Thiel's Method Research Articles

Surgical cystectomy training using human cadavers embalmed using Thiel's method: a pilot study.

To develop the use of Thiel soft embalmed human cadavers (TeC) in open radical cystectomy (ORC) training for the first time, to investigate the effect of cadaveric training on surgical trainees' technical skills/performance and to determine how trainees perceive the use of cadaveric workshops. A 3-day hands-on workshop was organised. Ten trainees performed ORC on five TeC, supervised by five experts. Feedback from trainees and mentors was evaluated on a five-point Likert scale. All procedures were completed in a fully equipped surgical environment and complied with the principles outlined in the Declaration of Helsinki. The workshop participants evaluated the anatomical and manipulation characteristics of the TeC as similar to real-life conditions. The colour and consistency of the urethra and ureter differed little from those in live patients. The trainees stated that the TeC were beneficial for learning the stages of ORC and urinary diversion (UD), while their self-confidence increased. In terms of realism, all steps of radical cystectomy (RC) were rated 4 out of 5 or higher on the Likert scale by both trainees and faculty. The use of TeC for RC und UD was perceived as favourable by trainees and faculty. The TeC demonstrated a surprising ability to mimic real-life anatomy and represent a new and effective surgical training tool.

Course of the extensor pollicis longus tendon considering the different functional positions of the wrist and the first ray-an anatomical study.

The aim of this anatomical study was to evaluate the course of the extensor pollicis longus (EPL) tendon, its positional relationship to adjacent structures, and the resulting clinical relevance under consideration of various functional positions. Twenty upper extremities from ten adult human cadavers embalmed using Thiel's method were included in this study. The greatest possible movement/slippage of the EPL tendon, the angle at which the tendon wraps around Lister's tubercle, and its course across the extensor carpi radialis longus and brevis (ECRL and ECRB) were recorded and defined in all functional positions. Our findings demonstrate ahigh range of motion of the tendon in relation to clinically relevant structures. Understanding the anatomical course of the EPL tendon, its potential extent of movement, and its resulting positional changes is essential for the diagnosis and surgical treatment of patients with complaints or injuries in the dorsoradial wrist region.

A new injection method for identifying the subpopliteal recess of the knee.

The posterolateral region of the knee has a complex and diverse anatomy. Hydrarthrosis of the knee can potentially communicate with other parts of the joint space. The joint fluid distribution reflects anatomical communications between synovial spaces. To observe the continuity between the knee joint cavity and the surrounding bursa, we devised a dissection method with a new injection agent, an eosin-containing congealed liquid that spreads uniformly over the entire space. The purpose of this study was to perform a detailed examination of the subpopliteal recess (SPR) where a bursa connects to the knee joint capsule. We also reported the advantages of this new injection agent compared with conventional materials (latex and epoxy resin). Twenty-two formalin-fixed cadavers (34 knees), two N-vinyl-pyrrolidone (NVP)-fixed cadavers (4 knees), and two cadavers (3 knees) fixed by Thiel's method were used. After filling the knee joint space and SPR with eosin congealed liquid, the specimens were dissected to investigate the morphology of the SPR. In addition, three different types of injection agents were assessed. The SPR extended distally along the popliteus tendon. The SPR length was 22.64 ± 11.38 mm from the upper end of the lateral tibial condyle to the lower end of the depression. The existence of a fabellofibular ligament made the SPR significantly longer, but abrasion of the femoral articular cartilage did not affect the SPR. Furthermore, the relationship between the popliteus muscle and the SPR was classified into three types (types 1-3). Types 2 and 3 in which the SPR extended to the proximal tibiofibular joint may cause instability of the knee joint. The eosin congealed liquid was highly useful in many aspects, such as fluidity and injection workability. The new dissection method with eosin congealed liquid provides insights into the anatomy of the posterior lateral knee, which are useful for radiological diagnoses and clinical treatments.

