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Background: To explore the clinical efficacy of natural orifice specimen extraction surgery (NOSES) combined with transanal endoscopic operations (TEOs) to remove specimens from the anus for laparo...

The gastroenterology (GI) hospitalist model has improved endoscopic operations through improved interdisciplinary coordination, efficiencies introduced in endoscopy unit workflow, and increased patient access to both inpatient and outpatient GI care. The challenges and opportunities associated with a GI hospitalist model and supporting a GI hospitalist team are reviewed, especially in relation to advanced endoscopy. The roles of the GI hospitalist in endoscopy quality measurement and value-based care are also explored. Greater awareness of the GI hospitalist model and tailoring it to fit the needs of the GI practice or endoscopy unit will be key to practice sustainability and growth.

Synopsis The COVID-19 pandemic represents an unprecedented health crisis that has challenged GI practices in major ways. Rapidly implemented global shutdowns resulted in sudden delays of endoscopic procedures. As the country is moving towards a full reopening, practices are wrestling with the challenge of a complete retooling of their operations with the goal of quickly returning to providing high-quality care to large numbers of patients in a safe and effective manner. At the same time, the longer-term impact of the pandemic on future practice operations needs to be assessed: What will post-pandemic GI care look like? Will some aspects of our work be changed forever and if so, what are these aspects and their implications on GI practice management? This chapter provides an overview of the impact of the pandemic on U.S. based GI practices and will discuss some key "lessons learned" that may affect future operations.

Utilization of anesthesia service in endoscopic operations can facilitate the procedural conditions and improve patient satisfaction. Comprehensive preprocedural/preanesthetic assessment should be preceded with focus on medical history, disorders that increase risk of aspiration, NPO status, ASA status, and airway evaluations, as these play an important role in perioperative complications. Preanesthetic assessment should serve as a guide to determining the appropriate depth of sedation for the patient, and indications for general anesthesia with endotracheal intubation should be reviewed. Finally, anesthesia care can be successfully implemented in ambulatory settings, including ambulatory surgery center and ambulatory endoscopy center with appropriate equipment and scheduling.

The literature review is devoted to the history of the development of endoscopic surgery of the lumbar spine: from open surgical interventions and puncture procedures – to percutaneous intracanal endoscopic operations, combining interventional and video endoscopic technologies and referred to in the English literature as “full-endoscopy”. The article also touches upon the historical aspects of fibroendoscopic and laparoscopic interventions on the lumbar spine. In conclusion, the principle of classification of endoscopic techniques is proposed.

Purpose of the study. To determine the need for perioperative antibiotic prophylaxis in video endoscopic operations in bariatric surgery. Materials and methods. The observational study included 152 patients who underwent sleeve gastrectomy for morbid obesity — 94 (61.84 %), gastric bypass surgery — 21 (13.82 %), mini-gastric bypass surgery — 31 (20.40 %) or gastric banding — 6 (3.94 %) in the absence of PAP. All surgical interventions were performed by one team of surgeons. The average duration of the operation was 140.69 ± 35.57 minutes. The overwhelming majority of patients belonged to the average age — 44.0 ± 8.5 years (from 23 to 64 years). The average body mass index (BMI) of all patients at the time of admission was 46.57 ± 7.12. Results. It was found that the development of infections of the surgical site (SSI) without the use of antibiotics in the perioperative period was absent, the frequency of presumed infections was 4.0 % (6 out of 151). Moreover, only in 1 case, an anastomotic leak was diagnosed, in 6 cases the focus of infection was not established and antibiotics (cefoperazone / sulbactam or cefepime, or ceftriaxone) were prescribed empirically for 2–3 days based on an increase in the number of blood leukocytes and a rise in body temperature above normal values. An increase in body temperature and an increase in the number of blood leukocytes in the initial state was associated with grade 4 on the ASA scale and an operation duration of more than 180 minutes. Conclusion. During endovideoscopic surgeries for morbid obesity, perioperative antibiotic prophylaxis is justified only in patients belonging to the 4th class on the ASA scale and the estimated duration of surgery is more than 3 hours.

