Name: endoscopic septoplasty with limited two-line resection: minimally invasive surgery for septal deviation
Uploaded: 2018-06-20T13:30:00.000+00:00
Duration: 6 min 13 s
Description: Watch this Scientific Journal Video about Endoscopic Septoplasty with Limited Two-line Resection: Minimally Invasive Surgery for Septal Deviation at JoVE.com

この作品は、若手研究者 (No. 81300810) 中国の国家自然科学基金、上海の若い医師の研修 (第 20141057)、上海自然科学基金 (第 16ZR1405100)、上海市によって賄われていた健康と家族計画 (ナンバー 201740187) の委員会。我々 はこの原稿の準備の間に言語の援助を提供するため LetPub (www.letpub.com) に感謝を思います。

ヒトを対象に関与、この手順は、眼耳鼻咽喉科病院、復旦大学、中国の制度上の審査委員会によって承認されました。提供されているすべての登録患者には、インフォームド コンセントが書き込まれます。
1. 手術のための準備
<ol><li>術前に、患者の鼻腔前方 rhinoscopy、内視鏡検査、コンピューター断層撮影 (CT) スキャンして確認し、偏差を見つけると15の兆候を識別するためとを調べます。</li>
	<li>全体として彼らの鼻の開存性を評価するために、手術前に視覚アナログ スケール (VAS) にこれを示すために患者をお願いします。 注: スケールの合計の長さが 10 cm、1 つの極端が、完全に明確な鼻 (すなわち、0 cm 得点 0%)、他の極端な鼻が完全につまって (10 cm の 100% を獲得)、センター 50% 閉塞と鼻。</li>
	<li>両方の鼻ホール 1 日手術前に、で上唇を削除します。</li>
	<li>手術の日、動作表16にそれらを配置した後、患者に全身麻酔を管理します。 注: は、麻酔とプロポ フォール、sulfentanyl、0.2 μ g/kg、0.6 mg/kg ロクロニウムの 2 〜 2.5 mg/kg を誘発します。0.1 μ g/kg/min のレミフェンタニルの持続静脈内投与とセボフルラン (0.8 最小肺胞濃度) の吸入麻酔を維持します。</li>
	<li>オペレーティング テーブル (背の高い位置) に 30 ° の傾斜し、(どちらも曲げても拡張) 中立的な立場で患者の頭部を置きます。</li>
</ol>2. 手術
注: は、全体の操作中に 0 度の内視鏡を使用します。
<ol><li>急勾配の 1% テトラカインと 0.1% エピネフリン 4 mL 20 mL の混合液とガーゼ (6 cm × 60 cm) を 8 個。鼻の粘膜を縮小に 5 分間、各鼻腔に 1 浸したガーゼの部分を置きます。</li>
	<li>手順の最後でエレベーターのある鼻腔の外側壁に向かって鼻甲介下を置きます。</li>
	<li>0.9 の 20 mL の混合液の数ミリリットルで 5 mL 注射器の針を用いて中隔に潜入 % 食塩水と、subperichondrial で 0.1% エピネフリン 0.05 mL と隔壁の両側の骨膜下面。 注: 場合両側に鼻中隔偏位していた、我々 定義凸側前方偏差の側として。</li>
	<li>第 15 刃隔軟骨の最大偏差 (すなわち、凸側) の同側側粘膜皮膚接合部でキリアン切開を確認します。中隔、鼻腔の床に続きをできるだけ高く、鼻腔の床に達した時点で後方に曲線の縦切開を開始します。 注: 切開は、鼻中隔の粘膜軟骨膜に浸透する必要があります。</li>
	<li>出血の場合は、吸引のエレベーターの subperichondrial 面の粘膜フラップを上げます。出血、なし 2 mm または 5 mm のエレベーターとフラップを上げます。上向きと下向きに凸の側の軟骨性と骨質の中隔を完全に公開鼻腔の床には、可能な限り高い標高を拡張します。</li>
	<li>背と四角形の軟骨の接合部と篩骨の垂直板の前方下軟骨に 2 mm エレベーターや数 15 刃の鋭い端を使用して縦切開をする (すなわちの最初の行、2LoRs). 同様に、四角形の軟骨、鼻中骨および上顎クレスト (つまり、2 番目の行) の接合部に優れた軟骨の横切開を行う (図 2 a)。 注: この方法で骨の中隔にその後方と下の添付ファイルから動員は中隔の軟骨と前部と優れた添付ファイルはそのまま残ります。</li>
	<li>吸引のエレベーターを持つ二国間骨の中隔を公開する側の口蓋を昇格させます。</li>
	<li>中隔の軟骨と (図 1 b) 隣接する骨の中隔の後部と下余白の 2 つのストリップを切除します。<ol>
<li>1/4、1/3 (時折 1/3、1/2) の最初の行 (図 2 b) 前後の寸法で軟骨の元の幅を切除します。</li>
		<li>1/4、1/3 (時折 1/3、1/2) (図 2) の 2 番目の行に垂直方向に軟骨の元の高さを切除します。</li>
	</ol>
</li>
	<li>肥厚骨中隔偏差を削除し、偏差を正中線に移動する部分的な破壊の変位を実行します。 注: 後部と下骨の中隔の豊富な除去は、すべての厚さとこの地域での奇形をオフにです。</li>
	<li>電気焼灼で、術中の出血を制御します。</li>
	<li>吸収性材料 (図 2 D) と二つの縫合による粘膜フラップを近似します。<ol>
<li>後方切開縫合糸を開始、反対側に隔壁を介してそれらを渡す、それらを皮膚切開部位の前方から戻ってプルします。</li>
		<li>それぞれ自分自身に縫合糸を結び目。2 つの縫合はパラレル、他の上の 1 つを配置します。</li>
	</ol>
</li>
</ol>3. の手順と手術後の評価
<ol><li>Nasopore と鼻腔をパックします。</li>
	<li>患者が血腫や中隔の感染症をチェックする手術後 1 週間を確認します。</li>
	<li>前方 rhinoscopy と 0 度内視鏡と鼻腔内を調べ、手術後 6 ヶ月 VAS で鼻の開存性を評価するために患者をお願いします。</li>
	<li>レコードの術後の鼻中隔血腫、一時的な歯の痛み、塞栓、癒着、鼻出血、鼻中隔膿瘍、中隔スイング、中隔穿孔、背は、手術の合併症として崩壊します。</li>
</ol>

