1,721,002 research outputs found
Novel Dissection Station for Endolaryngeal Microsurgery and Laser Surgery: Development and Dissection Course Experience
No full textObjective: We aimed to develop and validate an ex vivo dissection station for endolaryngeal surgery suitable for different kinds of laryngeal specimen and any type of operating technique (CO2 laser, cold instruments by endoscopic or microscopic techniques). Study Design: Experimental construction and validation of a highly specialized dissection station. Setting: Laboratory and international dissection course. Methods: We designed a lightweight dissection station made of polycarbonate resin approved for use with a CO2 laser. The cylindrical box hosts an articulated laryngeal support. The laryngoscope is positioned on an articulated arm, which is fixed on the construction’s footplate. Validation of the larynx box was performed during an international dissection course on laryngeal surgery held in January 2016. Results: We assessed the suitability of our novel dissection station among specialized laryngologists with a mean experience of 14 years. Feedback from the participants was very positive, with a mean general impression of 9.5 (out of 10 points) and a recommendation score of 9.6 for further use. Its utility in transforming the taught surgical steps into daily practice has been highly recognized, with a score of 9.5. Conclusion: The lightweight and transparent larynx box is suitable for any kind of laryngeal specimen, and any surgical intervention can be taught at reasonable cost. It is safe and suitable for use with CO2 lasers. Validation among experienced surgeons revealed its suitability in the teaching of endolaryngeal microsurgery and laser surgery
Epinephrine Use in Endoscopic Ear Surgery: Quantitative Safety Assessment
No full textIntroduction: The management of bleeding in exclusive endoscopic ear surgery (EES) is largely dependent on epinephrine use. However, to date its suitability and safety have not been assessed. The aim of the present study would be to assess the safety profile of topical application and/or local infiltrationof diluted epinephrine during EES regarding the intra- A nd postoperative periods. We hypothesize that epinephrine may be safely used during EES. Methods: Retrospective analysis of 90 EES cases performed at the University Hospital of Modena, Italy. Patient's charts and video recordings of the operations were assessed. Results: Epinephrine was used in all cases for hemostatic purposes as following: (1) diluted epinephrine (1:200,000) injection: Mean 1.2 mL (range: 0-3.5) corresponding to 0.006 mg (range 0-0.018), and (2) topical application (1:1,000) directly in the surgical field: Mean 7 cottonoids (range: 0-18) corresponding to mean 0.56 mg (range: 0-1.44). No major cardiovascular adverse effects were assessed. Only 2 intraoperative hypertensive events were recorded. One sensorineural hearing loss was observed in a case of cholesteatoma involving the stapes; no facial palsy occurred during the study period. Conclusion: The combined use of local injection and topical epinephrine is a safe and effective strategy to control bleeding in exclusive EES, when used within the dilutions and quantities reported in this study
Revision canal-wall down surgery: comparison of surgical outcomes with three different techniques
No full textObjective: This study aimed to analyze the role of the endoscope in revision canal-wall down (CWD) tympanomastoid surgery and compare its use to the more traditional microscopic approach. Moreover, we aim to investigate functional outcomes of revision surgeries in a cohort of two tertiary reference centers. Methods: A total of 103 patients undergoing revision surgery after previous CWD tympanomastoidectomy were included in the present study and divided in three groups according to the surgical technique used: endoscope exclusive (n = 22), combined (n = 35) and microscope exclusive (n = 46). Data regarding surgical indications, pre-operative clinical and audiological assessments, intraoperative findings and surgical considerations were extracted. During follow-up, data regarding anatomic and audiologic outcomes were collected and persistence or recurrence of the disease assessed. Results: The most frequent sites of cholesteatoma recurrence or persistence was the anterior epitympanum. There was a statistically significant ABG improvement of − 6.02 dB HL (95% CI − 8.87 to − 3.16, p < 0.001) between pre-operative and postoperative ABG, without significant effect of surgical technique. During follow-up, no significant differences regarding disease or otorrhea control were observed. Duration of surgery and hospitalization was shorter in the endoscopic cohort without statistical significance. Intra- and postoperative complications were lower in the endoscopic group. Conclusion: Revision CWD surgery can take advantage of the endoscope as a minimally invasive exclusive or adjunct tool to traditional microscopic procedures. Outcome measures of endoscopic revision CWD surgery showed anatomic and functional results comparable to those of the microscopic group. The complication rate, the duration of surgery and hospitalization were favorable in the endoscopic group
