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Cureus Jan 2024Appendectomy remains the gold standard for treating appendicitis, but advancements in laparoscopic techniques have shifted the paradigm. Natural orifice transluminal... (Review)
Review
Appendectomy remains the gold standard for treating appendicitis, but advancements in laparoscopic techniques have shifted the paradigm. Natural orifice transluminal endoscopic surgery (NOTES) and transvaginal appendectomy (TVA) offer a potentially less invasive alternative to traditional laparoscopic appendectomy (LA). This article systematically reviews the procedures, perceptions, and complications of TVA to assess its viability as a surgical option. Between January 1, 2003, and November 1, 2023, 4832 case reports, case series, and experimental and observational peer-reviewed publications were examined and filtered using the keyword "Transvaginal Laparoscopic Appendectomy." The publications were screened using PRISMA guidelines, and 20 studies were included for analysis and review. Survey results showed that women's acceptance of TVA was 43%, citing reduced invasiveness as a major reason for positive reception. TVA procedures exhibited consistency, with variations in appendectomy methods, appendix removal, and posterior fornix incision closure. Positive outcomes included shorter operation times, reduced postoperative pain, and minimal scarring. Complications were uncommon but included bladder puncture, urinary tract infections, and intra-abdominal abscesses. Indications primarily focused on surgical safety, reduced scarring, and postoperative benefits. Sexual function post-TVA exhibited no significant differences in most cases, with a recovery period of two to four weeks. This systematic review suggests that TVA is a promising alternative to traditional LA, offering potential advantages in terms of postoperative complications. While the existing literature indicates positive outcomes, further research with larger sample sizes and long-term follow-ups is needed to validate the efficacy and safety of TVA and assess how the procedure impacts the reproductive function of patients.
PubMed: 38333466
DOI: 10.7759/cureus.51962 -
Laryngo- Rhino- Otologie May 2024Endoscopic endonasal skull base surgery has gained acceptance worldwide. Comparative analysis has demonstrated that endoscopic skull base surgery may have advantages for... (Review)
Review
OBJECTIVE
Endoscopic endonasal skull base surgery has gained acceptance worldwide. Comparative analysis has demonstrated that endoscopic skull base surgery may have advantages for many pathologies of the anterior skull base, e. g., sinonasal malignant tumors; pathologies of the central skull base, e. g., pituitary adenomas, craniopharyngiomas; well-selected cases of planum sphenoidale and tuberculum sellae meningiomas; or for clival lesions, e. g., chordomas, chondrosarcomas, or selected meningiomas. Over the past three decades, interdisciplinary surgical teams, consisting of otolaryngologists and neurosurgeons, have provided detailed anatomical knowledge, suggested new approaches or modifications of established surgical techniques, and offered continued surgical education.
METHOD
A review of pertinent literature was conducted with an emphasis on interdisciplinary endoscopic surgery of skull base lesions.
RESULTS
Based on the authors̓ surgical experience in two different interdisciplinary endoscopic skull base centers, the authors classify approaches for endoscopic endonasal skull base surgery, describe indications, and key anatomic landmarks for common pathologies, and highlight surgical techniques to avoid complications.
CONCLUSION
Interdisciplinary endonasal endoscopic surgery combines surgical expertise, improves resection rates for many pathologies, and minimizes morbidity by reducing the incidence of surgical complications.
Topics: Skull Base Neoplasms; Humans; Endoscopy; Patient Care Team; Skull Base; Natural Orifice Endoscopic Surgery; Interdisciplinary Communication
PubMed: 38697142
DOI: 10.1055/a-2196-8984 -
Computerized Medical Imaging and... Sep 2023Digital twins of patients' hearts are a promising tool to assess arrhythmia vulnerability and to personalize therapy. However, the process of building personalized...
Digital twins of patients' hearts are a promising tool to assess arrhythmia vulnerability and to personalize therapy. However, the process of building personalized computational models can be challenging and requires a high level of human interaction. We propose a patient-specific Augmented Atria generation pipeline (AugmentA) as a highly automated framework which, starting from clinical geometrical data, provides ready-to-use atrial personalized computational models. AugmentA identifies and labels atrial orifices using only one reference point per atrium. If the user chooses to fit a statistical shape model to the input geometry, it is first rigidly aligned with the given mean shape before a non-rigid fitting procedure is applied. AugmentA automatically generates the fiber orientation and finds local conduction velocities by minimizing the error between the simulated and clinical local activation time (LAT) map. The pipeline was tested on a cohort of 29 patients on both segmented magnetic resonance images (MRI) and electroanatomical maps of the left atrium. Moreover, the pipeline was applied to a bi-atrial volumetric mesh derived from MRI. The pipeline robustly integrated fiber orientation and anatomical region annotations in 38.4 ± 5.7 s. In conclusion, AugmentA offers an automated and comprehensive pipeline delivering atrial digital twins from clinical data in procedural time.