<ol>
	<li>Chung, B. J., Batra, P. S., Citardi, M. J., Lanza, D. C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Endoscopic+septoplasty:+revisitation+of+the+technique,+indications,+and+outcomes.">Endoscopic septoplasty: revisitation of the technique, indications, and outcomes.</a> The American Journal of Rhinology. 21 (3), 307-311 (2007).</li><li>Hwang, P. H., McLaughlin, R. B., Lanza, D. C., Kennedy, D. W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Endoscopic+septoplasty:+indications,+technique,+and+results.">Endoscopic septoplasty: indications, technique, and results.</a> Otolaryngology-Head and Neck Surgery. 120 (5), 678-682 (1999).</li><li>Fettman, N., Sanford, T., Sindwani, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Surgical+management+of+the+deviated+septum:+techniques+in+septoplasty.">Surgical management of the deviated septum: techniques in septoplasty.</a> Otolaryngologic Clinics of North America. 42 (2), 241-252 (2009).</li><li>Killian, G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+submucous+window+resection+of+the+nasal+septum.">The submucous window resection of the nasal septum.</a> Annals of Otology, Rhinology &amp; Laryngology. 14, 363-393 (1905).</li><li>Freer, O. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+correction+of+deflections+of+the+nasal+septum+with+a+minimum+of+traumatism.">The correction of deflections of the nasal septum with a minimum of traumatism.</a> The Journal of The American Medical Association. 38, 636-642 (1902).</li><li>Aaronson, N. L., Vining, E. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Correction+of+the+deviated+septum:+from+ancient+Egypt+to+the+endoscopic+era.">Correction of the deviated septum: from ancient Egypt to the endoscopic era.</a> International Forum of Allergy &amp; Rhinology. 4 (11), 931-936 (2014).</li><li>Bloom, J. D., Kaplan, S. E., Bleier, B. S., Goldstein, S. 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M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Newer+concepts+of+septum+surgery;+present+status.">Newer concepts of septum surgery; present status.</a> Eye, Ear, Nose &amp; Throat Monthly. 27 (9), 403-406 (1948).</li><li>Gibson, T., Davis, W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+distortion+of+autogenous+cartilage+grafts:+Its+causes+and+prevention.">The distortion of autogenous cartilage grafts: Its causes and prevention.</a> British Journal of Plastic Surgery. 10, 257-274 (1958).</li><li>Kenedi, R. M., Gibson, T., Abrahams, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Mechanical+characteristics+of+skin+and+cartilage.">Mechanical characteristics of skin and cartilage.</a> Human Factors. 5, 525-529 (1963).</li><li>Stenstroem, S. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+&amp;#34;natural&amp;#34;+technique+for+correction+of+congenitally+prominent+ears.">A &amp;#34;natural&amp;#34; technique for correction of congenitally prominent ears.</a> Plastic and Reconstructive Surgery. 32, 509-518 (1963).</li><li>Fry, H. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Interlocked+stresses+in+human+nasal+septal+cartilage.">Interlocked stresses in human nasal septal cartilage.</a> British Journal of Plastic Surgery. 19 (3), 276-278 (1966).</li><li>Wang, T., 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+modified+septoplasty+with+three+high+tension+lines+resection.">A modified septoplasty with three high tension lines resection.</a> Acta Oto-Laryngologica. 130 (5), 593-599 (2010).</li><li>Trimarchi, M., Bellini, C., Toma, S., Bussi, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Back-and-forth+endoscopic+septoplasty:+analysis+of+the+technique+and+outcomes.">Back-and-forth endoscopic septoplasty: analysis of the technique and outcomes.</a> International Forum of Allergy &amp; Rhinology. 2 (1), 40-44 (2012).</li><li>Kilicaslan, A., Acar, G. 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著者が明らかに何もありません。

