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At least 1,171 records · Page 65Linked to original sources
PubMed2004

[The safety and usefulness of endoscopic polypectomy for treatment of Brunner's gland adenomas].

BACKGROUND/AIMS: Brunner's gland adenoma is a rare benign tumor of the duodenum. Although several cases of successful endoscopic polypectomy have been reported, the studies on the safety and usefulness of endoscopic polypectomy are extremely rare. Therefore, we report the results of 10 cases of Brunner's gland adenoma treated by endoscopic polypectomy. METHODS: Between November 1998 and January 2003, 10 cases of Brunner's gland adenoma were diagnosed. The mean age of the cases (6 male, 4 female) was 60.4 years. They were located in the bulb (9) and the second portion (1) of the duodenum. All cases were diagnosed and removed by endoscopic polypectomy. RESULTS: The size of the tumor ranged from 1.0 to 3.5 cm in diameter. Pedunculated polyps were found in three cases. In other seven cases, semipedunculated polyps were observed and, three of them were presented as submucosal tumor. All cases had no malignant foci. There was no complication such as bleeding, perforation, and pancreatitis after endoscopic polypectomy. During follow-up period (range 1~39 months) after endoscopic polypectomy, there was no complication and recurrence of the lesions. CONCLUSIONS: Endoscopic polypectomy was a safe and useful method for the treatment of duodenal Brunner's gland adenoma without complication and recurrence.

Adenoma↗
PubMed2004

Endoscopic stapling vs conventional methods of surgery for pharyngeal pouches: results, benefits and modifications.

Endoscopic stapling of pharyngeal pouches using the Endo GIA-30 stapling gun is a relatively new technique. We compared the outcome of patients who had endoscopic stapling of their pharyngeal pouch with those who had excision of the pouch along with a cricopharyngeal myotomy using conventional methods. A total of 19 patients were included in the study, 9 in the conventional technique group and 10 in the endoscopic stapling group. Data was collected by reviewing patient records and a postal questionnaire. Median stay in hospital for the conventional technique group was 10 days while in comparison the average stay in hospital for the endoscopic stapling group was 3.9 days. The median fasting time for the conventional technique group was 6 days while all patients in the endoscopic stapling group commenced oral feeding on day one post surgery. The postal questionnaire showed that endoscopic stapling was associated with a high patient satisfaction rate. We conclude that endoscopic stapling of pharyngeal pouches has similar results to the conventional open technique, but is less invasive and associated with a shorter stay in hospital. We also discuss a technical modification employed in the stapling of small pouches with thick anterior walls.

Adult↗
PubMed2004

[Endoscopic dilatation of benign gastrointestinal anastomotic stenosis with hydraulic balloon].

Incidence of postoperative anastomotic stenosis range from 5 to 30 percent though most of them are not clinically relevant. Strictures of gastrointestinal tract (GI) within reach of the endoscope may be treated successfully with dilatation. The aim of the study was to evaluate the technique of endoscopic balloon dilatation in the treatment of GI anastomotic strictures. The procedure of endoscopic dilatation was performed in 17 patients with obstruction due to the postoperative stricture of anastomosis. In 11 patients stenoses were localized in the lower and in 6 patients in the upper digestive tract. In all cases the stricture was caused by scar tissue and had benign character (confirmed by computed tomography and biopsy). Endoscopic hydraulic balloon dilatation was performed using a pressure of 2 atm. All dilatations of the upper digestive tract strictures were successful with immediate relieve of symptoms. In 4 patients with high grade stenoses after low anterior resection of the rectum anastomotic strictures did not dilate after endoscopic treatment. No complications of endoscopic dilatations were observed. Endoscopic balloon dilatation is useful in the treatment of symptomatic gastrointestinal anastomotic stenosis, but good results are expected only in low grade strictures.

Aged↗
PubMed2004

Removal of sinonasal tumors by the endonasal endoscopic approach.

