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Sample records for laparoscopic pelvic anatomy

  1. Demonstration of Pelvic Anatomy by Modified Midline Transection that Maintains Intact Internal Pelvic Organs

    ERIC Educational Resources Information Center

    Steinke, Hanno; Saito, Toshiyuki; Herrmann, Gudrun; Miyaki, Takayoshi; Hammer, Niels; Sandrock, Mara; Itoh, Masahiro; Spanel-Borowski, Katharina

    2010-01-01

    Gross dissection for demonstrating anatomy of the human pelvis has traditionally involved one of two approaches, each with advantages and disadvantages. Classic hemisection in the median plane through the pelvic ring transects the visceral organs but maintains two symmetric pelvic halves. An alternative paramedial transection compromises one side…

  2. Laparoscopic surgery for rectal prolapse and pelvic floor disorders

    PubMed Central

    Rickert, Alexander; Kienle, Peter

    2015-01-01

    Pelvic floor disorders are different dysfunctions of gynaecological, urinary or anorectal organs, which can present as incontinence, outlet-obstruction and organ prolapse or as a combination of these symptoms. Pelvic floor disorders affect a substantial amount of people, predominantly women. Transabdominal procedures play a major role in the treatment of these disorders. With the development of new techniques established open procedures are now increasingly performed laparoscopically. Operation techniques consist of various rectopexies with suture, staples or meshes eventually combined with sigmoid resection. The different approaches need to be measured by their operative and functional outcome and their recurrence rates. Although these operations are performed frequently a comparison and evaluation of the different methods is difficult, as most of the used outcome measures in the available studies have not been standardised and data from randomised studies comparing these outcome measures directly are lacking. Therefore evidence based guidelines do not exist. Currently the laparoscopic approach with ventral mesh rectopexy or resection rectopexy is the two most commonly used techniques. Observational and retrospective studies show good functional results, a low rate of complications and a low recurrence rate. As high quality evidence is missing, an individualized approach is recommend for every patient considering age, individual health status and the underlying morphological and functional disorders. PMID:26380050

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

    PubMed

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

    2009-01-01

    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

  4. Laparoscopic Pyelolithotomy in a Pelvic Kidney: A Case Report and Review of the Literature

    PubMed Central

    Hoenig, David M.; Shalhav, Arieh L.; Elbahnasy, Abdelhamid M.; McDougall, Elspeth M.

    1997-01-01

    Background and Objectives: Laparoscopic pyelolithotomy was performed in a pelvic kidney with a large renal pelvis calculus. Methods and Results: Laparoscopic pyelolithotomy was successfully performed in a pelvic kidney with an operative time of 310 minutes. The use of intraoperative fluoroscopy and a semi-automatic suturing device greatly facilitated the procedure. The patient's operative pain was managed with 3 doses of ketorolac; she resumed a regular diet the day after surgery, and was discharged on the first postoperative day. Conclusions: For patients with a large stone in the renal pelvis of an ectopic kidney, laparoscopic pyelolithotomy provides an effective approach. PMID:9876666

  5. Successful Laparoscopic Management of Ruptured Tubal Pregnancy with an Ipsilateral Ectopic Pelvic Kidney

    PubMed Central

    Belotte, Jimmy; Belotte, Jim; Alexis, Mitchell; Awonuga, Awoniyi O.; Aguin, Tina Jessica

    2014-01-01

    Objective. To report a case of successful laparoscopic management of a left ruptured tubal pregnancy in the setting of an ipsilateral ectopic pelvic kidney. Method. Case report was prepared at Wayne State University/Detroit Medical Center. The patient is a young woman gravida 2 para 0 in her twenties who presented with severe abdominal pain and vaginal bleeding. She had a plateaued beta HCG and ultrasonographic findings suggestive of ectopic left tubal pregnancy along with an ectopic ipsilateral pelvic kidney. The IRB approval is not needed, as this is a case report. The informed consent could not be obtained, as the patient was not reachable. Result. Multiple intraperitoneal adhesions, left ruptured ampullary ectopic pregnancy and left retroperitoneal pelvic mass consistent with ipsilateral ectopic pelvic kidney. Conclusion. Laparoscopic management of tubal pregnancy can be safely performed in the setting of an ipsilateral ectopic pelvic kidney. PMID:25136465

  6. A Novel Technique of Uterine Manipulation in Laparoscopic Pelvic Oncosurgical Procedures: “The Uterine Hitch Technique”

    PubMed Central

    Puntambekar, S. P.; Patil, A. M.; Rayate, N. V.; Puntambekar, S. S.; Sathe, R. M.; Kulkarni, M. A.

    2010-01-01

    Aim. To describe a new technique of uterine manipulation in laparoscopic management of pelvic cancers. Material and Methods. We used a novel uterine hitch technique in 23 patients from May 2008 to October 2008. These patients underwent pelvic oncologic surgery including laparoscopic radical hysterectomy (n = 7), laparoscopic anterior resection (n = 4), laparoscopic abdominoperineal resection (n = 3), laparoscopic posterior exenteration (n = 4), or laparoscopic anterior exenteration (n = 5). The uterus was hitched to the anterior abdominal.wall by either a single suture in the fundus or by sutures through the round ligaments. Results. The uterine hitch technique was successfully accomplished in all procedures. It was performed in less than 5 minutes in all cases. It obviated the need for vaginal manipulation. An extra port for retraction could be avoided. There were no intraoperative complications. Conclusion. A practical, cheap and reproducible method for uterine manipulation, during pelvic oncologic surgery is described. It improves the stability of the uterus and also obviates the need for keeping an additional assistant for vaginal manipulation in any of the procedures. PMID:22091356

  7. Efficacy of Laparoscopic Sacrocervicopexy for Apical Support of Pelvic Organ Prolapse

    PubMed Central

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

    2013-01-01

    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. PMID:23925017

  8. Laparoscopic Reconstructive Surgery is Superior to Vaginal Reconstruction in the Pelvic Organ Prolapse

    PubMed Central

    Park, Young-Han; Yang, Seong Cheon; Park, Sung Taek; Park, Sung Ho; Kim, Hong Bae

    2014-01-01

    Background: Our purpose was to provide the clinical advantages of the laparoscopic approach compare to the vaginal approach in correcting uterine and vaginal vault prolapse. Methods: Between June 2007 and June 2011, 174 women were admitted to HUMC (Hallym University Medical Center) and underwent pelvic reconstructive surgery for prolapsed vaginal vault and uterus. Upon retrospective review of the medical records, 174 of the patients who had symptoms of pelvic organ prolapsed and Baden-Walker prolapse grade ? 2 were selected and divided into two groups as follows: vaginal approach group (n=120) and laparoscopic approach group (n=54). We compared the results of clinical outcome by analyzing Student's t-test and ?2-test or the Fisher exact test as appropriate. Results: There were significant difference in success rates without reoperation for recurrence as 91.7% (vaginal approach group, n=110) vs 100% (laparoscopic approach group, n=54), p=0.032. Mean follow-up duration was 31.3 ± 7.6 months for vaginal approach group and 29.7 ± 9.7 months for laparoscopic approach group. The Foley catheter indwelling duration (4.7± 1.9 vs 3.4±2.1 days, p< 0.001) and the length of postoperative hospitalization (6.4 ± 2.1 vs 5.0 ± 1.9 days, p <0.001) were significantly longer in vaginal approach group, whereas the operative time was significantly longer (108.2 ± 38.6 vs 168.3 ± 69.7 minutes, p <0.001) in laparoscopic approach group. Conclusions: Our result suggest there is significantly lower recurrence rate requiring reoperation and less catheterization time but increased operative time for laparascopic sacrocolpopexy. PMID:25170290

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

    PubMed Central

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

    2005-01-01

    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. PMID:15960766

  10. Novel hybrid laparoscopic sacrocolpopexy for pelvic organ prolapse with a severe paravaginal defect.

    PubMed

    Ichikawa, Masao; Akira, Shigeo; Mine, Katsuya; Ohuchi, Nozomi; Kurose, Keisuke; Takeshita, Toshiyuki

    2013-02-01

    Abdominal sacrocolpopexy is the gold standard for treating pelvic organ prolapse (POP) because of safety and durable good results. More recently laparoscopic sacrocolpopexy (LSC), a less invasive approach, has become popular. Although these surgeries are versatile and can treat almost all patients with POP, these techniques have shortcomings. Specifically, reinforcement of lateral vaginal defects are not very strong, thus patients with POP and a severe paravaginal defect are not good candidates for abdominal or laparoscopic sacrocolpopexy. To overcome this problem, we developed a novel type of LSC, which can reinforce severe paravaginal defects by using a reversed T-shaped anterior mesh combining the advantage of transvaginal mesh surgery. We refer to this novel surgery as 'hybrid LSC'. Thus far, eight patients have successfully undergone this surgery. Hybrid LSC is a simple and secure method, and is an alternative treatment for POP with a severe paravaginal defect. PMID:23002783

  11. Transarterial embolization for pelvic hematoma following laparoscopic radical prostatectomy: A case report and review of the literature

    PubMed Central

    HIROSHIGE, TASUKU; MATSUO, MITSUNORI; UEDA, KOSUKE; NAKIRI, MAKOTO; NISHIHARA, KIYOAKI; IGAWA, TSUKASA

    2015-01-01

    The present study reports a case of hemorrhage from branches of the right obturator artery following laparoscopic radical prostatectomy. On post-operative day 9, the patient complained of lower abdominal pain, and the hemoglobin and hematocrit levels had decreased. Emergency computed tomography angiography showed a large pelvic hematoma suggesting active bleeding. Transarterial embolization (TAE) was performed using microcoils. There were no post-procedure complications. At 3 months post-surgery, using computed tomography, the pelvic hematoma was shown to have been absorbed. To the best of our knowledge, TAE for a hemorrhage from the obturator artery following laparoscopic prostatectomy has not previously been described. TAE is a safe and minimally invasive treatment compared with surgical intervention, and should be considered as a treatment for post-operative arterial hemorrhage. PMID:26622770

  12. Techniques of Fluorescence Cholangiography During Laparoscopic Cholecystectomy for Better Delineation of the Bile Duct Anatomy

    PubMed Central

    Kono, Yoshiharu; Ishizawa, Takeaki; Tani, Keigo; Harada, Nobuhiro; Kaneko, Junichi; Saiura, Akio; Bandai, Yasutsugu; Kokudo, Norihiro

    2015-01-01

    Abstract To evaluate the clinical and technical factors affecting the ability of fluorescence cholangiography (FC) using indocyanine green (ICG) to delineate the bile duct anatomy during laparoscopic cholecystectomy (LC). Application of FC during LC began after laparoscopic fluorescence imaging systems became commercially available. In 108 patients undergoing LC, FC was performed by preoperative intravenous injection of ICG (2.5?mg) during dissection of Calot's triangle, and clinical factors affecting the ability of FC to delineate the extrahepatic bile ducts were evaluated. Equipment-related factors associated with bile duct detectability were also assessed among 5 laparoscopic systems and 1 open fluorescence imaging system in ex vivo studies. FC delineated the confluence between the cystic duct and common hepatic duct (CyD–CHD) before and after dissection of Calot's triangle in 80 patients (74%) and 99 patients (92%), respectively. The interval between ICG injection and FC before dissection of Calot's triangle was significantly longer in the 80 patients in whom the CyD–CHD confluence was detected by fluorescence imaging before dissection (median, 90?min; range, 15–165?min) than in the remaining 28 patients in whom the confluence was undetectable (median, 47?min; range, 21–205?min; P?laparoscopic imaging systems and tended to decrease more steeply than those of the open imaging system as the target-laparoscope distance increased and porcine tissues covering the samples became thicker. FC is a simple navigation tool for obtaining a biliary roadmap to reach the “critical view of safety” during LC. Key factors for better bile duct identification by FC are administration of ICG as far in advance as possible before surgery, sufficient extension of connective tissues around the bile ducts, and placement of the tip of laparoscope close and vertically to Calot's triangle. PMID:26107666

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

    SciTech Connect

    Schallenkamp, John M.; Herman, Michael G. . E-mail: herman.michael@mayo.edu; Kruse, Jon J.; Pisansky, Thomas M.

    2005-11-01

    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 imaging device. Daily pretherapy and through-treatment electronic portal images (EPIs) were obtained for each of four treatment fields. The patients' pelvic bony anatomy, intraprostatic gold markers, and a best visual match to the target (i.e., prostate) were identified on simulation digitally reconstructed radiographs and during daily treatment setup and delivery. These data provided quantitative inter- and intrafractional analysis of prostate motion, its position relative to the bony anatomy, and the individual intraprostatic fiducial markers. Treatment planning margins, with and without on-line localization, were subsequently compared. Results: A total of 22,266 data points were obtained from daily pretherapy and through-treatment EPIs. The pretherapy three-dimensional (3D) average displacement of the fiducial markers, as a surrogate for the prostate, was 5.6 mm, which improved to 2.8 mm after use of the localization protocol. The bony anatomy 3D average displacement was 4.4 mm both before and after localization to the prostate (p = 0.46). Along the superior-inferior (SI), anterior-posterior (AP), and right-left (RL) axes, the average prostate displacement improved from 2.5, 3.7, and 1.9 mm, respectively, before localization to 1.4, 1.6, and 1.1 mm after (all p < 0.001). The pretherapy to through-treatment position of the bony landmarks worsened from 1.7 to 2.5 mm (p < 0.001) in the SI axis, remained statistically unchanged at 2.8 mm (p = 0.39) in the AP axis, and improved from 2.0 to 1.2 mm in the RL axis (p < 0.001). There was no significant intrafractional displacement of prostate position or bony anatomic landmarks. An intermarker distance was identified for all fiducial markers, and 96 were followed daily. Seventy-nine percent had a standard deviation of <1 mm, and 96% were <1.5 mm. Margins were 5.1, 7.3, and 5.0 mm in the SI, AP, and RL axes, respectively, before localization and 2.7, 2.9, and 2.8 mm after localization. Conclusions: Significant interfractional motion exists for patients' prostate and pelvic bony anatomy. However, these move independently, so the pelvic bony anatomy should not be used as a surrogate for prostate motion. Fiducial markers are stable within the prostate and allow significant margin reduction when used for on-line localization of the prostate.

  14. Surface curvature of pelvic joints from three laser scanners: separating anatomy from measurement error.

    PubMed

    Villa, Chiara; Gaudio, Daniel; Cattaneo, Cristina; Buckberry, Jo; Wilson, Andrew S; Lynnerup, Niels

    2015-03-01

    Recent studies have reported that quantifying symphyseal and auricular surface curvature changes on 3D models acquired by laser scanners has a potential for age estimation. However, no tests have been carried out to evaluate the repeatability of the results between different laser scanners. 3D models of the two pelvic joints were generated using three laser scanners (Custom, Faro, and Minolta). The surface curvature, the surface area, and the distance between co-registered meshes were investigated. Close results were found for surface areas (differences between 0.3% and 2.4%) and for distance deviations (average <20 ?m, SD <200 ?m). The curvature values were found to be systematically biased between different laser scanners, but still showing similar trends with increasing phases/scores. Applying a smoothing factor to the 3D models, it was possible to separate anatomy from the measurement error of each instrument, so that similar curvature values could be obtained (p < 0.05) independent of the specific laser scanner. PMID:25684259

  15. Anatomy and influence of the splenic artery in laparoscopic spleen-preserving splenic lymphadenectomy

    PubMed Central

    Zheng, Chao-Hui; Xu, Mu; Huang, Chang-Ming; Li, Ping; Xie, Jian-Wei; Wang, Jia-Bin; Lin, Jian-Xian; Lu, Jun; Chen, Qi-Yue; Cao, Long-Long; Lin, Mi

    2015-01-01

    AIM: To investigate the splenic hilar vascular anatomy and the influence of splenic artery (SpA) type in laparoscopic total gastrectomy with spleen-preserving splenic lymphadenectomy (LTGSPL). METHODS: The clinical anatomy data of 317 patients with upper- or middle-third gastric cancer who underwent LTGSPL in our hospital from January 2011 to December 2013 were collected. The patients were divided into two groups (concentrated group vs distributed group) according to the distance between the splenic artery’s furcation and the splenic hilar region. Then, the anatomical layout, clinicopathologic characteristics, intraoperative variables, and postoperative variables were compared between the two groups. RESULTS: There were 205 patients with a concentrated type (64.7%) and 112 patients with a distributed type (35.3%) SpA. There were 22 patients (6.9%) with a single branch of the splenic lobar vessels, 250 (78.9%) with 2 branches, 43 (13.6%) with 3 branches, and 2 patients (0.6%) with multiple branches. Eighty seven patients (27.4%) had type?I?splenic artery trunk, 211 (66.6%) had type II, 13 (4.1%) had type III, and 6 (1.9%) had type IV. The mean splenic hilar lymphadenectomy time (23.15 ± 8.02 vs 26.21 ± 8.84 min; P = 0.002), mean blood loss resulting from splenic hilar lymphadenectomy (14.78 ± 11.09 vs 17.37 ± 10.62 mL; P = 0.044), and number of vascular clamps used at the splenic hilum (9.64 ± 2.88 vs 10.40 ± 3.57; P = 0.040) were significantly lower in the concentrated group than in the distributed group. However, the mean total surgical time, mean total blood loss, and the mean number of harvested splenic hilar lymph nodes were similar in both groups (P > 0.05 for each comparison). There were also no significant differences in clinicopathological and postoperative characteristics between the groups (P > 0.05). CONCLUSION: It is of value for surgeons to know the splenic hilar vascular anatomy when performing LTGSPL. Patients with concentrated type SpA may be optimal patients for training new surgeons. PMID:26217091

  16. Surgical anatomy of the common iliac veins during para-aortic and pelvic lymphadenectomy for gynecologic cancer

    PubMed Central

    Tate, Shinichi; Nishikimi, Kyoko; Shozu, Makio

    2014-01-01

    Objective Compression of the left common iliac vein between the right common iliac artery and the vertebrae is known to be associated with the occurrence of left iliofemoral deep vein thrombosis (DVT). In this study, we described the variability in vascular anatomy of the common iliac veins and evaluated the relationship between the degree of iliac vein compression and the presence of DVT using the data from surgeries for gynecologic cancer. Methods The anatomical variations and the degrees of iliac vein compression were determined in 119 patients who underwent systematic para-aortic and pelvic lymphadenectomy during surgery for primary gynecologic cancer. Their medical records were reviewed with respect to patient-, disease-, and surgery-related data. Results The degrees of common iliac vein compression were classified into three grades: grade A (n=28, 23.5%), with a calculated percentage of 0%-25% compression; grade B (n=47, 39.5%), with a calculated percentage of 26%-50% compression; and grade C (n=44, 37%), with a calculated percentage of more than 50% compression. Seven patients (5.9%) had common iliac veins with anomalous anatomies; three were divided into small caliber vessels, two with a flattened structure, and two had double inferior vena cavae. The presence of DVT was associated with the elevated D-dimer levels but not with the degree of iliac vein compression in this series. Conclusion Although severe compression of the common iliac veins was frequently observed, the degree of compression might not be associated with DVT in surgical patients with gynecologic cancer. Anomalous anatomies of common iliac veins should be considered during systematic para-aortic and pelvic lymphadenectomy in the gynecologic cancer patients. PMID:24459583

  17. Importance of Adequate Gross Anatomy Education: The Impact of a Structured Pelvic Anatomy Course during Gynecology Fellowship

    ERIC Educational Resources Information Center

    Heisler, Christine Aminda

    2011-01-01

    Medical education underwent standardization at the turn of the 20th century and remained fairly consistent until recently. Incorporation of a patient-centered or case-based curriculum is believed to reinforce basic science concepts. One negative aspect is a reduction in hours spent with cadaveric dissection in the gross anatomy laboratory. For…

  18. Effect of certain yogic asanas on the pelvic congestion and it's anatomy.

    PubMed

    Mishra, S P; Singh, R H

    1984-10-01

    20 patient including 6 females and 14 males, between 20 years to 30 years of age, with complaints of chronic constipation refractory to various treatments by medicines, belching, sense of heaviness in the lower abdomen or pelvic region, offensive discharge from vagina (leucorrhoea) and bleeding per rectum with discomfort in the region of perineum were observed under instructions and supervision to practice certain yogic exercises for a period of three years. Viparitakarani, Goraksa asana, Uddyana Bandha and Mula Bandha (Nauli, Perineal Shrug) when practiced, relieved these patients were asked not to take any purgatives or laxatives. It was concluded from the present study that these complaints which can be ascribed to poor hemodynamics in the region of pelvis and perineum disappeared and patients showed obvious improvement after practicing these Asanas which reduced pelvic congestion and increased blood flow to the pelvic viscera i.e rectum, anal canal, prostate, uterus, vagina and levator ani and perineal muscles. PMID:22557465

  19. Ontogenetic scaling patterns and functional anatomy of the pelvic limb musculature in emus (Dromaius novaehollandiae)

    PubMed Central

    Main, Russell P.; Hutchinson, John R.

    2014-01-01

    Emus (Dromaius novaehollandiae) are exclusively terrestrial, bipedal and cursorial ratites with some similar biomechanical characteristics to humans. Their growth rates are impressive, as their body mass increases eighty-fold from hatching to adulthood whilst maintaining the same mode of locomotion throughout life. These ontogenetic characteristics stimulate biomechanical questions about the strategies that allow emus to cope with their rapid growth and locomotion, which can be partly addressed via scaling (allometric) analysis of morphology. In this study we have collected pelvic limb anatomical data (muscle architecture, tendon length, tendon mass and bone lengths) and calculated muscle physiological cross sectional area (PCSA) and average tendon cross sectional area from emus across three ontogenetic stages (n = 17, body masses from 3.6 to 42 kg). The data were analysed by reduced major axis regression to determine how these biomechanically relevant aspects of morphology scaled with body mass. Muscle mass and PCSA showed a marked trend towards positive allometry (26 and 27 out of 34 muscles respectively) and fascicle length showed a more mixed scaling pattern. The long tendons of the main digital flexors scaled with positive allometry for all characteristics whilst other tendons demonstrated a less clear scaling pattern. Finally, the two longer bones of the limb (tibiotarsus and tarsometatarsus) also exhibited positive allometry for length, and two others (femur and first phalanx of digit III) had trends towards isometry. These results indicate that emus experience a relative increase in their muscle force-generating capacities, as well as potentially increasing the force-sustaining capacities of their tendons, as they grow. Furthermore, we have clarified anatomical descriptions and provided illustrations of the pelvic limb muscle–tendon units in emus. PMID:25551028

  20. Ontogenetic scaling patterns and functional anatomy of the pelvic limb musculature in emus (Dromaius novaehollandiae).

    PubMed

    Lamas, Luis P; Main, Russell P; Hutchinson, John R

    2014-01-01

    Emus (Dromaius novaehollandiae) are exclusively terrestrial, bipedal and cursorial ratites with some similar biomechanical characteristics to humans. Their growth rates are impressive, as their body mass increases eighty-fold from hatching to adulthood whilst maintaining the same mode of locomotion throughout life. These ontogenetic characteristics stimulate biomechanical questions about the strategies that allow emus to cope with their rapid growth and locomotion, which can be partly addressed via scaling (allometric) analysis of morphology. In this study we have collected pelvic limb anatomical data (muscle architecture, tendon length, tendon mass and bone lengths) and calculated muscle physiological cross sectional area (PCSA) and average tendon cross sectional area from emus across three ontogenetic stages (n = 17, body masses from 3.6 to 42 kg). The data were analysed by reduced major axis regression to determine how these biomechanically relevant aspects of morphology scaled with body mass. Muscle mass and PCSA showed a marked trend towards positive allometry (26 and 27 out of 34 muscles respectively) and fascicle length showed a more mixed scaling pattern. The long tendons of the main digital flexors scaled with positive allometry for all characteristics whilst other tendons demonstrated a less clear scaling pattern. Finally, the two longer bones of the limb (tibiotarsus and tarsometatarsus) also exhibited positive allometry for length, and two others (femur and first phalanx of digit III) had trends towards isometry. These results indicate that emus experience a relative increase in their muscle force-generating capacities, as well as potentially increasing the force-sustaining capacities of their tendons, as they grow. Furthermore, we have clarified anatomical descriptions and provided illustrations of the pelvic limb muscle-tendon units in emus. PMID:25551028

  1. [Current treatment of endometriosis with laparoscopic surgery].

    PubMed

    Berkes, Eniko; Bokor, Attila; Rigó, János

    2010-07-11

    Surgical treatment of endometriosis aims to remove all visible areas of pelvic endometriosis and restore anatomy by division of adhesions, as well as relieve painful symptoms. In this paper, we summarize the advantages, disadvantages, and efficacy of different laparoscopic surgical procedures in the treatment of endometriosis-associated pelvic pain and infertility. Modern endometrial surgery primarily involves laparoscopy, while indication of previously widespread laparotomy has been restricted to special cases. Surgery for the treatment of peritoneal endometriosis includes several options: electrocoagulation, laser ablation, or excision of the lesions, all of which have similar efficacy in the therapy of endometriosis-associated pelvic pain and infertility. There are two effective techniques for treating ovarian endometrioma: excision (stripping) technique or ablation of the cyst wall. It has been conclusively proven that stripping provides a more favorable outcome than drainage and ablation with regard to alleviating pain symptoms and infertility. The treatment of deeply infiltrating endometriosis involves some of the most challenging dissections in endometrial surgery. Such deeply infiltrating lesions can be most securely removed with laser techniques. For example, rectovaginal septum endometriosis can be completely removed with laser therapy. In case of bowel endometriosis, the affected part of the bowel can be removed by segmental resection, disc resection, or superficial partial-thickness excision. In most cases segmental colorectal resection is employed, because it is the most effective treatment currently available. In case of slight ureteral endometriosis, laparoscopic ureterolysis can be an effective treatment option; however, with obstructive uropathy segmental resection and anastomosis are indicated. Laparoscopic uterosacral nerve ablation and praesacral neurectomy are ancillary procedures meant to further decrease endometriosis-associated pelvic pain symptoms. However, the efficacy of these techniques is not yet proven and currently they appear to offer no added benefits beyond those achievable with conservative surgery alone. The ever improving surgical techniques steadily increase the efficacy of the treatment of endometriosis-associated infertility and pelvic pain, as well as delay recurrence of the disease. PMID:20570794

  2. Near-infrared laparoscopic fluorescence for pelvic side wall delta mapping in patients with rectal cancer- 'PINPOINT' nodal assessment.

    PubMed

    Kazanowski, M; Al Furajii, H; Cahill, R A

    2015-10-01

    Low rectal cancers metastase lymphatically to the pelvic side wall in addition to cephalad spread alongside the superior rectal/inferior mesenteric arterial axis. Radical surgery in the West has focused resectional intent and effort on the midline en bloc oncological package by Total Mesorectal Excision. While neoadjuvant chemo/radiotherapy (now often administered to patients with radiologically locally advanced cancer) may contribute significant therapeutic effect to the lateral pelvic side walls, many patients with earlier preoperative stage low rectal cancer are offered surgery first (and indeed solely). Furthermore, some of those pretreated may have residual in situ lateral nodal disease and so risk understaging and undertreatment. Routine extended lymphadenectomy is on the otherhand unproven with respect to survival benefit and has likely no added role in the absence of definite (rather than possible) side-wall involvement. Near-infrared fluorescence pelvic side-wall delta mapping, as illustrated here in five patients undergoing abdominoperineal resection for rectal cancer after neoadjuvant therapy, may give the technological capacity to identify tumor site-draining nodes on the pelvic side and the focus the operating surgeon on this potential target for surgical resection (whether by berry picking or nerve sparing clearance) and prompt individualized diagnostic and therapeutic selection. PMID:26394741

  3. Robotics for Pelvic Reconstruction

    PubMed Central

    Ramm, Olga; Kenton, Kimberly

    2011-01-01

    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. PMID:21874147

  4. Sinus Anatomy

    MedlinePLUS

    ... Caregivers Contact ARS HOME ANATOMY Nasal Anatomy Sinus Anatomy Nasal Physiology Nasal Endoscopy Skull Base Anatomy Virtual Anatomy Disclosure ... Size + - Home > ANATOMY > Sinus Anatomy Nasal Anatomy Sinus Anatomy Nasal Physiology Nasal Endoscopy Skull Base Anatomy Virtual Anatomy Disclosure ...

  5. The evaluation of multi-structure, multi-atlas pelvic anatomy features in a prostate MR lymphography CAD system

    NASA Astrophysics Data System (ADS)

    Meijs, M.; Debats, O.; Huisman, H.

    2015-03-01

    In prostate cancer, the detection of metastatic lymph nodes indicates progression from localized disease to metastasized cancer. The detection of positive lymph nodes is, however, a complex and time consuming task for experienced radiologists. Assistance of a two-stage Computer-Aided Detection (CAD) system in MR Lymphography (MRL) is not yet feasible due to the large number of false positives in the first stage of the system. By introducing a multi-structure, multi-atlas segmentation, using an affine transformation followed by a B-spline transformation for registration, the organ location is given by a mean density probability map. The atlas segmentation is semi-automatically drawn with ITK-SNAP, using Active Contour Segmentation. Each anatomic structure is identified by a label number. Registration is performed using Elastix, using Mutual Information and an Adaptive Stochastic Gradient optimization. The dataset consists of the MRL scans of ten patients, with lymph nodes manually annotated in consensus by two expert readers. The feature map of the CAD system consists of the Multi-Atlas and various other features (e.g. Normalized Intensity and multi-scale Blobness). The voxel-based Gentleboost classifier is evaluated using ROC analysis with cross validation. We show in a set of 10 studies that adding multi-structure, multi-atlas anatomical structure likelihood features improves the quality of the lymph node voxel likelihood map. Multiple structure anatomy maps may thus make MRL CAD more feasible.

  6. Laparoscopic Surgery

    MedlinePLUS

    ... tissue when the laparoscopic instrument contacts the tumor. Recent research presented at various national and international conferences by experienced laparoscopic surgeons indicates that laparoscopic ...

  7. MR imaging of the pelvic floor: defecography.

    PubMed

    Brandão, Alice C; Ianez, Paula

    2013-05-01

    Defecography by magnetic resonance (MR) imaging makes it possible to view the multiple compartments of the pelvic floor at one examination, with high-resolution images at rest and dynamic images, providing accurate evaluation of the morphology and function of the anorectal and pelvic organs and muscles, involved in pelvic floor dynamics. MR imaging of the pelvic floor identifies the diseases affecting the evacuation mechanism, providing information essential for surgical planning and choice of treatment approach. This article focuses on the MR details of the pelvic floor anatomy and the most commonly observed anatomic and functional abnormalities. PMID:23642561

  8. Nasal Anatomy

    MedlinePLUS

    ... Nasal Anatomy Sinus Anatomy Nasal Physiology Nasal Endoscopy Skull Base Anatomy Virtual Anatomy Disclosure Statement CONDITIONS Adult ... Nasal Anatomy Sinus Anatomy Nasal Physiology Nasal Endoscopy Skull Base Anatomy Virtual Anatomy Disclosure Statement Printer Friendly ...

  9. Intraoperative laparoscopic complications for urological cancer procedures

    PubMed Central

    Montes, Sergio Fernández-Pello; Rodríguez, Ivan Gonzalez; Ugarteburu, Rodrigo Gil; Villamil, Luis Rodríguez; Mendez, Begoña Diaz; Gil, Patricio Suarez; Madera, Javier Mosquera

    2015-01-01

    AIM: To structure the rate of intraoperative complications that requires an intraoperative or perioperative resolution. METHODS: We perform a literature review of Medline database. The research was focused on intraoperative laparoscopic procedures inside the field of urological oncology. General rate of perioperative complications in laparoscopic urologic surgery is described to be around 12.4%. Most of the manuscripts published do not make differences between pure intraoperative, intraoperative with postoperative consequences and postoperative complications. RESULTS: We expose a narrative statement of complications, possible solutions and possible preventions for most frequent retroperitoneal and pelvic laparoscopic surgery. We expose the results with the following order: retroperitoneal laparoscopic surgery (radical nephrectomy, partial nephrectomy, nephroureterectomy and adrenalectomy) and pelvic laparoscopic surgery (radical prostatectomy and radical cystectomy). CONCLUSION: Intraoperative complications vary from different series. More scheduled reports should be done in order to better understand the real rates of complications. PMID:25984519

  10. Magnetic resonance imaging of pelvic floor dysfunction.

    PubMed

    Lalwani, Neeraj; Moshiri, Mariam; Lee, Jean H; Bhargava, Puneet; Dighe, Manjiri K

    2013-11-01

    Pelvic floor dysfunction is largely a complex problem of multiparous and postmenopausal women and is associated with pelvic floor or organ descent. Physical examination can underestimate the extent of the dysfunction and misdiagnose the disorders. Functional magnetic resonance (MR) imaging is emerging as a promising tool to evaluate the dynamics of the pelvic floor and use for surgical triage and operative planning. This article reviews the anatomy and pathology of pelvic floor dysfunction, typical imaging findings, and the current role of functional MR imaging. PMID:24210448

  11. Pelvic ring injuries: Emergency assessment and management.

    PubMed

    Halawi, Mohamad J

    2015-12-01

    Pelvic ring injuries are associated with significant morbidity and mortality. Understanding the anatomy of the pelvic ring is essential for accurate diagnosis and treatment. A systematic approach taking into account the mechanism of injury, physical examination, and radiographic assessment is important to quickly identify unstable pelvic disruptions and associated injuries. Because the pelvis is a ring structure, isolated pubic rami fractures on plain radiographs are unusual and should warrant careful evaluation for posterior pelvic disruption with computed tomography. Hemorrhagic shock can occur in about 10% of pelvic ring injuries. Immediate recognition and treatment of this life-threatening condition is critical in emergency management. In addition to fluid resuscitation and blood transfusion, circumferential wrapping, angiographic embolization, laparotomy with pelvic packing, and external fixation can be important life-saving adjuncts in the setting of hemodynamic instability. PMID:26566339

  12. Pelvic Neurofibroma

    PubMed Central

    Bakhshi, Girish D.; Tayade, Mukund B.; Yadav, Rajesh B.; Jadhav, Kavita V.; Shenoy, Sachin S.; Amin, Margi V.

    2014-01-01

    A 58-year old male presented with a hard lump in lower abdomen extending into pelvis. Clinical examination and computed tomography scan revealed pelvic retroperitoneal mass. Patient underwent exploratory laparotomy - revealing a well encapsulated retroperitoneal mass extending up to coccyx, posterior to the urinary bladder. It had displaced the recto-sigmoid colon and urinary bladder to the right. Histopathological findings revealed a neurofibroma. Pelvic neurofibromas are known to arise from certain pelvic organ. However, present case ruled out any organ involvement both on imaging and intraoperatively. This shows that these tumors can arise de novo also. A brief case report and review of literature is presented. PMID:25568767

  13. Recognition and Management of Urologic Injuries With Laparoscopic Hysterectomy.

    PubMed

    Dassel, Mark W; Adelman, Marisa R; Sharp, Howard T

    2015-12-01

    Injuries to the urinary tract during laparoscopic hysterectomy are quite rare, but are among the most serious injuries that occur during gynecologic surgery. Injury rates among subtypes of laparoscopic hysterectomy have been found to be similar. The most effective way to avoid urinary tract injury is knowledge of urinary tract anatomy and careful and thoughtful dissection. PMID:26457852

  14. Urogynecologic conditions: pelvic organ prolapse.

    PubMed

    Noor, Nabila; Garely, Alan D

    2015-03-01

    Chronic pelvic pain is a commonly encountered condition that often is multifactorial. Etiologies include gynecologic, urologic, gastrointestinal, and neurologic conditions. Laboratory tests, imaging, and surgical intervention are not always helpful in identifying the etiology of pelvic pain. For appropriate management of this complex disease process, a detailed history and physical examination, and a multidisciplinary approach are needed. Pelvic pain may be caused by endometriosis, pelvic inflammatory disease, adenomyosis, interstitial cystitis/painful bladder syndrome, or other factors. Evaluation may include keeping a pain diary; laboratory tests, such as a pregnancy test, urinalysis, or tests for sexually transmitted infections; ultrasonography of abnormalities detected on physical examination; and laparoscopy. Specific first-line treatments include nonsteroidal anti-inflammatory drugs and oral contraceptives for endometriosis; progestins, gonadotropin-releasing hormone analogs, aromatase inhibitors, or hysterectomy for adenomyosis; and education, food avoidance, and behavioral modifications for interstitial cystitis/painful bladder syndrome. Surgical options include nerve transection procedures, laparoscopic uterosacral nerve ablation, and presacral neurectomy, although data on effectiveness are limited. PMID:25756374

  15. Interfractional Variations in the Setup of Pelvic Bony Anatomy and Soft Tissue, and Their Implications on the Delivery of Proton Therapy for Localized Prostate Cancer

    SciTech Connect

    Trofimov, Alexei; Nguyen, Paul L.; Efstathiou, Jason A.; Wang, Yi; Lu, Hsiao-Ming; Engelsman, Martijn; Merrick, Scott; Cheng, Chee-Wai; Wong, James R.; Zietman, Anthony L.

    2011-07-01

    Purpose: To quantify daily variations in the anatomy of patients undergoing radiation therapy for prostate carcinoma, to estimate their effect on dose distribution, and to evaluate the effectiveness of current standard planning and setup approaches employed in proton therapy. Methods: We used series of computed tomography data, which included the pretreatment scan, and between 21 and 43 in-room scans acquired on different treatment days, from 10 patients treated with intensity-modulated radiation therapy at Morristown Memorial Hospital. Variations in femur rotation angles, thickness of subcutaneous adipose tissue, and physical depth to the distal surface of the prostate for lateral beam arrangement were recorded. Proton dose distributions were planned with the standard approach. Daily variations in the location of the prescription isodose were evaluated. Results: In all 10 datasets, substantial variation was observed in the lateral tissue thickness (standard deviation of 1.7-3.6 mm for individual patients, variations of >5 mm from the planning computed tomography observed in all series), and femur rotation angle (standard deviation between 1.3{sup o} and 4.8{sup o}, with the maximum excursion exceeding 10{sup o} in 6 of 10 datasets). Shifts in the position of treated volume (98% isodose) were correlated with the variations in the lateral tissue thickness. Conclusions: Analysis suggests that, combined with image-guided setup verification, the range compensator expansion technique prevents loss of dose to target from femur rotation and soft-tissue deformation, in the majority of cases. Anatomic changes coupled with the uncertainties of particle penetration in tissue restrict possibilities for margin reduction in proton therapy of prostate cancer.

  16. Interfractional variations in the set-up of pelvic bony anatomy and soft tissue, and their implications on the delivery of proton therapy for localized prostate cancer

    PubMed Central

    Trofimov, Alexei; Nguyen, Paul L.; Efstathiou, Jason A.; Wang, Yi; Lu, Hsiao-Ming; Engelsman, Martijn; Merrick, Scott; Cheng, Chee-Wai; Wong, James R.; Zietman, Anthony L.

    2010-01-01

    Purpose To quantify daily variations in the anatomy of patients undergoing radiation therapy for prostate carcinoma, to estimate their effect on dose distribution, and to evaluate the effectiveness of current standard planning and set-up approaches employed in proton therapy. Methods We used series of CT data, which included the pre-treatment scan, and between 21 and 43 in-room scans acquired on different treatment days, from 10 patients treated with intensity-modulated radiation therapy at Morristown Memorial Hospital. Variations in femur rotation angles, thickness of subcutaneous adipose tissue, and physical depth to the distal surface of the prostate for lateral beam arrangement were recorded. Proton dose distributions were planned with the standard approach. Daily variations in the location of the prescription iso-dose were evaluated. Results In all 10 datasets, substantial variation was observed in the lateral tissue thickness (standard deviation of 1.7–3.6 mm for individual patients, variations of over 5 mm from the planning CT observed in all series), and femur rotation angle (standard deviation between 1.3–4.8°, with the maximum excursion exceeding 10° in 6 out of 10 datasets). Shifts in the position of treated volume (98% iso-dose) were correlated with the variations in the lateral tissue thickness. Conclusions Analysis suggests that, combined with image-guided set-up verification, the range compensator expansion technique prevents loss of dose to target due to femur rotation and soft tissue deformation, in the majority of cases. Anatomic changes coupled with the uncertainties of particle penetration in tissue restrict possibilities for margin reduction in proton therapy of prostate cancer. PMID:20947266

  17. Pelvic Pain

    MedlinePLUS

    Pelvic pain occurs mostly in the lower abdomen area. The pain might be steady, or it might come and go. If the pain is severe, it might get in the way ... re a woman, you might feel a dull pain during your period. It could also happen during ...

  18. Laparoscopic herniorrhaphy.

    PubMed

    Filipi, C J; Fitzgibbons, R J; Salerno, G M; Hart, R O

    1992-10-01

    Laparoscopic inguinal hernia repair could represent an attractive alternative to conventional inguinal herniorrhaphy if it can be shown to result in less perioperative morbidity (primarily postoperative pain) or a decreased long-term recurrence rate. The data addressing either of these concerns will be forthcoming in ensuing years. The variations in the laparoscopic approach to the preperitoneal space and the differences in dissection and fixation techniques outlined in this article reflect the fact that the procedure is still evolving, and there is not yet a consensus on the best laparoscopic herniorrhaphy. It is likely that there will not be one laparoscopic technique applicable to all inguinal hernias. Rather, the patient's body habitus and the type of hernia encountered at laparoscopy will persuade the surgeon to use one of several techniques. Once a consensus is reached among surgeons as to the optimal laparoscopic hernia repair(s), it will be possible to begin gathering data concerning perioperative morbidity and recurrence rates. Only then can the question be answered whether laparoscopic inguinal herniorrhaphy has any advantages over the conventional extraperitoneal operation. A multicenter prospective nonrandomized trial has been initiated by our group in an attempt to determine whether laparoscopic inguinal herniorrhaphy has efficacy. The exact technique employed by the individual centers has not been strictly regulated, but general guidelines have been given. It is hoped that this project will provide information on whether laparoscopic inguinal herniorrhaphy is a useful alternative to conventional repair. Most of the laparoscopic inguinal herniorrhaphy techniques described in this article expose the patients to the inherent risks of initial laparoscopic penetration of the abdomen and the long-term possibility of adhesions to the sites where the peritoneum has been breached. Because these risks are not present in a conventional repair, the laparoscopic technique must have other advantages if it truly is to obtain a place in the armamentarium of general surgeons. PMID:1388300

  19. Pelvic Inflammatory Disease (PID)

    MedlinePLUS

    MENU Return to Web version Pelvic Inflammatory Disease Overview What is pelvic inflammatory disease (PID)? Pelvic inflammatory disease (PID) is an infection of the female reproductive organs (the uterus, ...

  20. Chronic Pelvic Pain

    MedlinePLUS

    ... 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 ...

  1. Larynx Anatomy

    MedlinePLUS

    ... Pictures Browse Search Quick Search Image Details Larynx Anatomy View/Download: Small: 648x576 View Download Add to My Pictures Title: Larynx Anatomy Description: Anatomy of the larynx; drawing shows the ...

  2. Vulva Anatomy

    MedlinePLUS

    ... Pictures Browse Search Quick Search Image Details Vulva Anatomy View/Download: Small: 720x634 View Download Add to My Pictures Title: Vulva Anatomy Description: Anatomy of the vulva; drawing shows the ...

  3. Pharynx Anatomy

    MedlinePLUS

    ... Pictures Browse Search Quick Search Image Details Pharynx Anatomy View/Download: Small: 720x576 View Download Add to My Pictures Title: Pharynx Anatomy Description: Anatomy of the pharynx; drawing shows the ...

  4. Radiologic management of pelvic ring fractures: Systematic radiographic diagnosis

    SciTech Connect

    Young, J.W.R.; Burgess, A.R.

    1987-01-01

    The book addresses issues surrounding the diagnosis and treatment of catastrophic pelvic injury: anatomy, diagnosis/classification procedure, the nature and importance of force vectors, radiologic approaches, surgical management, and complications. More than 100 x-rays and line drawings-printed in an oversized format to reveal every diagnostic nuance-are combined with concise explanatory text and summary tables to illustrate practical applications of fracture pattern recognition in treating pelvic injury.

  5. [Robotics-assisted laparoscopic colorectal resection].

    PubMed

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

    2013-08-01

    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

  6. Gallbladder removal - laparoscopic

    MedlinePLUS

    Cholecystectomy - laparoscopic ... Blunt LM. Laparoscopic cholecystectomy. In: Cameron JL, Cameron AM, eds. Current Surgical Th erapy. 11th ed. Philadelphia, PA: Elsevier Saunders; 2014. Jackson PG, ...

  7. The Pelvic Kidney of Male Ambystoma maculatum (Amphibia, Urodela, Ambystomatidae) with Special

    E-print Network

    Sever, David M.

    The Pelvic Kidney of Male Ambystoma maculatum (Amphibia, Urodela, Ambystomatidae) with Special- scopic anatomy of the pelvic kidney in male Ambystoma maculatum. The nephron of male Ambystoma macula of structure and chemistry to sex- ual segments of the kidneys in other vertebrates, lead us to believe

  8. Pelvic Inflammatory Disease (PID)

    MedlinePLUS

    ... Pelvic Inflammatory Disease (PID) STDs & Infertility STDs & Pregnancy Syphilis Trichomoniasis Other STDs See Also Pregnancy Reproductive Health ... Pelvic Inflammatory Disease (PID) STDs & Infertility STDs & Pregnancy Syphilis Trichomoniasis Other STDs See Also Pregnancy Reproductive Health ...

  9. Pelvic Floor Disorders Network

    MedlinePLUS

    ... and perform research studies related to women with pelvic floor disorders. In this way, studies can be done ... learn more about how to help women with pelvic floor problems. Treatments are available, but there are still ...

  10. Pelvic Support Problems

    MedlinePLUS

    ... are held in place by muscles of the pelvic floor . Layers of connective tissue called fascia also provide ... product that is used to empty the bowels. Pelvic Floor: A muscular membrane at the base of the ...

  11. Pelvic Support Problems

    MedlinePLUS

    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 ...

  12. Pelvic Organ Prolapse

    MedlinePLUS

    ... and layers of connective tissue, which are called fascia, become weakened, stretched, or are torn the pelvic ... delivery) can cause injury to the muscles or fascia of the pelvic floor. The increased pressure of ...

  13. Pelvic inflammatory disease (PID)

    MedlinePLUS

    Pelvic inflammatory disease is an infection of a woman's womb (uterus), ovaries, or fallopian tubes. ... Pelvic inflammatory disease (PID) is an infection caused by bacteria. When bacteria from the vagina or cervix travel to your ...

  14. Laparoscopic splenectomy.

    PubMed

    Kitano, S; Yoshida, T; Bandoh, T; Shuto, K; Ninomiya, K

    1996-09-01

    Laparoscopic splenectomy was carried out for the treatment of patients with splenic disorders; 20 idiopathic thrombocytopenic purpura, 1 hamartoma and 3 hereditary spherocytosis. With the patients in the right lateral position, four trocars were used. Under CO2 pneumoperitoneum with a pressure of 10 mmHg, the surrounding ligaments were divided with electrocautery. At the splenic hilum, the splenic artery and vein were exposed using ultrasonic dissector. After double ligation of these vessels, the spleen was dissected with an autostapler. The resected spleen contained in a nylon bag was fragmented with finger-fracture method and extracted through a port site extended up 2 or 3 cm in length. All the patients tolerated the procedure and no blood transfusion was required. Laparoscopic splenectomy is the preferred choice to resect the spleen because of the short hospital stay, less pain and good cosmesis. PMID:8923999

  15. Eye Anatomy

    MedlinePLUS

    ... News About Us Donate In This Section Eye Anatomy en Español email Send this article to a ... You at Risk For Glaucoma? Childhood Glaucoma Eye Anatomy Five Common Glaucoma Tests Glaucoma Facts and Stats ...

  16. Hand Anatomy

    MedlinePLUS

    ... del pulgar Dedo en gatillo See More... Hand Anatomy Hand Safety Fireworks Safety Lawnmower Safety Snowblower safety ... del pulgar Dedo en gatillo See More... Hand Anatomy Hand Safety Fireworks Safety Lawnmower Safety Snowblower safety ...

  17. Paraganglioma Anatomy

    MedlinePLUS

    ... Pictures Browse Search Quick Search Image Details Paraganglioma Anatomy View/Download: Small: 648x576 View Download Add to My Pictures Title: Paraganglioma Anatomy Description: Paraganglioma of the head and neck; drawing ...

  18. Laparoscopic cholecystectomy in situs inversus totalis.

    PubMed

    Mn, Raghuveer; S, Mahesh Shetty; Bb, Sunil Kumar

    2014-07-01

    Situs inversus totalis is a rare condition where the organs in the body is placed in the opposite side. When such patient presents with the diseases of the intra abdominal organs the diagnosis is challenging and the operative procedure to be performed will be difficult. This may require the anticipation of variations in anatomy, ergonomic changes required during surgery and mastery over the operative skills in reversed anatomy. Cholelithiasis in situs inversus totalis is one such situation. Herein we report a case of situs inversus totalis who underwent successful laparoscopic cholecystectomy for symptomatic gallbladder calculi. PMID:25177601

  19. Mesh-Based Transperineal Repair of a Perineal Hernia After a Laparoscopic Abdominoperineal Resection

    PubMed Central

    Lee, Taek-Gu

    2014-01-01

    A perineal hernia (PH) is formed by a protrusion of intra-abdominal viscera through a defect in the pelvic floor. This is a rare complication after a conventional abdominoperineal resection (APR). However, the risk of a PH may be increased after a laparoscopic resection because this technique can cause fewer postoperative adhesions, predisposing the small bowel to sliding down toward the pelvis. However, only a few case reports describe the transperineal approach for the repair of a PH after a laparoscopic APR. We present a case of a PH after a laparoscopic APR; the PH was repaired with synthetic mesh by using a transperineal approach. A transperineal approach using a mesh to reconstruct the pelvic floor is less invasive and more effective. We suggest that this technique should probably be the first choice for treating an uncomplicated PH that occurs after a laparoscopic APR. PMID:25210690

  20. A review of functional pelvic floor imaging modalities and their effectiveness.

    PubMed

    Ahmad, Aminah N; Hainsworth, Alison; Williams, Andrew B; Schizas, Alexis M P

    2015-01-01

    The anatomy of the pelvic floor is complex and clinical examination alone is often insufficient to diagnose and assess pathology. With a greater understanding of pelvic floor dysfunction and treatment options, imaging is becoming increasingly common. This review compares three imaging techniques. Ultrasound has the potential for dynamic assessment of the entire pelvic floor. Magnetic resonance imaging is able to rapidly image the entire pelvic floor but it is expensive and tends to underestimate pathology. Dynamic defaecating proctography or cystocolpoproctography is the current gold standard for posterior compartment imaging but requires opacification of the bladder to provide a global view. PMID:25770903

  1. Performance of Clinical and Laparoscopic Criteria for the Diagnosis of Upper Genital Tract Infection

    PubMed Central

    Boardman, Lori A.; Sung, C. James

    1997-01-01

    Objective: The purpose of this study was to validate the standard minimal clinical criteria and the laparoscopic triad of tubal edema, erythema, and purulent exudate used to diagnose acute upper genital tract infection. Methods: Subjects included women who either met the Centers for Disease Control and Prevention's (CDC) minimal criteria for acute pelvic inflammatory disease or had other signs of upper genital tract infection (i.e., atypical pelvic pain, abnormal uterine bleeding, or cervicitis). The subjects were evaluated with a baseline interview comprehensive laboratory testing, and either an endometrial biopsy or laparoscopy with endometrial and fimbrial biopsies for definitive diagnosis of upper genital tract infection. Patients were considered positive for upper genital tract infection if they had any of the following findings: 1) histologic evidence of endometritis or salpingitis; 2) laparoscopic visualization of purulent exudate in the pelvis without another source; or 3) positive testing for Neisseria gonorrhoeae or Chlamydia trachomatis from the endometrium, fallopian tubes, or pelvis. Results: One hundred twenty-nine women with adequate endometrial samples were evaluated between August 1993 and September 1997, and 62 had complete laparoscopic evaluations. The sensitivities of the CDC's minimal clinical criteria for pelvic inflammatory disease and the laparoscopic triad of edema, erythema, and purulent exudate were 65% and 60%, respectively. Conclusions: Commonly used minimal clinical criteria for pelvic inflammatory disease and the laparoscopic triad of tubal edema, erythema, and purulent exudate have limited sensitivity with correspondingly high false negative rates. PMID:18476154

  2. Sexual selection targets cetacean pelvic bones.

    PubMed

    Dines, James P; Otárola-Castillo, Erik; Ralph, Peter; Alas, Jesse; Daley, Timothy; Smith, Andrew D; Dean, Matthew D

    2014-11-01

    Male genitalia evolve rapidly, probably as a result of sexual selection. Whether this pattern extends to the internal infrastructure that influences genital movements remains unknown. Cetaceans (whales and dolphins) offer a unique opportunity to test this hypothesis: since evolving from land-dwelling ancestors, they lost external hind limbs and evolved a highly reduced pelvis that seems to serve no other function except to anchor muscles that maneuver the penis. Here, we create a novel morphometric pipeline to analyze the size and shape evolution of pelvic bones from 130 individuals (29 species) in the context of inferred mating system. We present two main findings: (1) males from species with relatively intense sexual selection (inferred by relative testes size) tend to evolve larger penises and pelvic bones compared to their body length, and (2) pelvic bone shape has diverged more in species pairs that have diverged in inferred mating system. Neither pattern was observed in the anterior-most pair of vertebral ribs, which served as a negative control. This study provides evidence that sexual selection can affect internal anatomy that controls male genitalia. These important functions may explain why cetacean pelvic bones have not been lost through evolutionary time. PMID:25186496

  3. Sexual selection targets cetacean pelvic bones

    PubMed Central

    Dines, J. P.; Otárola-Castillo, E.; Ralph, P.; Alas, J.; Daley, T.; Smith, A. D.; Dean, M. D.

    2014-01-01

    Male genitalia evolve rapidly, probably as a result of sexual selection. Whether this pattern extends to the internal infrastructure that influences genital movements remains unknown. Cetaceans (whales and dolphins) offer a unique opportunity to test this hypothesis: since evolving from land-dwelling ancestors, they lost external hind limbs and evolved a highly reduced pelvis which seems to serve no other function except to anchor muscles that maneuver the penis. Here we create a novel morphometric pipeline to analyze the size and shape evolution of pelvic bones from 130 individuals (29 species) in the context of inferred mating system. We present two main findings: 1) males from species with relatively intense sexual selection (inferred by relative testes size) have evolved relatively large penises and pelvic bones compared to their body size, and 2) pelvic bone shape diverges more quickly in species pairs that have diverged in inferred mating system. Neither pattern was observed in the anterior-most pair of vertebral ribs, which served as a negative control. This study provides evidence that sexual selection can affect internal anatomy that controls male genitalia. These important functions may explain why cetacean pelvic bones have not been lost through evolutionary time. PMID:25186496

  4. 257 Incidental Appendectomies During Total Laparoscopic Hysterectomy

    PubMed Central

    Fisher, Deidre T.; O'Holleran, Michael S.

    2007-01-01

    Objective: This retrospective observational report analyzes the demographics, blood loss, length of surgical duration, number of days in the hospital, and complications for 821 consecutive patients undergoing total laparoscopic hysterectomy over a 11-year period stratified by incidental appendectomy. Methods: A retrospective chart abstraction was performed. ANOVA and chi-square tests were performed with significance preset at P<0.05. Results: Of 821 consecutive patients undergoing total laparoscopic hysterectomy, 257 underwent elective appendectomy with the ultrasonic scalpel, either as part of their staging, treatment for pelvic pain, or prophylaxis against appendicitis. Comparing the 2 groups, no difference existed in mean age of 50±10 years or mean BMI of 27.6±6.7. Both groups had a similar mean blood loss of 130 mL. Surgery took less time (137 vs 118 minutes, P<0.0012) and the hospital stay was shorter in the appendectomy group (1.5 vs 1.2, P<0.0001) possibly because it was performed incidentally in most cases. No complications were attributable to the appendectomy, and complication types and rates in both groups were similar. Though all appendicies appeared normal, pathology was documented in 9%, including 3 carcinoid tumors. Conclusions: Incidental appendectomy during total laparoscopic hysterectomy is not associated with significant risk and can be routinely offered to patients planning elective gynecologic laparoscopic procedures, as is standard for open procedures. PMID:18237505

  5. Laparoscopic Spine Surgery

    MedlinePLUS

    ... Opportunities Login Laparoscopic Spine Surgery Patient Information from SAGES Download PDF Version Find a SAGES Surgeon Laparoscopic ... 2015 CME Credits Healthy Sooner: Patient Information Contact SAGES Society of American Gastrointestinal and Endoscopic Surgeons 11300 ...

  6. Robotic-assisted laparoscopic mesh sacrocolpopexy

    PubMed Central

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

    2010-01-01

    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. PMID:21789075

  7. Pelvic Congestion Syndrome

    PubMed Central

    Durham, Janette D.; Machan, Lindsay

    2013-01-01

    Patients with pelvic congestion syndrome present with otherwise unexplained chronic pelvic pain that has been present for greater than 6 months, and anatomic findings that include pelvic venous insufficiency and pelvic varicosities. It remains an underdiagnosed explanation for pelvic pain in young, premenopausal, usually multiparous females. Symptoms include noncyclical, positional lower back, pelvic and upper thigh pain, dyspareunia, and prolonged postcoital discomfort. Symptoms worsen throughout the day and are exacerbated by activity or prolonged standing. Examination may reveal ovarian tenderness and unusual varicosities—vulvoperineal, posterior thigh, and gluteal. Diagnosis is suspected by clinical history and imaging that demonstrates pelvic varicosities. Venography is usually necessary to confirm ovarian vein reflux, although transvaginal ultrasound may be useful in documenting this finding. Endovascular therapy has been validated by several large patient series with long-term follow-up using standardized pain assessment surveys. Embolization has been shown to be significantly more effective than surgical therapy in improving symptoms in patients who fail hormonal therapy. Although there has been variation in approaches between investigators, the goal is elimination of ovarian vein reflux with or without direct sclerosis of enlarged pelvic varicosities. Symptom reduction is seen in 70 to 90% of the treated females despite technical variation. PMID:24436564

  8. Magnetic resonance imaging of the pelvic floor: from clinical to biomechanical imaging.

    PubMed

    Brandão, Sofia; Da Roza, Thuane; Parente, Marco; Ramos, Isabel; Mascarenhas, Teresa; Natal Jorge, Renato M

    2013-12-01

    This article reviews the current role of magnetic resonance imaging in the study of the pelvic floor anatomy and pelvic floor dysfunction. The application of static and dynamic magnetic resonance imaging in the clinical context and for biomechanical simulation modeling is assessed, and the main findings are summarized. Additionally, magnetic resonance-based diffusion tensor imaging is presented as a potential tool to evaluate muscle fiber morphology. In this article, focus is set on pelvic floor muscle damage related to urinary incontinence and pelvic organ prolapse, sometimes as a consequence of vaginal delivery. Modeling applications that evaluate anatomical and physiological properties of pelvic floor are presented to further illustrate their particular characteristics. Finally, finite element method is described as a method for modeling and analyzing pelvic floor structures' biomechanical performance, based on material and behavioral properties of the tissues, and considering pressure loads that mimic real-life conditions such as active contraction or Valsalva maneuver. PMID:24030164

  9. Chronic Pelvic Pain

    MedlinePLUS

    ... period. Laparoscopy: A surgical procedure in which a slender, light-transmitting instrument, the laparoscope, is used to ... reproductive organs. Sigmoidoscopy: A test in which a slender device is placed into the rectum and lower ...