2LoRs プロシージャは、逸脱した鼻の隔壁の胎生学的、解剖学的知識に基づいています。鼻中隔は、3 つの異なるコンポーネントで構成されています: 前方の膜、真ん中の軟骨と後部と下の骨。鼻中隔の開発、中にさまざまなコンポーネントは異なる時系列で骨化します。通説では、軟骨がまだ成長しながら骨がその拡張を完了すること。したがって、軟骨を鼻中隔が変形して初期勢力で、その...

内視鏡 septoplasty が鼻中隔偏差1によって引き起こされる鼻の気道閉塞を治療するために耳鼻科で一般的に行わ手術です。鼻の気道閉塞の徴候と、septoplasty の目的は鼻気道の開存性の機能の改善を提供するために、原則は最小限の外科的侵襲2隔偏差を修正します。
Septoplasty、まだ今日使用されているプロシージャの先頭トレース バック フリーア、キリアン公開粘膜切除 (SMR)3と呼ばれていた初期の 20 世紀の技術。SMR は、鼻4、5の外観を構造的にサポートするための L 字の支柱を残して subperichondrial 平面の鼻軟骨偏差の直接の除去によって特徴付けられます。SMR は、徐々 に受け入れ、その時に、前の技術上の利点を示した。1990 年代、内視鏡検査は septoplasty1に適用されました。照明や手術場の可視化が非常に改善されて、直接かつ正確に切除を実行可能性があります6。その後、SMR の徴候が拡張されたと様々 な septoplasty 技術を開発しました。これらのテクニックは、切開、フラップの上昇、切除、縫合、またはパッキングの多様化が、一方、この直接除去の本質は変わっていません。したがって、軟骨を切除した大きく、一度、大中隔穿孔や鞍鼻変形などの合併症は7、8を発生します。
コトルと 1948 年に提案した Loring、逸脱した軟骨の切除は保守的な9をする必要があります。軟骨の偏差の直接の除去とは異なり、septoplasty に適用される軟骨のバイオメカニクスを必要と限られた手術で軟骨の偏差をまっすぐに軟骨の弾性特性の利用部分切開 (例えば傷や薄いスライス) と (例えば、完全カットまたはくさび) 完全切開などの介入。1958 年にギブソンとデイビス最初、軟骨が報告その成長パターン10の結果として内部自己ロック ストレス システム。凹面の側面の部分切開は凸側切開が強化、お辞儀、軟骨の湾曲を減らす、ストレスをリリースでしょう。1963 年、ケネディ、ギブソン、Abrahams はさらに肋骨軟骨11断面力分布をマッピングに関する研究のシリーズを通して自己ロック ストレス システムを実証。同じ年では、・ ステンスト ロームは antihelix12部分切開の効果を確認しました。数年後、フライは、一貫性のある13であった人間の鼻の中隔軟骨で結果を公開しました。つまり、軟骨の力学は、軟骨内で力を解放することによって軟骨の形態を変更する使用できます。この基礎理論に基づき、軟骨の力学的機能の活用術は、先進14でした。
後部と下の接合部に 2 回線切除 (2LoRs) の技術と鼻中隔、ここで、変更された内視鏡 septoplasty プロシージャの発生学と解剖学的知識を持つ以前手術を組み合わせることにより、軟骨性と骨質の隔壁 (図 1) が詳細に表示されます。この手順は外部鼻の奇形はない、鼻の開存性を改善するためにまたは真ん中の道または術前操作として介内の腋窩部へのアクセスを改善するときに逸脱した鼻の隔壁を修正する勧めします。この手順は、その低侵襲アプローチのため隔偏差を修正するため、子供で使用される可能性があります。

