Endoscopic or Microscopic Tympanoplasty Advantages and Disadvantages: A Theory Domain Systematic Review

Abstract Introduction Tympanoplasty is a reparative surgery that has multiple indications. The aid of a microscope or an endoscope is necessary to carry out the procedure. The classic method utilizes the microscope; however, in the recent decades, the endoscope has been popular. Although many articles try to compare these two techniques, there is still no robust evidence that confirms the superiority of either technique. In the present work, we seek to perform a systematic review contribute with this discussion. Objectives The present systematic review attempted to compare endoscopic and microscopic surgery techniques and to discover whether there would be superiority in the results of any of them, based on data currently available in the literature. Data Synthesis The objectives of the present review were organized according to the PICO planning and strategy adapted for systematic reviews. The inclusion and exclusion criteria were established aiming to select only select primary data. The main medical databases were searched usingan optimized search string with appropriate descriptors. The searched databases were MEDLINE, LILACS, SciELO, and EMBASE. A total of 99 studies were selected and 38 were fully assessed after the inclusion criteria were applied. All included articles were reviewed by all authors and their results were discussed and summarized. Conclusion The endoscopic technique was shown to be a safer technique comparable in effectiveness to the use of microscopy. In addition, it provides possible advantages such as shortening the surgical time and better postoperative pain outcomes.

Neurofibromatosis laríngea pediátrica: reporte de localización atípica / Pediatric neurofibromatosis of the larynx: report of atypical location

Los neurofibromas laríngeos (NFL) son tumores benignos poco frecuentes de localización principalmente supraglótica. Se manifiestan con síntomas obstructivos de la vía aérea. El tratamiento es la resección completa del tumor mediante abordaje endoscópico; se reserva la cirugía abierta para tumores de gran extensión. Se presenta el caso de un paciente pediátrico con localización atípica de NFL asociado a neurofibromatosis tipo 1 (NF1). Se realizó resección endoscópica del tumor y la anatomía patológica informó neurofibroma plexiforme. Es importante sospechar de esta patología en todo niño con estridor inspiratorio atípico progresivo. Se sugiere seguimiento a largo plazo por la alta probabilidad de recidiva.

Laryngeal neurofibromas (LNFs) are rare benign tumors mainly located in the supraglottis. LNFs occur with airway obstruction symptoms. The treatment is complete resection via an endoscopic technique; the open approach is reserved for large tumors. Here we describe the case of a pediatric patient with LNF of atypical location associated with neurofibromatosis type 1 (NF-1). The tumor was resected with an endoscopic technique, and the pathological study reported a plexiform neurofibroma. It is important to suspect this condition in any child with atypical, progressive inspiratory stridor. Long-term follow-up is recommended due to the high rate of recurrence

Oxigenoterapia hiperbárica como tratamiento complementario en mucormicosis asociada a COVID-19: a propósito de dos casos / Hyperbaric oxygen therapy as an adjunctive treatment for COVID-19-associated mucormycosis: a report of two cases

Reportamos los dos primeros casos, en Perú, sobre el uso del tratamiento con oxigeno hiperbárico coadyuvante (TOHC) en pacientes con mucormicosis asociado a COVID-19 (MAC). El primer caso es una mujer de 41 años, con dolor en hemicara y región palatina izquierdas con rinorrea purulenta de un mes de evolución. Al examen físico, solo evidencia fístula oroantral. El segundo caso se trata de un varón de 35 años, con disminución de agudeza visual izquierda y dolor palatino con fístula que drena secreción purulenta de cuatro meses de evolución. Ambos pacientes tienen el antecedente de diabetes, tuvieron COVID-19 moderado cuatro meses antes del ingreso, y recibieron corticoterapia por este diagnóstico. Ambos pacientes tuvieron una evaluación tomográfica que mostró compromiso del seno maxilar y tejido óseo circundante, con endoscopia nasal diagnóstica y terapéutica para desbridamiento. Se obtuvieron muestras compatibles con mucormicosis en estudio histológico. Los pacientes fueron tratados con limpieza quirúrgica y anfotericina B desoxicolato, sin embargo, presentaron evoluciones tórpidas. Por lo tanto, se adicionó la TOHC y mostraron una mejoría evidente tras cuatro semanas de tratamiento con controles subsiguientes sin presencia de mucormicosis. Resaltamos la evolución de estos pacientes con TOHC, en una enfermedad con importante morbimortalidad, que ha sido emergente durante la pandemia.

We present the first two cases reported in Peru of the use of adjuvant hyperbaric oxygen therapy (HBOT) in patients with COVID-19-associated mucormycosis (CAM). The first case is a 41-year-old woman, with pain in the left side of the face and palatine region with purulent rhinorrhea for a month. Only an oroantral fistula was found during physical examination. The second case is a 35-year-old male, with decreased left visual acuity and palatal pain with a fistula, draining purulent secretion for four months. Both patients have history of diabetes, had moderate COVID-19 four months prior to admission, and received corticosteroid therapy for this diagnosis. Tomographic evaluation of both patients showed involvement of the maxillary sinus and surrounding bone tissue; both received diagnostic and therapeutic nasal endoscopy for debridement. Histological analysis showed that the samples were compatible with mucormycosis. The patients underwent debridement and were treated with amphotericin B deoxycholate; however, they presented torpid evolution. Then, HBOT was added and the patients showed an evident improvement after four weeks of treatment with subsequent controls without the presence of mucormycosis. We highlight the favorable evolution of these patients while receiving HBOT as treatment for a disease with high morbimortality, which emerged during the pandemic.

Quality control of robotic surgical system natural orifice specimen extraction surgery in rectal cancer / 中华消化外科杂志

Robotic surgical system natural orifice specimen extraction surgery in rectal cancer has been carried out for nearly 10 years, which has entered the mature stage of technology. Development of the surgery in a healthy, orderly, scientific and standardized manner needs systema-tic, strict and whole-process quality control. Based on relevant literatures at home and abroad, and combined with team practical experiences, the authors elaborate on the key points of quality control of robotic surgical system natural orifice specimen extraction surgery in radical resection of rectal cancer, from the aspects of preoperative, intraoperative and postoperative quality control, as well as the quality control of surgeon training and qualifications, in order to provide reference for safe implementation and promotion of the surgery.

