Oblique Position Research Articles

Comparison of Eliminating Artificial Hydronephrosis and Creating Artificial Hydronephrosis in Percutaneous Nephrolithotomy in Oblique Supine Position

Introduction: The safety and effectiveness of percutaneous nephroscopic surgery without artificial hydronephrosis remain controversial, and there are few relevant studies. This retrospective study aimed to compare the efficacy of two different methods of eliminating and creating artificial hydronephrosis in percutaneous nephrolithotomy (PCNL) in the oblique supine position. Methods: This is a retrospective study. A total of 162 patients who underwent PCNL in an oblique supine position at our hospital were divided into two groups according to the surgical method: the free artificial hydronephrosis group (group A) and the artificial hydronephrosis group (group B). Group A was directly treated with PCNL under ultrasound guidance, and group B was treated with artificial hydronephrosis before PCNL. Several outcomes were measured, including procedure time, stone clearance rate, and incidence of complications. Results: The procedure time in group A lower than that in group B, and the incidence of sepsis was significantly lower in group A than in group B (p < 0.05). There was no statistical difference in stone clearance rate, success rate of primary establishment of puncture channel, unilateral change in perioperative red blood cell count, change in perioperative renal function, and perioperative complications (except sepsis) between the two groups (p > 0.05). Conclusion: For experienced physicians, PCNL without artificial hydronephrosis in an oblique supine position can be attempted to reduce the number of surgical steps without affecting the stone clearance rate and increasing the occurrence of complications.

Analysis and consideration of radiation dose distribution in cardiac catheterization interventions

objective: To assess the variations in radiation dose at different areas in the cardiac catheterization room during cardiac catheterization interventions. methods:To simulate the conventional operation in cardiac catheterization interventions, perform angiography on standard manikins ,the radiation dose was collected from 22 areas in the cardiac catheterization room under 8 projection angles, and each area was repeated 5 times, and the collected data was analyzed using one-way ANOVA and independent sample t-test. results:Analysis of the radiation dose in 22 areas under 8 projection angles revealed that the lowest radiation dose was found in the area at the end of the operating table in the cardiac catheterization room (p &lt; 0.05), and the highest radiation dose was found in the area on the left and right sides of the X-ray tube (p &lt; 0.05); the radiation dose in the area on the right side of the X-ray tube of the DSA machine was greater than that in the conventional standing area of the first operator (p &lt; 0.05)，and the radiation dose in the conventional standing area of the second operator was greater than that in the conventional standing area of the first operator (p &lt; 0.05); the radiation dose in the standing area of the first operator was highest in the cephalic position (CRA 30°) (p &lt; 0.05), and the radiation dose in the standing area of the second operator was highest in the left anterior oblique position (LAO 45°) (p &lt; 0.05); in the angle of RAO projection, the radiation dose in the right area of the X-ray tube was greater than that in the left area of the X-ray tube (p &lt; 0.05). Under the RAO projection angle, the radiation dose from the right side of the X-ray tube of the DSA machine was greater than that from the left side (p&lt;0.05), and the result was reversed at the projection angle of the LAO. conclusion:The radiation dose during cardiac catheterization interventions is lowest in the area at the end of the operating table, which can be used as a standing area for nurses and as an area for the placement of surgical equipment and supplies. At the same time, it is necessary to pay attention to the radiation dose to the second operator and to further improve the radiation protection measures for the second operator, and additional measures are needed to minimize the radiation dose to the operators in the cephalic position (CRA 30°) and in the left anterior oblique position (LAO 45°).

Assessment of the frequency of cesarean section according to the criteria of M. Robson in the Regional perinatal center №1 of Turkestan region

