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PubMed1999

Transanal endoscopic microsurgery for T1 rectal cancer in patients with synchronous colorectal cancer.

We treated T1 rectal cancer in three patients with synchronous colorectal cancer by transanal endoscopic microsurgery (TEM) before performing a radical operation for the second lesion. On pathological examination, all rectal specimens resected by TEM showed cancer invasion within the submucosal layer, while the margins of the specimen were completely free of cancerous tissue. Few complications were encountered with either the TEM for the rectal lesions or the succeeding radical operation for the second lesions. When patients present with synchronous colorectal cancer, including T1 rectal cancer, local excision of the rectal lesion via TEM can help to improve the patient's quality of life without affecting the curability of the disease.

Aged↗
PubMed2006

Morbidity in 201 patients with small sized meningioma treated by microsurgery.

BACKGROUND: The management of patients with small, often asymptomatic meningiomas is controversial and includes observation, microsurgery (MS) and stereotactic radiosurgery (SRS). The purpose of this retrospective study was to analyze the morbidity and the extent of removal after MS for small (< or =3 cm) intracranial meningiomas and compare these results to those of SRS reported in the literature. METHODS: All patients with an intracranial meningioma with a maximum diameter up to 3 cm operated on in our institution over a 10 year period (1992-2002) were included in the study and retrospectively analyzed. Patients were grouped into asymptomatic and symptomatic and according to tumor location as: group I (cranial vault, parasagittal, lateral sphenoid), group II (falx, frontobasal, medial sphenoid, parasellar and tentorial), group III (cavernous sinus, petroclival, petrosal, CPA and foramen magnum). FINDINGS: There were a total of 201 patients, of whom 102 were asymptomatic and 99 were symptomatic. The overall risk of permanent neurological morbidity was 4.9% in asymptomatic and 23.2% in symptomatic patients. The combined risk in asymptomatic and symptomatic patients was 5.4% in group I, 11.5% in group II, and 39.9% in group III lesions. Radical removal was achieved in all patients in group I, in 93.7% of group II, and 80% of group III lesions. There was no disease related mortality. CONCLUSIONS: MS provides excellent efficacy and morbidity results in groups I and II meningiomas, especially in asymptomatic patients and might therefore be considered the first choice of treatment for these patients. The results of MS in group III were worse than those of SRS reported in the literature.

Adult↗
PubMed2005

Microsurgery for cerebral arteriovenous malformation management: a Siberian experience.

Cerebral vascular malformations remain among the most difficult neurosurgical entities to treat. We report a retrospective study of the outcome in 95 consecutive patients with angiographically revealed arteriovenous malformations (AVMs). Fifty-four patients underwent microsurgical total AVM removal (group I). Forty-one patients who refused open surgery (group II) were managed either by endovascular embolisation (16 cases), radiosurgery (three) or followed up with medical treatment for their symptoms. In the first group pretreatment with the non-selective beta-blocker propranolol before surgery, the current neuronavigation techniques, intraoperative embolisation and AVM nidus colouring in high flow AVM were used for total microsurgical excision of the lesions. All AVM patients but one survived microsurgery. The mortality rate was 1.8% for group I. Six patients with grade IV-V AVM developed new temporal neurological symptoms following surgery. Four of them recovered completely in 3-6 weeks; two patients remained with mild persistent monoparesis and with homonymous hemianopsia postoperatively. In ten of 13 epileptic patients surgery produced a cure. No patient re-bled following surgery. No postoperative normal perfusion pressure breakthrough occurred. In the second group ten patients (24%) developed intracerebral haemorrhages, six of ten patients demonstrated progressive seizures. The mortality rate in group II totalled 17% over 6 years. Microsurgical management approaches must consider preoperative correction of impaired cerebral autoregulation, neuronavigation for preoperative planning and intraoperative orientation, intraoperative embolisation and dying of the nidus for large high-flow AVMs.

Adolescent↗
PubMed1983

Tubal microsurgery with the carbon dioxide laser.

