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1.
Surg Clin North Am ; 100(6): 1169-1182, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33128886

RESUMO

Intramural surgery is a minimally invasive surgical technique based on flexible endoscopy. The first step involves the initial mucosal incision for entry point. Then a submucosal tunnel is dissected to the site of the target anatomy. The procedure performed may include myotomy or lesion removal. When complete, the initial mucosal incision is closed. This technique separates the mucosal flap from the surgical site, minimizing the risk of full-thickness perforation and gastrointestinal leakage. Peroral endoscopic myotomy is the most studied application of intramural surgery but other procedures have emerged. This article explores principles of intramural surgery and summarizes its applications.


Assuntos
Endoscopia do Sistema Digestório/métodos , Gastroenteropatias/cirurgia , Trato Gastrointestinal/cirurgia , Membrana Mucosa/cirurgia , Dissecação , Endoscopia do Sistema Digestório/normas , Humanos , Cirurgia Endoscópica por Orifício Natural/métodos , Cirurgia Endoscópica por Orifício Natural/normas
2.
Surg Clin North Am ; 100(6): 1183-1192, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33128887

RESUMO

Achalasia is a neurodegenerative disorder of the lower esophagus characterized by high lower esophageal pressures and aperistalsis of the esophageal body. It remains a difficult to treat disease with significant burden on patients due to difficulty swallowing leading to malnutrition. Peroral endoscopic myotomy (POEM) is a newer endoscopic treatment of achalasia. It involves dividing the muscular layer of the esophagus through a submucosal tunnel. Ten-year data show POEM is a safe and effective treatment of achalasia. However, postoperative gastroesophageal reflux disease remains an important consideration.


Assuntos
Acalasia Esofágica/cirurgia , Miotomia de Heller/métodos , Cirurgia Endoscópica por Orifício Natural/métodos , Acalasia Esofágica/diagnóstico , Esfíncter Esofágico Inferior/cirurgia , Refluxo Gastroesofágico/etiologia , Miotomia de Heller/efeitos adversos , Humanos , Boca , Cirurgia Endoscópica por Orifício Natural/efeitos adversos
3.
Surg Clin North Am ; 100(6): 1215-1226, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33128890

RESUMO

Zenker diverticulum (ZD) is a rare but treatable surgical disease affecting the elderly. This article reviews current available evidence and management of ZD, which includes open surgical, rigid endoscopic, and flexible endoscopic diverticulotomy with common goal of complete division of cricopharyngeus muscle. Careful patient selection and operative intervention tailored to patient characteristics is important when evaluating patients for operative intervention for ZD. Described in detail is a novel flexible endoscopic approach using submucosal tunneling technique to perform cricopharyngeal myotomy, also called per oral endoscopic myotomy, which is demonstrated to be safe and effective in the management of ZD with low morbidity.


Assuntos
Cirurgia Endoscópica por Orifício Natural/métodos , Divertículo de Zenker/cirurgia , Mucosa Esofágica/cirurgia , Esfíncter Esofágico Superior/cirurgia , Humanos , Miotomia/métodos
4.
Am Surg ; 86(7): 796-798, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32683923

RESUMO

Laparoendoscopic hiatal hernia repair (LEHHR) involves laparoscopic repair of hiatal hernia with concomitant transoral incisionless fundoplication (TIF). The objective of this case presentation is to highlight the benefits of LEHHR in a patient with long term follow up. This patient is a 56-year-old woman with symptoms of gastroesophageal reflux disease for 40 years. Esophagogastroduodenoscopy (EGD) showed a 2 cm hiatal hernia. DeMeester score was 21.3. She underwent LEHHR 33 months ago. The patient underwent laparoscopic cholecystectomy for symptomatic biliary dyskinesia. This provided the opportunity to examine the operative anatomy. There were minimal adhesions to the liver. The partial fundoplication was intact. The angle of His was preserved. The fundus was spared from any adhesions as TIF utilizes the cardia rather than the fundus to create the wrap. The plane behind the stomach was undisturbed. LEHHR has 10 main benefits. Anatomical benefits result from the preservation of the angle of His. Functional benefits relate to a partial fundoplication which normalizes pH values. LEHHR avoids bleeding from short gastric vessels and the creation of a wrap when anatomical obstacles present. Strategic benefits are directed toward any subsequent revisional reflux surgery. The lack of adhesions, easy access to the base of left crus, and sparing the fundus render revisional surgery straightforward.


