Revisión de la cirugía endoscópica nasosinusal en la era de los tratamientos biológicos en una cohorte de 388 pacientes / Review of endoscopic sinus surgery in the era of biologic treatments in a cohort of 388 patients

Introducción y objetivo: Estudiar retrospectivamente la tasa de revisión quirúrgica nasosinusal en un hospital de tercer nivel a fin de aplicar las mejores estrategias terapéuticas. Método: Se realizó una revisión retrospectiva de pacientes intervenidos entre 2016 y 2020. Los factores evaluados incluyeron datos epidemiológicos, quirúrgicos, radiológicos e histopatológicos. En los casos de recidiva de patología nasosinsual se realizó una tomografía computerizada siguiendo la clasificación de Lund-Mackay y el recuento de eosinófilos. Se estudió también la tasa de revisión quirúrgica. Resultados: Se realizaron 506 cirugías endoscópicas nasosinusales (CENS) en 388 pacientes en 5 años. El 78% eran rinosinusitis crónicas (RSC), de las cuales el 18 % requirió cirugía de revisión. El índice de revisión fue mayor en pacientes con RSC con pólipos y asma (34%) o enfermedades respiratorias exacerbadas por AAS-EREA (42%). La mayor tasa de recurrencia se objetivó en el complejo osteomeatal (73%). Los pacientes con recuento elevado de eosinófilos en tejido polipoideo presentaban una tasa de cirugía de revisión del 34,2% y una OR de 3,2 (IC95 % 1,2-8,2). La terapia biológica se administró en 7 pacientes con asma grave. Discusión y conclusiones: La tasa de cirugía de revisión por RSC fue del 18%. Las recurrencias son frecuentes en el complejo osteomeatal. Es importante considerar los factores específicos que influyen en la tasa de cirugía de revisión, tales como el recuento elevado de eosinófilos, a fin de aplicar el mejor tratamiento. (AU)

Introduction and objective: To retrospectively review the revision surgical rate in a cohort cohort of a tertiary level hospital to select better strategies for recurrent patients. Method: A retrospective review of patients operated between 2016 and 2020 was carried out. The factors evaluated included epidemiological, surgical, radiological and histopathological data. In recurrences, Lund-Mackay CT score and eosinophil count was performed. Surgical revision rate was investigated. Results: We performed 506 Functional Endoscopic Sinus Surgery (FESS) on 388 patients for five years. Out of them, 78% were chronic rhinosinusitis (CRS). Globally, 18% required revision surgery, highest if they had CRS with polyps and asthma (34%), or aspirin-intolerance (42%). The highest rate of recurrence was on the osteometal complex (73%). Patients with elevate eosinophil count in nasal tissues present a revision surgical rate of 34.2% and an OR of 3.2 (IC95 % 1.2-8.2). Biologic therapy is administrated in 7 patients with severe asthma. Discussion and conclusions: The revision surgery rate for CRS was 18%. Recurrences are frequent in anterior meatal complex. It is important to consider patient-specific factors that affect revision surgery rates such as elevate eosinophil count to find better treatments for these worse patients. (AU)

Who named and built the Désormeaux endoscope? The case of unacknowledged opticians Charles and Arthur Chevalier.

Announced in 1855, the Désormeaux endoscope articulated a scope expansion in medical utility of the uréthroscope initially presented to the Académie de médecine in late 1853. The former epochal term was never formally claimed, and although evidencing creative thinking by Désormeaux himself, production was a poorly acknowledged but seemingly close collaboration with two leading Parisian instrument makers: Maison Chevalier for the optical parts and Maison Charrière for the accessory catheter.

Five thousand years of minimal access surgery: 1850 to 1990: Technological developments.

This is the second of a three-part series that charts the history of minimal access surgery from antiquity to current times. Although rapid developments in laparoscopic and robotic surgery have transformed surgical care over the last 30 years, our predecessors made significant advances in their time which set the principles for modern practice. Part I of this series described how ancient medical practitioners developed simple instruments, from metal or wood, for viewing body cavities. Improvements in the use of metal, glass and lighting allowed for inspection of deeper parts of the body. This second part of the series will show how advances in electrical technology allowed the development of improved lighting for endoscopy and laparoscopy along with the use of electrocautery for a wide range of therapeutic procedures.

