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The Journal of Thoracic and... Sep 2019
Topics: Arteries; Axillary Artery; Catheterization; Dissection
PubMed: 30770118
DOI: 10.1016/j.jtcvs.2018.11.146 -
European Archives of... Jan 2022The objective of this study is to describe the detailed surgical anatomy of the infracochlear approach to prevent complications and to compare the postauricular...
PURPOSE
The objective of this study is to describe the detailed surgical anatomy of the infracochlear approach to prevent complications and to compare the postauricular transcanal microscopic and endoscopic approaches to reach the petrous apex.
METHODS
Cadaver heads were dissected using a binocular surgical microscope, endoscopes, and an electric drill. The dimensions of the access field that could be reached and manipulated with surgical instruments and straight drill via postauricular transcanal microscopic and endoscopic approaches were evaluated.
RESULTS
Both postauricular microscopic and transcanal endoscopic approaches were considered to be inapplicable in cases with a tympanic cavity located jugular bulb closer than 3 mm to the cochlea. This relationship was seen in 3 (9%) sides of the cadavers. In 4 specimens (12%), a cochlear aqueduct with an open lumen was detected. Both postauricular microscopic and transcanal endoscopic approaches reached a nearly identic dissection area. Detailed anatomy of the approach and measurements about the topography of the third portion of the facial nerve from the tympanic cavity were presented.
CONCLUSION
Both traditional microscopic postauricular and endoscopic transcanal approaches provided comparable access areas to the inferior petrous apex with wide exposure, and radiologic measurements were compatible. A tympanic cavity located jugular bulb in close relation with cochlea was the only instance that restricted the applicability of this technique.
Topics: Cadaver; Cochlea; Dissection; Endoscopy; Humans; Petrous Bone
PubMed: 33532901
DOI: 10.1007/s00405-021-06635-6 -
Journal of Clinical Gastroenterology Jul 2022Third space endoscopy (TSE), a type of natural orifice transluminal endoscopic surgery, was first introduced a decade ago, and since then, has revolutionized the field... (Review)
Review
Third space endoscopy (TSE), a type of natural orifice transluminal endoscopic surgery, was first introduced a decade ago, and since then, has revolutionized the field of therapeutic endoscopy. TSE involves tunneling into the submucosal space between the intestinal mucosa and the muscularis propria. By accessing this "third space," endoscopists can perform minimally invasive myotomies, resections, and dissections while maintaining the mucosa and preventing full-thickness perforation. TSE procedures can be used to treat motility disorders as well as neoplasms throughout the gastrointestinal tract, which were traditionally conditions that would require open or laparoscopic surgery. The main TSE procedures include peroral endoscopic myotomy, gastric peroral endoscopic myotomy, Zenker peroral endoscopic myotomy, submucosal tunneling for endoscopic resection, endoscopic submucosal tunnel dissection, peroral endoscopic tunneling for restoration of the esophagus, and per-rectal endoscopic myotomy. Some of those procedures have now been accepted as viable alternative to surgical techniques due to their limited invasiveness, safety and cost. This review will explore the different techniques recently added to our arsenal while describing their potential efficacy and limitations.
Topics: Dissection; Endoscopy, Gastrointestinal; Esophageal Achalasia; Esophageal Sphincter, Lower; Humans; Intestinal Mucosa; Natural Orifice Endoscopic Surgery
PubMed: 35357336
DOI: 10.1097/MCG.0000000000001694 -
Facial Plastic Surgery Clinics of North... Aug 2020The use of energy-based devices as surgical tools during rhytidectomy was introduced in early 2007 to 2008 and occurred when the first fiber laser was approved for laser... (Review)
Review
The use of energy-based devices as surgical tools during rhytidectomy was introduced in early 2007 to 2008 and occurred when the first fiber laser was approved for laser lipolysis. It became evident that the fiber laser-assisted rhytidectomy could offer several advantages compared with conventional rhytidectomy. The use of energy devices now includes temperature-controlled radiofrequency and helium plasma devices. Energy devices continue to offer advantages compared with knife and scissor approaches: improved hemostasis; an ability to dissect into areas without full flap elevation; and the shrink-wrap late effects of collagen remodeling after energy-based treatment, which improves the results of rhytidectomy.
Topics: Combined Modality Therapy; Dissection; Helium; Hemostasis, Surgical; Humans; Laser Therapy; Plasma Gases; Plasma Skin Regeneration; Radiofrequency Therapy; Rejuvenation; Rhytidoplasty; Skin Aging
PubMed: 32503720
DOI: 10.1016/j.fsc.2020.03.006 -
Anatomical Record (Hoboken, N.J. : 2007) Apr 2022Over the last four millennia, the discipline of anatomy and its relationships with medicine and society have evolved dramatically. Human dissection, the perennial tool...
