Development and validation of an endoscopic ear surgery classification system.

OBJECTIVES/HYPOTHESIS: To design and validate a classification system for endoscopic ear surgery. STUDY DESIGN: Validation study. METHODS: A classification system was devised that quantifies use of the endoscope during middle ear surgery. Otologic operative reports were reviewed by attending surgeons and trainees. A power analysis was performed to determine number of cases needed to review. The following categories were used: class 0 is defined by using the microscope only; class 1 describes the use of endoscope for inspection without dissection; and class 2 describes mixed use of the endoscope and the microscope. It is further subdivided into 2a and 2b, where the endoscope is used for less than 50% of dissection and more than 50% of dissection, respectively. Class 3 describes the use of the endoscope for the entire surgery. Fifty cases were reviewed by three attending otologic surgeons, one resident, and one medical student. RESULTS: Weighted Cohen's Kappa for inter-rater agreement between the two institutional surgeons was 0.79 (95% bias corrected [BC] confidence interval [CI]: 0.58-0.93). Agreement between the external surgeon and the two institutional surgeons was 0.77 (95% BC CI: 0.58-0.89) and 0.76 (95% BC CI: 0.57-0.88). Weighted Kappa between institutional surgeons and a resident was 0.73 (95% BC CI: 0.53-0.88) and 0.62 (95% BC CI: 0.38-0.80), and between institutional surgeons and a medical student was 0.75 (95% BC CI: 0.56-0.89) and 0.70 (95% BC CI: 0.49-0.85). CONCLUSIONS: There was substantial inter-rater agreement. This classification system can be used as a simple and reliable tool to describe the extent to which an endoscope was used during ear surgery. LEVEL OF EVIDENCE: NA. Laryngoscope, 128:967-970, 2018.

Laser-assisted surgery of the upper aero-digestive tract: a clarification of nomenclature. A consensus statement of the European Laryngological Society.

Acronyms and abbreviations are frequently used in otorhinolaryngology and other medical specialties. CO2 laser-assisted transoral surgery of the pharynx, the larynx and the upper airway is a family of commonly performed surgical procedures termed transoral laser microsurgery (TLM). The abbreviation TLM can be confusing because of alternative modes of delivery. Classification and definition of the different types of procedures, performed transorally or transnasally, are proposed by the Working Committee for Nomenclature of the European Laryngological Society, emphasizing the type of laser used and the way this laser is transmitted. What is usually called TLM, would more clearly be defined as CO2 laser transoral microsurgery or CO2 TOLMS or CO2 laser transoral surgery only (with a handpiece) would be defined as CO2 TOLS. KTP transnasal flexible laser surgery would be KTP TNFLS. Transoral use of the flexible CO2 wave-guide with a handpiece would be a CO2 TOFLS. One can argue that these clarifications are not necessary and that the abbreviation TLM for transoral laser microsurgery is more than sufficient. But this is not the case. Laser surgery, office-based laser surgery and microsurgery are frequently and erroneously interchanged for one another. These classifications allow for a clear understanding of what was performed and what the results meant.

General principles and intraventricular neuroendoscopy: endoscopic techniques.

OBJECTIVE: To term and describe neuroendoscopic techniques. METHODS: A classification into three major groups of endoscopic techniques is presented. RESULTS: 1) Endoscopic neurosurgery ("channel" endoscopy) is mainly used in ventricular endoscopy. The surgical instruments are introduced via working channels that are located within the endoscope. 2) Endoscope-controlled microneurosurgery means that the endoscope is the only visualization tool and microsurgical instruments are used along the endoscope. Major applications are endonasal endoscopic skull base surgery, endoport surgery, and endoscopic transcranial surgery. 3) Endoscope-assisted microneurosurgery means that the microscope and the endoscope are used in the same surgery. The endoscopes are applied when hidden structures to be inspected are not visible in straight line with the microscope. CONCLUSIONS: Endoscopic techniques are a valuable addition to the neurosurgeon's armamentarium. Endoscopes are especially beneficial in deep and narrow surgical approaches and when "looking around a corner" is required.

[Composite Tissue Allotransplantation (CTA): organ or tissue transplantation?]. / Composite Tissue Allotransplantation (CTA): Organ- oder Gewebetransplantation?

Plastic surgery has a long tradition in transplantation issues. Skin transplantation has been introduced by plastic surgeons Padgett and Brown. The first kidney transplantation was performed by Dr. Murray, a plastic surgeon. Composite tissue allotransplantation (CTA) is an evolving new field with transplantation of hand, vascularised knees or partial faces. With the European Union (EU) directive 2004/23/EC come into effect with the German tissue law at August 1, 2007 one has question the classification of transplantation of the hands, arms or the face as tissue or organ transplantation. While solid organs are allocated based on the German Deutsche Stiftung Organspende (DSO) and EuroTransplant, this is not the case for tissues. While for example thoracic organ procurement is performed in heart-beating organ donors with established hemodynamics, this is not the case for tissues, either. Given the complexity of a hand or a face as a sample of bones, muscles, nerves, vessels, and skin this has to be taken into account for example in comparison to a cornea as a tissue graft. As such, Dr. Siemionow has proposed a face to be regarded as an organ when comparing it to a kidney. Currently, allocation procedures as well as procurement issues in CTA are much more similar to organ- rather than tissue transplantation. Thus, we believe that CTA of hands or partial faces has more similarities to organ than to mere tissue transplantation.

