Case Report : Wire-Guided Endoscopic Snare Retrieval of Proximally Migrated Pancreatic Stents after Endoscopic Papillectomy for Ampullary Adenoma

( La Young Yoon ),( Jong Ho Moon ),( Hyun Jong Choi ),( Seul Ki Min ),( Sang Woo Cha ),( Young Koog Cheon ),( Young Deok Cho ),( Moon Sung Lee ),( Jae Seon Kim ) 대한간학회 2011 Gut and Liver Vol.5 No.4

With the increasing use of pancreatic duct (PD) stents after endoscopic papillectomy (EP), complications such as proximal migration of the stent have become increasingly prevalent. A PD stent that migrates within a nondilated PD may be difficult to remove endoscopically. We performed endoscopic retrieval of proximally migrated PD stents after EP in 5 patients. Endoscopic retrieval was performed immediately after EP in one patient, the next day in 3 patients, and 2 weeks later in one patient. Wire-guided endoscopic retrieval was attempted in 4 patients, and the migrated stents were removed successfully in these 4 patients. No signifi cant procedure-related complications occurred, other than mild pancreatitis in a single patient. In one patient, endoscopic retrieval performed immediately after EP failed when using the conventional method, and the migrated stent was removed using a minisnare without a guidewire the next day; this patient developed severe pancreatitis. Wire-guided endoscopic snare retrieval seems to be a safe and effective method for removing proximally migrated PD stents after EP. (Gut Liver 2011;5:532-535)

총수담관결석의 내시경적 치료성적에 미치는 요인 예측에 관한 연구

송태진(Tae Jin Song),이홍식(Hong Sik Lee),김창덕(Chang Duck Kim),진윤태(Yoon Tae Jeen),엄순호(Soon Ho Um),류호상(Ho Sang Ryu),현진해(Jin Hai Hyun) 대한소화기학회 1996 대한소화기학회지 Vol.28 No.4

N/A Background/Aims: With advanced endoscopic techniques and lithotripsy devices, virtually all patients with common bile duct(CBD) stones can be successfully managed endoscopically. Nevertheless several factors are believed to make the endoscopic removal of CBD stones more difficult. Our intent was to evaluate the success rate of endoscopic removal of CBD stones and to determine which factors significantly influence the success rate. Methods: We retrospectively reviewed 232 patients who were submitted to endoscopic treatment (including mechanical lithotripsy and electrohydraulic lithotripsy) for removal of CBD stone during a recents 3 years period. Success was defined as complete stone removal within 3 endoscopic sessions considering the endoscopic techniques, patients compliances and cost effectiveness. Predictive factors such as size and number of stones, Billroth II operation, periampullary diverticulum, and the presence of cholangitis or pancreatitis were evaluated. Statistic analysis was performed by logistic discriminant analysis and CHAID methods. Results: The overall success rate in all 232 patients was 93.5%. Complete stone c1earance from the bile duct was achieved after a single session in 155 patients(66.8%) and after two sessions in 43 patients(18.5%), while 19 patients(8.2%) required three sessions. Only the size of stones and Billroth II operation were identified as significant predictors of failure of endoscopic stone removal. The numbers and sizes of stones, and Billroth II operation had an increasing effect on the frequency of endoscopic sessions required for complete stone removal. Complications were related mainly to endoscopic sphincterotomy, such as bleeding in 14(6.0%), one of whom required operation for hemostasis. Pancreatitis developed in 3 patients(1.3%). There were no death. Conclusions: Endoscopic stone removal should be recommended as first-line therapy because of its safety and effectiveness. Consideration about the predictive factors such as size, number and Billroth II operation for the outcomes of endoscopic stone removal may be useful in deciding treatrnent options for CBD stones. (Korean J Gastroenterol 1996; 28:537 - 548)

Accuracy of high‐frequency catheter‐based endoscopic ultrasonography according to the indications for endoscopic treatment of early gastric cancer

