Inferior Approach Research Articles

Action research in LSCM since 2010 – the emergence of design science

PurposeThe purpose of this study is the review of current status of action research (AR) and design science (DS) in logistics and supply chain management (SCM) and to compare AR and DS.Design/methodology/approachThe paper’s approach comprises the literature review of AR and DS articles.FindingsFirst, not much has changed in terms of number of published AR articles, despite frequent calls for more relevant research. One explanation is the academic system. Second, there is an increased focus on theory, which from a positive perspective is a sign of our field maturing, yet the academic system and current editorial philosophies may also contribute to this development. Third, DS is emerging as a potential replacement of AR.Research limitations/implicationsThe study provides suggestion for both authors and editors when it comes to the increased focus on theory. Comparing AR and DS, the two approaches are similar. However, while the increased focus on theory is reflected in DS, it also seems to be an inferior approach for ill-defined change-focused problems, requiring in-depth, collaborative, data-rich, longitudinal studies.Originality/valueThis paper is the first article that reviews and compares AR and DS in LSCM.

Laparoscopic Right Hemicolectomy with an Inferior Approach: How I Do It

Laparoscopic Right Hemicolectomy with an Inferior Approach: How I Do It

Further investigation of the lateral approach for the resection of Knosp grade 4 pituitary adenomas in endoscopic endonasal surgery.

The authors performed a further in-depth study of the lateral compartment of the cavernous sinus (LCCS) by the endoscopic endonasal approach to improve the safety and efficacy of the lateral approach for the removal of Knosp grade 4 pituitary adenomas (KG4PAs). Twenty-three cadaveric specimens were used for endoscopic endonasal dissection, and the LCCS was exposed to observe the neurovascular and fibrous structures within. A subclassification of the lateral approach based on further knowledge of the LCCS was proposed and used to resect 86 KG4PAs, and the surgical outcomes of these cases were reviewed. Type A KG4PAs represent tumor that was mainly distributed in the posterosuperior and superolateral compartments, type B KG4PAs represent tumor that was mainly distributed in the anteroinferior compartments, and type AB KG4PAs represent tumor that extended into each compartment with characteristics of types 4A and 4B. The authors identified multiple fibers that anchored the horizontal segment of the internal carotid artery (ICA) to the abducens nerve. The fibers, the sympathetic nerve, and the inferior lateral trunk form a partition-like structure in the LCCS named the abducens nerve-ICA complex (AIC), and the LCCS can be divided into the superolateral and inferolateral compartments by the AIC. Accordingly, the lateral approach was subclassified into the lateral superior (LS) approach and the anterior inferior (AI) approach. The LS approach was mainly used to resect type A KG4PAs, whereas the AI approach was used to resect type B KG4PAs, and a combination of the two was used to resect type AB KG4PAs. The gross-total, subtotal, and partial resection rates were 81.4%, 12.8%, and 5.8%, respectively. The numbers of cases of postoperative transient cranial nerve palsy, postoperative permanent cranial nerve palsy, ICA injury, and CSF leakage were 6 (6.9%), 2 (2.3%), 1 (1.2%), and 1 (1.2%), respectively. This study revealed that the LCCS is divided by the AIC into the superolateral and inferolateral compartments, avoiding the misconception that the LCCS has vertical communication. Therefore, the lateral approach was subclassified into the LS approach and the AI approach for the resection of KG4PAs, which allowed a high gross-total resection rate with acceptable safety in the surgical treatment of KG4PAs.

Transjugular Approach in Catheter Ablation of Ventricular Ectopy Originating from the Superior Tricuspid Annulus: An Effective Alternative to the Unsuccessful Transfemoral Approach

Ventricular premature complexes originating from the tricuspid valve can be a major challenge for the electrophysiologist. Anatomical features of the tricuspid valve impose limitations for mapping and catheter ablation through the femoral vein (inferior approach). In this case, we report the elimination of a ventricular ectopy by radiofrequency catheter ablation through the transjugular approach after three unsuccessful attempts through the inferior approach.

