Left Ports Research Articles

Integrated modeling method of the internal and external flow of helicopter/inlet

The internal and external integrated flow field modeling method of the helicopter/inlet system was studied. The boundary of internal flow field modeling was proposed. The internal and external integrated calculation model, including the helicopter fuselage, rotor, tail rotor, and other rotating components, as well as the internal flow field of the inlet, was established. On this basis, numerical calculation is carried out according to typical working conditions to analyze the flow field characteristics in the forward flight state and the influence of inlet back pressure on performance parameters. The results show that the integrated numerical calculation model established in this paper considers the internal and external interference of the actual rotor movement in the outflow field. The integrated flow field calculation in typical working conditions shows that the occlusion of the rotor blade and the fuselage will cause interference with the inlet flow field. The parameters of the left and right inlet ports will be different. With the decrease of inlet back pressure, the total pressure recovery decreases with the increase of flow rate and is obviously lower than that without rotor interference.

Robotic left apicoposterior bisegmentectomy for non–small cell lung cancer

Robotic left apicoposterior bisegmentectomy for non–small cell lung cancer

Surgical Technique of a Laparoscopic Pericervical Tourniquet Placement during Laparoscopic Myomectomy

Study Objective To provide a brief overview of the utility of pericervical tourniquet placement during laparoscopic myomectomy to minimize blood loss, and to demonstrate the surgical placement technique of a laparoscopic pericervical tourniquet during laparoscopic. Design Surgical education video. Setting Operating room and simulation lab. Patients or Participants 38-year-old G1P1 with heavy menstrual bleeding and bulky enlarged fibroid uterus (12 cm intramural posterior fibroid conglomerate). Interventions Pericervical tourniquet. Measurements and Main Results Growing evidence suggests that mechanical tourniquets are useful adjunct tools for minimizing blood loss and transfusion risk during laparoscopic myomectomy. Our port configuration includes a right, left, suprapubic and umbilical ports. We commonly use a heavy gage (0 or 1), long (36-inch) monofilament. Avascular windows are opened in the broad ligament bilaterally. The suprapubic port is used to pass the suture through the avascular windows and loop it around the uterus. Before the tourniquet is secured, careful inspection of the posterior aspect of the uterus is made to ensure that no important structures are looped within the tourniquet, as well as to ensure that the tourniquet is caudad to all the fibroids. A modified Roeder's knot is tied. The knot is tightened by pulling both ends of the suture. The post is pulled gently and by doing so, the knot starts to synch down to the uterus. At this point the needle drivers are used to alternate and tighten sequentially the knot. Care is taken to not close the needle driver completely while synching down the knot. This ensures that the knot continues to slide until the tourniquet is tight around the uterus, compressing the uterine arteries bilaterally. At the end of the myomectomy one end of the suture is cut, releasing the tourniquet and restoring normal blood flow to the uterus. Conclusion A laparoscopic pericervical tourniquet can be used as an adjunct to minimize blood loss during laparoscopic myomectomy. To provide a brief overview of the utility of pericervical tourniquet placement during laparoscopic myomectomy to minimize blood loss, and to demonstrate the surgical placement technique of a laparoscopic pericervical tourniquet during laparoscopic. Surgical education video. Operating room and simulation lab. 38-year-old G1P1 with heavy menstrual bleeding and bulky enlarged fibroid uterus (12 cm intramural posterior fibroid conglomerate). Pericervical tourniquet. Growing evidence suggests that mechanical tourniquets are useful adjunct tools for minimizing blood loss and transfusion risk during laparoscopic myomectomy. Our port configuration includes a right, left, suprapubic and umbilical ports. We commonly use a heavy gage (0 or 1), long (36-inch) monofilament. Avascular windows are opened in the broad ligament bilaterally. The suprapubic port is used to pass the suture through the avascular windows and loop it around the uterus. Before the tourniquet is secured, careful inspection of the posterior aspect of the uterus is made to ensure that no important structures are looped within the tourniquet, as well as to ensure that the tourniquet is caudad to all the fibroids. A modified Roeder's knot is tied. The knot is tightened by pulling both ends of the suture. The post is pulled gently and by doing so, the knot starts to synch down to the uterus. At this point the needle drivers are used to alternate and tighten sequentially the knot. Care is taken to not close the needle driver completely while synching down the knot. This ensures that the knot continues to slide until the tourniquet is tight around the uterus, compressing the uterine arteries bilaterally. At the end of the myomectomy one end of the suture is cut, releasing the tourniquet and restoring normal blood flow to the uterus. A laparoscopic pericervical tourniquet can be used as an adjunct to minimize blood loss during laparoscopic myomectomy.

