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Female Pelvic Floor Anatomy: The Pelvic Floor, Supporting Structures, and Pelvic Organs
The development of novel, less invasive therapies for stress urinary incontinence in women requires a thorough knowledge of the relationship between the pathophysiology of incontinence and anatomy. This article provides a review of the anatomy of the pelvic floor and lower urinary tract. Also discussed is the hammock hypothesis, which describes urethral support within the pelvis and provides an explanation of the continence mechanism.
Herschorn, Sender
Laparoscopic ovarian transposition for pelvic malignancies: indications and functional outcomes
Objective: To assess the indications and effectiveness of laparoscopic ovarian transposition before pelvic irradiation for a gynecologic cancer.Design: Prospective study.Setting: A gynecologic oncology department in a French anti-cancer center.Patient(s): Twenty-four patients treated for pelvic cancer.Intervention(s): Laparoscopic ovarian transposition to paracolic gutters. Uterine conservation in 18 patients.Main Outcome Measure(s): Clinical and laboratory follow-up tests of ovarian function.Result(s): Bilateral laparoscopic ovarian transposition
Philippe Morice; Damienne Castaigne; Christine Haie-Meder; Patricia Pautier; Janah El Hassan; Pierre Duvillard; Alain Gerbaulet; Guy Michel
Retroperitoneal Laparoscopic Pyelolithotomy in an Ectopic Pelvic Kidney
Background and Objectives: Retroperitoneal laparoscopic pyelolithotomy was performed in an ectopic pelvic kidney with renal pelvis calculi. Methods and Results: Laparoscopic pyelolithotomy was successfully performed in an ectopic pelvic kidney by using the retroperitoneal route. The total operation time was 130 minutes, and the estimated blood loss was <50mL. The patient was discharged on the second postoperative day without any complications. Conclusion: Laparoscopic pyelolithotomy is an effective treatment option for management of stones in the pelvis of an ectopic pelvic kidney. The retroperitoneal route may help to avoid intraoperative and postoperative complications.
Cirakoglu, Abdullah; Ozer, Serafettin
Laparoscopic removal of a benign pelvic retroperitoneal dermoid cyst
Retroperitoneal tumors are rare, often malignant, and difficult to diagnose. Surgical removal is associated with significant morbidity and mortality. We believe this to be the first report of laparoscopic removal of a benign pelvic retroperitoneal dermoid cyst from the right pararectal and presacral areas. Iatrogenic enterocele was prevented by laparoscopic suturing and knot tying to perform a modified McCall culdoplasty.
Leslie A. Sharpe; Dirk J. A. Van Oppen
Demonstration of Pelvic Anatomy by Modified Midline Transection that Maintains Intact Internal Pelvic Organs
ERIC Educational Resources Information Center
Gross dissection for demonstrating anatomy of the human pelvis has traditionally involved one of two approaches, each with advantages and disadvantages. Classic hemisection in the median plane through the pelvic ring transects the visceral organs but maintains two symmetric pelvic halves. An alternative paramedial transection compromises one side�
Steinke, Hanno; Saito, Toshiyuki; Herrmann, Gudrun; Miyaki, Takayoshi; Hammer, Niels; Sandrock, Mara; Itoh, Masahiro; Spanel-Borowski, Katharina
Laparoscopic sleeve gastrectomy: a guide to postoperative anatomy and complications
:��The purpose of this pictorial essay is to review the surgical technique, postoperative anatomy, and potential complications\\u000a of the laparoscopic sleeve gastrectomy. As the laparoscopic sleeve gastrectomy becomes an increasingly popular bariatric surgery,\\u000a it is important for radiologists to familiarize themselves with the procedure and possible complications.
David P. Katz; Stephen R. Lee; Arun C. Nachiappan; Marc H. Willis; Collin D. Bray; Carlos A. Farinas; Cliff J. Whigham; Felix Spiegel
[Functional anatomy of the pelvic floor].
The pelvic floor is the support of the pelvic viscera. The levator ani muscle (LA) with its two bundles (pubo- and iliococcygeus) is the major component of this pelvic floor. LA is formed essentially by type I fibers (slow twitch, with high oxidative capability and presence of slow myosin) as in postural muscles. The aerobic metabolism makes LA fragile to excentric contraction and to mitochondrial dysfunction. The innervation of the pelvic floor comes from the 2nd, 3rd, 4th anterior sacral roots; denervation affects pelvic dynamism. Perineum includes the musculofascial structures under the LA: ventrally the striated sphincter of urethra and the ischiocavernosus and bulbospongiosus, caudally the fatty tissue filling the ischioanal fossa. Pelvic fascia covers the muscles ; it presents reinforcements : the uterosacral and cardinal ligaments, the arcus tendineus fascia pelvis (ATFP) and the arcus tendineus levator ani (ATLA). The pelvis statics is supported by the combined action of all this anatomical structures anteriorly forming the perineal "hammock," medially the uterosacral and cardinal ligaments, posteriorly the rectovaginal fascia and the perineal body. The angles formed by the pelvic viscera with their evacuation ducts participate to the pelvic statics. During the pelvic dynamics the modification of these angles expresses the action of the musculofascial structures. PMID:24260836
Yiou, Ren�; Delmas, Vincent
Laparoscopic evaluation of infertile patients with chronic pelvic pain.
In this study over a 10-year period, 1584 patients complaining of infertility of more than 1 year duration were evaluated for their laparoscopic findings in relation to the presence or not of chronic pelvic pain (CPP). Infertility was the only complaint in 1215 cases (group 1), whereas 369 patients complained of infertility and CPP (group 2). All cases underwent routine infertility investigation and pelvic ultrasonography, followed by diagnostic laparoscopy, with infertility-only cases acting as a control group. At laparoscopy 76.7% of patients with CPP were found with pelvic pathology, compared with only 42.6% of cases without CPP (P < or = 0.0001). Omental-abdominal wall adhesions, advanced endometriosis, endometriomas with adhesions, pelvic venous congestion, and hydrosalpinges with pelvic adhesions were significantly more frequent in cases with CPP. Dysmenorrhoea was the most frequent type of CPP. Cases with CPP and a negative laparoscopy were further investigated using a multidisciplinary approach. In conclusion, chronic pelvic pain can be the result of several pelvic pathologies. Infertile patients with CPP are much more frequently found with an abnormal pelvis in comparison with cases without CPP. Laparoscopy is an invaluable diagnostic tool especially for symptomatic patients and should be used early in their diagnostic infertility work-up. PMID:16569325
Milingos, Spyros; Protopapas, Athanasios; Kallipolitis, George; Drakakis, Petros; Makrigiannakis, Antonios; Liapi, Anthi; Milingos, Dimitrios; Antsaklis, Aris; Michalas, Stylianos
Laparoscopic evaluation and management of chronic pelvic pain during adolescence.
Chronic pelvic pain (CPP) is a common symptom and a difficult condition to manage especially during adolescence. The aim of this study was to evaluate the role of laparoscopy in the diagnosis and treatment of CPP during this period of life. From January 1993 to December 1997, 98 patients, selected from a group of 180 patients who were referred to our clinic underwent laparoscopy. In most cases (60%) no abnormalities were observed. Endometriosis was found in 25% of cases, followed by ovarian cysts 7%, parovarian cysts 3%, pelvic inflammatory disease 3% and adhesions 2%. Laparoscopic treatment was performed as indicated by laparoscopic findings. We conclude that laparoscopy is a valuable and effective procedure in the diagnosis and management of CPP in a selected group of patients. PMID:10459441
Kontoravdis, A; Hassan, E; Hassiakos, D; Botsis, D; Kontoravdis, N; Creatsas, G
[Endosonographic anatomy of the pelvic floor].
With the aim of gaining a precise anatomical view of the anal canal, of the pelvic floor and his pathological changes, endorectal sonography was performed in 188 patients with carcinoma of the rectum without infiltration of the sphincter muscles. Based on our photographic material we designed a sonographic "map" of the pelvic floor. Transducer: Endo-P-Sonde, Siemens, with 5, 6 and 7, 5 MHz frequence and the possibility to obtain longitudinal and transversal sections. The following muscles were constantly seen: sphincter ani internus et externus, levator ani, obturator internus, ischiocavernosus, transversus perinei prof. et sup. and thereby ischiorectal and pelvirectal fossa were defined. On the basis of these exact knowledges diagnosis and therapy of perianal abscesses and fistulas can be improved. PMID:8967206
Schaeff, B; Paolucci, V
Normal Vulvovaginal, Perineal, and Pelvic Anatomy with Reconstructive Considerations
A thorough insight into the female genital anatomy is crucial for understanding and performing pelvic reconstructive procedures. The intimate relationship between the genitalia and the muscles, ligaments, and fascia that provide support is complex, but critical to restore during surgery for correction of prolapse or aesthetic reasons. The external female genitalia include the mons pubis, labia majora and minora, clitoris, vestibule with glands, perineal body, and the muscles and fascia surrounding these structures. Through the perineal membrane and the perineal body, these superficial vulvar structures are structurally related to the deep pelvic muscle levator ani with its fascia. The levator ani forms the pelvic floor with the coccygeus muscle and provides vital support to all the pelvic organs and stability to the perineum. The internal female genital organs include the vagina, cervix, uterus, tubes, and ovaries with their visceral fascia. The visceral fascia also called the endopelvic fascia, surrounds the pelvic organs and connects them to the pelvic walls. It is continuous with the paraurethral and paravaginal fascia, which is attached to the perineal membrane. Thus, the internal and external genitalia are closely related to the muscles and fascia, and work as one functioning unit.
Yavagal, Sujata; de Farias, Thais F.; Medina, Carlos A.; Takacs, Peter
Laparoscopic Inguinal Exploration and Mesh Placement for Chronic Pelvic Pain
Background and Objective: Chronic pelvic pain affects 15% of women. Our objective was to evaluate empiric laparoscopic inguinal exploration and mesh placement in this population. Methods: Retrospective cohort with follow-up questionnaire of women with lateralizing chronic pelvic pain (right or left), ipsilateral inguinal tenderness on pelvic examination, no clinical hernia on abdominal examination, and ipsilateral empiric laparoscopic inguinal exploration with mesh placement (2003�2009). Primary outcome was pain level at the last postoperative visit. Secondary outcomes were pain level and SF-36 scores from the follow-up questionnaire. Results: Forty-eight cases met the study criteria. Surgery was done empirically for all patients, with only 7 patients (15%) found to have an ipsilateral patent processus vaginalis (shallow peritoneal dimple or a deeper defect (occult hernia)). Of 43 cases informative for the primary outcome, there was pain improvement in 15 patients (35%); pain improvement then return of the pain in 18 patients (42%); and pain unchanged in 9 patients (21%) and worse in 1 patient (2%). Improvement in pain was associated with a positive Carnett's test in the ipsilateral abdominal lower quadrant (P = .024). Thirteen patients returned the questionnaire (27%), and the pain was now described as improved in 9 patients (69%), unchanged in 4 patients (31%), and worse in none. Three SF-36 subscales showed improvement (physical functioning, social functioning, and pain). Conclusion: In select women with chronic pelvic pain, empiric laparoscopic inguinal exploration and mesh placement results in moderate improvement in outcome. A positive Carnett's test in the ipsilateral abdominal lower quadrant is a predictor of better outcome.
Williams, Christina; Allaire, Catherine
Laparoscopic sacrocolpopexy versus transvaginal mesh for recurrent pelvic organ prolapse.
Both expert surgeons agree with the following: (1) Surgical mesh, whether placed laparoscopically or transvaginally, is indicated for pelvic floor reconstruction in cases involving recurrent advanced pelvic organ prolapse. (2) Procedural expertise and experience gained from performing a high volume of cases is fundamentally necessary. Knowledge of outcomes and complications from an individual surgeon's audit of cases is also needed when discussing the risks and benefits of procedures and alternatives. Yet controversy still exists on how best to teach new surgical techniques and optimal ways to efficiently track outcomes, including subjective and objective cure of prolapse as well as perioperative complications. A mesh registry will be useful in providing data needed for surgeons. Cost factors are also a consideration since laparoscopic and especially robotic surgical mesh procedures are generally more costly than transvaginal mesh kits when operative time, extra instrumentation and length of stay are included. Long-term outcomes, particularly for transvaginal mesh procedures, are lacking. In conclusion, all surgery poses risks; however, patients should be made aware of the pros and cons of various routes of surgery as well as the potential risks and benefits of using mesh. Surgeons should provide patients with honest information about their own experience implanting mesh and also their experience dealing with mesh-related complications. PMID:22930214
Iglesia, Cheryl B; Hale, Douglass S; Lucente, Vincent R
Laparoscopic management of patients with endometriosis and chronic pelvic pain.
Endometriosis has been traditionally included among the most important causes of chronic pelvic pain (CPP) in women of reproductive age. The main clinical manifestations of endometriosis are dysmenorrhea, dyspareunia, and chronic nonmenstrual pain. Despite the high prevalence of endometriosis in women suffering from CPP, controversy still exists regarding the true association between the stage and extent of this peculiar disease and the severity of pain. Over the last decade, advances in endoscopic technology have enabled gynecologic surgeons to recognize many atypical appearances of the endometriotic implants not known to exist before, thus allowing their complete excision or destruction. Laparoscopic surgery may offer considerable relief in patients with endometriosis and CPP. Although cases with advanced endometriosis seem to benefit the most, we also support surgical treatment in patients with early endometriosis diagnosed using laparoscopy, as many will experience improvement in their symptoms. PMID:14644834
Milingos, Spyros; Protopapas, Athanasios; Drakakis, Peter; Liapi, Anthoula; Loutradis, Dimitrios; Kallipolitis, George; Milingos, Dimitrios; Michalas, Stylianos
Laparoscopic Pelvic Lymph Node Dissection in the Staging of Prostate Cancer
Background: Men with localized prostate cancer who present with high risk features may benefit from determination of pelvic lymph node status by a laparoscopic lymph node dissection prior to definitive therapy. Methods: One hundred eighty-nine men with a median age of 69 years (range 49-80) with T1-T3 prostate cancer had a laparoscopic pelvic lymph node dissection (LPLND) prior to definitive
Laparoscopic technique and safety experience with barbed suture closure for pelvic cavity after abdominoperineal resection
Background Between April 2005 and December 2012, we performed laparoscopic colorectal resection with regional lymph node dissection on 273 cases of colorectal cancer patients. However, Laparoscopic rectal cancer surgery requires a high degree of skill. Any surgeon who is going to embark on these difficult resections should have at a minimum laparoscopic suturing skills in order to be able to close the peritoneal defect. Methods In laparoscopic surgery for rectal cancer, the intracorporeal suture technique required to close the pelvic cavity is very difficult. Barbed sutures have recently been proposed to facilitate laparoscopic suturing. Two patients with rectal cancer who underwent laparoscopic abdominoperineal resection (APR) with intracorporeal closure of the pelvic cavity from September to October 2012 were enrolled in this study. Results We present our initial experience of two consecutive cases of intracorporeal closure of the pelvic cavity by totally laparoscopic APR. After clinical follow-up, the two patients have no complaints and have shown no signs of recurrence. Conclusions We hypothesized that barbed sutures could potentially improve the efficiency of intracorporeal closure of the pelvic cavity after laparoscopic APR. Further, we expect that use of the V-Loc� will reduce intra-operative stress on the endoscopic surgeon.
Robot-Assisted Laparoscopic Pyeloplasty with Stone Removal in an Ectopic Pelvic Kidney
Ectopic pelvic kidneys with ureteropelvic junction obstruction and stones present a treatment challenge for the minimally invasive surgeon. A pure laparoscopic approach is less invasive than an open approach but is technically difficult with longer operative time. The use of the da Vinci robotic interface has the potential to refine the laparoscopic technique and improve outcomes. Here, we present successful management using the robotic technique of one such case of concomitant pyeloplasty and pyelolithotomy.
Nayyar, Rishi; Singh, Prabhjot
Laparoscopic Pelvic Autonomic Nerve-Preserving Surgery for Patients with Lower Rectal Cancer after Chemoradiation Therapy
Objective��This is a phase II study, the aim of which is to determine if a laparoscopic approach can be used in pelvic autonomic nerve-preserving\\u000a surgery for patients with lower rectal cancer following chemoradiation therapy.\\u000a \\u000a \\u000a \\u000a Methods��Patients with T3 lower rectal cancer treated by preoperative chemoradiation were recruited and subjected to laparoscopic pelvic\\u000a autonomic nerve-preserving surgery with total mesorectal excision and a
Jin-Tung Liang; Hong-Shiee Lai; Po-Huang Lee
Standardization of Laparoscopic Pelvic Examination: A Proposal of a Novel System
Objective. Laparoscopic pelvic assessment is often performed in a nonstandardized fashion depending on the surgeon's discretion. Reporting anatomic findings is inconsistent and lesions in atypical locations may be missed. We propose a method for systematic pelvic assessment based on anatomical landmarks. Design. Retrospective analysis. Setting. Tertiary care academic medical center. Intervention. We applied this system to operative reports of 540 patients who underwent diagnostic or operative laparoscopy for unexplained infertility between 2006 and 2012. The pelvis was divided into 2 midline zones (zone I and II) and right and left lateral zones (zone III and IV). All reports were evaluated for the comprehensiveness of description with respect to normal findings or pathology for each zone. Results. Of 540 surgeries, all reports commented on the uterus, tubes, and ovaries (100%), but only 17% (n = 93, 95% CI: 13.8�20.2) commented on the dome of the bladder and the anterior cul-de-sac. 24% (n = 130, 95% CI: 20.4�27.6) commented on the posterior cul-de-sac, and 5% (n = 29, 95% CI: 3.2�6.8) commented on the pelvic sidewall. Overall, 6% (n = 34, 95% CI: 4�8) reported near complete documentation of the pelvic zones. Conclusion. Implementation of a systematic approach for laparoscopic pelvic examination will enhance the diagnostic accuracy and provide better communication between care providers. In the absence of pelvic pathology, we recommend a minimum of 6 photographs of the 6 pelvic zones.
Bedaiwy, Mohamed A.; Pope, Rachel; Henry, Drisana; Zanotti, Kristin; Mahajan, Sangeeta; Hurd, William; Falcone, Tommaso; Liu, James
Laparoscopic ovarian transposition before pelvic radiation in rectal cancer patient: safety and feasibility
Background Infertility due to pelvic radiation for advanced rectal cancer treatment is a major concern particularly in young patients. Pre-radiation laparoscopic ovarian transposition may offer preservation of ovarian function during the treatment however its use is limited. Aim The study investigates the safety, feasibility and effectiveness of pre-radiation laparoscopic ovarian transposition and its effect on ovarian function in the treatment o locally advanced rectal cancer. Methods Charts review of all young female patients diagnosed with locally advanced rectal cancer, underwent laparoscopic ovarian transposition, then received preoperative radiotherapy at king Faisal Specialist Hospital and Research Centre between 2003�2007. Results During the period studied three single patients age between 21�27?years underwent pre-radiation laparoscopic ovarian transposition for advanced rectal cancer. All required pretreatment laparoscopic diversion stoma due to rectal stricture secondary to tumor that was performed at the same time. One patient died of metastatic disease during treatment. The ovarian hormonal levels (FSH and LH) were normal in two patients. One has had normal menstrual period and other had amenorrhoea after 4?months follow-up however her ovarian hormonal level were within normal limits. Conclusions Laparoscopic ovarian transposition before pelvic radiation in advanced rectal cancer treatment is an effective and feasible way of preservation of ovarian function in young patients at risk of radiotherapy induced ovarian failure. However, this procedure is still under used and it is advisable to discuss and propose it to suitable patients.
Endovaginal Ultrasonography: Methodology and Normal Pelvic Floor Anatomy
\\u000a High-resolution three-dimensional endovaginal ultrasonography (EVUS) provides a detailed evaluation of the pelvic floor muscles\\u000a and the levator ani complex, the lower urinary tract, and the anorectal region in planes that cannot be determined by conventional\\u000a two-dimensional EVUS. Multiplanar reconstruction and rendering techniques allow the investigator to correctly recognize and\\u000a measure specific anatomic elements of the pelvic floor and to understand
Giulio Aniello Santoro; Andrzej Pawe? Wieczorek; S. Abbas Shobeiri; Aleksandra Stankiewicz
Total laparoscopic radical hysterectomy and pelvic lymphadenectomy in locally advanced stage IB2-IIB cervical cancer patients after neoadjuvant chemotherapy
ObjectiveTo evaluate the feasibility and morbidity of total laparoscopic class C2 radical hysterectomy (TLRH) with pelvic lymphadenectomy in patients with locally advanced cervical cancer stage IB2 to IIB after neoadjuvant chemotherapy (NACT).
E. Vizza; A. Pellegrino; R. Milani; R. Fruscio; E. Baiocco; F. Cognetti; A. Savarese; F. Tomao; C. Chen; G. Corrado
Laparoscopic Removal of Mesh Used in Pelvic Floor Surgery
Various meshes are being used widely in clinical practice for pelvic reconstructive surgery despite the lack of evidence of their long-term safety and efficacy. Management of complications such as mesh erosion and dysparuenia can be challenging. Most mesh-related complications can probably be managed successfully via the transvaginal route; however, this may be impossible if surgical access is poor. This case
Su-Yen Khong; Alan Lam
Novel hybrid laparoscopic sacrocolpopexy for pelvic organ prolapse with a severe paravaginal defect.
Abdominal sacrocolpopexy is the gold standard for treating pelvic organ prolapse (POP) because of safety and durable good results. More recently laparoscopic sacrocolpopexy (LSC), a less invasive approach, has become popular. Although these surgeries are versatile and can treat almost all patients with POP, these techniques have shortcomings. Specifically, reinforcement of lateral vaginal defects are not very strong, thus patients with POP and a severe paravaginal defect are not good candidates for abdominal or laparoscopic sacrocolpopexy. To overcome this problem, we developed a novel type of LSC, which can reinforce severe paravaginal defects by using a reversed T-shaped anterior mesh combining the advantage of transvaginal mesh surgery. We refer to this novel surgery as 'hybrid LSC'. Thus far, eight patients have successfully undergone this surgery. Hybrid LSC is a simple and secure method, and is an alternative treatment for POP with a severe paravaginal defect. PMID:23002783
Ichikawa, Masao; Akira, Shigeo; Mine, Katsuya; Ohuchi, Nozomi; Kurose, Keisuke; Takeshita, Toshiyuki
Sentinel lymph node procedure followed by laparoscopic pelvic and paraaortic lymphadenectomy in women with IB2-II cervical cancer
Objective��To evaluate the contribution of the sentinel node (SN) procedure followed by pelvic and paraaortic lymphadenectomy to determine\\u000a lymph node status in women with locally advanced cervical cancer.\\u000a \\u000a \\u000a \\u000a Patients and methods��A total of 21 women with locally advanced cervical cancer underwent a first laparoscopic SN procedure and pelvic and paraaortic\\u000a lymphadenectomy followed by concurrent chemoradiotherapy (CCR). Laparoscopic radical hysterectomy was
Vincent Lavou�; Anne-Sophie Bats; Roman Rouzier; Charles Coutant; Emmanuel Barranger; Emile Dara�
Laparoscopic implantation of neural electrodes on pelvic nerves: an experimental study on the obturator nerve in a chronic minipig model
Background��Laparoscopic exposure of pelvic nerves has opened a new area in the field of neuromodulation. However, electrode design and\\u000a material deterioration remain issues that limit clinical application. The objective of this study was to evaluate experimentally\\u000a the laparoscopic implantation of different types of neural electrodes in order to achieve functional and selective electrical\\u000a stimulation of pelvic nerves.\\u000a \\u000a \\u000a \\u000a \\u000a Methods��This was a
Demetrio Larra�n; Pierre Rabischong; Revaz Botchorishvili; Georges Fraisse; Stephane Gallego; Philippe Gaydier; Jean Michel Chardigny; Paul Avan
Technique and outcomes about a new laparoscopic procedure: the Pelvic Organ Prolapse Suspension (POPS).
Pelvic organ prolapse suspension (POPS) is a recent surgical procedure for one-stage treatment of multiorgan female pelvic prolapse. This study evaluates the preliminary results of laparoscopic POPS in 54 women with a mean age of 55.2 and a BMI of 28.3. Patients underwent at the same time stapled transanal rectal resection (STARR) to correct the residual rectal prolapse. We had no relapses and the preliminary results were excellent. We evaluated the patients after 1 year follow-up and we confirmed the validity of our treatment. The technique is simpler than traditional treatments with an important reduction or completely disappearance of the pre-operative symptomatology. PMID:23837949
Ceci, F; Spaziani, E; Corelli, S; Casciaro, G; Martellucci, A; Costantino, A; Napoleoni, A; Cipriani, B; Nicodemi, S; Di Grazia, C; Avallone, M; Orsini, S; Tudisco, A; Aiuti, F; Stagnitti, F
Laparoscopic transperitoneal gonadal vein ligation for treatment of pelvic congestion secondary to Nutcracker syndrome: a case report.
Nutcracker syndrome is the term used to describe the patient with clinical symptoms of entrapment of the left renal vein between the aorta and the superior mesenteric artery. Pelvic congestion syndrome, which is a cause of chronic pelvic pain in women, may be due to Nutcracker syndrome. There are many modalities of treatment for Nutcracker syndrome. This is a case report of a 32-year old woman with pelvic congestion syndrome due to Nutcracker syndrome, who subsequently underwent laparoscopic transperitoneal left gonadal vein ligation. She has had complete remission of pain in 4 months after the operation and after 12 months of follow-up. Laparoscopic transperitoneal gonadal vein ligation is an approach that is safe, simple and provides good results for patient with pelvic congestion syndrome secondary to Nutcracker syndrome. PMID:23513481
Viriyaroj, Vichit; Akranurakkul, Prinya; Muyphuag, Bunlung; Kitporntheranunt, Maethaphan
Muscle architecture and functional anatomy of the pelvic limb of the ostrich (Struthio camelus).
The functional anatomy of the pelvic limb of the ostrich (Struthio camelus) was investigated in order to assess musculoskeletal specialization related to locomotor performance. The pelvic limbs of ten ostriches were dissected and detailed measurements of all muscle tendon units of the pelvic limb were made, including muscle mass, muscle length, fascicle length, pennation angle, tendon mass and tendon length. From these measurements other muscle properties such as muscle volume, physiological cross-sectional area (PCSA), tendon cross-sectional area, maximum isometric muscle force and tendon stress were derived, using standard relationships and published muscle data. Larger muscles tended to be located more proximally and had longer fascicle lengths and lower pennation angles. This led to an expected proximal to distal reduction in total muscle mass. An exception to this trend was the gastrocnemius muscle, which was found to have the largest volume and PCSA and also had the highest capacity for both force and power production. Generally high-power muscles were located more proximally in the limb, while some small distal muscles (tibialis cranialis and flexor perforatus digiti III), with short fibres, were found to have very high force generation capacities. The greatest proportion of pelvic muscle volume was for the hip extensors, while the highest capacity for force generation was observed in the extensors of the ankle, many of which were also in series with long tendons and thus were functionally suited to elastic energy storage. PMID:17118064
Smith, N C; Wilson, A M; Jespers, K J; Payne, R C
Concomitant Laparoscopic Surgery and Hysteroscopic Endometrial Ablation for Women with Chronic Pelvic Pain and Menorrhagia
From September 1993 to July 1995, 63 women (mean age 38 yrs, range 26-53 yrs, parity 0-7) with chronic pelvic pain (CPP) and menorrhagia underwent outpatient laparoscopic surgery and endometrial ablation. Operating time ranged from 9 to 110 minutes (mean 52 min). Laparoscopic procedures included excision of endometriosis (26), adhesiolysis (17), electromyolysis (4), uterine suspension (6), and appendectomy (4). At 6 to 20 months' follow-up 63 women reported no pain (24, 38.1%), significant improvement of pain (25, 39.7%), no change in amount of pain (9, 14.3%), and an increase of pain (5, 7.9%). Six patients had repeat laparoscopy. After hysteroscopic endometrial rollerball ablation and resection, the same women reported amenorrhea (31, 49.2%), hypomenorrhea (26, 41.3%), eumenorrhea (3, 4.8%), and no change in menstrual bleeding (3, 4.8%). Two women had a repeat endometrial ablation and one had hysterectomy for menorrhagia and CPP. Concomitant laparoscopic surgery and endometrial ablation is an effective alternative to hysterectomy for women with CPP and menorrhagia. PMID:9074259
Vilos; Drossos; Vilos
Comparative study of laparoscopic pyelolithotomy versus percutaneous nephrolithotomy in the management of large renal pelvic stones
Background The aim of the study is to investigate whether laparoscopic pyelolithotomy (LPL) could be used to manage large renal pelvic stones, generally considered excellent indications for percutaneous nephrolithotomy (PNL). Methods: This study was performed from May 2009 to March 2012 at Al-Azhar University Hospitals (Assiut and Cairo), Egypt. It included two groups of patients with large renal pelvic stones; only patients with stones 2.5 cm2 or greater were included. Group 1 included 40 patients treated by PNL and Group 2 included 10 patients treated by LPL. The differences between the two procedures were compared and analyzed. Results: There was no difference between the two groups regarding patient demographics and stone size. There was a statistically significant difference between the groups regarding mean estimated blood loss (65 � 12.25 [range: 52.75�77.25] vs. 180 � 20.74 [range: 159.26�200.74] mL, p ? 0001), mean hospital stay (2.3 � 0.64 [range: 1.66�2.94] vs. 3.7 � 1.4 [range: 2.3�5.1] days, p ? 0.006), rate of postoperative blood transfusion (0% vs. 4.8%, p ? 0.0024), and stone-free rate (80% vs. 78.6%, p ? 0.23). The mean operative time was significantly longer in Group 2 (LPL) (131 � 22.11 [range: 108.89�153.11) vs. 51.19 � 24.39 [range: 26.8�75.58] min, p ? 0001), respectively. Conclusion: Although PNL is the standard treatment in most cases of renal pelvic stones, LPL is another feasible surgical technique for patients with large renal pelvic stones.
Haggag, Yasser M.; Morsy, Gamal; Badr, Magdy M.; Al Emam, Abdel Baset A.; Farid, Mourad; Etafy, Mohamed
Dissecting the pelvic retroperitoneum and identifying the ureters. A laparoscopic technique.
A technique for dissecting the pelvic retroperitoneum and identifying the ureters and uterine arteries is described that makes use of the obliterated hypogastric arteries. The obliterated arteries are readily identified laparoscopically and, as relatively fixed structures, are easily dissected free of the bladder and surrounding areolar tissues. Once freed by blunt dissection, they are traced proximally to where they are joined by the uterine arteries to form the internal iliac arteries. Blunt dissection just proximal and medial to the uterine artery will open the pararectal space, the medial border of which is bounded by the ureter. The uterine arteries are then traced to where they cross the ureters and are freed from them by blunt dissection. The site at which the uterine arteries are divided and the extent to which the extraperitoneal spaces are developed and ureters mobilized off the medial leaf of the broad ligament are tailored to the operation performed. PMID:7738920
Kadar, N
[CT and MR imaging anatomy of the fascia in the pelvic extraperitoneal space].
CT and MRI anatomy of the fascia in the pelvic extraperitoneal space has not been established. CT and some MR imagings of nine patients who received irradiation to the pelvis and of eleven patients who received transarterial infusion for urinary bladder carcinoma were studied about the anterior and posterior attachment sites of the coccygeus muscle, the sacrouterine ligament and the lateral ligament. Observing the course of the inferior gluteal artery, the author set up three axial levels; (a), (b) and (c) levels, where the artery passes in front of the piriformis muscle, just gets over the coccygeus muscle and over the sacrospinous ligament, respectively. At (b) and (c) levels, the posterior attachment site of the sacrouterine ligament was the coccygeus muscle and the posterior attachment site of the lateral ligament was the sacrouterine ligament. By these ligaments, the pelvic extraperitoneal space was divided into three compartments; the prevesical, the perivesical and the perirectal spaces. The prevesical space was limited by the coccygeus muscle and the sacrouterine ligament posteriorly, the perivesical space was limited by the sacrouterine ligament and the lateral ligament posteriorly, and the perirectal space was surrounded by the sacrouterine ligament and the coccygeus muscle. On the coronal image through the level slightly posterior to the anus, the sacrouterine ligament attached to the levator ani muscle at a lateral third like a screen. On the basis of these results, new axial and coronal models of the pelvis extraperitoneal space are presented, which are useful for understanding the location and spread of the lesion. PMID:8327323
Nagayoshi, K
Laparoscopic nerve-sparing transperitoneal approach for endometriosis infiltrating the pelvic wall and somatic nerves: anatomical considerations and surgical technique
Purpose��Endometriotic or fibrotic involvement of sacral plexus and pudendal and sciatic nerves may be quite frequently the endopelvic\\u000a cause of ano-genital and pelvic pain. Feasibility of a laparoscopic transperitoneal approach to the somatic nerves of the\\u000a pelvis was determined and showed by Possover et al. for diagnosis and treatment of ano-genital pain caused by pudendal and\\/or\\u000a sacral nerve roots lesions
Marcello Ceccaroni; Roberto Clarizia; Carlo Alboni; Giacomo Ruffo; Francesco Bruni; Giovanni Roviglione; Marco Scioscia; Inge Peters; Giuseppe De Placido; Luca Minelli
Deep pelvic endometriosis: don't forget round ligaments. Review of anatomy, clinical characteristics, and MR imaging features.
Deep infiltrating endometriosis is an important gynecologic disease that may develop during the reproductive years and is responsible for severe pelvic pain. Deep pelvic endometriosis can affect the retrocervical region, uterosacral ligament, rectum, rectovaginal septum, vagina, urinary tract, and other extraperitoneal pelvic sites. Surgery remains the best therapeutic treatment for affected patients and an accurate preoperative evaluation of the extension of endometriotic lesions is essential for a successful outcome. However, many atypical locations for deep pelvic endometriosis exist although still lesser known to both gynecologists and radiologists such as endometriosis of the round ligaments of the uterus (RLUs). In this article, we review embryology and anatomy of the RLUs as well clinical characteristics associated with these endometriotic locations. In addition, we describe magnetic resonance (MR) imaging protocol, normal MR imaging appearances of the RLUs and the most common abnormal findings of endometriotic involvement of these ligaments at MR imaging. Radiologists should always keep in mind the RLUs as a possible site of deep pelvic endometriosis localization and should not forget to carefully look for them on MR images. PMID:24557639
Gui, Benedetta; Valentini, Anna Lia; Ninivaggi, Valeria; Marino, Marzia; Iacobucci, Marta; Bonomo, Lorenzo
Laparoscopic Davydov correction of a failed gracilis flap neovagina in a patient with Mayer-Rokitansky-Kuster-Hauser syndrome with a pelvic kidney.
The laparoscopic Davydov procedure is a surgical technique for creation of a neovagina in patients with Mayer-Rokitansky-Kuster-Hauser syndrome (MRKH) or vaginal agenesis. Herein we report its use in creating a neovagina after failure of a previous surgical attempt in a patient with a pelvic kidney, which has not been described to date. The patient, a 28-year-old woman with MRKH in whom creation of a neovagina using bilateral gracilis flaps had been attempted, was unable to have intercourse because of a shortened and scarred vagina. We successfully used the laparoscopic Davydov procedure to create a functional neovagina despite the previous surgery and the presence of a pelvic kidney. The Davydov procedure is an option for use in patients with MRKH with history of unsuccessful neovaginal surgery and can be performed in the presence of a pelvic kidney. PMID:23465266
Moriarty, Christopher R; Miklos, John R; Moore, Robert D
Surface anatomy of the inferior epigastric artery in relation to laparoscopic injury.
The inferior epigastric artery (IEA) is at risk of injury in laparoscopic surgery. Current descriptions of the course of the IEA do not provide surface landmarks useful to the surgeon. This study aimed to define surface relations and propose guidelines for safer trocar placement. The posterior surfaces of the anterior abdominal walls of 30 preserved cadavers were dissected. The surface anatomy of 60 IEAs and their branches were defined. At the level of the anterior superior iliac spine (ASIS), the IEA is 38% +/- 18% (95% confidence interval [CI]) from the midline to the ASIS. At the mid-inguinal point the relation is 40% +/- 17% and at the umbilicus 40% +/- 22%. The pattern of branches is highly variable. Although giving guidelines for trocar insertion can be treacherous, we found the following to be of value: 1) the midline is avascular; 2) the main stem of the IEA will be avoided if trocars are inserted more than two-thirds of the distance along a horizontal line between the midline and the ASIS; and 3) IEA branches are least frequently found in the lowest part of the abdomen lateral to the artery. PMID:15176037
Epstein, J; Arora, A; Ellis, H
Surgical anatomy of the common iliac veins during para-aortic and pelvic lymphadenectomy for gynecologic cancer
Objective Compression of the left common iliac vein between the right common iliac artery and the vertebrae is known to be associated with the occurrence of left iliofemoral deep vein thrombosis (DVT). In this study, we described the variability in vascular anatomy of the common iliac veins and evaluated the relationship between the degree of iliac vein compression and the presence of DVT using the data from surgeries for gynecologic cancer. Methods The anatomical variations and the degrees of iliac vein compression were determined in 119 patients who underwent systematic para-aortic and pelvic lymphadenectomy during surgery for primary gynecologic cancer. Their medical records were reviewed with respect to patient-, disease-, and surgery-related data. Results The degrees of common iliac vein compression were classified into three grades: grade A (n=28, 23.5%), with a calculated percentage of 0%-25% compression; grade B (n=47, 39.5%), with a calculated percentage of 26%-50% compression; and grade C (n=44, 37%), with a calculated percentage of more than 50% compression. Seven patients (5.9%) had common iliac veins with anomalous anatomies; three were divided into small caliber vessels, two with a flattened structure, and two had double inferior vena cavae. The presence of DVT was associated with the elevated D-dimer levels but not with the degree of iliac vein compression in this series. Conclusion Although severe compression of the common iliac veins was frequently observed, the degree of compression might not be associated with DVT in surgical patients with gynecologic cancer. Anomalous anatomies of common iliac veins should be considered during systematic para-aortic and pelvic lymphadenectomy in the gynecologic cancer patients.
Tate, Shinichi; Nishikimi, Kyoko; Shozu, Makio
Laparoscopic diagnosis and treatment of pelvic benign multicystic mesothelioma associated with high CA19.9 serum concentration.
We report a case of benign multicystic mesothelioma in a 20-year-old woman referred because of amenorrhea. She underwent pelvic transabdominal ultrasound, which disclosed a micropolycystic appearance of the ovaries and a fluid collection in the pouch of Douglas. Tumor serum markers revealed an increase in CA19.9. Abdominal and pelvic computed tomography scans confirmed the presence of ascites. Laparoscopy disclosed small, thin-walled, translucent cysts in the Douglas cavity. The cysts were free-floating in a yellowish, sticky, gelatinous material. Microscopically, cystic lesions showed mesothelium-lined cystic spaces surrounded by a delicate thin fibrovascular wall. With immunohistochemistry, the tumor cells were strongly positive for cytokeratin and calretinin. These aspects were suggestive of benign multicystic mesothelioma. Electron microscopy confirmed the mesothelial nature of this tumor. Serial evaluation of the CA19.9 concentration showed a progressive decrease in the serum marker in the normal range. The patient is now well and symptom-free with no recurrence 24 months after surgery. The association between benign multicystic mesothelioma and increased CA19.9 serum concentration has been described only once, in a man. To our knowledge, this is the second case of benign multicystic mesothelioma associated with increased CA19.9 serum concentration and the first diagnosed in a woman. In the present case, a minimally invasive laparoscopic approach enabled not only histologic diagnosis of benign multicystic mesothelioma but also its surgical treatment. Although benign multicystic mesothelioma is a rare pathologic entity, it is important that sonologists include it in the differential diagnosis of diseases that manifest with ascites. Furthermore, all surgeons should be aware of the macroscopic and laparoscopic appearance of the lesion, and its generally benign course. PMID:20226419
Pinto, Vincenzo; Rossi, Angela Cristina; Fiore, Maria Grazia; D'Addario, Vincenzo; Cicinelli, Ettore
Laparoscopic ileal pouch�anal anastomosis reduces abdominal and pelvic adhesions
Background��Postoperative adhesions are an expected outcome for the majority of open abdominal operations, occurring in more than 90%\\u000a of cases. Adhesions are responsible for more than 75% of small bowel obstruction cases. This study aimed to evaluate adhesions\\u000a to the anterior abdominal wall and adnexal organs after laparoscopic ileal-pouch anal anastomosis (IPAA).\\u000a \\u000a \\u000a \\u000a Methods��Patients who underwent laparoscopic IPAA for ulcerative colitis
Adrian A. Indar; Jonathan E. Efron; Tonia M. Young-Fadok
Modeling the Anatomy and Function of the Pelvic Diaphragm and Perineal Body Using a 'String Model'
NSDL National Science Digital Library
This article describes a simple yet effective and innovative model used to illustrate the anatomical arrangement of the perineal muscles and help explain the function of the pelvic diaphragm and perineal body. The model is called the "string model" because strings were used in place of the perineal muscles during the demonstration.
Satheesha Nayak (Melaka Manipal Medical College Manipal Campus); David W Rodenbaugh (Minnesota State University-Moorhead)
Laparoscopic surgery in endometriosis.
Endometriosis (the presence of endometrial glands and stroma outside of the uterine cavity) is a common gynecologic problem affecting 10% of women in the general population, 40% of women with infertility and 60% of women with chronic pelvic pain. Laparoscopy has revolutionized management of women with endometriosis. Diagnosis of endometriosis depends on visualization of endometriotic lesions and histologic confirmation. Endometriotic implants have a multitude of appearances: powder burns, red, blue-black, yellow, white, clear vesicular and peritoneal windows. Diagnostic laparoscopy is often combined with operative procedures to treat manifestations and symptoms of endometriosis. This often includes removal or laser vaporization of endometriotic implants, lysis of adhesions, restoration of normal anatomy and removal or fulguration of ovarian endometriomas (conservative surgery). Severe incapacitating endometriosis, recurrent endometriosis following conservative surgery and symptomatic endometriosis in women not desiring more children is often treated by laparoscopic unilateral or bilateral salpingo-oophorectomy or laparoscopically-assisted vaginal hysterectomy with bilateral salpingo-oophorectomy (radical surgery). Endometriosis affecting the appendix, ureters, bladder wall and rectosigmoid colon could be treated with laparoscopic appendectomy, excision of endometriotic implants or laparoscopic colectomy and anastomosis, respectively. Hydrodis-section and use of CO2 super pulsed laser aid in removal of adherent endometriotic implants without damage to normal underlying structures. Robotic-assisted laparoscopic surgery promises to provide advantages in the management of women with severe endometriosis secondary to 3-dimensional visualization, decreasing surgeon's fatigue and hand tremors and improving surgical precision. PMID:18560348
Eltabbakh, G H; Bower, N A
Laparoscopic Peritoneal Drainage of Symptomatic Lymphoceles after Pelvic Lymph Node Dissection Using Methylene Blue Instillation
Background: Lymphoceles are frequent complications of pelvic lymph node dissection. While small lymphoceles often remain undetected, larger ones can cause complications and require further treatment, e.g. percutaneous tube drainage alone or in combination with sclerotherapy. However, recurrence rates are considerable, and long-lasting drainage may lead to infection, prolonged hospitalization, and as a consequence, increased overall costs. We report the results
Zoltan Varga; Axel Hegele; Peter Olbert; Rainer Hofmann; Andres Jan Schrader
Laparoscopic removal of intravesical mesh following pelvic organ prolapse mesh surgery
With the increasing popularity of mesh in prolapse surgery, complications such as intravesical mesh will arise more frequently.\\u000a In three cases intravesical mesh was identified in the trigone of the bladder following laparoscopic mesh hysteropexy, open\\u000a sacral colpopexy, and transvaginal mesh repair and presented 9�months to 7�years later with a variety of symptoms including\\u000a recurrent urinary tract infections, suprapubic pain,
Christopher Maher; Benjamin Feiner
Laparoscopic nephroureterectomy for adult incontinence caused by functioning ectopic pelvic kidney draining into vagina.
A 29-year-old woman had been continent of the majority of her urine for her entire life but had constant, uncontrollable dribbling. A contrast CT scan showed a solitary functioning left kidney and a dysplastic right pelvic kidney with a tortuous dilated ureter running close to the vaginal vault. The kidney was removed whole at transperitoneal laparoscopy, rendering the patient continent. This is the first such case reported in an adult. PMID:15253815
Challacombe, Ben; Kelleher, Con; Sami, Tariq; Scott, Helena; Chandra, Ashish; O'Brien, Tim; Dasgupta, Prokar
Laparoscopic uterine anastomosis for traumatic separation of the cervix from the uterine corpus caused by closed pelvic fracture: case report and literature review.
Primary amenorrhea caused by separation of the cervix from the uterine body resulting from pelvic trauma is exceptionally rare. This case report describes the diagnosis and successful laparoscopic approximation of traumatic separation of the cervix from the uterine corpus. A 16-year-old girl who was involved in a car accident at age 2 years had primary amenorrhea and cyclic abdominal pain. A closed pelvic fracture was managed nonsurgically, with an uneventful recovery. Since age 13 years, the patient has been experiencing cyclic abdominal pain. Ultrasonography suggested a 5-cm left adnexal mass. Diagnostic laparoscopy revealed complete separation of the uterine corpus from the cervix, and an endometrioma in the left ovary. The uterine corpus was approximated to the cervix with circumferentially placed sutures under direct laparoscopic guidance. The endometrioma was resected concomitantly. Normal cyclic menstruation resumed 2 months postoperatively, without cyclic abdominal pain. This case report demonstrates successful laparoscopic approximation of traumatic separation of the uterine corpus from the cervix, manifested as primary amenorrhea. PMID:23465261
Zhang, Huan Xiao; Chen, Shu Qin; Jiang, Hong Ye; Yao, Shu Zhong
Laparoscopic para-aortic and pelvic lymphadenectomy and radical hysterectomy in a patient with cervical cancer, six months after primary chemoradiation.
Treatment of Stage IB-IIA cervical carcinoma is controversial. The choice to perform surgery or chemoradiation depends on the FIGO Stage, which does not include evaluation of lymph node involvement, although the prognosis of the patients depends on this evaluation. There is no method however, to safely evaluate preoperative lymph nodes metastasis, as both magnetic resonance imaging (MRI) and computed tomography (CT) have poor sensitivity and high specificity. As a result, inaccurate preoperative lymph node assessment can lead to suboptimal treatment. The authors report the case of a 42-year-old patient with cervical cancer Stage IB2, who was primary treated with chemoradiation. Although at the time of diagnosis no lymph node metastasis was detected, six months after treatment, an enlarged five-cm lymph node was found in the area of left iliac vein. The patient underwent laparoscopic pelvic and para-aortic lymphadenectomy and nerve sparing radical hysterectomy. Pathologic examination revealed one positive lymph node out of the 41 removed and no cancer cells in the uteral structures. There are cases of cervical cancer in which chemoradiation seems to be insufficient. Laparoscopic nerve-sparing radical hysterectomy can be the treatment in patients with lymph node metastasis after primary chemoradiation. It offers oncological safety combining the advantages of laparoscopy and the nerve-sparing technique. Furthermore, adjuvant chemotherapy or radiation can be initiated immediately, offering the best therapeutical choice in the authors' opinion. PMID:24475590
Zygouris, D; Kotsopoulos, I C; Chalvatzas, N; Maltaris, T; Kartsiounis, V; Kavallaris, A
Laparoscopic Diagnosis and Treatment of Pelvic Benign Multicystic Mesothelioma Associated with High CA19.9 Serum Concentration
We report a case of benign multicystic mesothelioma in a 20-year-old woman referred because of amenorrhea. She underwent pelvic transabdominal ultrasound, which disclosed a micropolycystic appearance of the ovaries and a fluid collection in the pouch of Douglas. Tumor serum markers revealed an increase in CA19.9. Abdominal and pelvic computed tomography scans confirmed the presence of ascites. Laparoscopy disclosed small,
Vincenzo Pinto; Angela Cristina Rossi; Maria Grazia Fiore; Vincenzo D'Addario; Ettore Cicinelli
Pelvic congestion syndrome and pelvic varicosities.
