Combined endoscopic endonasal & transoral approach to transpatial lesion involving the infratemporal fossa and masticator space: A case study and literature review / Abordaje endoscópico combinado endonasal y transoral a una lesión transespacial involucrando la fosa infratemporal y el espacio masticador: Reporte de caso y revisión de la literatura

Transpatial skull base lesions involving the infratemporal fossa (ITF) are challenging due to the complex neurovascular structures of the region. Open approaches have traditionally been utilized to access these spaces. We present a 55-year-old woman presented with a mesenchymal mass involving the left ITF and masticator space. A combined endoscopic endonasal transpterygoid approach was performed followed by an endoscopic transoral-transmandibular corridor to access and resect the tumor. The post-operative course was unremarkable with no recurrence during her follow-up. Combined endoscopic approaches for transpatial tumor resection offered sufficient exposure to access safely each space (AU)

Las lesiones de la base craneal con una distribución transespacial e involucrando la fosa infratemporal (ITF) representan un desafío debido a las complejas estructuras neurovasculares de dicha región. Los abordajes abiertos han sido empleados tradicionalmente para acceder a estas regiones. Presentamos el caso de una mujer de 55 años que consultó por una lesión mesenquimal localizada en la ITF izquierda y en el espacio masticatorio. Se realizó un abordaje combinado endoscópico transpterigoideo endonasal seguido de un abordaje endoscópico transoral-transmandibular para acceder y resecar el tumor. El curso postoperatorio fue anodino, y no ha presentado recidiva con 21 meses de seguimiento. Los abordajes endoscópicos combinados para la resección de lesiones tumorales, con una distribución transespacial involucrando la ITF, ofrecen una exposición suficiente para acceder de forma segura a cada espacio (AU)

Endoscopic transcanal surgery of pars tensa cholesteatoma: Preliminary results / Cirugía endoscópica transcanal del colesteatoma de la pars tensa: resultados preliminares

Introduction and objectives: The aim of the present study is the assessment of exclusive endoscopic ear surgery for the management of primarily acquired pars tensa cholesteatoma, which is commonly linked to the failure of the Eustachian tube leading to the formation of retraction pockets.Materials and methodsPatients suffering from primarily acquired pars tensa cholesteatoma, who underwent primary surgery in our clinic, between 2014 and 2018 were included in this retrospective study. The disease was classified according to the EAONO/JOS system. Exclusive endoscopic ear surgery was performed for patients without mastoid involvement, while a microscopic–endoscopic tympanoplasty was carried out in case of mastoid extension. We assessed the recidivism rate during the follow-up.ResultsCholesteatomas belonged to stage I in 28% of cases, to stage II in 68% and only one patient was stage III. Only a portion of the pars tensa was involved in 13 instances, the whole pars tensa in 3 and both the tensa and the flaccida in 9. 17 out of 25 patients underwent exclusive endoscopic ear surgery and 8 needed a combined approach. We discovered 1 recurrence and 6 residual diseases.ConclusionsWith only one case of recurrence in our series, we showed how pars tensa cholesteatoma cannot be exclusively explained through Eustachian tube dysfunction, but also through a ventilation blockage between the Eustachian tube and other mesotympanic areas due to the formation of intratympanic folds. Endoscopic ear surgery proved highly effective in the control of recurrences and it should be considered the treatment of choice. (AU)

Introducción y objetivos: El objetivo del presente estudio es la evaluación de la cirugía endoscópica exclusiva del oído para el manejo del colesteatoma de la pars tensa adquirido primario, que comúnmente está relacionado con la falla de la trompa de Eustaquio que conduce a la formación de bolsas de retracción.Materiales y métodosEn este estudio retrospectivo se incluyeron pacientes con colesteatoma de la pars tensa adquirido primario, que se sometieron a cirugía primaria en nuestra clínica, entre 2014 y 2018. La enfermedad se clasificó según el sistema EAONO/JOS. En pacientes sin afectación mastoidea se realizó únicamente cirugía endoscópica de oído, mientras que, en caso de extensión mastoidea, se realizó timpanoplastia microscópica-endoscópica. Se evaluó la tasa de recidiva durante el seguimiento.ResultadosEl 28% de los colesteatomas pertenecían al grado I, el 68% al grado II y solo un paciente estaba en el grado III. Solo una porción de la pars tensa estuvo afectada en 13 casos, toda la pars tensa en tres y tanto la tensa como la fláccida en nueve. Se sometieron a cirugía endoscópica exclusiva del oído 17 de 25 pacientes y ocho necesitaron un abordaje combinado. Descubrimos una recurrencia y seis enfermedades residuales.ConclusionesCon un solo caso de recurrencia en nuestra serie, mostramos cómo el colesteatoma de la pars tensa no puede explicarse exclusivamente por una disfunción de la trompa de Eustaquio, sino también por un bloqueo de la ventilación entre la trompa de Eustaquio y otras áreas mesotimpánicas debido a la formación de pliegues intratimpánicos. La cirugía endoscópica de oído demostró ser altamente eficaz en el control de las recurrencias y debe considerarse el tratamiento de elección. (AU)