Laparoscopic Left Gastric Artery-Preserving Subtotal Gastrectomy with D2 Lymphadenectomy in a Patient with Gastric Cancer and a Replaced Left Hepatic Artery

Introduction: An aberrant left hepatic artery (aLHA) may be seen in 8%–15% of cases1,2 and a replaced LHA (rLHA) may be seen in ~2%–11% of cases.1,3 An aLHA and a rLHA assume significant importance during gastric resections. A preoperative assessment of this anatomy is particularly important in laparoscopic surgery because of loss of tactile feedback of the arterial pulsation within the lesser omentum. When present, the artery of origin should be preserved. This video demonstrates a gastric resection for cancer where a diligent review of imaging identified a rLHA arising from the left gastric artery (LGA). An LGA preserving radical gastrectomy, without compromising oncologic principles, was performed. Methods: A 54-year-old male patient presented with melena and he underwent an upper endoscopy and was found to have an antropyloric lesion. Biopsy showed adenocarcinoma. A contrast-enhanced CT scan showed the tumor, perigastric lymph nodes, and a rLHA arising from the LGA—Michel's Type 2 anatomy.4 A laparoscopic LGA preserving subtotal gastrectomy with D2 lymphadenectomy was planned. The patient was operated in the French position with five ports, which included a 10-mm umbilical camera port, and 5- and 12-mm left and right working ports, respectively, in the midclavicular line. Standard steps of a subtotal gastrectomy with D2 lymphadenectomy were followed with modification to preserve the LGA. After dividing the greater omentum from the transverse colon, all the tissues around the left and right gastroepiploic, common hepatic, right gastric, proper hepatic, celiac axis, and proximal splenic arteries were meticulously cleared to remove all the lymph nodes en bloc. The lesser omentum was incised and the rLHA was identified along with the LGA. The LGA was circumferentially cleared and the gastric branches divided to complete the en bloc lymphadenectomy. Results: The patient had an uneventful recovery. He was tolerating solids by postoperative day 5. His postoperative liver function tests were normal. He was discharged on the eighth postoperative day. The histopathology was moderately differentiated adenocarcinoma pT1bN0 with 0/32 lymph nodes positive. Conclusion: During a laparoscopic gastric resection, it is pertinent to look for vascular anomalies, including a rLHA in the preoperative imaging to prevent accidental injury. When present, the vessel of origin should be preserved. A laparoscopic LGA sparing radical gastrectomy is feasible without compromising the oncologic safety. No competing financial interests exist. Runtime of video: 9 mins 51 secs

Real-Time Estimation of Molten Steel Flow in Continuous Casting Mold

To realize precise flow control of molten steel in the continuous casting mold, we developed a real-time flow estimation algorithm based on a three-dimensional transient model. Conventional model-based estimation suffers from the estimation error caused by disturbances, e.g., submerged entry nozzle (SEN) clogging. To incorporate the influence of the disturbances into the model calculation and reduce the estimation error, the developed algorithm adjusts the virtual external force at the SEN ports in the model. As a result of the simulation experiment, the asymmetrical flow caused by the nozzle clogging was successfully estimated, and the estimation error of the flow ratio of the left and right SEN ports was only 3 pct.

First Australian Experience with Total Thoracoscopic Left Atrial Appendage Occlusion with Atriclip PRO2 device

Introduction: Oral anticoagulation (OAC) decreases ischaemic stroke in non-valvular atrial fibrillation (AF). Closure of the left atrial appendage (LAA) should be considered in patients unsuitable for OAC. We describe the first Australian series of totally thoracoscopic external LAA occlusion with the Atriclip PRO2TM device. Methods: Patients with chronic AF at high risk of stroke and unable to take anticoagulation, or with embolic events despite anticoagulation, were considered for Atriclip device by a Heart Team at the Mount Hospital, Western Australia. All procedures were performed thoracoscopically, and not associated with any other cardiothoracic procedure. Under transesophageal echocardiography (TOE) guidance, LAA thrombus was excluded, and three 5-mm left chest ports were used for thoracoscopic insertion of the AtriClip device. Results: All 15 patients (mean age 77 years, 11 males) deemed suitable for the device underwent the procedure successfully with mean procedure time of 26 minutes. Median CHA2DS2VaSC and HASBLED scores were 4.5 (range 2–7) and 4 (1–5), respectively. No complication, reoperation, infection or persistent wound pain was reported. The median postoperative stay was 2 days (range 1–14 days) with no ICU admissions, and good to excellent patient satisfaction scores. A total of 2203 patient-days of post-discharge follow-up were obtained with no strokes despite no patient taking anticoagulants or antiplatelet agents. Post-procedure TOE and follow-up CT scans confirmed successful LAA occlusion (figure). Conclusions: Our initial experience with thoracoscopic LAA occlusion using the Atriclip device is excellent, with good safety, short procedure times and hospital stays, high satisfaction scores and no strokes during follow-up. Figure: 3D TOE showing complete LAA occlusion (left panel) and 3D CT reconstruction showing Atriclip device (right panel)

