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#February 2012
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Three trocar laparoscopic sigmoidectomy for diffuse diverticulosis with transanal specimen extraction: tips and tricks
The video demonstrates the case of a woman with recurrent diverticulitis, BMI 30. She has a background of a previous hysterectomy via a Pfannenstiel incision. A three-port sigmoidectomy with transanal excision was carried out.
Methods
The set up consisted of a 12mm umbilical optical port, a 12mm port in the right iliac fossa, and a 5mm operating port in the right flank. After initial peritoneoscopy, any abnormal adhesions were divided. The sigmoid colon mesentery was divided high, near the sigmoid colon in order to preserve the mesenteric vasculature. The mesentery was divided to the level of the rectum, which was then skeletonized. The proximal colon was mobilized free up to the level of the splenic flexure. The rectum was then ligated, washed out with betadine and transected. A Vicryl Loop was attached to the proximal stump which was then removed transanally. A colotomy was created above the level of the diverticula and the anvil of a circular stapler introduced into the proximal colon. The proximal sigmoid colon mesentery was divided and the sigmoid transected with a linear stapler. The specimen was then fully removed transanally. The anvil was then delivered through the colon via the fishing technique. The rectal stump was closed with a linear stapler. A colorectal anastomosis was fashioned with a circular stapler. After verifying that the colon was not twisted, an air test was performed.
Conclusion
The video demonstrates a three-port technique for laparoscopic sigmoidectomy with natural orifice specimen extraction (NOSE).
J Leroy, J Marescaux
Surgical intervention
6 years ago
2625 views
13 likes
0 comments
16:52
Three trocar laparoscopic sigmoidectomy for diffuse diverticulosis with transanal specimen extraction: tips and tricks
The video demonstrates the case of a woman with recurrent diverticulitis, BMI 30. She has a background of a previous hysterectomy via a Pfannenstiel incision. A three-port sigmoidectomy with transanal excision was carried out.
Methods
The set up consisted of a 12mm umbilical optical port, a 12mm port in the right iliac fossa, and a 5mm operating port in the right flank. After initial peritoneoscopy, any abnormal adhesions were divided. The sigmoid colon mesentery was divided high, near the sigmoid colon in order to preserve the mesenteric vasculature. The mesentery was divided to the level of the rectum, which was then skeletonized. The proximal colon was mobilized free up to the level of the splenic flexure. The rectum was then ligated, washed out with betadine and transected. A Vicryl Loop was attached to the proximal stump which was then removed transanally. A colotomy was created above the level of the diverticula and the anvil of a circular stapler introduced into the proximal colon. The proximal sigmoid colon mesentery was divided and the sigmoid transected with a linear stapler. The specimen was then fully removed transanally. The anvil was then delivered through the colon via the fishing technique. The rectal stump was closed with a linear stapler. A colorectal anastomosis was fashioned with a circular stapler. After verifying that the colon was not twisted, an air test was performed.
Conclusion
The video demonstrates a three-port technique for laparoscopic sigmoidectomy with natural orifice specimen extraction (NOSE).
Gastric bypass: jejunal obstruction and stenosis
Small bowel obstruction at or near the jejuno-jejunal anastomosis is a rare complication after gastric bypass, occurring in less than 1% of patients. Obstruction at the distal anastomosis is different from stricture at the proximal anastomosis, in that it is not caused by hypertrophic scarring. Rather, obstruction occurs due to either abnormal folding (kinking) of the anastomosis or narrowing of the anastomosis at the site of the enterotomy closure due to technical error. Since the distal anastomosis includes both the alimentary and the biliopancreatic limbs of the bypass, obstruction at this location may present with very different symptoms. Obstruction of the alimentary limb will result in nausea and vomiting, while obstruction of the biliopancreatic limb results in gastric remnant dilatation. Diagnosis is best accomplished with CT imaging, as plain X-rays will not show a dilated gastric remnant or biliopancreatic limb. Treatment of obstruction at the jejunojejunostomy often requires surgical intervention, although blockage due to edema may resolve with conservative management, sometimes requiring percutaneous decompression of the excluded stomach. It should also be remembered that bariatric patients may also suffer from obstruction caused by adhesions and may require lysis of such adhesions like any general surgical patient.
