Rigid Endoscope Research Articles

Relevant Anatomical Details in Rats Regarding Otologic Research

The objective of the study was to provide a detailed anatomical description of the rat’s ear anatomy that will prove insightful to different experimental otologic surgical procedures regardless of scope. Three male Wistar rats were enrolled in the study. Candidates were screened for systemic and otologic pathology. External ear canal endoscopy was carried out with a 30˚ rigid endoscope through an image capture system. Middle ear anatomical elements were analyzed under stereomicroscopy. 3D computer tomography image reconstruction was realized with a micro-CT to describe the anatomy. Image data from all three rats were analyzed. Anatomical annotations and surgical exposure recommendations were added for key elements. The most relevant images from all three rats were selected for representation. Detailed visualization of the structural elements of the tympanic cavity were clearly visible: promontory, round window, stapedial artery, stapes, incus, and tympanic membrane were all constant findings. We describe a step wise ventral surgical approach of the middle and inner ear for which we found that the clavotrapezius muscle was a reliable landmark. For the transtympanic approach the endoscopic transcanal access was an easy and reliable method for which a detailed anatomical representation was depicted. Further, anatomical similarities to humans were observed by stereomicroscopy and Micro-CT imaging reiterating that the rat model is suitable for otologic research. The endoscopic approach to the tympanic membrane is comfortable and less expensive than a microscope. The tendon of the clavotrapezius muscle can be a reliable landmark for discovering the tympanic bulla when considering a ventral approach. 3D Micro-CT reconstruction allows intact evaluation of the samples, simultaneously being a diagnostic and also a learning tool.

Separated Flow Through a Gap Between Two Coaxial Peristaltic Tubes

A peristaltic endoscope is a device that could locomote through curving and tortuous spaces where it has many real-life applications in different disciplines e.g., in the field of medicine, it helps in the process of catheterization in curved tubes which in turn relieve patient’s pain. The aim of this paper is to study a trapping phenomenon at the centerline of a gap between inner peristaltic endoscope and outer peristaltic tube of a fluid with viscosity variation and a novel phenomenon of separated flow at the boundary of these tubes. For understanding these phenomena, we formulate the flow of a fluid with viscosity variation through the gap between two coaxial peristaltic tubes in cylindrical coordinates with neglecting Reynolds number and wave number. Explicit forms for the velocity field, pressure rise and friction forces on inner and outer peristaltic tubes in terms of radius ratio, flow rate, parameter of viscosity and occlusion have been obtained. A new comparison between a rigid endoscope and a peristaltic endoscope through the gastrointestinal tract has been made for the pressure rising and drag (friction) forces results. Also, we identify type of pumping for various physical parameters of interest. In addition, separated flow points are determined numerically by using computer algebra system.

Foreign body aspirations in dental clinics: a narrative review.

Foreign body aspiration can produce a medical emergency. Obstruction of the airways can be life-threatening, and complications may develop in less-severe cases if it is left untreated. Although it is more prevalent in children by approximately three times, adults can still experience it, and it is more frequently related to healthcare in adults. Objects used in dental treatment are usually placed in the oral cavity and can be ingested or inhaled by accident. Dental treatment has been identified as an important cause of the misplacement of foreign bodies in the airway. However, few reports have been published on dentistry-related foreign body aspiration. This paper discusses the disease course, management, and clinical outcomes of foreign body aspiration, especially those associated with dentistry. The patient must be examined for respiratory distress. If the patient is unstable, urgent airway management and the maneuvers for removal should be performed. Radiographs and computed tomography can help identify and locate the object. The treatment of choice is often bronchoscopy, and both flexible and rigid endoscopes can be used depending on the situation. Preventive measures need to be implemented to avoid inhalation accidents given the potential consequences. Though the incidence is rare, healthcare levels need to be enhanced to avert morbidity and mortality. Radiological evaluation and bronchoscopy are vital for management.

Endoscopic findings in periapical surgery. A cross-sectional study of 206 roots.

