Videoendoscopic Surgery Research Articles

A comparative analysis and choice of surgical tactics in pediatric Crohn’s disease

Introduction. Currently, surgical complications in Crohn’s disease is still one of the most serious problems in pediatric surgery. An intensive development of video endoscopic surgery contributes to the active introduction of this technology in pediatric coloproctological practice. Crohn’s disease is still one of the most complex pathologies in pediatric gastroenterology, and surgical treatment of its complications is a disputable issue among pediatric surgeons. Up to now, there are no clear indications to surgery in the refractory form of Crohn’s disease, no standardized terms and types for surgical intervention, as well as no optimal variants of surgical access.Material and methods. A retrospective analysis of patients who had been treated surgically at departments of abdominal and emergency surgery in two pediatric hospitals in Moscow (Morozovskaya and Izmailovskaya ) was carried out. 39 children with Crohn’s disease, aged 4–17 year, were included in the study. All patients had standard clinical examination: clinical examination with anamnesis, laboratory and instrumental diagnostics.Results. The obtained results have shown that laparoscopic interventions have a number of advantages, such as less traumatic surgery, reduced exposure to anesthesia and shorter intestinal stimulation, less stay in ICU, shorter hospitalization as well as more rapid rehabilitation period.Conclusion. The performed assessment of outcomes after surgical treatment of children with complicated Crohn’s disease helped to develop indications for the selection of surgical technique in the ileocecal form. Thus, the obtained results improved outcomes in children with complicated Crohn’s disease because of the outlined indications for surgery and surgical tactics when minimally invasive techniques are more preferable.

Multifunctional video endoscopic surgery training simulator for students, residents and surgeons

<h3>ЦЕЛЬ ИССЛЕДОВАНИЯ</h3> Оценка возможности использования хирургического симулятора «Зарница» в освоении обучающимися высокотехнологичных хирургических видеоэндоскопических навыков. <h3>МАТЕРИАЛ И МЕТОДЫ</h3> Сведения о результатах освоения обучающимися с использованием симулятора «Зарница» высокотехнологичных хирургических видеоэндоскопических навыков получены при опросе 62 школьников, 32 студентов-кружковцев и ординаторов, 31 молодого врача-хирурга. <h3>РЕЗУЛЬТАТЫ</h3> Обобщенные результаты показывают, что оценка «отлично» наиболее часто встречалась у школьников, студентов 2-го курса и кружковцев с ординаторами, чаще остальных групп оценку «отлично» получали школьники. Это связано с недостаточным личным опытом работы как на различных симуляторах, так и в клинике. <h3>ЗАКЛЮЧЕНИЕ</h3> Наши данные показывают, что применение лапароскопического тренажера («Зарница») уместно при обучении высокотехнологичным хирургическим видеоэндоскопическим навыкам как студента, так и ординатора и врача-хирурга.

Videoendoscopic sentinel lymph node detection with icg and bilateral inguinofemoral lymphadenectomy in vulvar cancer comba-ozdemir technique.

ObjectiveThe authors present a surgical film for vulvar cancer surgery, which was performed via video endoscopy.MethodsAn 88-yearold woman with squamous cell carcinoma of the vulva and who underwent radical vulvectomy was treated with sentinel lymph node (SLN) and bilateral inguinofemoral lymphadenectomy, which is preferably performed via video endoscopic surgery with a near-infrared fluorescence video endoscopy system. SLN mapping was performed using indocyanine green and near-infrared fluorescence mapping.ResultsSLNs were detected in the left superficial inguinal area. The surgeons performed bilateral inguinofemoral lymphadenectomy.ConclusionNo postoperative early or late complications developed, and the patient was discharged 7 days after surgery. Stage 1B vulvar cancer was identified.

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.

