Anatomical Techniques Research Articles

Biogeographic implication of temperature-induced plant cell wall lignification

More than 200 years after von Humboldt’s pioneering work on the treeline, our understanding of the cold distribution limit of upright plant growth is still incomplete. Here, we use wood anatomical techniques to estimate the degree of stem cell wall lignification in 1770 plant species from six continents. Contrary to the frequent belief that small plants are less lignified, we show that cell wall lignification in ‘woody’ herbs varies considerably. Although trees and shrubs always exhibit lignified cell walls in their upright stems, small plants above the treeline may contain less lignin. Our findings suggest that extremely cold growing season temperatures can reduce the ability of plants to lignify their secondary cell walls. Corroborating experimental and observational evidence, this study proposes to revisit existing theories about the thermal distribution limit of upright plant growth and to consider biochemical and biomechanical factors for explaining the global treeline position.

Combined Vertical, Horizontal, and Rotational Acromioclavicular Joint Stabilization: “Closing the Circle” Technique

The biomechanical and anatomical complexity of the acromioclavicular joint makes its repair techniques particularly challenging. High rates of reduction subsidence and construction failures transversally affect both anatomic and nonanatomic repair techniques. The importance of addressing both vertical and horizontal instability has been highlighted in recent years. The authors aim to describe a surgical technique that combines vertical, horizontal, and rotational stabilization, in an attempt to restore the coracoacromioclavicular circle of stability.

The “Michelangelo Code”: The Quest for Universal Truth

Michelangelo’s unparalleled frescoes in the Sistine Chapel have been traditionally construed to represent the traditional, Roman Catholic interpretation of the Seven Days of Creation in the Book of Genesis and the Last Judgement. Indeed, in September 2018, Pope Francis I offered a benediction for the Vatican’s art treasures and for “those who contributed to the Church’s history through art.” A number of studies have suggested that Michelangelo concealed anatomic information about the human brain in his renderings of God and biblical prophets and saints. Was the anatomic content of these images purposeful or coincidental? Was the anatomy intentionally concealed? Is there a common pattern with symbolic connotations in the anatomic representations? Was Michelangelo sending an encoded message? In this study, we analyze the imagery in the Sistine frescoes in light of the literature surrounding Michelangelo’s artistry with a particular interest in the relationship between the certain purported anatomic depictions and details demonstrable using scientific and anatomic techniques available during the High Renaissance.

45 years’ experience with early childhood anatomical technique of feminising genitoplasty for 46 XX Congenital Adrenal Hyperplasia –observations of vaginal introital anatomy and its relationship to the perineal body

In Manchester, feminising genitoplasty is offered to children with 46XX Congenital Adrenal Hyperplasia (CAH) when there is a single perineal opening and/or enlarged clitoris. Our aims are to describe the anatomical reconstructive technique and present long-term outcomes. Our hypothesis is that 'the common channel (CC) length and distance to the vagina from perineal skin is mostly due to virilisation and hypertrophy of perineal tissue over the almost normally positioned vaginal introitus (V-I) in relation to the perineal body (PB)'. METHOD AND RESULTS: This is a retrospective notes review of all consecutive 46XX CAH operations from 1976 to December 2021. 99 patients, who had feminising genitoplasty and being followed-up, were included. 15 patients who were lost to follow up were excluded. Median age at surgery was 15 months. In 91, midline division of the labia majora, spongiosum, bulbo-spongiosus muscle (BSM) and CC down to PB was performed. This was sufficient to expose the V-I at the same level or within 5mm depth of PB in 88. In 78V-I was adequate taking 10/12fr dilator (Type 1). In 10, CC resembled a male urethra and V-I was narrow (Type 2), requiring widening by 5-10mm incision at 6 o'clock position. Dartos of labia majora was attached to BSM to reduce the distance to V-I from perineal skin and the gap was lined with inner foreskin to create a vestibule. Out of 70 who were post-pubertal, 75% (53/70) had adequate calibre vaginal openings. 5 had introitoplasty and 2 had dilatation under anaesthesia. 10 needed self dilators only. 29 patients, of one of the three surgeons, had measurements of clitoris, CC, urethra and vagina. A hymen was found in 86% (25/29). There was significant strong, inverse correlation between the CC length and the urethral length (r=-0.708, p<0.001, n=27) but not between CC and vaginal lengths. After adjusting for age, the urethral length of Type 2 patients was 3.825mm shorter than those of Type 1 (p=0.017). CONCLUSION: Our data show that 'high' confluence is mostly due to virilisation of genitalia; and the anatomical technique of reversing the fusion of the urethral folds, spongiosum and bulbo-spongiosus muscle could be performed with all degrees of virilisation with success in early childhood with no need of local flaps or mobilisation of the urethro-vaginal complex. About 10% require surgery to treat narrowing of vaginal opening post puberty.

