Percutaneous Endoscopic Technique Research Articles

Comparative efficacy of unilateral biportal and percutaneous endoscopic techniques in unilateral laminectomy for bilateral decompression (ULBD) for lumbar spinal stenosis

BackgroundUnilateral laminotomy for bilateral decompression (ULBD) has yielded positive results in the treatment of lumbar spinal stenosis (LSS). Unilateral biportal ULBD (UB-ULBD) and percutaneous endoscopic ULBD (PE-ULBD) are gaining popularity because of the progress that has been made in minimally invasive surgery (MIS). The objective of this study was to evaluate and compare the radiographic and clinical results of UB-ULBD and PE-ULBD.MethodsThis study retrospectively enrolled patients who underwent ULBD surgery for LSS. The patients were categorized into two groups on the basis of the surgical method: the UB-ULBD group and the PE-ULBD group. Data on the general demographic data, surgical details, clinical efficacy, radiography and complications were compared between the two groups were compared. The minimum follow-up duration was 12 months.ResultsA total of 113 LSS patients who had undergone ULBD at our institution were included, of whom 61 patients underwent UB-ULBD surgery and 52 underwent PE-ULBD surgery. The UB-ULBD group had a significantly shorter operation time (P < 0.05). The facet was significantly better preserved in the UB-ULBD group than in the PE-ULBD group, and the angle of ipsilateral facet joint resection in the UE-ULBD group was significantly smaller (P < 0.05). The ODI score, VAS score and modified Macnab criteria improved postoperatively in both groups. The UB-ULBD group had a 95.08% rate of excellent or good patient outcomes, whereas the PE-ULBD group had a 92.30% rate.ConclusionBoth UB-ULBD and PE-ULBD can provide favourable clinical outcomes when used to treat LSS. UB-ULBD is beneficial because of its shorter operation time, smaller angle of ipsilateral facet joint resection and better facet preservation, making it a viable and safe option for treating LSS while ensuring spinal stability.

Transpedicular Percutaneous Discectomy for High-Grade Down-Migrated Lumbar Disc Herniation

Objective: The purpose of this study was to evaluate the clinical outcomes of percutaneous endoscopic discectomy using the transpedicular approach for hernias with down-migration.Methods: The study involved a retrospective descriptive analysis of 7 patients who underwent surgery by 2 senior surgeons at 4 different hospitals between 2016 and 2024. The minimum follow-up period was 6 months. All patients were treated with lumbar discectomy through a transpedicular approach with an oblique trajectory. Preoperative and postoperative clinical data were collected for statistical analysis.Results: The surgical procedures were successful and complication-free for all patients. The preoperative and postoperative radicular visual analogue scale and Oswestry Disability Index scores were compared, and the differences were statistically significant (p&lt;0.05).Conclusion: At the last follow-up, 100% of patients had good to excellent results according to the modified MacNab criteria. The transpedicular approach, when using a percutaneous endoscopic technique, requires precise surgical planning and accurate knowledge of the vertebral anatomy. The technique can be made more accessible to inexperienced surgeons by describing it with different instrumentation.

Percutaneous spinal cord stimulation cylindrical lead placement for managing refractory neuropathic pain: A case series with an endoscopic-assisted approach.

