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At least 55 records · Page 3Linked to original sources

PubMed2005

Transanal endoscopic microsurgery: a prospective evaluation of functional results.

PURPOSE: Local excision is a commonly used technique for many benign and selected malignant rectal lesions. Compared with radical resection, it is associated with decreased morbidity and mortality and improved functional results. Transanal endoscopic microsurgery is gaining popularity because of its ability to access the upper rectum and its precise excision techniques. However, the functional consequences have not been extensively studied. METHODS: All patients subject to transanal endoscopic microsurgery prospectively completed preoperative and postoperative (6 weeks) surveys including Fecal Incontinence Severity Index, Fecal Incontinence Quality of Life, number of bowel movements per 24 hours, and ability to defer defecation. All data were collected by an independent research coordinator. Demographics, operative details, and complications were also collected prospectively. RESULTS: Forty-one patients successfully underwent transanal endoscopic microsurgery. Fourteen patients had malignant lesions and 27 had benign lesions. Two patients required abdominoperineal resection based on postoperative diagnosis. Thirty-nine patients have completed follow-up and were available for review. Mean length of surgery was 64 minutes and length of stay was 0.9 day. Average distance from the anal verge to the proximal tumor margin was 11.4 cm and mean tumor size was 8.75 cm. Twenty-three patients had full-thickness excision with primary closure, ten had full-thickness excision without closure, five had partial-thickness excision, one had an excision of a mass in the anovaginal septum, and one had resection of an anastomotic stricture. Each patient served as his own control. Preoperative and postoperative number of bowel movements per 24 hours were 2.0 and 2.0, respectively. Preoperative vs. postoperative urgency (ability to defer defecation less than ten minutes) was unchanged. Mean preoperative and postoperative Fecal Incontinence Severity Index scores were 2.4 (range, 0-43) and 2.4 (range, 0-17), respectively (higher scores indicate worse function). In addition, the four parameters measured by the Fecal Incontinence Quality of Life survey were unchanged when preoperative and postoperative data were compared. CONCLUSIONS: Transanal endoscopic microsurgery allows precise excision of tumors throughout the rectum. However, it involves inserting a 40-mm-diameter operating proctoscope and significant operating times. Despite this, as measured by ability to defer defecation, number of bowel movements per 24 hours, Fecal Incontinence Severity Index, and Fecal Incontinence Quality of Life survey, transanal endoscopic microsurgery has no detrimental affect on fecal continence.

Anal Canal↗

PubMedDate not supplied

Results of curative laser microsurgery of laryngeal carcinomas.

INTRODUCTION: Between 1979 and 1991 the author treated more than 1,200 patients with malignant tumors of the upper-aerodigestive tract transorally using laser microsurgery with curative, palliative, or symptomatic intention. PATIENTS AND METHODS: This report is based on 240 patients without prior treatment, treated between 1979 and 1985 with curative intention for cancer of larynx (pTis-pT4 (p)N0-pN2c). Patients with simultaneous second primaries and/or distant metastases were excluded. Neck metastases of the category N3 (UICC 1987) were not found in the group. Patients were divided into two groups. Group A (n = 159) includes glottic cancer as follows: Tis, 29; T1, 96; T2 (small, vocal cord mobile), 34. All patients were treated by laser microsurgery. There were only 6% local recurrences with one patient needing total laryngectomy. The overall 5-year survival rate (Kaplan-Meier) was 86.5%. The adjusted 5-year survival rate was 100%. The group B patients (n = 81) included 30 supraglottic patients. Fifty-eight patients were in tumor category pT2, among them there were 38 with glottic cancer (so called T2b, with vocal cord mobility impaired). Seventeen patients had pT3 and 6 pT4 tumors. RESULTS: Treatment consisted of laser microsurgery plus/minus neck dissection (23/81 = 28%) (mainly regionally limited functional surgery, only four radical neck dissections) plus/minus postoperative radiotherapy (29/81 = 35%). There were 22% local recurrences with six patients requiring total laryngectomy. The overall 5-year survival rate (Kaplan-Meier) was 59%. DISCUSSION: This study confirms the usefulness of laser microsurgery for laryngeal carcinoma. Surgery is individualized and adapted to the size of the tumor. Multiinstitutional studies are needed to compare laser microsurgery with radiation therapy.

