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1.
Med Educ Online ; 26(1): 1842661, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33108248

RESUMO

Methods of anatomical education have, as with many facets of normal life, been forced to evolve rapidly due to the Covid-19 pandemic. Whilst some authors claim that cadaver dissection is now under threat, we believe the centuries-old practice can and must be upheld.


Assuntos
Anatomia/educação , Infecções por Coronavirus/epidemiologia , Dissecação/educação , Educação de Graduação em Medicina , Pneumonia Viral/epidemiologia , Betacoronavirus , Cadáver , Humanos , Pandemias , Estudantes de Medicina
2.
Vestn Otorinolaringol ; 85(5): 106-108, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33140946

RESUMO

Today, endoscopic transcanal ear surgery with confident steps is becoming a practice. It will be used by the patient in repeated practice by the surgeon before being used in the patient. It is so important and popular in connection with this dissection work. Working on biomaterial sets itself several tasks: training manual skills to work with an endoscope and an instrument in the middle ear, stage-by-stage training for performing specific interventions, detailed analysis and understanding of structures anatomy and topography. This article presents a step-by-step dissection algorithm with an analysis of the each area anatomical landmarks, like a prototype. Moreover, the course of dissection allows you to work out the performance of type I tympanoplasty.


Assuntos
Endoscopia , Procedimentos Cirúrgicos Otológicos , Dissecação , Orelha Média/cirurgia , Humanos , Miringoplastia , Timpanoplastia
3.
Surg Clin North Am ; 100(6): 1069-1078, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33128880

RESUMO

Therapeutic endoscopy is an emerging field within general surgery. This article explores the evidence for and usage of endoscopic mucosal resection and endoscopic submucosal dissection throughout the gastrointestinal tract. We aim to educate surgeons and provide an understanding of these techniques. With education and appropriate training, the surgeon will gain confidence and hopefully adopt these tools into their daily practice.


Assuntos
Ressecção Endoscópica de Mucosa/métodos , Trato Gastrointestinal/cirurgia , Dissecação , Ressecção Endoscópica de Mucosa/educação , Ressecção Endoscópica de Mucosa/normas , Humanos , Curva de Aprendizado
4.
Surg Clin North Am ; 100(6): 1079-1089, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33128881

RESUMO

Advanced colonic polypectomy techniques are endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD), and they aim at organ preservation with low complication rates. Main goal of endoscopic submucosal dissection (ESD) is to accomplish en-bloc resection that will subsequently allow accurate histopathological evaluation. It consists of injection, circumferential incision, and dissection of the lesion. Steps of the procedure are discussed in detail along with technological advancements.


Assuntos
Pólipos do Colo/cirurgia , Colonoscopia/métodos , Ressecção Endoscópica de Mucosa/métodos , Pólipos do Colo/patologia , Dissecação/métodos , Humanos , Mucosa Intestinal/patologia , Mucosa Intestinal/cirurgia
5.
Surg Clin North Am ; 100(6): 1169-1182, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33128886

RESUMO

Intramural surgery is a minimally invasive surgical technique based on flexible endoscopy. The first step involves the initial mucosal incision for entry point. Then a submucosal tunnel is dissected to the site of the target anatomy. The procedure performed may include myotomy or lesion removal. When complete, the initial mucosal incision is closed. This technique separates the mucosal flap from the surgical site, minimizing the risk of full-thickness perforation and gastrointestinal leakage. Peroral endoscopic myotomy is the most studied application of intramural surgery but other procedures have emerged. This article explores principles of intramural surgery and summarizes its applications.


Assuntos
Endoscopia do Sistema Digestório/métodos , Gastroenteropatias/cirurgia , Trato Gastrointestinal/cirurgia , Membrana Mucosa/cirurgia , Dissecação , Endoscopia do Sistema Digestório/normas , Humanos , Cirurgia Endoscópica por Orifício Natural/métodos , Cirurgia Endoscópica por Orifício Natural/normas
6.
J Vis Exp ; (163)2020 09 09.
Artigo em Inglês | MEDLINE | ID: mdl-32986037

