1
|
Pedraza AM, Gupta R, Joshi H, Parekh S, Schlussel K, Berryhill R, Kaufmann B, Wagaskar V, Gorin MA, Menon M, Tewari AK. Saline-assisted fascial exposure (SAFE) technique to improve nerve-sparing in robot-assisted laparoscopic radical prostatectomy. BJU Int 2024; 133:451-459. [PMID: 38062880 DOI: 10.1111/bju.16238] [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: 12/30/2023]
Abstract
OBJECTIVE To provide a summary of our initial experience and assess the impact of the Saline-Assisted Fascial Exposure (SAFE) technique on erectile function (EF), urinary continence, and oncological outcomes after Robot-Assisted Laparoscopic Radical Prostatectomy (RALP). PATIENTS AND METHODS From January 2021 to July 2022, we included patients with a baseline Sexual Health Inventory for Men (SHIM) score of ≥17 and a high probability of extracapsular extension (ECE), ranging from 21% to 73%, as per the Martini et al. nomogram. A propensity score matching was carried out at a ratio of 1:2 between patients who underwent RALP + SAFE (33) and RALP alone (66). The descriptive statistical analysis is presented. The SAFE technique was performed using two approaches, transrectal guided by micro-ultrasound or transperitoneal. Its principle entails a low-pressure injection of saline solution in the periprostatic fascia to achieve an atraumatic dissection of the neural hammock. Potency was defined as a SHIM score of ≥17 and continence as no pads per day. RESULTS At follow-up intervals of 6, 13, 26, and 52 weeks, the SHIM score differed significantly between the two groups, favouring the RALP + SAFE (P = 0.01, P < 0.001, P < 0.001, and P = 0.01, respectively). These results remained significant when the mean SHIM score was assessed. As shown by the cumulative incidence curve, EF rates were higher in the RALP + SAFE compared to the RALP alone group (log-rank P < 0.001). The baseline SHIM and use of the SAFE technique were independent predictors of EF recovery. CONCLUSIONS The use of the SAFE technique led to better SHIM scores at 6, 13, 26, and 52 weeks after RALP in patients at high risk of ECE who underwent a partial NS procedure.
Collapse
Affiliation(s)
- Adriana M Pedraza
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Raghav Gupta
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Himanshu Joshi
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
- Department of Population Health Science and Policy, Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Sneha Parekh
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Kacie Schlussel
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Roy Berryhill
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Basil Kaufmann
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Vinayak Wagaskar
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Michael A Gorin
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Mani Menon
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Ashutosh K Tewari
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| |
Collapse
|
2
|
Huang CY, Lai CY, Reeves KD, Lam KHS, Li TY, Cheng CI, Wu YT. Volume Effect of Nerve Hydrodissection for Carpal Tunnel Syndrome: A Prospective, Randomized, and Single-Blind Study. J Ultrasound Med 2024; 43:161-169. [PMID: 37873682 DOI: 10.1002/jum.16349] [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] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 09/12/2023] [Accepted: 09/25/2023] [Indexed: 10/25/2023]
Abstract
OBJECTIVES This study compared ultrasound-guided nerve hydrodissection (HD) outcomes using two commonly used injectate volumes (10 and 5 mL) of normal saline to explore if there is a volume effect of HD for patients with moderate carpal tunnel syndrome (CTS). METHODS Twenty-four participants were randomly assigned to treatment with HD using ultrasound-guidance and either 10 mL or 5 mL of normal saline (HD-10 and HD-5 groups respectively). Our primary outcome measures were the change scores of the two subscales of the Boston Carpal Tunnel Syndrome Questionnaire: The Symptom Severity Scale (SSS) and Functional Status Scale (FSS). We conducted a one-way repeated analysis of variance for 3 time points (4, 12, and 24 weeks) for both SSS and FSS, respectively, for change scores from time 0, and percentage change from time 0. RESULTS All participants (n = 12 per group) completed the study. From 0 to 24 weeks the HD-10 group outperformed the HD-5 group for improvement in SSS (median ± IQR; -0.8 ± 0.4 versus -0.5 ± 0.5; P = .024) and FSS scores (mean ± SD; -0.8 ± 0.2 versus -0.5 ± 0.5; P = .011). The HD-10 group improvement in FSS subtest significantly exceeded the MCID percentage-change-based threshold of 27% (34%; P = .039). CONCLUSIONS Despite the limitations of small study size, a largely inert injectate, and a single injection approach, these findings in favor of the 10 mL group suggest that the volume used for ultrasound-guided HD in moderate CTS matters, and a higher volume is more effective.
Collapse
Affiliation(s)
- Chien-Yao Huang
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Centers, Taipei, Taiwan
| | - Chia-Ying Lai
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Centers, Taipei, Taiwan
| | | | - King Hei Stanley Lam
- The Hong Kong Institute of Musculoskeletal Medicine, Hong Kong
- Department of Family Medicine, The Chinese University of Hong Kong, Hong Kong
- Department of Family Medicine, The University of Hong Kong, Hong Kong
- Center for Regional Anesthesia and Pain Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Tsung-Ying Li
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Centers, Taipei, Taiwan
- Integrated Pain Management Center, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Chin-I Cheng
- Department of Statistics, Actuarial and Data Science, Central Michigan University, Mt. Pleasant, MI, USA
| | - Yung-Tsan Wu
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Centers, Taipei, Taiwan
- Integrated Pain Management Center, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan
- Department of Research and Development, School of Medicine, National Defense Medical Center, Taipei, Taiwan
| |
Collapse
|
3
|
Cárdenas-Suárez N, Urrutia-Villamil P, Reyes-Jimenez T, Pereira-Diaz O. Hydrodissection as a Novel Alternative After Failed Management of a Cervical Pregnancy With Methotrexate: Case Report and Literature Review. Cureus 2024; 16:e52556. [PMID: 38249658 PMCID: PMC10798570 DOI: 10.7759/cureus.52556] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2024] [Indexed: 01/23/2024] Open
Abstract
Cervical ectopic pregnancies (CEPs) are rare and life-threatening diagnoses. Risk factors have been associated with CEPs, yet their etiology and pathogenesis remain unknown. Timely intervention is vital for successful outcomes, yet it is challenged as there is no standardized approach to treatment. We present the case of a 42-year-old woman diagnosed with CEP following five weeks and one day of amenorrhea. The patient was treated with a two-dose regimen of intramuscular methotrexate (MTX) but failed to respond. Ultrasound-guided intrasac MTX injection was considered a secondary treatment. However, spontaneous expulsion was observed after administering lidocaine at different cervical points. Hydrodissection following systemic MTX could present a novel alternative for treating CEP. Expulsion of pregnancy after hydrodissection could be associated with tissue necrosis and/or destabilized implantation of pregnancy, secondary to the effects of MTX. Further research is vital for evaluating the underlying mechanisms for expulsion and the role of hydrodissection following MTX in treating CEP.
Collapse
Affiliation(s)
- Natalia Cárdenas-Suárez
- Department of Obstetrics and Gynecology, University of Puerto Rico Medical Sciences Campus, San Juan, PRI
| | | | | | - Olga Pereira-Diaz
- Department of Obstetrics and Gynecology, San Juan City Hospital, San Juan, PRI
| |
Collapse
|
4
|
Song Y, Wu M, Zhou R, Zhao P, Mao D. Application and evaluation of hydrodissection in microwave ablation of liver tumours in difficult locations. Front Oncol 2023; 13:1298757. [PMID: 38033497 PMCID: PMC10687428 DOI: 10.3389/fonc.2023.1298757] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 11/02/2023] [Indexed: 12/02/2023] Open
Abstract
Objective To investigate the safety and mid-term outcomes of hydrodissection-assisted microwave ablation (MWA) of hepatocellular carcinoma (HCC) in various difficult locations. Methods A total of 131 HCC patients who underwent ultrasound-guided MWA from March 2017 to March 2019 were included. Following ultrasound examination, patients with tumors at difficult locations were treated with hydrodissection-assisted MWA (hydrodissection group), while those with tumors at conventional locations received MWA (control group). Both groups were compared concerning baseline characteristics, ablation parameters, complete ablation rates, and complication rates. Kaplan-Meier curves analyzed local tumor progression and overall survival, with stratified analysis for different difficult locations (adjacent to gastrointestinal tract, diaphragm, and subcapsular tumors). Additionally, Cox regression analyses were conducted to assess the impact of different difficult locations on these outcomes. Results Complete ablation rates were similar between the hydrodissection and control groups (91.4% vs. 95.2%, P>0.05). Postoperative complications occurred in three patients, including liver abscess and biliary injury. No significant differences in major or minor complication rates were found between the groups (P>0.05). Local tumor progression was detected in 11 patients (8.4%) at the end of the follow-up period. Neither cumulative local tumor progression rate (P=0.757) nor overall survival rate (P=0.468) differed significantly between the groups. Stratified analysis showed no effect of tumor location difficulty on cumulative local tumor progression or overall survival. Tumor number and size served as independent predictors for overall survival, while minimal ablation margin ≤ 5mm independently predicted local tumor progression. In contrast, the tumor location was not statistically significant. Sensitivity analyses corroborated the robustness of the models. Conclusion Hydrodissection-assisted MWA for HCC in various difficult locations demonstrated safe and effective, with complete ablation and mid-term outcomes comparable to those for tumors in conventional locations.
Collapse
Affiliation(s)
| | - Meng Wu
- Department of Ultrasound, The Affiliated People’s Hospital of Ningbo University, Ningbo, Zhejiang, China
| | | | | | | |
Collapse
|
5
|
Omodani T, Takahashi K. Ultrasound-Guided Hydrodissection for Sural Neuropathy After Calcaneus Fracture Surgery: A Case Report. Cureus 2023; 15:e47749. [PMID: 38022034 PMCID: PMC10676283 DOI: 10.7759/cureus.47749] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2023] [Indexed: 12/01/2023] Open
Abstract
We present a case study of a 61-year-old man who experienced sural neuropathy following calcaneus fracture surgery, which was effectively treated using ultrasound-guided hydrodissection. Postoperatively, while the patient exhibited good bony fusion, he reported pain on the lateral side of the calcaneus. Ultrasound findings did not suggest any nerve discontinuity, but localized tenderness around the sural nerve was observed. After hydrodissection using 0.09% lidocaine, the patient's pain significantly decreased. Although hydrodissection alleviated the pain, complete resolution was achieved only post plate removal and neurolysis. This study represents the first report on the efficacy of hydrodissection for postoperative sural neuropathy, suggesting its potential as an effective treatment option.
Collapse
Affiliation(s)
- Toru Omodani
- Orthopaedics, Tokyo Advanced Orthopaedics, Tokyo, JPN
| | - Kenji Takahashi
- Sports Medicine and Joint Center, Funabashi Orthopaedic Hospital, Funabashi, JPN
| |
Collapse
|
6
|
Koonen L, van Amerongen M, Smulders K, Mangesius S, Cerna G, Klauser A, Mur E, Obradov M. Added value of ultrasound-guided percutaneous needle tenotomy over hydrodissection and physiotherapy in chronic lateral elbow tendinopathy: a pilot randomized controlled trial. J Ultrason 2023; 23:e358-e364. [PMID: 38020516 PMCID: PMC10668925 DOI: 10.15557/jou.2023.0040] [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: 05/13/2023] [Accepted: 08/24/2023] [Indexed: 12/01/2023] Open
Abstract
Aim of the study There is no consensus on the most suitable non-surgical treatment of chronic lateral elbow tendinopathy. The aim of this pilot randomized controlled trial was to evaluate the size of effect of ultrasound-guided percutaneous needle tenotomy. Material and methods Three intervention arms were formed: 1) percutaneous needle tenotomy, hydrodissection, and physiotherapy; 2) hydrodissection and physiotherapy; and 3) physiotherapy alone. Patients with chronic lateral elbow tendinopathy were randomized. Clinical endpoints included multiple questionnaires after three months: Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH), Numeric Rating Scale (NRS) pain at rest and during activity, and EuroQol 5D-5L (EQ-5D-5L). Results Thirty patients were included of 128 screened. The QuickDASH score improved in the percutaneous needle tenotomy and physiotherapy group, but not in the hydrodissection group. The NRS pain at rest and during activity improved more in the percutaneous needle tenotomy (resp. -2 and -2) and hydrodissection (resp. -3 and -3) groups than in the physiotherapy (resp. +1 and -1) group. The EQ-5D-5L improved similarly in all groups. Conclusions Patients receiving percutaneous needle tenotomy and/or hydrodissection may show better results in terms of pain but not in their functional outcomes compared to those who received physiotherapy alone. The size of effect, however, is small, so a large sample size is needed for a future randomized controlled trial to further investigate these results.
