This is to certify that this dissertation entitled “ENDOSCOPIC ASSISTED ADENOIDECTOMY A COMPARATIVE STUDY OF ENDOSCOPIC ASSISTED CURETTAGE ADENOIDECTOMY WITH CONVENTIONAL CURETTAGE ADENOIDECTOMY” is a bonafide original work of Dr. C. SUBASHINI Post Graduate Student (2006- 2009) in the department of Otorhinolaryngology, Government Stanley Medical College and Hospital, Chennai in partial fulfillment of the regulations laid down by the Tamil Nadu Dr. M.G.R. Medical University, Chennai for M.S. (Branch IV) Otorhinolaryngology examination held in March 2009.
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Between February 2016 and February 2017, 25 patients were operated for MVO at emergency department, Zagazig University Hospital. History, clinical examination, laboratory investigations and computed tomography (CT) scanning or computed tomography angiography was used to confirm the diagnosis. Patients were explored and diagnosis of MVO was confirmed and variable lengths of small bowel were resected (mean = 2.25 meters) and primary anastomoses were done. Our aim was to preserve as much bowel as possible, only frankly necrotic bowel was resected initially and then all patients underwent an endoscopic assisted second-look examination 72 hours later.
Introduction: Chronic subdural hematoma (CSDH) is one of the most common types of intracranial hemorrhages and carries a significant morbidi- ty; there is no clear optimal treatment. Recurrence, pneumocephaly and sei- zures are common complications. We will evaluate outcome after inner membrane fenestration in comparison to burr-hole evacuation only in cases of CSDH. Patients and Methods: Our work was conducted on 20 patients with CSDH from February 2017 to July 2017. Endoscopic-assisted micro- scopic fenestration technique was used to do inner membrane fenestration in ten patients and the other 10 patients operated upon by traditional burr-hole evacuation. Regular follow up was done up to one month. Results: Clinical outcome was nearly the same in the two groups. Recurrence rate was only noted in the non-fenestration group (20%). Midline shift was better in the membrane fenestration group after one month and we experienced no intra- operative surgical complications related to the fenestration technique. Post- operative complications, such as Pneumocephalus and seizures, were seen in both study groups. Conclusion: Endoscopic assisted microscopic technique decreases surgical risks to do inner membrane fenestration although there is no major difference between doing fenestration or not in clinical outcome, but it may decrease recurrence, but larger studies are needed .
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Figure 4: Endoscopic views after removal of supratentorial portion of epidermoid showing right-sided part of interpeduncular fossa and right- sided medial temporal lobe. (a): ps-pituitary stalk; po-pons; ds-dorsum sellae; and cl-clivus. (b): ps-pituitary stalk; mtl-medial temporal lobe; on-oculomotor nerve; mb-midbrain; an-abducent nerve; and po-pons. (c):on-oculomotor nerve; mtl-medial temporal lobe; and sca-superior cerebellar artery. (d): ps-pituitary stalk; ma-right mamillary body; ba-basillar artery; pca-posterior cerebral artery; and sca-superior cerebellar artery
In cases of unilateral sinusitis and/or sinusitis not responding to any drug regime, possibility of a foreign body in maxillary sinus should be kept in mind. In literature, the most common cause of maxillary sinus foreign body is oroantral fistula. Detailed history focused upon any previous dental procedure or accident should be elicited. And pre-operative CT scan should be ordered. Even though endoscopic approach with wide meatotomy is the most preferred procedure, the surgeon should also be prepared for Caldwell-Luc approach and the need should rise. And efforts should be made to remove all the foreign bodies from the maxillary sinus, irrespective of the impact on the symptom profile of the patient.
Endoscope-assisted microsurgery is a practical indication for application of en- doscopic technology. Endoscopic approach minimizes potential morbidity of approaching skull base tumors. This technique is usually associated with im- proved clinical outcome, shorter operating times, and decreased need for exten- sive surgical manipulation that may lead to greater morbidity . The current study involved a heterogenous group of skull base tumors divided into 3 groups. Group 1 patients were 10 cases with medial sphenoid wing meningiomas, Group 2 patients were 10 cases with suprasellar meningiomas, and Group 3 patients were 10 cases with CPA epidermoids. In this study, endoscope-assisted micro- surgery was performed. This technique allowed good microsurgical access as- sisted with excellent lighting and visualization through the endoscope. With a total gross resection in 90% of patients, the results of the current series are con- sidered. Gross tumor resection rate was 70% in group 1 patients and was 100% in both group 2 and group 3 patients. Total resection of the tumor in early post operative radiology was obtained in 70% of Group 1 patients, 100% of Group 2 patients, in 70% of Group 3 patients and in 80% of all study patients. Total re- section of the tumor in the 3-month follow up post operative radiology was ob- tained in 70% of Group 1 patients, 100% of Group 2 patients, in 100% of Group
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Myringoplasty is repair of the perforation of tympanic membrane when middle ear space, its mucosa and ossicle are free of disease. Myringoplasty is commonly done under microscopy; Major disadvantage of operating microscope is that it provides a magnified image along a straight line. Now a day’s Endoscope is widely used to perform various surgeries and very useful while operating in cavities. Therefore in the present study we correlate the outcome of myringoplasty by microscopic method and endoscopic method.
