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Pulp canal obliteration (PCO) in calcified teeth presents a challenge for endodontic treatment, especially when accompanied by discoloration. Guided endodontic access (GEA) has emerged as an advanced method for root canal therapy (RCT) in such cases. This case report describes the successful treatment of a calcified maxillary central incisor with discoloration using GEA. A 32-year-old female with a history of dental trauma presented with discoloration in the left maxillary central incisor that did not respond to external bleaching. Clinical examination revealed a pulpless infected canal with asymptomatic apical periodontitis. Cone-beam computed tomography (CBCT) and intraoral scanning were utilized to create a three dimensional (3D) template, enabling minimally invasive access preparation through the palatal aspect. The RCT was performed in a single visit, followed by tooth whitening using hydrogen peroxide. At 18 months follow-up, the tooth was asymptomatic, and the apical lesion was healed. GEA offers a predictable and conservative approach, preserving tooth structure and providing enhanced long-term prognosis for teeth with calcified canals and discoloration.

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This systematic review (PROSPERO-CRD42020147333) aimed to compare the effects of conservative, ultraconservative and truss access cavities with traditional access cavities on the load capacity of root-canal-treated teeth. Online databases were searched until December 2021, and 25 ex vivo studies in which the effects of different access cavities on load capacity of permanent teeth had been investigated were included. Quality assessment was completed using a modified risk of bias tool for in vitro studies adapted from previous studies. Meta-analysis was performed using the maximum-likelihood-based random-effects model with similar groups. Conservative access cavities significantly improved the load capacity of maxillary premolars (p < 0.01 [-1.32, -0.028]) and molars (p < 0.05 [-0.89, -0.02]) compared to traditional access cavities. Additionally, truss access cavities significantly improved the load capacity of mandibular molars with (p < 0.05, [-1.18, -0.02]) mesio-occluso-distal cavity preparations. Higher levels of evidence are needed to determine the long-term implications of minimal preparations for treatment outcomes.

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The disinfection of root canal through minimally invasive access cavity remains questionable. This in vitro study compared the effectiveness of three disinfection measures including conventional irrigation, ultrasonic assisted irrigation, and erbium:yttrium-aluminum-garnet (Er:YAG) laser assisted irrigation through conventionally or minimally invasive access. Sixty-six extracted maxillary first molars were randomly divided into group 1 conventionally invasive access group (CIA) and group 2 computer-guided minimally invasive access group (MIA). Each group was further randomly divided into three subgroups, (A) conventional irrigation (CI), (B) passive ultrasonic agitation (PUI), and (C) Er:YAG laser activated irrigation (LAI). Enterococcus faecalis (E. faecalis) infection model was established inside all root canals after instrumentation was performed up to ProTaper Universal F2. After various disinfection methods, microbial samples were collected from root canals by paper tip method and cultured, and colony forming units (CFU) values of each sample were calculated. Then the root canals were enlarged to the size of F3, after which dentin debris was collected from the F3 file. After dilution and culturing, the CFU value was calculated for each group. Two-way analysis of variance (ANOVA) was performed to test the interaction. The results revealed a significant antagonism (F = 3.394, P = 0.043). The bacterial CFU counts of group B and group C were significantly less than that of group A (P < 0.05), and there was no significant difference between group B and C (P > 0.05). Additionally, group 2A was better than group 1A (P < 0.05); there was no significant difference between group 1B and group 2B, group 1C and group 2C (P > 0.05). Comparison of the bacterial CFU counts in dentin debris after disinfection, the results revealed a significant antagonism (F = 7.224, P = 0.002), and group C had the least. The disinfection effect of Er:YAG laser or ultrasonic assisted computer-guided minimally invasive access is similar to conventionally invasive access, and Er:YAG laser is better than ultrasonic in removing bacteria from dentinal tubules and is easy to operate, which is more suitable for minimally invasive root canal treatment.

