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Robotic and laparoscopic female pelvic floor reconstruction  

Microsoft Academic Search

These disadvantages, in addition to inadequate experience in advanced laparoscopy in residency and fellowship programmes, and the recently introduced minimally invasive transvaginal sling and pelvic floor reconstructive procedures, have thwarted widespread adoption of laparoscopic surgery for urinary incontinence. However, the use of robotic and laparoscopic surgery in the management of female POP appears to be increasing. Many case series have




[Anatomy of the pelvic lymphatic system].  


The lymphatic system of the pelvis collects the lymph of the genital and urinary organs and of the digestive tract. It is formed by lymphatic nodes and vessels situated inside the conjunctive tissue, near the organs (visceral lymphatic nodes) but especially along the external, internal and common iliac vessels (iliac lymphatic nodes). These nodes receive afferent vessels issued from the different pelvic organs. From the iliac lymphnodes arise efferent vessels running towards lymphatic collectors, situated above them, and which end in the lymphatic lombar duct. The lymphatic pathways represent the preferential way of scattering of cancerous cells. Therefore, the knowledge of the anatomy, of the situation and of the draining of the nodes is of the utmost importance in the evaluation of a cancer of a pelvic organ. PMID:24007954

Wolfram-Gabel, R



Magnetic resonance assessment of pelvic anatomy and pelvic floor disorders after childbirth  

Microsoft Academic Search

To compare pelvic anatomy, using magnetic resonance imaging, between postpartum women with or without pelvic floor disorders.\\u000a We measured postpartum bony and soft tissue pelvic dimensions in 246 primiparas, 6–12-months postpartum. Anatomy was compared\\u000a between women with and without urinary or fecal incontinence, or pelvic organ prolapse; P?

Victoria L. Handa; Mark E. Lockhart; Kimberly S. Kenton; Catherine S. Bradley; Julia R. Fielding; Geoffrey W. Cundiff; Caryl G. Salomon; Christiane Hakim; Wen Ye; Holly E. Richter



Cutaneous Metastasis Following Laparoscopic Pelvic Lymphadenectomy for Prostatic Carcinoma  

Microsoft Academic Search

A case of implantation metastasis in the abdominal wall following transabdominal laparoscopic pelvic lymphadenectomy is reported. A cutaneous nodule was palpated at 1 of the laparoscopic ports 6 months after laparoscopic lymphadenectomy in a 66-year-old patient with stage T3pN1M0, grade 2 adenocarcinoma of the prostate. Aspiration cytology confirmed metastatic adenocarcinoma.

Chr H. Bangma; W. J. Kirkels; S. Chadha; F. H. Schroder



Laparoscopic radical hysterectomy (type III) with aortic and pelvic lymphadenectomy  

Microsoft Academic Search

OBJECTIVE: The purpose of this study was to incorporate a wide range of operative laparoscopic techniques to complete a type III radical hysterectomy with aortic and pelvic lymphadenectomy. STUDY DESIGN: A type III radical hysterectomy with bilateral aortic and pelvic lymph node dissection was separated into eight component parts: (1) right and left aortic lymphadenectomy, (2) right and left pelvic

Nick M. Spirtos; John B. Schlaerth; Ronald E. Kimball; Victoria M. Leiphart; Samuel C. Ballon



Laparoscopic Pelvic and Paraaortic Lymph Node Dissection in the Obese  

Microsoft Academic Search

Objective. The aim of this study was to determine the utility of laparoscopic pelvic and paraaortic lymph node dissection in obese women.Methods. We performed a retrospective analysis from 1\\/8\\/96 to 1\\/14\\/01 at the University of Oklahoma Health Science Center, evaluating patients who had a Quetelet index (QI) ?28 and had planned laparoscopic bilateral pelvic and paraaortic lymph node dissections (lnd)

Dennis R. Scribner Jr.; Joan L. Walker; Gary A. Johnson; D. Scott McMeekin; Michael A. Gold; Robert S. Mannel



Laparoscopic management of lymphocele after pelvic lymphadenectomy and radical retropubic prostatectomy.  


A new method of managing pelvic lymphoceles after urologic procedures is described. A patient with a symptomatic pelvic lymphocele after pelvic lymph node dissection and radical retropubic prostatectomy was treated laparoscopically. Technical aspects of laparoscopic marsupialization of lymphoceles are described, and the laparoscopic approach is compared with other modalities available for treating lymphoceles. PMID:1530829

Waples, M J; Wegenke, J D; Vega, R J



Pouch of Douglas pelvic hernia: a rare entity managed laparoscopically.  


Pouch of Douglas hernias are uncommon forms of pelvic hernia. They are most commonly seen in multiparous, elderly women and those having undergone previous pelvic surgery (Stamatiou et al. in Am Surg 76(5):474-479, 2010). Herein, we present a case of a 77-year-old female presenting with groin pain due to a Pouch of Douglas hernia. She had no previous abdominal or pelvic surgery. This was repaired via a trans-abdominal pre-peritoneal approach and the patient's symptoms resolved. To our knowledge, this is the first case report in the literature of an idiopathic Pouch of Douglas hernia managed laparoscopically. PMID:21290155

Bunni, J; Teichmann, D; Berstock, J R



Laparoscopic obturator nerve neurolysis after pelvic lymphadenectomy  

Microsoft Academic Search

Postoperative neuropathy is a known complication of major pelvic oncologic surgery. Obturator nerve injury complicating pelvic lymph node dissection has been reported in the literature. Severity and duration of symptoms are determined by the severity of the initial nerve lesion. Different management options have been described in the literature. We report here on a patient who developed right obturator neuropathy

Arash Rafii; Denis Querleu



Laparoscopic Para-aortic and Pelvic Lymphadenectomy: Experience with 150 Patients and Review of the Literature  

Microsoft Academic Search

Objective.The clinical usefulness of laparoscopic pelvic and para-aortic lymphadenectomy for staging and therapy of gynecological cancer was analyzed prospectively.Method.Laparoscopic para-aortic and pelvic lymphadenectomy was performed in 150 patients with cervical (n= 96), endometrial (n= 41), or ovarian cancer (n= 13). Lymphadenectomy was combined with laparoscopically assisted vaginal radical hysterectomy in 70 patients, with laparoscopically assisted vaginal hysterectomy and\\/or bilateral salpingo-oophorectomy

Marc Possover; Norman Krause; Karin Plaul; Rosemarie Kühne-Heid; Achim Schneider



Robotically assisted laparoscopic management of pelvic splenosis  

Microsoft Academic Search

Robotically assisted laparoscopy is a superior technique for the management of abdominopelvic splenosis, which is an often\\u000a unsuspected cause of pelvic pain. A 25-year-old female with a distant history of traumatic splenic rupture and splenectomy\\u000a was diagnosed with splenosis at the time of laparoscopy for vague abdominopelvic pain. She was transferred to our service\\u000a for evaluation and definitive surgical management.

R. Tyler Harney; Joseph Kelly; Martha Aldridge


Pelvic anatomy for obstetrics and gynecology residents: an experimental study using clay models  

Microsoft Academic Search

Objective: To determine whether clay modeling with lecture is more effective than lecture alone in teaching female pelvic anatomy.Methods: A pretest preceded a lecture on female pelvic anatomy in the following five groups of obstetrics and gynecology residents: postgraduate year 1 (PGY-1) residents at Women and Infants Hospital of Rhode Island (RI), PGY-1 residents at University of Connecticut (CT), and

Deborah L Myers; Lily A Arya; Anila Verma; Dianne L Polseno; Edward M Buchanan



Extended experience in the use of laparoscopic ultrasound to detect pelvic nodal metastasis in patients with cervical carcinoma  

Microsoft Academic Search

Objective. To evaluate the use of laparoscopic ultrasound (USG) to detect pelvic nodal metastasis in patients with early stage cervical carcinoma.Methods. Laparoscopic USG was used to search for pelvic lymph node metastasis in stage Ia2 to IIa cervical carcinoma patients before radical hysterectomy. Suspicious lymph nodes identified by laparoscopic USG were removed laparoscopically for pathological confirmation by frozen section. If

T. H Cheung; W. K Lo; M. Y Yu; W. T Yang; S Ho



Muscle architecture and functional anatomy of the pelvic limb of the ostrich (Struthio camelus)  

Microsoft Academic Search

The functional anatomy of the pelvic limb of the ostrich ( Struthio camelus ) was investigated in order to assess musculoskeletal specialization related to locomotor performance. The pelvic limbs of ten ostriches were dissected and detailed measurements of all muscle tendon units of the pelvic limb were made, including muscle mass, muscle length, fascicle length, pennation angle, tendon mass and

N. C. Smith; A. M. Wilson; K. J. Jespers; R. C. Payne



Laparoscopic trans-peritoneal pyelolithotomy in a pelvic kidney.  


Urinary lithiasis is one of the most common and the oldest known afflictions of the urinary tract. The management of renal stones has undergone radical changes in recent years, the latest being the minimally invasive procedures like extra-corporeal shock wave lithotripsy and percutaneous nephrolithotomy, making the open surgical procedures relatively obsolete. However, there are situations where the above-mentioned minimally invasive procedures prove to be lacking in achieving the cure; laparoscopic pyelolithotomy caters to such group of patients, e.g. the presence of calculi in malrotated or malpositioned kidneys. Herein, we report a case of pelvic kidney with a large calculus managed by laparoscopic trans-peritoneal pyelolithotomy. PMID:23168860

Ahangar, Shahnawaz; Durrani, Abdul Munnon; Qadri, Syed Javid; Patloo, Asim Mushtaq; Ganaie, Rouf Gul; Khan, Muneer



Management of pelvic lymphoceles following robot-assisted laparoscopic radical prostatectomy  

PubMed Central

Pelvic lymphocele is a potential complication of radical prostatectomy. Although lymphoceles often regress spontaneously, many may progress, precipitate clinical symptoms, and ultimately require intervention. To date, the best treatment of pelvic lymphoceles has not yet been fully defined. However, laparoscopic marsupialization is a definitive and efficacious surgical alternative to percutaneous drainage. It is effective, results in minimal patient morbidity, and allows for rapid recovery. We report our experience with management of clinically symptomatic pelvic lymphoceles following robotic-assisted prostatectomy using laparoscopic marsupialization.

Raheem, Omer A.; Bazzi, Wassim M.; Parsons, J. Kellogg; Kane, Christopher J.




Microsoft Academic Search

PurposeWe compared the results of extended (obturator, hypogastric, common and external iliac nodes) to modified (obturator and hypogastric nodes only) laparoscopic pelvic lymph node dissection in patients with clinically localized prostate cancer.

Nelson N. Stone; Richard G. Stock; Pamela Unger



Pelvic peritonization after laparoscopic abdominoperineal resection for low-rectal carcinoma treatment: surgical technique.  


Abdominoperineal resection is a standard method of low-rectum carcinoma treatment. It is associated with significant morbidity and mortality rates, which decreased with the development of preoperative diagnostic procedures, new surgical techniques and new surgical instruments. In this article, laparoscopic pelvic peritonization was used after laparoscopic rectum amputation for low-rectum carcinoma treatment. Pelvic peritonization is performed after laparoscopic recto-sigmoid extirpation, using the extended absorbable intracorporeal suture with titanic clip application after every second suture. The role of titanic clip is to grasp the extended suture and to mark the postoperative irradiation field. Laparoscopic pelvic peritonization after laparoscopic abdominoperineal rectum amputation is a simple procedure with clinical importance in possible adhesion and postirradiatic enteritis prevention. This procedure can satisfy all oncological requirements and minimally invasive surgery principles and is acceptable for every patient in which rectum amputation is indicated. PMID:19760934

Druzijani?, Nikica; Perko, Zdravko; Srsen, Darko; Pogoreli?, Zenon; Schwarz, Dragan; Jurici?, Josko


Robot-assisted laparoscopic pyeloplasty with stone removal in an ectopic pelvic kidney.  


Ectopic pelvic kidneys with ureteropelvic junction obstruction and stones present a treatment challenge for the minimally invasive surgeon. A pure laparoscopic approach is less invasive than an open approach but is technically difficult with longer operative time. The use of the da Vinci robotic interface has the potential to refine the laparoscopic technique and improve outcomes. Here, we present successful management using the robotic technique of one such case of concomitant pyeloplasty and pyelolithotomy. PMID:20529538

Nayyar, Rishi; Singh, Prabhjot; Gupta, Narmada P


Robot-Assisted Laparoscopic Pyeloplasty with Stone Removal in an Ectopic Pelvic Kidney  

PubMed Central

Ectopic pelvic kidneys with ureteropelvic junction obstruction and stones present a treatment challenge for the minimally invasive surgeon. A pure laparoscopic approach is less invasive than an open approach but is technically difficult with longer operative time. The use of the da Vinci robotic interface has the potential to refine the laparoscopic technique and improve outcomes. Here, we present successful management using the robotic technique of one such case of concomitant pyeloplasty and pyelolithotomy.

Nayyar, Rishi; Singh, Prabhjot



Functional specialisation of pelvic limb anatomy in horses (Equus caballus)  

PubMed Central

We provide quantitative anatomical data on the muscle–tendon units of the equine pelvic limb. Specifically, we recorded muscle mass, fascicle length, pennation angle, tendon mass and tendon rest length. Physiological cross sectional area was then determined and maximum isometric force estimated. There was proximal-to-distal reduction in muscle volume and fascicle length. Proximal limb tendons were few and, where present, were relatively short. By contrast, distal limb tendons were numerous and long in comparison to mean muscle fascicle length, increasing potential for elastic energy storage. When compared with published data on thoracic limb muscles, proximal pelvic limb muscles were larger in volume and had shorter fascicles. Distal limb muscle architecture was similar in thoracic and pelvic limbs with the exception of flexor digitorum lateralis (lateral head of the deep digital flexor), the architecture of which was similar to that of the pelvic and thoracic limb superficial digital flexors, suggesting a functional similarity.

Payne, RC; Hutchinson, JR; Robilliard, JJ; Smith, NC; Wilson, AM



Prostate position relative to pelvic bony anatomy based on intraprostatic gold markers and electronic portal imaging  

Microsoft Academic Search

Purpose: To describe the relative positions and motions of the prostate, pelvic bony anatomy, and intraprostatic gold fiducial markers during daily electronic portal localization of the prostate. Methods and Materials: Twenty prostate cancer patients were treated supine with definitive external radiotherapy according to an on-line target localization protocol using three or four intraprostatic gold fiducial markers and an electronic portal

John M. Schallenkamp; Michael G.. Herman; Jon J. Kruse; Thomas M. Pisansky



Laparoscopic bilateral pelvic and paraaortic lymph node sampoing: An evolving technique  

Microsoft Academic Search

OBJECTIVE: Reports describing laparoscopic lymph node sampling in patients with gynecologic malignancies have yet to describe a method to sample left-sided aortic lymph nodes that has been successful in a large series of patients. We submit our experience with evolving techniques that allow for excellent visualization and resection of both left and right aortic and pelvic lymph nodes.STUDY DESIGN: Forty

Nick M. Spirtos; John B. Schlaerth; Tanya W. Spirtos; Alan C. Schlaerth; Paul D. Indman; Ronald E. Kimball



Laparoscopic ovarian transposition before pelvic radiation in rectal cancer patient: safety and feasibility  

PubMed Central

Background Infertility due to pelvic radiation for advanced rectal cancer treatment is a major concern particularly in young patients. Pre-radiation laparoscopic ovarian transposition may offer preservation of ovarian function during the treatment however its use is limited. Aim The study investigates the safety, feasibility and effectiveness of pre-radiation laparoscopic ovarian transposition and its effect on ovarian function in the treatment o locally advanced rectal cancer. Methods Charts review of all young female patients diagnosed with locally advanced rectal cancer, underwent laparoscopic ovarian transposition, then received preoperative radiotherapy at king Faisal Specialist Hospital and Research Centre between 2003–2007. Results During the period studied three single patients age between 21–27?years underwent pre-radiation laparoscopic ovarian transposition for advanced rectal cancer. All required pretreatment laparoscopic diversion stoma due to rectal stricture secondary to tumor that was performed at the same time. One patient died of metastatic disease during treatment. The ovarian hormonal levels (FSH and LH) were normal in two patients. One has had normal menstrual period and other had amenorrhoea after 4?months follow-up however her ovarian hormonal level were within normal limits. Conclusions Laparoscopic ovarian transposition before pelvic radiation in advanced rectal cancer treatment is an effective and feasible way of preservation of ovarian function in young patients at risk of radiotherapy induced ovarian failure. However, this procedure is still under used and it is advisable to discuss and propose it to suitable patients.



Laparoscopic pelvic lymph node dissection, laparoscopically assisted seminal vesicle mobilization, and total perineal prostatectomy versus radical retropubic prostatectomy for prostate cancer  

Microsoft Academic Search

ObjectivesThe outcomes of patients with prostate cancer who were candidates for radical prostatectomy were compared with patients who underwent either: (1) radical retropubic prostatectomy (RRP); or (2) laparoscopic pelvic lymph node dissection, laparoscopically assisted seminal vesicle mobilization, and total perineal prostatectomy (LN-SV-TPP).

Joel M. H. Teichman; Pratap K. Reddy; John C. Hulbert



Robot-assisted laparoscopic transperitoneal pelvic lymphadenectomy and metastasectomy for melanoma: initial report of two cases  

PubMed Central

Robotic pelvic lymphadenectomy is a well established procedure in the urologic and gynecologic literature. To our knowledge robotic pelvic lymphadectomy for metastatic melanoma has yet to be described. Herein we present the first report of robot-assisted pelvic lymphadenectomy in malignant melanoma. After placement of six laparoscopic ports (12 mm camera, three 8-mm robotic ports, 12-mm and 5-mm assistant ports) the DaVinci S robot (Intuitive Surgical, CA, USA) was docked in standard fashion with the patient in low lithotomy. In both cases the patients had enlarged pelvic lymph nodes on computed tomography and complete excision of these masses was accomplished along with complete lymphadenectomy extending from Cooper’s ligament to just below the hypogastric artery in case 1 and to level of the bifurcation of aorta in case 2. A PK Maryland Dissector and monopolar scissors were used for dissection. Both patients were discharged on postoperative day #1. Robotic pelvic lymphadenectomy can be safely used for management of patients with metastatic melanoma involving the pelvic lymph nodes. Compared with the standard open procedure, pelvic lymphadenectomy with robotic assistance is associated with excellent vision and minimum morbidity.

Finley, David S.; Jakowatz, James; Ornstein, David K.



Laparoscopic insertion of pelvic tissue expander to prevent radiation enteritis prior to radiotherapy for prostate cancer  

PubMed Central

Radiation enteritis is a significant complication of external beam radiotherapy (EBRT) to the pelvis, particularly in patients having high dose radiotherapy (>80 Gy) and in those with a low pelvic peritoneal reflection allowing loops of small bowel to enter the radiation field. Laparoscopic insertion and subsequent removal of a pelvic tissue expander before and after external beam radiotherapy is a relatively convenient, safe and effective method for displacing loops of bowel out of the pelvis. We report on a patient with prostate cancer who ordinarily would not have been a candidate for EBRT due to loops of bowel low in the pelvis. With laparoscopic insertion and subsequent removal of a tissue expander, he was able to have radiotherapy to the prostate without developing radiation enteritis.



Female pelvic congenital malformations. Part I: embryology, anatomy and surgical treatment.  


This review covers the most important female congenital pelvic malformations. The first part focuses on the embryological development of the urogenital and anorectal apparatus, morphological features, and the diagnostic and surgical approach to abnormalities. Comprehension of the embryological development of the urogenital and anorectal apparatus is essential to understand the morphology of congenital pelvic abnormalities and their surgical treatment. Congenital pelvic malformations are characterized by specific common features; the severity of which often subverts the pelvic morphology completely and makes it difficult to comprehend before surgery. The development of imaging, mainly magnetic resonance imaging and ultrasound, in the investigation of pelvic floor disorders has recently become a fundamental tool for surgeons to achieve better understanding of the anatomy. Forty years ago, the primary aim of clinicians was to save the lives of such patients and to achieve anatomical normality. However, nowadays, functional reconstruction and recovery are essential parts of surgical management. Introduction of minimally invasive surgery has allowed the improvement of cosmetic results that is so important in paediatric or adolescent patients after reconstructive surgery. The option of sharing the complexity of pelvic congenital diseases by entrusting specific competencies to subspecialists (paediatric urologists, urogynaecologists, neurourologists, paediatric endocrinologists and neonatologists) has improved the quality of care for patients. However, at the same time, active interaction between various specialists remains fundamental. The exchange of knowledge and expertise, not only during the diagnostic-therapeutic process but also during follow-up, is crucial to obtain the best anatomical and functional results throughout the life of the patient. PMID:21783316

Laterza, Rosa M; De Gennaro, Mario; Tubaro, Andrea; Koelbl, Heinz



Efficacy of Laparoscopic Sacrocervicopexy for Apical Support of Pelvic Organ Prolapse  

PubMed Central

Background and Objectives: To evaluate the efficacy of laparoscopic sacrocervicopexy for apical support in sexually active patients with pelvic organ prolapse. Methods: One-hundred thirty-five women with symptomatic prolapse of the central compartment (Pelvic Organ Prolapse Quantitative [POP-Q] stage 2) underwent laparoscopic sacrocervicopexy. The operating physicians used synthetic mesh to attach the anterior endopelvic fascia to the anterior longitudinal ligament of the sacral promontory with subtotal hysterectomy. Anterior and posterior colporrhaphy was performed when necessary. The patients returned for follow-up examinations 1 month after surgery and then over subsequent years. On follow-up a physician evaluated each patient for the recurrence of genital prolapse and for recurrent or de novo development of urinary or bowel symptoms. We define “surgical failure” as any grade of recurrent prolapse of stage II or more of the POP-Q test. Patients also gave feedback about their satisfaction with the procedure. Results: The mean follow-up period was 33 months. The success rate was 98.4% for the central compartment, 94.2% for the anterior compartment, and 99.2% for the posterior compartment. Postoperatively, the percentage of asymptomatic patients (51.6%) increased significantly (P < .01), and we observed a statistically significant reduction (P < .05) of urinary urge incontinence, recurrent cystitis, pelvic pain, dyspareunia, and discomfort. The present study showed 70.5% of patients stated they were very satisfied with the operation and 18.8% stated high satisfaction. Conclusion: Laparoscopic sacrocervicopexy is an effective option for sexually active women with pelvic organ prolapse.

Rosati, Maurizio; Bracale, Umberto; Pignata, Giusto; Azioni, Guglielmo



Muscle architecture and functional anatomy of the pelvic limb of the ostrich (Struthio camelus)  

PubMed Central

The functional anatomy of the pelvic limb of the ostrich (Struthio camelus) was investigated in order to assess musculoskeletal specialization related to locomotor performance. The pelvic limbs of ten ostriches were dissected and detailed measurements of all muscle tendon units of the pelvic limb were made, including muscle mass, muscle length, fascicle length, pennation angle, tendon mass and tendon length. From these measurements other muscle properties such as muscle volume, physiological cross-sectional area (PCSA), tendon cross-sectional area, maximum isometric muscle force and tendon stress were derived, using standard relationships and published muscle data. Larger muscles tended to be located more proximally and had longer fascicle lengths and lower pennation angles. This led to an expected proximal to distal reduction in total muscle mass. An exception to this trend was the gastrocnemius muscle, which was found to have the largest volume and PCSA and also had the highest capacity for both force and power production. Generally high-power muscles were located more proximally in the limb, while some small distal muscles (tibialis cranialis and flexor perforatus digiti III), with short fibres, were found to have very high force generation capacities. The greatest proportion of pelvic muscle volume was for the hip extensors, while the highest capacity for force generation was observed in the extensors of the ankle, many of which were also in series with long tendons and thus were functionally suited to elastic energy storage.

Smith, N C; Wilson, A M; Jespers, K J; Payne, R C



Results of laparoscopic pelvic lymphadenectomy in patients at high risk for nodal metastases from prostate cancer  

Microsoft Academic Search

Background: Laparoscopic pelvic lymphadenectomy (LPLND) can be performed safely and with minimal morbidity in the staging of prostate\\u000a cancer. Its utility in evaluating patients at high risk for metastatic disease before primarily nonsurgical treatment modalities\\u000a was evaluated.\\u000a \\u000a \\u000a Methods: Twenty-four consecutive patients who underwent LPLND between June 1993 and July 1996 were studied. These patients were considered\\u000a poor surgical candidates based

Bruce R. Kava; Guido Dalbagni; Kevin C. Conlon; Paul Russo



Laparoscopic implantation of neural electrodes on pelvic nerves: an experimental study on the obturator nerve in a chronic minipig model  

Microsoft Academic Search

Background  Laparoscopic exposure of pelvic nerves has opened a new area in the field of neuromodulation. However, electrode design and\\u000a material deterioration remain issues that limit clinical application. The objective of this study was to evaluate experimentally\\u000a the laparoscopic implantation of different types of neural electrodes in order to achieve functional and selective electrical\\u000a stimulation of pelvic nerves.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  This was a

Demetrio Larraín; Pierre Rabischong; Revaz Botchorishvili; Georges Fraisse; Stephane Gallego; Philippe Gaydier; Jean Michel Chardigny; Paul Avan


A Modified Method in Laparoscopic Peritoneal Catheter Implantation: The Combination of Preperitoneal Tunneling and Pelvic Fixation  

PubMed Central

Introduction. Continuous ambulatory peritoneal dialysis (CAPD) is widely accepted for the management of end-stage renal disease (ESRD). Although not as widely used as hemodialysis, CAPD has clear advantages, especially those related to patient satisfaction and simplicity. Peritoneal dialysis (PD) catheter insertion can be accomplished by several different techniques. In this study, we aimed to evaluate our results obtained with peritoneal dialysis catheter placement by combination of pelvic fixation plus preperitoneal tunneling. Material and Methods. Laparoscopic peritoneal catheter implantation by combining preperitoneal tunneling and pelvic fixation methods was performed in 82 consecutive patients with end-stage renal disease. Sex, age, primary disease etiology, complications, mean duration of surgery, mean duration of hospital stay, morbidity, mortality, and catheter survival rates and surgical technique used were assessed. Analysis of catheter survival was performed using the Kaplan-Meier method. Results. Mean follow-up period was 28.35 ± 14.5 months (range of 13–44 months). Mean operative time was 28 ± 6 minutes, and mean duration of hospital stay was 3 ± 1 days. There were no conversions from laparoscopy to other insertion methods. None of the patients developed serious complications during surgery or the postoperative period. No infections of the exit site or subcutaneous tunnel, hemorrhagic complications, abdominal wall hernias, or extrusion of the superficial catheter cuff was detected. No mortality occurred in this series of patients. Catheter survival was found to be 92% at 3 years followup. Conclusions. During one-year followup, we had seven patients of migrated catheters due to separation of pelvic fixation suture from peritoneal surface, but they were reimplanted and fixated again laparoscopically with success. Over a three-year followup period, catheter survival was found to be 92%. In the literature, similar catheter survival rates without combination of the two techniques are reported. As a conclusion, although laparoscopic placement of PD catheters avoids many perioperative and early complications, as well as increasing catheter free survival period and quality of life, our results comparing to other studies in the literature indicate that different laparoscopic placement methods are still in debate, and further studies are necessary to make a more accurate decision.

Uzum, Gungor; Koc, Oguz; Duzkoylu, Yigit; Kucukyilmaz, Meltem; Tunal?, Vahit; Kose, Sennur



Findings of pelvic musculature and efficacy of laparoscopic muscle stimulator in laparoscopy-assisted anorectal pull-through for high imperforate anus  

Microsoft Academic Search

  Background: Laparoscopic findings of levator muscle and the efficacy of laparoscopic muscle stimulator (LMS) in infants with\\u000a high imperforate anus have not been reported. Methods: Twelve patients underwent laparoscopically assisted anorectoplasty\\u000a for high imperforate anus. Following laparoscopic dissection of the distal rectum and division of the fistula, levator muscles\\u000a in the pelvic floor were stimulated with a 5-mm-diameter LMS. Dilatation

T. Iwanaka; M. Arai; H. Kawashima; S. Kudou; J. Fujishiro; A. Matsui; S. Imaizumi



Endometriosis in Patients with Chronic Pelvic Pain: Is Staging Predictive of the Efficacy of Laparoscopic Surgery in Pain Relief?  

Microsoft Academic Search

Background\\/Aims: Endometriosis is considered an important cause of chronic pelvic pain. Despite its high prevalence, controversy still exists regarding the true association between the extent of endometriosis and the severity of symptoms. We conducted this prospective study to investigate the association between the stage of endometriosis and type and severity of pain, and to evaluate the efficacy of laparoscopic surgery

Spyros Milingos; Athanasios Protopapas; George Kallipolitis; Petros Drakakis; Dimitrios Loutradis; Anthoula Liapi; Aris Antsaklis



Robot-assisted laparoscopic prostatectomy in a 68-year-old patient with previous heart transplantation and pelvic irradiation  

Microsoft Academic Search

We report the case of a 68-year-old man who had previously undergone heart transplantation and pelvic irradiation for Hodgkin’s\\u000a lymphoma and who was under active surveillance for prostate cancer. In response to his increased prostate-specific antigen\\u000a levels and elevated Gleason score, he was offered robot-assisted laparoscopic prostatectomy.

Karol Axcrona; Ljiljana Vlatkovic; Jarl Hovland; Bjørn Brennhovd; Ulf Kongsgaard; Karl-Erik Giercksky


Comparative study of laparoscopic pyelolithotomy versus percutaneous nephrolithotomy in the management of large renal pelvic stones  

PubMed Central

Background The aim of the study is to investigate whether laparoscopic pyelolithotomy (LPL) could be used to manage large renal pelvic stones, generally considered excellent indications for percutaneous nephrolithotomy (PNL). Methods: This study was performed from May 2009 to March 2012 at Al-Azhar University Hospitals (Assiut and Cairo), Egypt. It included two groups of patients with large renal pelvic stones; only patients with stones 2.5 cm2 or greater were included. Group 1 included 40 patients treated by PNL and Group 2 included 10 patients treated by LPL. The differences between the two procedures were compared and analyzed. Results: There was no difference between the two groups regarding patient demographics and stone size. There was a statistically significant difference between the groups regarding mean estimated blood loss (65 ± 12.25 [range: 52.75–77.25] vs. 180 ± 20.74 [range: 159.26–200.74] mL, p ? 0001), mean hospital stay (2.3 ± 0.64 [range: 1.66–2.94] vs. 3.7 ± 1.4 [range: 2.3–5.1] days, p ? 0.006), rate of postoperative blood transfusion (0% vs. 4.8%, p ? 0.0024), and stone-free rate (80% vs. 78.6%, p ? 0.23). The mean operative time was significantly longer in Group 2 (LPL) (131 ± 22.11 [range: 108.89–153.11) vs. 51.19 ± 24.39 [range: 26.8–75.58] min, p ? 0001), respectively. Conclusion: Although PNL is the standard treatment in most cases of renal pelvic stones, LPL is another feasible surgical technique for patients with large renal pelvic stones.

Haggag, Yasser M.; Morsy, Gamal; Badr, Magdy M.; Al Emam, Abdel Baset A.; Farid, Mourad; Etafy, Mohamed



Laparoscopic Surgery Recording as an Adjunct to Conventional Modalities of Teaching Gross Anatomy  

PubMed Central

Objectives: In order to increase their effectiveness, methods of teaching morphological sciences need to be revised to incorporate the recent technological advances made in the field of medicine. Teaching human structure with conventional methods of prosections using dissected cadaveric specimen alone quite often fails to prepare students adequately for their clinical training. A learner-oriented method, incorporating three dimensional spatial anatomy and more closely mirroring the clinical setting, is required. Methods: With these challenges in mind, a 30-minute slow-paced video recording of a cholecystectomy performed laproscopically on a 45 year-old lady was adapted to supplement the conventional teaching of anatomy of the abdomen and pelvis. This study was carried out in October 2010. Results: The subjects of this study were 84 students in a first year preclinical MD course in human structure at the private Oman Medical College. Their feedback was obtained via questionnaire and revealed that the video presentation helped the students to realise the significance of the anatomical details learnt during the human structure course. Conclusion: Recordings of laparoscopic surgeries are an effective preclinical anatomy teaching resource in student-centred learning. They also help the students to appreciate the clinical relevance of gross anatomy and enhance their motivation to learn.

Kumar, Pananghat A.; Norrish, Mark; Heming, Thomas



Long-term experience on laparoscopic incontinent urinary diversion unrelated to cystectomy in radiated or recurrent pelvic malignancies  

PubMed Central

BACKGROUND: There are few reports describing series of cases about development on laparoscopic urinary diversions no related to cystectomy. The aim of this paper is to show the experience of our reference institutions for treatment of pelvic malignancies when laparoscopic techniques were applied to perform only urinary diversion without cystectomy or pelvic exenteration. MATERIALS AND METHODS: We included retrospectively 12 cases of cutaneous ureterostomy and 21 cases with a reservoir (16 ileal conduits, 2 colonic conduits and 3 wet colostomies) treated in our institute from 2004 to 2010. It was evaluated operative time, blood loss, intraoperative complications, conversion rate, length of large incision, post operative complications, analgesic consumption, time to food intake, hospital stay, time to recovery to normal activities. Mean time to follow-up was 3(2-7) years. RESULTS: All procedures were completed without conversions. In the cutaneous ureterostomy group the mean surgical time.

Tobias-Machado, Marcos; Lopes, Leonardo S; de Araujo, Felipe Brandao Correa; Starling, Eduardo S; Pompeo, Antonio Carlos Lima



The comparison of laparoscopic pyelolithotomy and percutaneous nephrolithotomy in the treatment of solitary large renal pelvic stones.  


The aim of the study is to investigate whether laparoscopic pyelolithotomy (LPL) could find a place in the management of large renal pelvic stones which are generally considered as excellent indications for percutaneous nephrolithotomy (PNL). Between 2006 and 2009, 26 consecutive patients with large (>4 cm(2)) renal pelvic stones were treated by LPL and their charts were compared to 26 match-paired patients treated with PNL during the same period. The patients were matched for age, BMI, stone size and location as well as presence of congenital anomalies. Perioperative and postoperative findings were compared. The mean age, mean stone size, rate of congenital anomalies, history open renal surgery and shock wave lithotripsy were similar in both groups (p > 0.05). The mean operation time was 138.40 ± 51.19 (range 70-240) min in LPL group as compared to 57.92 ± 21.12 (range 40-110) min in PNL group (p < 0.0001). There was one (3.8%) open conversion in the LPL group due to dense perirenal adhesions making the dissection difficult. The ureteropelvic junction (UPJ) obstruction concomitant to pelvic stones was successfully repaired laparoscopically in two cases. The mean drop in postoperative hemoglobin level was 0.9 ± 0.6 (range 0-2) g/dl in LPL group and 1.7 ± 1.1 (range 0-4) g/dl in PNL group (p = 0.024). Hospitalization was significantly shorter in PNL than LPL group (p = 0.0001). Stone-free rates were similar. Laparoscopic pyelolithotomy is associated with a longer operation time, is more invasive, and requires more skills when compared to PNL. However, LPL is associated with less blood loss. Laparoscopic pyelolithotomy is indicated for congenitally anomalous kidneys and especially in patients with concomitant UPJ. PMID:22307365

Tefekli, Ahmet; Tepeler, Abdulkadir; Akman, Tolga; Akçay, Muzaffer; Baykal, Murat; Karada?, Mert Ali; Muslumanoglu, Ahmet Y; de la Rosette, Jean



Laparoscopic Davydov correction of a failed gracilis flap neovagina in a patient with Mayer-Rokitansky-Kuster-Hauser syndrome with a pelvic kidney.  


The laparoscopic Davydov procedure is a surgical technique for creation of a neovagina in patients with Mayer-Rokitansky-Kuster-Hauser syndrome (MRKH) or vaginal agenesis. Herein we report its use in creating a neovagina after failure of a previous surgical attempt in a patient with a pelvic kidney, which has not been described to date. The patient, a 28-year-old woman with MRKH in whom creation of a neovagina using bilateral gracilis flaps had been attempted, was unable to have intercourse because of a shortened and scarred vagina. We successfully used the laparoscopic Davydov procedure to create a functional neovagina despite the previous surgery and the presence of a pelvic kidney. The Davydov procedure is an option for use in patients with MRKH with history of unsuccessful neovaginal surgery and can be performed in the presence of a pelvic kidney. PMID:23465266

Moriarty, Christopher R; Miklos, John R; Moore, Robert D



Modeling the Anatomy and Function of the Pelvic Diaphragm and Perineal Body Using a 'String Model'  

NSDL National Science Digital Library

This article describes a simple yet effective and innovative model used to illustrate the anatomical arrangement of the perineal muscles and help explain the function of the pelvic diaphragm and perineal body. The model is called the "string model" because strings were used in place of the perineal muscles during the demonstration.

Satheesha Nayak (Melaka Manipal Medical College Manipal Campus); David W Rodenbaugh (Minnesota State University-Moorhead)



Endoluminal ultrasound defines anatomy of the anal canal and pelvic floor  

Microsoft Academic Search

The aims of this study were to determine whether endoluminal ultrasound (ELUS) could identify various layers of the normal anal canal and to evaluate whether a 10-MHz probe provided better image resolution than a 7-MHz probe. Sonographic anatomy of the anal canal on ELUS was directly correlated with anatomic dissection of various layers (mucosa-submucosa, internal anal sphincter, and external anal

Joe J. Tjandra; Jeffrey W. Milsom; Vito M. Stolfi; Ian Lavery; John Oakley; James Church; Victor Fazio



Technique of pelvic lymphadenectomy after robot-assisted laparoscopic prostatectomy for prostate cancer.  


Pelvic lymphadenectomy for prostate cancer is an important tool in the prognostication of the disease in selected patients who are at risk of occult lymph node metastases. This procedure, usually performed in conjunction with radical prostatectomy, had progressed successfully from an open approach to the current robot-assisted approach. The following article and accompanying video describe the surgical technique of robot-assisted pelvic lymphadenectomy for prostate cancer. We also discuss the indications, patient selection, preparation, complications, and tips to avoid the major pitfalls in the procedure. PMID:23075403

Png, Keng-Siang; Koch, Michael O



[An updated overview on the anatomy and function of the female pelvic floor, with emphasis on the effect of vaginal delivery].  


Phylogenetically, the pelvic floor is a relatively old group of skeletal muscles which, along the acquisition of the erect posture by the human, gained a number of new important roles or were subjected to adaptation of some other roles performed earlier. The functional tasks of the pelvic floor in women (mostly of its prominent representatives - the levator ani muscles) include: supporting the contents of the abdominal cavity at the upright position, participation in the volitional and reflex compression of the urethra, narrowing the transverse dimension of the vagina and urogenital hiatus, involvement in sexual functions, and securing the terminal portion of the alimentary tract. The aim of this overview was to briefly review the information on the latest understanding of the anatomy of the pelvic floor, delineate its nomenclature recommended by the Federative Committee on Anatomical Terminology, and emphasize an array of physiological findings related to the contractility of these important muscles. The functional specialization of striated muscle fiber types and the anatomical basis of the relationship between vaginal delivery at term and postpartum urinary incontinence have been underlined. Nowadays, some intrapartum injuries to the pelvic floor can be successfully detected with ultrasound in the immediate postpartum period. This updated information should be part of a basic professional knowledge for obstetrician-gynecologist. PMID:23749692

Jó?wik, Maciej; Jó?wik, Marcin; Adamkiewicz, Maciej; Szymanowski, Pawe?; Jó?wik, Micha?



Microsoft Academic Search

1 Abstract - This report analyzes the variations in positioning and orientation of the pelvic bones in small cetaceans, and to contribute to establishing a possible homology based on the attachment of the abdominal musculature. Seven carcasses of three cetacean species (Tursiops truncatus, Sotalia guianensis, Pontoporia blainvillei) were analyzed. There is some variation in positioning and orientation of the pelvic

Paulo C. Simões-Lopes; Carolina S. Gutstein


Total laparoscopic posterior pelvic exenteration: a case report of low anterior resection with en bloc partial vaginectomy with sphincter preservation and handsewn coloanal anastomosis for locoregionally advanced carcinoma of rectum invading female genital tract.  


Posterior pelvic exenteration (PPE) has been used as modality of treatment for recurrent or primary cancer of rectum that has invaded into the female genital tract. We report a case of PPE performed for locoregionally advanced carcinoma of rectum invading the uterus; which was performed in a totally laparoscopic manner. The handsewn coloanal anastomosis was performed transrectally thus obviating the need for even a minilaparotomy for abdominal access for specimen retrieval or anastomotic stapler application. This is a first reported case in the literature where a total laparoscopic PPE was performed with successful outcome and oncological adequacy and safety. PMID:23386166

Puntambekar, Shailesh P; Kumthekar, Parag; Agarwal-Joshi, Geetanjali; Joshi, Saurabh; Nadkarni, Akshay



Laparoscopic hysterectomy with or without pelvic lymphadenectomy or sampling in a high-risk series of patients with endometrial cancer  

PubMed Central

Background The purpose of the study was to determine the outcome of all patients with endometrial adenocarcinoma cancer treated by laparoscopic hysterectomy at our institution, many of whom were high-risk for surgery. Methods Data was collected by a retrospective search of the case notes and Electronic Patient Records of the thirty eight patients who underwent laparoscopic hysterectomy for endometrial cancer at our institutions. Results The median body mass index was 30 (range 19–67). Comorbidities were present in 76% (29 patients); 40% (15 patients) had a single comorbid condition, whilst 18% (7 patients) had two, and a further 18% (7 patients) had more than two. Lymphadenectomy was performed in 45% (17 patients), and lymph node sampling in 21% (8 patients). Median operating time was 210 minutes (range 70–360 minutes). Median estimated blood loss was 200 ml (range 50–1000 ml). There were no intraoperative complications. Post-operative complications were seen in 21% (2 major, 6 minor). Blood transfusion was required in 5% (2 patients). The median stay was 4 post-operative nights (range 1–25 nights). In those patients undergoing lymphadenectomy, the mean number of nodes taken was fifteen (range 8–26 nodes). The pathological staging was FIGO stage I 76% (29 patients), stage II 8% (3 patients), stage III 16% (6 patients). The pathological grade was G1 31% (16 patients), G2 45% (17 patients), G3 24% (8 patients). Conclusion Laparoscopic hysterectomy can be safely carried out in patients at high risk for surgery, with no compromise in terms of outcomes, whilst providing all the benefits inherent in minimal access surgery.

Willis, Susan F; Barton, Desmond; Ind, Thomas EJ



Pelvic and acetabular fractures  

SciTech Connect

This treatise focuses primarily on the clinical aspects of diagnosis and treatments of pelvic and acetabular fractures. However, considerable attention is also paid to the radiographic diagnosis of trauma and postoperative effects. The book begins with a succinct review of pelvic and acetabular anatomy and pelvic biomechanics. It continues with a radiographic classification of pelvic injury, which will represent the major source of the book's interest for radiologists. The remainder of the book is concerned with clinical management of pelvic and acetabular trauma, including preoperative planning, surgical approaches, techniques of reduction, internal fixation, eternal fixation, post-operative care, and late problems. Even throughout this later portion of the book there are extensive illustrations, including plain radiographs, computed tomographic (CT) scans, reconstructed three-dimensional CT scans, and schematic diagrams of diverse pelvic and acetabular fractures and the elementary surgical techniques for their repair.

Mears, D.C.; Rubash, H.E.



Abdominal Cavity and Laparoscopic Surgery  

NSDL National Science Digital Library

For students interested in studying biomechanical engineering, especially in the field of surgery, this lesson serves as an anatomy and physiology primer of the abdominopelvic cavity. Students are introduced to the abdominopelvic cavityâa region of the body that is the focus of laparoscopic surgeryâas well as the benefits and drawbacks of laparoscopic surgery. Understanding the abdominopelvic environment and laparoscopic surgery is critical for biomechanical engineers who design laparoscopic surgical tools.

Integrated Teaching And Learning Program


Laparoscopic Lymphadenectomy for Gynecologic Malignancies  

Microsoft Academic Search

Objective. The purpose of our study was to detail our 5-year experience with laparoscopic lymphadenectomy for gynecologic malignancies.Methods. From 11\\/5\\/92 to 3\\/9\\/98, we performed laparoscopic lymphadenectomies on 94 patients with various gynecologic malignancies. Pelvic, paraaortic, and combinations of both pelvic and paraaortic lymphadenectomies were performed depending on the primary site of disease and indication for lymph node dissection. Data were

Peter R. Dottino; Daniel H. Tobias; AnnMarie Beddoe; Anne L. Golden; Carmel J. Cohen



Robotics for Pelvic Reconstruction  

PubMed Central

Robotic-assisted laparoscopy is increasingly used in female pelvic reconstructive surgery to combine the benefits of abdominally placed mesh for prolapse outcomes with the quicker recovery time associated with minimally invasive procedures. Level III data suggest that early outcomes of robotic sacrocolpopexy are similar to those of open sacrocolpopexy. A single randomized trial has provided level I evidence that robotic and laparoscopic approaches to sacrocolpopexy have similar short-term anatomic outcomes, although operating times, postoperative pain, and cost are increased with robotics. Patient satisfaction and long-term outcomes of both robotic and laparoscopic sacrocolpopexy are insufficiently studied despite their widespread use in the treatment of prolapse. Given the high reoperative rates for prolapse repairs, long-term follow-up is essential, and well-designed comparative effectiveness research is needed to evaluate pelvic floor surgery adequately.

Ramm, Olga; Kenton, Kimberly



Surgical Treatment for Chronic Pelvic Pain  

PubMed Central

The source of chronic pelvic pain may be reproductive organ, urological, musculoskeletal - neurological, gastrointestinal, or myofascial. A psychological component almost always is a factor, whether as an antecedent event or presenting as depression as result of the pain. Surgical interventions for chronic pelvic pain include: 1) resection or vaporization of vulvar/vestibular tissue for human papillion virus (HPV) induced or chronic vulvodynia/vestibulitis; 2) cervical dilation for cervix stenosis; 3) hysteroscopic resection for intracavitary or submucous myomas or intracavitary polyps; 4) myomectomy or myolysis for symptomatic intramural, subserosal or pedunculated myomas; 5) adhesiolysis for peritubular and periovarian adhesions, and enterolysis for bowel adhesions, adhesiolysis for all thick adhesions in areas of pain as well as thin ahesions affecting critical structures such as ovaries and tubes; 6) salpingectomy or neosalpingostomy for symptomatic hydrosalpinx; 7) ovarian treatment for symptomatic ovarian pain; 8) uterosacral nerve vaporization for dysmenorrhea; 9) presacral neurectomy for disabling central pain primarily of uterine but also of bladder origin; 10) resection of endometriosis from all surfaces including removal from bladder and bowel as well as from the rectovaginal septal space. Complete resection of all disease in a debulking operation is essential; 11) appendectomy for symptoms of chronic appendicitis, and chronic right lower quadrant pain; 12) uterine suspension for symptoms of collision dyspareunia, pelvic congestion, severe dysmenorrhea, cul-desac endometriosis; 13) repair of all hernia defects whether sciatic, inguinal, femoral, Spigelian, ventral or incisional; 14) hysterectomy if relief has not been achieved by organ-preserving surgery such as resection of all endometriosis and presacral neurectomy, or the central pain continues to be disabling. Before such a radical step is taken, MRI of the uterus to confirm presence of adenomyosis may be helpful; 15) trigger point injection therapy for myofascial pain and dysfunction in pelvic and abdominal muscles. With application of all currently available laparoscopic modalities, 80% of women with chronic pelvic pain will report a decrease of pain to tolerable levels, a significant average reduction which is maintained in 3-year follow-up. Individual factors contributing to pain cannot be determined, although the frequency of endometriosis dictates that its complete treatment be attempted. The beneficial effect of uterosacral nerve ablation may be as much due to treatment of occult endometriosis in the uterosacral ligaments as to transection of the nerve fibers themselves. The benefit of the presacral neurectomy appears to be definite but strictly limited to midline pain. Appendectomy, herniorraphy, and even hysterectomy are all appropriate therapies for patients with chronic pelvic pain. Even with all laparoscopic procedures employed, fully 20% of patients experience unsatisfactory results. In addition, these patients are often depressed. Whether the pain contributes to the depression or the depression to the pain is irrelevant to them. Selected referrals to an integrated pain center with psychologic assistance together with judicious prescription of antidepressant drugs will likely benefit both women who respond to surgical intervention and those who do not. A maximum surgical effort must be expended to resect all endometriosis, restore normal pelvic anatomy, resect nerve fibers, and treat surgically accessible disease. In addition, it is important to provide patients with chronic pelvic pain sufficient psychologic support to overcome the effects of the condition, and to assist them with underlying psychologic disorders.



Laparoscopic Treatment of Intrauterine Fallopian Tube Incarceration  

PubMed Central

Herniation of the pelvic structures into the uterine cavity (appendix vermiformis, small bowel, omentum, or fallopian tube) may occur after uterine perforation. In this paper, we describe one case of intrauterine fallopian tube incarceration treated by means of laparoscopic surgery.

Kondo, William; Bruns, Rafael Frederico; Nicola, Marcelo Chemin; Ribeiro, Reitan; Trippia, Carlos Henrique; Zomer, Monica Tessmann



Evaluation of the Gynecology Teaching Associate versus Pelvic Model Approach to Teaching Pelvic Examination.  

ERIC Educational Resources Information Center

Students were taught pelvic examination methods either by use of an inanimate model or use of the model and examination of volunteer gynecological teaching associates (GTAs). Students in the latter group were superior in communication and manual skills, and scored better on recognizing deviant pelvic anatomy. (MSE)

Shain, Rochelle N.; And Others



Test-retest and intra-observer repeatability of two-, three- and four-dimensional perineal ultrasound of pelvic floor muscle anatomy and function.  


