Descompresión microvascular endoscópica versus microscópica en neuralgia trigeminal en un centro Argentino / Endoscopic vs. microscopic techniques for the treatment of trigeminal neuralgia. Our experience at an Argentine care center

Resumen Introducción: La descompresión microvascular (DMV) en la neuralgia trigeminal es una técnica quirúrgica cuyo objetivo es revertir la compresión a la que se ve someti do un nervio por una estructura vascular. El objetivo de este estudio fue realizar una comparación directa entre la descompresión microvascular endoscópica (DMV-E) y la misma a través del uso del microscopio (DMV-M) en el tratamiento de la neuralgia del trigémino. Métodos: Se realizó un estudio de cohorte retrospec tivo de pacientes operados de neuralgia de trigémino, por un mismo cirujano, entre 2015 y 2021 en nuestra institución, tanto por técnica microquirúrgica como endoscópica. Resultados: Se obtuvieron un total de 31 pacientes divididos en dos grupos: Grupo M correspondiente a 15 (49%) pacientes abordados con técnica microscópica y Grupo E, con 16 (51%) pacientes intervenidos con técnica endoscópica. Se identificaron diferencias en el tamaño de la cra niectomía, más pequeña en el grupo E (2.50 cm vs 3.70 cm grupo M); y en el tiempo de internación, de 2.43 días en el grupo E vs. 4.46 días en el grupo M. El tiempo de cirugía fue similar para ambas técnicas quirúrgicas La principal compresión fue dada por la arteria ce rebelosa superior (ACS) en ambos grupos. Todos los pacientes presentaron mejoría del Barrow Neurological Institute Pain Intensity Score (BNI) en el postoperatorio en ambos grupos. Discusión: La DMV-E constituye una alternativa qui rúrgica interesante a la ya conocida DMV-M para el tratamiento de la neuralgia trigeminal, por requerir menores dimensiones en la incisión cutánea y tamaño de la craniectomía, acortando el tiempo de internación, lo cual no solo implica un beneficio para el paciente, sino que también representa menor costo de internación.

Abstract Introduction: Trigeminal neuralgia is a highly invali dating pathology, whose natural course has been modi fied thanks to decompressive microvascular surgery. The intervention can be carried out either with a microscope or via an endoscopic technique. Our goal was to compare these two techniques for the treatment of this complex pathology. Methods: Retrospective, analytical study of a cohort of patients treated by a single surgeon at our institution, in the period between 2015 and 2021. Results: We identified 31 patients and divided them into two groups: 15 (49%) treated using the microscopic technique (group M), and 16 (51%) exclusively via an endoscopic one (group E). Differences were observed between the means of the size of the craniectomy in group M (3.7 cm) compared to group E (2.5 cm); The mean length of hospital stay for patients in group E was shorter (4.46 days compared to that of patients in group M, whose hospital stay averaged 2.43 days). There were no differences between the two groups regarding the length of the procedure. In both groups, the predomi nant compression was due to the superior cerebellar artery (SCA). Pain outcomes were equivalent, with every patient in both groups having an improved postoperative Barrow Neurological Institute Pain Intensity Score (BNI). Discussion: Endoscopic microvascular decompression is an attractive option for the resolution of neurovas cular conflict as it provides functional results similar to the microscope technique, without requiring an exten sive craniectomy and associated to shorter in-hospital stay, which is beneficial for both the patient and the institution.

Risk factors analysis and prediction model construction of submucosal deep infiltration of early colorectal tumor / 中华肿瘤杂志

Objective: To investigate the risk factors for the development of deep infiltration in early colorectal tumors (ECT) and to construct a prediction model to predict the development of deep infiltration in patients with ECT. Methods: The clinicopathological data of ECT patients who underwent endoscopic treatment or surgical treatment at the Cancer Hospital, Chinese Academy of Medical Sciences from August 2010 to December 2020 were retrospectively analyzed. The independent risk factors were analyzed by multifactorial regression analysis, and the prediction models were constructed and validated by nomogram. Results: Among the 717 ECT patients, 590 patients were divided in the within superficial infiltration 1 (SM1) group (infiltration depth within SM1) and 127 patients in the exceeding SM1 group (infiltration depth more than SM1). There were no statistically significant differences in gender, age, and lesion location between the two groups (P>0.05). The statistically significant differences were observed in tumor morphological staging, preoperative endoscopic assessment performance, vascular tumor emboli and nerve infiltration, and degree of tumor differentiation (P<0.05). Multivariate regression analysis showed that only erosion or rupture (OR=4.028, 95% CI: 1.468, 11.050, P=0.007), localized depression (OR=3.105, 95% CI: 1.584, 6.088, P=0.001), infiltrative JNET staging (OR=5.622, 95% CI: 3.029, 10.434, P<0.001), and infiltrative Pit pattern (OR=2.722, 95% CI: 1.347, 5.702, P=0.006) were independent risk factors for the development of deep submucosal infiltration in ECT. Nomogram was constructed with the included independent risk factors, and the nomogram was well distinguished and calibrated in predicting the occurrence of deep submucosal infiltration in ECT, with a C-index and area under the curve of 0.920 (95% CI: 0.811, 0.929). Conclusion: The nomogram prediction model constructed based on only erosion or rupture, local depression, infiltrative JNET typing, and infiltrative Pit pattern has a good predictive efficacy in the occurrence of deep submucosal infiltration in ECT.

