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Purpose@#This study aimed to evaluate and compare the quality of total mesorectal excision (TME) and disease-free and overall survival rates between robotic and laparoscopic surgeries for rectal cancer. @*Methods@#From January 2015 to December 2018, 234 patients underwent curative robotic or laparoscopic surgery for rectal cancer at two centers. Ultimately, 201 patients were enrolled. To control for different demographic factors in the two groups, propensity score matching was used at a 1:1 ratio. Propensity scores were generated with the baseline characteristics, including age, sex, body mass index, American Society of Anesthesiologists score, previous abdominal surgery, tumor location, preoperative chemotherapy, and preoperative radiation. Finally, 134 patients were matched with 67 patients in the robotic surgery group and 67 patients in the laparoscopic surgery group. @*Results@#There was no significant difference in the pathologic stages between the robotic and laparoscopic surgery groups. Distal margin involvement was only observed in the robotic surgery group (1/67, 1.5%). Circumferential resection margin involvement was not different between the robotic surgery and laparoscopic surgery groups (3/67 [4.5%] and 4/67 [6.0%], respectively, P = 1.000). The quality of TME (complete, nearly complete, and incomplete) was similar between the robotic surgery and laparoscopic surgery groups (88.0%, 6.0%, 6.0% and 79.1%, 9.0%, 11.9%, respectively, P = 0.358). The disease-free and overall survival rates were not significantly different between the groups. @*Conclusion@#The quality of TME and disease-free and overall survival rates between the two surgeries were similar. There was no oncologic advantage of robotic surgery for rectal cancer compared to laparoscopic surgery.
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OBJECTIVES: Mastoid obliteration is used to obliterate the mastoid cavity following a mastoidectomy or to prevent the formation of a retraction pocket. This study evaluated the effectiveness of beta-tricalcium phosphate and polyphosphate (beta-TPP) for mastoid obliteration in middle ear surgeries in prospective human and animal studies. METHODS: Twenty patients with chronic otitis media underwent mastoid obliteration using beta-TPP after a intact canal wall mastoidectomy or simple mastoidectomy. The clinical data were prospectively evaluated including: the diagnosis, temporal bone computed tomography (TBCT), otoscopic findings, pure tone audiogram, and complications. In the animal experiment, beta-TPP was applied into the right bulla in five rats, and the opposite bulla was used as the control in the non-obliterated state. The skulls of five other rats were drilled out and the holes were obliterated with beta-TPP. TBCT were obtained at 3, 6, and 9 months after the obliteration and histologic analysis was done at 3 and 9 months after surgery. RESULTS: In the human study, fourteen TBCTs were obtained at 12 months after the surgery. All demonstrated no bone resorption in the obliterated mastoids. Among the 15 cases displaying retracted tympanic membranes preoperatively, 11 showed no retraction, 2 showed retraction postoperatively, 1 was lost to follow-up and 1 was a case of postoperative wound infection. Among 20 cases, one case developed a postoperative infection that necessitated a second operation. Sixteen underwent ossiculoplasty; hearing improvements were obtained in 15 cases and 1 case showed decreased hearing. In the animal study, new bone formation without significant bone resorption in the radiologic and histologic findings were noted in both the skull and bulla groups. CONCLUSION: Although beta-TPP is a foreign material having the possibility of infection, mastoid obliteration with it can be a treatment option in middle ear surgeries to prevent retraction pockets or the recurrence of diseases.
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Animals , Humans , Rats , Animal Experimentation , Blister , Bone Resorption , Calcium Phosphates , Cholesteatoma , Ear, Middle , Hearing , Lost to Follow-Up , Mandrillus , Mastoid , Osteogenesis , Otitis Media , Prospective Studies , Recurrence , Skull , Surgical Wound Infection , Temporal Bone , Tympanic MembraneABSTRACT
Meningioma's account for around 15% of all primary brain tumors with some 10% of meningiomas arising in the posterior fossa. In rare cases, a meningioma can form around the endolymphatic sac. When formed in the posterior fossa, meningioma tumors can produce vague, non-specific vertiginous symptoms. Research has observed that a subset of these lesions could produce symptoms indistinguishable from those of Meniere's disease. Therefore, we described the clinical features of a case of posterior petrous meningioma with recurrent vertigo as well as the substantial resolution of symptoms after tumor removal via transmastoid approach.