Minimally Invasive Inferior Intra-Articular Sacroiliac Joint Fusion: Successful Application of Osseous Stabilization Using Allograft Bone.

Minimally invasive sacroiliac joint (SIJ) fusion is the preferred surgical method for managing patients with recalcitrant, chronically severe SIJ pain and dysfunction refractory to conservative medical measures. The primary surgical objective of all minimally invasive SIJ fusion procedures is to provide immediate stabilization within the joint space to support osseous consolidation and the development of a mechanically solid arthrodesis. The intra-articular surgical approach to the SIJ with allograft bone placement utilizes a trajectory and easily identifiable landmarks that allow the surgeon to control the risk of violating important neuro-vascular structures. The intra-articular approach can employ a superior or inferior operative trajectory, with the former restricted to allograft placement in the ligamentous portion of the SIJ. The inferior approach utilizes decortication to surgically create a channel originating in the purely articular portion of the joint space allowing for truly intra-articular implant placement within the osseous confines of the ilium and sacrum. Positioning the implant along the natural joint line and securing it within the underlying sub-chondral bone, mortise and tenon fashion provides stabilization and large surface area contact at the bone implant interface. The inferior, intra-articular approach also places the implant perpendicular to the S1 endplate, near the sacral axis of rotation, which addresses the most significant biomechanical forces across the joint. Short-term, post-surgical observational data from a 57 patient multi-center registry using the inferior, intra-articular approach show uniform and statistically significant improvement in all clinical outcomes (p < 0.001 for all comparisons), including an average 3-point improvement in back pain severity from 6.8 preoperatively to 3.8 at 6 months. Further clinical evaluation with longer-term follow-up of the inferior, intra-articular SIJ fusion procedure is encouraged.

Inferior versus medial approach in laparoscopic colectomy with complete mesocolic excision and D3 lymphadenectomy for right-sided colon cancer: A propensity-score-matched analysis.

In laparoscopic colectomy with complete mesocolic excision and D3 lymphadenectomy for right-sided colon cancer, either an inferior approach (IA) or a medial approach (MA) is selected in our institution based on the surgeon's preference. The present study compared the treatment outcomes between IA and MA. This retrospective, single-centre study using propensity score matching analysed the short- and long-term outcomes of laparoscopic surgery in patients with right-sided colon cancer from 2010 to 2019 at Cancer Institute Hospital. After patient selection, 1011 patients remained for the analysis, of which 67% underwent IA surgery and 33% underwent MA surgery. After propensity score matching (1:1), 325 patients in each group were analysed. Regarding the short-term outcomes, there were no significant differences in the operation time, rate of conversion to open surgery or postoperative complication rate (Clavien-Dindo Grade ≥ III) between the two groups, although the intra-operative median blood loss was significantly less in the IA group than in the MA group (IA, 13 ml vs. MA, 20 ml, P < 0.0001). Regarding the long-term outcomes, the relapse-free survival, liver-relapse-free survival, cancer-specific survival and overall survival were all similar between groups. Both the IA and MA in laparoscopic colectomy with complete mesocolic excision and D3 lymphadenectomy for right-sided colon cancer are safe and feasible approaches; the IA may have an advantage over the MA in terms of reduced intra-operative blood loss. Based on their similar oncological outcomes, either the IA or MA can be selected, based on one's preference.

Atrial fibrillation ablation from above

Pulmonary vein isolation is a well-established therapy for symptomatic atrial fibrillation. The standard access for left atrial procedures is a transfemoral approach. Rarely, access to the heart from an inferior approach is not feasible due to congenital or acquired interruption of the inferior vena cava. In the present case, we discuss relevant aspects and technical issues related to the superior approach for pulmonary vein isolation.