Acceptance of Endoscopes in Otology - An Indian Perspective and Review of the Literature

Abstract Introduction The role of endoscopes in the ear, nose, and throat (ENT) field has been described since the 1980s; It started with endoscopic nasal surgeries, followed by otological and laryngological procedures, and, since then, it has experienced a rapid evolution. Endoscopes help otologists understand how to approach difficult areas of middle ear, as well as the physiology of middle ear cleft. Objectives Despite the introduction of endoscopes in the field of otology, microscopes are still widely used in clinics and in operation theaters either alone or with endoscopes. The present study, which was conducted amongst otologists in India, is on their experience with and knowledge of the use of the endoscope compared to microscopes. Methods A Google form-based questionnaire comprising 18 questions was developed and sent online to otologist all over the country. The final dataset included responses from 354 active otologists. Results Out of 354 participants, only 3% had more than 5 years of experience in endoscopic ear surgery (EES), and 16.1% had never worked with an endoscope. Endoscopes were used in clinics and in operation theaters by 74.9% of the participants. Conclusion There has been a rise in the acceptance and use of endoscopes among Indian otologists and otology surgeons in last few decades.

Effect of different courses of Budesonide on endoscopic dacryocystorhinostomy / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To compare the effect of different courses of budesonide nasal spray on the postoperative efficacy of endoscopic dacryocystorhinostomy.METHOD: Prospective study. A total of 90 patients(90 eyes)with chronic dacryocystitis who underwent endoscopic dacryocystorhinostomy in our hospital from January 2019 to April 2022 were selected, and they were randomly divided into three groups. In group A, 30 patients(30 eyes)continued to use budesonide nasal spray for 2mo after surgery; in group B, 30 patients(30 eyes)continued to use budesonide nasal spray for 3mo after surgery; in group C, 30 patients(30 eyes)continued to use budesonide nasal spray for 4mo after surgery. Follow-up for 6mo after surgery, Lund-Kenndey score, surgical efficacy and complications of the three groups were compared.RESULT: At 3, 4 and 6mo after surgery, the Lund-Kenndey score of group C was lower than that of group A(P&#x003C;0.05), and there was no statistical difference between group C and group B(P&#x003E;0.05). Following up to 6mo, the surgical efficacy of group C was better than that of group A, and the incidence of complications was lower than that of group A(P&#x003C;0.05); There was no statistically significant difference in efficacy and complications between group C and group B(P&#x003E;0.05).CONCLUSION: Budesonide combined with endoscopic dacryocystorhinostomy has acceptable efficacy in the treatment of chronic dacryocystitis. After 3mo of treatment, inflammation can be well controlled, which can reduce the occurrence of postoperative complications and improve the effective rate of surgery. However, increasing the treatment course cannot further improve the effective rate of surgery.

Dacryocystorhinostomy through nasal endoscope with extended bone window and high ostomy in the treatment of chronic dacryocystitis / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To investigate the efficacy and safety of dacryocystorhinostomy(DCR)through nasal endoscope with extended bone window and high ostomy in the treatment of chronic dacryocystitis.METHODS: Retrospective clinical study. A total of 50 patients(59 eyes)diagnosed with chronic dacryocystitis in our hospital from January 2018 to January 2020 were selected. They were divided into two groups according to the operation method, with 23 cases(29 eyes)in the simple stoma group and 27 cases(30 eyes)in the improved group. Patients in the simple stoma group were treated with transnasal endoscopic flat middle turbinate axillary DCR(simple stoma), and patients in the improved group were treated with transnasal endoscopic extended bone window with high-level stoma DCR. The total clinical efficiency, postoperative complication rate and satisfaction of the two groups were compared.RESULTS: The effective rate of the simple stoma group was 79% at 12mo after surgery, while that of the improved group was 97%(P=0.039). The total incidence of complications in the simple stoma group was 28%, while that in the improved group was 7%(P=0.042). The satisfaction rate of the simple stoma group was 65%, while that of the improved group was 93%(P=0.030).CONCLUSION: The treatment of chronic dacryocystitis with transnasal endoscopic extended bone window and high-level ostomy DCR further improved the efficiency of surgery and reduced the incidence of complications.

