Endoscopic Surgical Management Research Articles

An endonasal approach to the resection of a papillary seromucinous adenocarcinoma of the Eustacian tube

ObjectivesPapillary seromucinous adenocarcinoma of the sinonasal tract is exceedingly rare. The objectives of this case report are to describe a case of papillary seromucinous adenocarcinoma presenting in the nasopharynx and to review the literature pertaining to other similar cases.MethodsA review of the patient's chart and a review of the English literature were conducted.ResultsWe describe the case of a 64 year-old woman who presented with a 3-year history of epistaxis and right-sided otitis media with effusion. The patient had been followed for a known nasopharyngeal mass that had twice been biopsied and in both cases was considered a benign mass pathologically. A third biopsy was diagnosed as a low-grade papillary seromucinous adenocarcinoma. The patient was otherwise asymptomatic. The patient was referred to a multidisciplinary cancer clinic at which endoscopic resection was determined to be the preferred treatment modality. A literature review and approach to patients with nasopharyngeal masses will be presented.ConclusionsPapillary seromucinous adenocarcinoma is a rare tumor that can present in the nasopharynx. We describe the endoscopic surgical management of one such patient that presented to our care.

Contemporary Practice Patterns of Endoscopic Surgical Management for Benign Prostatic Hyperplasia Among Urologists in the United States

We describe contemporary trends in endoscopic surgical management for benign prostatic hyperplasia. We examined case logs submitted by urologists for American Board of Urology certification or recertification. We compared electrosurgical transurethral resection of the prostate vs laser vaporization or laser enucleation and determined the impact of surgeon age on practice patterns. We analyzed case logs from 2004 to 2010 for trends and used logistic regression models to assess the impact of surgeon age on endoscopic surgery use. A total of 3,955 urologists included at least 1 endoscopic surgical management in the case logs, while 2,334 (59%) exclusively performed electrosurgical transurethral resection of the prostate and 309 (8%) exclusively performed laser vaporization or laser enucleation. We observed a large increase in the number and proportion of laser procedures from 11% in 2004 to 44% in 2010. Although there was no difference in median age between urologists who performed exclusively electrosurgical transurethral resection and those who performed laser procedures, the latter had a substantially higher case volume. Older urologists were significantly less likely to perform laser vaporization or enucleation when undergoing the second recertification (OR 0.56/10 years of age, 95% CI 0.36-0.87, p = 0.009), but not the initial certification. There was a substantial increase in laser vaporization or laser enucleation procedures performed by urologists who underwent board certification or recertification in 2004 to 2010. However, of those undergoing the second recertification older age was significantly associated with a lower likelihood of performing laser procedures. These data provide estimates of current practice patterns and further our understanding of evolving surgical treatment for benign prostatic hyperplasia.

Śluzowiak zatok sitowych penetrujący do oczodołu i przedniego dołu czaszki – opis przypadku

Paranasal sinus mucocele is the cystic formation lined by inflammatory changed mucoperiosteum. This is slow-growing pathology with a tendency to bone erosion. The symptoms are dependent on the direction of the penetration, and are as follows: increasing headaches, deformations of frontal or orbital region, ophthalmic manifestations such as lacrimation, decreased visual acuity, exophthalmos, ocular movement limitation, diplopia. The most common location of the mucocele is fronto-ethmoid region. The most useful diagnostic tests are a magnetic resonance imaging (MRI) and a computed tomography (CT) which show the progress of the disease and bone destructions. Surgery is the only method of treatment (external approach or FESS). This paper reports the case of a 74-year-old woman with ethmoid mucocele penetrating into the orbit, frontal sinus and anterior cranial fossa with compression of frontal lobe of the brain. The patient underwent CT and MRI and was treated with endoscopic intranasal marsupialization of the cyst. There are no clinical signs of disease recurrence 7 months after surgery. The endoscopic surgical management in treatment of sinus mucocele is a good alternative to the operation from external approach because of its low invasiveness, low complication risk, rapid healing and good therapeutic effects.

