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Surgical and Radiologic Anatomy : SRA May 2022Anatomy has historically been taught via traditional medical school lectures and dissection. In many countries, practical or legal issues limit access to cadaveric...
PURPOSE
Anatomy has historically been taught via traditional medical school lectures and dissection. In many countries, practical or legal issues limit access to cadaveric dissection. New technologies are favored by students and could improve learning, complementing traditional teaching.
METHODS
All students in second-year medicine at a single medical school were submitted to a novel anatomical course with digital tool exposure. We explored a new combined teaching method: a physical blackboard lesson synchronized with digital dissection, imaging and direct evaluation (BDIE). Synchronized dissection is broadcast live in the classroom and in partner medical schools. Following the course, students completed a short survey about their perception of this new anatomic clinical course.
RESULTS
The survey included 183 students whom 178 completed the questionnaire, i.e., a 97% response rate. Ninety-nine percent of students thought this synchronized method useful to improve their understanding of anatomy and 90% stated it helped them retain this learning.
CONCLUSION
This BDIE method, in conjunction with teaching guidelines and dissection, is highly appreciated by students who consider it helps them to acquire lasting knowledge.
Topics: Anatomy; Cadaver; Curriculum; Dissection; Education, Medical, Undergraduate; Educational Measurement; Humans; Schools, Medical; Students, Medical; Teaching
PubMed: 35482103
DOI: 10.1007/s00276-022-02943-6 -
Folia Morphologica 2023The sternocleidomastoid muscles (SCM) are prominent paired muscles of the neck connecting proximally the manubrium sterni and the clavicle to the mastoid process and the... (Review)
Review
The sternocleidomastoid muscles (SCM) are prominent paired muscles of the neck connecting proximally the manubrium sterni and the clavicle to the mastoid process and the occipital bone distally. Following their points of attachment sternomastoid, sternooccipital, cleidomastoid and cleidooccipital portions of this muscle have been described. Altogether 23 case reports from year 2000 till 2020 with 29 subjects related to the SCM supernumerary variations were searched and analysed where parameters such as supernumerary proximal variation types (sternal vs. clavicular), insertional variation, unilaterality/bilaterality of the variation, study type, reported gender of the subjects and the country of research were extracted. The research shows that 48.3% of the subjects had bilateral presentation of SCM variations. If present unilaterally, three quarters of the cases were on the left side. The most frequent variation is located at the clavicular side of the proximal SCM head whereas isolated sternal sided proximal head variation or an insertional variation alone are very rare. Interestingly, with 96.6%, most of cases in the literature were discovered in cadavers during anatomical dissections. Male gender represented with 82.8% higher prevalence than females. The higher male prevalence in the body donor system, predominantly in the Asian continent could play a decisive role in the outcome as more than half of the reported cases stemmed from India in this period. Importantly, the knowledge of different anatomical variations of the SCM is highly relevant for surgical, clinical or radiological approaches in the neck.
Topics: Female; Humans; Male; Neck Muscles; Neck; Dissection; Sternum; Clavicle
PubMed: 35607877
DOI: 10.5603/FM.a2022.0045 -
Surgical Endoscopy Feb 2020Intraoperative neuromonitoring (IONM) is a useful adjunct for recurrent laryngeal nerve (RLN) mapping and identification in transoral endoscopic thyroidectomy vestibular...
OBJECTIVES/HYPOTHESIS
Intraoperative neuromonitoring (IONM) is a useful adjunct for recurrent laryngeal nerve (RLN) mapping and identification in transoral endoscopic thyroidectomy vestibular approach (TOETVA). This experimental study aimed to investigate the feasibility, safety, thresholds required of an endoscopic forceps that combine the function of surgical dissection and nerve stimulation.
STUDY DESIGN
Prospective experimental research.
