Invasive Endoscopic Techniques Research Articles

Редкий клинический случай: зернисто-клеточная опухоль пищевода (опухоль Абрикосова) у подростка

Granular cell tumors were first described by Weber in 1854. But its muscular origin was suggested, studied in detail and differentiated by the pathologist A.I. Abrikosov in 1926. With the development of immunohistochemical analysis, a version of Abrikosov's tumor pathogenesis appeared, suggesting its origin from Schwann cells. The data obtained confirmed the presence of protein S-100, neuron-specific enolase (NSE) and CD68 in tumor cells. At present, when carrying out histochemical analysis, the expression of proteins S-100 and CD68 in tumor cells is a diagnostic criterion for Abrikosov's tumor. In treatment of granular cell tumors of the esophagus, preference is given to minimally invasive endoscopic techniques, since conservative therapy has proved to be ineffective. Considering that in most cases the tumor is benign in nature, recently many authors have recommended endoscopic resection of the mucous membrane and dissection in the submucosa. This article presents the experience of treating a child with a rare Abrikosov's tumor in the lower third of the esophagus using endoscopic technique. The clinical case described proved to be a difficult diagnostic task, since Abrikosov's tumor in the esophagus in a teenager is an extremely rare pathology with a rare localization. To remove the tumor, a non-standard endoscopic technique was chosen, which made it possible to remove the formation in a single block, that is, radically, since preoperative morphological verification was impossible. Much attention is focused on the importance of endoscopic examination in diagnostic screening and the choice of treatment tactics. This work demonstrates high efficiency and safety of endoscopic tumor removal in this localization. The use of this surgical treatment technique made it possible to radically remove the tumor and ensure a smooth course of the postoperative period. The research was carried out in accordance with the principles of the Helsinki declaration. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: granular cell tumor, Abrikosov's tumor, tumor of the esophagus, esophagus, children, endoscopic treatment.

Efficacy and Complications of Unilateral Biportal Endoscopic Spinal Surgery for Lumbar Spinal Stenosis: A Meta-Analysis and Systematic Review

As an emerging minimally invasive endoscopic technique, unilateral biportal endoscopic spinal surgery (UBESS) has the advantages of flexibility, a wide and clear field of view, and less soft tissue damage. However, the clinical evidence is insufficient and controversy exists regarding UBESS for the treatment of lumbar spinal stenosis (LSS). In the present meta-analysis, we investigated the clinical efficacy and complications of UBESS for the treatment of LSS. The PubMed, Embase, Web of Science, and Cochrane Library databases were searched through to June 1, 2021 to identify all reported studies on UBESS for LSS. Only English-language studies with original reported data from ≥30 cases were considered for inclusion. The patient demographics, operative time, hospital stay, complications, visual analog scale (VAS) score, Oswestry disability index, and Macnab criteria were extracted. Quality assessment was performed using the Cochrane collaboration tool for randomized controlled trials and the Newcastle-Ottawa scale for retrospective studies. A meta-analysis was performed using a random or fixed effect model according to the heterogeneity. Thirteen studies with 586 patients and 607 operation levels were included. The mean single-level operative time, hospital stay, and follow-up duration were 61.10 minutes, 2.32 days, and 14.7 months, respectively. At the final follow-up visit, the mean VAS score for leg pain had decreased from 7.23 preoperatively to 1.83 postoperatively, the mean VAS score for back pain had decreased from 6.30 to 1.95, and the mean Oswestry disability index had significantly improved from 56.99 to 17.83. The average satisfied outcome (excellent or good using the Macnab criteria) was 86%. The overall complication rate was 5%, and the most common complication was a dural tear, with an incidence of 2%, followed by epidural hematoma with an incidence of 1%. The remaining complications were nerve root injury, inadequate decompression, and postoperative headache. From the available clinical results and experience from reported studies, UBESS for LSS is a feasible and effective approach and a worthwhile choice for clinicians. However, the complications associated with the procedure should also be seriously considered.

