Rigid Endoscope Research Articles

Transforming Subdural Hematoma Treatment in the Elderly: Insights from an Endoscopic Case Series.

Subdural hematoma (SDH), a critical brain condition, significantly affects the elderly, making traditional surgeries risky due to their length and potential for blood loss. Endoscope-assisted evacuation offers a safer, less invasive alternative by reducing operation time and minimizing damage, providing an effective solution for older patients. This study evaluated six patients treated with endoscopic evacuation for different stages of SDH from August 2019 to July 2023. Selection criteria were based on altered consciousness, lack of severe brain contusion, SDH thickness over 1 cm, or midline shift over 0.5 cm. The technique used a burr hole and rigid lens endoscope for hematoma removal, focusing on shorter surgery times and better outcomes. Patients aged between 63 to 84 years showed no surgical fatalities, with all recovering well by discharge. Hematoma clearance rates were 76.9% at three days, improving to 96.8% after one month. Endoscope-assisted evacuation is a safe, efficient treatment for elderly patients with various stages of SDH, offering a less invasive option with potential for better outcomes. It supports the trend towards minimally invasive neurosurgery, with further research needed to optimize patient selection and understand long-term benefits.

Endoscopic diagnosis of laryngeal precancerous lesions and early laryngeal cancer

ISince laryngeal cancer currently occupies a leading position in frequency of occurrence among all tumors of the upper respiratory tract of modern humans, the importance of its detection at an early stage of development cannot be overestimated. Existing diagnostic methods using rigid endoscopes, including direct and indirect laryngoscopy, have significant limitations in a number of patients. The use of modern video endoscopic technology allows diagnosing precancerous lesions and laryngeal cancer at an early stage of the tumor process, which significantly expands the possibilities of minimally invasive organ-preserving treatment.

Transcranial extraventricular endoscopic surgeries: Expanding the role of endoscope in neurosurgery.

Background and Aim: Transcranial endoscopic surgeries are mainly limited to intraventricular lesions. This study aims to elaborate on the various benefits of transcranial endoscopic surgeries in extraventricular regions of the brain. Methods and Materials/Patients: It is a retrospective study of transcranial extraventricular endoscopic surgeries (TEESs) operated between June 2022 to May 2023. The authors described the surgeries done for brain lesions other than intraventricular lesions as extraventricular surgeries. Access to the intracranial region was obtained through the transcranial approach. The transnasal rigid endoscope was used for the surgeries. The surgery was performed as either pure endoscopic surgery or endoscopic-assisted microscopic surgery. Results: The authors have performed 6 microvascular decompressions using an endoscope. Three pineal tumors, 3 craniopharyngiomas, 1 cerebellopontine angle epidermoid cyst, and 1 petrous neurenteric cyst were excised using an endoscope by transcranial approach. One internal carotid artery bifurcation aneurysm was clipped using an endoscope. All patients improved in the postoperative period. Surgeries were done using the 0-degree and 30-degree endoscopes. The endoscopic eye was able to reach the deep-seated area of surgical interest and authors were able to visualize the structures in a wide panoramic view with good illumination and magnification. There was no misinterpretation of structures. Conclusion: Endoscope can reach the deep-seated extraventricular areas of the brain with a narrow corridor, giving good illumination and magnification at the site of surgery. An endoscope can reach beyond the obstructing anatomical structure and visualize the area behind it. It is used as a complimentary to microscope to access the microscopic invisible areas. It has increased the ease of doing surgery, decreased tissue dissection, decreased complications, and improved surgical results. TEES improves the hand-eye coordination of surgeons in transcranial surgeries and it will help in adapting to exoscope easily

Feasibility of open cholangioscopy with disposable flexible endoscopes.

