Minimally Invasive Procedure Research Articles

The development and validation of a new simulator for endourology

IntroductionSimulation in medicine has developed a lot in the last few decades. There is a broad range of simulators available, above all for training in surgical procedures. Endourology can benefit much from simulation because the minimally-invasive procedures of endourology frequently have long learning curves, which can be reduced by training with simulators. Materials and methodsA low-fidelity simulator was designed for practicing endourology techniques that use cystoscopy. The process of validation involved 5 experts and 19 non-experts. Experts comprised medical professionals working in a department of urology who had performed at least 100 flexible cystoscopy procedures. Non-experts were residents in internal medicine without experience in any type of endoscopy. Information about face and content validity was collected by means of Likert scales from 1 to 5. To evaluate construct validity, we measured the time to complete two tasks, for which the procedure was evaluated by means of the OSATS global evaluation scale. ResultsNew simulator was successfully built according to its design. For all evaluated aspects of construct validity, there was a significant difference (p<0.05) between the group of experts and the group of non-experts. Content validity was scored 4.66 (standard deviation ±0.56) by the experts and 4.41 (±0.71) by the non-experts. In the face validity questionnaire, the average score was 4.14 (±0.94), the question receiving the highest score: 4.6 (±0.84) concerned immersion in the procedure. ConclusionThe simulator presented is valid both for training up new urologists in endourology technique and for experts seeking to perfect their skills.

Laparoscopic-assisted intraperitoneal placement of lumboperitoneal shunt in patients with idiopathic intracranial hypertension

BackgroundLumboperitoneal (LP) shunting is an effective treatment option aiming at cerebrospinal fluid diversion in cases of idiopathic intracranial hypertension. Confirming the distal end position, on the other hand, could be technically difficult, especially in obese people. With minimal invasive procedures, laparoscopic-assisted placement of the peritoneal side of the LP shunt became a valid treatment option. In this study, we aim to evaluate the operation duration, possible complications, and patient outcomes after the placement of a peritoneal catheter using the laparoscopically assisted technique.MethodsA retrospective analysis of clinical, preoperative, and postoperative data for 18 patients diagnosed with idiopathic intracranial hypertension and undergoing LP shunt surgery using the laparoscopic-assisted technique for intraperitoneal catheter placement between 2019 and 2021 was performed.ResultsThe average operating time was 93.89 min, and the average hospital stay was 2.3 days. There was no mortality among cases treated with the described technique, and no intraoperative complication occurred. Seven patients (38.9%) had LP shunt failure, with a median duration to failure of 212 days; three cases for slippage, two cases had over drainage, one case had peritoneal adhesions around the shunt tip, and one case had Arnold Chiari malformation.ConclusionsThe laparoscopic assisted technique is safe and feasible. It allowed a direct vision of the shunt tip position within the peritoneal cavity which helped in confirming position and assessing function, resulting in a superior option over classic surgical options. Short hospital stay, minimal postoperative pain, and low failure rates are the main advantages of described technique.

Desarrollo y validación de un nuevo simulador para endourología

IntroductionSimulation in medicine has developed a lot in the last few decades. There is a broad range of simulators available, above all for training in surgical procedures. Endourology can benefit much from simulation because the minimally-invasive procedures of endourology frequently have long learning curves, which can be reduced by training with simulators. Material and methodsA low-fidelity simulator was designed for practicing endourology techniques that use cystoscopy. The process of validation involved 5 experts and 19 non-experts. Experts comprised medical professionals working in a department of urology who had performed at least 100 flexible cystoscopy procedures. Non-experts were residents in internal medicine without experience in any type of endoscopy. Information about face and content validity was collected by means of Likert scales from 1 to 5. To evaluate construct validity, we measured the time to complete two tasks, for which the procedure was evaluated by means of the OSATS global evaluation scale. ResultsNew simulator was successfully built according to its design. For all evaluated aspects of construct validity, there was a significant difference (P<.05) between the group of experts and the group of non-experts. Content validity was scored 4.66 (standard deviation±0.56) by the experts and 4.41 (±0.71) by the non-experts. In the face validity questionnaire, the average score was 4.14 (±0.94), the question receiving the highest score: 4.6 (±0.84) concerned immersion in the procedure. ConclusionThe simulator presented is valid both for training up new urologists in endourology technique and for experts seeking to perfect their skills.

