The capsule endoscope swallowed from the mouth into the digestive system can capture the images of important gastrointestinal tract regions. It can compensate for the blind spot of traditional endoscopic techniques. It enables inspection of the digestive system without discomfort or need for sedation. However, currently available clinical capsule endoscope has some limitations such as the diagnostic information being not able to correspond to the orientation in the body, since the doctor is unable to control the capsule motion and orientation. To solve the problem, it is significant to track the position and orientation of the capsule in the human body. This study presents an AC excitation wireless tracking method in the capsule endoscope, and the sensor embedded in the capsule can measure the magnetic field generated by excitation coil. And then the position and orientation of the capsule can be obtained by solving a magnetic field inverse problem. Since the magnetic field decays with distance dramatically, the dynamic range of the received signal spans three orders of magnitude, we designed an adjustable alternating magnetic field generating device. The device can adjust the strength of the alternating magnetic field automatically through the feedback signal from the sensor. The prototype experiment showed that the adjustable magnetic field generating device was feasible. It could realize the automatic adjustment of the magnetic field strength successfully, and improve the tracking accuracy.
In order to promote the implementation of the three standards of central sterile supply department (CSSD), new standards for cleaning and disinfection/sterilization of flexible endoscope, dental instruments, and environmental surface in healthcare, this article elaborates about central management of CSSD; management of loaners and implants; technique of autoclave sterilization, ethylene oxide sterilization, and hydrogen peroxide sterilization; high level disinfection or sterilization of flexible endoscope; disinfection and sterilization of dental instruments; daily and enhanced cleaning and disinfection of environmental surface in healthcare facilities. This could help clinical healthcare workers to implement these new standards, effectively prevent nosocomical infection, and guarantee the personal safety of patients.
ObjectiveTo investigate clinical efficacy and advantages and disadvantages of primary closure with two endoscopes (1aparoscope+choledochoscope) or three endoscopes (laparoscope+choledochoscope+duodenoscope) through the cystic duct for treatment of gallbladder stone with secondary common bile duct (CBD) stones.MethodsThe clinical data of 83 patients with gallbladder stones with secondary CBD stones treated by two or three endoscopes combined with CBD exploration and lithotomy and primary closure through cystic duct from January 2017 to December 2018 in the Chengdu Second People’s Hospital were collected retrospectively. Among them, 41 patients were treated by two endoscopes mode (two endoscopes group), 42 cases were treated by three endoscopes mode (three endoscopes group).ResultsThere were no significant differences in the general conditions such as the gender, age, preoperative diameter of CBD, chronic diseases, etc. between the two and three endoscopes group (P>0.05). All 83 cases underwent the operations successfully and recovered well. The success rate of operation, stone clearance rate, drainage volume of abdominal drainage tube on day 1 after the operation, time of abdominal drainage tube removal after the operation, and hospitalization time had no significant differences between these two groups (P>0.05). The time of operation, intraoperative bleeding volume, and the postoperative pancreatitis rate in the three endoscopes group were significantly more (or higher) than those in the two endoscopes group (P<0.05), but the condition of liver function recovered after the operation was better than that in the two endoscopes group (P<0.05).ConclusionsWith the strict control of the operation indications, it is safe and feasible to use two or three endoscopes through the cystic duct pathway and primary closure of CBD for treatment of gallbladder stone with secondary CBD stones. However, the choice of operative methods of two or three endoscopes should be based on the general situation of the patients before and during the operation.
