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In central sterile services departments (CSSD), the functionality of rigid endoscopes, which are complex and fragile reusable devices, is usually controlled visually and is considered a complex and subjective task. ScopeControl® was developed to provide an automated quality control of rigid endoscopes by measuring the value of six parameters: viewing angle (VA), field of view (FV), color correctness (CC), light transmission (LT), fibers transmission (FT), and focus (FC). The aim of the present study was to assess the ability of ScopeControl® to pre-emptively identify endoscope defects before the surgeon considers them as defective. The same endoscope was evaluated by surgeons during surgery using a scoring scale as well as the CSSD staff using the ScopeControl® during reprocessing. The ScopeControl® categorized the endoscope into 3 groups: “passed,” “in danger,” and “failed.” Correlations between the surgeon’s evaluation and results of the ScopeControl® were calculated. One hundred sixty-six controls were carried out concerning 51 different endoscopes. According to the surgeon’s evaluation, 78.9% and 80.7% of controls were considered as satisfactory for image and brightness quality, respectively. Results obtained using ScopeControl® found that 13.3% of controls were considered as “passed,” 31.3% “in danger,” and 55.4% “failed,” with poor correlation with the surgeons’ evaluation. LT and FT parameters represented 95.2% of the reasons for failures. The ability of the ScopeControl® to detect endoscope defects earlier than surgeons was validated by tracking the results of endoscopes used and controlled several times. The ScopeControl® achieved an objective and consistent quality control of endoscopes and showed poor correlation with the surgeon’s opinion. In practice, the ScopeControl® could avoid the use of defective endoscopes in the surgery unit and thus improve the quality of the surgical procedure.

The article presents information on the stages and peculiarities of processing rigid endoscopes in the provision of outpatient medical care in the otorhinolaryngological service.

The natural connection between the duodenum and the pancreatic duct enables a minimally invasive access to the pancreas. Endoscopically this access is already regularly used, mainly for diagnostic and even for certain therapeutic purposes. With per-oral pancreatoscopy the endopancreatic approach allows the direct visualization of the pancreatic duct system potentially improving the diagnostic work-up of pancreatic cystic neoplasms, intrapancreatic strictures and removal of pancreatic duct stones. However, the endopancreatic access can equally be applied for surgical interventions. The objective of this review is to summarize endoscopic and surgical interventions using the endopancreatic access. Endopancreatic surgery stands for a further development of the endoscopic technique: a rigid endoscope is transabdominally introduced over the duodenum and the papilla to enable resections of strictures and inflamed tissue from inside the pancreas under visual control. While the orientation and localization of target structures using this minimally invasive approach is difficult, the development of an accurate image guidance system will play a key role for the clinical implementation and widespread use of endoscopic and surgical endopancreatic interventions.

In 2011, we developed bidirectional approach video-assisted neck surgery (BAVANS) for endoscopic thyroid cancer surgery. BAVANS combines two different approach pathways at 180 degrees to the cervical lesion for endoscopic thyroidectomy and complete cervical lymphadenectomy. We reported previously that the cranio-caudal approach is extremely useful for endoscopic complete lymph node dissection around the trachea. In 2014, we upgraded the initial BAVANS for better maneuverability and quality of lymph node dissection. A new high-tech rigid endoscope with a variable viewing direction (EndoCAMeleon™), has enabled us to reduce the camera port in the anterior neck while keeping the easy maneuverability and the same quality of central lymph node dissection (LND) as with the initial BAVANS. Endoscopic thyroid cancer surgery is now evolving concurrently with new visual technology.

