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Técnicas de Sutura , Humanos , Técnicas de Sutura/instrumentación , Acalasia del Esófago/cirugía , Miotomía/métodos , Miotomía/instrumentación , Cirugía Endoscópica por Orificios Naturales/métodos , Cirugía Endoscópica por Orificios Naturales/instrumentación , Masculino , Femenino , Gastroscopía/métodos , Gastroscopía/instrumentaciónRESUMEN
Objective: To evaluate the efficacy of transoral laser exoscopic surgery (TOLES) in a unicentric series of patients affected by benign and malignant glottic and supraglottic lesions, and compare outcomes with those of transoral laser microsurgery (TOLMS). Methods: To demonstrate the non-inferiority of TOLES in terms of operative time, margin status and complication rates, we compared outcomes of 93 patients treated by TOLES between July 2021 and July 2023 with those of a match-paired group of 107 historical patients treated by TOLMS. To perform a multiparametric ergonomic evaluation of TOLES vs TOLMS, we used observational methods for biomechanical overload risk assessment and wearable technologies comparing 15 procedures with TOLES vs a paired match of 13 surgeries performed with TOLMS by the same surgeon. Results: No significant differences were found in terms of surgical duration, positive margins, or complications between TOLES and TOLMS. Ergonomics assessment by inertial measurement units and electromyographic surface electrodes demonstrated a reduced biomechanical overload with TOLES compared to TOLMS. Conclusions: The many advantages of TOLES, such as its superior didactic value, better digital control of light even through small-bored laryngoscopes, improved binocular vision, and increase in surgical performance by 3 or 4-hand techniques, are difficult to be quantified. In contrast, its non-inferiority in terms of oncological results and better ergonomics compared to TOLMS are demonstrated herein.
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Terapia por Láser , Microcirugia , Humanos , Microcirugia/métodos , Microcirugia/instrumentación , Terapia por Láser/métodos , Terapia por Láser/instrumentación , Masculino , Femenino , Persona de Mediana Edad , Anciano , Boca , Neoplasias Laríngeas/cirugía , Resultado del Tratamiento , Cirugía Endoscópica por Orificios Naturales/métodos , Cirugía Endoscópica por Orificios Naturales/instrumentación , Ergonomía , Adulto , Laringe/cirugíaRESUMEN
Although the application of magnetic compression anastomosis is becoming increasingly widespread, the magnets used in earlier studies were mostly in the shape of a whole ring. Hence, a deformable self-assembled magnetic anastomosis ring (DSAMAR) was designed in this study for gastrointestinal anastomosis. Furthermore, its feasibility was studied using a beagle model. The designed DSAMAR comprised 10 trapezoidal magnetic units. Twelve beagles were used as animal models, and DSAMARs were inserted into the stomach and colon through the mouth and anus, respectively, via endoscopy to achieve gastrocolic magnamosis. Surgical time, number of failed deformations, survival rate of the animals, and the time of magnet discharge were documented. A month later, specimens of the anastomosis were obtained and observed with the naked eye as well as microscopically. In the gastrocolic anastomosis of the 12 beagles, the procedure took 65-120 min. Although a deformation failure occurred during the operation in one of the beagles, it was successful after repositioning. The anastomosis was formed after the magnet fell off 12-18 days after the operation. Naked eye and microscopic observations revealed that the anastomotic specimens obtained 1 month later were well-formed, smooth, and flat. DSAMAR is thus feasible for gastrointestinal anastomosis under full endoscopy via the natural orifice.
