Anterior Planes Research Articles

Is occlusal contact re-established within 6 months after bonding of a fixed anterior bite plane in adolescents with a Class II division 2 incisor relationship? A randomised controlled trial.

To determine if re-establishment of occlusal contact was achieved within 6 months after insertion of a fixed anterior bite plane in individuals with Class II division 2 incisor relationship, and to evaluate the occlusal and vertical skeletal changes and acceptance of the intra-oral scanner and bite plane. Single-centre two-arm parallel group randomised controlled trial with 1:1 allocation to intervention and control groups. Dundee Dental Hospital and Research School, UK. A total of 38 participants aged 9-16 years (11 males, 27 females) with Class II division 2 incisor relationship and increased overbite (greater than one-third incisor overlap). Participants were randomised to intervention (n = 19) and control (n = 19) groups using block randomisation. The intervention group had a fixed anterior bite plane, and the occlusion and vertical facial dimensions were monitored with intra-oral scans, lateral cephalograms and photographs. The control group received no treatment and occlusal and vertical facial dimensions were monitored with scans and photographs. Questionnaires were completed by participants and parents/carers. An intention-to-treat analysis was planned. The overbite reduced in all participants in the intervention group (mean initial overbite: 5.07 mm, 95% confidence interval [CI] = 4.15-6.00; mean overbite after 6 months: 2.45 mm, 95% CI = 1.93-2.96). There was a mean incisor intrusion of 0.29 mm (95% CI = 0.17-0.42) and mean eruption of the first molars of 0.23 mm (95% CI = 0.09-0.37). There was no significant change in incisor inclination or vertical skeletal change. Feedback from participants and their parents/carers were generally positive. Fixed anterior bite planes effectively reduce an increased overbite in adolescents with a Class II division 2 incisor relationship, due to a combination of incisor intrusion and molar eruption with no change in incisor inclination or vertical skeletal change. Intra-oral scanning and fixed anterior bite planes are acceptable in adolescents.

Role of the video head impulse test in the evaluation of vestibulo-ocular reflex in individuals with Parkinson's disease.

<p>Parkinson&rsquo;s disease (PD) is the most common movement disorder and the second most common neu&shy;rodegenerative disease of the central ner&shy;vous system. Dizziness is frequently reported by PD patients, yet there is a paucity of research focusing on the vestibulo-ocular reflex (VOR) in this population using high-frequency vestibular testing. This study aims to investigate the VOR in individuals with PD using the video head thrust test with and without suppression.&nbsp;</p>. <p>Forty individuals with PD and 40 healthy individuals were included in the study. According to the Hoehn-Yahr Scale, individuals with PD were defined as early stage with a score of 1&ndash;2.5 and middle to late stage with a score of 3 to 5. The Head Impulse Testing Paradigm (HIMP) and Suppression Head Impulse Testing Paradigm (SHIMP) were applied to all individuals.</p>. <p>No statistically significant difference was observed between the PD group and the control group in terms of semicircular canal (SCC) gains in both HIMP and SHIMP tests. No catch-up saccades were observed in the right anterior, right posterior, left anterior, and left posterior SCC planes in the PD and control groups. However, in the right lateral SCC plane 32 patients in the PD group had saccades, while 8 patients in the control group had saccades. In the left lateral SCC plane, 32 patients in the PD group and 9 patients in the control group had catch-up saccades. A statistically significant difference was observed in the number and amplitude of saccades in the right and left lateral SCC planes compared to the control group (p&lt;0.05). In addition, in the PD group, the amplitude, peak velocity, and latency of the anticompensatory saccades seen in SHIMP showed a statistically significant difference compared to the control group (p&lt;0.05).</p>. <p>VOR in the vertical SCC plane was not affected in individuals with PD. However, VOR in the lateral SCC plane was affected. It was concluded that when evaluating VOR with both HIMP and SHIMP in individuals with PD, the presence of catch-up saccades should be focused on and evaluated for possible vestibular dysfunction, even though SCC gains are normal. This study will contribute to a deeper understanding of vestibular function in PD, potentially informing better management strategies for dizziness in this population.&nbsp;</p>.

