Demonstration Of Anatomy Research Articles

William Aldren Turner (1864-1945).

William Aldren Turner (Fig.1) was born in Edinburgh, the son of William Turner (1832-1916) who at the time was senior demonstrator in Anatomy at the University, later Professor (1867). His paternal grandmother was Margaret Aldren. He was not related to the American endocrinologist Henry Hubert Turner (1892-1970) who described Turner syndrome (monosomy X) in 1938. Fig.1 William Aldren Turner (1864-1945).

Neurophysiologic Monitoring of Oculomotor Nerves During Transorbital Surgery: Proof of Concept and Anatomic Demonstration.

Transorbital neuroendoscopic surgery (TONES) is continuously evolving and gaining terrain in approaching different skull base pathologies. The objective of this study was to present our methodology for introducing recording electrodes, which includes a new transconjunctival pathway, to monitor the extraocular muscle function during TONES. A translational observational study was performed from an anatomic demonstration focused on the transconjunctival electrode placement technique to a descriptive analysis in our series of 6 patients operated using TONES in association with intraoperative neurophysiologic monitoring of the oculomotor nerves from 2017 to 2023. The stepwise anatomic demonstration for the electrode placement and correct positioning in the target muscle was realized through cadaveric dissection. The descriptive analysis evaluated viability (obtention of the electromyography in each cranial nerve [CN] monitored), security (complications), and compatibility (interference with TONES). In our series of 6 patients, 16 CNs were correctly monitored: 6 (100%) CNs III, 5 (83.3%) CNs VI, and 5 (83.3%) CNs IV. Spontaneous electromyography was registered correctly, and compound muscle action potential using triggered electromyography was obtained for anatomic confirmation of structures (1 CN III and VI). No complications nor interference with the surgical procedure were detected. The methodology for introducing the recording electrodes was viable, secure, and compatible with TONES.

Canine Upper Digestive Tract 3D Model: Assessing Its Utility for Anatomy and Upper Endoscopy Learning.

A teaching strategy using 3D-printed models of the canine upper digestive tract (UDT) for anatomy demonstration and upper endoscopy instruction was evaluated. The canine UDT (esophagus-stomach-duodenum) was scanned and 3D-printed molds were manufactured using silicone casting. First-year students were introduced to these 3D models in practical sessions alongside real specimens. Simultaneously, fifth-year students were trained in endoscope handling and anatomical recognition using 3D specimens. Both groups completed an anonymous survey. Results showed that overall, first-year (n = 93) and fifth-year (n = 45) students agreed or strongly agreed that the 3D-printed model was effective for learning purposes. In summary, first-year students highlighted an improved understanding of size, volume, topography, and easier manipulation of the 3D model compared to fresh specimens. Fifth-year students were more enthusiastic, finding the 3D model valuable for spatial vision and clinical training. While both groups were against completely replacing the natural UDT with the 3D model, first-year students were more hesitant. These findings suggest that the 3D model of the canine UDT is an effective tool for hands-on training in clinical endoscopy and a valuable, albeit complementary, resource for teaching anatomy and topography.

A cadaveric study and clinical application of the free superficial circumflex iliac artery perforator flap reconstruction of limb soft tissue defects

Introduction In recent decades the superficial circumflex iliac artery perforator (SCIP) flap technique has gradually overcome the previous disadvantages of its pedicle and donor site to be widely applied in treating tissue's defects. This article investigates the vascular anatomy of the SCIP flap and evaluates the result of using the flap to reconstruct limb defects. Materials and Methods The study was performed in two parts. Firstly a cross-sectional descriptive anatomical study comprising 49 groin dissections in 25 cadavers, with contrast radiographic demonstration of the vascular anatomy. Secondly a retrospective case series of 51 free SCIP flaps in 49 patients. Surgical outcomes were evaluated using the Vancouver Scar Scale on the regional function and the aesthetics of implanted flap and donor sites. Results The results of anatomical analysis on cadavers showed the superficial circumflex iliac arteries were detected in all specimens with an average diameter of 1.4 ± 0.3 mm. The superficial subcutaneous venous systems were also recorded, including two veins (superficial circumflex vein and superficial epigastric vein) in 79.5% with an average diameter of 2.3 ± 0.6 mm. The flap results showed the alive flap rate was 90.2%, partial-necrosis flap was 3.9% and total necrosis of the flap in 5.9%. In the aesthetic evaluation, fine line scars were seen in 13/51 cases (25.5%), stretch scars in 33/51 cases (64.7%) and hypertrophic scars in 5/51 patients (9.8%), with no cases of keloid scars. Conclusion The SCIP flap is a reliable free-tissue transfer for reconstructing limb soft tissue defects. Moreover, the SCIP flap is an ideal flap with pleasing aesthetics because the donor-site scar is situated in a well-hidden site. Care must be taken when vein grafts are used to lengthen the flap as flap necrosis rates increase.

