Inferior Approach Research Articles

Inferior and Intra-/Peri-Articular Superior Sacroiliac Joint Injection Approaches Under Ultrasound Guidance to Treat Metastasis-Related Posterior Pelvic Bone Pain.

Numerous mechanical and pathologic variables contribute to sacroiliac joint (SIJ) pain. The oncologic population has additional considerations, including tumor burden causing fracture, nerve compression, joint instability, and periosteal inflammation. Post-treatment changes may also restrict joint mobility, causing transitional pain. Currently, fluoroscopically guided SIJ injections, aimed at the inferior one third of the SIJ, are the gold standard for treatment but have only been described in the nononcologic population. Ultrasound (US) guidance may confer several benefits, including positioning, ease of procedure, lower costs, and, importantly, guidance to avoid neovascularization, metastatic disease, and other soft tissue structures. We aim to describe the advantages of US-guided SIJ injections for refractory malignant SIJ pain from extra-articular tumors. We then describe our technique and decision framework for accessing the superior or inferior SIJ in patients with metastatic sacroiliac pain. A retrospective review was performed on 5 patients with refractory malignant SIJ pain who underwent US-guided superior or inferior approach SIJ injection. Using imaging and outcomes, we developed a decision framework. Patients received either inferior or superior approach SIJ injections depending on location of tumor, extent of tumor invasion, and stability of the SIJ as per our framework. All patients reported improvement in pain and function without complications. We propose a decision framework for inferior vs. superior approach US-guided SIJ injections in the oncologic population with SIJ pain from metastases to the pelvis or sacrum. Having multiple techniques to approach the SIJ is important in the oncologic population, in whom metastatic tumor burden poses a technical challenge to performing these injections.

NATURALISM AND MATERIALISM

This article explores the nature and intellectual argument for naturalism and its dependent attitude, materialism. It touches on some of the alternatives but argues that they are inferior approaches to the manner in which knowledge and understanding are obtained. It extends the argument by touching on two subsidiary questions: the role of mathematics in describing the world and the origin of the laws of Nature.

The superior approach with the stomach roll-up technique improves intraoperative outcomes and facilitates learning laparoscopic distal pancreatectomy: a comparative study between the superior and inferior approach

We introduced a superior approach and a unique technique to retract the stomach, called the "stomach roll-up technique", to standardize laparoscopic distal pancreatectomy and increase educational effectiveness. The aim of this study was to evaluate the clinical outcomes of these procedures. Forty-five patients who underwent laparoscopic distal pancreatectomy by surgeons-in-training between January 2015 and December 2018 were included. Twenty laparoscopic distal pancreatectomies were performed using the inferior approach, and 25 procedures were performed using the superior approach. The stomach roll-up technique was used in all cases. The perioperative outcomes were retrospectively analyzed. Compared with the inferior approach, the superior approach was associated with a significantly shorter operation time (p < 0.001) and lower estimated blood loss (p = 0.011), and these differences were not affected by the exclusion of cases with conversion or concomitant procedures. In the univariate analysis adjusted for other covariates, a lower body mass index (p = 0.045), pancreatic tail tumor (p = 0.0178) and the superior approach (p = 0.0176) were significantly associated with a shorter operation time. The superior approach with the stomach roll-up technique is simple and will aid in educating surgeons on performing laparoscopic distal pancreatectomy.

Percutaneous Pericardiocentesis WiththeAnterior Approach: Demonstration of the Precise Course With ComputedTomography.

