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At least 1,441 records · Page 80Linked to original sources
PubMed2002

Minimally invasive endoscopic repair of pectus excavatum.

OBJECTIVE: We report our initial 3 years 4 months' single institution experience in 31 consecutive patients with pectus excavatum treated with minimally invasive endoscopic pectus excavatum repair utilizing a modification of the 'Nuss' technique. METHODS: Under general anesthesia, a curved steel bar is individually shaped for each patient to match the ideal chest wall shape and is placed through an endoscopically created retrosternal tunnel between two bilateral midaxillary line 2-cm incisions. The tunnels initially go along the outside of the rib cage, under the pectoral muscles. At the level of the sternum, these tunnels go retrosternal and communicate with each other. The steel bar is passed with the convexity facing posteriorly, within a protective flat silastic drain. Under endoscopic guidance, the curved steel bar is passed through one tunnel, under the sternum, and out the other tunnel. Once positioned, the bar is turned over, thereby correcting the deformity. An epidural catheter provides perioperative pain relief. RESULTS: Minimally invasive endoscopic pectus excavatum repair has been performed on 31 patients (age: range 4.4-31.0 years, median 15.0 years, mean 14.5 years). Median hospital length of stay is 4 days (range 3-10 days, mean 4.6 days). Pneumothorax occurred in five patients requiring tube thoracostomy in three. One patient developed delayed bilateral pleural effusions requiring drainage. Two patients developed evidence of sterile seroma formation at the skin incision several months after minimally invasive repair of pectus excavatum. These seromas resolved with non-interventional conservative medical treatment. No other complications occurred. CONCLUSION: The minimally invasive endoscopic pectus repair is safe and effective and currently our procedure of choice for primary pectus excavatum in all ages. Endoscopic visualization facilitates the safe creation of the retrosternal tunnel. Short-term results have been excellent. Further follow-up will be necessary to determine long-term results.

Adolescent↗
PubMed2003

Clinical benefits in endoscopic thyroidectomy by the axillary approach.

BACKGROUND: Surgical treatments for thyroid diseases require skin incisions that can result in prominent scars, complaints resulting from adhesions, hypesthesia, and paresthesia in the neck. We have developed an endoscopic thyroidectomy using an axillary approach. In this article, we compare our original technique with conventional open surgery from the aspects of surgical invasiveness and patients' complaints after surgery. STUDY DESIGN: Each procedure was performed in 20 patients with follicular tumors. The two groups were similar for age, gender, and the mean diameter of the thyroid tumor. No statistically significant difference in the final pathological diagnosis was found between the two groups. Surgical invasiveness and patients' complaints after surgery were compared using results of the operation and a questionnaire. RESULTS: The operating time for open surgery was significantly shorter than that for endoscopic surgery (p < 0.01). In the endoscopic surgery group, the patient questionnaires revealed that 4 patients had severe anterior chest pain on the first postoperative day. The postoperative pain decreased after, and we could not find any difference between the two groups with regard to postoperative pain. Three months after surgery, one patient who had received an endoscopic procedure complained of slight hypesthesia, and none of the patients complained of discomfort while swallowing. Among the patients who underwent open surgery, 13 patients (65%; p < 0.01) complained of hypesthesia or paresthesia and 6 patients (30%; p < 0.05) complained of discomfort while swallowing. All of the patients treated using the endoscopic procedure were satisfied with the cosmetic results, but 15 patients who underwent open surgery complained of unsatisfactory cosmetic results (p < 0.01). CONCLUSIONS: The incidence of postoperative complaints after endoscopic surgery is considerably lower than that after open surgery.

Adult↗
PubMed1998

Endoscopic femoral-popliteal/distal bypass grafting: a preliminary report.

