Apical Approaches Research Articles

Major factors for the effectiveness of apical endodontic microsurgery: a systematic review

Introduction: Apical endodontic microsurgery is a technique developed by the evolution of traditional apical endodontic surgery approaches and technologies. This enhancement was possible since the introduction of equipment like cone beam computed tomography, microscope, ultrasonic instruments, and biocompatibility root-end material filling, increasing the predictability and long-term success rates and survival of teeth. Objective: It explored and developed the main factors for the effectiveness of apical endodontic microsurgery. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from October to December 2023 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 118 articles were found, 43 articles were evaluated in full and 36 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 28 studies with a high risk of bias and 21 studies that did not meet GRADE and AMSTAR-2. Most studies did not show homogeneity in their results, with X2=57.5%<50%. It was concluded that the success of apical endodontic surgery in terms of healing existing periapical pathology, together with a good long-term prognosis, depends on correct diagnosis and planning, as well as the association of surgical techniques, well-executed protocols, and biocompatible materials. The apical endodontic microsurgical approach is predictable and has a high success rate, which resulted from the introduction of cone beam computed tomography, microscope, ultrasonic instruments, and materials such as MTA and bioceramics for retro-fillings.

Five-year surgical outcomes of transvaginal apical approaches in women with advanced pelvic organ prolapse.

In women with advanced prolapse, differences in vaginal apex anchoring sites may impact surgical outcomes over time. The primary aim was to compare 5-year surgical outcomes of uterosacral ligament suspension (ULS) versus sacrospinous ligament fixation (SSLF) in women with advanced (stage III-IV) prolapse. A secondary analysis was conducted in a subset of women with advanced prolapse from a multicenter randomized trial comparing ULS versus SSLF and its extended follow-up, using publicly accessible de-identified datasets. The primary outcome was time to failure, defined as any one of (1) apical descent > 1/3 into the vaginal canal or anterior/posterior compartment beyond the hymen, (2) bothersome vaginal bulge symptoms, or (3) re-treatment. Secondary outcomes include symptom severity measured by the Pelvic Organ Prolapse Distress Inventory (POPDI) and adverse events. Of 285 women, 90/147 (61.2%) in ULS and 88/138 (63.8%) in SSLF had advanced prolapse. Baseline characteristics did not differ between groups except for median-vaginal deliveries (3.0 [2.0, 5.0] versus 3.0 [2.0, 4.0], p < 0.01). The median time to failure was 1.7years ULS versus 2.0years SSLF (p = 0.42). Surgical failure increased over time in both groups with no intergroup difference; by year 5, the estimated failure rate was 67.7% ULS versus 71.5% SSLF (adjusted difference -3.8; 95%CI [-21.9, 14.2]). No differences were noted in individual failure components (p > 0.05). POPDI scores improved over 5years without intergroup difference (ULS -68.0 ± 61.1 versus SSLF -69.9 ± 60.3, adjusted difference -0.1 [-20.0, 19.9]). No difference in adverse events were observed (p > 0.05). In women with advanced prolapse, surgical failure, symptom severity, and adverse events did not differ between ULS and SSLF over 5years.

Anterior fibromuscular stroma-preserved endoscopic enucleation of the prostate: a precision anatomical approach.

Benign prostate obstruction (BOO) is becoming increasingly important in this aging society. Some urge/stress urinary incontinence (UUI/SUI) still occurs after endoscopic enucleation of the prostate (EEP). It remains unclear how post-EEP incontinence can be avoided. Currently, early apical release to ameliorate the traction of the external sphincter is the best technique for incontinence prevention. To describe our surgical technique of anterior fibromuscular stroma (AFS)-preserved EEP for BOO. The medical records of 60 consecutive patients who underwent AFS-preserved EEP for BOO in our center from September 2019 to December 2019 were retrospectively reviewed. AFS-preserved EEP starts at the 12 o'clock position of the urethra, and the junction between the AFS and transitional zone (T-zone) was identified. The AFS and T-zone were separated first to protect the AFS in the initial operative procedure. Then, following the usual enucleation procedure, AFS-preserved EEP could be achieved. Postoperative prostate-specific antigen (PSA), testosterone, urethral stricture, and voiding status, such as incontinence, uroflow, and postvoiding residual urine were assessed. The data show that AFS-preserved EEP could achieve similar surgical outcomes as other early apical release approaches. The preserved AFS provides a nice landmark at the 12 o'clock position during EEP.

