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Gnech M, 't Hoen L, Zachou A, Bogaert G, Castagnetti M, O'Kelly F, Quaedackers J, Rawashdeh YF, Silay MS, Kennedy U, Skott M, van Uitert A, Yuan Y, Radmayr C, Burgu B. Update and Summary of the European Association of Urology/European Society of Paediatric Urology Paediatric Guidelines on Vesicoureteral Reflux in Children. Eur Urol 2024; 85:433-442. [PMID: 38182493 DOI: 10.1016/j.eururo.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 12/05/2023] [Accepted: 12/13/2023] [Indexed: 01/07/2024]
Abstract
BACKGROUND AND OBJECTIVE The prescriptive literature on vesicoureteral reflux (VUR) is still limited and thus the level of evidence is generally low. The aim of these guidelines is to provide a practical approach to the treatment of VUR that is based on risk analysis and selective indications for both diagnostic tests and interventions. We provide a 2023 update on the chapter on VUR in children from the European Association of Urology (EAU) and European Society for Paediatric Urology (ESPU) guidelines. METHODS A structured literature review was performed for all relevant publications published from the last update up to March 2022. KEY FINDINGS AND LIMITATIONS The most important updates are as follows. Bladder and bowel dysfunction (BBD) is common in toilet-trained children presenting with urinary tract infection (UTI) with or without primary VUR and increases the risk of febrile UTI and focal uptake defects on a radionuclide scan. Continuous antibiotic prophylaxis (CAP) may not be required in every VUR patient. Although the literature does not provide any reliable information on CAP duration in VUR patients, a practical approach would be to consider CAP until there is no further BBD. Recommendations for children with febrile UTI and high-grade VUR include initial medical treatment, with surgical care reserved for CAP noncompliance, breakthrough febrile UTIs despite CAP, and symptomatic VUR that persists during long-term follow-up. Comparison of laparoscopic extravesical versus transvesicoscopic ureteral reimplantation demonstrated that both are good option in terms of resolution and complication rates. Extravesical surgery is the most common approach used for robotic reimplantation, with a wide range of variations and success rates. CONCLUSIONS AND CLINICAL IMPLICATIONS This summary of the updated 2023 EAU/ESPU guidelines provides practical considerations for the management and diagnostic evaluation of VUR in children. ADVANCING PRACTICE For children with VUR, it is important to treat BBD if present. A practical approach regarding the duration of CAP is to consider administration until BBD resolution. PATIENT SUMMARY We provide a summary and update of guidelines on the diagnosis and management of urinary reflux (where urine flows back up through the urinary tract) in children. Treatment of bladder and bowel dysfunction is critical, as this is common in toilet-trained children presenting with urinary tract infection.
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Affiliation(s)
- Michele Gnech
- Department of Paediatric Urology, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy.
| | - Lisette 't Hoen
- Department of Pediatric Urology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Alexandra Zachou
- Department of HIV and Sexual Health, Chelsea & Westminster Hospital, London, UK
| | - Guy Bogaert
- Department of Urology, University of Leuven, Leuven, Belgium
| | - Marco Castagnetti
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Padua, Italy
| | - Fardod O'Kelly
- Division of Paediatric Urology, Beacon Hospital Dublin & University College Dublin, Ireland
| | - Josine Quaedackers
- Department of Urology, University Medical Center Groningen, Groningen, The Netherlands
| | - Yazan F Rawashdeh
- Department of Urology, Section of Pediatric Urology, Aarhus University Hospital, Aarhus, Denmark
| | - Mesrur Selcuk Silay
- Division of Pediatric Urology, Department of Urology, Biruni University, Istanbul, Turkey
| | - Uchenna Kennedy
- Department of Pediatric Urology, University Children's Hospital Zurich, Zurich, Switzerland
| | - Martin Skott
- Department of Urology, Section of Pediatric Urology, Aarhus University Hospital, Aarhus, Denmark
| | - Allon van Uitert
- Department of Urology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Yuhong Yuan
- Department of Medicine, London Health Science Centre, London, Ontario, Canada, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Christian Radmayr
- Department of Urology, Medical University of Innsbruck, Innsbruck, Austria
| | - Berk Burgu
- Department of Pediatric Urology, Ankara University School of Medicine, Ankara, Turkey
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Pan X, Sun K, Lin S, Xu L. Endoscopic extraction of a large spherical foreign body in rectum:A case report. Asian J Surg 2024:S1015-9584(24)00634-1. [PMID: 38670812 DOI: 10.1016/j.asjsur.2024.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 04/03/2024] [Indexed: 04/28/2024] Open
Affiliation(s)
- Xinzhi Pan
- Department of Gastroenterology, Lianzhou People's Hospital, Lianzhou, 513400, Guangdong, China
| | - Kuangwei Sun
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Shiyue Lin
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Lishu Xu
- Department of Gastroenterology, Guangdong Provincial Geriatrics Institute, National Key Clinical Specialty, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, Guangdong, China.
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3
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Liu S, Su S, Long J, Cao S, Ren J, Li F, Gao Z, Gao H, Wang D, Hu F, Zhang X. Evaluating the learning curve of endoscopic surgery for spontaneous intracerebral hemorrhage: A single-center experience in a county hospital. J Clin Neurosci 2024; 123:209-215. [PMID: 38626528 DOI: 10.1016/j.jocn.2024.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 02/26/2024] [Accepted: 04/07/2024] [Indexed: 04/18/2024]
Abstract
BACKGROUND Endoscopic surgery has shown promise in treating Spontaneous Intracerebral Hemorrhage (sICH), but its adoption in county-level hospitals has been hindered by the high level of surgical expertise required. METHODS In this retrospective study at a county hospital, we utilized a Cumulative Sum (CUSUM) control chart to visualize the learning curve for two neurosurgeons. We compared patient outcomes in the learning and proficient phases, and compared them with expected outcomes based on ICH score and ICH functional outcome score, respectively. RESULTS The learning curve peaked at the 12th case for NS1 and the 8th case for NS2, signifying the transition to the proficient stage. This stage saw reductions in operation time, blood loss, rates of evacuation < 90 %, rebleeding rates, intensive care unit stay, hospital stay, and overall costs for both neurosurgeons. In the learning stage, 6 deaths occurred within 30 days, less than the 10.66 predicted by the ICH score. In the proficient stage, 3 deaths occurred, less than the 15.88 predicted. In intermediate and high-risk patients by the ICH functional outcome score, the proficient stage had fewer patients with an mRS ≥ 3 at three months than the learning stage (23.8 % vs. 69.2 %, P = 0.024; 40 % vs. 80 %, P = 0.360). Micromanipulating bipolar precision hemostasis and aspiration devices in the endoport's channels sped up the transition from learning to proficient. CONCLUSION The data shows a learning curve, with better surgical outcomes as surgeons gain proficiency. This suggests cost benefits of surgical proficiency and the need for ongoing surgical education and training in county hospitals.
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Affiliation(s)
- Shuang Liu
- Department of Neurosurgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Shengyang Su
- Department of Surgery, People's Hospital of Jinping Miao, Yao and Dai Autonomous Country, Honghe Prefecture, Yunnan Province, China
| | - Jinyong Long
- Department of Surgery, People's Hospital of Jinping Miao, Yao and Dai Autonomous Country, Honghe Prefecture, Yunnan Province, China
| | - Shikui Cao
- Department of Surgery, People's Hospital of Jinping Miao, Yao and Dai Autonomous Country, Honghe Prefecture, Yunnan Province, China
| | - Jirao Ren
- Department of Surgery, People's Hospital of Jinping Miao, Yao and Dai Autonomous Country, Honghe Prefecture, Yunnan Province, China
| | - Fuhua Li
- Department of Surgery, People's Hospital of Jinping Miao, Yao and Dai Autonomous Country, Honghe Prefecture, Yunnan Province, China
| | - Zihui Gao
- Department of Surgery, People's Hospital of Jinping Miao, Yao and Dai Autonomous Country, Honghe Prefecture, Yunnan Province, China
| | - Huaxing Gao
- Department of Neurology, People's Hospital of Jinping Miao, Yao and Dai Autonomous Country, Honghe Prefecture, Yunnan Province, China
| | - Deqiang Wang
- Department of Critical Care Medicine, People's Hospital of Jinping Miao, Yao and Dai Autonomous Country, Honghe Prefecture, Yunnan Province, China
| | - Fan Hu
- Department of Neurosurgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xiaobiao Zhang
- Department of Neurosurgery, Zhongshan Hospital, Fudan University, Shanghai, China.
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Moretto S, Saita A, Scoffone CM, Talso M, Somani BK, Traxer O, Angerri O, Knoll T, Liatsikos E, Herrmann TRW, Ulvik Ø, Skolarikos A, Cracco CM, Keller EX, Paciotti M, Piccolini A, Uleri A, Tailly T, Carmignani L, Pietropaolo A, Corrales M, Lughezzani G, Lazzeri M, Fasulo V, De Coninck V, Arena P, Nagele U, Ferretti S, Kronenberg P, Perez-Fentes D, Osther PJ, Goumas IK, Acquati P, Ajayi L, Diana P, Casale P, Buffi NM. Ureteral stricture rate after endoscopic treatments for urolithiasis and related risk factors: systematic review and meta-analysis. World J Urol 2024; 42:234. [PMID: 38613692 DOI: 10.1007/s00345-024-04933-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 03/15/2024] [Indexed: 04/15/2024] Open
Abstract
PURPOSE We aimed to accurately determine ureteral stricture (US) rates following urolithiasis treatments and their related risk factors. METHODS We conducted a systematic review and meta-analysis following the PRISMA guidelines using databases from inception to November 2023. Studies were deemed eligible for analysis if they included ≥ 18 years old patients with urinary lithiasis (Patients) who were subjected to endoscopic treatment (Intervention) with ureteroscopy (URS), percutaneous nephrolithotomy (PCNL), or shock wave lithotripsy (SWL) (Comparator) to assess the incidence of US (Outcome) in prospective and retrospective studies (Study design). RESULTS A total of 43 studies were included. The pooled US rate was 1.3% post-SWL and 2.1% post-PCNL. The pooled rate of US post-URS was 1.9% but raised to 2.7% considering the last five years' studies and 4.9% if the stone was impacted. Moreover, the pooled US rate differed if follow-ups were under or over six months. Patients with proximal ureteral stone, preoperative hydronephrosis, intraoperative ureteral perforation, and impacted stones showed higher US risk post-endoscopic intervention with odds ratio of 1.6 (P = 0.05), 2.6 (P = 0.009), 7.1 (P < 0.001), and 7.47 (P = 0.003), respectively. CONCLUSIONS The overall US rate ranges from 0.3 to 4.9%, with an increasing trend in the last few years. It is influenced by type of treatment, stone location and impaction, preoperative hydronephrosis and intraoperative perforation. Future standardized reporting and prospective and more extended follow-up studies might contribute to a better understanding of US risks related to calculi treatment.
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Affiliation(s)
- S Moretto
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Milan, Italy.
| | - A Saita
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Milan, Italy
| | - C M Scoffone
- Department of Urology, Cottolengo Hospital, Turin, Italy
| | - M Talso
- Department of Urology, Luigi Sacco University Hospital, Milan, Italy
| | - B K Somani
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK
| | - O Traxer
- Department of Urology, Sorbonne Université, Paris, France
| | - O Angerri
- Department of Urology, Fundació Puigvert Univ. Autonoma de Barcelona, Barcelona, Spain
| | - T Knoll
- Department of Urology, Sindelfingen Medical Center, University of Tübingen, Tübingen, Germany
| | - E Liatsikos
- Department of Urology, University Hospital of Patras, Patras, Greece
| | - T R W Herrmann
- Department of Urology, Spital Thurgau AG, Frauenfeld, Switzerland
- Hannover Medical School, Hannover, Germany
- Division of Urology, Department of Surgical Sciences, Stellenbosch University, Western Cape, South Africa
| | - Ø Ulvik
- Department of Urology, Haukeland University Hospital, Bergen, Norway
| | - A Skolarikos
- Second Department of Urology, Sismanoglio Hospital, National and Kapodistrian University of Athen, Athens, Greece
| | - C M Cracco
- Department of Urology, Cottolengo Hospital, Turin, Italy
| | - E X Keller
- Department of Urology, University Hospital Zurich, Zurich, Switzerland
| | - M Paciotti
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Milan, Italy
| | - A Piccolini
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Milan, Italy
| | - A Uleri
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Milan, Italy
| | - T Tailly
- Department of Urology, University Hospital Ghent, Ghent, Belgium
| | - L Carmignani
- Department of Urology, University of Milan, Milan, Italy
| | - A Pietropaolo
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK
| | - M Corrales
- Department of Urology, Sorbonne Université, Paris, France
| | - G Lughezzani
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Milan, Italy
| | - M Lazzeri
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Milan, Italy
| | - V Fasulo
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Milan, Italy
| | - V De Coninck
- Department of Urology, AZ Klina, Brasschaat, Belgium
| | - P Arena
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Milan, Italy
| | - U Nagele
- Department of Urology, General Hospital Hall in Tirol, Hall in Tirol, Austria
| | - S Ferretti
- Department of Urology, Azienda Ospedaliero-Universitaria di Modena, Baggiovara, Italy
| | - P Kronenberg
- Department of Urology, Hospital CUF Descobertas, Lisbon, Portugal
| | - D Perez-Fentes
- Department of Urology, University Hospital Complex of Santiago de Compostela, Santiago, Spain
| | - P J Osther
- Department of Urology, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark
| | - I K Goumas
- Department of Urology, Istituto Clinico Beato Matteo, Vigevano, Italy
| | - P Acquati
- Department of Urology, IRCCS Policlinico San Donato, Milan, Italy
| | - L Ajayi
- Department of Urology, Royal Free London NHS Foundation Trust, London, UK
| | - P Diana
- Department of Urology, Fundació Puigvert Univ. Autonoma de Barcelona, Barcelona, Spain
| | - P Casale
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Milan, Italy
| | - N M Buffi
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Milan, Italy
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AlSharhan SS, Aljubran HJ, Alrusayyis DF, AlGhuneem AA, AlMarzouq WF, Al Bar MH, AlSaied AS, Ashoor MM, ALEnazi AS, Alghamdi AA. Diagnostic accuracy of intrathecal fluorescein versus other radiological modalities in evaluating non-congenital skull base defects: a systematic review and meta-analysis. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08603-2. [PMID: 38581572 DOI: 10.1007/s00405-024-08603-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 03/05/2024] [Indexed: 04/08/2024]
Abstract
PURPOSE The intraoperative detection of cerebrospinal fluid (CSF) leaks during endoscopic skull base surgery is critical to ensure watertight sealed defects. Intrathecal fluorescein (ITF) is a valuable adjunct to intraoperative investigation. Hence, our aim is to summarize the evidence of the efficacy of ITF as an accurate diagnostic modality and reconstruction guide for non-congenital skull base defects. METHODS Using the Cochrane Central, MEDLINE, and Embase databases, we identified studies involving the use of ITF in non-congenital CSF leaks which were published until November 2023. The STATA 18 software was used for meta-analysis. RESULTS Fourteen studies met the inclusion criteria, in which seven studies were included in the meta-analysis. ITF was used in 1898 (90.3%) of patients, with a detection rate of 88.1%. The overall detection rate of non-congenital CSF leaks among ITF concentrations of 5% and 10% had a statistically significant pooled effect size of 2.6 (95% CI = 2.25, 2.95), while when comparing the ITF to other alternative radiological tests, it was not statistically significant with a mean difference of 0.88 (95% CI = - 0.4, 2.16). Moreover, the pooled prevalence was statistically significant in regards of the complications associated with ITF with an effect size of 0.6 (95% CI = 0.39, 0.82), indicating that 60% of patients who underwent ITF would experience at least one of the measured complications. CONCLUSION ITF is considered as an efficient tool in localizing skull base defects. However, there was no significant results when comparing the ITF to other alternative radiological tests. Accordingly, if the ITF intervention is indicated, patients should be carefully selected based on their clinical need.