A Paper-Based Simulation Model for Teaching Inguinal Hernia Anatomy

BackgroundInguinal hernias remain a challenging area of learning for medical students due to its relatively complex anatomy. Modern curriculum delivery methods are conventionally limited to didactic lectures and demonstration of anatomy intraoperatively. These strategies have limitations; lectures are inherently descriptive and based on 2-dimensional models, while intraoperative teaching is often unstructured and opportunistic.MethodsA paper-based model was developed comprising three overlapping paper panels simulating the anatomical layers of the inguinal canal which can be modified readily to further simulate various hernia pathologies and their surgical repair. These models were incorporated into a timetabled structured learning session for 3rd- and 4th-year medical students. Learners responded to fully anonymised surveys before and after the learning session.FindingsA total of 45 students participated in these sessions over a period of 6 months. Pre-learning session mean ratings for the learners’ confidence in their understanding of the layers of the inguinal canal, identifying indirect and direct inguinal hernias and in naming the contents of the inguinal canal were 2.5, 3.3 and 2.9, while post-learning session mean ratings were 8.0, 9.4 and 8.2, respectively. Paired samples Student’s t-tests for all three questions were statistically significant (p < 0.001). The mean rating for usefulness of the session was 9.6/10. Free comments from students emphasised the models’ usefulness as a visual learning aid.Discussion and ConclusionOur novel, low-cost paper model was associated with an improvement in learners’ perceived knowledge and understanding of inguinal canal anatomy and pathology.

Cadaveric Sheep Head Model for Anterior Clinoidectomy in Neurosurgical Training

Anterior clinoidectomy is an important procedure used in the treatment of a range of diseases of the frontotemporal region, both vascular and tumoral. Mastering this technique requires a high level of manual skills training. The objective of the study was to describe an easily accessible and economical alternative model of anterior clinoidectomy, with a principal focus on the significance of mastering technical skills and training tactile feedback. Five cadaveric sheep heads (10 sides) fixed in formalin and alcohol were injected with silicone and used to simulate extradural (5 sides) and intradural (5 sides) routes and 1 head was used to prepare an anatomic specimen for better demonstration of the anatomy of the paraclinoid region. A comparative anatomic analysis between the ovine and human anterior clinoid process was performed. Using cadaveric sheep models, all principal steps of the procedure for both the extradural and the intradural routes were imitated. A cadaveric sheep head model serves as a good model of anterior clinoidectomy regarding manual skills training and can serve as a good alternative to human cadaveric training.

Video Narrative of Upfront Above-knee Amputation for Fillet Flap Transfer in a Single Case of External Hemipelvectomy.