BACKGROUND: Patients requiring limb bypass or coronary artery bypass procedures frequently develop vein harvest-associated complications. Minimally invasive surgical techniques that can be employed during dissection of the greater saphenous vein could potentially reduce the significant incisional morbidity concomitant with this procedure. STUDY DESIGN: An endoscopic saphenous vein balloon dissector was developed and previously tested in the animal model. It was applied to a series of 16 leg bypass patients to dissect totally endoscopically the greater saphenous vein for either translocated or in situ procedures. The clinical course of these 16 patients was compared with the most recent 16 consecutive standard open saphenous vein bypass patients of similar age, disease, and risk factors. RESULTS: No venous conduit injuries occurred with the endoscopic dissection technique, and only one minor wound seroma resulted in the harvest tunnel, requiring simple aspiration. The length of stay averaged 3.8 days, but the trend was downward to 1.8 days for the last 8 consecutive endoscopically dissected patients. In comparison, there were five major wound complications in the 16 open saphenous vein bypass patients with an average length of stay of 6.2 days. CONCLUSIONS: Total endoscopic saphenous vein dissection for either translocated or in situ leg bypass patients can be performed atraumatically for both the patient and the venous conduit. Wound/incisional complications are decreased, and length of stay appears to be reduced. Minimally invasive, endoscopic saphenous vein harvest may be beneficial for both leg bypass patients and coronary artery bypass patients.

Aged↗
PubMed1998

Endoscopic axillary lymph node dissection: an experimental study in human cadavers.

BACKGROUND: The role of axillary lymph node dissection in the staging of patients with breast carcinoma is currently under evaluation. As a result of recent advances in minimally invasive techniques, an endoscopic approach to axillary lymph node dissection may be an attractive alternative to lymphadenectomy performed via a standard "open" axillary incision. The purpose of the present study was to evaluate the technical feasibility and safety of such an approach in human cadavers. STUDY DESIGN: Twelve axillary dissections (right in seven, left in five) were performed in seven cadavers. A 2.5-cm incision was made along the lateral chest wall 12 cm inferior to the apex of the axilla. The subcutaneous axillary space was expanded with a balloon dissector, and exposure was maintained with a prototype external lift device. Endoscopic dissection was performed with three or four 5-mm ports inserted into this space. Histologic analysis was performed to document the number of lymph nodes removed. RESULTS: The mean dissection time for endoscopic axillary lymphadenectomy was 56.7+/-19 minutes (range, 30-90 minutes). Structures visualized endoscopically included the axillary vein (12 of 12 patients), the long thoracic nerve (12 of 12 patients), the thoracodorsal nerve (10 of 12 patients), and the intercostobrachial nerve (11 of 12 patients). An average of 9.9+/-7.2 lymph nodes (range, 2-22 nodes) was removed from each axilla. Open exploration of the axilla after the endoscopic dissection confirmed no injuries to any neurovascular structures. Residual lymph nodes were removed from the axilla in 7 of 12 dissections (58%; average, 4.2+/-4.0 nodes per specimen). CONCLUSIONS: These results suggest that endoscopic axillary dissection is feasible with currently available technology. Clinical trials in patients with breast carcinoma may be warranted to evaluate this technique further.

Axilla↗
PubMedDate not supplied

Three-dimensional computed tomographic volume rendering techniques in endoscopic thoracoplasty.

