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At least 73 records · Page 4Linked to original sources
PubMed2002

Cadaveric and clinical study of endoscope-assisted microneurosurgery for cerebral aneurysms using angle-type rigid endoscope.

Highly advanced optical equipment enables endoscopic surgery to be performed in neurosurgery. We developed an angle-type rigid endoscope having an angled shaft, and has performed endoscope-assisted surgery in neck clipping of 50 cerebral aneurysms. Anatomical study concerning the perforating branch was made through a pterional approach using 3 cadavers. By using endoscope, we can observe the posterior communicating artery and anterior choroidal artery behind the internal carotid artery without retract the internal carotid artery and the surrounding structures. Furthermore IIIrd~VIIIth cranial nerve in opposite side and basilar artery in the posterior fossa can be observed. As the clinical study, we used endoscope in 50 clipping of cerebral aneurysms (29 Internal carotid artery aneurysms, 6 anterior communicating artery aneurysms, 2 anterior cerebral artery aneurysms, 7 middle cerebral artery aneurysms, 5 vertebral artery-posterior inferior cerebellar artery aneurysm, and basilar bifurcation aneurysms). The endoscopic image showed in incomplete clipping in 2 cases, where additional clipping was then performed. In all subject, complete clipping was performed using both microscopic and endoscopic view. Use of the angle-type rigid endoscope together with Doppler ultrasound, should increase the feasibility of complete clipping procedure, resulting in reduced complication rate.

Adult↗
PubMed2005

[Current hygiene status in endoscopic practice. Results from monitoring the reprocessing of flexible endoscopes in hospitals and private practices in Frankfurt on the Main, Germany, 2003/4].

Flexible endoscopy is essential for the practice of modern medicine. However, with inadequate reprocessing of endoscopes and additional instruments, infections can be transmitted. Therefore, guidelines for reprocessing flexible endoscopes have been published in many countries. The goal of the present survey was to examine the current compliance with German Guidelines in a German urban region, covering all hospitals (15 hospitals) and private practices (23 practices) of this area, without any exception. All endoscopic units in Frankfort on the Main were visited by members of the Public Health Service, using a checklist based on the recommendations of the German Guidelines. In 2004, a reevaluation of 14 hospitals and 20 private practices took place, either by analysing the written reports of the institutions or by revisiting the institutions. In 2003, compliance with the guidelines in hospitals was satisfactory. In practices, however, many problems were identified in 2003. Between 2003 and 2004, great improvements could be seen (data of 2003 in parentheses). At the end of 2004, in 90% of the practices adequate storage of the endoscope without risk of recontamination (2003:52%), correct reprocessing the bottle and the tube for air/water channel flushing including filling with sterilized water was observed (2003:74% and 52%). In 100% of the practices, ultrasonic cleaning (2003:26%) and sterilizing of endoscopic accessories was guaranteed (2003:57%) and routine tests of endoscopes after reprocessing (2003:56%) were performed. In conclusion the relevance and the effect of the advising and control of public health have been so efficient that between 2003 and 2004 most faults have been corrected. Therefore control visits of the Public Health Services should not only cover hygiene in reprocessing the endoscopes but also hygiene in reprocessing endoscopic accessories as well.

Endoscopy↗
PubMed2004

Endoscopic placement of the capsule endoscope in children.

BACKGROUND: Capsule endoscopy provides a minimally invasive examination of the entire small bowel. However, some children and disabled adults may be unable to independently ingest the capsule. A new method for endoscopic placement of the capsule endoscope is described. METHODS: Consecutive children who required capsule endoscopy of the small bowel and who were unable to independently ingest the capsule were selected for endoscopic placement. A net retrieval catheter and a translucent ligation adaptor were used to hold and stabilize alignment of the capsule during endoscopic insertion into the distal duodenum. RESULTS: Eleven pediatric patients underwent successful endoscopic placement of a capsule endoscope in the duodenum without complication. One capsule migrated back into the stomach, where it remained for the life of the battery. CONCLUSIONS: Endoscopic placement of the capsule endoscope by using the described technique appears to be effective and safe. It facilitates capsule endoscopy in patients who are unable to independently ingest the capsule.

Adolescent↗
PubMed2003

Endoscopic removal of sinonasal inverted papilloma including endoscopic medial maxillectomy.