Collapse
Affiliation(s)
- Laurens Koonen
- Department of Research, Sint Maartenskliniek Nijmegen, Ubbergen, The Netherlands
| | - Martin van Amerongen
- Department of Radiology, Sint Maartenskliniek Nijmegen, Ubbergen, The Netherlands
| | - Katrijn Smulders
- Department of Research, Sint Maartenskliniek Nijmegen, Ubbergen, The Netherlands
| | | | - Gabriella Cerna
- Department of Physical Medicine and Rehabilitation, Medical University Innsbruck, Innsbruck, Austria
| | - Andrea Klauser
- Department of Radiology, Medical University Innsbruck, Innsbruck, Austria
| | - Erich Mur
- Department of Physical Medicine and Rehabilitation, Medical University Innsbruck, Innsbruck, Austria
| | - Marina Obradov
- Department of Radiology, Sint Maartenskliniek Nijmegen, Ubbergen, The Netherlands
| |
Collapse
|
7
|
Valcavi R, Gaino F, Novizio R, Mercante G. Vocal Cord Monitoring by Flexible Fiberoptic Laryngoscopy During Thyroid Radiofrequency Ablation. VideoEndocrinology 2023; 10:41-43. [PMID: 37808918 PMCID: PMC10551754 DOI: 10.1089/ve.2023.0012] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 06/01/2023] [Accepted: 07/30/2023] [Indexed: 10/10/2023] Open
Abstract
Introduction: Thermal injury to recurrent laryngeal nerve (RLN) during radiofrequency ablation (RFA) can produce temporary or permanent vocal cord paralysis.1 Hydrodissection with cold 5% glucose of "danger triangle" protects RLN during RFA.2 When RFA is performed under local anesthesia, RLN function is monitored by patients producing vocal sounds.3 Large lesions requiring longer RFAs warrant general sedation where voice cannot be assessed, therefore, an additional technique for RLN protection is advisable. Observation of passive symmetrical vocal cord movements during breathing by laryngeal ultrasonography is useful in assessing vocal cord function4; however, flexible-fiberoptic fibrolaringoscopy (FFL) is gold standard for assessing vocal cord movements,5 anticipating potential RLN damage. We report FFL monitoring during RFA under general sedation on a large thyroid nodule. FFL during RFA may detect RLN irritation and dysfunction if asymmetry in passive vocal cord movements is noted. Should asymmetry appear, RFA operator stops delivering energy and repositions electrode needle. Materials and Methods: Thyroid function tests, blood glucose, creatinine, transaminase, International-Normalized-Ratio, and electrocardiogram were performed. Operating room (OR) layout created sufficient space for ear-nose-throat (ENT) and RFA operators. An examination with a fiberscope camera demonstrated normal vocal cord adduction during phonation and abduction during breathing. The procedure was assisted by an anesthetist administering fentanyl 50 mcg, midazolam 1.5 to 5.0 mg, and propofol infusion 2 mg/(kg·h). General sedation was conducted so that reflexes were attenuated but still observable. Incorporating in OR by an anesthetist who performs general sedation reduces side effects and complications.6 Ultrasonography showed a 34-mL right lobe nodule abutting on the RLN area. After sedation with propofol, the ENT specialist inserted an endoscope until the glottic plane. During calm breathing, vocal cords moved symmetrically. After obtaining anterior nodule hydrodissection from strap and sternocleidomastoid muscles with 10 mL of 2% lidocaine, posterior hydrodissection was achieved by ultrasound-guided administration of 30 mL of 5% cold glucose. Anterior and posterior hydrodissections merged, separating nodule from neck structures. The radiofrequency electrode needle was then inserted into the nodule, initially positioned in inferior nodule portion adjacent to danger triangle previously isolated by hydrodissection. Initial power was 30 watts. Moving-shot technique was used. Results: FFL was performed throughout thyroid RFA. Symmetric vocal cord movements during breathing demonstrated no RLN irritation. FFL monitoring allowed observation of natural reflexive phenomena, including swallowing. Complete nodule ablation was achieved. FFL performed post-RFA confirmed normal vocal cord motility. Conclusions: We report the first-time use of FFL for vocal cord monitoring during RFA. FFL was easily performed by the ENT specialist and well tolerated by the patient. Avoiding danger triangle and precise RFA needle positioning is key in preventing RLN injury. Benign nodules regrow if total ablation is not achieved7 and some authors propose additional procedures to complete ablation8 that obviously incurs costs. Total RFA nodule ablation-assisted FFL monitoring eliminates the need for repetitive RFAs, thus reducing overall treatment costs. Finally, FFL monitoring does not prolong procedure, as it is performed simultaneously with RFA. FFL is a valid technique when used in conjunction with hydrodissection to further prevent RLN thermal injury during RFA, especially indicated for large thyroid nodule ablation and professional voice users. Patient Consent and Permission: The patient provided written consent for FFL monitoring and permission to use his portrayals and ultrasonographic images during RFA. The study was completed in accordance with the Declaration of Helsinki as revised in 2013. Adherence to institutional review board protocols was granted. Disclaimer: Representation of any instrumentation within the video does not indicate any endorsement of the product and/or company by the publisher, the American Thyroid Association, or the authors. No competing financial interests exist. Runtime of video: 9 mins 39 secs.
Collapse
Affiliation(s)
- Roberto Valcavi
- Department of Endocrinology, Interventional Thyroidology, Endocrine and Thyroid Clinic, Reggio Emilia, Italy
| | - Francesca Gaino
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Department of Otorhinolaryngology-Head and Neck Surgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Roberto Novizio
- Interventional Thyroidology, Endocrine and Thyroid Clinic, Reggio Emilia, Italy
| | - Giuseppe Mercante
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Department of Otorhinolaryngology-Head and Neck Surgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| |
Collapse
|
8
|
Bejarano MC, Clearfield DA. Platelet Releasate Injection as a Novel Treatment for Ulnar Neuritis at the Elbow: A Case Report. Cureus 2023; 15:e42223. [PMID: 37605660 PMCID: PMC10440148 DOI: 10.7759/cureus.42223] [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] [Accepted: 07/19/2023] [Indexed: 08/23/2023] Open
Abstract
This report examines the efficacy of platelet releasate injection as a treatment method for ulnar neuritis. Platelet-rich plasma (PRP), an autologous product of concentrated platelets, has the potential to accelerate healing in injured peripheral nerves by releasing growth factors that promote nerve repair. Platelet releasate, the supernatant of thrombin-activated PRP, has yet to be thoroughly investigated as a treatment option for ulnar neuritis. In this report, a 42-year-old female patient presented with right-sided elbow and neck pain that was subsequently diagnosed as ulnar neuritis and neurogenic thoracic outlet syndrome. Initial imaging at the right elbow demonstrated ulnar nerve entrapment within the arcade of Struthers. The patient's symptoms were first managed with home exercise and ulnar nerve hydrodissection at the elbow, which decreased but did not resolve her pain. Platelet releasate injection of the ulnar nerve at the elbow was subsequently performed. Six weeks post-procedure, the patient reported additional pain improvement. Provocative tests at the elbow were negative and imaging demonstrated a normal-appearing ulnar nerve. Despite these results, the patient was not completely symptom-free; persistent symptoms were attributed to her concomitant neurogenic thoracic outlet syndrome. While platelet releasate injection has not previously been explored as a treatment option for ulnar neuritis, this case demonstrates how platelet releasate injection may facilitate healing in an ulnar nerve injured by entrapment. Further investigation could support platelet releasate injection as an effective monotherapy or as an adjunct treatment for ulnar neuritis and similar peripheral neuropathies.
Collapse
Affiliation(s)
- Michael C Bejarano
- Medicine, Texas College of Osteopathic Medicine at University of North Texas Health Science Center, Fort Worth, USA
| | - Daniel A Clearfield
- Sports Medicine, Motion Is Medicine Sports Medicine, North Richland Hills, USA
| |
Collapse
|
9
|
Liu Z, Chen Z, Liao X. Modified hydrodissection as a safe and effective treatment modality for rotating lens in cataract surgery. Indian J Ophthalmol 2023; 71:1021-1022. [PMID: 36872731 DOI: 10.4103/ijo.ijo_2809_22] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023] Open
Abstract
We describe in this article an effective and safe modification of hydrodissection technique in cataract surgery. The hydrodissection cannula tip is inserted into the capsulorhexis edge near the primary incision, with the cannula elbow resisting on the upper lip of the primary incision. Hydrodissection is then completed effectively and safely by squirting fluid to cleave the lens and capsular. This modified hydrodissection technique can be performed with high reproducibility and in a short practice period.
Collapse
Affiliation(s)
- Zhen Liu
- Department of Ophthalmology, Affiliated Hospital, North Sichuan Medical College, Nanchong, Sichuan; Chongqing Aier Eye Hospital, Chongqing, China
| | - Zeli Chen
- Chongqing Aier Eye Hospital, Chongqing, China
| | - Xuan Liao
- Department of Ophthalmology, Affiliated Hospital; Medical School of Ophthalmology and Optometry, North Sichuan Medical College, Nanchong, Sichuan, China
| |
Collapse
|
10
|
Raouf MM, Abo-Elhessein AK, Hasanein M, Abskharon JE, Hassan SS, Talaat EA, Elawamy AR, Kamel EZ. Efficacy of median nerve hydrodissection by hyalase versus midazolam in the treatment of carpal tunnel syndrome. Pain Manag 2023; 13:77-86. [PMID: 36637026 DOI: 10.2217/pmt-2022-0080] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Background: The objective was to determine which of midazolam or hyalase could improve the pain score and functional disability in median nerve hydrodissection. Methods: In a double-blind study with two groups, both received bupivacaine 15 mg with either 300 IU hyalase in 2 ml of saline (group HA) or 2 mg of midazolam in 2 ml of sterile saline (group MZ). Results: Statistically significantly lower post-injection Visual Analog Scale scores in group MZ compared with group HA at all follow-ups. Group MZ had significantly lower functional disability scores than group HA. Conclusion: Both drugs yielded favorable results. Midazolam was more impactful in alleviating pain and reducing functional disability up to 6 months.
Collapse
Affiliation(s)
- Mina Maher Raouf
- Department of Anesthesia, Intensive Care & Pain Medicine, Minia University Hospital, Minia, 61511, Egypt
| | - Amany Khairy Abo-Elhessein
- Department of Anesthesia, Intensive Care & Pain Medicine, Minia University Hospital, Minia, 61511, Egypt
| | - Manal Hasanein
- Department of Rheumatology & Rehabilitation, Assuit University, Assuit, 71513, Egypt
| | - John Ezzat Abskharon
- Institute of Diagnostic & Interventional Radiology, Frankfurt University Hospital, Frankfurt, 71513, Germany
| | - Shady Safwat Hassan
- Department of Neurology & Psychiatry, Faculty of Medicine, Assuit University, Assuit, 71513, Egypt
| | - Esraa Ahmed Talaat
- Department of Rheumatology & Rehabilitation, Assuit University, Assuit, 71513, Egypt
| | - Abdel-Raheem Elawamy
- Department of Anesthesia & Intensive Care, Assuit University, Assuit, 71513, Egypt
| | - Emad Zarief Kamel
- Department of Anesthesia & Intensive Care, Assuit University, Assuit, 71513, Egypt
| |
Collapse
|
11
|
Wu F, Wu Q, Xu W, Wu Z, Liu L, Zhou L. ["Leverage pry-off method" for effective prevention of thermal injury during microwave ablation of benign thyroid nodules]. Nan Fang Yi Ke Da Xue Xue Bao 2023; 43:122-7. [PMID: 36856220 DOI: 10.12122/j.issn.1673-4254.2023.01.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
OBJECTIVE To assess the safety and efficacy of"leverage pry-off method"for preventing thermal injury during microwave ablation of benign thyroid nodules. METHODS From July, 2017 to September, 2019, a total of 348 patients with benign thyroid nodules underwent ultrasound-guided microwave ablation. For protecting from thermal injury during the ablation, "hydrodissection technique" was used in 174 of the patients (admitted from July, 2017 to August, 2018) and "leverage pry-off method" in the other 174 patients (admitted from September, 2018 to September, 2019). All the patients were followed up for 1 to 12 months after the operation for observation of severe complications and nodular residues. RESULTS Ultrasound-guided microwave ablation was completed in all the 348 patients. The most common severe complication associated with the ablation was voice change, occurring in 3 cases (1.7%) in "hydrodissection technique" group and in 4 (2.3%) in the "leverage pry-off method" group, showing no significant difference between the two groups (P>0.05). During the follow-up, no significant difference was found in the rate of nodular residues between the "hydrodissection technique" group and "hydrodissection technique" group (9.8% vs 10.9% (P>0.05). CONCLUSIONS The "leverage pry-off method" is simple and effective for preventing thermal injury during microwave ablation of benign thyroid nodules.