BACKGROUND CONTEXT: Thoracoplasty is occasionally necessary to achieve an acceptable cosmetic result in the presence of a rib hump, especially in previously fused young adults with scoliosis. This usually requires the resection of four to five rib segments, and the morbidity associated with open posterior resection or of open anterior resection by means of thoracotomy is often considerable, apart from leaving an unsightly scar. We thought the use of an endoscopic internal rib resection technique would achieve the desired result with less morbidity. Our experience with using the technique of three-dimensional (3-D) computed tomographic (CT) volume rendering to plan our portals and releases for endoscopic scoliosis correction led us to believe the same techniques could be adapted to plan and endoscopically carry out the thoracoplasty. PURPOSE: To define the utility of 3-D CT volume rendering of the spine and thorax in the preoperative planning of endoscopic rib resection. STUDY DESIGN: A prospective evaluation of the utility of 3-D CT volume rendering for preoperative planning in patients with scoliosis undergoing endoscopic thoracoplasty for correction of rib humps. PATIENT SAMPLE: Four consecutive patients with previously fused scoliotic spines and pronounced right-sided rib humps requiring operative correction were selected. OUTCOME MEASURES: Outcome was assessed at a minimum follow-up of 6 months by clinical examination, patient satisfaction with the clinical result, and repeat helical CT scanning with 3-D reconstruction. METHODS: Four patients with previously fused scoliotic spines and pronounced rib humps underwent helical CT scanning with 3-D volume rendering, prior to endoscopic corrective surgery. All four patients had right-sided rib humps requiring corrective rib resection for cosmetic reasons. Using the technique of 3-D volume rendering, a vector plane was created to mirror the left scapula, and its intersections on the right chest wall were noted. The ribs to be resected were marked, and the length of rib resection was measured from the vector plane's intersection points with the ribs. In this way an estimate of the resection required to achieve the desired final position of the right elevated scapula could be determined. Entry portals were also estimated with vector lines to achieve optimal access to each rib. During surgery, the portal sites were assessed for access to the selected ribs. Also, the extent of rib resections was compared with the estimates. The final clinical outcome was assessed by clinical examination, patient satisfaction with the cosmetic result, and repeat helical CT scanning with 3-D reconstruction. RESULTS: The male to female ratio was 1:3, and the average age was 21 years. Our average estimated blood loss was 307 ml and average hospital stay was 4.75 days. The estimated portal sites were accurate and did provide for direct access to each selected rib involved in the deformity. We were able to resect the ribs at the points suggested by 3-D CT volume rendering, with the lengths of our resected segments matching our preoperative estimates. In all cases the elevated right scapula did descend into the rib resection bed, thus balancing the shoulder heights. An excellent cosmetic result was achieved in all cases as evaluated by clinical examination, patient's perception, and repeat helical CT scanning. CONCLUSION: The technique of 3-D CT volume rendering with vector plane estimates provides a reliable estimate of the rib resection required to achieve a cosmetically acceptable correction of the rib hump through minimally invasive techniques.

Adolescent↗
PubMed2004

Cost-effectiveness model of endoscopic screening and surveillance in patients with gastroesophageal reflux disease.

BACKGROUND & AIMS: Endoscopic screening and periodic surveillance for patients with Barrett's esophagus has been shown to be cost-effective in patients with esophageal dysplasia, with treatment for esophageal cancer limited to esophagectomy. Most gastroenterologists refer patients with high-grade dysplasia for esophagectomy, and effective endoscopic therapies are available for nonoperative patients with esophageal cancer. The cost-effectiveness of screening strategies that incorporate these nonsurgical treatment modalities has not been determined. METHODS: We designed a Markov model to compare lifetime costs and life expectancy for a cohort of 50-year-old men with chronic reflux symptoms. We compared 10 clinical strategies incorporating combinations of screening and surveillance protocols (no screening, screening with periodic surveillance for both dysplastic and nondysplastic Barrett's esophagus, or periodic surveillance for dysplasia only), treatment for high-grade dysplasia (esophagectomy or intensive surveillance), and treatment for cancer (esophagectomy or surgical and endoscopic treatment options). RESULTS: Screening and surveillance of patients with both dysplastic and nondysplastic Barrett's esophagus followed by esophagectomy for surgical candidates with high-grade dysplasia or esophageal cancer and endoscopic therapy for cancer patients who were not operative candidates cost $12,140 per life-year gained compared to no screening. Other screening strategies, including strategies that had no endoscopic treatment options, were either less effective at the same cost, or equally effective at a higher cost. CONCLUSIONS: The cost-effectiveness of screening and subsequent surveillance of patients with dysplastic as well as nondysplastic Barrett's esophagus followed by endoscopic or surgical therapy in patients who develop cancer compares favorably to many widely accepted screening strategies for cancer.

Adenocarcinoma↗
PubMed1997

The endoscopic treatment of cerebrospinal fluid rhinorrhoea: the Nottingham experience.

The conventional neurosurgical management of cerebrospinal fluid (CSF) rhinorrhoea has been by intracranial access. Otorhinolaryngologists have undertaken extracranial approaches where access has been possible, and more recently an endoscopic approach has been advocated. We report 17 patients with confirmed CSF rhinorrhoea treated with endoscopic techniques between 1993 and 1996. Follow-up ranged from four to 32 months and showed an overall closure rate of 16 out of 17 patients with no complications. No patient undergoing primary endoscopic repair developed anosmia. The use of fluorescein helped localize the site of the CSF leak in four patients in whom the computed tomography (CT) scan had not identified the site of the defect. We conclude that the endoscope is a valuable tool in the evaluation and subsequent treatment of CSF rhinorrhoea. Where the skull base defect is accessible to the endoscope, we propose that an endoscopic approach should be considered as the preferred method.

