The usefulness of a trans-illuminated introducer during the Nuss procedure.

Background There has been an increase in the number of patients undergoing the Nuss procedure for cosmetic purposes, thus increasing the need for safer surgery. However, there are reports of massive hemorrhage and organ damage during the Nuss procedure which involves dissection of the anterior mediastinum. We have developed the trans-illuminated introducer that allows safe surgery while maintaining a small surgical incision of less than 1 cm. Methods This study was a retrospective review of 306 patients aged 3-40 years who underwent the Nuss procedure using the trans-illuminated introducer at our hospital between April 2006 and December 2014. Results There were 29 (9.5%) early postoperative complications. The most common early complication was pneumothorax (15 cases, 4.9%). Five (1.6%) patients developed hemothorax in the early postoperative period, which occurred independently of the dissection process of the anterior mediastinum. None of these patients required reoperation or blood transfusion. There were no complications caused by the introducer during dissection of the anterior mediastinum. Conclusions Using the trans-illuminated introducer, we were able to dissect the anterior mediastinum without a major complication, such as massive hemorrhage from the mediastinum, while maintaining a small surgical incision for cosmetic purposes. Therefore, we consider that the trans-illuminated introducer is useful for improving the outcome of the Nuss procedure.

A new retrograde transillumination technique for videolaryngoscopic tracheal intubation.

This single-centre, prospective trial was designed to assess the efficacy of a new retrograde transillumination device called the 'Infrared Red Intubation System' (IRRIS) to aid videolaryngoscopic tracheal intubation. We included 40 adult patients, who were undergoing elective urological surgery under general anaesthesia. We assessed the ability to differentiate the transilluminated glottis from other structures and found a median (IQR [range]) larynx recognition time of 8 (5-14 [3-28]) s. The difference in laryngeal visibility on the screen between the deactivated vs. activated device expressed on a visual analogue scale was significant (6 (4-7 [2-10]) vs. 10 (8-10 [4-10]); p < 0.001). The number of laryngoscope insertions was 1 (1-2 [1-3]) and the device showed high values on a visual analogue scale ranging from 0 (lowest score) to 10 (highest score) for helpfulness (6 (5-7 [2-10])), credibility (10 (8-10 [5-10])) and ease of use (10 (9-10 [8-10])). Tracheal intubation with the system lasted 26 (16-32 [6-89]) s. No alternative technique of securing the airway was necessary. The lowest SpO2 during intubation was 98 (97-99 [91-100])%. We conclude that this method of retrograde transillumination can assist videolaryngoscopy.

Pen Torch Transillumination: Difficult Venepuncture Made Easy.

INTRODUCTION: Our novel technique of pen torch transillumination (PTI) uses a cheap and easily available instrument (Penlite-LP212®, Energizer®, Missouri, USA) to visualize superficial veins invisible to the naked eye. We evaluate the efficacy of PTI in improving venepuncture success rate (SR) for patients with poor venous access. METHODS: This prospective randomized controlled trial looked at adult patients (n = 69) aged 21-90 with difficult venous access (history of ≥3 consecutive attempts required for successful cannulation during the current admission) requiring non-emergent venepuncture. Patients underwent venepuncture over the upper-limb using one of the following: conventional venepuncture (control); Veinlite® EMS (TransLite®, Texas, USA), a commercial transillumination device; PTI. Outcome measures were: successful cannulation within 2 attempts and total duration of venepuncture. Fisher's exact and Kruskal-Wallis tests were performed. RESULTS: A significantly larger number of patients had successful venepuncture within 2 attempts using PTI (22/23, 95.7%) and Veinlite (23/23, 100%), compared to the controls (7/23, 30.4%) (p < 0.05). The total duration required for successful venepuncture was significantly shorter for Veinlite (mean 3.7 min, 1.0-5.3 min) and PTI (mean 8.5 min, range 1.08-27 min) compared to the controls (mean 23.2 min, range 1.88-46.5 min) (p < 0.05). CONCLUSIONS: PTI allows users to visualize veins invisible to the naked eye. Thrombosed/tortuous veins, branch points and valves, are easily identified and avoided. It has comparable efficacy to Veinlite® and is cheaper (Veinlite®-USD 227 vs. Penlite-LP212®-USD 7.00) and more easily available. PTI improves patient care, especially in developing regions where costs are a concern.

Near-IR and CP-OCT imaging of suspected occlusal caries lesions.

