Endoscope Research Articles

Endoscopical Monitoring of The Reproductive Tract During the Protocols for the Induction of Ovulation

By endoscopic examination is possible to visualize the vagina, the external cervical ostium, the lumen of the uterine body and the horns up to the uterotubal junctions, in order to obtain a large amount of information related with mare’s reproductive status. Mare’s endoscopic examination was performed at the Faculty of Veterinary Medicine Bucharest, at the Obstetrics and Gynecology Clinic. 15 mares (cycled and non-cycled) from different races have been examined in order to utilize them in a research study for the induction of ovulation. The examination was performed with a Olympus GIF K2, a flexible endoscope (130 cm length, 13 mm diameter and a 150 W light source). After contention of the mares air was infused in the uterine cavity for a good distention of the uterine walls.

Sterilization effect of rapid sterilizer to endoscope

目的 了解一种快速内镜灭菌器(汇日医用内镜灭菌器)对内窥镜灭菌性能.方法 采用电脑监控检测、生物指示剂方法和内镜灭菌临床试验,对其灭菌效果进行了监测.结果 经过该灭菌器常规灭菌程序696次灭菌处理,684次电脑监控检测达到灭菌条件,有12次电脑监控灭菌失败,需重新灭菌;生物指示剂检测60次,灭菌后的生物指示剂经细菌培养,全部无菌生长,即生物监测结果全部合格;内镜灭菌试验,抽检灭菌内镜经细菌培养58次,全部达到灭菌要求.结论 汇日医用内镜灭菌器灭菌效果可靠,灭菌过程故障可自动检出。

The effect and application evaluation of seamless management of hard endoscopic surgery equipment

Objective To investigate the effect of the seamless management application of damageable hard endoscopic surgery equipment.Methods Compare the hard endoscopic surgery equipments knowledge examination results and the defects and failure rates of equipments per one hundred operations before and after seamless management in 2007 and 2008 respectively.Results The examination results had been improved distinctively ( All P ＜ 0.01 ) in equipment construction, operation method, cleaning and disinfection, adjustmcnt method, defects inspection after implementing the seamless management of hard endoscopic surgery in 2008, it had happened 39 times of defects and failures on the hard endoscopic surgery equipment after implementing the seamless management in 2008, the defects and failure rate was 3% per one hundred surgical equipment, and it had happened 77 times of defects and failures in 2007, and the defects and failure rate was 7% per one hundred operation, so the seamless management has distinctive difference (P ＜ 0.01 ).Conclusions The seamless management method can reduce its blanks, low down the defect and failure rate of the hard endoscopic equipment, which has important significance upon the operation room management. Key words: Seamless management; Hard endoscope; Nursing quality

Nursing of intractable esophageal stenosis and esophageal fistula treated by endoprosthesis

Objective To explore the nursing method of intractable esophageal stenosis and esophageal fistula treated by endoprosthesis.Methods Alloy brackets were put into esophagus with the help of endoscope.Results Sixty two patients with intractable esophageal stenosis were treated by endoprosthesis.The diameter of narrow esophagus after operations was increased from (4.0 ± 1.5 ) mm to (18.5 ±1.1 ) mm (P＜0.01 ) .The degree of dysphagia was decreased from 2.78 ± 0.42 to 0.94 ± 0.73 ( P ＜ 0.01 ) .24 patients with infractory esophageal fistula were treated by endoprosthesis successfully.The intractable esophageal fistula were all healed and the symptoms of dysphagia and bucking disappeared.The patients could take food through the mouth.Conclusions It should be to take towardly nursing according to the characteristic of intractable esophageal stenosis and esophageal fistula.By dong this, we can make better clinical curative effect. Key words: Endoscope; Endoprosthesis; Intractable esophageal stenosis; Intractable esophageal fistula; Nursing

Diagnosis and treatment of biliary injury after orthotopic liver transplantation with choledochofibroscope