The paddle lead (PL) and cylindrical lead (CL) remain the main implant categories in spinal cord stimulation (SCS) for treating neuropathic pain. Surgeons often complain about the greater trauma associated with PL implantation, while percutaneous endoscopic technique offers a promising approach for minimizing the trauma associated to PL implantation. However, there remains a dearth of real-world case study on endoscopy-assisted CL implantation. This study aimed to demonstrate the endoscopic-assisted approach and outcomes of CL implantation in SCS for managing neuropathic pain. A retrospective case series. Patients aged 18 years and above with chronic neuropathic pain persisting for at least three months, refractory to standardized conservative treatment, were enrolled between January 2021 and March 2023. The surgical key steps including puncture, working cannula placement, endoscopic laminotomy and endoscopic CL introduction were demonstrated. Characteristics as demographics, follow-up time, visual analog scale (VAS) score, pain disability index (PDI) score and patient-reported outcomes measurement information system (PROMIS) scale were assessed. Successful CL implantation under endoscopy was achieved in all patients, including 3 with failed back surgery syndrome, 2 with complex regional pain syndrome and 2 with chronic pelvic pain. No spinal cord injuries, dural tears, lead migration, lead fractures, or postoperative infections were observed. VAS score of regional pain, PDI score as well as PROMIS of patient's quality of life were all significantly improved after surgery. Percutaneous endoscope-assisted CL implantation offered a new alternative technique for SCS in managing neuropathic pain.

To push or to pull? A clinical audit on the efficacy and safety of the pull and push percutaneous endoscopic gastrostomy techniques in oncological patients.

The peroral "pull" technique and the direct "push" procedure are the two main methods for percutaneous endoscopic gastrostomy (PEG) placement. Although pull-PEG is generally recommended as the first-line modality, many oncological patients require a push-PEG approach to prevent tumor seeding or overcome tumor-related obstruction. We aimed to compare the efficacy and safety of both PEG procedures in cancer patients. We retrospectively analyzed all consecutive PEG procedures within a tertiary oncological center. Patients were followed up with the hospital databases and National Cancer Registry to assess the technical success rate for PEG placement, the rate of minor and major adverse events (AEs), and 30-day mortality rates. We compared those outcomes between the two PEG techniques. Finally, risk factors for PEG-related adverse events were analyzed using a multivariable Cox proportional-hazard regression model adjusted for patients' sex, age, performance status (ECOG), Body Mass Index (BMI), diabetes, chemoradiotherapy (CRT) status (pre-/current-/post-treatment), and type of PEG. We included 1055 PEG procedures (58.7% push-PEG/41.4% pull-PEG) performed in 994 patients between 2014 and 2021 (mean age 62.0 [±10.7] yrs.; 70.2% males; indication: head-and-neck cancer 75.9%/other cancer 24.1%). The overall technical success for PEG placement was 96.5%. Although the "push" technique had a higher rate of all AEs (21.4% vs. 7.1%, Hazard Ratio [HR] =2.9; 95% CI=1.9-4.3, p<0.001), most of these constituted minor AEs (71.9%), such as tube dislodgement. The methods had no significant difference regarding major AEs and 30-day mortality rates. Previous CRT was associated with an increased risk of major AEs (hazard ratio=2.7, 95% CI=1.0-7.2, p=0.042). The risk of major AEs was comparable between the push- and pull-PEG techniques in cancer patients. Due to frequent tube dislodgement in push-PEG, the pull technique may be more suitable for long-term feeding. Previous CRT increases the risk of major AEs, favoring early ("prophylactic") PEG placement when such treatment is expected.

Removal of discal cyst using percutaneous full endoscopic via interlaminar route: a case report

BackgroundDiscal cyst, a rare disease with unclear pathogenesis, exhibits symptoms similar to lumbar disk herniation. Currently, there is no consensus on the optimal treatment for this condition.Case presentationThis report presents the clinical efficacy of the percutaneous endoscopic interlaminar approach surgery technique in patients diagnosed with lumbar 4–5 discal cyst. The patient exhibited sub-acute radiculopathy in the left leg accompanied by weakness of the extensor hallucis longus. Magnetic resonance imaging of the lumbar spine confirmed the presence of lumbar discal cysts, which exerted compression on the traversing nerve root. Surgical treatment involved performing percutaneous endoscopic interlaminar approach surgery without additional discectomy under general anesthesia. The symptoms were immediately alleviated following the removal of the discal cysts, and the weakness in the toe improved the day after the surgery. No recurrent symptoms or complications were observed during the 6-month follow-up period.ConclusionBased on our findings, we posit that percutaneous interlaminar endoscopic surgery represents a safe, minimally invasive, and appropriate approach for treating discal cysts.

