Fresh Adult Cadavers Research Articles

Step-by-Step Description of Percutaneous Full-Endoscopic C2 Ganglionectomy: An Anatomic Feasibility Study in Human Cadavers.

The percutaneous full-endoscopic C2 ganglionectomy (PEC2G), an innovative procedure developed for the surgical treatment of intractable occipital neuralgia, was firstly reported by us in 2021. However, a universally accepted and well-articulated protocol modality remains elusive. The primary objective of this anatomic investigation was to meticulously elucidate the standard procedural steps of PEC2G and assess the anatomic features supporting the safe implementation of PEC2G. Eighteen fresh adult cadavers were incorporated into this study. From this sample, 3 cadavers were subjected to bilateral PEC2G. Each procedure was documented and assessed, leading to the formulation of standard procedure criteria for PEC2G. Subsequently, 10 sets of anatomic parameters pertinent to this procedure were identified, quantified, and analyzed in 15 cadavers after complete bilateral endoscopic exposure of the C2 ganglion. An assessment of the technical feasibility and potential constraints associated with PEC2G was conducted, providing invaluable insights into the procedure's anatomic considerations. All 3 cadavers successfully underwent the PEC2G without any observed complications, such as dura tears or vertebral artery injuries. The C2 inferior articular process emerged as the optimal bony target for puncture, with the C2 pedicle serving as the standard guiding landmark en route to the C2 ganglion. In the 15 cadavers subjected to the planned procedure, 10 sets of anatomic parameters were quantified, establishing a foundational understanding of the anatomy in the context of PEC2G procedure. The results demonstrated that the characteristic of anatomic data pertinent to surgical site supported the safe implementation of PEC2G. This study contributes the standard surgical steps and crucial anatomic parameters relevant to PEC2G. The characteristic of anatomic data bolsters the safety credentials of this technique, which offers a reliable approach to achieve C2 ganglionectomy. These insights undeniably establish a robust foundation for the ongoing refinement and broader adoption of PEC2G.

Is the collateral circulation pattern in the hard palate affected by cleft deformity?

ObjectivesTo evaluate the influence of collateral vascularization on surgical cleft palate closure and deformities.Materials and methodsCorrosion casting was performed using red-colored acrylic resin in twelve fresh adult cadavers with a normal hard palate. Additionally, white-colored barium sulfate was injected into a fetus with a unilateral complete cleft palate, and layer-by-layer tissue dissection was performed. Both substances were injected into the external carotid arteries. Corrosion casting involved dissolving the soft and hard tissues of the orofacial area utilizing an enzymatic solution.ResultsIn normal palates, bilateral intraosseous infraorbital arteries formed a network in the premaxilla with the intraosseous nasopalatine- and greater palatine arteries (GPAs). The perforating GPAs anastomosed with the sphenopalatine artery sub-branches. Bilateral extraosseous GPA anastomoses penetrated the median palatine suture. Complex vascularization in the retrotuberal area was detected. In the cleft zone, anastomoses were omitted, whereas in the non-cleft zone, enlarged GPAs were distributed along the cleft edges and followed the anatomical course anteriorly to initiate the network with facial artery sub-branches.ConclusionsThe anatomical subunits of the palate exhibited distinct anastomosis patterns. Despite omitted anastomoses with collateral circulation in the cleft zone, arteries maintained their anatomical pattern as seen in the normal specimen in the non-cleft zone.Clinical relevanceBased on the findings in normal- and cleft palates, surgeons may expect developed anastomosis patterns in the non-cleft zone. Due to the lack of microcirculation in the cleft zone, the existent anastomoses should be maintained as much as possible by the surgical technique. This applies anteriorly in the incisive canal territory, alveolar ridges, and posteriorly in the retrotuberal area.

