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At least 73 records · Page 4Linked to original sources

PubMed2006

Long-term follow-up after transoral laser microsurgery and adjuvant radiotherapy for advanced recurrent squamous cell carcinoma of the head and neck.

PURPOSE: The aim of this study was to evaluate the efficacy of adjuvant radiotherapy after transoral laser microsurgery for advanced recurrent head-and-neck squamous cell carcinoma (HNSCC). PATIENTS AND METHODS: Between 1988 and 2000, 37 patients with advanced local recurrences (23 local and 14 locoregional recurrences) of HNSCC without distant metastases were treated in curative intent with organ-preserving transoral laser microsurgery and adjuvant radiotherapy (before 1994 split-course radiotherapy with carboplatinum, after 1994 conventional radiotherapy). Initial therapy of the primary (8.1% oral cavity, 35.1% oropharynx, 13.5% hypopharynx, and 43.3% larynx) before relapse was organ-preserving transoral laser microsurgery without any adjuvant therapy. RESULTS: After a median follow-up of 124 months, the 5-year overall survival rate was 21.3%, the loco-regional control rate 48.3%, respectively. In multivariate analysis, stage of original primary tumor (Stage I/II vs. Stage III/IV), and patient age (<58 years vs. >or=58 years) showed statistically significant impact on prognosis. In laryngeal cancer, larynx preservation rate after treatment for recurrent tumor was 50% during follow-up. CONCLUSION: Our data show that organ-preserving transoral laser microsurgery followed by adjuvant radiotherapy is a curative option for patients who have advanced recurrence after transoral laser surgery and is an alternative to radical treatment.

Adult↗

PubMed2006

Transoral robotic surgery (TORS): glottic microsurgery in a canine model.

OBJECTIVES/HYPOTHESIS: We hypothesize that bimanual, three-dimensional robotic surgery will prove valuable for glottic microsurgical procedures. STUDY DESIGN: To test this hypothesis, we developed and optimized a canine model for glottic microsurgery using a commercially available surgical robot. Methods Using a da Vinci Surgical Robot (Intuitive Surgical, Inc., Sunnyvale, CA), glottic microsurgery was performed with a hydrodissection technique in a canine model. The experiments were performed on two orotracheal intubated mongrel dogs under general anesthesia in the supine position on a standard operating room table. A videoscope and two, 360-degree rotating, 5- and 8-mm, wrested-end effector instruments were introduced transorally with three robotic arms. The surgeon performed the actual procedures while positioned at a robotic system console that was located across the operating room suite. The procedure was performed in duplicate and was documented with still and video photography. RESULTS: Glottic microsurgery was successfully performed using the da Vinci Surgical Robot, with both 5- and 8-mm instrumentation. The smaller, 5-mm instruments afforded greater visualization of the operative site and increased maneuverability, which resulted in reduced operative time. The robotic system provided excellent visualization as well as controlled and delicate microdissection at the vocal cord level. CONCLUSIONS: Robotic laryngeal microsurgery is technically feasible in the canine model and warrants consideration for evaluation in controlled human trials.

Animals↗

PubMed1988

Applications of microsurgery in urology.

The applications of microsurgery in urology have increased in the decade since urologists first used such techniques. The primary uses for microsurgery in urology at first were vasovasostomy, vasoepididymostomy, and testicular autotransplantation. Penile revascularization has recently become another procedure for which microsurgery is used with increasing frequency. As more urologists learn the techniques, other urologic applications for microsurgery surely will develop.

Cryptorchidism↗

PubMed2002

Comparison of endonasal endoscopic surgery and sublabial microsurgery for prolactinomas.