Over the last four millennia, the discipline of anatomy and its relationships with medicine and society have evolved dramatically. Human dissection, the perennial tool for anatomical discovery and education, has both guided this evolution and matured alongside it. Soon after the first cadaveric dissections recorded in ancient Greece, China, India, and Persia, clear endorsements of its practice fell largely silent in the anatomical record for 1,500 years before reappearing in Europe at the dawn of the Renaissance. Between the 13th and 18th centuries CE, the performance of anatomical dissection became a popular form of education and public entertainment, and the demand for human cadavers steadily increased among European anatomical schools while supply remained limited by legal statute. This gave rise to an informal group of amateur and professional body snatchers called the Resurrectionists and, later, inspired the Anatomy Act of 1832 CE. In the 20th and 21st centuries CE, voluntary body bequeathal programs have enabled the practice of human dissection to continue in academic centers as a cornerstone of anatomical education, now with a newfound focus on the development of affective skills. This article provides an abridged account of anatomy's development, highlighting key moments in its growth, the valuable contributions of many different societies to the discipline, and the important roles of several luminary anatomists of antiquity. Within the broader context of this history, it offers an overview of anatomical dissection's evocative past, spanning from its inception to its present-day practice.
Topics: Anatomists; Anatomy; Cadaver; China; Dissection; Europe; History, 15th Century; History, 16th Century; History, 17th Century; History, 18th Century; History, 19th Century; History, 20th Century; History, 21st Century; History, Ancient; History, Medieval; Humans
PubMed: 34551186
DOI: 10.1002/ar.24764 -
Morphologie : Bulletin de L'Association... Jun 2022The temporal bone contains structures related to hearing and balance, and is a valuable learning resource for medical students and trainee surgeons. The middle ear and...
INTRODUCTION
The temporal bone contains structures related to hearing and balance, and is a valuable learning resource for medical students and trainee surgeons. The middle ear and inner ear are difficult to demonstrate by cadaveric dissection as the structures are closely contained in a small space in the dense temporal bone. Consequently, the teaching and learning of the ear are largely relegated to virtual and theoretical images, and models, which has resulted in a knowledge gap in medical students and prospective surgeons. The present study aimed to elucidate a technique that exposes the structures and relations of the middle and inner ear by cadaveric dissection.
MATERIALS AND METHODS
Forty-seven adult formalin-fixed cadaveric specimens were dissected by the proposed technique. The method was evaluated based on the extent of the structures exposed and time taken for dissection.
RESULTS
The method exposed all the contents and relations of the middle and inner ear, including the course of the facial nerve in the petrous temporal bone, in a few minutes, without use of specialized instruments like saw, drill, endoscope, operating microscope or electric trephine.
CONCLUSION
This dissection method combines maximal exposure of the structures and relations of the middle and inner ear with a short dissection time, sans use of specialized tools. It can be incorporated in the gross anatomy curriculum for medical studentsdue to the short dissection time and completeness of structures exposed. The prosected specimen can also be plastinated for use as a teaching-learning resource for medical students and surgeons.
Topics: Adult; Cadaver; Dissection; Ear, Inner; Ear, Middle; Humans; Prospective Studies
PubMed: 33947629
DOI: 10.1016/j.morpho.2021.04.001 -
Pathobiology : Journal of... 2023Histopathology has historically been the critical technique for the diagnosis and treatment of human disease. Today, genomics, transcriptomics, and proteomics from... (Review)
Review
Histopathology has historically been the critical technique for the diagnosis and treatment of human disease. Today, genomics, transcriptomics, and proteomics from specific cells, rather than bulk tissue, have become key to understanding underlying disease mechanisms and rendering useful diagnostic information. Extraction of desired analytes, i.e., nucleic acids or proteins, from easily accessible formalin-fixed paraffin-embedded tissues allows for clinically relevant activities, such as sequencing biomarker mutations or typing amyloidogenic proteins. Genetic profiling has become routine for cancers as varied as non-small cell lung cancer and prostatic carcinoma. The five main tissue dissection techniques that have been developed thus far include: bulk scraping, manual macrodissection, manual microdissection, laser-capture microdissection, and expression microdissection. In this review, we discuss the importance of tissue dissection in clinical practice and research, the basic methods, applications, as well as some advantages and disadvantages for each modality.