Implantation of Surgical Paddle Electrodes Using Percutaneous Biportal-Endoscopic Technique for Spinal Cord Stimulation: An Anatomical Feasibility Study in Human Cadavers

BACKGROUND: Spinal cord stimulation is a technique in which different types of electrodes are placed in the spinal epidural space for neuromodulation. Surgical paddle electrodes (SEs) are usually implanted by a surgeon by performing open surgery with laminectomy. Recent advances in endoscopic spine surgery provide another option for minimally invasive SE implantation. OBJECTIVES: This anatomical study aims to examine the feasibility of implanting SEs in thoracic and cervical spine segments, discussing the specific advantages and disadvantages compared with previously reported methods. STUDY DESIGN: Laboratory study with Institutional Review Board No B2023-056. METHODS: Four fresh adult cadavers (2 women, 2 men) were operated on in this study. The posterior unilateral biportal endoscopic surgical approach, the accessibility to the intraspinal epidural space, and the technical possibilities and limitations of implantation of SEs were evaluated, as well as the surgical duration and complications. RESULTS: All the planned steps of the operation were successfully accomplished in all 4 cadavers. A total of 8 electrodes were successfully implanted through the working portal. Among them, 4 were located in the cervical segment and 4 in the thoracic segment. The proper position of the electrodes was also verified by fluoroscopy. No rupture of dura occurred during the operation. Except for the first cadaver, the duration of surgery did not exceed 1 hour. LIMITATIONS: Anatomical study on human cadavers, the quantity of cadavers, and the steep learning curve. CONCLUSIONS: The results of this anatomical study show that the SEs can be satisfactorily implanted in cervical and thoracic segments using the unilateral biportal endoscopic technique. KEY WORDS: Surgical paddle electrodes, spinal cord stimulation, unilateral biportal endoscopic technique, anatomical feasibility, anatomical study, cadavers, cervical, thoracic

Comparison of the Ventral Approach to the Canine Hip Joint Using Gelpi Retractors and an Elastic O-Ring Wound Retractor.

This study included 10 fresh adult cadavers of large breed dogs (6 males and 4 females). Their weight ranged from 25 to 45 kg (mean ± SD: 33.9 ± 6.2 kg). The breeds represented were crossbreed dogs (n = 5), German shepherds (n = 2), Bernese mountain dogs (n = 1), American Staffordshire terriers (n = 1), and Gordon setters (n = 1). Access to the target area and identification of the femoral head and neck was achieved with two Gelpi retractors inserted orthogonally and with the O-WR in all procedures. In each dog, the approach to the hip joint was made on the left and right sides. There was no significant difference in the area of the surgical wound bed between the two sides using either the Gelpi retractors (-0.52 ± 1.87 cm2; CI 95%: -1.86, 0.81 cm2; p = 0.398) or the O-WR (-0.27 ± 2.34 cm2; CI 95%: -1.94, 1.41 cm2; p = 0.729). The area of the surgical wound bed was 6.28 ± 1.72 cm2 (2.72-9.70 cm2) for the Gelpi retractors and 6.34 ± 1.81 cm2 (4.13-10.77 cm2) for the O-WR, and the difference between the Gelpi retractors and the O-WR was not significant (-0.06 ± 1.72 cm2; CI 95%: -0.86, 0.74 cm2; p = 0.879).

Anatomic study and clinical application of iliac crest chimeric tissue flap

To conduct anatomical study on the iliac crest chimeric tissue flap and summarize its effectiveness of clinical application in repairing limb wounds. Latex perfusion and anatomical study were performed on 6 fresh adult cadaver specimens with 12 sides, to observe the initial location, distribution, quantity, and direction of the common circumflexa iliac artery, the deep circumflexa iliac artery, and the superficial circumflexa iliac artery, and to measure their initial external diameter. Between December 2020 and September 2022, the iliac crest chimeric tissue flap repair was performed on 5 patients with soft tissue of limbs and bone defects. There were 3 males and 2 females, with an average age of 46 years (range, 23-60 years). Among them, there were 3 cases of radii and skin soft tissue defects and 2 cases of tibia and skin soft tissue defects. The length of bone defects was 4-8 cm and the area of skin soft tissue defects ranged from 9 cm×5 cm to 15 cm×6 cm. The length of the iliac flap was 4-8 cm and the area of skin flap ranged from 12.0 cm×5.5 cm to 16.0 cm×8.0 cm. The donor sites were directly sutured. Anatomical studies showed that there were 10 common circumflex iliac arteries in 5 specimens, which originated from the lateral or posterolateral side of the transition between the external iliac artery and the femoral artery, with a length of 1.2-1.6 cm and an initial external diameter of 0.8-1.4 mm. In 1 specimen without common circumflexa iliac artery, the superficial and deep circumflex iliac arteries originated from the external iliac artery and the femoral artery, respectively, while the rest originated from the common circumflex iliac artery. The length of superficial circumflex iliac artery was 4.6-6.7 cm, and the initial external diameter was 0.4-0.8 mm. There were 3-6 perforator vessels along the way. The length of deep circumflex iliac artery was 7.8-9.2 cm, and the initial external diameter was 0.5-0.7 mm. There were 3-5 muscular branches, 4-6 periosteal branches, and 2-3 musculocutaneous branches along the way. Based on the anatomical observation results, all iliac crest chimeric tissue flaps were successfully resected and survived after operation. The wounds at recipient and donor sites healed by first intention. All patients were followed up 8-24 months, with an average of 12 months. The tissue flap has good appearance and soft texture. X-ray film reexamination showed that all the osteotomy healed, and no obvious bone resorption was observed during follow-up. The common circumflex iliac artery, deep circumflex iliac artery, and superficial circumflex iliac artery were anatomically constant, and it was safe and reliable to use iliac crest chimeric tissue flap in repairing the soft tissue and bone defects of limbs.