Clinical Efficacy and Safety of Percutaneous Spinal Endoscopy versus Traditional Open Surgery for Lumbar Disc Herniation: Systematic Review and Meta-Analysis.

Objective Systematic analysis of the incidence of percutaneous spinal endoscopic technique and traditional open surgery for lumbar disc herniation. Methods A randomized controlled trial (RCT) and cohort study on complications related to traditional open surgery was searched on the MEDLINE, Cochrane Library, PubMed, Web of Science, Chinese journal full-text database (CNKI), Wanfang, and Embase database. Language is not limited. The quality of each study was evaluated, various complications were compiled into electronic baseline tables, and the data from these studies were available. Meta-analysis and synthesis were performed with the RevMan 5.3 software to evaluate the statistical significance of both surgical techniques in terms of various complications. Results 12 studies were eventually included, and a total of 2,797 patients were included in the analysis. Meta-analysis results showed that there was no statistical difference in postoperative paresthesia between percutaneous spinal endoscopy and traditional open surgery (OR = 1.17, 95% CI (0.82, 1.66), P = 0.38, I2 = 0%, Z = 0.88), direct nerve root damage (OR = 0.79, 95% CI (0.58, 1.07), P = 0.13, I2 = 73%, Z = 1.52), and intraoperative hemorrhage and hematoma formation (OR = 1.00, 95% CI (0.67, 1.48), P = 0.99, I2 = 0%, Z = 0.02), but there was a statistical difference in disc recurrence (OR = 2.24, 95% CI (1.56, 3.21), P < 0.0001, I2 = 81%, Z = 4.39). Conclusion Compared with the traditional open surgical treatment of lumbar disc herniation, percutaneous spinal endoscopic technology has obvious advantages in reducing nerve root injury, dural injury, and surgical area wound complications, but it is limited to preventing the technical characteristics of the surgical site, which is worse than that of open surgery.

A clinical case of surgical treatment of a gunshot blind penetrating complicated wound at the level of vertebrae CI—CII using percutaneous video endoscopic technique

<h3></h3> Приведен краткий обзор литературы по огнестрельным ранениям позвоночника и спинного мозга. В последнее время отмечается рост частоты огнестрельных позвоночно-спинномозговых ранений в связи с изменением характера и распространенности боевых действий, совершенствованием систем артиллерийского и стрелкового оружия. При анализе источников литературы выявлен дефицит работ, демонстрирующих ранения шейного отдела и краниовертебральной области. В представленном клиническом наблюдении показаны возможности чрескожной видеоэндоскопической хирургической техники для удаления металлического инородного тела (осколка) из позвоночного канала верхнешейного отдела позвоночника с симптоматикой ушиба спинного мозга. При этом созданы благоприятные условия для заживления послеоперационной раны и уменьшения числа возможных инфекционных осложнений, не нарушена стабильность позвоночного столба, у пациента отмечен регресс неврологических нарушений в раннем периоде травмы.

Transgastric Drainage for Esophageal Injuries: A Dynamic Strategy for a Heterogenous Patient Cohort.

Esophageal injury is a rare but potentially lethal surgical emergency. It is associated with significant morbidity and mortality because of mediastinal contamination and difficulty of access. Surgery in such septic patients exacts a heavy physiological price, mandating consideration of more conservative measures. We review our experience with transgastric drainage for esophageal perforation and high-risk anastomotic dehiscence. A select cohort of patients presenting with esophageal perforation, or complex anastomotic leaks, over 10 years were considered for transgastric drainage (TGD). A modified 36F chest drainage tube was inserted by percutaneous endoscopic gastrostomy technique, either endoscopically or at open surgery, and a negative pressure (-10 cmH2O) was applied until the leak had sealed. Endpoints include, length of stay, restoration of gastrointestinal tract continuity and mortality. Of 14 patients treated, 10 had perforations and 4 had complex anastomotic leaks. Ten patients had drainage alone, while 4 required concomitant operative intervention. The median duration of drain insertion for those treated with TGD alone was 19.5 days. Complete restoration of gastrointestinal tract continuity was achieved in all patients. There was no procedure-related morbidity or mortality. These results show that TGD is a safe and effective management strategy. We advocate its use alone or as an adjunct to operative treatment for esophageal perforation or anastomotic leaks. This is the first report of completely endoscopic TGD for esophageal perforation.

