Endoscopic Surgery Research Articles

Efficacy of a RADA-16 peptide hydrogel versus chitosan-based polymer in improving patient comfort during postoperative debridement: A randomized controlled trial.

Bioresorbable nasal packing is associated with a decreased incidence of adhesions and bleeding postoperatively after endoscopic sinus surgery (ESS). However, discomfort during postoperative debridement is still a major area of concern for patients. Our objective was to compare the efficacy of a peptide hydrogel to that of a chitosan-based polymer in reducing pain during debridement after ESS. A prospective, multicenter, randomized, blinded trial was conducted in adults undergoing bilateral total ethmoidectomy for chronic rhinosinusitis. Participants served as their own controls with each subject receiving the hydrogel in a randomized ethmoid cavity and chitosan-based polymer in the contralateral ethmoid cavity. Participants were evaluated at 1, 4, and 12weeks postoperatively. Pain during debridement as well as endoscopic evaluation of mucosal healing and hemostasis were measured. Thirty patients who underwent ESS were included in this trial. During the week 1 postoperative debridement, patients reported significantly less pain on the hydrogel-treated side compared to the chitosan-based polymer-treated side. There were no significant differences in bleeding severity, Lund-Kennedy scores, debridement time, or need for further intervention between the two groups. This study demonstrated the efficacy of a peptide hydrogel inminimizing pain during postoperative debridement.

Supporting left-handed trainees in sinus and skull base surgery: A call for inclusive ergonomics.

The surgeon's hand dominance impacts ergonomics in endoscopic endonasal surgery. Left-handed trainees experience difficulty learning certain surgical techniques. OR adjustments optimize ergonomics for left-handed trainees without compromising others.

A Novel Use of Hydrocolloid Dressing as a Packing Material after Functional Endoscopic Sinus Surgery

A Novel Use of Hydrocolloid Dressing as a Packing Material after Functional Endoscopic Sinus Surgery

Cognitive improvement after endoscopic third ventriculostomy surgery in long-standing overt ventriculomegaly in adults.

Long-standing overt ventriculomegaly in adults (LOVA) is a chronic form of hydrocephalus that can lead to cognitive deficits. Data on the cognitive profile of patients with LOVA and cognitive outcomes of endoscopic third ventriculostomy (ETV) are, however, scarce and mostly qualitative. Twenty-three consecutive patients with LOVA hydrocephalus underwent ETV surgery, and their cognitive status was assessed before surgery, immediately after surgery, and at the 5-month follow-up. Cognitive function was assessed using a neuropsychological battery measuring 6 cognitive domains: general cognitive status, attention/executive function, language, visuospatial skills, short-term memory, and long-term memory. Cognitive reserve was also estimated through a measure of premorbid IQ to assess its potential influence together with other clinical and demographic variables. Patients with LOVA did not experience general cognitive decline but rather selective long-term memory (p < 0.001) and visuospatial skills (p = 0.001) deficits alone. Moreover, ETV surgery led to significant immediate postoperative improvement in both domains (p = 0.002 and p < 0.001 respectively), that persisted at follow-up (p < 0.001 for both). However, improvement was observed only in patients with higher premorbid IQ (p < 0.001), while the others did not improve (p > 0.532). These findings confirm the effectiveness of ETV surgery and highlight the role of cognitive reserve in promoting plasticity of brain and cognitive functions thus fostering and predicting cognitive recovery.

Do Anatomical Variations of Sphenoid Sinus Influence Sella Exposure and Residual Disease in Pituitary Surgery? - A Study in an Indian Population.

