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At least 397 records · Page 22Linked to original sources
PubMed2002

Transanal endoscopic microsurgery for rectal cancer.

If curation is intended for rectal cancer, total mesorectal excision with autonomic nerve preservation (TME) is the gold standard. Transanal resection is tempting because of low mortality and morbidity rates. However, inferior tumour control, provoked by the limitations of the technique, resulted in its cautious application and use mainly for palliation. Transanal endoscopic microsurgery (TEM) is a minimal invasive technique for the local resection of rectal tumours. It is a one-port system, introduced transanally. An optical system with a 3D-view, 6-fold magnification and resolution as the human eye, together with the creation of a stabile pneumorectum, and specially designed instruments allow full-thickness excision under excellent view and a proper histological examination. The technique can also be applied for larger and more proximal tumours. Mortality, morbidity as well as incomplete excision rates are minimal. Local recurrence and survival rates seem comparable to TME in early rectal cancer. TEM is the method of choice when local resection of rectal cancer is indicated. Results justify a re-evaluation of the indications for the local excision of rectal cancer with a curative intent.

Adult↗
PubMed2006

Local resection for early rectal tumours: Comparative study of transanal endoscopic microsurgery (TEM) versus posterior trans-sphincteric approach (Mason's operation).

OBJECTIVE: To compare local resection of early rectal tumours by transanal endoscopic microsurgery (TEM) and the conventional posterior trans-sphincteric approach (Mason's operation). METHODS: The study group comprised 31 consecutive patients with early rectal tumours (18 villous adenomas, 13 adenocarcinomas) who underwent TEM in Kwong Wah Hospital, Hong Kong. The control group consisted of 51 patients with early rectal tumours (27 villous adenomas, 24 adenocarcinomas) who underwent Mason's operation in Peking Union Medical College Hospital, Beijing. Outcome measures included morbidity and mortality, operation time, recurrence rate and postoperative pathological staging. RESULTS: Age, sex and pathological staging were similar in the two groups. The tumour size, operation time and blood loss were similar. The median distance from the anal verge was significantly higher in the TEM group (TEM/Mason = 8.0/6.4 cm, p = 0.042). The postoperative resumption of food intake (TEM/Mason = 1/5 days, p = 0.002) and the median hospital stay (TEM/Mason = 4/10 days, p = 0.005) were significantly shorter in the TEM group. Analgesic intake was significantly less in the TEM group (TEM/Mason = 0/100 mg, p = 0.0003). There was no operation-related mortality and the resection margins were clear in both groups. Two patients (3.9%) in the Mason's group developed postoperative wound infection, and two patients (3.9%) developed faecal fistulae. There was one secondary haemorrhage in the TEM group that required injection sclerotherapy. On median follow-up of 23 months, there was no tumour recurrence in the TEM group, whereas two patients (3.9%) in the Mason's group experienced recurrence during a median follow-up of 30 months. CONCLUSION: TEM is as effective as the conventional posterior trans-sphincteric approach (Mason's operation) for local curative resection of early rectal tumours. TEM is less invasive, with shorter hospital stay and fewer complications than conventional Mason's operation.

Adenocarcinoma↗
PubMed2006

Platysma myofascial flap for reconstruction of oropharyngeal defects after transoral laser microsurgery of locally advanced carcinomas.

INTRODUCTION: Transoral laser microsurgery of locally advanced carcinomas of the lateral oropharynx often results in exposure of major vessels of the neck and may be accompanied by a substantial risk of intra- and post-operative bleeding. PROCEDURE: Six patients with tonsillar cancers radiologically infiltrating the parapharyngeal space underwent ipsilateral neck dissection with temporary protection of neck vessels. While the neck remained open, transoral laser resection of the primary tumour was performed. Pharyngeal defects were subsequently closed by a superiorly based platysma myofascial flap. RESULTS: All tumours were completely resected. Intra- and post-operative bleeding complications requiring blood transfusion or surgical revision did not occur. None of the patients developed a cervical fistula. During a mean follow-up time of 24.8 months, no local and/or regional recurrence was observed. CONCLUSION: The described approach is oncologically safe and seems to ensure reliable protection of neck vessels during and after transoral laser resection of locally advanced oropharyngeal carcinomas, as well as to prevent fistula formation.

Aged↗
PubMed1987

Closed microsurgery for the sequelae of neovascularisation from veno-occlusive retinopathies.

