The fibers of the circular junction of the linea alba in normal adult anatomy.

The linea alba (LA) is known to be useful to surgeons for making surgical incisions. Laparoscopic entry into the peritoneal cavity using the open technique may involve identification of a point just above or below the umbilicus where the peritoneum is fused to the LA. This anatomical site is found through superficial dissection to expose the junction between the umbilical stalk (US) and the LA, where distinct fibers seem to form a unique ligament-like structure in normal adult anatomy. This point, in fact, is part of a circular fibrous structure that exists almost like a ring around the remnant US. It is formed by the fusion of oblique and transverse fibers of the LA with circular fibers from proliferation of an encircling band of compact mesoderm to close a patent umbilical ring. We describe and name this anatomical landmark as junctio circularis alba or the "circular junction of the LA" as encountered in normal adult human anatomy. We believe this is crucial for describing key surgical procedures at this site to aid effective surgical training and reduce iatrogenic complications from laparoscopic port site entries.

One duct, two orifices, no names! the anatomy of the biliary cystic duct.

The biliary cystic duct (CD) connects the gallbladder to the extra-hepatic bile duct, and the point at which it does this delineates the division between the common hepatic duct and the common bile duct. Its clinical relevance in disease, and importance during interventions relating to the gallbladder mean that its normal and variant anatomy has been described extensively in literature. However, an aspect not yet fully described includes naming of its two orifices on either end. This is highly relevant for surgical, endoscopic, and percutaneous procedures. We describe these as encountered in normal CD and biliary tree anatomy. We believe this is crucial for interventions relating to the gallbladder and the biliary tree, including prevention of iatrogenic injury. Clin. Anat. 31:422-423, 2018. © 2018 Wiley Periodicals, Inc.

Bibliometric analysis of quality of life in implant-based breast reconstruction.

Background: Implant-based breast reconstruction (IBR), following mastectomy, significantly impacts patients' quality of life (QoL), necessitating accurate measurement through psychometrically robust patient-reported outcome measure (PROM) tools. This bibliometric analysis aims to discern trends, identify gaps, and evaluate the use of such tools in the IBR literature. Methods: The 100 most cited publications regarding QoL in implant-based reconstruction were identified on Web of Science, across all available journal years (from 1977 to 2024) on 10 March 2024. Study details, including the citation count, main content focus, outcome measures, and usage of psychological questionnaires, were extracted and tabulated from each publication. The Oxford Centre for Evidence-Based Medicine (OCEBM) levels of evidence (LOE) of each study were assessed. Results: The 100 most cited publications on QoL in implant-based reconstruction were identified, encompassing 64,192 patients and 28,114 reconstructed breasts. Citations per publication ranged from 62 to 457 (mean, 124.95 ± 73.05), with the highest-cited study being authored by Al-Ghazal (n = 457). The vast majority of publications were LOE II (n = 52), representative of prospective cohort studies, systematic reviews of non-randomised studies, and systematic review and meta-analysis. The number of publications for LOE V, IV, III, and I was 0, 7, 41, and 0, respectively. The main content focus was "quality of life" in 83 publications, with significant utilisation of the BREAST-Q questionnaire. A total of 80 publications used validated questionnaires with psychometric development. Conclusions: This analysis demonstrates that the research methodologies within IBR mostly consist of moderate-quality publications; however, notably, there was a lack of LOE I studies, underscoring a gap in high-quality research within the field. Moreover, only 62/100 used validated PROM tools. Future IBR research studies should be focussed on most robust methodologies, incorporating validated PROM tools, to optimise shared-decision making and informed consent.

What Are the Perceptions of General Surgical Trainees of Vascular Surgical Teaching Received During Their Higher Specialty Training Years in the UK?

OBJECTIVE: To garner the perceptions of select general surgical trainees of vascular surgical teaching received during their higher specialty training years in the United Kingdom. DESIGN: An embedded mixed methods research approach, with a predominantly qualitative research framework, based on phenomenology was used to design a questionnaire and focus group consisting of a purposive criterion-based sample. All responses were analyzed using reflexive thematic analysis by a single researcher. SETTING: The study setting was the eastern sub-deanery of "Kent, Surrey and Sussex" with 9 district general hospitals and 1 tertiary hospital and 50 higher general surgical trainees. PARTICIPANTS: Inclusion criteria were all general surgical trainees in the deanery who had attended vascular surgical teaching and done their vascular rotation over the last 5 years. The exclusion criteria were all trainees currently taking time out of the training programme due to personal or educational reasons, or who were yet to commence their vascular surgical rotation. After piloting, 10 trainees completed the questionnaire, responses from which helped facilitate a focus group of 4 participants. RESULTS: The perceptions of general surgical trainees can be classified into 2 overarching themes, one where they view it as an asset to their training, and the other where they view certain aspects as ineffective. They valued the in-depth experience gained from their rotation to improve their overall skills above other teaching methods. However, effectiveness of this was altered based on trainer and trainee motivation, continuity of supervision, hands-on experience, and timing of other supplementary methods such as lectures and simulation training. CONCLUSIONS: Albeit a small sample size, this study sheds light on perceptions of general surgical trainees towards vascular surgical teaching, which may help the wider surgical community. A feeling of shared responsibility between trainers and trainees may be brought on as an effect of making it an optional module, ensuring trainees select it for its long-term benefits.