BACKGROUND: Endonasal endoscopy is a promising minimally invasive surgery for the treatment of pituitary adenomas; it is also a good alternative to traditional sublabial microsurgery. In this study, we compared endoscopic surgery with microsurgery and evaluated both for their safety and effectiveness. We chose prolactinomas for study because their hormone and symptomatic changes facilitated the comparison. METHODS: During the past five years, 44 randomized prolactinoma patients underwent pituitary adenomectomy. Group A (22 patients) underwent endonasal endoscopic surgery for prolactinomas. Group B (22 patients) underwent sublabial transsphenoidal microsurgery for prolactinomas. RESULTS: In groups A and B, patients with prolactinoma exhibited significantly reduced postoperative prolactin levels, return of menstrual cycle, and relief of galactorrhea, (Wilcoxon signed rank test) (p < 0.001). But there were no statistically significant differences in the effectiveness of the procedures used in group A and group B. Visual improvement in cases of macroadenoma was satisfactory in both groups. Hospital stay in group A ranged from 2-5 days, with a mean of 3.2 days. Hospital stay in group B ranged from 4-8 days with a mean of 5.3 days. The hospital stay for group A patients was shorter (2.1 days) than for group B (Student t test, p < 0.05). The operative time was shorter by 1 hour in Group A (mean: 1.7 hours vs. mean: 2.7 hours, p < 0.05). There were fewer complications in group A (4.5%) than in group B (27%), p < 0.05. CONCLUSIONS: The endoscopic era of pituitary surgery may be coming. Endonasal endoscopic surgery may have the same effectiveness as traditional microsurgery. However, endoscopic surgery may shorten hospital stay and operative time, and lead to fewer complications. It seems to be a good minimally invasive surgical technique for prolactinomas.

Adolescent↗

PubMed1997

Principles of microsurgery.

The surgical principles and techniques used in ophthalmic microsurgery differ considerably from those used in general surgery. Successful ophthalmic microsurgery requires that the surgeon understand not only the design and complexities of the operating microscope, but how tissues are affected by minute manipulations with microsurgical instruments. Furthermore, ophthalmic microsurgery requires a detailed understanding of how microsurgical techniques need to be adjusted to accommodate the unique features of ocular tissues such as conjunctiva, cornea, and lens. A diligent effort to master the principles of ophthalmic microsurgery is probably the single most important prerequisite to becoming an accomplished ophthalmic surgeon.

Animals↗

PubMed1989

[Lumbar disk hernia: microsurgery--yes or no?].

Microsurgery has been performed in about three-quarters of 5,000 patients operated on since 1973 for herniation of a lumbar disc. The findings obtained in two groups of patients who had undergone primary surgery, in the one group by classical methods, in the other by microsurgery, are compared. The two groups were similar in respect of age and sex distribution, localisation of the discal hernia, duration of signs and symptoms and follow-up time. Results classified "very good" were seen more often in the microsurgery group, where no improvement or postoperative aggravation of the signs was relatively rare. The difference compared with the group treated by conventional surgery was mainly in respect of appearance of a postoperative vertebral syndrome, and not so much with regard to the radicular pain syndrome and radicular motor deficits. Unlike some other researchers, we found no difference between the two groups in respect of frequency of local reoperation or of spondylodiscitis. In patients whose disc hernia is mainly of a soft consistency, unilateral and at a single level only, microsurgery requires a shorter access, involves less damage to tissues, allows a better haemostasis and good surgical visualisation. The operation is minimally invasive, the area involved more or less extensive depending on the individual pathology. Magnification under good lighting is indicated in all cases.

Adult↗

PubMed2004

Transanal endoscopic microsurgery.

Transanal endoscopic microsurgery has become an established method of transanally excising rectal tumors. It uses a closed, airtight system that provides constant rectal distension, improved visibility, and longer reach than conventional instrumentation. Virtually any rectal adenoma and properly selected cancers can be removed with this technique. Transanal endoscopic microsurgery excision of cancers requires that strict selection criteria be satisfied and is best suited for T1 cancers. Transanal endoscopic microsurgery should not replace low anterior resection or abdominoperineal resection for those cancers that have either deep penetration into the rectal wall or lymph node metastases. This procedure is safe, is associated with minimal complications, and most patients can be treated on an outpatient basis. Complications include bleeding, urinary retention, temporary soilage, and inadvertent entry into the peritoneal cavity. Once transanal endoscopic microsurgery has been mastered, it may become the technique of choice for locally excising rectal neoplasms.

Adenoma↗

PubMed2005

Contemporary applications of transanal endoscopic microsurgery: technical innovations and limitations.