ObjectiveTo explore the therapeutic effect of gasless endoscopic thyroidectomy via axillary posterior approach for unilateral papillary thyroid microcarcinoma. MethodsThe clinicopathologic data of patients with unilateral papillary thyroid microcarcinoma who were treated by gasless endoscopic thyroidectomy via axillary posterior approach (observation group) or breast approach (control group) in the Xuzhou Central Hospital from January 2020 to February 2022 were collected. The operation time, accidental intraoperative bleeding, exposure time of recurrent laryngeal nerve, number of lymph node dissection, total hospital stay, and postoperative complications such as superior laryngeal nerve injury, cough due to drinking, temporary hoarseness, transient hypocalcemia, tunnel hematoma, and neck discomfort were compared between the two groups. Meanwhile, the cosmetic effects of the two groups were evaluated. ResultsA total of 87 patients who met the study conditions were enrolled in this study, including 47 cases in the observation group and 40 cases in the control group. There were no statistical differences in the baseline data such as gende, age, maximum tumor diameter, location of tumor, etc. between the two groups (P>0.05). Compared with the control group, the exposure time of recurrent laryngeal nerve was shorter (P<0.001) and the number of lymph node dissection was more (P=0.034), but the accidental intraoperative bleeding during operation was more (P=0.015) in the observation group. There were no statistical differences in the operation time and total hospital stay between the two groups (P>0.05). There were no superior laryngeal nerve injury and cough due to drinking in the two groups after operation, and there were no statistical differences between the two groups in the terms of postoperative temporary hoarseness, transient hypocalcemia, and tunnel hematoma (P>0.05), but it was found that the incidence of postoperative neck discomfort in the observation group was lower than that in the control group (P=0.043), and the postoperative cosmetic satisfaction score was also higher than that in the control group (P<0.001). ConclusionsFrom the results of this study, gasless endoscopic thyroidectomy via axillary posterior approach for unilateral papillary thyroid microcarcinoma is safe and feasible. It can quickly expose the recurrent laryngeal nerve and greatly improve the efficiency of lymph node dissection, as well as the cosmetic effect is better.
Due to the special structure and material of the flexible gastrointestinal (GI) endoscopes, it is difficult to reprocess endoscopes. Infections caused by endoscope reprocessing failure often occur. Strict implementation of the guidelines/relevant national standards and manufacturer's instructions is essential to prevent the occurrence of endoscopy-related infections and ensure patient safety. In 2020, ASGE (American Society for Gastrointestinal Endoscopy) released the "multisociety guideline on reprocessing flexible GI endoscopes and accessories". This paper aimed to promote the understanding of the reprocessing process of flexible GI endoscopes by the endoscope decontamination staff, and to provide references for clinical practice.
Objective To describe the current state of hospital infection prevention and control for flexible endoscope in Shanghai, and analyze the trend of infection prevention and control quality from 2018 to 2022. Methods According to Regulation for Cleaning and Disinfection Technique of Flexible Endoscope (WS 507－2016), the quality of infection prevention and control for flexible endoscope was divided into seven parts: organizational management, layout, cleaning and disinfection (sterilization) process, environmental disinfection and sterilization, final rinse water, recording and monitoring, and occupational protection. Each quality control item was judged according to the on-site score and the correction opinion, and the item with correction opinion was judged as “unqualified”, otherwise it was “qualified”. The results of the infection prevention and control quality supervision for flexible endoscope from 2018 to 2022 were reviewed and analyzed, and the qualification rates of quality control items for hospitals at different levels and in different years were calculated. Results From 2018 to 2022, the total qualification rates of organization management, final rinse water, environmental disinfection and sterilization, and occupational protection were over 90%, and the total qualification rates of cleaning and disinfection (sterilization) process, and records and monitoring were over 80%. There was no statistically significant difference in the annual qualification rate (P>0.05). The total qualification rate of the layout was 78.19%, which was significantly higher before the outbreak of COVID-19 (2018-2019) than after the outbreak of COVID-19 (2020-2022) (P<0.001). There was no significant difference in the qualification rate of different levels of hospitals in terms of organizational management, layout, cleaning and disinfection (sterilization) process, records and monitoring, or occupational protection item (P>0.05). There were statistical differences in the qualification rates of different levels of hospitals in terms of final rinse water and environmental disinfection and sterilization (P<0.05). Conclusions The infection prevention and control qualification rate of flexible endoscope in Shanghai is high. However, the layout qualification rate after the COVID-19 pandemic is lower than before. There has been no significant trend in the quality of other items in the past five years. Weaknesses in the cleaning and disinfection (sterilization) process, as well as in recording and monitoring, are identified as key areas in management. Targeted training and supervision are recommended to address these weaknesses.