BACKGROUND: The external approach is the golden standard for sinonasal tumor removal but is associated with several side effects, including facial scars, intracranial and extracranial complications, a long hospitalization period and high costs. Endoscopic sinus surgery enables resection of benign and selected malignant sinonasal tumors and has the advantages of no facial scars, better functional and structural preservation of the sinonasal complex, minimal trauma to surrounding tissue, a shorter hospitalization stay and lower costs. OBJECTIVES: To evaluate the advantages and limitations of endoscopic resection of benign and malignant sinonasal tumors, their recurrence and complication rates. METHODS: The medical and radiology records of 56 patients who underwent endonasal endoscopic resection of benign and malignant sinonasal tumors between 1996 and 2003 were retrospectively reviewed. Tumors located in the center of the nose and sinuses were endoscopically resected. RESULTS: Six cases of malignant tumor and 50 cases of benign tumor underwent resection by ESS. One of the patients with malignant tumor died, the remainder showing no evidence of disease on follow-up of 3-60 months (mean 26.8 months). Inverted papilloma was the most common benign tumor (40 patients). Seven patients (18%) had recurrence followed by endonasal resection. No major complications were recorded. Hospitalization stay was 2-7 days (mean 3.6 days). CONCLUSIONS: Endoscopic resection of benign sinonasal tumors that are centrally located in the nose and sinuses should be considered before the external approach is used. In very carefully selected cases of malignant tumors ESS is oncologically acceptable, but more experience is needed for discerning the indications for endoscopic resection of malignant tumors. The complication rate for endoscopic resection is low, there are no facial scars, hospitalization stay is short, and costs are low.

Adolescent↗
PubMed2004

[Imaging-navigated endoscopic sinus surgery].

OBJECTIVE: To evaluate the advantages and disadvantages of different type of image-guidance system in endoscopic sinus surgery. METHODS: Fifty-three endoscopic sinus surgery were performed under different type of image-guidance system, there were 24 chronic sinusitis with or without nasal polyp, 4 juvenile nasopharyngeal angiofibroma, 8 pituitary adenoma, 9 ethmoid ossifying fibroma, 2 nasopharyngeal mixed tumor, 1 nasal leiomyoma, 3 fungal sinusitis, and 2 inverting papilloma. RESULTS: In all cases, the preoperative time was 15-30 minutes, the registration rate were 1.3-2.0, the localization accuracy was within 1 mm. Compared with the traditional endoscopic sinus surgery, the operating time was similar, without obvious difference. No complication occurred. CONCLUSION: All types of image-guidance system could work well with endoscopic system, each of them had its own shortages. Every type of image-guidance system could identify the borders and critical anatomical structures in the corresponding CT data, especially in cases in which anatomical landmarks were no longer present, with anatomical variation, intranasal and anterior skull base tumor. Combined with endoscopic surgery, the image-guided endoscopic surgery provided accurate tumor resection while preserving normal tissue, increased surgical effectiveness, decreased overall surgical complications. It is believed that the image-guidance system is a useful tool for endoscopic sinus surgery.

Adolescent↗
PubMedDate not supplied

Endoscopic resection of sinonasal malignancies: a preliminary report.

BACKGROUND: A minimally invasive endoscopic approach for the management of sinonasal malignancy offers several advantages including excellent illumination, maximal preservation of uninvolved vital structures, and sparing of facial incisions. The purpose of this study was to evaluate the outcome and morbidity of endoscopic resection with or without combined radiotherapy and/or chemotherapy. METHODS: Forty-seven patients with sinonasal malignancy were diagnosed and/or treated with an endoscopic approach at The Cleveland Clinic Foundation and The University of Pennsylvania Medical Center from 1996 to 2003. Nineteen patients fulfilled the study criteria and had a minimally invasive endoscopic resection. Fifteen patients were treated with curative intent and four patients underwent palliative resection. RESULTS: The mean age was 56.9 (9-78 years) years and the mean follow-up period was 26.4 months. Combined radiation with or without chemotherapy pre- or postoperatively was given to 15 of 19 (78.9%) patients. Thirteen patients were resected strictly with an endoscopic approach and six patients were resected in combination with neurosurgery. There were no peri- and postoperative deaths. The local recurrence (LR) rate was 26.3% (5/19) and the distant metastasis rate was 15.8% (3/19). Overall survival rate (OS) was 78.9% (15/19) at a mean follow-up duration of 32.1 (4-74 months) months. The disease-free survival (DFS) rate was 68.4% (13/19) by clinical, endoscopic, and radiographic surveillance at a mean follow-up duration of 33.1 months. Patients treated with curative intent had LR, OS, and DFS rates of 21.4, 85.7, and 85.7%, respectively, and the patients treated for palliation had LR, OS, and DFS rates of 40, 60, and 15%, respectively. CONCLUSION: Minimally invasive endoscopic resection of sinonasal malignancy in combination with adjunctive therapies reduces treatment morbidity and yields LR, OS, and DFS rates that are comparable with traditional anterior craniofacial approaches.