To determine the feasibility of open cholangioscopy using disposable flexible endoscopes in canine cadavers and describe the surgical approach. Ex vivo experimental cadaveric study. Eight canine cadavers. Cadavers ranging from 5.8 to 43.8 kg underwent open transcholecystic cholangioscopy using a disposable flexible endoscope with a 3.8 mm outer diameter and 1.2 mm working channel and the surgical approach was described. The most distal anatomical region of the biliary tree towards the duodenal papilla that was visualized with the endoscope was recorded in each cadaver. A 2.7 mm rigid endoscope and a 1.9 mm flexible endoscope were also trialed and findings recorded. Endoscopic tools were trialed and their usage recorded. The disposable flexible endoscope was feasible for visualization of the junction of the common bile duct, cystic duct, and hepatic ducts in all eight dogs. Cholangioscopy using a 2.7 mm rigid endoscope did not provide further distal visualization. The 1.9 mm flexible endoscope was able to traverse down to the level of the major duodenal papilla in a 43.8 kg cadaver. Use of certain endoscopic tools can be considered through the disposable flexible endoscope although fluid instillation was affected. A 3.8 mm disposable flexible endoscope could be placed through an open transcholecystic approach to provide intraluminal endoscopic evaluation up to the level of the junction of the common bile duct, cystic duct, and hepatic ducts in dogs without cholecystic disease. Open transcholecystic cholangioscopy with a disposable flexible endoscope could provide a low-cost diagnostic and therapeutic tool in cases of obstructive biliary disease up to the level of the common bile duct.

The Endoscopic Management of Zenker's Diverticulum: A Comprehensive Review.

Zenker's Diverticulum (ZD) is the most common hypopharyngeal diverticulum; however, it is often underdiagnosed. It results from the herniation of the mucosa and submucosa through Killian's Triangle. Dysphagia is the primary symptom, occurring in 80-90% of cases. The primary goal of treatment is to transect the cricopharyngeal muscle (CM) and connect the ZD cavity to the esophageal lumen. Traditional treatments include surgical open transcervical diverticulectomy and CM septomyotomy, using rigid or flexible endoscopes. However, surgery is burdened by technical difficulties and not negligible rates of adverse events (AEs). For this reason, endoscopic techniques for ZD treatment have gained traction in recent years. Flexible endoscopic septum division (FESD), introduced nearly 20 years ago, involves a full-thickness incision of the diverticular septum. The advent of third-space endoscopy has led to the application of these techniques to ZD treatment as well. Zenker-POEM (Z-POEM) and, subsequently, Per Oral Endoscopic Septomyotomy (POES) have been developed. Hybrid techniques, such as Peroral Endoscopic Diverticulotomy (POED) and tunneling-free methods, represent additional ZD treatment options. This review outlines the armamentarium of ZD endoscopic management, summarizing the characteristics of these techniques, their benefits and limitations, and highlighting future research directions.

The Anaesthetic Efficacy of Tetracaine and Oxymetazoline Compared With Co-Phenylcaine in Healthy Individuals.

Nasal anaesthetic-decongestant sprays are commonly used prior to nasal instrumentation, such as flexible and rigid nasal endoscopy. Co-phenylcaine (lignocaine 5%, phenylephrine 0.5%, ENT Technologies Pty Ltd., Melbourne, VIC, Australia) is a combination spray commonly used for this purpose. However, lignocaine is less potent than other local anaesthetics, and both active constituents of Co-phenylcaine have a bitter taste. It was hypothesised that a combination spray containing tetracaine and oxymetazoline would both offer more potent topical anaesthesia and have a better taste. Four anaesthetic-decongestant nasal sprays were tested in 10 healthy participants (Co-phenylcaine, and tetracaine 0.5%, 1% and 2% with oxymetazoline 0.05%). Sensory thresholds were sequentially measured at the head of the inferior turbinate using Semmes-Weinstein monofilaments over the following hour. Participants also rated taste on a Likert-style scale, and reported whether they experienced subjective numbness of the maxillary teeth. A median peak sensory threshold of 60 g (the maximum tested) was observed with Co-phenylcaine, but this threshold was exceeded by all the tetracaine-based sprays. Tetracaine 2% with oxymetazoline 0.05% had a significantly more rapid onset than Co-phenylcaine (4 min vs. 6 min, p < 0.05) and a longer duration of action. Eight participants reported dental numbness after administration of tetracaine 2% with oxymetazoline 0.05%, but only one participant after Co-phenylcaine. Tetracaine-based sprays were generally perceived to taste less unpleasant than Co-phenylcaine. Tetracaine 2% with oxymetazoline 0.05% is a more potent and rapidly acting anaesthetic-decongestant spray than Co-phenylcaine, with a longer duration of action.

