Endo Group Research Articles

Middle-term stability of epicardial left ventricular electrodes for cardiac resynchronization therapy

IntroductionCardiac resynchronization therapy (CRT) is currently considered an effective and safe way to treat patients with severe heart failure. Unsuccessful attempts at endovascular insertion of the left ventricular (LV) electrode should prompt a consideration of having the electrode implanted by a cardiac surgeon. AimsThe aims of our work were to evaluate the electric parameters of CS-implanted LV electrodes and to compare them with transvenous implanted electrodes, identify the causes of endovascular implantation failure, compare the clinical and echocardiographic resynchronization effects, and compare the safety of both approaches. Methods and resultsPatients indicated for CRT had the LV electrode implanted either endovascularly (“endo” group) or epicardially (“epi” group; in cases of endovascular approach failure or as a part of another CS procedure). The trial was planned as a case–control study. Each group comprised 92 patients (26 females, 66 males) with an average age of 69 (epi) and 68 (endo) years, respectively. LV stimulation was effective at the 3-year follow-up in 98.1% of patients in the epi group and in 96.6% of patients in the endo group (p=NS). The groups were comparable with respect to the stimulation threshold both before discharge and at the 3-year follow-up. At the 1-month follow-up, this threshold was significantly higher in the epi group (1.62V vs. 1.06V, p<0.001) and the same was true for the 1-year and 2-year follow-ups (1.57V vs. 1.09V and 1.54V vs. 1.21V, respectively; p<0.001). Energetic output during LV stimulation was significantly higher in the epi group at all time points. The overall procedural effectiveness of endovascular implantation was 94.6%. Clinical response to CRT was noted in 71.4% of epi group patients and in 68.1% of endo group patients (p=NS). The average absolute increase in LV ejection fraction was comparable in both groups (6.0% vs. 7.2%, p=NS). Significantly higher 1- and 3-year mortality was noted in the epi group (19.0% vs. 5.5% and 21.7% vs. 6.5%, respectively; p<0.001). ConclusionEpicardial electrodes are capable of effective LV stimulation, as shown during middle-term follow-up. Epicardial LV stimulation is more demanding energetically. Resynchronization effects are similar in patients with epicardial and endocardial LV electrodes; however, the mortality of patients with epicardial LV electrodes seems to be significantly higher.

Elevated expression of transient receptor potential vanilloid type1 in dorsal root ganglia of rats with endometriosis.

Pain is the most pronounced complaint of women with endometriosis, however the underlying mechanism is still poorly understood. In the present study, the authors evaluate the effect of transient receptor potential vanilloid type 1 (TRPV1) of dorsal root ganglia (DRG) on endometriosis-associated pain. A total of 36 SD rats were randomly divided into a sham group (n=9) and a Model group (n=27), accepted auto-transplanted pieces of fat or uterus to the pelvic cavity. At 4 weeks, the Model group was randomly subdivided into the following groups: ENDO group (no treatment, n=9), BCTC group (Model + BCTC, an antagonist of TRPV1, n=9), Vehicle group (Model + cyclodextrin, the vehicle of BCTC, n=9). Tail-flick test was performed prior to surgery, 1 h prior to and following treatment of BCTC or cyclodextrin. The expression of TRPV1, substance P (SP), calcitonin gene-related peptide (CGRP) in L1-L6 DRG was measured via immunohistochemistry, western blotting and RT-qPCR. The results indicated that the Model group exhibited a significant decrease in tail flick latency compared to pre-surgical baseline, and the expression of TRPV1, SP, CGRP protein and mRNA in L1-L6 DRG significantly increased compared to the sham group. BCTC significantly improved tail flick latency, and downregulated the expression of TRPV1, SP and CGRP protein and mRNA levels in L1-L6 DRG compared to ENDO group. However, there were no significant differences of those in Vehicle group compared with the ENDO group. Taken together, the current study provides evidence that TRPV1 expressed in DRG may serve an important role in endometriosis-associated pain.