Intelligent analysis and measurement of semicircular canal spatial attitude.

The primary aim of this investigation was to devise an intelligent approach for interpreting and measuring the spatial orientation of semicircular canals based on cranial MRI. The ultimate objective is to employ this intelligent method to construct a precise mathematical model that accurately represents the spatial orientation of the semicircular canals. Using a dataset of 115 cranial MRI scans, this study employed the nnDetection deep learning algorithm to perform automated segmentation of the semicircular canals and the eyeballs (left and right). The center points of each semicircular canal were organized into an ordered structure using point characteristic analysis. Subsequently, a point-by-point plane fit was performed along these centerlines, and the normal vector of the semicircular canals was computed using the singular value decomposition method and calibrated to a standard spatial coordinate system whose transverse planes were the top of the common crus and the bottom of the eyeballs. The nnDetection target recognition segmentation algorithm achieved Dice values of 0.9585 and 0.9663. The direction angles of the unit normal vectors for the left anterior, lateral, and posterior semicircular canal planes were [80.19°, 124.32°, 36.08°], [169.88°, 100.04°, 91.32°], and [79.33°, 130.63°, 137.4°], respectively. For the right side, the angles were [79.03°, 125.41°, 142.42°], [171.45°, 98.53°, 89.43°], and [80.12°, 132.42°, 44.11°], respectively. This study successfully achieved real-time automated understanding and measurement of the spatial orientation of semicircular canals, providing a solid foundation for personalized diagnosis and treatment optimization of vestibular diseases. It also establishes essential tools and a theoretical basis for future research into vestibular function and related diseases.

Impact of Ultrasound Scanning Plane on Common Carotid Artery Longitudinal Wall Motion

ObjectiveThe arterial wall not only moves in the radial direction to expand circumferentially but also moves in the axial (longitudinal) direction in a predictable bidirectional pattern during a normal cardiac cycle. While common carotid artery (CCA) longitudinal wall motion (CALM) has been described previously, there is a lack of evidence-based method standardization to align practices for human measurement. The purpose of this study was to evaluate whether different scanning planes impact CALM outcomes in healthy males and females to provide clarity on data collection strategies. MethodsThirty-one healthy adults (16 females, 23 ± 3 y of age) underwent ultrasound scanning of the right CCA in the anterior, lateral, and posterior imaging planes. CALM was evaluated using a custom speckle-tracking algorithm and was analyzed as segmental motion outcomes (anterograde, retrograde, maximum displacement and radial-axial path length). ResultsNo differences in any CALM outcome were observed between imaging planes (p > 0.05), and equivalence testing indicated that retrograde CALM displacement was similar between anterior and posterior distal walls (p = 0.04). We observed no differences (p > 0.05) in CALM outcomes between the proximal (free-wall, adjacent to the internal jugular vein [IJV]) and distal wall in the posterior imaging plane. Qualitatively, it was more difficult to successfully track vascular tissue between the IJV and CCA due to the thin wall components and highly mobile wall in the radial direction. ConclusionIn the absence of clear differences between scanning planes, we recommend standardizing acquisition in the lateral plane and avoiding the IJV free-wall when evaluating CALM in humans.

Comparing Abdominal and Retroperitoneal Organ Sonographic Measurements to Postdissection Measurements: A Pilot Study

Objective: Variation in organ size can occur due to different sonographic scan planes used to make measurements. Diagnostic accuracy may be compromised due to the variations in organ measurement. Therefore, the aim of this study was to compare sonographic measurements and actual organ measurements, taken predissection and postdissection, to determine the accuracy of sonographic measurements, taken in various sonographic scan planes. Materials and Methods: Sonographic organ measurements were made of the liver, kidney, and spleen, prior to cadaver dissection. Liver length measurements were acquired in the midclavicular and intercostal sonographic scan planes. All kidney length, height, and width measurements were acquired scanning from the anterior and coronal planes. Spleen measurements were acquired using an intercostal sonographic scan plane, using longest dimension for length, and acquiring transverse measurements from both a 90-degree and a 180-degree transducer rotation. Descriptive statistics were reported using mean, standard deviation, median, and interquartile range. Results: Liver length, spleen length, right kidney length and width, and left kidney width showed no measurement differences. Sonographic measurements of right kidney height varied ( P &lt; .0001). The sonographic left kidney length was more accurate when acquired in the coronal plane ( P = .006), and the height measurement was more accurate taken from the anterior plane ( P &lt; .001). Spleen width varied between the 90-degree and 180-degree transducer rotation, and postdissection measures ( P = .0010). Conclusion: This pilot study would suggest that there is a need for the development of standardized sonographic organ measurement protocols.

