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Hoffmann AS, Betz CS, Böscke R, Weber RK. [Decision-making in the treatment of chronic rhinosinusitis with nasal polyps in the era of biologics]. HNO 2024; 72:225-230. [PMID: 38376799 DOI: 10.1007/s00106-024-01430-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2024] [Indexed: 02/21/2024]
Abstract
Chronic rhinosinusitis is one of the most common chronic diseases in the population. Chronic rhinosinusitis with nasal polyps (CRSwNP) in adults is predominantly characterized by a type 2 inflammatory endotype. If sufficient control cannot be achieved through primary drug therapy, surgical intervention is usually recommended as the next stage of treatment. Nowadays, various biologics are available that have been or will be approved for use in these patients. This review summarizes the presentations from the 29th Congress of the European Rhinologic Society in Sofia 2023 and the latest findings on decision-making in the treatment of CRSwNP. Standard therapy with medication and sinus surgery fails in some patients with CRSwNP. Biologics that act on the type 2 inflammatory pathway led to a reduction in the nasal polyp score (NPS), an improvement in nasal obstruction, and an improvement in quality of life without significant side effects. Biomarkers such as total IgE, serum eosinophils, and Osteoprotegerin (OPG) can provide indications of the success of the treatment. In summary, it can be said that for many patients with recurrent CRSwNP, a combination of paranasal sinus surgery and treatment with a biologic that is precisely tailored to the patient's endotype is the best option. However, the question of which surgical approach and which biologic at which time and for which patient is still ongoing and requires further studies.
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Affiliation(s)
- Anna S Hoffmann
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland.
| | - Christian S Betz
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland
| | - Robert Böscke
- Universitätsklinik für Hals-Nasen-Ohren-Heilkunde, Evangelisches Krankenhaus Oldenburg, Medizinischer Campus der Carl-von-Ossietzky Universität Oldenburg, Oldenburg, Deutschland
| | - Rainer K Weber
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Städtisches Klinikum Karlsruhe, Karlsruhe, Deutschland
- Sinus Academy, Karlsruhe, Deutschland
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2
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Schmitz L, Betz CS, Stölzel K. [Endoscopic endonasal anterior skull base surgery : Presentation of a monocentric entity profile]. HNO 2024; 72:265-271. [PMID: 38393669 PMCID: PMC10959777 DOI: 10.1007/s00106-024-01438-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND Extended endoscopic endonasal surgery (EEES) is an essential part of treatment of various pathologies of the anterior skull base. In addition to significant improvements in the quality of life of affected patients and a lower complication profile compared to open skull base surgery, the therapeutic results are comparable if the indications are correct. MATERIALS AND METHODS Data of all endoscopic endonasal skull base procedures performed at the University Skull Base Center Hamburg under the direction of the Department of Otorhinolaryngology between June 2018 and November 2022 were retrospectively collected. RESULTS A total of 50 cases were identified. Of these, 56% (28/50) were malignant tumors, 24% (12/50) were benign pathologies with direct skull base involvement, and 20% (10/50) were anterior skull base defects with rhinoliquorrhea. In 96% (48/50) of cases, the preoperatively set goal of surgery (representative biopsy, complete resection, closure of the skull base defect) could be achieved. Complications grade III or higher according to Clavien-Dindo occurred in 4/50 cases. During the observation period, n = 5 olfactory neuroblastomas were diagnosed, all of which were exclusively and successfully operated on endoscopically. CONCLUSION In recent years, the spectrum of endoscopically resectable pathologies of the anterior skull base has steadily expanded. In particular, midline-related tumors such as olfactory neuroblastoma or iatrogenic/idiopathic skull base defects with cerebrospinal fluid rhinorrhea are treated completely endoscopically with very good results. Nevertheless, there are also limitations to this technique. Due to high variance in the scope of frontobasal surgery, the extent, and the complex anatomy, as well as the overlapping responsibilities of the specialist disciplines, establishment of certified skull base centers and bundling of frontobasal surgery at these centers is highly relevant for quality assurance.
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Affiliation(s)
- Lisa Schmitz
- Klinik und Poliklinik für Hals‑, Nasen- und Ohrenheilkunde, Kopf- und Neurozentrum, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland.
| | - Christian S Betz
- Klinik und Poliklinik für Hals‑, Nasen- und Ohrenheilkunde, Kopf- und Neurozentrum, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland
| | - Katharina Stölzel
- Klinik und Poliklinik für Hals‑, Nasen- und Ohrenheilkunde, Kopf- und Neurozentrum, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland
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3
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Kouladouros K, Reissfelder C, Kähler G. Endoscopic Stricturoplasty with Linear Stapler: An Efficient Alternative for the Refractory Rectal Anastomotic Stricture. Dig Dis Sci 2023; 68:4432-4438. [PMID: 37855986 PMCID: PMC10635923 DOI: 10.1007/s10620-023-08156-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 10/10/2023] [Indexed: 10/20/2023]
Abstract
INTRODUCTION Symptomatic anastomotic stricture is a rare but major complication after left-sided colorectal surgery. Hydraulic balloon dilatation is the first-line treatment in cases where the complication occurs, but 20% of patients present with refractory strictures after multiple sessions. Endoscopic stricturoplasty with the use of a linear stapler is a novel therapeutic alternative for those difficult cases. MATERIALS AND METHODS We identified all patients in our department who underwent endoscopic stricturoplasty with a linear stapler between 2004 and 2022. The technical, periinterventional, and follow-up data of the patients were retrospectively analyzed. RESULTS We identified nine patients who fulfilled our inclusion criteria. The procedure was technically possible in eight cases, whereas in one case, the anatomy of the anastomosis did not allow for a correct placement of the stapler. All patients with a technically successful procedure were relieved from their symptoms and could have their ostomy reversed. There was no periprocedural morbidity and mortality. Two patients presented with a recurrent stricture eight and 26 months after the initial stricturoplasty, and the procedure was successfully repeated in both cases. CONCLUSIONS Endoscopic stricturoplasty is a feasible, safe, and minimally invasive alternative for the treatment of refractory anastomotic strictures in the distal colon and rectum for patients with a suitable anatomy.
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Affiliation(s)
- Konstantinos Kouladouros
- Central Interdisciplinary Endoscopy Department, Medical Faculty Mannheim, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
- Department of Surgery, Medical Faculty Mannheim, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
| | - Christoph Reissfelder
- Department of Surgery, Medical Faculty Mannheim, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Georg Kähler
- Central Interdisciplinary Endoscopy Department, Medical Faculty Mannheim, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
- Department of Surgery, Medical Faculty Mannheim, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
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4
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Ahrens M, Stier C. [Bariatric endoscopy-Possibilities and value in obesity medicine and surgery-A separate special field]. Chirurgie (Heidelb) 2023; 94:518-524. [PMID: 36930301 DOI: 10.1007/s00104-023-01836-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/30/2023] [Indexed: 03/18/2023]
Abstract
Endoscopy has become established as an important component in all preoperative, intraoperative and postoperative areas of bariatric surgery. As guidelines are not yet available, relevant studies and international position papers have been collected in this article. Preoperatively, endoscopy should be performed before sleeve gastrectomy (SG, detection of reflux status) and before bypass procedures (status survey of the postoperatively no longer accessible distal stomach). Routine endoscopic monitoring should be performed 2-3 years after SG and a OAGB (one anastomosis gastric bypass) for recording of the gastroesophageal reflex disease (GERD) status. In the first line complication management of hemorrhage and leakages, endoscopic procedures have prevailed over surgical ones due to more causal therapeutic approaches (except cases of general peritonitis where lavage and drainages are needed). In the treatment of late complications such as dumping, anastomosis dilatation and stenosis, bariatric endoscopy provides versatile, organ-preserving solutions and continues to demonstrate a high degree of innovation. In these postoperative fields of application, especially in the treatment of late complications, specific knowledge of bariatric anatomy and physiology as well as surgical treatment options are required in addition to endoscopic expertise. The special field of bariatric endoscopy has developed and will have an own importance closely linked to the bariatric surgery.
