PubMed · 8082593
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T M Davidson. 1994. Endoscopic sinus surgery.. https://pubmed.ncbi.nlm.nih.gov/8082593/
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The endoscope is useful for the diagnosis and surgical therapy of diseases of the nose, the paranasal sinuses and its neighboring regions, and allows for microinvasive, functional approaches. The reduced invasiveness of therapeutic procedures is sometimes accompanied by insufficient clearness of the surgical field, however. This significant problem is solved by the computer-assisted-surgery (CAS) system, an intraoperative localizer. It allows continuous orientation based on three-dimensional reconstructed preoperative CT scans with superimposed positioning of the endoscope. We have now adapted CAS for endoscopic sinus surgery, which meant that a variety of visualization methods were tested. A conventional straightforward endoscope was used in combination with, or as, the localizing probe. A dual-display technique was adjusted to video-endoscopic procedures: the information of the localizer is displayed on one monitor while the video-endoscopic picture is viewed on a second screen. In addition, a single-display technique with both images on one monitor was developed. It proved to be the most promising way of combining endoscopy and intraoperative CT-image-guided localization.
OBJECTIVES: To report the advantages of performing diagnostic and therapeutic urologic endoscopic procedures with the urologic surgeon in the standing-up position. METHODS: Our 25-year institutional experience with more than 10,000 cases of transurethral ablation of the prostate and other urologic endoscopic procedures, performed by the urologist in the standing-up position, was examined. A questionnaire of all 55 of our former urology residents was carried out to determine current practice trends. RESULTS: We have noted no drawbacks from performing transurethral surgery in the standing-up position. Ninety-two percent of the respondents believe that the standing-up position was more comfortable for endoscopic surgery than the sitting-down position. CONCLUSIONS: the standing-up technique of transurethral surgery minimizes positional stresses on the urologist's cervical and thoracic spine while optimizing endoscopic visualization and maneuverability. We recommend it in preference to the conventional sitting-down technique.
We report on the successful intrauterine surgical treatment of a twin pregnancy with an acardiac fetus. At 18 weeks of gestation the patient presented with polyhydramnios and a hydropic acardius acephalus and the donor twin showed signs of congestive heart failure. Colour Doppler ultrasound allowed localisation of the communicating vessels running on the placental surface towards the umbilicus of the acardiac twin. At 20 weeks we performed endoscopic laser coagulation of the umbilical vessels of the acardiac twin. A sheath (9.8 Charriere) with a 1.9 mm diameter rigid fetoscope (field of vision 60 degrees) was introduced percutaneously under local anesthesia into the amniotic cavity of the "pump" twin. Under sonographic control the fetoscope was directed towards the communicating vessels on the placental surface. A Nd-YAG laser (0.4 mm diameter fiber) was used to coagulate two vessels, artery and vein, until interruption of the reversed arterial perfusion was accomplished. Tricuspid regurgitation of the normal twin disappeared throughout the following two weeks and no further complications occurred throughout pregnancy. At 39 weeks a healthy girl was delivered vaginally. No at the age of 3 months she is developing normally. Minimal invasive endoscopic laser coagulation of the umbilical vessels of the acardiac twin appears to be the optimal currently available treatment for the normal twin, for which otherwise a high mortality ( > 50%) and morbidity must be expected.