简介：AbstractTransoral Endoscopic Thyroidectomy Vestibular Approach (TOETVA) is a recently described surgical technique where the thyroid and central neck can be accessed without a cutaneous incision. To date nearly 700 cases have been described within the English literature demonstrating the feasibility, safety, and efficacy of the technique. As more institutions begin to adopt the surgical approach, it is important that surgeons pay close attention to appropriate patient selection and surgical optimization to prevent experience-related complications. A valuable tool to facilitate these considerations is the utilization of surgeon-performed ultrasonography (US). While the merits of surgeon-performed US are well-documented within head & neck endocrine surgery as a whole, its value may be of even greater importance when implementing a novel surgical technique such as TOETVA. Here we highlight and summarize the role of surgeon-performed US within head & neck endocrine surgery, focusing on how it may influence patient selection and surgical planning with TOETVA.

简介：AbstractAdvances in imaging for preoperative localization have propelled the widespread adoption of minimally invasive/focused parathyroidectomy in primary hyperparathyroidism. Though it is performed through a relatively small incision, studies have shown that the presence of a neck scar increases attentional bias towards the neck resulting in compromised quality of life. Transoral endoscopic parathyroidectomy vestibular approach (TOEPVA) eliminates a neck scar. While indications for TOEPVA are the same as that of minimally invasive open parathyroidectomy, confident preoperative localization of the parathyroid with a surgeon performed ultrasound along with concordant localization with SPECT CT is an essential prerequisite before offering patients this approach for parathyroidectomy. Early data has demonstrated the feasibility and safety of this approach.

简介：AbstractBackground:Transoral vestibular approach thyroidectomy using robotic system has advantages with articulating instrumentation. Transoral robotic thyroidectomy (TORT) can be done either using just two robot arms for instruments and an extra one for the endoscopic camera, or using three robot arms for instruments (third arm through axila) and an additional arm for the camera.Pros of additional axillary arm for TORT:The 4th arm through an additional axillary port is mainly responsible for a counter-traction of strap muscles and thyroid tissue. The additional axillary port tract is also an excellent passage for the specimen removal with lower risk of disruption or fragmentation. Ultimately, these merits from the additional axillary arm allows TORT to be performed safely in a wide range of patient groups.Cons of additional axillary arm for TORT:One of the issue with the additional axillary arm in TORT is that it leaves a cutaneous scar. Another issue to consider is the cost. In some places, robotic surgery operation fee varies with the number of arms used during the operation. Retraction of strap muscles through subcutaneous stitches applied after establishing the working space may make up for the lack of counter-traction.Conclusion:TORT can be done safely with or without the transaxillary arm and surgeon may consider pros and cons based on multiple factors.

简介：AbstractThe surgical approach to lesions of the ventral craniovertebral junction (CVJ) has evolved significantly in the last several years with the advent of endoscopic skull base surgery. Differing pathologies of the CVJ can result in irreducible compression of the cervicomedullary region. The endoscopic endonasal approach lends itself well to this region due to the ventral location, and while there is a steep learning curve, is a safe and effective way to perform decompression of the cervicomedullary region. Herein, we discuss the anatomy of the CVJ, preoperative evaluation and surgical considerations, our surgical approach, complications, and outcomes.