Objective. To identify and analyze the groups of women who contribute the greatest and least to the frequency of caesarean sections in general. Conducting an assessment of the frequency of caesarean sections in the Regional Perinatal Center №1 of the Turkestan region according to the classification of M. Robson.Materials and methods. We conducted a retrospective analysis of the history of 5286 births in the Regional Perinatal Center No. 1. The history of childbirth of women who gave birth in 2022 was taken into account. According to the history of each birth to complete the table: method of delivery (delivery through the birth canal, caesarean section); parity (first time , repeated); number of fetuses (one, two, three or more); delivery period (up to 37 weeks., 37-40 weeks., 41-42 or more); type of fetal malformation (head, pelvis, transverse/ oblique); induction of labor (induction was carried out, induction was not carried out); spontaneous childbirth; the number of caesarean sections in the history (one or more) was taken into account.Results and discussion. The group contributed the most to the total CS frequency were 5 groups – with a history of one or more CSs, one fetal head arrival, ≥37 weeks – 24.1%; the group contributed the least to the total CS frequency was 9 groups – single fetal pregnancy, women with a horizontal or oblique fetal position, including women with a history of one or more CSs – 2.2%.Conclusion. The largest share of the group in the total frequency of CSwas Group 5 – 22.1% of all births, 888 (75.9%) of 1,170 women in this group underwent surgery, all pregnant women with scars on the uterus ; group 9 – 0.7% of births accounted for the smallest share of the group in the total frequency of CS, 100% of 38 women gave birth with CS.

Radiographic characterization of the maxillary septum and septal bullae in horses: An ex vivo study.

The anatomical variations of the maxillary septum and the septal bullae can generate challenges during the interpretation of radiographs of the horses' heads and make it difficult to accurately identify the sites affected in sinus disorders. The description of the radiographic appearance of these structures is currently scarce in the scientific literature. This work aims to describe the anatomical and radiographic characteristics of the maxillary septum and maxillary septal bullae in horses. Six chemically preserved equine cadaver heads were used which, after being submitted to the maxillary osseous flap, the maxillary septum and its respective bullae were identified. Radiographic examinations before and after contrast impregnation on these structures were performed. The positioning of the maxillary septum varied between the anatomical specimens and between the sides of the same specimen. The 30° oblique dorsoventral lateral and lateral projections allowed the identification of the maxillary septum and septal bullae. However, the bullae remained superimposed on the dental arches in the dorsoventral projections with the mandible in a neutral position or with the mandible displaced. The oblique offset radiographic positioning was suggested and proved effective for the examination of the maxillary septal bullae, where the mandible was displaced to the side of the bullae to be examined, and the radiographic beam inclined in the same direction. The maxillary septum and its bullae could be properly identified in a macroscopic way after the osseous flap and the contrasted radiographic examination allowed its adequate interpretation. Variations in size and position are considered normal for the equine species.

About the retromolar pad - its particularities and role in the stability and retention of the classic complete denture

Aim. This paper aims to bring back into focus the area of the retromolar pad as an important element for the support area and for achieving an effective marginal seal in case of completely edentulous mandible. Material and methods. 24 cases of complete mandibular edentation were analyzed and the characteristics of the retromolar pad were followed. Analyzing the appearance of the retromolar pad, an attempt was made to classify them into the classes proposed by J. Lejoyeux. The clinical implications of various aspects of this area were monitored. Results. In patients with the retromolar pad in the last three classes, difficulties were encountered in adapting the individual tray and during the functional impression; in cases with advanced resorption of the alveolar ridge and unfavorable retromolar pad, a poor marginal seal was obtained. Conclusions. From the analyzed cases, it was reconfirmed that in an old complete mandibular edentation, the retromolar pad can take an oblique or vertical position. Such a situation becomes unfavorable for the retention of the complete denture, for the marginal seal. Knowing the particularities of the completely edentulous prosthetic field and the clinical stages is essential for maintaining denture stability.

On the determination of the standing oblique detonation wave in an engine combustor using laser absorption spectroscopy of hydroxyl radical

Freejet experiments were conducted in the hypersonic flight-duplicated shock tunnel (JF-12) to understand the detonation combustion mode in the combustor of a standing oblique detonation ramjet (Sodramjet) engine prototype. Besides the traditional schlieren imaging to capture the oblique shock positions in the combustor, we implemented laser absorption spectroscopy of hydroxyl (OH) radical with three laser beams around the shock front. The Sodramjet engine combustor provides an ideal condition to measure OH because its molar fraction within the detonation front is estimated to exceed 0.03, which is much higher than other combustors. However, the harsh environment of freejet shock tunnel test poses a great challenge to the reliability of measurement systems. In this work, near-infrared tunable laser diode sensors centered at 1528 nm were chosen to measure the line-of-sight average of OH partial pressure. Continuous absorption measurements were conducted near the shock front, indicating a thin OH region after shock compression that could only be achieved by detonation combustion. The time-varied OH partial pressure was well predicted by the computational fluid dynamics (CFD) prediction. Our measurement results verified the detonation combustion of Sodramjet engine prototype and showed that in situ, real-time detonation diagnostics based on laser absorption spectroscopy is possible in freejet experiments of shock tunnel.