Topics: Humans; Atrial Fibrillation; Heart Atria; Magnetic Resonance Imaging
PubMed: 37392493
DOI: 10.1016/j.compmedimag.2023.102265 -
International Journal of Surgery Case... Oct 2023The first clinical presentation of a hernia developing along the Spigelian line had been reported by Klinkosch. The Belgian anatomist Adriaan van der Spieghel (Adrianus...
INTRODUCTION & IMPORTANCE
The first clinical presentation of a hernia developing along the Spigelian line had been reported by Klinkosch. The Belgian anatomist Adriaan van der Spieghel (Adrianus Spigelius) was the first to describe the semilunar line now known as the linea Spigeli in 1645. Spigelian hernias are rare and account for 1 % to 2 % of all abdominal wall hernias. Most of these hernia occurs in the lower abdomen where posterior sheath is deficient. The hernia ring is well defined defect in the transverse aponeurosis.
CASE PRESENTATION
A 60 year old female, presented with a palpable lump at the right lower quadrant of the abdomen since 7 month before her presentation.
CLINICAL DISCUSSION
For the first time the swelling is small and painless then gradually increase in size and associated with dull aching pain. The swelling was reducible with a defect of size 4 × 4 cm palpable in right iliac fossa. There was a positive cough impulse. The swelling was non tender. Other hernial orifices were normal. No inguinal lymphadenopathy noted. Abdominal ultrasonography done revealed a defect in abdominal wall in right iliac fossa with reducible bowel content. Depending on basis of clinical and investigations, a diagnosis of Spigelian hernia was made. After preparation for surgery, exploration done. The defect measuring 4 cm in length was identified and anatomical repair was done with nylon- 0, by suturing medial border of internal oblique and transverse abdominus muscle to the lateral border of rectum abdominal wall followed by hernioplasty by mesh.
CONCLUSION
Spigelian hernias are rare multifactorial disorder leading to defect in the transversus abdominis muscle in anterior abdominal wall. Spigelian hernias carry a significant risk of incarceration and strangulation of sac content. The management of spigelian hernias is almost always surgical which can be done in a traditional open fashion or laparoscopically.
PubMed: 37757738
DOI: 10.1016/j.ijscr.2023.108785 -
BMC Urology Feb 2024Postpartum stress urinary incontinence (SUI) is a common occurrence in women, and it has a profound effect on women's health and quality of life. This study aimed to...
PURPOSE
Postpartum stress urinary incontinence (SUI) is a common occurrence in women, and it has a profound effect on women's health and quality of life. This study aimed to investigate the risk factors for postpartum SUI and the relative importance of each factor, including pelvic floor ultrasound measurement data and clinical data.
METHOD
Pregnant women who delivered in our hospital from March 2021 to January 2022 were selected as the study population. The clinical and anatomical Data from women with SUI and those without SUI were collected and analyzed. The clinical and anatomical risk factors associated with postpartum SUI were identified using univariate and multivariate analyses.
RESULTS
A total of 255 participants were recruited. Logistic regression analysis indicated that age (OR:1.215, 95% CI:1.097-1.346, P < 0.001), vaginal delivery (OR:3.05, 95% CI:1.328-7.016, P < 0.009), parity (OR:3.059, 95% CI:1.506-6.216, P < 0.002), bladder neck descent (OR:4.159, 95% CI: 2.010-8.605, P < 0.001), the angle of the internal urethral orifice funnel (OR:1.133, 95% CI:1.091-1.176, P < 0.001) were important independent risk factors for postpartum SUI (all P < 0.05). The AUC was 0.883 (95% CI: 0.839-0.926) in the model.
CONCLUSIONS
Age, vaginal delivery, parity, bladder neck descent and the angle of the internal urethral orifice funnel are independent risk factors for postpartum SUI. To prevent the occurrence of postpartum SUI, high-risk factors of postpartum SUI should be identified as early as possible during pregnancy and after delivery, and postpartum pelvic floor rehabilitation training should be promoted.
