Endoscopic Surgery Group Research Articles

Decompression and reconstruction the spinal TB lesion of a single vertebra through thoracoscopy alone or combined with foraminal endoscopy.

This study aimed to compare the clinical efficacy of thoracoscopy combined with transforaminal endoscopy and thoracoscopy alone in the treatment of thoracic tuberculosis. Patients with thoracic tuberculosis who visited our hospital from February 2018 to October 2022 were retrospectively analyzed. The patients were divided into thoracoscopic combined transforaminal endoscopic surgery group (group A) and thoracoscopic surgery alone group (group B) according to the surgical methods. Surgery-related information, VAS score, ODI score, degree of spinal cord function improvement, fusion time, and progression of kyphotic deformity were compared. A total of 37 patients were included, 16 in group A and 21 in group B. Postoperative follow-up time was 10-48 months, with an average of 28.62 ± 10.53 months. All patients had significant improvement in chest and back pain and spinal cord function after the operation. There were statistical differences in operation time, intraoperative blood loss, incidence rate of complications, and JOA score at 1 week and 3 months after operation between the two groups (P<0.05). There was no significant difference in VAS, ODI score, kyphotic angle correction, kyphotic correction loss angle, postoperative drainage volume, and fusion time between the two groups (P>0.05). All patients had no recurrence of thoracic tuberculosis during follow-up. Thoracoscopy combined with transforaminal endoscopy produce equivalent long-term results with shorter operation time, less intraoperative blood loss, less complications and higher surgical safety comparing to thoracoscopy alone. And thoracoscopy combined with transforaminal endoscopy can fully decompress and facilitate the early recovery of spinal cord function.

A clinical comparative study of an outpatient treatment group and an endoscopic sinus surgery group for maxillary sinus fungus ball.

This study aimed to clarify the differences in the pathophysiology of maxillary sinus fungus balls (FB) among different case groups and to identify which patients with maxillary sinus FB would be suitable for outpatient procedures. Thirty-four patients diagnosed with maxillary sinus FB between January 2017 and December 2021 were divided into two groups (O and S). We retrospectively compared the clinical and imaging characteristics, and the treatment outcomes between the groups. Group O comprised 12 patients (13 sides) treated in an outpatient clinic and Group S comprised 15 patients (16 sides) treated with endoscopic sinus surgery (ESS). Compared to Group S, Group O had more patients with an enlarged maxillary sinus membranous portion, and shadows indicative of fungal masses (P < 0.01 and P < 0.05, respectively). In particular, the anteroposterior ratio of the open maxillary sinus membranous area was 0.68 ± 0.16 in Group O and 0.5 ± 0.12 in Group S. After surgery, Group O exhibited greater anteroposterior expansion of the maxillary sinus membranous portion compared to Group S (P < 0.01). Additionally, Group O had more patients with shadows in sinuses other than the maxillary sinus (P < 0.01) and medial displacement of the uncinate process (P < 0.01) than Group S. In addition, Group O required fewer procedures and hospital visits than Group S (P < 0.001 and P < 0.01, respectively). Determining the indications for outpatient procedures while considering the pathophysiology of maxillary sinus FB can significantly benefit patients and medical professionals in terms of safety and medical costs.

Association between postoperative pain and analgesic use in minimally invasive cardiac surgery.

This study aimed to investigate the effects of surgical methods on pain duration and oral analgesic administration in patients who underwent cardiac surgery using various minimally invasive methods. We included 90 patients who underwent an anterior incision with costal cartilage transection, lateral incision without costal cartilage transection, or total endoscopic cardiac surgery using a lateral incision and no retractor. Oral analgesics were postoperatively administered upon patient request. All the patients were instructed to rate their pain during the daytime 3 and 7 days postoperatively. Between-group differences included surgical method, wound size, operation/cardiopulmonary bypass time/cardiac arrest time, and intraoperative fentanyl dose. No differences were found in sex, age, diabetes status, paravertebral block use, or blood loss. The number of postoperative days, postoperative analgesic use, and pain 3 days postoperatively demonstrated no difference. Pain ratings were most severe for the costal cartilage resection group and least severe for the total endoscopic cardiac surgery group 7 days postoperatively. Similarly, patients who underwent costal cartilage research exhibited the highest rate of analgesic use for 30 days postoperatively, whereas patients who underwent total endoscopic cardiac surgery demonstrated the lowest. We revealed significant between-group differences in pain prevalence and postoperative oral analgesic administration in patients who underwent cardiac surgery relative to the minimally invasive surgical method used.