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Anastomosis Quirúrgica , Estudios de Factibilidad , Animales , Perros , Anastomosis Quirúrgica/métodos , Estómago/cirugía , Imanes , Magnetismo , Cirugía Endoscópica por Orificios Naturales/métodos , Cirugía Endoscópica por Orificios Naturales/instrumentación , Colon/cirugía , MasculinoRESUMEN
INTRODUCTION: Our aim was to determine whether bacteria contamination occurred within the surgical field or on endoscopic equipment during surgery using the transoral endoscopic thyroidectomy vestibular approach (TOETVA). MATERIALS AND METHODS: Participants were recruited from patients planned for TOETVA between May 2017 and December 2019. Bacterial samples were taken before and at the conclusion of the TOETVA procedure. The preoperative and postoperative samples were taken from the endoscopic materials and inferior oral vestibulum using a sterile flocked swab. RESULTS: The study resulted in 480 samples (80 TOETVAs). No vestibular, port site, or neck infections occurred in any of the patients. Three (3.7%) out of 80 patients developed postoperative fever. Our results show different microbial communities during TOETVA. The most prevalent species detected were S treptococcus species. Multivariate logistic regression analyses revealed that the degree of contamination depended on the sampling site (inferior vestibulum > equipment) ( P =0.03). In addition, the abundance of bacteria was affected by operative time ( P =0.013). There were no significant differences observed in isolation frequencies of bacteria in malignancy ( P =0.34). CONCLUSIONS: TOETVA surgery is categorized as a "clean-contaminated" operation. A swab identified the common colonizers of oral microbiota on the endoscopic equipment and within the surgical field.
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Cirugía Endoscópica por Orificios Naturales , Tiroidectomía , Humanos , Femenino , Masculino , Tiroidectomía/efectos adversos , Tiroidectomía/métodos , Persona de Mediana Edad , Cirugía Endoscópica por Orificios Naturales/efectos adversos , Cirugía Endoscópica por Orificios Naturales/instrumentación , Adulto , Contaminación de Equipos , Anciano , Infección de la Herida Quirúrgica/microbiología , Infección de la Herida Quirúrgica/etiología , Infección de la Herida Quirúrgica/epidemiología , Boca/microbiología , Bacterias/aislamiento & purificaciónRESUMEN
OBJECTIVE: To systematically review the literature to evaluate clinical and surgical outcomes for technologies that facilitate vaginal surgical procedures. DATA SOURCES: We systematically searched MEDLINE, EMBASE, and ClinicalTrials.gov from January 1990 to May 2022. METHODS OF STUDY SELECTION: Comparative and single-arm studies with data on contemporary tools or technologies facilitating intraoperative performance of vaginal gynecologic surgical procedures for benign indications were included. Citations were independently double screened, and eligible full-text articles were extracted by two reviewers. Data collected included study characteristics, technology, patient demographics, and intraoperative and postoperative outcomes. Risk of bias for comparative studies was assessed using established methods, and restricted maximum likelihood model meta-analyses were conducted as indicated. TABULATION, INTEGRATION, AND RESULTS: The search yielded 8,658 abstracts, with 116 eligible studies that evaluated pedicle sealing devices (n=32), nonrobotic and robotic vaginal natural orifice transluminal endoscopic surgery (n=64), suture capture devices (n=17), loop ligatures (n=2), and table-mounted telescopic cameras (n=1). Based on 19 comparative studies, pedicle sealing devices lowered vaginal hysterectomy operative time by 15.9 minutes (95% CI, -23.3 to -85), blood loss by 36.9 mL (95% CI, -56.9 to -17.0), hospital stay by 0.2 days (95% CI, -0.4 to -0.1), and visual analog scale pain scores by 1.4 points on a subjective 10-point scale (95% CI, -1.7 to -1.1). Three nonrandomized comparative studies and 53 single-arm studies supported the feasibility of nonrobotic vaginal natural orifice transluminal endoscopic surgery for hysterectomy, adnexal surgery, pelvic reconstruction, and myomectomy. Data were limited for robotic vaginal natural orifice transluminal endoscopic surgery, suture capture devices, loop ligatures, and table-mounted cameras due to few studies or study heterogeneity. CONCLUSION: Pedicle sealing devices lower operative time and blood loss for vaginal hysterectomy, with modest reductions in hospital stay and pain scores. Although other technologies identified in the literature may have potential to facilitate vaginal surgical procedures and improve outcomes, additional comparative effectiveness research is needed. SYSTEMATIC REVIEW REGISTRATION: PROSPERO, CRD42022327490.
