Endoscopic Laser Research Articles

Phonatory compensation in patients with larynx cancer after CO2 laser cordectomy.

CO2 laser endoscopic cordectomy is the method of laryngeal cancer treatment. The type of cordectomy (I-VI) depends on the extent of the tumor. Endoscopic laser surgery provides more satisfactory phonation conditions in comparison to open surgical procedures. The aim of the study was to classify phonatory compensation mechanisms after CO2 laser cordectomy using the HSDI. M aterial and methods: The study included 30 men treated and diagnosed at the Department of Otolaryngology and Department of Clinical Phonoaudiology and Logopedics, Medical University of Bialystok. The control included 30 men with no pathological changes in the larynx. Type III, IV and Va CO2 laser cordectomy have been for glottis cancer treatment. Postoperative evaluation has been conducted 6 months after the surgery. HSDI has been used in larynx visualization. R esults: Type I compensation occurs most frequently in patients after type III cordectomy. Advanced glottis cancer, as an indication for type IV and V cordectomy, leads to epiglottic hyperfunction and phonation involving vestibular folds - type II and III compensation. Type IV compensation is most frequent in type IV cordectomy. C onclusions: The type compensation is connected with the extent of glottis resection. In cordectomy including anterior commissure and the part of opposite fold (type Va), supraglottic hyperfunction with the participation of vestibular folds (type II and III compensation) has been recorded. Transmuscular cordectomy (type III) most often resulted in type I compensation. Type III-Va cordectomy caused reduction or absence of MW, decrease in amplitude and aperiodicity of vibrations in HSDI.

Surgical management of benign prostatic obstruction: 20-year population-level trends.

Benign prostatic obstruction (BPO) due to histological benign prostatic hyperplasia is highly prevalent among older men. Despite widespread use of medical therapy, surgical treatment remains a mainstay in the management of BPO. We sought to characterize trends in the surgical management of BPO in Ontario, Canada. We performed an interrupted time-series analysis using segmented regression among men aged 18 years and older undergoing surgical treatment for BPO between January 1, 1994 and December 31, 2014 in Ontario, Canada. The passage of time was considered the primary exposure. The primary outcome was the proportion of all BPO surgeries performed using each of the following modalities: transurethral resection of the prostate (TURP), endoscopic laser prostatectomy, open/laparoscopic prostatectomy, and others. We identified 136 459 men who underwent BPO surgery between 1994 and 2014. The annual age-adjusted rate of BPO surgery declined significantly over time (24 to 10 per 10 000 population in 1994 and 2014, respectively). From 1994-2001, there were no significant changes in the distribution of BPO surgical modalities, with TURP the most common throughout (97.2% and 97% in 1994 and 2001, respectively). From 2002-2014, there was a significant decline in the use of TURP (92.1% to 76.9%; p=0.027) with a corresponding increase in the use of endoscopic laser prostatectomy (3.5% to 21.9%; p=0.0008). This study demonstrates a shift in the management of BPO, with increasing use of endoscopic laser prostatectomy, beginning in 2002. However, TURP remains the most common treatment modality.