Anatomical location of motor branch points in the flexor digitorum superficialis for the injection site of botulinum toxin.

To locate the intramuscular nerve branches of the flexor digitorum superficialis (FDS) and determine the accurate site for botulinum toxin injection. This study anatomically dissected 24 arms of 12 fresh adult cadavers to find intramuscular nerve endings in the FDS. The motor branch points (MBPs), proximal limit points (PLPs), and distal limit points (DLPs) of the terminal intramuscular nerve endings were identified. These three parameters were expressed in longitudinal and transverse coordinates in relation to the FDS driving as a reference line. The mean length of the reference line was 234.6 ± 11.2mm. In the longitudinal coordinate, the MBPs, PLPs, and DLPs were located at 41.6% (standard deviation (SD) 2.6%), 35.1% (SD 4.1%), and 53.4% (SD 4.6%) of the reference line in the first main branch and 72.4% (SD 4.5%), 67.5% (SD 1.5%), and 82.0% (SD 5.7%) in the second main branch, respectively. The mean value of the transverse coordinate was not greatly deviated from the reference line. The MBPs of the first and second main branches are located approximately 41.6% and 72.4% of the reference line, which considers the FDS direction, respectively. This finding helps determine the optimal injection site for botulinum toxin in the FDS.

Skin Perfusion After Hemostatic Net: An Anatomic and Radiologic Study in a Cadaver Model.

The hemostatic net is a recent technique initially developed to reduce the occurrence of postoperative hematomas following facelift procedures. Its applications have expanded to include skin redraping, deep plane fixation, and other areas beyond the face. However, no experimental study has investigated its effect on skin blood supply. The aim of this study was to analyze facial skin vascularization after applying a hemostatic net to fresh cadavers. Fourteen hemifaces from fresh adult cadavers were examined. The study model involved a deep plane facelift procedure with the use of a hemostatic net. The first step, involving 4 hemifaces, included dissections and two-/three-dimensional angiographies by digital microangiography and computed tomography scan, respectively. The purpose was to evaluate the influence of the hemostatic net on vascular perfusion. The second step involved a sequential dye perfusion study performed on 10 other hemifaces that underwent facelift procedures with the hemostatic net to determine its impact on skin perfusion. The anatomic and radiologic techniques enabled visualization of skin, and showed the arterial system reaching the subdermal vascular plexus and branching between the vascular territories, without interference from the net. The sequential dye perfusion study showed staining after injection in each facelift flap, with comparable coloration distributions before and after the application of the net. The hemostatic net did not affect the skin blood supply, correlating with no clinical increases in ischemia and necrosis rates in the facelift flap. This study provides additional evidence supporting the safety of the hemostatic net in clinical practice.

Endoscopic Orientation of Juxta-pituitary Carotid in Transsphenoidal Approaches: Critical Considerations for Clinical Applications.