METHODS
TOETVA was performed in 12 piglets, i.e., 24 RLNs and 24 vagal nerves (VN). RLNs electromyography (EMG) was recorded via endotracheal surface electrodes. Baseline EMG of VN and RLN were recorded and compared by (a) percutaneously placed monopolar stimulator probe (Group I), (b) adapted Maryland endoscopic dissector applied on nerves at its tip-end (Group II) and (c) endoscopic dissector tip-lateral applied (Group III). EMG profiles, amplitude, latency, waveform, thresholds and supra-maximal stimulation (5 mA) were analyzed.
RESULTS
Application of the endoscopic device was feasible in all TOETVA and did not result in any morbidity. 24 RLNs and VNs were detected, stimulated and monitored. With increase of stimulation current, the amplitude of EMG increased, showing a dose-response curve. Mean VN stimulation thresholds were: Group I 0.28 mA, Group II 0.56 mA, Group III 0.58 mA (P1 = 0.00, P2 = 0.00, P3 = 0.11). Minimal current to evoked a maximal VN response was: Group I 0.65 mA, Group II 1.07 mA and Group III 1.14 mA (P1 = 0.00, P2 = 0.00, P3 = 0.48). Minimal current to evoke a RLN maximal response was Group I 0.6 mA, Group II 0.95 mA and Group III 1.05 mA (P1 = 0.00, P2 = 0.00, P3 = 0.31). Latency values were similar to each group. Repetitive (> 10 min) supra-maximal (> 5 mA) electrical stimulation was safe.
CONCLUSIONS
The application of endoscopic stimulating dissector is simple, effective and safe way to monitor both VN and RLN function during a TOETVA animal model. It provides surgeons with real-time feedback of EMG response and can be applied as a tool for RLN monitoring. Endoscopic instrument required higher current to evoke EMG response compared to hand probe stimulation. Tip-end required less current to evoke EMG response compared to tip-lateral mode of stimulation.
Topics: Animals; Dissection; Electric Stimulation; Electromyography; Feasibility Studies; Intraoperative Complications; Intraoperative Neurophysiological Monitoring; Male; Natural Orifice Endoscopic Surgery; Proof of Concept Study; Prospective Studies; Recurrent Laryngeal Nerve; Recurrent Laryngeal Nerve Injuries; Swine; Thyroidectomy; Vagus Nerve
PubMed: 31218426
DOI: 10.1007/s00464-019-06936-2 -
Brain Structure & Function Jan 2021The aim of this literature review is to present a summary of the published literature relating the details of the different modifications of specimen preparation for... (Review)
Review
The aim of this literature review is to present a summary of the published literature relating the details of the different modifications of specimen preparation for white matter dissection with the Klingler technique. For this review, 3 independent investigators performed an electronic literature search that was carried out in the Pubmed, Scopus and Web of Science databses up to December 2019. Furthermore, we performed citation tracking for the articles missed in the initial search. Studies were eligible for inclusion when they reported details of at least the first 2 main steps of Klingler's technique: fixation and freezing. A total of 37 full-text articles were included in the analysis. We included original anatomical studies in which human white matter dissection was performed for study purposes. The main three steps of preparation are the same in each laboratory, but the details of each vary between studies. Ten percent formalin is the most commonly used (34 studies) solution for fixation. The freezing time varied between 8 h and a month, and the temperature varied from - 5 to - 80 °C. After thawing and during dissections, the specimens were most often kept in formalin solution (13), and the concentration varied from 4 to 10%. Klingler's preparation technique involves three main steps: fixation, freezing and thawing. Even though the details of the technique are different in most of the studies, all provide subjectively good quality specimens for anatomical dissections and studies.
