Experience In Endoscopic Surgery Research Articles

Fully endoscopic approach for resection of brainstem cavernous malformations: a systematic review of the literature

BackgroundBrainstem cavernous malformations (BCMs) are benign lesions that typically have an acute onset and are associated with a high rate of morbidity. The selection of the optimal surgical approach is crucial for obtaining favorable outcomes, considering the different anatomical locations of various brainstem lesions. Endoscopic surgery is increasingly utilized in treating of BCMs, owing to its depth illumination and panoramic view capabilities. For intra-axial ventral BCMs, the best surgical options are endoscopic endonasal approaches, following the “two-point method. For cavernous hemangiomas on the dorsal side of the brainstem, endoscopy proves valuable by providing enhanced visualization of the operative field and minimizing the need for brain retraction.MethodsIn this review, we gathered data on the fully endoscopic approach for the resection of BCMs, and outlined technical notes and tips. Total of 15 articles were included in this review. The endoscopic endonasal approach was utilized in 19 patients, and the endoscopic transcranial approach was performed in 3 patients.ResultsThe overall resection rate was 81.8% (18/22). Among the 19 cases of endoscopic endonasal surgery, postoperative cerebrospinal fluid (CSF) leakage occurred in 5 cases, with lesions exceeding 2 cm in diameter in 3 patients with postoperative CSF rhinorrhea. Among the 20 patients with follow-up data, 2 showed no significant improvement after surgery, whereas the remaining 18 patients showed significant improvement compared to their admission symptoms.ConclusionsThis systematic literature review demonstrates that a fully endoscopic approach is a safe and effective option for the resection of BCMs. Further, it can be considered an alternative to conventional craniotomy, particularly when managed by a neurosurgical team with extensive experience in endoscopic surgery, addressing these challenging lesions.

Gasless robot-assisted transaxillary hemithyroidectomy (RATH): learning curve and complications

PurposeGasless robot-assisted transaxillary hemithyroidectomy (RATH) is regarded as an alternative surgical option for thyroid operations. However, the associated steep learning curve is a clinical concern. This study evaluated the learning curve of RATH for surgeons without experience of endoscopic surgery and the early surgical outcomes of RATH.MethodsWe conducted a retrospective study of patients who underwent gasless RATH and conventional hemithyroidectomy (CH) at Sun Yat-sen University Cancer Center, Guangzhou, China, from June 2021 to August 2022. The learning curve and early surgical outcomes of gasless RATH were evaluated. And the early surgical outcomes of gasless RATH were compared to CH.ResultsIn total, 105 patients who underwent gasless RATH and 104 patients who underwent CH were matched and assessed. The cumulative sum techniques (CUSUM) analysis showed that the peak point of gasless RATH operative time occurred at the 31st case. No clear single peak was identified in the CUSUM plot for drainage amount and blood loss. No significant difference in perioperative complications was observed between these two groups. Moreover, the number of postoperative patients who got sense of thyroid area traction were fewer in the gasless RATH group (n = 11, 10.5%) than in the CH group (n = 32, 30.8%).ConclusionGasless RATH can be considered as an alternative approach to the conventional open procedure, as it is an easy remote access technique, with shorter learning curves and certain advantage such as less sense of thyroid area traction.

Training in Skull Base Endonasal Endoscopic Surgery: Development and Validation of a Novel Low-Cost Simulation with Animal Cadaveric Model

BackgroundEndoscopic skull base surgery is constantly evolving and its scope has expanded. The acquisition of surgical skills involves a long learning curve with significant risks for the patient. Therefore, training in the laboratory has become essential to achieve appropriate proficiency and reduce the morbidity and mortality associated with these procedures. The objective of our work is to develop and validate a cost-effective and easily replicable simulator for endonasal endoscopy training using a swine cadaveric model. MethodWe used fresh Pietrain swine heads. Training exercises of increasing complexity were performed. A Specific Technical Skills and Knowledge Scale was created considering the objectives to be assessed in each task. After the simulation, the trainees were required to answer a satisfaction survey. ResultsTen participants were recruited (5 neurosurgery residents and 5 neurosurgeons). The simulator assessment showed statistically significant differences between groups. Performance was better among the group with endoscopic surgery experience. Face validity was assessed through a post-simulation questionnaire showing an overall mean score of 28.7 out of 30, indicating a highly positive overall assessment of the simulator. Furthermore, 100% of the trainees believe that including endoscopy training in their education would be beneficial. ConclusionsThe endonasal endoscopy training simulator using a swine cadaveric model is a useful and accessible tool for enhancing surgical skills in this field. It provides an opportunity for training outside the operating room, reducing the potential risks associated with patient practice, and improving the training of residents.

