Ioannis Paschopoulos

Background and Objectives: Hysteroscopy permits direct assessment and treatment of the uterine cavity, but diagnostic yield does not necessarily translate into improved fertility. This narrative review examines its role in subfertility and reproductive medicine. Materials and Methods: The original literature search covered PubMed/MEDLINE, Scopus and the Cochrane Library through February 2026. Targeted checks during revision added the 2026 chronic endometritis consensus and the full CERM trial report; these updates do not represent a new comprehensive search. Evidence was interpreted by study design, population, outcome and precision, without formal risk-of-bias assessment or meta-analysis. Results: Large randomised trials do not support routine hysteroscopy before first IVF or after repeated IVF failure when ultrasonography is normal. Polypectomy has evidence of improved pregnancy rates in women planning IUI, although spontaneous pregnancies contributed to that result and live-birth benefit remains uncertain. Hysteroscopic myomectomy may improve clinical pregnancy in women with cavity-distorting fibroids; evidence for live birth is less secure. Adhesiolysis restores cavity anatomy, but reproductive estimates largely derive from observational series. The small TRUST trial did not demonstrate a live-birth advantage from septum resection and cannot establish equivalence. Hysteroscopy may guide biopsy for chronic endometritis but does not replace histological assessment. CERM found no improvement with doxycycline in its composite of cumulative live births and ongoing pregnancies at ≥24 weeks among women with recurrent miscarriage and CD138-defined endometritis. Fertility-sparing endometrial cancer treatment requires oncological selection, progestin therapy and histological surveillance. Conclusions: Hysteroscopy should address a defined diagnostic or therapeutic question. Decisions should distinguish spontaneous conception, IUI and IVF/ICSI and acknowledge uncertainty in live-birth outcomes.

Persistent left superior vena cava (PLSVC) is the most frequently reported anatomical variant of the thoracic systemic venous system. While its association with congenital heart disease (CHD) is well recognized, its prevalence within CHD populations and its relative occurrence compared with non-CHD cohorts remain incompletely characterized. This study aimed to estimate the pooled prevalence of PLSVC among patients with CHD and to assess its relative frequency compared with that in control populations. A systematic review of PubMed, Scopus, and Web of Science was conducted from database inception to January 2026. Studies reporting the prevalence of PLSVC in CHD cohorts were included. A random-effects meta-analysis was performed, and risk ratios (RRs) were calculated for studies that included both CHD and non-CHD groups. Sixteen studies (n = 37,370) were included. The pooled prevalence of PLSVC in CHD patients was 6.36% (95% CI: 4.70–8.24). Significant heterogeneity was identified (I² = 97.6%). An increased likelihood of PLSVC was observed in CHD populations (RR = 15.34; 95% CI: 5.72–41.14). However, this relative risk is based on a highly limited number of comparative studies (n = 4) and exhibits substantial heterogeneity (I² = 92.47%); thus, it must be interpreted with significant caution. Subgroup analyses did not demonstrate statistically significant differences based on nationality (p = 0.59), study type (p = 0.32) and age group (p = 0.95), while imaging modality was statistically significant (p = 0.01). PLSVC is observed in a notable proportion of patients with CHD, although variability in reported prevalence is substantial and likely influenced by methodological differences across studies. Given its potential implications for catheter-based and surgical procedures, systematic evaluation of thoracic venous anatomy should be considered during the diagnostic and preoperative assessment of patients with CHD.

Introduction Patients with severe obesity are particularly vulnerable to the physiological effects of pneumoperitoneum during laparoscopic metabolic bariatric surgery (MBS). Low-pressure laparoscopy may reduce cardiopulmonary stress and postoperative pain; however, its feasibility in MBS remains debated. This study aimed to evaluate the feasibility and early outcomes of a low-impact laparoscopic sleeve gastrectomy (LIL-SG) technique, combining single-incision access with low-pressure pneumoperitoneum in patients with severe obesity. Methods Data from consecutive patients undergoing LIL-SG were prospectively collected, analyzed and compared with a matched retrospective cohort undergoing conventional SILS-SG. Patients with BMI ≥ 50 kg/m² or complex anatomical or cardiopulmonary conditions were excluded. Pneumoperitoneum was maintained at 10–12mmHg, with temporary increases to 14mmHg permitted if necessary. Primary outcomes included intraoperative feasibility, operative parameters, and early postoperative outcomes, including pain and opioid consumption. Results LIL-SG was successfully completed in 36 consecutive patients without conversion, additional trocar placement, or intraoperative complications. Pneumoperitoneum ≤ 12 mmHg was maintained in 72.2% of cases; temporary increases were required in 27.8% of patients (median duration: 12 min). Median operative time was 58 min, median blood loss was 10 mL. Overall postoperative morbidity was 8.3% (minor non-surgical complications). Mortality was null. Postoperative pain scores decreased rapidly, accompanied by reduction in opioid use; no patient required opioids after discharge. Safe discharge criteria were met by postoperative day 2 in 94.4% of patients. Preliminary comparative analysis with a matched cohort of patients undergoing conventional SILS-SG demonstrated significantly lower postoperative pain scores and opioid requirements in the LIL-SG group, while length of hospital stay tended to be shorter without reaching statistical significance. Conclusions LIL-SG combining single-incision access with low-pressure pneumoperitoneum is feasible and safe in carefully selected patients with severe obesity, offering favorable intraoperative performance, low morbidity, reduced postoperative pain, and decreased opioid requirements. Further comparative and long-term studies are warranted.

