Endoscopic Surgery Techniques Research Articles

The multimedia CD ROM: an innovative teaching tool for endoscopic sinus surgery.

The recent explosive growth in the use of endoscopic techniques in the performance of surgical procedures has created an important need for educational materials on this subject. However, limitations of currently available teaching tools frustrate the user and hamper the teaching and spread of these procedures. To improve on currently available methods, we developed a CD ROM video atlas of techniques in endoscopic sinus surgery (ESS). The multimedia CD ROM video atlas combines the best features of the surgical atlas with conventional videotapes. The component steps of procedures in ESS are presented to the viewer as brief, individual video sequences, accompanied by narration and a text of the highlights of each procedure. The use of digital video allows the user to access the segment of interest directly, in the order of preference, without having to sift through the other segments, as with conventional videocassettes. An interface allows control over playback of the video, and sequences can be reviewed instantly. Storage capacity of the CD ROM allows up to 60 minutes of video to be stored on each disk. The CD ROM combines the best elements of currently available educational tools and may represent a new approach for medical education.

Development of the Subfascial Endoscopic Perforator Vein Surgery (SEPS) and Its Influence on the Final Postoperative Results

The aim of this study is to present results of treatment of 97 patients (118 lower extrem ities) with chronic venous insufficiency (CVI) by use of the new technique of subfascial endoscopic perforator vein surgery (SEPS). Forty-seven extremities were assigned to class 4, 33 to class 5, and 38 to class 6 of CVI. Eighty extremities (group A), were operated on earlier (1989-1993) by use of standard open endoscopic approach under direct vision, which is described further, whereas 38 extremities (group B) were operated on later (1993-1994) with use of modified endoscopic technique. The latter involved indirect vision by means of video technique, application of vascular clips, subfascial insufflation of CO2, skin traction, and routine use of subfascial drainage. Clinical outcome of the early postoperative and three monthly follow-ups was judged on a published catego rization of operative results. There were 83.7% mild and moderate improvements in group A vs 89.4% in group B. The most significant late complication was dysesthesia in the distribution of the saphenous nerve. This was observed in 6.2% of patients in group A vs 2.6% in group B. We conclude that improvement of results of treatment was related to our growing experience and implementation of the modifications presented here.

A technique of percutaneous endoscopic intragastric surgery

SummaryA technique of percutaneous endoscopic intragastric surgery (PEIGS) is described. In PEIGS, three cannulae are inserted percutaneously into the gastric cavity, using a technique similar to that used in percutaneous endoscopic gastrostomy. Through these intragastric cannulae a rigid endoscope and two surgical instruments are brought into the gastric cavity. The gastric cavity is dilated by CO2 insufflation and large en bloc mucosectomy is carried out using a grasper and a high-frequency hook under percutaneous gastroscopic view. The mucosal defect is closed by suturing. After removal of the intragastric cannulae, the wounds in the stomach are closed by suturing. We also report a case with a large sessile adenoma in the gastric antrum containing a cancer focus. In this case we were able to remove the lesion (measuring 80 mm at its greatest diameter) in en bloc fashion by the PEIGS technique. During the follow-up period of 3 years the patient has had no tumour recurrence and enjoys an excellent quality of life. PEIGS can be a preferred choice of therapy in selected patients with sessile adenomas and carcinoma in situ of the stomach, and may also be used for other pathologies, such as pancreatic pseudocyst or intractable gastric haemorrhage.

Access techniques in endoscopic fetal surgery: F.I. Luks, J.A. Depsrest, B.F. Gilchrist, et al. Eur J Pediatr Surg 7:131–134, (June), 1997

Access techniques in endoscopic fetal surgery: F.I. Luks, J.A. Depsrest, B.F. Gilchrist, et al. Eur J Pediatr Surg 7:131–134, (June), 1997

