Validation of design and materials for additive manufacturing of endocavitary mechanical distractor

Purpose This paper describes the evolution of the design of a mechanical distractor fabricated using additive manufacturing (AM) technology for use in surgical procedures, such as transanal endoscopic microsurgery (TEM). The functionality of the final device was analysed and the suitability of different materials was determined. Design/methodology/approach Solid modelling and finite element modelling software were used in the design and validation process to allow the fabrication of the device by AM. Several prototypes were manufactured and tested in this study. Findings A new design was developed to greatly simplify the existing devices used in TEM surgery. The new design is easy to use, more economical and does not require pneumorectum. Different AM materials were investigated with regard to their mechanical properties, orientation of parts in the three-dimensional (3D) printer and cytotoxicity to select the optimal material for the design. Social implications The device designed by AM can be printed anywhere in the world, provided that a 3D printer is available; the 3D printer does not have to be a high-performance printer. This makes surgery more accessible, particularly in low-income regions. Moreover, patient recovery is improved and pneumorectum is not required. Originality/value A suitable mechanical distractor was designed for TEM, and different materials were validated for fabrication by AM.

Transanal endoscopic microsurgery in the treatment of patients with benign neoplasms and early rectal cancer

Introduction. Transanal endoscopic microsurgery (tem) is a method that allows the specialists to clearly visualize a tumor and bimanually remove the tumor using a set of special instruments. For a number of patients with a good tumor response to chemoradiation therapy (crt), tem is used as an advanced biopsy technique for tumor verification. The purpose of the study was to analyze the results of tem performed at a. Tsyb mrrc. Material and methods. Between 2015 and 2020, 64 patients (men – 42.2 % and women – 57.8 %) underwent tem. Forty patients had rectal cancer and 25 patients had benign rectal tumors. The indication for tem in patients with rectal cancer was the evidence of tis-t1 tumor by postoperative examination findings (mri and endosonography). Eleven patients with stage ii–iii rectal cancer received chemoradiation therapy. The indication for performing tem after rt in patients with rectal cancer was a good tumor response (mri trg1- 2). For statistical processing, commercial biomedical packages prism 3.1 and instat (graphpad software, inc., san diego, usa) were used. The significance of the differences between the indicators was assessed using the pearson χ2 test. Differences were considered significant if the p value was less than 0.05. Results. The median duration of surgery was 110 minutes (30–385). The volume of blood loss did not exceed 40 ml. Postoperative complications were observed in 15 cases (23.4 %). Grade 3 complications according to the clavien-dindo classification were observed in 5 (7.8 %) cases. Postoperative complications occurred more frequently in patients after crt (10.7 and 18.2 %; p=0.603), however, the differences were not statistically significant. At a median follow-up of 18 months (7–30), local relapses developed in 6 out of 26 (23 %) patients who underwent surgery alone. There were no signs of local recurrence in patients with adenocarcinomas after neoadjuvant chemotherapy and rectal adenomas. When comparing patients with the depth of tumor invasion tis-t1sm2 and t1sm3-t2, local relapses occurred in 1 of 21 (4.7 %) and 5 of 12 (41.6 %) cases, respectively (p=0.015). Conclusion. The analysis of the results of tem interventions in patients with rectal neoplasms allows us to conclude that this method of treatment is a priority for patients with benign rectal neoplasms and early rectal cancer. The method can also be used after rt or crt in patients with tumor invasion ≥t1sm3, provided a complete or almost complete tumor response to the treatment.

Endoscopic full-thickness dissection (EFTD) in the rectum: a case series

Background Rectal endoscopic full- thickness dissection (EFTD) using a flexible colonoscope is an alternative to the well-established trans-anal endoscopic microsurgery (TEM) and the trans-anal minimally invasive surgery (TAMIS) techniques for resecting dysplastic or malignant rectal lesions. This study evaluated EFTD safety by analyzing outcomes of the first patients to undergo rectal EFTD at the University Hospital of North-Norway. Methods The first 10 patients to undergo rectal EFTD at the University Hospital of North-Norway April, 2016 and January, 2021, were included in the study. The procedural indications for EFTD were therapeutic resection of non-lifting adenoma, T1 adenocarcinoma (AC), recurrent neuroendocrine tumor (NET) and re-excision of a T1-2 AC. Results EFTD rectal specimen histopathology revealed three ACs, five adenomas with high-grade dysplasia (HGD), one NET and one benign lesion. Six procedures had negative lateral and vertical resection margins and in three cases lateral margins could not be evaluated due to piece-meal dissection or heat damaged tissue. Two patients experienced delayed post-procedural hemorrhage, one of whom also presented with a concurrent post-procedural infection. No serious complications occurred. Conclusion Preliminary results from this introductory trial indicate that EFTD in the rectum can be conducted with satisfactory perioperative results and low risk of serious complications.