The development and scientific priorities of European urology of the second half of the XIX and early XX centuries are analyzed. The main dates of life and scientific and practical activity of Prof. Leopold Kasper are presented. The scientific views and thoughts of the scientist are noted. He specialized in urology under the leadership of G. Thompson, P. Freyer, F. Guyon, I. Albarran and L. Dittel after graduating from the University of Berlin in 1883. L. Kasper was the founder of a large German urological school. In addition, he is the author of many works, among which research on cystoscopy, endoscopic operations, functional diagnosis of kidneys diseases, treatment of renal tuberculosis and kidney stone disease, prostate diseases, transurethral galvanocaustics of bladder tumors, etc. are particularly distinguished. He constructed a special catheterization cystoscope (1895) through which for the first time it became possible to study the functional ability of each kidney individually, which greatly facilitated the recognition and treatment of surgical diseases of the kidneys and upper urinary tract. He improved and put into practice a functional renal test with floridzine and cryoscopic urine examination obtained from each kidney separately by catheterization of the ureters. It is noted that L. Kasper was one of the founders of the Society of German urologists, whose founding meeting was held in 1907 in Vienna. In the same year, L. Kasper, together with other prominent surgeons and urologists, founded the journal «Zeitschrift für Urologie», of which he was editor for decades. L. Kasper was an honorary member of nineteen scientific societies, including the Society of Moscow urologists, of which he was elected an honorary member in 1924.

Aim To determine the complexity of urinary stones from the standpoint of endoscopic surgery in order to create the standard for the postoperative course of endoscopic surgery for urolithiasis. Material and methods A total of 1317 endoscopic operations (PNL, URS), performed for upper urinary tract stones, were analyzed. Treatment results of 290 patients were studied prospectively, taking into account a stone density, determined by MSCT using HU scale. In 1027 patients, results were studied retrospectively, with a consideration of stone quantitative characteristics, size and shape. Results According to the study, stone density does not have a significant impact on the frequency and severity of complications and the efficacy of endoscopic treatment for urolithiasis. The number of stones, their size and stereometric configuration have a significant influence on the surgical procedure. From the position of endoscopic interventions, single upper urinary tract stones were determined as "simple", while multiple and staghorn stones were considered as "complexed" cases. Conclusion The "standard of the postoperative period" of endoscopic surgery for urolithiasis created with a consideration of specific features of endoscopic surgery for urolithiasis and the complexity of urinary stones is proved to be objective. Any deviation in the postoperative period from the standard course should be regarded as a complication and it is necessary to systematize them according to the Clavien-Dindo classification.

The effectiveness of the drug Frinosole in the complex treatment of early postoperative changes in the nasal mucosa after endonasal endoscopic surgery was studied. It has been confirmed that during surgical trauma of the mucous membrane of the nasal cavity, inhibition of the main functions of the respiratory epithelium occurs with a sharp increase in the absorption capacity of the mucous membrane of the nasal cavity. These changes correlate with the clinical picture of the early postoperative period. The data presented indicate a high efficacy of the drug in complex postoperative treatment and make it possible to recommend it for wider use in order to minimize the duration of the postoperative healing stages and prevent possible complications associated with excessive granulation and scarring of the nasal mucosa in the surgical areas.

The study objective is to describe the technique of intraoperative Doppler ultrasound (DU) of brain arteries and to determine the indications for its use during endoscopic transsphenoidal operations. Materials and methods. The study included 100 patients with skull base tumors (pituitary adenomas, trigeminal schwannomas, chordomas), operated via standard or extended transsphenoid endoscopic approaches. For DU, the location of the internal carotid artery (ICA) relative to the surface of the tumor or dura mater was determined as a red and/or blue color of the monitor screen in the M-mode window, accompanied by a characteristic sound signal. Results. DU was used to remove pituitary adenomas in 95 cases, trigeminal schwannomas in 3 cases, chordomas in 2 cases. Intraoperative DU helped to locate the ICA during removal of the laterosellar part of the tumor in all observations. In none of the cases presented were no injuries to the ICA. Сonclusion. DU is an effective and non-invasive method for detecting ICA during endoscopic operations which contributes to the safe disposal of laterosellar tumors. Adequate use of the method does not carry well-known and potential risks. DU should be performed when the tumor is removed from the cavernous sinus or its projection via the lateral extended transsphenoidal endoscopic access (to determine the safe boundaries of the dura mater section in the cavernous sinus projection).