The aims of the present study were to evaluate test-retest intra-observer repeatability of ultrasound measurement of the morphology and function of the pelvic floor muscles (PFMs). Seventeen subjects were tested twice. Two-, three- and four- dimensional ultrasound recorded cough, huff, muscle morphology and PFM contraction, respectively. Analyses were conducted offline. Measurements of levator hiatal dimensions demonstrated intra-class correlation coefficient (ICC) values of 0.61, 0.72, 0.86 and 0.92, for the anterior-posterior dimension, transverse dimension, resting area and narrowing during contraction, respectively. Muscle thickness showed variable reliability. ICC values for measurement of the position of the bladder neck were 0.86 and 0.82 at rest, in the vertical and horizontal direction. Displacement of the bladder neck during contraction, huff and cough demonstrated ICC values of 0.56, 0.59 and 0.51, respectively. Perineal ultrasound is a reliable method for measuring most of the tested parameters of morphology and function of the PFMs. PMID:17599234

Braekken, Ingeborg Hoff; Majida, Memona; Ellstrøm-Engh, Marie; Dietz, Hans Peter; Umek, Wolfgang; Bø, Kari



An atlas of radiological anatomy  

Microsoft Academic Search

This book contains a wealth of radiologic images of normal human anatomy; plain radiographs, contrast-enhanced radiographs, and computed tomography (CT) scans. There are 18 pages of magnetic resonance (MR) images, most on the brain and spinal cord, so that there are only two pages on MR imaging of the heart and two pages on abdominal and pelvic MR imaging. Twelve

J. Weir; P. Abrahams



Uterine prolapse after pelvic trauma: case report and literature review  

Microsoft Academic Search

Up to date, the connection of pelvic trauma with genital prolapse is not widely recognized. These cases could be classified\\u000a in a group where disruption of normal anatomy of the pelvis is apparent (i.e., pelvic fracture), and in a second group, where\\u000a pelvis remains unaffected by the pelvic trauma (i.e., seat belt-related injuries). The aim of the report is to

Themistoklis Mikos; Alexios Papanicolaou; Tryfon Tsalikis; Evangelos Ioannidis



Pelvic fractures: classification and nursing management.  


Fractures to the pelvis can occur as a result of low-energy or high-energy trauma. Pelvic fractures may be associated with significant internal bleeding and injury to the organs within the pelvis. Patients with pelvic fractures often have complex healthcare needs; fractures resulting from high-energy trauma may be associated with multiple injuries, whereas fractures resulting from low-energy trauma, such as falls, may be associated with multiple patient comorbidities. Nurses have a fundamental role in the assessment and observation of the patient following pelvic fracture and are crucial in identifying any changes or deterioration in the patient's condition that require prompt intervention. This article focuses on the relevant anatomy of the pelvis, epidemiology and classification of pelvic fractures, and outlines the management and complications of pelvic fractures. PMID:22206172

Walker, Jennie


Dilemmas in diagnosing pelvic pain: multiple pelvic surgeries common in women with interstitial cystitis  

Microsoft Academic Search

We determined the prevalence of pelvic surgeries in women with interstitial cystitis (IC) compared to community-based controls\\u000a through responses to a survey from 215 women with IC and 823 controls. Women with IC had a statistically higher prevalence\\u000a of hysterectomies (cases?=?42.3%, controls?=?21.4%), bladder suspensions (cases?=?21.9%, controls?=?5.7), pelvic or genital\\u000a surgeries other than cystoscopy (cases?=?26.5%, controls?=?16.2%), and laparoscopic pelvic surgeries (cases?=?22.8%,

Michael S. Ingber; Kenneth M. Peters; Kim A. Killinger; Donna J. Carrico; Ibrahim A. Ibrahim; Ananias C. Diokno



[Clinical application of laparoscopic proctocolectomy].  


Laparoscopic proctocolectomy is a safe and feasible but complicated procedure, which is widely used clinically. Fully understanding of surgical plane and vascular anatomy is important for operation. The anastomosis methods, the type of ileal reservoir pouch and whether or not performing protective ilostomy should be considered preoperatively. Many details should be paid attention to. PMID:23072018

Tao, Kai-xiong; Shuai, Xiao-ming



Pudendal artery pseudoaneurysm after robot-assisted laparoscopic radical prostatectomy.  


Pseudoaneurysms in urology, especially for pelvic surgeries, are rare. We report a patient who presented with late recurrent hematuria due to formation of an accessory pudendal artery pseudoaneurysm (Clavien grade III) after robot-assisted laparoscopic radical prostatectomy. PMID:23146345

Feng, Tom; Patel, Hiten D; Allaf, Mohamad E



Dynamic pelvic floor imaging: MRI techniques and imaging parameters.  


Magnetic resonance imaging (MRI) is an excellent tool to understand the complex anatomy of the pelvic floor and to assess pelvic floor disorders. MRI enables static and dynamic imaging of the pelvic floor. Using static T2-weighted sequences the morphology of the pelvic floor can be visualized in great detail. A rapid half-Fourier T2-weighted, balanced steady state free precession, or gradient-recalled echo sequence are used to obtain sagittal images while the patient is at rest, during pelvic squeeze, during pelvic strain and to document the evacuation process. On these images the radiologist identifies the pubococcygeal line (PCL) (which represents the level of the pelvic floor). In normal findings, the base of the anterior and the middle compartment are above the PCL at rest, and the pelvic floor elevates during contraction. During straining the pelvic floor muscles should relax and the pelvic floor descends normally less than 3 cm below the PCL. Pelvic floor MRI based on the static and dynamic MRI sequences allows for the detection and characterization of a vast array of morphologic and functional pelvic floor disorders. In this review, we focus on technical aspects of static and dynamic pelvic floor MRI. PMID:22349892

Reiner, Caecilia S; Weishaupt, Dominik



Laparoscopic-Induced Pneumocephalus in a Patient with a Ventriculoperitoneal Shunt  

Microsoft Academic Search

The authors report the case of laparoscopic-induced pneumocephalus in a ventriculoperitoneal shunt (VPS) patient undergoing a transperitoneal laparoscopic procedure. This case represents the first instance, to our knowledge, of forced retrograde air through a Holter valve placed 20 years ago. Abdominal laparoscopic surgery is a minimally invasive procedure utilized for a wide spectrum of abdominal and pelvic disorders. VPS systems

Jeffery Raskin; Daniel J. Guillaume; Brian T. Ragel



Retained faecolith: an avoidable complication of laparoscopic appendicectomy.  


A 26-year-old woman presented to the accident and emergency department 9 days post laparoscopic appendicectomy for a non-perforated, but gangrenous appendicitis. She was found to have a retained faecolith with a pelvic abscess. This case demonstrates one of the common pitfalls of the laparoscopic appendicectomy and we discuss some technical points to avoid such complications. PMID:24042211

Knight, Olivia; Brar, Ranjeet; Clark, Jeremy



[Retroperitoneal laparoscopic surgery; initial experience in the Hospital La Paz].  


We present the initial results of retroperitoneal laparoscopic surgery in the Hospital Universitario La Paz from July 2004 to December 2004. The program started after 2 years of pelvic laparoscopy surgery practice. The initial experience has been so good that we have reduced the contraindications for this technique and we have increased the number of laparoscopic surgery cases. PMID:16180315

Aguilera Bazán, A; Alonso y Gregorio, S; Cansino Alcaide, R; Hidalgo Togores, L; Cisneros Ledo, J; de la Peña Barthel, J


Present status of endoscopic surgery in Japan: laparoscopic surgery and laparoscopic assisted surgery for gastric cancer  

NASA Astrophysics Data System (ADS)

In this report, I would like to explain the latest data from the 7th National Survey 2004, by the Japan Society for Endoscopic Surgery (1). Next, I will explain you the comment on laparoscopic gastric cancer operation, in particular. We perform the following 3 surgical procedures. (1) Intragastric method (2) Laparoscopic lesion lifting method (3) Laparoscopic assisted gastric resection Mastery of basic techniques and thorough understanding of topographic anatomy are the most important (2). Furthermore, it is necessary for a surgeon with experience of at least 50 cases of laparoscopic surgery to be involved in surgery as an assistant.

Hiki, Yoshiki; Kitano, Seigo



Laparoscopic adrenalectomy for patients who have Cushing's syndrome.  


Laparoscopic adrenalectomy is one of the most significant advances in the past 20 years for treating adrenal disorders. When compared with open adrenalectomy, laparoscopic adrenalectomy is equally safe, effective, and curative; it is more successful in shortening hospitalization and convalescence and has less long-term morbidity. The laparoscopic approach is the procedure of choice for the surgical management of cortisol-producing adenomas and for patients who have corticotropin (ACTH)-dependent Cushing's syndrome for whom surgery failed to remove the source of ACTH. The keys to successful laparoscopic adrenalectomy are appropriate patient selection, knowledge of anatomy, delicate tissue handling, meticulous hemostasis, and experience with the technique of laparoscopic adrenalectomy. PMID:15850855

Young, William F; Thompson, Geoffrey B



[Laparoscopic appendectomy. Our experience].  


The advantages and applications of the videolaparoscopic technique (VL) versus open surgery in the treatment of acute and complicated appendicitis are not well defined. Our study examined 150 patients, 67 males and 83 females. They underwent surgery for acute appendicitis in emergency. The choice between open or laparoscopic tecnique was due to patient's clinical conditions and surgeon's experience. Two of these patients had no infiammatory process. Eleven patients were affected by gynaecological diseases. The last 137 patients underwent surgery for acute appendicitis and the diagnosis was confirmed. Among them, 35 (25%) were affected by a complicated appendicitis with diffuse or clearly defined peritonitis. In 134 patients the surgery was completed laparoscopically. The conversion rate was 2%. Morbility rate was 3%, due to intra abdominal abscesses secondary to acute complicated appendicitis. The mean operative time was 76 min and the mean hospital stay was 4.8 days. The death rate was 0%. In our experience, laparoscopic appendectomy has significant advantages over traditional open surgery in both acute and complicated appendicitis, especially in young women. In this way, we can diagnose pelvic disease that could be characterized by the same symptoms of acute appendicitis, then we suggest laparoscopic appendectomy even just to complete the diagnostic iter. Laparoscopy is useful in terms of convalescence, postoperative pain, hospital stay, aesthetic outcome and an easier exploration of the peritoneal cavity. PMID:22595725

Pezzolla, Angela; Milella, Marialessia; Lattarulo, Serafina; Barile, Graziana; Pascazio, Bianca; Ialongo, Paolo; Fabiano, Gennaro; Palasciano, Nicola


Retroperitoneal and pelvic extraperitoneal laparoscopy: an international perspective  

Microsoft Academic Search

Objectives. To assess technical preferences and current practice trends of retroperitoneal and pelvic extraperitoneal laparoscopy.Methods. A questionnaire survey of 36 selected urologic laparoscopic centers worldwide was performed.Results. Twenty-four centers (67%) responded. Overall, 3988 laparoscopic procedures were reported: transperitoneal approach (n = 2945) and retroperitoneal\\/extraperitoneal approach (n = 1043). Retroperitoneoscopic\\/extraperitoneoscopic procedures included adrenalectomy (n = 74), nephrectomy (n = 299), ureteral

Inderbir S. Gill; Ralph V. Clayman; David M. Albala; Yoshio Aso; Allen W. Chiu; Sakti Das; James F. Donovan; Gerhard J. Fuchs; Durga D. Gaur; Hideto Go; Leonard G Gomella; Martin T Grune; Lawrence M Harewood; Gunther Janetschek; Peter M Knapp; Elspeth M McDougall; Stephen Y Nakada; Glenn M Preminger; Paolo Puppo; Jens J Rassweiler; Peter L Royce; Raju Thomas; Donald A Urban; Howard N Winfield



Intravenous buscopan for analgesia following laparoscopic sterilisation.  


Following reports that tubal smooth muscle spasm may contribute to pelvic pain following laparoscopic sterilisation, we studied the effect of buscopan (an anticholinergic agent used to relieve smooth muscle spasm) on 45 patients undergoing general anaesthesia for day-case laparoscopic sterilisation. Patients were randomly allocated to receive either buscopan 20 mg or saline placebo after induction of anaesthesia. There were no significant differences in pain scores or postoperative analgesic requirements between the two groups. We conclude that intravenous buscopan confers no benefit in day-case laparoscopic sterilisation. PMID:10455843

Wilson, C M; Lillywhite, N; Matta, B; Mills, P; Wiltshire, S



The anatomy of learning anatomy.  


The experience of clinical teachers as well as research results about senior medical students' understanding of basic science concepts has much been debated. To gain a better understanding about how this knowledge-transformation is managed by medical students, this work aims at investigating their ways of setting about learning anatomy. Second-year medical students were interviewed with a focus on their approach to learning and their way of organizing their studies in anatomy. Phenomenographic analysis of the interviews was performed in 2007 to explore the complex field of learning anatomy. Subjects were found to hold conceptions of a dual notion of the field of anatomy and the interplay between details and wholes permeated their ways of studying with an obvious endeavor of understanding anatomy in terms of connectedness and meaning. The students' ways of approaching the learning task was characterized by three categories of description; the subjects experienced their anatomy studies as memorizing, contextualizing or experiencing. The study reveals aspects of learning anatomy indicating a deficit in meaningfulness. Variation in approach to learning and contextualization of anatomy are suggested as key-elements in how the students arrive at understanding. This should be acknowledged through careful variation of the integration of anatomy in future design of medical curricula. PMID:19551482

Wilhelmsson, Niklas; Dahlgren, Lars Owe; Hult, Håkan; Scheja, Max; Lonka, Kirsti; Josephson, Anna



Chronic Pelvic Pain  


... a specific diagnosis What you should know: The pelvic floor muscles act as a muscular sling that supports ... causes Chronic constipation or diarrhea can lead to pelvic floor dysfunction and pelvic pain can become very debilitating ...


Diffuse Histiocytic Proliferation Mimicking Mesothelial Hyperplasia in Endocervicosis of the Female Pelvic Peritoneum  

Microsoft Academic Search

Two cases of a diffuse histiocytic proliferation that mimicked mesothelial hyperplasia in the pelvic peritoneum of premenopausal women with endocervicosis are presented. The lesions were found incidentally on laparoscopic examination for pelvic pain and appeared as small friable excrescenses attached to the serosal surface of the pelvis. Histologic examination revealed a dense proliferation of round to oval cells with abun

Robert Ruffolo; Saul Suster



Laparoscopic treatment of intrauterine fallopian tube incarceration.  


Herniation of the pelvic structures into the uterine cavity (appendix vermiformis, small bowel, omentum, or fallopian tube) may occur after uterine perforation. In this paper, we describe one case of intrauterine fallopian tube incarceration treated by means of laparoscopic surgery. PMID:23738168

Kondo, William; Bruns, Rafael Frederico; Nicola, Marcelo Chemin; Ribeiro, Reitan; Trippia, Carlos Henrique; Zomer, Monica Tessmann



Sinus Anatomy  


Sinus Anatomy Rakesh Chandra, MD INTRODUCTION The paranasal sinuses (“the sinuses”) are air-filled cavities located within the bones ... tube responsible for clearing air pressure in the ears; it opens into the backside wall of the ...


A Network-Based Environment of Female Pelvic Region for Anatomical Education Based on Chinese Visible Human Datasets  

Microsoft Academic Search

Anatomy of female pelvic area represents a great challenge to medical students. In this paper, a network-based environment was developed for anatomical education of female pelvic region based on Chinese visible human (CVH) datasets. An image database was established to provide two-dimensional anatomical information of pelvic region. Based on image segmentation and contouring, a 3D virtual pelvic floor was reconstructed

Xiaolin Zheng; Nan Hu; Hongyan Luo; Liwen Tan; Shaoxiang Zhang; Jinlu Shan



Magnetic Resonance Imaging of Anatomic and Dynamic Defects of the Pelvic Floor in Defecatory Disorders  

Microsoft Academic Search

OBJECTIVE:Endoanal ultrasound identifies anal sphincter anatomy, and evacuation proctography visualizes pelvic floor motion during simulated defecation. These complementary techniques can evaluate obstructed defecation and fecal incontinence. Our aim was to develop a single, nonionizing, minimally invasive modality to image global pelvic floor anatomy and motion.METHODS:We studied six patients with fecal incontinence and seven patients with obstructed defecation. The anal sphincters

J. G. Fletcher; R. F. Busse; S. J. Riederer; D. Hough; T. Gluecker; C. M. Harper; A. E. Bharucha



Pelvic congestion syndrome.  


Pelvic congestion syndrome (PCS) is an important cause of chronic pelvic pain in female patients. Chronic pelvic pain, defined as lower abdominal or pelvic pain for a duration of 6 months or more, causes significant morbidity and results in a large number of diagnostic laparoscopies. It is of utmost importance to identify treatable causes of chronic pelvic pain, one of which is PCS. The etiology, clinical features, investigations, and treatment options in PCS have been discussed in this paper. PMID:23795992

Rane, Neil; Leyon, Joe Joseph; Littlehales, Tracey; Ganeshan, Arul; Crowe, Paul; Uberoi, Raman


Laparoscopic Hysteropexy in a Patient with Spina Bifida and Ventriculoperitoneal Shunt  

PubMed Central

Laparoscopic repair of pelvic organ prolapse in patients with ventriculoperitoneal shunts has not been previously described. The optimum management of patients with ventriculoperitoneal shunts undergoing laparoscopy is uncertain. We describe the case of a 21-year-old female patient with spina bifida and ventriculoperitoneal shunt who underwent laparoscopic hysteropexy for severe pelvic organ prolapse. The implications of performing laparoscopy on patients with ventriculoperitoneal shunts are reviewed along with strategies to reduce potential intraoperative complications.

Askari, Reza; Kasturi, Seshadri; Ravangard, Samadh F.



Laparoscopic-induced pneumocephalus in a patient with a ventriculoperitoneal shunt.  


The authors report the case of laparoscopic-induced pneumocephalus in a ventriculoperitoneal shunt (VPS) patient undergoing a transperitoneal laparoscopic procedure. This case represents the first instance, to our knowledge, of forced retrograde air through a Holter valve placed 20 years ago. Abdominal laparoscopic surgery is a minimally invasive procedure utilized for a wide spectrum of abdominal and pelvic disorders. VPS systems for cerebrospinal fluid diversion are used to treat hydrocephalus. We present a case of laparoscopic-induced pneumocephalus in a VPS patient undergoing a transperitoneal laparoscopic procedure. PMID:21412025

Raskin, Jeffery; Guillaume, Daniel J; Ragel, Brian T



What Are Pelvic Floor Disorders?  


What are Pelvic Floor Disorders? What is the Pelvic Floor? The pelvic floor is a term we use to describe the muscles, ... uterus, vagina, and rectum). Not only does the pelvic floor prevent these organs from falling down or out, ...


Pelvic inflammatory disease (PID)  


... may be no symptoms. People who experience an ectopic pregnancy or infertility often have had silent PID, which ... pelvic organs, possibly leading to: Chronic pelvic pain Ectopic pregnancy Infertility


Pelvic Support Problems  


The pelvic floor is a group of muscles and other tissues that form a sling or hammock across the pelvis. ... place so that they can work properly. The pelvic floor can become weak or be injured. The main ...


Pelvic laparoscopy - series (image)  


Pelvic laparoscopy is used both for diagnosis and for treatment and may be recommended for: pelvic pain due to ... or to perform certain surgical procedures. After the laparoscopy, the gas is released and the incision is ...


Antibodies to the chlamydial 60 kd heat-shock protein are associated with laparoscopically confirmed perihepatitis  

Microsoft Academic Search

OBJECTIVE: Our purpose was to examine clinical, microbiologic, serologic, and laparoscopic findings associated with perihepatitis.STUDY DESIGN: In a prospective study of 157 women with a clinical diagnosis of pelvic inflammatory disease, 27 women with laparoscopically confirmed perihepatitis and salpingitis were compared with 46 patients with salpingitis alone.RESULTS: Both current use or a history of ever using oral contraceptives was negatively

Deborah M. Money; Stephen E. Hawes; David A. Eschenbach; Rosanna W. Peeling; Robert Brunham; Pal Wölner-Hanssen; Walter E. Stamm



Laparoscopic complications in markedly obese urologic patients (A multi-institutional review)  

Microsoft Academic Search

Objectives. Significant obesity is considered to be a relative contraindication to laparoscopic surgery. This study reviews the complications encountered in massively obese patients undergoing urologic laparoscopic surgery.Methods. Body mass index (BMI) was used as an objective index to indicate massive obesity. Eleven institutions compiled retrospective data on 125 patients having a BMI greater than 30. Procedures performed included 76 pelvic

David Mendoza; Robert C. Newman; David Albala; Marc S. Cohen; Ashu Tewari; James Lingeman; Michael Wong; Louis Kavoussi; John Adams; Robert Moore; Howard Winfield; J. Matthew Glascock; Sakti Das; Larry Munch; Michael Grasso; Michael Dickinson; Ralph Clayman; Stephen Nakada; Elspeth M. McDougall; I. Stuart Wolf; John Hulbert; Raymond J. Leveillee; A. Houshair; Culley Carson



Robotic-assisted laparoscopic pyeloplasty: initial Australasian experience  

Microsoft Academic Search

Laparoscopic dismembered pyeloplasty has a success rate in excess of 90% for the treatment of uretero-pelvic junction (UPJ)\\u000a obstruction. Laparoscopic intracorporeal suturing, however, remains technically challenging and may lead to prolonged operating\\u000a times. Robotic-assisted suturing using the da Vinci® surgical system (Intuitive Surgical, CA, USA) may reduce the difficulty associated with intra-corporeal suturing. The da Vinci® surgical system was used to facilitate

Rohan Matthew Hall; Declan G. Murphy; Ben Challacombe; Anthony J. Costello; Jamie Kearsley



Successful laparoscopic management of primary omental pregnancy.  


Omental pregnancy is an extremely rare type of ectopic pregnancy. We present a case in which a 26-year-old woman was admitted to the emergency room with abdominal pain. She was diagnosed with a ruptured ectopic pregnancy after a positive urinary pregnancy test and transvaginal ultrasound. Laparoscopic surgery showed intact pelvic organs and an ectopic mass on the omentum. The patient was treated successfully with laparoscopic partial omentectomy, and pathologic examination confirmed an omental pregnancy. As evidenced by this case, laparoscopy can be useful to diagnose and treat unusually located ectopic pregnancies. PMID:19434418

Seol, Hyun-Joo; Kim, Tak; Lee, Seon-Kyung



Robotic Hybrid Technique in Rectal Surgery for Deep Pelvic Endometriosis.  


Background. Deep pelvic endometriosis is a complex disorder that affects 6% to 12% of all women in childbearing age. The incidence of bowel endometriosis ranges between 5.3% and 12%, with rectum and sigma being the most frequently involved tracts, accounting for about 80% of cases. It has been reported that segmental colorectal resection is the best surgical option in terms of recurrence rate and improvement of symptoms. The aim of this study is to analyze indications, feasibility, limits, and short-term results of robotic (Da Vinci Surgical System)-assisted laparoscopic rectal sigmoidectomy for the treatment of deep pelvic endometriosis. Patients and Methods. Between January 2006 and December 2010, 19 women with bowel endometriosis underwent colorectal resection through the robotic-assisted laparoscopic approach. Intraoperative and postoperative data were collected. All procedures were performed in a single center and short-term complications were evaluated. Results. Nineteen robotic-assisted laparoscopic colorectal resections for infiltrating endometriosis were achieved. Additional procedures were performed in 7 patients (37%). No laparotomic conversion was performed. No intraoperative complications were observed. The mean operative time was 370 minutes (range = 250-720 minutes), and the estimated blood loss was 250 mL (range = 50-350 mL). The overall complication rate was 10% (2 rectovaginal fistulae). Conclusions. Deep pelvic endometriosis is a benign condition but may have substantial impact on quality of life due to severe pelvic symptoms. We believe that robotic-assisted laparoscopic colorectal resection is a feasible and relatively safe procedure in the context of close collaboration between gynecologists and surgeons for treatment of deep pelvic endometriosis with intestinal involvement, with low rates of complications and significant improvement of intestinal symptoms. PMID:23657477

Cassini, Diletta; Cerullo, Guido; Miccini, Michelangelo; Manoochehri, Farshad; Ercoli, Alfredo; Baldazzi, Gianandrea



Instant Anatomy  

NSDL National Science Digital Library

Created by Professor Robert Whitaker, this website was designed to teach medical students about anatomy. Visitors to the site will find a range of materials, including diagrams, illustrations, quizzes, tips, mnemonics, and so on. On the homepage, visitors will find a What's New area, which includes podcasts that deal with subjects such as the small muscles of the hand and the anatomy of the posterior forearm. Other sections on the homepage include Head & Neck, Thorax, Abdomen, Arm, and Leg. Each of these sections includes dozens of illustrations, along with some useful Brain Training Games. These games are designed to increase comprehension of the materials covered in each area. Moving on, the Lectures area includes talks such as "Parasympathetic Supply of the Head," "Cortical Control of Cranial Nerves," and several others. The site is rounded out by a collection of iPhone and iPad apps, along with a set of detailed flash cards.

Whitaker, Andrew



Instant Anatomy  

NSDL National Science Digital Library

Dr Robert Whitaker, a professor at Cambridge University, creates this podcast covering anatomy. Intended as a tool for medical students and students in related fields, these podcasts are both entertaining and educational. Elucidated topics include the abdominal wall, the axilla and cubital fossa, and cranial nerves - to name a few. This collection will be useful for medical students, nurses, scientists, and medical assistants, among others.

Whitaker, Robert



Laparoscopic Total Mesorectal Excision  

PubMed Central

Objective To analyze total mesorectal excision (TME) for rectal cancer by the laparoscopic approach during a prospective nonrandomized trial. Summary Background Data Improved local control and survival rates in the treatment of rectal cancer have been reported after TME. Methods The authors conducted a prospective consecutive series of 100 laparoscopic TMEs for low and mid-rectal tumors. All patients had a sphincter-saving procedure. Case selection, surgical technique, and clinical and oncologic results were reviewed. Results The distal limit of rectal neoplasm was on average 6.1 (range 3–12) cm from the anal verge. The mean operative time was 250 (range 110–540) minutes. The conversion rate was 12%. Excluding the patient who stayed 104 days after a severe fistula and reoperation, the mean postoperative stay was 12.05 (range 5–53) days. The 30-day mortality was 2% and the overall postoperative morbidity was 36%, including 17 anastomotic leaks. Of 87 malignant cases, 70 (80.4%) had a minimum follow-up of 12 months, with a median follow-up of 45.7 (range 12–72) months. During this period 18.5% (13/70) died of cancer and 8.5% (6/70) are alive with metastatic disease. The port-site metastasis rate was 1.4% (1/70): a rectal cancer stage IV presented with a parietal recurrence at 17 months after surgery. The locoregional pelvic recurrence rate was 4.2% (3/70): three rectal cancers stage III at 19, 13, and 7 postoperative months. Conclusions Laparoscopic TME is a feasible but technically demanding procedure (12% conversion rate). This series confirms the safety of the procedure, while oncologic results are at present comparable to the open published series with the limitation of a short follow-up period. Further studies and possibly randomized series will be necessary to evaluate long-term clinical outcome in cancer patients.

Morino, Mario; Parini, Umberto; Giraudo, Giuseppe; Salval, Micky; Brachet Contul, Riccardo; Garrone, Corrado



[Robotics-assisted laparoscopic colorectal resection].  


The value of laparoscopic surgery for rectal cancer is still controversially discussed. Robotics offers the opportunity to leave the limitations of conventional laparoscopy behind us. The three-dimensional visualization and the superior dexterity by wristed instruments should be particularly helpful in complex laparoscopic procedures in confined spaces such as the small pelvis. Colorectal resections using the Da Vinci® system are well established and becoming increasingly more standard procedures. Nerve-sparing total mesorectal excision in patients with rectal cancer, total mesocolic excision in patients with right-sided colon cancer and rectopexy in patients with pelvic floor insufficiency are the most promising indications. The prospective randomized ROLARR study has been evaluating the application of the Da Vinci® system in laparoscopic rectal cancer surgery since 2011. Besides the currently available clinical data the perioperative and intraoperative logistics and strategy will be presented in detail. PMID:23942962

Mann, B; Virakas, G; Blase, M; Soenmez, M



Findings in 200 consecutive asymptomatic women, having a laparoscopic sterilization  

Microsoft Academic Search

Summary  Laparoscopic findings in 200 asymptomatic, healthy women having a sterilization were recorded; 148 patients (74%) had no abnormality\\u000a and 52 patients had abnormalities comprising pelvic adhesions (14%), uterine fibromyomas (5%), endometriosis (3%) and ovarian\\u000a or parovarian cysts (2%).

J. B. Trimbos; G. C. M. Trimbos-Kemper; A. A. W. Peters; C. D. van der Does; E. V. van Hall



Role for laparoscopic adrenalectomy in patients with Cushing's syndrome.  


Laparoscopic adrenalectomy is one of the most clinically important advances in the past 2 decades for the treatment of adrenal disorders. When compared to open adrenalectomy, laparoscopic adrenalectomy is equally safe, effective, and curative; it is more successful in shortening hospitalization and convalescence and has less long-term morbidity. The laparoscopic approach to the adrenal is the procedure of choice for the surgical management of cortisol-producing adenomas and for patients with corticotropin (ACTH) dependent Cushing's syndrome for whom surgery failed to remove the source of ACTH. The keys to successful laparoscopic adrenalectomy are appropriate patient selection, knowledge of anatomy, delicate tissue handling, meticulous hemostasis, and experience with the technique of laparoscopic adrenalectomy. PMID:18209873

Young, William F; Thompson, Geoffrey B



Anatomy Arcade  

NSDL National Science Digital Library

Anatomy truly gets interactive via these collection of fun and engaging games, videos, and other multimedia excursions. The site was created by Ben Crossett, a science teacher in Australia. Several years ago, he decided to craft some new resources like "Poke a Muscle" and "Whack-A-Bone" that would be both entertaining and educational. Visitors can look at the Games By Body System to get started, or they can also look over the Games By Type area. The types of games here include jigsaw puzzles, crosswords, word searches, and the nice catch all Just For Fun. The activities are also made interesting by the mere fact that they contain catchy visuals and jaunty tunes. The site also includes a place where teachers can offer feedback and an area just for students.

Crossett, Ben


KTP-532 laser utilization in endoscopic pelvic lymphadenectomy  

NASA Astrophysics Data System (ADS)

Laparoscopic pelvic lymphadenectomy has become increasingly of interest to Urologists in staging patients not only with prostatic carcinoma but for those patients suffering with carcinoma of the bladder. It also allows access for therapeutic treatment such as treatment of varicoceles and laser phototherapy for transmural coagulation of bladder cancers. Lasers have proven extremely better in allowing surgical incisions through the laparoscope and coagulation of bleeders. Both the KTP and Neodymium Yag Laser have been used for this purpose. The KTP Laser has distinct advantages in that it allows 1) flexible fiber easily used through laparoscopes, 2) the ability to coagulate and cut retroperitoneal tissue, and 3) seal lymphatics when lymph nodes are removed. The KTP fiber can be used to incise the retroperitoneum to expose the lymph node tissue. Grasping the lymph nodes with forceps, the laser can excise and coagulate the proximal and lymphatic channels. The laser fiber will not experience carbonization as can occur with the Yag Laser fiber unless a contact tip sapphire end is utilized. The KTP's laser fiber ability to give coagulation and ablation of tissue through a liquid medium allow it to be an excellent choice for laparoscopic pelvic lymphadenectomy.

Malloy, Terrence P.



Laparoscopic adrenalectomy for large adrenal masses.  


Open adrenalectomy has been the gold-standard therapy for adrenal neoplasms. Minimally invasive treatments, however, have assumed a more central role in the management of these lesions. The traditional benefits of laparoscopy, including reduced blood loss, shorter hospital duration, and improved convalescence, extend to adrenal disease without compromising the oncologic efficacy of the surgery. Contemporary series suggest that minimally invasive surgery is also a reasonable therapeutic modality for larger adrenal masses. Laparoscopic adrenalectomy for these large masses is a technically demanding procedure that should be undertaken by experienced laparoscopic surgeons familiar with retroperitoneal anatomy and adept with vascular techniques in the event of an open conversion. Oncologic outcomes collectively suggest that in the setting of adequate surgical resection, recurrence patterns relate more to disease-process biology than surgical approach. Neither size criteria, suspicion of malignancy, nor locally invasive disease should be considered an absolute contraindication to laparoscopic adrenalectomy. PMID:18366978

Rosoff, James S; Raman, Jay D; Del Pizzo, Joseph J



Laparoscopic Total Gastrectomy in a Gastric Cancer Patient with Intestinal Malrotation  

PubMed Central

As the incidence of early gastric cancer increases, laparoscopic surgery has become one of the treatments of choice for gastric cancer. With the increase of laparoscopic surgery, the chance of discovering aberrant anatomy during the operation also increases. We present a case of laparoscopic total gastrectomy in gastric cancer patients with intestinal malrotation. Intestinal malrotation occurs in one in every 500 births. We found that laparoscopic total gastrectomy in such patients can be performed successfully when it is performed with a proper Roux limb orientation through an alternative minilaparotomy.

Lee, Juhan; Lim, Joon Seok; Cho, In; Kwon, In Gyu; Choi, Yoon Young; Noh, Sung Hoon



Biomechanical analysis of the spino-pelvic organization and adaptation in pathology  

Microsoft Academic Search

Introduction  Standing in an erect position is a human property. The pelvis anatomy and position, defined by the pelvis incidence, interact\\u000a with the spinal organization in shape and position to regulate the sagittal balance between both the spine and pelvis. Sagittal\\u000a balance of the human body may be defined by a setting of different parameters such as (a) pelvic parameters: pelvic

Pierre Roussouly; João Luiz Pinheiro-Franco


Myofascial pelvic pain.  


Myofascial pelvic pain is fraught with many unknowns. Is it the organs of the pelvis, is it the muscles of the pelvis, or is the origin of the pelvic pain from an extrapelvic muscle? Is there a single source or multiple? In this state of confusion what is the best way to manage the many symptoms that can be associated with myofascial pelvic pain. This article reviews current studies that attempt to answer some of these questions. More questions seem to develop as each study presents its findings. PMID:22648177

Kotarinos, Rhonda



[Laparoscopic adrenalectomy].  


The authors performed three left and one right sided laparoscopic adrenalectomies between 3rd April and 8th August 1997. The indication of surgery was hormonally active cortical adenoma of about 2 cm size in three cases, a 6 cm large hormonally inactive tumour in one case respectively. For the operation on the left side three, on the right side four trocars with 11 mm diameter was used. The duration of the operations was between 115 and 220 min. The patients left one the second or third postoperative day, no complication was observed. The authors' opinion based on both literature data and their own experience is that laparoscopic approach to adrenalectomies is the method of choice today. PMID:9702083

Horányi, J; Tihanyi, T; Darvas, K; Rácz, K; Fütö, L



[Laparoscopic splenectomy].  


To date more than 400 laparoscopic splenectomies have been reported in the literature. The main indications for the procedure are benign haematological diseases, in particular idiopathic thrombocytopenic purpura. Laparoscopic splenectomy to treat malignant illnesses is rare and is usually restricted to small or only moderately enlarged spleens. Technically, the lateral abdominal approach with the patient in a right decubitus position has the advantage over the anterior approach in the supine patient of permitting better access to the organ. Under the force of gravity the stomach and intestines drop out of the operating field, and the splenic ligaments are placed under tension. This facilitates dissection with the harmonic scalpel and safe divisioning of the hilar vessels using the linear stapler. The individual steps of the procedure are described in detail. PMID:9586193

Reck, T; Köckerling, F; Scheuerlein, H; Hohenberger, W



Outpatient laparoscopic sterilization.  


This is a report on a pilot study conducted in Malaysia of outpatient sterilization utilizing laparoscopic technique under local anesthesia and sedation. The preliminary report based on 305 patients is presented with emphasis on the advantages and possible weaknesses of such procedure. Sterilization is performed in the Family Planning Specialist Center, Maternity Hospital. Patients are motivated towards sterilization during the immediate postpartum period in the Maternity Hospital and are counseled regarding the actual procedure. The mean age of the 305 patients was 32.08 years; the mean gravidity was 4.92; and the mean parity was 4.57. The majority of the patients came from the lower social strata with low educational attainment and low income. 253 cases of sterilizations were performed by laparoscopic procedures and 43 cases by minilaparotomy. In 9 cases difficulty was encountered with laparoscopy and subsequently the minilaparotomy was used. The majority of cases seemed to tolerate the sedation and local anesthesia fairly well and without much complaint of pain. Only a very small number of patients complained of pain particularly at the time when the Fallope or Lay rings were applied to the fallopian tubes. The overall complication rate was 14 (4.9%) and of these mild wound sepsis accounted for 6 (1.96%). Most of the wound sepsis was very mild and healed very quickly on daily dressing. No cases of pelvic sepsis were reported. There were 3 cases of uterine perforation by the uterine elevator. There were 2 cases where the fallopian tubes were traumatized and some degree of bleeding occurred. The bleeding was easily controlled by applying another Fallope ring. 2 patients had vomiting during the laparoscopic procedure. There were 7 cases of failed sterilization. 6 of the cases were performed by a trainee registrar in obstetrics and gynecology. The last was performed by a specialist gynecologist. Most of the failures were due to wrong application of rings. The cost per patient was estimated to be around 20 ringgit for a pair of tubal rings, anesthetic agents and suture materials. This preliminary study showed that female sterilization could be done easily as an outpatient procedure. PMID:6459518

Hamid Arshat; Yuliawiratman



Laparoscopic Instrumentation  

Microsoft Academic Search

\\u000a Laparoscopic instrumentation continues to evolve towards smaller, more reliable, and better ergonomic devices, with a larger\\u000a variety of choices. Since the first edition of this textbook, subtle improvements are readily apparent in existing devices\\u000a as first-generation instruments progress towards later-generation models. New technology exists to allow procedures to be\\u000a performed with fewer complications. Combined with refinements in techniques, new and

Patrick S. Lowry


Hematocele After Laparoscopic Appendectomy  

PubMed Central

Background: Laparoscopic appendectomy is one of the most common laparoscopic surgeries performed. We report an unusual complication of hematocele after laparoscopic appendectomy. Case Description: A 48-y-old male presented with swelling and discomfort in his right scrotum 11 d after he underwent laparoscopic appendectomy for acute appendicitis. Before the surgery, he had no scrotal swelling or inguinal hernia.

Bhullar, Jasneet Singh; Subhas, Gokulakrishna; Mittal, Vijay K.



Training for laparoscopic surgery  

Microsoft Academic Search

Laparoscopic cholecystectomy has rapidly become the procedure of choice for most patients with symptomatic gallbladder disease. Laparoscopic surgery, however, has not been a required component of most general surgery training programs. The demonstrated efficacy of laparoscopic surgery dictates that this discipline be rapidly incorporated into residency programs. Laparoscopic cholecystectomy and other surgical endoscopic procedures have been an integral part of

Karl A. Zucker; Robert W. Bailey; Scott M. Graham; William Scovil; Anthony L. Imbembo



Pelvic Inflammatory Disease (PID)  


... result in chronic pelvic pain, infertility, or an ectopic pregnancy. What Are the Symptoms of PID? PID can ... has more of a chance of being infertile. Ectopic pregnancy. If someone who has had PID does get ...


Pelvic Inflammatory Disease  


... infertile each year because of PID. Also, many ectopic pregnancies that occur are due to problems from PID. ... PID can lead to severe problems like infertility , ectopic pregnancy , and chronic pelvic pain. Any damage done to ...


Pelvic Floor Disorders Network  


... Incontinence Measurement Scale BOOST: Behavioral Therapy Of Obstetric Sphincter Tears: Behavioral Therapy versus Usual Care in Primiparous Women with Anal Sphincter Tears and Fecal Incontinence OPTIMAL: Operations and Pelvic ...


Pelvic Radiation in Women  

Microsoft Academic Search

\\u000a Pelvic radiation represents a major therapeutic strategy, either as adjuvant or primary treatment in the management of cancer\\u000a in women. This mainly concerns women with gynaecological malignancies: endometrial, cervical, vaginal, and vulva cancer; intestinal\\u000a malignancies: rectal and anal cancer, and bladder cancer. Further, long-term breast cancer survivors may experience similar\\u000a adverse effects after ovarian ablation accomplished by pelvic radiation. Finally,

Pernille T. Jensen


Gynecologic Pelvic Pain  

PubMed Central

The family physician dealing with gynecologic pelvic pain (acute or chronic) enters at the beginning of the problem as diagnostician, refers the patient to a specialist in the interim, and resumes care in the follow-up period. Patients with chronic pelvic pain (pelvic pain that has lasted for at least six months) can be difficult to treat because they often have a history of dysfunctional family life, sexual and marital problems, and often a hidden history of sexual molestation or incest. The family physician can best care for the patient with empathy, a long ventilated history, complete physical and pelvic examination, and pelvic ultrasonograpy if necessary. Laparoscopy normally shows pelvic adhesions in one third of these patients, minimal endometriosis in one third, and a normal pelvis in the final third. The family physician should specifically reassure patients with normal results that they do not have cancer. The ideal therapy combines both stimulation-produced analgesia and treatment of the psychological, emotional, sociological, and environmental aspects of the disease.

Kinch, Robert A.H.



[Pelvic floor and pregnancy].  


Congenital factor, obesity, aging, pregnancy and childbirth are the main risk factors for female pelvic floor disorders (urinary incontinence, anal incontinence, pelvic organ prolapse, dyspareunia). Vaginal delivery may cause injury to the pudendal nerve, the anal sphincter, or the anal sphincter. However the link between these injuries and pelvic floor symptoms is not always determined and we still ignore what might be the ways of prevention. Of the many obstetrical methods proposed to prevent postpartum symptoms, episiotomy, delivery in vertical position, delayed pushing, perineal massage, warm pack, pelvic floor rehabilitation, results are disappointing or limited. Caesarean section is followed by less postnatal urinary incontinence than vaginal childbirth. However this difference tends to disappear with time and following childbirth. Limit the number of instrumental extractions and prefer the vacuum to forceps could reduce pelvic floor disorders after childbirth. Ultrasound examination of the anal sphincter after a second-degree perineal tear is useful to detect and repair infra-clinic anal sphincter lesions. Scientific data is insufficient to justify an elective cesarean section in order to avoid pelvic floor symptoms in a woman without previous disorders. PMID:20456995

Fritel, X



Laparoscopic Appendectomy: Why It Should Be Done  

PubMed Central

Objective: Notwithstanding its widely perceived advantages, laparoscopic appendectomy has not yet met with universal acceptance. The aim of the present work is to illustrate retrospectively the results of a case-control experience with laparoscopic versus open appendectomy carried out at our institution. Methods: Between January 1993 and November 2000, 555 patients (M:F = 210:345; mean age 25.2±15 years) underwent emergency or urgent appendectomy, or both. Of them, 322 (52%) were operated on laparoscopically, and 233 (48%) were treated via conventional surgery, according to the presence of a well-trained surgical team. Results: The laparoscopic group conversion rate was 3.1% (10/322) and was mainly due to the presence of dense intraabdominal adhesions. Major intraoperative complications ranged as high as 0.3% (1/322) and 0%, respectively, in the laparoscopic and conventional groups (P=ns). Major postoperative complications were 1.6% (5/312) vs 0.8% (2/243), respectively (P=ns). Postoperative mortality was 0.3% (1/312) and 0.4% (1/243) in the laparoscopic and conventional subsets of patients. Reinterventions were 0.9% (3/322) in the laparoscopic patients versus nil in the open group (P=ns). Minor postoperative complications were observed in 0.6% (2/312) and 6.5% (16/243) of patients, respectively, in the laparoscopy and open surgery groups, and consisted mainly of wound infections (P=0.001). Flatus passage and hospitalization were significantly more rapid among the laparoscopic patients. The greater diagnostic accuracy of laparoscopy allowed the diagnosis of concurrent diseases in 12% (30/254) versus 1.5% (3/199) of patients with histology proven appendicitis treated via laparoscopy versus laparotomy (P<0.01). Similarly, among those patients without gross or microscopic evidence of appendicitis, or both gross and microscopic evidence, concurrent diseases were detected in 57.3% (39/68) of laparoscopic patients versus 8.8% (3/34) in the conventional ones (P<0.01). Conclusion: Even if limited by its retrospective nature, the present experience shows that laparoscopic appendectomy is as safe and effective as conventional surgery, has a higher diagnostic yield, causes less trauma, and offers a more rapid postoperative recovery. Such features make laparoscopy a challenging alternative to laparotomy in premenopausal women referred for urgent abdominal or pelvic surgery, or both.

De Simone, Paolo; Michelet, Ivan; Bedin, Natalino



Direct pelvic access percutaneous nephrolithotomy in management of ectopic kidney stone: a case report and literature review.  


Abstract Percutaneous nephrolithotomy (PNL) is an effective procedure for the treatment of patients with large or complex stones. PNL is challenging in anomalous kidneys, certain patients, such as those with renal ectopia. It is unable to undergo PNL in conventional technique safely in these cases. We presented a case report of laparoscopic-assisted PNL via direct pelvic puncture in a pelvic kidney stone and discussed previous published literature. A 49-year-old man presented with right lower quadrant pain and hematuria. Intravenous pyelography and three-dimensional computerized tomography revealed an opaque 2.7?×?1.7?cm pelvis renalis stone in a right side ectopic pelvic kidney with grade III hydronephrosis. Laparoscopic-assisted tubeless PNL was performed to remove the calculus. Laparoscopic-assisted PNL as a minimally invasive therapy in ectopic kidney has many advantages. Our case showed that, in pelvic ectopic kidney with pelvic stones greater than 1.5?cm in size, laparoscopic-assisted PNL via direct pelvis puncture is a safe and effective technique. PMID:23991847

Mehmet, Rifaioglu Murat; Rustu, Yalcinkaya Fatih; Hanefi, Bayarogullari; Mursel, Davarci; Fusun, Aydogan; Mehmet, Inci



The new face of gross anatomy.  


The nature of anatomy education has changed substantially over the past decade due to both a new generation of students who learn differently from those of past years and the enormity of advances in anatomical imaging and viewing. At Mount Sinai School of Medicine, our anatomy courses have been designed to meld classic dissection with the tools physicians and surgeons will use tomorrow. We introduce students to the newest technologies available for viewing the body, such as minimally invasive approaches, ultrasonography, three-dimensional visualizations, multi-axial computerized image reconstructions, multi-planar magnetic resonance imaging, and plastinated prosections. Students are given a hands-on, team-building experience operating laparoscopes in the laboratory. A great strength of our program is the important and active participation by faculty from 15 different basic and clinical departments, including several chairs and voluntary faculty. This interdisciplinary approach brings to our students direct, one-on-one encounters or presentations by our finest physicians and surgeons and our core anatomy faculty. In addition, the presence of many teaching assistants drawn from upper classmen and advanced graduate students adds an additional, vibrant dimension. Our anatomy programs for medical/graduate students and postgraduates are structured around three simple principles: (1) it is a privilege to teach, (2) we enlist only passionate teachers, and (3) it is our role to instill appreciation and respect for human form. PMID:12001214

Reidenberg, Joy S; Laitman, Jeffrey T



Laparoscopic cecopexy for cecal volvulus after laparoscopy. Case report and a review of the literature.  


Cecal volvulus is a rare cause of large bowel obstruction. Surgical therapy depends on visceral circulatory conditions at diagnosis. Possible options include endoscopic decompression, detorsion, cecopexy with or without cecostomy, right colectomy with immediate or delayed anastomosis. The present paper describes a case of cecal volvulus in a 40-year-old woman after laparoscopic removal of a pelvic mass successfully treated by laparoscopic cecopexy. PMID:17519847

Baldarelli, M; De Sanctis, A; Sarnari, J; Nisi, M; Rimini, M; Guerrieri, M



Laparoscopic segmental colorectal resection for endometriosis: limits and complications  

Microsoft Academic Search

Background  Deep pelvic endometriosis with colorectal involvement is a complex disorder often requiring segmental bowel resection. This\\u000a study investigated the limits and complications of laparoscopic segmental colorectal resection.\\u000a \\u000a \\u000a \\u000a Methods  Laparoscopic segmental colorectal resection was performed for 71 women with bowel endometriosis. Intra- and postoperative\\u000a complications were evaluated, together with symptom outcomes, by means of questionnaires completed before and after surgery.\\u000a Surgical procedures

E. Darai; G. Ackerman; M. Bazot; R. Rouzier; G. Dubernard



Single-session laparoscopic cystectomy and nephroureterectomy  

PubMed Central

Patients with high grade and/or muscle invasive bladder cancer and with concomitant diseases of the upper urinary tract, e.g. urothelial tumors (transitional cell carcinoma – TCC) or afunctional hydronephrotic kidneys, may be candidates for simultaneous cystectomy and nephroureterectomy. Although the progress in laparoscopic techniques made these procedures feasible and safe, they are still technically demanding so only experienced surgeons can perform them. The aim of the study is to report our experience with laparoscopic simultaneous en bloc resection of the urinary bladder together with unilateral or bilateral nephroureterectomy in patients with TCC. Our material consists of three cases operated on in three centers between 2002 and 2011. After having completed bilateral (1 case) or unilateral (2 cases) nephroureterectomy, we performed radical cystectomy with pelvic lymph node dissection. All the specimens, including the kidneys, ureters, bladder, and reproductive organs in the female, were collected in endobags and were retrieved en bloc using hypogastric incision in the male patient and the vaginal route in the female patients. The demographic and perioperative information was collected and analyzed. All procedures were completed laparoscopically without the need of conversion to open surgery. No major intra- or postoperative complications were observed. Only 1 patient suffered from prolonged lymphatic leakage. From our experience we can conclude that single-session laparoscopic cystectomy and nephroureterectomy are technically feasible and safe, and may be offered for the treatment of selected cases of TCC of the urinary tract.