Adult↗

PubMed2005

[Contribution of French surgeons to reconstructive microsurgery].

The authors report the contribution of French surgeons and particularly the plastic surgeons to the reconstructive microsurgery since 1972. Different domains are reviewed: animal experimentation, anatomical studies, reimplantations, free tissular transfer, free bone transfer, strategic original concept of transfer, free toes transfer, microsurgical reconstruction of malformative hand, free lymphatic transfer, nervous microsurgery, flap prefabrication, allotransplantations and the future of microsurgery. Three societies have the place of honour: the French Society of Plastic Reconstructive and Aesthetic Surgery, the Group for Advancement of Microsurgery and the World Society for Reconstructive Microsurgery.

Adult↗

PubMed2006

Transanal endoscopic microsurgery in rectal adenomas: experience of six Italian centres.

BACKGROUND/AIMS: Transanal endoscopic microsurgery is a minimally invasive technique that allows the excision of benign and selected malignant tumours. We present a study for evaluating surgical morbidity, mortality and local recurrence rate of patients with rectal adenomas treated with transanal endoscopic microsurgery in six different Italian centres following the same protocol. METHODS: A total of 882 patients with rectal lesions (adenomas and early stage of carcinomas) underwent transanal endoscopic microsurgery in six different Surgical Departments from January 1993 to October 2004. Five hundred and ninety patients had preoperative diagnosis of adenomas but 588 patients were regularly followed up to determine treatment efficacy in terms of local recurrence rate. RESULTS: The study involved 588 patients, with a median age of 66 years (25th percentile-75th percentile=58-71 years). No postoperative mortality was reported. Intraoperative complications were observed in three patients (0.5%). Minor complications occurred in 48 patients (8.2%) whereas major complications were found only in 7 patients (1.2%). Definitive histology confirmed adenomas in 530 cases (90.1%). Two patients (0.3%) were lost to follow-up so were not included in the paper. At median follow-up of 44 months (25th percentile-75th percentile=15-74 months), 23 (4.3%) adenomas recurred and were successfully retreated by transanal endoscopic microsurgery [20 cases (87%)] and by conventional surgery [3 patients (13%)]. No further recurrences were observed at subsequent follow-up. Thirty-one (5.3%) patients died during follow-up for old age, cardiac disease, etc. CONCLUSIONS: Transanal endoscopic microsurgery is, in our experience, an effective method for local resection of benign rectal tumours with morbidity of 11.4%, no postoperative mortality and with a percentage of local recurrence of 4.3%.

Adenoma↗

PubMed2005

Vestibular schwannomas: clinical results and quality of life after microsurgery or gamma knife radiosurgery.

OBJECTIVE: The aim of the present study was to evaluate the overall treatment efficacy (tumor control, facial nerve function, complications) and quality of life for patients treated primarily for unilateral vestibular schwannomas of 30 mm or less, either by microsurgery or by gamma knife (GK) radiosurgery. The results for the two treatment groups are compared with each other, with main emphasis on the long-term quality of life. METHODS: This is a retrospective study of 189 consecutive patients, 86 treated by microsurgery and 103 by gamma knife. The mean observation time was 5.9 years. All patients had a magnetic resonance imaging scan and clinical evaluation performed toward the end of the study. To evaluate the quality of life, we used two standardized questionnaires, the Glasgow Benefit Inventory and Short-Form 36. The questionnaires were sent to the 168 living patients. The reply rate was 83.3%. RESULTS: A total of 79.8% of the patients in the microsurgery group and 94.8% of the GK patients had a good facial nerve function (House-Brackmann Grade 1-2). Hearing was usually lost after microsurgery, whereas the GK patients had preserved hearing, which often became reduced over the years after the treatment. The treatment efficacy, defined as no need for additional treatment, was similar for the two treatment modalities. Quality of life was reduced compared with normative data, being most reduced in the microsurgery group. Some of the quality of life questions showed an association with facial nerve function and sex. CONCLUSION: Posttreatment facial nerve function, hearing, complication rates, and quality of life were all significantly in favor of GK radiosurgery.