Pelvic venous insufficiency (PVI), defined as retrograde flow in the gonadal and internal iliac veins, is the underlying cause of pelvic congestion syndrome (PCS), a common cause of disabling chronic pelvic pain in women of child-bearing age. PCS is a chronic pain syndrome characterized by positional pelvic pain that is worse in the upright position and is associated with pelvic and vulvar varicosities as well as symptoms of dyspareunia and postcoital pain. Through collaterals to the lower extremity venous system, PVI may also contribute to varicose vein formation and recurrence in the lower extremities. Endovascular embolization of the ovarian and internal iliac veins has become the treatment of choice for PVI and PCS. This article reviews the pelvic retroperitoneal venous anatomy, pathophysiology of PCS, treatment options and techniques, and clinical outcomes of embolotherapy for PCS. PMID:24840963
Koo, Sonya; Fan, Chieh-Min
Laparoscopic hysterectomy with or without pelvic lymphadenectomy or sampling in a high-risk series of patients with endometrial cancer
Background The purpose of the study was to determine the outcome of all patients with endometrial adenocarcinoma cancer treated by laparoscopic hysterectomy at our institution, many of whom were high-risk for surgery. Methods Data was collected by a retrospective search of the case notes and Electronic Patient Records of the thirty eight patients who underwent laparoscopic hysterectomy for endometrial cancer at our institutions. Results The median body mass index was 30 (range 19�67). Comorbidities were present in 76% (29 patients); 40% (15 patients) had a single comorbid condition, whilst 18% (7 patients) had two, and a further 18% (7 patients) had more than two. Lymphadenectomy was performed in 45% (17 patients), and lymph node sampling in 21% (8 patients). Median operating time was 210 minutes (range 70�360 minutes). Median estimated blood loss was 200 ml (range 50�1000 ml). There were no intraoperative complications. Post-operative complications were seen in 21% (2 major, 6 minor). Blood transfusion was required in 5% (2 patients). The median stay was 4 post-operative nights (range 1�25 nights). In those patients undergoing lymphadenectomy, the mean number of nodes taken was fifteen (range 8�26 nodes). The pathological staging was FIGO stage I 76% (29 patients), stage II 8% (3 patients), stage III 16% (6 patients). The pathological grade was G1 31% (16 patients), G2 45% (17 patients), G3 24% (8 patients). Conclusion Laparoscopic hysterectomy can be safely carried out in patients at high risk for surgery, with no compromise in terms of outcomes, whilst providing all the benefits inherent in minimal access surgery.
Willis, Susan F; Barton, Desmond; Ind, Thomas EJ
The complexity of pelvic anatomy and the extent of tumor growth makes treatment of patients with primary bone sarcomas in the pelvis difficult in terms of local control. Before the 1970s, most tumors in the bony pelvis were surgically treated with hindquarter amputation. Currently, improved techniques for clinical staging, adjuvant treatments, evolutions in metallurgy, and development of new surgical techniques make limb-salvage surgery and reconstruction possible alternatives to hemipelvectomy and resection-arthrodesis. The advantages of amputation over resections at the pelvis are a lower incidence of complications, a limited area at risk for recurrence, and a faster recovery time compared with all but the most limited pelvic resections. The disadvantages, especially after periacetabular resections, are leg-length discrepancy and impaired hip and gait function. The indication for limb salvage is the ability to obtain wide margins without compromising survival and function. Although having to resect the sciatic nerve to obtain adequate margins does not always mean that an amputation should be performed, the combination of a major pelvic resection and the functional consequences of sciatic nerve resection results in an extremity usually not worth saving; loss of femoral nerve function does not result in a significant gait disturbance, especially if the hemipelvis is stable. Reconstruction options after major pelvic resections have also evolved, but they remain difficult, especially when the acetabulum is involved. PMID:22310412
Mavrogenis, Andreas F; Soultanis, Konstantinos; Patapis, Pavlos; Guerra, Giovanni; Fabbri, Nicola; Ruggieri, Pietro; Papagelopoulos, Panayiotis J
Pelvic and acetabular fractures
This treatise focuses primarily on the clinical aspects of diagnosis and treatments of pelvic and acetabular fractures. However, considerable attention is also paid to the radiographic diagnosis of trauma and postoperative effects. The book begins with a succinct review of pelvic and acetabular anatomy and pelvic biomechanics. It continues with a radiographic classification of pelvic injury, which will represent the major source of the book's interest for radiologists. The remainder of the book is concerned with clinical management of pelvic and acetabular trauma, including preoperative planning, surgical approaches, techniques of reduction, internal fixation, eternal fixation, post-operative care, and late problems. Even throughout this later portion of the book there are extensive illustrations, including plain radiographs, computed tomographic (CT) scans, reconstructed three-dimensional CT scans, and schematic diagrams of diverse pelvic and acetabular fractures and the elementary surgical techniques for their repair.
Mears, D.C.; Rubash, H.E.
Early Introduction to the Pelvic Examination: An Anatomical Approach.
ERIC Educational Resources Information Center
The use of a special cadaver is discussed that could be used during the first-year gross anatomy course to supplement the usual dissection of pelvic viscera. Pelvic anatomy is emphasized from the perineal approach as used in a typical pelvic exam. (MLW)
And Others; Munger, Bryce L.
Robotics for Pelvic Reconstruction
Robotic-assisted laparoscopy is increasingly used in female pelvic reconstructive surgery to combine the benefits of abdominally placed mesh for prolapse outcomes with the quicker recovery time associated with minimally invasive procedures. Level III data suggest that early outcomes of robotic sacrocolpopexy are similar to those of open sacrocolpopexy. A single randomized trial has provided level I evidence that robotic and laparoscopic approaches to sacrocolpopexy have similar short-term anatomic outcomes, although operating times, postoperative pain, and cost are increased with robotics. Patient satisfaction and long-term outcomes of both robotic and laparoscopic sacrocolpopexy are insufficiently studied despite their widespread use in the treatment of prolapse. Given the high reoperative rates for prolapse repairs, long-term follow-up is essential, and well-designed comparative effectiveness research is needed to evaluate pelvic floor surgery adequately.
Ramm, Olga; Kenton, Kimberly
Learning curve for laparoscopic totally extraperitoneal repair of inguinal hernia
Background Laparoscopic totally extraperitoneal (TEP) repair has been accepted as a popular procedure for inguinal hernia repair, but surgeons still encounter technical difficulties owing to unfamiliar pelvic anatomy and limited working space. We sought to estimate the learning curve for laparoscopic TEP repair without supervision. Methods We retrospectively analyzed the medical records of patients scheduled for laparoscopic TEP repair of an inguinal hernia from December 2000 to October 2007. Results We reviewed medical records for 700 patients. The cases were divided into 8 groups: 20 patients each in groups I�V and 200 patients each in groups VI�VIII. No significant difference in demographic characteristics was identified among the groups. The mean duration of surgery significantly decreased (p < 0.001) in relation to experience; it reached a plateau of less than 30 minutes (mean 28 min) after 60 cases. The mean length of stay in hospital was 0.97 days, reaching a plateau after 20 cases. Six patients were converted to other techniques: 1 patient each in groups III and VIII and 4 patients in group VII. Three recurrences were detected; however, 2 were excluded because the patient had bilateral inguinal hernias. Conclusion We estimate the learning curve for laparoscopic TEP repair is 60 cases for a beginner surgeon. The presence of an experienced supervisor during the first 60 cases can help prevent unnecessary complications and shorten the duration of surgery.
Choi, Yoon Young; Kim, Zisun; Hur, Kyung Yul
Laparoscopic Hernia Repair - Complications
Laparoscopic hernioplasty is a technique which can present a number of specific complications. This paper reviews the complications that can occur during laparoscopic hernia repair and ways to avoid them; it also describes the surgical technique used successfully in over 1000 cases. Initial experience suggests that complications can be avoided with adequate knowledge, attention to surgical anatomy and the proper technique of laparoscopic hernioplasty. Early recurrences are rare and invariably result from inadequate surgical technique. Inadequate fixation of the mesh, inadequate mesh size, and failure to cover unidentified wall defects (hernias which have never been repaired), are the main causes of early recurrence of hernia. Experience, knowledge of complications and how to avoid them, adequate training and attention to the anatomy of the inguinal region are the most important factors in correcting inguinal hernia successfully by laparoscopy.
Reusch, Marcus; daRosa, Andre L. M.; Carlos, Jose Roberto B.
Is laparoscopic intraoperative cholangiogram a matter of routine?
Background: Intraoperative cholangiography during laparoscopic cholecystectomy reveals the anatomy of the biliary tree and any stones contained within it. The use of intraoperative cholangiography may be routine for all laparoscopic cholecystectomy. An alternative approach is a selective policy, performing intraoperative cholangiography only for those cases in which choledocholithiasis is suspected on clinical grounds, or those for which the anatomy appears
Matthew S. Metcalfe; M. B. B. Chir; Thao Ong; Martin H. Bruening; Harish Iswariah; Simon A. Wemyss-Holden; Guy J. Maddern
Is laparoscopic intraoperative cholangiogram a matter of routine?
BackgroundIntraoperative cholangiography during laparoscopic cholecystectomy reveals the anatomy of the biliary tree and any stones contained within it. The use of intraoperative cholangiography may be routine for all laparoscopic cholecystectomy. An alternative approach is a selective policy, performing intraoperative cholangiography only for those cases in which choledocholithiasis is suspected on clinical grounds, or those for which the anatomy appears unclear
Matthew S Metcalfe; Thao Ong; Martin H Bruening; Harish Iswariah; Simon A Wemyss-Holden; Guy J Maddern
Laparoscopic rectocele repair using polyglactin mesh
We assessed the efficacy of laparoscopic treatment of rectocele defect using a polyglactin mesh graft. From May 1, 1995, through September 30, 1995, we prospectively evaluated 20 women (age 38�74 yrs) undergoing pelvic floor reconstruction for symptomatic pelvic floor prolapse, with or without hysterectomy. Morbidity of the procedure was extremely low compared with standard transvaginal and transrectal approaches. Patients were
Thomas L. Lyons; Wendy K. Winer
... ACOG practice bulletin no. 51. Chronic pelvic pain. Obstetrics & Gynecology, 103 ,589�605. [top] UCSF Medical Center. ( ... profile of women with chronic pelvic pain. Clinical Obstetrics and Gynecology, 33 ,130�136 [top] What are ...
Preoperative assessment of vascular anatomy of inferior mesenteric artery by volume-rendered 3D-CT for laparoscopic lymph node dissection with left colic artery preservation in lower sigmoid and rectal cancer
AIM: To determine the distance between the branching point of the left colic artery (LCA) and the inferior mesenteric artery (IMA) by computed tomography (CT) scanning, for preoperative evaluation before laparoscopic colorectal operation. METHODS: From February 2004 to May 2005, 100 patients (63 men, 37 women) underwent angiography performed with a 16-scanner multi-detector row CT unit (Toshiba, Aquilion 16). All images were analyzed on a workstation (AZE Ltd, Virtual Place Advance 300). The distance from the root of the IMA to the bifurcation of the LCA was measured by curved multi-planar reconstruction on a workstation. RESULTS: The IMA could be visualized in all the cases, but the LCA was missing in two patients. The mean distance from the root of the IMA to the root of the LCA was 42.0 mm (range, 23.2-75.0 mm). There were no differences in gender, arterial branching types, body weight, height, and body mass index. CONCLUSION: Volume-rendered 3D-CT is helpful to assess the vascular branching anatomy for laparoscopic surgery.
Kobayashi, Michiya; Morishita, Satoshi; Okabayashi, Takehiro; Miyatake, Kana; Okamoto, Ken; Namikawa, Tsutomu; Ogawa, Yasuhiro; Araki, Keijiro
Laparoscopic inguinal hernia repair
Background��Despite numerous attempts to improve the techniques used for hernia repair, current published series show that recurrence\\u000a rates are as high as 5�20%. The complexity of inguinal anatomy, combined with multiple potential areas of weakness, has contributed\\u000a to the difficulty in preventing recurrences. However, the laparoscopic approach to inguinal herniorrhaphy has allowed clear\\u000a visualization of all preperitoneal fascial planes and
B. Ramshaw; F. Wo Shuler; H. B. Jones; T. D. Duncan; J. White; R. Wilson; G. W. Lucas; E. M. Mason
Test-retest and intra-observer repeatability of two-, three- and four-dimensional perineal ultrasound of pelvic floor muscle anatomy and function.
The aims of the present study were to evaluate test-retest intra-observer repeatability of ultrasound measurement of the morphology and function of the pelvic floor muscles (PFMs). Seventeen subjects were tested twice. Two-, three- and four- dimensional ultrasound recorded cough, huff, muscle morphology and PFM contraction, respectively. Analyses were conducted offline. Measurements of levator hiatal dimensions demonstrated intra-class correlation coefficient (ICC) values of 0.61, 0.72, 0.86 and 0.92, for the anterior-posterior dimension, transverse dimension, resting area and narrowing during contraction, respectively. Muscle thickness showed variable reliability. ICC values for measurement of the position of the bladder neck were 0.86 and 0.82 at rest, in the vertical and horizontal direction. Displacement of the bladder neck during contraction, huff and cough demonstrated ICC values of 0.56, 0.59 and 0.51, respectively. Perineal ultrasound is a reliable method for measuring most of the tested parameters of morphology and function of the PFMs. PMID:17599234
Braekken, Ingeborg Hoff; Majida, Memona; Ellstr�m-Engh, Marie; Dietz, Hans Peter; Umek, Wolfgang; B�, Kari
Pudendal artery pseudoaneurysm after robot-assisted laparoscopic radical prostatectomy.
Pseudoaneurysms in urology, especially for pelvic surgeries, are rare. We report a patient who presented with late recurrent hematuria due to formation of an accessory pudendal artery pseudoaneurysm (Clavien grade III) after robot-assisted laparoscopic radical prostatectomy. PMID:23146345
Feng, Tom; Patel, Hiten D; Allaf, Mohamad E
Interfractional Variations in the Setup of Pelvic Bony Anatomy and Soft Tissue, and Their Implications on the Delivery of Proton Therapy for Localized Prostate Cancer
Purpose: To quantify daily variations in the anatomy of patients undergoing radiation therapy for prostate carcinoma, to estimate their effect on dose distribution, and to evaluate the effectiveness of current standard planning and setup approaches employed in proton therapy. Methods: We used series of computed tomography data, which included the pretreatment scan, and between 21 and 43 in-room scans acquired on different treatment days, from 10 patients treated with intensity-modulated radiation therapy at Morristown Memorial Hospital. Variations in femur rotation angles, thickness of subcutaneous adipose tissue, and physical depth to the distal surface of the prostate for lateral beam arrangement were recorded. Proton dose distributions were planned with the standard approach. Daily variations in the location of the prescription isodose were evaluated. Results: In all 10 datasets, substantial variation was observed in the lateral tissue thickness (standard deviation of 1.7-3.6 mm for individual patients, variations of >5 mm from the planning computed tomography observed in all series), and femur rotation angle (standard deviation between 1.3{sup o} and 4.8{sup o}, with the maximum excursion exceeding 10{sup o} in 6 of 10 datasets). Shifts in the position of treated volume (98% isodose) were correlated with the variations in the lateral tissue thickness. Conclusions: Analysis suggests that, combined with image-guided setup verification, the range compensator expansion technique prevents loss of dose to target from femur rotation and soft-tissue deformation, in the majority of cases. Anatomic changes coupled with the uncertainties of particle penetration in tissue restrict possibilities for margin reduction in proton therapy of prostate cancer.
Trofimov, Alexei, E-mail: firstname.lastname@example.com [Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA (United States); Nguyen, Paul L. [Department of Radiation Oncology, Brigham and Women's Hospital, Boston, MA (United States); Efstathiou, Jason A.; Wang, Yi; Lu, Hsiao-Ming; Engelsman, Martijn [Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA (United States); Merrick, Scott [Department of Radiation Oncology, Morristown Memorial Hospital, Morristown, NJ (United States); Cheng, Chee-Wai [Midwest Proton Radiotherapy Institute, Department of Radiation Oncology, Indiana University, Bloomington, IN (United States); Wong, James R. [Department of Radiation Oncology, Morristown Memorial Hospital, Morristown, NJ (United States); Zietman, Anthony L. [Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA (United States)
Laparoscopic lower anterior rectal resection using a curved stapler: original technique and preliminary experience.
Laparoscopic low anterior rectal resection (LLAR), allowing better visualization and rectal mobilization, can reduce postoperative pain and recovery. A contour curved stapler (CCS) is a very helpful device because of its curved profile that consents better access into the pelvic cavity and allows to perform rectal closure and section in one shot, especially in the presence of a narrow pelvis, complex anatomy, or large tumors. We developed an original technique of laparoscopic rectal resection using CCS. Between 2005 and 2009, in 36 cases, we performed LLAR with a three-trocar technique, starting with mobilization of left colonic flexure followed by the section of inferior mesenteric vessels. The rectum was prepared up to the levator ani with total mesorectal excision. The Lapdisc was inserted trough a suprapubic midline incision, allowing the CCS stapler placement into the pelvic cavity. After the rectal section, the anastomosis was then performed with a circular stapler. Ileostomy was performed if neoadjuvant radiotherapy and chemotherapy have been carried out or if the anastomosis was below 4 cm from the anal verge. Mean operative time was 135 minutes and no intra- or postoperative bleeding occurred. In 27 patients we performed temporary ileostomy. In two cases we observed anastomotic leakage; one of these patients already had ileostomy. No anastomotic stenosis occurred after one-year follow-up. This procedure simplifies the section of the lower rectum, reduces leaking rate resulting from technical difficulties, and does not nullify the benefits of laparoscopy. PMID:23461949
Brescia, Antonio; Mari, Francesco Saverio; Favi, Francesco; Milillo, Andrea; Nigri, Giuseppe; Dall'oglio, Anna; Pancaldi, Alessandra; Masoni, Luigi
Sciatic hernia: laparoscopic transabdominal extraperitoneal repair with plug and patch
Sciatic hernia is a rare pelvic floor hernia that occurs through the greater or lesser sciatic foramen. Sciatic hernias often\\u000a present as pelvic pain, particularly in women, and diagnosis can be difficult. Transabdominal and transgluteal operative approaches,\\u000a including laparoscopic repair, have been reported. We show a laparoscopic technique using a plug of human allogeneic dermal\\u000a matrix and lightweight polypropylene extraperitoneal
A. C. Bernard; C. Lee; J. Hoskins; J. Lee; S. Patel; G. Ginn; B. Maley
... Pictures Browse Search Quick Search Image Details Pharynx Anatomy View/Download: Small: 720x576 View Download Add to My Pictures Title: Pharynx Anatomy Description: Anatomy of the pharynx; drawing shows the ...
... Pictures Browse Search Quick Search Image Details Larynx Anatomy View/Download: Small: 648x576 View Download Add to My Pictures Title: Larynx Anatomy Description: Anatomy of the larynx; drawing shows the ...
Recent advances in multi-detector computed tomography, magnetic resonance imaging, and ultrasound have led to the detection of incidental ovarian, uterine, vascular and pelvic nodal abnormalities in both the oncology and non-oncology patient population that in the past remained undiscovered. These incidental pelvic lesions have created a management dilemma for both clinicians and radiologists. Depending on the clinical setting, these lesions may require no further evaluation, additional immediate or serial follow-up imaging, or surgical intervention. In this review, guidelines concerning the diagnosis and management of some of the more common pelvic incidentalomas are presented. PMID:20880789
Gore, R M; Newmark, G M; Thakrar, K H; Mehta, U K; Berlin, J W
Surgery for pelvic organ prolapse: a historical perspective.
Surgical treatment of pelvic organ prolapse has evolved from the use of pomegranates as pessary devices to contemporary robot-assisted laparoscopic sacral colpopexy. Symptomatic pelvic organ prolapse requires correction of all the defects to achieve optimal outcomes. Factors to consider in selecting the appropriate repair include patient's age; stage of prolapse; vaginal length; hormonal status; desire for uterine preservation and coitus; symptoms of sexual, urinary, or bowel dysfunction; and any comorbidities that influence her eligibility for anesthesia or chronically increase intra-abdominal pressure. There is currently no consensus as to the best surgical approach for advanced pelvic organ prolapse. Reconstructive surgery for pelvic organ prolapse is currently performed by vaginal or abdominal (open, laparoscopic, and robotic approaches) approaches or a combination. It is important to maintain skills in proven procedures such as abdominal sacrocolpopexy and sacrospinous ligament suspension. This paper discusses the historical evolution of surgery for pelvic organ prolapse from antiquity to date. PMID:22528116
Barbalat, Yanina; Tunuguntla, Hari S G R
Successful management of chylous ascites after laparoscopic presacral neurectomy
Laparoscopic presacral neurectomy is a safe, effective, and well-established surgical procedure to relieve intractable dysmenorrhea and chronic pelvic pain. In one woman, substantial lymphatic leakage occurred due to damaged lymphatic vessels. Adequate exposure and coagulation of the presacral lymphatic zone through the laparoscope resolved the problem, and a substantial amount of chylous ascites was removed. The patient fully recovered after
Tsia-Shu Lo; Fang-Ping Chen; Kiu-Kwong Chu; Yung-Kuei Soong
An Operative and Anatomic Study to Help in Nerve Sparing during Laparoscopic and Robotic Radical Prostatectomy
Objective: To provide a detailed description of the steps involved in a laparoscopic radical prostatectomy in relation to the complex neurovascular anatomy of the male pelvis. Aim and hypothesis: We aimed at delineating the neurovascular anatomy to assist in nerve preservation during laparoscopic and robotic radical prostatectomies. Methods: A team of urologists and an anatomist performed anatomic dissections of 12
Ashutosh Tewari; James O. Peabody; Melissa Fischer; Richard Sarlea; Guy Vallancien; Mazen Hassan; Ashok K. Hemal; Mani Menon
An Operative and Anatomic Study to Help in Nerve Sparing during Laparoscopic and Robotic Radical Prostatectomy
Objective: To provide a detailed description of the steps involved in a laparoscopic radical prostatectomy in relation to the complex neurovascular anatomy of the male pelvis.Aim and hypothesis: We aimed at delineating the neurovascular anatomy to assist in nerve preservation during laparoscopic and robotic radical prostatectomies.Methods: A team of urologists and an anatomist performed anatomic dissections of 12 male cadavers
Ashutosh Tewari; James O Peabody; Melissa Fischer; Richard Sarle; Guy Vallancien; V Delmas; Mazen Hassan; Aditya Bansal; Ashok K Hemal; Bertrand Guillonneau; Mani Menon
[Laparoscopic appendectomy. Our experience].
The advantages and applications of the videolaparoscopic technique (VL) versus open surgery in the treatment of acute and complicated appendicitis are not well defined. Our study examined 150 patients, 67 males and 83 females. They underwent surgery for acute appendicitis in emergency. The choice between open or laparoscopic tecnique was due to patient's clinical conditions and surgeon's experience. Two of these patients had no infiammatory process. Eleven patients were affected by gynaecological diseases. The last 137 patients underwent surgery for acute appendicitis and the diagnosis was confirmed. Among them, 35 (25%) were affected by a complicated appendicitis with diffuse or clearly defined peritonitis. In 134 patients the surgery was completed laparoscopically. The conversion rate was 2%. Morbility rate was 3%, due to intra abdominal abscesses secondary to acute complicated appendicitis. The mean operative time was 76 min and the mean hospital stay was 4.8 days. The death rate was 0%. In our experience, laparoscopic appendectomy has significant advantages over traditional open surgery in both acute and complicated appendicitis, especially in young women. In this way, we can diagnose pelvic disease that could be characterized by the same symptoms of acute appendicitis, then we suggest laparoscopic appendectomy even just to complete the diagnostic iter. Laparoscopy is useful in terms of convalescence, postoperative pain, hospital stay, aesthetic outcome and an easier exploration of the peritoneal cavity. PMID:22595725
Pezzolla, Angela; Milella, Marialessia; Lattarulo, Serafina; Barile, Graziana; Pascazio, Bianca; Ialongo, Paolo; Fabiano, Gennaro; Palasciano, Nicola
Robot-assisted laparoscopic colorectal surgery.
Colorectal surgery can be difficult at open and laparoscopic surgery. This is particularly the case for rectal surgery deep in the pelvis. In obese males distal rectal dissection can be challenging because of instrument and visual limitations. Robot-assisted laparoscopic colorectal operations do not differ significantly from the standard laparoscopic approach but it has certainly been shown that it is feasible to perform the same operation using robotic assistance for the dissection. This allows the surgeon to benefit from vastly enhanced vision and dexterity, which may ultimately translate into benefit for the patient in terms of reduced operating time, and better preservation of pelvic nerves and other structures. PMID:14712879
Rockall, Timothy A; Darzi, Ara
The depth of focus of the latest-model "Chip-on-the-Tip" laparoscopes is limited to 10 cm. The proposed omnifocus laparoscope stretches this depth of focus to 160 cm. The proposed laparoscope is omnifocus, which means that all spots in the picture are in focus, not just certain designated spots as in autofocus devices. This is important because the entire scene needs to be focused during surgery. The omnifocus laparoscope is equipped with an array of color video cameras, each focused at a different distance. The distance information from the laparoscopic profilometer is used to generate a single omnifocused image. PMID:24513740
Iizuka, Keigo
Complications in pelvic floor surgery.
Pelvic floor disorders affect the quality of life of millions of women worldwide. Many options exist for the treatment of pelvic organ prolapse and urinary incontinence, surgery being one of the main strategies in the management of these conditions. Even though uncommon, all surgery has complications which can cause morbidity and rarely mortality. These complications can impair quality of life in the long-term and be a financial burden on both the patient and the health care system. Pelvic floor reconstructive surgery includes perioperative complications such as injury to neighboring organs, hemorrhage and infection. Recently the International Urogynecology Association and the International Continence Society have proposed a terminology and classification of complications related to female pelvic floor surgery, both using native tissue and synthetic implants to improve surgical audit and aid comparison between studies on pelvic floor procedures. Long-term complications such as pelvic pain and dyspareunia may be as high as 25%. Prolapse surgery associated with mesh may result in better anatomical outcomes but this is offset by the high complication rate, particularly that of mesh exposure which has been reported to be between 3-15%. Minimally invasive anti-incontinence procedures are associated with less morbidity than their abdominal predecessors but they are not free of complications. Complications of mid-urethral slings include those of mesh exposure (0.3%), voiding dysfunction (7%) and de novo urgency (25%). The risk and severity of complications varies depending on the procedure performed and on patient characteristics and, therefore, patients need to be informed of these risks or clinicians will be held responsible. This has never been more true than now with the debate regarding the value of transvaginal mesh and laparoscopic procedures for prolapse, their risks and potential benefits, and the associated medico-legal sequelae. PMID:23412020
Alvarez, J; Cvach, K; Dwyer, P
Pelvic Exenteration: Surgical Approaches
Although the incidence of local recurrence after curative resection of rectal cancer has decreased due to the understanding of the anatomy of pelvic structures and the adoption of total mesorectal excision, local recurrence in the pelvis still remains a significant and troublesome complication. While surgery for recurrent rectal cancer may offer a chance for a cure, conservative management, including radiation and chemotherapy, remain widely accepted courses of treatment. Recent improvement in imaging modalities, perioperative care, and surgical techniques, including bone resection and wound coverage, have allowed for reductions in operative mortality, though postoperative morbidity still remains high. In this review, the techniques, including surgical approaches, employed for management of locally recurrent rectal cancer are highlighted.
[Anatomic characteristics of pelvic fascia and ligaments in computerized tomography].
The pelvic fascia consists of two layers, the parietal and the visceral layers I whose appendages represented by various septa and ligaments subdivide the pelvis in intra- and extraperitoneal spaces. These structures are extremely thin but can be demonstrated thanks to the high-quality images obtained with the latest CT scanners and to the good natural contrast of pelvic fat. To assess the visibility of the anatomic features of these structures, 50 patients with no pelvic conditions which could affect the thickness of the pelvic fasciae and ligaments were examined with CT. The pelvic visceral fascia was clearly demonstrated in 60% of cases, the rectovesical and rectovaginal septa and the medial umbilical ligaments were demonstrated in 100% and 92% of cases, respectively. The umbilico-prevesical fascia and the lateral umbilical ligaments were poorly demonstrated. The depiction of these structures improves the knowledge of pelvic anatomy and yields major pieces of information to better understand several pelvic conditions. PMID:7997619
Pozzi Mucelli, R; Shariat Razavi, I
Management of symptomatic pelvic lymphocyst after radical pelvic or pelvic and paraaortic lymphadenectomy for cervical and endometrial cancer
Pelvic and paraaortic lymph node dissection, as part of the staging surgery for cervical and endometrial carcinoma, interrupts\\u000a the afferent lymphatics. The high acceptance by the community of gyn-oncologists was after finding that laparoscopic lymphadenectomy\\u000a can be performed in the majority of patients and is associated with low complication rate. Incidence of lymphocele formation\\u000a and incidence of severe complications associated
Andreas Kavallaris; Ehab Abu Marar; Daniel Beyer; Constanze Banz; Klaus Diedrich; Christopher Altgassen
... Pictures Browse Search Quick Search Image Details Paraganglioma Anatomy View/Download: Small: 648x576 View Download Add to My Pictures Title: Paraganglioma Anatomy Description: Paraganglioma of the head and neck; drawing ...
Eye Anatomy en Espa�ol email Send this article to a friend by filling out the fields below: Your name: ... You at Risk For Glaucoma? Childhood Glaucoma Eye Anatomy Five Common Glaucoma Tests Glaucoma Facts and Stats ...
Adrenalectomy is usually performed via transabdominal or posterior approaches. Unfortunately, both approaches are associated with painful postoperative syndromes. Recently, laparoscopic surgery was applied to organ removal.
M. Gagner; A. Lacroix; E. Bolte; A. Pomp
NSDL National Science Digital Library
This fascinating and informative website was created by a high school teacher in Granite City, Missouri. It brings together a wide range of resources designed to help students learn about anatomy. The materials are divided into three sections: Anatomy Galleries, Anatomy Topics, and Virtual Cat Dissection. The Anatomy Galleries area provides slides, photos, and illustrative materials related to eye dissection, sheep heart dissection, and cat muscles. The Anatomy Topics area includes overviews of the major body systems, including the nervous, circulatory, and endocrine systems. The site also includes a Virtual Cat Dissection, which walks interested parties through this process.
Robotic management of major vessel injury during pelvic lymphadenectomy.
Laparoscopic management of major vessel lesion is a challenging task during pelvic lymphadenectomy, and conversion is frequently necessary. Robotic surgery overcomes the limits of laparoscopy in vascular suturing. We describe a case of a 79-year-old woman with stage IB G3 endometrial adenocarcinoma, where an external iliac vein injury occurred during pelvic lymphadenectomy. This is the first case report that describes robotic management of a major vascular injury during pelvic lymphadenectomy by use of endoscopic bulldog clamps and robotic intracorporeal vascular sutures. PMID:23312253
Perutelli, Alessandra; Garibaldi, Silvia; Gargini, Antonio; Baldacci, Chiara; Basile, Stefano; Salerno, Maria Giovanna
Robotically assisted laparoscopic hysterectomy versus total abdominal hysterectomy and lymphadenectomy for endometrial cancer
ObjectiveTo compare surgical morbidity and clinical�pathologic factors for patients with endometrial cancer (EC) undergoing robotic-assisted laparoscopic hysterectomy (RALH) versus total abdominal hysterectomy (TAH) with aortic and\\/or pelvic lymphadenectomy (LA).
Sara A. DeNardis; Robert W. Holloway; Glenn E. Bigsby; Dirk P. Pikaart; Sarfraz Ahmad; Neil J. Finkler
[Laparoscopic appendectomy: the indications, limits and results].
A total of 10 young women with suspected acute appendicitis were studied. We investigated the value of laparoscopy in the diagnostic evaluation for possible appendicitis in women of reproductive age. At laparoscopy, appendicitis was diagnosed in seven patients (acute-6, subacute-1). Three women had a normal appendix and a pelvic inflammatory disease, a ruptured ovarian cyst and an ovarian cyst with torsion. Laparoscopic appendectomy was performed in 7 cases; a conversion to open operation were because of torsion of ovarian cyst; a laparoscopic cystectomy was necessary. There were no intraoperative and postoperative complications (no wound infections). Reintroduction of normal diet and discharge from hospital occurred earlier after laparoscopic than open surgery. It is concluded that diagnostic laparoscopy permits earlier definitive diagnosis and prompt institution of appropriate therapy for disease of the female reproductive tract that simulates appendicitis; laparoscopic appendectomy is practical and may have advantages over conventional operation (reduction of wound infections and earlier return to normal activities). PMID:9455406
T?rcoveanu, E; Bradea, C; B�rza, M; Stratan, I
Laparoscopic radical cystoprostatectomy with ileal conduit performed completely intracorporeally: the initial 2 cases
Objectives. To present the initial 2 patients who underwent laparoscopic radical cystoprostatectomy, bilateral pelvic lymphadenectomy, and ileal conduit urinary diversion, with the entire procedure performed exclusively by intracorporeal laparoscopic techniques.Methods. Two male patients, 78 and 70 years old, with muscle-invasive, organ-confined, transitional cell carcinoma of the urinary bladder underwent the procedure. The entire procedure, including radical cystoprostatectomy, pelvic node dissection,
Inderbir S Gill; Amr Fergany; Eric A Klein; Jihad H Kaouk; Gyung Tak Sung; Anoop M Meraney; Stephen J Savage; James C Ulchaker; Andrew C Novick
Laparoscopy-assisted gastrectomy has become a popular surgical option, particularly for the treatment of early gastric cancer. A multi-institutional clinical trial has recently demonstrated that satisfactory results have been obtained with the clinical outcomes of laparoscopic gastrectomy for early gastric cacer, which was not inferior to those obtained by a conventional open procedure. However, the indication of laparoscopic gastrectomy for the treatment of patients with advanced gastric cancer has remained controversial. In this paper, we describe the current status of gastric cancer treatment, including lymph node dissection and reconstruction procedures. We also provide future perspectives concerning the robot-assisted laparoscopic gastrectomy for gastric cancer. PMID:23198560
Yoshimura, Fumihiro; Uyama, Ichiro
The outcome of treatment for pelvic congestion syndrome.
Pelvic congestion syndrome is one of many causes of chronic pelvic pain. It is generally accepted that this is attributable to ovarian and pelvic vein incompetence which may result in varices in the lower limb leading to presentation in varicose vein clinics. However, far more patients have pelvic varices associated with varicose veins in the lower limb than have pelvic congestion syndrome. Magnetic resonance imaging and computed tomographic venography are usually used in the diagnosis of this condition and criteria have been established to identify pelvic varices. Many different treatments have been used to manage the symptoms of pelvic congestion. Hysterectomy combined with oophrectomy, open surgical ligation of ovarian veins and laparoscopic vein ligation have been used in the past. The most common treatments used currently involve embolization of pelvic and ovarian veins. The results of this treatment have been published in a limited number of clinical series, usually with fairly short follow-up periods. These treatments may be complicated by migration of embolization of coils used to occlude veins. The longest duration of follow-up currently reported is five years. Limited clinical evidence supports the use of embolotherapy in the management of pelvic congestion syndrome. PMID:22312071
Smith, P Coleridge
Laparoscopic Management of Abdominopelvic Abscesses in Tropical Pyomyositis
Tropical pyomyositis is a suppurative infectious disease of skeletal muscles. The most common causative organism is Staphylococcus aureus. Penicillin-resistant strains are frequently encountered. Abscesses may develop in muscle groups or body cavities remotely located from one another. We report a case of tropical pyomyositis presenting as a suppurative process in the left foreleg. Further workup, including CT scanning, demonstrated large, multi-loculated intraabdominal and pelvic abscesses. The abdominal and pelvic components were managed by laparoscopic exploration and drainage. This is the first known report of laparoscopic management of abdominopelvic abscesses associated with tropical pyomyositis.
Singh, Niten; Nelson, Jeffery M.
Radiological anatomy of prostatic arteries.
One of the most challenging aspects of prostatic arterial embolization for patients with lower urinary tract symptoms and prostate enlargement or benign prostatic hyperplasia is identifying the prostatic arteries (PAs). With preprocedural computed tomography angiography it is possible to plan treatment and exclude patients when arterial anatomy is not suited, or when extensive atherosclerotic changes may affect technical success. There is an excellent correlation between the computed tomography angiography and digital subtraction angiography findings, enabling correct depiction of the male pelvic arterial anatomy (internal iliac branching patterns, relevant variants as accessory pudendal arteries, and PA anatomy). The prostate has a dual vascular arterial supply: a cranial or vesico-PA (named anterior-lateral prostatic pedicle) and a caudal PA (named posterior-lateral prostatic pedicle). These 2 prostatic pedicles may arise from the same artery in patients with only 1 PA (found in 60% of pelvic sides), or may arise independently in patients with 2 independent PAs (found in 40% of pelvic sides). The anterior-lateral prostatic pedicle vascularizes most of the central gland and benign prostatic hyperplasia nodules, frequently arises from the superior vesical artery in patients with 2 independent PAs, and is the preferred artery to embolize. The posterior-lateral prostatic pedicle has an inferior or distal origin, vascularizes most of the peripheral and caudal gland, and may have a close relationship with rectal or anal branches. In up to 60% of cases considerable anastomoses may be seen between the prostatic branches and surrounding arteries that should be taken into account when planning embolization. PAs lack pathognomonic digital subtraction angiography features; thus correct anatomical identification of the male pelvic and PAs is necessary to avoid untargeted ischemia to the bladder, rectum, anus, or corpus cavernosum. PMID:23244724
Bilhim, Tiago; Tinto, Hugo Rio; Fernandes, L�cia; Martins Pisco, Jo�o
Laparoscopic Habib(TM) 4X: a bipolar radiofrequency device for bloodless laparoscopic liver resection
Background. In recent years the progress of laparoscopic procedures and the development of new and dedicated technologies have made laproscopic hepatic surgery feasible and safe. In spite of this laparoscopic liver resection remains a surgical procedure of great challenge because of the risk of massive bleeding during liver transection and the complicated biliary and vascular anatomy in the liver. A new laparoscopic device is reported here to assist liver resection laparoscopically. Methods. The laparoscopic Habib� 4X is a bipolar radiofrequency device consisting of a 2x2 array of needles arranged in a rectangle. It is introduced perpendicularly into the liver, along the intended transection line. It produces coagulative necrosis of the liver parenchyma sealing biliary radicals and blood vessels and enables bloodless transection of the liver parenchyma. Results. Twenty-four Laparoscopic liver resections were performed with LH4X out of a total of 28 attempted resections over 12 months. Pringle manoeuvre was not used in any of the patients. None of the patients required intraoperative transfusion of red cells or blood products. Conclusion. Laparoscopic liver resection can be safely performed with laparoscopic Habib� 4X with a significantly low risk of intraoperative bleeding or postoperative complications.
Pai, M.; Navarra, G.; Ayav, A.; Sommerville, C.; Khorsandi, S. K.; Damrah, O.; Jiao, L. R.
Pelvic congestion syndrome (PCS) is an important cause of chronic pelvic pain in female patients. Chronic pelvic pain, defined as lower abdominal or pelvic pain for a duration of 6 months or more, causes significant morbidity and results in a large number of diagnostic laparoscopies. It is of utmost importance to identify treatable causes of chronic pelvic pain, one of which is PCS. The etiology, clinical features, investigations, and treatment options in PCS have been discussed in this paper. PMID:23795992
Rane, Neil; Leyon, Joe Joseph; Littlehales, Tracey; Ganeshan, Arul; Crowe, Paul; Uberoi, Raman
Radical abdominal trachelectomy and pelvic lymphadenectomy with uterine conservation and subsequent pregnancy in the treatment of early invasive cervical cancer
Background: Recently, pregnancies in patients after radical vaginal trachelectomy and laparoscopic pelvic lymphadenectomy have been reported. Radical abdominal trachelectomy and pelvic lymphadenectomy with uterine conservation has been previously described; however, subsequent outcome and pregnancy has not. Methods: Three patients with cervical carcinoma, 1 with stage IA1 with lymph-vascular space invasion and 2 with stage IA2, were treated with radical abdominal
Michael Rodriguez; Omar Guimares; Peter G. Rose
NSDL National Science Digital Library
Please find links below: Human Anatomy Human Anatomy Online Human Body - Gray s Anatomy - Digestive Aparatus MEDtropolis - Virtual Body - can be viewed in English or Spanish. Contains tours of the Human Brain, Skeleton, Human Heart, and Digestive Tract. Respiratory System National Heart, Lung, and Blood Institute HealthTalk COPD (chronic obstructive pulmonary disease) American Lung Association - Disease Finder Association of Legal Aid Attorneys/UAW 2325 Canadian Lung Association Kids Health Family Living and Personal Living - Ms. Schultz added this link because on this page there is CDC, American ...
Schultz, Ms.
NSDL National Science Digital Library
There might not be such a thing as "instant" anatomy, but this nice site does offer up some podcasts on the matter that can provide a pathway to anatomical enlightenment. The site was created by Robert Whitaker, a professor of clinically applied topographical anatomy in the United Kingdom. Visitors can wander through a range of useful instructional materials here, and the nine free podcasts are some of the best items available. The titles include "Surface Anatomy," "Classification of the Joints," "Venous Drainage of the Limbs," and "Principles of Movements at Joints in the Upper Limb." Also, users have access to several free podcast apps, including a series of flashcards and embryology diagrams.
Whitaker, Robert
Sinus Anatomy Rakesh Chandra, MD INTRODUCTION The paranasal sinuses (�the sinuses�) are air-filled cavities located within the bones of the face and around the nasal cavity and eyes. Each sinus is ...
anatomy The nasal cavity is a potential space situated above the oral cavity and hard palate and below the skull base and intracranial ... of one or both sides of the nasal cavity. The left and right nasal cavities become continuous ...
Laparoscopic dissection of the intramural ureter to repair a complete transection of the distal ureter: Initial experience with a new minimally invasive technique that preserves the anatomy of the urinary tract
We report 2 patients with ureteral injury after a simple total laparoscopic hysterectomy for uterine myoma with a complete resection of the distal ureter. One patient had unilateral injury and the other 2 patients had bilateral injury. The surgical laparoscopic repair procedure was carried out 3 to 5 days after the injury. Surgery involved intramural dissection of the distal ureteral stump to expose at least 1 cm of the ureter, percutaneous ureteral stent placement, elimination of tension between the proximal ureter and the dissected distal stump, end-to-end anastomosis, and reinsertion of the distal ureter into the bladder muscle layer, which was previously dissected for the anastomosis.
Juarez-Soto, Alvaro; Arroyo-Maestre, Jose Miguel; Soto-Delgado, Manuel; Beardo-Villar, Pastora; Arrabal-Polo, Miguel Angel; Sanchez-Margallo, Francisco Miguel
Pelvic tuberculous granuloma successfully treated with laparoscopy to preserve fertility: a case report and review of the published work.
Tuberculous granuloma must be considered in the differential diagnosis of pelvic masses in women of reproductive age because the major sequela of pelvic tuberculosis is infertility; however, currently there is very little information about its fertility-preserving treatment. We report the case of a woman with a history of tuberculous peritonitis who referred to our hospital for evaluation of an adnexal mass and primary infertility. The patient underwent excision of pelvic tuberculous granuloma with fertility-preserving laparoscopic surgery. We resected as much of the tuberculous granuloma as possible using the laparoscopic technique without causing damage to the uterus or ovaries. In particular, we report for the first time in the published work the laparoscopic removal of tuberculous granuloma without causing damage to the uterus or ovaries. Our experience from this case suggests that laparoscopic diagnosis and treatment of tuberculous granuloma is a feasible procedure in a patient who wants to conceive. PMID:24888956
Nakahara, Tatsuo; Iwase, Akira; Mori, Masahiko; Kondo, Mika; Goto, Maki; Kikkawa, Fumitaka
[Robotics-assisted laparoscopic colorectal resection].
The value of laparoscopic surgery for rectal cancer is still controversially discussed. Robotics offers the opportunity to leave the limitations of conventional laparoscopy behind us. The three-dimensional visualization and the superior dexterity by wristed instruments should be particularly helpful in complex laparoscopic procedures in confined spaces such as the small pelvis. Colorectal resections using the Da Vinci� system are well established and becoming increasingly more standard procedures. Nerve-sparing total mesorectal excision in patients with rectal cancer, total mesocolic excision in patients with right-sided colon cancer and rectopexy in patients with pelvic floor insufficiency are the most promising indications. The prospective randomized ROLARR study has been evaluating the application of the Da Vinci� system in laparoscopic rectal cancer surgery since 2011. Besides the currently available clinical data the perioperative and intraoperative logistics and strategy will be presented in detail. PMID:23942962
Mann, B; Virakas, G; Blase, M; Soenmez, M
Pelvic Inflammatory Disease (PID)
... Pelvic Inflammatory Disease (PID) - CDC Fact Sheet Untreated sexually transmitted diseases (STDs) can cause pelvic inflammatory disease (PID), a serious ... It is a complication often caused by some STDs, like chlamydia and gonorrhea. Other infections that are ...
INTRODUCTION: This report describes our technique and experience in restoring the pelvic floor of females with pelvic organ prolapse. METHODS: Total pelvic mesh repair uses a strip of Marlex Mesh� secured between the perineal body and the sacrum. Two additional strips, attached to the first, are tunneled laterally to the pubis and support the vagina and bladder laterally. Candidates for
Eugene S. Sullivan; Christopher J. Longaker; Patrick Y. H. Lee
Intraoperative cholangiography for laparoscopic cholecystectomy.
Intraoperative cholangiography in the course of laparoscopic cholecystectomy is not only valuable to detect common bile duct stones, but also to delineate the anatomy of the biliary ducts, facilitate the dissection, avoid injuries to the biliary tract and identify other abnormalities, such as fistulas, cysts and tumors of the biliary system. Most surgeons use a variation of the transcystic injection of contrast. We describe herein a technique of cholangiography through the gallbladder, performed before starting any dissection in the cystic duct area, which has resulted in a rate of 92 percent of adequate cholangiograms and has proved to be easier, by far, and safer than the transcystic technique. A comparison was made between 405 instances of open cholecystectomies and 200 laparoscopic cholecystectomies with transcystic cholangiograms and 105 laparoscopic cholecystectomies with cholangiograms done through the gallbladder. All instances were done for symptomatic chronic or acute calculous cholecystitis. Satisfactory cholangiograms were obtained in 95 percent of open cholecystectomies and in only 68 percent of transcystic laparoscopic attempts. Complications and false-positive findings were seen in transcystic laparoscopic procedures in five and six instances, respectively. Cholangiography performed through the gallbladder was 100 percent successful among 73 patients with chronic cholecystitis and in 66 percent of 32 patients with acute calculous cholecystitis. For optimal visualization of the bile ducts, it is essential to exert pressure on the gallbladder after the injection of contrast to advance the contrast through the cystic duct. This is greatly facilitated by the use of a double-balloon catheter to avoid leak at the site of the gallbladder puncture. PMID:8480262
Kuster, G G; Gilroy, S; Graefen, M
Laparoscopic female sterilization is still the leading method of family planning for patients who have completed their family. Mechanical methods include clips and rings and are preferred because they are safe and efficient and can be used on a day case basis. Appropriate training ensures improved results with fewer complications. Clips and rings have an improved reversal potential. PMID:10459064
Filshie, M
Laparoscopy has become the preferred operative treatment for the removal of gallbladders containing symptomatic stones. Both length of stay and total unit cost has declined, through the use of the laparoscopic cholecystectomy procedure. However, the total cost of treating gallstones has increased. Consensus practice guidelines would indicate that there should be no increase in the number of gallbladder surgeries performed,
Richard E. Chard
[Pelvic actinomycosis in Tunisia: five cases].
