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Tabei T, Ito H, Inoue T, Watanabe T, Fukuda T, Yamamichi F, Matsuzaki J, Kobayashi K. Influence of tract location on the outcomes of endoscopic combined intrarenal surgery: A retrospective analysis of 1000 cases. Int J Urol 2024; 31:349-354. [PMID: 38131285 DOI: 10.1111/iju.15363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 12/05/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVES This study aimed to investigate the influence of tract location on surgical outcomes in endoscopic combined intrarenal surgery (ECIRS), considering the location of residual stones. METHODS From January 2015 to December 2021, 1417 consecutive patients underwent ECIRS in three hospitals. After excluding patients with preoperative percutaneous nephrostomy, intended multi-stage procedures, those with a tract in the renal pelvis, and those with multiple tracts, 1000 patients were retrospectively analysed by comparing three groups based on tract location: group 1 (upper calyx), group 2 (middle calyx), and group 3 (lower calyx). A multivariate logistic regression model was implemented to assess whether the tract location independently affected the stone-free status. RESULTS Patient characteristics were significantly different among the groups in terms of age, stone laterality, presence of calyceal stones, and hydronephrosis. There were no differences in stone-free rate (SFR) among the three groups. Multivariate analysis indicated that the tract location (group 1 or 2 compared with group 3) did not significantly affect the stone-free status (odds ratio = 1.4, 0.9-1.9, p = 0.066). Surgical duration significantly varied among the groups, with the shortest time observed in group 1. Organ injury was observed exclusively in group 1 (1.13%). Residual fragments were predominantly found in the lower calyx, with the calyx associated with the tract being the second most common location. CONCLUSIONS Tract location does not significantly affect SFR. To improve the SFR, observation of the lower calyx and tract placement is important.
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Affiliation(s)
- Tadashi Tabei
- Department of Urology, Fujisawa Shounandai Hospital, Fujisawa, Kanagawa, Japan
- Department of Urology, Yokosuka Kyosai Hospital, Yokosuka, Kanagawa, Japan
| | - Hiroki Ito
- Department of Urology, Yokosuka Kyosai Hospital, Yokosuka, Kanagawa, Japan
- Department of Urology, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan
| | - Takaaki Inoue
- Department of Urology, Hara Genitourinary Hospital, Kobe, Hyogo, Japan
| | - Takahiko Watanabe
- Department of Urology, Yokosuka Kyosai Hospital, Yokosuka, Kanagawa, Japan
| | - Tetsuo Fukuda
- Department of Urology, Ohguchi Higashi General Hospital, Yokohama, Kanagawa, Japan
| | - Fukashi Yamamichi
- Department of Urology, Hara Genitourinary Hospital, Kobe, Hyogo, Japan
| | - Junichi Matsuzaki
- Department of Urology, Ohguchi Higashi General Hospital, Yokohama, Kanagawa, Japan
| | - Kazuki Kobayashi
- Department of Urology, Yokosuka Kyosai Hospital, Yokosuka, Kanagawa, Japan
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Ono K, Fukuhara D, Nagahama K, Abe Y, Takahashi K, Majima T. Percutaneous Endoscopic Transforaminal Lumbar Interbody Fusion (PETLIF): Current Techniques, Clinical Outcomes, and Narrative Review. J Clin Med 2023; 12:5391. [PMID: 37629437 PMCID: PMC10455973 DOI: 10.3390/jcm12165391] [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: 06/26/2023] [Revised: 08/06/2023] [Accepted: 08/15/2023] [Indexed: 08/27/2023] Open
Abstract
Full endoscopic techniques are becoming more popular for degenerative lumbar pathologies. Percutaneous endoscopic lumbar interbody fusion (PETLIF) is a minimally invasive surgical technique for spondylolisthesis and lumbar spinal canal stenosis with instability. Nagahama first introduced PETLIF in 2019. This study investigated the clinical outcomes and complications of 24 patients who underwent PETLIF in our facility and compared them with previous studies. Literature searches were conducted on PubMed and Web of Science. The PETLIF surgical technique involves three steps to acquire disc height under general anesthesia. The procedure includes bone harvesting, spondylolisthesis reduction, endoscopic foraminoplasty, disc height expansion using an oval dilator, and intervertebral disc curettage. A cage filled with autologous bone is inserted into the disc space and secured with posterior fixation. Patients underwent PETLIF with an average operation time of 130.8 min and a blood loss of 24.0 mL. Postoperative hospital stays were 9.5 days. Improvement in VAS, disc height, spinal canal area, and % slip was observed, while lumbar lordosis remained unchanged. Complications included end plate injury, subsidence, and exiting nerve root injury. The differences between PETLIF and the extracted literature were found in patients' age, direct decompression, epidural or local anesthesia, approach, order of PPS, and cage insertion. In conclusion, PETLIF surgery is a practical, minimally invasive surgical technique for patients with lumbar degenerative diseases suffering from back and leg pain, demonstrating significant improvements in pain scores. However, it is essential to carefully consider the potential complications and continue to refine the surgical technique further to enhance the safety and efficacy of this procedure.