Radiologically Inserted Gastrostomy (RIG) at a Tertiary Center: Periprocedural Safety including Rationalization of Antibiotic Prophylaxis

Abstract Introduction Long-term percutaneous enteral nutrition forms an important part of treatment for patients with an inability to meet nutrient requirements orally. Radiologically inserted gastrostomy (RIG) is an alternative to the traditionally performed percutaneous endoscopic gastrostomy technique. However, there is marked heterogeneity in the way that RIG is performed. In addition, the role for antibiotic prophylaxis during RIG insertion is not clearly established. This study aimed to assess the safety of RIG insertion using our technique including the role of antibiotics in RIG insertion. Method Retrospective study over 5 years at a tertiary teaching hospital. Periprocedural or early complications within the first 2 weeks of the procedure were collected and correlated with the use of prophylactic antibiotics. Results A total of 116 patients met the inclusion criteria. 18-French tube was used in 96.6%. Note that 58.6% of procedures were done with intravenous sedation. Prophylactic 1 g cefazolin was used in 70 patients with 1 case of infection. Procedures were performed without antibiotics in 46 patients with 3 infections, p = 0.20.There were two major complications (1.7%) consisting of right gastric artery injury requiring embolization and gastric wall injury requiring laparotomy. There were 12 minor complications (10.3%) including 4 cases of infection, 3 of severe pain, 1 of minor bleeding, 2 of early dislodgement, and 2 of leak/bypass of gastric contents around the tube. Conclusion The technique used for RIG insertion at our institution results in a low complication rate. In addition, this study shows no significant difference in early peristomal infection rate with the use of antibiotic prophylaxis.

Novel Tracheostomy and Percutaneous Endoscopic Gastrostomy Technique for COVID-19 Patients in a Nonnegative Pressure Environment.

Novel Tracheostomy and Percutaneous Endoscopic Gastrostomy Technique for COVID-19 Patients in a Nonnegative Pressure Environment.

Percutaneous endoscopic gastrostomy (PEG) versus radiologic percutaneous gastrostomy (RPG): comparison of the results in our center in the last year

Rationale: Gastrostomy tube for enteral nutrition is placed more frequently by percutaneous application, either endoscopic (PEG) or radiologic technique (RPG). The rationale of our study is to compare the complications of all the patients who underwent both procedures in our hospital during year 2019.

A Historical Review of Endoscopic Spinal Discectomy

As an essential component of minimally invasive spine surgery, endoscopic spine surgery (ESS) has continuously evolved and has been accepted as a practical procedure by the worldwide spine community. Especially for lumbar disc herniation (LDH), the percutaneous endoscopic or full-endoscopic discectomy technique has been scientifically proven through randomized controlled trials and meta-analyses to be a good alternative to open discectomy. The initial concept of endoscopic spine discectomy was concerned with indirect disc decompression using various instruments such as blind forceps, a nucleotome, laser, radiofrequency coblation, and some chemical agents. The main surgical field has been shifted from the intradiscal space to the epidural space. Precise and selective discectomy for extruded LDH in the epidural space under high-quality endoscopic visualization is now feasible. Furthermore, the medical applications of ESS is broadening to include spinal stenosis, segmental instability, infection, and even intradural lesions. In this review article, I describe the history of endoscopic spine discectomy and decompression techniques, as well as evolution of the paradigm. This history may help indicate the future of practical ESS.

