Endoscopic Surgery Patients Research Articles

Laryngeal Preservation in Glottic Cancer: A Comparison of Hospital Charges and Morbidity among Treatment Options.

When total laryngectomy is not required, organ preservation surgery or radiotherapy is considered the standard of care for primary glottic cancer. These accepted treatment options are available for early and advanced glottic cancers due to equivalent locoregional control and survival rates. However, in today's climate of accountable care, the financial burden of treatment choices continues to increase in significance. We therefore compared hospital charges and treatment-related morbidity between organ-preserving surgery and radiation with or without chemotherapy-herein, (chemo)radiation-in the primary treatment of glottic cancer. Nationwide Inpatient Sample Database was analyzed to assess clinical and financial information. Population-based analysis. Patients (N = 5499) with primary glottic cancer undergoing treatment with laryngeal preservation strategies. Patients were subdivided by ICD-9 codes into 3 treatment groups: endoscopic resection, open partial laryngectomy, and (chemo)radiation. Treatment-related outcomes, charges, and length of hospitalization were analyzed among treatment groups. When adjusting for sex, age, race, comorbidity, and primary payer, (chemo)radiotherapy was associated with increased direct charges (P < .001; coefficient, $23,658.99; 95% confidence interval [95% CI]: $10,227.15-$37,090.84) and length of hospitalization (P < .001; hazard ratio, 0.593; 95% CI: 0.502-0.702) when compared with endoscopic surgery. As compared with open surgery, endoscopic surgery was associated with reduced hospital charges (P = .012; coefficient, $11,967.01; 95% CI: $2,784.17-$21,249.85) and duration of hospitalization (P < .001; hazard ratio, 0.749; 95% CI: 0.641-0.876). This analysis suggests that increased utilization of endoscopic surgery in patients with primary glottic cancer not requiring total laryngectomy may lead to reduced financial burden and duration of hospitalization when compared with open surgery or (chemo)radiation therapy.

Endoscopic Surgery in Nonhydrocephalous Third Ventricular Colloid Cysts: A Feasibility Study

The aim of this study was to investigate the feasibility and effectiveness of endoscopic neurosurgery for patients with third ventricular colloid cysts but without ventriculomegaly. Seventy-one patients with third ventricular colloid cysts were identified and recruited to this study. Eighteen of these patients did not have concomitant hydrocephalus and underwent primary endoscopic surgery for cyst resection. The surgical technique, the success rate, and patients' outcome were assessed and compared with another 53 patients with hydrocephalus who underwent similar procedures. Our study was performed in a retrospective basis, although in middle of our work we decided to study and follow nonhydrocephalus cases prospectively. The ventricular compartments were successfully cannulated and gross total resection and near total resection of the colloid cysts was achieved in all patients. There were no persistent operative complications related to the endoscopic procedure. The success rate for endoscopic surgery in patients without hydrocephalus was similar to its value in patients with hydrocephalus. Endoscopic resection of third ventricular colloid cyst in patients without hydrocephalus seems to be feasible, effective, and not contraindicated.

The Influence of Selected Preoperative Factors on the Course of Endoscopic Surgery in Patients with Chronic Rhinosinusitis

Epidemiological data shows the increasing prevalence of chronic rhinosinusitis which poses significant health, social and economic problems in today's world. Endoscopic paranasal sinus surgery is currently the method of choice in the treatment of chronic rhinosinusitis when conservative treatment methods fail. Therefore, maintaining a high percentage of therapeutic success with a constantly growing number of surgical procedures poses the major challenge to otolaryngologists. Appropriate surgical conditions have a great influence on the course of surgical procedure, the risk of complications and postoperative outcomes. The aim of this study was to analyse the influence of selected perioperative factors on the course of endoscopic surgery in patients with chronic rhinosinusitis. A group of 212 patients (105 women and 107 men) aged 19 to 74 (mean age 46.5) diagnosed with chronic rhinosinusitis were enrolled in the retrospective study. All patients underwent endoscopic sinus surgery. The analysis was concerned with the impact of such factors and clinical parameters as gender and age of patients, disease progression, previous (conservative and surgical) treatment, comorbidities, detrimental external factors, the scope of surgical treatment influencing the duration of surgery, bleeding in the surgical field and the total blood loss during surgery. It was found that the mean duration of surgery in the study group was 40.2 min, the mean blood loss was 312.17 mL and the mean degree of intraoperative bleeding scale reached 2.15. The intraoperative conditions deteriorate together with the increasing age of patients. Selected factors and clinical parameters, such as impaired nasal patency, olfactory disorders, the occurrence of nasal polyps, prior surgical treatment, the presence of aspirin-induced asthma and cardiovascular diseases, intranasal glucocorticoid therapy, a high degree of inflammatory changes in the sinuses and a large extent of surgery substantially influence the deterioration in intraoperative conditions. Knowledge of these factors and their impact on surgery enables more thorough, multidisciplinary preparation of patients for surgery, and thus enables the optimisation of surgical conditions.