Clinical efficacy of radical resection of rectal cancer with different surgical approaches and analysis of influencing factors of postoperative complications: a report of 3 418 cases / 中华消化外科杂志

Objective:To investigate the clinical efficacy of radical resection of rectal cancer with different surgical approaches and influencing factors of postoperative complications.Methods:The retrospective study was conducted. The clinicopathological data of 3 418 patients who underwent radical resection of rectal cancer in the Second Affiliated Hospital of Harbin Medical University from July 2011 to September 2020 were collected. There were 2 060 males and 1 358 females, aged (61±11)years. Patients meeting the requirements of radical resection and surgical indications underwent surgeries choosing from open radical colorectal cancer surgery, laparoscopic radical colorectal cancer surgery, and natural orifice specimen extraction surgery (NOSES). Observation indicators: (1) intraoperative and postoperative conditions of patients undergoing different surgical approaches; (2) comparison of preoperative clinical characteristics in patients undergoing different surgical approaches; (3) comparison of postoperative histopathological characteristics in patients undergoing different surgical approaches; (4) postoperative complications of patients undergoing different surgical approaches; (5) analysis of influencing factors of postoperative complications. Measurement data with normal distribution were represented as Mean± SD. Measurement data with skewed distribution were represented as M(range), and comparisons between groups was analyzed using the Kruskal-Wallis rank test. Comparison of ordinal data was analyzed using the non-parameter rank sum test. Count data were described as absolute numbers or percentages, and comparison between groups was analyzed using the chi-square test. Multivariate analysis was conducted using the Logistic regression model. Results:(1) Intraoperative and postoperative conditions of patients undergoing different surgical approaches. Of the 3 418 patients, 1 978 cases underwent open radical colorectal cancer sur-gery, 1 028 cases underwent laparoscopic radical colorectal cancer surgery and 412 cases underwent NOSES, respectively. The operation time, volume of intraoperative blood loss, cases with permanent stoma, preventive stoma or without fistula, time to postoperative first flatus, time to postoperative liquid food intake, cases transferred to intensive care unit after surgery, duration of postoperative hospital stay were 145(range, 55?460)minutes, 100(range, 30?1 000)mL, 435, 88, 1 455, 72(range, 10?220)hours, 96(range, 16?296)hours, 158, 10(range, 6?60)days, respectively, in patients undergoing open radical colorectal cancer surgery. The above indicators were 175(range, 80?450)minutes, 50(range, 10?800)mL, 172, 112, 744, 48(range, 14?120)hours, 72(range, 38?140)hours, 17, 9(range, 4?40)days, respectively, in patients undergoing laparoscopic radical colorectal cancer surgery and 180(range, 80?400)minutes, 30(range, 5?500)mL, 0, 45, 367, 48 (range, 14?144)hours, 72(range, 15?148)hours, 1, 6(range, 3?30)days, respectively, in patients undergoing NOSES. There were significant differences in the above indicators among the patients undergoing different surgical approaches ( H=291.38, 518.56, χ2=153.82, H=408.86, 282.97, χ2=78.66, H=332.30, P<0.05). (2) Com-parison of preoperative clinical characteristics in patients undergoing different surgical approaches. The gender, age, body mass index, cases with diabetes, cases with hypertension, cases with coronary heart disease, cases with anemia, cases with hypoproteinemia, cases with intestinal obstruction, tumor location, preoperative carcinoembryonic antigen, preoperative CA19-9 showed significant differences among patients undergoing open radical colorectal cancer surgery, laparoscopic radical colorectal cancer surgery and NOSES ( P<0.05). (3) Comparison of postoperative histopathological characteris-tics in patients undergoing different surgical approaches. Tumor histological type, tumor differentiation degree, tumor diameter, number of lymph node detected, nerve invasion, vascular invasion, lymph node invasion, tumor T staging, tumor N staging, tumor M staging, tumor TNM staging showed significant differences among patients undergoing open radical colorectal cancer surgery, laparos-copic radical colorectal cancer surgery and NOSES ( P<0.05). (4) Postoperative complications of patients undergoing different surgical approaches. Cases with postoperative complications as anastomotic leakage, abdominal infection, intestinal obstruction, anastomotic bleeding, incision complications, pulmonary infection, other complications were 52, 21, 309, 8, 130, 51, 59, respectively, in patients undergoing open radical colorectal cancer surgery. The above indicators were 33, 17, 75, 3, 45, 58, 9, respectively, in patients undergoing laparoscopic radical colorectal cancer surgery and 13, 4, 8, 0, 11, 10, 15, respectively, in patients undergoing NOSES. There were significant differences in the intes-tinal obstruction, incision complications, pulmonary infection, other complications among patients undergoing different surgical approaches ( χ2=122.56, 13.33, 20.44, 15.59, P<0.05) and there was no significant difference in the anastomotic leakage, abdominal infection, anastomotic bleeding among patients undergoing different surgical approaches ( χ2=0.96, 2.21, 3.08, P>0.05). (5) Analysis of influencing factors of postoperative complications. ① Analysis of influencing factors of intestinal obstruction in patients with radical resection of rectal cancer. Age as 20?39 years and 40?59 years, surgical approach as laparoscopic radical colorectal cancer surgery and NOSES were independent protective factors of intestinal obstruction in patients with radical resection of rectal cancer ( odds ratio=0.46, 0.59, 0.43, 0.13, 95% confidence interval as 0.21?1.00, 0.36?0.96, 0.33?0.56, 0.06?0.27, P<0.05). ② Analysis of influencing factors of incision complications in patients with radical resection of rectal cancer. Body mass index as 24.0?26.9 kg/m 2, surgical approach as laparoscopic radical colorectal cancer surgery and NOSES were independent protective factors of incision complications in patients with radical resection of rectal cancer ( odds ratio=0.24, 0.63, 0.46, 95% confidence interval as 0.11?0.51, 0.44?0.89, 0.24?0.87, P<0.05). ③ Analysis of influencing factors of pulmonary infection in patients with radical resection of rectal cancer. The surgical approach as laparoscopic radical colorectal cancer surgery was an independent risk factor of pulmonary infection in patients with radical resection of rectal cancer ( odds ratio=2.15, 95% confidence interval as 1.46?3.18, P<0.05), and tumor TNM staging as 0?Ⅰ stage was an independent protective factor ( odds ratio=0.10, 95% confidence interval as 0.01?0.88, P<0.05). ④ Analysis of influencing factors of other complica-tions in patients with radical resection of rectal cancer. Age as 20?39 years, 40?59 years, 60?79 years, body mass index as <18.5 kg/m 2, 18.5?23.9 kg/m 2, 24.0?26.9 kg/m 2, 27.0?29.9 kg/m 2, surgical approach as laparoscopic radical colorectal cancer surgery were independent protective factors of other complications in patients with radical resection of rectal cancer ( odds ratio=0.10, 0.29, 0.37, 0.08, 0.22, 0.35, 0.32, 0.29, 95% confidence interval as 0.01?0.81, 0.13?0.64, 0.17?0.78, 0.02?0.40, 0.09?0.52, 0.15?0.83, 0.12?0.89, 0.14?0.59, P<0.05). Conclusions:Compared to laparoscopic radical colorectal cancer surgery and NOSES, open radical colorectal cancer surgery has wide indication and short operation time, but less perioperative treatment effect. Laparoscopic radical colorectal cancer surgery and NOSES can achieve better surgical result and less postoperative complication when patients meeting surgical indications.