HoLEP Learning Curve-Resident Perspective: Survey of Senior Residents from High-Volume Tertiary Center.

Objective: We aim to report the learning curve and experience performing holmium laser enucleation of the prostate (HoLEP) from a resident standpoint trained at a tertiary high-volume center. Methods: An electronic survey was distributed to 10 surveyees that included recently graduated chief residents trained at Indiana University in the past 3 years i.e., between 2020 and 2022 with a 100% response rate. The questionnaire focused on HoLEP training experience based on a recently established mentorship curriculum in training the residents through each individual step of the surgery. Results: The average learning curve for performing HoLEP was reported to be greater than 25 cases with 50% of the residents reporting >50 cases to master the technique. The surgical difficulty of steps of the HoLEP were rated on a subjective scale of 1-5: 1 = very easy, 2 = easy, 3 = neutral, 4 = hard, and 5 = very hard. The common challenging steps in decreasing the order of difficulty as reported are performing apical enucleation, joining anterior and posterior planes, and dividing anterior commissure with a mean rating of 3.5, 3.1, and 3.1, respectively. The most difficult aspect of the surgery to master was performing apical dissection (60%). Comparing operative parameters for HoLEP with transurethral resection of the prostate in aspects of resection volume and times, 70% of candidates reported it better for HoLEP whereas 20% had similar times for both procedures. A total of 90% of the residents felt confident to offer HoLEP as part of their practice without the need for any further training. Regarding the initial challenge of including HoLEP surgery in practice, the majority (60%) reported difficulty with equipment set up in their practice while 20% reported difficulty maintaining efficient operating room (OR) times and turnover. Conclusion: We believe HoLEP can be performed immediately after residency training and incorporated into practice with high volume, repeated exposure to HoLEP surgery throughout residency based on study results. The average learning curve reported for performing HoLEP was greater than 25 cases.

Impact of septal deviation and turbinate hypertrophy on nasal airway obstruction: insights from imaging and the NOSE scale: a retrospective study

BackgroundThe aim of this study was to evaluate the effects of nasal septum deviation and inferior turbinate hypertrophy on nasal obstruction by utilizing the Nose Obstruction Symptom Evaluation (NOSE) values and paranasal sinus computed tomography (PSCT) findings for correct preoperative evaluation.MethodsNinety-six patients (57 males and 39 females) aged between 18 and 54 years (mean age, 30.3 ± 9.7 years) participated in this study. Among them, 56 patients underwent septoplasty combined with inferior turbinate outfracture, while 40 patients underwent septoplasty alone. Preoperative nasal examinations were performed on all patients. The direction, location, nasal septum deviation classification, and inferior turbinate hypertrophy size classification were carefully evaluated and compared with the NOSE survey results. PSCT of 56 patients were evaluated and classified by calculating the coronal location of septum deviation, the axial location of septum deviation, the coronal angle of septum deviation, and the axial angle of septum deviation.ResultsA positive correlation was found between the coronal location of the septal deviation and the preoperative NOSE 2, and the NOSE total, and the difference of postoperative and preoperative NOSE (p = 0.032, p = 0.007, p = 0.021, respectively). There was a statistically significant relationship between the coronal location of the septal deviation classification and the NOSE preoperative total values (p = 0.26). A negative statistically significant correlation was found between inferior turbinate hypertrophy and preoperative NOSE 5 values (p = 0.029).ConclusionWe conclude that the combination of PSCT and the NOSE scale is helpful in determining the severity of nasal obstruction prior to surgery. Specifically, we found that nasal septum deviations located in the anterior and coronal planes have a greater impact on nasal obstruction compared to deviations in the axial plane. Inferior turbinate fracture does not provide more benefit than septoplasty alone in treating patients’ nasal obstruction. These findings emphasize the importance of a comprehensive approach in addressing nasal obstruction for optimal patient outcomes.

