the procedure are necessary.

  8. Endoscopic suturing versus endoscopic clip closure of the mucosotomy during a per-oral endoscopic myotomy (POEM): a case-control study. (United States)

    Pescarus, Radu; Shlomovitz, Eran; Sharata, Ahmed M; Cassera, Maria A; Reavis, Kevin M; Dunst, Christy M; Swanström, Lee L


    Obtaining an adequate mucosal closure is one of the crucial steps in per-oral endoscopic myotomy (POEM). Thus far, there have been no objective data comparing the various available closure techniques. This case-controlled study attempts to compare the application of endoscopic clips versus endoscopic suturing for mucosotomy closure during POEM cases. A retrospective review of our prospective POEM database was performed. All cases in which endoscopic suturing was used to close the mucosotomy were matched to cases in which standard endoclips were used. Overall complication rate, closure time and mucosal closure costs between the two groups were compared. Both techniques offer good clinical results with good mucosal closure and the absence of postoperative leak. Closure time was significantly shorter (p = 0.044) with endoscopic clips (16 ± 12 min) when compared to endoscopic suturing (33 ± 11 min). Overall, the total closure cost analysis showed a trend toward lower cost with clips (1502 ± 849 USD) versus endoscopic suturing (2521 ± 575 USD) without reaching statistical significance (p = 0.073). The use of endoscopic suturing seems to be a safe method for mucosal closure in POEM cases. Closure time is longer with suturing than conventional closure with clips, and there is a trend toward higher overall cost. Endoscopic suturing is likely most cost-effective for difficult cases where conventional closure methods fail.

  9. Total Endoscopic Approach in Glomus Tympanicum Surgery

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    Ahmad Daneshi


    Full Text Available Introduction: Glomus tympanicum (GT is a benign primary tumor of the middle ear. The evolution of endoscopic ear surgery has allowed for an alternative approach to managing this vascular tumor. The purpose of this study was to evaluate an endoscopic approach in GT surgery, and also to investigate its applicability and feasibility.   Materials and Methods: Prospectively, 13 class I and II patients, according to the Glasscock-Jackson glomus classification, were candidates for management via a transcanal endoscopic approach. Patients were categorized into three groups according to the location of the tumor in the middle ear. Group A consisted of patients with tumors located anteriorly while occupying the Eustachian tube. Group B were patients with tumors located on the promontory with entirely visible tumor borders. Patients in Group C had tumors that occupied the entire middle ear. Under specially designed flap elevation and hemostasis, the tumors were completely removed using an endoscopic technique.   Results: Based on the classification criteria, three patients fell into Group A (30%, six into Group B (46%, and three into Group C (23%. The principal chief complaint was pulsatile tinnitus that disappeared after surgery in most cases. Hearing status was mostly mixed hearing loss. No change was detected in bone conduction after surgery, but air conduction was improved in nine cases. No major complication or recurrence was observed over 30 months of follow up.   Conclusion: Improved exposure and access in the endoscopic transcanal approach to GT leads to safe, rapid, and reliable tumor removal, as well as allowing comfortable surgery for both the surgeon and most patients.

  10. Endoscopic sleeve gastroplasty: the learning curve. (United States)

    Hill, Christine; El Zein, Mohamad; Agnihotri, Abhishek; Dunlap, Margo; Chang, Angela; Agrawal, Alison; Barola, Sindhu; Ngamruengphong, Saowanee; Chen, Yen-I; Kalloo, Anthony N; Khashab, Mouen A; Kumbhari, Vivek


    Endoscopic sleeve gastroplasty (ESG) is gaining traction as a minimally invasive bariatric treatment. Concern that the learning curve may be slow, even among those proficient in endoscopic suturing, is a barrier to widespread implementation of the procedure. Therefore, we aimed to define the learning curve for ESG in a single endoscopist experienced in endoscopic suturing who participated in a 1-day ESG training program.  Consecutive patients who underwent ESG between February 2016 and November 2016 were included. The performing endoscopist, who is proficient in endoscopic suturing for non-ESG procedures, participated in a 1-day ESG training session before offering ESG to patients. The outcome measurements were length of procedure (LOP) and number of plications per procedure. Nonlinear regression was used to determine the learning plateau and calculate the learning rate.  Twenty-one consecutive patients (8 males), with mean age 47.7 ± 11.2 years and mean body mass index 41.8 ± 8.5 kg/m 2 underwent ESG. LOP decreased significantly across consecutive procedures, with a learning plateau at 101.5 minutes and a learning rate of 7 cases ( P  = 0.04). The number of plications per procedure also decreased significantly across consecutive procedures, with a plateau at 8 sutures and a learning rate of 9 cases ( P  < 0.001). Further, the average time per plication decreased significantly with consecutive procedures, reaching a plateau at 9 procedures ( P  < 0.001).  Endoscopists experienced in endoscopic suturing are expected to achieve a reduction in LOP and number of plications per procedure in successive cases, with progress plateauing at 7 and 9 cases, respectively.

  11. Radiological findings after endoscopic incision of ureterocele

    Energy Technology Data Exchange (ETDEWEB)

    Cheon, Jung Eun; Kim, In One; Seok, Eul Hye; Cha, Joo Hee; Choi, Gook Myung; Kim, Woo Sun; Yeon, Kyung Mo; Kim, Kwang Myung; Choi, Hwang [Seoul National Univ. College of Medicine, Seoul (Korea, Republic of); Cheon, Jung Eun [Chungmu General Hospital, Chungmu (Korea, Republic of); Seok, Eul Hye [Seran General Hospital, Seoul (Korea, Republic of); Cha, Joo Hee [Green General Hospital, Seoul(Korea, Republic of); Choi, Guk Myung [Halla General Hospital, Cheju (Korea, Republic of)


    Endoscopic incision of ureterocele is considered a simple and safe method for decompression of urinary tract obstruction above ureterocele. The purpose of this study was to evaluate the radiological findings after endoscopic incision of ureterocele. We retrospectively reviewed the radiological findings (ultrasonography (US), intravenous urography, and voiding cystourethrography(VCU)) in 16 patients with ureterocele who underwent endoscopic incision (mean age at surgery, 15 months; M:F 3:13; 18 ureteroceles). According to the postoperative results, treatment was classified as successful when medical treatment was still required, and second operation when additional surgical treatment was required. Postoperative US (n=10) showed that in all patients, urinary tract obstruction was relieved: the kidney parenchima was thicker and the ureterocele was smaller. Intravenous urography (n=8), demonstrated that in all patients, urinary tract obstruction and the excretory function of the kidney had improved. Postoperative VCU indicated that in 92% of patients (12 of 13), endoscopic incision of the ureterocele led to vesicoureteral reflux(VUR). Of these twelve, seven (58%) showed VUR of more than grade 3, while newly developed VUR was seen in five of eight patients (63%) who had preoperative VCU. Surgery was successful in four patients (25%), partially successful in three (19%), and a second operation-on account of recurrent urinary tract infection and VUR of more than grase 3 during the follow-up period-was required by nine (56%). Although endoscopic incision of a ureterocele is a useful way of relieving urinary tract obstruction, an ensuing complication may be VUR. Postoperative US and intravenous urography should be used to evaluate parenchymal change in the kidney and improvement of uronary tract obstructon, while to assess the extend of VUR during the follow-up period , postoperative VCU is required.

  12. Endoscopic Sleeve Gastroplasty: How I Do It? (United States)

    Lopez-Nava, G; Galvão, M P; Bautista-Castaño, I; Jimenez-Baños, A; Fernandez-Corbelle, J P


    Primary endoscopic weight loss therapies are of interest for access, simplicity, and economy. The objective of this manuscript is to describe the endoscopic sleeve gastroplasty used in 50 patients. The goal of this procedure is to reduce the gastric lumen into a tubular configuration, with the greater curvature modified by a line of sutured plications. General anesthesia with endotracheal intubation is needed. An endoscopic suturing system requiring a specific double-channel endoscope delivers full-thickness sets of running sutures from the antrum to the fundus. Patients are admitted and observed, with discharge planned within 24 h. Post-procedure outpatient care includes diet instruction with intensive follow-up by a multidisciplinary team. Voluntary oral contrast and endoscopy studies are scheduled to assess the gastroplasty at 3, 6, and 12 months. The technique was applied in 50 patients (13 men) with an average body mass index (BMI) of 37.7 kg/m(2) (range 30-47) with 13 having reached 1 year. Procedure duration averaged 66 min during which six to eight sutures on average were placed. All patients were discharged in less than 24 h. There were no major intra-procedural, early, or delayed adverse events. Weight loss parameters were satisfactory, mean BMI changes from 37.7 ± 4.6 to 30.9 ± 5.1 kg/m(2) at 1 year, and mean %TBWL was 19.0 ± 10.8. Oral contrast studies and endoscopy revealed sleeve gastroplasty configuration at least until 1 year of follow-up. Endoscopic sleeve gastroplasty is a safe, effective, and reproducible primary weight loss technique.

  13. Early Outcomes of Endoscopic Vein Harvesting during the Initial Learning Period

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    Do Yeon Kim


    Full Text Available Background: The endoscopic vein harvesting (EVH method has been used in coronary artery bypass surgery in many countries. We started using the EVH method recently, and investigated the results during the early learning period. Methods: Between March 2012 and June 2014, 75 patients (31 patients in the EVH method group, and 44 patients in the open method group who underwent isolated first-time coronary artery bypass grafting using vein grafts were retrospectively analyzed with respect to the early outcomes including graft patency and risk factors for leg wound complications. For assessing the patency of vein graft, we performed coronary computed tomography angiography during the immediate postoperative period and 6 months later. Results: Mean harvesting time of endoscopic method was about 15 minutes. Patency rate during the immediate operative period and the 6-month patency rate were similar between the two groups (postoperative period: EVH 100% vs. open method 94.4%, p=0.493; at 6 months: EVH 93.3% vs. open method 90.9%, p=0.791. Leg wound complications occurred more frequently in the open method group (EVH 3.2% vs. open method 13.6%, p=0.127. According to the analysis, age was an independent risk factor for leg wound complications. Conclusion: EVH is a feasible method even for beginners and can be performed satisfactorily during their learning period.

  14. Software-assisted live visualization system for subjacent blood vessels in endonasal endoscopic approaches (United States)

    Lempe, B.; Taudt, Ch.; Maschke, R.; Gruening, J.; Ernstberger, M.; Basan, F.; Baselt, T.; Grunert, R.; Hartmann, P.


    Minimal invasive surgery methods have received growing attention in recent years. In vital important areas, it is crucial for the surgeon to have a precise knowledge of the tissue structure. Especially the visualization of arteries is desirable, as the destruction of the same can be lethal to the patient. In order to meet this requirement, the study presents a novel assistance system for endoscopic surgery. While state-of-the art systems rely on pre-operational data like computer-tomographic maps and require the use of radiation, the goal of the presented approach is to provide the clarification of subjacent blood vessels on live images of the endoscope camera system. Based on the transmission and reflection spectra of various human tissues, a prototype system with a NIR illumination unit working at 808 nm was established. Several image filtering, processing and enhancement techniques have been investigated and evaluated on the raw pictures in order to obtain high quality results. The most important were increasing contrast and thresholding by difference of Gaussian method. Based on that, it is possible to rectify a fragmented artery pattern and extract geometrical information about the structure in terms of position and orientation. By superposing the original image and the extracted segment, the surgeon is assisted with valuable live pictures of the region of interest. The whole system has been tested on a laboratory scale. An outlook on the integration of such a system in a clinical environment and obvious benefits are discussed.

  15. Nonvariceal Upper Gastrointestinal Bleeding: the Usefulness of Rotational Angiography after Endoscopic Marking with a Metallic Clip

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    Song, Ji Soo; Kwak, Hyo Sung; Chung, Gyung Ho [Chonbuk National University Medical School, Chonju (Korea, Republic of)


    We wanted to assess the usefulness of rotational angiography after endoscopic marking with a metallic clip in upper gastrointestinal bleeding patients with no extravasation of contrast medium on conventional angiography. In 16 patients (mean age, 59.4 years) with acute bleeding ulcers (13 gastric ulcers, 2 duodenal ulcers, 1 malignant ulcer), a metallic clip was placed via gastroscopy and this had been preceded by routine endoscopic treatment. The metallic clip was placed in the fibrous edge of the ulcer adjacent to the bleeding point. All patients had negative results from their angiographic studies. To localize the bleeding focus, rotational angiography and high pressure angiography as close as possible to the clip were used. Of the 16 patients, seven (44%) had positive results after high pressure angiography as close as possible to the clip and they underwent transcatheter arterial embolization (TAE) with microcoils. Nine patients without extravasation of contrast medium underwent TAE with microcoils as close as possible to the clip. The bleeding was stopped initially in all patients after treatment of the feeding artery. Two patients experienced a repeat episode of bleeding two days later. Of the two patients, one had subtle oozing from the ulcer margin and that patient underwent endoscopic treatment. One patient with malignant ulcer died due to disseminated intravascular coagulation one month after embolization. Complete clinical success was achieved in 14 of 16 (88%) patients. Delayed bleeding or major/minor complications were not noted. Rotational angiography after marking with a metallic clip helps to localize accurately the bleeding focus and thus to embolize the vessel correctly.

  16. Applied anatomy of a new approach of endoscopic technique in thyroid gland surgery. (United States)

    Liu, Hong; Xie, Yong-jun; Xu, Yi-quan; Li, Chao; Liu, Xing-guo


    To explore the feasibility and safety of transtracheal assisted sublingual approach to totally endoscopic thyroidectomy by studying the anatomical approach and adjacent structures. A total of 5 embalmed adult cadavers from Chengdu Medical College were dissected layer by layer in the cervical region, pharyngeal region, and mandible region, according to transtracheal assisted sublingual approach that was verified from the anatomical approach and planes. A total of 15 embalmed adult cadavers were dissected by arterial vascular casting technique, imaging scanning technique, and thin layer cryotomy. Then the vessel and anatomical structures of thyroid surgical region were analyzed qualitatively and quantitatively. Three-dimensional visualization of larynx artery was reconstructed by Autodesk 3ds Max 2010(32). Transtracheal assisted sublingual approach for totally endoscopic thyroidectomy was simulated on 5 embalmed adult cadavers. The sublingual observed access was located in the middle of sublingual region. The geniohyoid muscle, mylohyoid seam, and submental triangle were divided in turn in the middle to reach the plane under the plastima muscles. Superficial cervical fascia, anterior body of hyoid bone, and infrahyoid muscles were passed in sequence to reach thyroid gland surgical region. The transtracheal operational access was placed from the cavitas oris propria, isthmus faucium, subepiglottic region, laryngeal pharynx, and intermediate laryngeal cavit, and then passed from the top down in order to reach pars cervicalis tracheae where a sagittal incision was made in the anterior wall of cartilagines tracheales to reach a ascertained surgical region. Transtracheal assisted sublingual approach to totally endoscopic thyroidectomy is anatomically feasible and safe and can be useful in thyroid gland surgery.

  17. Novel Dry-Lab Training Method for Totally Endoscopic Coronary Anastomosis: A Pilot Study. (United States)

    Ujihira, Kosuke; Yamada, Akira

    We describe our original dry-lab training system for nonrobotic and beating heart endoscopic coronary artery anastomosis. All the materials used for this training were commercially available. We selected a boxed machine, which can produce pulsatile movements of artificial vessels, and on its roof, we installed a two-dimensional home video camera and a monitor. A multiple-holed plate was placed in front of the machine, and through these holes, a trainee inserted endoscopic surgical instruments and anastomosed the artificial vessels by running fashion while watching the monitor. This training program has four stages. During the first stage, a trainee has to demonstrate mastery in conducting a conventional off-pump coronary artery anastomosis without assistance. The second stage is the "nonbeating" version, and the third stage is the "beating" version with the model mentioned previously. After a trainee gets accustomed to the third stage, the original artificial vessel is replaced with an extremely fragile one, and this is the fourth stage. Our trainee conducted one hundred fourth-stage anastomoses and each procedure was recorded with the video camera. We analyzed several factors from the videos and evaluated the efficacy of the training method. We compared the outcomes of the first 50 consecutive anastomoses with the following 50 ones and described the learning curves. The comparison showed a significant decrease in anastomotic time and vessel injury. We considered the quality of anastomosis acceptable after 47 anastomoses, and anastomotic time fell below 15 minutes at the 81st training at the fourth stage. Our dry-lab system might be an effective training method for endoscopic coronary anastomosis.

  18. Life-threatening Duodenal Ulcer Bleeding from a Ruptured Gastroduodenal Artery Aneurysm in a Patient with Neurofibromatosis Type 1. (United States)

    Im, Kyu Sung; Kim, Sunyong; Lim, Jun Uk; Jeon, Jung Won; Shin, Hyun Phil; Cha, Jae Myung; Joo, Kwang Ro; Lee, Joung Il; Park, Jae Jun


    Vasculopathy is rarely reported in neurofibromatosis type 1, but when it occurs it primarily involves the aorta and its main branches. Among vasculopathies, aneurysmal dilatation is the most common form. Although several case reports concerning aneurysms or pseudoaneurysms of visceral arteries in neurofibromatosis type 1 patients have been reported, there are no reports describing gastroduodenal artery aneurysms associated with neurofibromatosis type 1. We experienced a case of life-threatening duodenal ulcer bleeding from a ruptured gastroduodenal artery aneurysm associated with neurofibromatosis type 1. We treated our patient by transarterial embolization after initial endoscopic hemostasis. To our knowledge, this is the first reported case of its type. High levels of suspicion and prompt diagnosis are required to select appropriate treatment options for patients with neurofibromatosis type 1 experiencing upper gastrointestinal bleeding. Embolization of the involved arteries should be considered an essential treatment over endoscopic hemostasis alone to achieve complete hemostasis and to prevent rebleeding.

  19. Virtual endoscopy of coronary arteries using electron-beam CT data sets

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    Nakanishi, Tadashi; Hata, Ryoichiro; Tamura, Akira; Shintaku, Kaeko; Takasu, Miyuki; Kohata, Minako; Ito, Katsuhide; Imazu, Michinori [Hiroshima Univ. (Japan). School of Medicine


    The purpose of this study was to determine the feasibility of electron-beam CT data sets to perform virtual endoscopy of coronary arteries. A porcine cadaver coronary phantom and patients with ischemic heart disease were scanned by an electron-beam CT. Virtual endoscopic images from each data set were created using commercially available software. Detectability of vessel orifices and fly-through distance from coronary orifices were evaluated. The smooth and round lumen and orifices of branches were clearly depicted with 1.5 mm gapless data sets and 3 mm collimation with 2 mm interval in the phantom study. Creation of virtual endoscopic views for all 3 branches was possible in most of the patients. The small calcified plaques were successfully excluded in all cases. The fly-through from vessel orifices was limited to proximal coronary artery in all cases. As there was an apparent difference between the phantom and patient data sets, the fly-through distance was found to depend on the image quality of a given data set. Vessel contrast determined by CT number is considered to be a major contributing factor determining image quality of the endoscopic images. Virtual endoscopic images of coronary arteries might provide additional information especially of bifurcated branches and orifices. (author)

  20. Design of wormlike automated robotic endoscope: dynamic interaction between endoscopic balloon and surrounding tissues. (United States)

    Poon, Carmen C Y; Leung, Billy; Chan, Cecilia K W; Lau, James Y W; Chiu, Philip W Y


    The current design of capsule endoscope is limited by the inability to control the motion within gastrointestinal tract. The rising incidence of gastrointestinal cancers urged improvement in the method of screening endoscopy. This preclinical study aimed to design and develop a novel locomotive module for capsule endoscope. We investigated the feasibility and physical properties of this newly designed caterpillar-like capsule endoscope with a view to enhancing screening endoscopy. This study consisted of preclinical design and experimental testing on the feasibility of automated locomotion for a prototype caterpillar endoscope. The movement was examined first in the PVC tube and then in porcine intestine. The image captured was transmitted to handheld device to confirm the control of movement. The balloon pressure and volume as well as the contact force between the balloon and surroundings were measured when the balloon was inflated inside (1) a hard PVC tube, (2) a soft PVC tube, (3) muscular sites of porcine colons and (4) less muscular sites of porcine colons. The prototype caterpillar endoscope was able to move inward and backward within the PVC tubing and porcine intestine. Images were able to be captured from the capsule endoscope attached and being observed with a handheld device. Using the onset of a contact force as indication of the buildup of the gripping force between the balloon and the lumen walls, it is concluded from the results of this study that the rate of change in balloon pressure and volume is two good estimators to optimize the inflation of the balloon. The results of this study will facilitate further refinement in the design of caterpillar robotic endoscope to move inside the GI tract.

  1. Endoscopic management of upper urinary tract urothelial carcinoma. (United States)

    Park, Bong Hee; Jeon, Seong Soo


    Upper urinary tract urothelial carcinoma (UTUC) is relatively uncommon. Radical nephroureterectomy with an ipsilateral bladder cuff excision has been the gold standard treatment for UTUC. However, recent advances in technology have made possible the increased use of endoscopic management for the treatment of UTUC. The definitive goal of endoscopic management of UTUC is cancer control while maintaining renal function and the integrity of the urinary tract. Endoscopic management includes both the retrograde ureteroscopic and antegrade percutaneous approaches. The endoscopic management of UTUC is a reasonable alternative for patients with renal insufficiency or a solitary functional kidney, bilateral disease, or a significant comorbidity that precludes radical surgery. Select patients with a functional contralateral kidney who have low-grade, low-stage tumors may also be candidates for endoscopic management. The careful selection of patients is the most important point for the successful endoscopic management of UTUC. It is crucial that patients are compliant and motivated, because a lifetime protocol of strict surveillance is necessary. Adjuvant topical therapy with Bacillus Calmette-Guerin or mitomycin C can be used after endoscopic management of UTUC in an attempt to reduce recurrence. In this article, we review current endoscopic techniques, indications for endoscopic treatment, clinical outcomes of endoscopic management, adjuvant topical therapy, and surveillance in patients with UTUC.

  2. Orbital cellulitis complicated by central retinal artery occlusion. (United States)

    Proctor, Charles M; Magrath, George N; de Castro, Luis E Fernández; Johnson, John H; Teed, Ronald G


    The authors present a case of a 16-year-old boy who sought treatment in Storm Eye Institute for orbital cellulitis complicated by central retinal artery occlusion. He was examined for severe signs of orbital cellulitis, including decreased vision and an afferent pupillary defect. Intravenous antibiotics failed to provide timely improvement, and the patient was surgically managed with endoscopic orbital decompression. An ocular examination under anesthesia revealed retinal ischemia in the affected eye, and fluorescein angiography confirmed the diagnosis of central retinal artery occlusion. The patient's vision improved slightly following resolution of the infection. Central retinal artery occlusion is a rare complication of orbital cellulitis in adults and has yet to be reported in the pediatric population.

  3. Radial Artery Aneurysm

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    Ali Fedakar


    Full Text Available Upper limb aneurysms are less frequently seen than the other aneurysm. Radial arterial aneurysm is usually associated with the trauma. Interventional procedures can cause pseudoaneurysm at the radial artery puncture sites. Radial artery aneurysm may cause the thromboembolic events at the fingers and the hand. We present a case of isolated radial arterial aneurysm with idiopathic origin.

  4. Single umbilical artery

    Directory of Open Access Journals (Sweden)

    Shanthi Ramesh


    Full Text Available The umbilical cord usually contains two arteries and one vein. The vein carries the oxygenated blood from the placenta to the fetus. The arteries carry the deoxygenated blood and the waste products from the fetus to the placenta. Occasionally, primary agenesis or secondary atrophy of one of the arteries occurs resulting in single umbilical artery.

  5. Single umbilical artery


    Shanthi Ramesh; Sangeetha Hariprasath; Gunasekaran Anandan; P John Solomon; Vijayakumar, V.


    The umbilical cord usually contains two arteries and one vein. The vein carries the oxygenated blood from the placenta to the fetus. The arteries carry the deoxygenated blood and the waste products from the fetus to the placenta. Occasionally, primary agenesis or secondary atrophy of one of the arteries occurs resulting in single umbilical artery.

  6. Single umbilical artery. (United States)

    Ramesh, Shanthi; Hariprasath, Sangeetha; Anandan, Gunasekaran; Solomon, P John; Vijayakumar, V


    The umbilical cord usually contains two arteries and one vein. The vein carries the oxygenated blood from the placenta to the fetus. The arteries carry the deoxygenated blood and the waste products from the fetus to the placenta. Occasionally, primary agenesis or secondary atrophy of one of the arteries occurs resulting in single umbilical artery.

  7. Efficacy of Endoscopic Fluorescein Video Angiography in Aneurysm Surgery-Novel and Innovative Assessment of Vascular Blood Flow in the Dead Angles of the Microscope. (United States)

    Hashimoto, Koji; Kinouchi, Hiroyuki; Yoshioka, Hideyuki; Kanemaru, Kazuya; Ogiwara, Masakazu; Yagi, Takashi; Wakai, Takuma; Fukumoto, Yuichiro


    In aneurysm surgery, assessment of the blood flow around the aneurysm is crucial. Recently, intraoperative fluorescence video angiography has been widely adopted for this purpose. However, the observation field of this procedure is limited to the microscopic view, and it is difficult to visualize blood flow obscured by the skull base anatomy, parent arteries, and aneurysm. To demonstrate the efficacy of a new small-caliber endoscopic fluorescence video angiography system employing sodium fluorescein in aneurysm surgery for the first time. Eighteen patients with 18 cerebral aneurysms were enrolled in this study. Both microscopic fluorescence angiography and endoscopic fluorescein video angiography were performed before and after clip placement. Endoscopic fluorescein video angiography provided bright fluorescence imaging even with a 2.7-mm-diameter endoscope and clearly revealed blood flow within the vessels in the dead angle areas of the microscope in all 18 aneurysms. Consequently, it revealed information about aneurysmal occlusion and perforator patency in 15 aneurysms (83.3%) that was not obtainable with microscopic fluorescence video angiography. Furthermore, only endoscopic video angiography detected the incomplete clipping in 2 aneurysms and the occlusion of the perforating branches in 3 aneurysms, which led to the reapplication of clips in 2 aneurysms. The innovative endoscopic fluorescein video angiography system we developed features a small-caliber endoscope and bright fluorescence images. Because it reveals blood flow in the dead angle areas of the microscope, this novel system could contribute to the safety and long-term effectiveness of aneurysm surgery even in a narrow operative field.

  8. endoscope-i: an innovation in mobile endoscopic technology transforming the delivery of patient care in otolaryngology. (United States)

    Mistry, N; Coulson, C; George, A


    Digital and mobile device technology in healthcare is a growing market. The introduction of the endoscope-i, the world's first endoscopic mobile imaging system, allows the acquisition of high definition images of the ear, nose and throat (ENT). The system combines the e-i Pro camera app with a bespoke engineered endoscope-i adaptor which fits securely onto the iPhone or iPod touch. Endoscopic examination forms a salient aspect of the ENT work-up. The endoscope-i therefore provides a mobile and compact alternative to the existing bulky endoscopic systems currently in use which often restrict the clinician to the clinic setting. Areas covered: This article gives a detailed overview of the endoscope-i system together with its applications. A review and comparison of alternative devices on the market offering smartphone adapted endoscopic viewing systems is also presented. Expert commentary: The endoscope-i fulfils unmet needs by providing a compact, highly portable, simple to use endoscopic viewing system which is cost-effective and which makes use of smartphone technology most clinicians have in their pocket. The system allows real-time feedback to the patient and has the potential to transform the way that healthcare is delivered in ENT as well as having applications further afield.

  9. Endoscope-assisted facelift thyroid surgery: an initial experience using a new endoscopic technique. (United States)

    Park, Jun-Ook; Kim, Sang-Yeon; Chun, Byung-Joon; Joo, Young-Hoon; Cho, Kwang-Jae; Park, Young Hak; Kim, Min-Sik; Sun, Dong-Il


    A new approach to modifying facelift incision was recently developed for robotic thyroid surgery that seemed to be advantageous over other existing approaches. In this study, we aimed to investigate the feasibility and safety of the facelift approach not only for robotic thyroid surgery, but also for endoscope-assisted thyroid surgery. Endoscope-assisted facelift thyroid lobectomy was performed for 11 patients with papillary microcarcinoma. All 11 operations were successfully performed endoscopically. This approach through a modified facelift incision provided safe dissection of the laryngeal nerves and exposed an adequate working space. We identified and preserved all neighboring critical structures (parathyroid gland and superior and recurrent laryngeal nerves) during surgery. The operative duration for simple thyroid lobectomy with central lymph node dissection in 11 patients was 120-180 min (average duration: 140 min). Sensory change around the earlobe occurred in three patients and was recovered within 2 months after surgery in all patients. No patient displayed laryngeal nerve palsy or a low-pitched voice. The facelift approach seems to provide a shorter and more direct route to the thyroid, requiring minimal dissection, and an adequate workspace not only for robotic surgery but also for endoscopic surgery. It is worthwhile to develop and refine the surgical techniques of endoscopic facelift thyroid surgery.

  10. Fundus imaging with a nasal endoscope

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    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.

  11. Portal biliopathy treated with endoscopic biliary stenting

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    Sung Jin Jeon


    Full Text Available Portal biliopathy is defined as abnormalities in the extra- and intrahepatic ducts and gallbladder of patients with portal hypertension. This condition is associated with extrahepatic venous obstruction and dilatation of the venous plexus of the common bile duct, resulting in mural irregularities and compression of the biliary tree. Most patients with portal biliopathy remain asymptomatic, but approximately 10% of them advance to symptomatic abdominal pain, jaundice, and fever. Magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography are currently used as diagnostic tools because they are noninvasive and can be used to assess the regularity, length, and degree of bile duct narrowing. Management of portal biliopathy is aimed at biliary decompression and reducing the portal pressure. Portal biliopathy has rarely been reported in Korea. We present a symptomatic case of portal biliopathy that was complicated by cholangitis and successfully treated with biliary endoscopic procedures.

  12. Portal biliopathy treated with endoscopic biliary stenting. (United States)

    Jeon, Sung Jin; Min, Jae Ki; Kwon, So Young; Kim, Jun Hyun; Moon, Sun Young; Lee, Kang Hoon; Kim, Jeong Han; Choe, Won Hyeok; Cheon, Young Koog; Kim, Tae Hyung; Park, Hee Sun


    Portal biliopathy is defined as abnormalities in the extra- and intrahepatic ducts and gallbladder of patients with portal hypertension. This condition is associated with extrahepatic venous obstruction and dilatation of the venous plexus of the common bile duct, resulting in mural irregularities and compression of the biliary tree. Most patients with portal biliopathy remain asymptomatic, but approximately 10% of them advance to symptomatic abdominal pain, jaundice, and fever. Magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography are currently used as diagnostic tools because they are noninvasive and can be used to assess the regularity, length, and degree of bile duct narrowing. Management of portal biliopathy is aimed at biliary decompression and reducing the portal pressure. Portal biliopathy has rarely been reported in Korea. We present a symptomatic case of portal biliopathy that was complicated by cholangitis and successfully treated with biliary endoscopic procedures.

  13. Endoscopic release of the cubital tunnel. (United States)

    Zajonc, Horst; Momeni, Arash


    It is safe to say that in situ decompression of the ulnar nerve in cubital tunnel syndrome has been demonstrated to achieve equivalent functional results when compared with more elaborate techniques, such as decompression with nerve transposition. The evolution toward procedures associated with less patient morbidity is reflected by the introduction of endoscopic techniques for the treatment of cubital tunnel syndrome. The authors have incorporated the endoscopic approach as proposed by Hoffmann and Siemionow into their practice and have obtained favorable results. Although the skin incision can frequently be kept to a minimum (<2 cm), superior visualization associated with this approach allows for in situ decompression of the ulnar nerve along a distance of up to 30 cm. Despite the extent of decompression performed, operative morbidity is minimal, with return to full duty being the rule even in manual laborers within 10 to 14 days postoperatively. Copyright © 2014 Elsevier Inc. All rights reserved.

  14. Percutaneus Endoscopic Gastrostomy in Intensive Care Unit

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    Demet Tok


    Full Text Available Since its introduction in the early 1980s, percutaneous endoscopic gastrostomy (PEG technique has been used to create a reliable route for long term enteral feeding in cri0,0tically ill patients. Our goals were to determine the complications of PEG in ICU patients.We evaluated the data of 13 intensive care unit patients undergoing bedside PEG for gastric tube placement using the “pull” technique. Percutaneous endoscopic gastrostomy was completed and gastric tube was placed successfully in all patients. Tubes remained in stomach from 13 to 831 days (mean 146 days. Six patients died because of the reasons unrelated to the PEG tube and seven patients were discharged from the hospital while being fed via the PEG. Nutritional intolerance (in 4 patients and bleeding (in 3 patients were observed and could be eradicated by appropriate maintenance. Bleeding was the main PEG complication observed in critically ill patients.

  15. Comprehensive review on endonasal endoscopic sinus surgery (United States)

    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

  16. [Endoscopic ureterolithotripsy with the holmium laser]. (United States)

    Lopatkin, N A; Mazo, E B; Chepurov, A K; Dondukov, Ts V; Safarov, R M; Dreval', A A


    One of the clinical and experimental investigations performed in the urological clinic of the Moscow Medical University and Research Institute of Urology aimed at elucidation of Ho-YAG-laser potential in endoscopic lithotripsy (EL). Russian Ho-YAG laser surgical units CTH-10 and LLT-3 with wave length 2.09 mu were employed. The studies showed that the developed laser units satisfied relevant medical and technical requirements. Low depth of laser impulse penetration (0.4 mm) obtained at EL warrants safety of the adjacent tissues which is essential in crushing fixed ureteroliths in the presence of severe inflammation in the ureteral wall. The conclusion is made that Ho-YAG laser EL is an effective treatment of ureteroliths. Further tests for EL efficacy in affections of the upper urinary tracts are advocated to define a proper place of EL in endoscopic urology.

  17. Current Considerations in Direct Percutaneous Endoscopic Jejunostomy

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    Yanfei Zhu


    Full Text Available For patients who are unable to meet their nutritional needs orally, enteral feeding via a percutaneous approach has become the mainstay of therapy. However, traditional enteral feeding methods, such as percutaneous endoscopic gastrostomy, may not be viable options for patients with severe gastroparesis or gastric outlet obstruction. Direct percutaneous endoscopic jejunostomy (DPEJ is an enteral access method that was first described more than 20 years ago and has gained popularity among gastroenterologists. This review discusses the indications for and contraindications to DPEJ, the procedure, the application of DPEJ in specific subsets of patients with gastrointestinal disorders, and presents a brief tabular summary of complications and success rates of DPEJ in case series published since 2000.