Monocentric Comparative Study of Conventional Surgery and Endovascular Treatment with Fenestrated Stentgrafts to Treat Juxtarenal and Pararenal Aneurysms of the Abdominal Aorta

To compare the surgical risk, the early mortality, and the late survival of patients operated electively for juxtarenal or pararenal (JRA) aneurysms with fenestrated stentgrafts (FSG) with those of patients treated by conventional surgery over a period when the two treatments were available. Between January 2005 and December 2014, we retrospectively included all the patients electively treated in our center for a JRA by excluding the type IV thoraco-abdominal aortic aneurysms. JRAs were classified in three anatomical categories according to a classification described in the literature. We compared the clinical and radiological data of the patients treated by fenestrated stentgraft (ENDO group) with those treated by conventional surgery (OPEN group). Preoperative surgical risk was measured by the ASA score and the clinical score of Lee. We then compared the surgical risk, the morbi-mortality at 30 days, and the survival at 5 years. One hundred and seventy patients were included, 125 in the OPEN group and 45 in ENDO group. The patients of the OPEN group were significantly younger (OPEN 69 years vs. ENDO 74 years, p=0.001). The anatomical distribution of the JRA did not differ between the two groups. ASA score and the score of Lee were significantly higher in the ENDO group (score of Lee ≥1, OPEN 50.4% vs. ENDO 68.9%, p=0.032; score of Lee≥2, OPEN 8.8% vs. ENDO 22.2%, p=0.019; ASA score ≥3 OPEN 32.8% vs. ENDO 75.6%, p<0.0001). The duration of hospitalization in reanimation was significantly longer in the OPEN group (3.4 days vs. 1.5, p=0.01). Mortality at 30 days was not significantly different between the two groups (OPEN 1.6% vs. ENDO 0%, p=0.394). Survival at 5 years was significantly higher in the OPEN group (OPEN 83% vs. ENDO 75%, p=0.003). After adjustment for age survivals were not significantly different (p=0.240). In this study, the conventional surgical treatment of JRA was majority. In spite of a higher surgical risk of the patients treated by FSG postoperative mortality was not significantly different between the two groups. The results of this study show that endovascular treatment with fenestrated stentgrafts and conventional surgery of the juxtarenal aneurysms can be used in a complementary way.

800 Oncological outcomes of radical nephroureterectomy versus kidney-sparing surgery for elective treatment of clinically organ-confined upper tract urothelial carcinoma of the distal ureter

Abstract To compare the oncological outcomes of radical nephroureterectomy (RNU), distal ureterectomy (DU), and endoscopic surgery (ENDO) for elective treatment of clinically organ-confined upper tract urothelial carcinoma (UTUC) of the distal ureter. From a multi-institutional collaborative database, we identified 304 patients with unifocal clinically organ-confined UTUC of the distal ureter and bilateral functional kidneys. Overall survival (OS), cancer-specific survival (CSS), local recurrence-free survival (LRFS), and intravesical recurrence-free survival (IVRFS), according to the surgery type, were compared using Kaplan-Meier statistics. Univariable and multivariable Cox regression analyses were performed to assess the adjusted outcomes of RNU, DU, and ENDO. Overall, 128 (42.1%), 134 (44.1%), and 42 (13.8%) patients were treated with RNU, DU, and ENDO, respectively. Although OS, CSS, and IVRFS were equivalent between the three surgical procedures, the 5-year LRFS rate was lower in the ENDO group (35.7%) when compared to RNU (95.0%; p

Abstract 19334: Management and Outcomes of Acute Retrograde Type A Aortic Dissection: Insights From the International Registry of Acute Aortic Dissection