Endoscopic total thyroidectomy using a unilateral transaxillary approach: A case report.

Endoscopic transaxillary thyroidectomy is a common method for remote-access thyroidectomy. The approach typically uses a gasless method, and a long incision to insert a special retractor. In addition, it is considered only suitable for unilateral lobectomy because of problems accessing contralateral parts of the thyroid gland. We describe here, a case of a young woman who had a total thyroidectomy performed using an endoscopic approach. We reduced the non-inflated 4-6 cm incision that is usually required, into three holes, and performed unilateral transaxillary thyroidectomy; this was verified by radioactive iodine uptake and thyroglobulin levels during follow-up. The approach was clinically successful and resulted in minimal scarring. More studies are required to optimize this promising technique.

Effect of helicobacter pylori infection eradication on serum level of anti-tissue transglutaminase in children with celiac disease.

BACKGROUND: Evidence shows the increase of anti-tissue transglutaminase (tTG) levels in various conditions, including infectious agents, independently of celiac disease (CD). The aim of this study was to investigate the effect of helicobacter pylori (H.pylori) infection eradication on serum level of tTG in children with CD. METHODS: This study was conducted on children aged 2 to 18 who referred to reference hospitals for diagnosis of CD. After upper endoscopy and biopsy to confirm CD and H.pylori infection, the children were divided into three groups (including group one: 16 CD patients with positive H. pylori; group two: 16 non-CD patients with positive H. pylori; and group three: 56 CD patients with negative H. pylori), respectively. The tTG level in study groups were compared after the eradication of H.pylori. RESULTS: The mean age of the subjects in the group one, two, and three was 9.7 ± 3.33, 11.8 ± 3.14, and 7.6 ± 3.32 years, respectively. Our results showed that in group one, mean tTG increased after eradication of H.pylori infection, however, these changes were not significant (182.43 vs. 157.18, P = 0.121). In the second group, although unlike the first group, mean tTG decreased after eradication of the infection, but still these changes were not significant (9.56 vs. 22.18, P = 0.449). Furthermore, at the baseline level, the mean tTG in the group three was closer to the mean tTG in the first group. CONCLUSION: Our findings showed that the eradication of H.pylori infection does not have a significant effect on tTG levels in children with and without CD.

High-pressure balloon dilatation of primary obstructive megaureter in children: a systematic review.

OBJECTIVE: We aimed to evaluate the effectiveness and complication rates of endoscopic high-pressure balloon dilatation (HPBD) in treating primary obstructive megaureter (POM) in children based on current literature. Specifically, we wanted to clarify the evidence on the use of HPBD in children under one year of age. METHODS: A systematic search of the literature was performed via several databases. The preferred reporting items for systematic reviews and meta-analyses guidelines were followed. The primary outcomes studied in this systematic review were the effectiveness of HBPD in relieving obstruction and reducing hydroureteronephrosis in children. The secondary outcome was to study the complication rate of endoscopic high-pressure balloon dilatation. Studies that reported one or both of these outcomes (n = 13) were considered eligible for inclusion in this review. RESULTS: HPBD significantly decreased both ureteral diameter (15.8 mm [range 2-30] to 8.0 mm [0-30], p = 0.00009) and anteroposterior diameter of renal pelvis (16.7 mm [0-46] to 9.7 mm [0-36], p = 0.00107). The success rate was 71% after one HPBD and 79% after two HPBD. The median follow-up time was 3.6 years (interquartile range 2.2-6.4 years). A complication rate of 33% was observed, but no Clavien-Dindo grade IV-V complications were reported. Postoperative infections and VUR were detected in 12% and 7.8% of cases, respectively. For children under one year of age, outcomes of HPBD seem to be similar to those in older children. CONCLUSIONS: This study indicates that HPBD appears to be safe and can be used as the first-line treatment for symptomatic POM. Further comparative studies are needed addressing the effect of treatment in infants, and also long-term outcomes of the treatment. Due to the nature of POM, identifying those patients who will benefit from HPBD remains challenging.

