这项工作得到了南山区卫生科技项目（批准号）NS2023002;NS2023044）、广东省医学科学研究基金（批准号：A2023195）、南山区卫生科技重大专项（批准号：）、广东省医学科学研究基金（批准号：号）、南山区卫生科技重大专项（批准号：号）、南山区卫生科技重大专项（批准号：NSZD2023023;NSZD2023026）、国家自然科学基金（批准号：82102640）和国家重点研发计划（批准号：2022YFC3602203）。

该协议遵守华中科技大学联合深圳医院伦理委员会制定的规定，该委员会已批准该协议。已获得患者的书面知情同意书。入组一名 31 岁的女性患者，她患有持续的左腿放射痛，视觉模拟量表 （VAS）7 等于 8。体格检查结果如下：（1）上半身右侧弯曲;（2）前倾和后倾的运动范围受限;（3）左直腿抬高试验和Braggard试验阳性;（4）左胫骨前力量4级;（5）左小腿外侧和左脚背侧麻木。MRI 证实腰椎 4-5 椎间盘突出症（左旁正中型）呈阳性。她接受过无效的门诊保守治疗，包括休息、非甾体抗炎药（塞来昔布 200 mg/天，持续 6 周）和针灸两个月。研究中使用的手术工具和设备列在 材料表中。
1.内窥镜下减压
<ol><li>体位和麻醉<ol><li>通过经椎间孔入路进行内窥镜腰椎间盘切除术8.将患者置于俯卧位，并在透视引导下标记皮肤穿刺点。局部消毒和悬垂后，将 0.5% 利多卡因 （10 mL） 注射到穿刺点。</li>
	</ol></li>
	<li>穿刺和套管放置<ol><li>使用 18 G 针在标记的穿刺点进行穿刺，并在透视下调整位置。逐步插入扩张套管（直径 3.7 毫米）并在透视下确认达到理想位置。</li>
	</ol></li>
	<li>内镜下腰椎减压术<ol><li>插入不同尺寸（直径 5 毫米、8 毫米和 10 毫米）的环钻锯并旋转以去除 L5 上关节突的颅、背和尾侧的骨头，以进行椎间孔成形术9。</li>
		<li>逐步暴露并去除软组织。观察椎间盘突出的疑似区域（丘陵状，通常与周围的平坦区域明显不同）。确定目标椎间盘突出和受压神经根10.</li>
		<li>识别并切除突出和松动的椎间盘（包括 AF、NP 和软骨终板）。检查减压的神经根，确认不存在残余椎间盘。 注意：为了确定目标突出，我们的经验是评估椎间盘材料的颜色、质地和形状。与周围的正常组织相比，破裂或突出的椎间盘可能会出现变色、碎裂或移位。为了检查减压神经根的状况，让患者咳嗽并观察减压神经根的“脉动”状态11。</li>
	</ol></li>
</ol>2. PLL-AF缝合技术
<ol><li>外侧 AF 撕裂的穿透<ol><li>使用一次性环形吻合器进行内窥镜缝合12.识别AF撕裂，并使用环形吻合器中的曲线形针头将第一针（丝制成，直径0.4 mm）穿透完整的横向AF组织（图1A）。检查并确认针脚已牢固固定（图 1B）。</li>
	</ol></li>
	<li>锁相环（PLL）缝合<ol><li>将第二针（丝质，直径 0.4 毫米）穿入 PLL 中，并确认它也穿透下方完整的内侧 AF。检查并确认针脚已牢固固定。然后，用方结拧紧第一针和第二针（图1C）。 注意：在减压后识别 PLL 有时可能具有挑战性。建议仔细操作并确定椎管的内侧和背侧区域。</li>
	</ol></li>
	<li>三、加强针脚<ol><li>在完整AF的侧面区域和第二针的颅骨位置（图1E）剪切第一针（图1D）并穿透第三针（丝绸制成，直径0.4毫米）。</li>
		<li>检查并确认针脚已牢固固定。打一个方结后剪断两针（图1F）。再次检查神经根，确保不存在压迫。</li>
	</ol></li>
</ol>3.术后管理
<ol><li>静脉注射 50 mg 氟比洛芬 axetil 治疗术后疼痛。</li>
	<li>手术后，在没有出现特殊情况或并发症的情况下，允许患者在术后一天离开床，并提供腰部支架13 （半刚性类型，带有金属或塑料支柱作为支撑）。</li>
</ol>

