Dual-Port 2D and 3D Endoscopy: Expanding the Limits of the Endonasal Approaches to Midline Skull Base Lesions with Lateral Extension

Objective To investigate a novel dual-port endonasal and subtemporal endoscopic approach targeting midline lesions with lateral extension beyond the intracavernous carotid artery anteriorly and the Dorello canal posteriorly. Methods Ten dual-port approaches were performed on five cadaveric heads. All specimens underwent an endoscopic endonasal approach from the sella to middle clivus. The endonasal port was combined with an anterior or posterior endoscopic extradural subtemporal approach. The anterior subtemporal port was placed directly above the middle third of the zygomatic arch, and the posterior port was placed at its posterior root. The extradural space was explored using two-dimensional and three-dimensional endoscopes. Results The anterior subtemporal port complemented the endonasal port with direct access to the Meckel cave, lateral sphenoid sinus, superior orbital fissure, and lateral and posterosuperior compartments of the cavernous sinus; the posterior subtemporal port enhanced access to the petrous apex. Endoscopic dissection and instrument maneuverability were feasible and performed without difficulty in both the anterior and posterior subtemporal ports. Conclusion The anterior and posterior subtemporal ports enhanced exposure and control of the region lateral to the carotid artery and Dorello canal. Dual-port neuroendoscopy is still minimally invasive yet dramatically increases surgical maneuverability while enhancing visualization and control of anatomical structures.     

经皮肾镜气压弹道碎石术治疗肾结石的护理

经皮肾镜气压弹道碎石术（PCNL）是治疗肾结石的有效手段。手术过程中出血少．结石清除率高，对肾脏影响很小，逐步取代了传统的开放手术，成为肾蛄石的主要治疗方法。2010年1月~2011年6月，我科应用PCNL治疗肾结石52例，效果满意。现将结果报告如下。     

Treatment options for active removal of renal stones

This study provides an update on the technological aspects of the methods for active removal of renal stones. Currently, extracorporeal shock wave lithotripsy (ESWL), ureteroscopy (URS) and percutaneous nephrolithotomy (PCNL) are the available options. Findings are based upon recent literature from the PubMed database and the European Association of Urology (EAU) guidelines. ESWL remains the option of choice for stones with diameter ≤ 20 mm due to its low invasive character, whereas PCNL is the standard for stones with diameter > 20 mm because of its high stone-free rates. Although ESWL treatment has become more patient friendly, its efficacy has not improved. On the other hand, URS has gained renewed interest due to new technological developments and improved treatment methods.     

Retroperitoneoscopic uretero-cutanostomy — our method of creating a pneumoretroperitoneum

Summary

Retroperitoneoscopic procedures were already being performed in the late 1970s. The clinical breakthrough of retroperitoneoscopy, however, came in 1992 with the balloon-dissecting technique of Gaur, facilitated by the experience gained with transperitoneal laparoscopic procedures in the upper retroperitoneum. A 60 year old woman with infiltrative bladder cancer and right-sided obstructive uropathy was a high risk patient for an open surgical operation. Until now, our retroperitoneoscopic procedures were usually performed by hydraulic video-optically controlled balloon dissection. With this patient, for the first time we created a pneumoretroperitoneum using an optical trocar-Visiport. In this way we entered the retroperitoneum by visualising all layers of the abdominal wall. Once inside the retroperitoneum we created a work space by blunt and sharp dissection under optical control, avoiding blood vessels. The ureter, which was dilated by infiltrative bladder carcinoma, was easily identified, clipped and transected. The proximal end of the ureter was pulled out through the skin incision for the first trocar. The ureter was spatulated and stented, and ureterocutanostomy was performed in the same way as in open surgery.     

鼻内镜下低温等离子消融术治疗肥厚性鼻炎临床分析

目的探讨对于肥厚性鼻炎患者采用鼻内镜下低温等离子消融术进行治疗的临床疗效。方法随机将256例肥厚性鼻炎患者分为对照组128例与治疗组128例。对照组采用传统下鼻甲部分切除手术,治疗组采用鼻内镜下低温等离子消融术。对2组疗效进行对比分析。结果治疗组有效率显著优于对照组,术后并发症发生情况显著低于对照组,P<0.05,差异具有统计学意义。结论采用鼻内镜下低温等离子消融术治疗肥厚性鼻炎,能显著提高疗效、微创、痛苦较小、术后恢复快及并发症少,有重要临床意义。     

耳内镜下自体腹壁脂肪修复中央性鼓膜穿孔的临床探讨

目的探讨耳内镜下腹壁脂肪修补中央性鼓膜穿孑L的临床效果。方法回顾性分析64例（68耳）中央性鼓膜穿孔的病例资料，均于耳内镜下行腹壁脂肪修补术，术后随访3—6个月，术后6个月复查纯音测听，观察术后疗效。结果鼓膜一次性愈合63耳；鼓膜部分愈合4耳，予新鲜鸡蛋膜外贴修补后愈合；1耳未愈；一次性治愈率为92．6％（63／68）。结论耳内镜视野清晰，使用简单方便；耳内镜下腹壁脂肪修补中央性鼓膜穿孔临床效果显著，值得在基层医院推广应用。