Background: Presentations and outcomes of acute aortic dissection (AD) with an entry tear in the ascending aorta may differ from retrograde dissection with an entry tear in the descending aorta. However, guidelines recommend urgent surgical repair for both entities. Methods and Results: All patients with AD enrolled in the International Registry of Acute Aortic Dissection (IRAD) between 1996 and 2014 were analyzed. We identified 99 patients (67 men; 63.2±14.0 years) with an entry tear in the descending aorta and retrograde extension into the arch or ascending aorta. Overall, independent predictors of retrograde type A AD were increasing age(OR 1.0; 95% CI, 1.0 to 1.0; P=0.004), history of cocaine abuse (OR 4.9; 95% CI, 1.7 to 13.6; P=0.003), back pain at presentation (OR 2.1; 95% CI, 1.3 to 3.3; P=0.002), and non-white race (OR 0.4; 95% CI, 0.2 to 0.6; P&lt;0.001). During initial hospitalization, 44 of these patients were managed medically (MED), 33 with open surgery(SURG) and 22with endovascular therapy (ENDO). Patients in the SURG group presented with larger ascending aortic diameters than MED and ENDO patients (P=0.04). The majority of the MED (72.7%) and ENDO (86.4%) patients had AD extension confined to zone 1 (proximal arch, P&lt;0.001), whereas most of the SURG patients (71.8%) presented with AD extension into zone 0 (proximal to the innominate artery, P&lt;0.001). Early (30-day or in-hospital) mortality rates of the MED, SURG and ENDO groups were 9.1%, 18.2%, and 13.6%, respectively (P=0.51), with 5-year survival of 86.7%, 80.0%, and 90.9%, respectively (mean follow-up, 3.3 years, log rank P=0.67). A trend of favorable early mortality was observed in patients with retrograde extension till zone 1 (8.6%) versus into zone 0 (18.6%, P=0.14).Early mortality of patients with retrograde type A AD (12.9%) was lower than those with type A AD (20.0%, P=0.001), while 5-year survival was similar (86.8% and 89.5%, respectively, mean follow-up, 3.0 years, log rank P=0.96). Conclusion: There is a subset of patients with acute retrograde type A AD who can be managed non-operatively with acceptable short and long-term results. This implies that a selective approach may be reasonable, particularly among those with proximal extension limited to the arch distal to the innominate artery.

Does Postthyroidectomy Syndrome Really Exist Following Thyroidectomy? Prospective Comparative Analysis of Open vs. Endoscopic Thyroidectomy.

ObjectivesThis study prospectively evaluated postthyroidectomy syndrome (PTS) through objective and subjective voice changes following thyroidectomy of open vs. endoscopic thyroidectomy.MethodsA prospective clinical trial (SCHBC IRB 09 26) was performed from Jan 2008 to Aug 2010 to compare the open thyroidectomy (OPEN group) and endoscopic thyroidectomy (ENDO group). Of the 110 patients, 75 completed the evaluation before and 1 and 6 months after surgery. Subjective parameters included perceptual analysis (GRBAS [grade, roughness, breathiness, asthenia, and strain] scale), stroboscopic or flexible fiberscopic analysis, voice handicap index, and 5-point visual analog scales for vocal fatigue, singing difficulty, difficulty with high-pitch phonation, and neck discomfort. Objective parameters included acoustic, aerodynamic analysis and the electroglottograph.ResultsFor the ENDO group (n=36), the operation time was longer than in the OPEN group (n=39; P<0.01). For the OPEN group, two objective and five subjective parameters were worse 1 month postoperatively; of these, two subjective parameters persisted for 6 months (P<0.05). For the ENDO group, three objective and six subjective parameters were worse 1 month postoperatively, and three of the subjective parameters persisted 6 months postoperatively (P<0.05).ConclusionPTS really exists following simple thyroidectomy and are very common for both OPEN and ENDO groups. Most of the parameters improved gradually over time, but some subjective changes persisted 6 months postoperatively.

Comparison of Conventional Open Thyroidectomy and Endoscopic Thyroidectomy via Breast Approach for Papillary Thyroid Carcinoma.

Purpose. The aim of this study was to evaluate the feasibility of endoscopic thyroidectomy via breast approach for papillary thyroid carcinoma (PTC). Methods. Between March 2008 and March 2013, 34 patients with PTC received endoscopic thyroidectomy (endo group) and 30 patients received conventional open thyroidectomy (open group). Patients in two groups underwent ipsilateral central compartment node dissection. The two groups were compared in terms of patient characteristics, perioperative clinical results, and postoperative complication. Results. The rates of lymph node metastasis in endo group and open group were 23.5% (8/34) and 13.3% (4/30), respectively, without statistically significant difference (P = 0.351). The mean number of lymph nodes dissected was 2.4 ± 2.9 in endoscopic group and 2.2 ± 1.9 in open group (P = 0.774). During the follow-up period, there was no recurrence or metastatic patients in two groups. All patients received the excellent cosmetic results in endo group, while 25 patients were satisfied with the cosmetic result and 5 were unsatisfied in the open group. Conclusions. The efficacy of endoscopic thyroidectomy via breast approach could be comparable to conventional open thyroidectomy in selected patients with PTC.