経鼻内視鏡下手術を行った鼻副鼻腔悪性腫瘍症例の臨床的検討

経鼻内視鏡下手術を行った鼻副鼻腔悪性腫瘍症例の臨床的検討

Surgical Treatment of Chronic Achilles Tendinopathy: Long-term Results of the Endoscopic Technique

Surgery has long been established as a valid alternative for chronic Achilles tendinopathies that have failed conservative treatment. Endoscopic procedures have shown satisfactory preliminary results for managing such injuries. The aim of the present study was to evaluate the long-term clinical outcomes of endoscopic surgery in patients with chronic midportion Achilles tendinopathy. We evaluated 27 endoscopic procedures in 24 patients (mean age 45.5 ± 8.9 years; 12 males and 12 females) with chronic Achilles tendinopathy and at least 5 (mean 7.7, range 5 to 14) years of follow-up. All ambulatory procedures consisted of paratenon debridement and longitudinal tenotomies. The clinical evaluation included 2 specific functional rating systems (the Achilles Tendon Scoring System and the Victorian Institute Sport Assessment-Achilles questionnaire) and a pain visual analog scale. Patient satisfaction with the procedure was assessed using a patient global assessment response to therapy Likert scale score. All patients had an improved clinical outcome at the final follow-up visit. Both scoring systems showed significant improvement in all clinical outcomes at the last follow-up visit. The Victorian Institute Sport Assessment-Achilles questionnaire score had improved from 37.0 ± 4.9 points preoperatively to 97.5 ± 12.1 points postoperatively (p = .0006). The Achilles Tendon Scoring System score had improved from 32.6 ± 13.1 points preoperatively to 97.2 ± 12.3 points postoperatively (p = .000006). The pain visual analog scale score averaged 0.2 ± 1.1, and the patient global assessment response to therapy score was 0.25 ± 0.71. The percentage of patients with an excellent patient global assessment response to therapy score was 85.1%. Two postoperative problems were reported (7.4%): a delayed keloid lesion and a seroma with chronic fistula. The infection rate and systemic complication rate were 0%. In conclusion, endoscopic surgery provided a high rate of excellent long-term results in patients with chronic midportion Achilles tendinopathy. Debridement of the paratenon and crural fascia, along with longitudinal tenotomies, using a minimally invasive procedure provided completely resolution of symptoms at 7 years postoperatively in 96% of patients in the present consecutive series.

Current status of robotic thyroidectomy and neck dissection using a gasless transaxillary approach

To describe refinements in surgical techniques using robotic thyroidectomy and robotic modified radical neck dissection (MRND), and to discuss the impact of such developments on thyroid cancer management, from oncological, functional, and surgical viewpoints. From 2009 to present, 23 reports, including three multicenter trials, on the conduct of robotic thyroid surgery via a gasless transaxillary approach appeared. Twenty-two studies discussed robotic thyroidectomy, whereas one described robotic MRND. These clinical studies showed that robotic surgery afforded identical or superior levels of surgical radicality and oncologic safety compared to use of conventional open or endoscopic surgery in patients with thyroid carcinomas. In such patients, the clinical benefits of robotic thyroidectomy include excellent cosmetic results, reduced pain, improvement in swallowing function, and low morbidity rates. From the viewpoint of surgeons, robotic surgery shortens the surgical learning curve, and causes less musculoskeletal discomfort compared with the conduct of open or endoscopic surgery. The accumulated evidence to date suggests that robotic thyroidectomy and MRND can benefit both patients and surgeons.