Our experience of closed microsurgery for vitreous haemorrhage and/or traction retinal detachment complicating extraretinal neovascularisation after retinal vein occlusion or Eales' and Behçet's periphlebitis is discussed. Many of these eyes represented a relatively simple management problem, but the visual outcome was often compromised by intrinsic macular damage. Some eyes had complicated vitreoretinal relationships which presented unexpected technical difficulties, while persisting retinal ischaemia posed the risk of rubeosis iridis or post-operative vitreous haemorrhage unless scatter endophotocoagulation was used.

Cataract Extraction↗
PubMed1989

Indentation microsurgery: internal searching for retinal breaks.

Breaks responsible for rhegmatogenous retinal detachments in 78 eyes could not be seen preoperatively owing to opacities in the media, previous buckling or other causes. Deep kinetic indentation of the sclera combined with endoillumination enabled retinal breaks to be identified during closed microsurgery in 95% of these eyes, and retinal reattachment was eventually achieved in 85%.

Adolescent↗
PubMed2002

History of the microscope and development of microsurgery: a revolution for reproductive tract surgery.

In the mid-1970s urologists in the field of paediatric and andrologic surgery felt that operating loupes did not provide sufficient magnification for their surgical work. Thus, urology finally introduced the operating microscope in the operating room, which was rather late in comparison to other surgical disciplines. Almost three decades later we can hardly imagine performing a vasovasostomy, a testicular autotransplantation or a penile reconstruction without the use of this sophisticated instrument. The following article from the history of medicine reveals the main steps in the technical development of the microscope, from early magnifying tools to the pioneering inventions of Carl Zeiss (1816-1888) and his successful company in Jena, Germany in the 19th century. Finally, the clinical application of microsurgery in the 20th century is described, focusing on reconstruction of the reproductive tract in andrology and gynaecology.

Female↗
PubMed2000

Failed vasectomy reversal: is a further attempt using microsurgery worthwhile?

OBJECTIVE: To determine, in failed vasectomy reversal, the usefulness of a revised anastomosis using microsurgery in achieving sperm in the ejaculate and fertility, and to relate the outcome to the site of the anastomosis, length of time from vasectomy, and presence or absence of sperm in the vas at surgery. PATIENTS AND METHODS: In a series of 28 patients with confirmed anastomotic obstruction undergoing vasectomy reversal (over a 10-year period), a microsurgical technique using an oblique end-to-end two-layer interrupted anastomosis with 10/0 Nylon was used to establish vasal continuity. Subsequent seminal analysis at 3-6 months and ensuing paternity were related to several variables. The results were compared with those obtained after 137 cases of primary microsurgical vasovasostomy. RESULTS: Sperm was restored to the ejaculate in 16 (57%) of the patients and successful fertilization was reported in nine (32%). The interval between vasectomy and reversal surgery was relevant to the outcome, with four out of four men having sperm in the ejaculate within 5 years and three achieving paternity. However, the fertility rate was still moderate after an interval of 6-10 years (two of six) and at > 10 years (four of 18). The presence of sperm in the ejaculate was related to whether or not sperm were found in the testicular end of the vas at operation, but absence did not preclude a successful outcome. The overall results were not significantly different from those after primary microsurgical reversal surgery. CONCLUSION: Microscopic vasovasostomy after previous obstructive failure provides the patient with a further reasonable chance of becoming fertile; although diminishing with time from vasectomy, even after a prolonged period there can be success. The absence of sperm at the time of vasovasostomy does not necessarily indicate failure, but in these cases the presence of thick creamy fluid in the vas predicts a poor outcome, and alternative methods of management should be considered. A microsurgical technique extending, if necessary, well into the convoluted part of the vas, is recommended. Microsurgical skills, relevant equipment and adequate time are required.

Adult↗
PubMedDate not supplied

CO(2) laser endolaryngeal microsurgery with the deflect tip of the pipe-guide handpiece.