Traditional suture tape versus multiple high-strength sutures for augmentation of anterior cruciate ligament primary repair: A time-zero biomechanical study

Background/objectiveDuring the initial stages of rehabilitation after anterior cruciate ligament (ACL) surgery, a pivotal role is played in ensuring effective recuperation and averting complications. An often-employed strategy to tackle ACL laxity during this period involves the incorporation of synthetic materials for reinforcement. The objective of this study is to compare the effectiveness of conventional suture tape and multiple high-strength sutures as augmentation techniques for ACL repair. MethodsTen preserved cadaveric knees embalmed using the Thiel method were segregated into two groups, each containing five knees. In one group, traditional suture tape was employed for augmentation, while the other group utilized multiple high-strength sutures. Each knee underwent a cyclic load of 1000 sine wave cycles, succeeded by an axial distraction load until failure ensued. The resultant displacement and ultimate load at failure were assessed to contrast the efficacy of the two augmentation techniques. ResultsThe group utilizing multiple high-strength sutures exhibited a significantly higher load to failure at time-zero (1690.7 N) compared to the suture tape group (987.6 N) (P = .003). Furthermore, the multiple high-strength sutures group demonstrated significantly reduced displacement after 1000 cyclic loads (6.6 mm) in comparison to the suture tape group (16.3 mm) (P < .001). ConclusionsMultiple high-strength sutures show better biomechanical properties for the augmentation of ACL repair at time-zero. Both suture tape and multiple high-strength sutures had ultimate load-to-failure values higher than the natural ACL loads. Therefore, these substances might serve as augmentation options to prevent the ACL's gradual elongation, a critical concern particularly in the initial stages of rehabilitation.

Morphology of the Radial Attachment of the Radioulnar Ligament and Surrounding Landmarks

The triangular fibrocartilage complex (TFCC) is composed of dorsal and palmar radioulnar ligaments (RULs). A common injury pattern of the RUL is the avulsion of the ulnar insertion, which can be treated by arthroscopic or open repair. Although the general method of TFCC reconstruction is a tendon graft with a bone tunnel, detailed information regarding the radial attachment of the RUL is unclear. This study aimed to clarify the morphology of the radial attachments of the palmar radioulnar ligament (PRUL), dorsal radioulnar ligament (DRUL), and short radiolunate ligament (SRL) using three-dimensional imaging. A total of 29 upper limbs (16 formalin-fixed and 13 embalmed by Thiel's embalming method) of Japanese cadavers were used. After gross observation, we marked the attachments of the PRUL, DRUL, and SRL using 0.7-mm diameter pins. We created three-dimensional images of the radius, outlining the PRUL, DRUL, and SRL attachments. The software application calculated the centers of the PRUL and DRUL attachments. The PRUL attachment was horizontally shaped. The center of the PRUL was 1.5 mm proximal and 5.8 mm radial to the tip of the palmar pyramid formed by the palmar cortex and the radioulnar and radiocarpal joint surfaces. The DRUL attachment was vertically shaped. The center of the DRUL was 2.0 mm proximal and 1.7 mm radial from the tip of the dorsal pyramid formed by the dorsal cortex and the radioulnar and radiocarpal joint surfaces. The length of the SRL was 9.2 mm. The SRL and PRUL were strongly conjoined. The anatomical center on the RUL attachment of the radius can be determined from osseous landmarks. The findings of this study contribute to the understanding of RUL attachment to the distal radius and may assist surgeons in performing anatomical reconstruction of TFCC.

Development of an educational three-dimensional anatomical structure replication tool and its application to medial open-wedge high tibial osteotomy

BackgroundWith the standardization of surgical techniques and continuous development of plate fixators, medial open-wedge high tibial osteotomy (OWHTO) has become an option for the treatment of medial knee osteoarthritis. However, it is also associated with several complications. To reduce the risk of these complications, it is essential for surgeons to accurately understand the three-dimensional (3D) anatomical structures, including the surroundings of the surgical field. Gross dissection using a cadaver provides a large surgical field and is the best learning method for studying anatomical structures in three dimensions; however, it is not available at all medical institutions. MethodsOne female cadaveric knee, fixed using the Thiel method, was used in this study, and OWHTO was performed. A series of photographs was taken from approximately 60 different angles at each stage of the autopsy for digital photogrammetry to ensure that there was at least a 60% overlap between photographs. ResultsEach 3D object was created to be faithful to the original specimen and displayed on an augmented reality headset. It was created to capture the subtle nuances of irregular shapes and structures, highlighting the unique ability of photogrammetry to capture pathology. This method allows surgeons to visualize the location of neurovascular injuries in the intraoperative field of view. ConclusionsUsing a technique that applies digital photogrammetry to create 3D objects from handheld photographs, this reports for the first time an educational tool that can reproduce the anatomy related to high tibial osteotomy in three dimensions.