The efficacy of function?preservation in treating paranasal sinus and nasal cavity neoplasms

Background: Craniofacial resection (CFR) has been regarded as the gold standard for paranasal sinus and nasal cavity (PNSNC) neoplasms. The improvement of surgical procedures has been ongoing in recent years. We analyzed the clinical curative effects of the function-preservation therapy that was mainly using nasal endoscopic surgery along with appropriate radiotherapy and chemotherapy as applicable. Methods: We performed a retrospective analysis of factors that influence the survival time of the 28 patients with PNSNC neoplasms who underwent nasal endoscopic surgery. All patients with tumor lesions underwent a complete resection in en bloc or piecemeal resection. Five cases did not undergo radiotherapy or chemotherapy; the remaining 23 patients had multimodality therapy. Results: The median follow-up time was 41.5 (range = 14–97) months. The overall 3-year survival rate was 78.57% for T3 cancer and 50% for those with T4. T classification (P = 0.031) and multimodality therapy (P = 0.038) were independent prognostic factors for postoperative 3-year survival rate of patients with PNSNC neoplasms. Conclusion: Function-preservation therapy based on the minimally invasive endoscopic resection (MIER) with appropriate adjuvant therapy not only prolonged the overall survival time but also provided an opportunity to preserve organ function at the same time, which helped to improve the patients’ quality of life

Frontoplastia endoscópica para tratamiento del envejecimiento facial / Endoscopic Frontoplasty for Treating Facial Aging

Introducción: En el concepto moderno de rejuvenecimiento facial, lo principal es conseguir un resultado natural sin marcas quirúrgicas. El lifting endoscópico fronto-témporo-orbitario es en la actualidad, el mejor método para conseguirlo. Objetivo: Determinar la efectividad de la técnica de frontoplastia endoscópica para el tratamiento del envejecimiento facial. Métodos: Se realizó un estudio observacional descriptivo de una serie de 28 casos con diagnóstico de envejecimiento facial atendidos en el Centro Nacional de Cirugía de Mínimo Acceso en el período comprendido entre enero de 2014 hasta enero de 2017. Se estudiaron las variables de: sexo, edad, estado civil, escolaridad, raza, tiempo quirúrgico y complicaciones transoperatorias. Resultados: La edad media fue de 54,4 (40-73) años. Predominó el sexo femenino (89,3 por ciento). El nivel medio de escolaridad 61,5 por ciento, estado civil casado 52,0 por ciento. La ptosis de las cejas con presencia de arrugas frontales y glabelares fue el diagnóstico más frecuente 13; 46,4 por ciento. El tiempo quirúrgico medio fue 80,9 (40-120) minutos. No existieron complicaciones intraoperatorias, conversiones, ni reintervenciones. En 27 pacientes (96,4 por ciento) hubo permanencia de los resultados en el tiempo. Se presentaron complicaciones en 4 pacientes (14,3 por ciento). Hubo 19 pacientes atendidos de manera ambulatoria (67,9 por ciento), con estancia hospitalaria de un día (32,1 por ciento). La totalidad mostró satisfacción con los resultados obtenidos. Conclusiones: La frontoplastia endoscópica es un método poco invasivo y muy efectivo para reposicionar las cejas descendidas además tratar las arrugas frontales y glabelares(AU)

Introduction: In the modern concept of facial rejuvenation, the main thing is to achieve a natural result without surgical marks. The endoscopic fronto-temporo-orbital lifting is currently the best method to achieve this. Objective: To determine the effectiveness of the endoscopic frontoplasty technique for the treatment of facial aging. Methods: A descriptive observational study of a series of 28 cases with a diagnosis of facial aging treated at the National Center for Minimal Access Surgery in the period from January 2014 to January 2017 was carried out. The variables of: sex, age, marital status, schooling, race, surgical time and intraoperative complications. Results: The mean age was 54.4 (40-73) years. The female sex prevailed (89.3 percent). The average level of schooling 61.5 percent, married marital status 52.0 percent. Ptosis of the eyebrows with the presence of frontal and glabellar wrinkles was the most frequent diagnosis 13; 46.4 percent. The mean surgical time was 80.9 (40-120) minutes. There were no intraoperative complications, conversions, or reinterventions. In 27 patients (96.4 percent) there was permanence of the results over time. Complications occurred in 4 patients (14.3 percent). There were 19 patients treated as outpatients (67.9 percent), with a hospital stay of one day (32.1 percent). All showed satisfaction with the results obtained. Conclusions: Endoscopic foreheadoplasty is a minimally invasive and very effective method for repositioning lowered eyebrows, as well as treating frontal and glabellar wrinkles(AU)

Endoscopic analysis of alterations in sinus floor elevation approaching the summers technique and immediate implant: a clinical trial with 10 years follow-up / Análise endoscópica das alterações na elevação do assoalho do seio maxilar com abordagem da técnica de Summer e implante imediato: um ensaio clínico com 10 anos de acompanhamento

The goal of this study was to evaluate by endoscopy, possible intercurrences during the sinus floor lifting employing the Summers technique, besides verify the implants' survival rate after 10 years. Six patients (12 sinus) were included in this study. The same surgeon performed the procedures, under local anesthesia and venous sedation in the hospital. All participants underwent sinus lift and implant placement in only one procedure, as previously planned, using endoscopic analysis (Stortz®). All cases received bovine bone graft (Bio-Oss®) before the implant placement. After 10 years, the patients were recalled for follow-up. Two intercurrences (16.66%) were detected using the endoscope, one simple rupture, and another perforation with the leaking of the graft within the sinus. Both were reverted and corrected immediately. There was one implant loss (8.33%), therefore this patient did not undergo any intercurrence in transoperative, and the membrane was elevated lesser than 5 mm. The survival rate reached was 91.66%. The osteotome technique constitutes a reliable method with a long-term of 10 years presenting a high implant survival rate, suggesting an elevation up to 5.5 mm in healthy patients. The occurrences in transoperative were only detected by the endoscopic analysis which must be stimulated to guarantee more secure visibility. Otherwise, the association the atraumatic technique and endoscope was tough, increased the costs, limiting the use routinely.

