Videoendoscopic Technology Research Articles

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.

Integrating optical coherence tomography with laryngeal videostroboscopy

During clinical voice assessment, laryngologists and speech-language pathologists rely heavily on laryngeal endoscopy with videostroboscopy to evaluate pathology and dysfunction of the vocal folds. The cost effectiveness, ease of use, and synchronized audio and visual feedback provided by videostroboscopic assessment serve to maintain its predominant clinical role in laryngeal imaging. However, significant drawbacks include only two-dimensional spatial imaging and the lack of subsurface morphological information. A novel endoscope will be presented that integrates optical coherence tomography that is spatially and temporally co-registered with laryngeal videoendoscopic technology through a common path probe. Optical coherence tomography is a non-contact, micron-resolution imaging technology that acts as a visual ultrasound that employs a scanning laser to measure reflectance properties at air-tissue and tissue-tissue boundaries. Results obtained from excised larynx experiments demonstrate enhanced visualization of three-dimensional vocal fold tissue kinematics and subsurface morphological changes during phonation. Real-time, calibrated three-dimensional imaging of the mucosal wave and subsurface layered microstructure of vocal fold tissue is expected to benefit in-office evaluation of benign and malignant tissue lesions. Future work calls for the in vivo evaluation of the technology in patients before and after surgical management of these types of lesions.

Застосування біогерметика “Сульфакрилат” при виконанні лапароскопічних операцій з приводу перфорації виразки дванадцятипалої кишки

У роботі викладено результати лікування 32 пацієнтів із перфоративною виразкою дванадцятипалої кишки із використанням малоінвазивних відеоендоскопічних технологій. Лапароскопічне зашивання перфорації виразки ДПК проведено у 28 (87,5 %) пацієнтів, у 4 (12,5 %) було виконано лапароскопічне висічення виразки та сегментарну дуоденопластику. У 19 (59,4 %) пацієнтів використано клейову композицію “Сульфакрилат” з метою додаткової герметизації лінії швів. Впроваджені методики дають можливість зменшити кількість ускладнень в післяопераційному періоді.

LAPAROSCOPIC SURGERY IN TREATMENT OF ENDOMETRIAL CANCER (RESULTS OF 7-YEAR CLINICAL EXPERIENCE AT THE N.N. PETROV NATIONAL MEDICAL RESEARCH ONCOLOGY CENTER)

Introduction . The main method of treatment of endometrial cancer, the most common oncological disease, is surgery. Introduction of high-tech operations into gynecological practice promoted active use of laparoscopy in treatment of malignant tumors of the endometrium. Objective . To evaluate effectiveness of video endoscopic surgery in treatment of endometrial cancer. Materials and methods. In the period from 2010 to 2016, 1127 patients with endometrial cancer underwent surgery using video endoscopic complex with high resolution cameras at the N.N. Petrov National Medical Research Oncology Center, Ministry of Health of Russia. Results . Using video endoscopic technology, excision of the uterus with appendages was performed in 588 (52.3 %) patients, excision of the uterus with appendages and pelvic lymph node dissection was performed in 523 (46.4 %) patients including 16 (1.4 %) patients with serous and papillary serous forms of endometrial cancer who also underwent omentectomy. No intraoperative complications were observed. In the majority of patients, postoperative period was characterized by early activization, satisfactory intestinal peristalsis on day 1, minimal complications, absence of contraindications for adjuvant beam therapy. Conclusion . Video endoscopic technology is a modern method of surgical treatment allowing to perform the full scope of planned radical surgical intervention in patients with endometrial cancer irrespectively of age and concomitant disorders with minimal traumatization, risk of intraand postoperative complications as well as favorable and fast rehabilitation period.

