Articles: cations.
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The safe working zone for lateral access to the L4/5 disc space has been said to lie in the anteroposterior (AP) midpoint of the disc space due to the location of the femoral nerve at that level. However, the AP location of the psoas muscle (and thus the lumbosacral plexus within) at L4/5 is variable. A psoas muscle lying excessively anteriorly at the L4/5 disc space may preclude safe access to the L4/5 disc space from a lateral transpsoas approach. ⋯ The location of the psoas muscle in relation to the L4/5 disc space is somewhat variable. In 11% of patients, the dorsal-most aspect of the psoas muscle was located within zones II or III, likely precluding safe access to the L4/5 disc space from a lateral transpsoas approach.
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Residents' lives are hectic-it is hard to find a place and time for training basic and advanced microsurgical skills. Surgical instruments and sutures can be purchased (or loaned from another department), but the most expensive and space-occupying device is the microscope. In developing countries, microscopes are used where they are needed most, in operating rooms. Furthermore, a conventional microscope is not portable. For all of these reasons, the availability of microscopes for training microsurgery is limited. ⋯ CCS is efficient, mobile, and easy to set up. Even though our smartphone-based training was in 2 dimensions, we could improve our microsurgical performance with conventional microscopes, which have 3-dimensional capability. CCS also provides an easy method to record one's microsurgical training. CCS improved both of the subjects' microsurgical performance, making it a good alternative for a traditional microscope.
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Randomized Controlled Trial
Double-blind randomized clinical trial of percutaneous endoscopic gastrostomy versus radiologically inserted gastrostomy in children.
The aim of this RCT was to determine whether radiologically inserted gastrostomy (RIG) in children is associated with more complications than percutaneous endoscopic gastrostomy (PEG). ⋯ PEG and RIG are both safe methods of gastrostomy insertion with a low rate of major complications. Registration number: NCT01920438 ( http://www.clinicaltrials.gov).
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Randomized Controlled Trial Multicenter Study
Randomized feasibility trial of replacing or discarding the nail plate after nail-bed repair in children.
Nail-bed injuries are the most common hand injury in children. Surgical dogma is to replace the nail plate after repairing the nail bed. Recent evidence suggests this might increase infection rates and returns to clinic. The aim of this feasibility trial was to inform the design and conduct of a definitive trial comparing replacing or discarding the nail plate after nail-bed repair. ⋯ Recruitment was rapid and nail-bed repair appeared to have low complication and infection rates in this pilot trial. The findings have led to revision of the definitive trial protocol, including the mode and timing of follow-up, and modification of the Zook classification.
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We aimed to prospectively evaluate NIR-C, VR-AR, and x-ray intraoperative cholangiography (IOC) during robotic cholecystectomy. ⋯ This high-tech protocol illustrates the multimodal imaging of biliary anatomy towards precision cholecystectomy. Those visualization techniques could complement to reduce the likelihood of biliary injuries (NCT01881399).