<table><tbody><tr><td>Nasal Endoscopy (0&lt;sup&gt;o&lt;/sup&gt;)</td><td>Karl Storz-Endoskope</td><td>7230 AA</td><td></td></tr><tr><td>Tetracaine</td><td>Eye &amp;amp; ENT Hospital of Fudan University</td><td>180130</td><td></td></tr><tr><td>Epinephrine Hydrochloride Injection</td><td>Shanghai Harvest Pharmaceutical Co., Ltd</td><td>10170405</td><td></td></tr><tr><td>Number 15 blade</td><td>Shanghai Pudong Jinhuan Medical Products Co., Ltd</td><td>35T1205</td><td></td></tr><tr><td>Suction Elevator</td><td>Zhejiang Tian Song Medical Products Co., Ltd</td><td>B2117.1</td><td>Width: 4 mm</td></tr><tr><td>Electrocoagulation</td><td>Shanghai Hutong Electronics. Co.,Ltd</td><td>GD350-B5</td><td></td></tr><tr><td>4-0 Brided Absorbable Suture</td><td>Covidien Healthcare</td><td>SL-691</td><td></td></tr><tr><td>Rongeur forcep</td><td>Zhejiang Tian Song Medical Products Co., Ltd</td><td>B2300.3</td><td></td></tr><tr><td>Nasopore</td><td>Nasopore, Stryker, USA</td><td></td><td>Lengh: 8 cm</td></tr><tr><td>Gauze</td><td>Ningbo Shenyuan Medical Material Co., Ltd</td><td></td><td>6 cm x 60 cm</td></tr><tr><td>5mm Elevator</td><td>Zhejiang Tian Song Medical Products Co., Ltd</td><td>B2067</td><td>Width: 5 mm</td></tr><tr><td>2mm Elevator</td><td>Shanghai Medical Instruments (Group) Ltd., Corp. Surgical Instruments Factory</td><td>HBL020</td><td>Width: 2 mm</td></tr></tbody></table>

endoscopic septoplasty with limited two-line resection: minimally invasive surgery for septal deviation

内視鏡 septoplasty は鼻中隔偏差によって引き起こされる鼻の気道閉塞を治療するために実行される一般耳鼻咽喉科手術です。それは、複数のバリエーションで長い歴史を持ちます。鼻腔の発生学と解剖学的知識に基づいて軟骨性と骨質の中隔の後部と下交差点 2 回線切除 (2LoRs) 手法を使用して変更された内視鏡 septoplasty 手順を提示この記事で中隔と軟骨の動作のバイオメカニクス。この手順では、四角形の軟骨を保持できます、できるだけ支援する枠組みと鼻中隔の維持に有用であります。2LoRs は、効果的かつ稀な合併症で鼻中隔偏差の補正のためサウンドに実証されています。鼻の開存性を改善するためにまたは真ん中の道または中鼻甲介の腋窩領域へのアクセスを改善するために任意の外部鼻の変形のない状態で鼻腔鼻中隔の偏位を修正するこの修正の手順を適用できます。子どもや若者にその低侵襲アプローチのため septoplasty の適応症の拡大にも使えます。