RESUMO

One of the most important things in the field of adult hippocampal neurogenesis (AHN) is the identification of the newly generated cells. The immunodetection of thymidine analogs (such as 5-Bromo-2'-deoxyuridine (BrdU)) is a standard technique used for visualizing these newly generated cells. Therefore, BrdU is usually injected in small animals intraperitoneally, so the thymidine analog gets incorporated into dividing cells during DNA synthesis. Detection is performed by immunohistochemical analysis of brain slices. Every research group that has been using this technique can appreciate that it requires special attention to minute details to achieve a successful stain. For instance, an important step is DNA denaturation with HCl, which allows it to reach the cell nucleus to stain it. However, the existing scientific reports describe very few of such steps in detail. Therefore, standardizing the technique is challenging for new laboratories as it can take several months to yield positive and successful outcomes. The purpose of this work is to describe and elaborate the steps to obtain positive and successful outcomes of the immunostaining technique in detail when working with the thymidine analog BrdU. The protocol includes the reagent preparation and setup, administration of thymidine analog in a rodent, transcardial perfusion, tissue preparation, peroxidase immunohistochemical reaction, use of avidin-biotin complex, immunofluorescence, counterstaining, microscopy imaging, and cell analysis.


Assuntos
Bromodesoxiuridina/metabolismo , Imuno-Histoquímica/métodos , Neurogênese , Timidina/análogos & derivados , Animais , Antígenos/metabolismo , Forma do Núcleo Celular , Proliferação de Células , Giro Denteado/citologia , Dissecação , Imunofluorescência , Processamento de Imagem Assistida por Computador , Imageamento Tridimensional , Masculino , Ratos Wistar , Fixação de Tecidos
8.
Facial Plast Surg ; 36(4): 351-357, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32866973

RESUMO

Rhytidectomy is a common procedure performed by facial plastic surgeons. On well-selected patients, rhytidectomy rejuvenates the aging face by repositioning soft tissues and improving facial shape. The fundamental goal of rhytidectomy, or facelift surgery, is to provide a more youthful facial appearance by elevating soft tissues that often descend with aging. The success and longevity of any rhytidectomy procedure are based on the individual patient's anatomy and aging and on the mobilization, elevation, and fixation of the soft tissues during the facelift procedure. Although surgeons often use many terms to describe a given facelift technique, anatomical terms are best used to name the facelift procedure, as the plane of dissection and the vector of elevation are what determines the end result. This paper attempts to simplify and demystify the deep plane facelift procedure and to describe the anatomy that makes this technique successful.


Assuntos
Ritidoplastia , Envelhecimento , Dissecação , Face , Humanos , Rejuvenescimento
9.
Facial Plast Surg ; 36(4): 358-375, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32866974

RESUMO

In this article, we will provide the reader with the anatomical and embryologic evidence supporting the use of the deep-plane approach in rhytidectomy and insight into the evolution of the technique into the vertical platysma advancement. The original description of the deep-plane technique only described a basic superficial muscular aponeurotic system dissection in the midface with the ability to use tension on the flap without aesthetic consequences. This plane of dissection provides additional advantages not previously described, including access to deeper anatomical structures such as the buccal fat pad, and allows in vivo assessment and treatment of jowling. We describe how extension of this dissection and selective release of facial ligaments allows us to optimize treatment outcomes and longevity, especially in cases of difficult anatomy or revisions. Further advancements include case-specific facial volume enhancement, created by complex flap design, and facial narrowing by preauricular contouring and parotid hypertrophy treatment. Insights into anatomical landmarks, technical nuances, and alternative approaches for facial variations are presented.


Assuntos
Estética Dentária , Ritidoplastia , Dissecação , Face/cirurgia , Retalhos Cirúrgicos
10.
Facial Plast Surg ; 36(4): 430-446, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32866980

RESUMO

Energy-based facelifting techniques are a relatively new genre of surgery. In this approach, the energy-based device-whether laser, radiofrequency plasma, or ultrasound-can be used in the superficial plane to elevate skin flaps before performing more traditional facelift techniques involving the superficial musculoaponeurotic system (SMAS) or platysma. The initial reports of utilizing fiber lasers as surgical tools date back to approximately 2007 and initial lipolasers were used to elevate facial skin flaps. The other energy-based devices were also tested. The author has probably the largest series of energy-based facial rejuvenation procedures, having performed over 3,000 of these procedures. The advantages of laser-assisted rhytidectomy include hemostasis, facilitated dissection in areas hard to elevate conventionally such as nasolabial folds or distal neck and the remodeling and tightening of tissue that results from the activation of the wound healing cascade of neocollagenesis and wound contraction. The author currently has a preference for energy device used during rhytidectomy and it is a high frequency ultrasound energy delivered by a five-ring 2.9- and 3.7-mm probe. The use of the ultrasound dissector in both superficial and deep procedures is highlighted in this article with emphasis on its use for deep cervicoplasty and subplatysmal procedures as well as sub-SMAS elevations of the facial deep plane.