Studying on the in vivo pathological evolution of spinal cord injury with the rat model by the method of integrated multispectral imaging and Raman spectroscopy

Spinal cord injury (SCI) is a debilitating neurological and pathological condition that results in significant impairments in motor, sensory, and autonomic functions. By integrating multispectral imaging (MSI) with Raman spectroscopy, a label-free optical methodology was developed for achieving a non-invasive in vivo understanding on the pathological features of SCI evolution. Under the guidance of captured the spectral imaging data cube with a rigid endoscope based MSI system, a special designed fiber probe passed through the instrumental channel for acquiring the finger-print spectral information from compression rat SCI models. After identifying the main visual features of injured spinal cord tissue in all Sham, 0-, 3- and 7-days post injury (0 DPI, 3 DPI, and 7 DPI) groups, the blood volume and oxygen content were visualized to describe hemorrhage, hypoxia and inflammatory state after acute injury. The averaged reflectance spectra, which were deduced from MSI data cubes, were utilized for describing oxygen saturation and hemoglobin concentration in living tissue. The results of Raman spectroscopy addressed complex compositional and conformational phenomena during SCI progression, correlated with the well-known event like neuronal apoptosis, hemorrhage, demyelination, and even the upregulation of chondroitin sulfate proteoglycans (CSPGs). A principal component analysis and linear discriminate algorithm (PCA-LDA) based discriminate model was introduced for categorizing spectral features in different injury stages, which was applicable for intraoperative interpretations on the complex pathological courses of SCI and therapeutic outcomes.

Endoscopic Endonasal Occipitocervical Fixation with a Customized Three-Dimensional Printed Titanium Plate-Screw Construct: A Cadaveric Feasibility Study

To evaluate the feasibility of a novel method for occipitocervical fixation (OCF) through the endonasal corridor. Thin-cut computed tomography scans were obtained for 5 cadaveric specimens. Image segmentation was used to reconstruct 3D models of each O-C1 joint complex. Using computer-aided design software, plates were custom-designed to span each O-C1 joint, sit flush onto the bony surface, and accommodate screws. The final models were 3D-printed in titanium. For implantation, specimens were held in pin-fixation and registered to neuronavigation. A rigid 0º endoscope was used for endonasal visualization. An inverted U-shaped nasopharyngeal flap was raised to expose the occipital condyles and C1. The plates were introduced and fixed with bone screws. Computed tomography scans were obtained to assess screw accuracy and proximity to critical neurovascular structures. Screw entry points and trajectories were recorded. Endonasal OCF was performed on 5 cadaveric specimens. The mean starting point for occipital condyle screws was 6.17 mm lateral and 5.38 mm rostral to the medial O-C1 joint. Mean axial and sagittal trajectories were 7.98° and 6.71°, respectively. The mean starting point for C1 screws was 16.11 mm lateral to the C1 anterior tubercle and 6.39 mm caudal to the medial O-C1 joint. Mean axial and sagittal trajectories were 10.97° and-9.91°, respectively. Endonasal OCF is technically and anatomically feasible. The application of this technique may allow for same-stage endonasal decompression and fixation, offering a minimally invasive alternative to current methods of fixation and advancing surgeons' ability to treat pathology of the craniovertebral junction. Next steps will focus on biomechanical testing.