This study aimed to confirm the precise course of a pericardiocentesis with the anterior approach using post-procedural computed tomography (CT). Percutaneous epicardial ventricular tachycardia (VT) ablation has been increasingly performed. Although the inferior approach has been the common method, the feasibility of the anterior approach has subsequently been reported. However, the precise course of the anterior approach has not been presented. An epicardial ablation with the anterior approach was performed in 15 patients. At the end of the procedure, the epicardial sheath was exchanged for a drainage tube to monitor bleeding. Of those patients, in 9 procedures in 8 patients a CT scan was performed just after the procedure to confirm the course of the drainage tube and to rule out any complications. Epicardial ablation was indicated for a failed endocardial VT ablation in 7 patients and epicardial substrate modification in 1 patient with Brugada syndrome. Volume-rendered images reconstructed from CT demonstrated each course of the drainage tubes and their relation to the surrounding organs. These images revealed that the tube had a curved trace, and did not penetrate the diaphragm or pass through the abdominal cavity. No injury to the surrounding organs was detected in any of the cases. The precise course of the drainage tube placed along the trajectory of the anterior approach wasableto be confirmed using post-procedural CT images. These images support the safety and feasibility of theanteriorapproach from the anatomic standpoint with a low incidence of abdominal viscera injury.

Swinging inferior turbinate approach to the nasolacrimal duct

ABSTRACTPurpose: To report a case of a lacrimal sac tumour identified at the time of endoscopic dacryocystorhinostomy and describe a swinging inferior turbinate approach to the nasolacrimal duct (NLD) to facilitate an en-bloc excision of the lacrimal drainage apparatus.Methods: An 88-year-old male presented with a 6-month history of epiphora and mucocele. Endonasal DCR was performed for nasolacrimal duct obstruction (NLDO). Intraoperatively, a biopsy was performed of abnormal appearing lacrimal sac mucosa, following opening of the lacrimal sac. Subsequent definitive management was performed via a combined external and endoscopic approach using a swinging inferior turbinate approach to the NLD to facilitate an en-bloc excision of the lacrimal drainage apparatus, without removal of the bony medial wall of the maxillary sinus.Results: The excised lacrimal drainage showed insitu and invasive squamous cell carcinoma of the canaliculi and lacrimal sac with focal divergent neuroendocrine and sebaceous differentiation. There was no local tumour recurrence or metastatic spread at 3 months of follow-up.Conclusions: We describe a swinging inferior turbinate approach to the NLD to facilitate an en-bloc excision of the lacrimal drainage apparatus, without entering the maxillary sinus. We believe this modified technique is a useful option to consider in the management of tumours of the lacrimal drainage apparatus.

Inferior Approach: a Safe Method for Identification of Recurrent Laryngeal Nerve During Thyroidectomy

The recurrent laryngeal nerve (RLN) and external branch of superior laryngeal nerve (EBSLN) and parathyroids have to be deliberately identified and preserved during each and every thyroidectomy. The RLN is vulnerable to injury at three sites during surgery. Various approaches have been adopted by surgeons the world over to identify and preserve the RLN. Here, we have adopted the ‘inferior approach’ (IA), which is an easy and a fruitful one. To safely identify and preserve the RLN in the neck using the inferior approach, an intra-operative analysis of RLN were conducted in 393 patients who underwent thyroidectomy for various indications at a tertiary care centre in North Malabar, Kerala, from January 2004 to December 2011 prospectively. The RLN was identified and preserved by inferior approach. Three hundred ninety-three cases were assessed (343 total and 50 hemi thyroidectomy); 358 and 375 RLN on left and right and 1 NRLN were identified. 64.88% of RLN was underneath, 7.14% was superficial to the main trunk and 27.97% was in between the branches of ITA. RLN enters the larynx mainly as a single trunk in 624 cases (85.11%), while it had branches in 110 cases (14.89%). Eighty-four cases (76.3%) had two branches and 26 cases (23.7%) had three branches. All nerves were identified and preserved using the inferior approach. We were unable to identify 2 RLN due to extensive adhesions and fibrosis of thyroiditis and malignancy. Fourteen patients had temporary hoarseness and no permanent vocal cord palsy was reported. Every thyroid surgeon should be aware of the anatomical variations of the RLN. Inferior approach is a safe technique for its identification and preservation.