Adult↗
PubMedDate not supplied

Comparison of endoscopic gastric mucosa features after administration of piroxicam to meloxicam and their correlation with dyspepsia symptoms in elderly patient with knee osteoarthritis.

AIM: to know the effect of piroxicam (COX-1 and COX-2 inhibitor NSAID) and meloxicam (selective COX-2 inhibitor NSAID) against the gastric mucosa. METHODS: a random, double-blind-parallel study and repeat measurement against 20 elderly-patients with knee-OA was conducted. Patients were divided into 2 equal groups, every group got piroxicam 20 mg/day or meloxicam 15 mg/day for 3 weeks. On the second group, sukralfat 2 x 1 g/day were given. To examine the difference before and after treatment, we used Wilcoxon signed rank test, to examine the difference within those groups we used Mann-whitney U test, to examine the correlation between endoscopic score and dyspepsia, we used the Spearman correlation test with significant correlation interpretation by Guilford rules. RESULTS: one of piroxicam group was resigned, so that there was 19 person left to complete this study. Piroxicam has caused elevation of endoscopic score in 78% subject compared to the beginning of study, and 22% of the subject has developed ulcers. Alteration of endoscopic feature after administration of this piroxicam was statistically significant (p< 0,05). Mild dyspepsia symptoms after piroxicam administration were positive on 67% subjects (p< 0,05). After administration of meloxicam, 40% subjects have elevated endoscopic score compared to beginning of the study (p< 0,05). Mild dyspepsia symptoms after meloxicam administration were positive on 40% subjects (p> 0,05). Meloxicam has less elevation of endoscopic score compared to the piroxicam (p< 0,05). By statistics, both of groups showed no difference in dyspepsia symptoms (p> 0,05). There was no significant correlation between elevation of endoscopic score and dyspepsia on both of groups. Nevertheless, it tends to have weak positive correlation (piroxicam group r= 0,306, p> 0,05, meloxicam group r= 0,330, p> 0,05). CONCLUSION: on this study, we conclude that the administration of either piroxicam or meloxicam in elderly-patient with knee-OA has caused the gastric mucosa impairment. The impairment after meloxicam administration is milder than piroxicam. There is no significant difference of dyspepsia symptoms in both of groups. There is correlation between endoscopic gastric mucosa features with the dyspepsia symptoms.

Aged↗
PubMedDate not supplied

The treatment of gastric fundal varices--endoscopic therapy versus interventional radiology.

BACKGROUND/AIMS: Balloon-occluded retrograde transvenous obliteration is an effective method for treating gastric fundal varices. The present retrospective study was performed to determine the clinical efficacy for gastric fundal varices associated with endoscopic therapy, surgery, and interventional radiology including balloon-occluded retrograde transvenous obliteration. METHODOLOGY: We classified 26 patients to a surgery group, an endoscopic therapy group, and an interventional radiology group according to initial treatment and subsequent treatment, and we compared the rates of hemostasis, eradication, and bleeding in these groups. RESULTS: Interventional radiology was successful in arresting acute hemorrhage in 100% of cases, while endoscopic therapy was successful in only 50% of cases. The rate of eradication was 100% in the Surgery group, 66.7% in the Endoscopic Therapy group, and 50% in the Interventional Radiology group. The cumulative bleeding rate at 5 years was 0% in the Surgery group, 0% in the Endoscopic therapy group, and 11.1% in the Interventional Radiology group. No significant difference was observed between the three groups. CONCLUSIONS: The treatment-of-choice for gastric fundal variceal hemorrhage is endoscopic injection sclerotherapy and ligation, with interventional radiology as the back-up procedure in case endoscopic injection sclerotherapy and ligation is unsuccessful. Interventional radiology is the treatment-of-choice for elective treatment of gastric fundal varices.