Effectiveness of removable anterior bite planes with varied mealtime protocols in correcting deep bites among growing patients: a randomized clinical trial.

To compare effectiveness of two protocols for correcting deep bite in growing patients using a removable anterior bite plane (RABP): full-time wear with appliance on during meals (F + M) vs off during meals (F - M) and to explore the relationship between average daily duration of wear and overbite (OB) correction rate, stratified by the wear protocol. Thirty-two growing patients with deep bite (mean age = 10.94 ± 2.17 years) were randomly assigned to the F + M (n = 16) or F - M (n = 16) group. Cephalometric radiographs were taken at baseline (T0) and when normal OB was achieved (T1). Duration of wear was recorded by a TheraMon microsensor within the appliance. A best-fit regression model for the relationship between daily duration of wear and OB correction rate was determined (α = 0.05). Both groups exhibited similar baseline characteristics and cephalometric changes, ie, molar extrusion, and incisor intrusion and proclination in both arches (P < .05), and intergroup differences were not significant. Here, F + M exhibited significantly faster rates of deep bite correction (1.83 ± 1.18 vs 1.08 ± 0.62 mm/month; P < .05) and mandibular molar extrusion (0.46 ± 0.25 vs 0.30 ± 0.18 mm/month, P < .05) compared with F - M. Best-fit regression models for relationship between daily duration of wear and OB correction rate were exponential for both F + M (R2 = 0.53) and F - M (R2 = 0.74). Here, F + M and F - M protocols resulted in comparable cephalometric changes among deep bite growing patients. However, the F + M group exhibited a faster correction rate. Daily duration of wear positively correlated with OB correction rate in an exponential manner.

The spread of injectate after deep serratus anterior plane and superficial parasternal intercostal plane blocks: a cadaveric dye study.

We investigated the distribution of injected dye after deep serratus anterior plane and superficial parasternal intercostal plane blocks in 15 Thiel embalmed cadavers. We injected 0.4 ml.kg-1 of 0.25% aqueous methylene blue solution into the deep serratus anterior and superficial parasternal intercostal planes using real-time ultrasound needle visualisation followed by posterior dissection to observe the distribution of the injected dye in the chest wall. The two blocks were performed bilaterally in 15 cadavers at the T5/T6 level, comprising 60 blocks in 30 hemithoraces in total. At dissection, the intercostal nerve territories were observed to be dyed completely from T2 to T6 in 28 of 30 hemithoraces, and extending caudal to T6 in 10 hemithoraces. Following the deep serratus anterior plane blocks in all cadavers, the dye was found to have spread to the axillae. Following the superficial parasternal intercostal plane blocks, the dye reached T7 in four cadaver dissections. We concluded that the territories innervated by the intercostal nerves (T2-T6 dermatomes) are dyed following the combination of the two blocks when performed at the T5-T6 intercostal space level. These techniques might provide an effective option for anaesthesia in breast surgery.

Association of Anterior and Posterior occlusal planes with skeletal class I, class II and class III malocclusion

Introduction: The occlusal plane is a very vital in stomatognathic system and the association between anterior occlusal planes and posterior occlusal plane plays an important role during orthodontic treatments. Methods: Lateral cephalometric radiographs of 270 adult patients of the different classes of malocclusion were used. Several angular measurements were measured and compared among all study groups to evaluate the existence of relationship between AOP and POP with skeletal and vertical patterns. Results: The skeletal patterns showed a significant difference in anterior occlusal plane angle relative to both SN plane and FH plane among all classes of malocclusion (p-value =0.001**) having a steeper inclined plane in Class II and flat inclined plane in Class III. POP in relation to FH plane and SN plane showed lowest angle in skeletal Class III and highest in Skeletal Class I patients. Conclusion: The occlusal planes were found to have an impact on the jaw base where the variation in its angulation of different occlusal planes had affected both sagittal and vertical facial patterns. AOP relative to SN and FH were steeper in Class II and flat in Class III, while the POP relative to FH showed the same value in Classes II and III. Keywords: Anterior occlusal plane, Posterior occlusal plane, Malocclusion, Skeletal patterns, Vertical pattern, Lateral cephalometric radiograph.

