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Direct Vision (direct + vision)
Selected AbstractsENDOSCOPIC NECROSECTOMY UNDER DIRECT VISION AFTER ENDOSCOPIC ULTRASOUND-GUIDED CYSTGASTROSTOMY FOR ORGANIZED PANCREATIC NECROSISDIGESTIVE ENDOSCOPY, Issue 1 2008Takeshi Hisa A 56-year-old man was referred for an enlarging pancreatic pseudocyst that developed after severe acute pancreatitis with gallstones. Abdominal ultrasound showed a huge cystic lesion with a large amount of solid high echoic components. Arterial phase contrast-enhanced computed tomography scan revealed arteries across the cystic cavity. Stents were placed after endoscopic ultrasound-guided cystgastrostomy; however, the stents were obstructed by necrotic debris, and secondary infection of the pseudocyst occurred. Therefore, the cystgastrostomy was dilated by a dilation balloon, and a forward-viewing endoscope was inserted into the cystic cavity. Many vessels and a large amount of necrotic debris existed in the cavity. Under direct vision, all necrotic debris was safely removed using a retrieval net and forceps. One year after this procedure, there was no recurrence. Our case indicates that peripancreatic fat necrosis can cause exposure of vessels across/along the cystic cavity, and blind necrosectomy should be avoided. [source] Difficult laparoscopic cholecystectomy in acute cholecystitis: use of ,finger port', a new approachHPB, Issue 3 2003R Sinha Background Adhesions in acute cholecystitis tax even the more experienced operator during laparoscopic cholecystectomy. Blunt and sharp dissection, electrocautery, laser, hydrodissection, and ultrasonic dissection may all have their limitations. Thus there is a need for an alternative and more effective method. Method Laparoscopic cholecystectomy was carried out in 281 patients with acute cholecystitis. Separation of the gallbladder from the adherent structures was carried out in 13 patients, using the forefinger of the left hand introduced through the right hypochondrial port. In two patients a second finger was introduced through the epigastric port. Results The mean time required for the dissection was 7.9 minutes. Finger dissection failed in three patients because of dense adhesions on a high subcostal position of the gallbladder. Discussion Finger dissection is easy, fast, and limits injury because of the direct vision and tactile sensation, which are missing in other methods of laparoscopic dissection. [source] Genetically Manipulated Human Skeletal Myoblast Cells for Cardiac TransplantationJOURNAL OF CARDIAC SURGERY, Issue 6 2002Kh H Haider Aim: Considering the promise of skeletal myoblast cell transplantation to improve cardiac function in myocardial myopathies, we aim in the present study to investigate the potential of human skeletal myoblast cells (HSMC) as a carrier for therapeutic genes for the heart muscle. Methods: Skeletal muscle sample is obtained from rectus femoris of the donor and is processed in the tissue culture to generate HSMC by a patented process of Cell Therapy Inc. The HSMC are grown in large 225 mm2 tissue culture flasks coated with collagen for enhanced cell adherence, using patented Super Medium (Cell Therapy Inc., Singapore) containing 10% fetal calf serum, to 80% confluence. The HSMC are passaged at regular time intervals of 48-72 hours to prevent in vitro differentiation. The HSMC thus obtained are transduced three times with retroviral vector carrying Lac-Z reporter gene before transplantation. The Lac-Z transduced HSMC are harvested by trypsinization, washed and re-suspended in serum free Super Medium. Ischemic Porcine model is created by clamping ameroid ring around left circumflex coronary artery in Yorkshire swine, four weeks prior to cell transplantation. For cell transplantation, the animal is anaesthetized, ventilated and heart is exposed by left thoracotomy. Fifteen injections (0.25 ml each) containing 300 million cells are injected in to the left ventricle endocardially under direct vision. For control animal, only culture medium without cells is injected. The animal is euthanized at pre-determined time, heart is explanted and processed for histological examination. The cryosectioning of the tissue and subsequent staining for Lac-Z expression and Hematoxylin-Eosin staining is carried out by standard methods. Results: The skeletal muscle samples processed by the patented method of Cell Therapy yield 85-90% pure HSMC. The preliminary data shows that repeated transductions of myoblast cells with retrovirus carrying Lac-Z yield highly efficient 70-75% Lac-Z positive HSMC population (Figure 1). Dye exclusion test using Trypan blue reveals >95% cell viability at the time of injection. Gross sections of the cardiac tissue stained positive for Lac-Z expression (Figure 2). Histological examination showed the presence of grafted myoblast cells expressing Lac-Z gene in the cardiac tissue (Figure 3). Conclusion: In the light of our preliminary results, we conclude that HSMC may prove to be excellent carriers of transgene for cardiac muscle cells which otherwise are refractory to ordinary gene transfection methods. The use of HSMC mediated