Endoscopic Treatment of Middle Cranial Fossa Arachnoid Cysts in Children: Surgical Results of 65 Cases

Congenital arachnoid cysts in the middle fossa accounts for 50% of all intracranial arachnoid cysts. Several management options have been described; however, no single technique has been universally adopted. We describe a series of pediatric patients with middle cranial fossa arachnoid cyst that were treated through an innovative minimally invasive endoscopic technique, along with their clinical aspects and surgical outcomes. Data from 65 patients operated between 2012 and 2018 were retrospectively analyzed. Follow-up ranged from 12 to 96 months. Clinical presentation and surgical outcomes were collected. Endoscopic cystocisternostomy was performed in all patients using a mini endoscope. There were 41 male and 24 female patients, with a mean age of 5.3 years at the time of treatment. Except for 4 patients, all presented with 1 or more symptoms, and the most frequent were intracranial hypertension signs. All patients were treated with the same surgical technique, with an efficacy of 81.5%. Using a mini endoscope allow us to perform multiple fenestrations along the arachnoid and deeply inspect the basal cisterns, achieving a much wider communication between the cyst and subarachnoid space with a high success rate and minimal invasiveness.

The learning curve for transoral incisionless fundoplication.

Background and study aims Transoral incisionless fundoplication (TIF) is a safe and effective minimally invasive endoscopic technique for treating gastroesophageal reflux disease (GERD). The learning curve for this technique has not been reported. We studied the learning curve for TIF when performed by a gastroenterologist by identifying the threshold number of procedures needed to achieve consistent technical success or proficiency (consistent creation of TIF valve ≥ 270 degrees in circumference, ≥ 2 cm long) and efficiency after didactic, hands-on and case observation experience. Patients and methods We analyzed prospectively collected data from patients who had TIF performed by a single therapeutic endoscopist within 17 months after basic training. We determined thresholds for procedural learning using cumulative sum of means (CUSUM) analysis to detect changes in achievement rates over time. We used breakpoint analysis to calculate procedure metrics related to proficiency and efficiency. Results A total of 69 patients had 72 TIFs. The most common indications were refractory GERD (44.7 %) and proton pump inhbitor intolerance (23.6 %). Proficiency was achieved at the 18 th to 20 th procedure. The maximum efficiency for performing a plication was achieved after the 26 th procedure, when mean time per plication decreased to 2.7 from 5.1 minutes (P < 0.0001). TIF procedures time varied until the 44 th procedure, after which it decreased significantly from 53.7 minutes to 39.4 minutes (P < 0.0001). Conclusions TIF can be safely, successfully, and efficiently performed in the endoscopy suite by a therapeutic endoscopist. The TIF learning curve is steep but proficiency can be achieved after a basic training experience and 18 to 20 independently performed procedures.

PEGASOS - A New Linking Mechanism for Modular Osteosynthesis Plates in Minimally Invasive Acetabular Surgery

Abstract Background: Recently presented minimally invasive endoscopic surgical techniques demonstrated the feasibility of implanting standard osteosynthesis plates for pelvic fractures. The reconstruction and internal fixation of complex acetabular fractures is still challenging. The goal of this study is to introduce a divisible implant, with a positive-locking in situ linking mechanism for plate osteosynthesis, making it possible to stabilize large and complex acetabular fractures with involvement of the quadrilateral surface. Method: Standard implants were used to recreate a base design. Using computer aided design (CAD), a three-dimensional standard implant was divided into two parts, so they could be re-allocated in situ. A critical objective was to reduce the cross-section of each part (clearance gauge). To connect the separated parts in situ, a new linking mechanism (cone in cone) was created. The new construct also features self-stabilization, self-centering, reinforced positional movement and preloading effects. Results: A linking system for plate osteosynthesis was developed entitled PEGASOS ("Percutaneous Endoscopic Guided Acetabulum-Stabilizing Osteosynthesis System"). Endoscopic implantation and in-situ-linking could be performed in a human cadaver. Therefore, we could demonstrate, that buttressing the quadrilateral surface of the acetabulum could be performed minimally invasive using a divisible suprapectineal buttress plate. Conclusion: We created a linking mechanism to couple two plates in situ. This mechanism enables an extremely strong, positive-locking connection, whereas its geometric shape allows for different relative movements during the locking procedure, with a single screw.

Closure techniques in exposed endoscopic full-thickness resection: Overview and future perspectives in the endoscopic suturing era.

Exposed endoscopic full-thickness resection (EFTR) without laparoscopic assistance is a minimally invasive natural orifice transluminal endoscopic surgery technique that is emerging as a promising effective and safe alternative to surgery for the treatment of muscularis propria-originating gastric submucosal tumors. To date, various techniques have been used for the closure of the transmural post-EFTR defect, mainly consisting in clip- and endoloop-assisted closure methods. However, the recent advent of dedicated tools capable of providing full-thickness defect suture could further improve the efficacy and safety of the exposed EFTR procedure. The aim of our review was to evaluate the efficacy and safety of the different closure methods adopted in gastric-exposed EFTR without laparoscopic assistance, also considering the recent advent of flexible endoscopic suturing.