Background A study is made of the findings of high-magnification rigid endoscopy at the root end surface following apicoectomy of teeth subjected to periapical surgery.Material and Methods A cross-sectional study was made of patients subjected to periapical surgery at the Unit of Oral Surgery and Implantology (University of Valencia, Valencia, Spain) between 2011 and 2019. Following apicoectomy, the root end surfaces were inspected, with the evaluation of untreated canals, isthmuses, craze lines, crack lines, opaque dentin and gaps. Likewise, an analysis was made of the association between patient age and the tooth type and restoration and the presence of craze lines, cracks, opaque dentin and gaps.Results The final sample consisted of 168 patients subjected to periapical surgery, with 177 operated teeth and 206 roots. Untreated canals were observed in 14 roots (6.8%). Isthmuses were identified in 74 roots (35.9%), particularly in the mesial root of the lower first molar (94.1%). In turn, craze lines were identified in 8.3% of the roots, cracks in 3.9%, and gaps in 53.4%. The prevalence of opaque dentin was 78.3%, with a greater presence in posterior teeth (90.3% in premolars and 86.2% in molars) than in anterior teeth (50.6%) (p<0.001). Patient age and tooth restoration showed no correlation to the studied parameters.Conclusions Craze lines and crack lines were observed in less than 10% of the roots, though opaque dentin was identified in 73% of the roots, particularly in posterior teeth, and gaps were found in over half of the canals. Key words:Endoscope, cracks, gaps, opaque dentin, periapical surgery.

Observation of Posttonsillectomy Wounds Using Endoscopy and Examination of the Postoperative Course by Wound Type

AbstractPalatine tonsillectomy is a surgical procedure that novice otolaryngologists should master early and is taught at many medical institutions. Unfortunately, however, the transoral procedure cannot provide a large enough field of view to doctors other than the one performing the operation. Therefore, it is difficult to share the surgical field and provide real-time teaching. Dissection of the wrong layer can cause postoperative bleeding and pain. Our department uses a 70-degree, 4-mm rigid endoscope for palatine tonsillectomy, which makes it possible for preceptors to teach tonsillectomy in real time and to evaluate the condition of the postoperative wound in detail. We classified the postoperative state after tonsillectomy into three stages, based on the degree of residual subcapsular connective tissue. We assessed the association between the amount of residual subcapsular connective tissue and the underlying disease that required indication for tonsillectomy, the postoperative course, and the operation time in 33 patients who had undergone palatine tonsillectomy at our institution between May 2017 and November 2020. We found that the more the subcapsular connective tissue that remained, the less the postoperative pain and bleeding. This association suggests that conserving the subcapsular connective tissue is important. Bringing the endoscope closer to the surgical field to observe the field without blind areas enables adequate hemostasis and easy sharing of the surgical field; therefore, this method is also effective for teaching tonsillectomy to surgical trainees.

The use of augmented reality navigation technology in combination with endoscopic surgery for the treatment of an odontogenic cyst of the upper jaw: A technical report.

PurposeThis report presents the first known use of a rigid endoscope with augmented reality technology for the removal of an odontogenic cyst that penetrated the maxillary sinus and illustrates its practical use in a patient.Materials and MethodsIn the preoperative period, cone-beam computed tomography was performed in a specially designed marker holder frame, and the contours of the cyst and the nearest anatomical formations were segmented in the 3D Slicer program. During the operation, a marker was installed on the patient’s head, as well as on the tip of the endoscope, which made it possible to visualize the mass and the movement of the endoscope. The surgical intervention was performed with the support of augmented reality in HoloLens glasses (Microsoft Corporation, Redmond, WA, USA).ResultsThe use of this technology improved the accuracy of surgical manipulations, reduced operational risks, and shortened the time of surgery and the rehabilitation period.ConclusionWith the help of modern technologies, a navigation system was created that helped to track the position of the endoscope in mixed reality in real time, as well as to fully visualize anatomical formations.