Feasibility Study of Endoscopic Surgery for Spontaneous Intracerebral Hemorrhage with Large Hematoma: a Comparison with Craniotomy Using Propensity Score Matching Analysis.

Spontaneous intracerebral hemorrhage (ICH) with large hematomas is commonly treated with craniotomy combined with decompressive craniectomy, procedures that involve huge trauma and require subsequent cranioplasty. Recently, endoscopic surgery has shown significant promise in treating ICH, but its feasibility for large hematomas remains uncertain. Therefore, this study aims to compare endoscopic surgery with craniotomy and to evaluate the efficacy and safety of endoscopic surgery in treating large hematomas ICH. A retrospective analysis was conducted on the clinical data from patients with spontaneous supratentorial ICH and hematoma volumes exceeding 50 mL who underwent either endoscopic surgery or craniotomy. Propensity score matching analysis was employed to reduce selection bias. The efficacy and safety of endoscopic surgery were evaluated by analyzing blood loss, postoperative edema, mortality rate, complications, and the Glasgow Outcome Scale (GOS) at 6-month follow-up. A total of 113 cases that met the criteria were collected, with 65 in the endoscopic surgery group and 48 in the craniotomy group. After propensity score matching, each group contained 34 cases. The mean hematoma volume was 64.84 ± 11.02 mL in the endoscopy group and 66.57 ± 12.77 mL in the craniotomy group (p = 0.554). Hematoma evacuation rates were 93.27% in the endoscopy group and 89.34% in the craniotomy group (p = 0.141). The endoscopy group exhibited lower blood loss, shorter surgical time, and reduced postoperative edema volume at 24 h compared to the craniotomy group. The rate of pulmonary infection was slightly lower in the endoscopy group compared to the craniotomy group (70.59% vs. 91.18%, p = 0.031), but there were no statistically significant differences in overall complications and mortality rate between the two groups. GOS scores were similar in both groups at the 6-month follow-up. Endoscopic surgery is safe and feasible for treating spontaneous supratentorial ICH with large hematomas, demonstrating efficacy similar to that of craniotomy with decompressive craniectomy.

A study on the safety and efficacy of endoscopic thyroidectomy via axillary approach for the treatment of thyroid cancer.

This study aims to evaluate the safety and efficacy of endoscopic thyroid cancer treatment using an axillary approach. Participants were allocated into 2 groups: one undergoing transaxillary endoscopic surgery and the other, traditional open surgery. We compared intraoperative and postoperative conditions, focusing on parameters such as intraoperative blood loss, duration of surgery, length of postoperative hospitalization, volume of postoperative drainage, number of lymph nodes cleared in the central region, neck pain scores, neck injury indices, cosmetic satisfaction, postoperative complications, and total hospitalization duration. Patients in the endoscopic treatment (ET) group experienced longer surgical times, less intraoperative bleeding, and increased postoperative drainage. These indicators showed significant differences between the groups (P < .05). For the group undergoing endoscopic surgery via the axillary approach, there was a lower neck pain score on the third postoperative day and higher cosmetic satisfaction at 3 months. However, there were no significant differences between the groups in terms of the number of lymph nodes cleared in the central area, and the incidence of complications such as difficulty breathing, difficulty swallowing, hoarseness, and subcutaneous hematoma (P > .05). The axillary approach endoscopic surgery group also showed significantly prolonged surgery times and postoperative hospital stays, with a significant increase in postoperative drainage fluid (P < .05). Concurrently, this technique involved smaller surgical incisions and effectively concealed scars in the armpit, leading to better outcomes in terms of intraoperative bleeding, neck pain scores, and postoperative cosmetic satisfaction. Non-inflatable ET via the axillary approach for treating thyroid cancer demonstrates promising efficacy and safety. It offers additional benefits of minimal pain and enhanced cosmetic outcomes, making it a viable option for clinical adoption and application.