Thirty New Zealand White female rabbits underwent tubal resection and reanastomosis for comparison of conventional microsurgery and laser microsurgical techniques. The rabbits were divided into three groups. The first group of 10 rabbits had 3 cm of tissue resected by knife from each uterine horn; the cut ends were then reanastomosed in one layer with 8-0 Vicryl sutures with the use of the operating microscope. The second group of 10 rabbits had 3 cm of tissue resected by laser from each uterine horn; the cut ends were then reanastomosed in one layer with 8-0 Vicryl. The third group of 10 rabbits had 3 cm of tissue resected by laser from each uterine horn; the cut ends were then reanastomosed by "welding" the tissues with the laser. All rabbits in the first group became pregnant. Only four in the second group became pregnant, but none in the third group became pregnant. It is concluded that the carbon dioxide laser beam as used in this study has no place in tubal resection and reconstruction.

Animals↗
PubMed1985

The effect of training in microsurgery.

One of the most important and fundamental prerequisites for successful microsurgery is serious and adequate training. This article presents the effect of microsurgical training on the functional end result of reanastomosis in the rabbit fallopian tube and evaluates the appropriate duration of laboratory training. In 50 New Zealand White female rabbits a microsurgical reanastomosis of the fallopian tube in its isthmic portion was performed. The rabbits were divided into five groups. In the first group only 30% of the rabbits conceived on the side operated on. The nidation index was only 0.269 as compared to 0.831 for the control side. Improvement in microsurgical skill following 100 isthmic anastomoses resulted in a 100% pregnancy rate for the last group. The nidation indexes in this group were the same on the side operated on and on the control side, 0.774 and 0.702, respectively. Scanning electron microscopic examination of the anastomosis site revealed a progressive increase in patency rate and in the amount of apposed mucosal folds in the three groups. A training program is recommended, which should bring about a nidation index and pregnancy rate that should not differ from the side operated on to the control side.

Animals↗
PubMed1990

Canniesburn "ever-ready" model to practise microsurgery.

An experimental model is described to practise microsurgery with material readily available in any routine operating theatre. By using a simple mathematical formula of C = pi x D, tubes of different diameters can be constructed for either end-to-end or end-to-side anastomoses.

Education, Medical, Graduate↗
PubMed1984

Surgery of the temporomandibular joint. II. Microsurgery.

The operating microscope has revolutionized many surgical procedures. Pioneering microtechniques for exploring and reconstructing the temporomandibular joint have been modified. The preauricular, endaural, and postauricular incisions may be used for approaching the temporomandibular joint in microsurgery procedures. Determinations of pathologic conditions and observations of temporomandibular joint function-dysfunction are dramatic and rewarding. Precision surgery using microinstruments, microneedles, microdrills, bipolar cautery, and the laser allows accuracy of technique that previously was impossible. Representative case presentations illustrate patient treatment, surgical incision, microsurgical technique employed, and clinical results obtained.

Adult↗
PubMed1983

A laboratory model for vascular microsurgery.

This article describes the microsurgical training model used at the Naval Regional Medical Center in San Diego, where first year residents spend two weeks of concentrated effort developing basic skills in microsurgery. This training is done outside the busy hospital environment so that no interruptions are encountered. Following this initial experience, weekly research sessions are continued to maintain proficiency and to develop new techniques. A description of the medical center's modifications of several previously used microsurgical techniques is presented. This model is economical and realistic for a student's initial exposure to microvascular surgery. It also serves as an expedient, yet challenging, means of maintaining proficiency when laboratory time is limited.

Animals↗
PubMed2004

Full-thickness intraperitoneal excision by transanal endoscopic microsurgery does not increase short-term complications.