简介：Duodenalpolypsorlesionsareuncommonlyfoundonupperendoscopy.Duodenallesionscanbecategorizedassubepithelialormucosally-based,andthetypeoflesionoftendictatesthework-upandpossibletherapeuticoptions.Subepitheliallesionsthatcanariseintheduodenumincludelipomas,gastrointestinalstromaltumors,andcarcinoids.Endoscopicultrasonographywithfineneedleaspirationisusefulinthecharacterizationanddiagnosisofsubepitheliallesions.Duodenalgastrointestinalstromaltumorsandlargeormultifocalcarcinoidsarebestmanagedbysurgicalresection.Brunner＇sglandtumors,solitaryPeutz-Jegherspolyps,andnon-ampullaryandampullaryadenomasaremucosally-basedduodenallesions,whichcanrequireremovalandaretypicallyamenabletoendoscopicresection.Severalanatomiccharacteristicsoftheduodenummakeendoscopicresectionofduodenallesionschallenging.However,advancedendoscopictechniquesexistthatenabletheresectionoflargemucosally-basedduodenallesions.Endoscopicpapillectomyisnotwithoutrisk,butthisprocedurecaneffectivelyresectampullaryadenomasandallowspatientstoavoidsurgery,whichtypicallyinvolvespancreaticoduodenectomy.Endoscopicmucosalresectionanditsvariations（suchascap-assisted,cap-band-assisted,andunderwatertechniques）enablethesafeandeffectiveresectionofmostduodenaladenomas.Endoscopicsubmucosaldissectionispossiblebutverydifficulttosafelyperformintheduodenum.

简介：Commercializedcapsule-typeendoscopesmovepassivelybyperistalticwaves(andgravity),whichmakesitdifficultfordoctorstodiagnosetheareasofinterestmorethoroughlyandactively.Toresolvethisproblemofpassivity,itisnecessarytofindaspeciallocomotionprinciple,whichfitsthegastrointestinal(GI)tract.Inthispaper,aleggedlocomotivemechanismwithshapememoryalloy(SMA)actuationbasedontheperistalticprincipleisproposed,andthenthestructureofthelocomotionmechanismisintroduced.Basedonthepreliminaryresults,thedesign,modeling,andfabricationofanSMAmicroactuationconceptforapplicationinanendoscopiccapsulearegiven,aswellastheSMAspringandleggedcomponentdesign,whichisthecoresectionofthesystemdesign.Weusedthepseudo-rigid-bodymodel(PRBM)toanalyzenonlinearandlargedeflectionsoftheSMAleggedcomponent.Thus,aprototypeendoscopewithanSMAspringandsixleggedcomponentswasdesignedandfabricated.Itis15mmindiameterand33mmintotallength,withahollowspacetohouseotherpartsneededforendoscopysuchasacamera,aradiofrequency(RF)module,andsensors.Duringtesting,thelocomotivemechanismwaseffectiveinaplastictubeenvironment.

简介：AbstractBackground:Endonasal endoscopic skull base surgery has undergone rapid technological developments and is now widely performed, but its strengths and weaknesses deserve further investigation and deliberation. This study was performed to investigate the surgical indications, complications, and technical advantages and disadvantages of endonasal endoscopic skull base surgery.Methods:The clinical data of 1886 endoscopic endonasal skull base surgeries performed in our ward at Beijing Tiantan Hospital from June 2006 to June 2016 were retrospectively analyzed.Results:One thousand ninety-three (73.4%, 1490) pituitary adenomas, 54 (24.9%, 217) chordomas, 28 (80.0%, 35) craniopharyngiomas, and 15 (83.3%, 18) meningiomas underwent total resection. Two patients died postoperatively, both having pituitary adenomas. Other postoperative complications included olfactory disorders (n = 226, 11.9%), postoperative cerebrospinal fluid leakage (n = 78, 4.1%), hypopituitarism (n = 74, 3.9%), diabetes insipidus (n = 64, 3.4%), intracranial infection (n = 36, 1.9%), epistaxis (n = 24, 1.3%), vascular injury (n = 8, 0.4%), optic nerve injury (n = 8, 0.4%), and oculomotor movement impairment (n = 4, 0.2%). In total, 1517 (80.4%) patients were followed up for 6 to 126 months (average, 42.5 months) postoperatively. A total of 196 (13.2%) pituitary adenomas and 13 (37.1%) craniopharyngiomas recurred but no meningiomas recurred. Chordomas recurred in 97 (44.7%) patients, in whom 5-year survival rate was 65%.Conclusion:Endoscopic surgery is an innovative surgical technique and the first choice for most midline extradural lesions such as chordomas, and an excellent choice for pituitary adenomas. It probably will be a good technique for many kinds of craniopharyngiomas and a common technique for most of skull base meningiomas, so the surgical indications of these cases should be chosen carefully to make good use of its respective advantages.

