Main Anatomical Landmarks Research Articles

Micro-Doppler for venous sinus localization in approaches to the cerebello-pontine angle.

Main anatomical landmarks of retrosigmoid craniotomy are transverse sinus (TS), sigmoid sinus (SS), and the confluence of both. Anatomical references and guidance based on preoperative imaging studies are less reliable in the posterior fossa than in the supratentorial region. Simple intraoperative real-time guidance methods are in demand to increase safety. This manuscript describes the localization of TS, SS, and TS-SS junction by audio blood flow detection with a micro-Doppler system. This is an additional technique to increase safety during craniotomy and dura opening, widening the surgical corridor to secure margins without carrying risks nor increase surgical time.

Repere anatomice în histerectomia radicală

Introduction. Customizing surgical radicality is a crucial element in contemporary cervical cancer surgery. Currently, anatomic structures are characterized based on many anatomic interpretations. In order to suggest its general applicability, this study proposes to standardize the definitions and anatomic landmarks of the various types of radical hysterectomy. Methodology. This paper is a literature review in which we selected relevant articles from PubMed database, starting with the year of publication 2010 until 2023, using the following keywords: “cervical cancer”, “radical hysterectomy”, “classification of radical hysterectomy”, “anatomic landmarks”, “tailoring surgery”, “nerve-sparing procedure”. Results. The lateral extent of resection serves as the basis for the updated Querleu-Morrow classification. The three-dimensional anatomic template used to define the resection limits is based on the precise anatomy of the paracolpium and parametrium. The main anatomic landmarks and avascular spaces of the pelvis serve as the basis for the oncologic procedures, including nerve-sparing techniques. There are four different types of radical hysterectomy, each type described with three-dimensional landmarks. There are three main objectives that never change: excising the central tumor with clear margins, removal of any possible lymph dissemination sites, and the control of metastatic disease. Conclusions. It is essential to base research evaluating radicality in the surgical treatment of cervical cancer on precise and generally accepted nomenclature and descriptions. Since the degree of parametrium excision affects late morbidity, particularly bladder and rectal dysfunctions, the thorough explanation and understanding of the many forms of radical hysterectomy are crucial.

V06-01 NERVE-SPARING ROBOT-ASSISTED RADICAL CYSTOPROSTATECTOMY WITH HYDRODISSECTION AND VASCULAR STAPLER: ADHERING TO SURGICAL PRINCIPLES

You have accessJournal of UrologyCME1 Apr 2023V06-01 NERVE-SPARING ROBOT-ASSISTED RADICAL CYSTOPROSTATECTOMY WITH HYDRODISSECTION AND VASCULAR STAPLER: ADHERING TO SURGICAL PRINCIPLES Nassib Abou Haidar, Hannah B. Ely, Jorge Daza, Ian J. Cooke, Muammer Altok, Ahmed A. Hussein, and Khurshid A. Guru Nassib Abou HaidarNassib Abou Haidar More articles by this author , Hannah B. ElyHannah B. Ely More articles by this author , Jorge DazaJorge Daza More articles by this author , Ian J. CookeIan J. Cooke More articles by this author , Muammer AltokMuammer Altok More articles by this author , Ahmed A. HusseinAhmed A. Hussein More articles by this author , and Khurshid A. GuruKhurshid A. Guru More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003274.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Radical cystectomy remains the gold-standard treatment of muscle-invasive bladder cancer. Nerve sparing approaches have been performed and described over the past decades. The advent of robotic approaches with superior vision and magnification, has allowed enhanced techniques of nerve sparing during radical cystectomy. We hereby illustrate the main anatomical landmarks and the use of hydrodissection for neurovascular bundle preservation during robotic assisted radical cystectomy. METHODS: In this video, we highlight the operative steps during radical cystectomy, to achieve neurovascular bundle preservation. We describe the technique of using Endo GIA to release the bladder pedicle as well as the use of saline needle hydrodissection to facilitate the dissection of the neurovascular bundle away from the prostate pedicle. We also describe the use of the Endo GIA stapler to divide the prostate pedicle, while minimizing the traction on the cavernosal nerves. RESULTS: We compiled the important operative steps as well as the essential anatomical landmarks that have been previously described to perform neurovascular bundle sparing during radical cystectomy. We further attempt to refine the technique of nerve sparing utilizing the advantage of magnification and superior functionality of robotic surgery. CONCLUSIONS: Robotic surgery has allowed improved vision and understanding of complex pelvic anatomy. This has made way for enhanced surgical technique for neurovascular preservation during radical cystectomy. Source of Funding: Roswell Park Alliance Foundation © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e509 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nassib Abou Haidar More articles by this author Hannah B. Ely More articles by this author Jorge Daza More articles by this author Ian J. Cooke More articles by this author Muammer Altok More articles by this author Ahmed A. Hussein More articles by this author Khurshid A. Guru More articles by this author Expand All Advertisement PDF downloadLoading ...