Collapse
|
12
|
Zhao ZL, Wei Y, Peng LL, Li Y, Lu NC, Wu J, Yu MA. Upgraded hydrodissection and its safety enhancement in microwave ablation of papillary thyroid cancer: a comparative study. Int J Hyperthermia 2023; 40:2202373. [PMID: 37121576 DOI: 10.1080/02656736.2023.2202373] [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] [Indexed: 05/02/2023] Open
Abstract
OBJECTIVES To study the efficacy and safety of an improved hydrodissection protocol based on the perithyroidal fascial space during microwave ablation for papillary thyroid carcinoma (PTC). METHODS The data of 341 patients (94 men and 247 women, median age 41 years old, 25%-75% interquartile range 34-53 years old, nodule maximum diameter 0.2-1.9 cm) who underwent microwave ablation for PTC were retrospectively reviewed. Among them, 185 patients underwent traditional hydrodissection and served as a control group, and 156 patients underwent improved hydrodissection based on perithyroidal fascial spaces, constituting the improved group. Improvements in safety were analyzed by comparing complications between the two groups. The characteristics of hydrodissected spaces, complications, and follow-up results were recorded. RESULTS Hydrodissection was successfully performed in all enrolled patients according to the protocol. The incidence of hoarseness caused by recurrent laryngeal nerve injury, the most common complication in thermal ablation of thyroid nodules, was significantly lower in the improved group than in the control group (1.9% vs. 8.1%, p = 0.021). The median hoarseness recovery time in the improved group was shorter than that in the control group (2 months vs. 3 months, p = 0.032). During follow-up, no local recurrence was encountered in either group. The tumor disappearance rate was not significantly different between the two groups (69.9% vs. 75.7%, p = 0.228). CONCLUSIONS Improved hydrodissection based on perithyroidal fascial spaces had better protective effects than traditional hydrodissection.
Collapse
Affiliation(s)
- Zhen-Long Zhao
- Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Ying Wei
- Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Li-Li Peng
- Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Yan Li
- Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Nai-Cong Lu
- Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Jie Wu
- Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Ming-An Yu
- Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China
| |
Collapse
|
13
|
Wei Y, Zhao ZL, Niu Y, Wu J, Cao SL, Peng LL, Li Y, Yu MA. Safety enhancement of improved hydrodissection for microwave ablation in secondary hyperparathyroidism. Int J Hyperthermia 2023; 40:2243408. [PMID: 37544651 DOI: 10.1080/02656736.2023.2243408] [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: 05/09/2023] [Revised: 07/20/2023] [Accepted: 07/28/2023] [Indexed: 08/08/2023] Open
Abstract
OBJECTIVE To study the safety of improved hydrodissection based on the periparathyroidal fascial space during microwave ablation (MWA) for secondary hyperparathyroidism (SHPT). MATERIALS AND METHODS Data from 337 patients (162 males and 175 females; mean age, 50.8 ± 12.8 [range, 16-84] years) who underwent MWA for SHPT were retrospectively reviewed. Among them, 177 patients underwent traditional hydrodissection (traditional group) and 160 patients underwent improved hydrodissection based on periparathyroidal fascial spaces (improved group). Safety enhancement was analyzed by comparing the complications between the two groups. The characteristics of the hydrodissected fascial spaces, complications, and the follow-up results were recorded. The baseline data, clinical parameters, laboratory indices and characteristics of SHPT lesions were analyzed to assess the risk factors associated with hoarseness. RESULTS Hydrodissection was successfully performed in all the enrolled patients according to the protocol. Six periparathyroid fascial spaces were hydrodissected, depending on the location of the SHPT lesions. The incidence of hoarseness due to recurrent laryngeal nerve injury, the most common complication of thermal ablation for SHPT lesions, was lower in the improved group than in the traditional group (6.9% vs. 13.0%, p = 0.044). The median hoarseness recovery time in the improved group was shorter than that in the traditional group (2 vs. 6 months, p < 0.001). There was no difference in technical efficiency between the two groups (improved group vs. traditional group: 75.0% vs. 70.6%; p > 0.05). CONCLUSIONS Compared with traditional hydrodissection, improved hydrodissection based on periparathyroidal fascial spaces could enhance safety during MWA for SHPT.
Collapse
Affiliation(s)
- Ying Wei
- Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Zhen-Long Zhao
- Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Yun Niu
- Department of Pathology, China-Japan Friendship Hospital, Beijing, China
| | - Jie Wu
- Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Shi-Liang Cao
- Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Li-Li Peng
- Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Yan Li
- Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Ming-An Yu
- Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China
| |
Collapse
|
14
|
Muacevic A, Adler JR. A Case Report on Abdominal Pain Treated With a New Technique of Ultrasound-Guided Transversus Abdominis Plane Hydrodissection Using a Low Concentration of Local Anesthetics. Cureus 2022; 14:e31966. [PMID: 36582553 PMCID: PMC9795083 DOI: 10.7759/cureus.31966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2022] [Indexed: 11/29/2022] Open
Abstract
Hydrodissection, a technique for performing morphological dissection between the target tissues via injection, has attracted attention in recent years. However, high-quality evidence is available only for a few entrapment neuropathies, such as carpal tunnel syndrome, and further case studies are needed for other diseases. This case report presents the first case of hydrodissection of the ventral ramus of the spinal nerve, which innervates the abdominal wall, to improve abdominal pain. A 59-year-old Japanese man with a history of cerebral infarction and dyslipidemia presented to the emergency department with the chief complaint of left upper abdominal pain that began two days earlier. The pain radiated to the left side of the back and left axilla. The abdomen was flat and soft with no tenderness on examination, and the pinch test was negative. However, Carnett's sign was observed in the left upper abdomen, and the location of the left upper abdominal pain and that of the radiating pain were consistent with the ninth thoracic vertebra (Th9) dermatome; thus, the cause of the left upper abdominal pain was determined to be the ventral ramus of the spinal nerve of Th9. Two weeks of physical therapy and lifestyle guidance were ineffective; therefore, hydrodissection of the transversus abdominis plane (TAP) between the myofascia of the internal oblique muscle and that of the transversus abdominis at the Th9 level using a 23G 60 mm needle under ultrasound guidance was planned. The abdominal pain immediately improved after hydrodissection, and the patient was able to work without pain. Thus, ultrasound-guided TAP hydrodissection with a low-concentration local anesthetic is effective in the treatment of abdominal pain caused by the entrapment of the ventral ramus of the spinal nerve due to adhesions between the myofascia of the internal oblique muscle and that of the transversus abdominis. This condition should be termed ventral ramus of spinal nerve entrapment syndrome (VERNES), and this concept and TAP hydrodissection must be made known to the public.
Collapse
|
15
|
Ananth S, Umemoto KK, Vyas D. Hydrodissection in Laparoscopic Cholecystectomies for Gangrenous Gallbladders. Int J Gen Med 2022; 15:7735-7738. [PMID: 36249897 PMCID: PMC9563322 DOI: 10.2147/ijgm.s364289] [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: 02/27/2022] [Accepted: 09/22/2022] [Indexed: 11/06/2022] Open
Abstract
To improve the quality of patient care for cholecystectomies for gangrenous gallbladders, multiple innovations have been introduced including laparoscopic and robotic surgery. However, laparoscopic cholecystectomies for gangrenous gallbladders performed by blunt dissection still represents one of the most technically challenging general surgery procedures, with a high rate of iatrogenic complications and suboptimal measures for key surgical parameters such as length of stay, operating time, and blood loss. For this reason, the novel use of surgical techniques such as hydrodissection, which involves the expulsion of normal saline streams at a predetermined pressure, for cholecystectomies for gangrenous gallbladders are of utmost importance. In this manuscript, we explore the application of hydrodissection in cholecystectomies for gangrenous gallbladders.
Collapse
Affiliation(s)
- Shahini Ananth
- California Northstate University College of Medicine, Elk Grove, CA, USA
| | - Kayla K Umemoto
- California Northstate University College of Medicine, Elk Grove, CA, USA
| | - Dinesh Vyas
- Department of Surgery, California Northstate University College of Medicine, Elk Grove, CA, USA,Department of Surgery, Adventist Hospital, Stockton, CA, USA,Correspondence: Dinesh Vyas, Department of Surgery, California Northstate University College of Medicine, 9700 W Taron Dr, Elk Grove, CA, 95757, USA, Tel +1 314 680-1347, Email
| |
Collapse
|
16
|
Chao TC, Reeves KD, Lam KHS, Li TY, Wu YT. The Effectiveness of Hydrodissection with 5% Dextrose for Persistent and Recurrent Carpal Tunnel Syndrome: A Retrospective Study. J Clin Med 2022; 11:jcm11133705. [PMID: 35806998 PMCID: PMC9267718 DOI: 10.3390/jcm11133705] [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: 06/10/2022] [Revised: 06/23/2022] [Accepted: 06/24/2022] [Indexed: 11/19/2022] Open
Abstract
Patients with failure of primary surgery for carpal tunnel syndrome (CTS) present a frustrating clinical problem because there are no relevant treatment guidelines, and the effect of current conservative management or revision surgery is unsatisfactory. Hydrodissection with 5% dextrose is emerging as an effective treatment for primary CTS and may be an effective alternative treatment method for persistent or recurrent post-surgical CTS. We retrospectively investigated the long-term effectiveness of hydrodissection with 5% dextrose for persistent or recurrent CTS. Thirty-six of forty consecutively-treated patients with either persistent or recurrent symptoms of CTS after surgery, who were treated with ultrasound-guided hydrodissection of the median nerve using 10 mL of 5% dextrose, were available to provide outcome data by a structured phone interview at least six months after treatment completion. Symptom relief ≥ 50% represented an effective outcome, while symptom relief < 50% was rated as a poor outcome. Nearly 2/3 (61.1%) of patients reported an effective outcome after a mean of 3.1 injections, with a post-injection follow-up mean of 33 (6−67) months. A non-significant trend toward a more frequently-effective outcome was observed in those with recurrent versus persistent symptoms following CTS (76.9% vs. 52.2%, p = 0.165). However, a significantly higher percentage of those with recurrent symptoms reported an excellent outcome, defined as a greater than 70% improvement (8/13 [61.6%] vs. 3/23 [13%], p = 0.006). The percentage of patients achieving an effective outcome was not significantly different between <2, 2−4, and >4 years of post-treatment follow-up (36.4% vs. 77.8% vs. 57.1%; p = 0.077). Hydrodissection with 5% dextrose may result in a clinically important and durable benefit in those experiencing persistent or recurrent CTS after surgery.
Collapse
Affiliation(s)
- Ta-Chung Chao
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei 114, Taiwan; (T.-C.C.); (T.-Y.L.)
| | | | - King Hei Stanley Lam
- The Hong Kong Institute of Musculoskeletal Medicine, Hong Kong;
- Department of Family Medicine, The Chinese University of Hong Kong, Hong Kong
- Department of Family Medicine, The University of Hong Kong, Hong Kong
- Center for Regional Anesthesia and Pain Medicine, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan
| | - Tsung-Ying Li
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei 114, Taiwan; (T.-C.C.); (T.-Y.L.)
- Integrated Pain Management Center, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei 114, Taiwan
| | - Yung-Tsan Wu
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei 114, Taiwan; (T.-C.C.); (T.-Y.L.)
- Integrated Pain Management Center, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei 114, Taiwan
- Department of Research and Development, School of Medicine, National Defense Medical Center, Taipei 114, Taiwan
- Correspondence: ; Tel.: +886-2-87923311 (ext. 13342)
| |
Collapse
|
17
|
Ferreira-Silva N, Galacho J, Ferreira-Dos-Santos G, Clendenen SR, Hurdle MFB. Ultrasound-guided hydrodissection of the superficial peroneal nerve for chronic neuropathic pain: a war veteran's story. Pain Manag 2022; 12:579-586. [PMID: 35416721 DOI: 10.2217/pmt-2022-0014] [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] [Indexed: 11/21/2022] Open
Abstract
Aim: This case report presents the application of ultrasound-guided hydrodissection of the superficial peroneal nerve to treat chronic refractory neuropathic pain, rated by the patient with an average intensity of 6/10 on the numerical rating scale. Materials & methods: Under ultrasound guidance, the nerve was identified compressed by a herniation of the peroneus brevis. An in-plane hydrodissection was performed using a solution of 10 ml of ropivacaine and methylprednisolone until the epineurium was entirely separated from the surrounding tissue. Results: At the 2-month follow-up, the patient reported a decrease of pain, which he rated a 2/10 on the numerical rating scale. At this point, night-time episodes of moderate pain persisted. The procedure was repeated and at the 6-month follow-up, the patient remained pain free. Conclusion: This case report suggests that consecutive ultrasound-guided hydrodissection techniques might be a valuable option in the treatment of superficial peroneal nerve entrapment neuropathy.