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Procedimientos Quirúrgicos Ginecológicos , Vagina , Humanos , Femenino , Vagina/cirugía , Procedimientos Quirúrgicos Ginecológicos/métodos , Procedimientos Quirúrgicos Ginecológicos/instrumentación , Procedimientos Quirúrgicos Robotizados/métodos , Tempo Operativo , Histerectomía Vaginal/métodos , Cirugía Endoscópica por Orificios Naturales/métodos , Cirugía Endoscópica por Orificios Naturales/instrumentaciónRESUMEN
AIM: Natural orifice specimen extraction (NOSE) in left-sided colorectal surgery requires application of the circular stapler anvil to the proximal bowel without exteriorization through an additional abdominal incision. We describe an intracorporeal method to secure the stapler anvil, termed the intracorporeal antimesenteric ancillary trocar (IAAT) technique. METHOD: The ancillary trocar is attached to the stapler anvil before introduction into the abdominal cavity through the anal or vaginal orifice. The colon is incised before the trocar spike is brought out through the antimesenteric surface 3-4 cm within the cut edge. A linear stapler is used to seal the bowel end. The ancillary trocar is detached and retrieved via the NOSE conduit. Following the NOSE procedure, a side-to-end colorectal anastomosis is performed with the transanal circular stapler. RESULTS: Ten consecutive patients underwent elective left-sided colorectal resection with IAAT for NOSE (seven transanal, three transvaginal) from January to June 2023. Median age and body mass index were 66 (range 47-74) years and 24.3 (range 17.9-30.8) kg/m2 respectively. Two (20%) patients underwent sigmoid colectomy for sigmoid volvulus while eight (80%) underwent anterior resection for colorectal cancer. Median operating time, operative blood loss and postoperative length of hospital stay were 170 (range 140-240) min, 20 (range 10-40) mL and 1 (range 1-3) day respectively. There were no postoperative complications, readmissions or reoperations. Median follow-up duration was 3 (range 1-6) months. CONCLUSION: The IAAT double-stapling side-to-end anastomotic technique is safe and feasible for patients undergoing left-sided colorectal resection with NOSE, resulting in good outcomes.
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Anastomosis Quirúrgica , Colectomía , Cirugía Endoscópica por Orificios Naturales , Humanos , Femenino , Persona de Mediana Edad , Anastomosis Quirúrgica/métodos , Anastomosis Quirúrgica/instrumentación , Anciano , Masculino , Cirugía Endoscópica por Orificios Naturales/métodos , Cirugía Endoscópica por Orificios Naturales/instrumentación , Colectomía/métodos , Colectomía/instrumentación , Colon/cirugía , Instrumentos Quirúrgicos , Vagina/cirugía , Engrapadoras Quirúrgicas , Grapado Quirúrgico/métodos , Grapado Quirúrgico/instrumentación , Recto/cirugía , Tempo OperativoRESUMEN
BACKGROUND: We describe a natural orifice technique for simultaneous endoluminal lateral suspension of apical vaginal wall and rectal prolapse fixation with ultrasound and fluoroscopic assistance. IMPACT OF INNOVATION: The technique is minimally invasive, can be performed under regional anaesthesia, and avoids laparotomy or use of a mesh in addition to preserving the uterus. TECHNOLOGY MATERIALS AND METHODS: This technique involves suprapubic transvaginal ventral suture colposuspension, fixation of the anterior rectal wall to the undersurface of the anterior abdominal wall and tack fixation of the posterior rectal wall to the underlying sacral promontory through a submucosal tunnel performed endoscopically with fluoroscopic and ultrasound assistance. PRELIMINARY RESULTS: Seven patients with a mean age of 63 years were followed between 3 to 11 months. CONCLUSIONS: This is a novel minimally invasive transluminal procedure that repairs concomitant rectal and vaginal prolapse in the same sitting. FUTURE DIRECTIONS: Improvement in the instrument design and incorporation of endoluminal robotic systems will enhance the technical ease. The study needs validation in larger series of patients with longer follow-up.