2855 To Determine the Clinical Profile of Patients With Esophageal Cancers

INTRODUCTION: Cancer of the esophagus ranks twelfth among the major cancers in the number of new cases diagnosed and seventh in the number of cancer death. Its high mortality rate makes it a major concern. Numerous approaches have been described for resection of esophagus. Combined modality therapy including radiotherapy and chemotherapy has raised hope for improvement of survival with promising preliminary data.Finally, for palliation of dysphagia in those patients with advanced disease,various newer therapeutic options have been introduced like endoscopic stenting and laser ablation. Thus this study elaborates view of current literature pertaining to the disease and concludes by comparing the results of the present study with the former national and international scenario. METHODS: The one year cross sectional study was conducted at tertiary care hospital. All the patients either gender who were diagnosed as esophageal cancer were included in the study. These patients were allowed to undergo necessary investigations and treatment while the subjects excluded from study were patients who were lost to follow up and the non cooperative patients who not interested to participate in the study while the frequency / percentages (%) and means ± SD computed for study variables. RESULTS: During one year study period total fifty patients with esophageal carcinoma were explored and studied. the frequency for male and female population was 32 (64%) and 18 (36%) with mean ± sd for age of male and female individuals was 54.47 ± 5.87 and 51.75 ± 7.72 respectively. Gender male 32 (64%) and female 18 (36%), type of lesion exophytic 05 (10%), infiltrative 10 (20%), ulcerative 35 (70%), location upper third 05 (10%), middle third 30 (60%) and lower third 15 (30%). Histological type squamous cell carcinoma 36 (72%) and adenocarcinoma 14 (28%). CONCLUSION: Carcinoma esophagus is one of the most common gastrointestinal tract malignancies. It was the second most common gastrointestinal cancer in our hospital, second only to carcinoma stomach, constituting 6.2% of all malignancies. Squamous cell carcinomas accounts for the vast majority of cancers arising in high- incidence areas throughout the world.Seventy two percent of our patients had squamous cell cancer while twenty eight percent had adenocarcinoma. This reflects the difference in epidemiology and the fact that adenocarcinoma is not rising in incidence in less well- developed nations like ours compared to the West.

TRACHEAL DIVERTICULUM: DIAGNOSIS AND TREATMENT OPTIONS

SESSION TITLE: Wednesday Medical Student/Resident Case Report Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/23/2019 09:45 AM - 10:45 AM INTRODUCTION: Tracheal Diverticulum is a rare and often incidental diagnosis found on chest imaging in an asymptomatic patient with underlying lung disease. Management includes conservative and possible surgical treatment depending on age and symptoms. CASE PRESENTATION: 72 yom presents with dyspnea and chronic cough. He is a nonsmoker and has a history of asthma, chronic sinusitis and right lung lobectomy after mva. Chest CT revealed pockets of air in superior mediastinum along the right posterior tracheal wall suggestive of tracheal diverticulum. Patient was medically managed with symptomatic improvement. DISCUSSION: Tracheal diverticulum (TD) is a benign and often incidental finding on chest imaging as an out pouching of the tracheal wall. According to their location, size and histopathology TD can be classified in either congenital or acquired. Acquired TD has a wide opening, can be found at any level in the thoracic cavity and occurs as a result of herniation of the weakened tracheal wall due to increased luminal pressure in the trachea. Congenital TD is thought to represent a malformation of the supernumerary branches of the trachea and usually occurs above the carina with small neck openings. The histopathological difference between them is the presence of smooth muscle and cartilage in congenital TD while acquired TD lacks these structures. Medical management of TD include physiotherapy, mucolytic and antibiotics in some cases. When symptomatic, patients may present with cough, hemoptysis and recurrent respiratory infections due to either the compression of adjacent organs or secondary bacterial infections. In symptomatic patients (cough, hemoptysis and recurrent respiratory infections) surgical treatment and endoscopic laser cauterization have been reported to be effective and safe. There is a lack of consensus regarding indications for treatment due to the rarity of this cases CONCLUSIONS: Tracheal diverticulum (TD) is defined as a benign out-pouching of the tracheal wall due to structural weakness that can be congenital or acquired in origin. Most cases are found incidentally since majority of patients are asymptomatic. Uncomplicated TDs are usually asymptomatic and when symptoms have occurred, they usually present with non-specific symptoms like pharyngeal discomfort, cough, dyspnea, and recurrent respiratory infection. Asymptomatic TDs usually require no treatment and managed conservatively while surgical excision is indicated in cases of recurrent infections or compression of adjacent organs. Reference #1: .Lee S-Y, Joo S, Lee GD, Ham SJ, Park CH, Lee S. A Case of Symptomatic Tracheal Diverticulum and Surgical Resection as a Treatment Modality. The Korean Journal of Thoracic and Cardiovascular Surgery. 2016;49(5):405-407. https://doi.org/10.5090/kjtcs.2016.49.5.405 Reference #2: Tanaka H, Mori Y, Kurokawa K, Abe S. Paratracheal air cysts communicating with the trachea: CT findings. J Thorac Imaging. 1997;12:38–40. https://doi.org/10.1097/00005382-199701000-00005. [PubMed][Cross Ref] Reference #3: Collin JD, Batchelor T, Hughes CW. Transcervical repair of tracheal diverticulum. Ann Thorac Surg. 2014;98:1490–2. https://doi.org/10.1016/j.athoracsur.2014.02.081. [PubMed] [Cross Ref DISCLOSURES: No relevant relationships by Anastasia Novikov, source=Web Response No relevant relationships by Theo Trandafirescu, source=Web Response

Thulium-Holmium:YAG Duo Laser in Conservative Upper Tract Urothelial Cancer Treatment: 13 Years Experience from a Tertiary National Referral Center.

