The ‘Maxillary Pull-through’ Technique: A Minimally Invasive Endoscopic-Assisted Approach to Nasal Septum Neoformations with Maxillary Bone Infiltration

Objective En-bloc maxillectomy with removal of the nasal septum is a rare procedure; preservation of the nasal bones and integrity of the alveolar ridge is even rarer. These procedures traditionally required a combined transfacial-transoral approach based on lateral rhinotomy. We describe a combined endoscopic transnasal-transoral approach for treatment of nasal septal malignancies that involve the hard palate. Study Design Description and validation of a surgical technique. Methods Excision of malignant tumours arising from the nasal septum was achieved in 4 patients using a transnasal-transoral endoscopic approach. Using 4-mm optics angled at 0° and 30°, the septum was freed from the ethmoid and removed en-bloc with the hard palate, by pulling the septum down through the hard palate. Results Of the 4 patients, 2 underwent complete removal of septal chondrosarcomas, one removal of a sinonasal undifferentiated carcinoma and one removal of a mucoepidermoid carcinoma. In two cases, the palatal mucosa was spared and repositioned to restore separation between the nose and oral cavity. The remaining two cases underwent complete resection of the hard palate; one palate was reconstructed using a pedicled temporalis muscle flap and the other by employing an obturator. No infection was encountered. Partial ethmoidectomy was performed in all four cases. The mean hospital stay was 5 days. All patients are free of disease after a mean follow-up of 4 years (range: 2–7 years). Conclusions Our new approach allows for minimally invasive resection of nasal septal malignancies that extend to the palate. Our maxillary pull-through technique is a valuable new surgical procedure for malignant pathologies of the nasal septum; the only drawback is that endoscopic surgery has a steep learning curve.

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Invasive Inverted Papilloma during Pregnancy: A Therapeutic Dilemma

American Journal of Rhinology ◽

10.2500/105065892781874630 ◽

1992 ◽

Vol 6 (4) ◽

pp. 133-134

Author(s):

John T. Lanza ◽

Gady Har-El ◽

Frank E. Lucente

Keyword(s):

Malignant Transformation ◽

Nasal Septum ◽

Hard Palate ◽

En Bloc Resection ◽

Bloc Resection ◽

Inverted Papilloma ◽

Lateral Nasal Wall ◽

En Bloc ◽

Nasal Tumor

Inverted papilloma (IP) is histologically classified as a benign nasal tumor. However, its aggressive local invasive character can lead to devastating morbidity, with a 10 to 20% rate of malignant transformation. Because of its proclivity for the lateral nasal wall, it is routinely treated with en-bloc resection. IP involving the palate is rare. We describe a case of IP without coexistent carcinoma completely eroding the hard palate, nasal septum, and bilateral nasal walls, in a 23-year-old woman in her seventh month of pregnancy.

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Role of extracorporeal life support in thoracic surgery

Perspectives in Surgery ◽

10.33699/pis.2020.99.10.420-426 ◽

2020 ◽

Vol 99 (10) ◽

Keyword(s):

Thoracic Surgery ◽

Extracorporeal Circulation ◽

Life Support ◽

Close Contact ◽

Extracorporeal Life Support ◽

Tumour Resection ◽

R0 Resection ◽

Malignant Tumours ◽

En Bloc ◽

Frequent Use

Besides the conventional extracorporeal circulation, commonly used in cardiac surgery, the methods of extracorporeal life support (ECLS) have been applied ever more frequently in thoracic surgery in recent years. The most commonly used modalities of such supports include extracorporeal membrane oxygenation (ECMO) and the Novalung interventional lung assist device (iLA). Successful application of ECLS has led to its more frequent use in general thoracic surgery, especially as a tool to treat hypercapnia and to ensure oxygenation and haemodynamic support. However, these methods are essential in lung transplant programmes; without their help, in most cases, it would not be possible to perform the transplantatioz or prevent the severe complications associated with critical primary graft dysfunction. Additionally, the extracorporeal circulation also facilitates the performing of specific surgical procedures that would not be feasible under standard conditions or would be associated with an inadequate risk. The application of extracorporeal life supports can fundamentally increase the level of resection when treating advanced intrathoracic malignancies that are in close contact with the heart and large vessels or even directly extend into them. Without the possibility of resecting such structures en bloc, together with the tumour, and, thus, achieving an R0 resection, these malignant tumours are often directly contraindicated for surgery or are operated non-radically, i.e. unsuccessfully. Complete tumour resection is the most important prognostic factor in the surgery.

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Future Interventional Oncology Catheter-Based Therapies

Digestive Disease Interventions ◽

10.1055/s-0037-1607964 ◽

2017 ◽

Vol 01 (03) ◽

pp. 225-232

Author(s):

Christopher Noda ◽

Mihail Roubhaka ◽

Resmi Charalel ◽

Abdulrahman Masrani ◽

Olaguoke Akinwande

Keyword(s):

Minimally Invasive ◽

Interventional Oncology ◽

Complete Removal ◽

Systemic Delivery ◽

Delivery Method ◽

Viral Therapy ◽

Attractive Option ◽

Rapid Pace ◽

Invasive Techniques ◽

All Diseases

AbstractMinimally invasive techniques in the treatment of cancer continue to develop at a rapid pace. Although surgical resection currently remains the only option for a complete cure, not all diseases are amenable to complete removal. This leaves opportunities to develop effective downstaging techniques as well as palliative care. In the realm of minimally invasive oncologic techniques, catheter-based therapies are an attractive option because malignancies require a blood supply to remain active. The intra-arterial (IA) delivery of specific tumoricidal drugs has been shown to be a successful delivery method in a variety of different cancers, and it is currently a progressive area of research. There is work both to increase the delivery specificity of oncologic drugs, including SW43 sigma receptor ligand and nanoparticle research. In addition, oncolytic viral therapy and 3-bromopyruvate have become increasingly more attractive tumoricidal drug prospects. In the future, the success of these therapies will ultimately determine the degree to which IA delivery will compete with the systemic delivery of drugs in the treatment of cancer.