Objective To provide information and assistance for research of bile duct injury in OLT through endoscopic observation and treatment of biliary complications after liver transplantation.Methods After OLT, all the cases in normal group, bile duct injury group and hepatic artery injury group were observed, diagnosed and recorded respectively. Meanwhile, the biopsy was performed through the endoscopy for pathological examination. For those cases without T tube, the biopsy was conducted by choledochoscopy in combination with duodenoscopy. Results The exterior and interior bile duct anatomy of the 9 cases in the normal group was normal. They had no bile duct stenosis and scar, their bile duct mucous membrane looked good and the anastomosis of the donor-receptor bile duct healed well. Restored mucous tissue coating with intact epithelium was found by pathological examination. Fibrous tissue and small vascular proliferation happened under epithelium scattered with plasmocyte and lymphocyte. Various kinds of bile duct stones-simple, multiple and casting mould type, were found in 12 cases with bile duct injury. Bile duet mucous membrane injured in different degrees was repaired after stone removed and obstruction relieved by endoscope. Bile duct tree becoming normal was seen by pacification examination. Three cases in the hepatic injury group had bile duct ischemic necrosis, losing of normal structure without bile duct wall and mucous membrane. Conclusion Bile ducts are injured in different degrees in OLT. The choledochofibroscopy is of the first choice for diagnosis and treatment of complications after OLT. Key words: Liver transplantation; Postoperative complication; Endoscopy; Bile duct injury; Pathology

Biliary reconstruction and complications of living donor liver transplantation

Objective To describe the feasibility of biliary reconstruction methods and to explore the preventing and curing methods for biliary complications. Methods A total of 77 cases of living donor liver transplantation were included in our study for retrospective analysis. The operation types included right lobe contain middle hepatic vein (n=29), right lobe without middle hepatic vein (n=45), left lobe (n=1) and left lateral lobe transplantation (n=1). The biliary reconstruction was performed by duct-to-duct and Roux-en-Y epaticojejunostomy. Results Fifty-four grafts had 1 bile duct and 23 had multiple ones. The duct-to-duct biliary reconstruction was performed for 75 adult cases and T-tube drainage was used in 63 patients. Meanwhile, the conventional Roux-en-Y epaticojejunostomy was utilized for 2 pediatric patients. Total biliary complication incidence was 36.4% (28/77) and the complications included bile leakage (10.4%, 8/77) and biliary stricture (26.0%, 20/77).The rate of biliary complication was remarkably different between single hepatic duct group and multiple group (P<0.05). All the 8 patients suffering from bile leakage were cured by percutaneous bile drainage guided by ultrasound. By percutaneous balloon cholangioplasty and placing stent through the T-tube tract or endoscopic retrograde balloon cholangioplasty, the liver function of biliary stricture cases got better and most cases were cured. Conclusion Protecting the blood supply of bile duct at the cutting surface and harvesting one bile duct stump as much as possible can reduce biliary complication effectively. Radiate intervention treatment such as percutaneous balloon cholangioplasty and endoscope treatment etc. are effective for treatment of biliary complications. Key words: Liver transplantation; Biliary tract reconstruction; Biliary complication

Spiral enteroscopy in diagnosis and managements of small bowel diseases

Objective To evaluate the use of spiral enteroscopy in diagnosis and treatment of small-bowel diseases. Methods The data of 8 patients who underwent spiral enteroseopy from July to September 2009 were retrospectively studied. The variables including maximal insertion depth, total procedure time, complications, and outcome were evaluated. Results The average maximal depth of intubation was 2. 2 m beyond the Ligament of Triez （0-3. 6 m beyond Ligament of Triez）, with a mean procedure time at 41 min （25 to 77 min）. Small bowel Crohn＇s disease was diagnosed in 2 eases with biopsy suggesting active inflammation and granular formation. Small intestinal tumor was detected in 1 patient with pathological finding of high grade dysplasia. Jejunal ulcer was detected in 1 patient. Multiple polyps were found in 1 patient after jejunal anastomosis, which were then treated with endoscopic argon plasma coagulation （APC）. No abnormalities were found in 3 other patients. No complications occurred during and after the procedure. The maneuver of spiral enteroscopy and APC were same as that of balloon enteroscopy. Conclusion Spiral enteroscopy is simple and convenient to operate, which is of great potential in clinical use. Key words: Endoscopes; Spiral enteroscopy; Small-bowel disease

Histopathologic study on endoscopic cyclophotocoagulation and trans-scleral cyclophotocoagulation in rabbit eyes