Long-term Outcome of Seizure Control and Neurologic Performance After Limited Hippocampal Radiofrequency Thermocoagulation for Mesial Temporal Lobe Epilepsy

Limited hippocampal radiofrequency thermocoagulation (RFTC) for patients with mesial temporal lobe epilepsy was associated with good short-term seizure control and few complications. We aimed to demonstrate the neuropsychologic outcomes and assess the prognostic factors of long-term seizure control in these patients. We included all patients with mesial temporal lobe epilepsy who underwent limited hippocampal RFTC from January 2016 to December 2020. Clinical data of age, sex, seizure control before and after operation were all corrected. Pre- and postoperative neuropsychologic function including full-scale intelligence quotient (FSIQ), memory quotient, and the Mini-Mental State Examination was used. Thirty-one patients (17 female and 14 male) with a mean epilepsy duration of 22.3 years and seizure frequency of 5.7 times per month were included. The intraoperative seizure rate was 19.3%, and a higher preoperative seizure frequency (P= 0.001) and longer duration of epilepsy (P= 0.042) were associated with the occurrence of intraoperative seizures. The postoperative FSIQ scores were significantly better than preoperative scores (mean 92.1 vs. 89.7, P= 0.014). Nine patients (29%) who underwent limited hippocampal RFTC were seizure-free at 1 year of follow-up. Responders represented 58% (n= 18) of patients at 1 year. The mean follow-up period was 34.7 ± 13.3 months. Five patients remained seizure free and 13 patients are still responders at the last follow-up visits. Long-term seizure frequency was 2.32 ± 2.86 times per month. Limited hippocampal RFTC is a safe stereotactic minimal invasive procedure with good neuropsychologic outcome and acceptable efficacy of seizure reduction in appropriately selected patients.

Minimal incision endoscopic PEG pull through (MIEPT) technique for buried bumper: first pediatric report

Minimal incision endoscopic PEG pull through (MIEPT) technique for buried bumper: first pediatric report

The Dresden Surgical Anatomy Dataset for Abdominal Organ Segmentation in Surgical Data Science

Laparoscopy is an imaging technique that enables minimally-invasive procedures in various medical disciplines including abdominal surgery, gynaecology and urology. To date, publicly available laparoscopic image datasets are mostly limited to general classifications of data, semantic segmentations of surgical instruments and low-volume weak annotations of specific abdominal organs. The Dresden Surgical Anatomy Dataset provides semantic segmentations of eight abdominal organs (colon, liver, pancreas, small intestine, spleen, stomach, ureter, vesicular glands), the abdominal wall and two vessel structures (inferior mesenteric artery, intestinal veins) in laparoscopic view. In total, this dataset comprises 13195 laparoscopic images. For each anatomical structure, we provide over a thousand images with pixel-wise segmentations. Annotations comprise semantic segmentations of single organs and one multi-organ-segmentation dataset including segments for all eleven anatomical structures. Moreover, we provide weak annotations of organ presence for every single image. This dataset markedly expands the horizon for surgical data science applications of computer vision in laparoscopic surgery and could thereby contribute to a reduction of risks and faster translation of Artificial Intelligence into surgical practice.

Anthropometric Measurements and Analysis for Objective Assessment of Gynecomastia Surgery Results.

Gynecomastia surgery is one of the most common aesthetic procedures in males. There is a lack of objective analytical parameters to judge outcomes. In this study, the authors aim to introduce novel anthropometric measurements and analysis techniques for the objective assessment of surgical outcomes based on specific aesthetic targets. To introduce quantification of gynecomastia surgery outcomes and compare the results among the different grades of gynecomastia. A total of 192 patients with gynecomastia were included. The patient cases were grouped according to grades and a set of anthropometric measurements were taken both before the operation and 6 months postoperatively. Liposuction and glandular excision were done through minimal incisions in all grades of gynecomastia, with the addition of ultrasound and nipple areola complex (NAC) lifting plaster in selected Grade 3 and all Grade 4 cases. A statistically significant improvement in the perimeter of the triangular relationship of sternal notch and nipples, the elevation of the NAC, the reduction of the area of the NAC, and the correction of asymmetry of the chest were seen in all grades of gynecomastia, with increased differences in higher grades. A systematic objective analysis of the specific aesthetic targets helps to reliably compare results in a standard way and for carrying out improvisation of surgeons' techniques. Meanwhile, this approach helps identifying the need for customization, eventually providing symmetric and aesthetically pleasing surgical results.

