Video Recordings Of Procedures Research Articles

Pediatric endoscopic subcutaneous mastectomy (pesma) with liposuction in adolescents with gynecomastia

BackgroundSurgical techniques for treatment of gynecomastia are increasingly less invasive. We described technical standardization of pediatric endoscopic subcutaneous mastectomy (PESMA) with liposuction.MethodsAll adolescents with primary gynecomastia, operated using PESMA with liposuction over the period June 2014–July 2021, were included. The video recording of procedures was analyzed to standardize the operative technique. After patient installation, 3 trocars were placed on the mid-axillary line. The technique included 5 steps: (1) subcutaneous injection of lipolysis solution and liposuction; (2) creation of working space using an inflated balloon; (3) gland dissection using 5-mm sealing device; (4) specimen extraction through the largest trocar orifice; and (5) placement of suction drainage tube.ResultsTwenty-four male adolescents, operated for Simon’s grade 2B and 3 gynecomastia using PESMA with liposuction over the study period, were included. Mean patient age was 16 years (range 15–18). Gynecomastia was bilateral in 19/24 (79.2%) and unilateral in 5/24 (20.8%). One (4.1%) conversion to open was reported. The mean operative time was 87 min (range 98–160) for unilateral and 160 min (range 140–250) for bilateral procedure. The mean length of stay was 2.2 days (range 1–4). Patients wore a thoracic belt for 15 up to 30 days postoperatively. Post-operative complications occurred in 5/24 (20.8%): 2- or 3 mm second-degree burns in 4 (16.7%) and subcutaneous seroma in 1 (4.1%). All complications were Clavien 2 grade and did not require further treatment. Aesthetic outcomes were very good in 21/24 (87.5%). Three (12.5%) boys had persistent minimal breast asymmetry but did never perceive it negatively.ConclusionPESMA combined with liposuction was feasible and safe for surgical treatment of gynecomastia in this selected cohort of patients. Although challenging, this procedure provided good aesthetic results, with no scars on the anterior thoracic wall. Standardization of the operative technique was a key point for successful outcome.

834 ENDOSCOPIC VACUUM THERAPY IN THE MANAGEMENT OF OESOPHAGEAL PERFORATIONS AND POST-OPERATIVE LEAKS

Abstract Oesophageal perforations and post-oesophagectomy anastomotic leaks are associated with high morbidity and mortality. Endoscopic vacuum therapy (EVT) is a novel treatment strategy with the potential to promote healing and ameliorate sepsis. Few instances of the use of EVT have been reported in the UK, wioth only two cases published outside our centre representing a limited aetiological and demographic spectrum. Methods From May 2019 to November 2020 8 patients aged 27–85 years underwent EVT for disparate oesophageal wall defects. Data regarding technical success and feasibility were analysed. Video recordings of procedures were undertaken with patient consent. Results Complete defect resolution was achieved in cases (87%), requiring median of 13 days of treatment (range 6–23), and necessitating 3 replacement procedures (range 1–4). Significant improvement in C-reactive protein was achieved in all patients undergoing treatment (P = 0.015). Over an average follow up of 360 days, no severe complications resulted directly from sponge placement, however 2 individuals (25%) developed oesophageal stricture necessitating endoscopic balloon dilatation, and one died whilst undergoing treatment. Conclusion Here we provide a video demonstration of the application of EVT in patients with oesophageal perforation or post-operative leak. Our data demonstrate this approach to be a safe, valuable tool for the management of a spectrum of oesophageal wall defects, with the potential to reduce associated morbidity and mortality in selected patients. Video Video of safe application of EVT. https://www.dropbox.com/s/rgypt6o1z93iui5/EVT.mp4?dl=0.

One-stop shop for variceal surveillance: integration of unsedated ultrathin endoscopy into the routine clinic visit

BackgroundThe endoscopic appearance of oesophageal varices determines the need for prophylaxis. However, as the point prevalence of varices is low (25%), the majority of surveillance endoscopies are unnecessary and costly....

