Videoendoscopic Technology Research Articles

Endoscopic diagnosis of laryngeal precancerous lesions and early laryngeal cancer

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

Esophageal anastomosis: experience of open surgery and modern possibilities of video endoscopic technologies. A review

The weakest link in laparoscopic gastrectomy is the esophageal anastomosis, the reliability of which, despite the large number of proposed techniques, remains insufficient. The article presents modern methods of intracorporeal esophageal anastomosis, assesses their advantages and disadvantages. Almost all techniques use a single-layered, mostly mechanical, suture. The probability of maintaining the tightness of a single-layered esophageal anastomosis in case of its healing by secondary tension is extremely small. The experience of open surgery has shown that the placement of the terminal esophagus and the first layer of sutures of anastomosis in a serous-muscular sheath, which is formed from the wall of the intestine or stomach using invagination or wrapping methods, provides a greater likelihood of maintaining the tightness of the anastomosis in any type of healing. Expanding indications for the use of these methods in open surgery and developing a technique for intracorporeal esophageal anastomosis with covering the first layer of sutures of anastomosis with the wall of the anastomosed organ seems to be a promising direction that can significantly reduce the incidence of anastomotic leak both in open and laparoscopic surgery.

Surgical aspects in treatment of gallblader parenchymatous polyps

Aim of this work is to pay attention to tactical approaches to patients with gallbladder polyps. Materials and methods. Authors analyze the experience of surgical treatment of 84 patients with gallbladder polyps for the period 2015-2021 yy. at the University Clinic. Results. Histological examination showed that hyperplastic polyps met most frequently in 47.6%, adenomatous polyps occurred in 45.3% and cholesterol (cholesterosis) in 7.1%. Conclusions. Gallbladder polyps have no specific symptoms. The potential for malignant transformation implies an active surgical approach, which leads to an increase in the number of surgical benefits. At the same time, minimally invasive, videoendoscopic technologies have sufficient capabilities for the radical removal of gallbladder polyps.

To the question of surgical correction of evacuatory disturbances of upper part of the gastrointestinal tract

Aim. To study the possibilities of using video endoscopic technologies in the surgical treatment of hiatal hernia and evaluate long-term results.Materials and methods: 52 patients who underwent laparoscopic correction of hiatal hernia were examined.Results. Excellent and good results were obtained in 31 patients (73,8%), a group with satisfactory treatment results were 2 (4,8%) patients, and an unsatisfactory result was observed in 9 (21,4%) patients.

Гигантская опухоль яичника у 16-летней девочки

Ovarian tumors are an important and urgent problem of modern gynecology. This is due to the difficulties in diagnosing neoplasms due to the absence of characteristic complaints and frequent asymptomatic course. Pediatric surgeons, pediatric gynecologists should conduct differential diagnostics between ovarian tumors and tumors of the abdominal cavity and retroperitoneal space in order to timely diagnose and treat neoplasms and prevent possible medical error. The article presents an indicative clinical case of the occurrence of giant mucinous ovarian cystadenoma in a teenage girl requiring differential diagnosis with formations of a different localization. Patient F., 16 years old, was admitted to the hospital in the direction of one of the regions of the Russian Federation. The reason for the patient's treatment to a gynecologist at the place of residence was pain in the lower abdomen for a month and an increase in the size of the abdomen. The patient was sent to the hospital to clarify the diagnosis and further treatment. Radical surgical treatment was performed: removal of the cyst of the left ovary using video endoscopic technologies

