Application Of Endoscopic Surgery Research Articles

The risk of prematurity in Cameroonian children born after in vitro fertilisation.

To evaluate the risk of prematurity in Cameroonian children born after in vitro Fertilisation. A retrospective cohort study. Conducted at the pediatric department of the Hospital Center for Research and Application in Endoscopic Surgery and Human Reproduction (HCRAESHR) in Yaoundé over eight months. Every newborn born after in vitro fertilisation (exposed group) and those born after spontaneous conception (non-exposed group) from a singleton pregnancy were included. Multiple pregnancies were excluded. One hundred newborns per group were recruited and matched according to the mode of delivery. The main outcome measure was prematurity at birth. Data were collected from the medical records of the newborns and reported on individual questionnaires. The t Student test was used to assess the differences in gestational age between the two groups. The generalised linear model using binomial probability distribution was used for multivariate analysis to determine prematurity risk factors. All results with a p-value ≤ 0.05 were considered statistically significant. Prematurity was significantly predominant in the exposed group (22% and 5%, respectively, p=0.002) compared to the non-exposed group. The risk of prematurity in the exposed group was 4.4 times higher than in the non-exposed group. After controlling for confounders (the maternal age, the sex of the baby, and maternal hypertension), this risk increased significantly from 4.4 to 7.67 (p=0.001). This study demonstrated the first evidence from our part of the world showing that in vitro fertilisation is an absolute risk of prematurity. None declared.

The evolution of interlaminar endoscopic spine surgery.

Due to the aging population, patients required spinal surgery for degenerative spondylopathy is increasing. With the advent of surgical instruments and techniques, minimally invasive spine surgery is prevalent worldwide. Besides microscopic techniques, endoscopic spine surgery has gotten attention gradually in this surgical field for the past two decades. There are two essential approaches developed currently, including transforaminal and interlaminar approach. These innovative equipment and skills promote the progression of endoscopic surgery from discectomy to decompression of spinal stenosis. Meanwhile, they also opened up the application of endoscopic surgery in a complicated situation. From the perspective of emerging technologies and techniques, the authors will review the evolution and describe the prospects of the interlaminar endoscopic spine surgery (IESS).

Investigation of Spermatic Abnormalities Associated with Smoking at The Hospital Center for Research and Application in Endoscopic Surgery and Human Reproduction, Cameroon, Cameroon

Introduction: The gradual deterioration of sperm parameters, observed over the years, is attributed to environmental factors such as tobacco. Smoking has already been incriminated in erectile dysfunction as well as in alterations in sperm quality. This study aims to determine the spermatic abnormalities associated with active and/or passive exposure to smoking. Methods: A cross-sectional analytical study was conducted over a period of 8 months (September 2016 - April 2017) at the Hospital Center for Research and Application in Endoscopic Surgery and Human Reproduction. All men with spermatic abnormalities who agreed to give informed consent were included consecutively. The mode of exposure to smoking and spermatic abnormalities were sought. The statistical analysis was done using the software Epi info version 3.5.4. using the Chi-square test with a value of p <0.05 considered as statistically significant. Results: A total of 228 men with a spermatic anomaly were included in the study, of whom 82 (36.0%) were exposed to smoking. The proportion of men with oligozoospermia was higher among smokers (49, 59.8%) than among non-smokers (62, 42.5%), similarly for those with oligoasthenozoospermia (smokers: 25, 30.5% vs. no smokers 37, 25.3%). These differences were statistically significant for oligozoospermia (p = 0.012) and oligoasthenozoospermia (p = 0.028). Conclusion: Spermatic abnormalities found in passive and/or active tobacco exposure were oligozoospermia and oligoasthenozoospermia.

