Endoscopy means looking inside and refers to looking inside the human body for medical reasons.

Overview

---

It is a minimally invasive diagnostic medical procedure used to evaluate the interior surfaces of an organ by inserting a small scope in the body, often but not necessarily through a natural body opening. Through the scope, one is able to see lesions.

An instrument may not only provide an image but also enable taking small biopsies and retrieve foreign objects. Endoscopy is the vehicle for minimally invasive surgery.

More on [ Endoscopy ]

Surgical Endoscopy

Upper gastrointestinal investigations before gastric banding
Thu, 29 Oct 2009 07:03:06 -0000
Abstract Background  Long-term complications after laparoscopic gastric banding (LAGB) are frequent, leading to reoperations for a substantial number of patients. It is not known whether esophageal motility or the lower esophageal sphincter (LES) play a role in the development of complications. The results of preoperative upper gastrointestinal (GI) testing were compared with outcome after LAGB. Methods  Before LAGB, 68 bariatric patients had esophageal manometry, endoscopy, and pH monitoring. For 61 of these patients (90% follow-up rate), the differences in weight loss, complications, and reoperation rate were retrospectively compared. Results  Of these patients, 8.2% had a nonspecific motility disorder of the esophagus, 44.3% had an incompetent sphincter shown by manometry, and 17.5% had acid reflux shown by pH monitoring. Endoscopic evaluation showed esophagitis in 10.3% and hiatal hernia in 33.8% of the patients. Abnormal pH monitoring and endoscopic findings were not predictive for the long-term outcome or complications. The presence of an incompetent LES led to reoperation for a greater number of patients (44.4 vs. 14.7%; p = 0.01), especially if the band was placed using the pars flaccida technique. Conclusions  Endoscopy and pH monitoring do not predict outcome for gastric banding and therefore have no relevance in the selection of patients for gastric banding. Patients with an incompetent LES shown by manometry had a higher reoperation rate. If this finding can be confirmed, patients with LES incompetence may need another intervention. Content Type Journal ArticleDOI 10.1007/s00464-009-0720-zAuthors Marco Bueter, University of Würzburg Department of Surgery Würzburg GermanyAndreas Thalheimer, University of Würzburg Department of Surgery Würzburg GermanyCarel W. le Roux, Hammersmith Hospital, Imperial College London Department of Metabolic Medicine Du Cane Road London W12 0NN UKAlexander Wierlemann, University of Würzburg Department of Surgery Würzburg GermanyFlorian Seyfried, University of Würzburg Department of Surgery Würzburg GermanyMartin Fein, University of Würzburg Department of Surgery Würzburg Germany Journal Surgical EndoscopyOnline ISSN 1432-2218Print ISSN 0930-2794
Ergonomics of disposable handles for minimally invasive surgery
Wed, 28 Oct 2009 20:13:25 -0000
Abstract Background  The ergonomic deficiencies of currently available minimally invasive surgery (MIS) instrument handles have been addressed in many studies. In this study, a new ergonomic pistol handle concept, realized as a prototype, and two disposable ring handles were investigated according to ergonomic properties set by new European standards. Methods  In this study, 25 volunteers performed four practical tasks to evaluate the ergonomics of the handles used in standard operating procedures (e.g., measuring a suture and cutting to length, precise maneuvering and targeting, and dissection of a gallbladder). Moreover, 20 participants underwent electromyography (EMG) tests to measure the muscle strain they experienced while carrying out the basic functions (grasp, rotate, and maneuver) in the x, y, and z axes. The data measured included the number of errors, the time required for task completion, perception of pressure areas, and EMG data. The values for usability in the test were effectiveness, efficiency, and user satisfaction. Surveys relating to the subjective rating were completed after each task for each of the three handles tested. Results  Each handle except the new prototype caused pressure areas and pain. Extreme differences in muscle strain could not be observed for any of the three handles. Experienced surgeons worked more quickly with the prototype when measuring and cutting a suture (~20%) and during precise maneuvering and targeting (~20%). On the other hand, they completed the dissection task faster with the handle manufactured by Ethicon. Fewer errors were made with the prototype in dissection of the gallbladder. In contrast to the handles available on the market, the prototype was always rated as positive by the