Adult↗

PubMed1999

Laparoscopic microsurgery: current and future status.

The successful introduction of microsuturing and microinstruments for operative laparoscopy has allowed the convergence of laparoscopy and traditional microsurgery, resulting in the evolution of the 'new microsurgery'. This more dynamic approach overcomes the limitations of open microsurgery by providing continuous magnification and the benefits of a closed environment, making laparoscopy a complete surgical tool. The test model for microsurgery is tubal anastomosis, which is very dependent on operative technique to attain well-established pregnancy rates. Our cumulative pregnancy results for laparoscopic microsurgical tubal anastomosis of 76% at 12 months, 70% at 9 months, 67% at 6 months and 44% at 3 months, compares favorably to the best results achieved by traditional open microsurgery. With this validation the technique is now employed as a complete solution for all tubal surgery. The ability to effect microsurgical repair of the ureter, bladder, bowel and vessels has expanded the surgical repertoire, allowing radical excision of deep endometriosis, severe enterolysis, and adhesiolysis.

Anastomosis, Surgical↗

PubMed1980

The impact of microsurgery in gynecology.

Reconstructive microsurgery has been associated with significantly improved results in infertility. These techniques have made the gynecologist much more conscious of peritoneal trauma and of postoperative adhesions. It has enabled the appreciation of normal and pathologic fine morphologic details. The assimilation of microsurgical principles into gynecology will provide its major benefit in terms of prophylaxis. A pelvic laparotomy in the female infant, adolescent, or young woman will aim at conservation and the avoidance of trauma, postoperative adhesions, and future reduction of fertility. Microsurgery enables a tubal transplantation. Although this is feasible today in a homozygous twin, the wider application of this procedure must await necessary progress in immunology. Microsurgical techniques are required for extracorporeal fertilization. In the not too distant future, microsurgery will become an integral part of fertility-promoting procedures. There will no longer be the need to qualify "microsurgery" since "fertility surgery" will simply imply "fertility microsurgery."

Endometriosis↗

PubMed2003

Conservative management, gamma-knife radiosurgery, and microsurgery for acoustic neurinomas: a systematic review of outcome and risk of three therapeutic options.

Conservative management, gamma-knife (GK) radiosurgery, and microsurgery are therapeutic options for acoustic neurinomas (ANs). To determine the outcomes and risks of these methods this systematic review analyzed data from 903 patients with conservative management, 1475 with GK radiosurgery, and 5005 with microsurgery from 38 studies identified in MEDLINE searches. Conservative management over a 3.1-year period showed that 51% of ANs showed a tumor growth, an average tumor growth rate was 1.87 mm year-1, 20% of ANs ultimately required surgical intervention, and a third of the patients lost useful hearing. GK radiosurgery significantly reduced the percentage of ANs that enlarged, to 8%, and reduced the percentage that underwent microsurgery to 4.6% over a 3.8-year period. Microsurgery removed 96% of ANs totally, with tumor recurrence, mortality, and major disability rates of 1.8%, 0.63%, and 2.9%, respectively. The majority of ANs grow slowly, but ultimately require intervention. Carrying the risk of hearing loss, conservative management should be supplemented with close follow-up. With a low rate of morbidity, GK radiosurgery suppresses tumor growth and provides good tumor control. Microsurgery provides the best tumor control, although mortality and morbidity are not completely eliminated.

Chi-Square Distribution↗

PubMed1992

[Microsurgery and laser surgery in conservative operations on the ovary. Experimental research].

In this study we compared two different conservative surgery techniques performed on 12 ovaries of female rabbits: microsurgery and CO2 Laser surgery. After the surgical procedure all the animals were investigated by a Laparotomy to evaluate the post-operative adhesion formation. Histological examinations were performed on 6 ovaries, to evaluate the possible damage to the ovarian parenchyma. We did not find significant differences between the two methods employed, particularly for the adherence formation and the parenchymal thermic damages: no post-operative adhesions were detected respectively in 3 ovaries operated on by microsurgery and 5 by laser surgery; slight adhesions were present in 2 ovaries treated with microsurgery and in 3 with laser surgery; 3 ovaries treated with microsurgery and 2 with laser surgery showed moderate adhesions. Only 2 ovaries treated with microsurgery presented severe adhesions.