Transtracheal high frequency jet ventilation in adults and chldren

Percutaneous high frequency transtracheal jet ventilation (TTJV) is a useful technique for diagnostic and therapeutic endoscopy of the larynx and subglottic space in otolaryngological patients. It provides excellent operative conditions by increasing the exposure of the surgical field, provides adequate gas exchange and reduces ignition hazards, all conditions that greatly increase the safety of the procedure. Postoperative endotracheal intubation or even tracheotomy may thus be avoided. The insertion of the catheter is a safe procedure provided that it is performed under direct endoscopic control. Adequate monitoring of the end-expiratory pressure together with constant clinical surveillance of chest movements and gas egress are of great importance to avoid pulmonary barotrauma. Because TTJV is more invasive than orotracheal intubation, it should not be used as a routine technique in pediatric endoscopic surgery, despite its advantages. However, in selected cases such as those with upper airway stenosis, TTJV can avoid a difficult and complicated procedure or the need for a tracheotomy and should therefore be considered and performed by experienced practitioners in specialized centers.

P-5-632 - Demonstration of octreotide effect on GH secretion by somatotroph adenomas in vitro using the reverse hemolytic plaque assay

Craniopharyngioma resection is one of the most challenging surgical procedures. Herein, we describe our extended endoscopic endonasal transsphenoidal surgery (EETS) technique, and the results of 9 years of use on primary and recurrent/residual craniopharyngiomas.This study reviewed 28 EETSs in 25 patients with craniopharyngiomas between January 2006 and September 2015. The patients were divided into 2 groups, newly diagnosed patients (group A, n = 15), and patients having residual or recurrent tumors (group B, n = 10). There was no significant difference between the groups in terms of the largest tumor diameter (P = 0.495), and all patients underwent EETS. The clinical and ophthalmologic examinations, imaging studies, endocrinologic studies, and operative findings for these cases were reviewed retrospectively.The number of gross total resections in group A was 13/15, and 7/10 in group B. Three of the patients developed postoperative cerebrospinal fluid leakage (all in group A). There were no neurovascular or ophthalmologic complications, and no meningitis or mortality was observed.There has been a notable increase in the use of EETS in the treatment of craniopharyngiomas during the last decade. Despite its increased use in the treatment of primary craniopharyngiomas, its implementation for recurrent or residual craniopharyngiomas has been viewed with suspicion. In this study, the results have been presented separately for primary and recurrent/residual craniopharyngiomas, so that the results can be compared. Overall, EETS is a reliable and successful surgical treatment method for primary and recurrent/residual craniopharyngiomas.

Access techniques in endoscopic fetal surgery.

Endoscopic surgery may in the future become an attractive alternative to open fetal surgery. Herein, we present our evolving experience with minimal access techniques in sheep and nonhuman primate models. Fifty-two pregnant sheep (term = 145 d) were used. All underwent laparotomy. Cannulas were 5 mm diameter with balloon fixation device. In group I (95-105 d, n = 22, and 70-74 d, n = 19), a total of 119 cannulas were placed by open hysterotomy and pursestring suture through myometrium and membranes. In group II (n = 11), access was obtained by Seldinger guidewire technique. Eight cannulas were introduced over a dilator and 7 were radially expanding endoscopic cannulas. Fifteen cannulas were also placed in 5 pregnant Rhesus monkeys using Seldinger and radially expanding techniques. Cannula removal was followed by insertion of a collagen sponge plug and oversewing of the myometrium. Mini-hysterotomies with purse-stringing provided excellent access to the amniotic cavity, without dissection of the membranes. Classic Seldinger technique with forward dilatation was equally effective, but caused stretching of membranes. In sheep and in primates, Seldinger technique with radial dilatation allowed safe access without membrane separation. Leak-proof removal of the cannulas was achieved in all primates. Open hysterotomy with purse-string and balloon-tipped cannula provides efficient and safe access to the gravid sheep uterus. Seldinger technique allows equally secure access, and alleviates the need for hysterotomies. Radial dilatation of the porthole eliminates forward dissection of the membranes, both in sheep and primate models. This method, and collagen plug insertion upon completion of the endoscopic procedure, may provide a truly minimally invasive approach to in-utero surgery.

A minimally invasive technique for endoscopic middle ear surgery.