Background: Retroperitoneal surgical corridors, particularly in robotic-assisted partial nephrectomy and donor surgery, require precise knowledge of hilar vascular orientation. The typically described Vein–Artery–Pelvis (VAP) anatomy is often assumed, yet its reliability is poorly quantified. Therefore, the purpose of the present study is to provide a comprehensive radioanatomical map of hilar architecture to enhance surgical safety and predictability. Methods: Contrast-enhanced computed tomography (CT) scans of the abdomen from 200 patients (104 males and 96 females) were evaluated. The anterior-to-posterior sequence of hilar structures, the frequency of early vascular branching, and the presence of accessory vessels were documented and stratified by sex and laterality. Results: The conventional VAP sequence was observed in a minority of cases, occurring in only 32.6% (131 sides). The map identified 37 distinct sequence variants. The most common variants included VAPA (9.0%), AVAP (7.8%), and VAAP (7.0%). Adherence to typical VAP anatomy was significantly lower in males (27.9%) than in females (37.7%). Arterial complexity, characterized by early branching or accessory vessels, was present in 43.2% of sides, with a significantly higher occurrence in males and on the right side. Venous mapping revealed a marked lateral disparity; accessory veins were predominantly right-sided (12.5%), whereas early venous branching was predominantly a left-sided feature (30.0%). Conclusions: Renal hilar architecture demonstrates substantial variability, with the classical VAP configuration representing a minority arrangement. These findings highlight the importance of individualized preoperative imaging assessment and may help anticipate anatomical complexity in retroperitoneal surgery.

Purposes: To provide a comprehensive meta-analytic synthesis of the morphological variability of the basilar artery (BA) - specifically fenestrations, persistent trigeminal arteries (PTA), and aberrant posterior inferior cerebellar artery (PICA) origin - and to elucidate their clinical implications for neuroradiological and neurosurgical procedures. Methods: Following PRISMA 2020 and Evidence-Based Anatomy guidelines, a systematic literature search of three databases was performed. Inclusion criteria focused on imaging studies (CTA, MRA, DSA) reporting the prevalence of specific BA variants. Pooled prevalence was calculated using random-effects models via R programming software. Results: Thirty-five studies involving 266,696 patients were included. The aberrant PICA origin from the BA was the most frequent variant, with a pooled prevalence of 4.53% (95% CI: 0.06–14.52). BA fenestration followed with a prevalence of 1.36% (95% CI: 0.93–1.86), showing a statistically significant difference in detection between MRA (1.69%) and DSA (0.24%). The rarest variant was the PTA, calculated at 0.20% (95% CI: 0.11–0.31). Considerable heterogeneity was observed across pooled estimates. Conclusions: Although BA variations are relatively infrequent, their precise identification is a clinical necessity for procedural safety. Awareness of these variants is vital for navigating complex vascular geometries and managing the potential risk of associated aneurysms during endovascular interventions.

