Improvements in planning lacrimal surgery using DICOM Horos® viewer 3D images.

INTRODUCTION AND OBJECTIVE: The individual anatomic variation of the course of the lacrimal duct and surrounding structures requires the thorough knowledge of its three-dimensional configuration in order to perform the surgery in the safest and most efficient way. The aim of this study was to consider virtual surgical planning in order to improve dacryocystorhinostomies. METHODS: Horos® was used as a viewer and manager of DICOM-format images for multiplanar, three-dimensional (3D) reconstruction when planning 148 first-time lacrimal operations and 26 reoperations by laser endonasal and endocanalicular DCRs. RESULTS: The 3D images of the CT dacryocystography were much better identified than the 2D ones, Horos® showing a statistically significant correlation (P < .0001). Over 98.27% of the images match the programme reconstruction. Less than 1.73% of them showed some discordance due to study distortion. These cases were related to trauma. The intraopearative location of the lacrimal system was very accurate, avoiding complications. CONCLUSIONS: Viewing and studying 3D images, Horos® is a very useful tool for diagnosis and preoperative planning. It is very helpful in complex conditions by marking surgical references, locating the lacrimal sac and controlling the post-operative permeability of the lacrimal system. The information loss produced by the image selection is also avoided. Another great advantage is that the programme is free.

Improvements in planning lacrimal surgery using DICOM Horos® viewer 3D images. / Mejora de la planificación de las cirugías lagrimales a partir de imágenes tridimensionales con el visualizador DICOM Horos®.

INTRODUCTION AND OBJECTIVE: The individual anatomic variation of the course of the lacrimal duct and surrounding structures requires the thorough knowledge of its three-dimensional configuration in order to perform the surgery in the safest and most efficient way. The aim of this study was to consider virtual surgical planning in order to improve dacryocystorhinostomies. METHODS: Horos® was used as a viewer and manager of DICOM-format images for multiplanar, three-dimensional (3D) reconstruction when planning 148 first-time lacrimal operations and 26 reoperations by laser endonasal and endocanalicular DCRs. RESULTS: The 3D images of the CT dacryocystography were much better identified than the 2D ones, Horos® showing a statistically significant correlation (P<.0001). Over 98.27% of the images match the programme reconstruction. Less than 1.73% of them showed some discordance due to study distortion. These cases were related to trauma. The intraopearative location of the lacrimal system was very accurate, avoiding complications. CONCLUSIONS: Viewing and studying 3D images, Horos® is a very useful tool for diagnosis and preoperative planning. It is very helpful in complex conditions by marking surgical references, locating the lacrimal sac and controlling the post-operative permeability of the lacrimal system. The information loss produced by the image selection is also avoided. Another great advantage is that the programme is free.

Mejora de la planificación de las cirugías lagrimales a partir de imágenes tridimensionales con el visualizador DICOM Horos® / Improvements in planning lacrimal surgery using DICOM Horos® viewer 3D images

Introducción y objetivos La variación anatómica individual del trayecto de la vía lagrimal y estructuras adyacentes requiere disponer del mejor conocimiento posible de su configuración tridimensional para afrontar una cirugía con mayor seguridad y eficacia. El objetivo del trabajo fue estudiar la utilidad de la planificación quirúrgica virtual para la mejora en la realización de las dacriocistorrinostomías (DCR). Métodos Se usó el programa Horos® como visualizador y gestor de imágenes en formato DICOM para reconstrucción multiplanar y tridimensional (3D) en la planificación de 148 cirugías lagrimales complejas de primera intención y 26 reintervenciones mediante DCR endocanalicular y endonasal con láser. Resultados Se identificaron más rápidamente y con mayor precisión en las imágenes en 3D de la dacriocistografía-TAC que con placas visualizadas en 2D, con una correlación clínico-radiológica estadísticamente significativa (p<0,0001) a favor de Horos®. Más del 98,27% de las imágenes coincidieron con las reconstrucciones del programa; menos del 1,73% presentaron algún grado de discordancia por distorsiones en el estudio; estos casos fueron los secundarios a traumatismos. La localización intraoperatoria del sistema lagrimal fue muy precisa por la buena orientación, evitando complicaciones. Conclusiones La mejora en la planificación prequirúrgica con utilización sistemática de Horos® para visualización y tratamiento de imágenes en 3D es una herramienta muy útil para el diagnóstico y planificación preoperatoria, facilita una cirugía segura en las patologías complejas, ya que marca referencias quirúrgicas y localiza el saco lagrimal, así como el control postoperatorio de la permeabilidad del aparato lagrimal. Evita la pérdida de información que se produce en la selección de imágenes (AU)