INTRODUCTION In tumor cases requiring extensive resection of the pelvis and proximal lower extremity, fillet flaps allow for reconstruction of massive defects without the addition of donor site morbidity. Flaps of this size simply are not available without harvesting spare parts, highlighting the importance of reliable reconstructive techniques and avoiding the additional morbidity associated with other flap donor sites. This method of reconstruction is currently done in only selected centers, and this article provides a more detailed description of this technique to elucidate the steps of this surgical procedure so that surgeons proficient in microsurgical techniques can assist orthopedic oncologists in the care of these sarcoma patients. SURGICAL VIDEOS The narrated supplemental digital content videos can help surgeons simplify operative planning and avoid complications. These videos highlight the utility of the upfront above the knee amputation (AKA) strategy of flap harvest, operative steps, and potential complications. SURGICAL TAKEAWAYS This article aims at reconstructive surgeons familiar with microsurgical techniques to help them perform this procedure in selected patients who otherwise would have the additional morbidity of a large donor site when undergoing resection of large sarcomas in the hip region. The AKA at the start of an external hemipelvectomy procedure is an excellent first step in fillet flap harvest. (See Video 1 [online], which shows a demonstration of proximal thigh sarcoma anatomy necessitating external hemipelvectomy.) Unlike in situ harvest techniques,1,2 the amputation step allows for the reconstructive and ablative teams to work in parallel, saves operative time, and permits aggressive oncologic resection when tumors encase neurovascular structures. The upfront AKA approach also avoids the possibility of flap injury during resection. {"href":"Single Video Player","role":"media-player-id","content-type":"play-in-place","position":"float","orientation":"portrait","label":"Video 1.","caption":"This video displays demonstration of proximal thigh sarcoma anatomy necessitating external hemipelvectomy. Above knee amputation is demonstrated prior to hemipelvectomy.","object-id":[{"pub-id-type":"doi","id":""},{"pub-id-type":"other","content-type":"media-stream-id","id":"1_mqd4rfxh"},{"pub-id-type":"other","content-type":"media-source","id":"Kaltura"}]} The main pitfall of performing an AKA at the beginning of the hemipelvectomy is the possibility of long ischemia times.1–3 Careful coordination between surgical teams and contact cooling can be used to minimize these risks. (See Video 2 [online], which shows how contact cooling can be used in a separate operating space to allow for flap dissection in parallel with the oncology procedure.) (See Video 3 [online], which shows tibia and fibula osteotomies to complete soft tissue fillet dissection.) Shaw et al’s retrospective review of contact cooling in 189 consecutive free flaps concluded that surface cooling does not affect flap outcomes if not done for more than 4 hours.4 Still, mindfulness toward the duration of ischemia is necessary, as the longest reported ischemia time before successful fillet transfer is 7 hours.1 Our group has performed at least three reconstructions with upfront AKA for flap harvest with no adverse ischemic outcomes. {"href":"Single Video Player","role":"media-player-id","content-type":"play-in-place","position":"float","orientation":"portrait","label":"Video 2.","caption":"This video contact cooling can be used in a separate operating space to allow for flap dissection in parallel with the oncology procedure. Pretibial and thigh incisions start fillet dissection. The femur is removed.","object-id":[{"pub-id-type":"doi","id":""},{"pub-id-type":"other","content-type":"media-stream-id","id":"1_4enas18l"},{"pub-id-type":"other","content-type":"media-source","id":"Kaltura"}]} {"href":"Single Video Player","role":"media-player-id","content-type":"play-in-place","position":"float","orientation":"portrait","label":"Video 3.","caption":"Tibia and fibula osteotomies complete soft tissue fillet dissection.","object-id":[{"pub-id-type":"doi","id":""},{"pub-id-type":"other","content-type":"media-stream-id","id":"1_sx54teuh"},{"pub-id-type":"other","content-type":"media-source","id":"Kaltura"}]} Another highlight of this video is the inevitability of aggressive vascular resection by the ablative surgeon, a phenomenon acknowledged by multiple authors.2,3 In this context, reconstructive surgeons should be proficient in end-to-side anastomosis of flap vessels and have large vascular clamps to obtain proximal and distal control of recipient vessels or stumps off of the aorta (See Video 4 [online], which shows dissection of recipient vessels in the pelvis and set up for vascular anastomosis). Reconstructive surgeons should also anticipate marginal wound healing difficulties with these resections by planning additional wound debridement and larger flap harvests before flap inset. Future investigations into hemipelvectomy reconstruction and refinement in techniques may improve the high wound-complication rates present in this patient population.3 {"href":"Single Video Player","role":"media-player-id","content-type":"play-in-place","position":"float","orientation":"portrait","label":"Video 4.","caption":"This video displays dissection of recipient vessels in pelvis and set up for vascular anastomosis are demonstrated.","object-id":[{"pub-id-type":"doi","id":""},{"pub-id-type":"other","content-type":"media-stream-id","id":"1_s7icc5d1"},{"pub-id-type":"other","content-type":"media-source","id":"Kaltura"}]} DISCLOSURE The authors have no financial interest to declare in relation to the content of the article. ACKNOWLEDGMENTS The authors acknowledge the assistance of Patrick Getty, MD (Musculoskeletal Surgical Oncology, Seidman Cancer Center, University Hospitals of Cleveland) and and Julian Kim, MD (University of South Carolina; Columbia, S.C.). An IRB exemption was obtained from the University Hospitals of Cleveland Institutional Review Board Office. The project was designated as nonhuman research. This article complies with the Declaration of Helsinki.