D Herron
Lecture
6 years ago
1198 views
8 likes
0 comments
10:10
Gastric bypass: jejunal obstruction and stenosis
Small bowel obstruction at or near the jejuno-jejunal anastomosis is a rare complication after gastric bypass, occurring in less than 1% of patients. Obstruction at the distal anastomosis is different from stricture at the proximal anastomosis, in that it is not caused by hypertrophic scarring. Rather, obstruction occurs due to either abnormal folding (kinking) of the anastomosis or narrowing of the anastomosis at the site of the enterotomy closure due to technical error. Since the distal anastomosis includes both the alimentary and the biliopancreatic limbs of the bypass, obstruction at this location may present with very different symptoms. Obstruction of the alimentary limb will result in nausea and vomiting, while obstruction of the biliopancreatic limb results in gastric remnant dilatation. Diagnosis is best accomplished with CT imaging, as plain X-rays will not show a dilated gastric remnant or biliopancreatic limb. Treatment of obstruction at the jejunojejunostomy often requires surgical intervention, although blockage due to edema may resolve with conservative management, sometimes requiring percutaneous decompression of the excluded stomach. It should also be remembered that bariatric patients may also suffer from obstruction caused by adhesions and may require lysis of such adhesions like any general surgical patient.
Management of transpyloric invagination of a gastrointestinal stromal tumor (GIST)
Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract. GISTs are most commonly found in the stomach (40-70%), but can occur in all other parts of the GI tract, with 20 to 40% of GISTs arising in the small intestine and 5 to 15% from the colon and rectum.
They typically grow endophytically, parallel to the bowel lumen, commonly with overlying mucosal necrosis and ulceration. They also vary in size, from a few millimeters to 40cm in diameter. Many GISTs are well defined by a thin pseudo-capsule.
Over 95% of patients present with a solitary primary tumor, and in 10 to 40% of these cases, the tumor directly invades neighboring organs. Gastric GISTs are usually presented with GI bleeding and abdominal pain. However, most patients are symptom-free and the lesions are discovered incidentally during an upper endoscopy performed for other reasons (chronic abdominal pain and intermittent gastric obstruction in this patient).
Surgery remains the mainstay of curative treatment.
Surgical resection of localized gastric GISTs is the preferred treatment modality, as resection of the tumor renders the only chance for cure at this time. Historically, a 1 to 2cm margin was thought to be necessary for an adequate resection. However, more recently, DeMatteo et al. demonstrated that tumor size and not negative microscopic surgical margins determine survival.
It is therefore accepted that the surgical goal should be a complete resection with gross negative margins only.
Given this, wedge resection has been advocated by many investigators for the majority of gastric GISTs.
J D'Agostino, Gf Donatelli, S Perretta, J Marescaux
Surgical intervention
6 years ago
2066 views
19 likes
0 comments
04:15
Management of transpyloric invagination of a gastrointestinal stromal tumor (GIST)
Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract. GISTs are most commonly found in the stomach (40-70%), but can occur in all other parts of the GI tract, with 20 to 40% of GISTs arising in the small intestine and 5 to 15% from the colon and rectum.
They typically grow endophytically, parallel to the bowel lumen, commonly with overlying mucosal necrosis and ulceration. They also vary in size, from a few millimeters to 40cm in diameter. Many GISTs are well defined by a thin pseudo-capsule.
Over 95% of patients present with a solitary primary tumor, and in 10 to 40% of these cases, the tumor directly invades neighboring organs. Gastric GISTs are usually presented with GI bleeding and abdominal pain. However, most patients are symptom-free and the lesions are discovered incidentally during an upper endoscopy performed for other reasons (chronic abdominal pain and intermittent gastric obstruction in this patient).
Surgery remains the mainstay of curative treatment.
Surgical resection of localized gastric GISTs is the preferred treatment modality, as resection of the tumor renders the only chance for cure at this time. Historically, a 1 to 2cm margin was thought to be necessary for an adequate resection. However, more recently, DeMatteo et al. demonstrated that tumor size and not negative microscopic surgical margins determine survival.
It is therefore accepted that the surgical goal should be a complete resection with gross negative margins only.
Given this, wedge resection has been advocated by many investigators for the majority of gastric GISTs.