Evaluation of endoscopic ureteral stone treatments in the period of decreasing severity of COVID-19 pandemic.

OBJECTIVE: During the COVID-19 pandemic, people's admissions to the hospital for their current illness were delayed. We aimed to reveal how this situation has affected the endoscopic treatment of ureteral stones. PATIENTS AND METHODS: Patients who were treated for 59 endoscopic ureteral stones in the pre-pandemic period between September 2019 and December 2019, and patients who were treated for 60 endoscopic ureteral stones between January 2022 and April 2022, when the effectiveness of the COVID-19 pandemic decreased, were evaluated in two groups. Pre-pandemic patients were classified as group 1, and patients treated during the period when the effectiveness of the pandemic decreased as group 2. The patients' ages, preoperative laboratory examinations and radiological findings, localization and size of the stones in the ureter, time until the operation, duration of the operation, length of hospital stay, preoperative ESWL history, complication rates according to the Modified Clavien classification were evaluated. The problems observed in the ureter during the operation were examined separately as edema, polyp formation in the ureter, distal ureteral stenosis, and adhesion of the stone to the mucosa. RESULTS: In group 1, 9 patients were female and 50 were male, with a mean age of 42.19 ± 14.06 years; in group 2, 17 patients were female and 43 were male, with a mean age of 45.23 ± 12.20 years. The stone size was found to be higher in group 2. Group 1 had more patients who did not develop complications in the Modified Clavien classification, and the proportion of group 2 patients in the grade I-II-IIIA-IIIB classification was higher. Considering the waiting time before hospitalization, it was determined that the rate of group 2 patients was higher in those with a waiting period of 31-60 days (33.9-48.3%) and ≥60 days (10.2-21.7%). Except for the development of ureteral polyps, all other problems rate were found to be higher in group 2 patients compared to group 1. CONCLUSIONS: During the COVID-19 pandemic, there was a delay in the treatment of ureteral stones in patients. In the next period, as a result of this delay, negative effects on the ureteral mucosa were detected and, accordingly, an increase in the complication rates of the operation was observed.

Study of visual SLAM methods in minimally invasive surgery.

In recent years, minimally invasive surgery has developed rapidly in the clinical practice of surgery and has gradually become one of the critical surgical techniques. Compared with traditional surgery, the advantages of minimally invasive surgery include small incisions and less pain during the operation, and the patients recover faster after surgery. With the expansion of minimally invasive surgery in several medical fields, traditional minimally invasive techniques have bottlenecks in clinical practice, such as the inability of the endoscope to determine the depth information of the lesion area from the two-dimensional images obtained, the difficulty in locating the endoscopic position information and the inability to get a complete view of the overall situation in the cavity. This paper uses a visual simultaneous localization and mapping (SLAM) approach to achieve endoscope localization and reconstruction of the surgical region in a minimally invasive surgical environment. Firstly, the K-Means algorithm combined with the Super point algorithm is used to extract the feature information of the image in the lumen environment. Compared with Super points, the logarithm of successful matching points increased by 32.69%, the proportion of effective points increased by 25.28%, the error matching rate decreased by 0.64%, and the extraction time decreased by 1.98%. Then the iterative closest point method is used to estimate the position and attitude information of the endoscope. Finally, the disparity map is obtained by the stereo matching method, and the point cloud image of the surgical area is finally recovered.

High-resolution anoscopy can diagnose precursors to anal cancer.

Anal cancer risk is increased in certain risk groups including people living with HIV (PLWH), especially in men who have sex with men, but also in organ transplant recipients and women with a history of cervical or vulva dysplasia or cancer. High-resolution anoscopy (HRA) is a tool to diagnose anal high-grade squamous intraepithelial lesions (HSIL), and HRA-guided treatment of anal HSIL has been shown to reduce the risk of anal cancer in PLWH. The purpose of this review is to increase the awareness of HRA but also of tertiary prevention by digital anal rectal examination.