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Objetivos Describir nuestra experiencia inicial con un novedoso abordaje laparoscópico inguinal y pélvico de acceso único mínimamente invasivo para realizar la disección de los ganglios linfáticos (DGL) en el cáncer de pene: la técnica de acceso único pélvico e inguinal (PISA, por las siglas en inglés de Pelvic and Inguinal Single Access).Material y métodos 10 pacientes en diversos estadios de carcinoma de células escamosas de pene (cN0 y ≥ pT1G3 o cN1/cN2) fueron operados mediante la técnica PISA entre 2015-2018. Se realizaron secciones congeladas intraoperatorias de forma rutinaria y se llevó a cabo secuencialmente la DGL pélvica ipsilateral como procedimiento en un solo acto y utilizando las mismas incisiones quirúrgicas ante la detección de ≥ 2 ganglios inguinales(pN2) o extensión ganglionar extracapsular (pN3). Variables: complicaciones posquirúrgicas a 30 días, pérdida de sangre estimada (PSE), tasa de transfusión, tiempo quirúrgico, tiempo hasta la retirada del drenaje y duración de la estancia hospitalaria (DEH). Las medianas y los rangos de los valores de las variables seleccionadas se presentaron como estadísticas descriptivas.Resultados La DGL inguinal fue bilateral en todos los casos y la DGL pélvica fue necesaria en el 40%. El tiempo quirúrgico total fue de 120-170 minutos y la mediana de PSE fue de 66 (30-100) cc. En ningún caso se requirió transfusión sanguínea. No se observaron complicaciones intraoperatorias y la tasa de complicaciones postoperatorias fue del 40% (10% de complicaciones mayores: linfocele inguinal sintomático). La mediana de la estancia hospitalaria fue de 5,8 (3-10) días. La mediana de tiempo hasta la retirada del drenaje inguinal fue de 4,7 días. Número medio de ganglios linfáticos extirpados mediante DGL inguinal: 10,25(8-14). Experiencia retrospectiva de volumen limitado de un centro de referencia con un seguimiento corto.

Objectives To describe our initial experience with a new minimally invasive inguinal and pelvic single-access laparoscopic approach, for performing lymph node dissection (LND) in penile cancer: the Pelvic and Inguinal Single Access (PISA) technique.Material and Methods 10 patients with different penile squamous cell carcinoma stages (cN0 and ≥pT1G3 or cN1/cN2) were operated by means of the PISA technique, between 2015-2018. Intraoperative frozen section analysis was carried out routinely and if ≥2 inguinal nodes (pN2) or extracapsular nodal extension (pN3) are detected, ipsilateral pelvic LND was performed sequentially as a single-stage procedure and using the same surgical incisions. Variables: 30-day postoperative complicactions, estimated blood loss (EBL), transfusion rate, operative time, time to drainage removal, and length of hospital stay (LOS). Medians and ranges of values for selected variables were reported as descriptive statistics.ResultsInguinal LND was bilateral in all cases, and pelvic LND was required in 40%. Total operative time was 120-170minutes and median EBL was 66 (30-100) cc. No blood transfusion was required. No intraoperative complications were noted, and postoperative complications rate was 40% (10% major complications- symptomatic inguinal lymphocele). Median LOS was 5.8 (3-10) days. Median time to inguinal drain removal was 4.7 days. Mean number of lymph nodes removed by inguinal LND: 10.25(8-14). Limited volume retrospective experience from a referral center with short follow-up. Outcomes reported may not be reproducible by surgeons with less experience and skills.Conclusions PISA is a novel, minimally invasive single-site surgical approach to one stage bilateral inguinal/pelvic LNDs for penile cancer showing a low rate of major complications