Role of the functional head impulse test in evaluating vestibulo-ocular reflex abnormalities in individuals with Parkinson's disease.

To assess vestibular-ocular reflex (VOR) function in patients with Parkinson's disease (PD) using a new method called functional head impulse test (fHIT). Case-control study. Tertiary medical center. Twenty individuals with PD were recruited for PD group, and twenty healthy individuals for the control group. Ages of both groups ranged from 47 to 76 years. According to the modified Hoehn-Yahr score, PD group was classified as an early stage with a range of 1-2.5 and a mid-late stage with a range of 3-5. Percentage of correct answers (%CA) was calculated using fHIT for lateral, anterior and posterior semicircular canal (SCC) planes. PD group had statistically lower fHIT %CA in the right lateral, left lateral, and left posterior SCC planes compared to control group (p < .05). There was no statistical difference between two PD severity groups and functional VOR abnormality. It was concluded that the functional VOR in the right lateral and left lateral and left posterior SCC plane was affected in individuals with PD. Our results show that impaired VOR and reduced dynamic visual acuity should be considered in individuals with PD for vestibular rehabilitation exercises.

Relationship of Occlusal Planes with Sella-Nasion and Frankfort Horizontal Planes in Different Skeletal Malocclusion. A Cephalometric Study

Objective: The objective of this study is to assess the relationship of anterior and posterior occlusal planes (AOP &amp; POP) with Sella-Nasion (SN) and Frankfort Horizontal (FH) planes in different skeletal malocclusion. Study Design and Setting: It was a cross-sectional study carried on 202 (40 males and 190 females) pretreatment lateral cephalogram of orthodontic patients of Jinnah Medical and Dental College, Karachi from June to September 2021. Methodology: The sample was divided into different skeletal pattern using ANB angle (Class I ANB 0-4°, Class II ANB&gt;4° and ANB Class III &lt;0°). The AOP and POP measured with respect to SN and FH planes in each class. Two way ANOVA was used to determine the relationship of occlusal planes among skeletal malocclusions. Results: 202 cephalogram, 40 males and 190 females were included in this study, out of which 102 (28 males and 102 females) were of class I, 88 (12 males and 76 females) were class II and 12 females were class III. Class II showed steeper SN-AOP and FH-POP than both Class I and Class III. There was statistically significant relationship between SN and AOP among all the three skeletal malocclusions (p&lt;0.005) and FH-AOP in class I and II (p&gt;0.025).While SN-POP and FH-POP were not statistically significant in all the three classes. Conclusions: Class II malocculsion showed steeper SN-AOP and FH-POP than Class I and Class III. POP to SN and FH were flatter in Class III.

Imaging study on the relationship between anterior and posterior occlusal planes and temporomandibular osteoarthrosis.

The aim of this study was to compare the anterior and posterior occlusal plane characteristics of patients with different temporomandibular joint osseous statuses. A total of 306 patients with initial cone beam CT (CBCT) and cephalograms were included. They were divided into three groups on the basis of their temporomandibular joint osseous status: bilateral normal (BN) group, indeterminate for osteoarthrosis (I) group, and osteoarthrosis (OA) group. The anterior and posterior occlusal planes (AOP and POP) of the different groups were compared. Then, the regression equation was established after adjusting for confounding factors, and a correlation analysis between the occlusion planes and other parameters was performed. SNA, SNB, FMA, SN-MP, Ar-Go, and S-Go were correlated with the occlusal planes. Relative to the BN and I groups, the FH-OP of the OA group increased by 1.67° on the average, FH-POP increased by 1.42° on the average, and FH-AOP increased by 2.05° on the average. The occlusal planes were steeper in the patients with temporomandibular osteoarthrosis than in the patients without it, and the mandible rotated downward and backward. The height of the mandibular ramus, the mandibular body length, and the posterior face height were small. In clinical practice, attention should be given to the potential risk of temporomandibular joint osteoarthrosis in such patients. In addition, SNB, FMA, SN-MP, Ar-Go, S-Go, and occlusal planes had moderate correlations.

