Microendoscopic Surgery Research Articles

Microendoscopic surgery: A comparison of four microendoscopes and a review of the literature

OBJECTIVE: Our purpose was to compare four microendoscopes to evaluate their clinical and cost effectiveness. STUDY DESIGN: The experience of 27 patients scheduled for diagnostic or minor operative procedures is reported. All patients had microendoscopic laparoscopy performed using the Medical Dynamics optical catheter (Englewood, Col.), the Origin Pixie microendoscope (Menlo Park, Calif.), the Imagyn Microlap (Laguna Niquel, Calif.), or the Karl Storz microendoscope (Culver City, Calif.). A 5 mm conventional laparoscope was used when visualization was inadequate. RESULTS: Thirteen patients had tubal sterilization. Fourteen patients had diagnostic laparoscopy. For 22 patients the microendoscopes were adequate. The remaining 5 patients required the use of a 5 mm laparoscope to complete the procedure. Among the microendoscopes, the Imagyn Microlap was considered to have the best combination of field of vision, clinical adaptability, ease of operation, mode of sterilization, and operating cost. The 5 mm endoscope provided the best visualization at the lowest overall cost. CONCLUSION: Microendoscopes are adequate for diagnostic and minor operative procedures. The 5 mm endoscope is the most clinically cost effective. (Am J Obstet Gynecol 1996;174:1757-62.)

Operationsweiterbildung mittels Multimediatechnik am Beispiel der endonasalen mikroendoskopischen Pansinusoperation*

The concept of multimedia involves the integration of various media into a single computer system which, properly configured, permits an interactive approach. Modern computer technology makes it possible to display of varied audio-visual documents on screen and allow the users to work independently and learn at their own pace. Our new teaching multimedia software (available in English or German) illustrates future possibilities for individualized interactive medical education. Required hardware consists of an IBM-compatible PC plus a CD-ROM drive, two speakers, and a special MPEG multimedia board. The program is supplied on a compact disc. The user begins at an introductory screen and works through the technique of endonasal sinus surgery individually and interactively. He can switch between the following chapters by clicking the mouse: an introduction to anatomy of this region, an atlas of computed tomography of the paranasal sinuses, and a chapter dealing with the danger areas. The main chapter contains a video about how to perform endonasal microendoscopic sinus surgery, which we have divided into thirteen sections. Each of these contains a section on dangers and complications with tips on to avoid and correct them (e.g. how to close a dura defect; what to do after damaging the anterior ethmoidal artery). In addition, CT scans of the relevant areas are shown. A special MPEG multimedia board permits full-screen video.

Sarcoidosis of the larynx: Preserving and restoring airway and professional voice

Professional voice users may present with disastrous dysponia and life-threatening upper airway disturbances due to a rare condition. Two teachers demonstrated extrathoracic obstructive laryngeal lesions by videolaryngoscopy and pulmonary function flow-volume loops. A characteristic "honking" voice and edematous, pink, diffuse turban-like enlargement of the supraglottic structures are considered pathognomonic of laryngeal sarcoidosis. Diagnosis was confirmed by biopsies, and clinical and radiologic findings. Sarcoidosis is a variable, disseminated disease involving many body organs, self-limited or progressive, with frequent exacerbations and remissions, affecting the larynx in 0.5-1.4% of patients. Spinal cord involvement demonstrated by new magnetic resonance imaging techniques can be heralded by voice changes detected in professional voice users. Systemic corticosteroid therapy combined with intralesional steroid injections and microendoscopic surgery, with or without tracheostomy, preserved and restored both professional voice and airway.

Microendoscopic surgery of the hypopharyngeal pouch with the CO2 laser.

In 1964 we started to treat hypopharyngeal (Zenker's) diverticula endoscopically, using the procedure described by Dohlman. With the increase in the number of patients (350), the technique and the instruments used have improved. This paper describes the technique, which involves exposure of the tissue bridge between esophagus and diverticulum with the aid of a specially designed scope and subsequent severance with the CO2 laser of this bridge under microscopic control. The use of an operating microscope and the laser is a great improvement in endoscopic treatment of hypopharyngeal diverticula.