Middle ear endoscopy should be considered a useful adjunctive or alternative method to microscopic surgical exploration for middle ear pathology. This minimally invasive technique provides excellent visualization for viewing the surgical micromorphology and pathological findings of the middle ear. Selected patients underwent middle ear endoscopy using a transtympanic approach. Rigid endoscopes of 2.7 mm and 1.9 mm caliber and 0 degrees, 30 degrees and 70 degrees viewing angles were introduced into the tympanic cavity through small tympanostomy incisions. The indications and technique with video monitoring are discussed.

ISMISS Meeting, Zurich, January 1997. 15th course for percutaneous endoscopic spinal surgery and complimentary techniques.

ISMISS Meeting, Zurich, January 1997. 15th course for percutaneous endoscopic spinal surgery and complimentary techniques.

Endoscopic approach to tumors of the anterior skull base and orbit

The techniques of functional endoscopic sinus surgery have become widely accepted for management of inflammatory disease. However, with the excellent visualization provided by the endoscope, these same techniques are now being used with great success managing benign tumors of the anterior skull base and orbit. This article will discuss our experience in managing such lesions since 1989, emphasizing general principles for resection and specific details for individual lesions including mucoceles, inverted papillomata, fibro-osseus lesions, and juvenile nasopharyngeal angiofibromata. Preoperative planning with computed tomography, magnetic resonance imaging and angiography is discussed. Our results to date using endoscopic resection are encouraging, but equally important is the postoperative monitoring afforded by the endoscope with the ability to detect early recurrence regardless of the resection technique used.

Middle Turbinate Stabilization Technique in Endoscopic Sinus Surgery

Lateralization of the middle turbinate with scarring and obstruction of the middle meatus after endoscopic ethmoidectomy has accounted for a high percentage of postoperative complications. To evaluate a suture stabilization technique of the middle turbinates in an attempt to solve this problem and preserve the middle turbinate. Retrospective chart review of 31 consecutive patients undergoing endoscopic sinus surgery with suture stabilization of the middle turbinate. With the technique of suture stabilization of the middle turbinate in 60 operated-on sides of 31 patients, 59 sides showed the middle meatus to be patent without synechia or maxillary sinus ostium obstruction postoperatively. The complication of lateralization of the middle turbinate with scarring and obstruction of the middle meatus after endoscopic ethmoidectomy can be prevented with suture stabilization of the middle turbinate, and the middle turbinate can be preserved.

Management of Sinusitis in the Asthmatic Patient

To describe pathophysiologic links between sinusitis and asthma; to identify means of diagnosing sinusitis in the asthmatic; to discuss the management of asthmatic patients with sinusitis, both medical and surgical; to examine the outcome of managing the asthmatic patient with sinusitis. Prospective and retrospective data from the author's experience was evaluated. Medline database was searched from January 1, 1984, using the keywords "asthma" and "sinusitis" without restriction to species or language; 48 articles identified. Relevant articles referenced in retrieved sources, current texts in otorhinolaryngology and sinus disease were also utilized. From data source abstracts, pertinent articles (33) and book chapters meeting the objectives of our paper were intensively reviewed. Clinical and experimental studies indicate that sinonasal inflammation can result in worsening of lower airway disease, while the exact nature of this relationship remains debated. Regardless of mechanism, identification of the asthmatic patient with chronic sinusitis using the techniques of nasal endoscopy and CT scanning can lead to treatment of sinusitis with overall sinus and asthmatic disease improvement. Proper management is first medical, while surgical approaches are reserved for persistent cases. Traditional, more radical, surgical approaches have shown good results overall, while newer techniques of functional endoscopic sinus surgery which respect anatomy and mucosal function are less studied but expected to result in similar or better long-term outcome. Sinusitis and asthma coexist and impact on one another at many different levels. Proper identification of the asthmatic patient with chronic sinusitis can be readily discerned by an accurate and thorough history and physical examination including nasal endoscopy and CT scanning. Proper medical and surgical management of sinusitis in the asthmatic patient can result in both improved sinonasal and asthmatic symptoms with fewer physician visits and decreased need for medication.

Powered Instrumentation in Functional Endoscopic Sinus Surgery I: Surgical Technique

The use of the microdebrider provides an excellent, safe and thorough technique in functional endoscopic sinus surgery. It provides atraumatic dissection with minimal bleeding which enables decreased surgical time and faster postoperative healing. It is easily learned and requires minimal supplemental instrumentation. We feel that it is a superior technique in the practice of functional endoscopic sinus surgery.