Assuntos
Ritidoplastia , Sistema Musculoaponeurótico Superficial/cirurgia , Dissecação , Pescoço/cirurgia , Rejuvenescimento
11.
BMC Surg ; 20(1): 172, 2020 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-32736550

RESUMO

BACKGROUND: The bare area was reportedly formed by direct adhesion between the liver and diaphragm, meaning that the bare area lacked serosal components. This study aimed to analyze the structure of the bare area by an integrated study of surgical and laparoscopic images and pathological studies and describe surgical procedures focusing on the multilayered structure. METHODS: Several surgical specimens of hepatectomy were analyzed histologically to evaluate the macroscopic structure of the bare area. Laparoscopic images and cadaver anatomy of the bare area were also examined. RESULTS: The multilayered structure of the bare area comprised the liver, sub-serosal connective tissue, liver serosa, parietal peritoneum, retroperitoneal connective tissue, epimysium of the diaphragm, and diaphragm, in order from the liver to the diaphragm. The liver serosa and the parietal peritoneum fused with each other. This multilayered structure of the bare area is observed almost constantly. There are two layers in the dissection of the bare area in surgical procedures, an outer layer of the fused peritoneum (near the diaphragm) and an inner layer of the fused peritoneum (near the liver). Laparoscopic images enabled us to recognize the multilayered structure of the bare area. CONCLUSIONS: Histopathological findings showed the bare area to be a multilayered structure. In cases where tumors are located underneath the bare area, it could be important to dissect the bare area, with careful attention to its multilayered structure. Surgical dissection of the bare area in the outer layer of the fused peritoneum could allow a sufficient safety margin.


Assuntos
Carcinoma Hepatocelular/cirurgia , Neoplasias do Colo/cirurgia , Hepatectomia , Neoplasias Hepáticas , Fígado/cirurgia , Peritônio/cirurgia , Idoso , Cadáver , Carcinoma Hepatocelular/patologia , Neoplasias do Colo/patologia , Diafragma/patologia , Diafragma/cirurgia , Dissecação , Feminino , Hepatectomia/métodos , Humanos , Laparoscopia , Fígado/anatomia & histologia , Fígado/patologia , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/secundário , Neoplasias Hepáticas/cirurgia , Masculino , Pessoa de Meia-Idade , Peritônio/anatomia & histologia , Peritônio/patologia , Membrana Serosa/anatomia & histologia , Membrana Serosa/patologia , Membrana Serosa/cirurgia
13.
Int. j. morphol ; 38(4): 1142-1147, Aug. 2020. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1124907

RESUMO

Disorders in the course of the neurovascular bed of the sexual neurovascular bundle (NVB) entail problems of gynecological, andrological and urological nature, for example, the state of impotence in men. The aim of the study was to establish a method to determine a projection. The Arteria pudenda interna, Vena pudenda interna and Nervus pudendus (sexual neurovascular bundle or NVB) from the infrapiriform foramen to the Alcock's canal (pudendal canal) in which the pudendal neurovascular bundle runs. Topographic and anatomical study was performed on 15 corpses without organ complex (remote shore): 9-from men and 6-women, aged 36 to 74 years. Each object of study (corpse) included 2 pairs of sexual NVB, a total of 30 investigated. The information obtained on the projection branches of the pudendal nerve, and pudendal internal artery and pudendal internal vein from infrapiriform foramen to the entrance of the pudendal canal. A method for determining the projection of sexual NVB in the gluteal region was developed. The projection of Arteria pudenda interna, Vena pudenda interna and Nervus pudendus from the infrapiriform foramen in the gluteal region and to the entrance of the pudendal canal is determined. The morphometric data necessary for the mathematical equation developed by us for the calculation of the boundaries of the projection of the desired plane in the course of the sexual NVB are obtained . Using these data in the method of mathematical calculation developed by us using the formula C'c' = 0,2679 x (A'G-AD+3), we determined the projection of the figure, in the form of a trapezoid, in the center of which the projection of the sexual NVB is determined.A method for determining the projection of the sexual neurovascular bundle in the gluteal region for diagnosis and therapeutic effects on sexual NPS was developed.