Topics: Humans; Carcinoma, Non-Small-Cell Lung; Prognosis; Lung Neoplasms; Dissection; Microdissection; Tissue Fixation; Paraffin Embedding
PubMed: 35952628
DOI: 10.1159/000525979 -
Anatomical Sciences Education Jan 2023Anatomy is an important component in the vertical integration of basic science and clinical practice. Two common pedagogies are cadaveric dissection and examination of... (Randomized Controlled Trial)
Randomized Controlled Trial
Anatomy is an important component in the vertical integration of basic science and clinical practice. Two common pedagogies are cadaveric dissection and examination of prosected specimens. Comparative studies mostly evaluate their immediate effectiveness. A randomized controlled trial design was employed to compare both the immediate and long-term effectiveness of dissection and prosection. Eighty third-year medical students undergoing their surgical rotation from the Yong Loo Lin School of Medicine were randomized into two groups: dissection and prosection. Each participated in a one-day hands-on course following a similar outline that demonstrated surgical anatomy in the context of its clinical relevance. A pre-course test was conducted to establish baseline knowledge. A post-course test was conducted immediately after and at a one-year interval to evaluate learner outcome and knowledge retention. A post-course survey was conducted to assess participant perception. Thirty-nine and thirty-eight participants for the dissection and prosection groups, respectively, were included for analysis. There was no significant difference between mean pre-course test scores between the dissection and prosection groups [12.6 (3.47) vs. 12.7 (3.16), P > 0.05]. Both the mean immediate [27.9 (4.30) vs. 24.9 (4.25), P < 0.05] and 1 year [23.9 (4.15) vs. 19.9 (4.05), P < 0.05] post-course test scores were significantly higher in the dissection group. However, when adjusted for course duration [dissection group took longer than prosection group (mean 411 vs. 265 min)], these findings were negated. There is no conclusive evidence of either pedagogy being superior in teaching surgical anatomy. Based on learner surveys, dissection provides a greater learner experience.
Topics: Humans; Anatomy; Dissection; Hand; Upper Extremity; Cadaver; Teaching; Students, Medical; Education, Medical, Undergraduate; Curriculum
PubMed: 34968002
DOI: 10.1002/ase.2166 -
Surgical Endoscopy Feb 2023Endoscopic submucosal dissection (ESD) is the standard endoscopic treatment for early gastric cancers (EGCs). However, obscured view and difficulty in submucosal lifting...
BACKGROUND
Endoscopic submucosal dissection (ESD) is the standard endoscopic treatment for early gastric cancers (EGCs). However, obscured view and difficulty in submucosal lifting during ESD have been demonstrated. Additionally, ESD is time-consuming and poses a high risk of perforation and bleeding when performed in challenging locations. The pocket-creation method (PCM) is a newly developed strategy for colorectal tumors, while the outcomes of application in the treatment of EGCs are rarely reported. In the present study, we aimed to compare the technical efficacy and safety of PCM-ESD and the conventional ESD (c-ESD) technique for the treatment of EGCs.
METHODS
This was a single-center retrospective study consisting of 162 patients with EGCs who underwent ESD between February 2019 and February 2021. One-to-one propensity score matching (PSM) was performed. In addition, clinicopathological characteristics and treatment outcomes were also compared.
RESULTS
PCM-ESD was more likely to be used in patients with larger lesions than c-ESD with/without traction. In addition, the resection speed for lesions of the PCM-ESD was faster compared with c-ESD without traction (median dissection speed: 19.6 mm/min vs. 15 mm/min; p < 0.001) and c-ESD with traction (median dissection speed after PSM: 19.9 mm/min vs. 15 mm/min; p = 0.001). In multiple linear regression analysis, significant factors related to a higher dissection speed were the treatment method of PCM-ESD (p = 0.034), the long diameter of the resected lesion (p = 0.001), and lesion location (p = 0.046).
CONCLUSIONS
Collectively, PCM-ESD appeared to be a safer and more effective treatment for EGCs than c-ESD. In addition, PCM-ESD could significantly improve the speed of tumor resection.
Topics: Humans; Stomach Neoplasms; Retrospective Studies; Treatment Outcome; Dissection; Endoscopic Mucosal Resection
PubMed: 36171450
DOI: 10.1007/s00464-022-09620-0 -
International Journal of Urology :... Aug 2019Renal cryoablation has become accepted as treatment for small renal tumors as an alternative to surgery. However, parallel with the increase in the use of this therapy,... (Review)
Review
Renal cryoablation has become accepted as treatment for small renal tumors as an alternative to surgery. However, parallel with the increase in the use of this therapy, there also has been increases in the number of reports of complications related to renal cryoablation. One potential complication is injury to important non-renal structures adjacent to the ablated renal tumor, such as the colon, duodenum, ureter, psoas muscle and so on. To prevent injury of adjacent organs, separating organs from the tumor is desirable. Over the past 15 years, several techniques have been developed to protect against injury of organs adjacent to renal tumors that are targets of cryoablation. The most commonly used technique for this purpose has been hydrodissection. Others include dissection with gas, balloon dissection and probe traction. To avoid injury of a ureter running near the renal tumor, pyeloperfusion is known to be useful. The rate of cases necessitating avoidance of organ injury by using these techniques is relatively high. In some cases, more than two techniques are combined. In the present review, we provided an overview of techniques currently available to protect against organ injuries, and discussed the advantages and disadvantages of each technique.
Topics: Cryosurgery; Dissection; Humans; Kidney; Kidney Neoplasms; Organs at Risk; Perfusion; Postoperative Complications; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 31094038
DOI: 10.1111/iju.14013