The Value of Endoscopic Exposure of Round Window in Cochlear Implant via Facial Recess

Abstract Background Cochlear implantation (CI) has been considered as the best treatment in patients with severe to profound hearing loss unaidable with hearing aids. The main value of endoscope-assisted cochlear implantation is improved visibility of the RW and reduced risk of complications, especially in patients with congenital malformations. Aim of the Work The aim of the present study was to assess the value of endoscopic assisted CI surgery via facial recess approach without elevating tympanic anulus. Methods This Prospective case series study non-randomized sample was performed on a total of 50 patients with severe to profound hearing loss unaidable with hearing aids undergoing unilateral endoscopic assisted cochlear implant surgery with round window electrode insertion at Ain Shams University hospitals from April 2020 till March 2022 and approved 94/2020MD by an ethical committee before the start of the recruitment. Results 50 CI operations with endoscopic assistance were prospectively evaluated. There were 23 male (46%) and 27 female (54%) patients. The majority of the cases were children (41 cases, 82%). Of those 50 patients, 39 (78%) were prelingually hearing impaired. Four cases (8%) had various inner ear abnormalities. The standard mastoidectomy and Posterior Tympanotomy (PT) approach were used for all cases. Med-El (FLEX28TM; FLEX24TM Med-El, Innsbruck, Australia), Advanced Bionics (AB)Mid-Scala Electrode and CochlearTM (NUCLEUS® CI422 WITH SLIM STRAIGHT, NUCLEUS® CI24RE CONTOUR ADVANCETM, Sydney, Australia) implants were used. Endoscope-assisted visualization of the RW region through the PT was performed in all cases Rigid endoscopes with 0o and 30o (1.9, 2.7 and 4 mm in width, 11 and 6 cm in length) and an HD (high-definition) camera system (Karl Storz, Tuttlingen, Germany) were used for the endoscopic evaluation. The RW region was visualized and identified by inserting the endoscope through the PT without elevating the tympanic annulus. Then we switched to the microscope and drilled the RW niche (tegmen) using both hands until a circumferential view of the RW membrane is obtained. After proper exposure, the electrode was inserted through an opening in the RW membrane mostly under microscopical vision. Endoscopic identification of the RW through the PT enabled us to perform regular surgery in all cases. The current study concludes the difference between microscopic exposure and endoscopic exposure represented by Saint Tomas classification regarding round window exposure found that endoscopic exposure of round window classification is better represented by downgrading in the classification of round window exposure as type I 29(58%), type IIa 18(36%) type IIb 3 (6%) Non were type III by endoscopic exposure compared to microscopic exposure of round window is a type I 7(14%), type II 14(28%), type IIb 22(44%) and type III 7 (14%). Conclusion As evident from the current study, Endoscopy proved a great value in exposure and identification of RW in CI surgery through posterior tympanotomy approach, especially in difficult cases. Endoscopic-assisted CI through facial recess could be easily done using 1.9mm 0-degree endoscopy even in cases e narrow PT or rotated cochlea

Fast Convergent Antinoise Dual Neural Network Controller With Adaptive Gain for Flexible Endoscope Robots.

Manual rigid endoscopes have defects such as a low efficiency, difficult operation, and safety risks, and the antinoise interference ability, convergence speed, and control accuracy of the neural network control technology for the existing autonomous endoscopes are often ignored. Solving these problems is important for the stable operation of endoscopes. Therefore, a new adaptive fast convergent antinoise dual neural network (AFA-DNN) controller for the visual servo control of ten-degree of freedom flexible endoscope robots (FERs) with physical constraints is proposed in this work. First, the control scheme of the FERs is formulated as a quadratic programming problem, and then, an AFA-DNN visual servo controller is designed for the FERs. The adaptive gains of the controller can accelerate the convergence, improve the antinoise ability, and increase the convergence accuracy of the controller. Then, according to the Lyapunov theory, the fast convergence of the AFA-DNN in finite time is proven for both noise-free and noisy conditions. The experimental results indicate that the FER controlled by the proposed AFA-DNN can accurately track various trajectories and that the AFA-DNN has a better antinoise interference ability, higher convergence accuracy, and faster convergence speed than conventional methods. The convergence speed of the AFA-DNN is increased by a factor of 4.22 by using the adaptive gains. Experiments also indicate that the AFA-DNN remains well functioning under various noise disturbances (such as constant, periodic, linear, and Gaussian noise).