Anatomical description and short-term follow up clinical results for ultrasound-guided injection of medial collateral ligament bursa: New conservative treatment option for symptomatic degenerative medial meniscus tear

BackgroundIn this study, we investigated newly developed ultrasound (US)-guided medial collateral ligament (MCL) bursa injection as a conservative therapy for symptomatic degenerative medial meniscal (MM) tears. We aimed to describe the anatomical target and precise technique of this injection, confirm its accuracy using fresh cadaveric knees, and then evaluate preliminary clinical outcomes. MethodsAnatomical studies were performed on three fresh cadavers. For the clinical study, 50 patients with medial knee joint pain without knee osteoarthritis were treated with US-guided MCL bursa injection. Severity of pain was assessed pre-injection, and 1 week and 4 weeks post-injection using a 0–10 numerical rating scale (NRS). Clinical success was defined as a full return to daily activities. All patients underwent magnetic resonance imaging (MRI) within 1 week of the first injection. Patients who underwent surgery within 12 months of the first injection were investigated as clinically unsuccessful cases, and MRI and arthroscopic findings were examined. ResultsCompared with pre-injection (6.8 ± 1.2), the average NRS score was significantly lower at 1 week (1.8 ± 2.0) and at 4 weeks (1.5 ± 1.7) post-injection (both P < 0.01). The primary clinical success rate was 76.0%, and injection-related adverse events were not observed. Nine patients underwent surgery (arthroscopic surgery for degenerative flap tear (n = 7) and high tibial osteotomy for medial meniscus posterior root tear and proximal tibial malalignment (n = 2)). ConclusionsUS-guided MCL bursa injection is safe, reproducible, and effective for symptomatic MM degenerative tears. However, US-guided injections of the MCL bursa may be ineffective for flap tears and posterior root tears.

Lobal structure of the liver of the black samble pushkin breed

ed in fur farming in the Russian Federation. In the literature, there are often materials on the anatomy of representatives of the mustelid family, such as the American mink, American polecat, American marten and others. Along with this, in modern morphology there is practically no information about the anatomy of sables, and in particular about the black Pushkin breed. The purpose of this study is to study the structural features of the liver in the Pushkin black sable breed, as well as to determine its morphometric characteristics in the studied animals. During the study, the corpses of the black sable Pushkin breed were used. In total, fifteen corpses of sables of the black Pushkin breed aged two to three years were examined. To study the structural features of the liver, traditional anatomical techniques were used. According to the results of the study, it was found that the sable of the black Pushkin breed has six lobes, since the average lobe has no independent significance in the anatomy of the liver; the most developed lobes of the liver are the right medial lobe and the left lateral, and the least developed square and caudate lobes.

Poster 158: Does an In-Situ Biceps Tenodesis with an Anatomic Length-Tension Relationship affect the Incidence of Popeye Deformity and Clinical Outcomes Compared to an Estimated Length-Tension Relationship Technique?

