Anoderm-preserving, completely closed hemorrhoidectomy with no mucosal incision

Abstract Background and study aims The pocket-creation method (PCM) facilitates dissection of the central part of a tumor. We previously developed the PCM with clip traction (PCM-CT) to facilitate opening the mucosal pocket, which otherwise could become cumbersome. In the present study, we aimed to examine the feasibility of PCM-CT for colorectal endoscopic submucosal dissection (ESD). Patients and methods PCM-CT was performed on 30 patients with early colorectal tumors from October 2019 to April 2020. PCM-CT allows efficient opening of the mucosal pocket by using the PCM to dissect the center of the lesion and then apply traction with a single clip after making a circumferential mucosal incision. Results The median specimen major axis length, ESD time, ESD speed, and en bloc resection rate were 48 mm, 84 minutes, 20 mm2/min, and 100 % (30/30), respectively. The success rates for the traction clip and median single-clip-traction time were 100 % (30/30) and 1.5 minutes, respectively. Conclusions Colorectal ESD using PCM-CT is a simple and promising method.

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Long-term follow-up of closed hemorrhoidectomy

Diseases of the Colon & Rectum ◽

10.1007/bf02554754 ◽

1983 ◽

Vol 26 (12) ◽

pp. 797-799 ◽

Cited By ~ 45

Author(s):

John C. McConnell ◽

Indru T. Khubchandani

Keyword(s):

Long Term Follow Up ◽

Closed Hemorrhoidectomy

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Successful endoscopic mucosal incision and enucleation of an implanted press‐through package sheet in the esophageal wall

Digestive Endoscopy ◽

10.1111/den.14184 ◽

2021 ◽

Author(s):

Tomoaki Suga ◽

Takaya Oguchi ◽

Kiyotomi Maruyama

Keyword(s):

Esophageal Wall ◽

Mucosal Incision

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Novel method for the management of stenosis after gastric endoscopic submucosal dissection: Mucosal incision with steroid injection contralateral to the severely contracted scar

Digestive Endoscopy ◽

10.1111/den.12400 ◽

2014 ◽

Vol 27 (5) ◽

pp. 622-626 ◽

Cited By ~ 6

Author(s):

Hirohito Mori ◽

Hideki Kobara ◽

Kazi Rafiq ◽

Noriko Nishiyama ◽

Shintaro Fujihara ◽

...

Keyword(s):

Endoscopic Submucosal Dissection ◽

Steroid Injection ◽

Submucosal Dissection ◽

Mucosal Incision ◽

Novel Method

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The Rostral Mucosa: The Door to Open and Close for Targeted Endoscopic Endonasal Approaches to the Clivus

Operative Neurosurgery ◽

10.1093/ons/opab141 ◽

2021 ◽

Author(s):

Paolo di Russo ◽

Arianna Fava ◽

Lorenzo Giammattei ◽

Thibault Passeri ◽

Atsushi Okano ◽

...

Keyword(s):

Minimally Invasive ◽

Tumor Resection ◽

Skin Incision ◽

Reconstruction Technique ◽

Endoscopic Endonasal ◽

Invasive Approach ◽

Mucosal Incision ◽

Reconstruction Strategy ◽

Further Development ◽

Targeted Approach

Abstract BACKGROUND Extended endoscopic endonasal approaches (EEAs) have progressively widened the armamentarium of skull base surgeons. In order to reduce approach-related morbidity of EEAs and closure techniques, the development of alternative strategies that minimize the resection of normal tissue and alleviate the use of naso-septal flap (NSF) is needed. We report on a novel targeted approach to the clivus, with incision and closure of the mucosa of the rostrum, as the initial and final step of the approach. OBJECTIVE To present an alternative minimally invasive approach and reconstruction technique for selected clival chordomas. METHODS Three cases of clival chordomas illustrating this technique are provided, together with an operative video. RESULTS The mucosa of the rostrum is incised and elevated from the underlying bone, as first step of surgery. Following tumor resection with angled scope and instruments, the mucosa of the sphenoid sinus (SS) is removed and the tumor cavity and SS are filled with abdominal fat. The mucosal incision of the rostrum is then sutured. A hangman knot is prepared outside the nasal cavity and tightened after the first stitch and a running suture is performed. CONCLUSION We propose, in this preliminary report, a new targeted approach and reconstruction strategy, applying to EEAs the classic concept of skin incision and closure for transcranial approaches. With further development in the instrumentations and visualization tools, this technique may become a valuable minimally invasive endonasal approach for selected lesions.