LGG-43. LASER-ASSISTED ENDOSCOPIC RESECTION OF TECTAL GLIOMA IN A 3-YEAR-OLD CHILD

Abstract BACKGROUND Pediatric tectal gliomas generally have a benign clinical course. However, some patients may present with non-communicating hydrocephalus needing endoscopic procedures. Historically, lasers have been used in neurosurgical procedures including neuroendoscopy, but their adoption was limited by a significant rate of complication due to their inappropriate wavelength and uncontrollable tissue interaction. Recently, a 2-micron near-infrared laser with adequate wavelength and minimal tissue penetration became available. CASE-REPORT We describe the case of a 3-year-old child who presented with gait ataxia, papilloedema and headache. Magnetic Resonance (MR) was performed and he was diagnosed with obstructive hydrocephalus due to tectal glioma. Endoscopic third ventriculostomy (ETV) and simultaneous endoscopic biopsy were performed during the same surgery using a single burr hole with a rigid endoscope, a 2-micron continuous-wave thulium laser and the aid of neuronavigation. After tumoral sample removal, the laser was used for hemostasis and to evaporate tissue near the tumour without mechanical stress to the brain tissue. The final histological analysis identified a non-otherwise specified (NOS) low-grade glioma. The hospitalization was uneventful and the boy was discharged home after 4 days. No new cognitive impairment was reported secondary to this procedure and the symptoms present in the preoperative period completely improved. At 1-year follow-up, neurological examination findings were unremarkable, and there was no radiographic evidence of tumour progression. CONCLUSIONS The use of the neuroendoscopic laser permits cutting and coagulating simultaneously, avoiding multiple instruments’ use (forceps and coagulation). It therefore makes neuroendoscopic procedures more straightforward with a minimum need to change tools, and particularly suitable also in a pediatric setting.

Five historical innovations that have shaped modern otolaryngological surgery.

Throughout history, many innovations have contributed to the development of modern otolaryngological surgery, improving patient outcomes and expanding the range of treatment options available to patients. This article explores five key historical innovations that have shaped modern otolaryngological surgery: Operative Microscope, Hopkins Rigid Endoscope, Laryngeal Nerve monitoring, Cochlear implants and Laser surgery. The selection of innovations for inclusion in this article was meticulously determined through expert consensus and an extensive literature review. We will review the development, impact and significance of each innovation, highlighting their contributions to the field of otolaryngological surgery and their ongoing relevance in contemporary and perioperative practice.

Endoscopic Management of Chronic Subdural Hematoma Using a Novel Brain Retractor

Endoscopic procedures are useful in chronic subdural hematoma especially when there are septations, solid/organized hematoma, and the presence of bridging or neovessels in the cavity. Visualizing the distal hematoma cavity by a rigid scope is challenging in large and curved ones due to the hindrance by the brain surface. Combining rigid endoscopy and brain retractor can overcome this limitation. A retrospective study of 248 patients managed by endoscopic technique was performed and the relevant literature was reviewed. The brain retractor was used in all patients. Average operative time, subgaleal drainage duration, and hospital stay were 56minutes, 3.1days, and 4.6days, respectively. The average preoperative Glasgow coma scale (GCS) score was 12, which improved to 14 and 15 in 223 and 23 patients, respectively at discharge. There were solid clots, septations, bridging vessels, curved hematoma cavities, rapid expansion of the brain after partial hematoma removal, and recurrences in 59, 52, 15, 49, 19, and 2 patients, respectively. There were 2 deaths, without any procedure-related mortality. Endoscope was very effective and safe in the management of chronic subdural hematoma, especially in about 51% patients with solid clots, septations, and bridging vessels which could have been difficult to treat by conventional burr hole. It can avoid craniotomy in such patients. Good visualization and complete hematoma removal were possible with the help of an endoscope and brain retractor in about 27% of patients which could have been difficult with a rigid endoscope alone.