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Affiliation(s)
- Koichiro Ono
- Department of Orthopedic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan; (D.F.); (T.M.)
| | - Daisuke Fukuhara
- Department of Orthopedic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan; (D.F.); (T.M.)
- Department of Orthopedic Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto 602-8566, Japan;
| | - Ken Nagahama
- Sapporo Endoscopic Spine Surgery Clinic, 1-13, North-16, East-16, Higashi-ku, Sapporo 065-0016, Japan;
| | - Yuichiro Abe
- Sapporo Medical Research, 1-20-1501, Kita13 Higashi2, Hidashi-ku, Sapporo 065-0013, Japan;
| | - Kenji Takahashi
- Department of Orthopedic Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto 602-8566, Japan;
| | - Tokifumi Majima
- Department of Orthopedic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan; (D.F.); (T.M.)
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Malik A, Sato KT, Riaz A. Acute Pancreatitis following Percutaneous Electrohydraulic Lithotripsy. Semin Intervent Radiol 2023; 40:294-297. [PMID: 37484449 PMCID: PMC10359116 DOI: 10.1055/s-0043-1769768] [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: 07/25/2023]
Abstract
The gold-standard treatment of acute calculous cholecystitis is cholecystectomy. For patients not suitable for surgery, endoscopic or percutaneous techniques can be used for gallbladder decompression. The national percutaneous cholecystostomy rates have increased by 567% from 1994 to 2009*. Some of these patients are still not surgical candidates after the acute cholecystitis episode has resolved. Hence, it is crucial to have a management plan in place for such patients. There are several peroral endoscopic treatment options available, including ultrasound-guided transmural drainage, lithotripsy, and transpapillary stenting**. Furthermore, due to the advent of percutaneous biliary endoscopes, interventional radiology (IR) can now perform percutaneous lithotripsy and gallstone removal followed by cystic duct stenting. This method aims to internalize gallbladder drainage without the need for a long-term external cholecystostomy tube. Acute pancreatitis is a rare complication that can arise following interventions involving the biliary and cystic ducts. Acute pancreatitis can occur after retrograde ampullary manipulation during endoscopic retrograde cholangiopancreatography. However, this can sometimes happen after percutaneous antegrade interventions performed by IR. In this report, we will examine a rare complication that occurred in a patient with acute calculous cholecystitis: acute pancreatitis following percutaneous electrohydraulic lithotripsy with cystic duct stenting performed by IR.
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Affiliation(s)
- Asad Malik
- Division of Interventional Radiology, Department of Radiology, Northwestern University, Chicago, Illinois
| | - Kent T. Sato
- Division of Interventional Radiology, Department of Radiology, Northwestern University, Chicago, Illinois
| | - Ahsun Riaz
- Division of Interventional Radiology, Department of Radiology, Northwestern University, Chicago, Illinois
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Jing X, Gong Z, Qiu X, Zhong Z, Ping Z, Hu Q. "Cave-in" decompression under unilateral biportal endoscopy in a patient with upper thoracic ossification of posterior longitudinal ligament: Case report. Front Surg 2023; 9:1030999. [PMID: 36684180 PMCID: PMC9852340 DOI: 10.3389/fsurg.2022.1030999] [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: 08/29/2022] [Accepted: 11/08/2022] [Indexed: 01/09/2023] Open
Abstract
Background Thoracic ossification of the posterior longitudinal ligament (TOPLL) requires surgery for spinal cord decompression. Traditional open surgery is extremely invasive and has various complications. Unilateral biportal endoscopy (UBE) is a newly developed technique for spine surgery, especially in the lumbar region, but rare in the thoracic spine. In this study, we first used a different percutaneous UBE "cave-in" decompression technique for the treatment of beak-type TOPLL. Methods A 31-year-old female with distinct zonesthesia and numbness below the T3 dermatome caused by beak-type TOPLL (T2-T3) underwent a two-step UBE decompression procedure. In the first step, the ipsilateral lamina, left facet joint, partial transverse process, and pedicles of T2 and T3 were removed. In the second step, a cave was created by removing the posterior third of the vertebral body (T2-T3). The eggshell-like TOPLL was excised by forceps, and the dural sac was decompressed. All procedures are performed under endoscopic guidance. A drainage tube was inserted, and the incisions were closed after compliance with the decompression scope via a C-arm. The patient's preoperative and postoperative radiological and clinical results were evaluated. Results Postoperative CT and MR films conformed complete decompression of the spinal cord. The patient's lower extremity muscle strength was greatly improved, and no complications occurred. The mJOA score improved from 5 to 7, with a recovery rate of 33.3%. Conclusion UBE spinal decompression for TOPLL showed favorable clinical and radiological results and offers the advantages of minimal soft tissue dissection, shorter hospital stays, and a faster return to daily life activities.