OBJECTIVES/HYPOTHESIS: Surgical excision is regarded as the treatment of choice for sinonasal inverted papilloma. Resection can be performed endoscopically or through an external approach. Debate exists about which approach to use. The study presents different endoscopic techniques for various tumor locations and reviews the results. STUDY DESIGN: A prospective study and an integrated literature review. METHODS: Seventeen consecutive patients with inverted papilloma who underwent endoscopic surgical excision, including medial maxillectomies and modified Lothrop procedures, were analyzed. Preoperative symptoms, computed tomography and magnetic resonance imaging findings, operative findings, tumor stage, and outcomes were recorded. RESULTS: Thirteen male and four female patients presented with inverted papilloma between December 1993 and October 2001. Nasal obstruction was the most common presenting symptom (50%). Sixty-five percent of tumors were either stage II or stage III. Endoscopic resection was the primary treatment in 14 patients. Of the three patients who were secondarily treated endoscopically, one had recurrence and was subsequently found to have focus of squamous cell carcinoma. The overall recurrence rate was 6% and the incidence of malignancy was 6% (1 of 17). Recurrence rate for primary resections was zero (0 of 14). Five patients underwent endoscopic medial maxillectomies, and one patient with frontal sinus inverted papilloma was successfully treated with a modified endoscopic Lothrop procedure. CONCLUSIONS: Endoscopic sinus surgery is a viable treatment alternative for sinonasal inverted papilloma. Recurrence rates for primary treatment are comparable to external approaches. Close follow-up of patients is mandatory because recurrence may be associated with malignancy.

Adult↗
PubMed2006

The endoscopic endonasal approach to the lateral recess of the sphenoid sinus via the pterygopalatine fossa: comparison of endoscopic and radiological landmarks.

OBJECTIVE: The endoscopic endonasal approach offers the opportunity to reach the pterygopalatine fossa, the lateral recess of the sphenoid sinus, and other areas of the cranial base through a minimally invasive approach. This study compares the anatomy of these areas when observed through an endoscopic endonasal view with the anatomy of the same regions as they appear in computed tomographic scans. The aim was to identify and correlate the corresponding anatomic structures, providing the surgeons with anatomic landmarks to guide them when operating in these areas through an endoscopic endonasal approach. METHODS: An anatomic dissection of six fixed cadaver heads was performed by an endoscopic endonasal approach. A step-by-step comparison of endoscopic and radiological images was made to identify the landmarks of the surgical field. RESULTS: The step-by-step comparison of endoscopic and radiological images acquired during the endoscopic endonasal approach to the lateral recess of the sphenoid sinus via the pterygopalatine fossa allowed the identification of all the relevant anatomic landmarks of the procedure. CONCLUSION: The endoscopic endonasal approach via the pterygopalatine fossa offers direct, minimally invasive access to the lateral recess of the sphenoid sinus, which can be monitored in each phase through consistent radiological imagery.

Cadaver↗
PubMed2004

[Endoscopic or endoscope-assisted surgery for sinonasal malignancy].

OBJECTIVE: To discuss the feasibility and therapeutic efficacy of resection of sinonasal malignant tumours through endoscopic or endoscope-assisted surgery. METHODS: Since 1997, 11 cases of malignant tumours were resected under endoscope or by endoscope-assisted surgery. Among them, 5 patients were followed-up for more than 3 years, including one case of nasal septum squamous cell carcinoma; one case of ethmoid sinus squamous cell carcinoma; one case of maxillary sinus adenoid cystic carcinoma and two cases of olfactory neuroblastoma. RESULTS: In the patients who were followed-up for more than three years, no local recurrence was found. There was only one case of cervical lymph node metastasis found on a patient with olfactory neuroblastoma 2. 5 years after resection. Four years after operation, this patient was suspected to have extensive metastasis in meninges, and only palliative treatment was suggested. CONCLUSIONS: By endoscope or by endoscope-assisted surgery, some of selected sinonasal malignant tumours can be thoroughly resected. The advantages are mini-invasive and avoidance of facial scar so as to improve the quality of life (QOL) of patients. Large amount of cases, random clinical study with lone- term follow-up are still needed to verify the feasibility and efficacy of endoscopic or endoscope-assisted surgery.