The superior approach with stomach roll-up technique has a stimulating effect on learning of laparoscopic distal pancreatectomy for training surgeons

Introduction: We introduced the superior approach and a unique technique to retract the stomach called the “stomach roll-up technique” to simplify and standardize laparoscopic distal pancreatectomy, and to facilitate the learning of laparoscopic pancreatic surgery for training surgeons. The aim of this study was to evaluate the clinical outcomes of our novel procedures. Method: Forty-five patients who underwent laparoscopic distal pancreatectomy by training surgeons between January 2015 and December 2018 were included. In this period, 20 laparoscopic distal pancreatectomies were performed using the inferior approach, and then 25 procedures were performed using the superior approach. The clinicopathological findings and perioperative outcomes were retrospectively analyzed. Result: Compared with the inferior approach, the superior approach was associated with significantly shorter operation time (p < 0.001) and less estimated blood loss (p = 0.011). There were no significant differences in postoperative outcomes between the groups. In multifactorial analysis, the superior approach was the only factor that had significantly positive effect on decreasing operation time (p = 0.002). Conclusion: Laparoscopic distal pancreatectomy using the superior approach with the stomach roll-up technique performed by training surgeons was associated with better intraoperative outcomes than those of the inferior approach. These techniques are simple and will aid pancreatic surgeons in performing laparoscopic distal pancreatectomy.

Position and size of the sphenoid door jamb in the lateral orbital wall for the orbital decompression.

The aim of this study was to identify the three-dimensional topography of the sphenoid door jamb (SDJ) in the lateral orbital wall and to propose navigational guidelines for safe deep lateral decompression using surgical landmarks. The 120 orbits and SDJs of 60 subjects were three-dimensionally reconstructed using Mimics software. The mean volumes of the orbit and SDJ were 24.3 mm3 and 2.0 mm3, respectively. The mean distances from the lateral orbital margin (LOM) to the anterior and posterior margins of the SDJ were 13.2 and 36.3 mm, respectively. The mean distances from the superior orbital fissure to the LOM and to the posterior margin of the SDJ were 40.2 mm and 4.6 mm, respectively. The mean distances from the inferior orbital fissure (IOF) to the anterior and posterior margins of the SDJ were 3.8 mm and 20.5 mm, respectively. In the superior approach of the orbit, it can be predicted that the area up to 3 cm posterior from the LOM is safe, while 1 cm posterior from the safe zone could be a dangerous zone. In the inferior approach of the orbit, the safe area will be about 1 cm posterior from the anterior tip of the IOF, and the area up to 1 cm posterior from the safe zone should be approached with extreme care.

An Integrated Statistical Method to Generate Potential Future Climate Scenarios to Analyse Droughts

The objective of this paper is to investigate different methods to generate future potential climatic scenarios at monthly scale considering meteorological droughts. We assume that more reliable scenarios would be generated by using regional climatic models (RCMs) and statistical correction techniques that produce better approximations to the historical basic and drought statistics. A multi-objective analysis is proposed to identify the inferior approaches. Different ensembles (equifeasible and non-equifeasible) solutions are analysed, identifying their pros and cons. A sensitivity analysis of the method to spatial scale is also performed. The proposed methodology is applied in an alpine basin, the Alto Genil (southern Spain). The method requires historical climatic information and simulations provided by multiple RCMs (9 RCMs are considered in the proposed application) for a future period, assuming a potential emission scenario. We generate future series by applying two conceptual approaches, bias correction and delta change, using five statistical transformation techniques for each. The application shows that the method allows improvement of the definition of local climate scenarios from the RCM simulation considering drought statistics. The sensitivity of the results to the applied approach is analysed.

Vibrant Soundbridge implantation via a retrofacial approach in a patient with congenital aural atresia

ObjectiveA method of Vibrant Soundbridge (VSB) placement to the round window (RW) via the retrofacial approach with preoperative evaluation of the relationship between the facial nerve (FN) and RW by 3D-CT reconstruction was proposed for the treatment of congenital aural atresia (CAA) patient. MethodsA fenestration to the mesotympanum was made mastoid portion of the FN. During the approach, part of the stapedial muscle was encountered and removed. The RW niche was identified, and the floating mass transducer was placed from an inferior approach into the RW niche. ResultsThere were no intra-operative or post-operative surgical complications. ConclusionThe VSB placement to the RW via the retrofacial approach with partial removal of the stapedial muscle can be feasible alternative in CAA cases associated with an anteriorly and laterally positioned aberrant FN. Preoperative assessment using 3D CT may facilitate in assessing the feasibility of the approach and implantation of VSB.