简介：Middleearsurgeryisusuallyperformedusingasurgicalmicroscope.Initially,inotorhinolaryngologypractice,endoscopeswereusedforparanasalsinussurgeries.Itwasonlylaterthattheywereappliedintheareaofotology.Inotologicsurgeries,endoscopeswerefirstusedtovisualizethemiddleear,beforebeingusedtoassistwithvisualizationofinstrumentsduringcholesteatomasurgeries,althoughtheyarestillnotusedaloneinvariousotologicsurgeries.Asinothersurgicalfields,thereisalsoatrendtowardsminimallyinvasiveinterventioninthefieldofotorhinolaryngology.Smallerincisionsperformedundertheguidanceofendoscopesarepreferredoverconventionallargeincisions.Usingthisapproach,improvedoutcomescanbeachievedandpostoperativemorbiditiescanbereduced.Inaddition,theoutcomesofgraftsperformedusingtheendoscopicapproacharesimilartothatachievedbythemicroscopicapproach.Therefore,endoscopicearsurgeryimplementationsarebecomingincreasinglypopular.

简介：Whereasmuchhasbeenlearnedaboutage-relatedauditorychangesintheinnerear,relativelylittleisknownabouttheagingeffectsonthevestibularpartoftheinnerear-theperipheralvestibularsystem.Herewereviewrelevantliteraturewithregardtotheprevalenceofvestibulardysfunction,vestibularfunctionalandstructuralchangesintheelderly.Theprevalenceofvestibulardysfunctionincreaseswithage.Functionally,asageincreases,VEMPamplitudesdecrease,VEMPthresholdsincrease,VORgainofHITdecreases.Duetothecomplexityofthevestibularsystem,variationsinsubjectageandmeasurementtechniques,findingsinVEMPlatencyandcalorictestsareconflicting.Toaddressthis,adirectmeasureoftheperipheralvestibularsystemshouldbeapplied.Structurally,age-relatedlossinvestibularganglionandotoconiahavebeennoted;haircellchangesarenotwelldefined;whilesubcellularchangesremaintobeexplored.Defininghowtheonsetofvestibulardysfunctioncorrelateswithstructuraldegenerationwillofferinsightsintothemechanismsunderlyingvestibularaging.

简介：Objectives:Theaimofourstudyistoexaminevestibular-evokedmyogenicpotentials(VEMPs)elicitedbythegalvanicvestibularstimulationinthesternocleidomastoidmuscle(SCM)inhealthysubjectsforclinicalapplicationsofauditoryneuropathyorvestibularneuropathyinthefuture.Methods:WeenrolledsixteenhealthysubjectstorecordtheaverageresponsesofSCMtogalvanicvestibularstimulation(GVS)[current3mA;duration1ms]byelectromyography(EMG).SPSS18.0softwarewasusedtoanalyzetheobtaineddataformeanandstandarddeviation.Results:Inallhealthysubjectsmastoid-foreheadgalvanicvestibularstimulationproducedapositive-negativebiphasicEMGresponsesonSCMipsilateraltothecathodalelectrode.Thelatencyofp13was11.7±3.0ms.Thelatencyofn23was17.8±3.4ms.Theamplitudeofp13-n23was147.0±69.0mV.Theinterauralasymmetryratio(AR)ofp13,n23latencyandtheamplitudewasrespectively0.12±0.09,0.08±0.08and0.16±0.10.Discussions:GalvanicvestibularstimulationcouldelicitbiphasicEMGresponsesfromSCMviathevestibularnervebutnotfromtheotolithorgans.Galvanicstimulationtogetherwithairconductedsound(ACS)orboneconductedvibration(BCV)canelicitVEMPsandmayenablethedifferentiationofretrolabyrinthinelesionsfromlabyrinthinelesionsinvestibularsystem.