Introduction and Objectives: To evaluate ablative safety and efficacy of thulium-holmium:YAG (TL-HL:YAG) duo laser in renal conserving retrograde intrarenal surgery (RC-RIRS) in upper tract urothelial carcinoma (UTUC). Materials and Methods: A retrospective study was performed on 178 consecutive patients referred for consideration of RC-RIRS UTUC-eLA (endoscopic laser ablation) in a tertiary center (January 2005 to December 2018). Key data were recorded using a standardized study proforma. Results: After endodiagnostic procedure, 42 declined rigorous endosurveillance protocol and went elsewhere for alternative treatment, leaving 136 patients, of whom 35 patients dropped out (25.7%) after undergoing primary radical nephroureterectomy (RNU) (unsuitable for renal preservation). This was left with 101 candidates who continued UTUC conservative management (intention-to-treat [ITT] population). Mean follow-up (FU) for these 101 patients was 28.7 months. At last FU (range 3-144 months), 70 patients (69.3%) were recurrence free, 22 (21.8%) had endoscopically treated recurrences, and a further 9 (8.9%) had undergone RNU. In the ITT population, kidney-preserving rate was 91%, whereas in imperative indications, it was 87.5%. Clavien-Dindo grade I complications only (self-limiting hematuria) were reported in 10%. Conclusions: Over a 13-year period, RC-RIRS UTUC treatment with the TL-HL:YAG duo laser was safe and oncologically noninferior to alternative combination laser energy technologies used for this indication.

Percutaneous transhepatic laser lithotripsy for intrahepatic cholelithiasis: A technical report.

Advances in interventional radiology have seen the adaptation of urological endoscopic laser techniques to treat biliary tract calculi. Percutaneous transhepatic biliary laser lithotripsy provides an effective alternative procedure for the management of intrahepatic or conventionally refractory choledocholithiasis which would otherwise require invasive and high-risk surgical intervention. Several small studies have validated the procedure for management in this subset of patients, with most achieving 100% calculi clearance with minimal complications. Most patients are suitable for percutaneous transhepatic biliary laser lithotripsy. Preprocedural imaging is useful for evaluating stone burden and planning percutaneous access. Holmium lasers are commonly used and act by vaporising water particles on and in the calculi, fragmenting the stone via thermal expansion. A series of catheters, wires, sheaths and dilators are used to allow introduction of the choledochoscope and laser so that calculi can be targeted. Percutaneous transhepatic biliary laser lithotripsy is often used in conjunction with balloon dredging and biliary stricture dilatation. Only experienced interventionalists should perform this procedure, and users should be aware of associated hazards. Repeat percutaneous transhepatic cholangiography is routinely performed to confirm eradication of stones. Treatment of biliary calculi and obstruction is important in preventing diseases such as cholangitis and cirrhosis. For patients unsuitable for conventional treatment, percutaneous transhepatic laser lithotripsy is a safe and effective alternative when performed by experienced interventional radiologists. Preprocedural planning is imperative to procedure success.

The surgical learning curve for endoscopic GreenLight™ laser enucleation of the prostate: an international multicentre study.