Experimental evaluation of a heat exchanger for different configurations between internal and external flow

In the present work, the determination of the thermal effectiveness and temperature of the air at the outlet of a scale prototype of a heat exchanger immersed in flowing water was developed experimentally. This depended on the position of the working fluid (air) and of the heat exchanger positioning configuration. The tested positions were parallel flow, quasi-parallel oblique, counterflow, quasi-counterflow oblique, and crossflow. The temperature of the air at the outlet of the heat exchanger and the thermal effectiveness are essential to determine the most convenient operating position of these systems, especially those related to shallow geothermal energy. The thermohydraulic aspects of the heat exchanger presented were evaluated, by the Number of Transfer Units-Effectiveness (NTU-ε) method, under conditions of water flow in a natural channel and air flow induced by a blower, the system was built from commercial copper pipe and temperature sensors were placed in both the exchanger and the water to record temperature changes. The results of this study indicate that when the exchanger is positioned in the oblique quasi-counterflow position and the oblique quasi-parallel position, it exhibits the lowest air outlet temperatures and highest thermal effectiveness, which is relevant for building cooling applications.

Comparative analysis of ultrasound-guided percutaneous biopsy of native kidneys in children and adults using the free-flank supine antero-lateral decubitus positioning.

Ultrasound-guided percutaneous biopsy (USPB) of the native kidneys is the preferred diagnostic method for several nephrological conditions in both adult and pediatric populations. Conventionally, native kidney biopsies are conducted with patients in the prone position (PP). However, an alternative approach involving the supine oblique antero-lateral position (SALP) has been explored, particularly for individuals who are obese, elderly, or critically ill. This study aimed to assess the feasibility and outcomes of USPB performed in SALP with a Free-Flank setting (FF-SALP) in pediatric patients (Group A) compared to adults (Group B). Data from kidney biopsies conducted between 2008 and 2021 were gathered. The study focused on the safety and the prevalence of biopsy samples containing a minimum of 10 glomeruli, histopathological yield in both groups. Complication rates were low in both groups (5.6% vs. 3.7%; p = 0.454), without major complications noted. The pediatric group achieved a significantly higher mean number of glomeruli per biopsy compared to the adult group (20.6 ± 12.3 vs. 15.7 ± 9.4; p < 0.001). However, when evaluating the minimum threshold of 10 glomeruli (76.3% vs. 68.5%; p = 0.072) and histopathologic yield (95.3% vs. 93.5%; p = 0.408), no differences were observed between groups. USPB of native kidneys in the FF-SALP position is a safe and effective method for tissue sampling in patients with parenchymal disease. It demonstrated comparable diagnostic yields and complication rates in the pediatric and adult populations, providing advantages in terms of airway management, making it particularly useful for pediatric patients that require general anesthesia.

Comparison of safety and efficacy of different positions in percutaneous nephrolithotomy: a network Meta-analysis.

Various new positions for percutaneous nephrolithotomy (PCNL) were proposed to reduce the limitations of the traditional position. This study was aimed to evaluate the efficacy and safety of the different PCNL positions. PubMed, Embase, Web of Science, and the Cochrane Library were searched for relevant randomized controlled trials (RCTs) up to April 18, 2023. We collected five common surgical positions used for PCNL: oblique supine position (OSP), supine position (SP), flank position (FP), split-leg oblique supine/flank position (SLP), and prone position (PP). Paired and network meta-analysis were conducted to compare relevant outcomes, including complications, operative time, stone free rates, hospital stay and hemoglobin loss among these different positions. The study included 17 RCTs with a total of 1841 patients. The result demonstrated that SLP significantly outperformed in terms of decreasing operation time (FP vs SLP MD- MD-41.65; OSP vs SLP MD 28.97; PP vs SLP MD 34.94), hospital stay, and hemoglobin loss. Ranking probabilities showed SLP had highest stone-free rate. Prone position was more likely to occur complications than others. Based on SMAA model, the benefit-risk analysis suggested the SLP was the optimal position in PCNL. For PCNL, the split-leg, flank, supine, and oblique supine positions are as secure as the prone position. Further RCTs are necessary to confirm the outstanding safety and efficacy of split-leg position. Besides, the position should be selected regard for the patient's demands, the surgeon's preference and learning curve.