Collapse
Affiliation(s)
- Nuno Ferreira-Silva
- Department of Physical Medicine & Rehabilitation, Hospital Professor Doutor Fernando da Fonseca, Amadora, Portugal
| | - João Galacho
- Department of Anesthesiology, Chronic Pain Unit, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - Guilherme Ferreira-Dos-Santos
- Department of Anesthesiology & Pain Medicine, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, M5T 2S8, Canada
| | - Steven R Clendenen
- Department of Anesthesiology & Perioperative Medicine, Mayo Clinic, Jacksonville, FL 32224, USA
| | | |
Collapse
|
18
|
Wang JC, Hsu PC, Wang KA, Chang KV. Response: "Commentary: Ultrasound-Guided Triamcinolone Acetonide Hydrodissection for Carpal Tunnel Syndrome: A Randomized Controlled Trial". Front Med (Lausanne) 2022; 9:841609. [PMID: 35350579 PMCID: PMC8957874 DOI: 10.3389/fmed.2022.841609] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 01/20/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Jia-Chi Wang
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, National Yang Ming University, Taipei, Taiwan
| | - Po-Cheng Hsu
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, National Yang Ming University, Taipei, Taiwan
| | - Kevin A Wang
- Division of General Surgery, Department of Surgery, Shin-Kong Memorial Hospital, Taipei, Taiwan.,School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Ke-Vin Chang
- Department of Physical Medicine and Rehabilitation and Community and Geriatric Research Center, National Taiwan University Hospital, Bei-Hu Branch and National Taiwan University College of Medicine, Taipei, Taiwan.,Center for Regional Anesthesia and Pain Medicine, Wang-Fang Hospital, Taipei Medical University, Taipei, Taiwan
| |
Collapse
|
19
|
Teng D, Dong C, Sun D, Liu Z, Wang H. Comparison of Ultrasound-Guided Core Needle Biopsy Under the Assistance of Hydrodissection With Fine Needle Aspiration in the Diagnosis of High-Risk Cervical Lymph Nodes: A Randomized Controlled Trial. Front Oncol 2022; 11:799956. [PMID: 35096601 PMCID: PMC8793772 DOI: 10.3389/fonc.2021.799956] [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: 10/22/2021] [Accepted: 12/21/2021] [Indexed: 12/07/2022] Open
Abstract
A randomized comparison of ultrasound (US)-guided core needle biopsy (CNB) under the assistance of hydrodissection with fine needle aspiration (FNA) was performed to evaluate the feasibility, safety and effectiveness for the diagnosis of high-risk cervical lymph nodes. Patients from December 2018 to May 2020 were randomly assigned to the CNB group and the FNA group at a ratio of 1:1. This study protocol was approved by the Ethics Committee of our hospital and registered in the Chinese Clinical Trial Registry (ChiCTR1800019370). The feasibility of CNB for high-risk cervical lymph nodes was evaluated by observing and recording the separation success rate (SSR) and technical success rate (TSR) of the CNB group. Safety was evaluated by comparing the incidence of major complications in the two groups. The diagnostic efficacy was evaluated by comparing the diagnostic accuracy, sensitivity, and specificity of the two groups. A total of 84 patients (84 lymph nodes) were randomized into the CNB (n = 42) and FNA (n = 42) groups. All patients in the CNB group achieved successful hydrodissection and biopsy. The SSR and TSR were both 100% in the CNB group. There were no major complications during or after the process in the two groups. Compared with the FNA group, the CNB group was significantly superior in terms of diagnostic accuracy and sensitivity (100% vs. 81.0%, P = 0.009; 100% vs. 79.2%, P = 0.035, respectively). The specificity of the two groups was 100%, and there was no significant difference. Compared with FNA, CNB under the assistance of hydrodissection is a feasible and safe method but is more effective for the diagnosis of high-risk cervical lymph nodes.
Collapse
Affiliation(s)
- Dengke Teng
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Chunhui Dong
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Daju Sun
- Department of Pathology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Zhuo Liu
- Department of Gastrointestinal Colorectal and Anal Surgery, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Hui Wang
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, China
| |
Collapse
|
20
|
Zheng L, Liu FY, Yu J, Cheng ZG, Yu XL, Dong XC, Han ZY, Liang P. Thermal ablation for papillary thyroid microcarcinoma located in the isthmus: a study with 3 years of follow-up. Future Oncol 2022; 18:471-480. [PMID: 35048734 DOI: 10.2217/fon-2021-0463] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Aims: To analyze the outcomes of thermal ablation for isthmic papillary thyroid microcarcinoma (PTMC). Patients & methods: Data for 21 isthmic-PTMC patients who underwent microwave ablation under ultrasound guidance were retrospectively collected. General information on patients and characteristics of tumors were collected. The technical effectiveness, tumor recurrence and volume changes and postoperative complications were recorded during the follow-up. Comparisons with 105 nonisthmic-PTMCs were done. Results: The technical effectiveness was 100%. No recurrence or lymph node metastases were detected. Tumor volume decreased significantly with a volume reduction rate of 1.00 ± 0.01 (range: 0.99 to 1.0) at the final evaluation and seven cases (31.8%) were completely resolved. No complication was encountered. No statistical differences were observed in terms of complications, recurrence or the volume reduction rate compared with the nonisthmic group (all p > 0.05). Conclusions: Percutaneous microwave ablation is an effective treatment strategy for isthmic-PTMC.
Collapse
Affiliation(s)
- Lin Zheng
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Fang-Yi Liu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Jie Yu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Zhi-Gang Cheng
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Xiao-Ling Yu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Xiao-Cong Dong
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Zhi-Yu Han
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Ping Liang
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| |
Collapse
|
21
|
Tsujino S, Seki Y, Maehara M, Shirasawa S. Palsy of the posterior interosseous nerve treated by targeted ultrasound-guided perineural hydrodissection. J Ultrason 2021; 21:e357-e360. [PMID: 34970449 PMCID: PMC8678637 DOI: 10.15557/jou.2021.0059] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 09/21/2021] [Indexed: 11/28/2022] Open
Abstract
Perineural hydrodissection is a minimally invasive technique using an injection of fluid to dissect the perineural plane and tissue space. This report describes a case of palsy of the descending branch of the posterior interosseous nerve (PIN) which was recovered by targeted ultrasound-guided perineural hydrodissection. Ultrasonographic examination was performed, and multiple stenotic lesions interrupted by hyperechoic bands within the fascicles of the PIN were found. Using ultrasonography, perineural hydrodissection was performed four times every other week. Fifteen weeks after the first hydrodissection, there was no restriction in the patient’s thumb and fingers movement, and ultrasonography revealed that multiple stenotic lesions had improved. Today, surgical treatment is recommended for patients with complete nerve constriction. However, there is no standardized approach for patients with incomplete or without nerve constriction. Ultrasound-guided perineural hydrodissection is a noninvasive and easy method. This procedure could be a useful diagnostic and therapeutic modality for the management of the disease.
Collapse
Affiliation(s)
- Shohei Tsujino
- Department of Orthopedic Surgery, Suwa Central Hospital, Nagano, Japan
| | - Yasuhiro Seki
- Department of Orthopedic Surgery, Suwa Central Hospital, Nagano, Japan
| | - Manabu Maehara
- Department of Rehabilitation Medicine, Suwa Central Hospital, Nagano, Japan
| | | |
Collapse
|
22
|
Wu YT, Wu CH, Lin JA, Su DC, Hung CY, Lam SKH. Efficacy of 5% Dextrose Water Injection for Peripheral Entrapment Neuropathy: A Narrative Review. Int J Mol Sci 2021; 22:12358. [PMID: 34830240 DOI: 10.3390/ijms222212358] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 11/11/2021] [Accepted: 11/12/2021] [Indexed: 12/19/2022] Open
Abstract
Current non-surgical treatment for peripheral entrapment neuropathy is considered insignificant and unsustainable; thus, it is essential to find an alternative novel treatment. The technique of perineural injection therapy using 5% dextrose water has been progressively used to treat many peripheral entrapment neuropathies and has been proven to have outstanding effects in a few high-quality studies. Currently, the twentieth edition of Harrison’s Principles of Internal Medicine textbook recommends this novel injection therapy as an alternative local treatment for carpal tunnel syndrome (CTS). Hence, this novel approach has become the mainstream method for treating CTS, and other studies have revealed its clinical benefit for other peripheral entrapment neuropathies. In this narrative review, we aimed to provide an insight into this treatment method and summarize the current studies on cases of peripheral entrapment neuropathy treated by this method.
Collapse
|
23
|
Schwarzman P, Samueli B, Shaco-Levy R, Baumfeld Y, Leron E, Weintraub AY. The role of hydrodissection in native tissue repair of anterior vaginal wall defects. Aust N Z J Obstet Gynaecol 2021; 62:98-103. [PMID: 34580858 DOI: 10.1111/ajo.13431] [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: 02/09/2021] [Revised: 06/24/2021] [Accepted: 08/31/2021] [Indexed: 12/01/2022]
Abstract
AIMS A variety of surgical techniques are available for vaginal prolapse repair, indicating a lack of consensus. A debate regarding the utility of hydrodissection for splitting the surgical plane of the vaginal wall exists. The aim of this study is to evaluate the impact of hydrodissection in anterior colporrhaphy (AC). MATERIALS Patients undergoing primary AC were randomly assigned to an approach with (study group) versus without (control group) hydrodissection. Five surgeons performed both techniques, and the trimmed vaginal tissue was retrieved for histological analysis. Two pathologists, blinded to the surgical approach, evaluated the presence of a loose connective tissue at the surgical dissection plane (controversially deemed 'fascia', as explained in this article). In addition, we compared the operative time, pain score and haemoglobin levels. After statistical analysis, data were presented using percentile, and statistical significance was tested using the χ2 and Fisher's exact tests. RESULTS Forty-six patients underwent primary elective AC, with 23 patients in each, the study and control groups. The groups were comparable regarding age (study group 60.33 ± 11.95 years and control group 59.86 ± 12.04, P = 0.90), menopausal status (study group 17 (73.9%) and control group 15 (68.2%), P = 0.67) and other characteristics. We found no difference in sample characteristics between the two groups. Connective tissue was found in only 13.6% (n = 3) of patients after hydrodissection and in 27.3% (n = 6) of patients without hydrodissection (P = 0.46). The hydrodissection group had significantly less bleeding than the control group (ΔHB 0.66 ± 0.66 vs 1.21 ± 0.84, P = 0.05). CONCLUSIONS After hydrodissection, less bleeding was noted without compromise the surgical planes.
Collapse
Affiliation(s)
- Polina Schwarzman
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Benzion Samueli
- Department of Pathology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ruth Shaco-Levy
- Department of Pathology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Yael Baumfeld
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,Faculty of Health Sciences, Clinical Research Center, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Elad Leron
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Adi Y Weintraub
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| |
Collapse
|
24
|
Bhatt AA, Whaley DH, Lee CU. Ultrasound-Guided Breast Biopsies: Basic and New Techniques. J Ultrasound Med 2021; 40:1427-1443. [PMID: 32997819 PMCID: PMC8246574 DOI: 10.1002/jum.15517] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 07/14/2020] [Revised: 08/18/2020] [Accepted: 09/11/2020] [Indexed: 05/28/2023]
Abstract
Ultrasound-guided breast biopsies can be challenging to perform, especially when the target is adjacent to the nipple, skin, or implant or when the target is small and in very posterior, dense fibroglandular tissue. Oftentimes, a slightly modified approach can result in a diagnostic biopsy specimen with minimal complications. After a brief review of basic techniques for ultrasound-guided breast biopsies that includes a review of conventional breast biopsy devices, a presentation of procedural modifications and techniques to consider for more challenging cases is described. In particular, novel open-trough and tandem-needle techniques are detailed. Several cases using these techniques are then presented.
Collapse
Affiliation(s)
- Asha A. Bhatt
- Department of RadiologyMayo ClinicRochesterMinnesotaUSA
| | | | | |
Collapse
|
25
|
Li TY, Chen SR, Shen YP, Chang CY, Su YC, Chen LC, Wu YT. Long-term outcome after perineural injection with 5% dextrose for carpal tunnel syndrome: a retrospective follow-up study. Rheumatology (Oxford) 2021; 60:881-887. [PMID: 32856082 DOI: 10.1093/rheumatology/keaa361] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [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: 03/13/2020] [Revised: 05/22/2020] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE Perineural injection therapy with 5% dextrose water is progressively becoming a mainstream method for treating carpal tunnel syndrome. However, its long-term outcome is still unknown. Hence, the purpose of this retrospective study was to investigate the long-term outcome after perineural injection therapy using 5% dextrose water. METHODS A total of 185 patients diagnosed with carpel tunnel syndrome at least 1 year post-therapy were enrolled. All the patients underwent ultrasound-guided perineural injection therapy using 10 ml of 5% dextrose water at the outpatient department. In a structured telephone interview, the patients were asked about the outcome post-therapy compared with pre-injection. A symptom relief ≥50% indicated effective outcome, and a symptom relief <50% was indicative of a poor outcome. RESULTS In total, 88.6% patients reported an effective outcome, and 11.4% rated the outcome as poor, after a mean of 2.2 injections with a mean of 1-3 years' post-injection follow-up. The outcome was significantly related with severity level, and the patients that reported a poor outcome had a significantly higher incidence of severe grade compared with those who reported an effective outcome (52.4% vs 31.7%, P = 0.03). Patients with mild, moderate and severe grades, respectively, required an average of 1.7 (0.1), 2.4 (0.2) and 2.6 (0.3) injections to reach an effective outcome (P = 0.006) (severe vs mild, P = 0.008; moderate vs mild, P = 0.062). CONCLUSION Perineural injection therapy is a novel approach for treatment of carpal tunnel syndrome with safe and outstanding long-term effects.