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Muacevic A, Adler JR. Endoscope-Assisted Traversal of a Ureteral Stricture From Percutaneous Nephrostomy Access. Cureus 2022; 14:e30913. [PMID: 36465772 PMCID: PMC9711930 DOI: 10.7759/cureus.30913] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2022] [Indexed: 01/25/2023] Open
Abstract
Interventional radiology-operated endoscopy has a small but growing number of applications. In this clinical case report, we describe the use of an endoscope to assist the traversal of a high-grade ureteral stricture from percutaneous nephrostomy (i.e., antegrade) access. Direct visualization of the stricture allowed the identification of a central channel that was not present in fluoroscopic images, making endoscopy essential to the technical success of the procedure. Endoscopy is a powerful adjunct to image-guided techniques, particularly in challenging interventions or cases with complex anatomy.
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单侧双通道脊柱内镜与经皮内镜及椎板间开窗髓核摘除术治疗腰椎间盘突出症临床对比研究. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2022; 36. [PMID: 36310455 DOI: 10.7507/1002-1892.202205129] [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: 01/24/2023]
Abstract
OBJECTIVE To investigate the effectiveness of unilateral biportal endoscopic discectomy (UBED), percutaneous endoscopic lumbar discectomy (PELD), and traditional fenestration discectomy (FD) in the treatment of lumbar disc herniation (LDH). METHODS The clinical data of 347 LDH patients who met the selection criteria and underwent discectomy between January 2017 and December 2021 were retrospectively analyzed. They were divided into FD group (160 cases), PELD group (86 cases), and UBED group (101 cases) according to operation methods. There was no significant difference in gender, age, surgical level distribution, disease duration, and preoperative visual analogue scale (VAS) score and Oswestry disability index (ODI) between groups ( P>0.05). The operation time, hospitalization stay, treatment cost, and incidence of surgery-related complications were recorded and compared between groups. The patients' pain and functional recovery were evaluated by VAS score and ODI before and after operation. RESULTS The operation time of FD group was significantly shorter than that of PELD group and UBED group, and the hospitalization stay was significantly longer than that of PELD group and UBED group ( P<0.05); there was no significant difference between PELD group and UBED group ( P>0.05). The treatment cost in UBED group was significantly higher than that in PELD group, and in PELD group than in FD group ( P<0.05). All the patients were followed up 6-24 months, with an average of 14.6 months. VAS score of lower extremity and ODI in 3 groups significantly improved after operation when compared with that before operation ( P<0.05). At 1 day after operation, VAS score of lower extremity of UBED group was significantly better than that in PELD group and FD group ( P<0.05), but there was no significant difference between PELD group and FD group ( P>0.05). There was no significant difference in VAS scores of lower extremity between the 3 groups at 1 and 3 months after operation ( P>0.05). The difference of ODI before and after operation in FD group and UBED group was slightly better than that in PELD group ( P<0.05), and there was no significant difference between FD group and UBED group ( P>0.05). Incidence of surgery-related complications in FD group (20.0%) was significantly higher than that in PELD group (12.8%) and UBED group (6.9%), and PELD group was significantly higher than UBED group ( P<0.05). All the incision infection occurred in FD group (12 cases), symptomatic disc cyst and myeloid hypertension-like occurred in 1 case each in PELD group. CONCLUSION UBED, PELD, and FD have similar effectiveness on lower extremity pain in early LDH. Compared with FD, UBED and PELD have the advantage of shorter hospitalization stay and fewer complications.
