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Anatomical Sciences Education Jul 2022While several innovative pedagogical practices have been developed and implemented in anatomy education since the onset of the coronavirus disease 2019 (Covid-19)...
While several innovative pedagogical practices have been developed and implemented in anatomy education since the onset of the coronavirus disease 2019 (Covid-19) pandemic, considering the value of in-person undergraduate dissection remains crucial. In this commentary, a human dissection course at the University of Toronto is used as an example to highlight the value of dissection for undergraduate learners in non-professional programs. In-person dissection allows for real life, anatomical variation, and supports the advancement of students' conceptual knowledge of the human body and visual-spatial abilities. Direct involvement with dissection during undergraduate training also provides students with an opportunity to practice and refine non-technical skills, such as communication and collaboration, while simultaneously promoting the development of students' professional identity formation. Further, dissection is a practical, hands-on experience that can provide students with insight into potential career aspirations related to anatomy and the health professions. It is suggested that as institutions veer from traditional pedagogical practices and evaluate how to best move forward post-pandemic, it is imperative that the value of undergraduate dissection is considered among new innovations in the field of anatomy.
Topics: Anatomy; COVID-19; Cadaver; Curriculum; Dissection; Education, Medical, Undergraduate; Humans; Students; Students, Medical
PubMed: 35523727
DOI: 10.1002/ase.2186 -
JSLS : Journal of the Society of... 2010Laparoscopic cholecystectomy is the gold standard for management of symptomatic gallstones. Electrocautery remains the main energy form used during laparoscopic... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Laparoscopic cholecystectomy is the gold standard for management of symptomatic gallstones. Electrocautery remains the main energy form used during laparoscopic dissection. However, due to its risks, search is continuous for safer and more efficient forms of energy. This review assesses the effects of dissection using ultrasonic energy compared with monopolar electrocautery during laparoscopic cholecystectomy.
METHODS
A literature search of the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library, MEDLINE, and EMBASE was performed. Studies included were trials that prospectively randomized adult patients with symptomatic gallstone disease to either ultrasonic or monopolar electrocautery dissection during laparoscopic cholecystectomy. Data were collected regarding the characteristics and methodological quality of each trial. Outcome measures included operating time, gallbladder perforation rate, bleeding, bile leak, conversion rate, length of hospital stay and sick leave, postoperative pain and nausea scores, and influence on systemic immune and inflammatory responses. For metaanalysis, the statistical package RevMan version 4.2 was used. For continuous data, Weighted Mean Difference (WMD) was calculated with 95% confidence interval (CI) using the fixed effects model. For Categorical data, the Odds Ratio (OR) was calculated with 95% confidence interval using fixed effects model.
RESULTS
Seven trials were included in this review, with a total number of 695 patients randomized to 2 dissection methods: 340 in the electrocautery group and 355 in the ultrasonic group. No mortality was recorded in any of the trials. With ultrasonic dissection, operating time is significantly shorter in elective surgery (WMD -8.19, 95% CI -10.36 to -6.02, P<0.0001), acute cholecystitis (WMD -17, 95% CI -28.68 to -5.32, P=0.004), complicated cases (WMD -15, 95% CI -28.15 to -1.85, P=0.03), or if surgery was performed by trainee surgeons who had performed <10 procedures (P=0.043). Gallbladder perforation risk with bile leak or stone loss is lower (OR 0.27, 95% CI 0.17 to 0.42, P<0.0001 and OR 0.13, 95% CI 0.04 to 0.47, P=0.002 respectively), particularly in the subgroup of complicated cases (OR 0.24 95% CI 0.09 to 0.61, P=0.003). Mean durations of hospital stay and sick leave were shorter with ultrasonic dissection (WMD -0.3, 95% CI -0.51 to -0.09, P=0.005 and WMD -3.8, 95% CI -6.21 to -1.39, P=0.002 respectively), with a smaller mean number of patients who stayed overnight in the hospital (OR 0.18, 95% CI 0.03 to 0.89, P=0.04). Postoperative abdominal pain scores at 1, 4, and 24 hours were significantly lower with ultrasonic dissection as were postoperative nausea scores at 2, 4, and 24 hours.