PURPOSE: Transanal endoscopic microsurgery (TEM) is a minimally invasive technique for full-thickness excision of benign and malignant rectal neoplasms located 4 to 24 cm above the anal verge. Entrance into the peritoneal cavity during TEM has been regarded as a complication that mandates conversion to open laparotomy for adequate repair of the defect. This study compares the rate of complications arising from TEM with and without intraperitoneal entry. METHODS: Patients undergoing peritoneal entry were compared to those who did not. RESULTS: No perioperative deaths occurred. There was no significant difference in the incidence of postoperative complications. No major complications occurred with peritoneal entry, and all peritoneal entries were closed transanally via endoscope. CONCLUSIONS: Entry into the peritoneum during TEM is not associated with an increased incidence of complication. Entry into the peritoneum during TEM excision does not mandate conversion to open laparotomy but may be safely repaired endoscopically. Lesions likely to be above the peritoneal reflection and within reach of the endoscope (4 to 24 cm) should be considered for TEM excision.

Aged↗
PubMed2005

[Could (allo)transplantation be the future of microsurgery?].

Composite tissue allotransplantation is an emerging practice in the field of reconstructive surgery. Although still restricted to patients with major physical defects, it could be more widely practiced in the close future. The broadening of reconstructive surgery with "tissue reconstitution" depends on the functional results from the first hand allografts and from progress in immunotherapy. The mastery of microsurgery is a fundamental prerequisite to this activity and its development. Plastic surgeons will soon have to conceive, define, and master innovative surgical procedures for tissue restoration by microsurgical allotransplantation.

Forecasting↗
PubMed2006

Preexpanded distant "super-thin" intercostal perforator flaps for facial reconstruction without the need for microsurgery.

BACKGROUND: Concept of the 'super-thin perforator flap' was introduced in 1994 by authors. Since then, various types of 'super-thin perforator flaps' were applied successfully especially for contour sensitive reconstruction such as face and neck. METHODS: Eleven patients requiring large flaps who presented with extensive disfiguring facial scar (male: seven cases, female: four cases). On the consideration of flaps' colour, texture and thickness requirements, the authors selected 'super-thin' anterior intercostal perforator flaps (AICP, range from 4 x 14 cm to 25 cm x 9 cm) for reconstruction purpose. First, tissue expanders (volume range from 800 cc to 1200 cc) were carefully inserted under the AICP. After the flaps were expanded for 2 months, distant scars were removed and the covering super-thinned flaps were transferred into recipient site. Two weeks later, pedicles in the anterior chest were cut down and flaps were transferred to replace all the left scars. RESULTS: Flap were survived without any complications. The colour, texture and thickness of the transferred flap were satisfactory, shrink of flaps were not observed after long term follow-up. The authors present a method of facial reconstruction that has the advantages of creating a large amount of thin tissue of both good colour and texture, without the need of microsurgery and few disadvantages of donor-site morbidity. The disadvantages are three-staged procedures, complications of tissue expansion and uncomfortable compulsory posture for patients. In our opinion, this is an alternative method of choice for reconstructing all large defects in the lower two-thirds of the face.

Adult↗
PubMed2004

Mitotic spindle: laser microsurgery in yeast cells.

Laser microsurgery has led to remarkable discoveries in a number of cell types. Two recent studies have shown that this classical technology can now be employed with small yeast cells. This advance will enable regional ablation to be combined with facile genetic manipulation in a eukaryotic cell.

Laser Therapy↗
PubMed2003

Sphincter-saving surgery in patients with rectal cancer treated by radiotherapy and transanal endoscopic microsurgery: 10 years' experience.

BACKGROUND/AIMS: Transanal endoscopic microsurgery (TEM) is a technique which allows minimally invasive full-thickness local excision of rectal tumours with perirectal fat dissection. METHODS: Our study examined a group of 137 selected patients with rectal cancer treated by TEM excision combined with preoperative radiotherapy. The definitive histology was as follows: 37 patients with pT1 stage rectal cancer (27%), 59 with pT2 (43%) and 23 with pT3 (17%). In 18 (13%) patients who underwent a full dose of radiotherapy and TEM, the pathologist did not find cancer cells in the specimen (pT0). RESULTS: Eleven (8%) patients developed minor complications, whereas three (2%) developed major complications. The perioperative mortality was nil. At the mean follow-up of 46 months (range 6-115 months), we observed seven (5%) local recurrences. Of those, three patients died from systemic spread of the disease at follow-up. The disease-free survival rate in T0 and T1 patients was 100%. The disease-free survival rates in T2 and T3 patients were 81 and 59%, respectively, at a mean follow-up of 46 months. CONCLUSIONS: The application of preoperative radiotherapy and TEM in the treatment of rectal tumours appears feasible, safe and effective in the present study, with optimal preservation of anal sphincter function.

