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Sharifi M, Yaser Kiarudi M, Gholamhoseinpour-Omran S, Alipour M, Bakhtiari E. Intravenous Tranexamic Acid for Control of Bleeding during External Dacryocystorhinostomy under General Anesthesia: A Randomized Clinical Trial. J Ophthalmic Vis Res 2024; 19:340-346. [PMID: 39359536 PMCID: PMC11443996 DOI: 10.18502/jovr.v19i3.13947] [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: 08/12/2023] [Accepted: 02/02/2024] [Indexed: 10/04/2024] Open
Abstract
Purpose To investigate the effect of intravenous tranexamic acid administered prior to external dacryocystorhinostomy (DCR) surgery to decrease intraoperative bleeding under general anesthesia. Methods This was a double-blinded randomized placebo-controlled trial. A total of 70 patients (35 intervention and 35 control) with nasolacrimal duct obstruction (NLDO) who were selected for DCR surgery between September 2021 and September 2022 were included. After clinical examinations and laboratory tests, patients were randomly classified into intervention and control groups. The intervention group received 10 mg/kg intravenous tranexamic acid to a maximum dose of 1 gr 30 minutes before the surgery. Controls received normal saline solution as a placebo. The amount of intraoperative bleeding and surgical time were compared between the two groups. Results The intervention group included 21 men (60%) and 14 women (40%), while the control group included 19 men (54.3%) and 16 women (45.7%). The mean ages of the participants were 55.46 ± 10.8 years and 58.06 ± 11.28 years in the intervention and control groups, respectively. A significant difference was observed between the two groups in the surgical time analysis (control group: 37.74 ± 9.52 minutes vs intervention: 26.03 ± 10.5 minutes; P < 0.001). Additionally, there was a significant difference in the bleeding volume between the intervention (70.66 ± 48.19 ml) and control (47.74 ± 60 ml) groups (P < 0.001). Conclusion Intravenous tranexamic acid administration before the DCR procedure can successfully control bleeding during the surgery.
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Affiliation(s)
- Mohammad Sharifi
- Eye Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | | | - Mohammad Alipour
- Eye Research Center, Department of Ophthalmology, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Elham Bakhtiari
- Clinical Research Unit, Mashhad University of Medical Sciences, Mashhad, Iran
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Locatello LG, De Zan ER, Tarantini A, Lanzetta P, Miani C. External dacryocystorhinostomy: A critical overview of the current evidence. Eur J Ophthalmol 2024:11206721241249214. [PMID: 38689455 DOI: 10.1177/11206721241249214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
PURPOSE External dacryocystorhinostomy (ext-DCR) is still considered the gold standard in the treatment of distal lacrimal duct obstruction. Despite an overall high success rate, some patients do relapse after surgery and the ideal perioperative management has not been identified yet. The purpose of this study is to critically discuss the published evidence in the last five years on the medical and surgical management of external dacryocystorhinostomy. Furthermore, the drawbacks of the available literature and the perspectives in this field will be also highlighted. METHODS Systematic review of the literature in the last 5 years by using PubMed and Google Scholar. RESULTS A total of 64 articles were included. Many technical modifications and surgical refinements have been proposed but a formal comparison among the various techniques is hampered by methodological heterogeneity. The use of local anesthesia, and the perioperative adjunctive techniques to reduce the risk of restenosis are also gaining popularity but the level of evidence remains weak. CONCLUSION Ext-DCR offers satisfactory clinical outcomes even though there are many gray areas that need to be addressed in future high-quality studies.