Background Endoscopic cyclophotocoagulation(ECP) is a new approach to treat refractory glaucoma.But,the histopathological change of ciliary body after ECP has not been reported yet.ObjectivePurpose of the present study is to explore the histopathologic change of ciliary body after ECP and investigate the mechanism of lowing intraocular pressure(IOP) of ECP and compared with trans-scleral cyclophotocoagulation (TSCP).MethodECP was performed on the right eyes of 30 adult pigmented rabbits and TSCP was taken in the fellow eyes.Other two normal pigmented rabbits were as control group.The clinical examinations were performed in day 1,3,5,7,14,28,42 and 56 after operation under the slim lamp to evaluate the inflammatory reactions of conjunctiva,sclera and cornea,and the IOP was detected in the same time points.The animals were sacrificed and the eyeballs were extracted for the examination of structure of ciliary body under the light microscope in day 7,14,28,42 and 56 after surgery respectively.ResultsThe mild inflammatory response and local opacity of lens were seen under the slim lamp in the eyes after ECP,and severe inflammatory reaction was in the eyes received TSCP.No opacity of lens was found after TSCP through the observing period.The lowing-IOP extent was significantly higher in ECP group than TSCP group after operation(P＜0.01).The structure of ciliary body epithelium was normal in normal rabbit eyes.The disruption of ciliary body epithelium,especially for non-pigment epithelial layer,edema of ciliary process were seen in the early period after ECP.Fourty-two days later,the irregulation of ciliary body epithelium and atrophy of ciliary process were exhibited under the light microscope.In TSCP group,the edema,blooding and damage of ciliary process were seen,but slight inflammatory response was in the ciliary epithelium.After 42 days of surgery,atrophy of ciliary body,irregular proliferation of pigmental and non-pigmental epithelial cells,thinness of sclera and scarring of ciliary stroma were revealed.ConclusionCompared with TSCP,ECP can selectively destroy ciliary epithelium effectively and thoroughly and therefore reduce IOP.The adverse effect of ECP is the opacity of lens.Less damage of adjacent tissue is found in ECP compared with TSCP. Key words: endoscope; cyclophotocoagulation; trans-scleral cyclophotocoagulation; ciliary body; intraocular pressure

高清医用电子内窥镜微型CMOS摄像模组

A novel miniaturized camera module with 1.3 megapixels for electronic endoscope is developed and presented.This module realizes long-distance and high-fidelity transmission of image data adopting Low-Voltage Differential Signaling technology.It includes a 1/5.5 inch CMOS image sensor with a resolution of 1 280×1 024 pixel2,a small integrated lens with field of view of 140° and two electric circuit boards.The lens fixed with inner screw thread is cemented directly onto the non-optical part of the image sensor's surface.Two printed circuit boards are assembled vertically,which reduces the size of the module down to 5.5 mm in width,5.2 mm in height and 15.0 mm in length.The 10-bit parallel digital signals are encoded into low-voltage differential signals before they are output through a twisted pair.A demonstration system is developed to evaluate the performance of the camera module.Experimental results show that the module's resolution reaches to 136 lp·mm-1,and the image transmission length is over 2 meters.The compact size,high resolution image,wide field of view and long-distance transmission enable the camera module to be used in video endoscopy,especially for HDTV gastroscopes and colonoscopes.

Clinical value of endoscopic optic nerve decompression in posttraumatic optic neuropathy patients with no light preception

Objective To investigate the clinical value of endoscopic optic nerve decompression in traumatic optic neuropathy patients with no light perception (NLP). Methods 13 NLP patients with traumatic optic neuropathy were performed endoscopic decompression of optic nerves basing on the Messerklinger technique and the clinical data were retrospective analyzed.Results Seven of 13 patients with NLP improved at least one grade after three to twelve months follow-up period and the total effective ratio was 54% (7/13). Six patients showed no change and one patient was lost during follow-up.Based on the duration from loss of vision to operation after trauma, all 13 patients were divided into 3-7 d group, 8-14 d group,15-21 d group and above 21 d group.In the analysis of the data of different groups, there was no difference in effect among groups (P＞0.05 ). Conclusion Potential benefit could be achieved from endoscopic decompression of optic nerve even for traumatic optic neuropathy patients with no light perception. Key words: Optic nerve trauma; Endoscope; Decompression; Surgery

Nasobasicranial surgical reconstruction with nasal septum periost flap in nasal endoscope.