Assuntos
Fundoplicatura/métodos , Hérnia Hiatal/cirurgia , Herniorrafia/métodos , Laparoscopia/métodos , Cirurgia Endoscópica por Orifício Natural/métodos , Feminino , Hérnia Hiatal/complicações , Hérnia Hiatal/diagnóstico , Humanos , Pessoa de Meia-Idade , Seleção de Pacientes
6.
Rev. argent. cir ; 112(2): 185-188, ilus
Artigo em Inglês, Espanhol | LILACS | ID: biblio-1125800

RESUMO

La cirugía endoscópica transluminal a través de orificios naturales (NOTES) ha sido aplicada por primera vez por K. Witzel en el año 2008, introduciendo el abordaje transoral para la patología tiroidea en cadáveres y puercos. En el año 2016, A. Anuwong publicó la primera serie de casos en seres humanos por abordaje vestibular. Referimos en esta ocasión el caso de una paciente de 37 años, quien acudió a la consulta por presentar una tumoración cervical anterior de dos meses de evolución. Ecografía tiroidea con bocio polinodular. Punción aspiración con aguja fina: lesión con hiperplasia folicular en lóbulo derecho e izquierdo. Se decide realizar tiroidectomía transoral endoscópica por abordaje vestibular. La duración de la intervención fue de 180 minutos, la pérdida sanguínea fue de 20 mL. El dolor, escaso y el tiempo de internación, 36 horas. En el presente trabajo se propone el desarrollo de esta técnica y la experiencia en nuestro primer caso de tiroidectomía total en patología tiroidea benigna.


Natural orifice transluminal endoscopic surgery (NOTES) was applied for the first time by K. Witzel in 2008, introducing the transoral endoscopic resection of the thyroid gland in human cadavers and living pigs. In 2016, A. Anuwong published the first case series using the vestibular approach in humans. We report the case of a 37-year-old female patient with a mass in the anterior aspect of the neck which appeared two months before consultation. The thyroid ultrasound reported multinodular goiter. The fine-needle aspiration (FNA) biopsy reported hyperplastic follicular nodule in both lobes. The patient underwent transoral endoscopic thyroidectomy by vestibular approach. Operative time was 180 minutes and blood loss was 20 mL. Pain was minimal and hospital stay was 36 hours. We report our first experience with total thyroidectomy in a patient with benign thyroid nodules.


Assuntos
Humanos , Feminino , Adulto , Tireoidectomia/métodos , Cirurgia Endoscópica por Orifício Natural/métodos , Glândula Tireoide , Neoplasias da Glândula Tireoide/patologia
7.
Bull Cancer ; 107(7-8): 823-829, 2020.
Artigo em Francês | MEDLINE | ID: mdl-32471700

RESUMO

Minimal invasive surgery and reconstructive surgery tend to become the standard in France in the management of head and neck tumors. The use of endoscopic approaches (through endoscopic endonasal/transoral approaches±robot-assisted) instead of open surgery and the use of reconstructive surgery using autologous (flaps) or heterologous materials aim to reduce surgical morbidity by making-up for the loss of substance to restore the function. The impact of these substantial changes in surgical techniques has not been assessed with respect to postoperative radiotherapy practice. Endoscopic endonasal approaches result, however, in piecemeal resection, which, along the analysis of resection margins (a key prognostic factor), make the interpretation of the quality of resection more complex for radiation oncologists. The definition of tumour sub-volumes to be irradiated and doses to these sub-volumes then requires accurate histosurgical mapping and close multidisciplinary consultation between surgeons, pathologists, radiologists and radiation oncologists. Similarly, the increasing use of various types of flaps (of soft tissue or bone flaps), adapted to the patient and tumor anatomy, is associated with substantial modifications to the operating bed. The delineation of tumour volumes in postoperative radiotherapy is made more complex. Tremendous multidisciplinary efforts should now be initiated to fully take advantage of surgical advances and to further optimize the therapeutic index by making radiotherapy also less toxic, i.e. "mini-morbid".