PURPOSE: Transanal endoscopic microsurgery (TEM) is a minimally invasive procedure used to transanally excise select benign and malignant tumors of the rectum. In properly selected patients, TEM can provide for decreased postoperative morbidity without compromising oncologic outcome. This report summarizes the recent literature concerning TEM, comprehensively analyzes the authors' experience with TEM, and describes recent technical innovations and indications. PATIENTS AND METHODS: Thirty-two consecutive patients scheduled for TEM were identified from our prospectively maintained colorectal service database. Clinicopathologic factors, postoperative complications, and oncologic outcomes were analyzed for all patients. In addition, a PubMed literature search was performed with use of the key words "transanal endoscopic microsurgery," "TEM," "rectal tumor," and "rectal cancer." RESULTS: Transanal endoscopic microsurgery was performed for rectal adenocarcinoma (n = 17; 53%), adenoma (n = 12; 38%), and carcinoid tumors (n = 3; 9%). Median tumor location was 9 cm from the anal verge (range, 3-15 cm). Of the 32 attempted TEM procedures, 27 (84%) were completed. Reasons for inability to complete TEM included narrow rectal lumen or contour of bony pelvis prohibiting passage of the operating proctoscope into the upper rectum and inability to maintain the proctoscope in the rectal lumen with carbon dioxide insufflation because of the distal location of the tumor. Innovations used in the excision of rectal tumors via TEM included the use of the harmonic scalpel, closure of the rectal defect with an extracorporeal slip knot, and a hybrid approach incorporating TEM and traditional transanal techniques. CONCLUSION: Transanal endoscopic microsurgery provides for low morbidity and does not appear to impair oncologic outcome in properly selected patients.

Adenocarcinoma↗

PubMed2001

Target gland functional status in patients with non-Cushing's pituitary macroadenomas undergoing transsphenoidal microsurgery.

OBJECTIVES: Hypopituitarism occurring in patients with pituitary macroadenoma may be reversible after pituitary microsurgery, and surgery itself can lead to hypopituitarism. This study was undertaken to evaluate target gland function prospectively in patients of non-Cushing's pituitary macroadenoma undergoing trans-sphenoidal microsurgery. MATERIAL AND METHODS: A prospective study of fifty patients of non-Cushing's pituitary adenoma was carried out to evaluate target gland (thyroid, adrenal and gonadal) undergoing trans-sphenoidal microsurgery. Thirty-two patients completed postoperative evaluation before radiotherapy. Target gland functions were assessed by measurement of T3, T4, TSH, basal and stimulated cortisol, LH, FSH, testosterone and estradiol. GH and PRL were also measured. Tumor size was assessed on CT/MRI scan. RESULTS: Hypothyroidism, hypoadrenalism and hypogonadism were present in 24%, 54% and 52% of patients. Preoperative hypopituitarism correlated with tumour size. Thyroid, adrenal and gonadal function improved in 87%, 50% and 31%; deteriorated in 4%, 29%, and 37%, respectively after trans-sphenoidal microsurgery. CONCLUSIONS: A subset of patients with non-Cushing's pituitary macroadenoma suffers from hypopituitarism, which reverses after surgery. Failure of recovery correlates with preoperative lower serum prolactin levels.

Adenoma↗

PubMed2001

Reconstructive microsurgery: reviewing the past, anticipating the future.

This article gives an overview of reconstructive microsurgery It is written for residents and fellows training in plastic and microsurgery and practitioners who are intimately involved in the clinical practice of complex reconstructions. The authors describe the highlights of the history of microsurgery and relevant clinical principles. The final portion of this article is designed to elucidate some of the tremendous advances in limb transplantation and the future directions of microsurgery.

Breast↗

PubMed2002

[Carbon dioxide laser transoral microsurgery for glottic carcinoma in situ].

OBJECTIVE: To evaluate the oncologic results of glottic carcinoma in situ (CIS) treated with transoral carbon dioxide laser microsurgery. METHODS: A retrospective review of 12 patients with glottic CIS previously untreated, treated with carbon dioxide laser transoral microsurgery between January 1990 and December 1999 was conducted. RESULTS: Initial and ultimate local control rates were 75%, and 100%, respectively. Three local failures occurred: two glottic CIS were treated by carbon dioxide laser transoral microsurgery, one squamous cell glottic carcinoma was treated by supracricoid partial laryngectomy with cricohyoidoepiglottopexy. The ultimate rate of laryngeal preservation rate was 100%. CONCLUSIONS: Based on the material of this study, recommended treatment for glottic CIS should be carbon dioxide laser transoral microsurgery. Difficulties in endoscopic exposure of the larynx is a contraindication. Further studies are necessary to confirm these preliminary results.