The early history and development of functional endoscopic sinus surgery.

BACKGROUND: The concept of endoscopic diagnosis and procedures on the nasal cavity had been investigated for several decades in Europe in the early part of the twentieth century. It was Prof Walter Messerklinger and his assistant, Heinz Stammberger, with US colleague, David Kennedy, who brought the science and technique of functional endoscopic sinus surgery to the wider world. METHODS: The author, an English-speaking surgeon, was present at this movement from the commencement of its propagation, and has recorded the remarkable ascendency of this technique throughout the world. CONCLUSION: The technique revolutionised the diagnosis and management of intranasal, sinus and intracranial conditions.

A History of Endoscopic Lumbar Spine Surgery: What Have We Learnt?

The new development and finally the general acceptance of surgical techniques among the worldwide surgical community sometimes create fascinating stories. This is also true for the history of endoscopic lumbar spine surgery. In the last 100 years there was a "natural" evolution of surgical techniques with continuous improvement and "refinement" of lumbar decompression techniques towards less invasive operations with the final "endpoint" of microsurgery. However the application of percutaneous, image-guided, and endoscopic technologies has revolutionized minimally invasive surgery. This article describes the history of endoscopic lumbar spine surgery and its major milestones and protagonists which have helped to make endoscopic lumbar spine surgery "disruptive" minimally invasive surgical technology which has changed the world of lumbar decompression surgery. "The past is the mother of the future"Henri Cartier Bresson, French Photographer, 1908-2004.

The birth of the Caribbean Society of Endoscopic Surgeons-A historical article.

The Caribbean Society of Endoscopic Surgeons (CaSES) is a regional surgical organization that acts as a quality-enhancing body for the Caribbean region. It does so through many activities including an annual regional meeting. In this historical article, the history, purpose and future developments of the organization is outlined.

The History of and Controversy over Kambin's Triangle: A Historical Analysis of the Lumbar Transforaminal Corridor for Endoscopic and Surgical Approaches.

The transforaminal corridor in the lumbar spine allows access to the traversing and exiting nerve roots, the thecal sac, and the intervertebral disc space. Surgeons performing midline and minimally invasive approaches for lumbar interbody fusion access the disc space within the boundaries created by the exiting root of a segment and the traversing root after a complete facetectomy and removal of the pars interarticularis and lamina. Endoscopic surgeons and interventional pain management physicians approach the lumbar segment through a similar corridor, but with the bony anatomy intact. Although the boundaries of the corridor may seem the same, the angle of the trajectory and the bone work between the two differ. The overlap between these 2 distinct access corridors has led to an openhanded application of the term Kambin's triangle. Initially described for endoscopic approaches to the lumbar spine for microdiscectomy, this working triangle has been grafted into the transforaminal lumbar interbody fusion literature. Given the similarities between these corridors, it is understandable how the lines of this nomenclature have blurred. The result has been an interchangeable application of the term Kambin's triangle for a variety of procedures in the spine literature. The objective of the current work is to add clarity to the various lumbar transforaminal corridors. The term Kambin's triangle should be limited to percutaneous access to the disc space for endoscopic procedures in the intact spine and should not be applied to transforaminal lumbar interbody fusion after laminectomy and facetectomy. Instead, the term expanded transforaminal corridor should be applied.

How Technology Shaped Modern Surgery.