Collapse
Affiliation(s)
- Tsung-Ying Li
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Neihu District, Taipei, Taiwan, Republic of China.,Integrated Pain Management Center, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Neihu District, Taipei, Taiwan, Republic of China
| | - Si-Ru Chen
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Neihu District, Taipei, Taiwan, Republic of China
| | - Yu-Ping Shen
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Neihu District, Taipei, Taiwan, Republic of China
| | - Chih-Ya Chang
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Neihu District, Taipei, Taiwan, Republic of China
| | - Yu-Chi Su
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Neihu District, Taipei, Taiwan, Republic of China
| | - Liang-Cheng Chen
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Neihu District, Taipei, Taiwan, Republic of China
| | - Yung-Tsan Wu
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Neihu District, Taipei, Taiwan, Republic of China.,Integrated Pain Management Center, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Neihu District, Taipei, Taiwan, Republic of China
| |
Collapse
|
26
|
Sharma GK, Botchu R. Dorsal scapular nerve entrapment neuropathy managed by ultrasound-guided hydrodissection - a case report. J Ultrason 2021; 21:74-76. [PMID: 33791120 PMCID: PMC8008197 DOI: 10.15557/jou.2021.0012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 10/03/2020] [Accepted: 11/09/2020] [Indexed: 11/22/2022] Open
Abstract
There are myriad causes for upper thoracic and interscapular pain which include pathologies involving the thoracic spine, costovertebral joints, facet joints and muscles (rhomboids and levator scapulae). Dorsal scapular nerve entrapment and the resulting neuropathy is a rare case of upper thoracic and medial scapular pain. The symptoms of dorsal scapular nerve entrapment neuropathy can be similar to other pathologies mentioned above. We report a rare case of dorsal scapular nerve entrapment managed successfully by ultrasound-guided hydrodissection, and describe the technique for the same. Awareness of this rare entity is advised while evaluating upper thoracic and interscapular pain.
Collapse
Affiliation(s)
- Gaurav Kant Sharma
- Department of Radiology, MGM Medical College and Hospital, Jaipur, India
| | - Rajesh Botchu
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK
| |
Collapse
|
27
|
Searle T, Al-Niaimi F, Ali FR. Saline in dermatologic surgery. J Cosmet Dermatol 2021; 20:1346-1347. [PMID: 33569876 DOI: 10.1111/jocd.13996] [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: 01/12/2021] [Accepted: 02/09/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Tamara Searle
- University of Birmingham Medical School, Birmingham, UK
| | - Firas Al-Niaimi
- Department of Dermatology, Aalborg University Hospital, Aalborg, Denmark
| | - Faisal R Ali
- Dermatological Surgery & Laser Unit, Guy's Hospital Cancer Centre, St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| |
Collapse
|
28
|
Hu HQ, Huang H, Huang J, Leng JC, Li M, Tang C, Li Y, Wu S. Case Report: Successful Outcome for Refractory Diabetic Peripheral Neuropathy in Patients With Ultrasound-Guided Injection Treatment. Front Endocrinol (Lausanne) 2021; 12:735132. [PMID: 34777245 PMCID: PMC8581352 DOI: 10.3389/fendo.2021.735132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 09/21/2021] [Indexed: 12/02/2022] Open
Abstract
Diabetic peripheral neuropathy is the most prevalent chronic complication of diabetes and is based on sensory and autonomic nerve symptoms. Generally, intensive glucose control and nerve nourishment are the main treatments. However, it is difficult to improve the symptoms for some patients; such cases are defined as refractory diabetic peripheral neuropathy (RDPN). In this paper, we present five patients treated with saline and mecobalamin by ultrasound-guided injection. The Visual Analog Scale and Toronto Clinical Scoring System were used to evaluate the symptoms, and the neuro-ultrasound scoring system and electrophysiological severity scale were evaluated by ultrasound and electrophysiological examination. In brief, ultrasound-guided hydrodissection may be a safe way to treat RDPN.
Collapse
|
29
|
Chen SR, Ho TY, Shen YP, Li TY, Su YC, Lam KHS, Chen LC, Wu YT. Comparison of short- and long-axis nerve hydrodissection for carpal tunnel syndrome: A prospective randomized, single-blind trial. Int J Med Sci 2021; 18:3488-3497. [PMID: 34522175 PMCID: PMC8436111 DOI: 10.7150/ijms.63815] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 08/02/2021] [Indexed: 01/04/2023] Open
Abstract
Background: This study is to compare the efficacy of short-axis hydrodissection with long-axis hydrodissection for patients with mild-to-moderate carpal tunnel syndrome (CTS). Methods: Forty-seven patients with mild-to-moderate CTS were enrolled in a prospective, randomized, single-blinded, controlled trial (6 months follow-up). With ultrasound guidance, patients in both groups (short-axis or long-axis groups) were injected with normal saline (5 mL per session). Assessments were performed before and 2 weeks after the injection, as well as at 1, 3, and 6 months post-intervention. The primary outcome measure was the Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) score and secondary outcomes included the cross-sectional area of the median nerve and electrophysiological studies. Results: Forty-four patients (21 wrists in the short-axis group and 23 wrists in the long-axis group) completed the study. Compared with the baseline, both groups showed improved BCTQ and cross-sectional area at all follow-up assessments (p<0.05). The short-axis group was not more effective except significant improvements in BCTQ-severity and BCTQ-function 1 month post-injection compared to the long-axis group (p = 0.031 and p = 0.023, respectively). Conclusions: Both short- and long-axis hydrodissection were effective for patients with mild-to-moderate CTS and the short-axis approach was not more effective than long-axis injection. Further studies with larger sample sizes, multiple injections, and larger injection volume are encouraged in the future.
Collapse
Affiliation(s)
- Si-Ru Chen
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, No. 325, Sec. 2, Cheng-Kung Road, Neihu District, Taipei, Taiwan, Republic of China
| | - Tsung-Yen Ho
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, No. 325, Sec. 2, Cheng-Kung Road, Neihu District, Taipei, Taiwan, Republic of China.,Department of Physical Medicine and Rehabilitation, Taichung Armed Forces General Hospital, No. 348, Sec. 2, Chungshan Road, Taiping District, Taichung City, Taiwan, Republic of China
| | - Yu-Ping Shen
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, No. 325, Sec. 2, Cheng-Kung Road, Neihu District, Taipei, Taiwan, Republic of China
| | - Tsung-Ying Li
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, No. 325, Sec. 2, Cheng-Kung Road, Neihu District, Taipei, Taiwan, Republic of China.,Integrated Pain Management Center, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, No. 325, Sec. 2, Cheng-Kung Road, Neihu District, Taipei, Taiwan, Republic of China
| | - Yu-Chi Su
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, No. 325, Sec. 2, Cheng-Kung Road, Neihu District, Taipei, Taiwan, Republic of China
| | - King Hei Stanley Lam
- The Hong Kong Institute of Musculoskeletal Medicine, Hong Kong.,Department of Family Medicine, the Chinese University of Hong Kong, Hong Kong.,Department of Family Medicine, the University of Hong Kong, Hong Kong
| | - Liang-Cheng Chen
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, No. 325, Sec. 2, Cheng-Kung Road, Neihu District, Taipei, Taiwan, Republic of China
| | - Yung-Tsan Wu
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, No. 325, Sec. 2, Cheng-Kung Road, Neihu District, Taipei, Taiwan, Republic of China.,Integrated Pain Management Center, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, No. 325, Sec. 2, Cheng-Kung Road, Neihu District, Taipei, Taiwan, Republic of China
| |
Collapse
|
30
|
Lin MT, Liao CL, Hsiao MY, Hsueh HW, Chao CC, Wu CH. Volume Matters in Ultrasound-Guided Perineural Dextrose Injection for Carpal Tunnel Syndrome: A Randomized, Double-Blinded, Three-Arm Trial. Front Pharmacol 2020; 11:625830. [PMID: 33391002 PMCID: PMC7773892 DOI: 10.3389/fphar.2020.625830] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [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: 11/04/2020] [Accepted: 11/26/2020] [Indexed: 12/17/2022] Open
Abstract
Ultrasound-guided perineural dextrose injection (PDI) has been reported effective for carpal tunnel syndrome (CTS). Higher volume of injectate may reduce adhesion of median nerve from other tissues, but volume-dependent effects of PDI in CTS remain unknown. We aimed to investigate whether PDI with different injectate volumes had different effects for CTS participants. In this randomized, double-blinded, three-arm trial, 63 wrists diagnosed with CTS were randomized into three groups that received ultrasound-guided PDI with either 1, 2 or 4 ml of 5% dextrose water. All participants finished this study. Primary outcome as visual analog scale (VAS) and secondary outcomes including Boston Carpal Tunnel Questionnaire (BCTQ), Disability of the Arm, Shoulder and Hand score (QuickDASH), electrophysiological studies and cross-sectional area (CSA) of the median nerve at carpal tunnel inlet were assessed before and after PDI at the 1st, 4th, 12th and 24th weeks. For within-group analysis, all three groups (21 participants, each) revealed significant improvement from baseline in VAS, BCTQ and QuickDASH at the 1st, 4th, 12th and 24th weeks. For between-group analysis, 4 ml-group yielded better VAS reduction at the 4th and 12th weeks as well as improvement of BCTQ and QuickDASH at the 1st, 4th, and 12th weeks, compared to other groups. No significant between-group differences were observed in electrophysiological studies or median nerve CSA at any follow-up time points. There were no severe complications in this trial, and transient minor adverse effects occurred equally in the three groups. In conclusion, ultrasound-guided PDI with 4 ml of 5% dextrose provided better efficacy than with 1 and 2 ml based on symptom relief and functional improvement for CTS at the 1st, 4th, and 12th week post-injection, with no reports of severe adverse effects. There was no significant difference between the three groups at the 24th-week post-injection follow-up. Clinical Trial Registration:www.ClinicalTrials.gov, identifier NCT03598322.
Collapse
Affiliation(s)
- Meng-Ting Lin
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
| | - Chun-Li Liao
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
| | - Ming-Yen Hsiao
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Hsueh-Wen Hsueh
- Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
| | - Chi-Chao Chao
- Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
| | - Chueh-Hung Wu
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.,Department of General Medicine, National Taiwan University Hospital Biomedical Park Branch, Hsinchu, Taiwan
| |
Collapse
|
31
|
Piraccini E, Calli M, Taddei S, Maitan S. Erector spinae plane block and rhomboid intercostal block for the treatment of post-mastectomy pain syndrome. Saudi J Anaesth 2020; 14:517-519. [PMID: 33447197 PMCID: PMC7796725 DOI: 10.4103/sja.sja_203_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 04/07/2020] [Indexed: 11/21/2022] Open
Abstract
Post-mastectomy pain syndrome (PMPS) can have multiple pain generators, including neuropathic pain and myofascial pain syndrome (MPS). Erector spinae plane (ESP) block and rhomboid intercostal block (RIB) have been used to provide anesthesia of the thorax and also for some chronic pain conditions. We describe a 43-year-old man suffering from right PMPS after right mastectomy, full axillary, and mammary lymph node dissection. We treated her with ESP blocks and RIB to reduce neuralgia and MPS: Neuropathic pain disappeared and the patient experienced only slight residual pain. The result was maintained 3 months later. This report suggests that ESP block and RIB with local anesthetic and corticosteroids with might be useful to treat a PMPS.
Collapse
Affiliation(s)
- Emanuele Piraccini
- Anesthesia, Intensive Care Nord and Pain Management Unit, Bellaria Hospital, Bologna, Italy
| | - Morena Calli
- Department of Surgery, Anesthesia and Intensive Care Section "G.B. Morgagni-Pierantoni" Hospital, Forlì, Italy
| | - Stefania Taddei
- Anesthesia, Intensive Care Nord and Pain Management Unit, Bellaria Hospital, Bologna, Italy
| | - Stefano Maitan
- Department of Surgery, Anesthesia and Intensive Care Section "G.B. Morgagni-Pierantoni" Hospital, Forlì, Italy
| |
Collapse
|
32
|
Schrier VJMM, Brault JS, Amadio PC. Ultrasound-Guided Hydrodissection With Corticosteroid Injection in the Treatment of Carpal Tunnel Syndrome: A Pilot Study. J Ultrasound Med 2020; 39:1759-1768. [PMID: 32255205 DOI: 10.1002/jum.15279] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 01/16/2020] [Revised: 03/04/2020] [Accepted: 03/13/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES Corticosteroid injections can provide (temporary) relief in patients with mild to moderate carpal tunnel syndrome (CTS). Hydrodissection as part of an injection has been associated with positive clinical outcomes but data for CTS so far has been scarce. This study is designed to assess patient tolerance and secondarily provide pilot data on the added effect of hydrodissection. METHODS Twenty CTS patients were randomized to an ultrasound-guided betamethasone injection with hydrodissection (5 mL) or without (2 mL). Patient tolerance was assessed directly after intervention and patient-reported outcome after 4 and 24 weeks. Intra-group data were compared using Wilcoxon Signed Rank and inter-group with Wilcoxon rank-sum tests. RESULTS Tolerance and pain scores did not differ between the two groups. Symptom scores decreased in both groups, but to a lesser extent in the hydrodissection group with a mean difference of -0.8 versus -1.5 in the control group at 4 weeks (P = .02). At 6 months, this difference was no longer present (P = .81). No statistically significant differences were found between the hydrodissection and control groups in the function or pain scores at follow-up at either time point. CONCLUSION After injection, both symptomatic and functional scores improved, but the hydrodissected group did not show additional improvement. Data presented can be used to support larger studies to assess the value of hydrodissection in CTS management.
