Open Access Technique Research Articles

High-resolution topographic surveying and change detection with the iPhone LiDAR.

This paper introduces a comprehensive protocol leveraging open-access techniques to create small- to medium-scale 3D representations of the environment by using iPhone and iPad light detection and ranging (LiDAR). The protocol focuses on two capabilities of the iPhone LiDAR. The first capability is 3D modeling: iPhone LiDAR rapidly generates detailed indoor and outdoor 3D models, providing insights into object size, volume and geometry. The second capability is change detection: the 3D models created by the LiDAR sensor can be used for precise measurement of changes over time. Compared to other 3D topographic surveying methods, this method is rapid, high resolution, low cost and easy to use. The protocol outlines iPhone LiDAR scanning practices, model export and change detection. The expected results after executing the protocol are (i) a detailed 3D model of a small- to medium-sized object or area of interest and (ii) a distance point cloud revealing change between two point clouds of the same object or area between different times. The entire protocol can be conducted within 2 h by anyone with an iPhone with the LiDAR sensor and a computer. This protocol empowers scientists, students and community members conducting research with a cheap, easy-to-use method for addressing a range of questions and challenges, thus benefiting experts and the broader community.

MEASUREMENTS OS PROJECTION AND ROTATION OF THE NASAL TIP IN PRIMARY RHINOSEPTOPLASTY: A LITERATURE REVIEW

Introduction: Postoperative scarring can later modify the structure of the nose and there are few articles found in the literature that demonstrate anthropometric measurements in the evolution of the postoperative period of rhinoseptoplasty. Objective: To identify variations in projection and rotation results of the nasal tip after primary rhinoseptoplasty with the course of healing. Materials and methods: A literature review on projection and rotation of the nasal tip in primary rhinoseptoplasty, in addition to the illustration of three clinical cases of caucasian patients with medium skin who underwent open primary rhinoseptoplasty. Results: In the three illustrated cases, there was an increase in the rotation of the nasal tip in the seven-day postoperative, with an average of 13.68º in the female cases and 5.15º in the male case. There was an average reduction of 2.41º after six months of healing. There was no pattern of variation in the tip projection measurement. Discussion: The rotation of the nasal tip is measured from the nasolabial angle and the projection is equivalent to the distance that it projects from the face, which can be measured using the Goode method. Currently, one of the biggest discussions in rhinoplasty is the long-term maintenance of tip rotation and projection in closed access techniques with columellar strut and structured open access techniques using the septal extension graft. Conclusion: The rotation of the nasal tip varies considerably in the initial postoperative period, but it drops on average 2-3º six months later. The projection of the nasal tip did not present great differences. For more significant results, studies with a larger number of patients are necessary.

Early Postoperative Sequelae After Open Sky Access in Nasal Osteotomy: A Comparative Study.

Nasal osteotomy is a powerful cornerstone step in almost all rhinoplasty procedures and is a major cause of postoperative periorbital ecchymosis and edema after rhinoplasty. Different accesses for osteotomy have been described, the most popular of which is the external perforating and the internal continuous methods. These accesses are blind maneuvers and have some drawbacks such as possible visible scar formation in the percutaneous access or high rate of mucosal tear in the endonasal access. Open sky access osteotomy after wide subperiosteal dissection had been described to overcome those disadvantages. Early postoperative sequelae have not been assessed in the literature after using this access. In the present study, we aim to assess early postoperative sequelae after using this technique in comparison with percutaneous perforating osteotomy. The study was conducted between November 2017 and January 2021. Forty patients were randomly assigned into 2 equal groups. Group A was subjected to lateral osteotomy by percutaneous perforating method, whereas group B underwent lateral osteotomy by the open sky access technique using a 2-mm curved osteotome. Early postoperative periorbital sequelae were assessed on the second and seventh postoperative days, using the grading system suggested by Kara et al (Plast Reconstr Surg. 1999;104:2213-2218). Mucosal tear was assessed on the second postoperative day using nasal endoscopy after removal of nasal packs. There was a statistically nonsignificant difference between the studied groups regarding ecchymosis and edema occurring on the second or seventh days. Meanwhile, mucosal tear was significantly less in the open sky access osteotomy group. Open sky access osteotomy is a safe method for lateral nasal osteotomy with direct visualization of the surgical field. It does not require a skin incision that could lead to a scar formation. It produces less mucosal tear than percutaneous perforating osteotomy. No statistically significant difference is found between both techniques regarding postoperative periorbital ecchymosis and edema on the second and seventh postoperative days.