Adult↗
PubMed1999

Tumors of the papilla of Vater--inadequate diagnostic impact of endoscopic forceps biopsies taken prior to and following sphincterotomy.

BACKGROUND: It has been proposed that adenomas of the papilla of Vater are precursors of adenocarcinomas. Duodenoscopy with ERCP and forceps biopsies have substantially improved the morphologic exploration of the major duodenal papilla. Yet there is little and contradictory information as to the diagnostic accuracy of endoscopic biopsies in tumors of the papilla. Moreover, after endoscopic sphincterotomy data on the diagnostic impact of endoscopic biopsies from the papilla are scarce and, in most cases, retrospectively obtained. Thus, the aim of the present prospective and histopathologically controlled study was to assess the diagnostic accuracy of endoscopic biopsies taken from tumors of the papilla before and after sphincterotomy. PATIENTS AND METHODS: Forty patients with tumors of the papilla of Vater were included in the study. In each case, a comparison was made between endoscopic forceps biopsy diagnoses prior to and following sphincterotomy and the definitive histological diagnosis after surgical tumor resection. RESULTS: Resected tumors were diagnosed histomorphologically as follows: 19 adenocarcinomas (47%), 6 tubular adenomas (15%), 7 villous adenomas (17%), 7 inflammatory non-neoplastic lesions (pseudotumors) (17%), and one adenomyoma (2%). Overall accuracy for preoperative histopathological diagnosis was 62% (25 of 40, 95% CI: 47%-76%) prior to sphincterotomy while it was 70% (28 of 40, 95% CI: 55%-81%) following the procedure. Regarding adenocarcinomas, sensitivity was found to be 21% (4 of 19, 95% CI: 8%-43%) prior to and 37% (7 of 19, 95% CI: 19%-58%) after sphincterotomy while specificity was 100% at both times. CONCLUSIONS: Endoscopic forceps biopsies do not allow for reliable preoperative diagnosis of tumors of the papilla of Vater.

Adenocarcinoma↗
PubMed2005

[Endoscopic repair of groin hernia--what ist evidence-based].

The endoscopic techniques of groin hernia repair have developed tremendously over the past 10 years. There are numerous prospective randomized clinical trials comparing conventional techniques of groin hernia repair with endoscopic methods. However, it is difficult to establish a proper meta-analysis of the currently available data due to widely differing study designs. We assessed the currently available prospective randomized clinical trials comparing conventional versus laparoscopic hernia repair. We conclude that based on present data there is a clear advantage for the endoscopic techniques regarding length of hospital stay, postoperative recovery and return to normal activity. The conventional techniques are superior regarding duration of operation and direct cost. Rate of recurrence are comparable in both, endoscopic and conventional approach using mesh prosthesis. Endoscopic techniques are far superior to conventional operation without the use of mesh prosthesis. In patients with recurrent hernia endoscopy offers a major advantage regarding postoperative pain, lenght of hospital stay, return to normal activity and rate of recurrence. We demonstrate these suggestions discussing our own results. Therefore we recomend endoscopic hernia repair in patients with bilateral or recurrent hernia.

Endoscopy↗
PubMed2003

Retrograde endoscopic laser therapy for transitional cell carcinoma of the upper urinary tract.

