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Gani K, Castelhano L, Correia F, Reis LR, Escada P. Endoscopic and External Dacryocystorhinostomy: Long Term Result from a Tertiary Center in Portugal. Indian J Otolaryngol Head Neck Surg 2024; 76:1613-1618. [PMID: 38566741 PMCID: PMC10982182 DOI: 10.1007/s12070-023-04368-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 11/14/2023] [Indexed: 04/04/2024] Open
Abstract
Dacryocystorhinostomy is the gold-standard for distal lacrimal obstructions. This study aims to report the demography, clinical presentation, influence of agger nasi opening, uncinectomy and septoplasty, the use of silicone stent tubes, complications and success of endoscopic and external dacryocystorhinostomy over a period of 11 years. Retrospective review of clinical records, from January 2012 to December 2022, at a tertiary center in Portugal. A total of 249 procedures, 6 external and 243 endoscopic, were performed, including 39 revision cases. There was a female predominance (79.9%) with a mean age at diagnosis of 66.4 years. Recurrent acute dacryocystitis, reported by 33.3%, was associated with higher success (p = 0.053). Agger nasi opening, uncinectomy and septoplasty were performed in 17.7%, 6.0% and 15.3% respectively, although associated with higher success rates, no statistically significant difference was found. Minor complication rates for both external and endoscopic approach was 33.3% and 32.1% respectively. Functional and anatomical success was 100% and 83.3%, respectively, for external dacryocystorhinostomy, and 91.4% and 85.1%, respectively, for endoscopic dacryocystorhinostomy. Revision surgery was associated with a worse anatomical success (p = 0.05). Endoscopic dacryocystorhinostomy is an effective and safe alternative to the external approach. Minor procedures can increase the success rate, but multicentre studies need to be performed for a statistically significant result.
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Affiliation(s)
- Kaamil Gani
- Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | | | | | | | - Pedro Escada
- Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
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Allon R, Cohen O, Bavnik Y, Milstein A, Halperin D, Warman M. Long-term Outcomes for Revision Endoscopic Dacryocystorhinostomy-The Effect of the Primary Approach. Laryngoscope 2020; 131:E682-E688. [PMID: 32521057 DOI: 10.1002/lary.28795] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 05/10/2020] [Accepted: 05/14/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVES/HYPOTHESIS Revision endoscopic dacryocystorhinostomy (END-DCR) is the preferred approach for failed primary surgeries, yet quality data on long-term outcomes are lacking. This study aimed to evaluate three aspects of revision END-DCR: 5-year success rates, patient satisfaction, and the primary surgical approach's possible impact on revision. METHODS This retrospective study included all revision END-DCRs conducted at Kaplan Medical Center between the years 2002 and 2015. For long-term follow-up analysis, two subgroups of first and second revision END-DCRs with a minimum of documented 5-year follow-up after surgery were defined. Data were analyzed according to the primary surgical approach. Surgical success was defined by either anatomical (observed patent lacrimal flow) or functional (symptoms cessation) success. Patient satisfaction was measured by a questionnaire. RESULTS After exclusions, a total of 45 eyes from 38 patients who underwent revision END-DCR surgeries were included in the study. The yearly success rates from immediate to 5 years following the first revision were 93.3%, 75.5%, 71.1%, 68.9%, 68.9%, and 68.9% for the entire cohort, respectively. Immediate and 5-year success rates following the second revision were 88.8% and 77.8%, respectively. Primary END-DCR showed favorable 5-year success rates and patient satisfaction over primary external dacryocystorhinostomy (EXT-DCR) in both first and second revisions, but this did not reach significance. CONCLUSIONS Revision END-DCR carries an excellent short-term success rate, which decreases mainly throughout the first 2 years following surgery. Postoperative follow-up should be maintained within this timeframe. Revision END-DCR following either primary endoscopic or EXT-DCR produces comparable surgical outcomes and patient-reported satisfaction. LEVEL OF EVIDENCE 3b Laryngoscope, 131:E682-E688, 2021.
