ObjectiveTo explore the therapeutic effect of gasless endoscopic thyroidectomy via axillary posterior approach for unilateral papillary thyroid microcarcinoma. MethodsThe clinicopathologic data of patients with unilateral papillary thyroid microcarcinoma who were treated by gasless endoscopic thyroidectomy via axillary posterior approach (observation group) or breast approach (control group) in the Xuzhou Central Hospital from January 2020 to February 2022 were collected. The operation time, accidental intraoperative bleeding, exposure time of recurrent laryngeal nerve, number of lymph node dissection, total hospital stay, and postoperative complications such as superior laryngeal nerve injury, cough due to drinking, temporary hoarseness, transient hypocalcemia, tunnel hematoma, and neck discomfort were compared between the two groups. Meanwhile, the cosmetic effects of the two groups were evaluated. ResultsA total of 87 patients who met the study conditions were enrolled in this study, including 47 cases in the observation group and 40 cases in the control group. There were no statistical differences in the baseline data such as gende, age, maximum tumor diameter, location of tumor, etc. between the two groups (P>0.05). Compared with the control group, the exposure time of recurrent laryngeal nerve was shorter (P<0.001) and the number of lymph node dissection was more (P=0.034), but the accidental intraoperative bleeding during operation was more (P=0.015) in the observation group. There were no statistical differences in the operation time and total hospital stay between the two groups (P>0.05). There were no superior laryngeal nerve injury and cough due to drinking in the two groups after operation, and there were no statistical differences between the two groups in the terms of postoperative temporary hoarseness, transient hypocalcemia, and tunnel hematoma (P>0.05), but it was found that the incidence of postoperative neck discomfort in the observation group was lower than that in the control group (P=0.043), and the postoperative cosmetic satisfaction score was also higher than that in the control group (P<0.001). ConclusionsFrom the results of this study, gasless endoscopic thyroidectomy via axillary posterior approach for unilateral papillary thyroid microcarcinoma is safe and feasible. It can quickly expose the recurrent laryngeal nerve and greatly improve the efficiency of lymph node dissection, as well as the cosmetic effect is better.
Objective To study the methods and techniques of the treatment forextensive suprasellar pituitary adenona and repairing hole.Methods From Feb. 2001 to Mar. 2003, 9 patients with exrensive suporasellar pituitary adenoma underwent resection via suprabital keyhole with endoscope-assisted microneurosurgery. Then the remaining tumor was removed with neuroendoscope via Ⅰand Ⅱ space of optic chiasma. The small bone flap was fixed with Ti clamp. Results After the tumor was removed with microneurosurgery, the remaining tumor was still found with endoscope in 7 cases. Remaining tumor was totally removed in 6 cases, almost removed in 3 cases. The vision improvement was found in 7 cases one week after surgery. In the other 2 cases, the vision remained unchanged. Follow-up was conducted in 6 cases for 6 to 22 months. Neuroradiological recovery of MRI with no recurrence of tumor was observed. No complication of incision was present. Conclusion Enough intra and extra-cranial space can be provided to operate via orbital roof approach to sellar tumors. Endoscope-assisted microneurosurgery can increase the total-resection and successful rate treatment for extensive suprasellar pituitary adenoma, reduce the possibility of complication, and pretect the function of brain from being injured. Fixation of small bone flap with Ti clamp is safe, easy and reliable.