Objectives:Biceps Popeye deformity is a common finding with rupture of the long head of the biceps tendon (LHBT), biceps tenodesis failure or length-tension mismatch during tenodesis. The Popeye muscle is a cosmetic deformity of the arm that may be accompanied by cramping and muscle fatigue and many patients are dissatisfied with the symptoms and appearance. Although prior studies have described physiologic landmarks to optimize the length-tension relationship during biceps tenodesis after LHBT rupture, no study has assessed the biceps muscle appearance after tenodesis “in-situ” prior to the release of the LHBT from the superior labrum for biceps tendon pathologies without complete rupture. Therefore, the purpose of this study is to assess clinical outcomes of an all-arthroscopic technique for biceps tenodesis which maintains the anatomic length-tension relationship of the LHBT prior to tenotomy from the superior labrum. We compared this group of patients to a control group of patients who underwent an interference screw tenodesis technique that required cutting the LHBT from the superior glenoid prior to tenodesis with an estimation of the anatomic length-tendon relationship potentially contributing to subtle biceps Popeye deformity. We hypothesize that an “in-situ” anatomic length-tension relationship tenodesis technique would reduce the risk of a Popeye deformity, reduce cramping and muscle fatigue, and have improved patient-reported outcome measures compared to an estimated length-tension relationship tenodesis with an interference screw.Methods:Consecutive patients who underwent arthroscopic biceps tenodesis with concomitant rotator cuff procedures were enrolled in this study from 2019-2021 and patients were grouped based on a change in senior author’s tenodesis technique, with the initial cohort having an arthroscopic interference screw subpectoral biceps tenodesis after tenotomy from the superior labrum in an “estimated” length-tension relationship technique (Group 1), and the later cohort having an arthroscopic suprapectoral biceps tenodesis “in-situ” with an anatomic length-tension relationship (Group 2) with the LHBT tied to the side of the humerus with all-suture unicortical anchors. Patients were assessed at a minimum of 3-month follow-up and asked about post-operative anterior arm pain and biceps muscle spasms, and if they notice any difference in appearance between their bicep muscles on a 4-point Likert scale (none, mild, moderate, severe). Patient-Reported Outcomes (PROs) of Veterans-Rand 12, American Shoulder and Elbow Score (ASES), EuroQol- 5 Dimension (EQ-5D), PROMIS 10, and Single Assessment Numeric Evaluation (SANE) were collected. Bilateral bicep images of participants were taken in three forearm positions with the elbow flexed 90 degrees: (1) maximal supination, (2) neutral, and (3) maximal pronation. Review of pronation, supination, and neutral forearm rotation bilateral biceps images were evaluated, after blinding and de-identification, by two shoulder and elbow fellowship-trained board-certified orthopedic surgeons for visual appearance and grade of Popeye deformity (none, mild, obvious Popeye). Non-parametric between-group comparison and analysis were performed with statistical significance set at p < 0.05.Results:Sixty-two patients (53% female, age 58.7 ± 9.0 years) were enrolled (33 in Group 1 and 29 in Group 2) with a mean follow-up of 9.8 ± 6.5 months. There were no significant differences between groups with respect to gender, age, and laterality of biceps tenodesis, as well as type and size of rotator cuff repair. There were no significant differences in ASES, EQ5D, and SANE scores between the two technique groups. However, PROMIS 10 Physical Health Scores were significantly improved in Group 2 (15.7 ± 2.3) compared to Group 1 (14.4 ± 2.9) (p=0.03). Patients in Group 2 experienced significantly less pain in their anterior arm than patients in Group 1 (19% vs. 33%, p=0.02) however there were no differences in biceps muscle spasm (3.4% vs. 5.2%, p=0.21). There also were no significant differences in patient-perceived biceps deformity between Group 1 (17.2%) and Group 2 (27%) (p=0.26). Similarly, there were no significant differences in surgeon-perceived biceps deformity between Group 1 and Group 2 (30.3% vs. 24.1%, p=0.47). Interrater reliability for surgeon assessment of a Popeye deformity was found to have a substantial agreement with a Kappa value of 0.77 (p <.0.001), 95% CI (0.645, 0.855).Conclusions:An arthroscopic suprapectoral biceps tenodesis performed “in-situ” with an anatomic length-tension relationship did not reduce the incidence of patient or surgeon perceived Popeye muscle deformity compared to an interference screw tenodesis performed after tenotomy in an “estimated” length-tension relationship technique. Interestingly, the “in-situ” length-tension technique reduced anterior arm pain and improved PROMIS 10 physical health scores post-operatively compared to the “estimated” interference screw technique.

Beyond the Brain: MIDS Extends BIDS to Multiple Modalities and Anatomical Regions.

Brain Imaging Data Structure (BIDS) provides a valuable tool to organise brain imaging data into a clear and easy standard directory structure. Moreover, BIDS is widely supported by the scientific community and has been established as a powerful standard for medical imaging management. Nonetheless, the original BIDS is restricted to magnetic resonance imaging (MRI) of the brain, limiting its implantation to other techniques and anatomical regions. We developed Medical Imaging Data Structure (MIDS), conceived to extend BIDS methodology to other anatomical regions and multiple imaging systems in these areas. The MIDS standard was developed to store and manage medical images as an extension of BIDS. It allows the user to handily save studies of multiple anatomical regions and imaging techniques. Besides, MIDS improves the classification of multiple images within the structure, allowing the possibility to unify them in a single study to apply on them preprocessing or artificial intelligence algorithms. Finally, the results generated are saved in the derivatives folder.

Real-time ultrasound-guided versus anatomic landmark-based thoracic epidural placement: a prospective, randomized, superiority trial