Synthesis, structure and properties of fully biobased thermoplastic polyurethanes, obtained from a diisocyanate based on modified dimer fatty acids, and different renewable diols

Different innovative macromolecular architectures have been elaborated and characterized. The synthesis of a set fully biobased thermoplastic polyurethanes (TPUs) was contingent on different renewable or potentially renewable building blocks such as 1,4-butanediol (BDO), isosorbide (ISO), and 2-heptyl-3,4-bis(9-isocyanatononyl)-1-pentylcyclohexane, the latter obtained after the chemical modification of a dimer fatty acid. These TPUs were prepared in a one-step bulk process using different hard segment (HS) species with varying ratios of ISO/BDO contents. The final molar masses were found to decrease when BDO was progressively exchanged by ISO, presumably due to the high dissymmetry and lesser reactivity of the latter species (bearing exo and endo groups) with respect to the former. This substitution (BDO vs. ISO) altered the crystallinity, the thermal transitions and the stability of the resulting polymers. TPUs with low ISO content present good mechanical performances with high elongation and Young’s Modulus. The deformation is however fully plastic, despite the “hard–soft” phase segregation proven by small-angle X-ray scattering analysis. These novel biobased materials are very attractive since they present highly tailorable properties by selecting appropriate HS content and suitable chemical structure.

Antioxidant, phase II and III responses induced by lipoic acid in the fish Jenynsia multidentata (Anablapidae) and its influence on endolsulfan accumulation and toxicity

Antioxidants like lipoic acid (LA) are known to trigger augmented antioxidant and phase II and III responses. This study aimed to evaluate the effect of LA in P-glycoprotein (Pgp) expression, glutathione-S-transferase (GST) activity, total antioxidant competence, levels of lipid peroxides (TBARS) and accumulation of the organochlorine insecticide endosulfan (Endo: α-, β-isomers and sulfate metabolite) in different organs of the fish Jenynsia multidentata. One hundred and twenty females (1.55±0.07g) were fed during 8days with (n=60) or without (n=60) a LA enriched ration (6000mg/kg). Four experimental groups were defined: −LA/−Endo; +LA/−Endo; −LA/+Endo; and +LA/+Endo. Endo groups were exposed during 24h to 1.4μg of insecticide/L. Results showed that only LA induced a significant increment in liver Pgp expression. GST activity was augmented in liver after exposure to LA or Endo. TBARS levels were lowered in liver and gills after LA pre-treatment. Total antioxidant capacity was lowered in liver of Endo exposed fish, a result that was reversed by LA pre-treatment. It is concluded that LA induced the expected effects in terms of Pgp expression, GST activity and reduced TBARS levels although favored α-Endo accumulation in brain. However, the Endo metabolism to the more persistent endosulfan sulfate was not facilitated by LA pre-treatment.

Endovascular Versus Open Repair of Popliteal Artery Aneurysms

The management of popliteal artery aneurysms (PAAs) has undergone significant transition from open surgery to endovascular graft placement with few longitudinal data evaluating outcomes. The Centers of Medicare & Medicaid Services Inpatient claims (2005-2007) were queried with a diagnosis of lower extremity artery aneurysm in association with elective Current Procedural Terminology codes for open (OPEN group) and endovascular (ENDO group) repair. A total of 2962 patients were identified. Endovascular interventions significantly increased over the time of the study (11.7% vs 23.6%, P < .0001). Overall complication rates for OPEN and ENDO groups did not differ significantly (11.3% vs 9.3%; P = .017). No differences in the 30- and 90-day mortality rates were found between OPEN versus ENDO groups. The ENDO group had greater 30- and 90-day reinterventions (4.6% vs 2.1%, P = .001 and 11.8% vs 7.4%, P = .0007, respectively). Length of stay (4.5 days vs 2.5 days, P < .0001) and charges ($43 180 vs $35 540, P < .0001) were greater for OPEN group. Despite a significant increase in the utilization of endovascular repair of PAAs, endovascular repair was associated with greater reinterventions over time and did not offer a mortality or cost benefit.