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Khayat A, Khayat M, Cline M, Riaz A. Percutaneous Biliary Endoscopy. Semin Intervent Radiol 2021; 38:340-347. [PMID: 34393344 DOI: 10.1055/s-0041-1731372] [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: 10/20/2022]
Abstract
Biliary endoscopy is underutilized by interventional radiologists and has the potential to become an effective adjunctive tool to help both diagnose and treat a variety of biliary pathology. This is particularly true in cases where endoscopic retrograde cholangiopancreatography fails or is not feasible due to surgically altered anatomy. Both preoperative clinical and technical procedural factors must be taken into consideration prior to intervention. In this article, clinical evaluation, perioperative management, and procedural techniques for percutaneous biliary endoscopy are reviewed.
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Affiliation(s)
- Adam Khayat
- NYU Long Island School of Medicine, Mineola, New York
| | - Mamdouh Khayat
- Division of Vascular and Interventional Radiology, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Michael Cline
- Division of Vascular and Interventional Radiology, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Ahsun Riaz
- Division of Vascular and Interventional Radiology, Department of Radiology, Northwestern Memorial Hospital, Chicago, Illinois
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Yang CC, Yeh KT, Liu KC, Wu WT. Ameliorated Full-Endoscopic Transforaminal Decompression for L5-S1 Foraminal and Extraforaminal Stenosis. Clin Spine Surg 2021; 34:197-205. [PMID: 34156037 PMCID: PMC8225233 DOI: 10.1097/bsd.0000000000001137] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 12/22/2020] [Indexed: 11/01/2022]
Abstract
STUDY DESIGN This is a retrospective review. OBJECTIVE To describe a modified surgical technique, full-endoscopic transforaminal decompression (FETD) in patients with L5-S1 foraminal stenosis or extraforaminal stenosis (EFS) and to detail the short-term results. SUMMARY OF BACKGROUND DATA Performing FETD surgery for L5-S1 FS and EFS is challenging because of high iliac crests in most cases and the difficulty in accurately differentiating between FS and EFS by images preoperatively. MATERIAL AND METHODS Patients who had solitary unilateral L5-S1 FS or EFS and had undergone FETD between October 2014 and December 2017 were included. In total, 22 patients underwent FETD for L5 root compressions at the L5-S1 levels. All patients were followed up for more than 1 year. RESULTS The mean visual analog scale score for back and leg pain, assessed preoperatively and at 12 months postoperatively, improved from 6.3±1.7 to 1.59±1.30 and from 7.29±0.78 to 1.41±1.20, respectively. The mean Oswestry Disability Index improved from 61.53% preoperatively to 15.8% at 12 months postoperatively. Neurovascular injury-related complications were absent in all these cases. CONCLUSION Successful short-term clinical outcome is achievable using the ameliorated FETD technique for treating L5-S1 FS and EFS.
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Affiliation(s)
- Chang-Chen Yang
- Institute of Medical Sciences, Tzu Chi University, Hualien
- Department of Orthopedics, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
| | - Kuang-Ting Yeh
- School of Medicine, Tzu Chi University, Hualien
- Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan, ROC
| | - Keng-Chang Liu
- Department of Orthopedics, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
| | - Wen-Tien Wu
- Institute of Medical Sciences, Tzu Chi University, Hualien
- School of Medicine, Tzu Chi University, Hualien
- Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan, ROC
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Zhang B, Kong Q, Yang J, Feng P, Ma J, Liu J. [Short-term effectiveness of percutaneous endoscopic transforaminal bilateral decompression for severe central lumbar spinal stenosis]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2019; 33:1399-1405. [PMID: 31650756 DOI: 10.7507/1002-1892.201904131] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Objective To observe the effectiveness and safety of percutaneous endoscopic transforaminal bilateral decompression for severe central lumbar spinal stenosis. Methods A retrospective analysis of 44 patients with single-segment severe central lumbar spinal stenosis with bilateral lower extremity symptoms between October 2015 and December 2017 was performed. Among them, 36 cases underwent bilateral decompression through bilateral transforaminal approach, and 8 cases underwent bilateral decompression through unilateral transforaminal approach. There were 25 males and 19 females, the age ranged from 56 to 89 years with an average of 68.6 years. The disease duration was 5-39 months with an average of 14.5 months. Involved segments: L 3, 4 in 6 cases, L 4, 5 in 33 cases, and L 5, S 1 in 5 cases. The dural sac cross-sectional area (DSCA) of the MRI was (66.36±8.48) mm 2. Morphological grading (MG) classification: 29 cases of grade C, 15 cases of grade D. The visual analogue scale (VAS) score of preoperative low back