Echocardiography in laboratory rabbits

Introduction. Rabbits are used as convenient models for studying drug cardiotoxicity. Echocardiography is one of the most informative non-invasive methods of assessing the cardiovascular system function. In literature, there is no clearly formulated protocol for heart ultrasound examination in rabbits. Purpose was the systematization of literature data on echocardiography techniques in rabbits.Materials and methods. The sources search involved the Scientific Electronic Library eLIBRARY.RU and the National Library of Medicine information base (PubMed.gov). The search covered the 15-year period. Original or review articles containing a detailed description of the echocardiography technique were included.Results and discussion. For animals anesthesia before the study, various drugs combinations based on ketamine, xylazine, medetomidine, zolazepam, tiletamine are used. In rabbits, it is possible to use M-, B-, Doppler echocardiography modes in a wide frequency range (5 – 12 MHz). Parasternal longitudinal, parasternal transverse and apical ultrasound approaches are applied. The parameters of the transmitral blood flow (peak A, peak E, ratio A/E, peak E', the magnitude of regurgitation), as well as the contractile function of the left ventricle (end systolic and diastolic volumes and sizes, stroke volume, cardiac output, shortening fraction) are subject to assessment. The Teicholz and Simpson methods can be used to calculate the ejection fraction. The literature under survey coveres listed parameters of normal values for various ages’ rabbits.Conclusion. Echocardiography is a relatively affordable non-invasive method for studying the state of cardiovascular system in rabbits in an experiment. The method can be used to analyze myocardium size, left ventricle contractile function, and assess the state of heart valvular apparatus. At present, normal values of echocardiographic parameters in rabbits have been experimentally established, which adds to the informative value of the method. Qualitative study performance requires special preparation, including careful animal anesthesia, the choice of the approaches and modes used.

Feasibility and safety of CT-aided pericardiocentesis from a subxiphoid anterior approach by using fluoroscopy in patients with chronic pericardial effusions.

BackgroundPericardiocentesis is an essential procedure for the diagnosis and treatment of pericardial effusions. The purpose of this study was to evaluate the feasibility and safety of a subxiphoid anterior approach using fluoroscopy aided by a sagittal axis chest computed tomography (CT) view in comparison with an ultrasound‐guided apical approach in patients with chronic pericardial effusion.MethodsAmong 72 consecutive patients (68.8 ± 14.4 years old, 52 males) with hemodynamically stable chronic pericardial effusions, a total of 85 procedures were retrospectively analyzed. We divided them into two groups according to the site of the approach for the pericardiocentesis.ResultsA subxiphoid anterior approach (n = 53) was performed guided by fluoroscopy. The sagittal axis view of the chest CT was constructed to determine the puncture angle and direction for the subxiphoid anterior approach. An apical approach (n = 32) was performed by ultrasound guidance. The success rates of the anterior and apical approaches were 98.1% and 93.8%, respectively. There were two cases with cardiac perforations in the apical approach group, while no cases developed perforations in the subxiphoid anterior approach group.ConclusionThe subxiphoid anterior approach for pericardiocentesis was feasible and safe for managing chronic pericardial effusions. A reconstruction of the sagittal axis view of the chest CT imaging was helpful to identify the direction and depth to access the pericardial space from the subxiphoid puncture site before the pericardiocentesis using the lateral fluoroscopic view.

Pericardiocentesis Procedure: Anatomical Structures and Approaches

Knowledge of accurate surface anatomy is essential for safe clinical practice. Different views and opinions for clinically important surface markings exist between clinicians. Pericardiocentesis is performed as an emergency procedure in conditions aggravating cardiac tamponade. The approach of pericardiocentesis should be held by the hands of an experienced operator because of the surrounding relations. Nowadays, the introduction of imaging-guided procedures, especially echo-guided procedures, has significantly improved the safety and feasibility of pericardiocentesis and has provided the possibility of choosing the best anatomical approach among the apical, subcostal and parasternal approaches. This case report also emphasizes the importance of instillation of agitated saline as a supplementary technique while performing echo-guided pericardiocentesis in order to reduce the likelihood of cardiac chamber perforations.