简介：AbstractCompletion thyroidectomy (CT) is employed after lobectomy when histopathological results mandates total removal of the gland as in case of well differentiated thyroid carcinoma (DTC). It is also employed as a second stage thyroid surgery when unfavorable events occur as in recurrent laryngeal nerve injury or when the surgeon finds out the case is beyond his/her expertise in an attempt to protect the contralateral side and allowing time for recovery or for an expert surgeon to help.

简介：客观：设计一个临床上适用的transoralpharyngealatlantoaxialreduction盘子(TARP)，介绍操作过程，并且评估它的初步的临床的效果。方法：一个新奇TARP系统，包括的蝴蝶钛合金板，self-lockingscrews，atlantoaxial减速器和另外的运作的仪器被开发。这个系统与先天或创伤的起源的无法缩减的atlantoaxial脱臼在五个病人上临床上被使用。在操作期间，减小被板和atlantoaxial减速器的联合行动在transoral关节版本和绳索解压缩以后完成。骨头接枝小粒在双边的atlantoaxial关节之间被植入，TARP被用来随后使地图集和轴不能调动。结果：临床的申请证明TARP能导致立刻的减小并且方法是操作上可行的并且它的帖子运作的效果令人满意。结论：TARP的设计是新奇的。运作的过程简单、易用。而且，立刻的减小能在操作期间被完成，固定是相对稳定的。TARP是为无法缩减的atlantoaxial脱臼的一种理想的选择并且可以为进一步临床的应用程序有优秀前景。

简介：客观；为了学习结构的相关解剖特征，在transoral包含了atlanto轴的减小板(TARP)通过为对待无法缩减的atlanto轴的脱臼并且为TARP的临床的申请提供解剖基础的transoral途径的内部固定。方法：十个新鲜craniocervical标本通过手术是微的由通过transoral的层的把的层途径。以后的咽头的墙，脊椎的动脉的功课，地图集和轴的邻近的结构的解剖关系，和为TARP内部固定的密切相关的解剖参数的层化是measured.Results：以后的咽头的墙由二层和二间隙星际组成了：mucosa，prevertebral扁带，制动火箭咽头的空间，和prevertebral空间。从到C_3的孔大酒瓶的前面的边的范围能被这条途径暴露。以后的咽头的墙的厚度是(3.6±0.3)在C1的前面的小块茎的公里(变化2.9-4.3公里)，(6.1±0.4)在C_1的侧面的团的公里(变化5.2-7.1公里)并且(5.5±0.4)在C_2的中央部分的公里(变化4.3-6.5公里)分别地。到前面的小块茎ofC_1，C_1螺丝钉入口点，和C_2螺丝钉入口点的从门牙牙齿的距离是(82。5±7。8)公里(变化71。4-96。2mm)，(90。1±3。8)公里(变化82.2-96。3公里)，并且(89。0±4。1)公里(变化81。3-95.3mm)分别地。在在地图集和中线的脊椎的动脉之间的距离是(25。2±2.3)公里(变化20.4-29。7公里)并且那在在轴和中线的脊椎的动脉之间是(18。4±2.6)公里(变化13.1-23.0公里)。为暴露的地图集和轴的允许的宽度是(39。4±2。2)公里(变化36。242。7公里)并且(39.0±2.1)公里(ranging35.842.3公里)分别地。在二个地图集螺丝钉插入点(C_1侧面的质量的前面的方面的中心)之间的距离(a)是(31.4±3.3)公里(变化25.4-36.6公里)。在连接连接twoC_2螺丝钉入口的二个C_1螺丝钉入口点和那的线之间的垂直距离(b)指(在vertebrae的中央部分，也就是对中线ofC_2vertebr