Improving prenatal detection of abdominal supraumbilical anomalies: The sonographic examination of fetal anechoic spaces of upper abdomen revisited

Visualization of the axial plane of the fetal abdomen is mandatory to obtain abdominal biometry in the assessment of fetal growth in the second and third trimesters. The main anatomic landmarks that must be identified in this view include the fetal stomach and the intrahepatic portion of the umbilical vein, which are easily identifiable as they appear anechoic on ultrasound. The gallbladder is the other prominent anechoic structure in this plane. Focused study of the morphological characteristics of, and spatial relationship among, these three anechoic spaces is a simple technique to detect anomalies involving fetal upper abdominal organs. In this review, the sonographic features of those conditions that can be detected using this technique, which was termed the Fetal Examination of the Anechoic Spaces of upper abdomen Technique (FEAST), are classified and illustrated.

A Novel Technique of Arthroscopic Femoral Tunnel Placement during Medial Patellofemoral Ligament Reconstruction for Recurrent Patellar Dislocation.

Recurrent patellar dislocation is a commonly encountered patellofemoral disease. Prompt surgical intervention is indicated for recurrent dislocation to restore patellofemoral stability. As one of the most preferred procedures, medial patellofemoral ligament (MPFL) reconstruction has been implemented on a large scale. Femoral tunnel placement remains a crucial technical issue during MPFL reconstruction and is critical to ensure the isometry and proper tension of the graft. Currently, visual-palpatory anatomic landmarks and fluoroscopy-guided radiographic landmarks comprise the main approaches to intraoperative femoral tunnel positioning. However, the accuracy of both methods has been questioned. This article introduces an arthroscopic femoral tunnel placement technique. Apart from traditional anteromedial and anterolateral portals, two auxiliary arthroscopic portals are specially designed. The adductor tubercle, the medial epicondyle and the posterior edge are selected as main anatomic landmarks and are directly visualized in sequence under arthroscope. The relative position between the femoral attachment of the MPFL and the three landmarks is measured on preoperative three-dimensional computed tomography, providing semi-quantified reference for intraoperative localization. This technique achieves minimally invasive tunnel placement without X-ray exposure, and especially suits obese patients for whom palpatory methods are difficult to perform.

An anatomical approach to the tarsal tunnel syndrome: what can ankle’s medial side anatomy reveal to us?

BackgroundThe heel is a complex anatomical region and is very often the source of pain complaints. The medial heel contains a number of structures, capable of compressing the main nerves of the region and knowing its anatomical topography is mandatory. The purpose of this work is to evaluate if tibial nerve (TN) and its main branches relate to the main anatomical landmarks of the ankle’s medial side and if so, do they have a regular path after emerging from TN.MethodsThe distal part of the legs, ankles and feet of 12 Thiel embalmed cadavers were dissected. The pattern of the branches of the TN was registered and the measurements were performed according to the Dellon–McKinnon malleolar-calcaneal line (DML) and the Heimkes Triangle (HT).ResultsThe TN divided proximal to DML in 87.5%, on top of the DML in 12,5% and distal in none of the feet. The Baxter’s nerve (BN) originated proximally in 50%, on top of the DML in 12,5% and distally in 37.5% of the cases. There was a strong and significant correlation between the length of DML and the distance from the center of the medial malleolus (MM) to the lateral plantar nerve (LPN), medial plantar (MPN) nerve, BN and Medial Calcaneal Nerve (MCN) (ρ: 0.910, 0.866, 0.970 and 0.762 respectively, p < 0.001).ConclusionsIn our sample the TN divides distal to DML in none of the cases. We also report a strong association between ankle size and the distribution of the MPN, LPN, BN and MCN. We hypothesize that location of these branches on the medial side of the ankle could be more predictable if we take into consideration the distance between the MM and the medial process of the calcaneal tuberosity.