Powered Instrumentation in Functional Endoscopic Sinus Surgery II: A Comparative Study

The present paper compares the use of the microdebrider as a form of powered instrumentation for endoscopic sinus surgery with traditional endoscopic surgical techniques. A group of 250 patients undergoing surgery with the microdebrider was compared with a group of 225 patients undergoing traditional procedures in order to evaluate their postoperative recovery, healing, and incidence of complications. The use of the microdebrider demonstrated faster healing with less crusting than standard techniques, as well as decreased bleeding, synechia formation, lateralization of the middle turbinate, and ostial reocclusion. The microdebrider offers excellent surgical results with fewer complications and faster healing than traditional techniques in functional endoscopic sinus surgery.

Special techniques in endoscopic sinus surgery

Educational objectives: To gain an improved understanding of sinus anatomy and of alternate surgical approaches for the management of DCR, orbital decompression, CSF leaks, encephaloceles, and optic nerve decompression.

Computer‐Assisted Endoscopic Sinus Surgery

Educational objectives: To introduce the participant to the new technique of computer-assisted endoscopic sinus surgery and to review important anatomic areas, with special attention to potential “danger areas.”

Sinus Disease in Cystic Fibrosis

Educational objectives: To understand cystic fibrosis with regards to diagnosis, medical management, and head and neck manifestations and to understand the application of endoscopic sinus surgery techniques to the sinonasal pathology in patients with cystic fibrosis.

Chronic Sinusitis Literature-Reply

Confusing terminology and contradictory statements categorize the minimal information available to the internist on the subject of chronic sinusitis. Much of this problem is caused, I suspect, by the nature of the illness. For some physicians, chronic sinusitis is a syndrome characterized by facial pain, rhinitis, and malaise; but for others, only the appropriate radiographic and endoscopic findings define the disease. The proceedings of an otolaryngology symposium entitled First-Line Management of Sinusitis1addresses the subtleties of chronic sinusitis and offers a particularly valuable guide for those in other specialties. This publication is especially helpful in describing newer concepts (eg, the primacy of the ostiomeatal complex) as well as updated techniques in functional endoscopic nasal surgery. The collected articles of an allergy meeting devoted exclusively to sinusitis2are also helpful. The medical perspective of this review emphasizes the allergic and immunologic features of the disease rather than the surgical and

The Endoscopic Approach to the Pituitary Gland

We present the use of the rigid sinus endoscope for the removal of two benign pituitary neoplasms. After a search of the relevant literature it appears that the use of the rigid endoscope has been confined to surgical procedures on the paranasal sinuses. With the addition of the techniques of endoscopic sinus surgery to this interface of otolaryngology and neurosurgery, we believe an alternative to transseptal or traditional transsinal procedures has been introduced. Both patients who underwent pituitary gland resection for benign adenoma presented with visual complaints prompting discovery of the tumors. Appropriate endocrinologic consultation was obtained before surgery. Septoplasty was not required in either patient. The procedures were performed with the patients under general anesthesia with the use of topical and injectable anesthetic solutions as with other endoscopic procedures. The first patient developed a cerebrospinal fluid rhinorrhea on the third postoperative day that was repaired with endoscopic application of

Nasal hamartoma: case report and review of the literature

Nasal masses in the pediatric population present with nasal obstruction, epistaxis and chronic rhinorrhea. We report on a 6-year-old boy with long-standing nasal obstruction. A large left nasal mass was evident on physical examination and CT scan. Techniques of functional endoscopic sinus surgery were used to resect the mass, which, on pathologic examination, proved to be a hamartoma. Hamartomas are non-neoplastic malformations, or inborn errors of tissue development. They are characterized by an abnormal mixture of tissues indigenous to that area of the body. Review of the literature revealed 5 previously reported cases of nasal hamartomas, only 2 of these in children. Our case is unique in that the hamartoma arose from the ethmoid and maxillary sinuses; previously reported cases arose from the septum and vestibule. This is the first reported case treated using a functional endoscopic sinus surgery approach.