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Anestesia de Conducción/métodos , Cirugía Endoscópica por Orificios Naturales , Prolapso Rectal , Prolapso Uterino , Estudios de Factibilidad , Femenino , Fluoroscopía/métodos , Humanos , Persona de Mediana Edad , Procedimientos Quirúrgicos Mínimamente Invasivos/instrumentación , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Cirugía Endoscópica por Orificios Naturales/instrumentación , Cirugía Endoscópica por Orificios Naturales/métodos , Mejoramiento de la Calidad , Prolapso Rectal/diagnóstico por imagen , Prolapso Rectal/cirugía , Procedimientos Quirúrgicos Robotizados/instrumentación , Procedimientos Quirúrgicos Robotizados/métodos , Cirugía Asistida por Computador/métodos , Dispositivos de Fijación Quirúrgicos , Resultado del Tratamiento , Ultrasonografía Intervencional/métodos , Prolapso Uterino/diagnóstico por imagen , Prolapso Uterino/cirugíaAsunto(s)
Enteroscopia de Balón/instrumentación , Infecciones Relacionadas con Catéteres/prevención & control , Cirugía Endoscópica por Orificios Naturales/instrumentación , Complicaciones Posoperatorias/prevención & control , Recto/cirugía , Adulto , Infecciones Relacionadas con Catéteres/etiología , Femenino , Enfermedades de la Vesícula Biliar/cirugía , Cálculos Biliares/cirugía , Humanos , Masculino , Persona de Mediana Edad , Pólipos/cirugía , Complicaciones Posoperatorias/etiologíaRESUMEN
High-precision delivery of microrobots at the whole-body scale is of considerable importance for efforts toward targeted therapeutic intervention. However, vision-based control of microrobots, to deep and narrow spaces inside the body, remains a challenge. Here, we report a soft and resilient magnetic cell microrobot with high biocompatibility that can interface with the human body and adapt to the complex surroundings while navigating inside the body. We achieve time-efficient delivery of soft microrobots using an integrated platform called endoscopy-assisted magnetic actuation with dual imaging system (EMADIS). EMADIS enables rapid deployment across multiple organ/tissue barriers at the whole-body scale and high-precision delivery of soft and biohybrid microrobots in real time to tiny regions with depth up to meter scale through natural orifice, which are commonly inaccessible and even invisible by conventional endoscope and medical robots. The precise delivery of magnetic stem cell spheroid microrobots (MSCSMs) by the EMADIS transesophageal into the bile duct with a total distance of about 100 centimeters can be completed within 8 minutes. The integration strategy offers a full clinical imaging technique-based therapeutic/intervention system, which broadens the accessibility of hitherto hard-to-access regions, by means of soft microrobots.
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Sistemas de Liberación de Medicamentos/instrumentación , Endoscopía/instrumentación , Robótica/instrumentación , Células 3T3 , Animales , Sistemas de Computación , Diagnóstico por Imagen/instrumentación , Diseño de Equipo , Femenino , Humanos , Magnetismo/instrumentación , Masculino , Ratones , Microscopía Electrónica de Rastreo , Microtecnología , Cirugía Endoscópica por Orificios Naturales/instrumentación , Ratas , Ratas Sprague-Dawley , Esferoides Celulares/trasplante , Sus scrofa , UltrasonografíaAsunto(s)
Cirugía Endoscópica por Orificios Naturales/métodos , Tonsila Palatina/cirugía , Paracentesis/métodos , Absceso Peritonsilar/cirugía , Adulto , Femenino , Humanos , Masculino , Cirugía Endoscópica por Orificios Naturales/instrumentación , Tonsila Palatina/diagnóstico por imagen , Paracentesis/instrumentación , Absceso Peritonsilar/diagnóstico , Resultado del Tratamiento , Ultrasonografía Doppler/métodos , Ultrasonografía Intervencional/métodos , Adulto JovenAsunto(s)
Neoplasias del Colon/cirugía , Íleon/cirugía , Cirugía Endoscópica por Orificios Naturales/instrumentación , Recto/cirugía , Anastomosis Quirúrgica/métodos , Colectomía/métodos , Neoplasias del Colon/patología , Humanos , Laparoscopía/métodos , Masculino , Persona de Mediana Edad , Manejo de Especímenes/métodos , Engrapadoras Quirúrgicas/efectos adversos , Resultado del TratamientoRESUMEN
Liposarcomas are rare malignant tumours of the connective tissue. Microscopically they resemble lipomas. They are usually found on the limbs or trunk. Fewer than 40 cases of hypopharyngeal liposarcoma have been reported in the literature. Surgical excision with a cervical or endoscopic approach has been the first-line treatment for these cases. We present a patient with the first documented primary excision via carbon dioxide laser using an entirely transoral approach. This case suggests a new standard of management but also highlights the difficulties with investigation and diagnosis in a rare presentation.