  10. Life-threatening rupture of an external iliac artery pseudoaneurysm caused by necrotizing fasciitis following laparoscopic radical cystectomy: a case report

    PubMed Central

    2014-01-01

    Background Pseudoaneurysms are caused by trauma, tumors, infections, vasculitis, atherosclerosis and iatrogenic complications. In this paper, we report about a patient with rupture of an external iliac artery pseudoaneurysm, which lead to hemorrhagic shock, after undergoing laparoscopic radical cystectomy and extended pelvic lymphadenectomy. Case presentation The patient was a 68-year-old Japanese male diagnosed with invasive bladder cancer. Laparoscopic radical cystectomy and extended pelvic lymphadenectomy were performed. On postoperative day 12, he developed a high fever and an acute inflammatory response with redness and swelling in the right inguinal region. He was diagnosed with necrotizing fasciitis and underwent debridement. On postoperative day 42, a sudden hemorrhage developed from the open wound in the right inguinal region. He was diagnosed with external iliac artery pseudoaneurysm rupture by computed tomography. Conclusion These complications occur extremely rarely after cystectomy with pelvic lymphadenectomy. There are no reports to date on these complications following laparoscopic cystectomy with pelvic lymphadenectomy. PMID:24885366

  11. Pelvic Floor Disorders

    MedlinePLUS

    ... group of muscles that form a sling or hammock across the pelvis. Together with their surrounding tissues, ... A-Z Topics Pelvic Pain Pregnancy Urinary Tract Health NICHD News and Spotlights Vacancy Announcement: NICHD Director ...

  12. Pelvic Inflammatory Disease

    MedlinePLUS

    Pelvic inflammatory disease (PID) is an infection and inflammation of the uterus, ovaries, and other female reproductive organs. It causes scarring ... United States. Gonorrhea and chlamydia, two sexually transmitted diseases, are the most common causes of PID. Other ...

  13. Pelvic Pain: Other FAQs

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    ... it affect my ability to become pregnant? Can alternative therapies help? Can it affect my emotional well-being? ... pain affect my ability to become pregnant? Can alternative therapies treat my pain? Can pelvic pain affect my ...

  14. Pelvic Inflammatory Disease

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    ... enabling JavaScript. Top Banner Content Area Skip Content Marketing Share this: Main Content Area Pelvic Infl?ammatory ... to be in a long-term, mutually monogamous relationship with a partner who has been tested and ...

  15. Pelvic Organ Prolapse

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    ... UPDATE ON THE SAFETY AND EFFECTIVENESS OF Transvaginal PLACEMENT for Pelvic Organ Prolapse . Back to top More ... About FDA Contact FDA Browse by Product Area Product Areas back Food Drugs Medical Devices Radiation-Emitting ...

  16. [Pelvic ganglioneuroma. Case report].

    PubMed

    Chelli, M; Mnif, N; Bouhala, T; Kara, M; Kribi, L; Kammoun, A; Lakhoua, M R; Hamza, R

    2000-06-01

    Ganglioneuroma is a neurogenic tumor originating from autonomic ganglia. It most commonly occurs in patients younger than 20 years with a slight predominance of females. The pelvic localization is rare. Imaging can lead to diagnosis but it is not specific. The diagnosis can only be confirmed by the pathologic study. The authors report one case of pelvic ganglioneuroma diagnosed in an 11-year-old child who also had hypertension and renal failure. PMID:10844340

  17. Early Pregnancy Loss Following Laparoscopic Management of Ovarian Abscess Secondary to Oocyte Retrieval

    PubMed Central

    Pabuccu, Emre Goksan; Taskin, Salih; Atabekoglu, Cem; Sonmezer, Murat

    2014-01-01

    Severe pelvic infections following ultrasound-guided transvaginal oocyte retrieval (TVOR) are rare but challenging. Ovarian abscess formation is one of the consequences and management of such cases as highly debated in pregnant patients. In this case report, an early fetal loss following laparoscopic management of ovarian abscess is described and possible etiologies are discussed. PMID:25379164

  18. Pelvic inflammatory disease in virginal adolescent females without tubo-ovarian abscess.

    PubMed

    Kielly, Maria; Jamieson, Mary Anne

    2014-02-01

    Pelvic inflammatory disease (PID) is an infection of the upper genital tract that is often caused by an ascending sexually transmitted infection. The complications of PID include pyosalpinx and tubo-ovarian abscess, infertility or ectopic pregnancy, and chronic pelvic pain of varying degrees. These sequelae underscore the importance of prompt diagnosis. We present 2 cases of PID in young women who denied any history of sexual activity or sexual abuse. Both cases were brought to the operating room with suspected appendicitis; however, laparoscopic evaluation revealed purulent fluid surrounding the pelvic organs. The literature is scant with respect to PID in the virginal patient. It is important to keep pelvic infection in the differential diagnosis of virginal patients who present with clinical symptoms of an acute abdomen. PMID:23953495

  19. Laparoscopic resection for rectal cancer and cholecystectomy for patient with situs inversus totalis

    PubMed Central

    Fang, Jia-Feng; Zheng, Zong-Heng; Wei, Bo; Chen, Tu-Feng; Lei, Pu-Run; Huang, Jiang-Long; Huang, Li-Jun; Wei, Hong-Bo

    2015-01-01

    Situs inversus totalis (SIT) is a rare congenital anomaly presenting with complete transposition of thoracic and abdominal viscera. Laparoscopic surgery for either rectal cancer or gallbladder diseases with SIT is rarely reported in the literature. A 39-year-old woman was admitted to hospital owing to rectal cancer. She was diagnosed with SIT by performing radiography and abdominal computed tomography scan as a routine preoperative investigation. We performed laparoscopic resection for rectal cancer successfully in spite of technical difficulties caused by abnormal anatomy. One year later, she was diagnosed with cholecysticpolyp, and we performed laparoscopic cholecystectomy for her uneventfully. With this case, we believe that performance by an experienced laparoscopic surgeon, either laparoscopic resection for rectal cancer or cholecystectomy with SIT is safe and feasible. PMID:26195883

  20. Retzius-sparing robot-assisted laparoscopic radical prostatectomy: Critical appraisal of the anatomic landmarks for a complete intrafascial approach.

    PubMed

    Asimakopoulos, Anastasios D; Miano, Roberto; Galfano, Antonio; Bocciardi, Aldo Massimo; Vespasiani, Giuseppe; Spera, Enrico; Gaston, Richard

    2015-10-01

    To provide an overview of the anatomical landmarks needed to guide a retropubic (Retzius)-sparing robot-assisted laparoscopic prostatectomy (RALP), and a step-by-step description of the surgical technique that maximizes preservation of the periprostatic neural network. The anatomy of the pelvic fossae is presented, including the recto-vesical pouch (pouch of Douglas) created by the reflections of the peritoneum. The actual technique of the trans-Douglas, intrafascial nerve-sparing robotic radical prostatectomy is described. The technique allows the prostate gland to be shelled out from under the overlying detrusor apron and dorsal vascular complex (DVC-Santorini plexus), entirely avoiding the pubovesical ligaments. There is no need to control the DVC, since the line of dissection passes beneath the plexus. Three key points to ensure enhanced nerve preservation should be respected: (1) the tips of the seminal vesicles, enclosed in a "cage" of neuronal tissue; a seminal vesicle-sparing technique is therefore advised when oncologically safe; (2) the external prostate-vesicular angle; (3) the lateral surface of the prostate gland and the apex. The principles of tension and energy-free dissection should guide all the maneuvers in order to minimize neuropathy. Using robotic technology, a complete intrafascial dissection of the prostate gland can be achieved through the Douglas space, reducing surgical trauma and providing excellent functional and oncological outcomes. PMID:26194970

  1. Cost comparison of robotic-assisted laparoscopic hysterectomy versus standard laparoscopic hysterectomy.

    PubMed

    Winter, Marc L; Leu, Szu-Yun; Lagrew, David C; Bustillo, Gerardo

    2015-12-01

    The aim of the study was to assess if the cost of robotic-assisted total laparoscopic hysterectomy is similar to the cost of standard laparoscopic hysterectomy when performed by surgeons past their initial learning curve. A retrospective chart review of all hysterectomies was performed for benign indications without concomitant major procedures at Orange Coast Memorial Medical Center (OCMMC) and Saddleback Memorial Medical Center between January 1, 2013 and September 30, 2013. Robotic-assisted total laparoscopic hysterectomies (RTLH) and standard laparoscopic hysterectomies (LAVH and TLH) were compared. Data analyzed included only those hysterectomies performed by surgeons past their initial learning curve (minimum of 30 previous robotic cases). The primary outcome was the direct total cost of patient's hospitalization related to hysterectomy. The secondary outcomes were estimated blood loss, surgery time, and days in hospital post-surgery. A multiple linear regression model was applied to evaluate the difference between RTLH and LAVH/TLH in hospital cost, blood loss, and surgery time, while adjusting for hospital, patient's age, body mass index (BMI), whether or not the patient had previous abdominal/pelvic surgery, and uterine weight. The ? (2) test was applied to examine the association between hospital stay and surgery type. There were 93 hysterectomies (5 LAVH, 88 RTLH) performed at OCMMC and 90 hysterectomies (6 LAVH, 17 TLH, 67 RTLH) performed at Saddleback Memorial Medical Center. The hospitalization total cost result showed that, after adjusting for hospital, age, BMI, previous abdominal/pelvic surgery, and uterine weight, RTLH was not significantly more expensive than LAVH/TLH (mean diff. = $283.1, 95 % CI = [-569.6, 1135.9]; p = 0.51) at the 2 study hospitals. However, the cost at OCMMC was significantly higher than Saddleback Memorial Medical Center (mean diff. = $2008.7, 95 % CI = [1380.6, 2636.7]; p < 0.0001); and the cost increased significantly with uterine weight (? = 3.8, 95 % CI = [2.3, 5.3]; p < 0.0001). Further analysis showed significantly less blood loss (mean diff. = -78.5 ml, 95 % CI = [-116.8, -40.3]; p < 0.0001) and shorter surgery time (mean diff. = -21.9 min., 95 % CI = [-39.6, -4.2]; p = 0.016) for RTLH versus LAVH/TLH. There was no significant association between hospital stay and surgery type (p = 0.43). After adjusting for patient-level covariates, there was no statistically significant cost difference of performing robotically assisted laparoscopic hysterectomy versus standard laparoscopic hysterectomy when performed by surgeons past their initial learning curve at two community hospitals. PMID:26530837

  2. Pelvic Inflammatory Disease (PID) Treatment

    MedlinePLUS

    ... Pelvic Inflammatory Disease (PID) STDs & Infertility STDs & Pregnancy Syphilis Trichomoniasis Other STDs See Also Pregnancy Reproductive Health ... Pelvic Inflammatory Disease (PID) STDs & Infertility STDs & Pregnancy Syphilis Trichomoniasis Other STDs See Also Pregnancy Reproductive Health ...

  3. Pelvic Inflammatory Disease (PID) Statistics

    MedlinePLUS

    ... STD on Facebook Sexually Transmitted Diseases (STDs) Pelvic Inflammatory Disease (PID) Statistics Recommend on Facebook Tweet Share Compartir ... Disease (PID) (November 17, 2015) Figure F. Pelvic Inflammatory Disease — Trends in Lifetime Prevalence of Treatment Among ...

  4. Single Incision Laparoscopic Myomectomy

    PubMed Central

    Ramesh, B; Vidyashankar, Madhuri; Bharathi, BV

    2011-01-01

    Single port laparoscopic surgery (SPLS), also called SILS is the natural extension of multi-incisional laparoscopic surgery, in the quest for reduction of traumatic insult and residual scarring to the patient. Today with the evolution of newer instruments, bidirectional self-retaining sutures, and surgical experience we are able to perform many surgeries in gynecology. PMID:22442539

  5. Laparoscopic triple cholecystectomy.

    PubMed

    Mottin, Cláudio Corá; Toneto, Marcelo Garcia; Padoin, Alexandre Vontobel

    2004-06-01

    Gallbladder triplication is an unusual congenital biliary malformation, and its laparoscopic management has not been described. We report the 11th case of gallbladder triplication and the first successfully treated with laparoscopic cholecystectomy. We consider the procedure reliable and safe, after proper identification of the common biliary duct. PMID:15471024

  6. [PELVIC FLOOR RECONSTRUCTION AFTER PELVIC EVISCERATION USING GRACILIS MUSCULOCUTANEOUS FLAP].

    PubMed

    Pavlov, V N; Bakirov, A A; Kabirov, I R; Izmajlov, A A; Kutlijarov, L M; Safiullin, R L; Urmancev, M F; Sultanov, I M; Abdrahimov, R V

    2015-01-01

    Evisceration of the pelvic organs (EPO) is a fairly uncommon surgical treatment that removes all organs from a patient's pelvic cavity. We use gracilis musculocutaneous flap to repair pelvic floor after EPO. Over the period from November 2013 to December 2014 we carried out EPO with reconstructive repair of the pelvic floor with gracilis musculocutaneous flap in 10 patients with locally advanced pelvic tumors. We describe the surgical procedure and surgical outcomes in these patients. Mean age of the patients was 55 years. Mean duration of EPO with the pelvic floor repair was 285 min., mean blood loss--595 mL and the average length of hospital stay--19 days. Gracilis musculocutaneous flap has a sufficient arterial supply and mobility for pelvic floor reconstruction. Necrosis of flap's distal edge occurred in one of the 10 clinical cases, while the remaining flaps were fully preserved. Complete healing of wounds with no signs of weakening of the pelvic floor muscles was observed in all cases. Pelvic floor reconstruction is an essential procedure in order to reduce complications associated with the evisceration of the pelvic organs. The Gracilis musculocutaneous flap is the logical alternative to repair pelvic floor defect. It does not contribute to complications like functional deficiency of the lower limbs, complications of stoma formation or weakening of the muscles of the anterior abdominal wall. PMID:26390558

  7. Laparoscopic and robotic surgical training in urology.

    PubMed

    Hoznek, András; Katz, Ran; Gettman, Matthew; Salomon, Laurent; Antiphon, Patrick; de la Taille, Alexandre; Yiou, René; Chopin, Dominique; Abbou, Clément-Claude

    2003-04-01

    The most important change in urology during the past decade was the development of minimally invasive surgery, particularly laparoscopy. However, the main drawback of laparoscopy is a steep learning curve, which results from the significant changes in the surgical environment. Although laparoscopy can provide important advantages for the patient, including decreased length of hospitalization, decreased analgesic requirement, and a shortened postoperative convalescence, one concern has been whether laparoscopic techniques should be learned solely in the operating room. For example, sports, music, and aviation are practiced before an actual performance is ever undertaken. In this review, the advantages and limitations of all available training modalities in minimally invasive surgery are described. Testing basic laparoscopic skills on inanimate models, becoming familiar with the principles of dissection and hemostasis on living animals, and studying surgical anatomy on cadavers should be considered as indispensable and complementary elements for laparoscopic training in the future. In addition, telementoring with the help of modern image processing and virtual reality eventually may become the basis of tomorrow's surgical instruction. PMID:12648430

  8. Pelvic inflammatory disease

    PubMed Central

    2013-01-01

    Introduction Pelvic inflammatory disease is caused by infection of the upper female genital tract and is often asymptomatic. Pelvic inflammatory disease is the most common gynaecological reason for admission to hospital in the US, and is diagnosed in approximately 1% of women aged 16 to 45 years consulting their GP in England and Wales. Methods and outcomes We conducted a systematic review and aimed to answer the following clinical questions: How do different antimicrobial regimens compare when treating women with confirmed pelvic inflammatory disease? What are the effects of routine antibiotic prophylaxis to prevent pelvic inflammatory disease before intrauterine contraceptive device (IUD) insertion? We searched: Medline, Embase, The Cochrane Library, and other important databases up to September 2013 (Clinical Evidence reviews are updated periodically; please check our website for the most up to date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA), the European Medicines Agency (EMA), and the UK Medicines and Healthcare products Regulatory Agency (MHRA). Results We found 13 RCTs or systematic reviews of RCTs that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. Conclusions In this systematic review, we present information relating to the effectiveness and safety of the following interventions: antibiotics (oral, parenteral, different durations, different regimens) and routine antibiotic prophylaxis (before intrauterine device insertion in women at high risk or low risk). PMID:24330771

  9. [Pelvic bone angiomas].

    PubMed

    Christ, F; Siemes, H D; Stiens, R

    1984-01-01

    Three patients were seen with angiomas of the pelvic bones; the radiological and clinical features are described and the literature reviewed. The patients had been observed for four to six years. The differential diagnosis includes infiltrating mesenchymal neoplasms and the histologically similar, but rare, Gorham-Stout syndrome. Recommended treatment is irradiation, which is effective up to a point. PMID:6420271

  10. The Anatomy of Learning Anatomy

    ERIC Educational Resources Information Center

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

    2010-01-01

    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.…

  11. A three-dimensional reconstructive study of pelvic cavity in the New Zealand rabbit (Oryctolagus cuniculus).

    PubMed

    Özkadif, Sema; Eken, Emrullah; Kalayc?, Ibrahim

    2014-01-01

    The present study has been performed to reveal biometrical aspects and diameter-related differences in terms of sexes regarding pelvic cavity via three-dimensional (3D) reconstruction by using multidetector computed tomography (MDCT) images of pelvic cavity of the New Zealand rabbit. A total of 16 adult New Zealand rabbits, including 8 males and 8 females, were used in this study. Under anesthesia, the images obtained from MDCT were stacked and overlaid to reconstruct the 3D model of the pelvic cavity using 3D modeling software (Mimics 13.1). Measurements, such as the conjugate, transverse, and vertical diameters of the pelvic cavity, and the pelvic inclination were calculated and analyzed statistically. Biometrical differences of the pelvic diameters in New Zealand rabbits of both sexes were shown clearly. It was concluded that the pelvic diameters revealed by 3D modeling techniques can shed light on medical students who take both anatomy training and gynecological applications. The authors hope that the synchronization of medical approaches may give rise to novel diagnostic and therapeutic developments related to pelvic cavity. PMID:25379534

  12. [Preoperative evaluation of laparoscopic surgery for colorectal cancer with a virtual three-dimensional multi-imaging].

    PubMed

    Takemasa, Ichiro; Yamamoto, Hirofumi; Doki, Yuichiro; Mori, Masaki

    2014-01-01

    Intraoperative palpation around the target organs and an overview of the operative field are difficult to achieve in laparoscopic surgery for colorectal cancer. Understanding the three-dimensional anatomy of the target organs and the neighboring structures along with a precise preoperative diagnosis is essential in individual cases for completion of an appropriate laparoscopic procedure. A routine virtual three-dimensional multi-imaging integrating PET/MDCT, CT colonography and CT angiography is useful for a precise diagnosis. Local anatomy and patient's features directly affect surgical outcome, especially in the laparoscopic surgery for the rectal cancer. CT pelvimetry is useful for a preoperative prediction of the difficulties of the laparoscopic surgery. These data should be taken into account when planning this procedure. PMID:24597352

  13. Thymus Gland Anatomy

    MedlinePLUS

    ... Browse Search Quick Search Image Details Thymus Gland Anatomy Adult View/Download: Small: 720x576 View Download Add to My Pictures Title: Thymus Gland Anatomy Adult Description: Anatomy of the thymus gland; illustration ...

  14. Normal Pancreas Anatomy

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    ... Browse Search Quick Search Image Details Normal Pancreas Anatomy View/Download: Small: 761x736 View Download Add to My Pictures Title: Normal Pancreas Anatomy Description: Anatomy of the pancreas; drawing shows the ...

  15. Normal Female Reproductive Anatomy

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    ... My Pictures Browse Search Quick Search Image Details Reproductive System, Female, Anatomy View/Download: Small: 720x756 View Download Add to My Pictures Title: Reproductive System, Female, Anatomy Description: Anatomy of the female reproductive ...

  16. Artery to Cystic Duct: A Consistent Branch of Cystic Artery Seen in Laparoscopic Cholecystectomy

    PubMed Central

    Rashid, Arshad; Mushtaque, Majid; Bali, Rajandeep Singh; Nazir, Saima; Khuroo, Suhail; Ishaq, Sheikh

    2015-01-01

    Uncontrolled arterial bleeding during laparoscopic cholecystectomy is a serious problem and may increase the risk of bile duct damage. Therefore, accurate identification of the anatomy of the cystic artery is very important. Cystic artery is notoriously known to have a highly variable branching pattern. We reviewed the anatomy of the cystic artery and its branch to cystic duct as seen through the video laparoscope. A single artery to cystic duct with the classical “H-configuration” was demonstrated in 161 (91.47%) patients. This branch may cause troublesome bleeding during laparoscopic dissection in the hepatobiliary triangle. Careful identification of artery to cystic duct is helpful in the proper dissection of Calot's triangle as it reduces the chances of hemorrhage and thus may also be helpful in prevention of extrahepatic biliary radical injuries. PMID:26240761

  17. Pelvic ultrasound in women.

    PubMed

    Sivyer, P

    2000-02-01

    High-resolution pelvic ultrasound (US) has much to offer the surgical assessment of female patients. Endovaginal and transperineal scanning as well as graded compression technique now supplement conventional transabdominal US. The application of duplex and color Doppler technology further enhances the information obtained, all contributing to improved diagnostic accuracy. The clinical indications for sonography as well as the salient features of common gynecologic, obstetric, and gastrointestinal disorders are discussed, as is the role of US guided intervention. PMID:10633146

  18. Gallbladder removal - laparoscopic - discharge

    MedlinePLUS

    ... laparoscopic cholecystectomy will take about 1 to 3 weeks for most people. You may have some of ... pain should ease over several days to a week. A sore throat from the breathing tube. Sucking ...

  19. Laparoscopic Spleen Removal (Splenectomy)

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    ... Login Laparoscopic Spleen Removal (Splenectomy) Patient Information from SAGES Download PDF Version Find a SAGES Surgeon What ... 2015 CME Credits Healthy Sooner: Patient Information Contact SAGES Society of American Gastrointestinal and Endoscopic Surgeons 11300 ...

  20. Laparoscopic Inguinal Hernia Repair

    MedlinePLUS

    ... Laparoscopic Inguinal Hernia Repair Surgery Patient Information from SAGES Download PDF Version Find a SAGES Surgeon About ... 2015 CME Credits Healthy Sooner: Patient Information Contact SAGES Society of American Gastrointestinal and Endoscopic Surgeons 11300 ...

  1. Laparoscopic Adrenal Gland Removal

    MedlinePLUS

    ... Laparoscopic Adrenal Gland Removal (Adrenalectomy) Patient Information from SAGES Download PDF Version Find a SAGES Surgeon What ... 2015 CME Credits Healthy Sooner: Patient Information Contact SAGES Society of American Gastrointestinal and Endoscopic Surgeons 11300 ...

  2. Laparoscopic Ventral Hernia Repair

    MedlinePLUS

    ... Login Laparoscopic Ventral Hernia Repair Patient Information from SAGES Download PDF Version Find a SAGES Surgeon Approximately ... 2015 CME Credits Healthy Sooner: Patient Information Contact SAGES Society of American Gastrointestinal and Endoscopic Surgeons 11300 ...

  3. Laparoscopic Colon Resection

    MedlinePLUS

    ... Login Laparoscopic Colon Resection Surgery Patient Information from SAGES Download PDF Version Find a SAGES Surgeon About ... 2015 CME Credits Healthy Sooner: Patient Information Contact SAGES Society of American Gastrointestinal and Endoscopic Surgeons 11300 ...

  4. Anatomy of the Eye

    MedlinePLUS

    ... Conditions Frequently Asked Questions Español Condiciones Chinese Conditions Anatomy of the Eye En Español Read in Chinese External (Extraocular) Anatomy Extraocular Muscles: There are six muscles that are ...

  5. Laparoscopic vs mini-incision open appendectomy

    PubMed Central

    Çiftçi, Fatih

    2015-01-01

    AIM: To compare laparoscopic vs mini-incision open appendectomy in light of recent data at our centre. METHODS: The data of patients who underwent appendectomy between January 2011 and June 2013 were collected. The data included patients’ demographic data, procedure time, length of hospital stay, the need for pain medicine, postoperative visual analog scale of pain, and morbidities. Pregnant women and patients with previous lower abdominal surgery were excluded. Patients with surgery converted from laparoscopic appendectomy (LA) to mini-incision open appendectomy (MOA) were excluded. Patients were divided into two groups: LA and MOA done by the same surgeon. The patients were randomized into MOA and LA groups a computer-generated number. The diagnosis of acute appendicitis was made by the surgeon with physical examination, laboratory values, and radiological tests (abdominal ultrasound or computed tomography). All operations were performed with general anaesthesia. The postoperative vision analog scale score was recorded at postoperative hours 1, 6, 12, and 24. Patients were discharged when they tolerated normal food and passed gas and were followed up every week for three weeks as outpatients. RESULTS: Of the 243 patients, 121 (49.9%) underwent MOA, while 122 (50.1%) had laparoscopic appendectomy. There were no significant differences in operation time between the two groups (P = 0.844), whereas the visual analog scale of pain was significantly higher in the open appendectomy group at the 1st hour (P = 0.001), 6th hour (P = 0.001), and 12th hour (P = 0.027). The need for analgesic medication was significantly higher in the MOA group (P = 0.001). There were no differences between the two groups in terms of morbidity rate (P = 0.599). The rate of total complications was similar between the two groups (6.5% in LA vs 7.4% in OA, P = 0.599). All wound infections were treated non-surgically. Six out of seven patients with pelvic abscess were successfully treated with percutaneous drainage; one patient required surgical drainage after a failed percutaneous drainage. There were no differences in the period of hospital stay, operation time, and postoperative complication rate between the two groups. Laparoscopic appendectomy decreases the need for analgesic medications and the visual analog scale of pain. CONCLUSION: The laparoscopic appendectomy should be considered as a standard treatment for acute appendicitis. Mini-incision appendectomy is an alternative for a select group of patients. PMID:26525039

  6. Workshop in clinical anatomy for residents in gynecology and obstetrics.

    PubMed

    Macchi, V; Munari, P F; Brizzi, E; Parenti, A; De Caro, R

    2003-09-01

    A workshop in the clinical anatomy of the female pelvic viscera has been part of the training program for the first year residents in Gynecology and Obstetrics at the University of Padova since the 1999-2000 academic year. The purpose of the workshop is to offer a direct experience of practical anatomy despite a shortage of cadavers. It is designed for six residents who work in three teams on three specimens. The anatomical specimens are unembalmed, unfixed, female pelvic visceral blocs that are harvested from the cadavers 24 hr after death. They are stored at -12 degrees C and removed from the freezer 12 hr before the workshop. The workshop is 3 hr in length and has two parts: one on theory and one practical. In the theoretical section (30 min), the teacher presents the topographical anatomy of the specimens and the residents analyze a clinically oriented worksheet. In the practical section (2 hr), the residents identify viscera, vessels, and nerves through inspection and palpation, and then a step-by-step dissection is carried out. In the last section (30 min), the workshop includes presentations on the three specimens that illustrate anatomical variability and assess knowledge of topographical anatomy. For many residents, this is the first practical experience of the anatomy of the female pelvic viscera because the anatomical courses for medical students do not include direct dissection by students. The unfixed viscera preserves the natural characteristics of the different tissues that exhibit the aspects of living organs, such as color, softness, and pliability, enhancing the knowledge of anatomy. The worksheet is structured as a guide to the anatomical basis of physical examination through inspection and palpation of the viscera. It also introduces the residents to the surgical anatomy of the female pelvis through a brief and selective dissection focused on the relationship between the different regional systems. PMID:12903067

  7. Hemobilia post laparoscopic cholecystectomy

    PubMed Central

    Bin Traiki, Thamer A.; Madkhali, Ahmad A.; Hassanain, Mazen M.

    2015-01-01

    Hepatic artery pseudoaneurysm is a rare complication of laparoscopic cholecystectomy. A high index of suspicion and early identification and therapy are important points needed to prevent rupture. We report a case of complex biliary and vascular injuries 4 weeks after a laparoscopic cholecystectomy. The patient had recurrent bleeding from a hepatic artery pseudoaneurysm that has been treated successfully with angiographic stenting and embolization. PMID:25666365

  8. Laparoscopic repair of recurrent lateral enterocele and rectocele.

    PubMed

    Solomon, Ellen R; Muffly, Tyler M; Hull, Tracy; Paraiso, Marie Fidela R

    2015-01-01

    It is difficult to determine what types of procedures should be attempted in patients who have recurrent prolapse. We present a case of recurrent lateral enterocele and rectocele after the patient had undergone multiple surgeries for pelvic organ prolapse (POP), including a vaginal hysterectomy, bladder-neck suspension, anterior colporrhaphy, site-specific rectocele repair, apical mesh implant, iliococcygeus vault suspension, and transobturator suburethral sling procedure. With recurrence, the patient underwent robot-assisted laparoscopic sacral colpopexy, tension-free vaginal tape transobturator sling insertion, rectocele repair, and perineorrhaphy with cystoscopy. She then presented with defecatory outlet obstruction and constipation and subsequently was treated with a stapled transanal rectal resection. The patient returned with continued defecatory dysfunction and a recurrent lateral enterocele and rectocele. The recurrence was treated laparoscopically using a lightweight polypropylene mesh. The postoperative period was uneventful. Two years later, the patient reported decreased defecatory symptoms and no further symptomatic prolapse. PMID:25224146

  9. Laparoscopic Repair of Left Lumbar Hernia After Laparoscopic Left Nephrectomy

    PubMed Central

    Milone, Luca; Gumbs, Andrew; Turner, Patricia

    2010-01-01

    Lumbar hernias, rarely seen in clinical practice, can be acquired after open or laparoscopic flank surgery. We describe a successful laparoscopic preperitoneal mesh repair of multiple trocar-site hernias after extraperitoneal nephrectomy. All the key steps including creating a peritoneal flap, reducing the hernia contents, and fixation of the mesh are described. A review of the literature on this infrequent operation is presented. Laparoscopic repair of lumbar hernias has all the advantages of laparoscopic ventral hernia repair. PMID:21333197

  10. Pancreatic insulinomas: Laparoscopic management.

    PubMed

    Antonakis, Pantelis T; Ashrafian, Hutan; Martinez-Isla, Alberto

    2015-11-10

    Insulinomas are rare pancreatic neuroendocrine tumors that are most commonly benign, solitary, and intrapancreatic. Uncontrolled insulin overproduction from the tumor produces neurological and adrenergic symptoms of hypoglycemia. Biochemical diagnosis is confirmed by the presence of Whipple's triad, along with corroborating measurements of blood glucose, insulin, proinsulin, C-peptide, ?-hydroxybutyrate, and negative tests for hypoglycemic agents during a supervised fasting period. This is accompanied by accurate preoperative localization using both invasive and non-invasive imaging modalities. Following this, careful preoperative planning is required, with the ensuing procedure being preferably carried out laparoscopically. An integral part of the laparoscopic approach is the application of laparoscopic intraoperative ultrasound, which is indispensable for accurate intraoperative localization of the lesion in the pancreatic region. The extent of laparoscopic resection is dependent on preoperative and intraoperative findings, but most commonly involves tumor enucleation or distal pancreatectomy. When performed in an experienced surgical unit, laparoscopic resection is associated with minimal mortality and excellent long-term cure rates. Furthermore, this approach confers equivalent safety and efficacy rates to open resection, while improving cosmesis and reducing hospital stay. As such, laparoscopic resection should be considered in all cases of benign insulinoma where adequate surgical expertise is available. PMID:26566426

  11. Pancreatic insulinomas: Laparoscopic management

    PubMed Central

    Antonakis, Pantelis T; Ashrafian, Hutan; Martinez-Isla, Alberto

    2015-01-01

    Insulinomas are rare pancreatic neuroendocrine tumors that are most commonly benign, solitary, and intrapancreatic. Uncontrolled insulin overproduction from the tumor produces neurological and adrenergic symptoms of hypoglycemia. Biochemical diagnosis is confirmed by the presence of Whipple’s triad, along with corroborating measurements of blood glucose, insulin, proinsulin, C-peptide, ?-hydroxybutyrate, and negative tests for hypoglycemic agents during a supervised fasting period. This is accompanied by accurate preoperative localization using both invasive and non-invasive imaging modalities. Following this, careful preoperative planning is required, with the ensuing procedure being preferably carried out laparoscopically. An integral part of the laparoscopic approach is the application of laparoscopic intraoperative ultrasound, which is indispensable for accurate intraoperative localization of the lesion in the pancreatic region. The extent of laparoscopic resection is dependent on preoperative and intraoperative findings, but most commonly involves tumor enucleation or distal pancreatectomy. When performed in an experienced surgical unit, laparoscopic resection is associated with minimal mortality and excellent long-term cure rates. Furthermore, this approach confers equivalent safety and efficacy rates to open resection, while improving cosmesis and reducing hospital stay. As such, laparoscopic resection should be considered in all cases of benign insulinoma where adequate surgical expertise is available. PMID:26566426

  12. Neurobiological Mechanisms of Pelvic Pain

    PubMed Central

    Leone Roberti Maggiore, Umberto; Candiani, Massimo

    2014-01-01

    Pelvic pain is a common condition which significantly deteriorates health-related quality of life. The most commonly identified causes of pain in the pelvic region are gynaecologic, urologic, gastrointestinal, neurological, and musculoskeletal. However, in up to 33% of patients the source of this symptom is not identified, frustrating both patients and health-care professionals. Pelvic pain may involve both the somatic and visceral systems, making the differential diagnosing challenging. This paper aimed to review the mechanisms involved in pelvic pain perception by analyzing the neural plasticity and molecules which are involved in these complex circuits. PMID:25110704

  13. [A technic for laparoscopic gastrostomy].

    PubMed

    Kala, Z; Vomela, J; Hanke, I

    1995-08-01

    The authors describe the technique of laparoscopic gastrostomy and laparoscopic assisted gastrostomy. It is an alternative method for patients, when PEG (percutaneous endoscopic gastronomy) or other more physiologic way of food administration is not possible to perform. PMID:7482053

  14. Role of conventional radiology and MRi defecography of pelvic floor hernias

    PubMed Central

    2013-01-01

    Background Purpose of the study is to define the role of conventional radiology and MRI in the evaluation of pelvic floor hernias in female pelvic floor disorders. Methods A MEDLINE and PubMed search was performed for journals before March 2013 with MeSH major terms 'MR Defecography' and 'pelvic floor hernias'. Results The prevalence of pelvic floor hernias at conventional radiology was higher if compared with that at MRI. Concerning the hernia content, there were significantly more enteroceles and sigmoidoceles on conventional radiology than on MRI, whereas, in relation to the hernia development modalities, the prevalence of elytroceles, edroceles, and Douglas' hernias at conventional radiology was significantly higher than that at MRI. Conclusions MRI shows lower sensitivity than conventional radiology in the detection of pelvic floor hernias development. The less-invasive MRI may have a role in a better evaluation of the entire pelvic anatomy and pelvic organ interaction especially in patients with multicompartmental defects, planned for surgery. PMID:24267789

  15. [Pelvic ring injury].

    PubMed

    Pavelka, T; Dzupa, V; Rysavý, M; Grill, R; Báca, V; Skála-Rosenbaum, J; Chmelová, J; Otcenásek, M

    2006-12-01

    The authors compare their experience with the treatment of pelvic ring injuries with the literature data concerning the etiology, diagnosis and classification of this trauma, co-existing pathologies, primary therapeutic procedures, timing of the definitive treatment, surgical approaches, osteosynthesis of the posterior and anterior segments, complications and lasting sequelae. The authors regard the issue of surgical treatment as an independent discipline in the field of musculoskeletal system traumatology. They see the reason for it in the variability and complexity of primary therapeutic procedures and the necessity of following up and attending to the patients in whom treatment of complications and lasting sequelae requires multi-disciplinary co-operation. PMID:17266844

  16. Regulatory Anatomy

    PubMed Central

    2015-01-01

    This article proposes the term “safety logics” to understand attempts within the European Union (EU) to harmonize member state legislation to ensure a safe and stable supply of human biological material for transplants and transfusions. With safety logics, I refer to assemblages of discourses, legal documents, technological devices, organizational structures, and work practices aimed at minimizing risk. I use this term to reorient the analytical attention with respect to safety regulation. Instead of evaluating whether safety is achieved, the point is to explore the types of “safety” produced through these logics as well as to consider the sometimes unintended consequences of such safety work. In fact, the EU rules have been giving rise to complaints from practitioners finding the directives problematic and inadequate. In this article, I explore the problems practitioners face and why they arise. In short, I expose the regulatory anatomy of the policy landscape. PMID:26139952

  17. Laparoscopic surgery in weightlessness

    NASA Technical Reports Server (NTRS)

    Campbell, M. R.; Billica, R. D.; Jennings, R.; Johnston, S. 3rd

    1996-01-01

    BACKGROUND: Performing a surgical procedure in weightlessness has been shown not to be any more difficult than in a 1g environment if the requirements for the restraint of the patient, operator, and surgical hardware are observed. The feasibility of performing a laparoscopic surgical procedure in weightlessness, however, has been questionable. Concerns have included the impaired visualization from the lack of gravitational retraction of the bowel and from floating debris such as blood. METHODS: In this project, laparoscopic surgery was performed on a porcine animal model in the weightlessness of parabolic flight. RESULTS: Visualization was unaffected due to the tethering of the bowel by the elastic mesentery and the strong tendency for debris and blood to adhere to the abdominal wall due to surface tension forces. CONCLUSIONS: There are advantages to performing a laparoscopic instead of an open surgical procedure in a weightless environment. These will become important as the laparoscopic support hardware is miniaturized from its present form, as laparoscopic technology becomes more advanced, and as more surgically capable crew medical officers are present in future long-duration space-exploration missions.

  18. Pelvic Insufficiency Fractures

    PubMed Central

    O’Connor, Timothy J.

    2014-01-01

    Pelvic insufficiency fractures may occur in the absence of trauma or as a result of low-energy trauma in osteoporotic bone. With a growing geriatric population, the incidence of pelvic insufficiency fracture has increased over the last 3 decades and will continue to do so. These fractures can cause considerable pain, loss of independence, and economic burden to both the patient and the health care system. While many of these injuries are identified and treated based on plain radiographs, some remain difficult to diagnose. The role of advanced imaging in these cases is discussed. In addition to treating the fracture, medical comorbidities contributing to osteoporosis should be identified and corrected. Specific attention has been given to 25-OH serum vitamin D screening and repletion. Treatment generally consists of providing pain control and assisting patients with mobilization while allowing weight bearing as tolerated. In those unable to do so, invasive techniques such as sacroplasty as well as internal fixation may be beneficial. The role of operative fixation in insufficiency fractures is also discussed. PMID:26246940

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

    PubMed Central

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

    2013-01-01

    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. PMID:23925014

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

    PubMed

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

    2013-10-01

    "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

  1. Pediatric laparoscopic dismembered pyeloplasty.

    PubMed

    Peters, C A; Schlussel, R N; Retik, A B

    1995-06-01

    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 patient was discharged home 36 hours after the procedure. The nephrostomy tube was removed 10 days postoperatively after radiographic demonstration of patency and 24 hours of clamping without pain. Followup excretory urography at 6 weeks showed much less hydronephrosis and a widely patent anastomosis. Our case illustrates the technical features and feasibility of laparoscopic pyeloplasty in children, and should encourage further development of pediatric urological reconstructive laparoscopic techniques. PMID:7752371

  2. Pelvic assessment and cephalo-pelvic disproportion in Central Tanzania.

    PubMed

    Bauer, O; Kingu, R; Laussen, T; Mbwana, K

    1988-12-01

    Among 201 primigravidae, pelvic assessment was analyzed prospectively during the third trimester to detect patients likely to suffer from cephalo-pelvic disproportion (CPD). If the sacral promontory (SP) was reached by the index finger (9.0-9.5 cm true conjugate) the pelvis was regarded as "suspect". All patients who later developed CPD were in this group. Of the screened primigravidas, 22% were advised to deliver in the hospital. Pelvic assessment is an important screening tool during antenatal care to detect high-risk primigravidas. PMID:2904892

  3. Laparoscopic Removal of Gossypiboma

    PubMed Central

    Özsoy, Zeki; Okan, Ismail; Daldal, Emin; Das?ran, Mehmet Fatih; Ang?n, Yavuz Selim; ?ahin, Mustafa

    2015-01-01

    Gossypiboma is defined as a mass caused by foreign body reaction developed around the retained surgical item in the operative area. When diagnosed, it should be removed in symptomatic patients. Minimal invasive surgery should be planned for the removal of the retained item. The number of cases treated by laparoscopic approach is rare in the literature. We present a case of forty-year-old woman referred to emergency room with acute abdomen diagnosed as gossypiboma and treated successfully with laparoscopic surgery. PMID:26451270

  4. Segmentation of Uterus Using Laparoscopic Ultrasound by an Image-Based Active Contour Approach for Guiding Gynecological Diagnosis and Surgery

    PubMed Central

    Gong, Xue-Hao; Lu, Jun; Liu, Jin; Deng, Ying-Yuan; Liu, Wei-Zong; Huang, Xian; Yang, Yong-Heng; Xu, Qin; Yu, Zhi-Ying

    2015-01-01

    In laparoscopic gynecologic surgery, ultrasound has been typically implemented to diagnose urological and gynecological conditions. We applied laparoscopic ultrasonography (using Esaote 7.5~10MHz laparoscopic transducer) on the retrospective analyses of 42 women subjects during laparoscopic extirpation and excision of gynecological tumors in our hospital from August 2011 to August 2013. The objective of our research is to develop robust segmentation technique for isolation and identification of the uterus from the ultrasound images, so as to assess, locate and guide in removing the lesions during laparoscopic operations. Our method enables segmentation of the uterus by the active contour algorithm. We evaluated 42 in-vivo laparoscopic images acquired from the 42 patients (age 39.1 ± 7.2 years old) and selected images pertaining to 4 cases of congenital uterine malformations and 2 cases of pelvic adhesions masses. These cases (n = 6) were used for our uterus segmentation experiments. Based on them, the active contour method was compared with the manual segmentation method by a medical expert using linear regression and the Bland-Altman analysis (used to measure the correlation and the agreement). Then, the Dice and Jaccard indices are computed for measuring the similarity of uterus segmented between computational and manual methods. Good correlation was achieved whereby 84%–92% results fall within the 95% confidence interval in the Student t-test) and we demonstrate that the proposed segmentation method of uterus using laparoscopic images is effective. PMID:26516767

  5. Explorable Three-Dimensional Digital Model of the Female Pelvis, Pelvic Contents, and Perineum for Anatomical Education

    ERIC Educational Resources Information Center

    Sergovich, Aimee; Johnson, Marjorie; Wilson, Timothy D.

    2010-01-01

    The anatomy of the pelvis is complex, multilayered, and its three-dimensional organization is conceptually difficult for students to grasp. The aim of this project was to create an explorable and projectable stereoscopic, three-dimensional (3D) model of the female pelvis and pelvic contents for anatomical education. The model was created using…

  6. Laparoscopic Pectopexy: A Prospective, Randomized, Comparative Clinical Trial of Standard Laparoscopic Sacral Colpocervicopexy with the New Laparoscopic Pectopexy—Postoperative Results and Intermediate-Term Follow-Up in a Pilot Study

    PubMed Central

    Schiermeier, Sven; Alkatout, Ibrahim; Anapolski, Michael

    2015-01-01

    Abstract Purpose: The purpose of the study was to compare the outcome of laparoscopic sacral colpocervicopexy with laparoscopic pectopexy. Our aim was to show that the safety and effectiveness of the new technique is similar to the traditional technique. We expected differences regarding defecation disorders. Patients and Methods: We randomly assigned patients to two treatment groups: 44 in the pectopexy and 41 in the sacropexy group. If necessary, the operative procedures were planned in a so-called multicompartment setting regarding the different pelvic floor disorders. All defects were managed at the same time. Eighty-one patients were examined 12 to 37 months after treatment (mean follow-up 20.67 months). Results: The long-term follow-up (21.8 months for pectopexy and 19.5 months for sacropexy) showed a clear difference regarding de novo defecation disorders (0% in the pectopexy vs 19.5% in the sacropexy group). The incidence of de novo stress urinary incontinence was 4.8% (pectopexy) vs 4.9% (sacropexy). The incidence of rectoceles (9.5% vs 9.8%) was similar in both groups. No de novo lateral defect cystoceles were found after pectopexy, whereas 12.5% were found after sacropexy. The apical descensus relapse rates, 2.3% for pectopexy vs 9.8% for sacropexy, were not statistically significant. The occurrence of de novo anterior defect cystoceles and rectoceles revealed no significant differences. Conclusion: Laparoscopic pectopexy is a novel method of vaginal prolapse therapy that offers clear practical advantages compared with laparoscopic sacropexy. Because laparoscopic pectopexy does not reduce the pelvic space, it results in a zero percentage of defecation disorders. PMID:25350228

  7. Recent advances in laparoscopic surgery.

    PubMed

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

    2013-02-01

    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

  8. Percutaneous transhepatic cholangiography for choledocholithiasis after laparoscopic gastric bypass surgery

    PubMed Central

    Milella, Marialessia; Alfa-Wali, Maryam; Leuratti, Luca; McCall, James; Bonanomi, Gianluca

    2014-01-01

    INTRODUCTION Gallstones are a common condition in bariatric patients after a laparoscopic Roux-en-Y gastric bypass (LRYGB). The management of ductal stones is challenging due to the altered gastrointestinal anatomy. Various techniques have been reported to manage bile duct stones. PRESENTATION OF CASE We present the successful percutaneous trans hepatic management of common bile duct stones after LRYGB. One year after a LRYGB for morbid obesity, a 59-year-old female presented with acute cholecystitis. One month after laparoscopic cholecystectomy a 1 cm calculus was found within the distal CBD and patient underwent a percutaneous trans hepatic cholangiography under local anesthetic. This involved a right sided anterior segmental duct puncture. With the sphincter dilated to 10 mm, a balloon catheter was used to push the stone into the duodenum leaving an internal- external drain. Patient recovered completely at follow up. DISCUSSION Patients with morbid obesity have a higher incidence of gallstones. After LRYGB, the altered anatomy does not allow the conventional endoscopic retrograde cholangiopancreatography (ERCP) for choledocholithiasis. Various techniques have been reported as means of managing bile duct stones in LRYGB patients. These include a double balloon enteroscope-assisted ERCP, laparoscopic transgastric ERCP, laparoscopic or open biliary surgery and interventional radiology. We report a non-surgical approach using percutaneous transhepatic technique under local anesthetic that resulted effective and could be applied more extensively. CONCLUSION Due to the increase of global obesity, bariatric centers need to strategically plan resources such as interventional radiology in order to manage post LRYGB choledocholithiasis safely, efficiently and in a cost effective manner. PMID:24705194

  9. Multidetector CT angiography of renal vasculature: normal anatomy and variants.

    PubMed

    Türkvatan, Aysel; Ozdemir, Mustafa; Cumhur, Turhan; Olçer, Tülay

    2009-01-01

    Knowledge of the variations in renal vascular anatomy is important before laparoscopic donor or partial nephrectomy and vascular reconstruction for renal artery stenosis or abdominal aortic aneurysm. Recently, multidetector computed tomographic (MDCT) angiography has become a principal imaging investigation for assessment of the renal vasculature and has challenged the role of conventional angiography. It is an excellent imaging technique because it is a fast and non-invasive tool that provides highly accurate and detailed evaluation of normal renal vascular anatomy and variants. The number, size and course of the renal arteries and veins are easily identified by MDCT angiography. The purpose of this pictorial essay is to illustrate MDCT angiographic appearance of normal anatomy and common variants of the renal vasculature. PMID:18665365

  10. Pelvic floor muscle training exercises

    MedlinePLUS

    ... nlm.nih.gov/pubmed/22258946 . Dumoulin C, Hay-Smith J. Pelvic floor muscle training versus no treatment, ... nlm.nih.gov/pubmed/20091581 . Herderschee R, Hay-Smith EJC, Herbison GP, Roovers JP, Heineman MJ. Feedback ...

  11. Pelvic Organ Prolapse--Surgery

    MedlinePLUS

    ... This discussion will help you to determine the best procedure for you. Pelvic reconstructive surgery can be performed through an incision in the vagina, through an incision made through the abdominal wall, or through a series of small incisions ...

  12. Novel combined approach in the management of non-healing solitary rectal ulcer syndrome – laparoscopic resection rectopexy and transanal endoscopic microsurgery

    PubMed Central

    Martinek, Lubomir; Vavra, Petr; Zonca, Pavel

    2015-01-01

    Solitary rectal ulcer syndrome (SRUS) is an uncommon chronic disorder with a wide range of endoscopic findings, clinical presentations and characteristic histopathological features. There is no clear consensus regarding SRUS management, because of its poorly understood pathogenesis and frequent association with various pelvic floor disorders. Laparoscopic resection rectopexy and transanal endoscopic microsurgery (TEM) were used for the treatment of non-healing SRUS. The present paper reports a case of non-healing SRUS due to obstructive defecation syndrome based on combined pelvic floor disorders (rectocele, enterocele, internal rectal prolapse and dolichosigma) successfully managed by a novel combined mini-invasive approach which has never been previously reported in the literature (laparoscopic resection rectopexy and TEM). The new minimally invasive concept seems to be safe and feasible – laparoscopic resection rectopexy results in effective correction of the obstructive defecation syndrome, while TEM allows comfortable access for radical resection of a rectal ulcer. PMID:26240632

  13. Anatomy of the Eye

    MedlinePLUS

    ... Errors Scientists in the Laboratory Visual Acuity Testing Anatomy of the Eye Drawing of the Eye Drawing ... Eye Normally Developing Eye Drawing of the Eye Anatomy of the Eye Drawing of the Eye NEI ...

  14. Constipation and pelvic outlet obstruction.

    PubMed

    Hedrick, Traci L; Friel, Charles M

    2013-12-01

    Caring for patients with constipation and pelvic outlet obstruction can be challenging, requiring skill, patience, and empathy on the part of the medical professional. The mainstay of treatment is behavioral with surgery reserved for a select group of patients. The evaluation, diagnostic, and treatment modalities of both constipation and pelvic outlet with a focus on current advancements and technology are explored in depth. PMID:24280404

  15. Fertility Considerations in Laparoscopic Treatment of Infiltrative Bowel Endometriosis

    PubMed Central

    Mohr, Catherine; Nezhat, Farr R.; Nezhat, Ceana H.; Seidman, Daniel S.

    2005-01-01

    Objective: The purpose of this study was to examine our experience with laparoscopic and laparoscopically assisted management of bowel endometriosis and to recommend treatment approaches, considering patient goals for both pain mitigation or fertility, or both. Methods: The medical records of 187 women treated laparoscopically for intestinal endometriosis were reviewed retrospectively for presenting symptoms, methods of surgical treatment, complications, and efficacy of treating pain and infertility. The extent of resection was determined by the severity of the endometriotic lesion, tempered by the patient's fertility goals. Results: The most common patient complaint preceding surgery was pelvic pain. In addition, 58 (31%) patients experienced impaired fertility. Of the patients available for long-term follow-up, 152 (85%) reported complete or significant long-term pain relief. Complete pain relief in the immediate postoperative period was significantly more likely with partial bowel resection compared with shaving only, 92% vs 80%, respectively, P<0.04. The least invasive procedure, shaving, was associated with a significantly lower complication rate, 6%, compared with 23% for disc excision (P<0.007) and 38% for segmental resection (P<0.001), and higher pregnancy rates. The incidence of pregnancy in patients with a history of infertility was 34% during the follow-up period. PMID:15791964

  16. Post partum pelvic floor changes.

    PubMed

    Fonti, Ylenia; Giordano, Rosalba; Cacciatore, Alessandra; Romano, Mattea; La Rosa, Beatrice

    2009-10-01

    Pelvic-perineal dysfunctions, are the most common diseases in women after pregnancy. Urinary incontinence and genital prolapsy, often associated, are the most important consequences of childbirth and are determined by specific alterations in the structure of neurological and musculo-fascial pelvic support.Causation is difficult to prove because symptom occur remote from delivery.Furthermore it is unclear whether changes are secondary to the method of childbirth or to the pregnancy itself.This controversy fuels the debate about whether or not women should be offered the choice of elective caesarean delivery to avoid the development of subsequent pelvic floor disfunction.But it has been demonstrated that pregnancy itself, by means of mechanical changes of pelvic statics and changes in hormones, can be a significant risk factor for these diseases. Especially is the first child to be decisive for the stability of the pelvic floor.During pregnancy, the progressive increase in volume of the uterus subject perineal structures to a major overload. During delivery, the parties present and passes through the urogenital hiatus leading to growing pressure on the tissues causing the stretching of the pelvic floor with possible muscle damage, connective tissue and / or nervous.In this article we aim to describe genitourinary post partum changes with particular attention to the impact of pregnancy or childbirth on these changes. PMID:22439048

  17. Post partum pelvic floor changes

    PubMed Central

    Fonti, Ylenia; Giordano, Rosalba; Cacciatore, Alessandra; Romano, Mattea; La Rosa, Beatrice

    2009-01-01

    Pelvic-perineal dysfunctions, are the most common diseases in women after pregnancy. Urinary incontinence and genital prolapsy, often associated, are the most important consequences of childbirth and are determined by specific alterations in the structure of neurological and musculo-fascial pelvic support. Causation is difficult to prove because symptom occur remote from delivery. Furthermore it is unclear whether changes are secondary to the method of childbirth or to the pregnancy itself. This controversy fuels the debate about whether or not women should be offered the choice of elective caesarean delivery to avoid the development of subsequent pelvic floor disfunction. But it has been demonstrated that pregnancy itself, by means of mechanical changes of pelvic statics and changes in hormones, can be a significant risk factor for these diseases. Especially is the first child to be decisive for the stability of the pelvic floor. During pregnancy, the progressive increase in volume of the uterus subject perineal structures to a major overload. During delivery, the parties present and passes through the urogenital hiatus leading to growing pressure on the tissues causing the stretching of the pelvic floor with possible muscle damage, connective tissue and / or nervous. In this article we aim to describe genitourinary post partum changes with particular attention to the impact of pregnancy or childbirth on these changes. PMID:22439048

  18. Laparoscopic-Assisted Surgical Procedures.

    PubMed

    Steffey, Michele A

    2016-01-01

    Laparoscopic-assisted procedures allow a balance between the improved patient recoveries often associated with smaller incisions and the need for appropriate visualization of visceral organs/identification of lesions. The organ systems of small animal veterinary patients that are highly amenable to laparoscopic-assisted procedures include the urinary bladder, the gastrointestinal tract, and the reproductive tracts. Laparoscopic-assisted procedures are especially beneficial in the approach to luminal organs, allowing the organ incision to be exteriorized through the body wall, protecting the peritoneal cavity from contamination from luminal contents. Procedure-specific morbidities and patient selection should be considered when choosing between assisted laparoscopic and open approaches. PMID:26410563

  19. Virtual reality in laparoscopic surgery.

    PubMed

    Uranüs, Selman; Yanik, Mustafa; Bretthauer, Georg

    2004-01-01

    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

  20. Laparoscopic Salpingo-oophorectomy in Conscious Sedation

    PubMed Central

    Bramante, Silvia; Conti, Fiorella; Rizzi, Maria; Frattari, Antonella; Spina, Tullio

    2015-01-01

    Introduction: Conscious sedation has traditionally been used for laparoscopic tubal ligation. General anesthesia with endotracheal intubation may be associated with side effects, such as nausea, vomiting, cough, and dizziness, whereas sedation offers the advantage of having the patient awake and breathing spontaneously. Until now, only diagnostic laparoscopy and minor surgical procedures have been performed in patients under conscious sedation. Case Description: Our report describes 5 cases of laparoscopic salpingo-oophorectomy successfully performed with the aid of conventional-diameter multifunctional instruments in patients under local anesthesia. Totally intravenous sedation was provided by the continuous infusion of propofol and remifentanil, administered through a workstation that uses pharmacokinetic–pharmacodynamic models to titrate each drug, as well as monitoring tools for levels of conscious sedation and local anesthesia. We have labelled our current procedure with the acronym OLICS (Operative Laparoscopy in Conscious Sedation). Four of the patients had mono- or bilateral ovarian cysts and 1 patient, with the BRCA1 gene mutation and a family history of ovarian cancer, had normal ovaries. Insufflation time ranged from 19 to 25 minutes. All patients maintained spontaneous breathing throughout the surgical procedure, and no episodes of hypotension or bradycardia occurred. Optimal pain control was obtained in all cases. During the hospital stay, the patients did not need further analgesic drugs. All the women reported high or very high satisfaction and were discharged within 18 hours of the procedure. Discussion and Conclusion: Salpingo-oophorectomy in conscious sedation is safe and feasible and avoids the complications of general anesthesia. It can be offered to well-motivated patients without a history of pelvic surgery and low to normal body mass index. PMID:26175550

  1. The sacroiliac joint: an overview of its anatomy, function and potential clinical implications

    PubMed Central

    Vleeming, A; Schuenke, M D; Masi, A T; Carreiro, J E; Danneels, L; Willard, F H

    2012-01-01

    This article focuses on the (functional) anatomy and biomechanics of the pelvic girdle and specifically the sacroiliac joints (SIJs). The SIJs are essential for effective load transfer between the spine and legs. The sacrum, pelvis and spine, and the connections to the arms, legs and head, are functionally interrelated through muscular, fascial and ligamentous interconnections. A historical overview is presented on pelvic and especially SIJ research, followed by a general functional anatomical overview of the pelvis. In specific sections, the development and maturation of the SIJ is discussed, and a description of the bony anatomy and sexual morphism of the pelvis and SIJ is debated. The literature on the SIJ ligaments and innervation is discussed, followed by a section on the pathology of the SIJ. Pelvic movement studies are investigated and biomechanical models for SIJ stability analyzed, including examples of insufficient versus excessive sacroiliac force closure. PMID:22994881

  2. Medical & Surgical Management of Pelvic Floor Disorders Affecting Defecation

    PubMed Central

    Schey, Ron; Cromwell, John; Rao, Satish S.C.

