Awake endoscopic laser surgery for early glottic carcinoma.

The objective of this study was to demonstrate the oncologic efficacy of awake endoscopic laryngeal surgery in the treatment of T1-T2 glottic carcinoma. This is a retrospective study. Seventy-one patients with early glottic carcinoma (T1a- 26, T1b- 18, T2- 27) who underwent awake flexible endoscopic laryngeal surgery under local anesthesia and mild intravenous sedation were included in the study. In 64 cases (90.1%) only endoscopic tumor ablation by Nd:YAG laser (in 32.4% of cases being preceded by diathermy snare excision) was performed, and in 7 T2 cases postoperative radiotherapy was also offered. There were no complications during or after the endoscopic surgery. Ultimate control of disease, including salvage treatment, was obtained in 67 patients (94.4%). Cure without recurrence was achieved in 60 cases (84.5%). Local control without salvage radiotherapy or/and open surgery was achieved in 64 (90.1%) patients. Larynx preservation was obtained in 66 (93.0%) cases. At 5 years from the beginning of endoscopic treatment, 74.6% of the patients were alive and free of disease. The best results were obtained in the T1a group of treated patients, all the patients being free of disease with the preserved larynx. Awake endoscopic laryngeal surgery is a safe and oncologically efficient method of treatment of early glottic carcinoma that can be considered as an alternative to the traditional approach, primarily, for patients with risks/contraindications for radiotherapy, general anesthesia, and transoral microsurgery, and also for the patients who prefer to avoid general anesthesia with its related risks and would rather choose office-based laryngeal surgery.

Insufflation-Free, Perianal Work Platform.

There is an ever increasing volume of colorectal surgery being performed endoscopically by anal access, as well as greater employment of robotics for these procedures. Intraluminal visualization for perianal operations is today dependent on insufflation of the bowel. When full-thickness resections above the peritoneal reflection become necessary, the peritoneal cavity becomes inflated, facilitating infection and necessitating general anesthesia and patient intubation. Our patented tool was originally envisioned to enable abdominal cavity access via a single 2cm port incision, suitable for insufflation-free laparoscopic surgery, under local anesthesia (e.g., cholecystectomy). On further consideration, this instrument was modified to be used for perianal colorectal surgery.

A Multidisciplinary Minimally Invasive Approach Is Necessary for the Contemporary Management of Esophageal Diverticula.

Background: Esophageal diverticula were traditionally treated with open surgery, which is associated with significant morbidity and mortality rates. Management has shifted to minimally invasive approaches with several advantages. We examine outcomes in patients with esophageal diverticula treated with minimally invasive techniques by a multidisciplinary surgical team at a single center. Materials and Methods: A retrospective review of a prospectively maintained database was performed for patients who underwent minimally invasive surgery for esophageal diverticula at our institution from June 2010 to December 2022. Primary outcomes were 30-day morbidity and mortality rates. Secondary outcomes were symptom resolution, length of stay (LOS), readmission, and need for reintervention. Results: A total of 28 patients were identified. Twelve patients had pharyngeal diverticula, 7 patients had midesophageal diverticula, and 9 patients had epiphrenic diverticula. Thirty-day morbidity and readmission rates were 10.7% (3 patients), 1 pharyngeal (sepsis), 1 midesophageal (refractory nausea), and 1 epiphrenic (poor oral intake). There were no esophageal leaks. Average LOS was 2.3 days, with the pharyngeal group experiencing a significantly shorter LOS (1.3 days versus 3.4 days for midesophageal, P < .01 versus 2.8 days for epiphrenic, P < .05). Symptom resolution after initial operation was 78.6%. Reintervention rate was 17.9%, and symptom resolution after reintervention was 100%. There were no mortalities. Conclusion: This study demonstrates that esophageal diverticula can be repaired safely and efficiently when performed by a multidisciplinary team utilizing advanced minimally invasive endoscopic and robotic surgical techniques. We advocate for the management of this rare condition at a high-volume center with extensive experience in foregut surgery.

Cricopharyngomyotomy: Outcomes of flexible endoscopic management of small and medium sized Zenker's diverticulum.

BACKGROUND: Zenker's diverticulum (ZD) was historically treated with an open transcervical myotomy with diverticulectomy, but endoscopic approaches have gained popularity, though with little recent data. This study aimed to report flexible endoscopic cricopharyngomyotomy (FEC) outcomes, particularly in smaller diverticula. METHODS: Patients with ZD treated with FEC at a tertiary center were reviewed. Patients were grouped by diverticulum size: small (sZD)≤1.5 â€‹cm; medium (mZD) â€‹> â€‹1.5 â€‹cm. RESULTS: Of 30 patients, median age, BMI, sex, and comorbidities were similar between sZD (n â€‹= â€‹18) and mZD (n â€‹= â€‹12). Overall, 80.0 â€‹% had the procedure performed with a needle knife. Median number of clips for mucosotomy closure (5.0[5.0,6.0]vs.7.0[5.0,7.0]clips;p â€‹= â€‹0.051), operative time (59.5[51.0,75.0]vs.74.5[51.0,93.5]minutes;p â€‹= â€‹0.498), length-of-stay (1.0[1.0,1.0]vs.1.0[1.0,1.0]days;p â€‹= â€‹0.397), and follow-up (20.8[1.1,33.4]vs.15.6[5.4,50.4]months;p â€‹= â€‹0.641) were comparable. There were no postoperative leaks; incomplete myotomy occurred in one sZD, yielding a clinical success rate of 96.7 â€‹%. CONCLUSIONS: FEC has a high success rate for ZD and an advantage in small diverticula, difficult to treat with stapling or open technique.

