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AIM: To describe a technique of managing intraocular lens (IOL) with deep dislocation in the vitreous cavity by performing pars plana vitrectomy (PPV) with only one pars plana incision under the direct illumination of the surgical microscope. METHODS: Patients who had in-the-bag or out-of-the-bag (spontaneous) IOL dislocation after uneventful phacoemulsification cataract extractions, with the dislocated IOL or IOL-capsular bag complex dropping completely into the vitreous since 2013 were included in our studies. The postoperative patients were followed up for 6mo. Detailed description of technique and retrospective description of eight typical cases were demonstrated in this study. RESULTS: A total of 40 surgeries were conducted using this technique. The main possible predisposing conditions included: post-vitrectomy, posterior capsule rupture or broken zonules, a history of ocular trauma, long axial length, secondary IOL implantation, chronic uveitis, retinitis pigmentosa and post-glaucoma surgery. In all eyes, the IOLs were successfully removed. No intraoperative or postoperative complications related to the procedures occurred. The preoperative corrected distance visual acuity (CDVA) ranged from 20/133 to 20/25, and at 6mo postoperatively, the CDVA was similar or the same. The intraocular pressure was all within the normal range. CONCLUSION: One-port PPV under direct vision with microscope illumination is a simple and safe surgical technique to managing IOL dislocation, which shortens the surgical time, and largely avoids surgical complications.

Extraction of the distal femoral cement mantle and restrictor during revision total hip arthroplasty (rTHA) is challenging and can compromise host bone stock. The aim of this study is to report outcomes of our femoral windowing technique for cement removal. We report on a cohort of 36 patients with an average age of 68.7 years who underwent 40 cemented rTHA between 2011 and 2017 using a vascularised anterior femoral window. Clinical and radiological outcomes were retrospectively reviewed with a mean follow-up of 6.6 years (range, 3.8–10). Latest mean WOMAC score was 25.4 and all windows achieved radiographic union by a mean of 7.9 weeks. Femoral component survivorship was 100% and 38 out of 40 rTHAs showed no evidence of radiological loosening. The vascularised anterior window to remove the distal femoral cement mantle under direct vision is safe and reproducible with excellent clinical and radiographic results.

The extracorporeal anastomosis technique for video-assisted thoracoscopic surgery (VATS) intrathoracic esophagogastric anastomosis is a convenient, easy technique to use in VATS esophagectomy. The surgeon can assess the viability and the status of the gastric conduit, and the introduction of a circular stapler can be easily done under direct vision extracorporeally, enabling easy and simple VATS intrathoracic anastomosis between the esophagus and the gastric conduit.

Purpose: To define the anatomical relationship of the major neurovascular structures to the standard endoscopic portals used in endoscopic hamstring repair. A secondary outcome was to determine the safest angle of insertion from each standard portal. Methods: Endoscopic portals were established in the 3 standard locations (lateral, medial, and inferior) and Steinmann pins inserted at various angles. Each hip was dissected and the distance between the pins and the pertinent anatomy measured. Results: The lateral portal placed the sciatic and posterior femoral cutaneous (PFC) nerves at greatest risk: direct injury to the sciatic nerve was seen in 11/30 (37%) of the lateral portals sited. A lateral portal with an approach at 60° was the most dangerous orientation with a mean distance of 0.36 ± 0.49 mm and 4.30 ± 2.69 mm from the sciatic and PFC nerves, respectively ( p < 0.001). The 60° medial portal was the safest of all portals measured, at a mean distance of 67.37 ± 11.06mm (range, 47–78 mm) from the sciatic nerve and 58.90 ± 10.57 mm (range 40–70 mm) from the PFC nerve. Conclusions: While currently described techniques recommend establishing the standard lateral portal first, this study shows that it carries the highest risk of injury if used blind. We recommend that the standard medial endoscopic portal is established first to identify the neurovascular structures and minimise iatrogenic neurovascular injury. The inferior and lateral portals can then be established created under direct vision. The lateral portal should be inserted in a more horizontal orientation to decrease the risk of nerve injury.

