Safety Of Endoscopic Surgery Research Articles

An Overview to MMESA Congress 2012 – Amman, Jordan

: Major Advances in the field of medical technology, especially in endoscopy, have inspired surgeons and patients who benefit from such advantages as well. Mediterranean & Middle Eastern Endoscopic Surgery Association (MMESA)-founded in 2001 in Beirut Lebanon-has served the above purpose quite well. It started as a group of friend surgeons, who shared the same point of view regarding education, and worked together to enhance the level of endoscopic surgery within all countries in the region. MMESA has not yet been successful in achieving its ideals, which include constant improvement of the quality and safety of endoscopic surgery under a common standard. MMESA is an apolitical association, defending the principles of peace and mutual understanding of all people, all nations, all credos and all races.

Scientific assessment of endoscopic surgical skills

Recently, significant attention has been focused on training and education for safe endoscopic surgery. A new assessment method, the Hiroshima University Endoscopic Surgical Assessment Device (HUESAD), has been designed at Hiroshima University to evaluate the smoothness of the movement of endoscopic instruments from velocity. Experts (with experience in performing more than 100 laparoscopic surgeries) and novices (with no experience in performing laparoscopic surgery) were recruited for this study. The aim of task 1 was to move the tip of the endoscopic instrument on the tops of poles from A to C, and task 2 was to move it from the right pole B to the left pole D. The peak velocity (Vp) and the time when peak velocity appears (Tp) were analyzed. Both the peak velocity (Vp) and the time when peak velocity appears (Tp) to perform task 1 and task 2 were significantly faster in the expert group than in the novice group. The peak velocity (Vp) and the time when peak velocity appears (Tp) in HUESAD, which indicate the smoothnes of the endoscopic procedure, are among the most important factors for assessing endoscopic surgical skills.

Endoluminal MR imaging of porcine gastric structure in vivo

Recently, several new endoscopic instruments have been developed. However, even with the full use of current modalities, the safety of endoscopic surgery is not guaranteed. Information regarding factors such as fibrosis and the blood vessels under the mucosa is very important for avoiding procedure-related complications. The aim of this study was to define the detailed anatomy of the gastric wall structure in vivo using original endoluminal radiofrequency coils for safer endoscopic therapy. Swine were used as the subjects and controlled with general anesthesia. Anatomical images were obtained with T1-weighted fast spin echo (T1FSE) and T2-weighted fast spin echo (T2FSE). Dynamic magnetic resonance (MR) angiography was also obtained with three-dimensional T1-weighted fast spoiled gradient recalled acquisition in the steady state (3D-DMRA) following the injection of hyaluronic acid sodium into the submucosal layer. Porcine gastric wall structure was visualized, and four layers were discriminated in the T1FSE and T2FSE images. The vascular structure was clearly recognized in the submucosa on 3D-DMRA. Endoluminal MR imaging was able to visualize the porcine stomach with similar quality to endoscopic ultrasonography imaging. Additionally, it was possible to visualize the vascular structures in the submucosal layer. This is the first report to show that blood vessels under the gastric mucosa can be depicted in vivo.

P-174 Education and training of safe endoscopic surgery for pediatric surgeons in Kyushu University(Poster Panel Discussion Social aspects surrounding pediatric surgeons,Better Life for Sick Children, Better Future for Pediatric Surgery,the 45th Annual Meeting of Japanese Society of Pediatric Surgeons)

P-174 Education and training of safe endoscopic surgery for pediatric surgeons in Kyushu University(Poster Panel Discussion Social aspects surrounding pediatric surgeons,Better Life for Sick Children, Better Future for Pediatric Surgery,the 45th Annual Meeting of Japanese Society of Pediatric Surgeons)

Endoscopic Surgery for Sinonasal Invasive Aspergillosis in Bone Marrow Transplantation Patients

Sinonasal invasive aspergillosis (IA) is an aggressive fungal infection with high mortality rates. It commonly develops in immunocompromised patients, often after bone marrow transplantation (BMT). Aggressive surgical debridement by an external approach has been considered a central element of treatment. We describe our experience in endoscopic management of IA in BMT patients in a retrospective study. Charts of BMT patients with IA in the past 5 years were reviewed. Demographic data, primary disease, comorbidities, signs and symptoms, blood test results, preparation for surgery, surgical technique, and outcome were recorded. Fourteen BMT patients, age ranging from 3 to 56 years, had sinonasal IA. The primary disease was acute myelogenous leukemia in 6, acute lymphoblastic leukemia in 3, chronic myeloblastic leukemia in one, severe combined immunodeficiency disease in 2, and myelodysplastic syndrome in 2 patients. Diagnosis was made by physical examination, biopsy, culture, and computed tomography scan. Treatment, including aggressive endoscopic debridement, a systemic antifungal medication, and local irrigations of amphotericin-B enabled eradication of IA in all patients. Seven patients required two or more operations. None required orbital exenteration or craniotomy. Six patients died of the primary illness or of comorbidities with no evidence of residual disease. Eight patients are alive. Early detection of IA in BMT patients enables aggressive treatment before the disease spreads into the orbit or brain. Proper preoperative preparation facilitates safe endoscopic surgery in patients with severe bleeding tendencies. Although sinonasal IA is lethal, endoscopic surgery is feasible and efficient, enabling excellent local control.