State‐of‐the‐Art Endoscopic Management of Larynx and Pharynx Cancer

Program Description: Transoral treatment of larynx and pharynx cancer has been done for over a century. Despite substantial technical innovations such as enhanced imaging, innovative laser technologies, and robotics guidance systems, radiotherapy and/or chemotherapy dominate the treatment strategy at many institutions. In part, this is due to limited familiarity with recent novel endoscopic surgical approaches. Outcomes data on transoral microsurgical management for advanced oropharynx and larynx cancer will be presented to illustrate the efficacy of surgical management of these diseases. Robotics and laser photoangiolysis of laryngeal cancer are two emerging technologies that can enhance endoscopic surgery. These novel and innovative treatment technologies can potentially be combined in the future to expand the indications for endoscopic surgery. This miniseminar will highlight advantages and disadvantages of endoscopic techniques and update the attendees on state-of-the-art procedural innovations. Educational Objectives: 1) Understand outcomes data on transoral laser microsurgery for advanced oropharyngeal and laryngeal cancer. 2) Understand the emerging role of robotics in endoscopic surgical management of larynx and pharynx cancer. 3) Understand concepts of photoangiolysis in treatment of aerodigestive tract malignancy.

Does Routine Endoscopic Ultrasound Alter Surgical Management of Patients With Pancreatic Cystic Lesions? A Retrospective Analysis of 93 Consecutive Patients

Does Routine Endoscopic Ultrasound Alter Surgical Management of Patients With Pancreatic Cystic Lesions? A Retrospective Analysis of 93 Consecutive Patients

Transnasal endoscopic management of recurrent juvenile nasopharyngeal angiofibroma

Objectives The purpose of this study was to present our experience with definitive endoscopic surgical management of the recurrent juvenile nasopharyngeal angiofibroma. Study design Retrospective study. Setting Tertiary care centre. Materials and methods This study includes 13 male adolescence patients with recurrent nasopharyngeal angiofibroma who received treatment at our centre between 2005 and 2010. The patient age ranged from 12 to 21 years (mean age, 15.7 years). Endoscopic two surgeons’ technique had been used. Follow up MRI every four months. Results Complete removal of the recurrent tumor was achieved in 10 cases. Three patients had incomplete removal with further recurrences. These recurrences were two in lateral wall of the sphenoid sinus (2 patients), and soft palate (one patient). Conclusion Recurrent JNAs are residual disease resulting from incomplete removal of the primary tumor. Transnasal endoscopic sinus surgery is an effective method for treating recurrent JNA. Follow up is essential and integral point in management of JNAs.

Endoscopic surgical management of vidian nerve schwannoma

Vidian nerve schwannomas are highly unusual, with only two reported cases in the world literature, and present with a constellation of symptoms that may be extremely vague. In the reported cases, open techniques have been utilized that required significant dismantling of the midfacial skeleton to access and manage these skull base lesions. Over the last 15 years, a paradigm shift in base of skull surgery has evolved with the advent of transnasal endoscopic techniques and instrumentation, improved surgical access and resectability of most skull-based pathologies, including vidian nerve lesions as reported here. We describe the varied clinical presentation and radiologic findings in two patients with such rare lesions. In addition, in one of these patients, we report on the first use of an expanded endonasal technique to access and remove vidian nerve schwannomas entirely endoscopically.

Decreasing Electrosurgical Transurethral Resection of the Prostate Surgical Volume During Graduate Medical Education Training is Associated With Increased Surgical Adverse Events

In the United States the numbers of electrosurgical transurethral prostate resection procedures have been decreasing. Since electrosurgical transurethral resection of the prostate is a difficult procedure to master, we hypothesized that recent residents are lacking in training for this procedure. We used summary case log information provided by the Accreditation Council for Graduate Medical Education to determine if the number of electrosurgical transurethral prostate resection procedures performed by graduating chief residents has decreased and if there has been an increase in surgical adverse events. In addition, we investigated whether the increased number of laser procedures impacted the rate of adverse events. Summary operative data from graduating chief resident case logs were provided by the Accreditation Council for Graduate Medical Education for academic years 2001 to 2007. The numbers of electrosurgical transurethral prostate resection procedures, laser procedures and procedures for adverse events were recorded for each year. The number of electrosurgical transurethral prostate resection procedures performed by graduating chief residents has steadily decreased from 58 in 2001 to 43 in 2007. Conversely the number of laser procedures started increasing in 2004. The rate of procedures for adverse events as a percentage of electrosurgical transurethral resection of the prostate procedures increased during the study period (from 3% in 2001 to 6% in 2007), and as a percentage of electrosurgical transurethral resection of the prostate and laser procedures the rate increased until 2005 and subsequently started decreasing. The rate of surgical adverse events, as measured by the need for subsequent procedures, has increased during the last 7 years. However, when laser procedures are accounted for, it appears that adverse events have recently started trending down as an increasing number of laser procedures started being performed.