Objective The aim of this study was to explore the clinical effect of treatment for recurrent axillary osmidrosis (AO) after small-incision minimally invasive surgery by trimming and electrocoagulation of apocrine glands under direct vision through double incisions parallel to axillary creases. Methods This was a retrospective study. From September 2012 to January 2019, 75 axillae in 48 cases of recurrent AO after small-incision minimally invasive surgery were treated using trimming and electrocoagulation of apocrine glands under direct vision through double incisions parallel to axillary creases. Patient data, such as sex, age, original surgery method, the severity of underarm malodor before and after the operation, and occurrence of complications, were collected and analyzed. Results For the follow-up of at least 12 months after the surgery, all patients' underarm malodor disappeared or was significantly reduced. Patients with preoperative severity of grade I did not show a recurring AO, whereas the recurrence rate of grade II and grade III AO was 7.9% and 14.3%, respectively. Furthermore, the AO recurrence rate was 9.1% for those younger than 18 years and 6.2% in those 18 years or older. Subcutaneous hematomas appeared on 3 axillae (4.0%), and the contraction of subdermal fibrotic bands appeared on 5 axillae (6.7%). Conclusions Patients with recurring AO after small-incision minimally invasive surgery achieved good treatment results by trimming and electrocoagulation of apocrine glands under direct vision through double incisions parallel to axillary creases.

Purpose of review To explore and report the recent evolution of transurethral management of urethral stricture disease. Recent findings In recent years, new promising techniques in the transurethral management of urethral stricture disease have emerged including adjuvant therapies to direct vision internal urethrotomy, regenerative therapy with buccal mucosa cells and minimally invasive transurethral urethroplasty procedures that avoid skin incisions. Summary Although further work is needed, the expanding field of transurethral therapies for urethral stricture disease demonstrates early promising results through a variety of modalities.

Introduction Mandibular distraction osteogenesis (MDO) effectively treats upper airway obstruction (UAO) in young patients with Robin sequence (RS). The most commonly used MDO devices have internal and external components that require manual activation. Although complications associated with MDO in infants with RS have been well documented, hardware/device malfunction has not been precisely described. The present study reports the authors' recent experiences with such problems, in an effort to shed light on these complications and identify potential steps to mitigate future related issues. Design The authors reviewed a prospectively gathered database to identify all young children under the age of 3 years who underwent MDO using buried internal devices for UAO associated with grade 3 RS from March 2007 to September 2019. We specifically focused on complications attributable to the hardware itself. Results Nineteen patients with 40 devices met inclusion criteria. The median age at MDO was 2.3 months (interquartile range 1.4-6.3 months). Intraoperative activation of all devices under direct vision resulted in satisfactory distraction. Four devices (10.5%) developed postoperative complications directly related to the device, including break down of component parts (N = 3) and failure to maintain distraction distance (N = 1). Two patients required surgical replacement of one device each, whereas the remaining complications occurred during the consolidation phase and did not require intervention. Conclusions This report documents a series of device/hardware malfunction in infants and young children undergoing MDO for severe UAO associated with RS. Despite rigorous testing and development, these devices may fail, resulting in patient morbidity.

Background Conservative surgery has proven advantageous in controlling hypopharyngeal squamous cell carcinoma (HSCC) and preserving speech and swallowing function in carefully selected patients, typically with early T-stages diseases. A variety of modified surgical procedures or techniques have been proposed. Methods In this study, we present a novel surgical approach for hypopharyngeal carcinoma resection utilizing the paraglottic space. Results The paraglottic space approach can help expose neoplasms under direct vision and save mucosa during surgery while sufficiently preserving laryngeal function, thus benefiting postoperative swallowing and reducing complications. A large cohort of 426 patients with HSCC underwent surgical treatment at our institution using this approach, demonstrating an overall survival (OS) rate of 52.3% and low incidences of postoperative complications. Conclusions This surgical approach can be applied in patients with the lesions that do not involve the paraglottic space.

Double-lumen tubes (DLTs) should be placed using a fibreoptic bronchoscope. This allows correct positioning of the bronchial lumen in the chosen mainstem bronchus. It also ensures that the blue bronchial cuff does not obstruct the side to be ventilated when it is inflated under direct vision. Fibreoptic bronchoscopy facilitates correct positioning of the ventilatory side slot of a right DLT over the right upper lobe bronchus. The anaesthetist must know the fibreoptic tracheobronchial anatomy to properly position left- and right-sided DLTs and should always reconfirm the position of a DLT with fibreoptic bronchoscopy after repositioning the patient. Maintaining orientation (anterior–posterior) during fibreoptic bronchoscopy is crucial to positioning a DLT, particularly after the patient has been turned to the lateral position. A fibreoptic bronchoscope can also be used as a guide to direct a DLT under direct vision into its correct position.