    2014-01-01

    Pelvic floor disorders that affect stool evacuation include structural (example: rectocele) and functional disorders (example: dyssynergic defecation). Meticulous history, digital rectal examination, and physiological tests such as anorectal manometry, colonic transit study, balloon expulsion and imaging studies such as anal ultrasound, defecography, and static and dynamic MRI can facilitate an objective diagnosis and optimal treatment. Management consists of education and counseling regarding bowel function, diet, laxatives, most importantly behavioral and biofeedback therapies, and lastly surgery. Randomized clinical trials have established that biofeedback therapy is effective in treating dyssynergic defecation. Because dyssynergic defecation may co-exist with conditions such as solitary rectal ulcer syndrome (SRUS), and rectocele, before considering surgery, biofeedback therapy should be tried and an accurate assessment of the entire pelvis and its function should be performed. Several surgical approaches have been advocated for the treatment of pelvic floor disorders including open, laparoscopic and trans-abdominal approach, stapled transanal rectal resection (STARR), and robotic colon and rectal resections. However, there is lack of well controlled randomized studies and efficacy of these surgical procedures remains to be established. PMID:22907620

  3. Appraisal of laparoscopic cholecystectomy.

    PubMed Central

    Graves, H A; Ballinger, J F; Anderson, W J

    1991-01-01

    This paper reports the experience of three general surgeons performing 304 laparoscopic cholecystectomies in three private hospitals between October 1989 and November 1990. Laparoscopic cholecystectomy boasts two major advantages over the conventional procedure: the remarkable reduction in postoperative pain and economic benefit, largely due to the patient's early return to work. Revealing a complication rate of 2% and no deaths, this study has shown that this procedure can offer patients these advantages with a medical risk no greater than that accompanying conventional cholecystectomy. Patient safety must be paramount, and it is the responsibility of the surgical community to ensure that all surgeons receive the highest quality training and that the technique is applied appropriately. Images Fig. 3. Fig. 4. Fig. 5. Fig. 6. Fig. 7. PMID:1828140

  4. Safety and efficacy of hysteroscopic sterilization compared with laparoscopic sterilization: an observational cohort study

    PubMed Central

    Mao, Jialin; Pfeifer, Samantha; Schlegel, Peter

    2015-01-01

    Objective To compare the safety and efficacy of hysteroscopic sterilization with the “Essure” device with laparoscopic sterilization in a large, all-inclusive, state cohort. Design Population based cohort study. Settings Outpatient interventional setting in New York State. Participants Women undergoing interval sterilization procedure, including hysteroscopic sterilization with Essure device and laparoscopic surgery, between 2005 and 2013. Main outcomes measures Safety events within 30 days of procedures; unintended pregnancies and reoperations within one year of procedures. Mixed model accounting for hospital clustering was used to compare 30 day and 1 year outcomes, adjusting for patient characteristics and other confounders. Time to reoperation was evaluated using frailty model for time to event analysis. Results We identified 8048 patients undergoing hysteroscopic sterilization and 44?278 undergoing laparoscopic sterilization between 2005 and 2013 in New York State. There was a significant increase in the use of hysteroscopic procedures during this period, while use of laparoscopic sterilization decreased. Patients undergoing hysteroscopic sterilization were older than those undergoing laparoscopic sterilization and were more likely to have a history of pelvic inflammatory disease (10.3% v 7.2%, P<0.01), major abdominal surgery (9.4% v 7.9%, P<0.01), and cesarean section (23.2% v 15.4%, P<0.01). At one year after surgery, hysteroscopic sterilization was not associated with a higher risk of unintended pregnancy (odds ratio 0.84 (95% CI 0.63 to 1.12)) but was associated with a substantially increased risk of reoperation (odds ratio 10.16 (7.47 to 13.81)) compared with laparoscopic sterilization. Conclusions Patients undergoing hysteroscopic sterilization have a similar risk of unintended pregnancy but a more than 10-fold higher risk of undergoing reoperation compared with patients undergoing laparoscopic sterilization. Benefits and risks of both procedures should be discussed with patients for informed decisions making. PMID:26462857

  5. Laparoscopic Appendicectomy: Calculating the Cost

    PubMed Central

    Needham, PJ; Laughlan, KA; Botterill, ID; Ambrose, NS

    2009-01-01

    INTRODUCTION Laparoscopic appendicectomy is a commonly performed procedure presenting a considerable cost burden. Given the additional operative costs of laparoscopic versus open appendicectomy, it is not clear whether the national tariffs are appropriate for laparoscopic appendicectomy. We conducted a study to establish the institutional costs, and to determine whether re-imbursement according to the national tariffs was sufficient. PATIENTS AND METHODS Data were collected prospectively on patients undergoing laparoscopic appendicectomy within Leeds Teaching Hospitals Trust. Theatre and bed costs were obtained. Cost analysis was performed, and costs were compared to the re-imbursement due. RESULTS Fifty laparoscopic appendicectomies were performed. Median operative time was 60 min. The median total operative cost of laparoscopic appendicectomy was £906. Median equipment cost for laparoscopically completed cases was £254. Median total in-patient cost was £1617 (range, £880–£3360). This compared with a mean re-imbursement of £1981 representing a cost benefit of £233 per case (P = 0.0009). CONCLUSIONS Despite a liberal use of disposable equipment, laparoscopic appendicectomy can still be performed within the confines of the national tariffs. There is a considerable variation in the cost of this procedure, and it may be possible to reduce costs by more stringent use of disposable equipment and standardising recovery protocols. PMID:19558761

  6. Kegel Exercises for Your Pelvic Muscles

    MedlinePLUS

    ... strengthen the pelvic muscles, just like it takes time to improve the muscles in your arms, legs or abdomen. ... exercises can strengthen pelvic muscles. These exercises often improve bladder ... ______ times daily. I spent _____ minutes exercising. At each exercise ...

  7. How Are Pelvic Floor Disorders Commonly Treated?

    MedlinePLUS

    ... Information Clinical Trials Resources and Publications How are pelvic floor disorders commonly treated? Skip sharing on social media ... Treatment Nonsurgical treatments commonly used for PFDs include: Pelvic floor muscle training (PFMT). Also called Kegel (pronounced KEY- ...

  8. How Are Pelvic Floor Disorders Diagnosed?

    MedlinePLUS

    ... Information Clinical Trials Resources and Publications How are pelvic floor disorders diagnosed? Skip sharing on social media links ... fee ). This test is used to evaluate the pelvic floor and rectum while the patient is having a ...

  9. [Ultrasonography in acute pelvic pain].

    PubMed

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

    2002-01-01

    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

  10. Management of Pelvic Organ Prolapse

    PubMed Central

    Choi, Kyung Hwa

    2014-01-01

    Quality of life is adversely affected by pelvic organ prolapse, the prevalence of which is increasing because of the persistently growing older population. Today, the tension-free vaginal mesh kit has grown in popularity owing to its comparable cure rate to traditional reconstructive surgery and the feasibility of an early return to normal life. However, significant debate remains over the long-term cure rate and the safety of tension-free vaginal mesh in the United States. The U.S. Food and Drug Administration recommends obtaining informed consent about the safety and cure rate when the patient chooses surgery using the tension-free vaginal mesh kit or meshes before surgery. The goal of surgery for pelvic organ prolapse is the restoration of anatomic defects. This review article provides an overview of basic surgical techniques and the results, advantages, and disadvantages of surgery for pelvic organ prolapse. PMID:25405010

  11. Laparoscopic management of a two staged gall bladder torsion

    PubMed Central

    Sunder, Yadav Kamal; Akhilesh, Sali Priyanka; Raman, Garg; Deborshi, Sharma; Shantilal, Mehta Hitesh

    2015-01-01

    Gall bladder torsion (GBT) is a relatively uncommon entity and rarely diagnosed preoperatively. A constant factor in all occurrences of GBT is a freely mobile gall bladder due to congenital or acquired anomalies. GBT is commonly observed in elderly white females. We report a 77-year-old, Caucasian lady who was originally diagnosed as gall bladder perforation but was eventually found with a two staged torsion of the gall bladder with twisting of the Riedel’s lobe (part of tongue like projection of liver segment 4A). This together, has not been reported in literature, to the best of our knowledge. We performed laparoscopic cholecystectomy and she had an uneventful post-operative period. GBT may create a diagnostic dilemma in the context of acute cholecystitis. Timely diagnosis and intervention is necessary, with extra care while operating as the anatomy is generally distorted. The fundus first approach can be useful due to altered anatomy in the region of Calot’s triangle. Laparoscopic cholecystectomy has the benefit of early recovery.

  12. Chlamydophila abortus Pelvic Inflammatory Disease

    PubMed Central

    Meusburger, Herwig; Hotzel, Helmut; Oehme, Albrecht; Neunteufel, Walter; Dierich, Manfred P.; Würzner, Reinhard

    2003-01-01

    We report the first documented case of an extragestational infection with Chlamydophila abortus in humans. The pathogen was identified in a patient with severe pelvic inflammatory disease (PID) by sequence analysis of the ompA gene. Our findings raise the possibility that Chlamydiaceae other than Chlamydia trachomatis are involved in PID. PMID:14720414

  13. Bone Health and Pelvic Radiotherapy.

    PubMed

    Higham, C E; Faithfull, S

    2015-11-01

    Survivors who have received pelvic radiotherapy make up many of the long-term cancer population, with therapies for gynaecological, bowel, bladder and prostate malignancies. Individuals who receive radiotherapy to the pelvis as part of their cancer treatment are at risk of insufficiency fractures. Symptoms of insufficiency fractures include pelvic and back pain and immobility, which can affect substantially quality of life. This constellation of symptoms can occur within 2 months of radiotherapy up to 63 months post-treatment, with a median incidence of 6-20 months. As a condition it is under reported and evidence is poor as to the contributing risk factors, causation and best management to improve the patient's bone health and mobility. As radiotherapy advances, chronic symptoms, such as insufficiency fractures, as a consequence of treatment need to be better understood and reviewed. This overview explores the current evidence for the effect of radiotherapy on bone health and insufficiency fractures and identifies what we know and where gaps in our knowledge lie. The overview concludes with the need to take seriously complaints of pelvic pain from patients after pelvic radiotherapy and to investigate and manage these symptoms more effectively. There is a clear need for definitive research in this field to provide the evidence-based guidance much needed in practice. PMID:26276560

  14. From open radical hysterectomy to robot-assisted laparoscopic radical hysterectomy for early stage cervical cancer: aspects of a single institution learning curve

    PubMed Central

    Zweemer, R. P.; van Baal, W. M.; van de Lande, J.; Dijkstra, J. C.; Verheijen, R. H. M.

    2010-01-01

    We analysed the introduction of the robot-assisted laparoscopic radical hysterectomy in patients with early-stage cervical cancer with respect to patient benefits and surgeon-related aspects of a surgical learning curve. A retrospective review of the first 14 robot-assisted laparoscopic radical hysterectomies and the last 14 open radical hysterectomies in a similar clinical setting with the same surgical team was conducted. Patients were candidates for a laparoscopic sentinel node procedure, pelvic lymph node dissection and open radical hysterectomy (RH) before August 2006 and were candidates for a laparoscopic sentinel node procedure, pelvic lymph node dissection and robot-assisted laparoscopic radical hysterectomy (RALRH) after August 2006. Overall, blood loss in the open cases was significantly more compared with the robot cases. Median hospital stay after RALRH was 5 days less than after RH. The median theatre time in the learning period for the robot procedure was reduced from 9 h to less that 4 h and compared well to the 3 h and 45 min for an open procedure. Three complications occurred in the open group and one in the robot group. RALRH is feasible and of benefit to the patient with early stage cervical cancer by a reduction of blood loss and reduced hospital stay. Introduction of this new technique requires a learning curve of less than 15 cases that will reduce the operating time to a level comparable to open surgery. PMID:20700514

  15. Musculoskeletal morphology of the pelvis and pelvic fins in the lungfish Protopterus annectens.

    PubMed

    King, Heather M; Hale, Melina E

    2014-04-01

    The West African lungfish (Protopterus annectens) performs benthic, pelvic fin-driven locomotion with gaits common to tetrapods, the sister group of the lungfishes. Features of P. annectens movement are similar to those of modern tetrapods and include use of the distal region of the pelvic fin as a “foot,” use of the fin to lift the body above the substrate and rotation of the fin around the joint with the pelvis. In contrast to these similarities in movement, the pelvic fins of P. annectens are long, slender structures that are superficially very different from tetrapod limbs. Here, we describe the musculoskeletal anatomy of the pelvis and pelvic fins of P. annectens with dissection, magnetic resonance imaging, histology and 3D-reconstruction methods. We found that the pelvis is embedded in the hypaxial muscle by a median rostral and two dorsolateral skeletal projections. The protractor and retractor muscles at the base of the pelvic fin are fan-shaped muscles that cup the femur. The skeletal elements of the fin are serially repeating cartilage cylinders. Along the length of the fin, repeating truncated cones of muscles, the musculus circumradialis pelvici, are separated by connective tissue sheets that connect the skeletal elements to the skin. The simplicity of the protractor and retractor muscles at the base of the fin is surprising, given the complex rotational movement those muscles generate. In contrast, the series of many repeating segmental muscles along the length of the fin is consistent with the dexterity of bending of the distal limb. P. annectens can provide a window into softtissue anatomy and sarcopterygian fish fin function that complements the fossil data from related taxa. This work, combined with previous behavioral examination of P. annectens, illustrates that fin morphologies that do not appear to be capable of walking can accomplish that function, and may inform the interpretation of fossil anatomical evidence. PMID:24741713

  16. Laparoscopic intersphincteric resection and J-pouch reconstruction without laparotomy.

    PubMed

    Beppu, Naohito; Matsubara, Nagahide; Noda, Masashi; Kimura, Fumihiko; Yamanaka, Naoki; Yanagi, Hidenori; Tomita, Naohiro

    2015-05-01

    In some cases, a J-pouch is not created after laparoscopic intersphincteric resection (Lap-ISR), because this procedure usually does not involve laparotomy. This study aimed to develop a new technique for Lap-ISR and J-pouch reconstruction without laparotomy and to assess the short- and long-term outcomes of this technique. After a rectal specimen is excised using the transanal approach, the reconstructed intestine is reinserted into the intra-abdominal space. To create the J-shape, the reconstructed intestine is looped back using Allis forceps, and the septum of the J-shape is divided using a surgical stapler. We performed 20 surgeries using the new technique. Although three patients developed pelvic infections, no J-pouch-related complications were noted. Intestinal continuity could be maintained in all patients who received a diverting stoma. PMID:25208815

  17. Anatomy Comic Strips

    ERIC Educational Resources Information Center

    Park, Jin Seo; Kim, Dae Hyun; Chung, Min Suk

    2011-01-01

    Comics are powerful visual messages that convey immediate visceral meaning in ways that conventional texts often cannot. This article's authors created comic strips to teach anatomy more interestingly and effectively. Four-frame comic strips were conceptualized from a set of anatomy-related humorous stories gathered from the authors' collective…

  18. Anatomy: Spotlight on Africa

    ERIC Educational Resources Information Center

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

    2008-01-01

    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…

  19. Laparoscopic Surgery - What Is It?

    MedlinePLUS

    ... because the instruments are placed so closely together. “Robotic surgery” or “robotic-assisted surgery” is a newer variation on minimally ... remainder of the operation is usually performed laparoscopically. Robotic surgery is gaining popularity primarily for rectal operations ...

  20. Should Cesarean Scar Defect Be Treated Laparoscopically? A Case Report and Review of the Literature.

    PubMed

    Api, Murat; Boza, Aysen; Gorgen, Husnu; Api, Olus

    2015-01-01

    Several obstetric complications due to inappropriately healed cesarean scar such as placenta accreta, scar dehiscence, and ectopic scar pregnancy are increasingly reported along with rising cesarean rates. Furthermore, many gynecologic conditions, including abnormal uterine bleeding, pelvic pain and infertility, are imputed to deficient cesarean scar healing. Hysteroscopy is the most commonly reported approach for the revision of cesarean scar defects (CSDs). Nevertheless, existing evidence is inadequate to conclude that either hysteroscopy or laparoscopy is effective or superior to each other. Although several management options have been suggested recently, the laparoscopic approach has not been thoroughly scrutinized. We present a case and reviewed the data related to the laparoscopic repair of CSDs and compared the hysteroscopic and laparoscopic management options based on the data from previously published articles. As a result of our analyses, the laparoscopic approach increases uterine wall thickness when compared with the hysteroscopic approach, and both surgical techniques seem to be effective for the resolution of gynecologic symptoms. Hysteroscopic treatment most likely corrects the scar defect but does not strengthen the uterine wall; thus, the potential risk of dehiscence or rupture in subsequent pregnancies does not seem to be improved. Because large uterine defects are known risk factors for scar dehiscence, the repair of the defect to reinforce the myometrial endurance seems to be an appropriate method of treatment. PMID:26122897

  1. Laparoscopic radical hysterectomy with lymphadenectomy in patients with early cervical cancer: our instruments and technique.

    PubMed

    Malzoni, Mario; Tinelli, Raffaele; Cosentino, Francesco; Perone, Ciro; Iuzzolino, Domenico; Rasile, Marianna; Tinelli, Andrea

    2009-12-01

    The purpose of this study is to describe the technique of total laparoscopic radical hysterectomy (type III procedure) with lymphadenectomy as performed at the Advanced Gynecological Endoscopy Center of the Malzoni Medical Center, Avellino, Italy. Seventy-seven patients underwent total laparoscopic radical hysterectomy (type II, III) with lymphadenectomy between January 2000 and March 2008. FIGO stage included five patients Ia1 with LVSI (lymph-vascular involvement), 24 patients Ia2, and 48 patients Ib1. 60 patients underwent a class III procedure and 17 patients a class II procedure according to the Piver classification. Histological types included squamous cell carcinoma in 65 patients, adenocarcinomas in 10 patients, and adenosquamous carcinoma in two. Para-aortic lymphadenectomy was performed up to the level of the inferior mesenteric artery in eight cases with positive pelvic lymph nodes at frozen section evaluation. Total laparoscopic radical hysterectomy can be considered a safe and effective therapeutic procedure for the management of early stage cervical cancer with a low morbidity; moreover, the laparoscopic route may offer an alternative option for patients undergoing radical hysterectomy, although multicenter studies and long-term follow-up are required to evaluate the oncologic outcomes of this procedure. PMID:18805001

  2. Laparoscopic resection of hilar cholangiocarcinoma

    PubMed Central

    Lee, Woohyung; Yoon, Yoo-Seok; Cho, Jai Young; Choi, YoungRok; Shin, Hong Kyung; Jang, Jae Yool; Choi, Hanlim

    2015-01-01

    Laparoscopic resection of hilar cholangiocarcinoma is technically challenging because it involves complicated laparoscopic procedures that include laparoscopic hepatoduodenal lymphadenectomy, hemihepatectomy with caudate lobectomy, and hepaticojejunostomy. There are currently very few reports describing this type of surgery. Between August 2014 and December 2014, 5 patients underwent total laparoscopic or laparoscopic-assisted surgery for hilar cholangiocarcinoma. Two patients with type I or II hilar cholangiocarcinoma underwent radical hilar resection. Three patients with type IIIa or IIIb cholangiocarcinoma underwent extended hemihepatectomy together with caudate lobectomy. The median (range) age, operation time, blood loss, and length of hospital stay were 63 years (43-76 years), 610 minutes (410-665 minutes), 650 mL (450-1,300 mL), and 12 days (9-21 days), respectively. Four patients had a negative margin, but 1 patient was diagnosed with high-grade dysplasia on the proximal resection margin. The median tumor size was 3.0 cm. One patient experienced postoperative biliary leakage, which resolved spontaneously. Laparoscopic resection is a feasible surgical approach in selected patients with hilar cholangiocarcinoma. PMID:26448923

  3. Laparoscopic herniorrhaphy in children.

    PubMed

    Bertozzi, Mirko; Marchesini, Laura; Tesoro, Simonetta; Appignani, Antonino

    2015-01-01

    The authors report their experience in laparoscopic repair of inguinal hernias in children. From May 2010 to November 2013, 122 patients with inguinal hernia underwent laparoscopic herniorrhaphy (92 males and 30 females). Telescope used was 5 mm, while trocars for the operative instruments were 3 or 2 mm. After introducing the camera at the umbilical level and trocars in triangulation, a 4-0 nonabsorbable monofilament suture was inserted directly through the abdominal wall. The internal inguinal ring was then closed by N or double N suture. All operations were performed in one-day surgery setting. In the case of association of inguinal and umbilical hernia an original technique was performed for positioning and fixing the umbilical trocar and for the primary closure of the abdominal wall defect. The postoperative follow-up consisted of outpatient visits at 1 week and 1, 3, and 6 months. The mean age of patients was 38.5 months. Of all patients, 26 were also suffering from umbilical hernia (19 males and 7 females). A total of 160 herniorrhaphies were performed; 84 were unilateral (66 inguinal hernia, 18 inguinal hernia associated with umbilical hernia), 38 bilateral (30 inguinal hernia, 8 inguinal hernia associated with umbilical hernia). Nine of 122 patients (6 males and 3 females) were operated in emergency for incarcerated hernia. A pre-operative diagnosis of unilateral inguinal hernia was performed in 106 cases. Of these patients, laparoscopy revealed a controlateral open internal inguinal ring in 22 cases (20.7%). The mean operative time was 29.9±15.9 min for the monolateral herniorrhaphies, while in case of bilateral repair the mean operative time was 41.5±10.4 min. The mean operative time for the repair of unilateral inguinal hernia associated with umbilical hernia was 30.1±7.4 while for the correction of bilateral inguinal hernia associated with umbilical hernia 39.5±10.6 min. There were 3 recurrences (1.8%): 2 cases in unilateral repair and 1 case a unilateral recurrence in a bilateral repair. No other complications were seen. Laparoscopic repair of inguinal hernia in children performed in this experience resulted a safe and effective procedure. PMID:26429119

  4. Obesity and pelvic floor dysfunction.

    PubMed

    Ramalingam, Kalaivani; Monga, Ash

    2015-05-01

    Obesity is associated with a high prevalence of pelvic floor disorders. Patients with obesity present with a range of urinary, bowel and sexual dysfunction problems as well as uterovaginal prolapse. Urinary incontinence, faecal incontinence and sexual dysfunction are more prevalent in patients with obesity. Uterovaginal prolapse is also more common than in the non-obese population. Weight loss by surgical and non-surgical methods plays a major role in the improvement of these symptoms in such patients. The treatment of symptoms leads to an improvement in their quality of life. However, surgical treatment of these symptoms may be accompanied by an increased risk of complications in obese patients. A better understanding of the mechanism of obesity-associated pelvic floor dysfunction is essential. PMID:25805440

  5. Filshie clip sterilization -- single puncture laparoscopic approach (a preliminary report).

    PubMed

    Ismail, M T; Arshat, H; Halim, A J

    1988-12-01

    In 1986, single puncture laparoscopic application of the Filshie clip was introduced into Malaysia's National Population and Family Development Board's female sterilization program for an evaluation. A total of 42 female sterilizations were performed by this method between June 1986 and December 1986. Laparoscopy was performed on an outpatient basis under local anesthesia. In 37 cases, the sterilization was interval. Filshie clips were successfully applied to the fallopian tubes of 40 women; in the remaining 2 cases, the latching mechanism jammed and Falope rings were used instead. The average time from application of 1st clip to skin closure was 10 minutes. During clip application, technical problems (faulty applicator, clip fell into the pelvic cavity, failure of latching mechanism) were encountered in 4 cases and surgical difficulties (poor visualization, hydrosalpinx, and tubal adhesions) occurred in 10 cases. In general, complications were minimal: 1 patient developed cynosis after anesyhesia (Pethidine) injection, the omentum was torn during introduction of the trocar in another, and a 3rd patient developed thrombophlebitis at the intravenous site. Only 1 pregnancy was recorded during the follow-up period; this occurred 15 months postoperatively and was intrauterine. Given the facts that this procedure is easy to learn, fast and simple, associated with no more complications than other laparoscopic procedures, and is cosmetically more acceptable to women, its more widespread application is recommended. PMID:12342172

  6. Design of a pressure sensing laparoscopic grasper

    E-print Network

    Reyda, Caitlin J. (Caitlin Jilaine)

    2011-01-01

    With smaller incisions, laparoscopic, or minimally invasive, surgery is considered safer for patients than open surgery. However, the safety of current laparoscopic grasping instruments can still be improved. Current devices ...

  7. Utility of fluorescent cholangiography during laparoscopic cholecystectomy: A systematic review

    PubMed Central

    Pesce, Antonio; Piccolo, Gaetano; La Greca, Gaetano; Puleo, Stefano

    2015-01-01

    AIM: To verify the utility of fluorescent cholangiography for more rigorous identification of the extrahepatic biliary system. METHODS: MEDLINE and PubMed searches were performed using the key words “fluorescent cholangiography”, “fluorescent angiography”, “intraoperative fluorescent imaging”, and “laparoscopic cholecystectomy” in order to identify relevant articles published in English, French, German, and Italian during the years of 2009 to 2014. Reference lists from the articles were reviewed to identify additional pertinent articles. For studies published in languages other than those mentioned above, all available information was collected from their English abstracts. Retrieved manuscripts (case reports, reviews, and abstracts) concerning the application of fluorescent cholangiography were reviewed by the authors, and the data were extracted using a standardized collection tool. Data were subsequently analyzed with descriptive statistics. In contrast to classic meta-analyses, statistical analysis was performed where the outcome was calculated as the percentages of an event (without comparison) in pseudo-cohorts of observed patients. RESULTS: A total of 16 studies were found that involved fluorescent cholangiography during standard laparoscopic cholecystectomies (n = 11), single-incision robotic cholecystectomies (n = 3), multiport robotic cholecystectomy (n = 1), and single-incision laparoscopic cholecystectomy (n = 1). Overall, these preliminary studies indicated that this novel technique was highly sensitive for the detection of important biliary anatomy and could facilitate the prevention of bile duct injuries. The structures effectively identified before dissection of Calot’s triangle included the cystic duct (CD), the common hepatic duct (CHD), the common bile duct (CBD), and the CD-CHD junction. A review of the literature revealed that the frequencies of detection of the extrahepatic biliary system ranged from 71.4% to 100% for the CD, 33.3% to 100% for the CHD, 50% to 100% for the CBD, and 25% to 100% for the CD-CHD junction. However, the frequency of visualization of the CD and the CBD were reduced in patients with a body mass index > 35 kg/m2 relative to those with a body mass index < 35 kg/m2 (91.0% and 64.0% vs 92.3% and 71.8%, respectively). CONCLUSION: Fluorescent cholangiography is a safe procedure enabling real-time visualization of bile duct anatomy and may become standard practice to prevent bile duct injury during laparoscopic cholecystectomy. PMID:26167088

  8. Laparoscopic radical prostatectomy.

    PubMed

    Krongrad, A

    2000-05-01

    The radical prostatectomy has been modified over the years. With the introduction to the modern operating room of robots and other tools has come the latest modification: the laparoscopic radical prostatectomy (LRP), first described almost 10 years ago. In the past 2 years, the technique of LRP has been made standard, reproducible, and efficient. The LRP virtually eliminates the physical and emotional toll of radical prostate surgery and reduces blood loss, hospital time, and cost. Published series demonstrate oncologic and functional results comparable with and perhaps better than what is seen with open radical prostatectomy. The LRP is a standard surgical technique in a growing number of medical centers, with world experience estimated at 500 cases. The LRP offers the urologic community a rare opportunity for tangibly improving care. PMID:12084339

  9. Pelvic fractures at a community hospital.

    PubMed

    Davis, F E

    1986-10-01

    One hundred twenty-eight pelvic fractures were reviewed. Of the 128 patients with pelvic fractures, there were seven deaths. Pelvic fractures associated with the greatest blood loss and complications were those which occurred in crush-type injuries secondary to automobile accidents or other heavy impact injuries. Unless fractures were of a crush-type with massive fractures, the amount of blood loss correlated more closely with the history of injury than it did with the x-ray appearance of pelvic fracture. A single patient in this series had greater than 45 units blood loss and exhibited many of the basic problems encountered when dealing with patients with major pelvic fractures. The case of this patient is reviewed in detail, including component therapy for massive blood loss. The prophylactic use of caval filtration or an umbrella device might be warranted in patients with massive pelvic fractures. PMID:3767141

  10. Skull Base Anatomy.

    PubMed

    Patel, Chirag R; Fernandez-Miranda, Juan C; Wang, Wei-Hsin; Wang, Eric W

    2016-02-01

    The anatomy of the skull base is complex with multiple neurovascular structures in a small space. Understanding all of the intricate relationships begins with understanding the anatomy of the sphenoid bone. The cavernous sinus contains the carotid artery and some of its branches; cranial nerves III, IV, VI, and V1; and transmits venous blood from multiple sources. The anterior skull base extends to the frontal sinus and is important to understand for sinus surgery and sinonasal malignancies. The clivus protects the brainstem and posterior cranial fossa. A thorough appreciation of the anatomy of these various areas allows for endoscopic endonasal approaches to the skull base. PMID:26614826

  11. Registry of laparoscopic cholecystectomy and new and evolving laparoscopic techniques.

    PubMed

    White, J V

    1993-04-01

    To collect information on the rapid application of laparoscopic surgery, the National Laparoscopic Surgery Registry surveyed more than 4,000 of the 16,000 currently practicing laparoscopic surgeons. Preliminary analysis of the data has revealed that most of the respondents had been trained in general surgery, but a small percentage were certified only in surgical subspecialties. Surgeons acquiring skills in laparoscopic surgery had various levels of experience ranging from less than 1 year to more than 38 years in surgical practice. Nearly 90% of the respondents attended a laparoscopic cholecystectomy course with hands-on training. In those courses, an average of 16 hours was devoted to animal laboratories for acquisition of skills. Additional training in the form of a preceptorship is being undertaken by an increasing number of surgeons. The future of minimally invasive surgery is being supported by rapid advances in technology. New video systems capable of displaying three-dimensional images and miniaturized fiberoptic scopes are now available. Computer enhanced three-dimensional ultrasound images provide the surgeon with the ability to examine the content and consistency of tissues in addition to their appearance. Advances in mechanical retraction may eliminate the need for carbon dioxide insufflation of the abdomen. Tissue repair using tissue glues or laser-mediated processes may reduce the need for endocavitary suturing. These advances in technology and techniques may reduce the morbidity and mortality of these surgical procedures and, ultimately, improve the standard of care for surgical patients. PMID:8480898

  12. Recognizing Myofascial Pelvic Pain in the Female Patient with Chronic Pelvic Pain

    PubMed Central

    Pastore, Elizabeth Anne; Katzman, Wendy B.

    2012-01-01

    Myofascial pelvic pain (MFPP) is a major component of chronic pelvic pain (CPP) and often is not properly identified by healthcare providers. The hallmark diagnostic indicator of MFPP is myofascial trigger points in the pelvic floor musculature that refer pain to adjacent sites. Effective treatments are available to reduce MFPP, including myofascial trigger point release, PMID:22862153

  13. Magnetic resonance imaging of pelvic floor disorders.

    PubMed

    Khatri, Gaurav

    2014-08-01

    Physical examination alone is often inadequate for evaluation of pelvic floor dysfunction. Magnetic resonance imaging (MRI) is a robust modality that can provide high-quality anatomic and functional evaluation of the pelvic floor. Although lack of standardized technique and radiologist inexperience may be relative deterrents in universal acceptance of pelvic floor MRI, the role of MRI is increasing as it is technically feasible on most magnets and offers some advantages over the traditional fluoroscopic defecography. This review focuses on the technical and interpretational aspects of anatomic and functional pelvic floor MRI. PMID:25099563

  14. Genetic and developmental basis of evolutionary pelvic reduction

    E-print Network

    Shapiro, Mike

    are still unknown3­5 . Marine threespine sticklebacks (Gasterosteus aculeatus) have a prominent pelvic of the postglacial lakes containing pelvic-reduced sticklebacks, and the rapid tempo of pelvic changes seen in a high

  15. Anatomy and art.

    PubMed

    Laios, Konstantinos; Tsoukalas, Gregory; Karamanou, Marianna; Androutsos, George

    2013-01-01

    Leonardo da Vinci, Jean Falcon, Andreas Vesalius, Henry Gray, Henry Vandyke Carter and Frank Netter created some of the best atlases of anatomy. Their works constitute not only scientific medical projects but also masterpieces of art. PMID:24640589

  16. Abdominal anatomy in the context of port placement and trocars

    PubMed Central

    Alkatout, Ibrahim; Mettler, Liselotte; Maass, Nicolai; Noé, Günter-Karl; Elessawy, Mohamed

    2015-01-01

    Although the anatomy of the human being has not changed, technical developments in operating materials and methods demand a simultaneous development in operative management. Developments in electronic and optical technologies permit many gynecological operations to be performed laparoscopically. One fundamental distinction between any other operating method and laparoscopy is the hurdle that the initial entry, whether with a needle, cannula, or trocar, is mostly performed blind. However, there is a risk that blind entry may result in vascular or organ damage. One of the difficulties associated with entry complications is that any damage may not be immediately recognized, leading to major abdominal reparative surgery, and at worst, a temporary colostomy. Therefore, the technical and operative quality of laparoscopic surgery begins with port placement and trocars. Visual access systems are available but are not yet widely used. The aim of this review was to introduce the different port placement and trocar systems as well as their correct and professional usage in correlation with the abdominal functional anatomy. PMID:26692776

  17. Vet Anatomy Lab 

    E-print Network

    Unknown

    2011-08-17

    notable Elizabethans. It deserves a place alongside its new historicist contenders as a rejoinder to be reckoned with. Peter Mitchell. ?The Purple Island? and Anatomy in Early Seventeenth- Century Literature, Philosophy, and Theology. Madison..., consisting exclusively of advanced graduate students and dedicated seventeenth- century scholars. He has written a book that makes a leisurely, albeit rigorous, case: ?The conceptual metaphors of anatomy and the analo- gies of the microcosm coalesce...

  18. Evidence-Based Anatomy

    PubMed Central

    Yammine, Kaissar

    2014-01-01

    Anatomy is a descriptive basic medical science that is no longer considered a research-led discipline. Many publications in clinical anatomy are prevalence studies treating clinically relevant anatomical variations and reporting their frequencies and/or associations with variables such as age, sex, side, laterality, and ancestry. This article discusses the need to make sense of the available literature. A new concept, evidence-based anatomy (EBA), is proposed to find, appraise, and synthetize the results reported in such publications. It consists in applying evidence-based principles to the field of epidemiological anatomy research through evidence synthesis using systematic reviews and meta-analyses to generate weighted pooled results. Pooled frequencies and associations based on large pooled sample size are likely to be more accurate and to reflect true population statistics and associations more closely. A checklist of a typical systematic review in anatomy is suggested and the implications of EBA for practice and future research, along with its scope, are discussed. The EBA approach would have positive implications for the future preservation of anatomy as a keystone basic science, for sound knowledge of anatomical variants, and for the safety of medical practice. Clin. Anat. 27:847–852, 2014. PMID:24797314

  19. Comparison of a flexible-tip laparoscope with a rigid straight laparoscope for single-incision laparoscopic cholecystectomy.

    PubMed

    Matsui, Yoichi; Ryota, Hironori; Sakaguchi, Tatsuma; Nakatani, Kazuyoshi; Matsushima, Hideyuki; Yamaki, So; Hirooka, Satoshi; Yamamoto, Tomohisa; Kwon, A-Hon

    2014-12-01

    This study assessed whether a flexible-tip laparoscope improves operative outcomes including operative length while performing single-incision laparoscopic cholecystectomy (SILC) compared with the use of a conventional straight laparoscope. The flexible-tip laparoscope decreased the operative time compared with the straight laparoscope. Although SILC has potential benefits, surgeons experience problems for in-line viewing through a laparoscope and from contact of instruments with the laparoscope, resulting in longer operative times and the need for additional ports. The aim of this study was to determine whether a flexible-tip laparoscope improves operative outcomes, including operative length and the rate of insertion of additional ports, while performing SILC compared with the use of a conventional rigid straight laparoscope. We reviewed data on patients for whom we performed SILC at the Department of Surgery, Kansai Medical University, for the period from November 1, 2009, to February 28, 2013. The information was assessed with respect to patient characteristics, types of laparoscope used, operative data as well as postoperative outcomes. Operating time for SILC using the flexible-tip laparoscope was significantly shorter than with the straight laparoscope (81.5 ± 23.2 vs 94.4 ± 21.1 minutes) as a result of a better view of the operating field without contact with working instruments. Although a trend was shown toward a reduced rate of the need for extra ports in the flexible-tip laparoscope group, the difference did not reach statistical significance. Using the flexible-tip laparoscope solved the problem of in-line viewing and decreased the operative time for SILC. PMID:25513924

  20. Automated branching pattern report generation for laparoscopic surgery assistance

    NASA Astrophysics Data System (ADS)

    Oda, Masahiro; Matsuzaki, Tetsuro; Hayashi, Yuichiro; Kitasaka, Takayuki; Misawa, Kazunari; Mori, Kensaku

    2015-05-01

    This paper presents a method for generating branching pattern reports of abdominal blood vessels for laparoscopic gastrectomy. In gastrectomy, it is very important to understand branching structure of abdominal arteries and veins, which feed and drain specific abdominal organs including the stomach, the liver and the pancreas. In the real clinical stage, a surgeon creates a diagnostic report of the patient anatomy. This report summarizes the branching patterns of the blood vessels related to the stomach. The surgeon decides actual operative procedure. This paper shows an automated method to generate a branching pattern report for abdominal blood vessels based on automated anatomical labeling. The report contains 3D rendering showing important blood vessels and descriptions of branching patterns of each vessel. We have applied this method for fifty cases of 3D abdominal CT scans and confirmed the proposed method can automatically generate branching pattern reports of abdominal arteries.

  1. Laparoscopic liver resection: wedge resections to living donor hepatectomy, are we heading in the right direction?

    PubMed

    Cherian, P Thomas; Mishra, Ashish Kumar; Kumar, Palaniappen; Sachan, Vijayant Kumar; Bharathan, Anand; Srikanth, Gadiyaram; Senadhipan, Baiju; Rela, Mohamad S

    2014-10-01

    Despite inception over 15 years ago and over 3000 completed procedures, laparoscopic liver resection has remained mainly in the domain of selected centers and enthusiasts. Requirement of extensive open liver resection (OLR) experience, in-depth understanding of anatomy and considerable laparoscopic technical expertise may have delayed wide application. However healthy scepticism of its actual benefits and presence of a potential publication bias; concern about its safety and technical learning curve, are probably equally responsible. Given that a large proportion of our work, at least in transplantation is still OLR, we have attempted to provide an entirely unbiased, mature opinion of its pros and cons in the current invited review. We have divided this review into two sections as we believe they merit separate attention on technical and ethical grounds. The first part deals with laparoscopic liver resection (LLR) in patients who present with benign or malignant liver pathology, wherein we have discussed its overall outcomes; its feasibility based on type of pathology and type of resection and included a small section on application of LLR in special scenarios like cirrhosis. The second part deals with the laparoscopic living donor hepatectomy (LDH) experience to date, including its potential impact on transplantation in general. Donor safety, graft outcomes after LDH and criterion to select ideal donors for LLR are discussed. Within each section we have provided practical points to improve safety in LLR and attempted to reach reasonable recommendations on the utilization of LLR for units that wish to develop such a service. PMID:25309070

  2. Laparoscopic liver resection: Wedge resections to living donor hepatectomy, are we heading in the right direction?

    PubMed Central

    Cherian, P Thomas; Mishra, Ashish Kumar; Kumar, Palaniappen; Sachan, Vijayant Kumar; Bharathan, Anand; Srikanth, Gadiyaram; Senadhipan, Baiju; Rela, Mohamad S

    2014-01-01

    Despite inception over 15 years ago and over 3000 completed procedures, laparoscopic liver resection has remained mainly in the domain of selected centers and enthusiasts. Requirement of extensive open liver resection (OLR) experience, in-depth understanding of anatomy and considerable laparoscopic technical expertise may have delayed wide application. However healthy scepticism of its actual benefits and presence of a potential publication bias; concern about its safety and technical learning curve, are probably equally responsible. Given that a large proportion of our work, at least in transplantation is still OLR, we have attempted to provide an entirely unbiased, mature opinion of its pros and cons in the current invited review. We have divided this review into two sections as we believe they merit separate attention on technical and ethical grounds. The first part deals with laparoscopic liver resection (LLR) in patients who present with benign or malignant liver pathology, wherein we have discussed its overall outcomes; its feasibility based on type of pathology and type of resection and included a small section on application of LLR in special scenarios like cirrhosis. The second part deals with the laparoscopic living donor hepatectomy (LDH) experience to date, including its potential impact on transplantation in general. Donor safety, graft outcomes after LDH and criterion to select ideal donors for LLR are discussed. Within each section we have provided practical points to improve safety in LLR and attempted to reach reasonable recommendations on the utilization of LLR for units that wish to develop such a service. PMID:25309070

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

    NASA Astrophysics Data System (ADS)

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

    1998-06-01

    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.

  4. Stereoscopic augmented reality using ultrasound volume rendering for laparoscopic surgery in children

    NASA Astrophysics Data System (ADS)

    Oh, Jihun; Kang, Xin; Wilson, Emmanuel; Peters, Craig A.; Kane, Timothy D.; Shekhar, Raj

    2014-03-01

    In laparoscopic surgery, live video provides visualization of the exposed organ surfaces in the surgical field, but is unable to show internal structures beneath those surfaces. The laparoscopic ultrasound is often used to visualize the internal structures, but its use is limited to intermittent confirmation because of the need for an extra hand to maneuver the ultrasound probe. Other limitations of using ultrasound are the difficulty of interpretation and the need for an extra port. The size of the ultrasound transducer may also be too large for its usage in small children. In this paper, we report on an augmented reality (AR) visualization system that features continuous hands-free volumetric ultrasound scanning of the surgical anatomy and video imaging from a stereoscopic laparoscope. The acquisition of volumetric ultrasound image is realized by precisely controlling a back-and-forth movement of an ultrasound transducer mounted on a linear slider. Furthermore, the ultrasound volume is refreshed several times per minute. This scanner will sit outside of the body in the envisioned use scenario and could be even integrated into the operating table. An overlay of the maximum intensity projection (MIP) of ultrasound volume on the laparoscopic stereo video through geometric transformations features an AR visualization system particularly suitable for children, because ultrasound is radiation-free and provides higher-quality images in small patients. The proposed AR representation promises to be better than the AR representation using ultrasound slice data.

  5. Laparoscopic cryptorchidectomy in standing bulls

    PubMed Central

    KANEKO, Yasuyuki; TORISU, Shidow; KITAHARA, Go; HIDAKA, Yuichi; SATOH, Hiroyuki; ASANUMA, Taketoshi; MIZUTANI, Shinya; OSAWA, Takeshi; NAGANOBU, Kiyokazu

    2015-01-01

    Laparoscopic cryptorchidectomy without insufflation was applied in 10 standing bulls aged 3 to 15 months. Nine bulls were preoperatively pointed out intra-abdominal testes by computed tomography. Preoperative fasting for a minimum of 24 hr provided laparoscopic visualization of intra-abdominal area from the kidney to the inguinal region. Surgical procedure was interrupted by intra-abdominal fat and testis size. It took 0.6 to 1.5 hr in 4 animals weighing 98 to 139 kg, 0.8 to 2.8 hr in 4 animals weighing 170 to 187 kg, and 3 and 4 hr in 2 animals weighing 244 and 300 kg to complete the cryptorchidectomy. In conclusion, standing gasless laparoscopic cryptorchidectomy seems to be most suitable for bulls weighing from 100 to 180 kg. PMID:25715955

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

    PubMed

    Go??biewski, Andrzej; Murawski, Maciej; Losin, Marcin; Królak, Marek; Czauderna, Piotr

    2011-09-01

    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. PMID:23255974

  7. What Are the Symptoms of Pelvic Pain?

    MedlinePLUS

    ... such as going to work, exercising, or having sex. Women describe pelvic pain in many ways. Pelvic pain ... some feel pain when lifting something heavy. Some women have pain in the vulva (the ... during sex or when inserting a tampon. 1 , 2 International ...

  8. Hemostasis in laparoscopic renal surgery

    PubMed Central

    Hassouna, Hussam A.; Manikandan, Ramaswamy

    2012-01-01

    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. PMID:22557709

  9. Determinants and Management Outcomes of Pelvic Organ Prolapse in a Low Resource Setting

    PubMed Central

    Eleje, GU; Udegbunam, OI; Ofojebe, CJ; Adichie, CV

    2014-01-01

    Background: The last decade has seen significant progress in understanding of the pathophysiology, anatomy and management modalities of pelvic organ prolapse. A review of the way we manage this entity in a low resource setting has become necessary. Aim: The aim of the study is to determine the incidence, risk factors and management modalities of pelvic organ prolapse. Materials and Methods: A 5-year cross-sectional study with retrospective data collection of women who attended the gynecologic clinic in Nnamdi Azikiwe University Teaching Hospital, Nnewi, south-east Nigeria and were diagnosed of pelvic organ prolapse was made. Proforma was initially used for data collection before transfer to Epi-info 2008 (v 3.5.1; Epi Info, Centers for Disease Control and Prevention, Atlanta, GA) software. Results: There were 199 cases of pelvic organ prolapse, out of a total gynecologic clinic attendance of 3082, thus giving an incidence of 6.5%. The mean age was 55.5 (15.9) years with a significant association between prolapse and advanced age (P < 0.001). The age range was 22-80 years. The leading determinants were menopause, advanced age, multiparity, chronic increase in intra-abdominal pressure (IAP) and prolonged labor. Out of the 147 patients with uterine prolapse, majority, 60.5% (89/147) had third degree prolapse. Vaginal hysterectomy with pelvic floor repair was the most common surgery performed. The average duration of hospital stay following surgery was 6.8 (2.9) days and the most common complication was urinary tract infection, 13.5% (27/199). The recurrence rate was 13.5% (27/199). Most of the patients who presented initially with pelvic organ prolapse were lost to follow-up. Conclusion: The incidence of pelvic organ prolapse in this study was 6.5% and the leading determinants of pelvic organ prolapse were - multiparity, menopause, chronic increase in IAP and advanced age. Most were lost to follow-up and a lesser proportion was offered conservative management. Early presentation of women is necessary so that conservative management could be offered if feasible. PMID:25328796

  10. Total pelvic floor ultrasound for pelvic floor defaecatory dysfunction: a pictorial review.

    PubMed

    Hainsworth, Alison J; Solanki, Deepa; Schizas, Alexis M P; Williams, Andrew B

    2015-11-01

    Total pelvic floor ultrasound is used for the dynamic assessment of pelvic floor dysfunction and allows multicompartmental anatomical and functional assessment. Pelvic floor dysfunction includes defaecatory, urinary and sexual dysfunction, pelvic organ prolapse and pain. It is common, increasingly recognized and associated with increasing age and multiparity. Other options for assessment include defaecation proctography and defaecation MRI. Total pelvic floor ultrasound is a cheap, safe, imaging tool, which may be performed as a first-line investigation in outpatients. It allows dynamic assessment of the entire pelvic floor, essential for treatment planning for females who often have multiple diagnoses where treatment should address all aspects of dysfunction to yield optimal results. Transvaginal scanning using a rotating single crystal probe provides sagittal views of bladder neck support anteriorly. Posterior transvaginal ultrasound may reveal rectocoele, enterocoele or intussusception whilst bearing down. The vaginal probe is also used to acquire a 360° cross-sectional image to allow anatomical visualization of the pelvic floor and provides information regarding levator plate integrity and pelvic organ alignment. Dynamic transperineal ultrasound using a conventional curved array probe provides a global view of the anterior, middle and posterior compartments and may show cystocoele, enterocoele, sigmoidocoele or rectocoele. This pictorial review provides an atlas of normal and pathological images required for global pelvic floor assessment in females presenting with defaecatory dysfunction. Total pelvic floor ultrasound may be used with complementary endoanal ultrasound to assess the sphincter complex, but this is beyond the scope of this review. PMID:26388109

  11. The Drosophila anatomy ontology

    PubMed Central

    2013-01-01

    Background Anatomy ontologies are query-able classifications of anatomical structures. They provide a widely-used means for standardising the annotation of phenotypes and expression in both human-readable and programmatically accessible forms. They are also frequently used to group annotations in biologically meaningful ways. Accurate annotation requires clear textual definitions for terms, ideally accompanied by images. Accurate grouping and fruitful programmatic usage requires high-quality formal definitions that can be used to automate classification and check for errors. The Drosophila anatomy ontology (DAO) consists of over 8000 classes with broad coverage of Drosophila anatomy. It has been used extensively for annotation by a range of resources, but until recently it was poorly formalised and had few textual definitions. Results We have transformed the DAO into an ontology rich in formal and textual definitions in which the majority of classifications are automated and extensive error checking ensures quality. Here we present an overview of the content of the DAO, the patterns used in its formalisation, and the various uses it has been put to. Conclusions As a result of the work described here, the DAO provides a high-quality, queryable reference for the wild-type anatomy of Drosophila melanogaster and a set of terms to annotate data related to that anatomy. Extensive, well referenced textual definitions make it both a reliable and useful reference and ensure accurate use in annotation. Wide use of formal axioms allows a large proportion of classification to be automated and the use of consistency checking to eliminate errors. This increased formalisation has resulted in significant improvements to the completeness and accuracy of classification. The broad use of both formal and informal definitions make further development of the ontology sustainable and scalable. The patterns of formalisation used in the DAO are likely to be useful to developers of other anatomy ontologies. PMID:24139062

  12. Laparoscopic management of appendicular mass

    PubMed Central

    Shindholimath, Vishwanath V; Thinakaran, K; Rao, T Narayana; Veerappa, Yenni Veerabhadrappa

    2011-01-01

    BACKGROUND: Laparoscopic appendectomy is becoming the preferred technique for treating acute appendicitis. However, its role in the treatment of complicated appendicitis is controversial. This study was undertaken to assess the feasibility of laparoscopic appendectomy for appendicular mass. MATERIALS AND METHODS: A retrospective review was performed of all the patients who were treated laparoscopically for appendicular mass from March 2007 to October 2009. Setting: Tertiary care hospital. RESULTS: A total of 120 patients were treated for appendicitis. A retrospective review of the patients’ records demonstrated that 19 patients (15.8%) had appendicular mass at the time of admission. The average operative time was 95 minutes (range 45-140 minutes). Pathological evidence of appendicitis was present in all the patients. The average length of hospital stay was six days (rang 6-9 days). Three patients (15.7%) had post- operative complications. Two patients developed wound infections and one patient was re-admitted with pain and a lump below the umbilical port. CONCLUSION: The findings suggest that laparoscopic appendectomy is feasible in patients with appendicular mass. The authors propose a prospective, randomized trial to verify this finding. PMID:21523236

  13. Laparoscopic lower urinary tract reconstruction.

    PubMed

    Anderson, K R; Clayman, R V

    2000-10-01

    In the past decade laparoscopy has been successfully utilized for both the obliterative and reconstructive management of urologic disease. We have seen not only an advance in the technology available to perform these procedures, but also an effort on the part of laparoscopic urologists to refine their techniques to allow them to perform more complicated procedures. In the lower urinary tract, the development of reconstructive procedures has been slow. While early interest in laparoscopy prompted several pioneers to perform the initial reconstructive procedures, the difficulties associated with these procedures at that time largely precluded their widespread application or adoption. Recently, improvements in the skills of laparoscopic urologists and the advent of instruments to facilitate suturing (e.g. EndoStitch semi-automatic suturing device, Lapra-Ty clips to replace intracorporeal knotting, and advances in staple and clip technology) have facilitated a renewed interest in laparoscopic reconstructive surgery of the lower urinary tract. At present, almost all types of urologic open reconstructive procedures have been accomplished laparoscopically: urinary diversion (e.g. ureteroileal loop urinary diversion and continent diversion), bladder reconstruction (e.g. ureterovesicostomy, bladder augmentation, bladder diverticulectomy, partial cystectomy), ureteral reimplantation, and, most recently, urethrovesical anastomosis following radical prostatectomy. This article will review the development of these procedures. PMID:11131313

  14. GENERAL ANATOMY Introductory remarks. _... . __ ____ 65

    E-print Network

    CHAPTER IV GENERAL ANATOMY Page Introductory remarks.· _·.·..·· · . ·__ ·· ·__·__ 65 Methods the arrangement and topography of the various systems of organs. The anatomy of edible oysters is described of the anatomy of C. virginica. The structure of the European oyster, O. edulis, is described by Orton (1937

  15. Learning Anatomy Enhances Spatial Ability

    ERIC Educational Resources Information Center

    Vorstenbosch, Marc A. T. M.; Klaassen, Tim P. F. M.; Donders, A. R. T.; Kooloos, Jan G. M.; Bolhuis, Sanneke M.; Laan, Roland F. J. M.

    2013-01-01

    Spatial ability is an important factor in learning anatomy. Students with high scores on a mental rotation test (MRT) systematically score higher on anatomy examinations. This study aims to investigate if learning anatomy also oppositely improves the MRT-score. Five hundred first year students of medicine ("n" = 242, intervention) and…

  16. Pre Visit Information Afternoon Anatomy

    E-print Network

    Daley, Monica A.

    Pre Visit Information Afternoon Anatomy Location The Royal Veterinary College Camden Campus Royal and identification using specimens from RVC's anatomy museum · Develop understanding of the role of veterinary Activity 0 Whole group introduction session Introduction to the Royal Veterinary College and Anatomy Museum

  17. Evaluation of acute pelvic pain in women.

    PubMed

    Kruszka, Paul S; Kruszka, Stephen J

    2010-07-15

    Diagnosis of pelvic pain in women can be challenging because many symptoms and signs are insensitive and nonspecific. As the first priority, urgent life-threatening conditions (e.g., ectopic pregnancy, appendicitis, ruptured ovarian cyst) and fertility-threatening conditions (e.g., pelvic inflammatory disease, ovarian torsion) must be considered. A careful history focusing on pain characteristics, review of systems, and gynecologic, sexual, and social history, in addition to physical examination helps narrow the differential diagnosis. The most common urgent causes of pelvic pain are pelvic inflammatory disease, ruptured ovarian cyst, and appendicitis; however, many other diagnoses in the differential may mimic these conditions, and imaging is often needed. Transvaginal ultrasonography should be the initial imaging test because of its sensitivities across most etiologies and its lack of radiation exposure. A high index of suspicion should be maintained for pelvic inflammatory disease when other etiologies are ruled out, because the presentation is variable and the prevalence is high. Multiple studies have shown that 20 to 50 percent of women presenting with pelvic pain have pelvic inflammatory disease. Adolescents and pregnant and postpartum women require unique considerations. PMID:20642266

  18. Effect of Surgical Removal of Endometriomas on Cyclic and Non-cyclic Pelvic Pain

    PubMed Central

    Api, Murat; Boza, Aysen Telce; Kayatas, Semra; Eroglu, Mustafa

    2015-01-01

    Background Endometriosis is a complex disease with a spectrum of pain symptoms from mild dysmenorrhea to debilitating pelvic pain. There is no concrete evidence in the literature whether endometriotic cyst per se, causes pain spectrum related to the disease. The aim of the present study was to evaluate the effect of surgical removal of endome- triomas on pain symptoms. Materials and Methods In this prospective, observational, before-after study, which was conducted between March 2012 and January 2013 in Training and Research Hospital,Adana, Turkey, a total of 23 patients including 16 sexually active and 7 vir- gin symptomatic women were questioned for non-cyclic pelvic pain (NCPP), intensity of the NCPP, presence of cyclic dysmenorrhea, and dyspareunia before and after the endometrioma operation. Participants who were sonographically diagnosed and later pathologically confirmed as having endometrioma without sign and symptoms of deep infiltrative endometriosis (DIE) were also questioned for pain symptoms before and after the laparoscopic removal of cyst wall. Patients with intraabdominal adhesions, history of pelvic inflammatory disease, and pathological diagnosis other than endometrioma were excluded. No ancillary procedures were applied for pain management, but if pain was present, pelvic peritoneal endometriotic lesions were ablated beside the removal of ovar- ian endometriotic cysts. Results Out of 23 cases with endometrioma, 91 and 78% reported to have NCPP and dysmenorrhea, respectively, before the operation, while 60 and 48%, respec- tively, after the operation (McNemar’s test, P=0.016 for both figures). Among the sexually active cases, 31% (5/16) had dyspareunia before the operation and only 1 case reported the pain relief after the operation (McNemar’s test, P=1). Intensity of NCPP were reported to be none (8.7%), moderate (21.7%), severe (56.5%) and un- bearable (13%) before the operation and decreased to none (43.5%), mild (43.5%), moderate (4.3%) and severe (8.7%) after the operation (Wilcoxon signed-rank test, P<0.001). Conclusion In symptomatic cases with ovarian endometrioma, without sign and symptoms of DIE, laparoscopic removal of the cysts with/without ablation of the peritoneal endometriotic lesions yields relief of NCPP and cyclic dysmenorrhea, but not dyspareunia. PMID:26246876

  19. [Laparoscopic treatment of benign ovarian cysts].

    PubMed

    Imme, Antonio; Caglià, Pietro; Gandolfo, Luigi; Cavallaro, Giovanni; Amodeo, Corrado

    2002-01-01

    Laparoscopic surgery is the most frequent indication for the management of benign ovarian cysts in the obstetric and gynaecological field. On the basis of their experience the authors address the clinical classification of benign ovarian pathology and the surgical laparoscopic procedures utilised in the treatment of adnexal cysts. Forty-two patients underwent laparoscopic surgery after a preoperative clinical and biological evaluation and imaging in order to exclude the presence of ovarian malignancies. All surgical procedures were carried out laparoscopically, with a conversion index of 0%. The morbidity was 2.3% (one case of haematoma of the umbilical trocar site) and there was no mortality. No late complications were observed. In conclusion, laparoscopic surgery in the management of ovarian cysts is technically feasible. On the basis of these findings laparoscopic surgery is the treatment of choice for adnexal cystic tumours after careful exclusion of malignancy. PMID:12239764

  20. Anatomy for Biomedical Engineers

    ERIC Educational Resources Information Center

    Carmichael, Stephen W.; Robb, Richard A.

    2008-01-01

    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…

  1. Anatomy of the Brain

    MedlinePLUS

    ... as well as how we function in our environment. The diagrams below show brain anatomy, or the various parts of the brain, from two different angles. Side View of the Brain Cross View of the Brain Learning about the various parts of the brain and ...

  2. Illustrated Speech Anatomy.

    ERIC Educational Resources Information Center

    Shearer, William M.

    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…

  3. Anatomy of the Honeybee

    ERIC Educational Resources Information Center

    Postiglione, Ralph

    1977-01-01

    In this insect morphology exercise, students study the external anatomy of the worker honeybee. The structures listed and illustrated are discussed in relation to their functions. A goal of the exercise is to establish the bee as a well-adapted, social insect. (MA)

  4. The Anatomy Puzzle Book.

    ERIC Educational Resources Information Center

    Jacob, Willis H.; Carter, Robert, III

    This document features review questions, crossword puzzles, and word search puzzles on human anatomy. Topics include: (1) Anatomical Terminology; (2) The Skeletal System and Joints; (3) The Muscular System; (4) The Nervous System; (5) The Eye and Ear; (6) The Circulatory System and Blood; (7) The Respiratory System; (8) The Urinary System; (9) The…

  5. The Influence of Pelvic Ramus Fracture on the Stability of Fixed Pelvic Complex Fracture

    PubMed Central

    Lei, Jianyin; Zhang, Yue; Wu, Guiying; Wang, Zhihua; Cai, Xianhua

    2015-01-01

    This study aims to evaluate the biomechanical mechanism of pelvic ring injury for the stability of pelvis using the finite element (FE) method. Complex pelvic fracture (i.e., anterior column with posterior hemitransverse lesion) combined with pelvic ramus fracture was used to evaluate the biomechanics stability of the pelvis. Three FE fracture models (i.e., Dynamic Anterior Plate-Screw System for Quadrilateral Area (DAPSQ) for complex pelvic fracture with intact pubic ramus, DAPSQ for complex pelvic fracture with pubic ramus fracture, and DAPSQ for complex pelvic fracture with fixed pubic ramus fracture) were established to explore the biomechanics stability of the pelvis. The pubic ramus fracture leads to an unsymmetrical situation and an unstable situation of the pelvis. The fixed pubic ramus fracture did well in reducing the stress levels of the pelvic bone and fixation system, as well as displacement difference in the pubic symphysis, and it could change the unstable situation back to a certain extent. The pelvic ring integrity was the prerequisite of the pelvic stability and should be in a stable condition when the complex fracture is treated. PMID:26495033

  6. Laparoscopic strategies for resection of insulinomas.

    PubMed

    Fernández-Cruz, Laureano; Cesar-Borges, Gleydson

    2006-05-01

    Sporadic insulinomas are suitable for the laparoscopic approach because they are solitary, resectable, and not metastatic. Laparoscopy and laparoscopic ultrasonography (LapUS) can identify lesions that are undetectable by preoperative imaging techniques. However, it is still worthwhile to attempt preoperative imaging by endoscopic ultrasonography to provide useful information for patient positioning and port placement. Laparoscopic pancreatic resection and laparoscopic enucleation are feasible and safe techniques. Conversion to the open approach should be considered for tumors that cannot be identified accurately by LapUS. In patients with insulinomas in the setting of multiple endocrine neoplasia 1, the laparoscopic approach is slightly different. Laparoscopic subtotal distal pancreatectomy preserving the spleen combined with laparoscopic enucleation of any tumors identified in the pancreatic head should be the standard operation. The advantages of laparoscopic pancreatic procedures should be those of all laparoscopic procedures, which obviously reduce the parietal damage in the abdomen. This may be associated with reductions in postoperative pain and hospital stay and an earlier return to previous activity. A cosmetic advantage is also clear because of the absence of long abdominal incision, and this should be taken into account, especially in young women. PMID:16773762

  7. Soft Tissue Mobilization to Resolve Chronic Pain and Dysfunction Associated With Postoperative Abdominal and Pelvic Adhesions: A Case Report.