INTRODUCTION: Radiographic methods have poor sensitivity for occlusal lesions and by the time the lesions are radiolucent they have typically progressed deep into the dentin. New more sensitive imaging methods are needed to detect occlusal lesions. In this study, cross-polarization optical coherence tomography (CP-OCT) and near-IR imaging were used to image questionable occlusal lesions (QOC's) that were not visible on radiographs but had been scheduled for restoration on 30 test subjects. METHODS: Near-IR reflectance and transillumination probes incorporating a high definition InGaAs camera and near-IR broadband light sources were used to acquire images of the lesions before restoration. The reflectance probe utilized cross-polarization and operated at wavelengths from 1,500 to 1,700 nm where there is an increase in water absorption for higher contrast. The transillumination probe was operated at 1,300 nm where the transparency of enamel is highest. Tomographic images (6 × 6 × 7 mm3 ) of the lesions were acquired using a high-speed swept-source CP-OCT system operating at 1,300 nm before and after removal of the suspected lesion. RESULTS: Near-IR reflectance imaging at 1,500-1,700 nm yielded significantly higher contrast (P < 0.05) of the demineralization in the occlusal grooves compared with visible reflectance imaging. Stains in the occlusal grooves greatly reduced the lesion contrast in the visible range yielding negative values. Only half of the 26 lesions analyzed showed the characteristic surface demineralization and increased reflectivity below the dentinal-enamel junction (DEJ) in 3D OCT images indicative of penetration of the lesion into the dentin. CONCLUSION: This study demonstrates that near-IR imaging methods have great potential for improving the early diagnosis of occlusal lesions. Lasers Surg. Med. 49:215-224, 2017. © 2017 Wiley Periodicals, Inc.

Near-IR transillumination and reflectance imaging at 1,300 nm and 1,500-1,700 nm for in vivo caries detection.

INTRODUCTION: Several studies suggest that near-IR imaging methods at wavelengths longer than 1,300 nm have great potential for caries detection. In this study, the diagnostic performance of both near-IR transillumination and near-IR reflectance was assessed on teeth scheduled for extraction due to orthodontic treatment (n = 109 teeth on 40 test subjects). METHODS: Three intra-oral near-IR imaging probes were fabricated for the acquisition of in vivo images using a high definition InGaAs camera and near-IR broadband light sources. Two transillumination probes provided occlusal and approximal images using 1,300 nm light which manifests the highest transparency in enamel. A third reflectance probe utilized cross-polarization and operated at wavelengths greater than 1,500 nm where water absorption is higher which reduces the reflectivity of sound tissues, significantly increasing lesion contrast. Teeth were collected after extraction and sectioned and examined with polarized light microscopy and microradiography which served as the gold standard. In addition, radiographs were taken of the teeth and the diagnostic performance of near-IR imaging was compared with radiography. RESULTS: Near-IR imaging was significantly more sensitive (P < 0.05) than radiography for the detection of lesions on both occlusal and proximal surfaces. CONCLUSION: Near-IR imaging methods are ideally suited for screening all tooth surfaces for carious lesions. Lasers Surg. Med. 48:828-836, 2016. © 2016 Wiley Periodicals, Inc.

Light Augmentation Device: A New Surgical Tool for Improved Laparoscopic Visibility and Transillumination: Proof-of-Concept Study.

The light augmentation device (LAD®) is a new disposable tool designed to improve observation by transillumination in laparoscopic surgery. It can be introduced into the abdomen through an 11-12 mm port as a supplementary light source. The miniaturized design allows the surgeon to pick up the device with an endograsper and to place it under direct vision where needed. This proof-of-concept study demonstrated safety and efficacy of the device in the animal model.

Visualization Enhancement of Dentinal Defects by Using Light-Emitting Diode Transillumination.

INTRODUCTION: Several recent studies have evaluated the presence of dentinal defects after root canal preparation in extracted human teeth by using the root sectioning methodology. The objective of this research was to investigate whether light-emitting diode (LED) transillumination enhances the visualization of dentinal defects by using a root sectioning methodology. METHODS: Forty mesial roots of mandibular molars were sectioned at 3, 6, and 9 mm from the apex with a low-speed saw under water cooling. Microscopic pictures of the specimens were taken by using ×19.2 magnification for the 3-mm slice and ×12.8 magnification for the 6- and 9-mm slices. The LED transillumination was done by positioning an LED probe at 4 different locations (mesial, distal, buccal, and lingual). The root canal lumen was masked, and 2 independent evaluators assessed the presence of dentinal defects on the non-LED and LED images. The number of dentinal defects was recorded, and χ(2) test was used for statistical analysis (P < .05). RESULTS: The number of slices presenting dentinal defects at 3, 6, and 9 mm were 2 (5%), 1 (2.5%), and 1 (2.5%), respectively, for the non-LED assessment and 8 (20%), 10 (25%), and 9 (22.5%), respectively, for the LED assessment. Overall, 4 of the specimens (10%) presented dentinal defects without LED evaluation, and 19 of the specimens (47.5%) presented dentinal defects with LED evaluation. This difference was statistically significant (P < .05). CONCLUSIONS: LED transillumination enhanced the visualization of dentinal defects in uninstrumented roots. The results from previous studies that used the traditional non-LED sectioning methodology should be evaluated with caution.