Application of the follower arm endoscope holder in type i tympanoplasty

Objective:To investigate the surgical outcomes and safety of the follower arm endoscope holder in assisting type Ⅰ tympanoplasty. Methods:The clinical data of 16 patients who underwent type Ⅰ tympanoplasty at the Department of Otorhinolaryngology, Peking Union Medical College Hospital, from November 2022 to September 2023 were retrospectively analyzed, among which 8 cases were operated by traditional otoscopy and 8 cases were operated by supported endoscopy.The surgical procedure was analyzed and the completion of supported endoscopic operation was observed, while the duration of the operation, the time consumed by the main steps, the frequency of wiping the lenses, the perioperative complications, and the improvement of the postoperative hearing were recorded and statistically analyzed. Results:Supporting endoscopic technology achieved real-time suction of bleeding, simultaneous traction and separation of tissues, precise removal of calcified spots on the inner side of the eardrum, trimming of the external auditory canal flap, stable separation of the handle of the malleus and the eardrum, and tensioned repositioning of the skin-cartilage flap. The average duration of surgery, time for external auditory canal flap preparation, and time for repositioning the skin-cartilage flap were reduced in the supporting endoscopic surgery group compared to the control group. The average lens wiping frequency was significantly lower in the supporting endoscopic surgery group compared to the control group. There was no statistically significant difference in postoperative hearing improvement between the two groups, and no infections or the need for secondary surgery due to eardrum re-perforation occurred postoperatively. Conclusion:Supported endoscopy technology realizes the need for endoscopic two-handed operation and convenient switching between one and two hands, accomplishes many operations that cannot be done by traditional endoscopic surgery, solves the problems of previous intraoperative one-handed operation and image instability, shortens the average operation time compared with traditional otoscopic surgery, and decreases the frequency of intraoperative wiping of the lens significantly compared with traditional otoscopic surgery, which is potentially worthwhile in terms of shortening the learning curve.

What is the applicability of tubal ligation with the vaginal natural orifice transluminal endoscopic surgery technique and its value in patient comfort?

The aim of this study was to observe the feasibility of the tubal/adnexal approach using vaginal natural orifice transluminal endoscopic surgery and compare its contribution with surgeon ergonomics and postoperative patient comfort with that of conventional laparoscopy. We completed this study retrospectively with 47 patients. Patients were followed at their postoperative first month. We analyzed the usability of the vaginal natural orifice transluminal endoscopic surgery method over conventional laparoscopy by comparing the demographics, surgical data, and postoperative findings collected between the two groups. Patients in the conventional laparoscopy group were older (39.1±3.3 years) than those in the vaginal natural orifice transluminal endoscopic surgery patient group (p=0.005). Pain intensity 24 h after surgery was lower in the vaginal natural orifice transluminal endoscopic surgery group (p=0.003), while sexual function and dyspareunia did not differ between the two groups in the first month. Patients in the vaginal natural orifice transluminal endoscopic surgery group were more relieved about painlessness and the comfort it brought than the conventional laparoscopy group (p=0.027, χ2=12.56). Patients subjected to the vaginal natural orifice transluminal endoscopic surgery procedure showed higher levels of satisfaction, less postoperative pain, and greater comfort than those subjected to conventional laparoscopy.