The diagnostic accuracy of 332 incisional biopsies in patients with malignant tumors in the musculoskeletal system

BackgroundIt is known that specimen collection followed by histopathological workup is the core of evidence-based medical therapy of musculoskeletal tumors. There exist many controversies about how a biopsy should be performed. While some centers recommend minimal invasive biopsy procedures, mostly the core needle biopsy (CNB), others prefer the incisional biopsy.Purpose of the studyThis study aimed to determine the accuracy of incisional biopsy for malignant tumors in the musculoskeletal system. Moreover, advantages and disadvantages to other biopsy methods are discussed.MethodsThis retrospective, single-center study about 844 incisional biopsies (benign and malignant) analysis the diagnostic accuracy of 332 malignant tumors, concerning the final histopathological result. In addition, surgical complications are analyzed to find the best way to plan and treat patients timely and correct. Secondary endpoints are the patients age, the pure operation time, as well as the type of tumor, and the subsequent therapy.ResultsIn summary, incisional biopsy corresponded a sensitivity of 100% for malignancy in 844 incisional biopsies and a specificity of 97.6% in 332 malignant tumors, but it features greater operative expense (incision/suture 23.5 min) and the risk of general anesthesia.ConclusionThe method of biopsy should be tailored to the individual patient and the experience of the center performing the procedure.

A Preliminary Experience of Endoscopic Total Mastectomy With Immediate Free Abdominal-Based Perforator Flap Reconstruction Using Minimal Incisions, and Literature Review.

Endoscopic total mastectomy (ETM) is predominantly performed with reconstruction using prostheses, lipofilling, omental flaps, latissimus dorsi flaps, or a combination of these techniques. Common approaches include minimal incisions, e.g., periareolar, inframammary, axillary, or mid-axillary line, which limit the technical ability to perform autologous flap insets and microvascular anastomoses, as such the ETM with free abdominal-based perforator flap reconstruction has not been robustly explored. We studied female patients with breast cancer who underwent ETM and abdominal-based flap reconstruction. Clinical-radiological-pathological characteristics, surgery, complications, recurrence rates, and aesthetic outcomes were reviewed. Twelve patients underwent ETM with abdominal-based flap reconstruction. The mean age was 53.4 years (range 36-65). Of the patients, 33.3% were surgically treated for stage I, 58.4% for stage II, and 8.3% for stage III cancer. Mean tumor size was 35.4 mm (range 1-67). Mean specimen weight was 458.75 g (range 242-800). Of the patients, 92.3% successfully received endoscopic nipple-sparing mastectomy and 7.7% underwent intraoperative conversion to skin-sparing mastectomy after carcinoma was reported on frozen section of the nipple base. Mean operative time for ETM was 139 minutes (92-198), and the average ischemic time was 37.3 minutes (range 22-50). Fifty percent of patients underwent deep inferior epigastric perforator, 33.4% underwent MS-2 transverse rectus abdominis musculocutaneous (TRAM), 8.3% underwent MS-1 TRAM, and 8.3% underwent pedicled TRAM flap reconstruction. No cases required re-exploration, no flap failure occurred, margins were clear, and no skin or nipple-areolar complex ischemia/necrosis developed. In the aesthetic outcome evaluation, 16.7% were excellent, 75% good, 8.3% fair, and none were unsatisfactory. No recurrences were observed. ETM through a minimal-access inferior mammary or mid-axillary line approach, followed by immediate pedicled TRAM or free abdominal-based perforator flap reconstruction, can be a safe means of achieving an "aesthetically scarless" mastectomy and reconstruction through minimal incisions.

Modified Reconstruction of The Proximal Tibiofibular Joint Using Iliotibial Band: A Case Report