The experience of endoscopic surgery in the treatment of benign and malignant airway tumors

The experience of endoscopic surgery in the treatment of benign and malignant airway tumors

Operative nuances and surgical limits of the endoscopic approach to clival chordomas and chondrosarcomas: A single-center experience of 72 patients

ObjectiveGross total resection (GTR) is the mainstay therapy for chordomas and chondrosarcomas to have the best prognosis. The aims of this study were to specify the limits of EEA, emphasize the need for additional combined approaches for tumors beyond these limitations for high resection rates, discuss the prognostic factors and operative nuances that affect GTR, and present the causes and characteristics of early and late recurrences. MethodsWe retrospectively analyzed the endoscopic endonasal surgeries in the Pituitary Research Center and Neurosurgery Department of the Kocaeli University Faculty of Medicine, Turkey between January 2004 and December 2019. We retrospectively reviewed the medical data, radiological images, and surgical videos of patients, and 72 patients with chordoma and chondrosarcoma were included in the study. ResultsBased on pathology reports, 72 patients (seven pediatric) were identified, to whom 91 endoscopic operations were performed. We determined the surgical limitations for each clival segment as superior, middle, and inferior. Then, we divided these into three subgroups according to whether the tumor shows dural invasion (extradural chordoma, large extradural - minimal intradural component, and minimal extradural - large intradural component). The tumors of 19 (26.4%), 25 (26.4%), and nine (12.5%) patients originated from the superior, middle, and inferior clivus, respectively. Nineteen (26.4%) patients had panclival involvement. GTR was performed in 47 (65.3%) the patients. The GTR rate in patients with panclival tumors was 47.3% (9/19). The experience, lateralization, dural involvement, and origin of the clivus affecting GTR were analyzed. Extradural – intradural extensions were verified as negative predictor factors for GTR, whereas tumors located in the superior (OR: 16.710, p=0.030) and middle (OR: 11.154, p=0.023) segments were positive predictive factors for GTR. ConclusionAn increasing experience in endoscopic surgery significantly increases the GTR rates by widening the surgical limitations. Due to dense bone infiltration and adhesion to critical neurovascular structures, recurrence rates are high despite performing GTR. Although surgery and adjuvant treatments improve the 5-year survival of patients, the mortality rates remain high. Therefore, surgery of these tumors should be performed by experienced centers. In addition to surgical and adjuvant therapies, targeted molecular and translational biological therapies are also needed for chordomas and chondrosarcomas in the future.

Application of an Extracorporeal-Assisted Intracorporeal Sliding Knot-Tying Technique in Minimally Invasive Surgery in Children.

Background: A retrospective study was carried out to determine the feasibility and safety of an extracorporeal-assisted intracorporeal sliding knot-tying technique in minimally invasive surgery in children. Materials and Methods: From June 2009 to December 2017, a total of 333 cases of pediatric minimally invasive surgery were performed using the extracorporeal-assisted intracorporeal sliding knot-tying technique. Polyester, polyglactin, and polydioxanone sutures were used for suturing and knotting. The average time used for knotting was recorded during the surgery. The patients were followed up for unraveled knots and recurrence of the diseases. Results: All 333 surgical procedures were performed successfully, including 152 cases of thoracoscopic diaphragmatic hernia repair, 151 cases of thoracoscopic diaphragmatic plication, 7 cases of thoracoscopic esophageal anastomosis, and 23 cases of laparoscopic esophageal hiatal hernia fundoplication. No serious complications or mortalities were observed. Twelve-month to 9-year follow-up showed that all pediatric patients recovered well and no recurrence or unraveled knots were found. Conclusions: This new knot-tying technique is safe and feasible for various minimally invasive endoscopic surgeries, especially for suturing tissues under tension, such as thoracoscopic diaphragmatic hernia repair, laparoscopic esophageal hiatal hernia repair, and fundoplication. All types of sutures can be used for this knot-tying technique. It is easy to learn and can be quickly mastered by doctors with endoscopic surgery experience.