Introduction Endoscopic transsphenoidal surgery (ETS) is the standard practice in pituitary surgeries. The sellar exposure becomes the main factor which determines the residual disease in ETS. Not many studies can be found in the literature on the influence of anatomical variations of the sphenoid on intraoperative sella exposure. Objective The aim of the current study is to ascertain whether sphenoid sinus variations play a role in sellar exposure and residual tumor volume. Methods This is a prospective study conducted in a south Indian tertiary care center between June 2020 to June 2022, with 21 study participants who were scheduled to have ETS. The relation of preoperative computed tomography (CT) and magnetic resonance imaging (MRI) parameters with the intraoperative area of sellar exposure and residual tumor volume was evaluated. Results Sphenoid sinus dimensions, like presellar width (mean = 1.89 ± 0.51 cm), maximum width (mean = 2.94 ± 1.09 cm), presellar depth (mean = 1.14 ± 0.55 cm), suprasellar depth (mean = 1.08 ± 0.24 cm), infrasellar depth (mean = 2.36 ± 0.92 cm), presellar height (mean = 2.22 ± 0.47 cm), or the 9 internal carotid artery (ICA)-related measures, did not have any correlation with the mean intraoperative area of sellar exposure (0.57 ± 0.28 cm 2 ). Also, the adequacy of sellar exposure did not relate to the residual tumor. Preoperative tumor volume was found to be higher (20.2 [55.3-13.2] cm 3 ) in patients with residual tumor compared with those with no residual tumor (5.9 [6.8-5.2] cm 3 ). Tumor extension had a significant association with the residual tumor volume. Conclusion According to the present study, anatomical variations of the sphenoid sinus do not influence the adequacy of sellar exposure. Further studies need to be undertaken concerning residual tumor volume as well as preoperative tumor volume and extension.

Anatomical study and clinical outcomes of endoscopic transoral surgery for benign salivary gland tumors in the parapharyngeal space

The existing literature provides little insight into the efficacy of transoral endoscopy in exposing benign tumors originating from salivary glands in the parapharyngeal space at the parotid gland base and resecting part of the deep lobe with a safe margin. This study aims to investigate the efficacy of the endoscopic transoral approach for the visualization and resection of such tumors.Through transoral endoscopic cadaveric dissections and surgical procedures, we examined the anatomical structures of the parapharyngeal space and the deep lobe of the parotid gland, identifying key anatomical landmarks. We conducted a retrospective analysis of 19 patients with benign salivary gland-derived tumors in the parapharyngeal space who underwent transoral endoscopic resection.Intraoperative visualization of the tumor pedicle and the deep lobe of the parotid gland was successfully achieved in all cases, allowing for resection with safe margins. During a median follow-up period of 54.0 months, imaging revealed no signs of recurrence.Endoscopic transoral approach provides effective visualization of the deep lobe of the parotid gland and the medial portion of the parotid bed from the parapharyngeal space. Benign tumors of salivary gland-derived in this area can be well exposed and safely resected with adequate margins.

Outcomes following endoscopic endonasal resection of craniopharyngiomas using intraoperative magnetic resonance imaging: Case series

BackgroundCraniopharyngiomas are rare tumors that originate from the squamous epithelium in Rathke's sac residues. There is a limited body of literature on the effect of using intraoperative magnetic resonance imaging (IO-MRI) in resection of craniopharyngiomas via endoscopic endonasal surgery (EES). The present study aims to assess the outcomes of EES for resection of craniopharyngiomas using IO-MRI. MethodsThis is a retrospective analysis of the data collected on the point of care, consisting of 27 patients who underwent EES for histologically confirmed craniopharingiomas. All procedures were performed by a single neurosurgeon in between 2018 and 2020. ResultsIO-MRI showed gross total resections were achieved in 25 (92.6 %) patients, and subtotal resections were achieved in 2 (7.4 %) patients. Pre-anticipated resection rate was achieved in the intraoperative scans in all patients and none of the patients required further resection. IO-MRI prolonged the anesthesia duration by an average of 32 ± 4 min. In the follow-up, 24 (88.9 %) cases of permanent diabetes insipidus and 10 (37 %) cases of panhypopituitarism were observed. Cerebrospinal fluid rhinorrhea complicated 6 (22.2 %) cases. ConclusionThis present study is the largest study evaluating the efficiency of IO-MRI in craniopharyngioma. In addition, unlike other studies, only the patients who underwent EES were included. Although it has been known that the EES for craniopharyngioma is an effective and less invasive technique, this presented early results would suggest that combining this method with IO-MRI did not make significant contributions to surgical outcome.

Sinonasal Complications of Combined Transseptal–Transnasal and Bilateral Transnasal Approaches for Endoscopic Endonasal Transsphenoidal Pituitary Surgery