Efficacy of Endoscopic sinus surgery for associated with filling material of the maxillary sinus, simultaneous sinus-lifting and dental implantation

Objectives: Optimization of the sinus-lifting in patients with filling material in maxillary sinus cavity by a one-stage endonasal endoscopic elimination of the sinuspathology and carrying out a sinus-lifting. Materials and methods: A total of 28 patients (12 males and 16 females, the age was 31 to 64 years, from 2016 to 2022) with ridge defects in age group were selected for the study. All patients had a partially or totally edentulous atrophied posterior maxilla. All patients underwent a thorough clinical examination according to a generally accepted scheme.For sinus surgery, used endoscope is 4.0 mm diameter rigid endoscope (Karl Storz). The fungal material, and hypertrophic mucosa within the maxillary sinus were removed and sent for pathological analysis.Sinus lifting procedures were performed using a lateral window approach. A total of 34 sinus lifting procedures were performed, using a mixture of bovine bone, autogenous bone and PRP. According to our surgical procedure we performed in our patients 1 a 2 stage sinus lifting, 98 implants were inserted. Dental prosthetic rehabilitation was undertaken 5 months after implants insertion and submerged healing. Implant success was assessed clinically and radiographically. The height of the graft and bone density was measured 6th and 9th month after surgery using serial CT. The following parameters were assessed: failure of the augmentation procedure, implant failure, and vertical bone height. Results: Any intraoperative and postoperative complications, such asbleeding, membrane perforation, swelling, ecchymosis, pain, nasal bleeding, and infection, were recorded clinically and radiographically. Of the 98 implants placed in these 28 patients, 3 failed to osseointegrate. The CT examination showed the presence of dense bone around and above the implants. The implants appeared to be well integrated with no peri-implant bone loss. At 6 years follow up, excellent integration of grafted tissue, steady levels of bone around the implants and healthy peri-implant tissues were reported. Implants placed in the reconstructed areas were demonstrated to integrate normally, postoperative occlusal function and esthetics have been favorable. Conclusion: The method of simultaneous endonasal sanitation of the maxillary sinus, sinus-lifting, dental implantation, allows to reduce the probability of perforation of the membrane, significantly shortening the rehabilitation period of patients with insufficient bone tissue in the maxillary sinus. These methods led to simpler, more comfortable, lower risks of morbidity, more predictable compared to more invasive maxillary sinus augmentation

COMPARATIVE EVALUATION OF 70O AND 90O RIGID ENDOSCOPE IN SUCCESSFUL VISUALIZATION OF THE HIDDEN AREAS OF LARYNX

OBJECTIVE&#x0D; To compare the success rate of 700 and 900 rigid endoscope in successful visualization of the hidden areas of larynx.&#x0D; MATERIAL AND METHODS&#x0D; A randomized control trial at the Department of Otorhinolaryngology Head and Neck surgery, Pakistan Institute of Medical Sciences, Islamabad, was done for a period of 06 months from 22nd May, 2018 to 22nd Nov, 2018. A written informed consent from 582 patients fulfilling the inclusion criteria were enrolled from the outpatient department (291 in each group). They were randomized in two groups using a computer-generated table. Patients in Group A undergone the procedure using 700 rigid telescope and those in Group B using 900 rigid telescopes. The following parameter was evaluated: subglottic area, anterior commissure and laryngeal surface of the epiglottis.&#x0D; RESULTS&#x0D; Total 582 patients were included in the study. Mean age (years) of patients was 38.88+12.71. 267 (group A) and 251 (group B) patients whom successful visualized subglottic area, whereas 261 and 239 patients from group A and B respectively, were successfully visualized with anterior commissure. Similarly, successfully visualized laryngeal surface of the epiglottis is 273 and 240 respectively for 700 &amp; 900 scopes.&#x0D; CONCLUSION&#x0D; The study findings concluded that rate of success of 700 rigid endoscope was more successful in visualization of the hidden areas of larynx as compared to 900 rigid endoscope.&#x0D; KEYWORDS&#x0D; Full Visualization of Subglottic, Anterior Commissure, Laryngeal Surface of&#x0D; Epiglottis, telescope, 700, 900 endoscope

Sinonasal Mucormycosis in a post Covid patient - first case in Sri Lanka

The Covid 19 infection which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is found to be associated with a wide range of bacterial and fungal co-infections. We report the first post COVID-19 Sino-orbital Mucormycosis infection in a patient with diabetes mellitus in Sri Lanka. A 57 years old female with a history of long standing uncontrolled diabetes presented with left facial pain and swelling. She has had a positive reverse-transcriptase polymerase chain reaction (RT-PCR) for SARS-CoV-2 one month back. On Rigid nasal endoscopy (RNE) blackish crusting was noted on the nasal septum. The Contrast enhanced CT scan (CECT) demonstrated fat stranding in premaxillary, infratemporal and pterygopalatine regions. Presence of mucormycosis was confirmed from biopsies following a functional endoscopic sinus procedure. Patient was treated with IV liposomal amphotericin B and with local nasal packs with amphotericin. Sinonasal biopsies after completion of 5g of Liposomal amphotericin B were negative and the patient was asymptomatic and discharged after 27 days of Amphotericin. Conclusion: A good prognosis can be achieved with an early diagnosis and debridement along with prompt conservative treatment of Amphotericin B.