Identification of Deep Cervical Fascial Layers During Anterior Cervical Spine Exposure.

Anterior approaches to the cervical spine are among the most common exposures by which neurosurgeons and orthopedic surgeons access the prevertebral space and ultimately the cervical disk and vertebral bodies. There is a paucity of literature describing the microanatomic fascial planes of the neck with respect to anterior cervical approaches. To delineate the microanatomic connections of the cervical fascial planes pertinent to anterior cervical exposure. Using a cadaveric model, original illustrations, the Visible Human Project, and an original surgical video, we demonstrate a stepwise method for identifying the correct planes for anterior cervical exposure. A step-by-step method for identifying the anterior cervical fascial planes intraoperatively is demonstrated. A comprehensive understanding of anterior cervical microsurgical anatomy is vital for performing a methodical yet efficient approach to the prevertebral space while minimizing retraction and iatrogenic injury to the surrounding neurovascular structures.

Cat-Ear-Line: A Sonographic Sign of Cortical Development?

Diagonal echogenic lines outside the lateral ventricle have often been observed in the anterior coronal planes of the normal fetal brain by neurosonography. We have observed abnormal shapes of these echogenic lines in cases of malformation of cortical development (MCD). We named the ultrasound finding "cat-ear-line" (CEL). This study aimed to examine how and when CEL develops in normal cases compared with MCD cases. We retrospectively examined the fetal brain volume dataset acquired through transvaginal 3D neurosonography of 575 control cases and 39 MCD cases from 2014 to 2020. We defined CEL as the hyperechogenic continuous lines through subplate (SP) and intermediate zone (IZ), pre-CEL as the lines that existed only within the SP, and abnormal CEL as a mass-like or mosaic shadow-like structure that existed across the SP and IZ. All fetuses in the MCD group had some neurosonographic abnormalities and were ultimately diagnosed with MCD. The CEL was detected in 97.9% (369/377) of the control group from 19 to 30 weeks. The CEL visualization rate of the MCD group in the same period was 40.0% (14/35) which was significantly lower than that of the control group (P < .001). From this study, it appears that the CEL is an ultrasound finding observed at and beyond 19 weeks in a normally developing fetus. In some MCD cases, pre-CEL at and beyond 19 weeks or abnormal CEL was observed. Maldeveloped CEL at mid-trimester may help identify cases at-risk of subsequent MCD.

Effects of anterior bite planes fabricated from acrylic resin and thermoplastic material on masticatory muscle responses and maximum bite force in children with a deep bite: A 6-month randomised controlled trial.

Anterior bite planes are bite-raising appliances used for deep bite correction. However, muscle responses to anterior bite planes of different harnesses may vary. To prospectively evaluate masticatory muscle activity, muscle balance and maximum bite force (MBF) responses to anterior bite planes fabricated from acrylic resin (ABP) or bi-laminate thermoplastic (TBP) over 6months in children with a deep bite. Sixty-six children were randomly assigned to the ABP, TBP or untreated control groups. Masticatory muscle activity, activity index (AC) and percentage overlapping coefficient (POC) were assessed by surface electromyography; MBF, using a custom-made bite force sensor. Data were collected before, immediately after appliance insertion and after 2 weeks and 1, 3 and 6months of treatment. Within- and between-group differences were analysed using the one-way ANOVA/Kruskal-Wallis and Mann-Whitney U tests (α=.05); Friedman's tests were used to assess within-group differences over time (α=.08). At rest, no dependent variables changed throughout the study. At maximum clenching, masticatory muscle activity immediately dropped significantly but returned to baseline values and was equal to the control group at 1-3months. The ABP group had significantly lower masseter activity and AC than the TBP group after insertion. Neither POC nor MBF were significantly different within or between groups. Masticatory muscle activity reduced after anterior bite plane insertion but returned to baseline after 1-3months. Masseter activity decreased significantly more in the ABP group than TBP group. Neither appliance significantly affected POC or MBF. Thai Clinical Trial Registry (TCTR20210330002).

