Usefulness of three-dimensional visualization technology in minimally invasive treatment for infected necrotizing pancreatitis

AIM To explore the value of three-dimensional(3 D) visualization technology in the minimally invasive treatment for infected necrotizing pancreatitis(INP). METHODS Clinical data of 18 patients with INP, who were admitted to the PLA General Hospital in 2017, were retrospectively analyzed. Two-dimensional images of computed tomography were converted into 3 D images based on 3 D visualization technology. The size, number, shape and position of lesions and their relationship with major abdominal vasculature were well displayed. Also, percutaneous catheter drainage(PCD) number and puncture paths were designed through virtual surgery(percutaneous nephroscopic necrosectomy) based on the principle of maximum removal of infected necrosis conveniently.RESULTS Abdominal 3 D visualization images of all the patients were well reconstructed, and the optimal PCD puncture paths were well designed. Infected necrosis was conveniently removed in abundance using a nephroscope during the following surgery, and the median operation time was 102(102 ± 20.7) min. Only 1 patient underwent endoscopic necrosectomy because of residual necrosis. CONCLUSION The 3 D visualization technology could optimize the PCD puncture paths, improving the drainage effect in patients with INP. Moreover, it significantly increased the efficiency of necrosectomy through the rigid nephroscope. As a result, it decreased operation times and improved the prognosis.

Endoscopic treatment of urothelial encrusted pyelo-ureteritis disease:A case series

BACKGROUND Urothelial encrusted pyelo-ureteritis disease is an infrequent condition and there is no unified surgical treatment and reference standard to consult.We have used a minimally invasive endoscopic method to treat three such cases,which yielded excellent results.CASE SUMMARY The first case was a 45-year-old man who had unilateral ureteropelvic junction(UPJ)atresia and contralateral stenosis and was treated by double endoscopic surgery using an anterograde percutaneous nephroscope coupled with a rigid retrograde ureteroscope.The second case was a 12-year-old boy who received a percutaneous nephroscopy on one side and a percutaneous nephroscopy with a rigid ureteroscope on the other side due to the presence of bilateral UPJ stenosis.The third case was a 32-year-old woman with bilateral lower ureteral stricture treated using a rigid retrograde ureteroscope.Endoscopic surgeries were successfully performed on all the three patients.Varying degrees of encrustation and erosion of the urothelium were observed during the operation.The calcified layer composition analysis showed magnesium ammonium phosphate or carbonate apatite.Two patients achieved a good prognosis.CONCLUSION Minimally invasive endoscopic treatment for urothelial encrusted pyelo-ureteritis disease can yield better results.