Early Endoscopic Sinus Surgery Versus Antibiotics Alone for Orbital Cellulitis from Acute Rhinosinusitis – A Retrospective Cohort Study

Background: Orbital cellulitis is a common complication of sinusitis that can cause blindness, intracranial infection, or even death. The standard treatment of orbital cellulitis from acute rhinosinusitis is to administer antibiotics and closely monitor the visual acuity. In this study, we explored the benefit of early endoscopic sinus surgery to improve the clinical outcome of the patients. Objective: To study the clinical outcomes of orbital cellulitis from acute rhinosinusitis patients who were treated with early endoscopic sinus surgery (within 48 hours after admission) versus antibiotics alone. Methods: We retrospectively reviewed the patients who were admitted to the Otolaryngology Department, Khon Kaen Hospital, Thailand with orbital cellulitis from acute rhinosinusitis from January 2013 to May 2023. The demographic data, treatment received, and clinical outcomes were collected. Results: This study included 77 patients. All patients were treated with empirical intravenous antibiotics. The mean age for all patients was 43.7 years. The most common underlying diseases were diabetes and hypertension. The most common symptoms and signs were periorbital swelling and chemosis. The early endoscopic sinus surgery was performed in 44 patients while 33 patients received antibiotics only. At 48 hours after admission, one patient in the early endoscopic sinus surgery group (2.27%) and 12 patients in the antibiotics-only group (36.36%) had no clinical improvement. The odds ratio of improvement after early endoscopic sinus surgery was 24.57 (95% CI 2.99 to 201.80, p = 0.003). The intravenous antibiotics duration and length of stay were also shorter in the early endoscopic sinus surgery group (p = 0.020 and 0.065, respectively) Conclusions: Early endoscopic sinus surgery in orbital cellulitis from acute rhinosinusitis patients may improve clinical outcomes, shorter intravenous antibiotics duration, and hospital stay.

Impact of Endoscopic Surgery Versus Robot CAS-R-2 Assisted with Stereotactic Drainage on Prognosis of Basal Ganglia Hypertensive Intracerebral Hemorrhage

To evaluate the impact of endoscopic surgery (ES) versus robot CAS-R-2 assisted with stereotactic drainage on prognosis of basal ganglia hypertensive intracerebral hemorrhage (HICH). This retrospective observational study included patients who underwent ES or robot CAS-R-2 assisted with stereotactic drainage for basal ganglia HICH in Shanghai Sixth People's Hospital between June 2017 and May 2022. The outcomes were 6-month mortality and modified Rankin Scale (mRS) score. A total of 94 patients were included; 68 (age 51.26 ± 9.18 years, 17 women) of them underwent ES, while the other 26 (age 56.50 ± 12.91, 11 women) underwent robot CAS-R-2. The 6-month mortality rates were similar (P > 0.05) between the patients who underwent ES (6 of 68, 8.82%) and robot CAS-R-2 (2 of 26,7.69%), while the rate of good prognosis in the ES group was significantly higher compared with that in the robot CAS-R-2 group (P= 0.024). Univariate logistic analysis found that endoscopic surgery, age, and hematoma volume were associated with poor prognosis at 6 months. Multivariate logistic regression analysis showed that, after adjusted for the preoperative hematoma volume and age, endoscopy surgery (relative risk 0.21, 95% CI 0.06-0.68, P= 0.009) was associated with good prognosis at 6 months follow-up. Compared with robot CAS-R-2 assisted with stereotactic drainage, ES might have higher rate of good prognosis at 6-month follow-up for basal ganglia HICH.