Endoscopic anatomy of superior and inferior transtentorial approach to the posterior third ventricle

Objective To conduct anatomic study of structures and exposure of the posterior third ventricle by simulating superior and inferior transtentorial approach with endoscope and to provide anatomical basis for treatment involving this area with endoscope. Methods Five formalin-fixed cadaver heads (10 sides) were dissected bilaterally. To observe and measure anatomical structures of the posterior third ventricle by endoscopic infratentorial-supracerebellar (midline or paramedian) approach and occipital-tentorial approach with comparison of exposure using different surgical approaches. Results (1) Measurement of anatomical structures: Average number of bridging veins of the cerebellum was 3.6±0.6. The diameter of the vein of Galen was 5.6±0.6 mm. The distance from Habenular commissure to confluence of sinuses was 74.4±6.7 mm and the distance from anterior commissure to confluence of sinuses was 107.2±7.3 mm. (2) Comparison of different surgical approaches: The exposed area of pineal glands was 19.6±2.8 mm2, which was almost the same to that in operations through infratentorial-supracerebellar (midline or paramedian) approach and occipital-tentorial approach. The average of exposed area in splenium of corpus callosum was 55.2±7.9 mm2, 34.7±7.9 mm2 and 44.9±5.9 mm2 , respectively, and in ipsilateral superior colliculus was 153.8±13.4 mm2, 177.5±24.0 mm2 and 197.6±19.8 mm2 , respectively. Both had statistically significant difference (all P<0.05). Conclusions Endoscopic superior and inferior transtentorial approach seems feasible and safe for removal of tumors in the posterior third ventricle. Selection of surgical approaches should be based on the tumor type, size, location and its relationship to the surrounding structures. Key words: Natural orifice endoscopic surgery; Anatomy; Surgical approach; Posterior third ventricle tumor

A single arm phase II study of rucaparib maintenance in patients with advanced pancreatic adenocarcinoma and a known deleterious BRCA1, BRCA2 or PALB2 mutation who have achieved stability on platinum therapy.

TPS531 Background: Pancreatic ductal adenocarcinoma (PDAC) is a highly lethal malignancy with a median overall survival of &lt; 1 year. A subset of PDAC is characterized by a homologous recombination deficiency (HRD). The most well-defined patients within this group are those with deleterious mutations in BRCA1, BRCA2 and PALB2. This subset of tumors respond exceptionally well to treatment with platinum agents, leading to durable responses. However, cumulative toxicity can complicate or even prevent continued therapy, and there is an unmet need to establish maintenance strategies for such patients.Prior studies have shown that BRCA1 and BRCA2 associated PDACs respond to PARP inhibitors. Cross-resistance to platinum and PARP inhibitors exists, so initiating PARP inhibitor therapy after the development of platinum-resistance is an inferior approach. In this setting, we have designed a phase II trial of rucaparib as maintenance therapy for patients with deleterious BRCA1, BRCA2 or PALB2 who have sustained stability on platinum-based treatment. Methods: We have enrolled 2 of 42 planned patients on study NCT03140670. Eligibility criteria include inoperable PDAC, a known somatic or germline deleterious mutation in BRCA1, BRCA2 or PALB2 and stability on platinum-based chemotherapy for ≥16 weeks. Patients who have progressed on platinum-based treatment or who have received prior therapy with PARP inhibitors are excluded. Patients will receive oral rucaparib twice daily continuously in 28-day cycles. The primary endpoint is progression-free survival at 6 months. Secondary endpoints include response rate, duration of response and overall survival. A pre-treatment tumor biopsy and biopsy at progression will be obtained, as well as serial blood collections for circulating tumor material. Correlative assays will include tumor and circulating tumor DNA sequencing to identify genomic predictors of outcome and study resistance mechanisms. Clinical trial information: NCT03140670.