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Affiliation(s)
- Markus Ahrens
- Chirurgische Klinik, AMEOS Klinikum Oldenburg, Mühlendamm 5, 23758, Oldenburg, Deutschland.
| | - Christine Stier
- Chirurgische Klinik, AMEOS Klinikum Oldenburg, Mühlendamm 5, 23758, Oldenburg, Deutschland
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Clapp B, Marrero K, Corbett J, Sharma I, Hage K, Vierkant RA, McKenzie T, Davis SS, Ghanem OM. Effect of operative times in bariatric surgery on outcomes: a matched analysis of the MBSAQIP database. Surg Endosc 2023:10.1007/s00464-023-09927-6. [PMID: 36752855 DOI: 10.1007/s00464-023-09927-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 01/28/2023] [Indexed: 02/09/2023]
Abstract
BACKGROUND The implications of operative time (OT) have been studied in different surgical specialties, showing a correlation with higher incidence rates of postoperative complications. However, the impact of OT on bariatric surgery complications is not well elucidated. METHODS A retrospective review of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database between 2015 and 2019 was performed. A total of 358,382 SG patients and 123,357 RYGB patients were included. The median OT was 68 min (10-720) and 113 min (10-640) for the sleeve gastrectomy (SG) group and the Roux-en-Y gastric bypass group, respectively. The groups were subdivided into two subgroups based on OT in comparison to the median time of each group. The subgroups were compared for surgical complications and outcomes. To reduce selection bias and risk of confounders, we performed a propensity score matching (PSM) for 22 variables. RESULTS In the PSM-matched cohort, 18,915 SG and 6,495 RYGB patients were included in each subgroup. The SG cohort showed higher rates of Clavien-Dindo Class 1, 2, 3a, 4, and 5 complications as well as higher rates of readmission, reoperation, and reintervention in the longer OT group before matching. After PSM, the subgroup with longer times continued to have higher rates of Clavien-Dindo Class 2 complications and higher rates of readmission and reoperation. Similarly, there were higher rates of all Clavien-Dindo class complications as well as readmission, reoperation, and reintervention in the RYGB group with higher OT. After PSM, there were still higher rates of Clavien-Dindo Class 3a complications as well as readmission and reintervention in the RYGB subgroup with prolonged OT. CONCLUSION In both SG and RYGB, longer OT was associated with increased rates of complications as well as readmission, reoperation, and reintervention. Surgeons should be cognizant of the increased rates of complications when operative times are longer.
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Affiliation(s)
- Benjamin Clapp
- Department of Surgery, Texas Tech HSC Paul Foster School of Medicine, El Paso, TX, USA
| | - Katie Marrero
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - John Corbett
- Department of Surgery, Texas Tech HSC Paul Foster School of Medicine, El Paso, TX, USA
| | - Ishna Sharma
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Karl Hage
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | | | | | - Scott S Davis
- Division of General and GI Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Omar M Ghanem
- Department of Surgery, Mayo Clinic, Rochester, MN, USA. .,Endocrine and Metabolic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
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Wu PH, Kim HS, An JW, Kim M, Lee I, Park JS, Lee JH, Kang S, Lee J, Yi Y, Lee JH, Park JH, Lim JH, Jang IT. Prospective Cohort Study with a 2-Year Follow-up of Clinical Results, Fusion rate, and Muscle Bulk for Uniportal Full Endoscopic Posterolateral Transforaminal Lumbar Interbody Fusion. Asian Spine J 2023; 17:373-381. [PMID: 36693430 PMCID: PMC10151642 DOI: 10.31616/asj.2022.0053] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 05/09/2022] [Indexed: 01/26/2023] Open
Abstract
Study Design Retrospective cohort study. Purpose Postoperative evaluation of the cross-sectional area of paraspinal muscle and clinical findings in patients who had interlaminar route uniportal full endoscopic posterolateral transforaminal lumbar interbody fusion (EPTLIF) after 2 years. Overview of Literature There are limited short-term follow-up studies on efficacy, safety, and physiological changes with a 2-year follow-up. There is no study on paraspinal muscle cross-sectional area change in patients who had undergone uniportal EPTLIF. Methods We evaluated patients who underwent EPTLIF with a minimum 24-month follow-up. Clinical parameters of the Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) were measured at the preoperative, 1-week postoperative mark, postoperative 3-month mark, and final follow-up. Preoperative and 1-year postoperative magnetic resonance imaging measurement of preoperative and postoperative Kjaer grade, right and left psoas muscle mass area, and right and left paraspinal muscle mass area was performed. Results EPTLIF with a minimum 24-month follow-up of 35 levels was included. The complication rate was 6%, and the mean Bridwell's fusion grade was 1.37 (1-2). There was statistically significant improvement at 1 week, 3 months, and 2 years in VAS (4.11±1.23, 4.94±1.30, and 5.46±1.29) and in ODI (40.34±10.06, 46.69±9.14, and 49.63±8.68), respectively (p <0.05). Successful operation rate with excellent and good MacNab's criteria at 2 years was 97%. There was an increment of statistically significant bilateral psoas muscle cross-sectional area, right side (70.03±149.1 mm²) and left side (67.59±113.2 mm²) (p <0.05). Conclusions Uniportal EPTLIF achieved good fusion and improved clinical outcomes with favorable paraspinal musculature bulk at the 2-year follow-up.
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Affiliation(s)
- Pang Hung Wu
- Spine Surgery, Nanoori Gangnam Hospital, Seoul, Korea.,Department of Orthopaedic Surgery, Juronghealth Campus, National University Health System, Singapore
| | | | - Jin Woo An
- Nanoori Spine and Joint Clinic with Saudi German Hospital Dubai, Dubai, UAE
| | - Myeonghun Kim
- Spine Surgery, Nanoori Gangnam Hospital, Seoul, Korea
| | - Inkyung Lee
- Spine Surgery, Nanoori Gangnam Hospital, Seoul, Korea
| | | | | | - Sangsoo Kang
- Spine Surgery, Nanoori Gangnam Hospital, Seoul, Korea
| | - Jeongshik Lee
- Spine Surgery, Nanoori Gangnam Hospital, Seoul, Korea
| | - Yeonjin Yi
- Spine Surgery, Nanoori Gangnam Hospital, Seoul, Korea
| | - Jun Hyung Lee
- Department of Internal Medicine, Chosun University School of Medicine, Gwangju, Korea
| | - Jun Hwan Park
- Medicine of the University of Debrecen, Debrecen, Hungary
| | - Jae Hyeon Lim
- Spine Surgery, Nanoori Gangnam Hospital, Seoul, Korea
| | - Il-Tae Jang
- Spine Surgery, Nanoori Gangnam Hospital, Seoul, Korea
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Varone A, Stephen A, Kheirbek T, Adams C, Cioffi W. Outcomes of PEG placement by acute care surgeons compared to those placed by gastroenterology. Surg Endosc 2022; 36:8214-8220. [PMID: 35477805 DOI: 10.1007/s00464-022-09262-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 04/10/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Percutaneous endoscopic gastrostomy (PEG) tubes are placed by gastroenterologists (GI) and surgeons throughout the country. At Rhode Island Hospital, before July of 2017, all PEGs were placed by GI. In July of 2017, in response to a growing need for PEGs, acute care surgeons (ACS) also began performing PEGs at the bedside in ICUs. The purpose of this study was to review and compare outcomes of PEG tubes placed by ACS and GI. METHODS Retrospective chart review of patients who received a PEG placed by ACS or GI at the bedside in any ICU from December 2016 to September 2019. Charts were reviewed for the following outcomes: Success rates of placing PEG, duration of procedure, major complications, and death. Secondary outcomes included discharge disposition, and rates of comfort measures only after PEG. RESULTS In 2017, 75% of PEGs were placed by GI and 25% surgery. In 2018, 47% were placed by GI and 53% by surgery. In 2019, 33% were placed by GI and 67% by surgery. There was no significant difference in success rates between surgery (146/156 93.6%) and GI (173/185 93.5%) (p 0.97). On average, GI performed the procedure faster than surgery [Median 10 (7-16) min vs 16 (13-21) mins, respectively, p < 0.001]. There were no significant differences between groups in any of the PEG outcomes or complications investigated. CONCLUSION Bedside PEG tube placement appears to be a safe procedure in the ICU population. GI and Surgery had nearly identical success rates in placing PEGs. GI performed the procedure faster than surgery. There were no significant differences in the reviewed patient outcomes or complications between PEGs placed by ACS or GI. Of note, when a complication occurred, ACS PEG patients typically were managed in the OR while GI tended to re-PEG patients highlighting a potential difference in management that should be further investigated.