Background Endoscopic endonasal transsphenoidal approaches are broadly used nowadays for a vast spectrum of pathologies sited in the anterior and middle cranial fossa. The usage of neuronavigation systems (neuronavigation) in these surgeries is crucial for improving orientations deeply inside the skull and increasing patient safety. Methods The aim of this study was to assess the use of optical neuronavigation, together with an intraoperative O-arm O2 imaging system, in a group of patients with hypophyseal adenoma that underwent a transnasal transsphenoidal surgery, and correlate the accuracy and its deviation during the navigational process against the use of conventional neuronavigation that uses preoperative MRI and CT scans. The overall group consisted of six patients, between 39 and 78 years old, with a diagnosis of hypophyseal adenoma. Patients were treated with an endoscopic transsphenoidal technique and all of them underwent preoperative MRI and CT scans of the brain. These images were used in the neuronavigation system StealthStation S7® during the surgery, where we defined two bony anatomical landmarks, such as a vomer or the origin of an intrasphenoidal septum, in each operated patient. The tip of the navigational instrument, under endoscopic control, pointed to these landmarks and the distance between the tip and the bony structure was measured on the neuronavigation system. Afterwards, intraoperative 3D x-ray imaging was performed via the mobile system O-arm O2® system with automatic transfer into the navigational system. Under endoscopic guidance, we localized the identical bony anatomical landmarks used in the previous measurement and re-measured the distance between the tip and bony landmark in images acquired by the O-arm. The results of both measurements were statistically compared. Results The mean error of accuracy during conventional neuronavigation with usage of preoperative CT and MRI scans was 2.65 mm. During the neuronavigation, with utilization of intraoperative 3D O-arm images, the mean error of accuracy 0 mm. These mean errors of accuracy (both measurement methods were compared by nonparametric Wilcoxon test) had a statistically significant difference (p = 0.043). Conclusions Based on this preliminary clinical study, we conclude that the O-arm is capable of providing intraoperative x-ray 3D images in sufficient spatial resolution in a clinically feasible acquisition. The mean error of accuracy during intraoperative navigation, based on 3D O-arm scans at the skull base, is significantly lower compared to the usage of navigation using conventional presurgical CT and MRI images. This suggests the suitability of this method for utilization during endoscopic endonasal skull base approaches.

Introduction. In endosurgery of the digestive tract, ‘cellular technologies’ are gaining popularity, including the use of blood components or blood cells with a haemostatic purpose. In this regard, the objective of the study is evaluation of the effectiveness of bleeding control and safety of resection of the hollow organs of the digestive tract in the experimental trauma models of the abdominal organs in laboratory animals. Materials and methods. The study was conducted in 20 mature male Chinchilla rabbits with the mean body mass of 2450 ± 210 g. All animals were divided into four experimental groups: the control group (without bleeding control); the group that received the infiltration of the wall of a hollow organ with saline; the group in which bleeding was controlled by argon plasma coagulation (APC), and the group wherein animals underwent haemostasis with autoplasma. Results. In the control group and the physiological saline group, no statistical difference was observed in the time of bleeding control. Autoplasma, due to preventive local administration, is more effective than APC and has a high haemostatic potential. Conclusion. Autoplasma has been found to be highly effective and safe for bleeding control in the gastrointestinal tract in the experimental model, which has paved the way for new possibilities for operations of various scales, including endoscopic operations.

Введение. Многочисленные публикации, посвященные успешному применению препарата Канефрон® Н («Бионорика», Германия) в рамках метафилактики мочекаменной болезни после дистанционной литотрипсии, а также профилактике и лечению инфекционно-воспалительных заболеваний нижних и верхних мочевых путей, послужили основанием для проведения собственного исследования эффективности и безопасности длительного приема препарата у пациентов с урологическими заболеваниями после проведения различных эндоскопических операций. Пациенты и методы. С января по июнь 2011 г. на базе ГБУЗ «ГКУБ № 47» были выполнены 882 трансуретральные и перкутанные эндоскопические операции. Основную группу составили пациенты, которым после эндоурологических вмешательств назначали препарат Канефрон® Н («Бионорика», Германия) в качестве компонента комплексной уроантисептической терапии. Препарат применяли в терапевтической дозе по 2 драже 3 раза в день курсом до 2 месяцев. Контрольную группу составили больные, которым после выполнения тех же операций проводилась стандартная уроантисептическая терапия (нитрофураны, пипимидиевая кислота и др.) в течение 2 месяцев. При обследовании пациентов основной и контрольной групы отслеживались такие показатели, как суточный диурез, лейкоцитурия, динамика симптомов заболевания и качество жизни пациентов. Результаты. Применение Канефрона Н после трансуретральных операций на нижних мочевых путях уменьшило ирритативную симптоматику, улучшило качество жизни пациентов, снизило лейкоцитурию и повысило диурез. Использование Канефрона Н после операций на верхних мочевых путях также улучшило качество жизни пациентов, снизило лейкоцитурию, повысило диурез и улучшило отхождение резидуальных фрагментов. У пациентов с оксалатными и уратными камнями было отмечено стойкое повышение рН мочи, что может являться частью метафилактики мочекаменной болезни. Нежелательных эффектов, связанных с приемом препарата отмечено не было. Выводы. Показаны преимущества использования препарата Канефрон® Н в реабилитации пациентов после эндоурологических операций.