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Affiliation(s)
- Salma S AlSharhan
- Department of Otolaryngology-Head and Neck Surgery, Imam Abdulrahman Bin Faisal University, King Faisal Ibn Abd Al Aziz, Al Rakah Ash Shamaliyah, 34221, Dammam, Saudi Arabia.
| | - Hussain J Aljubran
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Danah F Alrusayyis
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Aishah A AlGhuneem
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Wasan F AlMarzouq
- Department of Otolaryngology-Head and Neck Surgery, Imam Abdulrahman Bin Faisal University, King Faisal Ibn Abd Al Aziz, Al Rakah Ash Shamaliyah, 34221, Dammam, Saudi Arabia
| | - Mohammed H Al Bar
- Department of Otolaryngology-Head and Neck Surgery, Imam Abdulrahman Bin Faisal University, King Faisal Ibn Abd Al Aziz, Al Rakah Ash Shamaliyah, 34221, Dammam, Saudi Arabia
| | - Abdulmalik S AlSaied
- Department of Otolaryngology-Head and Neck Surgery, Imam Abdulrahman Bin Faisal University, King Faisal Ibn Abd Al Aziz, Al Rakah Ash Shamaliyah, 34221, Dammam, Saudi Arabia
| | - Mona M Ashoor
- Department of Otolaryngology-Head and Neck Surgery, Imam Abdulrahman Bin Faisal University, King Faisal Ibn Abd Al Aziz, Al Rakah Ash Shamaliyah, 34221, Dammam, Saudi Arabia
| | - Abdulaziz S ALEnazi
- Department of Otolaryngology-Head and Neck Surgery, Imam Abdulrahman Bin Faisal University, King Faisal Ibn Abd Al Aziz, Al Rakah Ash Shamaliyah, 34221, Dammam, Saudi Arabia
| | - Amal A Alghamdi
- Department of Family and Community Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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Yang L, Yang M, He M, Zhou X, Zhou Z. Endoscopic Surgery Versus Stereotactic Aspiration in Spontaneous Intracerebral Hemorrhage Treatment: A Systematic Review and Meta-Analysis. World Neurosurg 2024; 184:202-212. [PMID: 38316176 DOI: 10.1016/j.wneu.2024.01.162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 01/29/2024] [Indexed: 02/07/2024]
Abstract
OBJECTIVE To comprehensively compare the safety and efficacy of endoscopic surgery (ES) and stereotactic aspiration (SA) in patients with spontaneous intracerebral hemorrhage (sICH). METHODS We searched Web of Science, PubMed, Embase, and the Cochrane Central Register of Controlled Trials from inception to July 31, 2023. Studies comparing ES and SA for sICH treatment were also included. Outcome measures included primary outcomes (mortality and good functional outcome [GFO]) and secondary outcomes (evacuation rate, residual hematoma, perihematomal edema (PHE), operation time, volume of intraoperative blood loss, hospital stay duration, intensive care unit stay duration, hospital cost, complications, and reoperation). Subgroup analyses assessed the influence of age, hematoma volume, Glasgow Coma Scale score, and time to surgery on the outcomes. RESULTS Nine studies (1 randomized controlled trial and 8 observational studies) with 2105 patients (705 and 1400 in the ES and SA groups, respectively) were included in this meta-analysis. The final analysis indicated that compared with SA, ES was associated with enhanced GFO and a higher evacuation rate 1 day post-surgery along with reduced mortality and residual hematoma. Conversely, ES did not confer benefits in terms of perihematomal edema, operation time, intraoperative blood loss volume, or hospital stay duration compared with SA. Subgroup analysis highlighted the significant influences of age and hematoma volume on mortality, whereas hematoma volume and Glasgow Coma Scale score affected GFO. CONCLUSIONS ES is a safe and effective approach for sICH treatment, leading to improved patient prognosis and quality of life compared to SA.
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Affiliation(s)
- Linjing Yang
- Department of Radiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Mi Yang
- Department of Radiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Mingfeng He
- Department of Tumor, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xi Zhou
- Department of Radiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhiming Zhou
- Department of Radiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
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7
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Matassa-Patrone J, Agras-Menghi G, Espil P, Maccagno J, Navarrete P, Verdier E, Petre C, Acuña M, Saravia-Toledo A. Training in Skull Base Endonasal Endoscopic Surgery: Development and Validation of a Novel Low-Cost Simulation with Animal Cadaveric Model. World Neurosurg 2024; 184:74-85. [PMID: 38218436 DOI: 10.1016/j.wneu.2024.01.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Accepted: 01/07/2024] [Indexed: 01/15/2024]
Abstract
BACKGROUND Endoscopic skull base surgery is constantly evolving and its scope has expanded. The acquisition of surgical skills involves a long learning curve with significant risks for the patient. Therefore, training in the laboratory has become essential to achieve appropriate proficiency and reduce the morbidity and mortality associated with these procedures. The objective of our work is to develop and validate a cost-effective and easily replicable simulator for endonasal endoscopy training using a swine cadaveric model. METHODS We used fresh Pietrain swine heads. Training exercises of increasing complexity were performed. A Specific Technical Skills and Knowledge Scale was created considering the objectives to be assessed in each task. After the simulation, the trainees were required to answer a satisfaction survey. RESULTS Ten participants were recruited (5 neurosurgery residents and 5 neurosurgeons). The simulator assessment showed statistically significant differences between groups. Performance was better among the group with endoscopic surgery experience. Face validity was assessed through a postsimulation questionnaire showing an overall mean score of 28.7 out of 30, indicating a highly positive overall assessment of the simulator. Furthermore, 100% of the trainees believe that including endoscopy training in their education would be beneficial. CONCLUSIONS The endonasal endoscopy training simulator using a swine cadaveric model is a useful and accessible tool for enhancing surgical skills in this field. It provides an opportunity for training outside the operating room, reducing the potential risks associated with patient practice, and improving the training of residents.
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Affiliation(s)
- Jerónimo Matassa-Patrone
- Department of Neurosurgery, Sanatorio Güemes, University of Buenos Aires, Buenos Aires, Argentina; Neuroanatomy Laboratory of the Institute of Applied Sciences, Faculty of Medicine, University of Buenos Aires, Buenos Aires, Argentina.
| | - Giuliana Agras-Menghi
- Department of Neurosurgery, Ricardo Gutierrez Children's Hospital, Buenos Aires, Argentina
| | - Pablo Espil
- Department of Neurosurgery, Ricardo Gutierrez Children's Hospital, Buenos Aires, Argentina
| | - Juan Maccagno
- Department of Neurosurgery, Ricardo Gutierrez Children's Hospital, Buenos Aires, Argentina
| | - Paulina Navarrete
- Department of Neurosurgery, Ricardo Gutierrez Children's Hospital, Buenos Aires, Argentina
| | - Exequiel Verdier
- Department of Neurosurgery, Ricardo Gutierrez Children's Hospital, Buenos Aires, Argentina
| | - Cesar Petre
- Department of Neurosurgery, Ricardo Gutierrez Children's Hospital, Buenos Aires, Argentina
| | - Marcelo Acuña
- Neuroanatomy Laboratory of the Institute of Applied Sciences, Faculty of Medicine, University of Buenos Aires, Buenos Aires, Argentina
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8
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Alokkan J, Swathi R, Viswanatha B, Aishwarya N, James GA, Akshitha V. A Comparative Study of Endoscopic Endonasal Dacryocystorhinostomy Using an Inferiorly Based Flap Versus a Posteriorly Based Flap. Indian J Otolaryngol Head Neck Surg 2024; 76:1882-1885. [PMID: 38566630 PMCID: PMC10982167 DOI: 10.1007/s12070-023-04435-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 12/04/2023] [Indexed: 04/04/2024] Open
Abstract
To evaluate the outcome and complications of Endoscopic endonasal Dacryocystorhinostomy (DCR) using an inferiorly based mucosal flap as compared to a conventional posteriorly based mucosal flap with flap preservation and no stenting. 36 patients presenting with nasolacrimal duct obstruction were divided into two groups: the first group underwent endoscopic DCR using an inferiorly based mucosal flap, and the other group used a posteriorly based mucosal flap. In both groups, the mucosal flap was preserved, and bone was removed using Kerrison's punch. No stenting was done in any of the cases. The patency of the ostia was determined by syringing, and nasal endoscopy was done to look at the neo-ostium at follow-up visits to determine success and complications in each group. All 18 cases in the inferiorly based flap group had patent ostia with good mucosalization of the neo-ostium at 6-month follow-up. 3 of the 18 cases in the conventional posteriorly based flap group had failure due to granulation tissue formation around the neo-ostium. The use of an inferiorly based mucosal flap is easy to fashion and reposition at the end of the surgery. This technique has a good outcome with patent ostia during the follow-up period of 6 months.
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Affiliation(s)
- Jolene Alokkan
- Department of Otorhinolaryngology, East Point College of Medical Sciences and Research Centre, Bangalore, India
| | - R. Swathi
- Department of Otorhinolaryngology, East Point College of Medical Sciences and Research Centre, Bangalore, India
| | - B. Viswanatha
- Department of Otorhinolaryngology, East Point College of Medical Sciences and Research Centre, Bangalore, India
| | - N. Aishwarya
- Department of Otorhinolaryngology, East Point College of Medical Sciences and Research Centre, Bangalore, India
| | - Grace Ann James
- Department of Otorhinolaryngology, East Point College of Medical Sciences and Research Centre, Bangalore, India
| | - Vaddepalli Akshitha
- Department of Otorhinolaryngology, East Point College of Medical Sciences and Research Centre, Bangalore, India
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Hemmi T, Nomura K, Kobayashi Y, Numano Y, Ikeda R, Sugawara M, Katori Y. Epidemiology of postoperative bleeding after endoscopic nasal and sinus surgery and factors associated with bleeding. Eur Arch Otorhinolaryngol 2024; 281:1843-1847. [PMID: 38085306 PMCID: PMC10942910 DOI: 10.1007/s00405-023-08377-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 11/23/2023] [Indexed: 03/16/2024]
Abstract
PURPOSE Endoscopic nasal and sinus surgery is a surgical procedure frequently performed by otolaryngologists. Postoperative bleeding is detrimental to both healthcare providers and patients. We investigated the epidemiology of postoperative bleeding during endoscopic nasal and sinus surgery and explored possible bleeding triggers. METHODS We evaluated the patients who underwent endoscopic nasal and sinus surgery. Data regarding the age, sex, presence of hypertension, and abnormal coagulability, including oral anticoagulants, diagnoses, operative procedures, intraoperative use of drills and blood loss, and postoperative antimicrobial administration of eligible patients, were extracted from medical records and retrospectively reviewed. RESULTS One hundred and eighty-six patients underwent endoscopic nasal or sinus surgery during the study period, and postoperative bleeding occurred in 9 patients (4.8%). Posterior nasal neurotomy (PNN) was the procedure most likely to cause postoperative bleeding (4 surgeries, 13.3%). Postoperative antimicrobial administration significantly reduced the incidence of postoperative bleeding (p = 0.04). CONCLUSIONS Postoperative bleeding requiring intervention occurs in 4.8% of cases, and PNN is associated with a high risk of postoperative bleeding. Wound infection is a potential cause of postoperative bleeding, and antimicrobial administration should be considered in addition to local treatment.
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Affiliation(s)
- Tomotaka Hemmi
- Department of Otolaryngology, Tohoku Kosai Hospital, 2-3-11 Kokubun-cho, Aoba-Ku, Sendai, 980-0803, Japan.
| | - Kazuhiro Nomura
- Department of Otolaryngology, Tohoku Kosai Hospital, 2-3-11 Kokubun-cho, Aoba-Ku, Sendai, 980-0803, Japan
| | - Yuta Kobayashi
- Department of Otolaryngology, Head and Neck Surgery, Tohoku University School of Medicine, 1-1 Seiryo-machi, Aoba-Ku, Sendai, 980-8574, Japan
| | - Yuki Numano
- Department of Otolaryngology, Head and Neck Surgery, Tohoku University School of Medicine, 1-1 Seiryo-machi, Aoba-Ku, Sendai, 980-8574, Japan
| | - Ryoukichi Ikeda
- Department of Otolaryngology-Head and Neck Surgery, Iwate Medical University School of Medicine, 1-1-1 Yahaba-cho, Shiwa-gun, Iwate, 028-3695, Japan
| | - Mitsuru Sugawara
- Department of Otolaryngology, Tohoku Kosai Hospital, 2-3-11 Kokubun-cho, Aoba-Ku, Sendai, 980-0803, Japan
| | - Yukio Katori
- Department of Otolaryngology, Head and Neck Surgery, Tohoku University School of Medicine, 1-1 Seiryo-machi, Aoba-Ku, Sendai, 980-8574, Japan
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Bakhtiary F, Salamate S, Ahmad AES. Totally endoscopic micro-invasive aortic valve replacement. Multimed Man Cardiothorac Surg 2024; 2024. [PMID: 38530245 DOI: 10.1510/mmcts.2023.094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
Micro-invasive totally endoscopic aortic valve replacement surgery is a minimally invasive cardiac procedure that can be performed with the help of several techniques and technologies that employ the latest innovations in instrumentation and technological advances in the field, thereby greatly limiting the overall invasiveness of the procedure. With the help of a 3-dimensional camera, long instruments, a very small thoracotomy and a soft-tissue retractor without any rib retractor, the aortic valve can be easily and safely accessed for replacement. The other main features of these techniques are extracorporeal circulation that is achieved through peripheral percutaneous cannulation of the femoral vessels, antegrade cardioplegia, the use of automated devices for suturing the valvular ring and the prosthetic suture cuff, namely the RAM device, the Sew-Easy device and the Cor-Knot Mini device. Additionally, an automated vascular closure device such as the MANTA device is later used to close the femoral artery following decannulation.
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Affiliation(s)
| | - Saad Salamate
- Department of Cardiac Surgery, University Hospital Bonn, Germany
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11
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Chen K, Yang FG, Luo YC, He RJ. [Effect and complication among different kinds of spinal endoscopic surgery for lumbar disc herniation]. Zhongguo Gu Shang 2024; 37:228-34. [PMID: 38515408 DOI: 10.12200/j.issn.1003-0034.20220860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
OBJECTIVE To compare clinical efficacy and complication rate of percutaneous endoscopic transforaminal discectomy(PETD),percutaneous endoscopic interlaminar discectomy (PEID) and unilateral biportal endoscopic (UBE) in treating single-segment lumbar disc herniation(LDH). METHODS From October 2019 to August 2021,121 LDH patients with single-segment treated by spinal endoscopy were retrospectively analyzed and divided into three groups. In PETD group,there were 48 patients,including 19 males and 29 females,aged from 18 to 72 years old with an average of (44.0±13.9) years old;3 patients with L3,4 segments,27 patients with L4,5 segments,and 18 patients with L5S1 segments. In PEID group,there were 43 patients,including 23 males and 20 females,aged from 20 to 69 years old with an average of (40.1±12.1) years old;1 patient with L3,4 segments,15 patients with L4,5 segments,and 27 patients with L5S1 segments. In UBE group,there were 30 patients,including 12 males and 18 females,aged from 29 to 72 years old with an average of (41.2±15.0) years old;1 patient with L3,4 segments,18 patients with L4,5 segments,and 11 patients with L5S1 segments. Operation time,blood loss,fluoroscopy times and complications among three groups were observed and compared. Before opertaion,3 months after operation and at the latest follow-up,visual analogue scale (VAS) was used to evaluate low back pain and lower extremity pain,Oswestry disfunction index (ODI) was used to evaluate lumbar function,and modified MacNab was used to evaluate clinical efficacy at the latest follow-up. RESULTS All patients were performed endoscopic spinal surgery completly and were followed up for at least 12 months. One patient occurred dural sac rupture both in PETD and PEID group,and dural sac rupture was small,and there was no obvious discomfort after operation. Two patients were occurred intraoperative rupture of dural sac in UBE group. One patient was occurred cerebrospinal fluid leakage after operation,and was improved after rest in supine position and fluid rehydration. One patient without no significant postoperative discomfort. (1)There were no significant difference in operating time,blood loss and hospital stay between PETD and PEID group (P>0.05),while UBE group was higher than those of PETD and PEID group (P<0.05). There was no statistical significance in fluoroscopy times between PEID and UBE group (P>0.05),but PETD group was higher than that of PEID and UBE group (P<0.05). (2)VAS of low back pain at 3 months after operation in UBE group was higher than that in PETD and PEID group (P<0.05),but there was no significant difference between PETD and PEID group (P>0.05). At the latest follow-up,there was no significant difference in VAS of low back pain among three groups (P>0.05). (3)Lower extremity pain of VAS and ODI among 3 groups after operation were significantly improved at all time points compared with those before opertaion(P<0.05),and there were no statistical significance between groups (P>0.05),and there were no statistical significance in interaction between different time points and operation groups (P>0.05). (4) At the latest follow-up,according to the modified MacNab standard,the results of PETD group were excellent in 27 patients,good in 16 patients,moderate in 4 patients,poor in 1 patient;in PEID group,27 patients got excellent result,12 good,3 moderate,and 1 poor;in UBE group,16 patients got excellent,10 good,2 moderate,and 2 poor. There was no significant difference among three groups (χ2=0.308,P>0.05). Recurrence of lumbar disc herniation occurred in 1 patient among each three groups,symptoms were improved in 2 patients after symptomatic treatment,and 1 patient was treated in other hospitals. CONCLUSION PETD,PEID and UBE techniques could achieve good early clinical effects in treating lumbar disc herniation with similar complication rates. Both of PETD and PEID are single-channel minimally invasive surgery,with mild intraoperative tissue damage and quick postoperative recovery; while intraoperative fluoroscopy of PETD was relatively more frequent, and PEID was more suitable for L5S1 segment;UBE is a two-channel surgery,in which the intraoperative soft tissue damage is more severe,but exposure is broad,which is more suitable for complex cases.