    PubMed

    Wong, Yui Y; Smith, Ryan W; Koppenhaver, Shane

    2015-12-01

    Study Design Case report. Background Common complications from abdominal and pelvic surgery include adhesions and chronic pain. Laparoscopic adhesiolysis is sometimes used to reduce adhesions and related pain. Physical therapy interventions, such as soft tissue mobilization (STM), may be used for this condition; however, evidence to support its effectiveness is lacking. Case Description A 28-year-old woman with a history of 5 abdominal/pelvic surgeries presented with right-sided lower abdominal and anterior hip pain, which had been present since she had undergone a laparoscopic appendectomy with a right ovarian cystectomy surgery 1 year earlier. As an active-duty member in the US Navy, due to pain and weakness, she was unable to perform required curl-ups for her fitness test. Though she had been previously treated both surgically with laparoscopic adhesiolysis and nonsurgically with physical therapy consisting of stretching and strengthening exercises, her pain and function did not improve. She was again evaluated and treated with physical therapy and, based on the examination findings, STM was used to address her pain and dysfunction, which were thought to be related to intra-abdominal adhesions. Outcomes Following 5 sessions of physical therapy over a 3-week period that included STM and therapeutic exercises, followed by 5 additional sessions over a 4-week period that focused on therapeutic exercises, the patient reported substantially decreased pain, improved function, and a full return to previous level of activity, including unrestricted physical training in a military setting. Discussion The outcomes for this patient suggest that STM may be effective as a conservative treatment option for pain and dysfunction related to intra-abdominal adhesions from abdominal/pelvic surgery. Studies with a higher level of evidence, including potential comparison between STM and traditional laparoscopic adhesiolysis, are needed to further determine benefits of nonsurgical care for this condition. Level of Evidence Therapy, level 4. J Orthop Sports Phys Ther 2015;45(12):1006-1016. Epub 15 Oct 2015. doi:10.2519/jospt.2015.5766. PMID:26471853

  8. [Hedrocele, an unknown pelvic organ prolapse].

    PubMed

    Parsy, C; Cosson, M; Quinton, J-F; Laurent, N; Lucot, J-P; Tempremant, F; Poncelet, E

    2015-06-01

    Pelvic floor disorders are frequent and source of symptoms which can be invalidating for patients. Between them, hedrocele is a pathology often unknown and clinically difficult to diagnose. It is a herniation of fat pad, small bowel or sigmoid colon in the recto-uterine pouch (cul-de-sac of Douglas) exercising a mass effect on the anterior wall of the rectum. Pelvic magnetic resonance imaging with morphological sequences and dynamic sequences in thrust can be very useful, allowing a comprehensive study of pelvic floor dysfunction and confirming the complete diagnosis, especially before surgery. We suggest you some examples to illustrate this pathology in order to emphasize the importance of its diagnosis, especially preoperative. A better understanding of this pelvic floor dysfunction would improve the care of patients. PMID:26004024

  9. Robotic pelvic organ prolapse surgery.

    PubMed

    Sajadi, Kamran P; Goldman, Howard B

    2015-04-01

    Robotic sacrocolpopexy (RSC) has rapidly gained popularity over the past 10 years, owing to claims that it is associated with a reduced learning curve compared with standard laparoscopic sacrocolpopexy (LSC) and that it has equal efficacy to the gold-standard treatment, abdominal sacrocolpopexy (ASC). The specifics of the surgical technique used for RSC vary widely, but the basic steps and principles are largely the same. Although complication rates are low, specific complications can be minimized by meticulous attention to surgical technique at several important points in the procedure. Multiple levels of evidence support the efficacy of RSC, and show that it is associated with a shorter hospital stay and convalescence than ASC. The learning curve for RSC usually comprises 10-20 procedures but for those with extensive experience of laparoscopy it is likely to be even shorter. RSC is more expensive than LSC but cheaper than ASC. As RSC has only been used for about a decade, we await long-term outcomes of more than a few years. PMID:25800401

  10. Laparoscopic approach to retrorectal cyst

    PubMed Central

    Gunkova, Petra; Martinek, Lubomir; Dostalik, Jan; Gunka, Igor; Vavra, Petr; Mazur, Miloslav

    2008-01-01

    Retrorectal cysts are rare benign lesions in the presacral space which are frequently diagnosed in middle-aged females. We report here our experience with two symptomatic female patients who were diagnosed as having a retrorectal cyst and managed using a laparoscopic approach. The two patients were misdiagnosed as having an ovarian cystic lesion after abdominal ultrasonography. Computer tomography (CT) scan was mandatory to establish the diagnosis. The trocar port site was the same in both patients. An additional left oophorectomy was done for a coexisting ovarian cystic lesion in one patient in the same setting. There was no postoperative morbidity or mortality and the two patients were discharged on the 5th and 6th post operative days, respectively. Our cases show that laparoscopic management of retrorectal cysts is a safe approach. It reduces surgical trauma and offers an excellent tool for perfect visualization of the deep structures in the presacral space. PMID:19030218

  11. Laparoscopic Excision of Retroperitoneal Schwannoma

    PubMed Central

    Rajkumar, J S; Anirudh, J R; Akbar, S; Kishore, C M

    2015-01-01

    Schwannomas are tumours that arise from the myelin sheath of the nerves. A very unusual location for schwannoma is the retro peritoneal areas (less than 2%). We present herewith a patient who had a 4x5cm Schwannoma arising from the nerve root of L2 on the right side, which presented as a lump in the psoas major muscle. This was treated by total laparoscopic excision after splitting open the psoas major. In the published english medical literature we could find only 16 cases of laparoscopic resection of retroperitoneal schwannoma and we believe ours to be the first case that was done through a psoas muscle split technique. Technical and histopathological details are discussed elaborately in this article. PMID:26676094

  12. Systematic review of therapies for noncyclic chronic pelvic pain in women.

    PubMed

    Yunker, Amanda; Sathe, Nila A; Reynolds, William Stuart; Likis, Frances E; Andrews, Jeff

    2012-07-01

    We synthesized the literature (articles published between 1990 and May 2011) on the treatment of noncyclic and mixed cyclic/noncyclic chronic pelvic pain (CPP) in adult women. Two reviewers assessed studies against predetermined inclusion/exclusion criteria, extracted data regarding participant and intervention characteristics and outcomes, and assigned overall quality and strength of evidence ratings. Of 2081 studies, 21 addressed surgical or nonsurgical interventions. Definitions of CPP and participant characteristics varied across studies, and most studies were of poor quality, which precluded data synthesis. Although surgical and nonsurgical approaches both improved pain, neither was more effective when directly compared in 3 studies. Laparoscopic adhesiolysis or laparoscopic uterosacral nerve ablation did not further improve pain scores over diagnostic laparoscopy. The evidence to conclude that surgical intervention is either effective or ineffective or that one technique is superior to another is insufficient. Most studies on nonsurgical approaches evaluated hormonal therapies in endometriosis-associated CPP and were not placebo controlled. Few studies addressed nonhormonal or nonpharmacologic approaches. Harms reporting was limited. Overall, no nonsurgical treatment was more or less effective than another, except for the clear negative effect of raloxifene. In general, the literature addressing therapies for CPP in women is of poor quality and inconclusive. Improved characterizations of the targeted condition and interventions in CPP research, including a uniform definition and standardized evaluation, are necessary to inform treatment choices. PMID:22926248

  13. [Diagnostic measures before laparoscopic cholecystectomy].

    PubMed

    Weimann, A; Wagner, S; Dralle, H; Raab, R

    1995-05-01

    Successful use of laparoscopic cholecystectomy requires good cooperation between surgeon and gastroenterologist. Standard preoperative workup includes detailed history of the patient, blood chemistry of serum bilirubin and liver enzymes as well as sonography for the detection of common bile duct stones. Intravenous cholangiography can be performed to diagnose anatomic variations of the bile ducts. In case of common bile duct stones "therapeutic splitting" by endoscopic retrograde cholangiography with sphincterotomy and gallstone extraction preoperatively may help to avoid unnecessary conventional open cholecystectomy. PMID:7609591

  14. Chronic Pelvic Pain due to Pelvic Congestion Syndrome: The Role of Diagnostic and Interventional Radiology

    SciTech Connect

    Ganeshan, Arul; Upponi, Sara; Hon, Lye-Quen; Uthappa, M. C.; Warakaulle, Dinuke R.; Uberoi, Raman

    2007-11-15

    Chronic pelvic pain (CPP) is a common cause of gynecologic referral. Pelvic congestion syndrome, which is said to occurs due to ovarian vein incompetence, is a recognized cause of CPP. The aim of this paper is to briefly describe the clinical manifestations, and to review the role of diagnostic and interventional radiology in the management of this probably under-diagnosed condition.

  15. [Serious pelvic traumatisms in children].

    PubMed

    Allouis, M; Bracq, H; Catier, P; Babut, J M

    1981-01-01

    The rareness of pelvic fractures in children is due to the resilience of bony tissue and to the thickness of the periosteum at this age. Therefore, such fractures are most often seen after violent traumatisms, which explains their frequent association with visceral lesions that determine the gravity and dominate the prognosis. The authors have presented 9 observations of fractures of the pelvis, with or without pelvis dislocation, which were the most often associated with urological lesions either acute (urethral rupture, bladder rupture) neither chronic (hydronephrosis) but sometimes with vasculo-nervous, gynecological or others lesions. The different therapeutic techniques and their indications in the treatment of such fractures are similar to those used in the adult. Excepting those cases of polytraumatisms, where mortality remains elevated, the treatment of such fractures is most often satisfactory in the short term, but requires a thorough and prolonged monitoring in children presenting associated urological and gynecological lesions in order to evaluate with precision the long term prognosis. PMID:7226352

  16. [Anatomy of the skull].

    PubMed

    Pásztor, Emil

    2010-01-01

    The anatomy of the human body based on a special teleological system is one of the greatest miracles of the world. The skull's primary function is the defence of the brain, so every alteration or disease of the brain results in some alteration of the skull. This analogy is to be identified even in the human embryo. Proportions of the 22 bones constituting the skull and of sizes of sutures are not only the result of the phylogeny, but those of the ontogeny as well. E.g. the age of the skeletons in archaeological findings could be identified according to these facts. Present paper outlines the ontogeny and development of the tissues of the skull, of the structure of the bone-tissue, of the changes of the size of the skull and of its parts during the different periods of human life, reflecting to the aesthetics of the skull as well. "Only the human scull can give me an impression of beauty. In spite of all genetical colseness, a skull of a chimpanzee cannot impress me aesthetically"--author confesses. In the second part of the treatise those authors are listed, who contributed to the perfection of our knowledge regarding the skull. First of all the great founder of modern anatomy, Andreas Vesalius, then Pierre Paul Broca, Jacob Benignus Winslow are mentioned here. The most important Hungarian contributors were as follow: Sámuel Rácz, Pál Bugát or--the former assistant of Broca--Aurél Török. A widely used tool for measurement of the size of the skull, the craniometer was invented by the latter. The members of the family Lenhossék have had also important results in this field of research, while descriptive anatomy of the skull was completed by microsopical anatomy thanks the activity of Géza Mihálkovits. PMID:21661257

  17. Laparoscopic colon resection: a case report.

    PubMed

    Cooperman, A M; Katz, V; Zimmon, D; Botero, G

    1991-08-01

    The first case of a villous lesion of the colon removed by laparoscopic-guided surgery is reported. Injection of methylene blue into the lesion facilitated its access and exposure via the laparoscope. A very small skin incision allowed delivery onto the abdominal wall for resection and anastomoses. PMID:1834273

  18. Metroplasty to treat chronic pelvic pain resulting from outflow tract müllerian anomalies.

    PubMed

    Bhagavath, Bala; Behrman, Eric; Salari, Bijan W; Vitek, Wendy; Barhan, Sheela; Yaklic, Jerome L; Lindheim, Steven R

    2015-12-01

    Chronic pelvic pain can result from noncommunicating uterine cavities in patients with müllerian anomalies. Traditional management has been to resect the noncommunicating uterine horn. Two cases are described. One had a unicornuate uterus with noncommunicating left uterine horn (American Fertility Society [AFS] classification IIb) and the other had a normal external uterine contour with noncommunicating left uterine cavity that did not fit any category of the AFS classification of müllerian anomalies. Attempts at connecting the noncommunicating cavities hysteroscopically failed in both cases. Successful unification of the cavities was subsequently achieved in the first case using the classic Strassman metroplasty with the assistance of the robot. The unification of uterine cavities was achieved using a modified Strassman metroplasty in the second patient, as there was no uterine horn for landmark. Robot assistance was utilized in this case as well. Both patients are symptom free after surgery. We conclude that laparoscopic Strassman metroplasty, with or without robot assistance, is a viable alternative to resection of uterine horns in patients with hematometra, chronic pelvic pain, and noncommunicating uterine cavities. PMID:26363477

  19. Laparoscopic vs. laparoscopically assisted management of Meckel’s diverticulum in children

    PubMed Central

    Duan, Xufei; Ye, Guogang; Bian, Hongqiang; Yang, Jun; Zheng, Kai; Liang, Chong; Sun, Xuan; Yan, Xueqiang; Yang, Hu; Wang, Xin; Ma, Jingwei

    2015-01-01

    To investigate the management of Meckel’s diverticulum in children and the feasibility of using laparoscopic and laparoscopically assisted Meckel’s diverticulum resection and intestinal anastomosis according to the different subtypes classified laparoscopically. 55 symptomatic Meckel’s diverticulum cases were classified into two categories, the simple and the complex types depending on Meckel’s diverticulum appearance upon laparoscopic exploration. Forty-one cases of simple Meckel’s diverticulum were treated with simple diverticulectomy during laparoscopy, and 14 cases of complicated Meckel’s diverticulum were treated with laparoscopically assisted Meckel’s diverticulum resection and intestinal anastomosis. The operation time for the laparoscopically assisted was significant longer than laparoscopic-only surgeries [45~123 min (54.57 ± 20.17min) vs 29~78min (38.85 ± 9.75 min)], P = 0.013. Among the 55 cases, Just one child with simple type MD during laparoscopic exploration, and presented a diverticulum with a base that was considered to be in the mesangial margin. The remaining 54 patients were cured, and follow-up for 4~36 months revealed that they did not present abdominal pain, and no hematochezia occurred as a complication. Surgery selection either laparoscopy only or transumbilical laparoscopically assisted intestinal resection and intestinal anastomosis by laparoscopic exploration for Meckel’s diverticulum treatment, based on the type of Meckel’s diverticulum in children, is safe, feasible, and effective. PMID:25784978

  20. Anatomy relevant to conservative mastectomy

    PubMed Central

    O’Connell, Rachel L.

    2015-01-01

    Knowledge of the anatomy of the nipple and breast skin is fundamental to any surgeon practicing conservative mastectomies. In this paper, the relevant clinical anatomy will be described, mainly focusing on the anatomy of the “oncoplastic plane”, the ducts and the vasculature. We will also cover more briefly the nerve supply and the arrangement of smooth muscle of the nipple. Finally the lymphatic drainage of the nipple and areola will be described. An appreciation of the relevant anatomy, together with meticulous surgical technique may minimise local recurrence and ischaemic complications. PMID:26645002

  1. Transperitoneal laparoscopic left versus right live donor nephrectomy: Comparison of outcomes

    PubMed Central

    Pandarinath, Shrinivas Rudrapatna; Choudhary, Babulal; Chouhan, Harvinder Singh; Rudramani, Shivashankar; Dubey, Deepak

    2014-01-01

    Introduction: Although laparoscopic donor nephrectomy (LDN) is being performed at many centers, there are reservations on the routine use of laparoscopy for harvesting the right kidney due to a perception of technical complexity and increased incidence of allograft failure, renal vein thrombosis and the need for more back-table reconstruction along with increased operative time. Materials and Methods: We performed a prospective non-randomized comparison of transperitoneal laparoscopic left donor nephrectomy (LLDN) with laparoscopic right donor nephrectomy (RLDN) from August 2008 to May 2013. The operative time, warm ischemia time, intraoperative events, blood loss and post-operative parameters were recorded. The renal recipient parameters, including post-operative creatinine, episodes of acute tubular necrosis (ATN)? and delayed graft function were also recorded. Results: A total of 188 LDN were performed between August 2008 and May 2013, including 164 LLDN and 24 RLDN. The demographic characteristics between the two groups were comparable. The operative duration was in favor of the right donor group, while warm ischemia time, estimated blood loss and mean length of hospital stay were similar between the two groups. Overall renal functional outcomes were comparable between the two donor groups, while the recipient outcomes including creatinine at discharge were also comparable. Conclusions: RLDN has a safety profile comparable with LLDN, even in those with complex vascular anatomy, and can be successfully performed by the transperitoneal route with no added morbidity. RLDN requires lesser operative time with comparable morbidity. PMID:25097308

  2. HUMAN GROSS ANATOMY ANTH 695 SPRING 2014

    E-print Network

    Auerbach, Benjamin M.

    1 HUMAN GROSS ANATOMY ANTH 695 ­ SPRING 2014 THE UNIVERSITY OF TENNESSEE in Anatomy Lecture Series Fridays: 12:20 PM ­ 1:10 PM * All undergraduate anatomy labs may meet). However, use of the lab outside class

  3. University of Oregon Human Anatomy I

    E-print Network

    Lockery, Shawn

    University of Oregon Human Anatomy I HPHY 321 Fall 2014 Monday to take HPHY 321 (Anatomy I) & HPHY 322 (Physiology I) together. It is strongly recommended! Required Resources: 1. Anatomy & Physiology Revealed 3.0, Web

  4. The Surgical Treatment of Pelvic Bone Metastases

    PubMed Central

    Müller, Daniel A.; Capanna, Rodolfo

    2015-01-01

    Pelvic bone metastases are a growing concern in the field of orthopedic surgery. Patients with pelvic metastasis are individually different with different needs of treatment in order to attain the best possible quality of life despite the advanced stage of disease. A holistic collaboration among the oncologist, radiation therapist, and orthopedic surgeon is mandatory. Special attention has to be directed to osteolytic lesions in the periacetabular region as they can provoke pathological fractures and subsequent functional impairment. Different reconstruction techniques for the pelvis are available; the choice depends on the patient's prognosis, size of the bone defect, and response of the tumor to adjuvant treatment. If all the conservative treatments are exhausted and the patient is not eligible for surgery, one of the various percutaneous ablation procedures can be considered. We propose a pelvic analogue to the treatment algorithm in long bone metastasis and a scoring system in pelvic metastasis. This algorithm aims to simplify the teamwork and to avoid under- or overtreatment of pelvic bone metastases. PMID:25810925

  5. Pelvic-fracture urethral injury in children

    PubMed Central

    Hagedorn, Judith C.; Voelzke, Bryan B.

    2015-01-01

    Objective To review paediatric posterior urethral injuries and the current potential management options; because urethral injury due to pelvic fracture in children is rare and has a low incidence, the management of this type of trauma and its complications remains controversial. Methods We reviewed previous reports identified by searching the PubMed Medline electronic database for clinically relevant articles published in the past 25 years. The search was limited to the keywords ‘pediatric’, ‘pelvic fracture’, ‘urethral injury’, ‘stricture’, ‘trauma’ and ‘reconstruction’. Results Most paediatric urethral injuries are a result of pelvic fractures after high-impact blunt trauma. After the diagnosis, immediate bladder drainage via a suprapubic cystotomy, or urethral realignment, are the initial management options, except for a possible immediate primary repair in girls. The common complications of pelvic fracture-associated urethral injury include urethral stricture formation, incontinence and erectile dysfunction. Excellent results can be achieved with delayed urethroplasty for pelvic fracture-associated urethral injuries. Conclusion Traumatic injury to the paediatric urethra is rare and calls for an immediate diagnosis and management. These devastating injuries have a high complication rate and therefore a close follow-up is warranted to assure adequate delayed repair by a reconstructive urologist. PMID:26019977

  6. Pelvic girdle and fin of Tiktaalik roseae.

    PubMed

    Shubin, Neil H; Daeschler, Edward B; Jenkins, Farish A

    2014-01-21

    A major challenge in understanding the origin of terrestrial vertebrates has been knowledge of the pelvis and hind appendage of their closest fish relatives. The pelvic girdle and appendage of tetrapods is dramatically larger and more robust than that of fish and contains a number of structures that provide greater musculoskeletal support for posture and locomotion. The discovery of pelvic material of the finned elpistostegalian, Tiktaalik roseae, bridges some of these differences. Multiple isolated pelves have been recovered, each of which has been prepared in three dimensions. Likewise, a complete pelvis and partial pelvic fin have been recovered in association with the type specimen. The pelves of Tiktaalik are paired and have broad iliac processes, flat and elongate pubes, and acetabulae that form a deep socket rimmed by a robust lip of bone. The pelvis is greatly enlarged relative to other finned tetrapodomorphs. Despite the enlargement and robusticity of the pelvis of Tiktaalik, it retains primitive features such as the lack of both an attachment for the sacral rib and an ischium. The pelvic fin of Tiktaalik (NUFV 108) is represented by fin rays and three endochondral elements: other elements are not preserved. The mosaic of primitive and derived features in Tiktaalik reveals that the enhancement of the pelvic appendage of tetrapods and, indeed, a trend toward hind limb-based propulsion have antecedents in the fins of their closest relatives. PMID:24449831

  7. Uropathogenic Escherichia coli induces chronic pelvic pain.

    PubMed

    Rudick, Charles N; Berry, Ruth E; Johnson, James R; Johnston, Brian; Klumpp, David J; Schaeffer, Anthony J; Thumbikat, Praveen

    2011-02-01

    Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a debilitating syndrome of unknown etiology often postulated, but not proven, to be associated with microbial infection of the prostate gland. We hypothesized that infection of the prostate by clinically relevant uropathogenic Escherichia coli (UPEC) can initiate and establish chronic pain. We utilized an E. coli strain newly isolated from a patient with CP/CPPS (strain CP1) and examined its molecular pathogenesis in cell culture and in a murine model of bacterial prostatitis. We found that CP1 is an atypical isolate distinct from most UPEC in its phylotype and virulence factor profile. CP1 adhered to, invaded, and proliferated within prostate epithelia and colonized the prostate and bladder of NOD and C57BL/6J mice. Using behavioral measures of pelvic pain, we showed that CP1 induced and sustained chronic pelvic pain in NOD mice, an attribute not exhibited by a clinical cystitis strain. Furthermore, pain was observed to persist even after bacterial clearance from genitourinary tissues. CP1 induced pelvic pain behavior exclusively in NOD mice and not in C57BL/6J mice, despite comparable levels of colonization and inflammation. Microbial infections can thus serve as initiating agents for chronic pelvic pain through mechanisms that are dependent on both the virulence of the bacterial strain and the genetic background of the host. PMID:21078846

  8. The anatomy of anatomy: a review for its modernization.

    PubMed

    Sugand, Kapil; Abrahams, Peter; Khurana, Ashish

    2010-01-01

    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

  9. Anatomy Adventure: A Board Game for Enhancing Understanding of Anatomy

    ERIC Educational Resources Information Center

    Anyanwu, Emeka G.

    2014-01-01

    Certain negative factors such as fear, loss of concentration and interest in the course, lack of confidence, and undue stress have been associated with the study of anatomy. These are factors most often provoked by the unusually large curriculum, nature of the course, and the psychosocial impact of dissection. As a palliative measure, Anatomy

  10. Pelvic Fractures in Children Results from the German Pelvic Trauma Registry

    PubMed Central

    Zwingmann, Jörn; Aghayev, Emin; Südkamp, Norbert P.; Neumann, Mirjam; Bode, Gerrit; Stuby, Fabian; Schmal, Hagen

    2015-01-01

    Abstract As pelvic fractures in children and adolescents are very rare, the surgical management is not well delineated nor are the postoperative complications. The aim of this study using the prospective data from German Pelvic Trauma Registry study was to evaluate the various treatment approaches compared to adults and delineated the differences in postoperative complications after pelvic injuries. Using the prospective pelvic trauma registry established by the German Society of Traumatology and the German Section of the Arbeitsgemeinschaft für Osteosynthesefragen (AO), International in 1991, patients with pelvic fractures over a 12-year time frame submitted by any 1 of the 23 member level I trauma centers were reviewed. We identified a total of 13,525 patients including pelvic fractures in 13,317 adults and 208 children aged ?14 years and compared these 2 groups. The 2 groups’ Injury Severitiy Score (ISS) did not differ statistically. Lethality in the pediatric group was 6.3%, not statistically different from the adults’ 4.6%. In all, 18.3% of the pediatric pelvic fractures were treated surgically as compared to 22.7% in the adult group. No child suffered any thrombosis/embolism, acute respiratory distress syndrome (ARDS), multiorgan failure (MOF), or neurologic deficit, nor was any septic MOF detected. The differences between adults and children were statistically significant in that the children suffered less frequently from thrombosis/embolism (P?=?0.041) and ARDS and MOF (P?=?0.006). This prospective multicenter study addressing patients with pelvic fractures reveals that the risk for a thrombosis/embolism, ARDS, and MOF is significant lower in pediatric patients than in adults. No statistical differences could be found in the ratios of operative therapy of the pelvic fractures in children compared to adults. PMID:26705223

  11. [Combination fractures of the pelvic girdle: comparison of CT with the conventional pelvic image].

    PubMed

    Peters, J; Lörcher, U

    1989-12-01

    102 polytraumatised patients with pelvic fractures were studied by conventional x-rays of the pelvis as well as by computed tomography to obtain detailed information on type and degree of the fractures. We paid particular attention to acetabular and sacral fractures and combinations thereof. We found that only computed tomography enabled us to precisely define type and degree of pelvic injury. We thus draw the conclusion that each patient with proven or suspected pelvic injury should be subjected to a CT study to enable the surgeon to plan his therapy-conservative or surgical-to the best benefit of the patient. PMID:2630154

  12. [Laparoscopic and general surgery guided by open interventional magnetic resonance].

    PubMed

    Lauro, A; Gould, S W T; Cirocchi, R; Giustozzi, G; Darzi, A

    2004-10-01

    Interventional magnetic resonance (IMR) machines have produced unique opportunity for image-guided surgery. The open configuration design and fast pulse sequence allow virtual real time intraoperative scanning to monitor the progress of a procedure, with new images produced every 1.5 sec. This may give greater appreciation of anatomy, especially deep to the 2-dimensional laparoscopic image, and hence increase safety, reduce procedure magnitude and increase confidence in tumour resection surgery. The aim of this paper was to investigate the feasibility of performing IMR-image-guided general surgery, especially in neoplastic and laparoscopic field, reporting a single center -- St. Mary's Hospital (London, UK) -- experience. Procedures were carried out in a Signa 0.5 T General Elettric SP10 Interventional MR (General Electric Medical Systems, Milwaukee, WI, USA) with magnet-compatible instruments (titanium alloy instruments, plastic retractors and ultrasonic driven scalpel) and under general anesthesia. There were performed 10 excision biopsies of palpable benign breast tumors (on female patients), 3 excisions of skin sarcoma (dermatofibrosarcoma protuberans), 1 right hemicolectomy and 2 laparoscopic cholecystectomies. The breast lesions were localized with pre- and postcontrast (intravenous gadolinium DPTA) sagittal and axial fast multiplanar spoiled gradient recalled conventional Signa sequences; preoperative real time fast gradient recalled sequences were also obtained using the flashpoint tracking device. During right hemicolectomy intraoperative single shot fast spin echo (SSFSE) and fast spoiled gradient recalled (FSPGR) imaging of right colon were performed after installation of 150 cc of water or 1% gadolinium solution, respectively, through a Foley catheter; imaging was also obtained in an attempt to identify mesenteric lymph nodes intraoperatively. Concerning laparoscopic procedures, magnetic devices (insufflator, light source) were positioned outside scan room, the tubing and light head being passed through penetration panels. Intraoperative MR-cholangiography was performed using fast spin echo (SSFSE) techniques with minimal intensity projection 3-dimensional reconstruction. About skin sarcomas, 2 of them were skin recurrences of previously surgically treated sarcomas (all of them received preoperative biopsy) and the extent of the lesion was then determined using short tau inversion recovery (STIR) sequence. The skin was closed in each case without need for any plastic reconstruction. The breast lesions were visualized with both Signa and real-time imaging and all enhanced with contrast: 2 (20%) were visualized only after contrast enhancement; intraoperative real time imaging clearly demonstrated a resection margin in all cases. Maximum dimensions of breast specimens (range 8-50 mm, median 24.5 mm) were not significantly different from those measured by Signa (p>0.17, Student's paired t-test) or real time images (p>0.4): also there was no significant difference in lesion size between Signa and real time images (p>0.25). All postprocedure scans clearly demonstrated complete excision. The extent of the tumor at MR imaging was greater in each case than suggested by clinical examination. Adequate resection margins were planned using STIR sequences. Histological examination confirmed clear surgical margins of at least 1 cm in each case. During right hemicolectomy, both intraoperative SSFSE and FSPGR contrast imaging revealed the lesion and details of the colonic surface; imaging of the lymph node draining right colon was only partially successful, due to movement artifact. Concerning laparoscopic procedures, both FSE and SSFSE techniques produced reasonable images of the gallbladder and intrahepatic ducts, but the FSE imaging was of poor quality due to respiration artifact; however, SSFSE allowed visualization of the gallbladder and part of the common bile duct. About skin sarcomas, the extent of the tumor at MR imaging was greater in each case than suggested by clinical examination and in each case the com

  13. Health Instruction Packages: Cardiac Anatomy.

    ERIC Educational Resources Information Center

    Phillips, Gwen; And Others

    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…

  14. Laparoscopic approach to Meckel's diverticulum

    PubMed Central

    Papparella, Alfonso; Nino, Fabiano; Noviello, Carmine; Marte, Antonio; Parmeggiani, Pio; Martino, Ascanio; Cobellis, Giovanni

    2014-01-01

    AIM: To retrospective review the laparoscopic management of Meckel Diverticulum (MD) in two Italian Pediatric Surgery Centers. METHODS: Between January 2002 and December 2012, 19 trans-umbilical laparoscopic-assisted (TULA) procedures were performed for suspected MD. The children were hospitalized for gastrointestinal bleeding and/or recurrent abdominal pain. Median age at diagnosis was 5.4 years (range 6 mo-15 years). The study included 15 boys and 4 girls. All patients underwent clinical examination, routine laboratory tests, abdominal ultrasound and technetium-99m pertechnetate scan, and patients with bleeding underwent gastrointestinal endoscopy. The abdominal exploration was performed with a 10 mm operative laparoscope. Pneumoperitoneum was established based on the body weight. Systematic overview of the peritoneal cavity allowed the ileum to be grasped with an atraumatic instrument. The complete exploration and surgical treatment of MD were performed extracorporeally, after intestinal exteriorization through the umbilicus. All patients’ demographics, main clinical features, diagnostic investigations, operative time, histopathology reports, conversion rate, hospital stay and complications were registered and analyzed. RESULTS: MD was identified in 17 patients, while 1 had an ileal duplication and 1 a jejunal hemangioma. Fifteen patients had painless intestinal bleeding, while 4 had recurrent abdominal pain and exhibited cyst like structures in an ultrasound study. Eleven patients had a positive technetium-99m pertechnetate scan. In the patients with bleeding, gastrointestinal endoscopy did not name the source of hemorrhage. All patients were subjected to a TULA surgical procedure. An intestinal resection/anastomosis was performed in 14 patients, while 4 had a wedge resection of the diverticulum and 1 underwent stapling diverticulectomy. All surgical procedures were performed without conversion to open laparotomy. Mean operative time was 75 min (range 40-115 min). No major surgical complications were recorded. The median hospital stay was 5-7 d (range 4-13 d). All patients are asymptomatic at a median follow up of 4, 5 years (range 10 mo-10 years). CONCLUSION: Trans-umbilical laparoscopic-assisted Meckel’s diverticulectomy is safe and effective in the treatment of MD, with excellent results. PMID:25009390

  15. Clinical privileges for laparoscopic surgery.

    PubMed

    Albrink, M H; Rosemurgy, A S

    1993-06-01

    Laparoscopic cholecystectomy has undergone an explosive growth. Its benefits to patients--shortened recovery time and less pain--became immediately obvious. The procedure's development and adaptation have largely been devised and implemented by ingenious and creative private practitioners, not the typical mode of introduction. Most or many new procedures in the past evolved from academic institutions after laboratory and then clinical trials. With rapid development and acceptance has come an additional new burden among medical practitioners: credentialing and granting clinical privileges. PMID:8340775

  16. Management of ureteropelvic junction obstruction in horseshoe kidneys by an assortment of laparoscopic options

    PubMed Central

    Shadpour, Pejman; Akhyari, H. Habib; Maghsoudi, Robab; Etemadian, Masoud

    2015-01-01

    Introduction: We report our experience with laparoscopic management of ureteropelvic junction obstruction in horseshoe kidneys. Methods: Between February 2004 and March 2014, 15 patients with horseshoe kidneys and symptomatic ureteropelvic junction obstruction underwent laparoscopic management at our national referral centre. Depending on the anatomy and presence of obtrusive vessels or isthmus, we performed either dismembered, Scardino or Foley YV pyeloplasty, or Hellstrom vessel transposition. Patients were initially evaluated by ultrasonography, then diuretic scintiscan at 4 to 6 months, and followed by yearly clinical and sonographic exams. Results: This study included 11 male and 4 female patients between the ages of 4 to 51 year (average 17.7). The left kidney was involved in 12 patients (80%). Operation time was 129 minutes (range: 90–186), and patients were discharged within 2.8 days (range: 1–6). Although 8 (53.3%) patients had crossing vessels, of which 6 required transposing, the Hellstrom technique was solely used in 3 cases, of which notably 1 case failed to resolve and required laparoscopic Hynes within the next year. Eight cases underwent dismembered pyeloplasty, 2 Foley YV, 1 Scardino flap and 1 required isthmectomy and vessel suspension. At the mean follow-up of 60 (range: 18–120) months, the overall success rate was 93.3%. Conclusions: To our knowledge, this represents the largest report on laparoscopic pyeloplasty for horseshoe kidneys, providing the longest follow-up. Our findings confirm prior reports supporting laparoscopy and furthermore show that despite the prevalence of crossing vessels, transposition alone is seldom sufficient. PMID:26600883

  17. The quail anatomy portal.

    PubMed

    Ruparelia, Avnika A; Simkin, Johanna E; Salgado, David; Newgreen, Donald F; Martins, Gabriel G; Bryson-Richardson, Robert J

    2014-01-01

    The Japanese quail is a widely used model organism for the study of embryonic development; however, anatomical resources are lacking. The Quail Anatomy Portal (QAP) provides 22 detailed three-dimensional (3D) models of quail embryos during development from embryonic day (E)1 to E15 generated using optical projection tomography. The 3D models provided can be virtually sectioned to investigate anatomy. Furthermore, using the 3D nature of the models, we have generated a tool to assist in the staging of quail samples. Volume renderings of each stage are provided and can be rotated to allow visualization from multiple angles allowing easy comparison of features both between stages in the database and between images or samples in the laboratory. The use of JavaScript, PHP and HTML ensure the database is accessible to users across different operating systems, including mobile devices, facilitating its use in the laboratory.The QAP provides a unique resource for researchers using the quail model. The ability to virtually section anatomical models throughout development provides the opportunity for researchers to virtually dissect the quail and also provides a valuable tool for the education of students and researchers new to the field. DATABASE URL: http://quail.anatomyportal.org (For review username: demo, password: quail123). PMID:24715219

  18. Uterine arteriovenous malformation caused by intrauterine instrumentation for laparoscopic surgery due to left tubal pregnancy

    PubMed Central

    Chang, Kylie Hae-Jin; Park, Jong-Kyu; Park, Sung-Ho; Kim, Hong-Bae

    2014-01-01

    Uterine arteriovenous malformation (AVM) is a rare entity in gynecology with fewer than 100 cases reported in the literature. Due to abnormal connection between arteries and veins without an intervening capillary system, recurrent and profuse vaginal bleeding is the most common symptom which can be potentially life-threatening. Uterine AVM can be either congenital or acquired. Acquired AVM is reported as a consequence of previous uterine trauma such as curettage procedures, caesarean section or pelvic surgery. It is also associated with infection, retained product of conception, gestational trophoblastic disease, malignancy and exposure to diethlystilboestrol. We herein report a case of acquired uterine AVM located on the right lateral wall after intrauterine instrumentation for laparoscopic left salpingectomy due to left tubal pregnancy. The patient was successfully treated with embolization. PMID:25264537

  19. 'Pelvic digit' - an unusual development anomaly

    SciTech Connect

    Greenspan, A.; Norman, A.

    1982-12-01

    Five cases of a rare developmental anomaly involving extraskeletal bone formation are described - four in the pelvis and one arising from the 12th rib. Three of these bony growths, called 'Pelvic digits' had well developed 'joints' or pseudoarticulations. The similarity of this anomaly to posttraumatic myositis ossificans and avulsion injuries of the pelvis (rectus femoris) is pointed out and a differential diagnosis offered.

  20. We introduce a ur from pelvic

    E-print Network

    Lee, WonSook

    most precise r scans come fro le providing mentation is e work for a sing tions. Our mentation sche information e size, varyin ntial presence menting the f Seg a new way to CT scans. Th e to its pr gle pelvic scan goal is to eme which gre mur from a p accurate resul ber of factors from a CT pel

  1. Laparoscopic Anti-Reflux (GERD) Surgery

    MedlinePLUS

    ... Laparoscopic Anti-Reflux (GERD) Surgery Patient Information from SAGES Download PDF Version Find a SAGES Surgeon Surgery ... 2015 CME Credits Healthy Sooner: Patient Information Contact SAGES Society of American Gastrointestinal and Endoscopic Surgeons 11300 ...

  2. Laparoscopic appendectomy in the elderly: our experience

    PubMed Central

    2013-01-01

    Background Laparoscopic appendectomy for acute appendicitis is one of the most common surgical procedures performed in the world. We aimed to compare laparoscopic and open appendectomy in the elderly in our experience. Methods We performed a retrospective review of elderly patients who underwent appendectomy for acute appendicitis from 1st of January 2006 to the 31st of July 2012. We analyzed 39 appendectomies in elderly patients: 20 procedures were performed using open technique (Group O) and 19 using laparoscopic technique (Group L). Results In the analysis of intraoperative variables there was no statistically significant difference. In this study there was no statistically significant difference also in peri-operative variables. Conclusion Laparoscopic appendectomy is a safe and feasible technique in acute appendicitis also in the elderly. PMID:24266893

  3. Laparoscopic Management of a Torted Appendix

    PubMed Central

    Rajendran, N; Ameen, S; Rohatgi, A

    2006-01-01

    Torted appendices are a rare occurrence but should be considered when encountering a haemorrhagic congested appendix on laparoscopy. As adhesions are rarely present, laparoscopic excision is usually a feasible option. PMID:17059706

  4. Single-incision bilateral laparoscopic oophorectomy

    PubMed Central

    Bhandarkar, Deepraj; Katara, Avinash; Deshmane, Vinay; Mittal, Gaurav; Udwadia, Tehemton E

    2011-01-01

    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. PMID:21197250

  5. Laparoscopic sentinel lymph node mapping after cervical injection of indocyanine green for endometrial cancer – preliminary report

    PubMed Central

    Reinholz-Jaskolska, Malgorzata; Bidzinski, Mariusz

    2015-01-01

    Introduction Endometrial cancer (EC) has an increasing incidence worldwide, with lymph node metastases as the main prognostic factor. Systemic lymphadenectomy is connected with elevated morbidity. Sentinel lymph node (SLN) biopsy is intended to avoid extensive lymphadenectomy and provide significant oncologic information. Aim To evaluate the accuracy of laparoscopic SLN biopsy guided by indocyanine green (ICG) injection into the cervix in EC patients and to develop ideas to improve this method. The optimal time from dye injection to lymph node visualization was assessed. Material and methods This retrospective study was conducted between July 2014 and March 2015 in a group of 9 women with EC, at low and intermediate risk of recurrence, scheduled for total laparoscopic hysterectomy and pelvic lymphadenectomy. All patients underwent cervical ICG injection and SLN biopsy, followed by surgery. Pelvic lymph nodes were located using an ICG endoscopic camera. Results The following data were collected: There were 9 patients with endometrial cancer at low and intermediate risk of recurrence. Median patient age was 59 years, median body mass index (BMI) 28 kg/m2, endometrioid adenocarcinoma in 9 cases, grading: G1 – 1 patient, G2 – 8 patients. No intraoperative or postoperative complications were noted. Median time from ICG injection and SLN detection during surgery was 25 min. There were no lymph nodes metastasis, all identified by the SLN protocol using ICG injection. Conclusions Sentinel lymph node mapping can play a significant role in lymph node assessment and staging in early-stage EC patients with low risk of recurrence according to the ESMO classification. The use of SLN mapping in EC is much needed and the therapeutic benefit is high. PMID:26649087

  6. Management of symptomatic fibroids: conservative surgical treatment modalities other than abdominal or laparoscopic myomectomy.

    PubMed

    Istre, Olav

    2008-08-01

    Approximately 50% of women of reproductive age have fibroids, and at least 50% of these women have significant symptoms. However, until 15 years ago, the only surgical options available were hysterectomy and myomectomy, and as yet there are no proven effective long-term medical therapies. Fortunately, the past decade has witnessed the emergence of highly sophisticated diagnostic and therapeutic technologies for fibroids. Magnetic resonance imaging and high-resolution ultrasound are non-invasive, high-quality diagnostic procedures. The new treatment modalities include: laparoscopic and vaginal myomectomy; uterine artery embolization (UAE); magnetic-resonance-guided focused ultrasound surgery (MRgFUS); hysteroscopic resection where the fibroids are submucous; myolysis by heat, cold coagulation and laser; laparoscopic uterine artery occlusion; and temporary transvaginal uterine artery occlusion. It is, however, abundantly clear that there is no panacea that suits every woman, nor are all treatment types universally available to all women, even in the developed world. Laparoscopic surgery requires skills that are not common place, and there are limitations on the size and number of fibroids that can be treated by this modality. Much the same applies to vaginal myomectomy. UAE is now widely used in the USA and Western Europe, and has been recommended by the National Institute for Clincial Excellence (NICE) in the UK as an alternative therapy to hysterectomy. However, UAE is still under evaluation in terms of comparison with myomectomy. UAE has a range of complications including premature ovarian failure, chronic vaginal discharge and pelvic sepsis, and may have limited efficacy when the fibroids are large. Although there are a number of reports of successful pregnancy following UAE, the experience is limited and research is required in this area. MRgFUS was approved by the US Food and Drug Administration in 2004, while NICE recommended that the procedure should be used in an audit and research setting. Preliminary data following laparoscopic uterine artery occlusion suggest that outcomes are similar to those with UAE, but these data are derived from studies involving relatively small numbers. Temporary uterine artery occlusion is also promising, but has yet to be evaluated robustly. Thus there is no room for complacency; research involving the available treatment modalities is urgently needed, while innovations in search of newer and more effective therapies must continue. This chapter will review surgical treatment modalities other than hysterectomy and abdominal or laparoscopic myomectomy. PMID:18328788

  7. Laparoscopic Management of Renal Hydatid Cyst

    PubMed Central

    Bansal, Ankur

    2014-01-01

    Introduction: Renal involvement by hydatid disease is uncommon. The patients may be asymptomatic or present with flank pain, hematuria, and hypertension. Surgery is the mainstay of treatment, and options include cyst deroofing, partial nephrectomy, and total nephrectomy. We share our experience of laparoscopic management of 3 patients with large hydatid cysts of the kidney and review the literature. Case Description: Three patients with hydatid cysts of the kidney were treated at our institution between 2008 and 2010. In all 3 patients, hydatid disease involved the left kidney. One of the three cases also had concomitant liver involvement. Abdominal pain was the predominant symptom. A flank mass was palpable in 2 patients. The diagnosis was confirmed on abdominal ultrasonography and computed tomography in all 3 patients. Laparoscopic management was successfully completed in 2 patients. A large intrahepatic cyst in 1 patient prompted conversion to an open procedure. A special hydatid trocar-cannula system helps in eliminating the possibility of spillage from the cyst while puncturing and aspirating the cyst. Discussion: There are few reports on laparoscopic management of this uncommon disease of the kidney. In our series the laparoscopic management was attempted in all 3 cases. The procedures included laparoscopic aspiration of the cyst contents along with subtotal excision of the ectocyst in 2 patients and nephrectomy in 1 patient. The latter case had to be converted to an open procedure because of inaccessibility of the intrahepatic liver hydatid cyst. Laparoscopic management of renal hydatid cysts is feasible and safe. PMID:24960508

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

    PubMed

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

    1999-03-01

    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

  9. Automated Instrument Tracking in Robotically-Assisted Laparoscopic Surgery

    E-print Network

    Wang, Yuan-Fang

    Automated Instrument Tracking in Robotically-Assisted Laparoscopic Surgery Darrin R. Uecker automated instrument localization and scope maneuvering in robotically-assisted laparoscopic surgery efficient in performing surgery without requiring additional use of the hands. Key Words: Laparoscopy

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

    SciTech Connect

    Oh, Dongryul; Huh, Seung Jae Nam, Heerim; Park, Won; Han, Youngyih; Lim, Do Hoon; Ahn, Yong Chan; Lee, Jeong Won; Kim, Byoung Gie; Bae, Duk Soo; Lee, Je Ho

    2008-03-15

    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.

  11. OLFACTION: ANATOMY, PHYSIOLOGY AND BEHAVIOR

    EPA Science Inventory

    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.

  12. Gallstone ileus after laparoscopic cholecystectomy

    PubMed Central

    Ivanov, I; Beuran, M; Venter, MD; Iftimie-Nastase, I; Smarandache, R; Popescu, B; Bostin?, R

    2012-01-01

    Gallstone ileus represents a rare complication (0,3-0,5%) of a serious, but common disease-gallstones, which affect around 10% of the population in the USA and Western Europe. Associated diseases (usually severe), elderly patients, delayed diagnosis and therapy due to late presentation to the hospital, account for the morbidity and mortality rates described in literature. We present the case of a patient with partial colon obstruction due to a large gallstone that was “lost” during an emergency laparoscopic cholecystectomy. The calculus eroded the intestinal wall, partially occluding the lumen, triggering recurrent Kerwsky-like, subocclusive episodes. The intraperitoneal abscess has spontaneously drained through the subhepatic drain and once the tube has been removed, a persistent intermittent fistula became obvious. PMID:23049640

  13. Dosimetric intercomparison for multicenter clinical trials using a patient-based anatomic pelvic phantom

    SciTech Connect

    Ebert, M. A.; Harrison, K. M.; Howlett, S. J.; Cornes, D.; Bulsara, M.; Hamilton, C. S.; Kron, T.; Joseph, D. J.; Denham, J. W.

    2011-09-15

    Purpose: To assess dose delivery accuracy to clinically significant points in a realistic patient geometry for two separate pelvic radiotherapy scenarios. Methods: An inhomogeneous pelvic phantom was transported to 36 radiotherapy centers in Australia and New Zealand. The phantom was treated according to Phase III rectal and prostate trial protocols. Point dose measurements were made with thermoluminescent dosimeters (TLDs) and an ionisation chamber. Comprehensive site-demographic, treatment planning, and physical data were collected for correlation with measurement outcomes. Results: Dose delivery to the prescription point for the rectal treatment was consistent with planned dose (mean difference between planned and measured dose - 0.1 {+-} 0.3% std err). Dose delivery in the region of the sacral hollow was consistently higher than planned (+1.2 {+-} 0.2%). For the prostate treatment, dose delivery to the prostate volume was consistent with planned doses (-0.49 {+-} 0.2%) and planned dose uniformity, though with a tendency to underdose the PTV at the prostate-rectal border. Measured out-of-field doses were significantly higher than planned. Conclusions: A phantom based on realistic anatomy and heterogeneity can be used to comprehensively assess the influence of multiple aspects of the radiotherapy treatment process on dose delivery. The ability to verify dose delivery for two trials with a single phantom was advantageous.

  14. Minimally invasive colon resection (laparoscopic colectomy).

    PubMed

    Jacobs, M; Verdeja, J C; Goldstein, H S

    1991-09-01

    The successful application of laparoscopic surgery to gallbladder disease and acute appendicitis has encouraged clinical investigators to develop this technology further in an attempt to manage other pathologic disorders of the gastrointestinal (GI) tract. After gaining experience with various laparoscopic skills while performing clinical biliary tract surgery, appendectomy and then in a controlled animal laboratory, a pilot program for laparoscopic colonic surgery was initiated. Twenty patients with ages ranging from 43 to 88 years (mean age of 57 years) underwent laparoscope-assisted colon resection. In nine patients, a right hemicolectomy was performed and a sigmoid colectomy in eight. A low anterior resection, Hartman's procedure, and abdominal perineal resection were each performed in one patient. Indications for surgery were large villous adenomas or adenocarcinoma in 12, diverticular disease in 5, sigmoid endometrioma in 1, cecal volvulus in 1, and inflammatory bowel disease in 1. Eighty percent of patients were able to tolerate a liquid diet on the first postoperative day and 70% were discharged within 96 h eating a regular diet and having normal bowel movements. There were three operative complications: a 3 unit postoperative bleed managed without surgery, one patient developed marked edema of the rectosigmoid anastomosis requiring decompression with a rectal tube, and one individual with metastatic colon cancer was operated on for a mechanical small bowel obstruction 7 days after the initial laparoscopic surgery. Although laparoscope-assisted colonic surgery may still be considered a procedure in evolution, we feel that in time it has the potential to be as popular as laparoscopic cholecystectomy. PMID:1688289

  15. Minireview on laparoscopic hepatobiliary and pancreatic surgery

    PubMed Central

    Tan-Tam, Clara; Chung, Stephen W

    2014-01-01

    The first laparoscopic cholecystectomy was performed in the mid-1980s. Since then, laparoscopic surgery has continued to gain prominence in numerous fields, and has, in some fields, replaced open surgery as the preferred operative technique. The role of laparoscopy in staging cancer is controversial, with regards to gallbladder carcinoma, pancreatic carcinoma, hepatocellular carcinoma and liver metastasis from colorectal carcinoma, laparoscopy in conjunction with intraoperative ultrasound has prevented nontherapeutic operations, and facilitated therapeutic operations. Laparoscopic cholecystectomy is the preferred option in the management of gallbladder disease. Meta-analyses comparing laparoscopic to open distal pancreatectomy show that laparoscopic pancreatectomy is safe and efficacious in the management of benign and malignant disease, and have better patient outcomes. A pancreaticoduodenectomy is a more complex operation and the laparoscopic technique is not feasible for this operation at this time. Robotic assisted pancreaticoduodenectomy has been tried with limited success at this time, but with continuing advancement in this field, this operation would eventually be feasible. Liver resection remains to be the best management for hepatocellular carcinoma, cholangiocarcinoma and colorectal liver metastases. Systematic reviews and meta-analyses have shown that laparoscopic liver resections result in patients with equal or less blood loss and shorter hospital stays, as compared to open surgery. With improving equipment and technique, and the incorporation of robotic surgery, minimally invasive liver resection operative times will improve and be more efficacious. With the incorporation of robotic surgery into hepatobiliary surgery, donor hepatectomies have also been completed with success. The management of benign and malignant disease with minimally invasive hepatobiliary and pancreatic surgery is safe and efficacious. PMID:24634709

  16. Pelvic ring injuries in the military environment.

    PubMed

    Adams, S A

    2009-12-01

    Haemodynamically unstable patients with mechanically unstable pelvic ring injuries continue to present a challenge to all personnel involved. Road traffic accidents remain a significant cause of soldier morbidity and mortality in peacetime and in war. These pelvic ring disruptions are markers of high-energy transfer injuries and are associated with fatal exsanguinating haemorrhage. Identifying the ring injury and the source of bleeding remains a complex challenge. Early control of instability, both haemodynamic and mechanical is likely to produce the best results. Dealing with these issues in the military environment adds additional stress to this volatile situation. Multidisciplinary practice guidelines have been shown to reduce mortality and should be adopted by all establishments treating these causalities. A well-rehearsed ABC approach with a proactive approach to dot protection and promotion is ideal. PMID:20397605

  17. Pelvic Organ Prolapse-Associated Cystitis.

    PubMed

    Hamid, Rizwan; Losco, Giovanni

    2014-01-01

    Pelvic organ prolapse (POP) and urinary tract infection (UTI) are important problems, estimated to affect around 14 and 40 % of women, respectively, at some point in their lives. Positive urine culture in the presence of symptoms is the cornerstone of diagnosis of UTI and should be performed along with ultrasound assessment of postvoid residual (PVR) in all women presenting with POP and UTI. PVR over 30 mL is an independent risk factor for UTI, although no specific association with POP and UTI has been demonstrated. The use of prophylactic antibiotics remains controversial. The major risk factors for postoperative UTI are postoperative catheterisation, prolonged catheterisation, previous recurrent UTI and an increased urethro-anal distance-suggesting that global pelvic floor dysfunction may play a role. PMID:25170365

  18. Pelvic radiation disease: Updates on treatment options

    PubMed Central

    Frazzoni, Leonardo; La Marca, Marina; Guido, Alessandra; Morganti, Alessio Giuseppe; Bazzoli, Franco; Fuccio, Lorenzo

    2015-01-01

    Pelvic cancers are among the most frequently diagnosed neoplasms and radiotherapy represents one of the main treatment options. The irradiation field usually encompasses healthy intestinal tissue, especially of distal large bowel, thus inducing gastrointestinal (GI) radiation-induced toxicity. Indeed, up to half of radiation-treated patients say that their quality of life is affected by GI symptoms (e.g., rectal bleeding, diarrhoea). The constellation of GI symptoms - from transient to long-term, from mild to very severe - experienced by patients who underwent radiation treatment for a pelvic tumor have been comprised in the definition of pelvic radiation disease (PRD). A correct and evidence-based therapeutic approach of patients experiencing GI radiation-induced toxicity is mandatory. Therapeutic non-surgical strategies for PRD can be summarized in two broad categories, i.e., medical and endoscopic. Of note, most of the studies have investigated the management of radiation-induced rectal bleeding. Patients with clinically significant bleeding (i.e., causing chronic anemia) should firstly be considered for medical management (i.e., sucralfate enemas, metronidazole and hyperbaric oxygen); in case of failure, endoscopic treatment should be implemented. This latter should be considered the first choice in case of acute, transfusion requiring, bleeding. More well-performed, high quality studies should be performed, especially the role of medical treatments should be better investigated as well as the comparative studies between endoscopic and hyperbaric oxygen treatments. PMID:26677440

  19. Pelvic radiation disease: Updates on treatment options.

    PubMed

    Frazzoni, Leonardo; La Marca, Marina; Guido, Alessandra; Morganti, Alessio Giuseppe; Bazzoli, Franco; Fuccio, Lorenzo

    2015-12-10

    Pelvic cancers are among the most frequently diagnosed neoplasms and radiotherapy represents one of the main treatment options. The irradiation field usually encompasses healthy intestinal tissue, especially of distal large bowel, thus inducing gastrointestinal (GI) radiation-induced toxicity. Indeed, up to half of radiation-treated patients say that their quality of life is affected by GI symptoms (e.g., rectal bleeding, diarrhoea). The constellation of GI symptoms - from transient to long-term, from mild to very severe - experienced by patients who underwent radiation treatment for a pelvic tumor have been comprised in the definition of pelvic radiation disease (PRD). A correct and evidence-based therapeutic approach of patients experiencing GI radiation-induced toxicity is mandatory. Therapeutic non-surgical strategies for PRD can be summarized in two broad categories, i.e., medical and endoscopic. Of note, most of the studies have investigated the management of radiation-induced rectal bleeding. Patients with clinically significant bleeding (i.e., causing chronic anemia) should firstly be considered for medical management (i.e., sucralfate enemas, metronidazole and hyperbaric oxygen); in case of failure, endoscopic treatment should be implemented. This latter should be considered the first choice in case of acute, transfusion requiring, bleeding. More well-performed, high quality studies should be performed, especially the role of medical treatments should be better investigated as well as the comparative studies between endoscopic and hyperbaric oxygen treatments. PMID:26677440

  20. Recognition and Management of Nonrelaxing Pelvic Floor Dysfunction

    PubMed Central

    Faubion, Stephanie S.; Shuster, Lynne T.; Bharucha, Adil E.

    2012-01-01

    Nonrelaxing pelvic floor dysfunction is not widely recognized. Unlike in pelvic floor disorders caused by relaxed muscles (eg, pelvic organ prolapse or urinary incontinence, both of which often are identified readily), women affected by nonrelaxing pelvic floor dysfunction may present with a broad range of nonspecific symptoms. These may include pain and problems with defecation, urination, and sexual function, which require relaxation and coordination of pelvic floor muscles and urinary and anal sphincters. These symptoms may adversely affect quality of life. Focus on the global symptom complex, rather than the individual symptoms, may help the clinician identify the condition. The primary care provider is in a position to intervene early, efficiently, and effectively by (1) recognizing the range of symptoms that might suggest nonrelaxing pelvic floor dysfunction, (2) educating patients, (3) performing selective tests when needed to confirm the diagnosis, and (4) providing early referral for physical therapy. PMID:22305030

  1. Image acquisition in laparoscopic and endoscopic surgery

    NASA Astrophysics Data System (ADS)

    Gill, Brijesh S.; Georgeson, Keith E.; Hardin, William D., Jr.

    1995-04-01

    Laparoscopic and endoscopic surgery rely uniquely on high quality display of acquired images, but a multitude of problems plague the researcher who attempts to reproduce such images for educational purposes. Some of these are intrinsic limitations of current laparoscopic/endoscopic visualization systems, while others are artifacts solely of the process used to acquire and reproduce such images. Whatever the genesis of these problems, a glance at current literature will reveal the extent to which endoscopy suffers from an inability to reproduce what the surgeon sees during a procedure. The major intrinsic limitation to the acquisition of high-quality still images from laparoscopic procedures lies in the inability to couple directly a camera to the laparoscope. While many systems have this capability, this is useful mostly for otolaryngologists, who do not maintain a sterile field around their scopes. For procedures in which a sterile field must be maintained, one trial method has been to use a beam splitter to send light both to the still camera and the digital video camera. This is no solution, however, since this results in low quality still images as well as a degradation of the image that the surgeon must use to operate, something no surgeon tolerates lightly. Researchers thus must currently rely on other methods for producing images from a laparoscopic procedure. Most manufacturers provide an optional slide or print maker that provides a hardcopy output from the processed composite video signal. The results achieved from such devices are marginal, to say the least. This leaves only one avenue for possible image production, the videotape record of an endoscopic or laparoscopic operation. Video frame grabbing is at least a problem to which industry has applied considerable time and effort to solving. Our own experience with computerized enhancement of videotape frames has been very promising. Computer enhancement allows the researcher to correct several of the shortcomings of both laparoscopic video systems and videotapes, namely color imperfections, scanline problems, and lack of image resolution for later display. We present a history of laparoscopic imaging, the current state of the art, and future prospects for high-resolution images from laparoscopic and endoscopic systems.

  2. Laparoscopic Colorectal Resection in Octogenarian Patients

    PubMed Central

    Xie, Minghao; Qin, Huabo; Luo, Qianxin; He, Xiaosheng; Lan, Ping; Lian, Lei

    2015-01-01

    Abstract The population older than 80 years has been increasing. A significant proportion of colorectal diseases that require colorectal resection occur in very elderly patients. However, the benefits of laparoscopy remain controversial in octogenarians. A systematic review and meta-analysis of observational study was performed to compare clinical outcomes between laparoscopic versus open colorectal resection in octogenarians. The PubMed, EMBASE, Ovid, Web of Science, and Cochrane databases from the years 1990 to 2015 were searched for studies that compare surgical outcomes between laparoscopic and open colorectal resection in octogenarians (?80 years old). Seven eligible studies including 528 laparoscopic and 484 open colorectal resections were identified. Laparoscopic approach was associated with lower rate of mortality (odds ratio [OR] 0.48, P?=?0.03), overall complications (OR 0.54, P?Laparoscopic colorectal resection is as safe as open approach, and the short-term outcomes appear to be more favorable in octogenarians. PMID:26496302

  3. Laparoscopic use of laser and monopolar electrocautery

    NASA Astrophysics Data System (ADS)

    Hunter, John G.