  18. Current endoscopic approach to indeterminate biliary strictures (United States)

    Victor, David W; Sherman, Stuart; Karakan, Tarkan; Khashab, Mouen A


    Biliary strictures are considered indeterminate when basic work-up, including transabdominal imaging and endoscopic retrograde cholangiopancreatography with routine cytologic brushing, are non-diagnostic. Indeterminate biliary strictures can easily be mischaracterized which may dramatically affect patient’s outcome. Early and accurate diagnosis of malignancy impacts not only a patient’s candidacy for surgery, but also potential timely targeted chemotherapies. A significant portion of patients with indeterminate biliary strictures have benign disease and accurate diagnosis is, thus, paramount to avoid unnecessary surgery. Current sampling strategies have suboptimal accuracy for the diagnosis of malignancy. Emerging data on other diagnostic modalities, such as ancillary cytology techniques, single operator cholangioscopy, and endoscopic ultrasonography-guided fine needle aspiration, revealed promising results with much improved sensitivity. PMID:23180939

  19. Endoscopic treatment of vesicoureteral reflux in pediatric patients

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    Jong Wook Kim


    Full Text Available Endoscopic treatment is a minimally invasive treatment for managing patients with vesicoureteral reflux (VUR. Although several bulking agents have been used for endoscopic treatment, dextranomer/hyaluronic acid is the only bulking agent currently approved by the U.S. Food and Drug Administration for treating VUR. Endoscopic treatment of VUR has gained great popularity owing to several obvious benefits, including short operative time, short hospital stay, minimal invasiveness, high efficacy, low complication rate, and reduced cost. Initially, the success rates of endoscopic treatment have been lower than that of open antireflux surgery. However, because injection techniques have been developed, a recent study showed higher success rates of endoscopic treatment than open surgery in the treatment of patients with intermediate- and high-grade VUR. Despite the controversy surrounding its effectiveness, endoscopic treatment is considered a valuable treatment option and viable alternative to long-term antibiotic prophylaxis.

  20. Endoscopic Versus Open Cubital Tunnel Release (United States)

    Aldekhayel, Salah; Govshievich, Alexander; Lee, James; Tahiri, Youssef; Luc, Mario


    Background: Several surgical techniques exist for treatment of cubital tunnel syndrome. Endoscopic cubital tunnel release (ECTuR) has been recently reported as a promising minimally invasive technique. This study aims to compare outcomes and complications of open cubital tunnel release (OCTuR) and ECTuR in the treatment of idiopathic cubital tunnel syndrome. Methods: A systematic review of the literature (1980-2014) identified 118 citations. Studies including adults with idiopathic cubital tunnel treated exclusively by ECTuR or OCTuR were included. Outcomes of interest were postoperative grading, complications, number of reoperations, and the need for intraoperative conversion to another technique. Postoperative outcomes were combined into a uniform scale with 4 categories: “excellent,” “good,” “fair,” and “poor.” Results: Twenty studies met the inclusion criteria (17 observational and 3 comparative), representing 425 open and 556 endoscopic decompressions. In the open group, 79.8% experienced “good” or “excellent” results with 12% complication rate and 2.8% reoperation rate. In the endoscopic group, 81.8% experienced “good” or “excellent” results with 9% complication rate and 1.6% reoperation rate. Meta-analysis of 3 comparative studies demonstrated a significantly lower overall complication rate with ECTuR. Subgroup analysis of complications revealed a significantly higher incidence of scar tenderness and elbow pain with OCTuR. Conclusions: The current study demonstrates similar effectiveness between the endoscopic (ECTuR) and open (OCTuR) techniques for treatment of idiopathic cubital tunnel syndrome with similar outcomes, complication profiles, and reoperation rates. PMID:27418887


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    M. I. Shlyakhtov


    Full Text Available Aim. To analyze the efficacy of novel biodegradable Nasopore® nasal dressing for bleeding prevention in postoperative period after endonasal endoscopic dacryocystorhinostomy.Patients and methods. Two cohorts of patients who underwent endonasal endoscopic dacryocystorhinostomy were analyzed. In these patients, the area of rhinostoma was plugged with biodegradable Nasopore® or non-biodegradable Merocel® nasal dressing to prevent bleeding. 37 women and 9 men (mean age 56 years underwent the surgery which was performed under anesthetic using standard technology and endoscopic instruments. Nasopore® and Merocel® were used in 20 and 26 cases, respectively. Re-bleeding rate and the presence of post-operative discomfort were assessed. Specifics of nasal mucosa regeneration, formation of granulations, synechiae, and membranes in the area of nasolacrimal anastamosis were noted.Results. Efficacy of nasal dressing was assessed in the first week after the surgery. In group 1 (Nasopore®, no nasal bleeding was observed and no re-tamponade was required. In group 2 (Merocel®, nasal bleeding occurred in 10 cases (38.4% after nasal dressing removal, and re-tamponade was performed in 8 patients (30.8%. Main disadvantage of Merocel® is the «sawing» effect due to the pore texture of its surface. This property resulted in the bleeding after nasal dressing removal. None of group 1 patients complained of severe discomfort while 19% of group 2 patients experienced significant discomfort.Conclusions. Biodegradable Nasopore® nasal dressing use in endonasal endoscopic dacryocystorhinostomy prevents recurrent post-operative nasal bleedings, decreases patient discomfort, provides better anatomical and functional outcomes and improves quality of life and medical social rehabilitation. 

  2. Outcome of Endoscopic Transsphenoidal Surgery for Acromegaly. (United States)

    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.

  3. Quantum-Non-Demolition Endoscopic Tomography


    Fortunato, Mauro; Tombesi, Paolo; Schleich, Wolfgang P.


    We present a new indirect method to measure the quantum state of a single mode of the electromagnetic field in a cavity. Our proposal combines the idea of (endoscopic) probing and that of tomography in the sense that the signal field is coupled via a quantum-non-demolition Hamiltonian to a meter field on which then quantum state tomography is performed using balanced homodyne detection. This technique provides full information about the signal state. We also discuss the influence of the measu...

  4. Endoscopic variceal ligation-induced ulcer bleeding (United States)

    Cho, Eunae; Jun, Chung Hwan; Cho, Sung Bum; Park, Chang Hwan; Kim, Hyun Soo; Choi, Sung Kyu; Rew, Jong Sun


    Abstract This study was aimed to determine the risk factors of endoscopic variceal ligation-(EVL) induced ulcer bleeding. The prevalence of EVL-induced ulcer bleeding is reported to be 3.6%. However, there are only limited reports of this serious complication, and the risk factors and the treatment methods are not well established. A total of 430 patients who had undergone EVL in Chonnam National University Hospital from January 2014 to October 2016 were studied. EVL was performed for prophylaxis or acute hemorrhage. The patients were classified into 2 groups: a bleeding group (n = 33) and a non-bleeding group (n = 397). The patients who had endoscopically confirmed EVL-induced ulcer bleeding were included in the bleeding group. EVL-induced ulcer bleeding occurred in 7.7% (n = 33) of the patients. In a multivariate analysis, model for end-stage liver disease (MELD) score >10 (odds ratio [OR]: 3.42, 95% confidence interval [CI]: 1.10–10.64), concomitant GV F3 (OR: 14.1, 95% CI: 2.84–71.43), and detachment of o-ring bands on follow-up endoscopy (OR: 8.06, 95% CI: 2.55–25.64) were independent predictive factors of EVL-induced ulcer bleeding. Various endoscopic modalities were attempted for hemostasis (EVL in 8 cases [24.2%], endoscopic variceal obturation [EVO] with cyanoacrylate in 6 cases [18.2%], argon plasma coagulation [APC] in 1 case (3%), Sengstaken–Blakemore (SB) tube in 3 cases [9.1%]), and proton pump inhibitor therapy only in 15 cases (45.5%). MELD score >10, concomitant GV F3, and detachment of o-ring bands on follow-up endoscopy are risk factors for EVL-induced ulcer bleeding. PMID:28614248

  5. Endoscopic Evaluation of the Small Intestine

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    Steven J Shields


    Full Text Available Technological achievements in the area of endoscope design and development have resulted in instruments capable of advancing beyond the reach of simple gastroscopes. Such instruments, known as enteroscopes, form the bases of small bowel endoscopy. Recent widespread use of enteroscopes have contributed significantly to the understanding of small intestinal pathology and improved the ability to diagnose and treat patients with intestinal bleeding sources.

  6. Endoscopic vs microscopic myringoplasty: a different perspective. (United States)

    Lade, Himani; Choudhary, Santosha Ram; Vashishth, Ashish


    The objectives of this study were to ascertain the feasibility of transcanal endoscopic underlay myringoplasty using temporalis fascia and compare the results with microscopic myringoplasty. This prospective randomized trial included 60 patients with mucosal chronic otitis media with tympanic membrane perforations of all sizes and locations apart from posteriorly based small or moderate sized perforations. In the endoscopy group, 30 patients underwent exclusive transcanal myringoplasty using tympanomeatal flap elevation with underlay graft placement. In the microscopy group, 30 patients underwent myringoplasty using the postaural approach. Intra-operative variables compared were canalplasty and canal wall curettage for assessment of ossicular status. Graft uptake, hearing outcomes using pure tone audiometry and subjective cosmetic outcomes were assessed 24 weeks post-operatively and compared in the two groups. Resident feedback on the feasibility of endoscopic myringoplasty was obtained using a questionnaire. In the microscopy group, 5/30 patients required canalplasty due to canal overhangs and 4/30 required canal wall curettage for ossicular assessment, whereas none of the patients in the endoscopy group required these procedures. A graft uptake rate of 83.3% was observed in both groups post-operatively after 24 weeks. Mean air-bone gap pre- and post-operatively in the endoscopy group was 28.5 and 18.13 dB, respectively, whereas these values were 32.4 and 16.9 dB, respectively, in the microscopy group. Subjective cosmetic outcomes were better in the endoscopy group. Resident feedback on endoscopic myringoplasty was positive. Endoscopic myringoplasty appears to be an effective alternative to microscopic myringoplasty and results in excellent hearing with good cosmetic outcomes.

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

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    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.

  8. [Endoscopic implantation of endoprostheses in incurable esophageal and cardia cancer]. (United States)

    Wiesenhaken, U; Rogos, R


    The palliative treatment of tumorous stenosis of the esophagus and cardio-esophageal region by intubation with an endoprosthesis leads to an improved quality of life. The used endoscopic positioning provides better results than the surgical procedure. This method is easy in handling and has only few complications. The endoscopic positioning of endoprosthesis is also a really alternative of alimentary fistula. The positioning of plastic prosthesis under endoscopic control should be given preference in the palliative treatment of obstructing cardio-esophageal malignancy.

  9. Treatment Strategy after Incomplete Endoscopic Resection of Early Gastric Cancer


    Kim, Sang Gyun


    Endoscopic resection of early gastric cancer is defined as incomplete when tumor cells are found at the resection margin upon histopathological examination. However, a tumor-positive resection margin does not always indicate residual tumor; it can also be caused by tissue contraction during fixation, by the cautery effect during endoscopic resection, or by incorrect histopathological mapping. Cases of highly suspicious residual tumor require additional endoscopic or surgical resection. For in...

  10. Clinical outcomes of an endoscopic transclival and transpetrosal approach for primary skull base malignancies involving the clivus. (United States)

    Kim, Yong Hwy; Jeon, Chiman; Se, Young-Bem; Hong, Sang Duk; Seol, Ho Jun; Lee, Jung-Ii; Park, Chul-Kee; Kim, Dong Gyu; Jung, Hee-Won; Han, Doo Hee; Nam, Do-Hyun; Kong, Doo-Sik


    OBJECTIVE The endoscopic endonasal approach for treating primary skull base malignancies involving the clivus is a formidable task. The authors hypothesized that tumor involvement of nearby critical anatomical structures creates hurdles to endoscopic gross-total resection (GTR). The aim of this study was to retrospectively review the clinical outcomes of patients who underwent an endoscopic endonasal approach to treat primary malignancies involving the clivus and to analyze prognostic factors for GTR. METHODS Between January 2009 and November 2015, 42 patients underwent the endoscopic endonasal approach for resection of primary skull base malignancies involving the clivus at 2 independent institutions. Clinical data; tumor locations within the clivus; and anatomical involvement of the cavernous or paraclival internal carotid artery, cisternal trigeminal nerve, hypoglossal canal, and dura mater were investigated to assess the extent of resection. Possible prognostic factors affecting GTR were also analyzed. RESULTS Of the 42 patients, 37 were diagnosed with chordomas and 5 were diagnosed with chondrosarcomas. The mean (± SD) preoperative tumor volume was 25.2 ± 30.5 cm3 (range 0.8-166.7 cm3). GTR was achieved in 28 patients (66.7%) and subtotal resection in 14 patients (33.3%). All tumors were classified as upper (n = 17), middle (n = 17), or lower (n = 8) clival tumors based on clival involvement, and as central (24 [57.1%]) or paramedian (18 [42.9%]) based on laterality of the tumor. Univariate analysis identified the tumor laterality (OR 6.25, 95% CI 1.51-25.86; p = 0.011) as significantly predictive of GTR. In addition, the laterality of the tumor was found to be a statistically significant predictor in multivariate analysis (OR 41.16, 95% CI 1.12-1512.65; p = 0.043). CONCLUSIONS An endoscopic endonasal approach can provide favorable clinical and surgical outcomes. However, the tumor laterality should be considered as a potential obstacle to total removal.

  11. Treatment of nonseptic bursitis with endoscopic surgery

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    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

  12. Peroral endoscopic myotomy (POEM) for esophageal achalasia. (United States)

    Inoue, H; Minami, H; Kobayashi, Y; Sato, Y; Kaga, M; Suzuki, M; Satodate, H; Odaka, N; Itoh, H; Kudo, S


    Peroral endoscopic myotomy (POEM) was developed by our group to provide a less invasive permanent treatment for esophageal achalasia. POEM was performed in 17 consecutive patients with achalasia (10 men, 7 women; mean age 41.4 years). A long submucosal tunnel was created (mean length 12.4 cm), followed by endoscopic myotomy of circular muscle bundles of a mean total length of 8.1 cm (6.1 cm in distal esophagus and 2.0 cm in cardia). Smooth passage of an endoscope through the gastroesophageal junction was confirmed at the end of the procedure. In all cases POEM significantly reduced the dysphagia symptom score (from mean 10 to 1.3; P = 0.0003) and the resting lower esophageal sphincter (LES) pressure (from mean 52.4 mmHg to 19.9 mmHg; P = 0.0001). No serious complications related to POEM were encountered. During follow-up (mean 5 months), additional treatment or medication was necessary in only one patient (case 17) who developed reflux esophagitis (Los Angeles classification B); this was well controlled with regular intake of protein pump inhibitors (PPIs). The short-term outcome of POEM for achalasia was excellent; further studies on long-term efficacy and on comparison of POEM with other interventional therapies are awaited. Georg Thieme Verlag KG Stuttgart. New York.

  13. Esophageal Intramural Pseudodiverticulosis: A Rare Endoscopic Finding

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    Luciana Lopes de Oliveira


    Full Text Available A 76-year-old woman, presenting with a 4-year history of progressive dysphagia, was submitted to endoscopic examination. The upper endoscopy revealed a proximal esophageal stricture and inflammatory mucosa associated with multiples small orifices in the esophageal wall, some of them fulfilled with white spots suggestive of fungal infection. This was a typical endoscopic finding of esophageal intramural pseudodiverticulosis, a benign and rare condition, related to chronic esophagitis and others comorbid states, such as gastroesophageal reflux disease or infectious esophagitis, diabetes mellitus, alcohol consumption, and achalasia. Dysphagia is the predominant symptom and can be accompanied by esophageal stricture in 80% to 90% of patients. The pathogenesis is unknown, and as the pseudodiverticulosis is an intramural finding, endoscopy biopsies are inconclusive. The main histological finding is dilation of the submucosal glands excretory ducts, probably obstructed by inflammatory cells. The treatment consists in management of the underlying diseases and symptoms relief. In this particular case, the patient was submitted to antifungal drugs followed by endoscopic dilation with thermoplastic bougies, with satisfactory improvement of dysphagia.

  14. Frontiers of robotic endoscopic capsules: a review. (United States)

    Ciuti, Gastone; Caliò, R; Camboni, D; Neri, L; Bianchi, F; Arezzo, A; Koulaouzidis, A; Schostek, S; Stoyanov, D; Oddo, C M; Magnani, B; Menciassi, A; Morino, M; Schurr, M O; Dario, P


    Digestive diseases are a major burden for society and healthcare systems, and with an aging population, the importance of their effective management will become critical. Healthcare systems worldwide already struggle to insure quality and affordability of healthcare delivery and this will be a significant challenge in the midterm future. Wireless capsule endoscopy (WCE), introduced in 2000 by Given Imaging Ltd., is an example of disruptive technology and represents an attractive alternative to traditional diagnostic techniques. WCE overcomes conventional endoscopy enabling inspection of the digestive system without discomfort or the need for sedation. Thus, it has the advantage of encouraging patients to undergo gastrointestinal (GI) tract examinations and of facilitating mass screening programmes. With the integration of further capabilities based on microrobotics, e.g. active locomotion and embedded therapeutic modules, WCE could become the key-technology for GI diagnosis and treatment. This review presents a research update on WCE and describes the state-of-the-art of current endoscopic devices with a focus on research-oriented robotic capsule endoscopes enabled by microsystem technologies. The article also presents a visionary perspective on WCE potential for screening, diagnostic and therapeutic endoscopic procedures.

  15. Endoscopic transnasal approach for removing pituitary tumors

    Directory of Open Access Journals (Sweden)

    Mirian Cabral Moreira de Castro


    Full Text Available To describe a series of 129 consecutive patients submitted to the resection of pituitary tumors using the endoscopic transsphenoidal approach in a public medical center. Method: Retrospective analysis based on the records of patients submitted to the resection of a pituitary tumor through the endoscopic transsphenoidal approach between 2004 and 2009. Results: One hundred and twenty-nine records were analyzed. The tumor was non-secreting in 96 (74.42% and secreting in 33 patients (22.58%. Out of the secretory tumors, the most prevalent was the growth hormone producer (7.65%, followed by the prolactinoma, (6.98%. Eleven patients developed cerebral spinal fluid (CSF fistulas, and four of them developed meningitis. One patient died due to intracerebral hemorrhage in the postoperative period. Conclusion: The endoscopic transsphenoidal approach to sellar tumors proved to be safe when the majority of the tumors were non-secreting. The most frequent complication was CSF. This technique can be done even in a public hospital with financial limits, since the health professionals are integrated.

  16. Novel endoscopic management of buried bumper syndrome in percutaneous endoscopic gastrostomy: The Olympus HookKnife. (United States)

    Wolpert, Laura E; Summers, Dominic M; Tsang, Andrew


    Buried bumper syndrome (BBS) is an uncommon but serious complication of percutaneous endoscopic ga-strostomy. It involves the internal fixation device, or "bumper", migrating into the gastric wall and subsequent mucosal overgrowth. We described a case series of four patients with BBS treated with a novel endoscopic technique using a HookKnife between June 2016 and February 2017. The HookKnife is a rotating L-shaped cutting wire designed for hooking tissue and pulling it away from the gastric wall towards the lumen. The technique was successful in all four cases with no complications. Each patient was discharged on the day of treatment. The HookKnife is a manoeuvrable, safe and effective device for endoscopic removal of buried bumpers and could avoid surgery in a high risk group of patients. To our knowledge this technique has not been described previously. We suggest that this technique should be added to the treatment algorithms for managing BBS.

  17. Endoscopic removal of a dislocated tumour prothesis from the stomach

    Energy Technology Data Exchange (ETDEWEB)

    Rueckauer, K.; Dinkel, E.


    Endoscopic pertubation of oesophagogustric neoplasms is an established method of palliative treatment. The dislocated plastic prosthesis may be removed with difficulties from the stomach endoscopically. A simple technique for endoscopic removal of the prosthesis is described. The tube can be precisely centred within the oesophageal lumen by use of an intestinal decompression tube and additional guidance by the endoscopic retraction forceps. Thus gross damge of the exophytic tumor tissue with bleeding or perforation sequelae can be avoided. Injury to the patient does not exceed that caused by an ordinary gastroscopy.

  18. Early Gastric Cancer: Current Advances of Endoscopic Diagnosis and Treatment

    Directory of Open Access Journals (Sweden)

    Linlin Zhu


    Full Text Available Endoscopy is a major method for early gastric cancer screening because of its high detection rate, but its diagnostic accuracy depends heavily on the availability of endoscopic instruments. Many novel endoscopic techniques have been shown to increase the diagnostic yield of early gastric cancer. With the improved detection rate of EGC, the endoscopic treatment has become widespread due to advances in the instruments available and endoscopist’s experience. The aim of this review is to summarize frequently-used endoscopic diagnosis and treatment in early gastric cancer (EGC.

  19. Nefopam Reduces Dysesthesia after Percutaneous Endoscopic Lumbar Discectomy

    National Research Council Canada - National Science Library

    Ok, Young Min; Cheon, Ji Hyun; Choi, Eun Ji; Chang, Eun Jung; Lee, Ho Myung; Kim, Kyung Hoon


    Neuropathic pain, including paresthesia/dysesthesia in the lower extremities, always develops and remains for at least one month, to variable degrees, after percutaneous endoscopic lumbar discectomy (PELD...

  20. Pseudoaneurysm of the splenic artery mimicking a solid lesion

    Directory of Open Access Journals (Sweden)

    Raffaele Pezzilli


    Full Text Available A 64-year-old man presented to the hospital because of hematemesis; on admission, he had weakness and pale skin, tachycardia and hypotension. Laboratory tests revealed severe anemia (hemoglobin 7.8 g/dL; liver, renal and pancreatic function tests were normal. An upper digestive endoscopy revealed a gastric ulcer of the cardia, treated with metallic clips and adrenalin injection. The patient was treated with fluids and was transfused with three units of red blood cells. In the previous two months, due to the presence of bloating and diarrhea, associated with abdominal distension, a colon-computed tomography (CT revealed a large retroperitoneal hypodense mass, 53x37 mm in size, without contrast enhancement localized between the body and the tail of the pancreas and the stomach, near the splenic artery and without signs of infiltration. To better define the mass, endoscopic ultrasound and biopsy were performed; however histopathology of multiple biopsies was not diagnostic, because of the presence of necrotic tissue and inflammatory cells. Since hematemesis recurred, the patient underwent a second upper digestive endoscopic examination, but no source of bleeding was found. Then a new contrast enhanced CT was performed that showed a size reduction of the mass, the presence of blood in the stomach and a small pseudoaneurysm of the splenic artery. Because of these findings an angiograpghic study was carried out; angiography confirmed a splenic artery pseudoaneurysm that was successfully embolized with metal microcoils.

  1. Anomalous left coronary artery from the pulmonary artery (United States)

    ... of the left coronary artery arising from the pulmonary artery; ALCAPA; ALCAPA syndrome; Bland-White-Garland syndrome; ... children with ALCAPA, the LCA originates from the pulmonary artery. The pulmonary artery is the major blood ...

  2. Endoscopic ultrasound, endoscopic sonoelastography, and strain ratio evaluation of lymph nodes with histology as gold standard

    DEFF Research Database (Denmark)

    Larsen, Michael Hareskov; Fristrup, Claus Wilki; Hansen, Tine Plato


    BACKGROUND AND STUDY AIMS: Accurate lymph node staging is essential for the selection of an optimal treatment in patients with upper gastrointestinal cancer. Endoscopic ultrasound (EUS) and fine-needle aspiration (FNA) are considered to be the most accurate method for locoregional staging. Endosc...

  3. Design and evaluation of robotic steering of a flexible endoscope

    NARCIS (Netherlands)

    Ruiter, J.G.; Rozeboom, Esther; van der Voort, Mascha C.; Bonnema, M.; Broeders, Ivo Adriaan Maria Johannes


    In current flexible endoscopy the physician faces problems in manipulating the endoscope. A lot of experience is required to master the procedure. This paper describes the design of an add-on robotic module that improves the user interface of traditional endoscopes and allows a single physician to

  4. Is endoscopic nodular gastritis associated with premalignant lesions? (United States)

    Niknam, R; Manafi, A; Maghbool, M; Kouhpayeh, A; Mahmoudi, L


    Nodularity on the gastric mucosa is occasionally seen in general practice. There is no consensus about the association of nodular gastritis and histological premalignant lesions. This study is designed to investigate the prevalence of histological premalignant lesions in dyspeptic patients with endoscopic nodular gastritis. Consecutive patients with endoscopic nodular gastritis were compared with an age- and sex-matched control group. Endoscopic nodular gastritis was defined as a miliary nodular appearance of the gastric mucosa on endoscopy. Biopsy samples of stomach tissue were examined for the presence of atrophic gastritis, intestinal metaplasia, and dysplasia. The presence of Helicobacter pylori infection was determined by histology. From 5366 evaluated patients, a total of 273 patients with endoscopic nodular gastritis and 1103 participants as control group were enrolled. H. pylori infection was detected in 87.5% of the patients with endoscopic nodular gastritis, whereas 73.8% of the control group were positive for H. pylori (p gastritis were significantly higher than in the control group. Prevalence of atrophic gastritis and complete intestinal metaplasia were also more frequent in patients with endoscopic nodular gastritis than in the control group. Dysplasia, incomplete intestinal metaplasia and H. pylori infection are significantly more frequent in patients with endoscopic nodular gastritis. Although further studies are needed before a clear conclusion can be reached, we suggest that endoscopic nodular gastritis might serve as a premalignant lesion and could be biopsied in all patients for the possibility of histological premalignancy, in addition to H. pylori infection.

  5. Correlation between Endoscopic and Histological Gastritis in South ...

    African Journals Online (AJOL)

    Background: Inflammation of the gastric mucosa is a common finding in the general population. It is also common in clinical practice for Endoscopists to make an impression of gastritis on the basis of the general endoscopic appearance of the gastric mucosa. This concept of “endoscopic gastritis” was further given credibility ...

  6. Diagnosing Helicobacter pylori infection in vivo by novel endoscopic techniques. (United States)

    Ji, Rui; Li, Yan-Qing


    Infection with Helicobacter pylori (H. pylori) is a worldwide problem. Endoscopic observation of H. pylori infection in vivo would be helpful to obtain an immediate diagnosis. The aim of this review is to describe recent advances in endoscopic technology and to review the available literature pertaining to its clinical application in H. pylori infection. Endoscopic visualization of H. pylori infection is not always feasible using conventional endoscopy. Thus, advanced endoscopic techniques have been developed with the aim of providing a precise and ''real-time'' endoscopic diagnosis. Recently, new endoscopic techniques such as magnifying endoscopy, narrow band imaging, I-Scan, endocytoscopy and endomicroscopy help focus examination of the stomach to diagnose disease in a time-efficient manner, and the analysis of mucosal surface details is beginning to resemble histologic examination. The new detailed images have enabled endoscopists to observe microscopic structures, such as gastric pit patterns, microvessels and cell morphology. Accordingly, endoscopic prediction of H. pylori infection is possible by analysis of surface architecture of the mucosa, which influences the clinical management. These endoscopic techniques might lead us to easier diagnosis and treatment of H. pylori-related diseases.

  7. Endoscopic Resection of a Prominent Median Lobe During TURP: a ...

    African Journals Online (AJOL)

    Endoscopic Resection of a Prominent Median Lobe During TURP: a Simple Technique to Avoid Sub- Trigonal Resection. AA Attia, MTA Al-Hak. Abstract. No Abstract. Key Words: Benign prostatic hyperplasia, surgery, Transurethral resection of prostate, Endoscopic resection, prominent median lobe. Full Text: EMAIL FREE ...

  8. Endoscopic removal of nasal septum chondrosarcoma in paediatric patient

    Directory of Open Access Journals (Sweden)

    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.

  9. Endoscopic and histologic healing of Crohn's (ileo-) colitis with azathioprine

    NARCIS (Netherlands)

    D'Haens, G.; Geboes, K.; Rutgeerts, P.


    The correlation between disease activity and endoscopic findings in Crohn's disease is poor. Corticosteroids induce symptom relief without consistent improvement of endoscopic lesions. Our aim was to examine the effect of azathioprine therapy on healing of inflammatory lesions in patients with

  10. External versus endoscopic dacryocystorhinostomy for congenital nasolacrimal duct obstruction

    Directory of Open Access Journals (Sweden)

    Mortada A Abozaid


    Both approaches of pediatric DCR - that is, external and endoscopic - have comparable success rates, although the endoscopic approach has the advantages of avoidance of skin incision, preservation of the pump mechanism, and the ability to address other nasal pathologies at the time of surgery.

  11. Endoscopic treatment of pancreatic stones in patients with chronic pancreatitis

    NARCIS (Netherlands)

    Smits, M. E.; Rauws, E. A.; Tytgat, G. N.; Huibregtse, K.


    The aim of our study was to evaluate the long-term results of endoscopic pancreatic stone removal in patients with chronic pancreatitis. We retrospectively included 53 patients with chronic pancreatitis, in whom an attempt was made at endoscopic stone removal between 1984 and 1993. Patients

  12. Advances in colonic imaging: new endoscopic imaging methods

    NARCIS (Netherlands)

    Dekker, Evelien; Fockens, Paul


    There is a need for better endoscopic visualization in specific circumstances like detection of flat colorectal lesions and dysplasia-screening in ulcerative colitis. Chromoendoscopy is a technique with proven success, but many more, novel endoscopic techniques are currently under investigation. In

  13. Spectrum of Endoscopic Findings in Nigerians with Dyspepsia ...

    African Journals Online (AJOL)

    There are differing information on the commonest endoscopic findings in patients with dyspepsia from Nigeria. Objective: The aim of this study was to determine the spectrum of endoscopic findings in patients with dyspepsia. Patients and Methods: This is a hospital-based prospective study carried out at the Endoscopy Unit ...

  14. Responsiveness of Endoscopic Indices of Disease Activity for Crohn's Disease

    NARCIS (Netherlands)

    Khanna, Reena; Zou, Guangyong; Stitt, Larry; Feagan, Brian G.; Sandborn, William J.; Rutgeerts, Paul; McDonald, John W. D.; Dubcenco, Elena; Fogel, Ronald; Panaccione, Remo; Jairath, Vipul; Nelson, Sigrid; Shackelton, Lisa M.; Huang, Bidan; Zhou, Qian; Robinson, Anne M.; Levesque, Barrett G.; D'Haens, Geert


    The Crohn's Disease Endoscopic Index of Severity (CDEIS) and the Simple Endoscopic Score for Crohn's Disease (SES-CD) are commonly used to assess Crohn's disease (CD) activity; however neither instrument is fully validated. We evaluated the responsiveness to change of the SES-CD and CDEIS using data

  15. Sonographic and Endoscopic Findings in Cocaine-Induced Ischemic Colitis

    DEFF Research Database (Denmark)

    Leth, Thomas; Wilkens, Rune; Bonderup, Ole Kristian


    Cocaine-induced ischemic colitis is a recognized entity. The diagnosis is based on clinical and endoscopic findings. However, diagnostic imaging is helpful in the evaluation of abdominal symptoms and prior studies have suggested specific sonographic findings in ischemic colitis. We report...... sonographic and endoscopic images along with abdominal computed tomography in a case of cocaine-induced ischemic colitis....

  16. How does a biopsy of endoscopically normal terminal ileum ...

    African Journals Online (AJOL)

    Background: Terminal ileum endoscopy and biopsy are the diagnostic tools of diseases attacking the ileum. However, abnormal histological findings can be found in endoscopically normal terminal ileum. Objective: This study was performed to evaluate the histopathological results of biopsies from endoscopically normal ...

  17. Endoscopic Treatment of Chyluria Using Povidone Iodine with ...

    African Journals Online (AJOL)

    Objective: To evaluate the safety and efficacy of povidone iodine with contrast agent as a sclerosant for the endoscopic treatment of chyluria. Patients and Methods: From December 1999 to October 2003, a total of 22 patients having chyluria were treated. After their baseline evaluation they were subjected to endoscopic ...

  18. Bilateral retinal hemorrhage after endoscopic third ventriculostomy : iatrogenic Terson syndrome

    NARCIS (Netherlands)

    Hoving, Eelco W.; Rahmani, Mehrnoush; Los, Leonie I.; Renardel De Lavalette, Victor W.

    A serious ophthalmological complication of an endoscopic third ventriculostomy that created an iatrogenic Terson syndrome is described. A patient with an obstructive hydrocephalus was treated endoscopically, but due to the inadvertent use of a pressure bag during rinsing, in combination with a

  19. Outcomes of peripheral perfusion with balloon aortic clamping for totally endoscopic robotic mitral valve repair. (United States)

    Ward, Alison F; Loulmet, Didier F; Neuburger, Peter J; Grossi, Eugene A


    Although the technique of totally endoscopic robotic mitral valve repair (TERMR) has been well described, few reports have examined the results of peripheral perfusion with balloon clamping. We analyzed the outcomes of TERMR performed using this strategy. A total of 108 consecutive patients underwent TERMR by a 2-surgeon team. The preoperative evaluation included chest computed tomography and abdominal and pelvis computed tomography. Additional procedures included appendage exclusion in 96, patent foramen ovale closure in 29, cryoablation in 16, tricuspid valve repair in 2, and septal myectomy in 2. The mean patient age was 59 years (range, 21-86). Central venous drainage was obtained with a long cannula. Arterial return was achieved with femoral cannulation, when possible. An endoballoon catheter was placed through the femoral artery. Transesophageal echocardiography was used to position all catheters. Femoral artery perfusion was possible in 103 of 108 patients (95.3%). The subclavian artery was used in 5 patients (4.6%) with contraindications to retrograde perfusion. An endoballoon clamp was placed by way of the femoral artery. In 105 of 108 patients (97.2%), endoaortic occlusion was successfully used; the mean crossclamp time was 87.4 minutes. The coronary sinus cardioplegia catheter was placed successfully in 81 of the 108 patients (75%). Postoperatively, no or mild inotropic support was needed in 94 (87%) and moderate support in 14 (13.0%). Of the 108 patients, 55 (50.9%) were extubated in the operating room. No hospital mortality, aortic injury, vascular complications, or wound infections occurred. Complications included 2 strokes (no residual deficit) (1.8%) and atrial fibrillation in 18 (16.7%). The median hospital stay was 4 days. Eighty patients (74.1%) were discharged by postoperative day 5. A preoperative image-guided perfusion strategy and aortic balloon clamping permit routine TERMR with excellent myocardial preservation and minimal complications

  20. Superior mesenteric artery syndrome resulting from acute massive gastric dilatation caused by Helicobacter pylori-induced acute antral gastritis. (United States)

    Hashimoto, Hiroyuki; Seno, Akiko; Ishizaki, Akiko; Terasaki, Shuichi; Kimoto, Tatsuya


    A previously well, slender 14-year-old boy developed right epigastric pain with vomiting. His vomiting gradually changed to bile-stained fluid for 8 h. He was diagnosed with superior mesenteric artery syndrome with acute massive gastric dilatation by contrast-enhanced computed tomography, which also showed markedly thickened prepyloric gastric wall that may have caused gastric outlet stenosis. Acute gastric mucosal lesions of the antrum were confirmed by endoscopic and histological studies. Endoscopic biopsy specimens using rapid urease test and histopathology detected Helicobacter pylori. Serum anti-H. pylori antibody was negative. He did well after conservative treatment. We conclude that an acute form of superior mesenteric artery syndrome resulted from compression of the artery by acute massive gastric dilatation associated with transient gastric outlet stenosis caused by acute antral gastritis, which resulted from the initial H. pylori infection.