用于腰椎内窥镜纤维环修复的新型 PLL-AF 缝合技术

<ol>
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H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Repair,+regenerative+and+supportive+therapies+of+the+annulus+fibrosus:+Achievements+and+challenges.">Repair, regenerative and supportive therapies of the annulus fibrosus: Achievements and challenges.</a> Eur Spine J. 18 (3), 301-313 (2009).</li><li>Wang, Z., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+retrospective+study+of+the+mid-term+efficacy+of+full-endoscopic+annulus+fibrosus+suture+following+lumbar+discectomy.">A retrospective study of the mid-term efficacy of full-endoscopic annulus fibrosus suture following lumbar discectomy.</a> Front Surg. 9, 1011746 (2022).</li><li>Bird, S. B., Dickson, E. 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J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Annular+closure+device+for+disc+herniation:+Meta-analysis+of+clinical+outcome+and+complications.">Annular closure device for disc herniation: Meta-analysis of clinical outcome and complications.</a> BMC Musculoskelet Disord. 19 (1), 290 (2018).</li><li>Wang, Y., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Annulus+fibrosus+repair+for+lumbar+disc+herniation:+A+meta-analysis+of+clinical+outcomes+from+controlled+studies.">Annulus fibrosus repair for lumbar disc herniation: A meta-analysis of clinical outcomes from controlled studies.</a> Global Spine J. 14 (1), 306-321 (2024).</li><li>Ren, C., Qin, R., Li, Y., Wang, P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Microendoscopic+discectomy+combined+with+annular+suture+versus+percutaneous+transforaminal+endoscopic+discectomy+for+lumbar+disc+herniation:+A+prospective+observational+study.">Microendoscopic discectomy combined with annular suture versus percutaneous transforaminal endoscopic discectomy for lumbar disc herniation: A prospective observational study.</a> Pain Physician. 23 (6), E713-E721 (2020).</li></ol>

本研究的作者声明不存在利益冲突。

在内窥镜下实现出色的 AF 缝合具有显着的好处。预计它可以减少由 AF 破裂或隆起引起的神经机械刺激，从而减少术后残留的椎间盘源性腰痛和/或坐骨神经痛 4,12。关闭环状泪门可以减少由椎间盘释放炎症介质引起的神经根刺激5.此外，患者可以在手术后早期更有信心地活动。这种信心有助于加速恢复过程，并在恢复力量和功能方面取?...

经皮经椎间孔内窥镜椎间盘切除术 （PETD） 是一种用于切除腰椎椎间盘突出的微创手术，使用内窥镜进行 - 内窥镜是一根细管，尖端带有摄像头和灯，使外科医生能够在监视器上观察内部组织和周围结构1。通过监视器上的实时图像引导，外科医生可以通过大约 1 厘米的小皮肤切口进行套管2 的定位、穿刺和放置。接下来在内窥镜下逐步暴露，包括切除周围的软组织和椎间孔成形术以扩大目标腰椎孔的开口。一旦获得清晰的视野和足够的手术空间，就通过移除受压碎片3 对腰神经进行完全减压。
预防椎间盘突出症术后复发仍然是脊柱外科医生长期关注的问题。在手术过程中，将复发风险降至最低的一种策略是切除所有疑似分离的髓核 （NP），即使它尚未疝入耳道。这是因为破裂的纤维环 （AF） 无法完全修复，因此，易受椎间盘内压力影响的脱落 NP 组织将来可能会再疝4。
尽管在修复和再生髓核 （NP） 和纤维环 （AF） 的组织工程方面取得了可喜的进展，但它们都没有被临床证明有效5.完全减压后直接闭合心房颤动撕裂是降低腰椎间盘突出症 （LDH） 复发风险的重要技术。目前，在内窥镜检查下，最常用的 AF 修复缝合技术是在泪液部位进行简单的缝合，只需缝一针6。除了担心单针是否能产生足够的张力外，内窥镜减压后，经常会遇到环状撕裂两侧缝合面积不足（无论是质量还是数量）不足的情况。
因此，本研究提出了一种在PETD减压后缝合AF的新技术，方法是将附近的后纵韧带（PLL）拉动并缝合在AF撕裂上，并缝合三针（PLL-AF缝合技术）。