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Brain Neoplasms , Endolymphatic Hydrops , Endolymphatic Sac , Meniere Disease , Meningioma , VertigoABSTRACT
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BACKGROUND AND OBJECTIVES: Bondy operation is a type of modified radical mastoidectomy whose operation window is through an external auditory canal via removal of superior and posterior walls without management of the middle ears. However, the usefulness of this operation is unclear. This study aimed to review our clinical experience of modified Bondy operations and to clarify its usefulness. MATERIALS AND METHODS: Fifteen patients underwent a modified Bondy operation at the Department of Ajou University Hospital between 1996 and 2010. Their clinical data were retrospectively reviewed including age, gender, chief complaint, diagnosis, pure tone average (PTA, a mean threshold of 0.5, 1, 2, and 3 kHz before and 3 months after the operation), otoscopic finding, temporal bone computed tomography, and recurrence rate. RESULTS: The mean age of the 15 patients was 35.3+/-14 (range 18-65) years. Post-operative diagnosis of all cases was cholesteatoma (nine attic, three external auditory canal, one sinus, and two recurrent). Pre- and postoperative PTAs were 27.4+/-18.3 dBHL and 26.0+/-10.7 dBHL, respectively (p=0.72). No postoperative recurrence or complications were noted over at least a 3-month follow-up. CONCLUSIONS: Modified Bondy operation is a good option to preserve hearing and prevent recurrence after operations in cases of cholesteatoma with relatively preserved middle ears.
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Humans , Cholesteatoma , Ear Canal , Ear, Middle , Hearing , Recurrence , Retrospective Studies , Temporal BoneABSTRACT
BACKGROUND AND OBJECTIVES: Bondy operation is a type of modified radical mastoidectomy whose operation window is through an external auditory canal via removal of superior and posterior walls without management of the middle ears. However, the usefulness of this operation is unclear. This study aimed to review our clinical experience of modified Bondy operations and to clarify its usefulness. MATERIALS AND METHODS: Fifteen patients underwent a modified Bondy operation at the Department of Ajou University Hospital between 1996 and 2010. Their clinical data were retrospectively reviewed including age, gender, chief complaint, diagnosis, pure tone average (PTA, a mean threshold of 0.5, 1, 2, and 3 kHz before and 3 months after the operation), otoscopic finding, temporal bone computed tomography, and recurrence rate. RESULTS: The mean age of the 15 patients was 35.3+/-14 (range 18-65) years. Post-operative diagnosis of all cases was cholesteatoma (nine attic, three external auditory canal, one sinus, and two recurrent). Pre- and postoperative PTAs were 27.4+/-18.3 dBHL and 26.0+/-10.7 dBHL, respectively (p=0.72). No postoperative recurrence or complications were noted over at least a 3-month follow-up. CONCLUSIONS: Modified Bondy operation is a good option to preserve hearing and prevent recurrence after operations in cases of cholesteatoma with relatively preserved middle ears.
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Humans , Cholesteatoma , Ear Canal , Ear, Middle , Hearing , Recurrence , Retrospective Studies , Temporal BoneABSTRACT
BACKGROUND AND OBJECTIVES: Tympanosclerosis is a nonspecific and irreversible result of chronic inflammation or infection of the middle ear. However, there remains disagreement about how best to surgically treat tympanosclerotic ossicular fixation, with the controversy over its management when stapes is involved. The aim of this study was to evaluate operative findings and hearing results of tympanosclerosis involving the ossicular chain, which in turn would establish better surgical treatment of tympanosclerotic ossicular fixation. SUBJECTS AND METHODS: In this prospective study conducted from Mar 2000 to Dec 2007, 38 patients with tympanosclerosis who had undergone surgical treatment were evaluated. The clinical and operational records and pre- and postoperative pure tone audiograms were reviewed. RESULTS: Operative findings showed stapes fixation is the most common. In 8 patients (21.1%), stapes was mobile, while, in the remaining 30 patients (78.9%), stapes fixation was found. In all cases with stapes fixation, stapes mobilization was possible. Following hearing result reporting guideline by the Korean Otological Society, the success rate of middle ear surgery was 68.4% (26 of 38 patients). In cases with stapes fixation, the success rate was 66.6% (20 of 30 patients), while, in cases with no stapes fixation, the success rate was 75.0% (6 of 8 patients). However, there was no statistical significance between the two groups. CONCLUSION: Stapes fixation was found in 78.9% of tympanosclerotic ossicular fixation. In management of tympanosclerotic stapes fixation, meticulous excision of tympanosclerotic plaques and removal of new bone formation around stapes footplate after adequate exposure could achieve a relatively good hearing result without stapes surgery.
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Humans , Ear, Middle , Hearing , Inflammation , Myringosclerosis , Ossicular Replacement , Osteogenesis , Prospective Studies , Stapes , Stapes Mobilization , Stapes SurgeryABSTRACT
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BACKGROUND AND OBJECTIVES: A non-progressive and conductive hearing loss with normal eardrum, which has no history of trauma and infection is highly suggestive of a congenital ossicular malformation. Among ossicular anomalies, the most common anomalous ossicle is stapes. However, incus anomaly is sometimes encountered with or without stapes anomaly. The objectives of this study are to describe patterns of incus anomaly, encountered in patients who have a normal eardrum and to analyze their surgical results with special reference to the patterns of incus anomaly. SUBJECTS AND METHOD: We reviewed 26 patients (31 ears) with congenital incus anomaly, which were confirmed through exploratory tympanotomy at Ajou University Hospital from 1994 to 2005. We analyzed temporal bone CT, preoperative and postoperative audiometric findings, and surgical findings. RESULTS: 10 anomalous patterns were detected out of 31 cases of congenital incus anomaly. Incus without its long process was the most common anomalous pattern. In 15 out of 26 cases (57.7%), incus anomaly was associated with stapes anomaly, which was usually unilateral. We could get hearing improvement in 26 out of 31 ears (89.1%). CONCLUSION: Various anomalous patterns of incus were noted in our series. Incus anomaly was often associated with stapes anomaly, which was usually unilateral. The surgical result of incus anomaly was excellent except the cases without stapes.