Chlosta, Piotr; Myslak, Marek; Herlinger, Grzegorz; Dobronski, Piotr; Kryst, Piotr; Drewa, Tomasz



Comparison of laparoscopic versus conventional open surgical staging procedure for endometrial cancer  

PubMed Central

Objective The aim of this study was to compare the surgical outcomes of laparoscopic surgery and conventional laparotomy for endometrial cancer. Methods A total of 104 consecutive patients were non-randomly assigned to either laparoscopic surgery or laparotomy. All patients underwent comprehensive surgical staging procedures including total hysterectomy, bilateral salpingo-oophorectomy, and pelvic/para-aortic lymphadenectomy. The safety, morbidity, and survival rates of the two groups were compared, and the data was retrospectively analyzed. Results Thirty-four patients received laparoscopic surgery and 70 underwent laparotomy. Operation time for the laparoscopic procedure was 227.0±28.8 minutes, which showed significant difference from the 208.1±46.4 minutes (p=0.032) of the laparotomy group. The estimated blood loss of patients undergoing laparoscopic surgery was 230.3±92.4 mL. This was significantly less than that of the laparotomy group (301.9±156.3 mL, p=0.015). The laparoscopic group had an average of 20.8 pelvic and 9.1 para-aortic nodes retrieved, as compared to 17.2 pelvic and 8.5 para-aortic nodes retrieved in the laparotomy group. There was no significant difference (p=0.062, p=0.554). The mean hospitalization duration was significantly greater in the laparotomy group than the laparoscopic group (23.3 and 16.4 days, p<0.001). The incidence of postoperative complications was 15.7% and 11.8% in the laparotomy and laparoscopic groups respectively. No statistically significant difference was found between the two groups in the survival rate. Conclusion Laparoscopic surgical staging operation is a safe and effective therapeutic procedure for management of endometrial cancer with an acceptable morbidity compared to the laparotomic approach, and is characterized by far less blood loss and shorter postoperative hospitalization.

Kong, Tae Wook; Lee, Kyung Mi; Cheong, Ji Yoon; Kim, Woo Young; Yoo, Seung-Chul; Yoon, Jong-Hyuck; Chang, Ki-Hong; Ryu, Hee-Sug



Laparoscopic cystoprostatectomy in a heart transplant recipient.  


A 72-year-old orthotopic cardiac transplant recipient with multiple, previously resected, cutaneous squamous cell carcinoma (SCC) presented with invasive SCC of the urinary bladder. At surgery, clot retention was managed with clot evacuation and continuous bladder irrigation to facilitate dissection. Laparoscopic cystoprostatectomy and bilateral pelvic lymph node dissection with extracorporeal ileal conduit urinary diversion were performed in 6 hours without complication. This approach minimized blood loss and allowed sufficient time out of steep Trendelenberg to reequilibrate the patient's cardiovascular system. Final pathology revealed SCC with perivesical fat invasion. This immunocompromised patient remains disease free 2 months after resection. PMID:18574428

Lane, Brian R; Aron, Monish; Pritchard, Claudene; Fergany, Amr F; Desai, Mihir M



Robotic-assisted laparoscopic mesh sacrocolpopexy  

PubMed Central

The current ‘gold standard’ surgical repair for apical prolapse is the abdominal mesh sacrocolpopexy. Use of a robotic-assisted laparoscopic surgical approach has been demonstrated to be feasible as a minimally invasive approach and is gaining popularity amongst pelvic floor reconstructive surgeons. Although outcome data for robotic-assisted sacrocolpopexy (RASC) is only just emerging, several small series have demonstrated anatomic and functional outcomes, as well as complication rates, comparable to those reported for open surgery. The primary advantages thus far for RASC over open surgery include decreased blood loss and shorter hospital stay.

Gilleran, Jason P.; Johnson, Matthew; Hundley, Andrew



Laparoscopic findings in female genital tuberculosis  

Microsoft Academic Search

Objectives  To evaluate the laparoscopic findings in genital tuberculosis (TB).\\u000a \\u000a \\u000a \\u000a Methods  A total of 85 women of genital TB, who underwent diagnostic laparoscopy for infertility or chronic pelvic pain were enrolled\\u000a in this retrospective study conducted in our unit at All India Institute of Medical Sciences, New Delhi, India from September\\u000a 2004 to 2007.\\u000a \\u000a \\u000a \\u000a Results  The mean age was 28.2 years and the mean

Jai Bhagwan Sharma; Kallol K. Roy; M. Pushparaj; S. Kumar; N. Malhotra; S. Mittal



Cholecystogastric fistula: laparoscopic repair.  


We describe a patient with a cholecystogastric fistula treated by the laparoscopic approach. The use of intracorporeal suturing allows laparoscopic management of cholecystogastric fistulae without the need for an endoscopic transecting stapler. PMID:11525375

Prasad, A; Kapur, R



[Laparoscopic cholecystectomy in a patient with situs inversus].  


Laparoscopic cholecystectomy is the standard approach to manage symptomatic gallbladder stones. However, only twelve patients with total situs invertus have been previously reported in the literature. We report a new case of a 58-year-old patient hospitalized for acute pain of the left hypochondrium with fever. The diagnosis of acute cholecystitis with situs inversus totalis was made following clinical examination and radiological investigations. Laparoscopic cholecystectomy was subsequently performed through a modification of the technique to adapt to the mirror image anatomy. PMID:16460662

Bedioui, H; Chebbi, F; Ayadi, S; Makni, A; Fteriche, F; Ksantini, R; Jouini, M; Kacem, M; Ben Safta, Z



Managing pelvic inflammatory disease.  


Pelvic inflammatory disease (PID) describes the clinical features of sexually transmitted pelvic infection ranging from acute salpingitis to salpingo-oophoritis and ultimately pelvic abscess. Intra-tubal adhesions and pelvic adhesive disease are the long-term sequelae of PID which may lead to both sub-fertility and tubal ectopic pregnancy. Laparoscopy is the definitive diagnostic modality, but is invasive and not suitable for routine clinical practice especially in the primary care setting. Ascending infection by Neiserria gonorrhoea, Chlamydia trachomatis and less commonly bacterial vaginosis and mycoplasma have been traditionally associated as causative pathogens in PID. As polymicrobial infections are being implicated in PID before culture and sensitivity results are available empirical treatment based on clinical guidelines is justified initially. Pre-emptive testing and treatment for woman at increased risk of chlamydia has been shown to reduce the risk of PID by up to two-thirds. It is imperative that medical practitioners have low thresholds for testing and treatment of both sexually active young women and men. PMID:18705484

Sivalingam, N; Vanitha, N S; Loh, K Y



Challenges of Laparoscopic Surgery  

NSDL National Science Digital Library

Students teams use a laparoscopic surgical trainer to perform simple laparoscopic surgery tasks (dissections, sutures) using laparoscopic tools. Just like in the operating room, where the purpose is to perform surgery carefully and quickly to minimize patient trauma, students' surgery time and mistakes are observed and recorded to quantify their performances. They learn about the engineering component of surgery.

Integrated Teaching And Learning Program


Neural control of the female urethral and anal rhabdosphincters and pelvic floor muscles  

PubMed Central

The urethral rhabdosphincter and pelvic floor muscles are important in maintenance of urinary continence and in preventing descent of pelvic organs [i.e., pelvic organ prolapse (POP)]. Despite its clinical importance and complexity, a comprehensive review of neural control of the rhabdosphincter and pelvic floor muscles is lacking. The present review places historical and recent basic science findings on neural control into the context of functional anatomy of the pelvic muscles and their coordination with visceral function and correlates basic science findings with clinical findings when possible. This review briefly describes the striated muscles of the pelvis and then provides details on the peripheral innervation and, in particular, the contributions of the pudendal and levator ani nerves to the function of the various pelvic muscles. The locations and unique phenotypic characteristics of rhabdosphincter motor neurons located in Onuf's nucleus, and levator ani motor neurons located diffusely in the sacral ventral horn, are provided along with the locations and phenotypes of primary afferent neurons that convey sensory information from these muscles. Spinal and supraspinal pathways mediating excitatory and inhibitory inputs to the motor neurons are described; the relative contributions of the nerves to urethral function and their involvement in POP and incontinence are discussed. Finally, a detailed summary of the neurochemical anatomy of Onuf's nucleus and the pharmacological control of the rhabdosphincter are provided.

de Groat, William C.



Laparoscopic restaging of ovarian granulosa cells tumor: three cases report  

Microsoft Academic Search

Granulosa cell tumor (GCT) of the ovary is an uncommon neoplasm, often diagnosed at an early stage. Surgery is necessary for\\u000a definitive diagnosis and staging. Complete staging is recommended as for epithelial ovarian cancer and a restaging procedure\\u000a is sometime required. The staging procedure should include evaluation of para-aortic and pelvic lymph nodes. We report three\\u000a cases of laparoscopic restaging

Eugenio Volpi; Annamaria Ferrero; Elisa Cassina; Francesca Pastorino



Surgical management of pelvic Ewing's sarcoma  

PubMed Central

Background: Despite advances in adjuvant therapy, Ewing’s sarcoma of the pelvis remains an anatomic site with a poor prognosis due to its relative inaccessibility, complex anatomy, and limited reconstructive options available. This study evaluates the role of surgery in the management of patients with pelvic Ewing’s sarcoma who also have received conventional radiation therapy and chemotherapy. Materials and Methods: From July 1990 to July 2006, we received 10 patients with Ewing’s sarcoma of pelvis at our center. Nine patients were in stage II B and one in Stage III at the time of presentation to us. All patients underwent surgical resection after preoperative chemotherapy with or without radiotherapy, which was given at the discretion of the referral center. Reconstruction was attempted using plate osteosynthesis in four patients, SS wires and screws in three patients, free fibular strut graft in one patient, and none was done in two patients. Results: Functional outcome assessed by Enneking’s criteria revealed excellent outcome in two patients, good outcome in five patients, and poor outcome in two patients. At a mean followup of 10.3 years, seven patients remained free from the disease, and three patients died. The 5- and 10-year cumulative survival (Kaplan Meier method) was 63% and 34%, respectively. Conclusion: This study demonstrates that surgery plus chemotherapy and radiation therapy is helpful for treating patients with pelvic Ewing’s sarcoma, particularly in achieving local control.

Natarajan, Mayil Vahanan; Sameer, M Mohamed; Bose, Jagdish Chandra; Dheep, Kunal



The current status of robotic pelvic surgery: results of a multinational interdisciplinary consensus conference  

Microsoft Academic Search

Background  Despite the significant benefits of laparoscopic surgery, limitations still exist. One of these limitations is the loss of\\u000a several degrees of freedom. Robotic surgery has allowed surgeons to regain the two lost degrees of freedom by introducing\\u000a wristed laparoscopic instruments.\\u000a \\u000a \\u000a \\u000a Methods  At the first Pelvic Surgery Meeting held in Brescia in June 2007, the participants focused on the role of robotic

Steven D. Wexner; Roberto Bergamaschi; Antonio Lacy; Jonas Udo; Hans Brölmann; Robin H. Kennedy; Hubert John



MR-Based Three-Dimensional Modeling of the Normal Pelvic Floor in Women: Quantification of Muscle Mass  

Microsoft Academic Search

ncontinenceand prolapse remains elusive, in part becauseof limited knowledge of anatomy of thepelvic floor. Conventional two-dimensionalMR imaging was used by several researchgroups to assess the anatomy of the female pelvicfloor in cadavers and incontinent women[2--7]. Although not yet extensively evaluated,three-dimensional (3D) imaging has the potentialadvantage of quantification of muscle volume.This quantification may be valuable in theevaluation of pelvic floor...

Julia R. Fielding; Huseyin Dumanli; Andreas G. Schreyer; Shigeo Okuda; David T. Gering; Kelly H. Zou; Ron Kikinis; Ferenc A. Jolesz


Laparoscopic Palanivelu-hydatid-system aided management of retrovesical hydatid cyst.  


Hydatid cysts of the retrovesical region are rare. They are often adherent to the adjacent bowel and bladder, and complete removal is associated with potential injuries. The Palanivelu hydatid system allows minimally invasive treatment of hydatid cysts with no adjacent organ injuries. We describe the laparoscopic management of a pelvic hydatid cyst using this system. PMID:23671368

Subramaniam, Bala; Abrol, Nitin; Kumar, Rajeev



Laparoscopic Palanivelu-hydatid-system aided management of retrovesical hydatid cyst  

PubMed Central

Hydatid cysts of the retrovesical region are rare. They are often adherent to the adjacent bowel and bladder, and complete removal is associated with potential injuries. The Palanivelu hydatid system allows minimally invasive treatment of hydatid cysts with no adjacent organ injuries. We describe the laparoscopic management of a pelvic hydatid cyst using this system.

Subramaniam, Bala; Abrol, Nitin; Kumar, Rajeev



Testicular Vein Syndrome and Its Treatment with a Laparoscopic Approach  

PubMed Central

Background and Objectives: Testicular vein syndrome (TVS) is a rare cause of ureteral obstruction. Only 5 previous cases are on record in the literature, and no review exists on this topic to date. Laparoscopic treatment has never been mentioned in the management of TVS. Materials and Methods: We reviewed the literature related to this unusual entity to clarify the preoperative evaluation and the management of TVS. For this purpose, the data related to all the 5 cases previously reported so far in the English literature have been reviewed. Also, we report the sixth case of TVS, and the first patient to be successfully treated with the laparoscopic approach. This was a 37-year-old male with a 6-month history of left loin pain. Preoperative diagnosis was confirmed by CT-Urography. Results: Our patient underwent laparoscopic excision of the left testicular vein followed by ureteroureterostomy in a single sitting. The laparoscopic transperitoneal approach was used. Histopathological examination of the vein showed normal venous tissue. This is the sixth reported case of TVS and the first to be successfully treated with a laparoscopic technique. Conclusions: A laparoscopic approach is safe and effective for treating patients with TVS with the common advantages of minimal invasiveness and better visualization of the complex anatomy of the retroperitoneum. Thus, it should be the treatment of choice for TVS.

Arvind, Nand Kishore; Gupta, Shilpi Singh



Anatomy: Spotlight on Africa  

ERIC Educational Resources Information Center

|Anatomy departments across Africa were surveyed regarding the type of curriculum and method of delivery of their medical courses. While the response rate was low, African anatomy departments appear to be in line with the rest of the world in that many have introduced problem based learning, have hours that are within the range of western medical…

Kramer, Beverley; Pather, Nalini; Ihunwo, Amadi O.




Microsoft Academic Search

PurposeWe present a comprehensive account of clitoral anatomy, including its component structures, neurovascular supply, relationship to adjacent structures (the urethra, vagina and vestibular glands, and connective tissue supports), histology and immunohistochemistry. We related recent anatomical findings to the historical literature to determine when data on accurate anatomy became available.




Laparoscopic supracervical hysterectomy with transcervical morcellation and sacrocervicopexy: initial experience with a novel surgical approach to uterovaginal prolapse.  


The objective of this retrospective study was to evaluate the feasibility, safety, and efficacy of a new laparoscopic technique for the treatment of uterovaginal prolapse using a transcervical access port to minimize the laparoscopic incision. From February 2008 through August 2010, symptomatic pelvic organ prolapse in 43 patients was evaluated and surgically treated using this novel procedure. Preoperative assessment included pelvic examination, the pelvic organ prolapse quantification scoring system (POP-Q), and complex urodynamic testing with prolapse reduction to evaluate for symptomatic or occult stress urinary incontinence. The surgical procedure consisted of laparoscopic supracervical hysterectomy with transcervical morcellation and laparoscopic sacrocervicopexy with anterior and posterior mesh extension. Concomitant procedures were performed as indicated. All procedures were completed laparoscopically using only 5-mm abdominal port sites, with no intraoperative complications. Patients were followed up postoperatively for pelvic examination and POP-Q at 6 weeks, 6 months, and 12 months. The median (interquartile range) preoperative POP-Q values for point Aa was 0 (-1.0 to 1.0), and for point C was -1.0 (-3.0 to 2.0). Postoperatively, median points Aa and C were significantly improved at 6 weeks, 6 months, and 12 months (all p < .001). One patient was found to have a mesh/suture exposure from the sacrocervicopexy, which was managed conservatively without surgery. We conclude that laparoscopic supracervical hysterectomy with transcervical morcellation and laparoscopic sacrocervicopexy is a safe and feasible surgical approach to treatment of uterovaginal prolapse, with excellent anatomic results at 6 weeks, 6 months, and 12 months. Potential advantages of the procedure include minimizing laparoscopic port site size, decreasing the rate of mesh exposure compared with other published data, and reducing the rate of postoperative cyclic bleeding in premenopausal women by removing the cervical core. Longer follow-up is needed to determine the durability and potential long-term sequelae of the procedure. PMID:23084680

Rosenblatt, Peter L; Apostolis, Costas A; Hacker, Michele R; DiSciullo, Anthony


Laparoscopic Doppler Technology in Laparoscopic Renal Surgery  

PubMed Central

Background and Objectives: Laparoscopic Doppler technology has previously been reported to help identify vasculature during laparoscopy. Recently, we published our initial experience with this technology during laparoscopic radical nephrectomy, laparoscopic nephroureterectomy, laparoscopic partial nephrectomy, and robotic-assisted laparoscopic pyeloplasty. We now present a prospective, pilot evaluation of the Doppler probe for these procedures. Methods: A laparoscopic Doppler probe was used in the above laparoscopic renal surgeries in 50 patients. Anatomic findings, Doppler survey time, dissection time, operative time, estimated blood loss, changes in management, subjective time saved/utility, technical difficulties, clinical complications, and ease of use were prospectively recorded. Results: Mean Doppler survey time was 1.77 minutes. Mean hilar dissection time was 9.25 minutes. Eight accessory vessels were not seen on preoperative imaging in 7 patients (17%). In 3 cases of RALP, Doppler rectified preoperative imaging in detecting a crossing vessel. The probe altered management in 16% of patients, subjectively saved time in 78% of patients, and had 100% concordance with dissection. There were no complications but 2 technical failures. Conclusion: The probe is quick, safe, easy to use, and has perfect concordance with surgical dissection. Randomized comparison with and without Doppler assistance is necessary to confirm the utility of this technology.

Perlmutter, Mark A.; Hyams, Elias S.



The Virtual Pelvic Floor, a tele-immersive educational environment.  

PubMed Central

This paper describes the development of the Virtual Pelvic Floor, a new method of teaching the complex anatomy of the pelvic region utilizing virtual reality and advanced networking technology. Virtual reality technology allows improved visualization of three-dimensional structures over conventional media because it supports stereo vision, viewer-centered perspective, large angles of view, and interactivity. Two or more ImmersaDesk systems, drafting table format virtual reality displays, are networked together providing an environment where teacher and students share a high quality three-dimensional anatomical model, and are able to converse, see each other, and to point in three dimensions to indicate areas of interest. This project was realized by the teamwork of surgeons, medical artists and sculptors, computer scientists, and computer visualization experts. It demonstrates the future of virtual reality for surgical education and applications for the Next Generation Internet. Images Figure 1 Figure 2 Figure 3

Pearl, R. K.; Evenhouse, R.; Rasmussen, M.; Dech, F.; Silverstein, J. C.; Prokasy, S.; Panko, W. B.



Anatomic Basis of Sharp Pelvic Dissection for Curative Resection of Rectal Cancer  

PubMed Central

The optimal goals in the surgical treatment of rectal cancer are curative resection, anal sphincter preservation, and preservation of sexual and voiding functions. The quality of complete resection of rectal cancer and the surrounding mesorectum can determine the prognosis of patients and their quality of life. With the emergence of total mesorectal excision in the field of rectal cancer surgery, anatomical sharp pelvic dissection has been emphasized to achieve these therapeutic goals. In the past, the rates of local recurrence and sexual/voiding dysfunction have been high. However, with sharp pelvic dissection based on the pelvic anatomy, local recurrence has decreased to less than 10%, and the preservation rate of sexual and voiding function is high. Improved surgical techniques have created much interest in the surgical anatomy related to curative rectal cancer surgery, with particular focus on the fascial planes and nerve plexuses and their relationship to the surgical planes of dissection. A complete understanding of rectum anatomy and the adjacent pelvic organs are essential for colorectal surgeons who want optimal oncologic outcomes and safety in the surgical treatment of rectal cancer.

Kim, Nam Kyu



Laparoscopic Approaches to Colonic Malignancy  

Microsoft Academic Search

\\u000a The last two decades have witnessed the surge and success of laparoscopic approaches in several surgical arenas. Laparoscopic\\u000a cholecystectomy, laparoscopic solid organ surgery, and laparoscopic gastric bypass have become the standard of care. Adoption\\u000a of laparoscopic colectomy has remained low until the middle of this decade and is approaching 10% for benign disease [1].\\u000a \\u000a \\u000a Concerns over the appropriateness of laparoscopic

Juliane Bingener; Heidi Nelson


Functional anorectal and pelvic pain.  


Functional anorectal and pelvic pain syndromes represent a diverse group of disorders that affect the quality of life and about which many physicians possess little understanding. Nongynecologic causes include levator ani syndrome, proctalgia fugax, and coccygodnia, which can often be distinguished by careful history and physical examination. In women, chronic pelvic pain may arise from the uterus, cervix, ovaries, or from endometriosis and pelvic adhesions. This article reviews these diverse disorders and the approach to diagnosis and management. PMID:11394033

Wald, A



Laparoscopic proctectomy: oncologic considerations.  


The role of laparoscopic proctectomy in rectal cancer has not clearly been defined. Publications on long-term outcomes after laparoscopic proctectomy is lacking and there is a wide variation of practice patterns of rectal cancer management. Current data supports the feasibility of laparoscopic proctectomy for rectal cancer but due to surgeon, patient and tumor related factors open technique may be favored. Current series suggest that laparoscopic proctectomy can be performed with similar oncologic adequacy with regards to, circumferential resection margin, distal margin, local recurrence and quality of life. Ongoing trials will provide evidence clarifying the role of laparoscopic proctectomy in rectal cancer. Until then, high-level laparoscopic skills and meticulous preoperative evaluation of both patient and tumor can identify appropriate candidates. PMID:22678308

Asgeirsson, Theodor; Delaney, Conor P



Applied peritoneal anatomy.  


The peritoneal cavity is a complex anatomical structure with multiple attachments and connections. These are better understood with reference to the embryological development of this region. Armed with this knowledge, the diagnosis and assessment of a wide range of common intra-abdominal diseases becomes straightforward. This article will review and simplify the terminology, complex embryological development, and anatomy of the peritoneum, peritoneal attachments, and the reflections forming the peritoneal boundaries. Normal anatomy will be described using schematic diagrams with corresponding computed tomography (CT) and magnetic resonance imaging (MRI) images, including CT peritoneograms. The relevance of intra- and extra-peritoneal anatomy to common pathological processes will be demonstrated. PMID:23149392

Patel, R R; Planche, K



Laparoscopic herniorrhaphy in children  

Microsoft Academic Search

  Background: We report our clinical experience with 403 inguinal hernias in 279 children. They were treated via a purely laparoscopic\\u000a approach using 2-mm instruments, obviating the need for a groin incision. Methods: Laparoscopic herniorrhaphy was performed\\u000a in children ages 4 days to 15 years. A 5-mm laparoscope was inserted through the umbilicus, and two 2-mm needle holders were\\u000a inserted through

C. M. Gorsler; F. Schier



Laparoscopic reconstructive urology  

PubMed Central

Objective: Laparoscopic reconstructive urology is undergoing rapid change. We review the current status of laparoscopic reconstructive urology, with particular respect to pyeloplasty and reconstructive ureteric surgery. Methods: An extensive Medline search of reconstructive laparoscopic procedures was undertaken. The initial reports and large series reports of a range of procedures was examined and summarised. The most commonly practised procedure within this remit is laparoscopic pyeloplasty. Several series of over 100 patients have been published. Success rates average over 90% for laparoscopic pyeloplasty with a low complication rate. Much less common laparoscopic reconstructive urological procedures include ureteric re-implantation, Boari flap, urinary diversion and transuretero-ureterostomy. The results of these are encouraging. Conclusions: Laparoscopic pyeloplasty may be safely performed by either the transperitoneal or retroperitoneal routes with excellent results. It should be considered the “gold standard” for the management of UPJ obstruction, especially in those patients with significant hydronephrosis, renal impairment or a crossing vessel. Laparoscopic ureteric reimplantation, Boari flap, urinary diversion and transuretero-ureterostomy have been performed by experienced laparoscopic urologists with encouraging results.

Murphy, Declan; Challacombe, Ben; Rane, Abhay



Laparoscopic transperitoneal pyeloplasty.  


Laparoscopic pyeloplasty is a first-line option for the management of ureteropelvic junction obstruction. It has a greater success rate than endopyelotomy and is associated with a shorter and less intense convalescence than open surgical pyeloplasty. The technique is well established and reproducible, although the procedure is more difficult in certain situations, such as after a previous pyeloplasty. Because laparoscopic suturing is needed, it is considered an advanced laparoscopic procedure. Suturing devices can facilitate suturing, but they are not optimal for all repairs. This article and the accompanying video summarize the preoperative, intraoperative, and postoperative considerations for laparoscopic pyeloplasty. PMID:21235382

Wolf, J Stuart



[Intraoperative digital cholangiography during laparoscopic cholecystectomy interventions].  


In the last years, laparoscopic cholecystectomy has become the method of choice in the surgical treatment of gallbladder stones. Recently, the same laparoscopic approach has been used to remove choledochus stones. This surgical procedure needs the accurate intraoperative study of the biliary tree with diagnostic imaging modalities to better define the anatomy of the biliary ducts and the possible presence of choledochus stones. To this purpose, transcutaneous and endolaparoscopic US with dedicated probes and intraoperative cholangiography can be performed. In this study, we performed 30 laparoscopic cholecystectomies during which all the patients were submitted to intraoperative cholangiography with a digital fluoroscopic unit. The maneuvers for catheter insertion in the cystic duct and the examination as a whole took 3 to 5 minutes. Intraoperative cholangiography demonstrated choledochus stones in 3 patients, while preoperative US detected them in 2 patients only. In 8 cases the dynamic study, carried out with digital image acquisition, allowed to refer the biliary duct filling defects to artifacts caused by the presence of air bubbles. In conclusion, intraoperative cholangiography, also during endolaparoscopic cholecystectomy, plays a major role in the surgical assessment of the biliary tree. When the procedure was performed with a digital fluoroscopic unit, its diagnostic accuracy was higher and the images on the TV monitor were better visualized. PMID:7938729

Di Girolamo, M; Pavone, P; Lomanto, D; Carlei, F; Fiocca, F; Nardovino, M; Laghi, A; Lezoche, E; Speranza, V



Pathological Anatomy of Complications.  

National Technical Information Service (NTIS)

A number of papers in the recent literature have been concerned with various aspects of the pathogenesis of retinal detachment. Little has been written, however, about the pathological anatomy of the eye after operations for reattachment of the retina. In...

M. Boniuk L. E. Zimmerman



Pearl Millet Anatomy.  

National Technical Information Service (NTIS)

The literature on pearl millet (Pennisetum americanum Pennisetum typhoides) anatomy is limited. It is scattered in a variety of studies, most of which lack adequate illustration. Only two general descriptions are known to the authors. The present study is...

R. K. Maiti S. S. Bisen



Epidemiology of pelvic floor dysfunction.  


The epidemiology of female pelvic floor disorders, including urinary incontinence, pelvic organ prolapse, anal incontinence, and interstitial cystitis/painful bladder syndrome is reviewed. The natural history, prevalence, incidence, remission, risk factors, and potential areas for prevention are considered. PMID:19932408

Sung, Vivian W; Hampton, Brittany Star



Chronic pelvic pain in women  

Microsoft Academic Search

Chronic pelvic pain is a major public health problem for women throughout the developed world. The complex innervation of the pelvis and the anatomical proximity of pelvic viscera mean this symptom frequently overlaps traditional medical specialties, leading to diagnostic delay and frequently inadequate treatment. Careful history taking and examination can in itself be therapeutic and will likely identify a number

K Vincent



Pelvic injuries in child abuse  

Microsoft Academic Search

Three cases of child abuse are described in which pelvic injuries were prominent findings on radiologic examination: Two patients had pelvic fractures, and one was found to have heterotopic ossification of the soft tissues of the pelvis and thighs corresponding to extensive bruising in the pubic, genital, buttock, and thigh areas, resulting from physical and sexual abuse. These represent uncommon

D. S. Ablin; A. Greenspan; M. A. Reinhart



Two cases of malignant struma ovarii with metastasis to pelvic bone.  


Histologically, malignant struma ovarii metastasizes rarely, and only a few cases reported bone metastasis. Here, we describe 2 cases of biologically malignant struma ovarii with pelvic bone metastasis. Case 1 is a 22-year-old female who was found to have a large left ovarian mass during routine prenatal ultrasound. Papillary thyroid cancer arising in struma ovarii was identified after laparoscopic salpingo-oophorectomy. After total thyroidectomy, radioactive iodine whole-body scan revealed extrathyroidal iodine uptake in left anterior pelvis. Subsequent I-131 treatment resolved the pelvic metastasis. Case 2 is a 49-year-old female who was diagnosed with malignant struma ovarii in 1996 and presented in 2007 with pelvic recurrence and extensive left hip metastasis. Treatment with resection of the pelvic tumor, total thyroidectomy, and multiple I-131 ablation led to eventual resolution of the abdominal and left hip foci. In conclusion, we present 2 rare cases of malignant struma ovarii, both with metastasis to the pelvic bone. This report makes pelvic bone the most frequent site for bone metastasis in malignant struma ovarii. It also emphasizes the importance of total thyroidectomy in allowing identification and treatment of bony metastasis with radioactive iodine. PMID:23391779

Steinman, Rachel A; De Castro, Ismary O; Shrayyef, Muhammad; Chengazi, Vaseem; Giampoli, Ellen; Van Der Sloot, Paul; Calvi, Laura M; Wittlin, Steven D; Hammes, Stephen R; Hou, Runhua



Raising the thinker: new concept for dissecting the cystic pedicle during laparoscopic cholecystectomy.  


Imprecise dissection due to poor visualization of anatomic structures is among the major causes of biliary injuries during laparoscopic cholecystectomy. Developing new illustrational and rendering techniques represents an important part in decreasing visual deception and subsequent bile duct injuries. We use the model of one of the most well-known pieces of art, Rodin's The Thinker, to visualize the gallbladder and cystic pedicle structures. This minimizes visual deception before dissection, especially in cases with obscured structures. Our method, raising The Thinker, is based on the remarkable similarity between the sculpture and the topographic anatomy of the gallbladder. The method can be used not only for better orientation and visualization during laparoscopic cholecystectomy but also as a tool to complement the teaching of laparoscopic biliary anatomy to surgical residents and medical students. PMID:22184309

Neychev, Vladimir; Saldinger, Pierre F



Laparoscopic Warm-up Exercises Improve Performance of Senior-Level Trainees During Laparoscopic Renal Surgery  

PubMed Central

Abstract Background and Purpose Surgery is a high-stakes “performance.” Yet, unlike athletes or musicians, surgeons do not engage in routine “warm-up” exercises before “performing” in the operating room. We study the impact of a preoperative warm-up exercise routine (POWER) on surgeon performance during laparoscopic surgery. Materials and Methods Serving as their own controls, each subject performed two pairs of laparoscopic cases, each pair consisting of one case with POWER (+POWER) and one without (–POWER). Subjects were randomly assigned to +POWER or ?POWER for the initial case of each pairing, and all cases were performed ?1 week apart. POWER consisted of completing an electrocautery skill task on a virtual reality simulator and 15 minutes of laparoscopic suturing and knot tying in a pelvic box trainer. For each case, cognitive, psychomotor, and technical performance data were collected during two different tasks: mobilization of the colon (MC) and intracorporeal suturing and knot tying (iSKT). Statistical analysis was performed using SYSTAT v11.0. Results A total of 28 study cases (14+POWER, 14?POWER) were performed by seven different subjects. Cognitive and psychomotor performance (attention, distraction, workload, spatial reasoning, movement smoothness, posture stability) were found to be significantly better in the +POWER group (P?0.05) and technical performance, as scored by two blinded laparoscopic experts, was found to be better in the +POWER group for MC (P=0.04) but not iSKT (P=0.92). Technical scores demonstrated excellent reliability using our assessment tool (Cronbach ?=0.88). Subject performance during POWER was also found to correlate with intraoperative performance scores. Conclusions Urologic trainees who perform a POWER approximately 1 hour before laparoscopic renal surgery demonstrate improved cognitive, psychomotor, and technical performance.

Lee, Jason Y.; Mucksavage, Phillip; Kerbl, David C.; Osann, Kathryn E.; Winfield, Howard N.; Kahol, Kanav



The International Pelvic Pain Society  

NSDL National Science Digital Library

The International Pelvic Pain Society (IPPS) was founded in 1996 by health professionals as a forum for public and professional education regarding chronic pelvic pain. One of the primary objectives of the IPPS is to "educate health care professionals how to diagnose and manage chronic pelvic pain, thereby changing the lives of patients worldwide." The IPPS is especially focused on addressing the pelvic health needs of women. For health care providers, the IPPS website offers a number of helpful resources such as downloadable articles and Powerpoint presentations concerning Endoscopy, Vulvodunia, Pelvic Congestion, and Physical Therapy, to name a few. The site also offers a collection of Featured Scientific Articles, downloadable IPPS newsletters (current and past), an assemblage of annotated links to related organizations, and more. Offerings for patients include a downloadable Patient Education Booklet, Patient Testimonials, and a service for locating nearby health care providers.


Comparison between dynamic cystocolpoproctography and dynamic pelvic floor MRI: pros and cons: Which is the "functional" examination for anorectal and pelvic floor dysfunction?  


"Functional" imaging of anorectal and pelvic floor dysfunction has assumed an important role in the diagnosis and management of these disorders. Although defecography has been widely practiced for decades to evaluate the dynamics of rectal emptying, debate concerning its clinical relevance, how it should be done and interpreted continues. Due to the recognition of the association of defecatory disorders with pelvic organ prolapse in women, the need to evaluate the pelvic floor as a unit has arisen. To meet this need, defecography has been extended to include not only evaluation of defecation disorders but also the rest of the pelvic floor by opacifying the small bowel, vagina, and the urinary bladder. The term "dynamic cystocolpoproctography" (DCP) has been appropriately applied to this examination. Rectal emptying performed with DCP provides the maximum stress to the pelvic floor resulting in complete levator ani relaxation. In addition to diagnosing defecatory disorders, this method of examination demonstrates maximum pelvic organ descent and provides organ-specific quantification of organ prolapse, information that is only inferred by means of physical examination. It has been found to be of clinical value in patients with defecation disorders and the diagnosis of associated prolapse in other compartments that are frequently unrecognized by history taking and the limitations of physical examination. Pelvic floor anatomy is complex and DCP does not show the anatomical details pelvic magnetic resonance imaging (MRI) provides. Technical advances allowing acquisition of dynamic rapid MRI sequences has been applied to pelvic floor imaging. Early reports have shown that pelvic MRI may be a useful tool in pre-operative planning of these disorders and may lead to a change in surgical therapy. Predictions of hypothetical increase cancer incidence and deaths in patients exposed to radiation, the emergence of pelvic floor MRI in addition to questions relating to the clinical significance of DCP findings have added to these controversies. This review analyses the pros and cons between DCP and dynamic pelvic floor MRI, addresses imaging and interpretive controversies, and their relevance to clinical management. PMID:22446896

Maglinte, Dean D T; Hale, Douglass S; Sandrasegaran, Kumar



Transvaginal nephrectomy with a multichannel laparoscopic port: a cadaver study.  


OBJECTIVE To determine whether a novel port (QuadPort, Advanced Surgical Concepts, Wicklow, Ireland) can facilitate transvaginal nephrectomy (TN), a natural orifice transluminal surgery (NOTES) procedure, using standard and articulating laparoscopic instruments. MATERIALS AND METHODS Four fresh female cadavers were used in this feasibility study with a plan to perform two right-sided and two left-sided TN. Exclusion criteria were a history of nephrectomy and a height of >1.82 m. The cadaver was placed in the lithotomy position with the target side up 30-45 degrees . A three-channel R-port (Advanced Surgical Concepts) was placed in the umbilicus to monitor the transvaginal procedure. The four-channel QuadPort was placed through the posterior fornix into the peritoneal cavity. Regular laparoscopic instruments were used transvaginally to mobilize the colon, dissect the ureter, identify and divide the renal artery between clips, and divide the renal vein with a laparoscopic stapler. Remaining attachments of the kidney were divided and the specimen entrapped in a plastic bag before transvaginal extraction. RESULTS Three (two right- and one left-sided) TNs were performed successfully; one left-sided TN was aborted in the last cadaver due to dense pelvic adhesions from previous pelvic surgery. In the first two cadavers we required assistance from the umbilical port only to divide the attachments between the upper pole of the kidney and the diaphragm supero-posteriorly. In the third case we were able to perform this dissection completely transvaginally using a flexible gastroscope. CONCLUSIONS A completely NOTES-based TN in humans is challenging. Robust laparoscopic instruments have the requisite tensile strength when deployed through a large calibre, secure, multichannel transvaginal port. Extra-long laparoscopic instruments are helpful. The cephalad aspect of the hilum and the upper pole attachments are difficult areas. Novel and robust flexible instruments still need to be developed. PMID:19489791

Aron, Monish; Berger, Andre K; Stein, Robert J; Kamoi, Kazumi; Brandina, Ricardo; Canes, David; Sotelo, Rene; Desai, Mihir M; Gill, Inderbir S



Laparoscopic total abdominal colectomy  

Microsoft Academic Search

The aim of this study was to prospectively assess the impact of laparoscopy upon the outcome of total abdominal colectomy (TAC). Specifically, patients underwent standard laparotomy with TAC and ileoproctostomy (TAC + IP), TAC and ileoanal reservoir (TAC + IAR), laparoscopically assisted TAC + IP (L-TAC + IP), or laparoscopically assisted TAC + IAR (L-TAC + IAR). Parameters studied included

Steven D. Wexner; Olaf B. Johansen; Juan J. Nogueras; David G. Jagelman



[Management of uncomplicated pelvic inflammatory disease].  


Since the 1993 French consensus conference on uncomplicated pelvic inflammatory diseases (uPID), new antibiotics appeared and bacterial resistances did evoluate. This methodic analysis of the literature updates different aspects of its treatment. Antibiotherapy must be established early (EL3). Inpatient and intravenous treatment is not superior to outpatient and oral treatment (EL1). Ofloxacine+metronidazole association can be proposed in first intention (EL1). If case of Neisseria gonorrhoeae infection, one ceftriaxone injection must be associated (EL4). All the other antibiotics associations have shown to be efficient except the metronidazole+doxycycline association, which is not indicated (EL2). Two weeks treatment seems to be a sufficient duration. Laparoscopic treatment in first intention is not justified except for diagnostic doubts or unfavorable evolution of the medical treatment (EL4). Neither non-steroidic antiinflamatorries, nor corticosteroids, have been proved to be efficient to decrease the adherence risk in uPID (EL3). Early extraction of an intra uterine device (IUD) allows symptomatologic improvement (EL2). Partners treatment with azithromycin improves the 4 months bacteriologic results (EL2). HIV positive patients do not need specific treatment (EL3). PMID:23142353

Bourret, A; Fauconnier, A; Brun, J-L



Laparoscopic entry and exit.  


Minimal access surgery has emerged as an acceptable means of performing therapeutic and diagnostic surgical procedures. Although the gynecologist has utilized the laparoscope for several decades, only recently has laparoscopic surgery gained increased acceptance in the general surgical and urologic community. The number of laparoscopic procedures being performed routinely is now extensive and growing rapidly. It appears that the critical step in performing laparoscopic surgery is the establishment of pneumoperitoneum and the placement of the trocars. This initial part of the procedure when performed properly ensures safe and reliable access allowing the procedure to commence. Difficulties with this part of the procedure may preclude the operative procedure and more importantly may result in potentially severe injuries. Therefore a detailed discussion of the method of performing laparoscopic entry and exit will provide the urologist with the essentials to perform safe and successful laparoscopy. PMID:8239733

Oshinsky, G S; Badlani, G H; Smith, A D



Personal pelvic viewer  

US Patent & Trademark Office Database

The Personal Pelvic Viewer.TM. abbreviated PPV.TM. is a hand-held instrument which a woman may place by herself into her own vagina to conveniently view and record video images of the interior of her vagina and cervix on a remote monitor, such as a television, computer display, or computer monitor. The PPV possesses a sealed video camera and may obtain its battery power through a short cable to a remote transceiver unit which also provides a wireless communication link to a base station transceiver which in turn provides the video information to be displayed on the television, computer display, etc. The PPV provides a convenient instrument that allows a lone female to observe the interior of her own vagina in total privacy for medical reasons, to determine her own fertility, and to observe her sexual response.



Pelvic floor muscle training exercises  


... you are tightening the right muscles, keep in mind that all of the muscles of the pelvic floor relax and contract at the same time. Because these muscles control the bladder, rectum, and vagina, the following tips ...


[Anatomy of the liver].  


Over the past decades, great progress has been made in surgery on the liver. Technical achievements and the strict application of anatomical knowledge to surgical practice have added a new dimension to the field of liver surgery. In some cases, new facts about the anatomy of the liver needed considerable time before being implemented. Surgery of liver metastases, primary tumours of the liver and not least liver transplantation have focussed the interest of visceral surgeons more and more on this organ. Segment-orientated liver anatomy, a knowledge and consideration of vascular structures, and the observance of anatomical landmarks are the prerequisites for successful surgery on the liver. PMID:10960965

Scheuerlein, H; Köckerling, F



Gastroenterological Causes of Pelvic Pain  

Microsoft Academic Search

Chronic abdominal pain accounts for 10% of gynecological consultations and over 30% of diagnostic laparoscopies. There are\\u000a numerous causes of chronic pelvic pain, and it is important to consider non-gynecologic causes such as gastroenterological,\\u000a urological, and neurological causes. The most common gastroenterological cause of chronic abdominal and pelvic pain is irritable\\u000a bowel syndrome (IBS), but other gastrointestinal conditions such as

Aaron Brzezinski


Sectional neuroanatomy of the pelvic floor.  


This is the sixth in a series of articles on the spine. The first 5 reviewed the sectional anatomy of the cervical, thoracic, and lumbosacral spines. This paper will review both the male and female pelves. Procedures performed in the pelvis include electromyography of the anal sphincter, pudendal and sacral nerve stimulator implants, and botulinum toxin type A injections into the prostate, the bladder, the urethra, and the anus. Complications from these procedures are rare. Electromyography in this region is particularly uncomfortable. Botulinum toxin type A denervation may result in local effects such as incontinence or urinary retention or rarely remote effects such as limb weakness. Neurostimulators may get infected or may fail. This article provides anatomically accurate schematics of innervations of the pelvis that can be used to interpret magnetic resonance images of muscles and nerves in the pelvic floor region. Cross-sectional schematics of the male and female pelves were drawn as they appear on imaging projections. The relevant nerves were color coded. The muscles and the skin surfaces were labeled and assigned the color of the appropriate nerves. An organized comprehensive map of the motor innervation of both the male and female pelves allows the physician to increase the accuracy and efficacy of interventional procedures. This anatomic map could also assist the electromyographer in correlating the clinical and electrophysiologic findings on magnetic resonance images. PMID:20498557

Kass, Joseph S; Chiou-Tan, Faye Y; Harrell, John S; Zhang, Han; Taber, Katherine H


Laparoscopic lateral pancreaticojejunostomy  

Microsoft Academic Search

Background  Lateral pancreaticojejunostomy is considered as the standard surgery for chronic pancreatitis. Yet there are very few reports\\u000a of this procedure being done laparoscopically. We present our experience with laparoscopic lateral pancreaticojejunostomy\\u000a till date and describe our technique.\\u000a \\u000a \\u000a \\u000a Material and method  Since 1997, we have done 12 laparoscopic lateral pancreatojejunostomies. There were 9 females and 3 males and the average\\u000a age was

C. Palanivelu; R. Shetty; K. Jani; P. S. Rajan; K. Sendhilkumar; R. Parthasarthi; V. Malladi



Laparoscopic Duhamel procedure  

Microsoft Academic Search

Background: Between February 1995 and June 1998, 30 laparoscopic Duhamel pull-through procedures were performed in our department.\\u000a \\u000a \\u000a \\u000a \\u000a Methods: Our main aim was to prove the feasibility of the laparoscopic abdominal Duhamel procedure for different localizations of\\u000a Hirschsprung disease. We used one camera port and three working ports. The sigmoid colon and posterior rectum were mobilized\\u000a laparoscopically. A standard posterior colo-anal

P. de Lagausie; D. Berrebi; G. Geib; G. Sebag; Y. Aigrain



Urinary and Sexual Disorders After Laparoscopic TME for Rectal Cancer in Males  

Microsoft Academic Search

Background  Urinary and sexual dysfunctions are frequent after surgery for rectal cancer. Total mesorectal excision (TME) improves local\\u000a recurrence and survival rates, and does not hamper recognition and sparing of hypogastric and pelvic splanchnic nerves. It\\u000a is not known how laparoscopic rectal resection could change functional complication rates.\\u000a \\u000a \\u000a \\u000a \\u000a Materials and Methods  From a global series of 1,216 laparoscopic interventions for colorectal diseases,

Carlo Augusto Sartori; Alberto Sartori; Silvia Vigna; Rosario Occhipinti; Gian Luca Baiocchi



Superiority of laparoscopic rectal surgery: Towards a new era  

PubMed Central

While laparoscopic colon surgery has been established to some degree over this decade, laparoscopic rectal surgery is not standard yet because of the difficulty of making a clear surgical field, the lack of precise anatomy of the pelvis, immature procedures of rectal transaction and so on. On the other hand, maintaining a clear surgical field via the magnified laparoscopy may allow easier mobilization of the rectum as far as the levetor muscle level and may result less blood loss and less invasiveness. However, some unique techniques to keep a clear surgical field and knowledge about anatomy of the pelvis are required to achieve the above superior operative outcomes. This review article discusses how to keep a clear operative field, removing normally existing abdominal structures, and how to transact the rectum and restore the discontinuity based on anatomical investigations. According to this review, laparoscopic rectal surgery will become a powerful modality to accomplish a more precise procedure which has been technically impossible so far, actually entering a new era.

Fukunaga, Yosuke



Illustrated Speech Anatomy.  

ERIC Educational Resources Information Center

Written for students in the fields of speech correction and audiology, the text deals with the following: structures involved in respiration; the skeleton and the processes of inhalation and exhalation; phonation and pitch, the larynx, and esophageal speech; muscles involved in articulation; muscles involved in resonance; and the anatomy of the…

Shearer, William M.


Anatomy for Biomedical Engineers  

ERIC Educational Resources Information Center

|There is a perceived need for anatomy instruction for graduate students enrolled in a biomedical engineering program. This appeared especially important for students interested in and using medical images. These students typically did not have a strong background in biology. The authors arranged for students to dissect regions of the body that…

Carmichael, Stephen W.; Robb, Richard A.



Towards laparoscopic tissue aspiration.  


The soft tissue aspiration experiment has been further developed for application during laparoscopic surgery. The new setup has been tested and validated under lab-conditions and came then to in vivo operation. It is to our knowledge the first time ever a mechanical experiment has been performed under laparoscopic conditions on the human, which enables determining corresponding constitutive model equations. As most important results, the feasibility of laparoscopic tissue aspiration has been demonstrated and, based on an ad hoc parameter for the tissue stiffness, the liver and the stomach gave significantly different responses. Furthermore, the determined constitutive behavior for one healthy human liver was in line with results obtained from tissue aspiration during open surgery. Eventually, laparoscopic tissue aspiration might qualify as minimally invasive testing method for tactile feedback systems. The presented results are preliminary and more research is required. PMID:23876854

Hollenstein, Marc; Bugnard, Guillaume; Joos, Renzo; Kropf, Saskia; Villiger, Peter; Mazza, Edoardo



Laparoscopic transabdominal lateral adrenalectomy.  


Laparoscopic adrenalectomy is a mainstay of operative options for adrenal tumors and allows surgeons to perform adrenalectomies with less morbidity, less post-operative pain, and shorter hospital stays. The literature has demonstrated its efficacy to be equal to open adrenalectomy in most cases. With regard to malignant primary and metastatic lesions, controversy still remains, however, consideration of a laparoscopic approach for smaller, well circumscribed and non-invasive lesions is reasonable. During any laparoscopic resection, when there is doubt about the ability to safely remove the lesion with an intact capsule, conversion to an open approach should be considered. The primary goal of a safe and complete oncologic resection cannot be compromised. For most benign lesions, laparoscopic approaches are safe and feasible and conversion to an open approach is necessary only for lesions where size limits the ability of a minimally invasive resection. PMID:22933307

Bickenbach, Kai A; Strong, Vivian E



Laparoscopic pancreatic resections.  


