Principle and history of Natural Orifice Translumenal Endoscopic Surgery (NOTES)

The field of gastrointestinal endoscopy has been witnessing major advances over the last five decades. Developing from flexible endoscopy to endoscopic retrograde cholangiopancreatography (ERCP) in the 1950's and 70's to endoscopic ultrasound in the 80's, endoscopic technology has been transformed from serving purely diagnostic purposes to therapeutic applications. One recent major advance is the notion of using the flexible endoscope, taking it beyond the gastrointestinal lumen into what lies beyond the confines of the gastrointestinal tract. Natural orifice translumenal surgery offers the exciting potential to be safer, less invasive and possibly more cost‐effective than the traditional open surgical or laparoscopic approach. The history and principles of natural orifice translumenal endoscopic surgery (NOTES), along with future implications, are outlined in this article.     

Natural Orifice Transluminal Endoscopic Surgery (NOTES)

Abstract

This study aimed to assess the feasibility and long-term outcome of laparoscopic total mesorectal excision for middle and lower rectal cancer. Retrospective assessment was performed on 612 patients with middle and low rectal cancer in the surgery department of our hospital. Three-hundred and three patients underwent laparoscopic total mesorectal excision (LTME), and 309 patients underwent open TME (OTME). All the data regarding patient details, operative variables and the short- and long-term outcomes were collected and compared. The sphincter-preserving rates of the two groups were similar. The conversion rate in LTME was 2.31% (seven cases). Fourteen cases (6.67%) of protective diverting stoma were fashioned in the LTME group compared with 57 cases (26.64%) in the OTME group. The postoperative morbidity was the same in these two groups, while the postoperative period until bowel movement and hospital discharge was shorter in the LTME group (P < 0.01). The median follow-up period was 34 (6–81) months for the LTME group and 36 (6–81) months for the OTME group. Local recurrence rates, the five-year disease-free survival rate and the five-year overall survival rate showed no difference between the two groups. Laparoscopic surgery is feasible and safe in patients with middle and lower rectal caner and can provide favorable short-term and long-term outcomes.     

Development of advanced endoscopes for Natural Orifice Transluminal Endoscopic Surgery (NOTES)

Natural orifice transluminal endoscopic surgery (NOTES) is a hybrid procedure which uses flexible endoscopic technology to perform laparoscopic surgical procedures within the abdominal cavity. Initial reports of animal studies describe the use of standard endoluminal endoscopes to accomplish intra‐abdominal surgeries. Current flexible scopes suffer from several deficiencies which make them unlikely to be able to be used for large scale human NOTES experiences. This review analyzes the deficiencies of current endoscopes, discuses the requirements of the ideal NOTES endoscope and reviews some of the possible “endoscopes of the future” that are being developed for the next generation of surgery. Discussion focuses on the “R” scope (Olympus, Tokyo, Japan) and the Transport and Cobra scopes (USGI Medical, San Capistrano, CA).     

The history of idiopathic thrombocytopenic purpura (ITP).

Purpura, initially recognized in ancient times, was defined into clinical syndromes in the 16th, 17th and 18th centuries. With advances in microscope science in the nineteenth century, the platelet was identified, leading to the recognition of the thrombocytopenic component of idiopathic thrombocytopenic purpura (ITP). The 20th century brought recognition of the pathophysiology of the disorder and the clinical states were refined and treatments for ITP developed. The latter half of the 20th century has focused on the autoimmune components of ITP, attempting to develop diagnostic tests, apply new therapies, and elucidate the immune dysregulation associated with, and underlying, the disorder.     

Natural history of radiculopathy

Radicular pain is a frequent complaint of patients presenting to outpatient primary care and musculoskeletal clinics. Most cases of radiculopathy are self-limiting, and symptoms resolve over the course of weeks to months. There is spontaneous resolution of disc herniations, and clinical improvement correlates with morphologic resolution. Knowledge of the natural history of radiculopathy is crucial for the health care provider to appropriately counsel and treat patients with this disorder. Although each patient should be managed individually, the favorable prognosis of radiculopathy based on the natural history supports a conservative approach for the initial weeks to months for most patients.     

鼻内镜下手术切除鼻腔鼻窦内翻性乳头状瘤术中情况及复发情况比较研究

目的对鼻腔鼻窦内翻性乳头状瘤患者采用鼻内镜下手术方式切除的术中及复发情况进行探讨。方法选取笔者所在医院2014年5月~2016年5月收治的鼻腔鼻窦内翻性乳头状瘤患者共88例,随机分为鼻侧切开组和鼻内镜组,各组共有44例患者。用传统的鼻翼切开手术切除肿瘤治疗鼻侧切开组患者,用鼻内镜下手术治疗鼻内镜组,对比鼻侧切开组和鼻内镜组的手术时间、手术期间出血量及术后疼痛程度等指标,并进行一年随访,统计两组患者术后的总复发率等指标。结果用两种手术方式均成功切除病患鼻腔鼻窦内翻性乳头状瘤,鼻内镜组患者的手术时间为(85.3±10.8)min,术中出血量为(72.4±30.8)ml,术后疼痛VAS评分(3.5±1.1)分,与鼻侧切开组相比,P0.05。在手术后一年对两组患者进行随访,采用鼻侧切开手术治疗的患者共有30例被治愈,治愈率为68.1%,采用鼻内镜手术治疗的患者共有39例被治愈,治愈率达88.6%,达到11.3%复发率,对比两组的总复发率,差异有统计学意义(P0.05)。结论使用鼻内镜下手术切除鼻腔鼻窦内翻性乳头状瘤,手术操作精准,能够避免切开患者面部,伤口面积小,较低的复发率,预后效果显著。因此应当推广使用鼻内镜下手术治疗鼻腔鼻窦内翻性乳头状瘤。     