Minimally invasive management for multifocal pelvic retroperitoneal malignant paraganglioma: a neuropelveological approach

BackgroundPheochromocytoma and Paraganglioma (PGL) are rare neuroendocrine tumors, with an estimated incidence of about 0.6 cases per 100.000 person/year. Overall, 3–8% of them are malignant. These tumors are characterized by a classic triad of symptoms (headaches, palpitations, profuse sweating) due to hypersecretion of catecholamines. Despite several advantages of minimally invasive surgery (MIS) for PGL debulking, the surgical approach is not standardized yet. In this scenario, we aimed to report a case of a multiple recurrent PGL with metastatic retroperitoneal localization involving the pelvic sidewall, excised with MIS.Case presentationWe performed complete laparoscopic-assisted neuronavigation (LANN technique) with isolation of the sacral routes and the sciatic nerve to obtain complete exposure of the main anatomic landmarks. Robotic surgery was used to perform neurolysis of sacral plexus, and partial resection of left splanchnic nerves was needed. After the resection of the first mass, extensive neurolysis of all sacral routes, obturator nerve, pudendal nerve till the entrance of the pudendal (Alcock) canal, and sciatic nerve was performed. Finally, the mass was identified after trans gluteal incision and dissection of the maximum gluteal muscle, and a partial resection of the superior gluteal nerve and slicing of the sciatic nerve were needed to obtain a radical excision of the mass. Then neurorrhaphy of the sectioned nerve fibers of the superior gluteal nerve was performed, and nerve protection was obtained using a collagen nerve wrap. After 18 months of follow-up, the patient is free of disease at the MRI imaging and 123I-metaiodobenzylguanidine scintigraphy.ConclusionsMinimally invasive gynecological surgery with neuropelveological approach could be considered as a feasible option in case of multifocal pelvic retroperitoneal malignant paraganglioma of the pelvic side wall.

Preoperative 3D volume reconstruction of the posterior wall of the sphenoid sinus with Horos: A free, simple and reliable tool in endoscopic endonasal trans-sphenoidal surgery

BackgroundThe purpose of the study was to create computer-aided design models of the sphenoid sinus with a free-source software in order to perform a preoperative planning during trans-sphenoidal endoscopic surgery (TES) and clarify the three-dimensional anatomical features of the sphenoid sinus and its surrounding structures. MethodsFor each patient a 3D volume rendering of the sphenoid sinus was obtained from a thin slice head and maxilla-facial CT scan using a free-source DICOM viewer. The 3D models obtained preoperatively were examined preoperatively by six neurosurgeons in order to identify the boundaries of the sella. ResultsFor the main anatomical landmark, all of the observers were able to recognize the anatomical structure at a rate ranging from 80 to 98%, 28 to 60% and 25 to 58% for expert (n=3), inexpert (n=3) and the entire group of observers (n=6), respectively. The analysis of the data shows that both observation groups presented a lower recognition rate of the following parameters: right and left medial and lateral optocarotid recesses and tumor prominence, however, the sellar prominence, clival recess, planum sphenoidalis, right and left ICA prominence, right and left optic prominences represent the main anatomical landmarks to be recognized during TES immediately before the opening of the sellar floor. ConclusionsThe use of a preoperative 3D imaging is not in itself a novelty in the literature, however the fact that a simple tool obtained with a free-source software like Horos can represent a considerable help in surgical practice without resorting to the use of more complex software and expensive represents the real utility of this work.