Comparison of Two Entry Methods for Laparoscopic Port Entry

Background The first step in laparoscopic surgery is to establish the pneumoperitoneum for which many approaches have been introduced to minimize the complications. Although controversies exist regarding the most efficient technique, till now the best entry technique is still unsettled.
 Objective To compare the safety, operating time and outcome of Direct Trocar Insertion with a well-established and widely practised Open Access Technique.
 Method This is a prospective study at Nobel Medical College Teaching Hospital from November 2019 to February 2021. Patients were grouped into either of the two groups, Group 1 for Direct Trocar Insertion and Group 2 for Open Access Technique. They were later analysed for major and minor complications of the technique and a comparison of either method was done at the end of the study period.
 Result A total of 823 patients were enrolled in the study. Among the study population, 411 patients had Direct Trocar Insertion while 412 patients had Open Access Technique. The majority of the operation that was done during the study period was laparoscopic cholecystectomy. Patients in the Open Access Technique group experienced more complications compared to Direct Trocar Insertion group.
 Conclusion Despite the fear of adopting the Direct Trocar Insertion, this is a safe, better and quick technique for laparoscopic port entry. However, any surgeon practising laparoscopic surgery should be competent to adopt either technique to overcome failure in either process during port entry.

A new minimally invasive technique for the repair of diastasis recti: a pilot study

BackgroundDiastasis recti is an abdominal wall defect that occurs frequently in women during pregnancy. Patients with diastasis can experience lower back pain, uro-gynecological symptoms, and discomfort at the level of the defect. Diastasis recti is diagnosed when the inter-rectus distance is > 2 cm. Several techniques, including both minimally invasive and open access surgical treatment, are available. Abdominoplasty with plication of the anterior rectus sheath is the most commonly used, with the major limitation of requiring a wide skin incision. The new technique we propose is a modification of Costa’s technique that combines Rives–Stoppa principles and minimally invasive access using a surgical stapler to plicate the posterior sheaths of the recti abdominis.MethodsIt is a fully laparoscopic technique. The pneumoperitoneum is induced from a sovrapubic trocar, placed using an open access technique. The posterior rectus sheath is dissected from the rectus muscle using a blunt dissector to create a virtual cavity. The posterior sheets of the recti muscles are plicated using an endo-stapler. A mesh is then placed in the retromuscular space on top of the posterior sheet without any fixation. Using a clinical questionnaire, we analyzed the outcomes in 74 patients who underwent minimally invasive repair for diastasis of the rectus abdominis sheath.ResultsSeventy-four patients (9 men and 65 women) were treated using this technique. Follow-up was started two months after surgery. All procedures were conducted successfully. There were no major complications or readmissions. No postoperative infections were reported. There were two recurrences after six months. There was a significant reduction in symptoms.ConclusionsThis new method is feasible and has achieved promising results, even though a longer follow-up is needed to objectively assess this technique.

Outcomes of Open Versus Percutaneous Access for Patients Enrolled in the GREAT Registry