Evaluation of the Spermatic Profile of Men Consulting for Infertility of the Couple at the Hospital Center of Research and Application in Endoscopic Surgery and Human Reproduction, Cameroon

Introduction: Males are found to be solely responsible for 20-30% of infertility cases and contribute to 50% of cases overall. The present research aims to study the spermatic profile in infertile couples in Cameroon. Methods: This is a descriptive cross-sectional study over a period of eight months at the Hospital Center for Research and Application in Endoscopic Surgery and Human Reproduction. All men living in couples presenting for semen analysis as part of an infertility assessment and having given their informed consent were included consecutively. The statistical analysis of the data was done with the software Epi info version 3.5.4. Results: A total of 346 men were selected for the study. The majority (228, 65.9%) had sperm abnormalities, the most common being asthenozoospermia (48, 21.0%) and oligozoospermia (44, 19.3%). Conclusion: The spermatic profile of men in infertile couples was characterized by the importance of polymorphic alterations, the most frequent being asthenozoospermia and oligozoospermia.

Factors Associated with Spermatic Abnormalities in Men Consulting for Couple Infertility at the Hospital Center for Research and Application in Endoscopic Surgery and Human Reproduction, Cameroon

Introduction: The origin of male infertility remains multifactorial and idiopathic. The purpose of this study was to investigate the factors associated with sperm abnormalities in men consulting for couple infertility in Cameroon. Methods: An analytical cross-sectional study was carried out at the Hospital Center for Research and Application in Endoscopic Surgery and Human Reproduction in eight months in 346 male infertile couples who gave their informed consent. The statistical analysis was done using the software Epi info version 3.5.4. Chi square tests was performed with a p value <0.05 considered statistically significant. Results: Risk factors associated with sperm abnormalities were smoking (OR = 1.97, 95% CI = 1.25-3.09, p = 0.003), syphilis (OR = 2.78, 95% CI) % = 1.03-7.47, p = 0.035), mumps infection with testicular involvement (OR = 3.48, 95% CI = 1.1-12.02, p = 0.036), irradiation ( p = 0.011), varicocele (OR = 7.66, 95% CI = 2.31-25.4, p = 0.000) and congenital anorchia (OR = 5.27, 95% CI = 1, 2-23.03, p = 0.014). Conclusion: Risk factors for sperm abnormalities were smoking, irradiation, urogenital chlamydiosis, urogenital syphilis, mumps infection associated with testicular involvement, varicocele and congenital anorchia.

The application of endoscopic surgery in orbital sinusogenous complications in ENT Clinic CM UJ Krakow in 2004–2016

Introduction: Endoscopic surgery of the paranasal sinuses is a surgical technique that has revolutionized the surgical treatment of patients with chronic sinusitis. Application of this method now goes far beyond the conditions of the nasal cavity. Aim: It allows among other operations within the eye socket, acting alternative technique for the operation of the external appproauch. Material and Methods: This work is devoted to the analysis of the effectiveness of endoscopic surgery in the treatment of patients with orbital complications in the course of sinusitis in the Department of Otolaryngology SU in Cracow in the years 2004-–2016, aim of this study is to search for optimal treatment of patients with the above disorders. Results: In the group of patients operated on because of orbital abscess from reaching the outside in all patients had symptoms of revocation on the part of the orbit and ocular, and postoperative complications were not observed. Among patients undergoing endoscopic trocar in one patient there was no improvement in the function of the eye. It could lead to a too long period of time from the first appearance of symptoms (over 48 hours), and sometimes surgical intervention, as well as the occurrence of orbital hematoma in the second postoperative day and the necessity of re-operation of the external handle.

Advances in endoscopic surgery for small animal reproduction.

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

Ex-vivo investigation on the potential of 1470 nm diode laser light for enucleation of uterine leiomyoma