Dissection Techniques and Histological Sampling of the Heart in Large Animal Models for Cardiovascular Diseases

The standard gross examination and sampling are key elements in the reproducibility and success of experimental studies of cardiovascular diseases carried out in large animals. Considering the complex anatomy of the heart, interspecies differences, and the types of compensatory and pathological reactions, consistent protocols are challenging to implement. The utilization of multiple dissection protocols is usually adapted to suit the prosector's experience, and personal preference continues to be a source of experimental and interobserver variability. Here, the aim is to present the main anatomical features and landmarks, dissection protocols, and histological sampling standards of the heart in some commonly used species (including dogs, pigs, ruminants, and cats) as models of cardiovascular diseases. Two standard gross examination protocols are presented here. First, the inflow-outflow method, which follows the physiological blood flow direction through the heart and large vessels (frequently used in dogs, ruminants, and pigs), and second, the four-chamber dissection technique (exemplified in cats). Both techniques can be adapted to any species in certain experimental circumstances. The sampling protocols include all the areas of interest (sinoatrial node, ventricles, interventricular septum, atria, valves, and aorta), and if properly carried out, improve both the reproducibility and reliability of experimental studies.

Машинное обучение в задаче детекции элементов корня аорты

A significant increase in the number of transcatheter aortic valve replacements entails the development of auxiliary systems that solve the problem of intra- or preoperative assistance to such interventions. The main concept of such systems is the concept of computerized automatic anatomical recognition of the main landmarks that are key to the procedure. In the case of transcatheter prosthetics – elements of the aortic root and delivery system. This work is aimed at demonstrating the potential of using machine learning methods, the modern architecture of the ResNet V2 convolutional neural network, for the task of intraoperative real-time tracking of the main anatomical landmarks during transcatheter aortic valve replacement. The basis for training the chosen architecture of the neural network was the clinical graphical data of 5 patients who received transcatheter aortic valve replacement using commercial CoreValve systems (Medtronic Inc., USA). The intraoperative aortographs obtained during such an intervention with visualization of the main anatomical landmarks: elements of the fibrous ring of the aortic valve, sinotubular articulation and elements of the delivery system, became the output data for the work of the selected neural network. The total number of images was 2000, which were randomly distributed into two subsamples: 1400 images for training; 600 – for validation. It is shown that the used architecture of the neural network is capable of performing detection with an accuracy of 95-96% in terms of the metrics of the classification and localization components, however, to a large extent does not meet the performance requirements (processing speed): the processing time for one aortography frame was 0.097 sec. The results obtained determine the further direction of development of automatic anatomical recognition of the main landmarks in transcatheter aortic valve replacement from the standpoint of creating an assisting system – reducing the time of analysis of each frame due to the optimization methods described in the literature.

ANATOMICAL VARIATIONS OF THE PARIETAL FORAMEN AND ITS RELATIONS TO THE CALVARIAL LANDMARKS: A CROSS-SECTIONAL CADAVERIC STUDY.

The aim: Estimate the prevalence of the parietal foramen in the adult human skulls of Ukrainian origin, and study its morphology and relationships to main anatomical landmarks of the skull. Materials and methods: A cross-sectional observational study of PF was conducted with 42 random cadaveric adult human skull roofs (calvaria) collected from the laboratory and museum of Human Anatomy Department, Kharkiv National Medical University, Ukraine. The patency and the length of the PF canal were determined, and PF external/internal diameters and the distance to the calvarial landmarks from PF were measured using the caliper. Mean and standard deviation were calculated to compare with the existing data. Results: In the present study 85.7% (n = 36) of the calvaria had the PF, 54.8% (n = 23) had bilateral location of PF, 30.9% (n = 13) had unilateral presence of PF (right side: 23.8%, n=10 and left side: 7.1%, n=3), and 14.3 % (n = 6) demonstrated bilateral absence of PF. Conclusions: An anatomical variation in parietal foramen is not uncommon, and the differences can be based on multiple factors like geography and race. It is important to have detailed information on anatomical variations in different population groups to facilitate surgical and radiological interventions.