BackgroundThoracic epidural placement (TEP) using the conventional anatomic landmark-based technique is technically challenging, may require multiple attempts, and is associated with a high failure rate (12–40%). We hypothesized that real-time ultrasound guidance would be superior in the “first-pass” success rate of TEP, when compared with the conventional technique.MethodsThis prospective, randomized, superiority trial was conducted in a University hospital, and recruited 96 patients undergoing elective major abdominal or thoracic surgery and scheduled to receive a TEP for postoperative analgesia. Patients were randomly allocated to receive TEP using either the conventional technique (Gp-Conv, n = 48) or real-time ultrasound guidance (Gp-Usg, n = 48). The success of TEP was defined as eliciting loss of resistance technique and being able to insert the epidural catheter. The primary outcome variable was the “first-pass success rate” meaning the successful TEP at the first needle insertion without redirection or readvancement of the Tuohy needle. The secondary outcomes included the number of skin punctures, number of attempts, the overall success rate, TEP time, and total procedure time.ResultsThe first-pass success rate of TEP was significantly higher (p = 0.002) in Gp-Usg (33/48 (68.8%); 95%CI 55.6 to 81.9) than in Gp-Conv (17/48 (35.4%); 95%CI 21.9 to 49.0). There was no statistically significant difference (p = 0.12) in the overall success rate of TEP between the 2 study groups (Gp-Usg; 48/48 (100%) vs. Gp-Conv; 44/48 (91.7%); 95%CI 83.9 to 99.5). Ultrasound guidance reduced the median number of skin punctures (Gp-Usg; 1 [1, 1] vs Gp-Conv; 2 [1, 2.2], p < 0.001) and attempts at TEP (Gp-Usg; 1 [1, 2] vs Gp-Conv; 3 [1, 7.2], p < 0.001) but the procedure took longer to perform (Gp-Usg; 15.5 [14, 20] min vs Gp-Conv; 10 [7, 14] min, p < 0.001).ConclusionsThis study indicates that real-time ultrasound guidance is superior to a conventional anatomic landmark-based technique for first-pass success during TEP although it is achieved at the expense of a marginally longer total procedure time. Future research is warranted to evaluate the role of real-time ultrasound guidance for TEP in other groups of patients.Trial registrationThai Clinical Trials Registry; http://www.thaiclinicaltrials.org/; Trial ID: TCTR20200522002, Registration date: 22/05/2020.

Superior results of return to sport after double-bundle versus single-bundle anterior cruciate ligament reconstruction in young active patients

PurposeTo compare return to sport and clinical results in young active patients who underwent anatomic single-bundle (SB) versus double-bundle (DB) anterior cruciate ligament reconstruction (ACLR).MethodsYoung active patients undergoing SB or DB ACLR from 2017 to 2019 at our institution were retrospectively reviewed. The primary outcome measures were the rate and time to return to sports, with secondary measures including the Lachman test, pivot shift test, Lysholm scores, International Knee Documentation Committee (IKDC) scores and graft rupture.ResultsThe study included a total of 90 patients (DB group, 42; SB group, 48), with a mean follow-up of 27.1 ± 6.1 months. Young active patients who underwent DB ACLR had a higher rate of return to pivoting sports than those who underwent SB ACLR (HR = 2.4; 95% confidence interval [CI]: 1.4, 4.1; p = 0.013). The DB group returned to pivoting sports at a mean ± SD of 11.0 ± 2.9 months compared with 12.7 ± 2.7 months in the SB group (p = 0.01). There was one traumatic failure in the SB group and one contralateral ACL rupture in the DB group. There was no significant difference in the rate and time to return to running, Lachman test, pivot-shift test, Lysholm or IKDC scores in either group.ConclusionBoth anatomical SB and DB techniques achieved satisfactory clinical outcomes. DB techniques led to superior performance of return to pivoting sports but nonsignificant differences in time and rate of return to running, passive stability measurement, subjective knee function outcome and graft rupture rate in both groups at the 2-year follow-up. The DB ACLR should be considered a viable option to treat young patients with high activity demands.Level of evidenceIII.

Pterional Approach: Technical Variations, Functional, and Cosmetic Outcome in a Series of 1000 Patients

INTRODUCTION Most of the versatility of the pterional approach depends on a series of variations progressively reported by several groups, but little emphasized over the years. The present study condenses the technical notes which the authors adopted in their practice to maximize the surgical freedom of the pterional approach, at once lessening the approach-related complication rate. METHODS Data of a series of patients who underwent a pterional approach between January 2011 and May 2021 were retrospectively reviewed focusing on the technical variations compared to the original Yaşargil’s description. The anatomical rationale, technique, and advantages were outlined and validated through the appraisal of functional and cosmetic complications. RESULTS 994 patients were reviewed. Head extension was avoided in the case of anterior clinoidectomy. A single double-layered galea-pericranium flap was used for duraplasty. The submuscular technique, with compulsive preservation of deep temporal fascia and deep temporal arteries, was preferred for temporalis muscle dissection. McCarty keyhole was never used, thus avoiding exposing the orbit if unnecessary. Widening of the superior orbital fissure and thinning of the orbital roof allowed to significantly increase the working area. The average follow-up was 7.2 years. The overall rate of functional and cosmetic complications was 2.1. DISCUSSION In the authors' experience, the gradual adoption of technical variations related to the patient's positioning, soft tissue dissection, bony work, dura opening, and reconstruction allowed to enhance the versatility of the pterional approach concurrently decreasing the risk of functional and cosmetic complications.