Background . Endoscopes with a rigid relay optical system have several advantages over flexible endoscopes and therefore are widely used in medicine. The problem remains the predisposition of these endoscopes to the destruction of that part of the optical system, which is assembled from rigid rod glass lenses. The cause of the damage can be small (up to one degree) bends of the metal tube in the process of using the endoscope. Failure of the optical part of the endoscope during surgery can have serious negative consequences for the patient. Objective. The aim of the article is to improve the optical relay part of a rigid endoscope, aimed at a significant reduction of its destruction due to the bends of the tube. Methods. To eliminate the damage, the relay part of the optical system is proposed to be assembled from short rod lenses with spherical ends, which allow for flexible articulation of these lenses. It is proposed to place a special heat-resistant immersion in the gaps between the spherical ends of the lenses, which ensures the passage of light from one lens to another with virtually no loss of luminous flux. It is shown that the proposed improvement allows to bend the tube at an angle of up to 10 degrees without breakage of rod lenses, which is unprecedented for rigid endoscopes. It is confirmed that the introduction of an additional aberration compensator of two meniscus lenses located between one pair of adjacent rod lenses into the optical system provides high image quality across the entire field of view, superior to the image quality of the prototype. At the same time, the distribution of relative illumination in the image plane formed by the improved optical system remains almost unchanged. Results. Providing greater flexibility of the rigid endoscope increases its competitive ability. Further improvement of the optical system of rigid endoscopes will create the conditions for the introduction of new minimally invasive surgical techniques that will simplify, reduce the cost and make endosurgical procedures minimally traumatic.

Background The description and refinement of the transsphenoidal approach would not be possible without new tools and technologies developed by surgeons to facilitate this approach, which is nowadays the standard procedure for more than 90% of sellar lesions. The latest major change in transsphenoidal surgery was the introduction of the rigid endoscope and the subsequent description of the endoscopic endonasal approach. Traditional bayoneted instruments, when used for this technique, were inadequate. New instruments designed, specifically for this technique, are necessary to facilitate the surgeon's work and improve patient outcome. Objective This study describes a novel design of dissectors created specifically for endoscopic endonasal approaches. Methods To develop and design the Angelina dissectors, we used our extensive surgical experience to identify the shortcomings of the available dissectors used for transsphenoidal surgery and created the Angelina dissectors. Results The Angelina dissector was designed with a unique shaft shape which facilitates endoscopic endonasal surgery. Conclusion Even though an endoscopic endonasal approach is possible using other instruments, the design of these dissectors aids the surgeon's work. It is our impression, based on personal experience that it allows more freedom of movement and dexterity during the procedure, which could translate as an improved patient outcome.

Aim To present a case series describing an endoscopic technique with a small craniotomy for recurrent chronic subdural hematoma (rCSDH) treatment. Material and methods A total of 17 patients with rCSDH underwent neuroendoscopic hematoma removal with a small craniotomy under local or general anesthesia. The skin incision of the initial surgery on the convexity of the skull was extended, and a burr hole was created for a small craniotomy. After the removal of the outer membrane and hematoma through a small craniotomy, the hematoma was evacuated with a suction tube using the rigid endoscope. The entire hematoma cavity circumference was irrigated, while septations and trabeculae in the hematoma were cut. After hematoma evacuation, the inner membrane was incised and removed to allow brain expansion. Postoperative follow-up was performed for at least 6 months. Results The regrowth rate of rCSDH after the neuroendoscopy was 5.9%. One patient with recurrent chronic subdural hematoma regrowth required neuroendoscopy again, but no re-recurrence was observed for the next 6 months. All cases were successfully managed using this technique and the postoperative seizure rate was 23.5%. Conclusion This neuroendoscopic technique with a small craniotomy could be useful for recurrent chronic subdural hematoma because the hematoma and septations can be visualized and evacuated along the entire circumference of the hematoma cavity, and the inner membrane can be torn to allow brain expansion.

Semantic segmentation with deep learning to extract nerves from label-free endoscopic images obtained using coherent anti-Stokes Raman scattering (CARS) for nerve-sparing surgery is described. We developed a CARS rigid endoscope in order to identify the exact location of peripheral nerves in surgery. Myelinated nerves are visualized with a CARS lipid signal in a label-free manner. Because the lipid distribution includes other tissues as well as nerves, nerve segmentation is required to achieve nerve-sparing surgery. We propose using U-Net with a VGG16 encoder as a deep learning model and pre-training with fluorescence images, which visualize the lipid distribution similar to CARS images, before fine-tuning with a small dataset of CARS endoscopy images. For nerve segmentation, we used 24 CARS and 1,818 fluorescence nerve images of three rabbit prostates. We achieved label-free nerve segmentation with a mean accuracy of 0.962 and an F 1 value of 0.860. Pre-training on fluorescence images significantly improved the performance of nerve segmentation in terms of the mean accuracy and F 1 value ( p &lt, 0 . 05 ). Nerve segmentation of label-free endoscopic images will allow for safer endoscopic surgery, while reducing dysfunction and improving prognosis after surgery.