Appropriate head position for nasotracheal intubation by using lightwand device (Trachlight).

The purpose of this study was to determine the relationship between the head position and the subsequent ease of nasotracheal intubation by using the lightwand device Trachlight (TL). Patients requiring nasotracheal intubation were subdivided into 3 groups according to the intubated head position (group S: sniffing position; group E: extension position; and group N: neutral position). The number of attempts, the total intubation time, and the failures of the TL intubation were recorded. Intubation difficulty by means of TL was assessed by the ordinal 6-point scale. Of the 300 patients enrolled in the study, TL intubation was successful in 91.3% of them. There was no significant difference in the success rate of the first attempt between the groups. No correlation between the ordinal scale and the head position was observed. The total intubation time and the ratio of "unsuccessful" cases were not significantly different among the 3 groups. TL is an effective alternative for patients who require nasotracheal intubation. Our study did not determine the most favorable head position for nasotracheal intubation with the TL, so we recommend that nasotracheal intubation with TL be started with the head in the neutral position and then changed to a more appropriate position, if necessary, on an individual basis.

Transillumination imaging of intraocular tumours.

The purpose of this paper is to discuss a recently described modification of a standard photo slit lamp system for ocular transillumination, with special emphasis on the light transmission through the eye wall and the photographic technique. Transillumination photography was carried out with the Haag-Streit Photo-Slit Lamp BX 900 (Haag-Streit AG, Koeniz, Switzerland). After having released the background lighting optic fibre cable from its holder, the patient was positioned at the slit lamp, and the fibre tip was gently pressed against the sclera or the cornea of the patient's eye. During about 1/1000 of a second, the eye was illuminated by the flash and the scleral shadow of the tumour was exposed to the camera sensor. The images were of good diagnostic quality, making it easy to outline the tumours and to evaluate the involvement of intraocular structures. None of the examined patients experienced discomfort or negative side effects. The method is recommended in cases where photographic transillumination documentation of intraocular pathologies is considered important.

Lightwand-guided nasotracheal intubation in oromaxillofacial surgery patients with anticipated difficult airways: a comparison with blind nasal intubation.

In oromaxillofacial surgery patients, the incidence of difficult airways is up to 15.4-16.9%. Blind nasal intubation remains a safe technique for difficult airway management in some remote areas where a fibreoptic bronchoscope is not always available. The lightwand is an easy-to-use, highly economical device, and can facilitate endotracheal intubation through illumination in the neck. The study aims to evaluate the efficacy of nasotracheal intubation using lightwand in oromaxillofacial surgery patients with difficult airways. One hundred and sixteen patients with difficult airways requiring nasotracheal intubation were randomly divided into a lightwand group and a blind group, with 58 cases in each group. The first attempt and overall success rates of lightwand intubation were 84.5% and 93.1%, respectively, which were higher than those of blind intubation (65.5% and 75.9%, respectively; P<0.05). The total intubation time was 91.4±27.7s in the lightwand group and 130.7±33.4s in the blind group (P<0.001). Patients in the lightwand group also experienced more stable haemodynamic responses and less pharyngalgia. In conclusion, lightwand-guided nasotracheal intubation is superior to blind intubation in patients with difficult airways, with a higher success rate, more stable haemodynamic responses, and fewer postoperative complications.

Transillumination imaging for blood oxygen saturation estimation of skin lesions.

Detecting the early stages of melanoma can be greatly assisted by an accurate estimate of subsurface blood volume and blood oxygen saturation, indicative of angiogenesis. Visualization of this blood volume present beneath a skin lesion can be achieved through the transillumination of the skin. As the absorption of major chromophores in the skin is wavelength dependent, multispectral imaging can provide the needed information to separate out relative amounts of each chromophore. However, a critical challenge to this strategy is relating the pixel intensities observed in a given image to the wavelength-dependent total absorption existing at each spatial location. Consequently, in this paper, we develop an extension to Beer's law, estimated through a novel voxel-based, parallel processing Monte Carlo simulation of light propagation in skin which takes into account the specific geometry of our transillumination imaging apparatus. We then use this relation in a linear mixing model, solved using a multispectral image set, for chromophore separation and oxygen saturation estimation of an absorbing object located at a given depth within the medium. Validation is performed through the Monte Carlo simulation, as well as by imaging on a skin phantom. Results show that subsurface oxygen saturation can be reasonably estimated with good implications for the reconstruction of 3-D skin lesion volumes using transillumination toward early detection of malignancy.