Topics: Brain; Dissection; Humans; White Matter
PubMed: 33165658
DOI: 10.1007/s00429-020-02157-9 -
Surgical Endoscopy Mar 2022Conventional endoscopic submucosal dissection (C-ESD) is a technically demanding procedure with prolonged procedure times and higher risk of adverse events. To overcome... (Meta-Analysis)
Meta-Analysis
BACKGROUND AND AIMS
Conventional endoscopic submucosal dissection (C-ESD) is a technically demanding procedure with prolonged procedure times and higher risk of adverse events. To overcome the procedural difficulty of ESD, several traction-assisted techniques (T-ESD) have been developed to improve visualization of the submucosa in hopes to facilitate safe and effective dissection. The aim of this study was to conduct a meta-analysis that compares short-term outcomes (30-day) of T-ESD to C-ESD.
METHODS
Clinical studies published up to April 2020 comparing the efficacy and safety of T-ESD and C-ESD were identified using electronic bibliographic searches. Both randomized controlled trials and observational studies were included. Outcomes of interests were procedure time, rates of en bloc and R0 resection, and rates of adverse events. Fixed effect and random effect model were used to calculate pooled mean difference for continuous variables and risk differences (RDs) for categorical variables.
RESULTS
Twenty-three studies with 2574 patients were included in this meta-analysis, with a total of 2582 lesions (1292 T-ESD and 1290 C-ESD). Pooled estimates of T-ESD showed shorter procedure times (weighted mean difference = -20.35 min, 95% CI -27.51 to -13.19, p < 0.001), higher R0 resection rates (RD 0.04, 95% CI 0.01-0.06, p = 0.004) and lower perforation rates (RD -0.03, 95% CI -0.04 to -0.01, p = < 0.0001). No significant differences were seen in en bloc rates and bleeding risk between the two groups.
CONCLUSIONS
Traction-assisted ESD results in shorter procedure time, improved R0 resection rates and lower risk of perforation as compared to conventional ESD.
Topics: Dissection; Endoscopic Mucosal Resection; Humans; Traction; Treatment Outcome
PubMed: 33825013
DOI: 10.1007/s00464-021-08452-8 -
Plastic and Reconstructive Surgery Jul 2020The anatomical descriptions of the attachments of the female breast to the chest wall vary in their structure, location, and terminology within the published literature.
BACKGROUND
The anatomical descriptions of the attachments of the female breast to the chest wall vary in their structure, location, and terminology within the published literature.
METHODS
A dissection study of the attachments of the breast to the chest wall was conducted on 18 female embalmed breasts in the coronal (n = 15) and sagittal planes (n = 3).
RESULTS
Perimeter, posterior wall, and horizontal septum attachments were observed. The perimeter along its entire length was attached to the chest wall. Regional and anatomical variation was observed in this structure and location. Sharp dissection was required to remove it from the chest wall, in contrast to the blunt dissection required to remove the posterior wall and horizontal septum attachments.
CONCLUSIONS
The breast attaches to the chest wall along its entire perimeter, posterior wall, and horizontal septum, with the perimeter functioning as the primary anchor of the breast to the chest wall. The structure of the perimeter attachment is both periosteal and fascial and requires sharp dissection to remove it from the chest wall. The fascial structures of the posterior wall and horizontal septum require blunt dissection only. The structure of the perimeter has regional variation, and its location on the chest wall has anatomical variation. Detailed anatomical descriptions and illustrations are supported by photographic evidence of cadaver dissections in two planes. Clinical and anatomical terminology are linked, with clinical implications for medical anatomy education, breast modeling, and breast surgery.
Topics: Aged; Aged, 80 and over; Breast; Cadaver; Dissection; Female; Humans; Thoracic Wall
PubMed: 32590636
DOI: 10.1097/PRS.0000000000006954 -
Gastrointestinal Endoscopy Clinics of... Jan 2023Endoscopic resection has been widely applied especially in endoscopic submucosal dissection and third space endoscopy (TSE). Flexible endoluminal robotics allow... (Review)
Review
Endoscopic resection has been widely applied especially in endoscopic submucosal dissection and third space endoscopy (TSE). Flexible endoluminal robotics allow performance of endoscopic submucosal dissection with exposure of the submucosal plane for precise dissection using two robotic arms. The introduction of TSE revolutionized the horizon of therapeutic endoscopy to the submucosal space beneath and beyond the mucosa. Advantages of TSE include avoidance of full thickness incision in gastrointestinal tract through the submucosal tunneling for performance of peroral endoscopic myotomy and submucosal tunneling endoscopic resection. In future, robotic-driven devices should be developed to enhance performance of complex endoluminal procedures and TSE.