From a Single Penile Suspensory Ligament to a Penile Suspensory Apparatus: Application to the Buried Penis Surgery

Abstract Goals/Purpose The ligamentous system supporting the penis is widely called « penile suspensory ligament ». It supports and attaches the penis to the abdominal wall and the pubic bone. However, the complexity of the anatomy of the penile suspensory system was underestimated. The aim of this anatomical study was to describe the different ligamentous (features, insertion sites, path) and their functions. Methods/Technique The first step consisted in a description of the different components of the penile suspensory apparatus on two cadavers embalmed by the Thiel method. The second part was an evaluation of the function of each ligament on freshly dead cadavers. In the third stage, we applied those findings to an exploratory cohort of patients undergoing a penile lengthening surgery for buried penis. Results/Complications The penile suspensory apparatus consisted in four ligaments from anterior to posterior : the fundiform ligament, the suspensory ligament, dense vertical ligament and the arcuate ligament. The first two were loose, non-stabilizing and the two posterior ones were dense and stabilizing. In our cohort, 12 patients were included. The mean BMI was 38. The mean pre-operative flaccid length was 4.1 cm [2.2 cm – 7 cm] and at 6 months 8.2 cm [5.2 cm - 11.5 cm] which represents a mean augmentation of 100%. The mean pre-operative circumference at a flaccid state was 8.2 cm [2 cm – 11.5 cm] and at 6 months post-operative was 12.6 cm [8.3 cm - 16 cm] which represents a mean augmentation of 85.7%. The most common complication was a phimosis. Conclusion We have described the detailed anatomy of the penile suspensory apparatus. It is the first time that the dense vertical ligament was brought to light. To avoid instability in penile lengthening, the posterior part of the dense vertical ligament and the arcuate ligament must be spared.

Two fingerbreadths, one finger's width: on the proximity of the radial nerve to the deltoid tuberosity.

The aim of this study was to find a convenient technique to evaluate the location of the radial nerve (RN) with reference to the deltoid tuberosity (DT). Sixty-eight upper extremities, embalmed using a modified version of Thiel's method, were included in the study. The interval between the tip of the greater tubercle of the humerus and the distal tip of the lateral humeral epicondyle (LE) was defined as humeral length (HL). The most prominent point of the DT was used as the point of reference. Through this point, a horizontal reference line which met the humeral axis at the dorsal side of the humeral shaft was simulated. The longitudinal distance between the crossing point of the horizontal line and the humeral axis and the RN was measured (distance 1). The interval between the intersection point and the reference point at the DT was measured (distance 2). Data were evaluated in centimeters. For the whole sample, the HL averaged 31.0cm (SD: 2.3; range 26.2-36.9). Distance 1 averaged 2.2cm (SD: 0.3; range 1.6-3.1), and distance 2 averaged 1.2cm (SD: 1.0; range 0-2.8). The HL was larger in the male group when compared to females (p < 0.001; males mean: 32.2cm; females mean 29.5cm). There was no difference regarding distance 2 (p = 0.59; males mean: 1.2cm; females mean: 1.3cm) between the sexes. Distance 1 was significantly (p = 0.02) larger in the male group (mean: 2.3cm) when compared to females (mean: 2.1cm). Concerning sides, there were no differences regarding all evaluated parameters (HL: p = 0.6; Distance 1: p = 0.6; distance 2: p = 0.8). This study provides an easily applicable technique to localize the RN with reference to the DT.

Effects of superficial tissue and intermuscular connections on rectus femoris muscle shear modulus heterogeneity.

Intramuscular heterogeneity exists in the shear modulus of the rectus femoris (RF) muscle. However, the underlying heterogeneity mechanisms are not entirely understood. Previous research has reported that detachment of superficial tissues reduces the shear modulus by 50%. The aim of this study was to examine the effects of the skin, deep fascia, and intermuscular connections on the shear modulus of the RF at multiple sites. Eleven donors were fixed using the Thiel method. Measurements were performed at 0°, 60°, and 120° knee flexion in a neutral hip position. Tissue processing was performed under four conditions: superficial tissue (CONT), skin off (SKIN), deep fascia detachment (FASC), and intermuscular connections detachment (ALL). The shear modulus at the proximal, central, and distal regions were measured using ultrasound shear wave elastography. The study was approved by the Sapporo Medical University Ethical Committee. Three-way ANOVA revealed no significant interaction between treatment, site, and angle (P = 0.156), treatment and angle (P = 0.067), or site and angle (P = 0.441). There was a significant effect of treatment (P < 0.001), site (P = 0.010), and angle (P < 0.001) and interaction between treatment and site (P < 0.001). The proximal shear modulus was greater than the central for CONT. There were no significant differences between the measurement sites for SKIN. The distal shear modulus was greater than the proximal for FASC. The distal shear modulus was also greater than the proximal and central for ALL. Intramuscular regional differences that influence superficial tissue and intermuscular connections of RF elasticity heterogeneity were observed.

