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Surgical Endoscopy Apr 2022The pelvic autonomic nerves control and regulate anorectal and urogenital function. The dysfunction of pelvic autonomic nerves lead to disorders of anorectum, bladder... (Clinical Trial)
Clinical Trial
BACKGROUND
The pelvic autonomic nerves control and regulate anorectal and urogenital function. The dysfunction of pelvic autonomic nerves lead to disorders of anorectum, bladder and male sex organs. Thus the intraoperative identification of pelvic autonomic nerves could be crucial in complications prevention and diseases treatment. Our clinical trial aims at estimating the effectiveness and validity of intraoperative indocyanine green fluorescence imaging in pelvic autonomic nerves identification.
METHODS
Intraoperative fluorescence imaging using indocyanine green was performed in ten patients and the feasibility was determined. From February 2019 to June 2019, the seven patients undergoing laparoscopic colorectal resection was administrated 4.5 mg/Kg indocyanine green 24 h before surgery. The near-infrared fluorescence imaging was conducted during surgery. A novel white light and near-infrared dual-channel laparoscopic equipment was applied. For each patient, signal-background ratio values for pelvic autonomic nerves were recorded and analyzed.
RESULTS
We confirmed the dose and timing of indocyanine green administration was 4.5 mg/Kg and 24 h before surgery. Using the dual laparoscopic equipment, we could observe the splanchnic plexus, inferior mesenteric artery plexus, and sacral plexus successfully with a high signal background ratio value of 3.18 (standard deviation: 0.48).
CONCLUSION
This pilot trial shows feasibility of intraoperative indocyanine green fluorescence imaging in pelvic autonomic nerves observation. It demonstrates that nerves can be visualized using alternative imaging techniques but it is not ready yet for prime time. This technique might aid observation with white light alone.
REGISTRATION NUMBER
ChiCTR1900025336.
Topics: Autonomic Pathways; Female; Humans; Indocyanine Green; Laparoscopy; Male; Optical Imaging; Pelvis; Pilot Projects
PubMed: 33909127
DOI: 10.1007/s00464-021-08512-z -
The British Journal of Radiology 2016The management of trauma patients has evolved in recent decades owing to increasing availability of advanced imaging modalities such as CT. Nowadays, CT has replaced the... (Review)
Review
The management of trauma patients has evolved in recent decades owing to increasing availability of advanced imaging modalities such as CT. Nowadays, CT has replaced the diagnostic function of angiography. The latter is considered when a therapeutic option is hypothesized. Arterial embolization is a life-saving procedure in abdominopelvic haemorrhagic patients, reducing relevant mortality rates and ensuring haemodynamic stabilization of the patient. Percutaneous transarterial embolization has been shown to be effective for controlling ongoing bleeding for patients with high-grade abdominopelvic injuries, thereby reducing the failure rate of non-operative management, preserving maximal organ function. Surgery is not always the optimal solution for stabilization of a patient with polytrauma. Mini-invasivity and repeatability may be considered as relevant advantages. We review technical considerations, efficacy and complication rates of hepatic, splenic, renal and pelvic embolization to extrapolate current evidence about transarterial embolization in traumatic patients.
Topics: Abdominal Injuries; Embolization, Therapeutic; Hemorrhage; Humans; Pelvis; Radiology, Interventional; Tomography, X-Ray Computed; Wounds, Nonpenetrating
PubMed: 26642310
DOI: 10.1259/bjr.20150866 -
Annals of Surgery Jul 2023Magnetic resonance imaging-based subdivision of the pelvis into 7 compartments has been proposed for pelvic exenteration. The aim of the present anatomical study was to...
OBJECTIVE
Magnetic resonance imaging-based subdivision of the pelvis into 7 compartments has been proposed for pelvic exenteration. The aim of the present anatomical study was to describe the topographic anatomy of these compartments and define relevant landmarks and surgical dissection planes.
BACKGROUND
Pelvic anatomy as it relates to exenterative surgery is complex. Demonstration of the topographic peculiarities of the pelvis based on the operative situs is hindered by the inaccessibility of the small pelvis and the tumor bulk itself.
MATERIALS AND METHODS
Thirteen formalin-fixed pelvic specimens were meticulously dissected according to predefined pelvic compartments. Pelvic exenteration was simulated and illustrated in a stepwise manner. Different access routes were used for optimal demonstration of the regions of interest.
RESULTS
All the 7 compartments (peritoneal reflection, anterior above peritoneal reflection, anterior below peritoneal reflection, central, posterior, lateral, inferior) were investigated systematically. The topography of the pelvic fasciae and ligaments; vessels and nerves of the bladder, prostate, uterus, and vagina; the internal iliac artery and vein; the course of the ureter, somatic (obturator nerve, sacral plexus), and autonomic pelvic nerves (inferior hypogastric plexus); pelvic sidewall and floor, ischioanal fossa; and relevant structures for sacrectomy were demonstrated.