Adult↗

PubMed2003

[The clinical evaluation of patients with pituitary adenomas undergone transsphenoidal microsurgery].

OBJECTIVE: To evaluate the overall effect of transsphenoidal microsurgery for pituitary adenomas in recent 5 years and to discuss the surgical technique, application of new technology and postoperative follow-up results. METHODS: The clinical presentation, image characteristics, endocrinal findings, pathological types, tumor removal percentage, postoperative complication and follow-up of 1 462 patients with pituitary adenomas who underwent the transsphenoidal microsurgery from 1997 to 2002 were analysed retrospectively. RESULTS: Total rate of tumor removal for the patients achieved 97.0% in the patients with Hardy I adenomas, 95.2% with Hardy II, 90.5% with Hardy III, and 47.4% with Hardy IV respectively. A significant postoperative improvement both in clinical symptoms and endocrinal parameters was achieved. The tumor recurrence rate was 0.3%. CONCLUSIONS: With the improvement of microsurgical technique and application of novel technology, the indication of transsphenoidal microsurgery for pituitary adenomas was increasingly extended. Endoscope and(/or) neuronavigation-assisted microsurgery via transsphenoidal approach should be of the first choice for the treatment of pituitary adenomas. The routine postoperative radiotherapy is not required for patients with total tumor removal.

Adenoma↗

PubMedDate not supplied

[Microsurgery in orthopedics and in traumatology].

After having reviewed the historical background, the author presents the different applications of microsurgery in orthopaedics and in traumatology: nerve microsurgery (nerve sutures and grafts, neurotizations) and vascular microsurgery (vascularized bone grafts, free muscular flaps, free fascio-cutaneous flaps, replantations). Microsurgery is now part of the therapeutic arsenal of the orthopaedic surgeon.

Adolescent↗

PubMed2004

[Individualized therapy and outcomes of microsurgery, radiotherapy, and chemotherapy for astrocytoma].

BACKGROUND & OBJECTIVE: Astrocytomas, constitute about 75% of neuroepithelial tumors, is one of the most common primary tumors in central nervous system with fairly high incidence and poor prognosis. Individualized multimodality is the hope for improving prognosis of patients with astrocytoma. This study was designed to investigate the efficiency of individualized treatment of microsurgery, radiotherapy, and chemotherapy for 62 patients with astrocytoma. METHODS: Sixty-two patients with astrocytoma in study group were treated with individualized multimodality of microsurgery, postoperative radiotherapy, and/or postoperative chemotherapy according to in vitro sensitivity assay. After microsurgery, 59 patients accepted radiotherapy, 46 patients received chemotherapy. Fifty patients with astrocytoma in control group were treated with conventional treatment of surgery, chemotherapy, and radiotherapy. After surgery, 31 patients received radiotherapy following by BCNU chemotherapy, while 19 patients accepted BCNU chemotherapy following radiotherapy. Pathologic diagnosis of patients in study group were 19 cases of grade, 32 cases of grade III, and 11 cases of grade IV; in control group were 13 cases of grade II, 28 cases of grade III, and 9 cases of grade IV. Mean follow-up time were 25.8 months, and the outcome was evaluated by MRI, KPS, and survival rate. RESULTS: Tumor total resection rate in study group was 67.7%, while that in control group was 58.0%. There was no significant difference of KPS and survival rate in patients with low-grade astrocytoma between 2 groups, while the outcome of patients with malignant astrocytoma was significantly improved by individualized treatment. In study group, 2-year expectant survival rate of patients with astrocytoma of grade III, and grade IV were 93.7%, and 36.3%, while in control group were 67.5%, and 22.2% (P< 0.05). In glioblastoma patients, median survival time of study group was 18.68 months, while that of control group was 12.83 months (P< 0.01). CONCLUSION: Individualized microsurgery may improve the total resection of astrocytoma, and benefit to postoperative treatment.Individualized radiotherapy/chemotherapy may prevent patients from some complications. Individualized management may improve prognosis of patients with astrocytoma, particularly malignant astrocytoma.