Thirty years of Thiel embalming-A systematic review on its utility in medical research.

In 1992, Walter Thiel described and embalming method that rendered “lifelike” tissues. Over the last 30 years, the Thiel method has been introduced worldwide for medical training and scientific purposes. This review examines research which can be linked to the use of Thiel embalming. A systematic review was performed to identify articles published in the following categories: research content, disciplines involved, sources and quantities of tissues deployed, and changes in research scope related to changes in the chemical composition of Thiel embalming. Four‐hundred twenty‐four publications were included. A number of adaptations to the original Thiel protocol were found, aiming to provide suitable tissue‐substitutes in the development of emerging medical technologies or procedures. Musculoskeletal surgery, anesthesia and intensive care were the most common disciplines that used Thiel embalmed tissues for research. Anatomy and biomechanics played a lesser role. An increase over time was observed in research outputs related to the Thiel method, while the number of specimens used per study decreased. The main centers using Thiel embalming were in Graz, Dundee, Sapporo, Bern, Zurich and Ghent, which jointly accounted for more than 54% of all research conducted using this method. Following three decades of use, the Thiel method has evolved into being a well‐established embalming technique for research purposes. Its future is challenged by the demanding requirements on both technical facilities and personnel, limitations of certain chemicals for use as fixatives, costs, and questions as to how “lifelike” the embalmed‐tissues are from an objective standpoint, all of which warrants future investigations.

Embalming and Maintenance of a Pliable Cadaver Over a Two‐Year Period for Clinical Procedure Learning

IntroductionSoft Cue Embalmed (SCE) cadavers can be used in various procedure learnings, such as ultrasound guided regional anesthesia (UGRA), laparoscopic, orthopedic surgeries, and developing new equipment and surgical approaches. However, the SCE technique is not well known in Northern America due to lack of knowledge to make a SCE cadaver and because the original Thiel method (1992) needs a highly specific sequence, quality, and quantity of fluid injection with a long submersion. The aim of the project is to develop SCE cadavers in the Anatomical Board of the State of Florida’s facility for the residents’ procedure learning at UF.MethodsThe SCE method (Sikon &amp; Boaz 2012, unpublished) was used. Briefly, the donor was first perfused with 8‐liter Freedom Art (Formalin free, The Dodge Company), followed with Surgical Reality Fluid (SRF, Trinity Fluids, LLC) perfusion. 4‐gallon SRF was perfused with a pressure of 10 lb/ft over 90 minutes, then 1‐gallon SRF was to freely drip overnight. The completed SCE body was bagged and kept at room temperature for 4 weeks. The body was rinsed with soap and water at 2 weeks post SCE to remove the loose stratum corneum. Maintenance included monthly vacuuming extra transudate fluid in the 1 year, and spraying with SRF to prevent dehydration with wrapping film covering the donor in the 2nd year.ResultsThe 1st donor with SCE was 8 days postmortem without receiving pre‐conditioning perfusion which decomposed in 30 days after SCE. The 2nd donor was SCE prepared 2 days postmortem, and pre‐perfused with SCE following the preservation protocol restoring an intact fresh lifelike cadaver. Qualitatively, ultrasound images from the SCE cadaver were highly similar with those from a living person. Nerve, fascia, ligaments, vasculature and muscle images were clearly and easily identified. Skin elasticity and texture were lifelike. The successful SCE cadaver was stored and maintained for 25 months (2019 to 2021), which provided a long‐lasting lifelike simulating platform for procedure learning. Using SCE cadaver, ultrasound guided procedure learning included UGRA, lung ventilation, chest tube placement &amp; pericardiocentesis, and exploration of a novel prostate biopsy training. Other procedures included the dissection of hand &amp; facial areas as compared with formaldehyde embalmed donor, tracheal tube intubation, tracheotomy, and suturing practice during students' clerkships. There was no significant difference in CT images before and after SCE.DiscussionThe modified and simplified SCE method can make a “Thiel cadaver” more efficiently. Using a SCE cadaver, a learner can exercise hand‐on skill in a near‐real condition without psychological pressure and learning time can be individualized, which greatly increases the beginning learner’s confidence to master the procedure before working with patients. One SCE cadaver can be shared in various procedure training. Further, quantitative studies will be designed to optimize procedure learning. Integrating SCE cadavers into current simulation training programs appears both feasible and desirable.