A structured look at the problem of patients’ safety in surgery

To study surgeons' awareness about safety of patients in surgery and to determine necessary educational measures in this area. 110 surgeons were interviewed. Mean length of work was 16.1±0.97 years. 88.2% of surgeons worked at hospitals. 47.3% of surgeons were engaged elective surgery. Previously 55.5% of respondents were involved into conflict with patients. A half of respondents are familiar with WHO program «About patient' safety» and key issues of patient' safety during prevention of postoperative thromboembolic and infectious complications. 76% of respondents have the possibility to use videoendoscopic technologies, but only 36% of them realize these techniques. Up to 33% of respondents consider to be studied at certification cycles only. Many surgeons use the Internet as the main source of information. Current tendencies of surgical development require to focus on perioperative safety and the need for intensive research of the technologies of surgical patients' safety.

Foetal surgery and cleft lip and palate: current status and new perspectives

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.

Video-optic cable endoscopy forceps

We present a video-endoscopic technology for foreign body extractions with forceps. This can easily be followed and is recordable on video monitor in excellent quality. Instead of a rigid rod lens telescope, a fiberoptic video endoscope is inserted into the optical channel of a bronchoscopic forceps. This keeps the endoscopic device lightweight and easily maneuverable in different angles. The principle can be applied to other rigid diagnostic and therapeutic endoscopic equipment and represents a potential alternative technology to the use of cameras attached to rigid telescopes.

Thoracoscopy and video-assisted thoracic surgery.

Thoracoscopy is an old technique that has been recently revived with the development of video-endoscopic technology. Video-assisted thoracic surgery (VATS) is now an established surgical approach with proven benefits in the management of pleural diseases. It has been found to be particularly useful in establishing the diagnosis of pleural metastasis with an option for treatment. It also has an established therapeutic role in the management of the fibrinopurulent phase of empyema and the treatment of hemothorax. The technique is still continually evolving, and refinement of instrumentation promises to further reduce surgical trauma in selected procedures.

Comparison of direct monocular endoscopic, two- and three-dimensional display systems on surgical task performance in functional endoscopic sinus surgery

The operating endoscope has been an important advance in nasal and sinus surgery. Most surgeons describing the technique have used direct monocular vision, though some have recently been using videoendoscopic technology. Video monitoring offers the possibility of bimanual instrument handling and 3D visualization, with the appropriate equipment. We performed a study involving 10 surgeons, in which performance in simulated FESS was evaluated for direct endoscopic vision and compared with 2D and 3D video monitor display systems. There was a statistically significant difference in task performance time (visualizing or removing three small rings placed in the nasal cavity) between the three techniques. The direct technique was performed most slowly, participants taking longer with this technique than with the other two to perform the tasks. The 2D technique was more rapid, with the 3D technique taking the shortest time (P < 0.05). We feel that there is a place for further evaluation of video monitor controlled endoscopic sinus surgery.

Endoscopic Breast Augmentation

John Bostwick, III, MD Atlanta, GA Felmont F. Eaves, III, MD Atlanta, GA Foad Nahai, MD Atlanta, GA Minimally invasive surgical techniques based on video endoscopic technologies have become increasingly popular over the past several years. Although most commonly used in facial rejuvenation procedures, the endoscope has been a helpful adjunct for augmentation mammaplasty over the past 3 years. The rationale for using the endoscope in augmentation mammaplasty is based on the observation that it can provide clear visualization of soft tissue pockets through small incisions remote from the pocket itself. This visualization promotes precise dissection and hemostasis. Because visualization is most limited with the transaxillary augmentation, we have found endoscopic techniques most applicable through this route, and occasionally helpful with an inframammary approach. 1,2 Others 3,4 have described endoscopic techniques through circumareolar and transumbilical approaches. In an endoscopically assisted transaxillary augmentation …

