Efficacy Of Endoscopic Surgery Research Articles

Oncologic outcomes of surgical treatments of advanced sinonasal malignancies

Objective: To investigate the prognoses of advanced (T3-T4) sinonasal malignancies (SNM). Methods: The clinical data of 229 patients with advanced (T3-4) SNM who underwent surgical treatments in the First Affiliated Hospital of Sun Yat-sen University from 2000 to 2018 were retrospectively analyzed, including 162 males and 67 females, aged (46.8±18.5) years old. Among them, 167 cases received endoscopic surgery alone, 30 cases received assisted incision endoscopic surgery, and 32 cases received open surgery. The Kaplan-Meier method was used to estimate the 3-year and 5-year overall survival (OS) and event-free survival (EFS). Univariate and multivariate Cox regression analyses were performed to explore significant prognostic factors. Results: The 3-year and 5-year OS were respectively 69.7% and 64.0%. The median OS time was 43 months. The 3-year and 5-year EFS were respectively 57.8% and 47.4%. The median EFS time was 34 months. The 5-year OS of the patients with epithelial-derived tumors was better than that of the patients with mesenchymal-derived tumors and malignant melanoma (5-year OS was respectively 72.3%, 47.8% and 30.0%, χ2=36.01, P<0.001). Patients with microscopically margin-negative resection (R0 resection) had the best prognosis, followed by macroscopically margin-negative resection (R1 resection), and debulking surgery was the worst (5-year OS was respectively 78.4%, 55.1% and 37.4%, χ2=24.63, P<0.001). There was no significant difference in 5-year OS between the endoscopic surgery group and the open surgery group (65.8% vs. 53.4%, χ2=2.66, P=0.102). Older patients had worse OS (HR=1.02, P=0.011) and EFS (HR=1.01, P=0.027). Patients receiving adjuvant therapy had a lower risk of death (HR=0.62, P=0.038). Patients with a history of nasal radiotherapy had a higher risk of recurrence (HR=2.48, P=0.002) and a higher risk of death (HR=2.03, P=0.020). Conclusion: For patients with advanced SNM, the efficacy of endoscopic surgery can be comparable to that of open surgery when presence of safe surgical margins, and a treatment plan based on transnasal endoscopic surgery as the main comprehensive treatment is recommended.

Current Status of Endoscopic Surgery in Japan: The 15th National Survey of Endoscopic Surgery by the Japan Society for Endoscopic Surgery.

In Japan, the first endoscopic surgery, a laparoscopic cholecystectomy, was performed in 1990. Since then, operative procedures have been standardized, and the safety and efficacy of endoscopic surgery have been evaluated. In accordance with the social acceptance of endoscopic surgery as a less invasive type of surgery, the number of endoscopic procedures performed has increased in all surgical domains. The Japan Society for Endoscopic Surgery (JSES) has played an important role in the development of endoscopic surgery in Japan. Notably, a technical skills certification system for surgeons was established by the JSES to train instructors on how to teach safe endoscopic surgery. Furthermore, the JSES has conducted a national survey every 2 years. In 2019, 291,792 patients underwent endoscopic surgery in all surgical domains, such as abdominal, thoracic, mammary and thyroid gland, cardiovascular, obstetrics and gynecology, urologic, orthopedic, and plastic surgery. The 15th National Survey of Endoscopic Surgery conducted by the JSES demonstrated the status of laparoscopic surgery in Japan in 2018-2019.

Optimizing Visualization in Endoscopic Spine Surgery.

Given the inherent limitations of spinal endoscopic surgery, proper lighting and visualization are of tremendous importance. These limitations include a small field of view, significant potential for disorientation, and small working cannulas. While modern endoscopic surgery has evolved in spite of these shortcomings, further progress in improving and enhancing visualization must be made to improve the safety and efficacy of endoscopic surgery. However, in order to understand potential avenues for improvement, a strong basis in the physical principles behind modern endoscopic surgery is first required. Having established these principles, novel techniques for enhanced visualization can be considered. Most compelling are technologies that leverage the concepts of light transformation, tissue manipulation, and image processing. These broad categories of enhanced visualization are well established in other surgical subspecialties and include techniques such as optical chromoendoscopy, fluorescence imaging, and 3-dimensional endoscopy. These techniques have clear applications to spinal endoscopy and represent important avenues for future research.

Current status of endoscopic surgery in Japan: The 14th National Survey of Endoscopic Surgery by the Japan Society for Endoscopic Surgery.