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Neoplasias Hipofaríngeas/cirugía , Láseres de Gas/uso terapéutico , Liposarcoma/cirugía , Cirugía Endoscópica por Orificios Naturales/métodos , Anciano , Humanos , Neoplasias Hipofaríngeas/diagnóstico , Neoplasias Hipofaríngeas/patología , Hipofaringe/diagnóstico por imagen , Hipofaringe/patología , Hipofaringe/cirugía , Liposarcoma/diagnóstico , Liposarcoma/patología , Masculino , Cirugía Endoscópica por Orificios Naturales/instrumentación , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
STUDY OBJECTIVE: To determine the distances and angles that assure a safe entry into the pouch of Douglas (POD) during blind laparoscopic and robotic trocar entry. DESIGN: Trocars were inserted into the POD of 4 intact fresh frozen female pelves. Cadaveric dissection was performed, and the distance from the POD to the sacrum at rest and with maximal pressure to POD with the trocar was measured. In addition, the optimal angle for trocar insertion and entry was evaluated. SETTING: Inova Advanced Simulation and Technology Evaluation Center. PATIENTS: Fresh frozen cadavers with intact reproductive organs. INTERVENTIONS: Vaginal POD trocar insertion. MEASUREMENTS AND MAIN RESULTS: Measurements were recorded from the sacrum to the POD at rest and from the sacrum to the hymen with trocar pressure. The dissection demonstrated correct trocar placement in the POD of human cadaveric specimens. The mean distances from the sacrum to the hymen, the sacrum to the POD, and the sacrum to the POD with pressure were 18.75 cm, 9.75 cm, and 7.25 cm, respectively. After the deployment of the trocar, the tip was observed to be 2 cm below the cervix in the POD. The mean trocar angle to clear the sacral promontory and the neurovascular structures without injury to the uterus was 25° to 40° from the horizontal plane and 15° to 30° from the coronal plane. CONCLUSION: A direct trocar entry into the POD has been found to be feasible in fresh frozen cadaveric specimens. This study provided valuable information for the angle of entry into the POD to facilitate vaginal and robotic trocar entry for minimally invasive gynecologic procedures.
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Fondo de Saco Recto-Uterino/cirugía , Cirugía Endoscópica por Orificios Naturales , Procedimientos Quirúrgicos Robotizados , Instrumentos Quirúrgicos , Vagina/cirugía , Adulto , Autopsia , Pesos y Medidas Corporales , Cadáver , Fondo de Saco Recto-Uterino/patología , Estudios de Factibilidad , Femenino , Congelación , Humanos , Laparoscopía/efectos adversos , Laparoscopía/instrumentación , Laparoscopía/métodos , Persona de Mediana Edad , Cirugía Endoscópica por Orificios Naturales/efectos adversos , Cirugía Endoscópica por Orificios Naturales/instrumentación , Cirugía Endoscópica por Orificios Naturales/métodos , Tamaño de los Órganos , Procedimientos Quirúrgicos Robotizados/efectos adversos , Procedimientos Quirúrgicos Robotizados/instrumentación , Procedimientos Quirúrgicos Robotizados/métodos , Instrumentos Quirúrgicos/efectos adversos , Vagina/patologíaRESUMEN
Although robotic single-site (RSS) surgery employing cross setup of semirigid instruments allows effective triangulation of instruments, it has some limitations in performing RSS transabdominal and transvaginal surgeries. We introduced the robotic glove port technique (RGPT) using parallel setup of endowristed rigid instruments in performing RSS transabdominal surgery and transvaginal surgery in July of 2017. Thirty-five patients underwent RSS surgery with RGPT. Twenty-one patients had RSS transabdominal reconstructive or fertility-preserving surgeries such as myomectomy (12 patients), adenomyomectomy (3 patients), and ovarian endometriosis cystectomy (6 patients). Fourteen patients underwent robotic transvaginal surgery for natural orifice transluminal endoscopic surgery (NOTES) hysterectomy. All procedures were successfully performed, and no postoperative complications were observed. In all patients, the median total operative time, console time, and docking time were 160 min (range 106-240), 120 min (range 65-180), and 10 min (range 4-25), respectively. There was no conversion to another type of surgery, such as conventional laparoscopy, laparotomy, or traditional multiport robotic surgery. The findings showed that RSS surgery via the RGPT is safe and feasible, using the parallel setup of endowristed rigid instruments is easily performed on transvaginal routes and transabdominal routes. Therefore, this procedure may be an important complement to gynecologic surgeons' armamentarium in the field of robotic reconstructive or fertility-preserving surgeries such as myomectomy, adenomyomectomy, ovarian cystectomy, and transvaginal surgery for NOTES hysterectomy. Nevertheless, further prospective controlled studies are needed to determine its full clinical application.
