Rectal Foreign Body of Eggplant Treated Successfully by Endoscopic Transanal Removal

Transanal rectal foreign body implies that a foreign body has been inserted transanally due to sexual orientation or other reasons and cannot be removed. Such cases require emergency measures because foreign bodies often present difficulties in manual removal or endoscopic removal and may even require surgery when peritonitis due to gastrointestinal perforation occurs. We report a patient in our hospital who had a rectal foreign body inserted into the deep part of the proctosigmoid that could be removed endoscopically. A 66-year-old man visited our hospital because of an eggplant which had been inserted into his rectum by his friend and could not be removed. Since plain abdominal computed tomography showed a foreign body thought to be an eggplant in the proctosigmoid, the foreign body was captured and removed with a snare under lower gastrointestinal endoscope guidance.

194 Endoscopic Assisted Evacuation of Chronic Subdural Hematoma A Paradigm Shift or a Waste of Time?

INTRODUCTION Chronic subdural hematoma (CSDH) is a common neurosurgical condition encountered by neurologists and neurosurgeons. The incidence appears to be as high as 13.1 cases per 100,000 inhabitants and the peak incidence currently occurs in the eighth decade. The mainstay handling a symptomatic CSDH requires surgical evacuation, copious irrigation of blood clots with possible post operative temporary closed drainage. For decades Twist-drill craniostomy (TDC) and Burr-hole craniostomy played the main roles in the surgical approached with relatively high recurrence rates. It is emphasized that the highest risk for recurrence is seen with a mixed-density and layering type of hematoma on cranial CT and is probably due to the lack of adequate evacuation of the offending effusion due to limited exposure. METHODS We assigned 30 consentable adult patients undergoing surgery for presumed subacute/chronic SDH. Included are symptomatic patients with crescent-shaped hypo or isodense hematoma over the cerebral hemisphere, measuring minimal diameter of 10 mm regardless the extent of midline shift. Under general anesthesia traditional BHC approach was used, followed by introduction of 0° rigid endoscope. Using the endoscope guidance we performed thorough inspection of the subdural space, residual clots evacuation, internal membranes fenestration and occasional vessels coagulation. All patients underwent pre and post PT/OT evaluation. Clinical and Radiological follow-up was conducted immediate Post-op, 10 days and 3 months after the procedure. Standardized modified Rankin scale used to evaluate patients recovery. RESULTS >Our preliminary results show significantly better clinical and radiological outcome, early recovery and ambulation, fewer recurrence rate and less patients requiring post op drainage. Those findings upon validation can definitely change the traditional way we treat one of the most common neurosurgical conditions. CONCLUSION Its speculated that an endoscopically assisted CSDH procedures enables an improved extent of clot removal and release of loculated compartments. Logically, evacuating more of the hyper osmotic content in the subdural space should reduce membranous irritation with the consequent re-bleeding thus recurrence. Under vision control of bleeding source might have a positive impact on infection rate, recurrence rate and patient safety respectivey.

An Innovate Robotic Endoscope Guidance System for Transnasal Sinus and Skull Base Surgery: Proof of Concept

Objective Advanced transnasal sinus and skull base surgery remains a challenging discipline for head and neck surgeons. Restricted access and space for instrumentation can impede advanced interventions. Thus, we present the combination of an innovative robotic endoscope guidance system and a specific endoscope with adjustable viewing angle to facilitate transnasal surgery in a human cadaver model. Materials and Methods The applicability of the robotic endoscope guidance system with custom foot pedal controller was tested for advanced transnasal surgery on a fresh frozen human cadaver head. Visualization was enabled using a commercially available endoscope with adjustable viewing angle (15–90 degrees). Results Visualization and instrumentation of all paranasal sinuses, including the anterior and middle skull base, were feasible with the presented setup. Controlling the robotic endoscope guidance system was effectively precise, and the adjustable endoscope lens extended the view in the surgical field without the common change of fixed viewing angle endoscopes. Conclusion The combination of a robotic endoscope guidance system and an advanced endoscope with adjustable viewing angle enables bimanual surgery in transnasal interventions of the paranasal sinuses and the anterior skull base in a human cadaver model. The adjustable lens allows for the abandonment of fixed-angle endoscopes, saving time and resources, without reducing the quality of imaging.

A Technique with Manipulator-Assisted Endoscope Guidance for Functional Endoscopic Sinus Surgery

Objective. The goal of this study was to examine the theoretical feasibility of a new manipulator system for endoscope guidance in functional endoscopic sinus surgery. Study Design. The accuracy of endoscope positioning and time of endoscope movement with an endoscope manipulator system were determined with an artificial sinus model. Setting. A laboratory trial was performed. The time for 60 repetitions of manual compared to manipulator-assisted endoscope movements directed at 3 different target positions was evaluated. In addition, the alignment of the position vector for each endoscope movement was examined. Subjects and Methods. A zero-degree Hopkins II telescope with a camera was used to head for the target positions. First, the endoscope movements were done manually, and afterward the endoscope manipulator system was used for endoscope guidance. The alignment of the position vector of the endoscope was measured with a portable measuring arm. Results. There was no statistical difference between the time for manual and manipulator-assisted endoscope movements for all target positions. The alignment of the position vector of the endoscope was statistically different at 2 target positions: anterior ethmoid left side and ostium of maxillary sinus left side. There was no statistical difference at all other positions. Conclusion. The endoscope manipulator system has the potential to be integrated into the operating workflow without extending the time for endoscope guidance. The surgeon will be able to use both hands for the manipulation of the instruments. Less frequent endoscope movements and instrument changes may be expected after technical modification.

Correlation between bacteriology and computed tomography staging for chronic sinusitis

In this study we report on the correlation between bacteriology and disease severity staging by computed tomography (CT) for chronic sinusitis. When patients with chronic sinusitis underwent functional endoscopic sinus surgery (FESS), swab specimens were taken from the ipsilateral middle meati and ethmoid sinuses under endoscope guidance. The severity of chronic sinusitis was evaluated by pre-operative CT scans. The CT scans were staged by the Lund and Mackay system. The scores for the frontal, anterior ethmoid and maxillary sinuses and for the ostiomeatal complex were added. The culture rates were correlated with the added scores. Between November 1998 and January 2003, 79 pairs of specimens were collected from 79 patients whose CT scans were done within a day before FESS. The culture rates of middle-meatus specimens were moderately correlated with the scores, but those of ethmoid sinus specimens were negatively correlated with the scores. If Staphylococcus epidermidis and corynebacteria were considered normal flora, the bacteriology of the middle meatus was highly correlated with the CT scores. This study shows that culture rates of middle-meatal specimens tended to increase with the severity of chronic sinusitis.