This contribution provides an overview of various photogrammetric measurement techniques in minimally invasive surgery and presents a self-developed prototypical trinocular endoscope for reliable surface measurements. Most of the presented techniques focus on applications regarding laparoscopy, which mean endoscopic operations in the abdominal or pelvic cavities. Since endoscopic operations are very demanding to the surgeon, various assistant systems have been developed. Imaging systems may use photogrammetric techniques in order to perform 3D measurements during operation. The intra-operatively acquired 3D data may be used for analysis, model registration, guidance or documentation. Passive and active techniques have been miniaturised, integrated into endoscopes and investigated by several research groups. The main advantages and disadvantages of several active and passive techniques adapted to laparoscopy are described in this contribution. Additionally, a self-developed trinocular endoscope is described and evaluated.

Differential diagnostics of papillospasm and papillostenosis should be based on the complex of clinical and instrumental researches with the priority to endoscopic technologies. Conservative therapy should be considered as optimal option of treatment for the patients with papillospasm. Preference of endoscopic operations have to be in case of revealed papillostenosis of different degree. Similar differentiated diagnostics and treatment management justified in 90% of cases and led to improvement of patient’s conditions and their recovery.

In this review presents data on efficiency endoscopic operations at some ear diseases. Now endoscopic operations are widely applied at primary and residual (or recuring) middle ear cholesteatomas, tympanic membrane perforation, otosclerosis and cochlear implantation. Proceeding from resolving power of endoscopic technology, endoscopic operation can be applied as an independent method, or as an endoscopic assisted, to be combined with otomicrosurgery operation. Efficiency of endoscopic operation in many respects is defined by a possibility of panoramic visualization of anatomical structures of middle and inner ear, and also carrying out high-quality elimination of focus lesion from areas, being remote when performing otomicrosurgery operation.В обзоре представлены сведения об эффективности эндоскопических операций при некоторых заболеваниях уха. В настоящее время эндоскопические операции широко применяются при первичной и остаточной (или рецидивирующей) холестеатоме среднего уха, перфорации барабанной перепонки, отосклерозе и кохлеарной имплантации. Исходя из разрешающей способности эндоскопической технологии, эндоскопическая операция может применяться в виде самостоятельного метода либо в качестве эндоскопической ассистенции в комбинации с отомикрохирургической операцией. Эффективность эндоскопической операции во многом определяется возможностью обеспечения панорамного обзора анатомических структур среднего и внутреннего уха, а также проведения качественной элиминации очагов поражения из областей, являющихся труднодоступными при выполнении отомикрохирургической операции.

T ota l mesorectal excision is the “golden standard” of surgical treatment for rectal cancer. Development of endoscopic technologies allowed to implement the benefits of minimally invasive surgery in early rectal cancer treatment, decrease morbidity and mortality, improve functional outcome and quality of life. Oncological safety of this method is still a subject for discussion due to lack of lymph node harvest. Endoscopic operations for early rectal cancer are being actively implemented in daily practice, but lack of experience does not allow to include this method in national clinical prac-tice guidelines.

We sought to seek the potential role of endoscopic thyroidectomy with the retroauricular (RA) approach prior to future comparative study with the robotic RA thyroidectomy. Therefore, this study aims to verify the surgical feasibility of endoscopic RA thyroidectomy. Eighteen patients who underwent endoscopic RA thyroidectomy for clinically suspicious papillary thyroid carcinoma or benign lesions from January to December 2013 were retrospectively reviewed and analyzed. All endoscopic operations via RA or modified facelift approach were successfully performed, without any significant intraoperative complications or conversion to open surgery. Based on patient-reported outcome questionnaires, all patients were satisfied with their postoperative surgical scars. Endoscopic RA thyroidectomy is technically feasible and safe with satisfactory cosmetic results for patients where indicated.

Difficulties in endoscopic operations and therapeutic procedures seem to occur due to the complexity of operating the endoscope dial as well as difficulty in performing synchronized movements with both hands. We developed a prototype robotic-assisted flexible endoscope that can be controlled with a single hand in order to simplify the operation of the endoscope. The aim of this study was to confirm the operability of the robotic-assisted flexible endoscope (RAFE) by performing endoscopic submucosal dissection (ESD). Study 1: ESD was performed manually or with RAFE by an expert endoscopist in ex vivo porcine stomachs; six operations manually and six were performed with RAFE. The procedure time per unit circumferential length/area was calculated, and the results were statistically analyzed. Study 2: We evaluated how smoothly a non-endoscopist can move a RAFE compared to a manual endoscope by assessing the designated movement of the endoscope. Study 1: En bloc resection was achieved by ESD using the RAFE. The procedure time was gradually shortened with increasing experience, and the procedure time of ESD performed with the RAFE was not significantly different from that of ESD performed with a manual endoscope. Study 2: The time for the designated movement of the endoscope was significantly shorter with a RAFE than that with a manual endoscope as for a non-endoscopist. The RAFE that we developed enabled an expert endoscopist to perform the ESD procedure without any problems and allowed a non-endoscopist to control the endoscope more easily and quickly than a manual endoscope. The RAFE is expected to undergo further development.