gene delivery to cardiac muscle is safer as compared to direct injection of viral vectors in to the heart muscle. Furthermore, the grafted myoblast cells will additionally serve to strengthen the weakened heart muscle. Figure 1.Human Skeletal myoblasts transduced with Lac-Z carrying retrovirus and stained with x-gal. Figure 2.Gross sections of heart muscle stained for Lac-Z expression. Figure 3.X-gal stained porcine heart muscle counter-stained with Eosin. The heart was explanted 6 weeks after transplantation of Lac-Z stained human myoblasts. The arrow shows Lac-Z expressing myoblast cells. [source] A Xiphoid Approach for Minimally Invasive Coronary Artery Bypass SurgeryJOURNAL OF CARDIAC SURGERY, Issue 4 2000Federico Benetti M.D. However, opening the pleura has been a limitation of using these approaches. Aim: We used the xiphoid approach as an alternative to opening the pleura and to minimize pain after minimally invasive coronary artery bypass surgery. Methods: We review our surgical experience in 55 patients who underwent minimally invasive direct coronary artery bypass (MIDCAB) surgery through a xiphoid approach between October 1997 and August 1999. Thoracoscopy (n = 31) or direct vision (n = 24) were used for internal mammary artery (IMA) harvesting. Mean patient age was 67 ± 10 years and 65% were men. The mean Parsonnet score was 23 ± 10. Performed anastomoses included left IMA (LIMA) to the left anterior descending (LAD) artery (n = 53), LIMA-to-LAD and saphenous vein graft from the LIMA to the right coronary artery (n = 1), and LIMA-to-LAD and right IMA (RIMA) to right coronary artery (n = 1). Results: Postoperative complications included atrial fibrillation (12%), acute noninfectious pericarditis (12%), and acute renal failure (5%). Mean postoperative length of stay was 4 ± 2 days. Angiography was performed in 16 patients and demonstrated excellent patency of the anastomoses. There was no operative mortality. Actuarial survival was 98% in a mean follow-up period of 11 ± 5 months. Conclusions: Minimally invasive coronary artery bypass can be performed safely through a xiphoid approach with low morbidity, mortality, and a relatively short hospital stay. [source] Endoscopic fibrin sealing of gastrocutaneous fistulas after sleeve gastrectomy and biliopancreatic diversion with duodenal switchJOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 12 2008Theodossis S Papavramidis Abstract Background and Aim:, Gastrocutaneous fistulas (GCF) are uncommon complications accounting for 0.5,3.9% of gastric operations. When their management is not effective, the mortality rate is high. This study reports the conservative treatment of GCF in morbidly obese patients who underwent biliopancreatic diversion with duodenal switch. Methods:, Ninety-six morbidly obese patients were treated in our department with biliopancreatic diversion with duodenal switch (Marceau technique) and, in six of them, a high-output GCF developed. A general protocol was applied to all patients presenting a GCF. Everyone was treated by total parenteral nutrition (TPN) and somatostatin for at least 7 days after the appearance of the leak. If the leak continued, then fibrin glue was used as a tissue adhesive. Endoscopic application of the sealant was accomplished under direct vision via a double-lumen catheter passed through a forward-viewing gastroscope. Results:, All patients were treated successfully with conservative treatment (either solely with TPN and somatostatin, or with endoscopic fibrin sealing sessions). No evidence of fistula was observed at gastroscopy 3 and 24 months after therapy. Conclusion:, The conservative treatment of GCF following biliopancreatic diversion with duodenal switch is highly effective. All patients should enter a protocol that includes TPN and somatostatin. When the GCF persist, endoscopic sealing glue should be considered before operation because it is simple, safe, effective and, in some cases, life-saving. Therefore, conservative treatment should be employed as a therapeutic option in GCF developing after bariatric surgery. [source] The Surgical Anatomy of Lumbar Medial Branch Neurotomy (Facet Denervation)PAIN MEDICINE, Issue 3 2004Peter Lau FRACR ABSTRACT Objective., To demonstrate the validity of placing electrodes parallel to the target nerve in lumbar radiofrequency neurotomy. DESIGN., Previous data on the anatomy of the lumbar dorsal rami were reviewed and a demonstration cadaver was prepared. Under direct vision, electrodes were placed on, and parallel to, the L4 medial branch and the L5 dorsal ramus. Photographs were taken to record the placement, and radiographs were taken to illustrate the orientation and location of the electrode in relation to bony landmarks. Results., In order to lie in contact with, and parallel to, the target nerve, electrodes need to be inserted obliquely from below, so that their active tip crosses the neck of the superior articular process. At typical lumbar levels, the tip should lie opposite the middle two quarters of the superior articular process. At the L5 level, it should lie opposite the middle and posterior thirds of the S1 superior articular