V07-07 ANATOMICAL ROBOTIC-ASSISTED RADICAL PROSTATECTOMY: STEP-BY-STEP NERVE-SPARING TECHNIQUE FOR DIFFERENT GRADES OF PRESERVATION

You have accessJournal of UrologyCME1 May 2022V07-07 ANATOMICAL ROBOTIC-ASSISTED RADICAL PROSTATECTOMY: STEP-BY-STEP NERVE-SPARING TECHNIQUE FOR DIFFERENT GRADES OF PRESERVATION Marcio Covas Moschovas, Travis Rogers, Jonathan Noel, Jaber Abdel, Seetharam Bhat, and Vipul Patel Marcio Covas MoschovasMarcio Covas Moschovas More articles by this author , Travis RogersTravis Rogers More articles by this author , Jonathan NoelJonathan Noel More articles by this author , Jaber AbdelJaber Abdel More articles by this author , Seetharam BhatSeetharam Bhat More articles by this author , and Vipul PatelVipul Patel More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002598.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Over the years, since Binder and Kramer described the first Robotic-assisted Radical Prostatectomy (RARP) in 2000, different Nerve-sparing (NS) techniques have been proposed by several authors. However, even with the robotic surgery advantages, functional outcomes following RARP, especially erection recovery, still challenge surgeons and patients. In this scenario, we have described different ways and grades of neurovascular bundle preservation (NVB) using the prostatic artery as a landmark until our most recent technique with lateral prostatic fascia preservation and modified apical dissection. In this video compilation, we have illustrated the details of different grades of NVB preservation. METHODS: Our video describes the details of different degrees of nerve-sparing using anatomical landmarks. We have illustrated the key aspects of a full nerve sparing, partial nerve sparing and intrafascial dissection preserving the lateral prostatic fascia. RESULTS: After the anterior and posterior bladder neck dissection, we lift the prostate by the seminal vesicles to access the posterior aspect of the prostate. Then, we incise the Denonvilliers layers and work between an avascular plane to release the posterior NVB from 5 to 1 and 7 to 11 o’clock positions on the right and left sides, respectively. In sequence, we access the prostate anteriorly by incising the endopelvic fascia bilaterally (close to the prostate) until communicating the anterior and posterior planes. Finally, we control the prostatic pedicles with Hem-o-lok clips and then proceed for the apical dissection preserving the maximum amount of urethra length and periurethral tissues. CONCLUSIONS: Potency recovery following radical prostatectomy remains a challenge due to its multifactorial etiology. However, basic concepts for nerve-sparing are crucial to achieving optimal outcomes, such as minimizing the amount of traction used on dissection, avoiding excessive cautery, and neural preservation based on anatomical landmarks (arteries and planes of dissection). Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e661 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Marcio Covas Moschovas More articles by this author Travis Rogers More articles by this author Jonathan Noel More articles by this author Jaber Abdel More articles by this author Seetharam Bhat More articles by this author Vipul Patel More articles by this author Expand All Advertisement PDF downloadLoading ...

Optimization of the Static Posture Evaluation Process Through Digital Processing of Photographic Images.

Traditional methods of posture evaluation carried out by physical therapists manually measure or test the alignments of body segments, investing a long time for its development and adding an error percentage related to the level of professional expertise. The present study uses a system of two dimensions photogrammetry to investigate its applicability on measurement of posture parameters and the variation of the measurements using different photographic cameras locate at different distances from the subject. The "marker automatic measurement" system (LAM) filters and segments body markers on photographic images. Data were collected using a semi-professional, a mid-range cellphone and a sports camera. Tests were recorded by placing the camera at 2.50, 2.00 and 1.80 meters from the subject, and the lens at a height of 1.10, 1.00 and 0.97 meters with an illuminance of 29.92 lux. Subsequently, 30 volunteers participated in the postural tests. The Measurements were made on frontal, anterior and posterior planes as well as sagittal plane. The maximum absolute error on the measuring of distances was 0.64 cm. On angles related to the horizontal was 0.70 degrees and for angles concerning the vertical was 0.76 degrees.Clinical Relevance-By utilizing LAM system all three views were evaluated in less than a minute without counting the time for putting on the markers. The results obtained suggest that the system presents trustworthy results, which reduce considerably the time of carrying out posture evaluations where results are measurable, repeatable and away from the evaluator's subjectivity.