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Affiliation(s)
- Kang Chen
- Department of Orthopaedics, the First People's Hospital of Zigong, Zigong 643000, Sichuan, China
| | - Fu-Guo Yang
- Department of Orthopaedics, the First People's Hospital of Zigong, Zigong 643000, Sichuan, China
| | - Yuan-Chao Luo
- Department of Orthopaedics, the First People's Hospital of Zigong, Zigong 643000, Sichuan, China
| | - Ren-Jian He
- Department of Orthopaedics, the First People's Hospital of Zigong, Zigong 643000, Sichuan, China
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Wang F, Wang R, Zhang C, Song E, Li F. Clinical effects of arthroscopic-assisted uni-portal spinal surgery and unilateral bi-portal endoscopy on unilateral laminotomy for bilateral decompression in patients with lumbar spinal stenosis: a retrospective cohort study. J Orthop Surg Res 2024; 19:167. [PMID: 38444008 PMCID: PMC10916320 DOI: 10.1186/s13018-024-04621-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 02/11/2024] [Indexed: 03/07/2024] Open
Abstract
OBJECTIVE To investigate the clinical effectiveness of Arthroscopic-assisted Uni-portal Spinal Surgery (AUSS) in the treatment of lumbar spinal stenosis. METHODS A total of 475 patients with lumbar spinal stenosis from January 2019 to January 2023 were included in this study. Among them, 240 patients were treated with AUSS (AUSS group); the other 235 patients were treated with unilateral bi-portal endoscopy treatment (UBE group). The differences in surgery-related clinical indicators, pain degree before and after surgery, Oswestry Disability Index (ODI), CT imaging parameters of spinal stenosis, and clinical efficacy were compared between the two groups. RESULTS Patients in the AUSS group had a shorter operative time than those in the UBE group, and the length of incision and surgical bleeding were less than those in the UBE group, with statistically significant differences (P < 0.05). Before operation, there was no significant difference in the VAS score of low back pain and leg pain between the two groups (P > 0. 05). After operation, patients in both groups showed a significant reduction in low back and leg pain, and their VAS scores were significantly lower than before the operation (P < 0.05). Three months after surgery, the results of CT re-examination in both groups showed that the spinal stenosis of the patients was well improved, and the measurements of lumbar spinal interspace APDC, CAC, ICA, CAD and LAC were significantly higher than those before surgery (P < 0. 05). Besides, the lumbar function of patients improved significantly in both groups, and ODI measurements were significantly lower than those before surgery (P < 0.05). CONCLUSION Both AUSS and UBE with unilateral laminotomy for bilateral decompression can achieve good clinical results in the treatment of lumbar spinal stenosis, but the former has the advantages of simpler operation, shorter operation time, shorter incision length, and less surgical blood loss.
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Affiliation(s)
- Fang Wang
- Department of Orthopaedics, The Second Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, Xi'an, China
| | - Rui Wang
- Department of Orthopaedics, The Second Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, Xi'an, China
| | - Chengyi Zhang
- Department of Orthopaedics, The Second Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, Xi'an, China
| | - En Song
- Department of Sports Medicine, The First Affiliated Hospital of Kunming Medical University, Kunming, China.
| | - Fengtao Li
- Department of Orthopaedics, The Second Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, Xi'an, China.
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Zheng G, Ding W, Liu X, Liu Y, Sun H, Song X, Zheng H. Gasless Single-Incision Endoscopic Surgery via Subclavicular Approach for Lateral Neck Dissection in Patients with Papillary Thyroid Cancer. Ann Surg Oncol 2024; 31:1498-1508. [PMID: 38099992 DOI: 10.1245/s10434-023-14639-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 11/06/2023] [Indexed: 02/08/2024]
Abstract
BACKGROUND The technical difficulties and trauma of remote access methods in endoscopic surgery (ES) for lateral neck dissection (LND) can be daunting for most patients with papillary thyroid cancer (PTC) and surgeons. The purpose of study was to introduce gasless single-incision ES via a subclavicular approach (ESSA) and to explore its safety and efficacy for LND. METHODS Between January 2022 and February 2023, we retrospectively reviewed 17 patients with PTC who underwent ESSA for LND. In addition, 22 patients who received video-assisted ES (VAES) and 48 patients who underwent open surgery (OP) for LND during the same period were included. Clinicopathological characteristics, complications, and efficacy of the lymph node yield (LNY) were compared between the ESSA and the other two groups (VAES and OP). RESULTS The LNY from central and lateral neck dissection by ESSA was comparable to that by VAES (9.2 ± 8.1 vs. 9.5 ± 4.2, P = 0.986, and 33.5 ± 11.6 vs. 30.6 ± 9.2, P = 0.382, respectively) and OP (9.2 ± 8.1 vs. 11.0 ± 5.4, P = 0.420, and 33.5 ± 11.6 vs. 31.5 ± 7.9, P = 0.383, respectively). Swallowing impairment scores at 1 and 3 months were significantly lower after ESSA than those after VAES (1.8 ± 1.0 vs. 3.0 ± 1.2, P = 0.003, and 0.9 ± 0.8 vs. 1.7 ± 0.8, P = 0.006, respectively). The cosmetic satisfaction rate 1 month after surgery was significantly higher in the ESSA group than that in the VAES group (100 vs. 31.8%, P < 0.001). CONCLUSIONS ESSA is a safe and minimally invasive procedure that provides a scarless cervical appearance and has good efficacy for LND. Therefore, ESSA may be a feasible choice for selected patients with N1b PTC with cervical cosmetic needs.
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Affiliation(s)
- Guibin Zheng
- Department of Thyroid Surgery, The Affiliated Yantai Yuhuangding Hospital, Qingdao University, Yantai, People's Republic of China
| | - Weifang Ding
- Department of Health Care, The Affiliated Yantai Yuhuangding Hospital, Qingdao University, Yantai, People's Republic of China
| | - Xincheng Liu
- Department of Thyroid Surgery, The Affiliated Yantai Yuhuangding Hospital, Qingdao University, Yantai, People's Republic of China
| | - Yang Liu
- Department of Thyroid Surgery, The Affiliated Yantai Yuhuangding Hospital, Qingdao University, Yantai, People's Republic of China
| | - Haiqing Sun
- Department of Thyroid Surgery, The Affiliated Yantai Yuhuangding Hospital, Qingdao University, Yantai, People's Republic of China
| | - Xicheng Song
- Department of Otorhinolaryngology, Head and Neck Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai, People's Republic of China.
- Shandong Provincial Clinical Research Center for Otorhinolaryngologic Diseases, Yantai, Shandong, People's Republic of China.
| | - Haitao Zheng
- Department of Thyroid Surgery, The Affiliated Yantai Yuhuangding Hospital, Qingdao University, Yantai, People's Republic of China.
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Poeta N, Maffulli N, Bucolo F, Charpail C, Migliorini F, Guillo S. Endoscopic peroneus brevis tendon transfer for chronic ruptures of the Achilles tendon: surgical technique. J Orthop Surg Res 2024; 19:131. [PMID: 38341603 PMCID: PMC10858542 DOI: 10.1186/s13018-024-04534-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 01/03/2024] [Indexed: 02/12/2024] Open
Abstract
Chronic Achilles tendon rupture is usually defined as a rupture diagnosed 4-6 weeks after injury. The management of chronic Achilles tendon rupture (CATR) is a topic of hot debate, and no consensus has been achieved. Surgical management of CATR is recommended. Several approaches, techniques, and grafts have been described. Open techniques carry a high risk of wound breakdown, infection, and necessitate long rehabilitation times. Surgical techniques with smaller incisions to reduce the risk of scar fibrosis, pain, and infection are becoming common. The ipsilateral tendon of the hallux flexor longus and the peroneus brevis is commonly used. Endoscopic transfer of the peroneus brevis tendon is an innovative alternative to other procedures, with comparable results of other autografts even in elite athletes. The tendon of the peroneus brevis is harvested by tendoscopy before performing a calcaneal tendon endoscopy and fixing the graft in a calcaneal tunnel using an interference screw. After surgery, an anterior splint is placed for 3 weeks with immediate forefoot weight bearing. The rehabilitation starts on the 15th postoperative day.
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Affiliation(s)
- Nicola Poeta
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, SA, Italy
| | - Nicola Maffulli
- Department of Medicine and Psychology, University Hospital Sant'Andrea, University La Sapienza, 00185, Rome, Italy.
- Faculty of Medicine, School of Pharmacy and Bioengineering, Keele University, Stoke-on-Trent, ST4 7QB, England.
- Centre for Sports and Exercise Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Mile End Hospital, 275 Bancroft Road, London, E1 4DG, England.
| | - Fabrizio Bucolo
- SOS Pied Cheville Bordeaux-Mérignac-Bruges, Clinique du Sport, 4 rue Georges Negrevergne, 33700, Mérignac, France
| | - Christel Charpail
- SOS Pied Cheville Bordeaux-Mérignac-Bruges, Clinique du Sport, 4 rue Georges Negrevergne, 33700, Mérignac, France
| | - Filippo Migliorini
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Medical Centre, Pauwelsstraße 30, 52074, Aachen, Germany.
- Department of Orthopedics and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of Paracelsus Medical University, 39100, Bolzano, Italy.
| | - Stéphane Guillo
- SOS Pied Cheville Bordeaux-Mérignac-Bruges, Clinique du Sport, 4 rue Georges Negrevergne, 33700, Mérignac, France
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Atsmoni SC, Kinshuck A. Advances in laryngeal and airway surgery: what has changed? Br J Hosp Med (Lond) 2024; 85:1-7. [PMID: 38416518 DOI: 10.12968/hmed.2023.0257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
Laryngeal and airway surgery continues to see innovation and advances, similar to other specialties of modern medicine. Research in this field has led to a greater understanding of conditions resulting in new terminology, diagnoses and change in management. This article looks at advances in laryngeal and upper airway surgery and discusses their ongoing impact on clinical practice.
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Affiliation(s)
- Smadar Cohen Atsmoni
- Department of Otolaryngology and Head and Neck Surgery, Liverpool Head and Neck Centre, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Andrew Kinshuck
- Department of Otolaryngology and Head and Neck Surgery, Liverpool Head and Neck Centre, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
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Compagnone D, Mandelli F, Ponzo M, Langella F, Cecchinato R, Damilano M, Redaelli A, Peretti GM, Vanni D, Berjano P. Complications in endoscopic spine surgery: a systematic review. Eur Spine J 2024; 33:401-408. [PMID: 37587257 DOI: 10.1007/s00586-023-07891-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 07/18/2023] [Accepted: 08/06/2023] [Indexed: 08/18/2023]
Abstract
PURPOSE This systematic review aims to investigate the complication rate of endoscopic spine surgeries, stratifying them by technique, district and kind of procedure performed. METHODS This study was conducted according to the PRISMA statement. The literature search was conducted in MEDLINE, CINAHL, EMBASE, Cochrane Register, OTseeker and ScienceDirect database. Types of studies included were observational studies (cohort studies, case-control studies and case series) and randomised or quasi-randomised clinical with human subjects. No restrictions on publication year were applied. Repeated articles, reviews, expert's comments, congress abstracts, technical notes and articles not in English were excluded. Several data were extracted from the articles. In particular, data of perioperative (≤ 3 months) and late (> 3 months) complications were collected and grouped according to: (1) surgical technique [uniportal full-endoscopic spine surgery (UESS) or unilateral biportal endoscopic spine surgery (UBESS)]; (2) spinal district treated [cervical, thoracic or lumbar] and (3) type of procedure [discectomy/decompression or fusion]. Complication analysis was performed in subgroups with at least 100 patients to have clinically meaningful statistical validity. RESULTS A total of 117 full-text articles were assessed for eligibility. Of the 117 records included, 95 focused their research on UESS (14 LOE V, 33 LOE IV, 43 LOE III and five LOE II) and 23 on UBESS (three LOE V, eight LOE IV, 10 LOE III and two LOE II). A total of 20,020 patients were extracted to investigate the incidence of different perioperative and late complications, 10,405 for UESS and 9615 for UBESS. CONCLUSION The present study summarises the complications reported in the literature for spinal endoscopic procedures. On the one hand, the most relevant described were perioperative complications (transient neurological deficit, dural tear and dysesthesia) that are especially meaningful for endoscopic discectomy and decompression. On the other hand, late complications, such as mechanical implant failure, are more common in endoscopic interbody fusion. LEVEL OF EVIDENCE I.
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Affiliation(s)
| | - Filippo Mandelli
- Department of Spine Surgery, University Hospital Basel, Basel, Switzerland
| | - Matteo Ponzo
- IRCCS Ospedale Galeazzi Sant'Ambrogio, Milan, Italy
| | | | | | | | | | - Giuseppe Maria Peretti
- IRCCS Ospedale Galeazzi Sant'Ambrogio, Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, 20133, Milan, Italy
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Bhardwaj A, Ojha T, Soni N, Balhara M, Gour N. To Study the Efficacy of Coblation in the Endoscopic Surgery of Sinonasal and Skull Base Masses. Indian J Otolaryngol Head Neck Surg 2024; 76:137-140. [PMID: 38440439 PMCID: PMC10908875 DOI: 10.1007/s12070-023-04109-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 07/21/2023] [Indexed: 03/06/2024] Open
Abstract
Objective To study the efficacy of coblation in the endoscopic surgery of sinonasal and skull base masses. Study Design Prospective Interventional Study. Method 100 patients with signs and symptoms of nasal obstruction were enrolled for 14 months. On the basis of diagnosis they underwent endoscopic sinus surgery using coblator and their intra-operative blood loss, operation time, post-operative pain threshold using VAS(Visual analogue scale) were enlisted. Result 80% had Sinonasal polyp followed by Inverted papilloma in 8%, Angiofibroma in 5%, Hemangioma in 3%, Esthesioneuroblastoma in 2% and Rhinosporidiosis in 2%. The Minimum blood loss was 50 ml and Maximum was 600 ml. 30% patients had no pain, 60% had Mild pain and 10% had Moderate pain post procedure. Mean Operation time was 112.86 min. Conclusion Coblation has proven to have reduced operation time, blood loss and faster wound healing. It has now established itself as an essential tool for advance tumours in nasal surgeries.
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Affiliation(s)
- Arushi Bhardwaj
- Dept. Of Otorhinolaryngology, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan India
| | - Tarun Ojha
- Dept. Of Otorhinolaryngology, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan India
| | - Nikhil Soni
- Dept. Of Otorhinolaryngology, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan India
| | - Manan Balhara
- Dept. Of Otorhinolaryngology, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan India
| | - Nishant Gour
- Dept. Of Otorhinolaryngology, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan India
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Rueckert T, Rueckert D, Palm C. Methods and datasets for segmentation of minimally invasive surgical instruments in endoscopic images and videos: A review of the state of the art. Comput Biol Med 2024; 169:107929. [PMID: 38184862 DOI: 10.1016/j.compbiomed.2024.107929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 12/02/2023] [Accepted: 01/01/2024] [Indexed: 01/09/2024]
Abstract
In the field of computer- and robot-assisted minimally invasive surgery, enormous progress has been made in recent years based on the recognition of surgical instruments in endoscopic images and videos. In particular, the determination of the position and type of instruments is of great interest. Current work involves both spatial and temporal information, with the idea that predicting the movement of surgical tools over time may improve the quality of the final segmentations. The provision of publicly available datasets has recently encouraged the development of new methods, mainly based on deep learning. In this review, we identify and characterize datasets used for method development and evaluation and quantify their frequency of use in the literature. We further present an overview of the current state of research regarding the segmentation and tracking of minimally invasive surgical instruments in endoscopic images and videos. The paper focuses on methods that work purely visually, without markers of any kind attached to the instruments, considering both single-frame semantic and instance segmentation approaches, as well as those that incorporate temporal information. The publications analyzed were identified through the platforms Google Scholar, Web of Science, and PubMed. The search terms used were "instrument segmentation", "instrument tracking", "surgical tool segmentation", and "surgical tool tracking", resulting in a total of 741 articles published between 01/2015 and 07/2023, of which 123 were included using systematic selection criteria. A discussion of the reviewed literature is provided, highlighting existing shortcomings and emphasizing the available potential for future developments.
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Affiliation(s)
- Tobias Rueckert
- Regensburg Medical Image Computing (ReMIC), Ostbayerische Technische Hochschule Regensburg (OTH Regensburg), Germany.
| | - Daniel Rueckert
- Artificial Intelligence in Healthcare and Medicine, Klinikum rechts der Isar, Technical University of Munich, Germany; Department of Computing, Imperial College London, UK
| | - Christoph Palm
- Regensburg Medical Image Computing (ReMIC), Ostbayerische Technische Hochschule Regensburg (OTH Regensburg), Germany; Regensburg Center of Health Sciences and Technology (RCHST), OTH Regensburg, Germany
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Candy NG, Jukes AK, Van Der Veken J, Torpy DJ, Vrodos N, Santoreneos S, Wormald PJ, Psaltis AJ. The Learning Curve for Endoscopic Endonasal Transsphenoidal Pituitary Surgery: Evaluating Endocrine Outcomes. J Clin Neurosci 2024; 120:14-22. [PMID: 38160655 DOI: 10.1016/j.jocn.2023.12.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 12/20/2023] [Accepted: 12/26/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE In South Australia endoscopic endonasal approach (EEA) pituitary surgery has been practiced since 2006, largely by two neurosurgeons with a small fellowship-trained otolaryngology team. The aim of this cohort study was to determine if a "learning curve" can be established over this time period, as represented by structural and endocrine patient outcomes. METHOD Retrospective cohort study of patients undergoing EEA surgery between 2006 and 2021 in Adelaide, South Australia at three tertiary teaching hospitals.. Cases were divided by each surgeon and split into groups of sequential 40 cases. Endocrine assessment pre- and post-operatively involved static pituitary and end-organ hormones, with dynamic tests as required, assessed by an pituitary endocrinologist. Each hormonal axis (gonadal, cortisol, thyroid, prolactin and growth hormone) was documented preoperatively and at an early and long term follow up at 1-2 and 12 months, respectively. RESULTS The study included a cohort of 443 pituitary adenomas managed with endoscopic endonasal transsphenoidal surgery in a consecutive fashion between two neurosurgeons over 16-years. Gross tumour resection but not visual visual outcomes improved with surgical experience but this outcome may be neurosurgeon dependent. Endocrine outcomes were not consistently improved with experience, but lower rates of hypopituitarism were seen with experience with one neurosurgeon. Average follow up was approximately 5 years, and a minimum follow up of 12 months for all patients. CONCLUSIONS We present long term endocrine follow up for patients with functional and non-functional adenomas. Improved rates of gross tumour resection were evident with with surgical experience. However, there was no apparent change in post-operative endocrine outcomes.