TOTAL ENDOSCOPIC STAPES SURGERY. OUR TECHNIQUE AND EXPERIENCE OF 45 CASES

Objective: To assess the hearing results of transcanal endoscopic stapedotomy&#x0D; Study Design: Descriptive study.&#x0D; Place and Duration of Study: Pakistan Naval Ship Hafeez Islamabad Pakistan, from Jun 2016 to Jun 2020.&#x0D; Methodology: All patients with surgically confirmed otosclerosis were included in the study. All patients were operated with 0-degree 3mm, 14cm rigid endoscope under general anesthesia. Preoperative and post operative air bone gap was noted along with demographic data, middle ear anomalies (persistent stapedial artery, dehiscent facial nerve, anteriorly placed facial nerve, floating foot plate) and injury to chorda tympani. Postoperative air bone gap (A-B Gap) was documented 12 weeks after surgery. All patients were followed up for 6-12 months&#x0D; Results: Mean age of patients was, 37 years and standard deviation was 12.34 (range 27-52 years). Out of total 45 cases 13 were males (29%) and 32 females (71.%). Four (8.8%) patients had dehiscent facial canal and 1 (2.2%) patient had persistent stapedial artery. Average preoperative A-B gap was 35 db and Average Postoperative A-B Gap was 7 db. Chorda tympani was preserved in all cases. One patient (2.2%) complained of altered taste which resolved after 3 months. Four patients had Postoperative vertigo that lasted 2 days on average.&#x0D; Conclusion: Endoscopic trans canal Stapes surgery is scarless safe effective procedure demonstrable hearing benefits in all patients with minimum complications. The Technique is single handed and has steep learning curve.

ENDOSCOPIC CARTILAGE TYMPANOPLASTY. OUR TECHNIQUE AND EXPERIENCE OF 157 CASES

Objective: To assess the graft take rate and hearing gain in trans-canal endoscopic tympanoplasty Study&#x0D; Design: Descriptive study.&#x0D; Place and Duration of Study: Pakistan Naval Ship Hafeez, Islamabad Pakistan, form Dec 2015 to Jun 2018&#x0D; Methodology: All patients with dry central perforations of &gt;3 months history were included in the study. All Patients with perforations of pars tensa were booked for endoscopic cartilage tympanoplasty. All perforations were divided into four types small, medium, large and subtotal or total based on size of the tympanic membrane perforations. Small perforations involving &lt;25% area of Pars Tensa. Medium perforation are Perforations involving 25-50% of Tympanic membrane. Large perforations include Perforations involving 50-75% of pars tensa. Subtotal or total perforations are defined as perforations with &gt;75% perforation of the tympanic membranes. Wet Ears and perforations involving the Pars Flacida were excluded from the study. Preoperative Audiogram was carried out for all patients and A-B Gap were noted for all groups separately so as the demographic data including age and gender. Success was defined as complete closure of Tympanic membrane perforation at 3 months. All patients were operated with 0 Degree 3mm, 14cm rigid endoscope under general anesthesia.&#x0D; Results: Mean age of patients was. 37 years and standard deviation was 12.34 (range 12-58 years). Out of total 157 cases 81 patients male were males (51%) and 76 patients were females (49). Out of 157 ears operated 146 Perforations healed completely an overall success rate of 92%. Patients with small perforations had 100 percent success.....