Adolescent↗

PubMed2005

[Influence of regenerated fluid in vitreous cavity at various periods after vitreoretinal microsurgery on the proliferation and bFGF secretion of cultured human retinal pigment epithelial cells].

OBJECTIVE: To demonstrate the mechanism of positive effects of the sequential air-fluid exchange on the use of complicated vitroretinal microsurgery. METHODS: Seventy-one patients who underwent vitreoretinal microsurgery were performed 2 or 3 times sequential air-fluid exchange. The regenerated fliud in vitreous cavity at various periods was collected to act on cultured human retinal pigment epithelial (RPE) cells,and then the secretion of bFGF and the expressions of bcl-2 and ki-67 by RPE cells were observed. RESULTS: The expressions of bcl-2 and ki-67 were up-regulated and the secretion of bFGF significantly increased after RPE cells was acted with the regenerated fluid in the vitreous cavity. CONCLUSION: The sequential air-fluid exchange can mechanically reduce intraocular growth factors after the vitreoretinal microsurgery, indirectly restrain the proliferation of RPE cell, and improve the successful rate of vitreoretinal microsurgery.

Cell Division↗

PubMed2006

[Endoscopic transseptal transsphenoidal pituitary adenoma microsurgery].

OBJECTIVE: To introduce the approach and technique of endoscopic transseptal transsphenoidal pituitary adenoma microsurgery. METHOD: Endoscopic transseptal transsphenoidal pituitary adenoma microsurgery were performed in 23 patients. RESULT: Tumors were total resected in all of the patients. The mean volume of bleeding was 50 ml and there were not any severe complications. CONCLUSION: Compared with transsphenoidal pituitary adenoma microsurgery and endoscopic transsphenoidal pituitary adenoma surgery, endoscopic transseptal transsphenoidal pituitary adenoma microsurgery could combine the benefits of the two approaches. The approach has the benefit of microtrauma, convenience and could resect the tumor thoroughly. We could do best in treating suitable patients with good endoscopic technique.

Adolescent↗

PubMed2006

[Design of a quantitative keratoscope used for ocular microsurgery].

A new quantitative keratoscope used specially for ocular microsurgery to measure corneal astigmatism is reported. A combined cylinder-lens, which power can be changed by rotating lens in anti-direction equally, was designed according to the principal of the crossing cylinder lens. The axis direction is fixed when the lens is rotated. The corneal astigmatism can be measured by changing the power of the combined lens to adjust the corneal ring images. The keratoscope could be used to measure the corneal astigmatism quantitatively specially for ocular microsurgery. At the work-distance of 0.025 m, the maximum power of measured astigmatism was up to 8.50 D. The error of the measurement was less than 0.20 D. The keratoscope is a portable lens to be used easily during the ocular microsurgery. The reporting keratoscope is a simple combined cylinder-lens that can be used to measure corneal astigmatism, including the power and the axis of astigmatism, easily during ocular microsurgery.

Astigmatism↗

PubMed2006

[Application of microsurgery in diagnosis and treatment of larynx diseases].

THE AIM OF THE STUDY: was analyzing cases of laryngeal diseases and their location that required treatment by surgical procedure as well as analyzing complications resulting from microsurgery of the larynx and their location during surgical procedures and treatment performed in the Otolaryngology Clinic at Military Institute of the Health Services Central Military Hospital in Warsaw (years 1994-2003). MATERIAL AND METHODS: We analyzed 713 patients, of which 248 were women (34.8%) and 465 were men (65.2%) aged between 12 and 80 (the average age was 49.4 +/- 11.8), who were diagnosed as requiring microsurgery of the larynx using the Kleinsasser's set together with operating microscope and CO2 laser in selected cases. RESULTS: The total of 713 microsurgical operations was performed in the larynx area. The largest group were the patients who were diagnosed as having polyps (33.0%), chronic laryngitis (19.6%) and an established diagnosis of laryngeal carcinoma. Complications were observed in 416 patients (58.3%). CONCLUSIONS: Microsurgery of the larynx was the most often applied form of treatment of vocal fold polyps, chronic laryngitis and laryngeal carcinoma; pathological changes that require microsurgical treatment are mostly located in the epiglottis and the central part of the glottis whilst the major complications resulting from the microsurgery of the larynx are limited to superficial damage of the mucous membrane, mostly on the lips.

Adolescent↗