Laparoscopic Colposacropexy Mesh Excision Secondary to Severe Spondylodiscitis

To describe laparoscopic mesh excision for severe spondylodiscitis secondary to colposacropexy mesh infection and demonstrate its feasibility. Step-by-step description of the surgical procedure using an educational video. Spondylodiscitis is an uncommon and severe complication after sacrocolpopexy [1], with only 34 cases published to date [2]. Symptoms usually appear weeks after surgery, the most common being back pain irradiating toward the lower extremities and fever [3,4]. Treatment consists of intravenous antibiotic therapy for a minimum of 6 weeks, and approximately 70% require a surgical treatment [2] including mesh removal and debridement of the necrotic material [5]. A 55-year-old woman received an intervention for colposacropexy 2 months before owing to severe hysterocele and cystocele and consulted for fever and intense lumbar pain. She was diagnosed as having L5 to S1 spondylodiscitis secondary to colposacropexy mesh infection. She received endovenous antibiotic treatment for 6 weeks and underwent a laparoscopic mesh excision to facilitate resolution of infection. Laparoscopic approach with a standard 4-port placement configuration was used, enabling the identification of the colposacropexy mesh. Surgical strategy initially consisted of dissection of the promontory, vesicovaginal, and pararectal spaces, having previously identified the main anatomic landmarks to preserve them. Suspension of the promontory peritoneum and the bladder to the abdominal wall enabled a better exposure of the surgical field, facilitating the dissection and excision of the mesh. Postoperative course was uneventful, and the patient was discharged 4 days later. Owing to minimal morbidity and good results, laparoscopic mesh excision should be considered an effective treatment for spondylodiscitis secondary to mesh infection.

ПРЕДОПЕРАЦИОННОЕ ПЛАНИРОВАНИЕ НАКОСТНОГО ОСТЕОСИНТЕЗА ДЛИННЫХ ТРУБЧАТЫХ КОСТЕЙ

Objective. To compare the shape and size of human contralateral humerus bones based on the «Autoplan» program to justify the possibility of using healthy bone in a preoperative planning for bone osteosynthesis (on the example of the humerus). Methods. 20 patients underwent computed tomography of the chest, shoulder girdleand upper extremities. Two-dimensional medical imaging of separate layers were converted into three-dimensional models of the humerus bone STL format, which is used for 3D printing in all 3D printers. Preliminary registration to superimpose the mirrored left humerus bone on the right one was carried out for at least 4 key points; their matching in shape and size was analyzed. A comparison was made of the contralateral humerus bones of one patient according to computed tomograms of 20 people. The main anatomical landmarks of the humerus bones and the distance between adjacent points were selected for comparison when the bones were superimposed on each other. Superimposed humeral bones were compared using the Hausdorff distance calculation algorithm, which is used to measure the difference between scanned models and the ground-truth model separately. To visualize the result of calculating of Hausdorff distance, that is, the difference between the bones, color mapping of the latter was performed, where the proximity to red color means the difference tends to zero, the proximity to blue - to 1 cm (the maximal obtained difference). Results. The greatest difference was recorded in humeral heads - up to 6.8 mm, and in the epicondyle: the medial epicondyle - up to 4.5 mm, the lateral epicondyle - up to 4.4 mm. Color mapping allowed to see that the difference between the heads of the humerus increases from the center of the articular surface to the attachment points of the capsule. At the level of the diaphysis, from the anatomical neck to the condyles, the size differencesamong allbones in 20 patients was no more than 1.5 mm. Conclusion. Thereby, the comparison of the shape and size of the contralateral bones of the human humerus based on the «Autoplan» program will allow applying a three-dimensional model of healthy contralateral bone in the preoperative planning for bone osteosynthesis: thus reducing the surgical risks and injury for the patient. What this paper adds For the first time, the use of a 3-dimensional model for a preoperative planning method for long tubular bone osteosynthesis using the contralateral healthy bone for affected bone has been proposed. It has been found that in the preoperative period during osteosynthesis of the diaphysis of long tubular bones, it is possible to use a healthy contralateral bone for plate of the damaged bone (on the example of the humerus fracture). The identity of the shape and size of the humerus diaphyses with an accuracy of 1.5 mm has been proved, and the possibility of using a 3-dimensional model of a healthy bone for preoperative planning for long tubular bone osteosynthesis is justified.

