scholarly journals Rate-controlled intraventricular endoscopic irrigation via bipolar foot pedal activation: technical note

2020 ◽  
Vol 25 (4) ◽  
pp. 434-438
Author(s):  
Reid Hoshide ◽  
Robert C. Rennert ◽  
Carlos E. Sanchez ◽  
Joel R. Martin ◽  
Vincent J. Cheung ◽  
...  
Keyword(s):  
Irrigation System ◽  
Perioperative Complications ◽  
Tumor Resection ◽  
Technical Note ◽  
Flow Rates ◽  
Irrigation Flow ◽  
Single Operator ◽  
Controlled Irrigation ◽  
Rate Controlled ◽  
Manual Manipulation

Irrigation during intraventricular endoscopic surgery is critical for visualization, with normal intracranial pressure maintained by balancing fluid ingress and egress. Although irrigation is typically achieved through manual manipulation of inexact stopcocks, the authors have developed a rate-controlled, foot pedal–activated system for precise intraventricular irrigation by using a standard irrigating bipolar electrocautery machine.This study is a retrospective review of patients who underwent endoscopic intraventricular surgery between January 1, 2018, and September 25, 2019, in which this irrigation system was used. Important components of this system include a bipolar module irrigation regulator that is set to a desired rate, a secure connection of the bipolar irrigation tubing to the endoscope, and one or more open egress ports on the endoscope for passive fluid drainage. Nineteen consecutive patients were identified on review (average age ± SD, 4.3 ± 4.1 years). Procedures performed included third ventriculostomies (n = 10); arachnoid/choroid cyst fenestrations/resections (n = 3); biopsy/tumor resection (n = 1); and combined procedures (n = 5). Foot pedal–controlled irrigation provided visualization of all intraventricular structures. A single operator was able to control the endoscope, endoscopic instruments, and irrigation, with assistance as indicated for more complex maneuvers. There were no perioperative complications. Because this setup is easily constructed from a standard irrigating bipolar machine, delivers precise irrigation flow rates, and facilitates a single-surgeon bimanual technique, these data support the utility of foot-controlled irrigation for endoscopic intraventricular surgery.

scholarly journals Usefulness of tumor traction with a snare and endoclips in gastric submucosal tumor resection: a propensity-score-matching analysis

2020 ◽  
Author(s):  
Qiang Zhang ◽  
Jian-Qun Cai ◽  
Zhen Wang
Keyword(s):  
Propensity Score ◽  
Propensity Score Matching ◽  
Operative Time ◽  
Perioperative Complications ◽  
Tumor Resection ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Resection Rate ◽  
En Bloc ◽  
Gastric Submucosal Tumors

Abstract Background Endoscopic resection, including endoscopic submucosal dissection (ESD) and endoscopic full-thickness resection (EFR), was used to resect small gastric submucosal tumors (SMTs). Our team explored a method of tumor traction using a snare combined with endoclips to assist in the resection of SMTs. This study aims to explore the safety and effectiveness of the method. Methods This research performed a propensity-score-matching (PSM) analysis to compare ESD/EFR assisted by a snare combined with endoclips (ESD/EFR with snare traction) with conventional ESD/EFR for the resection of gastric SMTs. Comparisons were made between the two groups, including operative time, en bloc resection rate, perioperative complications, and operation-related costs. Results A total of 253 patients with gastric SMTs resected between January 2012 and March 2019 were included in this study. PSM yielded 51 matched pairs. No significant differences were identified between the two groups in perioperative complications or the costs of disposable endoscopic surgical accessories. However, the ESD/EFR-with-snare-traction group had a shorter median operative time (39 vs 60 min, P = 0.005) and lower rate of en bloc resection (88.2% vs 100%, P = 0.027). Conclusions ESD/EFR with snare traction demonstrated a higher efficiency and en bloc resection rate for gastric SMTs, with no increases in perioperative complications and the costs of endoscopic surgical accessories. Therefore, the method seems an appropriate choice for the resection of gastric SMTs.