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Affiliation(s)
- Luca Giovanni Locatello
- Department of Otorhinolaryngology, Academic Hospital "Santa Maria della Misericordia", Azienda Sanitaria Universitaria Friuli Centrale, Piazzale Santa Maria della Misericordia 15, 33100 Udine, Italy
| | | | - Anna Tarantini
- Department of Medicine - Ophthalmology , University of Udine, Udine, Italy
| | - Paolo Lanzetta
- Department of Medicine - Ophthalmology , University of Udine, Udine, Italy
- Istituto Europeo di Microchirurgia Oculare (IEMO), Udine and Milan, Italy
- University of Udine, Department of Medicine (DAME), Via Colugna 50, 33100 Udine, Italy
| | - Cesare Miani
- Department of Otorhinolaryngology, Academic Hospital "Santa Maria della Misericordia", Azienda Sanitaria Universitaria Friuli Centrale, Piazzale Santa Maria della Misericordia 15, 33100 Udine, Italy
- University of Udine, Department of Medicine (DAME), Via Colugna 50, 33100 Udine, Italy
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Khadamy J. Enhancing Precision: A Visual Guide to Drill-Assisted External Dacryocystorhinostomy Surgery. Cureus 2024; 16:e54110. [PMID: 38500904 PMCID: PMC10948118 DOI: 10.7759/cureus.54110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2024] [Indexed: 03/20/2024] Open
Abstract
This technical report aims to provide a visual guide to the drill-assisted external dacryocystorhinostomy (DCR) technique with silicone intubation. Through a step-by-step video demonstration, it addresses inherent documentation challenges and highlights crucial considerations. A critical aspect of the procedure's success lies in creating a clear space around the drilling area to prevent thermal burns and soft tissue wrapping around the burr. Additionally, it emphasizes the careful use of smaller burr diameters and the importance of drilling techniques, advocating for minimal perpendicular drilling while maintaining rotational polishing movements to minimize the risk of rapid penetration and potential nasal mucosal injury. The thermal cauterization of perforating nutrient vessels during bone drilling offers a significant advantage in reducing the risk of bleeding. A review of existing limited studies comparing drill-assisted and conventional external DCR reveals advantages such as shorter surgical duration, lower intraoperative hemorrhage rate, more regular osteotomy edges, increased ostomy patency, and potential prevention of soft tissue or mucosal injuries. Nonetheless, achieving these benefits necessitates enhanced hand and foot coordination. However, despite these benefits, a noticeable gap exists in the literature concerning comprehensive studies and comparative analyses. Furthermore, exploring the associated cost and learning curve of adopting this surgical technique is essential. This report aims to fill the existing gap in the literature and serve as a visual reference for surgeons interested in adopting drill-assisted external DCR.
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Affiliation(s)
- Joobin Khadamy
- Ophthalmology, University Hospital of Umeå, Umeå, SWE
- Ophthalmology, Skellefteå Eye Clinic, Skellefteå, SWE
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Goel R, Ojha S, Gaonker T, Shah S, Meher R, Arya D, Khanam S, Kumar S. Outcomes of 8 × 8 mm osteotomy in powered external dacryocystorhinostomy. Indian J Ophthalmol 2023; 71:2569-2574. [PMID: 37322681 PMCID: PMC10418034 DOI: 10.4103/ijo.ijo_3328_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 03/11/2023] [Accepted: 03/20/2023] [Indexed: 06/17/2023] Open
Abstract
Purpose To study the endoscopic ostium characteristics and outcome of 8 × 8 mm osteotomy in external dacryocystorhinostomy (DCR) using the microdrill system. Methods This prospective interventional pilot study was performed on 40 eyes of 40 patients with primary acquired nasolacrimal duct obstruction (NLDO) from June 2021 to September 2021 in patients undergoing external DCR. An 8 × 8 mm osteotomy was performed using round, cutting burr attached to a microdrill system. Success was defined as patent ostium on lacrimal syringing (anatomical) and a Munk score <3 (functional) at 12 months. Postoperative endoscopic ostium evaluation was done using a modified DCR ostium (DOS) scoring system at 12 months. Results The mean age of the study participants was 42.41 ± 11.77 years and the male-to-female ratio was 1:4. The mean duration of surgery was 34.15 ± 1.66 minutes and that for osteotomy creation was 2.5 ± 0.69 minutes. The mean intraoperative blood loss was 83.37 ± 11.89 ml. Anatomical and functional success rates were 95% and 85%, respectively. The mean modified DOS score was "excellent" in 34 patients (85%), "good" in 1 patient (2.5%), "fair" in 4 patients (10%), and "poor" in 1 patient (2.5%). Complications included nasal mucosal injury in 10% (4/40) of patients, complete cicatricial closure of ostium in 2.5% (1/40), incomplete cicatricial closure in 10% (4/40), nasal synechiae in 5% (2/40), and canalicular stenosis in 2.5% (1/40). Conclusion An 8 × 8 mm-sized osteotomy created by powered drill and covered by lacrimal sac-nasal mucosal flap anastomosis in external DCR is an effective technique that has minimal complications and shorter surgical time.