Laparoscopic Surgery for Acute Appendicitis Complicated by Peritonitis

Introduction . Acute appendicitis (AA) is one of the most common acute abdominal surgical diseases. The current incidence, according to various authors, is 22.8 per 10,000 inhabitants. Annually, 50 to 70 thousand people die from AA and its complications around the world. Laparoscopy is generally accepted as the most effective method of differential diagnosis of AA. It is fundamentally significant to move from the diagnostic stage to the therapeutic one, i.e. to perform the elimination of the disease, including cases with other surgery-requiring pathology detected. Aim . To evaluate the role of video-endoscopic surgical methods in the surgical management of acute appendicitis complicated by peritonitis. Materials and methods . The analysis of recent publications and personal clinical experience revealed that diagnostic laparoscopy, unless contraindicated, should be performed as the initial step in suspected acute abdominal pathology. When the surgery is technically performable, laparoscopy also causes curative effect. Results and discussion. The use of laparoscopy in surgical treatment of acute appendicitis complicated by peritonitis has proven advantages for the patient over open surgery. An adequate appendectomy as a reliable method for elimination of the source of peritonitis is the key to successful treatment of patients. Laparoscopic lavage in the early postoperative period against the postoperative peritonitis with developing complications, is considered to be an alternative method to non-surgical treatment or delayed intervention and to have better ultimate results than percutaneous drainage or relaparotomy. Conclusion . The success of video-endoscopic technologies application depends not only on the technical aspects, but also on the correct choice of indications for such an intervention and their appropriate combination with open surgeries.

Videolaparoscopic surgical treatment of strangulated paraesophageal hiatal hernia (clinical observation)

Relevance. Paraesophageal hiatal hernias are much less common than other types of diaphragmatic hernias. The risk of strangulation in this pathology is about 21 %. It is often very difficult to establish the correct diagnosis in time, because patients are admitted with an atypical clinic of acute cardiological or pulmonary pathology. Usually, the correct diagnosis is established only on the 4th day. Due to late diagnosis, necrosis and perforation of the strangulated organ occur, which causes high mortality; sometimes the correct diagnosis is established only at autopsy.Clinical observation. The patient was admitted to the surgical department on an emergency basis with complaints of intense pain in the lower chest and epigastric region, vomiting of eaten food. From the anamnesis it is known that about a year ago, periodic nausea and vomiting of food eaten began to bother. The last 12 hours before admission to the hospital, pain in the chest and epigastrium intensified, all eaten food came out with vomiting. X-ray diagnosed strangulated paraesophageal hernia of the esophageal opening of the diaphragm. During esophagogastroduodenoscopy it was impossible to pass into the distal parts of the stomach; hyperemia and petechial hemorrhages were detected in the zone of strangulation. Video-laparoscopic reduction of the hernial contents, resection of the hernial sac and anterior diaphragm crurorrhaphy were urgently performed. The early postoperative period was uneventful. The presented clinical observation indicates the promise of using video-endoscopic technologies for diagnosis and treatment of strangulated diaphragmatic hernias. The key to success is the timely establishment of the correct diagnosis. We consider it impractical to perform an antireflux intervention simultaneously in conditions of an acute inflammatory process.

Новые подходы к ведению пациентов с нестойкой ремиссией круглогодичного аллергического ринита на фоне персистирующей хламидийной инфекции

Currently, allergic rhinitis is a global socioeconomic problem. According to current statistics, from 15 to 30% of the world’s population suffers from year-round or seasonal allergic rhinitis. Increasingly, the attention of Russian clinicians is attracted by the problem of year-round allergic rhinitis as there is an increase in the incidence in patients of the central zone of the Russian Federation with this form of rhinitis due to sensitization to house dust mite allergens, epidermal allergens of domestic animals, insect and mold allergens. Despite a timely diagnosis and received basic treatment, patients suffering from year-round allergic rhinitis often fail to achieve stable remission. Therefore, we can conclude that a more thorough diagnosis of the disease is needed, aimed at identifying other factors that affect the course of the disease. Objective. To develop a scheme for diagnosing a possible persistent respiratory chlamydial infection that affects the course of year-round allergic rhinitis in patients with a tendency to transient remissions. Materials and methods. Computed tomography of the paranasal sinuses, nasal swab for flora, PCR scraping of the nasal mucosa for the detection of Epstein–Barr virus (EBV) DNA, determination of viral DNA of cytomegalovirus infection (CMV) (PCR scraping of the nasal mucosa), determination of DNA in the scraping of epithelial cells of the nasal mucosa (PCR scraping) of human herpes virus type 6 (HHV-6 type). Patients who had pathological changes in computed tomography of the paranasal sinuses, deviations from the normal flora during bacteriological culture, and positive results in the PCR study of the above infections were excluded from the study. Then, PCR scraping of the nasopharyngeal mucosa for the detection of chlamydia pneumoniae, a survey of complaints (SNOT-22 questionnaire), data from an objective examination method (examination of ENT organs using video endoscopic technologies), an immunological examination of blood serum for IgG antibodies to chlamydial infection, further avidity of IgG antibodies to chlamydia pneumoniae and serum IL-6. Conclusion. The proposed diagnostic scheme will allow identifying a possible persistent respiratory chlamydial infection, which is the cause of transient remission of year-round allergic rhinitis, and developing a new integrated approach to the management of patients with year-round allergic rhinitis associated with this infection.