pain was 2.3±1.0 and the VAS score of lower extremity pain was 7.8±1.2; the Oswestry disability index (ODI) was 77.8±7.3. Postoperative VAS scores, ODI scores, MG classification, and DSCA were recorded and compared with preoperative ones, and clinical outcomes were assessed by using the modified MacNab criteria. Results All patients successfully underwent surgery and the wounds healed by first intention. All 44 patients were followed up 13-46 months with an average of 24.8 months. One patient developed postoperative lower extremity paralysis and 1 patient developed a dural tear. There was no infection, recurrence, or revision surgery during the follow-up. Postoperative imaging showed that the central spinal canal was enlarged and the area of the dural sac was significantly increased compared with preoperative one. The VAS score of low back pain was 2.4±0.6 and 2.5±0.8 at 1 month after operation and at last follow-up, showing no significant difference when compared with preoperative scores ( P>0.05). The VAS of lower limb pain was 2.1±0.6 and 2.0±1.1 at 1 month after operation and at last follow-up, which was significantly improved when compared with preoperative scores ( P<0.05); but no significant difference was found between at 1 month after operation and at last follow-up ( P>0.05). At last follow-up, the ODI score was 19.7±6.4, and the DSCA was (104.93±12.56) mm 2, which was significantly improved when compared with preoperative values ( P<0.05). The MG classification was also significantly higher than preoperative one ( Z=-5.789, P=0.000). According to the modified MacNab criteria, the results were excellent in 32 cases, good in 9 cases, and fair in 3 cases, with an excellent and good rate of 93.2%. Conclusion Percutaneous endoscopic transforaminal bilateral decompression for treating severe central lumbar spinal stenosis has the advantages of less trauma, adequate decompression, and rapid recovery. The short-term effectiveness is good.
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Affiliation(s)
- Bin Zhang
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China;Department of Orthopedics, Hospital of Chengdu Office of People's Government of Tibetan Autonomous Region, Chengdu Sichuan, 610041, P.R.China
| | - Qingquan Kong
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China;Department of Orthopedics, Hospital of Chengdu Office of People's Government of Tibetan Autonomous Region, Chengdu Sichuan, 610041,
| | - Jing Yang
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Pin Feng
- Department of Orthopedics, Hospital of Chengdu Office of People's Government of Tibetan Autonomous Region, Chengdu Sichuan, 610041, P.R.China
| | - Junsong Ma
- Department of Orthopedics, Hospital of Chengdu Office of People's Government of Tibetan Autonomous Region, Chengdu Sichuan, 610041, P.R.China
| | - Junlin Liu
- Department of Orthopedics, Hospital of Chengdu Office of People's Government of Tibetan Autonomous Region, Chengdu Sichuan, 610041, P.R.China
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Fu TS, Wang YC, Lin TY, Chang CW, Wong CB, Su JY. Comparison of Percutaneous Endoscopic Surgery and Traditional Anterior Open Surgery for Treating Lumbar Infectious Spondylitis. J Clin Med 2019; 8:jcm8091356. [PMID: 31480610 PMCID: PMC6780224 DOI: 10.3390/jcm8091356] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 08/28/2019] [Accepted: 08/30/2019] [Indexed: 12/02/2022] Open
Abstract
Minimally invasive surgery is becoming popular for treating spinal disorders. The advantages of percutaneous endoscopic debridement and drainage (PEDD) for infectious spondylitis include direct observation of the lesion, direct pus drainage, and earlier pain relief. We retrospectively reviewed 37 patients who underwent PEDD and 31 who underwent traditional anterior open debridement and interbody fusion with bone grafting from 2004 to 2012. The causative organisms were isolated from 30 patients (81.1%) following PEDD, and from 25 patients (80.6%) following open surgery (p = 0.48). Staphylococcus aureus was the most common pathogen (38.2%). In the PEDD group, blood loss (<50 mL versus 585 ± 428 mL, p < 0.001) was significantly lesser and the duration of hospitalization (24.4 ± 12.5 days versus 31.5 ± 14.6 days, p = 0.03) was shorter than that in the open surgery group. Serologically, there were significantly faster C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) normalization rates in the PEDD group (p < 0.001, p = 0.009, respectively). In the two-year follow-up radiographs, 26 out of 30 (86.7%) open surgery patients showed bony fusions of the infected segments. On the contrary, sclerotic change of the destructive endplates was observed and the motion of infected spinal segments was still preserved in the PEDD group. There was no significant difference in the change of sagittal profile, including primary correction gain, correction loss, and actual correction gain/loss. PEDD is an effective alternative option and should be considered prior to traditional extensive spinal surgery—particularly for patients with early-stage spinal infection or serious complicated medical conditions.
