Anatomic considerations for open and endoscopic gluteal tendon surgery

Current surgical training: simultaneous training in open and laparoscopic surgery

Clinical practice guidelines for endoscopic breast surgery in patients with early-stage breast cancer: Chinese Society of Breast Surgery (CSBrS) practice guidelines 2021.

Considerable advances in endoscopic technique and experience have allowed an increasing number of patients with complex frontal sinus disease to be treated with endoscopic surgery. The objective of the current study was to evaluate management strategies and outcomes regarding treatment of lateral frontal sinus disease. Prospective case series. Academic tertiary medical center. Prospectively collected data concerning frontal sinus pathology located lateral to the plane of the lamina papyracea (lateral disease) were reviewed. Data were collected regarding demographics, etiology, surgical technique, revision rate, anatomic considerations, and clinical follow-up. Only patients with at least 24 weeks of clinical follow-up and pathology who required removal and dissection in this region were included in the study. Over 5 years, 156 patients (mean age, 47.9 years; range, 14-84 years) with 183 lateral frontal sinus pathologies and an average clinical follow up of 76 weeks (range, 24-237 weeks) were evaluated. Endoscopic or open surgery was attempted in 84 patients (54%) prior to intervention at our institution. Primary pathologies included inflammatory/obstructive diseases (n = 119), skull base defects (n = 33), and tumors (n = 31). Initial interventions included endoscopic (Draf IIA, n = 76; Draf IIB, n = 52; Draf III, n = 23), extended (IIA + trephine, n = 1; III + trephine, n = 2; III + osteoplastic flap, n = 2), and open (osteoplastic flap, n = 3; Reidel, n = 1; cranialization, n = 1) procedures. Seven patients (4%) required a subsequent revision procedure. The vast majority of lateral frontal sinus pathology was managed using endoscopic techniques with excellent outcomes and a low revision rate in the current study.

To provide an overview of complete mesocolic excision, along with a review of the relevant vascular anatomy and locoregional staging concepts, for abdominal radiologists. Complete mesocolic excision (CME) with central vascular ligation (CVL) for colon cancer has emerged as a technique that has growing interest in surgical oncology. Specific anatomic considerations and patterns of nodal spread have thus gained clinical significance, and should be familiar to abdominal radiologists. This review article provides an overview of CME with CVL, and discusses some of the important anatomic considerations in patients with colon cancer that are relevant to radiologists. Knowledge of CME with CVL and the relevant anatomic and staging considerations is important for abdominal radiologists, as this surgical technique becomes increasingly utilized.

The purpose of the study was to assess the applicability of a new ITKA GSD Basic 250 electrosurgical unit (ESU) to urologic endoscopic surgery, laparoscopic surgery and open urologic surgery, its possible interference with videorecording and stray currents in healthy tissues. A new ITKA GSD Basic 250 ESU (test ESU) was used and compared to conventional ESU (Berchtold Elektrotom 390 as reference ESU). Experimental surgery was carried out on three female pigs, which underwent endoscopic, laparoscopic and open surgery. Altogether 29 patients underwent either endoscopic or open surgery with the test ESU. In experimental surgery, the ideal cutting and coagulation settings of the test ESU were in the range 15 – 25 % for endoscopic surgery. In laparoscopic surgery, tissues were ideally resected and removed at 10–15% power settings. In open experimental surgery, the ideal power settings were 25–30%. In human surgery, the test ESU operated well at 25–35 % power settings in endoscopic surgery, while in open surgery on humans the ideal settings were 25–35% in monopolar use and 20–25%) in bipolar use. When used for endoscopic operations, the test ESU did not interfere with videorecording. Nor were any adverse effects seen in the surrounding tissues. The patients had neither early nor late complications. Histopathological findings revealed no differences in healing between the test ESU and reference ESU. Experimental and patient surgery showed the test ESU to be both safe and effective. It is suitable to be used in urologic endoscopic surgery, laparoscopic surgery and open urologic surgery. It does not interfere with videorecording or cause harmful stray currents in surrounding tissues. Power can be adjusted linearly and precisely. Low-power operation is also possible.