目的探讨鼻内镜下鼻中隔软骨瓣转位重建鼻颅底缺损的可能性。方法对30具成人湿性尸头标本进行解剖学测量，对5具冰冻保存的成人新鲜尸头标本进行鼻内镜下重建鼻颅底缺损的模拟手术实验。结果鼻中隔软骨瓣上边长38.17—49.95mm，平均（x±s，以下同）为（44.19±5.82）mm，鼻中隔软骨瓣下边长50.85～63.16mm，平均为（56.83±6.65）mm，鼻中隔软骨上下径长23.52～31.74mm，平均为（27.93±3.48）mm，鼻中隔软骨前后径长16.55～24.83mm，平均为（20.83±2.12）mm。模拟手术显示以鼻中隔软骨瓣重建鼻颅底缺损的操作可行。结论鼻颅底缺损在长（27.22±4.91）mm、宽（13.03±3.44）mm的范围时，可在鼻内镜下应用鼻中隔软骨瓣转位进行修复。

Modified endoscopic rhytidectomy in forehead and temporal area

Objective To explore the aesthetic efficacy of modified endoscopic rhytidectomy by using the techniques to minimize tissue damage,to obviate injury to the vessels and nerves,and to control bleeding and to firm fixation.Methods Two discontinuous incisions were made in the temporal scalp during the procedure,obviating injury to the branches of the superficial temporal vessels.Endoscopic technique was used to facilitate elevating,hemostasis,slinging and fixation in the plane under superficial temporal fascia.Three transverse incisions were made after the hairline in the forhead scalp,the operation was carried out by using endoscopic equipment,and the elevated forhead flap was slinged and fixed upward to the lamina externa cranii.Results 58 cases were received endoscopic forehead and temporal rhytidectomy,only slight edema was observed after surgery,and no obvisous ecchymosis was found.All patients returned home 7 days after operation.Degree of satisfaction on long-term follow-up showed that 56 cases(96.55%)improved obviously one year postoperatively;35 cases followed up 2 years,33(94.29%)of them improved obviously.None case was suffered from facial nerve injury.Conclusion The purpose of endoscopic rhytidectomy is to avoid carrying out the operation out of sight,to minimize unexpected damage to vessels and nerves,and to facilitate dissection,hemostasis,suturing,slingling and fixation.By refining the technique,we can achieve minimal injury,shorten recovery period,and obtain more satisfactory results,so the indication for operation is extended. Key words: Endoscope; Rhytidectomy; Forehead temporal

Cholecystectomy via natural orifice transluminal endoscopic surgery

Objective To evaluate the feasibility and relative merits of cholecystectomy via natural orifice transluminal endoscopic surgery （NOTES） in porcine model. Methods A total of 8 female pigs were divided into 4 groups to accept cholecystectomy via different NOTES approaches, which included single transvaginal dual-channel endoscopy, combination of trans-vaginal dual-channel endoscopy and trans-gastrie conventional endoscopy, laparoseopy assisted trans-vaginal dual-channel endoscopy, and single trans-vaginal dual-channel endoscopy with cap. An incision in the vaginal wall was made with a needle-knife, expanded with a cutting knife and enlarged with a dilating balloon, after which a dual-channel endoscope was advanced into the peritoneal cavity to locate and excise the gallbladder. The incision was closed with clips. Animals were sacrificed 1 week later to explore the changes in peritoneal cavity, including adhesion, injuries around the gallbladder and healing situation of the incisions. Results Cholecystectomy could not be accomplished with single endoscope technique, but was succeeded in 1 animal with combination technique and laparoscopy assisted technique, respectively, and was performed successfully in 2 pigs with cap assisted methods. Rupture of gallbladder occurred in combination group and bleeding occurred in laparoscnpy assisted group. Conclu- sion Cholecystectomy via NOTES is feasible, and cap assisted dual-channel endoscope with EMR-cap is the most desirable NOTES technique. Development of specialized instruments is the key of success. Key words: Endoscopic surgical procedures; Swine; Natural orifice transluminal endoscopicsurgery; Transgastric approach ; Transvaginal approach ; cholecystectomy