Introduction In sphenoid sinuses with ill-defined carotid bony landmarks, accidental injury of the internal carotid artery (ICA) remains one of the most challenging complications, which is particularly reported in the endoscopic endonasal transsphenoidal approaches (EETAs). Objectives To describe an anatomical model for the endoscopic orientation of the juxta-pituitary segment of the ICA in relation to the lateral opticocarotid recess (OCR) as a nearby bony landmark. Methods Dissection was performed progressively, simulating the EETA, in twenty fresh adult cadavers. After reducing the posterior and lateral walls of the sphenoid sinuses, various measurements were taken from both lateral OCRs to "contact points" on the juxta-pituitary segment of the ICA and lateral margins of the pituitary gland. Results The current results have enabled us to divide the region between the lateral OCRs into 3 compartments: 2 lateral parasellar compartments contain juxta-pituitary segments of the ICA with a mean width of 8 mm and a narrow range from 7 mm to 10 mm; and a central intercarotid sellar compartment represents the safe region for bone drilling, showing widely variable widths ranging from 9 mm to 20mm. In all specimens, the variation in the width of the intercarotid compartment correlated with the distance between both lateral OCRs. Conclusion The present study improves surgeon awareness of the variations in the course of the ICA through the EETA along sphenoid sinuses with ill-defined bony landmarks. An appreciation of the measurements taken in the present study can help in operative training, and can also provide a base for future studies to confirm ICA courses associated with a higher risk of injury.

Novel Clinical Anatomical Consideration of the Superficial and Deep Layers of the Deep Temporal Fascia.

The deep temporal fascia provides anchoring during thread lifting, which is a minimally invasive face-lifting procedure. However, anatomical studies involving the deep temporal fascia in addition to effective and safe thread-lifting procedures are scarce. The authors clarified the anatomy of the superficial layer of the deep temporal fascia and its surrounding structure using ultrasonography, histologic sections, and cadaveric dissection to propose an effective thread-lifting procedure guideline. The authors included 20 healthy young participants from the Republic of Korea. Real-time, two-dimensional, B-mode ultrasonography was performed. Longitudinal scanning was performed along three vertical lines: the line passing through the jugale, the anterior margin of the condylar process of the mandible, and the midpoint between the jugale and anterior margin of the condylar process. Histologic samples from three fresh adult cadavers were harvested from 2.5 cm above and below the zygomatic arch. Eighteen fresh adult hemifaces of cadavers from the Republic of Korea (six men and three women, aged 67.3 ± 7.2 years) were used to confirm the morphology of the deep temporal fascia. The superficial layer of the deep temporal fascia crossed the zygomatic arch and was connected to the origin of the zygomaticus major muscle at the line passing through the jugale. The superficial layer continued inferiorly to the parotidomasseteric fascia at the line passing through the midpoint and condylar process of the mandible. This study yielded the novel anatomy of the superficial layer of the deep temporal fascia, and this anatomical structure may be used for an ideal thread-lifting procedure.

Compare the clinical value of two minimally invasive approaches to locating radial nerve in the posterior humeral approach

PurposeTo compare the clinical value between locating radial nerve (RN) guided by Color Doppler ultrasonography and posterior antebrachial cutaneous nerve (PACN) in the posterior humeral approach.MethodsThe five fresh adult cadavers (ten upper arms) were selected to compare the two methods of locating the RN in the posterior humeral approach (guided by ultrasound and PACN) by measuring the operation time, the length of incision, and the area of subcutaneous free. And the comparison between the two groups was statistically analyzed by paired t-test.ResultsThe results of this study demonstrated that the length of incision and the area of subcutaneous free in the ultrasound group were smaller than that in the PACN group (P < 0.05), while the operation time was just the opposite (P < 0.05). However, after excluding the time of ultrasound location, the operation time in the ultrasound group was shorter than that in the PANC group, and the difference was statistically significant (P < 0.05).ConclusionThe RN can be quickly and safely exposed by both methods. The ultrasound approach requires a long learning curve, but is more minimally invasive and can help determine whether the intraoperative nerve is compressed by the plate. And the PACN method requires a longer incision and a wider area of subcutaneous free, while specialized equipment and professional training for surgeons are not required. In a word, these two methods have advantages and disadvantages, so they should be selected based on the exact situation.

An alternative route for petroclival tumors: Without mastoidectomy and superior petrosal sinus ligation: A cadaveric study