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Affiliation(s)
- Andrew Varone
- Department of Surgery, Rhode Island Hospital and the Warren Alpert Medical School of Brown University, 593 Eddy St, Providence, RI, 02903, USA.
| | - Andrew Stephen
- Department of Surgery, Rhode Island Hospital and the Warren Alpert Medical School of Brown University, 593 Eddy St, Providence, RI, 02903, USA
| | - Tareq Kheirbek
- Department of Surgery, Rhode Island Hospital and the Warren Alpert Medical School of Brown University, 593 Eddy St, Providence, RI, 02903, USA
| | - Charles Adams
- Department of Surgery, Rhode Island Hospital and the Warren Alpert Medical School of Brown University, 593 Eddy St, Providence, RI, 02903, USA
| | - William Cioffi
- Department of Surgery, Rhode Island Hospital and the Warren Alpert Medical School of Brown University, 593 Eddy St, Providence, RI, 02903, USA
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De'Ath HD, Nagendram S, Smith E, Ramadan M, Veeramootoo D, Singh S. A high-volume ERCP service led by surgeons is associated with good outcomes and meets national key performance indicators: results from a British district general hospital. Surg Endosc 2022; 36:6016-6023. [PMID: 35020059 DOI: 10.1007/s00464-021-08978-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 12/31/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Endoscopic retrograde cholangiopancreatography (ERCP) is a common, but technically challenging procedure used in the management of hepatopancreaticobiliary (HPB) disease. It is traditionally performed by medical gastroenterologists. In 2014, the British Society of Gastroenterology (BSG) proposed key performance indicators to evaluate and set standards of ERCP practice. This study aimed to compare our ERCP outcomes against these targets, in a centre where ERCP is exclusively performed by surgeons. METHODS A retrospective analysis of all ERCPs undertaken over a 38 months in a District General Hospital in the United Kingdom (UK), by three Upper Gastrointestinal Surgeons. Study outcomes were based upon, and compared against, BSG key performance indicators, including number of ERCPs per annum, proportion of successful cannulations of bile duct and stone clearance, ERCP-specific complications and mortality. RESULTS The unit's caseload over this period was 1324, equating to approximately 418 per annum (BSG minimum 200 per unit). Management of bile duct stones was the commonest indication for ERCP. Overall, 95% (1253/1324) of bile ducts were cannulated and 92% (645/698) for those undergoing their first ERCP. Bile duct clearance was achieved in 80% of patients (BSG recommend > 75%) and the successful stenting of extra-hepatic strictures in 94% (BSG recommend > 80%). The overall complication rate was 4.3% (BSG standard < 6%). Procedure-specific mortality was 0.3% (4/1324) where death was either caused by pancreatitis or sepsis. CONCLUSION A high-volume ERCP service led and performed exclusively by surgeons meets all BSG performance indicators, with good procedural and patient outcomes. Formal training pathways should be developed to encourage more surgical centres to provide an ERCP service and deal with what are common surgical pathologies.
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Affiliation(s)
- Henry D De'Ath
- Department of Upper Gastrointestinal Surgery, Frimley Park Hospital, Portsmouth Road, Camberley, Surrey, GU16 7UJ, England, UK.
| | - Sathyan Nagendram
- Department of Upper Gastrointestinal Surgery, Frimley Park Hospital, Portsmouth Road, Camberley, Surrey, GU16 7UJ, England, UK
| | - Eleanor Smith
- Department of Upper Gastrointestinal Surgery, Frimley Park Hospital, Portsmouth Road, Camberley, Surrey, GU16 7UJ, England, UK
| | - Mohamed Ramadan
- Department of Upper Gastrointestinal Surgery, Frimley Park Hospital, Portsmouth Road, Camberley, Surrey, GU16 7UJ, England, UK
| | - Darmarajah Veeramootoo
- Department of Upper Gastrointestinal Surgery, Frimley Park Hospital, Portsmouth Road, Camberley, Surrey, GU16 7UJ, England, UK
| | - Sukhpal Singh
- Department of Upper Gastrointestinal Surgery, Frimley Park Hospital, Portsmouth Road, Camberley, Surrey, GU16 7UJ, England, UK
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Rudiman R. Advances in gastrointestinal surgical endoscopy. Ann Med Surg (Lond) 2021; 72:103041. [PMID: 34888040 PMCID: PMC8636781 DOI: 10.1016/j.amsu.2021.103041] [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: 10/06/2021] [Revised: 11/06/2021] [Accepted: 11/09/2021] [Indexed: 11/22/2022] Open
Abstract
Surgeons have a role in observing, detect abnormalities, disease, and other deficiencies in function which could be treated. Diagnosing and treating back days were challenging for many reasons. However, technology's innovation enhances surgeons' ability to treat their patients. The term endoscopy refers to the Greek prefix endo- ("within") and the verb skopein ("to view or observe"). Endoscopy is practical both in the diagnosis and treatment of various pathologies. Technological advances, especially in endoscopy, gradually progress and discover many possibilities which allow rapid advancement. Endoscopy development aims to assess human orifice that has not been inspected, probed, and examined over the centuries. Endoscopy over these decades is improving, which led to new problem solving using advanced technological approaches. Thus, a surgeon can solve any issues from examination, diagnosis, and treatment using progressive endoscopy evolution. This review delivers a brief history of advances in surgical endoscopy and describes current endoscopy development.
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Affiliation(s)
- Reno Rudiman
- Division of Digestive Surgery, Department of General Surgery, School of Medicine, Padjadjaran University, Hasan Sadikin General Hospital, Bandung, Indonesia
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Sánchez López JD, Acosta Mérida MA, Toledano Trincado M, Segura Sampedro JJ, Trébol López J, Aranzana Gómez A, Álvarez Gallego M, Sánchez Guillén L. Technological implementation in General Surgery services in Spain. National survey and results. Cir Esp 2021; 99:707-715. [PMID: 34764063 DOI: 10.1016/j.cireng.2021.10.013] [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: 02/03/2021] [Accepted: 02/09/2021] [Indexed: 11/25/2022]
Abstract
Technology is one of the pillars of surgery in the 21st century and is a key factor in achieving better surgical results. The current surgical process involves not only surgical techniques, but also a very high degree of specialisation and the knowledge and use of techniques and devices from other fields. In Spain, there are no studies published at a national level in this regard. From the Minimally Invasive Surgery and Technological Innovation section of the Spanish Association of Surgeons we have designed a study whose main objective is to evaluate the degree of technological implantation in the specialty of General Surgery in Spain, as well as to analyze the devices available in the different centres of the country. We propose to make a detailed description of the applications of these devices and techniques by areas of interest, pointing out the pathologies and procedures in which this technology is used.
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Ruiz-Bueno P, Fadrique A, Buisán F. Anesthetic considerations for functional endoscopic sinus surgery in a patient with Kartagener syndrome. Rev Esp Anestesiol Reanim (Engl Ed) 2021; 68:537-541. [PMID: 34743908 DOI: 10.1016/j.redare.2020.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 08/24/2020] [Indexed: 11/18/2022]
Abstract
Kartagener's syndrome (KS) is a rare genetic disease characterised by the triad of sinusitis, bronchiectasis, and situs inversus. This syndrome is associated with an increased risk of respiratory complications. Therefore, both the anaesthetic technique and the agents used must be carefully chosen according to the type of intervention and the patient's baseline condition. We present the case of a 48-year-old woman with KS, scheduled for functional endoscopic sinus surgery (FESS) and septoplasty under general anaesthesia. The main anaesthetic considerations in patients with KS are related to anatomical variations, pulmonary and cardiac functions, and respiratory infections. In this case, measures that reduce perioperative complications in KS are reviewed together with the special anaesthetic management in FESS, derived primarily from the need to maintain a bloodless surgical field and the use of induced hypotension techniques.