01 5-Year surgical outcomes of transvaginal apical approaches in women with advanced pelvic organ prolapse

To compare 5-year surgical outcomes of uterosacral ligament suspension (ULS) versus (vs) sacrospinous ligament fixation (SSLF) in women with advanced pelvic organ prolapse (POP). Secondarily, to explore differences in outcomes between advanced vs stage II POP. A secondary analysis was conducted in a subset of women with advanced (stages III-IV) POP from a multicenter randomized trial comparing (1) SSLF vs ULS and (2) perioperative behavioral with pelvic floor muscle training (BPMT) vs usual care. Publicly accessible de-identified datasets of the index trial with 5-year follow-up were analyzed. The primary outcome was time to surgical failure, defined as (1) apical descent >1/3 into vaginal canal or anterior/posterior vaginal wall beyond the hymen, (2) bothersome vaginal bulge symptoms, or (3) retreatment (pessary or surgery) for POP. Secondary outcomes included symptom severity measured by the Pelvic Organ Prolapse Distress Inventory (POPDI), and adverse events (AEs). Outcomes in women with advanced stage POP were also compared to those with stage II POP. Of 285 women in the index study, 90 of 147 (61.2%) in the ULS group and 88 of 138 (63.8%) in SSLF had advanced POP. Baseline characteristics did not differ between groups (mean age ULS = 61.0 ± 10.1 vs SSLF = 60.2 ± 9.9, P = 0.58). Surgical failure increased over 5 years in both groups with no intergroup difference (P = 0.42, Figure). By year 5, the estimated surgical failure rate was 67.7% for ULS vs 71.5% for SSLF (adjusted difference [a-diff] = 3.8; 95% CI = 21.9, 14.2). No difference was noted in individual failure components (Figure); anatomic: 56.7% ULS vs 65.2% SSLF (a-diff = 8.4; 95% CI = 28.0, 11.2), symptomatic: 38.8% ULS vs 43.1% SSLF (a-diff = 4.3; 95% CI = 22.6, 14.1), retreatment: 20.0% USL vs 15.9% SSLF (a-diff = 4.1; 95% CI = 9.4, 17.7). POPDI scores improved from baseline to 5 years in both groups without intergroup difference (ULS = 68.0 ± 61.1 vs SSLF = 69.9 ± 60.3, a-diff = 0.1; 95% CI = 20.0, 19.9). AEs such as granulation tissue, suture exposure, and midurethral sling exposure did not differ over 5 years. Comparing women with advanced stages vs stage II POP, the estimated surgical failure did not differ over 5 years; 69.8% advanced vs 55.7% stage II (a-diff = 14.1%; 95% CI = 33.7, 5.6). However, anatomic failure was higher in women with advanced POP (61.1% advanced vs 33.8% stage II, a-diff = 27.3%; 95% CI = 47.5, -7.0). There was no difference in symptomatic failure (41.4% advanced vs 33.3% stage II, a-diff = 8.1; 95% CI = 25.3, 9.1) or retreatment (11.7% advanced vs 8.0% stage II, a-diff = 3.6; 95% CI = 12.0, 4.7). In women with advanced stage POP, surgical failure, symptom severity, and AEs did not differ between ULS and SSLF over 5 years. Compared to stage II POP, women with advanced POP had higher anatomic failure.