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Affiliation(s)
- Ruchi Goel
- Department of Ophthalmology (Guru Nanak Eye Centre), Maulana Azad Medical College, New Delhi, India
| | - Sweta Ojha
- Department of Ophthalmology (Guru Nanak Eye Centre), Maulana Azad Medical College, New Delhi, India
| | - Tanvi Gaonker
- Department of Ophthalmology (Guru Nanak Eye Centre), Maulana Azad Medical College, New Delhi, India
| | - Shalin Shah
- Department of Ophthalmology (Guru Nanak Eye Centre), Maulana Azad Medical College, New Delhi, India
| | - Ravi Meher
- Department of Otorhinolaryngology, Maulana Azad Medical College, New Delhi, India
| | - Deepanjali Arya
- Department of Ophthalmology (Guru Nanak Eye Centre), Maulana Azad Medical College, New Delhi, India
| | - Samreen Khanam
- Department of Ophthalmology (Guru Nanak Eye Centre), Maulana Azad Medical College, New Delhi, India
| | - Sushil Kumar
- Department of Ophthalmology (Guru Nanak Eye Centre), Maulana Azad Medical College, New Delhi, India
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Positional relationship between lacrimal sac and skull base: implication of risk of cerebrospinal fluid leakage during dacryocystorhinostomy. Sci Rep 2022; 12:14459. [PMID: 36002515 PMCID: PMC9402570 DOI: 10.1038/s41598-022-18859-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 08/22/2022] [Indexed: 11/20/2022] Open
Abstract
Cerebrospinal fluid (CSF) leakage is a rare but severe complication during dacryocystorhinostomy (DCR). Understanding the details of the anatomy of the lacrimal drainage system and skull base is essential to avoid this complication. We examined the positional relationship between the lacrimal sac and skull base using 16 cadavers (22 sides) and using computed tomographic images taken in 81 patients (81 sides). Consequently, the frontal sinus intervened between the lacrimal sac and skull base in 81.8–90.1% of cases. The lacrimal sac fundus and posterior lacrimal crest were far from the skull base/cribriform plate, and the skull base above the lacrimal sac was considerably thick. These results indicate that the risk of skull base injury and consequent CSF leakage during DCR is extremely low. However, surgeons should be cautious of this complication by indirect injury due to a twisting movement of a bone rongeur applied to the maxillary bone during creation of a bony window in patients with no interposition of the frontal and ethmoid sinuses between the lacrimal sac and skull base.
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Tachino H, Takakura H, Shojaku H, Fujisaka M, Ito S, Oi Y, Do AT, Fuchizawa C, Yunoki T, Hayashi A. Flap suturing endonasal dacryocystorhinostomy assisted by ultrasonic bone aspirator. Acta Otolaryngol 2022; 142:316-322. [PMID: 35382686 DOI: 10.1080/00016489.2022.2041721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND In the external dacryocystorhinostomy (DCR), a sutured anastomosis technique performed between the nasal mucosal and lacrimal sac flaps reported by Dupuy-Dutemps and Bourguet was the gold standard and was believed to lead to the success of the surgery. However, because of the small working space, a flap suturing technique has not been completely established in endonasal DCR (END-DCR). OBJECTIVES The effect of the modified flap suture anastomosis technique using a Sonopet ultrasonic bone aspirator was retrospectively compared to that using a diamond burr in patients with nasolacrimal duct obstruction. MATERIALS AND METHODS One hundred ten patients underwent the modified flap suturing technique using the Sonopet, and 30 patients were operated on using a diamond burr. RESULTS Successful patency of the lacrimal ostium (LO) was obtained in all patients in both groups. The rates of successful suturing during the operation and of a large diameter of the LO 3 months after the operation were significantly higher in patients in whom the Sonopet rather than the burr was used. CONCLUSIONS AND SIGNIFICANCE The Sonopet might offer similar surgical outcome to the traditional microdrill DCR and is a safer means of bone removal in END-DCR in the small working space.