Ứng dụng nội soi dải ánh sáng hẹp kết hợp nội soi vi phẫu bằng laser CO2 trong chẩn đoán và điều trị ung thư hạ họng, thanh quản giai đoạn sớm

TÓM TẮT Mục tiêu: Đánh giá kết quả ứng dụng nội soi dải ánh sáng hẹp kết hợp nội soi vi phẫu bằng Laser CO2 trong chẩn đoán và điều trị ung thư hạ họng và ung thư thanh quản giai đoạn sớm. Phương pháp nghiên cứu: Nghiên cứu tiến cứu, có can thiệp lâm sàng trên 18 bệnh nhân ung thư hạ họng, ung thư thanh quản ở giai đoạn sớm, được phát hiện tổn thương ác tính bằng nội soi dải ánh sáng hẹp, điều trị phẫu thuật nội soi vi phẫu bằng Laser CO2. Kết quả: Tuổi trung bình mắc bệnh là 63,8 ± 12,6; bệnh nhân có hút thuốc lá chiếm 61,1%; triệu chứng khàn tiếng chiếm 72%, ung thư giai đoạn T1a có tỷ lệ 72,2%; IPCL type V-1 là 72,2%; khả năng kiểm soát bờ rìa là 83,3%, không có tai biến trong phẫu thuật 17/18 trường hợp và di chứng sau phẫu thuật tháng thứ 1 là tăng sinh mô hạt (77,8%), tháng thứ 3 là dính mép trước dây thanh (27,8%). Kết luận: Nội soi dải ánh sáng hẹp có giá trị phát hiện sớm ung thư hạ họng, ung thư thanh quản. Phẫu thuật nội soi vi phẫu bằng Laser CO2 ung thư hạ họng, ung thư thanh quản ở giai đoạn sớm mang lại kết quả tốt, tỷ lệ tai biến và biến chứng sau phẫu thuật thấp, bảo tồn được tối đa chức năng phát âm, hô hấp và nuốt. ABSTRACT UTILITY OF NARROW - BAND IMAGING ENDOSCOPY COMBINED WITH CO2 LASER ENDOSCOPIC MICROSURGERY IN DIAGNOSIS AND TREATMENT OF EARLYSTAGE HYPOPHARYNGEAL AND LARYNGEAL CARCINOMA Objective: To evaluate the results of applying narrow band imaging endoscopy combined with CO2 laser endoscopic microsurgery to diagnose and treat early stage hypopharyngeal and laryngeal carcinoma. Methods: A prospective study was conducted on 18 patients with early stage hypopharyngeal and laryngeal carcinoma. Results: The mean age was 63.8 ± 12.6; smoker was 61.1%, the rate of hoarseness was 72%, T1a tumor stage was 72.2%, IPCL type V-1 was 72,2%, marginal tumor control was 83.3%. There were of 17/18 case with no complication during operation. The rate of extensive granuloma was 77.8% in the first month, and of anterior commissure adhesion was 27.8% in the third month post - surgery. Conclusion: Narrow band imaging endoscopy was a valuable tool in screening for early stage hypopharyngeal and laryngeal carcinoma. CO2 laser endoscopic microsurgery was an effective method. The rate of complication during and after surgery was low. This method restores the maximum function of speech, breathing and swallowing. Keywords: Early - stage pharyngeal cancer, early - stage laryngeal cancer, narrow - band imaging endoscopy, CO2 laser endoscopic microsurgery.

TP7.2.9 Natural orifice surgery in early rectal cancer; is it the way forward?