The last decade has seen an increase in the application of minimally invasive surgical procedures to the management of pancreatic disease. Laparoscopic pancreatic surgery is an advanced laparoscopic procedure with a significant learning curve. It should be considered only by surgeons with extensive experience in open pancreatic surgery who possess advanced laparoscopic 'skills. Early reports suggest that laparoscopic pancreatic surgery can be accomplished with acceptable morbidity and mortality for the resection of small benign and low-grade malignant lesions in the body and tail of the pancreas and for the internal drainage of pancreatic pseudocysts. Its role in the management of lesions in the head, neck, and uncinate process of the pancreas is yet to be determined. PMID:19845171

Nakeeb, Attila



Laparoscopic Inguinal Hernia Repair  


... inguinal hernia repairs are performed using a small telescope known as a laparoscope. If your surgeon has ... in the abdominal wall (muscle) using small incisions, telescopes and a patch (mesh). If may offer a ...


Laparoscopic Management of Malfunctioning Peritoneal Dialysis Catheters  

PubMed Central

Objectives Continuous ambulatory peritoneal dialysis (CAPD) is an established alternative method to hemodialysis for treating end-stage renal disease patients. Malfunction of the peritoneal catheter is a frequent complication in peritoneal dialysis (PD). Laparoscopy is a minimal invasive technique that allows rescue therapy of malfunctioning catheters and consecutive immediate resumption of PD. The purpose of this study is to present our experiences with laparoscopic repair of peritoneal catheter dysfunction Methods Between April 2006 and March 2010, 21 cases of laparoscopic interventions were performed for the salvage of malfunctioning CAPD catheter. Two trocars (5 mm) were used. Recorded data included patient demographics, catheter implantation method, date of malfunction, cause of dysfunction, procedure performed and complications. Results The primary etiology of dysfunction was omentum and/or small bowel wrapping with adhesions in fifteen cases, malpositioning in four cases, and tunnel infection in the remaining two cases. Adhesiolysis was performed in cases with adhesions. In the cases with malpositioning but no adhesions, the catheters were repositioned in the pelvic cavity. Two catheters had to be withdrawn and exchanged because of infection. There were no mechanical or infection problems. The overall success rate of catheter function (>30 days after laparoscopy) was 100%, except for two cases in which the catheters had to be removed. Conclusion Laparoscopy is a safe, highly effective and successful method for the evaluation and management of peritoneal dialysis catheter dysfunction.

Zakaria, Hazem M.



Minimally invasive (laparoscopic) surgery  

Microsoft Academic Search

  Minimally invasive (laparoscopic) surgery became a major part of general surgery with the introduction of laparoscopic cholecystectomy\\u000a in the late 1980s. This was the culmination of the development of instruments and techniques by many physicians; Kelling developing\\u000a pneumoperitoneum, Zollikofer using carbon dioxide, Kalk designing a lens system and the dual-trochar technique, Veress using\\u000a the Veress needle to create pneumoperitoneum, Hasson

H. S. Himal



Laparoscopic refundoplication in children  

Microsoft Academic Search

Background: Gastroesophageal fundoplication currently is one of the three most common major operations performed on infants and children\\u000a by pediatric surgeons in the United States. With the advent of laparoscopic surgery, the number of gastroesophageal fundoplications\\u000a has virtually exploded. Morbidity always was substantial with this operation, and laparoscopy has not changed this. We describe\\u000a our results with laparoscopic refundoplication in

D. C. van der Zee; N. M. A. Bax; B. M. Ure



Laparoscopic adrenalectomy for cancer.  


Laparoscopic procedures are preferred by surgeons and patients alike because of decreased pain, reduced perioperative morbidity, and an earlier return to self-reliance. During the last decade, laparoscopic adrenalectomy has become the technique most commonly used for the removal of benign adrenal tumors. The indications for laparoscopy in malignant adrenal tumors remains controversial, because oncologic resections have not been reproducible compared with open techniques. PMID:23158088

Creamer, Jennifer; Matthews, Brent D



Giant Peritoneal Loose Body in the Pelvic Cavity  

PubMed Central

We report a case of a large peritoneal loose body diagnosed on computed tomography. The most common causes of a peritoneal loose body are thought to be torsion and separation of the appendices epiploicae. Peritoneal loose bodies are usually small, 0.5 to 2.5 cm in diameter. However, "giant" peritoneal loose bodies, larger than 4 cm in diameter, are an uncommon disease and present with various symptoms, and are difficult to diagnose preoperatively. Especially, abdominal large peritoneal loose bodies are frequently misdiagnosed as tumorous disease preoperatively. In our case, the loose body appeared as a round pelvic mass with central calcifications and a distinct fat plane separating it from adjacent organs. Preoperatively, we suspected a tumorous lesion from the wall of the upper rectum; however, at laparoscopy, a large peritoneal loose body was detected. An extraction of the giant peritoneal loose body was performed laparoscopically.

Jang, Joung Teak; Kang, Haeng Ji; Yoon, Ji Young



Laparoscopic Total Mesorectum Excision  

PubMed Central

The main controversy of colon-rectal laparoscopic surgery comes from its use as a cancer treatment. Two points deserve special attention: the incidence of portsite tumor implantation and the possibility of performing radical cancer surgery, such as total mesorectum excision. Once these points are addressed, the laparoscopic approach will be used routinely to treat rectal cancer. To clarify these points, 32 patients with cancer of the lower rectum participated in a special protocol that included preoperative radiotherapy and laparoscopic total mesorectum excision. All data were recorded. At the same time, all data recorded from the experience of a multicenter laparoscopic group (Brazilian Colorectal Laparoscopic Surgeons – 130 patients with tumor of the lower rectum) were analyzed and compared with the data provided by our patients. Analysis of the results suggests that a laparoscopic approach allows the same effective resection as that of conventional surgery and that preoperative irradiation does not influence the incidence of intraoperative complications. The extent of lymph nodal excision is similar to that obtained with open surgery, with an average of 12.3 lymph nodes dissected per specimen. The rate of local recurrence was 3.12%. No port site implantation of tumor was noted in this series of patients with cancer of the lower rectum.

Quilici, F.A.; Cordeiro, F.; Reis, J.A.; Kagohara, O.; Simoes Neto, J.



Laparoscopic Total Mesorectal Excision in a Rectal Cancer Patient with Situs Inversus Totalis  

PubMed Central

Situs inversus totalis is a rare anomaly in which the abdominal and thoracic cavity structures are opposite their usual positions. A 41-yr-old woman, who had an ulcerating cancer on the rectum, was found as a case of situs inversus totalis. We present an overview of the operative technique for the first documented laparoscopic total mesorectal excision of a rectal cancer in the patient with situs inversus totalis. Careful consideration of the mirror-image anatomy permitted a safe operation using techniques not otherwise different from those used for the general population. Therefore, curative laparoscopic surgery for rectal cancer in this patient is feasible and safe.

Huh, Jung Wook; Cho, Sang Hyuk; Kim, Choong Young; Kim, Hoon Jin; Joo, Jae Kyoon; Kim, Young Jin



Robot-Assisted Laparoscopic Pyeloplasty  

Microsoft Academic Search

\\u000a Laparoscopic pyeloplasty offers the success of open surgery with the benefit of decreased postoperative pain and decreased\\u000a length of stay. Its use, however, is limited by the steep learning curve required for proficient laparoscopic skills. The\\u000a introduction of robotic assistance shortens the laparoscopic learning curve and may allow increased use of laparoscopy in\\u000a performing pediatric laparoscopic pyeloplasty. This chapter describes

Chad R. Tracy; Craig A. Peters


Effectiveness of ovarian suspension in preventing post-operative ovarian adhesions in women with pelvic endometriosis: A randomised controlled trial  

PubMed Central

Background Endometriosis is a common benign condition, which is characterized by the growth of endometrial-like tissue in ectopic sites outside the uterus. Laparoscopic excision of the disease is frequently carried out for the treatment of severe endometriosis. Pelvic adhesions often develop following surgery and they can compromise the success of treatment. Ovarian suspension (elevating both ovaries to the anterior abdominal wall using a Prolene suture) is a simple procedure which has been used to facilitate ovarian retraction during surgery for severe pelvic endometriosis. The study aims to assess the effect of temporary ovarian suspension following laparoscopic surgery for severe pelvic endometriosis on the prevalence of post-operative ovarian adhesions. Methods A prospective double blind randomised controlled trial for patients with severe pelvic endometriosis requiring extensive laparoscopic dissection with preservation of the uterus and ovaries. Severity of the disease and eligibility for inclusion will be confirmed at surgery. Patients unable to provide written consent, inability to tolerate a transvaginal ultrasound scan, unsuccessful surgeries or suffer complications leading to oophorectomies, bowel injuries or open surgery will be excluded. Both ovaries are routinely suspended to the anterior abdominal wall during surgery. At the end of the operation, each participant will be randomised to having only one ovary suspended post-operatively. A new transabdominal suture will be reinserted to act as a placebo. Both sutures will be cut 36 to 48 hours after surgery before the woman is discharged home. Three months after surgery, all randomised patients will have a transvaginal ultrasound scan to assess for ovarian mobility. Both the patients and the person performing the scan will be blinded to the randomisation process. The primary outcome is the prevalence of ovarian adhesions on ultrasound examination. Secondary outcomes are the presence, intensity and site of post-operative pain. Discussion This controlled trial will provide evidence as to whether temporary ovarian suspension should be included into the routine surgical treatment of women with severe pelvic endometriosis. Trial registration ISRCTN: ISRCTN24242218



The anatomy workbook  

SciTech Connect

This is an atlas of human anatomy presented in the form of line drawings, many of which correspond to imaging planes used in ultrasound (US), computed tomography (CT), and magnetic resonance (MR). The book is organized into 17 sections, each covering a specific structure or organ system. Large, uncluttered drawings are labeled for identification of structures of interest. Many illustrations include captions consisting of comments explaining major divisions within organs, specific anatomic relationships and landmarks, and pertinent vascular anatomy. Most organs are first depicted in isolation or in relation to important adjacent organs or blood vessels and are rendered as if viewed from anterior, posterior, inferior, or superior perspectives. The organs are demonstrated again in serial transverse, saggital, and coronal sections, each accompanied by a drawing of a body in anatomic position denoting the plane of the section.

Hagen-Ansert, S.L.



Robot-assisted laparoscopic radical prostatectomy in patients with pre-existing inflatable penile prosthesis  

Microsoft Academic Search

Patients with clinically localized prostate cancer presenting for extirpative therapy often have a prior history of pelvic\\u000a surgery. This must be taken into account when offering various surgical options. We present two patients who underwent robot-assisted\\u000a laparoscopic radical prostatectomy (RALRP) after having previously undergone implantation of three-piece inflatable penile\\u000a prostheses. A video is provided for illustration of our technique.

Aaron Sulman; Jeffery Piaccitelli; Li-Ming Su



Laparoscopic Versus Open Appendectomy  

PubMed Central

Summary Background Data: The value of laparoscopy in appendicitis is not established. Studies suffer from multiple limitations. Our aim is to compare the safety and benefits of laparoscopic versus open appendectomy in a prospective randomized double blind study. Methods: Two hundred forty-seven patients were analyzed following either laparoscopic or open appendectomy. A standardized wound dressing was applied blinding both patients and independent data collectors. Surgical technique was standardized among 4 surgeons. The main outcome measures were postoperative complications. Secondary outcome measures included evaluation of pain and activity scores at base line preoperatively and on every postoperative day, as well as resumption of diet and length of stay. Activity scores and quality of life were assessed on short-term follow-up. Results: There was no mortality. The overall complication rate was similar in both groups (18.5% versus 17% in the laparoscopic and open groups respectively), but some early complications in the laparoscopic group required a reoperation. Operating time was significantly longer in the laparoscopic group (80 minutes versus 60 minutes; P = 0.000) while there was no difference in the pain scores and medications, resumption of diet, length of stay, or activity scores. At 2 weeks, there was no difference in the activity or pain scores, but physical health and general scores on the short-form 36 (SF36) quality of life assessment forms were significantly better in the laparoscopic group. Appendectomy for acute or complicated (perforated and gangrenous) appendicitis had similar complication rates, regardless of the technique (P = 0.181). Conclusions: Unlike other minimally invasive procedures, laparoscopic appendectomy did not offer a significant advantage over open appendectomy in all studied parameters except quality of life scores at 2 weeks. It also took longer to perform. The choice of the procedure should be based on surgeon or patient preference.

Katkhouda, Namir; Mason, Rodney J.; Towfigh, Shirin; Gevorgyan, Anna; Essani, Rahila



[Ultrasonography in acute pelvic pain].  


Acute pelvic pain may be the manifestation of various gynecologic and non-gynecologic disorders from less alarming rupture of the follicular cyst to life threatening conditions such as rupture of ectopic pregnancy or perforation of inflamed appendix. In order to construct an algorithm for differential diagnosis we divide acute pelvic pain into gynecologic and non-gynecologic etiology, which is than subdivided into gastrointestinal and urinary causes. Appendicitis is the most common surgical emergency and should always be considered in differential diagnosis if appendix has not been removed. Apart of clinical examination and laboratory tests, an ultrasound examination is sensitive up to 90% and specific up to 95% if graded compression technique is used. Still it is user-depended and requires considerable experience in order to perform it reliably. Meckel's diverticulitis, acute terminal ileitis, mesenteric lymphadenitis and functional bowel disease are conditions that should be differentiated from other causes of low abdominal pain by clinical presentation, laboratory and imaging tests. Dilatation of renal pelvis and ureter are typical signs of obstructive uropathy and may be efficiently detected by ultrasound. Additional thinning of renal parenchyma suggests long-term obstructive uropathy. Ruptured ectopic pregnancy, salpingitis and hemorrhagic ovarian cysts are three most commonly diagnosed gynecologic conditions presenting as an acute abdomen. Degenerating leiomyomas and adnexal torsion occur less frequently. For better systematization, gynecologic causes of acute pelvic pain could be divided into conditions with negative pregnancy test and conditions with positive pregnancy test. Pelvic inflammatory disease may be ultrasonically presented with numerous signs such as thickening of the tubal wall, incomplete septa within the dilated tube, demonstration of hyperechoic mural nodules, free fluid in the "cul-de-sac" etc. Color Doppler ultrasound contributes to more accurate diagnosis of this entity since it enables differentiation between acute and chronic stages based on analysis of the vascular resistance. Hemorrhagic ovarian cysts may be presented by variety of ultrasound findings since intracystic echoes depend upon the quality and quantity of the blood clots. Color Doppler investigation demonstrates moderate to low vascular resistance typical of luteal flow. Leiomyomas undergoing degenerative changes are another cause of acute pelvic pain commonly present in patients of reproductive age. Color flow detects regularly separated vessels at the periphery of the leiomyoma, which exhibit moderate vascular resistance. Although the classic symptom of endometriosis is chronic pelvic pain, in some patients acute pelvic pain does occur. Most of these patients demonstrate an endometrioma or "chocolate" cyst containing diffuse carpet-like echoes. Sometimes, solid components may indicate even ovarian malignancy, but if color Doppler ultrasound is applied it is less likely to obtain false positive results. One should be aware that pericystic and/or hillar type of ovarian endometrioma vascularization facilitate correct recognition of this entity. Pelvic congestion syndrome is another condition that can cause an attack of acute pelvic pain. It is usually consequence of dilatation of venous plexuses, arteries or both systems. By switching color Doppler gynecologist can differentiate pelvic congestion syndrome from multilocular cysts, pelvic inflammatory disease or adenomyosis. Ovarian vein thrombosis is a potentially fatal disorder occurring most often in the early postpartal period. Hypercoagulability, infection and stasis are main etiologic factors, and transvaginal color Doppler ultrasound is an excellent diagnostic tool to diagnose it. Acute pelvic pain may occur even in normal intrauterine pregnancy. This may be explained by hormonal changes, rapid growth of the uterus and increased blood flow. Ultrasound is mandatory for distinguishing normal intrauterine pregnancy from threatened or spontaneous abortion, ectop

Kupesi?, Sanja; Aksamija, Alenka; Vuci?, Niksa; Tripalo, Ana; Kurjak, Asim



Kegel Exercises for Your Pelvic Muscles  


... muscles. Weak pelvic muscles can cause you to leak urine. Fortunately, pelvic muscles are just like other muscles--exercises can make them stronger. People who leak urine may have better control of these muscles ...



Microsoft Academic Search

Data on 186 Hereford heifers from five South Dakota ranches were collected to evaluate the relationships of pelvic structure and body measurements with calving difficulty (CD) and pelvic area. Body measurements obtained prebreeding and precalving included two internal pelvic and seven external rump measurements, three pelvic angles and two slope of rump measurements. A calving difficulty score (CDS) of 1

S. K. Johnson; G. H. Deutscher; A. Parkhurst


Abdominal wall paresis as a complication of laparoscopic surgery  

Microsoft Academic Search

Purpose  Abdominal wall nerve injury as a result of trocar placement for laparoscopic surgery is rare. We intend to discuss causes\\u000a of abdominal wall paresis as well as relevant anatomy.\\u000a \\u000a \\u000a \\u000a Methods  A review of the nerve supply of the abdominal wall is illustrated with a rare case of a patient presenting with paresis of\\u000a the internal oblique muscle due to a trocar

G. H. van Ramshorst; G.-J. Kleinrensink; J. J. Hermans; T. Terkivatan; J. F. Lange



Synthetic biomaterials for pelvic floor reconstruction  

Microsoft Academic Search

Pelvic organ prolapse and stress urinary incontinence increase with age. The increasing proportion of the aging female population\\u000a is likely to result in a demand for care of pelvic floor prolapse and incontinence. Experimental evidence of altered connective\\u000a tissue metabolism may predispose to pelvic floor dysfunction, supporting the use of biomaterials, such as synthetic mesh,\\u000a to correct pelvic fascial defects.

Matthew E. Karlovsky; Leslie Kushner; Gopal H. Badlani



Synthetic biomaterials for pelvic floor reconstruction  

Microsoft Academic Search

Pelvic organ prolapse and stress urinary incontinence increase with age. The increasing proportion of the aging female population\\u000a is likely to result in a demand for care of pelvic floor prolapse and incontinence. Experimental evidence of altered connective\\u000a tissue metabolism may predispose to pelvic floor dysfunction, supporting the use of biomaterials, such as synthetic mesh,\\u000a to correct pelvic fascial defects.

Matthew E. Karlovsky; Leslie Kushner; Gopal H. Badlani



Laparoscopic cholecystectomy for a left-sided gallbladder  

PubMed Central

Cholecystectomy is a common procedure. Abnormalities in the anatomy of the biliary system are common but an abnormal location of the gallbladder is much rarer. Despite frequent pre-operative imaging, the aberrant location of the gallbladder is commonly discovered at surgery. This article presents a case of a patient with the gallbladder located to the left of the falciform ligament in the absence of situs inversus totalis that presented with right upper quadrant pain. A laparoscopic cholecystectomy was performed and it was noted that the cystic duct originated from the right side. The presence of a left sided gall bladder is often associated with various biliary, portal venous and other anomalies that might lead to intra-operative injuries. The spectrum of unusual positions and anatomical gallbladder abnormalities is reviewed in order to facilitate elective and emergent cholecystectomy as well as other hepatobiliary procedures. With proper identification of the anatomy, minimally invasive approaches are still considered safe.

Iskandar, Mazen E; Radzio, Agnes; Krikhely, Merab; Leitman, I Michael



Surgical Margins and Short-Term Results of Laparoscopic Total Mesorectal Excision for Low Rectal Cancer  

PubMed Central

Background and Objectives: The confines of the narrow bony pelvis make laparoscopic surgery more challenging in the treatment of low rectal cancer. Macroscopic evaluation of the completeness of the mesorectum provides detailed information about the quality of surgery. This study was performed to observe the short-term outcomes and evaluate the macroscopic quality of specimens acquired from laparoscopic total mesorectal excision versus open total mesorectal excision in patients with low rectal cancer. Methods: A total of 177 patients with low rectal cancer underwent total mesorectal excision by either a laparoscopic (n = 87) or open (n = 90) approach. In all cases the surgical time, blood loss, intraoperative and postoperative complications, postoperative bowel opening, and hospital stay were assessed. Special attention was given to the macroscopic judgment concerning the cut edge of peritoneal reflection, Denonvilliers fascia, completeness of the mesorectum, and bowel wall below the mesorectum. Results: The surgical time was 160 ± 40 minutes in the laparoscopic group. It was not significantly different from that in the open group (P = .782). The operative blood loss was 28 ± 5 mL in the group undergoing laparoscopic surgery and 80 ± 20 mL in the group undergoing open surgery (P < .01). Intraoperative injuries to the pelvic autonomic nervous system were recorded in 4 cases in the laparoscopic group compared with 12 cases in the open group (P < .05). The incidences of chest infection and anastomotic leakage were similar between the 2 approaches. The postoperative bowel opening time was 2.1 ± 1.5 days in the laparoscopic group and 3.5 ± 1.6 days in the open group (P < .01), whereas the hospital stay was 5.2 ± 1.8 days and 7.0 ± 2.1 days, respectively (P < .01). Intact Denonvilliers fascia and complete total mesorectal excision were more likely to be achieved by the laparoscopic approach than the open approach (P < .01). Colorectal anastomoses were located significantly lower in the laparoscopic group than in the open group (P < .01). Conclusion: Laparoscopic total mesorectal excision has consistent advantages over open total mesorectal excision, including similar surgical time, less blood loss, reduced hospital stay, and shorter disability period. A complete macroscopic specimen is more likely to be acquired by laparoscopy because of the better pelvic view offered by the approach.

Yang, Qingqiang; Xiu, Peng; Qi, Xiaolong; Yi, Guoping



Magnetic resonance imaging of pelvic organ prolapse  

Microsoft Academic Search

Magnetic resonance imaging (MRI) of pelvic organ prolapse is technically feasible and has several advantages when compared with fluoroscopic cystoproctography. Organ descent and the supportive structures of the pelvic floor can be assessed with MRI. The role of MRI in evaluating patients with pelvic floor dysfunction is evolving, and there have been many developments in the past few years. The

H. K. Pannu; Russell H. Morgan



The female orgasm: Pelvic contractions  

Microsoft Academic Search

Eleven nulliparous women manually self-stimulated to orgasm, each on three separate occasions. Pelvic contraction pressure was measured by an anal probe and a vaginal probe simultaneously. Near the perceived start of orgasm, a series of regular contractions began in nine of the women. Anal and vaginal contraction waveforms were synchronized with each other, and the same number of orgasmic contractions

Joseph G. Bohlen; James P. Held; Margaret Olwen Sanderson; Andrew Ahlgren



[Pyeloplasty: pro laparoscopic].  


With increasing experience and availability of the da Vinci® robotic surgery system there has been an extension of the indications from initially exclusively ablative interventions, such as nephrectomy and radical prostatectomy to reconstructive interventions, such as pyeloplasty, bladder augmentation and urinary diversion. Laparocopic pyeloplasty has been established for both adults and children, with results comparable to the open procedure. In comparison the conventional laparoscopic procedure is little cost-intensive and therefore widely used. The available literature has to be analysed to find advantages for the cost-intensive, robot-assisted laparoscopic pyeloplasty from which patients can profit. PMID:22526175

Bader, P



Anatomy and radiological anatomy of the lumbar radicular canals  

Microsoft Academic Search

Summary The radicular canal is the lateral portion of the spinal canal when it is trefoil. It is a bony and ligamentary, monovertebral and indeformable space, the measurements of which are reproducible. The anatomy of this radicular canal has been studied in the whole of the lumbar vertebrae of 50 anatomical subjects. Its radiological anatomy has been defined by sagittal

B. Lassale; G. Morvan; M. Gottin



The anatomy of anatomy: a review for its modernization.  


Anatomy has historically been a cornerstone in medical education regardless of nation or specialty. Until recently, dissection and didactic lectures were its sole pedagogy. Teaching methodology has been revolutionized with more reliance on models, imaging, simulation, and the Internet to further consolidate and enhance the learning experience. Moreover, modern medical curricula are giving less importance to anatomy education and to the acknowledged value of dissection. Universities have even abandoned dissection completely in favor of user-friendly multimedia, alternative teaching approaches, and newly defined priorities in clinical practice. Anatomy curriculum is undergoing international reformation but the current framework lacks uniformity among institutions. Optimal learning content can be categorized into the following modalities: (1) dissection/prosection, (2) interactive multimedia, (3) procedural anatomy, (4) surface and clinical anatomy, and (5) imaging. The importance of multimodal teaching, with examples suggested in this article, has been widely recognized and assessed. Nevertheless, there are still ongoing limitations in anatomy teaching. Substantial problems consist of diminished allotted dissection time and the number of qualified anatomy instructors, which will eventually deteriorate the quality of education. Alternative resources and strategies are discussed in an attempt to tackle these genuine concerns. The challenges are to reinstate more effective teaching and learning tools while maintaining the beneficial values of orthodox dissection. The UK has a reputable medical education but its quality could be improved by observing international frameworks. The heavy penalty of not concentrating on sufficient anatomy education will inevitably lead to incompetent anatomists and healthcare professionals, leaving patients to face dire repercussions. PMID:20205265

Sugand, Kapil; Abrahams, Peter; Khurana, Ashish


[Complex pelvic injury in childhood].  


Pelvic disruptions are rare in children caused by the flexible anchoring of bony parts associated with a high elasticity of the skeleton. Portion of pelvic fractures in infants is lower than 5% even when reviewing cases of specialized centers. The part of complex pelvic injuries and multiple injured patients in infants is higher when compared to adults, a fact caused by the more intense forces that are necessary to lead to pelvic disruption in children. Combination of a rare injury and the capability of children to compensate blood loss for a long time may implicate a wrong security and prolong diagnostic and therapeutic procedures--a problem that definitely should be avoided. Three cases were analyzed and established algorithms for treatment of patients matching these special injury-features demonstrated. A good outcome may only be achieved when all components of injury pattern get recognized and treatment is organized following the hierarchy of necessity. Therefore in the time table first life-saving steps have to be taken and then accompanying injuries can be treated that often decisively influence life quality. As seen in our cases unstable and dislocated fractures require open reduction and internal fixation ensuring nerval decompression, stop of hemorrhage and realizing the prerequisite for effective treatment of soft tissue damage. The acute hemorrhagic shock is one of the leading causes of death following severe pelvic injuries. After stabilization of fracture, surgical treatment of soft tissue injuries and intraabdominal bleeding sources the immediate diagnostic angiography possibly in combination with a therapeutic selective embolization is a well established part of the treatment. The aim of complete restitution can only be accomplished by cooperation of several different specialists and consultants in a trauma center. PMID:12243021

Schmal, H; Klemt, C; Haag, C; Bonnaire, F



An Unusual Extremely Distant Noncommunicating Uterine Horn with Myoma and Adenomyosis Treated with Laparoscopic Hemihysterectomy  

PubMed Central

A 41-year-old woman referred to us with dysmenorrhea and severe pelvic pain although she was previously submitted to right laparotomic adnexectomy for ovarian endometrioma and to a subsequent operative laparoscopy for pelvic adhesions. After ultrasound examination, the patient underwent diagnostic hysteroscopy and operative laparoscopy which confirmed the clinic suspect of an unicornuate uterus. However, it was very unusual to see an extremely distanced right horn, without communication with uterus, without adnexa, and with a small myoma belonging to it. Moreover, omentum and bowel were attached to fundus of right horn and thick adhesions fixed it to rectum and right pelvic wall. Therefore, identification of anatomical structures was difficult, as it was extremely arduous to isolate the ureter, which was involved inside the adhesions surrounding the right uterine horn. Nevertheless, laparoscopic right hemihysterectomy was successfully performed and right horn was sent to our pathologist who recognized hypotrophic endometrium and adenomyosis.

Morelli, Michele; Mocciaro, Rita; Lico, Daniela; Zullo, Fulvio



Endovaginal ultrasound-assisted pain mapping in endometriosis and chronic pelvic pain.  


The objective of this study was to determine if the combination of tenderness-guided endovaginal ultrasound and digital pelvic exam (i.e. EVUS-assisted exam) for preoperative pain mapping, in cases without nodules or endometriomas, increases sensitivity/specificity for laparoscopic findings. This was a retrospective review of women with chronic pelvic pain ± infertility with preoperative pain mapping exam prior to laparoscopy (n = 97, 2006-7). Predictor variables (EVUS-assisted exam vs digital pelvic exam alone, for pain mapping) were coded as tender vs non-tender. Primary outcome was findings on laparoscopy (e.g. endometriosis or adhesions) and was coded as abnormal vs normal. We found that EVUS-assisted exam had greater sensitivity (0.81, 95% CI: 0.70-0.89) for abnormal laparoscopy compared with digital pelvic exam alone (0.58, 95% CI: 0.46-0.69) (McNemar's test, p < 0.001). Specificity was limited for both types of pain mapping (0.22, 95% CI: 0.08-0.44 for EVUS-assisted; and 0.39, 95% CI: 0.20-0.61 for digital), with no significant difference (p = 0.13). In conclusion, in the absence of nodules or endometriomas, EVUS-assisted exam increases sensitivity, but with no benefit in specificity, for prediction of abnormal laparoscopy. PMID:24127962

Yong, P J; Sutton, C; Suen, M; Williams, C



[Anatomy and anthropology].  


Methodological aspects of anatomy and anthropology are discussed as systems of sciences in their formation. The base of these systems is the laws of materialist dialectics on the unity of the structure and function and on relation of the social to the biological as hierarchically highest form of the matter movement towards the lowest form. In this classification of the systems of anthropological and anatomical sciences a heliocentric principle is used. Tasks of the bordering sciences--anatomical anthropology are considered. Its task is to study forms and factors on anatomical changeability of the organism. PMID:7436758

Nikitiuk, B A



Vaginal childbirth and pelvic floor disorders.  


Childbirth is an important event in a woman's life. Vaginal childbirth is the most common mode of delivery and it has been associated with increased incidence of pelvic floor disorders later in life. In this article, the authors review and summarize current literature associating pelvic floor disorders with vaginal childbirth. Stress urinary incontinence and pelvic organ prolapse are strongly associated with vaginal childbirth and parity. The exact mechanism of injury associating vaginal delivery with pelvic floor disorders is not known, but is likely multifactorial, potentially including mechanical and neurovascular injury to the pelvic floor. Observational studies have identified certain obstetrical exposures as risk factors for pelvic floor disorders. These factors often coexist in clusters; hence, the isolated effect of these variables on the pelvic floor is difficult to study. PMID:23638782

Memon, Hafsa U; Handa, Victoria L



Laparoscopic intrahepatic Glissonian approach for right hepatectomy is safe, simple, and reproducible  

Microsoft Academic Search

Background  Hemorrhage from portal and hepatic veins is a major concern with laparoscopic right hepatectomy (LRH). The standard hilar\\u000a approach is dissection of the portal pedicle outside the liver parenchyma with separate transection of the right hepatic artery,\\u000a portal vein, and bile duct [1–5, 7, 9]. Variations in anatomy can hamper vascular and biliary control. The intrahepatic Glissonian access avoids these

B. Topal; R. Aerts; F. Penninckx



Health Instruction Packages: Cardiac Anatomy.  

ERIC Educational Resources Information Center

|Text, illustrations, and exercises are utilized in these five learning modules to instruct nurses, students, and other health care professionals in cardiac anatomy and functions and in fundamental electrocardiographic techniques. The first module, "Cardiac Anatomy and Physiology: A Review" by Gwen Phillips, teaches the learner to draw and label…

Phillips, Gwen; And Others


Health Instruction Packages: Cardiac Anatomy.  

ERIC Educational Resources Information Center

Text, illustrations, and exercises are utilized in these five learning modules to instruct nurses, students, and other health care professionals in cardiac anatomy and functions and in fundamental electrocardiographic techniques. The first module, "Cardiac Anatomy and Physiology: A Review" by Gwen Phillips, teaches the learner to draw and label…

Phillips, Gwen; And Others


Recent advances in laparoscopic surgery.  


Laparoscopic surgery has been widely adopted and new technical innovation, procedures and evidence based knowledge are persistently emerging. This review documents recent major advancements in laparoscopic surgery. A PubMed search was made in order to identify recent advances in this field. We reviewed the recent data on randomized trials in this field as well as papers of systematic review. Laparoscopic cholecystectomy is the most frequently performed procedure, followed by laparoscopic bariatric surgery. Although bile duct injuries are relatively uncommon (0.15%-0.6%), intraoperative cholangiography still plays a role in reducing the cost of litigation. Laparoscopic bariatric surgery is the most commonly performed laparoscopic gastrointestinal surgery in the USA, and laparoscopic Nissen fundoplication is the treatment of choice for intractable gastroesophageal reflux disease. Recent randomized trials have demonstrated that laparoscopic gastric and colorectal cancer resection are safe and oncologically correct procedures. Laparoscopic surgery has also been widely developed in hepatic, pancreatic, gynecological and urological surgery. Recently, SILS and robotic surgery have penetrated all specialties of abdominal surgery. However, evidence-based medicine has failed to show major advantages in SILS, and the disadvantage of robotic surgery is the high costs related to purchase and maintenance of technology. Laparoscopic surgery has become well developed in recent decades and is the choice of treatment in abdominal surgery. Recently developed SILS techniques and robotic surgery are promising but their benefits remain to be determined. PMID:23126424

Lee, Wei-Jei; Chan, Chien-Pin; Wang, Bing-Yen



Laparoscopic hemicolectomy in a patient with situs inversus totalis after open distal gastrectomy  

PubMed Central

Situs inversus totalis (SIT) is a rare anomaly in which the abdominal and thoracic cavity structures are opposite their usual positions. Occasionally, a few patients with a combination of this condition and malignant tumors have been encountered. Recently, several laparoscopic operations have been reported in patients with SIT. We report a case of an 83-year-old man with situs inversus totalis who developed colon cancer after open distal gastrectomy. Laparoscopic hemicolectomy with radical lymphadenectomy in such a patient was successfully performed by careful consideration of the mirror-image anatomy. Techniques themselves was not different from those in ordinary cases. Thus, curative laparoscopic surgery for colon cancer in the presence of situs inversus totalis is feasible and safe.

Sumi, Yasuo; Tomono, Ayako; Suzuki, Satoshi; Kuroda, Daisuke; Kakeji, Yoshihiro



Laparoscopic colonic procedures  

Microsoft Academic Search

With the advent and general acceptance of laparoscopy as a means of surgically treating intraabdominal disease processes, procedures on organs other than the gallbladder and female genital tract have slowly evolved. After developing basic techniques in an animal model, a clinical series (n=19) of laparoscopic procedures for a variety of colonic lesions was undertaken and is herein presented. It included

Morris E. Franklin; Raul Ramos; Daniel Rosenthal; William Schuessler



Laparoscopic inguinal hernioplasty  

Microsoft Academic Search

Laparoscopic hernioplasty was performed in a prospective fashion in 100 inguinal hernias in 66 patients. When available, a self-expanding prosthesis of Mersilene, strengthened with a cross- or star-shaped wire of Nitinol, was used without fixation (group B, 43 hernias).

Jacques M. Himpens



Telesurgical Laparoscopic Radical Prostatectomy  

Microsoft Academic Search

Introduction: Telepresence surgery offers theoretically to overcome two main problems of laparoscopic surgery, i.e. the limitation to only four degrees of freedom and the lack of stereovision. Since 1998, telesurgical minimally invasive procedures have been performed with the da Vinci system mainly for cardiac bypass surgery. Clinical experience in urology is still very limited. We want to present our initial

Jens Rassweiler; Thomas Frede; Othmar Seemann; Christian Stock; Ludger Sentker



Pediatric Laparoscopic Dismembered Pyeloplasty  

Microsoft Academic Search

We performed laparoscopic dismembered pyeloplasty in a boy with right ureteropelvic junction obstruction using 4 cannula sites, and a dismembering and reanastomosis technique identical to that used in open pyeloplasty. Interrupted sutures were placed and tied intracorporeally. A nephrostomy tube was placed under direct vision for drainage but no ureteral stent was used. Total operating time was 5 hours. The

Craig A. Peters; Richard N. Schlussel; Alan B. Retik



Laparoscopic gastrostomy in children.  


During a 30-month period, 28 children aged 6 months-15 years underwent fashioning of a laparoscopic gastrostomy. Indications for operation included: feeding difficulties and failure to thrive in neurologically impaired children (13); chronic renal failure (9); and others (6). There were 17 conventional tube and 11 button gastrostomies. Twelve children had insertion of a gastrostomy alone; the others underwent a concomitant laparoscopic Nissen fundoplication (NFP). The average operation time for gastrostomy alone was 65 min (range 35-104) and for gastrostomy plus NFP 155 min (range 130-246). There were no specific laparoscopic complications. Two patients who required large volumes of eternal drugs and peritoneal dialysis from the 1st post-operative day developed minor external leaks from their stomas. It appears that laparoscopy provides for safe and precise positioning of any standard balloon or button gastrostomy. It is a particularly attractive technique for use in patients already undergoing a laparoscopic fundoplication and those in whom other minimally invasive techniques are contraindicated or fail. PMID:9238116

Humphrey, G M; Najmaldin, A



Laparoscopic surgery in pregnancy  

Microsoft Academic Search

A 32-year-old white lady suffering from tubal infertility was referred to our institution in November 1992 because of low abdominal pain due to a heterotopic pregnancy (one intrauterine sac and the other in the right tube). The patient had undergone, 8 weeks before, her second successful attempt at in vitro fertilization and embryo transfer. We decided to perform a laparoscopic

V. Remorgida; C. Carrer; A. Ferraiolo; M. Natucci; P. Anserini



Pharmacological Treatment of Pelvic Pain  

Microsoft Academic Search

The pharmacologic treatment of chronic pelvic pain requires knowledge about several classes of drugs. The standard approach\\u000a is to use non-opioid drugs such as non-steroidal anti-inflammatory drugs or acetaminophen initially with or without non-opioid\\u000a adjuvants (or adjuncts). Adjuvant therapy may include anticonvulsants, antidepressants, or a combination of both. Opioids\\u000a are appropriate, safe, and effective in the treatment of non-cancer chronic

Howard T. Sharp


Pelvic sepsis after stapled hemorrhoidopexy  

PubMed Central

Stapled hemorrhoidopexy is a surgical procedure used worldwide for the treatment of grade III and IV hemorrhoids in all age groups. However, life-threatening complications occur occasionally. The following case report describes the development of pelvic sepsis after stapled hemorrhoidopexy. A literature review of techniques used to manage major septic complications after stapled hemorrhoidopexy was performed. There is no standardized treatment currently available. Stapled hemorrhoidopexy is a safe, effective and time-efficient procedure in the hands of experienced colorectal surgeons.

van Wensen, Remco JA; van Leuken, Maarten H; Bosscha, Koop



Laparoscopic Management of Large Myomas  

PubMed Central

The objective of this article is to review the different techniques that have been adopted for removal of large myomas laparoscopically. We have also quoted literature about the impact of myomas on Pregnancy and obstetrical outcome and the effect of laparoscopic myomectomy on the same. Technical modifications to remove large myomas have been described along with methods to reduce intraoperative bleeding. This comprehensive review describes all possibilities of laparoscopic myomectomy irrespective of size, site and number.

Sinha, Rakesh; Sundaram, Meenakshi



Virtual reality in laparoscopic surgery.  


Although the many advantages of laparoscopic surgery have made it an established technique, training in laparoscopic surgery posed problems not encountered in conventional surgical training. Virtual reality simulators open up new perspectives for training in laparoscopic surgery. Under realistic conditions in real time, trainees can tailor their sessions with the VR simulator to suit their needs and goals, and can repeat exercises as often as they wish. VR simulators reduce the number of experimental animals needed for training purposes and are suited to the pursuit of research in laparoscopic surgery. PMID:15747974

Uranüs, Selman; Yanik, Mustafa; Bretthauer, Georg



Laparoscopic radical and partial cystectomy  

PubMed Central

Radical cystectomy remains the standard treatment for muscle invasive organ confined bladder carcinoma. Laparoscopic radical cystoprostatectomy (LRC) is an advanced laparoscopic procedure that places significant demands on the patient and the surgeon alike. It is a prolonged procedure which includes several technical steps and requires highly developed laparoscopic skills including intra-corporeal suturing. Here we review the development of the technique, the indications, complications and outcomes. We also examine the potential benefits of robotic-assisted LRC and explore the indications and technique of laparoscopic partial cystectomy.

Challacombe, Ben J.; Rose, Kristen; Dasgupta, Prokar



[Current treatment of pelvic ring fractures].  


Pelvic injuries are often associated with multiple injuries of other body regions, neurovascular and visceral lesions, as well as hemodynamic instability. The use of a standardized classification characterizing the severity and stability of pelvic fractures and the early stabilization of pelvic ring injuries in appreciation of damage control principles has helped to improve the number of survivors. This is particularly necessary due to the higher number of older patients.Complex pelvic trauma still represents a life-threatening situation for the patient, particularly in multiple traumatized patients. Standardized clinical investigations and modern concepts even in the preclinical therapy of complex pelvic fractures make a contribution to enhancement of treatment options. Because of the still problematic long-term results after surgery of instable pelvic fractures, the need for modern treatment concepts has to be adapted to the requirements. PMID:23989168

Culemann, U; Oestern, H J; Pohlemann, T



Lumbosacral spine and pelvic inlet changes associated with pelvic organ prolapse  

Microsoft Academic Search

Objective: To determine the association between advanced pelvic organ prolapse and changes in lumbar lordosis and\\/or pelvic inlet orientation.Methods: Lateral lumbosacral spine\\/pelvic x-rays were taken of women with grade 2 or greater uterovaginal prolapse and women with grade 1 or less prolapse standing in their usual upright posture. The angles of lumbar lordosis and the pelvic inlet were measured by

John K Nguyen; Lawrence R Lind; Jennifer Y Choe; Francis McKindsey; Robert Sinow; Narender N Bhatia



Laparoscopy-assisted lateral pelvic lymph node dissection for advanced rectal cancer.  


In Japan, there has been no indication of laparoscopic surgery for advanced lower rectal cancer because of the problem about the treatment of lateral pelvic lymph node metastasis. We report a new technique which allows lateral pelvic lymph node dissection like in open surgery for advanced rectal cancer. After laparoscopic total mesorectal excision for rectal cancer, a surgical incision of approximately 8 cm is placed in the supra-pubic area. Then, the latero-vesical area of the retroperitoneum, latero-vesical space is dissected bluntly with forceps. The external iliac artery and vein are taped and lymph node dissection is performed. As the external iliac vein is pulled internally, fatty tissue including lymph nodes in the obturator space is separated from the psoas major muscle. After completing of such a procedure, the obturator nerve is indentified in the fatty tissue with surrounding lymph nodes. As the external iliac vein is pulled laterally, fatty tissue including lymph nodes in the oburator space is dissected by fat aspiration procedure (FAP) using a suction tip. FAP is helpful to confirm the vascular system, by which the obturator space is skeletonized and anatomical structures are identified clearly. PMID:21410045

Kawahara, Hidejiro; Watanabe, Kazuhiro; Ushigome, Takuro; Noaki, Rohta; Kobayashi, Susumu; Yanaga, Katsuhiko


Experience in laparoscopic hysterectomy: analysis of three hundred cases.  


A personal experience with 300 cases of laparoscopic hysterectomy was analysed and its merits and demerits were discussed. The demographic features, indications, feasibility, complications, operating time, blood loss, hospital stay, cost effectiveness and its outcome were reviewed. The indications were uterine fibroid (40%), adenomyosis, dysfunctional uterine bleeding and pelvic inflammatory disease (36%), fibroid uterus with endometriosis (17.5%), postmenopausal bleeding (3%), ovarian neoplasm (2.1%) and fibroid uterus with ovarian cyst (1.4%). Two uterine malignancies and one case of potentially malignant ovarian neoplasm, were also encountered in our series. Assessibility score of above 20 was present in 55%. Haemorrhage was prevented intraoperatively by securing the large pedicles with electrocoagulation as well as large titanium clips (LT-400). Retrograde ureteric catheterisation was not necessary. Overall morbidity was present only in 10.62%. Intraoperative bladder injury was encountered in 1%, urinary fistula in 0.66%, primary and secondary haemorrhage in 0.33% respectively, and minor febrile morbidity in 4.66%. Conversion to conventional abdominal hysterectomy occurred in 0.66% of the cases. The average operating time was 141.99 +/- 31.678 min, the estimated blood loss was 237.07 +/- 76.76 ml and average hospitalisation was 3.37 +/- 0.66 days. The cost of laparoscopic hysterectomy was found similar to abdominal hysterectomy. Higher operating fee, operating theatre and anaesthesia charges did not affect the overall cost of laparoscopic hysterectomy because of shorter hospital stay. It is concluded that laparoscopic hysterectomy has definite role in gynaecological surgery. PMID:8924000

Mehra, S; Bokaria, R; Gujral, A; Bhat, V; Hotchandani, M



Grading pelvic prolapse and pelvic floor relaxation using dynamic magnetic resonance imaging  

Microsoft Academic Search

Objectives. With significant vaginal prolapse, it is often difficult to differentiate among cystocele, enterocele, and high rectocele by physical examination alone. Our group has previously demonstrated the utility of magnetic resonance imaging (MRI) for evaluating pelvic prolapse. We describe a simple objective grading system for quantifying pelvic floor relaxation and prolapse.Methods. One hundred sixty-four consecutive women presenting with pelvic pain

Craig V Comiter; Sandip P Vasavada; Zoran L Barbaric; Angelo E Gousse; Shlomo Raz



Laparoscopic adrenal cyst resection.  


Two patients with left adrenal cysts underwent laparoscopic resection. In one case an adrenal origin of the cyst was suspected. In the other case the cyst was thought to be renal in origin. Both patients were female, ages 16 and 40 years. Operative time was 150 and 160 minutes. Blood loss was 50 and 30 mL. One patient received 14 mg of morphine and 60 mg of ketorolac. The other patient did not require any parenteral analgesics. Hospital stay was 1 day for both patients. Return to normal activity occurred at 15 and 7 days postoperatively, respectively. Histology in both cases revealed benign adrenal cysts. Our experience supports the laparoscopic approach for resection of adrenal cysts. PMID:9892002

Williams, J F; Wolf, J S



Toward a highly-detailed 3D pelvic model: approaching an ultra-specific level for surgical simulation and anatomical education.  


The surgical anatomy of the pelvis is highly complex. Anorectal and urogenital dysfunctions occur frequently after pelvic oncological surgery and are mainly caused by surgical damage of the autonomic nerves. A highly-detailed 3D pelvic model could increase the anatomical knowledge and form a solid basis for a surgical simulation system. Currently, pelvic surgeons still rely on the preoperative interpretation of 2D diagnostic images. With a 3D simulation system, pelvic surgeons could simulate and train different scenes to enhance their preoperative knowledge and improve surgical outcome. To substantially enrich pelvic surgery and anatomical education, such a system must provide insight into the relation between the autonomic network, the lymphatic system, and endopelvic fasciae. Besides CT and MR images, Visible Human Datasets (VHDs) are widely used for 3D modeling, due to the high degree of anatomical detail represented in the cryosectional images. However, key surgical structures cannot be fully identified using VHDs and radiologic imaging techniques alone. Several unsolved anatomical problems must be elucidated as well. Therefore, adequate analysis on a microscopic level is inevitable. The development of a comprehensive anatomical atlas of the pelvis is no straightforward task. Such an endeavor involves several anatomical and technical challenges. This article surveys all existing 3D pelvic models, focusing on the level of anatomical detail. The use of VHDs in the 3D reconstruction of a highly-detailed pelvic model and the accompanying anatomical challenges will be discussed. PMID:23255348

Kraima, A C; Smit, N N; Jansma, D; Wallner, C; Bleys, R L A W; van de Velde, C J H; Botha, C P; DeRuiter, M C



[The establishment and meaning of the three-dimensional finite element model of pelvic floor levator ani muscle in an old healthy woman].  