Quantification and Comparison of Droplet Formation During Endoscopic and Microscopic Ear Surgery: A Cadaveric Model
Full text linkObjectives: The COVID-19 pandemic and the disproportional spread of the disease among otorhinolaryngologists raised concerns regarding the safety of health care staff. Therefore, a quantitative risk assessment for otologic surgery would be desirable. This study aims to quantitatively compare the risk of perioperative droplet formation between microscopic and endoscopic approaches. Study Design: Experimental research. Setting: Temporal bone laboratory. Methods: The middle ear of whole head specimens was injected with fluorescein (0.2 mg/10 mL) before endoscopic and microscopic epitympanectomy and mastoidectomy. Fluorescent droplet deposition on the surgical table was recorded under ultraviolet light, quantified, and compared among the interventions. Drilling time, droplet proportion, fluorescein intensity, and droplet size were assessed for every procedure. Results: A total of 12 procedures were performed: 4 endoscopic epitympanectomies, 4 microscopic epitympanectomies, and 4 mastoidectomies. The mean (SD) proportion of fluorescein droplets was 0.14‰ (0.10‰) for endoscopic epitympanectomy and 0.64‰ (0.31‰) for microscopic epitympanectomy. During mastoidectomy, the deposition of droplets was 8.77‰ (6.71‰). Statistical comparison based on a mixed effects model revealed a significant increase (0.50‰) in droplet deposition during microscopic epitympanectomy as compared with endoscopic epitympanectomy (95% CI, 0.16‰ to 0.84‰). Conclusions: There is considerable droplet generation during otologic surgery, and this represents a risk for the spread of airborne infectious diseases. The endoscopic technique offers the lowest risk of droplet formation as compared with microscopic approaches, with a significant 4.5-fold reduction of droplets between endoscopic and microscopic epitympanectomy and a 62-fold reduction between endoscopic epitympanectomy and cortical mastoidectomy
Facial sinus endoscopic evaluation, radiologic assessment, and classification
No full textObjectives: To describe facial sinus anatomy from an endoscopic perspective and present a radiologic classification. Methods: Facial sinus was studied by endoscopy and high-resolution computed tomography (HRCT) scan in 39 temporal bones that underwent exclusive transcanal endoscopic approach. A radiomorphologic classification based on the relationship between the facial sinus and the mastoid portion of the facial nerve is created as follows. In type A facial sinus, the pneumatization of the facial sinus did not extend medially or posteriorly to the mastoid portion of the facial nerve. In type B facial sinus, the pneumatization extended posteriorly to the mastoid portion of the facial nerve. In type C facial sinus, the pneumatization extended posteriorly and medially to the mastoid portion of the facial nerve. Results: In all the specimens that underwent HRCT (n = 31), facial sinus could be identified, and its depth classified, in relation to the facial nerve. In this group, 58% type A, 29% type B, and 13% type C facial sinuses were identified. In all the specimens (n = 39), the facial sinus could be assessed by means of an exclusive endoscopic transcanal approach, and anatomical variants of the chordiculus, previously known as chordal ridge, could be described: ridge (39%), bridge (18%), incomplete (15%), and absent (28%). Conclusion: Endoscopic exploration of the retrotympanum guarantees a very good exposure of the facial sinus, allowing detailed anatomic descriptions of its conformation and relationships with other structures. Improvement in our knowledge of its anatomy might decrease the possibility of residual disease during cholesteatoma surgery. Angled endoscopes (e.g. 45 °, 70 °) can guarantee a better view of the facial sinus. Level of Evidence: NA. Laryngoscope, 128:2397–2402, 2018
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Hints and Pitfalls: How to Start Endoscopic Ear Surgery Training