Gaining Mesenteric Length following Colorectal Resection: Essential Maneuvers to Avoid Anastomotic Tension.

A surgeon must possess the knowledge and technical skill to obtain length following a left-sided colorectal resection to perform a tension free anastomosis. The distal target organ - either rectum or anus - is fixed in location, and therefore requires surgeons to acquire mastery of proximal mobilization of the colonic conduit. Generally, splenic flexure mobilization (SFM) provides adequate length. Surgeons benefit from clearer understanding of the multiple steps involved in SFM as a result of improved visualization and demonstration of the relevant anatomy - adjacent organs and the attachments, embryologic planes, and mesenteric structures. Much may be attributed to laparoscopic and robotic platforms which provided improved exposure and as a result, development or refinement of novel approaches for SFM with potential advantages. Complete mobilization draws upon the sum or combination of the varied approaches to accomplish the goal. However, in the situation where extended resection is necessary or in the case of re-operative surgery sacrificing either more proximal or distal large intestine often occurs, the transverse colon or even the ascending colon represents the proximal conduit for anastomosis. This challenging situation requires familiarity with special maneuvers to achieve colorectal or coloanal anastomosis using these more proximal conduits. In such instances, operative techniques such as either ileal mesenteric window with retroileal anastomosis or de-rotation of the right colon (Deloyer's procedure) enable the intestinal surgeon to construct such anastomoses and thereby avoid stoma creation or loss of additional large intestine.

Checklist-based active learning in anatomy demonstration sessions during the COVID-19 pandemic: Perception of medical students

Human anatomy is an essential component of the medical curricula. Anatomy education has been significantly affected during the COVID-19 pandemic. The aim of this study was to explore student's perceptions on a blended learning approach using Checklist-based Active Learning in Anatomy Demonstration Sessions (CALADS) as a method in comparison to the two previously used methods; namely face-to-face Structured Problem-Related Anatomy Demonstrations (SPRAD) and online anatomy learning. A comparative, cross-sectional, survey-based study was conducted. The survey was composed of 13 questions that explored preference of learning anatomy in demonstration sessions of 4th year pre-clerkship students who have had their anatomy learning through face-to-face SPRAD in year 2 (before the COVID-19 pandemic), online in year 3 (during the COVID-19 pandemic), and CALADS method in year 4. Descriptive statistics were used, and the level of significance was set at P<0.05. The survey exhibited high internal consistency (Cronbach's α=0.953). Validity of the survey was established through exploratory factor analysis. The preferred method for more than half of the students was the CALADS method. Face-to-face SPRAD came next and lastly came the online method. However, more students preferred the online method in comparison to face-to-face method for "learning radiological anatomy". There were no statistically significant differences between male and female students regarding any of the survey questions. CALADS method, as a hybrid, student-centered, interactive learning method of learning practical anatomy, was preferred by pre-clerkship students as a more effective method in understanding anatomy than face-to-face and online learning methods.

Anatomical Variations of Cystic Ducts in Magnetic Resonance Cholangiopancreatography: A Retrospective Study With 265 Patients

Background: Anatomical variations of cystic duct (CD) are frequently unrecognized. It is important to be aware of these variations prior to any surgical, percutaneous, or endoscopic intervention procedures. Objectives: The purpose of our study was to demonstrate the imaging features of cystic duct and its variants using magnetic resonance cholangiopancreatography (MRCP) and document their prevalence in our population. Materials and Methods: This study included 265 patients who underwent magnetic resonance cholangiopancreatography due to different indications and variations of cystic duct were documented. Results: Normal lateral insertion of cystic duct at middle third of common hepatic duct was seen in 29.43% of cases. Medial insertion was seen in 2.63% of cases, 2.26% were low medial insertions. Low insertion of cystic duct was noted in 1.51 % of cases. Parallel course of cystic duct was present in 0.38% of cases. High insertion was noted in 0.38% cases and no case of short cystic duct was noted. No case of cystic duct draining into right hepatic duct was seen. Conclusion: Cystic duct variations are common and MRCP is an optimal imaging modality for demonstration of cystic duct anatomy. KEY WORDS: Cystic Duct, Hepatic Duct, Variation, MRCP.