Development and Validation of a Low-Cost Endoscopic Spine Surgery Simulator.

BackgroundMinimally invasive endoscopic techniques in spine surgery continue to gain in popularity. Unfortunately, there is a long learning period for novice endoscope users to acquire basic skills, and complex training simulators are frequently cost-prohibitive. This paper describes the development and validation of a low-cost endoscopic spine training simulator.MethodologyA low-cost endoscopic spine training model was created utilizing a budget of less than 65 USD. Afterward, a training curriculum consisting of five tasks was designed to mimic standard techniques frequently utilized in endoscopic spine surgery. This curriculum was tested on a cohort of surgical trainees. The initial time to completion as well as errors made during the tasks and repeat trials were recorded. A composite score was generated to quantify the overall scores which included both time and errors in each task.ResultsIn total, 11 students and surgical residents completed the curriculum. The first attempt required an average of 622 seconds for the completion of the curriculum compared to 283 seconds in the second trial (p < 0.001; SD = 36.75). In regards to trials in which errors were counted, fewer errors occurred during the second attempt (2.55 vs. 1.53); however, this difference was not statistically significant (p > 0.05). In regards to the composite score, the composite score of the intern group demonstrated an average improvement of 0.345 compared to an average improvement of 0.47 in the resident group.ConclusionsOur study demonstrates the feasibility of a low-cost endoscopic spine trainer as well as its efficacy in improving basic endoscopic skills in trainees.

Electrosurgery or laser for benign prostatic enlargement: trumpcard or pitfalls.

Purpose of reviewTo summarize and comment on publications of the last 2 years in the field of endoscopic surgery for benign prostatic enlargement, focusing on similarities and differences of laser and electrosurgery.Recent findingsBecause of good hemostasis and safety, invasive endoscopic surgery has evolved to a choice of treatment for vulnerable patients with ongoing antithrombotic medication and in same-day surgery. Recent publications show a good perioperative course and no deterioration in the postoperative outcome. Furthermore, alterations to the original surgical techniques of resection, enucleation, and vaporization have increased the preservation rate for antegrade ejaculation, advancing them to an appealing choice of treatment for sexually active men. Favorable outcomes can be achieved in both laser and electrosurgery. Only the choice of the surgical technique determines the outcome.SummaryVarious invasive endoscopic surgical techniques are available, offering different advantages and disadvantages for the patient. All of them can be performed with laser and electrosurgery. Therefore, focusing on the proper choice of surgical technique instead of the energy source will guarantee the patient to benefit most.

Biportal endoscopic debridement and percutaneous screw fixation technique for spinal tuberculosis: how I do it.

Biportal endoscopy and percutaneous screw fixation are promising techniques that can be applied to treat various degenerative spinal diseases. However, these techniques for spinal tuberculosis have not been reported. Using the biportal endoscopic technique, bilateral decompression, tissue biopsy, and granulation tissue removal were performed using the screw insertion site. Using the percutaneous fixation screw technique, posterior stabilization and sagittal angle restoration were achieved. Paraplegia and radiating pain improved neurologically. Kyphosis was radiologically restored. Spinal tuberculosis (Potts's disease) was histopathologically diagnosed. Minimally invasive endoscopic and percutaneous screw technique can aid the diagnosis and treatment of spinal tuberculosis.

Spine Surgery Complications in the Ambulatory Surgical Center Setting: Systematic Review.

