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INTRODUCTION: Kidneys are a retroperitoneal organ but the widely practiced laparoscopic approach to renal surgery is transperitoneal due to the advantages of greater working space at the cost of entering the peritoneal cavity, risk of injury to intraperitoneal organs, and the increased risk of postoperative bowel complications. The classic open approach to kidney procedures has been the flank approach without violating the peritoneal cavity instead of the retroperitoneal approach to renal surgery with the advantages of direct access to the renal hilum, especially the renal artery. Being a technically challenging procedure, the retroperitoneoscopic approach is less practiced and needs an experienced surgical team. Through this study, we have tried to unveil the myths and illustrate the exact position of ports, which is the decisive initial step in retroperitoneoscopic surgery. MATERIAL AND METHODS: This retrospective study was conducted at a developing tertiary center in northern India with novice staff mainly to determine the technical and anatomical caveats pertaining to the retroperitoneoscopic approach for renal surgeries, the challenges faced, and their resolutions. The decision for the site of incision for primary or camera port was taken only after a proper anatomical study of the cadavers and ongoing retroperitoneal surgical experience while treating various patients suffering from renal diseases. The study comprised eight patients, during the period from June 2023 to March 2024. Various parameters, such as demographic variables, diagnosis, mean operative time, estimated blood loss, technical difficulties encountered and their resolution, complications, and reasons for conversion were studied. A total of 15 cadavers were dissected during the above time period to study finer anatomical details of port positioning and other details. RESULTS: After an elaborate study of 15 cadavers and thereafter performing surgery on eight patients during the above time period, surgery was successfully performed on six patients, and two patients needed conversion to open procedure due to dense adhesions and non-progression while complications occurred in two patients (peritoneal rent and renal vein injury), which were managed laparoscopically. CONCLUSION: Nonetheless, restrictions of surgical space make retroperitoneoscopic space a challenging procedure but with elaborate experience, which we gained through cadaveric study, and surgical results obtained during the initial few cases such as the exact site of the primary port and technical intricacies, and handling of complications if and when faced, we hope our study will certainly make retroperitoneal space more amicable to urologists.
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The common carotid artery bifurcates into two terminal branches-the external and internal carotid arteries. The head, neck, and face regions principally get their blood supply from the external carotid artery and its branches. Some previous articles have mentioned the abnormal pattern of the external carotid artery branching and its variable origin. In this article, a rare case has been documented, having the combination of anomalies of the high carotid termination and bilateral variable origin of the ventral branches of the external carotid artery encountered during routine dissection of the head and neck region of a 55-year-old male cadaver in the Department of Anatomy. In this instance, on the right side of the neck, we observed the presence of a thyrolinguofacial trunk which arose from the ventral surface of the external carotid artery, and on the left side, the linguofacial trunk emerged from the ventral surface of the external carotid artery while the superior thyroid artery branched off directly from the left common carotid artery. This apart, there was bilateral high termination of the common carotid artery. Although the exact embryogenesis of such common arterial trunks anomalies and high carotid termination is not clear, detailed and precise anatomical knowledge of such a combination of anomalies will provide further insight for better radiological evaluation and to avert iatrogenic vascular injuries during any surgical procedures of the head and face region.
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BACKGROUND: Medical students who are prone to psychological stress due to their overburdened curriculum, are at an increased risk of getting adversely affected by the pandemic. The present study was planned to assess the anxiety level among undergraduate medical students across the country using generalized anxiety disorder scale (GAD-7). MATERIALS AND METHODS: In this online survey, anonymous data was collected through Google forms from undergraduate students from all the phases of MBBS course across the country from August 15, 2020, to October 15, 2020. Section I collected various demographic information, section II included GAD-7 questionnaire for assessing anxiety and section III had open- ended questions about their impending fear, uncertainties, and apprehensions. The data was expressed in percentage and association among the variables was determined using Chi-square test. Thematic analysis of the open-ended responses was done. RESULTS: Among the sample of 1208 students, 81% were from urban areas. During the pandemic, 77% were residing with their parents and 71% parents having stable jobs. Eighty percent students had no relative diagnosed with COVID-19, whereas 52% students had family members with comorbidity. The GAP score showed mild, moderate, and severe anxiety in 27, 24, and 16% students, respectively. Anxiety was significantly associated with rural setting and with COVID-19 positive or comorbid family member (P < 0.05). Open ended responses revealed that majority of the students were finding it difficult to cope with the academic stress at home but still did not want to join back. CONCLUSION: With such a high incidence of anxiety among medical students, it is pertinent to safeguard the mental health and implement efficient approaches to upkeep the scholastic, physical, emotional, and professional well-being of medical students during such vulnerable times.