Actinomycosis is a rare suppurative disease due to Actinomyces species. These Gram-positive, non-acid fast anaerobic filamentous bacteria are normal inhabitants of the human body, tending to reside in the oropharynx and bowel but are occasionally found in the vagina. Pelvic actinomycosis is a rare bacterial disease in women. Clinical manifestations are various and non specific and may be acute or chronic. No consensus exists for treatment. We reviewed files and identified all five cases of pelvic actinomycosis managed at Obstetrics and Gynaecology department "A" at the Maternity Center of Tunis over an eight-year period (1998-2005). The women's average age was 39.2 years. One patient was menopausal and consulted for bleeding. The other four patients were younger and had all been using an intrauterine device (IUD) for contraception. They presented with acute clinical manifestations. Their main symptom was pelvic pain. Three women had fever, and two presented with urinary tract obstruction. All patients had surgery. A pelvic abscess was found in four cases. Laparoscopic management was possible in only one case. Laparotomy was necessary in the other four. Four women had adnexectomies, two with hysterectomy. Digestive complications occurred in three cases. Actinomycosis was diagnosed only after surgery, by the histological examination. This series confirms the difficulties encountered in the management of pelvic actinomycosis. We review the recent literature and describe the diagnostic and therapeutic procedures currently recommended. The relationship between pelvic actinomycosis and IUDs, the most common method of contraception in Tunisia, is clearly established. Clinical diagnosis of pelvic actinomycosis is difficult because the symptoms are non-specific. Laboratory tests can help by showing serious inflammation, however. Imaging findings are also non-specific and may suggest an abscess or an inflammatory or neoplastic process. Interventional radiology, specifically CT- or ultrasound-guided aspiration biopsy can facilitate diagnosis, which in any case requires a histological examination. Treatment of pelvic actinomycosis is not standardized and depends on clinical form. Medical treatment is based on long-term penicillin G. It is always necessary and may be used alone in cases of preoperative diagnosis. Surgery should be offered only in resistant cases and should always be followed by long-term antibiotic treatment. The prognosis of correctly treated pelvic actinomycosis is generally good. PMID:19188130
Chelli, Dalenda; Hassini, Abdelwahed; Aloui, Fadhel; Sfar, Ezzeddine; Zouaoui, B�chir; Chelli, H�la; Chanoufi, Badis
Role of conventional radiology and MRi defecography of pelvic floor hernias
Background Purpose of the study is to define the role of conventional radiology and MRI in the evaluation of pelvic floor hernias in female pelvic floor disorders. Methods A MEDLINE and PubMed search was performed for journals before March 2013 with MeSH major terms 'MR Defecography' and 'pelvic floor hernias'. Results The prevalence of pelvic floor hernias at conventional radiology was higher if compared with that at MRI. Concerning the hernia content, there were significantly more enteroceles and sigmoidoceles on conventional radiology than on MRI, whereas, in relation to the hernia development modalities, the prevalence of elytroceles, edroceles, and Douglas' hernias at conventional radiology was significantly higher than that at MRI. Conclusions MRI shows lower sensitivity than conventional radiology in the detection of pelvic floor hernias development. The less-invasive MRI may have a role in a better evaluation of the entire pelvic anatomy and pelvic organ interaction especially in patients with multicompartmental defects, planned for surgery.
NSDL National Science Digital Library
The EMuseum at the University of Minnesota-Mankato provides this educational site on human anatomy. Although some parts of the site are still under construction, the Introduction to the Skeletal System section offers a straightforward introduction to the topic, complete with black-and-white skeletal photographs. Topics in this section include skeletal functions, axial and appendicular divisions, types of bone, bone composition, and a brief list of anatomical terms. For educators of introductory human anatomy, this site should provide interesting supplemental information.
Pelvic Floor Magnetic Resonance Imaging after Neonatal Single Stage Reconstruction in Male Patients With Classic Bladder Exstrophy
PurposeWe evaluate a magnetic resonance imaging (MRI) protocol used to study the pelvic floor anatomy in male patients following neonatal single stage complete bladder exstrophy and epispadias repair with osteotomies.
SAREL HALACHMI; WALID FARHAT; OSNAT KONEN; AZRA KHAN; JOHN HODAPP; DARIUS J. BAGLI; GORDON A. McLORIE; ANTOINE E. KHOURY
The surgical anatomy of the perineum.
The anatomy of the perineum and pelvis is complex. Those outside the specialist fields of colorectal surgery, urology and gynaecological surgery often have a less-than-complete understanding of the anatomical details of this region. The recent increase in complicated pelvic and perineal injuries caused by the detonation of Improvised Explosive Devices has brought into sharp focus, the importance of this area of surgical anatomy. The following article describes, in a systematic and detailed manner, the anatomy of the urogenital and anal regions of the perineum. The terminology in relation to the fascial layers and structures encountered in the perineum is elucidated. In addition, the surgical anatomy of the scrotum and its contents and the ligamentous support of the penis are described, with clear illustrations throughout. It is intended that this article will go some way towards clarifying the anatomy underlying the surgical management of complex perineal/pelvic injuries, and benefit both the specialist and non-specialist military surgeon. PMID:23631319
Mahadevan, V; Chandak, P
Interventional palliation for hypoplastic left heart syndrome (HLHS) could reduce the current morbidity and mortality. Stenting of the arterial duct is the critical interventional step for HLHS. We reviewed our experience with 40 consecutive patients with HLHS referred for stenting of the ductus arterious (DA). Thirty-nine of 40 (97%) infants had suitable anatomy and were successfully stented. The infants were
M. M. Boucek; C. Mashburn; E. Kunz; K.-C. Chan
Training for laparoscopic surgery
Laparoscopic cholecystectomy has rapidly become the procedure of choice for most patients with symptomatic gallbladder disease. Laparoscopic surgery, however, has not been a required component of most general surgery training programs. The demonstrated efficacy of laparoscopic surgery dictates that this discipline be rapidly incorporated into residency programs. Laparoscopic cholecystectomy and other surgical endoscopic procedures have been an integral part of
Karl A. Zucker; Robert W. Bailey; Scott M. Graham; William Scovil; Anthony L. Imbembo
\\u000a Laparoscopic instrumentation continues to evolve towards smaller, more reliable, and better ergonomic devices, with a larger\\u000a variety of choices. Since the first edition of this textbook, subtle improvements are readily apparent in existing devices\\u000a as first-generation instruments progress towards later-generation models. New technology exists to allow procedures to be\\u000a performed with fewer complications. Combined with refinements in techniques, new and
Patrick S. Lowry
Gallbladder duplication successfully removed laparoscopically using endoscopic nasobiliary tube
Laparoscopic cholecystectomy is sometimes difficult due to complicated biliary anatomy including gallbladder duplication, a rare anomaly of the biliary tract. We report a case of duplicated gallbladder successfully removed under laparoscopy using endoscopic nasobiliary (ENB) tube cholangiography. A 61-year-old Japanese woman presented us with right upper abdominal pain. Ultrasonography revealed two cystic structures lying in the gallbladder fossa, and the
K. Shirahane; K. Yamaguchi; T. Ogawa; S. Shimizu; K. Yokohata; K. Mizumoto; M. Tanaka
The Anatomy of Learning Anatomy
ERIC Educational Resources Information Center
The experience of clinical teachers as well as research results about senior medical students' understanding of basic science concepts has much been debated. To gain a better understanding about how this knowledge-transformation is managed by medical students, this work aims at investigating their ways of setting about learning anatomy.�
Wilhelmsson, Niklas; Dahlgren, Lars Owe; Hult, Hakan; Scheja, Max; Lonka, Kirsti; Josephson, Anna
KTP-532 laser utilization in endoscopic pelvic lymphadenectomy
NASA Astrophysics Data System (ADS)
Laparoscopic pelvic lymphadenectomy has become increasingly of interest to Urologists in staging patients not only with prostatic carcinoma but for those patients suffering with carcinoma of the bladder. It also allows access for therapeutic treatment such as treatment of varicoceles and laser phototherapy for transmural coagulation of bladder cancers. Lasers have proven extremely better in allowing surgical incisions through the laparoscope and coagulation of bleeders. Both the KTP and Neodymium Yag Laser have been used for this purpose. The KTP Laser has distinct advantages in that it allows 1) flexible fiber easily used through laparoscopes, 2) the ability to coagulate and cut retroperitoneal tissue, and 3) seal lymphatics when lymph nodes are removed. The KTP fiber can be used to incise the retroperitoneum to expose the lymph node tissue. Grasping the lymph nodes with forceps, the laser can excise and coagulate the proximal and lymphatic channels. The laser fiber will not experience carbonization as can occur with the Yag Laser fiber unless a contact tip sapphire end is utilized. The KTP's laser fiber ability to give coagulation and ablation of tissue through a liquid medium allow it to be an excellent choice for laparoscopic pelvic lymphadenectomy.
Malloy, Terrence P.
Laparoscopic Resection of Retroperitoneal Neural Tumors
Purpose Retroperitoneal neural tumor (RNT) is rarely excised laparoscopically, and the laparoscopic management of RNT remains controversial. We herein report 4 cases of laparoscopic excision of RNT that resulted in diverse clinical outcomes. Patients and Methods Between August 2005 and January 2011, we performed laparoscopic excision of RNT in 4 patients. The mean tumor size was 4.5 cm. The mean operative time was 297 minutes and the mean amount of blood loss was 55 ml. The surgeries were uneventful, with no operative complications or evidence of intra-abdominal bleeding. However, 2 patients required reoperation for delayed hemorrhage and urinoma formation, respectively. Results The postoperative pathological diagnoses were schwannoma in 3 patients and ganglioneuroblastoma in 1 patient. All patients were well with no signs of peripheral neuropathy or radiculopathy, and CT and/or 18F-FDG PET/CT performed during follow-up indicated no evidence of disease. Conclusions Obtaining extensive preoperative knowledge of the source neural and vascular anatomy of the tumor is important for the surgical planning of laparoscopic resection of RNT. When a great deal of care is taken to divide the tumor and the source nerves and vital vessels, safe execution of RNT can be achieved for minimal postoperative mortality and morbidity.
Nozaki, Tetsuo; Kato, Tomonori; Morii, Akihiro; Fuse, Hideki
NSDL National Science Digital Library
The College of Education and Human Development at the University of Minnesota has created this interactive and engaging set of resources designed to help college students learn about anatomy and physiology. Along with the learning modules, visitors can also take part in the rather fun "Anatomy Bowl". Here visitors can take on topics like biochemistry, the heart, and the reproductive system in a format that is quite similar to a certain popular television game show. Moving along, there's the "Self Test" section. Here visitors can take quizzes of varying lengths designed to test their knowledge of fifteen different subjects, including the endocrine system and the lymphatic system. The site also contains a "Timed Tests" area and a more comprehensive "Quiz Bowl" which allows visitors the opportunity to answer seventeen questions across a myriad of topics.
Jensen, Murray
NSDL National Science Digital Library
Created by Professor Robert Whitaker, this website was designed to teach medical students about anatomy. Visitors to the site will find a range of materials, including diagrams, illustrations, quizzes, tips, mnemonics, and so on. On the homepage, visitors will find a What's New area, which includes podcasts that deal with subjects such as the small muscles of the hand and the anatomy of the posterior forearm. Other sections on the homepage include Head & Neck, Thorax, Abdomen, Arm, and Leg. Each of these sections includes dozens of illustrations, along with some useful Brain Training Games. These games are designed to increase comprehension of the materials covered in each area. Moving on, the Lectures area includes talks such as "Parasympathetic Supply of the Head," "Cortical Control of Cranial Nerves," and several others. The site is rounded out by a collection of iPhone and iPad apps, along with a set of detailed flash cards.
Whitaker, Andrew
... Browse Search Quick Search Image Details Thymus Gland Anatomy Adult View/Download: Small: 720x576 View Download Add to My Pictures Title: Thymus Gland Anatomy Adult Description: Anatomy of the thymus gland; illustration ...
... Browse Search Quick Search Image Details Normal Pancreas Anatomy View/Download: Small: 761x736 View Download Add to My Pictures Title: Normal Pancreas Anatomy Description: Anatomy of the pancreas; drawing shows the ...
NSDL National Science Digital Library
This link on the American Anatomists Association (AAA) provides students and teachers with a one stop site for review of anatomy textbook and education resources (ex: flash cards and atlases). Textbooks include clinical anatomy, human anatomy and specialized regions.
Magnetic resonance imaging of the pelvic floor: from clinical to biomechanical imaging.
This article reviews the current role of magnetic resonance imaging in the study of the pelvic floor anatomy and pelvic floor dysfunction. The application of static and dynamic magnetic resonance imaging in the clinical context and for biomechanical simulation modeling is assessed, and the main findings are summarized. Additionally, magnetic resonance-based diffusion tensor imaging is presented as a potential tool to evaluate muscle fiber morphology. In this article, focus is set on pelvic floor muscle damage related to urinary incontinence and pelvic organ prolapse, sometimes as a consequence of vaginal delivery. Modeling applications that evaluate anatomical and physiological properties of pelvic floor are presented to further illustrate their particular characteristics. Finally, finite element method is described as a method for modeling and analyzing pelvic floor structures' biomechanical performance, based on material and behavioral properties of the tissues, and considering pressure loads that mimic real-life conditions such as active contraction or Valsalva maneuver. PMID:24030164
Brand�o, Sofia; Da Roza, Thuane; Parente, Marco; Ramos, Isabel; Mascarenhas, Teresa; Natal Jorge, Renato M
... to severe problems like infertility , ectopic pregnancy , and chronic pelvic pain. Any damage done to your pelvic organs before you start treatment likely cannot be undone. Still, don't put off getting treatment. If you do, you may not be able to have children. If you think you may have PID, see ...
The pelvic compartment syndrome
In the pelvic region three major compartments (gluteus medius-minimus compartment, gluteus maximus compartment, and iliopsoas compartment) can be distinguished from the smaller compartment of the tensor fasciae latae muscle. Pelvic compartment syndromes are rare. A clear history of trauma is often lacking. Association with drug and alcohol abuse is common, as is the association with the widespread use of anticoagulant
U. Bosch; H. Tscherne
Clinical observation of laparoscopic radical hysterectomy for cervical cancer
To evaluate safety, feasibility and the improvement of surgical method of laparoscopic extensive hysterectomy and pelvic lymph node dissection in patients with early-stage cervical cancer. Clinical data were prospectively collected from patients with IA2-IIA cervical cancer who underwent laparoscopic extensive hysterectomy (n1=22) and laparotomy (n2=23) in Department of Obstetrics and Gynecology in the Subei People�s Hospital from June 2010 to August 2013. The successful rates in two groups of operation were 100%. Blood loss, postoperative hospital stay, complication rate, postoperative recovery of gastrointestinal tract and bladder function of the laparoscopy group of the laparoscopic group were all better than those of the laparotomy group, and there were significant differences (all P < 0.05). But in the laparoscopy group, the operative time was longer than the laparotomy group with statistical significance (P < 0.05). There was no statistically significant difference in the number of excised lymph nodes and the duration time of postoperative urinary catheterization between the two groups (P > 0.05). Laparoscopic extensive hysterectomy and pelvic lymph node dissection can fully meet the requirement of laparotomy. It has the properties of minor trauma and rapid recovery. The clinical efficacy is superior to laparotomy surgery. The results indicated laparoscopic is an ideal method for the treatment of early cervical cancer.
Yin, Xiang-Hua; Wang, Zhong-Qin; Yang, Shi-Zhang; Jia, Hong-Yan; Shi, Min
Patients undergoing laparoscopic splenectomy were observed for their postoperative recovery and development of complications. It was a retrospective analysis done at Services Hospital and National Hospital and Medical Center, Lahore, from January 2010 to December 2012. A total of 13 patients underwent laparoscopic splenectomy and were included in the study. Patients were followed for their postoperative recovery and development of any complications. The median age of patients was 19 years ranging from 13 to 69 years. Accessory spleens were removed in 3 patients. Mean operating time was 158 minutes. One operation had to be converted to open because of uncontrolled hemorrhage. Six patients experienced postoperative complications including unexplained hyperpyrexia (n=2), pleural effusion (n=4) and prolonged pain > 48 hours (n=1). No deaths or infections were seen. Seven out of 8 patients with idiopathic thrombocytopenic purpura developed a positive immediate response to the splenectomy, defined as a platelet count greater than 100 x 109/L after the surgery, which was maintained without medical therapy. Mean hospital stay was 5.5 days. Average time to return to activity was 15 days. All patients were followed for 6 months and no follow-up complications were noted. PMID:24848397
Javed, Irfan; Malik, Awais Amjad; Khan, Ahsan; Allahnawaz; Shamim, Romaisa; Ayyaz, Mahmood
Laparoscopic sacrocolpopexy for uterine and post-hysterectomy prolapse: anatomical results, quality of life and perioperative outcome�a prospective study with 101 cases
Our prospective study evaluates laparoscopic sacrocolpopexy for vaginal vault prolapse focusing on perioperative data, objective\\u000a anatomical results using the pelvic organ prolapse quantification (POP-Q) system and postoperative quality of life using the\\u000a Kings Health questionnaire. One hundred one patients completed the study. Fifty five had laparoscopic supracervical hysterectomy\\u000a and sacrocolpopexy for uterine prolapse and 46 had laparoscopic sacrocolpopexy for post-hysterectomy
Dimitri Sarlos; Sonja Brandner; LaVonne Kots; Nicolle Gygax; Gabriel Schaer
Lymphoceles, Lymphorrhea, and Lymphedema after Laparoscopic and Open Endometrial Cancer Staging
Purpose��To evaluate the incidence of lymphoceles, lymphorrhea, and lymphedema after systematic pelvic lymphadenectomy in patients\\u000a who underwent laparoscopic or open abdominal staging for endometrial cancer.\\u000a \\u000a \\u000a \\u000a \\u000a Methods��A total of 138 consecutive women who underwent systematic laparoscopic pelvic lymphadenectomy for endometrial cancer staging\\u000a were compared to 123 historical control subjects staged via an open approach. Postoperative screening for lymphadenectomy-related\\u000a complications by ultrasound
Fabio Ghezzi; Stefano Uccella; Antonella Cromi; Giorgio Bogani; Claudio Robba; Maurizio Serati; Pierfrancesco Bolis
[Laparoscopic surgery in the treatment of urogenital prolapse. Current status].
Urogenital prolapse is an emerging problem because of the increasing life expectancy of populations. Nearly 42% of women between 15 and 97 years have a pelvic floor disorder (PFD). On the basis of Medline search, we present the main laparoscopical techniques to treat PFD: Burch, sacrocolpopexy, lateral suspension, uterosacral suspension, paravaginal repair, the benefits of laparoscopic surgery, its success rates and complications, and response to various questions that frequently arise about some techniques: should we perform a hysterectomy? Should we make a paravaginal repair? Should we treat prophylactically a stress urinary incontinence? What type of mesh should we use? What to prefer: staples or sutures? Is the posterior mesh necessary? PMID:22552102
Hamada, H
Seprafilm slurry does not increase complication rates after laparoscopic colectomy
Background��The ability of the Seprafilm adhesion barrier to prevent adhesion formation after abdominal and pelvic operations has been\\u000a proved. With laparoscopy, a major technical roadblock with these sheets is their delivery into the peritoneal cavity. This\\u000a study aimed to evaluate the incidence of postoperative complications and death after laparoscopic placement of Seprafilm slurry\\u000a in patients who underwent laparoscopic colectomy.\\u000a \\u000a \\u000a \\u000a \\u000a Methods��A
Adit Suresh; Brian G. Celso; Ziad T. Awad
Common postoperative findings unique to laparoscopic surgery.
The interpretation of images obtained in patients who have recently undergone abdominal or pelvic surgery is challenging, in part because procedures that were previously performed with open surgical techniques are increasingly being performed with minimally invasive (laparoscopic) techniques. Thus, it is important to be familiar with the normal approach used for laparoscopic surgeries. The authors describe the indications for various laparoscopic surgical procedures (eg, cholecystectomy, appendectomy, hernia repair) as well as normal postoperative findings. For example, port site hernias are more commonly encountered in patients with trocar sites greater than 10 mm and occur at classic entry sites (eg, the periumbilical region). Similarly, preperitoneal air can be encountered postoperatively, often secondary to trocar dislodgement during difficult entry or positioning. In addition, intraperitoneal placement of mesh during commonly performed ventral or incisional hernia repairs typically leads to postoperative seroma formation. Familiarity with normal findings after commonly performed laparoscopic surgical procedures in the abdomen and pelvis allows accurate diagnosis of common complications and avoidance of diagnostic pitfalls. PMID:24428286
Hindman, Nicole M; Kang, Stella; Parikh, Manish S
The Incidence and Anatomy of Accessory Pudendal Arteries as Depicted on Multidetector-Row CT Angiography: Clinical Implications of Preoperative Evaluation for Laparoscopic and Robot-Assisted Radical Prostatectomy
Objective To help preserve accessory pudendal arteries (APAs) and to ensure optimal postoperative sexual function after a laparoscopic or robot-assisted radical prostatectomy, we have evaluated the incidence of APAs as detected on multidetector-row CT (MDCT) angiography and have provided a detailed anatomical description. Materials and Methods The distribution of APAs was evaluated in 121 consecutive male patients between February 2006 and July 2007 who underwent 64-channel MDCT angiography of the lower extremities. We defined an APA as any artery located within the periprostatic region running parallel to the dorsal vascular complex. We also subclassified APAs into lateral and apical APAs. Two radiologists retrospectively evaluated the origin, course and number of APAs; the final APA subclassification based on MDCT angiography source data was determined by consensus. Results We identified 44 APAs in 36 of 121 patients (30%). Two distinct varieties of APAs were identified. Thirty-three APAs (75%) coursed near the anterolateral region of the prostatic apex, termed apical APAs. The remaining 11 APAs (25%) coursed along the lateral aspect of the prostate, termed lateral APAs. All APAs originated from the internal obturator artery and iliac artery or a branch of the iliac artery such as the inferior vesical artery. The majority of apical APAs arose from the internal obturator artery (84%). Seven patients (19%) had multiple APAs. Conclusion APAs are more frequently detected by the use of MDCT angiography than as suggested by previous surgical studies. The identification of APAs on MDCT angiography may provide useful information for the surgical preservation of APAs during a laparoscopic or robot-assisted radical prostatectomy.
Park, Beom Jin; Kim, Min Ju; Cho, Sung Bum; Kim, Yun Hwan; Chung, Kyoo Byung; Kang, Seok Ho; Cheon, Jun
Gallbladder removal - laparoscopic - discharge
... procedure called a laparoscopic cholecystectomy. Your doctor made 1 - 3 small cuts in your belly and used a ... Recovering from laparoscopic cholecystectomy usually takes around ... you recover: Pain in your belly. You may also feel pain in 1 or ...
[Laparoscopic appendectomy during pregnancy].
Results of diagnostic laparoscopy and laparoscopic appendectomy in 28 pregnant women are presented. Diagnostic laparoscopy was carried out in 9 women (32%), laparoscopic appendectomy--in 19 women (68%). Advantages of laparoscopic appendectomy are especially notable at late pregnancy. Due to small traumaticity amount of postoperative complications reduces, rehabilitation terms decrease, good conditions are formed for adequate self-independent birth activity and birth of healthy infants. Laparoscopic appendectomy application allows minimizing negative influence of carboxyperitoneum on pregnant uterus and fetus. PMID:19365328
Sazhin, V P; Klimov, D E; Sazhin, I V; Iurishchev, V A
Robotic-assisted laparoscopic mesh sacrocolpopexy
The current �gold standard� surgical repair for apical prolapse is the abdominal mesh sacrocolpopexy. Use of a robotic-assisted laparoscopic surgical approach has been demonstrated to be feasible as a minimally invasive approach and is gaining popularity amongst pelvic floor reconstructive surgeons. Although outcome data for robotic-assisted sacrocolpopexy (RASC) is only just emerging, several small series have demonstrated anatomic and functional outcomes, as well as complication rates, comparable to those reported for open surgery. The primary advantages thus far for RASC over open surgery include decreased blood loss and shorter hospital stay.
Gilleran, Jason P.; Johnson, Matthew; Hundley, Andrew
A laparoscopic transgastric approach to the treatment of sphincter of Oddi dysfunction postgastric bypass.
Obesity is endemic and bariatric surgery is increasing in an attempt to reduce the physiological and social cost. As the prevalence of bariatric surgery increases, in particular laparoscopic roux-en-Y gastric bypass (LRYGB), the need to investigate and treat subsequent pathology in the gastric remnant and biliary tree will accrue. We describe a novel combined surgical and endoscopic technique addressing the challenges of postoperative anatomy, allowing investigation and treatment of the gastric remnant and biliary tract. We present the case of a patient with sphincter of Oddi dysfunction post-LRYGB who underwent laparoscopic transgastric endoscopic injection of Botox into the ampulla with an excellent symptomatic relief. Subsequent laparoscopic transgastric sphincterotomy allowed definitive treatment and allowed symptom resolution at 6 months follow-up. Laparoscopic transgastric endoscopic investigation and treatment is a novel approach to circumvent the restrictions of post-LRYGB anatomy and may assume greater importance in an ageing obese population. PMID:23704421
Dickinson, Karen J; Beckett, Conrad G; May, John C; Halstead, James C
Laparoscopic tubotubal reanastomosis.
Normal patency was restored to the right fallopian tube of a 41-year-old sterilised woman by laparoscopic tubotubal reanastomosis. We believe that this is the first report of this procedure in Australia. Laparoscopic tubotubal reanastomosis combines the high success rates of microsurgical tubotubal reanstomosis with the advantages of the laparoscopic approach. PMID:9379977
St George, L I; Kapila, H B; Lahoud, R H
NSDL National Science Digital Library
Anatomy truly gets interactive via these collection of fun and engaging games, videos, and other multimedia excursions. The site was created by Ben Crossett, a science teacher in Australia. Several years ago, he decided to craft some new resources like "Poke a Muscle" and "Whack-A-Bone" that would be both entertaining and educational. Visitors can look at the Games By Body System to get started, or they can also look over the Games By Type area. The types of games here include jigsaw puzzles, crosswords, word searches, and the nice catch all Just For Fun. The activities are also made interesting by the mere fact that they contain catchy visuals and jaunty tunes. The site also includes a place where teachers can offer feedback and an area just for students.
Crossett, Ben
NSDL National Science Digital Library
Bartelby.com (last reviewed in the May 12, 2000 Scout Report) has placed yet another classic reference work online. This time, it's the 20th edition (1918) of Henry Gray's Anatomy of the Human Body. At Bartleby, the classic is given a new feel, with its 1,247 illustrations ("many in color and unchanged since the first edition of 1859") rendered in multiple resolutions, and its 13,000 entries presented in an encyclopedic subject index with hyperlinks to their respective pages and illustrations in the text. As with other Bartleby texts, access is free and the electronic book is searchable by keyword or browseable via the table of contents. The illustrations may also be accessed directly and browsed by thumbnail.
NSDL National Science Digital Library
This website, crafted by the State University of New York-Upstate Medical University, brings together key resources for students and others interested in human anatomy. These materials were designed with first year medical students in mind, but they will also be of use to individuals taking biology and other science-related courses. On the site, visitors can make their way through six sections ranging from extremities to the head and neck. Each area contains a variety of detailed anatomical charts, glossaries, and images. Radiology resources are also prominently featured within each section, providing students with a different perspective of the human body through x-rays, CT scans, and MRIs. Other helpful resources include fact sheets, quizzes, teaching materials, and other freely available course materials offered from other medical schools.
... Date: 04/12/2013 Related A-Z Topics Endometriosis Menstruation and Menstrual Problems Pelvic Floor Disorders All ... Health and Disease Branch Seeking New Treatments for Endometriosis 2012 Division of Intramural Research (DIR) Annual Report ...
... the pelvic floor . Layers of connective tissue called fascia also provide support. These supporting muscles and fascia ... intestine into the upper part of the vagina. Fascia: Tissue that supports the organs and muscles of ...
Total Pelvic Floor Reconstruction
\\u000a The pelvic organs are suspended by ligaments. Pelvic muscle forces stretch the organs against these ligaments to give them\\u000a shape, strength, and function, much like a trampoline or suspension bridge. Childbirth stretches the ligaments and fascia\\u000a laterally to cause fascial damage and ligamentous laxity. One consequence of this damage is organ prolapse. Another is organ\\u000a dysfunction, because the ligaments also
Peter Papa Petros
[Laparoscopic-assisted colectomy].
After gaining experience in laparoscopic cholecystectomy, laparoscopic appendectomy and other laparoscopic procedures, we decided to perform laparoscopic-assisted colectomy. During July 1992 to February 1993 we performed 14 such procedures. Ages ranged from 46-83 years (mean, 68). In all cases the indication for surgery was neoplasm of the colon. 8 of the tumors were located in the right colon and 6 in the sigmoid. Procedures performed were laparoscopic-assisted right hemicolectomy with a biofragmentable anastomotic ring or laparoscopic-assisted sigmoidectomy with end-to-end anastomosis. In 1 operation we combined laparoscopic cholecystectomy with laparoscopic right hemicolectomy. Operation time varied from 90-130 min (mean, 100 min). In our opinion the procedure is as radical as standard laparotomy with the number of lymph nodes per specimen ranging from 4-10 (mean, 7); the surgical margins were free of tumor in all cases. There was less pain in the postoperative period than with the standard procedure and the average time from operation to discharge was 7 days (range, 5-9). Complications included 1 fatality due to postoperative myocardial infarction, and 1 case of duodenal perforation which was sutured during the operation. We conclude that laparoscopic-assisted right hemicolectomy and laparoscopic sigmoidectomy are feasible for carcinoma, and that recovery is quicker and with less pain. However, we need a larger series and long-term follow-up to conclude whether the laparoscopic assisted technic is an adequate operation in cases of cancer. PMID:8144081
Walfisch, S; Twena, M; Avinoah, E; Charuzi, I
Life-threatening rupture of an external iliac artery pseudoaneurysm caused by necrotizing fasciitis following laparoscopic radical cystectomy: a case report
Background Pseudoaneurysms are caused by trauma, tumors, infections, vasculitis, atherosclerosis and iatrogenic complications. In this paper, we report about a patient with rupture of an external iliac artery pseudoaneurysm, which lead to hemorrhagic shock, after undergoing laparoscopic radical cystectomy and extended pelvic lymphadenectomy. Case presentation The patient was a 68-year-old Japanese male diagnosed with invasive bladder cancer. Laparoscopic radical cystectomy and extended pelvic lymphadenectomy were performed. On postoperative day 12, he developed a high fever and an acute inflammatory response with redness and swelling in the right inguinal region. He was diagnosed with necrotizing fasciitis and underwent debridement. On postoperative day 42, a sudden hemorrhage developed from the open wound in the right inguinal region. He was diagnosed with external iliac artery pseudoaneurysm rupture by computed tomography. Conclusion These complications occur extremely rarely after cystectomy with pelvic lymphadenectomy. There are no reports to date on these complications following laparoscopic cystectomy with pelvic lymphadenectomy.
Urinary Function following Laparoscopic Lymphadenectomy for Male Rectal Cancer
Objectives Urinary function can be protected following open lateral node dissection (LND) with pelvic autonomic nerve preservation (PANP) for advanced rectal cancer. However data regarding urinary function after laparoscopic LND with PANP have not been reported. The goal of this study was to determine the effects of laparoscopic LND with PANP on urinary function in male patients with rectal cancer. Methods Urine flowmetry was performed using an Urodyn flowmeter. Patients were also asked to complete the standardized International Prostate Symptom Score (IPSS) questionnaire before surgery and 6 months after. In total, this study consisted of 60 males with advanced rectal cancer. Results No significant differences were seen in maximal urinary flow rate, voided volume or residual volume before and after surgery. The total IPSS score increased significantly after surgery and at least 41 patients (68.3%) reported there was no change in one of the seven IPSS questions. Conclusions Laparoscopic LND with PANP was relatively safe in preserving urinary function.
Cao, Yong-kuan; Zhang, Lin; Wang, Pei-hong; Tang, Li-jun
The nail unit comprises the nail plate, the surrounding soft tissues, and their vasculature and innervation based upon the distal phalanx. The nail plate is a laminated keratinized structure lying on the nail matrix (15-25%), the nail bed with its distal onychodermal band (75-85%), and the hyponychium at its free edge. The distal part of the matrix, the lunula characterized by its half-moon shape, can be observed in some digits. The nail plate is embedded by the proximal and lateral folds. From the proximal nail fold, the cuticle (also known as the eponychium), adheres to the superficial surface of the proximal nail plate. The nail unit possesses a complex and abundant vascular network to ensure adequate blood supply. Finally, both the periungual soft tissues and the nail folds are innervated. The shapes, structure, and inter-relationships of these tissues are factors in the way nails present with disease and how we understand and manage those diseases. In particular, an understanding of the surgical anatomy is important for those undertaking diagnostic or curative operations on the nail. With this knowledge, the most appropriate surgery can be planned and the patient can be provided with accurate and clear guidance to enable informed consent. PMID:24079579
de Berker, David
Introduction Since the first reported laparoscopic sacrocolpopexy in 1991, a limited number of single-center studies have attempted to assess the procedure�s effectiveness and safety. Therefore, we analyzed a national Medicare database to compare real-world short-term outcomes of open and laparoscopic-assisted (including robotic) sacrocolpopexy on a United States sample of patients. Methods Public Use File data for a 5% random national sample of all Medicare beneficiaries age 65 and older were obtained from the Centers for Medicare and Medicaid Services for years 2004�2008. Women with pelvic organ prolapse were identified using ICD-9 diagnosis codes. CPT-4 procedure codes were used to identify women who underwent open (code 57280) or laparoscopic (code 57425) sacrocolpopexy. Individual subjects were followed for one year post-operatively. Outcomes measured, using ICD-9 and CPT-4 codes, included medical and surgical complications and re-treatment rates. Results 794 women underwent open and 176 underwent laparoscopic sacrocolpopexy. Laparoscopic sacrocolpopexy was associated with a significantly increased rate of re-operation for anterior vaginal wall prolapse (3.4% vs. 1.0%, p = 0.018). However, more medical (primarily cardiopulmonary) complications occurred post-operatively in the open group (31.5% vs. 22.7%, p = 0.023). When sacrocolpopexy was performed with concomitant hysterectomy, mesh-related complications were significantly higher in the laparoscopic group (5.4% vs. 0%, p = 0.026). Conclusion Laparoscopic sacrocolpopexy resulted in increased rate of reoperation for prolapse in anterior compartment. When hysterectomy was performed at the time of sacrocolpopexy, the laparoscopic approach was associated with an increased risk of mesh-related complications.
Khan, Aqsa; Alperin, Marianna; Wu, Ning; Clemens, J. Quentin; Dubina, Emily; Pashos, Chris L.; Anger, Jennifer T.
Effect of Laparoscopic Hysterectomy on the Vascularization of the Lower Urinary Tract
Introduction: The aim of this prospective study was to evaluate the changes in the vascularization of the lower urinary tract following laparoscopic hysterectomy (LH). Methods: Seventy women undergoing LH not under the indication of a uterine myoma were included. All subjects underwent urinalysis, pelvic examination, and introital color Doppler ultrasonography and completed a urinary questionnaire before and 6 months after
Cheng-Min Liu; Eing-Mei Tsai; Shih-Cheng Hsu; Chin-Hu Wu; Chiu-Lin Wang; Cheng-Yu Long
Diagnosis of pelvic inflammatory disease: time for a rethink
Objectives: To critically evaluate the available evidence base concerned with the diagnosis of pelvic inflammatory disease (PID) based on clinical presentation, and to investigate the relation between signs and symptoms and the presence of laparoscopically diagnosed PID using the largest available dataset. Methods: The evidence base was critically evaluated and data collected by Lund University between 1960 and 1969 were used to compare clinical presentation with the results of laparoscopic investigation. Three techniques were used in this investigation�sensitivity and specificity, likelihood ratios, and discriminant analysis. Results: None of the variables (abnormal vaginal discharge, fever >38�C, vomiting, menstrual irregularity, ongoing bleeding, symptoms of urethritis, rectal temperature >38�C, marked tenderness of pelvic organs on bimanual examination, adnexal mass, and erythrocyte sedimentation rate ?15 mm in the first hour) had both high specificity and sensitivity�most had low specificity and sensitivity. There was little variation in either the likelihood ratios or the post-test probabilities between the variables. The lowest likelihood ratio (0.97) produced a post-test probability of 78% (95% CI: 74% to 81%) whereas the highest (1.73) had a post-test probability of 84% (95% CI: 81% to 87%). The pretest probability of having PID based on the presence of lower abdominal pain was 79% (95% CI: 76% to 82%). The discriminant analysis indicated that three variables significantly influenced the prediction of the presence of PID: erythrocyte sedimentation rate (p<0.0001), fever (p<0.0001), and adnexal tenderness (p<0.0001). These variables correctly classified 65% of patients with laparoscopically diagnosed PID (95% CI: 61% to 69%). Conclusion: There is insufficient evidence to support existing diagnostic criteria, which have been based on a combination of empirical data and expert opinion. A new evidence base is urgently needed but this will require either a new investigation of the association between clinical presentation and PID based on a laparoscopic "gold standard" or the development of new diagnostic techniques.
Simms, I; Warburton, F; Westrom, L
Pelvic discontinuity: current solutions.
Pelvic discontinuity represents a rare but challenging problem for orthopaedic surgeons. It is most commonly encountered during revision total hip replacement, but can also result from an iatrogentic acetabular fracture during hip replacement. The general principles in management of pelvic discontinuity include restoration of the continuity between the ilium and the ischium, typically with some form of plating. Bone grafting is frequently required to restore pelvic bone stock. The acetabular component is then impacted, typically using an uncemented, trabecular metal component. Fixation with multiple supplemental screws is performed. For larger defects, a so-called 'cup-cage' reconstruction, or a custom triflange implant may be required. Pre-operative CT scanning can greatly assist in planning and evaluating the remaining bone stock available for bony ingrowth. Generally, good results have been reported for constructs that restore stability to the pelvis and allow some form of biologic ingrowth. PMID:24187366
Petrie, J; Sassoon, A; Haidukewych, G J
[Optimization of surgical treatment of pelvic prolapse in women].
The study was aimed to improving the efficiency and reducing the incidence of complications after transvaginal pelvic reconstructive surgery with the installation of synthetic mesh prosthesis for pelvic organ prolapse. The study involved 228 patients with II-IV stage pelvic prolapse, of which 144 (63.2%) underwent surgery by the TVM (Tension-free Vaginal Mesh) method, and 84 (36.8 %)--by the original method with the installation of patented mesh implant. In the group of patients who underwent reconstruction of the pelvic floor with the implantation of mesh prosthesis, original in form and method of installation, in the postoperative period significantly less stress urinary incontinence was detected, better functional results have been found, and significantly fewer intra- and postoperative complications were diagnosed. Transvaginal pelvic floor reconstruction with the use of technology to minimize operational approaches when setting the original mesh implant allows to effectively restoring the normal anatomy of the vagina, and characterized by high safety and good functional results. PMID:24649760
Tarasov, N I; Mironov, V N
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Sagittal spinal pelvic alignment.
The goal of any ambulatory patient is to maintain a horizontal gaze with the least amount of energy expenditure. With progressive deformity, and in particular sagittal malalignment, significant compensatory mechanisms must be used to achieve this goal. Each pelvis dictates the amount of lumbar lordosis required through its morphometric parameter pelvic incidence. The pelvis may compensate for decreasing lumbar lordosis (eg, age, flat back deformity) by retroverting and increasing pelvic tilt and decreasing the sacral slope. Underappreciation for these spinopelvic compensatory mechanisms leads to surgical under-correction, iatrogenic flat back and poor clinical outcomes. PMID:23561554
Klineberg, Eric; Schwab, Frank; Smith, Justin S; Gupta, Munish C; Lafage, Virginie; Bess, Shay
Laparoscopic microsurgical tubal anastomosis.
The authors explored the feasibility of performing true microsurgery through the laparoscope in 1990. The first laparoscopic microsurgical tubal anastomosis was performed in February 1992. Operative laparoscopy will continue to expand as technical feasibility continues to improve, driven by both hardware advances and increased surgical dexterity. Laparoscopic microsurgery will introduce a new dimension to reproductive surgery and over time, will replace laparotomy for microsurgery. PMID:10083938
Koh, C H; Janik, G M
... a tampon, urinary and/or bowel fecal incontinence, vaginal dryness or irritation, and pain with intercourse. As the pelvic organ prolapse gets worse some women complain of: A bulging, pressure heavy sensation in the vagina that worsens by the end of the day ...
Teaching instrument: a laparoscopic training model.
A laparoscopic training model with female surface anatomy has been developed. This training model is made of a plastic boutique-showing model that is equivalent to normal-size female anatomy from the neck to the upper thigh. Four holes were made on the model's abdominal wall as puncture-sites to enter the cavity, the first is 80-mm diameter at the umbilical area, and the other three 38-mm diameter holes are located on both sides of the lower abdomen and suprapubic area. The umbilical hole can be covered with a simulated abdominal wall made from 6.5-mm insulation sheet, fixed to the model using a rubber band. The other three puncture-sites were plugged with a flexible rubber diaphragm as working ports. When used as video-laparoscopy, the auto-focus camcorder is used as a telescope and is connected to a regular television set as a monitor. This model can be used for training of abdominal entry by Veress needle or trocar, laparoscopic tubal ligation (LTL), and video-eye-hand co-ordination. This model has been a training medium in our Department for 1 year and was included in the OSCE for the Board Examination of the Royal Thai College of Obstetricians and Gynecologists in the year 2000 to assess the process of Veress needle insertion. PMID:11853305
Tintara, H; Choobun, T
Neural control of the female urethral and anal rhabdosphincters and pelvic floor muscles
The urethral rhabdosphincter and pelvic floor muscles are important in maintenance of urinary continence and in preventing descent of pelvic organs [i.e., pelvic organ prolapse (POP)]. Despite its clinical importance and complexity, a comprehensive review of neural control of the rhabdosphincter and pelvic floor muscles is lacking. The present review places historical and recent basic science findings on neural control into the context of functional anatomy of the pelvic muscles and their coordination with visceral function and correlates basic science findings with clinical findings when possible. This review briefly describes the striated muscles of the pelvis and then provides details on the peripheral innervation and, in particular, the contributions of the pudendal and levator ani nerves to the function of the various pelvic muscles. The locations and unique phenotypic characteristics of rhabdosphincter motor neurons located in Onuf's nucleus, and levator ani motor neurons located diffusely in the sacral ventral horn, are provided along with the locations and phenotypes of primary afferent neurons that convey sensory information from these muscles. Spinal and supraspinal pathways mediating excitatory and inhibitory inputs to the motor neurons are described; the relative contributions of the nerves to urethral function and their involvement in POP and incontinence are discussed. Finally, a detailed summary of the neurochemical anatomy of Onuf's nucleus and the pharmacological control of the rhabdosphincter are provided.
de Groat, William C.
Laparoscopic Sigmoidectomy for Fistulized Diverticulitis
PURPOSE: Nowadays laparoscopic colorectal surgery has demonstrated its advantages, including reduced postopera- tive pain, decreased duration of ileus, and shorter hospital stay. Few studies report results of laparoscopic surgery in complicated diverticulitis. This study was designed to ana- lyze the results of laparoscopic sigmoidectomy in patients with fistulized sigmoiditis. METHODS: The authors retro- spectively reviewed 16 patients who had laparoscopic
S. R. Laurent; B. Detroz; O. Detry; C. Degauque; P. Honor�; M. Meurisse
PurposeTraditionally, live renal donors are evaluated with excretory urography and renal arteriography. Helical computerized tomography (CT) arteriography offers a less invasive alternative for demonstrating necessary anatomical information before laparoscopic allograft harvest. We evaluate the accuracy of helical CT arteriography in depicting renal vascular anatomy with an emphasis on the detection of arterial and venous anomalies.
Laparoscopic Radical Prostatectomy
Objectives: In an effort to reduce the morbidity associated to radical prostatectomy, we implemented laparoscopic surgery to this advanced ablative and reconstructive procedure. In our study, we describe our operative technique and assess our results in terms of oncologic cure, continence and potency.Methods: 200 patients with clinically localized prostate cancer underwent laparoscopic radical prostatectomy. 66 of these patients were either
Andr�s Hoznek; Laurent Salomon; Leif Eric Olsson; Patrick Antiphon; Fabien Saint; Antony Cicco; Dominique Chopin
A minimally invasive approach to undergraduate anatomy teaching
NSDL National Science Digital Library
Anatomy is one of the cornerstones of medical education. Unfortunately, sufficient evidence has accumulated to suggest a worldwide decline in the resources and time allocated to its teaching. Integration of anatomy with clinical medicine has been frequently advocated as the solution to this academic crisis. Consequently, new ways of harnessing clinical relevance to the teaching of anatomy must be sought to make it applicable to contemporary clinical practice. Human cadavers have been used to teach laparoscopic skills to surgical trainees for some time. More recently, centers in the United States have piloted the use of minimally invasive techniques in the teaching of anatomy to undergraduates. We believe that the use of laparoscopy on human cadavers may also be used to complement the teaching of anatomy to United Kingdom and European medical students. This would not only familiarize students with the topography and morphology of human anatomy, but also with the concept of manipulating anatomical structures to achieve a clinical outcome. Other benefits include improved three-dimensional orientation, increased dexterity, and development team-working skills amongst students. A UK feasibility study is currently underway.
Dr. Petrut Gogalniceanu (University College London)
Anatomy Atlases - A Digital Library of Anatomy Information
NSDL National Science Digital Library
This website provides a collection of anatomy atlases and encyclopedias including: Atlas of Human Anatomy, Atlas in Human Anatomy in Cross Section, Illustrated Encyclopedia of Human Anatomic Variation, Atlas of Microscopic Anatomy - A Functional Approach, and Anatomy of First Aid. Within each resource, images, original plates, and descriptions relevant to the image are provided.
PhD Ronald A Bergman (University of Iowa Carver College of Medicine)
This paper describes an extremely rare case of a huge aneurysmal bone cyst (ABC) in the pelvis, occurring in the patient�s 5th decade of life. The patient presented with a history of painless huge pelvic mass for 10 years. Plain radiograph and computed tomography showed huge expansile lytic lesion arising from the right iliac bone. A biopsy was performed and histology confirmed diagnosis of aneurysmal bone cyst. Unfortunately, the patient succumbed to profuse bleeding from the tumour.
Sharifah, MIA; Nor Hazla, MH; Suraya, A; Tan, SP
Anatomy is one of the oldest branches of medicine, with historical records dating back at least as far as the 3rd century\\u000a bc; animal research dates back equally as far. Aristotle (384�322 bc) studied comparative animal anatomy and physiology, and Erasistratus of Ceos (304�258 bc) studied live animal anatomy and physiology (1). Galen of Pergamum (129�199 ad) is probably the
Alexander J. Hill; Paul A. Iaizzo
The Virtual Pelvic Floor, a tele-immersive educational environment.
This paper describes the development of the Virtual Pelvic Floor, a new method of teaching the complex anatomy of the pelvic region utilizing virtual reality and advanced networking technology. Virtual reality technology allows improved visualization of three-dimensional structures over conventional media because it supports stereo vision, viewer-centered perspective, large angles of view, and interactivity. Two or more ImmersaDesk systems, drafting table format virtual reality displays, are networked together providing an environment where teacher and students share a high quality three-dimensional anatomical model, and are able to converse, see each other, and to point in three dimensions to indicate areas of interest. This project was realized by the teamwork of surgeons, medical artists and sculptors, computer scientists, and computer visualization experts. It demonstrates the future of virtual reality for surgical education and applications for the Next Generation Internet. Images Figure 1 Figure 2 Figure 3
Pearl, R. K.; Evenhouse, R.; Rasmussen, M.; Dech, F.; Silverstein, J. C.; Prokasy, S.; Panko, W. B.
The Virtual Pelvic Floor, a tele-immersive educational environment.