A model for fetal surgery through intrauterine endoscopy

Video-endoscopic technology may offer new hope for the future of fetal surgery. Ten time-dated pregnant ewes (95 to 105 days; term, 145 days) were used to develop a model of fetal surgery through intrauterine endoscopy. Special 5-mm ports were designed with short, flexible, balloon-tipped shafts. The cannulas were inserted through purse-stringed hysterostomies. Amnioinfusion of warmed physiological fluid (Hartmann) was used as the work medium. Fetal heart rate and oxygen saturation (pulse oximetry), temperature, and amniotic pressure were monitored continuously through endoscopically placed sensors. Surgical procedures included subcutaneous dissection of the abdominal wall and ligation of the urethra in the male fetus (n = 7), ligation of the urachus within the umbilical cord (n = 8), and endoscopy of the fetal esophagus and trachea (n = 6). Bloodless surgery was achieved with a novel coagulation device that allows bipolar cutting and coagulation in an electrolyte-rich fluid medium. The mean fetal operative time was 147 minutes (range, 130 to 195). The intraamniotic temperature was maintained between 38.0 ± 0.9°C and 41.7 ± 1.7°C throughout the procedure. Oxygen saturation ranged from 51 ± 20% to 72 ± 14%, and fetal heart rate from 120 to 140 beats per minute. In conclusion, intrauterine endoscopy in a fluid medium allows fully monitored surgical procedures, lasting more than 2 hours, to be performed on the fetal lamb.

Videoendoscopic procedures in thoracic surgery

Background: Current videoendoscopic technology and percutaneous techniques of exposure and dissection have been successfully applied to abdominal surgery with favourable results. Applications of this technology to our practice of thoracic surgery is the basis of this report. Methods: Video assisted thoracic surgery (VATS) has been performed in 43 patients for the following indications: Raynaud’s syndrome, undefined pulmonary nodule, persisting spontaneous pneumothorax, T1 bronchial carcinoma, and mediastinal cyst. Videoendoscopic surgical procedures were accomplished using double-lumen endotracheal anesthesia and a percutaneous stapling device. Procedures performed using this technique include thoracic sympathectomy, wedge or keel excision, blebectomy, lung apex stapling, parietal pleurectomy, and dissection of the mediastinal cyst. Results: Median operating time was 45 minutes (range, 15 to 90 minutes). Tissue diagnosis was obtained in all patients. Median diameter of excised nodules was 10 mm (range, 7 to 70 mm). There were no operative deaths. The 2 complications were prolonged air leaks after surgery of persistent pneumothorax, all patients left the hospital in excellent general condition. Conclusions: This new modality of thoracic surgery appears to have beneficial value for the patients. In our hands it proved as a secure way of doing thoracic surgery. Our case of removal of a benign cyst in the posterior mediastinum shows that video assisted thoracic surgery has expanding applications in the field of general thoracic surgery.

Videothoracoscopy: Improved technique and expanded indications

Current videoendoscopic technology and percutaneous techniques of exposure and dissection have been successfully applied to abdominal surgery with favorable results. Application of this technology to our practice of thoracoscopy is the basis of this report. Videothoracoscopy has been performed in 39 patients for the following indications: chronic pleural effusion, interstitial lung disease, mediastinal lymphadenopathy in lung cancer, persistent air leak after decortication, mediastinal mass, recurrent spontaneous pneumothorax, hydropneumothorax with persistent air leak, and pleural-based mass. The technique we employ includes lateral decubitus positioning and double-lumen endotracheal intubation with ipsilateral lung collapse. The videoscope, retractors, and instruments are introduced through separate 10-mm incisions. Percutaneous manipulation of instruments and the videoscope is guided by images produced on television screens without dissection, and if resection is performed, the incision is enlarged to allow specimen retrieval. Procedures performed using this technique include pleural biopsy, partial pleurectomy, lysis of adhesions, lung biopsies, staging lymph node biopsy, lung nodule biopsy, pleural-based mass resection, and mediastinal mass biopsy and resection. This videoendoscopic technique greatly improves visualization of thoracic anatomy, facilitating thoracoscopy and enhancing exploration of the chest. It is preferred over conventional thoracoscopy and, in some patients, reduces the magnitude of operation by avoiding thoracotomy.