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OBJECTIVES: To describe our initial experience with a new minimally invasive inguinal and pelvic single-access laparoscopic approach, for performing lymph node dissection (LND) in penile cancer: the Pelvic and Inguinal Single Access (PISA) technique. MATERIAL AND METHODS: 10 patients with different penile squamous cell carcinoma stages (cN0 and ≥pT1G3 or cN1/cN2) were operated by means of the PISA technique, between 2015-2018. Intraoperative frozen section analysis was carried out routinely and if ≥2 inguinal nodes (pN2) or extracapsular nodal extension (pN3) are detected, ipsilateral pelvic LND was performed sequentially as a single-stage procedure and using the same surgical incisions. VARIABLES: 30-day PCs, estimated blood loss (EBL), transfusion rate, operative time, time to drainage removal, and length of hospital stay (LOS). Medians and ranges of values for selected variables were reported as descriptive statistics. RESULTS: Inguinal LND was bilateral in all cases, and pelvic LND was required in 40%. Total operative time was 120-170 min and median EBL was 66 (30-100) cc. No blood transfusion was required. No intraoperative complications were noted, and postoperative complications rate was 40% (10% major complications-symptomatic inguinal lymphocele). Median LOS was 5.8 (3-10) days. Median time to inguinal drain removal was 4.7 days. Mean number of lymph nodes removed by inguinal LND: 10.25 (8-14). Limited volume retrospective experience from a referral center with short follow-up. Outcomes reported may not be reproducible by surgeons with less experience and skills. CONCLUSIONS: PISA is a novel, minimally invasive single-site surgical approach to one stage bilateral inguinal/pelvic LNDs for penile cancer showing a low rate of major complications.

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In the last decades, the move of medicine towards minimally invasive treatments is notorious and scientifically grounded. As dentistry naturally follows in its footsteps, minimal access preparation have also becume a trend topic in the endodontic field. This procedure aims to maximize preservation of dentine tissue backed up by the idea that this is an effective way to reduce the incidence of post-treatment tooth fracture. However, with the assessment of the body of evidence on this topic, it is possible to observe some key points (a) the demand for nomenclature standardization, (b) the requirement of specific tools such as ultra-flexible instruments, visual magnification, superior illumination, and three-dimensional imaging technology, (c) minimally invasive treatment does not seem to affect orifice location and mechanical preparation when using adequate armamentarium, but it (d) may impair adequate canal cleaning, disinfection and filling procedures, and also (e) it displays contradictory results regarding the ability to increase the tooth strengthen compared to the traditional access cavity. In spite of that, it is undeniable that methodological flaws of some benchtop studies using extracted teeth may be responsible for the conflicting data, thus triggering the need for more sophisticated devices/facilities and specifically designed research in an attempt to make clear the role of the access size/design on long-term teeth survival. Moreover, it is inevitable that a clinical approach such as minimal endodontic access cavities that demands complex tools and skilled and experienced operators bring to the fore doubts on its educational impact mainly when confronted with the conflicting scientific output, ultimately provoking a cost-benefit analysis of its implementation as a routine technique. In addition, this review discusses the ongoing scientific and clinical status of minimally invasive access cavities aiming to input an in-depth and unbiased view over the rationale behind them, uncovering not only the related conceptual and scientific flaws but also outlining future directions for research and clinical practices. The conclusions attempt to skip from passionate disputes highlighting the current body of evidence as weak and incomplete to guide decision making, demanding the development of a close-to-in situ laboratory model or a large and well-controlled clinical trial to solve this matter.

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Successful management of mandibular incisors with pulp canal obliteration using guided endodontics is described, for the first time in Iran. A 58-year-old man was referred for root canal treatment of teeth #24, #25 and #26. Upon radiographic examination, partial obliteration of the root canal system was detected. Cone-beam computed tomography (CBCT) was requested to enhance the diagnosis and detection of root canals. Next, a 3-dimensional (3D) guide was designed and printed to aid in localization and access to the root canal system with minimal destruction of the tooth structure. With the use of a targeted 3D guide, a conservative access cavity was prepared to avoid unnecessary removal of tooth structure. The teeth were successfully treated endodontically. Obtained results revealed that the technique can be effective and predictable for the management of calcified canals.