AIM: The aim of the present study was to investigate the safety and efficacy of endoscopic laser therapy for transitional cell carcinoma (TCC) of the upper urinary tract. METHODS: Tumors of the renal pelvis and ureteropelvic junction were detected by ureteroscopy. The tumors were subjected to biopsy, and after TCC was diagnosed, endoscopic laser therapy (Neodymium-YAG and Holmium-YAG) was conducted using a 6.9 Fr. flexible ureterorenoscope. RESULTS: From January 1997 to April 2002, six patients underwent ureteroscopic treatment. Tumor grade was 1 in four patients and 2 in two patients. Average tumor size was 1.45 cm. Endoscopic treatment was chosen for two patients because of the high medical risk associated with open surgery. Another patient underwent diagnostic ureteroscopy, followed immediately by endoscopic treatment. A further three patients elected to undergo ureteroscopic treatment. One patient with large (3 cm), multifocal and incompletely treated tumors died of metastatic disease 22 months after the initial operation. One patient requested nephroureterectomy one month after endoscopic treatment, and pathological examination of the resected specimen revealed no tumor. The other four patients have been followed up for a mean period of 14 months after initial treatment. Recurrence occurred in one patient, and was successfully treated by repeat endoscopic resection. None of the patients required blood transfusion or emergency open surgery. CONCLUSION: Ureteroscopic treatment of small, localized, low-grade TCC of the upper urinary tract is now a safe and feasible alternative to nephroureterectomy in selected patients.

Aged↗
PubMed2003

Outcomes of emergency common bile duct exploration: impact of preoperative endoscopic decompression.

BACKGROUND: Emergency common bile duct exploration (CBDE) is still required in patients acutely ill with complicated biliary tract stone disease when endoscopic decompression fails to reverse their condition. This study looks at the clinical profile of patients requiring emergency CBDE and examines the various factors influencing the postoperative outcome. METHODS: Clinical records of patients with emergency CBDE in Singapore General Hospital from January 1991 to December 1998 were reviewed. Factors influencing postoperative outcomes, for example, pre-existing medical problems, hepatic parameters, the impact of endoscopic procedures (if any) and indications for surgery, were correlated with postoperative morbidity and 30-day mortality. RESULTS: The records of 100 patients were available for review. Major indications for emergency CBDE were cholangitis (51%) and intraoperative findings of common bile duct obstruction during emergency laparotomy (23%). Six patients had emergency CBDE because of iatrogenic complication of attempted therapeutic endoscopic retrograde cholangiopancreaticography (ERCP) for biliary stones. Overall mortality was 14.0% and 8.0% had retained stones. Mortality was significantly influenced by age, prior biliary disease, preoperative endoscopic biliary decompression in acute cholangitis (33.3%vs 9.4%, P = 0.035) and endoscopic complications. CONCLUSIONS: Among patients requiring emergency CBDE, uncomplicated preoperative endoscopic biliary decompression benefits patients with acute cholangitis.

Adult↗
PubMed1999

Does the endoscopic incision of ureteroceles reduce the indications for partial nephrectomy?

OBJECTIVE: To determine whether the endoscopic incision of ureteroceles reduces the indications for partial nephrectomy. PATIENTS AND METHODS: Between 1987 and 1996, endoscopic incision was used as the first-line treatment of 18 children (13 boys, five girls, aged 8 days to 6 months) with a duplex-system ureterocele diagnosed antenatally (15) or in the first weeks of life during the course of a urinary infection (three). Of the 19 ureteroceles (one bilateral), four were intravesical and 15 ectopic, according to the American Academy of Paediatrics classification. Vesico-ureteric reflux into the inferior pole of the kidney was present in 10 children, seven of whom had an ectopic ureterocele. A functioning upper pole was detected by intravenous pyelography (IVP) in half the intravesical and in a third of the ectopic ureteroceles. RESULTS: Endoscopic incision resulted in decompression and reduction of dilatation in 16 cases; three with inferior pole reflux resolved on control cystography, whilst in seven with an ectopic ureterocele, reflux into the upper urinary tract was induced by endoscopic incision. In three children with an ectopic ureterocele, renal function had improved at 3 months, as assessed by IVP. Endoscopic incision was the only treatment for half the intravesical and six of 15 ectopic ureteroceles. Overall, nephrectomy was required in four of 18 patients (three partial nephrectomies for persistent dilatation and one total nephrectomy). Five nonfunctioning, undilated upper poles with no reflux were left in place. Nine vesico-ureteric reimplantations for persistent or induced reflux were carried out using the Cohen technique. CONCLUSION: Endoscopic incision can allow the deferral of nephrectomy, facilitate lower urinary tract reconstruction and reduce the indications for partial nephrectomy, if it is accepted that a nonfunctioning, undilated renal pole with no reflux can safely be left in place.