Assuntos
Neoplasias de Cabeça e Pescoço/radioterapia , Neoplasias de Cabeça e Pescoço/cirurgia , Cirurgia Endoscópica por Orifício Natural/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Retalhos Cirúrgicos/transplante , Humanos , Membrana Mucosa/cirurgia , Período Pós-Operatório , Lesões por Radiação/prevenção & controle , Radioterapia/efeitos adversos
8.
Trop Doct ; 50(3): 209-215, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32349606

RESUMO

Currently, transvaginal natural orifice transluminal endoscopic surgery (NOTES), the most minimally invasive option for laparoscopic surgery, suffers various technological restraints limiting its implementation. We discuss a simple modification for vaginal access to improve the existing hybrid NOTES technique. We retrospectively studied 18 women at our rural hospital in central India, who, under defined criteria, underwent transvaginal appendicectomy using innovative strategically designed submucosal tunnels. The procedure was successfully completed in all but the first three cases. None required additional abdominal trocar or analgesia beyond the first 6 h. The mean operative and hospitalisation times were 27.5 min and 18.5 h, respectively. We had no intraoperative complications and only one patient experienced postoperative self-limiting vaginal spotting. All patients were very pleased with the cosmetic results and sexual life as assessed by locally devised scales. On regular follow-up, all were progressing well. We recommend the method presented, as it is not only feasible and safe but has the potential to improve overall results. Clearly, a larger volume randomised trial would be optimal to confirm our conclusion.


Assuntos
Apendicectomia/métodos , Laparoscopia/métodos , Cirurgia Endoscópica por Orifício Natural/métodos , Adulto , Feminino , Hospitalização , Humanos , Índia , Pessoa de Meia-Idade , Duração da Cirurgia , Satisfação do Paciente , Estudos Retrospectivos , Resultado do Tratamento , Vagina
9.
J Surg Res ; 254: 16-22, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32402832

RESUMO

BACKGROUND: In the present paper, we introduce our experience with the novel method during laparoscopic anterior resection of upper rectal or sigmoid colon cancer by transrectal natural orifice specimen extraction (NOSE). METHODS: A prospective randomized controlled trial was performed from June 2016 to May 2019. Patients with upper rectal or sigmoid colon cancer were randomized in a 1:1 ratio to the NOSE group and the non-NOSE group. Preoperative and postoperative clinical variables were analyzed and compared between groups. Postoperative pain was analyzed utilizing a visual analog scale. Postoperative overall survival was analyzed using a Kaplan-Meier curve. RESULTS: A total of 276 patients were enrolled, of whom 254 were randomly divided into the NOSE group (n = 122) and the conventional laparoscopic group (n = 119). NOSE failed in 22 cases, which were converted to transabdominal specimen extraction. Intention-to-treat analysis was performed, and these 22 cases were included in the NOSE group. The incidence of postoperative complications was significantly lower in the NOSE group (11/122, 9%) than in the non-NOSE group (25/119, 21%). The NOSE group had a longer operation time, less blood loss, and a lower postoperative visual analog scale score than the non-NOSE group. The time for intestinal function recovery (ventilation) and the length of hospital stay were significantly longer in the non-NOSE group. The Kaplan-Meier survival curve showed no statistically significant difference in the disease-free survival rate between the NOSE group and the non-NOSE group. CONCLUSIONS: The novel NOSE method is safe and feasible to use in patients having colorectal cancer. Compared with traditional laparoscopic surgery, the postoperative complication rates of NOSE surgery were lower with an improved short-term clinical recovery.


Assuntos
Cirurgia Endoscópica por Orifício Natural/efeitos adversos , Cirurgia Endoscópica por Orifício Natural/métodos , Neoplasias Retais/cirurgia , Neoplasias do Colo Sigmoide/cirurgia , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Humanos , Laparoscopia/métodos , Tempo de Internação , Duração da Cirurgia , Complicações Pós-Operatórias/epidemiologia , Estudos Prospectivos , Resultado do Tratamento
11.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(4): 384-389, 2020 Apr 25.
Artigo em Chinês | MEDLINE | ID: mdl-32306607