Endoscopic Trans-Turbinal Medial Maxillectomy: A Modified Endoscopic Medial Maxillectomy Technique to Preserve the Inferior Turbinate

Endoscopic medial maxillectomy (EMM) and its modifications are surgical techniques are used to treat recalcitrant maxillary sinusitis as well as maxillary sinus tumors. In this report, we propose a simple and efficient modification of EMM, called endoscopic trans-turbinal medial maxillectomy (ETTMM), by which the inferior turbinate (IT), nasolacrimal duct, and anatomical integrity of the nasal valve area are preserved. A total of 10 patients (five tumorous and five nontumorous maxillary diseases) underwent ETTMM. Briefly, a turbinate mucosal flap on the superior aspect of the IT was elevated after middle meatal antrostomy. Then a trans-turbinal window was developed to expose the inferior meatus, after which an extended maxillary antrostomy was generated. Finally, the turbinate mucosal flap was repositioned after complete removal of the antral lesions. All lesions were successfully treated using ETTMM. Our modification was easy to perform, and we achieved good endoscopic visualization and accessibility throughout the whole antrum by creating a trans-turbinal window and extended maxillary antrostomy. We could perform postoperative surveillance easily through the wide antrostomy using rigid endoscopes of various angles. ETTMM is a simple and useful modification of EMM that provides clear visualization and great accessibility to most aspects of the maxillary antrum while preserving the nasal functional units, including the IT and nasal valve area.

Bioabsorbable dressing impregnated with betamethasone and ciprofloxacin after endoscopic sinus surgery: A randomized, double-blind, placebo-controlled study.

In addition to its hemostatic and stabilization role, biodegradable nasal packing can be used as a carrier for drugs after functional endoscopic sinus surgery (FESS). The aim of this study was to compare the influence of biodegradable synthetic polyurethane foam (NasoPore) soaked with ciprofloxacin, or betamethasone, or both to the same foam soaked with saline after FESS. 120 adults with chronic rhinosinusitis, with and without polyps, directed for bilateral full-house FESS were enrolled for the study. The patients were randomized and blinded into 3 groups, depending on the type of postoperative procedure applied. Thus, NasoPore soaked with antibiotic was provided to the first group; in the second group, the steroid was used; and the combination of both, in the third group. In each case, the aforementioned procedure was administered on one side of the nose, while NasoPore was soaked in saline on the other, at the end of the surgery, respectively. The patients were requested to complete a questionnaire during their postoperative visits at 2, 10, 30, 90, and 180 days, scoring the level of complaints on the VAS scale, separately for each side. The evaluation of the healing process was performed at each visit using rigid endoscopy and subsequently rated on numerical scales. Decreased mucosal edema and secretion; reduced Lund-Kennedy score; and favorable influences on facial pressure, nasal blockage, and smell were most evidently seen in the group receiving the antibioticsteroid combination. The application of biodegradable nasal packing with betamethasone and ciprofloxacin in sino-nasal surgery has positive effects not only on the healing process but also impacts patient's comfort. To optimize it, however, further research is needed.

Neuroendoscopic Navigated One-Step Removal of Crossed Ventricular Catheter Fragments: Technical Note

Abstract Introduction Neuroendoscopy plays an important role in minimally invasive neurosurgery. The authors reported an interesting case of a pediatric patient with multiple ventriculoperitoneal shunt (VPS) revision surgeries, presenting with VPS infection and with two crossed intraventricular floating catheter fragments, successfully removed through a neuroendoscopic navigated one-step procedure. A literature review regarding this exceedingly rare condition has also been discussed. Case Description An 11-year-old female patient with a history of congenital hydrocephalus was admitted to the emergency department with symptoms of intracranial hypertension, psychomotor agitation, and tetraparesis. She had a history of previous multiple VPS revisions. She had an urgent brain computed tomography scan that documented hydrocephalus; the VPS's intraventricular catheter tip was sited at the level of the right frontal horn. Two small floating catheter fragments, not connected to the VPS, were identified: the first close to the right lateral ventricle at the level of the right occipital horn, the second one between the right occipital horn and the third ventricle. First, she underwent an exteriorization of the distal catheter for VPS. Cerebrospinal fluid examination documented hyperproteinorrachia and a positive culture for Staphylococcus aureus. Then a navigated right transfrontal endoscopic approach to the right lateral ventricle was performed extending to the previous burr hole and achieving a wide range of working angle with a rigid 0-degree lens endoscope. Intermittent irrigation generating convective flow was performed such as to mobilize the catheters tip gently upward, to remove them by grasping. Finally, a whole VPS replacement has been performed. Conclusion Persistence of intraventricular floating catheter fragments can lead to subacute or chronic infections. Neuroendoscopic retrieval represents a safe and effective alternative to a more extensive and invasive surgical approach. However, the exact catheter tip identification, grasping, and removal can be difficult to achieve, due to the technical instrumentation characteristics and altered intraventricular anatomy in chronic congenital hydrocephalus. In our experience, endoscopic convective flow induction through saline irrigation can determine floating intraventricular catheter fragments movement aiming to their identification and subsequent successful endoscopic retrieval.