This was a systematic review study. This study aims to review current literature to determine the rates of complications in relation to spine surgery in ambulatory surgery centers (ASC). Recent improvements in anesthesia, surgical techniques, and technological advances have facilitated a rise in the use of ASC. Despite the benefits and lower costs associated with ASCs, there is inconsistent reporting of complication rates. This systematic review was completed utilizing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Pertinent studies were identified through Embase and PubMed databases using the search string ((("ambulatory surgery center") AND "spine surgery") AND "complications"). Articles were excluded if they did not report outpatient surgery in an ASC, did not define complications, were in a language other than English, were non-human studies, or if the articles were classified as reviews, book chapters, single case reports, or small case series (≤10 patients). The primary outcome was the frequency of complications with respect to various categories. Our query identified 150 articles. After filtering relevance by title, abstract, and full text, 22 articles were included. After accounting for 2 studies that were conducted on the same study sample, a total of 11,245 patients were analyzed in this study. The most recent study reported results from May 2019. While 5 studies did not list their surgical technique, studies reported techniques including open (6), minimally invasive surgery (2), endoscopic (4), microsurgery (1), and combined techniques (4). The following rates of complications were determined: cardiac 0.29% (3/1027), vascular 0.25% (18/7116), pulmonary 0.60% (11/1839), gastrointestinal 1.12% (2/179), musculoskeletal/spine/operative 0.59% (24/4053), urologic 0.80% (2/250), transient neurological 0.67% (31/4616), persistent neurological 0.61% (9/1479), pain related 0.57% (20/3479), and wound site 0.68% (28/4092). After literature review, this is the first study to comprehensively analyze the current state of literature reporting on the complication profile of all ASC spine surgery procedures. The most common complications were gastrointestinal (1.12%) and the most infrequent were vascular (0.25%). Case reports varied significantly with regard to the type and rate of complications reported. This study provides complication profiles to assist surgeons in counseling patients on the most realistic expectations.

Medical thoracoscopy treatment for pleural infections: a systematic review and meta-analysis

BackgroundComplicated parapneumonic effusions and empyema represent advanced stages of pleural infections and are characterized by a high mortality. Medical thoracoscopy is a safe and minimally invasive endoscopic technique prescribed to treat severe pleural infections. However, only a few studies evaluated its success rate. A systematic review of observational studies was performed to assess the efficacy of medical thoracoscopy in patients with complicated parapneumonic effusions and empyema, as well as its predictive factors.MethodsA search of the scientific evidence was carried out using PubMed, EMBASE, and Cochrane Central Register of Controlled Trials. Articles describing observational studies on medical thoracoscopy in patients with parapneumonic effusions and empyema were selected.ResultsEight studies met the inclusion criteria. The pooled treatment success rate of thoracoscopy was 85% (95% CI 80.0–90.0%; I2: 61.8%) when used as first-line intervention or after failure of chest tube. The pooled complication rate was 9.0% (95% CI 6.0–14.0%; I2: 58.8%). A pooled difference of treatment success of 9.0% (95% CI 1.0–18.0%) was found when post-thoracoscopy intra-pleural fibrinolysis was prescribed. Pooled success rate was higher in cases with pleural fluid culture negativity (pooled difference: 14.0%; 95% CI 4.0–24.0%).ConclusionsMedical thoracoscopy is effective and safe when prescribed for complicated parapneumonic effusions and empyema. Bacteriological negativity of pleural effusion specimens and administration of adjuvant intra-pleural fibrinolysis after the procedure are associated with a higher success rate.

How to Manage the Large Nonpedunculated Colorectal Polyp

How to Manage the Large Nonpedunculated Colorectal Polyp

Endoscopic Haglund’s Resection and Percutaneous Double-Row Insertional Achilles Repair

Insertional Achilles tendinopathy can be a debilitating condition that often fails to improve with nonsurgical management such as bracing and physical therapy. Traditional surgical techniques include an open debridement of the diseased tendon and resection of calcaneal spurs. This is followed by repair of the tendon. Suture anchors are often used to secure the tendon, but recent advances in tendon fixation, including the advent of double-row repairs, has allowed better biomechanical repairs and faster rehabilitation. Additionally, minimally invasive surgery and endoscopic techniques have advanced to allow successful treatment of all aspects of the condition while minimizing wound complications and infection. The authors present a technique to treat insertional Achilles tendinopathy and calcaneal bone spurs using minimally invasive surgery techniques while also incorporating a percutaneous double-row suture anchor repair. The technique utilizes 4 portals to access 2 endoscopic working planes. The burr is inserted deep to the tendon and the calcaneoplasty is performed. Subsequently, the endoscope is inserted alongside a shaver to remove bony debris and debulk the anterior aspect of the Achilles areas of tendinopathy. Following this, the portals are used to place a double-row suture anchor repair.Levels of Evidence: Level V.

Computed Tomography- (CT-) Based Virtual Surgery Planning for Spinal Intervertebral Foraminal Assisted Clinical Treatment.