To evaluate the preclinical and clinical performance of the pivoting lens rigid Endocameleon (ECAM) endoscope in white light cystoscopy (WLC).Preclinical evaluation was performed ex vivo in CT-based, anatomically accurate and validated bladder phantoms. Six defined tasks with objective endpoints were compared between ECAM-WLC and rigid WLC (30° view angle, rWLC) in 30 interventions. Subsequently, the comparison was transferred to in vivo n = 21 interventions. A validated usability score (System Usability Scale, SUS) as well as physician and patient-related outcomes were assessed using Likert-scale-based questionnaires. Intra- and postinterventional complications were recorded according to the Clavien-Dindo classification.The ex vivo evaluation showed a significant superiority of ECAM-WLC in 4 of 6 endoscopic tasks. Noteworthy is the lower pressure on the bladder neck due to the endoscopesalteration of the endoscope (4/60 vs 17/60, P.0001) and a more precise imaging of all bladder regions (22/30 vs 30/30, P = .046), including the anterior wall (0/30 vs 28/30, P.0001). In vivo, surgeons rated the ECAM-WLC with an "excellent" SUS of 86.79%, also expressing that ECAM-WLC would enhance bladder surface visualization (4.52/5.0 ± 0.51), with a preferred use for ECAM-WLC during their next cystoscopy (4.62 ± 0.50). Patients reported ECAM-WLC to be less painful (4.5/5.0 ± 0.84) compared to rWLC. No intervention-related complications were observed.ECAM-WLC is a safe and accessible procedure that could improve conventional diagnostic WLC by combination of the advantages of fWLC and rWLC.