Objective: Retrosigmoid approach and presigmoid approach and its derivatives including retrolabyrinthine, translabyrinthine, and transpetrosal approaches have long been used for reaching posterior and middle cranial fossa. In neurosurgery perspective, many types of tumors arise extradurally and surgical resection of these tumors is still challenging. We aimed to describe a modified way to approach posterior and middle fossa to contribute to the surgical management of petroclival tumors with posterior extension. Methods: Modified sigmoid approaches were performed bilaterally in 5 fresh adult cadaver heads. Results: In this approach, it was possible to reach the middle and posterior fossa with a single craniotomy. Temporal dura matter was dissected from the temporal bone with extradural gentle dissection. In addition, sigmoid sinus and superior petrosal sinus (SPS) were dissected off from the petrous bone meticulously. Subsequently, the posterolateral superior arcuate petrosectomy was performed with high-speed surgical drill extradurally by protecting the semicircular canal, labyrinthine channel, and cochlea. Dura matter was elevated for 1.5 cm with retractor above the mastoid bone. Dura was opened from an alternative area of Trautmann’s triangle. After having exposed and opened the dura, posterior fossa was reached at the level of 7.−8. cranial nerves. Conclusion: We described an alternative route which seems to be a feasible way to reach posterior and middle fossa without mastoidectomy and SPS ligation. Notably, this technique can be applicable to petroclival tumor surgery after more anatomic studies with cadaveric specimens.

Surgical landmarks for identification and preservation of the internal branch of the superior laryngeal nerve

To determine the topographical anatomic features of the internal branch of the superior laryngeal nerve (ibSLN) at the thyrohyoid membrane entrance area in relation to certain consistent anatomical structures. METHODS: Twenty-two fresh adult head cadavers (9 male, 13 female; age range 52-95years) with no signs of abnormality in the neck were dissected to determine the anatomic relationship of ibSLN and superior border of thyroid cartilage, thyroid notch, carotid bifurcation, hyoid corpus, and hyoid greater cornu. The topographical relationship between ibSLN and superior border of thyroid cartilage, thyroid notch, carotid bifurcation, hyoid corpus, and hyoid greater cornu was identified bilaterally in all cadavers. According to the measures, danger zone and safe zone areas for surgical could be predicted and for surgical manipulations as well. We provided the surgical anatomy and important landmarks for determining the internal branch of superior laryngeal nerve in the thyrohyoid membrane entrance region to avoid surgical damage during surgeries of this region.

Is the popliteal tendon sufficient for all-inside suture in lateral meniscus repair? A 22-case cadaver study

IntroductionArthroscopic lateral meniscus repair is performed in the “figure-of-4 position” (supine, with the affected knee flexed and the lower leg crossed over the extended contralateral leg), and anchorage is often on the popliteal tendon. Extending the limb at the end of the procedure alters the relations between the popliteal tendon and the repaired meniscus. The present study aimed to assess lateral meniscal suture fixation on the popliteal tendon after a cycle of flexion-extension. HypothesisExtending the knee can induce suture release. Type of studyCadaver study. Materials and methodsTwenty-two fresh adult human cadaver knee specimens were used. Under arthroscopy with all-inside implants, a vertical suture onto the popliteal tendon was performed through the lateral meniscus. Suture status was assessed under arthroscopy after a cycle of flexion-extension, and deemed defective if the suture was sufficiently loose for the arthroscope to be able to be passed through the popliteal hiatus, if the stitch had passed through the meniscus, or if the suture was broken. ResultsThirteen sutures (59.1%) remained well fixed, and 9 (40.1%) were defective: 4 (18.2%) were loose, in 4 (18.2%) the stitch had passed through the meniscus, and in 1 (4.5%) the suture had broken. ConclusionIn a population of elderly cadaver knee specimens, arthroscopic suture of the lateral meniscus to the popliteal tendon was defective after flexion-extension in 40% of cases. Stress seems to be exerted on the suture when extension is resumed. Thus, a single stitch seems insufficient for stable lateral meniscus repair. Clinical implicationsSuture of the lateral meniscus to the popliteal tendon undergoes stress when extension is resumed, potentially causing failure of lateral meniscus repair. Level of evidenceIV.

Use of free radial forearm and pronator quadratus muscle flap: Anatomical study and clinical application.

The authors present an anatomical study and clinical experience with radial forearm flap (RFF) and pronator quadratus muscle (PQM) application in the reconstruction of various body areas. The aim was to describe the anatomical placement and proportions of the PQM, the anatomical location of the major arterial branch of the radial artery supplying the PQM, and the application of this knowledge in clinical practice. The anatomical study was based upon an analysis of 13 fresh adult cadaver upper extremities, of which nine were female and four male; both arms from the same donors were used in four cases. The study of the PQM was performed using a dye-containing intraarterial injection, standard macro- and micro-preparation techniques, and chemical digestion. The data on the PQM size in males and females, thickness of the radial artery branch (the principal artery nourishing the muscle), and its position were analysed. The radial artery branch nourishing the PQM was identified in all cadaveric specimens of the anatomical study. In addition, 12 patients underwent reconstructions of soft and bony tissue defects using a RFF+PQM (pedicled or free flap). The radial artery branch perfusing the PQM was identified in all cases. The flap was used for the management of defects of the head (seven cases), arm (three cases) and lower leg (two cases). The harvest site healed well in all cases and, with the exception of one case in which a partial necrosis of the flap was observed, all flaps remained viable, which demonstrated the safety of the method.