Adenocarcinoma↗
PubMed2005

Adjuvant radiotherapy after transoral laser microsurgery for advanced squamous carcinoma of the head and neck.

PURPOSE: To evaluate the efficacy of an adjuvant radiotherapy after transoral laser microsurgery for advanced squamous cell carcinoma of the head and neck and to show that a less invasive surgery with organ preservation in combination with radiotherapy is an alternative to a radical treatment. PATIENTS AND METHODS: Between 1987 and 2000, 208 patients with advanced squamous cell carcinoma of the head and neck were treated with postoperative radiotherapy after surgical CO2 laser resection. Primary sites included oral cavity, 38; oropharynx, 88; larynx, 36; hypopharynx, 46. Disease stages were as follows: Stage III, 40 patients; Stage IV, 168 patients. Before 1994, the treatment consisted of a split-course radiotherapy with carboplatinum (Treatment A). After 1994, the patients received a conventional radiotherapy (Treatment B). RESULTS: Patients had 5-year locoregional control and disease-specific survival (DSS) rates of 68% and 48%, respectively. The 5-year DSS was 70% and 44% for Stages III and IV, respectively (p = 0.00127). Patients treated with a hemoglobin level greater or equal to 13.5 g/dL before radiotherapy had a 5-year DSS of 55% as compared with 39% for patients treated with a hemoglobin level greater than 13.5 g/dL (p = 0.0054). CONCLUSION: In this series of patients with advanced head-and-neck tumors, transoral laser surgery in combination with adjuvant radiotherapy resulted in locoregional control and DSS rates similar to those reported for radical surgery followed by radiotherapy. Treatment B has clearly been superior to Treatment A. A further improvement of our treatment regimen might be expected by the combination of adjuvant radiotherapy with concomitant platinum-based chemotherapy.

Adult↗
PubMed2005

Long-term outcome assessment for lingual nerve microsurgery.

OBJECTIVE: A retrospective study was undertaken to investigate the clinical outcomes resulting from the microsurgical repair of lingual nerve injuries. The study was based on patient chart review. PATIENTS AND METHODS: A total of 20 patients referred to the principal investigator (V.B.Z.), with a diagnosis of lingual nerve injury who underwent trigeminal nerve microsurgery during a 3-year period (1999 to 2002), were entered in this study. All patients received a complete history and physical examination, and thorough preoperative and postoperative neurosensory testing to evaluate clinical response to hot, cold, cotton wisp, vibration, 2-point discrimination, directional stroke, and fine touch as determined by Von-Frey filaments. RESULTS: All patients underwent an external neurolysis procedure in combination with an internal neurolysis, neuroma excision, or primary neurorrhaphy under microscopic guidance depending on the intraoperative findings. The average time from injury to surgery was 8 months. The patients were followed for an average of 9 months after surgery, and assessment was based on the patients subjective experience as well as standardized neurosensory testing. Eighteen patients (90%) had some improvement in neurosensory function and 2 patients (10%) reported no improvement. One of the patients exhibiting no clinical improvement had a prolonged delay in seeking treatment, and the distal nerve could not be localized intraoperatively. Most patients were operated on between 2.5 and 7 months after injury, and there was no statistical difference in outcome as a function of the time from injury to repair in this group of patients. This subgroup of responding patients averaged at least 50% improvement in neurosensory function. CONCLUSION: Microsurgical repair of lingual nerves provides moderate to significant improvements in clinical sensory function and is a useful option in treating affected individuals, especially when implemented soon after injury.

Adolescent↗