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Biportal endoscopic transorbital approach: a quantitative anatomical study and clinical application.Acta Neurochirurgica Sep 2020We devised a biportal endoscopic transorbital approach (BiETOA) to gain surgical freedom by making a port for the endoscope and investigated the benefits and limitations...
BACKGROUND
We devised a biportal endoscopic transorbital approach (BiETOA) to gain surgical freedom by making a port for the endoscope and investigated the benefits and limitations of BiETOA.
METHODS
A cylindrical port was designed and 3-D printed using biocompatible material. The port was inserted through a keyhole between the superolateral side of the orbital rim and the temporal muscle. An endoscope was inserted through the port, and other instruments were inserted through the conventional transorbital route. BiETOA was used to dissect eight cadaveric heads, and the angle of attack and surgical freedom were assessed.
RESULTS
The mean maximal angle of attack was significantly different in BiETOA and endoscopic transorbital approach (ETOA) (P < 0.01) but not in BiETOA and ETOA lateral orbital rim (LOR) osteotomy (P = 0.207, P = 0.21). The mean surgical freedom was significantly different in BiETOA and ETOA (P < 0.01) and in BiETOA and ETOA LOR osteotomy (P < 0.01). In the clinical cases, tumors were removed successfully without any complications.
CONCLUSIONS
BiETOA provided increased surgical freedom and better visibility of deep target lesion and resulted in good surgical and cosmetic outcomes.
Topics: Cadaver; Endoscopes; Humans; Natural Orifice Endoscopic Surgery; Orbit; Postoperative Complications; Printing, Three-Dimensional
PubMed: 32440923
DOI: 10.1007/s00701-020-04339-0 -
The Surgical Clinics of North America Feb 2000The inguinofemoral area constitutes the frontier between the abdomen and the lower limb. Because of the human standing position, the inguinal region is a zone supporting... (Review)
Review
The inguinofemoral area constitutes the frontier between the abdomen and the lower limb. Because of the human standing position, the inguinal region is a zone supporting the abdominal thrust, and is weakened by the orifice of the inguinal and femoral passages. Peritoneal diverticula may externalize into these orifices, leading to the formation of hernias. This article reviews the anatomic constituents of the inguinofemoral region and the anatomic basis for the treatment of hernias.
Topics: Female; Hernia, Femoral; Hernia, Inguinal; Humans; Inguinal Canal; Male
PubMed: 10685144
DOI: 10.1016/s0039-6109(05)70397-2 -
The American Journal of Cardiology Jan 1996The presence of an excitable gap during atrial fibrillation (AF), although short and variable, may be of potential importance for the development of alternative... (Review)
Review
The presence of an excitable gap during atrial fibrillation (AF), although short and variable, may be of potential importance for the development of alternative techniques for termination of AF by rapid pacing. Also the notion that perpetuation of AF may be partly dependent on macroreentry around the natural atrial orifices, may provide a new therapeutic option for the permanent cure of AF by interrupting the anatomical circular pathways in the atria by radiofrequency ablation. In our opinion the rapidly growing understanding of the electrophysiologic mechanisms of AF certainly warrants some optimism about the possibility of cure of AF in the near future without causing too much discomfort and without carrying on unacceptable risk.
Topics: Adolescent; Adult; Animals; Atrial Fibrillation; Cardiac Complexes, Premature; Cardiac Pacing, Artificial; Dogs; Electrophysiology; Female; Heart Atria; Humans; Male; Time Factors
PubMed: 8607387
DOI: 10.1016/s0002-9149(97)89114-x -
BMC Cardiovascular Disorders Dec 2015Double-orifice mitral valve is an extremely rare cardiac anomaly possibly originating from insufficient endocardial fusion in embryogenesis. Severe concomitant cardiac...