Long-term Outcomes of Immediate Versus Delayed Nephroureterectomy for Upper Tract Urothelial Carcinoma

To compare immediate nephroureterectomy with delayed nephroureterectomy after a trial of nephron-sparing endoscopic surgery in patients who were treated initially at our institution from 1996 to 2004 for upper tract urothelial carcinoma. Patients were monitored for upper tract recurrences, metastases, cancer-specific and overall survival. Survival outcomes and perioperative measurements were compared between treatment groups. Of 73 patients, 62 underwent immediate nephroureterectomy and 11 proceeded to nephroureterectomy after failed endoscopic management. Mean follow-up for all patients was 58 months and 75 months for patients who were alive at last follow-up. Patients treated initially with endoscopy averaged a surveillance procedure every 3.7 months and had a median delay to nephroureterectomy of 10 months. Perioperative measurements at time of nephroureterectomy did not differ between groups. Overall survival 5 years from initial resection in the delayed group and from nephroureterectomy in the immediate group was 64% and 59%, respectively; the corresponding 5-year cancer-specific and metastasis-free survival estimates were 91% vs 80% and 77% vs 73%, respectively (P>0.05). Pathologic progression from low to high-grade occurred in three of seven patients from the delayed group. Failure of endoscopic management necessitating nephroureterectomy does not appear to affect survival outcomes compared with immediate nephroureterectomy in patients with upper tract urothelial carcinoma. A trial of endoscopic management can be considered in patients with low-grade disease and a normal contralateral kidney. Endoscopy is a viable option when there are imperative indications for nephron sparing in the setting of high-grade disease.

Transforaminal endoscopic surgery for lumbar stenosis: a systematic review

Transforaminal endoscopic techniques have become increasingly popular in surgery of patients with lumbar stenosis. The literature has not yet been systematically reviewed. A comprehensive systematic literature review up to November 2009 to assess the effectiveness of transforaminal endoscopic surgery in patients with symptomatic lumbar stenosis was made. Two reviewers independently checked all retrieved titles and abstracts and relevant full text articles for inclusion criteria. Included articles were assessed for quality, and relevant data, including outcomes, were extracted by two reviewers independently. No randomized controlled trials were identified, but seven observational studies. The studies were of poor methodological quality and heterogeneous regarding patient selection, indications, operation techniques, follow-up period and outcome measures. Overall, 69–83% reported the outcome as satisfactory and a complication rate of 0–8.3%. The reported re-operation rate varied from 0 to 20%. At present, there is no valid evidence from randomized controlled trials on the effectiveness of transforaminal endoscopic surgery for lumbar stenosis. Randomized controlled trials comparing transforaminal endoscopic surgery with other surgical techniques are direly needed.

Endoscopic Diagnosis and Endoscopic Surgery for Patients with Pharyngeal and Laryngeal Cancers

Endoscopic Diagnosis and Endoscopic Surgery for Patients with Pharyngeal and Laryngeal Cancers

Quantitative analysis of the variation in angles of the carpal arch after open and endoscopic carpal tunnel release

Previous studies have demonstrated that the volume of the carpal canal increases after open and endoscopic surgery in patients with carpal tunnel syndrome. There is some controversy regarding the contribution of the post operative widening of the carpal arch to the increment in carpal canal volume. The objectives of this study were to: 1) evaluate the degree of variation in the angles formed by the borders of the carpal arch following the surgical division of the transverse carpal ligament; and 2) determine if there are differences in the variation of these angles after the classical open surgery versus endoscopic carpal tunnel release.Methods. The authors prospectively studied 20 patients undergoing carpal tunnel syndrome surgery: 10 patients were treated via the standard open technique, and 10 underwent endoscopic carpal tunnel release. The angles of the carpal arch were measured on CT scans of the affected hand obtained before and immediately after the surgical procedures.Measurements were performed at the level of the pisiform-scaphoid hiatus and at the level of the hook of the hamate-trapezium hiatus. There was widening of the postoperative angles of the carpal arch after open and endoscopic division of the flexor retinaculum; however, the difference between pre- and postoperative angulations reached statistical significance only in those patients treated by means of the open procedure. The mean (+/- SD) values for the postoperative increase in the angles at the level of the pisiform-scaphoid hiatus were 5.1 +/- 0.4 degrees after open surgery and 2.5 +/- 0.3 degrees after the endoscopically assisted procedure (p < 0.05). At the level of the hook of the hamate-trapezium hiatus, the mean values for the widening of the angles were 6.2 +/- 0.6 degrees for the open surgery group and 1.2 +/- 0.4 degrees for those patients treated by means of the endoscopic technique (p < 0.05). The widening of the postoperative angles of the carpal arch is a phenomenon observed at the proximal and distal levels of the carpal canal, and it can be noted after both open and endoscopically assisted carpal tunnel release. The endoscopic procedure yielded less increase in these angles than the open surgery.