成人患者 (> 18 歳の) 鼻中隔偏差でこの研究に含まれていた。除かれた septoplasty の以前の手術歴のある方や慢性副鼻腔炎、副鼻腔腫瘍、外鼻変形、伴う鼻中隔偏位を伴う患者。まっすぐ背、尾側軟骨の脱臼をした患者から大きい鼻翼も除外された鼻の玄関の 1 つに、突出していた。
30 人の患者は、この研究に含まれていた?...

Watch this Scientific Journal Video about Endoscopic Septoplasty with Limited Two-line Resection: Minimally Invasive Surgery for Septal Deviation at JoVE.com

Endoscopic Septoplasty with Limited Two-line Resection: Minimally Invasive Surgery for Septal Deviation

内視鏡 septoplasty は、複数のバリエーションで由緒ある手術です。本稿は 2 回線切除として知られている変更された septoplasty の手順を実行するステップバイ ステップの手術アプローチに焦点を当ててください。この手技は、外部鼻変形のない状態で逸脱した鼻中隔の修正を適用できます。

2 回線切除と内視鏡 Septoplasty: 隔偏差の低侵襲手術

Endoscopic septoplasty is a surgical procedure in otolaryngology that is commonly performed to treat nasal airway obstruction caused by nasal septal ...

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16.6K ビュー.  Fudan University. 内視鏡 septoplasty は、複数のバリエーションで由緒ある手術です。本稿は 2 回線切除として知られている変更された septoplasty の手順を実行するステップバイ ステップの手術アプローチに焦点を当ててください。この手技は、外部鼻変形のない状態で逸脱した鼻中隔の修正を適用できます。

ビデオ: Endoscopic Septoplasty with Limited Two-line Resection: Minimally Invasive Surgery for Septal Deviation

Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas

Endoscopic endonasal trans-sphenoidal surgery has become the gold standard for the surgical treatment of pituitary adenomas and many other pituitary lesions. Refinements in surgical techniques, technological advancements, and incorporation of neuronavigation have rendered this surgery minimally invasive. The complication rates of this surgery are very low while excellent results are consistently obtained through this approach.
This paper focuses on the step-by-step surgical approach to pituitary adenomas, which is based on personal experience, and details the results obtained with this minimally invasive surgery.

The aim of this paper is to describe the different steps of the endoscopic endonasal approach to the sella turcica.

内視鏡内視鏡下鼻内のトランス蝶アプローチ: 下垂体腺腫に対する低侵襲手術

Endoscopic endonasal trans-sphenoidal surgery has become the gold standard for the surgical treatment of pituitary adenomas and many other pituitary ...

神経科学

Combined Endoscopic and Transoral Approach for Total Maxillectomy

The technique of maxillectomy has been revised since it was first described in the 1820s. During the past decade, the endoscopic approach has been widely practiced for resecting maxilla. Compared with the traditional approaches, the combined endoscopic and transoral approach has many advantages such as avoiding facial incisions and postoperative scars and better visualization of the surgical margin. However, this technique is complicated to master and possess several challenges. Here, we demonstrate this approach step-by-step to show how to perform a total maxillectomy. We also reported nine cases with malignant tumors originating from the maxilla, and for all of them total maxillectomy was performed with combined endoscopic and transoral approach. Our data showed that the combination of the endoscopic and transoral approach could be used to resect the total maxilla successfully, though the tumor extended to the infratemporal and pterygopalatine fossa should be treated very carefully to avoid its spread in the local area. Furthermore, besides denture, other reconstruction methods should be attempted to improve the postoperative quality of life after the total maxillectomy.

The technique of maxillectomy has been revised since it was first described in the 1820s. During the past decade, the endoscopic approach has been widely ...