This paper describes the development of the Virtual Pelvic Floor, a new method of teaching the complex anatomy of the pelvic region utilizing virtual reality and advanced networking technology. Virtual reality technology allows improved visualization of three-dimensional structures over conventional media because it supports stereo vision, viewer-centered perspective, large angles of view, and interactivity. Two or more ImmersaDesk systems, drafting table format virtual reality displays, are networked together providing an environment where teacher and students share a high quality three-dimensional anatomical model, and are able to converse, see each other, and to point in three dimensions to indicate areas of interest. This project was realized by the teamwork of surgeons, medical artists and sculptors, computer scientists, and computer visualization experts. It demonstrates the future of virtual reality for surgical education and applications for the Next Generation Internet. PMID:10566378
Pearl, R K; Evenhouse, R; Rasmussen, M; Dech, F; Silverstein, J C; Prokasy, S; Panko, W B
Delayed Infection of a Pelvic Lymphocele following Robotic Radical Prostatectomy and Pelvic Lymphadenectomy: Two Cases
Pelvic lymphocele is an infrequent complication of pelvic surgery, usually presenting shortly after surgery. We report 2 cases with a delayed infected pelvic lymphocele presenting after transperitoneal pelvic lymphadenectomy and robotic radical prostatectomy for adenocarcinoma of the prostate. These cases illustrate that late infection of pelvic lymphoceles may occur following radical prostatectomy and pelvic lymphadenectomy. The practicing urologist should be
Mathias Tremp; Tullio Sulser; Hans-Helge Seifert
Pelvic, Hip, and Thigh Injuries
\\u000a Pelvic, hip, and thigh injuries are relatively rare in the young athlete (1). The young athlete with pelvic or hip pain may present with an acute injury necessitating immediate treatment. An acute\\u000a injury may cause pain in the pelvic, hip, thigh, or even knee region. More commonly, the young athlete will have a chronic\\u000a injury that will limit activities during
Jason H. Nielson
Outcome in Pelvic Ring Fractures
\\u000a Abstract\\u000a ��Pelvic ring fractures represent a negative prognostic factor for what concerns morbidity and mortality of a polytraumatized\\u000a patient. The subjective and functional prognosis of a pelvic ring fracture is dependent upon its degree of instability. Associated\\u000a severe peripelvic soft tissue injuries and neurovascular lesions (complex pelvic trauma) affect outcome negatively. Although\\u000a high rates of anatomic reduction and stable fixation
Martin H. Hessmann; Marcus Rickert; Alexander Hofmann; Pol M. Rommens; Michael Buhl
Various types of total laparoscopic nerve-sparing radical hysterectomies and their effects on bladder function
Objective This study was conducted to ascertain the correlation between preserved pelvic nerve networks and bladder function after laparoscopic nerve-sparing radical hysterectomy. Methods Between 2009 and 2011, 53 patients underwent total laparoscopic radical hysterectomies. They were categorized into groups A, B, and C based on the status of preserved pelvic nerve networks: complete preservation of the pelvic nerve plexus (group A, 27 cases); partial preservation (group B, 13 cases); and complete sacrifice (group C, 13 cases). To evaluate bladder function, urodynamic studies were conducted preoperatively and postoperatively at 1, 3, 6, and 12 months after surgery. Results No significant difference in sensory function was found between groups A and B. However, the sensory function of group C was significantly lower than that of the other groups. Group A had significantly better motor function than groups B and C. No significant difference in motor function was found between groups B and C. Results showed that the sensory nerve is distributed predominantly at the dorsal half of the pelvic nerve networks, but the motor nerve is predominantly distributed at the ventral half. Conclusion Various types of total laparoscopic nerve-sparing radical hysterectomies can be tailored to patients with cervical carcinomas.
Fujiwara, Kazuko; Ebisawa, Keiko; Hada, Tomonori; Ota, Yoshiaki; Andou, Masaaki
University of Portland Summer Courses- Anatomy & Anatomy Lab
NSDL National Science Digital Library
This website provides course information for intensive course study during summer school at the University of Portland. The courses available include: Anatomy, Anatomy Lab, Physiology and Physiology Lab.
University of Portland (University of Portland)
Pediatric Laparoscopic Nissen Fundoplication
MedlinePLUS Videos and Cool Tools
PEDIATRIC LAPAROSCOPIC NISSEN FUNDOPLICATION MOTHER AND CHILD HOSPITAL PRESBYTERIAN ST. LUKE�S, DENVER, COLORADO Broadcast September 8, 2005 ... m Dr. Steven Rothenberg and I�m a pediatric surgeon at the Mother and Child Hospital at ...
Laparoscopic Ventral Hernia Repair
... technique to fix tears or openings in the abdominal wall using small incisions, laparoscopes (small telescopes inserted into ... a patch (screen or mesh) to reinforce the abdominal wall. It may offer a quicker return to work ...
Cholecystectomy - Open and Laparoscopic
Cholecystectomy - Open and Laparoscopic Introduction Gallstones are a relatively common condition that causes severe pain in the abdomen. Sometimes, even though ... cystic duct to the common bile duct. Symptoms and their Causes Stones can form in the gallbladder. ...
Use of a laparoscopic instrument to improve urethrovesical anastomosis quality during retropubic radical prostatectomy.
Urethrovesical or urethroileal anastomosis is a critical step during radical surgery to obtain good postoperative continence without restenosis of the lumen. A number of surgical maneuvers and technical devices have been proposed for safer reconstruction of the urethrovesical junction. We experimentally used a 25-charrier cystoscope sheath as a guide for exact placement of sutures on the urethral stump with an instrument designed to perform laparoscopic sutures. Among the advantages of this technique are easy and quick placement of the stitches, which can be placed to an exact depth and in the desired direction. We believe that future modifications of laparoscopic instruments will make oncologic pelvic surgery easier. PMID:10708148
Escand�n, A S; Garcia, O G
ERIC Educational Resources Information Center
Anatomy departments across Africa were surveyed regarding the type of curriculum and method of delivery of their medical courses. While the response rate was low, African anatomy departments appear to be in line with the rest of the world in that many have introduced problem based learning, have hours that are within the range of western medical�
Kramer, Beverley; Pather, Nalini; Ihunwo, Amadi O.
Learning laparoscopic myomectomy
To describe and to analyse the learning effect in laparoscopic myomectomy. Hospital chart records of 351 patients were retrospectively\\u000a evaluated. Myomectomy was performed in a standardised fashion. To assess a potential learning effect, only cases presenting\\u000a a singular intramural fibroid were analysed if a surgeon had done more than ten laparoscopic myomectomies of this type. Cases\\u000a were analysed according to
C. Altgassen; S. Kuss; U. Berger; W. Michels; K. Diedrich; A. Schultze-Mosgau
Laparoscopic tubal anastomosis.
We conducted a retrospective chart review of 22 laparoscopic tubal anastomoses performed between May 1987 and May 1991. The procedures were modeled after the two-stitch technique of Swolin. Overall fertility rates were disappointing in this small series, although the first live birth has occurred. The two-stitch method and available laparoscopic suture needles and needle holders limited the surgical results. Modifications of technique and instrumentation should improve fertility outcome. PMID:9050454
Reich, H; McGlynn, F; Parente, C; Sekel, L; Levie, M
Transitions in laparoscopic cholecystectomy
��Background: Ambulatory laparoscopic cholecystectomy is a common practice in the United States, but its development remains\\u000a slow in most other countries. The objective of the current study was to report the impact of ambulatory surgery on the practice\\u000a of laparoscopic cholecystectomy in a major teaching hospital since the inception of the service. Methods: The hospital database\\u000a of patients who underwent
H. Lau; D. C. Brooks
Laparoscopic Repair of Left Lumbar Hernia After Laparoscopic Left Nephrectomy
Lumbar hernias, rarely seen in clinical practice, can be acquired after open or laparoscopic flank surgery. We describe a successful laparoscopic preperitoneal mesh repair of multiple trocar-site hernias after extraperitoneal nephrectomy. All the key steps including creating a peritoneal flap, reducing the hernia contents, and fixation of the mesh are described. A review of the literature on this infrequent operation is presented. Laparoscopic repair of lumbar hernias has all the advantages of laparoscopic ventral hernia repair.
Milone, Luca; Gumbs, Andrew; Turner, Patricia
Anatomy 199 Basic Human Anatomy Course Syllabus
NSDL National Science Digital Library
This Word document contains the course syllabus (with schedule) for a one-quarter (i.e. 10 week), five-credit undergraduate human anatomy course, which serves health science majors from multiple areas. This course was designed to either meet for lecture three days a week (1.5 hour lectures; the posted syllabus is based on three lectures per week) or five days a week (50 minute lectures), along with laboratory once a week (2 hour lab). The laboratory portion of the course uses prosected cadavers, bones, and models. This basic human anatomy course normally has between 200-450 students registered per quarter.
Dr. Jennifer M Burgoon (The Ohio State University Division of Anatomy)
The spastic pelvic floor syndrome
To determine whether a persistent contraction of the pelvic floor muscle during straining, as observed in constipated patients during defaecography, was due to a conscious action of the patients or really represented a functional disorder, segmental colonic transit studies were performed in 24 patients in whom the diagnosis spastic pelvic floor syndrome was made. Abnormal segmental transit indicating outlet obstruction
H. C. Kuijpers; G. Bleijenberg; H. de Morree
Explorable Three-Dimensional Digital Model of the Female Pelvis, Pelvic Contents, and Perineum for Anatomical Education
ERIC Educational Resources Information Center
The anatomy of the pelvis is complex, multilayered, and its three-dimensional organization is conceptually difficult for students to grasp. The aim of this project was to create an explorable and projectable stereoscopic, three-dimensional (3D) model of the female pelvis and pelvic contents for anatomical education. The model was created using�
Sergovich, Aimee; Johnson, Marjorie; Wilson, Timothy D.
Imaging of bariatric surgery: normal anatomy and postoperative complications.
Obesity is a disease that has reached epidemic proportions in the United States and around the world. During the past 2 decades, bariatric surgery has become an increasingly popular form of treatment for morbid obesity. The most common bariatric procedures performed include laparoscopic Roux-en-Y gastric bypass, laparoscopic adjustable gastric banding, and laparoscopic sleeve gastrectomy. Fluoroscopic upper gastrointestinal examinations and abdominal computed tomography (CT) are the major imaging tests used to evaluate patients after these various forms of bariatric surgery. The purpose of this article is to present the surgical anatomy and normal imaging findings and postoperative complications for these bariatric procedures at fluoroscopic examinations and CT. Complications after Roux-en-Y gastric bypass include anastomotic leaks and strictures, marginal ulcers, jejunal ischemia, small bowel obstruction, internal hernias, intussusception, and recurrent weight gain. Complications after laparoscopic adjustable gastric banding include stomal stenosis, malpositioned bands, pouch dilation, band slippage, perforation, gastric volvulus, intraluminal band erosion, and port- and band-related problems. Finally, complications after sleeve gastrectomy include postoperative leaks and strictures, gastric dilation, and gastroesophageal reflux. The imaging features of these various complications of bariatric surgery are discussed and illustrated. PMID:24471382
Levine, Marc S; Carucci, Laura R
MR angiography is a powerful tool in evaluating anatomy and pathology when applied to the male pelvis. MR angiography produces high-quality images of the arterial system approaching the resolution of CT angiography, without ionizing radiation. Additional advantages include the ability to obtain angiographic images in the absence of contrast material with non-contrast-enhanced MR angiographic techniques. Blood pool contrast agents, such as gadofosveset, have significantly improved the quality of venous system imaging. Steady state imaging with blood pool contrast agents allows for acquisition of superior-quality high-resolution images and other time-intensive techniques. PMID:24792680
Sutphin, Patrick D; Kalva, Sanjeeva P
Robot-Assisted Laparoscopic Pyeloplasty
\\u000a Laparoscopic pyeloplasty offers the success of open surgery with the benefit of decreased postoperative pain and decreased\\u000a length of stay. Its use, however, is limited by the steep learning curve required for proficient laparoscopic skills. The\\u000a introduction of robotic assistance shortens the laparoscopic learning curve and may allow increased use of laparoscopy in\\u000a performing pediatric laparoscopic pyeloplasty. This chapter describes
Chad R. Tracy; Craig A. Peters
Pelvic muscle rehabilitation: a standardized protocol for pelvic floor dysfunction.
Introduction. Pelvic floor dysfunction syndromes present with voiding, sexual, and anorectal disturbances, which may be associated with one another, resulting in complex presentation. Thus, an integrated diagnosis and management approach may be required. Pelvic muscle rehabilitation (PMR) is a noninvasive modality involving cognitive reeducation, modification, and retraining of the pelvic floor and associated musculature. We describe our standardized PMR protocol for the management of pelvic floor dysfunction syndromes. Pelvic Muscle Rehabilitation Program. The diagnostic assessment includes electromyography and manometry analyzed in 4 phases: (1) initial baseline phase; (2) rapid contraction phase; (3) tonic contraction and endurance phase; and (4) late baseline phase. This evaluation is performed at the onset of every session. PMR management consists of 6 possible therapeutic modalities, employed depending on the diagnostic evaluation: (1) down-training; (2) accessory muscle isolation; (3) discrimination training; (4) muscle strengthening; (5) endurance training; and (6) electrical stimulation. Eight to ten sessions are performed at one-week intervals with integration of home exercises and lifestyle modifications. Conclusions. The PMR protocol offers a standardized approach to diagnose and manage pelvic floor dysfunction syndromes with potential advantages over traditional biofeedback, involving additional interventions and a continuous pelvic floor assessment with management modifications over the clinical course. PMID:25006337
Pedraza, Rodrigo; Nieto, Javier; Ibarra, Sergio; Haas, Eric M
Pelvic Muscle Rehabilitation: A Standardized Protocol for Pelvic Floor Dysfunction
Introduction. Pelvic floor dysfunction syndromes present with voiding, sexual, and anorectal disturbances, which may be associated with one another, resulting in complex presentation. Thus, an integrated diagnosis and management approach may be required. Pelvic muscle rehabilitation (PMR) is a noninvasive modality involving cognitive reeducation, modification, and retraining of the pelvic floor and associated musculature. We describe our standardized PMR protocol for the management of pelvic floor dysfunction syndromes. Pelvic Muscle Rehabilitation Program. The diagnostic assessment includes electromyography and manometry analyzed in 4 phases: (1) initial baseline phase; (2) rapid contraction phase; (3) tonic contraction and endurance phase; and (4) late baseline phase. This evaluation is performed at the onset of every session. PMR management consists of 6 possible therapeutic modalities, employed depending on the diagnostic evaluation: (1) down-training; (2) accessory muscle isolation; (3) discrimination training; (4) muscle strengthening; (5) endurance training; and (6) electrical stimulation. Eight to ten sessions are performed at one-week intervals with integration of home exercises and lifestyle modifications. Conclusions. The PMR protocol offers a standardized approach to diagnose and manage pelvic floor dysfunction syndromes with potential advantages over traditional biofeedback, involving additional interventions and a continuous pelvic floor assessment with management modifications over the clinical course.
Pedraza, Rodrigo; Nieto, Javier; Ibarra, Sergio; Haas, Eric M.
Laparoscopic cholecystectomy in situs inversus-our experience of 6 cases.
Laparoscopic cholecystectomy is the standard procedure for symptomatic gall stone disease. Situs inversus is a condition where the visceral anatomy is reversed. Laparoscopic cholecystectomy in a patient of situs inversus is a technically difficult procedure. Six patients of situs inversus underwent laparoscopic cholecystectomy from January 2003 to December 2009. In the first patient of situs inversus, we operated by placing the ports in mirror image fashion as that of standard laparoscopic cholecystectomy. However in next five patients we modified the technique by interchanging the epigastric and left mid clavicular line ports to overcome the problem of handedness. The procedure was successfully completed in all six patients. No intraoperative or postoperative complications occurred. The mean operating time was 65�mins (45-85�mins). Laparoscopic cholecystectomy is safe in patients of situs inversus. However, extreme care and skill is required to identify the reversed anatomy and to overcome the problem of handedness. Interchanging the epigastric and left mid clavicular line ports makes the procedure easier. PMID:21966139
Patle, Nirmal M; Tantia, Om; Sasmal, Prakash Kumar; Khanna, Shashi; Sen, Bimalendu
Laparoscopic repair for groin hernias
Laparoscopic inguinal herniorrhaphy was first described by Ger, Schultz, Corbitt, and Filipi in the early 1990s (1-4) and burst upon the surgical scene just after laparoscopic cholecystectomy. It rapidly became popular, and many different techniques for repair were developed. Over the last decade much good work has been done to find which type of laparoscopic repair is best, to determine
Chad J. Davis; Maurice E. Arregui
Anatomy Atlases: A Digital Library of Anatomy Information
NSDL National Science Digital Library
This collection of atlases and textbooks is intended to educate patients, healthcare providers, and students in anatomy. Topics include human anatomy, human anatomy in cross-section, microscopic anatomy, anatomy of first aid, human anatomic variation, and osteology. The collection includes both historic and modern atlases, is searchable by keyword or term, and includes a frequently-asked-questions feature. Other materials include user reviews and links to related digital libraries.
Laparoscopic Versus Open Appendectomy
Summary Background Data: The value of laparoscopy in appendicitis is not established. Studies suffer from multiple limitations. Our aim is to compare the safety and benefits of laparoscopic versus open appendectomy in a prospective randomized double blind study. Methods: Two hundred forty-seven patients were analyzed following either laparoscopic or open appendectomy. A standardized wound dressing was applied blinding both patients and independent data collectors. Surgical technique was standardized among 4 surgeons. The main outcome measures were postoperative complications. Secondary outcome measures included evaluation of pain and activity scores at base line preoperatively and on every postoperative day, as well as resumption of diet and length of stay. Activity scores and quality of life were assessed on short-term follow-up. Results: There was no mortality. The overall complication rate was similar in both groups (18.5% versus 17% in the laparoscopic and open groups respectively), but some early complications in the laparoscopic group required a reoperation. Operating time was significantly longer in the laparoscopic group (80 minutes versus 60 minutes; P = 0.000) while there was no difference in the pain scores and medications, resumption of diet, length of stay, or activity scores. At 2 weeks, there was no difference in the activity or pain scores, but physical health and general scores on the short-form 36 (SF36) quality of life assessment forms were significantly better in the laparoscopic group. Appendectomy for acute or complicated (perforated and gangrenous) appendicitis had similar complication rates, regardless of the technique (P = 0.181). Conclusions: Unlike other minimally invasive procedures, laparoscopic appendectomy did not offer a significant advantage over open appendectomy in all studied parameters except quality of life scores at 2 weeks. It also took longer to perform. The choice of the procedure should be based on surgeon or patient preference.
Katkhouda, Namir; Mason, Rodney J.; Towfigh, Shirin; Gevorgyan, Anna; Essani, Rahila
Sectional depiction of the pelvic floor by CT, MR imaging and sheet plastination: computer-aided correlation and 3D model
The structures of the pelvic floor are clinically important but difficult to assess. To facilitate the understanding of the\\u000a complicated pelvic floor anatomy on sectional images obtained by CT and MR imaging, and to make the representation more vivid,\\u000a a computer-aided 3D model was created from a male and a female torso to develop a teaching tool. A male and
D. Beyersdorff; T. Schiemann; M. Taupitz; H. Kooijman; B. Hamm; V. Nicolas
Psychological Aspects of the Pelvic Exam
Many women are traumatized by pelvic exanimations, resulting in reactions ranging from mild anxiety and embarrassment to avoiding the exam altogether. Studies which surveyed how women feel about pelvic exams are discussed and analyzed as are projects utilizing the educational pelvic exam approach. The concept of psychological preparation for pelvic exams is presented incorporating the importance of personal control. The
Alice D Domar
Anatomy and Physiology Everyday
NSDL National Science Digital Library
Students use information from newspaper articles to write a paper or presentation on the correlation of information from the article and their understanding of it using knowledge gained in anatomy and physiology class.
Teresa Alvarez (St. Louis Community College Forest Park AHNS)
Dream Anatomy Learning Station
NSDL National Science Digital Library
This Web site contains the educational materials for Dream Anatomy, a new exhibit at the National Library of Medicine. Viewable online, the exhibit offers a somewhat macabre but undeniably fascinating survey of changes in anatomical representation over the last five centuries. Recently added to the main Dream Anatomy Web site, Learning Station provides lesson plans and activities intended for 6-12 graders. The material can be used exhibit or its online version. The lesson plans titled Beginnings of Anatomical Illustrations (grades 6-12) and Anatomical Metaphors (grades 7-8) have especially strong life sciences applications. Other online activities offer "fun ways for high school and older students to explore the content of Dream Anatomy." Altogether, Dream Anatomy Learning Station offers students a unique look at the intersection of art, science, and the imagination.
Laparoscopic sacrocolpopexy: results of a 100-patient series with 8�years follow-up
ObjectiveAssess the feasibility, safety and results at mean term of laparoscopic promontofixation, and to describe the operative technique.DesignRetrospective study.SettingDepartment of Gynaecology, Obstetrics and Reproductive Medicine, Caen University Hospital, France.SampleOne hundred patients included from June 1993 to June 2001.MethodsPre- and post-operative clinical assessment of pelvic statics problems in accordance with the international POP-Q classification. Annual follow-up of patients and recording of
Peter von Theobald; Ang�lique Ch�ret
Recurrence of unclassifiable uterine cancer after modified laparoscopic hysterectomy with morcellation.
In a premenopausal patient with a 1-year history of abnormal bleeding laparoscopic supracervical hysterectomy in combination with vaginal intrafascial cylindriform enucleation of the cervix was performed. Histologic evaluation of the morcellated uterus was unremarkable. Five months later the patient was diagnosed with a pelvic mass consistent with an undifferentiated adenocarcinoma. Retrospective evaluation of the cored and morcellated hysterectomy specimen showed clusters of malignant cells that may have been detected by preoperative curettage. PMID:9290479
Schneider, A
Percutaneous transhepatic cholangiography for choledocholithiasis after laparoscopic gastric bypass surgery
INTRODUCTION Gallstones are a common condition in bariatric patients after a laparoscopic Roux-en-Y gastric bypass (LRYGB). The management of ductal stones is challenging due to the altered gastrointestinal anatomy. Various techniques have been reported to manage bile duct stones. PRESENTATION OF CASE We present the successful percutaneous trans hepatic management of common bile duct stones after LRYGB. One year after a LRYGB for morbid obesity, a 59-year-old female presented with acute cholecystitis. One month after laparoscopic cholecystectomy a 1�cm calculus was found within the distal CBD and patient underwent a percutaneous trans hepatic cholangiography under local anesthetic. This involved a right sided anterior segmental duct puncture. With the sphincter dilated to 10�mm, a balloon catheter was used to push the stone into the duodenum leaving an internal- external drain. Patient recovered completely at follow up. DISCUSSION Patients with morbid obesity have a higher incidence of gallstones. After LRYGB, the altered anatomy does not allow the conventional endoscopic retrograde cholangiopancreatography (ERCP) for choledocholithiasis. Various techniques have been reported as means of managing bile duct stones in LRYGB patients. These include a double balloon enteroscope-assisted ERCP, laparoscopic transgastric ERCP, laparoscopic or open biliary surgery and interventional radiology. We report a non-surgical approach using percutaneous transhepatic technique under local anesthetic that resulted effective and could be applied more extensively. CONCLUSION Due to the increase of global obesity, bariatric centers need to strategically plan resources such as interventional radiology in order to manage post LRYGB choledocholithiasis safely, efficiently and in a cost effective manner.
Milella, Marialessia; Alfa-Wali, Maryam; Leuratti, Luca; McCall, James; Bonanomi, Gianluca
Should women with chronic pelvic pain have adhesiolysis?
Background Pelvic adhesions are found in up to 50% of women with CPP during investigative surgeries and adhesiolysis is often performed as part of their management although the causal or casual association of adhesions, and the clinical benefit of adhesiolysis in the context of CPP is still unclear. Our aim was to test the hypothesis of whether laparoscopic adhesiolysis leads to significant pain relief and improvement in quality of life (QoL) in patients with chronic pelvic pain (CPP) and adhesions. Methods This was a double-blinded RCT. This study was conducted in 2 tertiary referral hospitals in United Kingdom over 4�years. Women with chronic pelvic pain (CPP) were randomized into having laparoscopic adhesiolysis or diagnostic laparoscopy. Women were assessed at 0, 3 and 6�months for Visual analogue scale scores (VAS) and Quality of Life (QoL) measures (SF-12 and EHP-30). Results A total of 92 participants were recruited; 50 qualified to be randomized, with 26 in the adhesiolysis and 24 in the control group. The results are expressed in median (interquartile ranges). In women who underwent adhesiolysis, there was a significant improvement at 6�months in VAS scores (-17.5 (-36.0 - -5.0) compared to controls (-1.5 (-15.0 � 4.5; p?=?0.048); SF-12 scores physical component score (25.0 (18.8 � 43.8)) compared to controls (6.3 (-6.3 � 18.8); p?=?0.021), SF-12 emotional component score 32.5 (4.4 � 48.8) compared to controls -5 (-21.3 � 15.0); p?0.0074) and EHP-30 emotional well being domain 32.5 (4.4 � 48.8) compared to the controls -5 (-21.3 � 15.0; p?0.0074). Conclusions This study stopped before recruitment reached the statistically powered sample size due to difficulty with enrollment and lack of continued funding. In selected population of women presenting to the gynecological clinic with chronic pelvic pain, adhesiolysis in those who have adhesions may be of benefit in terms of improvement of pain and their quality of life. Trial registration number ISRCTN 43852269
Laparoscopic radical prostatectomy
Millions of men are diagnosed annually with prostate cancer worldwide. With the advent of PSA screening, there has been a shift in the detection of early prostate cancer, and there are increased numbers of men with asymptomatic, organ confined disease. Laparoscopic radical prostatectomy is the latest, well accepted treatment that patients can select. We review the surgical technique, and oncologic and functional outcomes of the most current, large series of laparoscopic radical prostatectomy published in English. Positive margin rates range from 2.1�6.9% for pT2a, 9.9�20.6% for pT2b, 24.5�42.3% for pT3a, and 22.6�54.5% for pT3b. Potency rates after bilateral nerve sparing laparoscopic radical prostatectomy range from 47.1 to 67%. Continence rates at 12 months range from 83.6 to 92%.
Lipke, Michael; Sundaram, Chandru P.
Laparoscopically Assisted Spinal Surgery
Background: Spinal surgery is one of the newest frontiers of videolaparoscopic surgery, but requires the cooperative efforts of both the spinal surgeon and the laparoscopic general surgeon. Data Base: We report our experience with 76 cases of laparoscopic spinal surgery, using both a transperitoneal and a retroperitoneal approach. Technical details and complications are described in detail. Conclusions: Fifty-one patients had a transperitoneal approach with an average operating time of 117 minutes. Uncomplicated cases stayed 4.4 days. Five patients required conversion. All but one patient had L5-S1 level surgery. Twenty-five patients had a retroperitoneal approach with 150 minutes operating time and a 5.7 day stay. Conversions were minimized with a two-balloon technique. The retroperitoneal approach allows for multiple level surgery with virtually unlimited fusion devices. Laparoscopically assisted spine surgery affords all the benefits of minimally invasive surgery, without limitations for the spinal surgeon.
Cattey, Richard P.; Stoll, James E.; Robbins, Stephen
Interstitial Cystitis and Endometriosis in Patients With Chronic Pelvic Pain: The "Evil Twins" Syndrome
Objective: To determine the prevalence of interstitial cystitis and endometriosis in patients with chronic pelvic pain. Methods: A prospective analysis was conducted in 178 women with CPP who presented with bladder base/anterior vaginal wall and/or uterine tenderness, with or without irritative voiding symptoms. The Potassium Sensitivity Test was used to assess bladder epithelial dysfunction. Patients were evaluated with concurrent laparoscopy and cystoscopy with hydrodistention. Results: Laparoscopic findings among the 178 patients with chronic pelvic pain supported a diagnosis of endometriosis in 134 (75%) patients, and cystoscopy confirmed a diagnosis of interstitial cystitis in 159 (89%) patients. Both interstitial cystitis and endometriosis were diagnosed in 115 patients (65%). The Potassium Sensitivity Test was positive in 146 (82%) patients, with 140 (96%) of these patients diagnosed with interstitial cystitis and 105 (72%) with endometriosis. Conclusions: Results of this prospective study show that interstitial cystitis and endometriosis may frequently coexist in patients with chronic pelvic pain. A positive Potassium Sensitivity Test accurately predicted the presence of interstitial cystitis in 96% of these patients with chronic pelvic pain, as confirmed by cystoscopic hydrodistention. It is necessary to consider the diagnosis of endometriosis and interstitial cystitis concurrently in the evaluation of patients with chronic pelvic pain to avoid unnecessary delay in identifying either condition.
Chung, Rosemary P.; Gordon, David
... Date: 04/12/2013 Related A-Z Topics Endometriosis Menstruation and Menstrual Problems Pelvic Floor Disorders All ... Health and Disease Branch Seeking New Treatments for Endometriosis 2012 Division of Intramural Research (DIR) Annual Report ...
Pelvic Inflammatory Disease (PID) Treatment
... Treatment Archive STDs Home Page Bacterial Vaginosis (BV) Chlamydia Gonorrhea Hepatitis Herpes HIV/AIDS & STDs Human Papillomavirus (HPV) Pelvic Inflammatory Disease (PID) STDs & Infertility Syphilis Trichomoniasis Other STDs File Formats Help: How ...
Pelvic Inflammatory Disease (PID) Statistics
... 45 Pelvic Inflammatory Disease�Hospitalizations of Women Aged 15�44 Years, United States, 1998�2010 Click for ... Initial Visits to Physicians� Offices by Women Aged 15�44 Years, United States, 2003�2012 Click for ...
Abdominal wall paresis as a complication of laparoscopic surgery
Purpose��Abdominal wall nerve injury as a result of trocar placement for laparoscopic surgery is rare. We intend to discuss causes\\u000a of abdominal wall paresis as well as relevant anatomy.\\u000a \\u000a \\u000a \\u000a Methods��A review of the nerve supply of the abdominal wall is illustrated with a rare case of a patient presenting with paresis of\\u000a the internal oblique muscle due to a trocar
G. H. van Ramshorst; G.-J. Kleinrensink; J. J. Hermans; T. Terkivatan; J. F. Lange
Effectiveness of ovarian suspension in preventing post-operative ovarian adhesions in women with pelvic endometriosis: A randomised controlled trial
Background��Endometriosis is a common benign condition, which is characterized by the growth of endometrial-like tissue in ectopic sites\\u000a outside the uterus. Laparoscopic excision of the disease is frequently carried out for the treatment of severe endometriosis.\\u000a Pelvic adhesions often develop following surgery and they can compromise the success of treatment. Ovarian suspension (elevating\\u000a both ovaries to the anterior abdominal wall
Wee-Liak Hoo; Ertan Saridogan; Alfred Cutner; George Pandis; Davor Jurkovic
Current status of robotically assisted laparoscopic surgery in reproductive medicine and gynaecology.
Laparoscopic techniques have revolutionized the concept of minimally invasive surgery. Robotically assisted surgery is one of the latest innovations in this field and many operative laparoscopic procedures have been performed in urology, cardiac and general surgery. More recently, the use of robotically assisted techniques have been introduced in gynaecology, and most available studies have shown it to be a safe and effective alternative to conventional laparoscopic surgery. However, whether or not to approach the management of certain gynaecological pathologies with a laparotomy or laparoscopy (conventional or with robotic aid) continues to be a point of debate. This article reviews recent developments in the endoscopic management of reproductive (tubal reanastomosis and myomectomies) and other gynaecological surgical conditions (hysterectomies, pelvic organ prolapse, repair of vesicovaginal fistulas and staging for gynaecological malignancies). Ongoing controversies associated with this technology, such as cost, learning curve, conversion rate to laparotomy, post-surgical fertility and complications, are briefly addressed. Long-term analysis of outcomes is ongoing. PMID:17579994
Bocca, Silvina; Stadtmauer, Laurel; Oehninger, Sergio
Chronic pelvic pain is a major public health problem for women throughout the developed world. The complex innervation of the pelvis and the anatomical proximity of pelvic viscera mean this symptom frequently overlaps traditional medical specialties, leading to diagnostic delay and frequently inadequate treatment. Careful history taking and examination can in itself be therapeutic and will likely identify a number of causal and perpetuating factors which should be managed within the context of a multidisciplinary clinic. PMID:19240284
Vincent, K
Chronic and Recurrent Pelvic Pain
\\u000a Chronic and recurrent pelvic pain (CPP) in �children and adolescents has been recognized for decades. However, data on the\\u000a etiology, natural history, treatment, and long-term consequences of painful pelvic conditions in these patients are lacking.\\u000a The problem�s prevalence remains uncertain, and the majority of therapies are extrapolated from research on adults. The normal\\u000a developmental changes and coping strategies of children
Lynda Wells
Laparoscopic cholecystectomy for a left-sided gallbladder.
Cholecystectomy is a common procedure. Abnormalities in the anatomy of the biliary system are common but an abnormal location of the gallbladder is much rarer. Despite frequent pre-operative imaging, the aberrant location of the gallbladder is commonly discovered at surgery. This article presents a case of a patient with the gallbladder located to the left of the falciform ligament in the absence of situs inversus totalis that presented with right upper quadrant pain. A laparoscopic cholecystectomy was performed and it was noted that the cystic duct originated from the right side. The presence of a left sided gall bladder is often associated with various biliary, portal venous and other anomalies that might lead to intra-operative injuries. The spectrum of unusual positions and anatomical gallbladder abnormalities is reviewed in order to facilitate elective and emergent cholecystectomy as well as other hepatobiliary procedures. With proper identification of the anatomy, minimally invasive approaches are still considered safe. PMID:24124340
Iskandar, Mazen E; Radzio, Agnes; Krikhely, Merab; Leitman, I Michael
Laparoscopic cholecystectomy for a left-sided gallbladder
Cholecystectomy is a common procedure. Abnormalities in the anatomy of the biliary system are common but an abnormal location of the gallbladder is much rarer. Despite frequent pre-operative imaging, the aberrant location of the gallbladder is commonly discovered at surgery. This article presents a case of a patient with the gallbladder located to the left of the falciform ligament in the absence of situs inversus totalis that presented with right upper quadrant pain. A laparoscopic cholecystectomy was performed and it was noted that the cystic duct originated from the right side. The presence of a left sided gall bladder is often associated with various biliary, portal venous and other anomalies that might lead to intra-operative injuries. The spectrum of unusual positions and anatomical gallbladder abnormalities is reviewed in order to facilitate elective and emergent cholecystectomy as well as other hepatobiliary procedures. With proper identification of the anatomy, minimally invasive approaches are still considered safe.
Iskandar, Mazen E; Radzio, Agnes; Krikhely, Merab; Leitman, I Michael
Laparoscopic vaginoplasty using a sigmoid graft through the umbilical single-incision hybrid transperineal approach: our initial experience.
Abstract Background: For better cosmetic appearance, attempts to reduce the number of laparoscopic wounds have been sought. Investigators have thus begun to carry out procedures through a single incision or natural orifice endoscopic surgery instead of using conventional laparoscopic surgery. The authors here describe transumbilical single-incision hybrid transperineal laparoscopic surgery as a novel approach for vaginoplasty using a sigmoid graft. Patients and Methods: From August 2010 to October 2012, 15 young females with Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome underwent laparoscopic sigmoid vaginosplasty using a combined transumbilical single-incision and transperineal approach. A multichannel single port was placed through the umbilical incision for the main laparoscopic procedures. A 12-mm trocar as an assisting working port was inserted into the pelvic cavity through the transvaginal dimple between the rectum and urethra. Results: A functioning vagina 12-15?cm in length and approximately 4?cm in width was created in all the patients. The average operative time and hospital stay were 151.5�34.2 minutes and 7.4�3.2 days, respectively. The only perioperative complications were 1 case of stress ulcer and 1 case with umbilical infection. All patients were satisfied with the surgery, and 12 of them had subsequent sexual activity. Conclusions: Transumbilical single-incision hybrid transperineal laparoscopic sigmoid vaginoplasty offers a feasible scarless approach for females with MRKH syndrome. The favorable cosmetic results would favor use of this type of vaginoplasty as an alternative to the conventional laparoscopic approach. PMID:24438220
Li, Suolin; Sun, Chi; Shi, Bin; Li, Meng; Liu, Lin
Laparoscopically assisted vaginal radical hysterectomy: systematic review of the literature.
Laparoscopically assisted vaginal radical vaginal hysterectomy (LAVRH), a minimally invasive technique that seems to be an attractive alternative to traditional surgery, remains unexplored in the treatment of cervical cancer. We searched Medline (1966-2013) and Scopus (2004-2013) search engines, as well as reference lists from all included studies. Ten studies were retrieved; including 6 retrospective cohort studies, 2 prospective cohort studies, 1 retrospective randomized trial, and a phase II randomized control trial. LAVRH provided equal recurrence-free rates when performed in patients with tumors not exceeding 2 cm in greatest diameter. Its main advantages seem to be less intraoperative blood loss and more radical pelvic lymphadenectomy. The primary disadvantages of the technique are a higher rate of disease-positive surgical margins, resulting in the need for adjuvant therapy, and the slow learning curve required for a surgeon to gain expertise. With use in minimally invasive surgery of newer techniques such as total laparoscopic radical hysterectomy and robotic-assisted radical hysterectomy, and possible future adoption of more conservative techniques such as cervical conization with pelvic lymphadenectomy, the question remains as to whether LAVRH will be adopted by the surgical community or lost to oblivion. PMID:23850361
Pergialiotis, Vassileios; Rodolakis, Alexandros; Christakis, Dimitrios; Thomakos, Nikolaos; Vlachos, Georgios; Antsaklis, Aristides
Pregnancy after laparoscopic sacral colpopexy: a case report.
We report a case of a pregnancy and follow the delivery of a young woman who previously underwent a laparoscopic sacral colpopexy (LSC) for pelvic organ prolapse (POP). A 38-year-old woman with POP desires pregnancy who after unsuccessful medical treatment with pessary underwent a laparoscopic uterine ventrosuspension (LUV). However, this procedure also failed and there was an immediate relapse. Thus, LSC was then performed. After which, she became pregnant culminating in elective caesarean delivery. The LUV failure was documented by a POP-Q classification and dynamic pelvic magnetic resonance (PMR) which was carried out 1 month after the surgery. When the same assessment was conducted after the LSC, it showed an optimal POP correction. The short-term post-delivery follow-up exhibited a small prolapse relapse, which remained stable 48 months after surgery as confirmed by a new PMR. Surgical correction of POP is possible in women with pregnancy desires. The result is variable and links to the POP stage and other surgical interventions. PMID:22120886
Gadonneix, Pierre; Campagna, Giuseppe; Villet, Richard
Laparoscopic hysterectomy: challenges and limitations.
Twenty years after the first description of vaginal hysterectomy with laparoscopic assistance by Kurt Semm in 1984 (1), and 16 years after the publication of the so-called laparoscopically assisted vaginal hysterectomy (LAVH) by Harry Reich in 1989 (2), it is time to review and evaluate the real benefits of laparoscopic hysterectomy. Although laparoscopic surgery is well accepted by gynaecologists worldwide for the treatment of certain gynaecological conditions, laparoscopic hysterectomy in Germany, and probably worldwide, is still only performed by a few specialists. Highly skilled surgical techniques, longer operating time and expensive technology are suggested to be the deterring factors. Laparoscopic hysterectomy, in its different forms, is an attractive and safe procedure for the management of benign gynaecological conditions and many authorities recommend its use on a larger extent. On the other hand, in our opinion, the use of laparoscopic hysterectomy for oncological indications is still controversial. Extensive experience of over 15 years, of the first author, in practising and teaching various forms laparoscopic hysterectomy, namely, laparoscopically assisted vaginal hysterectomy (LAVH), total laparoscopic hysterectomy (TLH), classic intrafascial supracervical hysterectomy (CISH) and laparoscopic supracervical hysterectomy (LSH), has led us to the firm conclusion that these techniques are advantageous to patients if performed for the appropriate indication. In particular, subtotal or supracervical hysterectomy, with the cervix remaining in its place, is associated with fewer complications and a very favourable outcome for the patient. Radical laparoscopic vaginal hysterectomy (RLVH), the last variant in our expos�, is only successful in an expert's hands. The surgical techniques of these varieties of laparoscopic hysterectomies will be described and illustrated in detail in this paper. PMID:16754157
Mettler, L; Ahmed-Ebbiary, N; Schollmeyer, T
NSDL National Science Digital Library
This article describes a teaching method that incorporates real world application of anatomy. To apply student's anatomy skills, anatomy students were educated on self defense moves and the anatomy involved to make each action occur.
Dr. Pamela S Stein (University of Kentucky College of Medicine Anatomy and Neurobiology); Dr. April D Richardson (University of Kentucky College of Medicine Anatomy and Neurobiology); Dr. Sandra D Challman (University of Kentucky College of Dentistry Instructional Technology Center)
Imaging in laparoscopic cholecystectomy--what a radiologist needs to know.
Laparoscopic cholecystectomy is the gold standard treatment option for cholelithiasis. In order to properly assess for the complications related to the procedure, an understanding of the normal biliary anatomy, its variants and the normal postoperative imaging is essential. Radiologist must be aware of benefits and limitations of multiple imaging modalities in characterizing the complications of this procedure as each of these modalities have a critical role in evaluating a symptomatic post-cholecystectomy patient. The purpose of this article is describe the multi-modality imaging of normal biliary anatomy and its variants, as well as to illustrate the imaging features of biliary, vascular, cystic duct, infectious as well as miscellaneous complications of laparoscopic cholecystectomy. We focus on the information that the radiologist needs to know about the radiographic manifestations of potential complications of this procedure. PMID:24657107
Desai, Naman S; Khandelwal, Ashish; Virmani, Vivek; Kwatra, Neha S; Ricci, Joseph A; Saboo, Sachin S
Pediatric Laparoscopic Dismembered Pyeloplasty
We performed laparoscopic dismembered pyeloplasty in a boy with right ureteropelvic junction obstruction using 4 cannula sites, and a dismembering and reanastomosis technique identical to that used in open pyeloplasty. Interrupted sutures were placed and tied intracorporeally. A nephrostomy tube was placed under direct vision for drainage but no ureteral stent was used. Total operating time was 5 hours. The
Craig A. Peters; Richard N. Schlussel; Alan B. Retik
The Anatomy of Anatomy: A Review for its Modernization
NSDL National Science Digital Library
This article describes the struggles anatomy education in the United Kingdom is facing, in particular available time and quality instruction for dissection labs. Described are the historical and modern teaching strategies used in anatomy and highlights of the positives and negatives of each. The focus of the author's statement is to highlight the need for a focus in anatomy pedagogy research and anatomy instructor programs.
Kapil Sugand (Imperial College London School of Medicine); Ashish Khurana (University Hospital of Wale Orthopedics)
Laparoscopic vs . Hand-Assisted Laparoscopic Sigmoidectomy for Diverticulitis
Introduction Sigmoid colectomy for diverticulitis can be technically challenging because of severe inflammation in the left-lower quadrant and pelvis. We hypothesized that hand-assisted laparoscopic technique may facilitate laparoscopic completion of this surgery while retaining the short-term benefits associated with �pure� laparoscopic surgery, in which an incision is made only for extracting the specimen. This study was designed to compare the
Sang W. Lee; James Yoo; Nadav Dujovny; Toyooki Sonoda; Jeffrey W. Milsom
An Unusual Extremely Distant Noncommunicating Uterine Horn with Myoma and Adenomyosis Treated with Laparoscopic Hemihysterectomy
A 41-year-old woman referred to us with dysmenorrhea and severe pelvic pain although she was previously submitted to right laparotomic adnexectomy for ovarian endometrioma and to a subsequent operative laparoscopy for pelvic adhesions. After ultrasound examination, the patient underwent diagnostic hysteroscopy and operative laparoscopy which confirmed the clinic suspect of an unicornuate uterus. However, it was very unusual to see an extremely distanced right horn, without communication with uterus, without adnexa, and with a small myoma belonging to it. Moreover, omentum and bowel were attached to fundus of right horn and thick adhesions fixed it to rectum and right pelvic wall. Therefore, identification of anatomical structures was difficult, as it was extremely arduous to isolate the ureter, which was involved inside the adhesions surrounding the right uterine horn. Nevertheless, laparoscopic right hemihysterectomy was successfully performed and right horn was sent to our pathologist who recognized hypotrophic endometrium and adenomyosis.
Morelli, Michele; Mocciaro, Rita; Lico, Daniela; Zullo, Fulvio
Clinical and Functional Anatomy of the Urethral Sphincter
Continence and micturition involve urethral closure. Especially, insufficient strength of the pelvic floor muscles including the urethral sphincter muscles causes urinary incontinence (UI). Thus, it is most important to understand the main mechanism causing UI and the relationship of UI with the urethral sphincter. Functionally and anatomically, the urethral sphincter is made up of the internal and the external sphincter. We highlight the basic and clinical anatomy of the internal and the external sphincter and their clinical meaning. Understanding these relationships may provide a novel view in identifying the main mechanism causing UI and surgical techniques for UI.
Ahn, Hyo Kwang; Huh, Youngbuhm
NSDL National Science Digital Library
Goldfish live in the water. They use their gills to breathe. Goldfish swim in water to move around. This goldfish has pectoral fins, pelvic fins, anal fins, and dorsal fins that it uses to swim. The tail is used to steer the goldfish wherever it is going.
N/A N/A (U.S. National Oceanic and Atmospheric Administration;)
Managing chronic pelvic pain following reconstructive pelvic surgery with transvaginal mesh.
In 2001, the US Food and Drug Administration (FDA) approved the first transvaginal mesh kit to treat pelvic organ prolapse (POP). Since the introduction of vaginal mesh kits, some vaginal meshes have been associated with chronic pelvic pain after reconstructive pelvic floor surgery. Pelvic pain results in between 0�% and 30�% of patients following transvaginal mesh placement. Common causes of chronic pelvic pain include pelvic floor muscle spasm, pudendal neuralgia, and infection. Paucity of data exists on the effective management of chronic pelvic pain after pelvic reconstructive surgery with mesh. We outline the management of chronic pelvic pain after transvaginal mesh placement for reconstructive pelvic floor repair based on our clinical experience and adaptation of data used in other aspects of managing chronic pelvic pain conditions. PMID:24217793
Gyang, Anthony N; Feranec, Jessica B; Patel, Rakesh C; Lamvu, Georgine M
Veterinary Anatomy Instruction
NSDL National Science Digital Library
With one of the most well regarded veterinary schools in the United States, the University of Minnesota continues to break new ground in the training of new veterinarians. Of course, more and more of these training materials are finding their way to the web, and this site will be quite helpful to those persons with an interest in this particular field. Created by different faculty members, the materials here are categorized by the course they are most commonly associated with, such as gross anatomy or neurobiology. In the gross anatomy section, visitors will find materials that include a glossary of terms related to veterinary anatomy and dissections, animations that illustrate the major gaits of various quadrupeds, and the nervous system pathways of canines. The neurobiology section contains instructional materials that include information about brain dissection neuroanatomy and neurohistology.
Radiology Anatomy Teaching Modules
NSDL National Science Digital Library
As more and more individuals elect to enter the various health science professions, there is an increased demand for teaching resources designed to keep students aware of basic skills and techniques. Created by the University of Washington, these radiology anatomy teaching modules are designed to supplement regular instruction and to serve as a reference resource for medical educators and students. Along the left side of the site visitors will find a muscle atlas, an online radiology guide, and the "Teaching Files" area. Further down the homepage, visitors will find the "Anatomy Teaching Modules" section. Here visitors can take advantage of modules that cover the basic radiographic anatomy of selected parts of the skeleton and related resources.
Veterinary Anatomy Instruction
NSDL National Science Digital Library
With one of the most well regarded veterinary schools in the United States, the University of Minnesota continues to break new ground in the training of new veterinarians on a regular basis. Of course, more and more of these training materials are finding their way to the web, and this site will be quite helpful to those persons with an interest in this particular field. Created by different faculty members, the materials here are categorized by the course they are most commonly associated with, such as gross anatomy or neurobiology. In the gross anatomy section, visitors will find materials that include a glossary of terms related to veterinary anatomy and dissections, animations that illustrate the major gaits of various quadrupeds, and the nervous system pathways of canines. The neurobiology section contains instructional materials that include information about brain dissection neuroanatomy and neurohistology.
Fertility Considerations in Laparoscopic Treatment of Infiltrative Bowel Endometriosis
Objective: The purpose of this study was to examine our experience with laparoscopic and laparoscopically assisted management of bowel endometriosis and to recommend treatment approaches, considering patient goals for both pain mitigation or fertility, or both. Methods: The medical records of 187 women treated laparoscopically for intestinal endometriosis were reviewed retrospectively for presenting symptoms, methods of surgical treatment, complications, and efficacy of treating pain and infertility. The extent of resection was determined by the severity of the endometriotic lesion, tempered by the patient's fertility goals. Results: The most common patient complaint preceding surgery was pelvic pain. In addition, 58 (31%) patients experienced impaired fertility. Of the patients available for long-term follow-up, 152 (85%) reported complete or significant long-term pain relief. Complete pain relief in the immediate postoperative period was significantly more likely with partial bowel resection compared with shaving only, 92% vs 80%, respectively, P<0.04. The least invasive procedure, shaving, was associated with a significantly lower complication rate, 6%, compared with 23% for disc excision (P<0.007) and 38% for segmental resection (P<0.001), and higher pregnancy rates. The incidence of pregnancy in patients with a history of infertility was 34% during the follow-up period.