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Surgery for Craniovertebral Junction Pathologies: Minimally Invasive Anterior Submandibular Retropharyngeal Key-Hole Approach

10.21203/rs.3.rs-112566/v1 ◽

2020 ◽

Author(s):

Árpád Viola ◽

István Kozma ◽

Dávid Süvegh

Keyword(s):

Minimally Invasive ◽

Wound Dehiscence ◽

Craniovertebral Junction ◽

Transoral Approach ◽

Velopharyngeal Insufficiency ◽

Safe Alternative ◽

Decompressive Laminectomy ◽

Neurological Improvement ◽

Second Stage ◽

Minimally Invasive Surgical

Abstract BackgroundOur objective was to develop a new, minimally invasive surgical technique for the resolution of craniovertebral junction pathologies, which can eliminate the complications of the previous methods, like liquor-leakage, velopharyngeal insufficiency and wound-dehiscence associated with the transoral or lateral approaches.MethodsDuring the first stage of the operation, three patients underwent occipito-cervical dorsal fusion, while the fourth patient received C1-C2 fusion according to Harms. C1-C2 decompressive laminectomy was performed in all four cases. Ventral C1-C2 decompression with microscope assisted minimally invasive anterior submandibular retropharyngeal key-hole approach (MIS ASR) method was performed in the second stage. The MIS ASR similarly to the traditional anterior retropharyngeal surgery – preserves the hard and soft palates, yet can be performed through a 25 mm wide incision with the use of only one retractor.ResultsThe MIS ASR approach was a success in all four cases, there were no intra- and postoperative complications. This method, compared to the transoral approach, provided on average 23% (4.56 cm2 / 6.05 cm2) smaller dural decompression area; nonetheless, the entire pathology could be removed in all cases. After the surgery, all patients have shown significant neurological improvement.ConclusionBased on the outcome of these four cases we think that the MIS ASR approach is a safe alternative to the traditional methods while improving patient safety by reducing the risks of complications.

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Undifferentiated Carcinoma After Laparoscopic Surgery for a Cystic Ovarian Tumour: A Case Study

Cancer Diagnosis & Prognosis ◽

10.21873/cdp.10067 ◽

2021 ◽

Vol 1 (5) ◽

pp. 499-505

Author(s):

KOSUKE SHIGEMATSU ◽

KOKI SAMEJIMA ◽

KEISUKE SAWADA ◽

TAKAHIRO UOTANI ◽

TAICHI AKAHORI ◽

...

Keyword(s):

Laparoscopic Surgery ◽

Relevant Literature ◽

Insertion Site ◽

Undifferentiated Carcinoma ◽

Ovarian Tumour ◽

Port Site ◽

Histopathological Diagnosis ◽

Malignant Tumours ◽

Tumour Metastasis ◽

Initial Surgery

Background: Laparoscopic surgery for malignant tumours occasionally results in recurrence at the trocar insertion site or port-site metastasis (PSM). We report on a patient requiring emergency laparoscopic surgery for an ovarian tumour with a review of the relevant literature. Case Report: A 42-year-old woman developed sudden abdominal pain and underwent laparoscopic right adnexectomy because of a suspected ovarian cystic tumour rupture. The postoperative histological diagnosis was a mucinous borderline ovarian tumour; however, an undifferentiated carcinoma was detected at the port site eight months after the initial surgery. The histopathological diagnosis of the abdominal wall tumour at the port site differed from intraoperative pathological findings, which was contradictory to PSM definition. Postoperatively, she received three systemic chemotherapy courses but died consequent to tumour metastasis. Conclusion: This is an atypical PSM case with histopathological differences from the initial tumour. Careful preoperative diagnosis and intraoperative attention are essential in such cases.

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How I do it: minimally invasive resection of a sub-ependymoma of the fourth ventricle

Acta Neurochirurgica ◽

10.1007/s00701-020-04601-5 ◽

2020 ◽

Author(s):

Marco V. Corniola ◽

Torstein R. Meling

Keyword(s):

Minimally Invasive ◽

Surgical Management ◽

Fourth Ventricle ◽

En Bloc Resection ◽

Bloc Resection ◽

Midline Incision ◽

En Bloc

Abstract Background A 54-year-old female was referred to our clinic with a lesion of the lower fourth ventricle extending to the median aperture. Here, we report the use a minimally invasive sub-occipital approach (MISA) as a safe and effective surgical management. Method We performed a MISA using a short midline incision and a 1-cm sub-occipital craniectomy. Dissection of the lesion was performed, and “en bloc” resection could be achieved. The lesion was confirmed to be a grade I sub-ependymoma. Conclusion MISA can be safely used when confronted to a lesion of the lower fourth ventricle.

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