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Affiliation(s)
- Nicholas G Candy
- Department of Surgery - Otolaryngology, Head and Neck Surgery, The University of Adelaide, Woodville South, Adelaide, SA; Department of Neurosurgery, Royal Adelaide Hospital, Adelaide, Australia; Department of Neurosurgery, Flinders Medical Centre, Adelaide, Australia.
| | - Alistair K Jukes
- Department of Neurosurgery, Royal Adelaide Hospital, Adelaide, Australia
| | - Jorn Van Der Veken
- Department of Neurosurgery, Flinders Medical Centre, Adelaide, Australia
| | - David J Torpy
- Department of Endocrinology, Royal Adelaide Hospital, Adelaide, Australia
| | - Nick Vrodos
- Department of Neurosurgery, Flinders Medical Centre, Adelaide, Australia
| | | | - Peter-John Wormald
- Department of Surgery - Otolaryngology, Head and Neck Surgery, The University of Adelaide, Woodville South, Adelaide, SA; Department of Otolaryngology, Head and Neck Surgery, Queen Elizabeth Hospital, Adelaide, Australia
| | - Alkis J Psaltis
- Department of Surgery - Otolaryngology, Head and Neck Surgery, The University of Adelaide, Woodville South, Adelaide, SA; Department of Otolaryngology, Head and Neck Surgery, Queen Elizabeth Hospital, Adelaide, Australia
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Choi JS, Kim J, Oh SJ, Ok YJ, Seong YW, Moon HJ. Transaortic removal of a large primary sarcoma from the left ventricle assisted by strategic partial resection and endoscopic guidance: a case report. J Cardiothorac Surg 2024; 19:34. [PMID: 38297348 PMCID: PMC10829275 DOI: 10.1186/s13019-024-02489-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 01/14/2024] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND Surgical resection remains the mainstay of treatment for cardiac sarcoma, a rare but lethal disease. Achieving complete removal of a large-sized left ventricular sarcoma remains a challenge even with various surgical approaches that have been employed. CASE PRESENTATION We present a case of a 74-year-old woman with shortness of breath who underwent surgical removal of a primary cardiac sarcoma, measuring 6 × 3.5 × 3 cm, attached to the septum of the left ventricle and caused sub-aortic valve obstruction. Transaortic approach was chosen and the access to this entire huge mass was enabled by using interim partial resection which created a space for further dissection and subsequent deeper endoscopic views. The further dissection was finally able to be advanced on the apex, and the residual mass was completely resected with gross tumor-free margins. CONCLUSION Interim partial resection and endoscopic guidance can highly facilitate the transaortic removal of even large left ventricular sarcomas.
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Affiliation(s)
- Jae-Sung Choi
- Department of Cardiovascular and Thoracic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, 20 Boramae-ro 5-gil, Dongjak-gu, Seoul, 07061, Republic of Korea.
| | - Jeongwon Kim
- Department of Cardiovascular and Thoracic Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Se Jin Oh
- Department of Cardiovascular and Thoracic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, 20 Boramae-ro 5-gil, Dongjak-gu, Seoul, 07061, Republic of Korea
| | - You Jung Ok
- Department of Cardiovascular and Thoracic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, 20 Boramae-ro 5-gil, Dongjak-gu, Seoul, 07061, Republic of Korea
| | - Yong Won Seong
- Department of Cardiovascular and Thoracic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, 20 Boramae-ro 5-gil, Dongjak-gu, Seoul, 07061, Republic of Korea
| | - Hyeon Jong Moon
- Department of Cardiovascular and Thoracic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, 20 Boramae-ro 5-gil, Dongjak-gu, Seoul, 07061, Republic of Korea
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21
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Court C, Girault A, Valteau B, Mercier O, Missenard G, Fadel E, Bouthors C. New technique of En bloc vertebral resection in the thoracolumbar region assisted by retroperitoneal laparoscopy in a single prone position: first results. Eur Spine J 2024:10.1007/s00586-023-08121-5. [PMID: 38246902 DOI: 10.1007/s00586-023-08121-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 11/26/2023] [Accepted: 12/24/2023] [Indexed: 01/23/2024]
Abstract
PURPOSE To describe the technique and review the oncological and surgical results of the En Bloc resection assisted by retroperitoneal laparoscopy in a single prone position for tumors in the thoracolumbar region. METHODS Monocentric retrospective case study. Procedure was performed in a single prone position by a dual team of spine and thoracovascular surgeons. An endoscopic balloon was inflated in the right retroperitoneal cavity. A plan was developed between the anterior spine and vena cava as well as abdominal aorta with segmental vessels ligation. Structures at risk were safely protected under endoscopy during horizontal or sagittal osteotomies. RESULTS From 2021, seven patients aged a median 52 years old (range, 34-67) were included. Involved spinal segments went from T11 to L3. Surgery was aborted in one case due to massive bleeding and ventilating difficulties. There were two partial and four total vertebral resections. Median operating duration and estimated blood loss were 405 min (range, 360-540) and 2.1 L (range, 1.2-19), respectively. Postoperative complications consisted of 1 urinary infection; 1 transient urinary retention; 1 posterior wound infection; 1 pneumothorax; 1 persistent partial motor deficit; 1 transient confusion; 1 pulmonary embolism; 1 CSF leak; 1 subdural hematoma; 1 retroperitoneal lymphocele. All margins were uncontaminated. All patients were alive and ambulatory at last follow-up. CONCLUSION Early results suggest En Bloc resection assisted by retroperitoneal videoscopy in tumors from T11 to L3/4 disk space is feasible, less invasive and safe. Careful surgical planning and experience in endoscopic vascular surgery are mandatory.
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Affiliation(s)
- Charles Court
- Orthopedic and Trauma Surgery Department. Spine and Tumor Surgery Unit. Hôpital Bicêtre. Assistance Publique Hôpitaux de Paris, Université Paris Saclay, 78 rue du Général Leclerc, 94270, Le Kremlin Bicêtre, France
| | - Antoine Girault
- Cardiothoracic Surgery Department, Center Chirurgical Marie Lannelongue, Université Paris Saclay, 133 avenue de la Résistance, 92350, Le Plessis Robinson, France
| | - Barthelemy Valteau
- Orthopedic and Trauma Surgery Department. Spine and Tumor Surgery Unit. Hôpital Bicêtre. Assistance Publique Hôpitaux de Paris, Université Paris Saclay, 78 rue du Général Leclerc, 94270, Le Kremlin Bicêtre, France
| | - Olaf Mercier
- Cardiothoracic Surgery Department, Center Chirurgical Marie Lannelongue, Université Paris Saclay, 133 avenue de la Résistance, 92350, Le Plessis Robinson, France
| | - Gilles Missenard
- Orthopedic and Trauma Surgery Department. Spine and Tumor Surgery Unit. Hôpital Bicêtre. Assistance Publique Hôpitaux de Paris, Université Paris Saclay, 78 rue du Général Leclerc, 94270, Le Kremlin Bicêtre, France
| | - Elie Fadel
- Cardiothoracic Surgery Department, Center Chirurgical Marie Lannelongue, Université Paris Saclay, 133 avenue de la Résistance, 92350, Le Plessis Robinson, France
| | - Charlie Bouthors
- Orthopedic and Trauma Surgery Department. Spine and Tumor Surgery Unit. Hôpital Bicêtre. Assistance Publique Hôpitaux de Paris, Université Paris Saclay, 78 rue du Général Leclerc, 94270, Le Kremlin Bicêtre, France.
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22
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Mei H, Lu X, Dong C, Lin H, Chen B, Li H, Ni Y. Combined microscope-endoscopy resection of petrous bone cholesteatoma with temporary facial nerve transposition versus nontransposition. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-023-08397-9. [PMID: 38227283 DOI: 10.1007/s00405-023-08397-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 12/04/2023] [Indexed: 01/17/2024]
Abstract
PURPOSE The narrow supralabyrinthine space affects surgical procedures. To study the effect of temporary transposition of geniculate ganglion of facial nerve versus nontransposition on lesion recurrence and facial nerve function in patients with petrous bone cholesteatoma. METHODS A total of 18 patients with petrous bone cholesteatoma involving the facial nerve were treated in our hospital from November 2016 to March 2023. The main surgical method is the extended supralabyrinthine approach assisted by a microscope and an endoscope. We collected and retrospectively analyzed their medical records. RESULTS Temporary facial nerve transposition was performed in five patients, and nontransposition was performed in 13 patients. Cholesteatoma recurred in three patients with facial nerve nontransposition, whereas none in patients with facial nerve transposition. In this study, except for one case with a second operation, postoperative facial paralysis in other cases was improved to varying degrees, and there was no significant difference between the two groups. CONCLUSION Temporary transposition of geniculate ganglion of facial nerve will not affect the postoperative nerve function of patients and can reduce the possibility of cholesteatoma recurrence of the petrous bone.
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Affiliation(s)
- Honglin Mei
- Department of Otorhinolaryngology, Eye and ENT Hospital, ENT Institute, Fudan University, Shanghai, 200031, China
- NHC Key Laboratory of Hearing Medicine, Fudan University, Shanghai, 200031, China
| | - Xiaoling Lu
- Department of Otorhinolaryngology, Eye and ENT Hospital, ENT Institute, Fudan University, Shanghai, 200031, China
- NHC Key Laboratory of Hearing Medicine, Fudan University, Shanghai, 200031, China
| | - Chunguang Dong
- Department of Otorhinolaryngology, First People's Hospital of Lianyungang, Jiangsu, 222002, China
| | - Hailiang Lin
- Department of Otorhinolaryngology, Eye and ENT Hospital, ENT Institute, Fudan University, Shanghai, 200031, China
- NHC Key Laboratory of Hearing Medicine, Fudan University, Shanghai, 200031, China
| | - Bing Chen
- Department of Otorhinolaryngology, Eye and ENT Hospital, ENT Institute, Fudan University, Shanghai, 200031, China.
- NHC Key Laboratory of Hearing Medicine, Fudan University, Shanghai, 200031, China.
- Institutes of Biomedical Sciences, Fudan University, Shanghai, 200032, China.
| | - Huawei Li
- Department of Otorhinolaryngology, Eye and ENT Hospital, ENT Institute, Fudan University, Shanghai, 200031, China.
- NHC Key Laboratory of Hearing Medicine, Fudan University, Shanghai, 200031, China.
- Institutes of Biomedical Sciences, Fudan University, Shanghai, 200032, China.
- The Institutes of Brain Science and the Collaborative Innovation Center for Brain Science, Fudan University, Shanghai, 200032, China.
| | - Yusu Ni
- Department of Otorhinolaryngology, Eye and ENT Hospital, ENT Institute, Fudan University, Shanghai, 200031, China.
- NHC Key Laboratory of Hearing Medicine, Fudan University, Shanghai, 200031, China.
- Otology and Skull Base Surgery, Eye and ENT Hospital, Fudan University, Shanghai, 200031, China.
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Chen Z, Shou X, Ji L, Cheng H, Shen M, Ma Z, He W, Ye Z, Zhang Y, Qiao N, Zhang Q, Wang Y. Presurgical Medical Treatment in Prolactinomas: Surgical Implications and Pathological Characteristics from 290 Cases. J Clin Endocrinol Metab 2024:dgad758. [PMID: 38163969 DOI: 10.1210/clinem/dgad758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 11/30/2023] [Accepted: 12/26/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE To review experience regarding the treatment of prolactinomas by endoscopic endonasal surgery (EES) focusing on the association between presurgical dopamine agonist (DA) treatment and perioperative outcomes, surgical morbidities, endocrine outcomes and pathological characteristics. METHODS A single-center series of 290 cases were analyzed retrospectively and clinical data were collected. Intratumoural collagen content was assessed by Masson's trichrome staining. RESULTS Tenacious tumor consistency (27.8% vs 9.8%, p < 0.001) was more common in DA pretreated patients compared to patients who prefer initial surgery. Moreover, DA pretreated macroadenomas presented more intraoperative blood loss (200 [100-400] ml vs 175 [100-300] ml, p = 0.014), longer surgical duration (177±95 mins vs 154±57 mins, p = 0.043) and more surgical morbidities (19.4% vs 8.9%, p = 0.034). Additionally, DA pretreated macroadenomas presented higher collagen volume fraction (CVF) than that of the initial surgery group (23.6 ± 2.2% vs 13.2 ± 2.1%, p = 0.001). Correlation analysis revealed a close correlation between CVF and the cumulative dose of bromocriptine (BRC) in macroadenomas (r = 0.438, p < 0.001). Regarding to endocrine outcomes, DA pretreated microadenomas showed lower proportion of initial remission compared to microadenomas who prefer initial surgery (86.7% vs 100%, p = 0.047). CONCLUSIONS This study described increased surgical difficulty and inferior endocrine outcomes which associated with tumor fibrosis secondary to presurgical BRC treatment in prolactinomas. Neurosurgeons should be noticed that presurgical BRC treatment may render subsequent surgery more challenging.
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Affiliation(s)
- Zhengyuan Chen
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- National Center for Neurological Disorders, Shanghai, China
- Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, China
- Neurosurgical Institute of Fudan University, Shanghai, China
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
| | - Xuefei Shou
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- National Center for Neurological Disorders, Shanghai, China
- Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, China
- Neurosurgical Institute of Fudan University, Shanghai, China
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
| | - Lijin Ji
- Department of Endocrinology and Metabolism, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Haixia Cheng
- Department of Pathology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Ming Shen
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- National Center for Neurological Disorders, Shanghai, China
- Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, China
- Neurosurgical Institute of Fudan University, Shanghai, China
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
| | - Zengyi Ma
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- National Center for Neurological Disorders, Shanghai, China
- Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, China
- Neurosurgical Institute of Fudan University, Shanghai, China
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
| | - Wenqiang He
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- National Center for Neurological Disorders, Shanghai, China
- Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, China
- Neurosurgical Institute of Fudan University, Shanghai, China
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
| | - Zhao Ye
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- National Center for Neurological Disorders, Shanghai, China
- Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, China
- Neurosurgical Institute of Fudan University, Shanghai, China
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
| | - Yichao Zhang
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- National Center for Neurological Disorders, Shanghai, China
- Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, China
- Neurosurgical Institute of Fudan University, Shanghai, China
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
| | - Nidan Qiao
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- National Center for Neurological Disorders, Shanghai, China
- Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, China
- Neurosurgical Institute of Fudan University, Shanghai, China
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
| | - Qilin Zhang
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- National Center for Neurological Disorders, Shanghai, China
- Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, China
- Neurosurgical Institute of Fudan University, Shanghai, China
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
| | - Yongfei Wang
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- National Center for Neurological Disorders, Shanghai, China
- Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, China
- Neurosurgical Institute of Fudan University, Shanghai, China
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
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Yao H, Yang W, Tang H, Cheng Y, Lin S, Wu ZB. Fully endoscopic far-lateral supracerebellar infratentorial approach for trigeminal neuralgia: illustrative case reports. Chin Neurosurg J 2024; 10:1. [PMID: 38167418 PMCID: PMC10759323 DOI: 10.1186/s41016-023-00353-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 12/06/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Trigeminal neuralgia (TN) is a common cause of craniofacial pain. The retrosigmoid approach is usually used to treat TN, but no cases of endoscopic far-lateral supracerebellar infratentorial approach (EF-SCITA) were used to undergo operation for TN. CASE PRESENTATION Two patients were presented with severe facial pain and preliminary diagnosis was TN. Preoperative magnetic resonance imaging revealed that a superior cerebellar artery (SCA) compressed the trigeminal nerve in case 1, and a tumor located in the petrous apex extending into the Meckel's cave compressed the trigeminal nerve in case 2. Operations were achieved through the EF-SCITA. The pain was totally relieved with no postsurgical complications in both cases. CONCLUSIONS We present the first two case reports of EF-SCITA to relieve classical and secondary TN successfully. The EF-SCITA can be a promising approach for treating TN.
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Affiliation(s)
- Hong Yao
- Department of Neurosurgery, Center of Pituitary Tumor, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197# Ruijin Er Road, Shanghai, 200025, China
| | - Wenlei Yang
- Department of Neurosurgery, Center of Pituitary Tumor, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197# Ruijin Er Road, Shanghai, 200025, China
| | - Hao Tang
- Department of Neurosurgery, Center of Pituitary Tumor, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197# Ruijin Er Road, Shanghai, 200025, China
| | - Yijun Cheng
- Department of Neurosurgery, Center of Pituitary Tumor, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197# Ruijin Er Road, Shanghai, 200025, China
| | - Shaojian Lin
- Department of Neurosurgery, Center of Pituitary Tumor, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197# Ruijin Er Road, Shanghai, 200025, China
| | - Zhe Bao Wu
- Department of Neurosurgery, Center of Pituitary Tumor, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197# Ruijin Er Road, Shanghai, 200025, China.