Endoscopic spinal tethered cord release: operative technique

This study aims to describe solely endoscopic surgical techniques for the treatment of spinal pathology. Here, we present a novel endoscopic technique for surgical untethering of the spinal cord by filum sectioning and discuss endoscopic surgical management of this entity. Two patients (ages 8 months and 10 years) presented with leg weakness, urine and bowel dysfunction, low back and neck pain, and thickened, fatty filum terminale. The elder patient presented with clinical incontinence and abnormal urodynamic studies. Both patients underwent a solely endoscopic approach using 0 degrees and 30 degrees , 4 mm in diameter and 18 cm in length rigid endoscopes via a hemilaminectomy. Intradural microdissection under a direct visualization of endoscope delivered the fatty filum into the durotomy. Electrical stimulation was performed while the lower extremities and the anal sphincter were monitored for electromyographic activity. After acquisition of positive controls, the filum was identified by the lack of sphincter and lower extremity electromyographic responses and was then cauterized and cut. Both patients had significant improvement of their preoperative symptoms, and one patient had resolution of the abnormal urodynamics and her Chiari symptoms. Tethered spinal cords can be safely and effectively untethered endoscopically. This procedure provides the advantages of reduced soft tissue injury, less postoperative pain, minimal blood loss, a smaller incision, and a shorter hospitalization. However, whether the endoscopic untethering technique achieves benefits above those associated with the open procedure remains to be determined by a control study.

Imagerie tomodensitométrique de l’artère ethmoïdale antérieure : confrontation radio-anatomique

To identify the anterior ethmoidal artery (AEA) of a skull specimen on CT prior to transnasal endoscopic surgical management of anterior epistaxis. From a medial canthotomy approach, the AEA was located and a marker placed on 9 skull specimens (18 AEA). CT with 2D reformations was then performed. The AEA were then dissected using an endoscopic anterior ethmoidectomy approach. The presence of AEA procidence was recorded. Correlation between CT and surgical findings allowed identification of 2 criteria predictive of AEA procidence: 1) presence of an ethmoid bulla above the AEA canal 2) AEA canal located below (not within) the ethmoid roof, anterior to the bulla. High resolution CT depiction of the AEA provides information regarding its accessibility for endoscopic ligation in patients with severe anterior epistaxis as an alternative to external ligation while demonstrating the upper limit of the anterior ethmoid.

Endoscopic treatment of sinonasal papilloma: a 12 year review

Conclusion: Endoscopic surgical management is recommended as a viable treatment option for sinonasal papilloma, with comparable results to those treated by an external approach. An external approach is still indicated in cases where the papilloma is not accessible endoscopically, or where there is extrasinus invasion. Long-term follow-up is essential for recurrence detection. Objectives: The goal of this study was to highlight our experience with endoscopic surgery for the management of sinonasal papilloma. Patients and methods: A retrospective study of all patients who underwent endoscopic surgery for the treatment of sinonasal papilloma over a 12 year period at the Gui de Chauliac Hospital, Montpellier, France. Results: A total of 55 patients were included in this study; 32 patients (58%) were treated exclusively by an endoscopic approach and 23 (42%) were treated by a combined approach. Minimal follow-up was 3 years. The overall recurrence rate was 7%. All recurrences occurred at the initial site and the average delay between surgery and recurrence was 30 months (14 months to 4 years).

Modified Endoscopic Medial Maxillectomy for Chronic Maxillary Sinusitis

Recently, modified endoscopic medial maxillectomy (MEMM) has been described as an alternative technique to open maxillectomy for benign sinonasal neoplasms. However, few reports discuss the efficacy of MEMM for treatment of inflammatory disease of the maxillary sinus. We evaluate the efficacy of MEMM in treating chronic maxillary sinusitis. A retrospective review of patients who underwent MEMM for refractory inflammatory disease between December 2002 and September 2004 was performed. All patients were treated with MEMM alone or as part of an endoscopic sinus surgery procedure. Standard demographic data, operative technique, and postoperative follow-up times were collected. Nineteen patients (average age, 57 years) underwent 24 EMMs for chronic maxillary sinusitis refractory to middle meatal antrostomy. All patients failed prior sinus surgery, including 14 Caldwell-Luc procedures. Average follow-up was 19.5 months (range, 10-27 months). One patient has persistent hyperplastic sinusitis that currently requires monthly follow-up and medical treatment. Our only complication was one nasolacrimal duct injury. MEMM is both a safe and an effective treatment for chronic maxillary sinusitis refractory to standard medical and endoscopic surgical management.