With the development of minimally invasive spine concepts and the introduction of new minimally invasive instruments, minimally invasive spine technology, represented by foraminoscopy, has flourished, and percutaneous foraminoscopy has become one of the most reliable minimally invasive procedures for the treatment of lumbar disc herniation. Percutaneous foraminoscopy is a safe and effective minimally invasive spinal endoscopic surgical technique. It fully protects the paravertebral muscles and soft tissues as well as the posterior column structure of the spine, provides precise treatment of the target nucleus pulposus tissue, with the advantages of less surgical trauma, fewer postoperative complications, and rapid postoperative recovery, and is widely promoted and used in clinical practice. In this paper, we can view the location, morphology, structure, alignment, and adjacency relationships by performing coronary, CT, and diagonal reconstruction along the attachment of the yellow ligaments and performing 3D reconstruction or processing techniques after performing CT scans. This allows clinicians to observe the laminoplasty and the stenosis of the vertebral canal in a more intuitive and overall manner. It has clinical significance for the display of the sublaminar spine as well as the physician's judgment of the disease and the choice of surgery.

Advances in Endoscopic Sinus Surgery Technique: The Impact of Technological Breakthroughs

Messerklinger initially characterized sinonasal mucociliary clearance patterns in the 1950’s using India ink particles and hypothesized that inflammatory disease within the sinuses, as well as anatomic variants, could obstruct mucus outflow. He introduced use of the endoscope for diagnostic evaluation, as well as surgical principles known as the Messerklinger technique [1]. In the following 70 years his technique, known as Endoscopic Sinus Surgery (ESS), was refined and popularized by Stammberger, Kennedy, and others [2,3]. Both emphasized the preservation of normal anatomic structures and re-establishment of natural mucociliary clearance patterns. Towards that end, Kennedy viewed the surgery as a functional and minimally invasive procedure, adding the term “functional” to ESS, with the procedure now widely known as Functional Endoscopic Surgery (FESS) [4]. Since then, minimally invasive endoscopic techniques have been further refined by a multitude of talented multi-disciplinary physicians, too numerous to name here [5].

Minimally Invasive Endoscopic Spine Surgical Techniques for Treating Radiculopathy Secondary to Sacroiliac Joint Fusion Complications: Case Series

Background: Minimally invasive SI joint fusion has increased in popularity. A possible complication that can result from the procedure is a radiculopathy (sacral or lumbar) that is caused by placement of the SI joint fusion implant. Case Report: Two cases are presented: A 60-year-old woman with a S1 radiculopathy secondary to a cortical bone fragment contacting the S1 nerve, and a 62-year-old man with a L5 radiculopathy and the anteriorly directed SI joint fusion implant positioned anteriorly and compressing on the L5 nerve. Both patients had resolution of their symptoms with endoscopic treatment. Conclusion: An endoscopic treatment is suggested here for radiculopathy secondary to minimally invasive SI joint fusion. Key words: Endoscopic spine surgery, lumbar radiculopathy, minimally invasive spine, SI joint fusion

The short-term outcomes of minimally invasive decompression surgery in patients with lumbar ossification or calcification of the ligamentum flavum.

Although minimally invasive endoscopic surgery techniques are established standard treatment choices for various degenerative conditions of the lumbar spine, the surgical indications of such techniques for specific cases, such as segments with ossification of the ligamentum flavum (OLF) or calcification of the ligamentum flavum (CLF), remain under investigation. Therefore, the authors aimed to demonstrate the short-term outcomes of minimally invasive endoscopic surgery in patients with degenerative lumbar disease with CLF or OLF. This is a retrospective cohort study including consecutive patients who underwent microendoscopic posterior decompression at the authors' institution, where the presence of OLF and CLF did not influence the surgical indication. Fifty-nine patients with OLF and 39 patients with CLF on preoperative CT were identified from the database. Subsequently, two matched control groups (one each matched to the OLF and CLF groups) were created using propensity scores to adjust for age, sex, preoperative Japanese Orthopaedic Association (JOA) score and Oswestry Disability Index, and diagnosis. The background, surgical outcomes, and changes in clinical scores were compared between the matched groups. If there was a significant difference in the improvement of clinical scores, a multivariate linear regression model was applied. On performing univariate analysis, patients with OLF were found to have a higher body mass index (Mann-Whitney U-test, p = 0.001), higher incidence of preoperative motor weakness (chi-square test, p = 0.019), longer operative time (Mann-Whitney U-test, p < 0.001), and lower improvement in the JOA score (mixed-effects model, p = 0.023) than the matched controls. On performing multivariate analysis, the presence of OLF was identified as an independent variable associated with a poor recovery rate based on the JOA score (multivariate linear regression, p < 0.001). In contrast, there were no significant differences between patients with CLF and their matched controls in terms of preoperative and surgical data and postoperative improvements in clinical scores. Although the perioperative surgical outcomes, including the surgical complications, and the in-hospital period did not significantly differ, the short-term improvement in the JOA score was significantly lower in patients with degenerative lumbar disease accompanied by OLF than in the patients from the matched control group. In contrast, there were no significant differences in the short-term improvement in clinical scores and perioperative outcomes between patients with CLF and their matched control group. Thus, the surgical indications of minimally invasive posterior decompression for patients with CLF can be the same as those for patients without CLF; however, the indications for patients with OLF should be further investigated in future studies, including the other surgical methods.