Clinical study of endoscopic surgery for recurrent nasopharyngeal carcinoma

Objective:To compare the clinical effects and complications of surgery + chemotherapy and radiotherapy + chemotherapy in patients with nasopharyngeal carcinoma recurrence, so as to compare the safety and efficacy of two different therapeutic methods. Methods:A retrospective analysis was performed on 40 patients with recurrent nasopharyngeal carcinoma after radiotherapy and chemotherapy admitted to our hospital from January 2016 to June 2020. Among them, 26 patients were treated with surgery. The recurrent tumor was removed under nasal endoscope, and the frozen resection margin was negative during the operation. Chemotherapy was continued for stage Ⅲ and Ⅳ patients from 3 to 5 weeks after surgery. Fourteen patients received secondary radiotherapy and chemotherapy. Postoperative complications and survival rate were observed. Results:There were 14 patients in the secondary chemoradiotherapy group（control group） and 26 patients in the nasal endoscopic surgery group（observation group）. Among the 26 patients, 19 patients underwent nasal septal mucosal repair, 5 patients underwent temporal muscle flap repair, 2 patients underwent submental flap repair, 2 patients had nasal septal mucosal flap necrosis and cerebrospinal fluid leakage, and the temporal muscle flap was used for secondary repair in the second stage operation, and 8 patients needed cervical lymph node dissection. The patients recovered well after surgery, and the patients in stage Ⅲ and Ⅳ were treated with chemotherapy after 3 weeks to 5 weeks according to the patient's wound condition. There were significant differences in the incidence of complications and 1-, 2-, and 3-year survival rates between the two groups（P<0.05）. Conclusion:Patients with recurrent nasopharyngeal carcinoma can be treated by nasal endoscopic surgery to remove the tumor, and the use of pedicled nasal septal mucosal flap or temporal muscle flap for skull base reconstruction, The operation can effectively prevent major complications such as internal carotid artery rupture and hemorrhage, and improve the survival rate and quality of life of patients. It provides a safe and effective treatment for patients with recurrent nasopharyngeal carcinoma.

Endoscopic surgery versus craniotomy for spontaneous intracerebral hemorrhage in the late elderly patients

ObjectivesTo compare the prognosis of late elderly patients with spontaneous intracerebral hemorrhage (ICH) treated by endoscopic evacuation and craniotomy Materials and MethodsUsing the Diagnosis Procedure Combination database, we identified patients aged ≥ 75 years who underwent surgery for spontaneous ICH within 48 hours after admission between April 2014 and March 2018. Eligible patients were classified into two groups according to the type of surgery (endoscopic surgery and craniotomy). Propensity-score matching weight analysis was conducted to compare the good neurological outcome modified Rankin Scale (mRS) score (0–4) at discharge as the primary endpoint between the two groups. Secondary endpoints were postoperative meningitis, tracheostomy, reoperation within 3 days and total hospitalization costs. ResultsAmong the 5,396 eligible patients, endoscopic surgery and craniotomy were performed in 895 and 4,501 patients, respectively. In the propensity-score matching weight analysis, all covariates were well balanced. The proportions of patients with a good prognosis (mRS score at discharge: 0–4) did not significantly differ between the surgical procedures (42.1% vs. 42.8%, p = 0.828). The proportions of meningitis, tracheostomy and reoperation were not significantly different between the two groups. Hospitalization costs were significantly higher in the craniotomy group than in the endoscopic surgery group (25,536 vs. 29,603 US dollars, p = 0.012). ConclusionsInhospital outcomes did not differ between endoscopic and open surgeries for spontaneous ICH in the late-stage elderly patients aged ≥75 years. Hospitalization costs were significantly higher in the craniotomy group, suggesting that endoscopic surgery may be more acceptable.

Comparison of the outcomes of endoscopic versus microscopic approach in cholesteatoma surgery: a randomized clinical study

