A comparative study between endoscopic and microscopic type 1 tympanoplasty

<p><strong>Background:</strong> The current study aims to compare type 1 microscopic tympanoplasty and endoscopic tympanoplasty and draws an evidence-based conclusion regarding the outcome.</p><p><strong>Methods:</strong> This randomized controlled clinical study consists of 60 patients, in which 30 cases allocated as group 1 underwent endoscopic myringoplasty, and 30 cases allocated as group 2 underwent conventional myringoplasty. Tympanic membrane (TM), pure tone audiometry (PTA) evaluated preoperatively and at 3 months postoperative follow-up.</p><p><strong>Results:</strong> Demographic distribution between the groups does not show a significant difference (χ2=6.67, p=0.16). There was no significant difference observed between TM perforation size between the groups (χ2=2.32, p=0.51). For the preoperative AB gap in group 1, the mean ABG was 28.20±2.67 and in group 2 was 28.20±0.80. The postoperative AB gap in group 1, the mean ABG was 17.40±3.01, and in group 2, the mean ABG was 19.67±2.93. The mean difference is 9.13, and it shows a statistically significant difference (p=0.001). The mean duration of surgery in group 1 was 130.83±34.84 and in group 2 was 168.33±16.88 min (p=0.001). In both groups, 90% have intact graft, and in 10% of patients’ residual perforation is present. The mean duration of hospitalization in group1 is 4.10±0.09 days and in group 2 is 4.97±0.18 days.</p><p><strong>Conclusions:</strong> By using the endoscopic addition, minimal invasive tympanoplasty can made possible the similar graft success rate with minimal pain. Endoscopic tympanoplasty uses very less operative time than microscopic surgery.</p><p> </p>

Combined underwater endoscopic and microscopic surgery for external auditory canal cholesteatoma: A case report

Transcanal endoscopic ear surgery is a minimally invasive procedure that allows a clear visualization of the middle ear. Recently, indications for endoscopic surgery have been expanding. We performed combined underwater endoscopic and microscopic surgery for external auditory canal cholesteatoma, the computer tomography of which indicates the possibility of cholesteatoma not only in the canal wall but also in the mastoid. The 30° endoscope and underwater technique makes the surgical view clear, and we could remove the cholesteatoma without canalplasty. To the best of our knowledge, no case of external auditory canal cholesteatoma treated with underwater endoscopic and microscopic surgery has been previously reported. This case indicates that the procedure could be a good indication for external auditory canal cholesteatoma.

Combined Exoscopic and Endoscopic Technique for Craniofacial Resection

We determined the feasibility of the combined exoscopic-endoscopic technique (CEE) as an alternative to the microscope in craniofacial resection (CFR). This retrospective study was conducted at a single institution and included eight consecutive patients with head and neck tumors who underwent CFR between September 2019 and July 2021. During the transcranial approach, microsurgery was performed using an exoscope in the same manner as in traditional microscopic surgery, and an endoscope was used at the blind spot of the exoscope. The exoscope provided images of sufficient quality to perform microsurgery, while the sphenoid sinus lumen was the blind spot of the exoscope during anterior (n = 3) and anterolateral CFR (n = 2), and the medial aspect of the temporal bone was the blind spot of the exoscope during temporal bone resection (n = 2). These blind spots were visualized by the endoscope to facilitate accurate transection of the skull base. The advantages of the exoscope and endoscope include compact size, ergonomics, surgical field accessibility, and equal visual experience for neurosurgeons and head and neck surgeons, which enabled simultaneous transcranial and transfacial surgical procedures. All the surgeries were successful without any relevant complications. CEE is effective in transcranial skull base surgery, especially CFR involving simultaneous surgical procedures.

Transsphenoidal Endoscopic versus Microscopic Approach in Treatment of Pituitary Adenomas: CSF Leak and GTR Systematic review