Mohr, Catherine; Nezhat, Farr R.; Nezhat, Ceana H.; Seidman, Daniel S.
Laparoscopic findings of subfertile female patients in a tertiary hospital.
Sub-fertility affects approximately 15% of couples. Approximately 40% of cases involve a male factor, 40% involve a female factor and the remainder involves both sexes. The polycystic ovary syndrome (PCOS) is one of the most common causes of sub-fertility due to anovulation in women. Treatment of sub-fertility in female partners mainly depends on the laparoscopic findings of patients with PCOS, pelvic inflammatory disease (PID), endometriosis and fibroid uterus. Between February 2007 and April 2009, 73 subfertile women with PCOS were evaluated on their laparoscopic findings in a tertiary hospital in Dhaka city. Mean�SD age was 28.55�3.98 years and primary sub-fertility was 68.5% vs. secondary 31.5% (p<0.01). In most cases, uterine size and position was normal (91.8%, p<0.001 and 89%, p<0.001) and 78.1% mobile. In most of the cases pouch of douglas was normal (78.1%, p<0.001) and adhesion absent (72.6%, p<0.001). In majority of the cases both right and left fallopian tubes were patent (80.8% vs. 75.3%) and ovary healthy (65.8% vs. 64.4%). Positive dye test of right and left fallopian tubes was significantly high (p<0.001). Careful evaluation of laparoscopic findings, are likely to help appropriate treatment modalities for desired outcome. PMID:21804500
Anwary, S A; Alfazzaman, M; Nasreen, Z A
The Drosophila anatomy ontology
Background Anatomy ontologies are query-able classifications of anatomical structures. They provide a widely-used means for standardising the annotation of phenotypes and expression in both human-readable and programmatically accessible forms. They are also frequently used to group annotations in biologically meaningful ways. Accurate annotation requires clear textual definitions for terms, ideally accompanied by images. Accurate grouping and fruitful programmatic usage requires high-quality formal definitions that can be used to automate classification and check for errors. The Drosophila anatomy ontology (DAO) consists of over 8000 classes with broad coverage of Drosophila anatomy. It has been used extensively for annotation by a range of resources, but until recently it was poorly formalised and had few textual definitions. Results We have transformed the DAO into an ontology rich in formal and textual definitions in which the majority of classifications are automated and extensive error checking ensures quality. Here we present an overview of the content of the DAO, the patterns used in its formalisation, and the various uses it has been put to. Conclusions As a result of the work described here, the DAO provides a high-quality, queryable reference for the wild-type anatomy of Drosophila melanogaster and a set of terms to annotate data related to that anatomy. Extensive, well referenced textual definitions make it both a reliable and useful reference and ensure accurate use in annotation. Wide use of formal axioms allows a large proportion of classification to be automated and the use of consistency checking to eliminate errors. This increased formalisation has resulted in significant improvements to the completeness and accuracy of classification. The broad use of both formal and informal definitions make further development of the ontology sustainable and scalable. The patterns of formalisation used in the DAO are likely to be useful to developers of other anatomy ontologies.
Medical & Surgical Management of Pelvic Floor Disorders Affecting Defecation
Pelvic floor disorders that affect stool evacuation include structural (example: rectocele) and functional disorders (example: dyssynergic defecation). Meticulous history, digital rectal examination, and physiological tests such as anorectal manometry, colonic transit study, balloon expulsion and imaging studies such as anal ultrasound, defecography, and static and dynamic MRI can facilitate an objective diagnosis and optimal treatment. Management consists of education and counseling regarding bowel function, diet, laxatives, most importantly behavioral and biofeedback therapies, and lastly surgery. Randomized clinical trials have established that biofeedback therapy is effective in treating dyssynergic defecation. Because dyssynergic defecation may co-exist with conditions such as solitary rectal ulcer syndrome (SRUS), and rectocele, before considering surgery, biofeedback therapy should be tried and an accurate assessment of the entire pelvis and its function should be performed. Several surgical approaches have been advocated for the treatment of pelvic floor disorders including open, laparoscopic and trans-abdominal approach, stapled transanal rectal resection (STARR), and robotic colon and rectal resections. However, there is lack of well controlled randomized studies and efficacy of these surgical procedures remains to be established.
Schey, Ron; Cromwell, John; Rao, Satish S.C.
Medical and surgical management of pelvic floor disorders affecting defecation.
Pelvic floor disorders that affect stool evacuation include structural (for example, rectocele) and functional disorders (for example, dyssynergic defecation (DD)). Meticulous history, digital rectal examination (DRE), and physiological tests such as anorectal manometry, colonic transit study, balloon expulsion, and imaging studies such as anal ultrasound, defecography, and static and dynamic magnetic resonance imaging (MRI) can facilitate an objective diagnosis and optimal treatment. Management consists of education and counseling regarding bowel function, diet, laxatives, most importantly behavioral and biofeedback therapies, and finally surgery. Randomized clinical trials have established that biofeedback therapy is effective in treating DD. Because DD may coexist with conditions such as solitary rectal ulcer syndrome (SRUS) and rectocele, before considering surgery, biofeedback therapy should be tried and an accurate assessment of the entire pelvis and its function should be performed. Several surgical approaches have been advocated for the treatment of pelvic floor disorders including open, laparoscopic, and transabdominal approach, stapled transanal rectal resection, and robotic colon and rectal resections. However, there is lack of well-controlled randomized studies and the efficacy of these surgical procedures remains to be established. PMID:22907620
Schey, Ron; Cromwell, John; Rao, Satish S C
Single incision laparoscopic right colectomy
Objective��This study was designed to describe the surgical technique for single-incision laparoscopic right colectomy and present preliminary\\u000a short-term results. Laparoscopic surgery has been fully validated as alternative, minimally invasive treatment for different\\u000a benign and malignant conditions. In the attempt to reduce even more the surgical trauma, natural orifices transluminal endoscopic\\u000a surgery (NOTES�) and single-incision laparoscopic surgery (SILS) have been proposed.
Luigi Boni; Gianlorenzo Dionigi; Elisa Cassinotti; Matteo Di Giuseppe; Mario Diurni; Stefano Rausei; Fabrizio Cantore; Renzo Dionigi
Laparoscopic right hemihepatectomy for hepatolithiasis
Background��Liver resection is the definitive treatment for unilateral hepatolithiasis [1]. Recently, laparoscopic major hepatectomias have become more common and are being performed in highly specialized centers\\u000a [2�4]. However, few laparoscopic liver resections for hepatolithiasis have been reported. Chen et al. [5] reported two cases of laparoscopic left lobectomy for hepatolithiasis, but to our knowledge, right hepatectomy has never\\u000a been reported
M. A. C. Machado; F. F. Makdissi; R. C. T. Surjan; A. R. F. Teixeira; A. Sep�lveda; T. Bacchella; M. C. C. Machado
Learning Anatomy Enhances Spatial Ability
ERIC Educational Resources Information Center
Spatial ability is an important factor in learning anatomy. Students with high scores on a mental rotation test (MRT) systematically score higher on anatomy examinations. This study aims to investigate if learning anatomy also oppositely improves the MRT-score. Five hundred first year students of medicine ("n" = 242, intervention) and�
Vorstenbosch, Marc A. T. M.; Klaassen, Tim P. F. M.; Donders, A. R. T.; Kooloos, Jan G. M.; Bolhuis, Sanneke M.; Laan, Roland F. J. M.
Computational Anatomy: An Emerging Discipline
This paper studies mathematical methods in the emerging new discipline of Computational Anatomy. Herein we formalize the Brown\\/Washington University model of anatomy following the global pattern theory introduced in [1, 2], in which anatomies are represented as deformable templates, collections of 0; 1; 2; 3 dimensional manifolds. Typical structure is carried by the template with the variabilities accommodated via the
Ulf Grenander; Michael I. Miller
Laparoscopic en bloc kidney transplantation
Laparoscopic donor nephrectomy is well establish procedure and having advantages over open donor nephrectomy in terms of having less pain, early ambulation and rapid post operative recovery. To extend the advantages of laparoscopic surgery to the recipient, recently we have performed laparoscopic kidney transplantations when kidney was procured from deceased donors. As a further extension of the procedure, here we present a case of laparoscopic en bloc kidney transplantation in obese diabetic recipient who received kidneys from 70 year old non-heart beating donor.
Modi, Pranjal; Thyagaraj, Krishnaprasad; Rizvi, Syed Jamal; Vyas, Jigish; Padhi, Sukant; Shah, Kamlesh; Patel, Ram
Kegel Exercises for Your Pelvic Muscles
... muscles. Weak pelvic muscles can cause you to leak urine. Fortunately, pelvic muscles are just like other muscles--exercises can make them stronger. People who leak urine may have better control of these muscles ...
[Possibilities of 4D ultrasonography in imaging of the pelvic floor structures].
Technological boom of the last decades brought urogynaecologists and other specialists new possibilities in imaging of the pelvic floor structures which may substantially add to search for etiology of pelvic floor dysfunction. Magnetic resonance imaging (MRI) is an expensive, less accessible method and may pose certain dyscomphort to the patient. 3D/4D ultrasonography overcomes these disadvantages and brings new possibilities especially in dynamic, real time imaging and consequently enables focus on functional anatomy of complex of muscles and fascial structures of the pelvic floor. With 3D/4D ultrasound we can visualise urethra and surrounding structures, levator ani and urogenital hiatus, its changes during muscle contraction and Valsalva man�vre. This method has great potential in diagnostics of pelvic organ prolapse, it may bring new knowledge of factors contributing to loss of integrity of pelvic floor structures resulting in prolapse and incontinence. Studies exist which describe changes in urogenital hiatus after vaginal delivery, further studies of large numbers of patients during longer period of time are though necessary so that conclusions can be drawn for clinical praxis. PMID:22312840
Dlouh�, K; Krofta, L
NSDL National Science Digital Library
This website created by faculty at the University of Zurich and University of Australia provides mini-lectures on regional anatomy. The lectures are broken up by the head, neck & trunk, upper limb, lower Limb, thorax, abdomen, and pelvis. Quizzes for each region are also available.
ERIC Educational Resources Information Center
This document features review questions, crossword puzzles, and word search puzzles on human anatomy. Topics include: (1) Anatomical Terminology; (2) The Skeletal System and Joints; (3) The Muscular System; (4) The Nervous System; (5) The Eye and Ear; (6) The Circulatory System and Blood; (7) The Respiratory System; (8) The Urinary System; (9) The�
Jacob, Willis H.; Carter, Robert, III
NSDL National Science Digital Library
Interactive grasshopper anatomy lessons. Mouthparts, legs, abdomen, various sutures are all featured, as well as well as more general discussions about the types of insect antennae,wings, legs, and mouthparts. An excellent flash demonstration of mouthpart modifications is also featured.
ERIC Educational Resources Information Center
Discusses normal anogenital anatomy in children in relation to the medical evaluation of child sexual abuse and summarizes state of current knowledge. Suggestions for further research, including cross-sectional studies comparing normal and abused children, and cross-sectional and longitudinal studies comparing different racial/ethnic groups.�
Berenson, Abbey B.
ERIC Educational Resources Information Center
In this insect morphology exercise, students study the external anatomy of the worker honeybee. The structures listed and illustrated are discussed in relation to their functions. A goal of the exercise is to establish the bee as a well-adapted, social insect. (MA)
Postiglione, Ralph
This book provides a lavishly illustrated survey of the anatomy of the nematode worm Caenorhabditis elegans. It will undoubtedly be useful and illuminating for the thousands of scientists who use C. elegans as their primary research organism, or to those contemplating a move into C. elegans research. It should also be of considerable value to anyone interested in biological structure
Jonathan Hodgkin
Synthetic biomaterials for pelvic floor reconstruction
Pelvic organ prolapse and stress urinary incontinence increase with age. The increasing proportion of the aging female population\\u000a is likely to result in a demand for care of pelvic floor prolapse and incontinence. Experimental evidence of altered connective\\u000a tissue metabolism may predispose to pelvic floor dysfunction, supporting the use of biomaterials, such as synthetic mesh,\\u000a to correct pelvic fascial defects.
Matthew E. Karlovsky; Leslie Kushner; Gopal H. Badlani
Synthetic biomaterials for pelvic floor reconstruction
Pelvic organ prolapse and stress urinary incontinence increase with age. The increasing proportion of the aging female population\\u000a is likely to result in a demand for care of pelvic floor prolapse and incontinence. Experimental evidence of altered connective\\u000a tissue metabolism may predispose to pelvic floor dysfunction, supporting the use of biomaterials, such as synthetic mesh,\\u000a to correct pelvic fascial defects.
Matthew E. Karlovsky; Leslie Kushner; Gopal H. Badlani
Laparoscopic gastric bypass versus laparoscopic adjustable gastric banding
BackgroundIndications for and results of laparoscopic adjustable gastric banding (LAGB) and laparoscopic gastric bypass (LGB) are still controversial, especially between Europe and the United States. The recent availability of gastric bandings in the United States made it necessary to compare the two techniques.
Laurent Biertho; Rudolf Steffen; Thomas Ricklin; Fritz F Horber; Alfons Pomp; William B Inabnet; Daniel Herron; Michel Gagner
Laparoscopic dissection of the ureter for radical laparoscopic hysterectomy
The most important step in radical hysterectomy is freeing the ureter from the anterior parametrium. In this paper we describe our modified technique for freeing the ureter from the anterior parametrium for a Piver II�III radical hysterectomy by means of pure laparoscopic surgery. Our series consists of seventeen patients undergoing laparoscopic hysterectomy. In evaluating the technique, we considered its feasibility,
Eugenio Volpi; Annamaria Ferrero; Alice Peroglio Carus; Elena Jacomuzzi; Piero Sismondi
Pediatric laparoscopic and robot-assisted laparoscopic surgery: technical considerations.
Laparoscopy has become an effective modality for the treatment of many pediatric urologic conditions that need both extirpative and reconstructive techniques. Laparoscopic procedures for urologic diseases in children, such as pyeloplasty, orchiopexy, nephrectomy, and bladder augmentation, have proven to be safe and effective with outcomes comparable to those of open techniques. Given the steep learning curve and technical difficulty of laparoscopic surgery, robot-assisted laparoscopic surgery (RAS) is increasingly being adopted in pediatric patients worldwide. Anything that can be performed laparoscopically in adults can be extended into pediatric practice with minor technical refinements. We review the role of laparoscopic and RAS in pediatric urology and provide technical considerations necessary to perform minimally invasive surgery successfully. PMID:22050504
Tomaszewski, Jeffrey J; Casella, Daniel P; Turner, Robert M; Casale, Pasquale; Ost, Michael C
Laparoscopic Adjustable Gastric Banding
. We introduced open adjustable silicone gastric banding (ASGB) for treatment of morbid obesity in our institution\\u000a in 1991. It was done in a prospective study comparing ASGB with vertical banded gastroplasty (VBG) with regard to weight loss.\\u000a After 200 cases of open ASGB and 210 VBG procedures and the encouraging weight loss results, we started laparoscopic placement\\u000a of the
Mitiku Belachew; Marc Legrand; Vernon Vincent; Michel Lismonde; Nicole Le Docte; Veronique Deschamps
Laparoscopic adjustable gastric banding
Summary��\\u000a Background: A body mass index (BMI) of 40 or above represents clinically severe obesity, and warrants operative treatment, if requested\\u000a to bariatric surgery. The Adjustable Silicone Gastric Banding (Lap-Band, Bioenterics) and the Swedish Adjustable Gastric\\u000a Band (SAGB, Obtech) are recently produced laparoscopic gastric restrictive procedures. The aim of this study was to assess\\u000a all the possible complications linked to
K. Miller; E. Hell
Laparoscopic surgery for diverticulitis
Background: Resection of diverticular disease may be quite challenging; the acute inflammatory process, thick sigmoid mesentery, and\\u000a any associated fistula or abscess can make this procedure technically demanding. The aim of this study was to compare the\\u000a results between laparoscopic and laparotomy-type resections stratified by disease severity and thereby predict outcome and\\u000a possibly a subset of patients who may benefit
M. E. Sher; F. Agachan; M. Bortul; J. J. Nogueras; E. G. Weiss; S. D. Wexner
Laparoscopic and Robotic Pyeloplasty
\\u000a Laparoscopic pyeloplasty as a treatment option for the obstructed ureteropelvic junction (UPJ) combines the advantage of an\\u000a open reconstruction under direct magnified vision with the low morbidity of an endoscopic approach. First described as a minimally\\u000a invasive treatment option by Schuessler and colleagues in 1993 (1), there are several large published series with extended\\u000a follow-up confirming long-term patency rates of
Sean P. Hedican; Murali K. Ankem
Endovaginal ultrasound-assisted pain mapping in endometriosis and chronic pelvic pain.
The objective of this study was to determine if the combination of tenderness-guided endovaginal ultrasound and digital pelvic exam (i.e. EVUS-assisted exam) for preoperative pain mapping, in cases without nodules or endometriomas, increases sensitivity/specificity for laparoscopic findings. This was a retrospective review of women with chronic pelvic pain � infertility with preoperative pain mapping exam prior to laparoscopy (n = 97, 2006-7). Predictor variables (EVUS-assisted exam vs digital pelvic exam alone, for pain mapping) were coded as tender vs non-tender. Primary outcome was findings on laparoscopy (e.g. endometriosis or adhesions) and was coded as abnormal vs normal. We found that EVUS-assisted exam had greater sensitivity (0.81, 95% CI: 0.70-0.89) for abnormal laparoscopy compared with digital pelvic exam alone (0.58, 95% CI: 0.46-0.69) (McNemar's test, p < 0.001). Specificity was limited for both types of pain mapping (0.22, 95% CI: 0.08-0.44 for EVUS-assisted; and 0.39, 95% CI: 0.20-0.61 for digital), with no significant difference (p = 0.13). In conclusion, in the absence of nodules or endometriomas, EVUS-assisted exam increases sensitivity, but with no benefit in specificity, for prediction of abnormal laparoscopy. PMID:24127962
Yong, P J; Sutton, C; Suen, M; Williams, C
Musculoskeletal morphology of the pelvis and pelvic fins in the lungfish Protopterus annectens.
The West African lungfish (Protopterus annectens) performs benthic, pelvic fin-driven locomotion with gaits common to tetrapods, the sister group of the lungfishes. Features of P. annectens movement are similar to those of modern tetrapods and include use of the distal region of the pelvic fin as a �foot,� use of the fin to lift the body above the substrate and rotation of the fin around the joint with the pelvis. In contrast to these similarities in movement, the pelvic fins of P. annectens are long, slender structures that are superficially very different from tetrapod limbs. Here, we describe the musculoskeletal anatomy of the pelvis and pelvic fins of P. annectens with dissection, magnetic resonance imaging, histology and 3D-reconstruction methods. We found that the pelvis is embedded in the hypaxial muscle by a median rostral and two dorsolateral skeletal projections. The protractor and retractor muscles at the base of the pelvic fin are fan-shaped muscles that cup the femur. The skeletal elements of the fin are serially repeating cartilage cylinders. Along the length of the fin, repeating truncated cones of muscles, the musculus circumradialis pelvici, are separated by connective tissue sheets that connect the skeletal elements to the skin. The simplicity of the protractor and retractor muscles at the base of the fin is surprising, given the complex rotational movement those muscles generate. In contrast, the series of many repeating segmental muscles along the length of the fin is consistent with the dexterity of bending of the distal limb. P. annectens can provide a window into softtissue anatomy and sarcopterygian fish fin function that complements the fossil data from related taxa. This work, combined with previous behavioral examination of P. annectens, illustrates that fin morphologies that do not appear to be capable of walking can accomplish that function, and may inform the interpretation of fossil anatomical evidence. PMID:24741713
King, Heather M; Hale, Melina E
Laparoscopic pylorus-preserving pancreatoduodenectomy
A case of chronic pancreatitis localized in the head of the pancreas with pancreas divisum was treated by laparoscopic pylorus-preserving pancreatoduodenectomy. The laparoscopic technique of resection and reconstruction with a gastrojejunostomy, hepaticojejunostomy, and pancreaticojejunostomy is described. The postoperative period was complicated by a jejunal ulcer and delayed gastric emptying necessitating a prolonged hospitalization and intravenous hyperalimentation. No fistulas occurred, a
M. Gagner; A. Pomp
Laparoscopic colopexy in a horse
An 11-year-old Trakehner gelding required 2 ventral midline celiotomies for correction of a large colon volvulus and a large colon displacement, respectively. Laparoscopic colopexy was performed 50 days following the 2nd celiotomy. Delayed laparoscopic colopexy is minimally invasive and does not disrupt the ventral midline incision following abdominal exploration.
Butt, Troy D.; Wilson, David G.
[Laparoscopic hysterectomy -- indications, technic, complications].
In recent decades, interest in laparoscopic gynecological practice increase. This technic applied first as a diagnostic tool in women with infertility. Subsequently starts to be used to perform surgery in small region of the fallopian tubes and ovaries, being increasingly developed and today, it is considered that any gynecological operation can be performed laparoscopically. PMID:24505638
Bechev, Bl; Kornovski, J; Kostov, I; Lazarov, I
Laparoscopic Radical Prostatectomy: Preliminary Results
Background: Retropubic and perineal radical prostatectomy are used for curative treatment of localized prostate cancer. More complex urological procedures are now being done with laparoscopy. We present our initial results of transperitoneal laparoscopic radical prostatectomy.Materials and Methods: Twenty laparoscopic radical prostatectomies were performed between May 1998 and May 1999. The mean age at the time of surgery was 64.2 years.
F. Jacob; L. Salomon; A. Hoznek; J. Bellot; P. Antiphon; D. K. Chopin; C. C. Abbou
Further phenotypic delineation of subtelomeric (terminal) 4q deletion with emphasis on intracranial and reproductive anatomy
OBJECTIVE: To describe selected morphological and developmental features associated with subtelomeric deletion at chromosome 4q. MATERIALS AND METHODS: A 21-year old female was brought for gynecologic evaluation of menorrhagia. High-resolution metaphase karyotype and subtelomere fluorescent in-situ hybridization (FISH) analysis were used for genotype determination. Pelvic anatomy was characterized via CT and laparoscopy; MR and CT were used for intracranial imaging.
Eric Scott Sills; MJ Burns; Laurinda D Parker; Lisa P Carroll; Lisa L Kephart; CS Dyer; Peter R Papenhausen; Jessica G Davis
The female orgasm: Pelvic contractions
Eleven nulliparous women manually self-stimulated to orgasm, each on three separate occasions. Pelvic contraction pressure was measured by an anal probe and a vaginal probe simultaneously. Near the perceived start of orgasm, a series of regular contractions began in nine of the women. Anal and vaginal contraction waveforms were synchronized with each other, and the same number of orgasmic contractions
Joseph G. Bohlen; James P. Held; Margaret Olwen Sanderson; Andrew Ahlgren
Cyclic pelvic pain and dysmenorrhea.
Primary dysmenorrhea, secondary dysmenorrhea, and cyclic pelvic pain syndromes represent a special subset of CPP. Although more common and no less debilitating, these conditions are better understood, more easily diagnosed, and more successfully treated than chronic pain states. It should be the expectation of both the physician and the patient that successful resolution of these complaints is possible. PMID:8115089
Smith, R P
Robotic-assisted laparoscopic cholecystectomy.
We report a case of laparoscopic cholecystectomy that was performed using a robotic surgical system. A 70-year-old woman underwent laparoscopic robotic cholecystectomy ZEUS, the robotic system used in our study, has three interactive robotic arms fixed to the side of the operating table. The arms are controlled by the surgeon, who sits at a remote computer console. The surgeon's movements can be scaled down, and tremor is filtered out. The robotic-assisted laparoscopic cholecystectomy was completed in 42 min. The time to set up the robot was 22 mins. All of the surgically reproducible robotic maneuvers were performed without any particular difficulty. The robotic movements were stable, accurate, and reliable, as well as easy to control with precision. Our preliminary experience indicates that robotic laparoscopic cholecystectomy is safe and can be as fast as conventional laparoscopic cholecystectomy. However, further clinical applications of robotic surgery are needed to confirm this observation. PMID:11961647
Goh, P M Y; Lomanto, D; So, J B Y
Laparoscopic surgery of the bile ducts.
Laparoscopic surgery of the bile ducts is evolving rapidly. Laparoscopic bile duct exploration is reaching wide application and is competitive with postoperative ERCP for treatment of choledocholithiasis. Staging laparoscopy is an important laparoscopic advance that is increasing resectability rates for pancreatic and hepatic tumors through laparoscopic detection of unresectable tumors. Bile duct injury is an important problem in laparoscopic cholecystectomy. Classification, avoidance, and management are discussed. PMID:8903564
Strasberg, S M; Callery, M P; Soper, N J
Comparison of endopyelotomy and laparoscopic pyeloplasty for poorly functioning kidneys with ureteropelvic junction obstruction
Endopyelotomy and laparoscopic pyeloplasty are established procedures for ureteropelvic junction obstruction (UPJO) and historically a high failure rate has been observed in poorly functioning units with UPJ obstruction. The aim of this study is to compare the results of laparoscopic pyeloplasty with endopyelotomy in poorly functioning renal units, i.e., GFR under 25 ml/min. Materials and Methods: Retrospective analysis of all the patients who underwent either laparoscopic pyeloplasty or endopyelotomy for ureteropelvic junction obstruction in poorly functioning units between January 1998 and June 2005 was done. Follow-up renal scans, done at three, six, 12 months and yearly thereafter, were studied. Success was defined as symptomatic relief and/ or improvement in function (10% over baseline) in renal scan. Results: There were 23 patients in the endopyelotomy group and 15 patients in the laparoscopic pyeloplasty group with mean age of 25.3 years (9-53) and 26 years (10-44), respectively. Mean pelvic volume was 41.2 8cc � 9.5 and 39.1cc � 9.85 in the endopyelotomy group and laparoscopic pyeloplasty group, respectively. Mean preoperative GFR was 17.4 � 5.7 ml/min and 21 � 4.5 ml/min in the endopyelotomy group and laparoscopic pyeloplasty group, respectively and mean postoperative GFR was 21 � 3.5 ml/min and 22 � 3.9 ml/min, respectively. Eighteen and 11 patients were symptomatic in ethe ndopyelotomy group and laparoscopic pyeloplasty group, respectively while symptomatic improvement was seen in 14 and 11 patients, respectively. Mean follow-up was 12 months in the laparoscopy group and 28 months in the endopyelotomy group. Success rate was better for laparoscopic surgery group (15/15 = 100%) than for endopyelotomy (18/23 = 78.26%). Conclusions: Though the improvement in renal function is less in patients with UPJO with poorly functioning kidneys undergoing endopyelotomy or laparoscopic pyeloplasty, laparoscopic pyeloplasty gives better results in the form of symptomatic relief; however, renal function remains stable whichever the approach chosen.
Singh, Pratipal; Kapoor, Rakesh; Suri, Amit; Singh, Kamal Jeet; Mandhani, Anil; Dubey, Deepak; Srivastava, Aneesh; Kumar, Anant
Vaginal childbirth and pelvic floor disorders
Childbirth is an important event in a woman�s life. Vaginal childbirth is the most common mode of delivery and it has been associated with increased incidence of pelvic floor disorders later in life. In this article, the authors review and summarize current literature associating pelvic floor disorders with vaginal childbirth. Stress urinary incontinence and pelvic organ prolapse are strongly associated with vaginal childbirth and parity. The exact mechanism of injury associating vaginal delivery with pelvic floor disorders is not known, but is likely multifactorial, potentially including mechanical and neurovascular injury to the pelvic floor. Observational studies have identified certain obstetrical exposures as risk factors for pelvic floor disorders. These factors often coexist in clusters; hence, the isolated effect of these variables on the pelvic floor is difficult to study.
Memon, Hafsa U; Handa, Victoria L
Simulation techniques in the anatomy curriculum: review of literature.
Modern medical education faces a problem of combining the latest technology, procedures and information with classic teaching methods. Simulation is a technique, which replaces or amplifies doctor-patient experiences in controlled conditions and therefore evokes or replicates substantial aspects of the real world in a fully interactive manner. The basic course of anatomy in medical education could be recognised as the best example of implementing new educational techniques such as simulation, into the traditional medical curriculum. The PubMed database was searched using specific key words. Finally 72 articles were accepted and were divided into 3 basic categories of teaching methods: Category 1 - cadaveric dissection, Category 2 - simulator based education and Category 3 - other. A state of the art anatomical curriculum offers numerous possibilities and solutions including the oldest like cadaveric dissection and newest like simulators. Different simulation techniques are used with different intensity; however cadaveric dissection is still the most popular method. The second most frequent method is simulation-based training, in which North America is the leading country. The identification of anatomical structures during virtual surgical procedures or laparoscopic robotic procedures can be integrated into the traditional anatomy course. New technologies are supportive and beneficial in anatomy teaching however each excitement of new technologies sometimes should be tempered and evaluated for its usefulness in making the learning process constructive for students and their future practice. PMID:24590516
Torres, K; Torres, A; Pietrzyk, L; Lisiecka, J; B?o?ski, M; B?cik-Donica, M; Sta?kiewicz, G; Maciejewski, R
Anatomy and physiology of the lower-extremity deep and superficial veins.
A thorough understanding of venous anatomy and physiology is foundational to the diagnosis and management of venous disease. Compared with the arterial system, there is significantly greater developmental variation in the venous system. The veins of the lower extremity include the superficial and deep veins, which are defined by their respective relationships to the muscular fascia. Perforating veins traverse the muscular fascia to connect superficial and deep veins. Communicating veins connect veins within the same venous compartment, either deep to deep or superficial to superficial. The deep veins of the lower extremities primarily drain muscles and are encompassed by muscular fascia. The veins located between the skin and the muscular fascia are considered superficial veins. Superficial veins drain the cutaneous microcirculation. The pelvic venous system is a complex transitional outflow pathway between the lower extremities, the pelvic structures, and the inferior vena cava. The terminology used to describe lower-extremity, pelvic, and abdominal vasculature conforms to published international standards. PMID:24840960
Black, Carl M
Two anatomic resources of canine pelvic limb muscles based on CT and MRI.
Advances in magnetic resonance (MR) imaging and three-dimensional (3D) modeling software provide the tools necessary to create sophisticated, interactive anatomic resources that can assist in the interpretation of MR images of extremities, and learning the structure and function of limb musculature. Modeling provides advantages over dissection or consultation of print atlases because of the associated speed, flexibility, 3D nature, and elimination of superimposed arrows and labels. Our goals were to create a diagnostic atlas of pelvic limb muscles that will facilitate interpretation of MR images of patients with muscle injury and to create a 3D model of the canine pelvic limb musculature to facilitate anatomic learning. To create these resources, we used structural segmentation of MR images, a process that groups image pixels into anatomically meaningful regions. The Diagnostic Atlas is an interactive, multiplanar, web-based MR atlas of the canine pelvic limb musculature that was created by manually segmenting clinically analogous MR sequences. Higher resolution volumetric MR and computed tomography (CT) data were segmented into separately labeled volumes of data and then transformed into a multilayered 3D computer model. The 3D Model serves as a resource for students of gross anatomy, encouraging integrative learning with its highly interactive and selective display capabilities. For clinicians, the 3D Model also serves to bridge the gap between topographic and tomographic anatomy, displaying both formats alongside, or even superimposed over each other. Both projects are hosted on an open-access website, http://3dvetanatomy.ncsu.edu/ PMID:22360713
Sunico, Sarena K; Hamel, Corentin; Styner, Martin; Robertson, Ian D; Kornegay, Joe N; Bettini, Chris; Parks, Jerry; Wilber, Kathy; Smallwood, J Edgar; Thrall, Donald E
The anatomy of the human body based on a special teleological system is one of the greatest miracles of the world. The skull's primary function is the defence of the brain, so every alteration or disease of the brain results in some alteration of the skull. This analogy is to be identified even in the human embryo. Proportions of the 22 bones constituting the skull and of sizes of sutures are not only the result of the phylogeny, but those of the ontogeny as well. E.g. the age of the skeletons in archaeological findings could be identified according to these facts. Present paper outlines the ontogeny and development of the tissues of the skull, of the structure of the bone-tissue, of the changes of the size of the skull and of its parts during the different periods of human life, reflecting to the aesthetics of the skull as well. "Only the human scull can give me an impression of beauty. In spite of all genetical colseness, a skull of a chimpanzee cannot impress me aesthetically"--author confesses. In the second part of the treatise those authors are listed, who contributed to the perfection of our knowledge regarding the skull. First of all the great founder of modern anatomy, Andreas Vesalius, then Pierre Paul Broca, Jacob Benignus Winslow are mentioned here. The most important Hungarian contributors were as follow: S�muel R�cz, P�l Bug�t or--the former assistant of Broca--Aur�l T�r�k. A widely used tool for measurement of the size of the skull, the craniometer was invented by the latter. The members of the family Lenhoss�k have had also important results in this field of research, while descriptive anatomy of the skull was completed by microsopical anatomy thanks the activity of G�za Mih�lkovits. PMID:21661257
P�sztor, Emil
Growing teratoma syndrome in a post laparoscopic excision of ovarian immature teratoma
A 26-year-old girl was referred to us in December 2008 with progressive pelvic mass while on chemotherapy. In May 2008, she presented with large adnexal mass and high alpha-fetoprotein (AFP, 265.7 ng/mL; normal range, 0 to 10). She underwent laparoscopic right salpingo-oophorectomy with staging. Since histology was immature teratoma grade I, FIGO stage 1 she was kept on surveillance. In September 2008, she developed recurrent pelvic mass with AFP levels of 2,400 ng/mL. Three courses of chemotherapy (bleomycin-etoposide-cisplatin) were given. Post-chemotherapy AFP normalized but tumor size increased. CT-scan (abdomen-pelvis) showed a large pelvic mass with calcification specks; infiltrating the sigmoid colon and abdominal wall. With provisional diagnosis of growing teratoma syndrome she had exploratory laparotomy with excision of pelvic mass along with sigmoid colon, excision of right pelvic and subcutaneous deposits, omentectomy and sigmoid anastomosis. Left ovary, left tube and uterus appeared normal and were preserved. Histology of all masses showed mature teratoma, no immature elements. At six months follow up she is disease free and has resumed menstruation. Growing teratoma syndrome is a clinico-pathological presentation during/post-chemotherapy in malignant ovarian germ cell tumor where mature teratoma grows and requires complete surgical excision. Our case highlights the safety and adequacy concerns of laparoscopic management of malignant ovarian tumor. Literature review suggests good prospects of resumption of menses, child bearing and five year survival in case of growing teratoma syndrome.
Sengar, Anju Rani
Relationship of pelvic infection and chronic pelvic pain.
The approach to the patient with CPP with a history of PID remains a diagnostic challenge even for the experienced clinician. From the initial diagnosis of presumed PID to managing the pain that may result, using an approach that looks at all factors, not just antecedent PID, allows the practicing physician to avoid becoming too narrowly focused in his or her approach. A clinical starting point would assume all possibilities for pelvic pain and evaluate for each. Given the history of one or more episodes of PID, especially if documented with a prior laparoscopy, earlier investigation for adhesions could be justified in selected patients. If the pelvic examination further suggests a pelvic source, a laparoscopy performed early rather than late in the work-up would seem appropriate. The key to management of the patients who have CPP following PID is to use any and all available diagnostic and therapeutic modalities to identify the source(s) before assuming that the patient suffers only from the known sequelae of PID. PMID:8115085
Lipscomb, G H; Ling, F W
Surgical anatomy of the liver.
Vital intrahepatic structures, especially the large veins, are of special concern to the surgeon. These intrahepatic structures are seldom taught or displayed in anatomy courses, and illustrations are often presented with the posterior surface of the liver facing the viewer, an aspect seldom seen by the surgeon. In this article, the topographical anatomy of the liver is described in a manner most useful to the practicing surgeon. For this purpose, specimens were specifically prepared to demonstrate the vascular anatomy. PMID:2928899
Ger, R
Laparoscopic donor nephrectomy
Background��Several large series of laparoscopic donor nephrectomy (LDN) have been published, largely focusing on immediate results and\\u000a short-term complications. The aim of this study was to examine the results of LDN and collect medium-term and long-term donor\\u000a followup.\\u000a \\u000a \\u000a \\u000a Methods��We examined the results of two surgeons who performed 500 consecutive LDNs from 1996 to 2005. Prospective databases were reviewed\\u000a for both
Edward H. Chin; David Hazzan; Daniel M. Herron; John N. Gaetano; Scott A. Ames; Jonathan S. Bromberg; Michael Edye
Laparoscopic CBD exploration (LCBDE) is a cost effective, efficient and minimally invasive method of treating choledocholithiasis. Laparoscopic Surgery for common bile duct stones (CBDS) was first described in 1991, Petelin (Surg Endosc 17:1705-1715, 2003). The surgical technique has evolved since then and several studies have concluded that Laparoscopic common bile duct exploration(LCBDE) procedures are superior to sequential endolaparoscopic treatment in terms of both clinical and economical outcomes, Cuschieri et al. (Surg Endosc 13:952-957, 1999), Rhodes et al. (Lancet 351:159-161, 1998). We started doing LCBDE in 1998.Our experience with LCBDE from 1998 to 2004 has been published, Gupta and Bhartia (Indian J Surg 67:94-99, 2005). Here we present our series from January 2005 to March 2009. In a retrospective study from January 2005 to March 2009, we performed 3060 laparoscopic cholecystectomies, out of which 342 patients underwent intraoperative cholangiogram and 158 patients eventually had CBD exploration. 6 patients were converted to open due to presence of multiple stones and 2 patients were converted because of difficulty in defining Calots triangle; 42 patients underwent transcystic clearance, 106 patients had choledochotomy, 20 patients had primary closure of CBD whereas in 86 patients CBD was closed over T-tube; 2 patients had incomplete stone clearance and underwent postoperative ERCP. Choledochoduodenosotomy was done in 2 patients. Patients were followed regularly at six monthly intervals with a range of six months to three years of follow-up. There were no major complications like bile leak or pancreatitis. 8 patients had port-site minor infection which settled with conservative treatment. There were no cases of retained stones or intraabdominal infection. The mean length of hospital stay was 3�days (range 2-8�days). LCBDE remains an efficient, safe, cost-effective method of treating CBDS. Primary closure of choledochotomy in select patients is a viable & safe option with shorter operative time and length of stay. LCBDE can be performed successfully with minimal morbidity & mortality. PMID:21966140
Savita, K S; Bhartia, Vishnu K
Laparoscopy-assisted lateral pelvic lymph node dissection for advanced rectal cancer.
In Japan, there has been no indication of laparoscopic surgery for advanced lower rectal cancer because of the problem about the treatment of lateral pelvic lymph node metastasis. We report a new technique which allows lateral pelvic lymph node dissection like in open surgery for advanced rectal cancer. After laparoscopic total mesorectal excision for rectal cancer, a surgical incision of approximately 8 cm is placed in the supra-pubic area. Then, the latero-vesical area of the retroperitoneum, latero-vesical space is dissected bluntly with forceps. The external iliac artery and vein are taped and lymph node dissection is performed. As the external iliac vein is pulled internally, fatty tissue including lymph nodes in the obturator space is separated from the psoas major muscle. After completing of such a procedure, the obturator nerve is indentified in the fatty tissue with surrounding lymph nodes. As the external iliac vein is pulled laterally, fatty tissue including lymph nodes in the oburator space is dissected by fat aspiration procedure (FAP) using a suction tip. FAP is helpful to confirm the vascular system, by which the obturator space is skeletonized and anatomical structures are identified clearly. PMID:21410045
Kawahara, Hidejiro; Watanabe, Kazuhiro; Ushigome, Takuro; Noaki, Rohta; Kobayashi, Susumu; Yanaga, Katsuhiko
Comparison of minimally invasive surgical approaches for hysterectomy at a community hospital: robotic-assisted laparoscopic hysterectomy, laparoscopic-assisted vaginal hysterectomy and laparoscopic supracervical hysterectomy
The study reported here compares outcomes of three approaches to minimally invasive hysterectomy for benign indications, namely, robotic-assisted laparoscopic (RALH), laparoscopic-assisted vaginal (LAVH) and laparoscopic supracervical (LSH) hysterectomy. The total patient cohort comprised the first 237 patients undergoing robotic surgeries at our hospital between August 2007 and June 2009; the last 100 patients undergoing LAVH by the same surgeons between July 2006 and February 2008 and 165 patients undergoing LAVHs performed by nine surgeons between January 2008 and June 2009; 87 patients undergoing LSH by the same nine surgeons between January 2008 and June 2009. Among the RALH patients were cases of greater complexity: (1) higher prevalence of prior abdominopelvic surgery than that found among LAVH patients; (2) an increased number of procedures for endometriosis and pelvic reconstruction. Uterine weights also were greater in RALH patients [207.4 vs. 149.6 (LAVH; P�<�0.001) and 141.1 g (LSH; P�=�0.005)]. Despite case complexity, operative time was significantly lower in RALH than in LAVH (89.9 vs. 124.8�min, P�<�0.001) and similar to that in LSH (89.6�min). Estimated blood loss was greater in LAVH (167.9�ml) than in RALH (59.0�ml, P�<�0.001) or LSH (65.7�ml, P�<�0.001). Length of hospital stay was shorter for RALH than for LAVH or LSH. Conversion and complication rates were low and similar across procedures. Multivariable regression indicated that LAVH, obesity, uterine weight�?250�g and older age predicted significantly longer operative time. The learning curve for RALH demonstrated improved operative time over the case series. Our findings show the benefits of RALH over LAVH. Outcomes in RALH can be as good as or better than those in LSH, suggesting the latter should be the choice primarily for women desiring cervix-sparing surgery.
Giep, Hoang N.; Hubert, Helen B.
[Laparoscopic hepatectomy with radiofrequency device].
Laparoscopic liver resections are gaining adherents among surgeons, as they show rapid recovery, shorter hospital stay and better cosmetic results. The use of a laparoscopic radiofrequency device was first carried out successfully in Brazil for resection of hepatocellular carcinoma of the segment VI in two cirrhotic patients. Although intraoperative bleeding remains a major challenge for the surgeon during laparoscopic liver resections, in both cases the hepatic vascular exclusion was expendable and there was no need for blood transfusion. Patients were discharged on the fourth postoperative day. PMID:23752645
Resende, Vivian; Lima, Cristiano Xavier; Lusckal, M�rio Marcos; Aguiar, Milton Carlos; Gammeri, Emanuele; Habib, Nagy Adley; da Cunha-Melo, Jos� Renan
The spastic pelvic floor syndrome
In 12 patients with constipation, it was detected by defecography that, during straining, the anorectal angle did not increase,\\u000a but remained at 90 degrees. These patients were unable to excrete barium. since the anorectal angle is a measure of activity\\u000a of the pelvic floor musculature, a dysfunction of this muscle was suspected. In order to determine whether this abnormality\\u000a represented
Han C. Kuijpers; Gijs Bleijenberg
From open radical hysterectomy to robot-assisted laparoscopic radical hysterectomy for early stage cervical cancer: aspects of a single institution learning curve
We analysed the introduction of the robot-assisted laparoscopic radical hysterectomy in patients with early-stage cervical cancer with respect to patient benefits and surgeon-related aspects of a surgical learning curve. A retrospective review of the first 14 robot-assisted laparoscopic radical hysterectomies and the last 14 open radical hysterectomies in a similar clinical setting with the same surgical team was conducted. Patients were candidates for a laparoscopic sentinel node procedure, pelvic lymph node dissection and open radical hysterectomy (RH) before August 2006 and were candidates for a laparoscopic sentinel node procedure, pelvic lymph node dissection and robot-assisted laparoscopic radical hysterectomy (RALRH) after August 2006. Overall, blood loss in the open cases was significantly more compared with the robot cases. Median hospital stay after RALRH was 5�days less than after RH. The median theatre time in the learning period for the robot procedure was reduced from 9�h to less that 4�h and compared well to the 3�h and 45�min for an open procedure. Three complications occurred in the open group and one in the robot group. RALRH is feasible and of benefit to the patient with early stage cervical cancer by a reduction of blood loss and reduced hospital stay. Introduction of this new technique requires a learning curve of less than 15 cases that will reduce the operating time to a level comparable to open surgery.
Zweemer, R. P.; van Baal, W. M.; van de Lande, J.; Dijkstra, J. C.; Verheijen, R. H. M.
From open radical hysterectomy to robot-assisted laparoscopic radical hysterectomy for early stage cervical cancer: aspects of a single institution learning curve.
We analysed the introduction of the robot-assisted laparoscopic radical hysterectomy in patients with early-stage cervical cancer with respect to patient benefits and surgeon-related aspects of a surgical learning curve. A retrospective review of the first 14 robot-assisted laparoscopic radical hysterectomies and the last 14 open radical hysterectomies in a similar clinical setting with the same surgical team was conducted. Patients were candidates for a laparoscopic sentinel node procedure, pelvic lymph node dissection and open radical hysterectomy (RH) before August 2006 and were candidates for a laparoscopic sentinel node procedure, pelvic lymph node dissection and robot-assisted laparoscopic radical hysterectomy (RALRH) after August 2006. Overall, blood loss in the open cases was significantly more compared with the robot cases. Median hospital stay after RALRH was 5 days less than after RH. The median theatre time in the learning period for the robot procedure was reduced from 9 h to less that 4 h and compared well to the 3 h and 45 min for an open procedure. Three complications occurred in the open group and one in the robot group. RALRH is feasible and of benefit to the patient with early stage cervical cancer by a reduction of blood loss and reduced hospital stay. Introduction of this new technique requires a learning curve of less than 15 cases that will reduce the operating time to a level comparable to open surgery. PMID:20700514
Schreuder, H W R; Zweemer, R P; van Baal, W M; van de Lande, J; Dijkstra, J C; Verheijen, R H M
[Urological relevance of pelvic fractures].
1. Apparently it is the anatomical difference of the paravesical structures which determines, whether a pelvic fracture will result in urological complications or not. The more the urogenital diaphragm is involved, the less is the risk of urological complications. The type of pelvic fracture and the magnitude of the trauma are of minor importance. 2. With respect to pathology and typology, one has to differentiate between incomplete and complete disruption of the urethra. The more pronounced the rupture is, the more the distal stump will retract back into the injured urogenital diaphragm. The longitudinal rupture splits the anterior wall of the urinary bladder and prostate; the rupture may extend into the membranaceous urethra. 3. Bleeding from the urethral meatus and the endogenous cystogram yield the most to the diagnosis of urological complications of a pelvic fracture. 4. The therapy is twofold. In the case of complete urethral disruption and dehiscence of the bony fragments, operative transvesical atraumatic splinting of the urethra by means of a Foley catheter is indicated. In the case of incomplete urethral rupture, transurethral insertion of a Foley catheter is usually sufficient and successful. 5. The results of the various therapeutical approaches equal the original extent of the urological complication. In addition to a certain degree of posttraumatic urethral stricturing, there are five further well defined sequelae of late urethral injuries. PMID:7197268
Sigel, A; Bornhof, C
Anatomy Adventure: A Board Game for Enhancing Understanding of Anatomy
ERIC Educational Resources Information Center
Certain negative factors such as fear, loss of concentration and interest in the course, lack of confidence, and undue stress have been associated with the study of anatomy. These are factors most often provoked by the unusually large curriculum, nature of the course, and the psychosocial impact of dissection. As a palliative measure, Anatomy�
Anyanwu, Emeka G.
The anatomy of anatomy: a review for its modernization.