To investigate the effect of surgical experience on the perioperative outcomes of endoscopic GreenLight™ (Boston Scientific Corporation, Marlborough, MA, USA) laser enucleation of the prostate (GreenLEP). A multicentre retrospective study of the first patients treated with GreenLEP by six surgeons was conducted. For each patient, surgical experience was coded as the total number of procedures performed by the surgeons before the patient's operation. The learning curve was analysed in terms of changes over time for the following variables: enucleation time, morcellation time, occurrence of intraoperative complications (IOCs), 3-month postoperative International Prostate Symptom Score (IPSS) reduction, and the rate of Pentafecta achievement. In total, 922 patients were analysed. At multivariable regression analyses adjusted for case mix, surgical experience was associated with shorter enucleation and morcellation time (P<0.001), lower IOC rate (P<0.001), higher 3-month postoperative reduction in IPSS (P=0.004), and higher probability of Pentafecta achievement (P<0.001). The relationship between surgical experience and enucleation time/IOCs appeared as non-linear, with a steep slope reduction within the first 100 cases and a plateau observed after 200 cases, whilst the IPSS improved rapidly early in the learning curve process and plateaued after ~100 procedures. Finally, there was a linear improvement in Pentafecta achievement, with a plateau observed after 270 cases. Surgical experience has a significant impact on the perioperative outcomes for GreenLEP procedures. After adjusting for patient and prostate characteristics, plateau results were achieved after a long learning curve. A more intensely mentored and structured training schedule might allow quicker and safer adoption of the procedure.

Factores de riesgo de formación cálculos en el tracto urinario superior tras cistectomía radical con derivación urinaria

Introduction and objectivesThe study was conducted to identify the risk factors of upper tract stone formation in patients with diversions after radical cystectomy (RC). Materials and methodsAll patients with diversion after RC were collected in our center from January 2005 to December 2013. Three different common diversions were included: Orthotopic neobladder (ON: 168 patients), Ileal Conduit (IC: 93 patients) or Ureterocutaneostomy (UC: 104 patients). Univariable and multivariable logistic regression analysis were conducted to identify the independent predictors of stone formation in the upper tract. ResultsA total of 365 consecutive patients (316 males, 49 females) were included. At a median follow-up of 48 months (range 12-65 months), 36 patients (9.9%) developed upper tract stone. Among them, 26 (72.2%), 5 (13.9%) and 5 (13.9%) patients underwent ON, IC and UC, respectively. 25 patients had renal stone and 11 ureter stone. Minimally invasive operations (endoscopic laser lithotripsy via the anterograde or retrograde approach in 24 cases, percutaneous nephrolithotomy in 9 cases and shock wave lithotripsy in 3 cases) were carried out successfully in all stone cases. On univariable and multivariable logistic regression analysis, diabetes mellitus, hypertension, urinary tract infection (UTI), anastomotic stenosis and types of diversions (P<.05) were positively associated with upper tract stone formation. ConclusionsThe variable predictors of upper tract stone may contain diabetes mellitus, hypertension, UTI, anastomotic stenosis and types of diversion.

Severe cryptococcal granulomas of the nasopharynx in a horse treated with standing endoscopic laser surgery and oral fluconazole

SummaryAn Arabian mare was referred due to a 4‐month history of bilateral mucopurulent nasal discharge, which was unresponsive to multiple courses of antimicrobials and intravenous sodium iodide. Digital radiographs revealed multiple variably sized nodular opacities within the nasopharynx. Upper airway endoscopy showed multiple, ulcerated granulomatous masses originating from the walls of the nasopharynx. Repeat culture of the exudate and from endoscopic biopsies grew only a mixed bacterial population. Standing endoscopic guided laser excision of two granulomas was performed and histopathology and culture from the center of a surgically excised granuloma identified Cryptococcus terrestris. Treatment with fluconazole (14 mg/kg bwt per os once then 5 mg/kg bwt per os q. 12 h) was administered for a total of 11 weeks. Follow‐up endoscopic examination was used to guide therapy duration, and the horse has since returned to competition and remained free of infection for &gt;1.5 years. Establishing a diagnosis of cryptococcal infection was difficult in this horse despite multiple culture attempts. This is the first report of Cryptococcus terrestris infection in a horse and treatment with oral fluconazole after surgical de‐bulking was successful.

