The modified biopsy technique conducting ultrasound bronchoscopy with endosonographic-guided position of the endoscopic instrument in the area of the pathological focus. The results of the first phase of the clinical trial

Background. The problem of diagnostics and treatment of malignant neoplasms of the lungs is urgent. Verification of a malignant process in the case of peripheral localization of a neoplasm in the lung using ultrasound bronchoscopy ranges from 30 to 85%. To improve the efficiency of ultrasound bronchoscopy, a modified biopsy technique for ultrasound bronchoscopy was developed and introduced into clinical practice at the Chelyabinsk Regional Clinical Center of Oncology and Nuclear Medicine. The essence of the modified technique is that it becomes possible for ultrasound visual control over the passage and deployment of biopsy forceps in real time. The technique was patented, patent for invention RU №2719666 C1 was issued. Aim. To clarify the information content of ultrasound bronchoscopy using a modified technique. Materials and methods. On the basis of the endoscopic Department of Chelyabinsk Regional Clinical Center of Oncology and Nuclear Medicine in 2019 and 2020, ultrasound bronchoscopy using this technique was performed on 40 patients with suspected peripheral malignant neoplasm of the lungs. The diagnosis of malignant neoplasm was verified in 67.5% of cases. Using the standard biopsy technique, the probability of verification of lung malignant neoplasms in 2019 and 2020 was 57.7%. Thus, the modified biopsy technique made it possible to increase the verification probability by 9.8%. The modified technique is relatively safe, complications during the procedure were detected in 2 patients (in 3.8% of cases) and were successfully treated conservatively. During and after the procedure, the patients were monitored and monitored. The ultrasound bronchoscopy according to the modified technique was satisfactorily tolerated by the patients. Results. The period of examination of patients when using this technique does not increase. The technique replaces more invasive diagnostic procedures. Conclusion. The use of the modified technique will improve the information content of ultrasound bronchoscopy, shorten the examination time for patients and accelerate the appointment of special treatment methods.

Simulation-to-real domain adaptation with teacher–student learning for endoscopic instrument segmentation

Purpose Segmentation of surgical instruments in endoscopic video streams is essential for automated surgical scene understanding and process modeling. However, relying on fully supervised deep learning for this task is challenging because manual annotation occupies valuable time of the clinical experts. Methods We introduce a teacher–student learning approach that learns jointly from annotated simulation data and unlabeled real data to tackle the challenges in simulation-to-real unsupervised domain adaptation for endoscopic image segmentation. Results Empirical results on three datasets highlight the effectiveness of the proposed framework over current approaches for the endoscopic instrument segmentation task. Additionally, we provide analysis of major factors affecting the performance on all datasets to highlight the strengths and failure modes of our approach. Conclusions We show that our proposed approach can successfully exploit the unlabeled real endoscopic video frames and improve generalization performance over pure simulation-based training and the previous state-of-the-art. This takes us one step closer to effective segmentation of surgical instrument in the annotation scarce setting.

A New Percutaneous Endoscopic Instrument for Far-migrated Disk Herniation: A Retrospective Single-Institution Study

Objective Compared with the traditional posterior approach, the transforaminal (TF) approach for percutaneous endoscopic lumbar diskectomy (PELD) in patients with disk herniation has a limited resection range that is problematic to treat far-migrated disk herniation. This study examined the usefulness of a newly developed percutaneous endoscopic instrument for far-migrated disk herniation. Methods This retrospective study included 22 patients with migrated disk herniation ≥ 10 mm who underwent transforaminal PELD using the new instrument between August 2014 and May 2017. The new instrument differs from conventional forceps because it has only one jaw that rotates in a plane perpendicular to the mouth opening. The migrated herniated disk is held between the instrument and bone surface, pulled out, and subsequently removed using conventional forceps. Results Herniated disks that had migrated up to 16 mm were removed successfully in all patients. Conclusions The new instrument is a useful tool that can expand the resection range of the TF approach for PELD.