BACKGROUND
Double-orifice mitral valve is an extremely rare cardiac anomaly possibly originating from insufficient endocardial fusion in embryogenesis. Severe concomitant cardiac anomalies and malfunction of the valve usually lead to an early diagnosis in childhood. Therefore the prevalence of isolated double-orifice mitral valve in adulthood is not known.
CASE PRESENTATION
We present the case of a 63 years old, female Caucasian patient with isolated double-orifice mitral valve diagnosed in routine echocardiographic evaluation after chemotherapy presenting without clinical symptoms.
CONCLUSION
Trans-thoracic echocardiography is a suitable modality to diagnose and further assess anatomical and functional properties of the anomaly. In the presence of double-orifice mitral valve concomitant cardiac anomalies and valvular stenosis or regurgitation must be excluded. If an isolated double-orifice mitral valve with no functional abnormalities is present, no further follow-up is necessary.
Topics: Echocardiography, Doppler, Color; Female; Heart Defects, Congenital; Humans; Incidental Findings; Middle Aged; Mitral Valve; Predictive Value of Tests
PubMed: 26681334
DOI: 10.1186/s12872-015-0168-0 -
Gastrointestinal Endoscopy Aug 2016Eight years have passed since the introduction of the per-oral endoscopy myotomy (POEM) procedure. POEM was initially received as an investigational procedure, but since... (Review)
Review
BACKGROUND AND AIMS
Eight years have passed since the introduction of the per-oral endoscopy myotomy (POEM) procedure. POEM was initially received as an investigational procedure, but since the revelation of promising safety and efficacy data, it is becoming the preferred treatment for achalasia. With the recent completion of our 1000th POEM procedure, we share our experience and knowledge through the discussion of clinical pearls, pitfalls, and practical considerations.
METHODS
The various aspects of the procedure and conditions that warrant special attention are discussed from our perspective, with a focus on areas in which there is currently limited evidence.
RESULTS
The key points on patient position, submucosal tunneling, myotomy, closure, intraprocedural bleeding, and advanced sigmoid achalasia are presented.
CONCLUSIONS
The dissemination of this information serves as a foundation for new POEM operators and as a catalyst for more-experienced operators to further refine and advance their POEM skills and stimulate international discourse and collaboration.
Topics: Anatomic Landmarks; Blood Loss, Surgical; Esophageal Achalasia; Esophageal Spasm, Diffuse; Esophageal Sphincter, Lower; Esophagogastric Junction; Esophagoscopy; Humans; Learning Curve; Natural Orifice Endoscopic Surgery; Patient Positioning; Wound Closure Techniques
PubMed: 27020899
DOI: 10.1016/j.gie.2016.03.1469 -
European Journal of Radiology May 2015The objective of this study was to clarify the anatomical variation of thyroid veins into the systemic vein using contrast-enhanced multi-detector row computed...
OBJECTIVE
The objective of this study was to clarify the anatomical variation of thyroid veins into the systemic vein using contrast-enhanced multi-detector row computed tomography (MDCT).
DESIGN AND METHODS
The subjects were 80 patients (34 males and 46 females; mean age, 50.1 years; age range, 15-92 years) with neck diseases who underwent MDCT. The number and location of inflow points of the thyroid veins into the systemic vein, and the length from the junction of bilateral brachiocephalic veins to the orifice of inferior thyroid vein were investigated by reviewing the axial and coronal images.
RESULTS
All superior thyroid veins were detected. Right and left middle thyroid veins were identified in 39 and 29 patients, respectively. Right inferior thyroid veins, left inferior thyroid veins, and common trunks were detected in 43, 46, and 39 patients, respectively; in five patients, two left thyroid veins were identified. All left inferior thyroid veins and 34 common trunks flowed into the innominate vein, while right ones had some variations in inflow sites. Mean lengths were 3.01±1.30 cm (range, 0.5-6.19) and 2.04±0.91 cm (0.5-4.4) in the left inferior thyroid vein and common trunk, and 1.96±1.05 cm (0.81-4.8) and 1.65±0.69 cm (0.63-2.94) in the right one flowing into the right internal jugular vein and the innominate vein, respectively.