Arterial access and device delivery in endovascular aortic repair (EVAR) and thoracic endovascular aortic repair (TEVAR) have evolved from open femoral or iliac artery exposure to selective percutaneous arterial access. Although regional application of percutaneous access for these 2 procedures varies widely, the use of this technique continues to increase. Currently, differences in the use of percutaneous access between EVAR and TEVAR have not been well explored. The Gore Global Registry for Endovascular Aortic Treatment (GREAT) registry collected relevant data for evaluation of these issues and the comparative results between open and percutaneous approaches in regard to complication rates and length of stay (LOS). This study was performed via a retrospective review of patients from the GREAT registry (Clinicaltrials.gov no. NCT01658787). The primary variable of this study was access site complications including postoperative hematoma, vessel dissection, and pseudoaneurysm. Patients were categorized by abdominal (EVAR) and thoracic (TEVAR) aortic procedures using percutaneous-only, cutdown-only, and combined vascular access techniques for a total of 6 groups. Standard statistical methodology was used to perform single-variable and multivariable analysis of a variety of covariates including LOS, geographical location of procedure, procedural success rate, and access sheath size. Of 4,781 patients from the GREAT registry, 3,837 (80.3%) underwent EVAR and 944 (19.7%) underwent TEVAR with percutaneous-only access techniques being used in 2,017 (42.2%) and cutdown-only in 2,446 (51.2%). There was variable application of percutaneous access by geographic region with Australia and New Zealand using this technique more frequently and Brazil using percutaneous access the least. No significant difference in the rate of access site complications was detected between the 6 groups of patients in the study; however, significantly lower rates of access site complications were associated with percutaneous-only compared with both cutdown-only and combined techniques (P=0.03). In addition, associated with significantly higher rates of access site complications was longer LOS (P<0.01). Average LOS was 5.2days and was higher in the TEVAR group (10.1days) than that in EVAR (4.0days, P<0.05). Increased sheath size does not appear to increase the risk of access site complication. There was no significant difference found in the complication rate between percutaneous and cutdown access techniques. This analysis demonstrates that percutaneous-only access is safe, has low complication rates, and has lower LOS compared with open access or combined access techniques.

Monitoring land-cover and land-use dynamics in Fanjingshan National Nature Reserve

Fanjingshan National Nature Reserve (FNNR) in China is a biodiversity hotspot that is part of a larger, multi-use landscape where tourism, farming, grazing, and other land uses occur. Payment for ecosystem services (PES) programs that encourage afforestation on farmlands may be important drivers of land-cover and land-use change in the region that surrounds FNNR. Our objective is to monitor and examine vegetation and land-use changes, including PES-related afforestation, between 1989 and 2017. We utilize several image processing techniques, such as illumination normalization approaches to suppress terrain effects, and multi-seasonal image compositing to minimize persistent cloud cover. Ancillary data were also incorporated to generate reliable vegetation and land-use change information. A random forest machine learning image classification routine is implemented through the cloud-based Google Earth Engine platform and refined using optimal classifier parameter tuning. Land-use transitions are identified and mapped with the implementation of stable training sites, discrete image classification, and logical land-use transition rules. Accuracy assessment results indicate our change detection workflow provides a reliable methodology to remotely monitor long-term forest cover and land-use changes in this mountainous, forested, and cloud prevalent region. We quantify the area of new built development and afforestation land and found that most of the land transitions took place in reserve buffer and its adjacent environs. For example, less than 2 km2 of new built was identified within the reserve boundary compared to 25 km2 for the entire study area between 1995 and 2016. We also shed light on the strengths and weaknesses of using Google Earth Engine for land-cover and land-use change studies. This efficient and open-access technique is important not only for assessing environmental changes and PES efficacy, but also for evaluating other conservation policies elsewhere.

Laparoscopic Access: Direct Trocar Insertion Versus Open Technique.

Creation of pneumoperitoneum and laparoscopic entry into the abdominal cavity are crucial initial steps of laparoscopic surgery and associated with bowel and major vessel injuries. Various methods have been described in literature such as Veress needle, open access technique (OAT), direct trocar insertion (DTI), and optical port. There is no consensus on the safest method of gaining access to the peritoneal cavity to create a pneumoperitoneum. DTI technique appears to be not well accepted by many due to the fear of causing injuries as it is a blind procedure. To compare the outcome of DTI in terms of feasibility and complications with a well-established and widely practiced OAT for a laparoscopic procedure. Nine hundred fifty-five participants were randomized to be in either of the two groups, that is, Group "A" for DTI and Group "B" for OAT. The primary endpoint was major complications (bowel, major vessel, and solid organ injury) and the secondary endpoint was port access time and minor complications directly related to access. Patients were assessed on the first postoperative day, at the time of discharge, 3 months, 6 months, and a year after discharge, for complications. There was no statistical difference in major complications between DTI and OAT groups, however, DTI was found to be superior to OAT in terms of port access time (P = .01), umbilical port-site hernia, port-site infection, and port-site pain (P = .01). This study further strengthens the literature on DTI being a good and safe technique of laparoscopic access. The technique of DTI is still underutilized and needs to be adopted by surgeons without fear.