Introduction: Instability of the proximal tibiofibular joint is a rare condition and may present with an atypical presentation due to its location and symptoms. Recent techniques and graft has allowed to repair tibiofibular joint. Iliotibial band autograft might be used as a choice for this case as its characteristic, cost effectiveness, minimal invasive graft harvesting procedure, and long term outcome bring consideration to use as choice for the treatment. Objective: To introduce the new technique for PTFJ instability by using ITB graft Case report: A 21-year-old office worker male came to our clinic with discomfort on lateral aspect of right knee. He injured his right knee after he externally twist his right knee when he was going to wake up (stand up) from bed. He experienced immediate lateral pain and swelling lateral knee pain persisted until 1 week before admitted to the hospital. Discussion: In our case, patient is a office worker without an adequate energy cause the joint becoming sublux. For the surgical technique , we took the graft form the center side of ITB with the intentional purpose of preventing Kaplan Fiber. For the reaming procedure we took place directly behind the fibula and keep the posterior capsule intact to prevent further damage and infection on surgical site. We choose to use biomaterial implant for this study because the use of biomaterial screw itself has a low complication rate compare to metallic screw with no significant different in outcome (6). This technique overall has a satisfaction result with improvement of Lyshom score Conclusion: Iliotibial band is an alternative graft that can be used for reconstruction in tibiofibular joint. For its minimal invasive technique and cost effectiveness and satisfy long term outcome coud be a consideration for the treatment in tibiofibular instability.

Echocardiographic right ventricular evaluation in cardiac surgery patients undergoing mitral valve reconstruction: a single center prospective observational study.

Mitral valve (MV) regurgitation (MR) is the second most frequent indication for valvular surgery in Europe. Right ventricular (RV) dysfunction is a common finding after cardiac surgery and might persist for years. The RV-function after MV surgery has been controversially discussed. We therefore aimed to evaluate early RV-performance in patients undergoing MV surgery. Between 09/2020 and 06/2022, ninety-two patients presenting with MR undergoing MV surgery were consented and prospectively included for evaluation. Echocardiographic evaluation was performed one day before surgery, one week after surgery and three months later. Primary endpoints reported RV-function changes including tricuspid annular plane systolic excursion (TAPSE), RV systolic prime (S') and fractional area change (FAC). Secondary endpoints included stability of MV repair, changes in left ventricular functions and early mortality. Mean patients' age was 59.1±11.4 years. Fifty-five (59.7%) patients were male. Most of patients presented with severe (n=88; 95.7%) MR. Mean systolic pulmonary artery pressure was 35.6±15.7 mmHg. Moderate or severe pulmonary arterial hypertension (PAH) was present in 60 (65.2%) patients. Patients underwent either isolated MV surgery (n=67; 72.8%) or combined with tricuspid valve surgery (n=25; 27.2%). Minimal invasive surgery was performed in 26.1% (n=24) of the patients. Postoperative short-term follow-up at 3 months reported RV-dysfunction in 44.5% (n=41) of the patients as indicated by reductions in TAPSE & RV S' from 21.2±4.7 to 14±3.3 mm (P<0.001) and from 14.7±4.3 to 9.7±2.8 cm/s (P<0.001) respectively. The FAC reduction from 42.9%±9.6% to 42.2%±9.9% was non-significant (P=0.593) and no need for redo mitral or tricuspid valve surgery was reported. Finally, the presence and severity of preoperative PAH played significant roles for the incidence of RV dysfunction, P=0.021 and P=0.047, respectively. Minimal invasive surgical procedure significantly reduced the incidence of postoperative RV-dysfunction (P=0.013). Study early results report a significant reduction of RV-function after MV surgery as measured by TAPSE, & RV S', even when the FAC remains unchanged. Even though, this finding has limited prognostic implications during an uneventful surgical course.

Comparison of percutaneous gallbladder aspiration with percutaneous cholecystostomy in acute cholecystostomy patients. Can gall bladder aspiration alone be sufficient?

The aim of this study is to compare the efficacy and complication rates of percutaneous gallbladder aspiration (PA) and percutaneous cholecystostomy (PC) in the management of AC and present the experiences of a single third-line center. The results of 159 patients with AC who admitted to our hospital between 2015 and 2020, that underwent PA and PC procedures, because they did not respond to conservative treatment and LC could not be performed, were retrospectively analyzed. Clinical and laboratory data before and 3 days after PC and PA procedure, technical success, complications, response to treatment, duration of hospital stay, and reverse transcriptase-polymerase chain reaction (RT-PCR) test results were recorded. Out of 159 patients, 22 (8 men 14 women) underwent PA procedure and 137 (57 men 80 women) underwent PC. No significant difference was detected between the PA and PC groups in terms of clinical recovery (P: 0.532) and duration of hospital stay (P: 0.138) in 72 h. The technical success of both procedures was 100%. While 20 out of 22 patients with PA were having a noticable recovery, only one was treated with twice PA procedures and a complete recovery was observed (4.5%). Complication rates were low in both groups and were statistically insignificant (P: 1.00). In this pandemic period, PA and PC procedures are effective, reliable, and successful treatment method that can be applied at the bedside for critical patients with AC who are not compatible with surgery, which are safe for health workers and low-risk minimal invasive procedures for patients. In uncomplicated AC patients, PA should be performed, and if there is no response to treatment, PC should be reserved as a salvage procedure. The PC procedure should be performed in patients with AC who have developed complications and are not suitable for surgery.