Inverse design of an ultra-compact broadband optical diode based on asymmetric spatial mode conversion.

The objective-first inverse-design algorithm is used to design an ultra-compact optical diode. Based on silicon and air only, this optical diode relies on asymmetric spatial mode conversion between the left and right ports. The first even mode incident from the left port is transmitted to the right port after being converted into an odd mode. On the other hand, same mode incident from the right port is reflected back by the optical diode dielectric structure. The convergence and performance of the algorithm are studied, along with a transform method that converts continuous permittivity medium into a binary material design. The optimal device is studied with full-wave electromagnetic simulations to compare its behavior under right and left incidences, in 2D and 3D settings as well. A parametric study is designed to understand the impact of the design space size and initial conditions on the optimized devices performance. A broadband optical diode behavior is observed after optimization, with a large rejection ratio between the two transmission directions. This illustrates the potential of the objective-first inverse-design method to design ultra-compact broadband photonic devices.

V1-01 ROBOTIC INTRACORPOREAL INDIANA POUCH: REPLICATING OPEN SURGERY

You have accessJournal of UrologyRobotics-Bladder/Reconstruction1 Apr 2016V1-01 ROBOTIC INTRACORPOREAL INDIANA POUCH: REPLICATING OPEN SURGERY Andre Luis de Castro Abreu, Giuseppe Simone, Sameer Chopra, Mariaconsiglia Ferriero, Rocco Papalia, Nariman Ahmadi, Riccardo Mastroianni, Daniel Park, Andre Berger, Salvatore Guaglianone, Rene Sotelo, Michelle Gallucci, Monish Aron, Inderbir Gill, and Mihir Desai Andre Luis de Castro AbreuAndre Luis de Castro Abreu More articles by this author , Giuseppe SimoneGiuseppe Simone More articles by this author , Sameer ChopraSameer Chopra More articles by this author , Mariaconsiglia FerrieroMariaconsiglia Ferriero More articles by this author , Rocco PapaliaRocco Papalia More articles by this author , Nariman AhmadiNariman Ahmadi More articles by this author , Riccardo MastroianniRiccardo Mastroianni More articles by this author , Daniel ParkDaniel Park More articles by this author , Andre BergerAndre Berger More articles by this author , Salvatore GuaglianoneSalvatore Guaglianone More articles by this author , Rene SoteloRene Sotelo More articles by this author , Michelle GallucciMichelle Gallucci More articles by this author , Monish AronMonish Aron More articles by this author , Inderbir GillInderbir Gill More articles by this author , and Mihir DesaiMihir Desai More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2115AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Continent cutaneous diversion is an option for patients undergoing cystectomy. Herein we report our experience of 10 consecutive patients who underwent completely intracorporeal robotic Indiana Pouch construction following robotic cystectomy. METHODS Surgical steps: Robotic cystectomy and pelvic lymph node dissection (PLND) are performed with a 6-trocar access. Robot is undocked and specimen extracted from the left lateral port. Both left side ports are closed and three additional ports are placed. Table is rotated 45 degree to left and the robot is re-docked on right side. Replicating open techniques: 12 cm of distal ileum and 30cm of right colon are isolated; side to side stapled ileocolonic anastomosis is performed; colonic segment is detubularized along the antimesenteric tenia up to 3cm distal to the ileocecal valve and U folded. The medial aspect of the folded colon is sewn. Ureterocolonic anastomoses are performed on the posterior aspect of the pouch. Bilateral J stents are placed in ureters and secured to a 24-Fr hematuria catheter inserted via the appendiceal orifice. After closing the lateral aspect of the pouch, a Foley catheter is inserted via the umbilical port and through efferent ileal limb and placed into the colonic pouch. The efferent limb is tapered with a 60mm stapler on the antimesenteric aspect. The ileocecal valve and the efferent limb are plicated to increase the outflow resistance. The efferent limb is now extracted and the stoma created at the umbilical site. RESULTS There were no intraoperative complications and all procedures (n=10) were successfully completed robotically. Median operative times were 60 min for cystectomy, 65 min for PLND, 45 min for repositioning/re-docking and 210 min for pouch construction. The median overall operative time was 365 (295-540) min. No patients were transfused. Median hospital stay was 9 days. 30-day complication rate was 40%. There were no grade 3 or 4 complications. At 3-month follow-up urodynamics demonstrated a mean maximum capacity of 270mL without ureteral reflux and minimal urine residual; 9 patients (90%) reported full continence. No patient died. CONCLUSIONS Robotic Indiana pouch can be safely performed, completely intracorporeally. This technique provides a minimally-invasive, time efficient approach with acceptable complication rates. Patients undergoing radical cystectomy can now be offered all types of urinary diversions robotically. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e61 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Andre Luis de Castro Abreu More articles by this author Giuseppe Simone More articles by this author Sameer Chopra More articles by this author Mariaconsiglia Ferriero More articles by this author Rocco Papalia More articles by this author Nariman Ahmadi More articles by this author Riccardo Mastroianni More articles by this author Daniel Park More articles by this author Andre Berger More articles by this author Salvatore Guaglianone More articles by this author Rene Sotelo More articles by this author Michelle Gallucci More articles by this author Monish Aron More articles by this author Inderbir Gill More articles by this author Mihir Desai More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Postal Culture: Writing and Reading Letters in Post-unification Italy. Gabriella Romani. Toronto: University of Toronto Press, 2014. Pp. x+272.