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OBJECTIVES: To assess related studies and discuss the clinical implications of endodontic access cavity (AC) designs. MATERIALS AND METHODS: A systematic review of studies comparing the fracture resistance and/or endodontic outcomes between different AC designs was conducted in two electronic search databases (PubMed and Web of Science) following the PRISMA guidelines. Study selection, data extraction, and quality assessment were performed. Meta-analyses were undertaken for fracture resistance and root canal detection, with the level of significance set at 0.05 (P = 0.05). RESULTS: A total of 33 articles were included in this systematic review. The global evaluation of the risk of bias in the included studies was assessed as moderate, and the level of evidence was rated as low. Four types of AC designs were categorized: traditional (TradAC), conservative (ConsAC), ultraconservative (UltraAC), and truss (TrussAC). Their impact on fracture resistance, cleaning/disinfection, procedural errors, root canal detection, treatment time, apical debris extrusion, and root canal filling was discussed. Meta-analysis showed that compared to TradAC, (i) there is a significant higher fracture resistance of teeth with ConsAC, TrussAC, or ConsAC/TrussAC when all marginal ridges are preserved (P < 0.05), (ii) there is no significant effect of the type of AC on the fracture resistance of teeth when one or two marginal ridges are lost (P > 0.05), and (iii) there is a significantly higher risk of undetected canals with ConsAC if not assisted by dental operating microscope and ultrasonic troughing (P < 0.05). CONCLUSIONS: Decreasing the AC extent does not necessarily present mechanical and biological advantages especially when one or more surfaces of the tooth structure are lost. To date, the evidence available does not support the application of TrussAC. UltraAC might be applied in limited occasions. CLINICAL RELEVANCE: Maintaining the extent of AC design as small as practical without jeopardizing the root canal treatment quality remains a pragmatic recommendation. Different criteria can guide the practitioner for the optimal extent of AC outline form which varies from case to case.

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Annular dilatation is the main mechanism for tricuspid regurgitation, but right ventricular dilatation often adds a restrictive mechanism, which may limit durability. We describe a subvalvular technique anchoring the chordal origins to the annuloplasty, with the aim to stabilize valve geometry and increase durability. A Goretex suture is attached to the anterior papillary muscle. One arm of the suture is stitched through the septal muscle and both arms are atrialized underneath the septal leaflet and tied to the annuloplasty band. In 12 patients (75 ± 6 years, EuroSCORE II 10 ± 9%), severe-torrential tricuspid regurgitation was successfully reduced to mild. Results were stable in all but one patient during follow-up (1-15 months). NYHA class and general health status was improved. This subvalvular technique is safe with the potential to generate a durable repair.

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INTRODUCTION: Several endodontic access cavity designs have been proposed in the past decade to access the root canal space in a minimally invasive manner. The rationale for this approach was derived from the assumption that preserving more tooth structure during access preparation will improve the tooth's resistance to fracture and its long-term survivability. However, is this assumption valid? Also, can this approach compromise other treatment-related aspects? METHODS: We conducted a literature review using 4 online databases and classified the access cavity designs presented in each article according to our proposed classification. RESULTS: Through the literature search, we identified 49 articles that evaluated the effect of the access cavity design on 11 different treatment parameters. The majority of the studies failed to demonstrate clear benefits of the minimally invasive access designs, whereas others raised concerns regarding the ability to adequately disinfect, fill, and restore teeth with a minimally invasive access cavity design. CONCLUSION: Minimally invasive access cavity designs present more risk than benefit on the outcome of endodontic treatment. Clinicians should reconsider the application of a minimally invasive access cavity for routine endodontics and cautiously apply it in selected cases when the proper armamentarium is available.

