Mediastinal anatomical landmarks, their variants and tips for video-assisted thoracoscopic navigation during oesophageal extirpation.

PURPOSE: There is no systematic description of primary anatomical landmarks that allow a surgeon to reliably and safely navigate the superior and posterior mediastinum's fat tissue spaces near large vessels and nerves during video-assisted endothoracoscopic interventions in the prone position of a patient. Our aim was to develop an algorithm of sequential visual navigation during thoracoscopic extirpation of the esophagus and determine the most permanent topographic and anatomical landmarks allowing safe thoracoscopic dissection of the esophagus in the prone position. METHODS: The anatomical study of the mediastinal structural features was carried out on 30 human cadavers before and after opening the right pleural cavity. RESULTS: For thoracoscopic extirpation of the esophagus in the prone position, anatomical landmarks are defined, their variants are assessed, and an algorithm for their selection is developed, allowing their direct visualization before and after opening the mediastinal pleura. CONCLUSION: The proposed algorithm for topographic and anatomical navigation based on the key anatomical landmarks in the posterior mediastinum provides safe performance of the video-assisted thoracoscopic extirpation of the esophagus in the prone position.

Intervertebral Canals and Intracanal Ligaments as New Terms in Terminologia anatomica.

This study addresses the cervical part of the vertebral column. Clinical pictures of dystrophic diseases of the cervical part of the vertebral column do not always correspond only to the morphological changes-they may be represented by connective tissue formation and nerve and vessel compression. To find out the possible reason, this morphometric study of the cervical part of the vertebral column in 40 cadavers was performed. CT scans were performed on 17 cadaveric material specimens. A total of 12 histological samples of connective tissue structures located in intervertebral canals (IC) were studied. One such formation, an intracanal ligament (IL) located in the IC, was found. Today, there is no term "intervertebral canal", nor is there a detailed description of the intervertebral canal in the cervical part of the vertebral column. Cervical intervertebral canals make up five pairs in segments C2-C7. On cadavers, the IC lateral and medial apertures were 0.9-1.5 cm and 0.5-0.9 cm, correspondingly. According to our histological study, the connective tissue structures in the IC are ligaments-IL. According to the presence of these ligaments, ICs were classified into three types. Complete regional anatomy characterization of the IC of the cervical part of the vertebral column with a description of its constituent anatomical elements was provided. The findings demonstrate the need to include the terms "intervertebral canal" and "intervertebral ligament" in the Terminologia anatomica.

Structural features of the anterior region of the mandible.

The research aims were to find out further intraosseous mandible organization indications and to structure it systematically. MATERIAL AND METHODS: in our research 400 mandibles were used: for the intraosseous examinations in total 300 mandibles of persons aged 20-65 were used. For all corpses cephalic index was measured. Segmentation of the mandibles were made by Jigley saw between medial root of the first molar at one side and central and second incisor of the opposite one. After that segments were stained with Schiff's reagent with following preparation. Dry preparations (n = 100) were used in exploration of mental foramen macroanatomy. RESULTS: mental foramen cavity depth was divided into three types: low, n = 33 (depth 269 ± 081 mm), medium, n = 36 (depth 358 ± 092 mm) and deep, n = 31 (depth 417 ± 036 mm); transverse size of the cavity is 3109 ± 041 mm and longitudinal size is 397 ± 055 mm. According to the mandible anterior intraosseous organization research it is possible to make a mental nerve intraosseous canal types systematization: semi-oval; straight; s-shaped type, formed by two opposite and transient bends. The S-shaped type (49%) is more common in persons with a dolichocephalic skull type, especially (57.55%) in mesocephalic type and semi-oval (66.36%) in brachycephalic type. CONCLUSION: nerve in the eponymous mental foramen, (which we would like to call a cavity), is branched into two large branches: the extraosseous branch, which innervates the soft tissues (such as Rr. mentales, Rr. labiales and Rr. gingivales), and the intraosseous branch, which runs from the mental foramen to the symphysis, from the latter branch to the first premolar, to the canine and to the incisors.