AN APPROACH TO DEMONSTRATE THE FORAMEN BURSA OMENTI MAJORIS AND THE GUARDING PERITONEAL FOLDS AND THE RECESSES OF OMENTAL BURSA

Background: Development of high-resolution computed tomographic imaging has substantially improved the radiologic examination of the omental bursa or lesser sac. However, dissection procedure to demonstrate the omental bursa and it two recesses in cadaver did not receive adequate attention in past decades. This was a Methods: crosssectional, observational study on 20 cadavers. Relatively disease-free fresh adult cadavers of both sexes were selected randomly. Omental bursa was exposed through transgastric approach. Photographs taken after proper exposure. Results: In every dissection, omental bursa, superior and inferior recesses, foramen bursa omenti majoris, right and left gastropancreatic folds were clearly understood. In our study, an effort was made to establish a cad Conclusion: averic dissection procedure to delineate omental bursa which may add to existing knowledge in medical education technology as well as help the surgoens particularly who are performing minimally invasive surgery (MIS)

Morphometric assessment of the external anatomy of fourth ventricle &amp; dorsal brainstem in South Indian population

Background: Morphometric analysis of ventricular system is helpful in the diagnosis and classification of hydrocephalus and in the assessment and follow-up of enlargement of ventricular system during therapy (ventricular shunts). Present study was aimed to study morphometric assessment of the external anatomy of fourth ventricle &amp; dorsal brainstem. Material and Methods: Present study was descriptive, observational study, conducted in apparently normal brain specimens from human cadavers with known age and sex. The brainstem was separated and the measurements of fourth ventricle &amp; cadaver brainstem were made using millimeter rulers. Results: In present study among 60 fresh adult human cadavers, height &amp; width of fourth ventricle was comparable among male &amp; females, difference was not significant statistically. Various brainstem measurements were comparable among male &amp; females, difference was not significant statistically. Conclusion: Baseline anatomical baseline data helps in interpreting pathological changes, planning surgery, and determining presence and progress of some neurological diseases.

Lower pole anatomy of horseshoe kidney and complete ureteral duplication: Anatomic and radiologic study applied to endourology

ABSTRACTPurpose:To analyze the 3-dimensional intrarenal anatomy of horseshoe kidneys (HK) and kidney with complete ureteral duplication (CUD), in polyester resin endocasts of the collecting system and in patients submitted to 3D computerized tomography scan (CT-scan).Materials and Methods:We analyzed seven 3-dimensional polyester resin endocasts of the kidney collecting system obtained from 6 fresh adult cadavers (4 with unilateral CUD and 2 with horseshoe kidney) and CT-scan reconstruction images of kidneys from 24 patients: 6 patients with HK, 8 with CUD and 10 patients without renal anomalies that were used as controls. We analyzed the spatial distribution of the calices, the infundibula diameters, the angle between the lower infundibulum and the renal pelvis (LIP) and the angle between the lower infundibulum and the inferior minor calyces (LIICA). Measurements of the width and length of the inferior infundibulum and the infundibula of the minor calyces, as well as the angles (LIP and LIICA) were made with the aid of the LibreOffice 6.3 software. The data were analyzed with the IBM® SPSS® Statistics.Results:There was no statistical difference in the inferior pole measurements between the groups with anomalies and the control group, both in polyester resin endocasts and CT-scan reconstruction images for LIP. When we compared the LIP in the CT-scan between HK versus CUD (p= 0.003), and HK versus the control group (p= 0.035), we observed statistical difference.Conclusions:The knowledge of spatial anatomy of lower pole is of utmost importance during endourologic procedures in patients with kidney anomalies. In the present study we observed that horseshoe kidneys had more restrictive anatomic factors in lower pole than the complete ureteral duplication.