Los trastornos en el curso de las estructuras del haz neurovascular sexual conllevan problemas de naturaleza ginecológica, andrológica y urológica, por ejemplo, el estado de impotencia en los hombres. El objetivo de este estudio fue establecer un método para determinar una proyección de los vasos pudendos internos y el nervio pudendo (haz neurovascular sexual o HNV) desde el foramen infrapiriforme hasta el canal de Alcock (canal pudendo). Se realizó un estudio topográfico y anatómico en 15 cadáveres: 9 hombres y 6 mujeres, entre 36 y 74 años. Se analizaron 30 muestras, cada cadáver incluyó 2 pares de HNV sexuales. Se obtuvo información sobre las ramas de proyección de la arteria, y vena pudenda interna y del nervio pudendo, desde el foramen infrapiriforme hasta la entrada al canal pudendo. Se desarrolló un método para determinar la proyección de NVB sexual en la región glútea. La proyección de la vena pudenda interna y del nervio pudendo se determinó desde el foramen infrapiriformis en la región glútea, hasta la entrada del canal pudendo. Se obtuvieron datos morfométricos necesarios para la ecuación matemática y obtener el cálculo de los límites de la proyección del plano deseado en el curso de la HNV sexual. Usando estos datos se utilizó la fórmula C'c '= 0,2679 x (A'G-AD + 3), y se realizó la proyección de la figura, en forma de trapecio, en el centro del cual se determinó la proyección de la HNV sexual. Se desarrolló un método para la proyección del haz neurovascular sexual en la región glútea, en el diagnóstico y los efectos terapéuticos sobre el NPS sexual.


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Artérias/anatomia & histologia , Nervo Pudendo/anatomia & histologia , Cadáver , Dissecação
14.
Int. j. morphol ; 38(4): 1065-1073, Aug. 2020. graf
Artigo em Espanhol | LILACS | ID: biblio-1124898

RESUMO

El jugar fue resignificado por Huizinga como un recurso didáctico y se lo denominó "ludoaprendizaje", "aprendizaje mediado por el juego" o "técnicas lúdicas". Diversos autores estudiaron su aplicación en distintos contextos fue desarrollado como estrategia didáctica por los impulsores de la Escuela Nueva. Distintos autores (Brunner, Frebel, Decroly, Montessori, Cossettini y Freire) han analizado sus proyecciones pedagógicas y resaltaron el valor formativo e impacto en las estrategias cognitivas para la resolución de problemas, desarrollar la atención y memoria, así como elemento motivador y de creatividad. El objetivo es evaluar el impacto de esta intervención didáctica en las concepciones culturales y conceptuales referidas al material cadavérico durante el TP y su afrontamiento. Realizamos un sstudio observacional y transversal mediante una encuesta aplicada a 658 alumnos (año 2016=198; año 2017= 228; año 2018= 232) que incluyó la Escala de ansiedad ante la muerte de Temple -EAM- modificada, preguntas poblacionales (edad, sexo, lugar de nacimiento, situación en la materia, aspectos laborales, estudios previos, motivaciones en relación con la elección de la carrera) y se indagaron términos asociados a los conceptos "material cadavérico" y "pieza anatómica" con la técnica de listados libres de Bernard y la técnica de montones para investigar concepciones culturales e imaginarios y grupos de dimensiones conceptuales. Dado que la arquitectura de la Cátedra divide a los alumnos en 2 salones distintos, para evaluar diferencias con la inclusión de actividades lúdicas en un grupo. Los resultados fueron procesados con pruebas de estadística descriptiva e inferencial (SPSS para dicho análisis y realización de dendogramas), para análisis de los términos Visual Anthropac Freelists versión: 1.0.1.36 y Visual Anthropac Pilesorts versión: 1.0.2.60. El presente trabajo cumple con los reparos ético-legales y normativos vigentes. Observamos que los términos "material cadavérico" y "pieza anatómica" se asociaron con repugnancia, asco, miedo y elemento de estudio, principalmente. En el grupo de alumnos con técnicas lúdicas se objetivó menor cantidad de términos negativos, así como dimensiones conceptuales más relacionadas con el material como recurso instruccional didáctico y no como factor de distrés. En conclusión, la implementación de técnicas lúdicas en la didáctica del proceso enseñanza y aprendizaje con material cadavérico en la materia Anatomía se asoció con un menor impacto negativo en los términos asociados y dimensiones conceptuales referidos al material cadavérico. Dicho impacto tiene injerencia en el contexto de la enseñanza y se asociaría con la disminución de factores negativos en el afrontamiento cadavérico.