Systematic review of electrophysiology procedures in patients with obstruction of the inferior vena cava

AimsThe objective of the study was to conduct a systematic review to describe and compare the different approaches for performing cardiac electrophysiology (EP) procedures in patients with interrupted inferior vena cava (IVC) or equivalent entities causing IVC obstruction.MethodsWe conducted a structured search to identify manuscripts reporting EP procedures with interrupted IVC or IVC obstruction of any aetiology published up until August 2020. No restrictions were applied in the search strategy. We also included seven local cases that met inclusion criteria.ResultsThe analysis included 142 patients (mean age 48.9 years; 48% female) undergoing 143 procedures. Obstruction of the IVC was not known before the index procedure in 54% of patients. Congenital interruption of IVC was the most frequent cause (80%); and, associated congenital heart disease (CHD) was observed in 43% of patients in this setting. The superior approach for ablation was the most frequently used strategy (52%), followed by inferior approach via the azygos or hemiazygos vein (24%), transhepatic approach (14%), and retroaortic approach (10%). Electroanatomical mapping (58%), use of long sheaths (41%), intracardiac echocardiography (19%), transesophageal echocardiography (15%) and remote controlled magnetic navigation (13%) were used as adjuncts to aid performance. Ablation was successful in 135 of 140 procedures in which outcomes were reported. Major complications were only reported in patients undergoing AF ablation, including two patients with pericardial effusion, one of whom required surgical repair, and another patient who died after inadvertent entry into an undiagnosed atrioesophageal fistula from a previous procedure.ConclusionThe superior approach is most frequent approach for performing EP procedures in the setting of obstructed IVC. Transhepatic approach is a feasible alternative, and may provide a “familiar approach” for transseptal access when it is required. Adjunctive use of long sheaths, intravascular echocardiography, electro‐anatomical mapping and remote magnetic navigation may be helpful, especially if there is associated complex CHD. With careful planning, EP procedures can usually be successfully performed with a low risk of complications.

Impact of Superior and Inferior Approach in Identification and Preservation of Spinal Accessory Nerve during Modified Radical Neck Dissection in Patients with Oral Squamous Cell Carcinoma

Background: During neck dissection, injuries to spinal accessory nerve (SAN) are most common cause of post-operative shoulder morbidity. Which is known as ‘Shoulder Syndrome’. Despite the evolution in neck dissection procedures from radical to super-selective neck dissection, post-operative shoulder dysfunction remains a point of exasperation for head and neck surgeons. It significantly impacts the standard of living for patients with head and neck cancer. According to the anatomic course and branching of SAN, there are various dissection technique for identification and preservation. Our comparison of superior dissection approach with inferior dissection approach for identification, preservation, and complete skeletonization of SAN in posterior neck dissection has not been studied based on its anatomical course.&#x0D; Objective: To compare Superior Vs. Inferior approach group in regards to safety and superiority of the approach for SAN preservation with minimal or no intraoperative and or post-operative functional complications.&#x0D; Methods: The patients will be randomly divided into two groups according to the approach used to identify and preserve SAN (superior Vs. inferior approach group). The intraoperative clinical and post-operative data will be collected and evaluated with appropriate statistical analysis.&#x0D; Results: Collected data from 24 patients will undergo statistical analysis to obtain the results.&#x0D; Conclusion: This study expects to find a superior modality amongst the Superior dissection approach and inferior dissection approach in terms of identification, preservation, and post-operative functional deficit for spinal accessory nerve.

Uniportal Thoracoscopic Single-Direction Basal Subsegmentectomy (Left S10a+ci): Trans-Inferior-Pulmonary-Ligament Approach

Thoracoscopic segmentectomy and subsegmentectomy have been widely accepted for the treatment of peripheral small lung cancers. Thoracoscopic basal subsegmentectomy, especially when performed through a uniportal procedure, is extremely technically challenging, and therefore there are seldom reports of its technical details. In this article, we present a uniportal thoracoscopic left S10a+ci subsegmentectomy following the single-direction strategy through the inferior pulmonary ligament approach.

A Fiber Dissection Study of the Anterior Commissure: Correlations with Diffusion Spectrum Imaging Tractography and Clinical Relevance in Gliomas.