    1991-07-01

    Most general surgeons are familiar with monopolar electrocautery, but few are equally comfortable with laser dissection and coagulation. At courses across the country, surgeons are being introduced to laparoscopy and laser use in one and two day courses, and are certified from that day forward as laser laparoscopists. Some surgeons are told that laser and electrosurgery may be equally acceptable techniques for performance of laparoscopic surgery, but that a surgeon may double his patient volume by advertising 'laser laparoscopic cholecystectomy.' The sale of certain lasers has skyrocketed on the basis of such hype. The only surprise is that laparoscopic cholecystectomy complications occurring in this country seem to be more closely related to the laparoscopic access and visualization than to the choice of laser of electrocautery as the preferred instrument for thermal dissection. The purpose of this article is to: 1) Discuss the physics and tissue effects of electrosurgery and laser; 2) compare the design and safety of electrosurgical and laser delivery systems; and 3) present available data comparing laser and electrocautery application in laparoscopic cholecystectomy.

  4. Visual search behaviour during laparoscopic cadaveric procedures

    NASA Astrophysics Data System (ADS)

    Dong, Leng; Chen, Yan; Gale, Alastair G.; Rees, Benjamin; Maxwell-Armstrong, Charles

    2014-03-01

    Laparoscopic surgery provides a very complex example of medical image interpretation. The task entails: visually examining a display that portrays the laparoscopic procedure from a varying viewpoint; eye-hand coordination; complex 3D interpretation of the 2D display imagery; efficient and safe usage of appropriate surgical tools, as well as other factors. Training in laparoscopic surgery typically entails practice using surgical simulators. Another approach is to use cadavers. Viewing previously recorded laparoscopic operations is also a viable additional approach and to examine this a study was undertaken to determine what differences exist between where surgeons look during actual operations and where they look when simply viewing the same pre-recorded operations. It was hypothesised that there would be differences related to the different experimental conditions; however the relative nature of such differences was unknown. The visual search behaviour of two experienced surgeons was recorded as they performed three types of laparoscopic operations on a cadaver. The operations were also digitally recorded. Subsequently they viewed the recording of their operations, again whilst their eye movements were monitored. Differences were found in various eye movement parameters when the two surgeons performed the operations and where they looked when they simply watched the recordings of the operations. It is argued that this reflects the different perceptual motor skills pertinent to the different situations. The relevance of this for surgical training is explored.

  5. HandPort Laparoscopic Surgery-Review and Current Status.

    PubMed

    Goel, Amit

    2015-06-01

    HandPort laparoscopic surgery is a hybrid operation that allows the surgeon to introduce his nondominant hand into abdominal cavity through the port while maintaining pneumoperitoneum. It also helps to gain experience and expertise to learn advanced laparoscopic procedures. The common surgeries where HandPort is useful are laparoscopic splenectomy, colectomies, and donor nephrectomies. HandPort facilitates dissection and extraction of specimens. Hand in abdomen restores tactile sensation which is lacking in laparoscopic procedures. It reduces operative time, increases technical expertise of surgeon, and decreases blood loss. This article reviews the current status of HandPort laparoscopic surgery, the various HandPort devices, and their use. PMID:26246704

  6. Laparoscopic ovariectomy in two standing llamas.

    PubMed

    King, M R; Hendrickson, D A; Southwood, L L; Trumble, T N; Johnson, L W

    1998-08-15

    Laparoscopic ovariectomy was performed in 2 llamas that were sedated but remained standing, avoiding possible complications associated with general anesthesia. All incisions were made in the left paralumbar fossa. The only intraoperative complications encountered were difficulty in maneuvering the laparoscope ventral to the uterine body in 1 llama because of distension of the urinary bladder, and a tendency to lean on the sidebar of the stocks in the other llama. The only postoperative complication was subcutaneous emphysema, which could be minimized by suctioning excess CO2 from the abdomen at completion of surgery. Laparoscopic ovariectomy was successful in these llamas and allowed direct examination and manipulation of the ovaries even though llamas were standing during surgery. PMID:9713537

  7. Reduced-Port Laparoscopic Surgery for a Tumor-Specific Mesorectal Excision in Patients With Colorectal Cancer: Initial Experience With 20 Consecutive Cases

    PubMed Central

    Bae, Sung Uk; Baek, Se Jin; Min, Byung Soh; Baik, Seung Hyuk; Kim, Nam Kyu

    2015-01-01

    Purpose Single-port plus one-port, reduced-port laparoscopic surgery (RPLS) may decrease collisions between laparoscopic instruments and the camera in a narrow, bony, pelvic cavity while maintaining the cosmetic advantages of single-incision laparoscopic surgery. The aim of this study is to describe our initial experience with and to assess the feasibility and safety of RPLS for tumor-specific mesorectal excisions (TSMEs) in patients with colorectal cancer. Methods Between May 2010 and August 2012, RPLS for TSME was performed in 20 patients with colorectal cancer. A single port with four channels through an umbilical incision and an additional port in the right lower quadrant were used for RPLS. Results The median operation time was 231 minutes (range, 160-347 minutes), and the estimated blood loss was 100 mL (range, 50-500 mL). We transected the rectum with one laparoscopic stapler in 17 cases (85%). The median time to soft diet was 4 days (range, 3-6 days), and the length of hospital stay was 7 days (range, 5-45 days). The median total number of lymph nodes harvested was 16 (range, 7-36), and circumferential resection margin involvement was found in 1 case (5%). Seven patients (35%) developed postoperative complications, and no mortalities occurred within 30 days. During the median follow-up period of 20 months (range, 12-40 months), liver metastasis occurred in 1 patient 10 months after surgery, and local recurrence was nonexistent. Conclusion RPLS for TSME in patients with colorectal cancer is technically feasible and safe without compromising oncologic safety. However, further studies comparing RPLS with a conventional, laparoscopic low-anterior resection are needed to prove the advantages of the RPLS procedure. PMID:25745622

  8. Laparoscopic surgery: A qualified systematic review

    PubMed Central

    Buia, Alexander; Stockhausen, Florian; Hanisch, Ernst

    2015-01-01

    AIM: To review current applications of the laparoscopic surgery while highlighting the standard procedures across different fields. METHODS: A comprehensive search was undertaken using the PubMed Advanced Search Builder. A total of 321 articles were found in this search. The following criteria had to be met for the publication to be selected: Review article, randomized controlled trials, or meta-analyses discussing the subject of laparoscopic surgery. In addition, publications were hand-searched in the Cochrane database and the high-impact journals. A total of 82 of the findings were included according to matching the inclusion criteria. Overall, 403 full-text articles were reviewed. Of these, 218 were excluded due to not matching the inclusion criteria. RESULTS: A total of 185 relevant articles were identified matching the search criteria for an overview of the current literature on the laparoscopic surgery. Articles covered the period from the first laparoscopic application through its tremendous advancement over the last several years. Overall, the biggest advantage of the procedure has been minimizing trauma to the abdominal wall compared with open surgery. In the case of cholecystectomy, fundoplication, and adrenalectomy, the procedure has become the gold standard without being proven as a superior technique over the open surgery in randomized controlled trials. Faster recovery, reduced hospital stay, and a quicker return to normal activities are the most evident advantages of the laparoscopic surgery. Positive outcomes, efficiency, a lower rate of wound infections, and reduction in the perioperative morbidity of minimally invasive procedures have been shown in most indications. CONCLUSION: Improvements in surgical training and developments in instruments, imaging, and surgical techniques have greatly increased safety and feasibility of the laparoscopic surgical procedures. PMID:26713285

  9. The Anatomy of ReadingThe Anatomy of Reading Bob DoughertyBob Dougherty

    E-print Network

    Dougherty, Bob

    with variation in anatomy and physiology · Predict & intervene before reading failure #12;Neural Basis of ReadingThe Anatomy of ReadingThe Anatomy of Reading Bob DoughertyBob Dougherty Stanford Institute for skill · Garden-variety brains · The anatomy of reading · Key cortical regions · Connected by important

  10. Computational Anatomy -Methods and Mathematical Challenges

    E-print Network

    Díaz, Lorenzo J.

    Computational Anatomy - Methods and Mathematical Challenges Martins Bruveris EPFL August 12, 2012´eformables pour la reconnaissance de formes et l' anatomie num´erique, PhD thesis, 2007] Martins Bruveris CA

  11. The transrectal single port laparoscopic radical prostatectomy in a cadaver model

    PubMed Central

    Akça, Oktay; Zargar, Homayoun; Autorino, Riccardo; Brandao, Luis Felipe; Gürler, Ahmet Selçuk; Av?ar, Abdullah; Horuz, Rahim; Albayrak, Selami

    2015-01-01

    Objective: To explore the feasibility of laparoscopic trans-rectal Natural Orifice Transluminal Endoscopic Surgery (NOTES) radical prostatectomy in a cadaveric model and to define anatomical landmarks of this surgical route. Materials and methods: After the ethical clearance, the study was conducted in Turkish Council of Forensic Medicine. With the cadaver in an exaggerated lithotomy position, a full thickness incision was made on the anterior wall of the rectum. The anteriorly visible Denonvilliers’ fascia was incised sharply, exposing the posterior surface of the prostate. A single-port device (GelPOINT®Path) was inserted transanally passing the incision on the anterior wall of the rectum, into the bluntly created space between rectum and prostate. Three, 10 mm ports were placed through the GelPOINT®Path, at 3, 6, and 9 o’clock positions. A 5 mm, 0° degree lens was introduced at 6 o’clock position; followed by laparoscopic scissors and laparoscopic grasper. Prostatic and periprostatic anatomy was defined as encountered during each step of the procedure. Results: Exposure of the posterior surface of the prostate and seminal vesicles was easily achieved. No additional openings of the rectal wall were made. Surgical specimen was extracted keeping its integrity. Conclusion: Transrectal radical prostatectomy is technically feasible in the cadaver model, being facilitated by previous experience with perineal surgery. Anatomical observations during the present experimental study suggest that the transrectal NOTES route provides good exposure of the operative field and easy access to the posterior surface of prostate, Future experimental endeavors should focus on reproducibility of this approach and feasibility of lymph node dissection using trans-rectal route. PMID:26328206

  12. Delayed intrahepatic subcapsular hematoma after laparoscopic cholecystectomy.

    PubMed

    de Castro, Steve M M; Reekers, Jim A; Dwars, Boudewijn J

    2012-01-01

    Intrahepatic subcapsular hematoma after laparoscopic cholecystectomy is a rare complication and is potentially life threatening. When radiologic studies confirm the presence of the hematoma, the decision to follow a conservative treatment should involve clinical monitoring. If there are signs of infection, the collection can safely be drained percutaneously. If there are signs of active bleeding, a selective embolization should be attempted first. If unsuccessful, subsequent surgical evacuation should be performed. We report the case of a patient with an intrahepatic subcapsular hematoma after laparoscopic cholecystectomy, which occurred 6 weeks after surgery, and review the literature concerning the management of these bleedings. PMID:22920379

  13. Single Incision Laparoscopic Cholecystectomy for Gallbladder Duplication

    PubMed Central

    Kabul Gürbulak, Esin; Öz?ahin, Hamdi; Düzköylü, Yi?it; Akgün, Ismail Ethem; Battal, Muharrem; Gürbulak, Bünyamin

    2015-01-01

    Duplication of the gallbladder is a rare congenital anomaly of the gallbladder, with an estimated prevalence of 1–3 per 3800 individuals. Unless properly diagnosed preoperatively, it can lead to biliary tract injuries and postoperative complications which may require reoperative surgeries. While previously reported cases have been treated with conventional laparoscopic cholecystectomy (LC), treatment with single incision laparoscopic surgery (SILS) has not been reported yet. We herein present the case of a 58-year-old female with gallbladder duplication who was successfully treated with SILS cholecystectomy. PMID:26266074

  14. Current Trends in Laparoscopic Ventral Hernia Repair

    PubMed Central

    Patapis, Paul; Zavras, Nick; Tzanetis, Panagiotis; Machairas, Anastasios

    2015-01-01

    Background and Objectives: The purpose of this study was to analyze the surgical technique, postoperative complications, and possible recurrence after laparoscopic ventral hernia repair (LVHR) in comparison with open ventral hernia repair (OVHR), based on the international literature. Database: A Medline search of the current English literature was performed using the terms laparoscopic ventral hernia repair and incisional hernia repair. Conclusions: LVHR is a safe alternative to the open method, with the main advantages being minimal postoperative pain, shorter recovery, and decreased wound and mesh infections. Incidental enterotomy can be avoided by using a meticulous technique and sharp dissection to avoid thermal injury. PMID:26273186

  15. Laparoscopic excision of infra-renal PEComa

    PubMed Central

    Bhanushali, Amol H; Dalvi, Abhay N; Bhanushali, Harikant S

    2015-01-01

    Perivascular epitheloid cell tumors (PEComas) are rare tumors of malignant potential. There is no normal cell variant to these cells. The family is large and includes angiomyolipoma, clear cell “sugar” tumor amongst others. Imaging modalities are not very diagnostic. The diagnosis hence is often postoperative. A 55-year old female presented to us with ultrasonographic diagnosis of solid mass in the right infrarenal region. Contrast-enhanced computerized sonography (CECT) suggested paraganglioma or a soft tissue retroperitoneal tumor. Laparoscopic excision was successful. The rarity of this pathology and laparoscopic modality of excision prompted us to publish this report.

  16. Laparoscopic Robot-Assisted Diaphragm Plication.

    PubMed

    Zwischenberger, Brittany A; Kister, Nathaniel; Zwischenberger, Joseph B; Martin, Jeremiah T

    2016-01-01

    Minimally invasive approaches to diaphragm plication for eventration include thoracoscopic and laparoscopic techniques. The elevated hemidiaphragm and ribs limit thoracoscopic techniques. We report our modification of the laparoscopic approach using robotic assistance with the da Vinci Surgical System, (Intuitive Surgical Inc, Sunnyvale, CA) to avoid single-lung ventilation, facilitate exposure, and allow more precise placement of plication sutures to achieve an even tension and maximum plication. Critical steps include creation of a small defect in the diaphragm to equalize pressures between cavities and placement of multiple, pledgeted interrupted horizontal mattresses. PMID:26694286

  17. Laparoscopic revolution in bariatric surgery

    PubMed Central

    Sundbom, Magnus

    2014-01-01

    The history of bariatric surgery is investigational. Dedicated surgeons have continuously sought for an ideal procedure to relieve morbidly obese patients from their burden of comorbid conditions, reduced life expectancy and low quality of life. The ideal procedure must have low complication risk, both in short- and long term, as well as minimal impact on daily life. The revolution of laparoscopic techniques in bariatric surgery is described in this summary. Advances in minimal invasive techniques have contributed to reduced operative time, length of stay, and complications. The development in bariatric surgery has been exceptional, resulting in a dramatic increase of the number of procedures performed world wide during the last decades. Although, a complex bariatric procedure can be performed with operative mortality no greater than cholecystectomy, specific procedure-related complications and other drawbacks must be taken into account. The evolution of laparoscopy will be the legacy of the 21st century and at present, day-care surgery and further reduction of the operative trauma is in focus. The impressive effects on comorbid conditions have prompted the adoption of minimal invasive bariatric procedures into the field of metabolic surgery. PMID:25386062

  18. COMPUTATIONAL ANATOMY: AN EMERGING Ulf Grenandery

    E-print Network

    COMPUTATIONAL ANATOMY: AN EMERGING DISCIPLINE Ulf Grenandery and Michael I. Millerz June 25, 1998 Abstract This paper studies mathematical methods in the emerging new discipline of Computational Anatomy. Herein we formalize the Brown/Washington University model of anatomy following the global pattern theory

  19. NEW CO-CHAIRS FOR ANATOMY &

    E-print Network

    Emmons, Scott

    #12;2 NEW CO-CHAIRS FOR ANATOMY & STRUCTURAL BIOLOGY Drs. John Condeelis and Robert Singer have been named co-chairs of the Department of Anatomy & Structural Biology. They had been serving jointly of anatomy in 1977. Appointed profes- sor in 1987, he currently serves as sci- entific director

  20. Human Anatomy III: Respiratory, Urinary & Digestive

    E-print Network

    Brown, Christopher A.

    1 Human Anatomy III: Respiratory, Urinary & Digestive Systems The Respiratory System Major in an aquatic insect larva Basic Anatomy of the Respiratory System I Air enters through the nose Inside nose Anatomy of the Respiratory System II #12;3 The Alveoli Alveoli are the capillaries of the lung; gas

  1. The Anatomy of Anatomy: A Review for Its Modernization

    ERIC Educational Resources Information Center

    Sugand, Kapil; Abrahams, Peter; Khurana, Ashish

    2010-01-01

    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.…

  2. Stump Cholecystitis: Laparoscopic Completion Cholecystectomy with Basic Laparoscopic Equipment in a Resource Poor Setting

    PubMed Central

    Cawich, Shamir O.; Simpson, Lindberg K.; Baker, Akil J.

    2014-01-01

    Introduction. Stump cholecystitis is a recognised condition in which a large gallbladder remnant becomes inflamed after subtotal cholecystectomy. When this occurs, a completion cholecystectomy is indicated. Traditionally, these patients were subjected to open surgery because the laparoscopic approach was anticipated to be technically difficult. We present a case of completion cholecystectomy using basic laparoscopic equipment in a resource poor setting to demonstrate that the laparoscopic approach is feasible. Case Description. A 57-year-old woman presented with right upper quadrant pain and vomiting. She had an elective open cholecystectomy seven years before but reported remarkably similar symptoms. Abdominal ultrasound suggested calculous acute cholecystitis. MRCP confirmed the presence of a large gallbladder remnant with stones. Gastroduodenoscopy excluded other differentials. She had an uneventful laparoscopic completion cholecystectomy performed. Discussion. Although traditional dogma suggested that a completion cholecystectomy should be performed through the open approach, several small studies have demonstrated that laparoscopic completion cholecystectomy is feasible and safe. This report adds to the existing data in support of the laparoscopic approach. PMID:25214849

  3. A strong pelvic floor is associated with higher rates of sexual activity in women with pelvic floor disorders

    PubMed Central

    Kanter, Gregg; Rogers, Rebecca G; Pauls, Rachel N; Kammerer-Doak, Dorothy; Thakar, Ranee

    2015-01-01

    Introduction and Hypothesis We evaluated the associations between pelvic floor muscle strength and tone with sexual activity and sexual function in women with pelvic floor disorders. Methods This was a secondary analysis of a multicenter study of women with pelvic floor disorders from the US and UK performed to validate the Pelvic Organ Prolapse/Incontinence Sexual Questionnaire, IUGA-Revised (PISQ-IR). Participants were surveyed about whether they were sexually active and completed the PISQ-IR and Female Sexual Function Index (FSFI) questionnaires to assess sexual function. Physical exams included assessment of pelvic floor strength by the Oxford Grading Scale, and assessment of pelvic floor tone per ICS guidelines. Results The cohort of 585 women was middle aged (mean age 54.9 +/?12.1) with 395 (67.5%) reporting sexual activity. Women with a strong pelvic floor (n=275) were more likely to report sexual activity than women with weak strength (n=280) (75.3 vs. 61.8%, p<0.001), but normal or hypoactive pelvic floor tone was not associated with sexual activity (68.8 vs. 60.2%, normal vs. hypoactive, p=0.08). After multivariable analysis, a strong pelvic floor remained predictive of sexual activity (OR 1.89, CI 1.18–3.03, p<0.01). Among sexually active women (n=370), a strong pelvic floor was associated with higher scores on the PISQ-IR domain of condition impact (Parameter Estimate 0.20+/?0.09, P=0.04), and FSFI orgasm domain (PE 0.51+/?0.17, P=0.004). Conclusion A strong pelvic floor is associated with higher rates of sexual activity as well as higher sexual function scores on the condition impact domain of the PISQ-IR and orgasm domain of the FSFI. PMID:25994625

  4. INTRODUCTION Chronic prostatitis/chronic pelvic pain syndrome

    E-print Network

    Apkarian, A. Vania

    INTRODUCTION · Chronic prostatitis/chronic pelvic pain syndrome affects 5-10% of men pathophysiological correlates of CP/CPPS pain (prostate inflammation, endocrine abnormalities, pelvic floor muscle/CPPS biomarkers can potentially advance diagnosis of mechanistically distinct pain subtypes and direct

  5. Effectiveness of false profile radiographs in detection of pelvic discontinuity.

    PubMed

    Wendt, Matthew C; Adler, Michael A; Trousdale, Robert T; Mabry, Tad M; Cabanela, Miguel E

    2012-08-01

    Pelvic dissociation is a rare but serious potential complication of total hip arthroplasty. The purpose of this study is to evaluate the effectiveness of the false profile view compared with traditional radiographs in detecting pelvic dissociation. Ten cadaver pelves were skeletonized, and noncemented acetabular hip arthroplasty components were implanted. Anteroposterior, lateral, iliac oblique, and false profile radiographs were obtained before and after creating pelvic dissociations and analyzed in a blinded fashion. The sensitivity of the false profile view for detecting pelvic dissociation was 79% (confidence interval, 70-86), which was greater than the sensitivity for anteroposterior and lateral views. This difference was statistically significant. False profile views are a potentially valuable addition to the traditional radiographic evaluation of pelvic discontinuity in hip arthroplasty. PMID:22197289

  6. Pelvic pain in urogynaecology. Part I: evaluation, definitions and diagnoses.

    PubMed

    Kavvadias, Tilemachos; Baessler, Kaven; Schuessler, Bernhard

    2011-04-01

    Aim of this review is to summarise the available literature on the definitions and assessment of pelvic pain in the urogynaecological patient. A MEDLINE search and a hand search of conference proceedings of the International Continence Society and International Urogynecological Association were performed. Sixty-nine articles were reviewed. The site of pain was specified in 45% of the articles, 20% used the digital examination of pelvic myofascial trigger points for the diagnosis; 20%, the Pelvic Pain and Urgency/Frequency Symptom Scale; 26%, the Interstitial Cystitis Symptom and Problem Index and 39%, a simple visual analogue scale. The diagnosis was interstitial cystitis in 67% and chronic pelvic pain in 19% of the articles. Consensus on the diagnostic procedures and definition of pelvic pain in the urogynaecological patient should be achieved in order to provide exact diagnostic information which will lead to more satisfying treatment options. PMID:20645076

  7. Effect of pelvic floor muscle exercises on pulmonary function

    PubMed Central

    Han, DongWook; Ha, Misook

    2015-01-01

    [Purpose] This study aimed to determine the correlation between pelvic floor muscle strength and pulmonary function. In particular, we examined whether pelvic floor muscle exercises can improve pulmonary function. [Subjects] Thirty female college students aged 19–21 with no history of nervous or musculoskeletal system injury were randomly divided into experimental and control groups. [Methods] For the pulmonary function test, spirometry items included forced vital capacity and maximal voluntary ventilation. Pelvic floor muscle exercises consisted of Kegel exercises performed three times daily for 4 weeks. [Results] Kegel exercises performed in the experimental group significantly improved forced vital capacity, forced expiratory volume in 1 second, PER, FEF 25–75%, IC, and maximum voluntary ventilation compared to no improvement in the control group. [Conclusion] Kegel exercises significantly improved pulmonary function. When abdominal pressure increased, pelvic floor muscles performed contraction at the same time. Therefore, we recommend that the use of pelvic floor muscle exercises be considered for improving pulmonary function. PMID:26644681

  8. Laparoscopic surgery: A pioneer's point of view.

    PubMed

    Périssat, J

    1999-08-01

    For a surgeon who performed some of the first laparoscopic cholecystectomies, laparoscopic surgery is undoubtedly the main revolution in the last decade of this century. It is impossible not to be fascinated by the extraordinary changes introduced in our profession in less than 10 years. However, looking back in history, one realizes that laparoscopy is but one of those leaps forward that have always punctuated the evolution of our profession. Since the last century we have witnessed the advent of painless surgery, infectionless surgery, reconstructive surgery, microsurgery, surgery under extracorporeal circulation, organ replacement, and so on. We are in the time of scarless surgery, with no lengthy postoperative handicap. Maybe tomorrow will see surgery performed by remote-controlled robots and surgery at the molecule level. The laparoscopic revolution is particularly important because for the first time surgery no longer involves any physical contact between the surgeon's hand and the patient. Let us hope that this will not lead to total absence of a human relationship in the surgical operation. To avoid this possibility we must remain resolutely involved in the development of laparoscopic surgery; we must keep our minds open to the future advances of science and technology and integrate them in our operative procedures. PMID:10415213

  9. [Lymphangioma of the retroperitoneum treated laparoscopically].

    PubMed

    Skach, J; Chrenko, M; Hromádka, P

    2014-09-01

    A case report of a female patient with pathological liquid collection in the retroperitoneum with chronic and recurrent pain in the epigastric region and dyspepsia. After a safe laparoscopic approach and removal of a cystic tumour, the finding was histologically described as lymphangioma. PMID:25301348

  10. Augmented Reality Visualization for Laparoscopic Surgery

    E-print Network

    State, Andrei

    Augmented Reality Visualization for Laparoscopic Surgery Henry Fuchs1 , Mark A. Livingston1 Reality Augmented reality (AR) refers to systems that attempt to merge computer graphics and real imagery experience and hand-eye coordination for a surgeon to adjust to this disparity. 1.2 Benefits of Augmented

  11. On the Anatomy of Understanding

    ERIC Educational Resources Information Center

    Wilhelmsson, Niklas; Dahlgren, Lars Owe; Hult, Hakan; Josephson, Anna

    2011-01-01

    In search for the nature of understanding of basic science in a clinical context, eight medical students were interviewed, with a focus on their view of the discipline of anatomy, in their fourth year of study. Interviews were semi-structured and took place just after the students had finished their surgery rotations. Phenomenographic analysis was…

  12. Curriculum Guidelines for Microscopic Anatomy.

    ERIC Educational Resources Information Center

    Journal of Dental Education, 1993

    1993-01-01

    The American Association of Dental Schools' guidelines for curricula in microscopic anatomy offer an overview of the histology curriculum, note primary educational goals, outline specific content for general and oral histology, suggest prerequisites, and make recommendations for sequencing. Appropriate faculty and facilities are also suggested.…

  13. Human Anatomy II: Circulatory System

    E-print Network

    Brown, Christopher A.

    1 Human Anatomy II: Circulatory System The Cardiovascular System Major functions include) Maintenance of fluid balance Protection against invading organisms Circulatory systems may be open or closed Open circulatory systems allow circulatory fluid to empty out of vessels Closed circulatory systems

  14. TEMPORAL DYNAMICS OF BRAIN ANATOMY

    E-print Network

    Thompson, Paul

    these changes. In neuroscience studies, these tools can reveal subtle brain changes in adolescence and old age1 TEMPORAL DYNAMICS OF BRAIN ANATOMY Arthur W. Toga and Paul M. Thompson Laboratory of Neuro Imaging Department of Neurology, UCLA School of Medicine Los Angeles, CA, USA A Review Article for: Annual

  15. Anorectal anatomy and imaging techniques.

    PubMed

    Solan, Patrick; Davis, Bradley

    2013-12-01

    The rectum and anus are two anatomically complex organs with diverse pathologies. This article reviews the basic anatomy of the rectum and anus. In addition, it addresses the current radiographic techniques used to evaluate these structures, specifically ultrasound, magnetic resonance imaging, and defecography. PMID:24280395

  16. Pelvic and reproductive structures in placoderms (stem gnathostomes).

    PubMed

    Trinajstic, Kate; Boisvert, Catherine; Long, John; Maksimenko, Anton; Johanson, Zerina

    2015-05-01

    Newly discovered pelvic and reproductive structures within placoderms, representing some of the most crownward members of the gnathostome stem group and the most basal jawed vertebrates, challenge established ideas on the origin of the pelvic girdle and reproductive complexity. Here we critically review previous descriptions of the pelvic structures in placoderms and reinterpret the morphology of the pelvic region within the arthrodires and ptyctodonts, in particular the position of the pelvic fin and the relationship of the male clasper to the pelvic girdle. Absence of clear articular surfaces on the clasper and girdle in the Arthrodira, along with evidence from the Ptyctodontida, suggest that these are separate structures along the body. We describe similarities between the pectoral and pelvic girdles and claspers, for example, all these have both dermal and perichondral (cartilaginous) components. Claspers in placoderms and chondrichthyans develop in very different ways; in sharks, claspers develop from the pelvic fin while the claspers in placoderms develop separately, suggesting that their independent development involved a posterior extension of the 'competent stripes' for fin development previously limited to the region between the paired pectoral and pelvic fins. Within this expanded zone, we suggest that clasper position relative to the pelvic fins was determined by genes responsible for limb position. Information on early gnathostome reproductive processes is preserved in both the Ptyctodontida and Arthrodira, including the presence of multiple embryos in pregnant females, embryos of differing sizes and of different sexes (e.g. male claspers preserved in some embyros). By comparison with chondrichthyans, these observations suggest more complex reproductive strategies in placoderms than previously appreciated. PMID:24889865

  17. Penile Rehabilitation after Pelvic Cancer Surgery

    PubMed Central

    Aoun, Fouad; Peltier, Alexandre; van Velthoven, Roland

    2015-01-01

    Erectile dysfunction is the most common complication after pelvic radical surgery. Rehabilitation programs are increasingly being used in clinical practice but there is no high level of evidence supporting its efficacy. The principle of early penile rehabilitation stems from animal studies showing early histological and molecular changes associated with penile corporal hypoxia after cavernous nerve injury. The concept of early penile rehabilitation was developed in late nineties with a subsequent number of clinical studies supporting early pharmacologic penile rehabilitation. These studies included all available phosphodiesterase type 5 inhibitors, intracavernosal injection and intraurethral use of prostaglandin E1 and to lesser extent vacuum erectile devices. However, these studies are of small number, difficult to interpret, and often with no control group. Furthermore, no studies have proven an in vivo derangement of endothelial or smooth muscle cell metabolism secondary to a prolonged flaccid state. The purpose of the present report is a synthetic overview of the literature in order to analyze the concept and the rationale of rehabilitation program of erectile dysfunction following radical pelvic surgery and the evidence of such programs in clinical practice. Emphasis will be placed on penile rehabilitation programs after radical cystoprostatectomy, radical prostatectomy, and rectal cancer treatment. Future perspectives are also analyzed. PMID:25785286

  18. Penile rehabilitation after pelvic cancer surgery.

    PubMed

    Aoun, Fouad; Peltier, Alexandre; van Velthoven, Roland

    2015-01-01

    Erectile dysfunction is the most common complication after pelvic radical surgery. Rehabilitation programs are increasingly being used in clinical practice but there is no high level of evidence supporting its efficacy. The principle of early penile rehabilitation stems from animal studies showing early histological and molecular changes associated with penile corporal hypoxia after cavernous nerve injury. The concept of early penile rehabilitation was developed in late nineties with a subsequent number of clinical studies supporting early pharmacologic penile rehabilitation. These studies included all available phosphodiesterase type 5 inhibitors, intracavernosal injection and intraurethral use of prostaglandin E1 and to lesser extent vacuum erectile devices. However, these studies are of small number, difficult to interpret, and often with no control group. Furthermore, no studies have proven an in vivo derangement of endothelial or smooth muscle cell metabolism secondary to a prolonged flaccid state. The purpose of the present report is a synthetic overview of the literature in order to analyze the concept and the rationale of rehabilitation program of erectile dysfunction following radical pelvic surgery and the evidence of such programs in clinical practice. Emphasis will be placed on penile rehabilitation programs after radical cystoprostatectomy, radical prostatectomy, and rectal cancer treatment. Future perspectives are also analyzed. PMID:25785286

  19. Pelvic floor disorders: what's the best test?

    PubMed

    Silva, Ana Catarina A; Maglinte, Dean D T

    2013-12-01

    Pelvic floor dysfunctions represent a common health problem affecting particularly post-menopausal women impacting significantly the quality of life. A large number of these patients suffer for many years without proper treatment often due to the lack of objective findings necessary to plan proper treatment. Because abnormalities of the different pelvic compartments are frequently associated, thorough diagnostic characterization of how many compartments are affected is paramount in order to plan the management approach that can include a multidisciplinary surgical approach. This pictorial essay will review the different imaging methods used for the characterization of these disorders, how to do them and its rationale providing a clinically understandable interpretation with clinical correlates and a correlation between fluoroscopic and MR defecography in order to illustrate the strengths and shortcomings of each. The need to use a standardized, reliable, and clinically understandable method of quantification has become more obvious in the last decades with the increasing rate of scientific and professional interchanges. A review of the grading systems used to convey the imaging findings also highlights the importance of using a standardized tool for comparing and communicating clinical findings understandable to referring physicians with proven inter-observer and intra-observer agreement of the examinations. PMID:24114036

  20. Laparoscopic Pyeloplasty in the Animal Model

    PubMed Central

    Elashry, Osama M.; Clayman, Ralph V.; Humphrey, Peter A.; Rayah, Heidi J.

    1997-01-01

    Purpose: Laparoscopic pyeloplasty has been associated with long operative times. This study proposed to evaluate the feasibility of two different laparoscopic techniques for the performance of pyeloplasty repair of secondary ureteropelvic junction (UPJ) obstruction. Materials and Methods: Sixteen female Yucatan mini-pigs underwent general anesthesia for cystoscopy, retrograde pyelography, urine culture and a baseline renal scan. Unilateral UPJ obstruction was created by ligating the UPJ over a 5F catheter. Six weeks later a laparoscopic pyeloplasty was performed utilizing an intracorporeal suturing technique and the Lapra-Ty suture clip or the Endostitch device with intracorporeal knot tying. Four control animals underwent only cystoscopy and in/out ureteral catheterization. In the study animals the ureteral stent was maintained for six weeks and at six weeks, three months and six months post-pyeloplasty the animals underwent the previously mentioned studies. At six months post-pyeloplasty the animals were euthanized and the UPJ was calibrated. Histopathology was obtained on the ureter below the anastomosis, at the anastomosis, above the anastomosis and on a renal biopsy. Results: All planned laparoscopic pyeloplasties were completed. However, the stricture model was too severe in that most animals developed 40-45% decrease in renal function in the kidney following ipsilateral UPJ ligation. There was no significant difference between the two pyeloplasty techniques with respect to operative time to perform the pyeloplasty (mean of 40 minutes), post-pyeloplasty ureteral caliber (7.5-8.0 F), serum creatinine or healing scores at, above or below the anastomosis. Conclusion: Laparoscopic pyeloplasty can be performed equally successfully with the Endostitch device and intracorporeal knot tying or with the intracorporeal suturing technique and Lapra-Ty clips. The resultant pyeloplasty is also equivalent for the two techniques. PMID:9876657

  1. Major Vascular Injury in Laparoscopic Urology

    PubMed Central

    Basiri, Abbas; Ziaee, Seyed-Amir-Mohsen; Tabibi, Ali; Nouralizadeh, Akbar; Radfar, Mohammad Hadi; Sarhangnejad, Reza; Mirsadeghi, Amin

    2014-01-01

    Background and Objectives: Major vascular injury is the most devastating complication of laparoscopy, occurring most commonly during the laparoscopic entry phase. Our goal is to report our experience with major vascular injury during laparoscopic entry with closed- and open-access techniques in urologic procedures. Methods: All 5347 patients who underwent laparoscopic urologic procedures from 1996 to 2011 at our hospital were included in the study. Laparoscopic entry was carried out by either the closed Veress needle technique or the modified open Hasson technique. Patients' charts were reviewed retrospectively to investigate for access-related major vascular injuries. Results: The closed technique was used in the first 474 operations and the open technique in the remaining 4873 cases. Three cases of major vascular injury were identified among our patients. They were 3 men scheduled for nephrectomy without any history of surgery. All injuries occurred in the closed-access group during the setup phase with insertion of the first trocar. The injury location was the abdominal aorta in 2 patients and the external iliac vein in 1 patient. Management was performed after conversion to open surgery, control of bleeding, and repair of the injured vessel. Conclusions: Given the high morbidity and mortality rates associated with major vascular injury, its clinically higher incidence in laparoscopic urologic procedures with the closed-access technique leads us to suggest using the open technique for the entry phase of laparoscopy. Using the open-access technique may decrease laparophobia and encourage a higher number of urologists to enter the laparoscopy field. PMID:25392667

  2. Intestinal Obstruction After Totally Extraperitoneal Laparoscopic Inguinal Hernia Repair

    PubMed Central

    Rink, Joanne

    2004-01-01

    Laparoscopic hernia repair is a frequently performed operation. Although it has many advantages over open inguinal hernia repair, laparoscopic surgery is not without complications. Small bowel obstruction is a complication unique to laparoscopic repair of inguinal hernias. It is reported following transabdominal preperitoneal repairs. We present a case of small bowel incarceration through a peritoneal defect after a totally extraperitoneal inguinal hernia repair. Techniques to avoid this complication are presented. The literature is reviewed. PMID:14974673

  3. Subhepatic Sterile Abscess 10 Years After Laparoscopic Cholecystectomy

    PubMed Central

    Bartels, Anne K.; Zamora, Jose Gonzales

    2015-01-01

    We present a case of a large, sterile, subhepatic abdominal wall abscess secondary to foreign body reaction to dropped gallstones during laparoscopic cholecystectomy performed 10 years ago. Dropped gallstones are common complications of laparoscopic cholecystectomy, but they rarely result in abscess formation. When abscesses do occur, they may present a few months to a few years after surgery. It is important to recognize dropped gallstones as an etiology for subhepatic abscess in patients with history of laparoscopic cholecystectomy. PMID:26157931

  4. [Laparoscopic cholecystectomy: 100 consecutive cases without postoperative morbidity].

    PubMed

    Klaiber, C; Metzger, A; Leepin, H; Saager, C

    1991-06-15

    100 consecutive patients underwent laparoscopic cholecystectomy for symptomatic gallbladder stones. We report our results and the management of choledocholithiasis. In two cases the laparoscopic procedure had to be converted into open cholecystectomy due to bleeding. There were no complications postoperatively. The results show that laparoscopic cholecystectomy is a safe procedure with real benefits. The main advantages are greater comfort for the patient, better cosmetic results, shortening of hospital stay and earlier return to full activity. We feel that, with a proper indication, laparoscopic removal of the gallbladder will establish itself as the procedure of choice in stone disease. PMID:1830401

  5. Laparoscopic assisted total gastrectomy for gastric cancer – operative technique

    PubMed Central

    Salih, Abdelmonim; Kazanowski, Michal; Walsh, Thomas N.

    2015-01-01

    For many years, open gastrectomy with lymphadenectomy was the gold standard treatment for gastric cancer. In recent years, however, laparoscopic assisted total gastrectomy with associated D2 lymphadenectomy has gained in popularity. It has a similar oncological outcome to open resection, but has all of the added advantages of a laparoscopic procedure, such as early mobilisation, less postoperative pain and shorter hospital stay. This article describes the operative techniques, including key procedure steps, as well as a guide for using the new OrVil device for the laparoscopic creation of the oesophago-jejunal anastomosis. A video of a laparoscopic assisted total gastrectomy is presented. PMID:25960805

  6. Robotic-Assisted Laparoscopic Donor Nephrectomy: Decreasing Length of Stay

    PubMed Central

    Cohen, Ari J.; Williams, Darin S.; Bohorquez, Humberto; Bruce, David S.; Carmody, Ian C.; Reichman, Trevor; Loss, George E.

    2015-01-01

    Background The number of robotic operations performed with the da Vinci Surgical System has increased during the past decade. This system allows for greater maneuverability and control than hand-assisted laparoscopic procedures, resulting in less tissue manipulation and irritation. Methods We retrospectively analyzed the results of 100 consecutive robotic-assisted laparoscopic donor nephrectomies and compared them to our most recent 20 hand-assisted laparoscopic donor nephrectomies. Results Between May 2008 and June 2012, 120 laparoscopic donor nephrectomies were performed at Ochsner Clinic Foundation. Of those, 100 live kidney donors underwent robotic-assisted laparoscopic donor nephrectomies. Surgical time and hospital length of stay improved after the first 20 patients receiving robotic-assisted laparoscopic nephrectomies, which was considered the learning curve. Sixty percent of patients who underwent robotic-assisted laparoscopic donor nephrectomies were released on postoperative day 1 compared to 45% of patients who underwent hand-assisted laparoscopic techniques. Conclusion In our experience, robotic-assisted laparoscopic donor nephrectomy resulted in decreased postoperative length of stay that decreased the global cost of the procedure and allowed our institution to admit more patients. PMID:25829876

  7. Anatomy of a Bird

    NASA Astrophysics Data System (ADS)

    2007-12-01

    Using ESO's Very Large Telescope, an international team of astronomers [1] has discovered a stunning rare case of a triple merger of galaxies. This system, which astronomers have dubbed 'The Bird' - albeit it also bears resemblance with a cosmic Tinker Bell - is composed of two massive spiral galaxies and a third irregular galaxy. ESO PR Photo 55a/07 ESO PR Photo 55a/07 The Tinker Bell Triplet The galaxy ESO 593-IG 008, or IRAS 19115-2124, was previously merely known as an interacting pair of galaxies at a distance of 650 million light-years. But surprises were revealed by observations made with the NACO instrument attached to ESO's VLT, which peered through the all-pervasive dust clouds, using adaptive optics to resolve the finest details [2]. Underneath the chaotic appearance of the optical Hubble images - retrieved from the Hubble Space Telescope archive - the NACO images show two unmistakable galaxies, one a barred spiral while the other is more irregular. The surprise lay in the clear identification of a third, clearly separate component, an irregular, yet fairly massive galaxy that seems to be forming stars at a frantic rate. "Examples of mergers of three galaxies of roughly similar sizes are rare," says Petri Väisänen, lead author of the paper reporting the results. "Only the near-infrared VLT observations made it possible to identify the triple merger nature of the system in this case." Because of the resemblance of the system to a bird, the object was dubbed as such, with the 'head' being the third component, and the 'heart' and 'body' making the two major galaxy nuclei in-between of tidal tails, the 'wings'. The latter extend more than 100,000 light-years, or the size of our own Milky Way. ESO PR Photo 55b/07 ESO PR Photo 55b/07 Anatomy of a Bird Subsequent optical spectroscopy with the new Southern African Large Telescope, and archive mid-infrared data from the NASA Spitzer space observatory, confirmed the separate nature of the 'head', but also added further surprises. The 'head' and major parts of the 'Bird' are moving apart at more than 400 km/s (1.4 million km/h!). Observing such high velocities is very rare in merging galaxies. Also, the 'head' appears to be the major source of infrared luminosity in the system, though it is the smallest of the three galaxies. "It seems that NACO has caught the action right at the time of the first high-speed fly-by of the 'head' galaxy through the system consisting of the other two galaxies," says Seppo Mattila, member of the discovery team. "These two galaxies must have met earlier, probably a couple of hundred million years ago." The 'head' is forming stars violently, at a rate of nearly 200 solar masses per year, while the other two galaxies appear to be at a more quiescent epoch of their interaction-induced star formation history. The 'Bird' belongs to the prestigious family of luminous infrared galaxies, with an infrared luminosity nearly one thousand billion times that of the Sun. This family of galaxies has long been thought to signpost important events in galaxy evolution, such as mergers of galaxies, which in turn trigger bursts of star formation, and may eventually lead to the formation of a single elliptical galaxy. The findings presented here are reported in a paper to appear in a future issue of the journal Monthly Notices of the Royal Astronomical Society ("Adaptive optics imaging and optical spectroscopy of a multiple merger in a luminous infrared galaxy", by P. Väisänen" et al.). Note [1]: The team is composed of P. Väisänen, A. Kniazev, D. A. H. Buckley, L. Crause, Y. Hashimoto, N. Loaring, E. Romero-Colmenero, and M. Still (SAAO, South Africa), S. Mattila (Tuorla Observatory, Finland), A. Adamo and G. Östlin (Stockholm University, Sweden), A. Efstathiou (Cyprus College, Nicosia, Cyprus), D. Farrah (Cornell University, USA), P. H. Johansson (Universitäts-Sternwarte München, Germany), E. B. Burgh and K. Nordsieck (University of Wisconsin, USA), P. Lira (Universidad de Chile, Santiago, Chile),

  8. Anatomy adventure: a board game for enhancing understanding of anatomy.

    PubMed

    Anyanwu, Emeka G

    2014-01-01

    Certain negative factors such as fear, loss of concentration and interest in the course, lack of confidence, and undue stress have been associated with the study of anatomy. These are factors most often provoked by the unusually large curriculum, nature of the course, and the psychosocial impact of dissection. As a palliative measure, Anatomy Adventure, a board game on anatomy was designed to reduce some of these pressures, emphasize student centered and collaborative learning styles, and add fun to the process of learning while promoting understanding and retention of the subject. To assess these objectives, 95 out of over 150 medical and dental students who expressed willingness to be part of the study were recruited and divided into a Game group and a Non-game group. A pretest written examination was given to both groups, participants in the Game group were allowed to play the game for ten days, after which a post-test examination was also given. A 20-item questionnaire rated on a three-point scale to access student's perception of the game was given to the game group. The post-test scores of the game group were significantly higher (P?anatomy. PMID:23878076

  9. Treatment of symptomatic pelvic varices by ovarian vein embolization

    SciTech Connect

    Capasso, Patrizio; Simons, Christine; Trotteur, Genevieve; Dondelinger, Robert F.; Henroteaux, Denis; Gaspard, Ulysse

    1997-03-15

    Purpose. Pelvic congestion syndrome is a common cause of chronic pelvic pain in women and its association with venous congestion has been described in the literature. We evaluated the potential benefits of lumboovarian vein embolization in the treatment of lower abdominal pain in patients presenting with pelvic varicosities. Methods. Nineteen patients were treated. There were 13 unilateral embolizations, 6 initial bilateral treatments and 5 treated recurrences (a total of 30 procedures). All embolizations were performed with either enbucrilate and/or macrocoils, and there was an average clinical and Doppler duplex follow-up of 15.4 months. Results. The initial technical success rate was 96.7%. There were no immediate or long-term complications. Variable symptomatic relief was observed in 73.7% of cases with complete responses in 57.9%. All 8 patients who had partial or no pain relief complained of dyspareunia. The direct relationship between varices and chronic pelvic pain was difficult to ascertain in a significant number of clinical failures. Conclusion. Transcatheter embolization of lumboovarian varices is a safe technique offering symptomatic relief of pelvic pain in the majority of cases. The presence of dyspareunia seemed to be a poor prognostic factor, indicating that other causes of pelvic pain may coexist with pelvic varicosities.

  10. Endovascular repair of abdominal aortic aneurysms: vascular anatomy, device selection, procedure, and procedure-specific complications.

    PubMed

    Bryce, Yolanda; Rogoff, Philip; Romanelli, Donald; Reichle, Ralph

    2015-01-01

    Abdominal aortic aneurysm (AAA) is abnormal dilatation of the aorta, carrying a substantial risk of rupture and thereby marked risk of death. Open repair of AAA involves lengthy surgery time, anesthesia, and substantial recovery time. Endovascular aneurysm repair (EVAR) provides a safer option for patients with advanced age and pulmonary, cardiac, and renal dysfunction. Successful endovascular repair of AAA depends on correct selection of patients (on the basis of their vascular anatomy), choice of the correct endoprosthesis, and familiarity with the technique and procedure-specific complications. The type of aneurysm is defined by its location with respect to the renal arteries, whether it is a true or false aneurysm, and whether the common iliac arteries are involved. Vascular anatomy can be divided more technically into aortic neck, aortic aneurysm, pelvic perfusion, and iliac morphology, with grades of difficulty with respect to EVAR, aortic neck morphology being the most common factor to affect EVAR appropriateness. When choosing among the devices available on the market, one must consider the patient's vascular anatomy and choose between devices that provide suprarenal fixation versus those that provide infrarenal fixation. A successful technique can be divided into preprocedural imaging, ancillary procedures before AAA stent-graft placement, the procedure itself, postprocedural medical therapy, and postprocedural imaging surveillance. Imaging surveillance is important in assessing complications such as limb thrombosis, endoleaks, graft migration, enlargement of the aneurysm sac, and rupture. Last, one must consider the issue of radiation safety with regard to EVAR. PMID:25763741

  11. Long-Term Outcome after Laparoscopic Bowel Resections for Deep Infiltrating Endometriosis: A Single-Center Experience after 900 Cases

    PubMed Central

    Ruffo, Giacomo; Scopelliti, Filippo; Manzoni, Alberto; Sartori, Alberto; Rossini, Roberto; Ceccaroni, Marcello; Minelli, Luca; Crippa, Stefano; Partelli, Stefano; Falconi, Massimo

    2014-01-01

    Background. Laparoscopic bowel resections for endometriosis are safe and effective but only short-term follow-up has been evaluated. In the present study long-term outcome in terms of intestinal and urinary function, fertility, chronic pain, and recurrence was assessed. Materials and Methods. From January 2002 to December 2010 nine hundred patients underwent laparoscopic bowel resection for endometriosis, and on 774 (86%) a questionnaire was administered. Patients were divided into 3 groups on the strength of the operation date. Postoperative diarrhea, constipation, rectal bleeding, tenesmus, dyschezia, dysuria, dyspareunia, fertility, and recurrence of disease were assessed. Results. The median follow-up was 54 months (range 1–120). All the evaluated symptoms significantly improved over time, with P = 0.0001 for dyspareunia, constipation, and pelvic pain and P = 0.004 for diarrhea. Nonsignificant improvement was reported for dysuria and rectal bleeding (with P = 0.452 and P = 0.097, resp.). Conclusions. The present results confirm that bowel resections for endometriosis are correlated with an acceptable complication rate even at long-term follow-up and that symptoms significantly improve over time, except for rectal bleeding and dysuria, the latter associated with a neurological damage. PMID:24877097

  12. From interstitial cystitis to chronic pelvic pain.

    PubMed

    Persu, C; Cauni, V; Gutue, S; Blaj, Irina; Jinga, V; Geavlete, P

    2010-01-01

    There are still many things to be found out about interstitial cystitis/painful bladder syndrome (IC/PBS) because the pathological processes underlying the condition are not yet elucidated, biological markers of the condition are not yet available, and the type and severity of symptoms can vary, so, clearly defining the condition is not yet possible. For example, it is not clearly understood whether IC/PBS represents a systemic disease, if it is localized in the bladder, or if it was initially localized in the bladder and it later evolved into a systemic disease. This condition is best managed by using a multidisciplinary approach. Management requires a good integration and knowledge of all pelvic organ systems and other systems including musculoskeletal, neurologic, and psychiatric systems. PMID:20968203

  13. From interstitial cystitis to chronic pelvic pain

    PubMed Central

    Cauni, V; Gutue, S; Blaj, I; Jinga, V; Geavlete, P

    2010-01-01

    There are still many things to be found out about interstitial cystitis/painful bladder syndrome (IC/PBS) because the pathological processes underlying the condition are not yet elucidated, biological markers of the condition are not yet available, and the type and severity of symptoms can vary, so, clearly defining the condition is not yet possible. For example, it is not clearly understood whether IC/PBS represents a systemic disease, if it is localized in the bladder, or if it was initially localized in the bladder and it later evolved into a systemic disease. This condition is best managed by using a multidisciplinary approach. Management requires a good integration and knowledge of all pelvic organ systems and other systems including musculoskeletal, neurologic, and psychiatric systems. PMID:20968203

  14. [Vascular complications after pelvic rami fracture].

    PubMed

    Fernández-Lombardía, J; Paz-Aparicio, A; Hernández-Vaquero, D

    2014-01-01

    The case is presented of a 78 year-old patient who suffered a right ileo- and ischiopubic rami fracture after a casual fall. A few hours later, she presented with sudden abdominal pain and hypotension. Imaging test showed extraperitoneal hemorrhage with active bleeding and hemodynamic compromise. The progressive worsening, with anemia and hemodynamic instability, required her being sent to the reference hospital for selective embolization of the bleeding point. After embolization, the patient?s situation stabilized, and she was then able to sit down one week later. The fracture consolidated 3 months later. Although low-energy pelvic fractures by lateral compression do not usually present with complications, sometimes they require a strict control due to the potential risk of vascular injuries. PMID:25242728

  15. Pelvic radiation therapy: Between delight and disaster

    PubMed Central

    Morris, Kirsten AL; Haboubi, Najib Y

    2015-01-01

    In the last few decades radiotherapy was established as one of the best and most widely used treatment modalities for certain tumours. Unfortunately that came with a price. As more people with cancer survive longer an ever increasing number of patients are living with the complications of radiotherapy and have become, in certain cases, difficult to manage. Pelvic radiation disease (PRD) can result from ionising radiation-induced damage to surrounding non-cancerous tissues resulting in disruption of normal physiological functions and symptoms such as diarrhoea, tenesmus, incontinence and rectal bleeding. The burden of PRD-related symptoms, which impact on a patient’s quality of life, has been under appreciated and sub-optimally managed. This article serves to promote awareness of PRD and the vast potential there is to improve current service provision and research activities. PMID:26649150

  16. High-energy pediatric pelvic and acetabular fractures.

    PubMed

    Amorosa, Louis F; Kloen, Peter; Helfet, David L

    2014-10-01

    Pediatric pelvic and acetabular fractures are rare injuries. They are almost always the result of a high-energy injury mechanism. A full trauma protocol should be instituted, having a high index of suspicion for associated life-threatening injuries. In the past, it was recommended that almost all of these injuries be treated nonoperatively. However, pelvic and acetabular fractures do not all remodel well. Prospective studies are needed to establish optimal treatment guidelines. Until then, in the presence of instability or significant displacement, operative fixation by a pelvic and acetabular fracture specialist should be considered to allow the best possible outcome. PMID:25199420

  17. Computational cardiac anatomy using MRI.

    PubMed

    Beg, Mirza Faisal; Helm, Patrick A; McVeigh, Elliot; Miller, Michael I; Winslow, Raimond L

    2004-11-01

    Ventricular geometry and fiber orientation may undergo global or local remodeling in cardiac disease. However, there are as yet no mathematical and computational methods for quantifying variation of geometry and fiber orientation or the nature of their remodeling in disease. Toward this goal, a landmark and image intensity-based large deformation diffeomorphic metric mapping (LDDMM) method to transform heart geometry into common coordinates for quantification of shape and form was developed. Two automated landmark placement methods for modeling tissue deformations expected in different cardiac pathologies are presented. The transformations, computed using the combined use of landmarks and image intensities, yields high-registration accuracy of heart anatomies even in the presence of significant variation of cardiac shape and form. Once heart anatomies have been registered, properties of tissue geometry and cardiac fiber orientation in corresponding regions of different hearts may be quantified. PMID:15508155

  18. THE CONTRIBUTION OF THE SECOND STAGE OF LABOR TO PELVIC FLOOR DYSFUNCTION: A PROSPECTIVE COHORT COMPARISON OF NULLIPAROUS WOMEN

    PubMed Central

    Rogers, RG; Leeman, LM; Borders, Noelle; Qualls, Clifford; Fullilove, Anne M; Teaf, Dusty; Hall, Rebecca J; Bedrick, Edward; Albers, Leah L

    2015-01-01

    Objective Maternal expulsive efforts are thought to damage the pelvic floor. We aimed to compare pelvic floor function and anatomy between women who delivered vaginally (VB) versus cesarean (CD) without entering the second stage of labor. Design Prospective cohort Setting University Hospital Midwifery practice Population Nulliparas Methods Pregnant nulliparas were recruited during pregnancy and women who underwent CD prior to the 2nd stage of labor at birth were recruited immediately postpartum. Both groups were prospectively followed to 6 months postpartum. Main Outcome Measures POPQ, perineal ultrasound(U/S) and Paper Towel Test(PTT), an objective measure of stress incontinence; Incontinence Severity Index(ISI), Pelvic Floor Impact Questionnaire(PFIQ-7), Wexner Fecal Incontinence Scale(W) and Female Sexual Function Index(FSFI) Results 336/448(75%)VB and 138/224(62%)CD followed up. The VB group was younger (23.9+/?4.9 vs 26.6+/?6.1 years, P<.001) and less overweight/obese (38 vs 56%, P<.001); baseline functional measures were similar(all P>.05). At followup, urinary incontinence (UI)(55 vs 46% ISI>0, P=.10), fecal incontinence(FI) (8 vs 13% FI on W, P = .12), sexual activity rates(88 vs 92%, P=.18) and PFIQ-7 scores were similar. Positive PTT tests(17 vs 6%, P=.002) and ?Stage 2 prolapse (22 vs 15%, P=.03) were higher with VB; differences were limited to points Aa and Ba. U/S findings were not different between groups. Stepwise multivariate analyses controlling for age, BMI, and non-Hispanic White race for prolapse of points Aa and Ba did not alter conclusions (all P <.004). Conclusions VB resulted in prolapse changes and objective UI, but did not result in increased self-report pelvic floor dysfunction at 6 months postpartum compared to women who delivered by CD without the second stage of labor. The second stage of labor has a modest effect on postpartum pelvic floor function. PMID:24548705

  19. Anatomy of the infant head

    SciTech Connect

    Bosma, J.F.

    1986-01-01

    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.