Electrocoagulation↗
PubMed1999

Endoscopic removal of submucous tumours.

Although gastrointestinal submucous tumours are increasingly being discovered with the development of endoscopic examination techniques, the reliable diagnosis of these lesions remains difficult at present. Before endoscopy became available, the treatment strategy for gastrointestinal submucous tumours was either surgery or observation. With the rapid evolution of therapeutic endoscopy, the endoscopic removal of various tumours in the gastrointestinal tract has been described, but the resection of submucous tumours is still reported only infrequently. Endoscopic removal of submucous tumours of the gastrointestinal tract has yet to become widespread, and this technique has not been fully evaluated. Not all patients need the treatment; however, endoscopic submucous tumour removal may be the treatment of choice for certain patient subgroups. This article reviews recent literature regarding the endoscopic removal of gastrointestinal submucous tumours and discusses the possibility of removing submucous tumours using endoscopic resection.

Adenocarcinoma, Mucinous↗
PubMed2002

Endoscopic screening for varices in cirrhosis: findings, implications, and outcomes.

At least two thirds of cirrhotic patients develop esophageal varices during their lifetime. Severe upper gastrointestinal (UGI) bleeding as a complication of portal hypertension develops in about 30%-40% of cirrhotics. Despite significant improvements in the early diagnosis and treatment of esophagogastric variceal hemorrhage, the mortality rate of first variceal hemorrhage remains high (20%-35%). Primary prophylaxis, the focus of this article, is treatment of patients who never had previous variceal bleeding to prevent the first variceal hemorrhage. The potential of preventing first variceal hemorrhage offers the promise of reducing mortality, morbidity, and associated health care costs. This article (1) reviews endoscopic grading of size and stigmata for esophageal and gastric varices, (2) describes data on prevalence and incidence of esophageal and gastric varices from prospective studies, (3) discusses independent risk factors from multivariate analyses of prospective studies for development of first esophageal or gastric variceal hemorrhage and possible stratification of patients based on these risk factors, (4) comments on the potential cost effectiveness of screening all newly diagnosed cirrhotic patients and treating high-risk patients with medical or endoscopic therapies, and (5) recommends further studies of endoscopic screening, stratification, and outcomes in prospective studies of endoscopic therapy. The author's recommendations are to perform endoscopic screening for the following subgroups of cirrhotics: all newly diagnosed cirrhotic patients and all other cirrhotics who are medically stable, willing to be treated prophylactically, and would benefit from medical or endoscopic therapies. Exclude patients who are unlikely to benefit from prophylactic therapies designed to prevent the first variceal hemorrhage, those with short life expectancy, and those with previous UGI hemorrhage (they should have already undergone endoscopy). For low or very low risk cirrhotic patients-those found to have no varices or small varices without stigmata-repeat endoscopy is recommended because screening for progression may be warranted in 2 or more years.

Esophageal and Gastric Varices↗
PubMed2000

Changes in digital flexor tendon mechanics after endoscopic and open carpal tunnel releases in cadaver wrists.

Digital flexor tendon excursion due to isolated wrist motion was measured in 5 cadaver wrists. Five sequential experimental conditions were tested: (1) intact wrists, (2) after single-incision endoscopic carpal tunnel release, (3) after addition of a distal endoscopic portal, (4) after conversion to an open palm incision, and (5) after suturing of the palm incision. Combined tendon excursion increased 27.8% after 1-incision and 29.7% after 2-incision endoscopic release; both increases were significant. A further increase in combined excursion to 43.4% over the value in intact wrists was measured after conversion to an open palm incision. Combined flexor tendon excursion after open release was significantly greater than excursion after either type of endoscopic release. Increases in excursion were also significant when flexor digitorum superficialis and flexor digitorum profundus tendons were considered separately. Excursion did not change significantly after skin suturing. These findings suggest that digital flexor tendon mechanics are closer to normal after endoscopic carpal tunnel release than after open release. It remains to be shown whether the difference is an advantage of endoscopic release over open release in the clinical setting. (J Hand Surg 2000; 25A:112-119.