Pterional Approach: Technical Variations, Functional, and Cosmetic Outcome in a Series of 1000 Patients

INTRODUCTION&#x0D; Most of the versatility of the pterional approach depends on a series of variations progressively reported by several groups, but little emphasized over the years.&#x0D; The present study condenses the technical notes which the authors adopted in their practice to maximize the surgical freedom of the pterional approach, at once lessening the approach-related complication rate.&#x0D; METHODS &#x0D; Data of a series of patients who underwent a pterional approach between January 2011 and May 2021 were retrospectively reviewed focusing on the technical variations compared to the original Yaşargil’s description. The anatomical rationale, technique, and advantages were outlined and validated through the appraisal of functional and cosmetic complications. &#x0D; RESULTS&#x0D; 994 patients were reviewed. Head extension was avoided in the case of anterior clinoidectomy. A single double-layered galea-pericranium flap was used for duraplasty. The submuscular technique, with compulsive preservation of deep temporal fascia and deep temporal arteries, was preferred for temporalis muscle dissection. McCarty keyhole was never used, thus avoiding exposing the orbit if unnecessary. Widening of the superior orbital fissure and thinning of the orbital roof allowed to significantly increase the working area. The average follow-up was 7.2 years. The overall rate of functional and cosmetic complications was 2.1.&#x0D; DISCUSSION&#x0D; In the authors' experience, the gradual adoption of technical variations related to the patient's positioning, soft tissue dissection, bony work, dura opening, and reconstruction allowed to enhance the versatility of the pterional approach concurrently decreasing the risk of functional and cosmetic complications.

Beyond the Brain: MIDS Extends BIDS to Multiple Modalities and Anatomical Regions.

Brain Imaging Data Structure (BIDS) provides a valuable tool to organise brain imaging data into a clear and easy standard directory structure. Moreover, BIDS is widely supported by the scientific community and has been established as a powerful standard for medical imaging management. Nonetheless, the original BIDS is restricted to magnetic resonance imaging (MRI) of the brain, limiting its implantation to other techniques and anatomical regions. We developed Medical Imaging Data Structure (MIDS), conceived to extend BIDS methodology to other anatomical regions and multiple imaging systems in these areas. The MIDS standard was developed to store and manage medical images as an extension of BIDS. It allows the user to handily save studies of multiple anatomical regions and imaging techniques. Besides, MIDS improves the classification of multiple images within the structure, allowing the possibility to unify them in a single study to apply on them preprocessing or artificial intelligence algorithms. Finally, the results generated are saved in the derivatives folder.

Feasibility of a novel algorithm for automated reconstruction of the left atrial anatomy based on intracardiac echocardiography

Abstract Funding Acknowledgements Type of funding sources: None. Background Intracardiac echocardiography (ICE) is frequently used to guide electrophysiology procedures. The novel pre-commercial automated algorithm is a model-based algorithm, developed using machine learning methodology, which reconstructs a 3D anatomy of the left atrium (LA) and its structures based on a set of 2D ultrasound (US) frames, without the need to manually annotate US contours. Potential advantages are shortening of mapping time and better anatomy resolution when compared to conventional anatomical mapping techniques. Purpose Determine the early feasibility of the automated LA anatomy algorithm in routine clinical setting. Methods We included 16 patients (64±9 years, 88% males, body mass index 27±3, parasternal long axis LA diameter 40±3mm) undergoing LA mapping/catheter ablation (conscious sedation in 56% and general anaesthesia in the remaining cases). 2D US frames were acquired from three ICE-positions: superior vena cava/high right atrium (RA) junction, RA and right ventricular outflow tract. The automated LA anatomy map was validated in two steps: 1) identification of anatomical structures (pulmonary veins [PV] and left atrial appendage) by alignment of the ablation catheter to the automated map; and 2) assessment of PV anatomical accuracy by analysing the relationship with the automated lesion tags (3mm lesion radius, 3mm for 8sec stability criteria and 5-20g average contact force) and the PV antrum of the automated map in 9 patients with paroxysmal atrial fibrillation undergoing first time point-by-point radiofrequency PV isolation (PVI). In step 2, PV pairs were divided into 6 segments (total of 12 segments per patient) and were classified as accurate, insufficient ("floating" lesion tags), or excessive anatomy (invisible lesion tags). Results Mean 2D US frames per patient was 29±6 and acquisition time was 16±4 min. In the step 1 validation, all anatomical structures were correctly identified in the 16 patients by the automated algorithm. The step 2 validation showed anatomical accuracy in 76% of all 108 PV segments analysed. There was a range of 0-2 and 0-5 of the total 12 segments per patient with insufficient and excessive anatomy, respectively. In all cases with PV segment anatomical discrepancy, this was corrected with standard anatomy collection with the ablation catheter in ≤2min. In the whole patient group, catheter ablation was successfully performed on the automated map without complications. Conclusions The automated ICE-based 3D LA map algorithm performed overall well and correctly identified the LA anatomical structures in all patients. Anatomical PV antrum accuracy was high, and the majority of PV segments needed no manual correction before proceeding to PVI.