BackgroundThe endoscopic combined transseptal–transnasal technique for pituitary adenoma excision is notable for enhanced postoperative functional outcomes. Our study compared the incidence of anterior nasal septal perforation and the resulting sinonasal complications between this method and the bilateral transnasal approach. MethodsUtilizing a retrospective cohort from a preeminent tertiary referral center, we analyzed 141 cases of endoscopic endonasal transsphenoidal surgery performed between March 2018 and May 2023. Outcomes for the transseptal–transnasal group (n = 71) and the conventional bilateral transnasal group (n = 70) were compared. Nasal endoscopy and computed tomography were used to assess anterior nasal septal perforation. Functional outcomes were assessed preoperatively and at 6 months postoperatively using the Connecticut Chemosensory Clinical Research Center (CCCRC) test, Cross-Cultural Smell Identification Test (CCSIT), Sino-Nasal Outcome Test-22 (SNOT-22), and nasal obstruction symptom evaluation (NOSE) ResultsThe transseptal–transnasal approach exhibited reduced rates of postoperative ear fullness (p < 0.001), along with fewer subjective complaints of smell/taste loss (p = 0.022) and thick nasal discharge (p = 0.008), compared to the conventional approach. However, objective smell test results were not significantly different between the two approaches (p = 0.243 and p = 0.454 for CCCRC and CCSIT, respectively). Additionally, although statistically insignificant, a higher incidence of anterior septal perforation was observed with the transseptal–transnasal approach (p = 0.067). ConclusionFor the surgical treatment of pituitary adenomas, the transseptal–transnasal approach offers several advantages over the bilateral transnasal method, particularly in reducing postoperative complications. However, this technique requires careful attention for preventing the occurrence of anterior septal perforation.

Endoscopic cardiac surgery: the path less taken

Endoscopic cardiac surgery: the path less taken

Extended transcavernous posterior clinoidectomy in endoscopic endonasal surgery.

Mastery of the posterior clinoidectomy technique is of utmost importance for neurosurgeons who specialize in endoscopic endonasal approaches, because the posterior clinoid process (PCP) is commonly involved in chondroid tumor resection. Three main techniques for posterior clinoidectomy have been developed: intradural, extradural, and transcavernous interdural. The authors introduce here a novel technical variant in which the transcavernous approach is extended to the dorsal clinoidal space after transection of the caroticoclinoid ligament, and they elaborate on its clinical application on the basis of anatomical dissections and radiological studies. The authors reviewed CT angiography images and 3D reconstruction of the PCP in 50 adults to analyze the height and presence of ossified ligament attachments. In addition, endoscopic endonasal posterior clinoidectomy was performed in 20 lightly embalmed postmortem human heads. Three techniques, including extradural, transcavernous, and extended transcavernous posterior clinoidectomy, were performed sequentially, and anatomical landmarks and areas exposed with each technique were investigated and compared. Using radiological studies, the authors categorized the PCPs as 1 of 2 types: 1) normal, defined as less than or equal to 8 mm high with no ossified ligament attachments; or 2) complex, defined as greater than 8 mm high with or without an ossified ligament attachment. Compared with extradural (exposed PCP height 4.7 ± 0.5 mm) and transcavernous (exposed PCP height 7.3 ± 0.8 mm) posterior clinoidectomies, the extended transcavernous posterior clinoidectomy provided the maximally exposed PCP height (9.6 ± 0.4 mm; p < 0.0001). This report details the extended transcavernous posterior clinoidectomy as a novel technical variant for achieving maximal exposure of the PCP in endoscopic endonasal surgery. In addition, the positive results establish the importance of preoperative skull base imaging for surgical planning.

S2068 From Traditional to Innovative: Social Media Insights Into the Evolving Preferences for Endoscopic Bariatric Surgery

S2068 From Traditional to Innovative: Social Media Insights Into the Evolving Preferences for Endoscopic Bariatric Surgery

Perioperative and postoperative effects of hydrostatic pressure applied to the dura mater on central nervous system in unilateral biportal endoscopic spine surgery.

To evaluate the changes in optic nerve sheath diameter (ONSD) caused by this pressure applied to the dura mater and postoperative complications. The study was conducted between 01.01.2022 and 01.06.2022 at Private Medicabil Hospital. The ONSD was measured 3mm behind the eyeball using US at 5 time points: T1 (in the supine position after anesthesia induction), T2 (after conversion to the prone position), T3 (in the prone position after applying pressure to the dura mater), T4 (in the prone position after the discontinuation of applying pressure to the dura mater), T5 (after conversion to the supine position). Postoperative complications were recorded. The ONSD at T3 was higher than those at all time points. For an ONSD value >5.3mm, the sensitivity, specificity, positive predictive, and negative predictive values were 87.5%, 71.9%, 50.9%, and 94.5%, respectively (Area under the curve 0.830, 95% Confidence Interval: 0.761-0.899, p<0.001) CONCLUSION: We think that the hydrostatic pressure applied to the dura mater in unilateral biportal endoscopic (UBE) surgeries causes changes in the ONSD sheath diameter and that monitoring ONSD with peroperative USG can reduce the possible complications in order to reduce the effects of this pressure on the central nervous system.