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INTRODUCTION: Dynamic navigation systems are used in dental implantology to optimize the accuracy of dental implant placement. METHODS: A 30-year-old man was seen at the endodontic clinic of the Universidad Autónoma de Yucatán for pain in the left maxillary lateral incisor. A previously treated tooth with symptomatic apical periodontitis was diagnosed. The patient accepted treatment, and after signing an informed consent form, minimally invasive coronal access was performed through a zirconia crown. Then a post removal was performed with an ultrasonic tip to 2 mm before the apical gutta-percha limit, and the removal of material was completed manually with a K-file. RESULTS: This case report demonstrates the use of dynamic navigation to remove a post from under a zirconia crown for the retreatment of a failing root canal procedure. The removal of fiber posts from endodontically treated teeth can present a unique challenge for clinicians. Numerous techniques and instrument kits are recommended for the removal of fiber posts, but the risk of excessive root structure damage is a major concern because the ability to differentiate the color difference between peripheral dentin and a bonded fiber post can complicate the accuracy of the removal. CONCLUSIONS: The dynamic navigation system enabled minimally invasive removal of the fiber post with a high degree of accuracy, thus ensuring that there was no unnecessary removal of root structure. Dynamic navigation using real-time monitoring could reduce the attendant risk of iatrogenic errors in complex treatment cases.

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INTRODUCTION: The aim of the present study was to compare the cyclic fatigue resistance of Reciproc R25 (R25) and Reciproc Blue R25 (R25B) instruments, after simulated clinical use in traditional (TradAC) and ultraconservative (UltraAC) endodontic access cavities. METHODS: Forty mandibular molars were randomly assigned into the following groups, according to the type of access and instrument to be used: TradAC and R25, TradAC and R25B, UltraAC and R25, and UltraAC and R25B. Teeth were accessed accordingly, and the root canals were prepared using "RECIPROC ALL" kinematics. The cyclic fatigue resistance of the forty used instruments was obtained measuring the time to fracture in an artificial stainless-steel canal. Ten brand new R25 and R25B were used as control groups. The fracture surfaces and the side cutting edges of the instruments were examined with a scanning electron microscope. Data were statistically analyzed using one-way ANOVA and post hoc Tukey tests with a significance level of P < 0.05. RESULTS: R25B instruments showed significantly higher cyclic fatigue resistance than R25, regardless of the access cavity type (P < 0.05). No differences were observed in the cyclic fatigue resistance between instruments without simulated clinical use and used in TradAC (P > 0.05). R25 and R25B used in UltraAC showed significantly lower cyclic fatigue resistance compared with the instruments used in TradAC and without simulated clinical use (P < 0.05). CONCLUSIONS: R25B files showed improved cyclic fatigue resistance than R25. The use of R25B and R25 files in mandibular molars with UltraACs decreased their cyclic fatigue resistance, compared with TradAC. CLINICAL RELEVANCE: The use of Reciproc and Reciproc Blue files in mandibular molars with ultra-conservative endodontic access cavities reduced their cyclic fatigue resistance. Clinicians should be aware about the reduced cyclic fatigue resistance of these files when used in mandibular molars with UltraAC, due to the synergistic effect of access angulation and severe curvature induced in the endodontic files.

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OBJECTIVE: To improve postoperative outcomes in patients with abdominal aortic aneurysms undergoing abdominal aorta replacement via mini-laparotomy by preoperative planning of localization and optimal length of incision. MATERIAL AND METHODS: There were 40 patients with abdominal aortic aneurysms who underwent abdominal aorta replacement via mini-laparotomy. Preoperative planning of mini-laparotomy was carried out in the main group (n=17), empirical mini-laparotomy - in the control group (n=23). Intraoperative parameters, postoperative recovery, complications, and conversion rate were evaluated. RESULTS: Significant differences were observed for conversion rate, duration of surgery and mechanical ventilation. Baseline characteristics and postoperative morbidity were similar. CONCLUSION: Preoperative planning of optimal length of skin incision and analysis of anterior abdominal wall topography using CT angiography significantly reduce duration of surgery, mechanical ventilation and conversion rate. Postoperative morbidity was similar in both groups. Thus, this approach should be used to assess advisability of mini-laparotomy in patients with abdominal aortic aneurysms.