New frontiers of surgery in vulvar cancer: from butterfly incision to videoendoscopic surgery

New frontiers of surgery in vulvar cancer: from butterfly incision to videoendoscopic surgery

A prospective study to compare haemodynamic and respiratory parameters using proseal laryengeal mask airway and endotracheal intubation in children undergoing videoendoscopic surgery

Proseal laryngeal mask airway (PLMA) is being used increasingly apart from its gold standard alternative endotracheal tube (ETT) in airway management during paediatric laparoscopy. Limited data is available on effects of carboperitoneum on hemodynamics and pulmonary mechanics in paediatric patients. We aimed to assess effect of carboperitoneum on hemodynamics and pulmonary mechanics in paediatric patients undergoing video-endoscopic surgeries when PLMA and ETT are used. After ethics committee approval and consent, 60 patients aged 1-10 years scheduled for laparoscopic surgeries were included in study and randomly allocated to two groups of 30 each. Airway maintained with PLMA in first group and ETT in group II. Hemodynamic parameters and ventilatory parameters were recorded at different time intervals from prior to insertion of airway device till deflation of carboperitoneum. Statistically significant increased heart rate, systolic, diastolic, mean blood pressure was observed in ETT group as compared to PLMA group during airway insertion and during rest of study period changes were analogous in both groups. Ventilatory parameters saturation, peak inspiratory pressure (PIP), plateau pressure (PP) and ETCO2 were comparable in both groups except during post deflation period where PP, PIP and ETCO2 remained elevated. Proseal-LMA can be equally good option in paediatric laparoscopy with better hemodynamic stability and ventilatory parameters as degree of changes caused by carboperitoneum in PLMA group was insignificant compared to ETT.

Video Endoscopic Surgery in the Treatment of Lumbar Canal Stenosis: A systematic review

Video Endoscopic Surgery in the Treatment of Lumbar Canal Stenosis: A systematic review

Experience and possibilities of video laparoscopy in emergency abdominal surgery

Objective. To evaluate the effectiveness and improve treatment outcomes for patients with acute abdominal pathologies using video laparoscopy. Materials and methods. The paper is based upon a ten-year experience of using video laparoscopy in emergency abdominal surgery. Within a decade (2008 2018), 23127 patients had been admitted to the surgical department of City Emergency Hospital in the city of Rostov-on-Don; among them 19748 patients were operated on. Video laparoscopic surgeries for acute appendicitis, acute cholecystitis, acute intestinal obstruction, perforated gastric and duodenal ulcers, and other acute abdominal surgical pathologies were performed in 15124 patients; the share of these interventions was 76.6 % of all cases.&#x0D; Results. Initially, when laparoscopy was introduced in emergency abdominal surgery, diagnostic laparoscopy was used in more than a half of the performed surgeries, mainly for acute appendicitis and abdominal injuries. Today, video endoscopic surgery is widely used for acute cholecystitis, acute pancreatitis, perforated ulcers, strangulated hernias, torsions of epiploic appendages of the colon and of the greater omentum. An effective use of video laparoscopy for therapeutic purposes allows increasing the number of laparoscopic operations performed in patients with emergency surgical pathology of abdominal organs.&#x0D; Conclusions. Video laparoscopy in urgent surgery allows establishing a diagnosis in time, performing dynamic video laparoscopy, eliminating concomitant pathology, diagnosing and, in some cases, preventing postoperative complications. Video laparoscopic surgery is easier for patients to tolerate; it reduces the number of complications, the period of staying at the hospital and the rehabilitation period, and opens up new possibilities for helping patients with emergency surgical conditions.

EVOLUTION OF VIEWS ON THE DEVELOPMENT AND IMPLEMENTATION OF MODERN SURGICAL MAGNETIC INSTRUMENTS ON THE CASE OF INFLAMMATORY PENETRATING INJURIES OF THE BREAST