Surgical Treatment of Pancreatic Cancer: Currently Debated Topics on Vascular Resection.

Vascular resections involving the superior mesenteric and portal veins (SMV-PV), celiac axis (CA), superior mesenteric artery (SMA) and hepatic artery (HA) have multiplied in recent years, raising the resection rate for pancreatic cancer (PDAC) and the related morbidity and mortality rates. While resection is generally accepted for resectable SMV-PV, the usefulness of associated arterial resection in borderline resectable (BRPC) and locally-advanced PDAC (LAPC) is much debated. Careful selection of splenic vein reconstruction is very important to prevent left-sided portal hypertension (LSPH). During distal pancreatectomy (DP), CA and common HA resection is largely accepted, while there is debate on the value of SMA and proper HA resection and reconstruction. Their resection is useless according to several reviews and meta-analyses, and some international societies, although some high-volume centers have reported good results. Short- and long-term reconstructed vessel patency varies with the type of reconstruction, the material used, and the surgeon's experience. Laparoscopic and robotic pancreaticoduodenectomy and DP are generally accepted if done by surgeons performing at least 10 such procedures annually. The usefulness of associated vascular resection remains highly controversial. Surgeons need to complete numerous minimally-invasive procedures to overcome the learning curve, and prevent an increase in complications and surgical mortality. Higher resectability rates and satisfactory long-term results have been reported after neoadjuvant therapy (NAT) for BRPC and LAPC requiring vascular resection. It is essential to select the most appropriate NAT for a given patient and to assess PDAC resectability preoperatively.

High-Definition Liposculpture 18-Year Evolution: Patient Safety and Aesthetic Outcomes.

High-definition liposculpture (HDL) emerged as an innovative surgical technique that allowed plastic surgeons to achieve improved aesthetic results with a natural and athletic appearance using minimal incisions and with imperceptible scarring. Its targets are high aesthetic standards and patient safety. This article summarizes the evolution of HDL by explaining upgrades to the original technique and comparing the complication rates among them. The authors retrospectively reviewed records from four private medical centers (Evolution Medical Center, Santa Barbara Medical Center, and Dhara Clinic in Bogota and FOSCAL in Bucaramanga, Colombia) of patients who underwent HDL performed by the senior author (A.E.H) over an 18-year period (2002 through 2019). Patients were classified into three groups: suction-assisted lipoplasty (period 1), vibration amplification of sound energy at resonance-assisted HDL (period 2), and dynamic definition liposculpture (period 3). The authors established a cohort of 5052 patients (4300 women and 752 men): 923 in period 1, 1272 in period 2, and 2857 in period 3. The most common complications included seroma, bruising, hematoma, acute anemia, hyperchromia, wrinkled skin, wound dehiscence, and local infections. HDL and dynamic-definition liposculpture procedures are safe and reproducible techniques to achieve an athletic and natural body contour. Complication rates, especially those related to bleeding, decreased as the technique evolved. These procedures are aimed toward patient safety to provide higher aesthetic outcomes using extensive medical, anatomic, artistic, and technological knowledge. Therapeutic, III.

The diagnostic and therapeutic challenges of medial plantar neuropathy in jogger's foot: a case report

Jogger's foot is characterised by a neuropathic pain along the medial arch of the foot caused by compression of the medial plantar nerve. It is more common in runners, especially when there is an anatomical predisposition or some extrinsic factor that may exert compression on the nerve. This article presents the case of a 59-year-old man, who had pain and paraesthesia along the medial plantar arch of the left foot, lasting for several months. Despite having undergone some conservative treatments (plantar orthosis and physiotherapy) and minimal invasive procedures (cortico-anaesthetic injection and shockwave therapy) the symptoms persisted and amyotrophy of the abductor hallucis muscle became clinically evident. At this point, a magnetic resonance image was taken, showing compression of the medial plantar nerve at the intersection of the flexor hallucis longus and the flexor digitorum longus tendons. Ultrasound-guided treatment with pulsed radiofrequency of the medial plantar nerve was then proposed to try and modulate his chronic neuropathic pain. After the procedure, the patient reported immediate relief of the symptoms, which were maintained over 6 months of follow up after the procedure. This case report illustrates a rare and frequently misdiagnosed cause of midfoot pain and its management using electromagnetic modulation of peripheral nerves by pulsed radiofrequency. This seems to be an effective technique, with long-lasting results.