Background Pituitary adenomas (PAs) are the second most common brain tumors, 10% to 20% of all primary brain tumors. Transsphenoidal approach is now the gold standard for treatment of PAs either microscopic or endoscopic. Aim of the Work to analyze the collective outcomes from studies comparing the microscopic transsphenoidal surgery (MTS) with the endoscopic transsphenoidal surgery (ETS) regarding gross total resection (GTR) and postoperative cerebrospinal fluid (CSF) leak. Patients and Methods we searched PubMed, Google scholar search engine, Cochrane database of systematic reviews, EMBASE and science Direct, using the following keywords “Pituitary adenoma/tumor, endoscopy or endoscopic, microscopy or microscopic, gross total/subtotal/near total/radicular resection/excision, hypophysectomy, debulking, CSF leak/leakage ". The mentioned databases were searched for studies published during period from the 1st of Jan 2015 to 31 Aug. 2020. Results Total number of patients in included studies was 1211 of which 621 (51.3%) underwent endoscopic surgery and 590 (48.7%) underwent microscopic surgery. Of 990 patient analysed for GTR, it was achieved in 334 patients (69.4%) in endoscopic group compared with 287 patients (56.4%) in microscopic group. Of 1211 patients, Postoperative CSF leak developed in 30 patients (5.7%) compared with 32 patients (4.7%) in endoscopic and microscopic group respectively. Conclusion GTR was found to be slightly higher in the endoscopic group especially in cases of suprasellar and lateral cavernous extensions. CSF leak showed no significant difference between the two groups.

SP1.1.15Long-term Outcomes of Open Verses Closed Rectal Defect After Transanal Endoscopic Microscopic Surgery

Aims Management of rectal defect after TEMS is a matter of debate. Data are lacking on the effect of these techniques on long term outcomes and continence of patients. We sought to analyse these in our patient cohort. Methods Patients who underwent TEMS between 2012 and 2019 were examined retrospectively from a prospectively maintained database. These were divided into two groups – open and closed rectal defect. Patient demographics were recorded and outcomes assessed including oncological staging, morbidity, mortality, length of stay and FISI scores. Results 170 matched patients were included, with 70 patients in the open and 100 in the closed rectal defect group. Short-term complications were 18.8% with no significant difference between the two groups. Most of the defects were well healed upon endoscopic follow-up; more unhealed/sinus formation was noticed in the open group (p = 0.01); more strictures were encountered in the closed group (p = 0.04). Overall, there was a significant difference in pre and post TEMS FISI scores in all three groups (p &lt; 0.00001, p &lt; 0.00001, p = 0.02). Comparing the open and closed defect groups, there was no difference in the functional outcome of patients in those who developed sinus or stricture but a significant difference in those with healed scar, with those in closed rectal defect group with worsening function (p = 0.02) Conclusion Both the approaches of rectal defect management are associated with pros and cons. Long term complications should be expected and actively followed up for. Patients should be thoroughly counselled about these and possible deterioration in continence post-TEMS

A study to compare the outcomes of CO2 laser assisted myringoplasty versus conventional type1 tympanoplasty in small central tympanic perforations

<p class="abstract"><strong>Background:</strong> The standard treatment of tympanic membrane perforation is conventional surgical closure using myringoplasty or a tympanoplasty type 1. In this study the role of cabon dioxide (CO₂)-laser-assisted de-epitheliazation of perforation margins and application of bioinert silastic sheet. Success rate was compared with conventional microscopic surgery.</p><p class="abstract"><strong>Methods:</strong> This was a comparative study containing 60 patients with small dry tympanic membrane perforation (diameter 1-3 mm). The causes of tympanic membrane perforations were mainly traumatic or the eardrum did not heal after spontaneous perforation caused by an acute otitis media or after surgery. The procedure was performed under local anaesthesia. CO₂ (acupulse) applied along the edge of the perforation until complete de-epitheliazation and application of bioinert silastic sheet in small dry perforation. Closure of eardrum perforation was monitored using an otoendoscope. Success rate of the CO₂ laser myringoplasty was compared with conventional type 1 tympanoplasty. </p><p class="abstract"><strong>Results:</strong> Complete eardrum closure occurred in 24 cases (80%), 06 patients (20%) had a residual perforation. The success rate of this procedure is lower than conventional type 1 tympanoplasty, which is 90-94%. There were no complications during and after the treatment.</p><p class="abstract"><strong>Conclusions:</strong> A closure rate of 80% (24/30) was achieved with a CO₂-laser-assisted de-epitheliazation. This procedure can be offered carefully to selected cases with perforation size &lt;3 mm, where the CO₂ facility is available before they undergo formal conventional microscopic surgery.</p><p class="abstract"> </p>

Melanocytic Nevus in the External Auditory Canal with Keratin Accumulation

Nevus is a benign melanocytic neoplasm and the most common type of skin tumor. It may occur anywhere on the skin, but it is rare in the external auditory canal (EAC). We present a case of melanocytic nevus in the EAC with keratin accumulation. In microscopic surgery, the mass was excised completely, and the wax and keratin material medial portion of the EAC behind the mass was removed. In this patient, a melanocytic nevus in the EAC caused symptoms of hearing loss and wax and keratin buildup. For melanocytic nevus in the EAC, excision and pathologic confirmation should be performed if there are symptoms or when malignant transformation is suspected.