Guideline No. 413: Surgical Management of Apical Pelvic Organ Prolapse in Women

To compare success and complication rates of apical suspension procedures for the surgical management of symptomatic uterine or vaginal vault prolapse. Women with symptomatic uterine or vaginal vault prolapse seeking surgical correction. Interventions included abdominal apical reconstructive repairs (sacrocolpopexy, sacrohysteropexy, or uterosacral hysteropexy) via open, laparoscopic, or robotic approaches; vaginal apical reconstructive repairs (vault suspensions or hysteropexy, sacrospinous, uterosacral, iliococcygeus, McCall's, or Manchester types); and vaginal obliterative procedures (with or without uterus in situ). Individual procedures or broad categories of procedures were compared: (1) vaginal versus abdominal routes for reconstruction, (2) abdominal procedures for reconstruction, (3) vaginal procedures for reconstruction, (4) hysterectomy and suspension versus hysteropexy for reconstruction, and (5) reconstructive versus obliterative options. The Urogynaecology Committee selected outcomes of interest: objective failure (obtained via validated pelvic organ prolapse [POP] quantification systems and defined as overall objective failure as well as failure rate by compartment); subjective failure (recurrence of bulge symptoms determined subjectively, with or without use of a validated questionnaire); reoperation for POP recurrence; complications of postoperative lower urinary tract symptoms (de novo or postoperative stress urinary incontinence; reoperation for persistent, recurrent, or de novo stress urinary incontinence; urge urinary incontinence; and voiding dysfunction); perioperatively recognized urinary tract injury (bladder or ureter); other complications (mesh exposure, defined as mesh being visible and exposed in the vagina, and non-sexual pelvic pain); and sexual function (de novo dyspareunia and sexual function score according to a validated questionnaire). This guideline will benefit patients seeking surgical correction of apical POP by improving counselling on surgical treatment options and possible outcomes. It will also benefit surgical providers by improving their knowledge of various surgical approaches. Data presented could be used to develop frameworks and tools for shared decision-making. We searched Medline, the Cochrane Central Register of Controlled Trials (CENTRAL), and Embase from 2002 to 2019. The search included multiple terms for apical POP surgical procedures, approaches, and complications. We excluded POP repairs using transvaginal mesh and studies that compared procedures without apical suspension. We included randomized controlled trials and prospective or retrospective comparative studies. We limited language of publication to English and French and accessibility to full text. A systematic review and meta-analysis was performed. The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and weak recommendations). Gynaecologists, urologists, urogynaecologists, and other health care providers who assess, counsel, and care for women with POP. All statements refer to correction of apical vaginal prolapse in the short and medium term (up to 5 years), except when otherwise specified.

Outcomes of native tissue transvaginal apical approaches in women with advanced pelvic organ prolapse and stress urinary incontinence.

Limited data exist comparing different surgical approaches in women with advanced vaginal prolapse. This study compared 2-year surgical outcomes of uterosacral ligament suspension (ULS) and sacrospinous ligament fixation (SSLF) in women with advanced prolapse (stage III-IV) and stress urinary incontinence. This was a secondary analysis of a multicenter 2 × 2 factorial randomized trial comparing (1) ULS versus SSLF and (2) behavioral therapy with pelvic floor muscle training versus usual care. Of 374 subjects, 117/188 (62.7%) in the ULS and 113/186 (60.7%) in the SSLF group had advanced prolapse. Two-year surgical success was defined by the absence of (1) apical descent > 1/3 into the vaginal canal, (2) anterior/posterior wall descent beyond the hymen, (3) bothersome bulge symptoms, and (4) retreatment for prolapse. Secondary outcomes included individual success outcome components, symptom severity measured by the Pelvic Organ Prolapse Distress Inventory, and adverse events. Outcomes were also compared in women with advanced prolapse versus stage II prolapse. Success did not differ between groups (ULS: 58.2% [57/117] versus SSLF: 58.5% [55/113], aOR 1.0 [0.5-1.8]). No differences were detected in individual success components (p > 0.05 for all components). Prolapse symptom severity scores improved in both interventions with no intergroup differences (p = 0.82). Serious adverse events did not differ (ULS: 19.7% versus SSLF: 16.8%, aOR 1.2 [0.6-2.4]). Success was lower in women with advanced prolapse compared with stage II (58.3% versus 73.2%, aOR 0.5 [0.3-0.9]), with no retreatment in stage II. Surgical success, symptom severity, and overall serious adverse events did not differ between ULS and SSLF in women with advanced prolapse. ClinicalTrials.gov Identifier: NCT01166373.