CONCLUSIONS
The numbers and orifices of thyroid veins were identified at high rates on contrast-enhanced MDCT. This strategy can provide anatomical information before selective venous sampling for measurements of parathyroid hormone.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Contrast Media; Female; Humans; Hyperparathyroidism; Jugular Veins; Male; Middle Aged; Observer Variation; Phlebography; Reproducibility of Results; Thyroid Gland; Tomography, X-Ray Computed; Vena Cava, Superior
PubMed: 25765896
DOI: 10.1016/j.ejrad.2015.02.009 -
American Journal of Ophthalmology Nov 2013To examine movement of the internal canalicular orifice with blinking and lacrimal drainage under endonasal endoscopic observation after dacryocystorhinostomy.
PURPOSE
To examine movement of the internal canalicular orifice with blinking and lacrimal drainage under endonasal endoscopic observation after dacryocystorhinostomy.
DESIGN
Observational anatomic study.
METHODS
Twenty internal canalicular orifices (right 9, left 11) from 15 patients (age range: 44-77 years) who underwent endoscopic endonasal dacryocystorhinostomy were prospectively examined. The patients sat on a chair with the chin projected slightly upward while digital images were taken. After examining the movement of the internal canalicular orifice with blinking, the patient's eye was stained with fluorescein dye, and diffusion from the orifice was examined with blinking.
RESULTS
The internal canalicular orifice closed during eyelid opening, although always incompletely. In eyelid closing, the orifice opened, and was pulled laterally without folds. All 20 internal canalicular orifices formed a diverticulum. Three specimens illustrated the upper and lower canalicular ends emptying into the diverticulum. The closing of these canalicular ends was always incomplete. Movement of the internal canalicular orifice was slight during normal blinking, but forced blinking resulted in more movement. Movement of the lacrimal sac wall was slight. During the first few seconds without blinking, no fluorescein dye flowed from the orifice. After several blinks, fluorescein dye flowed out slowly from the orifice, and increased in volume with more blinking. The fluorescein dye traveled inferiorly by gravity. A forced blinking was related to more dye inflow.
CONCLUSIONS
The internal canalicular orifice incompletely closed during eyelid opening, but this orifice largely opened during eyelid closing, with a slow gravitational inflow of lacrimal fluid.
Topics: Adult; Aged; Blinking; Cross-Sectional Studies; Dacryocystorhinostomy; Endoscopy; Eye Movements; Eyelids; Fluorescein; Fluorescent Dyes; Humans; Lacrimal Apparatus; Lacrimal Duct Obstruction; Middle Aged; Prospective Studies; Tears; Video Recording
PubMed: 23972312
DOI: 10.1016/j.ajo.2013.06.021 -
Surgical Innovation Feb 2019A recent development in minimally invasive surgery (MIS) is single-port surgery, where a single large multiport trocar is placed in the umbilicus. All medical schools...
INTRODUCTION
A recent development in minimally invasive surgery (MIS) is single-port surgery, where a single large multiport trocar is placed in the umbilicus. All medical schools require that students complete an anatomy course as part of the medical curriculum. However, there is limited instruction regarding the detailed parts of the "umbilicus." In several famous anatomy atlases, the umbilicus is not dissected at all and is merely represented as a button. Until now, the true nature of the umbilicus has not been anatomically demonstrated.
METHODS
Five cadavers were obtained from the Osaka Medical College medical student anatomy class. The umbilicus was dissected in the anatomy laboratory, to demonstrate all the layers. A detailed dissection was performed, focusing on the exact center of the umbilicus, in order to ascertain whether there exists a "natural orifice" or a fascial defect.
RESULTS
In all cadavers, a small defect of fascia was identified just below the center of the umbilicus. Yellow fatty tissue was present just below the skin in the exact center of the umbilicus. A probe placed exactly in the middle of this defect passes easily through into the abdominal cavity.