Transanal endoscopic microsurgery (TEM) was originally designed for the removal of rectal tumors, principally incipient adenomas, and adenocarcinomas up to 20 cm from the anal verge. However, with the evolution of the technique and the increase in surgeons' experience, new indications have emerged and TEM may now be used in place of other surgical procedures which are associated with higher morbidity. The aim of our study was to evaluate our group's use of TEM or transanal endoscopic operations (TEO) for conditions other than rectal tumors.An observational study of TEM (using Wolf equipment) or TEO (using Storz equipment) for indications other than excision of rectal tumors was conducted from June 2004 to July 2012.Four hundred twenty-four procedures were performed using TEM/TEO: removal of adenocarcinomas in 148 (34.9 %) patients, adenomas in 236 (55.7 %), post-polypectomy excision in 12 (2.8 %), removal of neuroendocrine tumors in 8 (1.9 %), and atypical indications in 20 (4.7 %). Atypical indications were pelvic abscess (3), benign rectal stenoses (2), rectourethral fistula after prostatectomy (3), gastrointestinal stromal tumor (3), endorectal condylomata acuminata (1), rectal prolapse (2), extraction of impacted fecaloma in the rectosigmoid junction (1), repair of traumatic and iatrogenic perforation of the rectum (2), and presacral tumor (3).The use of TEM/TEO in atypical indications may benefit patients by avoiding surgical procedures associated with greater morbidity.

Background Based on our previous experiences with endoscopic or robotic neck surgery utilizing the retroauricular (RA) or modified facelift (MFL) approach, we realized the value of verifying the feasibility of endoscopic supraomohyoid neck dissection (SOND). Therefore, the purpose of this study was to evaluate the potential role of endoscopic SOND. Methods Six patients who underwent elective endoscopic SOND of the ipsilateral neck for biopsy proven head and neck cancer from January 2011 to February 2012 were analyzed. Results All endoscopic operations via RA or MFL were successfully performed without any significant intraoperative complications or conversion to open surgery. Based on patient-reported outcome questionnaires, all patients were satisfied with the cosmetic surgical outcomes. Conclusion Endoscopic selective neck dissection via an RA or an MFL approach is technically feasible and safe with satisfactory cosmetic results for patients with clinically node-negative early-stage head and neck cancer. © 2013 Wiley Periodicals, Inc. Head Neck 36: 425–430, 2014

This research investigates using cryogenic saline mist, in comparison to the conventional saline irrigation, in neurosurgical bone grinding to prevent thermal injury to surrounding nerves and to increase the visibility of surgical area for endoscopic operations. Delivery of cryogenic mist directly towards the grinding zone along with a backward grinding motion was found important to maximize and localize the cooling effect, thus reducing bone temperature rise. Experimental results also showed a pre-cooling effect of the cryogenic mist that helps reduce the initial temperature of bone prior to the occurrence of grinding.

Over the past 20 years there has been a slow but continuous migration from open surgery to less invasive, more patient-friendly therapeutic options. Surgery is evolving away from the purely tactile craft of the twentieth century, towards a less invasive metier augmented by robotics and image-guidance. The future of surgery embraces a flexible, technology-enabled, and image-based approach. It will focus on less invasive approaches with the aim of cost-effective care. Therefore, modern surgical thinking needs to go further than laparoscopic or endoscopic replications of open established surgical techniques. The real act of discovery consists not only in finding new lands but in seeing with new eyes. Therefore, the idea of decreasing the morbidity of an operation challenges not only the way the intervention is delivered but also the surgical strategy itself. Because of advances in techniques and technology, what was once a fantasy is now a realistic goal: to safely and adequately address surgical issues with minimal or no anesthesia, in a same day facility, leaving little or no scar, and returning our patients to normal life the next day.