Needle consideration in umbilical two-port laparoscopic percutaneous extraperitoneal closure for patent processus vaginalis of children: hook-needle or forcep-needle

BackgroundAlthough umbilical two-port laparoscopic percutaneous extraperitoneal closure for the treatment of processus vaginalis patency of children has been verified to be safe and effective, the improvements of technical skills and instruments have been always on their ways. Recently, forcep-needle has begun to be used. In this study, we compared forcep-needle with hook-needle in this minimal invasive procedure for children suffered from hernia or hydrocele, with the aim to evaluate the instrumental convenience of the two needles.MethodsFrom July 2021 to May 2022, we begun to use hook-needle or forcep-needle in umbilical two-port laparoscopic percutaneous extraperitoneal closure for children suffered from hernia or hydrocele. The hook-needle group included nineteen children and the forcep-needle group included twenty-four ones. The data of the patients age, sex, side, operation time, postoperative hospital-stay, follow-up time, postoperative complications were evaluated. Common silk thread was used to encircle the internal ring preperitoneally.ResultsThere were no statistical differences between the two groups for the following items: age, sex, side, operation time, postoperative hospital-stay and postoperative complications (P > 0.05). The follow-up time of the hook-needle group was longer than that of the forcep-one (P = 0.0020). No open transfer happened for all the patients. One hydrocele boy in the hook-needle group reoccurred 1 month postoperatively due to the peritoneal broken. The single pole retreating of the hook-needle accompanied with chaotic movements, while for that of the forcep-needle, the double-arm retreating movements were more orderly. The outer surface of the forcep-needle was smooth without restrain, as for the hook-needle, an inlaid barb held the danger of brokening the peritoneum.ConclusionIn our preliminary experience of umbilical two-port laparoscopic percutaneous extraperitoneal closure using a hook-needle or a forcep-needle, in view of the instrumental convenience and safety, the double-arm and smooth outer surface designs of the forcep-needle contained more spatial orientation perceptions and safety.

Development of a minimal invasive surgical procedure for stress urinary incontinence

Development of a minimal invasive surgical procedure for stress urinary incontinence

Analogical Evaluation of Endoscopic Septoplasty in Posterior Septal Deviation

Background: Deviated Nasal Septum is one of the pronounced causes of Nasal Obstruction. A number of surgeries are being done since decades to alleviate symptoms. Recent advancement with endoscopes has revolutionized the surgical approach towards minimal invasive procedures. Aim: To analyze the post-op hospital stay and complications in headlight vs. endoscopic septoplasty Study design: The study is Cross sectional Randomized Control Trial. Place and duration of study: We conducted this study in ENT Unit I of Jinnah Hospital Lahore from June 2021 to January 2022. The follow up time was 2 months. Methodology: We performed this study on 30 patients who were diagnosed with Posterior Septal deviation. We randomly divided the patients into two groups. Group A was to undergo trans-nasal trans-speculum (TNTS) septoplasty while group B, endoscopic septoplasty. We analyzed the outcomes in the form of incidence of anterior nasal packing, post-op hospital stays and rate of adhesion formation. Results: We concluded that in Group A, nasal packing was required in 14(93.3%) patients, adhesion formation in 2(13.3%) patients and the mean post-operative hospital stay was 2.13±0.352 days while in Group B, only 3(20%) patients needed anterior nasal packing, none developed post-surgical adhesion formation and the mean postop hospital stay was 1.00±0.000 days. Practical implication: This study delineated that endoscopic septoplasty once mastered is far superior to Endonasal Conventional septoplasty and must be adopted in all public and private sectors to improve cost-effectiveness. Conclusion: We concluded that endoscopic septoplasty is far superior to trans-nasal trans-speculum (TNTS) septoplasty when post-op hospital stays and incidence of nasal packing was concerned in posterior septoplasty. However, there was no statistical difference in terms of post-surgical adhesion formation among the two studied groups. Keywords: Endoscopic Septoplasty, Trans-nasal trans-speculum (TNTS) septoplasty, Deviated Nasal Septum