Tendon injections - upper extremity.

Imaging-guided tendon procedures aim to reduce pain and increase function by controlling inflammation and stimulating healing. Ultrasound is the preferable guiding modality due to its high resolution and real-time demonstration of the tendinous anatomy and needle positioning. The technique includes appropriate patient positioning, which varies depending on the targeted tendon, as well as sterile and proper draping. For most procedures, we prefer the "in-plane" approach, which demonstrates the entire needle as it advances through different tissue layers. Upper limb injections commonly use corticosteroids and anesthetics with different reported short- and long-term results depending on the tendon treated; better results are obtained in the treatment of tenosynovitis (sliding tendons such as trigger finger and De Quervain's tenosynovitis). Shoulder and elbow tendinopathies (anchor tendons) may also benefit from injections containing irritants or healing stimulants such as dextrose (prolotherapy) and platelet-rich plasma or by the stimulation of healing via tendon perforations (fenestration). The hyaluronic acid injection has also been used in the treatment of both tenosynovitis and tendinopathies. For tendons passing through osteofibrous tunnels, an additional release may be performed, and the techniques are discussed in this review. Therefore, this article provides practicing musculoskeletal radiologists and trainees with a comprehensive review of tendon injection musculoskeletal image-guided procedures.

Visual live anatomical demonstrations among medical students by Surgeons.

Objective: To determine the results of visual live anatomical demonstrations among medical students by Surgeons. Study Design: Prospective study. Setting: Department of Anatomy, Liaquat Medical and Dental College, Darul Sehat Hospital. Period: Period of 3 years on the students of Batch 2017, 2018 and 2019. Material &amp; Methods: Total 300 students of first year medical students (MBBS) with full attendance in class over the year were included in study. The mode of presentations was theoretical, video and power-point presentations and through live surgeries. Exclusion criteria students with absenteeism in classes. Results: Out of 100 students enrolled every year, only 75 students were included due to full attendees as per inclusion criteria. Total of 225 students were enrolled. The mean age of students was 19.4 ±0.57 years in every year students. The students were assessed in their term exams and pre-prof exams and showed significant difference in pre-presentation and post-presentation scores. Another group scores with live surgical demonstrations compared those without live visual surgical demonstrations 75.89± 3.9 vs 74.7± 4.6 in year 2017, 79.46 ± 4.9 vs 74.8 ±4.3in year 2018) and 84.8± 3.4 vs 76.41± 4.3 in year 2019 students showed statistical significant difference p value&lt;0.000. Conclusion: The teaching of anatomy by surgeons has markedly improved performance and live visual demonstrations showed increase in interest of medical students.

Comparison of laparoscopic hysterectomy videos on YouTube and WebSurg platforms in terms of educational reliability and quality