Summary. The arms — to analyze the evolution of the development of modern surgical instruments in gunshot wounds chest.&#x0D; Materials and methods. 80 cases of using a modern magnetic surgical instrument for penetrating gunshot wounds of the chest were analyzed. Intraoperatively used: a magnetic multifunctional tool for the diagnosis and removal of metallic ferromagnetic foreign bodies, a flexible device for removing ferromagnetic foreign bodies, a magnetic tool for endovideoscopic diagnosis and removal of metallic ferromagnetic foreign bodies from the abdominal and pleural cavities, a magnetic nozzle for video endoscopic surgical interventions. When removing metal foreign bodies, the following methods were used: a method for preliminary determination of the material and properties of a foreign body, a method for video endoscopic laser visualization of the internal organs of the abdominal and pleural cavities.&#x0D; Results. Foreign bodies of the pleural cavity were diagnosed in 80 (100 %) wounded according to СT. Ferromagnetic metal foreign bodies of a gunshot origin of the pleural cavity were removed both during thoracotomy or minithoracotomy, and during thoracoscopic surgical interventions using the method of video endoscopic laser visualization of the internal organs of the abdominal and pleural cavities. The most convenient tool was the endoscopic magnetic tool for removing foreign bodies from the pleural or abdominal cavities. A magnetic nozzle for video endoscopic surgical interventions allows navigation both in the pleural cavity and along the wound channel.&#x0D; Conclusions.&#x0D; 1. The development of a surgical magnetic instrument was phased and began with the improvement of a surgical magnetic instrument to remove ferromagnetic foreign bodies of soft tissues.&#x0D; 2. The improvement of the tool took place as the restrictions on the use of the existing tool were established, which was a prerequisite for the development of a new tool.&#x0D; 3. It is advisable to create a special set of surgical magnetic instruments for video endoscopic surgery.

Video-endoscopic Tension-free Groin Hernia Repair via Total Extraperitoneal Approach.

IntroductionTension-free repair of groin hernias with synthetic material by video-endoscopic surgery is a widely accepted method that is performed by various approaches. We aim to present our results of video-endoscopic tension-free repair of groin hernias via the total extraperitoneal (TEP) approach.MethodsBetween September 2016 and December 2018, 124 patients with groin hernias underwent tension-free repair using prolene mesh by video-endoscopic surgery via the TEP approach. This is a retrospective analysis of 110 (88.7%) male and 14 (11.3%) female patients with a mean age of 48.1 years. Groin hernia types, locations of hernias, intraoperative and postoperative complications, results of the mean 24-month follow-up, and recurrence rate were reported.ResultsA total of 134 hernias were repaired in 124 patients who had 53 (42.7%) right, 61 (49.2%) left, and 10 (8.1%) bilateral groin hernias. The most common hernia type was an indirect inguinal hernia in 83/134 (62%) groin hernias. A total of 119 (88.8%) and 15 (11.2%) hernias were primary and recurrent, respectively. Seroma was detected in two (1.6%) patients in the early postoperative period. The mean duration of hospital stay was 1.4 (1-3) days. During the follow-up period, hernia recurrence was determined in three (2.4%) patients. Hernia recurrence was detected among patients who were operated on during the first half of the study.ConclusionTension-free repair of groin hernias by video-endoscopic technique via the TEP approach can be performed with very low complication and recurrence rates. The success of the TEP approach increases parallel to increasing surgical experience. The results of hernia repair via the TEP approach are highly satisfactory and encouraging, especially when attention is paid to proper patient selection during the learning curve period.

Anatomical Changes During Laparoscopic Procedures

Determining the exact sizes of anatomical structures play a very important today in laparoscopic surgery. This makes it possible to make a correct selection of gauges of instruments needed, prosthetic materials, and to make decisions regarding the further strategy of the surgical procedure. The device developed at the clinic has proven itself in everyday clinical practices. It is currently used in laparoscopic operations for hiatal hernias, choledoch measurements in patients with choledocholithiasis, stomach stump size measurements during the resection in patients with morbid obesity. The presented clinical case serves to confirm that obtaining objective data in video endoscopic surgery makes it possible to choose the optimal treatment strategy.

Modern technologies of video-endoscopic surgery of the breast in China

Endoscopic surgery is being actively developed in China due to scientific and technological progress and state support. Video-endoscopic surgery as one of these directions is actively used for lymph node dissection during mastectomy and breast reconstruction. This method results not only good functional and aesthetic results, but also positive outcomes of cancer treatment.