Anatomy has historically been a cornerstone in medical education regardless of nation or specialty. Until recently, dissection and didactic lectures were its sole pedagogy. Teaching methodology has been revolutionized with more reliance on models, imaging, simulation, and the Internet to further consolidate and enhance the learning experience. Moreover, modern medical curricula are giving less importance to anatomy education and to the acknowledged value of dissection. Universities have even abandoned dissection completely in favor of user-friendly multimedia, alternative teaching approaches, and newly defined priorities in clinical practice. Anatomy curriculum is undergoing international reformation but the current framework lacks uniformity among institutions. Optimal learning content can be categorized into the following modalities: (1) dissection/prosection, (2) interactive multimedia, (3) procedural anatomy, (4) surface and clinical anatomy, and (5) imaging. The importance of multimodal teaching, with examples suggested in this article, has been widely recognized and assessed. Nevertheless, there are still ongoing limitations in anatomy teaching. Substantial problems consist of diminished allotted dissection time and the number of qualified anatomy instructors, which will eventually deteriorate the quality of education. Alternative resources and strategies are discussed in an attempt to tackle these genuine concerns. The challenges are to reinstate more effective teaching and learning tools while maintaining the beneficial values of orthodox dissection. The UK has a reputable medical education but its quality could be improved by observing international frameworks. The heavy penalty of not concentrating on sufficient anatomy education will inevitably lead to incompetent anatomists and healthcare professionals, leaving patients to face dire repercussions. PMID:20205265
Sugand, Kapil; Abrahams, Peter; Khurana, Ashish
Comparison of Total Laparoscopic Hysterectomy and Laparoscopically Assisted Vaginal Hysterectomy
We compare the surgical results of 60 women undergoing laparoscopically assisted vaginal hysterectomy (LAVH) and 41 having total laparoscopic hysterectomy (TLH) under the indications of uterine fibroids or adenomyosis. With similar specimen weight, TLH required longer surgery duration (140.4 vs. 115.1 min; p < 0.05) than LAVH. Among women with uteri weighing ?200 g, TLH resulted in relatively smaller blood
Cheng Yu Long; Jia Hong Fang; Wei Chin Chen; Jinu Huang Su; Shih Cheng Hsu
Laparoscopic sacrocolpopexy: a comparison of Prolene and Tutoplast mesh.
A retrospective study was carried out to evaluate which mesh (cadaveric fascia lata (Tutoplast or Prolene mesh) is associated with the best outcome of laparoscopic sacrocolpopexy for vaginal vault prolapse. Nineteen women who had surgery with Tutoplast and 20 who underwent surgery with Prolene were followed and asked to complete the Urogenital Distress Inventory and Defecation Distress Inventory to measure disease-specific quality of life. The women were invited for a follow-up visit for pelvic examination at a mean time of 45 months. There were no significant differences in operating time, blood loss or hospital stay between the groups. The risk of re-intervention because of recurrent prolapse was higher in the Tutoplast group than in the Prolene group (relative risk 2.9 (95% Confidence interval 0.9-9.5)). Women in the Prolene group were significantly more satisfied with the operative result. PMID:19353330
Loffeld, Cora J W; Thijs, Susanne; Mol, Ben W; Bongers, Marlies Y; Roovers, Jan-Paul W R
Fracture Detection in Traumatic Pelvic CT Images
Fracture detection in pelvic bones is vital for patient diagnostic decisions and treatment planning in traumatic pelvic injuries. Manual detection of bone fracture from computed tomography (CT) images is very challenging due to low resolution of the images and the complex pelvic structures. Automated fracture detection from segmented bones can significantly help physicians analyze pelvic CT images and detect the severity of injuries in a very short period. This paper presents an automated hierarchical algorithm for bone fracture detection in pelvic CT scans using adaptive windowing, boundary tracing, and wavelet transform while incorporating anatomical information. Fracture detection is performed on the basis of the results of prior pelvic bone segmentation via our registered active shape model (RASM). The results are promising and show that the method is capable of detecting fractures accurately.
Wu, Jie; Davuluri, Pavani; Ward, Kevin R.; Cockrell, Charles; Hobson, Rosalyn; Najarian, Kayvan
Fracture Detection in Traumatic Pelvic CT Images.
Fracture detection in pelvic bones is vital for patient diagnostic decisions and treatment planning in traumatic pelvic injuries. Manual detection of bone fracture from computed tomography (CT) images is very challenging due to low resolution of the images and the complex pelvic structures. Automated fracture detection from segmented bones can significantly help physicians analyze pelvic CT images and detect the severity of injuries in a very short period. This paper presents an automated hierarchical algorithm for bone fracture detection in pelvic CT scans using adaptive windowing, boundary tracing, and wavelet transform while incorporating anatomical information. Fracture detection is performed on the basis of the results of prior pelvic bone segmentation via our registered active shape model (RASM). The results are promising and show that the method is capable of detecting fractures accurately. PMID:22287952
Wu, Jie; Davuluri, Pavani; Ward, Kevin R; Cockrell, Charles; Hobson, Rosalyn; Najarian, Kayvan
Pelvic radiculopathies, lumbosacral plexopathies, and neuropathies in oncologic disease: a multidisciplinary approach to a diagnostic challenge.
The purpose of this article is to familiarize the reader with the anatomy of the major pelvic nerves and the clinical features of associated lumbosacral plexopathies. To demonstrate this we illustrate several cases of malignant lumbosacral plexopathy on computed tomography, magnetic resonance imaging, and positron emission tomography/computed tomography. A new lumbosacral plexopathy in a patient with a prior history of abdominal or pelvic malignancy is usually of malignant etiology. Biopsies may be required to definitively differentiate tumour from posttreatment fibrosis, and in cases of inconclusive sampling or where biopsies are not possible, follow-up imaging may be necessary. In view of the complexity of clinical findings often confounded by a history of prior surgery and/or radiotherapy, a multidisciplinary approach between oncologists, neurologists, and radiologists is often required for what can be a diagnostic challenge. PMID:24433993
Brejt, Nick; Berry, Jonathan; Nisbet, Angus; Bloomfield, David; Burkill, Guy
Pelvic radiculopathies, lumbosacral plexopathies, and neuropathies in oncologic disease: a multidisciplinary approach to a diagnostic challenge
Abstract The purpose of this article is to familiarize the reader with the anatomy of the major pelvic nerves and the clinical features of associated lumbosacral plexopathies. To demonstrate this we illustrate several cases of malignant lumbosacral plexopathy on computed tomography, magnetic resonance imaging, and positron emission tomography/computed tomography. A new lumbosacral plexopathy in a patient with a prior history of abdominal or pelvic malignancy is usually of malignant etiology. Biopsies may be required to definitively differentiate tumour from posttreatment fibrosis, and in cases of inconclusive sampling or where biopsies are not possible, follow-up imaging may be necessary. In view of the complexity of clinical findings often confounded by a history of prior surgery and/or radiotherapy, a multidisciplinary approach between oncologists, neurologists, and radiologists is often required for what can be a diagnostic challenge.
Berry, Jonathan; Nisbet, Angus; Bloomfield, David; Burkill, Guy
NSDL National Science Digital Library
Wiley InterScience (described in the October 3, 1997 Scout Report) is the online journal service for John Wiley & Sons. As part of their contribution to the information highway, InterScience offers three separate Internet resource centers featuring anatomy, neuroscience, and genetics. Each Website is intended as a gateway for researchers and educators in relevant disciplines, and includes discussion about and links to Wiley publications (journals). While access to all Wiley publications is not free, several sample articles are provided for each journal.
Complications after laparoscopic sleeve gastrectomy
BackgroundLaparoscopic sleeve gastrectomy (LSG) has recently become a feasible option in the management of morbid obesity. The objective of this study was to examine the morbidity and mortality arising from LSG as a primary procedure for weight loss.
Peter F. Lalor; Olga N. Tucker; Samuel Szomstein; Raul J. Rosenthal
PurposeAn increasing number of operative procedures in pediatric urology can be performed by laparoscopy. We report our experience with laparoscopic heminephroureterectomy, which is a typical operation in pediatric patients.
Gunter Janetschek; Jorg Seibold; Christian Radmayr; Georg Bartsch
Thermostasis during laparoscopic urologic surgery.
It has been postulated that gaseous insufflation of the abdominal cavity results in temperature elevation, particularly in children, and that the use of heating blankets should be avoided during laparoscopic surgery. On review of the last 102 laparoscopic genitourinary cases, we conclude that the use of nonheated, nonhumidified carbon dioxide for insufflation during laparoscopic surgery under a general anesthetic results in mild hypothermia. The use of warming devices in this setting is both safe and appropriate. Children have a rise in temperature relative to preoperative measurement, although they are explicitly capable of hypothermia. Neither the duration of the procedure, the surgical approach, nor conversion to open exploration had a significant impact on temperature regulation. Adrenalectomy results in more exaggerated temperature changes than do other laparoscopic procedures. PMID:12396438
Kaynan, Ayal M; Winfield, Howard N
[Simultaneous operations during laparoscopic cholecystectomy].
Simultant laparoscopic operations were performed in 1993-2003 yrs period in 321 patients, including 287--using laparoscopic and 34--the combined (laparoscopic and open) access. Concurrent diseases were diagnosed preoperatively in 219 (68.2%) of patients and were disclosed while doing intraoperative revision--in 102 (31.8%). The simultant operations performance, as a rule, enhanced mildly the total duration of a basic stage, did not influence the duration of postoperative period and the patients rehabilitation essentially, as well as for frequency of the intra--and postoperative complications occurrence. The authors consider that it is expedient to perform laparoscopic intervention simultaneously for concurrent surgical diseases of abdominal cavity. PMID:15124463
Nichita?lo, M E; Skums, V V; Diachenko, A N; Litvinenko, A N; Ogorodnik, P V; Galochka, I P; Kondratiuk, A P; Litvin, A I; Petrenko, K N; Rudyk, A D
Robot-Assisted Laparoscopic Prostatectomy
MedlinePLUS Videos and Cool Tools
... R. 32, where we'll have a real-time demonstration of the robot-assisted laparoscopic prostatectomy, performed ... it is associated with a more rapid recovery time. Patients can expect to be in the hospital ...
Combined procedures with laparoscopic cholecystectomy.
With advancement in laparoscopic surgery a number of surgical procedures can be performed combined with laparoscopic cholecystectomy in a single surgery. We evaluate the safety & efficacy of such surgeries. A retrospective review of all patients who had undergone combined procedures with laparoscopic cholecystectomy during January 2005 to June 2009 was performed. 3144 laparoscopic cholecystectomies were performed in the period from January 2005 to June 2009. Of these, 401 cases were combined with another procedure. The mean operative time was 80�min (range 50-270�min). The mean hospital stay was 3.2�days (range 1-5�days). The mean no. of days injectable analgesics was required was 2�days (range 1 day-4�days). Combined procedures provide patients with all the benefits of minimal invasive surgery and also give the benefit of single time anaesthesia without adding to post operative morbidity & hospital stay. PMID:21966136
Savita, Ks; Khedkar, Indira; Bhartia, Vishnu K
Laparoscopic resection of giant liver hemangioma using laparoscopic Habib probe for parenchymal transection
Experience with laparoscopic liver resections is limited. Laparoscopic resection of a variety of liver lesions has been reported and is considered appropriate for lesions in the left lateral segment and inferior segments of the right lobe. Herein, we report a 52-year-old male patient who underwent a laparoscopic resection of giant liver hemangioma with the use of a laparoscopic 4� Habib probe.
Gadiyaram, Srikanth; Shetty, Neel
Laparoscopic surgery--anesthetic implications.
Laparoscopic cholecystectomy is a relatively new surgical procedure which is enjoying ever-increasing popularity and presenting new anesthetic challenges. The advantages of shorter hospital stay and more rapid return to normal activities are combined with less pain associated with the small limited incisions and less postoperative ileus compared with the traditional open cholecystectomy. The efficacy of laparoscopic appendectomy and hemicolectomy has been recently evaluated. However, there have been no prospective randomized studies to date comparing laparoscopic with traditional laparotomy techniques. The physiological effects of prolonged pneumoperitoneum and the longer duration of surgery with the laparoscopic techniques are of concern. The application of laparoscopic inguinal hernia repair may be limited because, unlike traditional surgical hepair, general anesthesia is required and concerns have been expressed about the duration of surgery and the possibility of hernia recurrence. Notwithstanding case reports and series describing successful diaphragmatic and hiatus hernia repair using a laparoscopic surgical technique, the frequently encountered complications of cervical surgical emphysema, pneumothorax, and pneumomediastinum, attributed to passage of insufflating gas through weak points or defects in the diaphragm, must be of major concern. Anesthesiologists must maintain a high index of suspicion for these potential complication and must undertake appropriate monitoring. If there is clinical evidence of a tension pneumothorax, immediate chest tube decompression is indicated. Intraoperative complications of laparoscopic surgery are mostly due to traumatic injuries sustained during blind trocar insertion and physiological changes associated with patient positioning and pneumoperitoneum creation. The choice of anesthetic technique for upper abdominal laparoscopic procedures is most frequently limited to general anesthesia. Controlled ventilation avoids hypercarbia, and an anesthetic technique incorporating antiemetics and nonsteroidal anti-inflammatory agents has reduced postoperative nausea and vomiting following laparoscopic cholecystectomy. The use of nitrous oxide during laparoscopic procedures remains controversial. Laparoscopic cholecystectomy is a major advance in the management of patients with symptomatic gall-bladder disease. However, in the present era of cost containment, older and sicker patients may present for this procedure on the day of surgery without adequate preoperative evaluation. Anesthesiologists should thus be prepared to recommend deflation of the pneumoperitoneum and possibly conversion to an open procedure if hemodynamic, oxygenation, or ventilation difficulties arise during the procedure. PMID:7831596
Cunningham, A J
Intra-abdominal gout mimicking pelvic abscess.
Gout is the most common crystal-induced arthritis. Gouty tophi typically deposit in the extremities, especially toes and fingers. We present an unusual case of intrapelvic tophaceous gout in a patient suffering from chronic gouty arthritis. CT and MRI of the abdomen and pelvic cavity disclosed calcified gouty tophi around both hips, and a cystic lesion with peripheral enhancement in the pelvic cavity along the course of the iliopsoas muscle. The intra-abdominal tophus mimicked pelvic abscess. PMID:15778870
Chen, Chia-Hui; Chen, Clement Kuen-Huang; Yeh, Lee-Ren; Pan, Huay-Ban; Yang, Chien-Fang
Pelvic inflammatory disease in the postmenopausal woman.
OBJECTIVE: Review available literature on pelvic inflammatory disease in postmenopausal women. DESIGN: MEDLINE literature review from 1966 to 1999. RESULTS: Pelvic inflammatory disease is uncommon in postmenopausal women. It is polymicrobial, often is concurrent with tuboovarian abscess formation, and is often associated with other diagnoses. CONCLUSION: Postmenopausal women with pelvic inflammatory disease are best treated with inpatient parenteral antimicrobials and appropriate imaging studies. Failure to respond to antibiotics should yield a low threshold for surgery, and consideration of alternative diagnoses should be entertained.
Jackson, S L; Soper, D E
The Pelvic Floor: Functional Concepts and Neurocontrol
\\u000a The background to the development of current ideas of pelvic floor function is reviewed. The importance of understanding motor\\u000a control mechanisms of pelvic floor responsiveness in health and disease is an underlying theme of the response to all forms\\u000a of treatment in pelvic floor disorders. This is an adaptive response based on the capacity of the system to respond when
Michael Swash
Health Instruction Packages: Cardiac Anatomy.
ERIC Educational Resources Information Center
Text, illustrations, and exercises are utilized in these five learning modules to instruct nurses, students, and other health care professionals in cardiac anatomy and functions and in fundamental electrocardiographic techniques. The first module, "Cardiac Anatomy and Physiology: A Review" by Gwen Phillips, teaches the learner to draw and label�
Phillips, Gwen; And Others
Complications of laparoscopic antireflux surgery
Over the last decade, the laparoscopic approach to antireflux surgery has been widely applied, resulting in improved early\\u000a outcomes and greater patient acceptance of surgery for gastroesophageal reflux disease. However, although short-term outcomes\\u000a are probably better overall than those following open surgery, it has become apparent that the laparoscopic approach is associated\\u000a with an increased risk of some complications, and
D. I. Watson; A. C. de Beaux
Laparoscopic treatment of ventral hernia
.�� Laparoscopic repair of abdominal wall hernias has been introduced recently to treat both spontaneous and incisional hernias\\u000a with reported good results. In the Mafraq and Al Jaziera Hospitals in the United Arab Emirates, 18 patients have been treated\\u000a using the laparoscopic technique. These cases included 11 incisional hernias, 5 spontaneous paraumbilical hernias, and 2 combined\\u000a incisional and paraumbilical hernias.
M. Farrakha
Laparoscopic colorectal resection for diverticulitis
This study evaluated outcome in patients undergoing laparoscopically assisted sigmoid resection for diverticular disease.\\u000a A total of 29 consecutive patients were treated surgically for colonic diverticulitis; in 27 of these laparoscopy was performed.\\u000a The review of medical records from a control group of 34 patients undergoing open resection were used for comparison. The\\u000a conversion rate was 7.5%. Using the laparoscopic
L. K�hler; D. Rixen; H. Troidl
Simulation of Laparoscopic Surgery Lab
NSDL National Science Digital Library
This simulation of laparoscopic surgery enables learners to practice and to learn this modern surgical technique. Learners discover how to manipulate a variety of instruments while watching a TV monitor, thereby learning to compensate while going from a 3-D situation to a 2-D situation. Learners also analyze the pros and cons of the procedure. Note: Laparoscopic instruments are needed for this activity; adult supervision and safety demonstration recommended. A/V equipment is also required.
Robitaille, Phyllis
Laparoscopic Surgery for Ulcerative Colitis
Laparoscopic techniques have become increasingly used in the treatment of ulcerative colitis: in experienced hands, they are safe and feasible. Recovery advantages have not been consistently demonstrated and functional results have been comparable to open surgery. Other possible benefits and costs issues have also been inconsistent. Further investigation on the role of laparoscopic surgery for ulcerative colitis with larger populations and longer follow-up with a focus on recovery parameters, quality of life, and costs are needed.
Stocchi, Luca
Complications of laparoscopic urologic surgery.
Laparoscopic techniques performed in the urologic setting have received great attention in the past decade. With the development of improved laparoscopic instrumentation, approaches to gonadal, renal, prostate, and bladder diseases have been successfully performed. A discussion of urologic laparoscopy (UL) with particular attention to potential complications and limitations is presented. Awareness of these evolving technologies remains critical to all surgeons with an interest in laparoscopy. PMID:15630945
Madeb, Ralph; Koniaris, Leonidas G; Patel, Hitendra R H; Dana, James F; Nativ, Ofer; Moskovitz, Boaz; Erturk, Erdal; Joseph, Jean V
Allograft AlloDerm� tissue for laparoscopic transabdominal preperitoneal groin hernia repair: A case report
INTRODUCTION Synthetic mesh is the prosthetic material used for most inguinal hernioplasties. However, when left in contact with intra-abdominal viscera, it often becomes associated with infection and migration, particularly in irradiated tissues, contaminated fields, immunosuppressed individuals, and patients with intestinal obstruction or fistula. AlloDerm� Regenerative Tissue Matrix (LifeCell Corporation, Branchburg, NJ) is derived from human cadaver skin and may be associated with fewer visceral adhesions and more durability in infected fields than synthetic mesh. PRESENTATION OF CASE We report the first case in which AlloDerm was used in a laparoscopic transabdominal preperitoneal repair of a multiple recurrent right inguinal hernia, a left femoral hernia, and an umbilical hernia in the same patient. Use of AlloDerm greatly enhanced the maneuverability during laparoscopic hernia repair due to its pliability and strength and eliminated the need to cover the prosthetic with peritoneum. DISCUSSION Previous pelvic radiation and multiple previous groin repairs can render the peritoneum friable, resulting in obstacles to successful closure. AlloDerm is a reasonable choice for groin hernia repairs when such factors are present. CONCLUSION The long-term durability of AlloDerm for laparoscopic groin hernia repairs is yet to be determined, but based on current data it seems prudent to use this technique in laparoscopic repair of complex groin hernias where infection is suspected or inadequate prosthetic coverage with peritoneum is anticipated.
Amirlak, Bardia; Gerdes, Jodi; Puri, Varun; Fitzgibbons, Robert J.
The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction
This article presents a standard system of terminology recently approved by the International Continence Society, the American Urogynecologic Society, and the Society of Gynecologic Surgeons for the description of female pelvic organ prolapse and pelvic floor dysfunction. An objective site-specific system for describing, quantitating, and staging pelvic support in women is included. It has been developed to enhance both clinical
Richard C. Bump; Anders Mattiasson; Kari B�; Linda P. Brubaker; John O. L. DeLancey; Peter Klarskov; Bob L. Shull; Anthony R. B. Smith
Recognizing Myofascial Pelvic Pain in the Female Patient with Chronic Pelvic Pain
Myofascial pelvic pain (MFPP) is a major component of chronic pelvic pain (CPP) and often is not properly identified by healthcare providers. The hallmark diagnostic indicator of MFPP is myofascial trigger points in the pelvic floor musculature that refer pain to adjacent sites. Effective treatments are available to reduce MFPP, including myofascial trigger point release,
Pastore, Elizabeth Anne; Katzman, Wendy B.
The Japanese quail is a widely used model organism for the study of embryonic development; however, anatomical resources are lacking. The Quail Anatomy Portal (QAP) provides 22 detailed three-dimensional (3D) models of quail embryos during development from embryonic day (E)1 to E15 generated using optical projection tomography. The 3D models provided can be virtually sectioned to investigate anatomy. Furthermore, using the 3D nature of the models, we have generated a tool to assist in the staging of quail samples. Volume renderings of each stage are provided and can be rotated to allow visualization from multiple angles allowing easy comparison of features both between stages in the database and between images or samples in the laboratory. The use of JavaScript, PHP and HTML ensure the database is accessible to users across different operating systems, including mobile devices, facilitating its use in the laboratory.The QAP provides a unique resource for researchers using the quail model. The ability to virtually section anatomical models throughout development provides the opportunity for researchers to virtually dissect the quail and also provides a valuable tool for the education of students and researchers new to the field. Database URL: http://quail.anatomyportal.org (For review username: demo, password: quail123)
Ruparelia, Avnika A.; Simkin, Johanna E.; Salgado, David; Newgreen, Donald F.; Martins, Gabriel G.; Bryson-Richardson, Robert J.
The Japanese quail is a widely used model organism for the study of embryonic development; however, anatomical resources are lacking. The Quail Anatomy Portal (QAP) provides 22 detailed three-dimensional (3D) models of quail embryos during development from embryonic day (E)1 to E15 generated using optical projection tomography. The 3D models provided can be virtually sectioned to investigate anatomy. Furthermore, using the 3D nature of the models, we have generated a tool to assist in the staging of quail samples. Volume renderings of each stage are provided and can be rotated to allow visualization from multiple angles allowing easy comparison of features both between stages in the database and between images or samples in the laboratory. The use of JavaScript, PHP and HTML ensure the database is accessible to users across different operating systems, including mobile devices, facilitating its use in the laboratory.The QAP provides a unique resource for researchers using the quail model. The ability to virtually section anatomical models throughout development provides the opportunity for researchers to virtually dissect the quail and also provides a valuable tool for the education of students and researchers new to the field. DATABASE URL: http://quail.anatomyportal.org (For review username: demo, password: quail123). PMID:24715219
Ruparelia, Avnika A; Simkin, Johanna E; Salgado, David; Newgreen, Donald F; Martins, Gabriel G; Bryson-Richardson, Robert J
Laparoscopic Cholecystectomy after Vertical Banded Gastroplasty.
Following vertical gastroplasty, laparoscopic cholecystectomy has been performed in 27 consecutive patients who developed symptomatic gallstones. Dissection identified structures without difficulty in these patients, and problems were not encountered in these procedures with the laparoscopic technique PMID:10742757
Deitel; Smith; Harmantas
Lessons Learned from Laparoscopic Gastric Banding.
The author reviews 27 laparoscopic gastric banding operations, of which 19 cases were completed. Of the 27 operations, eight were revisions of earlier laparoscopic banding. The lessons learned from these cases are highlighted. PMID:10757955
Improved Image-Guided Laparoscopic Prostatectomy.
National Technical Information Service (NTIS)
Laparoscopic Ultrasound probe (Intuitive Surgical, Sunnyvale, CA) was integrated with the daVinci surgical system for use in Robot-Assisted Laparoscopic Prostatectomy (RALP). Automatic robotic-assisted palpation (initially planned for months 18-24) was co...
I. Fleming
Laparoscopic pancreatic resection: is it worthwhile?
A series of 23 patients who had undergone an attempted laparoscopic Whipple (n = 10) or laparoscopic distal pancreatectomy\\u000a (n = 9) or laparoscopic enucleation (n = 4) since January 1992 were retrospectively reviewed. In the laparoscopic Whipple\\u000a group (6 women and 4 men; mean age 71 [range 33 to 82] years), eight had malignant periampullary tumors and two had
Michel Gagner; Alfons Pomp
Complete laparoscopic removal of a gastric trichobezoar.
Trichobezoars are seen usually in adolescent girls and laparotomy is required to remove them, though recently laparoscopic assisted and laparoscopic removal have been reported in adults and older children. We report this 4-year-old boy who underwent complete laparoscopic removal of a gastric trichobezoar, both for its rarity in such young boys and also because he is the youngest reported patient to undergo complete laparoscopic removal of a gastric trichobezoar. PMID:25013333
Vepakomma, Deepti; Alladi, Anand
Robotic-assisted laparoscopic excision of gossypiboma simulating bladder wall mass after 35 years of appendectomy
Gossypiboma or textiloma are terms commonly used to describe a retained sponge in the body that is composed of sponge invested within a layer of foreign body reaction in the form of an abscess or an aseptic fibrotic reaction. These cases are rarely reported despite an incidence of 1:1,000-1,500 of abdominal or pelvic surgery. We report a patient who presented with an incidental supravesical mass discovered upon work up for frequency and suprapubic pain. He had appendectomy 35 years ago. The mass was excised by robotic-assisted laparoscopic technique. The pathologic evaluation came as gossypiboma.
Rajih, Emad Sabri; Al-Khudair, Waleed Khalid; Al-Hussain, Turky; Al-Otaibi, Mohammed Faihan
Neglected Primary Omental Pregnancy after Laparoscopic and Medical Treatment: A Difficult Diagnosis?
The following case report describes a rare case of omental pregnancy in a fertile 34-year-old woman at 5 + 3 weeks of gestation who presented with abdominal pain. Clinical examination, vital signs, and laboratory values were within normal limits, so the woman was hospitalized and monitored. Laparoscopic exploration was performed according to the preoperative diagnosis of tubal pregnancy, but it showed normal pelvic organs. In view of the growth of the ?-HCG value, a medical approach was attempted, without success. Due to hemodynamic instability, an emergency laparotomy was performed, and it showed an omental pregnancy, confirmed at the pathological examination.
Martelli, Federica; De Carolis, Caterina; Parisi, Carmelo; Piccione, Emilio
Laparoscopic tubal anastomosis: reversal of sterilization.
A case of laparoscopic reversal of tubal sterilization is reported. The patient was a 38 year old woman sterilized by bipolar diathermia two years earlier. Refertilization was performed by laparoscopic end to end anastomosis of one tube. Postoperatively, the patient had one menstruation and then achieved an intrauterine pregnancy. The laparoscopic method of refertilization saves expensive hospitalization costs. PMID:8259759
Istre, O; Olsboe, F; Trolle, B
Hand-assisted laparoscopic radical nephrectomy.
Laparoscopic radical nephrectomy is the standard of care for the management of most renal cancers. The hand-assisted approach has bridged the gap between open nephrectomy and a pure laparoscopic approach. Hand-assisted laparoscopic nephrectomy allows tactile feedback, thus shortening the learning curve for some surgeons and allowing more experienced laparoscopists to perform more complex and challenging procedures. PMID:21254933
Patel, Sutchin R; Nakada, Stephen Y
Relief of Urinary Urgency, Hesitancy, and Male Pelvic Pain with Pulse Radiofrequency Ablation of the Pudendal Nerve: A Case Presentation
Background and Aims. This report demonstrates the utility of a pudendal nerve block by pulsed radiofrequency ablation (RFA) for the treatment of male pelvic pain and urinary urgency and hesitancy. Methods. The patient is an 86-year-old gentleman with a 30-year history of urinary hesitancy and urgency. The patient also had pain in the area of the perineum but considered it a secondary issue. The patient was seen by a number of specialists, tried various medications, and underwent a variety of procedures to no avail. Therefore, the patient underwent a pulsed RFA of the pudendal nerve. Results. The patient underwent a pulsed RFA of the pudendal nerve; the patient reported marked improvement in his pelvic pain as well as a drastic reduction in his urinary urgency and hesitancy. Conclusion. Urinary urgency and hesitancy and male pelvic pain are some of the most common symptoms affecting men. Pudendal nerve block by pulsed RFA is an effective treatment of pelvic pain. It may also hold some therapeutic value in the treatment of urinary urgency and hesitancy as our case demonstrated. Further studies are needed to help clarify both the anatomy of the pelvis as well as if pudendal blocks are effective in treating more than pelvic pain.
Pangarkar, Sanjog; Zeitlin, Scott I.
Development of virtual environments for training skills and reducing errors in laparoscopic surgery
NASA Astrophysics Data System (ADS)
In every surgical procedure there are key steps and skills that, if performed incorrectly, can lead to complications. In conjunction with efforts, based on task and error analysis, in the Videoscopic Training Center at UCSF to identify these key elements in laparoscopic surgical procedures, the authors are developing virtual environments and modeling methods to train the elements. Laparoscopic surgery is particularly demanding of the surgeon's spatial skills, requiring the ability to create 3D mental models and plans while viewing a 2D image. For example, operating a laparoscope with the objective lens angled from the scope axis is a skill that some surgeons have difficulty mastering, even after using the instrument in many procedures. Virtual environments are a promising medium for teaching spatial skills. A kinematically accurate model of an angled laparoscope in an environment of simple targets is being tested in courses for novice and experienced surgeons. Errors in surgery are often due to a misinterpretation of local anatomy compounded with inadequate procedural knowledge. Methods to avoid bile duct injuries in cholecystectomy are being integrated into a deformable environment consisting of the liver, gallbladder, and biliary tree. Novel deformable tissue modeling algorithms based on finite element methods will be used to improve the response of the anatomical models.
Tendick, Frank; Downes, Michael S.; Cavusoglu, Murat C.; Gantert, Walter A.; Way, Lawrence W.
Stereoscopic augmented reality using ultrasound volume rendering for laparoscopic surgery in children
NASA Astrophysics Data System (ADS)
In laparoscopic surgery, live video provides visualization of the exposed organ surfaces in the surgical field, but is unable to show internal structures beneath those surfaces. The laparoscopic ultrasound is often used to visualize the internal structures, but its use is limited to intermittent confirmation because of the need for an extra hand to maneuver the ultrasound probe. Other limitations of using ultrasound are the difficulty of interpretation and the need for an extra port. The size of the ultrasound transducer may also be too large for its usage in small children. In this paper, we report on an augmented reality (AR) visualization system that features continuous hands-free volumetric ultrasound scanning of the surgical anatomy and video imaging from a stereoscopic laparoscope. The acquisition of volumetric ultrasound image is realized by precisely controlling a back-and-forth movement of an ultrasound transducer mounted on a linear slider. Furthermore, the ultrasound volume is refreshed several times per minute. This scanner will sit outside of the body in the envisioned use scenario and could be even integrated into the operating table. An overlay of the maximum intensity projection (MIP) of ultrasound volume on the laparoscopic stereo video through geometric transformations features an AR visualization system particularly suitable for children, because ultrasound is radiation-free and provides higher-quality images in small patients. The proposed AR representation promises to be better than the AR representation using ultrasound slice data.
Oh, Jihun; Kang, Xin; Wilson, Emmanuel; Peters, Craig A.; Kane, Timothy D.; Shekhar, Raj
Laparoscopic cholecystectomy in patients with hepatic cirrhosis: a five-year experience.
Our institution is a tertiary referral center that specializes in hepatobiliary surgery. To evaluate the safety, efficacy, and conversion rate of laparoscopic cholecystectomy in patients with hepatic cirrhosis, we conducted a retrospective analysis of all cirrhotic patients undergoing attempted laparoscopic cholecystectomy during the period from 1991 to 1996. The diagnosis of cirrhosis was made on the basis of either a preoperative history, a liver biopsy, or the surgeon's operative description of the liver. All patients had early, well-compensated cirrhosis (Child's class A or B). A total of 30 patients underwent attempted laparoscopic cholecystectomy and five patients were converted to an open procedure (17%). The conversion rate for elective cases was 5% compared with 36% for urgent procedures. Two patients were converted because of varices and three because of unclear anatomy. No patients were converted because of bleeding. There were no operative deaths. The complication rate for elective procedures was 16%, with an average length of stay of 2.1 days, compared with 36% and 4.8 days, respectively, for urgent cases. Laparoscopic cholecystectomy in patients with early, well-compensated cirrhosis is safe and should be the treatment of choice for these patients. PMID:10481121
Friel, C M; Stack, J; Forse, A; Babineau, T J
Learning anatomy enhances spatial ability.
Spatial ability is an important factor in learning anatomy. Students with high scores on a mental rotation test (MRT) systematically score higher on anatomy examinations. This study aims to investigate if learning anatomy also oppositely improves the MRT-score. Five hundred first year students of medicine (n = 242, intervention) and educational sciences (n = 258, control) participated in a pretest and posttest MRT, 1 month apart. During this month, the intervention group studied anatomy and the control group studied research methods for the social sciences. In the pretest, the intervention group scored 14.40 (SD: � 3.37) and the control group 13.17 (SD: � 3.36) on a scale of 20, which is a significant difference (t-test, t = 4.07, df = 498, P < 0.001). Both groups show an improvement on the posttest compared to the pretest (paired samples t-test, t = 12.21/14.71, df = 257/241, P < 0.001). The improvement in the intervention group is significantly higher (ANCOVA, F = 16.59, df = 1;497, P < 0.001). It is concluded that (1) medical students studying anatomy show greater improvement between two consecutive MRTs than educational science students; (2) medical students have a higher spatial ability than educational sciences students; and (3) if a MRT is repeated there seems to be a test effect. It is concluded that spatial ability may be trained by studying anatomy. The overarching message for anatomy teachers is that a good spatial ability is beneficial for learning anatomy and learning anatomy may be beneficial for students' spatial ability. This reciprocal advantage implies that challenging students on spatial aspects of anatomical knowledge could have a twofold effect on their learning. PMID:23349122
Vorstenbosch, Marc A T M; Klaassen, Tim P F M; Donders, A R T Rogier; Kooloos, Jan G M; Bolhuis, Sanneke M; Laan, Roland F J M
Screening Pelvic Examination in Nonpregnant Adult Women
... worry and follow-up. Pelvic examination can cause anxiety, discomfort, pain, and embarrassment, especially in women who have a history of sexual abuse. What does the ACP recommend that patients and doctors do? Doctors should not do screening pelvic examinations on nonpregnant, adult women who do ...
Urogenital disorders after pelvic ring injuries
Introduction The close anatomical relationship between the skeletal and connective systems of the pelvis, neurological, and vascular structures and pelvic organs are predisposing factors for structural and functional damages of the urogenital system. Materials and methods We performed PUBMED and MEDLINE search using terms �pelvic ring trauma/disruption, bladder injury, urethral injury, sexual dysfunction�. Results The probability of damage of the pelvic organs increases along with the degree of disturbance of integrity of the pelvic ring. The most important risk factor of urogenital injuries is the rupture of the symphyseal joint. Patients with lesions of the urogenital system have a higher risk of mortality compared with patients without lesions of the urogenital system. Sexual dysfunctions along with urinary incontinence are a common consequence of the pelvic fracture in men and women. Conclusions Injuries of the urogenital organs during pelvic ring fractures have an important negative prognostic value in terms of morbidity and quality of life. A prerequisite for a successful therapeutic outcome in case of pelvic fractures with disturbance of pelvic ring integrity is cooperation of orthopedists and urologists, with possible early diagnosis and treatment of injuries of the urogenital organs.
Ter-Grigorian, Atom A.; Pushkar, Dmitry Y.
NSDL National Science Digital Library
With a longtime presence on the web, Professor Jim Swan of the University of New Mexico has created a fine set of online anatomy and physiology resources that he uses in his courses on a regular basis. Students of the human body will also want to avail themselves of these materials, which include sets of pathology images and slides that cover such conditions as coronary artery thrombosis, atherosclerosis, and so on. One rather handy section includes weblab modules that introduce acolytes to the world of the heart, the lungs, and the digestive system through slides and interactive photos. The site is rounded out by the "Virtual Microscope" area, which includes detailed slides and explanations of cartilage, bone, blood, and muscular tissue.
Swan, Jim
Multidisciplinary Management of Blunt Pelvic Trauma
Pelvic fractures account for ?3% of all fractures and usually occur in patients with polytrauma. Pelvic fractures usually indicate high energy transfer and a significant mechanism of injury, and they can involve massive hemorrhage. For this reason, mortality from pelvic trauma is high, ranging from 40% to 60% among patients in shock, and up to 90% in patients considered to be in extremis. Multidisciplinary approaches in the treatment of patients with pelvic fractures have resulted in improved outcomes for these complex and challenging injuries. In this article, we describe a case of a pediatric patient who suffered severe pelvic fracture with massive hemorrhage, requiring a multidisciplinary approach for control of hemorrhage and definitive repair of injuries.
Khanna, Pavan; Phan, Ho; Hardy, Andrew Hal; Nolan, Timothy; Dong, Paul
Minimal invasive treatment of ureteropelvic junction obstruction in low volume pelvis: A comparative study of endopyelotomy and laparoscopic nondismembered pyeloplasty
Objective: To evaluate the role of nondismembered laparoscopic pyeloplasty and percutaneous endopyelotomy for ureteropelvic junction obstruction (UPJO) with low volume renal pelvis. Material and Methods: Retrospective acquired data of 34 patients of laparoscopic nondismembered pyeloplasty was compared with 26 patients of UPJO with pelvic volume less than 50 ml undergoing antegrade endopyelotomy and analyzed for clinical parameters, operative outcomes and success of procedures. All patients were followed up clinically and with diuretic renogram at regular intervals. Results: Mean age, renal pelvic volume and preoperative glomerular filtration rate (GFR) was 25 years, 43.6 ml and 42.5 ml/min, respectively in endopyelotomy group and 21 years, 34.4 ml and 39.9 ml/min, respectively in laparoscopic pyeloplasty group. Mean operative time, postoperative analgesic requirement and mean hospital stay was 100min, 250 mg and 4 days, respectively in endopyelotomy group and 210 min, 300 mg and 4 days, respectively in laparoscopic pyeloplasty group. Only operative time was significantly different between two groups (P < 0.05). Mean follow-up was 36 and 39 months and success rates were 91.2% and 88.8% in laparoscopy and endopyelotomy group, respectively (P < 0.05). No significant complication was seen in endopyelotomy group while two patients had hematuria (one requiring blood transfusion) and three had increased drain output for more than 3 days in laparoscopy group. Conclusion: Percutaneous endopyelotomy is associated with significantly less operative time and postoperative complication rate and provides equivalent success in comparison to nondismembered laparoscopic pyeloplasty in patients with UPJO and low volume pelvis. It can be a preferred minimally invasive treatment modality for such patients.
Singh, Pratipal; Jain, Paresh; Dharaskar, Anand; Mandhani, Anil; Dubey, Deepak; Kapoor, Rakesh; Kumar, Anant; Srivastava, Aneesh
Oncological Outcome after Laparoscopic Radical Prostatectomy: 10 years Experience
Objective We analyzed the oncological outcome after laparoscopic radical prostatectomy (LRP) in a consecutive series of patients with prostate cancer. Material and Methods from 1998 to 2007, 1564 consecutive patients (median age 61 years, IQ range 56, 66) with clinically localized prostate cancer (cT1c-cT3a) were treated with LRP by two surgeons either at IMM (Paris, France) or MSKCC (New York, USA). Progression of disease was defined as a PSA of 0.1 ng/ml or greater with confirmatory rise, or initiation of secondary therapy and the information was available for 1422 patients. Patients were stratified as low, intermediate or high risk based on the pretreatment prostate cancer nomogram progression free probability of >90%, 89% to 71% and < 70% respectively. Results The overall 5-year and 8-year probability of freedom from progression was 78% (95% CI 74%�82%) and 71% (95% CI 63%, 78%) respectively. For low, intermediate and high risk cancer, the 5-year progression free probability was 91% (95% CI 85%�95%), 77% (95% CI 71%�82%) and 53% (95% CI 40%�65%) respectively. Surgical margins were positive in 13% of cases. The 5-year progression free probability was 49% (95%C.I. 35%� 61%) when the surgical margins were positive vs. 83% (95%C.I. 79%� 86%) in negative surgical margins cases. Nodal metastases were detected in 3% of the patients after limited pelvic lymph node dissection and in 10% after a standard pelvic lymph node dissection (p<0.001). The 3 year probability of freedom from progression for node positive patients was 49%. There were 22 overall deaths and 2 deaths from prostate cancer. Conclusion Laparoscopic radical prostatectomy provided 5 and 8-year cancer control in 78 and 71% of patients with clinically localized prostate cancer and 53% of those with high risk cancers at 5 years. A pelvic lymph node dissection limited to the external iliac nodal group is inadequate for detecting nodal metastases.
Touijer, Karim; Secin, Fernando P; Cronin, Angel M; Katz, Darren; Bianco, Fernando; Vora, Kinjal; Reuter, Victor; Vickers, Andrew J; Guillonneau, Bertrand
Laparoscopic management of chylous ascites following laparoscopic donor nephrectomy
Laparoscopic donor nephrectomy (LDN) is an established operation for organ procurement in living donor transplantation. Living donor renal transplantation is being performed more frequently and is associated with better graft function and survival. The minimal access approach for organ procurement from healthy individuals ensures early convalescence and improved patient participation. Here we describe a rare complication of LDN. Postoperative chylous ascites frequently occurs secondary to aortic surgery. Though previously described after LDN, its treatment remains contentious. Conventional strategies have adopted an expectant approach with medical management. These include parenteral feeding, bowel rest and somatostatin analogue usage. We report laparoscopic suture ligation as the principal management of postoperative chyle leak. We advocate surgical exploration in acute onset, high output chylous ascites. Pre-existing port site incisions were used for undertaking successful laparoscopic repair. This surgical approach enabled faster convalescence and reduced hospital stay�important considerations for our healthy living donor.
Sinha, Ashish; Mamode, Nizam
Entry Complications in Laparoscopic Surgery
To review the complications associated with laparoscopic surgery and provide clinical direction regarding the best practice based on the best available evidence. The laparoscopic entry techniques and technologies reviewed include the classic pneumoperitoneum (Veress/trocar), the open (Hasson), the direct trocar insertion, the use of disposable shielded trocars, radially expanding trocars and visual entry systems. Medline, Pubmed and Cochrane Databases were searched for English language articles published before December 2008. It is an evidence based fact that minimal access surgery is superior to conventional open surgery since this is beneficial to the women, community and the healthcare system.Over the past 50 years, many techniques, technologies and guidelines have been introduced to eliminate the risks associated with laparoscopic entry. No single technique or instrument has been proved to eliminate laparoscopic entry associated injury. Proper evaluation of the women, supported by surgical skills and good knowledge of the technology and instrumentation is the keystone to safe access and prevention of complications during laparoscopic surgery.
Krishnakumar, S; Tambe, P
Consequences of Conversion in Laparoscopic Colorectal Surgery
\\u000a Introduction��Laparoscopic procedures converted to open approaches have been associated with higher complication rates than laparoscopic\\u000a and open cholecystectomy and appendectomy. Laparoscopic colorectal resections have relatively high conversion rates compared\\u000a with other laparoscopic procedures. This study was designed to evaluate outcomes of conversions compared with laparoscopic\\u000a and open colorectal resections.\\u000a \\u000a \\u000a \\u000a Methods��We reviewed 498 consecutive colorectal resections performed between 1995 and 2002.
Rodrigo Gonzalez; C. Daniel Smith; Edward Mason; Titus Duncan; Russell Wilson; Jacqueline Miller; Bruce J. Ramshaw
The role of pelvic organs prolapse in the etiology of urinary incontinence in women
Background: Urinary incontinence is relatively common in women and is usually associated with pelvic organs prolapse. Our aim was to determine the relationship between type and intensity of urinary incontinence and different grades and types of pelvic organ prolapse among women. Materials and Methods: One-hundred female patients with the chief complaint of incontinence, who were diagnosed with pelvic organ prolapse participated in this study. Intensity of prolapse, stress and urge incontinence were evaluated using POP-Q (Pelvic Organ Prolapse Questionnaire), SEAPI (Stress related, Emptying ability, Anatomy, Protection, Inhibition) and Freeman criteria, respectively. Results: Patients� mean age was 51.95 � 12.82 years. The most common type of incontinence was stress incontinence (53%) and the most common prolapse type was cystocele (76%). Cystocele and rectocele had a significant relationship with stress (P value = 0.012) and urge incontinence (P value = 0.035), respectively; however, no relationship was observed between different grades of cystocele, rectocele and enterocele with different types of urinary incontinence (P value > 0.05). In patients with urge and mixed incontinence, prolapse grade significantly increased with age, but no such relationship was found in patients with stress incontinence. The number of vaginal deliveries had a significant relationship only with cystocele and rectocele grade; however, the relationship between other variables such as intensity of different types of urinary incontinence and enterocele grade with the number of deliveries was not significant. Conclusion: Pelvic organ prolapse had a significant relationship with urinary incontinence regardless of intensity and POP should be examined in all of these patients.
Zargham, Mahtab; Alizadeh, Farshid; Moayednia, Amir; Haghdani, Saeed; Nouri-Mahdavi, Kia
Effect of reactive oxygen species scavengers, antiinflammatory drugs, and calcium-channel blockers on carbon dioxide pneumoperitoneum-enhanced adhesions in a laparoscopic mouse model
Background��Postoperative adhesions are a clinical problem. They can cause female infertility, intestinal obstruction, chronic pelvic\\u000a pain, and difficulties at the time of reoperation. A variety of approaches described to prevent adhesions have shown variable\\u000a and inconsistent results. Therefore, this study aimed to evaluate most known substances in a laparoscopic mouse model to obtain\\u000a quantitative and comprehensive information on adhesion prevention.
M. M. Binda; C. R. Molinas; A. Bastidas; P. R. Koninckx
The phylogenetic and� embryologic basis and compared anatomy emphasize the understanding of the multiform organization, complex functions for the cosmetic aspects of the facial expression beyond an aged evolution doesn�t disturb the original smiling.
P Caix
The anatomy, physiology and function of the olfactory system are reviewed, as are the normal effects of olfactory stimulation. It is speculated that olfaction may have important but unobtrusive effects on human behavior....
This article reviews the underlying anatomy of trigger finger and thumb (fibrous digital pulleys, sesamoid bones), flexor tenosynovitis, de Quervain's syndrome, Dupuytren's contracture, some hand deformities in rheumatoid arthritis, the carpal tunnel syndrome and the ulnar nerve compression at Guyon's canal. Some important syndromes and structures have not been included but such are the nature of these seminars. Rather than being complete, we aim at creating a system in which clinical cases are used to highlight the pertinent anatomy and, in the most important part of the seminar, these pertinent items are demonstrated by cross examination of participants and teachers. Self learning is critical for generating interest and expanding knowledge of clinical anatomy. Just look at your own hand in various positions, move it, feel it, feel also your forearms while you move the fingers, do this repeatedly and inquisitively and after a few tries you will have developed not only a taste, but also a lifelong interest in clinical anatomy. PMID:23219083
Vargas, Ang�lica; Chiapas-Gasca, Karla; Hern�ndez-D�az, Cristina; Canoso, Juan J; Saavedra, Miguel �ngel; Navarro-Zarza, Jos� Eduardo; Villase�or-Ovies, Pablo; Kalish, Robert A
Intracorporeal Anastomosis in Laparoscopic Gastric Cancer Surgery
Laparoscopic gastrectomy has become widely used as a minimally invasive technique for the treatment of gastric cancer. When it was first introduced, most surgeons preferred a laparoscopic-assisted approach with a minilaparotomy rather than a totally laparoscopic procedure because of the technical challenges of achieving an intracorporeal anastomosis. Recently, with improved skills and instruments, several surgeons have reported the safety and feasibility of a totally laparoscopic gastrectomy with intracorporeal anastomosis. This review describes the recent technical advances in intracorporeal anastomoses using circular and linear staplers that allow for totally laparoscopic distal, total, and proximal gastrectomies. Data that demonstrate advantages in early surgical outcomes of a total laparoscopic method compared to laparoscopic-assisted operations are also discussed.