简介：ObjectiveThemainpurposeofthepresentstudywastodescribethevestibularfunctioninpatientswithauditoryneuropathy(AN),andtoassesstheirabilitytomaintainbalance.MethodsVestibularfunctiontestswereperformedon32patientswithANand36normalsubjectsincludingelectronystagmopraphy(ENG)andstaticpostrography(SPG).Theresultsfromthetwogroupswerecompared.ResultsEquilibriumfunctioninpatientswithAN,wasabnormal,comparedtonormalsubjects.ConclusionVestibularfunctiontests,espe-ciallystaticpostrography,shouldbeperformedonpatientswithAN.

简介：AbstractObjective:Nasal vestibular furunculosis (NVF) is characterized by an acute localized infection of the hair follicle in the skin lining of the nasal vestibule. This study provides an up-to-date narrative analysis on NVF, its presentation, complications and management.Methods:A literature search was conducted electronically with no time constraints using "Nasal Vestibular Furuncolosis" or "NVF" through Medline, Cochrane Library and Web of Science, including MeSH terms with no language restrictions. Included were: Studies that described NVF's presentation and subsequent management and excluded were: Irrelevant studies that did not provide details about NVF's presentation or management, furthermore studies that alluded to Nasal vestibulitis without furunculosis were excluded. There were no limitations on time, up until the review was commenced in May 2020.Results:Seven articles complied with the inclusion criteria. All papers reviewed were from 2015 to 2020. Three out of 4 studies reported duration of symptomatic NVF between 3 and 4 days. The most common presentation of NVF was reported as erythema, swelling, tender over the nasal tip. The most frequent, successful management of NVF frequently included intranasal topical mupirocin and in some cases oral sodium fusidate. NVF was reported to clear within 7 days by 2 studies. There were no randomised studies exploring NVF or NVF management.Conclusion:Although a very common condition, much research is required to allude to the pathophysiology and management of NVF. Future studies should explore the reasons as to the resistance of topical antibiotics in some patients, the differing strains of staphylococcus aureus and their resulting complications, the reasons behind the familiar connection and the most effective management plan for NVF.

简介：Objectives:Toevaluateaudiologicalandvestibularfunctionsviabasicaudiologicalevaluation,otoacousticemissionsandvideonystagmography(VNG)invitiligopatients.Materialandmethods:30vitiligopatients(8acrofacialand22mixedtypes)asthestudygroupand30normalhealthyadultsasthecontrolgroupwereincludedinthestudy.Allparticipantsweresubmittedtobasicaudiologicalevaluation,transientanddistortionproductotoacousticemmisions(TEOAEsandDPOAEs),vestibularassessmentincludinghistorytaking,officetestsandvideonystagmography(VNG)anddermatologicalassessmenttodeterminetype,percentofbodysurfaceareainvolvementanddurationofvitiligo.Results:Thisstudyshowedstatisticallysignificantdifferencebetweencontrolandstudygroupsinpuretoneaudiometry(PTA)andotoacousticemissionsresults.Fiftypercentofvitiligopatientshadperipheralvestibulardisorders(10vestibularneuritisand5posteriorcanalbenignparoxysmalpositionalvertigo.Conclusion:Theresultsinthisstudyshowedthat50%ofvitiligopatientssufferedfromperipheralvestibulardisordersinadditiontoauditoryaffection.Vitiligopatientsrequireroutinemonitoringforauditoryandvestibularfunctionsforearlyidentificationandmonitoringofchangesasthediseaseprogress.

简介：ThisworkisconductedinMansouraUniversityHospitals,Egypt,toshowtheadvantagesanddisadvantagesofendoscopicstapedotomyincomparisontomicroscopicstapedotomy.Theworkdescribedhasnotbeenpublishedpreviouslynorunderconsiderationforpublicationelsewhere.Theauthorsdeclarethatthereisnoconflictofinterest.ThisstudyisapartofamasterdegreethesissubmittedbyEslamMahmoudaspartialfulfillmentforamasterdegree.Institutionalreviewboardapproval,FacultyofMedicine-MansouraUniversity,wasobtainedforthestudy(IRB:MS/15.09.49).

