Anatomical variations of the pelvis during abdominal hysterectomy for benign conditions.

BACKGROUND: Anatomical variations are defined as atypical morphologic and positional presentations of anatomical entities. Pelvic anatomical variations encountered during abdominal hysterectomy can be of clinical interest, given that misidentification of certain structures can lead to iatrogenic injuries and postoperative sequelae. The aim of the present study was to detect and highlight the anatomical structures of interest and their variations to the surgeon performing abdominal hysterectomy for benign conditions. MATERIALS AND METHODS: A narrative review of the literature was performed including reports of anatomical variations encountered in cadavers, by surgeons during abdominal hysterectomy and radiologists on computed tomography angiography, searching within a 10-year span on PubMed database. Studies regarding the treatment of malignant conditions requiring lymphadenectomy and different modes of surgical approach were reviewed with regards to the aspects relevant to benign conditions. The search was extended to the reference lists of all retrieved articles. RESULTS: Ureters and the uterine arteries, due to anatomical variations, are the anatomical structures most vulnerable during abdominal hysterectomy. Specifically, the ureters can present multiplications, retroiliac positionings and ureteric diverticula, whereas, the uterine arteries can present notable variability in their origins. Such variations can be detected preoperatively or intraoperatively. CONCLUSIONS: Although rare, the presence of anatomical variations of the uterine arteries and ureters can increase the possibility of complications should they escape detection. Intraoperative misidentification could lead to improper dissection or ligation of the affected structures. Knowledge of these variations, coupled with extensive preoperative investigation and intraoperative vigilance can minimise the risk of complications.

Knee joint kinematics from familiarised treadmill walking can be generalised to overground walking in young unimpaired subjects.

We studied the familiarisation time required for reliable sagittal-plane knee kinematics and temporal-distance gait measurements to be obtained from treadmill walking. We also studied whether knee kinematics and temporal-distance gait measurements obtained from familiarised treadmill walking can be generalised to overground walking. Sixteen subjects without pathology walked on a level overground walkway and on a treadmill. A motion measurement system was used to measure sagittal plane knee movements and temporal-distance gait parameters during overground and treadmill walking. Highly reliable knee kinematics and temporal-distance gait measurements [intraclass correlation coefficient (ICC)(2,1)>/=0.93] were found after 6 min of treadmill walking. These measurements, obtained after 6 min of treadmill walking, were highly correlated with and not significantly different to those of overground walking. Reliable measurements that can be generalised to overground walking, can be obtained from the treadmill within a familiarisation time of 6 min.