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Affiliation(s)
- Raviv Allon
- Department of Otolaryngology-Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel.,Hadassah Medical School, Hebrew University, Jerusalem, Israel
| | - Oded Cohen
- Department of Otolaryngology-Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel.,Hadassah Medical School, Hebrew University, Jerusalem, Israel
| | - Yosef Bavnik
- Department of Otolaryngology-Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel.,Hadassah Medical School, Hebrew University, Jerusalem, Israel
| | - Asher Milstein
- Hadassah Medical School, Hebrew University, Jerusalem, Israel.,Department of Ophthalmology, Kaplan Medical Center, Rehovot, Israel
| | - Doron Halperin
- Department of Otolaryngology-Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel.,Hadassah Medical School, Hebrew University, Jerusalem, Israel
| | - Meir Warman
- Department of Otolaryngology-Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel.,Hadassah Medical School, Hebrew University, Jerusalem, Israel
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Trimarchi M, Giordano Resti A, Vinciguerra A, Danè G, Bussi M. Dacryocystorhinostomy: Evolution of endoscopic techniques after 498 cases. Eur J Ophthalmol 2019; 30:998-1003. [DOI: 10.1177/1120672119854582] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction: Endoscopic dacryocystorhinostomy is a well-known surgical practice used to treat nasolacrimal duct obstruction and widely considered as a valid alternative to external approaches. Purpose: We present a retrospective case series of 498 endoscopic dacryocystorhinostomies on 401 patients, from July 2004 to May 2018, at the Department of Otolaryngology, San Raffaele Hospital, Milan, Italy. Methods: Of the 498 procedures, 426 were unilateral and 72 were bilateral dacryocystorhinostomy. All patients underwent routine preoperative workup including fluorescein test (Jones test 1–2), probing and irrigation of the lacrimal way, nasal endoscopy, and maxilla-facial computed tomography scan. Surgical technique was based on nasal endoscopic dacryocystorhinostomy followed by positioning of a Catalano’s silicone stent, which was left in place for about 3 months. Anatomical success was defined as a patent ostium on irrigation, whereas functional success was defined as free lacrimal flow on functional test and resolution of epiphora. Results: Anatomic success was achieved in 91.54% cases in primary dacryocystorhinostomy and in 89.36% after revision, whereas functional success was obtained in 90.4% in primary and 85.1% in secondary dacryocystorhinostomies. After a second revision of endoscopic dacryocystorhinostomy, anatomical success was achieved in 90.1% and functional success in 88.7% of procedures. Conclusion: Our results confirm that endoscopic dacryocystorhinostomy can be considered as a valid surgical approach to primary nasolacrimal duct obstruction and revision cases. The key aspects in achieving functional and anatomical results are meticulous surgical procedure and precise follow-up.
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Affiliation(s)
- Matteo Trimarchi
- Division of Otolaryngology, Department of Surgical Sciences, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milano, Italy
| | - Antonio Giordano Resti
- Division of Ophthalmology, Department of Surgical Sciences, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milano, Italy
| | - Alessandro Vinciguerra
- Division of Otolaryngology, Department of Surgical Sciences, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milano, Italy
| | - Giulia Danè
- Division of Otolaryngology, Department of Surgical Sciences, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milano, Italy
| | - Mario Bussi
- Division of Otolaryngology, Department of Surgical Sciences, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milano, Italy
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Kim SW, Yeo SC, Joo YH, Cho HJ, Seo SW, Jeon SY. Limited endoscopic high septoplasty prior to endonasal dacryocystorhinostomy: Our experience of nine cases. Clin Otolaryngol 2017; 42:1363-1366. [PMID: 28326669 DOI: 10.1111/coa.12876] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2017] [Indexed: 11/30/2022]
Affiliation(s)
- S-W Kim
- Department of Otorhinolaryngology, Gyeongsang National University School of Medicine, Jinju, Korea.,Department of Otorhinolaryngology, Gyeongsang National University Hospital, Jinju, Korea.,Institute of Health Sciences, Gyeongsang National University, Jinju, Korea
| | - S C Yeo
- Department of Otorhinolaryngology, Gyeongsang National University Hospital, Jinju, Korea
| | - Y-H Joo
- Department of Otorhinolaryngology, Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - H-J Cho
- Department of Otorhinolaryngology, Gyeongsang National University Hospital, Jinju, Korea.,Institute of Health Sciences, Gyeongsang National University, Jinju, Korea
| | - S W Seo
- Institute of Health Sciences, Gyeongsang National University, Jinju, Korea.,Department of Ophthalmology, Gyeongsang National University School of Medicine, Jinju, Korea
| | - S-Y Jeon
- Department of Otorhinolaryngology, Gyeongsang National University School of Medicine, Jinju, Korea.,Department of Otorhinolaryngology, Gyeongsang National University Hospital, Jinju, Korea.,Institute of Health Sciences, Gyeongsang National University, Jinju, Korea
