Compared to the traditional way of opening the cranial cap, the path of endoscopic approach to removal of meathoma brings more advantages for patients but this procedure is also difficult, complex, requiring sophistication and high precision.
The entire laparoscopic procedure to remove a mesathinal tumor through the butterfly bone is presented in each of the following steps:
1. Preparation before surgery for meathoma
Resymnant imaging and cranial computer scans prior to laparoscopic surgery of the butterfly bone are essential for a meticulous evaluation of the size of the airways in the nose and the detection of malformations such as deviation of the nasal septum; learn the anatomy of the paranasal sinuses; the structure of the mesenterial tumor as well as the effect of compression on the surrounding brain parts, especially the blood vessels that nourish the brain.
In cases of laparoscopic laparoscopic surgery of the butterfly bone due to recurrent tumors, the bone formation of the previously removed butterfly sinus can be very fragile and without vascular stalks. However, the nasal septum can continue to be re-used by surveying with pre-surgical photographic means.
For recurrent but small-sized, non-pressurizing mesotoma, especially when the previously approached butterfly sinus has suffered icing damage that is difficult to recover, this treatment of a meathoma is best done through the opposite nostril.
2. Preparation of endoscopic equipment, patients and surgeons
2.1. Preparation of laparoscopic device for laparoscopic surgery of mesathoma
- Endoscopy machine 0 degree range 18 cm for nasal stages and butterfly sinuses
- 0 degree endoscopy machine with a range of 30 cm for the stage of access to the pit
- A 30-degree and 45-degree endoscopy machine is used at the end of surgery to examine the tumor cavity and remove the remnants of the tumor
- The outer casing of the endoscope should be used to reduce the duration of surgery, as it is possible to water and clean the lens. As a result, the in-and-out movement of the endoscope through the nasal cavity is significantly less
- The straight clamp holds the endoscope.
2.2. Patient Preparation
- Oxymetazoline nasal drop is impregnated on the eve of surgery and then again in the morning before transferring the patient to the operating room
- The patient is placed on his back in an inverted Trendelenburg position, with his hips and knees bent, raised to 20 degrees
- The patient's head is kept in a central position, located on a horseshoe-shaped head rack or fixed with a three-legged headrest
- The chin or bridge of the nose is maintained in a parallel direction to the ground with the head turning 15 degrees towards the surgeon and tilting 15 degrees towards the opposite shoulder (with the left ear towards the left shoulder)
- The insular tube is fixed to the left side of the lower jaw and throat
- Nasal cathex – the stomach is placed to suck blood and secretes before withdrawing the patient's snorkel
- Anesthesia the patient by infusion of propofol to reduce bleeding, keeping blood pressure about 90 mmHg and pulse about 60 times /min
- Drains in the nasal cavity can be placed in patients with large tumors with a wide pit extension
- For antiseptic, use betadine-absorbent ile cotton wool to clean the nasal cavity on both sides after determining the patient's location.
2.3. Preparation of surgeons
- Monitor placed behind the patient's head
- Additional screen placed in front of the surgeon
- The right-handed surgeon stands on the patient's right side
- During the nasal stage, the surgeon holds the endoscopic handle irrigated and sucked in the left hand and the surgical instrument (drill, suction, curette, etc.) in the right hand
- The endoscopic rack or position of the Mayo rack is adjusted by the surgeon as well as performing other suction operations during the nasal phase. At the same time, the surgeon can also control the endoscopy after reaching the tumor in collaboration with the main surgeon
- Bio-glue and hem bleeding tools are available for use during surgery.
>>>The article suggests: Symptoms of meathetic tumor
3. Laparoscopic laparoscopy of the butterfly bone
The course of butterfly bone surgery by laparoscopy to remove the pass-through meathoma consists of four stages. Phased results are the key to safe contact for the next stages.
3.1. Nasal stage
- The endoscopy machine is aligned with the nasal cavity floor and inserted in the middle of the septum
- Absorb the nasal septum with two pieces of cotton impregnated with a solution consisting of five tubes of adrenaline 1: 1000 diluted in 30 ml of 1% xylocaine. Keep in place for 5 minutes to 10 minutes for the drug to spread around. This is an important step to help create adequate space by opening the mucous nose
- Continue replacing the other cotton pads and hold on for 2 minutes to 5 minutes. It can be repeated 2 to 3 times to make flap of the nasal mucosa easy, limiting bleeding and swelling of the edema afterwards.
3.2. Butterfly sinus stage
- When the nasal line approaches the butterfly sinuses is enlarged, the front will be the butterfly bone
- Use an endoscopic tool to open the fore wall and widen the butterfly sinus septum.
3.3. Pit stage
- The butterfly sinus mucosa is located directly on the fore front city of the pit. This partition is easily punctured with a bipolar electric knife so as not to be stripped and avoid bleeding
- The boundaries of the pit are confirmed by multiple directions with a cranial positioning device or a rem resonance imaging scan right in the operating room
- Diamond drills are approached to open the pit floor by removing millimeters perimeter of the pit until the pit gland is seen
- The first part of the incision is sural and is opened in several ways, be it a vertical incision with secondary incisions that extend diagonally, a cross-shaped incision or two lateral cuts connected by a horizontal cut in the middle
- When the sural layer is opened, the pleural tumor will be peeled off in parts according to the entire perimeter to help remove the tumor in a single piece
- A multi-angle endoscope is inserted into the pit to check the tumor cavity to avoid missing the tumor remnants
- Before the end of the surgery, if remnants of the tumor are found, they will be removed using concave curved straws under direct vision using a range of 30 degrees. The angle range is located at 6 hours and these devices will be moved over the range at a position of 12 hours to fully observe the pit at another angle, avoiding leaving a hidden corner
- Finally, check the entire pit clockwise starting from the 6-hour clock position with a 30-degree endoscope.
3.4. Closure of the incision line
- After the tumor is removed, the surgeon will prepare to close the butterfly sinus. If necessary, a small skin incision is made in the abdominal wall to remove some of the fat tissue itself to fill the remaining void due to the removal of the tumor
- The hole in the wall of the butterfly sinus will be replaced by a bone graft from the nasal septum. However, synthetic grafting materials are sometimes used when there is no suitable septum fragment or the patient has had a laparoscopic laparoscopy once before
- In addition, a bio-glue is used on the graft in the butterfly sinuses, which helps to quickly heal and prevent the leakage of cerebral fluid from the brain mesmenis into the butterfly sinuses and the nasal edge cavities.
- Finally, a soft, flexible splint can be placed in the nose along the septum to control bleeding and prevent swelling. These splints also prevent adhesion that can lead to chronic nasal congestion.
In summary, with the benefits that endoscopy brings, butterfly bone surgery by laparoscopy to remove a mesathoma is preferred over the cranial opening method. However, patients need to have a certain understanding of the steps in the above surgical procedure in order to have the best preparation and coordination with doctors and bring a favorable surgery for themselves.
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