This paper presents a novel solution of a hand-held external controller to a miniaturized capsule endoscope in the gastrointestinal (GI) tract. Traditional capsule endoscopes move passively by peristaltic wave generated in the GI tract and the gravity, which makes it impossible for endoscopists to manipulate the capsule endoscope to the diagnostic disease areas. In this study, the main objective is to present an endoscopic capsule and a magnetic field navigator (MFN) that allows endoscopists to remotely control the locomotion and viewing angle of an endoscopic capsule. The attractive merits of this study are that the maneuvering of the endoscopic capsule can be achieved by the external MFN with effectiveness, low cost, and operation safety, both from a theoretical and an experimental point of view. In order to study the magnetic interactions between the endoscopic capsule and the external MFN, a magnetic-analysis model is established for computer-based finite-element simulations. In addition, experiments are conducted to show the control effectiveness of the MFN to the endoscopic capsule. Finally, several prototype endoscopic capsules and a prototype MFN are fabricated, and their actual capabilities are experimentally assessed via in vitro and ex vivo tests using a stomach model and a resected porcine stomach, respectively. Both in vitro and ex vivo test results demonstrate great potential and practicability of achieving high-precision rotation and controllable movement of the capsule using the developed MFN.

The article presents the results of the evaluation of the effectiveness of anti-inflammatory therapy in the perioperative period in patients with pathology of the paranasal sinuses. The study included patients (n=150) who underwent endoscopic surgery on the paranasal sinuses. All patients were divided into 3 groups. In the first (control) group (n=50) in the postoperative period, patients received standard therapy, which included antibiotic therapy and irrigation of the nasal cavity with saline. In the second comparison group (n=50), in addition to the standard treatment in the postoperative period, the preparation Erespal was added to 2 tab/day for 1 month. The third comparison group (n=50) started taking Erespal 2 tab/day 7 days before the surgery, and in the postoperative period the treatment continued in the same way as in the 2nd group (standard therapy and Erespal 2 tab/day after the operation for 1 month). The study showed that Erespal's effectiveness after endoscopic operations on the paranasal sinuses makes it possible to accelerate the recovery period of patients, leading subjectively to the normalization of well-being and objective positive changes from the mucous membrane of the nasal cavity (decrease in edema, hyperemia, smaller changes in postoperative CT of the ONP).В статье представлены результаты оценки эффективности противовоспалительной терапии в периоперационном периоде у пациентов с патологией околоносовых пазух (ОНП). В исследование вошли пациенты (n=150), которые перенесли эндоскопическое оперативное лечение на околоносовых пазухах. Все пациенты были разделены на три группы. В 1-й (контрольной) группе (n=50) в послеоперационном периоде пациенты получали стандартную терапию, которая включала антибиотикотерапию и орошение полости носа физиологическим раствором. Во 2-й группе сравнения (n=50), кроме стандартного лечения, в послеоперационном периоде был включен препарат эреспал по 2 таблетки в сутки в течение 1 мес. Пациенты в 3-й группе сравнения (n=50) начинали прием эреспала по 2 таблетки в сутки за 7 дней до операции, а в послеоперационном периоде лечение продолжалось по той же схеме, что и во 2-й группе (стандартная терапия и эреспал 2 таблетки в сутки после операции в течение 1 мес). Проведенное исследование доказало: эффективность препарата эреспал после эндоскопических операций на околоносовых пазухах дает возможность ускорить восстановительный период пациентов, приводя к нормализации самочувствия и объективным положительным изменениям слизистой оболочки полости носа (уменьшение отека, гиперемии, меньшим изменениям на послеоперационных КТ ОНП).

Ultrasonically activated devices (USADs) offer excellent coagulating dissection performance and are broadly used, particularly in endoscopic operations. Traditional USADs, however, have fixed linear shape and are thus limited in the directions from which organs can be approached. We have developed a small USAD transducer attached to the tip of an articulating device, offering a new kind of USAD in which the tip can bend as desired. We describe herein an evaluation of the coagulating dissection performance of this new articulating USAD and an in vivo confirmation of clinical usefulness.To evaluate coagulating dissection performance, we compared coagulating shearing on porcine splenic arteries between the articulating USAD and a Harmonic Scalpel II (HSII), representing a traditional USAD. Changing the amplitude of vibration between 60 microm and 80 microm and grip force among 1, 2, and 3 N, we measured the time required for division and bursting pressure of coagulating dissection. An in vivo experiment in a pig was also used to confirm the usefulness of the articulating USAD in laparoscopic operations.Division time did not differ significantly between the articulating USAD and HSII with an 80-microm amplitude of vibration and a grip force of 2 or 3 N. Bursting pressure of blood vessels showed no significant difference between articulating USAD and HSII under all experimental conditions. In the in vivo experiment, the new bendable tip of the articulating USAD displayed coagulating dissection performance equivalent to that of the traditional USAD.We have developed a new articulating USAD that can broaden the range of methods and approaches available for USADs and improve usefulness and safety.

