Endoscopic Surgery Techniques Research Articles

Patient satisfaction with endoscopic ear surgery technique: a comparative study with the postauricular incision microscopic technique

BackgroundEndoscopic ear surgery has numerous benefits, such as the capacity to obtain high-resolution pictures and visualize normally inaccessible locations such as the retrotympanum, sinus tympani, and facial recess. These areas are generally difficult to access with traditional microscopic techniques. Endoscopic ear surgery reduces operating time when performed by skilled surgeons, without the need for a postauricular incision wound.An essential aspect to consider when evaluating the effects of any procedure on individual satisfaction is the assessment of health-associated quality of life. It is a tool used for subjective assessment, which is regarded as a reliable measure of the satisfaction perceived—whether physically or mentally—resulting from a certain procedure.The goal of this study was to identify the benefits of middle ear surgery when done endoscopically compared to postauricular microscopic techniques in middle ear surgery. This was achieved by evaluating and comparing the level of satisfaction among patients who underwent either microscopic or endoscopic ear surgery.MethodsThe Chronic Ear Surgery Survey (CESS), a 13-point Likert scale survey designed specifically for assessing outcomes of surgery for chronic middle ear disease, was implemented to measure patient satisfaction. The survey comprises three subscales. We performed a retrospective study at the Otorhinolaryngology Department, Cairo University, Egypt. The study encompassed individuals who underwent surgery on the middle ear between March 2018 and September 2021.The patients were scheduled into two categories according to the technique of surgery (whether endoscopic or microscopic) in order to assess postoperative satisfaction using the Chronic Ear Surgery Survey (CESS).ResultsOur research findings demonstrated a statistically significant difference between the two categories in terms of the overall scores and all subscale scores of the Chronic Ear Surgery Survey (CESS), with patients who had middle ear surgery endoscopically (EES) showing better outcomes.ConclusionsIdentifying the elements that are strongly associated with subjective outcomes can assist surgeons in identifying patients who are more likely to have poorer satisfaction. This knowledge can be valuable in preoperative counseling. Endoscopic ear surgery (EES) seems to have a higher level of cosmetic acceptability, especially in terms of enhancing the socially related aspects of a patient's pleasure. This work thus supports the ongoing integration of endoscope utilization in otological surgical procedures.

Pain management after laparoscopic cholecystectomy: A systematic review and procedure-specific postoperative pain management (PROSPECT) recommendations.

Laparoscopic cholecystectomy can be associated with significant postoperative pain that is difficult to treat. We aimed to evaluate the available literature and develop updated recommendations for optimal pain management after laparoscopic cholecystectomy. A systematic review was performed using the procedure-specific postoperative pain management (PROSPECT) methodology. Randomised controlled trials and systematic reviews published in the English language from August 2017 to December 2022 assessing postoperative pain after laparoscopic cholecystectomy using analgesic, anaesthetic or surgical interventions were identified from MEDLINE, Embase and Cochrane Databases. From 589 full text articles, 157 randomised controlled trials and 31 systematic reviews met the inclusion criteria. Paracetamol combined with NSAIDs or cyclo-oxygenase-2 inhibitors should be given either pre-operatively or intra-operatively, unless contraindicated. In addition, intra-operative intravenous (i.v.) dexamethasone, port-site wound infiltration or intraperitoneal local anaesthetic instillation are recommended, with opioids used for rescue analgesia. As a second-line regional technique, the erector spinae plane block or transversus abdominis plane block may be reserved for patients with a heightened risk of postoperative pain. Three-port laparoscopy, a low-pressure pneumoperitoneum, umbilical port extraction, active aspiration of the pneumoperitoneum and saline irrigation are recommended technical aspects of the operative procedure. The following interventions are not recommended due to limited or no evidence on improved pain scores: single port or mini-port techniques, routine drainage, low flow insufflation, natural orifice transluminal endoscopic surgery (NOTES), infra-umbilical incision, i.v. clonidine, nefopam and regional techniques such as quadratus lumborum block or rectus sheath block. Several interventions provided better pain scores but are not recommended due to risk of side effects: spinal or epidural anaesthesia, gabapentinoids, i.v. lidocaine, i.v. ketamine and i.v. dexmedetomidine.

New Perspectives on Risk Assessment and Anticoagulation in Elective Spine Surgery Patients: The Impact of Ultra-Minimally Invasive Endoscopic Surgery Techniques on Patients with Cardiac Disease.