医学

Low-Cost Single-Port (LoCoSP) Device for a Transcervical Approach in Minimally Invasive Transhiatal Esophagectomy

Esophagectomy remains the preferred option to achieve curative treatment in advanced esophageal cancer, but the choice of surgical approach remains controversial. A transthoracic approach may improve lymph node dissection, but it has considerable morbidity and respiratory complications. Transhiatal access has been demonstrated as an efficient means of minimizing post-operative complications. Minimally invasive transhiatal esophagectomy may reduce operative trauma and morbidity as well as enhance postoperative recovery with no compromise in cancer recurrence or survival. Nevertheless, it has a technical limitation in terms of cervical esophagus dissection. Thus, a low-cost single-port device was developed to complete upper mediastinal dissection by a transcervical approach during minimally invasive transhiatal esophagectomy. This device uses a nasogastric tube, a number-eight sterile glove, a sterile sponge, and 3 permanent 5-mm trocars. The step-by-step process of transhiatal esophagectomy and the development of this device are described. This technique allows for the dissection of the upper mediastinum, as well as the esophagus over the aortic arch and behind the superior portion of the trachea. The harvesting of lymph nodes along the left recurrent laryngeal nerve and paratracheals was improved.

Low-Cost Single-Port LoCoSP Device for a Transcervical Approach in Minimally Invasive Transhiatal Esophagectomy

Here, we describe a step-by-step description of transhiatal esophagectomy and the development of a low-cost single-port device for a transcervical approach in a minimally invasive transhiatal esophagectomy.

低侵襲性経食道術における経子宮頸アプローチのための低コストシングルポート(LoCoSP)デバイス

Esophagectomy remains the preferred option to achieve curative treatment in advanced esophageal cancer, but the choice of surgical approach remains ...

The Microscopic Transcanal Approach in Stapes Surgery Revisited

The microscopic transcanal (aka transmeatal) surgical approach was first described in the 60s, offering a minimally invasive means of reaching the external auditory canal, the middle ear, and epitympanon. Such an approach avoids a retroauricular or endaural skin incision; however, working through a narrow space needs angled microsurgical instruments and specific training in otologic surgery. The transcanal approach restricts the working space; however, it offers a binocular microscopic vision into the middle ear without extended skin incisions and thus, reducing post-operative pain and bleeding. In addition, this minimally invasive approach avoids scar tissue complications, hypoesthesia of the auricle, and potential protrusion of the pinna. Despite its numerous advantages, this method is still not routinely performed by otologic surgeons. Since this minimally invasive technique is more challenging, there is a need for extensive training in order for it to be widely adopted by otologic surgeons. This article provides step-by-step surgical instructions for stapes surgery and reports possible indications, pitfalls, and limitations using this microscopic transcanal technique.

This article describes the microscopic transcanal technique for stapes surgery, providing step-by-step surgical instructions for familiarizing surgeons with this approach.

ステープ手術における顕微鏡経管アプローチの再考

The microscopic transcanal (aka transmeatal) surgical approach was first described in the 60s, offering a minimally invasive means of reaching the ...

Endoscopic Cholesteatoma Surgery

Implementation of endoscopes in cholesteatoma surgery resulted in considerable changes in the management of cholesteatoma in the last two decades. Compared to the microscopic approach with an excellent but straight-line view and limited illumination, the introduction of endoscopes provides a wide-angled panoramic view. Moreover, angled lenses allow the surgeon to visualize the middle ear and its hidden recesses through a transcanal, minimally-invasive approach. The endoscope enables the surgeon to remove limited cholesteatoma of the middle ear and its recesses using an exclusive endoscopic technique by taking advantage of these benefits. This reduces the rate of residual disease and sparing external incisions and excessive temporal bone drilling as in a transmastoid approach. Since transcanal endoscopic access is mainly a one-handed technique, it implies the need for specific procedures and technical refinements. This article describes a step-by-step guide as a surgical manual for endoscopic removal of epitympanic cholesteatoma. Different techniques for cholesteatoma dissection and bone removal for epitympanectomy, including curettage and powered instruments such as drills and ultrasonic devices with their outcomes, are discussed. This may offer ear surgeons insight into technical refinements and the latest technological developments and open the horizon for different techniques.

The present protocol describes a step-by-step guide for the complete endoscopic removal of epitympanic cholesteatoma with different techniques for cholesteatoma dissection and bone removal for epitympanectomy.