Introduction and objective The individual anatomic variation of the course of the lacrimal duct and surrounding structures requires the thorough knowledge of its three-dimensional configuration in order to perform the surgery in the safest and most efficient way. The aim of this study was to consider virtual surgical planning in order to improve dacryocystorhinostomies. Method Horos® was used as a viewer and manager of DICOM-format images for multiplanar, three-dimensional (3D) reconstruction when planning 148 first-time lacrimal operations and 26 reoperations by laser endonasal and endocanalicular DCRs. Results The 3D images of the CT dacryocystography were much better identified than the 2D ones, Horos® showing a statistically significant correlation (P<.0001). Over 98.27% of the images match the programme reconstruction. Less than 1.73% of them showed some discordance due to study distortion. These cases were related to trauma. The intraopearative location of the lacrimal system was very accurate, avoiding complications. Conclusions Viewing and studying 3D images, Horos® is a very useful tool for diagnosis and preoperative planning. It is very helpful in complex conditions by marking surgical references, locating the lacrimal sac and controlling the post-operative permeability of the lacrimal system. The information loss produced by the image selection is also avoided (AU)

[Results the application of mitomicyn during endonasal and endocanalicular dacryocystorhinostomy by diode laser]. / Resultados de la aplicación de mitomicina en la dacriocistorrinostomía endonasal y endocanalicular con láser diodo.

AIM OF THE STUDY: To study the effects, secondary effects and security of the intrasurgical application of mitomicyn C during endonasal and endocanalicular dacryocystorhinostomy with diode laser (TLA-ELA DCR). METHODS: We carried out a randomized, prospective, interventional and double blind study in 200 patients: intrasurgical mitomicyn C was applied in 150 of then (0.4 mgr/0.2 ml) for 5 minutes by means of a polivinil acetate dressing over the osteotomy. In other 50 patients MMC was not used we followed up at 24 hours, 10 days and 1, 3 and 6 months after surgery. Endoscopic aspects and possible complications were valued. The results were compared using the Chi-squared test with the Yates correction. We looked for the presence or abscense of secondary effects in the application of mitomicyn C. RESULTS: The average follow up was 15.25 months (range 6 to 21 months). The percentages of alterations for excesive scarring were 21.77% in patients without and MAC 8.03% in the ones MMC. The difference was statisticaly significant (p = 0.02). We did not find secondary effects due to application of mitomcyn. CONCLUSIONS: Intrasurgical application of topical MMC during TLA-ENL DCR reduces the number of pathological findings due to scarring of the surrouding area of the new drainage without secondary effects.

[Endonasal and endocanalicular dacryocystorhinostomy by diode laser. Preliminary results]. / Dacriocistorrinostomía endonasal y endocanalicular con láser diodo. Resultados preliminares.

AIM OF THE STUDY: To describe the surgical technique and to evaluate the clinical results after having performed the transcanalicular and endocanalicular dacryocystorhinostomies by diode laser, including the advantages and limits of this technique. METHODS: 34 were performed by diode laser in patients with clinical history of epiphora, with or without mucopurulent secretion, for nasolacrimal duct obstruction. The study was prospective, interventional, non randomized and non comparative. Diode laser was used to realize vaporization of lacrimal sac, osteotomy and vaporization with coagulation of nasal mucosa. The mean of surgical time was 15 minutes (range 7 to 29 minutes). Bicanalicular intubation was performed with a silicone tube and prolene filament for two months in all cases. Postsurgical follow-up was between 4 and 11 months. The degree of epiphora was evaluated by the Munk scale and lacrimal permeability was evaluated by endoscopic functional staining test in all cases. RESULTS: Out of the 34 DCR-EDN+ENC that were performed, 32 cases (94.11%) remain asymptomatic. Two of them (5.88%) required endonasal dacryocystorhinostomies by drilling, because the bony perforation was impossible to achieve by laser fiber. Two cases (5.88%) presented fibrosis and lacrimal and lower canaliculi obstruction, without epiphora because the superior canaliculi was permeable. CONCLUSION: Endonasal and endocanalicular dacryocystorhinostomy technique performed by diode laser is a valid method. It does not cause cutaneous scarring, it decreases thermic canalicular damage, it respects the lacrimal pump, it minimizes pain and bleeding, it needs less surgical time and it has turned into an out-patient procedure with a minimal surgical and postsurgical morbility.

[Transcanalicular dacryocystorhinostomy technique using diode laser]. / Dacriocistorrinostomía transcanalicular con láser diodo.