Transorbital endoscopic approaches to the skull base: a systematic literature review and anatomical description

Transorbital endoscopic approaches are increasing in popularity as they provide corridors to reach various areas of the ventral skull base through the orbit. They can be used either alone or in combination with different approaches when dealing with the pathologies of the skull base. The objective of the current study is to evaluate the surgical anatomy of transorbital endoscopic approaches by cadaver dissections as well as providing objective clinical data on their actual employment and morbidity through a systematic review of the current literature. Four cadaveric specimens were dissected, and step-by-step dissection of each endoscopic transorbital approach was performed to identify the main anatomic landmarks and corridors. A systematic review with pooled analysis of the current literature from January 2000 to April 2020 was performed and the related studies were analyzed. Main anatomical landmarks are presented based on the anatomical study and systematic review of the literature. With emphasis on the specific transorbital approach used, indications, surgical technique, and complications are reviewed through the systematic review of 42 studies (19 in vivo and 23 anatomical dissections) including 193 patients. In conclusion, transorbital endoscopic approaches are promising and appear as feasible techniques for the surgical treatment of skull base lesions. Surgical anatomy of transorbital endoscopic approaches can be mastered through knowledge of a number of anatomical landmarks. Based on data available in the literature, transorbital endoscopic approaches represent an important complementary that should be included in the armamentarium of a skull base team.

Pudendal Neurolysis: 6-Step Laparoscopic Approach

To demonstrate the safety and feasibility of the laparoscopic approach to perform pudendal neurolysis in a case of pudendal nerve entrapment syndrome [1-3]. A video tutorial that highlights the laparoscopic steps to performing pudendal neurolysis, with a focus on the main anatomic landmarks [4,5]. A tertiary care regional hospital. This video shows a 6-step approach to laparoscopic pudendal neurolysis for the treatment of pudendal nerve entrapment between the sacrospinous and sacrotuberous ligaments [2,6-8]. Step 1: Identification of the umbilical artery. Step 2: Dissection and development of the lateral paravesical space until the pelvic floor. Step 3: Identification of the arcus tendineus of the endopelvic fascia. Step 4: Identification of the ischial spine and the sacrospinous ligament covered by the coccygeus muscle. Step 5: Coagulation and section of the coccygeus muscle and the sacrospinous ligament. Step 6: Medialization of the pudendal nerve until its entrance into the Alcock canal. This video demonstrates the safety, feasibility, and reproducibility of laparoscopic pudendal neurolysis in 6 steps. A minimally invasive approach is adequate to treat the pudendal compression until the Alcock canal [2].

Laparoscopic TOT–like Burch Colposuspension: Back to the Future?