内視鏡的胆汁うっ滞症手術

Implementation of endoscopes in cholesteatoma surgery resulted in considerable changes in the management of cholesteatoma in the last two decades. ...

Full-Endoscopic Decompression for Thoracic Ossification of the Ligamentum Flavum Combined with Dural Ossification

Ossification of the ligamentum flavum (OLF) can result in spinal stenosis. Thoracic spinal cord compression due to spinal stenosis is a common cause of progressive thoracic myelopathy in Asian countries. The incidence of complications is high in open decompression surgeries for thoracic OLF. With dural ossification (DO), the risk of complications is even higher in thoracic OLF. We introduce a full-endoscopic decompression surgery for thoracic OLF combined with DO under local anesthesia. Hemilaminectomy is performed using a high-speed burr under the endoscopy first, and then decompression of the contralateral spinal canal is completed using an "over the top" technique. DO resection uses the eggshell technique; after the base of the DO is cut from the lamina, forceps or lamina rongeurs are typically used for removal. The dural defect left after resection does not need repair. Neurological function was improved, and no complications such as hematoma or neck pain occurred. On imaging, no pseudodural cyst, cerebrospinal fluid leakage, or wound complications were observed after the operation. Endoscopic surgery causes less damage to the posterior ligament complex, so no cases of persistent back pain complaints or secondary internal fixation requirements were found in this study. Full-endoscopic decompression can achieve good imaging and clinical effects in the treatment of thoracic OLF with DO.

We describe a minimally invasive surgery using a full-endoscopy system for the single segmental thoracic ossification of the ligamentum flavum, combined with dural ossification, at Hebei General Hospital.

Ossification of the ligamentum flavum (OLF) can result in spinal stenosis. Thoracic spinal cord compression due to spinal stenosis is a common cause of ...

Full-Endoscopic Interlaminar Approach for Decompression of Lateral Recess Stenosis

For lateral recess stenosis, extensive decompression with laminectomy is still performed in most centers. However, tissue-sparing surgeries are becoming more common. Full-endoscopic spinal surgeries have the advantages of being less invasive and offering a shorter recovery time. Here, we describe the technique of the full-endoscopic interlaminar approach for the decompression of lateral recess stenosis. The full-endoscopic interlaminar approach for the lateral recess stenosis procedure took approximately 51 min (range of 39-66 min). Blood loss could not be measured due to continuous irrigation. However, no drainage was required. There were no dura mater injuries reported in our institution. Furthermore, there were no injuries to the nerves, no cauda equine syndrome, and no hematoma formation. The patients were mobilized on the same day as surgery and discharged the next day. Therefore, the full-endoscopic technique for lateral recess stenosis decompression is a feasible procedure that lowers the operational time, complications, traumatization, and rehabilitation duration.

Technical advances and increased experience in full-endoscopic spinal surgeries enable these procedures to be performed with minimal incision, muscle retraction, and bone removal.

For lateral recess stenosis, extensive decompression with laminectomy is still performed in most centers. However, tissue-sparing surgeries are becoming ...

Clinical Application of Single-Surgeon, Three-Port, Laparoscopic Resection for Colorectal Cancer with Natural Orifice Specimen Extraction

Reduced-port laparoscopic surgery (RPLS) has been widely used for the radical resection of gastrointestinal tumors. Single-surgeon, three-port, laparoscopic radical resection for sigmoid colon or high rectal cancer with natural orifice specimen extraction surgery (NOSES) has the advantage of a small incision, quick postoperative recovery, and short hospital stay. Yet, there are still only a few reports on NOSES. This paper describes the indications, preoperative preparations, surgical steps, and precautions for single-surgeon, three-port, laparoscopic radical resection of the sigmoid colon and high rectal cancer, and intraoperative specimen collection through the natural orifice. 
The protocol focuses on the steps of radical dissection and the main technical points of resection and reconstruction. At the same time, a procedure for fixing an anvil seat by self-traction of extracorporeal silk thread, used for purse-string suture fixation after the proximal anvil was placed in the abdominal cavity, was creatively improved. This operation could effectively avoid problems such as an insufficient proximal intestinal tube, shaking off the anvil seat, and weak purse-string suture during a single operation. The surgical care had less variability and was easy to perform, effectively avoiding postoperative anastomotic leakage and bleeding due to excessive intraoperative anastomotic tissue. This surgery could be widely promoted in primary hospitals.