Comparison of short-term efficacy between laparoscopic surgery with natural orifice specimen extraction and laparoscopic-assisted surgery for radical resection of rectal cancer / 西安交通大学学报(医学版)

【Objective】 To explore the feasibility, safety and clinical application value of laparoscopic radical rectal cancer surgery with natural orifice specimen extraction (NOSE) by comparing the postoperative pathological data, surgery-related variables and postoperative recovery between laparoscopic radical rectal cancer surgery with NOSE and laparoscopic-assisted radical rectal cancer surgery. 【Methods】 A retrospective analysis was conducted on 74 patients who underwent radical rectal cancer surgery with anus preservation in the Department of General Surgery of The First Affiliated Hospital of Xi’an Jiaotong University from July 2017 to April 2022. Among them, 38 cases underwent surgery with specimen extraction through an abdominal auxiliary incision (auxiliary incision group), and 36 cases underwent surgery with specimen extraction through a natural orifice (NOSES group). The differences in the efficacy of the two surgeries were evaluated by comparing the postoperative pathological data, surgical variables, and postoperative recovery of the two groups. 【Results】 There were no statistically significant differences in general data and postoperative pathological data between the two groups (all P>0.05). The NOSES group exhibited significantly shorter operative time, time to first flatus, time to first oral intake postoperatively, and postoperative hospital stay compared to the auxiliary incision group (all P0.05). 【Conclusion】 Laparoscopic surgery with NOSE for rectal cancer is safe and feasible with minimally invasive and accelerated recovery, which is worth promoting and applying in clinical practice.

Tratamiento endoscópico del esófago de Barrett con displasia de bajo y alto grado / Endoscopic treatment of Barrett's esophagus with low- and high-grade dysplasia

RESUMEN Introducción: El esófago de Barrett es una condición esofágica adquirida, que puede evolucionar a un adenocarcinoma. Con el paso de los años, la terapia endoscópica ha remplazado la cirugía en el tratamiento de esta afección. Objetivos: Mostrar los resultados de la aplicación de la técnica de resección endoscópica de la mucosa y la ablación con Hibrid-APC en pacientes portadores de esófago de Barrett con displasia de bajo o alto grado. Métodos: Se realizó un estudio descriptivo y retrospectivo en 29 pacientes entre los años 2014-2019, en el Servicio de endoscopias del Centro Nacional de Cirugía de Mínimo Acceso. Se estudiaron variables sociodemográficas, se estableció la clasificación endoscópica del esófago de Barrett, se describieron las características de la lesión, el diagnóstico histológico, la terapéutica endoscópica, la presencia de complicaciones, la resección incompleta y recidiva. Se aplicaron técnicas de estadística descriptiva y métodos no paramétricos. Resultados: Predominó el sexo masculino (58,62 %) y el grupo de 41-60 años (58,62 %). El segmento corto con lesiones planas y el largo con lesiones elevadas fueron más frecuentes (37,93 %). Se realizaron 15 resecciones y 14 ablaciones con Hibrid-APC; se observó una estenosis como complicación de la resección endoscópica de la mucosa y recidivas con ambas técnicas (5 pacientes, 17 %), tres relacionadas con la resección y dos con el Hibrid-APC. El Hibrid-APC alcanzó una efectividad terapéutica del 85,71 % y la resección del 80 %. Conclusiones: El tratamiento endoscópico con displasia de bajo y alto grado, mostró ser un procedimiento efectivo y seguro, con bajo porciento de complicaciones y recidivas.

ABSTRACT Introduction: Barrett's esophagus is an acquired esophageal condition that can evolve into an adenocarcinoma. Over the years, endoscopic therapy has replaced surgery in the treatment of this condition. Objectives: to show the results of the application of the endoscopic mucosal resection and Hybrid-APC ablation technique in patients with Barrett's esophagus with low-grade or high-grade dysplasia. Methods: a descriptive and retrospective study was carried out in 29 patients between 2014 and 2019, in the Endoscopy service of the National Center for Minimal Access Surgery. Social and demographic variables were studied; endoscopic classification of Barrett's esophagus was established, as well as the characteristics of the lesion, histological diagnosis, endoscopic therapy, the presence of complications, incomplete resection and recurrence were described. Descriptive statistics techniques and non-parametric methods were applied. Results: male gender (58.62%) and the group aged 41-60 years (58.62%) predominated. The short segment with flat lesions and the long segment with raised lesions were more frequent (37.93%). A number of 15 resections and 14 ablations were performed with Hybrid-APC; one stricture was observed as a complication of endoscopic mucosal resection and recurrences with both techniques (5 patients, 17%), three related to resection and two to Hybrid-APC. The Hybrid-APC achieved a therapeutic effectiveness of 85.71% and the resection one of 80%. Conclusions: endoscopic treatment with low- and high-grade dysplasia proved to be an effective and safe procedure, with a low percentage of complications and recurrences.