Percutaneous Endoscopic Surgery for Lumbar Discal Cyst: Two Case Reports

Discal cyst is a rare disease, the pathogenesis is not yet clear and its symptoms are very similar to lumbar disc herniation. Although some cases may regress spontaneously, most cases of lumbar discal cysts are treated surgically. At present, there is no consensus on the treatment of this disease. The authors report the clinical usefulness of the percutaneous endoscopic transforaminal surgery technique in two patients with the lumbar 4-5 discal cyst. The clinical symptoms of both patients were unilateral lower extremity pain and lower back pain. Magnetic resonance imaging of the lumbar spine revealed lumbar discal cysts, causing compression to the spinal dura and roots. Both patients received conservative treatment for more than 6 months, but the clinical symptoms persisted so surgical treatment by percutaneous endoscopic transforaminal surgery without additional discectomy was performed under local anesthesia. The symptoms were relieved immediately after removal of the discal cysts. Postoperative magnetic resonance imaging showed that both patients had complete excision of discal cysts and complete decompression of the treated segmental. There were no recurrent lesions and complications during the follow-up period. We believe that percutaneous transforaminal endoscopic surgery could be a safe, mini-invasive and appropriate method for the treatment of discal cysts. J Med Cases. 2020;11(6):178-181 doi: https://doi.org/10.14740/jmc3474

Endoscopic Unilateral Laminotomy with Bilateral Discectomy Using Biportal Endoscopic Approach: Technical Report and Preliminary Clinical Results

Bilateral or huge disc herniations cause bilateral radiculopathy and severe lower back pain. In such cases, a bilateral discectomy may be required to resolve the radicular pain in both legs. We attempted a surgical technique involving bilateral lumbar discectomy via a unilateral approach using a percutaneous biportal endoscopic technique. The purpose of the present study was to describe our surgical technique and investigate the clinical outcomes in symptomatic bilateral lumbar disc herniation. Eleven patients with bilateral disc herniation of the L4-L5 or L5-S1 segments were surgically treated using the percutaneous biportal endoscopic approach. Biportal endoscopic unilateral laminotomy with bilateral discectomy was performed in all patients. Postoperative magnetic resonance imaging was performed 1 day after surgery, and the clinical parameters were investigated preoperatively and postoperatively. All enrolled patients were successfully treated by biportal endoscopic bilateral discectomy via a unilateral approach. Surgery was performed at the L4-L5 level in 1 patient and the L5-S1 level in 10 patients. The mean operative time was 67.5 ± 13.1 minutes. A visual analog scale of leg pain and the Oswestry disability indexshowed significant improvement after surgery (P<0.05). Endoscopic unilateral laminotomy with bilateral discectomy using the percutaneous biportal endoscopic approach could be an effective and alternative treatment of symptomatic bilateral herniated disc disease affecting L4-L5 or L5-S1 segments.

Diagnostic Role of Selective Spinal Nerve Block in Treatment of Lumbar Spine Diseases by Percutaneous Endoscopic Technique.

To assess the role of our modified selective spinal nerve block (SSNB) procedure to predict the results of the subsequent Percutaneous endoscopic transforaminal lumbar surgeries (PETLS). We retrospectively analyzed data of patients who underwent our modified SSNBs before PETLS from February 2013 to March 2018 Clinical outcome data were collected 3 days after PETLS and at follow-up visits. A total of 120 modified SSNB procedures (transforaminal-78 paravertebral-24, and interlaminar-18) in 92 patients presented positive response. The median follow-up period was 30.6 months. Based on Macnab criteria, the overall success rate (excellent and good results) was 83.7%. Fair and poor outcomes were observed in 10 and 5 patients, respectively. Patients with atypical extraforaminal herniations, and patients with two-level or multiple-level lumbar disc herniations or stenosis achieved desirable results after PETLS. There was significant improvement in the average VAS score for the leg three days after surgery (7.38±0.97 vs. 1.96 ±1.17, p < 0.05) and on follow-up visits (1.21 ± 0.83, p < 0.05). ODI was also significantly improved three days after surgery (37.20 ± 2.36 vs. 10.95 ± 2.25, p < 0.05 and at follow-up visits (8.90 ± 1.72, p < 0.05) CONCLUSION: The needle tip should be located closely near the intended compressed nerve via suitable approach combined with slowly injecting 1 ml lidocaine (1%) when performing our modified SSNB technique. It presents an alternative diagnostic procedure to identify the origin of pain of complicated lumbar diseases and to predict PETLS outcomes.