Adult↗
PubMed2004

Multidrug-resistant Pseudomonas aeruginosa cholangitis after endoscopic retrograde cholangiopancreatography: failure of routine endoscope cultures to prevent an outbreak.

BACKGROUND: Nosocomial infections due to medical devices are of increasing concern to infection control practitioners. Attempts to prevent such infections have included surveillance cultures of endoscopes and bronchoscopes. In July 2002, the infectious disease consultation service was asked to see three patients with sepsis due to multidrug-resistant Pseudomonas aeruginosa after endoscopic retrograde cholangiopancreatography (ERCP). OBJECTIVE: To describe an outbreak of multidrug-resistant P. aeruginosa sepsis after ERCP at an institution that performs routine surveillance cultures of endoscopes. DESIGN: A traditional outbreak investigation supplemented by pulsed-field gel electrophoresis (PFGE) was undertaken, including a case-control analysis based on the hypothesis that all infected individuals had their ERCP performed with the same endoscope. SETTING: A tertiary-care academic medical center. RESULTS: The case-control analysis confirmed the hypothesis that undergoing ERCP with the implicated endoscope was associated with a culture positive for Pseudomonas (P = .01). The available strains were identical by PFGE. This outbreak occurred despite a negative surveillance culture of the implicated endoscope 1 month earlier. CONCLUSIONS: Infectious morbidity can occur after endoscopy despite negative surveillance cultures. The practice of routine endoscope cultures does not prevent device-related infectious morbidity.

Aged↗
PubMed2004

Endoscopic capsule endoscope delivery for patients with dysphagia, anatomical abnormalities, or gastroparesis.

BACKGROUND: Capsule endoscopy relies on an intact swallowing mechanism and unimpeded passage of the capsule through the pylorus. A technique is described for endoscopic delivery of the capsule in patients with dysphagia, anatomical abnormality, or gastroparesis. METHODS: EGD is performed with concomitant placement of an overtube. A foreign body net retrieval device is passed through the endoscope and used to grasp the activated capsule in the net. The endoscope then is advanced through the overtube, and the capsule is released in the duodenum. OBSERVATIONS: Five patients underwent endoscopic placement of the capsule. Relative contraindications to peroral ingestion were the following: oropharyngeal dysphagia, pyloric stenosis (2), prior gastric surgery, and gastroparesis. Endoscopic delivery was successful in all cases and yielded positive findings in 4. There was no complication. CONCLUSIONS: Endoscopic delivery of the capsule endoscope for patients with dysphagia, anatomical abnormality, or gastroparesis is safe and effective.

Adult↗
PubMed2000

Endoscopic ultrasound-guided one-step transmural drainage of cystic abdominal lesions with a large-channel echo endoscope.

BACKGROUND AND STUDY AIMS: Transmual endoscopic drainage of peripancreatic fluid collections under endoscopic ultrasound (EUS) control has been reported. We evaluated a facilitated technique of one-step puncture and drainage using a new stenting device and a large-channel echo endoscope. PATIENTS AND METHODS: EUS-guided transumural drainage of cystic lesions was attempted in six male patients. The drainage sites were duodenal in two instances and gastric in four. The lesions were pseudocysts, arising from chronic pancreatitis (n=2), and following acute pancreatitis (n=3), and one abscess. The median size of the pseudocysts was 50mm (range, 25 to 90). The punctures were carried out under direct EUS guidance, using a new echo endoscope with a 3.2-mm working channel. Transmural drainage was done using modified 7-F stents. Stents were inserted directly over a 1-mm puncture needle and their position was optimized using a 7-F pusher connected to the stent by a special construction. The stents were released by withdrawing the needle. RESULTS: EUS-guided one-step drainage was technically successful in all 6 patients. It was possible to position the stents as desired, regardless of the location, size or pathogenesis of the target lesions. There were no complications associated with the endoscopic interventions. All the lesions, including two with putrid contents, had collapsed by the day following drainage. The stents were removed after a median period of 2 weeks (range 2-12). The cysts had completely resolved in four patients at follow-ups of 3-13 months (range). The patient with the gastric abscess underwent gastrectomy 2 weeks after stent extraction, because of a coincidental adenocarcinoma at the cardia, the abscess being resolved. One patient with necrotizing pancreatitis, who refused surgical treatment, died because of septic complications. CONCLUSIONS: New large-channel echo endoscopes allow more aggressive endoscopic interventions to be carried out safely under direct EUS control. One-step drainage using the new 7-F stent-over-needle device was effective for six cystic lesions of variable origin.