RESUMO

Objective: To explore the safety and feasibility of da Vinci robot surgical systems in natural orifice specimen extraction surgery (NOSES) for rectal neoplasms. Methods: A descriptive cohort study was used. Inclusion criteria: (1) age ≥18 years old; (2) diagnosis of rectal cancer by biopsy via colonoscopy or benign neoplasm locating in rectum that could not be resected locally through the anus; (3) R0 resection can be achieved by preoperative evaluation; (4) the CDmax (maximum circumferential diameter) was ≤5 cm or specimens could still be extracted from the anus despite a CDmax exceeding 5 cm but was along the longitudinal axis of the rectum. Exclusion criteria: (1) emergency operation due to gastrointestinal obstruction, perforation, or bleeding; (2) distal metastasis, induding lung, bone, or liver, that could not be resected simultaneously; (3) history of abdominal surgery or any other contraindications for robotic surgery. Clinicopathological data of 162 patients with rectal neoplasms who underwent robotic NOSES at the General Surgery Department of the Second Xiangya Hospital of Central South University from March 2016 to July 2019 were retrospectively collected. Of 162 patients, 94 were male and 68 were female; the average age was (57±13) years; the average BMI was (23.5±3.2) kg/m(2); the average distance from tumor to the anal verge was (8.2±2.9) cm. Five trocars were used to perform total mesorectal excision (TME), and the descending colon artery was preserved. Sterile endoscope sleeve for the specimen extraction was inserted into the pelvic cavity through the anus, and the resected specimen was pulled out through the sleeve. Outcomes of safety (operation time, intraoperative blood loss and postoperative morbidity of complication) and oncological outcomes (number of lymph nodes harvested, rate of lymph node metastasis and rate of positive resection margin) were collected. Results: All the 162 cases completed robotic NOSES successfully with no conversion to laparotomy. The average operation time was (188.7±79.8) minutes; the average blood loss was (47.1±33.2) ml; the average and the maximum CDmax of specimens were (3.4±1.5) cm and 12 cm respectively. A total of 154 patients underwent robotic TME. One underwent robotic TME plus resection of liver metastasis; one underwent robotic TME plus partial transverse colectomy; two patients underwent robotic TME plus ovariectomy; another two underwent robotic TME plus hysterectomy; one patient underwent robotic TME plus left partial nephrectomy due to renal angioleiomyoma; another one underwent robotic TME plus ureteral repair due to intraoperative injury of the left ureter. All the specimens were extracted through the anus. Protective ileostomy was performed in 6.8% (11/162) of the patients. The average number of lymph node harvested was 14.9±5.1. According to pathological reports, 156 neoplasms were adenocarcinoma. Tis stage was 1.3% (2/156), T1 stage was 9.0% (14/156), T2 stage was 26.3% (41/156), T3 stage was 35.9% (56/156), and T4 stage was 27.6% (43/156). Lymph node metastasis accounted for 34.6% (54/156), and simultaneous liver metastasis was observed in one case. Circumferential resection margins (CRMs) and upper and lower resection margins were negative in all the patients. The average postoperative feeding time and postoperative hospital stay were (4.2±4.1) days and (11.4±7.7) days, respectively. Postoperative morbidity of complication was 12.3% (20/162). The incidence of anastomotic leakage was 4.9% (8/162), of which only 4 cases (2.5%) received ileostomy. Within postoperative 90-day, no anal dysfunction or death were found. Conclusion: Robotic NOSES for rectal neoplasms is safe and feasible.


Assuntos
Adenocarcinoma/cirurgia , Cirurgia Endoscópica por Orifício Natural/métodos , Protectomia/métodos , Neoplasias Retais/cirurgia , Procedimentos Cirúrgicos Robóticos , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
12.
Int Forum Allergy Rhinol ; 10(8): 963-967, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32348025

RESUMO

Severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), which causes coronavirus disease 2019 (COVID-19), is highly contagious with devastating impacts for healthcare systems worldwide. Medical staff are at high risk of viral contamination and it is imperative to know what personal protective equipment (PPE) is appropriate for each situation. Furthermore, elective clinics and operations have been reduced in order to mobilize manpower to the acute specialties combating the outbreak; appropriate differentiation between patients who require immediate care and those who can receive telephone consultation or whose treatment might viably be postponed is therefore crucial. Italy was 1 of the earliest and hardest-hit European countries and therefore the Italian Skull Base Society board has promulgated specific recommendations based on consensus best practices and the literature, where available. Only urgent surgical operations are recommended and all patients should be tested at least twice (on days 4 and 2 prior to surgery). For positive patients, procedures should be postponed until after swab test negativization. If the procedure is vital to the survival of the patient, filtering facepiece 3 (FFP3) and/or powered air purifying respirator (PAPR) devices, goggles, full-face visor, double gloves, water-resistant gowns, and protective caps are mandatory. For negative patients, use of at least an FFP2 mask is recommended. In all cases the use of drills, which promote the aerosolization of potentially infected mucous particles, should be avoided. Given the potential neurotropism of SARS-CoV-2, dura handling should be minimized. It is only through widely-agreed protocols and teamwork that we will be able to deal with the evolving and complex implications of this new pandemic.