process. Conclusion., If electrodes are placed parallel to the target nerve, the lesions made can be expected to encompass the target nerves. If electrodes are placed perpendicular to the nerve, the nerve may escape coagulation, or be only partially coagulated. Placing the electrode parallel to the nerve has a demonstrated anatomical basis, and has been vindicated clinically. Other techniques lack such a basis, and have not been vindicated clinically. Suboptimal techniques may underlie suboptimal outcomes from lumbar medial branch neurotomy. [source] MULTIDISCIPLINARY PAIN ABSTRACTS: 5PAIN PRACTICE, Issue 1 2004Article first published online: 15 MAR 200 In this study, the authors prospectively evaluated whether abnormalities at the lumbar level as diagnosed by magnetic resonance imaging (MRI) are confirmed by epiduroscopy, and assessed if targeted epidural injection of medication alleviates sciatic pain. A flexible, 0.9-mm fiberoptic endoscope was introduced through a disposable steering shaft into the caudal epidural space and advanced until the targeted spinal nerve was identified. Adhesions were mechanically mobilized under direct vision, and a mixture of 120 mg methylprednisolone acetate, 600 IU hyaluronidase, and 150 ,g clonidine was applied locally. Pain scores were measured by the visual analog scale (VAS) and global subjective efficacy rating. Nineteen of 20 patients studied showed adhesions via epiduroscopy. Six patients showed concomitant signs of active root inflammation. Of 20 patients treated with a targeted epidural injection, 11 patients experienced significant pain relief at 3 months. This was maintained at 6 months for eight of the patients, at 9 months for seven of the patients, and at 12 months for seven of the patients. Mean VAS at 3 months was significantly reduced and this persisted at 12 months Epiduroscopy is of value in the diagnosis of spinal root pathology. In sciatica, adhesions unreported by MRI can be identified. Targeted epidural medication administered near the compromised spinal nerve results in substantial and prolonged pain relief. [source] The Value of Breast Ductoscopy in Radiologically Negative Spontaneous/Persistent Nipple DischargeTHE BREAST JOURNAL, Issue 4 2009Ercument Tekin MD Abstract:, Breast ductoscope is a fiberoptic endoscope used for examining the distal breast ducts under direct vision in order to identify the source of pathologic nipple discharge. The purpose of this study was to investigate the reliability of intra-operative breast ductoscopy in patients with pathologic nipple discharge, which could not be identified by radiologic tests. Between April 2002 and March 2007, breast ductoscopy was performed in 34 patients who had pathologic nipple discharge with no radiologic evidence about the source. The procedures were carried out under general anesthesia and ductoscopic findings were as well as the histopathology of the specimens were recorded and documented. In 88%, (30 of 34) of the patients, endoscope was successfully introduced into the external orifice of the ducts at the nipple and proximal breast ducts were successfully visualized. Ductoscopy revealed intraductal lesions (i.e., ductal obstruction, intraductal papilloma, red patches, and erythematoid platter) in 20 patients (66%). Among the 20 patients with visible endoluminal pathology, nine had a papilloma and eight had signs of either acute inflammation (bleeding, erythema) or previous inflammation with healing (adhesions and blocked ducts). In two cases, invasive breast carcinoma was identified, one of which was ductal carcinoma in situ (DCIS) with minimal invasion. In both cases, there had been blocked ducts. In one case DCIS was identified. Breast ductoscopy is a reliable and easy-to-use method to demonstrate the source of pathologic nipple discharge in cases with bleeding and other intraductal lesions. [source] Long-Term Results of Endonasal Sinus Surgery in Sinonasal PapillomasTHE LARYNGOSCOPE, Issue 9 2003Marcel Kraft MD Abstract Objective To assess the value of endonasal sinus surgery in the management of sinonasal papillomas. Study Design Retrospective study including 43 patients operated on for sinonasal papilloma in a long-term follow-up. Methods In 26 cases (60%) an endonasal approach, in eight cases (19%) an external approach, and in four cases (9%) a combined procedure was performed to remove these tumors. Five septal lesions (12%) were resected under direct vision. The original sections and charts of all patients were reviewed to assess clinical data. Follow-up information was available for 42 of our patients (98%) with a mean follow-up of 62 months. Results Histologic examination revealed 34 cases of inverted papilloma (79%), five cases of exophytic papilloma (12%), and four cases of columnar cell papilloma (9%). Malignancy occurred in 4 of 43 patients (9%), and recurrences developed in 8 of 42 patients (19%). Two of these recurrences happened after endoscopic sinus surgery (two inverted papillomas), three after lateral rhinotomy (three inverted papillomas), one after a combined procedure (one inverted papilloma), and two after simple resection (two exophytic