All-Arthroscopic Treatment of Combined Posterior Cruciate Ligament and Posterolateral Corner Instability

Injuries to the posterolateral corner (PLC) of the knee are uncommon, and usually associated with other ligamentous injuries. A combined posterior cruciate ligament (PCL) and PLC tear is the most frequent combination. Several studies describe anatomic reconstructive techniques using an open approach with large incisions and extensive exploration of the posterolateral structures. This Technical Note describes an all-arthroscopic technique as a safe and efficient treatment of combined PCL and PLC instability using the trans-septal approach.

PD45-07 PROSPECTIVE COMPARISON OF FUNCTIONAL OUTCOMES AFTER ENDOSCOPIC SURGICAL INTERVENTIONS FOR BENIGN PROSTATIC HYPERPLASIA: THE ROLE OF EJACULATION-SPARING ANATOMIC PHOTOSELECTIVE VAPORIZATION OF THE PROSTATE (ESA-PVP)

You have accessJournal of UrologyCME1 May 2022PD45-07 PROSPECTIVE COMPARISON OF FUNCTIONAL OUTCOMES AFTER ENDOSCOPIC SURGICAL INTERVENTIONS FOR BENIGN PROSTATIC HYPERPLASIA: THE ROLE OF EJACULATION-SPARING ANATOMIC PHOTOSELECTIVE VAPORIZATION OF THE PROSTATE (ESA-PVP) Mattia Sibona, Paolo Destefanis, Federico Vitiello, Eugenia Vercelli, Gabriele Montefusco, Alessandro Mara, Andrea Bosio, Alessandro Bisconti, and Paolo Gontero Mattia SibonaMattia Sibona More articles by this author , Paolo DestefanisPaolo Destefanis More articles by this author , Federico VitielloFederico Vitiello More articles by this author , Eugenia VercelliEugenia Vercelli More articles by this author , Gabriele MontefuscoGabriele Montefusco More articles by this author , Alessandro MaraAlessandro Mara More articles by this author , Andrea BosioAndrea Bosio More articles by this author , Alessandro BiscontiAlessandro Bisconti More articles by this author , and Paolo GonteroPaolo Gontero More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002613.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Ejaculatory Dysfunction (EjD) is still a common event after Benign Prostatic Hyperplasia (BPH) surgery, causing significant bother to younger and sexually active patients (pts). Recently, several ejaculation-sparing techniques were described. Ejaculation-sparing anatomic Photoselective Vaporization of the Prostate (ESa-PVP) with LBO laser has been proposed as a sexual function-sparing evolution of the anatomic PVP technique, showing promising preliminary results. The aim of our study was to present a prospective comparison of functional outcomes from a cohort of ESa-PVP pts versus standard PVP and Transurethral Resection of the Prostate (TUR-P). METHODS: Local Ethics Committee approval was obtained (n. 643/2018). Our study was conceived as a prospective, observational analysis. From 03/2018 to 06/2020, we enrolled pts undergoing endoscopic surgery for BPH at our institution (Molinette Hospital, Turin). Inclusion criteria: age > 50, sexually active, moderate to severe Lower Urinary Tract Symptoms (LUTS) [IPSS > 8]. Urinary and sexual function data were collected at baseline and at 6 and 12 month after surgery. Validated questionnaires were used to assess functional results (IPSS, IIEF5, MSHQ-Ej). Included pts were divided into groups, according to the type of intervention: bipolar TUR-P (group A); standard PVP (group B); ESa-PVP (group C). RESULTS: Globally, 95 pts were included (46 in group A, 26 in group B, 23 in group C). Median (IQR) age was 66 (60-71) years. Median prostate volume was 63 (50-90) cc. Median baseline IPSS score within groups was 25 vs 24.5 vs 28 (p=0.442); median IIEF-5 score was 21 vs 23.5 vs 20 (p=0.339); median MSHQ-Ej score was 30 vs 33.5 vs 34 (p=0.137). Baseline antegrade ejaculation rate was 84.78% vs 80.77% vs 91.30% (p=0.579). At 6-month follow-up, urinary and sexual function scores changed as follows: median IPSS: 6 vs 5 vs 1 (p=0.019); median IIEF5: 21 vs 21.5 vs 19 (p=0.750); median MSHQ-Ej: 4 vs 2 vs 15 (p=0.001). 6-month antegrade ejaculation rate was 28.89% vs 23.08% vs 60.87% (p=0.010). 12 months after surgery, no significant differences in IPSS and IIEF5 scores were detected within groups. Instead, median MSHQ-Ej score was 2 vs 2 vs 25 (p=0.006) and antegrade ejaculation rate was 26.09% vs 13.04% vs 58.82% (p=0.007). At a multivariable logistic regression analysis, pre-operative MSHQ-Ej score was identified as an independent predictor of antegrade ejaculation preservation both at 6 and 12 months, while surgical technique appeared as a significant predictor of the same outcome at 6 months. CONCLUSIONS: The Ejaculation-Sparing anatomic PVP technique (ESa-PVP) showed superiority over standard PVP and TUR-P in preserving antegrade ejaculation both at 6 and 12 month follow-up after BPH surgery. Source of Funding: none © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e785 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mattia Sibona More articles by this author Paolo Destefanis More articles by this author Federico Vitiello More articles by this author Eugenia Vercelli More articles by this author Gabriele Montefusco More articles by this author Alessandro Mara More articles by this author Andrea Bosio More articles by this author Alessandro Bisconti More articles by this author Paolo Gontero More articles by this author Expand All Advertisement PDF DownloadLoading ...