Endoscopic Resection of Upper Neck Masses via Retroauricular Approach Is Feasible With Excellent Cosmetic Outcomes

In this study, the authors introduce and evaluate the feasibility of endoscopic resection using the retroauricular approach for various benign lesions of the upper neck. A retrospective comparative analysis was performed on the clinical outcomes of patients who underwent surgery for upper neck masses as endoscopic resection using the retroauricular approach or conventional transcervical resection at the authors' center from January 2010 through August 2011. The primary outcome was the cosmetic satisfaction of the patients in each group. In addition, the feasibility of the procedure was evaluated by comparing the operation time; hospital stay; amount and duration of drainage; complications such as marginal mandibular nerve, lingual, or hypoglossal nerve palsy; paresthesia of the ear lobe; and wound problems such as hematoma and skin necrosis. Statistical analysis was performed by independent-samples t test and the Fisher exact test, and a P value less than .05 was considered statistically significant. Thirty-six patients underwent endoscopic resection (endo group; 15 men, 21 women; mean age, 38.8 ± 15.0 years) and 40 patients underwent conventional transcervical resection (conventional group; 18 men, 22 women; mean age, 45.1 ± 14.1 years). The operating time in the endo group was longer than in the conventional group (P = .003). No significant difference was observed in the overall perioperative complications between the 2 groups. Cosmetic satisfaction evaluated with a graded scale showed much better results in the endo group (P < .001). Endoscopic resection using the retroauricular approach is feasible for various benign upper neck masses when conducted by an experienced endoscopic surgeon, with excellent cosmetic results.

Endoscopic Benign Neck Mass Excision without Cervical Scar

Objective: Conventional transcervical approach leaves a visible scar on the neck, regardless of the size of the incision. The aim of this study was to determine the safety and feasibility of a transaxillary or retroauricular approach for the excision of benign neck masses by comparing it to the conventional open approach. Method: We prospectively compared the outcomes of endoscopic removal of benign neck lesions with the outcomes of conventional open surgery. Transaxillary approach was chosen for lesions mainly located in level III to V and the perithyroidal area and retroauricular approach was chosen for those located in level I or II area. Results: Operation was successful in all patients in endo group without any significant intraoperative complications or conversion to open surgery. The operating time in the endo group was longer than in the conventional group ( P = .010). The total amount ( P = .689) and duration ( P = .325) of drain between the 2 groups showed no significant difference. The mean duration of hospital stay was also comparable between the groups ( P =.129). No significant difference was observed in the overall perioperative complications between the 2 groups. Cosmetic satisfaction evaluated with the graded scale showed much better results in the endo group ( P = .000). Conclusion: Endoscopic resection via the transaxillary or retroauricular approach is safe and feasible for various benign cervical lesions with excellent cosmetic results.

Comparative Study of Robotic and Endoscopic Submandibular Gland Resection

Objective: Compare the short-term clinicopathologic results of robot-assisted submandibular gland (SMG) resection and endoscopic SMG resection via the retroauricular approach. Study Design: Prospective review of submandibular gland tumor or chronic dialadenitis conducted for 1 year in a tertiary hospital. Subjects Studied: Patients who underwent robotic or endoscopic submandibular gland resection via retroauricular approach. Clinical factors were compared using Mann-Whitney test. Results: The operation was successful in all patients of 2 groups without any significant intraoperative complications or conversion to open surgery. The operating time in the endo group was longer than the robot group ( P = .034). Total amount ( P = 1.000) and duration ( P = .801) of drain between the 2 groups showed no significant difference. The mean duration of hospital stay was also comparable between the groups ( P = 1.000). No significant difference was observed in the overall perioperative complications between the 2 groups. Patients of both groups showed excellent cosmetic satisfaction and showed no significant difference ( P = .891). Conclusion: Robotic and endoscopic SMG resection were both feasible with acceptable perioperative outcomes and excellent cosmetic results. Robot assisted resection showed benefit in shorter operating time.