Постановка проблеми: Сучасні жорсткі ендоскопи з релейною оптичною системою та малоінвазивна хірургія, що базуються на них, мають безліч переваг перед іншими видами хірургічного впливу, тому широко застосовуються в медицині. Не дивлячись на технологічний прогрес у розвитку оптичного приладобудування, залишається проблема в плані крихкості жорсткого ендоскопа, яка базується на принципі побудови стрижневих лінз, чия довжина багаторазово перевершує їх діаметр, що і є причиною таких частих поломок і витрат пов'язаних з ними. Причиною пошкоджень можуть бути невеликі (до 1,6 °) вигини металевого тубуса в процесі використання ендоскопа. Поломка оптичних компонентів ендоскопа під час хірургічної операції може мати серйозні негативні наслідки для пацієнта. Метою роботи: є розробка більш толерантної до вигинів оптичної системи, яка може бути інтегрована в стандартні жорсткі ендоскопи, не вимагаючи змін внутрішньої конфігурації, змін в жорсткості тубуса, його компонентів і матеріалiв. Результатом даної роботи є модернізація оптичної системи жорсткого ендоскопа iз значним оптико-технологічним та експлуатаційним поліпшенням показників, що підтверджується відповідними графіками якості зображення в середовищі "ZEMAX". Крім цього, порівняльний розрахунковий аналіз з використанням програмної системи кінцево-елементного аналізу "ANSYS Static Structurical" підтвердив, що нова напівгнучка ОС повністю відповідає закладеним у неї фізико-механічними властивостями і дозволяє толерантно нівелювати вигини тубуса ендоскопа при цьому багаторазово скорочуючи напруженості, що виникають в оптичній системі. Висновки: Обраний метод вирішення проблеми, а також технологія виробництва дозволяють дотримати співвідношення якості і комерційної складової, при якій нововведення технічних рішень перекривають втрати від подорожчання і ускладнення конструкції з наділенням нових переваг для конкурентоздатного протистояння з іншими виробниками. Така модернізація зробить серйозний внесок в розвиток ендоскопічної мікрооптики, якість хірургічних втручань, здоров'я пацієнтів, бюджет медичної установи і країни в цілому. Problem statement: Modern rigid endoscopes with a relay optical system and minimally invasive surgery based on them have many advantages over other types of surgical exposure, and are therefore widely used in medicine. Despite technological progress in the development of optical instrumentation, there remains a problem in terms of the fragility of a rigid endoscope, which is based on the principle of constructing rod lenses whose length is many times greater than their diameter, which is the reason for such frequent breakdowns and costs associated with them. The cause of the damage can be small (up to 1.6 °) bends of the metal tube in the process of using the endoscope. Failure of the optical components of the endoscope during surgery can have serious negative consequences for the patient. The aim of the work: is to develop a bend-resistant optical system for rigid endoscopes that can be integrated into standard rigid endoscopes without requiring changes in the internal configuration, changes in the stiffness of the tube, its components and materials. The result: of this work was the modernization of the optical system of a rigid endoscope with a significant opto-technological and operational improvement of indicators, which is confirmed by the corresponding graphs of image quality in the ZEMAX environment. In addition, a comparative calculation analysis using the ANSYS Static Structurical finite element analysis software system confirmed that the new semi-flexible optical system fully meets the physicomechanical properties incorporated in it and allows tolerantly leveling the bends of the endoscope tube while significantly reducing the stresses arising in the optical system. Conclusions: The chosen method of solving the problem, as well as the production technology, allows us to comply with the ratio of quality and commercial component, in which innovations in technical solutions cover losses from appreciation and complexity of the design with the provision of new advantages for a competitive confrontation with other manufacturers. Such modernization will make a significant contribution to the development of endoscopic microoptics, the quality of surgical interventions, patient health, the budget of the medical institution and the country as a whole. Постановка проблемы Современные жесткие эндоскопы с релейной оптической системой и базируемая на них малоинвазивная хирургия, имеют множество преимуществ перед другими видами хирургического воздействия, поэтому широко применяются в медицине. Не смотря на технологический прогресс в развитии оптического приборостроения, остается проблема в плане хрупкости жесткого эндоскопа, которая базируется на принципе построения стержневых линз, чья длинна многократно превосходит их диаметр, что и является причиной столь частых поломок и расходов связанных с ними. Причиной разрушений могут быть небольшие (до 1,6°) изгибы металлического тубуса в процессе использования эндоскопа. Поломка оптических компонентов эндоскопа во время хирургической операции может иметь серьезные негативные последствия для пациента. Целью роботы является разработка более толерантной к изгибам оптической системы для жестких эндоскопов которая может быть интегрирована в стандартные жесткие эндоскопы, не требуя изменений внутренней конфигурации, изменений в жесткости тубуса, его компонентам и материалам. Результатом данной работы была модернизация оптической системы жесткого эндоскопа с значительным оптико-технологическим и эксплуатационным улучшением показателей, что подтверждается соответствующими графиками качества изображения в среде “ZEMAX”. Помимо этого, сравнительный расчетный анализ с использованием программной системы конечно-элементного анализа “ANSYS Static Structurical” подтвердил, что новая полугибкая ОС полностью отвечает заложенным в неё физико-механическим свойствам и позволяет толерантно нивелировать изгибы тубуса эндоскопа при этом многократно сокращая напряженности, возникающие в оптической системе. Выводы: Выбранный метод решения проблемы, а также технология производства позволяют соблюсти соотношение качества и коммерческой составляющей, при которой нововведения технических решений перекрывают потери от удорожания и усложнения конструкции с наделением новых преимуществ для конкурентно способного противостояния с другими производителями. Такая модернизация привнесет серьезный вклад в развитие эндоскопической микрооптики, качество хирургических вмешательств, здоровье пациентов, бюджет медицинского учреждения и страны в целом.