Anatomie échographique de l’épaule

The tendons of the subscapularis, supraspinatus, infraspinatus and teres minor muscles plus the articular capsule of the scapulohumeral joint wrap around the head of the humerus to form the rotator cuff of the shoulder. No tendon is associated to the articular capsule in the inferior aspect of the joint. Anatomical concepts on the shoulder have recently evolved. In particular, recent cadaveric studies detailed the ultrastructural tendinous anatomy of the rotator cuff. These new concepts allow a more comprehensive understanding of sonographic images in both normal and pathologic situations. The anterior and posterior intervals of the rotator cuff respectively allow the implantation of the coracoid process and of the scapular spine on the body of the scapula. The acromion laterally extends the scapular spine. The shoulder can be sonographically explored with anterior, superior, posterior and inferior approaches. The position of the shoulder and of the transducer must be adjusted to avoid ultrasound impassable bone structures.

Effects of varying entry points and trendelenburg positioning degrees in internal jugular vein area measurements of newborns.

Recent guidelines from the National Institute for Clinical Excellence recommend the use of ultrasonography in the central venous catheterization of children. In this study, we aimed to compare area measurements using ultrasonography and efficiency of varying Trendelenburg degrees on the area measurements, for two different entry points used as internal jugular vein (IJV) cannulation points in newborns. Fifty-eight healthy newborns, weighing between 3000 and 3500 g, were recruited for this prospective study. Right IJV (RIJV) consecutive measurements were performed in three different Trendelenburg positions at 0°, 15°, and 30°, at two different entry points: The superior approach and an inferior approach. The landmark used in the superior approach was the top of the triangle formed by the two heads of the sternocleidomastoid muscle with the clavicle; while in the inferior approach, it was taken as the midpoint of the clavicle, as measured from the upper edge of the clavicle. The cross-sectional area (CSA) of the RIJV was significantly increased when using the inferior approach, compared to that in the superior approach, in all Trendelenburg degrees, including the neutral position. Both 15° and 30° Trendelenburg positioning resulted in a significant increase in CSA, both in superior and inferior approaches, when compared to neutral positioning. The use of 15° Trendelenburg positioning may have significant advantage for increasing the CSA when used with the inferior approach.

A Review of Methods for the Preservation of Laryngeal Nerves During Thyroidectomy.

The recurrent laryngeal nerve (RLN) provides motor innervation to the abductor and adductor muscles of the vocal cord, whereas the external branch of the superior laryngeal nerve (EBSLN) provides motor innervation to the cricothyroid muscle, which is the tensor muscle of the vocal cord. Both the RLN and the EBSLN are anatomically close to the thyroid and are therefore at risk of injury during thyroidectomy. These 2 laryngeal nerves must be carefully preserved during surgery to ensure that the function of the vocal cord is not impaired. Currently, complete exposure of the RLN during thyroidectomy is accepted as the gold standard method for the preservation of RLN. Sufficient knowledge of surgical anatomy, clinical experience, and meticulous surgical techniques are key factors in the identification and safe dissection of the RLN. During a thyroidectomy, the RLN can be identified using four different approaches, depending on the type of thyroid growth and choice of the surgeon: There are lateral, inferior, superior, and medial approaches.The lateral approach is the most commonly used technique in primary thyroid surgery. The RLN is usually found by dissection around the inferior thyroid artery at the level of the middle lobe of the thyroid. RLN is generally found at the site of its entry into the neck region devoid of scar formation when the inferior approach is used especially in cases with secondary surgery. The superior approach is recommended for patients with an huge goiter or large substernal goiter. In this approach, the upper pole of the thyroid is first released and then pulled forward and laterally, and the RLN is exposed on the nerve’s entry point (NEP), into the larynx, under the cricopharyngeus muscle. The medial approach is preferred for patients with substernally or retropharyngeally enlarged goiters. In this approach, the isthmus is first dissected and divided, and then the isthmus and the medial part of the lobe are dissected away from the trachea to reveal the anterolateral part of the trachea. The fibers between the lateral aspect of the second or third tracheal rings and the thyroid, and the fibers of the Berry ligament are gradually dissected cranially, to allow RLN to enter into the field of view lateral to the trachea. The preservation of the anatomical integrity of the RLN does not indicate that its functional integrity is also preserved. IONM is a tool for the functional assessment of RLN, and so this method is an addition to visually identifying RLN, which is the gold standard. IONM significantly contributes to visual identification of the RLN, determination of its anatomical variations, intraoperative recognition of RLN injury, prevention of bilateral vocal cord paralysis, and detection and preservation of electrical activity in the nerve in patients with preoperative vocal cord paralysis.Although there is no standardized method for the preservation of the EBSLN, 3 methods have been defined during the release of the upper pole of the thyroid. These methods involve dividing the branches of the superior thyroidal artery one by one on the capsule without visually identifying the EBSLN, searching and visually identifying the EBSLN before the dissection of the upper pole vessels, or detecting the EBSLN and dissecting the upper pole under the guidance of IONM. IONM also significantly contributes to the detection and confirmation of the EBSLN and dissection and preservation of the upper pole of the thyroid gland.