RATIONAL: In the treatment of colorectal cancer, from 1982 Heald proposed standardization of the total mesorectal excision, with a significant reduction in the recurrence rate. But the treatment of lower rectal lesions is still a challenge. AIM: To describe the association of robotic low anterior resection- TATA (Transanal Abdominal Transanal Resection), with transanal access using Transanal Endoscopic Operations - TEO in the treatment of lower rectal cancer. METHOD: The TATA performs robotic abdominal approach and the TEO performs the perineal approach, developing total mesorectal excision (TME) transanally (TaETM). RESULT: The TaETM technique was applied in a woman with rectal adenocarcinoma 5 cm from the anal verge that had been submitted to chemoradiation. The procedure was performed with satisfatory operative time and favorable oncological outcome (grade 3 mesorectal excision). CONCLUSION: This is a promising minimally invasive procedure in the armamentarium of rectal cancer treatment, specially in challenging scenarios such as narrow pelvis, obesity and very low rectal tumors. RACIONAL: No tratamento do câncer colorretal, a partir de 1982 Heald propôs padronização da excisão total do mesorreto, com redução importante no índice de recidivas. Apesar disso, o tratamento das lesões do reto inferior ainda permanecem um desafio. OBJETIVO: Descrever a associação da abordagem robótica por via abdominal - TATA (Transanal Abdominal Transanal Resection), com o acesso transanal utilizando o Transanal Endoscopic Operations - TEO no tratamento do câncer de reto inferior. MÉTODO: A TATA realiza o tempo abdominal por robótica e o TEO o tempo perineal, desenvolvendo a excisão total do mesorreto (ETM) por via transanal (TaETM). RESULTADO: A técnica TaETM foi aplicada em mulher com adenocarcinoma de reto a 5 cm da margem anal que tinha sido submetida à radioquimioterapia. O procedimento foi realizado com um tempo cirúrgico satisfatório bem como resultado oncológico favorável (ressecção mesorretal grau 3). Paciente obteve alta no segundo dia pós-operatório com seguimento ambulatorial satisfatório. CONCLUSÃO: Trata-se de um procedimento minimamente invasivo bastante promissor no arsenal terapêutico do câncer de reto, principalmente em situações de maior dificuldade técnica como pelve estreita, obesidade e lesões do reto distal.

In open surgery preparation, dissection and hemostasis are easy to perform compared with endoscopic surgery. In open surgery, the surgeon is able to use a variety of instruments and methods, In endoscopic surgery, scalpels cannot be used and the freedom of manipulation of instruments such as scissors and forceps is limited. Hence, endoscopic surgery depends on the availability of special methods, instruments, and equipments for different endoscopic operations. High-frequency surgery offers different methods and instruments for preparation, dissection, and hemostasis for endoscopic interventions.

The extension of fluorescence diagnosis into the near-IR region is promising, because this radiation penetrates more deeply into biological tissue, has higher contrast due to the absence of intrinsic fluorescence of the tissue, and can work in brightly lit operating rooms, as well as because new drugs have been developed that can specifically accumulate in pathological foci. The FLUM-808 multispectral system has been developed and makes it possible to visualize and simultaneously make quantitative estimates in IR fluorescence light and reflected white light or in as many as four spectrally separated fluorescences in the 410–950-nm range. Using the latter phenomena as an example, produced on experimental animals and during the performance of open, microsurgical, and endoscopic operations with indocyanine green as an IR fluorescence marker, it has been shown to be possible to employ the system to solve crucial medical problems: the detection of malignant tumors, metastases, and sentinel lymph nodes in the presence of cancer and the visualization of the circulatory and lymphatic systems and of bile ducts.

Minimally invasive techniques can reduce tissue damage. Endoscopic operations have advantages which have raised these procedures to the standard in various areas. In arthroscopy, working with rod-lens optics under continuous fluid irrigation has proven valuable. In addition to reduced traumatization, improved visual and light conditions are achieved. Full-endoscopic operations on the lumbar spine can usually be performed uniportal via trans-/extraforaminal or interlaminar approaches. Analogous to the arthroscopy, there is continuous intraoperative irrigation. Since usually only one access is used, the instruments must be inserted through an intraendoscopic working canal. These days, the equipment available offers operation-technical possibilities comparable to those known from microscope-assisted surgery.