The anterior commissure, which connects bilateral temporal lobes and olfactive areas, remains elusive in many aspects of its structure and functional role. To comparatively describe anatomical details of the anterior commissure using cadaveric fiber dissection (FD) and diffusion spectrum imaging (DSI) thus refining our knowledge of the tract and exploring its clinical relevance in glioma migration. Twelve normal postmortem hemispheres were treated with Klingler's method and subjected to FD with medial, inferior, and lateral approaches. The FD findings were correlated with DSI tractography results. To illustrate the clinical relevance, two patients with recurrent temporal high-grade glioma are described. Our FD and DSI tractography of the anterior commissure disclosed a new anatomical paradigm. The FD confirmed that the anterior limb (absent sometimes and variable) and the lateral/temporal extension include the rostral portion and caudal portion, respectively, of the anterior commissure fibers. The shape of the lateral/temporal extension predominantly resembles an 'H'. The DSI tractography findings corresponded to these FD results. According to the FD, the Virchow-Robin space is continuous with the subarachnoid space and very close to the anterior commissure. The two clinical cases presented severe disturbances of consciousness and behavior despite good local tumor control. Subsequent magnetic resonance images showed new lesions infiltrating the contralateral temporal lobes. FD combined with DSI provided anatomical details facilitating a better understanding of the anterior commissure. Glioma migration routes to the contralateral temporal lobe included the anterior commissure, Virchow-Robin space, and subarachnoid space and were clinically relevant.

This video demonstrates, step by step, a right thoracoscopic S9+10 segmentectomy through a subxiphoid approach combining both interlobar fissure and inferior pulmonary ligament approaches, on the basis of 3D-CT reconstruction and fluorescence imaging

This video demonstrates, step by step, a right thoracoscopic S9+10 segmentectomy through a subxiphoid approach combining both interlobar fissure and inferior pulmonary ligament approaches, on the basis of 3D-CT reconstruction and fluorescence imaging

CT‐guided percutaneous epicardial access for ventricular tachycardia ablation: A proof‐of‐concept study

The objective of this study was to evaluate the safety and efficacy of preprocedural computed tomography (CT) to guide percutaneous epicardial puncture for catheter ablation of ventricular tachycardia. A preprocedural CT was used to plan the site, angle, and depth of needle insertion during epicardial access in 10 consecutive patients undergoing ventricular tachycardia (VT) ablation. Adjacent structures (right ventricle, diaphragm, liver, colon, internal mammary artery) were visualized and the course of the needle was planned avoiding these structures. During epicardial access, a protractor was used to guide the angle of needle entry into the subxiphoid space. Postprocedural CT was performed to calculate the deviation between the planned and executed access and to assess for any collateral damage. Percutaneous epicardial access was obtained successfully in all the patients using anterior (n = 4) and inferior (n = 6) approaches. The planned site and angle of puncture was more caudal (2.9 ± 0.9 vs. 3.7 ± 0.7 cm, p = .021) and acute (61.7 ± 5.8 vs. 49.0 ± 5.4°, p = .011) for an anterior approach compared to an inferior approach, respectively. Postprocedure CT revealed minimal deviation of the puncture site (5.4 ± 1.0 mm), angle (5.4 ± 1.2°), and length of needle insertion (0.5 ± 0.2 cm). With regard to the site of entry in the pericardial space, there was a deviation of 5.9 ± 1.1, 6.1 ± 1.1, and 5.8 ± 1.4 mm in the x, y, and z dimensions, respectively. In eight patients with minimal deviation between planned and executed access, there was no collateral injury to adjacent viscera or vessels. In two patients with increased deviation of angle and length of needle insertion, there was entry through the diaphragm during inferior access. Utilizing pre-procedural CT planning may aid in the success and safety of percutaneous epicardial access during VT ablation.

Extended Anterior Inferior Approach to Endoscopic Medial Maxillectomy for Maxillary Sinus Lesions.