Use of current automatic smoke evacuation system in flexible gastrointestinal endoscopy: Its feasibility and potential usefulness.

Objectives: Flexible endoscopy does not have a system that can automatically evacuate surgical smoke generated in the gastrointestinal lumen. We aimed to investigate the feasibility and potential usefulness of automatic smoke evacuation systems in flexible endoscopy. Methods: [Bench] After surgical smoke generated in the stomach was evacuated by the evacuator, the degree of residual smoke and gastric luminal collapse were evaluated to optimize the evacuator settings. [Animal] Insufflation, suction, and total operation time to complete the protocol of 10 cauterizations of the gastric mucosa were measured in three groups: "manual suction only," "manual suction with automatic evacuation (50% force)," and "manual suction with automatic evacuation (70% force)." The stability of endoscopic visualization and operability was evaluated by 10 endoscopists blinded to those suction settings, and the number of manual suctions, insufflations, and total operation time were measured. Results: [Bench] The degree of residual smoke and gastric luminal collapse were inversely correlated. [Animal] When the automatic evacuator was partially used, there was no difference in the insufflation time, but the suction time (vs 50%; p = 0.011, vs. 70%; p = 0.011) and total operation time (vs. 50%; p = 0.012, vs. 70%; p = 0.036) were significantly reduced compared to manual operation only. Furthermore, manual suction with automatic evacuation (50% force) significantly improved the stability of endoscopic visualization and operability compared to manual operation only (p = 0.041, p = 0.0085). Conclusions: The automatic smoke evacuation in flexible gastrointestinal endoscopy was potentially feasible and useful by improving the device setting.

Various Endoscopic Approaches for Removal of Proventricular Foreign Bodies in Parrots-Three Case Reports.

Although the use of incision-free endoscopy for foreign body (FB) removal in dogs and cats has been extensively documented, its application in birds remains limited. Thus, we present the endoscopic removal of gastrointestinal (GI) FBs from psittacine birds, employing different patient positioning and anesthesia methods. Two blue-and-yellow macaws (Ara ararauna) and a Triton cockatoo (Cacatua galerita triton) were examined. X-ray imaging revealed FBs situated in the proventriculus in each case. The FBs, all identified as feeding tubes, were safely removed using grasping forceps during the endoscopic procedure, and no severe complications occurred. Based on the outcomes of each operation, the most suitable patient position may be ventral recumbency rather than dorsal recumbency, with the use of a mask or endotracheal intubation, depending on the anticipated operation time. However, a larger number of cases would be necessary to confirm the optimal patient positioning and anesthesia method.

Polipectomía colonoscópica monitorizada por laparoscopia (PCML) / Colonoscopic polypectomy monitored by laparoscopy

En pacientes con adenomas del colon, la polipectomía con asa puede ser técnicamente imposible debido a factores como la angulación del colon, imposibilidad de ver la base del pólipo, pólipos ocultos detrás de un pliegue de mucosa, o debido a cirugías previas. Para estos pacientes, la resección segmentaria del colon, abierta o laparoscópica es considerado el tratamiento óptimo. Objetivo: La combinación quirúrgica de endoscopia flexible y laparoscopia, usando CO2 en ambas, ha significado una nueva forma de manejo para estos pólipos difíciles, con la finalidad de evitar la resección colónica. Método: Estudio retrospectivo realizado en base a información colectada prospectivamente en la base de datos del Texas Endosurgery Institute. (n=320, mayo de 1990a mayo 2013). Describimos los antecedentes que nos permitieron implementar el procedimiento, de igual manera detallamos como realizamos la técnica y finalmente compartimos nuestros resulta-dos. Resultados:Se analiza la información relacionada con las 320 PCML realizadas en 198 pacientes. Conclusión: La PCML permite la exéresis de pólipos evitando la resección colónica, este procedimiento menos invasivo se traduce en tiempo de recuperación similar al de la colonoscopia sola, y se evitan las complicaciones relacionadas con la resección segmentaria del intestino grueso. Todos los pólipos son estudiados con biopsia intraoperatoria y de encontrarse hallazgos de malignidad la resección segmentaria laparoscópica es realizada(AU)

In patients with adenomas of the colon, loop polypectomy may be technically impossible due to factors as the angulation of the colon, inability to see the base of the polyp, polyps hidden behind a fold of mucosa, or due to previous surgeries. For these patients,segmental resection of the colon, open or laparoscopic is considered the optimal treatment. Objective:The surgical combination of flexible endoscopy and laparoscopy, using CO2 in both, has meant a new way of handling these difficult polyps in order to prevent colonic resections. Methods: A retrospective study carried out on the basis of information collected prospectively in the Texas Endosurgery Institute database. (n = 320, May 1990 to May 2013). We describe the background that allowed us to implement the procedure, just as detailed as we carry out the technique and finally share our results. Results: We analyzed a total of 320 CPML related information in 198 patients. Conclusion:The CPML allows excision of polyps preventing colonic resection, this procedure less invasive means similar to the single colonoscopy recovery time, and avoided the complications associated with segmental resection of the intestine. All polyps are studied with intraoperative biopsy and found malignant findings segmental resection, laparoscopic is performed(AU)