  1. Bilateral renal artery variation


    Üçerler, Hülya; Üzüm, Yusuf; İkiz, Z. Aslı Aktan


    Each kidney is supplied by a single renal artery, although renal artery variations are common. Variations of the renal arteryhave become important with the increasing number of renal transplantations. Numerous studies describe variations in renalartery anatomy. Especially the left renal artery is among the most critical arterial variations, because it is the referred side forresecting the donor kidney. During routine dissection in a formalin fixed male cadaver, we have found a bilateral renal...

  2. Outcome of endoscopic decompression of retrocalcaneal bursitis

    Directory of Open Access Journals (Sweden)

    Vamsi Kondreddi


    Full Text Available Background: Posterior heel pain due to retrocalcaneal bursitis, is a disabling condition that responds well to the conventional methods of treatment. Patients who do not respond to conservative treatment may require surgical intervention. This study evaluates the outcome of endoscopic decompression of retrocalcaneal bursitis, with resection of posterosuperior eminence of the calcaneum. Materials and Methods: This present study included 25 heels from 23 consecutive patients with posterior heel pain, who did not respond to conservative treatment and underwent endoscopic decompression of the retrocalcaneal bursae and excision of bony spurs. The functional outcome was evaluated by comparing the pre and postoperative American Orthopedic Foot and Ankle Society (AOFAS scores. The Maryland ankle and foot score was used postoperatively to assess the patient′s satisfaction at the one-year followup. Results: The University of Maryland scores of 25 heels were categorized as the nonparametric categories, and it was observed that 16 patients had an excellent outcome, six good, three fair and there were no poor results. The AOFAS scores averaged 57.92 ± 6.224 points preoperatively and 89.08 ± 5.267 points postoperatively (P < 0.001, at an average followup of 16.4 months. The 12 heels having noninsertional tendinosis on ultrasound had low AOFAS scores compared to 13 heels having retrocalcaneal bursitis alone. At one year followup, correlation for preoperative ultrasound assessment of tendoachilles degeneration versus postoperative Maryland score (Spearman correlation had shown a strong negative correlation. Conclusion: Endoscopic calcaneal resection is highly effective in patients with mild or no degeneration and yields cosmetically better results with fewer complications. Patients with degenerative changes in Achilles tendon had poorer outcomes in terms of subjective satisfaction.

  3. Limited Approach in Endoscopic Dacryocystorhinostomy of Pediatrics. (United States)

    Hashemi, Seyyed Mostafa; Eshaghian, Afrooz


    Limited spatial nasal cavity in children, make pediatric dacryocystorhinostomy (DCR) a difficult surgical procedure. We apply a limited approach to pediatric DCR and follow them for their consequences. An experimental study was done in pediatric DCR with limited approach (age consent, with general anesthesia, with nasal endoscopic surgery, lacrimal bone is exposed and extruded. In contrast with routine procedure, ascending process of maxillary sinus reserve; and marsupialization and wide exposure to lacrimal sac was done only by lacrimal bone defect; and cannulation preserve with temporary silicone tube. Between 2006 and 2012, 16 pediatric DCR was done by a unique surgeon in 2 otorhinolaryngologic centers. Before surgery 14 (87.5%) had epiphora, 3 (18.8%) had eye discharge, and 3 (18.8%) had eye sticky eye. Two (12.5%) had history of facial trauma, and 10 (62.5%) had congenital nasolacrimal duct insufficiency. Five (31.3%) had history of dacryocystitis. Patients were followed for 17 ± 9 months. Silicone tube stayed for 4 ± 2.5 months. We could follow 7 patients and minimal improvement or need to revision surgery considered as technical failure. After surgery, 3 patients had no epiphora with complete improvement; 2 had very good improvement with confidence of the patients and parents; 2 cases had unsuccessful surgery in our patients, who needs to another surgery. One of them had several probing and surgery before our endoscopic DCR. Limited approach in endoscopic DCR of pediatrics can be done in noncomplicated patients, with minimal manipulation, more confidence, and acceptable results.

  4. [Endoscopic ventriculocisternostomy complications in 108 hydrocephalic patients]. (United States)

    Alonso-Fernández, Luis; Leyva-Mastrapa, Tania; deJongh-Cobo, Enrique; Díaz-Alvarez, Manuel; Quintana-Pajon, Ingrid; Osuna, Irene Barrios; Morera-Pérez, Maricela


    Several reports have been published in relation to complications, sometimes fatal, associated to endoscopic ventriculocisternostomy (EVC). The objective of this study was to determine the range of complications using this surgical technique in a series of 108 patients. A retrospective and descriptive study was performed on 108 hydrocephalic patients: 76 children and 32 adults. All of them presented various forms of obstructive hydrocephalus. In a total of 108 patients, 114 EVC were performed. The follow-up period ranged between 6 months and 10 years (mean 6.8 years). Age of patients ranged from 6 days to 75 years old (mean 18 years). Aqueductal stenosis was the most common aetiology, with 62 patients (57.4%). Significant complications occurred in 10 patients (9.2%). During the course of the study, the complication rate dropped significantly. No patient died because of the procedure (mortality 0%). We applied the Endoscopic Third Ventriculostomy Success Score (ETVSS) developed by Kulkarni and collaborators to our series to know if this score could be useful in predicting ETV results. Like all minimally-invasive techniques, there is a steep learning curve for EVC. Correct patient selection and surgeon experience (which means not only familiarity with endoscopic techniques but also the performance of a minimum number of surgeries per year) are very important to avoid complications. The ETV Success Score devised closely approximates the predicted probability of ETV success. Copyright © 2014 Sociedad Española de Neurocirugía. Published by Elsevier España. All rights reserved.

  5. [Pull percutaneous endoscopic gastrostomy: personal experience]. (United States)

    Geraci, G; Sciumè, C; Pisello, F; Li Volsi, F; Facella, T; Tinaglia, D; Modica, G


    To review the indications, complications, and outcomes of percutaneous endoscopic gastrostomy (PEG), that are placed routinely in patients unable to obtain adequate nutrition from oral feeding for swallowing disorders (neurological diseases, head and neck cancer, oesophageal cancer, psychological disorders). Retrospective review of patients referred for PEG placement from 2003 to 2005. Endoscopic Surgery in Section of General and Thoracic Surgery, Faculty of Medicine and Surgery, Palermo, Italy. A total of 50 patients, 11 women and 39 men, referred our Section for PEG placement. Indications for PEG placement included various neurologic impairment (82%), oesophageal non-operable cancer (6%), cardia non-operable cancer (4%), cerebrovascular accident (2%), anorexia (2%), pharyngeal esophageal obstruction (2%), head and neck cancer (2%). All patients received preoperative antibiotics as short-term profilaxis. 51 PEGs were positioned in 50 patients. No major complications were registered; 45 patients (90%) were alive at 1 year follow-up and no mortality procedure-related was registered. Percutaneous endoscopic gastrotomy removal had been performed on 2 patients as end-point of treatment, and 43 patients continued to have PEGs in use at 2006. Outpatients PEG placement using conscious sedation is a safe and effective method for providing enteral nutrition. This technique constitutes the gold standard treatment for enteral nutrition in patients with neurologic impairment or as prophylactic in patients affected by head and neck cancer who needs demolitive surgery. Patients should be carefully assessed, and discussion with the patient and their families should be held to determine that the patient is an appropriate candidate. The Authors feel prophylactic antibiotics lessened the incidence of cutaneous perigastrostomy infection.

  6. Ophthalmic complications of endoscopic sinus surgery

    Directory of Open Access Journals (Sweden)

    Malgorzata Seredyka-Burduk

    Full Text Available Abstract Introduction: The proximity of the paranasal sinuses to the orbit and its contents allows the occurence of injuries in both primary or revision surgery. The majority of orbital complications are minor. The major complications are seen in 0.01-2.25% and some of them can be serious, leading to permanent dysfunction. Objective: The aim of this study was to determine the risk and type of ophthalmic complications among patients operated due to a chronic rhinosinusitis. Methods: This is a retrospective study of 1658 patients who underwent endoscopic sinus surgery for chronic rhinosinusitis with or without polyps or mucocele. Surgeries were performed under general anesthesia in all cases and consisted of polyps' removal, followed by middle metal antrostomy, partial or complete ethmoidectomy, frontal recess surgery and sphenoid surgery if necessary. The ophthalmic complications were classified according to type, frequency and clinical findings. Results: In our material 32.68% of the patients required revision surgery and only 10.1% had been previously operated in our Department. Overall complications occurred in 11 patients (0.66%. Minor complications were observed in 5 patients (0.3% with the most frequent being periorbital ecchymosis with or without emphysema. Major complications were observed in one patient (0.06% and were related to a lacrimal duct injury. Severe complications occurred in 5 cases (0.3%, with 2 cases and referred to a retroorbital hematoma, optic nerve injury (2 cases and one case of extraocular muscle injury. Conclusions: Orbital complications of endoscopic nasal surgery are rare. The incidence of serious complications, causing permanent disabilities is less than 0.3%. The most important parameters responsible for complications are extension of the disease, previous endoscopic surgery and coexisting anticoagulant treatment.

  7. Endoscopic Endonasal Approach to Mesencephalic Cavernous Malformations. (United States)

    He, Shi-Ming; Wang, Yuan; Zhao, Tian-Zhi; Zheng, Tao; Lv, Wen-Hai; Zhao, Lan-Fu; Chen, Long; Sterling, Cole; Qu, Yan; Gao, Guo-Dong


    Symptomatic cavernous malformations involving the brainstem are difficult to access by conventional approaches, which often require dramatic brain retraction to gain adequate operative corridor. Here, we present a successful endoscopic endonasal transclival approach for resection of a hemorrhagic, symptomatic mesencephalic cavernous malformation. A 20-year-old woman presented with acute onset of headache, nausea, and vomiting. Computed tomography scan revealed a ventral midbrain hemorrhage. On day 3 of admission, the patient developed left-sided hemiparesis, restriction of medial and lateral left-eye movements, and loss of left pupillary light reflex. Subsequent magnetic resonance imaging demonstrated an increase of the midbrain lesion to 1.2 cm × 1.7 cm. Diffusion tensor imaging showed compression and lateral displacement of the right corticospinal tract near the thalamus and cerebral peduncle. Given the patient's clinical presentation and the findings on imaging, we suspected a mesencephalic cavernous malformation. The patient underwent an endoscopic endonasal transclival resection of a ventral midline mesencephalon cavernous malformation. A dark red lesion was directly visualized under the endoscope. After a small cortiectomy, the pial and perforator vessels were dissected, and dark-brown blood was drained from the cavernoma cavity. Using a biopsy forceps and with careful attention to the cavernoma borders, the lesion was removed and hemostasis was achieved. Pathologic examination confirmed cavernous malformation. One week after the operation, magnetic resonance imaging demonstrated total resection of the lesion. A 3-month follow-up revealed improved neurologic symptoms with minimal surgical morbidity. Copyright © 2016 Elsevier Inc. All rights reserved.

  8. Endoscopic Removal of Foreign Bodies in Children

    Directory of Open Access Journals (Sweden)

    Chien-Heng Lin


    Full Text Available The ingestion of foreign bodies such as coins, fish bones, plastic toy parts, batteries, and needles is common in children. Although the majority of ingested foreign bodies pass through the gastrointestinal tract unaided, some children require either nonsurgical or surgical intervention. The medical records of children who presented to the pediatric emergency department of a single tertiary referral center between December 2001 and May 2006 were reviewed. A total of 87 patients underwent an endoscopic procedure because of suspected foreign body ingestion and foreign bodies were identified by endoscopy in 74 patients (85.1%. The mean age of these 74 patients was 3.4 years (range, 6 months to 13 years. The most common site of foreign body lodgment was the esophagus (n=38,51.4%; other sites included the stomach (n=33,44.6% and duodenum (n=3, 4.0%. The types of foreign bodies included coins (n=42, 56.8%, button batteries (n = 16, 21.6%, sharp objects (n = 9, 12.2%, chicken bones (n = 2, 2.7% and others (n=5, 6.7%. Only two foreign bodies (button batteries in the duodenum could not be removed successfully by endoscopy. Instead, they were moved into the intestine and then eliminated spontaneously the following day. There were no major complications caused by foreign body ingestion or endoscopic procedures. The outcome of all patients was uneventful without morbidity or mortality. In our experience, endoscopic removal of foreign bodies under general anesthesia is an effective and safe method in children; the method also prevents erosion and perforation of the gastrointestinal tract.

  9. Optimizing the surgical field in pediatric functional endoscopic sinus surgery: a new evidence-based approach. (United States)

    Ragab, Sameh M; Hassanin, Maher Z


    To conduct the first prospective randomized controlled study 1) evaluating the possibility of improving the quality of the operative field and to provide a bloodless functional endoscopic sinus surgery (FESS) in children through total intravenous anesthesia (TIVA) using remifentanil combined with propofol, and 2) testing the safety and efficacy of remifentanil in propofol-TIVA in inducing controlled hypotension in children at a target mean arterial blood pressure of 50 mm Hg. Randomized controlled trial. General hospital. Seventy children underwent FESS under hypotensive general anesthesia with equal randomization into two groups. Group I received TIVA with remifentanil, whereas group II had balanced anesthesia (BA) with esmolol. Heart rate, blood pressure, operative time, blood loss, and quality of the surgical conditions were recorded. Intraoperative blood loss in the TIVA group was less than in the BA group. The quality and dryness of the surgical field in both the visual analogue scale and the six-point scale was significantly better in the TIVA group than in the BA group. Hypotension was sustained at the target mean arterial blood pressure of 50 mm Hg in the two groups, without any significant difference. Improving the quality of the surgical field and providing a bloodless FESS in children is attainable with TIVA. TIVA using a combination of remifentanil and propofol is superior to BA, even with the use of additional potent hypotensive agents such as esmolol. Both techniques are safe and effective in inducing controlled hypotension in children at a target mean arterial blood pressure of 50 mm Hg.

  10. Artery Bypass Grafting

    African Journals Online (AJOL)


    nary artery disease (CAD) was coronary artery bypass graft (CAB G) using a segment of saphenous vein interposed between the ascend- ing aorta and the coronary artery distal to the obstructing lesion. This was performed by David Sabiston of Duke University in 1962. With the use of the recently developed technique of ...

  11. Carotid artery surgery - slideshow (United States)

    ... right- and left-internal carotid arteries, and the right- and left-external carotid arteries. The carotid arteries deliver oxygen-rich blood from the heart to both the head and brain. Review Date 6/1/2015 Updated by: Daniel ...

  12. Endoscopic treatment of Morel-Lavallee lesion. (United States)

    Kim, Sunghoon


    Morel-Lavallee lesion is a closed degloving soft tissue injury in which subcutaneous tissue is torn from the underlying muscular fascia. The tear leads to venolymphatic leak, and concomitant adipose tissue necrosis from the force of the trauma causes swelling and possible infection at the site of injury. The traditional treatment for the lesion is surgical drainage and debridement. In this report, an endoscopic method is described, which achieves the goal of an open surgical debridement but minimizes surgical morbidity. Copyright © 2016 Elsevier Ltd. All rights reserved.

  13. Endoscopic Treatment of Studer's Orthotopic Neobladder Lithiasis. (United States)

    Gil-Sousa, Diogo; Oliveira-Reis, Daniel; Cavadas, Vitor; Oliveira, Manuel; Soares, José; Fraga, Avelino


    Studer's neobladder lithiasis is a rare but important long term complication of this orthotopic bladder substitute technique. We report a case of a 45 year-old male patient, submitted to a radical cystoprostatectomy with a Studer's orthotopic neobladder 4 years before, presenting bad compliance to recommended urinary habits, increased production of mucus and high post voiding residue. CT scan and urethrocystography showed a distended pouch with 2 major sacculations with narrow communication and a stone in each sacculation. A minimally invasive endoscopic technique was successfully used in the treatment of the 2 small calculus.

  14. Endoscopic Treatment of Studer's Orthotopic Neobladder Lithiasis

    Directory of Open Access Journals (Sweden)

    Diogo Gil-Sousa


    Full Text Available Studer's neobladder lithiasis is a rare but important long term complication of this orthotopic bladder substitute technique. We report a case of a 45 year-old male patient, submitted to a radical cystoprostatectomy with a Studer's orthotopic neobladder 4 years before, presenting bad compliance to recommended urinary habits, increased production of mucus and high post voiding residue. CT scan and urethrocystography showed a distended pouch with 2 major sacculations with narrow communication and a stone in each sacculation. A minimally invasive endoscopic technique was successfully used in the treatment of the 2 small calculus.

  15. Contrast-enhanced harmonic endoscopic ultrasound

    DEFF Research Database (Denmark)

    Săftoiu, A; Dietrich, C F; Vilmann, P


    Second-generation intravenous blood-pool ultrasound contrast agents are increasingly used in endoscopic ultrasound (EUS) for characterization of microvascularization, differential diagnosis of benign and malignant focal lesions, and improving staging and guidance of therapeutic procedures. Although...... contrast-enhanced harmonic EUS based on a very low mechanical index (0.08 - 0.12). Quantification techniques based on dynamic contrast-enhanced ultrasound have been recommended for perfusion imaging and monitoring of anti-angiogenic treatment, mainly based on time-intensity curve analysis. Most...

  16. First Application of 7-T Magnetic Resonance Imaging in Endoscopic Endonasal Surgery of Skull Base Tumors. (United States)

    Barrett, Thomas F; Dyvorne, Hadrien A; Padormo, Francesco; Pawha, Puneet S; Delman, Bradley N; Shrivastava, Raj K; Balchandani, Priti


    Successful endoscopic endonasal surgery for the resection of skull base tumors is reliant on preoperative imaging to delineate pathology from the surrounding anatomy. The increased signal-to-noise ratio afforded by 7-T MRI can be used to increase spatial and contrast resolution, which may lend itself to improved imaging of the skull base. In this study, we apply a 7-T imaging protocol to patients with skull base tumors and compare the images with clinical standard of care. Images were acquired at 7 T on 11 patients with skull base lesions. Two neuroradiologists evaluated clinical 1.5-, 3-, and 7-T scans for detection of intracavernous cranial nerves and internal carotid artery (ICA) branches. Detection rates were compared. Images were used for surgical planning and uploaded to a neuronavigation platform and used to guide surgery. Image analysis yielded improved detection rates of cranial nerves and ICA branches at 7 T. The 7-T images were successfully incorporated into preoperative planning and intraoperative neuronavigation. Our study represents the first application of 7-T MRI to the full neurosurgical workflow for endoscopic endonasal surgery. We detected higher rates of cranial nerves and ICA branches at 7-T MRI compared with 3- and 1.5-T MRI, and found that integration of 7 T into surgical planning and guidance was feasible. These results suggest a potential for 7-T MRI to reduce surgical complications. Future studies comparing standardized 7-, 3-, and 1.5-T MRI protocols in a larger number of patients are warranted to determine the relative benefit of 7-T MRI for endonasal endoscopic surgical efficacy. Copyright © 2017 Elsevier Inc. All rights reserved.

  17. Video endoscopic inguinal lymphadenectomy (VEIL: minimally invasive resection of inguinal lymph nodes

    Directory of Open Access Journals (Sweden)

    M. Tobias-Machado


    Full Text Available OBJECTIVES: Describe and illustrate a new minimally invasive approach for the radical resection of inguinal lymph nodes. SURGICAL TECHNIQUE: From the experience acquired in 7 operated cases, the video endoscopic inguinal lymphadenectomy (VEIL technique was standardized in the following surgical steps: 1 Positioning of the inferior member extended in abduction, 2 Introduction of 3 work ports distal to the femoral triangle, 3 Expansion of the working space with gas, 4 Retrograde separation of the skin flap with a harmonic scalpel, 5 Identification and dissection of the long saphenous vein until the oval fossa, 6 Identification of the femoral artery, 7 Distal ligature of the lymph node block at the femoral triangle vertex, 8 Liberation of the lymph node tissue up to the great vessels above the femoral floor, 9 Distal ligature of the long saphenous vein, 10 Control of the saphenofemoral junction, 11 Final liberation of the surgical specimen and endoscopic view showing that all the tissue of the region was resected, 12 Removal of the surgical specimen through the initial orifice, 13 Vacuum drainage and synthesis of the incisions. COMMENTS: The VEIL technique is feasible and allows the radical removal of inguinal lymph nodes in the same limits of conventional surgery dissection. The main anatomic repairs of open surgery can be identified by the endoscopic view, confirming the complete removal of the lymphatic tissue within the pre-established limits. Preliminary results suggest that this technique can potentially reduce surgical morbidity. Oncologic follow-up is yet premature to demonstrate equivalence on the oncologic point of view.

  18. Laparoscopic caecal wedge resection with intraoperative endoscopic assistance. (United States)

    Giavarini, Luisa; Boni, Luigi; Cortellezzi, Camillo Claudio; Segato, Sergio; Cassinotti, Elisa; Rausei, Stefano; Dionigi, Gianlorenzo; Rovera, Francesca; Marzorati, Alessandro; Spampatti, Sebastiano; Sambucci, Daniele; Dionigi, Renzo


    Cancer is a potential evolution of adenomatous polyps, that is why nowadays screening programs for colorectal cancer are widely diffused. Colonoscopy is the gold standard procedure for identifying and resecting polyps; however, for some polyps resection during colonoscopy is not possible. The aim of the present study is to identify a fast and safe procedure for endoscopically resecting unresectable polyps. Patients with endoscopically unresectable polyps were scheduled for laparoscopic wedge resection under colonoscopic assistance. From November 2010 to November 2012 we treated 15 patients with endoscopically unresectable adenomatous polyps. All patients underwent a laparoscopic caecal wedge resection with intraoperative endoscopic assistance. All procedures were completed without complications and in all cases complete resection of the polyps was achieved. Laparoscopic wedge caecal resection with intraoperative colonoscopy is a fast and safe procedure that can be performed for large polyps that could not be treated endoscopically. Copyright © 2013 Elsevier Ltd and Surgical Associates Ltd. All rights reserved.

  19. Endoscopic scoring of late gastrointestinal mucosal damage after adjuvant radiochemotherapy (United States)

    Dabak, Resat; Uygur-Bayramicli, Oya; Gemici, Cengiz; Yavuzer, Dilek; Sargin, Mehmet; Yildirim, Mehmet


    AIM: To evaluate late effects of chemoradiation on gastrointestinal mucosa with an endoscopic scoring system and compare it to a clinical scoring system. METHODS: Twenty-four patients going to receive chemoradiation after gastric surgery underwent endoscopy four wk after surgery and one year after the chemoradiation finished. Upper gastrointestinal findings were recorded according to a system proposed by World Organisation for Digestive Endoscopy (OMED) and clinical scoring was done with RTOG-EORTC radiation morbidity scoring systems. RESULTS: There was no significant endoscopic difference in gastric and intestinal mucosa after chemoradiation (P > 0.05) and there was no association between endoscopic scores and clinical scores. Endoscopic changes were minimal. CONCLUSION: Late effects after chemoradiation in operated patients with gastric cancers can be evaluated with an endoscopic scoring system objectively and this system is superior to clinical scoring systems. PMID:16865788

  20. Robust feature tracking for endoscopic pose estimation and structure recovery (United States)

    Speidel, S.; Krappe, S.; Röhl, S.; Bodenstedt, S.; Müller-Stich, B.; Dillmann, R.


    Minimally invasive surgery is a highly complex medical discipline with several difficulties for the surgeon. To alleviate these difficulties, augmented reality can be used for intraoperative assistance. For visualization, the endoscope pose must be known which can be acquired with a SLAM (Simultaneous Localization and Mapping) approach using the endoscopic images. In this paper we focus on feature tracking for SLAM in minimally invasive surgery. Robust feature tracking and minimization of false correspondences is crucial for localizing the endoscope. As sensory input we use a stereo endoscope and evaluate different feature types in a developed SLAM framework. The accuracy of the endoscope pose estimation is validated with synthetic and ex vivo data. Furthermore we test the approach with in vivo image sequences from da Vinci interventions.

  1. Endoscopic resection of advanced and laterally spreading duodenal papillary tumors. (United States)

    Klein, Amir; Tutticci, Nicholas; Bourke, Michael J


    Historically, neoplasia of the duodenal papilla has been managed surgically, which may be associated with substantial morbidity and mortality. In the absence of invasive cancer, even lesions with extensive lateral duodenal wall involvement, or limited intraductal extension may be cured endoscopically with a superior safety profile. Endoscopic papillectomy is associated with greater risks of adverse events such as bleeding than resection elsewhere in the gastrointestinal tract. Additionally site-specific complications such as pancreatitis exist. A structured approach to lesion assessment, adherence to technical aspects of resection, endoscopic management of complications and post-resection surveillance is required. Advances have been made in all facets of endoscopic papillary resection since its introduction in the 1980s; extending the boundaries of endoscopic cure, optimizing outcomes and enhancing patient safety. These will be the focus of the present review. © 2015 Japan Gastroenterological Endoscopy Society.

  2. Surgical stress response: does endoscopic surgery confer an advantage?

    DEFF Research Database (Denmark)

    Kehlet, H


    "Open" surgical procedures are followed by profound changes in endocrine metabolic function and various host defense mechanisms, impaired pulmonary function, and hypoxemia. These physiologic changes are supposed to be involved in the pathogenesis of postoperative morbidity. Endoscopic surgery...... of postoperative pulmonary function and less hypoxemia with endoscopic operation. The slight modification of surgical stress responses by endoscopic surgery is in contrast to the common, though not universal, demonstration of less pain, shorter hospital stay, and less morbidity after endoscopic surgery....... In conclusion, endoscopic surgery has so far not been demonstrated to have important modifying effects on classic endocrine metabolic responses and only a slight inhibitory effect on various inflammatory responses, but with improved pulmonary function and less hypoxemia. More data are needed from major...

  3. Endoscopic management of difficult common bile duct stones (United States)

    Trikudanathan, Guru; Navaneethan, Udayakumar; Parsi, Mansour A


    Endoscopy is widely accepted as the first treatment option in the management of bile duct stones. In this review we focus on the alternative endoscopic modalities for the management of difficult common bile duct stones. Most biliary stones can be removed with an extraction balloon, extraction basket or mechanical lithotripsy after endoscopic sphincterotomy. Endoscopic papillary balloon dilation with or without endoscopic sphincterotomy or mechanical lithotripsy has been shown to be effective for management of difficult to remove bile duct stones in selected patients. Ductal clearance can be safely achieved with peroral cholangioscopy guided laser or electrohydraulic lithotripsy in most cases where other endoscopic treatment modalities have failed. Biliary stenting may be an alternative treatment option for frail and elderly patients or those with serious co morbidities. PMID:23345939

  4. Evaluation of the 3-dimensional endoscope in transsphenoidal surgery. (United States)

    Barkhoudarian, Garni; Del Carmen Becerra Romero, Alicia; Laws, Edward R


    Three-dimensional (3-D) endoscopy is a recent addition to augment the transsphenoidal surgical approach for anterior skull-base and parasellar lesions. We describe our experience implementing this technology into regular surgical practice. Retrospective review of clinical factors and outcomes. All patients were analyzed who had endoscopic endonasal parasellar operations since the introduction of the 3-D endoscope to our practice. Over an 18-month period, 160 operations were performed using solely endoscopic techniques. Sixty-five of these were with the Visionsense VSII 3-D endoscope and 95 utilized 2-dimensional (2-D) high-definition (HD) Storz endoscopes. Intraoperative and postoperative findings were analyzed in a retrospective fashion. Comparing both groups, there was no significant difference in total or surgical operating room times comparing the 2-D HD and 3-D endoscopes (239 minutes vs 229 minutes, P = .47). Within disease-specific comparison, pituitary adenoma resection was significantly shorter utilizing the 3-D endoscope (surgical time 174 minutes vs 147 minutes, P = .03). These findings were independent of resident or fellow experience. There was no significant difference in the rate of complication, reoperation, tumor resection, or intraoperative cerebrospinal fluid leaks. Subjectively, the 3-D endoscope offered increased agility with 3-D techniques such as exposing the sphenoid rostrum, drilling sphenoidal septations, and identifying bony landmarks and suprasellar structures. The 3-D endoscope is a useful alternative to the 2-D HD endoscope for transnasal anterior skull-base surgery. Preliminary results suggest it is more efficient surgically and has a shorter learning curve. As 3-D technology and resolution improve, it should serve to be an invaluable tool for neuroendoscopy.

  5. A technical review of flexible endoscopic multitasking platforms. (United States)

    Yeung, Baldwin Po Man; Gourlay, Terence


    Further development of advanced therapeutic endoscopic techniques and natural orifice translumenal endoscopic surgery (NOTES) requires a powerful flexible endoscopic multitasking platform. Medline search was performed to identify literature relating to flexible endoscopic multitasking platform from year 2004-2011 using keywords: Flexible endoscopic multitasking platform, NOTES, Instrumentation, Endoscopic robotic surgery, and specific names of various endoscopic multitasking platforms. Key articles from articles references were reviewed. Flexible multitasking platforms can be classified as either mechanical or robotic. Purely mechanical systems include the dual channel endoscope (DCE) (Olympus), R-Scope (Olympus), the EndoSamurai (Olympus), the ANUBIScope (Karl-Storz), Incisionless Operating Platform (IOP) (USGI), and DDES system (Boston Scientific). Robotic systems include the MASTER system (Nanyang University, Singapore) and the Viacath (Hansen Medical). The DCE, the R-Scope, the EndoSamurai and the ANUBIScope have integrated visual function and instrument manipulation function. The IOP and DDES systems rely on the conventional flexible endoscope for visualization, and instrument manipulation is integrated through the use of a flexible, often lockable, multichannel access device. The advantage of the access device concept is that it allows optics and instrument dissociation. Due to the anatomical constrains of the pharynx, systems are designed to have a diameter of less than 20 mm. All systems are controlled by traction cable system actuated either by hand or by robotic machinery. In a flexible system, this method of actuation inevitably leads to significant hysteresis. This problem will be accentuated with a long endoscope such as that required in performing colonic procedures. Systems often require multiple operators. To date, the DCE, the R-Scope, the IOP, and the Viacath system have data published relating to their application in human. Alternative forms of

  6. Usefulness of angiographic embolization endoscopic metallic clip placement in patient with non-variceal upper gastrointestinal bleeding

    Energy Technology Data Exchange (ETDEWEB)

    Yoon, Min Jae; Hwang, Cheol Mog; Kim, Ho Jun; Cho, Young Jun; Bae, Seok Hwan [Dept. of Radiology, Konyang University Hospital, Daejeon (Korea, Republic of); Shin, Byung Seok; Ohm, Joon Young [Dept. of Radiology, Chungnam National University College of Medicine, Daejeon (Korea, Republic of); Kang, Chae Hoon [Dept. of Radiology, Inje University College of Medicine, Pusan Paik Hospital, Busan (Korea, Republic of)


    The aim of this study is to assess the usefulness of angiographic embolization after endoscopic metallic clip placement around the edge of non-variceal upper gastrointestinal bleeding ulcers. We have chosen 41 patients (mean age, 65.2 years) with acute bleeding ulcers (22 gastric ulcers, 16 duodenal ulcers, 3 malignant ulcers) between January 2010 and December 2012. We inserted metallic clips during the routine endoscopic treatments of the bleeding ulcers. Subsequent transcatheter arterial embolization was performed within 2 hours. We analyzed the angiographic positive rates, angiographic success rates and clinical success rates. Among the 41 patients during the angiography, 19 patients (46%) demonstrated active bleeding points. Both groups underwent embolization using microcoils, N-butyl-cyano-acrylate (NBCA), microcoils with NBCA or gelfoam particle. There are no statistically significant differences between these two groups according to which embolic materials are being used. The bleeding was initially stopped in all patients, except the two who experienced technical failures. Seven patients experienced repeated episodes of bleeding within two weeks. Among them, 4 patients were successful re-embolized. Another 3 patients underwent gastrectomy. Overall, clinical success was achieved in 36 of 41 (87.8%) patients. The endoscopic metallic clip placement was helpful to locate the correct target vessels for the angiographic embolization. In conclusion, this technique reduced re-bleeding rates, especially in patients who do not show active bleeding points.

  7. Fully Endoscopic Minimally Invasive Transrectus Capitis Posterior Muscle Triangle Approach to the Posterolateral Condyle and Jugular Tubercle. (United States)

    Mingdong, Wang; Fernandez-Miranda, Juan C; Mathias, Roger Neves; Wang, Eric; Gardner, Paul; Wang, Hong


    Background  We evaluated a transrectus capitis posterior muscle triangle approach to the posterolateral foramen magnum, occipital condyles, jugular tubercle, and the fourth ventricle. We also assessed factors that affect the amount of bone removal required. Objective  To evaluate if the proposed approach is as effective as standard open approaches to expose the lateral portion of the foramen magnum. Methods  The proposed minimally invasive fully endoscopic approach was performed in 15 cadaveric specimens using 4-mm (0- and 45-degree) endoscopes. Results  Using a 5-cm straight paramedian incision, the rectus capitis posterior minor and major muscles were partially removed unilaterally, providing a corridor through the muscles to reach the foramen magnum region. After meticulous soft tissue dissection, key anatomical landmarks can be identified such as the greater occipital nerve, the vertebral artery that wraps around the atlanto-occipital joint, and the bony protuberance that heralds the occipital condyle. A suboccipital craniotomy associated with the transcondylar, supracondylar or paracondylar approach is performed depending on the amount of bone removal desired to maximize the surgical view. By doing so, the jugular foramen can be exposed laterally as well as the fourth ventricle medially. Conclusion  The proposed endoscopic approach can provide access through the transrectus capitis posterior muscle triangle leading directly to the occipital condyle. A stepwise approach is critical to gain a surgical corridor to the inferolateral petroclival region and the fourth ventricle.