Kim, Gwang Ha,Park, Do Youn,Kida, Mitsuhiro,Kim, Dae Hwan,Jeon, Tae Yong,Kang, Hyun Jeong,Kim, Dong Uk,Choi, Cheol Woong,Lee, Bong Eun,Heo, Jeong,Song, Geun Am Blackwell Publishing Asia 2010 Journal of gastroenterology and hepatology Vol.25 No.3

<P><B>Abstract</B></P><P><B>Background and Aim: </B> The development of endoscopic treatment, such as endoscopic submucosal dissection, extends the indications for endoscopic resection in patients with early gastric cancer (EGC). Endoscopic ultrasonography (EUS) is the first‐choice imaging modality for determining the depth of invasion of gastric cancer. The aim of the present study was to prospectively assess the accuracy of EUS for determining the depth of EGC, according to the accepted/extended indications.</P><P><B>Methods: </B> We prospectively included a total of 181 lesions in 178 patients, with an endoscopic diagnosis of EGC, who underwent EUS for staging the depth of tumor invasion using a 20‐MHz catheter probe. We investigated the accuracy of EUS for determining the depth of endoscopically‐suspected EGC and then analyzed the difference in the accuracy of EUS according to the accepted/extended indications.</P><P><B>Results: </B> Of the 178 patients, five patients were dropped because of the absence of final histological results. For the 176 lesions in 173 patients, the accuracy of EUS assessment for the depth of tumor invasion was 80.7% (142 of 176 lesions). The accuracy of EUS for the lesions with accepted indications and with extended indications was 97.6% (40 of 41 lesions) and 83.6% (46 of 57 lesions), respectively (<I>P</I> = 0.040). Of the lesions with extended indications, the accuracy of EUS decreased especially for the lesions with ulceration and those with minute submucosal invasion (79.2% and 42.9%, respectively).</P><P><B>Conclusions: </B> The accuracy of EUS for the lesions with the extended indications was lower than that for the lesions with the accepted indications. In particular, lesions with ulceration and minute submucosal invasion should be carefully considered prior to endoscopic treatment by pretreatment EUS staging.</P>

액와 단일절개 접근법을 이용한 내시경적 갑상선 절제술

김소영(So young Kim),유윤종(Yoonjong Ryu),정우진(Woo-Jin Jeong),안순현(Soon-Hyun Ahn) 대한두경부종양학회 2012 대한두경부 종양학회지 Vol.28 No.2

Background and Objectives:To assure the surgical completeness of the gasless endoscopic thyroidectomy via single incision axillary approach using flexible videoscope which provide wide angle and working space, we compared single incision axillary approach and axillo-areolar approach by means of clinical, surgical outcomes. Materials and Methods:From March 2011 to July 2012, 24 patients who had underwent endoscopic thyroid-ectomy via transaxillary approach were enrolled. Of total, 17 patients underwent single incision axillary ap-proach(group I) and the other 7 underwent axillo-areolar approach(group II). Results:Patient demographics, surgical indications were similar between the two groups. The operating time(group I 144.6min, group II 153.6 min ; p=.29), blood loss(group I : 55.4cc, group II : 35.7cc : p=.64), hospital stay(group I : 4.2days, group II : 4.4 days ; p=.65) were similar in the two groups. Overall, two patients in group I(2/17, 11.8%) experienced post-operative complications, including one hematoma and one seroma. Due to narrow working space, one patient was change to axillo-areolar approach during single incision axillary approach with 30° rigid endoscope. Conclu-sion:Single incision axillary approach is safe and effective similar to other endoscopic thyroidectomy methods using flexible videoscope. Different with 30° rigid endoscope, 10-mm flexible videoscope can put inside the ax-illary inicision site in different axis with endoscopic instruments. This difference in endoscopic axis help to pre-vent crash with endoscopic instrument.