CONCLUSIONS
With the widespread use of MIS, umbilical incision is commonly used to reduce pain and improve cosmetic results. This study consistently revealed a natural defect of fascia in the center of the umbilicus. Therefore, the umbilicus can be called a concealed "natural orifice." It is important to recognize and utilize this defect effectively to minimize unnecessary tissue trauma during MIS.
Topics: Cadaver; Dissection; Female; Humans; Japan; Laparoscopes; Male; Minimally Invasive Surgical Procedures; Natural Orifice Endoscopic Surgery; Schools, Medical; Sensitivity and Specificity; Umbilicus
PubMed: 30191768
DOI: 10.1177/1553350618797619 -
Clinical Techniques in Small Animal... Feb 2000Ureteral ectopia is a congenital abnormality of the terminal segment of one or both ureters in which the ureteral orifice is located distal to the trigone of the... (Review)
Review
Ureteral ectopia is a congenital abnormality of the terminal segment of one or both ureters in which the ureteral orifice is located distal to the trigone of the bladder. Continuous or intermittent urinary incontinence is the most frequently reported clinical symptom associated with ureteral ectopia. A variety of anatomic morphologies of ectopic ureters have been reported. Historically, surgical therapy focused on reestablishing drainage of the ureters into the bladder lumen. However, continued urinary incontinence after surgery is the most frequently reported complication. Specific classification and successful management of the various types of ectopic ureters remain diagnostic and therapeutic challenges to the veterinary clinician. Cystoscopic evaluation of the lower urinary tract and urodynamic evaluation of bladder and urethral function has improved the presurgical assessment of the patient. Surgical procedures, which are aimed at repositioning the ureteral orifice(s) within the bladder lumen and treating primary sphincter incompetence, are necessary to successfully manage small animal patients with ectopic ureters.
Topics: Animals; Dog Diseases; Dogs; Ureter; Ureteral Diseases
PubMed: 10911681
DOI: 10.1053/svms.2000.7302 -
The Journal of International Medical... Oct 2019This study aimed to assess the safety and efficacy of left liver anatomical resection via the left vertical groove following intraoperative antegrade cholangioscopy...
Left liver anatomical resection via the left vertical groove and intraoperative antegrade cholangioscopy in patients with left-sided hepatolithiasis and previous biliary tract surgery.
OBJECTIVE
This study aimed to assess the safety and efficacy of left liver anatomical resection via the left vertical groove following intraoperative antegrade cholangioscopy (biliary exploration through the left hepatic duct orifice) in patients with left-sided hepatolithiasis (LSH) and previous biliary tract surgery.
METHODS
Between January 2012 and January 2016, eligible patients with LSH (n = 28) who underwent left liver anatomical resection via the left vertical groove followed by intraoperative antegrade cholangioscopy, were referred to our hospital. Clinical results, such as the overall operative time, length of hospital stay, intraoperative complications, residual stones and postoperative bile leaks, were recorded and analyzed.
RESULTS
No residual stones and bile leakage occurred in the patients. No patients experienced intraoperative complications or T-tube placement. The mean operative time was 135.1 ± 18.9 minutes. The mean postoperative duration of hospitalization was 7.8 ± 1.8 days.
CONCLUSIONS
Left liver anatomical resection via the left vertical groove combined with intraoperative antegrade cholangioscopy is a safe and useful method for patients with LSH and previous biliary tract surgery. This technique simplifies the operative procedure by avoiding dissection of the porta hepatis and subsequent choledochotomy.
Topics: Adult; Aged; Biliary Tract; Biliary Tract Surgical Procedures; Cholangiography; Dissection; Female; Hepatic Artery; Humans; Intraoperative Care; Liver; Liver Diseases; Male; Middle Aged; Portal Vein; Treatment Outcome
PubMed: 31510834
DOI: 10.1177/0300060519864832