PURPOSE: To describe the surgical technique and to evaluate the clinical results of carrying out transcanalicular dacryocystorhinostomies using a diode laser (DCR-TC), including the advantages and limitations of this technique. METHODS: 43 DCR-TC were studied and they were analysed using a prospective, interventional, non randomized and non comparative study. We used local and topical anaesthesia in patients with a clinical history of epiphora or dacryocystitis for nasolacrimal obstruction. A diode laser was used to effect a vaporization of the lacrimal sac, osteotomy and vaporization with coagulation of nasal mucosa. The mean duration of surgery was 14 minutes (range 7 to 29 minutes). In all cases, and during a two-month period, bicanalicular intubation was carried out using a silicone tube and prolene filament. Follow-up was between 4 to 38 months. The degree of epiphora was evaluated using the Munk scale and lacrimal permeability was evaluated using Jones I and II tests by direct videoendoscopic control in all cases. RESULTS: 43 DCR-TC were realized, 39 cases are asymptomatic (90.7%). 2 of them (4.65%) had epiphora (degree 2 on the Munk scale) and permeable tract. One case (2.32%) presented lower canaliculi obstruction. One patient showed total osteotomy closing. CONCLUSIONS: Transcanalicular dacryocystorhinostomy carried out using a diode laser is a useful method because it does not cause cutaneous scarring, it hardly produces pain and bleeding, it respects the lacrimal pump, it needs less surgical time, it can be carried out in an out-patient surgery and it generates minimal intra and postsurgical morbility.

Dacriocistorrinostomía transcanalicular con láser diodo / Transcanalicular dacryocystorhinostomy technique using diode laser

Objetivo: Describir la técnica quirúrgica y evaluar los resultados clínicos tras la realización de Dacriocistorrinostomías transcanaliculares (DCR-TC) con láser diodo, incluyendo las ventajas y limitaciones de este procedimiento. Método: Mediante un estudio prospectivo e intervencional, no randomizado y no comparativo, se realizaron 43 DCR-TC con láser diodo bajo anestesia tópica y local en pacientes con historia clínica de epífora o dacriocistitis por obstrucción a nivel nasolagrimal. El láser diodo fue utilizado para realizar la vaporización de saco lagrimal, la osteotomía y la vaporización y coagulación de mucosa nasal. El tiempo quirúrgico medio fue de 14 minutos (rango 7-29 minutos). Se practica intubación bicanalicular con tubos de silicona e hilo de prolene durante dos meses en todos los casos. El seguimiento fue entre 4 y 38 meses. En todos los pacientes se valoró el grado de epífora mediante la escala de Munk y la permeabilidad lagrimal con el test de Jones I y II bajo control videoendoscópico directo. Resultados: De las 43 DCR-TC, permanecen asintomáticos 39 casos (90,7%). 2 pacientes (4,65%) tuvieron epifora (grado 2 en escala de Munk) y vía permeable. Un caso (2,32%) presentó obstrucción del canalículo inferior y un paciente (2,32%) mostró cierre completo de la osteotomía. Conclusiones: La Dacriocistorrinostomía transcanalicular con láser diodo es un método útil que no causa cicatriz cutánea, apenas produce dolor ni sangrado, respeta la bomba lagrimal, precisa menor tiempo quirúrgico, convirtiéndose en un procedimiento ambulatorio con morbilidad quirúrgica y postoperatoria mínima(AU)

Purpose: To describe the surgical technique and to evaluate the clinical results of carrying out transcanalicular dacryocystorhinostomies using a diode laser (DCR-TC), including the advantages and limitationss of this technique. Methods: 43 DCR-TC were studied and they were analysed using a prospective, interventional, non randomized and non comparative study. We used local and topical anaesthesia in patients with a clinical history of epiphora or dacryocystitis for nasolacrimal obstruction. A diode laser was used to effect a vaporization of the lacrimal sac, osteotomy and vaporization with coagulation of nasal mucosa. The mean duration of surgery was 14 minutes (range 7 to 29 minutes). In all cases, and during a two-month period, bicanalicular intubation was carried out using a silicone tube and prolene filament. Follow-up was between 4 to 38 months. The degree of epiphora was evaluated using the Munk scale and lacrimal permeability was evaluated using Jones I and II tests by direct videoendoscopic control in all cases. Results: 43 DCR-TC were realized, 39 cases are asymptomatic (90.7%). 2 of them (4.65%) had epiphora (degree 2 on the Munk scale) and permeable tract. One case (2.32%) presented lower canaliculi obstruction. One patient showed total osteotomy closing. Conclusions: Transcanalicular dacryocystorhinostomy carried out using a diode laser is a useful method because it does not cause cutaneous scarring, it hardly produces pain and bleeding, it respects the lacrimal pump, it needs less surgical time, it can be carried out in an out-patient surgery and it generates minimal intra and postsurgical morbility(AU)