O objetivo deste estudo foi avaliar através de endoscopia as possíveis intercorrências durante levantamento de seio maxilar fechado, além de verificar a taxa de sobrevivência dos implantes após 10 anos. Seis pacientes (12 seios maxilares) foram incluídos neste estudo com idades entre 26 e 74 anos. O mesmo cirurgião realizou os procedimentos, sob anestesia local e sedação venosa em ambiente hospitalar. Todos os participantes foram submetidos à elevação do seio nasal e colocação do implante em apenas um procedimento, conforme planejado anteriormente, por acompanhamento transcirúrgico da endoscopia (Stortz®). Todos os casos receberam enxerto ósseo bovino (Bio-Oss®) antes da colocação do implante. Após 10 anos, os pacientes foram chamados para acompanhamento. Foram detectadas duas intercorrências (16,66%) com o endoscópio, uma ruptura simples e outra perfuração com extravasamento do enxerto para dentro do seio. Ambos foram revertidos e corrigidos imediatamente. Houve perda de um implante (8,33%), portanto esse paciente não apresentou intercorrência no transoperatório e a membrana estava elevada menos de 5 mm. A taxa de sobrevivência alcançada foi de 91,66%. A técnica do osteótomo constitui um método confiável em longo prazo (10 anos) apresentando uma alta taxa de sobrevivência do implante, sugerindo que uma elevação de até 5,5 mm em pacientes saudáveis é possível. Assim, verificou-se que as ocorrências no transoperatório foram detectadas apenas pela análise endoscópica que deve ser estimulada para garantir uma visibilidade mais segura. Por outro lado, a associação da técnica fechada com o endoscópio foi difícil, aumentou os custos, limitando seu uso como rotina

Innovation and practice of endoscope-assisted nipple-sparing mastectomy combined with immediate subpectoral implant breast reconstruction without gas and mesh through small skin incisions / 中华内分泌外科杂志

Objective:To examine the feasibility and safety of endoscopic subcutaneous mastectomy and immediate reconstruction via a small skin incision approach without gas and mesh for early breast carcinomas.Methods:We analyzed 7 patients diagnosed with breast cancer who underwent an endoscopic subcutaneous mastectomy and immediate reconstruction from Jun. to Nov. 2021 using a gasless and meshless small skin incision approach at the Department of Thyroid and Breast Surgery, the First Affiliated Hospital of USTC. Mean age was 44.9 (29-63) years. Clinical stage, postoperative complications and other data of patients were collected. Patients were required to fill in BREAST-Q scale anonymously before and during postoperative follow-up. The difference was considered significant for P < 0.05. Results:The tumors were all unilateral and solitary lesions, with a mean diameter of 1.74 (0-5) cm. The average distance of mass from the nipple on imaging was 2.11cm (range 0 to 4) . Postoperative pathological clinical stage,1 patient was in Tis, 3 patients were in stage I, 2 patients were in stage II and a pathological complete response was achieved in one patient (ypT0pN0cM0 CR) . The mean operative time was 245.3 (195-316) min, the mean intraoperative bleeding volume was 37.1ml, the mean postoperative hospital stay was 5.1 d, and the median follow-up time was 8.8 (6-11.2) months. All the 7 patients had incision healing at the first stage, and no complications such as infection, incision complications, capsular contracture, nipple-areola complex or skin flap necrosis, removal or displacement of breast implant occurred. No local recurrence or metastasis was detected during the follow-up period. Compared with preoperative, the scores of postoperative psychosocial status, chest wall status were lower ( P<0.05) , but still ideal, while breast satisfaction and sexual satisfaction scores were not significantly different from preoperative baseline ( P>0.05) . Conclusion:This study indicates that endoscope-assisted breast reconstruction with gasless and meshless is a safe and feasible surgical intervention method for early breast cancer, with good cosmetic effects, and can be promoted as a new type of breast reconstruction.