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Bono BC, Milani D, Ferreli F, Olei S, Raspagliesi L, Tropeano MP, Lasio GB, Pessina F. Endoscopic Trans-Sphenoidal Resection of a Giant Pituitary Neuroendocrine Tumor with Third Ventricle Invasion and Obstructive Hydrocephalus: Surgical Anatomy and Two-Dimensional Operative Video. World Neurosurg 2024; 181:107. [PMID: 37871690 DOI: 10.1016/j.wneu.2023.10.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 10/15/2023] [Accepted: 10/16/2023] [Indexed: 10/25/2023]
Affiliation(s)
- Beatrice C Bono
- Department of Biomedical Sciences, Humanitas University, Milan, Italy; Department of Neurosurgery, IRCCS Humanitas Research Hospital, Milan, Italy.
| | - Davide Milani
- Department of Neurosurgery, Neurocenter of Southern Switzerland, Lugano, Switzerland
| | - Fabio Ferreli
- Department of Biomedical Sciences, Humanitas University, Milan, Italy; Department of Otorhinolaryngology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Simone Olei
- Department of Biomedical Sciences, Humanitas University, Milan, Italy; Department of Neurosurgery, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Luca Raspagliesi
- Department of Biomedical Sciences, Humanitas University, Milan, Italy; Department of Neurosurgery, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Maria Pia Tropeano
- Department of Neurosurgery, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Giovanni B Lasio
- Department of Neurosurgery, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Federico Pessina
- Department of Biomedical Sciences, Humanitas University, Milan, Italy; Department of Neurosurgery, IRCCS Humanitas Research Hospital, Milan, Italy
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Ishii A, Christophel E, Chollet M, Sandu K. Congenital laryngo-tracheo-esophageal clefts: updates from a quaternary care pediatric airway unit. Eur Arch Otorhinolaryngol 2024; 281:283-294. [PMID: 37816841 PMCID: PMC10764377 DOI: 10.1007/s00405-023-08263-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 09/25/2023] [Indexed: 10/12/2023]
Abstract
PURPOSE To review the operative techniques, outcomes, and complications following surgery in pediatric patients with laryngo-tracheo-esophageal clefts (LTEC). We describe a new combined approach to treat long LTECs. METHODS Twenty-five patients underwent surgical repair for LTEC from March 2012 to July 2022 at our hospital. Every patient underwent a diagnostic endoscopy under general anesthesia and spontaneous ventilation to assess the LTEC and synchronous aero-digestive comorbidities/malformations. All patients underwent at least one surveillance endoscopy after the repair at our institution. RESULTS The patients had multiple other malformations, specifically gastro-intestinal, synchronous airway, and cardiac. The cleft distribution according to the modified Benjamin and Inglis classification was type I (n = 5, 20%), type II (n = 6, 24%), type IIIa (n = 8, 32%), type IIIb (n = 4, 16%), and type IVa (n = 2, 8%). The median follow-up was 44.6 months. Five patients (20%) had undergone previous cleft corrective surgery(s). Seven patients (28%) had partial to complete breakdown of the repair, needing additional intervention(s), and two required a combined-open plus endoscopic repair. Preoperatively, most patients (n = 18, 72%) needed a feeding assistance. At latest follow-up, feeding assistance was weaned off in 13 out of 18 patients, which was a 72% improvement. Ten patients (40%) needed ventilation assistance before the surgery. Post-operatively, ventilatory assistance was weaned off in 6 patients, meaning a 60% improvement. CONCLUSION LTEC are rare malformations, and their management needs precise diagnosis, appropriate surgical planning, and execution, and dedicated post-operative care. Primary and revision repair of long clefts with tracheal extension may require a combined approach.
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Affiliation(s)
- Alessandro Ishii
- Department of Otorhinolaryngology, Lausanne University Hospital, Lausanne, Switzerland
| | - Emeline Christophel
- Department of Anaesthesia, Lausanne University Hospital, Lausanne, Switzerland
| | - Madeleine Chollet
- Department of Anaesthesia, Lausanne University Hospital, Lausanne, Switzerland
| | - Kishore Sandu
- Department of Otorhinolaryngology, Lausanne University Hospital, Lausanne, Switzerland.
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Judge C, Bandle J, Wang A, Gadbois K, Simsiman A, Wood R, Wisbach G. Laparoscopic-Assisted Transvaginal Cholecystectomy - the US Military Experience With Long-Term Follow Up. JSLS 2024; 28:e2023.00059. [PMID: 38562949 PMCID: PMC10984372 DOI: 10.4293/jsls.2023.00059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
Objectives We present our initial clinical experience applying Natural Orifice Transluminal Endoscopic Surgical (NOTES) technique to perform cholecystectomy in ten patients at a military institution. Methods A posterior colpotomy was created to accommodate a single site working port used to facilitate dissection and gallbladder mobilization under direct visualization via an infraumbilical port. The specimen was retrieved through the vagina and the colpotomy was closed with absorbable suture under direct visualization. Long-term follow up was performed over the phone to assess quality of life with 2 widely used health-related quality of life (HRQoL) surveys including RAND-36 Health Item Survey (Version 1.0),1 and the Female Sexual Function Index (FSFI).2. Results Ten women underwent a laparoscopic-assisted transvaginal cholecystectomy (TVC) with 7 available for long-term follow-up. The average age was 28.9 years (20-37) and the indications for surgery included symptomatic cholelithiasis (9) and biliary dyskinesia (1). The mean operative time was 129 mins (95-180), and median blood loss was 34 ml (5-400). There were no conversions and the average length of stay was 9.98 hours (2.4-28.8). Pain (analogue scale 1-10) on postoperative day three was minimal (mean 2.3) and was limited to the infraumbilical incision. On average patients returned to work by postoperative day six and resumed normal daily activities at seven days. Immediate postoperative complications included one incident of postoperative urinary retention requiring bladder catheterization. One intra-operative cholangiogram was successfully performed due to elevated preoperative liver enzymes without significant findings. Long-term complications included one asymptomatic incisional hernia repair at the infraumbilical port site. The RAND-36 survey demonstrated an average physical and mental health summary score of 82.2 and 63.7 with an average general health score of 63.6. The average FSFI total score was 21.8. Conclusion TVC is safe and effective. Implementation may improve operational readiness by returning service members to normal activities more expeditiously than conventional laparoscopy.
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Affiliation(s)
- Carolyn Judge
- Department of General Surgery, Naval Medical Readiness and Training Command, San Diego, California, USA. (Drs Judge, Bandle, Gadbois, and Wisbach)
- Department of Obstetrics and Gynecology, Naval Medical Readiness and Training Command, San Diego, California, USA. (Drs Wang, Simsiman, and Wood)
| | - Jesse Bandle
- Department of General Surgery, Naval Medical Readiness and Training Command, San Diego, California, USA. (Drs Judge, Bandle, Gadbois, and Wisbach)
- Department of Obstetrics and Gynecology, Naval Medical Readiness and Training Command, San Diego, California, USA. (Drs Wang, Simsiman, and Wood)
| | - Andrew Wang
- Department of General Surgery, Naval Medical Readiness and Training Command, San Diego, California, USA. (Drs Judge, Bandle, Gadbois, and Wisbach)
- Department of Obstetrics and Gynecology, Naval Medical Readiness and Training Command, San Diego, California, USA. (Drs Wang, Simsiman, and Wood)
| | - Kyle Gadbois
- Department of General Surgery, Naval Medical Readiness and Training Command, San Diego, California, USA. (Drs Judge, Bandle, Gadbois, and Wisbach)
- Department of Obstetrics and Gynecology, Naval Medical Readiness and Training Command, San Diego, California, USA. (Drs Wang, Simsiman, and Wood)
| | - Amanda Simsiman
- Department of General Surgery, Naval Medical Readiness and Training Command, San Diego, California, USA. (Drs Judge, Bandle, Gadbois, and Wisbach)
- Department of Obstetrics and Gynecology, Naval Medical Readiness and Training Command, San Diego, California, USA. (Drs Wang, Simsiman, and Wood)
| | - Robin Wood
- Department of General Surgery, Naval Medical Readiness and Training Command, San Diego, California, USA. (Drs Judge, Bandle, Gadbois, and Wisbach)
- Department of Obstetrics and Gynecology, Naval Medical Readiness and Training Command, San Diego, California, USA. (Drs Wang, Simsiman, and Wood)
| | - Gordon Wisbach
- Department of General Surgery, Naval Medical Readiness and Training Command, San Diego, California, USA. (Drs Judge, Bandle, Gadbois, and Wisbach)
- Department of Obstetrics and Gynecology, Naval Medical Readiness and Training Command, San Diego, California, USA. (Drs Wang, Simsiman, and Wood)
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Zou D, Chen X, Chen S, Zhang P, Lu Y. Impact of Endoscopic Surgery Versus Robot CAS-R-2 Assisted with Stereotactic Drainage on Prognosis of Basal Ganglia Hypertensive Intracerebral Hemorrhage. World Neurosurg 2024; 181:e589-e596. [PMID: 37898270 DOI: 10.1016/j.wneu.2023.10.097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 10/22/2023] [Indexed: 10/30/2023]
Abstract
OBJECTIVE To evaluate the impact of endoscopic surgery (ES) versus robot CAS-R-2 assisted with stereotactic drainage on prognosis of basal ganglia hypertensive intracerebral hemorrhage (HICH). METHODS This retrospective observational study included patients who underwent ES or robot CAS-R-2 assisted with stereotactic drainage for basal ganglia HICH in Shanghai Sixth People's Hospital between June 2017 and May 2022. The outcomes were 6-month mortality and modified Rankin Scale (mRS) score. RESULTS A total of 94 patients were included; 68 (age 51.26 ± 9.18 years, 17 women) of them underwent ES, while the other 26 (age 56.50 ± 12.91, 11 women) underwent robot CAS-R-2. The 6-month mortality rates were similar (P > 0.05) between the patients who underwent ES (6 of 68, 8.82%) and robot CAS-R-2 (2 of 26,7.69%), while the rate of good prognosis in the ES group was significantly higher compared with that in the robot CAS-R-2 group (P = 0.024). Univariate logistic analysis found that endoscopic surgery, age, and hematoma volume were associated with poor prognosis at 6 months. Multivariate logistic regression analysis showed that, after adjusted for the preoperative hematoma volume and age, endoscopy surgery (relative risk 0.21, 95% CI 0.06-0.68, P = 0.009) was associated with good prognosis at 6 months follow-up. CONCLUSIONS Compared with robot CAS-R-2 assisted with stereotactic drainage, ES might have higher rate of good prognosis at 6-month follow-up for basal ganglia HICH.
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Affiliation(s)
- Dongdong Zou
- Department of Neurosurgery, The Affiliated Sixth People's Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Xin Chen
- Department of Neurosurgery, The Affiliated Sixth People's Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Shuping Chen
- Intensive Care Unit, The Affiliated Sixth People's Hospital, Shanghai Jiaotong University, Shanghai, China.
| | - Pengqi Zhang
- Department of Neurosurgery, The Affiliated Sixth People's Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Youming Lu
- Department of Neurosurgery, The Affiliated Sixth People's Hospital, Shanghai Jiaotong University, Shanghai, China
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Xie G, Cheng X, Wan Y. Retrospective comparison of endoscopic transoral and bilateral areolar approaches for thyroglossal cyst resection: a single-centre experience. Eur Arch Otorhinolaryngol 2024; 281:335-341. [PMID: 37589752 DOI: 10.1007/s00405-023-08164-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 07/26/2023] [Indexed: 08/18/2023]
Abstract
PURPOSE Our study aimed to compare the efficacy, safety, and clinical effect of the transoral approach and the bilateral areolar approach (BAA) for endoscopic thyroglossal duct cyst (TGDC) resection. METHODS In total, 42 patients who received an endoscopic TGDC resection between January 2019 and May 2022 via a transoral (n = 22) or bilateral areolar (n = 20) approach by a single surgeon were retrospectively enrolled. We collected and compared the following data: patients' demographic data, complication events, operative time, bleeding volume, drainage volume, 6-h postoperative pain scores, length of hospitalisation, resected TGDC size, and cosmetic satisfaction. RESULTS There were no cases of conversion to a transcervical approach in the two groups. No significant differences were found between the two groups in terms of age, sex, body mass index, complication, bleeding volume, 6-h postoperative pain scores, and TGDC size (all p > 0.05). However, the operative time and patients' cosmetic satisfaction were higher in the transoral group than in the BAA group (all p < 0.05). In addition, the drainage volume and length of hospitalisation in the transoral group were less than those in the BAA group (all p < 0.05). CONCLUSIONS Both the transoral approach and BAA are safe and reliable; however, the transoral approach is more complex than the BAA and offers better cosmetic satisfaction. Doctors should choose the appropriate surgical procedure based on the patient's condition and preferences.
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Affiliation(s)
- Gang Xie
- Department of Otolaryngology, Head and Neck Surgery, Chaohu Hospital Affiliated to Anhui Medical University, Hefei, 230022, China
| | - Xiaowen Cheng
- Department of Clinical Laboratory, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China
| | - Yufeng Wan
- Department of Otolaryngology, Head and Neck Surgery, Chaohu Hospital Affiliated to Anhui Medical University, Hefei, 230022, China.
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Xu H, Li W, Zhang H, Wang H, Hu L, Gu Y, Wang D. Preliminary evidence for endoscopic surgery combined with postoperative anti-PD-1 immunotherapy in advanced recurrent nasopharyngeal carcinoma. BMC Cancer 2023; 23:1259. [PMID: 38129782 PMCID: PMC10734134 DOI: 10.1186/s12885-023-11760-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 12/14/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUD Endoscopic surgery can be used as the main treatment for advanced recurrent nasopharyngeal carcinoma (rNPC). However, there is a huge clinical controversy about the need for consolidated immunotherapy after surgery. METHODS We performed a retrospective propensity score-matched analysis (1:2) of patients with locally advanced rNPC who underwent endoscopic nasopharyngectomy (ENPG) combined with anti-programmed cell death protein-1 (PD-1) monotherapy or ENPG alone. The survival rate was analyzed by Kaplan-Meier method. The primary endpoint was progression-free survival (PFS). The secondary endpoints included overall survival (OS), objective response rate (ORR) and disease control rate (DCR). Potential surgical-related complications and immune-related adverse events (AEs) were also assessed. RESULTS We recruited 10 patients receiving ENPG plus anti-PD-1 monotherapy and 20 receiving ENPG alone. During the mean follow-up of 23.8 months, a significant improvement in the 2-year PFS was detected in the consolidation immunotherapy group compared to the ENPG alone group (80.0% vs. 40.0%; HR = 0.258; 95% CI: 0.09-0.72; p = 0.04), while the 2-year OS in the consolidation immunotherapy group was not significantly longer than that in the ENPG alone group (90.0% vs. 75.0%; HR = 0.482; 95% CI: 0.08-3.00; p = 0.50). The incidence of surgical-related complications in the consolidation immunotherapy group and ENPG alone group was 70.0 and 60.0%, respectively. Immune-related AEs were similar between the toripalimab arm (75.0%) and the camrelizumab arm (66.7%). Surgical-related complications depend on symptomatic treatments. Immune-related AEs were mild and tolerable. CONCLUSIONS Consolidation immunotherapy regimen for patients with advanced rNPC after ENPG compared to ENPG alone provides a superior PFS rate with a manageable safety profile.
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Affiliation(s)
- Haoyuan Xu
- ENT institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China
| | - Wanpeng Li
- ENT institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China
| | - Huankang Zhang
- ENT institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China
| | - Huan Wang
- ENT institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China
| | - Li Hu
- ENT institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China
| | - Yurong Gu
- ENT institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China.
| | - Dehui Wang
- ENT institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China.
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Yamazaki M, Watanabe Y, Kawakami M, Takayama T, Furukawa H, Fujimura T. A new training model using the self-healing properties of supramolecular hydrogels for endoscopic combined intrarenal surgery. Urolithiasis 2023; 52:13. [PMID: 38117339 DOI: 10.1007/s00240-023-01509-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 11/15/2023] [Indexed: 12/21/2023]
Abstract
The combination of hydronephrosis formation, ureteroscopic imaging, and ultrasound delineation has not been included in any non-biological training model of percutaneous nephrolithotomy or endoscopic combined intrarenal surgery. We aimed to develop a realistic kidney phantom using the self-healing properties of supramolecular hydrogels for percutaneous nephrolithotomy and endoscopic combined intrarenal surgery and evaluate its suitability as a training model.Expert and resident urologists performed ultrasound-guided renal pelvic punctures and flexible ureteroscopies for endoscopic combined intrarenal surgery using a training model. Subsequently, the training model was evaluated using a 17-item Likert scale questionnaire (range, 1-5 points). After being filled with carrageenan, the collecting system was inflated, and the relationship between the collecting system volume and collecting system pressure was determined. The durability of the model was verified by repeatedly inserting a 16-Fr access sheath. Five novices and seven urology experts performed the procedure. The mean questionnaire score was 4.25 (standard deviation, 0.37). The model was able to hold 50 mL of air, and the pressure in the collecting system ranged from 6 to 33 mmHg. Repeated punctures were possible even when a 16-Fr access sheath was inserted. Our new training model included the self-healing properties of supramolecular hydrogels, which are tough and flexible and can be evaluated using ultrasonography. According to the questionnaire score, the model was highly satisfactory and has potential as a new educational tool.
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Affiliation(s)
- Masahiro Yamazaki
- Department of Urology, Tochigi Medical Center Shimotsuga, Tochigi, Japan.