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tomy after ESD has been performed as standard addi- tional treatment after ESD. So, from 2000 to 2006, gas- trectomy after ESD was mainly performed by open sur- gery, and after 2007 it was performed by laparoscopic surgery. Reconstruction method was changed from B-I to RY around 2007. A total of 100 patients (6.4%) required additional surgical resection, and 10 patients were ex- cluded from this study because of emergent surgery. The reason of emergent surgery was uncontrolled bleeding, perforation and pan peritonitis, occurred by ESD acci- dentally. A total of 90 patients (median age, 66 years; range, 21 - 86 years) underwent surgical resection from May 2000 to July 2010. Distal gastrectomy after ESD was performed in 61 patients (median age, 68.8 years; range, 50 - 86 years) (Figure 1). LADG-standard group was diagnosed early gastric cancer, and performed lapa- roscopic assisted distal gastrectomy since 2000.
Abbreviations: AR: Augmented Reality; CAS: Computer Assisted Surgery; DICOM: Digital Imaging and Communications in Medicine; ENT: Ear, Nose, Throat; FESS: Functional Endoscopic Sinus Surgery; HW: Hardware; IT: Information Technology; LM: Leap Motion; MacOS: Operating Systems Developed and Marketed by Apple; MIS: Minimally Invasive Surgery; MRI: Magnetic Resonance Imaging; MSCT: Multislice Computer Tomography; NCAS: Navigation Computer Assisted Surgery; NESS: Navigation Endoscopic Sinus Surgery; OMC: Ostiomeatal Complex; OR: Operation Room; SI: Swarm Intelligence; SW: Software; SWOT: Strengths, Weaknesses, Opportunities, Threats; TIM: Total Imaging Matrix Technology; TM: Telemedicine; TS: Telesurgery; VC: Voice Command; VE: Virtual Endoscopy; VS: Virtual Surgery; VR: virtual reality; VRen: Volume Rendering; VW: Virtual World; Xcode IDE: The Center of the Apple development Experience; 2D/3D/4D: Two- Dimensional/Three-Dimensional/Four-Dimensional; 3DVR: Three-Dimensional Volume Rendering
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However, there are certain disadvantages of the XMR system. It increases the cost of the procedure, the inven- tories are expensive, and it requires trained and support- ive staff. Additionally, there is of course a slight increase in the time a patient has to stay in the operating room. However, although the cost of the surgery is a little higher, the XMR system definitely avoids a high dissa- tisfaction rate after the surgery, especially in the cases of HCC and HGM discs. Moreover, nowadays, we are selectively using XMR-assisted PELD only for patients with highly migrated or sequestrated discs. Of course, patients should be given the choice after informing them of the advantages and disadvantages of the procedures, including the extra expense. However, from our experi- ence, most patients choose XMR, showing that satisfac- tion and complete removal are more important factors for them than the cost of the procedure. Although there is no absolute contraindication of this technique for canal stenosis or other types of disc herniation, we emphasized using this technique in HCC and HGM discs not to miss the remnant disc fragments and to optimize the cost effectiveness of the procedure. Ano- ther factor is the use of antibiotics in our study. As this was our first experience with the XMR, which takes an extra 20 to 30 min to shift the patient to the MR suite, we followed the protocol by prescribing 6 days of extra oral antibiotics as a precautionary measure. However, we agree that this is not required, and we now give only one shot of preoperative intravenous antibiotics.
 von Bernstorff, W., Glitsch, A., Schreiber, A., Partecke, L.I. and Heidecke, C.D. (2009) ETVARD (Endoscopic Transanal Vacuum-Assisted Rectal Drainage) Leads to Complete but Delayed Closure of Extraperitoneal Rectal Anas- tomotic Leakage Cavities Following Neoadjuvant Radiochemotherapy. International Journal of Colorectal Disease, 24, 819-825. http://dx.doi.org/10.1007/s00384-009-0673-7
Abbreviations: API: Application Program Interface; AR: Augmented Reality; CAS: Computer Assisted Surgery; FESS: Functional Endoscopic Sinus Surgery; FDA: Food and Drug Administration; HW: Hardware; IDE: Integrated Development Environment; IT: Information Technology; LM: Leap Motion; MIS: Minimally Invasive Surgery; MRI: Magnetic Resonance Imaging; MSCT: multislice computer tomography; NCAS: Navigation Computer Assisted Surgery; NESS: Navigation Endoscopic Sinus Surgery; OR: Operation Room; OMC: Ostiomeatal Complex; ROI: Region Of Interest; SDK: Software Development Kit; SI: Swarm Intelligence; SW: Software; VC: Voice Command; VE: Virtual Endoscopy; VS: Virtual Surgery; VR: Virtual Reality; VRen: Volume Rendering; VW: Virtual World; 2D: Two- Dimensional; 3D: three-Dimensional; 3DV3: 3-Dimensional Volume Rendering
gogastroduodenal endoscopic examination was normal. Colonoscopic examination revealed a 4.5 cm-sized pedunculated polyp with multiple erosive surfaces and nodularity on the polyp head. The polyp was located in the distal descending colon and occupied nearly all of the colonic lumen with its large head and long, thick stalk (Fig. 1). First, we attempted to snare the stalk with a conventional method, but this was not possible due to the large size of polyp. Thus, we attempted to remove the polyp by dissecting its