Treatment of dacryocystorhinostomy and intubation under nasal endoscope on recurrent dacryocystitis after removal of artificial nasolacrimal duct / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To investigate the proportional distribution of the size of lacrimal sac in recurrent dacryocystitis after the removal of artificial nasolacrimal duct and the clinical effect of dacryocystorhinostomy under nasal endoscope on patients with recurrent dacryocystitis.METHODS: Totally 73 patients(73 eyes)with recurrent dacryocystitis after removal of artificial nasolacrimal duct in our hospital from January 2018 to November 2019 were retrospectively studied. All patients underwent dacryocystography after hospitalization, and then performed dacryocystorhinostomy combined with intubation of double- artificial nasolacrimal duct under nasal endoscope and general anesthesia. The size of lacrimal sac was measured, and the area and effective rate of fistula were analyzed respectively at 2wk, 1, 3 and 6mo after operation. RESULTS: There were 13 eyes with large dacryocyst(Transverse diameter > 5mm, 18%), 26 eyes with middle dacryocyst(Transverse diameter between 2-5mm, 36%), and 34 eyes with small dacryocyst(Transverse diameter <2mm, 47%); There was significant difference in the stoma area of dacryocystostomy at 2wk, 1, 3, 6mo respectively(<i>P</i><0.05); Compared with 2wk, 1, 3mo after operation, the stoma area at 6mo after operation significantly decreased by 14.08±0.68, 10.49±0.75, 0.31±0.23mm2(all <i>P</i><0.05); The curative rates were 100%, 93%, 88% and 85% at 2wk, 1, 3, 6mo after operation, respectively. CONCLUSION: After the removal of the artificial nasolacrimal duct, the majority of the patients with recurrent dacryocystitis typically featured medium and small lacrimal sac. The curative effect of this type of recurrent dacryocystitis by dacryocystorhinostomy and intubation under nasal endoscope was proved to be effective, which could serve as a proper and better choice in clinic practice.

Establishment and clinical validation of an artificial intelligence YOLOv51 model for the detection of precancerous lesions and superficial esophageal cancer in endoscopic procedure / 中华肿瘤杂志

Objective: To construct the diagnostic model of superficial esophageal squamous cell carcinoma (ESCC) and precancerous lesions in endoscopic images based on the YOLOv5l model by using deep learning method of artificial intelligence to improve the diagnosis of early ESCC and precancerous lesions under endoscopy. Methods: 13, 009 endoscopic esophageal images of white light imaging (WLI), narrow band imaging (NBI) and lugol chromoendoscopy (LCE) were collected from June 2019 to July 2021 from 1, 126 patients at the Cancer Hospital, Chinese Academy of Medical Sciences, including low-grade intraepithelial neoplasia, high-grade intraepithelial neoplasia, ESCC limited to the mucosal layer, benign esophageal lesions and normal esophagus. By computerized random function method, the images were divided into a training set (11, 547 images from 1, 025 patients) and a validation set (1, 462 images from 101 patients). The YOLOv5l model was trained and constructed with the training set, and the model was validated with the validation set, while the validation set was diagnosed by two senior and two junior endoscopists, respectively, to compare the diagnostic results of YOLOv5l model and those of the endoscopists. Results: In the validation set, the accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the YOLOv5l model in diagnosing early ESCC and precancerous lesions in the WLI, NBI and LCE modes were 96.9%, 87.9%, 98.3%, 88.8%, 98.1%, and 98.6%, 89.3%, 99.5%, 94.4%, 98.2%, and 93.0%, 77.5%, 98.0%, 92.6%, 93.1%, respectively. The accuracy in the NBI model was higher than that in the WLI model (P<0.05) and lower than that in the LCE model (P<0.05). The diagnostic accuracies of YOLOv5l model in the WLI, NBI and LCE modes for the early ESCC and precancerous lesions were similar to those of the 2 senior endoscopists (96.9%, 98.8%, 94.3%, and 97.5%, 99.6%, 91.9%, respectively; P>0.05), but significantly higher than those of the 2 junior endoscopists (84.7%, 92.9%, 81.6% and 88.3%, 91.9%, 81.2%, respectively; P<0.05). Conclusion: The constructed YOLOv5l model has high accuracy in diagnosing early ESCC and precancerous lesions in endoscopic WLI, NBI and LCE modes, which can assist junior endoscopists to improve diagnosis and reduce missed diagnoses.

Diagnosis and treatment of esophageal foreign body: Operation or endoscopy? / 中国胸心血管外科临床杂志

@#Objective    To summarize our experience in the treatment of esophageal foreign bodies. Methods    A retrospective analysis of 149 patients of esophageal foreign bodies in the Second Affiliated Hospital of Air Force Military Medical University from December 2011 to May 2019 was carried out, including 75 (50.3%) females and 74 (49.7%) males with an average age of 57 (2-85) years. Results    There were 146 patients confirmed by endoscopy, and 3 patients were not found foreign body. Among the confirmed patients, 127 patients were removed by gastroscope and 19 patients were treated by operation. Esophageal foreign bodies are mainly related to the types of food. Jujube seed is the most common food foreign body in the northwest China. The injury rate of mucosal was 47.54% within 48 hours. The complication rate of taking out the foreign body after 48 hours was 100.0%. The success rate by endoscopy decreased (P=0.005), if the foreign body combined perforation. There was no statistical difference between the neck and other parts when using ultra-fine gastroscope (P=0.157). Conclusion    The sharper the foreign body is, the easier the perforation is. The earlier the foreign body is removed, the less complications are. The size of the foreign body determines the difficulty of endoscopic removal. Gastroscopy is the first choice for diagnosis and treatment, especially ultra-fine gastroscopy, and the foreign bodies that cannot be removed by endoscopy need surgical treatment.