Endoscopic Surgery of the Thoracic and Lumbar Spine - A Report on 500 Treatments

During the last 6 years, endoscopic procedures have developed from being optional, additional intervention procedures to being the standard procedures for treating spinal trauma. They are based on the principles of traditional spinal surgery, i. e., reduction, reconstruction and retention of the anterior section of the spine. This development has been accompanied by a continual improvement of instruments, which also enables subtile interventions, such as anterior decompression of the myelon, under visual conditions that can only be compared to those of the surgical microscope, to be performed. The high level of primary and angular stability of modern implants makes exclusive anterior treatment seem possible in the case of suitable injury patterns, where dorsal intervention, which creates soft tissue trauma, does not have to be considered. Limiting factors include the extent of the malalignment that is to be corrected, damage to posterior structures and unsatisfactory bone quality, which always require additional posterior reconstruction and stabilisation measures. The safety of endoscopic surgery is reflected in the low rate of complications and short surgery times, which are comparable to those of open procedures. Endoscopic methods were introduced with the intention of reducing access morbidity, and this objective has been successfully realised. The reported complications are an expression of the dangers and limits of the procedures, of diagnosis and the risky subject of spinal surgery, which cannot be changed, even through the use of endoscopy.

Endoscopic Techniques for the Management of Spinal Trauma

Background: In the past few years, endoscopic operations on the spinal column have developed from representing exceptional interventions to becoming standard procedures in spinal surgery. Operating techniques and instruments have been standardized and unified, making it possible now to perform safe endoscopic surgery, as the results of more than 350 operative treatments in a 5-year period show. History: This development was aided by the scarcely satisfactory results of purely dorsal treatment concepts, which intensified the demand for reconstruction of the anterior load-bearing spinal column. It was the high access morbidity of the conventional open procedure which stood in the way of a broader use of open ventral operations in spinal surgery and which limited the indication for open interventions to a few cases showing marked destruction or malformation in the anterior section of the spine. For this constellation, the endoscopic procedures could provide a solution based on the reduced access morbidity typical for endoscopic procedures without the need to accept diminished surgical effectiveness. Indications: The possibilities of endoscopic spinal surgery have been developed continuously during the past few years, so that today nearly all operations in spinal traumatology can be performed endoscopically. Endoscopic splitting of the diaphragm also made it possible to open up the upper sections of the lumbar spine, so that the area between the third thoracic vertebra and the third lumbar vertebra is now accessible to endoscopic surgery. The potential indications include repositioning, the incision and resection of ligaments and intervertebral disks, the removal of fragmented sections of vertebrae including anterior decompression of the spinal canal, the replacement of vertebral bodies with biological or alloplastic materials and, last but not least, the minimally invasive insertion of an implant for ventral stabilization.

A new fine probe for electric cautery during endoscopic surgery.

The present paper introduces a new fine probe for electric cautery (1.65 mm in diameter, 22 cm long) that can be connected to a conventional cylindrical hand-controlled cautery holder, which is monopolar and widely used in general surgery. When cautery was required, a 14-gauge intravenous catheter was inserted at an appropriate site under the guidance of a videoscope. After removing the steel inner needle, the extra tube was used as the fine surgical port for the cautery probe. The position of insertion could be altered according to the operating field. Cautery was performed by conventional methods. There was no bleeding or air leakage at the site of puncture during or after surgery. The puncture wound was closed without any sutures. Based on these results, the new fine probe for cautery can reduce the number of surgical ports required for instruments during video-assisted surgery, thus improving the ease and safety of endoscopic surgery.

A new optic cleaning and visualization stabilizing system for endoscopic surgery

SummaryClear vision is an essential requirement for safe endoscopic surgery. Sudden haemorrhage or the steam-creating application of electrocautery and lasers frequently leads to the restriction or complete loss of the endoscopic vision with consequent withdrawal and time-consuming cleaning of the optic. This deficiency in the cleaning properties of the endoscope can be hazardous especially in critical operative situations requiring the full attention of the surgeon. In co-operation with Wiest Co., Munich, Germany, a visualization stabilizing system for endoscopic surgery has been developed. The system consists of a 12 mm multifunctional tube into which the 10 mm endoscope can be inserted. Integrated in this tube are channels with small nozzles at their tips for irrigation and drying of the front glass of the optic by means of saline solution and CO2 gas. Blood and vapour can easily be washed away and the remaining liquid layer or drops at the tip of the endoscope can be blown off to avoid optical distort...