The advent of ultra-minimally invasive endoscopic spine surgery, characterized by significantly reduced surgery times, minimal blood loss, and minimal tissue trauma, has precipitated a paradigm shift in the preoperative management of patients with cardiac disease undergoing elective spine procedures. This perspective article explores how these advancements have influenced the requirements for preoperative cardiac workups and the protocols surrounding the cessation of anticoagulation and antiplatelet therapies. Traditionally, extensive cardiac evaluations and the need to stop anticoagulation and antiplatelet agents have posed challenges, increasing the risk of cardiac events and delaying surgical interventions. However, the reduced invasiveness of endoscopic spine surgery presents a safer profile for patients with cardiac comorbidities, potentially minimizing the necessity for rigorous cardiac clearance and allowing for more flexible anticoagulation management. This perspective article synthesizes current research and clinical practices to provide a comprehensive overview of these evolving protocols. It also discusses the implications of these changes for patient safety, surgical outcomes, and overall healthcare efficiency. Finally, the article suggests directions for future research, emphasizing the need for updated guidelines that reflect the reduced perioperative risk associated with these innovative surgical techniques. This discussion is pivotal for primary care physicians, surgeons, cardiologists, and the broader medical community in optimizing care for this high-risk patient population.

Preliminary Clinical and Radiological Outcomes of the "No-Punch" Decompression Techniques for Unilateral Biportal Endoscopic Spine Surgery.

To avoid the most offending surgical instrument for dural tears, we develop a "no-punch" decompression technique for unilateral biportal endoscopic (UBE) spine surgery. This retrospective study enrolled 68 consecutive patients with degenerative lumbar spinal stenosis segments. The treatment results were evaluated using the visual analogue scale (VAS) for low back and leg pain, the Japanese Orthopaedic Association (JOA) scores, and the Oswestry Disability Index (ODI). Radiological outcomes were evaluated using the preoperative and postoperative magnetic resonance imaging. This study included 36 male and 32 female patients who received 109 segments of decompression, with an average age of 68.7 (37-90 years). The average operation time was 52.2 minutes. The average hospital stay was 3.1 days. There were no dural tears but 3 minor surgical complications, all treated conservatively. The VAS for low back and leg pain improved from 4.6 and 7.0 to 0.8 and 1.2. The JOA score improved from 16.2 to 26.8, with an improvement rate of 82.0%. The ODI improved from 50.1 to 18.7. All these improvements were statistically significant. The cross-sectional dural area improved from 61.1 to 151.3 mm2, with an average increase of 90.2 mm2 and 205.3%. 87.1% of the ipsilateral facet joints and 84.7% of the contralateral facet joints were preserved. In 61% of the decompressed segments, the ipsilateral facet joints were preserved better than the contralateral facet joints. The UBE "no-punch" decompression technique effectively avoids the dural tears. It provides effective neural decompression, excellent facet joint preservation, and good treatment outcomes.

Comparing endoscopic and conventional surgery techniques for carpal tunnel syndrome: A retrospective study

IntroductionThis study aimed to compare the effectiveness of endoscopic carpal tunnel release (ECTR) versus open carpal tunnel release (OCTR) in treating carpal tunnel syndrome (CTS), focusing on symptom relief, functional recovery and post-operative complications. MethodsA retrospective analysis was conducted on 44 patients diagnosed with CTS, randomly assigned to undergo either ECTR (n=23) or OCTR (n=21). Parameters evaluated included post-operative pain, grip strength, functional status using the Disability of the Arm, Shoulder and Hand (DASH) score and time to return to work. ResultsPatients who underwent ECTR demonstrated superior functional recovery and quicker return to daily and work activities compared to those in the OCTR group. Grip strength improvement post-surgery showed no significant difference between the groups. However, ECTR patients reported significantly lower DASH scores and faster return to work, indicating better outcomes. There were fewer reports of post-operative complications and scar sensitivity in the ECTR group. ConclusionECTR provides an effective alternative to OCTR for CTS treatment, with advantages in functional recovery speed, reduced post-operative discomfort and faster return to work. These findings support the adoption of ECTR as a preferred surgical approach for CTS, highlighting its potential to improve patient outcomes with minimal complications.