volunteers in the subjective surveys. Conclusions  None of the handles could fulfil all of the requirements with top scores. Each handle had its advantages and disadvantages. In contrast to the ring handles, the volunteers could fulfil most of the tasks more efficiently using the prototype handle without any remarkable pressure areas, cramps, or pain. Content Type Journal ArticleDOI 10.1007/s00464-009-0714-xAuthors D. Büchel, University Hospital of Tübingen Experimental OR and Ergonomics Ernst-Simon-Strasse 16 72072 Tübingen GermanyR. Mårvik, St. Olavs Hospital, Trondheim, Norwegian University of Science and Technology (NTNU) National Center for Advanced Laparoscopic Surgery Trondheim NorwayB. Hallabrin, University Hospital of Tübingen Experimental OR and Ergonomics Ernst-Simon-Strasse 16 72072 Tübingen GermanyU. Matern, University Hospital of Tübingen Experimental OR and Ergonomics Ernst-Simon-Strasse 16 72072 Tübingen Germany Journal Surgical EndoscopyOnline ISSN 1432-2218Print ISSN 0930-2794
Long-term effects of laparoscopic sleeve gastrectomy, gastric bypass, and adjustable gastric banding on type 2 diabetes
Wed, 28 Oct 2009 20:13:23 -0000
Abstract Background  This study aimed to compare the efficacy of laparoscopic sleeve gastrectomy (SG) with that of laparoscopic gastric bypass (GBP) and laparoscopic adjustable gastric banding (AGB) for glucose homeostasis in morbidly obese subjects with type 2 diabetes mellitus (T2DM) at a 3-year follow-up assessment and to elucidate the role of weight loss in the T2DM resolution after SG. Methods  For this study, 60 morbidly obese T2DM patients (44 females and 16 males) who underwent AGB (24 patients), GBP (16 patients), or SG (20 patients) between 1996 and 2008 were retrospectively analyzed. Age, sex, body mass index (BMI), estimated weight loss (EWL), fasting glycemia, HbA1c, euglycemic hyperinsulinemic clamp, discontinuation of diabetes treatment, and time until interruption of therapy were evaluated. Results  In the study, 54 patients received oral hypoglycemic agents for at least 12 months before surgery, and 6 patients received insulin. The mean follow-up period was 36 months. The resolution rate was 60.8% for the AGB patients, 81.2% for the GBP patients, and 80.9% for the SG patients. The postoperative time until interruption of therapy was 12.6 months for the AGB patients, 3.2 months for the GBP patients, and 3.3 months for the SG patients. The hyperinsulinemic euglycemic clamp test was performed 12 months after surgery for the cured patients. Insulin resistance was restored to normal values in all the patients. The greatest improvement from preoperative values occurred in the SG group. For the not-cured GBP and SG patients, an improvement of 120 mg/dl in fasting plasma glucose was observed 3 months after the surgery, suggesting an enhancement in insulin sensitivity, which determines better medical control. The resolution rate remained constant at the 36-month follow-up evaluation in both the GBP and SG groups. Conclusions  All three bariatric procedures are effective in treating diabetes, with a 3-year follow-up evaluation showing an effect that lasts. The AGB procedure was the least effective. The antidiabetic effect was similarly precocious after GBP and SG compared with AGB. This difference may indicate that a hormonal mechanism may be involved, independent of weight loss. Content Type Journal ArticleDOI 10.1007/s00464-009-0715-9Authors F. Abbatini, University “La Sapienza” Department of Surgical-Medical Digestive Diseases, Policlinico “Umberto I” Viale del Policlinico 00161 Rome ItalyM. Rizzello, University “La Sapienza” Department of Surgical-Medical Digestive Diseases, Policlinico “Umberto I” Viale del Policlinico 00161 Rome ItalyG. Casella, University “La Sapienza” Department of Surgical-Medical Digestive Diseases, Policlinico “Umberto I” Viale del Policlinico 00161 Rome ItalyG. Alessandri, University “La Sapienza” Department of Surgical-Medical Digestive Diseases, Policlinico “Umberto I” Viale del Policlinico 00161 Rome ItalyD. Capoccia, University “La Sapienza” Department of Clinical Sciences, Policlinico “Umberto I” Rome ItalyF. Leonetti, University “La Sapienza” Department of Clinical Sciences, Policlinico “Umberto I” Rome ItalyN. Basso, University “La Sapienza” Department of Surgical-Medical Digestive Diseases, Policlinico “Umberto I” Viale del Policlinico 00161 Rome Italy Journal Surgical EndoscopyOnline ISSN 1432-2218Print ISSN 0930-2794
Ten years of Swedish experience with intraductal electrohydraulic lithotripsy and laser lithotripsy for the treatment of difficult bile duct stones: an effective and safe option for octogenarians
Fri, 23 Oct 2009 05:51:45 -0000