Endoscopic transsphenoidal endonasal surgery in pituitary adenomas / Cirugía endoscópica vía endonasal transesfenoidal en adenomas de hipófisis

The pituitary adenomas comprise the largest part of pituitary neoplasms, representing between 9 and 12% of primary brain tumors. Currently, the treatment of election is the surgical, the trans-sphenoidal endonasal path has provided a broader panoramic view, being feasible more delicate and safe procedures. The objective of this study was to describe the management of pituitary adenomas by endoscopic surgery trans-sphenoidal endonasal path. This is a study in a series of cases, with a sample of 17 patients who met the selection criteria and were attended at the José Carrasco Hospital Arteaga, Cuenca - Ecuador, period 2018 - 2019. All patients presented informed consent for the performance of the surgery and the subsequent dissemination of the results. The 53% of the population belonged to the male gender, 47% were patients between 40 and 60 years old, 65% were detected with macroadenomas, and 29% presented complications such as nasal obstruction, sphenoiditis and headache, the residual tumor stage was due 24%.Endoscopic surgery trans-sphenoidal endonasal path is a safe, minimally invasive tool, a surgical alternative with a high rate of tumor excision, better control and fewer complications, which reduces the morbidity of patients.

Los adenomas de hipófisis comprenden la mayor parte de neoplasias hipofisiarias, representando entre el 9 y 12% de los tumores cerebrales primarios. En la actualidad el tratamiento de elección es el quirúrgico, la vía endonasal transesfenoidal ha proporcionado una visión panorámica más amplia, siendo factibles procedimientos más delicados y seguros. El objetivo de este estudio fue describir el abordaje de adenomas de hipófisis mediante cirugía endoscópica vía endonasal transesfenoidal. Diseñamos un estudio de corte longitudinal, con una muestra de 17 pacientes que cumplieron con los criterios de selección y fueron atendidos en el Hospital José Carrasco Arteaga de la ciudad de Cuenca - Ecuador, periodo 2018 - 2019. Todos los pacientes presentaron consentimiento informado para la realización de la cirugía y la posterior difusión de los resultados. El 53% de la población pertenecieron al sexo masculino, 47% fueron pacientes entre 40 y 60 años, al 65% se le detectó macroadenomas, el 29% presentaron complicaciones como obstrucción nasal, esfenoiditis y cefalea, la tasa de tumor residual fue del 24%. La cirugía endoscópica vía endonasal transesfenoidal es una herramienta segura, mínimamente invasiva, una alternativa quirúrgica con una elevada tasa de exéresis tumoral, mejor control y menos complicaciones, que reduce la morbilidad de los pacientes.

Effects of everting resection natural orifice specimen extraction surgery for colorectal cancer on postoperative function of patients / 肿瘤研究与临床

Objective:To investigate the effect of everting resection natural orifice specimen extraction surgery (NOSES) on postoperative function in patients with colorectal cancer.Methods:The clinical data of 78 patients with colorectal cancer treated in Chongqing Bishan District People's Hospital from June 2019 to June 2020 were retrospectively analyzed. According to the selected surgical methods, they were divided into the study group (45 cases) and the control group (33 cases). The control group underwent traditional laparoscopic radical resection of colorectal cancer, and the study group underwent everting resection NOSES. Perioperative indicators such as intraoperative bleeding, operation time, postoperative exhaust time and hospitalization time were observed in the two groups. Anal function indicators [anal constriction pressure, fecal incontinence severity score (Wexner score)], coagulation function indicators [activated partial thromboplastin time (APTT), prothrombin time (PT)], the levels of inflammatory factors [interleukin-6 (IL-6), C-reactive protein (CRP)] and pain factors [nerve growth factor (NGF), prostaglandin E2 (PGE2), neuropeptide Y (NPY)] before and after operation were compared between the two groups.Results:There were no significant differences in intraoperative bleeding and operation time between the two groups ( t values were 1.30 and 0.56, both P > 0.05); the postoperative exhaust time and hospitalization time of the study group were shorter than those of the control group ( t values were 26.88 and 7.42, both P < 0.05). At 3 months after operation, the anal constriction pressure in the two groups was lower than that before operation [study group: (177±10) mmHg (1 mmHg = 0.133 kPa) vs. (184±10) mmHg, t = 3.22, P < 0.001; control group: (178±10) mmHg vs. (184±10) mmHg, t = 2.36, P = 0.020]; the Wexner score was higher than that before operation [study group: (9.0±1.2) points vs. (7.9±1.2) points, t = 4.26, P < 0.001; control group: (10.3±1.2) points vs. (7.9±1.2) points, t = 7.80, P < 0.001], and the Wexner score in the study group was lower than that in the control group ( t = 4.57, P < 0.001). At 1 day after operation, APTT and PT in the two groups were shorter than those before operation (all P < 0.05), and APTT and PT in the study group were shorter than those in the control group [APTT: (26.2±2.2) s vs. (28.3±2.2) s, t = 4.23, P < 0.001; PT: (9.34±0.17) s vs.(11.03±0.41) s, t = 24.93, P < 0.001]. At 1 day after operation, the levels of IL-6 and CRP in the two groups were higher than those before operation (all P < 0.05); the levels of IL-6 and CRP in the study group were lower than those in the control group [IL-6: (8.6± 2.2) ng/L vs. (17.2±3.1) ng/L, t = 14.26, P < 0.001; CRP: (2.16±0.22) mg/L vs. (2.99±0.24) mg/L, t = 15.84, P < 0.001]. At 1 day after operation, the levels of NGF, PGE2 and NPY in the two groups were higher than those before operation (all P < 0.05), and the levels of NGF, PGE2 and NPY in the study group were lower than those in the control group [NGF: (302±7) pg/ml vs. (319±8) pg/ml, t = 9.76, P < 0.001; PGE2: (189±4) ng/L vs. (196±5) ng/L, t = 6.56, P < 0.001; NPY: (164±10) ng/L vs. (177±11) ng/L, t = 5.36, P < 0.001]. Conclusions:Everting resection NOSES can effectively shorten the postoperative exhaust time and hospitalization time of patients with colorectal cancer, have less impact on coagulation function and anal function, reduce the inflammatory reaction and the level of pain factors.