ObjectiveTo investigate the effectiveness of percutaneous endoscopic posterior cervical Key-Hole fenestration decompression and nucleus pulposus extirpation in the treatment of paracentral cervical disc herniation.MethodsBetween December 2015 and October 2018, 29 cases of paracentral cervical disc herniation were treated with percutaneous endoscopic posterior cervical Key-Hole fenestration decompression and nucleus pulposus extirpation. There were 16 males and 13 females, with an average age of 49.7 years (range, 39-78 years). The disease duration was 3.5-15.0 months (mean, 6.2 months). The herniated disc located at C3, 4 in 2 cases, C4, 5 in 5 cases, C5, 6 in 9 cases, C6, 7 in 12 cases, and C7, T1 in 1 case. The main symptoms were radiculopathy symptom. The operation time, intraoperative blood loss, hospital stay, and complications were observed and recorded. Visual analogue scale (VAS) score, Japanese Orthopaedic Association (JOA) score, cervical range of motion (ROM), Macnab standard, and cervical segment stability were used to evaluate the efficacy and safety of the operation.ResultsAll patients were followed up 11-43 months, with an average of 19.4 months. The operation time was 67-89 minutes (mean, 73.3 minutes); the intraoperative blood loss was 18-30 mL (mean, 22.9 mL); the hospital stay was 5-10 days (mean, 7.3 days). All the incisions healed by first intention. There was 1 case of hypodynia and hyperalgesia in the affected limb after operation,1 case of decreased limb muscle strength. The VAS scores and JOA scores at each time point after operation were superior to those before operation (P<0.05). There was no significant difference between the time points after operation (P>0.05). At last follow-up, the effectiveness was rated according to the Macnab standard as excellent in 11 cases, good in 15 cases, fair in 2 cases, and bad in 1 case, with an excellent and good rate of 89.7%. The CT and MRI showed the decompression of spinal canal and nerve canal. There was no significant difference in cervical ROM between pre- and post-operation (t=1.427, P=0.165), and no surgical segment instability occurred by X-ray films of flexion and extension of cervical vertebrae.ConclusionFor the paracentral cervical disc herniation with simultaneous compression of nerve roots and spinal cord, percutaneous endoscopic posterior cervical Key-Hole fenestration decompression and nucleus pulposus extirpation has the advantages of small trauma, quick recovery, and satisfactory effectiveness, and can be used as a safe and effective minimally invasive procedure.
ObjectivesTo explore the efficacy and prognostic factors of neuroendoscopic intracerebral hematoma evacuation in the treatment of hypertension-related intracerebral hemorrhage.MethodsA total of 122 patients with hypertension-related intracerebral hemorrhage treated in our hospital from October 2015 to May 2019 were categorized into experimental group (n=62) and control group (n=60). The experimental group was treated with endoscopic intracerebral hematoma removal, while the control group was treated with traditional craniotomy. The operative indexes, postoperative recovery, serum endothelin, IL-6, CRP levels and the incidence of postoperative complications were observed and compared between the two groups, and the relevant factors affecting the prognosis of patients undergoing neuroendoscopic intracerebral hematoma evacuation were analyzed.ResultsThe operation time, intraoperative blood loss, hematoma clearance rate, ICU treatment time, the volume of brain edema 7 days after operation, the postoperative intracranial pressure, NIHSS score and ADL score in experimental group were significantly superior to those in control group. The levels of serum endothelin, IL-6 and CRP in the experimental group were significantly lower than those in the control group after operation. The incidence of complications in the experimental group was lower than that in control group. Univariate analysis showed that the prognosis of patients undergoing neuroendoscopic evacuation of intracerebral hematoma was significantly correlated with the history of hypertension, preoperative GCS score, the amount of bleeding and whether been broken into the ventricle (P<0.05), but not with age, sex and location of hemorrhage (P>0.05). Multivariate logistic regression analysis showed that the history of hypertension above 10 years, blood loss above 50 mL, intraventricular rupture and preoperative GCS score were the risk factors affecting the prognosis of patients undergoing neuroendoscopic intracerebral hematoma evacuation.ConclusionsCompared with traditional craniotomy, neuroendoscopic evacuation of intracerebral hematoma has the advantages of better curative effect and lower incidence of postoperative complications in the treatment of hypertension-related intracerebral hemorrhage. The history of hypertension above 10 years, bleeding volume above 50 mL, breaking into the ventricle and preoperative GCS score are the risk factors affecting the prognosis of patients undergoing neuroendoscopic intracerebral hematoma evacuation.
The capsule endoscope swallowed from the mouth into the digestive system can capture the images of important gastrointestinal tract regions. It can compensate for the blind spot of traditional endoscopic techniques. It enables inspection of the digestive system without discomfort or need for sedation. However, currently available clinical capsule endoscope has some limitations such as the diagnostic information being not able to correspond to the orientation in the body, since the doctor is unable to control the capsule motion and orientation. To solve the problem, it is significant to track the position and orientation of the capsule in the human body. This study presents an AC excitation wireless tracking method in the capsule endoscope, and the sensor embedded in the capsule can measure the magnetic field generated by excitation coil. And then the position and orientation of the capsule can be obtained by solving a magnetic field inverse problem. Since the magnetic field decays with distance dramatically, the dynamic range of the received signal spans three orders of magnitude, we designed an adjustable alternating magnetic field generating device. The device can adjust the strength of the alternating magnetic field automatically through the feedback signal from the sensor. The prototype experiment showed that the adjustable magnetic field generating device was feasible. It could realize the automatic adjustment of the magnetic field strength successfully, and improve the tracking accuracy.