Abstract Background and objective: Patients suffering from uterine leiomyoma are often treated by hysterectomy or organ preserving myoma enucleation using electrosurgical, ultrasonic or radio-frequency techniques. Considerable thermal tissue damage leads to the development of scar formation which in the long term may result in complications during pregnancy. Therefore alternative techniques are required. Materials and methods: After ethical approval, human uteri myomatosus were used to investigate the interaction of 1470 nm diode laser light (Medilas D MultiBeam; Dornier MedTech Laser GmbH, Weßling, Germany) during surgical procedures (laser mode, continuous wave; laser power, 5–30 W; fiber core diameter, 600 μm; cutting velocity, 3 mm/s). Macroscopic and microscopic evaluation was performed to improve understanding of tissue ablation and coagulation processes. Additionally laser-assisted ex-vivo myoma enucleation procedures were performed to assess handling and applicability. Descriptive and correlation statistics were used for evaluation. Results: The macroscopic visible coagulation rim was calculated to be at a maximum of ~550 μm in lateral direction (superficial width), and ~300 μm in axial plane (sagittal depth). Microscopic examination of hematoxylin and eosin stained sagittal tissue slices showed a largest ablation depth of 279.1±186.8 μm and a maximum irreversibly damaged remaining tissue depth of 628.7±354.3 μm when a laser power of 30 W was applied. The ratio of the remaining tissue and ablation depth indicates that increased applied laser power results in a faster ablation than coagulation into the depth. Hands-on ex-vivo myoma enucleation at power levels of 20–25 W showed an ideal preparation situation with the potential for sufficient surface coagulation when the fiber-tissue distance is adjusted to 5–10 mm. Conclusion: Sufficient and effective ablation and coagulation of uterus myomatosus tissue and the ex-vivo myoma enucleation showed the potential of the 1470 nm diode laser as an innovative surgical tool for myoma enucleation. Based upon this study it should be clinically validated whether this procedure could become an alternative application in endoscopic surgery in gynecology.

The applications of endoscopic surgery in department of otorhinolaryngology-head and neck surgery

Endoscopic surgery has developed dramatically in the last few decades in otorhinolaryngology - head and neck surgery. Conventional sinus surgery with an external approach has been replaced by endoscopic sinus surgery, with endoscopic surgical techniques applied on structures of the sinus, including the nasal septum, orbit, and skull base. Endoscopic ear surgery was introduced with diagnostic methods initially, and has transformed surgical concepts in recent years. Endoscopic upper airway surgery was popularized in the 1970s, and its applications have been extended while minimizing morbidity. Endoscopic thyroidectomy is currently performed in some patients with large benign thyroid tumors or micropapillary carcinomas. The applications of endoscopic surgery will be extended to other parts of otorhinolaryngology - head and neck surgery in the near future.

Mo1661 Development of Bioabsorbable Materials for the Closure Following the NOTES Translumenal Procedure

Endoscopic procedures represent an advance from conventional laparoscopic operations, with intragastric procedures and NOTES seeing clinical applications. However, in translumenal procedures, there can be difficulty with the closure of the luminal defect area, or even when closure is possible, there are issues with stenosis and deformation arising after closure. In cases where direct suturing of a defective area with the opening or resection of the stomach and small and large intestines is not possible, and if closure became easily possible using some kind of replacement materials, it is thought that applications of endoscopic surgery would increase.

Minimally invasive trans-mediastinal endoscopic approach to insert phrenic stimulation electrodes in the human diaphragm: a preliminary description in cadavers

Diaphragm pacing by phrenic nerve (PN) stimulation is currently used for patients with central respiratory paralysis to be weaned from mechanical ventilation. Electrodes are inserted either through bilateral thoracotomy or through four ports laparoscopy. The aim of this experimental work is to demonstrate the feasibility of trans-mediastinal bilateral implantation of PN electrodes using a flexible gastroscope introduced through a cervical incision in human cadavers. Ten refrigerated and non-embalmed cadavers were used. The gastroscope was introduced through a cervical incision into the latero-tracheal space and then subsequently into both pleura by opening the mediastinal pleura. After identification of the PN, electrodes were introduced through an intercostal space to the desired diaphragmatic location using a long, pliable needle with the electrode loaded in its lumen. Results are described for each hemi-diaphragm not for an anatomic subject. Mediastinal exploration and introduction of the video gastroscope into the pleural cavities proved easy in all subjects. Pleural adherences were present in five hemi-diaphragms. The central tendon of both hemi-diaphragms could be identified unambiguously in all the subjects. Identification of the entry point of the phrenic nerve into the diaphragm was straightforward in 10 hemi-diaphragms. In the remaining 10, this proved more difficult because of mediastinal fat or lung parenchyma. Introduction of the electrode-holding needles through the intercostal space and their insertion close to the phrenic nerve entry point was also easy. Withdrawal of the needle from the diaphragm and 'capture' of the hook were successful on the first attempt in 14 hemi-diaphragms, but failed in six others in whom a second attempt was necessary. Trans-mediastinal implantation of PN stimulation electrodes is possible using a flexible endoscope. This application of endoscopic surgery could allow a minimally invasive placement of PN electrodes in patients with central respiratory paralysis, for example, at the time of tracheostomy.