Understanding laparoscopy
Over the last twenty years gynecologic laparoscopy has not developed as expected, and it is mainly due to the difficulty of the technique, and the amount of time needed to perform it. Laparoscopy was initially criticized because of its technical difficulty and low productivity in comparison with vaginal approaches and laparotomies, but today its benefits include less pain, shorter hospital stay and faster recovery. From a technical standpoint, the benefits of laparoscopy include high definition vision and image magnification, which are of great value if the surgeon understands the technique, masters ergonomics and develops surgical strategies and protocols. Subsequently, a good way to improve one’s skills is to follow continuing education and training programs, and respect the three basic rules of laparoscopy: a good exposure by means of suspension techniques and Trendelenburg position, to achieve good vision and to improve surgical performance; a balanced use of irrigation to prevent anatomical distortion; and concentrate on monitors at all times.
A Wattiez
Lecture
6 years ago
12150 views
498 likes
3 comments
59:38
Understanding laparoscopy
Over the last twenty years gynecologic laparoscopy has not developed as expected, and it is mainly due to the difficulty of the technique, and the amount of time needed to perform it. Laparoscopy was initially criticized because of its technical difficulty and low productivity in comparison with vaginal approaches and laparotomies, but today its benefits include less pain, shorter hospital stay and faster recovery. From a technical standpoint, the benefits of laparoscopy include high definition vision and image magnification, which are of great value if the surgeon understands the technique, masters ergonomics and develops surgical strategies and protocols. Subsequently, a good way to improve one’s skills is to follow continuing education and training programs, and respect the three basic rules of laparoscopy: a good exposure by means of suspension techniques and Trendelenburg position, to achieve good vision and to improve surgical performance; a balanced use of irrigation to prevent anatomical distortion; and concentrate on monitors at all times.
Fertility enhancing surgery
Professor David Adamson focuses on the role of laparoscopy in subfertile patients. Laparoscopy helps to diagnose and manage many gynecologic conditions that may induce spontaneous pregnancy and enhance Assisted Reproductive Technology (ART) results. In endometriosis, laparoscopy is required to establish the diagnosis and provide a better vision: it is first recommended in stage I-II by the American Society for Reproductive Medicine (ASRM). It should be considered in stage III-IV if the patient is young and after several IVF failures. Laparoscopic cystectomy is suitable if endometrioma is larger than 4cm prior to IVF. Myomas have to be removed when they distort the cavity or when they are intramural and voluminous. Laparoscopic myomectomy must be carried out by skilled surgeons. Adnexal masses should be removed if they exceed 5cm and persist for more than 3 months. Concerning polycystic ovarian syndrome (PCOS), ovarian drilling is indicated in case of failure of controlled ovarian hyperstimulation (COH). Laparoscopy is very useful for distal tubal occlusion to assess the quality of the tube and perform fimbrioplasty. It is also useful for ectopic pregnancy and sterilization reversal. As a conclusion, laparoscopy in subfertile patients must be performed in young women, without other infertility factors. Laparoscopy should also be envisaged when the disease is treatable and when the patients agree to have a 9 to 15 months’ interval prior to IVF.
D Adamson
Lecture
6 years ago
2360 views
16 likes
0 comments
26:49
Fertility enhancing surgery
Professor David Adamson focuses on the role of laparoscopy in subfertile patients. Laparoscopy helps to diagnose and manage many gynecologic conditions that may induce spontaneous pregnancy and enhance Assisted Reproductive Technology (ART) results. In endometriosis, laparoscopy is required to establish the diagnosis and provide a better vision: it is first recommended in stage I-II by the American Society for Reproductive Medicine (ASRM). It should be considered in stage III-IV if the patient is young and after several IVF failures. Laparoscopic cystectomy is suitable if endometrioma is larger than 4cm prior to IVF. Myomas have to be removed when they distort the cavity or when they are intramural and voluminous. Laparoscopic myomectomy must be carried out by skilled surgeons. Adnexal masses should be removed if they exceed 5cm and persist for more than 3 months. Concerning polycystic ovarian syndrome (PCOS), ovarian drilling is indicated in case of failure of controlled ovarian hyperstimulation (COH). Laparoscopy is very useful for distal tubal occlusion to assess the quality of the tube and perform fimbrioplasty. It is also useful for ectopic pregnancy and sterilization reversal. As a conclusion, laparoscopy in subfertile patients must be performed in young women, without other infertility factors. Laparoscopy should also be envisaged when the disease is treatable and when the patients agree to have a 9 to 15 months’ interval prior to IVF.
LSH and LIH tissue conserving solutions for hysterectomy
The objectives of pelvic floor reconstructive surgery are to restore anatomy, optimize function, and reduce morbidity. The anatomic fundamentals comprise normal vaginal axis, fascial attachments, fascial breaks, vascularity and neuromuscular considerations.