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>0.5% lidocaine&#160;</td>
			<td>Beijing Tide Pharmaceutical Co., Ltd</td>
			<td>H37022768</td>
			<td>For postoperative pain</td>
		</tr>
		<tr>
			<td>Dilatation cannula</td>
			<td>Beijing Tianqi Medical technology Co., Ltd., Beijing</td>
			<td>ZJ289019</td>
			<td>Cannulation</td>
		</tr>
		<tr>
			<td>Disposable annular stapler&#160;</td>
			<td>Medical Science &#38; Technology Co., Ltd., Beijing</td>
			<td>SMILE-L, 2020</td>
			<td>Suture</td>
		</tr>
		<tr>
			<td>Disposable stitches</td>
			<td>Medical Science &#38; Technology Co., Ltd., Beijing</td>
			<td>SMILE-L, 2020-022</td>
			<td>Stitch</td>
		</tr>
		<tr>
			<td>Flurbiprofen axetil&#160;</td>
			<td>Shandong Hualu Pharmaceutical Co., Ltd.</td>
			<td>H20041508</td>
			<td>For postoperative pain</td>
		</tr>
		<tr>
			<td>Puncture needle</td>
			<td>Beijing Tianqi Medical technology Co., Ltd., Beijing</td>
			<td>ZJ289033</td>
			<td>Puncture</td>
		</tr>
		<tr>
			<td>Trephine saws&#160;</td>
			<td>Beijing Tianqi Medical technology Co., Ltd., Beijing</td>
			<td>ZJ289036</td>
			<td>Foraminoplasty</td>
		</tr>
	</tbody>
</table>

a suture technique for ruptured annulus fibrosus following decompression under percutaneous transforaminal endoscopic discectomy

全内窥镜检查下纤维环破裂 （AF） 的缝合技术仍然具有挑战性。在完全减压后直接缝合破裂的环状撕裂已被证明可以降低内窥镜手术期间腰椎间盘突出症的复发率。内窥镜检查下的传统缝合手术仅涉及对破裂的 AF 进行简单缝合。由于泪门周围的 AF 组织薄弱且质量差，因此在缝合过程中将该区域用作针插入点可能会导致张力不足和 AF 闭合成功率低。目前，尚无基于视频的腰椎全内镜下AF撕裂缝合的详细技术说明。我们创新性地提出了一种覆盖和缝合AF撕裂的方法，即在腰椎内镜检查下拉起后纵韧带（PLL），并使用三针（PLL-AF缝合技术）。接受新型缝合技术的患者取得了令人满意的效果。手术6个月后，腰椎MRI在门诊未显示复发迹象。

在成功和充分的减压后，切除了L4/5处的突出椎间盘（图2A，A'）。在内窥镜下识别出局部 AF 撕裂（内侧和外侧撕裂边缘）和 PLL。第一次缝合确保外侧撕裂边缘得到控制和缝合。PLL 和内侧 AF 撕裂边缘与第一针一起被穿透并缝合。将第三针与第二针在第一针的颅侧绑在一起。该技术的关键点是穿透 PLL 和内侧完整 AF 并拉动以覆盖和缝合外侧 AF 撕裂。
<p class="jove...

Watch this Scientific Journal Video about Author Spotlight: Development and Application of a Novel Suture Technique for Annular Fibrosus Repair in Percutaneous Transforaminal Endoscopic Discectomy at 

作者聚焦： 经皮经椎间孔内窥镜椎间盘切除术中用于环状纤维肌瘤修复的新型缝合技术的开发和应用

该方案描述了一种创新的缝合技术，用于在经皮经椎间孔内窥镜椎间盘切除术中破裂的环状纤维。

经皮经椎间孔内窥镜椎间盘切除术减压后纤维环破裂的缝合技术

The suture technique for a ruptured annulus fibrosus (AF) under full-endoscopy remains challenging. Direct suturing of a ruptured annular tear after full ...