Some regions of the larynx such as the inferior surface of the vocal fold and the subglottis cannot be adequately irradiated with a conventional laser instrument and a microscopic manipulator coupled to an operating microscope. To improve on this disadvantage, we present a method for CO(2) laser endolaryngeal microsurgery with the deflect tip of the pipe-guide handpiece. After exposure of the larynx, a pipe-guide handpiece with a deflective tip is inserted into the laryngeal cavity, and the lesion is vaporized and removed via direct laryngoscope observation under the microscope. With the deflect tip of the CO(2) laser pipe-guide handpiece, the laser beam can be irradiated vertical to the laryngeal mucosa, especially in regions such as the inferior surface of the vocal fold and the subglottic mucosa. The mucosa can be adequately vaporized with this laser instrument. This technique allows the surgeon to perform a precise, more hemostatic endoscopic operation with decreased postoperative edema. Disadvantages of this surgical procedure are that surgeons cannot perform a hands-off operation through the narrow operation field of the microlaryngoscope.

Adult↗
PubMed2003

Histopathologic damage to vessels in head and neck microsurgery.

PURPOSE: This study assessed the incidence of pre-existing damage in recipient arteries excised before the vessels were used for microvascular anastomoses between 1988 and 1999. PATIENTS AND METHODS: Recipient arteries of the head and neck region from 100 patients who had undergone ablative surgery requiring microvascular tissue reconstruction were examined histologically. Past illnesses believed to be risk factors included hypertension, myocardial disease, and diabetes. Blood vessels chosen for microsurgical anastomoses were examined using histological staining, scanning electron microscopy, and immunofluorescence. RESULTS: Of the patients undergoing microvascular surgery, 51% showed histologic vessel abnormalities. Marked thickening of the blood vessel wall and severe exfoliation of the endothelial cells were observed in most arteries. Thickening of the intima was evaluated using scanning electron microscopy (Friedman's method; Microvasc Res 3:416, 1971). Values higher than twice the ratio of wall thickness-to-lumen diameter were observed in 9 recipient arteries. Six graft failures were correlated with both technical errors and pre-existing vessel lesions. CONCLUSIONS: This study revealed that most patients undergoing microsurgery in the head and neck region had pre-existing damage to vessels that hindered anastomoses. Pre-existing changes in the recipient arteries may cause technical difficulties and must be regarded as additional factors contributing to graft failure.

Adult↗
PubMed2000

Endoscope-assisted microsurgery for cerebral aneurysms.

We performed endoscope-assisted microsurgery for 64 patients with cerebral aneurysms from June 1998 to January 1999. Two patients were treated under picture-in-picture imaging using a surgical microscope connected with an endoscopic-image display system. The study included 34 patients with incidental discovery: 3 IC oph, aneurysm, 1 from cavernous (C3) portion, 8 at ICPC, 1 from infundibular dilatation, 2 at IC bifurcation, 6 at AcoA, 1 at A1A2, 8 at MCA, 1 at P1, 1 from basilar tip, 1 at AICA, 1 at VA and 1 from PICA. The study also included 30 patients with subarachnoid hemorrhage: 5 ICPC, 2 from anterior choroidal, 1 from IC infundibular dilatation, 10 from AcoA, 2 from A2A3, 7 from MCA, 2 from basilar tip and 1 from PICA. They were classified into gr. 1 for 2, gr. 2 for 8, gr. 3 for 10, gr. 4 for 7, and gr. 5 for 3 cases.

Carotid Artery Diseases↗
PubMed2002

Outcomes with eye reanimation microsurgery.

This study reviews the various microsurgical techniques available to reanimate the paralyzed eye sphincter. Traditional as well as several innovative procedures are described that the senior author has used over the past 20 years. The methods of evaluating such outcomes are discussed and analyzed with regard to eye reanimation. An independent panel of reviewers evaluated standardized preoperative and postoperative videos documenting eye closure and blink in patients with lagophthalmos. A significant difference in overall postoperative outcome of both eye closure and blink was demonstrated. In this particular population, those patients who underwent dynamic procedures more often yielded better results than those who did not. Detailed video documentation and independent grading of outcomes of eye closure and blink are necessary to assist in developing effective surgical treatments for paralytic lagophthalmos. Accurate measurement of the results of these interventions remains a considerable challenge in the field of eye reanimation microsurgery.

Blinking↗
PubMed2002

Combined minimally invasive approach using microsurgery and thoracoscopic surgery for resecting a dumbbell-type thoracic schwannoma.