Impact of urology simulation boot camp in improving endoscopic instrument knowledge

ObjectiveEducation and training of surgeons has traditionally focused on the development of individual knowledge, technical skills and decision making. Knowledge about endoscopic instruments is one of the core elements of urological training. We assessed the precourse knowledge of newly appointed urology trainees and the impact of boot camp in improving their knowledge.MethodsNewly appointed specialty trainees in urology took part in a pilot 5-day urology simulation boot camp (USBC). The aim of the USBC was to improve their confidence, procedural performance and non-technical skills, with one of the modules looking at the trainees’ knowledge about common endoscopic instruments in urology. Delegates were first asked to identify and assemble the instruments, followed by one-to-one teaching about the instruments. An Objective Structured Assessment Tool was used to assess their knowledge in the identification and assembly of the cystoscope, resectoscope and optical urethrotome, before and at the end of the course.ResultsData of two successive boot camps were collected to assess knowledge of instruments of newly appointed urology trainees. Majority of the trainees had good precourse knowledge of the cystoscopy kit, with 84% able to correctly identify the parts. Seventy-six per cent of candidates were able to identify the resectoscope equipment, but only approximately a third of trainees were able to correctly identify the urethrotome kit. The assembly of cystoscope, resectoscope and urethrotome was performed correctly in 74%, 42% and 32% at baseline and 94%, 90% and 77% postcourse, respectively. Overall performance improved significantly in the postcourse assessment (<0.001).ConclusionThis urology boot camp has addressed gaps in trainees’ core equipment knowledge and guided them to improve their knowledge with respect to identification and assembly of cystoscope, resectoscope and urethrotome.

Design, Analysis, and Experimental Evaluation of a Novel Three-Fingered Endoscopic Large-Organ Grasper

The currently available laparoscopic instruments are unable to manipulate and grasp the large intra-abdominal organs, such as spleen and kidney, with sufficient stability and safety. This paper describes a novel three-fingered endoscopic instrument, based on parallelogram mechanism, which can fully constrain the large organs and provide an effective grasping function. We first evaluated the efficacy of the design using a 3D model and finite element analysis. Then, a fully functional prototype was fabricated for experimental evaluations, including force propagation and pull force limitation characteristics. Finally, the instrument's capability for effective grasping was investigated on animal specimens in in vitro and in vivo examinations. The results of the force propagation analysis indicated a high amplification ratio of more than 1.2 for the actuating force when grasping large organs. The pull force experiments on a sheep heart specimen revealed a nearly linear relationship between the actuating force and the limit of the pulling force that could be attained without slippage. The resulting pinch force, however, was found to be injurious if the actuating force exceeded a limit of 8.6 N. The in vitro and in vivo examinations of the instrument indicated its capability to pass through a standard 10-mm trocar to enter the abdomen, open its fingers to a diameter of about 80 mm, and grasp and manipulate organs with different sizes, shapes, and properties. With further developments, the proposed design is expected to provide a practical and feasible solution for grasping of large organs during endoscopic operations. However, more preclinical examinations are needed to evaluate the potential risks of using rigid jaws against injury-prone soft organs.

Simultaneous involvement of lungs, larynx and middle ear by tuberculosis -a rare case

Simultaneous involvement of lungs, larynx and middle ear by tuberculosis is very rare. We present a rare case of simultaneous involvement of larynx and ear in a patient with pulmonary tuberculosis. A 17 years old male presented with fever and cough for 8 months, bilateral deafness for 5 months and hoarseness of voice for 3 months. The patient gave history of anorexia and progressive weight loss and history of close contact with tuberculosis patient. There were coarse crepitations on auscultation of both lungs. Indirect laryngoscopy revealed diffuse nodular swelling as well as thickening of the vocal cords. Examination of both ears revealed pale-yellow granulation tissue. ESR was 94 mm in 1st hour and chest radiograph showed diffuse patchy opacities extending over both lung fields. The results of two sputum examinations showed numerous acid-fast bacilli Histopathologic examination of punch biopsy from right and left ear lesions and biopsy tissue from laryngeal lesion taken by endoscopic instrument revealed granulomatous inflammation histologically consistent with tuberculosis.The patient responded well and promptly to the antituberculous therapy. The aim of this article is to create an awareness of Ear Nose Throat tuberculosis and to consider tuberculosis in the differential diagnosis of ear and laryngeal diseases and to emphasize the need for prompt recognition and treatment. DOI: http://dx.doi.org/10.3329/jdnmch.v17i1.12195 J. Dhaka National Med. Coll. Hos. 2011; 17 (01): 53-55