Endoscopic Management of Cranial Arachnoid Cysts Using Extra-Channel Method

Kim, Myung-Hyun,Jho, Hae-Dong The Korean Neurosurgical Society 2010 Journal of Korean neurosurgical society Vol.47 No.6

Objective : Arachnoid cysts (ACs) can be cured by making the definite and wide communication between the cyst and arachnoid space using endoscopy, but often it is impossible only through the usual working-channel (intra-channel) procedures. We discuss and propose a more valuable endoscopic technique with the presentation of our series of cases. Methods : We treated 9 patients with cortical AC in various locations with extra-channel endoscopic techniques. The patients ranged in age from 3 years to 60 years (mean age, 37.2 yrs). The follow-up period ranged from 12 to 26 months (mean follow-up duration, 17.2 months). All patients had large AC compressing the adjacent brain with clinical symptoms or signs. The authors performed extensive fenestration via single burr hole with the aid of endoscope. Being bypassed the rigid endoscope, through the space between the shaft of endoscope and guiding cannula (extra-channel method), fenestration procedures were done in the dry fields. Results : Eight (88.9%) patients had been treated successfully with endoscope. One patient required shunt procedure. Among the eight patients who were treated with endoscopic procedure, 6 patients (66.7%) showed cyst reduction, and two (22.2%) showed disappearance of cyst. Conclusion : We suggest that extra-channel method will be simple and easy to perform using more valuable instruments with wider working area, and may promise better results compared to the conventional intra-channel endoscopic procedures.

Radical Endoscopic Antrum Surgery fro the Treatment of Pediatric Sinusitis

Kim, Yong-Jae,Lee, Sang Hoon Korean Rhinologic Society 1998 Journal of rhinology Vol.5 No.2

The development of robotic flexible endoscopic platforms

Sun Gyo Lim 소화기인터벤션의학회 2020 Gastrointestinal Intervention Vol.9 No.1

Many different types of endoscopy robot have been developed or are under development. Some of these innovative biotechnologies are dedicated to complex endoscopic procedures such as endoscopic submucosal dissection whereas others are purely diagnostic. In endoscopy robotics, there are still several problems that need a solution. These problems basically concern robotic locomotion and instrument control, as well as clinical application. Flexible robotic endoscopic platforms are divided into four categories as follows: robot-assisted flexible endoscopy for maneuvering, robotic flexible endoscopy with therapeutic functions, active flexible colonoscopy, and active capsule endoscope. A thorough literature analysis was performed to assess the current status of robotic flexible endoscopic platforms designed for advanced endoluminal procedures.

Extended Application of Endoscopic Repair for Frontal Sinus Fractures

정재연,임소영,변재경,방사익,오갑성,문구현,Jeong, Jae-Yeon,Lim, So-Young,Pyon, Jai-Kyong,Bang, Sa-Ik,Oh, Kap-Sung,Mun, Goo-Hyun Korean Society of Plastic and Reconstructive Surge 2010 Archives of Plastic Surgery Vol.37 No.5

Purpose: The coronal approach for repair of frontal sinus fractures is associated with significant adverse sequelae including a long scar, alopecia, paresthesias, and, uncommonly, facial nerve injury. To minimize these complications, an endoscopic approach for repair of frontal sinus fractures was developed. The authors now present the results of an endoscopy-assisted approach for the treatment of frontal sinus fractures. Methods: From 2002 to 2009, five patients with frontal sinus fracture underwent endoscopic repair. Two slit incisions were placed in the scalp, and one or two stab incisions directly over the fractures were placed in the forehead. After subperiosteal dissection, fracture segments were reduced under direct vision and fixed with microplates or fibrin glue. Results: All patients had good cosmetic results and remained free of sinus complaints. There were no perioperative complications reported. Conclusion: Endoscopic repair of frontal sinus fractures is an efficacious technique that significantly reduces patient morbidity. A relatively wide range of anterior table fractures can be reduced using an endoscope. In cases of complicated comminuted fractures, fibrin glue helps to achieve satisfactory endoscopic reduction. Endoscopic repair is an alternative treatment for various anterior table fractures of the frontal sinus.