Endoscopic Resection vs. Open Surgery Combined With Radiotherapy for Locally Advanced Sinonasal Malignancies

Foetal surgery and cleft lip and palate: current status and new perspectives

OBJECTIVE:The objective of this study is to evaluate the clinical efficacies of open versus endoscopic surgery in the treatment of congenital diaphragmatic hernia (CDH) and investigate the feasibility and safety of endoscopic surgery as an alternative to open surgery in these cases.PATIENTS AND METHODS:A retrospective analysis was performed from June 2002 to February 2014. A total of 59 cases were attempted. The neonates were divided into either an endoscopic or open surgery group. The pre-, intra- and post-operative data on the neonates were analysed, and the surgery-related complications, survival rates and recurrence rates were compared between the two groups.RESULTS:Demographic characteristics were not significantly different between the two groups. Compared with open group, the hospital stay and post-operative mechanical ventilation time were significantly shorter, while surgery duration was significantly longer in the endoscopic surgery group. The recurrence rate was higher and the survival rate was lower in the endoscopic surgery group with no statistically significant and the recurrence rate has decreased over the past 5 years.CONCLUSIONS:We have demonstrated that the endoscopic surgery is safe and effective for repairing CDH. The endoscopic surgery is a minimally invasive procedure with fast post-operative recovery and a good cosmetic outcome.

In recent years, fully endoscopic decompression surgery for degenerative spine disease has become increasingly popular in the US. Although an endoscopic approach has demonstrated some benefits compared with open procedures in randomized controlled trials, the cost of advanced technologies remains contested. The authors evaluated the differences in costs and cost drivers between open and endoscopic decompression surgical procedures performed at a single institution. Using associated Current Procedural Terminology codes, the authors identified all open and endoscopic decompression lumbar surgical procedures performed from January 1, 2016, through December 31, 2022. Preoperative comorbidities, surgical characteristics, and postoperative outcomes were captured. The costs of index surgery-related readmission for revision, washout, or other complications were included in the index surgery expenses. Associated in-hospital costs were collected; these were reported in comparative percentages with open surgical procedures as the baseline because of an institutional agreement. Univariate and multivariate analyses were performed. The retrospective search identified 633 open surgical procedures and 195 endoscopic surgical procedures for inclusion. The two patient cohorts were similar, with clinically nonrelevant but statistically significant differences in mean age (open 55.7 years vs endoscopic 59.4 years, p = 0.01) and mean American Society of Anesthesiologists physical status class (open 2.3 vs endoscopic 2.4, p = 0.03). Postoperatively, patients who underwent open surgical procedures had significantly longer mean hospital stays (open 1.4 days vs endoscopic 0.7, p < 0.01) and more perioperative complications (open 7.9% of patients vs endoscopic 3.1%, p = 0.02), and they required washout surgical procedures in some cases (open 1.3% vs endoscopic 0%, p = 0.12). The largest cost difference between open and endoscopic surgical procedures was the significantly greater cost of disposable supplies for endoscopic cases (10.1% vs 31.7% of the total cost of open procedures, p < 0.01), and open surgical procedures were generally less costly in total (100.0% vs 115.1%, p < 0.01). In multivariate linear regression, endoscopic surgery was independently associated with greater total costs (standardized beta 15.9%, p < 0.01), although length of hospital stay (standardized beta 34.0%) and readmissions (standardized beta 30.0%, p < 0.01) had larger effects on cost. The endoscopic approach was associated with greater total in-hospital costs compared with open procedures. The findings of further cost evaluations, including those of patient-reported outcomes, social cost, and capital costs per procedure type, need to be included in operational and clinical decisions.

To explore the clinical effect and the influence factors after endoscopic surgery for chronic sinusitis. The clinical data of 337 patients with chronic sinusitis treated by endoscopic surgery were analyzed, including gender, age, culture level, course of the disease, the days of hospitalization, medical history, smoking, drinking, early surgery history, allergic rhinitis (AR) history, clinical classification, visual analogue scale (VAS) score, nasal endoscopy score, nasal polyps, CT examination score, side, nasal adhesion and postoperative follow-up compliance. The clinical effect of endoscopic sinus surgery was evaluated 6 months after operation according to the 1997 Haikou standard. SPSS 18.0 software and conducted chi-square test and logistic regression analysis were used to analyze the data. Three hundred and thirty-seven chronic sinusitis patients were followed up after endoscopic surgery. It was found that 298 cases (88.4%) cured, 29 cases (8.6%) improved, 10 cases (3.0%) invalid. The clinical curative effect of the patients with chronic rhinosinusitis without nasal polyp was better than that of the patients with chronic rhinosinusitis with nasal polyp, the difference was statistically significant (χ(2) = 10.932, P < 0.01). After many factors Logistic regression analysis, the most important effect factor in the clinical curative effect were clinical type, AR or not, VAS score, nasal endoscopic examination score, CT examination score, multiple nasal polyp or not, postoperative nasal adhesion or not and postoperative follow-up compliance. The clinical effective of endoscopic sinus surgery is influenced by not only surgery itself, but also by clinical classification, whether and not with AR and so on.