本研究描述了一种创新的缝合技术，用于经皮经椎间孔内窥镜椎间盘切除术中环状纤维破裂，我们提出了一种通过拉起腰椎下后纵韧带进行内窥镜检查来缝合环状纤维撕裂的方法。要进行腰椎疝症的内窥镜手术技术，外科医生必须具备丰富的经验。然而，并非每个腰椎疝患者都适合采用这种技术。在某些情况下，如果环状撕裂在减压后变得太窄，则可能不需要缝合。该技术提供了一种新的解决方案，可以解决由于传统的单碟缝合方法在腰椎内窥镜减压后出现的张力不足的问题。此外，环状纤维化撕裂周围的后纵韧带紧密可见，这有助于增加受压段处的腰椎管体积。

a-suture-technique-for-ruptured-annulus-fibrosus-following

Research

JoVE Journal

Medicine

A Suture Technique for Ruptured Annulus Fibrosus Following Decompression Under Percutaneous Transforaminal Endoscopic Discectomy

607 次观看.  Huazhong University of Science and Technology Union Shenzhen Hospital. 本研究描述了一种创新的缝合技术，用于经皮经椎间孔内窥镜椎间盘切除术中环状纤维破裂，我们提出了一种通过拉起腰椎下后纵韧带进行内窥镜检查来缝合环状纤维撕裂的方法。要进行腰椎疝症的内窥镜手术技术，外科医生必须具备丰富的经验。然而，并非每个腰椎疝患者都适合采用这种技术。在某些情况下，如果环状撕裂在减压后变得太窄，则可能不需要缝合。该?...

视频: 作者聚焦： 经皮经椎间孔内窥镜椎间盘切除术中用于环状纤维肌瘤修复的新型缝合技术的开发和应用

Topical Airway Anesthesia for Awake-endoscopic Intubation Using the Spray-as-you-go Technique with High Oxygen Flow

A patient&#39;s willingness to cooperate is an absolute precondition for successful awake intubation of the trachea. Whilst drug-sedation of patients can jeopardize their spontaneous breathing, topical anesthesia of the airway is a popular technique. The spray-as-you-go technique represents one of the simplest opportunities to anesthetize the airway mucosa. The application of local anesthetic through the working channel of the flexible endoscope is a widespread practice for anesthetists as well as pulmonologists. There is neither need for additional devices nor special training as a pre-requisite to perform this technique. However, a known clinical problem is the coughing and gagging reflex that may occur when the liquid anesthetic strikes the airway mucosa and other sensitive structures like the vocal cords. This can be avoided by the use of oxygen applied through the working channel with the aim of fogging the local anesthetic into finer particles. Furthermore, the oxygen flow provides a higher oxygen supply and contributes to a better view, dispersing mucus secretions and blood away from the lens. Using an atomizer with a high oxygen flow of 10 L/min we maximized these benefits, caused less coughing and had more satisfied and therefore cooperative patients. Possible, but very rare complications of using oxygen flow including gastric insufflation, organ rupture or barotrauma did not arise. We attribute the complication-free use of high oxygen flow to the design of the set, which permits flow and pressure release.

The topical anesthetic lidocaine was atomized using a high oxygen flow through the working channel of a flexible intubating endoscope to achieve topical airway anesthesia for awake endotracheal intubation. We prefer this modified spray-as-you-go technique for endoscopic intubation to classical bolus application because of higher patient satisfaction and better compliance.

气道局部麻醉清醒用于内镜插管使用喷雾为你去技术在高氧流量

A patient&#39;s willingness to cooperate is an absolute precondition for successful awake intubation of the trachea. Whilst drug-sedation of patients can ...

科研

医学

A Mobile Outside-in Technique of Transforaminal Lumbar Endoscopy for Lumbar Disc Herniations