Collapse
Affiliation(s)
- Verena J M M Schrier
- Departments of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
- Department of Plastic, Reconstructive, and Hand Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Jeffrey S Brault
- Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
| | - Peter C Amadio
- Departments of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
33
|
Gakis G, Karl A, Bertz S, Burger M, Fritsche HM, Hartmann A, Jokisch F, Kempkensteffen C, Miller K, Mundhenk J, Schneevoigt BS, Schubert T, Schwentner C, Wullich B, Stenzl A. Transurethral en bloc submucosal hydrodissection vs conventional resection for resection of non-muscle-invasive bladder cancer (HYBRIDBLUE): a randomised, multicentre trial. BJU Int 2020; 126:509-519. [PMID: 32578332 DOI: 10.1111/bju.15150] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine whether transurethral en bloc submucosal hydrodissection of bladder tumours (TUEB) improves the quality of the resection compared to conventional transurethral resection of bladder tumour (TURBT) in patients with non-muscle-invasive bladder cancer (NMIBC). PATIENTS AND METHODS A randomised, multicentre trial (HYBRIDBLUE) was conducted with a superiority design. Six German academic centres participated between September 2012 and August 2015. Based on literature analysis, a sample size for accurate histopathological assessment concerning muscle invasion was assumed to be feasible in 50% (P0 = 0.5) of TURBT and 80% of TUEB cases. After pre-screening of a total of 305 patients, participants were allocated to two study arms: Group I: hexaminolevulinate (HAL)-guided TUEB; Group II: conventional HAL-guided TURBT. The primary endpoint was the proportion of specimens that could be reliably evaluated pathologically concerning muscle invasiveness. Secondary endpoints included rates of histopathological completeness of the resection, muscularis propria content, recurrence, and complication rates. RESULTS A total of 115 patients (TUEB 56; TURBT 59) were eligible for final analysis. Adequate histopathological assessment, which included muscularis propria content and tumour margins (R0 vs R1), was present in 48/56 (86%) TUEB patients compared to 37/59 (63%; P = 0.006) in the TURBT group. R0 was confirmed in 30/56 TUEB patients (57%) and five of 59 TURBT patients (9%; P < 0.001). No complications of Grade ≥III were observed in both arms. At 3 and 12 months, three and 19 patients recurred in the TUEB group vs seven and 11 patients in the TURBT group, respectively (P = 0.33 and P = 0.08). CONCLUSIONS In this randomised study, TUEB was shown to be clinically safe regarding perioperative endpoints. An adequate histopathological assessment concerning muscle invasion was significantly better assessable in the TUEB arm compared to standard TURBT. This finding indicates the clinical potential for reducing the rate of early re-resections. Yet, a larger study with recurrence-free survival as the primary endpoint is needed to assess the oncological efficacy between both techniques.
Collapse
Affiliation(s)
- Georgios Gakis
- Department of Urology and Pediatric Urology, University Hospital of Würzburg, Würzburg, Germany.,Department of Urology, University Hospital of Tübingen, Tübingen, Germany
| | - Alexander Karl
- Department of Urology, University Hospital of Munich-Grosshadern, Munich, Germany
| | - Simone Bertz
- Department of Pathology, University Hospital of Erlangen-Nürnberg, Erlangen, Germany
| | - Maximillian Burger
- Department of Urology, Caritas St. Josef Hospital, University of Regensburg, Regensburg, Germany
| | - Hans-Martin Fritsche
- Department of Urology, Caritas St. Josef Hospital, University of Regensburg, Regensburg, Germany
| | - Arndt Hartmann
- Department of Pathology, University Hospital of Erlangen-Nürnberg, Erlangen, Germany
| | - Friedrich Jokisch
- Department of Urology, University Hospital of Munich-Grosshadern, Munich, Germany
| | | | - Kurt Miller
- Department of Urology, Charite, University Hospital of Berlin, Berlin, Germany
| | - Jens Mundhenk
- Department of Urology, Diakonie-Klinikum Stuttgart, Stuttgart, Germany
| | | | - Tina Schubert
- Department of Urology and Pediatric Urology, University Hospital of Würzburg, Würzburg, Germany.,Department of Urology, University Hospital of Tübingen, Tübingen, Germany
| | | | - Bernd Wullich
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Erlangen, Germany
| | - Arnulf Stenzl
- Department of Urology, University Hospital of Tübingen, Tübingen, Germany
| |
Collapse
|
34
|
Song B, Marathe A, Chi B, Jayaram P. Hydrodissection as a therapeutic and diagnostic modality in treating peroneal nerve compression. Proc (Bayl Univ Med Cent) 2020; 33:465-466. [PMID: 32675990 DOI: 10.1080/08998280.2020.1758006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 03/29/2020] [Revised: 04/12/2020] [Accepted: 04/16/2020] [Indexed: 01/16/2023] Open
Abstract
A 51-year-old man presented with pain in the region of his left patellar tendon and fibular head. He had previously undergone three L5 epidural steroid injections and physical therapy without relief. Prior magnetic resonance imaging was significant only for fat pad impingement, and electromyography and nerve conduction studies were negative. Ultrasound demonstrated an enlarged peroneal nerve suggestive of peroneal nerve entrapment. Three ultrasound-guided hydrodissection procedures offered symptomatic improvement and identified an area posterior to the fibular head that was unable to be hydrodissected, indicating scar tissue causing peroneal nerve compression. The patient was referred for peroneal nerve decompression at the area of entrapment with complete symptom relief. This case is unique in describing the ability of hydrodissection to identify nerve compression not visualized with other diagnostic tests.
Collapse
Affiliation(s)
- Bo Song
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of MedicineHoustonTexas.,Baylor College of MedicineHoustonTexas
| | | | - Bradley Chi
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of MedicineHoustonTexas.,Baylor College of MedicineHoustonTexas
| | - Prathap Jayaram
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of MedicineHoustonTexas.,Baylor College of MedicineHoustonTexas
| |
Collapse
|
35
|
Delzell PB, Patel M. Ultrasound-Guided Perineural Injection for Pronator Syndrome Caused by Median Nerve Entrapment. J Ultrasound Med 2020; 39:1023-1029. [PMID: 31705693 DOI: 10.1002/jum.15166] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 09/23/2019] [Accepted: 10/15/2019] [Indexed: 06/10/2023]
Abstract
Patients and physicians have increasingly sought minimally invasive procedures such as ultrasound-guided injection for the treatment of peripheral nerve entrapment syndromes. In this series, we assessed subjective outcome data in 14 patients who underwent ultrasound-guided perineural hydrodissection and steroid injection for pronator syndrome secondary to median nerve entrapment in the pronator tunnel. Excellent symptomatic relief (≥75% improvement) was achieved in 70% of nerves with 3-month follow-up data, with no significant change in symptoms between 3 and 6 months. These outcomes suggest that this technique could play a role in the management of pronator syndrome due to median nerve entrapment.
Collapse
Affiliation(s)
| | - Mital Patel
- Edward Hines Jr Veterans Administration Hospital, Hines, Illinois, USA
| |
Collapse
|
36
|
Samadi K, Arellano R. Comparison of clinical outcome between pyeloperfused versus non-pyeloperfused microwave ablation of renal cell carcinoma. Pol J Radiol 2019; 84:e447-52. [PMID: 31969964 DOI: 10.5114/pjr.2019.89966] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 10/09/2019] [Indexed: 01/20/2023] Open
Abstract
Purpose We present the outcomes of microwave ablation (MWA) of renal cell carcinoma (RCC) with and without pyeloperfusion. Material and methods A retrospective review of patients’ records was undertaken to identify patients with RCC, who were treated with MWA with and without adjunctive pyeloperfusion. The distance between the tumour and ureter as well as the tumour size were measured on axial imaging. Pyeloperfusion was performed in nine patients in this series after placement of a ureteral stent and instilment of diluted contrast into the ureter. MWAs of the tumours were performed under computed tomography (CT) guidance. Hydrodissection was performed to displace at-risk organs. Creatinine was measured as renal function index after and before the procedure. A CT scan was performed at the end of the procedure and also after one, three, and six months, to identify the presence of residual disease and complications. Results Eighteen biopsies of proven RCC were treated with 20 sessions of MWA. The average follow-up time for this study was 180 days. The average distance between the ureter and the tumour in axial CT view was 20.8 (± 2.9) mm. Primary efficacy was achieved in 88% of pyeloperfused patients and in 100% of the non-pyeloperfused patients. Two pyeloperfused patients required secondary procedure, and full secondary efficacy was achieved for both. There was only one grade 2 urological complication, which occurred in a patient who underwent pyeloperfusion. Creatinine was not significantly different after the procedure in this study (p-value 0.4). Conclusion In this study MWAs of RCCs were successfully performed using pyeloperfusion as a protective measure against thermal injury to the ureter.
Collapse
|
37
|
Yao Z, Wu T, Zheng B, Tan L, Lian Y, Liu B, Ren J. A Novel Strategy for Single-Session Ultrasound-Guided Radiofrequency Ablation of Large Benign Thyroid Nodules: A Pilot Cohort Study. Front Endocrinol (Lausanne) 2020; 11:560508. [PMID: 33117279 PMCID: PMC7575788 DOI: 10.3389/fendo.2020.560508] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 09/03/2020] [Indexed: 12/11/2022] Open
Abstract
Background: Ultrasound-guided radiofrequency ablation (RFA) of thyroid nodules (TNs) is a minimally invasive procedure that has been widely used to induce volume reduction in symptomatic solid benign TNs. The goal of this study was to investigate a novel therapeutic approach for single-session ablation of large thyroid nodules (LTNs, vol > 20 ml). Methods: We performed a pilot cohort study of 21 patients with symptomatic solid benign LTNs (vol > 20 ml), who accepted ultrasound-guided RFA treatment between September 2018 and November 2019. RFA was performed using an 18-gauge internally cooled electrode with ultrasonographic guidance in a single session combined with intraoperative hydrodissection and immediate contrast-enhanced ultrasound (CEUS) to optimize safety and efficacy. Nodule volume was evaluated before ablation and at 1, 3, and 6 months after initial ablation, and all patients were asked to assess the cosmetic score (from 1 to 4) and symptom score (from 0 to 10) before ablation and at every follow-up after ablation. Results: At the 6 month follow-up, there was significant nodule volume reduction, from 27.49 ml ± 7.9 (standard deviation) to 3.82 ml ± 5.02 (p = 0.001). Cosmetic signs (p = 0.001) and pressure symptoms (p = 0.001) were significantly improved. All patients underwent RFA without any major complications, and very few patients developed a change in voice (2/21). However, the changes subsided within 1 month. Almost half of the patients received an additional RFA (11/21) treatment to achieve complete ablation on the intraoperative immediate CEUS evaluation. Conclusion: RFA is effective for treating LTNs (vol > 20 ml) and controlling clinical symptoms with a low complication rate. Patients were satisfied with cosmetic sign and pressure symptom improvement. The intraoperative hydrodissection and immediate CEUS represent a novel therapeutic approach for single-session ablation of LTNs.
Collapse
Affiliation(s)
- Zhicheng Yao
- Department of General Surgery, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Tao Wu
- Department of Interventional Ultrasound, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Bowen Zheng
- Department of Interventional Ultrasound, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Lei Tan
- Department of Interventional Ultrasound, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yufan Lian
- Department of Interventional Ultrasound, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Bo Liu
- Department of General Surgery, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- *Correspondence: Bo Liu
| | - Jie Ren
- Department of Interventional Ultrasound, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- Jie Ren
| |
Collapse
|
38
|
Abdessater M, Elias S, Boustany J, El Khoury R. Bilateral laparoscopic ureterolysis using hydrodissection in retroperitoneal fibrosis: a new application of an old technique. Res Rep Urol 2019; 11:131-135. [PMID: 31119118 PMCID: PMC6507073 DOI: 10.2147/rru.s201396] [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: 01/13/2019] [Accepted: 03/05/2019] [Indexed: 11/30/2022] Open
Abstract
Objective: To describe our new laparoscopic approach in ureterolysis using the ERBEJET® 2 device to hydrodissect the ureters in idiopathic retroperitoneal fibrosis. Methods: Bilateral laparoscopic ureterolysis was done after medical therapy failure (steroids) in a 47 year old patient with retroperitoneal fibrosis. Ureteral stents were placed before surgery. Only five trocars were used for both sides, Toldt’s fascia was opened and the dissection was performed till the psoas muscle. The ureters were completely freed from the fibrotic tissue using the ERBEJET 2 device (pure hydrodissection). An omental wrap was passed behind the colonic flexure at the right and placed around the ureter. At the left, we closed Toldt’s fascia by running sutures back to the freed ureter. Results: The operating time was 198 mins. The blood loss was 50 cc. The hospital stay was 3 days. The double J stents were removed at 4 weeks postoperatively. After 2 years, the patient is free of symptoms with normal creatinine level and no urinary tract obstructions. Conclusions: Hydrodissection of the ureter in retroperitoneal fibrosis is a new application in the upper urinary tract laparoscopic approach that has not been described in literature before. It seems to offer excellent midterm outcomes. The use of ERBEJET 2 device seems to simplify the procedure and make it feasible and safe (less trauma to the ureter and more conservation of its blood supply). We believe that comparative studies are needed to assess the role of hydrodissection in ureterolysis for retroperitoneal fibrosis.