04: Transvaginal apical approaches for advanced pelvic organ prolapse

04: Transvaginal apical approaches for advanced pelvic organ prolapse

Granting of several types of cash fertilizer and distribution of apical approaches to growth

The objectives of this study are for the type of manure that is most appropriate for the improvement of fertility and the generation of the period of nutrients and the best time of pruning for the growth and yield of chili. This research is a Factorial experiment, with Basic. Design of Randomized Block Design (RBD) with 2 factors that tried and done in glass house lasted from July to November 2017. In the first factor type of manure from level 4: K 0 = no fertilizer, K 1 = cow manure, K2 = chicken manure laying hens, K 3 = rabbit manure. The dose of each fertilizer 20 tons ha-1. The second factor with 3 levels: P 0 = without trimming, P 1 = pruned apical shoots age 8 days after planting, P2 = pruning apical shoots age 16 days after planting. From the experiment will be obtained 12 treatment combinations and will be repeated 3 times. The interaction between several types of manure and apical trimming (K x P) was markedly significant (P &lt;0.05) to the variable wet weight of leaves and leaf dry weight. The interaction is very important (P &lt;0.01) against the maximum leaf number variables, wet root weight, root dry weight, and fresh fruit weight. Fresh weight of fruit obtained on interaction with manure by pruning apical part 16 days after planting (K3P2) of 47.67 g and when compared to the combination of no fertilizer and without pruning (K0P0) of 37.80 which can be increased 26, 11%.

Entry into the peritoneal cavity in posthysterectomy prolapse: an educational video.

Entry into the peritoneal cavity can be challenging in patients with posthysterectomy prolapse; however, it is important for vaginal surgeons to be able to enter the peritoneal cavity using various techniques to perform an intraperitoneal vaginal vault suspension. We present surgical footage of various methods of accessing the peritoneal cavity in posthysterectomy prolapse using posterior, anterior and apical approaches. This video highlights surgical techniques that can be used to enter the peritoneal cavity in posthysterectomy prolapse in a safe and reliable manner. Vaginal surgeons should be able to safely and confidently identify and enter the peritoneal cavity using various approaches to perform an intraperitoneal vaginal vault suspension.

Preoperative Risk Levels and Vascular Access in Transcatheter Aortic Valve Implantation-A Single-Institute Analysis-

Although transcatheter aortic valve implantation (TAVI) has been indicated for patients with high surgical risk, indications for or against the procedure become more difficult as vascular access becomes more proximal and/or invasive in order to accommodate patients with even higher risks. We compared preoperative factors including the European System for Cardiac Operative Risk Evaluation (EuroSCORE) and Society of Thoracic Surgeons Predicted Risk of Mortality (STS) score with postoperative survival in 195 patients undergoing TAVI during 2.5 years (January 2010 to June 2012), when vascular access routes were developed from iliofemoral (IL/Fm access, n = 149), axillo-clavicular, apical, and direct aortic approaches (alternative access, n = 46). Logistic regression analyses showed that alternative access was associated with reduced 30-day survival (P = 0.024), while high surgical risk (>15% in both EuroSCORE and STS score) was associated with reduced 1-year survival (P = 0.046). Thus, patients treated via IL/Fm access had acceptable outcome regardless of preoperative risk levels while patients with low surgical risk (<15%) had favorable outcome irrespective of access route. Since the remaining patients with combined risk factors, high preoperative risk level (>15%) requiring alternative access, had a prohibitive risk in our experience, they might have been considered untreatable or not amenable even to TAVI and offered medical or alternative managements.