Percutaneous endoscopic transforaminal lumbar discectomy (PETLD) has now become a standard of care for the management of lumbar disc disease. There are two techniques for the introduction of a working cannula with respect to disc&#8212;outside-in and inside-out. The aim of this prospective study is to describe the technical aspects of a novel mobile outside-in method in dealing with different types of disc prolapse. A total of 184 consecutive patients with unilateral lower limb radiculopathy due to lumbar disc prolapse were operated on with the mobile outside-in technique of PETLD. Their clinical outcomes were evaluated based on the type of disc prolapse they had, a visual analog scale (VAS) leg pain score, the Oswestry Disability Index (ODI), and the Macnab criteria. The completeness of the decompression was documented with a postoperative magnetic resonance imaging. The mean age of the patients was 50 &#177; 16 years and the male/female ratio was 2:1. The mean follow-up was 19 &#177; 6 months. A total of 190 lumbar levels were operated on (L1&#8211;L2: n = 4, L2&#8211;L3: n = 17, L3&#8211;L4: n = 27, L4&#8211;5: n = 123, and L5&#8211;S1: n = 19). Divided into types, the patient distribution was central: n = 14, paracentral: n = 74, foraminal: n = 28, far lateral: n = 13, superior-migrated: n = 8, inferior migrated: n = 38, and high canal compromise: n = 9. The mean operative time was 35 &#177; 12 (25 - 56) min and the mean hospital stay was 1.2 &#177; 0.5 (1&#8211;3) days. The VAS score for leg pain improved from 7.5 &#177; 1 to 1.7 &#177; 0.9. The ODI improved from 70 &#177; 8.3 to 23 &#177; 5. According to the Macnab criteria, 75 patients (40.8%) had excellent results, 104 patients (56.5%) had good results, and 5 patients (2.7%) had fair results. Recurrence (including early and late) was seen in 15 out of the 190 levels that were operated on (7.89%). This article presents a novel outside-in approach that relies on a precise landing within the foramen in a mobile manner and does not solely depend upon the enlargement of the foramen. It is more versatile in application and useful in the management of all types of disc prolapse, even in severe canal compromise and high migration.

Here we present a protocol of a novel outside-in technique of transforaminal endoscopic discectomy for lumbar disc herniations. The technical aspects of the technique, the wide indications of use, and the results of the treatment in 184 patients are described in detail.

腰椎间盘椎间盘经神经孔腰椎内窥镜的移动外技术

Percutaneous endoscopic transforaminal lumbar discectomy (PETLD) has now become a standard of care for the management of lumbar disc disease. There are ...

Murine Cervical Aortic Transplantation Model using a Modified Non-Suture Cuff Technique

With the introduction of powerful immunosuppressive protocols, distinct advances are possible in the prevention and therapy of acute rejection episodes. However, only minor improvement in the long-term results of transplanted solid organs could be observed over the past decades. In this context, chronic allograft vasculopathy (CAV) still represents the leading cause of late organ failure in cardiac, renal and pulmonary transplantation.
Thus far, the underlying pathogenesis of CAV development remains unclear, explaining why effective treatment strategies are presently missing and emphasizing a need for relevant experimental models in order to study the underlying pathophysiology leading to CAV formation. The following protocol describes a murine heterotopic cervical aortic transplantation model using a modified non-suture cuff technique. In this technique, a segment of the thoracic aorta is interpositioned in the right common carotid artery. With the use of the non-suture cuff technique, an easy to learn and reproducible model can be established, minimizing the possible heterogeneity of sutured vascular micro anastomoses.

Here, we present a protocol of heterotopic aortic transplantation in mice using the non-suture cuff technique in a cervical murine model. This model can be used to study the underlying pathology of chronic allograft vasculopathy (CAV) and can help evaluate new therapeutic agents in order to prevent its formation.

使用改性非缝合铐技术的宫颈主动脉移植模型

With the introduction of powerful immunosuppressive protocols, distinct advances are possible in the prevention and therapy of acute rejection episodes. ...

Endaural Endoscopic Atticoantrotomy (Retrograde Mastoidectomy) using a Constant Suction Bone-drilling Technique

Endoscopic middle ear surgery is a widely employed minimally invasive surgical technique to address middle ear and mastoid pathology. Bone drilling is the main technical challenge of endoscopic middle ear surgery. The accompanying video describes the detailed protocol of a constant-suction bone-drilling technique and the procedure of endaural exclusive endoscopic atticoantrotomy (retrograde mastoidectomy) using this technique. The main components of this bone-drilling technique include a soft and flexible suction tube, which is placed into the tympanic cavity to provide constant suction, and a soft sleeve, which is wrapped around the drill shaft to prevent the high-speed rotating shaft from damaging the lens of the endoscope. With these simple modifications, the traditional otological electrodrill can be used for drilling a tiny endaural incision in endoscopic middle ear surgery. Based on this bone-drilling technique, endaural endoscopic atticoantrotomy (retrograde mastoidectomy) can be successfully established for the removal of various amounts of bone, depending on the extent of the lesion. The short-term postoperative outcome seems promising.