The Lamella Ostium Extent Mucosa (LOEM) system: a new classification for endoscopic sinus surgery.

In the last decades, various types of endoscopic sinus surgery (ESS) have emerged as treatments for chronic rhinosinusitis (CRS), particularly with the development of personalized, endotype-driven approaches targeting mucosal inflammation and remodeling (1). Despite these advancements, the literature reports heterogeneous and often divergent outcomes, leaving the actual benefit of more extensive surgical approaches in CRS control a matter of ongoing debate (2,3). This discrepancy stems from inconsistent definitions of surgical techniques, leading to variations in osseous and mucosal resections depending on patient phenotype, disease severity and surgeon preference (4). To address this inconsistency, the Japanese Rhinology Society introduced a classification based on procedure extent, but it lacks details on anatomical structures and mucosal treatment (5). Similarly, the ACCESS system measures ESS extent with postoperative CT-scans but overlooks mucosal interventions (6).

Overcoming Challenges: Haemostasis in a Clival Plasmacytoma.

Solitary plasmacytomas of clivus are a rare entity, having only less than 20 cases reported so far in the literature; its diagnosis and management don't have a gold standard. Although endoscopic skull base surgery (ESBS) is less morbid, it poses a challenge to the surgeon because of the critical location close to vital structures and intraoperative bleeding. Here we present a case report on managing this rare entity and our challenges while dealing with this vascular tumour.

Optimizing Corticosteroid Sinonasal Irrigation Outcomes Through 3D Printing: A Randomized Pilot Clinical Trial.

Topical corticosteroid irrigation plays critical role in the management of chronic rhinosinusitis (CRS). Yet, its efficacy can be highly variable. We sought to determine if personalized, 3-dimensional (3D)-printed nasal models can optimize head positioning and irrigation parameters, therefore improving patient outcomes. Randomized, single-blinded clinical trial. Tertiary medical center from November 2021 to July 2023. Sixty-two patients with CRS were randomized into either control (CG), backfill (BG), or model (MG) groups; daily 2 mg mometasone irrigations were then performed for 2 months with either standard head-forward and natural side-tilt position (CG), a head tilt of 90° to the side with fluid entering the lower nostril (BG), or in an optimized position as determined by a patient-specific 3D printed irrigation model (MG), respectively. A total of 36 patients completed the trial (CG: N = 14/23; BG N = 11/23, MG: N = 11/16). Significant posttreatment improvement in Lund-Mackay (LM) scoring was only observed in the MG (-3.73, 95% confidence interval = -5.71, -1.75; P < .001). Patient-reported outcome measures (Nasal Obstruction Symptom Evaluation, Sinonasal Outcome Test-22, and Visual Analog Scale of nasal congestion) improved significantly among all groups. Optimal model penetration scores significantly correlated to posttreatment MG LM score (Spearman's r = 0.65, P < .05). Among all groups, patients with prior endoscopic sinus surgery (ESS) (n = 19) had objectively less opacification at baseline; however, experienced the same degree of opacification reduction and symptom reduction as those without prior ESS (n = 17). The use of 3D printing to personalize head positioning may significantly improve objective corticosteroid irrigation outcomes. Mometasone irrigation may have similar subjective and objective effects on patients regardless of prior surgical history. Level 1 prospective, randomized, single-blinded clinical trial NCT06118554.

Short-Term Bed Rest is not a Risk Factor for Venous Thromboembolism After Endoscopic Skull Base Surgery