Chronic Rhinosinusitis with Extensive Recurrent Bilateral Nasal Polyposis-Third Times The Charm

The prevalence of recurrence in chronic rhinosinusitis with nasal polyposis (CRSwNP) is up to 40% after 18 months. Compliance to continuous medical therapy postoperatively is crucial to ensure disease resolution. CRSwNP endotype type 2 which is more common in Caucasian had shown higher recurrence. We report a case with third recurrence and the possible risk factors. A 37-year-old male smoker presented with rhinorrhea, bilateral facial pain, and anosmia for 3 years. He had two previous sinus surgeries and septoplasty. His nasal symptoms recurred a few months after both surgeries. Due to the recent pandemic, he defaulted on follow up. Rigid endoscopy at initial presentation revealed bilateral grade 2 nasal polyps which progressed to grade 4 despite medical polypectomy. Computed tomography of paranasal sinus showed pansinusitis with bilateral extensive polyposis, with presence of frontal intrasinus calcification possibly due to chronic sinusitis or fungal infection. He contracted Covid-19 category 2A infection two months before his planned surgery. The patient underwent bilateral endoscopic sinus surgery revealing extensive polyposis occupying all paranasal sinuses and the nasal cavity, completely obstructing the nasal. Intraoperative blood loss from the mucosa of the sinuses amounted to 2 liters without any arterial bleeding, causing an increase in operative time due to persistent need to secure hemostasis. Histopathological findings showed benign inflammatory polyps. There were reactionary polyps seen in bilateral maxillary sinuses and ethmoids at 2 weeks post operatively. A short course of steroid and chlarythromycin were given to prevent progression of polyps. At 5 weeks post operative, he reported on return of smell, and no more nasal blockage. We discuss the risk factors and endotypes of nasal polyps in recurrence cases with the operative challenges in revision endoscopic nasal surgery. In conclusion, recurrence nasal polyps after revision surgery is multifactorial with some possible prevention.International Journal of Human and Health Sciences Supplementary Issue 01: 2024 Page: S55

Interrater Agreement of Height Assessment by Rigid Proctoscopy/Rectoscopy for Rectal Carcinoma.

Some guidelines for rectal carcinoma consider 12 cm, measured by rigid endoscopy, to be the cutoff tumor height for optional neoadjuvant chemoradiation therapy. Measuring differences of only a few centimeters may predetermine the choice of further therapy. However, rigid endoscopy may exhibit similar operator dependence to most other clinical examination methods. Evaluation of concordance of rigid rectoscopic tumor height measurements performed by 4 experienced examiners, 2 measuring with patients in the lithotomy position and 2 in the left lateral position. Assessment of tumor palpability and distance of the anal verge to the anocutaneous line were also evaluated. This study used a prospective observational design. This study was conducted at an academic teaching hospital that is a referral center for colorectal surgery. There were 50 patients, of whom 35 were men (70%). The median age was 72.5 years (53-88 years). Interrater agreement of tumor height assessment and tumor height of less than or greater than the 12-cm height limit. With an intraclass correlation coefficient of 0.947 (95% CI, 0.918-0.967, p < 0.001), interrater reliability of tumor height assessment was statistically rated "excellent." Despite this, in 26% of patients, there was no agreement regarding the allocation of the tumor <12- or >12-cm height limit. Furthermore, there was also considerable disagreement concerning tumor palpability and the distance of the anal verge to the anocutaneous line. Patient positioning was not found to influence results. Single-center study. Rigid rectal endoscopy may not be a sound pivotal basis for the consideration of optional chemoradiation therapy in rectal carcinoma. Application of a universally valid height limit ignores biological variability in body frame, gender, and acquired pelvic descent. Eligibility for neoadjuvant therapy should not rely on height measurements alone. Uniform MRI or CT imaging protocols, based on agreed upon terminology, including factors such as tumor height relative to the pelvic frame and peritoneal reflection, may be an important diagnostic addition to such a decision. See Video Abstract .Clinical trial registration: DRKS00012758 (German National Study Registry), ST-D 406 (German Cancer Society). ANTECEDENTES:Algunas guías para el carcinoma de recto consideran que 12 cm, medidos mediante endoscopia rígida, es la altura de corte del tumor para la quimiorradiación neoadyuvante opcional. Por lo tanto, una diferencia de medición de sólo unos pocos centímetros puede predeterminar la elección de una terapia adicional. Sin embargo, la endoscopia rígida puede presentar una dependencia del operador similar a la de la mayoría de los demás métodos de examen clínico.OBJETIVOS:Evaluación de la concordancia de las mediciones de la altura del tumor rectoscópico rígido realizadas por cuatro examinadores experimentados, dos en litotomía y dos en posición lateral izquierda. También se evaluó la evaluación de la palpabilidad del tumor y la distancia del borde anal a la línea anocutánea.DISEÑO:Estudio observacional prospectivo.LUGAR:Hospital universitario, centro de referencia para cirugía colorrectal.PACIENTES:50 pacientes, 35 varones (70%), mediana de edad 72,5 años (53-88 años).PRINCIPALES MEDIDAS DE RESULTADOS:Acuerdo entre evaluadores en la evaluación de la altura del tumor y la asignación del tumor por debajo o más allá del límite de altura de 12 cm.RESULTADOS:Con un coeficiente de correlación intraclase de 0,947 (IC del 95%: 0,918-0,967, p < 0,001), la confiabilidad entre evaluadores de la evaluación de la altura del tumor se calificó estadísticamente como "excelente". A pesar de esto, en el 26% de los pacientes no hubo acuerdo sobre la asignación del tumor por debajo o por encima del límite de 12 cm de altura. Además, también hubo un considerable desacuerdo con respecto a la palpabilidad del tumor y la distancia del borde anal a la línea anocutánea. No se encontró que la posición del paciente influyera en los resultados.LIMITACIONES:Estudio unicéntrico.CONCLUSIONES:La endoscopia rectal rígida puede no ser una base sólida y fundamental para considerar la quimiorradiación opcional en el carcinoma de recto. La aplicación de un límite de altura universalmente válido obviamente ignora la variabilidad biológica en la constitución corporal, el género y el descenso pélvico adquirido. La elegibilidad para la terapia neoadyuvante no debe depender únicamente de las mediciones de altura. Los protocolos uniformes de imágenes por resonancia magnética o tomografía computarizada, basados en una terminología acordada, incluidos factores como la altura del tumor en relación con la estructura pélvica y la reflexión peritoneal, pueden ser una adición diagnóstica importante para tal decisión. (Traducción-Yesenia Rojas-Khalil )Clinical trial registration: DRKS00012758 (German National Study Registry), ST-D 406 (German Cancer Society).