IntroductionThis study aimed to compare the educational reliability of laparoscopic hysterectomy videos on YouTube and WebSurg platforms. Materials and methodsWe performed an online search with the keyword “laparoscopic hysterectomy” on YouTube and WebSurg. On WebSurg, the surgical interventions in gynecology section were selected. On YouTube, the most relevant surgical videos according to algorithm of YouTube were included. 22 YouTube and 22 WebSurg videos were included in the study. Technical analysis were performed via calculation of ratios such as view/day, like/view, like/subscriber, view/subscriber, and Video Power Index. The videos were evaluated with usefulness and laparoscopic surgery video educational guidelines (LAP-VEGaS) scoring systems. ResultsView/day ratio was higher on YouTube than WebSurg [8.8 (42.1) and 2.5 (5.1), respectively; p = 0.02]. Like/view ratio was lower on YouTube than WebSurg [0.006 (0.01) and 0.01 (0.02), respectively; p = 0.001]. A significant difference was obtained only in the treatment section of usefulness scoring system [0 (0–2), and 0 (0–1) for YouTube and WebSurg, respectively; p = 0.04]. According to LAP-VEGaS, the scores of patient positioning, step-by-step approach, demonstration of intraoperative findings and anatomy, commentary in English parameters were significantly lower on YouTube compared to WebSurg [1(0–2) and 2(2–2), p < 0.001; 2 (0–2) and 2 (2–2), p = 0.004; 2(0–2) and 2(2–2), p < 0.001; 2(0–2) and 2(2–2), p = 0.009, respectively]. The total LAP-VEGaS score of YouTube was lower than WebSurg videos [10(4–16) and 13(10–15), respectively; p = 0.001). DiscussionWebSurg was found to be more reliable platform in terms of educational value and quality of laparoscopic hysterectomy videos compared to YouTube.

African Medical Educators and Anatomy Teachers' Perceptions and Acceptance of the Anatomage Table as an EdTech and Innovation: A Qualitative Study.

BackgroundThis article presents a qualitative study of African anatomists and anatomy teachers on the Anatomage Table–a modern medical education technology and innovation, as an indicator of African anatomy medical and anatomy educators’ acceptance of EdTech. The Anatomage Table is used for digital dissection, prosection, functional anatomy demonstration, virtual simulation of certain functions, and interactive digital teaching aid.Materials and MethodsAnatomy teachers [n=79] from 11 representative African countries, Ghana, Nigeria [West Africa], Ethiopia, Kenya, Rwanda [East Africa], Namibia [South Africa], Zambia [Southern Africa], Egypt [North Africa], and Sudan [Central Africa], participated in this study. Focus group discussions [FGDs] were set up to obtain qualitative information from stakeholders from representative institutions. In addition, based on the set criteria, selected education leaders and stakeholders in representative institutions participated in In-depth Interviews [IDIs]. The interview explored critical issues concerning their perceptions about the acceptance, adoption, and integration of educational technology, specifically, the Anatomage Table into the teaching of Anatomy and related medical sciences in the African continent. Recorded interviews were transcribed and analyzed using the Dedoose software.ResultsAfrican anatomists are generally technology inclined and in favor of EdTech. The most recurring opinion was that the Anatomage Table could only be a “complementary teaching tool to cadavers” and that it “can’t replace the real-life experience of cadavers.” Particularly, respondents from user institutions opined that it “complements the traditional cadaver-based approaches” to anatomy learning and inquiry, including being a good “complement for cadaveric skill lab” sessions. Compared with the traditional cadaveric dissections a majority also considered it less problematic regarding cultural acceptability and health and safety-related concerns. The lifelikeness of the 3D representation is a major factor that drives acceptability.

Prospective pre-operative 3-T MR neurography peripheral nerve mapping of upper extremity amputations implanted with FAST-LIFE electrode interfaces of robotic hands: technical report.

Fascicular targeting of longitudinal intrafascicular electrode (FAST-LIFE) interface enables hand dexterity with exogenous electrical microstimulation for sensory restoration, custom neural recording hardware, and deep learning-based artificial intelligence for motor intent decoding. The purpose of this technical report from a prospective pilot study was to illustrate magnetic resonance neurography (MRN) mapping of hand and nerve anatomy in amputees and incremental value of MRN over electrophysiology findings in pre-surgical planning of FAST-LIFE interface (robotic hand) patients. After obtaining informed consent, patients with upper extremity amputations underwent pre-operative 3-T MRN, X-rays, and electrophysiology. MRN findings were correlated with electrophysiology reports. Descriptive statistics were performed. Five patients of ages 21-59years exhibited 3/5 partial hand amputations, and 2/5 transradial amputations on X-rays. The median and ulnar nerve end bulb neuromas measured 10.1 ± 3.04mm (range: 5.5-14mm, median: 10.5mm) and 10.9 ± 7.64mm (2-22mm, 9.75mm), respectively. The ADC of median and ulnar nerves were increased at 1.64 ± 0.1 × 10-3 mm2/s (range: 1.5-1.8, median: 1.64 × 10-3 mm2/s) and 1.70 ± 0.17 × 10-3 mm2/s (1.49-1.98 × 10-3 mm2/s, 1.65 × 10-3 mm2/s), respectively. Other identified lesions were neuromas of superficial branch of the radial nerve and anterior interosseous nerve. On electrophysiology, 2/5 reports were unremarkable, 2/5 showed mixed motor-sensory neuropathies of median and ulnar nerves along with radial sensory neuropathy, and 1/5 showed sensory neuropathy of lateral cutaneous nerve of the forearm. All patients regained naturalistic sensations and motor control of digits. 3-T MRN allows excellent demonstration of forearm and hand nerve anatomy, altered diffusion characteristics, and their neuromas despite unremarkable electrophysiology for pre-surgical planning of the FAST-LIFE (robotic hand) interfaces.