The risk of Creutzfeldt–Jakob disease infection in cadaveric surgical training

The usefulness of cadaver surgical training in the clinical field is already well known. In Japan, the number of universities introducing cadaver surgical training is increasing. In addition to formalin fixation, various fixation methods are used, such as the Thiel method, saturated salt solution method, N-vinyl-2-pyrrolidone method, and fresh-frozen cadavers. Although protection against infections during fixation and cadaver surgical training has been implemented in most universities, it is currently inadequate. Furthermore, the possibility of undiagnosed infectious diseases in donors cannot be excluded. Prion diseases, such as Creutzfeldt-Jakob disease, are relatively rare, but they are fatal, with no effective treatment. The abnormal prion protein that causes prion diseases is resistant to formaldehyde and cannot be inactivated by all methods of cadaver fixation presently in use. Recently developed real-time quaking-induced conversion has been reported to be a useful screening method for prion infection. In addition, this article aims to raise awareness of prion diseases in cadaver surgical training by reviewing the current understanding of prion diseases in cadavers and their screening methods.

The advantages of modified Thiel technique in head and neck surgical anatomy teaching.

Thiel's body preservation method allows the donor body to retain color and soft tissue that are similar to those of a living individual. Since its initial description, the technique has not been developed much. Here, we propose a simpler protocol applied to the head and neck, making the technique easier, cheaper, and more accessible to a greater number of medical schools. The modified Thiel technique was applied to three heads separated from the body, followed by 6h of perfusion and 6weeks of fixation. This technique was compared with formalin (three heads) and freeze (three heads) preservations during academic training in head and neck surgery. Anatomical dissections included a parotid gland dissection, a submandibular gland dissection, an otologic and an endonasal dissection. Twelve surgeons blindly assessed the three types of preservations using a standardized questionnaire. The modified Thiel technique made possible better quality of dissection and tissue identification, with the exception of endonasal dissection. Concerning the endonasal dissection, the modified Thiel technique ranked best for smell, but all other criteria ranked lower than the freezing method. For the submandibular and parotid gland dissections, the modified Thiel technique was ranked best, with statistically significant differences (p < 0.002) for all items. The modified Thiel technique also ranked significantly better during otologic surgery regarding the quality of the skin/eardrum, bone, and muscle, and the smell. This study demonstrated that the modified Thiel technique is an embalming technique which improves the quality of head and neck surgical anatomy education.

Thiel embalming in neonates: methodology and benefits in medical training

Current teaching and training methods for surgical techniques in the pediatric population involve artificial models (manikins), animals or adult human cadavers embalmed using various techniques. We found no references in the literature concerning the use of the Thiel method in the pediatric population. The aim of this study, therefore, was to assess the viability of using pediatric human cadavers embalmed through Thiel’s technique and to compare them with standard pediatric manikins. After donation of a 24-week stillborn, the Thiel technique was carried out for fixation following the usual protocol. A video recording with eye-tracking glasses was used to perform an examination, and techniques. The same procedures were conducted on a pediatric manikin. Medical students, medical residents and physicians were asked to respond to questions in an online survey after being shown the video. A total of 92 responses were obtained. The Thiel-embalmed stillborn was assessed as superior to the manikin in all items. Our study confirmed that this technique is feasible even with extremely small donors. The value of this form of preservation for medical training is not widely known though it is receiving increasing interest. Our results show that Thiel fixation in pediatrics is clearly more highly valued than a manikin and offers great potential. This innovative application of the Thiel method in the pediatric population is technically possible. It poses no additional difficulties and is very positively assessed for undergraduate and postgraduate teaching.