Outcomes of with open and Seldinger-Guided Peripheral Cannulation Techniques in open heart surgery

Objective: In this study, we evaluated the results of open access and seldinger guided peripheral cannulation techniques in patients which underwent open heart surgery. Materials and Method: The results of heart surgery cases with peripheral artery and vein open access technique and seldinger guide technique between November 2010 and October 2017 were evaluated retrospectively. Edwards® Fem-Flex II and Medtronic Bio-Medicus™ NextGen percutaneous femoral artery and venous Cannulas were chosen. Peripheric cannulations were performed percutaneously with doppler ultrasonography via guided seldinger technique. Seldinger technique for peripheric cannulation was preferred even open exploration of the groin vessels were needed. Results: 65 patients (32 male, 33 female; mean age 43±37 years; range 3-81 years) were taken into the study that peripheral cannulation performed. In 18 (27.6%) patients minimally invasive technique was applied and 34 (52.3%) patients were redo cases. A mean flow of 4,108±0.6 m2 l/m2/m was achieved with vacuum application in only 6 patients (9.2%) for venous drainage. No hemothorax, pneumothorax or hematoma had occured in cannulation sites due to internal jugular vein or femoral cannulations. Surgical embolectomy was performed due to distal thrombus only in 4 patients (6.15%) to whom had conventional cannulation. In 4 patients (6.15%) femoral venous cannula couldnÂ’t reached up to the right atrium. Conclusion: In our opinion, seldinger technique either performed percutaneously or surgically is a faster, easier and superior technique in protecting distal limb perfusion when compared with open vasculotomy with proximal/distal clamping technique. Moreover, it can be safely applied in high risk redo cases as well as routine minimally invasive surgery.

Safety and Efficacy of Totally Percutaneous Access Compared With Open Femoral Exposure for Endovascular Aneurysm Repair

Purpose: To compare the safety and efficacy of percutaneous (PEVAR) vs open femoral access (OFA) techniques for endovascular aneurysm repair (EVAR). Methods: A systematic review of English-language articles (Medline, EMBASE, and Cochrane databases) between January 1999 and August 2016 returned 11 studies including 1650 patients with 2500 groin accesses eligible for the meta-analysis. Data extracted from each study were synthesized to evaluate technical success rates, procedure time, and complications for the 2 access approaches. Data are presented as the odds ratio (OR) or mean difference (MD) with 95% confidence intervals (CI). The quality of individual studies was evaluated based on the Newcastle-Ottawa scale. Results: The mean technical success rate in the PEVAR group was 94.5% (785/831). The overall OR was 0.38 (95% CI 0.12 to 1.18, p=0.09), indicating no significant difference between the methods. The procedure time in PEVAR was shorter than OFA (mean difference −24.52, 95% CI −46.45 to −22.60, p<0.001). Overall, the total complication rate was 15.3% in the OFA group vs 7.8% in the PEVAR group (OR 0.52, 95% CI 0.37 to 0.73, p<0.001). The meta-analysis identified significant differences between groups for all complications (p<0.001) and the following individual adverse events: wound infection (OR 0.28, 95% CI 0.10 to 0.81, p=0.02), pseudoaneurysm (OR 8.07, 95% CI 1.54 to 42.32, p=0.01), seroma (OR 0.10, 95% CI 0.02 to 0.55, p=0.008), and lymphocele or lymph leak (OR 0.19, 95% CI 0.04 to 0.92, p=0.04). Conclusion: PEVAR had a similar technical success rate, shorter procedure time, and lower complication rate compared with OFA. Thus, percutaneous access appears to be the preferential approach for EVAR. However, larger and randomized studies are needed to draw definitive conclusions.

PRS Global Open's Evolution: Logo, Growth, and Mission.

PRS Global Open's Evolution: Logo, Growth, and Mission.

A Safe Open Access Technique to Insert the First Trocar in Laparoscopic Surgery

Abstract Objective: Indications for laparoscopic surgery are becoming more numerous across many surgical disciplines. Despite modern developments in techniques and surgical equipment, the search continues for an optimal method of placing the first trocar and establishing a pneumoperitoneum. Subjects and Methods: Since 1998, this technique was used routinely for all laparoscopic procedures, including emergency and trauma cases. We describe a new open-entry technique that is easy to use and minimizes the risk of associated injuries. We enter the abdomen through a vertical incision ~1–1.5 cm long, made anywhere in the abdomen that is expected to be free of adhesions, although the preferred site is the upper edge of the umbilicus. The abdominal wall is elevated with Kocher clamps placed perpendicular to the incision and severed stepwise down to the peritoneum. The fold in the fascia created by the clamps prevents accidental injury to the abdominal organs. Then, the edges of the incision are held together with...