To the question of surgical correction of evacuatory disturbances of the upper departments of the gastrointestinal tract

Aim. To study the possibilities of using video endoscopic technologies in the surgical treatment of hiatal hernia and evaluate long-term results. Materials and methods. 52 patients who underwent laparoscopic correction of hiatal hernia were examined. Results. Excellent and good results were obtained in 31 patients (73,8%), a group with satisfactory treatment results were 2 (4,8%) patients, and an unsatisfactory result was observed in 9 (21,4%) patients.

Video endoscopic methods of laryngeal examination in modern phoniatry

Introduction. Modern diagnostics of laryngeal diseases is based on the use of video endoscopic technologies. The authors of the article, having almost thirty years of experience with various methods of video endoscopy, proposed a classification of video endoscopic methods of laryngeal examination. Objective. To develop an algorithm for the application of various video endoscopic methods of laryngeal examination in voice professionals with functional and organic dysphonia. Materials and methods. From 2020 to 2022, 2308 patients aged 18 to 80 years (43.2 ± 11.5) were examined in the phoniatric department of the St. Petersburg Research Institute of ENT. There were 1424 women (61,7 %), 884 men (38,3 %) people. Functional dysphonia was detected in 705 (30,5 %) people, acute and chronic laryngitis in 668 (28,9 %), tumor-like formations in 436 (18,9 %), the remaining nosological forms were diagnosed in 499 (21,7). All the patients turned out to be representatives of voice-speaking professions and complained of dysphonia.For videolaryngoscopy, videolaryngostroboscopy, autofluorescence endoscopy, NBI–endoscopy, equipment from various manufacturers was used. Results. An algorithm for the application of video endoscopic research methods in persons of voice-speech professions with dysphonia has been developed. Overview videolaryngoscopy and videostroboscopy were mandatory research methods for all patients with complaints of voice function. The use of these two methods proved to be sufficient for the diagnosis of functional dysphonia, paresis and paralysis, congenital malformations of the larynx, scar stenosis. In-depth diagnostics and differential diagnostics of tumor-like formations, various forms of chronic laryngitis, benign and malignant formations, in addition to videolaryngoscopy and videostroboscopy, included autofluorescence endoscopy or NBI endoscopy, which revealed the earliest stages of the pathological process. Conclusions. Only the complex application of various methods of video endoscopy of the larynx provided timely diagnosis and early treatment of dysphonia, maximum restoration of voice function, and, consequently, the preservation of professional longevity by persons of voice-speech professions.