Ureteroscopic lithotripsy with pressure-measuring ureteral access sheath for large ureteral stones

Introduction To evaluate the safety and efficacy of ureteroscopic lithotripsy with pressure-measuring ureteral access sheath (PM-UAS) for large ureteral stones. Material and methods A total of 258 consecutive patients with large ureteral stones ≥15 mm was enrolled. They were treated by ureteroscopic lithotripsy with PM-UAS in the oblique supine lithotomy position. The technology can precisely monitor and automatically control cavity pressure. The cavity pressure control value was set at –15 mmHg∼–5 mmHg. The cavity pressure limit value was set at 30 mmHg. Infusion flow rate was set at 100–200 ml/min. Postoperative data such as stone-free rate and complications were analyzed. Results PM-UAS was successfully implanted in 225 patients at one stage. Eighteen cases of patients who had failed the first surgery were successfully treated with a second operation. Fifty-one cases with stones migrating up to the kidney were converted to flexible lithotripsy. The other 15 cases were converted to percutaneous nephrolithotomy due to significant ureteral stenosis. The operative time was 49.5 ± 11.2 min. The stone-free rates after one month and three months were 87.2% (212/243) and 94.2% (229/243), respectively. Complications from grade I to II were observed in 25(10.3%) patients. No other complications from grade III to V were noted Conclusion The ureteroscopic lithotripsy with PM-UAS is safe and efficacious for large ureteral stones.

Studying the Effects of Shoulder Dystocia and Neonate-Focused Delivery Maneuvers on Brachial Plexus Strain: A Computational Study.

The purpose of this computational study was to investigate the effects of neonate-focused clinical delivery maneuvers on brachial plexus (BP) during shoulder dystocia. During shoulder dystocia, the anterior shoulder of the neonate is obstructed behind the symphysis pubis of the maternal pelvis, postdelivery of the neonate's head. This is managed by a series of clinical delivery maneuvers. The goal of this study was to simulate these delivery maneuvers and study their effects on neonatal BP strain. Using madymo models of a maternal pelvis and a 90th-percentile neonate, various delivery maneuvers and positions were simulated including the lithotomy position alone of the maternal pelvis, delivery with the application of various suprapubic pressures (SPPs), neonate in an oblique position, and during posterior arm delivery maneuver. The resulting BP strain (%) along with the required maternal delivery force was reported in these independently simulated scenarios. The lithotomy position alone served as the baseline. Each of the successive maneuvers reported a decrease in the required delivery force and resulting neonatal BP strain. As the applied SPP force increased (three scenarios simulated), the required maternal delivery force and neonatal BP strain decreased. A further decrease in both delivery force and neonatal BP strain was observed in the oblique position, with the lowest delivery force and neonatal BP strain reported during the posterior arm delivery maneuver. Data obtained from the improved computational models in this study enhance our understanding of the effects of clinical maneuvers on neonatal BP strain during complicated birthing scenarios such as shoulder dystocia.

The relationship between the oblique sagittal temporomandibular joint disc position and the volume surface area of the condyle in young TMD adults.