Percutaneous Intratumor Laser Ablation for Fetal Sacrococcygeal Teratoma

Objective: To evaluate the efficiency of percutaneous intratumor laser ablation for fetal solid sacrococcygeal teratoma (SCT). Subjects and Methods: We carried out percutaneous ultrasound-guided intratumor laser ablation through a 17-gauge needle using an output of 40 W in 7 fetuses with large solid SCT and reviewed the literature for minimally invasive therapy for this condition. Results: Laser ablation was carried out at a median gestational age of 20 (range 19–23) weeks, and in all cases there was elimination of obvious vascularization within the tumor and improvement in cardiac function. Three (43%) babies survived and had surgical excision of the tumor within 2 days of birth, 3 liveborn babies died within 5 days of birth and before surgery, and 1 fetus died within 2 weeks after the procedure. In previous series of various percutaneous interventions for predominantly solid SCT the survival rate was 33% (2/6) (95% CI 9.7–70%) for endoscopic laser to superficial vessels, 57% (4/7) (95% CI 25–84%) for intratumor laser, 67% (8/12) (95% CI 39–86%) for intratumor radiofrequency ablation, and 20% (1/5) (95% CI 3.6–62%) for intratumor injection of alcohol. Conclusions: In solid SCT, the reported survival from intratumor laser or radiofrequency ablation is about 50%, but survival does not mean success, and it remains uncertain whether such interventions are beneficial or not because the number of fetuses is small and there were no controls that were managed expectantly.

Endoscopic Ultrasound-Guided Confocal Laser Endomicroscopy Increases Accuracy of Differentiation of Pancreatic Cystic Lesions

Imaging patterns from endoscopic ultrasound (EUS)-guided needle-based confocal laser endomicroscopy (nCLE) have been associated with specific pancreatic cystic lesions (PCLs). We compared the accuracy of EUS with nCLE in differentiating mucinous from nonmucinous PCLs with that of measurement of carcinoembryonic antigen (CEA) and cytology analysis. We performed a prospective study of 144 consecutive patients with a suspected PCL (≥20 mm) who underwent EUS with fine-needle aspiration of pancreatic cysts from June 2015 through December 2018 at a single center; 65 patients underwent surgical resection. Surgical samples were analyzed by histology (reference standard). During EUS, the needle with the miniprobe was placed in the cyst, which was analyzed by nCLE. Fluid was aspirated and analyzed for level of CEA and by cytology. We compared the accuracy of nCLE in differentiating mucinous from nonmucinous lesions with that of measurement of CEA and cytology analysis. The mean size of dominant cysts was 36.4 ± 15.7 mm and the mean duration of nCLE imaging was 7.3 ± 2.8 min. Among the 65 subjects with surgically resected cysts analyzed histologically, 86.1% had at least 1 worrisome feature based on the 2012 Fukuoka criteria. Measurement of CEA and cytology analysis identified mucinous PCLs with 74% sensitivity, 61% specificity, and 71% accuracy. EUS with nCLE identified mucinous PCLs with 98% sensitivity, 94% specificity, and 97% accuracy. nCLE was more accurate in classifying mucinous vs nonmucinous cysts than the standard method (P < .001). The overall incidence of postprocedure acute pancreatitis was 3.5% (5 of 144); all episodes were mild, based on the revised Atlanta criteria. In a prospective study, we found that analysis of cysts by nCLE identified mucinous cysts with greater accuracy than measurement of CEA and cytology analysis. EUS with nCLE can be used to differentiate mucinous from nonmucinous PCLs. ClincialTrials.gov no: NCT02516488.

1131-P: Endoscopic Duodenal Submucosal Laser Ablation for the Treatment of Type 2 Diabetes Mellitus: Results of First-in-Human Pilot Study