INDICATIONS AND CONTRAINDICATIONS FOR REMOVAL OF FOREIGN BODIES OF LUNGS OF FLAMMABLE ORIGIN

Summary. The purpose of the study is to establish the indications and contraindications for the removal of foreign bodies of lungs of gunshot origin. Materials and methods. In the surgical department of the surgical clinic of the Military Medical Clinical Center of the Northern Region, 207 wounded who received gunshot wounds penetrating the chest were examined. The wounded were divided into 2 groups depending on the operational tactics used. The main group of 97 wounded who were treated using modern video endoscopic technology and magnetic surgical instruments. The comparison group consisted of 110 wounded who received traditional treatment. Results and their discussion. Using video endoscopic technologies and magnetic surgical instruments during surgery, 42 (54.5%) in the main group were removed, in the comparison group — 23 (27.4%) foreign bodies. The amount of surgery should not exceed the amount of damage that minimizes surgical trauma. The article presents indications and contraindications to the removal of foreign bodies of pulmonary origin. The differential approach allows to determine the surgical tactics depending on the location of the foreign body, its size and the fit of foreign bodies to the vessels, bronchi, mediastinum. Adherence to the rules of removal of foreign bodies of the lung, depending on the location of its location and size leads to a decrease in inappropriate surgical interventions and postoperative complications. Conclusions. 1. The distribution of foreign bodies by location and size allows you to clearly determine the tactics of treatment and avoid postoperative complications. 2. Surgical interventions to remove foreign bodies should be performed in the first days after stabilization of the patient’s condition using minimally invasive technologies.

THE CHOICE OF SURGICAL TACTICS FOR BOERHAAVE SYNDROME IN COMBINATION WITH BILATERAL PLEURAL EMPYEMA (CLINICAL CASE)

Introduction.Boerhaave syndrome is a rare, difficult to diagnose and formidable disease with a high mortality rate. For the treatment of this pathology, many variants of interventions have been proposed. Some surgeons prefer to use a thoracotomic access, others – a laparotomic transhiatal one. In the domestic literature there are scant observations of usement of minimally invasive technologies.Clinical observation.The patient was admitted to the surgical department for emergency indications. In the admission department spontaneous left side hydropneumothorax was diagnosted. Drainage of the left pleural cavity was performed. On the second day, a spontaneous rupture of the esophagus was diagnosed. Video-laparotranschiatal drainage of the posterior mediastinum, drainage of the left subhepatic space, Maydl jejunostomy was performed. In the postoperative period, intensive conservative therapy was carried out, massive lavage of the mediastinum and the left pleural cavity with antiseptic solutions. For a long time, there was a large drainage debit. Because of treatment the dynamics were positive. On the 45th day the drainage of the pleural cavity was removed. By the 66th day complete healing of the esophageal defect and removal of the mediastinal drainage.Discussion.Due to the difficulties in diagnosis, a spontaneous rupture of the esophagus was detected a day later. The applied surgical access and technique allowed to provide adequate drainage and sanitation of the posterior mediastinum and left pleural cavity. The subsequent tactics of managing the patient ensured his recovery. The trauma of the video-laparotranschiatal access is less, in comparison with open surgical interventions. We consider the experience of using video endoscopic technologies for Boerhaave syndrome positive and promising.

Historical aspects of video endoscopic surgery of the lumbar spine

The literature review is devoted to the history of the development of endoscopic surgery of the lumbar spine: from open surgical interventions and puncture procedures – to percutaneous intracanal endoscopic operations, combining interventional and video endoscopic technologies and referred to in the English literature as “full-endoscopy”. The article also touches upon the historical aspects of fibroendoscopic and laparoscopic interventions on the lumbar spine. In conclusion, the principle of classification of endoscopic techniques is proposed.

Minimally invasive removal of gastric leiomyoma

Leiomas are more common in men aged 20 to 50 years. In women, they occur at an older age and 3 times less often than in men. An essential point in the disease pathogenesis is rapid growth of leiomyomas and their tendency to ulceration with decay, which leads to the development of formidable complications in the form of bleeding, perforation of the hollow organ, followed by the development of peritonitis. The growth of leiomyomas occurs from the thickness of the muscle layer in the form of a single node, mainly endogastrically in 66.5 % of cases. Exogastric growth was noted in 24.6 %, mixed in 5 % and intramural in 3.9 % of cases. A rare representation of benign stomach tumors of non-epithelial origin is characterized by an extremely wide variety of their types and names. A clinical case of surgical treatment of gastric leiomyoma using minimally invasive technologies in a patient with concomitant pathology is presented. The neoplasm was detected during a screening examination of the respiratory system. The patient underwent laparoscopic removal of the neoplasm. A macro- and micropreparation of gastric leiomyoma is presented. After surgical treatment, a positive result was achieved, the patient was discharged from the clinic in a satisfactory condition. The modern development of medicine and the use of video endoscopic technologies significantly expand the possibilities of surgery for neoplasms of the gastrointestinal tract. This observation demonstrates the features of the clinical picture of benign gastric neoplasms and the possibility of using minimally invasive surgical technologies in their treatment against the background of severe comorbid pathology.