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Affiliation(s)
- P Ruiz-Bueno
- Servicio de Anestesiología y Reanimación, Hospital Clínico Universitario de Valladolid, Valladolid, Spain.
| | - A Fadrique
- Servicio de Anestesiología y Reanimación, Hospital de Medina del Campo, Medina del Campo, Valladolid, Spain
| | - F Buisán
- Servicio de Anestesiología y Reanimación, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
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Edwards PJE, Psychogyios D, Speidel S, Maier-Hein L, Stoyanov D. SERV-CT: A disparity dataset from cone-beam CT for validation of endoscopic 3D reconstruction. Med Image Anal 2021; 76:102302. [PMID: 34906918 PMCID: PMC8961000 DOI: 10.1016/j.media.2021.102302] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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: 12/18/2020] [Revised: 11/01/2021] [Accepted: 11/04/2021] [Indexed: 11/27/2022]
Abstract
Full torso porcine CT model for stereo-endoscopic reconstruction validation CT of endoscope and anatomy with constrained manual alignment provides a reference Accuracy analysis of repeated alignments and performance of existing algorithms presented Open sourced dataset for stereo reconstruction validation
In computer vision, reference datasets from simulation and real outdoor scenes have been highly successful in promoting algorithmic development in stereo reconstruction. Endoscopic stereo reconstruction for surgical scenes gives rise to specific problems, including the lack of clear corner features, highly specular surface properties and the presence of blood and smoke. These issues present difficulties for both stereo reconstruction itself and also for standardised dataset production. Previous datasets have been produced using computed tomography (CT) or structured light reconstruction on phantom or ex vivo models. We present a stereo-endoscopic reconstruction validation dataset based on cone-beam CT (SERV-CT). Two ex vivo small porcine full torso cadavers were placed within the view of the endoscope with both the endoscope and target anatomy visible in the CT scan. Subsequent orientation of the endoscope was manually aligned to match the stereoscopic view and benchmark disparities, depths and occlusions are calculated. The requirement of a CT scan limited the number of stereo pairs to 8 from each ex vivo sample. For the second sample an RGB surface was acquired to aid alignment of smooth, featureless surfaces. Repeated manual alignments showed an RMS disparity accuracy of around 2 pixels and a depth accuracy of about 2 mm. A simplified reference dataset is provided consisting of endoscope image pairs with corresponding calibration, disparities, depths and occlusions covering the majority of the endoscopic image and a range of tissue types, including smooth specular surfaces, as well as significant variation of depth. We assessed the performance of various stereo algorithms from online available repositories. There is a significant variation between algorithms, highlighting some of the challenges of surgical endoscopic images. The SERV-CT dataset provides an easy to use stereoscopic validation for surgical applications with smooth reference disparities and depths covering the majority of the endoscopic image. This complements existing resources well and we hope will aid the development of surgical endoscopic anatomical reconstruction algorithms.
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Affiliation(s)
- P J Eddie Edwards
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), University College London (UCL), Charles Bell House, 43-45 Foley Street, London W1W 7TS, UK.
| | - Dimitris Psychogyios
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), University College London (UCL), Charles Bell House, 43-45 Foley Street, London W1W 7TS, UK
| | - Stefanie Speidel
- Division of Translational Surgical Oncology, National Center for Tumor Diseases (NCT) Dresden, Dresden, 01307, Germany
| | - Lena Maier-Hein
- Division of Medical and Biological Informatics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Danail Stoyanov
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), University College London (UCL), Charles Bell House, 43-45 Foley Street, London W1W 7TS, UK
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13
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Ruiz-Bueno P, Fadrique A, Buisán F. Anesthetic considerations for functional endoscopic sinus surgery in a patient with Kartagener syndrome. Rev Esp Anestesiol Reanim (Engl Ed) 2021; 68:S0034-9356(20)30236-X. [PMID: 33836906 DOI: 10.1016/j.redar.2020.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 08/12/2020] [Accepted: 08/24/2020] [Indexed: 10/21/2022]
Abstract
Kartagener's syndrome (KS) is a rare genetic disease characterized by the triad of sinusitis, bronchiectasis, and situs inversus. This syndrome is associated with an increased risk of respiratory complications. Therefore, both the anesthetic technique and the agents used must be carefully chosen according to the type of intervention and the patient's baseline condition. We present the case of a 48-year-old woman with KS, scheduled for functional endoscopic sinus surgery (FESS) and septoplasty under general anesthesia. The main anesthetic considerations in patients with KS are related to anatomical variations, pulmonary and cardiac functions, and respiratory infections. In this case, measures that reduce perioperative complications in KS are reviewed together with the special anesthetic management in FESS, derived primarily from the need to maintain a bloodless surgical field and the use of induced hypotension techniques.
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Affiliation(s)
- P Ruiz-Bueno
- Servicio de Anestesiología y Reanimación, Hospital Clínico Universitario de Valladolid, Valladolid, España.
| | - A Fadrique
- Servicio de Anestesiología y Reanimación, Hospital de Medina del Campo, Medina del Campo, Valladolid, España
| | - F Buisán
- Servicio de Anestesiología y Reanimación, Hospital Clínico Universitario de Valladolid, Valladolid, España
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Sánchez López JD, Acosta Mérida MA, Toledano Trincado M, Segura Sampedro JJ, Trébol López J, Aranzana Gómez A, Álvarez Gallego M, Sánchez Guillén L. Technological implementation in General Surgery services in Spain. National survey and results. Cir Esp 2021; 99:S0009-739X(21)00051-8. [PMID: 33745719 DOI: 10.1016/j.ciresp.2021.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 02/09/2021] [Indexed: 11/28/2022]
Abstract
Technology is one of the pillars of surgery in the 21st century and is a key factor in achieving better surgical results. The current surgical process involves not only surgical techniques, but also a very high degree of specialisation and the knowledge and use of techniques and devices from other fields. In Spain, there are no studies published at a national level in this regard. From the Minimally Invasive Surgery and Technological Innovation section of the Spanish Association of Surgeons we have designed a study whose main objective is to evaluate the degree of technological implantation in the specialty of General Surgery in Spain, as well as to analyze the devices available in the different centres of the country. We propose to make a detailed description of the applications of these devices and techniques by areas of interest, pointing out the pathologies and procedures in which this technology is used.
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15
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Yoon JH, Jun CH, Han JP, Yeom JW, Kang SK, Kook HY, Choi SK. Endoscopic repair of delayed stomach perforation caused by penetrating trauma: A case report. World J Clin Cases 2021; 9:1228-1236. [PMID: 33644189 PMCID: PMC7896642 DOI: 10.12998/wjcc.v9.i5.1228] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 12/13/2020] [Accepted: 12/29/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Primary endoscopic closure of a perforated gastric wall during endoscopic procedures is mostly effective and well-tolerated; however, there are very few studies on the efficacy of endoscopic management of delayed traumatic gastric perforation. Herein, we report a novel case of a patient who was successfully treated for delayed traumatic stomach perforation using an alternative endoscopic modality.
CASE SUMMARY A 39-year-old woman presented with multiple penetrating traumas in the back and left abdominal cavity. Initial imaging studies revealed left diaphragmatic disruption and peri-splenic hemorrhage without gastric perforation. An emergency primary repair of the disrupted diaphragm with omental reduction and suturing of the lacerated lung was performed; however, delayed free perforation of the gastric wall was noted on computed tomography after 3 d. Following an emergency abdominal surgery for the primary repair of the gastric wall, re-perforation was noted 15 d postoperatively. The high risk associated with re-surgery prompted an endoscopic intervention using 2 endoloops and 11 endoscopic clips using a novel modified purse-string suture technique. The free perforated gastric wall was successfully repaired without additional surgery or intervention. The patient was discharged after 46 d without any complications.
CONCLUSION Endoscopic closure with endoloops and clips can be a useful therapeutic alternative to re-surgery for delayed traumatic gastric perforation.