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RESUMEN Introducción: La histerectomía constituye la segunda causa más frecuente de cirugía mayor en la mujer. Tres tipos de histerectomías son usadas en la actualidad: la histerectomía vaginal, la histerectomía abdominal y la histerectomía mínimamente invasiva. Esta última variedad se comenzó a realizar en Matanzas a finales de la pasada década. Objetivo: Evaluar las características clínicas epidemiológicas de las pacientes histerectomizadas por cirugía video laparoscópica. Métodos: Se realizó un estudio descriptivo y prospectivo. El universo lo conformaron todas las pacientes en las que se implementó esta técnica quirúrgica y se tomó como muestra al propio universo, 96 pacientes. Resultados: Predominó la edad comprendida entre 40 y 49 años con 44 pacientes; la raza negra con 51 pacientes; diagnóstico de miomatosis uterina con 87 casos; tiempo quirúrgico de 61-90 min con 57 pacientes y estadía hospitalaria de hasta 24 h en 93 de las pacientes. Se presentaron 3 complicaciones en total y el número de casos convertidos fue 0. Conclusiones: La histerectomía videolaparoscópica es implementada de forma segura y eficaz. Se realizó predominantemente en mujeres mayores de 40 años, con diagnóstico de miomatosis uterina. El tiempo quirúrgico promedio es mayor que el reportado en la literatura. La estadía hospitalaria es de 24 horas como promedio y se reincorporaron a sus actividades habituales rápidamente(AU)

ABSTRACT Introduction: Hysterectomy is the second most frequent type of major surgery among women. Three types of hysterectomy are currently used: vaginal hysterectomy, abdominal hysterectomy, and minimally invasive hysterectomy. This last variety began to be performed in Matanzas at the end of the last decade. Objective: To evaluate the clinical-epidemiological characteristics of patients hysterectomized. Methods: A descriptive and prospective study was carried out. The population was made up of all the patients operated on by this surgical technique. The whole population itself was taken as a sample (96 patients). Results: There was predominance of the age group 40-49 years (44 patients), the black race (51 patients), diagnosis of uterine myomatosis (87 cases), surgical time of 61-90 min (57 patients), and hospital stay of up to 24 hours (93 patients). There were three complications and the number of converted cases was 0. Conclusions: Videolaparoscopic hysterectomy is implemented safely and effectively. It was performed predominantly in women over 40 years of age and diagnosed with uterine myomatosis. Average surgical time is greater than that reported in the scientific literature. Hospital stay is 24 hours as an average. The patients returned to their usual activities quickly(AU)

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In the last decade, several access cavity designs involveing minimal removal of tooth tissue have been described for gaining entry to pulp chambers during root canal treatment. The premise behind this concept assumes that maximum preservation of as much of the pulp chamber roof as possible during access preparation would maintain the fracture resistance of teeth following root canal treatment. However, the smaller the access cavity, the more difficult it may be to visualize and debride the pulp chamber as well as locate, shape, clean and fill the canals. At the same time, a small access cavity may increase the risk of iatrogenic complications as a result of poor visibility, which may have an impact on treatment outcome. This study aimed to critically analyse the literature on minimal access cavity preparations, propose new nomenclature based on self-explanatory abbreviations and highlight the areas in which more research is required. The search was conducted without restrictions using specifics terms and descriptors in four databases. A complementary screening of the references within the selected studies, as well as a manual search in the highest impact journals in endodontics, namely International Endodontic Journal and Journal of Endodontics, was also performed. The initial search retrieved 1831 publications. The titles and abstracts of these papers were reviewed, and the full text of 94 studies was assessed. Finally, a total of 28 studies were identified as evaluating the influence of minimally invasive access cavity designs on the fracture resistance of teeth and on the different stages of root canal treatment (orifice location, canal shaping, canal cleaning, canal filling and retreatment). Overall, the studies had major methodological drawbacks and reported inadequate and/or inconclusive results on the utility of minimally invasive access preparations. Furthermore, they offered limited scientific evidence to support the use of minimally invasive access cavities to improve the outcome of root canal treatment and retreatment; they also provided little evidence that they preserved the fracture resistance of root filled teeth to a greater extent than traditional access cavity preparations. It was concluded that at present, there is a lack of supporting evidence for the introduction of minimally invasive access cavity preparation into routine clinical practice and/or training of undergraduate and postgraduate students.