This paper is to establish a three-dimensional finite element model (3D-FEM) of pelvic floor levator ani muscles in an old healthy women. We acquired the image data of the pelvic bones and pelvic floor muscles from CT and MRI scanning in a non-pregnant old healthy female volunteers. The 3-D reconstruction and mesh optimization of the whole pelvic bones and muscles with application of image processing software Mimics12.0 and Geomagic9.0 were obtained. Then we built the 3D-FEM of the musculoskeletal system of the pelvic bones and levator ani muscles with Ansys11.0 software. We obtained an accurate 3D-FEM of pelvic bones and levator ani muscles in the older healthy woman. The results showed that it was reliable to build 3D-FEM with CT and MRI scanning data and this model could vividly reflect the huge space anatomy of the real pelvic floor levator ani muscles. It avoids the defects to gain the model from the body of anatomical specimens in the past. The image data of model are closer to vivisection, and the model is more conducive to the latter finite element analysis. PMID:22097257

Chen, Wei; Wn, Lijun; Yan, Zhihan; Wang, Jusong; Fu, Yalan; Chen, Xiongfei; Liu, Kun; Wu, Zhipeng



Laparoscopic radical prostatectomy  

Microsoft Academic Search

The radical prostatectomy has been modified over the years. With the introduction to the modern operating room of robots and\\u000a other tools has come the latest modification: the laparoscopic radical prostatectomy (LRP), first described almost 10 years\\u000a ago. In the past 2 years, the technique of LRP has been made standard, reproducible, and efficient. The LRP virtually eliminates\\u000a the physical

Arnon Krongrad



Robotic laparoscopic fundoplication  

Microsoft Academic Search

Opinion statement  Gastroesophageal reflux disease is a very common disorder, and both medical and surgical treatments have shown outstanding\\u000a results. Whereas proton pump inhibitors are the mainstay of treatment, laparoscopic fundoplication has become a very attractive\\u000a alternative due to its efficacy and low morbidity. There are defined patient categories that may benefit more from laparoscopy\\u000a than medical therapy, but a conclusive

Dimitrios Stefanidis; James R. Korndorffer; Daniel J. Scott



Laparoscopic anatomical hepatic resection  

Microsoft Academic Search

.   Four patients underwent a laparoscopic left hepatic resection for solid tumor, two for metastasis from colonic cancer, and\\u000a two for focal nodular hyperplasia (final diagnosis). The procedure was performed according to the rules of conventional hepatic\\u000a surgery and cancer surgery. No blood transfusion was necessary. No surgical complication occurred. In malignant disease, laparoscopy\\u000a allows a good staging and the

G. Samama; L. Chiche; J. L. Bréfort; Y. Le Roux



Total Laparoscopic Pancreaticoduodenectomy  

PubMed Central

Introduction: Total laparoscopic pancreaticoduodenectomy (TLPD) remains one of the most advanced laparoscopic procedures. Owing to the evolution in laparoscopic technology and instrumentation within the past decade, laparoscopic pancreaticoduodenectomy is beginning to gain wider acceptance. Methods: Data were collected for all patients who underwent a TLPD at our institution. Preoperative evaluation consisted of computed tomography scan with pancreatic protocol and selective use of magnetic resonance imaging and/or endoscopic ultrasonography. The TLPD was done with 6 ports on 3 patients and 5 ports in 2 patients and included a celiac, periportal, peripancreatic, and periduodenal lymphadenectomy. Pancreatic stents were used in all 5 cases, and intestinal continuity was re-established by intracorporeal anastomoses. Results: Five patients underwent a TLPD for suspicion of a periampullary tumor. There were 3 women and 2 men with a mean age of 60 years and a mean body mass index of 32.8. Intraoperatively, the mean operative time was 9 hours 48 minutes, with a mean blood loss of 136 mL. Postoperatively, there were no complications and a mean length of stay of 6.6 days. There was no lymph node involvement in 4 out of 5 specimens. The pathological results included intraductal papillary mucinous neoplasm in 2 patients, pancreatic adenocarcinoma in 1 patient (R0 resection), benign 4-cm periampullary adenoma in 1 patient, and a somatostatin neuroendocrine carcinoma in 1 patient (R0, N1). Conclusion: TLPD is a viable alternative to the standard Whipple procedure. Our early experience suggests decreased length of stay, quicker recovery, and improved quality of life. Complication rates appear to be improved or equivalent.

Kamyab, Armin



Laparoscopic adrenal surgery  

Microsoft Academic Search

Summary.   Minimally invasive adrenalectomy is now an accepted alternative to conventional adrenalectomy. As in open surgery, several\\u000a different endoscopic approaches to the adrenal glands have been described. In principle, one must distinguish between the\\u000a laparoscopic and the retroperitoneoscopic access. All adrenal tumors – pheochromocytomas included – except adrenal carcinomas\\u000a can be removed endoscopically. However, the use of these techniques is

C. Nies; E. Möbius; M. Rothmund



[Experimental laparoscopic renal autograft].  


Laparoscopic surgery requires a long training period of time in which the complexity of the training is increased. The technique presented in this paper has been developed in order to find an experimental model that allows us to improve the learning of the vascular suture. Our main goal was to evaluate this technique as an experimental model for the vascular anastomosis, not to obtain a functional autotransplant. In this regard, here we summarize our experience during the first two cases performed. PMID:15046477

Aguilera Bazán, A; Murillo, S; Benito de la Víbora, J; Cisneros Ledo, J; de la Peña Barthel, J



Laparoscopic bariatric surgery  

Microsoft Academic Search

Laparoscopy has meant profound changes for the field of bariatric surgery. Bariatric operations, which are technically difficult\\u000a because of the patient population, were not performed laparoscopically until the last 5 years of the 20th century. The years\\u000a 1998 to 2003, herein defined as the Bariatric Revolution, saw profound changes in the way bariartric surgery was practiced.\\u000a Major changes in patient

B. Schirmer; Stephen H. Watts



Laparoscopic assisted endorectal pull-through with posterior sagittal approach to the repair of postoperative rectourethral and rectovaginal fistula  

Microsoft Academic Search

Rectourethral or rectovaginal fistula is a troublesome complication after anorectal surgery. The pelvic and perineal dissection\\u000a may be difficult because of severe fibrosis adhesion around the fistula. The authors applied a novel technique: a combined\\u000a laparoscopic assisted abdominal and posterior sagittal approach (PSA) to perform the redo surgery. Three boys and two girls\\u000a (3–13 years old): case 1 had rectovaginal fistula

Shaotao Tang; Ning Dong; Qiangsong Tong; Yong Wang; Yongzhong Mao



Fertility and tumor recurrence rate after conservative laparoscopic management of young women with early-stage borderline ovarian tumors  

Microsoft Academic Search

Objective: To evaluate the efficacy of laparoscopic conservative surgery in young women with borderline ovarian tumors who want to preserve their childbearing potential, and to assess whether pregnancy influences the recurrence rate during the follow-up evaluation period.Design: Retrospective study.Setting: Center for Reconstructive Pelvic Endosurgery, Reproductive Medicine Unit, S. Orsola Hospital, University of Bologna, Italy.Patient(s): Nineteen women (mean age 27.4 ±

Renato Seracchioli; Stefano Venturoli; Filippo Maria Colombo; Francesca Govoni; Stefano Missiroli; Anna Bagnoli



Anatomie de la région labiale  

Microsoft Academic Search

The phylogenetic and  embryologic basis and compared anatomy emphasize the understanding of the multiform organization, complex functions for the cosmetic aspects of the facial expression beyond an aged evolution doesn’t disturb the original smiling.

P Caix



Olfaction: anatomy, physiology and behavior  

PubMed Central

The anatomy, physiology and function of the olfactory system are reviewed, as are the normal effects of olfactory stimulation. It is speculated that olfaction may have important but unobtrusive effects on human behavior.

Benignus, Vernon A.; Prah, James D.



The anatomy of the mermaid.  


Investigation of the anatomy of the mermaid and of mermaid lore has revealed a tangled web of stories, sightings and specimens of the most diverse nature, extending worldwide into the realms of folklore and legend, zoology and cryptozoology, anatomy, physiology, radiography and folk medicine, ethnography, social history and the history of science. The stereotype we know as the mermaid is surely a fit subject for further serious study PMID:11620025

Heppell, D


Complications of laparoscopic colorectal surgery  

Microsoft Academic Search

PURPOSE: The aim of this study was to test if the techniques learned during our early learning experience have proved to be effective in reducing the complications specifically related to the laparoscopic technique of colorectal surgery. METHODS: From October 1991 until July 1996, 195 laparoscopic operations were performed on the colon and the rectum. These data were divided into “early”

Sergio W. Larach; Sanjiv K. Patankar; Andrea Ferrara; Paul R. Williamson; Santiago E. Perozo; Alan S. Lord



Choice of Laparoscopic Exposure Method  

Microsoft Academic Search

Presently, with few exceptions, carbon dioxide is the gas used for laparoscopic procedures in humans. CO2 is colorless, noncombustible, odorless, and inexpensive, and, because of its high solubility, is the least dangerous gas should a gas embolism occur during a laparoscopic procedure. Interestingly, several of the major drawbacks associated with the use of CO2 gas, namely, hypercarbia, acidosis, and other

Christopher A. Jacobi; C. Braumann


Telerobotics in laparoscopic general surgery  

Microsoft Academic Search

Summary  BACKGROUND: Telerobotic systems are considered to further improve laparoscopic surgery. They may have some advantages over conventional laparoscopic instruments such as increase in the degree of freedom and 3-D vision. On the other hand, loss of tactile sensitivity and enormous costs are limiting features of these devices. Currently, 2 systems are in use, the Da Vinciand the Zeussystem. METHODS: Our

C. Wullstein; M. Golling; W. O. Bechstein



Laparoscopic surgery complications: Postoperative peritonitis  

PubMed Central

Introduction: Complications within laparoscopic surgery, similar to classic surgery are inevitable and require immediate actions both to diminish intraoperative risks and to choose the appropriate therapeutic attitude. Peritonitis and hemorrhagic incidents are both part of the complications aspect of laparoscopic surgery. Fortunately, the incidence is limited, thus excluding the rejection of celioscopic methods. Patient’s risks and benefits are to be analyzed carefully prior recommending laparoscopic surgery. Materials and methods: This study presents a statistical analysis of peritonitis consecutive to laparoscopic surgery, experience of „Sf. Ioan” Emergency Hospital, Bucharest, and Department of Surgery (2000-2010). Results:There were 180 (0,96%) complicated situations requiring reinterventions, from a total of 18676 laparoscopic procedures. 106 cases (0,56%) represented different grades of postoperative peritonitis. Most frequently, there were consecutive laparoscopic appendicectomia and colecistectomia. During the last decade, few severe cases of peritonitis followed laparoscopic bariatric surgical procedures. Conclusions: This study reflects the possibility of unfavorable evolution of postoperative peritonitis comparing with hemorrhagic incidents within laparoscopic surgery.

Draghici, L; Draghici, I; Ungureanu, A; Copaescu, C; Popescu, M; Dragomirescu, C



Laparoscopic radical prostatectomy: preliminary results  

Microsoft Academic Search

Objectives. To evaluate our preliminary experience with laparoscopic radical prostatectomy. The indications for laparoscopy are currently being extended to complex oncologic procedures.Methods. Forty-three men underwent laparoscopic radical prostatectomy. We used five trocars. The surgical technique replicates the steps of traditional retropubic prostatectomy, except that the rectoprostatic cleavage plane is developed transperitoneally at the beginning of the procedure. In the first

C. C Abbou; L Salomon; A Hoznek; P Antiphon; A Cicco; F Saint; W Alame; J Bellot; D. K Chopin



Laparoscopic Repair of Ureteral Transection  

Microsoft Academic Search

Injury to the ureter is a possible complication of laparoscopic surgery. Traditionally, it is repaired by laparotomy. During laparoscopic surgery for bilateral ovarian remnants in a 29-year-old woman, the left ureter was transected. The ureter was repaired by primary end-to-end anastomosis by laparoscopy. The patient recovered uneventfully, and postoperative intravenous puelogram confirmed the repair to be intact.

Paul K. Tulikangas; Jeffrey M. Goldberg; Inderbir S. Gill



Laparoscopic Excision of an Infected \\  

Microsoft Academic Search

Primary retroperitoneal pseudocysts are rare entities. Though laparoscopic approach has been described in their treatment, open surgical excision is still the mainstay of treatment for these lesions. We present a case of infected retroperitoneal pseudocyst and its successful laparoscopic excision. The patient was an 80-year old female. Contrast enhanced CT scan of the abdomen and ultrasonography confirmed a large retroperitoneal

Chinnusamy Palanivelu; Muthukumaran Rangarajan; Rangaswamy Senthilkumar; Madhupalayam Velusamy Madhankumar; Shankar Annapoorni


Pregnancy Outcome Following Pelvic Infection  

PubMed Central

To determine whether a previous pelvic infection has an effect on the outcome of a subsequent pregnancy, we identified women with a diagnosis of pelvic inflammatory disease (PID), amnionitis, and postpartum or postabortal endometritis-salpingitis by a retrospective chart review of all patients admitted to the Department of Obstetrics and Gynecology at The New York Hospital-Cornell Medical Center between 1975 and 1977 and between 1985 and 1988. Antimicrobial regimens effective against Chlamydia trachomatis were initiated in 1985. Controls were randomly selected patients presenting during the same time period for routine examinations who had normal Pap smears and no infections. Both groups were comparable for age, race, gravity, and parity. Differences were evaluated by chi square analysis, using the Yates correction factor. We identified 183 women with a history of the above infections who subsequently conceived, and 82 controls. There were no differences in outcome between the two index groups. Term vaginal deliveries occurred in 14.2% of the women with a prior pelvic infection and in 56% of the controls (P < 0.001). Among the 97 women who had had PID, 21 (21.6%) had a spontaneous abortion in the subsequent pregnancy, as opposed to 6 (7.3%) of the controls (P = 0.013). In addition, eight of the women with PID (but no controls) went into preterm labor (P = 0.021). An increased incidence of preterm labor (P = 0.001) was also observed in women with a history of amnionitis. A history of endometritis was not associated with an increased prevalence of abnormal outcome in subsequent pregnancies. PID and amnionitis may adversely affect the outcome of subsequent pregnancies.

Chaudhry, Anu; Ledger, William J.; Witkin, Steven S.



[Open and laparoscopic adrenalectomy. 10 years review].  


We present a 10 years open adrenalectomy review in our Service and the beginning of laparoscopic adrenalectomy in the last year as a part of the retroperitoneal laparoscopic program at the Hospital Universitario La Paz . The first laparoscopic adrenalectomy was done after 21 retroperitoneal laparoscopic surgeries. Our initial experience has been so good that we have reduced the contraindications for this technique and we have increased the number of laparoscopic surgery cases. PMID:17253071

Aguilera Bazán, A; Pérez Utrilla, M; Alonso y Gregorio, S; Cansino Alcaide, R; Cisneros Ledo, J; De la Peña Barthel, J


Relief of Urinary Urgency, Hesitancy, and Male Pelvic Pain with Pulse Radiofrequency Ablation of the Pudendal Nerve: A Case Presentation  

PubMed Central

Background and Aims. This report demonstrates the utility of a pudendal nerve block by pulsed radiofrequency ablation (RFA) for the treatment of male pelvic pain and urinary urgency and hesitancy. Methods. The patient is an 86-year-old gentleman with a 30-year history of urinary hesitancy and urgency. The patient also had pain in the area of the perineum but considered it a secondary issue. The patient was seen by a number of specialists, tried various medications, and underwent a variety of procedures to no avail. Therefore, the patient underwent a pulsed RFA of the pudendal nerve. Results. The patient underwent a pulsed RFA of the pudendal nerve; the patient reported marked improvement in his pelvic pain as well as a drastic reduction in his urinary urgency and hesitancy. Conclusion. Urinary urgency and hesitancy and male pelvic pain are some of the most common symptoms affecting men. Pudendal nerve block by pulsed RFA is an effective treatment of pelvic pain. It may also hold some therapeutic value in the treatment of urinary urgency and hesitancy as our case demonstrated. Further studies are needed to help clarify both the anatomy of the pelvis as well as if pudendal blocks are effective in treating more than pelvic pain.

Pangarkar, Sanjog; Zeitlin, Scott I.



Pelvic Exenterations: Supralevator, Infralevator, and with Vulvectomy  

Microsoft Academic Search

The purpose of this study was to determine whether the different types (I, II, and III) of pelvic exenterations have prognostic implications in regard to operative features, postoperative complications, and survival. The records of the 133 patients who underwent pelvic exenteration at the Mayo Clinic from 1977 to 1986 were reviewed. The records were abstracted for duration of hospitalization, febrile

Javier F. Magrina; C. Robert Stanhope; Amy L. Weaver



Role of Laparoscopy in Identifying the Clinical Significance and Cause of Adhesions and Chronic Pelvic Pain: a Retrospective Review at the Kiel School of Gynecological Endoscopy  

PubMed Central

Objectives: We sought to define the role of laparoscopy in identifying the clinical significance, cause, and association between adhesions and chronic pelvic pain. Methods: A retrospective chart review was conducted from October 2004 to July 2005, at the Kiel School of Gynecological Endoscopy, University Hospitals Schleswig-Holstein, Campus Kiel, Germany. Included in the study was the analysis of 462 laparoscopic procedures; 275 (59.5%) of the patients undergoing these procedures had pelvic or abdominal adhesions. Of these, 84 (30.5%) patients were admitted with the main complaint of chronic pelvic pain. Further evaluation and assessment of this group was carried out. Results: Among those patients with adhesions, the second most frequent reason for admission was chronic pelvic pain (30.5%) (P<0.0005). In our study, adhesions were found in 79.2% (n=84) of patients (n=106) with chronic pelvic pain. These adhesions were thin- filmy (19.0%) or thick-fibrous (81.0%) adhesions containing blood vessels. Thick-fibrous adhesions were present in 50.0% of patients at multiple abdominopelvic sites (P<0.005). Conclusions: Thick-fibrous adhesions that extend beyond the pelvic sidewall can cause significant chronic abdominopelvic pain.

ALHujeily, Maher



Geometric modeling of pelvic organs.  


The pelvic floor can be subjected to different disorders, coming from a physiological change in the spatial configuration of the organs of interest: the bladder, the rectum, the uterus and the vagina. However, resort to surgery to replace them is complicated to achieve. In order to support the decision of the surgeon as to the invasive method to use for the patient, the MoDyPe (Pelvis Dynamics Modeling) project was launched, aiming at building a patient specific pelvic organ behavior. Our approach consists in creating thick surfaces of hollow organs, using periodic B-splines and offsets, then in controlling their discretization and in exporting a hexahedral model to provide input data for the study on the dynamics of the soft bodies of interest. From a segmentation step providing a dataset of 3D points, a function is built to measure the bidirectional distance between the surface and the data. It is minimized with an alternate iterative Hoschek-like method, by updating the parametric map and moving the control points. Several offsets of the base surface are then created to build up the thickness of the organ. PMID:22255297

Bay, Thierry; Chambelland, Jean-Christophe; Raffin, Romain; Daniel, Marc; Bellemare, Marc-Emmanuel



A randomized prospective trial of the postoperative quality of life between laparoscopic uterine artery ligation and laparoscopy-assisted vaginal hysterectomy for the treatment of symptomatic uterine fibroids: clinical trial design  

Microsoft Academic Search

BACKGROUND: Laparoscopy-assisted vaginal hysterectomy is one of the definite methods for the treatment of symptomatic uterine fibroids with lesser intraoperative bleeding and shorter hospitalization compared with abdominal hysterectomy. However, laparoscopy-assisted vaginal hysterectomy cannot preserve uterus and can show postoperative complications by the change of pelvic structure. Thus, laparoscopic uterine artery ligation has been introduced for relieving the symptoms caused by

Hee Seung Kim; Jae Weon Kim; Mi-Kyung Kim; Hyun Hoon Chung; Taek Sang Lee; Yong-Tark Jeon; Yong Beom Kim; Hye Won Jeon; Young Ho Yun; Noh Hyun Park; Yong Sang Song; Soon-Beom Kang



Mapping pelvic lymph nodes: Guidelines for delineation in intensity-modulated radiotherapy  

SciTech Connect

Purpose: To establish guidelines for delineating the clinical target volume for pelvic nodal irradiation by mapping the location of lymph nodes in relation to the pelvic anatomy. Methods and Materials: Twenty patients with gynecologic malignancies underwent magnetic resonance imaging with administration of iron oxide particles. All visible lymph nodes were outlined. Five clinical target volumes were generated for each patient using modified margins of 3, 5, 7, 10, and 15 mm around the iliac vessels. The nodal contours were then overlaid and individual nodes analyzed for coverage. The volume of normal tissue within each clinical target volume and planning target volume was also measured to aid selection of the margin that could provide maximal nodal, but minimal normal tissue, coverage. Results: In total, 1216 nodal contours were evaluated. The nodal coverage was 56%, 76%, 88%, 94%, and 99% using vessel margins of 3, 5, 7, 10, and 15 mm, respectively. The mean volume of bowel within the planning target volume was 146.9 cm{sup 3} with a 7-mm margin, 190 cm{sup 3} with a 10-mm margin, and 266 cm{sup 3} with a 15-mm margin. Minor modification to the 7-mm margin ensured 99% coverage of the pelvic nodes. Conclusion: Blood vessels with a modified 7-mm margin offer a good surrogate target for pelvic lymph nodes. By making appropriate adjustments, coverage of specific nodal groups may be increased and the volume of normal tissue irradiated decreased. On the basis of these findings, recommended guidelines for outlining pelvic nodes have been produced.

Taylor, Alexandra [Department of Radiotherapy, St. Bartholomew's Hospital, London (United Kingdom)]. E-mail:; Rockall, Andrea G. [Department of Radiology, St. Bartholomew's Hospital, London (United Kingdom); Reznek, Rodney H. [Department of Radiology, St. Bartholomew's Hospital, London (United Kingdom); Powell, Melanie [Department of Radiotherapy, St. Bartholomew's Hospital, London (United Kingdom)



The role of pelvic organs prolapse in the etiology of urinary incontinence in women  

PubMed Central

Background: Urinary incontinence is relatively common in women and is usually associated with pelvic organs prolapse. Our aim was to determine the relationship between type and intensity of urinary incontinence and different grades and types of pelvic organ prolapse among women. Materials and Methods: One-hundred female patients with the chief complaint of incontinence, who were diagnosed with pelvic organ prolapse participated in this study. Intensity of prolapse, stress and urge incontinence were evaluated using POP-Q (Pelvic Organ Prolapse Questionnaire), SEAPI (Stress related, Emptying ability, Anatomy, Protection, Inhibition) and Freeman criteria, respectively. Results: Patients’ mean age was 51.95 ± 12.82 years. The most common type of incontinence was stress incontinence (53%) and the most common prolapse type was cystocele (76%). Cystocele and rectocele had a significant relationship with stress (P value = 0.012) and urge incontinence (P value = 0.035), respectively; however, no relationship was observed between different grades of cystocele, rectocele and enterocele with different types of urinary incontinence (P value > 0.05). In patients with urge and mixed incontinence, prolapse grade significantly increased with age, but no such relationship was found in patients with stress incontinence. The number of vaginal deliveries had a significant relationship only with cystocele and rectocele grade; however, the relationship between other variables such as intensity of different types of urinary incontinence and enterocele grade with the number of deliveries was not significant. Conclusion: Pelvic organ prolapse had a significant relationship with urinary incontinence regardless of intensity and POP should be examined in all of these patients.

Zargham, Mahtab; Alizadeh, Farshid; Moayednia, Amir; Haghdani, Saeed; Nouri-Mahdavi, Kia



Student perceptions about learning anatomy  

NASA Astrophysics Data System (ADS)

This research study was conducted to examine student perceptions about learning anatomy and to explore how these perceptions shape the learning experience. This study utilized a mixed-methods design in order to better understand how students approach learning anatomy. Two sets of data were collected at two time periods; one at the beginning and one at the end of the academic semester. Data consisted of results from a survey instrument that contained open-ended questions and a questionnaire and individual student interviews. The questionnaire scored students on a surface approach to learning (relying on rote memorization and knowing factual information) scale and a deep approach to learning (understanding concepts and deeper meaning behind the material) scale. Students were asked to volunteer from four different anatomy classes; two entry-level undergraduate courses from two different departments, an upper-level undergraduate course, and a graduate level course. Results indicate that students perceive that they will learn anatomy through memorization regardless of the level of class being taken. This is generally supported by the learning environment and thus students leave the classroom believing that anatomy is about memorizing structures and remembering anatomical terminology. When comparing this class experience to other academic classes, many students believed that anatomy was more reliant on memorization techniques for learning although many indicated that memorization is their primary learning method for most courses. Results from the questionnaire indicate that most students had decreases in both their deep approach and surface approach scores with the exception of students that had no previous anatomy experience. These students had an average increase in surface approach and so relied more on memorization and repetition for learning. The implication of these results is that the learning environment may actually amplify students' perceptions of the anatomy course at all levels and experiences of enrolled students. Instructors wanting to foster deeper approaches to learning may need to apply instructional techniques that both support deeper approaches to learning and strive to change students' perceptions away from believing that anatomy is strictly memorization and thus utilizing surface approaches to learning.

Notebaert, Andrew John


The place of surface anatomy in the medical literature and undergraduate anatomy textbooks.  


The aims of this review were to examine the place of surface anatomy in the medical literature, particularly the methods and approaches used in teaching surface and living anatomy and assess commonly used anatomy textbooks in regard to their surface anatomy contents. PubMed and MEDLINE databases were searched using the following keywords "surface anatomy," "living anatomy," "teaching surface anatomy," "bony landmarks," "peer examination" and "dermatomes". The percentage of pages covering surface anatomy in each textbook was calculated as well as the number of images covering surface anatomy. Clarity, quality and adequacy of surface anatomy contents was also examined. The search identified 22 research papers addressing methods used in teaching surface anatomy, 31 papers that can help in the improvement of surface anatomy curriculum, and 12 anatomy textbooks. These teaching methods included: body painting, peer volunteer surface anatomy, use of a living anatomy model, real time ultrasound, virtual (visible) human dissector (VHD), full body digital x-ray of cadavers (Lodox(®) Statscan(®) images) combined with palpating landmarks on peers and the cadaver, as well as the use of collaborative, contextual and self-directed learning. Nineteen of these studies were published in the period from 2006 to 2013. The 31 papers covered evidence-based and clinically-applied surface anatomy. The percentage of surface anatomy in textbooks' contents ranged from 0 to 6.2 with an average of 3.4%. The number of medical illustrations on surface anatomy varied from 0 to 135. In conclusion, although there has been a progressive increase in publications addressing methods used in teaching surface anatomy over the last six to seven years, most anatomy textbooks do not provide students with adequate information about surface anatomy. Only three textbooks provided a solid explanation and foundation of understanding surface anatomy. Anat Sci Educ 6: 415-432. © 2013 American Association of Anatomists. PMID:23650274

Azer, Samy A



Laparoscopic colorectal resection for diverticulitis.  


This study evaluated outcome in patients undergoing laparoscopically assisted sigmoid resection for diverticular disease. A total of 29 consecutive patients were treated surgically for colonic diverticulitis; in 27 of these laparoscopy was performed. The review of medical records from a control group of 34 patients undergoing open resection were used for comparison. The conversion rate was 7.5%. Using the laparoscopic technique the duration of surgery was longer (165 vs. 121 min, P < 0.05), blood loss less (182 vs. 352 ml, P < 0.05), and subsequent blood transfusion less (0 vs. 61%). The incidence of complications following laparoscopic resection was lower (two anastomotic leakages, two wound infections) than in the conventional group. Convalescence in the laparoscopic group was more rapid and hospital stay shorter (7.9 vs. 14.3 days, P < 0.05). In the laparoscopic group patients expressed less pain at rest and in motion. The cost of the laparoscopically assisted procedure was less than that of conventional resection (7185 vs. 8975 DM). In this series laparoscopically assisted sigmoid resection for diverticulitis proved safe. Recovery was faster, hospital stay was shorter, and patients expressed less pain than in conventional open surgery. PMID:9548100

Köhler, L; Rixen, D; Troidl, H



3D surface reconstruction for laparoscopic computer-assisted interventions: comparison of state-of-the-art methods  

Microsoft Academic Search

One of the main challenges related to computer-assisted laparoscopic surgery is the accurate registration of pre-operative planning images with patient's anatomy. One popular approach for achieving this involves intraoperative 3D reconstruction of the target organ's surface with methods based on multiple view geometry. The latter, however, require robust and fast algorithms for establishing correspondences between multiple images of the same

A. Groch; A. Seitel; S. Hempel; S. Speidel; R. Engelbrecht; J. Penne; K. Höller; S. Röhl; K. Yung; S. Bodenstedt; F. Pflaum; T. R. Dos Santos; S. Mersmann; H.-P. Meinzer; J. Hornegger; L. Maier-Hein



Laparoscopic tailored Nissen fundoplication  

Microsoft Academic Search

Background  It is difficult sometimes to determine the suture points for proper Nissen fundoplication under laparoscopy. We introduce\\u000a a new procedure to define the suture points in Laparoscopic Nissen fundoplication (LNF).\\u000a \\u000a \\u000a \\u000a \\u000a Surgical technique  After dissection of the hiatus and mobilization of the fundus, the circumference of the esophagus c is measured at a point 2-cm cranial from the esophagogastric junction over the

Shinya Asami; Takashi Ishikawa; Shinichiro Kubo; Takayuki Iwamoto; Shinichiro Watanabe; Hitoshi Kin



Laparoscopic partial splenectomy  

Microsoft Academic Search

Background  The immunologic function of the spleen and its important role in immune defense has led to splenic-preserving surgery. This\\u000a study aimed to evaluate whether laparoscopic partial splenectomy is safe.\\u000a \\u000a \\u000a \\u000a Methods  Data on consecutive patients presenting with localized benign or malignant disease of the spleen were included in a prospective\\u000a database. The surgical technique consisted of six steps: patient positioning and trocar

S. Uranues; D. Grossman; L. Ludwig; R. Bergamaschi



Laparoscopic splenectomy for ITP  

Microsoft Academic Search

Background: A comparison of safety, efficacy, and cost of laparoscopic splenectomy (LS) vs open splenectomy (OS) for idiopathic thrombocytopenic\\u000a purpura (ITP) was performed.\\u000a \\u000a \\u000a \\u000a \\u000a Methods: The records of 49 consecutive patients who underwent splenectomy for ITP (31 LS and 18 OS) at a large metropolitan teaching\\u000a hospital between 3\\/91 and 8\\/95 were reviewed. Morbidity, mortality, hospital stay, operative time, blood loss,

R. L. Friedman; M. J. Fallas; B. J. Carroll; J. R. Hiatt; E. H. Phillips



Laparoscopic vessel sealing technologies.  


Laparoscopic vessel sealing devices have revolutionized modern laparoscopy. These devices fall into 2 major categories: advanced bipolar and ultrasonic instruments. The range of tissue effects available with these technologies is more limited than with conventional monopolar electrosurgery; however, both advanced bipolar and ultrasonic devices efficiently seal vessels (?7-mm and ?5-mm diameter, respectively), and most also have built-in tissue transection capabilities. These technologies have been the subject of a range of comparative studies on their relative advantages and disadvantages, and, to date, neither advanced bipolar or ultrasonic devices has been proven to be superior. PMID:23659750

Lyons, Stephen D; Law, Kenneth S K


Endometriosis and Chronic Pelvic Pain  

PubMed Central

Nurses often encounter patients with chronic pelvic pain associated with endometriosis, which is a puzzling and problematic gynecologic condition that has continued to plague women and baffle doctors and researchers worldwide since it was first identified by Dr. J. Sampson in the 1920s (Sampson, 1940). Endometriosis is defined as the growth, adhesion and progression of endometrial glands and stroma outside of the uterine cavity, with cellular activity evident in lesions, nodules, cysts or endometriomas (Audebert et al., 1992). Although it typically appears benign on histopathology, endometriosis has been likened to a malignant tumor since the lesions grow, infiltrate and adhere to adjacent tissues and interfere with physiologic processes (Kitawaki et al., 2002; Noble, Simpson, Johns, & Bulun, 1996). Ectopic endometriotic growths respond to cyclic changes of estrogen and proliferate and shed in a manner similar to eutopic endometrium. This cyclic ectopic activity results in internal bleeding, formation of scar tissue, inflammation and sometimes debilitating chronic pain (Kitawaki et al.).

Bloski, Terri; Pierson, Roger



Laparoscopic Cholecystectomy in Cirrhotics  

PubMed Central

Background and Objectives: Due to the concern of risk of intra- and postoperative complications and associated morbidity, cirrhosis of the liver is often considered a contraindication for laparoscopic cholecystectomy (LC). This article intends to review the literature and underline the various approaches to dealing with this technically challenging procedure. Methods: A Medline search of major articles in the English literature on LC in cirrhotic patients over a 16-y period from 1994 to 2011 was reviewed and the findings analyzed. A total of 1310 cases were identified. Results: Most the patients who underwent LC were in Child-Pugh class A, followed by Child-Pugh classes B and C, respectively. The overall conversion rate was 4.58%, and morbidity was 17% and mortality 0.45%. Among the patients who died, most were in Child-Pugh class C, with a small number in classes B and A. The cause of death included, postoperative bleeding, liver failure, sepsis, duodenal perforation, and myocardial infarction. A meta-analysis of 400 patients in the literature, comparing outcomes of patients undergoing LC with and without cirrhosis, revealed higher conversion rate, longer operative time, higher bleeding complications, and overall increased morbidity in patients with cirrhosis. Safe LC was facilitated by measures that included the use of ultrasonic shears and other hemostatic measures and using subtotal cholecystectomy in patients with difficult hilum and gallbladder bed. Conclusions: Laparoscopic cholecystectomy can be safely performed in cirrhotic patients, within Child-Pugh classes A and B, with acceptable morbidity and conversion rate.



Transvaginal laparoscopic donor nephrectomy.  


Laparoscopic donor nephrectomy (LDN) has numerous advantages over open donor nephrectomy. The cosmetic issues and pain that arise due to the 5 to 6-cm incisions on the abdominal wall in LDN have led to transvaginal laparoscopic donor nephrectomy (TVLDN). Between May and August 2012, we performed seven donor nephrectomies via a transvaginal approach. The mean age of the donors was 53.0 ± 9.52 years. The mean operative time was 97.29 ± 39.47 minutes and mean warm ischemia time, 220.71 ± 55.49 seconds. Donors were mobilized, began oral intake at 8 hours postoperative, and were all discharged within the first 24 hours. Except one dose of analgesic applied immediately after the operation, no additional medication was required. No infectious complications were encountered in any recipient. TVLDN may be a good alternative for female donors. Compared with LDN, TVLDN has benefits of less postoperative pain, faster recovery, shorter hospital stay, and excellent cosmetic results. PMID:23622577

Ero?lu, A; ?ener, C; Tabandeh, B; Tilif, S; Okçuo?lu Kad?o?lu, Z; Kaçar, S



Variant anatomy of sciatic nerve in a black Kenyan population.  


Knowledge of variant anatomy of the sciatic nerve is important in avoiding inadvertent injury during operations in the gluteal region and interpreting nondiscogenic sciatica. This variant anatomy may cause piriformis syndrome and failure of sciatic nerve block. The variations differ between populations but data from Africans is scarce. This study, therefore, investigated variations of sciatic nerve in a black Kenyan population. One hundred and sixty-four sciatic nerves from 82 cadavers of black Kenyans were exposed by dissection at the Department of Human Anatomy, University of Nairobi, Kenya. The level of bifurcation, relationship to piriformis, and topographic relations between the branches were studied. The results were analysed by SPSS version 16.0 and are presented by macrographs. In 33 (20.1%) cases division occurred in the pelvis, while in 131 (79.9%) it occurred outside the pelvis. A single trunk sciatic nerve exited below the piriformis muscle in 131 (79.9%) cases. In cases of pelvic division, the tibial nerve was always infrapiriformic, while the common peroneal nerve passed below piriformis in 16 (9.8%) cases, pierced the piriformis in 13 (7.9%), and passed above it in 4 (2.4%). For those in which division was extrapelvic, 110 (67.1%) were in the popliteal fossa, 17 (10.4%) in the middle third of the thigh, and 4 (2.4%) in the gluteal region. Where the division was pelvic, in 19 (11.6%) cases they continued separately, in 8 (4.9%) the two nerves reunited, and in 6 (3.7%) they were connected by a communicating nerve. The sciatic nerve in the Kenyan population varies from the classical description in over 30% of cases, with many high divisions, low incidence of piriformic course of common peroneal nerve, reunion, and unusual connection between common peroneal and tibial nerves. These variations may complicate surgery and interpretation of sciatic neuropathy. Preoperative nerve imaging and extra operative diligence in the gluteal region and the back of the thigh are recommended. PMID:21866528

Ogeng'o, J A; El-Busaidy, H; Mwika, P M; Khanbhai, M M; Munguti, J



[Magnetic resonance imaging elbow anatomy].  


Knowledge of the anatomy of the elbow joint has become intricate due to the advent of magnetic resonance imaging (MRI) techniques, as they are superior to represent the different soft tissues. This advantage allows evaluating in detail the increasingly frequent pathologic processes that occur in high performance athletes. The ideal MRI technique includes having the patient in a comfortable position, using an appropriate surface antenna and the right sequences in the appropriate planes depending on the entity. Being familiar with the normal elbow anatomy is crucial to properly identify the pathology and avoid potential diagnostic errors. PMID:22509650

Rodríguez-Ramírez, C L; Aguila-Mendoza, A


Tribute to a triad: history of splenic anatomy, physiology, and surgery--part 1.  


The spleen is an enigmatic organ with a peculiar anatomy and physiology. Though our understanding of this organ has improved vastly over the years, the spleen continues to produce problems for the surgeon, the hematologist, and the patient. The history of the spleen is full of fables and myths, but it is also full of realities. In the Talmud, the Midrash, and the writings of Hippocrates, Plato, Aristotle, Galen, and several other giants of the past, one can find a lot of Delphian and Byzantine ambiguities. At that time, splenectomy was the art of surgery for many splenic diseases. From antiquity to the Renaissance, efforts were made to study the structure, functions, and anatomy of the spleen. Vesalius questioned Galen; and Malpighi, the founder of microscopic anatomy, gave a sound account of the histology and the physiologic destiny of the spleen. Surgical inquiry gradually became a focal point, yet it was still not clear what purpose the spleen served. It has been within the past 50 years that the most significant advances in the knowledge of the spleen and splenic surgery have been made. The work of Campos Christo in 1962 about the segmental anatomy of the spleen helped surgeons perform a partial splenectomy, thereby avoiding complications of postsplenectomy infection. With the recent successes of laparoscopic splenectomy in selected cases, the future of splenic surgery will undoubtedly bring many more changes. PMID:9933705

McClusky, D A; Skandalakis, L J; Colborn, G L; Skandalakis, J E



Three-dimensional Ultrasound Appearance of Pelvic Floor in Nulliparous Women and Pelvic Organ Prolapse Women  

PubMed Central

The present study investigated the morphology and structure of pelvic floor in 50 nulliparous and 50 pelvic organ prolapse (POP) women using translabial three-dimensional (3D) ultrasound. The levator hiatus in POP women was significantly different from that in nullipara women. In POP women, the size of pelvic floor increased, with a circular shape, and the axis of levator hiatus departed from the normal position in 36 (72%) cases. The puborectalis was avulsed in 18 (36%) cases and the pelvic organs arranged abnormally in 23 (46%) cases. In summary, 3D ultrasound is an effective tool to detect the pelvic floor in POP women who presented with abnormalities in the morphology and structure of pelvic floor.

Ying, Tao; Li, Qin; Xu, Lian; Liu, Feifei; Hu, Bing




PubMed Central

Background and Aims Current concepts based on referral center data suggest that pelvic floor injury from obstetric trauma is a major risk factor for fecal incontinence (FI) in women. In contrast, a majority of community women only develop FI decades after vaginal delivery, and obstetric events are not independent risk factors for FI. However, obstetric events are imperfect surrogates for anal and pelvic floor injury, which is often clinically occult. Hence, our objectives were to evaluate the relationship between prior obstetric events, pelvic floor injury, and FI among community women. Design In this nested case-control study of 68 women with FI (cases; mean age 57y) and 68 age-matched controls from a population-based cohort in Olmsted County, MN, pelvic floor anatomy and motion during voluntary contraction and defecation were assessed by MRI. Obstetric events and bowel habits were recorded. Results By multivariable analysis, internal sphincter injury (cases-28%, controls-6%; odds ratio [OR], 8.8; 95% CI, 2.3–34) and reduced perineal descent during defecation (cases-2.6 ± 0.2 cm, controls-3.1 ± 0.2 cm; OR, 1.7; 95% CI, 1.2–2.4) increased FI risk, but external sphincter injury (cases-25%, controls-4%;p < 0.005) was not independently predictive. Puborectalis injury was associated (p<0.05) with impaired anorectal motion during squeeze, but was not independently associated with FI. Grade 3–4 episiotomy (OR, 3.9; 95% CI, 1.4–11) but not other obstetric events increased the risk for pelvic floor injury. Heavy smoking (? 20 pack-years) was associated (p=0.052) with external sphincter atrophy. Conclusions State-of-the-art imaging techniques reveal pelvic floor injury or abnormal anorectal motion in a minority of community women with FI. Internal sphincter injury and reduced perineal descent during defecation are independent risk factors for FI. In addition to grade 3–4 episiotomy, smoking may be a potentially preventable, risk factor for pelvic floor injury.

Bharucha, Adil E.; Fletcher, J.G.; Melton, L. Joseph; Zinsmeister, Alan R.



The necessity for prospective evidence for single-site umbilical laparoscopic surgery.  


During the past 10 years, the minimally invasive technique has become the standard approach for many thoracic, abdominal, and pelvic procedures in adults and children. We now know there are well-defined benefits to this approach. However, when it was introduced, the laparoscopic technique was quickly adopted without appropriate clinical evidence to justify its advantages over open surgery. With continued efforts to increase the benefits of minimally invasive surgery for their patients, surgeons have developed new techniques to further decrease the trauma of the operation and improve the postoperative cosmetic appearance for the patient. These innovations range from decreasing the size of the ports and instruments to the current group of techniques termed "scarless" surgery. In today's era of evidence-based medicine, it is important to scientifically evaluate the benefits of a new approach or technique. This article seeks to review the history of laparoscopic surgery, apply lessons learned during the past 10 years to the evolution of single incision laparoscopic surgery, and urge for sound prospective evaluation for the use of laparoscopic surgery using a single umbilical incision. PMID:21968160

St Peter, Shawn D; Ostlie, Daniel J



Osseous Anatomy of the Orbital Apex  

Microsoft Academic Search

The osseous anatomy of the orbital apex may be difficult to conceptualize because of the dif- ferent shapes and orientations of the optic ca- nal, superior and inferior orbital fissures, and foramen rotundum. However, knowing this anatomy is crucial to evaluate complex frac- tures, tumors, and inflammatory processes in- volving the orbital apex. Evaluating osseous anatomy of the orbital apex

David L. Daniels; Leighton P. Mark; Mahmood F. Mafee; Bruce Massaro; Lloyd E. Hendrix; Katherine A. Shaffer; David Morrissey; Charles W. Horner



Microsoft Academic Search

PurposeAn increasing number of operative procedures in pediatric urology can be performed by laparoscopy. We report our experience with laparoscopic heminephroureterectomy, which is a typical operation in pediatric patients.

Gunter Janetschek; Jorg Seibold; Christian Radmayr; Georg Bartsch



Laparoscopic repair of parapubic hernia.  


Since the introduction of laparoscopic cholecystectomy in the late 1980s, video technology has continued to find new applications in the field of general surgery. Laparoscopic inguinal herniorrhaphy is touted by many to provide a minimally invasive approach to the most commonly performed general surgical procedure, possibly with a lower incidence of recurrence. Additionally, laparoscopic repair of an incisional hernia with synthetic mesh allows a tension-free procedure while potentially reducing the risk of complications such as wound and mesh infections by avoiding the use of large abdominal wall incisions through old surgical scars. The parapubic hernia is a rare form of incisional hernia resulting from the detachment of muscular attachments to the pubic bone. It is a diagnostic and therapeutic challenge that is often misdiagnosed and mismanaged. We have found the laparoscopic approach to the parapubic hernia to be a superior method of managing this often challenging condition. PMID:11695979

Hirasa, T; Pickleman, J; Shayani, V



A New Technique for Laparoscopic Anterior Resection for Rectal Endometriosis  

PubMed Central

Background: Anterior rectal resection is sometimes necessary to treat deeply infiltrating rectovaginal endometriosis. We describe a completely laparoscopic approach as a new way of excising rectal endometriosis that can be used without opening any part of the rectum. This avoids opening the abdomen or any risk of fecal spillage. Methods: The patient received preoperative oral bowel preparation. Ureteric stents (6 F) were inserted cystoscopically. The peritoneum in the ovarian fossae was opened lateral to any disease and the rectum reflected off the back of the cervix, leaving any endometriosis on the front of the rectum. The pelvic peritoneum was reflected medially, below the level of the ureters. The mesorectum was then dissected off a 6-cm length of rectum by using a Harmonic scalpel. A circular end-to-end anastomosis instrument was passed anally until the outline of the anvil was visible, inside the colon, above the diseased rectum. The anvil was detached and held by a soft grasper before the rectum was then divided above and below the disease using a laparoscopic stapling device. The tip of the anvil was pushed through the proximal end of the colon allowing reanastomosis of the rectal stump. Conclusion: The patient was discharged after 5 days without complications.

English, James; Miles, W. F. Anthony; Giannopoulos, Theo



Laparoscopic colorectal resection for diverticulitis  

Microsoft Academic Search

This study evaluated outcome in patients undergoing laparoscopically assisted sigmoid resection for diverticular disease.\\u000a A total of 29 consecutive patients were treated surgically for colonic diverticulitis; in 27 of these laparoscopy was performed.\\u000a The review of medical records from a control group of 34 patients undergoing open resection were used for comparison. The\\u000a conversion rate was 7.5%. Using the laparoscopic

L. Köhler; D. Rixen; H. Troidl



Robotic-Assisted Laparoscopic Pyeloplasty  

Microsoft Academic Search

Robotic-assisted laparoscopic pyeloplasty (RALP) is an elegant, minimally invasive reconstructive procedure to treat UPJ obstruction.\\u000a The technique is discussed here in detail. Some selected patients can be discharged within 18 hours. Some series over five\\u000a years report success rates of between 95 and 100%. The benefits over laparoscopic pyeloplasty are arguable and need to carefully\\u000a be measured against the increased

Declan G. Murphy; Jamie Kearsley; Anthony J. Costello


Rhabdomyolysis after Laparoscopic Bariatric Surgery  

Microsoft Academic Search

Background: Postoperative rhabdomyolysis is an uncommon event. The aim of this study was to determine the incidence of rhabdomyolysis\\u000a following laparoscopic obesity surgery. Methods: Rhabdomyolysis was studied prospectively. Over a 6-month period, 66 consecutive\\u000a patients underwent bariatric surgery (gastric banding (n=50) and gastric bypass (n=16)). All patients underwent laparoscopic\\u000a procedures. A range of blood tests, including serum creatine phosphokinase (CPK)

Philippe Mognol; Stéphane Vignes; Denis Chosidow; Jean-Pierre Marmuse



Laparoscopic-assisted colon resection  

Microsoft Academic Search

The popularity and success of laparoscopic biliary tract surgery have persuaded surgeons to explore other applications for\\u000a rigid endoscopic surgery. From July 1990 to February 1993 a total of 65 patients (mean age 57 years; range 41–82) underwent\\u000a attempted laparoscopic colon resection. Indications for surgical intervention included cancer (39), adenomatous polyps (14),\\u000a diverticulosis (10), stricture (1), and foreign-body perforation (1).

K. A. Zucker; D. E. Pitcher; D. T. Martin; R. S. Ford



Neglected Primary Omental Pregnancy after Laparoscopic and Medical Treatment: A Difficult Diagnosis?  

PubMed Central

The following case report describes a rare case of omental pregnancy in a fertile 34-year-old woman at 5 + 3 weeks of gestation who presented with abdominal pain. Clinical examination, vital signs, and laboratory values were within normal limits, so the woman was hospitalized and monitored. Laparoscopic exploration was performed according to the preoperative diagnosis of tubal pregnancy, but it showed normal pelvic organs. In view of the growth of the ?-HCG value, a medical approach was attempted, without success. Due to hemodynamic instability, an emergency laparotomy was performed, and it showed an omental pregnancy, confirmed at the pathological examination.

Martelli, Federica; De Carolis, Caterina; Parisi, Carmelo; Piccione, Emilio



Retained appendicolith after laparoscopic appendectomy: the need for systematic double ligature of the appendiceal base.  


Appendicoliths are considered to be strong indicators of appendicitis and the complications of appendicitis. We report the case of a 29-year-old woman who underwent a laparoscopic appendectomy for appendicitis with an appendicolith. The appendix was divided with a single ligature at the appendiceal base, and an appendicolith escaped into the pelvis. Thereafter, the patient suffered recurrent pelvic abscess. The diagnosis of retained appendicolith was made by repeated CT scans that revealed a mobile spontaneous calcification within the abscess. This postoperative complication could have been avoided if a systematic division of the appendix had been performed between double ligatures. PMID:15214373

Guillem, P; Mulliez, E; Proye, C; Pattou, F



Directional asymmetry of pelvic vestiges in threespine stickleback  

Microsoft Academic Search

ABSTRACT Extensive reduction of the size and complexity of the pelvic skeleton (i.e., pelvic reduction),has evolved,repeatedly,in Gasterosteus,aculeatus. Asymmetrical,pelvic vestiges,tend,to be larger on the left side (i.e., left biased) in populations studied previously. Loss of Pitx1 expression is associated with pelvic reduction in G. aculeatus, and pelvic reduction maps to the Pitx1 locus. Pitx1 knockouts in mice have reduced hind limbs,

Michael A. Bell; Victoria Khalef; Matthew P. Travis



Laparoscopic bile duct injuries. Risk factors, recognition, and repair.  


Records of 11 patients undergoing biliary reconstruction after laparoscopic cholecystectomy are reviewed. Ductal injuries resulted from failure to define the anatomy of Calot's triangle. Risk factors include scarring, acute cholecystitis, and obesity. Presenting findings included anorexia, ileus, failure to thrive, pain, ascites, and jaundice. All patients required hepaticojejunostomies, which were multiple and above the hepatic bifurcation in four patients. Given the extensive nature of these injuries and the frequent need for intrahepatic anastomosis and early stenosis of repairs by referring physicians, we recommend reconstruction be undertaken by an experienced hepatobiliary surgeon. To avoid injuries, a greater appreciation of risk factors and anatomic distortion and variance and strict adherence to principles of dissection and identification of anatomic structures are suggested. The use of cholangiography and a low threshold for conversion to the open procedure are advised. PMID:1533509

Rossi, R L; Schirmer, W J; Braasch, J W; Sanders, L B; Munson, J L



Immediate Impact of an Intensive One-Week Laparoscopy Training Program on Laparoscopic Skills Among Postgraduate Urologists  

PubMed Central

Introduction: Laparoscopic techniques are difficult to master, especially for surgeons who did not receive such training during residency. To help urologists master challenging laparoscopic skills, a unique 5-day mini-residency (M-R) program was established at the University of California, Irvine. The first 101 participants in this program were evaluated on their laparoscopic skills acquisition at the end of the 5-day experience. Methods: Two urologists are accepted per week into 1 of 4 training modules: (1) ureteroscopy/percutaneous renal access; (2) laparoscopic ablative renal surgery; (3) laparoscopic reconstructive renal surgery; and (4) robot-assisted prostatectomy. The program consists of didactic lectures, pelvic trainer and virtual reality simulator practice, animal and cadaver laboratory sessions, and observation or participation in human surgeries. Skills testing (ST) simulating open, laparoscopic, and robotic surgery is assessed in all of the M-R participants on training days 1 and 5. Tests include ring transfer, suture threading, cutting, and suturing. Performance is evaluated by an experienced observer using the Objective Structured Assessment of Technical Skill (OSATS) scoring system. Statistical methods used include the paired sample t test and analysis of variance at a confidence level of P?0.05. Results: Between July 2003 and June 2005, 101 urologists participated in the M-R program. The mean participant age was 47 years (range, 31 to 70). The open surgical format had the highest ST scores followed by the robotic and then the laparoscopic formats. The final ST scores were significantly higher than the initial ST scores (P<0.05) for the laparoscopic (58 vs. 52) and the robotic (114 vs. 95) formats. Open surgical ST scores did not change significantly during the training program (191 vs. 194) (P=0.17). Conclusion: Laparoscopic and robotic ST scores, but not open ST scores, improved significantly during this intensive 5-day M-R program. The robotic ST scores demonstrated greater improvement than did the laparoscopic ST scores, suggesting that the transfer of laparoscopic skills may be improved using the robotic interface.