Background and Aims: Pectoral nerve blocks gained increasing recognition for adequate postoperative pain relief following breast surgery. Traditionally, anaesthetist administered preoperatively under ultrasound guidance, which added significantly to the total procedure time. We studied the effectiveness of intraoperative direct vision pectoral nerve block and reduction of total theatre time. Methods: We provided questionnaires to the eligible patients who underwent a mastectomy and or axillary node clearance from August 2018 to May 2019. All the patients had an intra-operative pectoral 1 and serratus plane (Pecs) block. Participants documented pain score twice daily, episodes of nausea or vomiting and type and dose of analgesia for the first seven postoperative days. We compiled and grouped the results into postoperative days 1 - 2 and 3 - 7 for data analysis. Results: Patients reported generally low levels of pain, with a median pain score of 1.75 out of 10 for postoperative days 1 - 2 (IQR 4). The score decreased to 0.7 for days 3 - 7 postoperatively (IQR 3) suggesting that most patients had generally minimal levels of pain apart from a few outliers. The average injection time for PECs blocks was 5 minutes, significantly less than USS guided techniques of 20 - 30 minutes. Conclusions: Our data suggest that nerve blocks under direct vision offer satisfactory efficacy in postoperative analgesia with minimal nausea and vomiting. This is in addition to substantial benefits in operative efficiency and reduction of total procedure time.

Minimally invasive cardiac surgery (MICS) has been routinely used to treat mitral and aortic valve disease for years. Most MICS are performed under direct vision. Totally endoscopic approach has emerged as an attractive procedure with or without robotic assist. We describe our technique for totally endoscopic valve operation that was iteratively improved over the years. A skin incision is limited to 3 cm - 4 cm centimeters without the need for rib-spreading. Central Message: Totally endoscopic valve surgery can be performed minimal three-port system utilizing 3D-endoscope

Background: To evaluate durability of DVIU results and recurrence of stricture if the CSIC was done regularly up to one year and weekly thereafter. Subjects and Methods: This retrospective study was conducted in the Department of Urology at tertiary care teaching hospital of Rajasthan, India. Files of all patients operated between January 2015 and July 2018 for single bulbar urethral strictures of less than 1-1.5cm size in length, iatrogenic, idiopathic, traumatic or inflammatory origins were evaluated. Patient with multiple or complicated strictures of post urethroplasty, post hypospadias repair, previous radiation or multiple DVIU were excluded from the study. Data of all patients who were on CSIC following direct vision internal urethrotomy were evaluated at 3, 6, 12 and 24 months. Results: Mean age of patients was 41.13 years with range in between 26-74 years. Most common cause of urethral strictures were idiopathic 66 (58.92%) followed by iatrogenic 27 (24.11%) causes. After 24 months of follow up 95 (84.82%) patients maintained urethral caliber up to 16 Fr. Failure or recurrence was found in 17 (15.18%) patients who required intervention. Conclusion: Direct vision internal urethrotomy (DVIU) with regular clean intermittent self-catheterization (CSIC) was found good success rate in bulbar urethral strictures upto 1 cm in selected patients.

Currently, kinesiologists who study the posture of people during walking rely on spreadsheets and visual posture assessment. Some technologies make it possible to include sensors in people's bodies to identify their movements. Today, artificial intelligence is supporting many medical processes. In this sense, our proposal focuses on developing software based on Computer Vision and Artificial Intelligence. The software is deployed in a robust architecture based on microservices to support the process of image analysis with high concurrency. This software assists specialists in the analysis and measurements of lower extremity angles and distances during gait. On this occasion, we are working with a local medical center, specialists in caring for high-performance athletes. One of its crucial kinesiology care activities is the performance of kinematic gait analysis.