- Department of Urology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke City, Tochigi, 329-0498, Japan.
| | - Yosuke Watanabe
- Department of Mechanical Systems Engineering, Graduate School of Science and Engineering, Yamagata University, Yamagata, Japan
| | - Masaru Kawakami
- Department of Mechanical Systems Engineering, Graduate School of Science and Engineering, Yamagata University, Yamagata, Japan
| | - Tatsuya Takayama
- Department of Urology, International University of Health and Welfare Hospital, Tochigi, Japan
| | - Hidemitsu Furukawa
- Department of Mechanical Systems Engineering, Graduate School of Science and Engineering, Yamagata University, Yamagata, Japan
| | - Tetsuya Fujimura
- Department of Urology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke City, Tochigi, 329-0498, Japan
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Liu S, Su S, Long J, Cao S, Ren J, Li F, Wang S, Niu H, Gao Z, Gao H, Wang D, Hu F, Zhang X. The impact of time to evacuation on outcomes in endoscopic surgery for supratentorial spontaneous intracerebral hemorrhage: a single-center retrospective study. Neurosurg Rev 2023; 47:2. [PMID: 38057420 DOI: 10.1007/s10143-023-02237-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 11/29/2023] [Accepted: 12/03/2023] [Indexed: 12/08/2023]
Abstract
Supratentorial spontaneous intracerebral hemorrhage (SICH) can be treated with endoscopic surgery, but the optimal timing remains uncertain. We retrospectively analyzed data from 46 patients who underwent endoscopic surgery for supratentorial SICH. We examined the relationship between time to evacuation and functional outcome at 3 months, adjusting for prognostic factors. Surgical outcomes and complications were compared between patients with early (≤ 12 h) or late (> 12 h) evacuation. Median time to evacuation was 12 h, and the rate of unfavorable outcome (modified Rankin Scale > 3 at 3 months) was 32.6%. Longer time to evacuation was independently associated with unfavorable outcome (odds ratio per hour delay: 1.26). Late evacuation carried a 7.25-fold higher risk of unfavorable outcome compared to early evacuation. This association held across subgroups based on hematoma volume, location, and intraventricular extension (P for interaction > 0.05). Patients with late evacuation had fewer spot signs (24% vs. 4.8%, P = 0.035) and markers of hemorrhagic expansion (36% vs. 9.5%, P = 0.018), longer neurosurgical intensive care unit (NSICU) stay (3.2 vs. 1.9 days, P = 0.011) and hospital stay (15.7 vs. 11.9 days, P = 0.014), and higher 30-day mortality (28.6 vs. 4%, P = 0.036) and complication rates (57.1% vs. 28.0%, P = 0.023). This study suggests a potential association between early endoscopic evacuation of supratentorial SICH and improved functional outcomes, lower 30-day mortality and reduced complications. The need for timely intervention in managing supratentorial SICH is highlighted, yet further validation through multi-center prospective studies is essential to substantiate these findings and provide a higher level of evidence.
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Affiliation(s)
- Shuang Liu
- Department of Neurosurgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Shengyang Su
- Department of Surgery, People's Hospital of Jinping Miao, Yao and Dai Autonomous Country, Honghe Prefecture, Yunnan Province, China
| | - Jinyong Long
- Department of Surgery, People's Hospital of Jinping Miao, Yao and Dai Autonomous Country, Honghe Prefecture, Yunnan Province, China
| | - Shikui Cao
- Department of Surgery, People's Hospital of Jinping Miao, Yao and Dai Autonomous Country, Honghe Prefecture, Yunnan Province, China
| | - Jirao Ren
- Department of Surgery, People's Hospital of Jinping Miao, Yao and Dai Autonomous Country, Honghe Prefecture, Yunnan Province, China
| | - Fuhua Li
- Department of Surgery, People's Hospital of Jinping Miao, Yao and Dai Autonomous Country, Honghe Prefecture, Yunnan Province, China
| | - Shoulong Wang
- Department of Surgery, People's Hospital of Jinping Miao, Yao and Dai Autonomous Country, Honghe Prefecture, Yunnan Province, China
- Department of Neurological Surgery, Yunnan Cancer Hospital, The Third Affiliated Hospital of Kunming Medical University, Kunming, Yunnan Province, China
| | - Huatao Niu
- Department of Surgery, People's Hospital of Jinping Miao, Yao and Dai Autonomous Country, Honghe Prefecture, Yunnan Province, China
- Department of Neurological Surgery, Yunnan Cancer Hospital, The Third Affiliated Hospital of Kunming Medical University, Kunming, Yunnan Province, China
| | - Zihui Gao
- Department of Surgery, People's Hospital of Jinping Miao, Yao and Dai Autonomous Country, Honghe Prefecture, Yunnan Province, China
| | - Huaxing Gao
- Department of Neurology, People's Hospital of Jinping Miao, Yao and Dai Autonomous Country, Honghe Prefecture, Yunnan Province, China
| | - Deqiang Wang
- Department of Critical Care Medicine, People's Hospital of Jinping Miao, Yao and Dai Autonomous Country, Honghe Prefecture, Yunnan Province, China
| | - Fan Hu
- Department of Neurosurgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Xiaobiao Zhang
- Department of Neurosurgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.
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Jiang D, Liu G, Yang B, Niu H, Fan H, Ren Z, Mu L, Xu X, Qiao X, Wu K, He D. 450-nm blue diode laser: a novel medical apparatus for upper tract urothelial lesions. World J Urol 2023; 41:3773-3779. [PMID: 37833548 PMCID: PMC10693503 DOI: 10.1007/s00345-023-04647-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 09/18/2023] [Indexed: 10/15/2023] Open
Abstract
OBJECTIVE To explore the feasibility, safety and effectiveness of the 450-nm blue diode laser (BL), novel blue laser in the treatment of upper tract urothelial carcinomas (UTUCs) and other lesions in a porcine model. MATERIAL AND METHODS For in vitro experiment, the ureter tissue was vaporised and coagulated with BL, green-light laser (GL) and Ho:YAG laser (Ho). The efficiency, width and depth of vaporisation, and depth of coagulation were recorded and compared. For in vivo experiments, four swines weighing 70 kg were used. In the acute group, different modes of operations were performed to evaluate the thermal damage, perforation and bleeding. In the chronic group, the overall appearance of the ureter and laser wound healing were observed by the naked eyes and H&E staining 3 weeks after surgery. RESULTS In in vitro study, the BL showed a higher efficiency of tissue vaporisation and less tissue coagulation for fresh ureter compared to GL and Ho. In the in vivo study, the power of BL set at 7 W was better, and the thickness of thermal damage varied with different surgery types in the range of 74-306 μm. After 3 weeks, the wound healed well static in vaporisation (SV), moving vaporisation (MV) and H&E staining indicated mucosal healing rather than scar healing. CONCLUSION 5-10W blue diode laser achieved a higher efficiency of tissue vaporisation and less tissue coagulation in a porcine model, indicating its potential application in the endoscopic surgery of UTUC as an optional device with high performance and safety.
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Affiliation(s)
- Dali Jiang
- Department of Urology, First Affiliated Hospital of Xi'an Jiaotong University, #277 Yanta West Road, Xi'an, 710061, People's Republic of China
| | - Guoxiong Liu
- Department of Urology, First Affiliated Hospital of Xi'an Jiaotong University, #277 Yanta West Road, Xi'an, 710061, People's Republic of China
- Department of Urology, Xianyang Central Hospital, Xianyang, 712000, People's Republic of China
| | - Bing Yang
- Xi'an Blueray Technology Co., Ltd., Xi'an, 710061, People's Republic of China
| | - Haoming Niu
- Xi'an Blueray Technology Co., Ltd., Xi'an, 710061, People's Republic of China
| | - Hengtong Fan
- Department of Urology, First Affiliated Hospital of Xi'an Jiaotong University, #277 Yanta West Road, Xi'an, 710061, People's Republic of China
| | - Zejun Ren
- Department of Urology, First Affiliated Hospital of Xi'an Jiaotong University, #277 Yanta West Road, Xi'an, 710061, People's Republic of China
| | - Liyue Mu
- Xi'an Blueray Technology Co., Ltd., Xi'an, 710061, People's Republic of China
| | - Xiaofeng Xu
- Department of Urology, Xianyang Central Hospital, Xianyang, 712000, People's Republic of China
| | - Ximin Qiao
- Department of Urology, Xianyang Central Hospital, Xianyang, 712000, People's Republic of China
| | - Kaijie Wu
- Department of Urology, First Affiliated Hospital of Xi'an Jiaotong University, #277 Yanta West Road, Xi'an, 710061, People's Republic of China.
| | - Dalin He
- Department of Urology, First Affiliated Hospital of Xi'an Jiaotong University, #277 Yanta West Road, Xi'an, 710061, People's Republic of China.
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Hurni Y, Simonson C, Di Serio M, Lachat R, Bodenmann P, Seidler S, Huber D. Feasibility and safety of vNOTES for gynecological procedures in obese patients. J Gynecol Obstet Hum Reprod 2023; 52:102687. [PMID: 37898303 DOI: 10.1016/j.jogoh.2023.102687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 10/20/2023] [Accepted: 10/24/2023] [Indexed: 10/30/2023]
Abstract
INTRODUCTION This study aimed to determine the feasibility and safety of transvaginal natural orifice transluminal endoscopic surgery (vNOTES) to treat benign and malign gynecological conditions in obese patients. MATERIAL AND METHODS We analyzed data from 79 obese patients with a body mass index (BMI) > 30 Kg/m2 operated by vNOTES for gynecological conditions between May 2020 and April 2023. The primary outcome was the feasibility of performing the surgery as initially planned. Data were presented for subgroups of patients with obesity class I (BMI 30.1 - 34.9 Kg/m2), class II (BMI 35.0 - 39.9 Kg/m2), and class III (BMI ≥ 40.0 Kg/m2). RESULTS Patients presented obesity class I in 39 cases (49.4 %), class II in 27 cases (34.2 %), and class III in 13 cases (16.4 %). Fifty-two patients (65.8 %) underwent vNOTES hysterectomy, 26 patients (32.9 %) underwent procedures limited to the adnexa, and 1 patient (1.3 %) underwent myomectomy. The conversion rate was 0 %, 11.1 %, and 7.7 % in obesity class I, II, and III, respectively. Intraoperative bladder injury was observed in 1 case (1.3 %) and rectal serosal tear in 2 cases (2.5 %). Postoperatively, we observed 3 cases (3.8 %) of wound infection, 2 cases (2.5 %) of cystitis, and 1 case (1.3 %) of deep vein thrombosis. DISCUSSION This study demonstrated the feasibility and safety of performing gynecological vNOTES procedures in obese patients. However, obesity could be associated with longer and more complex interventions, especially in obesity class II and III patients.
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Affiliation(s)
- Yannick Hurni
- Department of Gynecology and Obstetrics, Valais Hospital, Av. du Grand-Champsec 80, Sion 1951, Switzerland.
| | - Colin Simonson
- Department of Gynecology and Obstetrics, Valais Hospital, Av. du Grand-Champsec 80, Sion 1951, Switzerland
| | - Marcello Di Serio
- Department of Gynecology and Obstetrics, Valais Hospital, Av. du Grand-Champsec 80, Sion 1951, Switzerland
| | - Régine Lachat
- Department of Gynecology and Obstetrics, Valais Hospital, Av. du Grand-Champsec 80, Sion 1951, Switzerland
| | - Pauline Bodenmann
- Department of Gynecology and Obstetrics, Valais Hospital, Av. du Grand-Champsec 80, Sion 1951, Switzerland
| | - Stéphanie Seidler
- Department of Gynecology and Obstetrics, Valais Hospital, Av. du Grand-Champsec 80, Sion 1951, Switzerland
| | - Daniela Huber
- Department of Gynecology and Obstetrics, Valais Hospital, Av. du Grand-Champsec 80, Sion 1951, Switzerland; Department of Pediatrics, Gynecology and Obstetrics, Geneva University Hospitals, Boulevard de la Cluse 30, Geneva 1205, Switzerland
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Norasi H, Hallbeck MS, Elli EF, Tollefson MK, Harold KL, Pak R. Impact of preferred surgical modality on surgeon wellness: a survey of workload, physical pain/discomfort, and neuromusculoskeletal disorders. Surg Endosc 2023; 37:9244-9254. [PMID: 37872425 PMCID: PMC10709269 DOI: 10.1007/s00464-023-10485-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 09/17/2023] [Indexed: 10/25/2023]
Abstract
BACKGROUND We compared surgeons' workload, physical discomfort, and neuromusculoskeletal disorders (NMSDs) across four surgical modalities: endoscopic, laparoscopic, open, and robot-assisted (da Vinci Surgical Systems). METHODS An electronic survey was sent to the surgeons across an academic hospital system. The survey consisted of 47 questions including: (I) Demographics and anthropometrics; (II) The percentage of the procedural time that the surgeon spent on performing each surgical modality; (III) Physical and mental demand and physical discomfort; (IV) Neuromusculoskeletal symptoms including body part pain and NMSDs. RESULTS Seventy-nine out of 245 surgeons completed the survey (32.2%) and 65 surgeons (82.2%) had a dominant surgical modality: 10 endoscopic, 15 laparoscopic, 26 open, and 14 robotic surgeons. Physical demand was the highest for open surgery and the lowest for endoscopic and robotic surgeries, (all p < 0.05). Open and robotic surgeries required the highest levels of mental workload followed by laparoscopic and endoscopic surgeries, respectively (all p < 0.05 except for the difference between robotic and laparoscopic that was not significant). Body part discomfort or pain (immediately after surgery) were lower in the shoulder for robotic surgeons compared to laparoscopic and open surgeons and in left fingers for robotic surgeons compared to endoscopic surgeons (all p < 0.05). The prevalence of NMSD was significantly lower in robotic surgeons (7%) compared to the other surgical modalities (between 60 and 67%) (all p < 0.05). CONCLUSIONS The distribution of NMSDs, workload, and physical discomfort varied significantly based on preferred surgical approach. Although robotic surgeons had fewer overall complaints, improvement in ergonomics of surgery are still warranted.
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Affiliation(s)
- Hamid Norasi
- Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, MN, USA
- Division of Health Care Delivery Research, Mayo Clinic, Rochester, MN, USA
| | - M Susan Hallbeck
- Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, MN, USA.
- Division of Health Care Delivery Research, Mayo Clinic, Rochester, MN, USA.
- Department of Surgery, Mayo Clinic, Rochester, MN, USA.
| | - Enrique F Elli
- Department of Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Matthew K Tollefson
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
- Department of Urology, Mayo Clinic, Rochester, MN, USA
| | | | - Raymond Pak
- Department of Urology, Mayo Clinic, Jacksonville, FL, USA
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Pholprajug P, Kotheeranurak V, Liu Y, Kim JS. The Endoscopic Lumbar Interbody Fusion: A Narrative Review, and Future Perspective. Neurospine 2023; 20:1224-1245. [PMID: 38171291 PMCID: PMC10762387 DOI: 10.14245/ns.2346888.444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 09/21/2023] [Accepted: 10/10/2023] [Indexed: 01/05/2024] Open
Abstract
Lumbar interbody fusion stands as a preferred surgical solution for degenerative lumbar spine diseases. The procedure primarily aims to establish lumbar segment stability, directly addressing patient symptoms associated with spinal complications. Traditional open surgery, though effective, is linked with notable morbidities and extended recovery time. To mitigate these concerns, minimally invasive surgery (MIS) has garnered significant popularity, presenting an appealing alternative with numerous benefits such as reduced soft tissue trauma, decreased blood loss, and expedited recovery. Among MIS procedures, full endoscopic spinal surgery, characterized by its minimal invasiveness, holds the potential to further minimize morbidities while enhancing surgical outcomes. Endoscopic lumbar interbody fusion, a novel procedure within this paradigm, has gained attention for offering advantages comparable to those of minimally invasive transforaminal lumbar interbody fusion. However, the safety, efficacy, and associated surgical techniques and instrument design of this method continue to be subjects of ongoing debate. This paper critically reviews current evidence on the safety, efficacy, and advantages of endoscopic lumbar spinal interbody fusion, examining whether it could indeed supersede existing mainstream techniques.
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Affiliation(s)
| | - Vit Kotheeranurak
- Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University, and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Yanting Liu
- Spine Center, Department of Neurosurgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jin-Sung Kim
- Spine Center, Department of Neurosurgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Cucu AI, Costea CF, Perciaccante A, Donell ST, Bianucci R. The Evolution of Pituitary Gland Surgery from the Ancients to the Millennials. World Neurosurg 2023; 180:52-65. [PMID: 37683915 DOI: 10.1016/j.wneu.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 08/31/2023] [Accepted: 09/01/2023] [Indexed: 09/10/2023]
Abstract
Located at the base of the skull, the pituitary gland has a long and controversial history, not only in terms of its anatomy, but especially in the functions it performs and in the attempt to approach it surgically. Considered by Galen of Pergamon to have a role in releasing waste products of the brain, a theory accepted until the 17th century, the pituitary gland became a separate entity once with the anatomical descriptions of the famous Andreas Vesalius. At the beginning of the 18th century, researches of the time began to be more and more interested in this gland, trying to identify its functions, and at the same time correcting the traditional theories that were wrong or incomplete. Later, they turned their attention to experimental animal studies that represented the germinal nucleus for the transcranial and endoscopic pituitary surgery. In this review, an attempt has been made to record the entire history of anatomy, physiology and surgery of the pituitary gland, from antiquity to the current day's surgical techniques.