Reconstruction of central skull base defects after the removal of chiasmosellar tumors

The study objective is to describe currently available and optimal methods of central skull base reconstruction.Material and methods. This article describes a 10-year experience of endoscopic surgery in reconstructing the defects after the removal of chiasmosellar tumors.Results. We developed a strategy for assessing the risks for postoperative liquorrhea and choosing an optimal surgical technique. This strategy allows maintaining the incidence of postoperative liquorrhea of 4 %.Conclusion. Autografts are the most widely used material for reconstructing skull base defects after the removal of chiasmosellar tumors. The multilayer reconstruction is more preferable due to the high risk of postoperative liquorrhea.

Evaluation of Clinical Usefulness of a Medical Monitor Equipped With an Organic Electroluminescence Panel in Comparison With Liquid Crystal Display Monitors

The medical liquid crystal display (LCD) monitor is a conventionally used imaging device for diagnosis and during endoscopic surgery. Recently, a medical organic electroluminescence panel, the organic light-emitting diode (OLED) monitor, was made available commercially. The advantages of the OLED monitor include good color reproducibility, high contrast, and high video responsiveness. In this nonclinical study, we compared the clinical usefulness and image quality of the OLED monitor and those of the LCD monitor using videos of gynecologic endoscopic surgeries. Monitors were set for blind evaluation. Five evaluators with varying experience in endoscopic surgery evaluated 21 surgery videos played simultaneously on an OLED monitor and two LCD monitors for 2 to 3 minutes twice. Evaluators judged 13 clinical usefulness indices and 11 image quality indices using a 5-point scale (1, very good; 5, very poor) for each video. The mean scores of clinical usefulness indices of the OLED monitor and the LCD monitors 1 and 2 were 2.2 to 2.7, 2.1 to 3.3, and 3.0 to 3.2, respectively. Of seven indices measured, five including motion response, the ability to differentiate organs, recognize lesions, and reproduce actual images, and the general impression of picture quality were statistically superior with use of the OLED monitor compared with the LCD monitor 1, and two including ability to distinguish blood vessels and the ureters were statistically superior with use of the LCD monitor 1 compared with the OLED monitor. The mean scores of image quality indices of the OLED monitor and the LCD monitors 1 and 2 were 1.8 to 3.2, 2.6 to 3.6, and 2.8 to 4.0, respectively. Each index of the OLED monitor was superior to or comparable with those of the LCD monitors. We conclude that the OLED monitor is superior to the LCD monitors insofar as several video presentation characteristics required in gynecologic endoscopic surgery. These findings suggest that the OLED monitor is expected to contribute detailed assessment of organs and the operative field.

Extended applications of endoscopic sinus surgery and its reference to cranial base and pituitary fossa.

Sinus surgery has the potential of allowing ENT surgeons to encroach the boundaries of our colleagues in ophthalmology and neurosurgery. The advent of nasal endoscope and lately powered instrumentation and computer-assisted navigational systems has avoided the use of the conventional and more radical approaches by the ENT surgeon for the treatment of inflammatory pathology or tumors of the orbit and skull base. As rhinologists have gained more experience in endoscopic surgery, more areas related to the orbit and the anterior skull base are accessible and surgery is safer.