To demonstrate a modification of the classic Burch procedure, called "laparoscopic transobturator tape (TOT)-like Burch colposuspension." The technique does not involve any type of prosthesis placement, and it is an alternative for patients with stress urinary incontinence in a future without meshes. Describing and standardizing the procedure in different steps makes the surgery reproducible for gynecologists and safe for the patients. Step-by-step educational video, underlining and focusing on the main anatomical landmarks. A university tertiary care hospital. The patient is set under general anesthesia and in lithotomy position. The distinct steps of the procedure are performed as followed: Step 1: Installation. Two 10-mm trocars are positioned in the midline and 2 5-mm trocars in the suprapubic region. The recommended intra-abdominal pressure is 6 to 8 mm Hg, and excessive Trendelenburg is not needed. Step 2: Entry in the Retzius space. The median umbilical ligament and the vesicoumbilical fascia are transected. Step 3: Exposure of the Retzius space and the anatomical structures. The dissection is continued consecutively toward the pubic bone and the Cooper's ligament, laterally toward the external iliac vessels and the corona mortis and medially toward the bladder neck. Step 4: Vaginal dissection. The pubocervical is dissected at the level of the pubourethral ligaments. Step 5: Suspension of the vagina to the Cooper's ligament. In contrast to the standard technique, with the TOT-like Burch, the sutures on the pubocervical fascia are placed at the level of the attachment of the arcus tendinous fascia pelvis and the pubourethral ligament. This way of suspension ensures a lateral traction on the bladder neck, resembling the effect of the TOT, which leads to lower incidence of dysuric symptoms. Step 6: Peritoneal closure. The classic colposuspension was created in 1961 for the treatment of stress urinary incontinence prolapse [1]. In the following years, vaginal meshes gained popularity as a treatment option for prolapse and for incontinence owing to their ease of use and satisfying results, which led to a decreased use of the Burch procedure [2,3]. In 2019, the Food and Drug Administration forbid the production of the transvaginal meshes for prolapse [4], an interdiction that could influence the use of synthetic meshes for incontinence in the future [5]. Owing to these recent events, searching for an effective way of management for patients with stress urinary incontinence without any synthetic prostheses, gynecologists have turned back to the 60-year-old Burch colposuspension. One of the drawbacks of the original technique is the high incidence of voiding difficulties-up to 22% [6]. Owing to the knowledge of the exact course of traction with the TOT, in our modified technique, the lateral direction of the suspension provides a tension-free support on the urethra and the bladder neck. The laparoscopic TOT-like Burch colposuspension is a safe and effective treatment for patients with stress urinary incontinence with low rates of dysuric symptoms and represents a valuable alternative for gynecologists in a future without meshes.

Sacrohysteropexy: A Way to Spare the Uterus

To show the safety and feasibility of laparoscopic sacrohysteropexy for treating uterine prolapse. An educational video to explain the laparoscopic steps of this procedure by focusing on the main anatomic landmarks and on tips and tricks to avoid complications. A tertiary care university hospital. Laparoscopic sacropexy with uterus preservation for grade 3 apical defect. This video shows a stepwise approach to laparoscopic sacrohysteropexy demonstrating its feasibility and safety. There is a wide choice of surgical procedures and approaches focused on pelvic organ prolapse repair. Since many years, uterine prolapse has been an indication for hysterectomy, regardless of the occurrence of uterine disease and patients' desires. With the introduction of minimally invasive surgery, the uterine-sparing procedures are being increasingly taken into account, especially in young women [1]. Sacrohysteropexy is a uterus-sparing procedure that allows for a reduction in operating time, intraoperative blood loss, mesh-related complications, and surgical costs [2]. Furthermore, this technique has a high success rate with an objective cure rate of 100% for the apical compartment and 80% for all compartments and does not seem to increase the pelvic organ prolapse recurrence rate [3]. Sacropexy is not a life-threatening procedure, but its main objective is to restore functional anatomy with the primary goal of improvement in patient's quality of life. Moreove, no difference has been found with or without uterus preservation in term of postoperative recurrence rate or ent's quality of life [4]. However, high patient satisfaction has been recently reported; therefore, uterine preservation should be considered during patient's counseling.

Selective neurotomy of the sciatic nerve branches to the hamstring muscles: An anatomical study