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Affiliation(s)
- Andrei Ionut Cucu
- Faculty of Medicine and Biological Sciences, Stefan cel Mare University of Suceava, Suceava, Romania; Department of Neurosurgery, Prof. Dr. N. Oblu Emergency Clinical Hospital, Iasi, Romania
| | - Claudia Florida Costea
- Department of Ophthalmology, Prof. Dr. N. Oblu Emergency Clinical Hospital, Iasi, Romania.
| | - Antonio Perciaccante
- Laboratoire Anthropologie, Archéologie, Biologie (LAAB), UFR des Sciences de la Santé, Université Paris-Saclay (UVSQ) & musée du quai Branly - Jacques Chirac, Montigny-le-Bretonneux, France; Department of Medicine "San Giovanni di Dio" Hospital, Azienda Sanitaria Universitaria Giuliano Isontina, Gorizia, Italy
| | - Simon T Donell
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Raffaella Bianucci
- Department of Cultures and Societies, University of Palermo, Italy; The Ronin Institute, Montclair, New Jersey, USA
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Tahara S, Hattori Y, Aso S, Uda K, Kumazawa R, Matsui H, Fushimi K, Yasunaga H, Morita A. Endoscopic surgery versus craniotomy for spontaneous intracerebral hemorrhage in the late elderly patients. J Stroke Cerebrovasc Dis 2023; 32:107327. [PMID: 37677895 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 06/22/2023] [Accepted: 08/22/2023] [Indexed: 09/09/2023] Open
Abstract
OBJECTIVES To compare the prognosis of late elderly patients with spontaneous intracerebral hemorrhage (ICH) treated by endoscopic evacuation and craniotomy MATERIALS AND METHODS: Using the Diagnosis Procedure Combination database, we identified patients aged ≥ 75 years who underwent surgery for spontaneous ICH within 48 hours after admission between April 2014 and March 2018. Eligible patients were classified into two groups according to the type of surgery (endoscopic surgery and craniotomy). Propensity-score matching weight analysis was conducted to compare the good neurological outcome modified Rankin Scale (mRS) score (0-4) at discharge as the primary endpoint between the two groups. Secondary endpoints were postoperative meningitis, tracheostomy, reoperation within 3 days and total hospitalization costs. RESULTS Among the 5,396 eligible patients, endoscopic surgery and craniotomy were performed in 895 and 4,501 patients, respectively. In the propensity-score matching weight analysis, all covariates were well balanced. The proportions of patients with a good prognosis (mRS score at discharge: 0-4) did not significantly differ between the surgical procedures (42.1% vs. 42.8%, p = 0.828). The proportions of meningitis, tracheostomy and reoperation were not significantly different between the two groups. Hospitalization costs were significantly higher in the craniotomy group than in the endoscopic surgery group (25,536 vs. 29,603 US dollars, p = 0.012). CONCLUSIONS Inhospital outcomes did not differ between endoscopic and open surgeries for spontaneous ICH in the late-stage elderly patients aged ≥75 years. Hospitalization costs were significantly higher in the craniotomy group, suggesting that endoscopic surgery may be more acceptable.
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Affiliation(s)
- Shigeyuki Tahara
- Department of Neurological Surgery, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan.
| | - Yujiro Hattori
- Department of Neurological Surgery, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan; Department of Anatomy and Neurobiology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan.
| | - Shotaro Aso
- Department of Biostatistics and Bioinformatics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
| | - Kazuaki Uda
- Health Services Research and Development Center, University of Tsukuba, Ibaraki, Japan.
| | - Ryosuke Kumazawa
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan.
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.
| | - Akio Morita
- Department of Neurological Surgery, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan.
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Lebdai S, Ben Boujema M, Benard A, Barry Delongchamps N, Benchikh A, Bruyere F, Della Negra E, Descazeaud A, Doizi S, Fourmarier M, Mallet R, Misrai V, Pelegrin T, Rouscoff Y, Ruffion A, Villers A, Saillour F, Robert G. Standardized technique for ejaculation preservation during prostatic endoscopic ablative surgery. World J Urol 2023; 41:3041-3049. [PMID: 37715788 DOI: 10.1007/s00345-023-04592-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 08/15/2023] [Indexed: 09/18/2023] Open
Abstract
PURPOSE Ejaculatory dysfunction is the most common side effect of benign prostatic hyperplasia surgery. Modified techniques have emerged with the aim of preserving antegrade ejaculation without compromising obstruction relief. None are standardized or validated. The PARTURP study is a randomized study investigating partial versus complete prostate resection. We conducted an investigator consensus meeting to define the ideal surgical technique to achieve both correct obstruction relief with ejaculation preservation. METHODS An expert consensus meeting involving all investigators of the PARTURP study took place to define a common technique using the nominal group methodology. The objectives were to define the areas to be resected and the areas to be preserved; to define the criteria for proper obstruction relief; to define the criteria for proper ejaculation preservation. RESULTS All investigators (n = 15) attended the consensus meeting, and agreement between all the participants was obtained. The anatomical landmarks to be preserved are located around the verumontanum and along the posterior part of the prostatic urethra. These structures must be preserved up to 2 cm from the verumontanum. The participants agreed on the need to preserve the urethral mucosa in all the areas to be preserved and to reach the enucleation plane in the areas of resection. CONCLUSIONS Anatomical landmarks for ejaculation-sparing surgery have been defined by the investigators of the PARTURP randomized study. These landmarks will be used during the study, and the clinical outcomes of this ejaculation-sparing technique will be compared with complete resection with up to 3 years follow-up.
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Affiliation(s)
- Souhil Lebdai
- Urology Department, University Hospital of Angers, CHU Angers, 4 Rue Larrey, 49933, Angers Cedex 9, France.
| | - Méric Ben Boujema
- Methodology Department, University Hospital of Bordeaux, Bordeaux, France
| | - Antoine Benard
- Methodology Department, University Hospital of Bordeaux, Bordeaux, France
| | | | - Amine Benchikh
- Urology Department, Clinique Des Franciscaines, Versailles, France
| | - Franck Bruyere
- Urology Department, University Hospital of Tours, Tours, France
| | | | | | - Steeve Doizi
- Urology Department, Hôpital Tenon, APHP, Paris, France
| | | | - Richard Mallet
- Urology Department, Hôpital Prive Francheville, Périgueux, France
| | | | | | - Yohan Rouscoff
- Urology Department, Polyclinique Saint Georges, Nice, France
| | - Alain Ruffion
- Urology Department, University Hospital of Lyon, Lyon, France
- EA 3738-CICLY EMR UCBL Lyon 1, Lyon, France
| | - Arnaud Villers
- Urology Department, University Hospital of Lille, Lille, France
| | - Florence Saillour
- Methodology Department, University Hospital of Bordeaux, Bordeaux, France
| | - Grégoire Robert
- Urology Department, University Hospital of Bordeaux, Bordeaux, France
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Humbert M, Bastit V, Perreard M, Roussel LM, Senol MK, Hitier M, Patron V. Review of olfactory cleft roof anatomy. Eur Ann Otorhinolaryngol Head Neck Dis 2023; 140:289-295. [PMID: 37926654 DOI: 10.1016/j.anorl.2023.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
Progress in skull-base endoscopic surgery has improved our knowledge of olfactory cleft (OC) anatomy. This article presents a review of current knowledge concerning the OC roof: descriptive anatomy, radiological exploration, and endoscopic observation. The OC is a narrow area in the most superior part of the nasal cavity. Its roof is the thinnest structure separating the nasal cavities from the brain; it comprises three superimposed tissues: nasal mucosa, ethmoid cribriform plate (ECP), and dura mater. The ECP comprises the anterior ECP containing the ethmoidal slit (ES) medially and the cribroethmoidal foramen (CEF) laterally; and the posterior ECP, comprising the olfactory foramina. The OC roof is bordered anteriorly by the nasal bone roof, laterally by the lateral ethmoid masses, and posteriorly by the jugum and anterior wall of the sphenoid sinuses. Imaging is crucial for analyzing this wall, providing precise detailed information on conformation and anatomic relations with adjacent structures such as the anterior ethmoidal artery. Understanding OC roof anatomy and correct interpretation of imaging are essential for safety in present-day functional endoscopic sinus surgery and anterior skull-base oncologic surgery.
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Affiliation(s)
- M Humbert
- Service d'ORL et de chirurgie cervico-faciale, CHU de Caen Normandie, Caen, France; Inserm 1086 ANTICIPE, université de Normandie, Normand, Caen, France.
| | - V Bastit
- Service d'ORL et de chirurgie cervico-faciale, CHU de Caen Normandie, Caen, France; Inserm 1086 ANTICIPE, université de Normandie, Normand, Caen, France
| | - M Perreard
- Service d'ORL et de chirurgie cervico-faciale, CHU de Caen Normandie, Caen, France; Inserm 1086 ANTICIPE, université de Normandie, Normand, Caen, France
| | - L M Roussel
- Service d'ORL, CLCC Henri-Becquerel, 76038 Rouen, France
| | - M K Senol
- Service d'ORL et de chirurgie cervico-faciale, CHU de Caen Normandie, Caen, France
| | - M Hitier
- Service d'ORL et de chirurgie cervico-faciale, CHU de Caen Normandie, Caen, France; Inserm COMETE, Université de Normandie, Caen, France
| | - V Patron
- Service d'ORL et de chirurgie cervico-faciale, CHU de Caen Normandie, Caen, France; EA 7451 BioConnecT, Université de Normandie, UNICAEN, Caen, France
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Peng D, Tan Y, Yang S, Zhou M, Lv L, Liang C, Zhu H, Li R, Liu D. Peroral Endoscopic Myotomy for Achalasia in Older Adults: A Retrospective Analysis of 39 Cases with a Minimum Follow-Up of 5 Years. Dysphagia 2023; 38:1286-1294. [PMID: 36725760 DOI: 10.1007/s00455-023-10554-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 01/09/2023] [Indexed: 02/03/2023]
Abstract
Peroral endoscopic myotomy (POEM) has demonstrated favorable short-term safety and efficacy in older adults, while a comprehensive understanding of the long-term outcomes were vague. We aimed to evaluate clinical outcomes in older adults' 5-year postop after undergoing POEM to treatment achalasia. Older adults from a single hospital who received POEM between January 2010 and January 2017 were analyzed. Older persons were reached to evaluate their symptoms at present and encouraged repeat examinations for objective follow-up. The clinical success, POEM-related indicators, POEM-related adverse events, and quality of life were assessed. Thirty-nine older adults with a mean age of 70.82 ± 4.72 who underwent POEM were studied at a mean 84.23 ± 25.06 month follow-up. The preoperative diagnosis was achalasia type I in 7 older adults, achalasia type II in 26 older adults, and achalasia type III in 2 older adults. Sixteen older adults had prior treatment and 21 older adults suffered from comorbidities. The median operative time was 50 (25-120) minutes, and perioperative adverse events were recorded in four older adults. The current Eckardt scores were significantly lower than that before POEM (2.08 ± 2.12 vs. 6.58 ± 1.78, P < 0.001). Besides, long-term clinical success was gained in 66.7% of older adults. Three older adults received postop treatment for symptom recurrence. Ultimately, 80.6% of old adults expressed satisfaction with POEM, while 27.8% of older adults suffered from symptomatic reflux. In conclusion, POEM can provide symptomatic improvement in a large proportion of older adults with achalasia at 5-year postop.
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Affiliation(s)
- Dongzi Peng
- Department of Gastroenterology, The Second Xiangya Hospital of Central South University, Changsha, China
- Research Center of Digestive Disease, Central South University, Changsha, China
| | - Yuyong Tan
- Department of Gastroenterology, The Second Xiangya Hospital of Central South University, Changsha, China
- Research Center of Digestive Disease, Central South University, Changsha, China
| | - Si Yang
- Department of Gastroenterology, The Second Xiangya Hospital of Central South University, Changsha, China
- Research Center of Digestive Disease, Central South University, Changsha, China
| | - Mei Zhou
- Department of Gastroenterology, The Second Xiangya Hospital of Central South University, Changsha, China
- Research Center of Digestive Disease, Central South University, Changsha, China
| | - Liang Lv
- Department of Gastroenterology, The Second Xiangya Hospital of Central South University, Changsha, China
- Research Center of Digestive Disease, Central South University, Changsha, China
| | - Chengbai Liang
- Department of Gastroenterology, The Second Xiangya Hospital of Central South University, Changsha, China
- Research Center of Digestive Disease, Central South University, Changsha, China
| | - Hongyi Zhu
- Department of Gastroenterology, The Second Xiangya Hospital of Central South University, Changsha, China
- Research Center of Digestive Disease, Central South University, Changsha, China
| | - Rong Li
- Department of Gastroenterology, The Second Xiangya Hospital of Central South University, Changsha, China.
- Research Center of Digestive Disease, Central South University, Changsha, China.
| | - Deliang Liu
- Department of Gastroenterology, The Second Xiangya Hospital of Central South University, Changsha, China
- Research Center of Digestive Disease, Central South University, Changsha, China
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Lu JY, Zhang GL, Lin XJ, Chen DR, Zheng ZF, Chen Y, Lin LS. Clinical study on single-port endoscopic resection via a gasless transaxillary approach in the treatment of breast fibroadenoma in adolescents. BMC Surg 2023; 23:279. [PMID: 37710235 PMCID: PMC10503113 DOI: 10.1186/s12893-023-02186-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 09/05/2023] [Indexed: 09/16/2023] Open
Abstract
BACKGROUND Breast fibroadenoma is the most common benign breast tumour. This study aimed to investigate the advantages and disadvantages of endoscopic-assisted resection via a gas-less transaxillary single-port approach for breast fibroadenoma in adolescent patients, compared with a traditional approach. METHODS The clinical data of 83 patients with breast fibroadenoma treated in our hospital from October 2019 to October 2021 were collected for retrospective analysis. These patients were divided into an endoscopic-assisted surgery (ES) group (n = 39) and a traditional open surgery (OS) group (n = 44) according to the surgical approach. The operative time, intraoperative blood loss, incision length, postoperative complications, and patient satisfaction were compared between the two groups. RESULTS The surgical cost was (5.1 ± 0.6) thousand Yuan [(0.7 ± 0.1) thousand US dollars] in the ES group and (3.5 ± 2.7) thousand Yuan [(0.5 ± 0.4) thousand US dollars] in the OS group, showing a statistically significant difference (p < 0.001). There was no significant difference in surgical time, intraoperative blood loss, incision length, or the rate of postoperative complications between the two groups. Stratified analysis revealed that the ES group had a significantly shorter operative time [(57.00 ± 10.26) min vs. (78.27 ± 7.63)] (p < 0.001), a smaller incision length [(3.73 ± 0.34) cm vs. (4.42 ± 0.44) cm] (p < 0.001), and a lower complication incidence rate (11.1% vs. 63.6) (p = 0.011) than the OS group in the cases with a nodule number ≥ 3. The satisfaction score using the BREAST-Q scale indicated that psychosocial well-being and patient satisfaction with the breast in the ES group were significantly superior to those in the OS group [(91.18 ± 3.12) points vs. (87.00 ± 4.45) points and (91.03 ± 6.80) points vs. (84.45 ± 6.06) points, respectively] (p < 0.001). CONCLUSION ES is a safe and effective method for the treatment of fibroadenoma. In patients with multiple fibroadenomas (≥ 3 tumours), ES has a shorter operative time and fewer postoperative complications. ES demonstrates a significant, prominent advantage in cosmetic appearance. However, it should be noted that ES is associated with higher costs than OS.
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Affiliation(s)
- Jing-Yu Lu
- Department of Breast Surgery, The Affiliated Hospital of Putian University, 351100, Putian, Fujian, China
| | - Guo-Liang Zhang
- Department of Thyroid Surgery, The Affiliated Hospital of Putian University, 351100, Putian, Fujian, China
| | - Xiao-Jing Lin
- Operation Room, The Affiliated Hospital of Putian University, 351100, Putian, Fujian, China
| | - Dar-Ren Chen
- Comprehensive Breast Cancer Centre, Changhua Christian Hospital, Changhua, Taiwan
| | - Zi-Fang Zheng
- School of Clinical Medicine, Fujian Medical University, (No. 1 Xuefu North Road, University New District, 350122, Fuzhou, Fujian, China
| | - Yu Chen
- Department of Breast Surgery, The Affiliated Hospital of Putian University, 351100, Putian, Fujian, China
| | - Li-Sheng Lin
- School of Clinical Medicine, Fujian Medical University, (No. 1 Xuefu North Road, University New District, 350122, Fuzhou, Fujian, China.
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Candy NG, Ovenden C, Jukes AK, Wormald PJ, Psaltis AJ. The learning curve for endoscopic endonasal pituitary surgery: a systematic review. Neurosurg Rev 2023; 46:241. [PMID: 37698777 PMCID: PMC10497425 DOI: 10.1007/s10143-023-02136-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 07/24/2023] [Accepted: 08/28/2023] [Indexed: 09/13/2023]
Abstract
Recent literature demonstrates that a learning curve exists for endoscopic pituitary surgery. However, there is significant variability in the way these studies report their outcomes. This study aims to systematically review the literature regarding outcomes for endoscopic pituitary surgery and how this may be related to a surgical learning curve. An electronic search of the databases Medline, Scopus, Embase, Web of Science and Cochrane Library databases was performed and data extracted according 2020 Preferred Reporting Items of Systematic Reviews and Meta-Analyses (PRISMA) statement. Ten articles were included in the review as they examined the following: rates of gross total resection, average operative time, CSF leak rate, visual outcomes, endocrine outcomes and how these results were influenced by surgical experience. We have demonstrated that a learning curve exists for some outcome variables for endoscopic pituitary surgery. However, there is significant heterogeneity in the current body of literature which makes clear comparisons difficult.
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Affiliation(s)
- Nicholas G Candy
- Department of Surgery - Otolaryngology, Head and Neck Surgery, The University of Adelaide, Basil Hetzel Institute for Translational Research, Woodville South, Adelaide, Australia.