The author reports on the methods and results of the last 10 years in the treatment of pseudo-paralysis caused by the adhesions and scars in the interary region and in the commissura posterior-bilateral vocal cord paralysis and severe scarred laryngeal stenoses. During the stated period 68 patients were operated on. 4 patients were treated by an endolaryngeal approach for scarred adhesions developing in the interary region or in the commissura posterior. The operation was successful in all 4 patients. In 4 cases of laryngeal stenoses resulting from bilateral vocal cord paralysis, the Rethi-type operation was performed successfully in each case. In 33 cases, of which 32 could be analysed, the laryngo-microsurgical latero-fixation method was applied, with or without arytaenoidectomy, based on the endo-extralaryngeal suture technique developed by the author in previous animal experiments. In 29 patients the cannula was successfully removed after the endoscopic operations. 27 patients were operated on severe laryngeal stenoses. Of the 27 patients 24 had the cannula removed after the operations. In 3 patients the operations proved unsuccessful, and in these cases further operations are necessary.

Results of surgical treatment of 128 successive patients with primary hyperparathyroidism (PHPT) within 2007-2008 years were analyzed in the article. 107 operations have been performed by the conventional approach with revision of all 4 parathyroid glands, 21 operations — using minimally invasive methodics (12 endoscopic operations and 9 targeted operations through mini incision). Multiglandular disease was observed in 12.5% of all cases. Comparison of conventional and minimally invasive surgery demonstrates advantages of the endoscopic and targeted operations in cosmetic results and recovery time having the same rate of complications. The obligatory conditions for effective minimally invasive operations in patients with PHPT include undoubtful localisation of adenoma, low risk of multiglandular disease, availability of quick parathyroid hormone assay (at least — in few days)., В статье приведен анализ 128 операций по поводу первичного гиперпаратиреоза (ПГПТ), выполненных на протяжении 2007-2008 годов в специализированной клинике эндокринной хирургии. 107 операций проведены традиционным методом с ревизией всех 4 околощитовидных желез, 21 операция — с помощью эндоскопической техники (12) или через нацеленный мини-доступ (9). В 12,5% всех операций отмечено поражение более чем одной железы. Малоинвазивные операции демонстрируют преимущества в косметическом эффекте и скорейшем выздоровлении при одинаковом риске рецидива и осложнений. Условиями проведения малоинвазивных операций при ПГПТ являются четкая локализация аденомы околощитовидной железы, низкий риск мультигляндулярного поражения, возможность получения быстрого результата анализа на содержание паратгормона в крови (оптимально — интраоперационный экспресс-анализ).

OBJECTIVE: We developed a modified soft tissue retractor for preventing problems that occur outside of the microscopic view field during microsurgery. INSTRUMENTATION AND OPERATIVE PROCEDURE: The characteristics of the modified soft tissue retractor are detachable handgrips, which can be easily released and fixed with the manipulation of an equipped button, and a new lock adjuster, which changes its form and position so that it is withdrawn into a corner space between both arms in proportion to the open angle of the arms. The retractor is used with handgrips, as in the conventional method, until the microsurgery begins. When microsurgery begins, the handgrips are released. We have used this retractor in 45 microsurgeries and 42 burr-hole surgeries, such as stereotactic or endoscopic operations. RESULTS: The detachable handgrips can resolve problems caused by handgrips and a lock lever in conventional retractors, such as interference with the free movement of the microsurgical operator's hands, restriction of operative approach angle or direction of the light axis of a microscope, and catching or tangling of instrument cords and thin thread. In addition to microsurgery, it was beneficial in burr-hole surgeries, because operators can manipulate instruments, such as a stereotactic arm or an endoscope, without having to handle the retractor handgrips. CONCLUSION: Our modified soft tissue retractor is very useful for performing steady and safe microsurgery.

Transanal access is one of many currently used procedures for rectal cancer treatment. The techniques used for local excision include conventional transanal excision, posterior access, therapeutic colonoscopy and transanal endoscopic approaches. The aim of the present study was to present a new surgical proctoscope for the endoscopic transanal excision of rectal lesions. A cylindrical proctoscope with a diameter of 4 cm was devised and built. The end inserted into the anus has a bevelled aspect and rounded borders, allowing correct exposure of the anal lesion. The rectoscope is fixed to the anal border with surgical thread through perforations in the external end. A base screw holds a fibre-light which illuminates the operative field. Part of the equipment is a guide which is positioned inside the rectoscope on insertion into the anus. In operations utilizing this proctoscope, 17 adenomas, 25 adenocarcinomas, 1 carcinoid and 1 endometrioma were excised. The diameter of the lesions varied from 1 to 6 cm. The range of procedures that are possible with this new proctoscope are similar to those achieved with conventional techniques which, however, require more expensive equipment. Hence, the present study demonstrates that this newly devised low-cost proctoscope is an efficient tool for the transanal endoscopic excision of rectal lesions.