Vlaovic, Peter D.; Sargent, Eric R.; Boker, John R.; Corica, Federico A.; Chou, David S.; Abdelshehid, Corollos S.; White, Shannon M.; Sala, Leandro G.; Chu, Frank; Le, Todd; Clayman, Ralph V.



Evaluation of pelvic wedge for gynaecological laparoscopy.  


Seventy-eight ASA 1 and 2 women scheduled for elective diagnostic laparoscopy under general anaesthesia were randomly allocated into two groups. Patients were either positioned with a 20 degrees Trendelenberg tilt (group T) or with a wedge placed under the pelvis (group W). A standard general anaesthetic technique was used in all patients. The endoscopic view of pelvic organs was graded on a four-point scale by the operating surgeon. Heart rate (HR), mean arterial pressure (MAP), S(p)O(2), and peak airway pressure (Paw) were continuously measured. Significantly more patients (77%) in group W had grade 1 view (clear view of pelvic organs without additional manoeuvres) when compared with group T (46%). Mean Paw increased significantly in group T when compared with group W. The use of a pelvic wedge provides a better view of pelvic viscera than 20 degrees Trendelenberg tilt during gynaecological laparoscopy. PMID:18821888

Kundra, P; Kanna, V; Bupathi, A; Sudeep, K



Laparoscopic-Assisted Resection of Meckel's Diverticulum in Children  

PubMed Central

Background and Objectives: Meckel's diverticulum (MD) presents unique challenges for a pediatric surgeon, as it is prone to varied complications. This case series highlights the diverse presentations and laparoscopic management of MD in children. Methods: We performed a retrospective analysis of consecutive cases of laparoscopic-assisted transumbilical Meckel's diverticulectomy (LATUM) performed by the same surgeon for incidental as well as diverse Meckel's diverticular complications over 20 months. Results: Eight patients (5 males and 3 females) aged 3 years to 13 years (median, 12) underwent LATUM. Three patients had painless per-rectal bleeding and 1 presented with intestinal obstruction due to a mesodiverticular band and intestinal ischemia. Two patients had features masquerading as appendicitis; one had perforated MD with secondary inflammation of the appendix, and the other had a torsed, gangrenous MD. In 2 patients, incidental MD with a narrow base was noted at appendicectomy for appendicitis. All patients underwent successful LATUM along with appendicectomy in 4 patients. The operative duration was 72 minutes to 165 minutes (mean, 112.1±30.6). There were no operative complications, and no conversion to open surgery was required. The hospital stay was 4 days to 7 days (mean, 4.7±1.2). The patient with mesodiverticular band intestinal obstruction presented with adhesive intestinal obstruction 2 weeks after the surgery. Laparoscopic-assisted minilaparotomy was done to release the pelvic adhesions. There were no other complications during the follow-up (median, 11 months). Conclusions: LATUM is a simple, safe, and effective procedure with a better cosmetic outcome that can be performed for diverse manifestations of MD. The technique also allows palpation of the MD and avoids use of expensive staplers.

Chui, Chan Hon; Jacobsen, Anette Sundfor



How Much Anatomy is Enough?  

NSDL National Science Digital Library

This article describes a study conducted at 8 Dutch Medical Schools investigating the effect of various didactic approaches to teaching anatomy on performance. Outcomes discussed include that good test performance is not related to teaching style, but rather course hours, clinical relevance, and revisiting anatomical concepts.



The Anatomy of Health Insurance  

Microsoft Academic Search

This article describes the anatomy of health insurance. It begins by considering the optimal design of health insurance policies. Such policies must make tradeoffs appropriately between risk sharing on the one hand and agency problems such as moral hazard (the incentive of people to seek more care when they are insured) and supplier-induced demand (the incentive of physicians to provide

David M. Cutler; Richard J. Zeckhauser



Pelvic Girdle Pain: Indication for Surgery?  

Microsoft Academic Search

\\u000a Fusion of the sacroiliac joints (SIJs) is described in ten cohort studies. The diagnostic procedure is complicated due to\\u000a the lack of clear diagnostic tests. In most cases, the indication for surgery is unbearable longstanding pelvic girdle pain\\u000a (PGP) after pelvic trauma, with or without fractures, arthritis or remaining pain after pregnancy. Fifty-one patients, 39\\u000a women and 10 men referred

Bengt Sturesson


Low-energy osteoporotic pelvic fractures  

Microsoft Academic Search

The vast majority of pelvic fractures in geriatric patients are classified as stable injuries. The current treatment strategies\\u000a of these fractures involve pain management and mobilization. Pain-related immobility may pose a serious hazard to patients\\u000a with severe preexisting comorbidities. There is paucity of literature on the outcome and mortality after osteoporotic pelvic\\u000a fractures in the elderly. This review aims to

Dietmar Krappinger; Christian Kammerlander; David J. Hak; Michael Blauth



A questionnaire on pelvic floor dysfunction postpartum  

Microsoft Academic Search

Introduction and hypothesis  The incidence of obstetric anal sphincter injuries is used in Sweden as a measurement of quality of care and this might influence\\u000a the reporting. However, the correlation between reported diagnosis of pelvic floor injury at delivery and pelvic floor symptoms\\u000a a year later is unknown. A questionnaire could identify such symptoms and provide beneficial feedback to obstetrical practices.

Charlotte Luthander; Thomas Emilsson; Gunnar Ljunggren; Margareta Hammarström



LUCY: a 3-D pelvic model for surgical simulation.  


Development of 3-D models of human anatomy for use in virtual reality simulators is anticipated to enhance surgical training. These models may be a valuable resource for gaining mastery of minimal-access procedures. The pelvis portion (hip to upper-thigh) of a 32-year-old female cadaver was frozen and sectioned axially in approximately 2-mm increments as the first step in producing an accurately representative 3-D model of the human female pelvis. Photographic exposures of the entire series of 95 sections were then converted to digital format. Adobe PhotoShop masks for each structure were created and converted into wire-frame and surface-textured models; this aggregate model set was named "LUCY." To date, 3-D representations of 40 pelvic structures (over 2200 individual masks) have been modeled In conjunction with haptic technology, these virtual anatomic models will enable users to practice fundamental surgical manipulations and procedures such as tubal ligation and ovariectomy. The deployment of surgical-simulation models such as LUCY may facilitate technical-performance aspects of surgical training, particularly those associated with minimal-access procedures. Manipulations and procedures can be practiced over the Internet, providing a host of flexible options to enhance the surgical curricula. PMID:15559342

Heinrichs, William LeRoy; Srivastava, Sakti; Dev, Parvati; Chase, Robert A



Lessons Learned from Laparoscopic Gastric Banding.  


The author reviews 27 laparoscopic gastric banding operations, of which 19 cases were completed. Of the 27 operations, eight were revisions of earlier laparoscopic banding. The lessons learned from these cases are highlighted. PMID:10757955




Initial Experiences with Robot-Assisted Laparoscopic Radical Cystectomy  

PubMed Central

Purpose Robot-assisted laparoscopic radical cystectomy (RLRC) is a new option for the treatment of muscle-invasive bladder cancer, and case series for RLRC have been increasing recently. We report our operative technique and initial experiences with RLRC with extracorporeal urinary diversion. Materials and Methods Between October 2008 and November 2009, 17 consecutive patients with muscle-invasive bladder cancer underwent RLRC, pelvic lymph node dissection, and extracorporeal urinary diversion. Urinary diversion included 13 ileal conduits and 4 orthotopic neobladders (Studer method). Data were collected prospectively on patient demographics, intraoperative parameters, pathologic staging, and postoperative outcomes. Results The mean patient age was 63.7 years. The mean body mass index was 22.6 kg/m2. No patients had a history of previous abdominal surgery. The mean operative time was 379.1 minutes, including 32.6 minutes for pelvic lymph node dissection, 185.2 minutes for RLRC, and 159.4 minutes for urinary diversion. The mean estimated blood loss was 210.5 ml. The mean hospital stay was 20.7 days and the mean time to oral intake and ambulation was 5.0 and 1.3 days, respectively. There were no major perioperative complications. The pathologic reports showed urothelial cell carcinomas in all cases. Conclusions Our initial clinical experiences indicate that RLRC with pelvic lymph node dissection and extracorporeal urinary diversion is a safe and feasible procedure with minimal blood loss and rapid recovery. Long-term follow up in a larger patient population is needed to determine the true oncological and functional benefit of this procedure.

Kwon, Se-Yun; Kim, Bum Soo; Kim, Tae-Hwan; Yoo, Eun Sang



Laparoscopic partial splenic resection.  


Twenty domestic pigs with an average weight of 30 kg were subjected to laparoscopic partial splenic resection with the aim of determining the feasibility, reliability, and safety of this procedure. Unlike the human spleen, the pig spleen is perpendicular to the body's long axis, and it is long and slender. The parenchyma was severed through the middle third, where the organ is thickest. An 18-mm trocar with a 60-mm Endopath linear cutter was used for the resection. The tissue was removed with a 33-mm trocar. The operation was successfully concluded in all animals. No capsule tears occurred as a result of applying the stapler. Optimal hemostasis was achieved on the resected edges in all animals. Although these findings cannot be extended to human surgery without reservations, we suggest that diagnostic partial resection and minor cyst resections are ideal initial indications for this minimally invasive approach. PMID:7773460

Uranüs, S; Pfeifer, J; Schauer, C; Kronberger, L; Rabl, H; Ranftl, G; Hauser, H; Bahadori, K



Development of virtual environments for training skills and reducing errors in laparoscopic surgery  

NASA Astrophysics Data System (ADS)

In every surgical procedure there are key steps and skills that, if performed incorrectly, can lead to complications. In conjunction with efforts, based on task and error analysis, in the Videoscopic Training Center at UCSF to identify these key elements in laparoscopic surgical procedures, the authors are developing virtual environments and modeling methods to train the elements. Laparoscopic surgery is particularly demanding of the surgeon's spatial skills, requiring the ability to create 3D mental models and plans while viewing a 2D image. For example, operating a laparoscope with the objective lens angled from the scope axis is a skill that some surgeons have difficulty mastering, even after using the instrument in many procedures. Virtual environments are a promising medium for teaching spatial skills. A kinematically accurate model of an angled laparoscope in an environment of simple targets is being tested in courses for novice and experienced surgeons. Errors in surgery are often due to a misinterpretation of local anatomy compounded with inadequate procedural knowledge. Methods to avoid bile duct injuries in cholecystectomy are being integrated into a deformable environment consisting of the liver, gallbladder, and biliary tree. Novel deformable tissue modeling algorithms based on finite element methods will be used to improve the response of the anatomical models.

Tendick, Frank; Downes, Michael S.; Cavusoglu, Murat C.; Gantert, Walter A.; Way, Lawrence W.



Laparoscopic Anterograde Cholecystectomy in Acute Cholecystitis  

PubMed Central

In the laparoscopic surgery of acute cholecystitis, no identification of anatomic structures in Calot triangle prevents the retrograde disection. Therefore, the anterograde disection of gall bladder, which we often use in open cholecystectomy, was applied as an alternative method in laparoscopic cholecystectomy in our 2 cases. Through this method, the safety of the attempt was increased and the patients were not deprived of the comfort of laparoscopic cholecystectomy. Keywords Laparoscopic anterograde cholecystectomy; Acute cholecystitis; Gall bladder

Engin, Omer; Yildirim, Mehmet; Cengiz, Fevzi; Ilhan, Enver



Optimal teaching environment for laparoscopic ventral herniorrhaphy  

Microsoft Academic Search

.   The introduction of laparoscopic techniques after residency training has created a new paradigm dependent on laparoscopic\\u000a workshops. This study tested the benefit of an animate course and evaluated the role of proctoring in learning to perform\\u000a laparoscopic ventral hernia repair (LVHR). Surgeons who had taken a 1-day LVHR course (n=59) were polled to determine previous experience with laparoscopic procedures

B. T. Heniford; B. D. Matthews; E. Box; C. Backus; K. Kercher; F. Greene; R. Sing



Oncological Outcome after Laparoscopic Radical Prostatectomy: 10 years Experience  

PubMed Central

Objective We analyzed the oncological outcome after laparoscopic radical prostatectomy (LRP) in a consecutive series of patients with prostate cancer. Material and Methods from 1998 to 2007, 1564 consecutive patients (median age 61 years, IQ range 56, 66) with clinically localized prostate cancer (cT1c-cT3a) were treated with LRP by two surgeons either at IMM (Paris, France) or MSKCC (New York, USA). Progression of disease was defined as a PSA of 0.1 ng/ml or greater with confirmatory rise, or initiation of secondary therapy and the information was available for 1422 patients. Patients were stratified as low, intermediate or high risk based on the pretreatment prostate cancer nomogram progression free probability of >90%, 89% to 71% and < 70% respectively. Results The overall 5-year and 8-year probability of freedom from progression was 78% (95% CI 74%–82%) and 71% (95% CI 63%, 78%) respectively. For low, intermediate and high risk cancer, the 5-year progression free probability was 91% (95% CI 85%–95%), 77% (95% CI 71%–82%) and 53% (95% CI 40%–65%) respectively. Surgical margins were positive in 13% of cases. The 5-year progression free probability was 49% (95%C.I. 35%– 61%) when the surgical margins were positive vs. 83% (95%C.I. 79%– 86%) in negative surgical margins cases. Nodal metastases were detected in 3% of the patients after limited pelvic lymph node dissection and in 10% after a standard pelvic lymph node dissection (p<0.001). The 3 year probability of freedom from progression for node positive patients was 49%. There were 22 overall deaths and 2 deaths from prostate cancer. Conclusion Laparoscopic radical prostatectomy provided 5 and 8-year cancer control in 78 and 71% of patients with clinically localized prostate cancer and 53% of those with high risk cancers at 5 years. A pelvic lymph node dissection limited to the external iliac nodal group is inadequate for detecting nodal metastases.

Touijer, Karim; Secin, Fernando P; Cronin, Angel M; Katz, Darren; Bianco, Fernando; Vora, Kinjal; Reuter, Victor; Vickers, Andrew J; Guillonneau, Bertrand



Laparoscopic subtotal splenectomy in hereditary spherocytosis  

Microsoft Academic Search

The paper by Sanjeev Dutta et al. [1] about the laparoscopic approach to partial splenectomy in children with hereditary spherocytosis states that they have developed a novel laparoscopic partial splenectomy technique that combines the benefits of partial splenectomy with those of a laparoscopic approach. This technique, however, is not new, as erroneously stated by the authors. The technique was first

C. Vasilescu; O. Stanciulea; C. Arion



Laparoscopic Radical Nephrectomy for Renal Cell Carcinoma  

Microsoft Academic Search

Laparoscopic radical nephrectomy has been developed and applied for patients with renal cell carcinoma since 1992. The number of patients undergoing laparoscopic radical nephrectomy has explosively increased worldwide in the recent years, and laparoscopy is extended to patients with advanced disease. It is very important to clarify the present status of laparoscopic radical nephrectomy among the treatment modalities for patients

Yoshinari Ono; Ryohei Hattori; Momokazu Gotoh; Tsuneo Kinukawa; Shin Yamada; Osamu Kamihira


The split image artifact in pelvic ultrasonography: the anatomy and physics.  


Transverse ultrasound scans of the pelvis often demonstrate double images or an apparent widening of the structures deep to the bladder. The phenomenon occurs when the real-time transducer is placed on the midline of the abdominal wall. Most of the widening effect or split image is caused by refraction of sound at the interface between the abdominal wall muscle and the collection of fat deep to the muscle. Using Snell's Law, it is possible to calculate the amount of splitting for a given anatomic configuration. The phenomenon is most exaggerated when the object is furthest away from the transducer and when the curvature between muscle and fat is largest. PMID:3156252

Sauerbrei, E E



Ošet?ení nestabilní zlomeniny pánve v akutní fázi (Pelvic Damage Control Surgery) Management of Unstable Pelvic Fracture in the Acute Phase (Pelvic Damage Control Surgery)  

Microsoft Academic Search

SUMMARY Pelvic fractures are serious injuries. For the diagnosis and treatment of unstable pelvic ring fracture in a haemodyna- mically unstable patient, it is necessary to use standard procedures with the objective to stabilise both blood circulation and the pelvic ring. According to the state of the patient, the choice is between life-saving surgery, damage control surge- ry and procedures




Acute effects of pelvic irradiation on the adult uterus revealed by dynamic contrast-enhanced MRI.  


Objective: Pelvic radiation therapy (RT) can influence fertility in female rectal cancer survivors. Data regarding its effects on the adult uterus are scant. This study aims to evaluate the uterus before and after RT, using dynamic contrast-enhanced MRI. Methods: Eligible patients (n=10) received RT for rectal cancer, had an intact uterus and underwent dynamic contrast-enhanced MRI before and after RT. Seven patients were pre-menopausal. Results: Patients received pelvic RT (median, 50.2?Gy) with concurrent 5-fluorouracil. Five patients were treated with intensity modulated RT (IMRT) and five with a three-field technique. The median D95 of the uterus was 30?Gy; D05 was 48?Gy; and V95 was 97%. The median cervical D95 was 45?Gy; D05, 50?Gy; and V95, 100%. Cervical dose was higher with IMRT than with three-field plans (p?0.038). On T2 MRI, the junctional zone was visible in nine patients before and in one after RT (p=0.001). Median cervical length (2.3 vs 3.0?cm) and endometrial thickness (2.6 vs 5.9?mm) were reduced after RT (p?0.008). In pre-menopausal patients, the volume transfer constant, Ktrans, (0.069 vs 0.195, p=0.006) and the extracellular extravascular volume fraction, Ve, (0.217 vs 0.520, p=0.053) decreased. Conclusion: Pelvic RT significantly affected uterine anatomy and perfusion. Cervical dose was higher with IMRT than three-field plans, but no attempt was made to constrain the dose. Advances in knowledge: Pelvic RT significantly affects the adult uterus. These findings are crucial to understand the potential consequences of RT on fertility, and they lay the groundwork for further prospective studies. PMID:24052311

Milgrom, S A; Alberto Vargas, H; Sala, E; Frankel Kelvin, J; Hricak, H; Goodman, K A



The urogynecological side of pelvic floor MRI: the clinician's needs and the radiologist's role.  


In pelvic floor dysfunction (PFD), magnetic resonance imaging of the pelvic floor supporting system from a functional point of view allows radiologists to recognize and classify the types of defects in each supporting structure (namely, the urethral supporting system, the vaginal supporting system, and the anal sphincter complex). Combined analysis of both the static and dynamic images of patients reporting stress urinary incontinence and pelvic organ prolapse has revealed a close relationship between certain anatomical defects in the pelvic organ support system and specific PFD. Because of the consistency and reproducibility of this relationship, radiologists can accurately identify and report the underlying structural defects, allowing clinicians to individually tailor surgical techniques for each patient. This is important because even those patients presenting with the same clinical symptoms may have different underlying structural derangement or abnormalities that may warrant a different treatment plan or approach. In view of the reported high rate of dysfunction recurrence after surgical treatment and clinicians' desire for a test that can pinpoint each patient's structural and anatomical defects, this approach provides the necessary scientific evidence on which best clinical practice can be based, and the data-reporting system used for analysis provides a tool for accurately planning reconstructive surgery, reducing the risk of surgical failure, dysfunction recurrence, and reoperation. With the improved radiological evidence made possible by combined image analysis, clinicians can now have the documentation that they need to plan more effective procedures and thus produce better outcomes. This review focuses on the MRI anatomy of the pelvic floor from a functional point of view and from the urogynecological side of floor dysfunction (UI and POP), adopting a problem-oriented approach. The first section of this article provides the basic essential anatomical information about the pelvic floor and briefly reviews the pathophysiology and clinical features of SUI and POP. The second portion details the vital role of the radiologist in obtaining accurate images for the clinician to use in planning reconstructive surgery. In addition, it includes case examples, illustrating how to report MRI findings systematically and comprehensively on both the static and dynamic images, using a recently developed integrated MRI analytical approach from a purely functional point of view that may enhance radiologists' interaction with clinicians and bridges the gap between radiology and surgery. PMID:22653053

Farouk El Sayed, Rania



Head and neck vascular anatomy.  


Conventional computed tomography (CT) and magnetic resonance (MR) angiography provide excellent vascular images; however, every radiologist interpreting routine cross-sectional imaging of the head and neck must recognize normal and abnormal vascular structures. Knowledge of the normal cross-sectional appearance of vessels can help to define spacial anatomy and provide for recognition of abnormal vessels. Intracranially, the major arterial branches of the Circle of Willis are routinely visualized on MR and CT, as are the dural venous sinuses and major tributaries to the deep and superficial venous system. Using a combination of CT and MR images, we demonstrate the normal cross-sectional vascular anatomy of the head and neck and the important anatomic relationships key to accurate imaging analysis. PMID:9449756

Johnson, M H



Hip: Anatomy and US technique  

PubMed Central

Ultrasound (US) has always had a relatively limited role in the evaluation of the hip due to the deep location of this joint. However, many hip diseases are well detectable at US, but before approaching such a study it is necessary to be thoroughly familiar with the normal anatomy and related US images. The study technique is particularly important as optimization of various parameters is required, such as probe frequency, focalization, positioning of the probe, etc. Also the patient’s position is important, as it varies according to the area requiring examination. For the study of the anterior structures, the patient should be in the supine position; for the medial structures, the leg should be abducted and rotated outward with the knee flexed; for the lateral structures, the patient should be in the controlateral decubitus position; for the posterior structures the patient must be in the prone position. US study of the hip includes assessment of the soft tissues, tendons, ligaments and muscles, and also of the bone structures, joint space and serous bursae. The purpose of this article is to review the normal anatomy of the hip as well as the US anatomy of this joint.

Molini, L.; Precerutti, M.; Gervasio, A.; Draghi, F.; Bianchi, S.



Anatomy of the infant head  

SciTech Connect

This text is mainly an atlas of illustration representing the dissection of the head and upper neck of the infant. It was prepared by the author over a 20-year period. The commentary compares the anatomy of the near-term infant with that of a younger fetus, child, and adult. As the author indicates, the dearth of anatomic information about postnatal anatomic changes represents a considerable handicap to those imaging infants. In part 1 of the book, anatomy is related to physiologic performance involving the pharynx, larynx, and mouth. Sequential topics involve the regional anatomy of the head (excluding the brain), the skeleton of the cranium, the nose, orbit, mouth, larynx, pharynx, and ear. To facilitate use of this text as a reference, the illustrations and text on individual organs are considered separately (i.e., the nose, the orbit, the eye, the mouth, the larynx, the pharynx, and the ear). Each part concerned with a separate organ includes materials from the regional illustrations contained in part 2 and from the skeleton, which is treated in part 3. Also included in a summary of the embryologic and fetal development of the organ.

Bosma, J.F.



Laparoscopic surgical technique to facilitate management of high anorectal malformations - report of seven cases  

PubMed Central

Anorectal malformations (ARMs) occur in approximately 1 per 5000 live births. The most commonly used procedure for repair of high ARMs is posterior sagittal anorectoplasty (PSARP). This operation is performed entirely through a perineal approach. The first report of laparoscopically assisted anorectal pull-through (LAARP) for repair of ARMs was presented by Georgeson in 2000. The aim is presenting early experience with laparoscopically assisted anorectal pull-through technique in boys with high anorectal malformations. In the last 5 years 7 boys (9 months to 2 years old) with high ARMs were operated on using the LAARP technique. Laparoscopically the rectal pouch was exposed down to the urethral fistula, which was clipped and divided. Externally, the centre of the muscle complex was identified using an electrical stimulator. In the first 4 patients after a midline incision of 2 cm at the planned anoplasty site, a tunnel to the pelvis was created bluntly and dilated with Hegar probes under laparoscopic control. In the last 3 boys a minimal PSARP was done creating a channel into the pelvis. The separated rectum was pulled down and sutured to the perineum. Laparoscopic mobilization of the rectal pouch and fistula division was possible in all cases. There were no intraoperative complications except one ureteral injury. Patients were discharged home on post-operative day 5 to 7. The early results prove that LAARP, an alternative option to PSARP for treatment of imperforate anus, offers many advantages, including excellent visualization of the pelvic anatomical structures, accurate placement of the bowel into the muscle complex and a minimally invasive abdominal and perineal incision. It allows for shorter hospital stay and faster recovery. However, to compare the functional results against the standard procedure (PSARP), longer follow-up of all patients is necessary.

Murawski, Maciej; Losin, Marcin; Krolak, Marek; Czauderna, Piotr



Epidemiology and outcome of complex pelvic injury.  


Soft tissue injuries associated with pelvic fractures are often responsible for compromised haemodynamics. The objective of this study was to clarify what parameters determine patient outcome. In a cohort study, all patients with a pelvic fracture treated between 1991 and 2001 at a Level I trauma center were analysed for associated intrapelvic injuries, classification, severity of trauma, type of intervention and outcome. Of 552 patients with a pelvic fracture who entered the study, 15.5% presented with associated intrapelvic injuries secondary to the fracture (group I). A subgroup of patients with lacerations of branches of the iliac artery was identified as being at high risk for lethal outcome; they represented 4.3% of all patients with pelvic fracture (group II). The overall mortality reached 4.4%; it increased in group I to 15.5%, and in group II to 33.3%. In the subgroup with pelvic arterial haemorrhage (group II), the severity of injury, the proportion of multiple injured patients, the prevalence of unstable fractures and the incidence of sepsis were significantly increased. The only predictive factor for outcome was the amount of blood transfused, suggesting that fast elimination of the bleeding source decides about patient survival. PMID:15792206

Schmal, Hagen; Markmiller, Max; Mehlhorn, Alexander T; Sudkamp, Norbert P



Granulomatous Peritonitis After Laparoscopic Cholecystectomy  

PubMed Central

Background: Granulomatous peritonitis may indicate a number of infectious, malignant, and idiopathic inflammatory conditions. It is a very rare postoperative complication, which is thought to reflect a delayed cell-mediated response to cornstarch from surgical glove powder in susceptible individuals. This mechanism, however, is much more likely to occur with open abdominal surgery when compared with the laparoscopic technique. Methods: We report a case of sterile granulomatous peritonitis in an 80-y-old female after a laparoscopic cholecystectomy. Management was conservative, and no relapse was observed after over 1-y of follow-up. Discussion: We propose that peritoneal exposure to bile acids during the laparoscopic removal of the gallbladder was the trigger of granulomatous peritonitis in this patient. Severe complications, such as peritoneal adhesions, intestinal obstruction, and fistula formation, were observed, but no fatalities were reported. Conclusion: We should be aware of this rare cause of peritonitis in the surgical setting.

Remotti, Daniele; Galluzzo, Michele; Gasbarrone, Laura



Laparoscopic ultrasound and gastric cancer  

NASA Astrophysics Data System (ADS)

The management of gastrointestinal malignancies continues to evolve with the latest available therapeutic and diagnostic modalities. There are currently two driving forces in the management of these cancers: the benefits of minimally invasive surgery so thoroughly demonstrated by laparoscopic surgery, and the shift toward neoadjuvant chemotherapy for upper gastrointestinal cancers. In order to match the appropriate treatment to the disease, accurate staging is imperative. No technological advances have combined these two needs as much as laparascopic ultrasound to evaluate the liver and peritoneal cavity. We present a concise review of the latest application of laparoscopic ultrasound in management of gastrointestinal malignancy.

Dixon, T. Michael; Vu, Huan



Hemostasis in laparoscopic renal surgery  

PubMed Central

Hemorrhage is a potential risk at any step of laparoscopic nephrectomies (LNs). The advances in surgical equipment and tissue sealants have increased the safety and efficiency of performing LN and laparoscopic partial nephrectomy (LPN). However, hemostasis remains a major issue and there is still scope for further development to improve haemostatic techniques and devices. In this article a literature review of the current methods and techniques of hemostasis was carried out using the MEDLINE ®/PubMed® resources. The results of the review were categorized according to the three main operative steps: Dissection, control of renal pedicle and excision of the renal lesion.

Hassouna, Hussam A.; Manikandan, Ramaswamy



Endoscopic Anatomy of the Middle Ear  

Microsoft Academic Search

Good knowledge of anatomy is fundamental for every surgeon. Middle ear anatomy is really complex and sometimes is challenging\\u000a for otologists, who need to explore every single compartment for a radical removal of pathology. With introduction of the\\u000a endoscope in middle ear surgery, anatomy of middle ear spaces has become wider and clearer due to a better magnification and\\u000a to

Daniele Marchioni; Gabriele Molteni; Livio Presutti



Laparoscopic treatment of endometriosis.  


Endometriosis can be considered as a chronic disease which is characterized by the presence of ectopic endometrium outside the endometrial cavity and which is associated with symptoms as pelvic pain and infertility. Medical treatment is often not sufficient in patients with moderate to severe endometriosis and deep infiltrative endometriosis (DIE), therefore requiring surgical intervention. Over the past 15 years, we have built a multidisciplinary surgical team to perform a radical but fertility preserving resection of extensive endometriosis with involvement of surrounding organ systems, realizing a good clinical outcome with low complication and recurrence rate, a very good improvement of QOL and a high pregnancy rate. However, for future research evaluating surgical treatment of extensive endometriosis, it is important to reach agreement on study design and on reporting clinical outcome data. A multicenter study with clear patient identification and well defined outcome parameters needs to be set up. Moreover, prevention of DIE with colorectal extension is important, ideally by early identification and management of girls and women at risk. Years of pain and disability as well as a lot of money could be saved when patients, at risk of developing extensive forms of endometriosis could be diagnosed during adolescence. PMID:23598780

Meuleman, C; Tomassetti, C; Gaspar Da Vitoria Magro, M; Van Cleynenbreugel, B; D'Hoore, A; D'Hooghe, T



Chinese validation of Pelvic Floor Distress Inventory and Pelvic Floor Impact Questionnaire  

Microsoft Academic Search

Introduction and hypothesis  The purpose of this study was to investigate the reliability and validity of the Chinese version of Pelvic Floor Distress\\u000a Inventory (PFDI) and Pelvic Floor Impact Questionnaire (PFIQ).\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Women who presented for pelvic floor disorders completed the Chinese version of PFDI and PFIQ, SF-36, a 3-day urinary and\\u000a fecal diary. POP-Q assessment, urodynamic study, anal manometry, and ultrasound

Symphorosa Shing Chee Chan; Rachel Yau Kar Cheung; Alice Ka Wah Yiu; Jimmy Chak Man Li; Beatrice Pui Yee Lai; Kwong Wai Choy; Tony Kwok Hung Chung


Impact of pelvic radiotherapy on female sexuality  

Microsoft Academic Search

Purpose  To assess physical and psychological morbidity, sexual functioning and social and relationship satisfaction among women treated\\u000a with pelvic radiotherapy.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Observational (case–control) study of 199 women: 98 submitted to pelvic radiotherapy for the treatment of uterine, rectal\\u000a or anal cancers and 101 without a personal history of cancer and similar socio-demographic variables. These completed a socio-demographic\\u000a and clinical questionnaire, and validated

Ana Cláudia Rodrigues; Rubina Teixeira; Tânia Teixeira; Sofia Conde; Paula Soares; Isabel Torgal


Sexual function in women after surgery for pelvic organ prolapse  

Microsoft Academic Search

Our objective was to evaluate the effect of surgical repair of pelvic organ prolapse on female sexual function. Sixty seven\\u000a women with pelvic organ prolapse were recruited in the study. Degree of pelvic organ prolapse was assessed using pelvic organ\\u000a prolapse quantitation (POPQ) staging system. Female sexual function index (FSFI) questionnaire was used to assess sexual function\\u000a of the cases

Mahyar Azar; Sima Noohi; Shokoufeh Radfar; Mohammad Hadi Radfar



Myofascial dysfunction associated with chronic pelvic floor pain: Management strategies  

Microsoft Academic Search

Myofascial pain as a cause of chronic pelvic pain with or without pelvic organ pathology is well-documented in the literature.\\u000a Causes of this pain are multifactorial, including specific pelvic organ pathologies, neuromuscular disorders, and psychologic\\u000a causes. Management of this myofascial component of chronic pelvic pain involves a multidisciplinary approach including physicians,\\u000a physical therapists, neurologists, and psychiatrists. Treatment strategies, including behavioral

Arun K. Srinivasan; Jonathan D. Kaye; Robert Moldwin



Does a pelvic belt influence sacroiliac joint laxity?  

Microsoft Academic Search

Objective. To evaluate the influence of different positions and tensions of a pelvic belt on sacroiliac joint laxity in healthy young women.Background. Clinical experience has shown that positive effects can be obtained with different positions and tensions of a pelvic belt. A functional approach to the treatment of the unstable pelvic girdle requires an understanding of the effect of a

Léonie Damen; Cornelis W Spoor; Chris J Snijders; Henk J Stam



Contraction of the pelvic floor muscles during abdominal maneuvers  

Microsoft Academic Search

Sapsford RR, Hodges PW. Contraction of the pelvic floor muscles during abdominal maneuvers. Arch Phys Med Rehabil 2001;82:1081-8. Objective: To determine whether voluntary abdominal muscle contraction is associated with pelvic floor muscle activity. Design: Pelvic floor muscle activity was recorded during contractions of the abdominal muscles at 3 different intensities in supine and standing positions. Setting: Research laboratory. Participants: Six

Ruth R. Sapsford; Paul W. Hodges



Simultaneous dynamic proctography and peritoneography for pelvic floor disorders  

Microsoft Academic Search

PURPOSE: We sought to evaluate a new diagnostic technique for the identification of rectal and pelvic floor pathology in patients with obstructed defecation, pelvic fullness\\/ prolapse, and\\/or chronic intermittent pelvic floor pain. METHODS: Thirteen symptomatic women with either a nondiagnostic physical examination or nondiagnostic dynamic proctography (DPG) were studied. After placement of intraperitoneal and intrarectal contrast material, resting and straining

Stephen M. Sentovich; Lucian J. Rivela; Alan G. Thorson; Mark A. Christensen; Garnet J. Blatchford



Outpatient protocol for biofeedback therapy of pelvic floor outlet obstruction  

Microsoft Academic Search

Pelvic floor outlet obstruction is a rare cause of severe constipation. Anal myectomy, subtotal colectomy, and medical therapy have limited success. The purpose of this study was to develop a short outpatient treatment using biofeedback techniques. Nine patients with severe constipation and straining resulting from pelvic floor outlet obstruction underwent complete investigation of the pelvic floor musculature and anal sphincter

James W. Fleshman; Zeev Dreznik; Kathleen Meyer; Robert D. Fry; Robert Carney; Ira J. Kodner



Suprapubic approach for laparoscopic appendectomy  

PubMed Central

Objective: To evaluate the results of laparoscopic appendectomy using two suprapubic port incisions placed below the pubic hair line. Design: Prospective hospital based descriptive study. Settings: Department of surgery of a tertiary care teaching hospital located in Rohtas district of Bihar. The study was carried out over a period of 11months during November 2011 to September 2012. Participants: Seventy five patients with a diagnosis of acute appendicitis. Materials and Methods: All patients underwent laparoscopic appendectomy with three ports (one 10-mm umbilical for telescope and two 5 mm suprapubic as working ports) were included. Operative time, conversion, complications, hospital stay and cosmetic results were analyzed. Results: Total number of patients was 75 which included 46 (61.33%) females and 29 (38.67%) males with Mean age (±Standard deviation {SD}) at the time of the diagnosis was 30.32 (±8.86) years. Mean operative time was 27.2 (±5.85) min. One (1.33%) patient required conversion to open appendectomy. No one patient developed wound infection or any other complication. Mean hospital stay was 22.34 (±12.18) h. Almost all patients satisfied with their cosmetic results. Conclusion: A laparoscopic approach using two supra pubic ports yields the better cosmetic results and also improves the surgeons working position during laparoscopic appendectomy. Although, this study had shown better cosmetic result and better working position of the surgeon, however it needs further comparative study and randomized controlled trial to confirm our findings.

Singh, Manish K.; Kumar, Mani K.; Mohan, Lalit



Robot-assisted laparoscopic choledochojejunostomy  

Microsoft Academic Search

Background: Endoscopic stenting is the treatment of choice for palliative relief of biliary obstruction by a periampullary tumor. If treated surgically, a choledochojejunostomy and Roux-en-Y diversion is still performed by laparotomy in a large number of cases due to technical challenges of the biliodigestive anastomosis in the laparoscopic approach. Robotic systems may enhance dexterity and vision and might therefore support

J. P. Ruurda; K. W. van Dongen; J. Dries; I. H. M. Borel Rinkes; I. A. M. J. Broeders



Laparoscopic repair of epiphrenic diverticulum.  


Epiphrenic diverticula (ED) are a rare clinical entity characterized by out-pouchings of the esophageal mucosa originating in the distal third of the esophagus, close to the diaphragm. The proportion of diverticula reported symptomatic enough to warrant surgery is extremely variable, ranging from 0% to 40%. The natural history of ED is still almost unknown and the most intriguing question concerns whether or not they all need surgical treatment. From 1993 to 2010 35 patients underwent surgery at our institution. Eleven patients were treated via a thoracotomic approach alone and were excluded from present study. The remaining 24 patients formed our study population. Seventeen patients (48.6%) underwent surgery via a purely laparoscopic approach, and received a diverticulectomy + myotomy + antireflux procedure. Seven patients (23%), with ED positioned well above inferior pulmonary vein, were treated via a combined laparoscopic-thoracotomic approach: they all underwent diverticulectomy + myotomy + an antireflux procedure. Mortality was nil. The overall morbidity rate was 25%. A suture leakage occurred in 4 patients (16.6%) and they were all conservatively treated. Patients' symptom scores decreased from a median of 15 to 0 (P = 0.0005). Laparoscopic surgery for ED is effective, but given the not negligible incidence of complications such suture-line leakage, should be considered only in symptomatic patients or in event of huge diverticula. A tailored combined laparoscopic-thoracotomic approach may be useful in case of ED located high in mediastinum or with large neck. PMID:23200079

Zaninotto, Giovanni; Parise, Paolo; Salvador, Renato; Costantini, Mario; Zanatta, Lisa; Rella, Antonio; Ancona, Ermanno



Laparoscopic-assisted colon resection.  


The popularity and success of laparoscopic biliary tract surgery have persuaded surgeons to explore other applications for rigid endoscopic surgery. From July 1990 to February 1993 a total of 65 patients (mean age 57 years; range 41-82) underwent attempted laparoscopic colon resection. Indications for surgical intervention included cancer (39), adenomatous polyps (14), diverticulosis (10), stricture (1), and foreign-body perforation (1). A laparoscopic-assisted technique whereby the specimen was removed and the anastomosis was completed outside of the abdomen was used in all patients. A dilated umbilical opening was used for right-sided lesions and a left-lower-quadrant muscle-splitting incision for descending and sigmoid colon resections. Two patients required conversion to open laparotomy. There were no deaths and only four complications (pneumonia 1, urinary tract infection 1, prolonged ileus 1, and subfascial abscess 1). The mean postoperative stay was 4.4 days (range 3-8 days) and the average interval for return to normal activity was 8 days. Laparoscopic-assisted colon resection appears to be a safe and beneficial option for many patients with pathologic disorders of the large intestine. Future clinical trials are needed to fully determine the appropriateness of this procedure in patients with localized malignancies. PMID:8153858

Zucker, K A; Pitcher, D E; Martin, D T; Ford, R S



The myths of laparoscopic surgery  

Microsoft Academic Search

Laparoscopic surgery has been rapidly accepted without rigorous scientific study. New procedures and technologies have advanced rapidly, and most gynecologists have embraced these techniques. I believe that the new technology has given rise to the following myths: (1) that there are associated cost savings, (2) that new technology is always better than the old, (3) that a steep learning curve

Michael P. Hopkins



Laparoscopic bladder augmentation using stomach  

Microsoft Academic Search

We present a case of bladder augmentation with stomach, via a laparoscopic approach. The patient was a 17-year-old girl with sacral agenesis and a poorly compliant bladder. A wedge of stomach, based on the right gastroepiploic pedicle, was obtained using a stapled technique. The bladder was opened and the gastric segment was sutured in place. A needle suspension was also

Steven G. Docimo; Robert G. Moore; John Adams; Louis R. Kavoussi



Laparoscopic colectomy: A critical appraisal  

Microsoft Academic Search

A multicenter retrospective study was undertaken to assess the efficacy and safety of laparoscopy in colon and rectal surgery. To minimize potential bias in interpretation of the results, all data were registered with an independent observer, who did not participate in any of the surgical procedures. Sixty-six patients underwent a laparoscopic procedure. Operations performed included sigmoid colectomy (19), right hemicolectomy

P. M. Falk; R. W. Beart; S. D. Wexner; A. G. Thorson; D. G. Jagelman; I. C. Lavery; O. B. Johansen; R. J. Fitzgibbons



Two-port laparoscopic adnexal surgery with a multichannel port using a wound retractor: is it safe and minimally scarring?  


This study aimed to explore and evaluate the feasibility and safety of laparoscopic adnexal surgery using a two-port technique with a multichannel port, using a wound retractor, as previously reported. A series of patients undergoing two-port laparoscopy for a benign pelvic mass were enrolled in this study. To perform two-port laparoscopic surgery, the ancillary 5-mm trocar was inserted at the left iliac fossa under laparoscopic view after umbilical trocar insertion. The inserted umbilical trocar was removed and the skin incision was extended about 1.5 cm with index-finger-passable width. An Alexis wound retractor XS (Applied Medical, Santa Rancha Margarita, CA) was inserted through the umbilical wound. Two trocars were inserted into two fingers of a no. 6 surgical rubber glove and ligated with rubber bands. The wrist portion of the rubber glove covered the wound retractor, and the edge of the wound retractor was clamped with three Babcock clamps to prevent carbon-dioxide gas leakage. Both a 10-mm laparoscope and atraumatic forceps were inserted through the umbilical multichannel port. Laparoscopic adnexal surgery was performed in the usual manner. A total of 19 patients were enrolled. The operative procedures were adnexectomy (n = 8), myomectomy (n = 1), and ovarian cystectomy and/or salpingectomy (n = 10). There were no operative complications, conversion to laparotomy, or additional trocar insertions. The mean operation time was 81.3 +/- 28.7 min. The pathologic diagnosis were mature cystic teratoma (n = 6), benign cyst (n = 4), endometrial cyst (n = 3), serous cystadenoma (n = 3), mucinous cystadenoma (n = 1), leiomyoma (n = 1), and tubo-ovarian abscess (n = 1). The mean postoperative hospital stay was 4.0 +/- 1.3 days. This two-port method seems to be safe and needs no additional cost from the use of the conventional laparoscopic instruments. It is also cosmetically effective and highly appreciated by patients, leaving minimal abdominal scarring. PMID:19694570

Yi, Sang-Wook



[Anatomy of the eustachian tube].  


The auditory tube is part of a complex anatomical functional system, which even today is not completely explained. It plays a crucial role in the understanding of the pathogenesis of chronic middle ear infections and possible therapeutic interventions--particularly in infants. This paper summarizes the current knowledge of eustachian tube gross anatomy and histology, its peritubular structures and its topographic relationship to the internal carotid artery in adults. Anatomical aspects specific to infancy are related to their possible influence on tube function. PMID:23670679

Böckers, A



Anesthetic implications of laparoscopic surgery.  

PubMed Central

Minimally invasive therapy aims to minimize the trauma of any interventional process but still achieve a satisfactory therapeutic result. The development of "critical pathways," rapid mobilization and early feeding have contributed towards the goal of shorter hospital stay. This concept has been extended to include laparoscopic cholecystectomy and hernia repair. Reports have been published confirming the safety of same day discharge for the majority of patients. However, we would caution against overenthusiastic ambulatory laparoscopic cholecystectomy on the rational but unproven assumption that early discharge will lead to occasional delays in diagnosis and management of postoperative complications. Intraoperative complications of laparoscopic surgery are mostly due to traumatic injuries sustained during blind trocar insertion and physiologic changes associated with patient positioning and pneumoperitoneum creation. General anesthesia and controlled ventilation comprise the accepted anesthetic technique to reduce the increase in PaCO2. Investigators have recently documented the cardiorespiratory compromise associated with upper abdominal laparoscopic surgery, and particular emphasis is placed on careful perioperative monitoring of ASA III-IV patients during insufflation. Setting limits on the inflationary pressure is advised in these patients. Anesthesiologists must maintain a high index of suspicion for complications such as gas embolism, extraperitoneal insufflation and surgical emphysema, pneumothorax and pneumomediastinum. Postoperative nausea and vomiting are among the most common and distressing symptoms after laparoscopic surgery. A highly potent and selective 5-HT3 receptor antagonist, ondansetron, has proven to be an effective oral and IV prophylaxis against postoperative emesis in preliminary studies. Opioids remain an important component of the anesthesia technique, although the introduction of newer potent NSAIDs may diminish their use. A preoperative multimodal analgesic regimen involving skin infiltration with local anesthesia. NSAIDs to attenuate peripheral pain and opioids for central pain may reduce postoperative discomfort and expedite patient recovery/discharge. There is no conclusive evidence to demonstrate clinically significant effects of nitrous oxide on surgical conditions during laparoscopic cholecystectomy or on the incidence of postoperative emesis. Laparoscopic cholecystectomy has proven to be a major advance in the treatment of patients with symptomatic gallbladder disease.

Cunningham, A. J.



Laparoscopic management of bile duct and bowel injury during laparoscopic cholecystectomy  

Microsoft Academic Search

Accidentai injuries to the bile duct and bowel are significant risks of laparoscopic surgery and sometimes require conversion\\u000a to open surgery. Although some of the injuries related to laparoscopic cholecystectomy can be managed by endoscopic techniques,\\u000a laparoscopic surgery is not yet sufficiently perfected. We investigated the efficacy of laparoscopic management combined with\\u000a endoscopic tube or stent insertion in cases of

A.-Hon Kwon; Hiroyuki Inui; Yasuo Kamiyama



CT of abdominal and pelvic trauma  

Microsoft Academic Search

CT is the diagnostic study of choice at most institutions in the evaluation of hemodynamically stable, blunt abdominal trauma. It is highly specific and sensitive in the detection and definition of the extent of most intra-abdominal and pelvic injuries. The clinical examination is the most important factor in the decision regarding whether surgery should be undertaken. However, a progressive and

John L Roberts



Strengthening the pelvic floor with Kegel exercises  

Microsoft Academic Search

Pelvic floor exercises (PFE) have become a standard nursing intervention, both to prevent as well as to treat incontinence. A review of the literature shows great variety in the protocols for performing PFE, and inconsistent use of perineometers, palpation tests, or other biofeedback devices. Results are difficult to compare because of methodological inconsistencies. Suggestions for further research are included.

C. A. Pierson



Adolescent pelvic examination. An effective practical approach.  


The American Academy of Pediatrics has recommended that pediatric health care be extended through the adolescent years. Thus, there is a need to refamiliarize the physician with the pelvic examination. Formerly, workshops used simulated plastic models ("Ginny") to accomplish this goal. Such workshops have been conducted at the annual meeting of the American Academy of Pediatrics for several years. At the 1987 meeting in New Orleans, La, two workshops involving live models (gynecologic teaching assistants) were planned and implemented with great success. Following a didactic segment, each participant was given an opportunity to perform the pelvic examination with immediate feedback from the gynecologic teaching assistant as to the completeness and appropriateness of the pelvic examination. The immediate response of the attendees was overwhelmingly positive. A questionnaire was sent to the enrollees 8 months after the meeting to determine whether this experience had affected their attitude toward and approach to the pelvic examination. Eighty-three percent of questionnaires were returned with an affirmative response. This positive response suggested that such workshops be continued in an effort to reach as many pediatricians as possible. PMID:1951219

Tolmas, H C



Experiences of Women with Chronic Pelvic Pain.  

National Technical Information Service (NTIS)

This ethnographic study describes how a group of women with chronic pelvic pain (CPP) learned to develop self-care strategies that allowed them to function in their culturally prescribed roles through. out their illnesses. The sample consisted of 12 Europ...

J. K. Kadinsky J. S. Boyle



Errors in reproducing pelvic radiation portals  

Microsoft Academic Search

Verification films were obtained at least weekly on 28 patients receiving routine pelvic irradiation for gynecologic malignancy. The patients were divided into three groups by weight: 100 to 125 lb, 126 to 150 lb, and over 150 lb. A total of 208 films were taken and evaluated for degree of accuracy and types of error for each patient group. A

M. J. S. Richards; D. A. Buchler



Chronic Prostatitis\\/Chronic Pelvic Pain Syndrome and Pelvic Floor Spasm: Can We Diagnose and Treat?  