Endaural Endoscopic Atticoantrotomy Retrograde Mastoidectomy using a Constant Suction Bone-drilling Technique

In this paper, we present the protocol and short-term outcomes of endaural exclusive endoscopic atticoantrotomy using a constant suction bone-drilling technique.

使用恒定抽吸骨术的内窥镜下盂骨切开术（逆行切除术）

Endoscopic middle ear surgery is a widely employed minimally invasive surgical technique to address middle ear and mastoid pathology. Bone drilling is the ...

A Two-Step Method for Percutaneous Transhepatic Choledochoscopic Lithotomy

Intrahepatic and extrahepatic choledocholithiasis is a challenge in the field of biliary surgery. We present our experience using a two-step percutaneous transhepatic choledochoscopic lithotomy (PTCSL) procedure to treat challenging biliary stones. We retrospectively reviewed 81 patients with intrahepatic and extrahepatic choledocholithiasis treated using this two-step PTCSL from January 2013 to January 2020, including 40 males and 41 females, with an average age of 66 years. In contrast to traditional percutaneous transhepatic cholangioscopy (PTCS), a channel was established directly through a 16F Amplatz sheath, and the stone in the channel was removed with the aid of a nephroscope. The clinical efficacy and complications of all patients were analyzed. Eighty-one patients (81/81, 100%) had their biliary stones successfully removed; 62/81 patients (76.5%) had biliary stones completely removed after the first operation; 17/81 patients (21%) underwent a second operation; 2/81 patients (2.5%) needed a third operation to completely remove the stones. The incidence of severe bleeding during the operation was 0%, and there were no deaths. The use of the two-step PTCSL method is safe and efficacious, and contributes to a better prognosis of intrahepatic and extrahepatic choledocholithiasis.

This "two-step method" significantly improved the success rate of percutaneous transhepatic choledochoscopy and achieved a better prognosis of intrahepatic and extrahepatic choledocholithiasis.

经皮经肝胆胆镜截石术的两步法

Intrahepatic and extrahepatic choledocholithiasis is a challenge in the field of biliary surgery. We present our experience using a two-step percutaneous ...

Full-Endoscopic Isolation Zone Technique for the Treatment of Lumbar Disc Herniation

Lumbar disc herniation (LDH) is a type of serious sinus or sciatic nerve dysfunction caused by nucleus pulposus protrusion and annulus fibrosus tears. Its clinical symptoms often include severe low back pain, limited lumbar movement, sciatic nerve pain in the lower limbs, and even cauda equina syndrome. The common treatment for LDH is a conservative treatment scheme involving medicine, rest, and physical therapy. However, if the conservative treatment scheme is ineffective, a surgical treatment approach is adopted. Traditional open lumbar surgery has some disadvantages, including the potential for severe surgical trauma, severe blood loss during the operation, instability of the lumbar spine, and loss of the lumbar motor unit. Among the minimally invasive surgical schemes, full-endoscopic spine surgery (FESS) is undoubtedly the most appropriate and has the advantages of minimal trauma, high safety, quick postoperative recovery, and the retention of the stable structure and the motor unit of the lumbar spine. However, simultaneously, incomplete removal of the nucleus pulposus and residual nerve dysfunction after surgery can occur. To avoid these shortcomings, we studied a specific spinal endoscopy technique, the "isolation zone" surgical strategy, which can effectively block the pain from the nerve conduction pathway by completely relieving the nerve compression and nerve dysfunction through the orderly treatment of the protruding nucleus pulposus, the fissure of the annulus fibrosus, the sinus nerve, and the surrounding inflammatory soft tissues.

Here, we present a protocol for the &#34;isolation zone&#34; technique in the treatment of lumbar disc herniation (LDH) under full-endoscopic spine surgery (FESS), including intervertebral foramen formation, targeted catheterization, nucleus pulposus resection, and annulus fibrosus formation, which together completely block the pain from the nerve conduction pathway.

