The Pitfalls and Strategies of Endoscopic Localization in Laparoscopic Colectomy: A Case Report

Background: laparoscopic segmental colectomy is suitable for removing difficult polyps that are large, broad-based, or located in tortuous bowel segments. As we know, accurate segmental resection depends on precise localization. So far, intraoperative labeling of lesions by colonoscopy is increasingly performed for achieving appropriate resection margins, but a certain deviation is also found. There is no unified and standard endoscopic polyp localization method at present.Case presentation: A 63-year-old woman was admitted because she was diagnosed as a large and broad-based colonic polyp which was unsuitable for colonoscopic polypectomy. During endoscopy-assisted laparoscopic segmental colectomy, the irradiation angle of colonoscopy light on the polyp head was responsible for the localization errors. We proposed three-step measures of correct endoscopic polyp localization to ensure the accurate resection in laparoscopic segmental colectomy.Conclusions: Three-step measures of correct endoscopic polyp localization ensured the successful resection of colonic polyps in laparoscopic colectomy. Their advantages include simplicity, practicality and reliable localization.

Removal of Ingested Magnetic Bodies via Laparoscopic Appendectomy

Ingestion of a foreign body is a frequent diagnosis in the pediatric population. In a small percentage of cases, foreign bodies themselves are strong magnets, and swallowing of multiple magnetic bodies can lead to serious complications in the gastrointestinal tract. Two consecutive case reports of patients who swallowed two magnetic beads are presented. In both cases, the abdominal radiograph described two magnets in contact, one in the area of the left hypochondrium and one in the right hypogastrium. Attempts of endoscopic localization and removal were unsuccessful. Due to the failure of magnet progression, laparoscopic revision of the abdominal cavity was indicated in both patients on the 25th and 4th day after swallowing. Using the magnetic forces between the magnets and the laparoscopic instruments, the foreign bodies were localized in the appendix of the first patient and in the cecum of the other one. The magnets were extracted together with the removal of the appendix in both patients. This is one of the first articles describing the successful extraction of foreign magnetic bodies from the gastrointestinal tract via laparoscopic appendectomy.

Anatomicosurgical References for Endoscopic Localization of Sphenopalatine Foramen: A Cadaveric Study

ABSTRACT Introduction In patients with posterior epistaxis, generally the source of bleeding is branches of sphenopalatine artery (SPA), which enter the nasal cavity through the sphenopalatine foramen (SPF). Cases of intractable massive bleeding may require endonasal endoscopic occlusion of these vessels. Materials and methods A total of 32 hemisections of formalinfixed cadaveric heads were used. The anatomic variations of SPF, its distance from anatomical landmarks, and angle of elevation of endoscope were studied so as to facilitate accurate localization of the foramen and endoscopic arterial ligation. Results The SPF was generally single; however, multiple exits in the form of accessory foramina were found in 36.75% hemisections. The transition of superior and middle meatuses was the most common location of SPF, followed by the superior meatus, and middle meatus was the least common site. The accessory foramina were commonly present in the superior meatus. Ethmoid crest was distinctly visible in all but two cases. In majority of the cases, the SPF was located within a range of 55 to 65 mm from the anterior nasal spine (ANS); 60 to 70 mm from piriform aperture, 50 to 60 mm from limen nasi, 20.1 to 25 mm vertically above the floor of nasal cavity, and 8 to 15 mm from the inferior turbinate (IT). The angulation of SPF from the floor of nasal cavity was 20 to 30°. Conclusion Exploration of lateral nasal wall (LNW) up to middle meatus would minimize the risk of missing any arterial branch, and the data of distance from the anatomical references would assist in more precise localization of SPF during endoscopic ligation or cauterization of the branches of the SPA. How to cite this article Aggarwal A, Gupta T, Sahni D, Gupta A. Anatomicosurgical References for Endoscopic Localization of Sphenopalatine Foramen: A Cadaveric Study. Clin Rhinol An Int J 2016;9(3):109-114.