Aged↗
PubMed2005

[Management of sinonasal inverted papilloma: endoscopic excision vs traditional procedures].

OBJECTIVE: To evaluate the effect of endoscopic resection and traditional procedure in the management of sinonasal inverted papilloma with a staging system based on endoscopic examination of the nasal cavity and computed tomography (CT) scan evaluation. METHODS: Two hundred and twenty-two patients with sinonasal inverted papilloma treated surgically were retrospectively reviewed. There were 23 cases in stage I; 119 cases in stage II; 65 cases in stage III and 15 cases in stage IV. Among these patients, 122 cases were treated endoscopically; 100 cases were treated by traditional surgical techniques, including 56 cases with lateral rhinotomy; 27 cases with intranasal approach and 15 cases with Caldwell-Luc technique. RESULTS: The inverted papilloma was removed completely and no serious complications were encountered by all four kinds of techniques used. With an average follow-up of 3. 8 years, the recurrence rate for endoscopic group was 14.8% (18/122, four patients were in group I; nine in group II; four in group III; and one patient in group IV. No recurrence was found in group III who underwent endoscopic excision combined with Caldwell-Luc procedure. The recurrence rate for lateral rhinotomy group was 33. 9% (19/56, one patients in group I; six in group II; nine in group III; three in group IV). The recurrence rate for intranasal approach group was 51.9% (14/27, two patients were in group I; ten in group II; and two in group III). The recurrence rate for Caldwell-Luc procedure group was 29.4% (5/17, all in group II and group III). Regardless of approaches, patients who had primary resection had a recurrence of 26. 8%, whereas those with secondary resection had a recurrence of 20. 9% (P = 0.39). CONCLUSIONS: The endoscopic surgical technique was proved to be a better method for treating sinonasal inverted papilloma in stage I and stage II. Better results for patients in stage III would be achieved by combining endoscopic technique with Caldwell-Luc procedure. As to patients with stage IV, radical external approaches should be considered.

Adolescent↗
PubMed1992

Endoscopic ligation of esophageal varices.

Endoscopic variceal ligation was developed to provide a safe alternative to conventional injection sclerotherapy which is known to be associated with a substantial incidence of non-bleeding treatment related complications. Laboratory studies in portal hypertensive dogs have shown the technique results in obliteration of vascular structures in the submucosa by scar tissue formation. The clinical technique of endoscopic ligation is performed in the endoscopy suite or intensive care unit in a fashion similar to endoscopic sclerotherapy except an endoscopic overtube is routinely employed. Initial single arm trials of endoscopic ligation in 146 consecutive patients showed the technique to be effective for control of active bleeding and eradication of varices while being associated with a low incidence of non-bleeding complications. Endoscopic ligation has been investigated in three additional single arm trials and is currently under investigation in three prospective randomized studies comparing the technique with sclerotherapy. Data from these studies have confirmed that endoscopic ligation is at least equal to sclerotherapy for treatment of actively bleeding varices and prevention of recurrent bleeding. The new technique appears to result in a significantly lower risk of non-bleeding treatment related complications than conventional sclerotherapy.

Animals↗
PubMedDate not supplied

Laparoscopic-assisted percutaneous endoscopic gastrostomy in children and adolescents.