The duodenum has recently emerged as a key regulator in glucose metabolism via modulation of a complex network of neural and hormonal signals in response to ingested food. DiaGone™ is an endoscopic device which utilizes precisely controlled laser technology to target the duodenal submucosal neural plexi with the aim of improving glucose control by modulating the gastrointestinal neurohumoral axis. Nine subjects (5 males) with obesity (BMI 34.0 ± 4.6 kg/m2) and type 2 diabetes mellitus (T2DM) insufficiently controlled on metformin were included in this first-in-human trial in order to assess the efficacy and safety of DiaGone™. Subjects were instructed to continue with regular diet 24h after the procedure and metformin dose was not changed during the study period. Biochemical and anthropometric parameters were assessed at baseline and 3 and 6 months after the procedure and continuous glucose monitoring (CGM) and a standard liquid meal test were performed at baseline and 3 months after the procedure. DiaGone™ significantly decreased HbA1C from 78.3 ± 13.3 mmol/mol at baseline to 64.9 ± 6.4 mmol/mol and 64.8 ± 7.1 mmol/mol at 3 and 6 months, respectively (p&amp;lt;0.01). Similarly, a decrease in fasting glucose levels was noted (12.4 ± 3.5 vs. 9.5 ± 2.0 vs. 9.7 ± 2.7 mmol/l, p&amp;lt;0.01) with no significant changes in fasting insulin levels. Glucose AUC during the 150 min meal test 3 months after the procedure showed a reduction of 20% from baseline (43,435 vs. 34,096, p&amp;lt;0.01). No significant changes were observed in AUC for insulin. No adverse events related to the procedure or significant changes in weight were reported throughout the 6-month period. In conclusion, these pilot results suggest that endoscopic duodenal submucosal laser ablation using the DiaGone™ device is associated with improvements in both baseline and postprandial glycemia as well as HbA1C with no significant changes in insulin levels or body weight while having a favorable safety and tolerability profile. Disclosure M. Mraz: None. I. Marcovitch: Employee; Self; Digma Medical. I. Lankova: None. H. Kratochvilova: None. A. Cinkajzlova: None. M. Benes: None. J. Korner: Board Member; Self; Digma Medical. Stock/Shareholder; Self; Digma Medical. Z. Vlasakova: None. J. Spicak: None. T. Pelikanova: None. M. Haluzik: None. Funding MH CZ - DRO; Institute for Clinical and Experimental Medicine (IN00023001); RVO (VFN64165)

Endoscopic Ultrasound-guided Needle-based Confocal Laser Endomicroscopy: Appraisal Concerning In-vivo Imaging of Intraductal Papillary Mucinous Neoplasm

Differential diagnosis between benign and potentially malignant cystic pancreatic lesions may be difficult. Previously we have compared cyst fluid serine protease inhibitor Kazal type I (SPINK1) with some traditionally used tumour markers (amylase, CEA, Ca19-9) and found that it may be a new promising maker in the differential diagnosis of cystic pancreatic lesions. In the present study, we focused on cyst fluid SPINK1 levels in benign and potentially malignant cystic pancreatic lesions.Sixty-one patients operated on for cystic pancreatic lesion in Tampere University Hospital, Finland and in Verona University Hospital, Italy, were included. Cyst fluid was aspirated during surgery, stored at −70 °C, and analysed with immunofluorometric assay for SPINK1. The final diagnosis was acute pancreatitis with fluid collection (Acute FC) in 4 patients, chronic pseudocyst (PS) in 17 patients, serous cystadenoma (SCA) in 7 patients, mucinous cystadenoma (MCA) in 21 patients and intraductal papillary-mucinous neoplasm (IPMN) in 12 patients (9 main/mixed duct type and 3 branch duct type).The acute FC patients had high SPINK1 levels. Among chronic cysts, SPINK1 levels were significantly higher in patients with potentially malignant cysts (main/mixed duct IPMN and MCA) than with benign cysts (side branch IPMN and SCA), (median and range, [480 (13–3602) vs. 18 (0.1–278) μg/L]; p < 0.0001). In the subcohort of 24 patients with <3 cm chronic cyst, cyst fluid SPINK 1 levels were significantly lower in SCA or side branch IPMN (3 [2–116] μg/L) than in main duct IPMN or MCA (638 [66–3602] μg/L; p = 0.018). The best sensitivity and specificity to differentiate any size MCA or main/mixed type IPMN from SCA or side branch IPMN were 85% and 84% (AUC 0.94; cut-off value 118 μg/L). The best sensitivity and specificity to differentiate <3 cm MCA or main duct IPMN from SCA or side branch IPMN were 93% and 89% (AUC 0.98; cut-off value 146 μg/L).Cyst fluid SPINK1 may be a possible marker in the differential diagnosis of benign and potentially malignant cystic pancreatic lesions.