Microsoft Academic Search

National Institutes of Health category III prostatitis, also known as chronic prostatitis\\/chronic pelvic pain syndrome, is\\u000a a common condition with significant impact on quality of life. This clinically defined syndrome has a multifactorial etiology\\u000a and seems to respond best to multimodal therapy. At least half of these patients have pelvic floor spasm. There are several\\u000a approaches to therapy including biofeedback,

Karin E. Westesson; Daniel A. Shoskes



Laparoscopic partial nephrectomy without ischemia.  


The warm ischaemia time appears the most prominent modifiable risk factor for the development of renal impairment following laparoscopic partial nephrectomy. Historically, hilar clamping was the 'gold standard' technique, but now we are pushing our techniques to achieve the ultimate: 'zero ischaemia' approach. Results from 'early unclamping' techniques reinforced the importance of 'every minute counts' (28). Subsequent techniques in non-hilar clamping demonstrated that this approach was indeed feasible, but at the expense of higher bleeding, positive margins, and collecting system breach rates. With the advancement of technology, through the use of robotic assistance, improved haemostatic agents, as well as various imaging modalities (laparoscopic ultrasound, CT angiography), the surgeon can now potentially perform Nephron Sparing Surgery (NSS) in a more precise manner. Specifically, with the use of superselective clamping of the feeding vessel(s) to the tumour, the remaining healthy renal parenchyma should be less compromised, with associated low bleeding rates. NSS in the form of laparoscopic partial nephrectomy is clearly evolving, with increasing demands on the surgeon, requiring more expertise and experience, with the added assistance from other specialties (anaesthetists, radiologists etc). To be able to regularly perform Laparoscopic Partial Nephrectomy (LPN) without ischaemia safely, the laparoscopist must develop his / her experience in a stepwise fashion, perhaps commencing with artery-only clamping, leading on to early declamping, and then 'on demand' clamping. When moving on to LPN without ischaemia, patient selection is paramount. The ideal patient would harbour a single small, polar, exophytic renal mass with a normal functioning contralateral kidney. Although currently the techniques and outcomes laparoscopic partial nephrectomy without ischaemia published are limited to a few authors, with no current long term results to prove its full worth and reproducibility, early results are very encouraging. The pursuit of acquiring 'zero ischaemia' is clearly worthwhile, but needs to be measured against the potential risks of increased morbidity and positive margin rates. PMID:23406810

Hotston, Matthew R; Keeley, Francis X


Ligamentous influence in pelvic load distribution.  


BACKGROUND CONTEXT: The influence of the posterior pelvic ring ligaments on pelvic stability is poorly understood. Low back pain and sacroiliac joint (SIJ) pain are described being related to these ligaments. Computational approaches involving finite element (FE) modeling may aid to determine their influence. Previous FE models lacked in precise ligament geometries and material properties, which might have influence on the results. PURPOSE AND STUDY DESIGN: The aim of this study is to investigate ligamentous influence in pelvic stability by means of FE using precise ligament material properties and morphometries. METHODS: An FE model of the pelvis bones was created from computer tomography, including the pubic symphysis joint (PSJ) and the SIJ. Ligament data were used from 55 body donors: anterior (ASL), interosseous (ISL), and posterior (PSL) sacroiliac ligaments; iliolumbar (IL), inguinal (IN), pubic (PL), sacrospinous (SS), and sacrotuberous (ST) ligaments; and obturator membrane (OM). Stress-strain data were gained from iliotibial tract specimens. A vertical load of 600 N was applied. Pelvic motion related to altered ligament and cartilage stiffness was determined in a range of 50% to 200%. Ligament strain was investigated in the standing and sitting positions. RESULTS: Tensile and compressive stresses were found at the SIJ and the PSJ. The center of sacral motion was at the level of the second sacral vertebra. At the acetabula and the PSJ, higher ligament and cartilage stiffnesses decrease pelvic motion in the following order: SIJ cartilage>ISL>ST+SS>IL+ASL+PSL. Similar effects were found for the sacrum (SIJ cartilage>ISL>IL+ASL+PSL) but increased ST+SS stiffnesses increased sacral motion. The influence of the IN, OM, and PL was less than 0.1%. Compared with standing, total ligament strain was reduced to 90%. Increased strains were found for the IL, ISL, and PSL. CONCLUSIONS: Posterior pelvic ring cartilage and ligaments significantly contribute to pelvic stability. Their effects are region- and stiffness dependent. While sitting, load concentrations occur at the IL, ISL, and PSL, which goes in coherence with the clinical findings of these ligaments serving as generators of low back pain. PMID:23755919

Hammer, Niels; Steinke, Hanno; Lingslebe, Uwe; Bechmann, Ingo; Josten, Christoph; Slowik, Volker; Böhme, Jörg



Design Projects in Human Anatomy & Physiology  

ERIC Educational Resources Information Center

|Very often, some type of writing assignment is required in college entry-level Human Anatomy and Physiology courses. This assignment can be anything from an essay to a research paper on the literature, focusing on a faculty-approved topic of interest to the student. As educators who teach Human Anatomy and Physiology at an urban community…

Polizzotto, Kristin; Ortiz, Mary T.



Routine left robotic-assisted laparoscopic donor nephrectomy is safe and effective regardless of the presence of vascular anomalies.  


The classic approach to donor nephrectomy consists of preferential procurement of the kidney without vascular anomalies. We studied the effect of routine procurement of the left kidney regardless the presence of multiple arteries on the outcomes of robotic-assisted laparoscopic living donor nephrectomy (LLDN) with particular reference to the incidence of urological complications. From August 2000 to July 2005, 209 left LLDNs were performed. We analyzed the outcomes of donors and recipients in relation to the presence of multiple vessels versus normal anatomy. We divided the patients into two groups: group A (n = 148) with normal vascular anatomy and group B (n = 61) with vascular anomalies. In the donors, no significant difference in conversion to open surgery rate, blood loss, length of stay, was noted between the two groups; operative time and warm ischemia time were slightly higher in group B. One-year patient survival was 98% in both groups while the 1-year graft survival was 96.6% in group A and 96% in group B. Only one urological complication was noted in the group with normal anatomy (0.7%) versus none in the group with multiple arteries. Left kidney procurement using robotic-assisted laparoscopic technique is safe and effective, even in the presence of vascular anomalies. PMID:16827680

Gorodner, Verónica; Horgan, Santiago; Galvani, Carlos; Manzelli, Antonio; Oberholzer, José; Sankary, Howard; Testa, Giuliano; Benedetti, Enrico



A Suspected Pelvic Aneurysmal Bone Cyst in Pregnancy  

PubMed Central

Albeit rare, the majority of identified bone lesions in pregnancy spare the pelvis. Once encountered with a pelvic bone lesion in pregnancy, the obstetrician may face a challenging situation as it is difficult to determine and predict the effects that labor and parturition impart on the pelvic bones. Bone changes and pelvic bone fractures have been well documented during childbirth. The data regarding clinical outcomes and management of pregnancies complicated by pelvic ABCs is scant. Highly suspected to represent an aneurysmal bone cyst, the clinical evaluation of a pelvic lesion in the ilium of a pregnant individual is presented, and modes of delivery in such a scenario are discussed.

Foulk, Brooke



“Silent” rupture of unscarred gravid uterus with subsequent pelvic abscess: Successful laparoscopic management  

Microsoft Academic Search

Intrapartum rupture of an unscarred uterus is rare in current times. However, it is still associated with significant maternal and fetal mortality and morbidity. Unlike rupture or dehiscence of a previous cesarean scar, which is occasionally bloodless, complete rupture of a gravid unscarred uterus frequently results in fetal jeopardy and significant maternal intraperitoneal bleeding, causes acute abdomen, and demands emergency

Chung-hsien Sun; Cheng-i Liao; Yuen-yee Kan



Acetabular orientation with different pelvic registration landmarks.  


This study determined the relationship of various pelvic landmarks to the pelvic plane in the lateral position. Five whole-body cadavers were used in this study. All navigation data were collected using the OrthoPilot navigation system (B. Braun Aesculap, Tuttlingen, Germany) to register all landmarks. The pelvic plane was registered with the body in the supine position for comparison. The ipsilateral posterosuperior iliac spine (PSIS) and contralateral PSIS were registered for comparison of the line made by the 2 anterosuperior iliac spines (ASIS) in the supine position. Registration points along the acetabular rim at the 12-, 3-, and 9-o'clock positions were recorded, and the transverse acetabular ligament (TAL) was registered using the ends and middle of the ligament for the 3 registration points. Inclination as determined by the TAL was 49.7 degrees +/-25.8 degrees , whereas the acetabular rim resulted in an inclination of 36.3 degrees +/-7.2 degrees . When the interspinal posterior line was calculated, the difference in inclination compared with the pelvic plane was 1.8 degrees +/-1.7 degrees . Anteversion using the acetabular rim resulted in a difference of 8.1 degrees +/-4.9 degrees and using the TAL resulted in a difference of 13.4 degrees +/-7.9 degrees . The difference in anteversion using the pelvic plane and the posterior interspinal line was 1.2 degrees +/-1.3 degrees . This study determined that the alternative landmarks of the acetabular rim and the TAL were not as accurate as using the posterior interspinal line as determined by registering the PSIS. PMID:19835300

Mihalko, William M; Kammerzell, Sergej; Saleh, Khaled J



Optimizing electrode implantation in sacral nerve stimulation—an anatomical cadaver study controlled by a laparoscopic camera  

Microsoft Academic Search

Background and aim  Sacral nerve stimulation is the therapy of choice in patients with neurogenic faecal and urine incontinence, constipation\\u000a and some pelvic pain syndromes. The aim of this study is to determine the best insertion angles of the electrode under laparoscopic\\u000a visualization of the sacral nerves.\\u000a \\u000a \\u000a \\u000a Materials and methods  Five fresh cadaver pelvises were dissected through an anterior approach of the

N. C. Buchs; J.-C. Dembe; J. Robert-Yap; B. Roche; J. Fasel



Spontaneous Healing of a Rectovaginal Fistula Developing after Laparoscopic Segmental Bowel Resection for Intestinal Deep Infiltrating Endometriosis  

PubMed Central

The surgical treatment of intestinal deep infiltrating endometriosis has an associated risk of major complications such as dehiscence of the intestinal anastomosis, pelvic abscess, and rectovaginal fistula. The management of postoperative rectovaginal fistula frequently requires a reoperation and the construction of a stoma for temporary fecal diversion. In this paper we describe a 27-year-old woman undergoing laparoscopic treatment of deep infiltrating endometriosis (extramucosal cystectomy, resection of the uterosacral ligaments, resection of the posterior vaginal fornix, and segmental bowel resection) complicated by a rectovaginal fistula, which healed spontaneously with nonsurgical conservative treatment.

Trippia, Carlos Henrique; Zomer, Monica Tessmann



Spontaneous healing of a rectovaginal fistula developing after laparoscopic segmental bowel resection for intestinal deep infiltrating endometriosis.  


The surgical treatment of intestinal deep infiltrating endometriosis has an associated risk of major complications such as dehiscence of the intestinal anastomosis, pelvic abscess, and rectovaginal fistula. The management of postoperative rectovaginal fistula frequently requires a reoperation and the construction of a stoma for temporary fecal diversion. In this paper we describe a 27-year-old woman undergoing laparoscopic treatment of deep infiltrating endometriosis (extramucosal cystectomy, resection of the uterosacral ligaments, resection of the posterior vaginal fornix, and segmental bowel resection) complicated by a rectovaginal fistula, which healed spontaneously with nonsurgical conservative treatment. PMID:23710392

Kondo, William; Ribeiro, Reitan; Trippia, Carlos Henrique; Zomer, Monica Tessmann



Prevention of childbirth injuries to the pelvic floor.  


The majority of childbirth injuries to the pelvic floor occur after the first vaginal delivery. Cesarean sections performed after the onset of labor may not protect the pelvic floor. Elective cesarean section is the only true primary prevention strategy for childbirth injuries to the pelvic floor. Alternative primary prevention strategies include elective cesarean section for women with nonmodifiable risks for childbirth injuries to the pelvic floor, antepartum pelvic floor exercises, or intrapartum pudendal nerve monitoring. Secondary prevention strategies must focus on modifying obstetric practices that predispose women to pelvic floor injury. These factors are best delineated for anal incontinence and include restrictive use of episiotomy, mediolateral episiotomy when necessary, spontaneous over forceps-assisted vaginal delivery, vacuum extraction over forceps delivery, and antepartum perineal massage. Finally, tertiary prevention strategies should address the mode of delivery made for women with childbirth injuries to the pelvic floor who desire future fertility. PMID:12112955

Heit, M; Mudd, K; Culligan, P



Laparoscopic Repair of a Traumatic Bladder Rupture  

PubMed Central

Laparoscopic repair of the traumatic intraperitoneal bladder rupture is a proven, safe, and effective technique in the appropriate setting. A 23-year-old male with traumatic intraperitoneal bladder rupture proven by cystogram after a motor vehicle collision was successfully repaired via a laparoscopic approach. We describe the technique in detail including 2-layer closure and follow-up care. A review of the literature using PubMed with the key words [laparoscopic repair bladder injury] AND [bladder trauma] was performed. We recommend the consideration of laparoscopic repair of the intraperitoneal bladder rupture in more trauma patients who meet criteria.

Hugo Cuadra, Rene; Ricchiuti, Daniel J.



Evaluation of pelvic fixation in neuromuscular scoliosis: a retrospective study in 55 patients  

PubMed Central

The literature has described different indications for pelvic fixation in neuromuscular scoliosis. We retrospectively evaluated changes in pelvic obliquity for a minimum of two years among three groups: group I (initial pelvic obliquity >15°; with pelvic fixation), group II (initial pelvic obliquity >15°; without pelvic fixation), and group III (initial pelvic obliquity <15°; without pelvic fixation). We used iliac screws for pelvic fixation in group I. There was significant postoperative improvement (p?pelvic obliquity. There was no significant loss of correction in Cobb’s angle, thoracic kyphosis, and lumbar lordosis among all three groups; however, group II showed significant correction loss in pelvic obliquity compared to groups I and III at final follow-up (p?pelvic obliquity >15° require pelvic fixation to maintain the correction and balance over time while obliquity <15° does not require pelvic fixation.

Modi, Hitesh N.; Song, Hae-Ryong; Hyuk Yang, Jae; Jajodia, Nirmal



Management of major bile duct injury after laparoscopic cholecystectomy: a case report  

PubMed Central

Introduction Bile duct injury is a severe and potentially life-threatening complication of laparoscopic cholecystectomy. Several series have described a 0.5% to 0.6% incidence of bile duct injury during laparoscopic cholecystectomy. The aim of this study was to analyze the presentation, characteristics, related investigation, and treatment results of major bile duct injuries after laparoscopic cholecystectomy. Case presentation A rare case of a 48-year-old Greek woman with a triple bile duct injury (right and left hepatic duct ligation and common bile duct cross-section) is presented. A Roux en Y hepaticojejunostomy was performed after repeated endoscopic retrograde cholangiopancreatographies, percutaneous transhepatic catheterization of the ducts and magnetic resonance cholangiographies to delineate the biliary anatomy and assess the level of injury. Conclusion Early recognition and an adequate multidisciplinary approach are the cornerstones for the optimal final outcome. Suboptimal management of injuries often leads to more extensive damage to the biliary tree and its vasculature. Early referral to a tertiary care center with experienced hepatobiliary surgeons and skilled interventional radiologists would appear to be necessary to assure optimal results.



Hitching the gallbladder in laparoscopic-assisted cholecysto-cholangiography: a simple technique.  


Neonatal cholestatic disorder in the late neonatal period requires often cholangiography to differentiate between biliary atresia and other causes of prolonged neonatal jaundice. A simplified method of a laparoscopic-assisted cholecysto-cholangiography is presented. Retrospective chart review was conducted of all patients who from May 2002 to April 2012 underwent a laparoscopic-assisted cholecysto-cholangiography with routine fixation of the fundus of the gallbladder to the lateral aspect of the abdominal wall. A total of 18 infants (8 boys) aged 41-104 (median 64) days underwent laparoscopic-assisted cholecysto-cholangiography for prolonged jaundice. The technique identified ten cases of a patent bile duct system and eight biliary atresias. (Thirty-two cases of suspected biliary atresia were confirmed by laparoscopy alone.) Two cases required suturing of a bile leak at the puncture site. Hitching the gallbladder to the lateral abdominal wall is a simple method allowing an optimal radiographic assessment of the extra- and intra-hepatic bile duct anatomy. PMID:23857561

Houben, C H; Wong, H Y; Mou, W C; Chan, K W; Tam, Y H; Lee, K H



Technical difficulties and its remedies in laparoscopic cholecystectomy in situs inversus totalis: A rare case report  

PubMed Central

INTRODUCTION Laparoscopic cholecystectomy is considered to be the gold standard surgical procedure for cholelithiasis and is one of the commonest surgical procedures in the world today. However, in rare cases of previously undiagnosed situs inversus totalis (with dextrocardia), the presentation of the cholecystitis, its diagnosis and the operative procedure can pose problems. We present here one such case and discuss how the diagnosis was made and difficulties encountered during surgery and how they were coped with. PRESENTATION OF CASE A 35 year old female presented with left hypochondrium pain and dyspepsia, for 2 years. A diagnosis of cholelithiasis with situs inversus was confirmed after thorough clinical examination, abdominal and chest X-rays and ultrasonography of the abdomen. Laparoscopic cholecystectomy, which is the standard treatment, was performed with numerous modifications in the positioning of the monitor, insufflator, ports and the position of the members of the surgical team and the laparoscopic instruments. The patient had an uneventful recovery. DISCUSSION Situs inversus totalis is itself a rare condition and when associated with cholelithiasis poses a challenge in the management of the condition. We must appreciate the necessity of setting up the operating theatre, the positioning of the ports, the surgical team and the instruments. CONCLUSION Therefore, it becomes important for the right handed surgeons to modify their techniques and establish a proper hand eye coordination to adapt to the mirror image anatomy of the Calot's triangle in a patient of situs inversus totalis.

Arya, S.V.; Das, Anupam; Singh, Sunil; Kalwaniya, Dheer Singh; Sharma, Ashok; Thukral, B.B.



The bikini area and bikini line as a location for anterior subcutaneous pelvic fixation: an anatomic and clinical investigation.  


Anterior external fixation for pelvic fractures has been the standard for acute stabilization but definitive treatment often leads to pin tract infection, is uncomfortable, and limits patient mobility. We recently developed a subcutaneous anterior pelvic fixator which addresses these issues (INFIX). The objective of this study is to introduce the Bikini Area and Bikini Line as the subcutaneous anatomical location where this apparatus is placed. A study was preformed on eight cadaveric specimens to define the location of the subcutaneous device with respect to anatomic structures. We examined 23 people of various body mass indexes to examine the anterior pelvic anatomy. This was followed by implantation on 42 individuals in whom we reviewed CT scans to assess the location of the implant. We asked these same 42 individuals whether they could sit, stand, and lie on their sides and if they had any discomfort. We measured the dimensions of 26 retrieved rods to approximate the curve of the Bikini Line. Finally in 14 individuals we performed vascular ultrasound to assess the flow in the iliac and femoral vessels with the implant in place in the sitting and standing position. Neurovascular structures are not affected by placing the INFIX device at the Bikini Line, patients are comfortable, mobile and complications are minimized by this procedure. A rod placed on the Bikini Line which connects screws inserted into the anterior inferior iliac spine on each side does not interfere with sitting, standing, or the neurovascular structures. PMID:22927118

Vaidya, R; Oliphant, B; Jain, R; Nasr, K; Siwiec, R; Onwudiwe, N; Sethi, A



Pelvic Insufficiency Fracture After Pelvic Radiotherapy for Cervical Cancer: Analysis of Risk Factors  

SciTech Connect

Purpose: To investigate the incidence, clinical characteristics, and risk factors of pelvic insufficiency fracture (PIF) after pelvic radiotherapy (RT) in cervical cancer. Methods and Materials: Medical records and imaging studies, including bone scintigraphy, CT, and MRI of 557 patients with cervical cancer who received whole-pelvic RT between January 1998 and August 2005 were reviewed. Results: Eighty-three patients were diagnosed as having PIF after pelvic RT. The 5-year cumulative incidence of PIF was 19.7%. The most commonly involved site was the sacroiliac joint. Pelvic pain developed in 48 patients (57.8%) at diagnosis. Eleven patients (13.3%) needed admission or narcotics because of severe pain, and others had good relief of symptoms with conservative management. In univariate analysis, age {>=}55 years (p < 0.001), anteroposterior/posteroanterior parallel opposing technique (p = 0.001), curative treatment (p < 0.001), and radiation dose {>=}50.4 Gy (p = 0.005) were the predisposing factors for development of PIF. Concurrent chemotherapy (p = 0.78) was not significant. Multivariate analysis showed that age {>=}55 years (p < 0.001), body weight <55 kg (p = 0.02), curative treatment (p = 0.03), and radiation dose {>=}50.4 Gy (p = 0.04) were significant predisposing factors for development of PIF. Conclusion: The development of PIF is not rare after pelvic RT. The use of multibeam arrangements to reduce the volume and dose of irradiated pelvic bone can be helpful to minimize the risk of fracture, especially in elderly women with low body weight.

Oh, Dongryul [Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of); Huh, Seung Jae [Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of)], E-mail:; Nam, Heerim; Park, Won; Han, Youngyih; Lim, Do Hoon; Ahn, Yong Chan [Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of); Lee, Jeong Won; Kim, Byoung Gie; Bae, Duk Soo; Lee, Je Ho [Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of)



Laparoscopic Resection of Large Adrenal Tumors  

PubMed Central

Background: Laparoscopic adrenalectomy has rapidly replaced open adrenalectomy as the procedure of choice for benign adrenal tumors. It still remains to be clarified whether the laparoscopic resection of large (?8cm) or potentially malignant tumors is appropriate or not due to technical difficulties and concern about local recurrence. The aim of this study was to evaluate the short- and long-term outcome of 174 consecutive laparoscopic and open adrenalectomies performed in our surgical unit. Methods: Our data come from a retrospective analysis of 174 consecutive adrenalectomies performed on 166 patients from May 1997 to December 2008. Fifteen patients with tumors ?8cm underwent laparoscopic adrenalectomy. Sixty-five patients were men and 101 were women, aged 16 years to 80 years. Nine patients underwent either synchronous or metachronous bilateral adrenalectomy. Tumor size ranged from 3.2cm to 27cm. The largest laparoscopically excised tumors were a ganglioneuroma with a mean diameter of 13cm and a myelolipoma of 14cm. Results: In 135 patients, a laparoscopic procedure was completed successfully, whereas in 14 patients the laparoscopic procedure was converted to open. Seventeen patients were treated with an open approach from the start. There were no conversions in the group of patients with tumors >8cm. Operative time for laparoscopic adrenalectomies ranged from 65 minutes to 240 minutes. In the large adrenal tumor group, operative time for laparoscopic resection ranged from 150 minutes to 240 minutes. The postoperative hospital stay for laparoscopic adrenalectomy ranged from 1 day to 2 days (mean, 1.5) and from 5 days to 20 days for patients undergoing the open or converted procedure. The mean postoperative stay was 2 days for the group with large tumors resected by laparoscopy. Conclusion: Laparoscopic resection of large (?8cm) adrenal tumors is feasible and safe. Short- and long-term results did not differ in the 2 groups.

Farfaras, Athanasios; Vasiliadis, George; Pappa, Theodora; Aggeli, Chrysanthi; Vasilatou, Evagelina; Kaltsas, Gregory; Piaditis, George




PubMed Central

Gallstone disease is still a major health problem worldwide. Open cholecystectomy was the standard treatment for symptomatic gallstones for more than 100 years. The introduction of laparoscopic cholecystectomy in the late 1980s has led to dramatic changes in the management of gallstone disease. The aim of this review is to equip the general practitioner with the answers to questions a patient may ask about the current management of gallstones.

Al-Mulhim, Abdulmohsen A.



Robot-Assisted Laparoscopic Ultrasound  

Microsoft Academic Search

\\u000a Novel tools for existing robotic surgical systems present opportunities for exploring improved techniques in minimally invasive\\u000a surgery. Specifically, intraoperative ultrasonography is a tool that is being used with increased frequency, yet has limitations\\u000a with existing laparoscopic systems. The purpose of this study was to develop and to evaluate a new ultrasound system with\\u000a the da Vinci\\u000a ® Surgical System (Intuitive

Caitlin M. Schneider; Gregory W. Dachs; Christopher J. Hasser; Michael A. Choti; Simon P. DiMaio; Russell H. Taylor



Laparoscopic resection of sigmoid diverticulitis  

Microsoft Academic Search

Background: In the large bowel, resection of the sigmoid colon is the most commonly performed laparoscopic intervention because large\\u000a bowel lesions often are located in this part of the bowel and the procedure technically is the most favorable one. A number\\u000a of publications involving case series or the results of highly experienced individual surgeons already have confirmed the\\u000a feasibility of

F. Köckerling; C. Schneider; M. A. Reymond; H. Scheuerlein; J. Konradt; H. P. Bruch; C. Zornig; L. Köhler; E. Bärlehner; A. Kuthe; G. Szinicz; H. A. Richter; W. Hohenberger



Laparoscopic Procedures in Trauma Care  

Microsoft Academic Search

\\u000a The modern concept of diagnostic laparoscopy for trauma patients emerged in the early 1970s. The literature shows that a variety\\u000a of laparoscopic techniques are applicable to patients with abdominal trauma. Treatment of abdominal trauma requires a precise\\u000a diagnosis that is not always possible with imaging techniques. As the danger is particularly great that an injury to the diaphragm\\u000a or intestines

Selman Uranues; Abe Fingerhut; Roberto Bergamaschi


Laparoscopic Radical Nephrectomy: Transperitoneal Approach  

Microsoft Academic Search

\\u000a Radical nephrectomy, as described by Robson et al. in 1963, is the traditional gold standard approach to the management of\\u000a renal tumors (1). This procedure has an established success rate but is associated with significant postoperative pain and\\u000a prolonged convalescence, stemming from the flank, subcostal, Chevron or thoraco-abdominal incisions typically used. Laparoscopic\\u000a radical nephrectomy, as introduced by Clayman and associates

Leslie A. Deane; David I. Lee; Jaime Landman; Chandru P. Sundaram; Ralph V. Clayman


Severe endometriosis: laparoscopic rectum resection  

Microsoft Academic Search

Aim  Endometriosis is a frequent benign disease of women in reproductive age. An infiltration of the spatium rectovaginal is rare,\\u000a but if it occurs, in up to 73% the rectum is involved. If there is the indication for surgery, a partial resection of the\\u000a rectum might be necessary. This can be performed by a laparoscopic approach. It is the aim of

Ingolf Juhasz-Böss; Claus Lattrich; Alois Fürst; Eduard Malik; Olaf Ortmann



Laparoscopic treatment of pancreatic insulinoma.  


Laparoscopy and laparoscopic ultrasonography (LUS) have been proposed for the diagnosis and treatment of pancreatic insulinoma. We present for cases of pancreatic insulinoma approached by laparoscopy guided by LUS. In three cases, insulinomas were in the pancreatic body and in one case in the pancreatic head. All lesions were detected preoperatively by abdominal US and confirmed by computed tomography. Laparoscopy was performed under general anesthesia. LUS was performed using a 10-mm flexible probe. In two cases the adenoma was enucleated using scissors and electrocoagulation, major vessels were controlled using clips, and enucleation was completed using a 30-mm endo-GIA. In one case a laparoscopic distal pancreatectomy with spleen preservation was performed. In one case the adenoma was deep in the pancreatic head; minilaparotomy was performed and the adenoma enucleated. Patients were discharged in good health 5-7 days after surgery. The postoperative course was complicated in one case of enucleation by peripancreatic fluid collection that was treated percutaneously. Our experience confirms that accurate localization followed by excision of tumors via the laparoscopic approach constitute a significant advance in the management of insulinoma. PMID:12802660

Goletti, O; Celona, G; Monzani, F; Caraccio, N; Zocco, G; Lippolis, P V; Battini, A; Seccia, M; Cavina, E



[Laparoscopic management of extrauterine pregnancy].  


The radioimmunologic assay of human chorionic gonadotropin and ultrasound have contributed to an earlier diagnosis of ectopic tubal pregnancy. Laparoscopy has modified not only diagnostic, but even therapeutic approach. In fact laparoscopic approach and medical treatment with methotrexate have proved to be safe and effective. Between October 1991 and December 1993 by the Department of Obstetric and Gynecology of the Hospital Felice Villa (Mariano Comense -- CO) all patients (14) with suspected extra-uterine pregnancy were submitted to laparoscopy. Of these 12 were treated by laparoscopic salpingostomy or aspiration. Five cases in which trophoblastic tissue was not present at histologic specimen were submitted to medical treatment with methotrexate. In 2 cases in which the tube was ruptured we performed a salpingectomy after laparotomy. We didn't have any early or late complication. After laparoscopy betahCG levels were monitored every 2 days. We didn't have any case of trophoblastic persistency or any recurrence. Recent studies have demonstrated lower morbidity and higher fertility rate in women treated laparoscopically for GEU. However data from literature show some discrepancy. As a matter of fact it is not so evident that fertility is better preserved by operative laparoscopy than laparotomy. Anyway laparoscopy presents a better outcome for the patient and requires less days of hospitalization. PMID:8820391

Borsellino, G; Danile, G



Laparoscopic nephrectomy for Wilms' tumor.  


The role of minimally invasive surgery for the treatment of pediatric urological tumors has been limited to biopsies and resection for small neuroblastomas and benign tumors. The purpose of this study is to present the experience of a Brazilian group pioneering laparoscopic nephrectomy for Wilms' tumor. A total of 15 children with unilateral non-metastatic Wilms' tumor were preoperatively treated with vincristine and actinomycin D, and afterwards were submitted to laparoscopic nephrectomy and lymph node sampling. A Veress needle umbilical punction was performed and a four-trocar transperitoneal approach was used. The tumor was extracted inside a plastic bag and without morcellation through a Pfannenstiel incision. In all 15 patients the tumor was completely removed, as well as lymph node samples and no ruptures occurred. A fibrous capsule involved the tumor, making the dissection easy to perform. Intraoperative bleeding was minimal. The postoperative course was free of complications and all the patients were discharged early. No recurrences or long-term complications have been detected in 7-61 months or more of follow-up. We conclude that laparoscopic nephrectomy for Wilms' tumor is a feasible and safe procedure in a selected group of children after chemotherapy. It reproduces all the steps of the open surgical approach required to treat this tumor, with the advantages of a short hospital stay and cosmetically more acceptable incisions. PMID:19496712

Duarte, Ricardo Jordão; Dénes, Francisco Tibor; Cristofani, Lílian Maria; Srougi, Miguel



Robotic-assisted laparoscopic pyeloplasty: a pilot study  

Microsoft Academic Search

Objectives. Robotic technology has been employed to manipulate the laparoscope during urologic procedures. However, to our knowledge, robotic technology has not been previously applied to actually perform the urologic laparoscopic procedure. The objective of this study was to determine the feasibility and efficacy of performing robotic-assisted laparoscopic pyeloplasty and compare it with conventional laparoscopic pyeloplasty in an acute porcine model.Methods.

Gyung Tak Sung; Inderbir S Gill; Thomas H. S Hsu



Robotic-assisted laparoscopic radical prostatectomy: the Frankfurt technique  

Microsoft Academic Search

The robotic technique, which was first introduced in laparoscopic heart surgery, has revolutionized laparoscopic surgery over the last 5 years. In May 2000, our department accomplished the first robot assisted laparoscopic radical prostatectomy. Since that time we have performed more than 118 such procedures and several other laparoscopic operations using the robotic technique. We here summarize our experience in robot assisted

M. Wolfram; R. Bräutigam; T. Engl; W. Bentas; S. Heitkamp; M. Ostwald; W. Kramer; J. Binder; R. Blaheta; D. Jonas; W.-D. Beecken



Imaging findings of biliary and nonbiliary complications following laparoscopic surgery  

Microsoft Academic Search

Laparoscopic techniques are evolving for a wide range of surgical procedures although they were initially confined to cholecystectomy and exploratory laparoscopy. Recently, surgical procedures performed with a laparoscope include splenectomy, adrenalectomy, gastrectomy, and myomectomy. In this article, we review the spectrum of complications and illustrate imaging features of biliary and nonbiliary complications after various laparoscopic surgeries. Biliary complications following laparoscopic

Jin-Young Choi; Myeong-Jin Kim; Mi-Suk Park; Joo Hee Kim; Joon Seok Lim; Young Taik Oh; Ki Whang Kim



Functional MRI of the Pelvic Floor  

Microsoft Academic Search

Taking all the above-mentioned into account, indications for functional cine MRI still remain controversial. The method itself\\u000a is not yet standardized, and so far only a 2D approach for functional imaging of the pelvic floor exists. With the advance\\u000a of fast “parallel imaging” a stack of two to three slices within the same acquisition time seems possible.\\u000a \\u000a In patients with

Tanja Fischer; Andreas Lienemann


Imaging of Abdominal and Pelvic Injuries  

Microsoft Academic Search

Trauma to abdominal and pelvic structures often occurs in the setting of multisystemic injury. Rapid and accurate diagnosis\\u000a is a mainstay in reducing mortality and morbidity of these patients. Choice and employment of any particular radiological\\u000a investigation would depend on the radiological armamentarium available and the urgency of demand in the life-threatening situation.\\u000a While US has an important role in

S. Leschka; H. Alkadhi; L. Husmann; S. Wildermuth


[Quantitative trauma mechanics in pelvic fracture].  


Quasistatic loading of the isolated pelvis and of the pelvis in situ is reported; dynamic loading with an impactor and on 90 degrees car/car side impact are then considered. The isolated pelvis was loaded laterally at the ala of the ilium and the pelvis in situ in the anterior-posterior direction in the area of the symphysis with universal dynamometer; the loading profile was a rigid disk 150 mm in diameter. Some dynamic tests were performed with an impactor with rigid disk 80 mm in diameter as impact surface; the impact was applied against the trochanter major area at a velocity of 30-35 km/h. Otherwise, the pelvic area was stressed by impact through the intrusion of the car side or by impaction of the pelvis against a rigid wall. In the tests conducted with isolated pelves, forces of 850-4850 N were measured; pelvic fractures were observed, specifically fractures of the acetabular margin, pubic bone, and ischium, and comminuted fractures of the symphysis and the iliosacral. In the impactor tests, forces of 6.5-11 kN were enough to cause, pelvic fracture except in one case, and fractures of the femoral neck were found in some cases in addition. With quasistatic anterior-posterior loading of the pelvis in situ, forces of 4,700-10,000 N were measured in cases in which fractures were found. PMID:7676253

Fleischer, G; Kallieris, D; Käppner, R; Schmidt, G



Laparoscopic bowel mobilization combined with intraoperative colonoscopic polypectomy in patients with an inaccessible polyp of the colon  

Microsoft Academic Search

Background: The purpose of this report was to describe a simple technique suitable for polyps where circumstances of the bowel anatomy\\u000a prevent complete access and control of the colonoscopic procedure.\\u000a \\u000a \\u000a \\u000a \\u000a \\u000a Methods: By combining laparoscopic mobilization of the bowel with colonoscopic polypectomy, previously inaccessible polyps could be\\u000a snared in two patients.\\u000a \\u000a \\u000a \\u000a \\u000a \\u000a Results: Both patients had 3-cm large sessile adenomas in the

K. Smedh; S. Skullman; A. Kald; B. Anderberg; P.-O. Nyström



Imaging of complications of laparoscopic cholecystectomy  

Microsoft Academic Search

Laparoscopic cholecystectomy has gained widespread acceptance for treatment of cholelithiasis. Because radiologists have aprimary role in recognizing and treating complications of this surgical technique, we reviewed the clinical records and imaging studies of 29 patients with complications after laparoscopic cholecystectomy. Complications included bile duct injuries (15 cases), retained common bile duct stones (seven cases), cystic duct stump leak (four cases),

Ellen M. Ward; Andrew J. LeRoy; Claire E. Bender; John H. Donohue; Rollin W. Hughes



Laparoscopic excision of splenic hydatid cyst  

PubMed Central

Hydatid disease of the spleen is a rare condition. The standard treatment is open total or partial splenectomy. Recently hand assisted laparoscopic total splenectomy for splenic hydatid cyst has been reported. A case is described of splenic hydatid cyst in a 45 year old man that was excised laparoscopically; the related literature is reviewed.???Keywords: hydatid disease; spleen; laparoscopy; Jordan

Gharaibeh, K



Diffusion of laparoscopic technologies in Denmark  

Microsoft Academic Search

It has been predicted that minimally invasive therapy will have dramatic consequences for the specialty of general surgery, as demonstrated by the diffusion of laparoscopic cholecystectomy. To investigate the determinants of the diffusion in Denmark of five laparoscopic technologies (cholecystectomy, appendicectomy, surgery for colon cancer, surgery for inguinal hernia and fundoplication), questionnaires on seventeen factors' influence on the adoption (stimulating

Peter Bo Poulsen; Sven Adamsen; Hindrik Vondeling; Torben Jørgensen



Robotic-assisted laparoscopic dismembered pyeloplasty  

Microsoft Academic Search

ObjectivesTo evaluate the feasibility and efficacy of robotic-assisted laparoscopic pyeloplasty. Laparoscopic pyeloplasty has been shown to have a success rate comparable to that of the open surgical approach. However, the steep learning curve has hindered its acceptance into mainstream urologic practice. The introduction of robotic assistance provides advantages that have the potential to facilitate precise dissection and intracorporeal suturing.

Vipul Patel



Laparoscopic-assisted abdominal aortic aneurysm repair  

Microsoft Academic Search

Since the advent of laparoscopy, the sweeping changes seen in general surgery have not been paralleled in vascular surgery. There have been case reports of laparoscopic-assisted aortobifemoral bypass for occlusive disease. Because aneurysmal disease comprises the majority of aortic surgery, we pursued animal and cadaveric feasibility studies for laparoscopic-assisted abdominal aortic aneurysm (AAA) repair. We present a case report of

M. H. M. Chen; E. A. Murphy; V. Halpern; G. R. Faust; J. M. Cosgrove; J. R. Cohen



Laparoscopic ablation of peripelvic renal cysts  

Microsoft Academic Search

Recently, laparoscopic surgery has been reported for symptomatic renal cysts. A 60-year-old female was referred to Toyama Medical and Pharmaceutical University Hospital with a chief complaint of general fatigue and left back pain. CT demonstrated bilateral peripelvic renal cysts, and DIP demonstrated left hydronephrosis and a medial shift of the left renal pelvis. Laparoscopic ablation of bilateral peripelvic renal cysts

Akiou Okumura; Hideki Fuse; Yasuhiro Muraishi; Remon Nishio; Tetsuo Nozaki



Hand-assisted laparoscopic sigmoidectomy for diverticulitis  

Microsoft Academic Search

BACKGROUND: Sigmoid colectomy for diverticular disease, a routine procedure when performed using standard open methods, can prove much more challenging using minimum access techniques. Hand-assisted laparoscopic colectomy is a new technique that reportedly has a minimum learning curve, yet retains the benefits of a laparoscopic procedure. The purpose of this study was to perform and then prospectively to evaluate the

Michael J. Mooney; Patrick L. Elliott; Derrick B. Galapon; Linda K. James; Laura J. Lilac; Michael J. O'Reilly



Direct inguinal hernias in children: laparoscopic aspects  

Microsoft Academic Search

Among 109 children treated laparoscopically for inguinal hernias, 5 had direct hernias, more than would normally be anticipated.\\u000a Two of the hernias were recurrences of indirect hernias operated upon previously using the open technique. Direct hernias\\u000a are easier to detect with the laparoscopic technique.

F. Schier



Redo laparoscopic repair of benign esophageal disease.  


Laparoscopic fundoplication for gastroesophageal reflux disease has been associated with excellent symptom control. Compared with medical treatment, laparoscopic Nissen fundoplication has shown favorable control of typical reflux symptoms. However, in approximately 2% to 17% of patients, surgical treatment fails. The role of reoperative repair for reflux disease and the factors that contribute to it are examined. PMID:22608677

Wee, Jon O



Laparoscopic vs open hemicolectomy for colon cancer  

Microsoft Academic Search

Background: The role of laparoscopic resection in the management of colon cancer is still a subject of debate. In this clinical study, we compared the perioperative results and long-term outcome for two unselected groups of patients undergoing either laparoscopic or open hemicolectomy for colon cancer. Methods: This prospective nonrandomized study was based on a series of 248 consecutive patients operated

E. Lezoche; F. Feliciotti; A. M. Paganini; M. Guerrieri; A. De Sanctis; S. Minervini; R. Campagnacci



Scrub Nurse Robot for Laparoscopic Surgery  

Microsoft Academic Search

During laparoscopic surgeries, changing forceps is a relatively simple procedure that requires a nurse or another surgeon; however, most hospitals lack a scrub nurse in the operating room. Therefore, we have developed an assisting robot for laparoscopic surgery that is able to pass or receive forceps under the voice control of the surgeon. This robot system consists of a magazine

Kazuto Takashima; Hiromichi Nakashima; Toshiharu Mukai; Shuji Hayashi



Laparoscopic Prostatectomy: Where Do We Stand?  

PubMed Central

Laparoscopic radical prostatectomy is an effective treatment for localized prostate cancer. This cost-intensive and technically demanding operation currently takes longer than the standard open procedures, but with increasing experience, it is eventually associated with lower costs and is nearly as fast. As more urologists gain such experience, the laparoscopic approach may challenge the standard approaches.

Remzi, Mesut; Djavan, Bob



Laparoscopic Surgery for Inflammatory Bowel Disease  

Microsoft Academic Search

Laparoscopic surgery has recently been gaining acceptance as an alternative approach for patients with inflammatory bowel disease. There is increasing evidence demonstrating the multiple potential benefits of laparoscopy including faster recovery, reduced costs, and lower morbidity. For patients with acute colitis, a laparoscopic subtotal colectomy and end ileostomy have been shown to be feasible and safe in experienced hands. When

Sergio Casillas; Conor P. Delaney



Cicatrical Cecal Volvulus Following Laparoscopic Cholecystectomy  

PubMed Central

Laparoscopic cholecystectomy is the procedure of choice for the treatment of symptomatic biliary disease. There is currently no agreement on the management of spilled gallstones, which commonly occurs during laparoscopic cholecystectomy and may produce significant morbidity. We present a case of spilled gallstones causing cicatrical cecal volvulus and also provide a review of pertinent literature.

Morris, Michael W.; Barker, Andrea K.; Harrison, James M.; Anderson, Andrew J.



Laparoscopic repair of an incarcerated obturator hernia  

Microsoft Academic Search

Obturator hernia is a rare cause of bowel obstruction. Occurring primarily in elderly women, it has a high incidence of incarceration and a high mortality rate. This report describes the successful laparoscopic reduction and repair of an incarcerated obturator hernia. Using open laparoroscopy, an incarcerated obturator hernia was diagnosed intraoperatively. After laparoscopic reduction, a transabdominal preperitoneal repair was completed using

T. L. Bryant; R. K. Umstot



Successful Transfer of Open Surgical Skills to a Laparoscopic Environment Using a Robotic Interface: Initial Experience With Laparoscopic Radical Prostatectomy  

Microsoft Academic Search

PurposeFor a skilled laparoscopic surgeon the learning curve for achieving proficiency with laparoscopic radical prostatectomy (LRP) is estimated at 40 to 60 cases. For the laparoscopically naïve surgeon the curve is estimated at 80 to 100 cases. The development of a robotic interface might significantly shorten the LRP learning curve for an experienced open yet naïve laparoscopic surgeon. To our




Laparoscopic Repair for Perforated Peptic Ulcer  

PubMed Central

Objective To compare the results of open versus laparoscopic repair for perforated peptic ulcers. Summary Background Data Omental patch repair with peritoneal lavage is the mainstay of treatment for perforated peptic ulcers in many institutions. Laparoscopic repair has been used to treat perforated peptic ulcers since 1990, but few randomized studies have been carried out to compare open versus laparoscopic procedures. Methods From January 1994 to June 1997, 130 patients with a clinical diagnosis of perforated peptic ulcer were randomly assigned to undergo either open or laparoscopic omental patch repair. Patients were excluded for a history of upper abdominal surgery, concomitant evidence of bleeding from the ulcer, or gastric outlet obstruction. Patients with clinically sealed-off perforations without signs of peritonitis or sepsis were treated without surgery. Laparoscopic repair would be converted to an open procedure for technical difficulties, nonjuxtapyloric gastric ulcers, or perforations larger than 10 mm. A Gast- rografin meal was performed 48 to 72 hours after surgery to document sealing of the perforation. The primary end-point was perioperative parenteral analgesic requirement. Secondary endpoints were operative time, postoperative pain score, length of postoperative hospital stay, complications and deaths, and the date of return to normal daily activities. Results Nine patients with a surgical diagnosis other than perforated peptic ulcer were excluded; 121 patients entered the final analysis. There were 98 male and 23 female patients recruited, ages 16 to 89 years. The two groups were comparable in age, sex, site and size of perforations, and American Society of Anesthesiology classification. There were nine conversions in the laparoscopic group. After surgery, patients in the laparoscopic group required significantly less parenteral analgesics than those who underwent open repair, and the visual analog pain scores in days 1 and 3 after surgery were significantly lower in the laparoscopic group as well. Laparoscopic repair required significantly less time to complete than open repair. The median postoperative stay was 6 days in the laparoscopic group versus 7 days in the open group. There were fewer chest infections in the laparoscopic group. There were two intraabdominal collections in the laparoscopic group. One patient in the laparoscopic group and three patients in the open group died after surgery. Conclusions Laparoscopic repair of perforated peptic ulcer is a safe and reliable procedure. It was associated with a shorter operating time, less postoperative pain, reduced chest complications, a shorter postoperative hospital stay, and earlier return to normal daily activities than the conventional open repair.

Siu, Wing T.; Leong, Heng T.; Law, Bonita K. B.; Chau, Chun H.; Li, Anthony C. N.; Fung, Kai H.; Tai, Yuk P.; Li, Michael K. W.



D-light for laparoscopic fluorescence diagnosis  

NASA Astrophysics Data System (ADS)

To evaluate the role of ALA induced fluorescence diagnosis in laparoscopic surgery, we induced peritoneal carcinosis in rats by multilocular intraabdominal tumorcell implantation (CC531). The animals were photosensitized by intraabdominal ALA lavage. Laparoscopy was performed with both, conventional white and then blue light (D-Light, KARL STORZ Germany) excitation. Laparoscopy with conventional white light showed peritoneal carcinoma foci from 0.1 to 2 cm in diameter. All macroscopically visible tumors (n equals 142) were fluorescence positive after laparoscopic blue light excitation. In addition, 30 laparoscopic not visible (white light) tumors showed fluorescence and were histologically confirmed as colon carcinoma metastases. We conclude that only ALA induced laparoscopic fluorescence detection after blue light excitation is the adequate method to detect the entire extent of the intraabdominal tumor spread. Fluorescence laparoscopy is essential for laparoscopic staging of colorectal cancer because of a higher rate of cancer foci detection.

Gahlen, Johannes; Laubach, Hans-Heinrich; Stern, Josef; Pressmar, Jochen; Pietschmann, Mathias; Herfarth, Christian



Anatomy and Function of the Normal Lung  


... Patients | | More Anatomy and Function of the Normal Lung For Patients What Kind of Medications Are There ... Need Oxygen Therapy? Other Medications To understand your lung condition, you should be familiar with how the ...


Michelangelo: Art, anatomy, and the kidney  

Microsoft Academic Search

Michelangelo: Art, anatomy, and the kidney. Michelangelo (1475–1564) had a life-long interest in anatomy that began with his participation in public dissections in his early teens, when he joined the court of Lorenzo de' Medici and was exposed to its physician-philosopher members. By the age of 18, he began to perform his own dissections. His early anatomic interests were revived

Garabed Eknoyan



Anatomy: Simple and Effective Privacy Preservation  

Microsoft Academic Search

This paper presents a novel technique, anatomy, for publishing sen- sitive data. Anatomy releases all the quasi-identifier and s ensitive values directly in two separate tables. Combined with a grouping mechanism, this approach protects privacy, and captures a large amount of correlation in the microdata. We develop a linear-time algorithm for computing anatomized tables that obey the l-diversity privacy requirement,

Xiaokui Xiao; Yufei Tao



Spanish language translation of pelvic floor disorders instruments  

Microsoft Academic Search

The purpose of the study is to translate existing measures of pelvic symptoms and quality of life from English into Spanish,\\u000a facilitating research participation of Hispanic\\/Latina women. The forward–backward translation protocol was applied then adjudicated\\u000a by a concordance committee. The measures included the Pelvic Floor Distress Inventory (PFDI), Pelvic Floor Impact Questionnaire\\u000a (PFIQ), Medical, Epidemiological, and Social Aspects of Aging

Amy E. Young; Paul M. Fine; Rebecca McCrery; Patricia A. Wren; Holly E. Richter; Linda Brubaker; Morton B. Brown; Anne M. Weber



Alternative Methods to Pelvic Floor Muscle Awareness and Training  

Microsoft Academic Search

Pelvic floor muscles are increasingly incorporated into Yoga and Pilates classes and for lower back pain physiotherapy. Other\\u000a techniques, including Feldenkrais physiotherapy, which develops pelvic floor awareness through movement and functional integration,\\u000a and Cantienica, whereby a pelvic floor contraction is palpated externally after movements between the ischial tuberosities,\\u000a greater trochanters, and the coccyx. Whole-body vibrations through biomechanical stimulation of the

Kaven Baessler; Barbara E. Bell


Human pelvic extramural ganglion cells: a semiquantitative and immunohistochemical study  

Microsoft Academic Search

In pelvic surgery, much attention is paid to nerve bundles but not to ganglion cells. Using serial section histology of 14\\u000a postmortem-treated hemipelvis (eight males, six females; mean, 79 years old), we examined the population number, distribution,\\u000a and tyrosine hydroxylase-immunoreactivity (TH-IR; suggesting sympathetic neurons) of extramural pelvic ganglion cells. All\\u000a pelvic ganglion cells were uniformly sized (25–30 ?m) contrasting with small intramural

Kanoko Imai; Kenichi Furuya; Michihiro Kawada; Yusuke Kinugasa; Kiichi Omote; Akiyoshi Namiki; Eiichi Uchiyama; Gen Murakami



Minimally Invasive Therapies for Chronic Pelvic Pain Syndrome  

Microsoft Academic Search

Chronic pelvic pain syndrome (CPPS) is a common problem among men and women worldwide. It is a symptoms-complex term for interstitial\\u000a cystitis\\/painful bladder syndrome in women and chronic prostatitis\\/chronic pelvic pain syndrome in men. Patients often present\\u000a with a combination of lower urinary tract symptoms with pelvic pain and sexual dysfunction. No gold standard exists for diagnosis\\u000a or treatment of

Salim A. Wehbe; Jennifer Y. Fariello; Kristene Whitmore



Pelvic fracture-related urethral and bladder injury.  