Objective to refine the method of incisional biopsy in the diagnosis of oral mucosa cancer using the auto-fluorescent stomatoscopy. Materials and method.The study was conducted on the base of the Samara Regional Clinical Oncology Center. The inclusion criterion for patients was the diagnose of the oral mucosa cancer of various localization. Patients were divided into 2 groups. The main group included patients (n=43), who were being diagnosed for cancer with the help of optimized incisional biopsy of the oral mucosa formations, using the "AFS-400" autofluorescence complex and glasses with a green light filter for identification. The patients of the control group (n=46) received the standard biopsy procedure under direct vision. Results.The first incisional biopsies revealed cancer in 25 (54%) patients of the control group and in 36 (84%) patients of the main group. A histological verification of the diagnosis was necessary in 7 (16%) patients of the main group and required the second biopsy. In the control group, for the same purpose, 17 (37%) patients underwent the second biopsy and 4 (9%) patients required the third biopsy procedure. Exophytic-papillary forms of cancer were the most complex for histological verification. The primary biopsy of these cases was effective in 16 (37%) patients in the main group and in 8 (17%) patients in the control group (p = 0.036). In patients with initial stages of cancer (I-II), with the first incision biopsy, the histological verification of cancer was achieved in 16 (37%) cases in the main group and in 8 (17%) cases in the control group (p = 0.036). Conclusion.The use of the "AFS-400" autofluorescent complex and glasses with a green light filter for incisional biopsy of oral mucosal formations allows histological verification of cancer with the first biopsy in 84% of cases, including in stages I - II in 16 (37%) cases and in exophytic papillary forms in 16 (37%) cases. The significant difference was registered for the similar indicators of the control group (p = 0.036).

Background: During percutaneous nephrolithotomy, retrograde flexible ureteroscopy can be utilized to facilitate repositioning of stones, enable direct vision percutaneous access, minimize radiation exposure, reduce operating times, and improve stone-free rates. Although advancements in technique and flexible ureteroscope technology for the past decades have rendered complications rare, herein we report a case of a retained ureteroscope during percutaneous nephrolithotomy that was effectively managed endoscopically. Case Presentation: A 59-year-old Caucasian gentleman with a history of recurrent bilateral nephrolithiasis presents for a left-sided percutaneous nephrolithotomy for a large stone burden >4 cm. A ureteral access sheath was used and retrograde ureteroscopy was performed to first reposition several stones into the renal pelvis. During manipulation, we were unexpectedly unable to retract the ureteroscope from the access sheath. We describe procedural details leading up to the event and subsequent intraoperative management using an antegrade approach. Conclusion: A retained flexible ureteroscope is a rare but serious intraoperative complication that may require invasive open surgical management. However, careful endoscopic management may be feasible in select cases, allowing for preservation of ureter and instrument.

Objective Postinfarction ventricular septal defects (VSDs) is one of the serious mechanical complications of acute myocardial infarction and it is associated with high mortality even with surgical repair. Combining surgical patch closure with an Amplatzer septal occluder device (ASOD) is a novel technique that has not been reported before. Deploying an ASOD under direct vision through a left ventriculotomy followed by exclusion patch repair is a novel and dependable surgical technique of a repair for patients with postinfarction VSD. Methods This is a case series of two patients with large inferior postinfarction VSDs who underwent open repair with an ASOD deployed under direct vision through a left ventriculotomy followed by surgical exclusion patch repair. Results There was no immediate intraoperative complication from the repair, no residual VSD, no in hospital mortality. One patient was taken back to the operative room for bleeding on the day of surgery. One patient was discharged to a rehab facility and the other was discharged home. Both patients continue to do well after hospital discharge without any residual VSD. Conclusions Coupling the patch exclusion technique with an Amplatzer septal occluder device for the treatment of post infarction ventricular septal defect is a novel technique with excellent short-term results, but the long-term outcomes of this approach remain unknown.

Although 1st and 2nd generation supraglottic airway devices (SADs) have many desirable features, they are nevertheless inserted in a similar 'blind' way as their 1st generation predecessors. Clinicians mostly still rely entirely on subjective indirect assessments to estimate correct placement which supposedly ensures a tight seal. Malpositioning and potential airway compromise occurs in more than half of placements. Vision-guided insertion can improve placement. In this article we propose the development of a 3rd generation supraglottic airway device, equipped with cameras and fiberoptic illumination, to visualise insertion of the device, enable immediate manoeuvres to optimise SAD position, verify whether correct 1st and 2nd seals are achieved and check whether size selected is appropriate. We do not provide technical details of such a '3rd generation' device, but rather present a theoretical analysis of its desirable properties, which are essential to overcome the remaining limitations of current 1st and 2nd generation devices. We also recommend that this further milestone improvement, i.e. ability to place the SAD accurately under direct vision, be eligible for the moniker '3rd generation'. Blind insertion of SADs should become the exception and we anticipate, as in other domains such as central venous cannulation and nerve block insertions, vision-guided placement becoming the gold standard.

Surgical management of patients affected by structural valve deterioration of bioprostheses in tricuspid valve position represents a challenge. Furthermore, transcatheter valve-in-valve implantation (TVIVI) recently emerged as an interesting option in high-risk surgical patients. When surgery is performed, replacement of the dysfunctional tricuspid bioprosthesis could be a difficult procedure due to the risk of heart rupture during the prosthesis removal. Herein we report the case of a 52-year-old female patient in which a transcatheter TVIVI was successfully performed under direct vision as a bailout strategy due to the impossibility of bioprosthesis removal.