Su1584 Development of Bioabsorbable Materials Aimed at a Closure Following the NOTES® Transluminal Procedure

Endoscopic procedures represent an advance from conventional laparoscopic operations, with NOTES seeing clinical applications. However, in translumenal procedures, there can be difficulty with the closure of the luminal defect area, or even when closure is possible, there are issues with stenosis and deformation arising after closure. In cases where direct suturing of a defective area with the opening or resection of the stomach and large intestines is not possible, and if closure became easily possible using some kind of replacement materials, it is thought that applications of endoscopic surgery would increase.

Surgical technique of endoscopic sentinel lymphadenectomy in the N0 neck

There is an increasing demand for sentinel lymphadenectomy, which was developed to reduce the extent of surgical interventions in cancer patients. Among surgical techniques, endoscopic technology has evolved to become an integral part of the surgical approach. However, the application of endoscopic surgery in the neck, except for thyroid surgery, has so far failed to gain widespread acceptance. The challenge of endoscopic neck surgery is to create an adequate working cavity to make surgical dissection reliable. This is especially true if levels of the neck that are distant from the skin incision are to be dissected. This article reports on the development of a minimally invasive, endoscopic lymphadenectomy via a single skin incision. Through the use of a specially designed endoscope with spreadable blades, the dissection of soft tissue in a working cavity is possible. Based on our preliminary results with this technique, the potentials and limitations of this method are discussed. However, it must be stated that the technique is still on an experimental level and has to be further improved. The technical aspects and importance of endoscopic lymphadenectomy in the neck are promising and show scientific and clinical potential. The future goal of the described technique is to perform even extended soft tissue interventions utilizing a minimally invasive endoscopic approach.

Assessing the Adequacy of Endoscopically Tied Knots: A Functional Approach

Endoscopic intracorporeal knots have potentially enormous applications in endoscopic surgery. We describe a method for testing the security of various types of endoscopically tied knots using a vessel perfusion manometer system. A 4-cm segment of porcine splenic artery was placed on the mucosal surface of a pig stomach. The two ends of the vessel were brought out through the gastric wall and connected to a two-way manometer. One end was also joined to a pressure infusion bag. The stomach was mounted in an Erlangen training model. A long 3/0 nylon thread, previously introduced into the submucosal layer of the stomach and encircling the vessel, was brought out from the mouth. Three-throw square knots, Mayo knots, "surgeon's" knots and five-throw square knots were tied and pushed into place using a cap attached to a gastroscope. The pressure at the two ends of the artery was compared. If the pressure could be increased to over 200 mm Hg at one end without a change in the other, the knot was considered secure. Each type of knot was tested 12 times under endoscopic vision. The range for mean knotting time was 3.4 - 4.5 minutes. Five-throw knots took significantly longer to tie than three-throw knots (P < 0.005). There was one loose knot in each of the three-throw and Mayo groups, and three each in the "surgeon's" and five-throw groups (P > 0.05). This system is a reliable model for testing intracorporeal knots tied endoscopically. A three-half-hitches square knot with 3/0 nylon, tied using a flexible endoscope and knot-tightening cap, can withstand pressure up to 200 mm Hg.