Collapse
Affiliation(s)
- Maher Abdessater
- Urology Department, Centre Hospitalier Régional René DUBOS, Pontoise, 95300, France
| | - Sandra Elias
- Anesthesia Department, Institut Gustave Roussy, Villejuif, 94550, France
| | - Johnny Boustany
- Urology Department, Notre Dame Des Secours University Medical Center, Byblos, Lebanon
| | - Raghid El Khoury
- Urology Department, Notre Dame Des Secours University Medical Center, Byblos, Lebanon
| |
Collapse
|
39
|
Yamagami T, Yoshimatsu R, Kajiwara K, Yamanishi T, Minamiguchi H, Karashima T, Inoue K. Protection from injury of organs adjacent to a renal tumor during percutaneous cryoablation. Int J Urol 2019; 26:785-790. [PMID: 31094038 DOI: 10.1111/iju.14013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 03/02/2019] [Accepted: 04/07/2019] [Indexed: 01/20/2023]
Abstract
Renal cryoablation has become accepted as treatment for small renal tumors as an alternative to surgery. However, parallel with the increase in the use of this therapy, there also has been increases in the number of reports of complications related to renal cryoablation. One potential complication is injury to important non-renal structures adjacent to the ablated renal tumor, such as the colon, duodenum, ureter, psoas muscle and so on. To prevent injury of adjacent organs, separating organs from the tumor is desirable. Over the past 15 years, several techniques have been developed to protect against injury of organs adjacent to renal tumors that are targets of cryoablation. The most commonly used technique for this purpose has been hydrodissection. Others include dissection with gas, balloon dissection and probe traction. To avoid injury of a ureter running near the renal tumor, pyeloperfusion is known to be useful. The rate of cases necessitating avoidance of organ injury by using these techniques is relatively high. In some cases, more than two techniques are combined. In the present review, we provided an overview of techniques currently available to protect against organ injuries, and discussed the advantages and disadvantages of each technique.
Collapse
Affiliation(s)
- Takuji Yamagami
- Department of Radiology, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan
| | - Rika Yoshimatsu
- Department of Radiology, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan
| | - Kenji Kajiwara
- Department of Radiology, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan
| | - Tomoaki Yamanishi
- Department of Radiology, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan
| | - Hiroki Minamiguchi
- Department of Radiology, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan
| | - Takashi Karashima
- Department of Urology, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan
| | - Keiji Inoue
- Department of Urology, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan
| |
Collapse
|
40
|
Blumenthal EZ, Mimouni M. Remote hydrodissection. Eur J Ophthalmol 2019; 30:209-211. [PMID: 30722695 DOI: 10.1177/1120672119827774] [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] [Indexed: 11/17/2022]
Abstract
We describe a technique for performing hydrodissection in which the cannula tip is not advanced beyond the capsulorhexis edge, nor embedded into the cortex, but instead is placed within the capsulorhexis boundaries, pointing to the capsulorhexis edge, and angled slightly posterior to it. The fluid stream squirted from the cannula creates a cleavage plane between the capsule and cortex (hydrodissection), with a distinct wave dissecting the posterior capsule off the overlying cortex. By later rotating the angle slightly more posteriorly, hydrodelineation occurs, with the resultant "golden ring," and often, multiple "golden rings." The cleavage planes obtained using this technique may be more precise than when embedding the cannula tip under and beyond the capsulorhexis edge. This "remote hydrodissection" technique is easy and reproducible with soft and medium lenses, becoming more difficult to perform with harder cataracts. Hence, we recommend that this modification should initially be learned/tried on softer lenses.
Collapse
Affiliation(s)
- Eytan Z Blumenthal
- Department of Ophthalmology, Rambam Health Care Campus, Haifa, Israel.,School of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Michael Mimouni
- Department of Ophthalmology, Rambam Health Care Campus, Haifa, Israel.,School of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| |
Collapse
|
41
|
Żabicki B, Kubiak K, Gabriel M, Juszkat R. Percutaneous direct thrombin injection with hydrodissection to manage type II endoleak after endovascular abdominal aortic aneurysm repair. Pol J Radiol 2018; 83:e461-4. [PMID: 30655925 DOI: 10.5114/pjr.2018.80250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 07/09/2018] [Indexed: 11/17/2022] Open
Abstract
Type II endoleak is the most common complication after endovascular abdominal aortic aneurysm repair (EVAR). The management remains controversial. We present a case in which endoleak was successfully treated by direct percutaneous thrombin injection with hydrodissection. This method seems to be a safe and feasible alternative method for treatment of type II endoleak.
Collapse
|
42
|
Alsaeid MA. Dexamethasone versus Hyaluronidase as an Adjuvant to Local Anesthetics in the Ultrasound-guided Hydrodissection of the Median Nerve for the Treatment of Carpal Tunnel Syndrome Patients. Anesth Essays Res 2019; 13:417-422. [PMID: 31602055 PMCID: PMC6775841 DOI: 10.4103/aer.aer_104_19] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background: Carpal tunnel syndrome (CTS) is one of the most common focal entrapment neuropathies. Although the exact etiology remains unclear, high-pressure-related intracarpal tunnel compression of the median nerve (MN), progressing ischemia, and mechanical strangulation are common mechanisms. The therapeutic managements for CTS depend on the disease severity, varying from a conservative treatment to surgical interventions. Conservative treatment is helpful for most of the patients with mild-to-moderate CTS. Hydrodissection is a minimally invasive procedure of injecting solutions into some anatomical spaces to facilitate dissection and adhesiolysis. Steroids as an anti-inflammatory drugs are used to treat chronic pain conditions. Hyaluronidase as an adhesolysis agent can also be used for epidural injections with local anesthetics (LAs) and steroids for control of chronic back pain. Aim of the Study: This study was carried out to compare the efficacy of hyaluronidase versus dexamethasone as adjuvants to the mixture of LAs in ultrasound (US)-guided hydrodissection of the median nerve in mild to moderate cases of carpal tunnel syndrome. Settings and Design: This study was a prospective randomized controlled double-blinded clinical study. Methods: 40 patients aged from 20 to 60 years old with clinical, electrophysiologic, and ultrasonographic evidence of mild to moderate CTS were included in this study. Each patient was assessed at the baseline (prior to injection) and at 1 week, 1 month, 3 months, and 6 months intervals after injection: (1) The Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) which is a frequently used patient-based questionnaire for measurement of CTS. primary outcome. (2) Median motor and sensory nerve conduction studies (NCS) secondary outcome. (3) Median nerve ultrasonography. The ultrasound examination included measurement of the median nerve cross-sectional area (CSA) at the distal wrist crease (DWC). Also, the median nerve echogenicity, mobility, and vascularity at the DWC were assessed by US. Secondary outcome. All outcome assessments were assessed by single investigator who was blinded to the study details. All patients received US guided hydrodissection of the median nerve at the distal wrist crease. The selected patients were randomly allocated into 2 groups containing 20 patients each according to the study drugs; Group (D) received 5 mL (3 mL plain bupivacaine 0.5% and 2 mL (8 mg) dexamethasone), and Group (H) received 5 mL (3 mL plain bupivacaine 0.5% and 2 mL normal saline containing 300 international units (IU) hyaluronidase. Ultrasound-guided intracarpal injection using ultrasonography (Sono Scape A5; Shinzhen, China) with a 10-18-MHZ linear array transducer was performed by the same physician who was not aware of study groups, the MN was observed at the inlet of the carpal tunnel, 3 ml of solution was injected via the in-plane ulnar approach, to detach the MN from the transverse carpal ligament and an additional 2 ml was injected to separate the MN from underlying flexor tendons. All patients were observed for 30 minutes post injection for possible side effects before discharge. Normally distributed numerical data are presented as mean ± standard deviation, and differences between the groups were compared using the independent Student's t-test. Chi-square test was used for categorical data. Intragroup data at different follow up time points were evaluated using paired Student's t-test. All statistical tests were two-tailed, with P < 0.05 being considered statistically significant. Results: The demographic data of the patients in both groups were statistically insignificant (P-value >0.05). In the pre-injection time, there were no statistically significant differences between both groups as regards BCTQ (SSS, FSS), electrophysiological studies (SNCV, DML), and sonographic data (CSA, echogenicity score, mobility score, and vascularity score). The comparison between both groups showed that measured parameters as regards BCTQ (SSS, FSS), electrophysiological studies (SNCV, DML), and sonographic data (CSA, echogenicity score, mobility score, and vascularity score) were significantly improved in group H compared with group D in the follow up periods at 1 week, 1 month, 3 months and 6 months post-injection (P-value <0.05). The comparison within each group showed that in group D, the measured parameters; BCTQ (SSS, FSS), electrophysiological studies (SNCV, DML), and sonographic data (CSA, echogenicity score, mobility score, and vascularity score) were statistically significantly improved at 1 week, 1 month and 3 months follow up post-injection times but they were not significantly improved at 6 months post-injection time compared with the pre-injection data (P-value >0.05). While in group H, these measured parameters were statistically significantly improved in the all follow up post-injection times; at 1 week, 1 month, 3 months and even at 6 months periods compared with the baseline pre-injection data (P-value < 0.05). Conclusion: In this study, it was concluded that MN hydrodissction using hyaluronidase (as an adhesolysis agent) significantly improved patients with mild to moderate CTS compared to steroid (as an anti-inflammatory agents) hydrodissection of MN as regards BCTQ (SSS, FSS), electrophysiological studies (SNCV, DML), and sonographic data (CSA, echogenicity score, mobility score, and vascularity score) not only at 1 week, 1 month and 3 months follow up post-injection times but these parameters were also significantly improved at 6 months post-injection time in bupivacaine- hyaluronidase hydrodissection group compared to bupivacaine-steroid hydrodissection group.
Collapse
Affiliation(s)
- Mohammed Awad Alsaeid
- Department of Anesthesia and Pain Management, Faculty of Medicine, Fayoum University, Fayoum, Egypt
| |
Collapse
|
43
|
Abstract
Traditional hydrodissection may cause posterior capsule rupture (PCR) if excessive fluid accumulates. In this study, we describe the successful application of a novel minimal fluid hydrodissection technique in 100 consecutive cataract surgery cases. This technique separates the nucleus from the capsule utilizing low hydrostatic pressure and precise kinetic movement of a small volume (around 0.2 cc) of balanced salt solution. There were no instances of PCR. This technique is suitable for a range of cases, including femtosecond laser-assisted cataract surgery and posterior subcapsular cataract.
Collapse
Affiliation(s)
- Hung-Yuan Lin
- Universal Eye Center, Zhongli, Taiwan.,Department of Optometry, Central Taiwan University of Science and Technology, Taichung, Taiwan.,Department of Ophthalmology, Fujian Medical University, Fujian Sheng, China
| | | | - Ting-Yu Lin
- Department of Chemistry, Barnard College, Columbia University, New York, USA
| | - Ming Chen
- Department of Surgery, Division of Ophthalmology, University of Hawaii, John A. Burns School of Medicine, Honolulu, HI, USA
| | | |
Collapse
|
44
|
Lazio MS, Vallin A, Giannini C, Taverna C, Maggiore G, Saraceno MS, Gallo O. Phonosurgical Resection Using Submucosal Infusion Technique for Early Glottic Lesions: Diagnostic and Therapeutic Procedure? Ann Otol Rhinol Laryngol 2018; 128:277-285. [PMID: 30547680 DOI: 10.1177/0003489418819544] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES: The aim of this study was to assess the feasibility of the submucosal infusion combined with microflap dissection via laser CO2 as both a diagnostic and therapeutic procedure for superficial glottic lesions. To define a safe surgical procedure in terms of local control, a morphometric study of surgical margins was performed. METHODS: From January 2011 to January 2016, we treated 122 patients with early glottic lesions with phonomicrosurgery. Patients with effective hydrodissection underwent a microflap and type I-II diagnostic cordectomy. In the others, a biopsy was carried out, and in the case of a malignant lesion, a type III to VI cordectomy was performed. Disease-free survival (DFS) for all the lesions was also determined according to comparative assessments of surgical margins. The Voice Handicap Index was used to evaluate functional outcomes. RESULTS: In 27 cases (32%), hydrodissection was effective; specifically, 24 (88.8%) were premalignant lesions, and 3 (11.2%) had a carcinoma. In 56 patients (68%), hydrodissection was not adequate, and a biopsy was performed: 9 (16%) were premalignant and 47 (84%) malignant lesions. The DFS analysis suggests that margins >0.7 mm resulted in a cutoff that can guarantee a safe procedure in the case of effective hydrodissection ( P < .05). CONCLUSION: Phonomicrosurgery may be both a diagnostic and therapeutic option with oncological efficacy for superficial glottic lesions of undetermined nature when surgical margins exceed 0.7 mm. In case of inadequate hydrodissection, the hypothesis of an infiltrative carcinoma warrants a wider cordectomy.