Assuntos
Infecções por Coronavirus , Transmissão de Doença Infecciosa/prevenção & controle , Controle de Infecções , Cirurgia Endoscópica por Orifício Natural/métodos , Pandemias , Pneumonia Viral , Base do Crânio/cirurgia , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Humanos , Controle de Infecções/métodos , Controle de Infecções/organização & administração , Itália , Procedimentos Cirúrgicos Nasais/métodos , Procedimentos Neurocirúrgicos/métodos , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle
13.
Ann R Coll Surg Engl ; 102(6): 442-450, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32347742

RESUMO

INTRODUCTION: Head and neck carcinoma of unknown primary represents 1-5% of all head and neck cancers and presents a diagnostic and therapeutic dilemma. In approximately 40% of cases, a primary tumour location remains unknown despite investigation. With advancements in our understanding of the role of high-risk human papilloma virus in head and neck cancer, transoral robotic surgery presents an option for diagnosis and therapy. MATERIALS AND METHODS: This is a retrospective case series from a single centre. Case notes were reviewed for 28 patients who had transoral robotic surgery for head and neck carcinoma of unknown primary between May 2015 and July 2019. RESULTS: Transoral robotic surgery identified an oropharyngeal primary tumour in 19 of 28 (67.8%) patients. All oropharyngeal primaries were p16 positive. The base of tongue identification rate was 63.2%. Median length of inpatient stay postoperatively was 1.0 day. Normal oral intake resumed within 48 hours in 96% (27/28) of patients. Three patients (10.3%) suffered minor postoperative bleeds that were all managed conservatively. DISCUSSION: The base of tongue primary identification rate (63.2%) in this series is consistent with that previously reported (43-63%; 95% confidence interval). Primary tumour identification rate if a patient is p16 positive is 86.3% (19/22), with 100% of these being oropharyngeal. We suggest future investigation into p16 status as a means of stratifying patients with head and neck carcinoma of unknown primary for transoral robotic surgery. CONCLUSION: Transoral robotic base of tongue mucosectomy (or lingual tonsillectomy) is a promising technique that offers a high yield of positive identification for the primary tumour. It is well tolerated with minimal associated morbidity. Our findings are comparable with those in the current literature.


Assuntos
Cirurgia Endoscópica por Orifício Natural/métodos , Neoplasias Primárias Desconhecidas/cirurgia , Neoplasias Orofaríngeas/diagnóstico , Procedimentos Cirúrgicos Robóticos/métodos , Carcinoma de Células Escamosas de Cabeça e Pescoço/cirurgia , Neoplasias da Língua/cirurgia , Feminino , Hospitais Universitários/estatística & dados numéricos , Humanos , Tempo de Internação/estatística & dados numéricos , Londres , Masculino , Pessoa de Meia-Idade , Mucosa Bucal/patologia , Mucosa Bucal/cirurgia , Cirurgia Endoscópica por Orifício Natural/efeitos adversos , Cirurgia Endoscópica por Orifício Natural/estatística & dados numéricos , Neoplasias Orofaríngeas/patologia , Neoplasias Orofaríngeas/cirurgia , Seleção de Pacientes , Estudos Retrospectivos , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Procedimentos Cirúrgicos Robóticos/estatística & dados numéricos , Carcinoma de Células Escamosas de Cabeça e Pescoço/secundário , Neoplasias da Língua/secundário
15.
J Surg Oncol ; 122(1): 36-40, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32334445

RESUMO

Transoral endocrine surgery encompasses a group of operations whereby the thyroid or parathyroid gland is removed through the oral vestibule. This operation has the advantage of leaving no cutaneous scar and a risk profile similar to open surgery. Adoption of this technique has increased dramatically over the last several years. It is of paramount importance for surgeons to undergo adequate training before adopting this technique.