Chronic rhinosinusitis in congenital craniofacial malformations

To review developmental abnormalities and iatrogenic alterations in sinus anatomy that may predispose patients with congenital craniofacial malformations to chronic rhinosinusitis. Retrospective study. Seven patients with craniofacial malformations who were surgically treated by the senior author were included in the study. All were diagnosed with chronic rhinosinusitis refractory to medical management. Four patients had undergone previous corrective craniofacial surgery, and three of these patients developed iatrogenic sinus disease. Demographic data, diagnoses and anatomical abnormalities were included. Abnormal sinus anatomy was present in all patients, most commonly skull base abnormalities and dehiscent lamina papyracea. All patients underwent successful endoscopic surgical management (n = 7) for their chronic rhinosinusitis. Two patients had adjuvant external procedures. There were no complications and no recurrences after a mean follow up time of 15 months. Otolaryngologists should be aware of the possibility of chronic rhinosinusitis in patients with craniofacial malformations. Careful preoperative evaluation of radiographic studies should be performed as most of these patients will have abnormal sinus anatomy. In addition, patients who undergo surgery to correct their craniofacial malformations are susceptible to altered sinus anatomy that may predispose them to the development of iatrogenic chronic rhinosinusitis.

HOLMIUM LASER ENUCLEATION VERSUS TRANSURETHRAL RESECTION OF THE PROSTATE: RESULTS FROM A 2-CENTER, PROSPECTIVE, RANDOMIZED TRIAL IN PATIENTS WITH OBSTRUCTIVE BENIGN PROSTATIC HYPERPLASIA

To our knowledge we report the first multicenter, prospective, randomized study comparing holmium laser enucleation (HoLEP) and transurethral prostate resection (TURP) for obstructive benign prostatic hyperplasia. From January to October 2002, 100 consecutive patients with symptomatic obstructive benign prostatic hyperplasia were randomized at 2 centers to surgical treatment with HoLEP (52 in group 1) or TURP (48 in group 2). Patients in the 2 groups were preoperatively assessed by scoring subjective symptoms questionnaires. Preoperative and perioperative parameters were also evaluated, the latter at 1, 6 and 12 months of followup. At baseline all patients had obstruction (Schäfer grade greater than 2). At the 1, 6 and 12-month followups no statistically significant differences were observed between the 2 groups in terms of urodynamic findings and subjective symptom scoring. In the HoLEP group mean total time in the operating room +/- SD was significantly longer than for TURP (74 +/- 19.5 vs 57 +/- 15 minutes, p < 0.05), while catheterization time (31 +/- 13 vs 57.78 +/- 17.5 minutes, p < 0.001 and hospital stay (59 +/- 19.9 vs 85.8 +/- 18.9 hours, p < 0.001) were significantly shorter in the HoLEP group. Transient stress and urge incontinence were more common in the HoLEP group, although at the 12-month followup results were comparable. The overall complication rate was comparable in the 2 groups. Erectile function was also maintained in the followup period from baseline in each group, as expected. HoLEP and TURP were equally effective for relieving obstruction and lower urinary tract symptoms. HoLEP was associated with shorter catheterization time and hospital stay. At 1 year of followup complications were similar in the 2 groups.

The place of endoscopic sinus surgery in the treatment of paranasal sinus mucocoeles.

Mucocoeles of the paranasal sinuses often enlarge slowly resulting in local bone erosion with subsequent extension into the adjacent orbit or intracranial space. We have reviewed the management of 59 patients with 68 mucocoeles. The variety of presentations is examined and discussed. Although diplopia has previously been stated as a very common finding we have found this not to be the case and believe that it may be that previous reports originate from ophthalmology centres. Forty-four patients underwent endoscopic surgical management of their mucocoeles, nine had a combined external and endoscopic procedure and 14 patients had an external approach. One patient needed no surgery. The mean follow-up period was 6 years 3 months. There was the lowest number of recurrences in the endoscopic surgical group. We emphasize the importance of long-term follow-up.

Endoscopic surgical management of sphenoid sinus disease.