全内窥镜隔离区技术治疗腰椎间盘突出症

Lumbar disc herniation (LDH) is a type of serious sinus or sciatic nerve dysfunction caused by nucleus pulposus protrusion and annulus fibrosus tears. Its ...

Fully Endoscopic Mitral Valve Repair with Percutaneous Cannulation of Groin Vessels

Endoscopic mitral valve surgery (EMS) has become a standard of care at specialized heart centers, further reducing surgical trauma compared to a traditional minimally invasive, thoracotomy-based approach. Exposure of the groin vessels for the establishment of cardiopulmonary bypass (CPB) via surgical cutdown in minimally invasive surgery (MIS) may result in wound healing disorders or seroma formation. The avoidance of surgical exposure of the groin vessels by using fully percutaneous techniques for the insertion of a CPB cannula with the implementation of vascular pre-closure devices has the potential to reduce these complications and improve clinical results. Herein, we present the utilization of a novel plug based vacsular closure device with a resobable collagen plug and the absence of suture material for closure of the arterial access for CPB in MIS. While this device was initially predominantly used in transcatheter aortic valve implantation (TAVI) procedures, with its safety and feasibility shown, we herein show that it can be used in CPB cannulation, since it is capable of closing arterial access sites up to 25 French (Fr.) in size. This device may be suitable to significantly reduce groin complications in MIS and simplify the establishment of CPB. Here, we describe the fundamental steps of EMS, including percutaneous groin cannulation and decannulation using a vascular closure device.

This protocol demonstrates in detail how to perform fully endoscopic mitral valve surgery (EMS) with percutaneous cannulation of the groin vessels, using a percutaneous plug-based vascular closure device. Fundamental steps and useful instructions are described in detail for each step.

经皮插管腹股沟血管全内镜二尖瓣修复术

Endoscopic mitral valve surgery (EMS) has become a standard of care at specialized heart centers, further reducing surgical trauma compared to a ...

<meta charset="utf8"></head><body>用微创脊柱手术治疗腰椎管狭窄症

Percutaneous Endoscopic Unilateral-Approach Bilateral Decompression for Lumbar Spinal Stenosis

Lumbar spinal stenosis (LSS) involves the narrowing of the spinal canal due to degenerative changes in the vertebral joints, intervertebral discs, and ligaments. LSS encompasses central canal stenosis (CCS), lateral recess stenosis (LRS), and intervertebral foramen stenosis (IFS). The utilization of lumbar endoscopic unilateral laminotomy for bilateral decompression (LE-ULBD) has gained popularity in the treatment of CCS and LRS. This popularity is attributed to the rapid development of endoscopic instruments and the progress of endoscopic philosophy.
In this technical report, a detailed introduction to the steps and key points of LE-ULBD is provided. Simultaneously, a retrospective review of 132 consecutive patients who underwent LE-ULBD for central canal and/or lateral recess stenosis was conducted. The outcomes after more than two years of follow-up were assessed using the visual analogue score (VAS), Oswestry Disability Index (ODI), Japanese Orthopaedic Association (JOA) scores, and the modified MacNab criteria to evaluate surgical efficacy. All 132 patients underwent LE-ULBD successfully. Among them, 119 patients were rated as "excellent," while 13 patients were rated as "good" based on the modified MacNab criteria during the last follow-up. Incidental dural tears occurred in four cases, but there were no post-operative epidural hematomas or infections. The experience demonstrates that LE-ULBD is a less invasive, effective, and safe approach. It can be considered as an alternative option for treating patients with lumbar central canal stenosis and/or lateral recess stenosis.

<meta charset="utf8"></head><body>作者聚焦：LE-ULBD 作为一种安全、有效和微创治疗腰椎管狭窄症的方法的范围

The present protocol describes the steps and key points of lumbar endoscopic unilateral laminotomy for bilateral decompression for the treatment of degenerative lumbar spinal stenosis.

经皮内窥镜单侧入路双侧减压治疗腰椎管狭窄症

Lumbar spinal stenosis (LSS) involves the narrowing of the spinal canal due to degenerative changes in the vertebral joints, intervertebral discs, and ...

Methods Article

经皮经椎间孔内窥镜椎间盘切除术减压后纤维环破裂的缝合技术