Assuntos
Procedimentos Cirúrgicos Endócrinos/métodos , Cirurgia Endoscópica por Orifício Natural/métodos , Glândulas Paratireoides/cirurgia , Glândula Tireoide/cirurgia , Tireoidectomia/métodos , Humanos , Neoplasias da Glândula Tireoide/cirurgia
16.
J Laparoendosc Adv Surg Tech A ; 30(6): 635-638, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32315561

RESUMO

Over the past decade, per-oral endoscopic myotomy has been shown to be a durable minimally invasive approach to the treatment of esophageal achalasia. Patients with suspected achalasia should undergo upper endoscopy, timed barium esophagram, and high-resolution manometry to confirm the diagnosis. The procedure includes several key steps including mucosotomy, submucosal tunneling, selective myotomy of the circular muscle layer, and mucosotomy closure. Specialized endoscopic dissection tools are used during the procedure to access the submucosal space. Common procedural challenges include minor bleeding and capnoperitoneum.


Assuntos
Acalasia Esofágica/cirurgia , Esfíncter Esofágico Inferior/cirurgia , Esofagoscopia/métodos , Miotomia/métodos , Cirurgia Endoscópica por Orifício Natural/métodos , Procedimentos Cirúrgicos do Sistema Digestório , Gastroscopia/métodos , Humanos , Manometria/métodos , Período Pós-Operatório , Resultado do Tratamento
17.
Int J Pediatr Otorhinolaryngol ; 134: 110044, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32320837

RESUMO

OBJECTIVES: Cerebrospinal fluid (CSF) rhinorrhea in children is relatively uncommon. Endoscopic repair techniques in adults have become first line for nasal-based CSF leaks, and this meta-analysis looks at the success rates of CSF leak cessation following endoscopic repair in children. METHODS: Three researchers extracted information involving patient population, surgical technique, outcomes of interest, and study design. A computerized search of MEDLINE, EMBASE and the Cochrane library (January 1990-September 2019) looked for several papers on the subject of CSF leak repair in children using endoscopic technique. RESULTS: A total of 15 studies met inclusion criteria. Endoscopic repair of CSF rhinorrhea in children shows a pooled weighted success rate of 94% after first attempt. The most common etiology was traumatic followed by congenital. Iatrogenic defects secondary to tumor resection are becoming more common. The high success rate was irrespective of the techniques using. CONCLUSION: Endoscopic repair techniques have a highly successful closure rate for children presenting with CSF rhinorrhea.


Assuntos
Rinorreia de Líquido Cefalorraquidiano/cirurgia , Endoscopia/métodos , Cavidade Nasal , Cirurgia Endoscópica por Orifício Natural/métodos , Adolescente , Vazamento de Líquido Cefalorraquidiano/cirurgia , Rinorreia de Líquido Cefalorraquidiano/etiologia , Criança , Pré-Escolar , Traumatismos Craniocerebrais/complicações , Encefalocele/complicações , Humanos , Doença Iatrogênica , Lactente , Meningocele/complicações , Complicações Pós-Operatórias/cirurgia , Estudos Retrospectivos , Resultado do Tratamento
18.
Otolaryngol Head Neck Surg ; 162(6): 839-852, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32204654

RESUMO

OBJECTIVES: To compare the effectiveness of transoral robotic surgery (TORS) versus plasma ablation (PA) in tongue base reduction surgery for obstructive sleep apnea (OSA). DATA SOURCES: PubMed, Scopus, Cochrane Library, OVID. REVIEW METHODS: Keywords searched included OSA, tongue base surgery, TORS, and coblation. Outcomes included pre- to postoperative apnea-hypopnea index, Epworth Sleepiness Scale (ESS), and lowest oxygen saturation. Additional outcomes included surgical success rate, postoperative bleeding, operative time, and length of stay. RESULTS: A total of 690 unique articles were identified, of which 60 underwent full-text review. Twenty-six articles were included in final analysis, comprising 18 studies on TORS (834 patients) and 11 studies on PA (294 patients). Mean differences of apnea-hypopnea index, ESS, and lowest oxygen saturation for TORS were -23.92, -7.6, and 5.83% (all P < .01). Corresponding values for PA were -22.07, -4.14, and 5.48% (all P < .00001). TORS had greater ESS reduction than PA (P = .02). Follow-up duration was shorter in TORS than PA (mean ± SD: 4.2 ± 2.6 vs 4.6 ± 1.4 months, P = .0482). Surgical success rates in TORS and PA were similar (57.6% vs 60.3%, P = .4474). Postoperative bleeding occurred less frequently in TORS versus PA (3.3% vs 7.5%, P = .0103). Operative time was longer for TORS than PA (77.9 ± 16.4 minutes vs 44.0 ± 12.9 minutes, P < .0001). Length of stay was similar between TORS and PA (3.9 ± 1.6 days vs 3.9 ± 2.5 days, P = .9047). CONCLUSION: Tongue base reduction with TORS or PA each effectively treats OSA and provides comparable results. The choice between techniques might depend on patient factors, availability of technology, and associated costs.