Paper 12: Biomechanical Comparison of Anatomic Restoration of the Ulnar Footprint Versus Traditional Ulnar Tunnels in Ulnar Collateral Ligament Reconstruction

Objectives:Current techniques for ulnar collateral ligament (UCL) do not reproduce the anatomic ulnar footprint of the UCL. The purpose of this study was to describe a novel UCL reconstruction technique that utilizes proximal-to-distal ulnar bone tunnels to better recreate the anatomy of the UCL and compare the biomechanical profile at time zero between this technique, the native UCL, and the traditional docking technique. Our hypothesis was that the biomechanical profile of the anatomic technique is similar to the native UCL and traditional docking technique.Methods:Ten matched cadaveric elbows were potted with the forearm in neutral rotation. The palmaris longus tendon graft was harvested, and bones were sectioned 14 cm proximal and distal to the elbow joint. Specimen testing included: (1) native UCL testing performed at 90° flexion with 0.5 Nm valgus moment preload, (2) cyclic loading from 0.5-to-5 Nm valgus moment for 1000 cycles at 1 Hz, and (3) load to failure at 0.2 mm/s. Elbows then underwent UCL reconstruction with one elbow of each pair receiving the classic docking technique using either anatomic (proximal-to-distal) or traditional (anterior-to-posterior) tunnel locations. Specimen testing was then repeated, as described above.Results:There was no difference between maximum load at failure or valgus angle between the anatomic or traditional tunnel location techniques (34.90 ± 10.65 Nm vs. 37.28 ± 14.26 Nm, P = 0.644) or the native UCL (45.83 ± 17.03 Nm, P = 0.099). Additionally, there was no difference in valgus angle after 1000 cycles across the anatomic (4.58 ± 1.47°), traditional (4.08 ± 1.28°), or native UCL (4.07 ± 1.99°). Anatomic group and the native UCL had similar valgus angles at failure (24.13 ± 5.86° vs. 20.13 ± 5.70°, P = 0.083), while the traditional group had a higher valgus angle at failure compared to the native UCL (24.88 ± 6.18° vs. 19.44 ± 5.86°, P = 0.015).Conclusions:UCL reconstruction with the docking technique utilizing proximal-to-distal ulnar tunnels to restore the anatomic ulnar footprint better recreates the anatomy of the UCL while providing valgus stability comparable to reconstruction with docking technique using traditional anterior-to-posterior ulnar tunnel locations. These results suggest that utilization of the anatomic tunnel location in UCL reconstruction has similar biomechanical properties compared to the traditional method at the time of initial fixation (i.e., not accounting for healing following reconstruction in vivo) while keeping the ulnar tunnels further from the ulnar nerve. Further studies are warranted to determine if an anatomically based UCL reconstruction results in differing outcomes compared to traditional reconstruction techniques.