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Procedimientos Quirúrgicos Ginecológicos/instrumentación , Cirugía Endoscópica por Orificios Naturales/instrumentación , Procedimientos de Cirugía Plástica/instrumentación , Procedimientos Quirúrgicos Robotizados/instrumentación , Abdomen/cirugía , Cistectomía/instrumentación , Cistectomía/métodos , Femenino , Procedimientos Quirúrgicos Ginecológicos/métodos , Humanos , Histerectomía/instrumentación , Histerectomía/métodos , Cirugía Endoscópica por Orificios Naturales/métodos , Procedimientos de Cirugía Plástica/métodos , Procedimientos Quirúrgicos Robotizados/métodos , Miomectomía Uterina/instrumentación , Miomectomía Uterina/métodos , Vagina/cirugíaRESUMEN
BACKGROUND: In patients with ultralow rectal cancer, surgical resection of the tumor without impairing sphincter function remains a technical challenge. The purpose of this study was to describe a new technique of transanal natural orifice specimen extraction (NOSE) surgery using our independently developed devices, aiming to achieve precise cancer resection and preserve sphincter function in patients with ultralow rectal cancer. METHODS: Precision functional sphincter-preserving surgery (PPS) was performed on nineteen patients with ultralow rectal cancer between June 2019 and April 2020. With the help of our independently developed devices, surgeons directly and accurately removed the lower edge of the tumor and retained healthy rectal tissue on the nontumorous side. Hand-sewn anastomosis with a mattress suture was used to achieve sturdy anastomosis. Preoperative baseline characteristics, operative details, 90-day postoperative complications, costs, and anal function score at 6 months after surgery were documented. RESULTS: Nineteen ultralow rectal cancer patients with a median distance to the dentate line of 2.0 cm successfully underwent PPS without serious postoperative complications. Six out of nineteen patients (31.6%) received a prophylactic stoma. The average cost was 62164.1 yuan. At 6 months after surgery, the average Wexner anal function score and the average Vaizey score were both 3 points. CONCLUSIONS: PPS can be employed to precisely resect rectal tumors and preserve sphincter function in ultralow rectal cancer patients. The use of our devices enhanced surgical efficiency, reduced the need for prophylactic stoma, reduced surgery-related costs, and prevented abdominal surgical incisions.
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Cirugía Endoscópica por Orificios Naturales/métodos , Neoplasias del Recto/cirugía , Anciano , Canal Anal/cirugía , Anastomosis Quirúrgica/métodos , Humanos , Masculino , Persona de Mediana Edad , Cirugía Endoscópica por Orificios Naturales/efectos adversos , Cirugía Endoscópica por Orificios Naturales/instrumentación , Tratamientos Conservadores del Órgano , Complicaciones Posoperatorias/etiología , Recto/cirugía , Estomas QuirúrgicosRESUMEN
The transvaginal natural orifice transluminal endoscopic surgery (vNOTES) is a new minimally invasive and emerging technique. Feasibility and safety profiles of peritoneal access via transvaginal routes have been demonstrated especially for the adnexal surgery. In order to be reproducible and replicable with a standardized procedure, we propose the step-by-step video description of the vNOTES salpingectomy. The advantages of the vNOTES (low postoperative pain, faster postoperative recovery, scarless surgery) could lead to a promising alternative to conventional laparoscopic salpingectomy/adnexectomy.