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INTRODUCTION: The aim of this study was to determine and compare the difference in the volume of dentin and enamel removed (DER) to prepare 3 different access cavities and to propose a standardization of the access cavities according to their volume of DER. METHODS: One hundred twenty maxillary and mandibular molars and premolars were assigned to 3 subgroups for each tooth type (n = 10): the traditional endodontic cavity (TEC) group; the conservative endodontic cavity (CEC) group with partial unroofing and convergent walls; and the ultraconservative endodontic cavity (UEC) group, preserving most part of the pulp chamber roof and the occlusal surface. The sliced image data of cone-beam computed tomographic images before and after access cavity preparation were exported as Digital Imaging and Communications in Medicine files and imported into the MeVisLab framework system (MeVis Research, Bremen, Germany). After segmentation, the volumes of coronal dentin and enamel were measured, and the difference in the percentage of volume of DER for endodontic access cavity preparation was calculated. The data were subjected to statistical analyses (analysis of variance) with a level of significance set at P < .05. RESULTS: The percentage of volume of DER was less than 6% for the UEC group, up to 15% for the CEC group, and more than 15% for the TEC group, with a statistically significant difference among all groups in all of the tooth types analyzed (P < .05). CONCLUSIONS: The present study showed significantly different percentages of volume of DER among the groups analyzed (ie, UEC < CEC < TEC). A standardization of access cavity preparation was proposed according to the percentage of volume of DER.

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BACKGROUND: Thyroid carcinoma (TC) is more likely to occur in young women. The aim of this study was to compare the aesthetic effect of different thyroidectomies. METHODS: One hundred twenty female patients who underwent thyroidectomy were evenly distributed into three groups: conventional access (CA), aesthetic principles access (APA) and minimally invasive access (MIA). The Patient and Observer Scar Assessment Scale (POSAS) was used as the assessment tool for the linear scar. RESULTS: The patients in the MIA group showed significantly less intraoperative blood loss, less drainage, a shorter scar length and a shorter duration of drainage than those in the CA group and the APA group. However, the operation time of 129.0 min in the MIA group was significantly longer than the 79.6 min in the CA group and the 77.0 min in the APA group. The best aesthetic score, as assessed by the Observer Scar Assessment Scale (OSAS), was obtained in the APA group. The Patient Scar Assessment Scale (PSAS) scores were significantly lower in the APA group and CA group than in the MIA group. Significantly lower objective scar ratings were found in the APA group than in the other two groups. CONCLUSION: These results show that APA produced the best surgical outcomes in TC patients, indicating that conventional thyroidectomy can produce an ideal aesthetic result using the principles of aesthetic surgery. Thyroid surgery need not be performed through excessively short incisions for the sake of patient satisfaction with the scar's appearance. TRIAL REGISTRATION: This clinical trial was retrospectively registered on ClinicalTrials.gov PRS on August 1st,2017 ( NCT03239769 ).

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A novel minimally invasive technique for left atrial myxoma surgery involving a combination of mini-sternotomy and restricted left atrial dome incision is described. Surgery is performed through a mini-J sternotomy at third intercostal space and a standard aorto-right atrial cannulation. Exposure of cardiac mass is obtained by a restricted incision of the left atrial dome which provides excellent view of the entire interatrial septum. Base of the tumor base is clearly visualized making the en-bloc excision extremely easy. Three cases were successfully treated with this technique and discharged with mild analgesic requirements. The limited invasiveness and the avoidance of wide incisions in the heart chambers are points of strength of this approach and allow to overcome the limitations of the currently used interatrial groove or transeptal approaches, as scarce visualization of the septum and site of tumor attachment and risk of conduction disturbances or traumatic injury to the mass.

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We report two cases of dural arteriovenous fistulae treated endovascularly, where percutaneous venous or arterial access was not suitable. In both cases, a different surgical access technique was used to allow transcranial cannulation of the appropriate venous sinus or of the varix to gain access and occlude the fistula.