We present a case of a thoracic schwannoma with an intravertebral component, a so-called "dumbbell-type" tumor, that was resected with a combined minimally invasive approach using microsurgery and thoracoscopic surgery simultaneously. A 31-year-old man was admitted to our hospital for treatment of a thoracic schwannoma 45 mm in maximal diameter at the level of the third thoracic vertebra. After the tumor was separated from intravertebral structures by using a microsurgical technique via the posterior approach with a hemilaminectomy and minimal unilateral facetectomy, the mass was removed completely by using video thoracoscopy. We stress that this approach should be the most useful and less invasive technique for treating the dumbbell-type of thoracic neurogenic tumor compared with a single or combination technique involving thoracotomy, multi-level laminectomy and costotransversectomy. Below, we make some notes on this technique from the neurosurgeon's standpoint.

Adult↗
PubMed2003

[Comparison between transoral microsurgery by CO2 laser and conventional surgical therapy for T2 glottic carcinoma].

BACKGROUND: Transoral CO2 laser excision of early glottic cancer was first introduced in the 1970s. Since then it has become a serious alternative to surgery with conventional instruments. PATIENTS AND METHODS: Between January 1987 and December 1997, 46 patients with T2 N0 M0 glottic carcinoma have been treated by either transoral laser microsurgery or fronto-lateral partial laryngeal resection with curative intention. Long-term results of both methods were compared after analysation of tumor-localization and recurrence-rate. Evaluation parameters were: incidence of local recurrence and incidence of death due to local recurrence. Other aspects of investigation were hospitalisation-time and treatment related patient morbidity. RESULTS: Analysis of the data of our study shows that local recurrences were 5 % lower in cases of laser surgical tumor resection as opposed to conventional surgery (11 % vs. 16 %). If evaluated in accordance to localization of local recurrence in combination with primary tumor localization, results show that all three recurrent tumors in the group of laser resected patients had a primary in the anterior glottic area; two out of the three recurrences following fronto-lateral laryngeal resection were localized in the mid-third of the vocal cord. Hospital-admittance in laser-resected patients was shorter by one day when compared with the group of conventional surgery (10 vs. 11 days). CONCLUSION: T2-Tumors of the anterior glottic area should preferably be approached by conventional surgery (external approach), particularly when endoscopical visualization is difficult. In contrast, T2-tumors of the medial and posterior glottic area should be resected endolaryngeally with the laser.

Adult↗
PubMed2004

Irrigation pressure and vessel injury during microsurgery: a qualitative study.

Irrigation solution is routinely used in microsurgery. While the anticoagulation solution may aid in anastomotic patency, the direct effect of pressure irrigation can have a detrimental effect on the vessel. An experimental study was performed to determine the effect of irrigation pressure on the vessel wall. Histological evaluation with hematoxylin and eosin (H&E) stain and scanning electron microscopy (SEM) was performed on the arteries of New Zealand white rabbits irrigated with lactated Ringer's solution at pressures of 80 mmHg, 100 mmHg, and 500 mmHg. H&E staining and SEM microscopy demonstrated injury to the endothelial cells and internal elastic lamina at pressures of 100 mmHg or greater. Controlling microsurgical irrigation pressure to less than 100 mmHg may help to avoid vessel injury.

Animals↗
PubMed2006

Validation of a 1-mm transit time flow probe and the potential for use in microsurgery.

The objective of this study was to validate a prototype transit time ultrasound flow probe (Medi-Stim Butterfly Flowmeter BF 2004) of only 1 mm and to evaluate its potential for use in microsurgery. Knowledge of the ability of this kind of system to measure flow in small vessels and at small flow rates did not previously exist. The experimental design was an in vitro study using the median artery of 15-kg pigs. The vessel was perfused by the pigs' own heparinated blood, at a known flow rate, using a Gemini infusion pump. The infusion rate was increased stepwise, starting at 1 ml/min until 16 ml/min. Transit time flow was measured continuously. The results showed very accurate flow measurements at all flow rates when compared to the known infusion rate of the Gemini pump. However, at flow rates below 4 ml/min, variation became a problem.

Animals↗
PubMed2007

The vessel protector: an instrument for operative microsurgery.

Since the introduction of microsurgery and free flap transfers, the techniques of dissection and harvesting of flaps and their vascular pedicles have continuously advanced. As the vascular pedicles of free and pedicled flaps should be protected during their harvest or dissection, the usual trials to protect pedicle vessels depend ultimately on the surgeon and clinical experience. A new microsurgical instrument, the vessel protector, facilitating protection and holding of the vascular pedicle has been developed. Through experimental and clinical trials, the instrument has been demonstrated to protect the structures inside a distal coiled end while also holding them. This has several advantages over conventional dissection by jeweler's forceps and scissors.

Animals↗