Hosogi, Hisahiro
Investigation of the anatomy of the mermaid and of mermaid lore has revealed a tangled web of stories, sightings and specimens of the most diverse nature, extending worldwide into the realms of folklore and legend, zoology and cryptozoology, anatomy, physiology, radiography and folk medicine, ethnography, social history and the history of science. The stereotype we know as the mermaid is surely a fit subject for further serious study PMID:11620025
Heppell, D
NSDL National Science Digital Library
Skull Anatomy 4.0 is an interactive learning tool for topographic, bony, and radiographic anatomy of the skull. It provides photographic-quality, digitized images of the face and radiographs of the skull offering over 120 anatomical features to identify. The mouse is used to identify features and a quiz is provided for student self-tests. Student files are password protected but accessible by the instructor. The downloadable file runs under Windows.
Laparoscopic liver resection: A review.
Laparoscopic liver surgery was slower to develop than other fields of laparoscopic surgery because of a steep learning curve, and fear of uncontrolled bleeding or gas embolism. However, laparoscopic liver resection (LLR) is associated with significant advantages: faster recovery, less post-operative pain, less morbidity, easier subsequent surgery and better cosmetic results. Since the inception of this technique, more than 3000 procedures have been reported. The aim of this update was to review the literature in order to define the indications (malignant tumors, benign tumors, major resections), the advantages and limits of this approach as well as the expected value of new technology, such as intra-operative guidance or robotics, in the development of this branch of surgery. PMID:24365035
Tranchart, H; Dagher, I
Granulomatous Peritonitis After Laparoscopic Cholecystectomy
Background: Granulomatous peritonitis may indicate a number of infectious, malignant, and idiopathic inflammatory conditions. It is a very rare postoperative complication, which is thought to reflect a delayed cell-mediated response to cornstarch from surgical glove powder in susceptible individuals. This mechanism, however, is much more likely to occur with open abdominal surgery when compared with the laparoscopic technique. Methods: We report a case of sterile granulomatous peritonitis in an 80-y-old female after a laparoscopic cholecystectomy. Management was conservative, and no relapse was observed after over 1-y of follow-up. Discussion: We propose that peritoneal exposure to bile acids during the laparoscopic removal of the gallbladder was the trigger of granulomatous peritonitis in this patient. Severe complications, such as peritoneal adhesions, intestinal obstruction, and fistula formation, were observed, but no fatalities were reported. Conclusion: We should be aware of this rare cause of peritonitis in the surgical setting.
Remotti, Daniele; Galluzzo, Michele; Gasbarrone, Laura
Laparoscopic live-donor nephrectomy.
Laparoscopic nephrectomy with ablative intent has been performed clinically. The current study aimed to determine whether a physiologically and anatomically intact kidney suitable for transplantation could be harvested laparoscopically. Three weeks after an ablative laparoscopic right nephrectomy, 15 pigs were divided into two groups: the study group (n = 10) underwent a laparoscopic live-donor left nephrectomy of the solitary kidney and conventional autotransplantation; the control group (n = 5) underwent an open live-donor left nephrectomy of the solitary kidney and conventional autotransplantation. All study kidneys underwent laparoscopic in situ hypothermic perfusion. The mean length of the left renal artery and vein were similar in the study and control groups: 3.1 cm and 3.4 cm, respectively, in the study group compared with 2.5 cm and 3.8 cm, respectively, in the control group (P = 0.5). No intraoperative renal vascular injuries or postoperative ureteral complications were noted in either group. Renal histopathologic examination immediately after live-donor nephrectomy and at 1 month post-transplant showed similar findings in the two groups. The mean serum creatinine at 7 and 30 days postoperatively was not significantly different: 2.1 mg/dL and 1.6 mg/dL, respectively, in the study group and 1.7 mg/dL, and 1.4 mg/dL, respectively, in the control group (P = 0.4). We conclude that laparoscopic live-donor nephrectomy can be performed safely and reproducibly in the porcine model. PMID:8061673
Gill, I S; Carbone, J M; Clayman, R V; Fadden, P A; Stone, M A; Lucas, B A; McRoberts, J W
Evaluation of acute pelvic pain in women.
Diagnosis of pelvic pain in women can be challenging because many symptoms and signs are insensitive and nonspecific. As the first priority, urgent life-threatening conditions (e.g., ectopic pregnancy, appendicitis, ruptured ovarian cyst) and fertility-threatening conditions (e.g., pelvic inflammatory disease, ovarian torsion) must be considered. A careful history focusing on pain characteristics, review of systems, and gynecologic, sexual, and social history, in addition to physical examination helps narrow the differential diagnosis. The most common urgent causes of pelvic pain are pelvic inflammatory disease, ruptured ovarian cyst, and appendicitis; however, many other diagnoses in the differential may mimic these conditions, and imaging is often needed. Transvaginal ultrasonography should be the initial imaging test because of its sensitivities across most etiologies and its lack of radiation exposure. A high index of suspicion should be maintained for pelvic inflammatory disease when other etiologies are ruled out, because the presentation is variable and the prevalence is high. Multiple studies have shown that 20 to 50 percent of women presenting with pelvic pain have pelvic inflammatory disease. Adolescents and pregnant and postpartum women require unique considerations. PMID:20642266
Kruszka, Paul S; Kruszka, Stephen J
Endometriosis and Chronic Pelvic Pain
Nurses often encounter patients with chronic pelvic pain associated with endometriosis, which is a puzzling and problematic gynecologic condition that has continued to plague women and baffle doctors and researchers worldwide since it was first identified by Dr. J. Sampson in the 1920s (Sampson, 1940). Endometriosis is defined as the growth, adhesion and progression of endometrial glands and stroma outside of the uterine cavity, with cellular activity evident in lesions, nodules, cysts or endometriomas (Audebert et al., 1992). Although it typically appears benign on histopathology, endometriosis has been likened to a malignant tumor since the lesions grow, infiltrate and adhere to adjacent tissues and interfere with physiologic processes (Kitawaki et al., 2002; Noble, Simpson, Johns, & Bulun, 1996). Ectopic endometriotic growths respond to cyclic changes of estrogen and proliferate and shed in a manner similar to eutopic endometrium. This cyclic ectopic activity results in internal bleeding, formation of scar tissue, inflammation and sometimes debilitating chronic pain (Kitawaki et al.).
Bloski, Terri; Pierson, Roger
A reliable and simple method of allograft fixation in laparoscopic posterior-loop rectopexy (LPR) was developed. The study was carried out on 40 cadavers, peak effort of separation of the net fixed to the sacrum by various methods was evaluated. Effort of separation in fixation of the net by sutures was 10.1 +/- 2.12 kg, in fixation by hernial stapler--1.13 +/- 0.36 kg, stapler "Pro-Tack"--6.38 +/- 1.85 kg, in fixation of the net by the new device--8.9 +/- 0.75 kg. From 1995 till 1999 LPR was performed with the new device in 15 patients, the open posterior-loop rectopexy (OPR) with fixation of the net by non-absorbable sutures--in 16 patients. In LPR intraoperative blood flow was twice as small (146.0 +/- 79.2 ml) as in OPR (275.6 +/- 76.9 ml). Mean time of LPR was 183.1 +/- 69.8 min, OPR--211.3 +/- 57.9 min. Relief of pain after LPR enabled with reduction of narcotic analgetics requirement (58.3 +/- 1.5 mg). Mean dose of narcotic analgetics after OPR was 93.2 +/- 1.4 mg. The proposed method of allograft fixation and device for it realization are effective and meet all requirements. PMID:11400450
Vorob'ev, G I; Shelygin, Iu A; Frolov, S A; Sushkov, O I
Teaching Pelvic Examinations Under Anaesthesia: What Do Women Think?
Objective: Medical students need to undertake supervised pelvic examinations to achieve competence. This experience is frequently obtained by conducting pelvic examinations on anaesthetized patients who are undergoing gynaecological surgery. Our research was carried out to determine patients' expectations of medical students performing intraoperative pelvic examinations. Methods: Patients at the Calgary Pelvic Floor Disorders Clinic were asked to complete questionnaires including
Sara Wainberg; Heather Wrigley; Justine Fair; Sue Ross; Calgary AB
Pelvic reconstructive surgery in renal transplant recipients
Introduction and hypothesis��Thousands of women undergo renal transplantation each year. Many develop pelvic floor conditions after transplantation requiring\\u000a surgical correction. This study describes our experience with pelvic reconstructive surgery in renal transplant recipients.\\u000a \\u000a \\u000a \\u000a Methods��Retrospective chart review identified five renal transplant patients who had pelvic reconstructive surgery for urodynamic\\u000a stress incontinence and prolapse between January 2000 and May 2008. Data included
David Shveiky; Adam Blatt; Andrew I. Sokol; Huong G. Nghiem; Cheryl B. Iglesia
Delayed onset advanced pelvic organ prolapse after pelvic trauma in a nulliparous young female: case report.
Reports have shown that high-energy pelvic trauma might be associated with advanced pelvic organ prolapse in conjunction with other causes. We report the case of a 21-year-old nulliparous, premenopausal, non-overweight woman with no predisposing factors for prolapse who developed stage IV massive pelvic organ prolapse and stress urinary incontinence 4 years after a severe pelvic traumatic accident. Most likely, the pelvic trauma, as a single factor, was the causative factor for the massive procidentia. The onset on the prolapse was delayed until 4 years after the pelvic accident. The patient was managed with sacrospinous ligament hysteropexy along with anterior and posterior vaginal wall repair and perineorrhaphy. Despite satisfactory surgical management, long-term regular follow-up is still required. PMID:21161180
Ko, Po-Chun; Lo, Tsia-Shu
Background and Aims Current concepts based on referral center data suggest that pelvic floor injury from obstetric trauma is a major risk factor for fecal incontinence (FI) in women. In contrast, a majority of community women only develop FI decades after vaginal delivery, and obstetric events are not independent risk factors for FI. However, obstetric events are imperfect surrogates for anal and pelvic floor injury, which is often clinically occult. Hence, our objectives were to evaluate the relationship between prior obstetric events, pelvic floor injury, and FI among community women. Design In this nested case-control study of 68 women with FI (cases; mean age 57y) and 68 age-matched controls from a population-based cohort in Olmsted County, MN, pelvic floor anatomy and motion during voluntary contraction and defecation were assessed by MRI. Obstetric events and bowel habits were recorded. Results By multivariable analysis, internal sphincter injury (cases-28%, controls-6%; odds ratio [OR], 8.8; 95% CI, 2.3�34) and reduced perineal descent during defecation (cases-2.6 � 0.2 cm, controls-3.1 � 0.2 cm; OR, 1.7; 95% CI, 1.2�2.4) increased FI risk, but external sphincter injury (cases-25%, controls-4%;p < 0.005) was not independently predictive. Puborectalis injury was associated (p<0.05) with impaired anorectal motion during squeeze, but was not independently associated with FI. Grade 3�4 episiotomy (OR, 3.9; 95% CI, 1.4�11) but not other obstetric events increased the risk for pelvic floor injury. Heavy smoking (? 20 pack-years) was associated (p=0.052) with external sphincter atrophy. Conclusions State-of-the-art imaging techniques reveal pelvic floor injury or abnormal anorectal motion in a minority of community women with FI. Internal sphincter injury and reduced perineal descent during defecation are independent risk factors for FI. In addition to grade 3�4 episiotomy, smoking may be a potentially preventable, risk factor for pelvic floor injury.
Bharucha, Adil E.; Fletcher, J.G.; Melton, L. Joseph; Zinsmeister, Alan R.
Pelvic Floor Muscle Training in Prevention and Treatment of Pelvic Organ Prolapse
\\u000a This chapter describes the four randomized controlled trials (RCTs) published on the effect of pelvic floor muscle training\\u000a (PFMT) to treat pelvic organ prolapse (POP) and symptoms of prolapse. The results of all four trials show a significant effect\\u000a of PFMT. However, to date there is only one full-scale RCT using the gold standard Pelvic Organ Prolapse Quantification (POP-Q)\\u000a system
Kari B�; Ingeborg Hoff Br�kken
Laparoscopic treatment of endometriosis.
Endometriosis can be considered as a chronic disease which is characterized by the presence of ectopic endometrium outside the endometrial cavity and which is associated with symptoms as pelvic pain and infertility. Medical treatment is often not sufficient in patients with moderate to severe endometriosis and deep infiltrative endometriosis (DIE), therefore requiring surgical intervention. Over the past 15 years, we have built a multidisciplinary surgical team to perform a radical but fertility preserving resection of extensive endometriosis with involvement of surrounding organ systems, realizing a good clinical outcome with low complication and recurrence rate, a very good improvement of QOL and a high pregnancy rate. However, for future research evaluating surgical treatment of extensive endometriosis, it is important to reach agreement on study design and on reporting clinical outcome data. A multicenter study with clear patient identification and well defined outcome parameters needs to be set up. Moreover, prevention of DIE with colorectal extension is important, ideally by early identification and management of girls and women at risk. Years of pain and disability as well as a lot of money could be saved when patients, at risk of developing extensive forms of endometriosis could be diagnosed during adolescence. PMID:23598780
Meuleman, C; Tomassetti, C; Gaspar Da Vitoria Magro, M; Van Cleynenbreugel, B; D'Hoore, A; D'Hooghe, T
Dynamics of Female Pelvic Floor Function Using Urodynamics, Ultrasound and Magnetic Resonance Imaging (MRI)
In this review the diagnostic potential of evaluating female pelvic floor muscle (PFM)) function using magnetic and ultrasound imaging in the context of urodynamic observations is considered in terms of determining the mechanisms of urinary continence. A new approach is used to consider the dynamics of PFM activity by introducing new parameters derived from imaging. Novel image processing techniques are applied to illustrate the static anatomy and dynamics PFM function of stress incontinent women pre and post operatively as compared to asymptomatic subjects. Function was evaluated from the dynamics of organ displacement produced during voluntary and reflex activation. Technical innovations include the use of ultrasound analysis of movement of structures during maneuvers that are associated with external stimuli. Enabling this approach is the development of criteria and fresh and unique parameters that define the kinematics of PFM function. Principal among these parameters, are displacement, velocity, acceleration and the trajectory of pelvic floor landmarks. To accomplish this objective, movement detection, including motion tracking algorithms and segmentation algorithms were developed to derive new parameters of trajectory, displacement, velocity and acceleration, and strain of pelvic structures during different maneuvers. Results highlight the importance of timing the movement and deformation to fast and stressful maneuvers, which are important for understanding the neuromuscular control and function of PFM. Furthermore, observations suggest that timing of responses is a significant factor separating the continent from the incontinent subjects.
Constantinou, Christos E.
The place of surface anatomy in the medical literature and undergraduate anatomy textbooks.
The aims of this review were to examine the place of surface anatomy in the medical literature, particularly the methods and approaches used in teaching surface and living anatomy and assess commonly used anatomy textbooks in regard to their surface anatomy contents. PubMed and MEDLINE databases were searched using the following keywords "surface anatomy," "living anatomy," "teaching surface anatomy," "bony landmarks," "peer examination" and "dermatomes". The percentage of pages covering surface anatomy in each textbook was calculated as well as the number of images covering surface anatomy. Clarity, quality and adequacy of surface anatomy contents was also examined. The search identified 22 research papers addressing methods used in teaching surface anatomy, 31 papers that can help in the improvement of surface anatomy curriculum, and 12 anatomy textbooks. These teaching methods included: body painting, peer volunteer surface anatomy, use of a living anatomy model, real time ultrasound, virtual (visible) human dissector (VHD), full body digital x-ray of cadavers (Lodox(�) Statscan(�) images) combined with palpating landmarks on peers and the cadaver, as well as the use of collaborative, contextual and self-directed learning. Nineteen of these studies were published in the period from 2006 to 2013. The 31 papers covered evidence-based and clinically-applied surface anatomy. The percentage of surface anatomy in textbooks' contents ranged from 0 to 6.2 with an average of 3.4%. The number of medical illustrations on surface anatomy varied from 0 to 135. In conclusion, although there has been a progressive increase in publications addressing methods used in teaching surface anatomy over the last six to seven years, most anatomy textbooks do not provide students with adequate information about surface anatomy. Only three textbooks provided a solid explanation and foundation of understanding surface anatomy. PMID:23650274
Azer, Samy A
Pelvic (between the hips) radiation - discharge
... pelvis. Woman should not wear girdles or pantyhose. Cotton underwear is best. Keep buttocks and pelvic areas ... cancer: basic principles, uses, and complications. In: Lentz GM, Lobo RA, Gershenson DM, Katz VL, eds. Comprehensive ...
Pelvic Exercises May Help His Sex Life
Peritoneal gallstones following laparoscopic cholecystectomy
Background: Gallstone spillage during laparoscopic cholecystectomy (LC) is a common intraoperative event. Although gallstones left in the peritoneal cavity were initially considered harmless, a significant number of complications have been reported. Our aim was to quantify the likelihood, and to document the range, of subsequent complications. Methods: A Medline search from 1987 to January 2003 was performed. Articles with more
J. C. Woodfield; M. Rodgers; J. A. Windsor
Laparoscopic Extravesical Ureteral Reimplantation: Technique
Laparoscopic extravesical ureteral reimplantation in children is currently a technically demanding procedure with sparse literature to aid in mastering the learning curve. We present our most recent technique and lessons learned after 20 cases in children 4�15 years of age. The literature is also reviewed to encapsulate the current state-of-the-art.
Capolicchio, John-Paul
Laparoscopic resection of giant liver hemangioma using laparoscopic Habib probe for parenchymal transection.
Experience with laparoscopic liver resections is limited. Laparoscopic resection of a variety of liver lesions has been reported and is considered appropriate for lesions in the left lateral segment and inferior segments of the right lobe. Herein, we report a 52-year-old male patient who underwent a laparoscopic resection of giant liver hemangioma with the use of a laparoscopic 4� Habib probe. PMID:22623829
Gadiyaram, Srikanth; Shetty, Neel
Student perceptions about learning anatomy
NASA Astrophysics Data System (ADS)
This research study was conducted to examine student perceptions about learning anatomy and to explore how these perceptions shape the learning experience. This study utilized a mixed-methods design in order to better understand how students approach learning anatomy. Two sets of data were collected at two time periods; one at the beginning and one at the end of the academic semester. Data consisted of results from a survey instrument that contained open-ended questions and a questionnaire and individual student interviews. The questionnaire scored students on a surface approach to learning (relying on rote memorization and knowing factual information) scale and a deep approach to learning (understanding concepts and deeper meaning behind the material) scale. Students were asked to volunteer from four different anatomy classes; two entry-level undergraduate courses from two different departments, an upper-level undergraduate course, and a graduate level course. Results indicate that students perceive that they will learn anatomy through memorization regardless of the level of class being taken. This is generally supported by the learning environment and thus students leave the classroom believing that anatomy is about memorizing structures and remembering anatomical terminology. When comparing this class experience to other academic classes, many students believed that anatomy was more reliant on memorization techniques for learning although many indicated that memorization is their primary learning method for most courses. Results from the questionnaire indicate that most students had decreases in both their deep approach and surface approach scores with the exception of students that had no previous anatomy experience. These students had an average increase in surface approach and so relied more on memorization and repetition for learning. The implication of these results is that the learning environment may actually amplify students' perceptions of the anatomy course at all levels and experiences of enrolled students. Instructors wanting to foster deeper approaches to learning may need to apply instructional techniques that both support deeper approaches to learning and strive to change students' perceptions away from believing that anatomy is strictly memorization and thus utilizing surface approaches to learning.
Notebaert, Andrew John
Hemorrhage After Low-Energy Pelvic Trauma.
BACKGROUND:: Severe pelvic hemorrhage after low-energy trauma has been described in some reports of single cases only. However, it might not be as rare and unique as generally expected. The aim of this study was therefore to present a case series of 11 patients with severe pelvic hemorrhage after sustaining low-energy trauma and to discuss relevant considerations for the management of these patients. METHODS:: A consecutive series of eleven patients with pelvic hemorrhage and the need for arterial embolization after sustaining low-energy pelvic trauma was identified. A contrast-enhanced computed tomography (CT) scan was performed in all patients, if pelvic hemorrhage was suspected due to a relevant hemoglobin (Hb) drop. After the CT scans showed active arterial bleeding, arterial embolization was immediately performed. RESULTS:: All patients sustained low-energy pelvic injuries after simple falls from standing height. The mean initial Hb level was 13.0 g/dL. Contrast-enhanced CT scans were performed after a mean of 14.3 hours after trauma and showed contrast medium extravasations in all patients. The mean Hb level at the time of CT scan was 9.0 g/dL. Embolization was successfully performed in all patients within a mean of 4.5 hours. CONCLUSIONS:: Geriatric patients are prone to arterial hemorrhage after low-energy pelvic trauma. They should be admitted as an inpatient for observation with repeated control of the Hb level to diagnose hemorrhage at an early stage. Contrast-enhanced CT scans is the preferred imaging method for the assessment of pelvic hemorrhage, whereas arterial embolization is highly successful in terms of hemostasis. PMID:21841508
Krappinger, Dietmar; Zegg, Michael; Jeske, Christian; El Attal, Rene; Blauth, Michael; Rieger, Michael
Pelvic tuberculosis and shock in the puerperium.
Pelvic tuberculosis (TB) in pregnancy and puerperium is rare. Its atypical presentation as puerperal shock is more rare. We describe a case of pelvic TB that manifested as shock in a teenager who was two weeks postpartum. She failed to respond to antibiotics. Ziehl-Neelsen staining of aspirated pus from the left fossa collection in the abdominal cavity was positive for mycobacterium TB. Prompt treatment with antitubercular therapy could save patients from this life-threatening condition. PMID:21606719
Agarwal, Manika; Das, Ananya; Singh, Ahanthem Santa
Chronic pelvic pain in the adolescent.
Chronic pelvic pain occurs commonly in the adolescent and can be a diagnostic and therapeutic challenge for the clinician, the adolescent, and her family. Defined as lower quadrant or lower abdominal pain lasting 3-6 months or longer, chronic pelvic pain can lead to missed school and activities, decreased functioning, and decreased quality of life in the adolescent. Both the primary care clinician and the pediatric gynecologist need to be aware of the most common causes of chronic pelvic pain in the adolescent, including surgical and nonsurgical, gynecologic versus other pathology including the psychosomatic, and the role of the mind in control of somatic pain in the adolescent. Adding to this complexity is the standard adolescent sense of invulnerability; a knowledge of adolescent development remains essential to the delivery of appropriate gynecologic care for this age group. Education and communication with both the adolescent and her family requires sensitivity, especially in cultures where adolescent sexuality is taboo or discouraged. This chapter will discuss the developmental stages of adolescence and how that impacts care of the patient with chronic pelvic pain at the varying ages, the issue of confidentiality when obtaining a sexual history on the adolescent, and etiologies of chronic pelvic pain specific to the adolescent, including gynecologic and nongynecologic causes. Diagnostic and treatment considerations for chronic pelvic pain in the adolescent will also be addressed. PMID:22846533
Hicks, Caitlin W; Rome, Ellen S
Variant anatomy of sciatic nerve in a black Kenyan population.
Knowledge of variant anatomy of the sciatic nerve is important in avoiding inadvertent injury during operations in the gluteal region and interpreting nondiscogenic sciatica. This variant anatomy may cause piriformis syndrome and failure of sciatic nerve block. The variations differ between populations but data from Africans is scarce. This study, therefore, investigated variations of sciatic nerve in a black Kenyan population. One hundred and sixty-four sciatic nerves from 82 cadavers of black Kenyans were exposed by dissection at the Department of Human Anatomy, University of Nairobi, Kenya. The level of bifurcation, relationship to piriformis, and topographic relations between the branches were studied. The results were analysed by SPSS version 16.0 and are presented by macrographs. In 33 (20.1%) cases division occurred in the pelvis, while in 131 (79.9%) it occurred outside the pelvis. A single trunk sciatic nerve exited below the piriformis muscle in 131 (79.9%) cases. In cases of pelvic division, the tibial nerve was always infrapiriformic, while the common peroneal nerve passed below piriformis in 16 (9.8%) cases, pierced the piriformis in 13 (7.9%), and passed above it in 4 (2.4%). For those in which division was extrapelvic, 110 (67.1%) were in the popliteal fossa, 17 (10.4%) in the middle third of the thigh, and 4 (2.4%) in the gluteal region. Where the division was pelvic, in 19 (11.6%) cases they continued separately, in 8 (4.9%) the two nerves reunited, and in 6 (3.7%) they were connected by a communicating nerve. The sciatic nerve in the Kenyan population varies from the classical description in over 30% of cases, with many high divisions, low incidence of piriformic course of common peroneal nerve, reunion, and unusual connection between common peroneal and tibial nerves. These variations may complicate surgery and interpretation of sciatic neuropathy. Preoperative nerve imaging and extra operative diligence in the gluteal region and the back of the thigh are recommended. PMID:21866528
Ogeng'o, J A; El-Busaidy, H; Mwika, P M; Khanbhai, M M; Munguti, J
Clinical value of extended pelvic lymph node dissection in patients subjected to radical prostatectomy
Introduction Extended pelvic lymph node dissection (ePLND) is advised to complement radical prostatectomy (RP) in intermediate and high risk prostate cancer patients. Aim To assess the risk of nodal involvement in patients subjected to laparoscopic radical prostatectomy and to characterize the group of patients with lymph node (LN) metastases. Material and methods Data of patients subjected to laparoscopic radical prostatectomy with ePLND between February 2011 and June 2013 were analyzed. The LN that were removed included presacral nodes, common, external and internal iliac nodes and obturator ones. Results Mean number of removed LNs was 19. Metastases within LN were found in 13 (16.6%) patients. In comparison to those without LN involvement, patients who were found to have LN metastases had a greater number of positive biopsy cores (3.7 vs. 5.3, p < 0.01), maximum percentage of cancer in biopsy core (47.0 vs. 67.6, p < 0.01), greater biopsy and specimen Gleason scores (7.0 vs. 7.7 and 7.0 vs. 7.8) and more frequently advanced clinical and pathological stage. The most frequent landing sites of prostate cancer were obturator and presacral nodes (100% and 38%). Eleven patients (85%) among those with positive LN had locally advanced disease. Conclusions The risk of LN metastases in intermediate and high risk prostate cancer patients is significant. Therefore, if radical prostatectomy is chosen, ePLND should be performed. The majority of patients with involvement of pelvic LN have locally advanced disease which would refer them to adjuvant radiation if managed without nodal dissection.
Piotrowicz, Sebastian; Skrzypczyk, Michal; Golabek, Tomasz; Chlosta, Piotr; Borowka, Andrzej
Atlas of Goat Anatomy. Part I. Osteology.
National Technical Information Service (NTIS)
The purpose of the investigation was to establish a reference source for the normal anatomy of the angora goat (Capra hircus). This report, the first in a series, presents the skeletal anatomy of this animal. (Author)
C. E. Hopkins G. L. Leppart T. E. Hamm
Gynaecological laparoscopic surgery: eight years experience in the Yaound� Gynaeco-Obstetric and Paediatric Hospital, Cameroon.
This is a retrospective analysis of eight years of gynaecological laparoscopic surgery in a resource-limited setting. All gynaecological patients managed by laparoscopy at the Yaound� Gynaeco-Obstetric and Paediatric Hospital from 1 January 2004 to 30 November 2011 were included. Amongst the 9194 gynaecological surgeries performed during the study period, 6.9% (633) were done by laparoscopy. Most of the women underwent an operative laparoscopy (568/592; 95.9%). The most common indication was infertility (415/592; 70.1%). Diagnostic laparoscopies were mostly indicated for chronic pelvic pain (18/24; 75%). The most common surgical finding was tubo-peritoneal adhesions (412/592; 69.6%). A total of 35 patients (35/592; 5.9%) had at least one complication. The mean duration of hospitalization was 3.4 �1.8 days. The general uptake of gynaecological laparoscopic surgery is low in our setting. The laparoscopic complication rate of 5.9% is encouraging. PMID:24395883
Mboudou, Emile; Morfaw, Frederick L I; Foumane, Pascal; Sama, Julius Dohbit; Mbatsogo, Bernard Armand Enama; Minkande, Jacqueline Ze
Radiologic investigation after laparoscopic inguinal hernia repair
Laparoscopic instead of open surgical repair of inguinal hernias is becoming more frequent. Radiologists may expect different\\u000a postoperative findings depending on the technique used. We studied how radiology had been used postoperatively and what findings\\u000a were encountered after laparoscopic herniorraphy. Postoperative radiologic examinations related to hernia repair of all consecutive\\u000a patients that had had laparoscopic herniorraphy in Malm� University hospital
Martin Larmark; Olle Ekberg; Agneta Montgomery
One-Stage Laparoscopic Restorative Proctocolectomy
PURPOSE: There is significant concern in the current literature over the safety of laparoscopic techniques in removal of the entire colon and rectum. The purpose of this study was to examine the results of a one-stage laparoscopic-assisted restorative proctocolectomy in patients with mucosal ulcerative colitis and familial adenomatous polyposis in a single institution experience. METHODS: All patients who underwent laparoscopic-assisted
Alex J. Ky; Toyooki Sonoda; Jeffrey W. Milsom
Laparoscopic management of gastric gastrointestinal stromal tumors
Gastrointestinal stromal tumors (GISTs) are the most frequent gastrointestinal tumors of mesodermal origin. Gastric GISTs represent approximately 70% of all gastrointestinal GISTs. The only curative option is surgical resection. Many surgical groups have shown good results with the laparoscopic approach. There have not been any randomized controlled trials comparing the open vs laparoscopic approach, and all recommendations have been based on observational studies. The experience obtained from gastric laparoscopic surgery during recent decades and the development of specific devices have allowed the treatment of most gastric GISTs through the laparoscopic approach.
Correa-Cote, Juan; Morales-Uribe, Carlos; Sanabria, Alvaro
Laparoscopic Inguinal Hernia Repair in Children
Background: This study aimed to document the authors' experience with laparoscopic inguinal hernia repair in children. Methods: Ninety-three hernia repairs were performed in 64 children. The neck was closed with a purse string suture by using 4-0 absorbable suture. Results: Ninety-three indirect inguinal hernial sacs were closed in 64 children. Nine percent of children had an ectopic testis. The mean operating time for laparoscopic ring closure was 25 minutes (range, unilateral 21 to 35; bilateral, 28 to 50). The contralateral processus vaginalis was patent in 20% of children. In 24% of children, the final procedure was modified based on the findings of a dilated internal ring. A laparoscopic ilio-pubic tract repair was done in these cases. Laparoscopic mobilization, orchiopexy followed by ilio-pubic tract repair was done in 9% of children. Scrotal swelling occurred in one child. Hydrocoele occurred in one patient. Recurrence rate was 3.1%. Conclusion: Laparoscopic inguinal hernia repair in children can be offered, as it is safe, reproducible, and technically easy for experienced laparoscopic surgeons. Iliopubic tract repair may be added in cases with dilated internal ring. Recurrence following laparoscopic ring closure can be managed with laparoscopic ilio-pubic tract repair. The long-term follow-up of laparoscopic ilio-pubic tract repair is awaited.
Chinnaswamy, Palanivelu; Jani, Kalpesh V.; Parthasarthi, R.; Shetty, Roshan A.; Kavalakat, Alfie Jose; Prakash, Anand
Chronic Pelvic Pain due to Pelvic Congestion Syndrome: The Role of Diagnostic and Interventional Radiology
Chronic pelvic pain (CPP) is a common cause of gynecologic referral. Pelvic congestion syndrome, which is said to occurs due to ovarian vein incompetence, is a recognized cause of CPP. The aim of this paper is to briefly describe the clinical manifestations, and to review the role of diagnostic and interventional radiology in the management of this probably under-diagnosed condition.
Ganeshan, Arul; Upponi, Sara [John Radcliffe Hospital, Department of Radiology (United Kingdom); Hon, Lye-Quen [The Royal Hallamshire Hospital, Department of Radiology (United Kingdom); Uthappa, M. C.; Warakaulle, Dinuke R. [Stoke Mandeville Hospital, Department of Radiology (United Kingdom); Uberoi, Raman [John Radcliffe Hospital, Department of Radiology (United Kingdom)], E-mail: email@example.com
Laparoscopic Management of Adnexal Masses
Background and Objective: Although laparoscopic surgery for removal of adnexal masses is common, controversy exists about the safety and efficacy of this procedure for patients with malignancies. The aim of this study was to evaluate the effectiveness and safety of laparoscopic surgical treatment for patients with adnexal masses. Methods: This was a retrospective chart review of one surgeon's experience in managing patients diagnosed with adnexal masses at 2 urban referral teaching hospitals in New York City. We reviewed the charts for 100 consecutive patients who underwent operative laparoscopy for management of adnexal masses between March 4, 1996 and November 9, 1998. Conversion to laparotomy, malignancy rate, complications, length of stay, and blood loss were recorded for each patient. Results: Laparoscopic management was successfully completed for 81 of the 100 patients in this study; however, 19 required conversion to laparotomy. All 81 patients managed laparoscopically had a benign diagnosis, whereas 7 of the 19 patients who underwent laparotomy were diagnosed with malignancy. The median length of stay, estimated blood loss, and operating room time were significantly lower for those treated by laparoscopy alone compared with those converted to laparotomy (2 vs. 7 days; 100 vs. 500 ccs; 130 vs. 235 minutes, respectively; P < 0.05). Though few patients were in the laparotomy group, that data are presented for completeness. A total of 10 complications occurred, 4 in the group of patients managed laparoscopically (2 enterotomies, 1 pneumothorax, and 1 vaginal cuff cellulitis). Six complications occurred in those managed with laparotomy (2 enterotomies, 2 wound infections, 1 pneumonia, and 1 postoperative fever). The indications for conversion to laparotomy were: 7 malignancies (5 ovarian cancers and 2 uterine cancers), 7 dense adhesions, 2 small bowel enterotomies, 1 intraoperative bleeding, 1 secondary to a large uterus (880 grams), and 1 secondary to a large myoma (13 cm x 14.5 cm x 6 cm). Conclusions: The laparoscopic approach is effective and safe for managing patients with adnexal masses of unknown pathology. Malignancies can be diagnosed accurately, converted to laparotomy, and staged appropriately. Adequate surgical skills along with timely use of frozen sections are required for successful operative management.
Emeney, Pamela L.; Byrne, Daniel W.
Laparoscopic tubal sterilization: long-term postoperative follow-up.
93 women who underwent laparoscopic tubal coagulation during 1972-1973 were followed up for periods of 18 months to 3 years. Ages ranged from 17 to 47 years (mean 30.7) and 71% had 2-4 children. 8 requested sterilization prior to conception and 5 had pregnancy previously terminated by abortion. Most common postoperative complaints were tenderness at the incision site and shoulder or neck pain. In the 64 cases in which sterilization alone was performed average blood loss was less than 50 cc. In 8 cases it was associated with diagnositc dilatation and curettage, in 20 with therapeutic abortion, and in 1 with laparotomy. Complications included 1 case each of bleeding mesosalpinx controlled by cautery, wound hematoma, hematoma epiploic appendix, and peritoneal burn. A detailed menstrual history 18-36 months after operation found 73 of the 93 had regular periods with amount of bleeding and length of cycle generally unchanged. Of the 20 with menstrual changes, 2 developed amenorrhea within 1 year and 8 with preoperative menstrual irregularities were unchagned. 10 developed longer periods and/or shorter intervals. 5 related these changes to discontination of oral contraceptives. Of the remaining 1 had an abnormal Pap smear, 2 were 40-45 years of age (1 of whom refused vaginal hysterectomy for stress incontinence), and 2 were 35-40 with no previous history of cesarean sections or pelvic complaints. The majority (77%) of the women were satisfied with the procedure, 16% uncertain, and 5 patients expressed regret. 4 of the 5 who regretted the operation reported gynecological complaints. 5 required subsequent surgery. In 3 of the 5 the indication preexisted the sterilization and a more thorough screening might have prevented 2 surgical procedures. In this series the incidence of postoperative gynecological disease 18-36 months after laparoscopic tubal ligation is significantly lower than that reported in the literature for conventional tubal ligation. PMID:131021
Rubinstein, L M; Lebherz, T B; Kleinkopf, V
Spontaneous Healing of a Rectovaginal Fistula Developing after Laparoscopic Segmental Bowel Resection for Intestinal Deep Infiltrating Endometriosis
The surgical treatment of intestinal deep infiltrating endometriosis has an associated risk of major complications such as dehiscence of the intestinal anastomosis, pelvic abscess, and rectovaginal fistula. The management of postoperative rectovaginal fistula frequently requires a reoperation and the construction of a stoma for temporary fecal diversion. In this paper we describe a 27-year-old woman undergoing laparoscopic treatment of deep infiltrating endometriosis (extramucosal cystectomy, resection of the uterosacral ligaments, resection of the posterior vaginal fornix, and segmental bowel resection) complicated by a rectovaginal fistula, which healed spontaneously with nonsurgical conservative treatment.
Trippia, Carlos Henrique; Zomer, Monica Tessmann
Robotic-Assisted Laparoscopic Prostatectomy for High-Risk Prostate Cancer: Technical Considerations and Review of the Literature
Men with high-risk prostate cancer are at significant risk of progressive, symptomatic disease leading to metastases or death from prostate cancer. Surgery�specifically robotic-assisted laparoscopic prostatectomy (RALP)�is increasingly being considered as a key component of a multimodal strategy to treat these patients. Herein, we review key technical considerations of performing RALP with bilateral pelvic lymphadenectomy in men with high-risk disease. Recent literature supporting the increasing role of surgery either alone or in combination with adjuvant therapies to treat men with high-risk prostate cancer is also reviewed.
Stroup, Sean P.; Kane, Christopher J.
Simultaneous laparoscopic adrenalectomy and laparoscopic nephron-sparing surgery - new experience with port placement.
The aim of the study was to describe simultaneous laparoscopic adrenalectomy and laparoscopic nephron-sparing surgery, to discuss the details of a convenient laparoscopic approach and the way of port placement, as well as to present a review of the literature concerning combined laparoscopic procedures. A 72-year-old woman was admitted to our department because of a tumor of the right adrenal gland and a small tumor of the right kidney. The patient underwent simultaneous laparoscopic adrenalectomy and laparoscopic nephron-sparing surgery. The postoperative period was uncomplicated. The patient was discharged from the hospital on the 4(th) postoperative day. We believe that the proposed way of trocar placement would help to avoid a 'rollover' problem between the laparoscope and a Satinsky clamp or a 'crossing swords' problem between a Satinsky clamp and manipulators. PMID:24501608
Panek, Wojciech; Szydelko, Tomasz; Lewandowski, Jaroslaw; Tuchendler, Tomasz; Urba?czyk, Grzegorz; Litarski, Adam; Apozna?ski, Wojciech
Simultaneous laparoscopic adrenalectomy and laparoscopic nephron-sparing surgery - new experience with port placement
The aim of the study was to describe simultaneous laparoscopic adrenalectomy and laparoscopic nephron-sparing surgery, to discuss the details of a convenient laparoscopic approach and the way of port placement, as well as to present a review of the literature concerning combined laparoscopic procedures. A 72-year-old woman was admitted to our department because of a tumor of the right adrenal gland and a small tumor of the right kidney. The patient underwent simultaneous laparoscopic adrenalectomy and laparoscopic nephron-sparing surgery. The postoperative period was uncomplicated. The patient was discharged from the hospital on the 4th postoperative day. We believe that the proposed way of trocar placement would help to avoid a �rollover� problem between the laparoscope and a Satinsky clamp or a �crossing swords� problem between a Satinsky clamp and manipulators.
Panek, Wojciech; Lewandowski, Jaroslaw; Tuchendler, Tomasz; Urbanczyk, Grzegorz; Litarski, Adam; Apoznanski, Wojciech
Anatomy of Sea Turtles (Manual).
National Technical Information Service (NTIS)
The need for an up-to-date guide to the anatomy of sea turtles became clear toward the end of the 1900s. Increasing numbers of individuals developed the interest, talents, and techniques to study the biology of sea turtles, contend with their illnesses an...
J. Wyneken
NSDL National Science Digital Library
In this activity, students examine hydra, a fresh-water relative of coral, under a microscope to observe feeding behavior and identify stinging cells that are characteristic of corals. They also learn more about the individual animals that make up coral reefs and construct simple models of coral polyp anatomy and feeding behavior.
NSDL National Science Digital Library
This article describes a study conducted at 8 Dutch Medical Schools investigating the effect of various didactic approaches to teaching anatomy on performance. Outcomes discussed include that good test performance is not related to teaching style, but rather course hours, clinical relevance, and revisiting anatomical concepts.
Technical difficulties and its remedies in laparoscopic cholecystectomy in situs inversus totalis: A rare case report
INTRODUCTION Laparoscopic cholecystectomy is considered to be the gold standard surgical procedure for cholelithiasis and is one of the commonest surgical procedures in the world today. However, in rare cases of previously undiagnosed situs inversus totalis (with dextrocardia), the presentation of the cholecystitis, its diagnosis and the operative procedure can pose problems. We present here one such case and discuss how the diagnosis was made and difficulties encountered during surgery and how they were coped with. PRESENTATION OF CASE A 35 year old female presented with left hypochondrium pain and dyspepsia, for 2 years. A diagnosis of cholelithiasis with situs inversus was confirmed after thorough clinical examination, abdominal and chest X-rays and ultrasonography of the abdomen. Laparoscopic cholecystectomy, which is the standard treatment, was performed with numerous modifications in the positioning of the monitor, insufflator, ports and the position of the members of the surgical team and the laparoscopic instruments. The patient had an uneventful recovery. DISCUSSION Situs inversus totalis is itself a rare condition and when associated with cholelithiasis poses a challenge in the management of the condition. We must appreciate the necessity of setting up the operating theatre, the positioning of the ports, the surgical team and the instruments. CONCLUSION Therefore, it becomes important for the right handed surgeons to modify their techniques and establish a proper hand eye coordination to adapt to the mirror image anatomy of the Calot's triangle in a patient of situs inversus totalis.
Arya, S.V.; Das, Anupam; Singh, Sunil; Kalwaniya, Dheer Singh; Sharma, Ashok; Thukral, B.B.
Laparoscopic surgery for choledochal cysts.
Laparoscopic cystectomy has become a common procedure for choledochal cysts. The cyst should be removed completely just above the confluence of the common biliopancreatic channel at the distal end and approximately 5 mm from the confluence of the right and left hepatic ducts at the proximal end to avoid complications of the cystic remnant. The operation is feasible and safe. The rate of conversion to open surgery is low. The rate of complication under skill laparoscopic surgeons is also low, even lower than in open surgery. There was no difference between hepaticoduodenostomy and hepaticojejunostomy concerning the rate of cholangitis. Gastritis due to bilious reflux occurred with a low rate in hepaticoduodenostomy. Both techniques could be used for choledochal cysts; however, hepaticoduodenostomy should be applied for choledochal cysts without intrahepatic dilatation of biliary tract. PMID:23572286
Liem, Nguyen Thanh
The decline of laparoscopic sterilisation.
Female sterilisation is an extensively used method of contraception all over the world but there appears to be a decline in the performance of this procedure in Ireland. There also appears to be an increased uptake of safe, long-acting contraceptive alternatives. We set out to establish the extent of the decline of laparoscopic sterilisation and to explore possible explanations. Data for female sterilisation from Ireland was obtained from the Hospital In-Patient Enquiry Scheme (HIPE) section of the Economic and Social Research Institute for the years 1999 to 2004. Recent sales figures for long acting reversible contraceptives, specifically the levo-norgestrel-loaded intrauterine system (LNG-IUS) (Mirena) and the etonogestrel implant (Implanon) were also obtained. Laparoscopic tubal ligations reduced from 2,566(1999) to 910 (2004). In the corresponding period the use of Mirena coils increased from 4,840 (1999) to 17,077 (2004). PMID:18450251
Horgan, R; Higgins, J R; Burke, G
[The laparoscopic treatment of varicocele].
Laparoscopic treatment of varicocele is described for 37 patients. The operation was performed under endotracheal, epidural and intravenous anesthesia with ligation of the testicular vein in 18 patients. Ligation with the dissection was conducted in 19 patients. On the first postoperative day 2 patients were given promedol (2%, 1.0 ml), the rest were injected baralgin (2-3 injections). The patients were discharged after 1-2 days of hospital stay and resumed their usual way of life 2-7 days after the discharge. One month later varicocele disappeared in 29 patients, diminished in size in 7 patients, pain relief occurred in 15 patients. Due to its advantages (simple performance, good visualization of the testicular vein, minimal use of narcotic drugs, short hospital stay, absence of serious complications) laparoscopic treatment may be considered as a method of choice. PMID:9123663
Stepanov, V N; Mumladze, R B; Kadyrov, Z A; Perel'man, V M; Rozikov, Iu Sh; Tomkevich, B A; Puzhik, A M; Kosachenko, V M
Combined acetabulum and pelvic ring injuries.
Combined fractures of the acetabulum and pelvic ring are more common than previously believed, with an incidence as high as 15.7%. Recent series that include combined injuries indicate that the incidence of lateral compression and anteroposterior compression pelvic ring injuries is similar and that transverse and both-column acetabular fractures are the most common acetabular fracture patterns. Combined injuries most often are the result of high-energy mechanisms, and, compared with patients who present with isolated pelvic or acetabular injury, patients with combined injury typically have higher injury severity scores, higher transfusion requirements, and lower systolic blood pressure, with reported mortality rates of 1.5% to 13%. Treatment requires a multidisciplinary approach. The first priority is resuscitation following the Advanced Trauma Life Support protocols. Once the patient is stable, acetabular fractures and pelvic ring injuries should be assessed individually, and the most appropriate treatment for each should be outlined. These treatments should then be integrated to develop the most appropriate overall treatment strategy. Although outcomes data are available for isolated acetabulum and pelvic ring disruptions, no such data currently exist for combined injuries. PMID:24788446
Halvorson, Jason J; Lamothe, Jeremy; Martin, C Ryan; Grose, Andrew; Asprinio, David E; Wellman, David; Helfet, David L
Pelvic girdle and fin of Tiktaalik roseae.
A major challenge in understanding the origin of terrestrial vertebrates has been knowledge of the pelvis and hind appendage of their closest fish relatives. The pelvic girdle and appendage of tetrapods is dramatically larger and more robust than that of fish and contains a number of structures that provide greater musculoskeletal support for posture and locomotion. The discovery of pelvic material of the finned elpistostegalian, Tiktaalik roseae, bridges some of these differences. Multiple isolated pelves have been recovered, each of which has been prepared in three dimensions. Likewise, a complete pelvis and partial pelvic fin have been recovered in association with the type specimen. The pelves of Tiktaalik are paired and have broad iliac processes, flat and elongate pubes, and acetabulae that form a deep socket rimmed by a robust lip of bone. The pelvis is greatly enlarged relative to other finned tetrapodomorphs. Despite the enlargement and robusticity of the pelvis of Tiktaalik, it retains primitive features such as the lack of both an attachment for the sacral rib and an ischium. The pelvic fin of Tiktaalik (NUFV 108) is represented by fin rays and three endochondral elements: other elements are not preserved. The mosaic of primitive and derived features in Tiktaalik reveals that the enhancement of the pelvic appendage of tetrapods and, indeed, a trend toward hind limb-based propulsion have antecedents in the fins of their closest relatives. PMID:24449831
Shubin, Neil H; Daeschler, Edward B; Jenkins, Farish A
Crush pelvic injury in the Sichuan earthquake evaluated by multidetector CT scanning.
CT scanning is sensitive and specific for the identification of pelvic fractures and injury to the pelvic wall soft tissue and the pelvic cavity. Crush pelvic trauma in an earthquake can be identified by multidetector CT scanning. PMID:20581405
Chen, Tian-wu; Yang, Zhi-gang; Dong, Zhi-hui; Wang, Qi-ling; Yao, Jin; Deng, Wen; Zhuang, Hua
Crush pelvic injury in the Sichuan earthquake evaluated by multidetector CT scanning
CT scanning is sensitive and specific for the identification of pelvic fractures and injury to the pelvic wall soft tissue and the pelvic cavity. Crush pelvic trauma in an earthquake can be identified by multidetector CT scanning.
Tian-wu Chen; Zhi-gang Yang; Zhi-hui Dong; Qi-ling Wang; Jin Yao; Wen Deng; Hua Zhuang
Posterior pelvic floor prolapse and a review of the anatomy, preoperative testing and surgical management.