scholarly journals Performance evaluation and optimization studies of border irrigation system for wheat in the Indian Punjab

Water SA ◽  
2019 ◽  
Vol 45 (1 January) ◽  
Author(s):  
Samanpreet Kaur ◽  
Amina Raheja ◽  
Rajan Aggarwal
Keyword(s):  
Performance Evaluation ◽  
Water Resources ◽  
Irrigation System ◽  
Irrigation Efficiency ◽  
Inflow Rate ◽  
Surface Irrigation ◽  
Row Crops ◽  
Flow Rates ◽  
Irrigation Methods ◽  
Off Time

Surface irrigation methods are the most widely practiced worldwide for irrigation of row crops. The major problem with these methods is low irrigation efficiency, mainly due to poor design. In the Punjab, border irrigation is used to irrigate wheat crops grown over 90% of the cultivated area. The evaluation of existing border systems using a surface irrigation model showed that the irrigation conditions, comprising of inflow rate, border dimensions, and cut-off time, were diverse in tubewell and canal irrigated areas. The study also examined the feasibility of optimizing border dimensions taking into consideration the existing irrigation conditions for achieving more than 60% application efficiency as compared to the 30–40% achieved under present field conditions. In the case of a border length of 60 m, it was recommended to increase border width in the range of 10–45 m and 20–60 m for different flow rates of 10, 20 and 30 L/s in light and medium soils, respectively. For higher flow rates, a border length ranging from 120–150 m was found to be optimum. For a border length of 150 m, it was recommended to keep a border width ranging from 4–38 m and 8–65 m in light soils and medium soils, respectively, for flow rates of 10, 20, 30 and 60 L/s. Optimizing border dimensions is a practical way to achieve efficient and judicious use of water resources.

Endoscopic Transsphenoidal Approach for Resection of Malignant Pituitary Blastoma in an 18-Month-Old Infant: A Technical Note

2014 ◽  
Vol 10 (4) ◽  
pp. 649-653 ◽  
Author(s):  
Malik Zaben ◽  
Mohsin Zafar ◽  
Shafqat Bukhari ◽  
Paul Leach ◽  
Charoline Hayhurst
Keyword(s):  
Malignant Tumor ◽  
Intraoperative Complications ◽  
Tumor Resection ◽  
Cerebrospinal Fluid Leak ◽  
Technical Note ◽  
Transsphenoidal Approach ◽  
Nasoseptal Flap ◽  
Endoscopic Endonasal ◽  
One Year ◽  
Fluid Leak

Abstract BACKGROUND: Sella and suprasellar tumors are increasingly managed via an endoscopic transsphenoidal approach, but infant endoscopic surgery has not been reported. Pituitary blastoma is a rare sellar malignant tumor that primarily occurs in infants and is managed by surgical resection (cytoreduction) followed by adjuvant therapy. OBJECTIVE: To describe the technique and feasibility of resection of a pituitary blastoma via endoscopic endonasal transsphenoidal approach in an 18-month-old infant. METHODS: Endoscopic endonasal transsphenoidal approach for resection of a pituitary malignant tumor in an infant. RESULTS: Near-total tumor resection was achieved. The skull base was reconstructed by using a nasoseptal flap with no cerebrospinal fluid leak or any other intraoperative complications. The postoperative course was uneventful. One-year follow-up showed complete resolution of the tumor. CONCLUSION: The endoscopic endonasal transsphenoidal approach with nasoseptal flap reconstruction could be used as a safe, yet minimally invasive and innovative technique for the resection of pituitary blastoma in infants.

scholarly journals Posterior Approach to Meckel's Cave: Retrosigmoid Craniectomy with Endoscopic Assistance