The history of endoscopy and minimally invasive surgery is the story of technological advances in illumination, optics, and imaging that allowed operations to be performed within the body. After invention of the incandescent bulb by Joseph Swan and Thomas Edison in 1879, the basic design of early cystoscopes remained unchanged during the first half of the 20th century. Three inventions made endoscopy and laparoscopy possible. Invented in the 1950s, the Hopkins glass rod lens system was so elegant and effective-it gave images 80 times better than traditional Galilean optics-that endoscopes of the same design remain in use today. Also, originating in the same decade, fiber optics had in turn two major contributions: Flexible endoscopy and the transfer of light from a high voltage source into the body to illuminate internal structures and organs. Solid-state camera technology, developed in the late 1970s and 1980s, gave images of exceptional detail from a camera chip at the eyepiece of an endoscope. The panorama of advances created by the same technologies-global telecommunications, cellphone cameras, images from interplanetary space probes-reveals endoscopy and laparoscopic surgery as two more examples of today's technological age.

Philipp Bozzini (1773-1809): The earliest description of endoscopy.

The widespread use of endoscopy in today's clinical arena underscores its utility and growing significance within the field of medicine. Primitive forms of endoscopy have existed for hundreds of years, but it was not until the early 19th century that Dr Philipp Bozzini invented an endoscope that would form the basis of modern endoscopy. Born into an influential Italian family, Bozzini practiced medicine in a time and place of conflict and political unrest. His passion, ingenuity, and important social connections allowed him to create and introduce to the medical profession the Lichtleiter (light-conductor), which overcame two key issues plaguing endoscopy: inadequate lighting and poor penetration. A combination of professional rivalry and his premature passing stifled enthusiasm and further work on the Lichtleiter, but its value would not be lost forever. The advancements in the field of endoscopy that have come since the time of the Lichtleiter all build upon the principles of Bozzini, who became widely acknowledged as the father of modern endoscopy.

Gerald J. Marks, M.D., FACS (1925-), founder of the Society of American Gastrointestinal Endoscopic Surgeons (SAGES).

This historical vignette describes the professional career of Gerald J. Marks, the founder of the Society of American Gastrointestinal and Endoscopic Surgeons and the International Federation of Societies of Endoscopic Surgeons. Dr. Marks is also the founding Associate Editor of Surgical Endoscopy, which celebrated its 30th anniversary in 2017. Dr. Marks is a renowned colorectal surgeon, an accomplished watercolor artist, and a fascinating personality.

Rhode Island Hospital's Contribution to the Field of Endoscopic Spine Surgery.

The first academic program in endoscopic spine surgery in the United States opened its doors at Rhode Island Hospital in 2012. Published advances in the field since its inception have included treatments for a myriad of pathologies including lumbar and thoracic disc herniations, spondylolisthesis, spine tumors as well as treatments for complications of other spinal procedures including spinal fusion, kyphoplasty, and total disc replacement. In this issue of the Rhode Island Medical Journal we summarize the history of the procedure as well as some of the interesting progress going on in this field in Rhode Island. [Full article available at http://rimed.org/rimedicaljournal-2017-06.asp].

Evolution in Visualization for Sinus and Skull Base Surgery: From Headlight to Endoscope.

Rhinoscopy became a formal field of study in the mid-nineteenth century as improvements in nasal specula were made and the potent vasoconstrictive effects of cocaine on the intranasal tissues were discovered. Since then, a multitude of advances in visualization and illumination have been made. The advent of the Storz-Hopkins endoscope in the mid-twentieth century represents a culmination of efforts spanning nearly 2 centuries, and illumination has evolved concomitantly. The future of endoscopic sinus surgery may integrate developing technologies, such as 3-dimensional endoscopy, augmented reality navigation systems, and robotic endoscope holders.

Endoscopic third ventriculostomy: A historical review.

BACKGROUND: Endoscopic third ventriculostomy (ETV) has become one of the most common neuroendoscopic procedures. METHODS: In this article, we will review the major milestones in the history of ETV development from its early use by Walter Dandy to the techniques currently employed with advanced technology. CONCLUSIONS: ETV has become an important technique in the armamentarium of the neurosurgeon. From a meager beginning with few applications, our knowledge of long-term outcomes has evolved. ETV has a rich history and more recently, has had a renewed interest in its use. Our current understanding of its indications is growing and is based on a century of development through trial and error.