BackgroundHamstring spasticity can bring about a flexion deformity of the knee, liable to cause disability. Surgical treatment by selective neurotomies of the sciatic nerve branches leading to the hamstring muscles may then be indicated. Few studies have investigated the precise origin of these branches on the sciatic nerve, describing the innervation pattern of the hamstring muscles. Further anatomical data are needed to enhance surgical techniques in neurotomies of the sciatic nerve branches, to define the best incision and surgical approach and what section and length of the SN need to be exposed. Therefore, we performed an anatomical study to: (1) define a surgical approach to perform selective neurotomies of the sciatic nerve branches for hamstring spasticity?(2) whether the anatomical variants of the hamstring innervation have been identified? HypothesisOur anatomical data could lead to the definition of an approach to the sciatic nerve for the purpose of selective neurotomy. Material and methodsTwenty posterior compartments of the thigh were dissected. We counted each branch of the sciatic nerve leading to the hamstring and described their arising point using the centre of the lateral surface of the great trochanter and the lower edge of the gluteus maximus muscle as main anatomical landmarks. We also described the presence of branch divisions and their muscular penetrating points. ResultsThe mean distances between the center of the lateral surface of the great trochanter and the emergence of branches from the SN were: 2.2±3.6cm (−5 to 9cm) for the long head of the biceps femoris muscle, 2.3±3cm (−4 to 10cm) for the semitendinosus muscle, and 2.2±3cm (−5 to 8cm) for the semimembranosus muscle. No branches originated from the sciatic nerve below the lower edge of the gluteus maximus muscle. In summary the branches innervating the hamstrings originated from the SN within an interval of 15cm (5cm above and 10cm below the centre of the lateral surface of great trochanter). The average number of sciatic nerve branches for the hamstring muscles was 4.7 (minimum: 3; maximum: 6) with 1.8 branches for the long head of the biceps [1 in 7/20 (35%), 2 in 10/20 (50%), and 3 in 3/20 (15%)], 1.5 branches for the semitendinosus [1 in 11/20 (55%) and 2 in 9/20 (45%)], 1.4 branches for the semimembranosus [1 in 12/20 (60%) and 2 in 8/20 (40%)]. No branches had a common origin with cutaneous nerves. DiscussionThis anatomical study enabled us to propose an approach to exposing the sciatic nerve in order to perform a selective neurotomy: horizontal cutaneous incision on the gluteal fold, incision of the lower edge of the gluteus maximus, exposure of the sciatic nerve to a distance of 10cm below the great trochanter, and visualization of the nerve branches to the hamstring muscles. Exposure of the nerve above the great trochanter is not necessary because the branches which emerge from the SN above the great trochanter are still contiguous with the SN. Level of evidenceIV: prospective study without control.

In vivo and in vitro neck dissection specimen labelling: a new method for precise orientation of specimens

As the main anatomical and radiological landmarks are lacking in neck dissection specimens, orientation and labelling of the lymph node levels becomes very important for precise histopathological reporting. A few labelling techniques for neck dissection specimens have been described previously, which can aid the histopathologist in orienting the specimen. However, a combined method of specimen labelling in which the ND specimen is labelled during the operation and once it has been resected would improve specimen orientation. This article describes a technique of in vivo and in vitro labelling of neck dissection specimens that specifies the levels of the lymph nodes with proper anatomical landmarks. This technique eliminates the grey areas between levels II and III and between levels III and IV, which are difficult to identify precisely in neck dissection specimens. This technique is easily reproducible and represents a useful tool in attaining precise pathological reporting.

Brain ultrasound rehearsal before surgery: A pilot cadaver study.

It has been shown that brain ultrasonography (US) is an efficient tool for improving three-dimensional (3D) spatial orientation during neurosurgical interventions. However, it necessitates specific training as it is highly operator-dependent. To date, neurosurgeons have relied solely on intraoperative practice to improve their mastery of brain US; this has obvious limitations. Herein, we consider whether a study of brain US on human cadavers could enable a training platform for neurosurgeons and residents to be developed. Standard two-dimensional (2D) brain US was performed on two human cadavers (one fresh-frozen and one Thiel-prepared) through left frontoparietal, left frontal, right temporal, and left parietal craniotomies. US workflow and image quality were assessed in both preparations. It was possible to assess US in both cadaver preparations; however, the specimen prepared with Thiel-fixation performed better, with superior image quality and specimen usability at room temperature. US images were obtainable through all surgical corridors with the main intracranial anatomical landmarks easily identifiable. US of cadaveric brains is feasible and delivers good quality results. This technique could allow neurosurgeons to develop the expertise required for a successful clinical application preoperatively. Clin. Anat. 30:1017-1023, 2017. © 2017 Wiley Periodicals, Inc.