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Affiliation(s)
- Tsai-Sheng Fu
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Keelung branch 20401, Taiwan.
| | - Ying-Chih Wang
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Keelung branch 20401, Taiwan
| | - Tung-Yi Lin
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Keelung branch 20401, Taiwan
| | - Chia-Wei Chang
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Keelung branch 20401, Taiwan
| | - Chak-Bor Wong
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Keelung branch 20401, Taiwan
| | - Juin-Yih Su
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Keelung branch 20401, Taiwan
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Raymond CJ, Khayat M, Chick JFB, Srinivasa RN. Endoscopy as an Adjunct to Image-Guided Interventions: A New Frontier in Interventional Radiology. Tech Vasc Interv Radiol 2019; 22:119-124. [PMID: 31623750 DOI: 10.1053/j.tvir.2019.04.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 12/28/2022]
Abstract
Endoscopy is an underutilized technique in the practice of interventional radiology. The objectives of this article are to discuss potential uses of interventional radiology-operated endoscopy and to outline basic endoscopy setup and equipment uses. Endoscopy represents a new frontier to the fluoroscopically-guided procedures in biliary, gastrointestinal, and genitourinary disease that interventional radiologists commonly perform. It shows promise to improve interventional radiology procedure success rates and reduce procedure-associated risk for patients. Endoscopy has been traditionally performed by gastroenterologists and urologists and is relatively new in the practice of interventional radiology. The hand-eye coordination and manual dexterity required to perform standard image-guided procedures places interventional radiologists in a unique position to introduce endoscopy into standard practice. A focused and collaborative effort is needed by interventional radiologists to learn the techniques required to successfully integrate endoscopy into practice.
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Affiliation(s)
- Clifford J Raymond
- Department of Radiology, Division of Vascular and Interventional Radiology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Mamdouh Khayat
- Department of Radiology, Division of Vascular and Interventional Radiology, The Ohio State University Wexner Medical Center, Columbus, OH.
| | - Jeffrey Forris Beecham Chick
- Division of Interventional Radiology, Department of Radiology, University of Washington, 1959 Northeast Pacific Street, Seattle, WA 98195
| | - Ravi N Srinivasa
- Department of Radiology, Division of Vascular and Interventional Radiology, UCLA Medical Center, Los Angeles, CA
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Roberts DG, Plotnik AN, Chick JF, Srinivasa RN. Interventional radiology-operated percutaneous cholecystoscopy with ultrasonic lithotripsy and stone basket retrieval: A treatment for symptomatic cholelithiasis in non-operative candidates. J Med Imaging Radiat Oncol 2019; 63:340-345. [PMID: 30925003 DOI: 10.1111/1754-9485.12879] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 03/02/2019] [Indexed: 01/14/2023]
Abstract
Interventional radiology-operated percutaneous endoscopy has seen a recent resurgence with potential to return to the scope of Interventional Radiology practice. Endoscopy adds a new dimension to the Interventional Radiology armamentarium by offering a unique opportunity to diagnose and treat conditions under direct visualization with improved maneuverability. Cholecystoscopy (gallbladder endoscopy), as a method for percutaneous removal of gallstones, is an effective treatment option in patients with symptomatic cholelithiasis who are poor candidates for surgical cholecystectomy. This article presents a case of Interventional Radiology-operated cholecystoscopy using ultrasonic lithotripsy and stone basket retrieval with an emphasis on the equipment, technique, and peri-procedural management essential to the procedure, as well as a review of the literature.
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Affiliation(s)
- Dustin G Roberts
- David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Adam N Plotnik
- David Geffen School of Medicine at UCLA, Los Angeles, California, USA.,Division of Interventional Radiology, Department of Radiology, UCLA, Los Angeles, California, USA
| | - Jeffrey Fb Chick
- Cardiovascular and Interventional Radiology, INOVA Alexandria Hospital, Alexandria, Virginia, USA
| | - Ravi N Srinivasa
- David Geffen School of Medicine at UCLA, Los Angeles, California, USA.,Division of Interventional Radiology, Department of Radiology, UCLA, Los Angeles, California, USA
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