Cadaveric Study on Comparison of Neck Extension Angles for Endotracheal Intubation in Rabbits Using a Rigid and Flexible Endoscope.

Endotracheal intubation in rabbits is always challenging due to the unique anatomical conformation. To improve endotracheal intubation success, this study determined the relationship between head placement angles guided by endoscope-assisted visualization techniques and the endotracheal intubation success rate. Thirty-two rabbit cadavers were used in the study. Six veterinary practitioners who had no experience with rabbit endotracheal intubation were randomly assigned to intubate rabbit cadavers using the guidance of either a rigid endoscope (RE) or flexible endoscope (FE), with the head placement angles with an ascending neck at 90, 100, 110, 120 and 130 degrees. The endotracheal intubation completed in 90 s was determined to be a success. The success rates using RE and FE were 97.2% and 95.9%, respectively. The means and standard error of means (SEM) of endotracheal intubation times guided by RE and FE were 53.7 ± 4.68 and 55.2 ± 4.24 s, respectively. Results from survival time analysis show that the five veterinarians successfully intubated the rabbit within 90 s, regardless of the different types of endoscopes. Angle was the only significant factor that affected the endotracheal intubation success. The head placement angle at 110 and 120 degrees had the highest success rate of endotracheal intubation compared to 90 degrees (p ≤ 0.05). In conclusion, for inexperienced veterinarians, the success of endotracheal intubation in rabbits, guided by endoscope-assisted visualized techniques regardless of rigid endoscope or flexible endoscope guidance, is improved when the head extension is 110 and 120 degrees.

Osseous choanal atresia in a canine patient

AbstractA 2‐year‐old, male, intact dog presented with a history of stertorous breathing since infancy, unresponsive to antibiotic therapy. On rostral rigid endoscopy, there were no remarkable findings. However, computed tomography revealed bilateral atresia of the nasal choanae, with focal hyperossification and severe narrowing, with accompanying hypoventilation of the nasopharynx. Retrograde flexible nasopharyngoscopy confirmed the severe partial choanal atresia. Surgical intervention was declined by the owner due to reasonably acceptable quality of life; therefore, only environmental modifications and symptomatic care have been implemented so far.