Minilaparoscopy vs. standard laparoscopic donor nephrectomy: comparison of safety, efficacy and cosmetic outcomes in a randomized clinical trial.

This study was conducted to compare safety, efficacy and cosmetic outcome between standard laparoscopic live donor nephrectomy (sLDN) and mini-laparoscopic donor nephrectomy (mLDN) in a randomized clinical trial. From March 2012 to June 2013, 100 consecutive kidney donors were randomly assigned to two equal groups for laparoscopic donor nephrectomy. mLDN: Six to eight centimeters Pfannenstiel incision was made slightly above pubis symphysis and 11 millimeters trocar was fixed through exposed fascia using open technique. Five mm port was placed under direct vision at the umbilicus for camera insertion and two 3.5 mm ports were placed in subxiphoid and paraumbilical area. sLDN: Ten mm port was placed at umbilicus using open access technique for camera insertion. Five mm trocar for grasping and 11 mm trocar for vascular clipping were placed at subxiphoid and paraumbilical areas under direct vision, respectively. The second 5 mm trocar was placed in suprapubic area. Cosmetic appearance was assessed three months after surgery by using the Patient Scar Assessment Questionnaire (PSAQ). Demographic data of the patients was not significantly different between two groups. Total operative time and ischemic time was nearly similar in both groups (104 ± 21 vs. 114 ± 24 min; P = .327 and 4.03 vs. 4.07 min; P = .592). There were no cases of conversion to open surgery. Mean hospital stay was similar between the two groups [2.1 (2-5) vs. 2.4 (2-5) days; P = .346]. Kidney graft function assessed by serum creatinine val­ues (mg/dL) of recipients, was equivalent in both groups (1.58 vs. 1.86: P = .206). Mean appearance score (34 vs. 29) and consciousness score (22 vs. 18) in PSAQ showed significantly better results in the mLDN group. Our experience in this study revealed that peri- and post-operative findings were comparable between sLDN and mLDN, but mLDN has significant better cosmetic appearance than standard laparoscopic approach.

The impact of TAVI on vascular complications incidence: a literature review

Aim: This article provides a literature review on the post-procedural outcomes of patients who have undergone transfemoral transcatheter aortic valve implantation (TAVI). Background: TAVI is a less invasive treatment option than surgical aortic valve replacement (SAVR) for aortic stenosis. Aortic stenosis in the UK has a prevalence rate of 5% in people aged 75 and over. Access sites used for TAVI procedures include trans-aortic, subclavian, carotid, apical (TA) and femoral (TF) ( National Institute for Health and Care Excellence (NICE), 2012 ). Transfemoral TAVI access sites were previously closed using an open surgical access technique (closure of the skin using sutures). However, over the years, the use of percutaneous access closure devices such as Perclose Proglide has increased. Nevertheless, there is a gap in the literature that assesses the postoperative vascular complications in patients who undergo TAVI. Conclusion: This review highlights the importance of measuring patients' post-procedural outcomes, as well as the need for increased confidence and competence in all health professionals in their provision of care to patients, and more evidence-based care. Relevance to clinical practice: Nurses can improve patient care by observing the patient and ensuring their safety following the TAVI procedure. They should therefore be competent in recognising any major or minor vascular complications after transfemoral TAVI and assessing their significance.

Open-access technique and "critical view of safety" as the safest way to perform laparoscopic cholecystectomy.