Advantages of organ protection in colorectal tumor specimen collection through natural orifice specimen extraction surgery / 中华胃肠外科杂志

In recent years, natural orifice specimen extraction surgery (NOSES) has been widely used in surgery of colorectal cancer. The rapid development of NOSES is mainly attributed to its own great advantages and values, including the reduction of surgical trauma, the acceleration of postoperative recovery and the reduction of adverse psychological reactions for patients. These advantages of NOSES are also important embodiment and perfect interpretation of the organ functional protection. Organ functional preservation is a hot topic in surgery today, and it is also an inevitable requirement for minimally invasive surgery. Essentially, NOSES and organ functional preservation are proposed in the same background, and the goals are highly compatible. NOSES is an important practitioner of organ functional preservation, and organ functional preservation is also the vane of the development of the theoretical system of NOSES. These two items complement each other and together constitute the important element in the development of modern minimally invasive surgery. In order to comprehensively discuss the relationship between NOSES and organ functional protection, we elaborate the important role and value of functional protection in NOSES from five key procedures of colorectal surgery, namely surgical approach, extent of resection, lymph node dissection, digestive tract reconstruction and specimen extraction.

Mucormicosis orbitorrinocerebral: el manejo más allá de la cirugía. Informe de caso clínico y revisión de la literatura / Rhino-orbital-cerebral mucormycosis: management beyond surgery. Clinical case report and literature review

Introducción: se presenta el caso clínico de un paciente con mucormicosis orbitorrinocerebral y revisión de la literatura. Caso clínico: se trata de hombre de 45 años que consultó por síntomas nasosinusales manejado ambulatoriamente con múltiples antibióticos sin mejoría, por lo cual se realizó manejo quirúrgico con toma de muestras que revelaron hifas compatibles con mucormicosis. Cuando acudió a la institución presentaba extensión de la infección a todas las cavidades nasales y parte de la base del cráneo. En la búsqueda de la inmunosupresión, se encontró una diabetes de novo de difícil control. Discusión: la mucormicosis orbitorrinocerebral es una enfermedad altamente invasiva que requiere un manejo multidisciplinario, cirugías seriadas y extendidas, antimicóticos tópicos y sistémicos. El pronóstico mejora y la evolución puede ser favorable cuando se logra controlar la causa de la inmunosupresión, en este caso la diabetes. Conclusiones: es requisito fundamental realizar un tratamiento multidisciplinario en el abordaje de estos pacientes, tanto en la especialidad clínica como en la quirúrgica, psicosocial, nutricional y de rehabilitación.

Introduction: It is the clinical case of a patient with rhino-orbital-cerebral mucormycosis and the review of the literature. Clinical case: We present the case of a previously healthy young man who started with sinonasal symptoms and hyphae compatible with mucormycosis were found in the initial samples of outpatient care. When he came to the institution, the infection had spread to all the nasal cavities and part of the skull base. Discussion: Searching for baseline immunosuppression, only difficult-to-control diabetes and de novo diagnosis were found. It required multidisciplinary management, serial and extended surgeries, topical, venous and oral antifungals. The prognosis improved and the evolution became favorable when glycemic control was achieved. Conclusion: It is a fundamental requirement to carry out a multidisciplinary work for the approach to these patients, both in the clinical, surgical, psychosocial, nutritional and rehabilitation specialties.

Efficacy analysis of endoscopic submucosal dissection and transanal endoscopic microsurgery in the treatment of rectal neuroendocrine tumors / 中华消化杂志

Objective:To compare the short- and long-term efficacy and safety of endoscopic submucosal dissection (ESD) and transanal endoscopic microsurgery (TEM) in the treatment of rectal neuroendocrine tumor (NET) with maximum diameter ≤20 mm.Methods:From January 1, 2014 to June 30, 2022, the clinical data of 111 patients with rectal NET with maximum diameter ≤20 mm treated by ESD or TEM at Peking University People′s Hospital were retrospectively analyzed. According to the treatment of ESD or TEM, 111 patients with rectal NET were divided into ESD group (76 cases) and TEM group (35 cases). The clinicopathological characteristics (age, distance from anal margin, depth of invasion, etc.) were compared between patients with tumor maximum diameter<10 mm and 10 to 20 mm, and between ESD group patients and TEM group patients. The clinical efficacy and prognosis were also compared between ESD group and TEM group. The follow-up time was 41 months (16 months, 76 months). The propensity score matching (PSM) method was used to balance the differences of clinical characteristics between ESD and TEM groups. Independent sample t test, Wilcoxon rank-sum and chi-square test were used for statistical analysis. The risk factors of lymph node or distant metastasis were analyzed by univariate and multivariate binary logistic regression. Results:The maximum tumor diameter of 111 patients with rectal NET was (6.6±0.3) mm (ranged from 2 to 20 mm). The maximum tumor diameter of 85 cases (76.6%) was <10 mm and that of 26 cases (23.4%) was between 10 mm and 20 mm. There were statistically significant differences in age, distance from the anal margin and incidence of submucosal infiltration between patients with tumor maximum diameter<10 mm and patients with tumor maximum diameter 10 to 20 mm ((49.8±11.6 ) years old vs. (56.8±13.8) years old; 5.0 cm (4.0 cm, 8.0 cm) vs. 8.0 cm (5.0 cm, 8.0 cm); 69.4%, 59/85 vs. 96.2%, 25/26; t=2.58, Z=-2.23, χ2=6.35, P=0.011, 0.026 and 0.012). The en block resection rate of rectal NET treated with ESD or TEM was 100.0%(111/111), the complete resection rate was 93.7% (104/111), and the postoperative bleeding rate was 2.7% (3/111). There were no postoperative perforation or other major complications. During the follow-up period, there was no local recurrence. The metachronous recurrent rate was 0.9% (1/111), 3.6% (4/111) patients had lymph node or distant metastasis, and there was no death. Compared with patients with tumor maximum diameter<10 mm, more patients with tumor maximum diameter of 10 to 20 mm selected TEM (57.7%, 15/26 vs. 23.5%, 20/85), and the difference was statistically significant ( χ2=10.76, P=0.001). Before PSM, a total of 7 patients in the ESD group had positive vertical margins, and during the follow-up of 21 months (15 months, 48 months), 2 patients had lymph node or distant metastasis and received surgery. The proportion of patients with tumor maximum diameter of 10 to 20 mm and submucosal invasion in TEM group were both higher than those in ESD group (42.9%, 15/35 vs. 14.5%, 11/76; 88.6%, 31/35 vs. 69.7%, 53/76), and the differences were statistically significant( χ2=10.76 and 3.65, P=0.001 and 0.032). After PSM, there were no statistically significant differences in the complete resection rate, postoperative bleeding rate, metachronous recurrence rate, lymph node or distant metastasis rate between ESD group and TEM group (89.3%, 25/28 vs.100.0%, 28/28; 3.6%, 1/28 vs. 0, 0/28; 3.6%, 1/28 vs. 0, 0/28; 0, 0/28 vs.3.6%, 1/28; all P>0.05). However, the operation time and hospital stay of the ESD group were both shorter than those of the TEM group (27.0 min (25.0 min, 30.0 min) vs. 39.0 min (32.0 min, 45.0 min); 5.0 d (4.0 d, 5.0 d) vs. 6.0 d (3.0 d, 9.0 d)), and the differences were statistically significant ( Z=-3.38 and -2.23, P=0.001 and 0.021). Conclusion:The efficacy of ESD and TEM in rectal NET with maximum diameter ≤ 20 mm is equal, however, ESD has the advantage of shorter procedure time and hospital stay.