2019 ◽  
Vol 80 (S 03) ◽  
pp. S331-S332
Author(s):  
Paramita Das ◽  
Hamid Borghei-Razavi ◽  
Nina Z. Moore ◽  
Pablo F. Recinos
Keyword(s):  
Tumor Resection ◽  
Cranial Nerves ◽  
Auditory Brainstem ◽  
Technical Note ◽  
Auditory Brainstem Responses ◽  
Case Review ◽  
Meckel’S Cave ◽  
Meckel's Cave ◽  
Endoscopic Assistance ◽  
Loss Of Hearing

Background Meckel's cave involvement in tumors pose a challenge due to their surrounding neurovascular structure and deep location. Case Review A 24-year-old male presented with progressive headaches and right sided trigeminal neuralgia with a large epidermoid. The tumor extended from the ambient cistern to the cerebellomedullary cistern and involved Meckel's cave (Fig. 1). Technical Note/Video Description A retrosigmoid craniectomy was performed. Cranial nerves 3, 4, 6, 7, and 10, and auditory brainstem responses were monitored. Once the craniectomy was completed the dura was opened and cerebrospinal fluid (CSF) was released from the cisterna magna to allow for the tumor resection to be done without the use of any retractors (Fig. 2). Care was taken to ensure that cranial nerves in the posterior fossa were detethered to prevent any traction injury. Using ring curettes the pearly white epidermoid tumor was able to be debulked. After all the possible tumor was resected with the microscope, the 30-degree endoscope was used to identify the porus trigeminus. Malleable ring curettes and a malleable suction were used to remove the soft tumor from this location. The patient transiently had loss of hearing but this returned within 2 weeks after surgery. Conclusions The retrosigmoid approach is familiar to all neurosurgeons and with the adjunct of an angled endoscope, the posterior Meckel's cave can be easily reached. This is particularly useful for tumors with soft consistency. The assistance of the endoscope allows Meckel's cave visualization without additional drilling while still allowing safe resection of tumor from around the trigeminal nerve.The link to the video can be found at: https://youtu.be/01aqOyUmSW0.

Improved Patient Safety Due to Catheter-Based Gas Bubble Removal During TURBT

2020 ◽  
Vol 9 (2) ◽  
pp. 1-11
Author(s):  
Holger Fritzsche ◽  
Elmer Jeto Gomes Ataide ◽  
Axel Boese ◽  
Michael Friebe
Keyword(s):  
Patient Safety ◽  
Irrigation System ◽  
Removal Rate ◽  
Bubble Formation ◽  
Technical Solution ◽  
Air Bubbles ◽  
Gas Bubble ◽  
Suction System ◽  
Gas Formation ◽  
Controlled Irrigation

TURBT (transurethral resection of bladder tumor) is a standard treatment for bladder cancer. Gas bubble formation is caused by the heating of the RF-electrode from the resectoscope, which causes visual impairments and can also lead to explosive gas formation. The purpose of this work is to find a proper technical solution for removing the air bubbles and toxic gases during electro-resection thereby providing patient safety as well as better operating comfort for surgeons. A continuously controlled irrigation system and catheter based simultaneous suction system was designed, implemented and tested, with an average removal rate of 70% of the air bubbles and gases that appeared inside the urinary bladder. The setup was tested using a dedicated phantom.

Evaluation of a soil moisture sensor to reduce water and nutrient leaching in turfgrass (Cynodon dactylon cv. Wintergreen)

2007 ◽  
Vol 47 (2) ◽  
pp. 215 ◽  
Author(s):  
S. M. Pathan ◽  
L. Barton ◽  
T. D. Colmer
Keyword(s):  
Soil Moisture ◽  
Cynodon Dactylon ◽  
Irrigation System ◽  
Irrigation Scheduling ◽  
Couch Grass ◽  
Moisture Sensor ◽  
Soil Moisture Sensor ◽  
Application Rates ◽  
Controlled Irrigation ◽  
Conventional Irrigation