Collapse
Affiliation(s)
- Maria Silvia Lazio
- 1 Clinic of Otolaryngology, Head and Neck Surgery, Department of Translational Surgery and Medicine, Careggi University Hospital, Florence, Italy
| | - Alberto Vallin
- 1 Clinic of Otolaryngology, Head and Neck Surgery, Department of Translational Surgery and Medicine, Careggi University Hospital, Florence, Italy
| | - Costanza Giannini
- 1 Clinic of Otolaryngology, Head and Neck Surgery, Department of Translational Surgery and Medicine, Careggi University Hospital, Florence, Italy
| | - Cecilia Taverna
- 2 Section of Anatomic Pathology, Department of Surgery and Translational Medicine, Careggi University Hospital, Florence, Italy
| | - Giandomenico Maggiore
- 1 Clinic of Otolaryngology, Head and Neck Surgery, Department of Translational Surgery and Medicine, Careggi University Hospital, Florence, Italy
| | - Massimo Squadrelli Saraceno
- 1 Clinic of Otolaryngology, Head and Neck Surgery, Department of Translational Surgery and Medicine, Careggi University Hospital, Florence, Italy
| | - Oreste Gallo
- 1 Clinic of Otolaryngology, Head and Neck Surgery, Department of Translational Surgery and Medicine, Careggi University Hospital, Florence, Italy
| |
Collapse
|
45
|
Randev S, Gupta VK, Kumar P, Mahajan V, Angurana SK, Guglani V. Brain Hydatid in a Child. J Pediatr 2018; 199:280. [PMID: 29699795 DOI: 10.1016/j.jpeds.2018.03.016] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Accepted: 03/07/2018] [Indexed: 11/16/2022]
Affiliation(s)
- Shivani Randev
- Department of Pediatrics; Government Medical College and Hospital
| | - Vipin K Gupta
- Department of Neurosurgery; Government Medical College and Hospital
| | | | - Vidushi Mahajan
- Department of Pediatrics; Government Medical College and Hospital
| | | | - Vishal Guglani
- Department of Pediatrics; Government Medical College and Hospital; Chandigarh, India
| |
Collapse
|
46
|
Salman Roghani R, Holisaz MT, Tarkashvand M, Delbari A, Gohari F, Boon AJ, Lokk J. Different doses of steroid injection in elderly patients with carpal tunnel syndrome: a triple-blind, randomized, controlled trial. Clin Interv Aging 2018; 13:117-124. [PMID: 29403268 PMCID: PMC5779277 DOI: 10.2147/cia.s151290] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [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] [Indexed: 11/23/2022] Open
Abstract
Background Carpal tunnel syndrome (CTS) is commonly seen in elderly populations, in part due to increased presence of predisposing comorbidities as well as physiological changes. We aimed at comparing the effectiveness of different doses of steroid using the ultrasound-guided hydrodissection method in elderly patients with CTS. Methods We conducted a prospective, triple-blind, randomized, controlled trial in elderly patients with CTS. Patients were allocated to one of three groups by simplified randomization. Groups I–III received 80 mg triamcinolone (2 mL) and 1 mL of 2% lidocaine; 40 mg triamcinolone (1 mL), 1 mL of 2% lidocaine, and 1 mL normal saline; and 1 mL of 2% lidocaine and 2 mL normal saline, respectively to make up to 3 mL volume. A wrist splint was then applied for support. Outcome measures included the visual analog scale (VAS) and the Boston Carpal Tunnel Questionnaire, and median motor and sensory nerve conduction and its sonographic inlet cross-sectional area were used as objective measures. All data were recorded at baseline and 2, 12, and 24 weeks after injection. The investigators, patients, and statistician were blinded to the treatment assignment. Results In total, 161 patients were recruited without statistically significant demographic differences between the three groups. There were no statistically significant differences between groups in any outcome, with the exception of the median distal motor latency, which was greater in Group II at all three follow-up visits, and significant baseline VAS difference between Groups I and III. Conclusion Hydrodissection with lidocaine and normal saline is as effective as hydrodissection with low- and high-dose steroid medication in elderly patients with CTS in this study, but further studies with matched baseline measures and also a sham group are suggested for definitive recommendation.
Collapse
Affiliation(s)
- Reza Salman Roghani
- Department of Neurobiology, Care Sciences and Society, Division of Clinical Geriatrics, Karolinska Institutet, Stockholm, Sweden.,Physical Medicine and Rehabilitation Research Center, Shahid Beheshti University of Medical Sciences
| | - Mohammad Taghi Holisaz
- Department of Physical Medicine and Rehabilitation, Baqiyatallah University of Medical Sciences
| | - Masoud Tarkashvand
- Department of Physical Medicine and Rehabilitation, Baqiyatallah University of Medical Sciences
| | - Ahmad Delbari
- Research Center on Aging, University of Social Welfare and Rehabilitation, Tehran, Iran
| | - Faeze Gohari
- Physical Medicine and Rehabilitation Research Center, Shahid Beheshti University of Medical Sciences
| | - Andrea J Boon
- Department of Physical Medicine and Rehabilitation.,Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Johan Lokk
- Department of Neurobiology, Care Sciences and Society, Division of Clinical Geriatrics, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
47
|
Evers S, Thoreson AR, Smith J, Zhao C, Geske JR, Amadio PC. Ultrasound-guided hydrodissection decreases gliding resistance of the median nerve within the carpal tunnel. Muscle Nerve 2018; 57:25-32. [PMID: 28622409 PMCID: PMC5722677 DOI: 10.1002/mus.25723] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [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] [Accepted: 06/09/2017] [Indexed: 11/09/2022]
Abstract
INTRODUCTION The aim of this study was to assess alterations in median nerve (MN) biomechanics within the carpal tunnel resulting from ultrasound-guided hydrodissection in a cadaveric model. METHODS Twelve fresh frozen human cadaver hands were used. MN gliding resistance was measured at baseline and posthydrodissection, by pulling the nerve proximally and then returning it to the origin. Six specimens were treated with hydrodissection, and 6 were used as controls. RESULTS In the hydrodissection group there was a significant reduction in mean peak gliding resistance of 92.9 ± 34.8 mN between baseline and immediately posthydrodissection (21.4% ± 10.5%; P = 0.001). No significant reduction between baseline and the second cycle occurred in the control group: 9.6 ± 29.8 mN (0.4% ± 5.3%; P = 0.467). DISCUSSION Hydrodissection can decrease the gliding resistance of the MN within the carpal tunnel, at least in wrists unaffected by carpal tunnel syndrome. A clinical trial of hydrodissection seems justified. Muscle Nerve 57: 25-32, 2018.
Collapse
Affiliation(s)
- Stefanie Evers
- Biomechanics Laboratory and Tendon and Soft Tissue Biology Laboratory, Division of Orthopedic Research, Mayo Clinic, Rochester, MN, United States
- Department of Plastic, Reconstructive and Hand surgery, Erasmus MC, Rotterdam, the Netherlands
- Department of Rehabilitation Medicine, Erasmus MC, Rotterdam, the Netherlands
| | - Andrew R. Thoreson
- Biomechanics Laboratory and Tendon and Soft Tissue Biology Laboratory, Division of Orthopedic Research, Mayo Clinic, Rochester, MN, United States
| | - Jay Smith
- Departments of Physical Medicine and Rehabilitation, Radiology and Anatomy, Mayo clinic, Rochester, MN, United States
| | - Chunfeng Zhao
- Biomechanics Laboratory and Tendon and Soft Tissue Biology Laboratory, Division of Orthopedic Research, Mayo Clinic, Rochester, MN, United States
| | - Jennifer R. Geske
- Department of Biomedical Statistics and Informatics, Mayo clinic, Rochester, MN, United States
| | - Peter C. Amadio
- Biomechanics Laboratory and Tendon and Soft Tissue Biology Laboratory, Division of Orthopedic Research, Mayo Clinic, Rochester, MN, United States
| |
Collapse
|
48
|
Cheng Z, Yu X, Han Z, Liu F, Yu J, Liang P. Ultrasound-guided hydrodissection for assisting percutaneous microwave ablation of renal cell carcinomas adjacent to intestinal tracts: a preliminary clinical study. Int J Hyperthermia 2017. [PMID: 28641464 DOI: 10.1080/02656736.2017.1338362] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
PURPOSE To evaluate the safety and efficacy of the clinical application of hydrodissection under ultrasound (US) guidance for assisting percutaneous microwave ablation (MWA) for the treatment of renal cell carcinomas (RCCs) adjacent to the intestinal tract. MATERIALS AND METHODS From April 2014 to December 2016, clinical data from 24 patients with 25 RCCs were retrospectively analysed. Percutaneous MWA under the assistance of US-guided hydrodissection were performed to treat RCCs with a mean maximal diameter of 3.80 ± 1.60 cm because the distance between the index tumour and the adjacent intestinal tracts were less than 0.5 cm on imaging. The separation success rate of the hydrodissection, technique efficacy rate of the MWA, local tumour progression (LTP), complications, and renal function including serum creatinine (Cr) and blood urea nitrogen (BUN) were assessed. RESULTS In total, 28 sessions of hydrodissection and MWA procedures were performed (one procedure in 22 patients and two procedures in 3 patients), and the separation success rate was 100% (28/28). The technique efficacy rate was 100% (25/25), and no LTP occurred. One patient exhibited a major complication (4.2%). Minor complications in 5 patients (20.8%) and side effects in 12 patients (50.0%) occurred. Compared with the pre-MWA levels, there were no significant differences in serum Cr and BUN 1-day post-MWA and at the last follow-up. CONCLUSIONS US-guided hydrodissection assistance for percutaneous MWA could be a safe and effective alternative for selected patients with RCCs adjacent to the intestinal tracts and can achieve good local tumour control and renal function preservation.
Collapse
Affiliation(s)
- Zhigang Cheng
- a Department of Interventional Ultrasound , Chinese PLA General Hospital , Beijing , China
| | - Xiaoling Yu
- a Department of Interventional Ultrasound , Chinese PLA General Hospital , Beijing , China
| | - Zhiyu Han
- a Department of Interventional Ultrasound , Chinese PLA General Hospital , Beijing , China
| | - Fangyi Liu
- a Department of Interventional Ultrasound , Chinese PLA General Hospital , Beijing , China
| | - Jie Yu
- a Department of Interventional Ultrasound , Chinese PLA General Hospital , Beijing , China
| | - Ping Liang
- a Department of Interventional Ultrasound , Chinese PLA General Hospital , Beijing , China
| |
Collapse
|
49
|
Abstract
The irrigation dynamic pressure-assisted hydrodissection technique (irrigation-hydro [iH]) does not require performing manual hydrodissection using a syringe and cannula to achieve cortical-capsular cleavage during cataract surgery. Since the iH technique uses the phaco tip to intentionally vacuum the intraocular fluid in order to induce the irrigation dynamic pressure for cortical-capsular cleavage, there is a reduction in the intraocular pressure (IOP) from the bottle-height-dependent hydrostatic pressure. Thus, since the peak irrigation pressure derived from the phaco tip sleeve will be limited by the height of the irrigation fluid bottle, this is advantageous in helping to avoid excessively high IOP during cortical-capsular hydrodissection. Using this technique, we were able to effectively perform phacoemulsification without complications in 607 of 609 cataract eyes. Our findings show that utilization of the iH technique would be of benefit to patients, as it prevents high-pressure hydrodissection-related complications, such as capsular block syndrome and tears in the anterior hyaloid membrane during cataract surgery.
Collapse
Affiliation(s)
- Yoichiro Masuda
- Department of Ophthalmology, The Jikei University, Katsushika Medical Center
| | | | - Noriko Kato
- Department of Ophthalmology, The Jikei University, Katsushika Medical Center
| | - Genichiro Takahashi
- Department of Ophthalmology, The Jikei University, Katsushika Medical Center
| | | | - Hiroshi Tsuneoka
- Department of Ophthalmology, The Jikei University, School of Medicine, Tokyo, Japan
| |
Collapse
|
50
|
Abstract
Use of the phaco tip technique for lens cleavage and removal does not require manual hydrodissection using a syringe and cannula, or cortical removal using an irrigation/aspiration tip. The phaco tip is the only surgical instrument required for this technique. Its advantages include maintaining a stable intraocular pressure during cortical cleaving hydrodissection and lens removal, which includes the cortex.
Collapse
Affiliation(s)
- Yoichiro Masuda
- Department of Ophthalmology, Jikei University Katsushika Medical Center
| | | | | | - Toshinori Okamoto
- Department of Ophthalmology, Jikei University Katsushika Medical Center
| | - Hiroshi Tsuneoka
- Department of Ophthalmology, Jikei University School of Medicine, Tokyo, Japan
| |
Collapse
|