Aims Transanal-endoscopic microsurgery (TEMS) for early rectal cancer is an attractive alternative to radical surgery. With proper patient selection, it is possible to achieve acceptable oncological outcomes with fewer complications. We aim to study the outcomes following TEMS for suspicious or proven rectal cancers performed in our unit. Method We performed a retrospective analysis of prospectively collected data between May-17 and Oct-20. The patients’ details, tumour specific data, short term outcomes, and recurrences were recorded. Results A total of 45 patients with early rectal cancer (M = 29, F = 15) were included in this study. With1 exclusion due to intraoperative rectal perforation, 44 were available for further analysis. Eleven had a diagnosis of cancer at the time of surgery, an additional 11 patients were confirmed on final histology, and 22 were benign. Final histology showed: T1=14, T2=4, T3=3 &Tx=1. The majority (68%) had clear resection margins (R1=3, R2=1, Rx = 3). Twelve patients went on to have further treatment. Seven had resectional surgery (AR = 5, APR=2) for unfavorable histology (2), residual disease (3), or recurrence (2). The other 5(23%) received chemotherapy+/-radiotherapy (unfit/patients’ choice) for unfavorable. Histology (3) or residual disease (2). Conclusion With judicious patient selection, it is possible to offer a less invasive option with acceptable oncological and patient related outcomes for suspicious and proven malignant rectal lesions. The majority of patients (84%) were able to avoid radical surgery or stoma, thereby reducing the associated morbidity. Whilst this is a single institution study, we believe with available expertise this could be widely replicated.

EP.TU.393Management of Suspicious Neoplastic Rectal Lesions in Octogenarians by a Specialist Early Rectal Cancer MDT

Aims To assess management of early rectal cancers in octogenarians going through a regional Small and Early Rectal Cancer MDT observing oncological outcomes, morbidity, mortality and quality of life after treatment Methods Consecutive octogenarian patients treated via the SERC MDT between Dec 2013 and Dec 2019 were examined retrospectively from a prospectively maintained database. Patients underwent transanal endoscopic microsurgery (TEMS), endoscopic submucosal dissection (ESD), contact radiotherapy or hybrid combinations. Patient demographics were recorded and outcomes assessed including pre and post-operative oncological staging, morbidity, mortality, length of stay and FISI scores Results 85 patients were assessed. 38 had TEMS, 40 had EMR, ESD or hybrid procedures and 7 had contact radiotherapy. Of the 38 patients who underwent TEMS, there was minor morbidity in 5 patients, one cancer recurrence and no cancer related mortality. FISI scores pre- and post-procedure were markedly different with deterioration in control of flatus and mucus, but no faecal incontinence. Of the 40 patients who underwent EMR, ESD or hybrid procedures, 2 had minor morbidity and 3 had adenocarcinomas detected requiring further treatment Conclusions Management of octogenarians with early rectal cancer via a specialist MDT provides a safe option with minimal morbidity and no mortality in a subgroup of patients who would otherwise constitute a high risk cohort for surgical intervention. A deterioration in continence in this group highlights the need for careful counselling of patients to achieve the optimal balance between oncological outcomes and quality of life

Features of combined endoscopic tympanoplasty in children with chronic otitis media with cholesteatoma

Topicality: Chronic purulent otitis media is a disease that is often encountered in everyday practice by otolaryngologists. To date, the full rehabilitation of the middle ear in pediatric practice has caused much debate about the method of surgery and remains a difficult surgical task. Aim: to develop a more effective combined method of endoscopic microsurgery in children with chronic otitis media with cholesteatoma. Materials and methods: examined 52 children aged from 2 to 12 years, operated on a closed variant of tympanoplasty for cholesteatoma otitis. Patients were divided into 2 groups: 1st group (comparison), which used the standard technique of closed variant of surgery with retroauricular incision using an operating microscope (33 patients); and the 2nd group (main), where the combined surgery with retroauricular incision with the using of a microscope and endoscope and endoaural drainage of the antrum was performed in 19 patients. Results: We conducted an analysis of different types of tympanoplasty in a closed variant of tympanoplasty in children with cholesteatoma otitis and endoaural drainage of the antrum or without it. In the main group, the number of secondary engraftment of the neotympanic membrane decreased 3.4 times, residual perforations – 2.9 times, residual cholesteatoma – 2.9 times, the number of repeated operations – 3.5 times relative to the comparison group. Conclusion: At the combined surgery of cholesteatoma otitis with endoscopic support at patients of the main group the percent of residual cholesteatoma is lower. The endoaural drainage of the antrum provides additional ventilation and drainage of the reconstructed cavities of a middle ear in the early postoperative period, increases the number of primary engraftment of the neotympanic membrane and reduces the percentage of residual perforations.