Operative alternatives depending on the pelvic floor compartment:
Posterior wall: Enterocele:
Enterocele repair performed vaginally, which is a minimally invasive approach; Mc Call’s culdoplasty; sacrospinous fixation; sacral culpopexy and mesh kits.
Rectocele: posterior colporrhaphy; fascial reconstruction; Zacharin grafting and mesh kits. Abdominal alternatives include enterocele repair, high McCall’s suspension, sacral culdopexy and sacrospinous vault suspension. All of these can be carried out laparoscopically.
Anterior wall: Abdominal approach: open or laparoscopic Burch, paravaginal repair and sling. Vaginal alternative: anterior culdorrhaphy, traditional sling, TVT, TOT, RF sling, etc. Recommendations: the defects should be assessed preoperatively, and at the time of surgery, the objective is to evaluate the pelvis, to isolate the defects, and to repair each defect. The site-specific repair technique includes standard modified lithotomy position, trocar placement to facilitate suturing, repair of posterior defects first; anterior defect repair with paravaginal defects repaired first, followed by Burch sutures, and permanent sutures for all structural repairs. Failure or complications include poor vaginal axis, recurrent enterocele, graft problems, Urinary Stress Incontinence (USI) and sacral radiculopathy.
Conclusions: The objectives of pelvic surgery can be accomplished via laparoscopy. In virtually all studies evaluating the morbidity of laparoscopy versus laparotomy, morbidity was less in the laparoscopic group.
T Lyons
Lecture
6 years ago
1444 views
7 likes
0 comments
23:12
LSH and LIH tissue conserving solutions for hysterectomy
The objectives of pelvic floor reconstructive surgery are to restore anatomy, optimize function, and reduce morbidity. The anatomic fundamentals comprise normal vaginal axis, fascial attachments, fascial breaks, vascularity and neuromuscular considerations.
Operative alternatives depending on the pelvic floor compartment:
Posterior wall: Enterocele:
Enterocele repair performed vaginally, which is a minimally invasive approach; Mc Call’s culdoplasty; sacrospinous fixation; sacral culpopexy and mesh kits.
Rectocele: posterior colporrhaphy; fascial reconstruction; Zacharin grafting and mesh kits. Abdominal alternatives include enterocele repair, high McCall’s suspension, sacral culdopexy and sacrospinous vault suspension. All of these can be carried out laparoscopically.
Anterior wall: Abdominal approach: open or laparoscopic Burch, paravaginal repair and sling. Vaginal alternative: anterior culdorrhaphy, traditional sling, TVT, TOT, RF sling, etc. Recommendations: the defects should be assessed preoperatively, and at the time of surgery, the objective is to evaluate the pelvis, to isolate the defects, and to repair each defect. The site-specific repair technique includes standard modified lithotomy position, trocar placement to facilitate suturing, repair of posterior defects first; anterior defect repair with paravaginal defects repaired first, followed by Burch sutures, and permanent sutures for all structural repairs. Failure or complications include poor vaginal axis, recurrent enterocele, graft problems, Urinary Stress Incontinence (USI) and sacral radiculopathy.
Conclusions: The objectives of pelvic surgery can be accomplished via laparoscopy. In virtually all studies evaluating the morbidity of laparoscopy versus laparotomy, morbidity was less in the laparoscopic group.
Emergency endoscopic esophageal variceal band ligation for active bleeding
Upper digestive bleeding is a frequent complication in cirrhotic patients. In some cases, it can be disastrous with collapse, especially considering coagulopathies in these patients. The management must be multidisciplinary involving an anesthesiologist, an endoscopist, and sometimes an interventional radiologist.
Emergency variceal band ligation is the first step to achieve hemostasis once the patient has been medically stabilized.
This video presents the case of a 91-year-old cirrhotic man, presenting with hepatitis C virus (HCV). He was admitted to the emergency department for massive hematemesis. Blood tests showed hemoglobin levels at 8 g/dL and the patient was hemodynamically stable. Sandostatin® injection, proton pump inhibitors (PPI), antibiotics, vitamin K were started immediately to a full dose regimen. Once fresh frozen plasma and blood transfusion have been carried out, an endoscopy was scheduled within the first 12 hours.