The 2 main challenges of laparoscopic cholecystectomy are primary peritoneal access and safe identification, ligation, and division of the cystic duct and cystic artery. This is a 13-year period retrospective study from January 2000 to December 2012. All the operations were performed by 1 surgeon and all the data were collected from the hospitals archive. A total of 929 laparoscopic cholecystectomies were performed for symptomatic cholelithiasis. The first author was involved in all the operations either by performing or assisting in them. The open access (OA) technique was used in all cases for the creation of pneumoperitoneum. After establishing the pneumoperitoneum, the "critical view of safety" (CVS) technique was used to ligate and divide the cystic duct and cystic artery. When the OA was not possible or CVS was not feasible, the operation was converted to open. Successful establishment of pneumoperitoneum with OA was possible in 911 of 929 (98.06%) patients and CVS was achieved in 873 patients (95.82%). In 18 patients the operation was converted to open because of dense adhesions not permitting the establishment of the pneumoperitoneum. No intraoperative or postoperative complications occurred in these patients. No bile duct injury occurred in this series. Postoperative complications were recorded in 19 patients (2.04%). Five patients had bleeding from port sites, 12 patients had wound infection at the umbilical incision, and 2 patients developed subhepatic collections, which were drained percutaneously under computed tomographic guidance. In this series of laparoscopic cholecystectomies, we used the "open access" technique to create pneumoperitoneum and we obtained the "critical view of safety" for the identification of the cystic duct. Our results show that this approach is the safest way to perform and teach laparoscopic cholecystectomy.

Major vascular injury in laparoscopic urology.

Background and Objectives:Major vascular injury is the most devastating complication of laparoscopy, occurring most commonly during the laparoscopic entry phase. Our goal is to report our experience with major vascular injury during laparoscopic entry with closed- and open-access techniques in urologic procedures.Methods:All 5347 patients who underwent laparoscopic urologic procedures from 1996 to 2011 at our hospital were included in the study. Laparoscopic entry was carried out by either the closed Veress needle technique or the modified open Hasson technique. Patients' charts were reviewed retrospectively to investigate for access-related major vascular injuries.Results:The closed technique was used in the first 474 operations and the open technique in the remaining 4873 cases. Three cases of major vascular injury were identified among our patients. They were 3 men scheduled for nephrectomy without any history of surgery. All injuries occurred in the closed-access group during the setup phase with insertion of the first trocar. The injury location was the abdominal aorta in 2 patients and the external iliac vein in 1 patient. Management was performed after conversion to open surgery, control of bleeding, and repair of the injured vessel.Conclusions:Given the high morbidity and mortality rates associated with major vascular injury, its clinically higher incidence in laparoscopic urologic procedures with the closed-access technique leads us to suggest using the open technique for the entry phase of laparoscopy. Using the open-access technique may decrease laparophobia and encourage a higher number of urologists to enter the laparoscopy field.

Evolution of Laparoscopic Live Donor Nephrectomy: A Single-Center Experience with 1510 Cases over 14 Years

This study evaluated the outcomes of laparoscopic donor nephrectomy (LDN) and proposed modifications for kidney donation surgery. From February 1997 to February 2011, 1510 LDNs were performed. Surgical modifications included a modified open access technique for entry into the abdominal cavity, using vascular clips for safe and cost-effective control of the renal pedicle, control of the lumbar veins, and adrenal vein using bipolar cautery instead of clips, and leaving the gonadal vein intact with the ureter. Kidneys were extracted by hand through a Pfannenstiel incision. Heparin was not used after the first 300 cases to prevent potential hemorrhagic complications. Although three major vascular injuries occurred using the closed access method that were managed successfully, no access-related complications occurred using the modified open access technique. Clip failure did not happen in any cases. Patient and graft survival at 1 year post-transplantation were 96.5% and 95.5%, respectively, and at 5 years post-transplantation were 95.3% and 89.5%, respectively. The proposed surgical modifications are based on 14 years of experience and 1510 cases, and make LDN simple, safe, and cost-effective. The excellent recipient and graft outcomes with minimal morbidity obtained further confirm that LDN can be considered as the gold standard for kidney donation surgery.

Buccal Fat Pad Lifting: An Alternative Open Technique for Malar Augmentation

The purpose of the study was to introduce a novel technique for malar augmentation using buccal fat pad pedicle flaps and to evaluate the long-term results and complications of the technique. The investigators designed and conducted a prospective clinical trial. Patients underwent unilateral malar augmentation surgery using buccal fat pad pedicle flaps from June 2011 through June 2012. Patients underwent surgery for esthetic reasons or for trauma with severely comminuted or old zygomaticomaxillary complex fractures that could not be reduced precisely. The primary predictor variable was the buccal fat pad pedicle flap technique. The primary outcome variables included the amount of augmentation and resorption (which was estimated by comparing pre- with postsurgical photographic views), pain, edema, bruising, and nerve and parotid duct injuries. Thirteen patients (8 men and 5 women) underwent malar augmentation in the cheekbone area using the buccal fat pad pedicle flap technique. One year after surgery, the average amount of resorption was 0.376 mm. Other major complications, such as prolonged bruising, massive hematoma, intense pain, asymmetry, and parotid duct injury, were not observed. These results indicate that this new open-access technique should be considered an alternative method for the management of mild to moderate malar depression in patients undergoing esthetic and post-trauma surgery.