Glasses-free Three Dimensional Endoscopic Display System with Multi-face Detection / 中国医疗器械杂志

The glasses-free three dimensional(3D) endoscopic display system provides the surgeon with the depth information of the minimally invasive surgery scene obtained from the binocular perspective, which can effectively relieve the surgeon's posture fatigue and visual fatigue during the long-term surgery, and assist in the operation of surgical instruments more accurately to reduce the damage to the surrounding tissues of the operation area. However, the glasses-free 3D display device currently has the problem of a narrow optimal viewing zone and easy crosstalk, especially in the surgical teaching application scenario, which performs poorly. In order to overcome the limitation of the narrower field of view, we introduce deep learning algorithms to detect and locate multiple faces, fine-tune the 3D display grating of the endoscope, rearrange pixels, and change the best view area, so that more people can get the best view. The experimental results show that the face detection accuracy of the method is 97.88%, and the detection time is 135 frames/ms, which achieves high accuracy while maintaining real-time performance.

The influence of the maxillary sinus on maxillary posterior tooth endodontic microsurgery / 口腔疾病防治

@#Endodontic microsurgery is one effective method for preserving teeth affected by periapical disease, and is also an essential technique for treating difficult cases. However, due to the restricted operating space at the posterior site and the proximity of the root apex to the maxillary sinus, endodontic surgery in the posterior maxillary area represents great challenges. This article summarizes the anatomical relationship between the maxillary sinus and the maxillary posterior teeth, the influence on endodontic microsurgery, and the application of assistive techniques on maxillary posterior teeth, such as 3D-printed surgical guides and ultrasonic osteotomes. Literature review results show that the spatial relationship between the apex of maxillary posterior teeth and the maxillary sinus is usually divided into three categories: the apex enters the maxillary sinus; the apex contacts the bottom of the maxillary sinus; and there is a distance between the apex and the bottom of the maxillary sinus. CBCT should be performed before the operation, and the periapical state of the tooth and the maxillary sinus and the distance between the lesions and the sinus floor should be considered to evaluate the difficulty of the operation. Meanwhile, during surgery, equipment such as surgical guides, endoscopes and ultrasonic osteotomes should be used to ensure that the operation is safer, reliable, precise and less invasive, but the clinical popularity of ultrasonic osteotomes still needs further promotion. Moreover, high-quality clinical studies on the long-term effects of micro-apical surgery in the posterior maxillary area are still lacking.

The effect of swallowing intervention on improving the esophageal examination by magnetically controlled capsule endoscopy: a cohort study / 中华消化杂志

Objective:To investigate the effect and feasibility of swallowing intervention on esophageal examination by magnetically controlled gastric capsule endoscope (MCE), and to provide theoretical evidence for clinical application.Methods:From January 2021 to May 2022, 196 subjects who underwent MCE examination at West China Hospital, Sichuan University were prospectively enrolled. According to the swallowing action during MCE procedure, the subjects were divided into routine examination control group and swallowing-controlled intervention group with 98 cases in each group. The data of gender, age, history of smoking and drinking, body mass index, clinical symptoms (abdominal pain or abdominal distension, hematochezia, melena or positive fecal occult-bloodtest), esophageal transit time of MCE and detection rate of esophageal lesions were compared between the 2 groups. Wilcoxon rank sum test and chi-square test were used for statistical analysis.Results:There were no significant differences in age, gender, smoking history, drinking history, body mass index, history of diabetes, history of hypertension, and indication of MCE examination between the routine examination control group and swallowing-controlled intervention group (all P>0.05). All the subjects successfully completed the examination, and the capsules were excreted from the body. The median esophageal transit time of swallowing-controlled intervention group was longer than that of the routine examination control group (44.50 s (26.75 s, 101.25 s) vs. 11.00 s (5.00 s, 29.00 s)), and the difference was statistically significant ( Z=-8.13, P<0.001). The esophageal transit time of the patients aged 40 to 59 years old was longer than that of the patients aged <40 years old, but shorter than that of the patients aged ≥60 years old (54.00 s (36.25 s, 64.75 s) vs. 28.00 s (23.00 s, 35.00 s) and 69.50 s (64.75 s, 73.00 s)), and the differences were statistically significant ( Z=-6.72 and -6.91, both P<0.001). The detection rate of esophageal lesions of swallowing-controlled intervention group was higher than that of routine examination control group (22.4%, 22/98 vs. 11.2%, 11/98), and the difference was statistically significant ( χ2=4.41, P=0.036). Conclusion:Command-controlled swallowing can effectively prolong the time of esophagus examination by MCE, and improve the detection rate of esophageal lesions by MCE.