Quiste de Thornwaldt. A propósito de un caso

Se presenta el caso de una mujer de 49 años, que acudió al servicio de otorrinolaringología con tiempo de enfermedad de tres meses presentando dolor y rigidez cervical, además de inestabilidad. Al ser evaluada, en la resonancia magnética de fosa posterior con contraste, se observó una lesión nodular en nasofaringe compatible con quiste de Thornwaldt. La endoscopia nasal evidenció una lesión compatible con dicho diagnóstico. Se decidió tratamiento quirúrgico, realizándose marsupialización bajo abordaje endoscópico transnasal. En el postoperatorio, la paciente refirió mejoría del dolor y de la rigidez cervical, pero persistió la inestabilidad. Por tratarse de una patología infrecuente y cuya forma de presentación es poco común se reporta el caso y se realiza una revisión del tema.

SUMMARY We present the case of a 49-year-old female patient attending the otorhinolaryngology service with a 3-month history of pain and neck rigidity plus instability. A contrast MRI of the posterior fossa revealed a nodular lesion in the nasopharynx compatible with a Thornwaldt cyst. A nasal endoscopy confirmed the diagnosis. Excision of the cyst under trans nasal endoscopy was performed. Instability persisted but neck pain and neck rigidity improved. We carried-out a literature review.

Tumores de Fosa Pterigopalatina: Tipos de abordajes quirúrgicos y complicaciones / Pterygopalatine Fossa Tumors: Types of surgical approaches and complications

INTRODUCCIÓN. La fosa pterigopalatina es una zona anatómica de difícil acceso, que al presentar masas tumorales genera un alto riesgo de morbimortalidad en población juvenil y adulta, que precisa determinar las complicaciones asociadas a cirugía. OBJETIVO. Evaluar los tipos de abordaje quirúrgico, complicaciones e identificar la estirpe histológica de los tumores de fosa pte-rigopalatina. MATERIALES Y MÉTODOS. Estudio transversal retrospectivo. Población y muestra conocida de 29 Historias Clínicas de pacientes con hallazgos de imagen e histopatológico de tumores con invasión a fosa pterigopalatina divididos en dos grupos: A) resección de masa tumoral y B) biopsia de masa tumoral, operados en el Hospital de Especialidades Carlos Andrade Marín en el período de enero 2017 a diciembre de 2020. RESULTADOS. El 82,76% (24; 29) fueron hombres, con promedio de edad de 30,6 años. El 82,76% (24; 29) de las masas tumorales se originaron en nasofaringe; no se reportaron casos primarios. El tumor más frecuente fue el Angio-fibroma Nasofaringeo Juvenil 68,97% (20; 29), seguido por los tumores malignos con el 20,69% (6; 29), siendo usual el carcinoma adenoideo quístico. En el 62,07% (18; 29) el tumor invadió Fosa Infratemporal y en el 44,83% (13; 29) hacia esfenoides. En el grupo A, el abordaje quirúrgico empleado en el 20,83% (5; 24) fue mediante técnica abierta y en el 79,17% (19; 24) con técnica endoscópica, tanto uni 31,58% (6; 19) como multiportal 68,42% (13; 19). La complicación fue la hiposensibilidad facial en el 12,5% (3; 24), todos en abordajes abiertos. CONCLUSIÓN. Se evaluó los tipos abordaje quirúrgico y se identificó la estirpe histológica de los tumores de fosa pterigopalatina

INTRODUCTION. The pterygopalatine fossa is an anatomical area of difficult access, which when presenting tumor masses generates a high risk of morbimortality in the juvenile and adult popula-tion, which needs to determine the complications associated with surgery. OBJECTIVE. To eva-luate the types of surgical approach, complications and identify the histologic type of pterygopala-tine fossa tumors. MATERIALS AND METHODS. Retrospective cross-sectional study. Population and known sample of 29 Clinical Histories of patients with imaging and histopathological findings of tumors with invasion to pterygopalatine fossa divided into two groups: A) resection of tumor mass and B) biopsy of tumor mass, operated at the Carlos Andrade Marín Specialty Hospital in the period from january 2017 to december 2020. RESULTS. The 82,76% (24; 29) were men, with an average age of 30,6 years. 82,76% (24; 29) of the tumor masses originated in nasopharynx; no primary cases were reported. The most frequent tumor was juvenile nasopharyngeal angiofibroma 68,97% (20; 29), followed by malignant tumors with 20,69% (6; 29), being usual the adenoid cystic carcinoma. In 62,07% (18; 29) the tumor invaded the Infratemporal Fossa and in 44,83% (13; 29) into the sphenoid. In group A, the surgical approach used in 20,83% (5; 24) was by open technique and in 79,17% (19; 24) by endoscopic technique, both uni 31,58% (6; 19) and multiportal 68,42% (13; 19). The complication was facial hyposensitivity in 12,5% (3; 24), all in open approaches. CONCLUSION. The types of surgical approach were evaluated and the histologic type of pterygo-palatine fossa tumors was identified.