Gf Donatelli, L Marx, J Marescaux
Surgical intervention
6 years ago
1566 views
25 likes
0 comments
02:05
Emergency endoscopic esophageal variceal band ligation for active bleeding
Upper digestive bleeding is a frequent complication in cirrhotic patients. In some cases, it can be disastrous with collapse, especially considering coagulopathies in these patients. The management must be multidisciplinary involving an anesthesiologist, an endoscopist, and sometimes an interventional radiologist.
Emergency variceal band ligation is the first step to achieve hemostasis once the patient has been medically stabilized.
This video presents the case of a 91-year-old cirrhotic man, presenting with hepatitis C virus (HCV). He was admitted to the emergency department for massive hematemesis. Blood tests showed hemoglobin levels at 8 g/dL and the patient was hemodynamically stable. Sandostatin® injection, proton pump inhibitors (PPI), antibiotics, vitamin K were started immediately to a full dose regimen. Once fresh frozen plasma and blood transfusion have been carried out, an endoscopy was scheduled within the first 12 hours.
Single stage laparo-endoscopic management of acute cholecystitis and common bile duct stones
This video demonstrates the case of a 27-year-old woman, admitted to the emergency department for acute right hypochondrium pain.
Clinical examination found a positive Murphy’s sign. Biological findings showed a cholestasis (Gamma Glutamyl Transferase at 576 l/U, Alkaline Phosphatase at 346 l/U), and cytolysis (AST at 460 I/U, ALT at 635 I/U) without jaundice.
Abdominal ultrasonography confirmed the presence of acute cholecystitis with thickening of the gallbladder wall associated with a moderate 8mm dilatation of the common bile duct without any lithiasis.
Antibiotic therapy was started and cholecystectomy with intraoperative cholangiography was decided upon because of the clinical presentation and biological disturbance.
Gf Donatelli, L Marx, C Callari, J Marescaux
Surgical intervention
6 years ago
1983 views
9 likes
0 comments
04:38
Single stage laparo-endoscopic management of acute cholecystitis and common bile duct stones
This video demonstrates the case of a 27-year-old woman, admitted to the emergency department for acute right hypochondrium pain.
Clinical examination found a positive Murphy’s sign. Biological findings showed a cholestasis (Gamma Glutamyl Transferase at 576 l/U, Alkaline Phosphatase at 346 l/U), and cytolysis (AST at 460 I/U, ALT at 635 I/U) without jaundice.
Abdominal ultrasonography confirmed the presence of acute cholecystitis with thickening of the gallbladder wall associated with a moderate 8mm dilatation of the common bile duct without any lithiasis.
Antibiotic therapy was started and cholecystectomy with intraoperative cholangiography was decided upon because of the clinical presentation and biological disturbance.
Endoscopic staple-assisted diverticulostomy in the treatment of Zenker’s diverticulum
Zenker’s diverticulum (ZD) is an acquired pulsion pouch that was first described by Ludlow in 1769. It develops within a natural anatomic dehiscence zone (Killian’s triangle), which is located between the cricopharyngeal and the inferior constrictor muscles, and is due to failure of the cricopharyngeus to relax with swallowing.
The principles of treatment include division of the obstructing cricopharyngeal muscle and adequate drainage of the pouch. This can be achieved successfully with an endoscopic per-oral technique using an endoscopic stapler, as described by Collard in 1993.
Adequate cervical extension and opening of the mouth are a prerequisite for the procedure, which is otherwise indicated for all patients having a symptomatic ZD larger than 2.0cm. Very small diverticula (< 1.0cm), make it difficult to achieve adequate exposure and a complete myotomy; in contrast, very large diverticula leave behind a residual pouch which may be responsible for postoperative dysphagia.
ESD provides short inpatient and operating times, along with a short anesthesia time (mean of 10 to 30 minutes duration). Also, it only causes a mild postoperative discomfort and the patient is able to resume a diet on the same day. It is therefore cost-effective. The most common encountered complications are chipped teeth, postoperative fever and aspiration pneumonia.
Overall, results of this technique in appropriately selected patients are excellent, with a success rate well above 90%.
Needed equipment for this procedure includes:
- Weerda’s diverticuloscope
- Endopath™ articulating endoscopic stapler ATB 45
- Standard cartridges 45mm/3.5mm
- Endo Stitch™ with 2/0 silk sutures
- Closed-end esophageal suction
- 4mm, 0-degree rigid endoscope, 30cm long
References
Ludlow A. A case of obstructed deglutition from a preternatural dilation of and bag formed in the pharynx. Medical Observations Inquiries 1769;3:85-101.