Objective To investigate the causes, clinical features, treatment and prognosis of chronic sinusitis and nasal polyps with endoscopic sinus surgery. Methods A total of 10 patients (10 eyes) from clinic of Xi’an No.4 Hospital between January 2001 and December 2016 due to vision loss caused by endoscopic sinus surgery were prospectively examined. All patients were enrolled and administered visual acuity testing, ophthalmic examinations, color photography, and other clinical observations. Results Ten cases of ocular complications occurred, including central retinal artery occlusion in 1 case, optic nerve injury in 6 cases, orbital hemorrhage in 2 cases, and orbital infection in 1 case. Conclusions The complications of endoscopic sinus surgery in patients with chronic rhinosinusitis and nasal polyps are complex, and the preparation, familiarity with nasal endoscopic resection and skilled operation can reduce the occurrence of complications. Timely detection of eye complications can reduce the risk of serious consequences. Visual impairment caused by endoscopic sinus surgery is difficult to treat and result in poor prognosis. Key words: Nasosinusitis; Nasal polyp; Endoscopic surgery; Eye; Complication

To assess the outcomes of infants followed-up at least 12 months after open and endoscopic fetal surgery for the treatment of spina bifida. A searching in The Cochrane Library, LILACS, PubMed and SCOPUS databases for fetal meningomyelocele (MMC) open or endoscopic surgery in humans from 2003 on-wards with follow-up at least 12 months. The rate of the estimated proportions was evaluated by the 95% confidence interval (CI). A total of 19 studies were finally included (17 open and 2 endoscopic surgery). The results suggested that the rate for ventriculoperitoneal shunt placement were 40% (29%, 51%) versus 45% (34%, 56%) for open surgery group and endoscopic surgery group. The rate of hindbrain herniation reversal was 34% (28%, 52%) versus 86% (49%, 97%), the lower extremity function rates for both groups were 47% (30%, 64%) versus 86% (49%, 97%), and bladder dysfunction rates for both groups were 72% (53%, 88%) versus 29% (8%, 64%), respectively. Open and endoscopic fetal surgery for MMC presented similar ventriculoperitoneal shunt rates. Open and endoscopic fetal surgery for MMC presented similar ventriculoperitoneal shunt rates in infants followed at least 12 months.

Comparing clinical and radiological success in open versus endoscopic surgery of primary vesicoureteral reflux.

Conventionally, open surgery (OS), including standard craniotomy (SC) and decompressive craniectomy (DC) with hematoma evacuation, is adopted to treat life-threatening large spontaneous supratentorial intracerebral hemorrhage (ICH). Recently, endoscopic surgery (ES), a minimally invasive surgical treatment, has gained increased popularity. However, the safety and efficacy of ES for life-threatening large ICH is uncertain. The aim of this study was to evaluate the effectiveness and safety of ES for life-threatening large ICH and compare it with traditional OS. We retrospectively analyzed the clinical and imaging data of consecutive supratentorial ICH patients with preoperative Glasgow Coma Scale (GCS) score ⩽ 8, who underwent ES or OS between May 2015 and October 2021. To minimize bias in case selection, propensity score matching was performed (ratio 1:2, caliper o.2). The primary outcome was a prognosis-based dichotomized (favorable or unfavorable) outcome of the 5-point Glasgow Outcome Scale (GOS) at 6 months. Favorable outcome was defined as a GOS score of 4 to 5 at 6 months. Sensitivity analysis was also performed to ensure the robustness of the findings. Of 695 patients who underwent surgical treatment for spontaneous ICH, 191 patients were identified to be eligible, with 58 patients in the ES group and 133 patients in the OS group. Propensity score matching improved covariate balance and generated a comparable cohort (53 ES and 106 OS) for all analyses. The ES group had a higher incidence of the primary outcome of favorable outcome at 6 months (ES 20/53 (37.7%) vs. OS 22/106 (20.8%); propensity score-matched relative risk (RR) (95% CI) = 1.74 (1.13-2.68); p = 0.013). Sensitivity analysis showed the result was stable. ES is a safe treatment for life-threatening large spontaneous supratentorial ICH patients and may achieve better outcomes than OS.

View Supplementary Video 1 Laryngoscope, 2020