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Ming-Ming Zhang et al. Endoscopic ultrasound-guided needle-based confocal laser endomicroscopy for diagnosis of gastric subepithelial tumors: a pilot study

Therapeutic effects of endoscopic ultrasound-guided holmium laser ablation for pancreatic primary implantation carcinoma in nude mice

Objective To explore the effectiveness of endoscopic ultrasound(EUS)-guided holmium laser ablation for primary pancreatic implantation tumor in nude mice. Methods Pancreatic cancer cell line SW1990 were implanted into 20 4-6-week-old male balb/c nude mice to establish primary pancreatic implantation tumor in situ models. Then the nude mice were randomly divided into two groups, the treatment group(n=10) and the control group(n=10). The treatment group underwent EUS-guided holmium laser ablation in the pancreatic tumor. And no interventions were given to the control group. The volume of tumors of the two groups were measured under EUS at time points of 7 d, 14 d and 28 d after ablation. The activities, appetites and psychosis of all nude mice were evaluated in the meantime. At 28 d after ablation, lesions of pancreas were dissected and sliced for H&E staining. Results There were no complications in the treatment group, and all nude mice could tolerate the procedure. The mental state, activities and appetites of nude mice in the experimental group were better than those in the control group. Tumors of the control group enlarged. There was significant difference in the tumor size between the two groups at 28 d after ablation. HE staining showed coagulation necrosis in the ablation area. Conclusion EUS-guided holmium laser, producing coagulative necrosis in the ablation area, is effective for primary pancreatic implantation carcinoma in nude mice for about 28 days. Key words: Ultrasonography; Laser therapy, Holmium; Disease modelsl; Rats, nude

Technical standardization of MIS management of children with pilonidal sinus disease using pediatric endoscopic pilonidal sinus treatment (PEPSiT) and laser epilation

PurposeThis study aimed to standardize the technique of pediatric endoscopic pilonidal sinus treatment (PEPSiT) associated with laser epilation. MethodsAll pediatric patients presenting with acute or chronic pilonidal sinus disease (PSD) who underwent PEPSiT in our institution over a 36-month period (July 2015–July 2018), were included in the study. Pre- and postoperative management, recurrence rate, postoperative pain, hospital stay, analgesic requirements, and patient satisfaction levels were evaluated. ResultsA total of 59 patients (23 girls and 36 boys) underwent PEPSiT during the study period. Ten/59 patients (16.9%) had recurrent PSD after open repair, and 4/59 (6.7%) presented a concomitant pilonidal cyst. All children underwent laser epilation pre- and postoperatively over the last 15 months. The average length of surgery was 27.5 min (range 20–45). The average pain score during the first 48 postoperative hours was 2.7 (range 2–5), and the average analgesic requirement was 20 h (range 16–24). The average hospitalization was 22.4 h (range 18–36). At 1 month postoperatively, external openings were healed in all patients. During follow-up, 1 recurrence (1.6%) was recorded and successfully re-treated with PEPSiT. ConclusionsWe believe that PEPSiT represents the technique of choice for treatment of PSD in the pediatric population. It is crucial to standardize the technique consisting of pre- and postoperative laser epilation, PEPSiT, and accurate postoperative wound management with eosin and sulfadiazine spray. Level of evidenceTreatment study — Level IV

Feasibility of single position endoscopic laser balloon ablation for atrial fibrillation: The open 8 approach.

Ablation without shaft repositioning may make the endoscopic laser ablation system (EAS) more like a single shot approach. We tested the feasibility of wide circumferential ablation (WCA; no carina ablation and no shaft repositioning) in an "open 8" pattern for pulmonary vein isolation (PVI). Forty-eight patients (n = 48, age 64.6 ± 12 years) with paroxysmal and persistent atrial fibrillation (AF) were referred to our center for PVI with the EAS. WCA for the lateral and septal pulmonary veins was attempted in all patients. If not feasible, individual full circular isolation of each pulmonary vein (iPVI) was performed. Additional lesions were applied if acute complete electrical isolation was not achieved on the first encirclement. Any documented episode of AF after a 1-month blanking period was registered as a recurrence. Bilateral WCA was feasible in 21 out of 48 patients (43.8%). Additional lesions for complete electrical isolation after the first-pass ablation were less in WCA compared with iPVI (P = 0.02). WCA was accomplished faster, with less applied energy at both lateral (P < 0.01) and septal side (P < 0.01). The mean follow-up of the patient population was 232 ± 150 days. AF recurrence occurred later in patients treated with WCA (315 ± 124 vs 110 ± 88 days, P = 0.008). WCA with the EAS is safe, at least moderately feasible and highly effective, if achieved. Compared with iPVI it may be less time consuming, results in less energy application, and suppresses AF more effectively.