Microvascular reconstruction of the hypopharynx: defect classification, treatment algorithm, and functional outcome based on 165 consecutive cases.

The objectives of this study were three-fold: to develop a scheme for classification of hypopharyngeal defects, to establish a reconstructive algorithm based on this system, and to assess the functional outcome of such reconstruction. This study is a retrospective review of a 14-year experience with 165 consecutive microvascular reconstructions of the hypopharynx in 160 patients. The average patient age was 59 years (95 percent CI, 37 to 81). Thirty-four patients were operated on for recurrent disease; 71 had preoperative radiotherapy. Partial defects were reconstructed with radial forearm flaps (n = 52); circumferential defects were reconstructed with jejunum (n = 90); and extensive, noncircumferential longitudinal defects were reconstructed with rectus abdominis flaps (n = 23). The overall free flap success rate was 98 percent. Six flaps required reexploration, two of which were salvaged. The incidence of fistula was 7 percent and stricture, 4 percent. Preoperative radiotherapy was significantly associated with risk of recipient site complications (OR, 2.3; 95 percent CI, 1.0 to 5.0). Follow-up data were available on 95 percent of patients: 53 percent were able to tolerate an unrestricted diet, 23 percent a soft diet, 12 percent liquids only, and 12 percent were limited to tube feedings. The treatment algorithm for microvascular hypopharyngeal reconstruction is based on the type of defect with partial defects with radial forearm flaps, circumferential defects reconstructed with free jejunal flaps, and extensive, multilevel defects reconstructed with rectus abdominis myocutaneous flaps. Microvascular reconstruction of pharyngeal defects is highly successful with few postoperative complications. With appropriate flap selection, functional outcome can be optimized.

[A new classification for standardizing nomenclature in wound closure by microvascular flap-plasty]. / Eine neue Klassifizierung für die Standardisierung der Nomenklatur beim Wundverschluss durch mikrovaskuläre Lappenplastiken.

The profusion of terms currently used to describe microvascular flap wound closure according to the time of reconstruction makes reliable comparisons of outcomes between institutions difficult if not impossible. To address the issue, a consistent terminology applicable to microvascular flap wound closure in general was formulated with respect to our experience with a total of 197 microvascular tissue transplantations. The nomenclature presented divides microvascular flap closure into three categories: "primary microvascular flap closure" (within 24 hours). "delayed primary microvascular flap closure" (two to seven days), and "secondary microvascular flap closure" (after seven days). This is consistent with known biological, microbiological, and surgical principles of wound closure in general and should provide a simple basis for classifying microvascular flap wound closure. Sample cases are selected to illustrate the categories within this new classification scheme.

Standardizing the classification and description of follicular unit transplantation and mini-micrografting techniques. The American Society for Dermatologic Surgery, Inc.

Previous attempts at classifying small graft transplants have focused mainly upon graft size and have not taken into consideration other technical factors involved in graft production that may influence the outcome of the surgery. The proposed classification attempts to consider these factors by including various technical aspects of harvesting, dissection, and placement, all of which impact the quality and quantity of the small grafts used in the procedure. By standardizing the nomenclature, as well as the description of the other factors involved in the surgery, communication between physicians and patients may be facilitated. In addition, different procedures may be more accurately studied and compared.

Microdiscectomía lumbar con la técnica de Caspar y ligamentoplastía interespinosa con Ethibon / Lumbar microdiscectomy with caspar technique and interspinal ligamentoplasty with ethilbond

Es un estudio retrospectivo de 44 pacientes con 61 hernias discales, en el cual se valoran los resultados clínicos y radiográficos obtenidos mediante la técnica de microcirugía y ligamantoplastía, para el tratamiento de hernias discales con inestabilidad de la columna lumbar, durante un seguimiento de 39 meses. Encontrando un 88.40 por ciento de excelentes resultados, un 9.30 por ciento de buenos resultados y malos 2.27 por ciento. Se discuten ampliamente las ventajas y desventajas de esta técnica sobre el método convencional

Staging of adnexal adhesions: a brief history.

Arriving at a system for staging adnexal disease is a scientific, clinical and political process which has already begun. Gynecologic oncologists started this process in 1967, and are still arriving at refinements and adjustments in the staging of cancer after 22 years. To rigorously evaluate new medical and surgical technologies in the treatment of adhesions it is important for infertility surgeons to continue the process of working towards a classification system, keeping in mind that it will take a long time.