Learning Curve of Biportal Endoscopic Spinal Surgery: A Retrospective 2-Center Study

OBJECTIVEBiportal endoscopic spinal surgery (BESS) technique is a novel, useful and minimally invasive therapeutic strategy for lumbar degenerative diseases, which has advantages over other surgical techniques. However, the degree of technical difficulty in learning BESS is controversial and not well established. This study aims to determine the learning curve of BESS technique through cumulative sum (CUSUM) analysis. METHODSA total of 144 consecutive patients who underwent BESS with lumbar decompressive discectomy between 2017 and 2023 were included. A retrospective bi-center study was performed. RESULTSThree doctors with endoscopy experience employed the BESS technique for 51, 42 and 46 procedures, respectively. The CUSUM test of the three doctors showed adequate technical ability at the 45th, 41st and 44th operations respectively. Two doctors without endoscopy experience gave up further use of BESS technique due to technical difficulties after initial attempt. The overall complication rates of the three surgeons using the BESS technique were 3.92% (n = 2), 6.82% (n = 3), and 2.17% (n = 1), respectively. CONCLUSIONSOur study demonstrated that BESS is an effective treatment, and the learning curves of BESS for lumbar discectomy using CUSUM analysis were 41 ∼ 45 cases in trainees with endoscopic experience. Endoscopic experience contributes to the learning curve of the BESS technique.

Arterial Blood Supply of the Stifle Joint in Horses.

The vascularization pattern of the equine stifle joint is insufficiently described in the literature, even though there is a growing need for knowledge of the exact blood supply, as (i) arthroscopy and endoscopic surgery techniques are increasingly performed in horses and (ii) ex vivo models of menisci need nutrient supply that mimic the in vivo situation. The aim of this study was to describe the vessels involved in the stifle joint supply and the exact branching pattern of the popliteal artery. Colored latex was injected into the arteries of nine pelvic limbs of equine cadavers (n = 6) to evaluate the occurrences, variations and approximate diameters of vessels that supplied the stifle joints. Next to a branch of the saphenous and descending genicular arteries, eleven branches of the popliteal artery could be described in horses that feed the vascular network of the stifle joint. With a focus on the blood supply of the menisci, a vascularization map was created to show the main influx to these intra-articular structures in detail. These findings are potentially of great importance to both clinicians in preparation of best-suited incisions for arthroscopy and researchers designing new approaches for meniscal studies and choosing suitable animal models.

Biportal endoscopic bone graft repair and percutaneous screw fixation for lumbar spondylolysis-technical note and clinical outcomes.

Lumbar spondylolysis involves a bony defect in the vertebral pars interarticularis, predominantly affecting the lower lumbar spine. This condition is a significant etiological factor in lumbar instability and recurrent lower back pain, particularly in young individuals. While conservative treatments are the primary intervention, they often fail to provide relief, necessitating surgical approaches. Notwithstanding, executing bone grafting and fixation in the pars interarticularis defect simultaneously through minimally invasive surgery remains challenging. This study elucidates the biportal endoscopic spinal surgery (BESS) technique, innovatively applied for bone graft repair and percutaneous cannulated screw fixation in a patient with lumbar spondylolysis. We offer a detailed walkthrough of the technical procedures supplemented with follow-up radiographic evidence. The BESS technique facilitated meticulous clearance of the defect site, coupled with bone grafting and cannulated screw fixation, effectively addressing lumbar spondylolysis through a minimally invasive approach. This method holds promise for achieving substantial osseous fusion at the vertebral pars interarticularis defect site. The BESS procedure for lumbar spondylolysis ensures a clean and prepared defect site for grafting and encourages successful osseous fusion, spotlighting its potential as a viable surgical strategy in managing this condition.

Prevalence and Techniques of endoscopic Spinal Surgery among accredited Training Centers in Switzerland

Prevalence and Techniques of endoscopic Spinal Surgery among accredited Training Centers in Switzerland

Endoscopic Anatomy of the Skull Base.

Presently, endoscopic skull base surgery has undergone significant advancements since its inception over two decades ago. Nevertheless, it is imperative to underscore that the fundamental basis of all surgical procedures lies in the meticulous understanding of anatomy, with particular emphasis on the ventral anatomy. This facet has recently garnered increased attention.Following the advancements in endoscopic skull base surgery techniques, this chapter will concentrate on the pertinent anatomical considerations that serve as key foundations for successful procedures. These considerations are categorized into two planes: the sagittal plane and the coronal plane.The sagittal plane is further subdivided into five distinct approaches, namely,(1) the transcribriform approach, (2) the transplanum approach, (3) the transsellar approach, (4) the transclival approach, and (5) the transodontoid approach.On the other hand, the coronal plane is delineated into seven specific zones to facilitate comprehension and potential applications: (1) the petrous apex approach, (2) the intrapetrous approach, (3) the suprapetrous approach, (4) the cavernous sinus approach, (5) the infratemporal approach, (6) the medial condyle approach, and (7) the jugular foramen approach.By organizing the anatomical aspects in this systematic manner, the information provided becomes more accessible, fostering a comprehensive understanding of the subject matter for potential future application.