Abstract Background  Endoscopic procedures using electrohydraulic lithotripsy (EHL) or intraductal laser lithotripsy (ILL) are the methods of choice for managing difficult common bile duct (CBD) stones. This retrospective study examined 10 years of Swedish experience using a mother-baby endoscopic system to assist in the fragmentation of CBD stones by EHL and ILL. Methods  Between 1995 and 2006, 44 patients with a median age of 80 years underwent EHL or ILL at two Swedish centers after conventional endoscopic fragmentation of CBD stones had failed. Long-term follow-up assessment was conducted for 9 to 126 months (median, 53 months). Results   Final stone clearance after EHL or ILL treatment with or without additional conventional endoscopic retrograde cholangiopancreatography (ERCP) was achieved for 34 (77%) of 44 patients. The results for 10 patients (23%) were defined as failures. Complete or partial stone fragmentation and definitive duct clearance were achieved in one session for 23 patients (52%). A second EHL or ILL attempt made in five cases of primary failure led to definitive stone clearance in three cases. Two patients experienced perioperative complications (stone basket impaction). Mild post-ERCP pancreatitis occurred for one patient and cholangitis for two patients. During long-term follow-up evaluation, recurrent CBD stones were found in one patient. Content Type Journal ArticleDOI 10.1007/s00464-009-0716-8Authors Fredrik Swahn, Karolinska University Hospital Huddinge Department of Surgery Stockholm SwedenGunnar Edlund, Östersund Hospital Department of Surgery Östersunds sjukhus 831 83 Östersund SwedenLars Enochsson, Karolinska University Hospital Huddinge Department of Surgery Stockholm SwedenConny Svensson, Östersund Hospital Department of Surgery Östersunds sjukhus 831 83 Östersund SwedenBo Lindberg, Intervention and Technology (CLINTEC), Karolinska Institutet Department of Clinical Science Stockholm SwedenUrban Arnelo, Karolinska University Hospital Huddinge Department of Surgery Stockholm Sweden Journal Surgical EndoscopyOnline ISSN 1432-2218Print ISSN 0930-2794
Short-term outcomes of laparoscopic total mesorectal excision following neoadjuvant chemoradiotherapy
Thu, 22 Oct 2009 18:52:09 -0000
Abstract Objective  To investigate the feasibility of laparoscopic total mesorectal excision (TME) in mid and lower rectal cancers following neoadjuvant chemoradiation (nCRT). Background  The laparoscopic approach for colon cancer has been widely accepted. A few studies have shown that there are advantages of laparoscopic over open TME surgery for rectal cancer. However, the role of laparoscopy has not been clearly defined specifically in cases following nCRT. Methods  All patients with rectal cancer who underwent nCRT were identified; no operations for rectal carcinoma were performed laparoscopically between 1997 and 2005. The laparoscopic cases were matched to open cases based on gender, procedure, age, and body mass index (BMI). The medical records were reviewed and short-term outcome was compared between these two groups. Statistical analysis was performed using SPSS© 15 software. Results  Between 2002 and 2008, 64 patients were identified, including 32 patients who underwent laparoscopic surgery and 32 who had a laparotomy. There was no difference between the two groups based on gender, procedure, age, BMI or American Society of Anesthesiologists (ASA) classification. The procedures performed within each group included 8 abdominoperineal resections and 24 anterior resections, which included 20 colonic J-pouch-anal anastomoses and 4 straight coloanal anastomoses. In the laparoscopic group, 12 patients underwent totally laparoscopic operations, 12 were either laparoscopic-assisted or hand-assisted procedures, and 8 were converted to laparotomy. The reasons for conversion included bleeding, splenic injury, and difficult anatomy. There were no differences in comorbidities, tumor location, tumor size, tumor stage or radiation dose between the two groups. Operative time was longer in the laparoscopic group (267 ± 76 versus 205 ± 49 min, p < 0.001). Operative blood loss, complication rate, and mortality rate were all similar between the two groups. However, the laparoscopic group benefited from shorter length of stay (6.1 ± 2.4 versus 7.6 ± 2.3 days, p = 0.012), earlier first bowel movement (1.9 ± 1 versus 3.3 ± 2.4 days, p = 0.006), and shorter time to regular diet (3.9 ± 2.1 versus 5.8 ± 2.5 days, p = 0.003). There was no difference in lymph node harvest (both positive node harvest and total lymph node harvest), distal margin or radial margin. Conclusions  In our experience, laparoscopic TME for mid and lower rectal cancer is feasible and safe. Patients benefit from the short-term advantages of