Topics: Pregnancy; Female; Humans; Urinary Incontinence, Stress; Prospective Studies; Quality of Life; Postpartum Period; Risk Factors
PubMed: 38365685
DOI: 10.1186/s12894-024-01430-x -
Journal of the Canadian Association of... Aug 2023Identification and photo-documentation of the ileocecal valve (ICV) and appendiceal orifice (AO) confirm completeness of colonoscopy examinations. We aimed to develop...
BACKGROUND AND AIMS
Identification and photo-documentation of the ileocecal valve (ICV) and appendiceal orifice (AO) confirm completeness of colonoscopy examinations. We aimed to develop and test a deep convolutional neural network (DCNN) model that can automatically identify ICV and AO, and differentiate these landmarks from normal mucosa and colorectal polyps.
METHODS
We prospectively collected annotated full-length colonoscopy videos of 318 patients undergoing outpatient colonoscopies. We created three nonoverlapping training, validation, and test data sets with 25,444 unaltered frames extracted from the colonoscopy videos showing four landmarks/image classes (AO, ICV, normal mucosa, and polyps). A DCNN classification model was developed, validated, and tested in separate data sets of images containing the four different landmarks.
RESULTS
After training and validation, the DCNN model could identify both AO and ICV in 18 out of 21 patients (85.7%). The accuracy of the model for differentiating AO from normal mucosa, and ICV from normal mucosa were 86.4% (95% CI 84.1% to 88.5%), and 86.4% (95% CI 84.1% to 88.6%), respectively. Furthermore, the accuracy of the model for differentiating polyps from normal mucosa was 88.6% (95% CI 86.6% to 90.3%).
CONCLUSION
This model offers a novel tool to assist endoscopists with automated identification of AO and ICV during colonoscopy. The model can reliably distinguish these anatomical landmarks from normal mucosa and colorectal polyps. It can be implemented into automated colonoscopy report generation, photo-documentation, and quality auditing solutions to improve colonoscopy reporting quality.
PubMed: 37538187
DOI: 10.1093/jcag/gwad017 -
Europace : European Pacing,... Aug 2023Incomplete left atrial appendage occlusion (LAAO) due to peri-device leak (PDL) is a limitation of the therapy. The Amulet IDE trial is the largest randomized... (Randomized Controlled Trial)
Randomized Controlled Trial
AIMS
Incomplete left atrial appendage occlusion (LAAO) due to peri-device leak (PDL) is a limitation of the therapy. The Amulet IDE trial is the largest randomized head-to-head trial comparing the Amulet and Watchman 2.5 LAAO devices with fundamentally different designs. The predictors and mechanistic factors impacting differences in PDLs within the Amulet IDE trial are assessed in the current analysis.
METHODS AND RESULTS
An independent core lab analysed all images for the presence or absence of severe PDL (>5 mm). The incidence, mechanistic factors, predictors using propensity score-matched controls, and evolution of severe PDLs through 18 months were assessed. Of the 1878 patients randomized in the trial, the Amulet occluder had significantly fewer severe PDLs than the Watchman device at 45 days (1.1 vs. 3.2%, P < 0.001) and 12 months (0.1 vs. 1.1%, P < 0.001). Off-axis deployment or missed lobes were leading mechanistic PDL factors in each device group. Larger left atrial appendage (LAA) dimensions including orifice diameter, landing zone diameter, and depth predicted severe PDL with the Watchman device, with no significant anatomical limitations noted with the Amulet occluder. Procedural and device implant predictors were found with the Amulet occluder attributed to the learning curve with the device. A majority of Watchman device severe PDLs did not resolve over time through 18 months.
CONCLUSION
The dual-occlusive Amplatzer Amulet LAA occluder provided improved LAA closure compared with the Watchman 2.5 device. Predictors and temporal observations of severe PDLs were identified in the Amulet IDE trial.
CLINICAL TRIAL REGISTRATION
https://clinicaltrials.gov Unique identifier NCT02879448.
Topics: Humans; Atrial Appendage; Atrial Fibrillation; Cardiac Surgical Procedures; Treatment Outcome; Septal Occluder Device; Cardiac Catheterization; Stroke
PubMed: 37584233
DOI: 10.1093/europace/euad237