Surgical treatment results of metastatic spine disease with using minimally invasive technologies, including 3D video endoscopic technologies

Was to evaluate the results of surgical treatment of patients with metastatic lesions of the spine using 3-D video endoscopic technologies. We analysed the results of surgical treatment of 33 patients with metastatic lesions of the thoracic spine using a 3D video-assisted thoracoscopic intervention that was performed from November 2017 to December 2019. When examining patients, the following were used: X-ray of the spine, spiral computed tomography (CT), magnetic resonance imaging (MRI), as well as the SINS, Bilsky, Karnovsky, Tokuhashi, Frankel, SF-36 and VAS scales. The actual life expectancy of the patients completely coincided with the predicted one according to the Tokuhashi scale. Regression of neurological disorders in the early postoperative period (before discharge from the hospital) was observed in 6% of patients (complete in 3%, partial in 3%). When evaluating the results of treatment 12 months after surgery, regression of neurological symptoms was observed in 19% of patients. At the same time, complete regression of neurological disorders occurred in 10%, partial in 9% of patients. When assessing the quality of life on the SF-36 scale, improvement was observed according to the most of the criteria. Also, in the postoperative period, there was a persistent decrease in the intensity of pain syndrome according to VAS compared with the preoperative level. The use of 3-D video endoscopic technologies in the surgical treatment of patients with metastatic lesions of the spine made it possible to improve the quality of life of patients and reduce the number of complications.

TREATMENT OF PATIENTS WITH MEDIASTINAL TUMORS

OBJECTIVEwas to evaluate the immediate results of treatment of patients with mediastinal tumors.METHODS AND MATERIALS. We treated 240 patients (123 man, 117 woman) with mediastinal tumors. Age range were from 13 to 73 year old. The anterior mediastinum tumors were located in 201 cases, the posterior mediastinal tumors were located in 38 cases. All patients were operated. Video endoscopic technologies were used in 128 cases.RESULTS. Tumor removal was supplemented other operations in 20 cases. Using video thoracoscopic operations, we had six cases of conversion. One patient died during the initial anesthesia due to the increase in tumor compression of the mediastinal structures. There were post operation complications with 21 (8.75 %) patients. Fatal outcome in the early postoperative period was in 6 (2.5 %) patients.CONCLUSION. The tactics of treating patients with mediastinal tumors should be individual and depend on the results of the examination, the localization of the tumor and its connection with the surrounding structures.

Video-assisted anal fistula treatment (VAAFT): A decade experience

The most ideal management for anal fistula has continued to evade surgical practitioners through the years. Video-assisted anal fistula treatment (VAAFT) is a relatively novel technique introduced as a minimally invasive surgical treatment of anal fistula. Based on published studies on VAAFT in the past decade, healing rates have varied worldwide, ranging from 54.4 to 92.5%. The published recurrence rates are at overall similar to other sphincter-sparing procedures. The primary advantage of VAAFT is the ability to use videoendoscopic technology to accurately visualize the fistula anatomy and manage the tracts while preserving sphincter function, resulting in minimal complications and faster recovery. Higher quality comparative studies with longer follow-up are still needed in order for this procedure to gain more widespread acceptance among colorectal surgeons in the future.