Tiroidectomía transoral endoscópica por abordaje vestibular (TOETVA): primer caso en Perú / Transoral endoscopic thyroidectomy via vestibular approach (TOETVA): first case in Peru

RESUMEN La calidad de vida luego de la cirugía de la glándula tiroides es tan importante como el control de la enfermedad. Para mejorar los resultados cosméticos y la satisfacción del paciente se usan abordajes endoscópicos usando incisiones fuera de la región cervical. La tiroidectomía transoral endoscópica no deja ninguna cicatriz visible en la piel y es una técnica quirúrgica segura. Se presenta el caso de una paciente mujer de 29 años con una tumoración benigna de la glándula tiroides con síntomas compresivos y preocupaciones estéticas, sometida a hemitiroidectomia derecha mediante abordaje transoral vestibular endoscópico en un tiempo de 150 minutos y sangrado mínimo. Los resultados son comparables con la técnica quirúrgica abierta, con un mejor resultado estético y mejora en la calidad de vida.

ABSTRACT Quality of life after thyroid gland surgery is as important as disease control. To improve cosmetic results and patient satisfaction, endoscopic approaches are used using incisions outside the cervical region. Endoscopic transoral thyroidectomy does not leave any visible scarring on the skin. We present the case of a 29-year-old female patient with a benign thyroid gland tumor with compressive symptoms and aesthetic concerns, who underwent a right hemithyroidectomy by means of an endoscopic transoral vestibular approach in a time of 150 minutes and minimal bleeding, without complications in the postoperative period. The transoral endoscopic vestibular approach for endoscopic resection of the thyroid gland is safe and the results are comparable with the open surgical technique, with a better cosmetic result and improved quality of life.

Technical points of 4K laparoscopic assisted transanal total mesorectal excision / 中华消化外科杂志

Surgical treatment of low rectal cancer is a difficult point in colorectal surgery, which has the problem of mutual restriction between radical resection and functional protection. With the development of laparoscopic total mesenterectomy, minimally invasive operation through anal endoscopy and the gradual improvement of the concept of natural orifice transluminal endoscopic surgery, the transanal total mesorectal excision (taTME) is formed in line with the principle of radical resection of rectal cancer. On the premise of ensuring radical resection, taTME can maximize organ preservation and function protection, and improve the quality of life of patients. 4K laparoscopic system can provide a clear surgical field and improve the surgical precision, which is helpful for the accurate anatomy of low rectal cancer. The authors share the clinical experience of 4K laparoscopy assisted taTME in order to provide references for surgical colleagues.

Comparison of the mid- and long-term outcomes between natural orifice specimen extraction surgery and conventional laparoscopic surgery with abdominal auxiliary incision in the treatment of rectal cancer based on propensity score matching method / 中华胃肠外科杂志

Objective: To compare the mid- and long-term outcomes between natural orifice specimen extraction surgery (NOSES) and conventional laparoscopic surgery with abdominal auxiliary incision in the treatment of rectal cancer. Methods: A propensity score matching study was conducted. Patients with pathological diagnosis of rectal adenocarcinoma, preoperative imaging assessment of T1-3 and body mass index <28 kg/m(2) were included. Those who underwent local resection or abdominoperineal resection, had simultaneous multiple primary cancers, malignant intestinal obstruction or perforation, received neoadjuvant radiotherapy, and were unsuitable for laparoscopic surgery were excluded. From January 2017 to January 2019, 264 patients undergoing laparoscopic rectal cancer surgery at the Department of Colorectal Tumor Surgery, Shengjing Hospital of China Medical University were enrolled in this study, and divided into the NOSES group (52 cases) and the auxiliary incision group (212 cases). Propensity score matching method was used as 1:1 to match the initial data, and 46 pairs were finally obtained. SPSS 26.0 was used for data analysis, and 2-year disease-free survival, intraoperative and perioperative indicators were compared between the two groups. Results: The tumor short diameter in the NOSES group and the auxiliary incision group was (2.9±0.8) cm and (3.1±1.0) cm (t=0.842, P=0.402) respectively. Other baseline data were also comparable between the two groups(all P>0.05). There were no significant differences in operative time, intraoperative blood loss, length of hospital stay and postoperative complication rate between the two groups (all P>0.05). The time to first flatus [2 (1-6) days vs. 3 (1-6) days, Z=-3.035, P=0.002] and to liquid food intake [3 (1-6) days vs. 3 (2-7) days, Z=-2.587, P=0.010] after surgery in the NOSES group were earlier than those that in the auxiliary incision group. Compared with the auxiliary incision group, the postoperative pain score was lower [3 (2-5) vs. 4 (3-7), Z=-5.477, P<0.001], and the aesthetic score was higher [8 (6-9) vs. 7 (5-8), Z=-6.329, P<0.001] in the NOSES group. The distal resection margin in the NOSES group was longer than that in the auxiliary incised group [(3.7±1.2) cm vs. (2.9±1.4) cm, t=3.287, P<0.001]. There were no significant differences in proximal resection margin the number of harvested lymph nodes and positive rate of circumferential resection margin between the two groups (all P>0.05). The 2-year disease-free survival rate in the NOSES group and the auxiliary incision group was 93.5% and 89.1% respectively, and the difference was not statistically significant (P=0.466). Conclusions: NOSES has similar mid- and long-term outcomes to conventional laparoscopic surgery and the advantages of better cosmetic effect, less postoperative pain and faster recovery, which is more in line with the concept of minimally invasive and worthy of clinical promotion.