Usefulness of Thiel-Embalmed Cadavers for Training in Organ Procurement

The number of brain-dead donors has been increasing; however, the opportunity for young surgeons to experience deceased donor surgeries is extremely limited, especially in many Asian countries including Japan. Deceased donor surgeries require unique surgical skills and knowledge; however, it is difficult to provide on-the-job guidance and education. Therefore, cadaver training is meaningful and suitable for the training of deceased donor surgeries. Thiel's embalming method (TEM) provides natural coloration, flexibility, and tissue plasticity, and is widely used for cadaver surgical training. In this study, we evaluated the usefulness of Thiel's embalmed cadaver training for organ procurement surgery. Each trainee performed hepatectomy, pancreatectomy, and nephrectomy using conventional open techniques. Faculty experts of transplantation surgery and organ procurement took attendees through surgical steps. After the procedure, all participants were asked to complete a voluntary, anonymous survey, consisting of a 10-point satisfaction scale, to evaluate their perceptions of the training. A total of 33 gastrointestinal surgeons participated in the training program for procuring the liver, pancreas, and kidneys. In the questionnaire administered to the participants, the evaluation was generally satisfactory, with an average of 9.1 points on the 10-point scales. Some participants expressed that Thiel-embalmed cadavers are more suitable for training on organ procurement compared with animals used in wet-lab training. We conclude that organ procurement training in human cadavers preserved by TEM is useful and suitable for practicing deceased donor organ procurement, especially in countries where deceased donors are not common, as in Japan.

Quantitative Evaluation of Ankle Instability Using a Capacitance-Type Strain Sensor

Category:Basic Sciences/Biologics; Ankle; SportsIntroduction/Purpose:Manual evaluation is an important method for assessing ankle instability, but it is not quantitative. Capacitance-type sensors can be used to measure the distance on the basis of the capacitance value. We applied the sensor to the noninvasive device for measuring ankle instability and showed its utility.Methods:First, five ankles embalmed by Thiel's method were used in an experiment using a cadaver. The capacitance-type sensor was fixed alongside the anterior talofibular ligament (ATFL) of a specially made brace, and the anterior drawer test was performed. The test had been performed for the intact ankle, with the ATFL transected, and with both the ATFL and calcaneofibular ligament (CFL) transected. The anterior drawer distance was calculated by the sensor. Intra and interinvestigator reliability were also analyzed. Next, as a clinical study, a brace with a sensor was fitted to 22 ankles of 20 patients with a history of ankle sprain. An anterior drawer test at a load of 150 N was conducted using a Telos stress device. The anterior drawer distances measured by the sensor and based on X-ray images were then compared.Results:The mean anterior drawer distance for the intact cadavers was 3.7 +- 1.0 mm, 6.1 +- 1.6 mm with the ATFL transected (P < 0.001), and 7.9 +- 1.8 mm with the ATFL and CFL transected (P < 0.001). The intrainvestigator intraclass correlation coefficients (ICC) were 0.862-0.939, and the interinvestigator ICC was 0.815. In the experiments on patients, the mean anterior drawer distance measured by the sensor was 2.9 +- 0.9 mm and 2.7 +- 0.9 mm from the X-ray images. The correlation coefficient between the sensor and the X-ray images was 0.843.Conclusion:We carried out a quantitative evaluation of anterior drawer laxity using a capacitance-type sensor and found it had high reproducibility. It was also very strongly correlated with stress radiography measurements in patients with ankle instability. Capacitance-type sensors can be used for the safe, simple, and accurate evaluation of ankle instability.

Comparison of four transdiaphragmatic approaches to remove cavoatrial tumor thrombi: a pilot study.

IntroductionSurgical treatment of kidney cancer with a tumor thrombus spreading through the inferior vena cava (IVC) up to the right atrium remains a challenge.The aim of this article was to 1. assess the safety and feasibility of four transdiaphragmatic surgical approaches to the right atrium from the abdominal cavity; 2. to evaluate the feasibility of palpation and displacement of thrombi below the diaphragm.Material and methodsFour cadaveric specimens preserved with the Thiel method to assess each surgical access: 1) extrapericardial T-shaped diaphragmotomy, 2) extrapericardial T-shaped + circular diaphragmotomy, 3) transpericardial T-shaped diaphragmotomy with longitudinal pericardiotomy, 4) transpericardial T-shaped + circular diaphragmotomy with longitudinal and circular pericardiotomy.Different diameters and density of tumor thrombus simulators, placed at various levels from the cava-diaphragm junction, were used to evaluate the palpation and displacement of the thrombus. Two surgeons performed each assessment independently.ResultsApproaches 2, 3 and 4 were significantly better than approach 1, regarding the feasibility of palpation, according to both surgeons (surgeon 1 Chi-square 21.56, p = 0.001; surgeon 2 Chi-square 27.83, p <0.0001). Approach 1 also showed a significant higher number of impossible displacements recorded by both surgeons (surgeon 1 Chi-square 19.02, p = 0.004; surgeon 2 Chi-square 20.01, p = 0.003). Only surgeon 1 recorded a significant lower number of easy palpations at 4 cm from the cava-diaphragm junction (Chi-square 14.10, p = 0.007). There were no high-risk complications in any approach.ConclusionsThe transdiaphragmatic access to the right atrium from the abdominal cavity is feasible using three of the four surgical approaches. They are an adequate alternative to sternotomy.