Endoscope-Assisted Correction of Primary Varicose Veins

The purpose of this study is to evaluate the possibilities and results of application of endoscopic surgery in the operation of primary varicose veins. With good illumination and magnified viewing, the varicosities, incompetent perforating veins, and healthy veins were clearly visualized. The incompetent perforating veins were clipped and divided securely. The varicose veins and tributaries were dissected and removed completely after being clipped and divided. The healthy veins were preserved if possible. Primary varicose veins in 43 limbs of 37 patients were operated. The operation was conducted through one access incision in 31 limbs (72%), two incisions in 11 limbs (25%), and three incisions in 1 limb. The mean number of incisions was 1.3 in each limb. Hematoma formation occurred in 1 patient due to the slipping of one clip on the third postoperative day. The other patients had uneventful postoperative courses. All 37 patients were reviewed 4 to 30 months postoperatively. Only one limb had recurrent varices at a new site. Ninety-seven percent of limbs (42 of 43) had no recurrence of varicose veins. Seventy-eight percent of patients (29 of 37) were extremely pleased with this operation. Although the other 22% of patients (8 of 37) appreciated this operation, they were not completely satisfied because some preoperative complaints persisted. In this series, the recurrent rate of varicose veins was low (1 in 43 limbs) and postoperative scarring was minimized, in addition to the advantages of endoscopic surgery. These results demonstrate that endoscopic surgery is a worthy alternative procedure for correcting primary varicose veins.

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Applications of endoscopic surgery in pediatric patients.

Although the advent of endoscopic technology is expanding the fields of reconstructive and aesthetic surgery in adults, there have been few reports of the use of this technology in the pediatric population. Because of their minimally invasive nature, yet wide range of exposure, endoscopic techniques have much appeal for this age group. Here we present our experience with endoscopic pediatric plastic surgery. From February of 1995 to August of 1997, 104 patients underwent 139 procedures utilizing 5- and 10-mm endoscopes. There were 58 male and 46 female patients. The mean age at surgery was 5.6 years (range, 3 weeks to 19 years). The most common type of procedures performed were insertion of tissue expanders (n = 34), excision of benign head and neck masses (n = 27), torticollis release (n = 20), excision of vascular lesions (n = 13), and miscellaneous procedures, (n = 10). There were 26 complications in 139 procedures (19 percent). Seventeen (65 percent) were in the tissue expander group. The rest were scattered among the groups with other diagnoses. Although there did not appear to be a specific type of complication associated with endoscopy, 77 percent occurred in the first 2 months of our study. This suggests a relatively steep technical learning curve. These results demonstrate that endoscopic techniques are eminently applicable in the pediatric population, providing the benefits of small and remote incisional wounds, with complication rates that are comparable with those of conventional open surgical treatment.

Interventional magnetic resonance imaging.

The development of minimally invasive surgical and interventional techniques has created a need for more accurate and sensitive image guidance and monitoring. Magnetic resonance imaging, with its superior soft tissue discrimination and multiplanar facilities, seems the obvious choice for an ideal image-guidance tool. Until recently, the employment of MRI in this role has been prevented by the physical constraints of conventional, closed-configuration machines. The problem has now been overcome by the development of an open design allowing both horizontal and vertical access to the patient in the scanner so that procedures can be performed concurrent with image acquisition. This configuration, together with the use of fast gradient echo sequences which can scan at speeds close to real time, means that a wide range of interventional procedures can be performed with on-line image guidance and monitoring. In addition, the versatility of the open design means that patients can assume physiological positions to allow dynamic joint imaging to be performed. This opens up a whole new field in the understanding of joint pathophysiology. This review article discusses these recent technological developments and their clinical applications. In particular, the potential role in guidance of biopsies, monitoring of thermal ablation techniques and applications in endoscopic surgery is outlined.

IN MINIMAL ACCESS SURGERY

The pediatrician must be cognizant of the extensive applications of endoscopic surgery in the pediatric patient. The ability to provide either outpatient surgery or short-stay surgery appears to be cost-effective and appropriate state-of-the-art medical care. As the array of surgical instruments continues to evolve, new and innovative endoscopic procedures will become increasingly available.

IN MINIMAL ACCESS SURGERY

The pediatrician must be cognizant of the extensive applications of endoscopic surgery in the pediatric patient. The ability to provide either outpatient surgery or short-stay surgery appears to be cost-effective and appropriate state-of-the-art medical care. As the array of surgical instruments continues to evolve, new and innovative endoscopic procedures will become increasingly available.