Complications of transoral endoscopic thyroidectomy vestibular approach (TOETVA) / Tireoidectomia endoscópica transoral por acesso vestibular (TOETVA) e complicações

ABSTRACT The thyroidectomy is the most frequently executed procedure in head and neck surgery. Since its first description by Kocher, the transverse cervical incision has been the main access to the thyroid site, as it provides broad exposure of the central neck compartment. Despite the meticulous suture of the incision, the development of a scar with variable dimensions is unavoidable and, hence, some patients might not agree to the approach, due to this consequence. The transoral endoscopic thyroidectomy vestibular access (TOETVA) gains importance as an alternative to the traditional surgery, since it avoids the formation of visible scars. The objective of this study is to develop a systematic review on the currently available literature to evaluate possible complications related to the TOETVA. The systematic review was based on the databases of Medline, Cochrane library, Embase and Scielo/Lilacs, resulting in the selection of six studies, which were compared in regard of the type of study duration of the study and identified complications. Our study showed that TOETVA is related to complications similar to the ones identified in the conventional approach, such as hematoma, seroma, recurrent laryngeal nerve injury, hypoparathyroidism, surgical site infection. The TOETVA was associated to a higher risk of thermic injury of the skin and mentual nerve paresthesia. Moreover, it was possible to conclude that TOETVA is a safe procedure for well selected patients, with favorable conditions and concerned about the aesthetic outcome. The risk of complications of the procedure should always be explained to those patients.

RESUMO A tireoidectomia é o procedimento cirúrgico mais frequentemente realizado na cirurgia de cabeça e pescoço. Desde sua descrição por Kocher, a incisão cervical transversa constitui o principal acesso à loja tireoideana e permite ampla exposição à região central do pescoço. Apesar do fechamento meticuloso da incisão, uma cicatriz de dimensões variáveis é inevitável, e certos pacientes podem discordar de tal abordagem. A tireoidectomia vestibular endoscópica transoral (TOETVA) ganha importância como alternativa à cirurgia tradicional, pois evita a formação de cicatrizes visíveis. O objetivo de estudo é realizar uma revisão sistemática da literatura das possíveis complicações da TOETVA. Foi realizada revisão sistemática da literatura nas bases de dados Medline, The Cochrane Library, Embase e SciElo/Lilacs, sendo selecionados seis artigos e tabulados os dados de tipo de estudo, período do estudo e complicações apresentadas. O estudo mostra que a TOETVA apresenta complicações semelhantes à técnica convencional, como hematoma, seroma, lesão de nervo laríngeo recorrente, hipoparatireoidismo, além de infecção de sítio cirúrgico, com maior risco de lesão térmica da pele e parestesia por lesão do nervo mentual. Em adição, foi possível concluir que a TOETVA é uma técnica segura para pacientes bem selecionados, com condições favoráveis e com especial preocupação com resultados estéticos, devendo sempre ser orientados sobre possíveis complicações.

Pérdida de agudeza visual progresiva en paciente con proptosis. Caso clínico y revisión de la literatura / Progressive visual impairment in a patient with proptosis. Case report and review of the literature.

Introducción: a raíz del siguiente reporte de caso clínico se pretende repensar el diagnóstico diferencial de los tumores orbitales y revisar la literatura existente al respecto. Caso: paciente de 54 años, fumadora, acude a nuestro centro por una pérdida de agudeza visual progresiva de dos años de evolución en el ojo derecho, que se acompañaba de proptosis. Las pruebas de imagen basadas en resonancia magnética y tomografía por emisión de positrones ­ tomografía computarizada (PET-TC) realizadas describían una lesión intraconal derecha de morfología indefinida, que rodeaba el nervio óptico. El estudio inmunohistoquímico y molecular anatomopatológico confirmó la sospecha de síndrome linfoproliferativo extranodal de bajo grado. Discusión: el manejo endoscópico de estas lesiones puede resultar en una menor comorbilidad en comparación con el abordaje externo tradicional. El papel de la cirugía radica en la obtención de una muestra de la lesión que permita un correcto diagnóstico. Conclusiones: el abordaje multidisciplinar con oftalmólogos, hematólogos y expertos en radioterapia permite obtener buenos resultados quirúrgicos y clínicos en la inmensa mayoría de casos.

Introduction: as result of the following clinical case report, we intend to review the differential diagnosis of orbital tumors and review the existing literature in this regard. Case report: a 54-year-old smoking patient, consulted to our department due to a progressive visual impairment over the last two years in her right eye. She presented proptosis in her clinical examination. Imaging studies based on MRI and PET-CT described a right intraconal lesion with an undefined morphology surrounding the optic nerve. Orbital tumors differential diagnosis is delicate. Nevertheless, Non-Hodgkin lymphomas followed by metastasis are the two most common found in this location. The immunohistochemistry and molecular studies, confirmed the suspected diagnosis of extranodal low-grade lymphoproliferative syndrome. Discussion: endoscopic management of these lesions may result in a lower comorbidity compared to traditional external approaches. Role of surgery lays in obtainment of a quality sample which allows a proper diagnosis. Conclusions: multidisciplinary approach with ophthalmologists, hematologists and radiotherapy experts enhance good surgical and clinical results in the vast majority of cases.

Subphrenic splenic implantation after splenectomy： A case report / 中南大学学报(医学版)

Subphrenic splenic implantation is a rare disease, usually occurred followed the splenic trauma and splenectomy. Surgeries are often necessary for diagnosing and treating it. A 46-year-old male post-splenectomy patient, tolerating abdominal bloating and pain for more than 1 year, was admitted to the Second Xiangya Hospital, Central South University. Fundus bulge suggested a possibility of stromal tumors originating from the muscularispropria layer with endoscopic ultrasound. Slightly stomachic thickness was detected using enhanced computed tomography (CT). Without any improvement for symptoms after medication, the patient strongly requested to undergo an endoscopic therapy. Natural orifice transluminal endoscopic surgery (NOTES) result confirmed it as subphrenic splenic implantation with postoperative pathology. In this case, NOTES helped us to confirm the diagnosis, relieve the symptoms, as well as prevent secondary surgery injury, which would be helpful to other clinicians.