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Cirugía Endoscópica por Orificios Naturales/métodos , Salpingectomía/métodos , Femenino , Humanos , Laparoscopía , Cirugía Endoscópica por Orificios Naturales/instrumentación , Dolor Postoperatorio/diagnóstico , Salpingectomía/instrumentación , VaginaAsunto(s)
COVID-19/prevención & control , Transmisión de Enfermedad Infecciosa de Paciente a Profesional/prevención & control , Cirugía Endoscópica por Orificios Naturales/instrumentación , Adulto , Aerosoles/aislamiento & purificación , Anciano , COVID-19/transmisión , Femenino , Humanos , Masculino , Persona de Mediana Edad , Otolaringología/instrumentación , Satisfacción del Paciente , Equipo de Protección Personal/virología , SARS-CoV-2RESUMEN
OBJECTIVE: During the COVID-19 pandemic, there has been considerable interest in identifying aerosol- and droplet-generating procedures, as well as efforts to mitigate the spread of these potentially dangerous particulates. This study evaluated the efficacy of a prototype nasolaryngoscopy hood (PNLH) during various clinical scenarios that are known to generate aerosols and droplets. STUDY DESIGN: Prospective detection of airborne aerosol generation during clinical simulation while wearing an PNLH. SETTING: Clinical examination room. METHODS: A particle counter was used to calculate the average number of 0.3-µm particles/L detected during various clinical scenarios that included sneezing, nasolaryngoscopy, sneezing during nasolaryngoscopy, and topical spray administration. Experiments were repeated to compare the PNLH versus no protection. During the sneeze experiments, additional measurements with a conventional N95 were documented. RESULTS: There was a significant increase in aerosols detected during sneezing, sneezing during nasolaryngoscopy, and spray administration, as compared with baseline when no patient barrier was used. With the PNLH in place, the level of aerosols returned to comparable baseline levels in each scenario. Of note, routine nasolaryngoscopy did not lead to a statistically significant increase in aerosols. CONCLUSION: This study demonstrated that the PNLH is a safe and effective form of protection that can be used in clinical practice to help mitigate the generation of aerosols during nasolaryngoscopy. While nasolaryngoscopy itself was not shown to produce significant aerosols, the PNLH managed to lessen the aerosol burden during sneezing episodes associated with nasolaryngoscopy.
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COVID-19/prevención & control , COVID-19/transmisión , Transmisión de Enfermedad Infecciosa de Paciente a Profesional/prevención & control , Laringoscopía/instrumentación , Cirugía Endoscópica por Orificios Naturales/instrumentación , Aerosoles , Humanos , Cavidad Nasal , Equipo de Protección PersonalRESUMEN
OBJECTIVE: To compare transoral robotic surgery (TORS) versus non-TORS tongue resection procedures performed for obstructive sleep apnea from January 2010 to September 2015 using a national database, focusing on patient characteristics, performance of concurrent procedures, operative time, length of hospital stay, and postoperative complications. METHODS: A cohort of adults undergoing TORS and non-TORS tongue resection procedures was identified in the Nationwide Inpatient Sample, a publicly-available national administrative database incorporating a stratified sample of hospital discharge records. Outcomes were annual case volumes, prolonged (≥3 days) hospital stay, and complications. Statistical analyses examined potential associations between TORS and prolonged hospital stay and complications. RESULTS: From 2010 to 2015, 5709 hospital discharges included tongue resection surgery to treat obstructive sleep apnea. There was a gradual decline and stabilization in overall volumes, with the proportion of TORS use showing an initial increase, followed by a decrease and rebound increase. TORS patients were less likely to undergo concurrent nasal surgery (15% vs. 44%, P < .01), but there was no association between the use of TORS and concurrent palatal surgery. TORS use was not associated with concurrent hypopharyngeal surgery overall, but it was associated with specific types of hypopharyngeal surgery. TORS use was associated with patient age, payor, and certain hospital characteristics. TORS use was associated with an increased risk of prolonged hospital stay (33% vs. 25%, P = .045) but was not associated with complications. CONCLUSION: This study provides insight into TORS use in tongue resection surgery for obstructive sleep apnea during this period of early TORS adoption. LEVEL OF EVIDENCE: Level 3 (cohort study). Laryngoscope, 131:E1735-E1740, 2021.