Treatment of recurrent inguinal hernia after TransInguinal PrePeritoneal (TIPP) surgery: feasibility and outcomes in a case series.

TransInguinal PrePeritoneal (TIPP) inguinal hernia repair (IHR) combines an open anterior approach with a preperitoneal position of the mesh. Advantages include reduced chronic postoperative inguinal pain, low recurrence rates and quick recovery. Critics have expressed concerns that recurrent IHR after TIPP could be difficult and with an increased risk of complications due to the formation of scar tissue in both the anterior and posterior anatomical inguinal planes. This study reports feasibility and outcomes of recurrent IHR after TIPP repair. Patients who underwent recurrent IHR after TIPP between January 2013 and January 2015 in a single hernia-dedicated teaching hospital were included. Exclusion criteria were femoral hernia, incarcerated hernia and reasons for unreliable follow-up. Electronic medical records were assessed retrospectively to register surgical outcomes and complications. Thirty-three patients underwent surgical repair of recurrent inguinal hernia after TIPP. Twenty patients were treated with a "re-TIPP when possible" strategy; resulting in 13 successful re-TIPPs and 7 conversions to Lichtenstein repair. Eleven patients underwent a primary Lichtenstein's repair, the remaining two patients underwent recurrent IHR using other techniques (TransREctus sheath PrePeritoneal and TransAbdominal PrePeritoneal repair). Mean time of surgery was 44.7min (standard deviation 16.7). There was one patient (3.0%) with a re-recurrent inguinal hernia during follow-up. Other minor complications included urinary tract infection. These results indicate that after TIPP it is feasible and safe to perform re-surgery for recurrent inguinal hernia with an anterior approach again. For these recurrences, a Lichtenstein repair can be performed, or a "re-TIPP if possible"strategy can be applied by experienced TIPP surgeons, tailored to the intraoperative findings. Whether a re-TIPP has advantages over Lichtenstein should be evaluated in a prospective manner.

Long-Term Outcomes in Ventricular Assist Device Outflow Cannula Anastomosis to the Descending Aorta

BackgroundLeft ventricular assist device (LVAD) implantation via thoracotomy with outflow cannula anastomosis to the descending aorta is an alternative implantation technique that uses a single incision and avoids anterior mediastinal planes. We evaluated long-term survival and hospital readmissions after LVAD implantation via thoracotomy with outflow cannula anastomosis to the descending aorta. MethodsAdult patients implanted with a continuous flow centrifugal LVAD at an academic center were retrospectively analyzed. Patients were assigned to 1 of 2 cohorts based on the anastomosis site of the LVAD outflow cannula: ascending aorta cohort (Asc-Ao) and descending aorta cohort (Desc-Ao). Primary and secondary outcomes were survival and hospital readmissions during device support. Readmission analysis included patients with ≥30-day survival after discharge. Multivariable analysis and propensity score matching were performed. ResultsSurvival analysis included 330 patients (Asc-Ao: 272, Desc-Ao: 58). Readmission analysis included 277 patients (Asc-Ao: 231, Desc-Ao: 46) and a total of 1028 readmissions during 654 patient-years of follow-up were analyzed. There was no significant difference in in-hospital, 6-month, 1-year, 3-year, and 5-year mortality between the two cohorts. Readmission-free survival, 30-day readmission, number of admissions per year and hospital length of stay per year were not significantly different between the 2 cohorts after adjustment for patient characteristics. ConclusionsThis study found no difference in long-term survival or hospital readmissions between LVAD implantation via thoracotomy with outflow cannula anastomosis to the descending aorta and standard implantation.