BackgroundEndoscopic ear surgery is a new, less invasive otologic procedure. Since 1990s, it has been grown in prominence because of anatomical and physiological theories. It offers a view of hidden places, avoids mastoidectomies and endaural vertical and postauricular incisions, and has many other benefits over microscopic surgery. The purpose of this study was to distinguish the difference between the outcomes of microscopic and endoscopic cholesteatoma surgery.MethodsEighty individuals who were diagnosed with cholesteatoma participated in this randomized clinical research. Patients were randomly allocated into two equivalent treatment groups. One group submitted to tympanoplasty via microscopic ear surgery and the other group had exclusive trans-canal endoscopic ear surgery. All patients had preoperative otomicroscopic and radiologic assessment to ensure cholesteatoma diagnosis. Audiological evaluations were also obtained.ResultsThere was no discernible difference in the tested groups’ operational times, air-bone gaps, or air conduction. The endoscopic surgery group healed significantly more quickly than the microscopic surgery group (5.4 0.5 vs 7.7 0.5 weeks, p > 0.001). The frequency of residual lesions (5.0% vs 22.5%, p = 0.023) and recurrence (7.5% vs 27.5%, p = 0.019) was significantly lower in the endoscopic group of patients.ConclusionsWhen comparing healing times, rates of residual disease and rates of recurrence, endoscopic surgery clearly outperforms microscopic surgery. The endoscope encourages visualization and magnification of anatomy while being less invasive thanks to its improved picture quality, lighting, and capacity to “see around the corner.” Additionally, a significant portion of viable mastoid tissues and healthy mucosa were preserved.

Port-access versus sternotomy for treatment of long-standing persistent rheumatic atrial fibrillation combined with mitral valve surgery

Objectives: To compare the efficiency of atrial fibrillation (AF) ablation combined with mitral valve (MV) surgery through port-access with through traditional approach.&#x0D; Methods: From July 2019 to October 2021, 81 patients with long-standing persistent rheumatic AF underwent biatrial ablation using monopolar radiofrequency devices combined with MV surgery. Patients were divided into two groups: sternotomy group (n=44) and totally endoscopic surgery (TES) group (n=37). Left atrial reduction was performed in all patients. The postoperative and follow-up results were analyzed and compared between the two groups. The mean follow-up times of the sternotomy and the TES groups were 22.2 ± 6.1 months and 20.3 ± 7.7 months, respectively.&#x0D; Results: The perioperative characteristics did not differ between the two groups except that the aortic cross-clamp time and the cardiopulmonary bypass time of the TES group were longer than that of the sternotomy group. One patient in the TES group underwent reoperation. During the follow-up period, one death due to an unknown cause, one stroke for each group, and two patients with prosthetic dysfunction. The rates of atrial rhythm categories at the time of post-operation, discharge, 3-month, 6-month, and 1-year follow-up did not differ between the two groups. At 1-year follow-up, the rates of freedom from AF of the sternotomy group and the TES group were 90.9% and 91.9%, respectively; meanwhile, the rates of sinus rhythm were 86.4% and 86.5%, respectively.[1]&#x0D; Conclusions: AF ablation combined with mitral valve surgery can be performed through port-access as safely and effectively as through the traditional approach.

An endoscopic approach to stapes surgery needs less external auditory canal wall removal than a microscopic approach

Background Although many advantages of endoscopic stapes surgery have been reported, there is little objective data on whether it provides better visualization than the microscopic approach. Objectives To evaluate and compare audiological results, external auditory canal wall removal area, and adverse event rates between endoscopic and microscopic stapes surgery. Material and methods Data from patients who received stapedotomy were collected. Pre and postoperative audiometry, procedure-related parameters, and adverse events were analyzed in conventional microscopic and endoscopic groups. Results There were no differences in procedure time or postoperative hearing between the endoscopic and microscopic surgery groups. The mean procedure times were 87.3 ± 18.9 min in the endoscopic group and 79.9 ± 23.5 min in the microscopic group. The mean postoperative air-bone gaps were 10.9 ± 8.3 dB in the endoscopic group and 10.5 ± 7.8 dB in the microscopic group. There were no differences in the rate of sensorineural hearing loss, postoperative pain, facial palsy, vertigo, or dysgeusia between the two groups. The bony removal area of the posterosuperior external auditory canal wall measured by two observers was significantly less in the endoscopic group than in the microscopic group. Conclusions Endoscopic stapedotomy needed less external auditory canal wall removal and showed similar audiological outcomes to microscopic stapedotomy.