This study evaluated water application rates, leaching and quality of couch grass (Cynodon dactylon cv. Wintergreen) under a soil moisture sensor-controlled irrigation system, compared with plots under conventional irrigation scheduling as recommended for domestic lawns in Perth, Western Australia by the State’s water supplier. The cumulative volume of water applied during summer to the field plots of turfgrass with the sensor-controlled system was 25% less than that applied to plots with conventional irrigation scheduling. During 154 days over summer and autumn, about 4% of the applied water drained from lysimeters in sensor-controlled plots, and about 16% drained from lysimeters in plots with conventional irrigation scheduling. Even though losses of mineral nitrogen via leaching were extremely small (representing only 1.1% of the total nitrogen applied to conventionally irrigated plots), losses were significantly lower in the sensor-controlled plots. Total clippings produced were 18% lower in sensor-controlled plots. Turfgrass colour in sensor-controlled plots was reduced during summer, but colour remained acceptable under both treatments. The soil moisture sensor-controlled irrigation system enabled automatic implementation of irrigation events to match turfgrass water requirements.

Extended orbital exenteration for sinonasal malignancy with orbital apex extension: surgical technique and clinical analysis

2015 ◽  
Vol 123 (1) ◽  
pp. 52-58 ◽  
Author(s):  
Takashi Sugawara ◽  
Masaru Aoyagi ◽  
Takahiro Ogishima ◽  
Yoshihisa Kawano ◽  
Masashi Tamaki ◽  
...  
Keyword(s):  
Cell Carcinoma ◽  
Skull Base ◽  
Perioperative Complications ◽  
Tumor Resection ◽  
Neurological Deficits ◽  
Orbital Exenteration ◽  
Orbital Apex ◽  
Orbital Cavity ◽  
Sinonasal Malignancy ◽  
Sinonasal Malignancies

OBJECT The majority of sinonasal malignancies present with advanced disease, and cure rates are generally poor. Surgical extirpation remains the mainstay of treatment. In cases of sinonasal malignancy with orbital apex extension, gross-total tumor resection requires orbital exenteration and bony skull base resection around the orbital apex to provide sufficient margins. In this retrospective study, the authors describe their surgical strategy in and technique for orbital exenteration with orbital apex resection in patients at Tokyo Medical and Dental University who had sinonasal malignancy with orbital apex extension. They also analyzed the clinical features of and the results in these patients. METHODS Between February 2001 and August 2012 at the authors' institution, sinonasal malignancy with orbital apex extension was treated using craniofacial tumor resection with orbital exenteration including skull base bone around the orbital apex. The authors describe this technique and analyze the surgical indications, extent of resection, primary tumor location, outcome, pathological findings, and neoadjuvant and adjuvant therapies of the patients who underwent the technique. RESULTS The patients consisted of 12 men and 3 women with a mean age of 47.7 years (range 14–79 years). The longest postoperative follow-up was 9.5 years, and the shortest was 0.67 year (mean 3.0 years). Tumor originated at the ethmoid sinus in 6 patients (40%), maxillary sinus in 5 (33%), nasal cavity in 2 (13%), and orbital cavity and maxillary bone in 1 patient each (7%). Histological analysis of tumor specimens revealed squamous cell carcinoma in 9 patients (60%), rhabdomyosarcoma in 2 (13%), and small cell carcinoma, mucoepidermoid carcinoma, adenoid cystic carcinoma, and Ewing sarcoma in 1 patient each (7%). Two patients experienced recurrences at 1 and 5 months after treatment; these patients died at 5 and 10 months after surgery, respectively. Estimated 5-year recurrence-free survival (RFS) was 86.7%, and estimated 5-year overall survival (OS) was 86.2%; there was no perioperative mortality. None of the patients had new neurological deficits as a result of the surgery, but 5 patients suffered infectious complications from the graft transplanted into the cavity after resection. There were no other perioperative complications. CONCLUSIONS These authors are the first to describe a technique for extended orbital exenteration with orbital apex skull base resection. The technique provided sufficient margins for gross-total resection of the sinonasal malignancy with orbital apex extension. The estimated 5-year OS and RFS rates were high, and the perioperative complication rate was acceptably low, demonstrating the safety and efficacy of this technique.

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