[Endoscopic frontal sinus revision following transcutaneous endoscopic puncture and diaphanoscopy]. / Die endonasale Stirnhöhlenrevision nach transkutaner endoskopischer Punktion und Diaphanoskopie.

BACKGROUND: Endoscopic revision sinus surgery in case of frontal sinus pyocele may poses a great surgical challenge for various reasons. Due to the often troublesome anatomical changes caused by prior resection and findings of scaring with new bone formation, the identification of the frontal sinus in revision surgery is frequently a challenge for the surgeon. An easy endoscopic technique for a safe endonasal identification of the frontal sinus in revision surgery is therefore of major importance. MATERIAL AND METHODS: 4 patients (3 men, 1 female) were enrolled with an acute frontal pyocele following prior open frontal sinus surgery over an external access. All patients were subjected to standard endonasal endoscopic frontal sinus surgery. The frontal sinus was endonasally approached after endoscopic transcutaneous frontal sinus puncture through the pre-existing bone defect achieving a diaphanoscopy with endonasal identification of the frontal sinus floor. RESULTS: The external endoscopic puncture and illumination of the frontal sinus was performed in all 4 patients with a modular endoscopic system (Sinus View). A visual exploration of the frontal sinus was easily carried out after irrigation. A clear endonasal identification of the frontal sinus floor by diaphanoscopy was achieved in all patients and guided a direct opening of the frontal sinus. A stable frontal sinus drainage type IIb according to Draf was reached in all cases. CONCLUSION: Transcutaneous frontal sinus puncture with an modular endoscope allows not only to verify frontal sinus pyocele diagnosis, but also provides the option to open the frontal sinus directly guided by the diaphanoscopy at the frontal sinus floor even in situations of complex anatomy.

A modified digital slit lamp camera system for transillumination photography of intraocular tumours.

PURPOSE: To describe a new technique for transillumination photography of uveal melanoma and other intraocular tumours based on a simple modification of a standard digital slit lamp camera system. METHODS: Transillumination imaging was performed with a digital slit lamp camera (Photo-Slit Lamp BX 900; Haag-Streit, Koeniz, Switzerland) modified by releasing the distal end of the background illumination fibre cable from its holder. The patient's eye was held open, and the head was positioned on the head and chin rest of the slit lamp. Transillumination was achieved by gently pressing the tip of the light fibre cable against the globe. The camera was then fired and the flash delivered through the cable while synchronising with the camera shutter. RESULTS: This technique was applied in five patients with ciliary body or anterior choroidal tumours. Photographs were of good diagnostic quality, making it possible to outline the tumour borders and evaluate any ciliary body involvement. No patient experienced discomfort or negative side effects. CONCLUSIONS: We recommend this technique in all cases where transillumination and photographic documentation of intraocular tumours are considered important.

Laser-supported diaphanoscopy: a new technique in laparoscopic-endoscopic rendezvous procedures allowing better and more tissue-sparing tumor resection than wedge resection.

BACKGROUND: Locating gastrointestinal stromal tumors (GIST) during laparoscopic surgery continues sometimes to be difficult and inaccurate. In addition, the methods used for tumor mapping often do not lead to precise location of tumors. Also, they are too expensive or too complex for an easy surgical approach. Furthermore, the standard wedge resection often sacrifices too much healthy tissue. METHODS: The current study introduces an innovative tissue-sparing method using laser-supported diaphanoscopy (Endolight) for exact location of GIST during laparoscopic surgery. The instrument was developed by the authors' group. This study retrospectively evaluated two groups of patients experiencing GIST. The first group of 10 patients was treated by standard wedge resection. The second group of 10 patients was treated by Endolight-guided laparoscopic resection during a laparoscopic-endoscopic rendezvous procedure. RESULTS: After precise location of GIST using Endolight, all patients could be successfully resected. The largest resection margins using Endolight (9.8±3.8 mm) were significantly smaller than the largest resection margins using wedge resection (stapler) without Endolight (21.5±9.1 mm; p<0.0001). The average surgery time for the group treated by standard wedge resection was 65 min (range, 28-108 min). The surgery time required for the group treated by Endolight-guided resections ranged from 48 to 189 min (average, 123 min). The number of marks used for Endolight resections ranged from four to seven depending on the location and size of the tumor. CONCLUSION: The reported technique allows the precise location of GIST, leading to exact and tissue-sparing transmural laparoscopic resection of these tumors compared with standard wedge-resection. Laser-supported diaphanoscopy using the newly developed innovative device offers new perspectives and a highly effective technique for resecting GIST that combines an endoscopic with a laparoscopic approach.