The present study aims to compare the volume surface area of the condyle, the horizontal condylar axial angle and the disc-condyle angle between temporomandibular disorder (TMD) and asymptomatic volunteers, explore and analyze the relationship between the temporomandibular joint (TMJ) disc position in oblique sagittal plane and the volume surface area of the condyle in young adults with TMD symptoms. 84 young adult volunteers were received TMJ examination by Magnetic Resonance Imaging (MRI) and Cone Beam Computed Tomography (CBCT). TMD and asymptomatic volunteers were 42 each. MRI was used to assess the position of TMJ disc in the oblique sagittal plane with the condyle apex method. CBCT data were used for three-dimensional (3D) reconstruction of condyle and the measurements of the horizontal condylar axial angle and the volume surface area of the condyle. The condylar volume surface area of the TMD group was smaller than that of the asymptomatic group (p < 0.05), the disc condyle angle was larger than that of the asymptomatic group (p < 0.05), and no significant difference was found in the horizontal condylar axial angle (p > 0.05). In terms of correlation, the volume surface area of the condyle were negatively correlated with the position of the articular disc in TMD patients (p < 0.05). This significant negative correlation suggests that the possibility of disc displacement can be considered when poor condylar morphology is found.

Influence of static and dynamic changes in body positions on functional changes of the cardiovascular system

The autonomic nervous system (ANS) plays an important role in the regulation of heart activity, breathing and blood pressure. Through changes in sympathetic and parasympathetic activity, it participates in the regulation, coordination and integration of internal organ function. The method of spectral analysis of heart rate variability (SAHRV) is used to examine the functional status of autonomic regulation of heart activity. During the examination, clino-ortho-clinostasis is used, which makes it possible to assess the reactivity of functional changes in the sympathetic and parasympathetic systems.We were therefore interested in what functional changes in the autonomic regulation of heart activity will occur during static and dynamic changes in the position of the body head down and up at angles of ± 45°.For the research, we used the method of spectral analysis of heart rate variability, supplemented by blood pressure measurement during the experiment. The experimental group included 24 healthy women aged 20-30. Before and after the experiment, a standard examination of the functional state of the autonomic nervous system was performed in the clino-ortho-clinostatic position.&#x0D; During the experimental sequence, changes in sympathetic, vagus, heart rate and blood pressure reactivity were monitored in the following positions:&#x0D; &#x0D; in an inclined position of the body with the head up – angle +45°&#x0D; in an inclined position of the body with the head down – angle -45°&#x0D; during dynamic changes in oblique body positions +-45°&#x0D; &#x0D; An auto-traction reclining couch was used for the investigation of oblique positions.&#x0D; The resultsDuring the application of oblique positions of the body, there are significant changes in the activity of the autonomic regulation of heart activity.In the head down position, there is an increased activation of the parasympathetic, a decrease in heart rate and an increase in systolic and diastolic pressure.During dynamic changes in body positions +- 45°, there is significant alternating activation of baroreflexes, modulated by sympathetic and vagal aktivity.&#x0D; ConclusionThe research study draws attention to the existence to multiple interconnections of regulatory mechanisms between the autonomic nervous system, cardiovascular and cardiorespiratory systems.

Epidural anesthesia in a patient with placenta accreta for intra-aortic ballooning and cesarean section

Postpartum hemorrhage (PPH) is one of the main causes of maternal death besides cardiovascular disease. Among the causes of PPH is placenta accreta. Hysterectomy is usually performed in placenta accreta to save the mother's life. However, hysterectomy has a direct impact on fertility so that a new strategy was developed, namely the use of prophylaxis Intra-abdominal Aortic Balloon Occlusion (IABO). Anesthetic management plays an important role in ensuring the safety of placenta accreta patients.&#x0D; We present a case of a 34-year-old woman G3P1A1 38+3 weeks with a history of antepartum hemorrhage, complete placenta previa with moderate risk morbidly adherent placenta (MAP), oblique breech position, oligohydramnios, intrauterine growth restriction (IUGR), and previous cesarean section (CS) 4 y ago. She was ASA-II and planned cystoscopy and ureteral catheter insertion by a urologist. The aortic ballooning angioplasty was done through inguinal area by a cardiothoracic surgeon. Followed by CS for 120 minutes, and duration of arterial blockade that can be maintained for 20 min during CS. The operation was performed using epidural anesthesia. Induction with an initial epidural dose was carried out using levobupivacaine 0.5% 15 ml in 5 ml increments every 5 min.&#x0D; Placenta accreta can cause massive bleeding, disseminated intravascular coagulation (DIC), and damage to the liver and kidneys. Massive bleeding caused by placenta accreta significantly increases maternal morbidity and mortality. The latest technology called Intra-abdominal Aortic Balloon Occlusion (IABO) is an option to reduce bleeding and the need for transfusions during and after surgery. Epidural anesthesia is considered a favorable anesthetic option for these patients, as it can also be used as a good postoperative analgesia.&#x0D; Key words: Placenta Accreta; Intra-abdominal Aortic Balloon Occlusion; Epidural anesthesia&#x0D; Citation: Supraptomo RTH. Epidural anesthesia in a patient with placenta accreta for intra-aortic ballooning and cesarean section. Anaesth. pain intensive care 2023;27(6):768−771; DOI: 10.35975/apic.v27i6.2144&#x0D; Received: January 27, 2023; Revised: March 05, 2023; Accepted: October 26, 2023