Chang CY, Payyapilli RJ, Scher RL.Endoscopic staple diverticulostomy for Zenker's diverticulum: review of literature and experience in 159 consecutive cases. Laryngoscope. 2003 Jun;113(6):957-65.
Leporrier J, Salamé E, Gignoux M, Ségol P. Zenker's diverticulum: diverticulopexy versus diverticulectomy. Ann Chir. 2001 Feb;126(1):42-5.
Wasserzug O, Zikk D, Raziel A, Cavel O, Fleece D, Szold A. Endoscopically stapled diverticulostomy for Zenker's diverticulum: results of a multidisciplinary team approach. SurgEndosc. 2010 Mar;24(3):637-41. Epub 2009 Aug 18.
Feeley MA, Righi PD, Weisberger EC, Hamaker RC, Spahn TJ, Radpour S, Wynne MK.
Zenker's diverticulum: analysis of surgical complications from diverticulectomy and cricopharyngealmyotomy. Laryngoscope. 1999 Jun;109(6):858-61.
Cook RD, Huang PC, Richstmeier WJ, Scher RL.Endoscopic staple-assisted esophagodiverticulostomy: an excellent treatment of choice for Zenker's diverticulum. Laryngoscope. 2000 Dec;110(12):2020-5.
Cummings CW, Haughey BH, Thomas JR, Harker LA, Flint PW. Cummings Otolaryngology: Head and Neck Surgery. Chapter 74.
S Bouhabel, J Bolduc-Bégin, G Rakovich, A Rahal
Surgical intervention
6 years ago
1184 views
5 likes
0 comments
03:34
Endoscopic staple-assisted diverticulostomy in the treatment of Zenker’s diverticulum
Zenker’s diverticulum (ZD) is an acquired pulsion pouch that was first described by Ludlow in 1769. It develops within a natural anatomic dehiscence zone (Killian’s triangle), which is located between the cricopharyngeal and the inferior constrictor muscles, and is due to failure of the cricopharyngeus to relax with swallowing.
The principles of treatment include division of the obstructing cricopharyngeal muscle and adequate drainage of the pouch. This can be achieved successfully with an endoscopic per-oral technique using an endoscopic stapler, as described by Collard in 1993.
Adequate cervical extension and opening of the mouth are a prerequisite for the procedure, which is otherwise indicated for all patients having a symptomatic ZD larger than 2.0cm. Very small diverticula (< 1.0cm), make it difficult to achieve adequate exposure and a complete myotomy; in contrast, very large diverticula leave behind a residual pouch which may be responsible for postoperative dysphagia.
ESD provides short inpatient and operating times, along with a short anesthesia time (mean of 10 to 30 minutes duration). Also, it only causes a mild postoperative discomfort and the patient is able to resume a diet on the same day. It is therefore cost-effective. The most common encountered complications are chipped teeth, postoperative fever and aspiration pneumonia.
Overall, results of this technique in appropriately selected patients are excellent, with a success rate well above 90%.
Needed equipment for this procedure includes:
- Weerda’s diverticuloscope
- Endopath™ articulating endoscopic stapler ATB 45
- Standard cartridges 45mm/3.5mm
- Endo Stitch™ with 2/0 silk sutures
- Closed-end esophageal suction
- 4mm, 0-degree rigid endoscope, 30cm long
References
Ludlow A. A case of obstructed deglutition from a preternatural dilation of and bag formed in the pharynx. Medical Observations Inquiries 1769;3:85-101.
Chang CY, Payyapilli RJ, Scher RL.Endoscopic staple diverticulostomy for Zenker's diverticulum: review of literature and experience in 159 consecutive cases. Laryngoscope. 2003 Jun;113(6):957-65.
Leporrier J, Salamé E, Gignoux M, Ségol P. Zenker's diverticulum: diverticulopexy versus diverticulectomy. Ann Chir. 2001 Feb;126(1):42-5.
Wasserzug O, Zikk D, Raziel A, Cavel O, Fleece D, Szold A. Endoscopically stapled diverticulostomy for Zenker's diverticulum: results of a multidisciplinary team approach. SurgEndosc. 2010 Mar;24(3):637-41. Epub 2009 Aug 18.
Feeley MA, Righi PD, Weisberger EC, Hamaker RC, Spahn TJ, Radpour S, Wynne MK.