  8. Spontaneous renal artery dissection. (United States)

    John, Santhosh G; Pillai, Unnikrishnan; Vaidyan, Philip B; Ishiyama, Takaaki


    Isolated spontaneous dissection of renal arteries or its branches are extremely rare. Most cases of renal artery dissection are associated with underlying pathology of the renal arteries. We report a case of spontaneous dissection of the left main renal artery and infarction of the left kidney with positive antiphospholipid antibody. Extensive work up of the patient including imaging studies confirmed the diagnosis of SRAD. Antiphospholipid antibodies may have a role in the pathogenesis of arterial dissection by causing endothelial dysfunction. This is a first literature report.

  9. Rare Endoscopic Manifestation of Pancreatic Adenocarcinoma

    Directory of Open Access Journals (Sweden)

    Haritha Chelimilla


    Full Text Available Gastric ulcer secondary to direct invasion from pancreatic adenocarcinoma is rare. Metastases to the stomach have been commonly reported with melanoma and with primary tumors of the breast, lung, ovary, liver, colon and testis. We report a patient who presented with epigastric pain and in whom subsequently upper endoscopy showed a malignant gastric ulcer secondary to direct invasion from pancreatic adenocarcinoma of the body. An 81-year-old female presented to our hospital with epigastric pain and subsequently underwent endoscopy with endoscopic ultrasound for evaluation of a pancreatic body mass. She had a large gastric ulcer in the fundus which was in direct continuity with the pancreatic mass. Pathology from biopsy of the ulcer revealed invasive well-to-moderately-differentiated adenocarcinoma, and immunohistochemical stains were strongly positive for CA19-9, CK7, CK19 and carcinoembryonic antigen. These findings were consistent with a histopathological diagnosis of metastatic carcinoma of the pancreas. Patients with gastrointestinal metastases usually have advanced malignancy with poor prognosis. Endoscopic evaluation with adequate biopsies should be performed for symptomatic patients.

  10. Laser Endoscopic Microsurgery of Laryngeal Cancers

    Directory of Open Access Journals (Sweden)

    Moustapha, Sereme


    Full Text Available Introduction The aim of our study is to present our experience in treating laryngeal cancers with endoscopic CO2 laser surgery. Materials and Methods This retrospective study was conducted from January 2008 to December 2012 at Antoine Lacassagne Center of Nice. The functional and oncologic results of this surgical technique were analyzed and discussed. Results The average length of hospital stay was 2.5 days. Phonatory results were considered excellent in 75% of our patients who maintained satisfactory phone communication skills after their interventions. Chronic hoarseness was the most common reason for bilateral or extended cordectomies. On the oncologic basis, histologic exam showed 90% of our margins were normal. The clinical control showed excellent laryngeal preservation in 94.23%. In 5 years, the overall survival was estimated at 96.15%. Conclusion This study shows the benefit of the laser endoscopic microsurgery for the preservation of laryngeal functions and the local histologic control, essentially for early stage laryngeal cancers.


    Directory of Open Access Journals (Sweden)

    A. L. Goncharov


    Full Text Available The identification of small colon lesions is one of the major problems in laparoscopic colonic resection.Research objective: to develop a technique of visualization of small tumors of a colon by preoperative endoscopic marking of a tumor.Materials and methods. In one day prior to operation to the patient after bowel preparation the colonoscopy is carried out. In the planned point near tumor on antimesentery edge the submucous infiltration of marking solution (Micky Sharpz blue tattoo pigment, UK is made. The volume of entered solution of 1–3 ml. In only 5 months of use of a technique preoperative marking to 14 patients with small (the size of 1–3 cm malignant tumors of the left colon is performed.Results. The tattoo mark was well visualized by during operation at 13 of 14 patients. In all cases we recorded no complications. Time of operation with preoperative marking averaged 108 min, that is significantly less in comparison with average time of operation with an intra-operative colonoscopy – 155 min (р < 0.001.Conclusions. The first experience of preoperative endoscopic marking of non palpable small tumors of a colon is encouraging. Performance of a technique wasn't accompanied by complications and allowed to reduce significantly time of operation and to simplify conditions of performance of operation.

  12. [Endoscopic treatment of vesicoureteral reflux in children]. (United States)

    Burkin, A G; Iatsyk, S P; Sharkov, S M; Rusakov, A A; Tin, I F


    The one of the most common defects of the ureter-vesical segment in children is the condition, leading to a disorder of obturative function of this segment. Complications of vesicoureteral reflux include continuously recurrent pyelonephritis, reflux nephropathy. In this regard, the choice of the optimal treatment strategy based on minimal invasion is considered as one of the priorities of pediatric urology. The article presents the data obtained during the treatment of VUR in children of different ages in the Clinic of Reproductive Health FSBSI SCCH. A comparative evaluation of the results of endoscopic correction of vesicoureteral reflux depending on the kind of the bulking agent was performed. It was found that the use of endocorrection of reflux is highly effective surgical procedure, with the high number of positive results against the background of use of bulking agent "vantris". The study discriminates a group of patients with vesicoureteral reflux, intractable for endoscopic correction with cystoscopically normal structure of the orifices that allows to refer this method to the initial stage of treatment of the disease.

  13. Posterior endoscopic discectomy: Results in 300 patients

    Directory of Open Access Journals (Sweden)

    Mohinder Kaushal


    Full Text Available Background: Posterior endoscopic discectomy is an established method for treatment of lumbar disc herniation. Many studies have not been reported in literature for lumbar discectomy by Destandau Endospine System. We report a series of 300 patients operated for lumbar dissectomy by Destandau Endospine system. Materials and Methods: A total of 300 patients suffering from lumbar disc herniations were operated between January 2002 and December 2008. All patients were operated as day care procedure. Technique comprised localization of symptomatic level followed by insertion of an endospine system devise through a 15 mm skin and fascial incision. Endoscopic discectomy is then carried out by conventional micro disc surgery instruments by minimal invasive route. The results were evaluated by Macnab′s criteria after a minimum followup of 12 months and maximum up to 24 months. Results: Based on modified Macnab′s criteria, 90% patients had excellent to good, 8% had fair, and 2% had poor results. The complications observed were discitis and dural tear in five patients each and nerve root injury in two patients. 90% patients were able to return to light and sedentary work with an average delay of 3 weeks and normal physical activities after 2 months. Conclusion: Edoscopic discectomy provides a safe and minimal access corridor for lumbar discectomy. The technique also allows early postoperative mobilization and faster return to work.

  14. Endoscopic Management of Primary Sclerosing Cholangitis. (United States)

    Barkin, Jodie A; Levy, Cynthia; Souto, Enrico O

    Primary sclerosing cholangitis (PSC) remains a rare but potentially devastating chronic, cholestatic liver disease. PSC causes obstruction of intra- and/or extra-hepatic bile ducts by inflammation and fibrosis, leading to biliary obstruction, cirrhosis and portal hypertension with all associated sequelae. The most dreaded consequence of PSC is cholangiocarcinoma, occurring in 10-20% of patients with PSC, and with population-based estimates of a 398-fold increased risk of cholangiocarcinoma in patients with PSC compared to the general population. We use the 4-D approach to endoscopic evaluation and management of PSC based on currently available evidence. After laboratory testing with liver chemistries and high-quality cross-sectional imaging with MRCP, the first D is Dominant stricture diagnosis and evaluation. Second, Dilation of strictures found during ERCP is performed using balloon dilation to as many segments as possible. Third, Dysplasia and cholangiocarcinoma diagnosis is performed by separated brushings for conventional cytology and fluorescence in situ hybridization (FISH), and consideration for direct cholangioscopy with SpyGlass™. Fourt and finally, Dosing of antibiotics is critical to prevent peri-procedural cholangitis. The aim of this review article is to explore endoscopic tools and techniques for the diagnosis and management of PSC and provide a practical approach for clinicians.

  15. Non-endoscopic Mechanical Endonasal Dacryocystorhinostomy

    Directory of Open Access Journals (Sweden)

    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.

  16. Endoscopic management of complications of chronic pancreatitis. (United States)

    Dumonceau, Jean-Marc; Macias-Gomez, Carlos


    Pseudocysts and biliary obstructions will affect approximately one third of patients with chronic pancreatitis (CP). For CP-related, uncomplicated, pancreatic pseudocysts (PPC), endoscopy is the first-choice therapeutic option. Recent advances have focused on endosonography-guided PPC transmural drainage, which tends to replace the conventional, duodenoscope-based coma immediately approach. Ancillary material is being tested to facilitate the endosonography-guided procedure. In this review, the most adequate techniques depending on PPC characteristics are presented along with supporting evidence. For CP-related biliary obstructions, endoscopy and surgery are valid therapeutic options. Patient co-morbidities (e.g., portal cavernoma) and expected patient compliance to repeat endoscopic procedures are important factors when selecting the most adapted option. Malignancy should be reasonably ruled out before embarking on the endoscopic treatment of presumed CP-related biliary strictures. In endoscopy, the gold standard technique consists of placing simultaneous, multiple, side-by-side, plastic stents for a one-year period. Fully covered self-expandable metal stents are challenging this method and have provided 50% mid-term success.

  17. Endoscopic Third Ventriculostomy in Previously Shunted Children

    Directory of Open Access Journals (Sweden)

    Eva Brichtova


    Full Text Available Endoscopic third ventriculostomy (ETV is a routine and safe procedure for therapy of obstructive hydrocephalus. The aim of our study is to evaluate ETV success rate in therapy of obstructive hydrocephalus in pediatric patients formerly treated by ventriculoperitoneal (V-P shunt implantation. From 2001 till 2011, ETV was performed in 42 patients with former V-P drainage implantation. In all patients, the obstruction in aqueduct or outflow parts of the fourth ventricle was proved by MRI. During the surgery, V-P shunt was clipped and ETV was performed. In case of favourable clinical state and MRI functional stoma, the V-P shunt has been removed 3 months after ETV. These patients with V-P shunt possible removing were evaluated as successful. In our group of 42 patients we were successful in 29 patients (69%. There were two serious complications (4.7%—one patient died 2.5 years and one patient died 1 year after surgery in consequence of delayed ETV failure. ETV is the method of choice in obstructive hydrocephalus even in patients with former V-P shunt implantation. In case of acute or scheduled V-P shunt surgical revision, MRI is feasible, and if ventricular system obstruction is diagnosed, the hydrocephalus may be solved endoscopically.

  18. Endoscopic vs. tactile evaluation of subgingival calculus. (United States)

    Osborn, Joy B; Lenton, Patricia A; Lunos, Scott A; Blue, Christine M


    Endoscopic technology has been developed to facilitate imagery for use during diagnostic and therapeutic phases of periodontal care. The purpose of this study was to compare the level of subgingival calculus detection using a periodontal endoscope with that of conventional tactile explorer in periodontitis subjects. A convenience sample of 26 subjects with moderate periodontitis in at least 2 quadrants was recruited from the University of Minnesota School of Dentistry to undergo quadrant scaling and root planing. One quadrant from each subject was randomized for tactile calculus detection alone and the other quadrant for tactile detection plus the Perioscope ™ (Perioscopy Inc., Oakland, Cali). A calculus index on a 0 to 3 score was performed at baseline and at 2 post-scaling and root planing visits. Sites where calculus was detected at visit 1 were retreated. T-tests were used to determine within-subject differences between Perioscope™ and tactile measures, and changes in measures between visits. Significantly more calculus was detected using the Perioscope™ vs. tactile explorer for all 3 subject visits (pcalculus detection from baseline to visit 1 were statistically significant for both the Perioscope™ and tactile quadrants (pcalculus detection from visit 1 to visit 2 was only significant for the Perioscope™ quadrant (pcalculus at this visit. It was concluded that the addition of a visual component to calculus detection via the Perioscope™ was most helpful in the re-evaluation phase of periodontal therapy. Copyright © 2014 The American Dental Hygienists’ Association.

  19. [Conversional and endoscopic procedures following bariatric surgery]. (United States)

    Zorron, R; Bothe, C; Junghans, T; Pratschke, J; Benzing, C; Krenzien, F


    The Roux-en-Y gastric bypass (RYGB) is the therapy of choice in bariatric surgery. Sleeve gastrectomy and gastric banding are showing higher rates of treatment failure, reducing obesity-associated morbidity and body weight insufficiently. Moreover, gastroesophageal reflux disease (GERD) can occur refractory to medication. Therefore, a laparoscopic conversion to RYGB can be reasonable as long as specific conditions are fulfilled.Endoscopic procedures are currently being applied to revise bariatric procedures. Therapy failure following RYGB occurs in up to 20 % of cases. Transoral outlet reduction is the minimally invasive method of choice to reduce gastrojejunal anastomosis of the alimentary limb. The diameter of a gastric sleeve can be unwantedly enlarged as well; that can be reduced by placement of a longitudinal full-thickness suture.Severe hypoglycemic episodes can be present in patients following RYGB. Hypoglycemic episodes have to be diagnosed first and can be treated conventionally. Alternatively, a laparoscopic approach according to Branco-Zorron can be used for non-responders. Hypoglycemic episodes can thus be prevented and body weight reduction can be assured.Conversional and endoscopic procedures can be used in patients with treatment failure following bariatric surgery. Note that non-invasive approaches should have been applied intensively before a revisional procedure is performed.

  20. Disposable sheath that facilitates endoscopic Raman spectroscopy (United States)

    Wang, Wenbo; Short, Michael; Tai, Isabella T.; Zeng, Haishan


    In vivo endoscopic Raman spectroscopy of human tissue using a fiber optic probe has been previously demonstrated. However, there remain several technical challenges, such as a robust control over the laser radiation dose and measurement repeatability during endoscopy. A decrease in the signal to noise was also observed due to aging of Raman probe after repeated cycles of harsh reprocessing procedures. To address these issues, we designed and tested a disposable, biocompatible, and sterile sheath for use with a fiber optic endoscopic Raman probe. The sheath effectively controls contamination of Raman probes between procedures, greatly reduces turnaround time, and slows down the aging of the Raman probes. A small optical window fitted at the sheath cap maintained the measurement distance between Raman probe end and tissue surface. To ensure that the sheath caused a minimal amount of fluorescence and Raman interference, the optical properties of materials for the sheath, optical window, and bonding agent were studied. The easy-to-use sheath can be manufactured at a moderate cost. The sheath strictly enforced a maximum permissible exposure standard of the tissue by the laser and reduced the spectral variability by 1.5 to 8.5 times within the spectral measurement range.

  1. A Haptic Guided Robotic System for Endoscope Positioning and Holding. (United States)

    Cabuk, Burak; Ceylan, Savas; Anik, Ihsan; Tugasaygi, Mehtap; Kizir, Selcuk


    To determine the feasibility, advantages, and disadvantages of using a robot for holding and maneuvering the endoscope in transnasal transsphenoidal surgery. The system used in this study was a Stewart Platform based robotic system that was developed by Kocaeli University Department of Mechatronics Engineering for positioning and holding of endoscope. After the first use on an artificial head model, the system was used on six fresh postmortem bodies that were provided by the Morgue Specialization Department of the Forensic Medicine Institute (Istanbul, Turkey). The setup required for robotic system was easy, the time for registration procedure and setup of the robot takes 15 minutes. The resistance was felt on haptic arm in case of contact or friction with adjacent tissues. The adaptation process was shorter with the mouse to manipulate the endoscope. The endoscopic transsphenoidal approach was achieved with the robotic system. The endoscope was guided to the sphenoid ostium with the help of the robotic arm. This robotic system can be used in endoscopic transsphenoidal surgery as an endoscope positioner and holder. The robot is able to change the position easily with the help of an assistant and prevents tremor, and provides a better field of vision for work.

  2. Computer-Aided Endoscopic Diagnosis Without Human-Specific Labeling. (United States)

    Wang, Shuai; Cong, Yang; Fan, Huijie; Liu, Lianqing; Li, Xiaoqiu; Yang, Yunsheng; Tang, Yandong; Zhao, Huaici; Yu, Haibin


    Most state-of-the-art computer-aided endoscopic diagnosis methods require pixelwise labeled data to train various supervised machine learning models. However, it is a tedious and time-consuming work to collect sufficient precisely labeled image data. Fortunately, we can easily obtain huge endoscopic medical reports including the diagnostic text and images, which can be considered as weakly labeled data. In this paper, our motivation is to design a new computer-aided endoscopic diagnosis system without human specific labeling; in comparison with most state of the arts, ours only depends on the endoscopic images with weak labels mined from the diagnostic text. To achieve this, we first cast the endoscopic image folder and included images as bag and instances and represent each instance based on the global bag-of-words model. We then adopt a feature mapping scheme to represent each bag by mining the most suspicious lesion instance from each positive bag automatically. In order to achieve self-online updating from sequential new coming data, an online metric learning method is used to optimize the bag-level classification. Our computer-aided endoscopic diagnosis system achieves an AUC of 0.93 on a new endoscopic image dataset captured from 424 volunteers with more than 12k images. The system performance outperforms other state of the arts when we mine the most positive instances from positive bags and adopt the online phase to mine more information from the unseen bags. We present the first weakly labeled endoscopic image dataset for computer-aided endoscopic diagnosis and a novel system that is suitable for use in clinical settings.

  3. [Combined transgastric and transcolonic endoscopic salpingectomy: experiment with pigs]. (United States)

    Li, Wen; Sun, Gang; Wang, Xiang-Dong; Xiao, Jian-Guo; Sun, Guo-Hui; Huang, Xue-Fei; Kantsevoy, Sergey V


    To compare the feasibility and safety of combined transgastric and transcolonic dual approach and those of transgastric single approach in endoscopic salpingectomy. Two female Chinese Nongda miniature pigs underwent gastric and colonic lavage with tap water followed by disinfection of mucosa with 1:10 iodophor. An endoscope was inserted and the colonic wall was punctured with a needle knife, dilated with a balloon-dilator and a double-channel endoscope was advanced into the peritoneal cavity. Under direct observation through this endoscope, a trans-gastric entrance was made with the second double-channel endoscope. With the help of transcolonic endoscope, the left Fallopian tube was ligated and partially resected using the transgastric endoscope. With the help of transgastric endoscope, liver biopsy was performed using the transcolonic endoscope. Finally, the gastric incision was closed with 3 clips and the colonic incision was closed with a loop and a clip. Antibiotics were used for 3 days following the procedures. Seventeen days later laparotomy was performed to observe the infection, visceral damage and adhesion, healing of the incisions of gastrointestinal duct, etc. Compared with the single route, the dual routes were more convenient to perform the liver biopsy and salpingectomy. The pigs drank and ate normally soon after the resuscitation. The pigs looked well and gained weight during 2 weeks after the operation. Repeat endoscopy in 2 weeks showed a well-healed gastric incision with 2 clips still in place and a healed colonic incision with 1 clip still attached. The necropsy revealed a complete transmural healing of the gastric incision with minimal adhesion and a complete healing of the colonic incision without any adhesion. Few adhesions were found around the liver biopsy site and the salpingectomy site without any intraperitoneal infection or organ damage. Combined transgastric and transcolonic approach appears safe and feasible and facilitates

  4. Endoscopic transorbital route to the cavernous sinus through the meningo-orbital band: a descriptive anatomical study. (United States)

    Dallan, Iacopo; Di Somma, Alberto; Prats-Galino, Alberto; Solari, Domenico; Alobid, Isam; Turri-Zanoni, Mario; Fiacchini, Giacomo; Castelnuovo, Paolo; Catapano, Giuseppe; de Notaris, Matteo


    OBJECTIVE Exposure of the cavernous sinus is technically challenging. The most common surgical approaches use well-known variations of the standard frontotemporal craniotomy. In this paper the authors describe a novel ventral route that enters the lateral wall of the cavernous sinus through an interdural corridor that includes the removal of the greater sphenoid wing via a purely endoscopic transorbital pathway. METHODS Five human cadaveric heads (10 sides) were dissected at the Laboratory of Surgical NeuroAnatomy of the University of Barcelona. To expose the lateral wall of the cavernous sinus, a superior eyelid endoscopic transorbital approach was performed and the anterior portion of the greater sphenoid wing was removed. The meningo-orbital band was exposed as the key starting point for revealing the cavernous sinus and its contents in a minimally invasive interdural fashion. RESULTS This endoscopic transorbital approach, with partial removal of the greater sphenoid wing followed by a "natural" ventral interdural dissection of the meningo-orbital band, allowed exposure of the entire lateral wall of the cavernous sinus up to the plexiform portion of the trigeminal root and the petrous bone posteriorly and the foramen spinosum, with the middle meningeal artery, laterally. CONCLUSIONS The purely endoscopic transorbital approach through the meningo-orbital band provides a direct view of the cavernous sinus through a simple and rapid means of access. Indeed, this interdural pathway lies in the same sagittal plane as the lateral wall of the cavernous sinus. Advantages include a favorable angle of attack, minimal brain retraction, and the possibility for dissection through the interdural space without entering the neurovascular compartment of the cavernous sinus. Surgical series are needed to demonstrate any clinical advantages and disadvantages of this novel route.

  5. An anatomical basis for endoscopic cubital tunnel release and associated clinical outcomes. (United States)

    Mirza, Ather; Mirza, Justin B; Lee, Brian K; Adhya, Shawn; Litwa, Joshua; Lorenzana, Daniel J


    To study the ulnar nerve in fresh-frozen cadavers as related to endoscopic release of the cubital tunnel and to present a retrospective review of patients treated with decompression via endoscopic visualization. To further our understanding of relevant anatomy, we dissected 26 cadaver limbs. We paid special attention to fascial membranes as potential sites of constriction as well as the position of nerves, vessels, and aberrant anatomy. These findings facilitated our understanding of the extent of release in 80 patients (92 cases) with endoscopic cubital tunnel simple decompression. Outcome measures included Disabilities of the Arm, Shoulder, and Hand score, Gabel and Amadio score, and grip and pinch strengths. We noted fascial bands proximal to the medial epicondyle in 12 of 26 cadaver specimens, 2 of which could be the so-called arcade of Struthers. We observed a high degree of variability in the anatomy of the flexor pronator aponeurosis distal to the medial epicondyle. Where present (n = 10), medial antebrachial cutaneous nerve branches crossed the ulnar nerve at an average distance of 2.9 cm from the medial epicondyle (range, 1.0-4.5 cm). Aberrant structures were noted in 8 of the 26 specimens, including an anconeus epitrochlearis muscle in 2 specimens, a basilic vein crossing the ulnar nerve in 4 specimens, and an accessory origin of the medial head of the triceps from the medial intermuscular septum in 2 specimens. In the clinical portion of this study, the average Disabilities of the Arm, Shoulder, and Hand score before surgery was 49 (n = 34) and after surgery was 25 (n = 56). The Gabel and Amadio outcome scores were 24 excellent, 40 good, 25 fair, and 3 poor (n = 92). Average follow-up was 8.2 months (range, 0.1-35 mo). Cadaveric dissections shed light on vulnerable anatomical structures during release, including branches of the medial antebrachial cutaneous nerve, ulnar nerve, brachial artery, fascial bands, and basilic vein. The high degree of

  6. Endoscopic hemostasis with endoscopic mucosal resection and multiple synchronous early gastric cancers: a case report


    Fujihara Shintaro; Mori Hirohito; Nishiyama Noriko; Kobayashi Mitsuyoshi; Kobara Hideki; Masaki Tsutomu


    Abstract Introduction Endoscopic hemostasis for severe upper gastrointestinal bleeding due to tumors, such as gastrointestinal stromal tumors and malignant lymphoma, is temporarily effective. However, permanent hemostasis is difficult in many cases because of diffuse bleeding. Case presentation A 60-year-old Japanese woman was admitted to our hospital with hematemesis. Endoscopy revealed multiple gastric polyps and fresh blood in her stomach. One of the gastric polyps, which was associated wi...

  7. Peroral endoscopic myotomy (POEM) is safe and effective in the setting of prior endoscopic intervention. (United States)

    Sharata, Ahmed; Kurian, Ashwin A; Dunst, Christy M; Bhayani, Neil H; Reavis, Kevin M; Swanström, Lee L


    We aimed to determine the safety and feasibility of peroral endoscopic myotomy (POEM) in the setting of prior endoscopic interventions. This study involves 40 consecutive patients undergoing POEM. POEM was performed for esophageal motility disorders, including achalasia, nutcracker with nonrelaxing lower esophageal sphincter (LES), hypertensive lower esophageal sphincter, and diffuse esophageal spasm. Outcome measures include length of procedure (LOP), intraoperative complications, and dysphagia relief. Forty patients, with a mean age of 54 ± 19 years, underwent POEM. The pre-POEM intervention group consisted of 12 patients (nine achalasia, two nutcracker with nonrelaxing LES, and one diffuse esophageal spasm) who also had previous endoscopic treatment, while the pre-POEM non-intervention group consisted of 28 patients (22 achalasia, 3 hypertensive LES, 2 nutcracker with nonrelaxing LES, and 1 diffuse esophageal spasm). Ten patients had botox injections and two patients had large caliber balloon dilations prior to POEM. The median preoperative Eckardt score was 5 in the pre-POEM intervention group vs 6 in the pre-POEM non-intervention group (p value = 0.4). There was no statistical difference in the mean LOP (134 ± 43 vs 131 ± 41, p = 0.8) or the incidence of intraoperative complications (17 vs 3 %, p = 0.2) between the two groups. There was also no difference in the 6-month postoperative median Eckardt scores between the two groups (1 vs 1, p = 0.4). POEM is safe and effective even following preoperative endoscopic large caliber balloon dilations or botox injection. These interventions do not seem to contribute to increased adverse intraoperative or postoperative clinical outcomes.

  8. Endoscopic management of bleeding gastric varices--an updated overview. (United States)

    Crisan, Dana; Tantau, Marcel; Tantau, Alina


    Gastric varices (GVs) are known to bleed massively and often difficult to manage with conventional techniques. This article aims to overview the endoscopic methods for the management of acute gastric variceal bleeding, especially the advantages and limits of GV obliteration with tissue adhesives, by comparison with band ligation and other direct endoscopic techniques of approach. The results of indirect radiological and surgical techniques of GV treatment are shortly discussed. A special attention is payed to the emerging role of endoscopic ultrasound in the therapy of bleeding GV, in the confirmation of its eradication and in follow-up strategies.

  9. A Lethal Complication of Endoscopic Therapy: Duodenal Intramural Hematoma

    Directory of Open Access Journals (Sweden)

    Turan Calhan


    Full Text Available Duodenal intramural hematoma (DIH usually occurs in childhood and young adults following blunt abdominal trauma. It may also develop in the presence of coagulation disorders and may rarely be an iatrogenic outcome of endoscopic procedures. Management of DIH is usually a conservative approach. A case of intramural duodenal hematoma that developed following endoscopic epinephrine sclerotherapy and/or argon plasma coagulation and that was nonresponsive to conservative therapy in a patient with chronic renal failure who died from sepsis is being discussed in this report. Clinicians should be aware of such possible complications after endoscopic hemostasis in patients with coagulation disorders.

  10. Transoral endoscopic thyroidectomy using vestibular approach: updates and evidences. (United States)

    Anuwong, Angkoon; Kim, Hoon Yub; Dionigi, Gianlorenzo


    Recently, natural orifice transluminal endoscopic surgery (NOTES) has been applied in thyroid surgery with transoral access. The benefit of transoral endoscopic thyroidectomy is the potential for scar-free surgery. However, there are many concerns over some aspects, such as infection, recurrent laryngeal nerve injury, and oncological outcome. In this paper, we have reviewed the development history and the current clinical evidence of this innovative surgery. We conclude that the transoral endoscopic thyroidectomy vestibular approach (TOETVA) is feasible and can be considered no longer an experimental operation.

  11. Application of wireless electrical non-fiberoptic endoscope: Potential benefit and limitation in endoscopic surgery. (United States)

    Chen, Chih-Hao; Chang, Ho; Liu, Tsang-Pai; Huang, Tun-Sung; Chen, Chao-Hung


    Conventional rigid endoscope requires a bundle of optic fibers for illumination and a set of camera for viewing body cavity. The design is bulky in the hand-held part and the laterally positioned optic fibers may hinder manipulation of instruments, especially in single port surgery. We designed a simplified unit to replace conventional endoscope. We used an independent front image sensor along with six light emitting diode crystals. A wireless module working in 2.4 GHz and its antenna were integrated into the hand-help part. Two 800 mA batteries were used for power supply. The study was tested in two 35 kg pigs. Some simple thoracoscopic and laparoscopic operations were simulated to test the reliability and surgeon's acceptability. Signal Noise ratio can be controlled well in the setting of the operative room. Signal transmission was influenced significantly when covered by damped gauze or drape. The best quality of wireless transmission is through line-of-sight. Dropping frame is less than 1 frame per second in 99% time period during the test. Wireless modules in the design of rigid endoscope may be a plausible option with good acceptability. Copyright © 2015 IJS Publishing Group Limited. Published by Elsevier Ltd. All rights reserved.

  12. testicular artery arising from an aberrant right renal artery

    African Journals Online (AJOL)



    Aug 17, 2017 ... Correspondence to Dr. Emmanuel Henry Suluba, Department of Anatomy, School of Medicine,. Muhimbili University of Health and ... vein, left colic artery and the descending colon. Both right and left testicular arteries as ... anatomy of the vessels such as testicular arteries, ovarian arteries, renal arteries and.

  13. A randomized trial comparing multiband mucosectomy and cap-assisted endoscopic resection for endoscopic piecemeal resection of early squamous neoplasia of the esophagus

    NARCIS (Netherlands)

    Zhang, Yue-Ming; Boerwinkel, David F.; Qin, Xiumin; He, Shun; Xue, Liyan; Weusten, Bas L. A. M.; Dawsey, Sanford M.; Fleischer, David E.; Dou, Li-Zhou; Liu, Yong; Lu, Ning; Bergman, Jacques J. G. H. M.; Wang, Gui-Qi


    Piecemeal endoscopic resection for esophageal high grade intraepithelial neoplasia (HGIN) or early squamous cell carcinoma (ESCC) is usually performed by cap-assisted endoscopic resection. This requires submucosal lifting and multiple snares. Multiband mucosectomy (MBM) uses a modified variceal band

  14. Duplicated middle cerebral artery (United States)

    Perez, Jesus; Machado, Calixto; Scherle, Claudio; Hierro, Daniel


    Duplicated middle cerebral artery (DMCA) is an anomalous vessel arising from the internal carotid artery. The incidence DMCA is relatively law, and an association between this anomaly and cerebral aneurysms has been documented. There is a controversy whether DMCA may have perforating arteries. This is an important fact to consider in aneurysm surgery. We report the case of a 34-year-old black woman who suffered a subarachnoid hemorrhage and the angiography a left DMCA, and an aneurysm in an inferior branch of the main MCA. The DMCA and the MCA had perforating arteries. The aneurysm was clipped without complications. The observation of perforating arteries in our patient confirms that the DMCA may have perforating arteries. This is very important to be considered in cerebral aneurysms surgery. Moreover, the DMCA may potentially serve as a collateral blood supply to the MCA territory in cases of MCA occlusion. PMID:22140405

  15. Multivessel coronary artery thrombosis. (United States)

    Kanei, Yumiko; Janardhanan, Rajesh; Fox, John T; Gowda, Ramesh M


    Simultaneous thrombosis of multiple epicardial coronary arteries is an uncommon clinical finding in ST-segment elevation myocardial infarction (STEMI). We describe a 37-year-old male present with inferior wall STEMI who was found to have large thrombi in both the right coronary artery (RCA) and the left anterior descending artery (LAD). We reviewed 23 patients with multivessel thrombosis in acute myocardial infarction in the literature. The mean age of patients was 53 +/- 14 years (32-82 years); 74% were males, and most patients had multiple risk factors for coronary artery disease. The LAD (78%) and RCA (87%) were the arteries involved for most patients. Aspiration thrombectomy was used in 3 cases. Though it is rare, STEMI with multiple culprit arteries can occur, and it is crucial to recognize this condition to determine the proper treatment, since most of these patients are critically ill.

  16. Single incision endoscopic surgery for lumbar hernia. (United States)

    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.

  17. Endoscopic placement of enteral feeding tubes. (United States)

    Rafferty, Gerard P; Tham, Tony Ck


    Malnutrition is common in patients with acute and chronic illness. Nutritional management of these malnourished patients is an essential part of healthcare. Enteral feeding is one component of nutritional support. It is the preferred method of nutritional support in patients that are not receiving adequate oral nutrition and have a functioning gastrointestinal tract (GIT). This method of nutritional support has undergone progression over recent times. The method of placement of enteral feeding tubes has evolved due to development of new feeding tubes and endoscopic technology. Enteral feeding can be divided into methods that provide short-term and long-term access to the GIT. This review article focuses on the current range of methods of gaining access to the GIT to provide enteral feed.

  18. Automatic specular reflections removal for endoscopic images (United States)

    Tan, Ke; Wang, Bin; Gao, Yuan


    Endoscopy imaging is utilized to provide a realistic view about the surfaces of organs inside the human body. Owing to the damp internal environment, these surfaces usually have a glossy appearance showing specular reflections. For many computer vision algorithms, the highlights created by specular reflections may become a significant source of error. In this paper, we present a novel method for restoration of the specular reflection regions from a single image. Specular restoration process starts with generating a substitute specular-free image with RPCA method. Then the specular removed image was obtained by taking the binary weighting template of highlight regions as the weighting for merging the original specular image and the substitute image. The modified template was furthermore discussed for the concealment of artificial effects in the edge of specular regions. Experimental results on the removal of the endoscopic image with specular reflections demonstrate the efficiency of the proposed method comparing to the existing methods.

  19. Diode laser and endoscopic laser surgery. (United States)

    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.

  20. Endoscopic Optical Enhancement Technologies in IBD

    Directory of Open Access Journals (Sweden)

    Gian Eugenio Tontini


    Full Text Available Optical enhancement technologies are emerging as promising tools to improve diagnosis and clinical management of patients with inflammatory bowel diseases (IBD. The use of dye-based and dye-less chromoendoscopy may improve either characterisation of mucosal inflammation or detection of dysplastic and early neoplastic lesions. Confocal laser endomicroscopy and endocytoscopy both allow for in vivo and real-time microscopic analysis of the tissue. Moreover, the newly introduced molecular imaging has now also become feasible for in vivo diagnosis in IBD. This review focuses on the more recent progresses of advanced endoscopic imaging techniques in the setting of IBD and provides the reader with an updated overview on accepted clinical evidence and ongoing fields of research.