Visible Pancreatic Tail Pseudocyst on Abdominal Transplenic Scan

Chronic pancreatitis is the end result of a continuous, prolonged, inflammatory, and fibrosing process that affects the pancreas. Pseudocyst is a common sequela of acute pancreatitis or chronic pancreatitis. It is difficult to detect pancreatic disease on abdominal ultrasonography, especially when it is located in the pancreatic tail. A 56-year-old male visited with upper abdominal pain. We could visualize a pseudocyst on abdominal transplenic scan in the right oblique position. We confirmed a diagnosis of chronic pancreatitis and pseudocyst on computed tomography. Abdominal transplenic scan is useful for visualizing pancreatic tail disease.

The Utility and Appropriateness of Single-Position Circumferential Lumbar Interbody Fusion Using O-Arm-Based Navigation in the Novel Oblique Position.

Single-position surgery with patients in a lateral position, which involves inserting percutaneous pedicular screws (PPS) and lateral interbody fusion (LIF) to avoid changing the position, has been reported. The purpose of the present study was to evaluate the utility and appropriateness of single-position LIF-PPS using O-arm-based navigation in the innovative oblique position. This study involved a retrospective analysis of 92 consecutive patients with lumbar spondylolisthesis who underwent LIF-PPS using O-arm-based navigation. Thirty-five subjects demonstrated surgery with repositioning, as well as 24 in the lateral decubitus position, and 33 in the oblique during PPS, where the position was changed to the lateral decubitus position using bed rotation without resetting. We compared these three groups in terms of the surgery time, blood loss, and the accuracy of the screw placement. The operative time was significantly shorter in the single-position surgery, both in the lateral and oblique positions, compared to surgery in a dual position. The blood loss was significantly increased in the lateral position compared to the dual and oblique positions. The screw trajectory angle on the downside was significantly smaller in the lateral position, and the accuracy of the screw placement on the downside was significantly lower in the lateral position compared to the dual and oblique positions. Single-position surgery could reduce the average surgery time by about 60 min. The present study indicated the oblique position during PPS insertion might make single-position surgery more useful to improve the accuracy of PPS on the downside, with less blood loss.

Efficacy of simultaneous bilateral surgery using the oblique overriding position in the treatment of bilateral kidney stones

Efficacy of simultaneous bilateral surgery using the oblique overriding position in the treatment of bilateral kidney stones

Novel Instrument for Clinical Evaluations of Active Extraocular Muscle Tension

Strabismus can be caused by abnormal tension of the extraocular muscles (EOMs) attached to the eyeball in superior, inferior, lateral, medial, superior oblique, and inferior oblique positions. Evaluating the tension in each EOM is crucial for surgical planning in strabismus, which is conducted by adjusting the tension on the EOM. The purpose of this study was to develop a compact measuring device to non-invasively evaluate the active EOM tension. The proposed device employed a cotton-tipped medical swab to transfer the EOM tension connected to the force sensor as a non-invasive medium. The tilting angle of the swab and the force of active EOM tension were wirelessly transferred to a laptop computer for recording and real-time displaying of the measured values. The active EOM tensions for the four recti muscles were 101.7 ± 15.0 g (mean ± SD) for the lateral rectus; 88.0 ± 15.4 g for the medial rectus; 61.3 ± 6.8 g for the inferior rectus; and 121.3 ± 38.5 g for the superior rectus. These values were higher than the reported values of 45–60 g measured in previous studies. In the previous studies, however, the EOM was detached from the globe and attached to a strain gauge, and, thus, there were no passive elastic forces from ocular connective tissue, resulting in lower values compared with the current study. The previous methods were also complex and not suitable for clinical measurement. Thus, the proposed method, which is non-invasive and mimics the conventional force generation test with a cotton-tipped swab, could facilitate the evaluation of active EOM tension, both clinically in strabismus management and in research into understanding its pathophysiology.