Here, we present a protocol to successfully perform single-surgeon, three-port, laparoscopic resection for colorectal cancer with natural orifice specimen extraction.

天然オリフィス検体抽出による大腸癌に対する単一外科医、3ポート、腹腔鏡下切除術の臨床応用

Reduced-port laparoscopic surgery (RPLS) has been widely used for the radical resection of gastrointestinal tumors. Single-surgeon, three-port, ...

Endoscopic Balloon Dilatation of the Eustachian Tube via the Soft Palate Approach in Miniature Pigs

The eustachian tube (ET) is one of the most complex organs in the human body, and its dysfunction may lead to a variety of diseases. In recent years, an increasing number of scholars have opted to conduct ET-related studies using large experimental animals such as miniature pigs or sheep, yielding promising results. Typically, conventional endoscopic procedures are performed through the nasal approach for large experimental animals. However, due to the elongated and narrow nasal cavity in these animals, transnasal surgeries are challenging. 
To address this issue, we explored an ET surgery approach via the soft palate. The animal was placed in a supine position. After endotracheal intubation under general anesthesia, a mouth opener was used to fully expose the upper palate. Local infiltration with diluted adrenal fluid was performed for anesthesia of the area. A sickle knife was then used to make a longitudinal soft palate incision at the junction of the soft and hard palates. After hemostasis, an endoscope was inserted into the nasopharynx cavity, allowing the visualization of the pharyngeal opening of the ET on the posterior lateral wall of the nasal cavity. 
Subsequently, a specialized pusher was used to insert a balloon into ET. The balloon was inflated, maintained at 10 bar for 2 min, and then removed. The incision in the soft palate was then sutured to ensure proper alignment. The soft palate healed well after the operation. This surgical approach is suitable for ET-related procedures in large experimental animals (e.g., miniature pigs, sheep, and dogs). The surgical procedure is simple, with a short surgical time, and wound healing is rapid. Under endoscopy, the pharyngeal opening of the ET is visible, and it is thus a good choice for procedures such as balloon dilation of the ET.

In this study, we present a protocol to explore an eustachian tube surgery approach via the soft palate in miniature pigs. The surgical procedure is simple, with short surgical time, and wound healing is rapid; it is thus a good choice for procedures such as balloon dilation of the eustachian tube.

The eustachian tube (ET) is one of the most complex organs in the human body, and its dysfunction may lead to a variety of diseases. In recent years, an ...

Surgical Management of Persistent or New Symptoms After Hiatal Hernia Repair

Following a hiatal hernia repair, patients can present with recurrent or new symptoms. Symptoms can occur anywhere from weeks to years after surgery. These may include recurrent reflux, dysphagia, regurgitation, weight loss, or deteriorating quality of life. While nonoperative management can be pursued in some patients, reoperation may be the only option in select patients. A thorough preoperative workup, including a repeat esophagram, upper endoscopy, +/- chest computed tomography (CT) scan, manometry, pH probe, and/or gastric emptying study, is warranted to better understand the pathophysiology of the presenting symptoms. If a recurrent hernia, slipped, or migrated wrap is identified, surgery is considered. Pseudoachalasia must also be ruled out if obstructive symptoms are observed at the hiatus. Such an exhaustive workup is indeed necessary to ensure accurate diagnosis and optimal outcome. In addition, an understanding of the factors that may have led to the recurrence will increase the chances of a successful reoperation. Although a technically demanding procedure, redo hiatal hernia repair utilizing a minimally invasive approach is increasingly being employed with promising outcomes. Herein, the steps of a redo hiatal hernia repair via a minimally invasive approach will be outlined and detailed.

Redo foregut surgery is challenging in today's clinical practice and is fraught with increased morbidity and reportedly a lower 'success' rate than the index procedure. Here, we present a protocol for a redo hiatal hernia repair via a minimally invasive approach.

Following a hiatal hernia repair, patients can present with recurrent or new symptoms. Symptoms can occur anywhere from weeks to years after surgery. ...