The role of MR venography with time-resolved imaging in diagnosis of pelvic congestion syndrome

BackgroundPelvic congestion syndrome (PCS) represents a diagnostic challenge due to its variable clinical presentation, complex anatomy, and pathophysiology. Accurate delineation of the venous anatomy, detection of venous reflux or obstruction, its extent will enable interventional radiologists to successfully treat such patients and to avoid recurrence. Magnetic resonance imaging (MRI) allows a noninvasive examination of the anatomy and flow inside the pelvic veins in addition to its excellent soft-tissue contrast allowing evaluation of the pelvic organs. Our study is aiming to investigate the role and accuracy of MR venography with time-resolved imaging (TR-MRV) as a diagnostic tool for pretreatment planning of PCS.ResultsOur study included 25 female patients with mean age 48 ± 12.34, who were referred to the radiology department in the period from April/2019 to April/2020 with clinical and ultrasound features suggesting PCS. TR-MRV was performed and interpreted in a blind fashion evaluating the vascular anatomy, venous dilatation, and reflux. The results were compared to conventional venography as a reference. The sensitivity, specificity, and accuracy of TR-MRV in the detection of ovarian vein reflux were 87%, 80%, and 84%, respectively, versus 75%, 53%, and 72% in internal iliac vein reflux and 92%, 69%, and 64% for pelvic venous plexus reflux. Demonstration of the venous anatomy was excellent in 68% of the patients and was sufficient in 32%. Ovarian vein dilatation was detected in 16 patients by venography and in 10 patients by TR-MRV. The weighted k-values (Cohen's Kappa coefficient statistics) indicated excellent agreement between the two observers for identifying all the refluxing veins by TRI in each patient (k = 0.78).ConclusionMRI with TR imaging has shown high diagnostic accuracy when compared to conventional venography in evaluating pelvic congestion syndrome before endovascular treatment and thus facilitating treatment planning.

Demonstration of the epigastric vessels surface anatomy with equation model: An anatomical feasibility study

Introduction: The objective of this study is to design a patient-specific model to predict the location of epigastric vessels on the abdominal surface and to show clinicians safe areas before surgical intervention. Material and Methods: A total of 200 patients who underwent color Doppler ultrasound evaluation of the deep epigastric vessel before gynecological laparoscopic surgery were recruited in the study. The deep epigastric vessels were identified at three equal levels between the xiphoid and umbilicus, and five equal levels between the umbilicus and the symphysis pubis. The distance between the epigastric vessels and the midline was measured bilaterally at each level. Linear mixed effect modeling was used to assess the anatomical location of the epigastric vessels. Results: The model with waist circumference term was found to be the model with best performance metric. This model included waist circumferences as a covariate, the region of the epigastric vessel as a categorical variable, and random effects for patients. The model that calculates the expected distance from the midline of the epigastric vessels for different regions and waist circumferences are presented as “Distance to midline (cm) = 2.57 + Region A + Region B × Waist Circumference.” Discussion and Conclusion: With the equation model, we proposed, the location of the epigastric vessels can be determined specifically for the patient and the abdominopelvic regions. This model can be a guide to prevent vascular injury.

Anatomy education for medical students in the United Kingdom and Republic of Ireland in 2019: A 20-year follow-up.