Difficult laryngeal exposure during suspension microlaryngoscopic surgeries is a common situation encountered by the phonosurgeons nowadays. It leads to unnecessary trauma, incomplete surgery and even abortion of the procedure. Although various methods have been described to counter the situation, they might not be adequate in some cases with very anteriorly placed larynx. This study is intended to determine the utility of angled rigid endoscope along with malleable endoscopic instruments to improve surgical access in cases with inadequate glottic exposure during suspension microlaryngoscopy. In this cross sectional study conducted at Lokmanya Tilak Municipal Medical College and General Hospital in Mumbai, 50 patients of voice disorders who underwent Suspension Microlaryngoscopy from July 2014 to December 2017 were included. Out of these patients, 5 patients (10%) presented with difficult laryngeal exposure that were operated using readily available angled rigid endoscope along with malleable endoscopic instruments, without requirement of any specially designed instruments. There was improvement in laryngeal exposure in all the cases following utilisation of angled endoscopes. The surgeries were carried out under video monitor guidance with complete excision of the vocal cord lesions. Our study concluded that the cases in which the laryngeal exposure cannot be improved even by various external procedures, can be enhanced by application of angled rigid endoscopes and the vocal cord lesions can be excised completely by using malleable endoscopic instruments.

Background There is a deficit of reliable epidemiologic studies exploring the prevalence of Chronic Rhinosinusitis with Nasal Polyps (CRSwNP). Recent data suggests that occupational dust exposure may be involved in its physiopathology. Objectives To compare the prevalence of nasal polyposis (NP) in a group of workers with occupational dust exposure (textile workers) and in a control group (retail store workers). Methods Cross-sectional study with a random sample of textile and retail store employees. Clinical data was gathered through a systematic interview, which included RhinoQOL and CAT questionnaires. A systematic endoscopic nasal examination was performed using a 0 degree rigid endoscope. Lund-Kennedy endoscopic score was determined for each participant. Statistical analysis was performed with SPSS. Results 316 participants were included in the study, i.e. 215 textile workers and 101 retail store workers. NP was found in 19 subjects among textile workers and none in the control group. The prevalence of NP increased by age strata and by years of dust exposition. Polypoid degeneration of the middle turbinate was more prevalent in the exposed group with Lund-Kennedy scoring also higher. RhinoQOL and CAT questionnaires had both significantly higher scores among textile employees. Previous medical diagnosis of atopic diseases or chronic lower airway diseases did not differ between exposed and control groups or even between subjects with and without NP. Conclusions These results point to an important correlation between occupational dust exposure and NP occurrence.

Even with the use of most sophisticated microscope sometimes the relationship between the aneurysm and the adjacent structures are not clearly defined. The straight line of view by microscope results in inadequate visualization of structures that lie immediately behind other structures like the neck, branches or perforators of the aneurysm. Hence exposure of these structures may require risky retraction either of the parent artery or the aneurysm itself, which can be overcome by clear anatomical information obtained by the use of endoscope instead of attempting extensive manipulation under the microscope. The endoscope permits close up, wide angled views of regional anatomic features and verification of the optimal clip position. Visual conformation of regional anatomy achieved using the rigid endoscope provides valuable information for subsequent microsurgical procedures and enhances the safety and reliability. Endoscopic-assisted microsurgery is an exceptional aid and using the PIP (picture-in picture) technology, simultaneous observation of microscope and endoscopic images can be viewed through the ocular system of microscope. The advantages of neuroendoscope include the ability to look around corners and behind obstructions. With less brain retraction, smaller operative exposures and better visualization, neuroendoscopy may reduce operative morbidity. However the surgeon should be familiar with this technique and be prepared for the inconveniences and risks during the procedure.

Label-free visualization of nerves and nervous plexuses will improve the preservation of neurological functions in nerve-sparing robot-assisted surgery. We have developed a coherent anti-Stokes Raman scattering (CARS) rigid endoscope to distinguish nerves from other tissues during surgery. The developed endoscope, which has a tube with a diameter of 12 mm and a length of 270 mm, achieved 0.91% image distortion and 8.6% non-uniformity of CARS intensity in the whole field of view (650 μm diameter). We demonstrated CARS imaging of a rat sciatic nerve and visualization of the fine structure of nerve fibers.