Application of four-valve technique in the improved conjunctivo-dacryocystorhinostomy / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To investigate the safety and effectiveness of four-valve technique in the improved conjunctivo-dacryocystorhinostomy. METHODS: Retrospective clinical study. A total of 28 patients(28 eyes)who were treated in our hospital from September 2017 to June 2020 with lacrimal disease were selected as the research subjects. These patients were treated with conjunctivo-dacryocystorhinostomy. Postoperative follow-up was performed for 6-12mo to observe the surgical effect, satisfaction and postoperative complications.RESULTS: The positive rate of fluorescein sodium dye excretion test after surgery in this group of patients was 96%(27/28), the success rate of surgery was 96%(27/28), the cure rate was 68%(19/28), the improvement rate was 28%(8/28), the ineffective rate was 4%(1/28)and the overall satisfaction of patients was 93%(26/28). The postoperative complications included ocular foreign body sensation(28 eyes), conjunctival hyperemia(11 eyes), nasal cavity and conjunctival sac bleeding(8 eyes)and lacrimal passage tube out(1 eye). CONCLUSION: The four-valve technique is used to improve the conjunctivo-dacryocystorhinostomy with high success rate, less complications, safety and effectiveness.

A minimally invasive endoscope assisted retrosigmoid approach for removal of arachnoid cysts in the internal auditory canal: a step by step description / Abordagem retrosigmoide minimamente invasiva assistida por endoscopia para remoção de cistos aracnóides no conduto auditivo interno: descrição passo a passo

Abstract Introduction: Arachnoid cyst in the internal auditory canal is a quite rare pathology but due to its compressive action on the nerves in this district should be surgically removed. Several surgical techniques have been proposed but no surgeons have used the minimally assisted endoscope retrosigmoid approach for its removal. Objective: To investigate the feasibility of using a minimally invasive endoscope assisted retro-sigmoid approach for surgical removal of arachnoid cysts in the internal auditory canal. Methods: Minimally invasive endoscope assisted retrosigmoid approach allows to access to the internal auditory canal through a minimally invasive retrosigmoid approach that combines the use of a microscope and an endoscope. It is performed in six steps: soft tissue step, bone step, dura step, cerebellopontine angle step (performed using an endoscope and a microscope), microscope-endoscope assisted arachnoid cysts removal and closure. We tested minimally invasive endoscope assisted retrosigmoid approach for removal of arachnoid cysts in the internal auditory canal on two human cadaveric heads (specimens) of subjects affected from audio-vestibular disorders and with arachnoid cysts in the internal auditory canal confirmed by magnetic resonance imaging. Results: The mass was completely and successfully removed from the two specimens with no damage to the nerves and/or vessels in the surgical area. Conclusion: The results of our study are encouraging and support the feasibility of using minimally invasive endoscope assisted retrosigmoid approach for removal of arachnoid cysts in the internal auditory canal. While further clinical in-vivo studies are needed to confirm the accuracy and safety of using the minimally invasive endoscope assisted retrosigmoid approach for this specific surgery, our group has successfully used the minimally invasive endoscope assisted retrosigmoid approach in the treatment of microvascular compressive syndrome, schwannoma removal and vestibular nerve resection.

Resumo Introdução: O cisto aracnóide no conduto auditivo interno é uma doença bastante rara, mas, devido à sua ação compressiva sobre os nervos deste local, ele deve ser removido cirurgicamente. Várias técnicas cirúrgicas foram propostas, mas ninguém utilizou a abordagem retrosigmoide minimamente invasiva assistida por endoscopia para a sua remoção. Objetivo: Investigar a viabilidade do uso da abordagem retrosigmoide minimamente invasiva assistida por endoscopia para remoção cirúrgica de cistos aracnóides no conduto auditivo interno. Método: A abordagem retrosigmoide minimamente invasiva assistida por endoscopia permite o acesso ao conduto auditivo interno através de uma abordagem retrosigmóide minimamente invasiva que combina o uso de um microscópio e um endoscópio. É realizada em seis etapas: do tecido mole, óssea, dura-máter, do ângulo pontocerebelar (realizado com um endoscópio e um microscópio), remoção e fechamento assistidos por endoscópio-microscópico. Testamos a abordagem retrosigmoide minimamente invasiva assistida por endoscopia para remoção de cistos aracnóides no conduto auditivo interno em duas cabeças de cadáveres humanos (espécimes) de indivíduos afetados por distúrbios auditivos-vestibulares e com cistos aracnóides no conduto auditivo interno confirmado por imagem de ressonância magnética. Resultados: A lesão foi removida completamente e com sucesso nos dois espécimes sem dano aos nervos e/ou vasos na área cirúrgica. Conclusão: Os resultados do nosso estudo são encorajadores e apoiam a viabilidade do uso da abordagem retrosigmoide minimamente invasiva assistida por endoscopia para remoção de cistos aracnóides no conduto auditivo interno. Embora mais estudos clínicos in vivo sejam necessários para confirmar a precisão e a segurança do uso da abordagem retrosigmoide minimamente invasiva assistida por endoscopia para essa cirurgia específica, nosso grupo utilizou com sucesso a abordagem retrosigmoide minimamente invasiva assistida por endoscopia no tratamento da síndrome compressiva microvascular, remoção de schwannoma e ressecção do nervo vestibular.