A rare cause of acute urinary retention: Anterior urethral stones

Anterior urethra stones are extremely rare causes of acute urinary retention. The data of 34 adult patients who presented with acute urinary retention between August 2011 and September 2017 and treated with anterior urethra were evaluated retrospectively. Their ages, sizes of stones, locations, etiological factors, physical examination findings, treatment modalities, operation period and complications were analyzed. All the patients were male and the mean age was 46.9 ± 17.88 years. All of the stones evaluated in the study were single and the mean stone size was 12.17 ± 3.23 (6-19) mm. Location of the urethral calculi was fossa navicularis in 12 (35.3%) patients, bulbar urethra in 7 (20.6%) patients and penile urethra in 15 (44.1%) patients. A total of 20 patients had urinary calculi located in the other parts of the urinary system at the time of presentation. Stone of the 7 patients with fossa navicularis localized had been treated by intraurethral instillation of 2% lidocaine gel, the other 5 patients had been treated with ventral meatotomy. Urethral stone of the 7 patients with penile and bulbar urethra located was taken by the help of direct forceps without requiring any fragmentation operation. Other stones were treated with endoscopic holmium laser lithotripsy. As a result of surgery operations, urinary tract infection in 3 patients, urethrorrhagia in 2 patients and hematuria in 5 patients were observed. We consider that it is very important to keep anterior urethral stones in mind among differential diagnosis especially in male patients admitted with acute urinary retention. acute urinary retention.

Data Set for the Reporting of Carcinomas of the Hypopharynx, Larynx, and Trachea: Explanations and Recommendations of the Guidelines From the International Collaboration on Cancer Reporting.

The International Collaboration on Cancer Reporting is a nonprofit organization whose mission is to develop evidence-based, universally available surgical pathology reporting data sets. Standardized pathologic reporting for cancers facilitates improved communication for patient care and prognosis and the comparison of data between countries to progressively improve clinical outcomes. Laryngeal cancers are often accompanied by significant morbidity, although surgical advances (such as transoral endoscopic laser microresection and transoral robotic surgery) provide new alternatives. The anatomy of the larynx is complex, with an understanding of the exact anatomic sites and subsites, along with recognizing anatomic landmarks, being crucial to classification and prognostication. This review outlines the data set developed for the histopathology reporting in Carcinomas of the Hypopharynx, Larynx and Trachea and discusses the main elements required and recommended for reporting.

Laparoscopic nephroureterectomy with laser endoscopic transuretral disinsertion in lateral decubitus: Progressive adaptation to retroperitoneocopic approach

BackgroundThe ureteral disinsertion with bladder cuff technique continues to evolve. We present the endoscopic laser transurethral technique combined with a transperitoneal and retroperitoneal laparoscopic approach in lateral decubitus, without patient repositioning, for treating urothelial carcinomas of the upper urinary tract. Materials and methodsWe present 3 laparoscopic nephroureterectomies: 1 transperitoneal and 2 retroperitoneal. Disinsertion was performed in lateral decubitus using a flexible cystoscope and a 365-μm holmium laser fiber. The endoscopic technique was progressively adapted to 3-port and single-port retroperitoneoscopic approaches. Before laparoscopic handling of the kidney, ureter was clamped below the tumor. The endoscopic technique was then started. Both approaches were simultaneously employed. ResultsNephroureterectomies were achieved performing en bloc endoscopic disinsertion of the bladder cuff and ensuring a closed system comparable to open technique. The second case required reconversion due to technical problems and extension of the surgical time. No relapses were diagnosed during follow-up. ConclusionResults are comparable to open surgery, technique ensured compliance to oncology principles, enabled disinsertion in lateral decubitus and avoid patient repositioning saving surgical time.The results reflect the benefits of minimally invasive surgery in all cases.