Differences in Trocar Positioning within the Vertebral Body Using Two Different Positioning Methods: Effect on Trainee Performance

Abstract

Purpose. To evaluate the educational effect of the Japanese Society of Interventional Radiology 7th Academic Summer Seminar from a technical perspective. Materials and Methods. Nineteen trainees participated in the seminar. The seminar consisted of vertebroplasty trainings using swine with the single-plane landmark method and with the ISOcenter Puncture (ISOP) method. All trainees were advised by an instructor as they operated the instruments and punctured the vertebra. For each trainee, the accuracy in the final position of the needle tip of the initial puncture in each swine training was evaluated. Results. Error in the final position of the needle tip of ≥5 mm from the target puncture site occurred in the lateral direction in 42% (8/19) of trainees with the landmark method and 5% (1/19) with the ISOP method. No error ≥5 mm occurred in the vertical or anteroposterior directions. In terms of puncture accuracy, error in the lateral direction was significantly lower with the ISOP method than with the landmark method (2.2 ± 1.5 mm versus 5.6 ± 3.2 mm). Conclusion. This seminar was effective training for trocar placement for beginners. The puncture was more accurate with the ISOP method than with the landmark method.

Percutaneous direct pancreatic duct intervention in management of pancreatic fistulas: a primary treatment or temporizing therapy to prepare for elective surgery

“…Minimally-invasive duct occlusion techniques close pancreatic fistulas quickly and safely, preventing the need for surgery [ 17 – 19 ]. Duct occlusion can also simulate the effect of pancreatectomy of an isolated segment of gland [ 4 ]. In this instance occlusion/embolization renders the isolated pancreas non-functional and eliminates the fistula (patient #1), which would be the objective of surgical resection of the expendable portion of pancreas.…”

“…For anastomotic fistulas after pancreato-duodenectomy an enteric access was necessary to enable trans-anastomotic cannulation. This approach was similar to what an endoscopically placed trans-anastomotic stent would achieve, and was created with direct puncture of the jejunal loop, or through a trans-hepatic tract if a direct enteric access was not feasible [ 3 , 4 ]. After the source of fistula was reached the duct was cannulated with angiographic catheters and guidewires.…”

“…While percutaneous drainage of PFC is widely utilized, a focal disruption of the duct can be an uncontrolled source of pancreatic secretions that can interfere with healing. Percutaneous interventions of the main pancreatic duct have been described but the experience reported is limited [ 2 – 4 ]. This study evaluates the feasibility, safety, and efficacy of percutaneous direct pancreatic duct interventions in the management of duct fistulas that were ineligible for, or had failed surgical and endoscopic management.…”

A Technical Improvement for Percutaneous Puncture of the Intervertebral disc by Passing Lateral to the Superior Articular Process Using the Isocenter Puncture Method

“…ISOP was originally developed for puncturing vertebral bodies, such as in percutaneous vertebroplasty (PVP) or biopsy of vertebral tumors [5,8]. A more accurate puncture was possible with the ISOP method compared with that with the landmark method in a swine experiment reported by Komemushi et al [9]. As a result, a more accurate puncture of a site within the intervertebral disc is achievable compared with that with conventional methods.…”