Nowadays many dental professionals have been complaining of severe pain in the lower back and neck region. This is mainly due to the improper chair side positioning and stance. Mostly this measure is taken to achieve the direct vision while working on the patients. Cervical Spondylosis, slip disc, muscle injuries are few of the conditions which are seen if improper chair side posture is maintained for a long time. Our working posture needs to be ideal while working for long hours as this will help in the prevention of any injuries seen due to our occupation. Joint stiffness of the hands, carpal tunnel syndrome and blurred vision are some other occupational hazards associated with dentists. This article is a comprehensive review that mentions the hazardous effects of improper chair side posture and suggests some exercises to avoid injury in the long run. Keywords: Posturodontics, Ergonomics, Musculoskeletal disorders.

There is a lack of guidelines concerning common carotid artery (CCA) occlusive disease in the presence of a patent internal carotid artery (ICA). A novel surgical technique that disobliterates an occluded CCA was successfully performed in three cases. The detailed surgical steps are presented herein. After proximal division of the CCA behind the sternoclavicular junction, the occluded CCA was endarterectomized via antegrade ring stripping. After removal of the atheromatous core, the CCA was everted, and the wall remnants were cleaned under direct vision. Simultaneous eversion endarterectomy of the ICA was performed when necessary. After reversion of the CCA, it was transposed and anastomosed to the ipsilateral subclavian artery distal to the orifice of the vertebral artery. This novel technique can be used in selected cases by experienced surgeons.

Aim This prospective study aimed to evaluate the safety and efficacy of video-assisted anal fistula treatment (VAAFT) in complex fistula-in-ano (FIA). Method Consecutive patients presenting with complex FIA were recruited between November 2012 and November 2018. The primary outcome was healing of the fistula. Results Seventy-two patients were included, 39 (54%) of whom were men, with a mean age of 46 (±11) years. The mean follow-up was 32 (±18) months. Complete healing was achieved in 64 (89%) patients. When persistent and recurrent cases were considered together, the failure rate was 21% and the success rate 79%. When patients failed, they were offered VAAFT again, after which there was an in increase in the healing rate, which overall (primary and secondary) was 86%. There was no statistically significant deterioration in continence. Eight (11%) patients experienced postoperative complications which required no additional surgical intervention. Conclusion VAAFT represents a promising, sphincter-saving technique for the treatment of complex FIA. It has proved efficacious, with 79% of patients achieving complete healing after its primary application. After a second use, this reached 86%. The main advantage of VAAFT compared with other sphincter-saving techniques is working under direct vision. VAAFT has a good safety profile with 11% of patients experiencing minor complications, and there is no effect on continence.

Objective Minimally invasive multivessel coronary artery bypass grafting (MIM CABG) has demonstrated its safety, effectiveness and high rate of reproducibility. However, minithoracotomy CABG is still rarely performed. In this study, we retrospectively analyze the CT-angiographic graft patency rates for the patients subjected to this operation. Methods A total of 245 patients were subjected to MIM CABG by a left minithoracotomy approach between 2014 and 2018. The left internal thoracic artery (LITA) harvesting, proximal, and distal anastomoses were performed under direct vision. The patients then underwent 128-slice computed tomography coronary angiography (CTA). The angiographic results were obtained for 127 (51.8%) patients (the follow-up period of 31.1 ± 7.8 months, from 15 to 45 months). Of the total patients, 204 (83.2%) were followed clinically during the time period from 12 to 56 months. Results Complete revascularization was performed for all the patients. The mean number of grafts was 2.6 ± 0.5. The perioperative mortality was 0.4% (1 patient). There were two conversions to sternotomy (0.8%), four reopenings for bleeding (1.6%), three myocardial infarctions (1.2%), and one stroke (0.4%). Twenty-two patients (9.0%) received transfusions. The long-term mortality was 4.4% (nine patients). Three patients (1.5%) suffered from a stroke during the follow-up period. For five patients (2.4%), repeat revascularization was necessary. For the examined patients, the overall graft patency rate was 89.8%, the LITA graft patency rate was 98.4%, the radial artery patency was 100%, and the saphenous vein graft patency was 84.0%. Conclusions MIM CABG allows complete surgical revascularization with excellent clinical outcomes and promising angiographic graft patency rates.