Independent reliability and availability analyses of modified classification for migrated lumbar disc herniation.

STUDY DESIGN: Retrospective cohort study. OBJECTIVE: The purpose of this study was to evaluate the reliability of modified classification system of migrated nucleus pulposus and its clinical application value. METHODS: We retrieved 1000 lumbar MRI of different patients in Hangzhou Hospital of Traditional Chinese Medicine from January 2016 to December 2019 for interpretation, and screened 105 migrated lumbar MRI for inclusion in the study. Three spinal surgeons made classification according to the modified classification method. Two weeks later, the sorting data of the patients were shuffled and the classification was judged by three doctors again. The consistency and repeatability of the improved classification were evaluated by Kappa coefficient. The general data of the included patients were collected. The patients were followed up for 2 years, and the risk factors of surgical treatment of patients with migrated lumbar disc herniation were analyzed. The treatment plan, surgical approach, operation time, VAS score, ODI score and other relevant data of the included patients were collected to evaluate the guiding effect of the classification system on clinical practice. RESULTS: In this study, the incidence of migrated lumbar disc herniation was about 10.5%, and most of the patients were male. Patients with higher BMI are more likely to develop this disease. Our study confirmed that the modified classification has moderate to high confidence. During the 2-year follow-up period, 66 patients (62.9%) were treated conservatively, and the patients with conservative treatment were mainly A2 and B2 type (59.1%). Thirty-nine patients (37.1%) underwent surgical treatment. The patients recovered well after operation, and the low back pain and ODI index were significantly improved at 1 year after operation (P < 0.05). We suggest that type A1 and B1 migrated nucleus pulposus can be removed by posterior approach. For type A2, B2, C1, C2, the lateral approach is recommended to remove the nucleus pulposus directly. Logistic regression and ROC analysis showed that disease duration (≥ 1 year) and BMI (≥ 24) maybe were risk factors for surgical treatment of patients with migrated lumbar disc herniation. CONCLUSION: The modified classification has good reliability. In the current study, the experience level of spine surgeons does not affect the reliability of the classification system. Our study confirmed that this classification has a good reference value for guiding the treatment plan and the choice of surgical approach.

Endoscopic Removal of a Retained Throat Pack: A Profound Lesson.

Throat packing/pharyngeal packing is typically applied in all oral and maxillofacial surgeries. It prevents the entry of saliva, blood, disinfectant, other liquids, and oral foreign objects (brackets) into the trachea or esophagus. The retention of throat packing results in severe complications such as airway obstruction and digestive tract symptoms. We present a case of postextubation throat pack ingestion. The pack was identified and retrieved successfully from the gastrointestinal tract.

The effect of endoscopic transsphenoidal somatotroph tumors resection on pituitary hormones: systematic review and meta-analysis.

PURPOSE: Currently, endoscopic transsphenoidal surgery is the main treatment for pituitary neuroendocrine tumors (PitNETs). Excision of the tumor may have positive or negative effects on pituitary endocrine function, and the pituitary function of somatotroph tumors is a point of particular concern after the operation. This study aimed to conduct a meta-analysis on the effect of endoscopic transsphenoidal somatotroph tumor resection on pituitary function. METHODS: A systematic literature search was conducted for articles that included the evaluation of pituitary target gland before and after endoscopic transsphenoidal pituitary tumor resection and were published between 1992 and 2022 in PubMed, Cochrane, and Ovid MEDLINE. RESULTS: Sixty-eight studies that included biochemical remission rates in 4524 somatotroph tumors were concluded. According to the 2000 consensus, the biochemical remission rate after transsphenoidal endoscopic surgery was 66.4% (95% CI, 0.622-0.703; P = 0.000), the biochemical remission rate was 56.2% according to the 2010 consensus (95% CI, 0.503-0.620; P = 0.041), and with the rate of biochemical remission ranging from 30.0 to 91.7% with investigator's definition. After endoscopic resection, adrenal axis dysfunction was slightly higher than that before surgery, but the difference was not statistically significant. Hypothyroidism was 0.712 times higher risk than that before surgery (OR = 0.712; 95% CI, 0.527-0.961; P = 0.027). Hypogonadism was 0.541 times higher risk than that before surgery (OR = 0.541; 95% CI, 0.393-0.746; P = 0.000). Hyperprolactinemia was 0.131 times higher risk than that before surgery (OR = 0.131; 95% CI, 0.022-0.783; P = 0.026). The incidence of pituitary insufficiency was 1.344 times the risk before surgery after endoscopic resection of somatotroph tumors, but the difference was not statistically significant. CONCLUSIONS: In patients with somatotroph tumors after undergoing endoscopic surgery, the risk of dysfunction and pituitary insufficiency tend to increase, while preoperative thyroid insufficiency, gonadal insufficiency, and hyperprolactinemia will be partially relieved.