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Affiliation(s)
- Jae Hyun Yoon
- Department of Gastroenterology and Hepatology, Chonnam National University Hospital and College of Medicine, Gwangju 61469, South Korea
| | - Chung Hwan Jun
- Department of Internal Medicine, Mokpo Hankook Hospital, Mokpo 58643, South Korea
| | - Jae Pil Han
- Department of Internal Medicine, Mokpo Hankook Hospital, Mokpo 58643, South Korea
| | - Ji-Woong Yeom
- Department of Surgery, Mokpo Hankook Hospital, Mokpo 58643, South Korea
| | - Seung-Ku Kang
- Department of Cardiothoracic Surgery, Mokpo Hankook Hospital, Mokpo 58643, South Korea
| | - Hyun Yi Kook
- Department of Nursing, Chonnam National University Hospital, and College of Nursing, Gwangju 61469, South Korea
| | - Sung Kyu Choi
- Department of Gastroenterology and Hepatology, Chonnam National University Hospital and College of Medicine, Gwangju 61469, South Korea
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Gollub MJ, Das JP, Bates DDB, Fuqua JL 3rd, Golia Pernicka JS, Javed-Tayyab S, Paroder V, Petkovska I, Garcia-Aguilar J. Rectal cancer with complete endoscopic response after neoadjuvant therapy: what is the meaning of a positive MRI? Eur Radiol 2021; 31:4731-8. [PMID: 33449186 DOI: 10.1007/s00330-020-07657-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 11/30/2020] [Accepted: 12/18/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To determine the short-term outcomes of discordant tumor assessments between DWI-MRI and endoscopy in patients with treated rectal cancer when tumor-bed diffusion restriction is present ("+DWI"). METHODS In this HIPPA-compliant, IRB-approved retrospective study, rectal MRI and endoscopic reports were reviewed for patients with locally advanced primary rectal adenocarcinoma (LARC) treated with chemoradiotherapy or total neoadjuvant therapy and imaged between January 2016 and December 2019. Eligible patients had a +DWI and endoscopy within 2 weeks of each other. True positive MRI were those with tumor on endoscopy and/or biopsy (TPa) or in whom endoscopy was negative for tumor, but subsequent 3-month follow-up endoscopy and DWI were both positive (TPb). The positive predictive value of DWI-MRI was calculated on a per-scan and per-patient basis. DWI-negative MRI exams were not explored in this study. RESULTS In total, 397 patients with nonmetastatic primary LARC were analyzed. After exclusions, 90 patients had 98 follow-up rectal MRI studies with +DWI. Seventy-six patients underwent 80 MRI scans and had concordant findings at endoscopy (TPa). Seventeen patients underwent 18 MRI scans and had discordant findings at endoscopy (FP); among these, 4 scans in 4 patients were initially false positive (FP) but follow-up MRI remained +DWI and the endoscopy turned concordantly positive (TPb). PPV was 0.86 per scan and per patient. In 4/18 (22%) scans and 4/17 (24%) patients with discordances, MRI detected tumor regrowth before endoscopy. CONCLUSIONS Although most +DWI exams discordant with endoscopy are false positive, 22% will reveal that DWI-MRI detects tumor recurrence before endoscopy. KEY POINTS • Most often, in post-treatment assessment for rectal cancer when DWI-MRI shows restriction in the tumor bed and endoscopy shows no tumor, +DWI MRI will be proven false positive. • Conversely, our study demonstrated that, allowing for sequential follow-up at a 3-month maximum interval, DWI-MRI may detect tumor presence in the treated tumor bed before endoscopy in 22% of discordant findings between DWI-MRI and endoscopy. • Our results showed that a majority of DWI-MRI-positive scans in treated rectal cancer concur with the presence of tumor on endoscopy performed within 2 weeks.
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Khusid JA, Khargi R, Seiden B, Sadiq AS, Atallah WM, Gupta M. Thulium fiber laser utilization in urological surgery: A narrative review. Investig Clin Urol 2021; 62:136-147. [PMID: 33660440 PMCID: PMC7940849 DOI: 10.4111/icu.20200467] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 10/06/2020] [Revised: 11/02/2020] [Accepted: 12/15/2020] [Indexed: 11/18/2022] Open
Abstract
The thulium fiber laser (TFL) is a novel technology under active investigation as an conceivable alternative to the Holmium:yttrium-aluminum-garnet (Ho:YAG) laser, which is currently the gold standard for an array of urologic procedures. The purpose of this review is to discuss the existing literature on the functionality and effectiveness of TFL in urological practice. We conducted a search of the PubMed, Medline, Web of Science Core Collection, SCOPUS, Embase (OVID), and Cochrane Databases for all full articles and systematic reviews on the TFL. We found a total of 35 relevant pieces of literature. The early research findings pertaining to the TFL exhibit numerous potential advantages over the Ho:YAG laser. In vitro and ex vivo studies have highlighted the TFL's ability to utilize smaller laser fibers, obtain faster stone ablation rates, and achieve less retropulsion when tested against the Ho:YAG laser in lithotripsy. Currently, there is limited in vivo research that investigates the utilization of the TFL. The in vivo results that are available, however, look promising both for laser lithotripsy and soft tissue ablation. Indeed, the existing literature suggests that the TFL has great potential and may possess numerous technological advantages over the Ho:YAG laser, especially in laser lithotripsy. Although these early studies are promising, randomized control trials are needed to assess the full applicability of the TFL in urology.
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Affiliation(s)
- Johnathan A Khusid
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Raymond Khargi
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Benjamin Seiden
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Areeba S Sadiq
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - William M Atallah
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Mantu Gupta
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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18
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Shin DS, Hwang SC. Neurocritical Management of Traumatic Acute Subdural Hematomas. Korean J Neurotrauma 2020; 16:113-125. [PMID: 33163419 PMCID: PMC7607034 DOI: 10.13004/kjnt.2020.16.e43] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 09/09/2020] [Accepted: 09/09/2020] [Indexed: 11/15/2022] Open
Abstract
Acute subdural hematoma (ASDH) has been a major part of traumatic brain injury. Intracranial hypertension may be followed by ASDH and brain edema. Regardless of the complicated pathophysiology of ASDH, the extent of primary brain injury underlying the ASDH is the most important factor affecting outcome. Ongoing intracranial pressure (ICP) increasing lead to cerebral perfusion pressure (CPP) decrease and cerebral blood flow (CBF) decreasing occurred by CPP decrease. In additionally, disruption of cerebral autoregulation, vasospasm, decreasing of metabolic demand may lead to CBF decreasing. Various protocols for ICP lowering were introduced in neuro-trauma field. Usage of anti-epileptic drugs (AEDs) for ASDH patients have controversy. AEDs may reduce the risk of early seizure (<7 days), but, does not for late-onset epilepsy. Usage of anticoagulants/antiplatelets is increasing due to life-long medical disease conditions in aging populations. It makes a difficulty to decide the proper management. Tranexamic acid may use to reducing bleeding and reduce ASDH related death rate. Decompressive craniectomy for ASDH can reduce patient's death rate. However, it may be accompanied with surgical risks due to big operation and additional cranioplasty afterwards. If the craniotomy is a sufficient management for the ASDH, endoscopic surgery will be good alternative to a conventional larger craniotomy to evacuate the hematoma. The management plan for the ASDH should be individualized based on age, neurologic status, radiologic findings, and the patient's conditions.
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Affiliation(s)
- Dong-Seong Shin
- Department of Neurosurgery, Soonchunhyang University Bucheon Hospital, Bucehon, Korea
| | - Sun-Chul Hwang
- Department of Neurosurgery, Soonchunhyang University Bucheon Hospital, Bucehon, Korea
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19
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Blank JJ, Krausert TB, Olson LR, Goldblatt MI, Lewis BD, Redlich PN, Treat R, Kastenmeier AS. Resident perception of fundamental endoscopic skills exam: a single institution's experience. Surg Endosc 2020; 34:4645-4654. [PMID: 31925502 DOI: 10.1007/s00464-019-07235-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 10/28/2019] [Indexed: 01/25/2023]
Abstract
BACKGROUND Graduating general surgery residents are required to pass the FES exam for ABS certification. Trainees and surgery educators are interested in defining the most effective methods of exam preparation. Our aim is to define trainee perceptions, performance, and the most effective preparation methods regarding the FES exam. METHODS General surgery residents from a single institution who completed the FES exam were identified. All participated in a flexible endoscopy rotation, and all had access to an endoscopy simulator. Residents were surveyed regarding preparation methods and exam difficulty. Descriptive statistics and a Kruskal-Wallis test were used. RESULTS A total of 26 trainees took the FES exam with a first-time pass rate of 96.2%. Of 26 surveys administered, 21 were completed. Twenty trainees (76.9%) participated in a dedicated endoscopy curriculum. Scores were not different among those who received dedicated curricular instruction compared to those who did not (547 [IQR 539-562.5] vs. 516 [484.5-547], p = 0.1484; 535.5 [468.5-571] vs. 519 [464.75-575], p = 0.9514). Written exam difficulty was rated as 5.5 on a 10-point Likert scale, and 85.7% felt it was a fair assessment of endoscopy knowledge; skills exam difficulty was rated as 7, and 71% felt it was a fair assessment of endoscopy skills. Online FES modules, the endoscopy clinical rotation, and an exam preparation session with a faculty member were most effective for written exam preparation. The most effective skills exam preparation methods were independent simulator practice, the endoscopy clinical rotation, and a preparation session with a faculty member. The most difficult skills were loop reduction and retroflexion. Skill decay did not appear to be significant. CONCLUSIONS A clinical endoscopy rotation, a method for independent skills practice, and faculty-mediated exam instruction appear to be effective exam preparation methods. When these are present, trainees report minimal need for dedicated exam preparation time prior to taking the FES exam.