  20. Hip: Anatomy and US technique

    PubMed Central

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

    2011-01-01

    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. PMID:23397030

  1. Prognostic and Safety Roles in Laparoscopic Versus Abdominal Radical Hysterectomy in Cervical Cancer: A Meta-analysis

    PubMed Central

    Cao, Tiefeng; Feng, Yanling; Huang, Qidan; Wan, Ting

    2015-01-01

    Abstract Objective: Studies comparing the prognostic results between laparoscopic radical hysterectomy (LRH) and abdominal radical hysterectomy (ARH) in cervical cancer reported contradictory results. We aimed to evaluate the prognostic and safety roles of LRH by pooling studies in a meta-analysis. Materials and Methods: Original articles were searched in PubMed, EMBASE, and the Cochrane Library. The survival results (5-year disease-free survival [DFS], 5-year overall survival [OS], and recurrence rate [RR]), safety parameters (intra-, peri-, and postoperative complication rates and postoperative bowel or bladder recovery days), efficiency parameters (pelvic/para-aortic lymph nodes removed), and other parameters (operative time, estimated blood loss, and hospital of stay) between the two approaches were reviewed. Results: For the 2922 cases identified, DFS, OS, and RR did not differ in balanced prognostic factors, including lymph node metastasis, Stage IIB or above, non–squamous cancer histology, grade G3, lymphovascular space invasion, tumor size ?4?cm, and positive parametrial and vaginal margin rates. Meanwhile, LRH was associated with higher complication rates and a shorter time to the recovery of bowel or bladder function than for ARH. The number of removed pelvic or para-aortic lymph nodes did not significantly differ. Other parameters showed LRH was associated with a longer operative time, less blood loss, and a shorter length of hospital stay. The survival and prognostic results did not differ in balanced prognostic factors. Conclusions: LRH is safe and has lower operative complication rates than ARH. PMID:26584414

  2. Laparoscopic cholecystectomy using 2-mm instruments.

    PubMed

    Uranüs, S; Peng, Z; Kronberger, L; Pfeifer, J; Salehi, B

    1998-10-01

    Today, laparoscopic cholecystectomy is the method of choice for treatment of symptomatic gallbladder disorders. It minimizes effects of the operation that are independent of the gallbladder, such as trauma to the abdominal wall and other soft tissue. The surgical wounds were even smaller when 2-mm trocars were used. Laparoscopic cholecystectomy using 2-mm instruments was performed in a consecutive series of 14 patients with symptomatic gallstones. The procedure was completed in 12 cases, with conversion to open surgery in two cases. Intraoperative cholangiography was always performed. The postoperative course was always uneventful. The cosmetic effect was highly satisfactory. The procedure using 2-mm instruments could be indicated in selected patients with uncomplicated gallstone disease. PMID:9820716

  3. Laparoscopic Management of a Complex Adrenal Cyst

    PubMed Central

    Kodama, Koichi; Takase, Yasukazu; Niikura, Susumu; Shimizu, Akiko; Tatsu, Hiroki; Saito, Katsuhiko

    2015-01-01

    Adrenal cysts are rare, and their clinical management remains controversial. We report a case involving an adrenal cyst with a complicated appearance on radiological studies. Unenhanced computed tomography revealed a unilocular, noncalcified, hypoattenuating mass with a thin wall in the left adrenal gland. The lesion gradually increased in size from 10 to 50?mm at two-year follow-up. On contrast-enhanced magnetic resonance imaging, a mural nodule with contrast enhancement was observed. The entire adrenal gland was excised en bloc via a lateral transperitoneal laparoscopic approach without violating the principles of surgical oncology. The pathological diagnosis was an adrenal pseudocyst. Laparoscopic adrenalectomy is a safe option for the treatment of complex adrenal cysts, while maintaining the benefits of minimal invasiveness. PMID:26634170

  4. Laparoscopic surgery for left paraduodenal hernia.

    PubMed

    Fukunaga, Masaki; Kidokoro, Akio; Iba, Toshiaki; Sugiyama, Kazuyoshi; Fukunaga, Tetsu; Nagakari, Kunihiko; Suda, Masaru; Yosikawa, Seiichirou

    2004-04-01

    Paraduodenal hernia is a rare condition but the most common internal hernia. We describe the case of a 51-year-old man who was admitted with a complaint of 2 months' duration of recurrent left lower abdominal pain. Left paraduodenal hernia complicated by bowel malrotation was diagnosed, and the patient underwent laparoscopic surgery since no bowel necrosis was observed. The bowel incarcerated in the hernial sac was reduced, and an Endostitch was used to close the hernial orifice with continuous sutures. The postoperative course was good, and the patient was discharged 7 days after surgery. For paraduodenal hernia without bowel necrosis, particularly a left hernia, reduction of the incarcerated bowel and closure of the hernial orifice are relatively easy in terms of technique, and laparoscopic surgery may be the surgical method of choice because of its minimal invasiveness and aesthetic advantage. PMID:15107222

  5. Perforated diverticulitis sigmoidei after laparoscopic cholecystectomy

    PubMed Central

    Eljaja, Salameh; Hadi, Sabah; El-Hussuna, Alaa

    2015-01-01

    We present a case of 47-year-old healthy man who underwent an uneventful elective laparoscopic cholecystectomy. Despite the postoperative analgesia with non-steroidal anti-inflammatory drugs (NSAIDs), the patient developed diffuse abdominal pain culminating on the second postoperative day when the patient also had rebound tenderness. A diagnostic laparoscopy showed diverticular perforation, which was treated with laparoscopic lavage and drain. The patient's condition continued to deteriorate and the drain output resembled faecal material necessitating an emergency sigmoidium resection. The histopathological examination confirmed inflammation and perforation in the diverticulosis-bearing segment. The use of NSAID can be a reason for perforation, and may be for diverticulitis. NSAID should be used with caution in patients with a previous history or endoscopic-verified diverticulosis. PMID:25770142

  6. Laparoscopic Resection of Symptomatic Gastric Diverticula

    PubMed Central

    Zelisko, Andrea; Rodriguez, John; El-Hayek, Kevin

    2014-01-01

    Gastric diverticula are rare and usually asymptomatic. This report, however, describes two examples of symptomatic gastric diverticula successfully treated by laparoscopic resection. Both patients were male and in their sixth decade of life. One patient was relatively healthy with no past medical history, whereas the other patient had chronic pain issues and at presentation was also undergoing evaluation for hyperaldosteronism. The patients presented with gastrointestinal symptoms, including nausea, emesis, abdominal pain, and change in bowel function. In both cases, a gastric diverticulum was identified by CT scan, and precise anatomic position was determined by upper endoscopy. After discussion with the treating teams, including a gastroenterologist and surgeon, surgical treatment and resection was elected. Successful laparoscopic removal was accomplished in both patients, and they were discharged home after tolerating liquid diets. Both patients reported resolution of their abdominal symptoms at follow-up. PMID:24680154

  7. The spastic pelvic floor syndrome. Large bowel outlet obstruction caused by pelvic floor dysfunction: a radiological study.

    PubMed

    Kuijpers, H C; Bleijenberg, G; de Morree, H

    1986-01-01

    To determine whether a persistent contraction of the pelvic floor muscle during straining, as observed in constipated patients during defaecography, was due to a conscious action of the patients or really represented a functional disorder, segmental colonic transit studies were performed in 24 patients in whom the diagnosis spastic pelvic floor syndrome was made. Abnormal segmental transit indicating outlet obstruction occurred in 92% of the patients. Four different types of segmental transit abnormalities were observed which suggested that the spastic pelvic floor syndrome involved a functional outlet obstruction leading to retrograde filling of the colon and severe straining. A causative relation with other anorectal abnormalities is suggested. PMID:3598314

  8. Cooperative laparoscopic endoscopic and hybrid laparoscopic surgery for upper gastrointestinal tumors: Current status

    PubMed Central

    Ntourakis, Dimitrios; Mavrogenis, Georgios

    2015-01-01

    AIM: To investigate the cooperative laparoscopic and endoscopic techniques used for the resection of upper gastrointestinal tumors. METHODS: A systematic research of the literature was performed in PubMed for English and French language articles about laparoscopic and endoscopic cooperative, combined, hybrid and rendezvous techniques. Only original studies using these techniques for the resection of early gastric cancer, benign tumors and gastrointestinal stromal tumors of the stomach and the duodenum were included. By excluding case series of less than 10 patients, 25 studies were identified. The study design, number of cases, tumor pathology size and location, the operative technique name, the endoscopy team and surgical team role, operative time, type of closure of visceral wall defect, blood loss, complications and length of hospital stay of these studies were evaluated. Additionally all cooperative techniques found were classified and are presented in a systematic approach. RESULTS: The studies identified were case series and retrospective cohort studies. A total of 706 patients were operated on with a cooperative technique. The tumors resected were only gastrointestinal stromal tumors (GIST) in 4 studies, GIST and various benign submucosal tumors in 22 studies, early gastric cancer (pT1a and pT1b) in 6 studies and early duodenal cancer in 1 study. There was important heterogeneity between the studies. The operative techniques identified were: laparoscopic assisted endoscopic resection, endoscopic assisted wedge resection, endoscopic assisted transgastric and intragastric surgery, laparoscopic endoscopic cooperative surgery (LECS), laparoscopic assisted endoscopic full thickness resection (LAEFR), clean non exposure technique and non-exposed endoscopic wall-inversion surgery (NEWS). Each technique is illustrated with the roles of the endoscopic and laparoscopic teams; the indications, characteristics and short term results are described. CONCLUSION: Along with the traditional cooperative techniques, new procedures like LECS, LAEFR and NEWS hold great promise for the future of minimally invasive oncologic procedures. PMID:26604655

  9. The laparoscopic management of Swyer syndrome: Case series

    PubMed Central

    Malhotra, Neena; Dadhwal, Vatsla; Sharma, Kandala Aparna; Gupta, Deepika; Agarwal, Sumita; Deka, Dipika

    2015-01-01

    Swyer syndrome, also known as 46 XY pure gonadal dysgenesis, is a rare endocrine disorder. Affected individuals are phenotypically female with female genitalia, normal Mullerian structures, absent testicular tissue, and a 46 XY chromosomal constitution. We report a series of eight cases of Swyer syndrome, of which six were managed by laparoscopic gonadectomy. The two other cases had to undergo an exploratory laparotomy in view of their presentation with adnexal masses. Two of the girls were siblings. The chief presenting complaint was primary amenorrhea. Four girls also presented with a history of poor development of secondary sexual characters. The average age at presentation was 16.19±2.85 years. The average height was 158.33 ±4.63 cm, and the average weight was 49.33±8.44 kg. Breast development was either Tanner 2 or 3 in four girls, whereas three girls had a Tanner 1 underdeveloped breasts. Axillary and pelvic hair was sparse in all the girls. The vagina was well canalized in all the girls. Hormonal evaluation revealed hypergonadotropic hypogonadism with a mean follicle-stimulating hormone (FSH) level of 95.81 mIU/L and a mean luteinizing (LH) level of 24.15 mIU/L. Imaging analysis revealed the presence of a small uterus in all the cases, except one. Bilateral ovaries were either not visualized or streak gonads were present. Adnexal mass was detected in two of the six cases with raised carcinoembryonic antigen (CA) 125 levels in one case. Genetic analysis revealed a karyotype of 46 XY in six girls, 46 XY/45 X in one, and the culture repeatedly failed in one girl. Because of the risk of malignancy, bilateral gonadectomy was performed in all cases. Histopathological analysis revealed that three of the six cases had dysgerminoma. The patients have been started on hormone replacement therapy. Laparoscopy is a minimally invasive modality for the definitive diagnosis and treatment of cases with Swyer syndrome. An early diagnosis of Swyer syndrome is possible during workup for primary amenorrhea before they present with adnexal masses.

  10. Advances in Laparoscopic Skills Training and Management.

    PubMed

    Fransson, Boel A

    2016-01-01

    Veterinarians interested in adding minimally invasive surgery (MIS) to their surgical repertoire need a distinct set of skills. These MIS skills do not transfer from open surgery; they require specific training. Training based solely on practice in live patients becomes limited and inconsistent. In addition, ethical and cost issues arise when advanced procedures are practiced in live patients. This article discusses the Veterinary Applied Laparoscopic Training program, which provides simulation-based training for MIS. PMID:26396055

  11. Testing of the Anorectal and Pelvic Floor Area

    MedlinePLUS

    ... rectum looks for lesions such as rectal polyps. Ultrasonography of the anal sphincters may be used to ... Large Intestine Disorders of the Pelvic Floor Motility Testing Esophagus Stomach Small Intestine Large Intestine Anorectal and ...

  12. Animal models of female pelvic organ prolapse: lessons learned

    PubMed Central

    Couri, Bruna M; Lenis, Andrew T; Borazjani, Ali; Paraiso, Marie Fidela R; Damaser, Margot S

    2012-01-01

    Pelvic organ prolapse is a vaginal protrusion of female pelvic organs. It has high prevalence worldwide and represents a great burden to the economy. The pathophysiology of pelvic organ prolapse is multifactorial and includes genetic predisposition, aberrant connective tissue, obesity, advancing age, vaginal delivery and other risk factors. Owing to the long course prior to patients becoming symptomatic and ethical questions surrounding human studies, animal models are necessary and useful. These models can mimic different human characteristics – histological, anatomical or hormonal, but none present all of the characteristics at the same time. Major animal models include knockout mice, rats, sheep, rabbits and nonhuman primates. In this article we discuss different animal models and their utility for investigating the natural progression of pelvic organ prolapse pathophysiology and novel treatment approaches. PMID:22707980

  13. Pelvic Floor Rehabilitation in the Treatment of Fecal Incontinence

    PubMed Central

    Scott, Kelly M.

    2014-01-01

    Fecal incontinence (FI) is a prevalent problem that can drastically affect quality of life. Pelvic floor rehabilitation is an important first-line treatment for patients with FI, and many published case reports and a small number of randomized controlled trials (RCTs) provide limited evidence for its efficacy. Pelvic floor rehabilitation approaches to the treatment of FI include pelvic floor muscle training, biofeedback, and volumetric training with rectal balloon catheters. Various forms of external electrical stimulation have also been described and may be of added benefit. Behavioral bowel retraining is an important part of a good rehabilitative approach as well. Pelvic floor rehabilitation treatment for FI is thought to be effective and safe, with reported success rates in a majority of studies at 50 to 80%. Many more high-quality RCTs are needed to define optimal treatment protocols. PMID:25320568

  14. Tactile Imaging Markers to Characterize Female Pelvic Floor Conditions

    PubMed Central

    van Raalte, Heather; Egorov, Vladimir

    2015-01-01

    The Vaginal Tactile Imager (VTI) records pressure patterns from vaginal walls under an applied tissue deformation and during pelvic floor muscle contractions. The objective of this study is to validate tactile imaging and muscle contraction parameters (markers) sensitive to the female pelvic floor conditions. Twenty-two women with normal and prolapse conditions were examined by a vaginal tactile imaging probe. We identified 9 parameters which were sensitive to prolapse conditions (p < 0.05 for one-way ANOVA and/or p < 0.05 for t-test with correlation factor r from ?0.73 to ?0.56). The list of parameters includes pressure, pressure gradient and dynamic pressure response during muscle contraction at identified locations. These parameters may be used for biomechanical characterization of female pelvic floor conditions to support an effective management of pelvic floor prolapse. PMID:26389014

  15. Parallel genetic origins of pelvic reduction in vertebrates

    E-print Network

    Clayton, Dale H.

    at the Pitx1 locus control pelvic reduction in a population of threespine sticklebacks (Gasterosteus aculeatus to study the genetic basis of parallel evolution. Threespine (Gasterosteus aculeatus) and ninespine

  16. Exercise May Help Prevent Pregnancy-Linked Pelvic Pain

    MedlinePLUS

    ... nlm.nih.gov/medlineplus/news/fullstory_155128.html Exercise May Help Prevent Pregnancy-Linked Pelvic Pain Women ... Oct. 13, 2015 (HealthDay News) -- Women who routinely exercise in the three months prior to conceiving may ...

  17. Surgical Tutorial of a Robotic-Assisted Anterior Pelvic Exenteration

    MedlinePLUS Videos and Cool Tools

    ... to proceed with a pelvic exenteration using the robotic system both to minimize the risk of complications due to the precision of the instrumentation and of our vision as well last our ability to minimize bleeding ...

  18. Core value of laparoscopic colorectal surgery.

    PubMed

    Li, Xin-Xiang; Wang, Ren-Jie

    2015-12-10

    Since laparoscopy was first used in cholecystectomy in 1987, it has developed quickly and has been used in most fields of traditional surgery. People have now accepted its advantages like small incision, quick recovery, light pain, beauty and short hospital stays. In early times, there are still controversies about the application of laparoscopy in malignant tumor treatments, especially about the problems of oncology efficacy, incision implantation and operation security. However, these concerns have been fully eliminated by evidences on the basis of evidence-basis medicine. In recent years, new minimally invasive technologies are appearing continually, but they still have challenges and may increase the difficulties of radical dissection and the risks of potential complications, so they are confined to benign or early malignant tumors. The core value of the laparoscopic technique is to ensure the high quality of tumor's radical resection and less complications. On the basis of this, it is allowed to pursue more minimally invasive techniques. Since the development of laparoscopic colorectal surgery is rapid and unceasing, we have reasons to believe that laparoscopic surgery will become gold standard for colorectal surgery in the near future. PMID:26676111

  19. Laparoscopic treatment of congenital choledochal cyst.

    PubMed

    Shimura, H; Tanaka, M; Shimizu, S; Mizumoto, K

    1998-10-01

    We describe the laparoscopic treatment of a patient presenting with congenital choledochal cyst. Our patient was a 19-year-old man with a complaint of recurrent abdominal pain due to pancreatitis. The choledochal cyst was type I and had a common channel of pancreatobiliary duct, as revealed by endoscopic retrograde cholangiopancreatography. Under laparoscopic guidance, the dilated bile duct and the gallbladder were excised, and a Roux-en-Y anastomosis was constructed with an endo-EEA. Finally, end-to-side anastomosis was carried out by the continuous suture method, aided by an Endostitch between the stump of the hepatic duct and the Roux-en-Y limb. After the operation, slight hyperamylasemia was observed for several days but further treatment was not necessary. Postoperative symptoms were minimal, and the patient was discharged on the 11th day after the procedure. Although it is difficult and time-consuming, laparoscopic operation is highly beneficial for the patient. The use of such instruments as the endostapler and Endostitch may help to simplify this complex intracorporeal procedure involving division and anastomosis of the digestive tract. PMID:9745070

  20. Multiresolution foveated laparoscope with high resolvability.

    PubMed

    Qin, Yi; Hua, Hong; Nguyen, Mike

    2013-07-01

    A key limitation of the state-of-the-art laparoscopes for minimally invasive surgery is the tradeoff between the field of view and spatial resolution in a single-view camera system. As such, surgical procedures are usually performed at a zoomed-in view, which limits the surgeon's ability to see much outside the immediate focus of interest and causes a situational awareness challenge. We proposed a multiresolution foveated laparoscope (MRFL) aiming to address this limitation. The MRFL is able to simultaneously capture wide-angle overview and high-resolution images in real time; it can scan and engage the high-resolution images to any subregion of the entire surgical field in analogy to the fovea of human eye. The MRFL is able to render equivalently 10 million pixel resolution with a low data bandwidth requirement. The system has a large working distance (WD) from 80 to 180 mm. The spatial resolvability is about 45 ?m in the object space at an 80 mm WD, while the resolvability of a conventional laparoscope is about 250 ?m at a typically 50 mm surgical distance. PMID:23811873

  1. Core value of laparoscopic colorectal surgery

    PubMed Central

    Li, Xin-Xiang; Wang, Ren-Jie

    2015-01-01

    Since laparoscopy was first used in cholecystectomy in 1987, it has developed quickly and has been used in most fields of traditional surgery. People have now accepted its advantages like small incision, quick recovery, light pain, beauty and short hospital stays. In early times, there are still controversies about the application of laparoscopy in malignant tumor treatments, especially about the problems of oncology efficacy, incision implantation and operation security. However, these concerns have been fully eliminated by evidences on the basis of evidence-basis medicine. In recent years, new minimally invasive technologies are appearing continually, but they still have challenges and may increase the difficulties of radical dissection and the risks of potential complications, so they are confined to benign or early malignant tumors. The core value of the laparoscopic technique is to ensure the high quality of tumor’s radical resection and less complications. On the basis of this, it is allowed to pursue more minimally invasive techniques. Since the development of laparoscopic colorectal surgery is rapid and unceasing, we have reasons to believe that laparoscopic surgery will become gold standard for colorectal surgery in the near future. PMID:26676111

  2. LEAF ANATOMY OF ORCUTTIEAE (POACEAE: CHLORIDOIDEAE): MORE EVIDENCE OF C4 PHOTOSYNTHESIS WITHOUT KRANZ ANATOMY

    E-print Network

    Pockman, William T.

    LEAF ANATOMY OF ORCUTTIEAE (POACEAE: CHLORIDOIDEAE): MORE EVIDENCE OF C4 PHOTOSYNTHESIS WITHOUT KRANZ ANATOMY LAURA M. BOYKIN1,2,3 , WILLIAM T. POCKMAN1 AND TIMOTHY K. LOWREY1 1 Department of Biology, University of New Mexico, Albuquerque, NM 87131 ABSTRACT C4 photosynthesis without Kranz anatomy (single

  3. Tools for Predicting Biomechanical Consequences of Alterations to Orofacial Anatomy

    E-print Network

    British Columbia, University of

    Tools for Predicting Biomechanical Consequences of Alterations to Orofacial Anatomy 2008-facial anatomy and predicting functional deficits associated with jaw surgery, such as mandible reconstruction that detailed examination of the biomechanics of surgically reconstructed anatomy through computer simulation

  4. Department of Anatomy & Neurobiology Boston University School of Medicine

    E-print Network

    Spence, Harlan Ernest

    Department of Anatomy & Neurobiology Boston University School of Medicine Ph.D. Program Boston University School of Medicine Doctor of Philosophy in Anatomy & Neurobiology #12; Department of Anatomy & Neurobiology Boston University School of Medicine Ph.D. Program Guidelines Revised

  5. Department of Anatomy & Neurobiology Boston University School of Medicine

    E-print Network

    Spence, Harlan Ernest

    Department of Anatomy & Neurobiology Boston University School of Medicine Masters Program of Medicine Vesalius Program Master of Science in Anatomy & Neurobiology #12;Department of Anatomy & Neurobiology Boston University School of Medicine Masters Program Guidelines Revised Summer 2015 2

  6. Disseminated Mycobacterium Simiae with Pelvic Malakoplakia in an AIDS Patient

    PubMed Central

    Chitasombat, Maria Nina; Wattanatranon, Duangkamon

    2015-01-01

    Malakoplakia in an acquired immunodeficiency syndrome (AIDS) patient with disseminated Mycobacterium simiae infection presented with a large pelvic mass that caused organ dysfunction from mimicking a tumor. Malakoplakia is a rare, chronic granulomatous abnormal host response toward infectious agents, presenting as a tumor-like lesion. This is the first report of pelvic malakoplakia after disseminated M. simiae infection in an AIDS patient. PMID:26483613

  7. Giant abdomino-pelvic adipose tumors of childhood.

    PubMed

    Cascini, Valentina; Lisi, Gabriele; Lauriti, Giuseppe; Sindici, Giulia; Chiesa, Pierluigi Lelli

    2012-01-01

    Adipose tumors are rare in pediatric age and are commonly represented by benign forms: lipoma and lipoblastoma/lipoblastomatosis. Generally localized in subcutaneous tissue of the trunk and extremities, they can exceptionally occur as giant intra-peritoneal or pelvic masses. These tumors could reach considerable size prior to diagnosis since they are asymptomatic. The authors report a case series of three giant abdomino-pelvic adipose tumors. PMID:21877241

  8. Who is doing laparoscopic appendicectomies and who taught them?

    PubMed Central

    Noble, H.; Gallagher, P.; Campbell, W. B.

    2003-01-01

    BACKGROUND: Laparoscopic appendicectomy offers potential advantages, but its use seems variable and perhaps related to the enthusiasm of individual trainees. There is limited opportunity in many hospitals for consultants to do and teach laparoscopic appendicectomy because of the way emergency work is organised. METHODS: This study investigated the use and teaching of laparoscopic appendicectomy in two health regions, by a questionnaire sent to all specialist registrars (SpRs) in general surgery and completed by 78% (56 of 72). RESULTS: Of the responding SpRs, 43% had performed a laparoscopic appendicectomy (with an average of 2.5 supervised by a consultant and 7.5 with a more junior assistant). Of these, 92% had been taught by a consultant, but only 31% (33 of 108) of the consultants for whom they were currently working had done appendicectomy laparoscopically, and laparoscopic appendicectomy was only being performed on 14% of the SpRs current firms (47% with upper gastrointestinal and 40% with colorectal specialist interest). Some 5-30% of patients on those firms were treated laparoscopically, mostly at the preference of the SpR. CONCLUSIONS: Dedicated consultant time for emergencies would facilitate teaching of laparoscopic appendicectomy but theatre time, costs of disposable instruments, and the inexperience of many consultants in this operation are likely to continue limiting its use. Further debate is needed on its place in the treatment of appendicitis. PMID:14594538

  9. Effect of laparoscopic abdominal surgery on splanchnic circulation: Historical developments

    PubMed Central

    Hatipoglu, Sinan; Akbulut, Sami; Hatipoglu, Filiz; Abdullayev, Ruslan

    2014-01-01

    With the developments in medical technology and increased surgical experience, advanced laparoscopic surgical procedures are performed successfully. Laparoscopic abdominal surgery is one of the best examples of advanced laparoscopic surgery (LS). Today, laparoscopic abdominal surgery in general surgery clinics is the basis of all abdominal surgical interventions. Laparoscopic abdominal surgery is associated with systemic and splanchnic hemodynamic alterations. Inadequate splanchnic perfusion in critically ill patients is associated with increased morbidity and mortality. The underlying pathophysiological mechanisms are still not well understood. With experience and with an increase in the number and diversity of the resulting data, the pathophysiology of laparoscopic abdominal surgery is now better understood. The normal physiology and pathophysiology of local and systemic effects of laparoscopic abdominal surgery is extremely important for safe and effective LS. Future research projects should focus on the interplay between the physiological regulatory mechanisms in the splanchnic circulation (SC), organs, and diseases. In this review, we discuss the effects of laparoscopic abdominal surgery on the SC. PMID:25561784

  10. EYE MOVEMENTS IN A VIRTUAL LAPAROSCOPIC TRAINING ENVIRONMENT

    E-print Network

    Atkins, M. Stella

    are a promising alternative to traditional surgery training methods es- pecially in minimally-invasive proceduresEYE MOVEMENTS IN A VIRTUAL LAPAROSCOPIC TRAINING ENVIRONMENT by Benjamin Law B.Math, University of thesis: Eye Movements in a Virtual Laparoscopic Training Environment Examining Committee: Dr. John Dill

  11. Visual Tracking of Laparoscopic Instruments in Standard Training

    E-print Network

    Faloutsos, Petros

    Surgery, Surgery Training, Machine Vision Introduction Laparoscopic surgery is the most common and widelyVisual Tracking of Laparoscopic Instruments in Standard Training Environments Brian F. ALLEN, University of California, Los Angeles b Department of Surgery, University of California, Los Angeles Abstract

  12. An integrative review and severity classification of complications related to pessary use in the treatment of female pelvic organ prolapse

    PubMed Central

    Abdulaziz, Marwa; Stothers, Lynn; Lazare, Darren; Macnab, Andrew

    2015-01-01

    Introduction: Pessary use is the preferred non-surgical treatment option for female pelvic organ prolapse. As pessaries can be used chronically to alter pelvic floor anatomy, consideration of short-and long-term complications is important in patient management. We systematically reviewed articles describing the complications of pessary use to determine frequency and severity. Methods: A systematic search via MEDLINE and PubMed using the key terms “complications,” “pessary,” “pelvic organ prolapse,” “side effects” was conducted for the years 1952 to 2014 inclusively. Selected articles cited in the publications identified were also considered. Only full-text material published in English was reviewed. All pessary-related complications described were collated; overall frequency within case reports and case series were calculated and severity was graded using the Clavien-Dindo classification. Results: In total, 61 articles met the inclusion criteria. The most common complications reported were vaginal discharge/vaginitis, erosion, and bleeding. Complications were related to pessary shape and material, and duration in situ. Clavien-Dindo classification of complication severity found that all 5 grade levels were attributed to pessary use; serious grade 4 and 5 complications included cancer, adjacent organ fistula and death. Conclusion: There are few detailed reports of complications of pessary use relative to the estimated frequency of pessary use worldwide. Prospective studies documenting complications by shape, material, and size, and objectively classifying complication severity are required. As serious grade 4 and 5 complications of pessary use occur, further development of clinical follow-up guidelines for long-term pessary users is justified. PMID:26225188

  13. Enhanced muscle activity during lumbar extension exercise with pelvic stabilization

    PubMed Central

    Lee, Ho-Seong

    2015-01-01

    The purpose of this study was to investigate whether pelvic stabilization affects multifidus (MF) and iliocostalis lumborum (IL) muscle activities during dynamic extension exercise. Nine males (age, 25.1±6.3 yr; height, 176.6±2.4 cm; body mass, 74.9±6.7 kg) performed an isometric lumbar extension strength test and dynamic exercise in an upright seated position with or without pelvic stabilization. The electromyography and muscle strength of the MF and IL muscles were measured when the subjects performed the isometric lumbar extension strength test at the trunk angle 110°, 146°, and 182°. In addition, the trunk extensor muscle activities were measured using 50% muscle strength of maximum isometric strength during a dynamic trunk extension exercise. The MF and IL muscle activities were significantly higher at 110°, 146°, and 182° with pelvic stabilization than that without pelvic stabilization during the isometric lumbar extension strength test (P<0.05) and the dynamic exercise (P<0.05). These results suggest that the lumbar extension exercise with pelvic stabilization may be more effective for MF and IL muscle activity compared to that without pelvic stabilization.

  14. Pelvic Vein Embolisation in the Management of Varicose Veins

    SciTech Connect

    Ratnam, Lakshmi A.; Marsh, Petra; Holdstock, Judy M.; Harrison, Charmaine S.; Hussain, Fuad F.; Whiteley, Mark S.; Lopez, Anthony

    2008-11-15

    Pelvic vein incompetence is common in patients with atypical varicose veins, contributing to their recurrence after surgery. Therefore, refluxing pelvic veins should be identified and treated. We present our experience with pelvic vein embolisation in patients presenting with varicose veins. Patients presenting with varicose veins with a duplex-proven contribution from perivulval veins undergo transvaginal duplex sonography (TVUS) to identify refluxing pelvic veins. Those with positive scans undergo embolisation before surgical treatment of their lower limb varicose veins. A total of 218 women (mean age of 46.3 years) were treated. Parity was documented in the first 60 patients, of whom 47 (78.3%) were multiparous, 11 (18.3%) had had one previous pregnancy, and 2 (3.3%) were nulliparous. The left ovarian vein was embolised in 78%, the right internal iliac in 64.7%, the left internal iliac in 56.4%, and the right ovarian vein in 42.2% of patients. At follow-up TVUS, mild reflux only was seen in 16, marked persistent reflux in 6, and new reflux in 3 patients. These 9 women underwent successful repeat embolisation. Two patients experienced pulmonary embolisation of the coils, of whom 1 was asymptomatic and 1 was successfully retrieved; 1 patient had a misplaced coil protruding into the common femoral vein; and 1 patient had perineal thrombophlebitis. The results of our study showed that pelvic venous embolisation by way of a transjugular approach is a safe and effective technique in the treatment of pelvic vein reflux.

  15. Anterior subcutaneous internal fixation for treatment of unstable pelvic fractures

    PubMed Central

    2014-01-01

    Background Fractures of the pelvic ring including disruption of the posterior elements in high-energy trauma have both high morbidity and mortality rates. For some injury pattern part of the initial resuscitation includes either external fixation or plate fixation to close the pelvic ring and decrease blood loss. In certain situations – especially when associated with abdominal trauma and the need to perform laparotomies – both techniques may put the patient at risk of either pintract or deep plate infections. We describe an operative approach to percutaneously close and stabilize the pelvic ring using spinal implants as an internal fixator and report the results in a small series of patients treated with this technique during the resuscitation phase. Findings Four patients were treated by subcutaneous placement of an internal fixator. Screw fixation was carried out by minimally invasive placement of two supra-acetabular iliac screws. Afterwards, a subcutaneous transfixation rod was inserted and attached to the screws after reduction of the pelvic ring. All patients were allowed to fully weight-bear. No losses of reduction or deep infections occurred. Fracture healing was uneventful in all cases. Conclusion Minimally invasive fixation is an alternative technique to stabilize the pelvic ring. The clinical results illustrate that this technique is able to achieve good results in terms of maintenance of reduction the pelvic ring. Also, abdominal surgeries no longer put the patient at risk of infected pins or plates. PMID:24606833

  16. Full robotic assistance for laparoscopic tubal anastomosis: a case report.

    PubMed

    Falcone, T; Goldberg, J; Garcia-Ruiz, A; Margossian, H; Stevens, L

    1999-02-01

    Optical magnification and long instrumentation significantly increase surgical tremor, which makes laparoscopic microsuturing difficult. Therefore, laparoscopic tubal anastomosis has not gained wide acceptance among gynecologic surgeons. Robotic assistance facilitates this type of procedure by filtering tremor, reducing the surgeon's fatigue, and scaling the maneuvers. The authors have successfully completed a case of laparoscopic tubal reanastomosis using a "master-slave" robot to perform the standard microsuturing technique. A 33-year-old woman, gravida 2, para 2, requested reversal of her previous tubal ligature. A right isthmic-isthmic tubal anastomosis was performed laparoscopically, with faithful adherence to the authors' standard technique applied at laparotomy. Full robotic assistance was used to anastomose the tube. A chromotubation test showed anastomotic patency without leak. The patient recovered uneventfully after surgery and was discharged within 24 h after the procedure. Laparoscopic microsurgical tubal anastomosis with full robotic assistance is feasible and safe in humans. PMID:10194702

  17. Postoperative Delayed Duodenum Perforation following Elective Laparoscopic Cholecystectomy.

    PubMed

    Jing, Kong; Shuo-Dong, Wu

    2014-01-01

    Background. Duodenum injury is extremely rare complication of laparoscopic cholecystectomy with potentially fatal consequences. Methods. Over the past 13-year period, 3000 laparoscopic cholecystectomies were performed in our institution. Duodenum injury only occurred in one patient recently who had undergone gastrectomy owing to duodenal diverticulum. The diagnosis and management of this rare complication of laparoscopic cholecystectomy are described, and the literature is reviewed. Results. We present this case of duodenum injury on the fourth postoperative day after selective laparoscopic cholecystectomy was treated successfully by percutaneous needle aspiration and catheter drainage. The hospital stay was 26 days. No abscess recurred during the follow-up period. Conclusion. Duodenum injuries are extremely rare complications of laparoscopic cholecystectomy with potentially fatal consequences if not promptly recognized and treated. Sonographically guided percutaneous needle aspiration and catheter drainage can be used to treat the intraperitoneal abscess. Billroth II subtotal gastrectomy and gastrojejunostomy were beneficial for the treatment. PMID:24790609

  18. Postoperative Delayed Duodenum Perforation following Elective Laparoscopic Cholecystectomy

    PubMed Central

    Jing, Kong; Shuo-Dong, Wu

    2014-01-01

    Background. Duodenum injury is extremely rare complication of laparoscopic cholecystectomy with potentially fatal consequences. Methods. Over the past 13-year period, 3000 laparoscopic cholecystectomies were performed in our institution. Duodenum injury only occurred in one patient recently who had undergone gastrectomy owing to duodenal diverticulum. The diagnosis and management of this rare complication of laparoscopic cholecystectomy are described, and the literature is reviewed. Results. We present this case of duodenum injury on the fourth postoperative day after selective laparoscopic cholecystectomy was treated successfully by percutaneous needle aspiration and catheter drainage. The hospital stay was 26 days. No abscess recurred during the follow-up period. Conclusion. Duodenum injuries are extremely rare complications of laparoscopic cholecystectomy with potentially fatal consequences if not promptly recognized and treated. Sonographically guided percutaneous needle aspiration and catheter drainage can be used to treat the intraperitoneal abscess. Billroth II subtotal gastrectomy and gastrojejunostomy were beneficial for the treatment. PMID:24790609

  19. Zoom lens design using liquid lens for laparoscope.

    PubMed

    Lee, Seungwan; Choi, Minseog; Lee, Eunsung; Jung, Kyu-Dong; Chang, Jong-Hyeon; Kim, Woonbae

    2013-01-28

    Traditional laparoscopic optical systems consisting of about 30 lenses have low optical magnification. To magnify tissue during surgical operations, one must change from one laparoscope to another or use a magnifying adapter between the laparoscope and the sensor. Our work focuses on how to change the sag of a liquid lens while zooming from 1 × zoom, to 2 × , and 4 × in an optical design for a laparoscope. The design includes several lenses and two liquid lenses with variable focal lengths. A pair of laparoscopes for 3-D stereoscopy is placed within a tube 11 mm in diameter. The predicted depth resolution of tissue is 0.5 mm without interpolation at 4 × zoom. PMID:23389159

  20. Simulation System for Training in Laparoscopic Surgery

    NASA Technical Reports Server (NTRS)

    Basdogan, Cagatay; Ho, Chih-Hao

    2003-01-01

    A computer-based simulation system creates a visual and haptic virtual environment for training a medical practitioner in laparoscopic surgery. Heretofore, it has been common practice to perform training in partial laparoscopic surgical procedures by use of a laparoscopic training box that encloses a pair of laparoscopic tools, objects to be manipulated by the tools, and an endoscopic video camera. However, the surgical procedures simulated by use of a training box are usually poor imitations of the actual ones. The present computer-based system improves training by presenting a more realistic simulated environment to the trainee. The system includes a computer monitor that displays a real-time image of the affected interior region of the patient, showing laparoscopic instruments interacting with organs and tissues, as would be viewed by use of an endoscopic video camera and displayed to a surgeon during a laparoscopic operation. The system also includes laparoscopic tools that the trainee manipulates while observing the image on the computer monitor (see figure). The instrumentation on the tools consists of (1) position and orientation sensors that provide input data for the simulation and (2) actuators that provide force feedback to simulate the contact forces between the tools and tissues. The simulation software includes components that model the geometries of surgical tools, components that model the geometries and physical behaviors of soft tissues, and components that detect collisions between them. Using the measured positions and orientations of the tools, the software detects whether they are in contact with tissues. In the event of contact, the deformations of the tissues and contact forces are computed by use of the geometric and physical models. The image on the computer screen shows tissues deformed accordingly, while the actuators apply the corresponding forces to the distal ends of the tools. For the purpose of demonstration, the system has been set up to simulate the insertion of a flexible catheter in a bile duct. [As thus configured, the system can also be used to simulate other endoscopic procedures (e.g., bronchoscopy and colonoscopy) that include the insertion of flexible tubes into flexible ducts.] A hybrid approach has been followed in developing the software for real-time simulation of the visual and haptic interactions (1) between forceps and the catheter, (2) between the forceps and the duct, and (3) between the catheter and the duct. The deformations of the duct are simulated by finite-element and modalanalysis procedures, using only the most significant vibration modes of the duct for computing deformations and interaction forces. The catheter is modeled as a set of virtual particles uniformly distributed along the center line of the catheter and connected to each other via linear and torsional springs and damping elements. The interactions between the forceps and the duct as well as the catheter are simulated by use of a ray-based haptic-interaction- simulating technique in which the forceps are modeled as connected line segments.

  1. Pelvic Belt Effects on Pelvic Morphometry, Muscle Activity and Body Balance in Patients with Sacroiliac Joint Dysfunction

    PubMed Central

    Soisson, Odette; Lube, Juliane; Germano, Andresa; Hammer, Karl-Heinz; Josten, Christoph; Sichting, Freddy; Winkler, Dirk; Milani, Thomas L.; Hammer, Niels

    2015-01-01

    Introduction The sacroiliac joint (SIJ) is frequently involved in low back and pelvic girdle pain. However, morphometrical and functional characteristics related to SIJ pain are poorly defined. Pelvic belts represent one treatment option, but evidence still lacks as to their pain-reducing effects and the mechanisms involved. Addressing these two issues, this case-controlled study compares morphometric, functional and clinical data in SIJ patients and healthy controls and evaluates the effects of short-term pelvic belt application. Methods Morphometric and functional data pertaining to pelvic belt effects were compared in 17 SIJ patients and 17 controls. Lumbar spine and pelvis morphometries were obtained from 3T magnetic resonance imaging. Functional electromyography data of pelvis and leg muscles and center of pressure excursions were measured in one-leg stance. The numerical rating scale was used to evaluate immediate pain-reducing effects. Results Pelvic morphometry was largely unaltered in SIJ patients and also by pelvic belt application. The angle of lumbar lateral flexion was significantly larger in SIJ patients without belt application. Muscle activity and center of pressure were unaffected by SIJ pain or by belt application in one-leg stance. Nine of 17 patients reported decreased pain intensities under moderate belt application, four reported no change and four reported increased pain intensity. For the entire population investigated here, this qualitative description was not confirmed on a statistical significant level. Discussion Minute changes were observed in the alignment of the lumbar spine in the frontal plane in SIJ patients. The potential pain-decreasing effects of pelvic belts could not be attributed to altered muscle activity, pelvic morphometry or body balance in a static short-term application. Long-term belt effects will therefore be of prospective interest. PMID:25781325

  2. AUTOMATIC ANATOMY RECOGNITION VIA FUZZY OBJECT Jayaram K. Udupaa

    E-print Network

    Ciesielski, Krzysztof Chris

    AUTOMATIC ANATOMY RECOGNITION VIA FUZZY OBJECT MODELS Jayaram K. Udupaa , Dewey Odhnera , Alexandre radiological practice, computerized automatic anatomy recognition (AAR) during radiological image reading

  3. [Anatomy of the eustachian tube].

    PubMed

    Böckers, A

    2013-06-01

    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

  4. Gross anatomy of network security

    NASA Technical Reports Server (NTRS)

    Siu, Thomas J.

    2002-01-01

    Information security involves many branches of effort, including information assurance, host level security, physical security, and network security. Computer network security methods and implementations are given a top-down description to permit a medically focused audience to anchor this information to their daily practice. The depth of detail of network functionality and security measures, like that of the study of human anatomy, can be highly involved. Presented at the level of major gross anatomical systems, this paper will focus on network backbone implementation and perimeter defenses, then diagnostic tools, and finally the user practices (the human element). Physical security measures, though significant, have been defined as beyond the scope of this presentation.

  5. [Pelvic actinomycosis simulating adnexal malignant tumor].

    PubMed

    Benkiran, L; Gamra, L; Lamalmi, N; Essouyeh, M; Regragui, A; Amrani, M; Souadka, A; Melabbas, M A

    2002-01-01

    The purpose of this report is to describe the case of a 35-year-old patient admitted to the National Oncology Institute in Rabat, Morocco for pelvic pain and deteriorating general status ongoing for 8 months. Clinical and ultrasonographic examination showed a heterogenous mass measuring 7 cm in maximum width located inferior and lateral to the inferior aspect of the right side of the uterus. These findings were suggestive of a malignant tumor of the right ovary. Ovariectomy and omentectomy were performed. Histological examination of surgical specimens demonstrated right tubo-ovarian actinomycosis associated with peritonitis. Genital tract actinomycosis is an uncommon finding in women of childbearing age. It is due to colonization by a pyogenic bacteria (Actinomyces) usually secondary to a gastrointestinal infection, e.g. ileocecum, and sometimes in association with the presence of an intrauterine device or foreign body. Based on this case report, the authors discuss abdominopelvic actinomyocosis with emphasis on tumor-like findings that can lead to misdiagnosis by clinicians and radiologists. PMID:12038184

  6. Geometric modeling of pelvic organs with thickness

    NASA Astrophysics Data System (ADS)

    Bay, T.; Chen, Z.-W.; Raffin, R.; Daniel, M.; Joli, P.; Feng, Z.-Q.; Bellemare, M.-E.

    2012-03-01

    Physiological changes in the spatial configuration of the internal organs in the abdomen can induce different disorders that need surgery. Following the complexity of the surgical procedure, mechanical simulations are necessary but the in vivo factor makes complicate the study of pelvic organs. In order to determine a realistic behavior of these organs, an accurate geometric model associated with a physical modeling is therefore required. Our approach is integrated in the partnership between a geometric and physical module. The Geometric Modeling seeks to build a continuous geometric model: from a dataset of 3D points provided by a Segmentation step, surfaces are created through a B-spline fitting process. An energy function is built to measure the bidirectional distance between surface and data. This energy is minimized with an alternate iterative Hoschek-like method. A thickness is added with an offset formulation, and the geometric model is finally exported in a hexahedral mesh. Afterward, the Physical Modeling tries to calculate the properties of the soft tissues to simulate the organs displacements. The physical parameters attached to the data are determined with a feedback loop between finite-elements deformations and ground-truth acquisition (dynamic MRI).

  7. Frank Netter's Legacy: Interprofessional Anatomy Instruction

    ERIC Educational Resources Information Center

    Niekrash, Christine E.; Copes, Lynn E.; Gonzalez, Richard A.

    2015-01-01

    Several medical schools have recently described new innovations in interprofessional interactions in gross anatomy courses. The Frank H. Netter MD School of Medicine at Quinnipiac University in Hamden, CT has developed and implemented two contrasting interprofessional experiences in first-year medical student gross anatomy dissection laboratories:…

  8. Design Projects in Human Anatomy & Physiology

    ERIC Educational Resources Information Center

    Polizzotto, Kristin; Ortiz, Mary T.

    2008-01-01

    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 college,…

  9. Shark Attack! Sinking Your Teeth into Anatomy.

    ERIC Educational Resources Information Center

    House, Herbert

    2002-01-01

    Presents a real life shark attack story and studies arm reattachment surgery to teach human anatomy. Discusses how knowledge of anatomy can be put to use in the real world and how the arm functions. Includes teaching notes and suggestions for classroom management. (YDS)

  10. Anatomy Education Faces Challenges in Pakistan

    ERIC Educational Resources Information Center

    Memon, Ismail K.

    2009-01-01

    Anatomy education in Pakistan is facing many of the same challenges as in other parts of the world. Roughly, a decade ago, all medical and dental colleges in Pakistan emphasized anatomy as a core basic discipline within a traditional medical science curriculum. Now institutions are adopting problem based learning (PBL) teaching philosophies, and…

  11. Spine lateral flexion strength development differences between exercises with pelvic stabilization and without pelvic stabilization

    NASA Astrophysics Data System (ADS)

    Straton, Alexandru; Gidu, Diana Victoria; Micu, Alexandru

    2015-02-01

    Poor lateral flexor muscle strength can be an important source of lumbar/thoracic back pain in women. The purpose of this study was to evaluate pelvic stabilization (PS) and no pelvic stabilization (NoPS) lateral flexion strength exercise training on the development of isolated right and left lateral flexion strength. Isometric torque of the isolated right and left lateral flexion muscles was measured at two positions (0° and 30° opposed angle range of motion) on 42 healthy women before and after 8 weeks of PS and NoPS lateral flexion strength exercise training. Subjects were assigned in three groups, the first (n=14) trained 3 times/week with PS lateral flexion strength exercise, the second (n=14) trained 3 times/week with NoPS lateral flexion strength exercise and the third (control, n=14) did not train. Post training isometric strength values describing PS and NoPS lateral flexion strength improved in greater extent for the PS lateral flexion strength exercise group and in lesser extent for the NoPS lateral flexion strength exercise group, in both angles (p<0.05) relative to controls. These data indicate that the most effective way of training the spine lateral flexion muscles is PS lateral flexion strength exercises; NoPS lateral flexion strength exercises can be an effective way of training for the spine lateral flexion muscles, if there is no access to PS lateral flexion strength training machines.

  12. The 2008 Anatomy Ceremony: Essays

    PubMed Central

    Elansary, Mei; Goldberg, Ben; Qian, Ting; Rizzolo, Lawrence J.

    2009-01-01

    When asked to relate my experience of anatomy to the first-year medical and physician associate students at Yale before the start of their own first dissection, I found no better words to share than those of my classmates. Why speak with only one tongue, I said, when you can draw on 99 others? Anatomical dissection elicits what our course director, Lawrence Rizzolo, has called a “diversity of experience,” which, in turn, engenders a diversity of expressions. For Yale medical and physician associate students, this diversity is captured each year in a ceremony dedicated to those who donated their bodies for dissection. The service is an opportunity to offer thanks, but because only students and faculty are in attendance, it is also a place to share and address the complicated tensions that arise while examining, invading, and ultimately disassembling another’s body. It is our pleasure to present selected pieces from the ceremony to the Yale Journal of Biology and Medicine readership. — Peter Gayed, Co-editor-in-chief, Yale Journal of Biology and Medicine and Chair of the 2008 Anatomy Ceremony Planning Committee PMID:19325944

  13. Normal Bone Anatomy and Physiology

    PubMed Central

    Clarke, Bart

    2008-01-01

    This review describes normal bone anatomy and physiology as an introduction to the subsequent articles in this section that discuss clinical applications of iliac crest bone biopsy. The normal anatomy and functions of the skeleton are reviewed first, followed by a general description of the processes of bone modeling and remodeling. The bone remodeling process regulates the gain and loss of bone mineral density in the adult skeleton and directly influences bone strength. Thorough understanding of the bone remodeling process is critical to appreciation of the value of and interpretation of the results of iliac crest bone histomorphometry. Osteoclast recruitment, activation, and bone resorption is discussed in some detail, followed by a review of osteoblast recruitment and the process of new bone formation. Next, the collagenous and noncollagenous protein components and function of bone extracellular matrix are summarized, followed by a description of the process of mineralization of newly formed bone matrix. The actions of biomechanical forces on bone are sensed by the osteocyte syncytium within bone via the canalicular network and intercellular gap junctions. Finally, concepts regarding bone remodeling, osteoclast and osteoblast function, extracellular matrix, matrix mineralization, and osteocyte function are synthesized in a summary of the currently understood functional determinants of bone strength. This information lays the groundwork for understanding the utility and clinical applications of iliac crest bone biopsy. PMID:18988698

  14. Evaluation of Specialized Laparoscopic Suturing and Tying Devices

    PubMed Central

    Madan, Atul K.; Tebbit, Christopher L.; Park, William C.; Kumari, Nakka V. Aruna; Shervin, Nina

    2004-01-01

    Background: Laparoscopic suturing and tying constitute advanced minimally invasive surgery skills. Developing proficiency in the standard methods with needle drivers is often an arduous process. Recent advances in laparoscopic instrumentations has allowed for easier methods of suturing and tying. This study investigated the hypothesis that the use of a specialized suturing device and a specialized tying device allows inexperienced medical students to suture and tie laparoscopically. Methods: Preclinical medical students who had not received any training in open or laparoscopic surgery were included in this investigation. Each student was given a 5-minute demonstration of a specialized suturing device and a specialized tying device. The medical students were not allowed to deploy either device before actual use. After the demonstration, each student was given the device to use in a porcine model. Times were recorded and a subjective grade was given for each student. Results: Twenty medical students were involved in this study. All medical students were able to complete the task of suturing and tying. The average time to suture was 104.6 seconds and the average time to tying was 31.2 seconds. The average subjective performance grade was 90 (out of 100). Conclusion: Specialized devices are easy to learn and use for laparoscopic suturing and tying with minimal instruction even for inexperienced medical students. Even surgeons who are not well versed in laparoscopic surgery should be able to suture and tie with certain laparoscopic instruments. PMID:15119669

  15. [In vitro development of laparoscopic skills].

    PubMed

    Gödri, Veronika; Haidegger, Tamás; Saftics, György; Sándor, József; Wéber, György

    2012-08-01

    Minimally invasive surgery is a popular alternative to open surgical procedures. Laparoscopic surgeries require highly skilled surgeons with solid theoretical background and significant amount of practice. Pelvitrainers or simulators provide a good opportunity for practicing and developing laparoscopic skills. Laparoscopic training of medical students of the Semmelweis University is performed at the Institute of Experimental Surgery and Surgical Techniques on Apollo pelvitrainers. The trainer, the performed exercises and the time limits have to be validated by several measurements. Statistical evaluation of the results provides a possibility for the numerical evaluation of surgical skills as well as validating the usability of the pelvitrainer. In our study we tested the peg transfer exercise in pelvitrainers on four groups with different surgical background and level of expertise, complete novices (50 persons), medical students (326 persons), surgical residents (15), and experienced surgeons (4), respectively. A time limit of 240 s was defined for novices and 100 s for professionals. During the evaluation of the results the average time and the number of errors were calculated. The mean completion time of amateurs was 365.7 ± 130 s (mean ± standard deviation), with 2.57 errors. The performance of medical students was characterized by 159.3 ± 61.1 s average time with 1.21 errors, the completion time of residents was 257.9 ± 75.7 s with 1.13 error points, and 117.2 ± 29.1 s for the surgeons. These data show significant differences between the group, except between the results of medical students and surgeons. We plan to extend this study with the inclusion of more, experienced surgeons. PMID:22940390

  16. The economic considerations in laparoscopic surgery.

    PubMed

    MacFadyen, B V; Lenz, S

    1994-07-01

    There has been increasing concern in the medical, business, and insurance communities and government agencies about the rising cost of health care. Since 1980 the cost of medical care has increased from $280 billion dollars per year to $670 billion dollars in 1990, and was estimated at $900 billion in 1993. Several factors have contributed to this increase, including the high cost of hospitalization and new expensive technology, such as laparoscopic cholecystectomy. This present cost analysis was undertaken to determine the cost variables in laparoscopic cholecystectomy to see if changes in physician, nursing, and administration work activities could decrease the cost of hospitalization. Fifty-four patients who had an uncomplicated elective cholecystectomy during a five-month period in 1993 were assessed in terms of cost components of hospitalization, including nursing unit labor costs, surgery personnel labor costs, supply/instrument cost, and ancillary costs. Nine general surgeons participated in this study, four of whom accounted for 71% of the annual volume of cases. This analysis was performed with the help of Baxter Corporate Consulting, a Division of Baxter Healthcare Corporation. From this study, it was found that the average cost for uncomplicated laparoscopic cholecystectomy patients was $1589 +/- $223. The operating room and supply/instrument component costs were the two largest expenses, accounting for 42% of the total cost. Reimbursement from various insurance agencies were also evaluated, and it was determined that a contract made with a local HMO caused the hospital to lose an average of $443.00 per patient.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:7974099

  17. Preemptive analgesia with Ketamine for Laparoscopic cholecystectomy

    PubMed Central

    Singh, Harsimran; Kundra, Sandeep; Singh, Rupinder M; Grewal, Anju; Kaul, Tej K; Sood, Dinesh

    2013-01-01

    Background: The aim of preemptive analgesia is to reduce central sensitization that arises from noxious inputs across the entire perioperative period. N-methyl d-aspartate receptor antagonists have the potential for attenuating central sensitization and preventing central neuroplasticity. Materials and Methods: Patients undergoing laparoscopic cholecystectomy were randomized into four groups of 20 patients each, who were administered the study drug intravenously 30 min before incision. Groups A, B, and C received ketamine in a dose of 1.00, 0.75 and 0.50 mg/kg, respectively, whereas group D received isotonic saline. Anesthetic and surgical techniques were standardized. Postoperatively, the degree of pain at rest, movement, and deep breathing using visual analogue scale, time of request for first analgesic, total opioid consumption, and postoperative nausea and vomiting were recorded in postanesthesia care unit for 24 h. Results: Pain scores were highest in Group D at 0 h. Groups A, B, and C had significantly decreased postoperative pain scores at 0, 0.5, 3, 4, 5, 6, and 12 h. Postoperative analgesic consumption was significantly less in groups A, B, and C as compared with group D. There was no significant difference in the pain scores among groups A, B, and C. Group A had a significantly higher heart rate and blood pressure than groups B and C at 0 and 0.5 h along with 10% incidence of hallucinations. Conclusion: Preemptive ketamine has a definitive role in reducing postoperative pain and analgesic requirement in patients undergoing laparoscopic cholecystectomy. The lower dose of 0.5 mg/kg being devoid of any adverse effects and hemodynamic changes is an optimal dose for preemptive analgesia in patients undergoing laparoscopic cholecystectomy. PMID:24249984

  18. Laparoscopically assisted ventriculoperitoneal shunt placement: a prospective randomized controlled trial.

    PubMed

    Schucht, Philippe; Banz, Vanessa; Trochsler, Markus; Iff, Samuel; Krähenbühl, Anna Katharina; Reinert, Michael; Beck, Jürgen; Raabe, Andreas; Candinas, Daniel; Kuhlen, Dominique; Mariani, Luigi

    2015-05-01

    OBJECT In ventriculoperitoneal (VP) shunt surgery, laparoscopic assistance can be used for placement of the peritoneal catheter. Until now, the efficacy of laparoscopic shunt placement has been investigated only in retrospective and nonrandomized prospective studies, which have reported decreased distal shunt dysfunction rates in patients undergoing laparascopic placement compared with mini-laparotomy cohorts. In this randomized controlled trial the authors compared rates of shunt failure in patients who underwent laparoscopic surgery for peritoneal catheter placement with rates in patients who underwent traditional mini-laparotomy. METHODS One hundred twenty patients scheduled for VP shunt surgery were randomized to laparoscopic surgery or mini-laparotomy for insertion of the peritoneal catheter. The primary endpoint was the rate of overall shunt complication or failure within the first 12 months after surgery. Secondary endpoints were distal shunt failure, overall complication/ failure, duration of surgery and hospitalization, and morbidity. RESULTS The overall shunt complication/failure rate was 15% (9 of 60 cases) in the laparoscopic group and 18.3% (11 of 60 cases) in the mini-laparotomy group (p = 0.404). Patients in the laparoscopic group had no distal shunt failures; in contrast, 5 (8%) of 60 patients in the mini-laparotomy group experienced distal shunt failure (p = 0.029). Intraoperative complications occurred in 2 patients (both in the laparoscopic group), and abdominal pain led to catheter removal in 1 patient per group. Infections occurred in 1 patient in the laparoscopic group and 3 in the mini-laparotomy group. The mean durations of surgery and hospitalization were similar in the 2 groups. CONCLUSIONS While overall shunt failure rates were similar in the 2 groups, the use of laparoscopic shunt placement significantly reduced the rate of distal shunt failure compared with mini-laparotomy. PMID:25534231

  19. Japanese-Style Acupuncture for Endometriosis-Related Pelvic Pain in Adolescents and Young Women: Results of a Randomized Sham-Controlled Trial

    PubMed Central

    Wayne, Peter M.; Kerr, Catherine E.; Schnyer, Rosa N.; Legedza, Anna T. R.; Savetsky-German, Jacqueline; Shields, Monica H.; Buring, Julie E.; Davis, Roger B.; Conboy, Lisa A.; Highfield, Ellen; Parton, Barbara; Thomas, Phaedra; Laufer, Marc R.

    2008-01-01

    Study Objective To assess feasibility, and collect preliminary data for a subsequent randomized, sham-controlled trial to evaluate Japanese-style acupuncture for reducing chronic pelvic pain and improving health related quality of life (HRQOL) in adolescents with endometriosis. Design Randomized, sham-controlled trial. Settings Tertiary-referral hospital. Participants Eighteen young women (13–22y) with laparoscopically-diagnosed endometriosis-related chronic pelvic pain. Interventions A Japanese style of acupuncture and a sham acupuncture control. Sixteen treatments were administered over 8 weeks. Main outcome measures Protocol feasibility, recruitment numbers, pain not associated with menses or intercourse, and multiple HRQOL instruments including Endometriosis Health Profile, Pediatric Quality of Life, Perceived Stress, and Activity Limitation. Results Fourteen participants (out of 18 randomized) completed the study per protocol. Participants in the active acupuncture group (n=9) experienced an average 4.8 (sd=2.4) point reduction on a 11 point scale (62%) in pain after 4 weeks, which differed significantly from the control group’s (n=5) average reduction of 1.4 (s.d.=2.1) points (P=0.004). Reduction in pain in the active group persisted through a 6 month assessment; however, after 4 weeks, differences between the active and control group decreased and were not statistically significant. All HRQOL measures indicated greater improvements in the active acupuncture group compared to the control; however, the majority of these trends were not statistically significant. No serious adverse events were reported. Conclusion Preliminary estimates indicate that Japanese-style acupuncture may be an effective, safe, and well-tolerated adjunct therapy for endometriosis-related pelvic pain in adolescents. A more definitive trial evaluating Japanese-style acupuncture in this population is both feasible and warranted. PMID:18794019

  20. Recurrent mucinous cystadenoma: a laparoscopic approach.

    PubMed

    Turkyilmaz, Esengul; Korucuoglu, Umit; Kutlusoy, Fatma; Efeturk, Tunay; Dogan, Hayriye Tatli; Onan, Anil; Guner, Haldun; Taskiran, Cagatay

    2009-03-01

    The second most common epithelial tumor of the ovary is mucinous-type, and it constitutes 8-10% of all ovarian tumors. The recurrence of mucinous cystadenoma is very rare after complete excision. Only four such cases have been reported till date. The case presented in this report is the fifth, who had her initial surgery performed by gynecologic oncology team by laparotomy and was followed up by the same group. After recurrence at the same ovary, the patient underwent laparoscopic evaluation and unilateral salpingoophorectomy was performed. The final histopathological diagnosis was mucinous cystadenoma, just the same as the initial cyst. PMID:18584185

  1. Augmented reality assisted laparoscopic partial nephrectomy.

    PubMed

    Schneider, Adrian; Pezold, Simon; Saner, Andreas; Ebbing, Jan; Wyler, Stephen; Rosenthal, Rachel; Cattin, Philippe C

    2014-01-01

    Computer assisted navigation is a widely adopted technique in neurosurgery and orthopedics. However, it is rarely used for surgeries on abdominal organs. In this paper, we propose a novel, noninvasive method based on electromagnetic tracking to determine the pose of the kidney. As a clinical use case, we show a complete surgical navigation system for augmented reality assisted laparoscopic partial nephrectomy. Experiments were performed ex vivo on pig kidneys and the evaluation showed an excellent augmented reality alignment error of 2.1 mm ± 1.2 mm. PMID:25485399

  2. Personalizing pelvic floor reconstructive surgery in aging women.

    PubMed

    Mannella, Paolo; Giannini, Andrea; Russo, Eleonora; Naldini, Gabriele; Simoncini, Tommaso

    2015-09-01

    Pelvic floor dysfunction is a growingly frequent condition in aging individuals. Urinary or rectal incontinence, constipation, pelvic organ prolapse, pelvic pain or sexual dysfunction are common problems in this age range. Such conditions carry a severe impact on quality of life, but also limit individual independence in daily activities, favor social isolation and carry health risks. Diagnosis and treatment of pelvic floor dysfunction in aging women is tricky, since multiple interfering conditions affecting muscle tone and nerve function are common in these individuals. Diabetes mellitus, sarcopenia, use of drugs that affect cognition or impact bowel or urinary function are just a few examples. These conditions need to be thoroughly taken into account during pre-operative work up for their potential impact on the success of surgery and vice versa. Functional reconstruction aimed at treating symptoms rather than anatomic defects is key to success. The recent advancements in surgical treatment of urinary incontinence and pelvic organ prolapse allow for more options to achieve the best surgery in each patient. PMID:26142653

  3. Insufficiency Fractures After Pelvic Radiotherapy in Patients With Prostate Cancer

    SciTech Connect

    Igdem, Sefik; Alco, Guel; Ercan, Tuelay; Barlan, Metin; Ganiyusufoglu, Kuersat; Unalan, Buelent; Turkan, Sedat; Okkan, Sait

    2010-07-01

    Purpose: To assess the incidence, predisposing factors, and clinical characteristics of insufficiency fractures (IF) in patients with prostate cancer, who received pelvic radiotherapy as part of their definitive treatment. Methods and Materials: The charts of 134 prostate cancer patients, who were treated with pelvic radiotherapy between 1998 and 2007 were retrospectively reviewed. IF was diagnosed by bone scan and/or CT and/or MRI. The cumulative incidence of symptomatic IF was estimated by actuarial methods. Results: Eight patients were identified with symptomatic IF after a median follow-up period of 68 months (range, 12-116 months). The 5-year cumulative incidence of symptomatic IF was 6.8%. All patients presented with lower back pain. Insufficiency fracture developed at a median time of 20 months after the end of radiotherapy and was managed conservatively without any need for hospitalization. Three patients were thought to have metastatic disease because of increased uptake in their bone scans. However, subsequent CT and MR imaging revealed characteristic changes of IF, avoiding any further intervention. No predisposing factors for development of IF could be identified. Conclusions: Pelvic IF is a rare complication of pelvic radiotherapy in prostate cancer. Knowledge of pelvic IF is essential to rule out metastatic disease and prevent unnecessary treatment, especially in a patient cohort with high-risk features for distant spread.