Study to assess proper timing of laryngoscopy in post-thyroid surgery patients to detect recurrent laryngeal nerve injury

Background: Thyroid surgeries are commonly done nowadays for benign and malignant conditions. Recurrent laryngeal nerve palsy (RLNP) is an important and potentially catastrophic complication of thyroid surgery. The purpose of the study was to determine the impact of rigid endoscopy (Hopkins rod-lens telescope) performed at different time intervals on the diagnosis of RLNP in post-thyroid surgery patients. Aims and Objectives: To assess Proper Timing of Laryngoscopy in Post-thyroid Surgery patients to Detect RLN Injury. Materials and Methods: Rigid endoscopy was performed postoperatively at day 0 (T0), at 2nd day post-op (T1), and day 14 (T2). For patients with RLNP, repeated examinations were performed at 2 months (T3), 6 months (T4), and 12 months (T5). Results: The study included 50 patients of thyroid swelling with different diagnoses. Overall, 35 patients appeared for postoperative laryngoscopic examination of the vocal folds at our center, providing 61 nerves at risk. RLNP rate was 8.1% at T0, 11.5% at T1, 9.8% at T2, 8.1% at T3, 4.9% at T4, and 3.3% at T5. T1 was significantly superior to all other time intervals in terms of diagnosis of RLNP but statistically not significant. Conclusion: Rigid endoscopy is essential for the detection of vocal cord paralysis after thyroidectomy. We report different time evaluation criteria of vocal cord morbidity with great and significant variability of results. Second day post-op inspection of the larynx (T1) is suggested.

Indication for the endoscopic treatment of Zenker’s diverticula

: Zenker’s diverticulum (ZD) is a false pulsion diverticulum located in Killian’s triangle. It accounts for about 70% of all esophageal diverticula. ZD incidence is uncommon, and it is mostly present in the elderly population. Although the pathophysiology has not been completely elucidated, an impaired relaxation of the cricopharyngeal muscle (CPM) has been identified as the leading mechanism. For this reason, the current therapeutic modalities are based on CPM myotomy to eliminate diverticular bolus retention, improve bolus flow, relieve outflow obstruction, and mitigate neuromotor impairment. The conventional open approach through a left cervicotomy has been mostly replaced by transoral techniques using either rigid endoscopy or flexible endoscopes. The minimally invasiveness of these techniques allows for reinterventions in case of recurrence. Endoscopic techniques present several advantages in terms of lower risk of adverse events, can be accomplished without the need for general anesthesia and neck hyperextension, and provide for a rapid patient recovery. The recent introduction of cutting-edge technology Z-POEM allows through a direct septal visualization for a complete myotomy, leading to a lower recurrence rate and higher symptoms resolution than endoscopic septotomy. The potential advantages also account for lower complication rates making it a promising technique.

A novel, cost-effective lens irrigation system for rigid endoscopes in transnasal endoscopic surgery.

In transnasal endoscopic surgical procedures, the lens of the endoscope often becomes fogged or smeared with mucus or blood. The surgeon has to clean the lens and reintroduce the endoscope multiple times during the surgery, making it a tiring process. This paper describes an innovative lens irrigation system comprising a modified 16 Fr Foley catheter, a 20 cc or 50 cc syringe filled with warm normal saline (0.9 per cent), and a commercially available intravenous infusion set. The rigid endoscope is introduced into the catheter through the urine draining port. When the lens gets smudged with blood or mucus, the irrigating saline in the syringe is forced through the inflating port. A clear vision was restored immediately on flushing the syringe. The system did not compromise the operative space or hinder manoeuvrability. This cost-effective, innovative lens irrigation system saves the time spent in cleaning the lens and enhances operational efficiency, especially in a low-income setting.