A Novel Esophagogastrostomy Technique for Laparoscopic Proximal Gastrectomy: Conical Remnant Gastroesophageal Side-overlap Fundoplication.

There is currently no universally-accepted, ideal method of esophagogastric reconstruction to address reflux esophagitis and anastomotic complications of esophagogastrostomy after proximal gastrectomy. In June 2022, two patients with Siewert type II carcinoma of esophagogastric junction underwent laparoscopic proximal gastrectomies, using a novel esophagogastrostomy technique of Conical remnant GastroEsophageal side-Overlap fundoplication (CGEO). On postoperative day 4, upper gastrointestinal fluoroscopy was performed, with patients in downward and left oblique positions, allowing gastrografin to accumulate within fundic reconstructions. No reflux into the esophagus was subsequently observed, and both patients were discharged (postoperative days 9 and 11). Six months after surgery, endoscopic view showed that the reconstructed cardia returned to its normal state, in the absence of any reflux symptoms. As of April 2023, we have operated on four patients using CGEO, and all of them recovered without obvious reflux symptoms. CGEO is a feasible and safe reconstructive esophagogastrostomy procedure following laparoscopic proximal gastrectomy for Siewert type II esophagogastric junction carcinoma.

Percutaneous transforaminal endoscopic surgery (PTES) and mini-incision L5/S1 OLIF with a self-lock cage for the surgical treatment of L5 spondylolisthesis

ObjectivesWe reported thirteen cases of percutaneous transforaminal endoscopic surgery (PTES) under local anesthesia and mini-incision L5/S1 OLIF (OLIF51) with a self-lock cage for the treatment of L5 spondylolisthesis.MethodsFrom Jan 2019 to Feb 2020, the patients with L5 spondylolisthesis with nerve root symptoms undergoing PTES and OLIF51 were included in this study. PTES under local anesthesia was performed in a prone position, and OLIF51 with a self-lock cage and allograft was then undertaken through a left abdominal mini-incision and oblique retroperitoneal approach between bilateral iliac vessels with the external oblique, internal oblique and transverse abdominal muscles bluntly separated in turn for L5/S1 in a right oblique position under general anesthesia. Back and leg pain were preoperatively and postoperatively evaluated using the VAS, and the clinical outcomes were evaluated with the ODI before surgery and at the 2-year follow-up. The anterior and posterior intervertebral space height (AISH, PISH), lumbar lordotic, and surgical segmental lordotic angle (SLA) were measured on lumbar spine X-rays preoperatively and postoperatively. The fusion status was assessed according to Bridwell’s fusion grades.ResultsThirteen cases of L5 spondylolisthesis were included. The operation duration was 49.1 ± 5.6 min for PTES and 73.6 ± 8.2 min for OLIF. There was blood loss of 25 (15–45) ml. The incision length was 7.5 ± 1.1 mm for PTES and 46.8 ± 3.8 mm for OLIF. The hospital stay was 5 (4–6) days, and the follow-up duration was 29 (24–37) months. For the clinical evaluation, the VAS of back and leg pain significantly dropped after surgery (p < 0.001), and the ODI significantly decreased from 64.7 ± 7.8% to 12.9 ± 4.3% 2 years after surgery (p < 0.001). AISH, PISH and SLA significantly improved after surgery (p < 0.05). Fusion grades based on the Bridwell grading system at the 2-year follow-up were grade I in 9 segments (69.2%) and grade II in 4 segments (30.8%). No patients had any form of permanent iatrogenic nerve damage or major complications. No failure of instruments was observed.ConclusionsPTES and mini-incision OLIF51 with a self-lock cage is a viable option of minimally invasive surgery for L5 spondylolisthesis, which can achieve direct neurologic decompression, satisfactory fusion and hardly destroys the rectus abdominis and its sheath, paraspinal muscles and bone structures.