OBJECTIVE: Pediatric gastric access for long-term enteral feeding may be performed via a laparotomy, laparoscopy, or a percutaneous approach. In children and adolescents, laparoscopic-assisted gastrostomy may be difficult due to a thick abdominal wall. Therefore, if the abdominal wall is estimated to be >2 cm on physical examination, or in children in whom a percutaneous endoscopic gastrostomy was unsuccessfully attempted by a gastroenterologist, we routinely perform a laparoscopic-assisted percutaneous endoscopic gastrostomy. METHODS: From January 1998 through February 2003, we retrospectively reviewed 15 cases of a laparoscopic-assisted percutaneous endoscopic gastrostomy. Instruments used to perform this technique are a percutaneous endoscopic gastrostomy kit, an Olympus flexible endoscope, and one 5-mm STEP port placed through an infraumbilical incision for a 5-mm, 30-degree scope. RESULTS: Age range was 2 years to 20 years (mean, 10). Operative time ranged from 20 minutes to 45 minutes. When a concurrent laparoscopic Nissen fundoplication was performed (n = 6), the percutaneous endoscopic gastrostomy was placed after completion of the Nissen fundoplication. No intraoperative complications occurred, and all tubes were successfully placed. Feeds were instituted the following day and advanced to goal. To date, no postoperative complications have occurred, and revision has not been necessary. CONCLUSIONS: Laparoscopic-assisted percutaneous endoscopic gastrostomy in children and adolescents is safe and effective. Utilizing laparoscopy permits evaluation of the peritoneum and lysis of adhesions, if necessary. Moreover, laparoscopy provides excellent exposure for accurate placement of the PEG, while avoiding injury to other organs.

Adolescent↗
PubMed1999

Endoscopic removal of cysticercal cysts within the fourth ventricle: technique and results.

There is no consensus as to the optimum management of patients who harbor cysticercal cysts within the fourth ventricle. Compared with the alternative treatment options of anthelmintic medication and/or cerebrospinal fluid shunting, the surgical removal of the cyst has the advantage of eliminating the inflammatory nidus and potentially obviating the need for a complication-prone shunt. Here, an endoscopic surgical approach is described and proposed as a superior alternative to the suboccipital craniotomy for removal of a fourth ventricle cyst. A retrospective analysis was conducted to compare five consecutive endoscopic cases with eight previous consecutive cases in which a suboccipital craniotomy was performed to remove fourth ventricle cysticercal cysts. Comparisons are made with regards to success in removing the cyst, length of operation, surgical blood loss, postoperative discomfort, and complications. A detailed description of the endoscopic technique is given. Endoscopic removal of all cysts within the fourth ventricle was successful in each case. The mean length of operative times was shorter and the blood loss was reduced with the endoscopic procedure compared with the suboccipital craniotomy (2.5 +/- 0.8 hours and 5.3 +/- 2.2 hours [p = 0.02], 19 +/- 4ml and 269 +/- 203 ml [p = 0.02], respectively). The endoscopic procedure was safe and associated with less postoperative discomfort in most patients. In properly selected patients, the endoscopic removal of cysticercal cysts located within the fourth ventricle is superior to the suboccipital craniotomy and should be considered as the primary treatment for this condition.

Journal Article↗
PubMed2006

[Endoscopic removal of sinonasal tumors].

OBJECTIVES: To evaluate the efficacy of endoscopic surgery for sinonasal tumors. PATIENTS AND METHODS: Clinical records of 20 patients (10 males, 10 females; mean age 34; range 12 to 63 years) who underwent endoscopic tumor resection with diagnosis of sinonasal tumor between January 1998 and August 2004 were retrospectively reviewed. Patients who were operated by transnasal endoscopic surgery or by combined (endoscopic or external) surgical methods were included in the study. Patients were reviewed for age, sex, pathologic diagnosis and tumor location, surgical techniques, need for additional surgery, complications, recurrence, and follow-up period. RESULTS: There were five osteomas, one fibrous dysplasia, one ossifying fibroma, seven inverted papillomas, one oncocytic papilloma, three angiofibromas, one schwannoma, and one esthesioneuroblastoma. The patients follow-up period ranged between 6 months and 6 years (mean 26 months). The fibrous dysplasia involving the posterior ethmoid sinuses was subtotally resected due to its close proximity to the optic nerve. One inverted papilloma of the maxillary sinus was resected by a combined endoscopic and Caldwell-Luc approach. A combined endoscopic intranasal and external frontoethmoidectomy approach was performed for the removal of frontal sinus schwannoma. Recurrence was observed in one of the inverted papilloma cases. Total removal of the tumors was achieved in all other cases without any complications or recurrences. CONCLUSION: Low recurrence rates in our series showed that endoscopic resection of nasal-paranasal sinus tumors in selected cases, may be an appropriate method as solely or in combined with other surgical techniques for experienced surgeons.