简介：AbstractBackground:Although the single-stage posterior realignment craniovertebral junction (CVJ) surgery could treat most of the basilar invagination (BI) and atlantoaxial dislocation (AAD), there are still some cases with incomplete decompression of the spinal cord, which remains a technique challenging situation.Methods:Eleven patients were included with remained myelopathic symptoms after posterior correction due to incomplete decompression of the spinal cord. Transoral odontoidectomy assisted by image-guided navigation and intraoperative CT was performed. Clinical assessment and image measurements were performed preoperatively and at the most recent follow-up.Results:Eleven patients were followed up for an average of 47 months. Symptoms were alleviated in 10 of 11 patients (90.9%). One patient died of an unknown reason 1 week after the transoral approach. The clinical and radiological parameters pre- and postoperatively were reported.Conclusion:Transoral odontoidectomy as a salvage surgery is safe and effective for properly selected BI and AAD patients after inadequate indirect decompression from posterior distraction and fixation. Image-guided navigation and intraoperative CT can provide precise information and accurate localization during operation, thus enabling complete resection of the odontoid process and decompression of the spinal cord.

简介：摘要Endoscopic ultrasound (EUS) has both diagnostic and therapeutic clinical applications. This review article focuses on recent advances in two commonly performed procedures: EUS-guided tissue acquisition and EUS-guided drainage. There is a shift from acquiring aspirates for cytology to obtaining tissue cores for histological diagnoses and molecular analyses. There is growing interest and research about artificial intelligence in EUS. Artificial intelligence may potentially be useful to guide clinical decision making if biopsy results are non-diagnostic. The range of EUS-guided drainage procedures has expanded. EUS-guided drainage of walled-off pancreatic fluid collections is an accepted first line treatment option. EUS-guided palliative drainage of malignant biliary obstruction after unsuccessful endoscopic retrograde cholangiopancreatography (ERCP) is now an accepted alternative to percutaneous transhepatic biliary drainage. EUS-guided gallbladder drainage for management of acute cholecystitis is now a preferred option over percutaneous cholecystostomy for non-surgical candidates. Other EUS-created gastrointestinal anastomoses such as EUS-guided gastroenterostomy in the context of gastric outlet obstruction, and EUS-directed transgastric ERCP for Roux-en-Y gastric bypass are now technically feasible, but further prospective randomized studies are needed to establish the actual clinical impact.

简介：Objective:Toreportdetectionofvestibular-evokedmyogenicpotentials(VEMPs)intheminiaturepig.Methods:Potentialsevokedby1000HztoneburstswererecordedfromneckextensormusclesandthemassetermusclesinnormaladultBamaminiaturepigsanesthetizedwith3%pentobarbitalsodiumandCarbacholII.Results:ThelatencyofthefirstpositivewavePfromneckextensormuscleswas7.65±0.64ms,withanamplitudeof1.66±0.34uvandarateofsuccessfulinductionof75%at80dBSPL.Thelatencyofpotentialsevokedfromthemassetermuscleswas7.60±0.78ms,withanamplitudeof1.31±0.28uvandaratesuccessfulinductionof66%at80dBSPL.Conclusion:ThelatenciesandthresholdsofVEMPsrecordedfromtheneckextensormuscleandthemassetermuscleappeartobecomparableinnormaladultBamaminiaturepigs,althoughtheamplituderecordedfromtheneckextensormuscleseemstobehigherthanthatfromthemassetermuscle.However,becauseoftheirusuallyrelativelysuperficialandeasilyaccessiblelocation,aswellastheirlargevolumeandstrongcontractions,massetermusclesmaybebettertargetmusclesforrecordingmyogenicpotentials.