A Pilot Study of Endoscopic Submucosal Dissection Using an Endoscopic Assistive Robot in a Porcine Stomach Model

김병곤,Hyuk Soon Choi,Sei Hoon Park,Jun Ho Hong,Jung Min Lee,Seung Han Kim,Hoon Jai Chun,Daehie Hong,Bora Keum 거트앤리버 소화기연관학회협의회 2019 Gut and Liver Vol.13 No.4

Background/Aims: Endoscopic assistive devices have been developed to reduce the complexity and improve the safety of surgeries involving the use of endoscopes. We developed an assistive robotic arm for endoscopic submucosal dissection (ESD) and evaluated its efficiency and safety in this in vitro pilot study. Methods: ESD was performed using an auxiliary transluminal endoscopic robot. An in vitro test bed replicating the intra-abdominal environment and pig stomachs were used for the experiment. Participants were divided into skilled operators and unskilled operators. Each group performed ESD 10 times by using both conventional and robot-assisted methods. The perforation incidence, operation time, and resected mucous membrane size were measured. Results: For the conventional method, significant differences were noted between skilled and unskilled operators regarding operation time (11.3 minutes vs 26.7 minutes) and perforation incidence (0/10 vs 6/10). Unskilled operators showed a large decrease in the perforation incidence with the robot-assisted method (conventional method vs robot-assisted method, 6/10 vs 1/10). However, the operation time did not differ between the conventional and robotassisted methods. On the other hand, skilled operators did not show differences in the operation time and perforation incidence between the conventional and robot-assisted methods. Among both skilled and unskilled operators, the operation time decreased with the robot-assisted method as the experiment proceeded. Conclusions: The surgical safety of unskilled operators greatly improved with robotic assistance. Thus, our assistive robotic arm was beneficial for ESD. Our findings suggest that endoscopic assistive robots have positive effects on surgical safety.

Endoscopic Transforaminal Suprapedicular Approach in High Grade Inferior Migrated Lumbar Disc Herniation

Kim, Hyeun-Sung,Ju, Chang-Il,Kim, Seok-Won,Kim, Jong-Gue The Korean Neurosurgical Society 2009 Journal of Korean neurosurgical society Vol.45 No.2

Objective : Although endoscopic procedures for lumbar disc diseases have improved greatly, the postoperative outcomes for high grade inferior migrated discs are not satisfactory. Because of anatomic limitations, a rigid endoscope cannot reach all lesions effectively. The purpose of this study was to determine the feasibility of endoscopic transforaminal suprapedicular approach to high grade inferior-migrated lumbar disc herniations. Methods : Between May 2006 and March 2008, a suprapedicular approach was performed in 53 patients with high grade inferior-migrated lumbar disc herniations using a rigid endoscope and a semi-rigid flexible curved probe. One-to-four hours after surgery, the presence of remnant discs was checked with MRI. The outcomes were evaluated with the visual analogue scale (VAS) score and the Oswestry Disability Index (ODI) one week after surgery. Results : The L2-3 level was involved in 2 patients and the L3-4 level was involved in 14 patients, while the L4-5 level was involved in 39 patients. There were single piece-type in 34 cases and a multiple piece-type in 19 cases. Satisfactory results were obtained in all cases. The mean preoperative VAS for leg pain was $9.32{\pm}0.43$ points (range, 7-10 points), whereas the mean ODI was $79.82{\pm}4.53$ points (range, 68-92 points). At the last follow-up examination, the mean postoperative VAS for leg pain was $1.78{\pm}0.71$ points and the mean postoperative ODI improved to $15.27{\pm}3.82$ points. Conclusion : A high grade inferior migrated lumbar disc is difficult to remove sufficiently by posterolateral endoscopic lumbar dscectomy using a rigid endoscope. However, a satisfactory result can be obtained by applying a transforaminal suprapedicular approach with a flexible semi-rigid curved probe.