Combined use of choledochoscope and duodenoscope in treatment of bile peritonitis after removal of T-tube.
(41/196)
BACKGROUND: Biliary leakage after removal of a T-tube has significant morbidity and mortality. Its etiology is multifactorial. The treatment and outcome of this complication vary. In the present study we evaluated the procedures and efficacy of combined use of choledochoscope and duodenoscope in the treatment of bile peritonitis after T-tube removal. METHODS: The procedures and results of 11 cases of biliary leakage after removal of T-tube who had been treated from January 1998 to June 2004 by combined use of choledochoscope and duodenoscope were analyzed retrospectively. RESULT: After the treatment, 9 patients were cured, and 2 were reoperated on and cured. CONCLUSIONS: Biliary leakage after removal of T-tube can be cured successfully by combined use of choledochoscope and duodenoscope. Importantly, the method is simple, effective and safe, and mostly reoperation can be avoided. (+info)
Recent technological developments: in situ histopathological interrogation of surgical tissues and resection margins.
(42/196)
OBJECTIVES: The tumour margin is an important surgical concept significantly affecting patient morbidity and mortality. We aimed in this prospective study to apply the microendoscope on tissue margins from patients undergoing surgery for oral cancer in vivo and ex vivo and compare it to the gold standard "paraffin wax", inter-observer agreement was measured; also to present the surgical pathologist with a practical guide to the every day use of the microendoscope both in the clinical and surgical fields. MATERIALS AND METHODS: Forty patients undergoing resection of oral squamous cell carcinoma were recruited. The surgical margin was first marked by the operator followed by microendoscopic assessment. Biopsies were taken from areas suggestive of close or positive margins after microendoscopic examination. These histological samples were later scrutinized formally and the resection margins revisited accordingly when necessary. RESULTS: Using the microendoscope we report our experience in the determination of surgical margins at operation and later comparison with frozen section and paraffin section margins "gold standard". We were able to obtain a sensitivity of 95% and a specificity of 90%. Inter-observer Kappa scores comparing the microendoscope with formal histological analysis of normal and abnormal mucosa were 0.85. CONCLUSION: The advantage of this technique is that a large area of mucosa can be sampled and any histomorphological changes can be visualized in real time allowing the operator to make important informed decisions with regards the intra-operative resection margin at the time of the surgery. (+info)
Percutaneous endoscopy-guided biopsy of an intracystic tumor with a mammary ductoscopy.
(43/196)
BACKGROUND: Intracystic abnormalities of the breast may result from debris, intracystic papilloma, or rarely breast cancer. Intracystic tumors cannot be diagnosed based on imaging examinations or fine needle aspiration alone, and therefore excisional biopsy must be performed. We have treated many cases who had nipple discharge with mammary ductoscopy since 1992, and we have used this method to diagnose intracystic tumors. METHODS: An endoscope was inserted into the cyst percutaneously, and the intracystic tumor was biopsied using forceps. RESULTS: Six intracystic tumors were biopsied with the endoscope. Four of six cases were cancer, and two were benign papillomas. CONCLUSION: We were able to visualize and accurately biopsy intracystic tumors of the breast using mammary ductoscopy. (+info)
Pure endoscopic endonasal odontoidectomy: anatomical study.
(44/196)
Different disorders may produce irreducible atlanto-axial dislocation with compression of the ventral spinal cord. Among the surgical approaches available for a such condition, the transoral resection of the odontoid process is the most often used. The aim of this anatomical study is to demonstrate the possibility of an anterior cervico-medullary decompression through an endoscopic endonasal approach. Three fresh cadaver heads were used. A modified endonasal endoscopic approach was made in all cases. Endoscopic dissections were performed using a rigid endoscope, 4 mm in diameter, 18 cm in length, with 0 degree lenses. Access to the cranio-vertebral junction was possible using a lower trajectory, when compared to that necessary for the sellar region. The choana is entered and the mucosa of the rhinopharynx is dissected and transposed in the oral cavity in order to expose the cranio-vertebral junction and to obtain a mucosal flap useful for the closure. The anterior arch of the atlas and the odontoid process of C2 are removed, thus exposing the dura mater. The endoscopic endonasal approach could be a valid alternative to the transoral approach for anterior odontoidectomy. (+info)
Anatomic structural study of cerebellopontine angle via endoscope.