In Japan, the first endoscopic surgery, a laparoscopic cholecystectomy, was performed in 1990. Since then, operative procedures have been standardized, and the safety and efficacy of endoscopic surgery have been evaluated. In accordance with the social acceptance of endoscopic surgery as a less invasive type of surgery, the number of endoscopic procedures performed has increased in all surgical domains. The Japan Society for Endoscopic Surgery (JSES) has played an important role in the development of endoscopic surgery in Japan. Notably, a technical skills certification system for surgeons was established by the JSES to train instructors on how to teach safe endoscopic surgery. Furthermore, the JSES has conducted a national survey every two years to evaluate the status of endoscopic surgery over time. In 2017, 248 743 patients underwent endoscopic surgery in all surgical domains, such as abdominal, thoracic, mammary and thyroid gland, cardiovascular, obstetrics and gynecology, urologic, orthopedic, and plastic surgery. The 14th National Survey of Endoscopic Surgery conducted by the JSES demonstrated the status of laparoscopic surgery in Japan in 2016-2017.

Surgical Management of Moderate Basal Ganglia Intracerebral Hemorrhage: Comparison of Safety and Efficacy of Endoscopic Surgery, Minimally Invasive Puncture and Drainage, and Craniotomy

To date, no standard surgical procedure has been proven effective for intracerebral hemorrhage (ICH), particularly deep hematomas. This retrospective study evaluated the effectiveness and safety of endoscopic surgery, minimally invasive puncture and drainage, and craniotomy for treating moderate basal ganglia ICH. Patients with basal ganglia ICH (N= 177) were divided into 3 groups based on therapeutic intervention as follows: endoscopic surgery group (n= 61), minimally invasive puncture and drainage group (n= 60), and craniotomy group (n= 56). Patient characteristics at admission were recorded. Operative time; blood loss during operation; evacuation rate; postoperative complications secondary to perihematomal edema, including rebleeding, infectious meningitis, pulmonary infection, gastrointestinal bleeding, and epilepsy; mortality; and Glasgow Outcome Scale scores were compared among the 3 groups. Minimally invasive puncture and drainage was the least traumatic procedure and had the shortest operative time, but it could not remove the hematoma quickly; moreover, it had the highest rebleeding rate. Craniotomy was effective in removing the hematoma but resulted in marked trauma and had the highest incidence of pulmonary infection. Endoscopic surgery was safer and more effective than the other 2 surgical methods, with greater improvement in neurologic outcomes and no change in mortality. Minimally invasive neuroendoscopic management has the advantages of direct vision, efficient hematoma evacuation, and relatively good results. Endoscopic surgery may be a more promising approach for the treatment of moderate basal ganglia ICH.

Efficacy of Endoscopic Surgery in Management of Patients with Lumbar Canal Stenosis

Background Data: The treatment of lumbar stenosis has originally included extensive resections of posterior neural arch components. Moreover, wide muscular dissection and retraction is generally used to accomplish sufficient visualization. With the advancing noninvasive neuro-imaging modalities; the major component of neurological pressure typically occurs at the level of the interlaminar window. Microendoscopic decompressive laminotomies (MEDL) have now increased popularity among spine specialists for the treatment of lumbar canal stenosis. It has been developed from the unilateral hemilaminotomy technique.Purpose: To evaluate the efficacy of lumbar endoscopic decompression in patients of segmental lumbar canal stenosis from a unilateral skin incision.Study Design: A prospective clinical case study.Patients and Methods: A total of 30 patients 10 males and 20 females were operated in Alexandria Main University Hospital, during the period from January 2013 to June 2015. The degree of pain and disability were assessed pre-operatively using the Visual Analogue Scale (VAS), both for radicular pain and back pain (if present), and the Oswestry Disability Index (ODI). The length of the incision, the duration of surgery, the operative blood loss, and duration of hospital stay were calculated. Mean follow up period for patients was 38.5±18.2 months (Range, 36-48).Results: The mean age was 62.7±6.9 years. All patients had claudicating sciatica; 57% had bilateral sciatica, while 43 % had unilateral sciatica. 60% had low back pain. Only 3 patients (10%) had motor weakness preoperatively. 24 patients (80%) had single level affection, while 6 patients (20%) had double level affection. We operated totally on 36 segmental levels. There was a statistically significant reduction for the mean values of VAS both for radicular pain and back pain in the follow up period (P<0.001). Also, there was a statistically significant reduction for the ODI mean value in the follow up period (P<0.001). Operative blood loss was 109.5±63.2 ML. Mean operative time was 103.8±32.7 minutes. Mean duration of hospital stay was 1.5±0.6 days (Range, 1-3 days). We had two patients of intraoperative dural tears (7%) with no postoperative CSF leak occurred, two patients (7%) had superficial wound infection, no patients had deep wound infection or discitis, and no patients encountered of postoperative instability in the follow up period. Conclusion: Endoscopic surgery for bilateral decompression through a unilateral approach is a useful and effective procedure for treating patients with lumbar canal stenosis with encouraging results. (2018ESJ161)