Impalement injuries are one of the severe types of injuries combining effects of both penetrating and blunt trauma leading to crushing injury, wound contamination, and multi-organ damage. These types of injuries are usually a result of falls from a height, vehicular accidents, and slip with strong external force. A 12-year-old boy was involved in a road traffic accident where an auto-rickshaw toppled. A loose rusted iron frame penetrated through his left knee and lower thigh. The impaled rod was removed under direct vision and the fractured lateral femoral condyle was fixed under general anesthesia. Impalement injuries require a multidisciplinary approach. The management of each case has to be individualized. Extensive wound exposure, extraction under direct vision, adequate debridement, and antibiotic coverage are pearls of management.

The last several decades have witnessed a huge expansion of surgical and interventional treatment of cardiac disease. Axel Cappelen from Oslo, Norway was one of the first to operate on the heart, something that had until then, been considered foolish and without chance of success [1] . Cappelen dared to operate on the heart in spite of Billroth's stark warning against such "unwise" attempts as he ligated a bleeding coronary artery caused by a stabbing injury. Most of the innovation in recent years has been within the interventional cardiology domain in contrast to the first 7 decades of the 20th century, when surgeons dominated. Cardiac surgeons have developed less invasive procedures, although the most common surgical incision is based on the time-honoured and large median sternotomy incision. Many surgeons continue to prefer the concept of "Grosse Chirurgen, Grosse Schnitte" and have stayed away from minimisation and continue to use direct vision, usually augmented by magnification glasses, median sternotomy and cardiopulmonary bypass (CPB). However, new technology has made the need for CPB less important [2] . In this article a selection of recently developed devices for cardiac intervention will be described.

Introducción: La magnificación del campo visual en Endodoncia es un paso esencial que permite la realización de diagnósticos y tratamientos más precisos, teniendo en cuenta la gran atención al detalle. Sin embargo, hay elementos que se pueden pasar por alto durante el tratamiento, por tal motivo, se hace indispensable el uso de la tomografía computarizada de haz cónico. Objetivo: Determinar la concordancia en la localización y ubicación de conductos radiculares y variaciones anatómicas encontradas en el tercio cervical de los dientes seleccionados, mediante visión directa, lupas, microscopio y Tomografía computarizada de haz cónico como gold estándar. Materiales y métodos: Estudio observacional descriptivo de corte transversal, de evaluación de tecnologías diagnósticas, con una muestra de 50 dientes naturales, primeros premolares humanos extraídos con fines diferentes a la investigación, recolectados durante septiembre a diciembre del 2020. Luego se observaron bajo visión directa, lupas Zumax 5X, microscopio clínico Dentools MSA y tomografía computarizada de haz cónico con voxel de 0.075mm analizadas con el software Romexis, marca Planmenca. Resultados: Se logró observar que hubo una mayor concordancia con la visualización microscopio clínico al ser la muestra evaluada por el investigador experto, teniendo un valor kappa de 0,135. Conclusiones: Se concluye que con la visión directa se presentan mayores diferencias de concordancia entre los investigadores independientemente de su experiencia clínica; con lupas quirúrgicas hay similar concordancia inter-evaluador, a diferencia del examen con microscopio clínico, en el cual es la experiencia y la curva de aprendizaje marcan la diferencia. Se presentan más similitudes inter-observador cuando se presentan conductos tipo I independientemente del método de visualización debido a la sencillez de su ubicación y tamaño del orificio de entrada. Además, el uso de ayudas diagnosticas como lo es la CBCT, representa un complemento para el conocimiento de la anatomía. Introduction: The magnification of the visual field in Endodontics is an essential step that allows the realization of more precise diagnoses and treatments, considering the great attention to detail. However, there are elements that can be overlooked during treatment, for this reason, the use of cone beam computed tomography is essential. Objective: To determine the concordance in the localization and location of root canals and anatomical variations found in the cervical third of the selected teeth, using direct vision, magnifying loupes, microscope and cone beam computed tomography as a gold standard. Materials and methods: Cross-sectional descriptive observational study, about evaluation of diagnostic technologies, with a sample of 50 natural teeth, first human premolars extracted for non-research purposes, collected during September to December 2020, Zumax 5X magnifying glasses, Dentools MSA clinic microscope and cone beam computed tomography of 0.075mm voxel, analized with Romexis software, brand Planmenca. Results: It was observed that there was a greater concordance with the clinical microscope visualization as the sample was evaluated by the expert researcher, taking into account a kappa value of 0.135. Conclusions: It is concluded that with direct vision there are greater differences in agreement between researchers regardless of their clinical experience; With surgical loupes there is a similar inter-rater agreement, unlike the examination with a clinical microscope, in which experience and the learning curve make the difference. There are more observer similarities when Type I canals are present regardless of the visualization method due to the simplicity of their location and the size of the entrance orifice. In addition, the use of diagnostic aids such as CBCT, represents a complement to the knowledge of anatomy. Especialista en Endodoncia http://www.ustabuca.edu.co/ustabmanga/presentacion Especialización