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Efficacy of precutting endoscopic mucosal resection with full or partial circumferential incision using a snare tip for difficult colorectal lesions

Endoscopy ◽

10.1055/a-0956-6879 ◽

2019 ◽

Vol 51 (09) ◽

pp. 871-876 ◽

Cited By ~ 4

Author(s):

Naohisa Yoshida ◽

Ken Inoue ◽

Osamu Dohi ◽

Ritsu Yasuda ◽

Ryohei Hirose ◽

...

Keyword(s):

Endoscopic Mucosal Resection ◽

En Bloc Resection ◽

Bloc Resection ◽

Complete Resection ◽

Benign Lesions ◽

Resection Rate ◽

En Bloc ◽

Mucosal Resection ◽

Therapeutic Outcomes ◽

Mucosal Incision

Abstract Background We analyzed the efficacy of precutting endoscopic mucosal resection (EMR), which is a method of making a full or partial circumferential mucosal incision around a tumor with a snare tip for en bloc resection. Methods We reviewed cases from 2011 to 2018 in which precutting EMR (n = 167) and standard EMR (n = 557) were performed for lesions of 10 – 30 mm. Precutting EMR was indicated for benign lesions of 20 – 30 mm or lesions of < 20 mm for which standard EMR was difficult. Through propensity score matching of the two groups, the therapeutic outcomes for 35 lesions of ≥ 20 mm and 98 lesions of < 20 mm in each group were analyzed. Results In the two sizes of lesion, there were significant differences between the precutting and standard groups in the en bloc resection rate (≥ 20 mm 88.6 % vs. 48.5 %, P < 0.001; < 20 mm 98.0 % vs. 85.7 %, P = 0.004) and the histological complete resection rate (≥ 20 mm 71.4 % vs. 42.9 %, P = 0.02; < 20 mm 87.8 % vs. 67.3 %, P < 0.001). Conclusion Precutting EMR enabled high en bloc resection rates in cases involving difficult lesions.

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Feasibility and safety of third-space endoscopic full-thickness resection in ex vivo and in vivo porcine models

Endoscopy International Open ◽

10.1055/a-0858-2210 ◽

2019 ◽

Vol 07 (04) ◽

pp. E471-E476 ◽

Cited By ~ 1

Author(s):

Osamu Goto ◽

Motoki Sasaki ◽

Teppei Akimoto ◽

Atsushi Tatsuguchi ◽

Mitsuru Kaise ◽

...

Keyword(s):

Ex Vivo ◽

Third Space ◽

R0 Resection ◽

Full Thickness ◽

Entry Site ◽

Submucosal Tunnel ◽

Endoscopic Full Thickness Resection ◽

Mucosal Incision ◽

Technical Issues

Abstract Background and study aims Endoscopic full-thickness resection (EFTR) involves several technical issues that need to be addressed. We devised a novel technique termed third-space EFTR and investigated its feasibility and safety in animal models. Methods Third-space EFTR was performed in three isolated porcine stomachs (ex vivo) and four live pigs (in vivo, 1-week survival). The technique involved a circumferential mucosal incision, submucosal tunnelling on the proximal side, endoscopic suturing of the surrounding mucosa, a circumferential seromuscular incision in the submucosal tunnel, transoral retrieval and entry site closure of the tunnel. The technical outcomes were investigated. Results In the ex vivo study, the procedure was successfully completed with R0 resection. In the in vivo study, the procedure was completed in all pigs; however, R0 resection failed in one pig owing to snaring resection. All pigs survived without severe adverse events. Conclusions Our findings indicate that third-space EFTR is feasible and safe. This technique may be useful as a minimally invasive endoscopic option for reliable treatment of small gastric submucosal tumours.

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