ObjectiveTo summarize our experience in the treatment of esophageal foreign bodies.MethodsA retrospective analysis of 149 patients of esophageal foreign bodies in the Second Affiliated Hospital of Air Force Military Medical University from December 2011 to May 2019 was carried out, including 75 (50.3%) females and 74 (49.7%) males with an average age of 57 (2-85) years.ResultsThere were 146 patients confirmed by endoscopy, and 3 patients were not found foreign body. Among the confirmed patients, 127 patients were removed by gastroscope and 19 patients were treated by operation. Esophageal foreign bodies are mainly related to the types of food. Jujube seed is the most common food foreign body in the northwest China. The injury rate of mucosal was 47.54% within 48 hours. The complication rate of taking out the foreign body after 48 hours was 100.0%. The success rate by endoscopy decreased (P=0.005), if the foreign body combined perforation. There was no statistical difference between the neck and other parts when using ultra-fine gastroscope (P=0.157).ConclusionThe sharper the foreign body is, the easier the perforation is. The earlier the foreign body is removed, the less complications are. The size of the foreign body determines the difficulty of endoscopic removal. Gastroscopy is the first choice for diagnosis and treatment, especially ultra-fine gastroscopy, and the foreign bodies that cannot be removed by endoscopy need surgical treatment.
ObjectiveTo review the research progress of total endoscopic minimally invasive technique in treating cervical nerve root canal stenosis (CNRCS).MethodsThe related literature at home and abroad was extensively reviewed. The research history, current situation, research progress, advantages and disadvantages of minimally invasive treatment of CNRCS under total endoscope were summarized.ResultsIn recent years, with the continuous development of minimally invasive technique of total endoscope in spine surgery, the surgical treatment methods are also constantly innovated. Compared with the traditional open surgery, minimally invasive treatment of CNRCS under total endoscope can obtain better effectiveness, keep the stability of the cervical segment to the maximum extent, reduce the impact on the activity of the cervical spine and the occurrence of related surgical complications, which is an effective minimally invasive technology.ConclusionThe minimally invasive treatment of CNRCS under total endoscope has achieved some results, which is expected to be one of the indispensable means to treat CNRCS, but it still needs to be improved.
Objective To summarize the development of endoscopic thyroid surgery and expound the advantages and disadvantages. Method Reviewed the domestic and foreign literatures on different ways of endoscopic thyroid surgery. Results Gagner tried accomplish subtotal parathyroidectomy with endoscope at the first time in 1996. And then, Hüscher improved the endoscope technology and applied on thyroidectomy in 1997. Henceforth, endoscopic thyroid surgery had developed rapidly, from small neck incision surgery, such as endoscopic assisted small neck incision thyroidectomy, to traceless neck surgery, such as thoraco mammary approach, areola approach, axillary approach, retroauricular approach, combined approach, etc., to traceless body surface skin surgery in recent years, such as natural cavity oral approach. Completed endoscopic surgery makes the incision scar hide or even disappear, which had attracted the attention and learning of thyroid specialist clinicians all over the world. The choice of patients was more and more broad and diverse, and all kinds of approaches had different advantages and disadvantages.Conclusions The advantages, disadvantages, indications and contraindications of various endoscopic approaches are different. According to the location differences of individual thyroid masses and the requirements for aesthetics, the most appropriate endoscopic thyroid approach is selected to achieve the optimal solution of manual approach.
Considering the problems such as reposition limited, easily detached and singly fired of the existing clip products, we developed an endoscopic multiple-clip applier which can apply 4 clips fired successively at a time. The instrument also equipped with an independent grasper which can be used to clamp target tissues. In order to explore its feasibility and effectiveness of endoluminal closure of gastric perforation, 22 pig stomachs were making a 1 cm full-thickness incision from outside and closed by multiple-clip applier (n=12) in vitro. Outcome was measured by bursting pressure and compared with negative control (n=5) and hand suture (n=5). We set a threshold pressure value (10 mm Hg) for a secure closure. Except 2 cases of invalid data, the mean bursting pressures of negative control, multiple-clip applier, hand suture were (1.5±0.3) mm Hg, (46.0±7.1) mm Hg, and (72.5±7.7) mm Hg, respectively. The results showed that bursting pressure of multiple-clip applier was significantly higher than that of negative control (P＜0.05) and threshold value. Multiple-clip applier can be served as an effective and safe device to perform the endoluminal closure of gastric perforation.