Adult↗
PubMed2002

A new powered endoscope holding arm for endoscopic surgery of the cranial base.

Over the past 20 years endoscopy has become an essential part of nearly all surgical specialities. In the field of skull base surgery recent articles describe new applications and highlight improved results in pituitary adenoma removal, vascular decompression surgery, and in the resection of many other skull base tumors. The strength of the endoscope in skull base surgery lies in its ability to see behind bony apices and neurovascular structures, which normally obscure the view of the operating microscope. Paramount to the success of the endoscope in skull base and pituitary surgery is the ability to secure the arm in position. Operating in the confined spaces of the skull, the instability and difficult adjustment of currently available endoscope holding arms is cumbersome for the surgeon and dangerous to the patient. Many surgeons have commented that the currently available endoscope holding arms are inadequate for contemporary applications of endoscopic skull base surgery. In this article we describe a new pneumatically powered endoscope holding arm, which provides the level of stability and ease of adjustment necessary for current and future applications of endoscope skull base surgery.

Endoscopes↗
PubMed2004

Development of hybrid integrated endoscope-holder system for endoscopic microneurosurgery.

OBJECTIVE: Endoscopic techniques in the field of neurosurgery are under development. To perform sophisticated bimanual procedures in the delicate surgical fields of neurosurgery, rigid endoscope fixation devices with accurate locking and a safe releasing system are required. Here, we report the development of a new hybrid integrated endoscope-holder system. INSTRUMENTATION: The basic concepts of the holding device were as follows: 1) it should combine both video system and holding device; 2) it should have easy maneuverability and accurate fixation and be equipped with a safe releasing mechanism; and 3) it should be able to be used universally either in a primary or an assisting endoscopic procedure. A negatively actuated air-locking system and a bayonet-shaped endoscope were newly developed. Clinical trials of 25 patients were performed, and each prototype was tested and modified until the functional requirements were fulfilled. The final version was tested for accuracy and security in fixation and releasing mechanism. RESULTS: Eight problems were encountered in the clinical trials and improved. Accuracy in fixation of the final version was superior to the most advanced endoscope-holder on the market. No dangerous events were observed during repetitive insertion, fixation, and release in the simulated deep surgical field in the cadaveric skull. No apparent complications were noted in the clinical application. CONCLUSION: We have developed a highly reliable, accurately fixable, and easily maneuverable hybrid endoscope-holder system. To achieve a safer, more accurate, and less invasive surgery in the current socioeconomic demands, commercial manufacturers and surgeons in multiple centers need to combine their efforts to create useful techniques.

Adult↗
PubMedDate not supplied

Increased role of the otolaryngologist in endoscopic pituitary surgery: endoscopic hydroscopy of the sella.

BACKGROUND: The aim of this study was to discuss the use of nasal irrigation and suction systems in endoscopic pituitary surgery to examine the sella and facilitate tumor removal. We describe a new technique of sellar exploration. METHODS: Following the endoscopic approach to the pituitary by the otolaryngology team, pituitary masses are resected. Then, the ClearESS nasal irrigation and suction system is used by the otolaryngology team to visualize the sella ("hydroscopy"). The combination of this ClearESS technology and angled endoscopes is used to scrutinize previously inaccessible areas of the tumor bed. RESULTS: Over 50 patients have undergone minimally invasive pituitary surgery via the endoscopic approach with postresection hydroscopy of the sella. The use of angled endoscopes in combination with the ClearESS technology greatly increased visualization of the sella, thereby facilitating complete tumor removal. There have been no complications associated with the use of hydroscopy. CONCLUSION: The use of angled endoscopes in conjunction with hydroscopy increases visualization of the sella. The otolaryngologist plays a critical role in this examination with manipulation of the angled endoscopes. Therefore, the role of the otolaryngologist is extended beyond the approach to the pituitary.

Endoscopes↗
PubMed2000

A new remote-controlled endoscope positioning system for endoscopic solo surgery. The FIPS endoarm.