Dimethicone powder in bowel preparation before capsule endoscopy

Objective To evaluate the effect of the dimethicone powder in bowel preparation before capsule endoscopy （CE） and to observe its possible adverse effects. Methods A total of 60 patients receiving CE were prospectively randomized into 2 groups according to bowel preparation method. In dimethicone powder group, patients were arranged to take dimethicone powder 30 min before the examination on basis of macrogol electrolytes powder and in control group, patients had macrogol electrolytes powder only. Images of small intestine were equally divided into segments A, B and C according to intestinal transit time, and reviewed by 2 experienced physicians independently. Intraluminal gas bubbles were graded and any possible adverse effects were monitored. Results Interobserver agreement was excellent （P 〈 0. 05 ）. In segments A and C, images from dimethicone powder group were less interfered by gas bubble than those from control group （ P 〈 0. 05 ） , but in segment B there was no difference between 2 groups （ P 〉 0.05 ）. No adverse effects were observed. Conclusion The dimethicone powder administration before capsule endoscopy improves the visualization of the intestinal mucosa. Key words: Capsule endoscopes; Dimethicone powder

Application of self-made gastroscope outer casing in treatment of esophagogastric variceal bleeding

Objective To estimate the success rate of emergency endoscopic treatment in patients with esophagogastric variceal bleeding using self-made gastroscope outer casing and to investigate bow to prevent complications. Methods A total of 11 patients with esophagogastric variceal bleeding underwent endoscopic treatment with self-made gastroscope outer casing, which consisted of a wire reinforced plastic casing (1.05 cm in inner diameter, 1.35 cm in outer diameter and 50 cm in length), a 3.8 cm×3.8 cm balloon fixed on the casing head and its cavity connected to the gas pipeline placed in casing tail, an anti-reflux pad in the insert entrance of the endoscope tail as well.as a flushing hole. The endoscopy was introduced to the esophagus or stomch together with outer casing to wash and pump the hematocele out from the side of flushing hole. In patients with hemorrhagic lesion in esophageal vein, the balloon was used to press bleeding vein and intravascular sclerotherapy was performed simutanously. In those with hemorrhagic lesion in gastric vein, the balloon was pressed on esophageal vein near to the cardia and intravascular sclerotherapy was performed. Results During the process of examination, the hemorrhagic lesion was fully exposed because of flushing, and bleeding was controlted in all patients after sclerotherapy. No complication such as aspiration or perforation was seen. Conclusions For emergency endoscopic treatment of esophagogastric variceal bleeding, gastroscope outer casing is helpful in removing intragastric hematocele and maintaining a clear field of vision. It can be effectively improving the efficacy of sclerot herapy. Key words: Esophageal and gastric varices; Oastrointestind hemorrhage; Endoscoping, digestive system

Nursing of the neoplasty of multiple cerebrospinal fluid rhinorrhea (MCSFR) on combined frontal -nose approach through endoscope

Objective To summarization nursing experience of the neoplasty of multiple cerebrospinal fluid rhinorthea (MCSFR) on combined frontal - nose approach through endoscope. Methods 5cases (7surfaces) of MCSFR were observed and cared. Results 5cases (7surfaces) were repaired successfully. Follow - up survey had been over one year through periodic endoscope after operation. All cases were cured finally. Conclusions Neoplasty of combined frontal - nose approach through endoscope is simple, safe. Correct nursing is important for suceessful operation. Key words: Cerebrospinal fluid rhinorrhea; Frontal sinus; Endoscopy; Nursing