Modification of the Surgical Strategy for the Dissection of the Recurrent Laryngeal Nerve Using Continuous Intraoperative Nerve Monitoring.

The aim of this study was to describe first experiences and changes in management using continuous intraoperative neuromonitoring (C-IONM) in thyroid and parathyroid surgery. Retrospective analysis of patients who underwent surgery with C-IONM since 2012. Surgical maneuvers were modified when electrophysiologic events occurred. Patients with persistent loss of signal (LOS) underwent postoperative laryngoscopy. One hundred and one patients (of 1586 neck surgeries) were included and 19 had events: In 13 these were temporary (resolved before end of surgery) and led to intraoperative modifications in surgical approach; in all cases traction was released, and in 8, recurrent laryngeal nerve (RLN) approach was changed [superior approach (2), inferior approach (2), both (4)]. Six patients had persistent LOS (5.9%, present at end of procedure), with RLN palsy (RLNP) on postoperative day 1: In three, LOS occurred at electrode placement on the vagus nerve, leading to distal placement of the electrode allowing ipsilateral dissection under continuous monitoring; all three had complete recovery at 6months. In the three other patients, LOS occurred on the RLN: one probable thermal, one traction lesion and one accidental section of the anterior RLN branch. The RLN recovered within 6months in two patients, and in the third, RLNP persisted after 6months (1/101=1%). C-IONM provides real-time evaluation of the RLN function, allowing for adaptation of surgical maneuvers to prevent RLNP. It seems particularly useful in difficult cases like redo neck surgery, invasive thyroid cancer and intrathoracic or large goiter. Care should be given at electrode placement on the vagus nerve.

GW28-e1147 Different approaches for catheter ablation of para-Hisian accessory pathway: Implication for mapping and ablation

Catheter ablation of para-Hisian accessory pathways (APs) has been challenging because of the neighboring conduction tissue. Some different approaches, including the inferior vena cava approach (IVC-A), the non-coronary cusp approach (NCC-A) or the superior vena cava approach (SVC-A), have been

Perventricular double-device closure of wide-spaced multi-hole perimembranous ventricular septal defect