In the field of endoscopic solo surgery, the assistance received by the surgeon from ergonomical positioning devices is extremely important. They aid in both the retracting of instruments and the positioning of the endoscope. However, passive systems derived from open surgery have not proved satisfactory. Therefore, we set out to develop a remote-controlled arm capable of moving a rigid endoscope with about four degrees of freedom, while maintaining an invariant point of constraint motion coincident with the trocar puncture site through the abdominal wall. The system is driven by means of speaker-independent voice control or a finger-ring joystick clipped onto the instrument shaft close to the handle. When the joystick is used, the motion of the endoscope is controlled by the fingertip of the operating surgeon, which is inserted into the small ring of the controller in such a way as to make the motion of the fingertip correspond directly to the motion of the tip of the endoscope. A study was performed to compare the two different interfaces available for the system. With both interfaces, the guiding system allows for transparent and intuitive operation. Its set-up is easy; it is safe and reliable to use during the intervention; and it is faster than human assistance. With its improved ergonomy, this new generation of remote-controlled endoscope positioning system represents a further step toward the diffusion of solo surgery techniques in minimally invasive therapy. In our opinion, this prototype creates a valid compromise between human and robotic control of rigid endoscopes.

Animals↗
PubMed2006

Complete endoscopic closure of gastric perforation induced by endoscopic resection of early gastric cancer using endoclips can prevent surgery (with video).

BACKGROUND: When gastric perforation occurs during endoscopic resection for early gastric cancer, a surgical treatment generally is performed. Considering the increasing number of EMRs and the possibility of perforation, our research sought to investigate whether endoscopic treatment for gastric perforation is possible. METHODS: From 1987 to 2004, 121 of 2460 patients who underwent gastric EMR at the National Cancer Center Hospital had gastric perforation during EMR (4.9%). The initial 4 patients were treated with emergent surgery. The subsequent 117 patients who were treated with endoclips formed our study population. RESULTS: Endoscopic closure with endoclips in 115 patients (98.3%) was successful. Two patients with unsuccessful endoscopic closure underwent emergent surgery. In the past 6 years, patients with perforation during gastric EMR treated with endoscopic closure had a recovery rate similar to that of the nonperforation cases. CONCLUSIONS: Gastric perforation during endoscopic resection can be conservatively treated by complete endoscopic closure with endoclips.

Adult↗
PubMed2006

Endoscopic removal of eroded bands in vertical banded gastroplasty: a novel use of endoscopic scissors (with video).

BACKGROUND: Vertical banded gastroplasty (VBG) as a surgical therapy for morbid obesity was first described in 1982. VBG involves partitioning the stomach with a vertical staple line and restricting the outlet pouch with a Gortex band. Complications of VBG include partial and total erosion of the band through the vertical staple line or through the lesser curvature into the gastric pouch. Band erosion occurs after surgery in 1% to 3% of patients, and patients may present with symptoms of obstruction, weight gain, nausea, pain, and bleeding. Unless a band has freely eroded from the stomach wall, allowing spontaneous elimination or simple endoscopic retrieval, surgical removal has been required heretofore. Previous attempts at endoscopic removal of eroded bands have included the use of neodymium-yttrium aluminum garnet laser ablation and other electrosurgical devices. Endoscopic scissors transection to remove an eroded laparoscopic band has been described in Europe but has not been performed in the United States. OBJECTIVE: In this series, we describe the endoscopic removal of partially eroded bands embedded in the gastric wall by using flexible endoscopic scissors to sever and subsequently withdraw the bands endoscopically through the mouth. CONCLUSIONS: Eroded gastric bands have been safely removed endoscopically in 2 ambulatory outpatients. DESIGN: Case series. SETTING: Tertiary-care academic center. MAIN OUTCOME MEASUREMENTS: Efficacy and safety. LIMITATIONS: Highly selected motivated patient population.

Device Removal↗
PubMed2005

A large endoscopic resection by endoscopic submucosal dissection procedure for early gastric cancer.