History of Skull Base Surgery

Skull base surgery is a surgical field that involves the cooperation of multiple surgical and medical specialties, including neurosurgery, head-neck surgery, plastic-reconstructive surgery, radiation oncology, as well as multiple medical supporting teams. This field has been developed with the collaborative efforts of these medical specialties, and its history can be divided into five phases: Beginning of surgery(Prior to 1940); Early skull base surgery driven by the ENT-HN surgery group(1940-70); Conventional skull base surgery development based on anatomical, physiological knowledge and microsurgical equipment and technique(1970-90); Reflection and consolidation of the surgical dimension(1995-2005); and Evolution of endoscopic and new skull base surgical techniques(2005-). Several topics and advancements have improved this surgical field, such as access to the cavernous sinus, petrosal-temporal bone, and foramen magnum; concepts of minimally invasive surgical techniques; advanced endoscopic instruments; knowledge of biological assessments; and development of surgical robotics. To achieve a safe and effective surgery for cases of difficult cranial base lesions, clinicians must understand the origin of the surgical field, the detailed anatomy and physiology of the skull base, and the basic microsurgical techniques.

Histological study of a low‐cost embalming technique with preservation for nearly three years at room temperature

IntroductionThe fixation of cadavers occurs when substances prevent tissue decomposition and is also called embalming. Various techniques for fixing and preserving cadavers, more or less sophisticated, have been described over the last few years. This work is the continuation of a research line on the fixation technique published in 2020 by Masuko &amp; Andrade, that allows the fixation and conservation of a human cadaver at room temperature for a long period (more than two years) with characteristics and mobility similar to those of a fresh corpse.Materials and MethodIn this step we use a donated 14‐years‐old female cat, that was embalmed using a solution published by Masuko &amp; Andrade, in 2020, with peristaltic pump [alcohol 1000ml; phenol 1000mg; glycerin 1000ml; sodium nitrate 1000mg; formaldehyde 2000ml; distilled water 14000ml]. Femoral arterial accesses and complementary injections of formaldehyde were performed in muscles limbs. The cat was maintained at room temperature, ranging from 19.7 to 34.8ºC (67.46–94.64ºF) and the humidity (37–97%) in body bag covered with blackout sheet, without any additional preservation method to mantain the animal. Samples of tissues (skin and subcutaneous tissue, muscle and colon) were collected after 1m175 days of embalming and submitted to histological staining (HE).ResultsThis method resulted in a soft and flexible specimen with almost natural colors (Figs. 1, 2). Histological analysis indicated the preservation of tissue and cell structure in the different samples examined, even after 1,175 days of fixation. Epidermis and dermis structure identifiable and preserved, making it possible to visualize attachments such as hair follicles. In dermis, it is possible to identify blood vessels and the general structure of the unmodeled dense connective tissue; muscle tissue is well preserved, with the structure of muscle fibers identifiable both in the longitudinal and transversal sections; the colon presents the general structure of the tunics preserved. It is possible to identify mucosal villi, despite the poor clarity of the already altered lining epithelium, vessels in the submucosal conjunctiva and the smooth musculature of the tunica muscularis.DiscussionThe preservation technique presented in 2020 has low cost and easy execution, being effective in humans and now in animals, maintaining the morphological characteristics of the anatomical specimen for an extended period of time.ConclusionWe present an alternative anatomical technique for teaching and research in anatomy centers that have to deal with the toxicity of fixation products and the costs of obtaining and maintaining anatomical specimens.

The Comparison Study of Anatomic Vapor-incision Technique (AVIT) Using the 180W-XPS Greenlight Laser and Photoselective Vaporization of the Prostate for the Treatment of Benign Prostatic Hyperplasia

ObjectiveTo prospective compared the preoperative parameters and postoperative functional outcomes between anatomic vapor-incision technique (AVIT) and the photoselective vaporization of prostate (PVP) with Greenlight 180W-XPS. MethodsTotal 174 BPH patients were enrolled in the study and 86 cases, 88 cases were underwent with traditional PVP and AVIT, respectively. The relevant pre-, intra-, and postoperative data were recorded and compared between the both groups. ResultsNo significant differences were observed between both groups in baseline characteristics and no major complications (capsule perforation and TUR syndrome) occurred intraoperatively. In AVIT group, the energy consumption and energy density were greater than those in PVP group. The operative time and laser time were longer in AVIT group than it in PVP group. Compared to the AVIT group, the incidence of irritative symptoms after operation was higher in the PVP group. During the follow-up period, the functional outcomes (IPSS, QoL, prostate volume and PSA level) in both groups were significant improved compared to the baseline. The reduction of prostate volume and PSA level were significant greater in AVIT group than it in PVP group. ConclusionCompared to PVP, AVIT is safe and efficacious treatment for BPH patients with more adenoma removal and more improvements of clinical outcomes. But the long-term follow-up data is needed to evaluate the functional outcomes and retreatment rates.