Transoral videoendoscopic resection of head-and-neck Tumors in 4-hand technique

Videoendoscopic surgery in 4-hand technique is a standard procedure in laparoscopic and also in transsphenoidal pituitary operations. In recent years transoral videoendoscopic resection of head and neck tumours in 4-hand technique (TOVR) gained more and more importance. From March 2013 28 transoral videoendoscopic resections of oropharyngeal (n = 5)-, hypopharyngeal (n = 12) and laryngeal (n = 11) carcinomas in 4-hand technique werde successfully performed. In all 28 cases a R0-resection without extension to a transcervical surgical approach was achieved transorally. Even in patients with minor mobility of the cervical vertebral column (n = 9) and reduced adjustment facilities of the Kleinsasser laryngoscope or Weerda distending laryngoscope transoral tumor resection could be successfully performed with the use of rigid angular optics. TOVR is an effective, cheap and minimally invasive surgical procedure featuring numerous advantages compared to CO2 laser resection and can be considered as real alternative for traditional resection methods of head and neck tumours.

Practical aspects of treatment of kidney cancer in a modern hospital: the evolution of surgical approaches

Objective: analysis of results of the outcomes of surgical treatment for renal tumors in the Saint Petersburg City Hospital No. 40 over the last 5 years and determination the trends.Materials and methods. The study included 293 patients that underwent 296 surgeries for renal tumors. The majority of patients (87.84 %) were diagnosed with localized cancer, whereas locally advanced and metastatic forms were detected in 4.39 and 7.77 % of cases respectively. We performed radical nephrectomy (RNE) or nephron sparing (NS) via open or minimally invasive route (videoendoscopic or robot-assisted surgery using the da Vinci Surgical System).Results. Organ-preserving surgeries were performed in 52.36 % of patients, RNE – in 47.64 % of patients; minimally invasive and open surgeries were conducted in 95.95 and 4.05 % respectively. In individuals with stage cT1a cancer, NS and RNE were performed in 87 and 13 % of cases respectively; in patients with stage cT1b cancer, NS and RNE were performed in 50.82 and 49.18 % of cases respectively. The majority (90.2 %) of patients with renal tumors &gt;7 cm underwent minimally invasive surgeries, primarily RNE. The incidence of severe postoperative complications after NS and RNE was comparable: 5.75–8.06 and 1.67–15.38 % respectively (р = 0.64).Conclusion. Minimally invasive NS is the method of choice for stage сT1 tumors; however, in some cases, we should also consider it for tumors &gt;7 cm. Videoendoscopic surgery is the most preferable option for these patients, whereas robot-assisted techniques should be used for organpreserving surgeries and RNE in difficult cases.

The Use of Simulation Technologies in the Formation of the Basic Skills of Videoendoscopic Surgery in Clinical Residents Enrolled in Training Programs for Surgical Specialists

Wide introduction of videoendosurgical technologies in all surgical specialties has become a challenge for teachers of medical universities. According to many authors, the use of virtual simulators proved to be unjustified, which compelled us to conduct a study to determine the place of virtual endosurgical simulators in the training program of a specialist of surgical profile. The experiment involved 36 clinical residents who took the training simulation course (108 hours) in the training virtual clinic (simulation training center) of VSMU N. N. Burdenko during 2016-2017. Students were divided into two groups. In the first group, classes were held on the Gross-SMITH simulators, equipped with simulators of laparoscopes ending with cameras with options axis angle 0 and 30 degrees. In the second group, classes were held on a virtual simulator with tactile backlink LapVR. At the end of the course, each resident was asked to do control exercise – to stitch pig's stomach, which had a wound with two markings indicating where to lead the needle. Videoendosurgical simulator Gross-SMITH was used to perform a control exercise. The results of the study confirmed the effectiveness of the use of virtual endosurgical simulators with tactile backlink in the formation of the basic skills of videoendoscopic surgery. The formation of the skill of tying an intracorporal knot proved to be more effective in training with the use of videoendosurgical simulators Gross-SMITH and real surgical instruments.