- Department of Neurosurgery, Royal Adelaide Hospital, Adelaide, Australia.
| | | | - Alistair K Jukes
- Department of Neurosurgery, Royal Adelaide Hospital, Adelaide, Australia
| | - Peter-John Wormald
- Department of Surgery - Otolaryngology, Head and Neck Surgery, The University of Adelaide, Basil Hetzel Institute for Translational Research, Woodville South, Adelaide, Australia
| | - Alkis J Psaltis
- Department of Surgery - Otolaryngology, Head and Neck Surgery, The University of Adelaide, Basil Hetzel Institute for Translational Research, Woodville South, Adelaide, Australia
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Ouattassi N, Wissam EL, Asmae A, Zaki Z, EL Alami MN. Current Management of Congenital Choanal Atresia: Litteratur Review. Indian J Otolaryngol Head Neck Surg 2023; 75:2227-2234. [PMID: 37636763 PMCID: PMC10447839 DOI: 10.1007/s12070-022-03398-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 12/07/2022] [Indexed: 08/29/2023] Open
Abstract
Background Congenital Choanal Artesia (CCA) is a rare cause of upper airway obstruction, yet it is the most common congenital anomaly of the nose. While the unilateral condition could be undiagnosed, bilateral CCA may be life-threatening, especially for newborns. Some CCA may be associated with other congenital abnormalities, which leads to a systematic screening during the diagnostic assessment. The diagnosis is easy. However, surgical management is still controversial. Methods We conducted a retrospective study gathering data on management of CCA over 42 months. We reported epidemiological aspects and results of our series, and discussed management issues. Results We operated 22 choanae using the endoscopic technique. The age of bilateral CCA patients on the day of surgery ranged from 8 to 21 days (mean 11.7+/_ 2.6 days). Their birth weight ranged from 2.9 to 4.5 kg (mean 3.4 +/_ 0.5 kg), and their gestational age ranged from 30 to 41 weeks. Surgery duration for neonatal bilateral CCA repair ranged from 75 to 110 min (mean 90 min +/_ 11.5 min). We performed an exclusive endonasal endoscopic approach for all patients with no stenting or mitomycin C application. We deplore one post operative complication related to minor palatal perforation resolved spontaneously. Conclusion Since newborns solely depend on nasal breathing during the first month of life, bilateral CCA is an emergency. Endonasal endoscopic management is the primary procedure. Currently, surgery steps are standardized. However, how to prevent post-operative synechiae and restenosis is still controversial. The mainstream is meticulous post-operative nursing with frequent endonasal saline irrigation, regular removal of crust, and prevention of inflammation due to reflux or infection.
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Affiliation(s)
- Naouar Ouattassi
- Faculty of Medicine and Pharmacy, Sidi Mohammed Benabdellah University, Fez, Morocco
| | - ELguerch Wissam
- Department of Otorhinolaryngology (ENT) and head - neck surgery, Hassan II university hospital, Km 2.200, Sidi Hrazem Road, BP. 1893, 30000 Fez, Morocco
| | - Akhana Asmae
- Faculty of Medicine and Pharmacy, Sidi Mohammed Benabdellah University, Fez, Morocco
| | - Zouheir Zaki
- Faculty of Medicine and Pharmacy, Sidi Mohammed Benabdellah University, Fez, Morocco
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Fischer E, Jawed KJ, Cleary K, Balu A, Donoho A, Thompson Gestrich W, Donoho DA. A methodology for the annotation of surgical videos for supervised machine learning applications. Int J Comput Assist Radiol Surg 2023; 18:1673-1678. [PMID: 37245179 DOI: 10.1007/s11548-023-02923-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 04/14/2023] [Indexed: 05/29/2023]
Abstract
PURPOSE Surgical data science is an emerging field focused on quantitative analysis of pre-, intra-, and postoperative patient data (Maier-Hein et al. in Med Image Anal 76: 102306, 2022). Data science approaches can decompose complex procedures, train surgical novices, assess outcomes of actions, and create predictive models of surgical outcomes (Marcus et al. in Pituitary 24: 839-853, 2021; Røadsch et al. in Nat Mach Intell, 2022). Surgical videos contain powerful signals of events that may impact patient outcomes. A necessary step before the deployment of supervised machine learning methods is the development of labels for objects and anatomy. We describe a complete method for annotating videos of transsphenoidal surgery. METHODS Endoscopic video recordings of transsphenoidal pituitary tumor removal surgeries were collected from a multicenter research collaborative. These videos were anonymized and stored in a cloud-based platform. Videos were uploaded to an online annotation platform. Annotation framework was developed based on a literature review and surgical observations to ensure proper understanding of the tools, anatomy, and steps present. A user guide was developed to trained annotators to ensure standardization. RESULTS A fully annotated video of a transsphenoidal pituitary tumor removal surgery was produced. This annotated video included over 129,826 frames. To prevent any missing annotations, all frames were later reviewed by highly experienced annotators and a surgeon reviewer. Iterations to annotated videos allowed for the creation of an annotated video complete with labeled surgical tools, anatomy, and phases. In addition, a user guide was developed for the training of novice annotators, which provides information about the annotation software to ensure the production of standardized annotations. CONCLUSIONS A standardized and reproducible workflow for managing surgical video data is a necessary prerequisite to surgical data science applications. We developed a standard methodology for annotating surgical videos that may facilitate the quantitative analysis of videos using machine learning applications. Future work will demonstrate the clinical relevance and impact of this workflow by developing process modeling and outcome predictors.
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Affiliation(s)
- Elizabeth Fischer
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Hospital, Washington, DC, USA.
| | - Kochai Jan Jawed
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Hospital, Washington, DC, USA
| | - Kevin Cleary
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Hospital, Washington, DC, USA
| | - Alan Balu
- Division of Neurosurgery, Center for Neuroscience and Behavioral Medicine, Children's National Hospital, Washington, DC, USA
- Georgetown University School of Medicine, Washington, DC, USA
| | | | | | - Daniel A Donoho
- Georgetown University School of Medicine, Washington, DC, USA
- Department of Neurosurgery and Pediatrics, School of Medicine and Health Sciences, George Washington University, Washington, DC, USA
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46
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Takeuchi S, Hanakita J, Takahashi T, Kanematsu R, Suda I, Nakamura S, Minami M. Unrecognized dural tear during percutaneous endoscopic lumbar surgery confirmed with myelography. Radiol Case Rep 2023; 18:2992-2994. [PMID: 37441450 PMCID: PMC10333110 DOI: 10.1016/j.radcr.2023.05.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 05/28/2023] [Indexed: 07/15/2023] Open
Abstract
Iatrogenic dural tear is usually recognized during the surgery. We describe a rare case of unrecognized dural tear caused by percutaneous endoscopic lumbar surgery at another hospital clearly confirmed with dynamic myelography. Although magnetic resonance imaging of the lumbar spine showed no obvious fluid collection suggesting dural tear, dynamic myelography revealed leakage of intradural subarachnoid contrast medium along root sleeve into the intervertebral disc space. In the setting of endoscopic spine surgery, incidental dural tear might be overlooked due to the narrow and fluid-filled surgical field. Dynamic myelography is useful to evaluate the precise condition caused by unrecognized dural tear.
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Affiliation(s)
- Shu Takeuchi
- Department of Neurosurgery, National Cerebral and Cardiovascular Center Hospital, 6-1, Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
- Department of Spinal Disorders Center, Fujieda Heisei Memorial Hospital, Shizuoka, Japan
| | - Junya Hanakita
- Department of Spinal Disorders Center, Fujieda Heisei Memorial Hospital, Shizuoka, Japan
| | - Toshiyuki Takahashi
- Department of Spinal Disorders Center, Fujieda Heisei Memorial Hospital, Shizuoka, Japan
| | - Ryo Kanematsu
- Department of Spinal Disorders Center, Fujieda Heisei Memorial Hospital, Shizuoka, Japan
| | - Izumi Suda
- Department of Spinal Disorders Center, Fujieda Heisei Memorial Hospital, Shizuoka, Japan
| | - Sho Nakamura
- Department of Spinal Disorders Center, Fujieda Heisei Memorial Hospital, Shizuoka, Japan
| | - Manabu Minami
- Department of Spinal Disorders Center, Fujieda Heisei Memorial Hospital, Shizuoka, Japan
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Tanaka T, Liu X, Momozaki N, Honda E. Endoscopic-assisted removal of bilateral traumatic intracerebral hemorrhage: A case report. Surg Neurol Int 2023; 14:288. [PMID: 37680938 PMCID: PMC10481816 DOI: 10.25259/sni_268_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 07/31/2023] [Indexed: 09/09/2023] Open
Abstract
Background Decompressive craniectomy or craniotomy is an effective method for reducing intracranial pressure in patients with traumatic brain injury. However, contralateral intracranial hematoma is a rare but serious complication. Recently, the endoscopic technique has been described as a minimally invasive, safe, and effective treatment for intracranial hematoma evacuation. To the best of our knowledge, no technical report has described bilateral traumatic intracerebral hemorrhage (TICH) evacuation using a neuroendoscope. Case Description A 62-year-old man was admitted to the hospital after a fall due to intoxication. His initial Glasgow Coma Scale (GCS) score was 14. Initial computed tomography (CT) revealed a right temporal skull fracture, bilateral frontal and right temporal tip contusions, and acute subdural hematoma. During admission, his condition deteriorated to a GCS score of 6 points, and follow-up CT showed hemorrhagic progression of left frontal and right temporal contusion with midline shift and brainstem compression. Emergency surgery was performed for TICH in the left frontal lobe and right temporal lobe. A burr hole was made in each of the left frontal and right temporal regions, and we used a neuroendoscope to assist in the evacuation of the hematoma. Postoperative CT showed adequate evacuation of the hematoma. The patient regained consciousness and was discharged after 2 months. Conclusion Bilateral TICH was rapidly and sequentially removed by burr-hole craniotomy and endoscopic hematoma evacuation without rapid decompression by craniotomy. The hematoma did not increase. This report demonstrates that the endoscopic-assisted technique allows the safe treatment of bilateral TICH.
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Affiliation(s)
- Tatsuya Tanaka
- Department of Neurosurgery, International University of Health and Welfare, School of Medicine, Narita, Japan
| | - Xuan Liu
- Department of Neurosurgery, Shiroishi Kyoritsu Hospital, Shiroishi, Japan
| | - Nobuaki Momozaki
- Department of Neurosurgery, Imari Arita Kyoritsu Hospital, Arita, Japan
| | - Eiichiro Honda
- Department of Neurosurgery, Shiroishi Kyoritsu Hospital, Shiroishi, Japan
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Nakajima S, Murofushi K, Matsuda S, Shimada S, Shimoji K, Nakao Y, Yamamoto T. A case report of hydrocephalus due to diffuse villous hyperplasia of the choroid plexus: surgical treatment by combination a flexible videoscope with a rigid endoscope. Childs Nerv Syst 2023; 39:2045-2051. [PMID: 37393333 DOI: 10.1007/s00381-023-06012-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 05/27/2023] [Indexed: 07/03/2023]
Abstract
PURPOSE Diffuse villous hyperplasia of the choroid plexus (DVHCP) and choroid plexus papilloma (CPP) are rare benign tumors usually diagnosed as a result of progressive hydrocephalus, especially in childhood. We present the case of a Japanese boy diagnosed with progressive hydrocephalus due to DVHCP. METHODS Case: A 2-year and 3-month-old Japanese boy was found to have delayed motor development (equivalent to 1 year and 2 months old), an enlarged head circumference of 51 cm within + 1.5 standard deviation (S.D.), and incomplete closure of the anterior fontanel. The magnetic resonance imaging (MRI) showed lobular enlargement of the bilateral choroid plexuses extending from the trigone to the body and inferior horn of the lateral ventricle. The endoscopic choroid plexus coagulation surgery was performed to reduce the CSF formation rate. RESULTS DVHCP was diagnosed both pathologically and clinically. Postoperatively, the patient progressed without complications, such as cerebrospinal fluid leakage. Although ventricular enlargement persisted, the anterior fontanel recessed, and the expansion of the head circumference stopped. CONCLUSION Few cases of bilateral DVHCP and CPP have been reported in the literature. We encountered a case in which effective choroid plexus coagulation was performed for hydrocephalus due to DVHCP using less invasive endoscopic technique. It also represented an association between DVHCP and the gain of chromosome 9p.
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Affiliation(s)
- Shintaro Nakajima
- Department of Neurosurgery, Juntendo University Shizuoka Hospital, Izunokuni City, Shizuoka, Japan
| | - Keisuke Murofushi
- Department of Neurosurgery, Juntendo University Shizuoka Hospital, Izunokuni City, Shizuoka, Japan
| | - Shinpei Matsuda
- Department of Pediatrics, Juntendo University Shizuoka Hospital, Izunokuni City, Shizuoka, Japan
| | - Shino Shimada
- Department of Pediatrics, Juntendo University Shizuoka Hospital, Izunokuni City, Shizuoka, Japan
| | - Kazuaki Shimoji
- Department of Neurosurgery, International University of Health and Welfare Hospital, Narita City, Chiba, Japan
| | - Yasuaki Nakao
- Department of Neurosurgery, Juntendo University Shizuoka Hospital, Izunokuni City, Shizuoka, Japan
| | - Takuji Yamamoto
- Department of Neurosurgery, Juntendo University Shizuoka Hospital, Izunokuni City, Shizuoka, Japan.
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Ochi T, Suzuki H, Hirai Y, Yamanaka T, Matsumoto H, Kaiho T, Inage T, Ito T, Tanaka K, Sakairi Y, Yoshino I. Robot-assisted thoracic surgery versus video-assisted thoracic surgery for mediastinal lesions. J Thorac Dis 2023; 15:3840-3848. [PMID: 37559661 PMCID: PMC10407470 DOI: 10.21037/jtd-23-377] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 06/19/2023] [Indexed: 08/11/2023]
Abstract
BACKGROUND Robot-assisted thoracic surgery (RATS) has become widely used for mediastinal procedures since 2018 when it was included in insurance coverage in Japan. Few studies have compared the surgical outcomes of RATS with the more established video-assisted thoracic surgery (VATS) approach to mediastinal surgery. We aimed to compare the perioperative outcomes of VATS and RATS to examine the advantages of the RATS approach in a single institutional cohort. METHODS A total of 144 patients who underwent VATS and 46 who underwent RATS mediastinal surgery between 2014 and 2022 were enrolled. We compared clinicopathological features such as age, sex, smoking history, respiratory function, surgical field, laterality, surgical procedure, board certification of the surgeon, and histology between the two groups. Perioperative outcomes including operation time, volume of blood lost, number of conversion cases to open surgery, duration of chest drainage, postoperative hospital stay, and postoperative complications were also reviewed. RESULTS The comparison of patient characteristics between the groups showed significant differences in median age (VATS, 52.5 years; RATS, 67.0 years; P=0.001), combined resection of surrounding tissues of the tumor (VATS, 2.1%; RATS, 10.9%; P=0.02), board certification of the surgeon (VATS, 53.5%; RATS, 100.0%; P<0.001), and histology (RATS group had a higher percentage of thymic epithelial tumors, P=0.01). Regarding perioperative outcomes, the median operation time was 120 min in the VATS group and 88 min in the RATS group, showing a significant difference (P=0.03). There were no significant differences in the volume of blood lost, incidence of conversion to open chest surgery, duration of chest drainage, postoperative length of stay in hospital, and incidence of perioperative complications. In the perioperative outcomes of cases operated on by board-certified surgeons, the median operation time (VATS, 117 min; RATS, 88 min; P=0.02) and median postoperative length of stay in hospital (VATS, 7 days; RATS, 6 days; P=0.001) showed significant differences, while other postoperative outcomes were not significantly different. CONCLUSIONS RATS for mediastinal surgery is as safe as the VATS approach and may result in a shorter operative time and postoperative hospital stay. Further analysis of RATS for mediastinal surgery in a larger cohort is warranted.
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Affiliation(s)
| | | | - Yuki Hirai
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Takahiro Yamanaka
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Hiroki Matsumoto
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Taisuke Kaiho
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Terunaga Inage
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Takamasa Ito
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Kazuhisa Tanaka
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yuichi Sakairi
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Ichiro Yoshino
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
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50
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Candy NG, Hinder D, Jukes AK, Wormald PJ, Psaltis AJ. Olfaction preservation in olfactory groove meningiomas: a systematic review. Neurosurg Rev 2023; 46:186. [PMID: 37500988 PMCID: PMC10374754 DOI: 10.1007/s10143-023-02096-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 07/08/2023] [Accepted: 07/20/2023] [Indexed: 07/29/2023]
Abstract
Olfactory groove meningiomas (OGM) are a skull base neoplasm that represents between 8 and 13% of all intracranial meningiomas. Approach selection focuses on achieving frontal lobe decompression, gross total resection and vision preservation. Recently, there has been a focus on olfaction and considering its preservation as a quality-of-life outcome measure. An electronic search of the databases Medline, Scopus, Embase, Web of Science and Cochrane library databases was performed and data extracted according 2020 Preferred Reporting Items of Systematic Reviews and Meta-Analyses (PRISMA) statement. Six articles were selected for inclusion mainly based due to reporting quantitative outcomes for olfaction assessed by a smell identification test (e.g. sniffin' sticks). Objective olfaction preservation can be achieved with a variety of surgical approaches. More research which includes objective assessment of olfactory function and ideally as well QoL outcome measures is needed to further optimize the treatment pathways in OGM patients.
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Affiliation(s)
- Nicholas G Candy
- Department of Surgery Otolaryngology, Head and Neck Surgery, The University of Adelaide, Basil Hetzel Institute for Translational Research, Woodville South, Adelaide, Australia.
| | - Dominik Hinder
- Department of Surgery Otorhinolaryngology Head and Neck Surgery, Queen Elizabeth Hospital, Adelaide, SA, Australia
| | - Alistair K Jukes
- Department of Neurosurgery, Royal Adelaide Hospital, Adelaide, Australia
| | - Peter-John Wormald
- Department of Surgery Otolaryngology, Head and Neck Surgery, The University of Adelaide, Basil Hetzel Institute for Translational Research, Woodville South, Adelaide, Australia
| | - Alkis J Psaltis
- Department of Surgery Otolaryngology, Head and Neck Surgery, The University of Adelaide, Basil Hetzel Institute for Translational Research, Woodville South, Adelaide, Australia
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