CONCLUSIONS
A systematic approach to pelvic anatomy according to the 7 magnetic resonance imaging-defined compartments clearly revealed crucial anatomical landmarks and key structures facilitating pelvic exenterative surgery. Compartment-based pelvic anatomy proved to be a sound concept for beyond TME surgery and provides a basis for tailored resection procedures.
Topics: Male; Female; Humans; Pelvis; Rectal Neoplasms; Rectum; Hypogastric Plexus; Peritoneum
PubMed: 36538640
DOI: 10.1097/SLA.0000000000005715 -
International Braz J Urol : Official... 2022
Topics: Humans; Pelvis
PubMed: 35373953
DOI: 10.1590/S1677-5538.IBJU.2022.03.04 -
Scientific Reports May 2021The EOS is a medical imaging system that incorporates simultaneous orthogonal images, producing three-dimensional (3D) reconstructions of the whole skeletal system in...
The EOS is a medical imaging system that incorporates simultaneous orthogonal images, producing three-dimensional (3D) reconstructions of the whole skeletal system in various functional positions. Despite growing interest in the pelvic 3D position, the validity of the EOS has not yet been well studied. We investigated the trueness and precision of EOS imaging for pelvic parameters and orientation and assessed whether the measurement using the EOS was affected by the pelvic orientation itself. The orientation of the anterior pelvic plane and pelvic parameters of a custom-made pelvic phantom were measured by three raters using the EOS, and the measurements obtained were compared with the true values. The standard deviations of the measurement errors were 3.23°, 0.26°, 0.23°, 2.98°, 0.88°, and 3.22° for flexion, obliquity, rotation, pelvic incidence, spinopelvic tilt, and sacral slope, respectively. The root-mean square averages of the standard deviation of each measurement were 4.05°, 0.41°, 0.28°, 4.80°, 0.99°, and 5.13°, respectively. The measurement errors for sacral slope correlated significantly with geometric means of flexion, obliquity, and rotation (r = 0.364, p = 2.67 × 10). The EOS rendered accurate and reliable measurements regarding pelvic 3D position, even with positional variation, but positional variation could affect measurements of sacral slope.
Topics: Computer Simulation; Humans; Imaging, Three-Dimensional; Pelvis; Phantoms, Imaging; Posture; Reproducibility of Results; Sacrum; Software
PubMed: 34001983
DOI: 10.1038/s41598-021-89958-y -
Abdominal Imaging Aug 2015
Topics: Abdomen; Abdominal Neoplasms; Humans; Magnetic Resonance Imaging; Multimodal Imaging; Pelvic Neoplasms; Pelvis; Positron-Emission Tomography
PubMed: 26216376
DOI: 10.1007/s00261-015-0511-z -
Radiographics : a Review Publication of... 2020Venous thromboembolism (VTE), which includes deep venous thrombosis and pulmonary embolism, is a significant cause of morbidity and mortality. In recent decades, US, CT,... (Review)
Review
Venous thromboembolism (VTE), which includes deep venous thrombosis and pulmonary embolism, is a significant cause of morbidity and mortality. In recent decades, US, CT, and MRI have surpassed catheter-based angiography as the imaging examinations of choice for evaluation of vascular structures and identification of thrombus owing to their ready availability, noninvasive nature, and, in the cases of US and MRI, lack of exposure to ionizing radiation. As a result, VTE and associated complications are commonly identified in day-to-day radiologic practice across a variety of clinical settings. A wide range of hereditary and acquired conditions can increase the risk for development of venous thrombosis, and many patients with these conditions may undergo imaging for unrelated reasons, leading to the incidental detection of VTE or one of the associated complications. Although the development of VTE may be an isolated occurrence, the imaging findings, in conjunction with the clinical history and vascular risk factors, may indicate a predisposing condition or underlying diagnosis. Furthermore, awareness of the many clinical conditions that result in an increased risk of venous thrombosis may aid in detection of thrombus and any concomitant complications. For these reasons, it is important that practicing radiologists be familiar with the multimodality imaging findings of thrombosis, understand the spectrum of diseases that contribute to the development of thrombosis, and recognize the potential complications of hypercoagulable states and venous thrombosis. RSNA, 2020.
Topics: Abdominal Cavity; Humans; Pelvis; Thrombophilia; Venous Thrombosis
PubMed: 32330086
DOI: 10.1148/rg.2020190097 -
Obstetrics and Gynecology May 2019To further evaluate relationships of the pelvic ureter to clinically relevant structures and to characterize the anatomy, histology, and nerve density of the distal... (Observational Study)
Observational Study
OBJECTIVE
To further evaluate relationships of the pelvic ureter to clinically relevant structures and to characterize the anatomy, histology, and nerve density of the distal ureter.
METHODS
In this observational cadaveric study, 35 female cadavers were examined, 30 by gross dissections and five microscopically. Ureter length and segments of pelvic ureter were measured. Closest distances between the ureter and clinically relevant points were recorded. The distal pelvic ureter and surrounding parametrium were evaluated microscopically. Nerve density was analyzed using automated quantification of peripheral nerve immunostaining. Average measurements of nerve density in the anterior and posterior quadrants surrounding the ureter were statistically compared using a two-tailed t test. Descriptive statistics were used for analyses with distances reported as mean±SD (range).