Anatomical education in the United Kingdom (UK) and Ireland has long been under scrutiny, especially since the reforms triggered in 1993 by the General Medical Council's "Tomorrow's Doctors." The aim of the current study was to investigate the state of medical student anatomy education in the UK and Ireland in 2019. In all, 39 medical schools completed the survey (100% response rate) and trained 10,093medical students per year cohort. The teachers comprised 760 individuals, of these 143 were employed on full-time teaching contracts and 103 were employed on education and research contracts. Since a previous survey in 1999, the number of part-time staff has increased by 300%, including a significant increase in the number of anatomy demonstrators. In 2019, anatomy was predominantly taught to medical students in either a system-based or hybrid curriculum. In all, 34 medical schools (87%) used human cadavers to teach anatomy, with a total of 1,363 donors being used per annum. Gross anatomy teaching was integrated with medical imaging in 95% of medical schools, embryology in 81%, living anatomy in 78%, neuroanatomy in 73%, and histology in 68.3%. Throughout their five years of study, medical students are allocated on average 85h of taught time for gross anatomy, 24h for neuroanatomy, 24h for histology, 11h for living anatomy, and 10 for embryology. In the past 20 years, there has been an average loss of 39h dedicated to gross anatomy teaching and a reduction in time dedicated to all other anatomy sub-disciplines.

Anatomical Variation in the Fissurization of Lung with Embryological and Clinical correlations- A Case Report

Lungs are paired conical organs present in the thoracic cavity, which are responsible for gaseous exchange for oxygenation of blood. Both the lungs are divided into lobes by fissures. The right lung is divided into upper, middle and lower lobes by two fissures. The fissures are horizontal and oblique fissure whereas the left lung is divided into upper and lower lobes by oblique fissure. The left lung is divided into upper and lower lobe by oblique fissure. Both the lungs have ten bronchopulmonary segments (structurally separate and functionally independent units). Embryological evidence showed that the lungs developed from the endodermal counterpart of the foregut. Around 22 days of embryonic period, diverticulum are develop, then between 26-28 days lung buds develop. The right bronchial buds and left bronchial buds are branched into secondary and tertiary buds at 5th and 6th week of embryonic life consecutively. During routine anatomy dissection and demonstration in the Department of Anatomy, a 50 year old male cadaver showed anatomical variation in the right lung. The present study observed that the right lung showed partial horizontal fissure. The reason for partial or incomplete fissure formation is due to incomplete or absence of obliteration of prenatal fissure which indicates partial fusion of lobes, generally fissures separating the broncho-pulmonary segments in prenatal life. The reports says that incomplete fissures of the lung may lead to spread of infection like pneumonia to adjacent lobe and collapse in endobronchial lesions and gradation of the fissures of the lungs are very important for lung surgeries. The present study concludes that the knowledge of anatomical variation of lung is of utmost important in the field of pulmonary medicine.

1187 Adapting Postgraduate Anatomy Education During The COVID-19 Pandemic

AimA solid understanding of anatomy and its application is crucial to the development of safe surgeons. Cadaveric dissection has traditionally been the gold standard for learning anatomy however the disruption of anatomy teaching from the COVID-19 pandemic has led to a shift in methods for teaching both undergraduate and postgraduate students. We sought to design, deliver and evaluate a virtual MRCS anatomy revision course for doctors led by anatomy demonstrators.MethodA series of six high yield revision sessions on the anatomy of the abdomen and pelvis, upper limb, lower limb, thorax and head and neck were organised on a virtual platform. The course was advertised on social media targeting groups for doctors. These sessions were taught by a senior anatomy demonstrator and previous examiner for the MRCS. This was followed by a series of interactive single best answer questions. The answers were then discussed in a subsequent session facilitated by current junior anatomy demonstrators. Feedback on student satisfaction, relevance and content of each session was collated.ResultsOnline feedback was completed by 263 students and was universally positive. Our results highlight the relevance of the sessions for doctors preparing for both MRCS part A and B examinations. Our aim is to develop this teaching series to create an environment where postgraduate learners feel supported and can build on pre-existing knowledge.ConclusionsVirtual anatomy teaching can be a sustainable method of supporting the learning process of doctors preparing for surgical examinations, complementing independent study, virtual dissection and hands on cadaveric dissection.