Usefulness of post-operative endoscopic score for optimal treatment selection in recurrent eosinophilic chronic rhinosinusitis.

This study retrospectively analysed post-operative endoscopic scores to determine the optimal post-operative treatment in patients with eosinophilic chronic rhinosinusitis undergoing functional endoscopic sinus surgery. In total, 339 adults who underwent initial bilateral functional endoscopic sinus surgery for eosinophilic chronic rhinosinusitis were enrolled. Patients were divided into group A, which required no additional post-operative treatment; group B, which required local/systemic steroids post-operatively; and group C, which further required dupilumab and/or revision surgery. Sixty-five per cent of patients could be treated with initial functional endoscopic sinus surgery (group A). Post-operative steroids were required in 35 per cent of patients with a post-operative endoscopic score of 30 per cent (group B). Further advanced treatments with dupilumab and/or revision functional endoscopic sinus surgery were required in 10 per cent of patients with a post-operative endoscopic score of 65 per cent (group C). The post functional endoscopic sinus surgery endoscopic score can be used as an index to determine treatment at the time of eosinophilic chronic rhinosinusitis recurrence.

Oncologic outcomes of surgical treatments of advanced sinonasal malignancies

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

Endoscope-Assisted Keyhole Surgery for Traumatic Subacute Subdural Hematoma Evacuation in Emergencies.

This study aimed to investigate whether a simple endoscopic method was effective for the evacuation of traumatic subacute subdural hematomas. A total of 51 patients with subacute subdural hematomas requiring surgery were enrolled in this study. An endoscopic hematoma evacuation was performed through a small bone window for 22 patients. Hematoma evacuation by open surgery was performed for 29 patients. The postoperative Glasgow Coma Scale scores improvement, surgery times, displacement of midline measurements, and intraoperative blood loss were recorded and analyzed for each patient. The average time from the initial incision to suture completion was 38.41±6.97minutes for the endoscopic surgery group and 74.66±9.54minutes for the open-surgery group (P<0.01). The average total blood loss was 41.36±10.82ml for the endoscopic group and 250.00±58.25ml for the open-surgery group (P<0.01). No postoperative bleeding occurred in either group. The midline displacement measurement showed significant improvement on the day after surgery, with 5.29±1.91mm in the study group versus 6.75±1.37mm in the control group (P<0.01). At the 1-month follow-up appointment, the midline measurement was normal in both groups. Computed tomography scans revealed almost no residual hematomas, representing an average evacuation rate of 100% in both groups. The average Glasgow Coma Scale scores improvement on the day after surgery were 1.77±1.93 in the endoscopic surgery group and 1.66±0.77 in the open-surgery group (P=0.766). Endoscopic subacute subdural hematoma removal through a small bone window achieved satisfactory hematoma removal using a minimally invasive method when compared with an open-surgery method.

An exploration of safety and feasibility of transoral vestibular endoscopy in the treatment of thyroid malignant tumors