papilloma). Conclusions In keeping with our experience, the endonasal endoscopic approach, often in combination with a medial maxillectomy, is favored for the treatment of sinonasal papilloma because of a lower recurrence rate and a better cosmetic result. In some larger tumors and lesions in difficult locations, better visualization can be obtained by a combined external and endonasal approach. [source] Awake intubation using the LMA-CTrachÔ in patients with difficult airways,ANAESTHESIA, Issue 4 2009A. M. López Summary We studied 21 patients with known difficult airways who underwent awake tracheal intubation using the LMA CTrachÔ. Patients were given midazolam, atropine, a continuous infusion of remifentanil and topical lidocaine applied to the oropharyx. We limited the number of insertion attempts to three and the time to adjust the view to 5 min. In case of failure, we performed awake fibreoptic tracheal intubation. We found insertion of the device was successful and well tolerated in all patients. Vocal cords could be seen immediately in nine patients and following corrective manoeuvres in 10 patients. Tracheal intubation was successful in 20 patients: 19 cases under direct vision and in one blindly. In one patient with undiagnosed lingual tonsil hyperplasia, tracheal intubation was impossible using the device. No patient had an unpleasant recall of the procedure. We conclude that the LMA CTrach is easy to use, well tolerated and suitable for awake orotracheal intubation in patients with known difficult airways. [source] Evaluation of laparoscopic surgery for Hirschsprung's disease from the standpoint of invasiveness and colonic motility: Prolapsing technique with extra-anal mucosectomyASIAN JOURNAL OF ENDOSCOPIC SURGERY, Issue 3 2009Y Morikawa Abstract Objective: Laparoscopic pull-through has become the standard surgical modality for Hirschsprung's disease in the field of pediatric surgery. This article discusses the minimal invasiveness of the prolapsing technique. This technique allows mucosectomies to be performed under direct vision even at the deepest dissected portion because the procedure is conducted via an extra-anal approach. Method: The laparoscopic prolapsing technique (Lap) is compared with the conventional open Soave technique in terms of the change in CRP and WBC, defecation function, both clinical and manometric, after surgery. Results: As a result, the timing of surgery has become earlier and the patients younger. Soiling occurs in 33% of open Soave and 0% of Lap patients. Manometry after Lap. pull-through revealed a positive recto-anal inhibitory reflex in 39% and evoked high amplitude propagated contraction was demonstrated in 85% of patients. Conclusion: These results suggest that the present technique, including minimal dissections of the mesentery and the preservation of pelvic nerves in combination with fine mucosectomy under direct vision, could be beneficial for postoperative anorectal function in patients with Hirschspurung's disease. [source] Concomitant management of renal calculi and pelvi-ureteric junction obstruction with robotic laparoscopic surgeryBJU INTERNATIONAL, Issue 9 2005Fatih Atug Authors from the USA describe their experience using robotic-assisted laparoscopic pyeloplasty and stone extraction, and present their technical recommendations. They point out the not unexpected finding that concurrent stone extraction and pyeloplasty was rather longer than in patients having pyeloplasty alone. OBJECTIVE To present technical recommendations for robotic-assisted laparoscopic pyeloplasty (RALP) and stone extraction, as patients with kidney stones proximal to a pelvi-ureteric junction obstruction (PUJO) present a technical challenge, and have traditionally been managed with open surgery or percutaneous antegrade endopyelotomy. PATIENTS AND METHODS From November 2002 to April 2005, 55 patients had RALP for PUJO; eight of these had concomitant renal calculi. Stone burden and location were assessed with a preoperative radiological examination. Before completing the PUJO repair, one robot working arm (cephalad one) was temporarily undocked to allow passage of a flexible nephroscope into the renal pelvis and collecting systems under direct vision. Stones were extracted with graspers or basket catheters and removed via the port. The surgical-assistant port in the subxiphoid area was used to introduce laparoscopic suction and other instruments. RESULTS The Anderson-Hynes dismembered pyeloplasty was the preferred reconstructive technique in all patients. Operations were completed robotically with no conversions to open surgery. All patients were rendered stone-free, confirmed by imaging, and there were no intraoperative or delayed complications during a mean (range) follow-up of 12.3 (4,22) months. The mean operative time was 275.8 min, 61.7 min longer than in patients who did not have concomitant stone removal. CONCLUSIONS Concurrent stone extraction and PUJO repair can be successful with RALP. Operative times are longer than in patients with isolated PUJO repair, but this is to be expected as there is an additional procedure. [source] | |||||||||||||||||||