Adolescent↗
PubMedDate not supplied

Endoscopic submucosal dissection for gastric neoplasia: experience with the flex-knife.

Although the standard treatment for gastric neoplasia is still surgical resection, endoscopic resection has been accepted for some of these lesions in an early stage. Among several methods of endoscopic resection, endoscopic submucosal dissection has been developed to remove the lesions in an en bloc fashion regardless of size, shape, coexisting ulcer, and location. However, indication of endoscopic submucosal dissection is strictly confined by two aspects; those are the possibility of nodal metastases and technical difficulty. Nowadays, several knives for endoscopic submucosal dissection are available and each of them has some merits and demerits. We describe how to perform endoscopic submucosal dissection in the stomach by using the flex-knife, a new endoscopic device specifically designed for submucosal dissection, emphasizing its special features from our experience.

Endoscopy↗
PubMed2006

[Only used unilateral transnasal approach applied endoscopic sinus surgery for pituitary adenomas].

Endoscope-assisted transnasal approach (TNA) for pituitary adenoma is a new alternative for Hardy's surgery (TSS). We performed TNA using only an endoscope through unilateral nostril. In our approach to sphenoid sinus, we apply method of endoscopic sinus surgery (ESS-TNA). We enter the sphenoid sinus directly through the natural ostium and do not brake the nasal septum nor vomer bone. Since September 2004 we had operated on 12 patients by endoscopic TNA. Six were non-functioning adenomas, and 6 were functioning adenomas. We are first to open the ethomoid sinus to make the space for middle concha to be displaced laterally. Secondary, we widen the natural ostium of the sphenoid sinus, retracting the middle concha laterally. The results were compared with those in 10 cases by TSS operated in our institute. Adenoma removal more than 80% was achieved in 58% by endoscopic TNA whereas in 50% by TSS. We had no case with postsurgical infection. Transient DI occurred in 4 cases and 1 case showed permanent. CSF rhinorrhea was seen in the case having small empty sellae in front of adenoma. For this case, we packed the fat tissue at the floor of the sella with endoscope under local anesthesia to close the fistula. Three cases that had hemianopsia before surgery showed the recovery postoperatively. In 6 functional adenoma, postoperative endocrinological examinations showed normalization in 3 cases and improvements in 3 cases. Postsurgical hospitalization days were 11.4 by endoscopic TNA whereas 15.4 by TSS. Our method showed same or better results than TSS in the removal rate and complication rate whereas the postoperative duration of nasal packing and hospitalization days were shorter than TSS.

Adenoma↗
PubMed2006

In-vivo endoscopic visualization of patho-anatomy in painful degenerative conditions of the lumbar spine.