No full textThe application of endoscopic technique to otologic and lateral skull base surgery represents an important alternative (exclusive or combined with the microscope) to the traditional microscopic approaches because of its great advantages in terms of visualisation of surgical corners and magnification of structures. However, endoscopic ear surgery is characterised by some specific technical and manual skills. Thus, a challenging learning curve, due to the one-handed technique and the necessity to develop hand-eye coordination, has to be considered. Similarly to the training programme for acquisition of surgical skills in endonasal anterior skull base surgery, published by Snyderman in 2007, a staged training programme for acquisition of surgical skills for endoscopic middle ear and lateral skull base surgery was proposed by our group. Five stages characterised by increasing complexity are described in our article, in order to follow a progression from lateral to medial, considering the coronal plane of the ear and the temporal bone. Comparatively, the development of the ovine model as an inexpensive, safe and reliable model for otologic surgery has progressively led to the application of the same training programme on this ex vivo model. Indeed, it represents an excellent setting to start manoeuvring the instruments for endoscopic ear surgery and to gain confidence in holding the endoscope and moving it inside the external auditory canal and tympanic cavity
Correlation of Radiologic Versus Endoscopic Visualization of the Middle Ear: Implications for Endoscopic Ear Surgery
No full textOBJECTIVES: To determine the limits of visualization during transcanal endoscopic ear surgery (EES) by correlating the relationship between radiologic and endoscopic anatomy using angled optics. METHODS: Radiology and endoscopic visualization of tensor fold, protympanum, facial sinus (FS), sinus tympani (ST), subtympanic sinus (STS), hypotympanum, and aditus ad antrum were analyzed using a transcanal approach in 30 human temporal bones specimens with different angled endoscopes (0 degree, 45 degrees, 70 degrees) to check for the full visualization of these regions. High-resolution computed tomography (CT) was performed prior to dissection to classify retrotympanic anatomy. According to previously published descriptions, FS, ST, and STS were classified into types A, B, and C depending on their morphology relative to the mastoid segment of the facial nerve. These radiologic findings were compared to endoscopic visualization of these same structures using a Chi-squared test. RESULTS: Visualization of the posterior wall of three different retrotympanic areas was significantly associated (FS p < 0.01; ST p < 0.01; STS p = 0.02) with the radiologic classification and endoscopic optical angle. Angled endoscopy improved visual access to the other subsites, especially the aditus ad antrum and the tensor fold (>70% with 45 degrees and 70 degrees). CONCLUSION: Complete visual access to the hidden recesses of the middle ear can be achieved using angled endoscopes (45 degrees and 70 degrees). We observed a statistically significant association of endoscopic visualization to radiologic description of the retrotympanum on CT and the optical angle used. The prediction of the endoscopic exposure of the retrotympanum from the preoperative CT is possible. Even with the use of 70 degrees lens, retrotympanum is not fully visualized on transcanal endoscopy if a type C retrotympanic recesses (posterior and medial to the facial nerve) is present. This represents a technical limit of exclusive transcanal EES
An ovine model for exclusive endoscopic ear surgery
No full textIMPORTANCE: With the international spread of exclusive transcanal endoscopic ear surgery, the need for a suitable and affordable surgical training model has grown during the past years. OBJECTIVE: To develop and validate an ex vivo animal model for exclusive endoscopic ear surgery. DESIGN, SETTING, AND ANIMAL MODELS: In an experimental study, we compared ovine and human middle ear anatomy in 4 specimens and assessed the lamb as a model for endoscopic ear surgery. After confirming its suitability, we developed a surgical training program for canaloplasty, myringoplasty, and ossiculoplasty. From March 1 to May 31, 2016, the ex vivo model was tested, assessing the time needed for dissection and complications. Each experience was subjectively validated on a scale from 1 (very poor) to 10 (excellent). MAIN OUTCOMES AND MEASURES: Suitability of the lamb model for training in exclusive endoscopic ear surgery. RESULTS: We assessed the suitability of our novel lamb model on 20 ovine middle ears. All interventions could be performed in a satisfactory manner. The mean (SD) time required to perform canaloplasty was 29.7 (13.2) minutes, for middle ear dissection was 7.7 (2.6) minutes, for myringoplasty was 7.7 (4.3) minutes, and for ossiculoplasty was 10.4 (2.7) minutes. The time required for canaloplasty and tympano-meatal flap elevation during dissection decreased from 46.4 minutes in the first 5 cases to 16.2 minutes in the last 5 cases, representing an absolute difference of 30.2 minutes (95% CI, 22.28-38.12). Subjective ratings revealed excellent values for tissue quality (8.9 points of 10), overall satisfaction (8.3 points), and the learning experience (8.8 points). CONCLUSIONS AND RELEVANCE: The ovine model is suitable for endoscopic ear surgery. We describe a novel, exclusively endoscopic approach in an ex vivo animal model for middle ear surgery. The proposed surgical program leads the trainee step by step through the main otologic procedures and is able to enhance his or her surgical skills
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