Biomedical subjects

V V Poorten

Publications and source records attributed to V V Poorten.

3 recordsLinked to original sources

PubMed2000

An image-based 3D planning environment for hemicricolaryngectomy and reconstruction by tracheal autotransplantation.

OBJECTIVE: A new conservation method for unilateral glottal cancer with significant subglottal extension consists of a hemicricolaryngectomy and subsequent reconstruction of the laryngeal defect with a transferable patch of revascularized cervical trachea. In order to restore the three crucial functions of the larynx - airway patency, speech, and swallowing--the reconstructed larynx should resemble a situation with one paralyzed and one intact vocal fold at the glottal level. We hypothesize that this result can be achieved when the tracheal patch meets a typical surgical constraint--the so-called paramedian position at the glottal level - and when the patch is rigidly applied. This hypothesis was tested by developing and using an image-based planning system in a number of situations. MATERIALS AND METHODS: An image-based surgery simulator was developed according to the working hypothesis. To validate the transfer from planning towards actual surgery, a cadaver study was set up. Based on a patient case-study, the sufficiency of the hypothesis for obtaining good functional results was evaluated. Finally, post-operative images of patients who were doing well after being operated without pre-operative planning were compared with retrospective planning to check the necessity of the hypothesis in obtaining good functionality of the neolarynx. RESULTS: We were able to design an efficient surgery simulator. The transfer from planning towards actual surgery is accurate, and satisfactory functional results were obtained from the patient case-study. The results from the retrospective planning showed that the hypothesis is not necessary to obtain good functional results, and that the smallest possible resection is preferred from the oncological point of view. CONCLUSION: The working hypothesis is sufficient for good functional results, but is unnecessary and often undesirable from an oncological point of view. Important lessons are drawn concerning our long-term goal of pre-operative determination of the shape and position of a tracheal patch suitable for optimizing the (neo-) laryngeal functions.

Cadaver↗

PubMed2000

Cutting forceps in functional endoscopic sinus surgery.

Twenty years of Functional Endoscopic Sinus Surgery have brought about a large amount of innovations and a variety of instruments, all claiming to result in better endoscopic procedures and/or better postoperative outcome. An example of such an innovation is the cutting forceps, which has been claimed to result in better wound healing. However, like several other instruments, it has never been proven to be superior to conventional non-cutting forceps techniques. A prospective, randomised double-blind study in 100 consecutive patients, undergoing bilateral FESS, compared the short term clinical outcome of surgery using cutting instruments to that of non-cutting instruments. Symptoms and endoscopic findings were evaluated at four time points during the first three postoperative weeks. Both types of surgery resulted in reduction of symptoms and in endoscopically visible healing over time, but no significant difference between the two methods was found, neither in symptom relief, nor in endoscopic impression of improvement. In conclusion, endoscopic sinus surgery with cutting instruments can be considered effective in resolving sinus disease. However, these instruments do not generate a better healing process than non-cutting instruments in the first weeks postoperatively.

Adolescent↗

PubMed1998

Tracheal autotransplantation: a reliable reconstructive technique for extended hemilaryngectomy defects.

OBJECTIVES: Current surgical treatment for a glottic cancer with significant subglottic extension is a total laryngectomy. The objective of this study was to expand laryngeal conservation procedures by using a reconstructive technique that allows for the repair of hemicricolaryngectomy defects. STUDY DESIGN: After resection of the ipsilateral thyroid, cricoid, and arytenoid for advanced T3 glottic cancer, the laryngeal defect was reconstructed by means of an autotransplanted segment of trachea in four patients. The reconstruction consisted of a transferable patch that was constructed from a segment of revascularized cervical trachea. METHODS: During a 14-day period, a 4-cm segment of cervical trachea was wrapped by a free radial forearm fascial flap. In the second stage, the glottic cancer was removed and the cervical trachea was isolated on its fascial blood supply and transformed into a patch that was used to repair the extended hemilaryngectomy defect. Two different patch designs were used. Two patients underwent reconstruction with a patch augmented at the glottic level (group A); two patients underwent reconstruction without glottic augmentation on the patch (group B). Tracheal continuity was restored by an end-to-end reanastomosis. The postreconstruction morphology of the two patch designs was compared with the preoperative laryngeal morphology. RESULTS: The autotransplantation technique led to complete restoration of the subglottic airway lumen in all four patients. Although the anterior-posterior glottic diameter was reduced by 36% in group A patients and by 43.5% in group B patients, a sufficient glottic airway lumen was obtained. The glottic sphincteric function was restored in both groups. CONCLUSIONS: Tracheal autotransplantation may be used reliably to repair hemicricolaryngectomy defects. Augmentation of the patch at the level of the glottis is not essential for successful rehabilitation.

Humans↗