Endoscopic endonasal trans-cribriform approachfor drainage of frontal lobe abscess in invasivemucormycosis – A case report

Abstract Introduction:Mucormycosis is a belligerent fungal infection that can cause fatal complications. Patients at risk arethose with poorly controlled diabetes mellitus, and similar immunosuppressed states. Tissue invasion and infarctionsecondary to angioinvasion are the pathognomonic features of the disease. The management of brain abscesseshas become increasingly complicated requiring close collaboration between various departments encompassinginfectious disease specialists, neurologists, radiologists and neurosurgeons. ENT surgeons are seldom involved inthe management of brain abscesses, but with the advancements in Endoscopic Sinus Surgery techniques, ENTsurgeons are now treating the skull base, meningeal and brain pathologies.Methods:A case report of a 36-year-old male with complaints of headache, left-sided facial pain, difficultyin opening left eye for 10 days, with a history of one episode of generalized seizure that lasted for 4 min,recently detected type 2 diabetic mellitus. Local examination revealed left-sided nasal crusting and an old palataldefect. KOH mount was positive for mucorales. CT scan PNS revealed left-sided maxillary, ethmoidal, sphenoidalfrontal sinusitis with erosion of left lamina papyracea, left extraconal and intraconal involvement with erosion ofleft cribriform plate. MRI brain revealed additional hyperdensities in both medial frontal, and parietal lobe withdiffusion restriction. The patient underwent left-sided endoscopic sinus surgery with endoscopic endo- nasal trans-cribriform drainage of frontal lobe abscess, with retro bulbar Amphotericin B injection, with a neurosurgical team onstandby in the event of unexpected complications. The eschar and pus drained from the frontal lobe abscess wassent for histopathological examination, culture and sensitivity. The patient was extubated, and the postoperativeperiod was uneventful.

What is the applicability of tubal ligation with the vaginal natural orifice transluminal endoscopic surgery technique and its value in patient comfort?

The aim of this study was to observe the feasibility of the tubal/adnexal approach using vaginal natural orifice transluminal endoscopic surgery and compare its contribution with surgeon ergonomics and postoperative patient comfort with that of conventional laparoscopy. We completed this study retrospectively with 47 patients. Patients were followed at their postoperative first month. We analyzed the usability of the vaginal natural orifice transluminal endoscopic surgery method over conventional laparoscopy by comparing the demographics, surgical data, and postoperative findings collected between the two groups. Patients in the conventional laparoscopy group were older (39.1±3.3 years) than those in the vaginal natural orifice transluminal endoscopic surgery patient group (p=0.005). Pain intensity 24 h after surgery was lower in the vaginal natural orifice transluminal endoscopic surgery group (p=0.003), while sexual function and dyspareunia did not differ between the two groups in the first month. Patients in the vaginal natural orifice transluminal endoscopic surgery group were more relieved about painlessness and the comfort it brought than the conventional laparoscopy group (p=0.027, χ2=12.56). Patients subjected to the vaginal natural orifice transluminal endoscopic surgery procedure showed higher levels of satisfaction, less postoperative pain, and greater comfort than those subjected to conventional laparoscopy.

A Study on the Possibility of Endoscopic Modified Lothrop Procedure Using Imaging Measurements

Background and Objectives Endoscopic modified Lothrop procedure (EMLP) is indicated after the failure of standard endoscopic sinus surgery techniques to alleviate frontal sinus disease. Three parameters, such as nasal beak thickness (NBT), accessible dimension of frontal recess (AD), and distance of frontal sinus (DFS), are important in the preoperative evaluation and selection of patients for EMLP. The purpose of this study is to apply the parameters to determine the feasibility of EMLP for the Korean population.Subjects and Method Sinus CT was performed on a total of 233 people, and a study was conducted using 466 bilateral sides with the following parameters: 1) NBT 2) the distance from the posterior margin of nasal beak to the anterior margin of skull base (DNBSB) 3) the right and left AD and 4) the right and left DFS. If the values of NBT, AD, and DFS of the study group were less than 10 mm, greater than 5 mm and 7 mm, respectively, they were considered candidates for the EMLP.Results DNBSB, NBT, AD, and DFS were 6.97±1.96 mm, 7.01±1.58 mm, 7.16±2.40 mm, and 9.47±2.91 mm, respectively. Parameters except DNBSB showed significant differences in male and female. The feasibility of EMLP was 75.36% for male and 57.89% for female, with 68.24% overall.Conclusion The overall feasibility of EMLP was 68.24% for the study group, where feasibility was lower for female than for male.