Full-Endoscopic Surgery for Hypothalamic Hamartoma Resection.

Hypothalamic hamartomas (HH) are rare developmental anomalies of the inferior hypothalamus that often cause refractory epilepsy, including gelastic seizures. Surgical resection is an effective method to treat drug-resistant epilepsy and endocrinopathy in a suitable patient group. Open surgery, endoscopic surgery, ablative procedures, and stereotactic radiosurgery can be utilized. In this study, we aimed to describe the full-endoscopic approach for HH resection. The technique involves the use of an intraoperative ultrasonography (USG) system, a 30° rigid endoscope system that has an outside diameter of 2.7 mm with two working channels, a stylet that has an outer diameter of 3.8 mm, a monopolar coagulation electrode, a fiberoptic light guide, and the endovision system. Microforceps and monopolar electrocautery are the two main surgical instruments for HH removal. The protocol is easy to apply after a particular learning curve has been passed and shorter than open surgical approaches. It leads to less blood loss. Full-endoscopic surgery for HH is a minimally invasive technique that can be applied safely and effectively with good seizure and endocrinological outcomes. It provides low surgical site pain and early mobilization.

Endoscopic MIS-TLIF with Destandau's system: leveraging endoscopy with conventional instruments.

This presentation showcases an endoscopic minimally invasive spine surgery (MISS) technique for lumbar interbody fusion. Significantly expanding the scope of Destandau's system within MISS, it serves as a pivotal link to unilateral biportal endoscopy (UBE) for endofusion. The method involves minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) using a 4-mm rigid endoscope through Destandau's system. With the widespread familiarity with Destandau's system and the absence of specialized instrument requirements, this approach is easily adoptable, particularly in resource-limited centers. The favorable clinical and radiological outcomes underscore the effectiveness of this technique, propelling the role of endoscopy in MISS, particularly in endofusion. The video can be found here: https://stream.cadmore.media/r10.3171/2024.1.FOCVID23216.

PECULIARITIES OF THE COURSE AND TREATMENT OF ACUTE INFECTIOUS RHINOSINUSITIS IN VOICE-SPEAKING PROFESSIONALS

Numerous scientific studies are dedicated to the study of the morphological structure of the vocal cords and the diagnostic criteria of their lesions. The purpose of the work: the study of changes in the quality of the voice and the condition of the vocal cords in persons of voice-speaking professions who were treated for acute viral or bacterial rhinosinusitis and continued to work (had vocal strain) during the illness.Research material and methods. The examination data of 24 patients (16 women and 8 men) of voice-speaking professions who were treated for acute viral or bacterial rhinosinusitis and continued to work (had voice strain) during the illness were analyzed. For each patient, a phoniatric patient study card was filled out, in which passport data was noted, including profession, patient complaints, data on life history, disease history and objective examination of ENT organs: pharyngoscopy, rhinoscopy, otoscopy, indirect laryngoscopy, which was performed with the help of 700 or 900 rigid endoscope. Research results. The analysis of the examination data of 24 patients (16 women and 8 men) of voice professionals who were treated for acute viral or bacterial rhinosinusitis and continued to work (had vocal strain) during the illness showed that during the control examination of the data of the patients for 7-10 days since the beginning of treatment, indirect laryngoscopy and stroboscopy revealed: hemorrhage in one fold - 3 cases, prenodular thickening of the edges of the vocal folds - 8 cases. The mobility of the folds was preserved in all patients, but during phonation, a gap formed between the folds in 19 patients, which was accompanied by hypertonus of the vestibular folds in 3 cases. During stroboscopy of this group of patients, vocal fold asynchrony was detected in 21 cases. The PMF was shortened in 21 patients and was 12 + 1.3 s (norm – 16s), and in men – 16 + 1.5 s (norm – 21s). Conclusions. In the treatment of patients of voice-speaking professions with acute viral or bacterial rhinosinusitis, changes in the vocal folds are observed, with possible hypertonus.