Comparison of complications rates in endoscopic surgery performed by a clinical assistant vs. An experienced endoscopic surgeon

Study Objectives:(a) To find out the actual incidence of complications during endoscopic surgeries. (b) Comparison of complication rate between an experienced laparoscopic surgeon (> 10 years of experience in endoscopic surgery) and a clinical assistant (> 3 years of experience in endoscopic surgery). (c) How to manage complications in endoscopic surgery. (d) Concrete suggestions to reduce the complication rate.Design:Retrospective study (Canadian Task Force classification ii-2).Setting:Tertiary gynecologic endoscopic unit.Patients:A total of 3204 cases of gynecologic endoscopic surgery out of which 2001 were laparoscopic and 1203 were hysteroscopic surgeries.Interventions:Laparoscopic and hysteroscopic gynecologic surgeries in indicated cases.Measurements and Main Results:The study was carried out between April 2003 and October 2007 at a referral center for endoscopic surgery. A total of 3204 cases of gynecologic endoscopic surgery were studied. There were five significant complications in laparoscopic surgeries and four significant complications in hysteroscopic surgeries seen in four years and six months. All the complications could be managed with no mortality. Conversion to laparotomy was needed in eight cases of laparoscopic surgeries and none in hysteroscopic surgeries.Conclusion:The risk of complication reduces with the experience in endoscopic surgery. However, the proper grooming of a novice in experienced hands, for a sufficient period of time, can minimize the complication rate in the initial learning phase. The complication may be utilized as a stepping-stone to overcome any given situation without panic, but with adequate safety.

The role of functional sinus surgery for treatment of antrochoanal polyp

Antrochoanal polyp (ACP) is a benign lesion which arises from the mucosa of maxillary sinus, fills it and expands through natural ostium towards choana protruding in the epipharynx. to present our experience in endoscopic surgery of ACP. prospective study included 24 patients operated at the Institute of Otorinolaryngology and Maxillofacial surgery, Clinical Center of Serbia, Belgrade, in the period 2002-2004. Subjective symptoms, endoscopic and CT findings were evaluated postoperatively, following up the patients in the period 12-20 months. Subjective difficulties of patients were tested by 100mm-analogue scale, while endoscopic and CT findings were demonstrated by three-stage scale from 0 to 2. Applying the technique of ACP extraction in Trendelenburg's position and approaching the part which protrudes in the epipharynx, we successfully removed the endonasal part by means of curved forceps for epipharyngeal biopsy. By endoscopic middle meatotomy, the natural ostium of maxillary sinus was expanded and pathological process from the very sinus was successfully removed. only one female patient had the majority of symptoms after the operation, while all others had no complaints. Endoscopic and CT findings were normal in all patients at the latest control, without any signs of ACP recurrence. There were no intraoperative or postoperative complications. minimal damage to sinus mucosa due to forceps is lesser problem than complications developed upon creating even the miniature opening in the canine fossa. Using this technique, a dexterous surgeon may successfully extract patho-logical process with minimal incidence of recurrence, and, more important, with no complications and maximally fast recovery of patients.

Cyber visual training as a new method for the mastery of endoscopic surgery

We devised a new method incorporating cyber visual training whereby novices in endoscopic surgery are instructed via repetition of a video-recorded procedure. We then conducted a study designed to investigate the impact of this cyber visual training on the mastery of intracorporeal knot-tying as an endoscopic technique. For the cyber visual training a 10-min video of the same procedure was replayed at normal, slow, and rapid speeds or presented in a series of still images. The training was undertaken by 36 medical students and 1st year trainee doctors who had had no experience of endoscopic surgery. They were divided into three groups, each of all received the same introductory lecture. Group A was only given training with the instructor for 15 min. Group B trained with the instructor for 15 min and was allowed self-training for 10 min. Group C viewed the cyber video beforehand and then underwent training with the instructor for 15 min. For all participants, the time required to complete a knot-tying task was measured and the level of endoscopic skill before and after the training was assessed using a virtual reality system the minimally Invasive Surgical Trainer-Virtual Reality (MIST-VR), in terms of the following three parameters: time, errors, and efficiency of hand movements. The Steel-Dwass test was used to evaluate the differences among the three groups in task performance. Group C completed the knot-tying task faster than group A (p = 0.0375), but there were significant differences between groups A and B and groups B and C. There were no significant differences in the parameters assessed using the MIST-VR. Our new concept of cyber visual training is effective for mastering the knot-tying technique. This type of training should be widely applicable to other procedures, such as dissection, clipping, and hemostasis.

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.