Animals↗

PubMed2006

[Perceptual method and videostroboscopy in patients with vocal fold hypertrophy underwent microsurgery].

INTRODUCTION: Chronic hypertrophic laryngitis concerns many people in our population. Their etiopathogenesis is complicated and usually connected with exogenous harmful factors like occupational or environmental exposure. Organic voice disorders of the larynx, particularly concerning vocal folds are the cause of dysphonia. Both surgical and conservative methods in the treatment of patients with laryngeal hypertrophy are applied. Objective assessment of the voice improvement after microsurgery is the subject of discussion of many authors. The problem of voice improvement is rarely approached to in the comprehensive way, that is with reference to activity and anatomy of the larynx. The basic aim of this research was to asses phonation function of the larynx after microsurgery on the basis of subjective and videostroboscopic voice analysis. The second aim was to estimate the surgical treatment effectiveness depending on vocal fold hypertrophy extensiveness. MATERIAL AND METHOD: The research was conducted on 50 subjects chosen from the population of patients with vocal fold hypertrophy treated at the Department of Laryngology Silesian Medical Academy in Zabrze from January to December 2003. All the examined patients underwent classical microsurgery. Voice quality examinations were done just before microsurgery and 3 months after the operation. On the basis of histopathological results, following diagnosis were established: vocal fold polyps (oedematosus, teleangiectaticus and inflammatorius), oedema Reincke, laryngeal papilloma, laryngeal granuloma and cyst. The research methodology included: perceptual voice examination based on GRBAS scale (G--grade; R--roughness; B--breathiness; A--asthenicity; S--strain) and assessment of vibrations of vocal folds in videostroboscopy. Examination results in two groups with different extensiveness of vocal fold hypertrophy were compared. The control group presented 30 subjects without any voice disorders who did not use their voice for professional purposes. RESULTS: In both groups (with minor and extensive vocal fold lesions) significant improvement in perceptual and videostroboscopic voice parameters was observed. The results in the group with minor vocal fold lesions were better after microsurgery. CONCLUSIONS: The methodology based on the application of the two methods of voice examination could be an objective rate in the estimation of the treatment progress.

Adult↗

PubMed2003

Microsurgery for Potential Radiosurgical Skull Base Lesions: A Retrospective Analysis and Comparison of Results.

The outcomes of 26 complex skull base tumors treated with microsurgery were compared with the outcomes of similar tumors treated with radiosurgery as reported in the literature. The University neurosurgery database was searched for patients who underwent microsurgery for the treatment of skull base tumors between 1990 and 2001 at Louisiana State University Health Sciences Center in Shreveport, Louisiana. Twenty-six skull base meningiomas treated by microsurgery by the senior author (AN) were identified retrospectively. On imaging, the tumors were well defined and less than 3 cm in the greatest diameter, making them ideal candidates for a radiosurgical procedure had this modality been available. The follow-up and outcomes of these 26 patients were compared with the published outcomes of similar tumors treated with radiosurgery. Total excision was achieved in 17 (65.3 %) patients. Excision was subtotal in 9 (34.6 %) patients due to the critical locations of their tumors. The median hospital stay for these patients was 4 days (range, 3 to 12 days). Two patients (7.6 %) had transient cerebrospinal fluid leaks from the wound, and 2 (7.6 %) had transient facial paresis. Overall, preoperative symptoms improved in 23 (88.4 %) patients. The median follow-up was 56 months (range, 3 to 120 months). The overall survival rate for all was 87.2 +/- 3.7 % at 50 months. Two patients (7.6 %) subsequently underwent repeat surgery for a recurrent or progressive disease. The actuarial 8-year tumor control rate was 86.4 +/- 4.4 % using the Kaplan-Meier method. For small skull base tumors with benign histology, microsurgery is as safe and effective a treatment option as stereotactic radiosurgery. The symptomatic improvement in patients is better with microsurgery than with radiosurgery because the volume of the tumor is reduced immediately. A combined approach using both modalities is usually needed for larger tumors when attempts at total resection would jeopardize the neurologic function of the patient.