Major pelvic ring fracture (PRF) due to blunt trauma results in lower urinary tract injury (LUTI) in up to 10% of cases. Significant comorbidity may result and this is particularly the case for unrecognised injury. The increase in military injuries due to improvised explosive devices in recent conflicts has revealed a complex injury cohort. The incidence of pelvic fracture related LUTI in these casualties is up to three times higher than that seen in civilian patients with pelvic fracture. A complete understanding of LUTI following pelvic fracture is still lacking. Complex fractures of the anterior pelvic arch are associated with LUTI and initial management is largely conservative. In battlefield injuries, the combination of the blast wave, penetrating fragment and bodily displacement results in open pelvic fracture combined with gross perineal and pelvic soft-tissue destruction and traumatic femoral amputations. These are some of the most challenging injuries that any surgical team will manage and life saving measures are the priority. There are established pathways for the management of LUTI following blunt trauma related pelvic fracture. Military injuries are more complex and require a significantly different approach. This paper outlines the developments in the understanding and management of pelvic fracture-related LUTI, focussing primarily on injury mechanisms and early management. Recent military surgical experience is discussed, highlighting the significant differences to civilian practice. PMID:23631324

Durrant, Jordan J; Ramasamy, A; Salmon, M S; Watkin, N; Sargeant, I



Parallel genetic origins of pelvic reduction in vertebrates  

PubMed Central

Despite longstanding interest in parallel evolution, little is known about the genes that control similar traits in different lineages of vertebrates. Pelvic reduction in stickleback fish (family Gasterosteidae) provides a striking example of parallel evolution in a genetically tractable system. Previous studies suggest that cis-acting regulatory changes at the Pitx1 locus control pelvic reduction in a population of threespine sticklebacks (Gasterosteus aculeatus). In this study, progeny from intergeneric crosses between pelvic-reduced threespine and ninespine (Pungitius pungitius) sticklebacks also showed severe pelvic reduction, implicating a similar genetic origin for this trait in both genera. Comparative sequencing studies in complete and pelvic-reduced Pungitius revealed no differences in the Pitx1 coding sequences, but Pitx1 expression was absent from the prospective pelvic region of larvae from pelvic-reduced parents. A much more phylogenetically distant example of pelvic reduction, loss of hindlimbs in manatees, shows a similar left–right size bias that is a morphological signature of Pitx1-mediated pelvic reduction in both sticklebacks and mice. These multiple lines of evidence suggest that changes in Pitx1 may represent a key mechanism of morphological evolution in multiple populations, species, and genera of sticklebacks, as well as in distantly related vertebrate lineages.

Shapiro, Michael D.; Bell, Michael A.; Kingsley, David M.



Fibularis tertius: revisiting the anatomy.  


Fibularis tertius (FT) may be used during reconstructive surgery and muscle transposition with retention of function. The muscle was examined in both lower limbs of 41 cadavers. Measurements were made of muscle belly length and width, tendon length and width, and the size of the origin on the fibula. Tendon insertion, nerve and blood supplies were also examined. FT was absent in five (6.1%) lower limbs of three (7.3%) subjects. The size of its origin demonstrated inter- and intra-individual variation. FT arose from the distal fibula and on average occupied (28.4 +/- 9.1)% (mean +/- S. D.) of the total shaft length. In all cases the tendon inserted into the dorsal surface of the shafts of both the fourth and fifth metatarsals. A small nerve branch consistently arose from the deep fibular nerve near the origin of extensor digitorum longus. The nerve ran parallel to the length of this muscle, between it and extensor hallucis longus, before piercing FT. Anatomy textbooks describe FT as inserting into the fifth metatarsal only. This study, supported by data from previous reports, suggests that the "textbook" accounts of FT should be updated to record that most commonly its tendon reaches both the fourth and fifth metatarsals. PMID:17584875

Rourke, K; Dafydd, H; Parkin, I G



Anatomy of the avian cecum.  


The gross anatomy of the avian ceca is reviewed. In most birds, right and left ceca arise laterally or ventrolaterally at the junction of the small and large intestines. In a few species, the ceca open into the rectum ventrally or dorsally. In many herons and bitterns, only one cecum is present, and in the secretary bird there are two pairs of ceca. Ceca are absent in woodpeckers, hummingbirds, swifts, kingfishers, pigeons, mousebirds, cuckoos, and parrots. Ceca may be classified according to length into long, moderately or poorly developed, and vestigial types. In most birds, the ceca are simple tubular structures with minor variations in shape. However, in a few species, including the ostrich, rheas, kiwis, some tinamous, the red-throated loon, screamers, the satyr tragopan, the great bustard, and the pin-tailed sandgrouse, the ceca are sacculated or have diverticula. There is usually no correlation between the development of the ceca and systematic position. Except in grouse (Tetraonidae), in which the long ceca are related to the fibre content of the diet, the correlation between cecal development and diet is extremely limited. There is no relationship between the size of the ceca and the length and width of the rectum. PMID:2575123

McLelland, J



Functional specialization and ontogenetic scaling of limb anatomy in Alligator mississippiensis.  


Crocodylians exhibit a fascinating diversity of terrestrial gaits and limb motions that remain poorly described and are of great importance to understanding their natural history and evolution. Their musculoskeletal anatomy is pivotal to this diversity and yet only qualitative studies of muscle-tendon unit anatomy exist. The relative masses and internal architecture (fascicle lengths and physiological cross-sectional areas) of muscles of the pectoral and pelvic limbs of American alligators (Alligator mississippiensis Daudin 1801) were recorded for an ontogenetic series of wild specimens (n = 15, body masses from 0.5 to 60 kg). The data were analysed by reduced major axis regression to determine scaling relationships with body mass. Physiological cross-sectional areas and therefore muscle force-generating capacity were found to be greater in the extensor (anti-gravity) muscles of the pelvic limb than in the pectoral limb, reflecting how crocodylians differ from mammals in having greater loading of the hindlimbs than the forelimbs. Muscle masses and architecture were generally found to scale isometrically with body mass, suggesting an ontogenetic decrease in terrestrial athleticism. This concurs with the findings of previous studies showing ontogenetic decreases in limb bone length and the general scaling principle of a decline of strength : weight ratios with increasing size in animals. Exceptions to isometric scaling found included positive allometry in fascicle length for extensor musculature of both limbs, suggesting an ontogenetic increase in working range interpreted as increasing postural variability - in particular the major hip extensors - the interpretation of which is complicated by previous described ontogenetic increase of moment arms for these muscles. PMID:20148991

Allen, Vivian; Elsey, Ruth M; Jones, Nicola; Wright, Jordon; Hutchinson, John R



Functional specialization and ontogenetic scaling of limb anatomy in Alligator mississippiensis  

PubMed Central

Crocodylians exhibit a fascinating diversity of terrestrial gaits and limb motions that remain poorly described and are of great importance to understanding their natural history and evolution. Their musculoskeletal anatomy is pivotal to this diversity and yet only qualitative studies of muscle-tendon unit anatomy exist. The relative masses and internal architecture (fascicle lengths and physiological cross-sectional areas) of muscles of the pectoral and pelvic limbs of American alligators (Alligator mississippiensis Daudin 1801) were recorded for an ontogenetic series of wild specimens (n = 15, body masses from 0.5 to 60 kg). The data were analysed by reduced major axis regression to determine scaling relationships with body mass. Physiological cross-sectional areas and therefore muscle force-generating capacity were found to be greater in the extensor (anti-gravity) muscles of the pelvic limb than in the pectoral limb, reflecting how crocodylians differ from mammals in having greater loading of the hindlimbs than the forelimbs. Muscle masses and architecture were generally found to scale isometrically with body mass, suggesting an ontogenetic decrease in terrestrial athleticism. This concurs with the findings of previous studies showing ontogenetic decreases in limb bone length and the general scaling principle of a decline of strength : weight ratios with increasing size in animals. Exceptions to isometric scaling found included positive allometry in fascicle length for extensor musculature of both limbs, suggesting an ontogenetic increase in working range interpreted as increasing postural variability – in particular the major hip extensors – the interpretation of which is complicated by previous described ontogenetic increase of moment arms for these muscles.

Allen, Vivian; Elsey, Ruth M; Jones, Nicola; Wright, Jordon; Hutchinson, John R



Laparoscopic surgery for renal cell carcinoma.  


New minimally invasive technologies are currently being applied to the management of renal cell carcinoma in an effort to decrease operative time, pain, morbidity and hospital stay. Foremost among these is the burgeoning role of laparoscopy in tumor destruction and complete in vivo resection. The primary modalities in clinical use today are laparoscopic radical nephrectomy, laparoscopic partial nephrectomy, laparoscopic renal cryoablation and laparoscopic radiofrequency ablation. Most initial reports include only highly selected patients with unifocal, small, exophytic, peripheral lesions away from the collecting system. As experience with these techniques increases, larger and more difficult lesions are being approached laparoscopically, with promising anecdotal results reported. Laparoscopic access to the kidney may be retroperitoneal or transperitoneal. Complete tumor destruction with maximal preservation of unaffected nephrons remains the goal. Herein, an update on laparoscopic surgery for renal cell carcinoma is presented. For each procedure, the current indications and contraindications, perioperative data, complications and oncological outcomes are described. In the future, it appears likely that laparoscopy will play a major role in the established treatment options for renal cell carcinoma, with open surgery being reserved for specific indications. PMID:14686705

Hasan, Waleed A; Abreu, Sidney C; Gill, Inderbir S



[Comparison of laparoscopic and open splenectomy].  


Introduction: Conventional operative techniques are gradually being replaced by minimally invasive surgical methods in the surgery of the spleen. We summarized our 10-year-experience after the introduction of laparoscopic splenectomy at the University of Szeged, Department of Surgery, comparing open and minimally invasive techniques. Material and method: Between 1st January 2002 and 1st December 2011 we performed 141 splenectomies of which 17 were acute operations. Of the 124 elective procedures 54 were laparoscopic and 70 open operations. In 40 cases (open procedures) splenectomy was part of multivisceral surgery which were excluded from the analysis. In this retrospective analysis a comparison of laparoscopic and open elective technique was carried out. Results: Average operating time of laparoscopic procedures was slightly longer than that of open technique (133 vs. 122 minutes, p = 0.074). After the learning period, duration of laparoscopic procedures became shorter (first five years: 147 min., second five years: 118 min, p = 0.003), larger spleens were removed (220 vs. 450 grams, p = 0.063) and conversion rate became lower. In cases of laparoscopic procedures fewer reoperations needed to be performed (1.5% vs. 6%, p = 0.718), bowel motility recovered earlier (2 vs. 3 days, p = 0.002) and hospital stay was shorter (5 vs. 8 days, p ? 0.001). Conclusion: Our study proves that laparoscopic splenectomy is a safe method with many advantages. Our results correlate with data of international publications. PMID:23428723

Nyilas, Aron; Paszt, Attila; Simonka, Zsolt; Abrahám, Szabolcs; Pál, Tamás; Lázár, György



Robot-assisted laparoscopic pyeloplasty: outcomes reported by a centre with no previous laparoscopic experience  

Microsoft Academic Search

Laparoscopic pyeloplasty (LP) has proved to be an effective minimally invasive treatment for ureteropelvic junction obstruction\\u000a (UPJO). However, its application is still limited by the challenge of the laparoscopic learning curve, which seems to be overcome\\u000a by the recent introduction of robot assistance. The aim of this manuscript is to show our outcomes after the first robot-assisted\\u000a laparoscopic pyeloplasties (RP)

Claudio Giberti; Fabrizio Gallo; Maurizio Schenone; Pierluigi Cortese



Laparoscopic resection of abdominal paragangliomas.  


Paragangliomas are rare catecholamine-secreting tumors arising from chromaffin tissue of the autonomic nervous system. Although they can arise anywhere along the paravertebral axis, the majority is intra-abdominal in location. Frequently, these tumors are closely associated with major vascular structures, necessitating open techniques for resection. As laparoscopic techniques have advanced, minimally invasive approaches to these complex tumors have been attempted. This study presents 3 patients with abdominal paragangliomas, highlighting the use of high-quality preoperative imaging and intraoperative surgeon-performed ultrasound in allowing safe minimally invasive resection of these tumors. PMID:21304376

Mitchell, Jamie; Siperstein, Allan; Milas, Mira; Berber, Eren



Pathology Case Study: Progressive Abdominal / Pelvic Pain  

NSDL National Science Digital Library

This is a case study presented by the University of Pittsburgh Department of Pathology in which a woman presented with progressively worsening abdominal/pelvic pain over a period of 6 weeks. She experienced minor intermittent pain. Visitors can view both gross and microscopic descriptions, including images, and have the opportunity to diagnose the patient. This is an excellent resource for students in the health sciences to familiarize themselves with using patient history and laboratory results to diagnose disease. It is also a helpful site for educators to introduce or test students of pathology.

Mcfadden, Kathryn



Incidental pelvic lesions in the oncology patient  

PubMed Central

Abstract The identification of an incidental (i.e. unexpected and asymptomatic) lesion can create a dilemma for the clinician and radiologist. The incidental abnormality may represent metastatic disease, a second primary malignancy or a benign lesion. The diagnosis and management of such incidental findings will depend in part on the clinical setting, the pathology and stage of underlying primary malignancy and the imaging features of the incidental abnormality. This article reviews the diagnosis and management of incidental pelvic lesions in the oncology patient.

Riddell, A.M.



[Pelvic arteriovenous malformation : a case report].  


A 70-year-old male presented with intermittent macroscopic hematuria. There was no history of previous trauma or pelvic operation. At first, we were unable to clarify the origin of the hematuria, but 3D computed tomography revealed an arteriovenous malformation (AVM) consisting of multiple feeding vessels arising from the bilateral, especially right, internal iliac artery. Treatment with transcatheter arterial embolization (TAE) with a combination of lipiodol and N-butyl-2-cyanoacrylate twice was effective. He needs to be followed up carefully for recurrence of AVM. PMID:23945325

Suzuki, Kotaro; Kusuda, Yuji; Yamada, Yuji; Nose, Ryuichiro; Matsui, Takashi; Sanda, Yuki; Mori, Takeki; Sugimoto, Koji



Pathogenesis of Chlamydia induced pelvic inflammatory disease  

PubMed Central

Further research is necessary to elucidate the pathogenesis of chlamydial PID. It is hoped that these endeavours will eventually lead to a vaccine to prevent not only chlamydia infection, but also chlamydia associated infertility, ectopic pregnancy, and chronic pelvic pain. In the meantime we need to develop strategies to prevent primary and secondary chlamydia infection and its sequelae. Recently, Scholes et. al demonstrated that a population based approach to identify and test women at high risk for cervical C trachomatis infection effectively reduced risk of PID. Hopefully, through the use of public health measures, we can see similar decreases of chlamydia associated genital tract disease worldwide. ???

Cohen, C. R.; Brunham, R. C.



Laparoscopic heminephrectomy of a horseshoe kidney.  


Minimally invasive surgery has revolutionized surgery for urologic disorders, and laparoscopic procedures have become widely available for several different ablative and reconstructive operations. Laparoscopic heminephrectomy in patients with horseshoe kidney can be a technically challenging procedure due to aberrant vessels, functional parenchyma in the isthmus, and abnormal location. We report the management of a case of symptomatic nonfunctioning left moiety of a horseshoe kidney with emphasis on its surgical technique combined with a review of the literature. Laparoscopic heminephrectomy is a feasible option in the surgical management of benign and malignant conditions of the horseshoe kidney and can be performed safely using a transperitoneal or a retroperitoneal approach. PMID:21985738

Khan, Atif; Myatt, Andrew; Palit, Victor; Biyani, Chandra Shekhar; Urol, D


Laparoscopic resection of giant mesenteric cyst.  


Benign cystic tumors are rare intra-abdominal lesions that may be retroperitoneal, mesenteric, or omental. Most of them cause nonspecific symptoms, but rarely, they cause serious complications such as volvulus, rupture, or bowel obstruction. The diagnosis of these tumors can be made by abdominal ultrasonography or CT. Their only treatment is surgical excision, which can be done by either laparotomy or laparoscopic surgery. In last decade, laparoscopic surgical approaches have replaced open procedures in many surgical abdominal diseases. In this paper, a patient with laparoscopically excised mesenteric cyst is presented along with a literature review. PMID:11132914

Polat, C; Ozaçmak, I D; Yücel, T; Ozmen, V



Fever and Diarrhea after Laparoscopic Bilioenteric Anastomosis  

PubMed Central

Bile duct injuries are well-known complications of laparoscopic and open cholecystectomies. Here, we report anastomosis of the common bile duct to the transverse colon that occurred as a complication of laparoscopic cholecystectomy. To the best of our knowledge, a similar case has not been reported in the literature so far. As in our patient, persistent diarrhea (in addition to fever and icterus) can be a warning sign of complication after these procedures. Surgeons who do advanced laparoscopic techniques must be familiar with this complication.

Fazeli, Mohammad S.; Kazemeini, Alireza; Safari, Saeed; Larti, Farnoosh



Laparoscopic Heminephrectomy of a Horseshoe Kidney  

PubMed Central

Minimally invasive surgery has revolutionized surgery for urologic disorders, and laparoscopic procedures have become widely available for several different ablative and reconstructive operations. Laparoscopic heminephrectomy in patients with horseshoe kidney can be a technically challenging procedure due to aberrant vessels, functional parenchyma in the isthmus, and abnormal location. We report the management of a case of symptomatic nonfunctioning left moiety of a horseshoe kidney with emphasis on its surgical technique combined with a review of the literature. Laparoscopic heminephrectomy is a feasible option in the surgical management of benign and malignant conditions of the horseshoe kidney and can be performed safely using a transperitoneal or a retroperitoneal approach.

Khan, Atif; Myatt, Andrew; Palit, Victor



Diagnostic Laparoscopy and Adhesiolysis: Does It Help with Complex Abdominal and Pelvic Pain Syndrome (CAPPS) in General Surgery?  

PubMed Central

Abdominal pains secondary to adhesions are a common complaint, but most surgeons do not perform surgery for this complaint unless the patient suffers from a bowel obstruction. The purpose of this evaluation was to determine if lysis of bowel adhesions has a role in the surgical management of adhesions for helping treat abdominal pain. The database of our patients with complex abdominal and pelvic pain syndrome (CAPPS) was reviewed to identify patients who underwent a laparoscopic lysis of adhesion without any organ removal and observe if they had a decrease in the amount of abdominal pain after this procedure. Thirty-one patients completed follow-up at 3, 6, 9, and 12 months. At 6, 9, and 12 months postoperation, there were statistically significant decreases in patients' analog pain scores. We concluded that laparoscopic lysis of adhesions can help decrease adhesion-related pain. The pain from adhesions may involve a more complex pathway toward pain resolution than a simple cutting of scar tissue, such as “phantom pain” following amputation, which takes time to resolve after this type of surgery.

McClain, Gregory D.; McCarus, Steven D.; Caceres, Aileen; Kim, John



Diagnostic laparoscopy and adhesiolysis: does it help with complex abdominal and pelvic pain syndrome (CAPPS) in general surgery?  


Abdominal pains secondary to adhesions are a common complaint, but most surgeons do not perform surgery for this complaint unless the patient suffers from a bowel obstruction. The purpose of this evaluation was to determine if lysis of bowel adhesions has a role in the surgical management of adhesions for helping treat abdominal pain. The database of our patients with complex abdominal and pelvic pain syndrome (CAPPS) was reviewed to identify patients who underwent a laparoscopic lysis of adhesion without any organ removal and observe if they had a decrease in the amount of abdominal pain after this procedure. Thirty-one patients completed follow-up at 3, 6, 9, and 12 months. At 6, 9, and 12 months postoperation, there were statistically significant decreases in patients' analog pain scores. We concluded that laparoscopic lysis of adhesions can help decrease adhesion-related pain. The pain from adhesions may involve a more complex pathway toward pain resolution than a simple cutting of scar tissue, such as "phantom pain" following amputation, which takes time to resolve after this type of surgery. PMID:21902933

McClain, Gregory D; Redan, Jay A; McCarus, Steven D; Caceres, Aileen; Kim, John


Laparoscopic assisted endorectal pull-through with posterior sagittal approach to the repair of postoperative rectourethral and rectovaginal fistula.  


Rectourethral or rectovaginal fistula is a troublesome complication after anorectal surgery. The pelvic and perineal dissection may be difficult because of severe fibrosis adhesion around the fistula. The authors applied a novel technique: a combined laparoscopic assisted abdominal and posterior sagittal approach (PSA) to perform the redo surgery. Three boys and two girls (3-13 years old): case 1 had rectovaginal fistula after rectal dialation and modified Swenson's procedure; case 2 had rectovestibular fistula after twice perineal anorectoplasty; case 3 had rectourethral fistula after twice anorectoplasty; case 4 was imperforate anus with Hirschsprung's disease and rectourethral fistula that had been misdiagnosed; case 5 had rectourethral fistula after abdominoperineoanoplasty and Mollard procedure and posterior sagittal anorectoplasty. Laparoscopic assisted abdominal dissection was done first to mobilize the colon as far as the mid pelvis, and the normal colon was marked with a suture. The lower pelvic dissection was performed through the posterior sagittal route, the proximal rectum was mobilized and servered, the distal rectum was left undisected, endorectal mucosectomy with electric ablation was performed, then the fistula was closed from inside the rectum, and the stump of the colon was pulled through the rectum, the stump and the dentate line were anastomosed extraanally. Colostomy was done in case 2 and case 5. The postoperative follow-up showed no recurrent fistula, and all patients had attained normal voluntary bowel actions, but one child had infrequent minor soiling. Laparoscopic assisted endorectal pull-through of the intact colon can offer precise dissection, minimal abdominal injure, and spare troublesome mobilization of the fistula, and can prevent the recurrent of fistula. Posterior sagittal approach provides a direct repair of the fistula and anastomosis. PMID:17705045

Tang, Shaotao; Dong, Ning; Tong, Qiangsong; Wang, Yong; Mao, Yongzhong



Pelvic inflammatory disease (PID) from Chlamydia trachomatis versus PID from Neisseria gonorrhea: from clinical suspicion to therapy.  


Pelvic inflammatory disease (PID) is the most significant complication of sexually transmitted infections in childbearing-age women and it represents an important public health problem because of its long-term sequelae (chronic pelvic pain, tubal infertility, ectopic pregnancy). Prior to the mid 1970s PID was considered a monoetiologic infection, due primarily to Neisseria gonorrhea. Now it is well documented as a polymicrobial process, with a great number of microrganisms involved. In addition to Neisseria gonorrhea and Chlamydia trachomatis, other vaginal microrganisms (anaerobes, Gardnerella vaginalis, Haemophilus influenzae, enteric Gram negative rods, Streptococco agalactie, Mycoplasma genitalium) also have been associated with PID. There is a wide variation in PID clinical features; the type and severity of symptoms vary by microbiologic etiology. Women who have chlamydial PID seem more likely than women who have gonococcal PID to be asymptomatic. Since clinical diagnosis is imprecise, the suspicion of PID should be confirmed by genital assessment for signs of inflammation or infection, blood test and imaging evaluation. Laparoscopic approach is considered the gold standard. According to the polymicrobial etiology of PID, antibiotic treatment must provide broad spectrum coverage of likely pathogens. Early administration of antibiotics is necessary to reduce the risk of long-term sequelae. PMID:23007248

De Seta, F; Banco, R; Turrisi, A; Airoud, M; De Leo, R; Stabile, G; Ceccarello, M; Restaino, S; De Santo, D



Laparoscopy: Learning a New Surgical Anatomy?  

ERIC Educational Resources Information Center

|Operative laparoscopy has progressed rapidly in recent years, and this alternative to the conventional approach for abdominal surgery has allowed the description of new planes, spaces, and anatomic references as a result of the artificial rupture of the "anatomical continuum". Magnified laparoscopic views and the ability to deeply explore…

Jimenez, Angel Martin; Aguilar, Jose-Francisco Noguera



Pathologic Malgaigne fracture following pelvic irradiation. A case report  

SciTech Connect

A 48-year-old woman developed symptomatic superior and inferior pubic rami fractures with a concomitant subluxation of the ipsilateral sacroiliac joint three years after pelvic irradiation for a gynecologic malignancy. Pathologic pelvic fractures (PPF) caused by irradiation may be difficult to distinguish from those caused by metastatic disease. PPF produce prolonged disability.

Jones, A.R.; Lachiewicz, P.F.



Diagnosing interstitial cystitis in women with chronic pelvic pain  

Microsoft Academic Search

Objective: To determine the prevalence of interstitial cystitis (IC) and to evaluate the Interstitial Cystitis Symptom and Problem Index as a screening tool for IC in women with chronic pelvic pain.Methods: Forty-five women scheduled to undergo laparoscopy for chronic pelvic pain were recruited. The women were questioned about lower urinary tract symptoms; the Interstitial Cystitis Symptom and Problem Index was

Jeffrey Clemons; Lily A. Arya; Deborah L. Myers



Childbirth and the pelvic floor: “the gynaecological consequences”  

Microsoft Academic Search

This review addresses the effects of childbirth on the pelvic floor, urinary continence mechanisms and the perineum. Genitourinary prolapse affects 15% of women and stress incontinence 20–30%. The major risk factors are age and childbirth, with severity increasing with parity. There are three mechanisms of support for the pelvic organs and bladder neck. These are (i) the muscular component: levator

Christian Phillips; Ash Monga



Curative Surgery for Local Pelvic Recurrence of Rectal Cancer  

Microsoft Academic Search

Background\\/Aims: Local pelvic recurrence of rectal cancer after radical resection has been associated with morbidity and cancer-related death. This study retrospectively evaluated outcome following curative resection for rectal cancer recurring after surgery on the basis of prognosis, type of procedure and perioperative morbidity. Methods: A total of 85 consecutive patients with local pelvic recurrence of rectal cancer were evaluated. Of

Norio Saito; Keiji Koda; Nobuhiro Takiguchi; Kenji Oda; Masato Ono; Masanori Sugito; Kiyotaka Kawashima; Masaaki Ito



Ischiorectal fossa abscess after pelvic floor injection of botulinum toxin.  


Botulinum toxin is used to treat pelvic floor tension myalgia; however, its safety profile is poorly understood. We report an ischiorectal fossa abscess after pelvic floor injections of botulinum toxin. Physicians need to be aware of this possible complication, consider alternate injection techniques and antiseptic preparation before injection. PMID:22381609

Brueseke, Taylor J; Lane, Felicia L



Polysomnographic characteristics of sleep disorders in chronic pelvic pain  

Microsoft Academic Search

Objective: We performed a pilot study to determine if patients with chronic pelvic pain have a consistent or unique sleep disorder by a polysomnographic sleep study.Methods: Overnight polysomnography was performed prospectively in 11 women with chronic pelvic pain (ages 33–44 years, mean 35). None of the women were taking sedating or psychoactive medications in the month prior to testing. Sleep

Kathleen T. Dunlap; Li Yu; Bruce J. Fisch; Thomas E. Nolan



Laparoscopic Management of Gallstone Ileus  

PubMed Central

Gallstone ileus is an uncommon entity that was first described by Bartholin in 1654. Despite advances in peri-operative care, morbidity and mortality remain high in patients with gallstone ileus because: 1) they are geriatric patients; 2) they often have multiple comorbidities; 3) presentation to the hospital is delayed; 4) many are volume depleted with electrolyte abnormalities; and 5) the diagnosis of gallstone ileus is difficult to make. Traditional management has entailed open laparotomy with relief of intestinal obstruction by enterotomy and stone extraction. Cholecystectomy and takedown of the cholecystoenteric fistula can be performed. We propose an alternative method of management in an attempt to limit operative trauma and improve morbidity and mortality. We review the literature and describe two patients with gallstone ileus who were managed laparoscopically. One patient underwent laparoscopic assisted enterolithotomy, and the other patient underwent diagnostic laparoscopy with disimpaction of the gallstone into the large bowel. They were discharged after their ileus had resolved on the fourth and sixth postoperative day, respectively. Laparoscopy is a powerful diagnostic and therapeutic tool that can be effectively used to treat gallstone ileus.

Evan, Stephen J.; Kavic, Michael S.



Uterine vein rupture at delivery as a delayed consequence of laparoscopic surgery for endometriosis: a case report.  


Laparoscopic resection of deep infiltrating endometriosis (DIE) has been reported to be an effective method for reduction of endometriosis-associated pain. As its complications, bowel perforation, urinary tract injury and neurogenic bladder are well known; however, uterine vein rupture during pregnancy has not been reported previously. We encountered a case of hemoperitoneum resulting from uterine vein rupture at a delivery as a delayed consequence of laparoscopic resection of DIE. A 31-year-old, para 2 woman underwent laparoscopic resection of lateral pelvic peritoneum, uterosacral ligaments, and bilateral endometriomas, exposing uterine vessels, which we covered with fibrin glue. Endometriosis-associated pain disappeared, and then the patient conceived 4 months later. The course of pregnancy and induction of labor with controlled oxytocin infusion was uneventful, and the patient delivered a female baby without asphyxia. Immediately after delivery, low abdominal pain with hypotension occurred despite absence of abnormal vaginal bleeding. Ultrasonography and the blood hemoglobin value suggested hemorrhagic shock owing to hemoperitoneum; therefore emergency exploratory laparotomy was performed. Active bleeding was found at the right uterine vein, which was then sutured for hemostasis. The patient received a blood transfusion and recovered without any problems. The bleeding lesion was located at the vein on which the peritoneum had been removed at the first laparoscopy, which suggested that the operation for DIE included a risk of uterine vessel rupture during pregnancy. PMID:19573834

Wada, Shinichiro; Yoshiyuki, Fukushi; Fujino, Takafumi; Sato, Chikara


Sarcomatoid carcinoma in the pelvic cavity.  


Sarcomatoid carcinoma in the pelvic cavity is very rare. A 58-year-old Japanese man was admitted to our hospital because of lower abdominal fullness. CT and MRI revealed a large mass in the left pelvic cavity. Transurethral bladder endoscopy showed tumor invasion, and large biopsies were obtained from the bladder lesion. Histologically, the tumor was composed of malignant round cells with hyperchromatic nuclei. Many intracytoplasmic vacuoles were present. No carcinomatous areas were seen. Immunohistochemically, the tumor cells were positive for cytokeratin (CK) 18, vimentin, p53 and Ki-67 (labeling 80%). The tumor cells were negative for panCK AE1/3, CD5/6, CK7, CK8, CK14, CK19, CK20, CK 34BE12, EMA, desmin, calretinin, WT-1, S100 protein, ?-smooth muscle actin, CEA, CD34, CD45, CD20, factor VIII-related antigen, synaptophysin, p63, CDX2, and myoglobin. Because the CK18 was diffusely expressed, the pathological diagnosis was sarcomatoid carcinoma. PMID:23573329

Terada, Tadashi



Sarcomatoid carcinoma in the pelvic cavity  

PubMed Central

Sarcomatoid carcinoma in the pelvic cavity is very rare. A 58-year-old Japanese man was admitted to our hospital because of lower abdominal fullness. CT and MRI revealed a large mass in the left pelvic cavity. Transurethral bladder endoscopy showed tumor invasion, and large biopsies were obtained from the bladder lesion. Histologically, the tumor was composed of malignant round cells with hyperchromatic nuclei. Many intracytoplasmic vacuoles were present. No carcinomatous areas were seen. Immunohistochemically, the tumor cells were positive for cytokeratin (CK) 18, vimentin, p53 and Ki-67 (labeling 80%). The tumor cells were negative for panCK AE1/3, CD5/6, CK7, CK8, CK14, CK19, CK20, CK 34BE12, EMA, desmin, calretinin, WT-1, S100 protein, ?-smooth muscle actin, CEA, CD34, CD45, CD20, factor VIII-related antigen, synaptophysin, p63, CDX2, and myoglobin. Because the CK18 was diffusely expressed, the pathological diagnosis was sarcomatoid carcinoma.

Terada, Tadashi



Small bowel obstruction in percutaneous fixation of traumatic pelvic fractures  

PubMed Central

The use of external fixation for the initial treatment of unstable, complex pelvic injuries with hemodynamic instability remains an effective treatment for multiply injured patients. Bowel entrapment within a pelvic fracture is a rarely reported, potentially fatal complication. Here, we report a polytrauma patient with pelvic fractures who developed an intestinal obstruction after an external fixation. At an explorative laparotomy, we found an ileum segment trapped in the sacral fracture. Reported cases of bowel entrapment in pelvic fractures, especially in sacral fractures, are exceedingly rare. The diagnosis is often delayed due to difficulty distinguishing entrapment from the more common adynamic ileus. In conclusion, clinicians and radiologists should be aware of this potentially lethal complication of pelvic fractures treatment. To exclude bowel entrapment, patients with persistent ileus or sepsis should undergo early investigations.

Bini, Roberto; Quiriconi, Fabrizio; Viora, Tiziana; Leli, Renzo



Archosaurian respiration and the pelvic girdle aspiration breathing of crocodyliforms.  

PubMed Central

Birds and crocodylians, the only living archosaurs, are generally believed to employ pelvic girdle movements as a component of their respiratory mechanism. This in turn provides a phylogenetic basis for inferring that extinct archosaurs, including dinosaurs, also used pelvic girdle breathing. I examined lung ventilation through cineradiography (high-speed X-ray filming) and observed that alligators indeed rotate the pubis to increase tidal volume, but did not observe pelvic girdle movement contributing to lung ventilation in guinea fowl, emus or tinamous, despite extensive soft-tissue motion. Re-examination of fossil archosaurs reveals that pubic rotation evolved in basal crocodyliforms and that pelvic girdle breathing is not a general archosaurian mechanism. The appearance of pelvic aspiration in crocodyliforms is a striking example of the ability of amniotes to increase gas exchange or circumvent constraints on respiration through the evolution of novel accessory breathing mechanisms.

Claessens, Leon P A M



Can pelvic floor injury secondary to delivery be prevented?  


The number of women suffering from pelvic floor disorders (PFD) is likely to grow significantly in the coming years with a growing older population. There is an urgent need to investigate factors contributing to the development of PFD and develop preventative strategies. We have reviewed the literature and analyzed results from our own study regarding the association between delivery mode, obstetrical practice and fetal measurements, and damage to the pelvic floor. Based on our findings, we have suggested a flowchart helping the obstetrician to conduct vaginal delivery with minimal pelvic floor insult. Primiparity, instrumental delivery, large fetal head circumference, and prolonged second stage of delivery are risk factors for PFD. Pelvic floor integrity should always be seriously considered in every primiparous woman. All efforts should be aimed at minimizing any insult, which might have a significant impact on the woman's pelvic integrity and future quality of life. PMID:21822710

Lavy, Yuval; Sand, Peter K; Kaniel, Chava I; Hochner-Celnikier, Drorith



A tactile sensor for laparoscopic cholecystectomy.  


During laparoscopic surgery, surgeons observe the three-dimensional abdominal cavity on a two-dimensional TV monitor, which is a limitation. Another limitation is that surgeons are unable to estimate the softness of organs or tissues during laparoscopic surgery as they are only allowed to use instruments which touch objects and direct palpation is not permitted during the procedure. The tactile sensor which we used displays the object softness immediately as a digital score, which can then be superimposed on a TV monitor as a graph. With the tactile sensor, we were able to ascertain the presence of a gallstone in the gallbladder or cholecystic duct during laparoscopic cholecystectomy and also able to discriminate between a stone and an air bubble during intraoperative cholangiography. We were convinced that the tactile sensor would be useful in laparoscopic surgery, which does not permit surgeons to palpate objects with human fingers. PMID:9294278

Matsumoto, S; Ooshima, R; Kobayashi, K; Kawabe, N; Shiraishi, T; Mizuno, Y; Suzuki, H; Umemoto, S



Laparoscopic Marsupialization of Symptomatic Polycystic Kidney Disease  

Microsoft Academic Search

PurposeAlthough laparoscopic unroofing of simple renal cysts has proved to be an effective form of therapy, its use for treatment of multiple renal cysts or symptomatic autosomal dominant polycystic kidney disease only recently has been investigated.

James A. Brown; Vicente E. Torres; Bernard F. King; Joseph W. Segura



Should all distal pancreatectomies be performed laparoscopically?  


Despite the relatively slow start of laparoscopic pancreatectomy relative to other laparoscopic resections, an increasing number of these procedures are being performed around the world. Operations that were once considered impossible to perform laparoscopically, such as pancreaticoduodenectomy and central pancreatectomy are gaining momentum. Technology continues to improve, as does surgical experience and prowess. There are both enough experience and data (though retrospective) to confirm that LDP with or without spleen preservation appears to be a safe treatment for benign or noninvasive lesions of the pancreas. Based on the fact that LDP can be performed with similar or shorter operative times, blood loss, complication rates, and length of hospital stay than ODP, it can be recommended as the treatment of choice for benign and noninvasive lesions in experienced hands when clinically indicated. It is very difficult to make clear recommendations with regard to laparoscopic resection of malignant pancreatic tumors due to the lack of conclusive data. As long as margins are negative and lymph node clearance is within accepted standards, LDP appears to have no untoward oncologic effects on outcome. Certainly more data, preferably in the manner of a randomized clinical trial, are needed before additional recommendations can be made. Potential benefits of laparoscopic resection for cancer include the ability to inspect the abdomen and abort the procedure with minimal damage if occult metastases are identified. This does not delay the onset of palliative chemotherapy, which would be the primary treatment in that circumstance. In fact, there is evidence to suggest that there is a greater likelihood of receiving systemic therapy if a laparotomy is avoided in patients who have radiologically occult metastases. Patients may also undergo palliative laparoscopic gastric and biliary bypass if indicated. Faster wound healing may also translate into a shorter waiting time before initiating adjuvant chemotherapy and/or radiation therapy. If the patient develops a wound infection, the infection should be more readily manageable with smaller incisions. Although not proven clinically relevant in humans, the reduction in perioperative stress associated with laparoscopic resection may translate to a cancer benefit for some patients. One report compared markers of systemic inflammatory response in 15 subjects undergoing left pancreatectomy. Eight had hand-access laparoscopic procedures and the rest had standard open surgery. The subjects in the laparoscopic group had statistically lower C-reactive protein levels than the open group on postoperative days one (5.5 mg/dL versus 9.7 mg/dL, P = .006) and three (8.5 mg/dL versus 17.7 mg/dL, P = .003), suggesting that the laparoscopic approach to left pancreatectomy is associated with less inflammation. While this report is underpowered, it supports the notion that MIS cancer surgery may induce less of a systemic insult to the body than standard open cancer surgery. More work in this area is necessary before any firm conclusions can be drawn. An important issue to consider is that of training surgeons to perform these complex procedures laparoscopically. Not all pancreatectomies are amenable to the laparoscopic approach, even in the most skilled hands. As such, only a percentage of cases will be performed this way and expectations to educate surgeons adequately to perform advanced laparoscopic procedures can be unrealistic, resulting in more "on-the-job" training. Another aspect that draws some controversy is that of the totally laparoscopic procedure versus the hand-access approach. No laparoscopic instrument provides the tactile feedback possible to obtain with the hand. The HALS approach allows for this, and the opportunity to control bleeding during the procedure. HALS also provides a way to improve confidence during the learning-curve phase of these operations. Finally, it is important to remember that if the procedure is failing to progress laparoscopically, or if cancer surgery princ

Merchant, Nipun B; Parikh, Alexander A; Kooby, David A



Laparoscopic mitrofanoff appendicovesicostomy: Our experience in children  

PubMed Central

Introduction: The Mitrofanoff principle was originally described as a method to provide an alternative means to access the bladder. It creates a conduit to the bladder through which patients with a sensitive, absent, or traumatized urethra can perform clean intermittent catheterization (CIC) easily. We report our experience with complete laparoscopic Mitrofanoff appendicovesicostomy to promote a catheterizable abdominal stoma. Materials and Methods: A 4-port transperitoneal approach was used to create a complete laparoscopic Mitrofanoff appendicovesicostomy. Results: Six children with a mean age of 12.8 years (range 9-16 years) underwent laparoscopic Mitrofanoff appendicovesicostomy. Mean operative time was 139.6 min and Mean estimated blood loss was 46 cc. No cases of urinary leaks were noted. There have been no cases of either stomal stenosis or appendicovesical stenosis noted. Conclusions: Pure laparoscopic Mitrofanoff appendicovesicostomy is feasible and is associated with reasonable outcome with early recovery, resumption of normal activities and excellent cosmesis.

Nerli, Rajendra B.; Reddy, Mallikarjun; Devraju, Shishir; Prabha, Vikram; Hiremath, Murigendra B.; Jali, Sujata



[Laparoscopic nephron sparing surgery. Initial experience].  


We present our initial experience in laparoscopic nephron sparing surgery. It's a technically advanced procedure requiring considerable minimally invasive expertise. This technique is particularly attractive compared to an open conventional procedure with its larger incision and associated morbidity. PMID:17711165

Aguilera Bazán, A; Alonso y Gregorio, S; Pérez Utrilla, M; Cansino Alcalde, J R; Cisneros Ledo, J; De la Peña Barthel, J



Single-incision bilateral laparoscopic oophorectomy  

PubMed Central

Although single-incision laparoscopic surgery made an appearance on the surgical scene only recently, it is being increasingly applied in the treatment of a variety of disorders. We report single-incision bilateral laparoscopic oophorectomy and salpingooophorectomy performed in two patients who had previously undergone breast conservation surgery for early breast cancer. Each procedure was undertaken using two 5-mm and one 3-mm ports inserted through a 2-cm transverse supraumbilical incision and standard laparoscopic instruments. The operative time was 50 and 65 min respectively and the blood loss negligible. The patients were discharged 36 and 24 h after surgery, required minimal postoperative analgesia and remain well at a follow up of 19 and 17 months, respectively. With the benefit of improved cosmesis, the single-incision approach holds the potential to replace the traditional bilateral laparoscopic oophorectomy.

Bhandarkar, Deepraj; Katara, Avinash; Deshmane, Vinay; Mittal, Gaurav; Udwadia, Tehemton E



Factors predisposing women to chronic pelvic pain: systematic review  

PubMed Central

Objective To evaluate factors predisposing women to chronic and recurrent pelvic pain. Design, data sources, and methods Systematic review of relevant studies without language restrictions identified through Medline, Embase, PsycINFO, Cochrane Library. SCISEARCH, conference papers, and bibliographies of retrieved primary and review articles. Two reviewers independently extracted data on study characteristics, quality, and results. Exposure to risk factors was compared between women with and without pelvic pain. Results were pooled within subgroups defined by type of pain and risk factors. Results There were 122 studies (in 111 articles) of which 63 (in 64 286 women) evaluated 54 risk factors for dysmenorrhoea, 19 (in 18 601 women) evaluated 14 risk factors for dyspareunia, and 40 (in 12 040 women) evaluated 48 factors for non-cyclical pelvic pain. Age < 30 years, low body mass index, smoking, earlier menarche (< 12 years), longer cycles, heavy menstrual flow, nulliparity, premenstrual syndrome, sterilisation, clinically suspected pelvic inflammatory disease, sexual abuse, and psychological symptoms were associated with dysmenorrhoea. Younger age at first childbirth, exercise, and oral contraceptives were negatively associated with dysmenorrhoea. Menopause, pelvic inflammatory disease, sexual abuse, anxiety, and depression were associated with dyspareunia. Drug or alcohol abuse, miscarriage, heavy menstrual flow, pelvic inflammatory disease, previous caesarean section, pelvic pathology, abuse, and psychological comorbidity were associated with an increased risk of non-cyclical pelvic pain. Conclusion Several gynaecological and psychosocial factors are strongly associated with chronic pelvic pain. Randomised controlled trials of interventions targeting these potentially modifiable factors are needed to assess their clinical relevance in chronic pelvic pain.

Latthe, Pallavi; Mignini, Luciano; Gray, Richard; Hills, Robert; Khan, Khalid



A comparison of the pelvic angle applied using lateral table tilt or a pelvic wedge at elective caesarean section.  


Lateral table tilt or a pelvic wedge are commonly used to reduce inferior vena cava compression during obstetric anaesthesia in the supine position. Direct measurement of pelvic angle allows individual assessment of the effectiveness of these manoeuvres in achieving a tilted position. We observed routine practice during caesarean section after random allocation to one or other of these methods. The anaesthetist managing the case was asked to position the women after induction of spinal anaesthesia using either left table tilt or a wedge under the right hip. We then measured pelvic angle in all women, and the table angle in women who had table tilt. The mean (SD [range]) pelvic angle was 20.2° (8.1° [9°-37°]) in 18 women with table tilt and 21.0° (7.5° [10°-36°]) in 17 women with a wedge. The mean (SD [range]) table angle was 12.4° (3.1° [8°-21°]) in the women with table tilt. There was a significant difference between table angle and pelvic angle in the women with table tilt (p?=?0.0003), but no significant difference in pelvic angle between the table tilt and wedge groups. Measurement of table angle does not represent pelvic position adequately in the majority of women. However, this study showed that lateral table tilt and a pelvic wedge were equally effective in producing tilt of the pelvis. PMID:23003211

Kinsella, S M; Harvey, N L



Greek anatomist herophilus: the father of anatomy.  


One of the most stirring controversies in the history of Anatomy is that Herophilus, an ancient Greek anatomist and his younger contemporary, Erasistratus, were accused of performing vivisections of living humans. However, this does not detract from the fact that Herophilus has made phenomenal anatomical observations of the human body which have contributed significantly towards the understanding of the brain, eye, liver, reproductive organs and nervous system. It is notable that he was the first person to perform systematic dissection of the human body and is widely acknowledged as the Father of Anatomy. He has been hailed as one of the greatest anatomists that ever lived, rivaled only by Andreas Vesalius who is regarded as the founder of modern human anatomy. PMID:21267401

Bay, Noel Si-Yang; Bay, Boon-Huat



Greek anatomist herophilus: the father of anatomy  

PubMed Central

One of the most stirring controversies in the history of Anatomy is that Herophilus, an ancient Greek anatomist and his younger contemporary, Erasistratus, were accused of performing vivisections of living humans. However, this does not detract from the fact that Herophilus has made phenomenal anatomical observations of the human body which have contributed significantly towards the understanding of the brain, eye, liver, reproductive organs and nervous system. It is notable that he was the first person to perform systematic dissection of the human body and is widely acknowledged as the Father of Anatomy. He has been hailed as one of the greatest anatomists that ever lived, rivaled only by Andreas Vesalius who is regarded as the founder of modern human anatomy.

Bay, Noel Si-Yang



Laparoscopic Retroperitoneal Lymph Node Dissection: Extraperitoneal Approach  

Microsoft Academic Search

We review our early experience with laparoscopic retroperitoneal lymph node dissection (RPLND) via extraperitoneal approach\\u000a to assess the precise pathological status of retroperitoneal lymph nodes in early-stage testicular cancer. A total of 32 patients\\u000a (23 with stage I, 4 with stage IIa, and 5 with stage IIb) with testicular cancer underwent extraperitoneal laparoscopic RPLND\\u000a in the supine position. After developing

Makoto Satoh; Akihiro Ito; Yoichi Arai


The learning curve for laparoscopic cholecystectomy  

Microsoft Academic Search

Background: The use of laparoscopic surgical procedures without previous training has grown rapidly. At the same time, there have been allegations of increased complications among less experienced surgeons.Methods: Using multivariate regression analyses, we evaluated the relationship between bile duct injury rate and experience with laparoscopic cholecystectomy for surgeons in the Southern Surgeons Club.Results: Fifty-five surgeons performed 8,839 procedures. Fifteen bile

Michael J Moore; Charles L Bennett



Complications of laparoscopic pyeloplasty in children  

Microsoft Academic Search

Introduction  Laparoscopic pyeloplasty in children has been proven to be safe and effective, with comparable results to open surgery. Due\\u000a to the extension of laparoscopic indications from ablative to reconstructive procedures requiring endoscopic suturing, most\\u000a centres have plateaued within their learning curve. Based on our own experience with a little more than 100 cases, we focus\\u000a on the complications and the

Rajendra B. Nerli; Mallikarjun Reddy; Vikram Prabha; Ashish Koura; Praveen Patne; M. K. Ganesh