Gastrectomy with lymph node dissection has provided an excellent therapeutic outcome for patients with early gastric cancer, with a 5-year survival rate of 96%. The prevalence of lymph node metastasis of intramucosal- and submucosal-invading cancer was reported as approximately 3% and 20%, respectively, which means surgery may have been excessive for many patients with these diseases. The endoscopic distinction between mucosal and submucosal invasion is made correctly in only approximately 80% of tumors. However, this means that the pretreatment diagnosis is incorrect for 20% of those tumors otherwise identified as candidates for local treatment. Furthermore, the evaluation of lymphatic-vascular involvement associated with lymph node metastasis is available only through accurate histologic examination. It is essential to evaluate accurately the endoscopically resected specimen and then decide whether or not an additional surgical procedure is warranted. There are several techniques for endoscopic mucosal resection. It is difficult to correctly assess the depth of tumor invasion from resected materials by conventional endoscopic procedures in lesions larger than 15 mm. This is because such lesions often are resected piecemeal because of the size limitation of a resectable specimen. A new endoscopic procedure, endoscopic submucosal dissection, using an insulation-tipped needle knife specifically designed at the National Cancer Center Hospital, Japan, is superior to other endoscopic methods in the treatment of early gastric cancer, and provides an en bloc specimen. En bloc resections allow precise histologic staging and have the potential to prevent recurrent disease.

Equipment Design↗
PubMed2003

Guidewire technique for endoscopic transpapillary procurement of bile duct biopsy specimens without endoscopic sphincterotomy.

BACKGROUND: Endoscopic sphincterotomy may be required when endoscopic transpapillary bile duct biopsy specimens are needed for tissue diagnosis. However, endoscopic sphincterotomy has potential complications. A guidewire technique for obtaining transpapillary biopsy specimens without endoscopic sphincterotomy was evaluated. METHODS: A total of 13 patients (11 men, 2 women; mean age 67.5 years) with biliary stricture or obstruction underwent endoscopic retrograde cholangiography. A guidewire was then inserted across the stricture or obstruction and into an intrahepatic duct. Alongside the guidewire, the biopsy forceps (1.5 mm diameter) was introduced into the papillary orifice with the duodenoscope extremely close to the papilla. OBSERVATIONS: Tissue was obtained in 92.3% of the cases for histopathologic evaluation without difficulty or complication. The single failure occurred in a patient who had undergone a partial gastrectomy with Billroth I anastomosis. CONCLUSIONS: The guidewire technique for endoscopic transpapillary procurement of biopsy specimens of the bile duct obviates the need for endoscopic sphincterotomy.

Aged↗
PubMed2002

Accuracy of the initial endoscopic diagnosis in the discrimination of gastric ulcers: is endoscopic follow-up study always needed?

BACKGROUND: Endoscopic follow-up study of gastric ulcers has been recommended routinely because of the possibility that a gastric neoplasm will be missed in the initial endoscopy. Some authors, most of them reporting data from areas of low gastric carcinoma incidence, have questioned this policy because of the low numbers of curable cancers detected and the high cost of such a program. GOALS: To assess the accuracy of endoscopy diagnosis of gastric ulcers, and to evaluate the efficacy and cost of a gastric ulcer follow-up endoscopic program in an area with an intermediate incidence rate of gastric cancer. STUDY: A retrospective study was used to identify all the gastroscopies in which a gastric ulcer had been diagnosed during a 6-year period. The endoscopic impression was compared with the histologic diagnosis, sensitivity, specificity, positive and negative predictive values, and the likelihood ratio. Patients who completed a follow-up program also were reviewed. For each neoplasm discovered, the number of endoscopies and global cost were calculated. RESULTS: In the 741 gastroscopies performed, 547 gastric ulcers were diagnosed in 529 patients. Biopsies were taken in 330 patients, in whom 341 gastric ulcers were found. At the index endoscopy, 41 gastric neoplasms (12.4%) were diagnosed. The accuracy of endoscopic malignancy diagnosis was as follows: positive predictive value of 0.68, negative predictive value of 0.98, sensitivity of 0.82, and specificity of 0.95. The likelihood ratio was 16. A total of 117 patients completed the follow-up program. Three new cases of gastric cancer (2.6%) were identified. In these three cases, the initial opinion of the endoscopist was uncertain. In the authors' experience, the cost of each gastric cancer diagnosed has been $4.653 (U.S. dollars). CONCLUSIONS: The endoscopic impression correlates with the histologic diagnosis even in a area of intermediate gastric cancer incidence. Endoscopic follow-up study may be restricted to cases of uncertain or malignant endoscopic impression.

Adenocarcinoma↗