  1. MR-guided endoscopic sinus surgery. (United States)

    Hsu, L; Fried, M P; Jolesz, F A


    We describe an interactive, intraoperative imaging-guided method for performing endoscopic sinus surgery (ESS) within a vertically open MR system. The procedure was performed with intraoperative imaging using a 0.5-T magnet with a 56-cm vertical gap. Interactive control of imaging planes was accomplished by optical tracking with two infrared light-emitting diodes mounted on an aspirator probe. The probe's position defined the location of the orthogonal imaging planes. Twelve patients with varying degrees of sinus disease underwent ESS with MR imaging guidance. Patients had acute and chronic sinusitis, nasal polyposis causing airway obstruction, or tumor requiring tissue biopsy. All procedures were performed with the patients under general anesthesia. The integration of endoscopy with optical tracking and intraoperative interactive imaging allowed localization of anatomic landmarks during ESS. No complications were encountered.

  2. Quality of endoscopic surveillance of Barrett's esophagus

    DEFF Research Database (Denmark)

    Vogt, Jes Sefland; Larsen, Anders Christian; Sommer, Thorbjørn


    OBJECTIVES: The aim of this study was to evaluate adherence to Barrett's esophagus (BE) surveillance guidelines in Denmark. METHODS: The Danish Pathology Registry was used to identify 3692 patients. A total of 300 patients were included by drawing a simple random sample. Description of the BE seg......OBJECTIVES: The aim of this study was to evaluate adherence to Barrett's esophagus (BE) surveillance guidelines in Denmark. METHODS: The Danish Pathology Registry was used to identify 3692 patients. A total of 300 patients were included by drawing a simple random sample. Description...... with insufficient quality of BE surveillance. Lack of endoscopic evidence of BE in the Danish Pathology Registry may have underestimated the incidence of adenocarcinoma in BE patients in previous studies....

  3. Popliteal artery entrapment syndrome.

    LENUS (Irish Health Repository)

    O'Leary, D P


    Popliteal artery entrapment syndrome is a rare abnormality of the anatomical relationship between the popliteal artery and adjacent muscles or fibrous bands in the popliteal fossa. The following is a case report of a 19 year old female, in whom popliteal artery entrapment syndrome was diagnosed, and successfully treated surgically. A review of literature is also presented and provides details on how PAES is classified, diagnosed both clinically and radiologically, and treated surgically.

  4. Celiac Artery Compression Syndrome

    Directory of Open Access Journals (Sweden)

    Mohammed Muqeetadnan


    Full Text Available Celiac artery compression syndrome is a rare disorder characterized by episodic abdominal pain and weight loss. It is the result of external compression of celiac artery by the median arcuate ligament. We present a case of celiac artery compression syndrome in a 57-year-old male with severe postprandial abdominal pain and 30-pound weight loss. The patient eventually responded well to surgical division of the median arcuate ligament by laparoscopy.

  5. [Natural orifice transluminal endoscopic surgery: current situation]. (United States)

    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 revolution> 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.

  6. Endoscopic Management of Idiopathic Subglottic Stenosis. (United States)

    Shabani, Sepehr; Hoffman, Matthew R; Brand, William T; Dailey, Seth H


    To describe a homogeneous idiopathic subglottic stenosis (ISS) population undergoing endoscopic balloon dilation and evaluate factors affecting inter-dilation interval (IDI). Retrospective review of 37 patients. Co-morbidity prevalence versus normal population was evaluated using chi-square tests. Correlations were evaluated using Pearson product moment tests. Independent samples t tests/rank sum tests assessed differences between groups of interest. All patients were female aged 45.9 ± 15.4 years at diagnosis. Four required a tracheotomy during management. Most prevalent co-morbidity was gastroesophageal reflux disease (GERD) (64.9%; P = .036). Body mass indices (BMI) at first and most recent dilation were 29.8 and 30.8 ( P = .564). Degree of stenosis before first dilation was 53 ± 14%. Patients underwent 3.8 ± 1.8 dilations (range, 1-11). Average IDI was 635 ± 615 days (range, 49-3130 days), including 556 ± 397 days for patients receiving concomitant steroid injection and 283 ± 36 for those who did not ( P = .079). Inter-dilation interval was not correlated with BMI ( r = 0.0486; P = .802) or number of co-morbidities ( r = -0.225, P = .223). Most patients with ISS can be managed endoscopically, and IDI may be increased with steroid injection. Gastroesophageal reflux disease is a common co-morbidity. Body mass index did not change over time despite potential effects on exercise tolerance; BMI did not affect IDI. Methods to determine optimal timing for next intervention are warranted.

  7. Endoscopic ultrasound practice survey in latin america. (United States)

    Drigo, Juliana Marques; Castillo, Cecilia; Wever, Wallia; Obaldía, José Ricardo Ruíz; Fillipi, Sheila; Ribeiro, Manoel C S A; Rossini, Lucio G B


    Endoscopic ultrasound (EUS) has become an important imaging modality for the diagnosis, staging and treatment of gastrointestinal disorders. However, no official data exists regarding clinical EUS practice in Latin America (LA). This study assessed current EUS practice and training. A direct mail survey questionnaire was sent to 268 Capítulo Latino Americano de Ultrasonido Endoscópico members between August 2012 and January 2013. The questionnaire was sent out in English, Spanish and Portuguese languages and was available through the following site: Responses were requested only from physicians who perform EUS. A total of 70 LA physicians answered the questionnaire until January 2013. Most of the participants were under 42 years of age (53%) and 80% were men. Most participants (45.7%) perform EUS in Brazil, 53% work in a private hospital. The majority (70%) also perform endoscopic retrograde cholangiopancreatography. A total 42% had performed EUS for 2 years or less and 22.7% for 11 years or more. Only 10% performed more than 5000 EUS. The most common indication was an evaluation of pancreatic-biliary-ampullary lesions. Regarding training, 48.6% had more than 6 months of dedicated hands-on EUS and 37% think that at least 6 months of formal training is necessary to acquire competence. Furthermore, 64% think that more than 50 procedures for pancreatic-biliary lesions are necessary. This survey provides insight into the status of EUS in LA. EUS is performed mostly by young endoscopists in LA. Diagnostic upper EUS is the most common EUS procedure. Most endosonographers believe that formal training is necessary to acquire competence.

  8. Endoscopic inter laminar management of lumbar disease (United States)

    Yadav, Yad Ram; Parihar, Vijay; Kher, Yatin; Bhatele, Pushp Raj


    Discectomy for lumbar disc provides faster relief in acute attack than does conservative management. Long-term results of open, microscopy-, and endoscopy-assisted discectomy are same. Early results of endoscopy-assisted surgery are better as compared to that of open surgery in terms of better visualization, smaller incision, reduced hospital stay, better education, lower cost, less pain, early return to work, and rehabilitation. Although microscopic discectomy also has comparable advantages, endoscopic-assisted technique better addresses opposite side pathology. Inter laminar technique (ILT) and trans foraminal technique (TFT) are two main endoscopic approaches for lumbar pathologies. Endoscopy-assisted ILT can be performed in recurrent, migrated, and calcified discs. All lumbar levels including L5-S1 level, intracanalicular, foraminal disc, lumbar canal and lateral recess stenosis, multiple levels, and bilateral lesions can be managed by ILT. Migrated, calcified discs, L5-S1 pathology, lumbar canal, and lateral recess stenosis can be better approached by ILT than by TFT. Most spinal surgeons are familiar with anatomy of ILT. It can be safely performed in foramen stenosis and in uncooperative and anxious patients. There is less risk of exiting nerve root damage, especially in short pedicles and in presence of facet osteophytes as compared to TFT. On the other hand, ILT is more invasive than TFT with more chances of perforations of the dura matter, pseudomeningocele formation, and cerebrospinal fluid fistula in early learning curve. Obtaining microsurgical experience, attending workshops, and suitable patient selection can help shorten the learning curve. Once adequate skill is acquired, this procedure is safe and effective. The surgeon must be prepared to convert to an open procedure, especially in early learning curve. Spinal endoscopy is likely to achieve more roles in future. Endoscopy-assisted ILT is a safer alternative to the microscopic technique. PMID

  9. Endoscopic coverage of fetal myelomeningocele in utero. (United States)

    Bruner, J P; Richards, W O; Tulipan, N B; Arney, T L


    Our goal was to evaluate the safety and efficacy of minimally invasive surgery for the coverage of myelomeningocele in utero. Women in the mid-second trimester of a pregnancy complicated by fetal myelomeningocele were offered an experimental procedure designed to prevent ongoing exposure of the spinal cord to the intrauterine environment. The procedure consisted of maternal laparotomy while the patient was under both general and epidural anesthesia, with exposure of the gravid uterus. Endoscopic ports were placed for camera and operating instruments. Amniotic fluid was removed and replaced with carbon dioxide. The fetus was then positioned and a maternal split-thickness skin graft was placed over the exposed spinal cord or neural elements. The skin graft and a covering of Surgicel Absorbable Hemostat were attached with fibrin glue prepared from autologous cryoprecipitate. Four fetuses with open myelomeningocele underwent endoscopic coverage of the spinal lesion between 22 weeks 3 days and 24 weeks 3 days of gestation. One infant, delivered by planned cesarean section at 35 weeks' gestation after demonstration of fetal lung maturity, is almost 3 years old. A second infant was delivered by cesarean section at 28 weeks after preterm labor and is now almost 6 months old. Both survivors manifest only mild motor and somatosensory deficits. One fetus who was delivered 1 week after operation after development of amnionitis died in the delivery room of extreme prematurity. The final fetus died intraoperatively from abruptio placentae. Minimally invasive fetal surgery appears to constitute a feasible approach to nonlethal fetal malformations that result in progressive and disabling organ damage.

  10. Renal Branch Artery Stenosis

    DEFF Research Database (Denmark)

    Andersson, Zarah; Thisted, Ebbe; Andersen, Ulrik Bjørn


    Renovascular hypertension is a common cause of pediatric hypertension. In the fraction of cases that are unrelated to syndromes such as neurofibromatosis, patients with a solitary stenosis on a branch of the renal artery are common and can be diagnostically challenging. Imaging techniques...... that perform well in the diagnosis of main renal artery stenosis may fall short when it comes to branch artery stenosis. We report 2 cases that illustrate these difficulties and show that a branch artery stenosis may be overlooked even by the gold standard method, renal angiography....

  11. Atherosclerotic femoral artery aneurysms

    DEFF Research Database (Denmark)

    Levi-Mazloum, Niels Donald; Schroeder, T V


    Based on a clinical suspicion of an increase in the proportion of deep femoral aneurysms, we reviewed the case records of patients who underwent reconstructive procedures for femoral aneurysms to investigate if this could be confirmed and explained by selection of patient or modality of diagnosis...... femoral artery and 3 the deep femoral artery. The proportion of deep femoral aneurysm was therefore 3/17 = 18%. Previous series report that aneurysms of the profunda femoris artery occurs in only 1% to 2.6% of all femoral artery aneurysms. No explanation was found for this significant increase (p

  12. Anaesthetic management of endoscopic resection of juvenile ...

    African Journals Online (AJOL)

    Two patients had preoperative embolisation of the feeding vessel. Standard anaesthesia induction technique, together with invasive monitoring, was used. Controlled hypotension (mean arterial pressure of 60 ± 5 mmHg) was achieved with the help of inhalational anaesthetics, vasodilators and beta blockers. Mean duration ...

  13. MEMS ultrasonic probe rotary scanning imaging system for medical endoscope (United States)

    Chen, Xiaodong; Wen, Shijie; Yu, Daoyin


    Medical ultrasonic endoscope is the combination of electronic endoscope and ultrasonic sensor technology. Ultrasonic endoscope sends the ultrasonic probe into coelom through the biopsy channel of an electronic endoscope and rotates it by a micro motor, acquiring fault histology features of digestive organs. Compared with external ultrasonic detection, the system reduces the distance between the transducer and the organ, diminishing the effects on imaging of fats and body cavity gas. On the basis of ultrasonic imaging system, this paper implements a pulse echo imaging system. We describe the ultrasonic probe, emission circuit, receiving circuit and protective circuit in detail. With the demodulation circuit, we get the amplitude of echo which indicates the objects. And to achieve the rotary scan, we design a synchronous control circuit and a data transfer circuit basing on the USB2.0 interface. Finally we get a grey image with 256 grey levels after coordinate conversion.

  14. Diversion neovaginitis after sigmoid vaginoplasty: endoscopic and clinical characteristics

    NARCIS (Netherlands)

    Sluis, W.B. van der; Bouman, M.B.; Meijerink, W.J.H.J.; Elfering, L.; Mullender, M.G.; Boer, N.K. de; Bodegraven, A.A. van


    OBJECTIVE: To assess the endoscopic characteristics of the sigmoid-derived neovagina, which have been scarcely described. DESIGN: Prospective observational study. SETTING: University tertiary medical center. PATIENT(S): Patients that underwent sigmoid vaginoplasty. INTERVENTION(S): Patients were

  15. Endoscopic Thermal Fasciotomy for Chronic Exertional Compartment Syndrome. (United States)

    Voleti, Pramod B; Lebrun, Drake G; Roth, Cameron A; Kelly, John D


    Chronic exertional compartment syndrome is an activity-induced condition that occurs when intracompartmental pressures within an osteofascial envelope increase during exercise, leading to reversible ischemic symptoms such as pain, cramping, numbness, or weakness. Nonoperative treatment options for this condition have shown limited success and are often undesirable for the patient given the requirement for activity modification. Traditional surgical treatment options involving open or subcutaneous fasciotomies have more favorable results, but these techniques are associated with significant morbidity. Endoscopically assisted fasciotomy techniques afford the advantages of being minimally invasive, providing excellent visualization, and allowing accelerated rehabilitation. The purpose of this article is to describe a technique for performing endoscopically assisted fasciotomies for chronic exertional compartment syndrome of the lower leg using an entirely endoscopic thermal ablating device. The endoscopic thermal fasciotomy technique is associated with minimal morbidity, ensures excellent hemostasis, and affords an early return to sports.

  16. Endoscopic Thermal Fasciotomy for Chronic Exertional Compartment Syndrome (United States)

    Voleti, Pramod B.; Lebrun, Drake G.; Roth, Cameron A.; Kelly, John D.


    Chronic exertional compartment syndrome is an activity-induced condition that occurs when intracompartmental pressures within an osteofascial envelope increase during exercise, leading to reversible ischemic symptoms such as pain, cramping, numbness, or weakness. Nonoperative treatment options for this condition have shown limited success and are often undesirable for the patient given the requirement for activity modification. Traditional surgical treatment options involving open or subcutaneous fasciotomies have more favorable results, but these techniques are associated with significant morbidity. Endoscopically assisted fasciotomy techniques afford the advantages of being minimally invasive, providing excellent visualization, and allowing accelerated rehabilitation. The purpose of this article is to describe a technique for performing endoscopically assisted fasciotomies for chronic exertional compartment syndrome of the lower leg using an entirely endoscopic thermal ablating device. The endoscopic thermal fasciotomy technique is associated with minimal morbidity, ensures excellent hemostasis, and affords an early return to sports. PMID:26900549

  17. Pattern of Endoscopic Findings of Upper Gastrointestinal Tract in ...

    African Journals Online (AJOL)

    UGT) including gastro esophageal reflux (GERD), peptic ulcer diseases (PU), and upper gastrointestinal malignancies was not studied recently in Sudan. Objectives: The aim of this study is to know the pattern of endoscopic findings of upper ...

  18. Per-oral endoscopic myotomy (POEM) for esophageal achalasia. (United States)

    Pescarus, Radu; Shlomovitz, Eran; Swanstrom, Lee L


    Per-oral endoscopic myotomy (POEM) is a new minimally invasive endoscopic treatment for achalasia. Since the first modern human cases were published in 2008, around 2,000 cases have been performed worldwide. This technique requires advanced endoscopic skills and a learning curve of at least 20 cases. POEM is highly successful with over 90 % improvement in dysphagia while offering patients the advantage of a low impact endoscopic access. The main long-term complication is gastroesophageal reflux (GER) with an estimated incidence of 35 %, similar to the incidence of GER post-laparoscopic Heller with fundoplication. Although POEM represents a paradigm shift in the treatment of achalasia, more long-term data are clearly needed to further define its role in the treatment algorithm of this rare disease.

  19. Treatment Strategy after Incomplete Endoscopic Resection of Early Gastric Cancer (United States)

    Kim, Sang Gyun


    Endoscopic resection of early gastric cancer is defined as incomplete when tumor cells are found at the resection margin upon histopathological examination. However, a tumor-positive resection margin does not always indicate residual tumor; it can also be caused by tissue contraction during fixation, by the cautery effect during endoscopic resection, or by incorrect histopathological mapping. Cases of highly suspicious residual tumor require additional endoscopic or surgical resection. For inoperable patients, argon plasma coagulation can be used as an alternative endoscopic treatment. Immediately after the incomplete resection or residual tumor has been confirmed by the pathologist, clinicians should also decide upon any additional treatment to be carried out during the follow-up period. PMID:27435699

  20. [Current options for percutaneous endoscopic access to the digestive tract

    NARCIS (Netherlands)

    Romkens, T.E.H.; Jong, D.J. de; Kristinsson, J.O.; Wanten, G.J.A.


    Four patients, aged 67, 52, 56 and 64 years, respectively, undergoing percutaneous colostomy or jejunostomy are presented to illustrate current options for percutaneous endoscopic access to the digestive tract. The first patient had Parkinson's disease and required percutaneous jejunostomy for

  1. Percutaneous endoscopic lumbar discectomy: Results of first 100 cases

    National Research Council Canada - National Science Library

    Kanthila Mahesha


      Background: Lumbar disc herniation is a major cause of back pain and sciatica. The surgical management of lumbar disc prolapse has evolved from exploratory laminectomy to percutaneous endoscopic discectomy...


    Directory of Open Access Journals (Sweden)

    A. O. Guz


    Full Text Available Squamous cell head and neck carcinoma is frequently associated with dysphagia. An adequate enteral nutrition is the key to successful treatment and rehabilitation of these patients. Percutaneous endoscopic gastrostomy is the preferred route of feeding and nutritional support in head and neck cancer patients with dysphagia. We report a rare case of implantation metastasis of laryngeal cancer following percutaneous endoscopic gastrostomy. Our experience in treating this complication has been described. Percutaneous endoscopic gastrostomy is a less-invasive procedure than open gastrostomy. Percutaneous endoscopic gastrostomy can be accompanied by severe complications such as implantation metastasis at gastrostomy site. Careful monitoring can provide early detection of this complication and early treatment. 

  3. Endoscopically assisted craniosynostosis surgery (EACS): The craniofacial team Nijmegen experience

    NARCIS (Netherlands)

    Delye, H.H.K.; Arts, S.; Borstlap, W.A.; Blok, L.M.; Driessen, J.J.; Meulstee, J.W.; Maal, T.J.J.; Lindert, E.J. van


    INTRODUCTION: An evaluation of our first 111 consecutive cases of non-syndromic endoscopically assisted craniosynostosis surgery (EACS) followed by helmet therapy. METHODS: Retrospective analysis of a prospective registration database was performed. Age, duration of surgery, length of hospital stay,

  4. Mimicking disinfection and drying of biofilms in contaminated endoscopes

    NARCIS (Netherlands)

    Kovaleva, J.; Degener, J. E.; van der Mei, H. C.


    The effects of peracetic acid-based (PAA) disinfectant with, and without, additional drying on Candida albicans, Candida parapsilosis, Pseudomonas aeruginosa and Stenotrophomonas maltophilia, isolated from contaminated flexible endoscopes, in single-and dual-species biofilms were studied. Biofilms

  5. [Experience of managing substernal goiter by totally endoscopic procedure]. (United States)

    Fan, Qing; Gong, Ke; Zhu, Bin; Zhang, Neng-wei


    To summarize the experience of managing substernal goiter by totally endoscopic procedure and evaluate the curative effect, we analysed eight patients diagnosed as substernal goiter type I and treated with totally endoscopic technique via central routing approach during March 2011 to June 2013 in Beijing Shijitan Hospital retrospectively. The feasibility, safety and curative effect of this surgical technique were estimated. All the cases were successfully operated with the totally endoscopic procedure, and the pathological result showed that 6 were goiter and the other 2 were minimal papillary carcinoma. None of the patients suffered from any complication, and the median follow up time was 6 months (1-28 months). The totally endoscopic technique is a feasible, safe and cosmic one for managing substernal goiter type I.

  6. Electrocardiographic Changes in Elderly Patients During Endoscopic Retrograde Cholangiopancreatography

    Directory of Open Access Journals (Sweden)

    NG Kounis


    Full Text Available BACKGROUND: Cardiorespiratory complications may occur during gastrointestinal endoscopy, and elderly people seem to be more vulnerable to these complications during endoscopic procedures involving the manipulation of abdominal viscera. OBJECTIVES: To determine the incidence of cardiac arrhythmias, changes in oxygen saturation, heart rate and blood pressure during endoscopic retrograde cholangiopancreatography (ERCP via Holter monitoring in elderly patients older than 70 years of age.

  7. Evaluation of four commercial automatic endoscope washing machines. (United States)

    Lynch, D A; Porter, C; Murphy, L; Axon, A T


    Four commercially available endoscope washing machines (Pyser System 83, Wolf Fiberscope Disinfector, Olympus EW20, Keymed Auto-Disinfector) were evaluated. In most cases the machines were expensive, immobile and noisy, and could only wash one endoscope per cycle. Daily use involved repetitive chores and contact with glutaraldehyde. Disinfection procedures were flawed; no machine auto-disinfected adequately. In conclusion, these machines are unsatisfactory and represent a potential source of serious infection.

  8. Surgical versus endoscopic treatment of bile duct stones

    DEFF Research Database (Denmark)

    Martin, D J; Vernon, D R; Toouli, J


    10% to 18% of patients undergoing cholecystectomy for gallstones have common bile duct (CBD) stones. Treatment options for these stones include pre- or post-operative endoscopic retrograde cholangiopancreatography (ERCP) or open or laparoscopic surgery.......10% to 18% of patients undergoing cholecystectomy for gallstones have common bile duct (CBD) stones. Treatment options for these stones include pre- or post-operative endoscopic retrograde cholangiopancreatography (ERCP) or open or laparoscopic surgery....

  9. Postoperative complications following percutaneous endoscopic gastrostomy are common in children

    DEFF Research Database (Denmark)

    Halvard Hansen, Erik Sören; Qvist, N.; Rasmussen, L.


    Aim: Inserting a feeding tube using percutaneous endoscopic gastrostomy may be necessary to ensure that children with eating problems receive sufficient enteral nutrition. The aim of this study was to investigate the perioperative and postoperative complications of percutaneous endoscopic...... were grade 3b complications. No gastrostomy-related deaths were observed, and no single preoperative risk factor was identified. Perioperative complications were experienced by 2.6% of the patients. Conclusion: Gastrostomy feeding tube placement was associated with a high rate of postoperative...



    GALVÃO-NETO,Manoel dos Passos; GRECCO,Eduardo; de Souza, Thiago Ferreira; Luiz Gustavo de QUADROS; SILVA, Lyz Bezerra; CAMPOS, Josemberg Marins


    ABSTRACT Background: Less invasive and complex procedures have been developed to treat obesity. The successful use of Endoscopic Sleeve Gastroplasty using OverStitch(r) (Apollo Endosurgery, Austin, Texas, USA) has been reported in the literature. Aim: Present technical details of the procedure and its surgical/ endoscopic preliminary outcome. Method: The device was used to perform plications along the greater curvature of the stomach, creating a tubulization similar to a sleeve gastrect...

  11. The optimal endoscopic screening interval for detecting early gastric neoplasms. (United States)

    Park, Chan Hyuk; Kim, Eun Hye; Chung, Hyunsoo; Lee, Hyuk; Park, Jun Chul; Shin, Sung Kwan; Lee, Yong Chan; An, Ji Yeong; Kim, Hyoung-Il; Cheong, Jae-Ho; Hyung, Woo Jin; Noh, Sung Hoon; Kim, Choong Bae; Lee, Sang Kil


    The optimal interval between endoscopic examinations for detecting early gastric neoplasms, including gastric adenomas, has not previously been studied. To clarify the optimal interval between endoscopic examinations for the early diagnosis of both gastric cancers and adenomas. Retrospective study. University-affiliated tertiary-care hospital, Seoul, Korea. Patients who were treated for gastric neoplasms between January 2008 and August 2013. Questionnaire survey for interval between the penultimate endoscopy and diagnosis of a gastric neoplasm. A total of 846 patients were divided into 5 groups according to the interval between endoscopic examinations. The proportion of gastric neoplasms treated with endoscopic submucosal dissection and the proportion of advanced gastric cancers according to the interval between endoscopic examinations. In total, 197, 430, and 219 patients were diagnosed with gastric adenoma, early gastric cancer, and advanced gastric cancer, respectively. In multivariate analysis, the proportion of gastric neoplasms treated with endoscopic submucosal dissection was significantly higher in the ≤12 months, 12 to 24 months, and 24 to 36 months endoscopy interval groups than in the no endoscopy within 5 years group (all P gastric cancers was significantly lower in the ≤12 months and 12 to 24 months endoscopy interval groups than in the no endoscopy within 5 years group (all P gastric neoplasms compared with biennial or triennial endoscopy. We recommend biennial endoscopic screening for gastric neoplasms in order to increase the proportion of lesions discovered while they are still endoscopically treatable and to reduce the number of lesions that progress to advanced gastric cancer. Copyright © 2014 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.

  12. Mortality reduction from gastric cancer by endoscopic and radiographic screening


    Hamashima, Chisato; Shabana, Michiko; Okada, Katsuo; Okamoto, Mikizo; Osaki, Yoneatsu


    To evaluate mortality reduction from gastric cancer by endoscopic screening, we undertook a population?based cohort study in which both radiographic and endoscopic screenings for gastric cancer have been carried out. The subjects were selected from the participants of gastric cancer screening in two cities in Japan, Tottori and Yonago, from 2007 to 2008. The subjects were defined as participants aged 40?79 years who had no gastric cancer screening in the previous year. Follow?up of mortality ...

  13. Sedation Monitoring and Management during Percutaneous Endoscopic Lumbar Discectomy


    Menekse Oksar; Tulin Gumus; Orhan Kanbak


    Percutaneous endoscopic laser discectomy (PELD) is a painful intervention that requires deep sedation and analgesia. However, sedation should be light at some point because cooperation by the patient during the procedure is required for successful surgical treatment. Light sedation poses a problem for endotracheal intubation, while patients placed in the prone position during percutaneous endoscopic discectomy pose a problem for airway management. Therefore, under these conditions, sedation s...

  14. Percutaneous endoscopic lumbar discectomy: Results of first 100 cases


    Kanthila Mahesha


    Background: Lumbar disc herniation is a major cause of back pain and sciatica. The surgical management of lumbar disc prolapse has evolved from exploratory laminectomy to percutaneous endoscopic discectomy. Percutaneous endoscopic discectomy is the least invasive procedure for lumbar disc prolapse. The aim of this study was to analyze the clinical outcome, quality of life, neurologic function, and complications. Materials and Methods: One hundred patients with lumbar disc prolapse who wer...



    Guz, A. O.; A. S. Zakharov; A. V. Garev


    Squamous cell head and neck carcinoma is frequently associated with dysphagia. An adequate enteral nutrition is the key to successful treatment and rehabilitation of these patients. Percutaneous endoscopic gastrostomy is the preferred route of feeding and nutritional support in head and neck cancer patients with dysphagia. We report a rare case of implantation metastasis of laryngeal cancer following percutaneous endoscopic gastrostomy. Our experience in treating this complication has been de...

  16. Endoscopic and radiological diagnostics of esophagus diseases in dogs


    Krstić Vanja; Krstić Nikola


    In order to expand the range of diagnostic methods for determining diseases of the esophagus and to make them more present in everyday practise, it is desirable to work out in more detail the procedure of endoscopic and radiological examinations, determine their limitations and possibilities, describe the topographic-anatomical and morphological status of the esophagus in an endoscopic and radiological picture, as well as to define which diseases of this organ are most represented. The paper ...

  17. Endoscopic digital holography for measuring flows in opaque vessels (United States)

    Arévalo, Laura; Palero, Virginia; Lobera, Julia; Arroyo, M. Pilar


    In this work a new application of digital holography for the study of cardio vascular diseases is proposed. The simultaneous measurement of the blood flow velocity and the vein wall deformation can be obtained by combining digital holography and endoscopy. Endoscopes are used for the illumination and recording of digital holograms inside a vein model. Two different endoscopes have been used in different vein models in order to test the technique performance. Preliminary results of flow velocity and wall deformation are presented.

  18. Endoscopic Diagnosis of Leiomyosarcoma of the Esophagus, a Rare Neoplasm


    Ravini, Mario; Torre, Massimo; Zanasi, Giulio; Vanini, Marco; Camozzi, Mario


    We report a case of leiomyosarcoma of the distal third of the esophagus in a 51-year-old woman presenting with a six-month history of severe epigastric pain, disphagia and weight loss. The diagnosis, suspected on endoscopic examination, was preoperatively acheived by biopsy and immunohistological stain. Surgical treatment was undertaken with good results. Differentiation between leiomyosarcoma and more common esophageal neoplasm may be difficult if based on radiographic and endoscopic appeara...

  19. Endoscopic submucosal dissection in Spain: outcomes and development possibilities

    Directory of Open Access Journals (Sweden)

    Juan J. Vila


    Full Text Available Endoscopic submucosal dissection (ESD allows endoscopic, curative, en-bloc resection of superficial malignant or premalignant lesions. This procedure was conceived over 10 years ago in Japan, but has not experienced great expansion in Western countries for different reasons. This article reviews ESD indications and outcomes, and reflects on the reasons that prevent ESD from becoming common clinical practice in Western hospitals. Finally, recommendations on ESD training in our setting are made.

  20. Endoscopic resection for gastric schwannoma with long-term outcomes. (United States)

    Cai, Ming-Yan; Xu, Jia-Xin; Zhou, Ping-Hong; Xu, Mei-Dong; Chen, Shi-Yao; Hou, Jun; Zhong, Yun-Shi; Zhang, Yi-Qun; Ma, Li-Li


    Gastric schwannoma is not so recognized by clinicians as its counterparts. The efficacy of endoscopic resection has not been described yet. Our aim was to assess the efficacy and safety of endoscopic resection in the management of gastric schwannoma. Retrospective data were reviewed from January 2008 to December 2013 in our center. Fourteen patients who had endoscopic resection with the final pathology result of gastric schwannoma were included in the study. Of the 14 patients, there were 12 females and two males. The median age was 59 years (range 32-83). Thirteen tumors (92.9 %) were from the muscularis propria and one located in the submucosa. Endoscopic en bloc resection was achieved in 12 patients (12/14, 85.7 %), including seven cases of endoscopic full-thickness resection (EFTR). The mean resected tumor size was 1.73 ± 1.10 cm (range 0.3-4.0 cm). In one case, endoscopic resection was suspended due to the limited experience of EFTR during the early period of the study. In another case, due to the difficult tumor location (gastric angle) and extraluminal growth pattern, the patient was referred to laparoscopic surgery. In the 12 successful endoscopic resection cases, during the median follow-up time of 4 years (range 17-77 months, one patient lost), no tumor residue, recurrence or metastasis was found. Endoscopic resection is safe and effective in treating gastric schwannoma with excellent long-term outcomes. However, it should be performed with caution because schwannoma is mainly located in the deep muscular layer, which leads to the full-thickness resection of gastric wall.

  1. Bilateral retinal hemorrhage after endoscopic third ventriculostomy: iatrogenic Terson syndrome. (United States)

    Hoving, Eelco W; Rahmani, Mehrnoush; Los, Leonie I; Renardel de Lavalette, Victor W


    A serious ophthalmological complication of an endoscopic third ventriculostomy that created an iatrogenic Terson syndrome is described. A patient with an obstructive hydrocephalus was treated endoscopically, but due to the inadvertent use of a pressure bag during rinsing, in combination with a blocked outflow channel, a steep rise in intracranial pressure occurred. Postoperatively the patient experienced disturbed vision caused by bilateral retinal hemorrhages, and an iatrogenic Terson syndrome was diagnosed. The pathogenesis of Terson syndrome is discussed based on this illustrative case.

  2. Minimally invasive (endoscopic-computer assisted) surgery: Technique and review


    Kumar, Anand; Yadav, Nirma; Singh, Shipra; Chauhan, Neha


    Endoscopic or minimally invasive surgery popular as keyhole surgery is a medical procedure in which endoscope (a camera) is used, and it has gained broad acceptance with popularity in several surgical specialties and has heightened the standard of care. Oral and maxillofacial surgery is a modern discipline in the field of dentistry in which endoscopy has developed as well as widely used in surgeries and is rapidly gaining importance. The use of different visual as well as standard instruments...

  3. Endoscopic classification of representations of quasi-split unitary groups

    CERN Document Server

    Mok, Chung Pang


    In this paper the author establishes the endoscopic classification of tempered representations of quasi-split unitary groups over local fields, and the endoscopic classification of the discrete automorphic spectrum of quasi-split unitary groups over global number fields. The method is analogous to the work of Arthur on orthogonal and symplectic groups, based on the theory of endoscopy and the comparison of trace formulas on unitary groups and general linear groups.

  4. Endoscopic therapy for gastrointestinal bleeding after liver transplantation

    Directory of Open Access Journals (Sweden)

    LIU Bo


    Full Text Available Objective To investigate the clinical effect of endoscopic therapy for patients with esophagogastric variceal bleeding (EVB after liver transplantation. Methods A retrospective analysis was performed for the clinical data of 8 patients who experienced EVB after liver transplantation and underwent endoscopic therapy, especially endoscopic features. The clinical outcome was evaluated, including hemostasis rate, change in varicose veins after treatment, and short-term recurrence and bleeding rate. Results The eight patients had a mean age of 55.00(44.75-61.50 years, and the mean time from liver transplantation to bleeding was 71.50(18.75-107.25 months. As for primary diseases, 6 patients had hepatitis B cirrhosis (among whom one patient each was complicated by liver cancer, alcoholic cirrhosis, and acute liver necrosis, and three were complicated by subacute liver necrosis, one had hepatitis C cirrhosis, and one had unexplained liver cirrhosis. Of all patients, 2 underwent sclerotherapy, 6 underwent endoscopic variceal ligation, and 6 underwent tissue adhesive treatment. The endoscopic therapy achieved successful hemostasis in all patients. No patients experienced rebleeding at discharge or the 12-month follow-up visit. One patient underwent selective endoscopic therapy due to the recurrence of varices. Conclusion Gastrointestinal bleeding remains a serious complication after liver transplantation. Besides antiviral therapy, the presence of varices should be closely monitored.