The degenerative processes in an aging spine have been defined traditionally only by our knowledge of the biology of disc and facet degeneration, as well as interpretation of post-mortem cryosections by forensic anatomist Wolfgang Rauschning, M.D. In this chapter, visualization of in-vivo patho-anatomy in a degenerating disc and spinal segment is demonstrated at surgery using the Yeung Endoscopic Spine System (Y.E.S.S.), (Richard Wolf Surgical Instrument Company, Vernon Hills, IL, USA). An Institutional Review Board (IRB)-approved study of endoscopic treatment for degenerative conditions of the lumbar spine incorporated intraoperative probing under local anesthesia and endoscopic treatment of the visualized patho-anatomy. An intraoperative evocative chromo-discogram, using indigocarmine, was used to elicit discogenic pain and label the fissured and degenerative nucleus pulposus for surgical removal and thermal modulation. Painful patho-anatomy was probed in a conscious patient. The most common endoscopic finding was Inflammatory tissue in the disc and annulus. Inflammation was correlated with the presence of annular tears. Patho-physiologic changes that affect the exiting nerve, which contains the Dorsal Root Ganglion (DRG), was associated with stenotic and chemical irritation. Unavoidable postoperative dysesthesia was associated with the presence of an inflammatory membrane, and removal or thermal coagulation of "anomalous" furcal nerves in the foramen that branched off of the exiting spinal nerve. Neo-angiogenesis and neurogenesis in the inflammatory membrane present in the foraminal triangle was a new finding not reported in traditional clinical studies. Visualization and treatment of pathologic findings inside (annular tears) and outside the disc in Herniated Nucleus Pulposus (HNP), synovial cysts, foraminal stenosis, central stenosis, spondylolisthesis, is demonstrated. The endoscopic foraminal approach to the spine and disc is a technique that provides access to patho-anatomy in the lumbar spine not usually feasible with traditional surgical methods. Favorable surgical results allow for continued evolution of the endoscopic method, concomitant with the continued evolution of endoscopic spinal surgery.

Back Pain↗
PubMed2006

The transition from open to endoscopic saphenous vein harvesting and its clinical impact: The Texas Heart Institute experience.

Open saphenous vein harvesting can be associated with wound complications, incision pain, prolonged convalescence, and poor cosmetic results. Endoscopic vein harvesting has been widely used for prevention of these problems. We compared outcomes of open and endoscopic vein harvesting for coronary artery bypass grafting at the Texas Heart Institute. We retrospectively analyzed data from 1,573 consecutive coronary artery bypass procedures performed at our institution during a 20-month period. Each procedure included saphenectomy by endoscopic vein harvesting (n = 588) performed by physician assistants, or by traditional open vein harvesting (n = 985) performed by physicians or physician assistants. The primary outcome variable was the incidence of postoperative leg infections. Both groups were similar in terms of preoperative risk factors. After surgery, leg wound infections were significantly less frequent in the endoscopic vein harvesting group (3/588, 0.5%) than in the open vein harvesting group (27/985, 2.7%; P < 0.002). The most common organism involved in leg infections was Staphylococcus (20/30, 66%): S. aureus was present in 14 of 30 infections (47%). Open vein harvesting was the only significant independent risk factor for leg infection. We conclude that endoscopic vein harvesting reduces leg wound infections, is safe and reliable, and should be the standard of care when venous conduits are required for coronary artery bypass grafting and vascular procedures. Although the transition from open to endoscopic vein harvesting can be challenging in institutions, it can be successful if operators receive adequate training in endoscopic technique and are supported by surgeons and staff.

Aged↗
PubMed2006

[Retrospective analysis of effects and complications in cases treated with endoscopic evacuation of intracerebral hemorrhage].

We described our experience of 22 cases treated with endoscopic evacuation of intracerebral hematoma, including 16 putaminal, 3 thalamic, and 1 cerebellar hemorrhages. All endoscopic procedures were performed under local anesthesia. A rigid-rod endoscope and a suction device attached was introduced through a transparent sheath into the hematoma cavity. Putaminal hemorrhage was sufficiently evacuated (56-100%), but thalamic hemorrhage was insufficiently removed (less than 40%). In 3 cases, postoperative CT demonstrated enlargement of the hematoma after the endoscopic procedure. In one case, postoperative rebleeding was recognized on a postoperative follow-up CT scan. In 2 cases, uncontrollable arterial bleeding occurred during the endoscopic procedure, followed by craniotomy and removal of the hematoma under a microscope. Endoscopic hematoma evacuation should be an efficient procedure for intracerebral hemorrhage after a secure method of hemostasis during the endoscopic evacuation process has been developed.

Adult↗