Transvaginal natural Orifical transluminal Endoscopy for sacrocolpopexy: A case series report

BackgroundTo describe the surgical technique and operative outcomes of transvaginal natural orifice transluminal endoscopic surgery (V-NOTES) for sacrocolpopexy with or without robotic surgical system in patients with pelvic organ prolapse (POP). MethodsPatients with POP undergoing traditional transvaginal natural orifice transluminal endoscopic surgery (TV-NOTES) or robotic transvaginal natural orifice transluminal endoscopic surgery (RV-NOTES) for sacrocolpopexy performed by one surgeon from Sep 2020 to Jan 2023 in our hospital were included in this study. The baseline demographics and operative outcomes were collected and analyzed. In addition, some surgical skills were presented. The operative outcomes of V-NOTES for sacrocolpopexy performed by three beginners were also presented. ResultsEight patients who underwent TV-NOTES, and two patients who underwent RV-NOTES were included in this study. The mean operative time was 180 ± 49 min, and the estimated blood loss was 107 ± 82 ml for these ten cases. Particularly, the operative time of the two patients who underwent RV-NOTES was 275 and 132 min, while the estimated blood loss (EBL) was 100 and 50 ml respectively. During the follow-up period, no mesh exposure and recurrence were observed. In addition, five cases of TV-NOTES for sacrocolpopexy by beginners were all successfully completed. ConclusionBoth TV-NOTES and RV-NOTES appeared to be feasible and safe for sacrocolpopexy.

What About My Weight? Insufficient Weight Loss or Weight Regain After Bariatric Metabolic Surgery.

This review study aimed to investigate the definition, etiology, risk factors (RFs), management strategy, and prevention of insufficient weight loss (IWL) and weight regain (WR) following bariatric metabolic surgery (BMS). Electronic databases were searched to retrieve relevant articles. The inclusion criteria were English articles with adult participants assessing the definition, prevalence, etiology, RFs, management strategy, and prevention of IWL/WR. Definition: The preferred definition for post-BMS IWL/WR are the terms "Lack of maintenance of total weight loss (TWL)>20%" and "weight change in percentage compared to nadir weight or weight loss". Prevalence: The exact prevalence of IWL/WR is still being determined due to the type of BMS and various definitions. Etiology: Several mechanisms, including hormonal/metabolic, dietary non-adherence, physical inactivity, mental health, and anatomic surgical failure, are possible etiologies of post-BMS IWL/WR. Risk factors: Preoperative body mass index (BMI), male gender, psychiatric conditions, comorbidities, age, poor diet, eating disorders, poor follow-ups, insufficient physical activity, micronutrients, and genetic-epigenetic factors are the most important RFs. Management Strategy: The basis of treatment is lifestyle interventions, including dietary, physical activity, psychological, and behavioral therapy. Pharmacotherapy can be added. In the last treatment line, different techniques of endoscopic surgery and revisional surgery can be used. Prevention: Behavioral and psychotherapeutic interventions, dietary therapy, and physical activity therapy are the essential components of prevention. Many definitions exist for WR, less so for IWL. Etiologies and RFs are complex and multifactorial; therefore, the management and prevention strategy is multidisciplinary. Some knowledge gaps, especially for IWL, exist, and these gaps must be filled to strengthen the evidence used to guide patient counseling, selection, and improved outcomes.

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.

Advances in endoscopic sleeve gastroplasty for the treatment of obesity and metabolic disease

Obesity poses a serious threat to human health, and although bariatric surgery has been proven effective treatment for morbidly obese patients, its surgical risks and high medical costs limit its clinical application and popularity. Endoscopic sleeve gastroplasty (ESG), as a relatively new endoscopic surgery technique for weight loss, has satisfactory weight loss effects compared to laparoscopic sleeve gastrectomy and lifestyle interventions, while preserving the normal structure of the stomach. Its weight loss effects and safety have been validated in multicenter studies abroad. Although, ESG has not yet been widely performed in China, with the gradual maturity of this technique, its prospects are worth attention in the field of weight loss. In the future, large-scale, long-term, multi-center studies are urgently needed in China to clarify the long-term effects, remission of comorbidities, and occurrence of complications of ESG surgery in obese and metabolic disease patients.