Thenar endoscopy is an evolving technique that may be used for treatment of specific pathological conditions involving thenar musculature and deep spaces. Proximal and distal thenar portals provide access to intermuscular planes and intramuscular cysts. “Cystoscopic” visualization is useful for obtaining biopsy of cyst tissues under direct vision and the communication with the adjacent joint can be identified. Excision of cyst lining and septae ensures complete excision of the ganglion cyst.

Augmented Reality (AR) headsets have become the most ergonomic and efficient visualization devices to support complex manual tasks performed under direct vision. Their ability to provide hands-free interaction with the augmented scene makes them perfect for manual procedures such as surgery. This study demonstrates the reliability of an AR head-mounted display (HMD), conceived for surgical guidance, in navigating in-depth high-precision manual tasks guided by a 3D ultrasound imaging system. The integration between the AR visualization system and the ultrasound imaging system provides the surgeon with real-time intra-operative information on unexposed soft tissues that are spatially registered with the surrounding anatomic structures. The efficacy of the AR guiding system was quantitatively assessed with an in vitro study simulating a biopsy intervention aimed at determining the level of accuracy achievable. In the experiments, 10 subjects were asked to perform the biopsy on four spherical lesions of decreasing sizes (10, 7, 5, and 3 mm). The experimental results showed that 80% of the subjects were able to successfully perform the biopsy on the 5 mm lesion, with a 2.5 mm system accuracy. The results confirmed that the proposed integrated system can be used for navigation during in-depth high-precision manual tasks.

Cataract surgery continues to evolve and advance in terms of new technology and improved techniques, offering a final result of better visual quality and faster visual recovery for our patients. Intraocular lens (IOL) delivery into the eye is a critical step in cataract surgery. Currently, eye surgeons load the IOL into the cartridge under the operating microscope or ophthalmic assistants load the IOL under their own direct vision. Because ophthalmic assistants load the IOL unaided, the IOL may be mishandled and lead to challenges such as IOL slippage, breakage, or incorrect orientation. In order to overcome these challenges and facilitate the surgical process, here we describe a novel technique by introducing a magnifier to the surgical table to aid ophthalmic assistants during this crucial step in cataract surgery. This not only saves time but also improves precision while loading IOL into the cartridge during cataract surgery.

SUMMARYDetection and management of posterior approximal caries lesions are still problematic. Inspection of approximal surfaces is challenging, and bitewing radiographs are used when direct vision is not possible. Unfortunately, there is no definite radiographic appearance to identify lesion cavitation with absolute certainty. Many lesions detected radiographically within the outer half of dentin are not cavitated, often resulting in unnecessary restorative treatment. Our study compared radiographic depth of approximal caries lesions with presence of cavitation in adults using visual inspection following temporary tooth separation (TTS). We conducted this observational descriptive cross-sectional study at two dental schools in two cities in Chile. Clinicians were unaware of radiographic depths of lesions and examined 147 participants (57.3% female and 42.7% male) following TTS. Using the common classification system that consists of E0 (no lesion), E1 (lesion within the outer half of enamel), E2 (lesion within the inner half of enamel), D1 (lesion within the outer third of dentin), D2 (lesion within the middle third of dentin), and D3 (lesion within the inner third of dentin), a trained dentist evaluated all the processed films. Cavitation was detected in only three sites (0.22%) within the E0 category, seven sites (3.41%) in E1, five sites (14.8%) in E2, four sites (14.8%) in D1, six sites (50%) in D2, and eight sites (61.5%) in D3. Considering that restorative treatment should be indicated strictly for cavitated lesions, our findings support indication for restorative treatment for D3 lesions and the rationale for TTS for D1-D2 caries lesions to allow direct visual inspection to determine whether there is surface cavitation.