This consensus aims to elucidate the applications of 3D fluorescence technology in thoracic surgery, summarizing its clinical value and prospects in areas such as sub-lobar resection, mediastinal structure protection, and lymph node dissection, providing a reference for the clinical practice of 3D fluorescence technology in thoracic surgery. Furthermore, this consensus is committed to advancing the research and innovation of domestically produced 3D fluorescence medical endoscopes. It seeks to clarify clinical practice needs and technical development directions, promote the widespread application of high-quality domestic medical endoscopes, and support the independent innovation and development of China's medical equipment industry.
ObjectiveTo summarize our experience in the treatment of esophageal foreign bodies.MethodsA retrospective analysis of 149 patients of esophageal foreign bodies in the Second Affiliated Hospital of Air Force Military Medical University from December 2011 to May 2019 was carried out, including 75 (50.3%) females and 74 (49.7%) males with an average age of 57 (2-85) years.ResultsThere were 146 patients confirmed by endoscopy, and 3 patients were not found foreign body. Among the confirmed patients, 127 patients were removed by gastroscope and 19 patients were treated by operation. Esophageal foreign bodies are mainly related to the types of food. Jujube seed is the most common food foreign body in the northwest China. The injury rate of mucosal was 47.54% within 48 hours. The complication rate of taking out the foreign body after 48 hours was 100.0%. The success rate by endoscopy decreased (P=0.005), if the foreign body combined perforation. There was no statistical difference between the neck and other parts when using ultra-fine gastroscope (P=0.157).ConclusionThe sharper the foreign body is, the easier the perforation is. The earlier the foreign body is removed, the less complications are. The size of the foreign body determines the difficulty of endoscopic removal. Gastroscopy is the first choice for diagnosis and treatment, especially ultra-fine gastroscopy, and the foreign bodies that cannot be removed by endoscopy need surgical treatment.
Objective To investigate the effectiveness of spinal canal decompression with microendoscopic disectomy (MED) and pillar vertebral space insertion through pedicle of vertebral arch for thoracolumbar neglected fracture. Methods Between February 2006 and November 2009, 30 patients with thoracolumbar neglected fracture were treated by spinal canal decompression with MED and pillar vertebral space insertion through pedicle of vertebral arch. There were 22 males and 8 females with an average age of 36.2 years (range, 17-58 years). The disease duration was 6 weeks to 14 months with an average of 5.3 months. All patients had single vertebral compression fracture, including T9 in 1 case, T11 in 2 cases, T12 in 5 cases, L1 in 11 cases, L2 in 5 cases, L3 in 5 cases, and L4 in 1 case. The preoperative Cobb angle was (27.5 ± 7.5) ° . The preoperative height of vertebrae was (26.67 ± 5.34) mm. The visual analogue score (VAS) was 5.8 ± 1.4. According to Wolter classification for spinal canal stenosis, there were 17 cases of grade 1, 10 cases of grade 2, and 3 cases of grade 3. According to Frankel grade, 3 cases were in grade A, 8 cases in grade B, 13 cases in grade C, and 6 cases in grade D. Results The average operation time was 70 minutes (range, 40-120 minutes) and the average blood loss was 180 mL (range, 100-400 mL). The hematoma occurred in 1 case, and other incisions healed by first intension. No deep vein thrombosis of the lower extremity occurred. All patients were followed up 26 months on average (range, 24-46 months). The Cobb angle and vertebral height at 3 days and last follow-up were significantly improved when compared with ones before operation (P lt; 0.01). At last follow-up, the spinal canal stenosis was grade 0 in 27 cases and grade 1 in 3 cases according to Wolter classification. At 24 months after operation, the spinal function was obviously improved; 1 case was in grade A, 1 case in grade B, 3 cases in grade C, 9 cases in grade D, and 16 cases in grade E according to Frankle grade, showing significant differences when compared with preoperative ones (P lt; 0.05). The VAS score at 1 month after operation was significantly higher than that before operation (P lt; 0.01), then the score showed downtrend along with time, and it was significantly lower at 24 months after operation than before operation (P lt; 0.01). Conclusion Spinal canal decompression with MED and pillar vertebral space insertion for thoracolumbar neglected fracture has short surgical time, less blood loss, and satisfactory reduction, but higher technical requirement is necessary for MED.