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Factors influencing endoscopic dacryocystorhinostomy outcome. Eur Arch Otorhinolaryngol 2017; 274:2773-2777. [DOI: 10.1007/s00405-017-4541-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Accepted: 03/15/2017] [Indexed: 11/25/2022]
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Trottmann M, Sroka R, Braun C, Liedl B, Schaaf H, Graw M, Becker AJ, Stief CG, Khoder WY. Micro-endoscopy of the human vas deferens: a feasibility study of a novel device in several ex vivo models. Andrology 2016; 5:75-81. [PMID: 27860356 DOI: 10.1111/andr.12282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Revised: 07/17/2016] [Accepted: 08/02/2016] [Indexed: 11/30/2022]
Abstract
The aim of this study was to show limitation as well as potential of micro-endoscopy techniques as an innovative diagnostic and therapeutic approach in andrology. Two kinds of custom-made micro-endoscopes (ME) were tested in ex vivo vas deferens specimen and in post-mortem whole body. The semi-rigid ME included a micro-optic (0.9 mm outer diameter [OD], 10.000 pixels, 120° vision angle [VE], 3-20 mm field depth [FD]) and an integrated fibre-optic light source. The flexible ME was composed of a micro-optic (OD = 0.6 mm, 6.000 pixels, 120° VE, 3-20 mm FD). The ex vivo study included retrograde investigation of the vas deferens (surgical specimen n = 9, radical prostatectomy n = 3). The post-mortem investigation (n = 4) included the inspection of the vas deferens via both approaches. The results showed that antegrade and retrograde rigid endoscopy of the vas deferens were achieved as a diagnostic tool. The working channel enabled therapeutic use including biopsies or baskets. Using the flexible ME, the orifices of the ejaculatory ducts were identified. In vivo cadaveric retrograde cannulation of the orifices was successful. Post-mortem changes of verumontanum hindered the examinations beyond. Orifices were identified shaded behind a thin transparent membrane. Antegrade vasoscopy using flexible ME was possible up to the internal inguinal ring. Further advancement was impossible because of anatomical angle and lack adequate vision guidance. The vas deferens interior was clearly visible and was documented by pictures and movies. Altogether, the described ME techniques were feasible and effective, offering the potential of innovative diagnostic and therapeutic approaches for use in the genital tract. Several innovative indications could be expected.
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Affiliation(s)
- M Trottmann
- Department of Urology, Klinikum Grosshadern, University of Munich, Munich, Germany
| | - R Sroka
- Department of Urology, Klinikum Grosshadern, University of Munich, Munich, Germany.,LIFE Centre, University Hospital of Munich, Munich, Germany
| | - C Braun
- Department for Forensic Medicine, University of Munich, Munich, Germany
| | - B Liedl
- Department of Urogenital Surgery, Clinics for Surgery Munich-Bogenhausen, Munich, Germany
| | - H Schaaf
- Polydiagnost GmbH, Hallbergmoos, Germany
| | - M Graw
- Department for Forensic Medicine, University of Munich, Munich, Germany
| | - A J Becker
- Department of Urology, Klinikum Grosshadern, University of Munich, Munich, Germany
| | - C G Stief
- Department of Urology, Klinikum Grosshadern, University of Munich, Munich, Germany
| | - W Y Khoder
- Department of Urology, Klinikum Grosshadern, University of Munich, Munich, Germany
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Steele TO, Wilson M, Strong EB. Ultrasonic bone aspirator assisted endoscopic dacryocystorhinostomy. Am J Otolaryngol 2016; 37:202-6. [PMID: 27178508 DOI: 10.1016/j.amjoto.2016.01.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Accepted: 01/22/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate the ultrasonic bone aspirator versus traditional powered drill technique for use in endoscopic dacryocystorhinostomy. STUDY DESIGN Retrospective chart review. SETTING Academic institution. SUBJECTS AND METHODS A retrospective chart review of all patients undergoing endoscopic dacryocystorhinostomy from June 2010 through May 2014 was performed. Data were collected from 63 eyes of 63 patients. Recorded data points include: age, gender, etiology of epiphora, procedure type, success rate, need for septoplasty, and length of follow-up. Surgical failure was defined as no improvement in epiphora, postoperative dacryocystitis, or inability to irrigate the lacrimal system post-operatively. RESULTS Sixty three consecutive patients underwent endonasal endoscopic dacryocystorhinostomy. Twenty nine patients underwent powered microdrill DCR (pDCR); 34 patients underwent ultrasonic bone aspirator DCR (uDCR). There was no statistically significant difference between groups in terms of age or gender. The success rates were: pDCR 86.2% and uDCR 94.1% (p=0.4). Concurrent septoplasty was performed in 48% of pDCR patients and 21% of uDCR patients (p=0.03) There was no significant difference in surgical success when septoplasty was controlled for (p=0.39). CONCLUSION Ultrasonic bone aspirator dacryocystorhinostomy has a similar success rate to traditional powered microdrill dacryocystorhinostomy.