Impact of experience on self-assessment accuracy of clinical colonoscopy competence

Self-assessment is important for life-long learning and a recommended assessment method for endoscopy skills. Prior literature has not investigated self-assessment accuracy of colonoscopic competence in the clinical setting. This study aimed to determine the self-assessment accuracy of novice, intermediate, and experienced endoscopists. Novice (performed<50 previous colonoscopies), intermediate (50-500), and experienced (>1000) endoscopists from 5 hospitals each performed a clinical colonoscopy. Video recordings of procedures were independently assessed by 2 blinded expert endoscopists by using the Gastrointestinal Endoscopy Competency Assessment Tool (GiECAT). Externally assessed and self-assessed GiECAT scores were defined as the mean of the 2 video-based ratings and as participants' own assigned ratings, respectively. Self-assessment accuracy between the externally assessed and self-assessed scores was evaluated by using absolute difference scores, intraclass correlation coefficients, and the Bland-Altman analysis. Twenty novice, 10 intermediate, and 10 experienced endoscopists participated. There was moderate agreement of externally assessed and self-assessed GiECAT scores, with an intraclass correlation coefficient of 0.65 (95% confidence interval, 0.44-0.80). The absolute difference scores among the 3 groups were significantly different (P= .002), with experienced endoscopists demonstrating a more accurate self-assessment ability compared with novices (P=.002). Bland-Altman plots suggest that novice and experienced endoscopists tend to overrate and underrate their clinical competence, respectively; no specific trends were associated with intermediates. Participants demonstrated moderate self-assessment accuracy of clinical competence. Endoscopist experience was positively associated with self-assessment accuracy; novices demonstrated lower self-assessment accuracy compared with experienced endoscopists. Moreover, novices tended to overestimate their performances. Novice endoscopists may benefit from targeted interventions to improve self-assessment accuracy.

Flap dimensions created with the Hansatome microkeratome: Correlation with Orbscan-derived anterior segment data

To investigate the flap dimensions created by Hansatome microkeratome (Bausch & Lomb Surgical) and their correlation with anterior segment biometric data measured by the Orbscan II (Bausch & Lomb). Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey. Forty-four myopic eyes of 22 patients (mean age 29 years +/- 7 [SD]) that had laser in situ keratomileusis surgery using the Hansatome microkeratome were enrolled in the study. Intraoperative images taken from video recordings of procedures were analyzed with image analysis software to determine flap size and hinge size. White-to-white corneal diameter, corneal curvatures (K(max), K(min)), corneal thickness, and anterior chamber depth were deducted from Orbscan measurement. Correlation analyses between flap dimensions and Orbscan-derived anterior segment biometric data were done. The mean corneal flap diameter was 9.56 +/- 0.28 mm in the right eye and 9.62 +/- 0.28 mm in the left eye. There was no difference in flap size between the right and left eyes (P=.43). The mean hinge size was 4.98 +/- 0.37 mm in the right eye and 5.07 +/- 0.41 mm in the left eye. There was no difference in hinge size between the right and left eyes (P=.46). There was a significant correlation between flap size and preoperative corneal thickness (P<.001, r=0.487), but there was no correlation between flap size and corneal curvature (P=.40, r=-0.12), white-to-white corneal diameter (P=.11, r=0.47), or anterior chamber depth (P=.52, r=0.09). There was also no correlation between hinge size and preoperative anterior segment biometric data. The Hansatome microkeratome produced a flap whose diameter is close to the intended flap diameter, and preoperative corneal thickness seems to be the important factor in determining flap size.

Impact of Video on Endourology

Recent technical advances in video equipment have made this technology a useful adjunct for endourologic procedures. Video monitoring facilitates both medical and patient education, and video recording of procedures provides permanent documentation for patient files. Newer video cameras provide improved magnification and visibility to facilitate the performance of endourologic procedures, in part by enabling assistants and ancillary personnel to coordinate their activities during a case. The multisystem capability and ease of handling of available video systems make this equipment an important part of endourologic procedures.