  5. Outcomes following Purely Endoscopic Endonasal Resection of Pituitary adenomas

    Directory of Open Access Journals (Sweden)

    Rezaul Amin


    Full Text Available Background: The use of endoscope for the management of pituitary adenoma is not new. The better magnification and illumination provided by the endoscope gives better outcome than microscopic pituitary surgery. Objective: To find out the benefits of endoscope in relation to microscopic surgery. Materials and Methods: We performed 45 cases of pituitary adenoma surgery by endoscopic endonasal approach from July 2008 to July 2010. Results: Forty five cases underwent endoscopic transsphenoidal approach. Gross total removal was done in 35 cases and subtotal removal was done in 10 cases. Residual tumours were seen in 10 cases (22% in postoperative follow-up MRI scan. Visual improvement was satisfactory, and hormonal improvement of functional adenoma was nice. Postoperative visual acuity and visual field were improved in 75% cases. There were 37% cases of temporary diabetes insipidus and about 4.5% cases of permanent diabetes insipidus. The average duration of follow-up was 20 months. One patient required reexploration to correct visual deterioration in the immediate postoperative period. There were 4.5% cases of CSF leak and 6.6% mortality. Mortality was due to electrolyte imbalance and improper management of infection and hydrocephalus. Conclusion: Endoscopic endonasal pituitary surgery now has become a gold standard surgery for most of the pituitary adenomas because of its better advantages in relation to microscopic surgery and less complications and less hospital stay.

  6. Endoscopic Therapeutic Approach for Dysplasia in Inflammatory Bowel Disease. (United States)

    Hong, Sung Noh


    Long-standing intestinal inflammation in patients with inflammatory bowel disease (IBD) induces dysplastic change in the intestinal mucosa and increases the risk of subsequent colorectal cancer. The evolving endoscopic techniques and technologies, including dye spraying methods and high-definition images, have been replacing random biopsies and have been revealed as more practical and efficient for detection of dysplasia in IBD patients. In addition, they have potential usefulness in detailed characterization of lesions and in the assessment of endoscopic resectability. Most dysplastic lesions without an unclear margin, definite ulceration, non-lifting sign, and high index of malignant change with suspicion for lymph node or distant metastases can be removed endoscopically. However, endoscopic resection of dysplasia in chronic IBD patients is usually difficult because it is often complicated by submucosal fibrosis. In patients with dysplasias that demonstrate submucosa fibrosis or a large size (≥20 mm), endoscopic submucosal dissection (ESD) or ESD with snaring (simplified or hybrid ESD) is an alternative option and may avoid a colectomy. However, a standardized endoscopic therapeutic approach for dysplasia in IBD has not been established yet, and dedicated specialized endoscopists with interest in IBD are needed to fully investigate recent emerging techniques and technologies.

  7. [Treatment of pain in chronic pancreatitis by an endoscopic method]. (United States)

    Seicean, Andrada; Burtin, Pascal; Boyer, Jean; Pascu, Oliviu


    The epigastric pain is the most frequent manifestation in chronic pancreatitis. It is due to intraductal pancreatic pressure, presence of compressive pseudocysts and probably to neuroinflammatory process caused by alcohol. The aim of our study was to assess the influence of endoscopic treatment on pain in chronic pancreatitis and the correlation between residual pain after endoscopic treatment and pancreatic morphology. Forty-four patients from the Gastroenterology Department of Angers (France) with chronic pancreatitis were included in our retrospective clinical study. Thirty-seven patients underwent a diagnostic ERCP and only 28 needed an endoscopic treatment. The pain was evaluated semi-quantitatively before and after the endoscopic treatment. The mean follow-up was 28.6 months. Among the 28 patients with endoscopic treatment, 18 had a complete improvement of the pain, 4 an incomplete improvement and 6 had no improvement; these last were submitted to pancreatic surgery. The pain evolution had a good correlation with the reduction of Wirsung diameter; there was no correlation with ductal stenosis, residual lithiasis and pseudocysts presence. Alcohol consumption had no influence on the pain evolution. The endoscopic treatment of intraductal lithiasis and pseudocysts is a useful method for Wirsung decompression, improving the pain in chronic pancreatitis.

  8. Postoperative seizure following transforaminal percutaneous endoscopic lumbar discectomy (United States)

    Kertmen, Hayri; Gürer, Bora; Yilmaz, Erdal Resit; Sekerci, Zeki


    Endoscopic surgery for lumbar disc herniation has been available for more than 30 years. Transforaminal percutaneous endoscopic lumbar discectomy is a well-known, safe, and effective method used for the treatment of the lumbar disc herniation. The published complications of the transforaminal percutaneous endoscopic lumbar discectomy consist of infections, thrombophlebitis, dysesthesia, dural tear, vascular injury, and death. Seizure after transforaminal percutaneous endoscopic lumbar discectomy is an extremely rare complication. A 20-year-old patient applied at our department who had undergone transforaminal percutaneous endoscopic lumbar. During the procedure, while performing the discography, non-ionic contrast media was administered into the thecal sac inadvertently. Two hours after surgery, the patient developed generalized tonic-clonic seizure of 5-min duration. Diagnosis of iohexol-induced seizure was made and the patient was treated supportively without anti-epileptics. Here we present the first case of seizure after transforaminal percutaneous endoscopic lumbar discectomy, which was caused by inadvertent administration of the contrast media into the thecal sac. PMID:27695562

  9. Refractory gastric antral vascular ectasia: a new endoscopic approach. (United States)

    Zulli, C; Del Prete, A; Romano, M; Esposito, F; Amato, M R; Esposito, P


    Gastric antral vascular ectasia (GAVE) is an uncommon disorder observed in patients with liver cirrhosis, causing upper gastro-intestinal haemorrhage. GAVE is diagnosed through esophagogastroduodenoscopy and is characterized by the presence of visible columns of red tortuous enlarged vessels along the longitudinal folds of the antrum (i.e., so-called watermelon stomach). Pharmacological, endoscopic and surgical approaches have been proposed for the treatment of GAVE. Endoscopy represents the gold standard for GAVE treatment. The most widely used endoscopic approach is represented by Neodymium:yttrium-aluminum-garnet (Nd:YAG) laser. Argon plasma coagulation (APC) has been proven to be more efficient in terms of costs and complication rates than and equally effective as Nd:YAG. Other endoscopic procedures proposed for this treatment are banding ligature (EBL) and sclerotherapy with Polidocanol. Refractory GAVE represents a therapeutic challenge because it may cause persistent anemia, often leading to repeated blood transfusions due to the inefficacy of pharmacological and endoscopic therapeutic approaches. Endoscopic band ligation (EBL) has been shown to be superior to APC in the treatment of refractory GAVE. Surgical antrectomy by Billroth I anastomosis can be considered in selected cases. In this study, we report a successful endoscopic treatment of refractory GAVE by using a combination of submucosal injection of 1% Polidocanol at the four antral quadrants and subsequent application of APC on the visible antral lesions in two patients.

  10. Endoscopic features of gastrointestinal tuberculosis and crohn's disease

    Directory of Open Access Journals (Sweden)

    Praneeth Moka


    Full Text Available Endoscopic examination of the gastrointestinal (GI tract plays a very important role in the diagnosis and follow-up of patients with Crohn's disease (CD and intestinal tuberculosis (TB. The clinical, morphological, and histological features of GI TB and CD are so similar that it becomes difficult to differentiate between these two entities. In geographical regions such as India where both GI TB and CD are prevalent, differential diagnosis between the two is challenging. While there is a lot of similarities between these two disorders, these two can be differentiated from each other with a combination of clinical, endoscopic, histological, radiological, and endoscopic features. The observation of the characteristic lesions at endoscopic examination and the extent of involvement in CD and intestinal TB is an important step in differentiation between these two disorders. While the most important endoscopic characteristics such as involvement of left side of the colon and presence of longitudinal ulcerations and cobblestoning support a diagnosis of CD, predominant involvement of ileocecal region and transverse ulcers support the diagnosis of intestinal TB. In this review, we have described the usefulness and limitations of endoscopic modalities in the diagnosis and differentiation of intestinal TB and CD.

  11. Endoscopical appearances of nonsteroidal anti inflammatory drug (NSAID- enteropathy

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    Marcellus Simadibrata


    Full Text Available Non Steroidal Anti Inflammatory Drugs (NSAID have been associated with a sudden and sustained rise in the incidence of gastrointestinal ulcer complications. The aim of the study was to reveal the endoscopical abnormalities found in the duodenum & proximal jejunum due to NSAID. Thirty eight patients taking NSAID for their arthritis or rheumatism were included in this study. Gastro-duodeno-jejunoscopy was done with Olympus PCF-10. The endoscopical appearances of NSAID entero gastropathy were evaluated with a scoring system. The NSAID-entero-gastropathy appearances were endoscopically seen as hyperemia, erosion and ulcer. From all patient recruited, 7.9% complaint of diarrhea and 71.1% complaint of dyspepsia. Endoscopically, in the duodenal bulb we found 79% cases of hyperemia, 39.5% cases of erosion and 7.9% cases of ulcer. In the second part (descending part of the duodenum we found 28.9% cases of hyperemia, 15.8% cases of erosion and 2.6% case of ulcer. In the jejunum, we found 7.9% cases of hyperemia, 2.6% case of erosion and no ulcer. It is concluded that the most frequent abnormal endoscopical appearances in NSAID- enteropathy was hyperemia. The most frequent site of NSAID-enteropathy abnormal findings was in the duodenal bulb. (Med J Indones 2005; 14: 225-9Keywords: NSAID-enteropathy, endoscopical appearances.

  12. Modified technique for common carotid artery transposition in standing horses. (United States)

    Tapio, Heidi; Argüelles, David; Gracia-Calvo, Luis A; Raekallio, Marja


    To describe a modified technique for permanent translocation of the common carotid artery (CCA) to a subcutaneous position in standing horses. Experimental study. Healthy adult Standardbred and Warmblood horses (n = 8). Surgery was performed with the horses standing under sedation and with local anesthesia. A combination of previously described techniques was used modifying the approach and closure of the incision. The right CCA was approached through a linear skin incision dorsal and parallel to the jugular vein and through the brachiocephalicus and omohyoideus muscles. The artery was dissected free of its sheath and elevated to the skin incision with Penrose drains. The brachiocephalicus muscle was sutured in two layers underneath the artery leaving it in a subcutaneous position. The horses were allowed to heal for 3 weeks prior to catheterization of the artery. The transposed CCA was successfully used for repeated catheterization in six of eight horses for a period of 10 weeks. None of the horses had intraoperative complications. Two horses developed mild peri-incisional edema that resolved spontaneously. Right-sided laryngeal hemiplegia was observed endoscopically in two horses postoperatively. Two horses developed complications (surgical site infection and excessive periarterial fibrosis) that compromised the patency of the CCA and precluded catheterization. Permanent translocation of the CCA in standing horses was successful in six out of eight horses. Upper airway endoscopy postoperatively may be warranted as laryngeal hemiplegia may ensue. © 2016 The American College of Veterinary Surgeons.

  13. Extended Endoscopic Endonasal Approaches for Cerebral Aneurysms: Anatomical, Virtual Reality and Morphometric Study

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    Alberto Di Somma


    Full Text Available Introduction. The purpose of the present contribution is to perform a detailed anatomic and virtual reality three-dimensional stereoscopic study in order to test the effectiveness of the extended endoscopic endonasal approaches for selected anterior and posterior circulation aneurysms. Methods. The study was divided in two main steps: (1 simulation step, using a dedicated Virtual Reality System (Dextroscope, Volume Interactions; (2 dissection step, in which the feasibility to reach specific vascular territory via the nose was verified in the anatomical laboratory. Results. Good visualization and proximal and distal vascular control of the main midline anterior and posterior circulation territory were achieved during the simulation step as well as in the dissection step (anterior communicating complex, internal carotid, ophthalmic, superior hypophyseal, posterior cerebral and posterior communicating, basilar, superior cerebellar, anterior inferior cerebellar, vertebral, and posterior inferior cerebellar arteries. Conclusion. The present contribution is intended as strictly anatomic study in which we highlighted some specific anterior and posterior circulation aneurysms that can be reached via the nose. For clinical applications of these approaches, some relevant complications, mainly related to the endonasal route, such as proximal and distal vascular control, major arterial bleeding, postoperative cerebrospinal fluid leak, and olfactory disturbances must be considered.

  14. Extended Endoscopic Endonasal Approaches for Cerebral Aneurysms: Anatomical, Virtual Reality and Morphometric Study (United States)

    de Notaris, Matteo; Enseñat, Joaquim; Alobid, Isam; San Molina, Joan; Berenguer, Joan; Cappabianca, Paolo


    Introduction. The purpose of the present contribution is to perform a detailed anatomic and virtual reality three-dimensional stereoscopic study in order to test the effectiveness of the extended endoscopic endonasal approaches for selected anterior and posterior circulation aneurysms. Methods. The study was divided in two main steps: (1) simulation step, using a dedicated Virtual Reality System (Dextroscope, Volume Interactions); (2) dissection step, in which the feasibility to reach specific vascular territory via the nose was verified in the anatomical laboratory. Results. Good visualization and proximal and distal vascular control of the main midline anterior and posterior circulation territory were achieved during the simulation step as well as in the dissection step (anterior communicating complex, internal carotid, ophthalmic, superior hypophyseal, posterior cerebral and posterior communicating, basilar, superior cerebellar, anterior inferior cerebellar, vertebral, and posterior inferior cerebellar arteries). Conclusion. The present contribution is intended as strictly anatomic study in which we highlighted some specific anterior and posterior circulation aneurysms that can be reached via the nose. For clinical applications of these approaches, some relevant complications, mainly related to the endonasal route, such as proximal and distal vascular control, major arterial bleeding, postoperative cerebrospinal fluid leak, and olfactory disturbances must be considered. PMID:24575410

  15. Range of S-100β levels during functional endoscopic sinus surgery with moderately controlled hypotension. (United States)

    Kwon, Youngsuk; Jang, Ji Su; Hwang, Sung Mi; Lee, Jae Jun; Lee, Jun Ho; Joo, Sungmin; Lee, In-Gon; Hong, Sung Jun


    The aim of this study is to determine the range of S-100β levels during functional endoscopic sinus surgery (FESS) when the mean arterial pressure (MAP) was controlled within 60-70 mmHg. After anesthesia induction with propofol and remifentanil, the patient was positioned in the reverse Trendelenburg position and MAP was controlled within 60-70 mmHg during surgery. For the S-100β assay, blood was taken from a radial arterial catheter before (baseline) and at 20 (T 20 ) and 60 (T 60 ) min after setting the reverse Trendelenburg position and controlled hypotension, and at 60 (T post60 ) min after the end of the operation. In total, 34 patients completed the study. Baseline S-100β was 0.00837 ± 0.00785 ng/mL. The levels at T 20 and T 60 were 0.02057 ± 0.01739 and 0.01987 ± 0.01145 ng/mL, respectively. The level of T post60 was 0.05436 ± 0.02318 ng/mL. The level at T 20 increased significantly versus the baseline level (P hypotension (MAP >60 mmHg) was provided. Thus, moderate hypotension would be seemed to be a safe and effective anesthetic technique for FESS without risk for cerebral ischemia.

  16. Heritability of cilioretinal arteries

    DEFF Research Database (Denmark)

    Taarnhøj, Nina Charlotte; Munch, Inger C; Kyvik, Kirsten O


    of healthy monozygotic and dizygotic twins were examined using digital fundus photography and visual assessment of grayscale fundus photographs and color transparencies to detect the presence of cilioretinal arteries. RESULTS: Cilioretinal arteries were present in 45.1% of participants and 28.8% of eyes...

  17. Peripheral artery disease - legs (United States)

    ... the legs, feet, and toes Painful, non-bleeding sores on the feet or toes (most often black) that are slow ... block small arteries Coronary artery disease Impotence Open sores ... (gangrene) The affected leg or foot may need to be amputated

  18. Carotid Artery Screening (United States)

    ... that look for inherited genetic markers linked to disease, and imaging tests that produce pictures of the inside of the body. These ... a risk factor. Risk factors for carotid artery disease include: age high blood pressure diabetes tobacco smoking high cholesterol coronary artery disease (CAD) obesity ...

  19. Successful Treatment of Early Gastric Cancer Adjacent to a Fundal Varix by Endoscopic Submucosal Dissection and Endoscopic Cyanoacrylate Therapy


    Kim, Yeon Soo; Cho, Won Young; Cho, Joo Young; Jin, So Young


    Endoscopic submucosal dissection (ESD) was developed for the en bloc resection of large early gastrointestinal neoplasms. A disadvantage of ESD is its technical difficulty, which requires advanced skills and is associated with a higher rate of complications. Endoscopic variceal obturation (EVO) using cyanoacrylate has emerged as the initial treatment of choice for acute gastric variceal bleeding. This procedure achieves hemostasis in 90% of cases. A 52-year-old patient with Child A alcoholic ...

  20. Endoscopic ultrasound-guided biliary drainage versus percutaneous transhepatic biliary drainage after failed endoscopic retrograde cholangiopancreatography: a meta-analysis


    Baniya R; Upadhaya S; Madala S; Subedi SC; Shaik Mohammed T; Bachuwa G


    Ramkaji Baniya, Sunil Upadhaya, Seetharamprasad Madala, Subash Chandra Subedi, Tabrez Shaik Mohammed, Ghassan Bachuwa Hurley Medical Center, Michigan State University, Flint, MI, USA Abstract: The failure rate of endoscopic retrograde cholangiopancreatography for biliary cannulation is approximately 6%–7% in cases of obstructive jaundice. Percutaneous transhepatic biliary drainage (PTBD) is the procedure of choice in such cases. Endoscopic ultrasound-guided biliary drainage (EGBD) i...



    Prajkta A Thete; Mehera Bhoir; M.V.Ambiye


    Routine dissection of a male cadaver revealed the presence of bilateral double renal arteries. On the right side the accessory renal artery originated from the abdominal aorta just above the main renal artery. On the left side the accessory renal artery originated from the abdominal aorta about 1 cm above the main renal artery. Knowledge of the variations of renal vascular anatomy has importance in exploration and treatment of renal trauma, renal transplantation, renal artery embolization, su...

  2. [Endoscopic sinus surgery in flowing water]. (United States)

    Noda, K; Doi, K; Noiri, T; Koizuka, I; Kubo, T


    A balloon has been developed that completely fills the choana, preventing water from leaking into the pharynx even when the water is entering into the nasal cavity at a rate of 1000 ml per minute. The balloon enables endoscopic sinus surgery (ESS) to be safely performed in "flowing water". This surgical technique is similar to that used in transurethral resections of the prostate because the tip of the endoscope is kept clean, and blood, debris and resected tissues are continuously removed by the water flow. In addition, the water pressure helps to suppress bleeding. This technique enables ESS to be performed with greater ease and efficiency. We have performed ESS in flowing water on 38 patients with chronic sinusitis under local anaesthesia. No complications, such as water leakage into the pharynx, were encountered, and only a few patients felt discomfort from the insertion of the balloon. Even if the balloon had burst, an emergency could have been easily prevented by withdrawing the endoscope from the nasal cavity and stopping the flow of water. Ultrasonography (USG) was used to examine the water-filled nasal cavity during surgery (SSD-2000 and Micro Tip Radial (ASU-101); Aloka, Ltd., Japan). Using USG, the middle turbinate, the inferior turbinate and the nasal septum could be visualized in a single coronal image. When the sensor was in the posterior ethmoid sinus, the orbit and its optic nerve could also be visualized. Since this surgery is performed under local anesthesia, eye movements can rapidly alter the position of the optic nerve. Thus, visualization of the optic nerve's exact position is extremely important. Unfortunately, USG is not very useful for localizing structures and guiding the surgeon to distant tumors or cysts located behind thick bones, since ultrasound can not penetrate hard masses or bones. In this situation, navigation systems are more reliable than USG. Nevertheless, USG is often useful for depicting surgical sites, especially during a

  3. Endoscopic Rectus Abdominis and Prepubic Aponeurosis Repairs for Treatment of Athletic Pubalgia. (United States)

    Matsuda, Dean K; Matsuda, Nicole A; Head, Rachel; Tivorsak, Tanya


    Review of the English orthopaedic literature reveals no prior report of endoscopic repair of rectus abdominis tears and/or prepubic aponeurosis detachment. This technical report describes endoscopic reattachment of an avulsed prepubic aponeurosis and endoscopic repair of a vertical rectus abdominis tear immediately after endoscopic pubic symphysectomy for coexistent recalcitrant osteitis pubis as a single-stage outpatient surgery. Endoscopic rectus abdominis repair and prepubic aponeurosis repair are feasible surgeries that complement endoscopic pubic symphysectomy for patients with concurrent osteitis pubis and expand the less invasive options for patients with athletic pubalgia.

  4. Some cardiopulmonary effects of midazolam premedication in clenbuterol-treated bitches during surgical endoscopic examination of the uterus and ovariohysterectomy

    Directory of Open Access Journals (Sweden)

    G.F. Stegmann


    Full Text Available Midazolam was administered intravenously to 8 bitches in a randomised, placebo-controlled clinical trial before propofol induction of surgical anaesthesia. Anaesthesia was maintained with isoflurane-in-oxygen during surgical endoscopic examination of the uterus and ovariohysterectomy. Clenbuterol was administered at the start of surgery to improve uterine muscle relaxation, and to facilitate endoscopic examination of the uterus. Ventilation was controlled. Induction of anaesthesia with propofol to obtain loss of the pedal reflex resulted in a statistically significant (P < 0.05 decrease in minute volume and arterial oxygen partial pressure in the midazolam group. Apnoea also occurred in 50 % of dogs in the midazolam group. The dose for propofol in the midazolam group was 7.4 mg/kg compared to 9.5 mg/kg in the control. Minute volume was significantly (P < 0.05 higher in both groups during isoflurane maintenance, compared to the value after incremental propofol to obtain loss of the pedal reflex. Propofol induction resulted in a 25-26 % reduction in the mean arterial blood pressure in both groups, and the administration of clenbuterol at the start of surgery resulted in a transient, but statistically significant (P < 0.05, decrease in mean arterial blood pressure in the midazolam group during isoflurane anaesthesia. It is concluded that intravenous midazolam premedication did not adversely affect cardiovascular function during propofol induction, but intra-operative clenbuterol during isoflurane maintenance of anaesthesia may result in transient hypotension. Midazolam premedication may increase adverse respiratory effects when administered before propofol induction of anaesthesia.

  5. A randomised trial of endoscopic submucosal dissection versus endoscopic mucosal resection for early Barrett's neoplasia. (United States)

    Terheggen, Grischa; Horn, Eva Maria; Vieth, Michael; Gabbert, Helmut; Enderle, Markus; Neugebauer, Alexander; Schumacher, Brigitte; Neuhaus, Horst


    For endoscopic resection of early GI neoplasia, endoscopic submucosal dissection (ESD) achieves higher rates of complete resection (R0) than endoscopic mucosal resection (EMR). However, ESD is technically more difficult and evidence from randomised trial is missing. We compared the efficacy and safety of ESD and EMR in patients with neoplastic Barrett's oesophagus (BO). BO patients with a focal lesion of high-grade intraepithelial neoplasia (HGIN) or early adenocarcinoma (EAC) ≤3 cm were randomised to either ESD or EMR. Primary outcome was R0 resection; secondary outcomes were complete remission from neoplasia, recurrences and adverse events (AEs). There were no significant differences in patient and lesion characteristics between the groups randomised to ESD (n=20) or EMR (n=20). Histology of the resected specimen showed HGIN or EAC in all but six cases. Although R0 resection defined as margins free of HGIN/EAC was achieved more frequently with ESD (10/17 vs 2/17, p=0.01), there was no difference in complete remission from neoplasia at 3 months (ESD 15/16 vs EMR 16/17, p=1.0). During a mean follow-up period of 23.1±6.4 months, recurrent EAC was observed in one case in the ESD group. Elective surgery was performed in four and three cases after ESD and EMR, respectively (p=1.0). Two severe AEs were recorded for ESD and none for EMR (p=0.49). In terms of need for surgery, neoplasia remission and recurrence, ESD and EMR are both highly effective for endoscopic resection of early BO neoplasia. ESD achieves a higher R0 resection rate, but for most BO patients this bears little clinical relevance. ESD is, however, more time consuming and may cause severe AE. NCT1871636. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to

  6. Comparison of the Effects of Magnesium Sulfate and Dexmedetomidine on Operation Field of Candidates for Endoscopic Sinus Surgery

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    Full Text Available Background and Objective: One of the main treatments for chronic rhinosinusitis is endoscopic surgery. In this procedure, intraoperative bleeding due to limited view of the surgeon can bring about surgical complications. To have a clear operation field for endoscopic sinus surgery, bleeding management is necessary. We aimed to compare the effects of magnesium sulfate and dexmedetomidine on operation field of candidates for endoscopic sinus surgery. Materials and Methods: In this triple-blind clinical trial, 60 candidates for endoscopic sinus surgery were randomly divided into two groups of Dexmedetomidine and Magnesium sulfate. Before anesthesia, magnesium sulfate was administered for 10 min at a dose of 50 mg/kg and at a dose 15 mg/kg/h afterwards. In the other group, dexmedetomidine was given for 10 min before anesthesia at a dose of 1 mic/kg and at a dose of 0.6 mic/kg/h thereupon. The hemodynamic status of both groups was recorded 1, 5, 15, 30, and 60 min post-tracheal intubation. The results were analyzed using SPSS, version 16. Results: In general, 20 (66.7% patients in the Dexmedetomidine group and 18 (60.0% patients in the Magnesium sulfate group were male (P=0.592. The mean ages of the Dexmedetomidine and Magnesium sulfate groups were 37.93 and 39.56 years, respectively (P=0.250. The mean surgical durations in the Dexmedetomidine and Magnesium sulfate groups were 79.03±41.8 min and 87.30± 15.09 min, respectively (P=0.003. Mean arterial pressure (MAP in the Dexmedetomidine group was less than in the Magnesium Sulfate group at all the assessed times, except for the first time. The difference between the two groups was not significant only at first time. There was no statistical difference between the two groups in terms of mean saturation oxygen peripheral (SpO2 at all the recorded times. The mean intraoperative heart rate and mean pain intensity were lower in the Dexmedetomidine group than the Magnesium sulfate group. In the Magnesium

  7. Endoscopic therapy of rectal carcinoid: a report of 27 cases

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    Zhi-feng ZHAO


    Full Text Available Objective To assess the effect of treatment of rectal carcinoid tumors through endoscopy.Methods Endoscopic dissection was performed for patients during Jun.2005 to Dec.2009,in whom an elevated lesion in rectal mucosa as seen through colonoscopy,and highly suspected to be rectal carcinoid by endoscopic ultrasound(EUS,with the diameter of the lesion smaller than 1.0cm,was excised through endoscope.After being proved to be totally excised,endoscopic biopsy was performed at 4 to 6 sites along borderline of the tumor.Accurate rate of EUS was evaluated by postoperative pathology.Invasion and entirety of excised tumor were analyzed by pathological examination.Colonoscopy and liver ultrasound were carried out one time every half a year during the follow-up.Results 27 patients with elevated lesion in rectal mucosa were investigated.Rectal carcinoid was highly suspected in these patients and met the indication for endoscopic excision.The elevated lesion in rectal mucosa was excised successfully by endoscopy in all cases.Postoperative pathology confirmed that corvect diagnosis of rectal carcinoid was 92.6%(25/27.Interstitialoma was found in 1 patient,and granular cell tumor in another patient.All the 25 patients with rectal carcinoid were followed up with an average follow-up time of 33.7±12.5 months.Metastases and recurrence had not been found.Conclusions EUS has a good diagnostic specificity in the elevated lesion of rectal mucosa,and can accurately assess the indication of endoscopic excision.Endoscopic excision is a safe and effective method for rectal carcinoid which is smaller than 1.0 cm.

  8. Endoscopic management of erosion after banded bariatric procedures. (United States)

    Spann, Matthew D; Aher, Chetan V; English, Wayne J; Williams, D Brandon


    Prosthetic materials wrapped around a portion of the stomach have been used to provide gastric restriction in bariatric surgery for many years. Intraluminal erosion of adjustable and nonadjustable gastric bands typically occurs many years after placement and results in various symptoms. Endoscopic management of gastric band erosion has been described and allows for optimal patient outcomes. We will describe our methods and experience with endoscopic management of intraluminal gastric band erosions after bariatric procedures. University hospital in the United States. A retrospective review of our bariatric surgery database identified patients undergoing removal of gastric bands. A chart review was then undertaken to confirm erosion of prosthetic material into the gastrointestinal tract. Baseline characteristics, operative reports, and follow-up data were analyzed. Sixteen patients were identified with an eroded gastric band: 11 after banded gastric bypass, 3 after laparoscopic adjustable gastric band (LAGB), and 2 after vertical banded gastroplasty. All patients were successfully treated with endoscopic removal of the prosthetic materials using either endoscopic scissors or ligation of the banding material with off-label use of a mechanical lithotripter device. Complications included a postoperative gastrointestinal bleed requiring repeat endoscopy, 1 patient with asymptomatic pneumoperitoneum requiring observation, and 1 with seroma at the site of LAGB port removal. Endoscopic management of intraluminal prosthetic erosion after gastric banded bariatric procedures can be safe and effective and should be considered when treating this complication. Erosion of the prosthetic materials inside the gastric lumen allows for potential endoscopic removal without free intraabdominal perforation. Endoscopic devices designed for dividing eroded LAGBs may help standardize and increase utilization of this approach. Copyright © 2017 American Society for Bariatric Surgery

  9. Endoscopic management of eroded prosthesis in vertical banded gastroplasty patients. (United States)

    Karmali, Shahzeer; Snyder, Brad; Wilson, Erik B; Timberlake, Matthew D; Sherman, Vadim


    One of the major complications of applying a prosthetic device to facilitate gastric partitioning has been intraluminal erosion of the prosthesis. Removing an eroded gastric band is fraught with difficulty secondary to the extensive inflammatory response around the proximal stomach and left lobe of the liver. As a result, bariatric clinicians have attempted to apply endoscopic technology to facilitate removal of eroded gastric prostheses. Our study reports on our experience of applying endoscopic scissor transection to remove eroded gastric prostheses in a large tertiary-care medical center. A retrospective chart review was conducted to identify all adult (>18 years old) patients managed endoscopically for removal of eroded prosthesis post bariatric surgery at the Baylor College of Medicine Comprehensive Bariatric Surgery Center and the University of Texas-Houston Bariatric Surgery Program. Nine patients, mean body mass index (BMI) 39.5 +/- 7.3 kg/m(2), were managed endoscopically to remove eroded gastric prosthesis post vertical banded gastroplasty. All patients (9/9) reported symptoms consistent with a proximal gastric outlet obstruction (dysphagia, nausea, vomiting). Inadequate weight loss was reported by 67% (6/9) of patients. The mean time for endoscopic band removal was 28.0 +/- 8.8 min. All eroded bands were evident at the end of the gastric pouch and were visualized with either a normal or retroflexed endoscopic view. All nine patients were discharged the same day of their procedure. Mean follow-up of the patients was 9.7 weeks (1-30 weeks). Three patients underwent revisional bariatric surgery following the band removal. Our study demonstrates that endoscopic scissor transaction is a safe and effective modality in removing eroded gastric prostheses after vertical banded gastroplasty and avoids the pitfalls associated with removing the eroded bands surgically. It also allows the patient and surgeon to make an insightful decision regarding a revisional

  10. Smartphone-Based Endoscope System for Advanced Point-of-Care Diagnostics: Feasibility Study. (United States)

    Bae, Jung Kweon; Vavilin, Andrey; You, Joon S; Kim, Hyeongeun; Ryu, Seon Young; Jang, Jeong Hun; Jung, Woonggyu


    Endoscopic technique is often applied for the diagnosis of diseases affecting internal organs and image-guidance of surgical procedures. Although the endoscope has become an indispensable tool in the clinic, its utility has been limited to medical offices or operating rooms because of the large size of its ancillary devices. In addition, the basic design and imaging capability of the system have remained relatively unchanged for decades. The objective of this study was to develop a smartphone-based endoscope system capable of advanced endoscopic functionalities in a compact size and at an affordable cost and to demonstrate its feasibility of point-of-care through human subject imaging. We developed and designed to set up a smartphone-based endoscope system, incorporating a portable light source, relay-lens, custom adapter, and homebuilt Android app. We attached three different types of existing rigid or flexible endoscopic probes to our system and captured the endoscopic images using the homebuilt app. Both smartphone-based endoscope system and commercialized clinical endoscope system were utilized to compare the imaging quality and performance. Connecting the head-mounted display (HMD) wirelessly, the smartphone-based endoscope system could superimpose an endoscopic image to real-world view. A total of 15 volunteers who were accepted into our study were captured using our smartphone-based endoscope system, as well as the commercialized clinical endoscope system. It was found that the imaging performance of our device had acceptable quality compared with that of the conventional endoscope system in the clinical setting. In addition, images captured from the HMD used in the smartphone-based endoscope system improved eye-hand coordination between the manipulating site and the smartphone screen, which in turn reduced spatial disorientation. The performance of our endoscope system was evaluated against a commercial system in routine otolaryngology examinations. We also

  11. New endoscopic ultrasonography techniques for pancreaticobiliary diseases

    Directory of Open Access Journals (Sweden)

    Ken Kamata


    Full Text Available Endoscopic ultrasonography (EUS is widely used to evaluate pancreaticobiliary diseases, especially pancreatic masses. EUS has a good ability to detect pancreatic masses, but it is not sufficient for the differential diagnosis of various types of lesions. In order to address the limitations of EUS, new techniques have been developed to improve the characterization of the lesions detected by EUS. EUS-guided fine needle aspiration (EUS-FNA has been used for diagnosing pancreatic tumors. In order to improve the histological diagnostic yield, a EUS-FNA needle with a core trap has recently been developed. Contrast-enhanced harmonic EUS is a new imaging modality that uses an ultrasonographic contrast agent to visualize blood flow in fine vessels. This technique is useful in the diagnosis of pancreatic solid lesions and in confirming the presence of vascularity in mural nodules for cystic lesions. EUS elastography analyzes several different variables to measure tissue elasticity, color patterns, and strain ratio, using analytical techniques such as hue-histogram analysis, and artificial neural networks, which are useful for the diagnosis of chronic pancreatitis and pancreatic cancer.