The act of playing is as ancient as humanity itself, yet Huizinga was the one who re-signified the concept of "ludic" as a didactive resource related to culture. Play-based learning was developed as a didactic strategy by the forerunners of the New School. Several Authors (Brunner, Frebel, Decroly, Montessori, Cossettini and Freire) have analyzed its pedagogy projections and stressed the impact and formative value in the cognitive strategies involved in problem solving tasks, attention and memory development, as well it's motivational and creativity elements. The object of the present work is to evaluate the impact of these didactic interventions in the cultural and conceptual conceptions of the students related to cadaveric material in the course of practical working during anatomy classes. Observational and transversal study through a questionnaire applied to 658 medical students (2016, n = 198; 2017, n= 228; 2018 n=232) which included a Modified Templer Death Anxiety Scale, population questions (age, gender, place of birth, situation regarding the subject, work-related aspects, former studies, motivations related to career choice). Terminology related to "cadaveric material" and "anatomic piece" was investigated with Bernard's free-listing and lot-drawing techniques in order to investigate cultural and imaginary conceptions and groups of conceptual dimensions. The class structure divides the students in two different ckassrooms, in order to evaluate difference with the inclusion of play-based activities in one of them. The results were processed using tests of descriptive and inferencial statistics (SPSS and dendrogram making), to evaluate the terminological analysis, Visual Anthropac Freelists versión: 1.0.1.36 and Visual Anthropac Pilesorts versión: 1.0.2.60. The present research takes into account all current ethical and legal norms. It has been observed that terms such as "cadaveric material" and "anatomic piece" were associated mainly with repugnancy, disgust, fear and study material. It was observed, in the group of student using play based techniques, a lesser number of negative terminology, as well as conceptual dimensions related with the material as a didactic and instructional resource instead of a distress factor. In conclusion the implementation of play-based techniques in the learning process of the Anatomy coursework was positively associated with a lesser negative impact in both associated terminology and in conceptual dimensions related to cadaveric material. Such an impact is of particular importance in the context of teaching and it would relate with the decrease of negative factors in cadaveric affronting.


Assuntos
Humanos , Masculino , Feminino , Estudantes de Medicina/psicologia , Atitude Frente a Morte , Dissecação/psicologia , Educação Médica/métodos , Jogos Recreativos , Anatomia/educação , Ansiedade , Cadáver , Adaptação Psicológica , Estudos Transversais , Inquéritos e Questionários , Cultura , Medo , Neurociência Cognitiva , Aprendizagem
15.
Medicine (Baltimore) ; 99(31): e21475, 2020 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-32756171

RESUMO

RATIONALE: Typically, the tendon of the pectoralis major inserts into the crest of the greater tubercle of the humerus. However, anomalous insertion sites of the pectoralis major tendons have been noted. PATIENT CONCERNS: The cadaver of a 95-year-old Japanese man was selected from the bodies used for gross anatomy practice at the Tokai University School of Medicine in 2018. DIAGNOSIS: In this cadaver, the left side of the pectoralis major tendon appeared to insert at the crest of the greater tubercle and lesser tubercle of the humerus, forming a tunnel measuring 2.5 cm in total length. INTERVENTION: We removed the fat and skin around the shoulder joint and upper extremity for observational purposes and carefully examined the structures during gross anatomy. OUTCOMES: The medial side of the insertion of the pectoralis major tendon was not into the humerus but had combined with the tendon of the latissimus dorsi, which then loosely inserted into the humerus. As the roof and both walls comprised the tendon of the pectoralis major and the floor was formed by the tendon of the latissimus dorsi and humerus, the structure formed a tunnel. LESSONS: This study is important for orthopedic and rehabilitation physicians in treating diseases of the long head of the biceps brachii tendon. As part of management, the condition of the tendon of the pectoralis major should be confirmed using magnetic resonance imaging or echocardiography.