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Humans , Ear , Hearing , Hearing Loss, Conductive , Incus , Stapes , Temporal Bone , Tympanic MembraneABSTRACT
BACKGROUND AND OBJECTIVES: Detailed information on how ossicles change in the developing temporal bone would be helpful in understanding biomechanical knowledge of ossicles. In this study, three dimensional structural images of mouse were investigated through Micro-CT to understand developmental anatomy of its ossicles. MATERIALS AND METHOD: Thirty five temporal bones of BALB/c mice, aged from gestational day 11 to postnatal day 21, and adults were investigated. Three-dimensional highresolution reconstructions of the ossicles of the left sided temporal bones were obtained using a Micro-CT system. The right sided temporal bones were used for the histological study. RESULTS: Internal biomechanical characters (volume fraction, structure model index, degree of anisotropy, etc) of murine ossicles and temporal bones were attained to the adult level at postnatal day 21. CONCLUSION: This study will be useful in understanding the more accurate microstructure of murine temporal bone, and will provide the anatomical basis for the future animal studies.
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Adult , Aged , Animals , Humans , Mice , Anisotropy , Ear Ossicles , Imaging, Three-Dimensional , Temporal BoneABSTRACT
OBJECTIVES: A non-progressive and conductive hearing loss with normal eardrum, but no history of trauma and infection, is highly suggestive of a congenital ossicular malformation. Among ossicular anomalies, stapes anomaly is the most common. The purpose of this study is to describe patterns of stapes anomaly and to analyze its surgical outcome with special reference to its patterns. METHODS: We conducted a retrospective case review. The subjects comprised 66 patients (76 ears) who were decisively confirmed by the exploratory tympanotomy as congenital stapes anomalies without any anomalies of the tympanic membrane and external auditory canal. The preoperative and postoperative audiological findings, temporal bone computed tomography scan, and operative findings were analyzed. RESULTS: There were 16 anomalous patterns of stapes among which footplate fixation was the most common anomaly. These 16 patterns were classified into 4 types according to the status of stapes footplate. Successful hearing gain was achieved in 51 out of 76 ears (67.1%) after surgical treatment. CONCLUSION: Footplate fixation was usually bilateral, whereas stapes anomalies associated with other ossicular anomaly were usually unilateral. The success of the surgical treatment of stapes anomaly might depend on its developmental status of the footplate. Stapes anomalies were detected without any fixed patterns, therefore, it is quite possible to detect a large variety of patterns in future.
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Humans , Ear , Ear Canal , Hearing , Hearing Loss, Conductive , Ossicular Replacement , Retrospective Studies , Stapes , Temporal Bone , Tympanic MembraneABSTRACT
BACKGROUND AND OBJECTIVES: The purpose of this study is to evaluate the validity and reliability of the whispered voice test, which has been suggested as a screening test tool for hearing in the elderly group. SUBJECTS AND METHOD: A prospective multicenter trial has been designed. One hundred and seventy two elderly subjects from four university hospitals were included in this study. A whispered voice test using a number list and number/word list was performed by two testers for each elderly subject. To evaluate their test-retest reliability, a second whispered voice test was done 1-2 weeks later. The result of the whispered voice test was analyzed with the criteria of 26 dB and 40 dB hearing level, checked by pure tone audiometry. Sensitivity, specificity, and cut-off point of whispered voice test at each gold standard, inter-observer reliability and test-retest reliability have been investigated. RESULTS: There were significant differences with respect to correctly answered numbers in the whispered voice test between the normal and impaired hearing group at both criteria of 26 dBHL and 40 dBHL. With the 26 dB criteria of hearing level which showed higher inter-observer reliability of the number/word list, the whispered voice test has 86.0% sensitivity and 58.9% specificity with the cut-off point of 3 out of six on the number set. The test-retest reliability of whispered voice test using the number list was as high as 0.9 of correlation coefficient. However, the inter-observer reliability of whispered voice test was less than 0.6 (Cohen's kappa value). CONCLUSION: As a screening test for hearing in the elderly group, the whispered voice test has quite high sensitivity and test-retest reliability. The environmental sound level and test method for each tester, however, should be monitored to get better specificity and inter-observer reliability.