Comprehensive anatomy of the superior hypogastric plexus and its relationship with pelvic surgery landmarks: defining the safe zone around the promontory.

Pelvic surgery carries an inherent risk of autonomic nerve injury leading to genitourinary and bowel dysfunction due to the close proximity of the superior hypogastric plexus (SHP). The aim of this study was to define the detailed anatomy of SHP and identify its relationship with the vascular landmarks and ureters for pelvic autonomic nerve-preserving surgery. A cadaveric study on the detailed anatomy of the SHP was conducted in our surgical anatomy research unit. Between 02/2019 and 10/2019, macroscopic anatomical dissections were performed on 45 fresh adult cadavers (39 male, 6 female). Distances between the SHP, major vascular structures, and other anatomical landmarks were measured. Three types of SHP morphology were observed: mesh (64.8%), single nerve (24.4%), and fiber (10.8%). SHP bifurcation was located inferior to the aortic bifurcation in all cases; however, it was observed cranial to the promontory in 80% of the cases, whereas 18% were caudally and 2% were over the promontory. The closest vessels to the left and right of the SHP bifurcation were the left common iliac vein (LCIV) (86.2%, the mean distance was 8.49 ± 7.97mm) and the right internal iliac artery (RIIA) (48.2%, mean distance was 13.4 ± 9.79mm), respectively. At SHP bifurcation level, the lateral edge of the SHP was detected on the LCIV in 22 cases and on the RIIA in 10 cases for the left and right side of the plexus, respectively. The distance between the SHP bifurcation and the ureter was 27.9mm on the right and 24.2mm on the left. The width of the left (LHN) and right hypogastric nerves (RHN) were 4.35mm and 4.62mm at 2cm below the SHP bifurcation, respectively. LHN was on the vascular structures in 13 cases, whereas RHN in only 1 case, 2cm below the SHP bifurcation. Understanding the location of the SHP, including its relationship with important anatomical landmarks, might prevent iatrogenic injury and reduce postoperative morbidity in the pelvic surgery setting.

Optimal placement for needle electromyography of the supinator muscle: Cadaveric studies.

The existing methods for needle electromyography are confusing as to which is the safest and most effective. Our aim was to identify the optimal and safest needle electromyographic insertion site in the supinator muscle. We performed a two-step cadaveric dissection of the supinator muscle and related neurovascular structures. The study was performed using 18 upper limbs of 9 fresh adult cadavers (step 1) and 14 upper limbs of 7 fresh adult cadavers (step 2). In step 1, an imaginary line connecting the radial head (RH) and midpoint of the dorsal wrist (RW line) was drawn, and the distance from the RH to the point where the RW line and posterior interosseous nerve (PIN) intersect (L_CROSS) was measured on the RW line. In step 2, the needle was inserted 30 mm distal to the RH according to the results of step 1. After injection with India ink, dissection was performed to measure the distance between the needle insertion site and PIN (L_CROSS_Inj) on the RW line. The median L_CROSS was 51.4 (35.5-65.6) mm. Needle insertion spared the PIN in all cases during step 2, and the needle was inserted into the supinator muscle in all cases. The median L_CROSS_Inj was 27.4 (13.2-39.8) mm. A safe and accurate needle insertion site for the supinator muscle is approximately 30 to 40 mm distal to the RH along the RW line.

Lymphatic Drainage of Bartholin’s Gland in Fresh Adult Cadavers: Implications in Terms of Groin Surgery in Case of Bartholin’s Gland Carcinoma

Objective: To investigate the lymphatic drainage of Bartholin’s gland and its therapeutic implications in Bartholin’s gland carcinoma. Materials and Methods: Data were obtained from the anatomical study of ten fresh female cadavers with groin and pelvic dissections after lymphatic channel and node staining by injection of Lipiodol dye solution into Bartholin’s gland. Results: We distinguished three different lymphatic pathways: i) the superficial inguinal pathway, identified in 61.5% of cases, ii) the internal pudendal pathway (towards the pararectal fossa), identified in 30.8% of cases, and iii) the pelvic pathway, identified in 15.4% of cases, one after an inguinal pathway and the other following the labiocrural fold. No evidence of stained lymphatic structures was found in 31.6% of cases. The principal pathway was always ipsilateral. Conclusion: Ipsilateral groin lymphadenectomy offers the most effective ratio between oncological safety and surgery-related complications.