Clinical efficacy evaluation of minimally invasive periodontal therapy assisted by endoscopy / 口腔疾病防治

Objective @# To investigate the clinical effect of periodontal endoscope-assisted scaling and root planing (SRP) in treating advanced periodontitis. @*Methods@# Nineteen cases of grade Ⅲ and Ⅳ periodontitis selected from June 2017 to January 2019 in the Nanjing Stomatological Hospital, Medical School of Nanjing University were divided into the periodontal endoscope and control groups. In the periodontal endoscope group, SRP was performed under a periodontal microscope in one treatment after initial supragingival scaling; in the control group, SRP was performed under regular conditions, and additional SRP was conducted in positive bleeding on probing sites twice every other week as needed. Periodontal status, including probing depth (PD), bleeding on probing (BOP) and attachment loss (AL), was recorded by a Florida probe.@*Results@# For sites of 4<PD ≤ 6 mm, there was no significant difference in PD- and BOP-positive rates or AL between the two groups at baseline. The PD- and BOP-positive rates and AL in the endoscope group and control group decreased significantly from baseline at 3 and 6 months. PD in the endoscope group was smaller than that in the control group at 3 months (P < 0.05). There was no significant difference between the two groups at 6 months (P >0.05). There was no significant difference in the BOP positive rate or AL change between the two groups at 3 months and 6 months (P > 0.05). For sites with PD > 6 mm, at baseline, the positive rates of PD, BOP and AL in the endoscope group were more serious than those in the control group, and the differences were statistically significant. The PD- and BOP-positive rates and AL in the endoscope group and control group decreased significantly from baseline at 3 and 6 months. However, PD in the endoscope group became shallower than that in the control group (P < 0.05) after 3 and 6 months. There was no significant difference in the BOP positive rate or AL between the two groups (P>0.05). @*Conclusion @#When compared to regular SRP, periodontal microscope-assisted SRP achieves better improvement in PD and is more beneficial for reducing the BOP and AL of deeper sites.

Clinical study of periodontal endoscope-assisted subgingival scaling in the treatment of residual pocket / 华西口腔医学杂志

OBJECTIVES@#To compare the treatment effects of periodontal endoscope-assisted and traditional subgingival scaling on residual pockets.@*METHODS@#A total of 13 patients with periodontitis from Dept. of Periodontics, West China Hospital of Stomatology, Sichuan University were recruited. After 4-6 weeks of initial treatment, the residual pockets with a probing depth (PD) of ≥4 mm and attachment loss (AL) of ≥4 mm and bleeding on probing were examined with traditional (control group) and periodontal endoscope-assisted subgingival scaling (endoscopy group) in a randomly controlled split-mouth design. At baseline and 6 weeks and 3 months after treatment, plaque index (PLI), PD, AL, and bleeding index (BI) were measured. Differences in these clinical parameters within and between groups and patient-reported outcomes were compared.@*RESULTS@#A total of the 694 sites of 251 teeth were included in this trial. Both groups showed significant improvement in each periodontal parameters 6 weeks and 3 months after treatment (@*CONCLUSIONS@#Periodontal endoscope-assisted subgingival scaling resulted in better effects than traditional subgingival scaling when the residual pockets were in a single-rooted tooth, with a PD of ≥5 mm but without vertical alveolar bone resorption and furcation involvement.

Canaliculotomy with novel R-S lacrimal tube for canaliculitis under lacrimal endoscope / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To investigate the clinical effect of canaliculotomy joint novel R-S lacrimal tube implantation under lacrimal endoscope for canaliculitis.<p>METHODS: Thirty-one patients(thirty-two eyes)diagnosed as canaliculitis were investigated from July 2016 to September 2019 in our department. All patients have treated with canaliculotomy joint lacrimal tube implantation under lacrimal endoscope. The patients were randomly divided into two groups. Group A was treated with novel R-S lacrimal tube for 15 cases 15 eyes, and group B was treated with annular silicone tube. They were removed the lacrimal tube after 2-3mo, and followed postoperatively for at least 1a. The treatment results were comparatively analyzed.<p>RESULTS: The effective rate was 93% in group A and 94% in group B(<i>P</i>>0.05). The mean time of lacrimal tube implantation of group A was 2.27±1.335min, and group B was 5.29±1.404min. The total rate of complications was 7% in group A and 47% in group B. The rate of foreign body sensation in nasal cavity was 7% in group A and 41% in group B. The rate of increased nasal secretions was 0 in group A and 29% in group B. The difference of the mean time of lacrimal tube implantation, the rate of complications, the rate of foreign body sensation in nasal cavity and the rate of increased nasal secretions between two groups was statistically significant(<i>P</i><0.05).<p>CONCLUSION: Canaliculotomy joint novel R-S lacrimal tube implantation under lacrimal endoscope is an effective way. The novel R-S lacrimal tube has the advantages of simple operation, less postoperative complications and high patient comfort.