Experience with the novel unifemoral parallel sheath technique in percutaneous intervention of chronic total coronary occlusions

Background Percutaneous interventions to address chronic coronary occlusions (CTO-PCI) often require simultaneous ipsi- and contralateral coronary injections. Although radial access is increasingly popular, bifemoral artery access is still the preferred choice of CTO operators. The aim of this case series is to demonstrate the feasibility and safety of the unifemoral parallel sheath technique, which avoids two puncture sites, increases patient comfort, and improves procedure ergonomics. It offers rapid second access to the femoral artery adjacent to the first sheath as well as closure by unilateral manual compression without or with 1 or 2 vascular closure devices. Results We retrospectively evaluated the procedure results in 90 consecutive CTO patients where an ipsilateral parallel sheath access was considered. Placement of the second sheath uneventfully failed in two because of severe femoral calcification and narrowing. In 96.6%, the first sheath was 7 F (3.4% 6F), while the second sheath was 4 F in 22.7%, 5 F in 64.7%, and 6 or 7 F in 11.4% each. No major complications nor severe bleeding events occurred, and the mean drop of hemoglobin was low (0.6 g/dL ± 0.86). Conclusion In CTO-PCI requiring contralateral coronary injections or the retrograde technique, the ipsilateral parallel sheath technique might be a feasible alternative to the standard bifemoral or femoral-radial access.

Our experience with retrograde technique in difficult laparoscopic cholecystectomy

Background: Gall bladder pathologies are some of the commonly encountered conditions in one’s surgical practice. Cholecystectomy is among the routinely performed procedures in most surgical units. Laparoscopic surgery is preferred to open cholecystectomy because of its various advantages. In straightforward cases, the antegrade technique is routinely employed. The retrograde technique is generally reserved for the difficult cases. The retrograde technique may be used safely with adequate experience, thus reducing the need for conversion into open surgery.Methods: Total 100 cases of consecutive difficult laparoscopic cholecystectomies were included in this study, which were operated using retrograde technique.Results: Out of the 100 patients 79 were females and 21 were males. Mean age of the patients was 44.2 years. Out of the 100 cases, 98 cases could be successfully managed using the retrograde technique. 2 cases were converted to open surgery. Bleeding was encountered in 3 cases, which was successfully managed laparoscopically. Bile duct injury was seen in 1 case which was managed after conversion.Conclusions: With adequate surgical expertise and proper instrumentation, retrograde dissection technique may be safely used in difficult laparoscopic cholecystectomy, reducing the rate of conversion to open surgery.

Management of the Embedded Tracheoesophageal Prosthesis: Retrograde Removal and Replacement

Objective: To describe the retrograde removal of a tracheoesophageal (TE) prosthesis embedded in the common wall between the trachea and esophagus with preservation of the original tracheoesophageal puncture (TEP) tract with subsequent placement of new tracheoesophageal prosthesis for voice restoration. Methods: The Blom-Singer TEP Set (InHealth Technologies, Carpinteria, CA) was used to facilitate this procedure. The coated wire leader cable was threaded through the small opening in the posterior tracheal wall and into the lumen of the old TE prosthesis. The wire was pulled through the mouth in retrograde fashion - bringing the old TE prosthesis out with it and dilating the existing TEP tract. A new prosthesis was then placed over the end of the wire and returned through the stoma, delivering the prosthesis through the TE tract and into the stoma. Results: Safe, voice restoration with avoidance of need for multiple procedures. Conclusion: Removal of an embedded prosthesis and simultaneous replacement of a new prosthesis was safely and efficiently achieved using a retrograde technique which maintained the patency of the prior TE tract and restored voice.

Seeker Uncinectomy: A Randomized Controlled Cadaveric Trial

Background Endoscopic sinus surgery is a common surgery, in which the uncinate process of the ethmoid is removed as the first surgical step. There are multiple techniques for uncinectomy. Herein we describe a new and simple uncinectomy technique. Methods We performed a randomised controlled trial with blinded assessors. Eight cadaveric heads were used to compare the new technique to the commonly used technique; retrograde uncinectomy. The procedures were performed by 2 rhinologists, and the findings were evaluated by 2 senior rhinologists blinded to the technique and the surgeon who did. They assessed the final view of the procedure and the complications. Thereafter, they assessed the procedure for the duration and ease of each technique for teaching purposes. Results Fifteen uncinectomies were performed, 7 using the retrograde technique, and 8 using the new technique. The mean durations were 5.64 min using the seeker uncinectomy and 7.57 min using the retrograde uncinectomy, p-value = 0.017. The completion was better in seeker uncinectomy; however, not significant statistically, p > 0.05. The complications with the new technique were inferior turbinate injury in 12.5% and natural ostium non-identification in 12.5%, p > 0.05. With retrograde uncinectomy, lacrimal injury occurred in 14.3%, p > 0.05. The ease of teaching scores was higher for the seeker uncinectomy. Conclusion Based on this cadaveric trial, seeker uncinectomy seems to be a safe and easy to perform technique. However, injury to the inferior turbinate and missing the natural ostium must be taken into consideration. These warrant further studies on the clinical application of this procedure.