Assuntos
Músculos Peitorais/anatomia & histologia , Músculos Superficiais do Dorso/anatomia & histologia , Tendões/anormalidades , Idoso de 80 Anos ou mais , Pontos de Referência Anatômicos , Cadáver , Dissecação , Humanos , Masculino
16.
PLoS One ; 15(8): e0237043, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32750081

RESUMO

The aim of this study was to clarify the heights and spatial relationships of the facial muscles acting on the nasolabial fold (NLF) by dissection and three-dimensional microcomputed tomography for use in aesthetic treatments. This study used 56 specimens from 34 embalmed adult Korean. A reference line (RF) was set to imitate the NLF after removing the skin, from the superior point of the alar facial crease to the lateral point of the orbicularis oris muscle at the level of the corner of the mouth. The heights and spatial relationships of the facial muscles along the RF could be categorized into five main patterns. The dominant pattern was that the levator labii superioris alaeque nasi muscle (LLSAN), levator labii superioris muscle (LLS), zygomaticus minor muscle (Zmi), and zygomaticus major muscle (Zmj) were on the medial third, medial half, middle third, and lateral third of the RF, respectively. In micro-CT imaging, beneath the skin of the medial half of the NLF, the LLSAN and Zmi fibers inserted into the dermis of the NLF and adjacent to the NLF. Beneath the skin of the middle third of the NLF, the Zmi fibers were found before the muscle inserted into the dermis of the NLF and adjacent to the NLF. Beneath the skin of the lateral third of the NLF, the lateral margin of the orbicularis oris muscle and some Zmj fibers were found at the location of the NLF. The present study utilized dissections and micro-CT to reveal the general pattern and variations of heights and spatial relationships of the facial muscles passing beneath the NLF. These findings will be useful for understanding which muscles affect specific parts of NLFs with various contours, for reducing the NLF in aesthetic treatments, and for reconstructing the NLF in cases of facial paralysis.


Assuntos
Músculos Faciais/anatomia & histologia , Sulco Nasogeniano/anatomia & histologia , Cadáver , Dissecação , Feminino , Humanos , Masculino , República da Coreia , Microtomografia por Raio-X
18.
Eur. j. anat ; 24(4): 277-280, jul. 2020. ilus
Artigo em Inglês | IBECS | ID: ibc-193960

RESUMO

Many muscular variations of the upper extremity have been reported. The majority of these variations are associated with forearm muscles. However, the muscular variations of the hand are uncommon. In the current study we found a unique supernumerary muscle in the right hand of a middle-aged male cadaver. This muscle originated from the one of the tendons of flexor digitorum superficialis (FDS) muscle that goes to the index finger and then traversed 5 cm distally to attach the same tendon. The knowledge of muscular variations is very essential for surgeons and clinicians to plan the standard surgical approaches


No disponible


Assuntos
Humanos , Mãos/anatomia & histologia , Mãos/inervação , Cadáver , Músculos/anatomia & histologia , Dissecação/métodos , Variação Anatômica
19.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(7): 670-675, 2020 Jul 25.
Artigo em Chinês | MEDLINE | ID: mdl-32683829

RESUMO

The introduction of total mesorectal excision and wider use of laparoscopic surgery pushed the field of colorectal surgery into an era of interfasical dissection. The Japanese suggestion of fascial arrangement of the trunk in a multilaminar, symmetrical and parallel way helps in better understanding of fascial relationship and interfascial planes surrounding the colon and the rectum. However, different interpretations of the multilayer retroperitoneal fascial relationship, complexity of fascial structures within the pelvis and dense adhesion between two apposed fasciae at special points make it still challenging for the surgeon to decide on the precise interfascial plane for colorectal mobilization. Small vessels on fasica propria of the rectum and various retroperitoneal fascia, especially ureterohypogastric fascia show distinctive features. The root of small vessels on fascia propria of the rectum helps to identify the anterolateral and posterolateral interfascial plane in the middle and low rectum. The longitudinal trajectory of small vessel on ureterohypogastric fascia and scarcity interfascial vascular communication between mesocolic and retroperitoneal fascia help the surgeon to find and stay in the interfacial plane during colorectal mobilization. More knowledge of fascial and interfascial plane will certainly help achieve better mesocolic mesorectal integrity and reduce the risk of injuries to autonomic nerves. More anatomical, histological and embryological studies are warranted with respect to relationship between small vessels and fasciae.