Objective:To investigate the safety and feasibility of transoral vestibular endoscopy in the treatment of patients with thyroid malignant tumors. Methods:120 patients with thyroid cancer admitted to Xi 'an Central Hospital from January 2019 to December 2021 were selected and randomly divided into endoscopic surgery group（60 cases） and traditional open surgery group（60 cases）. The general operation conditions, postoperative complications and postoperative quality of life were compared between the two groups. Results:The intraoperative blood loss, indwelling drainage tube time and average length of hospital stay in the endoscopic surgery group were significantly lower than those in the traditional open surgery group （P<0.05）, while the operation time and number of lymph nodes dissected were significantly higher than those in the traditional open surgery group （P<0.05）. There was no significant differences in VAS score at 24h after surgery, white blood cell count, TgAb （+） and temporary hypothyroidism between the two groups at 24 h after operation （P >0.05）. The CRP, total drainage volume, TgAb and serum calcium in the endoscopic surgery group were higher than those in the traditional open surgery group, and the PTH and Tg were lower than those in the traditional open surgery group （P<0.05）.One case of hoarseness,2 cases of extremities numbness, 1 case of subcutaneous effusion and 2 cases of chin nerve injury occurred in the endoscopic surgery group, the total incidence of postoperative complications was 10.00%. Five cases of hoarseness, 11 cases of choking cough limbs numbness, 1 case of drinking water, 1 case of postoperative bleeding and 4 cases of subcutaneous effusion occurred in the traditional open surgery group, the total postoperative incidence of complications was 36.67%, the total incidence of complications in endoscopic surgery group was lower than that in traditional open surgery group （P<0.05）. The total scores of physiological status, social/family status, emotional status, functional status and quality of life in endoscopic surgery group were significantly lower than those in traditional open surgery group （P<0.05）. Conclusion:The application of oral vestibular endoscopy in the treatment of thyroid malignant tumors has the advantages of good surgical status and postoperative recovery, fewer postoperative complications.The patient was well tolerated,with positive safety，this technique has high clinical application value.

Evaluation of stab avulsion versus subfascial endoscopic perforator surgery in the management of chronic venous insufficiency resulting from incompetent leg perforators in primary varicose veins

Chronic venous insufficiency (CVI) resulting from incompetent perforators due to varicose veins is a common surgical condition present in at least 10% of the general population. This study was planned to evaluate stab avulsion vs subfascial endoscopic perforator surgery in the management of incompetent perforators resulting in CVI. Forty patients of CVI resulting from primary varicose veins, falling into class 4 to 6 as per the clinical part of CEAP classification, along with Duplex assessment with proven incompetent perforators of lower extremity, irrespective of the status of saphenousfemoral or saphenous-popliteal junction status, were included in the study. All the patients were randomized into two groups, A and B, by a computer-generated draw. Group A patients underwent stab avulsion, and group B patients underwent SEPS for incompetent perforators. The following parameters were evaluated: (i) pain score using a visual analog scale at 1 hour, 12 hours and 24 hours after surgery, (ii) ulcer healing 1 month and 3 months after surgery, (iii) reversal of skin changes after 1 month and 3 months of surgery during follow-up, and (iv) wound-related complications. Early relief of symptoms in terms of ulcer healing, reversal of skin changes, and decreased incidence of wound complications was found to be better in the subfascial endoscopic perforators surgery (SEPS) group.

Comparison of preoperative anxiety, bruxism, and postoperative pain among patients undergoing surgery for septoplasty, endoscopic sinus surgery, and tympanoplasty.

Septoplasty, endoscopic sinus surgery, and tympanoplasty are the most commonly performed elective functional ear-nose-throat surgeries. Aim: This study investigated the relationship between preoperative anxiety, bruxism, and postoperative pain in inpatient groups undergoing three different functional otorhinolaryngologic surgeries. Patients and. This study was conducted in a single center of a tertiary referral hospital. The patients (n = 90) who had undergone septoplasty (group A), endoscopic sinus surgery (group B), and tympanoplasty (group C) were included. The State-Trait Anxiety Inventory (STAI) questionnaire and the Amsterdam Preoperative Anxiety Information Scale (APAIS) were administered. To evaluate bruxism, a self-questionnaire was administered, and for the evaluation of pain, the visual analogue scale (VAS) was administered. In group C, preoperative STAI and APAIS and early and late pain values were higher than in the other groups. When patients were divided into two groups according to the presence of bruxism. A significant difference was found between the preoperative STAI and immediate and late VAS values (P < 0.001). A strong correlation was observed between APAIS and early and late VAS values in group C (P < 0.001). Patients who will undergo tympanoplasty should be aware of the preoperative anxiety level and pain follow-up. Bruxism can be considered a vital follow-up parameter that manifests due to high preoperative anxiety. It may also be useful to examine preoperative bruxism and take appropriate measures due to its pain-increasing effect in patients.