Public Preferences and Predicted Uptake for Esophageal Cancer Screening Strategies: A Labeled Discrete Choice Experiment

INTRODUCTION:As novel, less invasive (non)endoscopic techniques for detection of Barrett's esophagus (BE) have been developed, there is now renewed interest in screening for BE and related neoplasia. We aimed to determine public preferences for esophageal adenocarcinoma screening to understand the potential of minimally invasive screening modalities.METHODS:A discrete choice experiment was conducted in 1,500 individuals, aged 50–75 years, from the general population. Individuals were repeatedly asked to choose between screening scenarios based on conventional upper endoscopy, transnasal endoscopy, nonendoscopic cell collection devices, breath analysis, and a blood test, combined with various levels of test sensitivity and specificity, and no screening. A multinomial logit model was used to estimate individuals' preferences and to calculate expected participation rates.RESULTS:In total, 554 respondents (36.9%) completed the survey. The average predicted uptake was 70.5% (95% confidence interval: 69.1%–71.8%). Test sensitivity (47.7%), screening technique (32.6%), and specificity (19.7%) affected screening participation (all P < 0.05). A low test sensitivity had the highest impact on screening participation, resulting in a 25.0% (95% confidence interval: 22.6%–27.7%) decrease. Respondents preferred noninvasive screening tests over endoscopic and capsule-based techniques, but only if sensitivity and specificity were above 80%.DISCUSSION:Our study suggests that individuals generally prefer noninvasive BE screening tests. However, these tests would unlikely improve screening uptake when associated with a much lower accuracy for detecting BE and esophageal adenocarcinoma compared with conventional upper endoscopy. Improving accuracy of minimally invasive screening strategies and informing the target population about these accuracies is therefore essential to maximally stimulate screening participation.

A Minimally Invasive Endoscopic Technique for Fascia Lata Graft Acquisition and Fascial Reapproximation.

Fascia lata remains a popular and robust graft to repair osteodural defects in endoscopic neurosurgery. Classically, this graft is obtained via a large incision in the thigh that is prone to pain and muscle herniation after surgery. To present a novel technique for harvesting fat and fascia lata graft and reapproximating the edges via an endoscopic approach through the thigh using an "outside-in" technique to prevent muscle herniation. Initially our technique was performed in cadavers and includes the following: small 2 cm incision in the lateral thigh to accommodate the endoscope, use of blunt dissection and endoscopic tools to obtain the graft, and reapproximation of the fascia via an outside-in technique using conventional sutures with endoscopic visualization to retrieve the sutures beneath the skin and tie them. We then applied the technique to a patient undergoing transsphenoidal tumor resection. This technique was trialed in 3 cadaver specimens (6 limbs) and was used successfully in a patient with excellent cosmetic results seen in follow-up. Endoscopic retrieval of fascia lata is feasible via a very small incision. Reapproximation of the cut fascial edges to minimize muscle herniation can quickly and easily be performed with an outside-in technique detailed here. Additional case series may help to solidify the endoscopic retrieval as a preferred technique for fascia lata graft.

Photodynamic therapy in combined treatment of cholangiocellular carcinoma (case report)

In this article a case report of an effective combined treatment of a patient with locally advanced cholangiocellular cancer who underwent neoadjuvant regional chemotherapy, extended surgery, adjuvant regional chemotherapy, as well as a set of minimally invasive endoscopic and percutaneous endobiliary techniques, which allowed the progression of the disease, including to increase the patients survival rate is presented. (5 figs, bibliography: 5 refs).