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Affiliation(s)
| | | | - Lisa R Olson
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Brian D Lewis
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Philip N Redlich
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Robert Treat
- Department of Biostatistics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Andrew S Kastenmeier
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA. .,Department of Surgery, Medical College of Wisconsin Affiliated Hospitals, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA.
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20
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Mascagni P, Riva P, Guerriero L, Shlomovitz E, Dallemagne B, Marescaux J, Swanström L, Perretta S. A curriculum to democratize and standardize flexible endoscopy fundamental knowledge and skills: a critical review of the first 5 years of a surgical endoscopy university diploma. Surg Endosc 2020; 35:2473-2479. [PMID: 32974778 DOI: 10.1007/s00464-020-07657-7] [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: 03/03/2020] [Accepted: 05/15/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND As flexible endoscopy offers many advantages to patients, access to training should be aggressively encouraged. In 2014, the IRCAD-IHU-Strasbourg launched a year-long university diploma using advanced education methods to offer surgeons and gastroenterologists high-quality, personalized training in flexible endoscopy. This paper describes and critically reviews the first 5 years of the University Diploma in Surgical Endoscopy (UDSE). METHODS The UDSE aims to progressively transmit theoretical knowledge, clinical judgment, and practical skills on basic and advanced flexible endoscopy. The 300-h year-long curriculum is composed of 100 h of online lectures with tests, 150 h of clinical rotations and 50 h of hands-on sessions. The hands-on training is delivered through validated mechanical simulators, virtual reality simulators, and specifically designed ex vivo and in vivo animal models. Participants' demographics, training, and clinical experience were recorded. Trainees' evaluations of each online lecture, hands-on training, and clinical rotations were assessed using a Likert scale from 1 (not satisfactory) to 5 (outstanding). Trainees' skill progression was evaluated using the Global Assessment of Gastrointestinal Endoscopic Skills (GAGES) proficiency test. Finally, clinical uptake was surveyed. RESULTS 162 (79.01% males) trainees from 38 countries enrolled and successfully completed the first 5 courses. The vast majority of the trainees were surgeons and 19.14% were gastroenterologist. Sixty-nine (42.59%) participants were residents and 97 (56.79%) had no prior experience in flexible endoscopy. The online lectures, on-site sessions, and clinical rotations were highly appreciated receiving an overall average score of 4.33/5, 4.56/5, 4.43/5, respectively. Trainees' endoscopic skills improved significantly (16.68 vs. 20.53 GAGES scores; p = 0.016). At an average of 18.83 months following the course, 31 alumni (77.50% of repliers) started to use a flexible endoscope in their practice. CONCLUSIONS Over its 5-year evolution, the UDSE has proven to be a valid means to ease access to the fundamental knowledge, practical skills, and clinical judgment necessary to achieve proficiency in surgical endoscopy.
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Affiliation(s)
- Pietro Mascagni
- Endoscopia Digestiva Chirurgica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.,Institute of Image-Guided Surgery, Institut Hospitalo-Universitaire (IHU), Strasbourg, France
| | - Pietro Riva
- Institute of Image-Guided Surgery, Institut Hospitalo-Universitaire (IHU), Strasbourg, France.,Department of General Surgery, Humanitas Research Hospital IRCCS, Milano, Italy
| | - Ludovica Guerriero
- Institute of Image-Guided Surgery, Institut Hospitalo-Universitaire (IHU), Strasbourg, France
| | - Eran Shlomovitz
- Institute of Image-Guided Surgery, Institut Hospitalo-Universitaire (IHU), Strasbourg, France.,Department of Surgery and Medical Imaging, University Health Network, Toronto, Canada
| | | | - Jacques Marescaux
- Institute of Image-Guided Surgery, Institut Hospitalo-Universitaire (IHU), Strasbourg, France.,IRCAD, Research Institute Against Digestive Cancer, Strasbourg, France
| | - Lee Swanström
- Institute of Image-Guided Surgery, Institut Hospitalo-Universitaire (IHU), Strasbourg, France
| | - Silvana Perretta
- Institute of Image-Guided Surgery, Institut Hospitalo-Universitaire (IHU), Strasbourg, France. .,Department of General, Digestive, and Endocrine Surgery, University Hospital of Strasbourg, Strasbourg, France. .,IRCAD, Research Institute Against Digestive Cancer, Strasbourg, France.
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21
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Alicandri-Ciufelli M, Fermi M, Di Maro F, Soloperto D, Marchioni D, Presutti L. Endoscopic facial nerve decompression in post-traumatic facial palsies: pilot clinical experience. Eur Arch Otorhinolaryngol 2020; 277:2701-2707. [PMID: 32355994 DOI: 10.1007/s00405-020-05997-7] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 04/18/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE Post-traumatic facial nerve (FN) paralysis might need surgical decompression in selected patients. Different microscope-based surgical techniques are described in the literature such as the transmastoid, the middle cranial fossa and the translabyrinthine approach. The effectiveness of the transcanal endoscopic approach (TEA) in managing such condition has never been described and its possible indications has to be defined. METHODS Retrospective multi-centric case series of patients with post-traumatic FN paralysis surgically treated with TEA. From July 2013 to July 2017, 6 patients underwent TEA for post-traumatic FN paralysis with involvement of the second genu and/or the tympanic segment of the nerve. The surgical technique is described step by step, with focus on anatomic landmarks. Post-operative outcomes are specified in terms of FN postoperative function and audiologic results. RESULTS The TEA showed to recover a House-Brackmann grade I-II FN function in 83.2% of the patient. Post-operative air-bone gap significantly improved; whereas, the pure-tone average bone conduction did not differ significantly. CONCLUSIONS TEA represents a viable option for the treatment of post-traumatic facial palsy in patients with radiologic evidence of tympanic segment and/or perigeniculate region involvement with no involvement of the mastoid segment of the FN. Transcanal endoscopic facial nerve decompression is a safe and effective approach in highly selected cases. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Matteo Alicandri-Ciufelli
- Otorhinolaryngology Head and Neck Surgery Department, University Hospital of Modena, Largo del Pozzo 71, 41100, Modena, Italy
| | - Matteo Fermi
- Otorhinolaryngology Head and Neck Surgery Department, University Hospital of Modena, Largo del Pozzo 71, 41100, Modena, Italy.
| | - Flavia Di Maro
- Otorhinolaryngology Head and Neck Surgery Department, University Hospital of Verona, Piazzale Aristide Stefani 1, 37126, Verona, Italy
| | - Davide Soloperto
- Otorhinolaryngology Head and Neck Surgery Department, University Hospital of Verona, Piazzale Aristide Stefani 1, 37126, Verona, Italy
| | - Daniele Marchioni
- Otorhinolaryngology Head and Neck Surgery Department, University Hospital of Verona, Piazzale Aristide Stefani 1, 37126, Verona, Italy
| | - Livio Presutti
- Otorhinolaryngology Head and Neck Surgery Department, University Hospital of Modena, Largo del Pozzo 71, 41100, Modena, Italy
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22
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Heo DH, Lee N, Park CW, Kim HS, Chung HJ. Endoscopic Unilateral Laminotomy with Bilateral Discectomy Using Biportal Endoscopic Approach: Technical Report and Preliminary Clinical Results. World Neurosurg 2020; 137:31-7. [PMID: 32028006 DOI: 10.1016/j.wneu.2020.01.190] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 01/23/2020] [Accepted: 01/24/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Bilateral or huge disc herniations cause bilateral radiculopathy and severe lower back pain. In such cases, a bilateral discectomy may be required to resolve the radicular pain in both legs. We attempted a surgical technique involving bilateral lumbar discectomy via a unilateral approach using a percutaneous biportal endoscopic technique. The purpose of the present study was to describe our surgical technique and investigate the clinical outcomes in symptomatic bilateral lumbar disc herniation. METHODS Eleven patients with bilateral disc herniation of the L4-L5 or L5-S1 segments were surgically treated using the percutaneous biportal endoscopic approach. Biportal endoscopic unilateral laminotomy with bilateral discectomy was performed in all patients. Postoperative magnetic resonance imaging was performed 1 day after surgery, and the clinical parameters were investigated preoperatively and postoperatively. RESULTS All enrolled patients were successfully treated by biportal endoscopic bilateral discectomy via a unilateral approach. Surgery was performed at the L4-L5 level in 1 patient and the L5-S1 level in 10 patients. The mean operative time was 67.5 ± 13.1 minutes. A visual analog scale of leg pain and the Oswestry disability index showed significant improvement after surgery (P < 0.05). CONCLUSION Endoscopic unilateral laminotomy with bilateral discectomy using the percutaneous biportal endoscopic approach could be an effective and alternative treatment of symptomatic bilateral herniated disc disease affecting L4-L5 or L5-S1 segments.