<i>Postal Culture: Writing and Reading Letters in Post-unification Italy</i>. Gabriella Romani. Toronto: University of Toronto Press, 2014. Pp. x+272.

Factors that Predict Increased Catheter Tip Movement in Left Internal Jugular Vein Implantable Venous Access Ports upon Standing

To determine the characteristics that predict catheter tip movement with positional changes in patients with left-sided, internal jugular vein (IJV) implantable venous access ports. A retrospective review revealed 264 patients with left IJV ports placed at one academic institution from 2008 to 2013 with follow-up upright chest radiographs. Demographic information was recorded and anatomic measurements were made on both procedural fluoroscopic imaging and upright chest radiographs. Multivariate regression analysis was performed to determine which factors had statistically significant relationships with catheter tip movement distance. Mean catheter tip movement was 1.49 ± 1.97 cm. There was a statistically significant positive relationship between catheter tip movement distance and age (p = 0.03), body mass index (BMI) (p = 0.02), innominate vein angle (p<0.01) and dual- compared to single-lumen ports (p = 0.02). Port pocket location, venous access site and gender did not demonstrate statistical significance. The factors associated with increased positional catheter tip movement for left IJV ports include patient age, BMI, innominate vein angle and dual- vs single-lumen port. This information can be useful in determining initial placement position and avoiding complications associated with catheter malposition.

461. Robotic assisted versus laparoscopic resection for rectal cancer: Short-term outcomes from early experience from consecutive patients

Purpose: Robotic surgery has been advocated for the radical excision of rectal cancer. The aim of this study is to compare short-term outcomes and surgical quality of robot-assisted and laparoscopic total mesorectal excision (TME) in patients with rectal cancer.

462. Robotic splenic flexure mobilization is not difficult anymore: ‘Inferior penetration method’

462. Robotic splenic flexure mobilization is not difficult anymore: ‘Inferior penetration method’

3:57 PM; Abstract No. 130; FEATURED ABSTRACT - Cone beam CT venography vs. cortisol measurements to confirm selective right adrenal vein catheterization during adrenal vein sampling: does anatomical selectivity correlate with biochemical selectivity ratios?

body. Regression analysis was performed to determine if there were statistically significant relationships between catheter tip migration distances and innominate vein angles, internal jugular vein access locations, subcutaneous pocket locations, number of catheter lumens and various patient demographics. Results: The range of catheter tip migration distances for the entire population was -4.01 to 9.97 cm with a mean of 1.49 cm 1.97. There was a statistically significant positive relationship between catheter tip migration distance and age (P1⁄40.0319), body mass index (BMI) (P1⁄40.0244), innominate vein angle (P1⁄40.0028) and dual compared to single lumen ports (P1⁄40.0199). Whereas port pocket location, venous access site, gender and number of days between initial placement and follow-up radiograph did not demonstrate statistical significance. Conclusion: Increased age, increased BMI, increased innominate vein angle and dual vs single lumen ports predict increased positional catheter tip migration for left internal jugular subcutaneous central venous ports. This information can be useful during initial port placement and also when deciding whether or not to revise a port with a catheter that has been inadvertently cut short.