Surgical tactics for victims of gunshot wounds of the diaphragm specialized stage of medical care in conditions of a modern armed conflict

Introduction. The diaphragm gunshot wounds are serious combat injuries. The main functions of the diaphragm are to change the intra-abdominal pressure and the outflow of lymph and blood from the abdominal cavity due to the constant contraction and relaxation. Therefore, when it is injured at the same time with a powerful painful impulse, cardiopulmonary disorders quickly arise. Purpose: To improve the results of surgical treatment of patients with gunshot wounds through the introduction of new video endoscopic technologies at the stage of specialized surgical care. Materials and methods. The article analyzes the features of specialized surgical care in 64 patients with gunshot wounds who were treated at the surgical clinic of the Military Medical Clinical Center of the Northern Region (III level of medical care). New minimally invasive methods are proposed to improve the outcomes of surgical treatment of victims with diaphragm gunshot wounds at level III of health care delivery. Results. Thus, the use of video thoracoscopic technique in the surgical treatment of the diaphragm wound and its suturing in the proposed method allowed to improve the results of treatment by increasing the average value of diaphragmatic excursion in deep breath in the main group to 3.73 ± 0.31 cm, whereas in the comparison group 2.21 ± 0.38 cm. The severity of the pain syndrome on the of Visual Аnalogue Scale 5 days after surgical treatment was 5.2 ± 2.3 points in the injured main group, 6.7 ± 2.1 points in the comparison group. The ratio of vital lung capacity to the required vital lung capacity in the main group was 75.3 ± 2.2%, in the comparison group 64.1 ± 1.7%. Conclusions. The use of video thoracoscopy increases the efficiency of the diagnosis of gunshot wounds of the diaphragm. The use of laser imaging and fluorescence diagnosis of diaphragm wounds ensure the adequacy of the removal of paravulary necrotic tissues. The suturing of the wounds in accordance with the anatomical and functional structure of the diaphragm with the use of plaques improves the immediate postoperative results of surgical treatment.

Advanced ultrasound for prenatal interventions.

Ultrasound is an integral part of prenatal interventions. Doppler studies and 3-dimensional ultrasound (3DUS) are frequently used to determine whether fetal surgery is required. The operator’s experience remains crucial for reducing procedure-related morbidity. Real-time 3DUS (or 4DUS) can simultaneously display the needle tip in three orthogonal planes, providing reassurance that no fetal parts are in the path. In experienced hands, 4DUS guidance may not be more effective than B-mode, but its value for less-experienced operators remains to be determined. Recent developments in needle, shunt, and video endoscopic technologies may compliment the use of image-guided in utero procedures. Future developments of higher-dimensional transducers and image software may improve the utility of ultrasound for invasive obstetric interventions.

Combined video-endoscopic and transcutaneous approach for surgical treatment of acute necrotizing pancreatitis

Now-a-days, high-resolution ultrasound allows an accurate and relatively early diagnosis of congenital malformations. In a limited number of such conditions foetal surgery may be lifesaving. However, premature labour has been the major drawback for open foetal surgery. Recently, improvement of video-endoscopic technology has boosted the development of operative techniques for feto-endoscopic surgery, which has been demonstrated to be less invasive than the open approach. Main clinical application of fetoscopic procedures today is the treatment of feto-foetal transfusion syndrome.Although still in development, feto-endoscopic surgery seems to offer new hope for surgical foetal therapy not only in cases of life threatening conditions. Experimental intrauterine correction of cleft lip and palate (CLP) has been lately performed using the feto-endoscopic approach. This procedure offers two major advantages: first, scarless foetal wound healing and bone healing without callus formation, which would also allow a better/normal maxillary growth, and second, significant decrease of foetal and maternal morbidity.Herein, we report the current status of experimental and clinical foetal surgery and propose possible directions for continuing research to make intrauterine procedures safer. Furthermore, we discuss current knowledge and new perspectives of experimental foetal cleft lip and palate repair, which in the future may lead to such excellent results in the operative treatment of clefts, that less or no secondary corrections and therapies, such as orthodontic, dental, logopedic, etc. would be needed. Only if these conditions can be fulfilled, will we be able to improve substantially our therapy for the human foetus with a cleft lip and palate. In spite of all efforts, however, it must be considered that it may not ever be possible to find the optimal treatment method for this or other craniofacial malformations.