Tubeless Percutaneous Nephrolithotomy (PCNL) with Reversed Polaris™ Loop Stent: Reduced Postoperative Pain and Narcotic Use

Two disadvantages of tubeless PCNL are the morbidity of a ureteral stent and subsequent cystoscopy for removal. We present a use of the Polaris Loop stent to facilitate tubeless PCNL and minimize pain and narcotic use. The Polaris stent has two fine loops distally to minimize bladder irritation. Following PCNL, we place the Polaris stent antegrade in reverse orientation. The pigtail rests in the bladder and the loops in the nephrostomy tract with the string tether secured at the skin for simple, atraumatic removal. Twenty-four patients underwent tubeless PCNL since October 2006 through January 2007. Comparison was made with 29 patients who underwent standard PCNL June 2006 through September 2006 for equal indications. Pain (visual analog scale), narcotic use (milligrams morphine equivalents), and length of stay were analyzed. Pain was significantly less in the tubeless group, mean 1.6 versus 2.5 (p=0.01). Narcotic use was much greater for standard patients (26.9 mg versus 13.4 mg, p=0.01). These differences were independent of percutaneous approach (subcostal versus intercostal). Tubeless patients were more likely to be discharged postoperative day 1 compared to standard patients (96% versus 72%, p=0.02). No tubeless patient required blood transfusion. One standard patient developed pseudoaneurysm requiring transfusion and arterial embolization. Tubeless PCNL with the Polaris stent results in decreased postoperative pain and narcotic use, and earlier hospital discharge. Our novel use of the Polaris Loop stent in tubeless PCNL redefines state-of-the-art for minimally invasive endoscopic surgery in patients with heavy stone burden.

Endoscopic surgery in patients with borderline tumor of the ovary: A follow-up study of thirty-five patients

Study objective To study the long-term outcome of 35 patients after endoscopic surgery of ovarian borderline tumor. Design Descriptive study (Canadian Task Force classification II-2). Setting Outpatient clinic. Patients Thirty-five women with histologically proven ovarian borderline tumors underwent adnexal surgery by laparoscopy in an outpatient clinic. Interventions We report a series of 41 patients treated by endoscopic surgery for borderline tumors of the ovary, 35 of whom were followed up for 2 to 12 years after surgery. Measurements and main results Of a total of 3138 patients referred for endoscopic surgery to treat ovarian tumors, 7 were found to have cancer, and 41 were found to have borderline tumors. The borderline tumor was diagnosed before surgery by vaginal ultrasonography in 45.7% of patients, during surgery in an additional 22.9%, but only by postoperative histologic study in 31.4% of patients. There were no intraoperative or postoperative complications in the patients with borderline tumor, and all have remained healthy for the period of their follow-up. Conclusion Provided a strict management protocol is followed, endoscopic surgery is safe and effective for the treatment of borderline tumors of the ovary.

Endoscopic Surgery for Sinonasal Invasive Aspergillosis in Bone Marrow Transplantation Patients

Sinonasal invasive aspergillosis (IA) is an aggressive fungal infection with high mortality rates. It commonly develops in immunocompromised patients, often after bone marrow transplantation (BMT). Aggressive surgical debridement by an external approach has been considered a central element of treatment. We describe our experience in endoscopic management of IA in BMT patients in a retrospective study. Charts of BMT patients with IA in the past 5 years were reviewed. Demographic data, primary disease, comorbidities, signs and symptoms, blood test results, preparation for surgery, surgical technique, and outcome were recorded. Fourteen BMT patients, age ranging from 3 to 56 years, had sinonasal IA. The primary disease was acute myelogenous leukemia in 6, acute lymphoblastic leukemia in 3, chronic myeloblastic leukemia in one, severe combined immunodeficiency disease in 2, and myelodysplastic syndrome in 2 patients. Diagnosis was made by physical examination, biopsy, culture, and computed tomography scan. Treatment, including aggressive endoscopic debridement, a systemic antifungal medication, and local irrigations of amphotericin-B enabled eradication of IA in all patients. Seven patients required two or more operations. None required orbital exenteration or craniotomy. Six patients died of the primary illness or of comorbidities with no evidence of residual disease. Eight patients are alive. Early detection of IA in BMT patients enables aggressive treatment before the disease spreads into the orbit or brain. Proper preoperative preparation facilitates safe endoscopic surgery in patients with severe bleeding tendencies. Although sinonasal IA is lethal, endoscopic surgery is feasible and efficient, enabling excellent local control.