Contributions of the Thiel's Method in teaching and researching anatomy

Knowledge of the human body is based on teaching and research. Anatomy remains an essential prerequisite for medical personnel to know the human body. The idea of Thiel's technique is to preserve the natural texture, volume, color and shape of the body. The objective of this study was to analyze a literature review of this technique from the perspective of anatomy teaching and biomechanical research. We have taken up the process of Thiel's method from the original publication, stating the known applications of this technique in teaching and research. We have integrated into our study the specific advantages of using bodies preserved by this method in intertropical countries with a warm climate: the example of Gabon. Biomechanical research and teaching of medical and surgical sciences are regularly performed on human cadavers. Anatomical dissection therefore represents one of the main activities of anatomy laboratories. We have limited our analysis to aspects of anatomy teaching, research, and clinical and surgical practice. We have sought to popularize the Thiel body preservation technique. It offers many advantages. Teaching and research on human cadavers preserved by this method is an educational alternative. The simulation centre creates the conditions of a surgical block for the learners. We recommend this technique to anatomists and clinicians. This technique seems to be very interesting for structures with a limited number of bodies.

Thiel's embalming method: review of the literature and our institute's experience

Purpose: We aimed to present one of the best researched methods of cadaver preservation, Thiel's method, and share our own 9–year experience in comparison with that of the literature.&#x0D; Methods: Thiel's embalming method uses intravascular injection of a solution combined of several chemicals, such as water–based mixtures of monopropylene glycol, ammonium nitrate, potassium nitrate, sodium sulfite, boric acid, chlorocresol, formaldehyde, ethanol, and morpholine. Initial perfusion via the carotid and femoral arteries is followed by immersion in a cadaver storage basin in embalming solution for at least 4–6 months. After this, cadavers are stored in plastic bags in refrigerators and are used for months to years.&#x0D; Results: Since 2008, we have successfully embalmed 16 cadavers using Thiel's method. Due to the beneficial characteristics of this method, Thiel's embalmed cadavers have become an important part of our education and research. Despite initial technical difficulties, we managed to upgrade the method and assure better long–lasting preservation.&#x0D; Conclusions: Thiel embalmed cadavers resemble realistic living bodies and serve as an appropriate model for teaching and research.

Myocardial revascularization using the posterior intercostal arteries as grafts: anatomical variation aspect

Purpose: The posterior intercostal arteries (PIAs) present potential alternative graft sites because of their histological, morphological, and anatomical features. We investigated the anatomical variations of the origin and course of the left fifth and right seventh PIAs, since these arteries have been demonstrated as the most suitable for in situ grafting of the coronary arteries. The aim of this study was to determine whether variations of the PIAs as grafts could influence or limit myocardial revascularization.&#x0D; Methods: PIAs from the origin to the mid–axillary line were dissected from 44 cadavers embalmed via Thiel's method. The origin and course of the arteries was documented. The lengths of the common trunks, the distances to the costal angle levels, and the diameters of the arteries at the origin, at the point of division from the common trunk, and at the costal angle level were measured to calculate the diameter reduction rate.&#x0D; Results: Anatomical variations of the left fifth PIA were found in 25% of the cadavers. No variations were found in the right seventh PIAs. The length of the common trunk influences the length of the obtained pedicle. The PIA diameter is dependent on the origin from the aorta. The target PIA should be harvested before the costal angle level to assure a proper diameter of the conduit.&#x0D; Conclusion: Potential anatomical variations of the PIA must be considered when harvesting a vessel for CABG to avoid technical problems in PIA harvesting and hemodynamic changes.