Background: Sex estimation represents a pivotal element of forensic anthropological investigation, conventionally dependent on highly dimorphic skeletal components such as the pelvis and skull. The purpose of the current study was to systematically evaluate the diagnostic accuracy of sternal measurements for sex estimation and to identify methodological- or population-based moderators that influence classification performance. Methods: A systematic review and meta-analysis were conducted in accordance with PRISMA 2020 guidelines. R programming software was used to perform statistical meta-analysis. Pooled sensitivity, specificity, diagnostic odds ratio (DOR), likelihood ratios (LR±), and overall accuracy were calculated using random-effects meta-analysis. Subgroup analyses and meta-regression were performed based on population origin, study design, statistical approach, and measurement protocol. Results: Forty-one studies comprising 293 predictive models were included. The overall pooled sensitivity and specificity were 80.9% (95% CI: 79.7–82.1) and 74.0% (95% CI: 72.4–75.5), respectively, with a mean accuracy of 77.3%. Subgroup analysis revealed that studies involving African populations and imaging-based methods achieved the highest accuracy. Machine learning- and ROC-based methods outperformed traditional discriminant analysis. Combined sternal measurements (manubrium and body) yielded the most robust diagnostic performance (accuracy: 87.3%). Significant heterogeneity (I² > 85%) was observed. Conclusions: Sternal morphometry exhibits a moderate to high degree of diagnostic accuracy in sex estimation and possesses significant forensic importance, especially in situations where more sexually dimorphic features are inaccessible. Nonetheless, variations across populations, the absence of standardized protocols, and methodological heterogeneity constrain its universal applicability.

Background/Objectives: The sphenoid sinus (SS) exhibits marked morphological variability, influencing the relationship of critical neurovascular skull base structures. This study aimed to characterize sphenoid sinus pneumatization (SSP) patterns and assess their impact on the course of the internal carotid artery (ICA), optic nerve (ON), Vidian nerve (VN), and maxillary nerve (MN) within a Greek adult population. Methods: A retrospective analysis of 253 adult skull base computed tomography (CT) scans was performed. The degree and direction of SSP were classified according to established radiological criteria. Anterior, lateral, and posterior extensions were evaluated. The course of adjacent neurovascular structures was categorized as typical, protruding, or dehiscent. Associations between pneumatization types and neurovascular variants were analyzed. Results: The sellar complete type was the predominant SS pattern (63.2%), followed by sellar incomplete (27.7%) and presellar (8.7%) types; agenesis was rare (0.4%). Posterior (63.6%) and lateral (46.6%) extensions were most common. Lateral and posterior pneumatization significantly correlated with protrusion and/or dehiscence of adjacent neurovascular structures, particularly the ICA, ON, and VN. LW extension was strongly associated with ON protrusion (96%), while PP and full-lateral extensions correlated with VN protrusion (56.1% and 79.9%, respectively). No significant sex- or side-related differences were identified. Conclusions: SSP demonstrates extensive morphological variability that significantly affects the anatomical course and osseous coverage of neighboring neurovascular structures. Comprehensive preoperative CT evaluation of SS anatomy is essential for planning endoscopic transsphenoidal and extended skull base procedures to minimize the risk of neurovascular injury.

Background and Objectives: Intertrochanteric hip fractures (ITFs) are common in older adults and frequently coexist with knee osteoarthritis (KOA). Although both conditions share key biomechanical risk factors, the specific relationship between KOA severity and ITF stability has not been well defined. Recent evidence suggests that degenerative knee changes may alter lower-limb load distribution and increase susceptibility to unstable fracture patterns. This study evaluated whether KOA severity, graded using the Kellgren–Lawrence (KL) system, is associated with ITF stability according to the 2018 AO/OTA classification. Materials and Methods: A retrospective observational study was conducted on 138 patients with IHFs treated between 2018 and 2023. KOA severity was assessed using KL grades I–IV on non-weight-bearing anteroposterior knee radiographs. Lateral wall thickness (LWT) was measured using the Hsu method, with Results: Among 138 patients, 98 (71.0%) had unstable ITFs. Advanced KOA was significantly more common in the unstable group (KL III 45.9%, KL IV 48.0%; p < 0.001). KL grade showed a significant inverse correlation with LWT (Pearson’s r = −0.394, p < 0.001). Each one-grade increase in KL severity was associated with a 3.8 mm reduction in LWT (p < 0.001). In multivariable logistic regression, KL grade remained an independent predictor of fracture instability (adjusted OR = 4.9, 95% CI: 2.8–8.8, p < 0.001), whereas age and comorbidities were not significant. ROC analysis demonstrated good discriminatory power (AUC = 0.79). A KL ≥ III threshold achieved 95% sensitivity and 56% specificity for predicting instability. Conclusions: Higher KOA severity is strongly associated with unstable ITF patterns. KL grade independently predicts instability and may serve as a simple, accessible radiographic indicator of biomechanical vulnerability and fracture risk in older adults. Incorporating KOA severity into the preoperative evaluation may enhance risk stratification, guide selection of fixation strategy, and support individualized rehabilitation planning.