BackgroundDevice closure of a wide-spaced multi-hole PmVSD is difficult to succeed in percutaneous approach. This study is to evaluate the feasibility, safety and efficacy of perventricular device closure of wide-spaced multi-hole PmVSD using a double-device implanting technique.MethodsSixteen patients with wide-spaced multi-hole PmVSD underwent perventricular closure with two devices through an inferior median sternotomy approach under transesophageal echocardiographic guidance. The largest hole and its adjacent small holes were occluded with an optimal-sized device. The far-away residual hole was occluded with the other device using a probe-assisted delivery system. All patients were followed up for a period of 1 to 4 years to determine the residual shunt, atrioventricular block and the adjacent valvular function.ResultsThe number of the holes of the PmVSD was 2 to 4. The maximum distance between the holes was 5.0 to 10.0 mm (median, 6.4 mm). The diameter of the largest hole was 2.5 to 7.0 mm (median, 3.6 mm). The success rate of double-device closure was 100%. Immediate residual shunts were found in 6 patients (38%), and incomplete right bundle branch block at discharge occurred in 3 cases (19%). Both complications decreased to 6% at 1-year follow-up. Neither of them had a severe device-related complication.ConclusionsPerventricular closure of a wide-spaced multi-hole PmVSD using a double-device implanting technique is feasible, safe, and efficacious. In multi-hole PmVSDs with the distance between the holes of more than 5 mm, double-device implantation may achieve a complete occlusion.

Surgical Approaches to the Temporal Horn: An Anatomic Analysis of White Matter Tract Interruption.

Surgical access to the temporal horn is necessary to treat tumors and vascular lesions, but is used mainly in patients with mediobasal temporal epilepsy. The surgical approaches to this cavity fall into 3 primary categories: lateral, inferior, and transsylvian. The current neurosurgical literature has underestimated the interruption of involved fiber bundles and the correlated clinical manifestations. To delineate the interruption of fiber bundles during the different approaches to the temporal horn. We simulated the lateral (trans-middle temporal gyrus), inferior (transparahippocampal gyrus), and transsylvian approaches in 20 previously frozen, formalin-fixed human brains (40 hemispheres). Fiber dissection was then done along the lateral and inferior aspects under the operating microscope. Each stage of dissection and its respective fiber tract interruption were defined. The lateral (trans-middle temporal gyrus) approach interrupted "U" fibers, the superior longitudinal fasciculus (inferior arm), occipitofrontal fasciculus (ventral segment), uncinate fasciculus (dorsolateral segment), anterior commissure (posterior segment), temporopontine, inferior thalamic peduncle (posterior fibers), posterior thalamic peduncle (anterior portion), and tapetum fibers. The inferior (transparahippocampal gyrus) approach interrupted "U" fibers, the cingulum (inferior arm), and fimbria, and transected the hippocampal formation. The transsylvian approach interrupted "U" fibers (anterobasal region of the extreme capsule), the uncinate fasciculus (ventromedial segment), and anterior commissure (anterior segment), and transected the anterosuperior aspect of the amygdala. White matter dissection improves our knowledge of the complex anatomy surrounding the temporal horn. Identifying the fiber bundles at risk during each surgical approach adds important information for choosing the appropriate surgical strategy.

The single-center experience with the standardization of single-site laparoscopic colectomy for right-sided colon cancer.

Complete mesocolic excision (CME) with central vascular ligation (CVL) has been widely accepted as a surgical treatment for right-sided colon cancer. Single-site laparoscopic colectomy (SLC) is associated with reduced pain and improved cosmesis, in comparison to the multi-site laparoscopic colectomy (MCL). Although the feasibility of CME+CVL under MCL has been reported, SLC for right-sided colon cancer is generally challenging. The purpose of this study is to demonstrate our efforts to standardize the SLC for right-sided colon cancer. This retrospective study enrolled 202 consecutive patients with right-sided colon cancer who underwent laparoscopic colectomy for right-sided colon cancer, using an inferior approach and intraoperative navigation surgery, between 2008 and 2014. The patients were divided into 3 groups, based on the period of treatment, as follows: Period I (2008-2009, n=56), Period II (2010-2011, n=70), and Period III (2012-2014, n=76). The patient's baseline characteristics did not differ among the three periods. The ratio of SLC significantly increased with the passage of the time. The short-term outcomes were similar among the three periods. As for oncological clearance, there was a significant increase in the number of resected lymph nodes with the passage of the time (P<0.05). We successfully standardized SLC for right-sided colon cancer.