Modern Indications for Endoscopic Endonasal Surgery

Endoscopic endonasal surgery has become a standard procedure for functional treatment of benign pathologies. Materials and improved surgeon skills have allowed the number of indications for this approach to increase. We describe some of the main pathologies, including malignancies, that can be treated endoscopically, focussing on the orbital and skull base pathologies. The orbital indications discussed here are dacryocystorhinostomy, orbital decompression, and optic nerve decompression. Advantages of endoscopic surgery for aggressive benign tumours such as inverted papilloma and juvenile nasopharyngeal angiofibroma are described. The skull base pathologies detailed are ethmoid adenocarcinoma and esthesioneuroblastoma for the anterior skull base surgery and endoscopic transsphenoidal approach to the sella for pituitary tumour surgery. Evidence of the safety and efficacy of endoscopic surgery is increasing but there is a lack of randomised long-term studies.

An analysis on endoscopic surgery for non-invasive fungal rhinitis and sinusitis

Objective To investigate the efficacy of endoscopic surgery for non-invasive fungal rhinitis and sinusitis.Methods The efficacy of pure functional endoscopic surgery and nasal endoscopy plus Caldwell-Luc procedure for non-invasive fungal rhinitis and sinusitis were observed and compared.Results In the group of pure functional endoscopic surgery,25 patients cured,3 improved,and 2 cases were ineffective; while in the group of nasal endoscopy plus Caldwell-Luc procedure,27 patients cured,3 improved,and no one was ineffective,with no statistical difference betweem the two groups.Conclusions Both pure functional endoscopic surgery and nasal endoscopy combined with Caldwell-Luks procedure is efficacious.We should select an appropriate surgical approach according to different conditions. Key words: Non-invasive fungal rhinitis and sinusitis; Endoscopic surgery; Efficacy

Thoracoscopically Assisted Anterior Fusion for Unstable Thoracolumbar Spine Fractures

Objective. To assess the efficacy of endoscopic surgery for treatment of thoracolumbar spine fractures. Material and Methods. Retrospective case history review of 88 patients operated on for acute unstable fractures of thoracic and lumbar vertebrae was performed. Radiological dynamics of kyphosis, operation time, intraoperation blood loss, and pain syndrome severity were assessed in the early postoperative period using visual analogue scale. Results. The best results in combined interventions were achieved using anterior spinal fusion with implant insertion. The average operation time for thoracoscopic fusion exceeded that for thoracotomic approach. The blood loss was less than during open surgery. The pain syndrome intensity was less in patients who underwent thoracoscopic fusion. Conclusion. A two-stage combined intervention provides a reliable short-segment stabilization at the injured level with minimal loss of correction due to a circumferential fixation. Endoscopic fusion ensures formation of a solid bone block by less invasive surgery. The smallest loss of correction is observed when anterior implants are used.

Advances in endoscopic surgery for hepatocellular carcinoma

Endoscopic microwave coagulation therapy (MCT) or radio-frequency ablation (RFA) was developed in 1994. 213 endoscopic ablations (37% of 570 ablations) and 40 endoscopic hepatectomies (12% of 328 hepatectomies) were performed in our department. Appropriate selection of thoraco- and laparoscopic approach, marginal pre-ablation method, pre-coagulation method using RFA, and laparoscopic hand-assisted approach are important points. To evaluate the efficacy of endoscopic surgery, the operative outcomes were compared to 86 patients who underwent open non-systematic partial hepatectomy, smaller than 4 cm, and up to three tumors, in the same period. In endoscopic ablation, endoscopic hepatectomy, and open hepatectomy, the percent of liver damage B/C, intraoperative blood loss, operating time, percent requiring blood product, postoperative hospital stay, 5-year cumulative survival rate and complication rate was 49%, 20%, 17%, 23g, 346g, 850g, 3.2 hrs, 5.2 hrs, 6.6 hrs, 1%, 12%, 21%, 8 days, 9 days, 18 days, 54%, 68%, 63%, and 8.2%, 6.7%, 12% respectively. No implantation of malignant cells was encountered in endoscopic surgery. Endoscopic surgery can become a new therapeutic modality in treatment strategy for HCC.