Robotic is better than VATS? Ten good reasons to prefer robotic versus manual VATS surgery in lung cancer patients

Different variants of minimally invasive lung resection have been described during the last decades including uniportal, non-intubated video-assisted thoracoscopic surgery (VATS), as well as, more recently, the subxiphoid VATS lobectomy. Robot-assisted thoracic surgery (RATS) is a relatively recent evolution of manual videoendoscopic surgery, born with the idea to make minimally invasive techniques an option even for complex procedures with the help of computer and micromechanics. Thus, after a period to gain confidence with the new system, robotic surgery found a great consensus among surgeons. With its development and diffusion in many surgical disciplines, including thoracic surgery, studies on its efficacy, safety and feasibility compared to conventional techniques have been performed. This has produced a healthy competition between VATS and RATS, even if these studies gave controversial results in terms of perioperative outcome and complications. A definitive conclusion is not available about a real benefit for the patients in the field of lung cancer treatment. Despite that, many aspects of robotic surgical platforms foreshadow that robotic systems will become an essential reality in the surgeon’s armamentarium of the future. We expose the main features of robotic surgery to demonstrate that RATS is better than VATS to treat lung cancer patients.

Managing obstructive gastric volvulus: challenges and solutions

Managing obstructive gastric volvulus: challenges and solutions Hector Alejandro Rodriguez-G,1 Andrew S Wright,2–4 Robert B Yates1–3 1Department of Surgery, Center for Esophageal and Gastric Surgery, 2Center for Videoendoscopic Surgery, 3Hernia Center, 4Institute for Simulation and Interprofessional Studies, UWMC, University of Washington, Seattle, USA Abstract: Gastric volvulus is the abnormal torsion of the stomach along its short or long axis. Most patients who experience gastric volvulus present with mild or intermittent gastric obstructive symptoms. However, severe acute gastric volvulus can result in complete gastric outlet obstruction and ischemia. Consequently, acute gastric volvulus warrants immediate evaluation and management. The goals of management are to relieve the obstruction and prevent recurrent volvulus. Techniques to manage gastric volvulus depend on patient characteristics and the presence of gastric ischemia. In the absence of gastric ischemia, gastric volvulus can be managed with anterior abdominal wall gastropexy or paraesophageal hernia repair. If gastric ischemia is present, operative resection of the affected portion of the stomach is indicated. When operative management is indicated, many patients with gastric volvulus can be managed with minimally invasive (laparoscopic, endoscopic, or laparoendoscopic) techniques. Keywords: gastric volvulus, paraesophageal hernia, hiatal hernia

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.

Video endoscopic surgery in the treatment of patients with early ovarian cancer

Video endoscopic surgery in the treatment of patients with early ovarian cancer

Videoendoscopic Single-Port Nipple-Sparing Mastectomy and Immediate Reconstruction

Single-incision videoendoscopic surgery has recently become popular as a result of the ongoing search for less invasive procedures. The aim of this study was to evaluate the safety and efficacy of endoscopic single-port nipple-sparing mastectomy, axillary lymphadenectomy, and immediate reconstruction in patients with breast cancer. From May 14, 2012 through January 23, 2013, 10 patients underwent videoendoscopic single-port nipple-sparing mastectomy and axillary dissection via a single, limited incision and immediate prosthetic reconstruction. Patient charts were reviewed, and demographic data, operative time, complications and pathology results were analyzed. In all patients, videoendoscopic surgery was performed successfully. Of 10 patients, 7 were diagnosed as having invasive ductal carcinoma, 2 had a ductal carcinoma in situ, and 1 underwent bilateral prophylactic mastectomy. The weight of the resected gland was 300-650 g, with a mean of 420 g. There were no operative complications, and the mean operative time was 250 minutes (range, 160-330 minutes). One-stage reconstruction with implants was performed on 4 patients, whereas expanders were placed in the remaining 6. Surgical margins of all cases were pathologically negative, and there were no recurrences observed during the early follow-up period. Videoendoscopic single-port nipple-sparing mastectomy is technically feasible even in larger breasts, enabling immediate reconstruction with good cosmetic outcomes. However, further studies with larger clinical series and long-term follow-up are required to compare the safety and efficacy of the technique with those of the standard nipple-sparing mastectomy.