Mid-term results of 150 TAVI comparing apical versus femoral approaches

BackgroundTranscatheter aortic-valve implantation (TAVI) is a new therapeutic choice for treating aortic stenosis in patients considered high risk for surgery. This blooming therapeutic technique still requires evaluation of medium and long term outcome.MethodWe hereby report our results of the first 150 consecutive patients to receive TAVI implants in our population recruited from July 2009 to March 2013 in a retrospective and monocentric study. We analyzed long term morbidity and mortality criteria. We compared the apical and femoral approach results and researched predictors of cardiac mortality.ResultsThe mean monitoring period was 387.62 days, mean Euroscore was 21.8, and mean Society of Thoracic Surgeons (STS) risk score was 9.2. The success rate for the procedure was 94.6 %. A total of 39 patients died. The mortality rates at the immediate perioperative point, 30 days, 1 year, and 2 years, were 4 %, 11.3 %, 22.7 %, and 26 %, respectively. As regards complications, there were 10 hemodynamic complications (6.6 %) and 20 vascular (13.3 %), 11 cardiac tamponades (7.4 %), eight mechanical (5.3 %), ten major hemorrhagic (6.7 %), 14 pulmonary (9.3 %), and 18 infectious complications (12 %). When comparing the rates of reported complications in terms of different approaches, we observed significantly more hemodynamic complications in the apical group (p = 0.049). Pulmonary complications were also significantly more common in cases of apical approach (p = 0.029). The majority of the patients reported clear functional improvement throughout their follow-up.ConclusionThe results of the first 150 patients to receive the implant at the Nancy University Teaching Hospital (CHU Nancy) were consistent with findings in the literature. TAVI proved a credible and effective alternative to surgical valve replacement for patients at high risk during surgery.

Comparative Endoscopic Anatomic Description of the Mitral Valvular Complex: a Cadaveric Study

We compared the aortic, left atrial, and apical approaches to visualize the mitral valve with the goal to investigate the endoscopic anatomy and give exact step-by-step descriptions of these views. The mitral valvular complex of human cadaveric fresh hearts was investigated from three approaches using 0, 30, and 70 degrees rigid endoscopic optics. In 30 cases after the removal of the hearts, the endoscopes were introduced directly into the aortic root through an aortotomy, left atrium through a standard atriotomy, and apex of the heart through a transmural incision. In 10 cases, the in situ visualization was performed using standard surgical approaches, such as partial upper ministernotomy, right and left minithoracotomy. The investigation was performed first with the mitral valve open, then the left ventricle was filled with saline, and the valve was closed by clamping the aorta. For the visualization of ventricular surfaces of the mitral leaflets and the subvalvular apparatus, the apical approach was most optimal. The aortic approach had limitations at the posterior leaflet. Using the atrial approach, we did not obtain any direct visual information about the subvalvular apparatus with the valve closed. The atrial surfaces of the leaflets were best visible using both the atrial and apical approaches with the mitral valve open. In the case of a closed valve, the apical approach did not allow for an investigation of the atrial surfaces. The aortic approach was useful to visualize the atrial surface of the posterior leaflet with an opened valve. In mitral valve repairs through the left atrium, an additional aortic or apical view could be useful to obtain functional information about the subvalvular apparatus by the sealing probe.

An Assessment of the Optimal Lens Fit Rate in Keratoconus Subjects Using Three-Point-Touch and Apical Touch Fitting Approaches With the Rose K2 Lens

To compare the number of ordered lenses required to achieve an optimal lens fit between three-point-touch and apical touch fittings in keratoconus subjects with nipple and oval cones using the first definite apical clearance lens (FDACL) as a starting point. First trial lens was selected following manufacturer's guidelines and the back optic zone radius (BOZR) was flattened or steepened in 0.10 mm steps until a FDACL was found. Subsequently, subjects were randomly allocated to three-point-touch (BOZR 0.10 mm flatter than FDACL) and apical touch fittings (BOZR 0.40 mm flatter than FDACL). Changes were made solely in total lens diameter, edge lift, and/or back vertex power until an optimal lens fit was achieved. Differences between fitting approaches were compared in terms of optimal lens fit rates defined as the percentage of subjects successfully fitted with the first lens ordered from the manufacturer. Sixty-one subjects (109 eyes) were randomly allocated to three-point-touch and apical touch fitting approaches. An average of 2.3 trial lenses were necessary to achieve the FDACL. An optimal lens fit rate was achieved with the first lens in 84 of 109 eyes (77%). No statistically significant differences in optimal lens fit rates were found between three-point-touch and apical touch fitting approaches (83% and 71%, respectively; P = 0.12) and between nipple and oval cones (81% and 68%, respectively; P = 0.12). The use of the FDACL provides a systematic, reliable, and repeatable starting point for Rose K2 contact lens fitting in keratoconus. Eye care practitioners should anticipate higher optimal lens fit rates when using three-point-touch (83%) in comparison with apical touch contact lens fittings (71%).