Endoscopic CO(2)-Laser Surgery for Vocal Cord Cancer

A retrospective study is reported on endoscopic CO(2)-laser microsurgery in 69 patients with histologically verified early vocal cord cancer. A flexible nasopharyngolaryngoscope (STORZ Co) was used for preoperative assessment and occasionally for postoperative follow-up.Six years of experience with this technique have led to endoscopic cordectomy, previously not accepted as a therapeutic method alone, but which has become the favored method with use of the CO(2) laser endoscopically. Laser surgery as a therapeutic endoscopic procedure provided successful treatment of early vocal cord cancer in 59 (86%) of the 69 patients. The initial success rate together with "salvage" treatment modalities reached 96% (66/69 patients).Endoscopic laser surgery resulted in a decrease in voice intensity and phonatory duration from near normal to mildly abnormal. Voice preservation succeeded in 97% of all patients. Thus, the data demonstrate that endoscopic laser surgery is a useful modem method of therapeutic endoscopy for early vocal cord carcinoma.     

Natural history of melanocytic nevi

The natural history of common acquired nevi begins with junctional nevi, which first evolve into compound nevi and then intradermal nevi. The clinical appearance and histopathology of these lesions permit precise identification. Spitz nevi, blue nevi, congenital nevi and dysplastic nevi represent subcategories that also have easily identifiable features. An understanding of the nature of benign nevi makes it easier to identify potentially life-threatening melanomas.     

Natural history of venous thromboembolism

Venous thromboembolism (VTE) originates in systemic venous thrombosis and has different etiological mechanisms and natural history from arterial thrombosis. VTE typically originates as deep venous thrombosis in a lower extremity, where it may give rise to acute symptoms “upstream” from the obstructed vein, result in pulmonary embolism, and/or cause chronic venous obstruction. Pulmonary embolism may result in acute respiratory symptoms, cardiovascular collapse and, uncommonly, may also cause chronic disease.     

Natural history of diabetic gastroparesis

OBJECTIVE: The major aim of this study was to evaluate the prognosis of diabetic gastroparesis. RESEARCH DESIGN AND METHODS: Between 1984 and 1989, 86 outpatients with diabetes (66 type 1, 20 type 2; 40 male, 46 female) underwent assessment of solid and liquid gastric emptying and esophageal transit (by scintigraphy), gastrointestinal symptoms (by questionnaire), autonomic nerve function (by cardiovascular reflex tests), and glycemic control (by HbAlc and blood glucose concentrations during gastric emptying measurement). These patients were followed up in 1998. RESULTS: Of the 86 patients, solid gastric emptying (percentage of retention at 100 min) was delayed in 48 (56%) patients and liquid emptying (50% emptying time) was delayed in 24 (28%) patients. At follow-up in 1998, 62 patients were known to be alive, 21 had died, and 3 were lost to follow-up. In the group who had died, duration of diabetes (P = 0.048), score for autonomic neuropathy (P = 0.046), and esophageal transit (P = 0.032) were greater than in those patients who were alive, but there were no differences in gastric emptying between the two groups. Of the 83 patients who could be followed up, 32 of the 45 patients (71%) with delayed solid emptying and 18 of the 24 patients (75%) with delay in liquid emptying were alive. After adjustment for the effects of other factors that showed a relationship with the risk of dying, there was no significant relationship between either gastric emptying or esophageal transit and death. CONCLUSIONS: In this relatively large cohort of outpatients with diabetes, there was no evidence that gastroparesis was associated with a poor prognosis.     

孤立性蝶窦病变的内镜手术治疗

【目的】探讨孤立性蝶窦病变的内镜下治疗方法及疗效。【方法】回顾分析2005年1月至2008年12月30例孤立性蝶窦病变患者的临床资料。内镜手术采用方式为鼻内镜下经鼻腔和筛窦入路蝶窦开放术。【结果】所有病例均顺利完成手术,均未发生严重并发症。随访半年到1年,蝶窦炎、蝶窦脓肿、蝶窦囊肿、真菌性蝶窦炎、蝶窦息肉等27例病人均无复发。其余3例蝶窦恶性肿瘤病人术中只行活检,未完整切除肿块。【结论】对孤立性蝶窦病变根据病变性质、鼻腔情况及术野要求采用不同的鼻内镜术式是可取的。