Myriad open and endoscopic approaches are employed to resect maxillary sinus lesions, each with associated advantages and disadvantages. The inferior and anterior portion of the sinus remains a challenging space to access. To describe the extended anterior inferior approach to endoscopic medial maxillectomy (EAMM) as a novel and valuable addition to a stepwise approach for minimizing surgical morbidity without compromising tumor outcomes. To report the outcomes of patients treated with this approach. A retrospective case series study of 9 patients who underwent EAMM between 2016 and 2019 at a tertiary care referral center was performed. The endoscopic technique is described. The duration of follow-up ranged from 1 to 53 months. Intraoperative steps, including transection of the nasolacrimal duct and execution of an intraoperative dacryocystorhinostomy, were reviewed. Postoperative outcomes, including patient symptoms at follow-up and tumor recurrence, were recorded. Adequate exposure with gross total tumor resection or margin-negative tumor resection was achieved in all cases. Sparing of the nasolacrimal duct was achieved in 2 patients. No patients reported persistent epiphora, empty nose syndrome, or changes in cosmesis such as alar or nasal tip collapse. One patient reported unilateral V2 hypoesthesia at 6 months postoperatively that had resolved by his next follow-up 18 months after surgery. Postoperative tumor surveillance was achieved by endoscopic examinations in all patients and there was no evidence of tumor recurrence at a median follow-up of 22 months. The EAMM provides improved access to the inferior-posterior-medial maxillary sinus. This approach minimizes the risk of hypoesthesia and change in cosmesis present in other approaches, and obviates division of the nasolacrimal duct for inferior, posterior-medial attached lesions. This progressive escalation of approach for maxillary sinus lesions minimizes injury to nasal and nasolacrimal structures without compromising tumor outcomes.

An endoscopic endonasal approach to craniopharyngioma via the infrachiasmatic corridor: a single center experience of 84 patients.

The infrachiasmatic corridor is the most important surgical access route for craniopharyngiomas and was identified and used in clinical series. The aims of this study were to describe the characteristics that assist dissection and resection rates in endoscopic surgery of solid, cystic, and recurrent cases and their importance in the infrachiasmatic corridor in endoscopic surgery. One hundred operations on 84 patients with pathologically identified craniopharyngioma were included in the study. The MRI findings were evaluated, and the location of the lesions was classified as (1) infrasellar; (2) sellar; or (3) suprasellar. In the sagittal plane, we measured the longest diameter of cystic and solid components and the height of chiasm-sella. Images were assessed for the extent of resection and were classified as gross total resection. This was deemed as the absence of residual tumor and subtotal resection, which had residual tumor. The infrasellar location was reported in 7/84 (8.3%) patients, the sellar location in 8/84 (9.5%), and the suprasellar location in 69/84 (82.1%) patients. The narrow and high chiasm-sella were observed in 28/69 (40.5%) and 41/69 patients (59.4%), respectively. The mean distance of the chiasm-sella was 9.46± 3.76. Gross total tumor resection was achieved in 60/84 (71.4%) and subtotal tumor resection was performed in 24/84 (28.6%) patients. The results revealed that suprasellar location (OR: 0.068; p = 0.017) and recurrent cases (OR: 0.011; p<0.001) were negative predictive factors on GTR. Increasing the experience (OR: 42,504; p = 0.001) was a positive predictor factor for GTR. An EETS approach that uses the infrachiasmatic corridor is required for skull base lesions extending into the suprasellar area. The infrachiasmatic corridor can determine the limitations of endoscopic craniopharyngioma surgery. This corridor is a surgical safety zone for inferior approaches.

The video depicts a three-dimensional interactive quantitative surgical planning inferior pulmonary ligament approach VATS right S9+10 segmentectomy.

The video depicts a three-dimensional interactive quantitative surgical planning inferior pulmonary ligament approach VATS right S9+10 segmentectomy.