IntroductionDeep venous thromboembolisms (DVT) increase morbidity in postoperative patients, and no current guidelines identify which patients undergoing endoscopic endonasal approach (EEA) to the skull base may be at increased risk. Postoperative care for these patients often includes a period of inactivity to prevent transient ICP shifts which may impact skull base reconstruction. We seek to characterize if postoperative bedrest puts EEA patients at increased risk of developing thromboembolic complications. MethodsRetrospective chart review of patients undergoing intradural surgery with primary skull base reconstruction for intraoperative CSF leak via EEA for any skull base pathology between July 2018 and May 2024 was performed yielding 221 patients who met inclusion criteria. Univariate and multivariable regression were performed with patient demographics, extent of approach, intraoperative leak flow rate, bedrest duration, presence and length of postoperative lumbar drainage (LD), and use of postoperative mechanical VT prophylaxis. ResultsThe mean age of included patients was 52.6 ± 16.8 years, 48% were male, and 3.6% of patients had DVTs. Age (OR 1.01, 95% CI 0.96-1.06, p=0.83), sex (OR 0.40, 95% CI 0.05-2.19, p=0.31), BMI (OR 0.98, 95% CI 0.87-1.07, p=0.74), extended approach (OR 0.80, 95% CI 0.13-4.36, p=0.80), CSF leak flow rate (OR 5.71, 95% CI 0.77-118.90, p=0.14), bedrest duration (OR 1.06, 95% CI 0.77-1.27, p=0.60), and presence of LD (OR 1.10, 95% CI 0.55-2.02, p=0.76) were not significant predictors of postoperative VTE incidence on multivariable analysis. ConclusionShort-term bedrest after EEA is not a risk factor for development of VTE in the immediate postoperative period.

Inter‐prefectural and urban–rural regional disparities in rectal cancer and rectal resections: A Japanese nationwide population‐based cohort study from 2014 to 2019

AbstractAimThis observational study aimed to elucidate the regional disparities in rectal cancer (RC) and rectal resections (RRs) across Japan.MethodsThe annual incidence of RC, and number of all RRs and board‐certified surgeons by the Japan Society for Endoscopic Surgery were examined by prefecture in Japan from 2014 to 2019. The surgical approaches were broken down by open and laparoscopic. Disparities in 47 prefectures and urban–rural disparities were evaluated using the Gini coefficient and unpaired t‐test.ResultsThe annual national average incidence of RC was 50 127 and the number of all RRs was 39 903. Gini coefficients for RC, and laparoscopic and all RRs were &lt;0.2, indicating low inequality. There was no significant difference between urban and rural prefectures in the number of RRs, despite a significantly higher incidence of RC in rural prefectures and a significantly higher number of board‐certified surgeons in urban prefectures (p &lt; 0.05).ConclusionRC and laparoscopic and all RRs exhibited minimal inter‐prefectural disparities. The urban–rural analysis revealed significant differences in the incidence/number of RC and board‐certified surgeons between urban and rural prefectures, despite minor differences in RRs regardless of approach. This pattern suggests a potential migration of surgical services from rural to urban areas. This preliminary study is expected to contribute to a basic epidemiological database for RC and RRs.

Design and kinematics analysis of a cable-stayed notch manipulator for transluminal endoscopic surgery

The friction between the joints of the continuum manipulator with discrete joints brings great difficulties to kinematic modeling. The traditional driving wire arrangement limits the load capacity of the manipulator. A cable-stayed notch manipulator for transluminal endoscopic surgery is proposed, and a driving force coupling kinematic mode is established. The manipulator is fabricated from a superelastic Nitinol tube with bilaterally cut rectangular notches and is actuated by a stay cable. By applying the comprehensive elliptic integral solution (CEIS) for large deformation beams, the bending angle of each elastic beam is obtained, and the kinematics from the driving space to the joint space is formed. According to the bending angle of each elastic beam, the expression of the manipulator in Cartesian space can be obtained by geometric analysis. The kinematics from the joint space to the Cartesian space is established. The outer diameter of the manipulator is only 3.5 mm, and the inner diameter can reach 2 mm, allowing instruments to pass through. The maximum error of the manipulator movement is less than 5%. The load capacity of the manipulator has been verified through the stiffness experiments, and the maximum load of the manipulator can reach 400 g. The cable-stayed notch manipulator can be accurately modeled on the base of CEIS, and its motion accuracy can meet the needs of engineering applications. The compact size and excellent load capacity of the manipulator make it potential for application in transluminal endoscopic surgical robots.

S1552 Safety and Efficacy of Natural Orifice Transluminal Endoscopic Surgery in Humans: A Systematic Review and Meta-Analysis

S1552 Safety and Efficacy of Natural Orifice Transluminal Endoscopic Surgery in Humans: A Systematic Review and Meta-Analysis

181 - Natural Orifice Transluminal Endoscopic Surgery (NOTES) hystero-sacrocolpoplexy as a new approach for uterine prolapse treatment.

181 - Natural Orifice Transluminal Endoscopic Surgery (NOTES) hystero-sacrocolpoplexy as a new approach for uterine prolapse treatment.