The vagina proper extends from the hymen to the cervix and uterus. The anterior wall of the rectum and the posterior vaginal wall are fused for approximately 3 to 4 cm into the vagina. Above this, a plane of dissection is easily created. Plastic repair of the posterior vagina that utilizes ''fascia'' are in fact using the split adventicia and fibromuscular walls of the vagina to support the anterior wall of the rectum. Evaluation of posterior vaginal wall defects requires not only an anatomical description of the prolapse, but also correlation of any functional derangements that may exist. Evaluation may include; defecography, bowel transit studies, manometry, endoluminal ultrasound and magnetic resonance imaging. Surgical correction of posterior vaginal wall prolapse includes vaginal, trans anal and abdominal approaches. Vaginal approaches include site specific repairs and traditional posterior colporrhaphy with levator ani placation. Graft augmentation has been described with both approaches in an effort to improve outcomes and decrease failure rates. PMID:18487967
Kleeman, S D; Karram, M
Laparoscopic Radical Nephrectomy: Transperitoneal Approach
\\u000a Radical nephrectomy, as described by Robson et al. in 1963, is the traditional gold standard approach to the management of\\u000a renal tumors (1). This procedure has an established success rate but is associated with significant postoperative pain and\\u000a prolonged convalescence, stemming from the flank, subcostal, Chevron or thoraco-abdominal incisions typically used. Laparoscopic\\u000a radical nephrectomy, as introduced by Clayman and associates
Leslie A. Deane; David I. Lee; Jaime Landman; Chandru P. Sundaram; Ralph V. Clayman
Laparoscopic resection of sigmoid diverticulitis
Background: In the large bowel, resection of the sigmoid colon is the most commonly performed laparoscopic intervention because large\\u000a bowel lesions often are located in this part of the bowel and the procedure technically is the most favorable one. A number\\u000a of publications involving case series or the results of highly experienced individual surgeons already have confirmed the\\u000a feasibility of
F. K�ckerling; C. Schneider; M. A. Reymond; H. Scheuerlein; J. Konradt; H. P. Bruch; C. Zornig; L. K�hler; E. B�rlehner; A. Kuthe; G. Szinicz; H. A. Richter; W. Hohenberger
Transperitoneal vs. Retroperitoneal Laparoscopic Approaches
\\u000a The application of standard laparoscopy to pediatric urologic surgery has clearly evolved over the past decade. One reason\\u000a for the slower pace as compared to adult urology is that most cases in pediatric urology are reconstructive and require advanced\\u000a laparoscopic skills. Despite these obstacles, advances in technology and increased reporting of patient series in the literature\\u000a show that laparoscopy clearly
John C. Thomas
Clipless versus conventional laparoscopic cholecystectomy.
Abstract Laparoscopic cholecystectomy has been the gold standard technique for cholecystectomy and has proven more effective than the conventional open technique. The laparoscopic technique utilizes surgical clips for cystic duct occlusion, which come with their own set of complications. With the advent of new vessel and duct sealing technology, alternative energy instruments have been explored for the occlusion of the cystic duct without the use of clips. The Harmonic(�) scalpel (Ethicon Endo-Surgery, Cincinnati, OH) has become one of the more widely used instruments. In this retrospective study, 208 patients received surgical clip placement or the Harmonic scalpel was used for cystic duct occlusion. The postoperative complications were documented, and rates were calculated for outpatient follow-up, for re-admission, and specifically for the complications of a bile leak. When adjusted for the cause of bile leak (cystic duct versus common bile duct versus accessory duct), the use of the Harmonic scalpel versus clip placement had comparable rates of bile leak at 1.75% and 0.66%, respectively. The use of the Harmonic scalpel is deemed safe and comparable to clip placement at the discretion of the surgeon for cystic duct ligation. Further research with larger homogeneous studies and assessments of cost-effectiveness would further enhance the increasing use of the Harmonic scalpel in laparoscopic cholecystectomy. PMID:23231472
Wills, Edward; Crawford, George
Symptomatic internal hernias after laparoscopic bariatric surgery
Background: The aim of this study was to describe the occurrence and clinical characteristics of symptomatic internal hernias (IH) after laparoscopic bariatric procedures. Methods: We conducted a retrospective review of cases of IH after 1,064 laparoscopic gastric bypasses (LGB) and biliopancreatic diversions with duodenal switch (LBPD-DS) performed from September 1998 to August 2002. Results: We documented 35 cases of IH
E. Comeau; M. Gagner; W. B. Inabnet; D. M. Herron; T. M. Quinn; A. Pomp
Risk of complications following gynecological laparoscopic surgery
Objective: To determine the incidence and predictors of risk for operative complications, conversions to laparotomy, and postoperative admissions following laparoscopic procedures.Methods: We obtained demographic information and medical history on all 843 women who underwent laparoscopic procedures at the Brigham and Women�s Hospital between January and December 1994. All major complications following surgery were recorded. Major operative complications were defined as
R. Mirhashemi; B. L. Harlow; E. Ginsberg; L. B. Signorello; R. Berkowitz; S. Feldman
Factors contributing to failure of laparoscopic myomectomy.
Laparoscopic myomectomy is one of the best treatment options for women with symptomatic fibroids who wish to maintain their fertility. Compared with myomectomy by laparotomy, the laparoscopic approach is associated with shorter hospital stay, faster recovery, less postoperative pain, and reduced adhesion formation. Laparoscopic myomectomy is technically challenging, and occasionally the procedure needs to be completed by laparotomy. In this review, I will describe my team's experience with laparoscopic myomectomy and discuss factors contributing to failure. The most important factors affecting conversion of a laparoscopic myomectomy to laparotomy are patient selection and the laparoscopic expertise of the surgeon. Each surgeon should determine his or her criteria for laparoscopic myomectomy. Other factors include posterior intramural location, soft consistency associated with the use of gonadotropin releasing hormone agonist (GnRHa), the diameter of the dominant myoma, and the weight of the myoma. The use of robot-assisted technology may provide a means to overcome the challenges encountered with enucleation, extraction, and repair that are seen with conventional laparoscopic myomectomy. PMID:23975446
Al-Talib, Ayman
Laparoscopic Prostatectomy: Where Do We Stand?
Laparoscopic radical prostatectomy is an effective treatment for localized prostate cancer. This cost-intensive and technically demanding operation currently takes longer than the standard open procedures, but with increasing experience, it is eventually associated with lower costs and is nearly as fast. As more urologists gain such experience, the laparoscopic approach may challenge the standard approaches.
Remzi, Mesut; Djavan, Bob
Laparoscopic-assisted colectomy learning curve
PURPOSE: The purpose of this paper is to establish the number of cases necessary to master laparoscopic removal of the left or right colon. METHODS: Data were obtained by chart review and by individually completed questionnaires. RESULTS: A total of 144 laparoscopic-assisted or intracorporeal right or left hemicolectomies were completed by four surgeons at separate institutions. Questionnaires were completed by
Anthony J. Simons; Gary J. Anthone; Adrian E. Ortega; Morris Franklin; James Fleshman; W. Peter Geis; Robert W. Beart
Experience with laparoscopic double gallbladder removal
Double gallbladder is a rare congenital anomaly and an encounter with it while performing cholecystectomy laparoscopically is a challenge to the laparoscopic surgeon. A 28-year-old man complaining of epigastric pain was evaluated at Teikyo University Hospital, Mizonokuchi, Japan. There were no abnormal laboratory findings. Ultrasonography revealed an acoustic shadow in each compartment without any inflammatory changes in the gallbladder. No
N. Miyajima; T. Yamakawa; A. Varma; K. Uno; S. Ohtaki; N. Kano
Hand-assisted laparoscopic sigmoidectomy for diverticulitis
BACKGROUND: Sigmoid colectomy for diverticular disease, a routine procedure when performed using standard open methods, can prove much more challenging using minimum access techniques. Hand-assisted laparoscopic colectomy is a new technique that reportedly has a minimum learning curve, yet retains the benefits of a laparoscopic procedure. The purpose of this study was to perform and then prospectively to evaluate the
Michael J. Mooney; Patrick L. Elliott; Derrick B. Galapon; Linda K. James; Laura J. Lilac; Michael J. O'Reilly
Laparoscopic Versus Open Appendectomy: A Metaanalysis
Background: There have been numerous retrospective and uncontrolled series of laparoscopic appendectomy (LA), as well as 16 prospective randomized studies published to date. Although most of these have concluded that the laparoscopic technique is as least as good as open appendectomy (OA), there has been considerable controversy as to whether LA is superior. To help clarify this issue, we performed
Robert Golub; Fazi Siddiqui; Dieter Pohl
Laparoscopic treatment of hepatic hydatid cysts
Background: Because of limited experience worldwide, controversies about the laparoscopic treatment of liver hydatid cysts have not been resolved. The aim of this study was to describe the technical details of a laparoscopic method we developed in 1992 and report the initial results from an endemic area. Methods: Of the 30 consecutive patients with 33 liver hydatid cysts considered for
Ridvan Seven; Eren Berber; Selcuk Mercan; Levent Eminoglu; Demir Budak
Urologic injuries in pelvic ring disruptions.
Pelvic ring disruptions are the result of high energy blunt trauma and are associated with other significant injuries in greater than 50% of the cases. These injuries may involve neurovascular structures and other organ systems. Lower urinary tract injuries may occur in as much as 25% of patients with pelvic ring disruptions. Coordinated care between the orthopaedist and urologist is required for successful treatment of the urologic and pelvic injury. Of primary importance to the orthopaedist is the potential for infection after open stabilization of the anterior arch. When contaminated urine communicates with the anterior arch, the possibility of infection exists. Early repair of bladder disruptions with simultaneous anterior arch plating minimizes this risk. The treatment of urethral disruptions and the safest method for urinary drainage remain controversial, however. PMID:8769434
Watnik, N F; Coburn, M; Goldberger, M
Simultaneous laparoscopic management of ureteropelvic junction obstruction and renal lithiasis: the combined experience of two academic centers and review of the literature
Introduction Approximately one out of five patients with ureteropelvic junction obstruction (UPJO) present lithiasis in the same setting. We present our outcomes of simultaneous laparoscopic management of UPJO and pelvic or calyceal lithiasis and review the current literature. Methods Thirteen patients, with a mean age of 42.8�13.3 years were diagnosed with UPJO and pelvic or calyceal lithiasis. All patients were subjected to laparoscopic dismembered Hynes�Anderson pyeloplasty along with removal of single or multiple stones, using a combination of laparoscopic graspers, irrigation, and flexible nephroscopy with nitinol baskets. Results The mean operative time was 218.8�66 minutes. In two cases, transposition of the ureter due to crossing vessels was performed. The mean diameter of the largest stone was 0.87�0.25 cm and the mean number of stones retrieved was 8.2 (1�32). Eleven out of 13 patients (84.6%) were rendered stone-free. Complications included prolonged urine output from the drain in one case (Clavien grade I) and urinoma formation requiring drainage in another case (Clavien grade IIIa). The mean postoperative follow-up was 30.2 (7�51) months. No patient has experienced stone or UPJO recurrence. Conclusion Laparoscopy for the management of UPJO along with renal stone removal seems a very appealing treatment, with all the advantages of minimally invasive surgery. Concomitant renal stones do not affect the outcome of laparoscopic pyeloplasty, at least in the midterm. According to our results and the latest literature data, we advocate laparoscopic management as the treatment of choice for these cases.
Stravodimos, Konstantinos G; Giannakopoulos, Stilianos; Tyritzis, Stavros I; Alevizopoulos, Aristeides; Papadoukakis, Stefanos; Touloupidis, Stavros; Constantinides, Constantinos A
Laparoscopic Repair for Perforated Peptic Ulcer
Objective To compare the results of open versus laparoscopic repair for perforated peptic ulcers. Summary Background Data Omental patch repair with peritoneal lavage is the mainstay of treatment for perforated peptic ulcers in many institutions. Laparoscopic repair has been used to treat perforated peptic ulcers since 1990, but few randomized studies have been carried out to compare open versus laparoscopic procedures. Methods From January 1994 to June 1997, 130 patients with a clinical diagnosis of perforated peptic ulcer were randomly assigned to undergo either open or laparoscopic omental patch repair. Patients were excluded for a history of upper abdominal surgery, concomitant evidence of bleeding from the ulcer, or gastric outlet obstruction. Patients with clinically sealed-off perforations without signs of peritonitis or sepsis were treated without surgery. Laparoscopic repair would be converted to an open procedure for technical difficulties, nonjuxtapyloric gastric ulcers, or perforations larger than 10 mm. A Gast- rografin meal was performed 48 to 72 hours after surgery to document sealing of the perforation. The primary end-point was perioperative parenteral analgesic requirement. Secondary endpoints were operative time, postoperative pain score, length of postoperative hospital stay, complications and deaths, and the date of return to normal daily activities. Results Nine patients with a surgical diagnosis other than perforated peptic ulcer were excluded; 121 patients entered the final analysis. There were 98 male and 23 female patients recruited, ages 16 to 89 years. The two groups were comparable in age, sex, site and size of perforations, and American Society of Anesthesiology classification. There were nine conversions in the laparoscopic group. After surgery, patients in the laparoscopic group required significantly less parenteral analgesics than those who underwent open repair, and the visual analog pain scores in days 1 and 3 after surgery were significantly lower in the laparoscopic group as well. Laparoscopic repair required significantly less time to complete than open repair. The median postoperative stay was 6 days in the laparoscopic group versus 7 days in the open group. There were fewer chest infections in the laparoscopic group. There were two intraabdominal collections in the laparoscopic group. One patient in the laparoscopic group and three patients in the open group died after surgery. Conclusions Laparoscopic repair of perforated peptic ulcer is a safe and reliable procedure. It was associated with a shorter operating time, less postoperative pain, reduced chest complications, a shorter postoperative hospital stay, and earlier return to normal daily activities than the conventional open repair.
Siu, Wing T.; Leong, Heng T.; Law, Bonita K. B.; Chau, Chun H.; Li, Anthony C. N.; Fung, Kai H.; Tai, Yuk P.; Li, Michael K. W.
Laparoscopic tubal anastomosis and reversal of sterilization.
Fallopian tube interruption is a common form of contraception worldwide. For a variety of reasons (e.g. change in marital status, wish for additional children, psychological factors), many of these women seek restoration of fertility. Laparoscopic tubal anastomosis is one of the newest of these procedures by which this can be achieved. Sixteen women underwent laparoscopic microsurgical anastomosis. We used a three-stitches technique with tubal cannulation adapted from methods described in the literature. Five pregnancies occurred, giving an overall pregnancy rate of 31.2%. Surgical outcome depends on the patient's age, the method of tube interruption and the length of Fallopian tube segments being anastomosed. In this study, the feasibility of laparoscopic tubal sterilization reversal is confirmed, as well as the benefits offered by laparoscopic procedures in terms of quality of life. Further improvement of surgical outcome will be achieved not only through better laparoscopic techniques but also through careful screening for surgical indications. PMID:10325266
Barjot, P J; Marie, G; Von Theobald, P
Laparoscopic Diagnosis and Treatment in Gynecologic Emergencies
Objective: To present an analysis of our experience with 22 consecutive cases of acute abdominal gynecologic emergencies managed with a laparoscopic approach. Methods: From March 1997 to October 1998, 22 patients with a diagnosis of acute abdominal gynecologic emergencies underwent laparoscopic intervention. A transvaginal ultrasound was performed on all patients preoperatively to supplement the diagnostic workup. Surgical time, complications, and length of hospital stay were evaluated, and the laparoscopic diagnosis was compared with the preoperative diagnosis. Results: The laparoscopic diagnosis was different from the preoperative diagnosis in 31.8% of patients. Of the 22 patients, laparoscopic therapeutic procedures were performed in 18 (81.8%), all satisfactorily, and with no need for conversion to open surgery. No morbidity or mortality occurred. Conclusion: Laparoscopy is a safe and effective method for diagnosing and treating gynecologic emergencies.
Cantele, Hector; Leyba, Jose Luis; Navarrete, Manuel; Llopla, Salvador Navarrete
Laparoscopic palliation of polycystic liver disease.
The role of laparoscopic surgery in the management of polycystic liver disease (PCLD) is not well defined. The authors hypothesized that laparoscopic fenestration for PCLD relieves symptoms caused by polycystic liver disease. In this study, 11 patients underwent 20 laparoscopic cyst fenestration operations as treatment for symptoms of their PCLD. Symptoms leading to surgery were pain and pressure in 15 (75%) and early satiety in 12 (60%) patients. The median hospital stay was 1 day. The symptoms resolved postoperatively in all the patients. An additional laparoscopic fenestration was required in six (55%) patients for recurrent symptoms. The average time to reoperation was 22 +/- 16 months. Two patients required hepatic transplantation. Initial symptom resolution occurred in all the patients undergoing redo fenestration. The authors conclude that laparoscopic fenestration for PCLD is safe, results in minimal "down" time and relieves the symptoms caused by PCLD. Symptomatic relief usually is temporary, and repeat surgery is required for recurring symptoms in half of the patients. PMID:15531969
Robinson, T N; Stiegmann, G V; Everson, G T
Total Pelvic Exenteration for Gynecologic Malignancies
Total pelvic exenteration (PE) is a radical operation, involving en bloc resection of pelvic organs, including reproductive structures, bladder, and rectosigmoid. In gynecologic oncology, it is most commonly indicated for the treatment of advanced primary or locally recurrent cancer. Careful patient selection and counseling are of paramount importance when considering someone for PE. Part of the evaluation process includes comprehensive assessment to exclude unresectable or metastatic disease. PE can be curative for carefully selected patients with gynecologic cancers. Major complications can be seen in as many as 50% of patients undergoing PE, underscoring the need to carefully discuss risks and benefits of this procedure with patients considering exenterative surgery.
Diver, Elisabeth J.; Rauh-Hain, J. Alejandro; del Carmen, Marcela G.
Anatomy adventure: a board game for enhancing understanding of anatomy.
Certain negative factors such as fear, loss of concentration and interest in the course, lack of confidence, and undue stress have been associated with the study of anatomy. These are factors most often provoked by the unusually large curriculum, nature of the course, and the psychosocial impact of dissection. As a palliative measure, Anatomy Adventure, a board game on anatomy was designed to reduce some of these pressures, emphasize student centered and collaborative learning styles, and add fun to the process of learning while promoting understanding and retention of the subject. To assess these objectives, 95 out of over 150 medical and dental students who expressed willingness to be part of the study were recruited and divided into a Game group and a Non-game group. A pretest written examination was given to both groups, participants in the Game group were allowed to play the game for ten days, after which a post-test examination was also given. A 20-item questionnaire rated on a three-point scale to access student's perception of the game was given to the game group. The post-test scores of the game group were significantly higher (P?0.05) than those of the non-game counterparts. Also the post-test score of the game based group was significantly better (P?0.05) than their pretest. The students in their feedback noted in very high proportions that the game was interesting, highly informative, encouraged team work, improved their attitude, and perception to gross anatomy. PMID:23878076
Anyanwu, Emeka G
Surgical anatomy imaging associated with cervical cancer treatment: A cadaveric study.
The objectives of this study were to visualize the surgical anatomical structures in the female pelvis by computed tomography and to investigate the components of the parametrium for anatomical education, radiological diagnosis, and surgical simulation. We surgically dissected fresh female cadavers maintained in precise surgical anatomic positions and examined the anatomical structures using experimental fine cell detector multislice computed tomography (FDCT) with a slice thickness of 0.3125 mm. In addition, we established a three-dimensional (3D) reconstruction model for precise observation of the surgical anatomy using Materialise's Interactive Medical Image Control System (Mimics). We evaluated two-dimensional (2D) images of the surgical anatomical structures in combination with the 3D reconstruction model. The 3D model was reconstructed from 430 serial axial pelvic CT images of a cadaver. The cardinal ligament, uterosacral ligament, paravesical space, and pararectal space were visualized on the CT images obtained from the surgically dissected part. The parametrium components were clearly distinguished on the surgically dissected side. Based on the information from the dissected side, these components on the undissected side could be distinguished as well. We recognized the parametrium components in the area extirpated during radical hysterectomy. The approach using cadavers, experimental FDCT, and 3D software provided excellent visualization of pelvic structures. High-quality images of surgical anatomical structures provide new insight regarding precise surgical anatomy in the female pelvis. The radiological information has practical usefulness for radiotherapeutic planning and surgical simulation. PMID:24343837
Nakamura, Masaru; Fujii, Takuma; Imanishi, Nobuaki; Jinzaki, Masahiro; Yamada, Minoru; Kuribayashi, Sachio; Aoki, Daisuke
Immunohistochemical characterisation of pelvic autonomic ganglia in male mice
Pelvic ganglia are mixed sympathetic-parasympathetic ganglia and provide the majority of the autonomic innervation to the urogenital organs. Here we describe the structural and histochemical features of the major pelvic ganglion in the male mouse and compare two different mouse strains. The basic structural features of the ganglion are similar to those in the male rat. Almost all pelvic ganglion
Yewlan Wanigasekara; Mark E. Kepper; Janet R. Keast
Pregnancy and childbirth: the effects on pelvic floor muscles.
This article examines the risks of damage to the pelvic floor that are associated with pregnancy and delivery. It will aim to dispel some myths about pelvic floor exercises and pregnancy and will look at the latest recommendations about pelvic floor muscle exercise. PMID:19326654
Herbert, Julia
Image characteristics of computer tomography urography in pelvic lipomatosis
Pelvic lipomatosis is a rare disease where fat tissue deposition is observed in spaces of the pelvic area. The disease has a wide range of presenting obstruction symptoms varying from lower urinary tract symptoms to bowel symptoms. In this report, we described the clinical findings, classical radiological features and treatment in an elderly male patient with pelvic lipomatosis.
Xia, Shengqiang; Yan, Yang; Peng, Bo; Yang, Bin; Zheng, Junhua
Outpatient protocol for biofeedback therapy of pelvic floor outlet obstruction
Pelvic floor outlet obstruction is a rare cause of severe constipation. Anal myectomy, subtotal colectomy, and medical therapy have limited success. The purpose of this study was to develop a short outpatient treatment using biofeedback techniques. Nine patients with severe constipation and straining resulting from pelvic floor outlet obstruction underwent complete investigation of the pelvic floor musculature and anal sphincter
James W. Fleshman; Zeev Dreznik; Kathleen Meyer; Robert D. Fry; Robert Carney; Ira J. Kodner
Twenty-first century laparoscopic hysterectomy: should we not leave the vaginal step out?
The objective of this study was to compare surgical outcomes for laparoscopically assisted vaginal hysterectomy (LAVH) with total laparoscopic hysterectomy (TLH) in three teaching hospitals in the Netherlands. This study is a multicenter cohort retrospective analysis of consecutive cases (Canadian Task Force classification II-2). One hundred and four women underwent a laparoscopic hysterectomy between March 1995 and March 2005 at one of three teaching hospitals. This included 37 women who underwent LAVH and 67 who underwent TLH. Blood loss, operating time, and intraoperative complications such as bladder or ureteric injury as well as conversion to an open procedure were recorded. In the TLH group, average age was statistically significant lower, as well as the mean parity, whereas estimated uterus size was statistically significant larger, compared to the LAVH group. Main indication in both groups was dysfunctional uterine bleeding. In the TLH group, mean blood loss (173 mL) was significant lower compared to the LAVH group (457 mL), whereas length of surgery, uterus weight, and complication rates were comparable between the two groups. The method of choice at the start of the study period was LAVH, and by the end of the study period, it had been superceded by TLH. LAVH should not be regarded as the novice's laparoscopic hysterectomy. Moreover, with regard blood loss, TLH shows advantages above LAVH. This might be due to the influence of the altered anatomy in the vaginal stage of the LAVH procedure. Therefore, when a vaginal hysterectomy is contraindicated, TLH is the procedure of choice. LAVH remains indicated in case of vaginal hysterectomy with accompanying adnexal surgery. PMID:20234845
Twijnstra, A R H; Kianmanesh Rad, N A; Smeets, M J G H; Admiraal, J F; Jansen, F W
[Acute thrombosis of pelvic and leg veins in agenesis of the renal segment of the inferior vena cava].
A 19-year-old, otherwise asymptomatic man presented to the hospital of orthopaedic surgery with acute severe pain like lumbago. Symptomatic treatment was performed after extensive orthopaedic diagnostic procedures. On the third day after admission he showed clinical signs of deep vein thrombosis with painful swelling and livid discoloration of both legs. Colour duplex ultrasound revealed complete thrombosis of the leg and pelvic veins bilaterally, but the cranial extent was not clear. Contrast-enhanced helical computer tomography of the abdomen and the pelvis confirmed deep pelvic vein thrombosis and showed extension into the inferior vena cava. Moreover, the study revealed the agenesis of the renal segment of the inferior vena cava with collateral flow through dilated lumbar veins to enlarged azygous and hemiazygous, through vertebral and paravertebral venous plexus. The renals were drained via dilated capsular veins. The agenesis of renal vena cava is a very rare anomaly causing acute thrombosis of the deep leg and pelvic veins. Other risk factors of thromboembolic disease were not found. The patient was treated successfully with systemic thrombolysis. Therefore we used ultra-high streptokinase infusion (9 million units over 6 hours). Colour duplex ultrasound revealed good flow into deep leg and pelvic veins after three cycle of lysis. Magnetic resonance angiography of the abdomen and pelvis was performed to evaluate the successful fibrinolysis with complete recanalisation of the pelvic veins and to demonstrate the venous anatomy. Permanent oral anticoagulation with phenprocoumon is indicated to decrease the high rate of recurrent thrombosis. Compression stockings were prescribed. To prevent thrombosis, additional risk factors like smoking, immobilization and unusual physical activity should be strictly avoided. PMID:11220087
K�rber, T; Petzsch, M; Placke, J; Ismer, B; Schulze, C
Early postoperative and long-term oncological outcomes of laparoscopic treatment for patients with familial adenomatous polyposis
Purpose We evaluated the short- and long-term outcomes of laparoscopic total proctocolectomy with ileal pouch-anal anastomosis (TPC/IPAA) for treatment of familial adenomatous polyposis (FAP). Also, we assessed the oncologic outcomes in FAP patients with coexisting malignancy. Methods From August 1999 to September 2010, 43 FAP patients with or without coexisting malignancy underwent TPC/IPAA by a laparoscopic-assisted or hand-assisted laparoscopic surgery. Results The median age was 33 years (range, 18 to 58 years) at the time of operation. IPAA was performed by a hand-sewn method in 21 patients (48.8%). The median operative time was 300 minutes (range, 135 to 610 minutes), which reached a plateau after 22 operations. Early postoperative complications within 30 days occurred in 7 patients (16.3%) and long-term morbidity occurred in 15 patients (34.9%) including 6 (14.0%) with desmoid tumors and 3 (7.0%) who required operative treatment. Twenty-two patients (51.2%) were diagnosed with coexisting colorectal malignancy. The median follow-up was 58.5 months (range, 7.9 to 97.8 months). There was only 1 case of local recurrence in the pelvic cavity. No cases of adenocarcinoma at the residual rectal mucosa developed. 5-year disease-free survival rate for 22 patients who had coexisting malignancy was 86.5% and 5-year overall survival rate was 92.6%. Three patients died from pulmonary or hepatic metastasis. Conclusion Laparoscopic TPC/IPAA in patients with FAP is feasible and offers favorable postoperative outcomes. It also delivered acceptable oncological outcomes in patients with coexisting malignancy. Therefore, laparoscopic TPC/IPAA may be a favorable treatment option for FAP.
Kim, Hye Jin; Park, Jun Seok; Park, Soo Yeun; Choi, Wohn Ho; Ryuk, Jong Pil
Corona mortis exposition during laparoscopic procedure for gynecological malignancies.
Corona mortis (CMOR) is an anastomotic branch between the external iliac or inferior epigastric vessels and the obturator artery or vein, or any vascular connection between the obturator and the external iliac systems in general with high anatomic variability. The aim of this study was to evaluate the type of anastomosis, if arterial, venous or both and the other subtypes of CMOR. Twenty-five laparoscopic procedures of bilateral pelvic lymphadenectomy for gynecological oncologic procedures (50 half pelvises) were performed. CMOR was located in 15 half pelvises on the right side (60�%), in 7 half pelvises on the left side (28�%), in 3 patients it was evidenced bilaterally. CMOR was dissected in 26/50 (52�%) half pelvises. Venous anastomosis was more frequently (46�%) followed by both venous and arterial vessels; in only 8�% (2/26) an arterial communication was observed. 83�% of venous anastomosis were single communications. One isolated arterial anastomosis was evidenced in two patients. In the cases of both arterial and venous anastomosis, one venous and one arterial vessel in 5/6 (83�%) were detected, and one type of anastomosis with one arterial and two venous vessels. Our data suggest that venous CMOR is usually present in higher frequency than the arterial one, followed by the combined type with arterial and venous connections. The isolated venous anastomosis resulted the frequent subtype. PMID:24390752
Pellegrino, Antonio; Damiani, Gianluca Raffaello; Marco, Stefanetti; Ciro, Sportelli; Cofelice, Vito; Rosati, Federica
Laparoscopic complete urinary tract exenteration with the specimen withdrawn transvaginally.
OBJECTIVE To describe the technique of laparoscopic complete urinary tract exenteration (LaCUTE), where specimens are withdrawn en bloc through the vagina, and to compare our results for patients had this procedure with those who had surgery by traditional open methods PATIENTS AND METHODS From February 2006 to June 2008, five patients had LaCUTE and three CUTE at our institute. The surgical procedure included bilateral nephroureterectomy, bilateral pelvic lymphadenectomy, radical cystourethrectomy, radical hysterectomy, bilateral salpingo-oophorectomy. RESULTS In the LaCUTE group the mean (range) patient age was 58 (46-73) years, the blood loss was 378 (290-490) mL, the operative duration was 492 (405-560) min and the hospital stay was 12.2 (9-17) days. All patients had negative surgical margins on pathological examination. The LaCUTE group had significantly less blood loss but longer surgery than the open group. At a mean follow-up of 14.5 and 16.0 months, respectively, there was no evidence of recurrent cancer in both groups. CONCLUSIONS With further experience and improvement in surgical techniques, LaCUTE with vaginal specimen en bloc withdrawal will become feasible for uraemic female patients with urothelial cancer. PMID:19154504
Li, Ching-Chia; Wang, Hsun-Shuan; Wu, Wen-Jeng; Chou, Yii-Her; Liu, Chia-Chu; Long, Cheng-Yu; Hus, Shih-Cheng; Chuang, Chieh-Han; Jang, Mei-Yu; Huang, Shu-Pin; Juan, Yung-Shun; Huang, Chun-Hsiung
Abdominal Aortic Aneurysm Associated with�Congenital Solitary Pelvic Kidney Treated with Novel Hybrid Technique.
Renal ectopia in the rare condition of associated abdominal aortic aneurysm presents a difficult clinical challenge with respect to access to the aorto-iliac segment and preservation of renal function because of its anomalous renal arterial anatomy and inevitable renal ischemia at the time of open repair. Multiple operative techniques are described throughout the literature to cope with both problems. We report a case of a 57-year-old male with an aorto-iliac aneurysm and a congenital solitary pelvic kidney successfully treated by hybrid total renal revascularization using iliorenal bypass followed by unilateral internal iliac artery coil embolization and conventional endovascular aortic aneurysm repair without any clinical evidence of renal impairment. PMID:24517982
Malinowski, Michael J; Al-Nouri, Omar; Hershberger, Richard; Halandras, Pegge M; Aulivola, Bernadette; Cho, Jae S
Ultrasound (US) has always had a relatively limited role in the evaluation of the hip due to the deep location of this joint. However, many hip diseases are well detectable at US, but before approaching such a study it is necessary to be thoroughly familiar with the normal anatomy and related US images. The study technique is particularly important as optimization of various parameters is required, such as probe frequency, focalization, positioning of the probe, etc. Also the patient�s position is important, as it varies according to the area requiring examination. For the study of the anterior structures, the patient should be in the supine position; for the medial structures, the leg should be abducted and rotated outward with the knee flexed; for the lateral structures, the patient should be in the controlateral decubitus position; for the posterior structures the patient must be in the prone position. US study of the hip includes assessment of the soft tissues, tendons, ligaments and muscles, and also of the bone structures, joint space and serous bursae. The purpose of this article is to review the normal anatomy of the hip as well as the US anatomy of this joint.
Molini, L.; Precerutti, M.; Gervasio, A.; Draghi, F.; Bianchi, S.
Hip: Anatomy and US technique.
Ultrasound (US) has always had a relatively limited role in the evaluation of the hip due to the deep location of this joint. However, many hip diseases are well detectable at US, but before approaching such a study it is necessary to be thoroughly familiar with the normal anatomy and related US images. The study technique is particularly important as optimization of various parameters is required, such as probe frequency, focalization, positioning of the probe, etc. Also the patient's position is important, as it varies according to the area requiring examination. For the study of the anterior structures, the patient should be in the supine position; for the medial structures, the leg should be abducted and rotated outward with the knee flexed; for the lateral structures, the patient should be in the controlateral decubitus position; for the posterior structures the patient must be in the prone position. US study of the hip includes assessment of the soft tissues, tendons, ligaments and muscles, and also of the bone structures, joint space and serous bursae. The purpose of this article is to review the normal anatomy of the hip as well as the US anatomy of this joint. PMID:23397030
Molini, L; Precerutti, M; Gervasio, A; Draghi, F; Bianchi, S
Combined laparoscopic ovariectomy and laparoscopic-assisted gastropexy in dogs susceptible to gastric dilatation-volvulus
This prospective study describes a simple method of combining laparoscopic ovariectomy and laparoscopic-assisted prophylactic gastropexy and determines the duration of surgery, complications, and long-term outcome including prevention of gastric dilatation-volvulus (GDV). Laparoscopic ovariectomy and laparoscopic-assisted gastropexy were performed on 26 sexually intact female dogs susceptible to GDV. The mean surgery time was 60.8 � 12.4 min. No GDV episode was seen during the study period (mean follow-up: 5.2 � 1.4 y). All dogs had an intact gastropexy attachment assessed by ultrasonography at 1 y. Post-operative complications were minor and owners were satisfied with the procedure. Combined laparoscopic ovariectomy and laparoscopic- assisted gastropexy appears to be a successful and low morbidity alternative procedure to both ovariectomy/ovariohysterectomy and gastropexy via open ventral-midline laparotomy.
Rivier, Pablo; Furneaux, Rob; Viguier, Eric
Combined laparoscopic ovariectomy and laparoscopic-assisted gastropexy in dogs susceptible to gastric dilatation-volvulus.
This prospective study describes a simple method of combining laparoscopic ovariectomy and laparoscopic-assisted prophylactic gastropexy and determines the duration of surgery, complications, and long-term outcome including prevention of gastric dilatation-volvulus (GDV). Laparoscopic ovariectomy and laparoscopic-assisted gastropexy were performed on 26 sexually intact female dogs susceptible to GDV. The mean surgery time was 60.8 � 12.4 min. No GDV episode was seen during the study period (mean follow-up: 5.2 � 1.4 y). All dogs had an intact gastropexy attachment assessed by ultrasonography at 1 y. Post-operative complications were minor and owners were satisfied with the procedure. Combined laparoscopic ovariectomy and laparoscopic- assisted gastropexy appears to be a successful and low morbidity alternative procedure to both ovariectomy/ovariohysterectomy and gastropexy via open ventral-midline laparotomy. PMID:21461209
Rivier, Pablo; Furneaux, Rob; Viguier, Eric
Use of the Laparoscope Holder for Liver Retraction during Urological Laparoscopic Surgery
Purpose During laparoscopy, as in open surgery, exposure is critical. Here, we describe the use of a laparoscope holder to facilitate the liver lift during urological laparoscopic surgery. Materials and Methods Laparoscopic right radical nephrectomy (n = 3), partial nephrectomy (n = 1), and adrenalectomy (n = 2) were performed with 4 ports. At the beginning of the operation, the small snake retractor was placed through the 5-mm port under direct vision and the liver was lifted in the appropriate direction to optimize exposure. Results The laparoscope holder provided quick, reproducible retraction to facilitate exposure. No complications occurred with its use. The device reduced the need for a dedicated second assistant to stand bedside. Conclusions We achieved significant improvements in the safety and efficiency of liver retraction during urological laparoscopic surgery using the laparoscope holder.
Nozaki, Tetsuo; Iida, Hiroaki; Morii, Akihiro; Fujiuchi, Yasuyoshi; Komiya, Akira; Fuse, Hideki
Pathogenesis of Chlamydia induced pelvic inflammatory disease
Further research is necessary to elucidate the pathogenesis of chlamydial PID. It is hoped that these endeavours will eventually lead to a vaccine to prevent not only chlamydia infection, but also chlamydia associated infertility, ectopic pregnancy, and chronic pelvic pain. In the meantime we need to develop strategies to prevent primary and secondary chlamydia infection and its sequelae. Recently, Scholes
C. R. Cohen; R. C. Brunham
Chronic Prostatitis\\/Chronic Pelvic Pain Syndrome and Pelvic Floor Spasm: Can We Diagnose and Treat?
National Institutes of Health category III prostatitis, also known as chronic prostatitis\\/chronic pelvic pain syndrome, is\\u000a a common condition with significant impact on quality of life. This clinically defined syndrome has a multifactorial etiology\\u000a and seems to respond best to multimodal therapy. At least half of these patients have pelvic floor spasm. There are several\\u000a approaches to therapy including biofeedback,
Karin E. Westesson; Daniel A. Shoskes
Observations by a University Anatomy Teacher and a Suggestion for Curricular Change: Integrative anatomy for undergraduates
NSDL National Science Digital Library
This article describes the need, purpose, and establishment of an undergraduate integrative anatomy course. The article also explains a survey conducted to evaluate the number of anatomy programs in undergraduate institutes in Washington.
David Darda (Central Washington University Biological Sciences)
Laparoscopic subtotal hysterectomy versus laparoscopic total hysterectomy: a decade of experience
At present, there are only few data on the surgical outcomes of laparoscopic hysterectomy (LH). Up till now, it has been unclear\\u000a whether there is a difference in number of complications among the subcategories of laparoscopic total hysterectomy and laparoscopic\\u000a subtotal hysterectomy (LSH). Therefore, we have performed a retrospective analysis to evaluate the peri- and postoperative\\u000a outcomes in women undergoing
J. S. van Evert; J. M. J. Smeenk; F. P. H. L. J. Dijkhuizen; J. H. de Kruif; K. B. Kluivers
Feasibility of Laparoscopic Sleeve Gastrectomy as a Revision Procedure for Prior Laparoscopic Gastric Banding
Background: Laparoscopic sleeve gastrectomy (LSG), initially described by Gagner's group as the first stage of the laparoscopic\\u000a duodenal switch in super-obese patients, is now gaining wide diffusion among bariatric surgeons as a new restrictive operation.\\u000a Methods: From January 2005 to January 2006, 8 obese patients with BMI 37-74 kg\\/m2 underwent LSG for conversion from a prior complicated or failed laparoscopic
Paolo Bernante; Mirto Foletto; Luca Busetto; Fabio Pomerri; Francesco Francini Pesenti; Maria Rosa Pelizzo; Donato Nitti
Laparoscopic ureterocystoplasty with mitrofanoff system.
Abstract Purpose: To describe a laparoscopic surgical technique for ureterocystoplasty in pediatric patients with the Mitrofanoff procedure. Patients and Methods: The procedure was performed in 4 patients (2 females and 2 males), 8-11 years old (average, 9.5 years), with a history of myelomeningocele and secondary neurogenic bladder. The patients were evaluated before the surgery with renal ultrasound, voiding cystourethrography, and renal scintigraphy. All subjects reported left hydronephrosis with severe dilatation of ureter and the collector system, left megaureter with grade V vesicoureteral reflux, and left functional exclusion, with right renal normal function. The urodynamic investigations revealed low bladder size and bladder leak point pressure (BLPP) above 40?cm H2O. The laparoscopic ureterocystoplasty augmentation procedure and the Mitrofanoff procedure with the proximal ureter were performed in these patients. Complications and outcomes were recorded and compared with those of the postoperative urodynamic test. Results: The 2-4 years of follow-up of the patients and its urodynamic postoperative evaluation reported at least 75% of the capacity according to their age, compliance that varied between 15 to 20?mL/cm H2O, and a BLPP of less than 40?cm H2O. This last parameter is considered of low risk to damage the upper urinary tract. There was no leaking of urine by the stoma over the 4 hours of catheterization. Conclusions: Even though enterocystoplasty is the gold standard to increase the capacity of the neurogenic bladder, it has an elevated morbidity. So the use of a dilative ureter to increase bladder size and create a Mitrofanoff stoma in patients with neurogenic bladder, pop-off phenomenon, and renal ipsilateral atrophy could be considered by the laparoscopic approach. PMID:24475883
Landa Ju�rez, Sergio; Fern�ndez, Ana Mar�a Castillo; Castro, Niccolo Ruiz; De La Cruz Ya�ez, Hermilo; Hern�ndez, Carlos Garc�a
Anatomy and embryology of the biliary tract.
Working knowledge of extrahepatic biliary anatomy is of paramount importance to the general surgeon. The embryologic development of the extrahepatic biliary tract is discussed in this article as is the highly variable anatomy of the biliary tract and its associated vasculature. The salient conditions related to the embryology and anatomy of the extrahepatic biliary tract, including biliary atresia, choledochal cysts, gallbladder agenesis, sphincter of Oddi dysfunction, and ducts of Luschka, are addressed. PMID:24679417
Keplinger, Kara M; Bloomston, Mark
Laparoscopic approach to Meckel's diverticulum
AIM: To retrospective review the laparoscopic management of Meckel Diverticulum (MD) in two Italian Pediatric Surgery Centers. METHODS: Between January 2002 and December 2012, 19 trans-umbilical laparoscopic-assisted (TULA) procedures were performed for suspected MD. The children were hospitalized for gastrointestinal bleeding and/or recurrent abdominal pain. Median age at diagnosis was 5.4 years (range 6 mo-15 years). The study included 15 boys and 4 girls. All patients underwent clinical examination, routine laboratory tests, abdominal ultrasound and technetium-99m pertechnetate scan, and patients with bleeding underwent gastrointestinal endoscopy. The abdominal exploration was performed with a 10 mm operative laparoscope. Pneumoperitoneum was established based on the body weight. Systematic overview of the peritoneal cavity allowed the ileum to be grasped with an atraumatic instrument. The complete exploration and surgical treatment of MD were performed extracorporeally, after intestinal exteriorization through the umbilicus. All patients� demographics, main clinical features, diagnostic investigations, operative time, histopathology reports, conversion rate, hospital stay and complications were registered and analyzed. RESULTS: MD was identified in 17 patients, while 1 had an ileal duplication and 1 a jejunal hemangioma. Fifteen patients had painless intestinal bleeding, while 4 had recurrent abdominal pain and exhibited cyst like structures in an ultrasound study. Eleven patients had a positive technetium-99m pertechnetate scan. In the patients with bleeding, gastrointestinal endoscopy did not name the source of hemorrhage. All patients were subjected to a TULA surgical procedure. An intestinal resection/anastomosis was performed in 14 patients, while 4 had a wedge resection of the diverticulum and 1 underwent stapling diverticulectomy. All surgical procedures were performed without conversion to open laparotomy. Mean operative time was 75 min (range 40-115 min). No major surgical complications were recorded. The median hospital stay was 5-7 d (range 4-13 d). All patients are asymptomatic at a median follow up of 4, 5 years (range 10 mo-10 years). CONCLUSION: Trans-umbilical laparoscopic-assisted Meckel�s diverticulectomy is safe and effective in the treatment of MD, with excellent results.
Papparella, Alfonso; Nino, Fabiano; Noviello, Carmine; Marte, Antonio; Parmeggiani, Pio; Martino, Ascanio; Cobellis, Giovanni
Laparoscopic treatment of gallbladder duplication
Background: Gallbladder duplication is a rare congenital condition, which can now be detected preoperatively by imaging studies.\\u000a \\u000a \\u000a \\u000a \\u000a \\u000a Methods: We report a case of duplicated gallbladder with symptomatic unilobar gallstones. Appropriate biliary workup (ultrasound,\\u000a oral cholecystography, and intravenous cholangiography) allowed a correct preoperative diagnosis.\\u000a \\u000a \\u000a \\u000a \\u000a \\u000a Results: Laparoscopic treatment included selective removal of the diseased accessory gallbladder. However, postoperative acute cholecystitis\\u000a and symptomatic
J.-F. Gigot; B. Van Beers; L. Goncette; J. Etienne; A. Collard; P. Jadoul; A. Therasse; J. B. Otte; P.-J. Kestens
Single-incision total laparoscopic hysterectomy
Single-incision laparoscopic surgery is an alternative to conventional multiport laparoscopy. Single-access laparoscopy using a transumbilical port affords maximum cosmetic benefits because the surgical incision is hidden in the umbilicus. The advantages of single-access laparoscopic surgery may include less bleeding, infection, and hernia formation and better cosmetic outcome and less pain. The disadvantages and limitations include longer surgery time, difficulty in learning the technique, and the need for specialized instruments. Ongoing refinement of the surgical technique and instrumentation is likely to expand its role in gynecologic surgery in the future. We perform single-incision total laparoscopic hysterectomy using three ports in the single transumbilical incision.
Sinha, Rakesh; Sundaram, Meenakshi; Mahajan, Chaitali; Raje, Shweta; Kadam, Pratima; Rao, Gayatri; Shitut, Prachi
Single-incision total laparoscopic hysterectomy.
Single-incision laparoscopic surgery is an alternative to conventional multiport laparoscopy. Single-access laparoscopy using a transumbilical port affords maximum cosmetic benefits because the surgical incision is hidden in the umbilicus. The advantages of single-access laparoscopic surgery may include less bleeding, infection, and hernia formation and better cosmetic outcome and less pain. The disadvantages and limitations include longer surgery time, difficulty in learning the technique, and the need for specialized instruments. Ongoing refinement of the surgical technique and instrumentation is likely to expand its role in gynecologic surgery in the future. We perform single-incision total laparoscopic hysterectomy using three ports in the single transumbilical incision. PMID:21197248
Sinha, Rakesh; Sundaram, Meenakshi; Mahajan, Chaitali; Raje, Shweta; Kadam, Pratima; Rao, Gayatri; Shitut, Prachi
Laparoscopic rescue after tubal anastomosis failure.
Laparoscopic rescue after tubal anastomosis failure is reported for the first time. The patient was a 33 year old woman sterilized by Pomeroy's method. Reconstruction of fertility was achieved by mini-laparotomy with isthmo-isthmic end-to-end anastomosis of bilateral tubes. Unfortunately, the patient did not become pregnant and tubal occlusion was diagnosed 6 months later by hysterosalpingography. Laparoscopic rescue with repeat isthmic-ampullary anastomosis and adhesiolysis was performed. Post-operatively, the patient had one menstruation and then achieved an intrauterine pregnancy. Instead of in-vitro fertilization/embryo transfer, laparoscopic rescue may be an alternative option for the patient with failed anastomosis. PMID:8582986
Lee, C L; Lai, Y M; Huang, H Y; Soong, Y K
Laparoscopic Heminephrectomy of a Horseshoe Kidney
Minimally invasive surgery has revolutionized surgery for urologic disorders, and laparoscopic procedures have become widely available for several different ablative and reconstructive operations. Laparoscopic heminephrectomy in patients with horseshoe kidney can be a technically challenging procedure due to aberrant vessels, functional parenchyma in the isthmus, and abnormal location. We report the management of a case of symptomatic nonfunctioning left moiety of a horseshoe kidney with emphasis on its surgical technique combined with a review of the literature. Laparoscopic heminephrectomy is a feasible option in the surgical management of benign and malignant conditions of the horseshoe kidney and can be performed safely using a transperitoneal or a retroperitoneal approach.
Khan, Atif; Myatt, Andrew; Palit, Victor
Laparoscopic ureteral reimplantation in a renal transplant
We present what is to our knowledge, the first case of laparoscopic ureteral reimplantation reported in the renal transplant. The ureteral stenosis is one of the most difficult renal transplant complications to deal with. With the development of the endourological approach, this treatment has become the first treatment option for these patients. The patient is a 28-year-old female who received a renal allograft from a cadaver donor in 2008. Ureteral stenosis was diagnosed. The laparoscopic approach seems to be a good option over the open approach