Objective To describe the current state of hospital infection prevention and control for flexible endoscope in Shanghai, and analyze the trend of infection prevention and control quality from 2018 to 2022. Methods According to Regulation for Cleaning and Disinfection Technique of Flexible Endoscope (WS 507－2016), the quality of infection prevention and control for flexible endoscope was divided into seven parts: organizational management, layout, cleaning and disinfection (sterilization) process, environmental disinfection and sterilization, final rinse water, recording and monitoring, and occupational protection. Each quality control item was judged according to the on-site score and the correction opinion, and the item with correction opinion was judged as “unqualified”, otherwise it was “qualified”. The results of the infection prevention and control quality supervision for flexible endoscope from 2018 to 2022 were reviewed and analyzed, and the qualification rates of quality control items for hospitals at different levels and in different years were calculated. Results From 2018 to 2022, the total qualification rates of organization management, final rinse water, environmental disinfection and sterilization, and occupational protection were over 90%, and the total qualification rates of cleaning and disinfection (sterilization) process, and records and monitoring were over 80%. There was no statistically significant difference in the annual qualification rate (P>0.05). The total qualification rate of the layout was 78.19%, which was significantly higher before the outbreak of COVID-19 (2018-2019) than after the outbreak of COVID-19 (2020-2022) (P<0.001). There was no significant difference in the qualification rate of different levels of hospitals in terms of organizational management, layout, cleaning and disinfection (sterilization) process, records and monitoring, or occupational protection item (P>0.05). There were statistical differences in the qualification rates of different levels of hospitals in terms of final rinse water and environmental disinfection and sterilization (P<0.05). Conclusions The infection prevention and control qualification rate of flexible endoscope in Shanghai is high. However, the layout qualification rate after the COVID-19 pandemic is lower than before. There has been no significant trend in the quality of other items in the past five years. Weaknesses in the cleaning and disinfection (sterilization) process, as well as in recording and monitoring, are identified as key areas in management. Targeted training and supervision are recommended to address these weaknesses.
Objective To explore the application of robot-assisted pedicle screw fixation combined with total endoscopic decompression and interbody fusion in single segment lumbar decompression and fusion. Methods A total of 27 cases undergoing single segment lumbar decompression and fusion between August 2020 and May 2021 in the People’s Hospital of Deyang City were retrospectively collected. They were divided into group A and B according to their surgery method. The patients in group A underwent robot-assisted pedicle screw fixation combined with total endoscopic decompression and interbody fusion surgery, while the ones in group B underwent traditional posterior decompression and fusion. The operation time, amount of bleeding, Visual Analogue Scale (VAS) score and Oswestry Disability Index (ODI) score before operation and one month and three months after operation, and success rate of screw placement were compared. Results There were 12 patients in group A, 5 males and 7 females, aged (59.83±6.79) years, and 15 patients in group B, 6 males and 9 females, aged (53.73±14.87) years. The amount of intraoperative bleeding [(195.00±45.23) vs. (240.00±47.06) mL] and postoperative hospital stay [(5.92±1.56) vs. (8.33±3.62) d] in group A were less than those in group B (P<0.05), while the operation time [(185.80±52.13) vs. (160.70±21.37) min] and the success rate of screw placement [100.0% (48/48) vs. 96.7% (58/60)] had no statistical difference between the two groups (P>0.05). The VAS score and ODI score of the two groups decreased significantly over time (P<0.05), but there was no significant difference in VAS score between the two groups at the same time point before operation, one month after operation, or three months after operation (P>0.05). The ODI score of group A was better than that of group B one month after operation (P=0.010), but there was no significant difference between the two groups before operation or three months after operation (P>0.05). Conclusion Compared with traditional open surgery, the application of robot-assisted total endoscopic lumbar decompression and fusion technology in single segment lumbar fusion has good early clinical outcome, high success rate of screw placement, and small trauma, which is beneficial to early functional recovery and has the significance of further exploring its application prospect.