Objective
Microscopic surgery is currently considered the ‘gold standard’ for middle-ear, mastoid and lateral skull base surgery. The coronavirus disease 2019 pandemic has made microscopic surgery more challenging to perform. This work aimed to demonstrate the feasibility of the Vitom 3D system, which integrates a high-definition (4K) view and three-dimensional technology for ear surgery, within the context of the pandemic.
Method
Combined approach tympanoplasty and ossiculoplasty were performed for cholesteatoma using the Vitom 3D system exclusively.
Results
Surgery was performed successfully. The patient made a good recovery, with no evidence of residual disease at follow up. The compact system has excellent depth of field, magnification and colour. It enables ergonomic work, improved work flow, and is ideal for teaching and training.
Conclusion
The Vitom 3D system is considered a revolutionary alternative to microscope-assisted surgery, particularly in light of coronavirus disease 2019. It allows delivery of safe otological surgery, which may aid in continuing elective surgery.
Lipoid proteinosis is a rare genetic condition, which typically presents in infancy with dysphonia and subsequent skin involvement. Two cases are presented to demonstrate that laryngotracheal symptoms can be controlled with interval laser debulking and the 'pepper pot' technique without causing stenosis.
A case of a primary tracheal schwannoma refractory to endoscopic treatment in a 54-year-old male is reported. Previous treatment was by endoscopic laser debulking. Computed tomography (CT) 2 months later demonstrated a recurrent tumour involving the anterior tracheal wall with intraluminal tracheal extension. Treatment was successful by limited tracheal resection with primary anastomosis performed 2 weeks following the scan. The histology confirmed a benign neurogenic tumour derived from Schwann cells and clear margins.
An e-referral system monitors activity accurately. Systemic improvement in referral pathways would lead to better patient care and enable services to factor in the unseen component of workload and prompt realistic staffing.
A 4-month-old boy presented with a cystic swelling at the floor of the mouth causing acute airway compromise. The only previous history of note, was a tongue tie release at 3 days old. CT scan suggested a dermoid cyst with extensive floor of mouth abscess. He had an excision of the cyst and drainage of the superimposed abscess and made a good recovery. The histology report revealed a dermoid cyst which is a rare diagnosis in a child, particularly within the oral cavity. Early treatment is required to remove these lesions especially when they cause airway compromise or swallowing difficulties. This is the first case to our knowledge which suggests tongue tie release procedures causes a predisposition to the development of dermoid cysts in the oral cavity.
Objective: Transurethral resection of the prostate (TURP) operations are frequently deferred. Consequently, patients awaiting TURP have multiple urology-related admissions for problems such as urinary retention. This audit aims to determine the effect of TURP deferments on the frequency and duration of urology-related admissions, as well as the financial implication in our institution over a three-month period. Patients and methods: A retrospective, electronic database review of patients who received a TURP at Northwick Park Hospital, between 1 January 2014-31 March 2014, was carried out. The following data were extracted: (a) date the patient was listed for TURP; (b) date patient underwent TURP; (c) number of deferments between a patient being listed for surgery and receiving their operation; (d) reason(s) for deferment; and (e) number, duration and indication of urology-related inpatient admissions whilst awaiting TURP. Using this data, we calculated the cost of urology-related admissions whilst awaiting surgery. Results: In total, 44 patients underwent a TURP operation. Of these, 21 patients had their TURP deferred. There were 23 urology-related admissions whilst patients awaited a TURP. Fifteen of these admissions were attributed to eight patients with deferments to surgery. They spent a total of 45 days/30 nights in hospital. The remaining eight urologyrelated admissions were accounted for by six patients with no deferments to surgery. They spent 12 days/3 nights in hospital. We approximate a daily cost of £250 for an NHS bed. This equates to a total cost of £11,250 (£1406 per patient) for the eight patients who had TURPs deferred versus £3000 (£500 per patient) for those six patients without deferments. Conclusion: Patients who have their TURP operations deferred have an increased frequency and duration of urologyrelated admissions, associated with an additional cost of at least £900 per patient.
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