Topics: Humans; Endoscopic Mucosal Resection; Endoscopy, Gastrointestinal; Dissection; Gastrointestinal Tract
PubMed: 36375883
DOI: 10.1016/j.giec.2022.09.006 -
The Journal of Thoracic and... Jan 2022
Topics: Aged; Dissection; Humans
PubMed: 32362387
DOI: 10.1016/j.jtcvs.2020.03.136 -
Anatomical Sciences Education Mar 2022Innovative reforms in medical education will require instructional tools to support these changes and to give students more flexibility in where and how they learn. At...
Innovative reforms in medical education will require instructional tools to support these changes and to give students more flexibility in where and how they learn. At Colorado State University, the software program Virtual Canine Anatomy (VCA) was developed to assist student learning both inside and outside the anatomical laboratory. The program includes interactive anatomical photographs of dissected canine cadavers, dissection instructions with accompanying videos and diagrams, radiographs, and three-dimensional models. There is a need to evaluate the effectiveness of instructional tools like VCA so that decisions on pedagogical delivery can be evidence-based. To measure the impact of VCA on student outcomes in a dissection laboratory, this study compared student attitudes, quiz scores, dissection quality and accuracy, and instructor reliance between students with and without access to VCA. Students with VCA needed less time with teaching assistants (P < 0.01), asked teaching assistants fewer questions (P = 0.04), felt that the dissection was easier (P = 0.02), and were in stronger agreement that they had access to adequate resources (P = 0.02). No differences were found in the dissection quality or accuracy, quiz scores, or attitudes regarding overall enjoyment of the activity between the two groups. This study shows that VCA increases student independence and can be used to enhance anatomical instruction.
Topics: Anatomy; Animals; Cadaver; Computer-Assisted Instruction; Curriculum; Dissection; Dogs; Education, Medical, Undergraduate; Educational Measurement; Humans; Learning; Students; Students, Medical
PubMed: 33838080
DOI: 10.1002/ase.2087 -
International Journal of Environmental... Dec 2021Most medical and health science schools adopt innovative tools to implement the teaching of anatomy to their undergraduate students. The increase in technological... (Review)
Review
Most medical and health science schools adopt innovative tools to implement the teaching of anatomy to their undergraduate students. The increase in technological resources for educational purposes allows the use of virtual systems in the field of medicine, which can be considered decisive for improving anatomical knowledge, a requisite for safe and competent medical practice. Among these virtual tools, the Anatomage Table 7.0 represents, to date, a pivotal anatomical device for student education and training medical professionals. This review focuses attention on the potential of the Anatomage Table in the anatomical learning process and clinical practice by discussing these topics based on recent publication findings and describing their trends during the COVID-19 pandemic period. The reports documented a great interest in and a positive impact of the use of this technological table by medical students for teaching gross anatomy. Anatomage allows to describe, with accuracy and at high resolution, organ structure, vascularization, and innervation, as well as enables to familiarize with radiological images of real patients by improving knowledge in the radiological and surgical fields. Furthermore, its use can be considered strategic in a pandemic period, since it ensures, through an online platform, the continuation of anatomical and surgical training on dissecting cadavers.
Topics: COVID-19; Computer-Assisted Instruction; Curriculum; Dissection; Education, Medical, Undergraduate; Humans; Pandemics; SARS-CoV-2; Students, Medical
PubMed: 34948857
DOI: 10.3390/ijerph182413247