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23
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Kumar R, Thomas C, Darr A, Donnai M. Parapharyngeal abscess and vocal cord palsy caused by minor salivary gland sialadenitis: an atypical presentation treated using an endoscopic surgical approach. Ann R Coll Surg Engl 2019; 102:e45-e47. [PMID: 31538802 DOI: 10.1308/rcsann.2019.0132] [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: 11/22/2022] Open
Abstract
Parapharyngeal infections carry a significant risk of extensive suppuration and airway compromise. We report the case of a patient presenting with a right paranasopharyngeal abscess, featuring atypical symptoms that made diagnosis particularly challenging. Complications included evidence of right vocal cord paralysis, likely secondary to involvement of the vagus nerve. Notably, this paralysis occurred in isolation, without involvement of cranial nerves IX or XI, which would be expected from jugular foramen encroachment. Imaging demonstrated the presence of a collection extending towards the skull base, which was drained using a transnasal endoscopic approach, avoiding the use of external incisions. Tissue biopsies from the abscess wall suggest that the underlying aetiology was minor salivary gland sialadenitis, which has not been previously reported in the literature.
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Affiliation(s)
- R Kumar
- Ear, Nose and Throat Department, New Cross Hospital, Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - C Thomas
- Ear, Nose and Throat Department, New Cross Hospital, Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - A Darr
- Ear, Nose and Throat Department, New Cross Hospital, Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - M Donnai
- Ear, Nose and Throat Department, New Cross Hospital, Royal Wolverhampton NHS Trust, Wolverhampton, UK
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Choi DJ, Kim JE, Jung JT, Kim YS, Jang HJ, Yoo B, Kang IH. Biportal Endoscopic Spine Surgery for Various Foraminal Lesions at the Lumbosacral Lesion. Asian Spine J 2018; 12:569-73. [PMID: 29879787 DOI: 10.4184/asj.2018.12.3.569] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 09/28/2017] [Accepted: 10/17/2017] [Indexed: 11/08/2022] Open
Abstract
The stenosing foramen of L5-S1 by several degenerative diseases is one of the challenging areas on surgical approaching because of the deeper depth and steep slope in the lumbosacral junction. The floating view using unilateral biportal endoscopic spine surgery rather than docking into the Kambin's zone can make the foraminal structures seen panoramically and permit dynamic handling of various instruments without destroying the facet joint and causing iatrogenic instability. Fine discrimination of structural margins in helps of the higher magnification and gentle manipulation of neural structures just as in open spine surgery could be guaranteed using floating technique from the target structures. Selective decompression with preserving innocent structures including facet joints could relieve foraminal lesions at the L5-S1 and decrease the necessity of fusion surgery caused by wider decompression and iatrogenic instability.
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Sandler BJ, Biertho L, Anvari M, Rumbaut R, Morales-Garza LA, Torres-Barrera G, Marceau S, Hong D, Smith CD, Horgan S. Totally endoscopic implant to effect a gastric bypass: 12-month safety and efficacy outcomes. Surg Endosc 2018; 32:4436-42. [PMID: 29679149 DOI: 10.1007/s00464-018-6186-0] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 04/06/2018] [Indexed: 01/14/2023]
Abstract
BACKGROUND Only a small percentage of candidates for bariatric surgery ever undergo a procedure for weight loss. Devices duplicating key effects of bariatric surgeries with removable, fully trans-oral implants could extend their benefits to patients unwilling to undergo anatomy-altering abdominal surgeries. METHODS Thirty-two obese subjects (mean BMI: 42.3) were enrolled in a prospective, multicenter, single-arm, feasibility trial of the first fully trans-oral endoscopic gastrointestinal bypass device. The device is a cuff attached to the distal esophagus by transmural anchors and connected to a 120-cm sleeve diverting undigested nutrients to the jejunum. Bodyweight, vital signs, adverse events, medications, HbA1c, fasting glucose, and lipids were collected at baseline and follow-up visits. Device status was endoscopically assessed every 6 months. RESULTS The fully trans-oral procedure was successful in all subjects without intraoperative adverse events or postoperative infections. Twenty-eight of 32 subjects (88%) remained implanted with continuing follow-up beyond their 12-month visit. At 12 months, the 32 subjects had lost an average of 44.8% of excess body weight, 17.6% of total body weight, 20.8 kg, and 7.5 BMI points. Weight loss depended on capture of ingesta by the esophageal cuff, with 18 of 32 subjects without visible gaps around their cuffs at the 6 month endoscopy having significantly greater EWL (53.6 vs. 33.4% in the remaining subjects, p < 0.002). Mean HbA1c and fasting glucose declined by 1.1% points and 29 mg/dL in type 2 diabetic subjects, 80% of whom had remission of their diabetes at 12 months. CONCLUSION This study demonstrates the feasibility, safety, and efficacy of a fully trans-oral gastrointestinal bypass implant. This purely endoscopic device may provide a valuable addition to the armamentarium of treatment available for the management of morbid obesity.
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Al-Mansour MR, Fung EC, Jones EL, Zayan NE, Wetzel TD, Martin Del Campo SE, Jalilvand AD, Suzo AJ, Dettorre RR, Fullerton JK, Meara MP, Mellinger JD, Narula VK, Hazey JW. Surgeon-performed endoscopic retrograde cholangiopancreatography. Outcomes of 2392 procedures at two tertiary care centers. Surg Endosc 2017; 32:2871-2876. [PMID: 29273876 DOI: 10.1007/s00464-017-5995-x] [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] [Received: 09/06/2017] [Accepted: 12/02/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Endoscopic retrograde cholangiopancreatography (ERCP) is a common procedure that, in the United States, is traditionally performed by gastroenterologists. We hypothesized that when performed by well-trained surgeons, ERCP can be performed safely and effectively. The objectives of the study were to assess the rate of successful cannulation of the duct of interest and to assess the 30-day complication and mortality rates. METHODS We retrospectively reviewed the charts of 1858 patients who underwent 2392 ERCP procedures performed by five surgeons between August 2003 and June 2016 in two centers. Demographic and historical data, indications, procedure-related data and 30-day complication and mortality data were collected and analyzed. RESULTS The mean age was 53.4 (range 7-102) years and 1046 (56.3%) were female. 1430 (59.8%) of ERCP procedures involved a surgical endoscopy fellow. The most common indication was suspected or established uncomplicated common bile duct stones (n = 1470, 61.5%), followed by management of an existing biliary or pancreatic stent (n = 370, 15.5%) and acute biliary pancreatitis (n = 173, 7.2%). A therapeutic intervention was performed in 1564 (65.4%), a standard sphincterotomy in 1244 (52.0%), stent placement in 705 (29.5%) and stone removal in 638 (26.7%). When cannulation was attempted, the rate of successful cannulation was 94.1%. When cannulation was attempted during the patient's first ERCP the cannulation rate was 92.4%. 94 complications occurred (5.4%); the most common complication was post-ERCP pancreatitis in 75 (4.2%), significant gastrointestinal bleeding in 7 (0.4%), ascending cholangitis in 11 (0.6%) and perforation in 1 (0.05%). 11 mortalities occurred (0.5%) but none of which were ERCP-related. CONCLUSION When performed by well-trained surgical endoscopists, ERCP is associated with high success rate and acceptable complication rates consistent with previously published reports and in line with societal guidelines.