Assuntos
Neoplasias do Colo/cirurgia , Fáscia/anatomia & histologia , Mesentério/cirurgia , Neoplasias Retais/cirurgia , Colectomia/efeitos adversos , Colectomia/métodos , Colo/anatomia & histologia , Colo/cirurgia , Dissecação , Fáscia/irrigação sanguínea , Humanos , Mesentério/anatomia & histologia , Mesentério/irrigação sanguínea , Traumatismos dos Nervos Periféricos/etiologia , Traumatismos dos Nervos Periféricos/prevenção & controle , Peritônio/anatomia & histologia , Peritônio/irrigação sanguínea , Peritônio/cirurgia , Protectomia/efeitos adversos , Protectomia/métodos , Reto/anatomia & histologia , Reto/cirurgia
20.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(7): 689-694, 2020 Jul 25.
Artigo em Chinês | MEDLINE | ID: mdl-32683831

RESUMO

Objective: To observe the anatomical architecture of rectosacral fascia and discuss the best plan for accurate peri-rectal dissection in laparoscopic/robotic total mesorectal resection (TME). Methods: A descriptive cohort study was carried out. A total of 127 patients with rectal cancer who underwent TME in the Department of Colorectal Surgery at the affiliated Union hospital of Fujian Medical University were included, patients' demographics with their pathological details and operation videos were collected for analysis. Another 20 high-definition images of post-TME surgical specimens were collected from our digital database. A total of 28 cadaveric models were examined at the Laboratory of Clinical Applied Anatomy, Fujian Medical University, to observe the anatomical details of rectosacral fascia. Results: (1) Anatomical observation showed that the pre-hypogastric fascia attaches to the proper fascia of the mesorectum in a horizontal arc posteriorly, forming the rectosacral fascia. If this fusion couldn't be identified and appropriately transected during posterior space dissection, it would be easy to destroy the proper fascia and dissect through the mesorectum resulting in residual mesorectum tissue. After the fascia transaction, the proper fascia of the mesorectum is still intact distally. The upper part of rectosacral fascia bilaterally re-separated again into the proper fascia and pre-hypogastric fascia. The pre-hypogastric fascia acts as a "fascia barrier" when dissecting the lateral space constantly from posterior to anterior. The right attachment of the rectosacral fascia was gradually transected. The pelvic plexus from the right S2-S4 was covered by the pre-hypogastric fascia which is considered the outer side layer of rectosacral fascia laterally. It was observed that the fascia continued with the anterior layer of the Denonvilliers' fascia, which has been transected during anterior space dissection. The proper fascia, which is the inner side layer of rectosacral fascia laterally, was still intact. The edge of the right rectosacral fascia attachment ran obliquely from the back and upward into the front direction. The left extension was similar to the right. (2) Cadaveric specimens: at the level of the lower edge of S4 vertebral body, the pre-hypogastric fascia fused with the proper fascia to form the rectosacral fascia. The right attachment margin of the rectosacral fascia was cut off step by step. The attachment margin of the rectosacral fascia went from the back and upward to the front downward direction. The right edge of rectosacral fascia attachment continued with the anterior layer of the Denonvilliers' fascia at the pre-rectal space and attached to the pre-hypogastric fascia laterally. The pelvic plexus sends out many tiny rectal branches on the anterolateral side, which pass through the transitional area between pre-hypogastric fascia and the anterior layer of the Denonvilliers' fascia to innervate the rectum. (3) TME specimens observation: the posterior attachment of rectosacral fascia was curved around the mesorectum with bilateral oblique attachments. The mesorectum was covered by fusion fascia below the posterior and bilateral attachment margin while it was covered only by the proper fascia above it. Conclusion: according to the morphological characteristics of rectosacral fascia, the rectosacral fascia should be dissected at the level of S4 vertebral body posterior to the rectum in an arc, shape and then enter the superior-levator space. Before dissecting the bilateral spaces, the anterior space of the rectum should be dissected first. The anterior layer of the Denonvilliers' fascia should be cut off into an inverted "U" shape, and then the lateral space should be dissected from anterior to posterior. Finally, the lateral attachment of rectosacral fascia was transected to ensure the integrity of the mesorectum without damaging the pelvic plexus branches and NVB.


Assuntos
Fáscia/anatomia & histologia , Fasciotomia/métodos , Mesentério/cirurgia , Protectomia/métodos , Neoplasias Retais/cirurgia , Cadáver , Estudos de Coortes , Dissecação , Humanos , Laparoscopia , Mesentério/anatomia & histologia , Reto/anatomia & histologia , Reto/cirurgia , Procedimentos Cirúrgicos Robóticos , Sacro
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