Comparison of the Novel Two-Hand Technique Using the Saraj Endocath with the Traditional Three-Hand Technique in Transnasal Endoscopic Pituitary Surgery: An Innovation for the Future

Endoscopic surgery has become the preferred treatment of sellar lesions because of its minimally invasive nature. Visualization is frequently obscured as a result of the frequent contact of the lens with blood and tissue debris. We seek to alleviate these problems and increase the efficiency and safety of neuroendoscopic surgery by introducing a new device (Saraj Endocath) combining the major function of suction with the endoscope. A total of 75 patients with pituitary macroadenoma who were eligible for transnasal transsphenoidal endoscopic excision were included in the study between January 2020 and January 2023. Forty-one patients were operated on by the traditional 3-hand technique and 34 patients were operated on using the Saraj Endocath. The duration of surgery, in-out frequency of the endoscope, number of wipes needed to clean the endoscopic lens, and outcomes were assessed. A questionnaire regarding assistance, ergonomics, and instrument handling compared the Saraj Endocath procedure with the traditional technique. The 3-hand technique was converted into the 2-hand technique. The mean operative time using the novel technique with the Saraj Endocath was reduced significantly compared with the traditional technique. The mean number of in-out movements of the endoscope and the number of wipes per hour decreased significantly using the Saraj Endocath. There was no dependency on the assistant's expertise and skills. The use of the Saraj Endocath can effectively reduce the mean operative time by decreasing the frequency of in-out movement and wiping off the lens of the endoscope. It reduces fatigue, avoids clustering of instruments and hands, and minimizes the dependency on assistants.

Surgical treatments and outcomes of acquired laryngotracheal stenosis: our experience

BACKGROUND: We report the ten-year experience of Unit of Otolaryngology, Miulli Hospital, concerning the surgical treatment of laryngotracheal stenosis (LTS).METHODS: Retrospective observational study conducted on 48 patients.RESULTS: Myer-Cotton staging used to standardize the measurement of laryngotracheal stenosis (LTS) showed a marked reduction up to grade I in 90% of patients treated with the endoscopic (“endo”) surgery technique and in 100% of patients treated with the open (“open”) surgery technique. There was no statistical significance between the “endo” group and the “open” group for the percentage of decannulation: (100% for “open” surgery techniques. 62% for “endo” surgery technique). The clinical target is achieved almost for the patients of both groups with a slightly higher percentage for the group “open” (100% vs. 90%). There were no statistically significant differences for the reintervention parameter in relation to the different treatment modalities (“endo” =36% vs. “open” =17%) or to the main sites of stenosis (laryngotracheal =40%, tracheal =33%, laryngeal =31%).CONCLUSIONS: The surgical outcomes confirm the good efficacy of the work carried out up to now. We hope to be able to objective, through instrumental methods or questionnaires, the pre and postoperative clinical condition of LTS patients undergoing “open” or “endo” surgery.

Transthoracic Aortic Clamp Technique for Port-Only Endoscopic Robotic Mitral Surgery.

Many robotic mitral surgeons utilize right thoracotomy with transthoracic clamping of the aorta, while a smaller number employ a port-only endoscopic approach with endoaortic balloon occlusion of the aorta. We present our technique for a port-only endoscopic robotic approach with transthoracic clamping. From July 2019 through December 2022, 133 patients underwent port-only endoscopic robotic mitral surgery with transthoracic clamp aortic occlusion and antegrade cardioplegia. Perfusion was through the femoral artery in 101 patients (76%) and axillary in 32 patients (24%). Clamp technique involved placing the clamp at the mid-ascending aorta, dynamic valve testing to 90 mm aortic root pressure, and closure of the cardioplegia cannula site prior to clamp removal. Indications for clamp utilization over balloon occlusion included both balloon supply issues and aortoiliac anatomy. Mitral repair was performed in 122 patients (92.7%) and mitral valve replacement in 11 patients (8.3%). Mean aortic occlusion time was 92 ± 21.4 min. Mean time from left atrial closure to clamp removal was 8.7 (7.2 to 12.8) min. There were no injuries to the aorta or surrounding structures, mortality, strokes, or renal failure. For robotic teams with endoaortic balloon capability, this technique may be useful in certain patients with aorto-iliac pathology or limited femoral artery access. Alternatively, robotic teams who employ transthoracic aortic clamping through a thoracotomy may find this technique useful to transition to a port-only endoscopic approach.