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Affiliation(s)
- Toby O Steele
- Department of Otolaryngology-Head and Neck Surgery, University of California Davis, Sacramento, CA.
| | - Machelle Wilson
- Department of Public Health Sciences/Biostatistics, Clinical and Translational Science Center, University of California Davis, Sacramento, CA
| | - E Bradley Strong
- Department of Otolaryngology-Head and Neck Surgery, University of California Davis, Sacramento, CA
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Weber RK, Hosemann W. Comprehensive review on endonasal endoscopic sinus surgery. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2015; 14:Doc08. [PMID: 26770282 PMCID: PMC4702057 DOI: 10.3205/cto000123] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Endonasal endoscopic sinus surgery is the standard procedure for surgery of most paranasal sinus diseases. Appropriate frame conditions provided, the respective procedures are safe and successful. These prerequisites encompass appropriate technical equipment, anatomical oriented surgical technique, proper patient selection, and individually adapted extent of surgery. The range of endonasal sinus operations has dramatically increased during the last 20 years and reaches from partial uncinectomy to pansinus surgery with extended surgery of the frontal (Draf type III), maxillary (grade 3-4, medial maxillectomy, prelacrimal approach) and sphenoid sinus. In addition there are operations outside and beyond the paranasal sinuses. The development of surgical technique is still constantly evolving. This article gives a comprehensive review on the most recent state of the art in endoscopic sinus surgery according to the literature with the following aspects: principles and fundamentals, surgical techniques, indications, outcome, postoperative care, nasal packing and stents, technical equipment.
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Affiliation(s)
- Rainer K. Weber
- Division of Paranasal Sinus and Skull Base Surgery, Traumatology, Department of Otorhinolaryngology, Municipal Hospital of Karlsruhe, Germany
- I-Sinus International Sinus Institute, Karlsruhe, Germany
| | - Werner Hosemann
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Greifswald, Germany
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Segal KL, Van Tassel SH, Kim C, Hsu N, Kacker A, Lelli GJ. Comparison of the extrusion rate of Crawford tubes. Int J Ophthalmol 2015; 8:791-3. [PMID: 26309881 DOI: 10.3980/j.issn.2222-3959.2015.04.26] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 12/26/2014] [Indexed: 11/02/2022] Open
Abstract
AIM To compare the outcomes of dacryocystorhinostomy (DCR) using traditional Crawford tubes (TCT) and Crawford tubes with suture (CTS) in the lumen. METHODS Retrospective case series consisting of patients who underwent DCR between 2008 and 2013. RESULTS A total of 61 DCRs were performed on 50 patients. Patients who underwent DCR using CTS had higher rates of prolapse compared to the TCT group (50% vs 9.4%; P=0.003). Stent removal occurred earlier in patients who received CTS (3.3mo vs 5.1mo; P=0.004). Success rates were equivalent between the two groups (75% vs 81.1%; P=0.684). CONCLUSION CTS in the lumen increases the risk of prolapse, prompting earlier tube removal in patients following DCR for nasolacrimal duct obstruction (NLDO). Earlier removal of tubes does not appear to significantly decrease success rates.
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Affiliation(s)
- Kira L Segal
- Department of Ophthalmology, Weill Cornell Medical College, New York 10021, USA
| | - Sarah H Van Tassel
- Department of Ophthalmology, Weill Cornell Medical College, New York 10021, USA
| | - Charles Kim
- Department of Ophthalmology, Weill Cornell Medical College, New York 10021, USA
| | - Nicole Hsu
- Department of Otolaryngology, Weill Cornell Medical College, New York 10021, USA
| | - Ashutosh Kacker
- Department of Otolaryngology, Weill Cornell Medical College, New York 10021, USA
| | - Gary J Lelli
- Department of Ophthalmology, Weill Cornell Medical College, New York 10021, USA
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