laparoscopy, including shorter length of hospital stay, time to tolerating a regular diet, and time to first bowel movement or stoma function. Although there were no short-term differences in oncologic parameters, the long-term oncologic outcome requires further investigation. Content Type Journal ArticleDOI 10.1007/s00464-009-0702-1Authors P. Denoya, Cleveland Clinic Blvd Department of Colorectal Surgery 2950 Weston Fl 33331 USAH. Wang, Cleveland Clinic Blvd Department of Colorectal Surgery 2950 Weston Fl 33331 USAD. Sands, Cleveland Clinic Blvd Department of Colorectal Surgery 2950 Weston Fl 33331 USAJ. Nogueras, Cleveland Clinic Blvd Department of Colorectal Surgery 2950 Weston Fl 33331 USAE. Weiss, Cleveland Clinic Blvd Department of Colorectal Surgery 2950 Weston Fl 33331 USASteven D. Wexner, Cleveland Clinic Blvd Department of Colorectal Surgery 2950 Weston Fl 33331 USA Journal Surgical EndoscopyOnline ISSN 1432-2218Print ISSN 0930-2794
Mixed reality for robotic treatment of a splenic artery aneurysm
Wed, 14 Oct 2009 05:44:59 -0000
Abstract Background  Techniques of mixed reality can successfully be used in preoperative planning of laparoscopic and robotic procedures and to guide surgical dissection and enhance its accuracy. Methods  A computer-generated three-dimensional (3D) model of the vascular anatomy of the spleen was obtained from the computed tomography (CT) dataset of a patient with a 3-cm splenic artery aneurysm. Using an environmental infrared localizer and a stereoscopic helmet, the surgeon can see the patient’s anatomy in transparency (augmented or mixed reality). This arrangement simplifies correct positioning of trocars and locates surgical dissection directly on top of the aneurysm. In this way the surgeon limits unnecessary dissection, leaving intact the blood supply from the short gastric vessels and other collaterals. Based on preoperative planning, we were able to anticipate that the vascular exclusion of the aneurysm would result in partial splenic ischemia. To re-establish the flow to the spleen, end-to-end robotic anastomosis of the splenic artery with the Da Vinci surgical system was then performed. Finally, the aneurysm was fenestrated to exclude arterial refilling. Results  The postoperative course was uneventful. A control CT scan 4 weeks after surgery showed a well-perfused and homogeneous splenic parenchyma. The final 3D model showed the fenestrated calcified aneurysm and patency of the re-anastomosed splenic artery. Conclusions  The described technique of robotic vascular exclusion of a splenic artery aneurysm, followed by re-anastomosis of the vessel, clearly demonstrates how this technology can reduce the invasiveness of the procedure, obviating an otherwise necessary splenectomy. Also, the use of intraoperative mixed-reality technology proved very useful in this case and is expected to play an increasing role in the operating room of the future. Content Type Journal ArticleCategory VideoDOI 10.1007/s00464-009-0703-0Authors Andrea Pietrabissa, Università di Pisa Sezione di Chirurgia Mininvasiva, Divisione di Chirurgia I Universitaria, Dipartimento di Oncologia, dei Trapianti e Delle Nuove Tecnologie in Medicina Ospedale di Cisanello, via Paradisa 2 56124 Pisa ItalyLuca Morelli, Università di Pisa Sezione di Chirurgia Mininvasiva, Divisione di Chirurgia I Universitaria, Dipartimento di Oncologia, dei Trapianti e Delle Nuove Tecnologie in Medicina Ospedale di Cisanello, via Paradisa 2 56124 Pisa ItalyMauro Ferrari, Università di Pisa Divisione di Chirurgia Vascolare, Dipartimento di Oncologia, dei Trapianti e Delle Nuove Tecnologie in Medicina Pisa ItalyAndrea Peri, Università di Pisa Sezione di Chirurgia Mininvasiva, Divisione di Chirurgia I Universitaria, Dipartimento di Oncologia, dei Trapianti e Delle Nuove Tecnologie in Medicina Ospedale di Cisanello, via Paradisa 2 56124 Pisa ItalyVincenzo Ferrari, Università di Pisa Center for Computer Assisted Surgery ENDOCAS Pisa ItalyAndrea Moglia, Università di Pisa Center for Computer Assisted Surgery ENDOCAS Pisa ItalyLuigi Pugliese, Università di Pisa Sezione di Chirurgia Mininvasiva, Divisione di Chirurgia I Universitaria, Dipartimento di Oncologia, dei Trapianti e Delle Nuove Tecnologie in Medicina Ospedale di Cisanello, via Paradisa 2 56124 Pisa ItalyFabio Guarracino, Azienda Ospedaliero-Universitaria Pisana Divisione di Anestesiologia Pisana ItalyFranco Mosca, Università di Pisa Sezione di Chirurgia Mininvasiva, Divisione di Chirurgia I Universitaria, Dipartimento di Oncologia, dei Trapianti e Delle Nuove Tecnologie in Medicina Ospedale di Cisanello, via Paradisa 2 56124 Pisa Italy Journal Surgical EndoscopyOnline ISSN 1432-2218Print ISSN 0930-2794

Subscribe to Endoscopic RSS feed