Journal Article↗

PubMed2003

Transoral laser microsurgery for squamous cell carcinoma of the base of the tongue.

OBJECTIVE: To determine the role of transoral laser microsurgery for base of tongue squamous cell carcinoma. DESIGN: Retrospective unicenter study of the oncologic and functional results of laser microsurgery of tongue base carcinoma performed between 1986 and 1997. SETTINGS: University hospital department. PATIENTS: We reviewed 48 previously untreated patients with base of tongue squamous cell carcinoma, who were treated with transoral laser microsurgery. Distribution of the T categories were T1, 2%; T2, 25%; T3, 15%; and T4, 58%; 94% belonged to the stages III and IVa. Selective neck dissection was performed in 43 patients; 23 patients underwent postoperative radiotherapy with or without simultaneous chemotherapy. MAIN OUTCOME MEASURES: Local control rate, recurrence-free and overall survival rates, mean performance status scale scores for normalcy of diet and understandability of speech. RESULTS: The Kaplan-Meier 5-year local control rate was 85%. There was no local recurrence in T1 and T2 lesions, but there was a 20% local recurrence rate in T3 and T4 tumors. Kaplan-Meier 5-year recurrence-free and overall survival rates were 73% and 52%, respectively. Mean performance status scale scores were 92% for normalcy of diet and 88% for understandability of speech. Twenty-one patients survived at least 5 years after treatment. They have a preserved larynx and live without tracheostoma or gastrostomy tube. CONCLUSIONS: Our concept of organ and function preserving laser microsurgery for selected patients with base of tongue cancer seems to be justified considering the achieved oncological and functional results. Final proof of the effectiveness of the new therapeutic concept presented herein requires well-designed prospective studies.

Adult↗

PubMed1998

Experimental models in microsurgery.

The development of experimental microsurgery can be considered the natural evolution of a diffuse need to increase precision in many fields of surgery. Microsurgery accelerated the possibility of deepening many unclear aspects of pathophysiology, using miniaturized and reproducible experimental models. We report briefly on the fundamental principles of microsurgery and the most frequently performed and useful models of experimental microsurgery, especially to employ as training models for surgeons, but also as bases for developing new and always-welcome models.

Disease Models, Animal↗

PubMed1988

New directions in male reproductive microsurgery.

During the past decade, microsurgery has become a urologic subspecialty. Historically, vascular and vasal anastomosis have formed the foundation of genitourinary microsurgery. With the advent of improved instrumentation and the interest of devoted urologic microsurgeons, a multitude of new applications of microsurgery in urology have developed. In this paper, we discuss some of the new directions in male reproductive microsurgery.

Cryptorchidism↗

PubMed1997

Costs and effects of microsurgery versus radiosurgery in treating acoustic neuroma.

This study analyses costs and effects of treating acoustic neuroma patients by using microsurgery compared to radiosurgery. Radiosurgery is the stereotactic application of radiotherapy and an innovative medical technology. Cost and effect estimates of conventional treatment were based on a retrospective study in the Netherlands. Similar data for a comparable group of patients in Sweden were collected for radiosurgery, as this treatment option is currently not available in the Netherlands. Fifty-three acoustic neuroma patients who had been operated on the University Hospital Rotterdam between November 1990 and February 1995 were included. This group was compared with 92 acoustic neuroma patients treated with radiosurgery (Gamma Knife. Stockholm, Sweden) in the same period. Data on health care use were collected from patient files. To obtain data on production losses and quality of life, a questionnaire was sent by mail in February 1995. This booklet consisted of the Health and Labour-questionnaire (HLQ), the Short Form-36 (SF36) and the EuroQol. The response rate was 92%. Direct costs for microsurgery amounted to Dfl. 20.072,- and for radiosurgery to Dfl. 14.272,-. Indirect costs were respectively Dfl. 16.400,- and Dfl. 1.020,-. General health rating was better for radiosurgery than for microsurgery. On the whole, differences in clinical outcomes between the two patient groups were small. Assuming a reasonable occupancy rate of the expensive radiosurgery equipment, we demonstrated that for the short term treating patients with acoustic neuroma with an extra-meatal tumour diameter of less than 3 centimeters, radiosurgery is more cost-effective than microsurgery.