Light intensity distribution in images from rigid endoscopes used in minimal access sinus surgery.

Objectives/HypothesisTo investigate the pattern of intensity levels in images generated by the two most commonly used rigid endoscopes angulations in sinus surgery: 0° and 30°.MethodsAn enclosed light box containing an optical square grid, under endoscope illumination set just below saturation level, was used for measuring light distribution levels across test images. Endoscopes with 0° and 30° angulations were tested at 10 mm from the grid, typical for sinus surgery. The grid was set perpendicular to the axis of the shaft of the endoscope. The grayscale light intensity (GLI) levels (0 = black, 255 = white) in each of the grid squares were quantified from the digitized images.ResultsLight intensity was highly non‐uniform for both endoscopes. The brightest area of the field of view was at the center for the 0° endoscope and at about 20% of the image diameter proximally from the center for the 30° endoscope. For the 0° endoscope with a maximum value of about 230 GLI (90% of white saturation) at the center the minimum value was about 100 GLI at the periphery. The 30° endoscope with a similar maximum GLI value of 226 had a minimum of under 50 GLI at the most distant periphery, too dark for clear grid line definition.ConclusionThere are wide variations in light intensity across the image circle and much reduced illumination of the field edge. Surgeons should be aware of this fact so that accommodation can be made when surgical manipulation is performed away from the center of the endoscope field. This is especially relevant in angled cavities such as the frontal sinus recess, where the degree of angulation necessitates “edge of field” surgery.

Smartphone-enabled otoscopy: method evaluation in clinical practice

ObjectiveTo assess the diagnostic agreement between smartphone-enabled otoscopy and rigid otoendoscopy in tympanic membrane and middle ear diseases. MethodsA cross-sectional study was carried out to analyze otoscopies in patients seen at a general otorhinolaryngology (ORL) outpatient clinic, from June to December 2019. Eighty-three images of patients obtained from otoscopies performed through a smartphone device and a rigid endoscope were included, recorded, and stored for further analysis. The images were first analyzed by an experienced otologist, who assigned his diagnostic impression (defined as the gold standard) on each of the images. After this analysis, the images were displayed to a group of secondary raters (an experienced otorhinolaryngologist, a second-year resident in ORL, and a general practitioner). A questionnaire was applied related to each image. ResultsThere was high agreement between the smartphone device and the otoendoscopy images for all professionals, with a Kappa coefficient of 0.97 (p < 0.001). The smartphone device showed a diagnostic sensitivity of 81.1% and a specificity of 71.1%. As for the otoendoscopy, it showed a sensitivity of 84.7% and a specificity of 72.4%. The image classification as “2 = Good” was the most frequent one, with 34.9% for otoendoscopy and 31.6% for the smartphone device. ConclusionThere was a high diagnostic agreement between smartphone device-guided otoscopy and the rigid otoendoscopy, demonstrating the feasibility of using this device in clinical practice.Level of Evidence: 3

Providing one-lung ventilation in posttracheostomic tracheal stenosis for thoracoscopic plastic of the right diaphragm dome

The article is devoted to the consideration of a clinical case of providing artifcial one-lung ventilation for performing thoracoscopic plastic of the right dome of the diaphragm in a patient with grade 3 posttracheostomy cicatricial tracheal stenosis. The patient is presented after a new coronavirus infection COVID-19 from 2020, prolonged mechanical ventilation through a tracheostomy tube (74 days), the development of medium thoracic cicatricial tracheal stenosis of grade 3 (the lumen of the narrowest part of the trachea is 4 mm) after decannulation and the development of relaxation of the right dome of the diaphragm (according to CT data, the dome is located at the level of the IV intercostal space). The frst stage under conditions of combined general anesthesia and high-frequency ventilation of the lungs was performed to restore the lumen of the trachea by bougienage of the stenosis area with tubes of a rigid endoscope under the control of a fberoptic bronchoscope with further nasotracheal intubation with a thermoplastic single-lumen endotracheal tube with a diameter of 8.0 with a cuff. At the second stage, during thoracoscopic plastic of the right dome of the diaphragm, to provide artifcial one-lung ventilation, a bronchial blocker was used, introduced through the same endotracheal tube into the right main bronchus under the control of a fberoptic bronchoscope.