To assess the outcome of functional endoscopic sphenoid sinus surgery, and to determine the predictors of outcome. Retrospective chart review of 651 consecutive endoscopic sinus procedures performed between 1992 and 1997. USC University Hospital, University of Southern California, Los Angeles. Seventy-four patients (11.4% of all endoscopic procedures) with sphenoid sinus disease were selected. All 74 patients were mailed a sinusitis-specific questionnaire, and 46 of them (62.2%) responded. Outcome measures derived from clinician ratings were applied to all 74 patients, and those derived from self-report were applied to 46. Outcome measures were determined from patient questionnaires at a minimum of 6-month postoperative follow-up, operative complications, and clinician perceptual ratings. Patient questionnaires addressed general patient satisfaction, symptom score, and medication usage. A statistical analysis was performed using chi2 test, linear regression, and one-way nonparametric ANOVA. Favorable surgical outcomes based on general patient satisfaction (84.8%, n = 39) and clinician perceptual rating (78.4%, n = 58) were noted. Minor postoperative complications were noted in 10 patients (13.5%) and 8 patients (10.8%) needed revision endoscopic procedures during follow-up. Of the complications, eight (80%) occurred in revision endoscopic procedures. The use of an expanded, sinus-specific symptom score revealed far fewer favorable outcomes (56.5%, n = 26). Seven outcome predictors were established, although none of the predictors held for more than one of the six outcome measures used. Endoscopic sphenoid sinus surgery is safe and effective. An expanded symptom score is recommended to assess the outcome of this procedure.

Approach to endoscopic diagnosis of acute nonvariceal upper gastrointestinal hemorrhage

Endoscopy can be used to identify the exact cause and iste of acute upper gastrointestinal bleeding in over 95% of cases. Findings at urgent endoscopy can contribute to precise prediction of rebleeding, guide triage of patients, and in most cases lead to definitive endoscopic therapy or direct surgical management. Making an accurate diagnosis during urgent endoscopy can be challenging; analogous to endoscopic retrograde cholangiopancreatography (ERCP), where cannulation of the desired duct is the major initial hurdle to performing therapy, in gastrointestinal (GI) bleeding, the prerequisite to endoscopic hemostasis is clear identification and access to the bleeding site. Thorough knowledge of the differential diagnosis and natural history of various causes of acute upper GI bleeding is essential. Emergency endoscopy in the acute GI bleeder can be technically difficult and risky to the patient and can require close coordination with intensive care physicians and nurses. Cardiopulmonary complications causing severe morbidity, such as aspiration of blood, usually can be avoided by careful attention to details of resuscitation and medical management, before, during, and after endoscopy.

Endoscopic Surgical Management of Glottic Laryngeal Cancer

This article recounts the historical development of the endoscopic surgical management of stage I and stage II glottic cancer. The indications and surgical approach to treating stage I cancer and the rationale for extending the original limitations to the endoscopic treatment of highly selected stage II glottic cancers is described. The indications, technique, and outcomes of the endoscopic treatment of stage II glottic cancer are also presented.

Current status of endoscopic surgical management of tubal pregnancy

A worldwide increase in the incidence of ectopic pregnancy has been reported in the last two decades. Recently developed diagnostic tools markedly improved the early diagnosis capability. These include: 1, rapid and sensitive beta hCG and progesterone assays; 2, improved ultrasonogaphic visualization of the pelvic organs; 3, the wide application of diagnostic laparoscopy. Today, most cases are diagnosed before a rupture occurs. Accordingly, treatment has shifted from an immediate, life-saving intervention to conservative methods of management, directed at preserving fertility and reducing morbidity. Endoscopic surgical tecniques have also rapidly improved in the last decade, thus, this treatment option apparently became the treatment of choice in most centers. Laparoscopic conservative treatment of tubal pregnancy is as effective and safe as treatment with laparotomy and has the advantage of decrease in hospital stay, cost, and delay in return to normal activity. This review will focus on the endoscopic surgical procedures and their place in view of the other surgical and non-surgical options.

Surgical management of severe laryngomalacia.

Infants and children with laryngomalacia exhibit varying degrees of upper airway obstruction and dysphagia. Although the disorder is usually self-limited, the potential exists for symptoms so severe that operative intervention cannot be avoided. Relief of progressive airway compromise traditionally has involved bypassing the obstruction with tracheotomy. Recently, endoscopic surgical management of the most severe cases has been reexamined by the authors and others. Thirteen infants and children underwent supraglottoplasty (also referred to as epiglottoplasty or partial arytenoidectomy) for severe, complicated laryngomalacia. Endoscopic laser removal of flaccid supraglottic tissue resulted in improvement of the airway in all patients. In most patients, associated symptoms improved or completely resolved. Supraglottoplasty is an effective alternative to tracheotomy in carefully selected patients with severe laryngomalacia.