Adult↗

PubMed2002

Transanal endoscopic microsurgery excision: is anorectal function compromised?

PURPOSE: Transanal endoscopic microsurgery is a new technique that has not yet found its place in routine practice. The procedure results in dilation of the anal sphincter with a large-diameter operating sigmoidoscope, sometimes for a prolonged period. The purpose of the present study was to assess the effect of transanal endoscopic microsurgery on anorectal function. METHODS: Eighteen consecutive patients undergoing transanal endoscopic microsurgery excision of rectal tumors, of whom 13 were available for evaluation, were included. Continence was scored by a numeric scale before surgery and at three and six weeks after surgery. Anorectal physiology studies were performed preoperatively and six weeks postoperatively with manometry, pudendal nerve motor terminal latency, anal mucosal electrosensitivity, rectal balloon volume studies, and endoanal ultrasound. RESULTS: There was a significant reduction in mean anal resting pressure (104 +/- 32 cm H2O before surgery, 73 +/- 30 cm H2O after surgery; P = 0.0009). There was no significant change in squeeze or cough pressure, pudendal nerve terminal motor latency, anal mucosal electrosensitivity, or rectal balloon study volumes. Fall in resting pressure was significantly correlated with length of operating time (r2 =0.39, P = 0.047). There was no significant change in mean continence score after surgery. CONCLUSION: Transanal endoscopic microsurgery results in a reduction in internal sphincter tone. This did not affect continence in a short-term study.

Adult↗

PubMed1983

Experience with the carbon dioxide laser in gynecologic microsurgery.

The value of the carbon dioxide laser in gynecologic microsurgery remains controversial. Initial reports on the success of the laser in infertility surgery were not supported by substantial patient data. The majority of researchers involved with laser microsurgery agree that the technique has numerous advantages, including excellent hemostasis, decreased tissue destruction, exacting precision of dissection and shortened operating time. There are, however, relatively small numbers of patients treated with this modality who have been followed up for a sufficient period of time to determine the ultimate effect the laser will have on pregnancy rates. Since our first laser microsurgical procedure in November, 1980, we have performed more than 150 such procedures. The procedures have included neosalpingostomy, tubal reanastomosis, vaporization of adhesions, and removal of endometriosis. The technique is safe as shown by the absence of any laser-related complication in our cases. We now have 69 patients who have been followed up for more than 1 year since the time of the procedure. The following work is a presentation of pregnancy data and patency rates from this patient group. These results are presented in an effort to offer some objectivity to the comparison of laser microsurgery and standard microsurgery.

Adult↗

PubMed2006

Blood gas changes in patients undergoing laryngeal microsurgery.

BACKGROUND: The aim of this prospective, single-blind study was to assess the variations in the blood levels of PaO(2), PaO(2)/FiO(2), PaCO(2), and acid-base balance of patients undergoing laryngeal microsurgery under general anesthesia using small-bore endotracheal tubes. METHODS: 25 male patients were intubated with endotracheal tubes of 5.5-mm-inner diameter and fifteen female patients were intubated with endotracheal tubes of 5-mm-inner diameter during surgery. PaO(2)/FiO(2), PaO(2), PaCO(2), percentage saturation of O(2) and HCO(3), and pH levels were monitored before surgery and at 15-min intervals during laryngeal microsurgery. Respiratory function's values (dead space, peak inspiratory pressure (PIP) and dynamic compliance) were recorded every 15 min throughout laryngeal microsurgery. RESULTS: No significant differences were observed between the pre- and intra-operative values of percentage saturation of O(2), PaO(2)/FiO(2) and HCO(3) until 120th min. There was no significant difference in respiratory function's values intraoperatively. Under anesthesia, PaO(2) levels significantly increased when compared with preoperative values. Another significant increase was observed in PaCO(2) levels after the 60th min. However, compared with preoperative values, pH levels significantly decreased under anesthesia at the 105th and 120th min. CONCLUSION: Laryngeal microsurgery under general anesthesia can be performed using small-bore endotracheal tubes. This is not likely to have any adverse effects on a patient's blood gases and acid-base balance unless the operation lasts longer than 105 min.

Acid-Base Equilibrium↗