Objectives Fishbone ingestion is a common problem worldwide, and the first step for managing this condition is to locate the fishbone precisely. However, until now, no study has analysed the true location of fishbone and its associated factors. Thus, this study identified the factors predicting the true location of fishbone and subsequently attempted to provide a management algorithm for fishbone ingestion. Patients and methods This retrospective study was carried out at St Martin De Porres Hospital, Taiwan, between January 2015 and January 2016. All patients were diagnosed as having fishbone ingestion within the pharynx and underwent fishbone removal. Results This study included 198 consecutive patients with a mean age of 43.1 years (range: 1-84 years). The sensitivity of lateral neck radiography in the diagnosis of fishbone in the pharynx was only 22%. The fishbone locations were as follows: the tonsil in 72 (36.4%) patients, the tongue base / vallecula in 112 (56.6%) and the hypopharynx in 14 (7.0%). Multiple logistic regression analysis showed that patient age and fishbone length were significant independent risk factors associated with the true location of fishbone ingestion. Among all patients, fishbone was removed transorally under direct vision in 73 (36.9%) patients and using flexible nasopharyngoscopy in 125 (63.1%) patients. Conclusion Patient age and fishbone length are important independent factors associated with the location of ingested fishbone. Lateral neck radiography is not beneficial for diagnosing fishbone ingestion within the pharynx. Flexible nasopharyngoscopy, by contrast, is an important method for the diagnosis and treatment of fishbone ingestion within this location.

Purpose: To quantify the visible area of the articular surface of the distal humerus exposed by the lateral para-olecranon (LPO) approach and to compare this with the bilaterotricipital (BT) and olecranon osteotomy (OO) approaches. Methods: We examined 12 elbows from 6 fresh cadavers (mean age, 93.5 years; range, 90–99 years; 3 men and 3 women). Elbows on one side of the cadavers underwent the LPO approach. The opposite elbows underwent the BT approach followed by the OO approach. Macroscopically observable articular cartilage was coated with synthetic silicone resin paint under direct vision. The dissected bone was fixed on the table and photographs of the distal humerus were taken from anteriorly and posteriorly. The color-coded areas projected on 2 planes were quantified using digital photography and computer analysis software. Results: Proportions of the total visible area, summation of the anterior and posterior visible articular areas, were 25.3% ± 2.2% for the BT procedure, 46.4% ± 8.4% for the LPO procedure, and 58.5% ± 5.7% for the OO procedure, showing significant differences among the 3 procedures. The LPO procedure achieves better exposure of the posterior articular surface than the BT procedure, but the LPO procedure had limitations in the anterior visible area compared with the OO procedure. In particular, direct vision of the humeral trochlea was restricted by the presence of the olecranon. Conclusions: The LPO approach has improved visualization of the distal humeral articular surface compared with the BT approach but not as good as that achieved with the OO approach. Clinical relevance: The LPO approach is applicable to cases of AO type C1 and C2 distal humeral fractures and some cases of type C3 fracture, excluding those accompanied by complex fractures in the trochlea of the humerus. It is important to evaluate the fracture line of the humeral trochlea in preoperative computed tomography to determine whether to use the LPO or OO approach for AO type C3 fracture. Key words: distal humeral fracture, olecranon osteotomy, posterior approach for elbow

Objective To evaluate the safety and effectiveness of fluoroscopy-free RIRS (Retrograde intrarenal surgery) method in urolithiasis. Study design An observational study. Place and duration of study Department of Urology, Hitit University Corum Training and Research Hospital, Corum, Turkey, from October 2014 and October 2017. Methodology Preoperative and postoperative data of 62 cases of renal calculi that underwent fluoroscopy-free RIRS procedure by a single surgeon were prospectively evaluated. All manipulations were performed with a novel technique; under direct vision during the operation. Fluoroscopy device was kept at hand in the operating room, but was not used. Results The mean age was found as 51.73 ±12.63 (22-82) years. Fortyone patients (66.1%) were males and 21 (33.9%) were females. The mean size of stones were 19.29 ±7.64 (10-40) mm. The stone-free rate was calculated as 42 (67.7%) cases in a single session one month after the surgery, and 15 (24.2%) cases after the second session at the postoperative first month. A total of 57/61 (91.9%) patients were stone-free after the second procedure. No major intraoperative and postoperative complications were observed. As for the minor complications, one patient (1.6%) developed hematuria and four patients (6.5%) had fever. Conclusion The described fluoroscopy-free RIRS procedure can be performed effectively and safely in patients diagnosed with renal calculi, by endourologists.