Valproic Acid and Progestin Inhibit Lesion Growth and Reduce Hyperalgesia in Experimentally Induced Endometriosis in Rats

Accumulating evidence suggests that endometriosis is an epigenetic disease. This study was designed to evaluate the effect of valproic acid (VPA) and progesterone (P4) in a rat model of endometriosis on serum tumor necrosis factor-α (TNF-α) levels, hot plate and tail-flick latencies, lesion size, and body weight. We used 77 adult female rats, and endometriosis was induced by autotransplanting pieces of uterus (ENDO) or fat (SHAM) to the pelvic cavity. The BLANK group received no surgery. After 2 weeks, the ENDO group was further divided, randomly, into 5 groups, receiving, respectively, treatment with low- and high-dose VPA, P4 alone, VPA + P4, and no treatment. The SHAM rats received no treatment. The BLANK rats were further divided into 2 groups, one received VPA treatment and the other, no treatment. After 4 weeks, all rats were sacrificed. Response latency in hot plate and tail-flick tests, body weight, and serum TNF-α levels were measured before the surgery, before and after the treatment, along with lesion size. We found that induced endometriosis reduced response latency. ENDO rats receiving VPA and/or P4 treatment had significantly reduced lesion size as compared with untreated ones, and had significantly improved response to noxious thermal stimuli. They also had significantly increased weight gain. Serum TNF-α levels increased following surgery but eventually decreased regardless of treatment or not. In conclusion, VPA is well tolerated. Treatment with VPA significantly reduces lesion growth and improves sensitivity to nocifensive stimuli. The improvement is specific to endometriosis-induced hyperalgesia. Thus, histone deacetylase inhibitors may be a promising therapeutics for treating endometriosis.

Endoscopic vs Transfacial Resection of Sinonasal Adenocarcinomas

Compare the survival and the complication rates of 2 comparable groups of patients who underwent either endoscopic or transfacial resection of a sinonasal adenocarcinoma. Historical cohort study. Tertiary referral center. Twenty-four patients with sinonasal adenocarcinomas who recently underwent an endoscopy (the ENDO group, 1999-2009) were compared with 24 patients who underwent a lateral rhinotomy procedure (the LR group, 1993-2007). The present retrospective study included patients who would have had an endoscopic resection in 2011. The groups were comparable in terms of age and sex (P = .49), as well as tumor stages; 43 of the 48 patients had undergone postoperative radiotherapy. There were 13 T1-T2 and 11 T3-T4 tumors in the ENDO group compared with 12 T1-T2 and 12 T3-T4 tumors in the LR group (P = .77). The mean length of follow-up was 38 months for the ENDO group and 89 for the LR group. The overall survival and recurrence-free rates were not significantly different (P = .3 and P = .87, respectively). The median duration of hospitalization was significantly shorter in the ENDO group than in the LR group (4 vs 8 days, P < .0001). The rate of early complications was identical in both groups (12.5%). The endoscopic approach is a safe and effective treatment in selected sinonasal adenocarcinoma cases. The early oncological outcome and morbidity associated with the endoscopic approach were comparable with a transfacial approach. Hospitalization was significantly reduced by the endoscopic approach. Although the endoscopic approach is less invasive, it requires an optimal preoperative imaging protocol and an experienced surgical team.

Transgastric endoscopic pneumoperitoneum versus laparoscopy: effects on host systemic and peritoneal inflammatory responses in a porcine model