3:48 PM; Abstract No. 129 - Feasibility of barbed suture for incision closure in implantable chest ports

body. Regression analysis was performed to determine if there were statistically significant relationships between catheter tip migration distances and innominate vein angles, internal jugular vein access locations, subcutaneous pocket locations, number of catheter lumens and various patient demographics. Results: The range of catheter tip migration distances for the entire population was -4.01 to 9.97 cm with a mean of 1.49 cm 1.97. There was a statistically significant positive relationship between catheter tip migration distance and age (P1⁄40.0319), body mass index (BMI) (P1⁄40.0244), innominate vein angle (P1⁄40.0028) and dual compared to single lumen ports (P1⁄40.0199). Whereas port pocket location, venous access site, gender and number of days between initial placement and follow-up radiograph did not demonstrate statistical significance. Conclusion: Increased age, increased BMI, increased innominate vein angle and dual vs single lumen ports predict increased positional catheter tip migration for left internal jugular subcutaneous central venous ports. This information can be useful during initial port placement and also when deciding whether or not to revise a port with a catheter that has been inadvertently cut short.

Harvesting bilateral internal thoracic arteries using a novel subxiphoid approach versus the conventional lateral thoracic approach—results of an experimental study

A new method was developed to harvest bilateral internal thoracic artery grafts using a subxiphoid approach and robotic assistance. The present study compared the potential utility of the subxiphoid method with that of the lateral thoracic approach. The first part of the study examined the optimal placement of the instrument ports to maximize the robotic arms' range of motion. The second part of the study examined the 2 approaches for harvesting bilateral internal thoracic arteries from pig carcasses. The obtained graft lengths and time needed to conduct each procedure were compared using the Mann-Whitney U test. The preliminary study suggested that optimal positioning of the instrument ports was achieved by placing the right and left instrument ports far apart and linearly arranging all the ports. Using this configuration, the subxiphoid approach yielded a left internal thoracic artery that was 11.7 ± 1.90 cm long compared with 9.17 ± 0.74 cm using the conventional approach (P=.0131). The right internal thoracic arteries (11.8 ± 1.69 cm) obtained using the subxiphoid approach were significantly longer than those obtained using the conventional approach (8.88 ± 0.58 cm). The time needed to harvest the right internal thoracic arteries (34.7 ± 8.14 minutes) was significantly shorter using the subxiphoid approach than using the conventional approach (52.3 ± 8.21 minutes). Because of the maximized lengths of the grafts and the duration of the procedure, therobot-assisted subxiphoid approach could be an effective method for performing minimally invasive myocardial revascularization in patients with multivessel disease.

Anatomic Fitting of Total Artificial Hearts for In Vivo Evaluation

Successful anatomic fitting of a total artificial heart (TAH) is vital to achieve optimal pump hemodynamics after device implantation. Although many anatomic fitting studies have been completed in humans prior to clinical trials, few reports exist that detail the experience in animals for in vivo device evaluation. Optimal hemodynamics are crucial throughout the in vivo phase to direct design iterations and ultimately validate device performance prior to pivotal human trials. In vivo evaluation in a sheep model allows a realistically sized representation of a smaller patient, for which smaller third-generation TAHs have the potential to treat. Our study aimed to assess the anatomic fit of a single device rotary TAH in sheep prior to animal trials and to use the data to develop a three-dimensional, computer-aided design (CAD)-operated anatomic fitting tool for future TAH development. Following excision of the native ventricles above the atrio-ventricular groove, a prototype TAH was inserted within the chest cavity of six sheep (28-40 kg). Adjustable rods representing inlet and outlet conduits were oriented toward the center of each atrial chamber and the great vessels, with conduit lengths and angles recorded for future analysis. A three-dimensional, CAD-operated anatomic fitting tool was then developed, based on the results of this study, and used to determine the inflow and outflow conduit orientation of the TAH. The mean diameters of the sheep left atrium, right atrium, aorta, and pulmonary artery were 39, 33, 12, and 11 mm, respectively. The center-to-center distance and outer-edge-to-outer-edge distance between the atria, found to be 39 ± 9 mm and 72 ± 17 mm in this study, were identified as the most critical geometries for successful TAH connection. This geometric constraint restricts the maximum separation allowable between left and right inlet ports of a TAH to ensure successful alignment within the available atrial circumference.