Endoscopic diagnosis and treatment of infants with posthemorrhagic hydrocephalus

Objective To study the application of flexible endoscope for diagnosis and treatment of infants with posthemorrhagic hydrocephalus. Method 28 cases of infants with posthemorrhagic hydrocephalus were diagnosed and treated with flexible neuron-endoscope in our hospital, from April 2006 to October 2008. Intraventricular haemorrhage in 25, subarachnoid hemorrhage in 2 and infratentorial subdural hematoma in 1. Ventricle irrigation was performed with flexible neuro-endoscope in all patients except 1 hematoma cavity irrigation in the case of infratentorial subdural hematoma. Followed third ventriculostomy in 18 ,simultaneous choroid plexus cauterization in 7 ,lamina terminals fenestration in 4 and the multi septum fenestration in the ventricles in 1. Endoscopic opening of the foramen of magendie with transaqueductal approach in 3. Endoscopic aqueductoplasty in 6. Results Among 28 cases of infants with posthemorrhagic hydrocephalus, only 17 diagnoses occupied 60. 7% (17/28) were defined preoperatively by neural images and the other 11 were diagnosed by overall exploration to the ventricular system under flexible endoscope. Postoperative diencephalic seizures occurred in 6, obstruction in basal cistern was defined by second ETV in 2 patients on 80 days and 7 months after operation respectively. Good results showed in the follow up of 2 to 35 months(median 13.5 months) with no complications such as intraventricular infection or subdural effusion. Conclusions Overall exploration to the ventricular system under flexible endoscope is reliable for diagnosis of posthemorrhagic hydrocephalus. Ventricle irrigation to evacuate the blood blot as far as possible is benefit to decrease the opportunity of obstruction of the stoma or shunt catheter. Second ETV is worth to advocate to identify the cause of unsatisfactory operative results. Key words: Cerebral hemorrhage; Hydrocephalus; Infants; Flexible neuroendoscope

Endoscopic third ventriculostomy in treatment of chronic complicated hydrocephalus

Objective To explore the effects of endoscopic third ventricuiostomy in treatment of chronic complicated hydrocephalus. Method The clinical data of 15 cases of chronic complicated hydroephalus with endoscopic third ventriculostomy were analyzed retrospectively. Results Satisfying post -operative results were obtained in 15 cases. No complications occurred. One patient suffered recurrent hydrocephalus after first operation and underwent second third ventriculostomy. During operation orificium fistuloe was closed and patient recurred well after operation. Conclusions Endoscopic third ventriculostomy is reliable and effective in treatment of chronic complicated hydrocephalus. Key words: Endoscopes; Hydrocephalus; Third ventricle

Endoscopic treatment of the lesions in foramen of monro region

Objective To probe the indications and applied value of endoscopic treatment of the lesions in foramen of Monro region. Method20 cases of lesions in foramen of Monro region were selected. The bases of the solid tumors were cauterized,which made the tumors away from the foramen of Monro gradually,and the tumors were hold and took by forceps with endoscope. The cyst walls were excised directly or after cyst liquid taken out according to the quality of the lesions. The thinner obstructions of the foramen of Monro were penetrated. Results 9 astrocytomas were totally resected, 1 primitive neuroectodermal tumor was partially resected ;The walls of the cyst lesions were totally removed in 2 cases and partially excised in 4 ones. 2 cases of thin obstruction of the foramen of Monro were penetrated. All patients had no obvious complications, and had good long-term follow-up results. Condnsions Neuroendoscopic technique is feasible in the lesions in foramen of Monro region, which can improve the safety and the efficiency, and minimize brain trauma. Key words: Cerebral ventricles; Foramen of Monro; Eendoscopes; Neoplasms; Cysts

Neuroendoseopic endonasal transsphenoidal surgery for pituitary adenomas

Objective To study surgical techniques of neuroendoscopic endonasal transsphenoidal approach for pituitary adenomas. Method 47 pituitary adenomas cases treated through endoscopic transsphenoidal approach were analyzed retrospectively. Results Total resection of adenoma was achieved in 39 cases and subtotal resection in 8 cases among neuroendoscopic technique series. The average time of operation was 85 min. There was significant difference comparing the average time of operation and degree of resection between later 27 cases and earlier 20 cases. Conclusions Unilateral endonasal transsphenoidal approach operated by neuroendoscopic techniques were convenient, safe and effective. Neuroendoscope-attached surgery could provide a more minimal invasion and excellent exposure for pituitary adenomas that result in more complete removal of tumors. Excellent application of this technique for pituitary adenomas lies on the surgical experience and judgments based on the comprebensive understanding of pathological state of disease. Key words: Pituitary neoplasms; Endoscopes