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Affiliation(s)
- Hirohiko Tachino
- Department of Otolaryngology, Head & Neck Surgery, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, Japan
| | - Hiromasa Takakura
- Department of Otolaryngology, Head & Neck Surgery, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, Japan
| | - Hideo Shojaku
- Department of Otolaryngology, Head & Neck Surgery, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, Japan
| | - Michiro Fujisaka
- Department of Otolaryngology, Head & Neck Surgery, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, Japan
| | - Shinsuke Ito
- Department of Otolaryngology, Head & Neck Surgery, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, Japan
| | - Yutaro Oi
- Department of Otolaryngology, Head & Neck Surgery, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, Japan
| | - Anh Tram Do
- Department of Otolaryngology, Head & Neck Surgery, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, Japan
| | | | - Tatsuya Yunoki
- Department of Ophthalmology, University of Toyama, Toyama, Japan
| | - Atsushi Hayashi
- Department of Ophthalmology, University of Toyama, Toyama, Japan
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Ucar F, Cetinkaya S, Seyrek L. The effectiveness of the dacryocystorhinostomy operation with physiodispenser in nasolacrimal duct obstruction. Orbit 2021; 41:305-310. [PMID: 33550897 DOI: 10.1080/01676830.2021.1877732] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Purpose: To evaluate the effectiveness of the dacryocystorhinostomy (DCR) operation with physiodispenser in nasolacrimal duct obstruction.Methods: Two hundred and twelve eyes from 150 patients with chronic dacryocystitis who had undergone external DCR operation with Kerrison punch were included in Group 1. Two hundred and fourteen eyes from 150 patients with chronic dacryocystitis who had undergone external DCR operation with physiodispenser were included in Group 2.Results: There were no significant differences between the two groups in terms of age and sex (p > .05). Excessive bleeding requiring cauterization was observed in 41 (19%) patients in Group 1 and 8 (3%) patients in Group 2 (p < .05) during surgery. The mean operation duration was 32.36 ± 5.46 (26-42) minutes in the first group and 20.41 ± 4.98 (15-28) minutes in the second group (p < .05). Functional success rate at the end of the second postoperative year was 90.2% in the first group and 92.4% in the second (p > .05). Anatomical success rate at the end of second postoperative year was 95.8% in the first group and 98.1% in the second (p > .05).Conclusion: DCR operation with physiodispenser shortens the operation duration, reduces excessive bleeding, and has high functional and anatomical success rates.
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Affiliation(s)
- Fikret Ucar
- Ophthalmology Department, Konyagoz Eye Hospital, Konya, Turkey
| | | | - Lutfi Seyrek
- Ophthalmology Department, Konyagoz Eye Hospital, Konya, Turkey
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Horiguchi A, Ojima K, Shinchi M, Hirano Y, Hamamoto K, Ito K, Asano T, Azuma R. Usefulness of a high-speed surgical air drill in pubectomy during delayed anastomotic urethroplasty for pelvic fracture urethral injury. Int J Urol 2020; 27:1002-1007. [PMID: 32776376 DOI: 10.1111/iju.14344] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 07/06/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Pubectomy is an ancillary technique used to increase exposure of the disrupted urethra and reduce anastomotic tension, which can be difficult for inexperienced surgeons. The objective of the present study was to illustrate the use of an air drill enabling delicate and precise bone resection in pubectomy for delayed anastomotic urethroplasty for pelvic fracture urethral injury. METHODS Between 2009 and 2019, 88 male patients underwent delayed anastomotic urethroplasty with pubectomy for pelvic fracture urethral injury. A total of 73 procedures used a high-speed surgical air drill (HiLAN HS; Aesculap, Tuttlingen, Germany) equipped with a short-hand piece. Operative time and blood loss in the air drill patient group (group 1) were compared with that of patients who underwent pubectomy using a rongeur and/or gouge (group 2, n = 15). RESULTS In 65 group 1 patients, urethroplasty was carried out using the perineal approach, with partial inferior pubectomy. Eight group 1 patients, whose proximal urethral end was displaced upward superior to the upper edge of pubis, underwent urethroplasty using the perineal and abdominal approach, with a superior partial pubectomy and supracrural urethral rerouting. No difficulty was encountered using the air drill in any of the cases. There was no significant difference in median operative time between the groups (group 1 256 min vs group 2 228 min; P = 0.31). The median blood loss in group 1 was significantly lower than group 2 (149 mL vs 453 mL; P < 0.0001). CONCLUSIONS Surgical air drills might facilitate pubectomy in patients undergoing delayed anastomotic urethroplasty for pelvic fracture urethral injury. This tool offers the advantage of a delicate bone resection with reduced blood loss.
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Affiliation(s)
- Akio Horiguchi
- Department of Urology, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Kenichiro Ojima
- Department of Urology, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Masayuki Shinchi
- Department of Urology, Nishisaitama-chuo National Hospital, Tokorozawa, Saitama, Japan
| | - Yusuke Hirano
- Department of Urology, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Koetsu Hamamoto
- Department of Urology, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Keiichi Ito
- Department of Urology, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Tomohiko Asano
- Department of Urology, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Ryuichi Azuma
- Department of Plastic Surgery, National Defense Medical College, Tokorozawa, Saitama, Japan
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