Characteristics of Patients with Ventricular Septal Defect that Had Been Closed with Transcatheter in Dr. Soetomo General Hospital from January 2019 to December 2021

VSD is the most common congenital heart disease in newborns. VSD can close spontaneously in the early years of life. However, VSD can not close spontaneously in a few patients and cause complications so that it is necessary to perform VSD closure earlier, one of all options is transcatheter. Transcatheter is a minimal invasive procedure with a high success rate and safety also the incidence of cardiorespiratory disturbances are less while using transcatheter devices making it an alternative intervention for VSD closure. This study aims to determine the outcome characteristics and complications of VSD closure with transcatheter intervention. This study was a descriptive observational study using a cross-sectional design with a retrospective approach, based on secondary data. Sampling was done by total sampling technique. A sample of 27 patients was obtained with a mean age of 4.48 ± 3,298 years, an average weight of 17.70 ± 10.5550 kg, and male sex dominated by 55.6%. The most common type of VSD that was closed with a transcatheter was the perimembranous type of 70.4% and the size of the VSD was dominated by the medium size of 85.2%. The transcatheter VSD closure was successful in 24 patients (88.9%) and failed in three (11.1%). Residual shunt developed in one of three patients who failed. The most common complication was arrhythmia with NSVT type of 62,96%. Other complications were PVC 7.4%, aortic valve regurgitation 3.7%, and hypotension 3.7%. Closure of VSD by transcatheterization has a high success rate, no death is found, and there are no major complications that require long-term or life-threatening therapy. All complications found only occurred during transcatheterization, i.e. arrhythmia, mild aortic valve regurgitation, and hypotension.

Clinical analysis of 59 cases of pediatric nasal dermal sinus cysts with midfacial infection as the first symptom

Objective:To review the clinical and radiological presentation and management of infected nasal dermal sinus cysts（NDSC） in children. Methods:Clinical data were collected from 59 NDSC children with secondary fronto-orbital area infection who presented to Beijing Children's Hospital from January 2007 to December 2021. All patients underwent preoperative imaging workup, including MRI and CT. All patients underwent endoscopic excision of a NDSC under general anesthesia. Results:A total of 59 patients were included in the study,while 58 presented with a sinus, 1 presented with a cyst.The main lesions of NDSC included nasal root in 20 cases （33.9%）, nasal bridge in 34 cases （57.6%）, nasal tip in 4 cases （6.8%）, and nasal tip and nasal root in 1 case （1.7%）. The depth of lesions included 6 cases （10.2%） of superficial type of nasal frontal bone, 33 cases （55.9%） of nasal frontal bone, 19 cases （32.2%） of intracranial epidural type, and 1 case （1.7%） of intracranial epidural type. The main sites of infection included inner canthus in 15 cases （25.4%）, nasal dorsum in 22 cases （37.3%）, nasal root in 16 cases （27.1%）, and forehead in 6 cases （10.2%）. Among 59 cases, 7 cases （11.9%） were complicated with other diseases, and 4 cases（6.8%） had external nasal deformities. Surgical approaches included transverse incision in 12 cases（20.3%）, minimal midline vertical incision in 41 cases （69.5%）, external rhinoplasty in 4 cases （6.8%） and bicoronal incision with vertical incision in 2 cases （3.4%）. The range of lesions was completely consistent with MRI results.All cases were successfully operated without one-stage nasal dorsum reconstruction. All patients were followed up from 7 to 173 months（average 52.2 months）. There were 6 cases of recurrence, all of which were in situ recurrence. The operation was performed again, and no recurrence has occurred since the follow-up, No nasal deformity was noted, and cosmetic outcome were favorable for all patients. Conclusion:NDSC infection in children with midfacial infection as the first symptom is rare in clinical practice, and its manifestations are diverse. Early diagnosis and rational treatment are very important to improve the cure rate.Preoperative high resolution MRI combined with CT scanning is of great significance in judging the course of NDSC, especially the intracranial extension. The treatment goal is to achieve minimally invasive and individualized treatment under the premise of complete excision of the lesion, and take into account the cosmetic needs.