RESULTS
Gross dissections revealed ureter length of 26.3±1.4 (range 24-29) cm (right), 27.6±1.6 (25-30.5) cm (left). Lengths of ureter from pelvic brim to uterine artery crossover were 8.2±1.9 (4.4-11.5) cm (right), 8.5±1.5 (4.5-11.5) cm (left) and from crossover to bladder wall 3.3±0.7 (2.4-5.8) cm (right), 3.2±0.4 (2.6-4.1) cm (left). Intramural ureter length was 1.5±0.3 (1-2.2) cm (right) and 1.7±1.2 (0.8-2.5) cm (left). Distances from the ureter to uterine isthmus: median 1.7 (range 1-3.0) cm (right) and 1.7 (1.0-2.9) cm (left); lateral anterior vaginal fornix 1.5 (1.0-3.1) cm (right) and 1.7 (0.8-3.2) cm (left); lateral vaginal apex 1.3 (1.0-2.6) cm (right) and 1.2 (1.1-2.2) cm (left) were recorded. Microscopy demonstrated denser fibrovascularity posteromedial to the ureter. Peripheral nerve immunostaining revealed greater nerve density posterior to the distal ureter.
CONCLUSION
Proximity of the ureter to the uterine isthmus and lateral anterior vagina mandates careful surgical technique and identification. The intricacy of tissue surrounding the distal ureter within the parametrium and the increased nerve density along the posterior distal ureter emphasizes the importance of avoiding extensive ureterolysis in this region.
Topics: Aged; Aged, 80 and over; Cadaver; Female; Humans; Middle Aged; Pelvis; Ureter; Urinary Bladder; Vagina
PubMed: 30969205
DOI: 10.1097/AOG.0000000000003221 -
American Journal of Physical... Sep 2020Obstetric demands have long been considered in the evolution of the pelvis, yet consideration of the interaction of pregnancy, the pelvis, and the gastrointestinal tract...
OBJECTIVES
Obstetric demands have long been considered in the evolution of the pelvis, yet consideration of the interaction of pregnancy, the pelvis, and the gastrointestinal tract (gut) is lacking. Here, we explore sex differences in the relationship of gut volume with body size and pelvic dimensions.
MATERIALS AND METHODS
Computed tomography (CT) scans of living adult Homo sapiens (46 females and 42 males) were obtained to measure in vivo gut volume (GV) and to extract 3D models of the pelvis. We collected 19 3D landmarks from each pelvis model to acquire pelvic measurements. We used ordinary least squares regression to explore relationships between GV and body weight, stature, and linear pelvic dimensions.
RESULTS
The gut-pelvis relationship differs between males and females. Females do not exhibit significant statistical correlations between GV and any variable tested. GV correlates with body size and pelvic outlet size in males. GV scales with negative allometry relative to body weight, stature, maximum bi-iliac breadth, inferior transverse outlet breadth, and bispinous distance in males.
DISCUSSION
The lack of association between GV and body size in females may be due to limits imposed by the anticipation of accommodating a gravid uterus and/or the increased plasticity of the pelvis. The pattern of relationship between GV and the pelvic outlet suggests the role of the bony pelvis in supporting the adominal viscera in females may be small relative to its role in childbirth. We conclude that gut size inference in fossil hominins from skeletal proxies is limited and confounded by sexual dimorphism.
Topics: Adult; Anatomic Landmarks; Anthropology, Physical; Anthropometry; Female; Gastrointestinal Tract; Humans; Male; Pelvis; Pregnancy; Sex Characteristics
PubMed: 32519366
DOI: 10.1002/ajpa.24084 -
Gynecologic Oncology May 2022The term 'out-of-the-box surgery' in gynecologic oncology was recently coined to describe the resection of tumor growing out of the endopelvic cavity. In the specific... (Review)
Review
The term 'out-of-the-box surgery' in gynecologic oncology was recently coined to describe the resection of tumor growing out of the endopelvic cavity. In the specific case of pelvic sidewall involvement, a laterally extended pelvic resection may be required. As previously defined by Höckel, this resection requires the en bloc removal of structures including the pelvic sidewall muscles, bones, nerves, and/or major vessels. This complex radical procedure leads to tumor-free margins in more than 75% of the patients, with reliable functional results. The rate of recurrence and overall survival are directly correlated with clear resection margins. Progress in imaging, surgical techniques, and perioperative care currently offer the opportunity to attempt surgical curative resection in selected patients for whom palliative therapy was the only alternative. However, the procedure is associated with a high rate of major postoperative complications affecting up to 60% of patients. Multidisciplinary expert centers are the most likely to achieve this complex surgery with favorable oncological outcomes. The aim of this review is to summarize the key issues of out-of-the-box surgery in gynecologic cancer.
Topics: Female; Genital Neoplasms, Female; Humans; Neoplasm Recurrence, Local; Pelvic Exenteration; Pelvis; Postoperative Complications
PubMed: 35331571
DOI: 10.1016/j.ygyno.2022.03.002