Recently, there has been an increased incidence of Barrett’s adenocarcinoma and its resection by endoscopic submuco- sal dissection (ESD) has been reported . Barrett’s esophagus originates from gastroesophageal reflux disease (GERD) and occasionally progresses to esophageal adenocarcinoma. A local resection of cancerous lesions in the Barrett’s esophagus mucosal layer (T1a) is recom- mended as a therapeutic option because it is minimally invasive. ESD is common in Japan because it allows en bloc resection of large lesion ; however, GERD-induced submucosal fibrosis beneath the cancerous lesion often makes ESD difficult to perform. A lesion occupying the
The detailed usage of TA is essential for clinical practice. In the included studies, TA was used in two methods: 1) injected into cautery ulcer base after endoscopic surgery (ESD), and it is supposed to prevent the occurrence of stenosis in high- risk patients with size of esophagus defection > 3/4; and 2) injected into the narrowest area of the esophagus stenosis combined with ED, and it is supposed to prevent the recur- rence of stenosis in esophageal stenosis patients. The TA dose was varied in three studies and fixed in 10 studies ranging from 20 to 100 mg, and the dose did not differ significantly in the two injection method studies. More detailed descriptions of TA injection are presented below.
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approximately 8 mmHg and then a 30-degree 10-mm endoscope was inserted into the subcutaneous space through the trocar sleeve. The trocar sleeve was placed in the lower exterior margin incision of breast, and the operating instruments were inserted into the other two trocars (Figure 1D). Under endoscopy, we found the tumor had been almost dissected (Figure 1E). Fibrous tissues connected with the tumor were removed and then levels I and II axillary lymph nodes were dissected endoscopically. The endoscopic dissection method of axillary lymph nodes was described previously . The dissected tumor and axillary specimen (Figure 1F) were extracted through the axillary incision. A suction drainage tube was inserted into the axillary space through the inferior trocar hole.
proach to the treatment of craniosynostosis demon- strates that the best results are obtained when pa- tients are referred very early in life. We use the concept of rapid and exponential brain growth that takes place during the first 6 months of life to achieve normocephaly. Our results indicate that the best time to perform this procedure is under 6 months of age, preferably at 3 months. Because our techniques are minimally invasive and surgery can be done quickly, concern for massive blood losses are minimized. Only 1 patient required an intraoperative blood transfusion, and of those patients who received a transfusion after surgery, none was done under life- threatening conditions. Of the 103 patients whom we treated endoscopically, only 4 patients stayed in the hospital longer than 1 day. There were no blood transfusion reactions or electrolyte or metabolic problems. Careful anthropometric and photographic documentation has shown that the majority of the patients have achieved normocephaly or significant correction, as shown in Figs 1 through 5. The overall skull smoothness and contour has been that of nor- mal children with no problems associated with me- tallic rigid fixation (or lack thereof). Analysis and comparison of hospital charges for patients who un- dergo endoscopic craniectomy reaches approxi- mately $14 000 (current Midwest hospital charges). This is compared with a cohort of 50 patients who underwent calvarial vault remodeling with an aver- age cost close to $39 000 (current Midwest hospital charges).
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the uterine cervix throughout entire surgery. Baekelandt  and Kale et al.  also reported their procedures in 10 and 7 patients, respectively. The greatest difference between this study compared with Yan et al. was that they used endoscopic techniques from the start to the end of the surgery, including colpotomies until uterus detachment. The mean OT in Baekelandt ’ s patients was 97 min and in Kale et al. was 73.1 min. Due to the lim- ited case number and simply technical report, learning curves were not discussed by these studies.
and microsurgery. Among all fields of use, the purpose of augmented reality is to simplify and to accelerate access to complex data by combining the elements of the operating field of the surgeon. Augmented reality can be applied to conventional microsurgery, but indications remain limited due to the impossibility to use endoscopy because a conventional microscope remains an exoscope and does not allow internal vision. Considering the prospects, endoscopic telemicrosurgery of the brachial plexus could evolve. From an internal view of a cavity, the anatomical structures of the brachial plexus and their relationship with other structures including vascular tissues can be difficult to identify. The registration in real time by magnetic resonance angiography images with direct intraoperative vision could act as a true anatomical global positioning system.
Robotics in CABG surgery has certainly evolved more slowly than in other surgical specialties. Some blame the absence of tactile feedback, but it also related to the meticulous nature of the surgery, which involves anastomosing 1–2 mm vessels on a potentially beating heart in a relatively fixed position within the thorax. Despite this limitation, pioneers in the field have made impressive strides, and the potential for progress is evident. With regard to robot-assisted mitral valve surgery, critics cite longer CPB times as a significant drawback of the procedure; however, these have not translated into increased perioperative morbidity, and in fact, patients tend to have shorter overall ICU and hospital stays.
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