Internal jugular vein catheterization: a comparative study of apical and paracarotid approaches

Central venous catheterization (CVC) is a frequently performed procedure in ICUs for both monitoring and definitive central venous access. Although the apical approach is the most preferred technique in our practice, a modified landmark guided technique that uses only the carotid artery pulsation as a landmark (paracarotid approach) to locate the puncture site for internal jugular venous (IJV) catheterization attained a high success rate with few complications. The aim of the study was to compare two approaches used for IJV cannulation: the apical approach and the paracarotid approach. The primary endpoint was the rate of success. The secondary endpoints were the related adverse events and the difficulty factors (number of attempts).

Usefulness of the Right Parasternal Approach to Evaluate the Morphology of Atrial Septal Defect for Transcatheter Closure Using Two-Dimensional and Three-Dimensional Transthoracic Echocardiography

The aim of this study was to demonstrate the feasibility and usefulness of addition of the right parasternal approach to the conventional left parasternal and apical approaches using two-dimensional (2D) and three-dimensional (3D) transthoracic echocardiography (TTE) for morphologic evaluation in cases of transcatheter closure of atrial septal defects (ASDs). In 112 consecutive patients with ASDs, the morphology of the defects was evaluated for transcatheter closure in the right parasternal view in addition to the conventional left views using 2D and 3D TTE. Measurements of the maximal ASD diameter and detection of deficient rim obtained on 2D TTE were compared with those obtained by 2D transesophageal echocardiography. The shapes and locations of ASDs visualized by 3D TTE were compared with those visualized by 3D transesophageal echocardiography. In 88 patients (80.0%), optimal images from the right parasternal approach for morphologic evaluation of ASDs were obtained. Although there was a significant difference in maximal ASD diameter obtained only in the conventional left approach compared with transesophageal echocardiographic measurements (P < .05), when the right parasternal approach was applied, a significant difference was not found (P= .18), and the diagnostic concordance of the rim deficiency was improved from 85.2% to 90.9%. Three-dimensional TTE from the right parasternal approach improved visualization of the shape and location of ASDs from 65.5% to 74.5%. Additional use of the right parasternal approach enables detailed morphologic evaluation for transcatheter closure of ASDs. In patients with suboptimal images on 3D TTE in the left conventional approach, additional 3D TTE in the right parasternal approach can improve the feasibility of obtaining optimal 3D images to evaluate the shapes and locations of ASDs.

Benefits from Apical Chest Tube Drainage in Pneumothorax

Pneumothorax is the accumulation of air in the pleural space. Pneumothorax may occur spontaneously (primary spontaneous pneumothorax, PSP). Chest tube drainage (CTD) is the most common choice for treatment of PSP. This study aimed to evaluate patients treated with CTD, regarding demographic and diagnostic characteristics, and to compare the effectiveness of apical and axillary approaches. We retrospectively analyzed a total of 217 patients with PSP regarding symptoms, duration of complaints, and treatment procedures. There were 196 (90.3%) male patients and mean age was 25.22 ± 5.37 years. The approach of CTD was determined randomly; being performed with the apical approach on 93 (42.9%) and axillary on 124 patients (57.1%). There were no statistically significant differences between the two groups in terms of age, sex, BMI, collapse size, and complaint duration. However, a statistically significant relationship was determined between collapse size and leading symptoms where the significance was related to dyspnea (p < 0.001). This led to the thought that dyspnea increases with the increase of collapse size. The patients who were admitted to hospital in the later term when compared with others, had a larger collapse size (p < 0.001). This also led to the thought that collapse increases in relation to time due to late admission of patients. Hospitalization time was significantly shorter in patients who had apical CTD (p < 0.001). In conclusion, inserting the tube from the apex could shorten the treatment period.

Comparison of Operative Characteristics of Two Minimally-Invasive Apical Sacropexy Approaches: Laparoscopic and Robotic

Study Objective: The aim of this study was to compare operative characteristics of the two minimally-invasive approaches to sacral colpopexy: laparoscopic and robotic, as well as assess robotic learning curve with a newly-developed robotic program.