The host systemic and peritoneal immune responses during natural orifice transluminal endoscopic surgery (NOTES) continues to be delineated. The immune response to laparoscopy (LAP) has been favorably depicted. However, the immunologic effects of NOTES are yet to be determined, and the introduction of contaminants via the host orificium may have deleterious effects. The purpose of this study was to characterize the effect that NOTES would have on porcine systemic and peritoneal immune function. Twenty-four pigs were divided into three groups: ENDO (upper-endoscopy control), NOTES, and LAP. All animals had blood and peritoneal lavage samples collected for cytokine analysis pre- and postoperatively. Interleukin-1β (IL-1β), interleukin-6 (IL-6), interleukin-10 (IL-10), tumor necrosis factor α (TNFα), and interferon γ (IFNγ) levels were quantified using enzyme-linked immunosorbent assay (ELISA). Peritoneal lavage samples were cultured and identified by group and time of collection for microbiological analysis. TNFα was found in detectable levels in serum samples of all three groups. For the NOTES group, there was a significant increase in TNFα at t=1h (P<0.01), which dropped significantly at t=48h (P<0.01). IL-1β was present as an early response in NOTES lavage samples (t=0 and t=1h). Both LAP and NOTES had similar elevation of IL-1β in the final lavage samples at t=48h. The other cytokines were not consistently found above detectable levels in any group. Similar microbiological contaminants were found in the ENDO and LAP groups. In the NOTES group, no significant growth was observed from cultures at 48h. For measurable cytokines, the NOTES inflammatory response was not significantly different from that of the LAP group. NOTES did not carry a significantly increased amount of microbiological contamination at 48h compared to LAP. These data suggest that the host immune response to NOTES does not significantly differ from that to LAP in a porcine model.

Endoscopic vs Transfacial Removal of Sinusal Adenocarcinoma

Objective: Compare the overall survival, recurrence-free survival, and complication rates between 2 comparable groups of patients operated by an endoscopic or a transfacial resection of a sinonasal adenocarcinoma. Method: A first group of 24 patients with a sinonasal adenocarcinoma recently operated endoscopically (« ENDO », 1999-2009) is compared to another group of 24 patients operated anteriorly by a transfacial approach (lateral rhinotomy “LR” 1993-2007). In this retrospective study, we included patients who would have had in 2010 an endoscopic resection. Results: Groups were comparable in terms of age and sex ( P = .49) and tumoral stages with 13T1-T2/11T3-T4 in the group ENDO and 12T1-T2/12T3-T4 in the group LR ( P = .77). a total of 43 out of 48 patients have had a postoperative radiation therapy. The mean follow-up was respectively of 27 and 82 months for the groups ENDO and LR. After 27 months, the overall survival curves were not significantly different. The recurrence-free rates were equally similar in both groups ( P = .71). The median duration of hospitalization was significantly shorter in the ENDO group (4 vs 8 days, P &lt; .0001). The rate of early complications was strictly identical in both groups (3/24). Conclusion: The endoscopic approach is an effective treatment in selected cases of sinonasal adenocarcinomas. Early oncological outcome and morbidity are comparable to a transfacial approach. Hospitalization was significantly reduced and skin scars avoided. This procedure is less invasive but requires an optimal preoperative imaging protocol and an experienced surgical team.

Endoscope-Assisted Transoral Reduction and Internal Fixation Versus Closed Treatment of Mandibular Condylar Process Fractures—A Prospective Double-Center Study

The aim of this international AO-study was to compare the functional outcome after open versus closed treatment of mandibular condylar neck fractures. A prospective comparative study with two follow-ups (FU) at 8-12 weeks and 1 year was undertaken in two clinics, which exclusively privileged either surgical or conservative treatment due to different therapeutic agendas. Patients from clinic 1 (ENDO group) received endoscope-assisted transoral open reduction and internal fixation, whereas patients from clinic 2 (CONS group) were treated conservatively without surgery. Patients with unilateral condylar neck fractures showing one or more of the following conditions were included: displacement of the condyle with an inclination >30° and/or severe functional impairment such as malocclusion or open bite, with or without dislocation of the condylar fragment; severe pain upon palpation or movement, and/or vertical shortening of the ascending ramus. High or intracapsular condylar neck fractures were excluded. 75 patients (44 CONS and 31 ENDO patients) with condylar neck fractures were included in this study. The Asymmetric Helkimo Dysfunction Score (A-HDS) was slightly lower in the CONS group than in the ENDO group at the 8-12-week FU, corresponding to better function on the short-term. At the 1-year FU, however, there were slightly better values in the ENDO group. For the Clinical Dysfunction Index (Di) and the Anamnestic Dysfunction Index (Ai), CONS patients had a better outcome than ENDO patients at the 8-12 week FU, ie, a higher proportion of ENDO patients had severe symptoms due to the operative trauma. Yet these symptoms improved by one year, finishing with a significant higher proportion of symptom-free patients in the ENDO group. In addition, these patients had better values for the Index for Occlusion and Articulation Disturbance (Oi) at both FU examinations, ie, the proportion of patients without any occlusal disturbances was significantly higher in the ENDO group. On average, the duration of postoperative maxillo-mandibular fixation (MMF) was 3 times longer for the CONS group than for the ENDO group (33 vs. 11 days). Both treatment options may yield acceptable results for displaced condylar neck fractures. Especially in patients with severe malocclusion directly after trauma, however, endoscope-assisted transoral open reduction and fixation seems to be the appropriate treatment for prevention of occlusal disturbances during FU.