Imputação múltipla para o preenchimento de dados faltantes em banco de dados de propriedades físico-hídricas do solo

Missing values in databases is a common issue and almost inevitable, however, how works deal with it are rarely mentioned in most publications. Multiple imputation (MI) is an efficient method for statistical estimates of missing values from incomplete data. The objective of this study was to evaluate the efficiency of the MI using the MICE (Multivariate Imputation by Chained Equations) algorithm to fill in missing data in a database of soil physico-hydrical properties, and to show that it is more feasible to perform the imputation than the complete case analysis (CCA). Preliminary analysis of the database was performed to check the suitability of the proposed algorithm. Imputation of the missing data of each variable was adjusted using linear regression models. The variables with missing data comprise the model as the dependent variable and the other variables, which were correlated with the same, enter as covariates. The analysis was performed by comparing the values of the estimates, their standard errors and 95% confidence intervals. It was concluded that MICE presented better performance than CCA, since, although the statistical comparison of the two methods was similar, multiple imputation maintains the size of the database and preserves the general distribution. MI is a very prominent method to handle missing data. With this study, we aim to help more soil researchers to get started with implementing MI techniques instead of inferior approaches in order to improve statistical analysis accuracy. Our study confirmed that multiple imputation is applicable to missing data in soil properties database.

GlmGamPoi: fitting Gamma-Poisson generalized linear models on single cell count data.

MotivationThe Gamma-Poisson distribution is a theoretically and empirically motivated model for the sampling variability of single cell RNA-sequencing counts and an essential building block for analysis approaches including differential expression analysis, principal component analysis and factor analysis. Existing implementations for inferring its parameters from data often struggle with the size of single cell datasets, which can comprise millions of cells; at the same time, they do not take full advantage of the fact that zero and other small numbers are frequent in the data. These limitations have hampered uptake of the model, leaving room for statistically inferior approaches such as logarithm(-like) transformation.ResultsWe present a new R package for fitting the Gamma-Poisson distribution to data with the characteristics of modern single cell datasets more quickly and more accurately than existing methods. The software can work with data on disk without having to load them into RAM simultaneously.Availabilityand implementationThe package glmGamPoi is available from Bioconductor for Windows, macOS and Linux, and source code is available on github.com/const-ae/glmGamPoi under a GPL-3 license. The scripts to reproduce the results of this paper are available on github.com/const-ae/glmGamPoi-Paper.Supplementary information Supplementary data are available at Bioinformatics online.

Safety and efficacy of superior calyceal access versus inferior calyceal access for pelvic and/or lower calyceal renal calculi- a prospective observational comparative study

ObjectiveTo compare efficacy and safety between superior calyceal access and inferior calyceal access for pelvic and/or lower calyceal renal stones.MethodsConsecutive patients presenting with Pelvic and/or inferior calyceal renal calculi were allocated to the superior calyceal access (group 1) or inferior calyceal access (group 2) treatment arm. Allocation of treatment access was based on the surgeon’s preference. Variables studied included stone free rate, operating time, intraoperative and postoperative complications. Statistical analysis was executed using SPSS, Version 16.0. The statistical significance was evaluated at 5% level of significance (p value < 0.05).ResultsBetween July 2018 and February 2019, 63 patients were included in each group. The percutaneous inserted guidewire entered the ureter in 92% in group1 and 74.6% in group 2 (p = 0.034). Stone fragments migrated to the middle calyx in 3.2% in group1 and 9.5% in group 2 (p = 0.033). A second puncture was required in one patient in group 1 and in 5 patients in group 2 (p = 0.04). The operative duration (minutes) was 13.46 ± 1.09 in the group 1 while 16.58 ± 1.44 in the group 2 (p = 0.002). Thoracic complications (hydropneumothorax) occurred to 2 patients in superior calyceal access group managed with intercostal tube drainage (p = 0.243).Post operatively blood transfusion was required in two patients in group 2 (p = 0.169). Angioembolization was done in one patient among the inferior calyceal access approach (p = 0.683). Complete stone clearance assessed at 3 months was 96.8% in group 1 and 85.7% in group 2 (p = 0.046).ConclusionsSuperior calyceal access is a safe and most efficacious in terms of achieving complete stone clearance rate with reduced operative time, minimal blood loss, less need for a second puncture and auxiliary procedures at minimal complications.Study registrationClinical trials registry – INDIA; CTRI/2018/07/014,687.

Inferior approach instead of standard "pull-down" technique for transseptal puncture in difficult anatomy.

Inferior approach instead of standard "pull-down" technique for transseptal puncture in difficult anatomy.