Korenkov Michael
Department of General and Visceral Surgery, Klinikum Werra-Meissner Eschwege, Germany.
Surg Technol Int. 2018 Jun 1;32:105-108.
The video-assisted subcutaneous destruction of the sinus tract (VADST) is a novel, minimally-invasive technique for the treatment of pilonidal sinus disease (PSD). This is an advancement of the previously described subcutaneous destruction of the sinus tract and the removal of hairs as well as the long-term vessel-loop drainage of the wound channel (DST). Although the first results of this operation seemed to be promising, some of my colleagues felt that the blind approach to this procedure could be its potential "weak point". As a result of this critique, the procedure was enhanced with the subcutaneous video-assisted inspection of the natal cleft. Throughout most steps of VADST, like the widening of pilonidal pits with mosquito and/or Pean clamps, the subcutaneous destroying of the sinus tract, lifting the skin in a natal cleft with a curette, removing the hair with a Pean clamp and a subcutaneous vessel-loop drainage, were found to be similar to DST. The new steps involve the possibility of the video-assisted control of hair vestiges and bleedings as well as the removal of hair and debris under visual control. A rigid choledochoscope from Berci (Firma Richard Wolf GmbH, Knittlingen, Germany) was used for the subcutaneous endoscopic examination of the natal cleft area. Neither gas application nor water perfusion were necessary for this step. Three patients with simple forms of PSD, and one patient with an acute abscess formation, underwent the VADST procedure. The patients with simple forms of PSD had no adverse events during the first eight weeks postoperatively. The patient with an acute abscess formation developed a purulent inflammation that required a wide local excision with an open-wound healing. Due to the very small number of patients in this report, we were not able to asses this technique properly. Contrary to DST, we intend to use VADST, not only for the treatment of patients with simple forms (primary pilonidal sinus without abscessed inflammation with maximal three orifices, all of them inside the navicular area), but also for the treatment of complex PSD forms.
视频辅助皮下窦道破坏术（VADST）是一种用于治疗藏毛窦疾病（PSD）的新型微创技术。这是对先前描述的皮下窦道破坏术、毛发清除术以及伤口通道长期血管袢引流术（DST）的改进。尽管该手术的初步结果似乎很有前景，但我的一些同事认为该手术的盲目操作方式可能是其潜在的“弱点”。基于这一批评意见，该手术通过皮下视频辅助检查臀裂得到了改进。在VADST的大多数步骤中，如用蚊式钳和/或皮安钳扩大藏毛窦坑、皮下破坏窦道、用刮匙在臀裂处提起皮肤、用皮安钳清除毛发以及皮下血管袢引流，都与DST相似。新步骤包括视频辅助控制毛发残留和出血以及在视觉控制下清除毛发和碎屑的可能性。使用了来自贝西公司（德国克尼特林根的理查德·沃尔夫有限公司）的硬质胆道镜对臀裂区域进行皮下内镜检查。此步骤既无需充气也无需注水。3例单纯型PSD患者和1例急性脓肿形成患者接受了VADST手术。单纯型PSD患者在术后前8周没有出现不良事件。急性脓肿形成的患者发生了脓性炎症，需要进行广泛的局部切除并开放伤口愈合。由于本报告中的患者数量非常少，我们无法对该技术进行恰当评估。与DST不同，我们打算将VADST不仅用于治疗单纯型患者（原发性藏毛窦，无脓肿性炎症，最大三个窦口，均在舟状窝区域内），还用于治疗复杂型PSD。