Is Robotic Surgery Superior to Endoscopic and Open Surgeries in Thyroid Cancer?

Endoscopic thyroidectomies have been performed using various approaches, and indications have expanded with the development of new surgical techniques and instruments. Endoscopic thyroid surgery using bilateral axillo-breast approaches have excellent cosmetic results and a symmetrical, optimal operative view. However, because of the two-dimensional view and the nonflexible instruments, these approaches are not easy to use in performing a central lymph node dissection (CND). Robotic surgery has drawn attention as a potentially safe and effective method for treating thyroid cancer. The aim of the present study was to determine whether robotic surgery is superior to endoscopic and open surgery through comparing technical aspects and surgical outcomes. From October 2008 to December 2009, 302 patients had total thyroidectomies and CND with cancer less than 1 cm. Patients were divided into three groups according to operation methods (open group; n = 138), (endo group; n = 95), (robot group; n = 69). Young patients preferred the robotic and endoscopic surgery. The number of retrieved lymph nodes in the open group (4.8 ± 2.8) was not different from the robot group (4.7 ± 2.7) and the endo group (4.6 ± 3.7). The operative time of the robot group was longer than the open and the endo group. The total drain amount in the robot group was more than the open and endo groups; however, there was no difference in the length of hospitalization and complication rates. There were no differences between the open (0.8 ± 2.0) and robot groups (0.8 ± 1.4), but the endo group (2.4 ± 6.3) showed higher postoperative serum thyroglobulin off thyroid hormone (Off-Tg) when compared to the open and robot groups. Robotic surgery was equal to open surgery except with respect to operative time and was superior to endoscopic surgery in Off-Tg levels presenting completeness of the operation in thyroid cancer surgery. Because it has excellent cosmetic results and various technical advantages, it should be considered in young, low-risk patients with thyroid carcinoma less than 1 cm.

Endoscopic Thyroidectomy via an Axillo-Breast Approach without Gas Insufflation for Benign Thyroid Nodules and Micropapillary Carcinomas: Preliminary Results

PurposeTo examine the feasibility of endoscopic thyroidectomy (ET) via an axillo-breast approach without gas insufflation for large thyroid tumors and micropapillary carcinomas.Materials and MethodsThe patients in the benign group were separated into groups 1 (n=95, <4 cm in tumor diameter) and 2 (n=37, ≥4 cm in tumor diameter). Also, 57 patients in the micropapillary carcinoma group underwent an endoscopic hemithyroidectomy (HT) (group 3) and were compared with 60 patients who received conventional open HT (group 4). Postoperative functional outcome, local complications, surgical outcomes, and pathological outcomes were compared between the groups.ResultsIn the benign group, there was no significant difference in mean operating time, hospital stay, or overall perioperative complications between the two groups. In the micropapillary carcinoma group, mean operating time and hospital stay in group 3 were significantly longer than in group 4 (p=0.015 and p≤0.001). The overall perioperative complications did not differ significantly between the groups. The postoperative cosmetic result was better in groups 1-3 (endo group) than in group 4 (open group).ConclusionET via a gasless axillo-breast approach seems to be a safe procedure even for benign thyroid lesions ≥4 cm and micropapillary carcinomas. Although it has the advantage of better cosmetic results over open thyroidectomy, there is room for improvement in terms of lessening its invasiveness and shortening the operative time.