  12. Endoscopic Optical Coherence Tomography in Urology (United States)

    Pan, Yingtian; Waltzer, Wayne; Ye, Zhangqun

    Clinical statistics has shown a stable prevalence of bladder cancer in recent years, which by far remains among the most common types of malignancy in the USA. With smoking as the most well-established risk factor, bladder cancer is the fourth most common cancer occurrences in male population [1]. In the year of 2014, an estimated 74,690 new cases are expected to occur with estimated 15,580 deaths. Bladder cancer often refers to transitional cell carcinoma (TCC) as it originates primarily from the epithelial cell layer (i.e., urothelium) of the bladder. Unlike prostate-specific antigen (PSA) for prostate cancer screening, there is currently no effective screening technique approved or recommended for the population at average risk [2-5]. As a result, hematuria (i.e., blood in the urine) is often the first clinical symptom of bladder cancer. Fortunately, urinary bladder is more accessible than prostate glands endoscopically; thus cytology following white-light cystoscopy has been the gold standard for current clinical detection of bladder cancer. This is important because bladder cancer if diagnosed prior to muscle invasion (e.g., superficial or at

  13. [Percutaneous endoscopic gastrostomy in childhood and adolescence]. (United States)

    Behrens, R; Muschweck, H; Richter, T


    Nasogastric tube-feeding often is necessary in the treatment of chronically ill patients. The disadvantage (irritation of the hypopharynx, dislocation, stigma) can be avoided by the percutaneous endoscopic gastrostomy (PEG). In childhood there is only limited experience with this techniques. We report about 89 children with PEG. Indications were central dysphagia (67), dystrophy caused by chronic renal failure or congenital heart disease (15), application of special diets (6) and gastric volvulus (1). The endoscopy was done in sedation. The PEG was placed in the stomach (73) or duodenum (16). 14 Complications were observed: inflammation at the insertion site (2), perforation (2, healing under conservative treatment), dislocation of the duodenal part into the stomach or occlusion (6) and distraction of the retention disk (4). There were no procedures-related deaths. The mean duration of the PEG was more than 1 year. The affected persons were very pleased with the efficacy of this treatment. In all patients (including infants) requiring long-term tube-feeding the option of a PEG should be taken into consideration. In our experience the PEG is associated with a low rate of complications and provides a major improvement for children who are dependent on tube feeding.

  14. Functional endoscopic sinus surgery in pediatric population

    Directory of Open Access Journals (Sweden)

    Farhadi M


    Full Text Available This is a report of 30 cases of pediatric functional endoscopic sinus surgery (FESS. 28 of these children had chronic sinusitis and 2 had acute sinusitis the most common chief complaints were: 1 Chronic Rhinorea 2 Nasal obstruction 3 Chronic cough. Systemic predisposing conditions were allergy in 7 pts and immotile cilliasyndrome in 2 pts, all of the procedures were performed under general anesthesia. The most common procedures were: 1 Resection of lateral part of the middle turbinate. 2 Antrostomy of the maxillary sinus. 3 Turbinoplasty of the inf turbinate. 4 Anterior erhnoidectomy, (Messerklinger, Approach. There were no kajor complication and only 3 cases of minor complication (2=regeneration of polipoid tissues, 1 synechia occurred. The duration of follow up was from 6-18 mths recovery occurred in 26 pts. Two of the pts didn't respond because of severe allergy and were referred to immunologist for further therapy 2 others didn't respond appropriately because of immotile cilliasyndrome

  15. Sedation for Percutaneous Endoscopic Lumbar Discectomy

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    Menekse Oksar


    Full Text Available Although anesthetic requirements for minimally invasive neurosurgical techniques have been described in detail and applied successfully since the early 2000s, most of the literature on this subject has dealt with cranial cases that were operated on in the supine or sitting positions. However, spinal surgery has also used minimally invasive techniques that were performed in prone position for more than 30 years to date. Although procedures in both these neurosurgical techniques require the patient to be awake for a certain period of time, the main surgical difference with minimally invasive spinal surgery is that the patients are in the prone position, which may result in increased requirement of airway management because of deep sedation. In addition, although minimally invasive spinal surgery progresses slowly and different techniques are used with no agreement on the terminology used to describe these techniques thus far, the anesthetist needs to understand the surgical and anesthetic requirements for each type of intervention in order to take necessary precautions. This paper reviews the literature on this topic and discusses the anesthetic necessities for percutaneous endoscopic laser surgery.

  16. Sedation for Percutaneous Endoscopic Lumbar Discectomy (United States)


    Although anesthetic requirements for minimally invasive neurosurgical techniques have been described in detail and applied successfully since the early 2000s, most of the literature on this subject has dealt with cranial cases that were operated on in the supine or sitting positions. However, spinal surgery has also used minimally invasive techniques that were performed in prone position for more than 30 years to date. Although procedures in both these neurosurgical techniques require the patient to be awake for a certain period of time, the main surgical difference with minimally invasive spinal surgery is that the patients are in the prone position, which may result in increased requirement of airway management because of deep sedation. In addition, although minimally invasive spinal surgery progresses slowly and different techniques are used with no agreement on the terminology used to describe these techniques thus far, the anesthetist needs to understand the surgical and anesthetic requirements for each type of intervention in order to take necessary precautions. This paper reviews the literature on this topic and discusses the anesthetic necessities for percutaneous endoscopic laser surgery. PMID:27738652

  17. [Identification of insulinomas by endoscopic ultrasonography]. (United States)

    Ardengh, José Celso; Valiati, Loana Heuko; Geocze, Stephan


    The aim of this study is to compare EUS and the others diagnostics tests in the correct localization of insulinomas. We prospectively investigated 30 patients with endoscopic ultrasound with a clinical diagnosis of insulinomas prior to surgical exploration. They were submitted to abdominal ultrasonography, spiral computed tomography and four patients were submitted to magnetic ressonance before EUS. Surgery was the gold standard for tumor localization. Twenty-six tumors were benign (86.6%) and four were malign (13.4%). The median size tumors detected by EUS was 1.5 cm. The overall sensitivity of EUS in identifying insulinomas was 86.6% compared to 33% for CT, 40% to MRI and 90.9% to IUS. In 12 patients we were able to perform EUS-guided fine needle aspiration. Insulinoma was diagnosed in ten cytological specimens (83.3%). Tumors located in the head and body of the pancreas were seen by EUS in all patients, respectively but those located in the tail were diagnosed only in 55.5% of the cases. EUS has a high sensibility in the identification and localization of pancreatic insulinomas and should replace traditional methods of image when clinical suspicion is high.

  18. New endoscopic ultrasonography techniques for pancreticobiliary diseases

    Energy Technology Data Exchange (ETDEWEB)

    Kamata, Ken; Kitano, Masayuki; Omoto, Shunsuke; Kadosaka, Kumpei; Miyata, Takeshi; Minaga, Kosuke; Yamao, Kentaro; Imai, Hajime; Kudo, Masatoshii [Dept. of Gastroenterology and Hepatology, Kinki University Faculty of Medicine, Osaka (Japan)


    Endoscopic ultrasonography (EUS) is widely used to evaluate pancreaticobiliary diseases, especially pancreatic masses. EUS has a good ability to detect pancreatic masses, but it is not sufficient for the differential diagnosis of various types of lesions. In order to address the limitations of EUS, new techniques have been developed to improve the characterization of the lesions detected by EUS. EUS-guided fine needle aspiration (EUS-FNA) has been used for diagnosing pancreatic tumors. In order to improve the histological diagnostic yield, a EUS-FNA needle with a core trap has recently been developed. Contrast-enhanced harmonic EUS is a new imaging modality that uses an ultrasonographic contrast agent to visualize blood flow in fine vessels. This technique is useful in the diagnosis of pancreatic solid lesions and in confirming the presence of vascularity in mural nodules for cystic lesions. EUS elastography analyzes several different variables to measure tissue elasticity, color patterns, and strain ratio, using analytical techniques such as hue-histogram analysis, and artificial neural networks, which are useful for the diagnosis of chronic pancreatitis and pancreatic cancer.

  19. [Acute multiple organ failure after endoscopic polypectomy]. (United States)

    Kočan, Ladislav; Vašková, Janka; Vaško, Ladislav; Lakyová, Lucia; Kočanová, Hana; Simonová, Jana; Simon, Róbert; Firment, Jozef


    Serious intraabdominal infections belong among life treating diseases. They are based on spreading infections from focal sources of inflammation in abdomen or damaged intestinal wall. Treatment strategies are surgical intervention, antimicrobial therapy, distributional shock treatment and accurate nutritional support (1). Glutamine and selenium supplementation may improve intestinal functions and restore antioxidant defence (2). Septic shock with multiple organ failure accompanied by serious catabolism and decrease of albumin had developed in a patient after endoscopic polypectomy. Infection source was not discovered by medical imaging examinations non surgical laparotomy. After distributive shock treatment, wide spectral antibiotics and enteral and parenteral nutrition the patients health improved. As adjuvant therapy intravenous supplementation was administered: glutamine in daily dose 2g and sodium selenite in continual infusion in daily dose 750 μg over 6 days. During intensive therapy, inflammatory markers decreased: C-reactive protein, procalcitonin, leukocyte count and neutrophils. Albumin levels increased. The paper describes therapeutic options during septic shock treatment and reversion possibilities in the catabolic phase of disease.Key words: colonoscopy, septic shock, multiorgan failure, enteral nutrition, parenteral nutrition.

  20. [Computerized speech recognition-based endoscopic findings]. (United States)

    Molnár, B; Gergely, J; Prónai, L; Papik, K; Zágoni, T; Fehér, J; Kutor, L; Tulassay, Z


    Discrete, Hidden Markov model based speech recognition and phoneme based speech synthesis techniques were applied for gastroscopy reporting and machine control. The authors developed a special program for grammatical analysis of the sentences. Altogether 100 patient findings were grammatically analysed. The sentences were grouped according to the topographical order of the investigation: oesophagus, cardia, fundus, corpus, antrum, pylorus, bulbus, postbulbar section, and the pathological findings: erosion, ulceration, malignancy. Speech samples from 3 deep voiced male investigators were collected. The recognition rate was above 95%. A simulation program was also developed for dictation and controlling of the different equipment (monitor, printer, video, endoscope) in the gastroscopy laboratory by speech recognition. Speech synthesis was applied for the evaluation of understanding. This module artificially synthesizes the answer of the system giving backup for the understood information. With additional developments the discrete word speech 'recognition' achieved the level of routine application in medical reporting. However, ready-to-use developments need the joint activity of speech technology and endoscopy industry with end-user teams.

  1. Bleeding Complications After Endoscopic Lung Volume Reduction Coil Treatment: A Retrospective Observational Study. (United States)

    Simon, Marcel; Ittrich, Harald; Harbaum, Lars; Oqueka, Tim; Kluge, Stefan; Klose, Hans


    Endoscopic lung volume reduction coil (LVRC) treatment is an option for selected patients with severe emphysema. This study was conducted to determine the incidence of bleeding complications after LVRC treatment, to identify risk factors and to discuss treatment options in case of hemoptysis which does not resolve spontaneously. Retrospective observational study conducted in the Department of Respiratory Medicine at the University Medical Center Hamburg-Eppendorf in all subjects in whom LVRC treatment was performed between April 1, 2012 and September 30, 2015. During the study period, 101 LVRC procedures were performed in 62 subjects. Early post-procedural bleeding was encountered in 65.3% of cases. Hemoptysis was significantly more likely to occur in patients receiving acetylsalicylic acid (P=.005). Hemoptysis resolved spontaneously in 98.5% of cases. In the one case (1.5%) with persistent hemoptysis, bronchial artery embolization was successful in terminating bleeding. Hospital stay was significantly prolonged in subjects with hemoptysis (P=.01). No significant differences were found between subjects with or without hemoptysis in terms of chronic obstructive pulmonary disease exacerbations within four weeks after LVRC treatment (P=.18). Late bleeding complications were observed in 3 subjects (3.0%). In 2 of these cases, bronchial artery embolization was performed and bleeding was successfully terminated. Self-limiting low volume bleeding is a common finding in the first days after LVRC treatment. However, persistent bleeding may occur in the early post-procedural phase and late after LVRC treatment. In these cases, bronchial artery embolization was a feasible and successful approach to terminating bleeding. Copyright © 2016 SEPAR. Publicado por Elsevier España, S.L.U. All rights reserved.

  2. Endoscopic release for carpal tunnel syndrome. (United States)

    Vasiliadis, Haris S; Georgoulas, Petros; Shrier, Ian; Salanti, Georgia; Scholten, Rob J P M


    Carpal tunnel syndrome (CTS) is the most common compressive neuropathy of the upper extremity. It is caused by increased pressure on the median nerve between the transverse carpal ligament and the carpal bones. Surgical treatment consists of the release of the nerve by cutting the transverse carpal ligament. This can be done either with an open approach or endoscopically. To assess the effectiveness and safety of the endoscopic techniques of carpal tunnel release compared to any other surgical intervention for the treatment of CTS. More specifically, to evaluate the relative impact of endoscopic techniques in relieving symptoms, producing functional recovery (return to work and return to daily activities) and reducing complication rates. This review fully incorporates the results of searches conducted up to 5 November 2012, when we searched the Cochrane Neuromuscular Disease Group Specialized Register, CENTRAL, MEDLINE and EMBASE. There were no language restrictions. We reviewed the reference lists of relevant articles and contacted trial authors. We also searched trial registers for ongoing trials. We performed a preliminary screen of searches to November 2013 to identify any additional recent publications. We included any randomised controlled trials (RCTs) and quasi-RCTs comparing endoscopic carpal tunnel release (ECTR) with any other surgical intervention for the treatment of CTS. We used standard methodological procedures expected by the Cochrane Collaboration. Twenty-eight studies (2586 hands) were included. Twenty-three studies compared ECTR to standard open carpal tunnel release (OCTR), five studies compared ECTR with OCTR using a modified incision, and two studies used a three-arm design to compare ECTR, standard OCTR and modified OCTR.At short-term follow-up (three months or less), only one study provided data for overall improvement. We found no differences on the Symptom Severity Scale (SSS) (scale zero to five) (five studies, standardised mean

  3. Coronary Artery Bypass

    Directory of Open Access Journals (Sweden)

    Kadri Ceberut


    Full Text Available Ancient schwannoma is a rare variant of neural tumors though rarely seen in the thorax. The combination with coronary artery diseases is also rare. Here we describe a 66 year-old male who had undergone one-stage combined surgery for thoracic ancient schwannomas removal and coronary artery disease. The masses were, respectively, 13 cm in the middle mediastinum and 5 cm in diameter originating from the intercostal nerve. The tumors were successfully removed using sternotomy, and then a coronary artery bypass grafting was performed. Here we discuss this rare tumor in relation to the relevant literature.

  4. Endoscopic hemostasis with endoscopic mucosal resection and multiple synchronous early gastric cancers: a case report

    Directory of Open Access Journals (Sweden)

    Fujihara Shintaro


    Full Text Available Abstract Introduction Endoscopic hemostasis for severe upper gastrointestinal bleeding due to tumors, such as gastrointestinal stromal tumors and malignant lymphoma, is temporarily effective. However, permanent hemostasis is difficult in many cases because of diffuse bleeding. Case presentation A 60-year-old Japanese woman was admitted to our hospital with hematemesis. Endoscopy revealed multiple gastric polyps and fresh blood in her stomach. One of the gastric polyps, which was associated with oozing bleeding, was found near the anterior wall of the lower gastric body. We initially applied hemostatic forceps and argon plasma coagulation over the tumor surface, but the bleeding persisted. After endoscopic mucosal resection, exposed vessels were seen at the base of the mucosal resection site with oozing bleeding. Coagulation of the bleeding vessels using hemostatic forceps allowed successful completion of the hemostatic procedure. Our patient also had eight synchronous gastric cancer lesions. Histological examination of the resected specimens showed various types of cancer. Conclusion This is a case report of gastric cancer associated with eight gastric cancer lesions, confirmed by histology, in which hemostasis was achieved through endoscopy.

  5. Office-based endoscopic revision using a microdebrider for failed endoscopic dacryocystorhinostomy. (United States)

    Park, Jongyeop; Kim, Hochang


    This article is to introduce office-based endoscopic revision surgery using a microdebrider for failed endoscopic dacryocystorhinostomy (EN-DCR). The authors conducted retrospective, non-comparative, interventional case series analysis of 27 eyes of 24 patients, treated by office-based revision EN-DCR using a microdebrider. After local anesthesia, anatomical failures (cicatrization, granuloma, synechia) after primary EN-DCR were treated with a microdebrider (Osseoduo 120, Bien-Air Surgery, Le Noirmont, Switzerland) in an office setting, and a bicanalicular silicone tube was placed. Anatomical improvement and functional relief of epiphora were evaluated at 6-months after revision. The causes of failed EN-DCR were rhinostomy site cicatrization (17/27, 63.0 %), granulomatous obstruction (7/27, 25.9 %) and synechial formation (3/27, 11.1 %). The anatomical success rate was 100 %, and 85.2 % cases achieved complete relief of epiphora. The surgery did not exceed 10 min in any case and no complications were observed. Office-based revision EN-DCR using a microdebrider provided prompt management of post-DCR epiphora. The portable nature and all-round ability of the microdebrider allowed office-based surgery, which offered advantage to work with the surgeon's own well-trained office staff. Office-based revision EN-DCR can be both time- and money-saving, and might be regarded the treatment of choice for failed EN-DCR.

  6. A randomized trial of Rapid Rhino Riemann and Telfa nasal packs following endoscopic sinus surgery

    NARCIS (Netherlands)

    Cruise, A. S.; Amonoo-Kuofi, K.; Srouji, I.; Kanagalingam, J.; Georgalas, C.; Patel, N. N.; Badia, L.; Lund, V. J.


    OBJECTIVES: To compare Telfa with the Rapid Rhino Riemann nasal pack for use following endoscopic sinus surgery. DESIGN: Prospective, randomized, double-blind, paired trial. SETTING: Tertiary otolaryngology hospital. PARTICIPANTS: Forty-five adult patients undergoing bilateral endoscopic sinus

  7. Endoscopic Cyclophotocoagulation for the Treatment of Glaucoma in Boston Keratoprosthesis Type II Patient (United States)

    Poon, Linda Yi-Chieh; Chodosh, James; Vavvas, Demetrios G.; Dohlman, Claes H.


    We describe the surgical technique of endoscopic cyclophotocoagulation in a Boston keratoprosthesis type II patient. This patient with ocular cicatricial pemphigoid had pars plana endoscopic cyclophotocoagula through wounds created in the eyelids. PMID:28079656

  8. Peroral endoscopic full and partial-thickness myotomy. A viability study in an animal model

    Directory of Open Access Journals (Sweden)

    C.D. Quiroz-Guadarrama


    Conclusions: The endoscopic myotomy technique is feasible. Endoscopic partial-thickness myotomy was associated with shorter surgery duration and better results during the intraoperative period and the 7-day follow-up.

  9. Calf Contouring with Endoscopic Fascial Release, Calf Implant, and Structural Fat Grafting

    Directory of Open Access Journals (Sweden)

    Ercan Karacaoglu, MD


    Conclusions: A novel endoscopic approach for lower leg contouring is discussed. Endoscopic fasciotomy technique with calf implant and structural fat grafting for improved lower leg aesthetics is a simple, effective, reliable, and predictable technique for calf contouring.

  10. Endoscopic balloon dilatation for Crohn's strictures of the gastrointestinal tract is feasible

    DEFF Research Database (Denmark)

    Karstensen, John Gásdal; Hendel, Jakob; Vilmann, Peter


    Despite optimized medical treatment, Crohn´s disease can cause gastrointestinal (GI) strictures, which requires surgical intervention. Lately, endoscopic balloon dilatation has been established as an alternative to surgery. In the following, we report our experiences with endoscopic dilatation...

  11. Transforaminal endoscopic surgery for symptomatic lumbar disc herniations: a systematic review of the literature

    NARCIS (Netherlands)

    Nellensteijn, J.M.; Ostelo, R.W.J.G.; Bartels, R.; Peul, W.; van Royen, B.J.; van Tulder, M.W.


    The study design includes a systematic literature review. The objective of the study was to evaluate the effectiveness of transforaminal endoscopic surgery and to compare this with open microdiscectomy in patients with symptomatic lumbar disc herniations. Transforaminal endoscopic techniques for

  12. Diversion neovaginitis after sigmoid vaginoplasty: endoscopic and clinical characteristics. (United States)

    van der Sluis, Wouter B; Bouman, Mark-Bram; Meijerink, Wilhelmus J H J; Elfering, Lian; Mullender, Margriet G; de Boer, Nanne K H; van Bodegraven, Adriaan A


    To assess the endoscopic characteristics of the sigmoid-derived neovagina, which have been scarcely described. Prospective observational study. University tertiary medical center. Patients that underwent sigmoid vaginoplasty. Patients were invited yearly to undergo neovaginoscopy and sigmoidoscopy, preceded by taking a medical history and physical examination, as routine follow-up. Endoscopic signs of neovaginal inflammation. Thirty-four patients with a sigmoid neovagina underwent a total of 43 combined neovaginoscopies and sigmoidoscopies. After a mean postoperative time of 23 months, the most notable endoscopic features of the sigmoid-derived neovagina comprised a diminished vascular pattern, edema, granularity, friability, decreased resilience, and erythema. In the control rectosigmoidoscopy images, no concurrent abnormalities were observed. When applying the MAYO score to the neovaginal images, 12 (35%) patients scored MAYO 0, 19 (56%) MAYO I, 3 (9%) MAYO II, and none MAYO III. The presence of neovaginal discharge and malodor correlated with inflammatory endoscopic alterations. The endoscopic appearance of a sigmoid segment after use in neovaginoplasty differs significantly from that of the remaining rectosigmoid. Inflammatory changes of the sigmoid-derived neovagina were observed in most patients. Clinically, the inflammatory changes appear similar to those encountered in diversion colitis. Copyright © 2016 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  13. Miniature endoscope for a combined OCT-LIF system (United States)

    Tumlinson, Alex; Hariri, Lida; Barton, Jennifer K.


    An endoscopic system that provides simultaneous cross-sectional imaging and fluorescence spectroscopy is described. The first application of this device was the investigation of mouse colon cancer in vivo. This system combined optical coherence tomography (OCT), which provided high-resolution cross-sectional structural information in the form of a two-dimensional image, and laser induced fluorescence (LIF), which yielded histochemical information about the tissue. The design challenge and solution of packaging these two systems with widely different optical requirements are described in detail. The illumination geometry of the endoscope was similar to earlier published OCT and LIF catheter endoscope designs. However, several unique design challenges encountered in combining these two systems have been addressed. The use of a rodprism to reduce the asymmetry in the OCT beam caused by a cylindrical window is presented. Materials selection for use with wavelengths from 325nm - 1310nm presented a challenge usually avoided in OCT endoscopes. Preliminary mouse colon data collected with this endoscopic device is compared with previous experiments performed by researchers in our lab working with an earlier bulk-optic, combined OCT-LIF system.

  14. Endoscopic gastritis, serum pepsinogen assay, and Helicobacter pylori infection. (United States)

    Lee, Sun-Young


    Endoscopic findings of the background gastric mucosa are important in the Helicobacter pylori-seroprevalent population. It is strongly correlated not only with the risk of gastric cancer, but also with the excretion ability of gastric mucosa cells. In noninfected subjects, common endoscopic findings are regular arrangement of collecting venules, chronic superficial gastritis, and erosive gastritis. In cases of active H. pylori infection, nodularity on the antrum, hemorrhagic spots on the fundus, and thickened gastric folds are common endoscopic findings. The secreting ability of the gastric mucosa cells is usually intact in both noninfected and actively infected stomachs, and the intragastric condition becomes hyperacidic upon inflammation. Increased serum pepsinogen II concentration correlates well with active H. pylori infection, and also indicates an increased risk of diffuse-type gastric cancer. In chronic inactive H. pylori infection, metaplastic gastritis and atrophic gastritis extending from the antrum (closed-type chronic atrophic gastritis) toward the corpus (open-type chronic atrophic gastritis) are common endoscopic findings. The intragastric environment is hypoacidic and the risk of intestinal-type gastric cancer is increased in such conditions. Furthermore, there is a decrease in serum pepsinogen I concentration when the secreting ability of the gastric mucosa cells is damaged. Serologic and endoscopic changes that occur upon H. pylori infection are important findings for estimating the secreting ability of the gastric mucosa cells, and could be applied for the secondary prevention of gastric cancer.

  15. Combined transnasal and transoral endoscopic approaches to the craniovertebral junction

    Directory of Open Access Journals (Sweden)

    I H El-Sayed


    Full Text Available Objectives: To describe and evaluate a new technique of a combined endoscope-assisted transnasal and transoral approach to decompress the craniovertebral junction. Materials and Methods: A retrospective cohort of patients requiring an anterior decompression at the craniovertebral junction over a 12-month period was studied. Eleven patients were identified and included in the study. Eight of the patients had an endoscopic approach [endonasal (2, endooral (2, and combined (4]. Four of the 8 patients in the endoscopic group had a prior open transoral procedure at other institutions. These 8 patients were compared with a contemporary group of 3 patients who had an open, transoral-transpalatal approach. Charts, radiographic images, and pathologic diagnosis were reviewed. We evaluated the following issues: airway obstruction, dysphagia, velopharyngeal insufficiency (VPI, length of hospital stay (LOS, adequate decompression, and the need for revision surgery. Results: Adequate anterior decompression was achieved in all the patients. The endoscopic cohort had a reduced LOS (P = 0.014, reduced need for prolonged intubation/tracheotomy (P =0.024 and a trend toward reduced VPI (P = 0.061 when compared with the open surgery group. None of the patients required a revision surgery. Conclusion: Proper choice of endoscopic transnasal, transoral, or combined approaches allows anterior decompression at the craniovertebral junction, while avoiding the need to split the palate. A combined transnasal-transoral approach appears to reduce procedure-related morbidity compared with open, transoral, and transpalatal surgeries.

  16. Benefits and harms of endoscopic screening for gastric cancer. (United States)

    Hamashima, Chisato


    Gastric cancer has remained a serious burden worldwide, particularly in East Asian countries. However, nationwide prevention and screening programs for gastric cancer have not yet been established in most countries except in South Korea and Japan. Although evidence regarding the effectiveness of endoscopic screening for gastric cancer has been increasingly accumulated, such evidence remains weak because it is based on results from studies other than randomized controlled trials. Specifically, evidence was mostly based on the results of cohort and case-control studies mainly conducted in South Korea and Japan. However, the consistent positive results from these studies suggest promising evidence of mortality reduction from gastric cancer by endoscopic screening. The major harms of endoscopic screening include infection, adverse effects, false-positive results, and overdiagnosis. Despite the possible harms of endoscopic screening, information regarding these harms remains insufficient. To provide appropriate cancer screening, a balance of benefits and harms should always be considered when cancer screening is introduced as a public policy. Quality assurance is very important for the implementation of cancer screening to provide high-quality and safe screening and minimize harms. Endoscopic screening for gastric cancer has shown promising results, and thus deserves further evaluation to reliably establish its effectiveness and optimal use.

  17. Evaluation of a compound eye type tactile endoscope (United States)

    Yoshimoto, Kayo; Yamada, Kenji; Sasaki, Nagisa; Takeda, Maki; Shimizu, Sachiko; Nagakura, Toshiaki; Takahashi, Hideya; Ohno, Yuko


    Minimally invasive surgical techniques for endoscope become widely used, for example, laparoscopic operation, NOTES (Natural Orifice Translumenal Endoscopic Surgery), robotic surgery and so on. There are so many demand and needs for endoscopic diagnosis. Especially, palpation is most important diagnosis on any surgery. However, conventional endoscopic system has no tactile sensibility. There are many studies about tactile sensor for medical application. These sensors can measure object at a point. It is necessary to sense in areas for palpation. To overcome this problem, we propose compound eye type tactile endoscope. The proposed system consists of TOMBO (Thin Observation Module by Bound Optics) and clear silicon rubber. Our proposed system can estimate hardness of target object by measuring deformation of a projected pattern on the silicon rubber. The purpose of this study is to evaluate the proposed system. At first, we introduce approximated models of the silicone and the object. We formulate the stiffness of object, the deformation of silicone, and the whole object. We investigate the accuracy of measured silicone's lower surface for deformation of silicone by prototype system. Finally, we evaluate the calculated stiffness of the soft object.

  18. Design of the new rigid endoscope distortion measurement system (United States)

    Zhai, Xiaohao; Liu, Xiaohua; Liu, Ming; Hui, Mei; Dong, Liquan; Zhao, Yuejin; Wang, Yakun; Li, Yonghui; Zhou, Peng


    Endoscopic imaging quality affects industrial safety and medical security. Rigid endoscope distortion is of great signification as one of optical parameters to evaluate the imaging quality. This paper introduces a new method of rigid endoscope distortion measurement, which is different from the common methods with low accuracy and fussy operation. It contains a Liquid Crystal Display (LCD) to display the target, a CCD to obtain the images with distortion, and a computer to process the images. The LCD is employed instead of common white screen. The autonomous control system of LCD makes it showing the test target designed for distortion, and its parameter is known. LCD control system can change the test target to satisfy the different demand for accuracy, which avoids replacing target frequently. The test system also contains a CCD to acquire images in the exit pupil position of rigid endoscope. Rigid endoscope distortion is regarded as centrosymmetric, and the MATLAB software automatically measures it by processing the images from CCD. The MATLAB software compares target images with that without distortion on LCD and calculates the results. Relative distortion is obtained at different field of view (FOV) radius. The computer plots the curve of relative distortion, abscissa means radius of FOV, ordinate means relative distortion. The industry standard shows that, the distortion at 70% field of view is pointed on the curve, which can be taken as an evaluation standard. This new measuring method achieves advantages of high precision, high degree of intelligence, excellent repeatability and gets calculation results quickly.

  19. A high definition Mueller polarimetric endoscope for tissue characterisation (United States)

    Qi, Ji; Elson, Daniel S.


    The contrast mechanism of medical endoscopy is mainly based on metrics of optical intensity and wavelength. As another fundamental property of light, polarization can not only reveal tissue scattering and absorption information from a different perspective, but can also provide insight into directional tissue birefringence properties to monitor pathological changes in collagen and elastin. Here we demonstrate a low cost wide field high definition Mueller polarimetric endoscope with minimal alterations to a rigid endoscope. We show that this novel endoscopic imaging modality is able to provide a number of image contrast mechanisms besides traditional unpolarized radiation intensity, including linear depolarization, circular depolarization, cross-polarization, directional birefringence and dichroism. This enhances tissue features of interest, and additionally reveals tissue micro-structure and composition, which is of central importance for tissue diagnosis and image guidance for surgery. The potential applications of the Mueller polarimetric endoscope include wide field early epithelial cancer diagnosis, surgical margin detection and energy-based tissue fusion monitoring, and could further benefit a wide range of endoscopic investigations through intra-operative guidance.

  20. Gastric schwannomas: radiological features with endoscopic and pathological correlation

    Energy Technology Data Exchange (ETDEWEB)

    Hong, H.S. [Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seodaemoon-gu, Seoul (Korea, Republic of); Ha, H.K. [Department of Radiology, University of Ulsan College of Medicine, Songpa-gu, Seoul (Korea, Republic of)], E-mail:; Won, H.J.; Byun, J.H.; Shin, Y.M.; Kim, A.Y.; Kim, P.N.; Lee, M.-G. [Department of Radiology, University of Ulsan College of Medicine, Songpa-gu, Seoul (Korea, Republic of); Lee, G.H. [Internal Medicine, University of Ulsan College of Medicine, Songpa-gu, Seoul (Korea, Republic of); Kim, M.J. [Pathology, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul (Korea, Republic of)


    Aim: To describe the radiological, endoscopic, and pathological findings of gastric schwannomas in 16 patients. Materials and methods: The radiological, endoscopic, and pathological findings of 16 surgically proven cases of gastric schwannoma were retrospectively reviewed. All patients underwent computed tomography (CT) and four patients were evaluated with upper gastrointestinal series. Two radiologists reviewed the CT and upper gastrointestinal series images by consensus with regard to tumour size, contour, margin, and growth pattern, the presence or absence of ulcer, cystic change, and the CT enhancement pattern. Endoscopy was performed in eight of these 16 patients. Six patients underwent endoscopic ultrasonography. Pathological specimens were obtained from and reviewed in all 16 patients. Immunohistochemistry was performed for c-kit, CD34, smooth muscle actin, and S-100 protein. Results: On radiographic examination, gastric schwannomas appeared as submucosal tumours with the CT features of well-demarcated, homogeneous, and uncommonly ulcerated masses. Endoscopy with endoscopic ultrasonography demonstrated homogeneous, submucosal masses contiguous with the muscularis propria in all six examined cases. On pathological examination, gastric schwannomas appeared as well-circumscribed and homogeneous tumours in the muscularis propria and consisted microscopically of interlacing bundles of spindle cells. Strong positivity for S-100 protein was demonstrated in all 16 cases on immunohistochemistry. Conclusion: Gastric schwannomas appear as submucosal tumours of the stomach and have well-demarcated and homogeneous features on CT, endoscopic ultrasonography, and gross pathology. Immunohistochemistry consistently reveals positivity for S-100 protein in the tumours.

  1. Endoscopic Management of a Primary Duodenal Carcinoid Tumor

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    Albin Abraham


    Full Text Available Carcinoids are rare, slow-growing tumors originating from a variety of different neuroendocrine cell types. They are identified histologically by their affinity for silver salts and by positive reactions to neuroendocrine markers such as neuron-specific enolase, synaptophysin and chromogranin. They can present with various clinical symptoms and are difficult to diagnose. We present the case of a 43-year-old woman who was referred for evaluation of anemia. Upper endoscopy showed a duodenal bulb mass around 1 cm in size. Histopathological and immunohistochemistry staining were consistent with the diagnosis of a carcinoid tumor. Further imaging and endoscopic studies showed no other synchronous carcinoid lesions. Endoscopic ultrasound (EUS revealed a 1 cm lesion confined to the mucosa and no local lymphadenopathy. Successful endoscopic mucosal resection of the mass was performed. Follow-up surveillance 6 months later with EUS and Octreoscan revealed no new lesions suggestive of recurrence. No consensus guidelines exist for the endoscopic management of duodenal carcinoid tumors. However, endoscopic resection is safe and preferred for tumors measuring 1 cm or less with no evidence of invasion of the muscularis layer.

  2. Anatomy of renal arterial supply. (United States)

    Khamanarong, K; Prachaney, P; Utraravichien, A; Tong-Un, T; Sripaoraya, K


    A thorough knowledge of the variations of the renal artery has grown in importance with the increasing numbers of renal transplants, vascular reconstructions, and various surgical and radiologic techniques. The literature indicates that multiple renal arteries are found in 9- 76% of cadavers. The purpose of this study is to establish the incidence and characteristics of variations of renal arteries in Thais. A total of 267 Thai cadavers were dissected in the anatomy laboratory. The anatomical findings included: a single hilar artery in 82% of cases; double renal arteries in 17% of cases (one hilar artery with an upper polar artery occurred in 7%; two hilar arteries in 7%, and one hilar artery combined with one lower polar artery in 3%); and triple renal arteries occurred in 1% (two hilar arteries with one upper polar artery in 0.4% and two hilar arteries with one lower polar artery in 0.6%). In preparation for interventions, such as living renal donation, vascular reconstruction, renovascular hypertension, or radical nephrectomy, the results indicate that preoperative renal imaging is necessary and that operative techniques with attention to multiple renal arteries should be considered. Copyright 2004 Wiley-Liss, Inc.