Bologna guidelines for diagnosis and management of adhesive small bowel obstruction (ASBO): 2013 update of the evidence-based guidelines from the world society of emergency surgery ASBO working group

BackgroundIn 2013 Guidelines on diagnosis and management of ASBO have been revised and updated by the WSES Working Group on ASBO to develop current evidence-based algorithms and focus indications and safety of conservative treatment, timing of surgery and indications for laparoscopy.RecommendationsIn absence of signs of strangulation and history of persistent vomiting or combined CT-scan signs (free fluid, mesenteric edema, small-bowel feces sign, devascularization) patients with partial ASBO can be managed safely with NOM and tube decompression should be attempted. These patients are good candidates for Water-Soluble-Contrast-Medium (WSCM) with both diagnostic and therapeutic purposes. The radiologic appearance of WSCM in the colon within 24 hours from administration predicts resolution. WSCM maybe administered either orally or via NGT both immediately at admission or after failed conservative treatment for 48 hours. The use of WSCM is safe and reduces need for surgery, time to resolution and hospital stay.NOM, in absence of signs of strangulation or peritonitis, can be prolonged up to 72 hours. After 72 hours of NOM without resolution, surgery is recommended.Patients treated non-operatively have shorter hospital stay, but higher recurrence rate and shorter time to re-admission, although the risk of new surgically treated episodes of ASBO is unchanged. Risk factors for recurrences are age <40 years and matted adhesions. WSCM does not decrease recurrence rates or recurrences needing surgery.Open surgery is often used for strangulating ASBO as well as after failed conservative management. In selected patients and with appropriate skills, laparoscopic approach is advisable using open access technique. Access in left upper quadrant or left flank is the safest and only completely obstructing adhesions should be identified and lysed with cold scissors. Laparoscopic adhesiolysis should be attempted preferably if first episode of SBO and/or anticipated single band. A low threshold for open conversion should be maintained.Peritoneal adhesions should be prevented. Hyaluronic acid-carboxycellulose membrane and icodextrin decrease incidence of adhesions. Icodextrin may reduce the risk of re-obstruction. HA cannot reduce need of surgery.Adhesions quantification and scoring maybe useful for achieving standardized assessment of adhesions severity and for further research in diagnosis and treatment of ASBO.

Solid pseudopapillary tumor of the pancreas: Report of five cases

Introduction: Solid pseudopapillary tumor of the pancreas (SPT) is a rare pancreatic tumor with an unclear pathogenesis and good prognosis after resection. We report our experience with the diagnostic and therapeutic management of these tumors over 10 years. Case Series: A retrospective chart review was performed for all patients undergoing pancreatic resection at our institution from 2001-2011. Patients with final pathology demonstrating SPT were identified. Of 617 pancreatic resections performed at our institution, five patients (0.8%) were found to have solid pseudopapillary tumor of the pancreas. All patients were female with a mean age of 39.2 years. Abdominal pain was the presenting symptom in four patients. MRI demonstrated pancreatic head involvement in three patients and pancreatic tail involvement in one patient. CT scan was used to diagnose one tumor located in the body of the pancreas. Mean tumor size was 8.0 cm, Surgical treatment consisted of two open pancreaticoduodenectomies, one laparoscopic pancreaticoduodenectomy, one laparoscopic subtotal pancreatectomy and one laparoscopic distal pancreatectomy. Surgical pathology revealed no evidence of vascular invasion in any of the tumors and an Ro resection complete resection with no microscopic residual tumor was obtained in all patient. No patients had involved lymph nodes with a mean of 16 lymph nodes inspected. No complications from any pancreatic resection were observed. Conclusion: Solid pseudopapillary tumors of the pancreas are a rare but treatable pancreatic tumor. Complete surgical excision is the treatment of choice and can be achieved through an open or minimal access technique.