Zenker's diverticulum: analysis of surgical complications from diverticulectomy and cricopharyngealmyotomy. Laryngoscope. 1999 Jun;109(6):858-61.
Cook RD, Huang PC, Richstmeier WJ, Scher RL.Endoscopic staple-assisted esophagodiverticulostomy: an excellent treatment of choice for Zenker's diverticulum. Laryngoscope. 2000 Dec;110(12):2020-5.
Cummings CW, Haughey BH, Thomas JR, Harker LA, Flint PW. Cummings Otolaryngology: Head and Neck Surgery. Chapter 74.
Arthroscopic interposition arthroplasty: preliminary results
Purpose. – In carpometacarpal (CMC) arthritis of the thumb, the use of interposition techniques (polylactic acid, pyrocarbon, dacron) has been increasing recently. These techniques are most often combined with open or arthroscopic complete or partial trapeziectomy. This article reports the
results at one year of the arthroscopic interposition of an absorbable implant performed without trapeziectomy.
Methods. – Our series included 25 patients aged 60.5 years on average, presenting with osteoarthritis of the trapeziometacarpal joint that had been medically treated for 18.5 months on average. All patients were operated using 1-ulnar (U) and 1-radial (R) portals. After joint debridement, a polylactic acid implant was inserted under arthroscopic control. Outcome evaluation consisted of the assessment of pain intensity, grip strength, pinch strength, opposition, thumb abduction and Dell radiological staging.
Results. – The average follow-up was 14 months. Postoperative radiological data showed significant differences from baseline clinical data regarding all evaluated variables: 0.68 vs. 3.5 for pain, 24.76 Kg vs. 16.64 Kg for grip strength, 6.44 Kg vs. 3.64 Kg for pinch strength, 8.6 vs. 7.28 for opposition, 81.28 vs. 69.68 for thumb abduction, and 1.08 vs. 2.88 on the Dell stage. Eleven complications occurred, including a type 1 complex regional pain syndrome, one sepsis, and nine inflammatory reactions that resolved after an average of 3 weeks.
Conclusions. – Our technique is simple, rapid, cost-effective, and does not necessitate trapeziectomy, even partial. It has the same indications as other non-radical interventions. The follow-up duration of our study was too short for long-term evaluation but short-term outcome appeared superior to that in other published series. The regional inflammatory reactions that occurred in our series were transient and probably related to implant resorption. Our promising results suggest extending the indication of arthroscopic interposition to more advanced stages of proximal joint osteoarthritis.
P Liverneaux
Lecture
6 years ago
265 views
3 likes
0 comments
11:20
Arthroscopic interposition arthroplasty: preliminary results
Purpose. – In carpometacarpal (CMC) arthritis of the thumb, the use of interposition techniques (polylactic acid, pyrocarbon, dacron) has been increasing recently. These techniques are most often combined with open or arthroscopic complete or partial trapeziectomy. This article reports the
results at one year of the arthroscopic interposition of an absorbable implant performed without trapeziectomy.
Methods. – Our series included 25 patients aged 60.5 years on average, presenting with osteoarthritis of the trapeziometacarpal joint that had been medically treated for 18.5 months on average. All patients were operated using 1-ulnar (U) and 1-radial (R) portals. After joint debridement, a polylactic acid implant was inserted under arthroscopic control. Outcome evaluation consisted of the assessment of pain intensity, grip strength, pinch strength, opposition, thumb abduction and Dell radiological staging.
Results. – The average follow-up was 14 months. Postoperative radiological data showed significant differences from baseline clinical data regarding all evaluated variables: 0.68 vs. 3.5 for pain, 24.76 Kg vs. 16.64 Kg for grip strength, 6.44 Kg vs. 3.64 Kg for pinch strength, 8.6 vs. 7.28 for opposition, 81.28 vs. 69.68 for thumb abduction, and 1.08 vs. 2.88 on the Dell stage. Eleven complications occurred, including a type 1 complex regional pain syndrome, one sepsis, and nine inflammatory reactions that resolved after an average of 3 weeks.
Conclusions. – Our technique is simple, rapid, cost-effective, and does not necessitate trapeziectomy, even partial. It has the same indications as other non-radical interventions. The follow-up duration of our study was too short for long-term evaluation but short-term outcome appeared superior to that in other published series. The regional inflammatory reactions that occurred in our series were transient and probably related to implant resorption. Our promising results suggest extending the indication of arthroscopic interposition to more advanced stages of proximal joint osteoarthritis.