  4. A single-institution approach to total pelvic exenteration.

    PubMed

    Chokshi, Ravi J; Fowler, Jeffrey; Cohn, David; Bahnson, Robert; Lumbley, Joshua; Martin, Edward W

    2011-12-01

    The objective of this study was to describe in detail the technique of total pelvic exenteration. Total pelvic exenteration (TPE) was first described in 1948 by Brunschwig. Since its description, complications of the procedure and surgical innovations have changed the approach to this radical surgery. We have described our institutional approach and outcomes of TPE. Fifty-four patients underwent TPE between 2004 and 2010 by the Division of Surgical Oncology at the Ohio State University Medical Center. Fifty-three patients have complete medical records available for review. Outcomes are described and have shaped these techniques. Patients were divided into various groups based on their histology: colorectal (n = 36), gynecologic (n = 6), urologic (n = 5), squamous cell (n = 2), sarcomatous disease (n = 3), and severe infections (n = 1). These were divided into two groups-colorectal (n = 36) and noncolorectal (n = 17)-for analysis. Demographics, operative time, length of stay, and complication rates were similar between the two groups. The median survival was 21.4 months for the colorectal group and 6.9 months for the noncolorectal group. Total pelvic exenteration for colorectal tumors has improved survival when compared with patients undergoing exenteration for pelvic malignancies of other origins. Total pelvic exenteration continues to be associated with high morbidity; however, with appropriate patient selection and proper operative technique, a perioperative mortality of 0 per cent can be achieved. PMID:22273221

  5. Management of disorders of the posterior pelvic floor.

    PubMed Central

    Berman, Loren; Aversa, John; Abir, Farshad; Longo, Walter E.

    2005-01-01

    INTRODUCTION: Constipation is a relatively common problem affecting 15 percent of adults in the Western world, and over half of these cases are related to pelvic floor disorders. This article reviews the clinical presentation and diagnostic approach to posterior pelvic floor disorders, including how to image and treat them. METHODS: A Pubmed search using keywords "rectal prolapse," "rectocele," "perineal hernia," and "anismus" was performed, and bibliographies of the revealed articles were cross-referenced to obtain a representative cross-section of the literature, both investigational studies and reviews, that are currently available on posterior pelvic floor disorders. DISCUSSION: Pelvic floor disorders can occur with or without concomitant physical anatomical defects, and there are a number of imaging modalities available to detect such abnormalities in order to decide on the appropriate course of treatment. Depending on the nature of the disorder, operative or non-operative therapy may be indicated. CONCLUSION: Correctly diagnosing pelvic floor disorders can be complex and challenging, and the various imaging modalities as well as clinical history and exam must be considered together in order to arrive at a diagnosis. PMID:16720016

  6. The Relationship Between Foot and Pelvic Alignment While Standing

    PubMed Central

    Khamis, Sam; Dar, Gali; Peretz, Chava; Yizhar, Ziva

    2015-01-01

    A normal motion and segmental interrelationship has been determined as a significant factor in normal function. Yet, the relationship between distal segments and pelvic alignment needs further investigation. The aim of this study was to investigate the interrelationship between distal and proximal lower extremity segments while standing and during induced feet hyperpronation. Changes in alignment of the pelvis and lower extremities were measured at a gait laboratory using the VICON 612 computerized motion analysis system. Thirty-five healthy volunteer subjects were recruited. Four randomized repeated-measure standing modes were used: standing directly on the floor and then on three wedges angled at 10°, 15° and 20° to induce bilateral hyperpronation for 20 seconds. A significant (p<0.05) bi-variate relationship was found between the anterior pelvic tilt and thigh internal rotation, in all four standing positions (.41?r?.46, in all p<0.014). A combined effect of rotational alignment between segments and the cumulative effect of foot hyperpronation on pelvic tilt revealed that only the shank significantly affected pelvic alignment, acting as a mediator between a foot and a thigh with the thigh having a crude significant effect on the pelvis. When internal rotation of the shank occurs, calcaneal eversion couples with thigh internal rotation and anterior pelvic tilt. It can be concluded that in response to induced hyperpronation, the shank is a pivotal segment in postural adjustment. PMID:26240652

  7. Breakage of fascial closure device during laparoscopic surgery

    PubMed Central

    Katara, A. N.; Bhandarkar, D. S.; Shah, R. S.; Udwadia, T. E.

    2005-01-01

    Breakage of instruments during laparoscopic surgery is rare. However, when it does occur, locating and retrieving the broken part of the instrument can be cumbersome. Moreover, inability to do so may carry serious medicolegal implications. We report a patient in whom the tip of a fascial closure device broke during laparoscopic surgery. This was located by intraoperative fluoroscopy and retrieved from the extraperitoneal plane via a small incision. The paper discusses the probable factors responsible for breakage of the fascial closure device in our patient and reviews the previously reported cases of the rare complication of breakage of instruments during laparoscopic surgery. PMID:21206652

  8. Laparoscopic Transhiatal Esophagectomy for Barrett's Esophagus with High Grade Dysplasia

    PubMed Central

    Nguyen, Ninh T.; Schauer, Philip R.

    1998-01-01

    Background: A number of case reports have described the application of minimally invasive surgical techniques to accomplish esophagectomy. However, most reports have employed thoracoscopic or laparoscopic techniques to perform esophagectomy in addition to an “access” incision which often approaches a standard laparotomy or thoracotomy. Case Report: This report describes a total laparoscopic transhiatal esophagectomy in a 55 year old female with Barrett's esophagus and high grade dysplasia. Conclusions: The patient had an uneventful recovery and was discharged home on the fourth day after a total laparoscopic esophagectomy. This report demonstrates the technical feasibility of this complex procedure by a minimally invasive approach. PMID:9876716

  9. Single-incision laparoscopic management of a giant hepatic cyst

    PubMed Central

    Willems, Kaitlin; Monsivais, Sharon; Vassaur, Hannah; Buckley, Francis P.

    2015-01-01

    Large symptomatic hepatic cysts may warrant surgical management. Traditional multiport laparoscopic technique is typically preferred over open laparotomy, but the use of the single-incision laparoscopic approach for this diagnosis is not well documented. Here, we describe the case of a 68-year-old woman who underwent complete anterior wall fenestration, excision and cauterization of a simple hepatic cyst via a single-incision laparoscopic technique through an incision at the umbilicus. The objective of this case report is to document single-incision laparoscopy as a safe, feasible and cosmetically appealing approach for the management of a large hepatic cyst. PMID:26224889

  10. Anatomy: Simple and Effective Privacy Preservation Xiaokui Xiao Yufei Tao

    E-print Network

    Zhang, Jun

    Anatomy: Simple and Effective Privacy Preservation Xiaokui Xiao Yufei Tao Department of Computer}@cse.cuhk.edu.hk ABSTRACT This paper presents a novel technique, anatomy, for publishing sen- sitive data. Anatomy releases method based on generalization. Specifically, anatomy permits aggregate reasoning with average error

  11. Frank Netter's legacy: Interprofessional anatomy instruction.

    PubMed

    Niekrash, Christine E; Copes, Lynn E; Gonzalez, Richard A

    2015-01-01

    Several medical schools have recently described new innovations in interprofessional interactions in gross anatomy courses. The Frank H. Netter MD School of Medicine at Quinnipiac University in Hamden, CT has developed and implemented two contrasting interprofessional experiences in first-year medical student gross anatomy dissection laboratories: long-term, informal visits by pathologists' assistant students who work with the medical students to identify potential donor pathologies, and a short-term, formal visit by fourth-year dental students who teach craniofacial anatomy during the oral cavity dissection laboratory. A survey of attitudes of participants was analyzed and suggest the interprofessional experiences were mutually beneficial for all involved, and indicate that implementing multiple, contrasting interprofessional interactions with different goals within a single course is feasible. Two multiple regression analyses were conducted to analyze the data. The first analysis examined attitudes of medical students towards a pathologists' assistant role in a health care team. The question addressing a pathologists' assistant involvement in the anatomy laboratory was most significant. The second analysis examined attitudes of medical students towards the importance of a good foundation in craniofacial anatomy for clinical practice. This perceived importance is influenced by the presence of dental students in the anatomy laboratory. In both instances, the peer interprofessional interactions in the anatomy laboratory resulted in an overall positive attitude of medical students towards pathologists' assistant and dental students. The consequences of these interactions led to better understanding, appreciation and respect of the different professionals that contribute to a health care team. PMID:26014811

  12. Pregnancy hemoperitoneum and placenta percreta in a patient with previous pelvic irradiation and ovarian failure

    SciTech Connect

    Pridjian, G.; Rich, N.E.; Montag, A.G. )

    1990-05-01

    Placenta percreta in a patient with previous pelvic irradiation has never been described. Reported is a case of placenta percreta with hemoperitoneum associated with a second-trimester incomplete abortion in a patient with previous pelvic irradiation and ovarian failure.

  13. Trans-venous occlusion of incompetent pelvic veins for chronic pelvic pain in women: a systematic review.

    PubMed

    Hansrani, Vivak; Abbas, Abeera; Bhandari, Sahil; Caress, Ann-Louise; Seif, Mourad; McCollum, Charles N

    2015-02-01

    Chronic pelvic pain (CPP) affects 24% of women worldwide; the cause cannot be identified in 40% despite invasive investigations. Dilated, refluxing pelvic veins may be a cause of CPP and treatment by trans-venous occlusion is increasingly performed when gynecological causes are excluded, but is it effective? A systematic review of the literature published between 1966 and July 2014 was conducted. Two authors independently reviewed potential studies according to a set of eligibility criteria, with a third assessor available as an arbiter. Thirteen studies including 866 women undergoing trans-venous occlusion of pelvic veins for CPP were identified (Level of evidence: one study grade 2b, 12 studies grade four). Statistical significant improvements in pelvic pain were reported in nine of the 13 studies. Technical success was reported in 865 of 866 (99.8%) with low complication rates: coil migration in 14 women (1.6%), abdominal pain in ten women (1.2%) and vein perforation in five (0.6%). In a study on varicose veins of the legs, recurrence was seen in 13% of 179 women 5-years following coil embolization. Subjective improvements in pain were seen in all 13 studies after treatment by trans-venous occlusion. All 13 studies were of poor methodological quality. Complication rates were low and no fatalities occurred. Well-designed studies are essential to determine whether pelvic vein incompetence (PVI) is associated with CPP, and to explore whether trans-venous occlusion of PVI improves quality of life for these women. PMID:25590499

  14. [Endometriosis: an essential differential diagnosis of chronic pelvic pain].

    PubMed

    Wenger, Jean-Marie; Zormpa, Maria; Dällenbach, Patrick; Weber, Laura

    2012-10-24

    In the context of chronic pelvic pain, endometriosis plays a significant role due to its frequency and its effects on the quality of women's lives. It affects 3-10% of women of reproductive age. The clinical signs are part from chronic pelvic pain, dysmenorrhea, dyspareunia, urinary and digestive symptoms as well as infertility. The clinical signs and symptoms may vary and the clinical examination may be difficult to interpret for a physician who is not familiar with the condition. This explains the fact that it takes more time to make the diagnosis of endometriosis. Delay of diagnosis, multiple consultations and complex surgical procedures implicate physical and psychological suffering for the patient with serious complications. For all these reasons, the differential diagnosis of chronic pelvic pain in women should include endometriosis. PMID:23167072

  15. Radical prostatectomy - discharge

    MedlinePLUS

    ... prostatectomy - discharge; Laparoscopic radical prostatectomy - discharge; LRP - discharge; Robotic-assisted laparoscopic prostatectomy - discharge ; RALP - discharge; Pelvic lymphadenectomy - ...

  16. Differential diagnosis of pelvic cystic lesions caused by hemorrhage from inflammatory abscess using CT attenuation in women with acute abdomen.

    PubMed

    Sato, Kazuko; Kajihara, Takeshi; Miki, Akinori; Hirabayashi, Eriko; Shintani, Daisuke; Niitsu, Mamoru; Ishihara, Osamu; Itakura, Atsuo

    2015-11-01

    To determine the efficacy of computed tomography (CT) attenuation of cystic lesions measured on an image browsing system to distinguish abscess from hematoma in women with acute abdomen. The medical records of female patients of reproductive age with acute abdomen who were treated over a 7-year period in a single center and who had undergone laparotomy or laparoscopic surgery and preoperative pelvic CT scanning were retrospectively analyzed to identify those with hematoma or abscess cyst formation. Nineteen patients with tubo-ovarian abscess (abscess group) and six patients with hematoma (hematoma group) formation in the pelvis were included in the analysis. The preoperative CT images of the tubo-ovarian cyst were retrospectively investigated on the basis of cyst attenuation. CT attenuation of the cyst measured by both two gynecologists could be used to clearly distinguish inflammatory disease with abscess formation from bleeding disease with hematoma. CT attenuation on a picture archiving and communication system can distinguish hematoma from abscess in women with acute abdomen. This may significantly contribute to making differential diagnosis without interpretation by a medical radiologist. PMID:26663935

  17. Differential diagnosis of pelvic cystic lesions caused by hemorrhage from inflammatory abscess using CT attenuation in women with acute abdomen

    PubMed Central

    Sato, Kazuko; Kajihara, Takeshi; Miki, Akinori; Hirabayashi, Eriko; Shintani, Daisuke; Niitsu, Mamoru; Ishihara, Osamu; Itakura, Atsuo

    2015-01-01

    ABSTRACT To determine the efficacy of computed tomography (CT) attenuation of cystic lesions measured on an image browsing system to distinguish abscess from hematoma in women with acute abdomen. The medical records of female patients of reproductive age with acute abdomen who were treated over a 7-year period in a single center and who had undergone laparotomy or laparoscopic surgery and preoperative pelvic CT scanning were retrospectively analyzed to identify those with hematoma or abscess cyst formation. Nineteen patients with tubo-ovarian abscess (abscess group) and six patients with hematoma (hematoma group) formation in the pelvis were included in the analysis. The preoperative CT images of the tubo-ovarian cyst were retrospectively investigated on the basis of cyst attenuation. CT attenuation of the cyst measured by both two gynecologists could be used to clearly distinguish inflammatory disease with abscess formation from bleeding disease with hematoma. CT attenuation on a picture archiving and communication system can distinguish hematoma from abscess in women with acute abdomen. This may significantly contribute to making differential diagnosis without interpretation by a medical radiologist.

  18. Solo Intracorporeal Esophagojejunostomy Reconstruction Using a Laparoscopic Scope Holder in Single-Port Laparoscopic Total Gastrectomy for Early Gastric Cancer

    PubMed Central

    Ahn, Sang-Hoon; Son, Sang-Yong; Jung, Do Hyun; Park, Young Suk; Shin, Dong Joon; Park, Do Joong

    2015-01-01

    Single-incision laparoscopic total gastrectomy for gastric cancer has recently been reported by Seoul National University Bundang Hospital. However, this is not a popular procedure primarily because of the technical difficulties involved in achieving consistent intracorporeal esophagojejunostomy. At Seoul National University Bundang Hospital, we recently introduced a simple, easy-to-use, low-profile laparoscopic manual scope holder that enables the maintenance of a stable field of view, the most demanding condition in single-port gastrectomy. In this technical report, we describe in detail the world's first solo single-incision laparoscopic total gastrectomy with D1+ lymph node dissection and intracorporeal esophagojejunostomy for proximal early gastric cancer. PMID:26161287

  19. Clinical anatomy of the knee.

    PubMed

    Saavedra, Miguel Ángel; Navarro-Zarza, José Eduardo; Villaseñor-Ovies, Pablo; Canoso, Juan J; Vargas, Angélica; Chiapas-Gasca, Karla; Hernández-Díaz, Cristina; Kalish, Robert A

    The clinical anatomy of several pain syndromes of the knee is herein discussed. These include the iliotibial tract syndrome, the anserine syndrome, bursitis of the medial collateral ligament, Baker's cyst, popliteus tendon tenosynovitis and bursitis of the deep infrapatellar bursa. These syndromes are reviewed in terms of the structures involved and their role in knee physiology. All of the discussed structures can be identified in their normal state and more so when they are affected by disease. The wealth of information gained by cross examination of the medial, lateral, posterior and anterior aspects of the knee brings to life knowledge acquired at the dissection table, from anatomical drawings and from virtual images. PMID:23219082

  20. Art, antiquarianism and early anatomy.

    PubMed

    Guest, Clare E L

    2014-12-01

    Discussions of the early relationship between art and anatomy are shaped by Vasari's account of Florentine artists who dissected bodies in order to understand the causes of movement, and the end of movement in action. This account eclipses the role of the study of antiquities in Renaissance anatomical illustration. Beyond techniques of presentation, such as sectioning and analytic illustration, or a preoccupation with the mutilated fragment, antiquarianism offered a reflection on the variant and the role of temperament which could be adapted for anatomical purposes. With its play on ambiguities of life and death, idealisation and damage, antiquarianism also provided a way of negotiating the difficulties of content inherent in anatomical illustration. As such, it goes beyond exclusively historical interest to provoke reflection on the modes, possibilities and humane responsibilities of medical illustration. PMID:24696510

  1. Laparoscopic Radiofrequency Thermal Ablation for Uterine Adenomyosis

    PubMed Central

    Pontrelli, Giovanni; Campana, Colette; Steinkasserer, Martin; Ercoli, Alfredo; Minelli, Luca; Bergamini, Valentino; Ceccaroni, Marcello

    2015-01-01

    Background and Objectives: Symptomatic uterine adenomyosis, unresponsive to medical therapy, is a challenging condition for patients who desire to preserve their uterus. This study was an evaluation of the feasibility and efficacy of laparoscopic radiofrequency thermal ablation of symptomatic nodular uterine adenomyosis. Methods: Fifteen women with symptomatic nodular adenomyosis, who had no plans for pregnancy but declined hysterectomy, underwent radiofrequency thermal ablation. Ultrasonography was performed at baseline and at postoperative follow-ups at 3, 6, 9, and 12 months. The impact of uterine adenomyosis–related symptoms was assessed according to the visual analog scale. Results: The median number of nodular lesions treated per patient was 1 (range, 1–2). The median baseline volume of the adenomyosis area was 60 cm3 (range, 18–128). The median reduction in volume was 32, 49.4, 59.6, and 65.4% at 3, 6, 9, and 12 months, respectively. A significant progressive improvement in the symptoms score was observed at the 4 follow-ups. Conclusion: In this study, laparoscopic radiofrequency thermal ablation reduced uterine adenomyosis–related symptoms and volume, with significant relief of symptoms.

  2. Laparoscopic Duodenojejunostomy for Superior Mesenteric Artery Syndrome

    PubMed Central

    St. Peter, Shawn D.; Hughes, Jenevieve H.; Swain, James M.

    2009-01-01

    Background: Superior mesenteric artery (SMA) syndrome, also called Wilkie's syndrome, is a rare clinical phenomenon believed to be caused by compression of the third portion of the duodenum by the overlying superior mesenteric artery. We present the case of a 32-year-old female who presented with epigastric pain, weight loss, and vomiting. Methods: Her workup included a normal upper endoscopy as well as an abdominal CT scan and upper GI contrast study that confirmed the diagnosis of superior mesenteric artery syndrome. The patient was taken to the operating room and underwent successful treatment with laparoscopic duodenojejunostomy. Results: The patient achieved complete relief of her symptoms and is able to eat a regular diet without difficulty. SMA syndrome is a real anatomic clinical pathology resulting in chronic, consistent obstructive symptoms. An upper GI series and CT scan with contrast can confirm the diagnosis. Conclusion: Laparoscopic duodenojejunostomy should be considered the treatment of choice for these patients, because it offers a high likelihood of excellent outcome based on the current literature. PMID:19660228

  3. International experience for laparoscopic major liver resection.

    PubMed

    Dagher, Ibrahim; Gayet, Brice; Tzanis, Dimitrios; Tranchart, Hadrien; Fuks, David; Soubrane, Olivier; Han, Ho-Seong; Kim, Ki-Hun; Cherqui, Daniel; O'Rourke, Nicholas; Troisi, Roberto I; Aldrighetti, Luca; Bjorn, Edwin; Abu Hilal, Mohammed; Belli, Giulio; Kaneko, Hironori; Jarnagin, William R; Lin, Charles; Pekolj, Juan; Buell, Joseph F; Wakabayashi, Go

    2014-10-01

    Although minor laparoscopic liver resections (LLRs) appear as standardized procedures, major LLRs are still limited to few expert teams. The aim of this study was to report the combined data of 18 international centers performing major LLR. Variables evaluated were number and type of LLR, surgical indications, number of synchronous colorectal resections, details on technical points, conversion rates, operative time, blood loss and surgical margins. From 1996 to 2014, a total of 5388 LLR were carried out including 1184 major LLRs. The most frequent indication for laparoscopic right hepatectomy (LRH) was colorectal liver metastases (37.0%). Seven centers used hand assistance or hybrid approach selectively for LRH mostly at the beginning of their experience. Seven centers apply Pringle's maneuver routinely. The conversion rate for all major LLRs was 10% and mean operative time was 291?min. Mean estimated blood loss for all major LLR was 327?ml and negative surgical margin rate was 96.5%. Major LLRs still remain challenging procedures requiring important experience in both laparoscopy and liver surgery. Stimulating the younger generation to learn and accomplish these techniques is the better way to guarantee further development of this surgical field. PMID:25098667

  4. Modelling the pelvic floor for investigating difficulties during childbirth

    NASA Astrophysics Data System (ADS)

    Li, Xinshan; Kruger, Jennifer A.; Chung, Jae-Hoon; Nash, Martyn P.; Nielsen, Poul M. F.

    2008-03-01

    Research has suggested that athletes involved in high-intensity sports for sustained periods have a higher probability of experiencing prolonged second stage of labour compared to non-athletes. The mechanism responsible for this complication is unknown but may depend on the relative size or tone of the pelvic floor muscles. Prolonged training can result in enlargement and stiffening of these muscles, providing increased resistance as the fetal head descends through the birth canal during a vaginal birth. On the other hand, recent studies have suggested an association between increased muscle bulk in athletes and higher distensibility. This project aims to use mathematical modelling to study the relationship between the size and tone of the pelvic floor muscles and the level of difficulty during childbirth. We obtained sets of magnetic resonance (MR) images of the pelvic floor region for a female athlete and a female non-athlete. Thirteen components of the pelvic floor were segmented and used to generate finite element (FE) models. The fetal head data was obtained by laser scanning a skull replica and a FE model was fitted to these data. We used contact mechanics to simulate the motion of the fetal head moving through the pelvic floor, constructed from the non-athlete data. A maximum stretch ratio of 3.2 was induced in the muscle at the left lateral attachment point to the pubis. We plan to further improve our modelling framework to include active muscle contraction and fetal head rotations in order to address the hypotheses that there is a correlation between the level of difficulty and the size or tone of the pelvic floor muscles.

  5. Pelvic Actinomyces israelii abscess: a differential diagnosis of a pelvic mass.

    PubMed

    Dhillon, Ajit Kaur; Fairlie, Neil; Finch, Guy

    2015-01-01

    A 52-year-old woman was admitted to our district general hospital, with a rapidly growing, increasingly tender mass in the right iliac fossa, difficulty mobilising with a fixed flexion deformity of the right hip and 15?kg weight loss in 5?months. Her 8-month long surgical history for investigation of a pelvic mass stemmed from the removal of an intrauterine device. It included radiological and surgical investigations. We report the second case in the literature, of a patient presenting with abdominal wall abscess, psoas abscess and hydronephrosis as a long-term complication of Actinomyces israelii infection of the ipsilateral ovary with a favourable outcome having excluded ovarian malignancy. PMID:26607184

  6. Laparoscopic vs open abdominoperineal resection in the multimodality management of low rectal cancers

    PubMed Central

    Wang, Yu-Wei; Huang, Li-Yong; Song, Cheng-Li; Zhuo, Chang-Hua; Shi, De-Bing; Cai, Guo-Xiang; Xu, Ye; Cai, San-Jun; Li, Xin-Xiang

    2015-01-01

    AIM: To evaluate the safety and feasibility of laparoscopic abdominoperineal resection compared with the open procedure in multimodality management of rectal cancer. METHODS: A total of 106 rectal cancer patients who underwent open abdominoperineal resection (OAPR) were matched with 106 patients who underwent laparoscopic abdominoperineal resection (LAPR) in a 1 to 1 fashion, between 2009 and 2013 at Fudan University Shanghai Cancer Center. Propensity score matching was carried out based on age, gender, pathological staging of the disease and administration of neoadjuvant chemoradiation. Data regarding preoperative staging, surgical technique, pathological results, postoperative recovery and complications were reviewed and compared between the LAPR and OAPR groups. Perineal closure around the stoma and pelvic floor reconstruction were performed only in OAPR, not in LAPR. Therefore, abdominoperineal resection procedure-specific surgical complications including parastomal hernia and perineal wound complications were compared between the open and laparoscopic procedure. Regular surveillance of the two cohorts was carried out to gather prognostic data. Disease-free survival was analyzed using Kaplan-Meier estimate and log-rank test. Subgroup analysis was performed in patients with locally advanced disease treated with preoperative chemoradiation followed by surgical resection. RESULTS: No significant difference was found between the LAPR group and the OAPR group in terms of clinicopathological features. The operation time (180.8 ± 47.8 min vs 172.1 ± 49.2 min, P = 0.190), operative blood loss (93.9 ± 60.0 mL vs 88.4 ± 55.2 mL, P = 0.494), total number of retrieved lymph nodes (12.9 ± 6.9 vs 12.9 ± 5.4, P = 0.974), surgical complications (12.3% vs 15.1%, P = 0.549) and pathological characteristics were comparable between the LAPR and OAPR group, respectively. Compared with OAPR patients, LAPR patients showed significantly shorter postoperative analgesia (2.4 ± 0.7 d vs 2.7 ± 0.6 d, P < 0.001), earlier first flatus (57.3 ± 7.9 h vs 63.5 ± 9.2 h, P < 0.001), shorter urinary drainage time (6.5 ± 3.4 d vs 7.8 ± 1.3 d, P < 0.001), and shorter postoperative admission (11.2 ± 4.7 d vs 12.6 ± 4.0 d, P = 0.014). With regard to APR-specific complications (perineal wound complications and parastomal hernia), there were no significant differences between the two groups. Similar results were found in the 26 pairs of patients administered neoadjuvant chemoradiation in subgroup analysis. During the follow-up period, no port site recurrences were observed. CONCLUSION: Laparoscopic abdominoperineal resection for multidisciplinary management of rectal cancer is safe, and is associated with earlier recovery and shorter admission time in combination with neoadjuvant chemoradiation. PMID:26401082

  7. Delayed complication of pelvic lymphocele: Ileal conduit obstruction

    PubMed Central

    Bankar, Sanket S.; Bakshi, Ganesh K.; Prakash, Gagan; Sable, Nilesh P.

    2015-01-01

    Radical cystectomy is the standard treatment for muscle invasive bladder cancer. Lymphocele is a common sequalae of pelvic lymphadenectomy. We report an unusual presentation of pelvic lymphocele developing after radical cystectomy reconstructed with an ileal conduit where the patient developed obstruction of the ileal conduit loop due to external pressure of the lymphocele. Catheter drainage of the conduit relieved the symptoms and a computerized tomography scan showed a large lymphocele causing acute angulation and resultant obstruction of the ileal conduit. The patient was treated with percutaneous drainage of the lymphocele and remains symptom-free on follow-up at 1 year. PMID:26166973

  8. Delayed complication of pelvic lymphocele: Ileal conduit obstruction.

    PubMed

    Bankar, Sanket S; Bakshi, Ganesh K; Prakash, Gagan; Sable, Nilesh P

    2015-01-01

    Radical cystectomy is the standard treatment for muscle invasive bladder cancer. Lymphocele is a common sequalae of pelvic lymphadenectomy. We report an unusual presentation of pelvic lymphocele developing after radical cystectomy reconstructed with an ileal conduit where the patient developed obstruction of the ileal conduit loop due to external pressure of the lymphocele. Catheter drainage of the conduit relieved the symptoms and a computerized tomography scan showed a large lymphocele causing acute angulation and resultant obstruction of the ileal conduit. The patient was treated with percutaneous drainage of the lymphocele and remains symptom-free on follow-up at 1 year. PMID:26166973

  9. Age-related Changes in Maximum Pelvic Anteversion and Retroversion Angles Measured in the Sitting Position

    PubMed Central

    Asai, Hitoshi; Tsuchiyama, Hiroyuki; Hatakeyama, Tomoyuki; Inaoka, Pleiades Tiharu; Murata, Kanichirou

    2014-01-01

    [Purpose] The purpose of this study was to investigate the relationship between age and the maximum pelvic anteversion and retroversion angles, as well as the associated pelvic range of motion, measured in a sitting position with free knee movement. [Subjects] A total of 132 healthy volunteers (74 women, 58 men; age range, 20–79 years) were divided into six groups based on age (20–29, 30–39, 40–49, 50–59, 60–69, and 70–79 years). [Methods] The maximum pelvic anteversion and retroversion angles were measured manually five times by a goniometer in a sitting position that allowed free movement of the knee joints. [Results] There was a significant effect of age group on the maximum pelvic anteversion and retroversion angles and pelvic range of motion (the difference between these angles). There was a significant correlation between age and the maximum pelvic anteversion angle, maximum pelvic retroversion angle, and pelvic range of motion. [Conclusion] The maximum pelvic anteversion and retroversion angles and pelvic range of motion were significantly correlated with age. The maximum pelvic anteversion angle and pelvic range of motion were most affected by age. PMID:25540507

  10. Parasitic myoma after laparoscopic surgery: a mini-review

    PubMed Central

    Erenel, Hakan; Temizkan, Osman; Mathyk, Begüm Aydo?an; Karata?, Suat

    2015-01-01

    The aim of this review is to summarize the cases of parasitic myomas after laparoscopic surgery. A literature search was performed using the PubMed database for the period of January 1997 to December 2014. We used the following keywords: “laparoscopic hysterectomy,” “laparoscopic myomectomy,” “morcellation,” “parasitic fibroids,” “parasitic myomas,” and “leiomyomatosis.” A total of 29 articles meeting the selection criteria were included in our review, describing 53 patients who underwent surgery for parasitic myomas. Parasitic myoma is a rare condition resulting from the small fibroid fragments left after morcellation and can be either asymptomatic or symptomatic. Although it is rare, patients should be informed about the risk of this condition after laparoscopic surgery. It is important for surgeons to look for small fibroid fragments during and after morcellation and make an effort to remove every piece of tissue. PMID:26401114

  11. Robotic-assisted laparoscopic adrenalectomy for an adrenal adenoma

    PubMed Central

    Deniwar, Ahmed; Mohamed, Hossam Eldin; Noureldine, Salem I.

    2015-01-01

    The patient was referred for management of a left adrenal incidentaloma. Preoperative CT scan and MRI showed focal calcification. Here we are presenting this video demonstrating robotic-assisted laparoscopic adrenalectomy for left adrenal mass. PMID:26425459

  12. Transumbilical pure single-port laparoscopic donor nephrectomy

    PubMed Central

    Kim, Joo Mee; Jeong, Won Jun; Choi, Byung Jo; Yuk, Seung Mo; Hwang, Jeong Kye

    2015-01-01

    Transumbilical single-port laparoscopic donor nephrectomy (SPLDN) is a novel, rapidly evolving, minimally invasive treatment modality for kidney transplantation. This method causes minimal parietal injury, has cosmetic advantages, and allows rapid recovery because of low postoperative pain and short hospital stay. Like other abdominal surgeries, when conducted by experienced laparoscopic surgeons, it can meet the same graft requirements as conventional laparoscopic surgery. Here, we report the first two cases of transumbilical SPLDN at Daejeon St. Mary's Hospital, The Catholic University of Korea. We used the umbilicus as a common path for laparoscopic procedures and as a route for specimen retrieval. The operating times were 230 and 265 minutes in cases 1 and 2, respectively. No intra- or postoperative complications were noted. In case 1, the wound length was 4 cm and duration of hospitalization was 2 days. In case 2, the wound length was only 2.5 cm, and the duration of hospitalization was only 1 day. PMID:26576409

  13. Laparoscopic gastric surgery for cancer: Where do we stand?

    PubMed Central

    Antonakis, Pantelis T; Ashrafian, Hutan; Isla, Alberto Martinez

    2014-01-01

    Gastric cancer poses a significant public health problem, especially in the Far East, due to its high incidence in these areas. Surgical treatment and guidelines have been markedly different in the West, but nowadays this debate is apparently coming to an end. Laparoscopic surgery has been employed in the surgical treatment of gastric cancer for two decades now, but with controversies about the extent of resection and lymphadenectomy. Despite these difficulties, the apparent advantages of the laparoscopic approach helped its implementation in early stage and distal gastric cancer, with an increase on the uptake for distal gastrectomy for more advanced disease and total gastrectomy. Nevertheless, there is no conclusive evidence about the laparoscopic approach yet. In this review article we present and analyse the current status of laparoscopic surgery in the treatment of gastric cancer. PMID:25339815

  14. Laparoscopic approach for inflammatory bowel disease surgical managment.

    PubMed

    Maggiori, Léon; Panis, Yves

    2012-01-01

    For IBD surgical management, laparoscopic approach offers several theoretical advantages over the open approach. However, the frequent presence of adhesions from previous surgery and the high rate of inflammatory lesions have initially questioned its feasibility and safety. In the present review article, we will discuss the role of laparoscopic approach for IBD surgical management, along with its potential benefits as compared to the open approach. PMID:23373362

  15. Understanding Colds: Anatomy of the Nose

    MedlinePLUS

    ... Colds Prevention Treatment Children Complications Special Features References Common Cold Understanding Colds Anatomy of the Nose The nose ... cm (3/8 inch) per minute. What a Common Cold Is A common cold is an illness caused ...

  16. Distinguished The Anatomy of A Disaster

    E-print Network

    Aydilek, Ahmet

    Distinguished 2006 Series The Anatomy of A Disaster ED LINK Wednesday, May 10, 2006 12:00 PM - 1 generated by Katrina? What are the lessons learned for building back a more resilient and reliant hurricane

  17. Molecular Cell Biology Cell Biology and Anatomy ----------------------------------------------------------------------------

    E-print Network

    Miyashita, Yasushi

    Molecular Cell Biology A G C T 14 Cell Biology and Anatomy associated proteins (MAPs) using molecular cell biology, biophysics, structural biology, and molecular genetics. ·Molecular cell biological study of KIFs ·Studies of the mechanism for recognition of and binding

  18. Comparison of transumbilical single-port laparoscopic cholecystectomy and fourth-port laparoscopic cholecystectomy

    PubMed Central

    Ye, Guanxiong; Qin, Yong; Xu, Shengqian; Wu, Chengjun; Wang, Shi; Pan, Debiao; Wang, Xinmei

    2015-01-01

    This work aims to compare the curative effect of transumbilical single-port laparoscopic cholecystectomy (TUSPLC) and four-port laparoscopic cholecystectomy (FPLC). 200 patients with cholecystolithiasis were enrolled in this study. They were randomly divided into TUSPLC group and FPLC group, 100 cases in each group, and the TUSPLC and FPLC was performed, respectively. The surgical time, intraoperative complication, conversions rate, postoperative pain, postoperative analgesic drug use, incision infection, postoperative hospitalization time and postoperative cosmetic results in two groups were compared. The total conversion rate, conversion rate with Nassar grade II, and conversion rate with Nassar grade III in TUSPLC group were significantly higher than FPLC group (P < 0.01), and the incision cosmetic result after 1 month in TUSPLC group was obviously better than FPLC group (P < 0.01), but the surgical time in TUSPLC group was significantly longer than FPLC group (P < 0.01). There was no significant difference of incision infection, intraoperative complication, and postoperative hospitalization time, incision pain in postoperative first and second day, postoperative use of analgesia drug and incision cosmetic result on discharge day between two groups (P > 0.05). TUSPLC has obvious advantage in treatment of Nassar grade I patients with cholecystolithiasis. It can be used as a supplement for standard laparoscopic gallbladder surgery. It is safe and feasible, without abdominal scar, thus achieving to excellent cosmetic result and high satisfaction in patients. PMID:26221325

  19. Structuralized box-trainer laparoscopic training significantly improves performance in complex virtual reality laparoscopic tasks

    PubMed Central

    Stefaniak, Tomasz J.; Makarewicz, Wojciech; Proczko, Monika; Gruca, Zbigniew; ?ledzi?ski, Zbigniew

    2011-01-01

    Introduction In the era of flowering minimally invasive surgical techniques there is a need for new methods of teaching surgery and supervision of progress in skills and expertise. Virtual and physical box-trainers seem especially fit for this purpose, and allow for improvement of proficiency required in laparoscopic surgery. Material and methods The study included 34 students who completed the authors‘ laparoscopic training on physical train-boxes. Progress was monitored by accomplishment of 3 exercises: moving pellets from one place to another, excising and clipping. Analysed parameters included time needed to complete the exercise and right and left hand movement tracks. Students were asked to do assigned tasks prior to, in the middle and after the training. Results The duration of the course was 28 h in total. Significant shortening of the time to perform each exercise and reduction of the left hand track were achieved. The right hand track was shortened only in exercise number 1. Conclusions Exercises in the laboratory setting should be regarded as an important element of the process of skills acquisition by a young surgeon. Virtual reality laparoscopic training seems to be a new, interesting educational tool, and at the same time allows for reliable control and assessment of progress. PMID:23255997

  20. A Warm-up Laparoscopic Exercise Improves the Subsequent Laparoscopic Performance of Ob-Gyn Residents: a Low-Cost Laparoscopic Trainer

    PubMed Central

    Do, Ann T.; Kerr, Angela; Serur, Eli; Robertazzi, Robert R.; Stankovic, Miljan R.

    2006-01-01

    Introduction: Residents traditionally acquire surgical skills through on-the-job training. Minimally invasive laparoscopic techniques present additional demands to master complex surgical procedures in a remote 2-dimensional venue. We examined the effectiveness of a brief warm-up laparoscopic simulation toward improving operative proficiency. Methods: Using a “Poor-Man's Laparoscopy Simulator,” 12 Ob/Gyn residents and 12 medical students were allocated 10 minutes to transfer 30 tablets with a 5-mm grasper from point A to point B via laparoscopic visualization in a warm-up exercise. Participants repeated the exercise following a 5-minute pause. Mean scores, expressed in seconds/tablet, and overall improvement (percentage difference between warm-up and follow-up) were analyzed according to postgraduate standing (PGY1-4), dexterity skills, and pertinent vocational activities. Results: Significant improvements were noted for both residents (+25%) and medical students (+29%), P<0.0001. Scores between the 2 groups, however, were not significant (P=0.677). Proficiency was not influenced by PGY standing. Interestingly, the best (8.73 sec/pill) and the worst (25 sec/pill) scores were attained by a medical student and a chief resident, respectively, suggesting the contribution of individual aptitude. Conclusion: A brief warm-up exercise before an actual laparoscopic surgical procedure significantly improves subsequent laparoscopic performance. PMID:17212883

  1. Laparoscopic extraperitoneal para-aortic lymphadenectomy

    PubMed Central

    Iserte, Pablo Padilla; Minig, Lucas; Zorrero, Cristina

    2015-01-01

    Lymph nodes are the main pathway in the spread of gynaecological malignancies, being a well-known prognostic factor. Lymph node dissection is a complex surgical procedure and requires surgical expertise to perform the procedure, thereby minimising complications. In addition, lymphadenectomy has value in the diagnosis, prognosis, and treatment of patients with gynaecologic cancer. Therefore, a video focused on the para-aortic retroperitoneal anatomy and the surgical technique of the extraperitoneal para-aortic lymphadenectomy is presented. PMID:26435746

  2. Safety and effectiveness of three-port laparoscopic cholecystectomy

    PubMed Central

    Mayir, Burhan; Dogan, Ugur; Koc, Umit; Aslaner, Arif; B?lec?k, Tuna; Ensar?, Cemal Ozben; Cakir, Tugrul; Oruc, Mehmet Tahir

    2014-01-01

    Most commonly performed laparoscopic surgery is laparoscopic cholecystectomy. Although cholecystectomy through three port is not commonly preferred, researches have shown that it is a safe and feasible way of surgery. Material and Methods. We evaluate 100 patient that have undergone elective laparoscopic cholecystectomy through three port (group one). These patients were compared with 50 patients that have undergone laparoscopic cholecystectomy through four port (group two). Complications, lenght of stay in hospital, operation time, conversion to open surgery rate were compared in two group. Results: In group one, fourth port was necessary for nine (9%) patients. Duration of operation in group one was in average 31 min and in group two, 31, 3 min. Operation time, lenght of stay in hospital, complication rate, conversion to open surgery rate was similar in both groups. Conclusion: Three port laparoscopic cholecystectomy is a safer method when performed by experienced surgeons. Laparoscopic cholecyctectomy can be tried through three ports firstly and can be continued with addition of fourth port if necessary. PMID:25232432

  3. Laparoscopic Appendectomy Performed by Residents and Experienced Surgeons

    PubMed Central

    Bernini, Marco; Martini, Francesco; Rossi, Michele; Tommasi, Cinzia; Miranda, Egidio; Sanchez, Luis Josè; Naspetti, Riccardo; Manetti, Roberto; Ferrara, Angelo; Nesi, Silvia; Boffi, Bernardo; Farsi, Marco; Moretti, Renato

    2009-01-01

    Background: Laparoscopic appendectomy is widely performed by surgical residents, but its changing indications and outcomes have been poorly investigated. The aim of this study was to examine whether a difference exists in indications and outcomes between laparoscopic appendectomies performed by residents and those performed by experienced surgeons. Methods: Between 1999 and 2007, 218 laparoscopic appendectomies were performed and recorded. Data were analyzed to compare operations performed by residents with those by experienced surgeons in terms of indications for surgery and severity of disease. Moreover, laparoscopic appendectomies were thoroughly compared regarding outcomes and complications. Results: The residents had fewer conversions with laparoscopic appendectomy (8% vs 17%, P=0.04), and similar complication rates (12% vs 13%, P=0.16), compared with experienced surgeons. The median operating time was also comparable (67 minutes vs 60 minutes, P=0.23). However, patients operated on by residents had more emergencies (86% vs 70%, P=0.009), included more foreigners (27% vs 15%, P=0.03), and had intermediate to severe diseases, (81 vs 52%, P<0.001) than patients did operated on by experienced surgeons. Conclusions: Surgical residents performed more emergency laparoscopic appendectomies on foreign patients suffering from intermediate to severe diseases compared with experienced surgeons, with comparable surgical outcomes and lower conversion rates. PMID:19793482

  4. Fascial Repair of Laparoscopic Ports with Allis-Hemostat Technique.

    PubMed

    Tavassoli, Alireza; Bagheri, Reza; Feizzadeh, Behzad; Tavassoli, Fatemeh; Barekati, Neusha

    2015-12-01

    Port site hernias are one of the most serious complications associated with laparoscopic surgery. In this study, we present a simple and reliable method for port site closure in laparoscopic surgery. From 2005 to 2011, 500 patients who underwent laparoscopic surgery were enrolled for the study. They were evaluated considering age, sex, indication of laparoscopic surgery, and early and late complications of port site and were followed up at least for 1 year after the surgery. In our study, 180 males and 320 females with mean age of 36 years were enrolled. The most common indication for laparoscopic surgery was cholecystectomy in 320 patients (64 %). There were no early or late complications of port site after surgery. Our method is a new modification of the procedure presented by Spalding. Using Allis forceps and putting it under the fascia seems to be a more suitable technique which facilitates the laparoscopic port repair. We found it to be extremely safe, simple, and easy to teach. PMID:26730002

  5. Laparoscopic ischemic conditioning of the stomach prior to esophagectomy.

    PubMed

    Yetasook, A K; Leung, D; Howington, J A; Talamonti, M S; Zhao, J; Carbray, J M; Ujiki, M B

    2013-07-01

    Several complications after esophagectomy with gastric pull-up are associated with ischemia within the gastric conduit. The aim of this study is to assess the feasibility of laparoscopic ischemic preconditioning of the stomach prior to thoracotomy, esophagectomy, and gastric pull-up with an intrathoracic anastomosis. A retrospective review of 24 consecutive patients between October 2008 and July 2011 with esophageal adenocarcinoma (stage I-III) undergoing laparoscopic gastric ischemic conditioning prior to esophagectomy was conducted. Conditioning included laparoscopic ligation of the left and short gastric arteries, celiac node dissection, and jejunostomy tube placement. Formal resection and reconstruction was then performed 4-10 days later. Of the 24 patients, 88% received neoadjuvant chemotherapy/radiation therapy. Twenty-three of the 24 patients underwent successful laparoscopic ischemic conditioning and subsequent esophagectomy. Total mean number of lymph nodes harvested was 21.8 (±8.0), and a mean of 5.3 (±2.4) celiac lymph nodes identified. There were no conversions to an open procedure. Length of stay was 3.8 (±4.8) days with a median length of stay of 2 (1-24) days. Three patients experienced anastomotic leak, six patients experience delayed gastric emptying, and two patients developed anastomotic stricture. There were no surgical site infections. R0 resection was achieved in all patients who underwent laparoscopic ischemic conditioning followed by esophagectomy. Laparoscopic ischemic conditioning of the gastric conduit has been shown to be feasible and safe. PMID:22816598

  6. The sagittal anatomy of the sacrum among young adults, infants, and spondylolisthesis patients.

    PubMed

    Marty, C; Boisaubert, B; Descamps, H; Montigny, J P; Hecquet, J; Legaye, J; Duval-Beaupère, G

    2002-04-01

    The anatomic pelvic parameter "incidence" - the angle between the line perpendicular to the middle of the sacral plate and the line joining the middle of the sacral plate to the center of the bicoxo-femoral axis - has been shown to be strongly correlated with the sacral slope and lumbar lordosis, and ensures the individual an economical standing position. It is important for determining the sagittal curve of the spine. The angle of incidence has also been shown to depend partly on the sagittal anatomy of sacrum, which is established in childhood while learning to stand and walk. The purpose of this study was (1) to define the relationship between the sacrum and the angle of incidence, and (2) to compare these parameters in three populations: young adults, infants before walking, and patients with spondylolisthesis. Forty-four normal young adults, 32 infants not yet walking and 39 patients with spondylolisthesis due to isthmic spondylolysis underwent a sagittal full-spine radiography. A graphic table and the software for bidimensional study of the sacrum developed by J. Hecquet were used to determine various anatomic and positional parameters. Comparison tests of means, and multiple and partial correlation tests were used. A study of the reliability of the measurements using factorial plan methods was performed. The sagittal anatomic parameters of the sacrum were found to have a close relationship with the pelvic parameter of incidence angle, and therefore with the sagittal balance of the spine. The anatomy of the sacrum in spondylolisthesis patients is particular in that some features are much like those of young infants, but it is more curved and the incidence angle is significantly larger. There is a close relationship between angle of incidence and the slip of spondylolisthesis. All the parameters of young infants are significantly smaller than those of adults. It can be concluded that the sagittal anatomy of the sacrum plays a key role in spinal sagittal balance. The sacral bone is an integral a part of the pelvis and constitutes the undistorted part of the spinal curves. Organization of sagittal curves during growth can be followed up by looking at the sacrum. The sacrum in the spondylolisthesis group differs from the normal, and the greater angle of incidence and sacral slope in this group could predispose to vertebral slip. PMID:11956917

  7. Clinical significance of single-port laparoscopic splenectomy: comparison of single-port and multiport laparoscopic procedure

    PubMed Central

    Han, Eui Soo; Kim, Dong Goo; Lee, Jun Suh; Kim, Eun Young; Lee, Soo Ho; Hong, Tae Ho; Na, Gun Hyung

    2015-01-01

    Purpose Single-port laparoscopic splenectomy has been performed sporadically. The aim of this study is to assess our experience with single-port laparoscopic splenectomy compared to conventional multiport laparoscopic surgery for the usual treatment modality for various kinds of splenic disease. Methods Between October 2008 to February 2014, 29 patients underwent single-port laparoscopic splenectomy and 32 patients received multiport laparoscopic splenectomy. We retrospectively analyzed the clinical outcomes of single-port group and multiport group. Results The body mass index and disease profiles of the both groups were similar. The operative times of single-port and multiport group were 113.6 ± 39.9 and 95.9 ± 38.9 minutes, respectively (P = 0.946). The operative blood loss of the two groups were 295.8 ± 301.3 and 322.5 ± 254.5 mL (P = 0.582). Postoperative retrieved splenic weight of the single-port and multiport groups were 283.9 ± 300.7 and 362.3 ± 471.8 g, respectively (P = 0.261). One single-port partial splenectomy and 6 multiport partial splenectomies were performed in this study. There was one intraoperative gastric wall injury. It occurred in single-port group, which was successfully managed during the operation. Each case was converted to laparotomy in both groups due to bleeding. There was one mortality case in the multiport laparoscopic splenectomy group, which was not related to the splenectomy. Mean hospital stay of the single-port and multiport group was 5.8 ± 2.5 and 7.3 ± 5.2 days respectively (P = 0.140). Conclusion Single-port laparoscopic splenectomy seems to be a feasible approach for various kinds of splenic disease compared to multiport laparoscopic surgery. PMID:26236693

  8. 42 CFR 410.56 - Screening pelvic examinations.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... screening pelvic examination (including a clinical breast examination) if it is performed by a doctor of... of her medical history or other findings) of developing cervical cancer or vaginal cancer, as determined in accordance with the following risk factors: (i) High risk factors for cervical cancer:...

  9. 42 CFR 410.56 - Screening pelvic examinations.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... screening pelvic examination (including a clinical breast examination) if it is performed by a doctor of... of her medical history or other findings) of developing cervical cancer or vaginal cancer, as determined in accordance with the following risk factors: (i) High risk factors for cervical cancer:...

  10. 42 CFR 410.56 - Screening pelvic examinations.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... screening pelvic examination (including a clinical breast examination) if it is performed by a doctor of... of her medical history or other findings) of developing cervical cancer or vaginal cancer, as determined in accordance with the following risk factors: (i) High risk factors for cervical cancer:...