An Asymmetric Arbitrary Branch-Line Coupler Terminated By One Group Of Complex Impedances

A novel arbitrary asymmetric branch-line coupler structure terminated by one group of complex impedances is proposed. Two left ports of the proposed branch-line coupler are terminated by equal arbitrary complex impedances, and the other two right ports are terminated by equal real impedances. Arbitrary power division ratios are feasible for the proposed structure. Using rigorous even- and odd-mode analysis and scattering parameters theory based on complex impedances, the closed-form design formulas for designing the proposed branch-line coupler is obtained. To validate the proposed structure and the given design equations, a microstrip branch-line coupler operating at the center frequency of 2.5GHz and terminated by 20 and 30 − 6j Ohm impedances is designed, simulated and measured. There is a good agreement between the simulated and measured results.

Learning Curve of Minimally Invasive Two-Port Laparoscopic Myomectomy

BACKGROUND AND OBJECTS: To examine the learning curve of minimally invasive 2-port total laparoscopic myomectomy (TTLM). TTLM was performed by using only umbilicus and left inguinal ports, for 30 patients at our university affiliated hospital between May 2009 and February 2010. The times required for each of the 5 surgical phases of the early and late cases performed by the same surgeon were compared by using a DVD time counter. The mean surgical time was 82.5±5.2 minutes, blood loss was 42.1±7.5mL, and weight of specimen was 65.3±13.3g. The eighth case was the first in which the surgical time fell below the overall mean surgical time. Comparison of the mean time of each phase between the 7 early and the subsequent (late) cases revealed significant differences in the times required for suturing. Although this was a feasibility study, the results suggest that this technique can be mastered after 7 cases. Learning curve, Suturing.

Nanoplasmonic power splitters based on the horizontal nanoplasmonic slot waveguide

Ultracompact power splitters based on the horizontal nanoplasmonic slot waveguide (Cu/SiO2/Si/SiO2/Cu, whose propagation loss is measured to be ∼0.36 dB/μm at 1550 nm for waveguide with ∼47-nm-wide Si core and ∼26-nm surrounding SiO2) are designed, simulated, and fabricated using the standard complementary metal-oxide-semiconductor technology. The 1 × 2 Y-splitters with the opening angle of 60°, 120°, and 180° are measured to have the excess losses of ∼1.4, ∼1.7, and ∼3.2 dB, compared with the theoretical values of ∼1.4, ∼1.5, and ∼1.8 dB, respectively. The 1 × 3 cross-splitter delivers normalized output powers of ∼ −7.6, ∼ −4.2, and ∼ −7.2 dB at the left, middle, and right output ports, respectively, compared with the theoretical value of ∼ −6.6 dB. Reasons of the discrepancy between the experimental and theoretical results are discussed, and approaches to further reduce the excess loss are then proposed.

Clear Visualization of Anterior Vitreous Incarceration into Cannulae during 25-Gauge Vitrectomy in Eyes with Asteroid Hyalosis

To demonstrate anterior vitreous incarceration in the cannulae at 3 ports during 25-gauge vitrectomy in eyes with asteroid hyalosis. In 6 eyes with asteroid hyalosis, 3-port 25-gauge pars plana vitrectomy was conducted using conventional 25-gauge cannula (4 eyes) or 25-gauge EdgePlusTM trocar/cannula system (2 eyes). The relationship between the cannulae and anterior vitreous was observed during surgery. The 3 ports were observed at the beginning of vitrectomy. At the infusion port, incarceration of anterior vitreous containing asteroid bodies between the cannula and the infusion tip was clearly observed in all 6 eyes, irrespective of the cannula used. When the incarcerated vitreous fibers were excised using a vitreous cutter, the infusion fluid flowed toward the center of the vitreous. At both the left and right ports, anterior vitreous containing asteroid bodies was incarcerated into the cannulae in all 6 eyes irrespective of the cannula used. The incarcerated vitreous fibers were excised. At the end of surgery, no vitreous prolapse was found at the 3 ports in all eyes. When using the 25-gauge cannula system, incarceration of anterior vitreous fibers into the cannulae of 3 ports from the beginning of surgery was clearly depicted in eyes with asteroid hyalosis. Excising the incarcerated anterior vitreous fibers is useful to ensure good perfusion and prevent vitreous prolapse.