  3. Coronary Artery Bypass Surgery (United States)

    ... don't help, you may need coronary artery bypass surgery. The surgery creates a new path for ... narrowed area or blockage. This allows blood to bypass (get around) the blockage. Sometimes people need more ...

  4. Pulmonary Arterial Hypertension (United States)

    Pulmonary Arterial Hypertension What Is Pulmonary Hypertension? To understand pulmonary hypertension (PH) it helps to understand how blood ows throughout your body. While the heart is one organ, it ...

  5. Coronary artery spasm (United States)

    ... blocker or a long-acting nitrate long-term. Beta-blockers are another type of medicine that is used with other coronary artery problems. However, beta-blockers may make this problem worse. They should be ...

  6. Peripheral Arterial Disease (United States)

    Peripheral arterial disease (PAD) happens when there is a narrowing of the blood vessels outside of your heart. The cause of ... smoking. Other risk factors include older age and diseases like diabetes, high blood cholesterol, high blood pressure, ...

  7. Arterial bypass leg - slideshow (United States)

    ... presentations/100155.htm Arterial bypass leg - series—Normal anatomy To use the sharing features on this page, ... Bethesda, MD 20894 U.S. Department of Health and Human Services National Institutes of Health Page last updated: ...

  8. Mesenteric artery ischemia (United States)

    ... this page: // Mesenteric artery ischemia To use the sharing features on this page, ... be removed. Outlook (Prognosis) The outlook for chronic mesenteric ischemia is good after a successful surgery. However, it ...

  9. Carotid Artery Disease (United States)

    ... heart. It also helps you lose weight, control diabetes and reduce stress. Limit alcohol. Control chronic conditions. Managing conditions such as diabetes and high blood pressure helps protect your arteries. ...

  10. Mid-term outcomes for Endoscopic versus Open Vein Harvest: a case control study

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    Chetcuti Karen


    Full Text Available Abstract Background Saphenous vein remains the most common conduit for coronary artery bypass grafting with increasing uptake of minimally invasive harvesting techniques. While Endoscopic Vein Harvest (EVH has been demonstrated to improve early morbidity compared to Open Vein Harvest (OVH, recent literature suggests that this may be at the expense of graft patency at one year and survival at three years. Methods We undertook a retrospective single-centre, single-surgeon, case-control study of EVH (n = 89 and OVH (n = 182. The primary endpoint was death with secondary endpoints including acute coronary syndrome, revascularisation or other major adverse cardiac events. Freedom from angina, wound complications and self-rated health status were also assessed. Where repeat angiography had been performed, this was reviewed. Results Both groups were well matched demographically and for peri-operative characteristics. All cause mortality was 2/89 (2% and 11/182 (6% in the EVH and OVH groups respectively. This was shown by Cox Log-Rank analysis to be non-significant (p = 0.65, even if adjusting for inpatient mortality (p = 0.74. There was no difference in the rates of freedom from angina (p = 1.00, re-admission (p = 0.78 or need for further anti-anginals (p = 1.00. There was a significant reduction in the incidence of leg wound infections and complications in the endoscopic group (EVH: 7%; OVH: 28%; p = 0.0008 and the skew of high patient self-rated health scores in the EVH group (61% compared to 52% in the open group approached statistical significance (p = 0.06. Conclusions While aware of the limitations of this small retrospective study, we are heartened by the preliminary results and consider our data to be justification for continuing to provide patients the opportunity to have minimally invasive conduit harvest in our centre. More robust evidence is still required to elucidate the implications of endoscopic techniques on conduit patency and patient

  11. A middle mesenteric artery


    Milnerowicz, Stanislaw; Milnerowicz, Artur; Taboła, Renata


    In 114 cases of the transverse colon isolated from cadavers (50 male, 64 female), anatomical examinations of the arterial system of the colon were performed. Arteriograms were obtained after dissecting and contrasting the colonic vessels with Mixobar contrast. In one case, on arteriography of the colon with its mesentery isolated from a 55-year-old male cadaver, a rare anatomical variant was found. The third mesenteric artery originated directly from the aorta—halfway between the superior and...

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

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    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

  13. Coronary artery fistulas

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    V. M. Subbotin


    Full Text Available Coronary artery fistulas are classified as abnormalities of termination and referred to as major congenital anomalies. Most coronary artery fistulas are small, unaccompanied by clinical symptoms, and diagnosed by echocardiography or coronarography performed for an unrelated cause. Such fistulas usually do not cause any complications and can spontaneously resolve. However, larger fistulas are usually >3 tones the size of a normal caliber of a coronary artery and may give rise to clinical symptoms in these cases. The clinical symptoms of coronary artery fistulas may mimic those of various heart diseases depending on which chamber a fistula drains into. Most fistulas are congenital. Congenital coronary artery fistulas may occur as an isolated malformation or be concurrent with other cardiac anomalies, more frequently with critical pulmonary stenosis or atresia with an intact interventricular septum and pulmonary stenoses, Fallot's tetralogy, aortic coarctation, and left heart hypoplasia. When choosing a treatment modality, one should take into account the number of fistula communications, the feeding vessel, localization of drainage, degree of myocardial damage, and hemodynamic relevance of the shunt caused by the presence of a fistula. The goal of treatment is to obliterate a fistula by preserving normal coronary blood flow. The risk for persisting fistula should be balanced with the potential risk of complications related to a procedure of coronarography and fistula occlusion. Percutaneous transcatheter coil occlusion of coronary artery fistulas is the modality of choice in children with the suitable anatomy of fistula communications and without concomitant congenital heart diseases.

  14. Evaluation of the tip-bending response in clinically used endoscopes

    NARCIS (Netherlands)

    Rozeboom, Esther; Reilink, Rob; Schwartz, Matthijs P.; Fockens, Paul; Broeders, Ivo Adriaan Maria Johannes

    Background and study aims: Endoscopic interventions require accurate and precise control of the endoscope tip. The endoscope tip response depends on a cable pulling system, which is known to deliver a significantly nonlinear response that eventually reduces control. It is unknown whether the current

  15. Endoscopic treatment for complex biliary and pancreatic duct injuries

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    Simon Bouchard


    Full Text Available Severe injuries of biliary or pancreatic ducts are associated with significant morbidity and mortality. Severe bile duct injuries such as major biliary leaks, complete transection, or complete occlusion of bile ducts can be grouped under the term complex bile duct injuries (CBDI. In the spectrum of pancreatic duct injuries, disconnected pancreatic duct syndrome (DPDS represents the most severe form and most often occurs after a severe episode of acute pancreatitis. Treatment of these complex injuries is quite challenging and for many years surgical management has been considered the treatment of choice. However, in the past few years, some studies have reported the successful management of CBDI or DPDS using endoscopic procedures alone or in combination with a percutaneous approach. In this review, we detail the endoscopic or combined endoscopic/percutaneous treatment possibilities for CBDI and DPDS.

  16. 3D endoscopic imaging using structured illumination technique (Conference Presentation) (United States)

    Le, Hanh N. D.; Nguyen, Hieu; Wang, Zhaoyang; Kang, Jin U.


    Surgeons have been increasingly relying on minimally invasive surgical guidance techniques not only to reduce surgical trauma but also to achieve accurate and objective surgical risk evaluations. A typical minimally invasive surgical guidance system provides visual assistance in two-dimensional anatomy and pathology of internal organ within a limited field of view. In this work, we propose and implement a structure illumination endoscope to provide a simple, inexpensive 3D endoscopic imaging to conduct high resolution 3D imagery for use in surgical guidance system. The system is calibrated and validated for quantitative depth measurement in both calibrated target and human subject. The system exhibits a depth of field of 20 mm, depth resolution of 0.2mm and a relative accuracy of 0.1%. The demonstrated setup affirms the feasibility of using the structured illumination endoscope for depth quantization and assisting medical diagnostic assessments

  17. [Endoscopic treatment of obesity and complications following bariatric surgery]. (United States)

    Feisthammel, J; Blüher, M; Mössner, J; Hoffmeister, A


    The prevalence of obesity in the population has been increasing for many years. Due to associated comorbidities the treatment of obesity is becoming more important. Conservative treatment alone is often unsuccessful, particularly in cases of severe obesity. In these cases, multimodal therapy in specialized treatment units is warranted. Between conservative treatment and bariatric surgery, interventional endoscopic treatment options also play an increasing role. Nowadays, implantation of gastric balloons and duodenojejunal bypass liners (EndoBarrier) are the most often used endoscopic options. A further typical application of endoscopy in the treatment of obesity is the management of complications after bariatric surgery, such as stenosis and insufficiency. This article gives an overview on the currently available endoscopic options associated with treatment of obesity.

  18. Endoscopic management of posttraumatic supraglottic stenosis in the pediatric population.

    LENUS (Irish Health Repository)

    Oosthuizen, Johannes Christiaan


    OBJECTIVES: Pediatric blunt laryngeal trauma is a rare and potentially life-threatening entity. External injuries can be misleading, and a high index of suspicion, as well as early intervention, is essential to achieve the best possible outcome. The authors of this report review the management of blunt laryngeal trauma in the pediatric population and describe the endoscopic management of posttraumatic supraglottic stenosis. METHODS: Methods used were case report from a tertiary referral institution and review of the literature. RESULTS: We describe the case of a 13-year-old girl whom developed supraglottic stenosis following blunt laryngeal trauma. Innovative endoscopic techniques were used in the successful management of this exceedingly rare entity. CONCLUSION: Early recognition and intervention are of paramount importance if successful endoscopic management of blunt laryngeal trauma is to be considered.

  19. Robot-assisted endoscopic intrauterine myelomeningocele repair: a feasibility study. (United States)

    Aaronson, Oran S; Tulipan, Noel B; Cywes, Robert; Sundell, Håkan W; Davis, Georges H; Bruner, Joseph P; Richards, William O


    Animal experiments have suggested that the intrauterine environment causes secondary injury to the congenitally dysplastic spinal cord. This in turn suggests that early closure of the myelomeningocele sac might prevent secondary injury and therefore improve neurologic outcome. This study was designed to examine the technical feasibility of performing intrauterine myelomeningocele repair using a robot-assisted endoscopic system in an animal model. Six fetal sheep underwent creation and repair of a full-thickness skin lesion using the da Vinci system. With the device's advanced articulated instruments and three-dimensional optics, it was possible to endoscopically repair the induced skin defects. We conclude that, with the recent evolution in robotics and minimally invasive techniques, intrauterine endoscopic surgery has become a realistic goal that promises to reduce the associated risks of fetal surgery and extend the indications for its use. Copyright 2002 S. Karger AG, Basel

  20. Bilateral endoscopic endonasal marsupialization of nasopalatine duct cyst

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    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.

  1. Esophageal Perforation due to Transesophageal Echocardiogram: New Endoscopic Clip Treatment

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    John Robotis


    Full Text Available Esophageal perforation due to transesophageal echocardiogram (TEE during cardiac surgery is rare. A 72-year-old female underwent TEE during an operation for aortic valve replacement. Further, the patient presented hematemesis. Gastroscopy revealed an esophageal bleeding ulcer. Endoscopic therapy was successful. Although a CT scan excluded perforation, the patient became febrile, and a second gastroscopy revealed a big perforation at the site of ulcer. The patient's clinical condition required endoscopic intervention with a new OTSC® clip (Ovesco Endoscopy, Tübingen, Germany. The perforation was successfully sealed. The patient remained on intravenous antibiotics, proton pump inhibitors and parenteral nutrition for few days, followed by enteral feeding. She was discharged fully recovered 3 months later. We clearly demonstrate an effective, less invasive treatment of an esophageal perforation with a new endoscopic clip.

  2. Correcting the Chromatic Aberration in Barrel Distortion of Endoscopic Images

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    Y. M. Harry Ng


    Full Text Available Modern endoscopes offer physicians a wide-angle field of view (FOV for minimally invasive therapies. However, the high level of barrel distortion may prevent accurate perception of image. Fortunately, this kind of distortion may be corrected by digital image processing. In this paper we investigate the chromatic aberrations in the barrel distortion of endoscopic images. In the past, chromatic aberration in endoscopes is corrected by achromatic lenses or active lens control. In contrast, we take a computational approach by modifying the concept of image warping and the existing barrel distortion correction algorithm to tackle the chromatic aberration problem. In addition, an error function for the determination of the level of centroid coincidence is proposed. Simulation and experimental results confirm the effectiveness of our method.

  3. Treatment results of functional endoscopic sinus surgery in chronic sinusitis

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    Naraghi M


    Full Text Available Background: Endoscopic sinus surgery has been used for diagnosis and treatment of chronic inflammatory diseases of paranasal sinuses since recent years. Materials and Methods: In this study 104 patients with chronic sinusitis (with or without polyps which were managed with endoscopic sinus surgery (ESS were followed for 6 to 24 months after surgery (24 patients refused to continue follow up and the recovery rate of symptoms were evaluated. Results: The effectiveness of this therapy is statistically approved and the most important symptom which diminished was nasal obstruction (from 95 percent to 18.5 percent, the least important symptom which diminished was anosmia (from 57 percent to 21 percent. Conclusion: This study confirmed the efficacy of functional endoscopic sinus surgery in improvement of chronic sinusitis symptoms.

  4. [Colorectal diseases in AIDS patients and endoscopic findings]. (United States)

    Averbach, M; Cutait, R; Corrêa, P; Duarte, M I; Leite, K; Borges, J L


    In order to establish which are the most frequent endoscopic detectable colorectal disorders in AIDS patients with intestinal complaints we analysed 236 colonoscopies in a series of 186 patients. The colonoscopic procedure was always followed by biopsies, even in the absence of macroscopic lesions. The most frequent diagnosis was colitis due to citomegalovirus infection observed in 64 exams (27.1%) and presented with an inflammatory pattern with ulcers, followed by Cryptosporidium sp., found in 31 exams (13.1%). This infection, conversely, presented as an inflammatory non-ulcerative lesion. Others pathogens found in lower frequency were: Mycobacterium sp., Histoplasma capsulatum, Herpes simplex, Isospora sp., Giardia sp., Candida sp. and Campilobacter sp.. Neoplastic lesions, mostly Kaposy's sarcoma, were detected in 10 of the colonoscopies (4.2%). The most frequent colorectal disorders in AIDS patients detected by endoscopic procedures are citomegalovirus and Cryptosporidium infection. Biopsies are always necessary to confirm the endoscopic diagnosis and to identify the presence of associated pathogens.

  5. Endoscopic Pubic Symphysectomy for Athletic Osteitis Pubis. (United States)

    Matsuda, Dean K; Sehgal, Bantoo; Matsuda, Nicole A


    Osteitis pubis is a common form of athletic pubalgia associated with femoroacetabular impingement. Endoscopic pubic symphysectomy was developed as a less invasive option than open surgical curettage for recalcitrant osteitis pubis. This technical note demonstrates the use of the anterior and suprapubic portals in the supine lithotomy position for endoscopic burr resection of pubic symphyseal fibrocartilage and hyaline endplates. Key steps include use of the suprapubic portal for burr resection of the posteroinferior symphysis and preservation of the posterior and arcuate ligaments. Endoscopic pubic symphysectomy is a minimally invasive bone-conserving surgery that retains stability and may be useful in the treatment of recalcitrant osteitis pubis or osteoarthritis. It nicely complements arthroscopic surgery for femoroacetabular impingement and may find broader application in this group of co-affected athletes.

  6. Indigo carmine for the selective endoscopic intervertebral nuclectomy. (United States)

    Kim, Inn-Se; Kim, Kyung-Hoon; Shin, Sang-Wook; Kim, Tae-Kyun; Kim, Jeung-Il


    This study was undertaken to prove that the selectively infiltrated parts of nucleus pulposus with indigo carmine was degenerated parts of nucleus pulposus. This study was done, between August and October 2002, in 5 patients, who received endoscopic discectomy, due to intervertebral disc herniation. Discogram was done with mixture of indigo carmine and radioactive dye. Blue discolored part was removed through endoscope, and small undiscolored part was removed together for the control. The two parts were stained with hematoxylin and eosin and compared under the microscope. Undiscolored part was normal nucleus pulposus, composed of chondrocytes with a matrix of type II collagen and proteoglycan, mainly aggrecan. However, in discolored part, slits with destruction of collagen fiber array and ingrowth of vessel and nerve were observed. Using indigo carmine in endoscopic discectomy gives us selective removal of degenerated disc.

  7. The comparison of different medical electronic endoscope systems (United States)

    Ye, Wei; Wang, Liqiang; Duan, Huilong


    This paper presents a miniaturized CMOS camera for high-definition (HD) medical electronic endoscope system with resolution of 1.3 MegaPixel. LVDS technology is used for image data stream transmission between the sensor and the HD image workstation to realize a long distance, high speed, high signal integrity and low noise system. Considering the real-time video image processing and the complexity of the design of HD image workstation, four solutions for medical electronic endoscope systems, namely USB based image acquisition system, PCIe acquisition data board based method, ARM embedded system based solution and DSP based electronic endoscope system have been proposed, analyzed and compared with each other. We found that the four solutions have their own advantages and disadvantages. Taking into account the strong control capacity of ARM, powerful data processing ability and high operating speed of DSP, good portability and other factors, we decided to use ARM + DSP embedded based system.


    Directory of Open Access Journals (Sweden)

    D. V. Perlin


    Full Text Available Introduction. Endoscopic radical prostatectomy is a highly effective treatment for localized prostate cancer. Intrafascial prostate dissection ensures early recovery of urine continence function and erectile function. This article sums up our own experience of performing intrafascial endoscopic prostatectomy.Materials and methods. 25 patients have undergone this procedure. 12 months after surgery 88.2 % of the patients were fully continent, 11.7 % had symptoms of minimal stress urinary incontinence. We encountered no cases of positive surgical margins and one case of bio-chemical recurrence of the disease.Conclusion. Oncologically, intrafascial endoscopic radical prostatectomy is as effective as other modifications of radical prostatectomy and has the benefits of early recovery of urine continence function and erectile function. 

  9. Endoscopic Ultrasound Elastography: Current Clinical Use in Pancreas. (United States)

    Mondal, Utpal; Henkes, Nichole; Patel, Sandeep; Rosenkranz, Laura


    Elastography is a newer technique for the assessment of tissue elasticity using ultrasound. Cancerous tissue is known to be stiffer (hence, less elastic) than corresponding healthy tissue, and as a result, could be identified in an elasticity-based imaging. Ultrasound elastography has been used in the breast, thyroid, and cervix to differentiate malignant from benign neoplasms and to guide or avoid unnecessary biopsies. In the liver, elastography has enabled a noninvasive and reliable estimate of fibrosis. Endoscopic ultrasound has become a robust diagnostic and therapeutic tool for the management of pancreatic diseases. The addition of elastography to endoscopic ultrasound enabled further characterization of pancreas lesions, and several European and Asian studies have reported encouraging results. The current clinical role of endoscopic ultrasound elastography in the management of pancreas disorders and related literature are reviewed.

  10. Transanal endoscopic microsurgery versus endoscopic mucosal resection for large rectal adenomas (TREND-study

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    Geldof Han


    Full Text Available Abstract Background Recent non-randomized studies suggest that extended endoscopic mucosal resection (EMR is equally effective in removing large rectal adenomas as transanal endoscopic microsurgery (TEM. If equally effective, EMR might be a more cost-effective approach as this strategy does not require expensive equipment, general anesthesia and hospital admission. Furthermore, EMR appears to be associated with fewer complications. The aim of this study is to compare the cost-effectiveness and cost-utility of TEM and EMR for the resection of large rectal adenomas. Methods/design Multicenter randomized trial among 15 hospitals in the Netherlands. Patients with a rectal adenoma ≥ 3 cm, located between 1–15 cm ab ano, will be randomized to a TEM- or EMR-treatment strategy. For TEM, patients will be treated under general anesthesia, adenomas will be dissected en-bloc by a full-thickness excision, and patients will be admitted to the hospital. For EMR, no or conscious sedation is used, lesions will be resected through the submucosal plane in a piecemeal fashion, and patients will be discharged from the hospital. Residual adenoma that is visible during the first surveillance endoscopy at 3 months will be removed endoscopically in both treatment strategies and is considered as part of the primary treatment. Primary outcome measure is the proportion of patients with recurrence after 3 months. Secondary outcome measures are: 2 number of days not spent in hospital from initial treatment until 2 years afterwards; 3 major and minor morbidity; 4 disease specific and general quality of life; 5 anorectal function; 6 health care utilization and costs. A cost-effectiveness and cost-utility analysis of EMR against TEM for large rectal adenomas will be performed from a societal perspective with respectively the costs per recurrence free patient and the cost per quality adjusted life year as outcome measures. Based on comparable recurrence rates for TEM and EMR

  11. Limits of endoscopic treatment of sylvian arachnoid cysts in children. (United States)

    Di Rocco, Federico; R James, Syril; Roujeau, Thomas; Puget, Stephanie; Sainte-Rose, Christian; Zerah, Michel


    The optimal surgical management of sylvian arachnoid cysts is debated. We present our experience in children who were treated endoscopically, focusing on the limits and complications of this approach. Seventeen children with a temporo-sylvian arachnoid cyst have been treated using a purely temporal endoscopic approach. In all but one case, the recognition of anatomical landmarks was obtained at the insertion of the endoscope. In one child, the orientation and opening of the basal cisterns were more difficult due to the thickness and opacity of the membranes. Nevertheless, it was possible to perform the cysto-cisternostomy endoscopically in all children with several stomies in 13. In one child, a venous bleeding occurred. There were no other intraoperative complications. There were no postoperative cerebrospinal fluid leaks. In two patients, a symptomatic subdural collection developed which required a transient subdural-peritoneal shunt. No subdural collection was noted on a delayed follow-up (mean, 23 months). Preoperative symptoms related to the mass effect exerted by the cyst resolved in all children. Two children presented a recurrence, 12 and 20 months after endoscopic surgery, respectively. At the redo-endoscopy, the stomies were found to be closed. Their reopening resulted in the disappearance of the symptoms. An endoscopic approach can be used safely in the management of sylvian arachnoid cysts. An effective opening of the deep arachnoid membranes into the basal cisterns could be performed in all patients with the resolution of the preoperative symptoms. However, the long-term efficacy of the stoma needs to be assessed.

  12. Expandable gastric port for natural orifice translumenal endoscopic surgery. (United States)

    Hashiba, Kiyoshi; Siqueira, Pablo R; Brasil, Horus A; Moribe, Daniel; D'Assunção, Marco Aurélio


    The risk of intraabdominal contamination is a critical consideration during most natural orifice translumenal endoscopic surgery (NOTES) procedures. The objective of this study was to determine a safe and efficient pathway for the endoscope in a transgastric NOTES procedure. A pilot experimental study in live pigs was performed. Five White Landrace pigs, weighing approximately 30-35 kg, underwent the placement of a device consisting of an expandable sheath, the distal portion of which was composed of a fully covered self-expanding metal stent, and an introducer made with an outer catheter, a pushing catheter, and an inner, guiding catheter. The sheath was attached to the stent by suturing it in place. The initial gastric opening was made by means of a needle knife papilotome with electrocoagulation, aimed to the anterior gastric wall. Then, it was dilated with an endoscopic 1.8-cm balloon. The set was introduced over a Savary guidewire. After the set placement, the outer tube was slowly retrieved. Finally, the delivery system was removed from the pig, leaving the entire endoscopic port in place. The expandable gastric port was placed without difficulty in all animals. Endoscope insertion into the expandable gastric port was very easily performed. The endoscope had a wide range of movement inside the peritoneal cavity. The gastric port sealed the gastric wall, avoiding gross contamination of the peritoneal cavity and maintaining the pneumoperitoneum without excessive inflation of the intestine. Use of a gastric port can minimize contamination of the peritoneal cavity due to the spillage of gastric contents during a transgastric NOTES procedure and can also facilitate performance of the procedure.

  13. Mortality reduction from gastric cancer by endoscopic and radiographic screening. (United States)

    Hamashima, Chisato; Shabana, Michiko; Okada, Katsuo; Okamoto, Mikizo; Osaki, Yoneatsu


    To evaluate mortality reduction from gastric cancer by endoscopic screening, we undertook a population-based cohort study in which both radiographic and endoscopic screenings for gastric cancer have been carried out. The subjects were selected from the participants of gastric cancer screening in two cities in Japan, Tottori and Yonago, from 2007 to 2008. The subjects were defined as participants aged 40-79 years who had no gastric cancer screening in the previous year. Follow-up of mortality was continued from the date of the first screening to the date of death or up to December 31, 2013. A Cox proportional hazards model was used to estimate the relative risk (RR) of gastric cancer incidence, gastric cancer death, all cancer deaths except gastric cancer death, and all-causes death except gastric cancer death. The number of subjects selected for endoscopic screening was 9950 and that for radiographic screening was 4324. The subjects screened by endoscopy showed a 67% reduction of gastric cancer compared with the subjects screened by radiography (adjusted RR by sex, age group, and resident city = 0.327; 95% confidence interval [CI], 0.118-0.908). The adjusted RR of endoscopic screening was 0.968 (95%CI, 0.675-1.387) for all cancer deaths except gastric cancer death, and 0.929 (95%CI, 0.740-1.168) for all-causes death except gastric cancer death. This study indicates that endoscopic screening can reduce gastric cancer mortality by 67% compared with radiographic screening. This is consistent with previous studies showing that endoscopic screening reduces gastric cancer mortality. © 2015 The Authors. Cancer Science published by Wiley Publishing Asia Pty Ltd on behalf of Japanese Cancer Association.

  14. MINOP: development of a miniaturized endoscopic operation system for neurosurgery (United States)

    Guber, Andreas E.; Wieneke, Paul


    Within the framework of R&D activities in the field of microsystems technology, the Institute for Microstructure Technology of Karlsruhe Research Center among others has started to improve the functionality of existing medicotechnical instruments by increased integration of microtechnical components. On the basis of microsystems fabrication techniques, completely novel medical endoscope systems have become feasible. In cooperation with clinical, technical and industrial partners, a novel endoscopic operation system based on microsystems technology is being developed by the Institute for Microstructure Technology and the Aesculap AG company, Tuttlingen within the framework of the MINOP joint project. This new system shall be applied above all in the field of neurosurgery. This newly conceived endosystem is characterized by a multitude of novelties. It can perform a number of both sensor and actor functions. Due to its extremely small outer diameter, it can be applied through minute openings. As a result of the integrated microfluidic control system, the flexible endoscope can be moved to the actual site of operation on a previously specified path. This will allow future bi- and triportal neuro-endoscopic interventions for critical operations in the brain area. The different lumina of the flexible endoscope fulfill various functions. Via the optical fibers, laser radiation may be led to the distal end of the endoscope. Using microtechnical fabrication methods, special plastic microlenses have been produced. The working channel can be applied for rinsing and removal. Furthermore, the cleaning of the optics or the taking of tissue samples are possible. If required, another laser fiber can be driven forward through the working channel for selective therapy. For the first time, high-performance microinstruments have been developed on the basis of novel materials. These instruments can be applied either through the working channel or through an additional trocar.

  15. Solitary Rectal Ulcer Syndrome: Demographic, Clinical, Endoscopic and Histological Panorama. (United States)

    Abbasi, Amanullah; Bhutto, Abdul Rabb; Taj, Ali; Aurangzaib; Baloch, Akhtar; Masroor, Muhammad; Munir, S M


    To assess the demographic, clinical, endoscopic and histological spectrum of Solitary Rectal Ulcer Syndrome (SRUS). Cross-sectional observational study. Medical Unit-III, Civil Hospital Karachi (CHK) and Ward 7, Jinnah Postgraduate Medical Centre (JPMC), Karachi, from January 2009 to June 2012. Patients with SRUS, based on characteristic endoscopic and histological findings, were enrolled. Patients were excluded if they had other causes of the rectal lesions (neoplasm, infection, inflammatory bowel disease, and trauma). Endoscopically, lesions were divided on the basis of number (solitary or multiple) and appearance (ulcerative, polypoidal/nodular or erythematous mucosa). Demographic, clinical and endoscopic characteristics of subjects were evaluated. Forty-four patients met the inclusion criteria; 21 (47.7%) were females and 23 (52.3%) were males with overall mean age of 33.73 ±13.28 years. Symptom-wise 41 (93.2%) had bleeding per rectum, 39 (88.6%) had mucous discharge, 34 (77.3%) had straining, 34 (77.3%) had constipation, 32 (72.7%) had tenesmus, 5 (11.4%) had rectal prolapse and 2 (4.5%) had fecal incontinence. Twelve (27.27%) patients presented with hemoglobin less 10 gm/dl, 27 (61.36%) with 10 - 12 gm/dl and 05 (11.36%) subjects had hemoglobin more than 12 gm/dl. Endoscopically, 26 (59.1%) patients had mucosal ulceration, 11 (25.0%) had mucosal ulceration with polypoid characteristics; while only polypoid features were found in 7 (15.9%) subjects. Solitary rectal ulcer syndrome affects adults of both genders with diverse clinical presentation and nonspecific endoscopic features.

  16. Catheter-based infrared light scanner as a tool to assess conduit quality in coronary artery bypass surgery. (United States)

    Burris, Nicholas; Schwartz, Kimberly; Tang, Cha-Min; Jafri, M Samir; Schmitt, Joseph; Kwon, Michael H; Toshinaga, Ozeki; Gu, Junyan; Brown, Jamie; Brown, Emile; Pierson, Richard; Poston, Robert


    Endothelial disruption within saphenous vein and radial artery grafts increases thrombosis risk. However, no clinically applicable method for imaging the intima currently exists. We used a novel infrared imaging technology, optical coherence tomography (OCT; LightLab Imaging, Inc, Westford, Mass), to visualize the intima within harvested conduits. Conduits were procured endoscopically (37 saphenous vein grafts and 8 radial artery grafts) or with the open technique (9 radial artery grafts) from 50 patients. Surplus segments were analyzed by means of OCT for evidence of preexisting pathology or traumatic injury. Focal plaques in radial artery grafts and the intimal hyperplasia area in saphenous vein grafts were quantified as having an intimal/medial thickness ratio of greater than 0.5. Biopsy specimens were obtained for histologic confirmation and to analyze matrix metalloproteinase 2 levels (saphenous vein grafts) and prostacyclin/nitric oxide metabolites (radial artery grafts). Interobserver kappa coefficients and a Bland-Altman analysis were used to determine the reproducibility and accuracy of OCT interpretations. Radial artery imaging revealed plaque in 76%. Endoscopically harvested vessels showed intraluminal clot (38%) and intimal tears ranging from severe (6%) to mild (88%). In saphenous vein grafts intimal thickening was detected in 86% and intraluminal clotting in 68%. The intimal/medial thickness ratio determined by means of OCT correlated directly with matrix metalloproteinase 2 levels (R = 0.6804) in saphenous vein grafts and inversely with metabolites of prostacyclin (R = -0.55) and nitric oxide (R = -0.58) in radial artery grafts. OCT imaging was reproducible (interobserver kappa coefficients of >0.81 for the characterization of plaque types) and showed a strong correlation with histology (R = 0.8, P < .001). OCT imaging provides an accurate, real-time, and reproducible means for assessing saphenous vein graft and radial artery graft bypass conduits

  17. Endoscopic Transnasal Approach for Cholesterol Granuloma of the Petrous Apex

    Directory of Open Access Journals (Sweden)

    Mohammad Samadian


    Full Text Available Cholesterol granulomas are rare round or ovoid cysts. They contain cholesterol crystals surrounded by foreign bodies of giant cells and are characterized by chronic inflammation. Large cholesterol granuloma can compress surrounding tissue especially cranial nerves. There are several types of surgery for the resection of cholesterol granuloma. We describe 4 cases of cholesterol granuloma operated on via transnasal endoscopic approach. In this report, we describe radiologic and pathologic features of this lesion and explain the advantages and disadvantages of transsphenoidal endoscopic approach for these rare lesions.

  18. Recent advances in endoscopic ultrasonography-guided biliary interventions (United States)

    Kawakubo, Kazumichi; Kawakami, Hiroshi; Kuwatani, Masaki; Haba, Shin; Kawahata, Shuhei; Abe, Yoko; Kubota, Yoshimasa; Kubo, Kimitoshi; Isayama, Hiroyuki; Sakamoto, Naoya


    Interventional endoscopic ultrasonography (EUS) based on EUS-guided fine-needle aspiration has rapidly spread as a minimally invasive procedure. Especially in patients with failed endoscopic retrograde cholangiopancreatography, EUS-guided biliary intervention is reported to be useful as salvage therapy. EUS-guided biliary interventions are carried out using three techniques: EUS-guided bilioenteric anastomosis, EUS-guided rendezvous procedure, and EUS-guided antegrade treatment. Although interventional EUS is not yet a standardized procedure, there have been recent advances in this field that address various biliary diseases. Here, we summarize the indications, techniques, clinical results of previous studies, and future perspectives. PMID:26327757

  19. Medical Devices for Obesity Treatment: Endoscopic Bariatric Therapies. (United States)

    Vargas, Eric J; Rizk, Monika; Bazerbachi, Fateh; Abu Dayyeh, Barham K


    Endoscopic bariatric therapies (EBTs) are effective tools for the management of obesity. By mimicking restrictive and bypass surgery physiology, they provide a safe and effective treatment option with the added capabilities of reaching a broader population. Multiple efficacious medical devices, such as intragastric balloons, endoscopic suturing/plication devices, and bypass liners, at various stages of development are available in the United States. EBTs represent the newest addition to a multidisciplinary approach in obesity management. This article reviews several devices' safety and efficacy for primary care providers in the era of evolving obesity treatment. Copyright © 2017 Elsevier Inc. All rights reserved.

  20. Full endoscopic endonasal transsellar-transclival approach: the modularity concept. (United States)

    Pérez-Borredá, Pedro; Simal-Julián, Juan Antonio; de San Román-Mena, Laila Pérez; Botella-Asunción, Carlos


    Endoscopic endonasal approaches (EEAs) constitute a reasonable option for the treatment of lesions that involve the sellar and clival regions. We describe, step by step, the full EEA expanded to the middle and lower clivus for the treatment of perisellar lesions. Delimiting different modules around the sellar region is useful in establishing the best endoscopic approach for each tumor. A craniopharyngioma (CP) with clival extension will be used as an illustrative example of the modularity concept of these approaches. Transsellar-transclival EEA allows complete resection of lesions located in the sellar and infrasellar region with a low rate of complications.