[Preoperative Evaluation of Saphenous Vein Graft Using Plain Computed Tomography for Endoscopic Saphenous Vein Harvesting].

We report the preoperative evaluation of saphenous vein (SV) graft using plain computed tomography (CT) for endoscopic saphenous vein harvesting (EVH). We made three-dimensional (3D) images of SV by using plain CT images. EVH was performed in 33 patients from July 2019 to September 2020. The mean age of the patients was 69±23 years, and 25 patients were men. The success rate of EVH was 93.9%. Hospital mortality was 0%. Postoperative wound complications was 0%. The early patency was 98.2% (55/56). 3D images of SV by plain CT are very important information for EVH because of surgical procedure in a closed space. Early patency is good and mid and long term patency of EVH may be improved due to safety and gentle technique by CT information.

Endoport-Assisted Endoscopic Surgery for Removal of Lateral Ventricular Tumors: Our Experience and Review of the Literature.

Background: Endoscopic surgery has emerged in recent years as an alternative to conventional microsurgical approaches for removal of intraventricular tumors. Endoports have enhanced tumor access and visualization with a significant reduction in brain retraction. Objective: To evaluate the safety and efficacy of endoport-assisted endoscopic technique for the removal of tumors from the lateral ventricle. Methods: The surgical technique, complications, and postoperative clinical outcomes were analyzed with a review of the literature. Results: Tumors were primarily located in one lateral ventricular cavity in all 26 patients, and extension to the foramen Monro and the anterior third ventricle was observed in seven and five patients, respectively. Except for three patients with small colloid cysts, all other tumors were larger than 2.5 cm. A gross total resection was performed in 18 (69%), subtotal in five (19%), and partial removal in three (11.5%) patients. Transient postoperative complications were observed in eight patients. Two patients required postoperative CSF shunting for symptomatic hydrocephalus. All patients improved on KPS scoring at a mean follow-up of 4.6 months. Conclusions: Endoport-assisted endoscopic technique is a safe, simple, and minimally invasive method to remove intraventricular tumors. Excellent outcomes comparable to other surgical approaches can be achieved with acceptable complications.

A Novel Brain Retractor for Endoscopic Evacuation of Chronic Subdural Hematoma.

Background: Endoscopic chronic subdural hematoma (CSDH) evacuation is a safe and effective alternative to the conventional burr hole technique. Although a rigid endoscope has the advantage of good visualization, there are risks of brain damage due to limited space to accommodate the scope and frequent lens soiling. Objective: This technical note describes a novel brain retractor to overcome the limitations of rigid endoscopy. Methods: The novel brain retractor (by senior author) was made by dividing a silicon tube longitudinally into two halves, and tapered for easy introduction in the operative cavity. Sutures were placed at the outer end of the retractor to prevent migration and to assist in angulation. Results: The novel retractor along with endoscopic assistance was used in 362 CSDH procedures. Endoscopy combined with this retractor provided additional help in complete removal of hematoma in organized/solid clots, septa, bridging vessels, and rapid expansion of brain in 83, 23, 21, and 24 patients, respectively (n = 151, 44%). Although there were three deaths (due to poor preoperative status), and two recurrences, there were no retractor-induced complications. Conclusions: The novel brain retractor assists endoscope in proper visualization of complete hematoma cavity by gentle and dynamic brain retraction, helps in thorough irrigation of hematoma cavity, protects the brain, and prevents lens soiling. It allows easy insertion of the endoscope and instruments using bimanual technique even in patients with a small width of hematoma cavity.