Analysis of Variance↗
PubMed2003

Is primary endoscopic puncture of ureterocele a long-term effective procedure?

BACKGROUND/PURPOSE: For more than a decade, endoscopic puncture of ureterocele has been recommended as an initial and, in the majority of the patients, as a definitive procedure. This study evaluates the long-term effectiveness of primary endoscopic puncture of ureterocele. METHODS: Over the last 18 years (1984 through 2001), 52 patients (median age 3 months) underwent primary endoscopic puncture of ureterocele. The median follow-up was 9 years (6 months to 18 years). Antenatal ultrasound scan detected hydronephrosis and led to the postnatal diagnosis of ureterocele in 12 (23%) children, whereas in the remaining 40 (77%) children the diagnosis was made on investigation for urinary tract infection (UTI). The ureterocele presented as a part of renal duplication in 48 (92%) patients and a single system in 4 (8%). Forty-four (92%) of the patients with duplication presented with non- or poorly functioning upper poles. Vesicoureteric reflux (VUR) was seen in the lower moiety of the ipsilateral kidney in 31 and in 18 of the contralateral kidney comprising 49 renal refluxing units (RRU). RESULTS: Complete decompression of the ureterocele was achieved in 48 (92%) patients after the first endoscopic puncture. Four (8%) patients required a second puncture of ureterocele. Nine (17%) of the 52 patients underwent nephrectomy for a nonfunctioning kidney. Ten (19%) patients required upper pole partial nephrectomy owing to nonfunctioning upper pole. Twenty-nine (59%) of the 49 RRU showed spontaneous resolution of VUR. Sixteen (33%) RRU underwent endoscopic correction of VUR. One required ureteric reimplantation. The remaining 4 (8%) are maintained on prophylactic antibiotics. Five (10%) patients had VUR in the upper pole moieties after ureterocele puncture. CONCLUSIONS: Our data suggest that primary endoscopic puncture of ureteroceles is a simple, long-term, effective, and safe procedure avoiding complete reconstruction in the majority of the patients.

Child↗
PubMed1995

Endoscopic Sphincterotomy and Stone Extraction.

Recent development of new cannulation techniques, improvement of lithotripsy methods, and the advent of laparoscopic cholecystectomy have extended the efficacy and broadened the application of endoscopic sphincterotomy and stone extraction. Choledocholithiasis, a condition that once was believed to invariably require surgical intervention, now can successfully be treated endoscopically in 85% to 90% of cases, with a complication rate of 7% to 10% and a mortality rate of 0.5% to 1.0%. In patients scheduled for laparoscopic cholecystectomy in whom bile duct stones are suspected, the indication and timing of perioperative endoscopic retrograde cholangiopancreatography depend on the likelihood of ductal stones being present as well as local endoscopic expertise. The increase in the number of younger patients referred for endoscopic stone extraction, mainly as a consequence of the advent of laparoscopic cholecystectomy, and the unknown long-term effects of sphincterotomy have led to the development of techniques in which stones are extracted from the bile duct without sphincterotomy. This article concentrates on the technique of endoscopic sphincterotomy and stone extraction, defines its indications (with special reference to laparoscopic cholecystectomy) and discusses occurrence and management of complications.

Journal Article↗
PubMed2001

Endoscopic surgery for pineal region tumors.

Endoscopic surgery may play an important role in most patients with pineal region tumors. We report our experience with 5 patients treated by a burr hole endoscopic technique. The procedure included in all cases third ventriculostomy for the correction of hydrocephalus, CSF sample for cytology and tumor markers, and tumor biopsy for histological diagnosis. Endoscopic biopsies showed a pineocytoma in two cases, a germinoma in 2 and a low-grade astrocytoma in one. We agree that endoscopic surgery may allow us to select cases requiring a microsurgical approach (medium-sized or large non-germ-cell tumors) from cases to be treated only by irradiation and chemotherapy (germinomas and other non-germ-cell tumors). Then, in some patients with pineal region tumors the endoscopic procedure remains the only surgical treatment. When a direct microsurgical approach is indicated, it may be performed in a non-emergency situation and after correction of the hydrocephalus by endoscopic third ventriculostomy.

Adolescent↗