Virtual endoscopy combined with intraoperative neuronavigation for planning of endoscopic surgery in patients with occlusive hydrocephalus and intracranial cysts

We assessed the clinical value of MR ventriculoscopy (virtual endoscopy, VE) combined with image-guided frameless stereotaxy for endoscopic surgery of occlusive hydrocephalus and intracranial cysts. VE was obtained in 20 patients with hydrocephalus and three with intracranial cysts. All surgical operations were endoscopic. The path of the rigid endoscope to the target point was planned using neuronavigation. VE was carried out along the same trajectory retrospectively in 20 cases and prospectively in three. The results were analysed for demonstration of anatomical landmarks and structures at risk. VE was successful in all patients. Possible obstacles to endoscopic access to the lamina terminalis and the basal cisterns and structures at risk, such as the basilar artery, were clearly shown in relation to the direction of the endoscope. However, the floor of the third ventricle and septum pellucidum were not clearly seen and possible abnormalities could therefore not be appreciated. VE can provide realistic simulation of endoscopic third ventriculostomy and cystostomy. The appropriate trepanation point and trajectory of the endoscope can be assessed with regard to the size of the foramen of Monro and the position of vulnerable structures. This simulated trajectory can be adapted to the field of operation by image-guided neuronavigation. This regime may potentially reduce the risk of damage to intracranial structures.

Fertility after laparoscopic surgery for endometriomas

There are a number of published studies documenting pregnancy rates after endoscopic surgery in patients with endometriomas. These reports present similar pregnancy rates regardless of the surgical technique used to treat the cyst. This finding indicates that it does not matter whether the endometrioma is excised or ablated. However, debate about the nature of the cleavage plane of the cyst has led some surgeons to suggest that excision may damage the follicular reserve of the ovary. Furthermore, pregnancy rates after surgery cannot be compared in the same way as pregnancy rates after in vitro fertilization and embryo transfer because of lack of standardization. A review of the published studies relating to the laparoscopic management of endometriomas was performed to examine this issue further. Each paper was analysed using pre-set criteria to identify the methodology used and how the results were presented. Wide variation was found in the criteria used to select patients and in the way the results were reported. In view of these findings, there is an urgent need for surgical studies with consistent definitions of infertility and end-points, or a national system of audit.

Ｃｏｌｏｒ‐ｃｏｄｅｄ ｓｏｎｏｇｒａｐｈｙ（カラードプラ）を用いた神経内視鏡手術の経験

Neuroendoscopic technique, less invasive than conventional methods, has been recently introduced for the fenestration of the cystic lesions of the brain in pediatric neurosurgery. However, real-time monitoring is desirable for endoscopic surgery in patients with congenital malformations where anatomical structure are distorted, aberrant blood vessels are often found and, the intracranial volume goes on changing during the procedure.Two cases of neuroendoscopic fenestration guided by color-coded sonography were presented. The first case was a 20-day-old boy who had interhemispheric multilocular arachnoid cysts. Neuroendoscopic fenestration of the cyst wall was performed at the age of 20 days and 5 months respectively. The second case was a fourteen-year-old boy with the cyst of cavum septi pellucidi and ventric lar dilatation. During endoscopic surgery color-coded sonography showed the direction of the endoscope, the position and motion of the tip of the endscope and the site of perforation performed. The blood vessels between or around cysts were also visualized. In both cases, cystic walls were perforated successfully and cysts were shrunken.It was indicated that color-coded sonography was useful for real-time monitoring in neuroendoscopic surgery particularly in neonates and infants.

Zenker's diverticulum--a historical review and trends in therapy.

More than 200 years have passed since the pulsion diverticulum of hypopharynx was first described. This paper reviews different opinions on its etiology over the centuries. The German pathologist F.A. von Zenker, who successfully pursued research on a variety of topics, is often associated with this diverticulum through his classical work from 1867 "Krankheiten des Oesophagus", which deals with the pathogenesis and clinical presentations of this herniation of the posterior mucosal wall. Numerous surgical techniques, which have been practised mainly during this century, are also reviewed. Different options of endoscopic surgery, which is presently the preferred approach at many medical centers, are described and discussed. Our own experience of endoscopic surgery in patients with Zenker's diverticulum is also presented.