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Affiliation(s)
- Mazen R Al-Mansour
- Department of Surgery, The Ohio State University/Wexner Medical Center, N729 Doan Hall, 410 West 10th Avenue, Columbus, OH, 43210, USA
| | - Eleanor C Fung
- Department of Surgery, The Ohio State University/Wexner Medical Center, N729 Doan Hall, 410 West 10th Avenue, Columbus, OH, 43210, USA
| | - Edward L Jones
- Department of Surgery, Denver Veterans Affairs Medical Center, University of Colorado, Denver, CO, USA
| | - Nichole E Zayan
- Department of Surgery, The Ohio State University/Wexner Medical Center, N729 Doan Hall, 410 West 10th Avenue, Columbus, OH, 43210, USA
| | - Timothy D Wetzel
- Department of Surgery, The Ohio State University/Wexner Medical Center, N729 Doan Hall, 410 West 10th Avenue, Columbus, OH, 43210, USA
| | - Sara E Martin Del Campo
- Department of Surgery, The Ohio State University/Wexner Medical Center, N729 Doan Hall, 410 West 10th Avenue, Columbus, OH, 43210, USA
| | - Anahita D Jalilvand
- Department of Surgery, The Ohio State University/Wexner Medical Center, N729 Doan Hall, 410 West 10th Avenue, Columbus, OH, 43210, USA
| | - Andrew J Suzo
- Department of Surgery, The Ohio State University/Wexner Medical Center, N729 Doan Hall, 410 West 10th Avenue, Columbus, OH, 43210, USA
| | - Rebecca R Dettorre
- Department of Surgery, The Ohio State University/Wexner Medical Center, N729 Doan Hall, 410 West 10th Avenue, Columbus, OH, 43210, USA
| | - James K Fullerton
- Department of General Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Michael P Meara
- Department of Surgery, The Ohio State University/Wexner Medical Center, N729 Doan Hall, 410 West 10th Avenue, Columbus, OH, 43210, USA
| | - John D Mellinger
- Department of General Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Vimal K Narula
- Department of Surgery, The Ohio State University/Wexner Medical Center, N729 Doan Hall, 410 West 10th Avenue, Columbus, OH, 43210, USA
| | - Jeffrey W Hazey
- Department of Surgery, The Ohio State University/Wexner Medical Center, N729 Doan Hall, 410 West 10th Avenue, Columbus, OH, 43210, USA.
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Abstract
INTRODUCTION Several surgical treatments exist for treatment of gastroparesis, including gastric electrical stimulation, pyloroplasty, and gastrectomy. Division of the pylorus by means of endoscopy, Per-Oral Pyloromyotomy (POP), is a newer, endoluminal therapy that may offer a less invasive, interventional treatment option. METHODS We describe and present a video of our step by step technique for POP using a lesser curvature approach. The following are technical steps to complete the POP procedure from the lesser curve approach. CONCLUSION In our experience, these methods provide promising initial results with low operative risks, although long-term outcomes remain to be determined.
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Affiliation(s)
- Matthew T Allemang
- Section of Surgical Endoscopy, Department of General Surgery, The Cleveland Clinic Foundation, 9500 Euclid Avenue, A-100, Cleveland, OH, 44195, USA.
| | - Andrew T Strong
- Section of Surgical Endoscopy, Department of General Surgery, The Cleveland Clinic Foundation, 9500 Euclid Avenue, A-100, Cleveland, OH, 44195, USA
| | - Ivy N Haskins
- Section of Surgical Endoscopy, Department of General Surgery, The Cleveland Clinic Foundation, 9500 Euclid Avenue, A-100, Cleveland, OH, 44195, USA
| | - John Rodriguez
- Section of Surgical Endoscopy, Department of General Surgery, The Cleveland Clinic Foundation, 9500 Euclid Avenue, A-100, Cleveland, OH, 44195, USA
| | - Jeffrey L Ponsky
- Section of Surgical Endoscopy, Department of General Surgery, The Cleveland Clinic Foundation, 9500 Euclid Avenue, A-100, Cleveland, OH, 44195, USA
| | - Matthew Kroh
- Department of General Surgery, The Cleveland Clinic Foundation- Abu Dhabi, Abu Dhabi, United Arab Emirates
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Balayssac D, Pereira B, Bazin JE, Le Roy B, Pezet D, Gagnière J. Warmed and humidified carbon dioxide for abdominal laparoscopic surgery: meta-analysis of the current literature. Surg Endosc 2016; 31:1-12. [PMID: 27005288 DOI: 10.1007/s00464-016-4866-1] [Citation(s) in RCA: 34] [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] [Received: 12/17/2015] [Accepted: 03/09/2016] [Indexed: 01/01/2023]
Abstract
BACKGROUND The creation of a pneumoperitoneum for laparoscopic surgery is performed by the insufflation of carbon dioxide (CO2). The insufflated CO2 is generally at room temperature (20-25 °C) and dry (0-5 % relative humidity). However, these physical characteristics could lead to alterations of the peritoneal cavity, leading to operative and postoperative complications. Warming and humidifying the insufflated gas has been proposed to reduce the iatrogenic effects of laparoscopic surgery, such as pain, hypothermia and peritoneal alterations. Two medical devices are currently available for laparoscopic surgery with warm and humidified CO2. METHODS Clinical studies were identified by searching PubMed with keywords relating to humidified and warmed CO2 for laparoscopic procedures. Analysis of the literature focused on postoperative pain, analgesic consumption, duration of hospital stay and convalescence, surgical techniques and hypothermia. RESULTS Bibliographic analyses reported 114 publications from 1977 to 2015, with only 17 publications of clinical interest. The main disciplines focused on were gynaecological and digestive surgery ). Analysis of the studies selected reported only a small beneficial effect of warmed and humidified laparoscopy compared to standard laparoscopy on immediate postoperative pain and per procedure hypothermia. No difference was observed for later postoperative shoulder pain, morphine equivalent daily doses, postoperative body core temperature, recovery room and hospital length of stay, lens fogging and procedure duration. CONCLUSIONS Only few beneficial effects on immediate postoperative pain and core temperature have been identified in this meta-analysis. Although more studies are probably needed to close the debate on the real impact of warmed and humidified CO2 for laparoscopic procedures.
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Affiliation(s)
- David Balayssac
- Délégation à la Recherche Clinique et à l'Innovation, CHU de Clermont-Ferrand, Villa annexe IFSI, 58, rue Montalembert, 63003, Clermont-Ferrand Cedex, France. .,Faculté de Médecine et de Pharmacie, Clermont Université, 63001, Clermont-Ferrand, France. .,INSERM, U1107, 63000, Clermont-Ferrand, France.
| | - Bruno Pereira
- Délégation à la Recherche Clinique et à l'Innovation, CHU de Clermont-Ferrand, Villa annexe IFSI, 58, rue Montalembert, 63003, Clermont-Ferrand Cedex, France
| | - Jean-Etienne Bazin
- Délégation à la Recherche Clinique et à l'Innovation, CHU de Clermont-Ferrand, Villa annexe IFSI, 58, rue Montalembert, 63003, Clermont-Ferrand Cedex, France.,Faculté de Médecine et de Pharmacie, Clermont Université, 63001, Clermont-Ferrand, France.,Anesthésie Réanimation, CHU de Clermont-Ferrand, 63058, Clermont-Ferrand, France
| | - Bertrand Le Roy
- Chirurgie Digestive, CHU de Clermont-Ferrand, 63058, Clermont-Ferrand, France
| | - Denis Pezet
- Délégation à la Recherche Clinique et à l'Innovation, CHU de Clermont-Ferrand, Villa annexe IFSI, 58, rue Montalembert, 63003, Clermont-Ferrand Cedex, France.,Faculté de Médecine et de Pharmacie, Clermont Université, 63001, Clermont-Ferrand, France.,Chirurgie Digestive, CHU de Clermont-Ferrand, 63058, Clermont-Ferrand, France
| | - Johan Gagnière
- Chirurgie Digestive, CHU de Clermont-Ferrand, 63058, Clermont-Ferrand, France
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Abstract
BACKGROUND AND OBJECTIVES Placement of surgical gastric access is a common operative procedure, with multiple techniques. We describe a cost-effective, safe, and easy-to-perform primary endoscopic gastrostomy button placement in the pediatric population, using a novel double-transcutaneous lasso U-stitch push technique. METHODS This is a retrospective review of a single center's experience of 24 consecutively performed primary gastrostomy button placements in infants and children aged 3 weeks to 20 years, from October 2012 through October 2014. RESULTS The procedure was generally well tolerated, with no intraoperative complications. No conversions to laparoscopic or open procedures were necessary. There were no early tube dislodgements and no postoperative complications within the first 4 weeks. CONCLUSION The endoscopic primary gastrostomy button placement with a transcutaneous lasso U-stitch is a safe, fast, elegant, and cost-effective alternative to a standard percutaneous endoscopic gastrostomy placement.
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Affiliation(s)
- Federico G Seifarth
- Department of Pediatric Surgery, Cleveland Clinic Children's Hospital, Cleveland, OH, USA
| | - Matthew L Dong
- Department of General Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Alfredo D Guerron
- Department of General Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Jose S Lozada
- Department of General Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - David K Magnuson
- Department of Pediatric Surgery, Cleveland Clinic Children's Hospital, Cleveland, OH, USA
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