Epiduroscopic intervention in patients with a failed back surgery syndrome

Epiduroscopy is a percutaneous endoscopic technique with an interesting diagnostic and therapeutic potential. The study was aimed to evaluate the effectiveness of this modern minimally invasive method in treating pain together with the accompanying neurological symptoms of patients with a failed back surgery syndrome (FBSS). In the retrospective multicentre clinical study, we monitored the effect of epiduroscopic performance in 40 patients with FBSS before epiduroscopy and after 6 and 12 months. The results of the study indicated a significant improvement in back pain after 6 months, at p<0.05. At the same time, a significant improvement was observed in pain radiating to the lower limbs after 6 and 12 months at p<0.05, as well as a significant improvement in the Oswestry Disability Index of the limbs after 6 months and after 12 months (p<0.05). The current summarised results indicate a significant positive effect of epiduroscopy in the treatment of chronic back pain with a reduction in radiating pain to the lower extremities and an increase in patients' quality of life after the procedure (Tab. 2, Fig. 1, Ref. 23).

Initial Experience and Analysis of Outcomes Using the Visualized Percutaneous Endoscopic Lumbar Discectomy Technique for the Treatment of Lumbar Disc Herniation.

To introduce a visual surgical concept using a retrospective comparison of the outcomes between visualized percutaneous endoscopic lumbar discectomy (V-PELD) and conventional PELD techniques. Data from 61 patients in the conventional PELD group and 55 in the V-PELD group. Data included the duration of the operation, number of intraoperative radiation exposure events, and follow-up information for 24 months. The Oswestry Disability Index (ODI) and visual analog scale (VAS) scores were collected. The mean (± SD) operating time for the V-PELD group was 57.82 ± 11.25 min, and the mean duration of radiation exposure was 0.74 ± 0.32 min. The mean operating time for the conventional group was 63.16 ± 14.49 min (p < 0.05), and the mean duration of radiation exposure was 2.81 ± 1.12 min (p < 0.001). All patients in both groups demonstrated significant improvement in the ODI and VAS scores after surgery (p < 0.05). V-PELD is a minimally invasive surgical technique that involves less radiation exposure and is more efficient for treating lumbar disc herniation.

Re: Liu KC, Yang SK, Ou BR, et al. Using Percutaneous Endoscopic Outside-In Technique to Treat Selected Patients with Refractory Discogenic Low Back Pain

Re: Liu KC, Yang SK, Ou BR, et al. Using Percutaneous Endoscopic Outside-In Technique to Treat Selected Patients with Refractory Discogenic Low Back Pain

Novel intragastric trocar placement by percutaneous endoscopic gastrostomy technique to facilitate pyloromyotomy.

Novel intragastric trocar placement by percutaneous endoscopic gastrostomy technique to facilitate pyloromyotomy.

Effect of minimally invasive percutaneous endoscopic technique in treatment of lum bar disc herniatien and its effect on plasma factor C-reactive protein, creatine phosphokinase and interleukin-6

Effect of minimally invasive percutaneous endoscopic technique in treatment of lum bar disc herniatien and its effect on plasma factor C-reactive protein, creatine phosphokinase and interleukin-6