Assuntos
Glossectomia/métodos , Cirurgia Endoscópica por Orifício Natural/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Apneia Obstrutiva do Sono/cirurgia , Humanos , Boca , Resultado do Tratamento
19.
Otolaryngol Head Neck Surg ; 163(2): 284-292, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32204653

RESUMO

OBJECTIVES: The advent of endonasal endoscopic skull base surgery (ESBS) has redefined the management of pediatric sellar and suprasellar lesions. To date, the outcomes of these procedures have not been systematically reviewed. This study performed a systematic review with meta-analysis of surgical outcomes for pediatric patients undergoing ESBS for sellar and suprasellar lesions. DATA SOURCES: PubMed (National Library of Medicine, National Institutes of Health), Scopus (Elsevier), and Cochrane Library (Wiley). REVIEW METHODS: Articles reporting on pediatric patients undergoing ESBS for craniopharyngiomas, pituitary adenomas, and Rathke's cleft cysts were reviewed. The primary outcome was postoperative cerebrospinal fluid (CSF) leak. Secondary outcomes included endocrine, visual, and other complications. RESULTS: Twenty-five articles reporting on 554 patients were included. Overall postoperative CSF leak rate was 8.6%, with tumor-specific rates of 10.6% in craniopharyngiomas, 6.5% in pituitary adenomas, and 7.2% in Rathke's cleft cysts (P > .05). Older studies demonstrate higher postoperative CSF leak rates as compared with more recent studies (12.5% vs 6.1%, P = .0082). Younger children (8.9-12.6 years old) experienced a higher rate of postoperative CSF leaks as compared with older children (13.0-16.6 years old; 12.9% vs 4.9%, P = .0016). Additional postoperative complications included diabetes insipidus (26.7%), hypopituitarism (46.6%), visual deficits (2.6%), meningitis (3.4%), and weight gain (3.4%). CONCLUSION: ESBS for pediatric sellar and suprasellar lesions is overall an effective management approach with an increasingly favorable risk-benefit profile. Younger children may be more susceptible to postoperative CSF leak as compared with older pediatric patients. Tumor type does not appear to be an independent risk factor for postoperative CSF leak in this population.


Assuntos
Adenoma/cirurgia , Cistos do Sistema Nervoso Central/cirurgia , Craniofaringioma/cirurgia , Cirurgia Endoscópica por Orifício Natural , Neoplasias Hipofisárias/cirurgia , Criança , Humanos , Cirurgia Endoscópica por Orifício Natural/métodos , Nariz , Sela Túrcica
20.
Gastrointest Endosc Clin N Am ; 30(2): 267-289, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32146946

RESUMO

GERD is a spectrum disorder, and treatment should be individualized to the patient's anatomic alterations. Trans-oral incisionless fundoplication (TIF 2.0) is an endoscopic procedure which reduces EGJ distensibility, thereby decreasing tLESRs, and also creates a 3-cm high pressure zone at the distal esophagus in the configuration of a flap valve. As it produces a partial fundoplication with a controlled valve diameter, gas can still escape from the stomach, minimizing the side-effect of gas-bloat. Herein we discuss the rationale, mechanism of action, patient selection, step-by-step procedure, safety and efficacy data, it's use with concomitant laparoscopic hernia repair, and future emerging indications.


Assuntos
Fundoplicatura/métodos , Refluxo Gastroesofágico/cirurgia , Laparoscopia/métodos , Cirurgia Endoscópica por Orifício Natural/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Boca/cirurgia , Estômago/cirurgia , Resultado do Tratamento
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