  11. Adaptive Evolution of Pelvic Reduction in Sticklebacks by Recurrent Deletion

    E-print Network

    Chan, Yingguang

    ). Threespine stickleback fish (Gasterosteus aculeatus) make it possible to analyze the evo- lution, genetics that extends along the ventral and lateral sides of the fish (inspiring the scien- tific name Gasterosteus aculeatus, or bony stom- ach with spines). Although most sticklebacks develop a robust pelvic apparatus

  12. Ilioinguinal approach to manage benign pelvic and acetabular tumors.

    PubMed

    Mott, M P; Meehan, R E; Zhu, H

    2001-07-01

    Benign osteoblastic and cystic lesions involving the anterior column and wall of the pelvis and acetabulum are technically difficult areas to approach and achieve successful surgical outcomes. Tumors in this area are rare, leaving little information in the literature regarding how best to surgically approach them. Previous authors have reported small series of patients treated using anteromedial, iliofemoral, and intracapsular dissections. The ilioinguinal approach has been extensively described and used in the modern-day treatment of pelvic and acetabular fractures involving the anterior column and wall. Despite its use for acetabular trauma, application of the ilioinguinal approach in the treatment of benign pelvic and acetabular lesions has not been described. We reviewed the management of 5 patients with benign pelvic or acetabular tumors treated using the ilioinguinal approach. Diagnoses included aneurysmal bone cysts in 3 patients and osteoid osteomas in 2 patients, involving the pelvic anterior column and wall. The approach has permitted satisfactory exposure of the lesions for operative treatment. At an average follow-up of 3 years (range, 2-4 years), excellent functional outcome and no recurrences were noted. There were 2 patients with lateral femoral cutaneous nerve palsies, both of which resolved completely by 8 weeks. Encouraging results from our study demonstrate a new application for the ilioinguinal approach in the treatment of benign anterior column and wall lesions of the pelvis and acetabulum. PMID:11482510

  13. Medical Treatments for Endometriosis-Associated Pelvic Pain

    PubMed Central

    Luppi, Stefania; Ricci, Giuseppe

    2014-01-01

    The main sequelae of endometriosis are represented by infertility and chronic pelvic pain. Chronic pelvic pain causes disability and distress with a very high economic impact. In the last decades, an impressive amount of pharmacological agents have been tested for the treatment of endometriosis-associated pelvic pain. However, only a few of these have been introduced into clinical practice. Following the results of the controlled studies available, to date, the first-line treatment for endometriosis associated pain is still represented by oral contraceptives used continuously. Progestins represent an acceptable alternative. In women with rectovaginal lesions or colorectal endometriosis, norethisterone acetate at low dosage should be preferred. GnRH analogues may be used as second-line treatment, but significant side effects should be taken into account. Nonsteroidal anti-inflammatory drugs are widely used, but there is inconclusive evidence for their efficacy in relieving endometriosis-associated pelvic pain. Other agents such as GnRH antagonist, aromatase inhibitors, immunomodulators, selective progesterone receptor modulators, and histone deacetylase inhibitors seem to be very promising, but there is not enough evidence to support their introduction into routine clinical practice. Some other agents, such as peroxisome proliferator activated receptors-? ligands, antiangiogenic agents, and melatonin have been proven to be efficacious in animal studies, but they have not yet been tested in clinical studies. PMID:25165691

  14. Late complication of laparoscopic sleeve gastrectomy.

    PubMed

    Dakwar, Anthony; Assalia, Ahmad; Khamaysi, Iyad; Kluger, Yoram; Mahajna, Ahmad

    2013-01-01

    Laparoscopic sleeve gastrectomy (LSG) is gaining popularity for the treatment of morbid obesity. It is a simple, low-cost procedure resulting in significant weight loss within a short period of time. LSG is a safe procedure with a low complication rate. The complications encountered nevertheless can result in morbidity and even mortality. The most significant complications are staple-line bleeding, stricture, and staple-line leak. The purpose of this paper is to present a patient who suffered from a staple-line leak presenting 16 months after LSG. Review of the current literature regarding this complication as well as outline of a strategy for the management of post-LSG gastric leaks is suggested. PMID:23662218

  15. Late Complication of Laparoscopic Sleeve Gastrectomy

    PubMed Central

    Assalia, Ahmad; Kluger, Yoram

    2013-01-01

    Laparoscopic sleeve gastrectomy (LSG) is gaining popularity for the treatment of morbid obesity. It is a simple, low-cost procedure resulting in significant weight loss within a short period of time. LSG is a safe procedure with a low complication rate. The complications encountered nevertheless can result in morbidity and even mortality. The most significant complications are staple-line bleeding, stricture, and staple-line leak. The purpose of this paper is to present a patient who suffered from a staple-line leak presenting 16 months after LSG. Review of the current literature regarding this complication as well as outline of a strategy for the management of post-LSG gastric leaks is suggested. PMID:23662218

  16. Pelvic skeleton reduction and Pitx1 expression in threespine stickleback populations.

    PubMed

    Bell, Michael A; Ellis, Kaitlyn E; Sirotkin, Howard I

    2007-01-01

    The pelvic skeleton of threespine stickleback fish contributes to defence against predatory vertebrates, but rare populations exhibit vestigial pelvic phenotypes. Low ionic strength water and absence of predatory fishes are associated with reduction of the pelvic skeleton, and lack of Pitx1 expression in the pelvic region is evidently the genetic basis for pelvic reduction in several populations. Pelvic vestiges in most populations are larger on the left (left-biased), apparently because Pitx2 is expressed only on that side. We used whole-mount in situ hybridization to study Pitx1 expression in 19 populations of Gasterosteus aculeatus from lakes around Cook Inlet, Alaska, USA. As expected, specimens from six populations with full pelvic structures usually expressed Pitx1 in the limb bud; those from eight populations with left-biased pelvic reduction usually did not express it. Specimens from one of three populations with right-biased or unbiased pelvic reduction sometimes expressed Pitx1. One of two populations in which the pelvic spines (but not the girdle) are usually absent often expressed Pitx1. In terms of Jacob's 1977 'tinkering' metaphor, Pitx1 was the spare part with which natural selection usually tinkered for stickleback pelvic reduction, but it also tinkered with other genes that have smaller effects. PMID:17710856

  17. Pressure Ulcer-Related Pelvic Osteomyelitis: A Neglected Disease?

    PubMed

    Bodavula, Phani; Liang, Stephen Y; Wu, Jiami; VanTassell, Paige; Marschall, Jonas

    2015-09-01

    Background. ?Decubitus ulcers can become complicated by pelvic osteomyelitis. Little is known about the epidemiology of pressure ulcer-related pelvic osteomyelitis. Methods. ?We performed a retrospective cohort study of adult patients with pressure ulcer and pelvic osteomyelitis admitted to an academic center from 2006 to 2011. Data on clinical presentation, diagnostic evaluation, and treatment during the index admission were collected. Outcome measures included length of hospital stay and number of readmissions in the subsequent year. Results. ?Two hundred twenty patients were included: 163 (74%) were para/quadriplegic and 148 (67%) were male (148; 67%). Mean age was 50 (±18) years. Pelvic osteomyelitis was the primary admission diagnosis for 117 (53%). Fifty-six (26%) patients had concurrent febrile urinary tract infection. Wound cultures collected for 113 patients (51%) were notable for methicillin-resistant Staphylococcus aureus (37; 33%), Streptococci (19; 17%), and Pseudomonas spp (20; 18%). Plain films were obtained in 89 (40%) patients, computed tomography scans were obtained for 81 (37%) patients, and magnetic resonance images were obtained for 40 (18%) patients. Most patients received osteomyelitis-directed antibiotics (153; 70%), 134 of 153 (88%) of which were scheduled to receive ?6 weeks of treatment. Fifty-five (25%) patients underwent surgery during the index admission; 48 (22%) patients received a combined medical-surgical approach. One third of patients had ?2 readmissions during the subsequent year. Patients treated with a combined approach were less likely to be readmitted than those who received antibiotics alone (0 [range, 0-4] vs 1 [0-7] readmissions; P = .04). Conclusions. ?This is one of the largest cohort studies of pressure ulcer-related pelvic osteomyelitis to date. Significant variations existed in diagnostic approach. Most patients received antibiotics; those treated with a combined medical-surgical approach had fewer hospital readmissions. PMID:26322317

  18. Pressure Ulcer-Related Pelvic Osteomyelitis: A Neglected Disease?

    PubMed Central

    Bodavula, Phani; Liang, Stephen Y.; Wu, Jiami; VanTassell, Paige; Marschall, Jonas

    2015-01-01

    Background.?Decubitus ulcers can become complicated by pelvic osteomyelitis. Little is known about the epidemiology of pressure ulcer-related pelvic osteomyelitis. Methods.?We performed a retrospective cohort study of adult patients with pressure ulcer and pelvic osteomyelitis admitted to an academic center from 2006 to 2011. Data on clinical presentation, diagnostic evaluation, and treatment during the index admission were collected. Outcome measures included length of hospital stay and number of readmissions in the subsequent year. Results.?Two hundred twenty patients were included: 163 (74%) were para/quadriplegic and 148 (67%) were male (148; 67%). Mean age was 50 (±18) years. Pelvic osteomyelitis was the primary admission diagnosis for 117 (53%). Fifty-six (26%) patients had concurrent febrile urinary tract infection. Wound cultures collected for 113 patients (51%) were notable for methicillin-resistant Staphylococcus aureus (37; 33%), Streptococci (19; 17%), and Pseudomonas spp (20; 18%). Plain films were obtained in 89 (40%) patients, computed tomography scans were obtained for 81 (37%) patients, and magnetic resonance images were obtained for 40 (18%) patients. Most patients received osteomyelitis-directed antibiotics (153; 70%), 134 of 153 (88%) of which were scheduled to receive ?6 weeks of treatment. Fifty-five (25%) patients underwent surgery during the index admission; 48 (22%) patients received a combined medical-surgical approach. One third of patients had ?2 readmissions during the subsequent year. Patients treated with a combined approach were less likely to be readmitted than those who received antibiotics alone (0 [range, 0–4] vs 1 [0–7] readmissions; P = .04). Conclusions.?This is one of the largest cohort studies of pressure ulcer-related pelvic osteomyelitis to date. Significant variations existed in diagnostic approach. Most patients received antibiotics; those treated with a combined medical-surgical approach had fewer hospital readmissions. PMID:26322317

  19. Laparoscopic rectopexy in solitary rectal ulcer.

    PubMed

    Kargar, Saeed; Salmanroughani, Hassan; Binesh, Fariba; Taghipoor, Shokoh; Kargar, Shady

    2011-01-01

    Patients with Solitary Rectal Ulcer Syndrome (SRUS) come to a physician with passage of mucus and bloody liquid within defecation. The treatment for SRUS is depended to the severity of symptoms and the existance of rectal prolapse. This study is a report of the assessing of rectopexy as surgical modalities for 62 medical treatment resistant SRUS patients who were referred to the gastrointestinal department of Shahid Sadoughi Medical University and Mojibian hospital. The present non-randomized clinical trial was carried out in 62 SRUS patients from 1991 till 2005. In these patients SRUS was confirmed by histology. They were symptomatic after conservative therapy and referred for surgical intervention. All of them had been undergone abdominal rectopexy by two laparoscopic surgeons. In our study, rectal bleeding and history of digitalization had the highest and lowest frequency of symptoms and signs in our cases respectively. Abdominal rectopexy was done in 39 cases and complete recovery in our cases was 69.23%. Complete recovery rate in cases with dysplasia (63.8%) was significantly higher than cases without that (P=0.04). Complete recovery rate in cases that had finger defecation (85%) was significantly higher than cases without that (50%) (P=0.03). Laparoscopic rectopexy is one of the main surgical techniques for treatment of SRUS. This technique can present complete recovery for SRUS patients. Some of them include topical medications, behavior modification supplemented by fiber and biofeedback and surgery were more available and studied. But it seems that education of SRUS patient conservative treatment remain cornerstone in the SRUS management. PMID:22174170

  20. Auditory pathways: anatomy and physiology.

    PubMed

    Pickles, James O

    2015-01-01

    This chapter outlines the anatomy and physiology of the auditory pathways. After a brief analysis of the external, middle ears, and cochlea, the responses of auditory nerve fibers are described. The central nervous system is analyzed in more detail. A scheme is provided to help understand the complex and multiple auditory pathways running through the brainstem. The multiple pathways are based on the need to preserve accurate timing while extracting complex spectral patterns in the auditory input. The auditory nerve fibers branch to give two pathways, a ventral sound-localizing stream, and a dorsal mainly pattern recognition stream, which innervate the different divisions of the cochlear nucleus. The outputs of the two streams, with their two types of analysis, are progressively combined in the inferior colliculus and onwards, to produce the representation of what can be called the "auditory objects" in the external world. The progressive extraction of critical features in the auditory stimulus in the different levels of the central auditory system, from cochlear nucleus to auditory cortex, is described. In addition, the auditory centrifugal system, running from cortex in multiple stages to the organ of Corti of the cochlea, is described. PMID:25726260

  1. Molecular Anatomy of Palate Development

    PubMed Central

    Potter, Andrew S.; Potter, S. Steven

    2015-01-01

    The NIH FACEBASE consortium was established in part to create a central resource for craniofacial researchers. One purpose is to provide a molecular anatomy of craniofacial development. To this end we have used a combination of laser capture microdissection and RNA-Seq to define the gene expression programs driving development of the murine palate. We focused on the E14.5 palate, soon after medial fusion of the two palatal shelves. The palate was divided into multiple compartments, including both medial and lateral, as well as oral and nasal, for both the anterior and posterior domains. A total of 25 RNA-Seq datasets were generated. The results provide a comprehensive view of the region specific expression of all transcription factors, growth factors and receptors. Paracrine interactions can be inferred from flanking compartment growth factor/receptor expression patterns. The results are validated primarily through very high concordance with extensive previously published gene expression data for the developing palate. In addition selected immunostain validations were carried out. In conclusion, this report provides an RNA-Seq based atlas of gene expression patterns driving palate development at microanatomic resolution. This FACEBASE resource is designed to promote discovery by the craniofacial research community. PMID:26168040

  2. LAPAROSCOPIC SALPINGECTOMY IN TWO CAPTIVE LEOPARDS (PANTHERA PARDUS) USING A SINGLE PORTAL ACCESS SYSTEM.

    PubMed

    Hartman, Marthinus J; Monnet, Eric; Kirberger, Robert M; Schoeman, Johan P

    2015-12-01

    Laparoscopic salpingectomy was performed in two adult leopards (Panthera pardus) using a single portal access system, with a multicannulated single-incision laparoscopic surgery port, without any complications. The poorly developed ovarian bursa provided easy access to the uterine tube for salpingectomy. Laparoscopic salpingectomy can be safely performed in the leopard using a single portal access system. PMID:26667558

  3. Investigation of Partial Directed Coherence for Hand-Eye Coordination in Laparoscopic training

    E-print Network

    Atallah, Louis

    Abstract. Effective hand-eye coordination is an important aspect of training in laparoscopic surgeryInvestigation of Partial Directed Coherence for Hand- Eye Coordination in Laparoscopic training of the proposed technique for minimally invasive surgery, two laparoscopic experiments have been con- ducted

  4. Three-Dimensional Modeling of the Pelvic Floor Support Systems of Subjects with and without Pelvic Organ Prolapse

    PubMed Central

    Xie, Bing; Wang, Jianliu

    2015-01-01

    The purpose of this study was to develop three-dimensional finite element models of the whole pelvic support systems of subjects with and without pelvic organ prolapse (POP) that can be used to simulate anterior and posterior wall prolapses. Magnetic resonance imaging was performed in one healthy female volunteer (55 years old, para 2) and one patient (56 years old, para 1) with anterior vaginal wall prolapse. Contours of the pelvic structures were traced by a trained gynecologist. Smoothing of the models was conducted and attachments among structures were established. Finite element models of the pelvic support system with anatomic details were established for both the healthy subject and the POP patient. The models include the uterus, vagina with cavity, cardinal and uterosacral ligaments, levator ani muscle, rectum, bladder, perineal body, pelvis, obturator internus, and coccygeal muscle. Major improvements were provided in the modeling of the supporting ligaments and the vagina with high anatomic precision. These anatomically accurate models can be expected to allow study of the mechanism of POP in more realistic physiological conditions. The resulting knowledge may provide theoretical help for clinical prevention and treatment of POP. PMID:25710033

  5. TH-C-BRD-11: Robustness of Pencil Beam Scanning Proton Therapy for Pelvic Cancer Under Anatomical Changes

    SciTech Connect

    Dinges, E; Bhatia, S; Gross, B; McGuire, S; Wang, D

    2014-06-15

    Purpose: Pencil beam scanning (PBS) proton therapy provides excellent dosimetric benefits in pelvic cancer treatment, yet day-to-day anatomical variations in pelvic region tend to cause range uncertainties. This study evaluates the dosimetric robustness under anatomical changes for three PBS intensity-modulated proton therapy (IMPT), IMPT using worstcase robust optimization (thereafter ‘Robust IMPT’), and single-field uniform dose (SFUD), in cervical cancer treatment. Methods: IMPT, Robust IMPT, and SFUD plans using the same beam directions and the same prescription (Rx) were generated on computed tomography (CT) images acquired on the simulation day. The dose from each plan was then recomputed on CT images acquired in subsequent two to five weeks using the same protocol. The weekly CTs were registered to the planning CT based on bony anatomy. Target coverage was considered adequate on each weekly CT if dose to 99% of the internal target volume (D-ITV99%) reached at least 95% of the Rx dose. Statistical analysis was then performed on the 21 weekly CT images available for the 7 enrolled patients. Results: Statistically, IMPT was unable to maintain target coverage (mean D-ITV99% = 90.5% Rx, p = 0.004), and SFUD was able to maintain target coverage (mean D-ITV99% = 98.0% Rx, p = 0.0064), in the weeks following simulation. Robust IMPT was able to improve the robustness of IMPT significantly (p < 0.0001), though its maintenance of target coverage was not statistically significant by the 95% Rx criteria (mean D-ITV99% = 96.0%, p = 0.1677). Conclusion: During the multi-week treatment course with anatomical variations, SFUD is robust in terms of maintaining target coverage while IMPT is not. The worst-case optimized Robust IMPT, assuming ±3.5% range uncertainties, improves the robustness of IMPT under anatomical changes significantly, even though it was not designed to account for anatomical changes by mechanism.

  6. Laparoscopic Nissen Fundoplication in Children: A Single Surgeon's Experience

    PubMed Central

    Hopkins, Mary Ann

    1999-01-01

    Background and Objectives: Adult laparoscopic Nissen fundoplication has been steadily growing since its introduction to the United States in the 1990s. Its advantage over the traditional open approach is manifold. Application of laparoscopic fundoplication to children is slowly but surely following this trend. This study evaluates our initial experience with pediatric laparoscopic Nissen fundoplications. Patients and Methods: We reviewed the records of 25 consecutive laparoscopic Nissen fundoplications performed by a single surgeon (GS) at our institution in the past three years. The patient ages ranged from 7 months to 18 years (mean, 7 years). All patients had documented gastroesophageal reflux disease. Complications from the reflux included vomiting in 15 patients, failure to thrive in nine, esophagitis in nine, and pulmonary symptoms in six. Results: All Nissen fundoplications were performed laparoscopically without need for conversion to open technique. Blood loss was less than 50 cc in all cases. A tube gastrostomy was concurrently performed in 17. Mean operative time in all cases was 221 minutes. Average postoperative day on which feedings were begun was day 2, with an average resumption of regular feedings on postoperative day 3.5. Average date of discharge was postoperative day 6.8. Complications included difficulty controlling glucose in an insulin-dependent diabetic, and a lost needle, which added an additional hour to the operative time. There were eight admissions to the pediatric intensive care unit, all for observation secondary to their underlying medical problems. There was one postoperative death due to an underlying medical condition. Conclusions: Laparoscopic Nissen fundoplication is a safe and effective treatment option for children suffering from significant reflux. Time to regular feeding, analgesia requirements and hospital stay are decreased when compared to traditional procedures. Laparoscopic Nissen fundoplication may well become the procedure of choice for pediatric gastroesophageal reflux disease. PMID:10694071

  7. Exploring relationships between personality and anatomy performance.

    PubMed

    Finn, Gabrielle M; Walker, Simon J; Carter, Madeline; Cox, David R; Hewitson, Ruth; Smith, Claire F

    2015-11-12

    There is increasing recognition in medicine of the importance of noncognitive factors, including personality, for performance, and for good medical practice. The personality domain of conscientiousness is a well-established predictor of performance in workplace and academic settings. This study investigates the relationships between the "Big Five" personality domains, the facets of conscientiousness and performance in a practical anatomy examination. First- and second-year undergraduate medical students (n?=?85) completed a paper-based questionnaire, which included a 50-item measure of the Big Five personality domains (neuroticism, extraversion, openness to experience, agreeableness, and conscientiousness) and a 60-item measure of the six conscientiousness facets (orderliness, dutifulness, achievement-striving, self-discipline, self-efficacy, and cautiousness) from the International Personality Item Pool (IPIP). In addition, routinely-collected academic performance scores from the end of semester anatomy practical examinations (spotters) were obtained. Anatomy examination performance correlated moderately with conscientiousness (r?=?0.24, P?=?0.03). Of the six facets of conscientiousness, a positive relationship was observed between anatomy examination performance and achievement striving (r?=?0.22, P?=?0.05). In conclusion, this study found that performance in an anatomy examination was related to higher levels of conscientiousness and, more specifically, to higher levels of achievement striving. The results have implications for selection and assessment in medicine. Anat Sci Educ 8: 547-554. © 2015 American Association of Anatomists. PMID:25716097

  8. Virtual reality training versus blended learning of laparoscopic cholecystectomy: a randomized controlled trial with laparoscopic novices.

    PubMed

    Nickel, Felix; Brzoska, Julia A; Gondan, Matthias; Rangnick, Henriette M; Chu, Jackson; Kenngott, Hannes G; Linke, Georg R; Kadmon, Martina; Fischer, Lars; Müller-Stich, Beat P

    2015-05-01

    This study compared virtual reality (VR) training with low cost-blended learning (BL) in a structured training program.Training of laparoscopic skills outside the operating room is mandatory to reduce operative times and risks.Laparoscopy-naïve medical students were randomized in 2 groups stratified for sex. The BL group (n?=?42) used E-learning for laparoscopic cholecystectomy (LC) and practiced basic skills with box trainers. The VR group (n?=?42) trained basic skills and LC on the LAP Mentor II (Simbionix, Cleveland, OH). Each group trained 3?×?4?hours followed by a knowledge test concerning LC. Blinded raters assessed the operative performance of cadaveric porcine LC using the Objective Structured Assessment of Technical Skills (OSATS). The LC was discontinued when it was not completed within 80?min. Students evaluated their training modality with questionnaires.The VR group completed the LC significantly faster and more often within 80?min than BL (45% v 21%, P?=?.02). The BL group scored higher than the VR group in the knowledge test (13.3?±?1.3 vs 11.0?±?1.7, P?laparoscopic surgery. The efficiency of the training was judged higher by the VR group than by the BL group.VR and BL can both be applied for training the basics of LC. Multimodality training programs should be developed that combine the advantages of both approaches. PMID:25997044

  9. A laparoscopic simulator – maybe it is worth making it yourself

    PubMed Central

    Piotrowski, Piotr; J?drzejczyk, Adam; Pawe?czak, Dariusz; Pasieka, Zbigniew

    2014-01-01

    Introduction Laparoscopic trainers have gained recognition for improving laparoscopic surgery skills and preparing for operations on humans. Unfortunately, due to their high price, commercial simulators are hard to obtain, especially for young surgeons in small medical centers. The solution might be for them to construct a device by themselves. Aim To make a relatively cheap and easy to construct laparoscopic trainer for residents who wish to develop their skills at home. Material and methods Two laparoscopic simulators were designed and constructed: 1) a box model with an optical system based on two parallel mirrors, 2) a box model with an HD webcam, a light source consisting of LED diodes placed on a camera casing, and a modeling servo between the webcam and aluminum pipe to allow electronic adjustment of the optical axis. Results The two self-constructed simulators were found to be effective training devices, the total cost of parts for each not exceeding $100. Advice is also given for future constructors. Conclusions Home made trainers are accessible to any personal budget and can be constructed with a minimum of practical skill. They allow more frequent practice at home, outside the venue and hours of surgical departments. What is more, home made trainers have been shown to be comparable to commercial trainers in facilitating the acquisition of basic laparoscopic skills. PMID:25337161

  10. Laparoscopic Resection for Rectal Cancer: What Is the Evidence?

    PubMed Central

    Chan, Dedrick Kok-Hong; Chong, Choon-Seng; Lieske, Bettina; Tan, Ker-Kan

    2014-01-01

    Laparoscopic colectomy for colon cancer is a well-established procedure supported by several well-conducted large-scale randomised controlled trials. Patients could now be conferred the benefits of the minimally invasive approach while retaining comparable oncologic outcomes to the open approach. However, the benefits of laparoscopic proctectomy for rectal cancer remained controversial. While the laparoscopic approach is more technically demanding, results from randomised controlled trials regarding long term oncologic outcomes are only beginning to be reported. The impacts of bladder and sexual functions following proctectomy are considerable and are important contributing factors to the patients' quality of life in the long-term. These issues present a delicate dilemma to the surgeon in his choice of operative approach in tackling rectal cancer. This is compounded further by the rapid proliferation of various laparoscopic techniques including the hand assisted, robotic assisted, and single port laparoscopy. This review article aims to draw on the significant studies which have been conducted to highlight the short- and long-term outcomes and evidence for laparoscopic resection for rectal cancer. PMID:24822196

  11. [Indications for laparoscopic treatment of large incisional hernias].

    PubMed

    Dietz, U A; Wiegering, A; Germer, C-T

    2015-04-01

    Hernia surgeons and patients have learned to appreciate the advantages of minimally invasive laparoscopic procedures. After overcoming the early learning curve phase, smaller wound surface areas, shorter operation times and briefer hospital stays have become routine. Severe surgery-related complications are rare. Patients with poor risk profiles (e.g. age >70 years, BMI >30 and nicotine consumption) profit especially from these advantages. This positive picture is clouded, however, by the need for an intraperitoneal mesh and specifically by the unchanged recurrence rate. The latter is not significantly lowered even by laparoscopic intraperitoneal on-lay mesh (laparoscopic IPOM) procedures. The current literature shows that irrespective of surgical technique, e.g. retromuscular mesh or laparoscopic IPOM, the risk profile and size of the hernia defect are independent factors that determine the prognosis for recurrence. While a cure of incisional hernia is no longer the only goal, the new indication scenario has two main goals: (a) for young patients at low risk or in patients for whom functional and morphological reconstruction of the abdominal wall are of primary importance, an open retromuscular mesh procedure is indicated (despite the higher morbidity) and (b) for older patients and chiefly for patients with a complex risk profile for whom treatment of the ventral hernia symptoms is paramount, laparoscopic procedures are indicated (due to the lower morbidity). This algorithm assumes that the treating surgeons have the requisite expertise and is discussed using the examples of four complex case reports. PMID:25060397

  12. Breaking Barriers to Successful Implementation of Day Case Laparoscopic Cholecystectomy.

    PubMed

    Reynolds, I; Bolger, J; Al-Hilli, Z; Hill, A D K

    2015-01-01

    Laparoscopic cholecystectomy is a common procedure performed in both emergency and elective settings. Our aim was to analyse the trends in laparoscopic surgery in Ireland in the public and private healthcare systems. In particular we studied the trend in day case laparoscopic cholecystectomy. National HIPE data for the years 2010-2012 was obtained. Similar datasets were obtained from the three main health insurers. 19,214 laparoscopic cholecystectomies were carried out in Ireland over the 3-year period. More procedures were performed in the public system than the private system from 2010-2012. There was a steady increase in surgeries performed in the public sector, while the private sector remained static. Although the ALOS was significantly higher in the public sector, there was an increase in the rate of day case procedures from 416 (13%) to 762 (21.9%). The day case rates in private hospitals increased only slightly from 29 (5.1%) in 2010 to 40 (5.9%) in 2012. Day case laparoscopic cholecystectomy has been shown to be a safe procedure, however significant barriers remain in place to the implementation of successful day case units nationwide. PMID:26349348

  13. Laparoscopic repair of iatrogenic vesicovaginal and rectovaginal fistula

    PubMed Central

    Chu, Lei; Wang, Jian-Jun; Li, Li; Tong, Xiao-Wen; Fan, Bo-Zhen; Guo, Yi; Li, Huai-Fang

    2015-01-01

    Objective: To investigate the clinical efficacy of laparoscopic repair of iatrogenic vesicovaginal fistulas (VVF) and rectovaginal fistulas. Methods: Seventeen female patients with iatrogenic fistulas (11 cases of VVF and 6 cases of high rectovaginal fistulas) were included. All patients were hospitalized and underwent laparoscopic fistula repair in our hospital between 2008 and 2012. The mean age of the patients was 44.8 ± 9.1 years. The fistulas and scar tissue were completely excised by laparoscopy, orifices were tension-free closed using absorbable sutures, omental flaps were interposed between the vagina and the bladder or rectum, and drainage was kept after repair. Results: Laparoscopic repair of fistulas was successful in all 17 patients. No complication was found during or after repair. No reoperation was needed after the repair. The operative time was 80.2 ± 30.0 minutes (range 50-140 minutes). The blood loss was 229.4 ± 101.6 ml (range 100-400 ml). The double J catheters were placed in 7 patients and removed 1-2 months after repair. Eight VVF patients underwent cystoscopy 3 months after laparoscopic repair and there were no abnormal findings. The follow-up time was 17.1 ± 6.5 months (range 8-29 months). Conclusion: Laparoscopic repair of VVF and rectovaginal fistulas is a safe and an effective minimally invasive procedure for treatment of iatrogenic fistula. PMID:25932174

  14. RESEARCH New Phytol. (2000), 147, 389400 Comparative anatomy of ectomycorrhizas

    E-print Network

    Massicotte, Hugues

    2000-01-01

    RESEARCH New Phytol. (2000), 147, 389­400 Comparative anatomy of ectomycorrhizas synthesized SUMMARY The morphology and anatomy of ectomycorrhizas of Rhizopogon parksii, Rhizopogon vinicolor, but rather had a pinnate form. All species had diagnostic features of ectomycorrhizas: a well

  15. Effect of anatomy on spectroscopic detection of cervical dysplasia

    E-print Network

    Mirkovic, Jelena

    It has long been speculated that underlying variations in tissue anatomy affect in vivo spectroscopic measurements. We investigate the effects of cervical anatomy on reflectance and fluorescence spectroscopy to guide the ...

  16. Totally Laparoscopic Roux-en-Y Gastrojejunostomy after Laparoscopic Distal Gastrectomy: Analysis of Initial 50 Consecutive Cases of Single Surgeon in Comparison with Totally Laparoscopic Billroth I Reconstruction

    PubMed Central

    Cho, In; Choi, Yoon Young; Kim, Yoo Min; Noh, Sung Hoon

    2014-01-01

    Purpose Roux-en-Y reconstruction (RY) in laparoscopic distal gastrectomy for gastric cancer is a more complicated procedure than Billroth-I (BI) or Billroth-II. Here, we offer a totally laparoscopic simple RY using linear staplers. Materials and Methods Each 50 consecutive patients with totally laparoscopic distal gastrectomy with RY and BI were enrolled in this study. Technical safety and surgical outcomes of RY were evaluated in comparison with BI. Results In all patients, RY gastrectomy using linear staplers was safely performed without any events during surgery. The mean operation time and anastomosis time were 177.0±37.6 min and 14.4±5.6 min for RY, respectively, which were significantly longer than those for BI (150.4±34.0 min and 5.9±2.2 min, respectively). There were no differences in amount of blood loss, time to flatus passage, diet start, length of hospital stay, and postoperative inflammatory response between the two groups. Although there was no significant difference in surgical complications between RY and BI (6.0% and 14.0%), the RY group showed no anastomosis site-related complications. Conclusion The double stapling method using linear staplers in totally laparoscopic RY reconstruction is a simple and safe procedure. PMID:24339302

  17. Ontology-enriched Visualization of Human Anatomy

    SciTech Connect

    Pouchard, LC

    2005-12-20

    The project focuses on the problem of presenting a human anatomical 3D model associated with other types of human systemic information ranging from physiological to anatomical information while navigating the 3D model. We propose a solution that integrates a visual 3D interface and navigation features with the display of structured information contained in an ontology of anatomy where the structures of the human body are formally and semantically linked. The displayed and annotated anatomy serves as a visual entry point into a patient's anatomy, medical indicators and other information. The ontology of medical information provides labeling to the highlighted anatomical parts in the 3D display. Because of the logical organization and links between anatomical objects found in the ontology and associated 3D model, the analysis of a structure by a physician is greatly enhanced. Navigation within the 3D visualization and between this visualization and objects representing anatomical concepts within the model is also featured.

  18. Greek anatomist herophilus: the father of anatomy

    PubMed Central

    Bay, Noel Si-Yang

    2010-01-01

    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

  19. Greek anatomist herophilus: the father of anatomy.

    PubMed

    Bay, Noel Si-Yang; Bay, Boon-Huat

    2010-12-01

    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

  20. Laparoscopic management of intra-abdominal infections: Systematic review of the literature

    PubMed Central

    Coccolini, Federico; Tranà, Cristian; Sartelli, Massimo; Catena, Fausto; Saverio, Salomone Di; Manfredi, Roberto; Montori, Giulia; Ceresoli, Marco; Falcone, Chiara; Ansaloni, Luca

    2015-01-01

    AIM: To investigate the role of laparoscopy in diagnosis and treatment of intra abdominal infections. METHODS: A systematic review of the literature was performed including studies where intra abdominal infections were treated laparoscopically. RESULTS: Early laparoscopic approaches have become the standard surgical technique for treating acute cholecystitis. The laparoscopic appendectomy has been demonstrated to be superior to open surgery in acute appendicitis. In the event of diverticulitis, laparoscopic resections have proven to be safe and effective procedures for experienced laparoscopic surgeons and may be performed without adversely affecting morbidity and mortality rates. However laparoscopic resection has not been accepted by the medical community as the primary treatment of choice. In high-risk patients, laparoscopic approach may be used for exploration or peritoneal lavage and drainage. The successful laparoscopic repair of perforated peptic ulcers for experienced surgeons, is demonstrated to be safe and effective. Regarding small bowel perforations, comparative studies contrasting open and laparoscopic surgeries have not yet been conducted. Successful laparoscopic resections addressing iatrogenic colonic perforation have been reported despite a lack of literature-based evidence supporting such procedures. In post-operative infections, laparoscopic approaches may be useful in preventing diagnostic delay and controlling the source. CONCLUSION: Laparoscopy has a good diagnostic accuracy and enables to better identify the causative pathology; laparoscopy may be recommended for the treatment of many intra-abdominal infections. PMID:26328036

  1. A Rare Reason for Pelvic Pain in Pregnancy: Infectious Sacroiliitis

    PubMed Central

    Cekmez, Yasemin; Göçmen, Ahmet; Arslan, O?uz; ?anl?kan, Fatih; Ba?c? Türkmen, Simge

    2015-01-01

    Introduction. Although the incidence of pregnancy-associated sacroiliitis is low, it is associated with significant morbidity and mortality. Timely diagnosis of the disease is confusing due to its nonspecific clinical features. Case. A 28-year-old woman at 34 weeks of gestation with severe pain in her right buttock radiating down the backside of the right thigh was admitted to our hospital. White blood cell (WBC) count and C-reactive protein (CRP) were elevated. The pelvic magnetic resonance imaging (MRI) scan revealed right sacroiliitis. Conclusion. Infectious sacroiliitis should be considered as a differential diagnosis even in low-risk women who present with debilitating pelvic pain in pregnancy and medical treatment should not be delayed. PMID:26064130

  2. Hemorrhage Detection and Segmentation in Traumatic Pelvic Injuries

    PubMed Central

    Davuluri, Pavani; Wu, Jie; Tang, Yang; Cockrell, Charles H.; Ward, Kevin R.; Najarian, Kayvan; Hargraves, Rosalyn H.

    2012-01-01

    Automated hemorrhage detection and segmentation in traumatic pelvic injuries is vital for fast and accurate treatment decision making. Hemorrhage is the main cause of deaths in patients within first 24 hours after the injury. It is very time consuming for physicians to analyze all Computed Tomography (CT) images manually. As time is crucial in emergence medicine, analyzing medical images manually delays the decision-making process. Automated hemorrhage detection and segmentation can significantly help physicians to analyze these images and make fast and accurate decisions. Hemorrhage segmentation is a crucial step in the accurate diagnosis and treatment decision-making process. This paper presents a novel rule-based hemorrhage segmentation technique that utilizes pelvic anatomical information to segment hemorrhage accurately. An evaluation measure is used to quantify the accuracy of hemorrhage segmentation. The results show that the proposed method is able to segment hemorrhage very well, and the results are promising. PMID:22919433

  3. Is total pelvic exenteration reasonable primary treatment for rectal carcinoma?

    PubMed Central

    Williams, L F; Huddleston, C B; Sawyers, J L; Potts, J R; Sharp, K W; McDougal, S W

    1988-01-01

    Total pelvic exeneration (TPE) is reasonable primary surgical therapy in select patients with large bulky locally invasive rectal cancers that can be removed en bloc. Many do not have either nodal or distant metastasis. Furthermore, TPE can be curative and often is palliative for similar lesions that are recurrent or nonresponsive to radiation therapy. Operative mortality rates should be under 10% and can be under 5% for primary cases. Although improvement in preoperative management and operative technique, especially with urinary conduits and postoperative care is clear, both early and late complications are significant. Unfortunately, preoperative identification of those patients requiring TPE rather than abdominoperineal or low anterior resection remains poor. Furthermore, recent improvements in techniques for pelvic slings to prevent small bowel entrapment and protection from irradiation or myocutaneous flaps to obliterate the massive dead space are not yet clearly established as preventors of either early or later complications. PMID:3291792

  4. Is total pelvic exenteration reasonable primary treatment for rectal carcinoma?

    PubMed

    Williams, L F; Huddleston, C B; Sawyers, J L; Potts, J R; Sharp, K W; McDougal, S W

    1988-06-01

    Total pelvic exeneration (TPE) is reasonable primary surgical therapy in select patients with large bulky locally invasive rectal cancers that can be removed en bloc. Many do not have either nodal or distant metastasis. Furthermore, TPE can be curative and often is palliative for similar lesions that are recurrent or nonresponsive to radiation therapy. Operative mortality rates should be under 10% and can be under 5% for primary cases. Although improvement in preoperative management and operative technique, especially with urinary conduits and postoperative care is clear, both early and late complications are significant. Unfortunately, preoperative identification of those patients requiring TPE rather than abdominoperineal or low anterior resection remains poor. Furthermore, recent improvements in techniques for pelvic slings to prevent small bowel entrapment and protection from irradiation or myocutaneous flaps to obliterate the massive dead space are not yet clearly established as preventors of either early or later complications. PMID:3291792

  5. Anatomy of an entry vehicle experiment

    NASA Technical Reports Server (NTRS)

    Eide, D. G.; Wurster, K. E.; Helms, V. T.; Ashby, G. C.

    1981-01-01

    The anatomy and evolution of a simple small-scale unmanned entry vehicle is described that is delivered to orbit by the shuttle and entered into the atmosphere from orbit to acquire flight data to improve our knowledge of boundary-layer behavior and evaluate advanced thermal protection systems. The anatomy of the experiment includes the justification for the experiments, instrumentation, configuration, material, and operational needs, and the translation of these needs into a configuration, weight statement, aerodynamics, program cost, and trajectory. Candidates for new instrumentation development are also identified for nonintrusive measurements of the boundary-layer properties.

  6. Functional Anatomy of the Outflow Facilities.

    PubMed

    Pizzirani, Stefano; Gong, Haiyan

    2015-11-01

    In order to understand the pathophysiology, select optimal therapeutic options for patients and provide clients with honest expectations for cases of canine glaucoma, clinicians should be familiar with a rational understanding of the functional anatomy of the ocular structures involved in this group of diseases. The topographical extension and the structural and humoral complexity of the regions involved with the production and the outflow of aqueous humor undergo numerous changes with aging and disease. Therefore, the anatomy relative to the fluid dynamics of aqueous has become a pivotal yet flexible concept to interpret the different phenotypes of glaucoma. PMID:26337760

  7. Anatomy Transfer Dicko Ali-Hamadi1,2,3

    E-print Network

    Plotkin, Joshua B.

    Anatomy Transfer Dicko Ali-Hamadi1,2,3 Tiantian Liu4 Benjamin Gilles5,1 Ladislav Kavan4 Franc University of Pennsylvania 5 LIRMM-CNRS Figure 1: A reference anatomy (left) is automatically transferred with anatomical rules. Abstract Characters with precise internal anatomy are important in film and visual effects

  8. Perceptions of Anatomy Education--A Student's View

    ERIC Educational Resources Information Center

    Joslin, Sarah

    2008-01-01

    Changes in anatomy education over the last two decades have, in large part, led to less emphasis on gross anatomy in the medical curriculum. This has led many to question whether streamlined anatomy courses truly provide adequate preparation for medical practice. Rather than wondering about the effects of these changes, we should be actively…

  9. Anatomy of a Shows the 9 components of

    E-print Network

    Venditti, Jeremy G.

    Anatomy of a Hillslope Shows the 9 components of hillslopes and the dominant transport processes and pathways Handout #12;Anatomy of a Hillslope Dominated by vertical soil formation processes Shows the 9 components of hillslopes and the dominant transport processes and pathways #12;Anatomy of a Hillslope

  10. Teaching Anatomy and Physiology Using Computer-Based, Stereoscopic Images

    ERIC Educational Resources Information Center

    Perry, Jamie; Kuehn, David; Langlois, Rick

    2007-01-01

    Learning real three-dimensional (3D) anatomy for the first time can be challenging. Two-dimensional drawings and plastic models tend to over-simplify the complexity of anatomy. The approach described uses stereoscopy to create 3D images of the process of cadaver dissection and to demonstrate the underlying anatomy related to the speech mechanisms.…

  11. Properties of Publications on Anatomy in Medical Education Literature

    ERIC Educational Resources Information Center

    Vorstenbosch, Marc; Bolhuis, Sanneke; van Kuppeveld, Sascha; Kooloos, Jan; Laan, Roland

    2011-01-01

    Publications on anatomy in medical education appear to be largely anecdotal. To explore this, we investigated the literature on anatomy in medical education, aiming first to evaluate the contribution of the literature on anatomy in medical education to "best evidence medical education" (BEME) and second to evaluate the development of this…

  12. Computational Anatomy, Object Matching, and the Level Set Method

    E-print Network

    Ferguson, Thomas S.

    Computational Anatomy, Object Matching, and the Level Set Method Wei-Hsun Liao1, Luminita Vese2 matching in computational anatomy. We present a new framework for warping pairs of overlapping and non and the infinite dimensional group actions is discussed. 1 Introduction Computational anatomy [1, 2] is an emerging

  13. Models of Normal Variation and Local Contrasts in Hippocampal Anatomy

    E-print Network

    Thompson, Paul

    Models of Normal Variation and Local Contrasts in Hippocampal Anatomy Xinyang Liu1 , Washington Mio of continuous spherical shapes and use it to analyze the anatomy of the hippocampus. To account for the geometry contrasts in the anatomy of different populations. The tool is applied to the detection, characterization

  14. Learning of Cross-Sectional Anatomy Using Clay Models

    ERIC Educational Resources Information Center

    Oh, Chang-Seok; Kim, Ji-Young; Choe, Yeon Hyeon

    2009-01-01

    We incorporated clay modeling into gross anatomy and neuro-anatomy courses to help students understand cross-sectional anatomy. By making clay models, cutting them and comparing cut surfaces to CT and MR images, students learned how cross-sectional two-dimensional images were created from three-dimensional structure of human organs. Most students…

  15. Guidelines for Standard Photography in Gross and Clinical Anatomy

    ERIC Educational Resources Information Center

    Barut, Cagatay; Ertilav, Hakan

    2011-01-01

    Photography has a widespread usage in medicine and anatomy. In this review, authors focused on the usage of photography in gross and clinical anatomy. Photography in gross and clinical anatomy is not only essential for accurate documentation of morphological findings but also important in sharing knowledge and experience. Photographs of cadavers…

  16. Introduction The anatomy and physiology of an organism is determined

    E-print Network

    Teichmann, Sarah

    6317 Introduction The anatomy and physiology of an organism is determined primarily by the protein basis of their anatomy and physiology and of why they differ between organisms. In this paper, we is an arthropod with a much more complex anatomy and physiology than the nematode Caenorhabditis elegans. We

  17. OBESITY AND PELVIC FLOOR DISORDERS: A REVIEW OF THE LITERATURE

    PubMed Central

    Greer, W. Jerod; Richter, Holly E.; Bartolucci, Alfred A.; Burgio, Kathryn L.

    2011-01-01

    OBJECTIVE To review the current literature and summarize the effect of obesity on outcomes of surgical treatment of pelvic floor disorders (PFDs) as well as the effect of weight loss on PFD symptoms. DATA SOURCES Relevant sources were identified by a MEDLINE search from 1966 to 2007 (key words: obesity, pelvic floor disorders, urinary incontinence, fecal incontinence, pelvic organ prolapse). References of relevant studies were hand searched. METHODS OF STUDY SELECTION Relevant human observational studies, randomized trials, and review articles were included. 246 articles were identified; 20 were used in reporting and analyzing the data. Meta-analyses were performed for topics meeting the appropriate criteria. TABULATION, INTEGRATION AND RESULTS There is good evidence that surgery for stress urinary incontinence in obese women is as safe as in their non-obese counterparts, but cure rates may be lower in the obese patient. Meta-analysis revealed cure rates of 81% and 85% for the obese and non-obese groups, respectively [P < 0.001; OR: 0.576 (95% CI: 0.426 – 0.779)] Combined bladder perforation rates were 1.2% in the obese and 6.6% in the non-obese [P = 0.015; OR: 0.277 (95% CI: 0.098 – 0.782)]. There is little evidence on which to base clinical decisions regarding the treatment of fecal incontinence (FI) and pelvic organ prolapse (POP) in obese women, as few comparative studies were identified addressing the outcomes of prolapse surgery in obese patients compared to normal-weight controls. Weight loss studies indicate that both bariatric and non-surgical weight loss lead to significant improvements in PFD symptoms. CONCLUSION Surgery for UI in obese women is safe, but more trials are needed to evaluate its long-term effectiveness as well as treatments for both FI and POP. Weight loss, both surgical and non-surgical, should be considered in the treatment of PFDs in the obese woman. PMID:18669733

  18. Chronic pelvic pain syndrome: role of a thorough clinical assessment.

    PubMed

    Quaghebeur, Jörgen; Wyndaele, Jean-Jacques

    2015-04-01

    Chronic pelvic pain syndrome (CPPS) presents with a variety of symptoms affecting multiple systems. There is no universal treatment that can be given to all patients with CPPS. The results of treatment depend greatly on an accurate diagnosis. A thorough clinical assessment, including a "four-step plan", should include paying special attention to the musculoskeletal system. This assessment is not difficult to perform and provides valuable information on possible muscular problems and neuropathy. PMID:25253424

  19. Transcatheter embolization of pelvic vessels for control of intractable hemorrhage

    SciTech Connect

    Lang, E.K.

    1981-08-01

    Transcatheter embolization for intractable hemorrhage from pelvic organs was performed in 46 patients. Advantages are discussed regarding different embolic materials, particle size, and embolization directed at branch vessels versus divisional arteries. An optimal approach for managing hemorrhage of different etiologies is developed, taking advantage of (a) selective embolization techniques, (b) pharmacologic manipulation of blood flow, and (c) the ability of embolic material to allow restitution of flow and/or continued collateral perfusion via the precapillary plexus.

  20. Laparoscopic upper-pole heminephrectomy for duplicated renal collecting system with superselective artery clamping using virtual partial nephrectomy analysis of Synapse Vincent: A case report.

    PubMed

    Yoshida, Kenji; Kinoshita, Hidefumi; Hayami, Yutaro; Nakamoto, Takahiro; Takayasu, Kenta; Sugi, Motohiko; Matsuda, Tadashi

    2015-11-01

    A 22-year-old woman was diagnosed with a duplicated renal collecting system with hydronephrosis and parenchymal loss in the upper pole of the left kidney. She underwent laparoscopic left upper-pole nephrectomy. Although a complex hilar vascular anatomy was identified during the operation, preoperative three-dimensional computed tomographic reconstruction using a three-dimensional image analysis device (Synapse Vincent; Fuji Medical Systems, Tokyo, Japan) greatly helped to accurately identify the anatomical renal hilum. For further detail, virtual partial nephrectomy analysis using a Voronoi decomposition was used to visualize the area supplied by a selected arterial branch including the atrophic cleavage line. We controlled the bleeding with selective clamping and safely carried out upper-pole heminephrectomy according to the preoperative plan. PMID:26300298

  1. Need for simulation in laparoscopic colorectal surgery training

    PubMed Central

    Celentano, Valerio

    2015-01-01

    The dissemination of laparoscopic colorectal surgery (LCS) has been slow despite increasing evidence for the clinical benefits, with a prolonged learning curve being one of the main restrictions for a prompt uptake. Performing advanced laparoscopic procedures requires dedicated surgical skills and new simulation methods designed precisely for LCS have been established: These include virtual reality simulators, box trainers, animal and human tissue and synthetic materials. Studies have even demonstrated an improvement in trainees’ laparoscopic skills in the actual operating room and a staged approach to surgical simulation with a combination of various training methods should be mandatory in every colorectal training program. The learning curve for LCS could be reduced through practice and skills development in a riskfree setting. PMID:26425266

  2. [Preoperative ERCP and laparoscopic cholecystectomy for treatment of choledocholithiasis].

    PubMed

    Metzger, J; Berbig, R; Muller, C

    1993-03-01

    Out of 110 patients suffering from gallstone-related symptoms, 21 underwent ERCP prior to laparoscopic cholecystectomy. Indications for this combined treatment were laboratory signs of cholestasis (36%), pancreatitis (29%), pathological IVC (18%), sonographic evidence for bile duct dilatation (10%) and cholangitis (7%). Local and general complications were not increased neither intraoperatively nor postoperatively. Median duration of postoperative hospital stay was four days for ERCP-treated patients as compared to three days for patients subjected to laparoscopic cholecystectomy only. In summary treatment of choledocholithiasis by a combination of preoperative ERCP and laparoscopic cholecystectomy offers the following advantages: high patient comfort, low incidence of complications and short hospitalization compares favourably with conventional common bile duct exploration. PMID:8473184

  3. Laparoscopic Cystogastrostomy for Pancreatic Pseudocyst: A Case Report

    PubMed Central

    Morisaki, T.; Noshiro, H.; Mizumoto, K.; Yamaguchi, K.; Chijiiwa, K.; Tanaka, M.

    2000-01-01

    A 49-year-old man with a history of acute pancreatitis was hospitalized with a diagnosis of pancreatic pseudocyst. Ultrasonography, computed tomography, and magnetic resonance imaging all demonstrated a homogeneous cyst, 9 × 4 cm in size, at the tail of the pancreas without mural nodules or septa. Because an intestinal structure was identified between the cyst and stomach preoperatively by computed tomography and endoscopic ultrasonography, laparoscopic cystogastrostomy was carried out instead of percutaneous or endoscopic cyst drainage. The cyst was exposed by dissecting the lesser omentum and found to have no adhesion to the surrounding tissues. Anastomosis was performed using an endoscopic linear stapler via small cystotomy and gastrotomy openings on the lesser curvature, which were then sutured laparoscopically. The postoperative course was uneventful. Laparoscopic surgery is recommended as a safe, reliable, and minimally invasive treatment for managing pancreatic pseudocyst. PMID:11051191

  4. Prophylaxis of extrahepatic bile duct injuries during laparoscopic cholecystectomy.

    PubMed

    Rustamov, G; Pashaev, K; Tagiev, S; Rustamov, E

    2009-02-01

    The laparoscopic cholecystectomy is a "gold standard" for the gallstone treatment. But, like in all spheres of human activity it's necessary to perfect the operative technique for improving the results of any operation. Extrahepatic bile duct injuries are the main serious complications of laparoscopic cholecystectomy. The aim of the research is to investigate the causes of extrahepatic bile duct injuries and to work out preventive measures. Retrospective analysis of case histories of 3127 patients who underwent cholecystectomy from October 1994 to January in the minimal invasive surgical department of the Central Hospital of Caspian Shipping Company was conducted. The original method of tissue dissection for different laparoscopic operations was introduced. Advantages of the method: delicate tissue dissection, less time for operation, gentle tissue separation in Calot's triangle, safe separation of the gallbladder from the liver bed, low postoperative complication rate. PMID:19276461

  5. Two pregnancy cases of uterine scar dehiscence after laparoscopic myomectomy

    PubMed Central

    Song, Soo-Youn; Yoo, Hee-Jun; Kang, Byung-Hun; Ko, Young-Bok; Lee, Ki-Hwan

    2015-01-01

    Uterine scar dehiscence following laparoscopic myomectomy rarely occurs but can compromise both maternal and fetal well-being in subsequent pregnancy. We here present two cases of pregnancy complicated by preterm birth that resulted from uterine scar dehiscence following laparoscopic myomectomy. First case was a nulligravida who had scar dehiscence at 26 weeks of gestation after having a laparoscopic myomectomy 3 months prior to conception. Two weeks later, we observed her fetal leg protruding through the defect. The other case was a primigravida with a history of prior cesarean delivery, whose sonography revealed myomectomy scar dehiscence at 31 weeks of gestation. Within a few hours after observing, the patient complained of abdominal pain that was aggravating as fetal leg protruded through the defect. In both cases, babies were born by emergency cesarean section. Conservative management can be one of treatment options for myomectomy scar dehiscence in preterm pregnancy. However, clinicians should always be aware of the possibility of obstetric emergencies.

  6. Study on an infrared endoscope for energized laparoscopic method

    NASA Astrophysics Data System (ADS)

    Chen, Minghui; Song, Chengli

    2014-11-01

    An infrared endoscopic system has been developed to investigate thermal spread and collateral damage during energized laparoscopic surgery, the system consists of an infrared endoscope and a thermal camera (3-5 ?m) with combined thermal sensitivity of 0.05°C. The system performance was evaluated in live animals with electrosurgical devices to monitor intraoperative thermal changes. During activation periods, the peak temperature of the jaws averaged 100.5 ± 5.8 ° with a thermal spread of 3.0 ± 0.9 mm. For laparoscopic dissections of the esophagus-gastric junction with the 10 mm Atlas, the maximum jaw temperature was 105.2 ± 2.1 ° with a bigger thermal spread of 11.5 ± 7.2 mm). The study has confirmed that infrared endoscopy is a very useful tool adjunct to conventional endoscopy, which may improve the safety of energized laparoscopic dissections.

  7. Need for simulation in laparoscopic colorectal surgery training.

    PubMed

    Celentano, Valerio

    2015-09-27

    The dissemination of laparoscopic colorectal surgery (LCS) has been slow despite increasing evidence for the clinical benefits, with a prolonged learning curve being one of the main restrictions for a prompt uptake. Performing advanced laparoscopic procedures requires dedicated surgical skills and new simulation methods designed precisely for LCS have been established: These include virtual reality simulators, box trainers, animal and human tissue and synthetic materials. Studies have even demonstrated an improvement in trainees' laparoscopic skills in the actual operating room and a staged approach to surgical simulation with a combination of various training methods should be mandatory in every colorectal training program. The learning curve for LCS could be reduced through practice and skills development in a riskfree setting. PMID:26425266

  8. [Laparoscopic tubal coagulation--technic and follow-up results].

    PubMed

    Hopp, H; Rummler, S; Reumuth, J

    1983-01-01

    This report presents 155 cases of laparoscopic electrocoagulation of the fallopian tubes. 53 coagulations were performed with unipolar devices, 102 ones with bipolar technique.--The patency of tubal obliteration was tested 12 weeks after the operation hysterosalpingographically.--In 4 cases the contrast medium was forced through the obliterated part of the fallopian tube, but controlled a half year later the tubes are completely closed. Hysterosalpingographic studies are not suited to criticize the reliability of laparoscopic sterilization. Severe operative and early postoperative complications were not to be seen.--The laparoscopic bipolar coagulation of the fallopian tubes is a method without the high of electric accidents. There is a great efficacy in producing sterility. PMID:6219521

  9. Anatomy of a Busted Comet

    NASA Technical Reports Server (NTRS)

    2008-01-01

    [figure removed for brevity, see original site] Poster Version (Figure 1)

    NASA's Spitzer Space Telescope captured the picture on the left of comet Holmes in March 2008, five months after the comet suddenly erupted and brightened a millionfold overnight. The contrast of the picture has been enhanced on the right to show the anatomy of the comet.

    Every six years, comet 17P/Holmes speeds away from Jupiter and heads inward toward the sun, traveling the same route typically without incident. However, twice in the last 116 years, in November 1892 and October 2007, comet Holmes mysteriously exploded as it approached the asteroid belt. Astronomers still do not know the cause of these eruptions.

    Spitzer's infrared picture at left hand side of figure 1, reveals fine dust particles that make up the outer shell, or coma, of the comet. The nucleus of the comet is within the bright whitish spot in the center, while the yellow area shows solid particles that were blown from the comet in the explosion. The comet is headed away from the sun, which lies beyond the right-hand side of figure 1.

    The contrast-enhanced picture on the right shows the comet's outer shell, and strange filaments, or streamers, of dust. The streamers and shell are a yet another mystery surrounding comet Holmes. Scientists had initially suspected that the streamers were small dust particles ejected from fragments of the nucleus, or from hyerpactive jets on the nucleus, during the October 2007 explosion. If so, both the streamers and the shell should have shifted their orientation as the comet followed its orbit around the sun. Radiation pressure from the sun should have swept the material back and away from it. But pictures of comet Holmes taken by Spitzer over time show the streamers and shell in the same configuration, and not pointing away from the sun. The observations have left astronomers stumped.

    The horizontal line seen in the contrast-enhanced picture is a trail of debris that travels along with the comet in its orbit.

    The Spitzer picture was taken with the spacecraft's multiband imaging photometer at an infrared wavelength of 24 microns.

  10. A shell finite element model of the pelvic floor muscles.

    PubMed

    d'Aulignac, D; Martins, J A C; Pires, E B; Mascarenhas, T; Jorge, R M Natal

    2005-10-01

    The pelvic floor gives support to the organs in the abdominal cavity. Using the dataset made public in (Janda et al. J. Biomech. (2003) 36(6), pp. 749-757), we have reconstructed the geometry of one of the most important parts of the pelvic floor, the levator ani, using NURB surfaces. Once the surface is triangulated, the corresponding mesh is used in a finite element analysis with shell elements. Based on the 3D behavior of the muscle we have constructed a shell that takes into account the direction of the muscle fibers and the incompressibility of the tissue. The constitutive model for the isotropic strain energy and the passive strain energy stored in the fibers is adapted from Humphrey's model for cardiac muscles. To this the active behavior of the skeletal muscle is added. We present preliminary results of a simulation of the levator ani muscle under pressure and with active contraction. This research aims at helping simulate the damages to the pelvic floor that can occur after childbirth. PMID:16298856

  11. Development of a standardized laparoscopic caecum resection model to simulate laparoscopic appendectomy in rats

    PubMed Central

    2014-01-01

    Background Laparoscopic appendectomy (LA) has become one of the most common surgical procedures to date. To improve and standardize this technique further, cost-effective and reliable animal models are needed. Methods In a pilot study, 30 Wistar rats underwent laparoscopic caecum resection (as rats do not have an appendix vermiformis), to optimize the instrumental and surgical parameters. A subsequent test study was performed in another 30 rats to compare three different techniques for caecum resection and bowel closure. Results Bipolar coagulation led to an insufficiency of caecal stump closure in all operated rats (Group 1, n?=?10). Endoloop ligation followed by bipolar coagulation and resection (Group 2, n?=?10) or resection with a LigaSure™ device (Group 3, n?=?10) resulted in sufficient caecal stump closure. Conclusions We developed a LA model enabling us to compare three different caecum resection techniques in rats. In conclusion, only endoloop closure followed by bipolar coagulation proved to be a secure and cost-effective surgical approach. PMID:24934381

  12. Simulation of tissue cutting and bleeding for laparoscopic surgery using auxiliary surfaces.

    PubMed

    Basdogan, C; Ho, C H; Srinivasan, M A

    1999-01-01

    Realistic simulation of tissue cutting and bleeding is important components of a surgical simulator that are addressed in this study. Surgeons use a number of instruments to perform incision and dissection of tissues during minimally invasive surgery. For example, a coagulating hook is used to tear and spread the tissue that surrounds organs and scissors are used to dissect the cystic duct during laparoscopic cholecystectomy. During the execution of these procedures, bleeding may occur and blood flows over the tissue surfaces. We have developed computationally fast algorithms to display (1) tissue cutting and (2) bleeding in virtual environments with applications to laparoscopic surgery. Cutting through soft tissue generates an infinitesimally thin slit until the sides of the surface are separated from each other. Simulation of an incision through tissue surface is modeled in three steps: first, the collisions between the instrument and the tissue surface are detected as the simulated cutting tool passes through. Then, the vertices along the cutting path are duplicated. Finally, a simple elastic tissue model is used to separate the vertices from each other to reveal the cut. Accurate simulation of bleeding is a challenging problem because of the complexities of the circulatory system and the physics of viscous fluid flow. There are several fluid flow models described in the literature, but most of them are computationally slow and do not specifically address the problem of blood flowing over soft tissues. We have reviewed the existing models, and have adapted them to our specific task. The key characteristics of our blood flow model are a visually realistic display and real-time computational performance. To display bleeding in virtual environments, we developed a surface flow algorithm. This method is based on a simplified form of the Navier-Stokes equations governing viscous fluid flow. The simplification of these partial differential equations results in a wave equation that can be solved efficiently, in real-time, with finite difference techniques. The solution describes the flow of blood over the polyhedral surfaces representing the anatomical structures and is displayed as a continuous polyhedral surface drawn over the anatomy. PMID:10538392

  13. Conditioned place preference for mating is preserved in rats with pelvic nerve transection

    PubMed Central

    Meerts, Sarah H.; Clark, Ann S.

    2009-01-01

    Female rats exhibit a conditioned place preference (CPP) for a context paired with mating. The present experiment tested the hypothesis that the activation of the pelvic nerve mediates the reinforcing effects of mating for female rats. Rats underwent bilateral pelvic nerve or sham transection and then received paced mating, nonpaced mating or the control treatment during a CPP procedure. Pelvic nerve transection did not affect the CPP for paced or nonpaced mating. In tests of paced mating behavior, contact-return latencies following intromissions were significantly shorter in rats with pelvic nerve transection than rats with sham transections. These results show that the pathway conveying the reinforcing effects of mating stimulation does not depend on the integrity of the pelvic nerve, but that activation of the pelvic nerve contributes to the display of paced mating behavior. PMID:19485560

  14. Role of Trans Vaginal Ultrasound and Doppler in Diagnosis of Pelvic Congestion Syndrome

    PubMed Central

    Sharma, Kaveri; Varghese, Jessy; Malik, Gaurav; Kuruvilla, Robin

    2014-01-01

    Pelvic congestion syndrome (PCS) is a cause of chronic pelvic pain in women and is defined as pelvic pain lasting for more than six months.The diagnosis of PCS is a challenging task for the gynaecologist. It can be due to many varied causes like endometriosis, adhesions, chronic pelvic inflammatory disease (PID), ovarian cyst, fibroids, pelvic varicosities. Radiology plays an important role in the diagnosis and management of PCS. Pelvic UltraSonography (PUS),transvaginal sonography (TVS) with doppler, Magnetic resonance imaging (MRI), computed tomography (CT) and ovarian venography are usually used in the diagnosis of this condition. We report a case of a 35-year-old multiparous patient with history of pain in lower abdomen, vaginal discharge and general lethargy for past three years who was diagnosed as a case of PCS based on typical TVS and Doppler findings. PMID:25177607

  15. Two-Year Community: Human Anatomy Software Use in Traditional and Online Anatomy Laboratory Classes: Student-Perceived Learning Benefits

    ERIC Educational Resources Information Center

    Kuyatt, Brian L.; Baker, Jason D.

    2014-01-01

    This study evaluates the effectiveness of human anatomy software in face-to-face and online anatomy laboratory classes. Cognitive, affective, and psychomotor perceived learning was measured for students using Pearson Education's Practice Anatomy Laboratory 2.0 software. This study determined that student-perceived learning was significantly…

  16. [Laparoscopic repair of umbilical hernias--initial experience].

    PubMed

    Germanov, G; Tsvetkov, I; Radionov, M; Pozharliev, T

    2006-01-01

    In this study the autors present their initial experience with 8 patients with umbilical hernias, operated laparoscopically in the surgery clinic of the university hospital "Sweta Anna" in Sofia for the period from 2002 to 2005. There were no intraoperative complications as well suppurations detected for a 18 months postoperative follow up. We found out lesser postoperative pain and shorter reccurence period by the laparoscopically operated patients in comparison with these, who had undergone a conventional repair. The autors made a review of the related literature and the conclusion, that LVHR is a effective, suitable method for operative treatment of umbilical hernias greater than 4 cm and recidive ones. PMID:18788109

  17. Amyand's hernia: Our experience in the laparoscopic era.

    PubMed

    Sahu, Diwakar; Swain, Sudeepta; Wani, Majid; Reddy, Prasanna Kumar

    2015-01-01

    Amyand's hernia is a rare presentation of inguinal hernia, in which the appendix is present within the hernia sac. This entity is a diagnostic challenge due to its rarity and vague clinical presentation. A laparoscopic approach can confirm the diagnosis as well as serve as a therapeutic tool. When the appendix is not inflamed within the inguinal hernia sac, then appendicectomy is not always necessary. Our case series emphasize the same presumption as three patient of Amyand's hernia underwent laparoscopic transabdominal preperitoneal hernioplasty without appendicectomy. The aim of this paper is to review the literature with regards to Amyand's hernia and provide new insight in its diagnosis and treatment. PMID:25883458

  18. Monolimb Paralysis after Laparoscopic Appendectomy Due to Conversion Disorder

    PubMed Central

    Song, Sung Hyuk; Lee, Kyeong Hwan

    2014-01-01

    Limb paralysis can develop for various reasons. We found a 13-year-old patient who became paralyzed in her lower extremities after laparoscopic appendectomy. Some tests, including electrodiagnostic studies and magnetic resonance imaging, were performed to evaluate the cause of lower limb paralysis. None of the tests yielded definite abnormal findings. We subsequently decided to explore the possibility of psychological problems. The patient was treated with simultaneous rehabilitation and psychological counseling. Paralysis of the patient's lower extremity improved gradually and the patient returned to normal life. Our findings indicate that psychological problems can be related to limb paralysis without organ damage in patients who have undergone laparoscopic surgical procedures. PMID:25426280

  19. [Laparoscopic cholecystectomy--results in the initial 100 cases].

    PubMed

    Frei, E; Middendorp, J; Klaiber, C; Akovbiantz, A

    1990-12-18

    100 patients underwent laparoscopic cholecystectomy for symptomatic gallbladder stones. In seven cases the laparoscopic procedure had to be converted into an open cholecystectomy due to bleeding, injury to the choledochus and acute cholecystitis. There were no postoperative complications. We feel that the indication for this method is broad. Independent of the size, the number and the chemical composition of calculi, this method is used for symptomatic gallbladder stones. All together the main advantages are higher comfort for the patient, better cosmetic results, shortening of hospital stay and sooner return to full activity. PMID:2148634

  20. Amyand's hernia: Our experience in the laparoscopic era

    PubMed Central

    Sahu, Diwakar; Swain, Sudeepta; Wani, Majid; Reddy, Prasanna Kumar

    2015-01-01

    Amyand's hernia is a rare presentation of inguinal hernia, in which the appendix is present within the hernia sac. This entity is a diagnostic challenge due to its rarity and vague clinical presentation. A laparoscopic approach can confirm the diagnosis as well as serve as a therapeutic tool. When the appendix is not inflamed within the inguinal hernia sac, then appendicectomy is not always necessary. Our case series emphasize the same presumption as three patient of Amyand's hernia underwent laparoscopic transabdominal preperitoneal hernioplasty without appendicectomy. The aim of this paper is to review the literature with regards to Amyand's hernia and provide new insight in its diagnosis and treatment. PMID:25883458