Transillumination instrument facilitates faster and more accurate dissection of right colon segment for oesophageal reconstruction.

BACKGROUND: Venous insufficiency of a right colon interposition in oesophageal reconstruction can be a fatal complication. The right colon segment could allow restoration of swallowing and speech in reconstruction of the entire oesophagus. The right colon segment is a good choice because of the large middle colic artery and isoperistaltic direction. However, because of the anatomical variation of the veins and the tiny venous network of the right colon, its success rate is lower compared with that of the left colon segment. Therefore, we devised a simple instrument of transillumination that can provide an improved view during surgery of the venous network of the right colon and ileocecal region when dissecting this important structure. METHODS: Thirty-six patients underwent oesophageal reconstruction with a right colon segment using the instrument. The instrument of transillumination was used in all cases while exploring the pedicle vessels and the venous network of the right colon. RESULTS: No patients developed complications related to the use of the instrument. CONCLUSION: The instrument of transillumination is a simple and useful tool for facilitating dissection of the right colon segment. In the future, the technique could be used for all types of bowl dissection.

Nonvisible insufficient subcutaneous reticular venous plexus can be observed through the skin using a new illumination method.

BACKGROUND: Insufficient subcutaneous reticular venous plexus (ISRVP) is an overlooked disease because the human eye cannot see many of the insufficient veins. OBJECTIVE: To present a total reticular vision (TRV) method that exposes nonvisible ISRVP to normal vision. METHOD & MATERIALS: TRV used visual-spectrum white and red light of 700 nm and infrared light of 15 to 850 nm from an ultradigital viewer camera. We studied 124 asymptomatic subjects from the general population without visible ISRVP. Another six patients with ISRVP without other venous pathology were compared with six healthy controls, Very low pressure was applied to the proximal thigh, and minimal volume increments on the medial malleolus were photoplethysmographically registered to validate subcutaneous venous reflux. RESULTS: Total reticular vision exposed ISRVP on the lower extremities in 72 of 124 subjects (58%), with observed damaged veins corresponding to more than 90% of nonvisible and 5% of visible portions of ISRVP. Subcutaneous reflux was registered only in patients with ISRVP. CONCLUSION: Total reticular vision exposed more than 90% of nonvisible ISRVP, a new pathology, allowing for the study of its relationship with other superficial venous insufficiencies. The authors have indicated no significant interest with commercial supporters.

In vivo near-IR imaging of approximal dental decay at 1,310 nm.

OBJECTIVE: The high transparency of dental enamel in the near-IR (NIR) light at 1,310-nm can be exploited for imaging dental caries without the use of ionizing radiation (X-rays). We present the results of the first in vivo imaging study in which NIR images were acquired of approximal contact surfaces. METHODS: NIR imaging hand-pieces were developed and attached to a compact InGaAs focal plane array and subsequently used to acquire in vivo NIR images of 33 caries lesions on 18 test subjects. The carious lesions were discernible on bitewing radiographs, but were not visible upon clinical examination. RESULTS: NIR images were acquired in vivo from three directions and the majority of lesions examined were too small to require restoration, based on accepted bitewing radiograph criteria. All but one of the 33 lesions examined were successfully imaged from at least one direction. CONCLUSION: This first in vivo study of imaging at the 1,310-nm wavelength region shows that NIR imaging has great potential as a screening tool for the detection of approximal lesions without the use of ionizing radiation.

Multispectral optical imaging of skin-lesions for detection of malignant melanomas.

Optical imaging of skin-lesions for early detection and management of the most fatal skin-cancer malignant melanoma is of significant interest in mass screening of skin-lesions with high-risk population. Surface illumination based optical imaging methods such as epiluminescence light microscopy (ELM) through "Dermascopy" has shown a significant potential in improving early diagnosis of malignant melanomas. Limitations of surface reflectance based imaging systems have been realized in analyzing images for important vascular and depth dependent information. We have developed a novel optical imaging system, the Nevoscope, that uses multispectral transillumination as to provide images of skin-lesions showing sub-surface pigmentation as well as vascular architecture based blood volume information. This paper presents multispectral Nevoscope transillumination method to compare and analyze ratiometric measurements to epiluminescence imaging for its ability to discriminate malignant melanomas from dysplastic nevi and other normal skin-lesions.