(45/196)
BACKGROUND: Minimally invasive surgery in skull base relying on searching for possible anatomic basis for endoscopic technology is controversial. The objective of this study was to observe the spatial relationships between main blood vessels and nerves in the cerebellopontine angle area and provide anatomic basis for lateral and posterior skull base minimally invasive surgery via endoscopic retrosigmoid keyhole approach. METHODS: This study was conducted on thirty dried adult skulls to measure the spatial relationships among the surface bony marks of posterior cranial fossa, and to locate the most appropriate drilling area for retrosigmoid keyhole approach. In addition, we used 10 formaldehyde-fixed adult cadaver specimens for simulating endoscopic retrosigmoid approach to determine the visible scope. RESULTS: The midpoint between the mastoid tip and the asterion was the best drilling point for retrosigmoid approach. A hole centered on this point with the 2.0 cm in diameter was suitable for exposing the related structures in the cerebellopontine angle. Retrosigmoid keyhole approach can decrease the pressure on the cerebellum and expose the related structures effectively which include facial nerve, vestibulocochlear nerve, trigeminal nerve, glossopharyngeal nerve, vagus nerve, accessory nerve, hypoglossal nerve, anterior inferior cerebellar artery, posterior inferior cerebellar artery and labyrinthine artery, etc. CONCLUSIONS: Exact location on endoscope retrosigmoid approach can avoid dragging cerebellum during the minimally invasive surgery. The application of retrosigmoid keyhole approach will extend the application of endoscopic technology. (+info)
Comparison of the results of open carpal tunnel release and KnifeLight carpal tunnel release.
(46/196)
INTRODUCTION: The study compares the results of open release of carpal tunnel syndrome with a release done with a proprietary instrument, the KnifeLight, which uses a minimal access approach. METHODS: A retrospective study was conducted on two groups of patients operated on by the same surgeon between January 1998 and August 2002. All cases presented with numbness of six months duration or more, and a positive Phalen's test. Open carpal tunnel release was done in the first group of 26 consecutive patients before the KnifeLight was introduced in January 2000. The KnifeLight technique was used in a second consecutive group of 49 patients. In two patients, the KnifeLight procedure was abandoned because the median nerve could not be safely separated from the transverse carpal ligament. RESULTS: The two groups were shown to be comparable with respect to clinical presentation and nerve conduction studies. There was no complication in both groups. However, no advantage could be demonstrated in the use of the KnifeLight procedure as compared to the open procedure in respect to improvement in pain, numbness or patient satisfaction. The study also showed that the severity of nerve conduction changes is not related to the severity of numbness. It is also not a good guide to the improvement of numbness and patient satisfaction after the operation. CONCLUSION: The method was found to be acceptable to patients as an office procedure. The cost of doing either procedure is reduced when done as an office procedure, but there is a cost incurred in the use of the KnifeLight instrument. (+info)
Doppler-endosonography with the GF-UE 160 electronic radial echoendoscope - current use and future potential.
(47/196)
This tutorial survey with images examines current and possible future applications of the recently introduced 360-degree Doppler capable echoendoscopes. The better gray-scale resolution together with flow, spectral and color Doppler can improve EUS investigations in the mediastinum, abdomen and pelvis. There is no or very little EUS literature covering such important fields a Budd-Chiari syndrome, anatomic variations of the celiac trunk and hepatic artery, mesenteric artery flow determinations in the evaluation of mesenteric ischemia and arterial compression syndromes (celiac, superior mesenteric artery and hepatic artery). Additional other areas of possible future research are suggested. (+info)
Double balloon endoscopy associated pancreatitis: a description of six cases.
(48/196)
AIM: To perform a single-center analysis of all double balloon endoscopy (DBE) related cases of pancreatitis identified prospectively from a recorded DBE-complication database. METHODS: From November 2003 until January 2007, 603 DBE procedures were performed on 412 patients, with data on complications recorded in a database. The setting was a tertiary care center offering DBE. DBE was performed from the antegrade or retrograde route. Outcome measurements included age, gender, medication, indication, DBE-endoscope type, insertion depth, procedure duration, findings, interventions, post-procedural abdominal pain, and post-procedural hospitalization. RESULTS: This is the largest single-center study reporting on post-DBE pancreatitis prospectively. Six patients (1.0%) developed post-DBE pancreatitis, all after antegrade DBE. There was no association with gender, duration of the procedure or type of endoscope. The mean age was 51.9 years (range 25-78). Four patients had severe pancreatitis. Of these, two had inflammatory signs in the body-tail region, one had pancreatitis in the tail region, and the total pancreas was involved in one. CONCLUSION: The incidence of post-DBE pancreatitis in our series is higher than previously reported. We found no relation with DBE-endoscope type. The inflammatory changes occurred in the body-tail region of the pancreas, suggesting that post-DBE pancreatitis is caused by repetitive mechanical strain on the pancreas. (+info)