CONCLUSION
Based on a few trials with relatively small patient samples, this review does not attempt to advocate the use of a single-dissection technology but rather to elucidate results that could be used in future trials and analyses. It demonstrates, with statistical significance, a shorter operating time, hospital stay and sick leave, lower gallbladder perforation risk especially in complicated cases, and lower pain and nausea scores at different postoperative time points. However, many of these potential benefits are subjective, and prone to selection, and expectation bias because most included trials are unblinded. Also the clinical significance of these statistical results has yet to be proved. The main disadvantages are the difficulty in Harmonic scalpel handling, and cost. Appropriate training programs may be implemented to overcome the first disadvantage. Cost remains the main universal issue with current ultrasonic devices, which outweighs the potential clinical benefits (if any), indicating the need for further cost-benefit analysis.
Topics: Cholecystectomy, Laparoscopic; Dissection; Electrosurgery; Humans; Length of Stay; Pain, Postoperative; Randomized Controlled Trials as Topic; Ultrasonics
PubMed: 20412640
DOI: 10.4293/108680810X12674612014383 -
Journal of Visualized Experiments : JoVE May 2012This dissection and sampling procedure was developed for the Network for Pancreatic Organ Donors with Diabetes (nPOD) program to standardize preparation of pancreas...
This dissection and sampling procedure was developed for the Network for Pancreatic Organ Donors with Diabetes (nPOD) program to standardize preparation of pancreas recovered from cadaveric organ donors. The pancreas is divided into 3 main regions (head, body, tail) followed by serial transverse sections throughout the medial to lateral axis. Alternating sections are used for fixed paraffin and fresh frozen blocks and remnant samples are minced for snap frozen sample preparations, either with or without RNAse inhibitors, for DNA, RNA, or protein isolation. The overall goal of the pancreas dissection procedure is to sample the entire pancreas while maintaining anatomical orientation. Endocrine cell heterogeneity in terms of islet composition, size, and numbers is reported for human islets compared to rodent islets. The majority of human islets from the pancreas head, body and tail regions are composed of insulin-containing β-cells followed by lower proportions of glucagon-containing α-cells and somatostatin-containing δ-cells. Pancreatic polypeptide-containing PP cells and ghrelin-containing epsilon cells are also present but in small numbers. In contrast, the uncinate region contains islets that are primarily composed of pancreatic polypeptide-containing PP cells. These regional islet variations arise from developmental differences. The pancreas develops from the ventral and dorsal pancreatic buds in the foregut and after rotation of the stomach and duodenum, the ventral lobe moves and fuses with the dorsal. The ventral lobe forms the posterior portion of the head including the uncinate process while the dorsal lobe gives rise to the rest of the organ. Regional pancreatic variation is also reported with the tail region having higher islet density compared to other regions and the dorsal lobe-derived components undergoing selective atrophy in type 1 diabetes. Additional organs and tissues are often recovered from the organ donors and include pancreatic lymph nodes, spleen and non-pancreatic lymph nodes. These samples are recovered with similar formats as for the pancreas with the addition of isolation of cryopreserved cells. When the proximal duodenum is included with the pancreas, duodenal mucosa may be collected for paraffin and frozen blocks and minced snap frozen preparations.
Topics: Dissection; Humans; Organ Preservation; Pancreas; Tissue and Organ Harvesting
PubMed: 22665046
DOI: 10.3791/4039 -
Acta Orthopaedica Et Traumatologica... May 2023This study aimed to describe the course, branches, and variances of the posterior tibial artery, which provides the arterial supply of the plantar surface of the foot,...
OBJECTIVE
This study aimed to describe the course, branches, and variances of the posterior tibial artery, which provides the arterial supply of the plantar surface of the foot, starting from the tarsal tunnel level to provide descriptive information for all surgical interventions, diagnostic radiological procedures, and promising endovascular therapies in the tarsal region.
METHODS
In this study, a dissection of 48 feet was performed on 25 formalin-fixed cadavers (19 males and 6 females). Surgical instruments and a digital caliper were used for dissection and measurements, and the critical structures were recorded by a Canon 250D camera to be illustrated later.
RESULTS
All parameters were significantly longer in male cadavers compared to females. According to the correlation analysis, while there was a significant and robust correlation between the axial line and pternion-deep plantar arch (R=.830, P .05), a moderate correlation was found between the axial line and sphyrion-bifurcation (R=.575; P < .05), axial line and deep plantar arch-2nd interdigital commissure (R=.457; P < .05), and sphyrion-bifurcation and pternion-deep plantar arch (R=.480; P < .05). Variation in any branch of the posterior tibial artery was observed in 27 of the 48 studied sides.
CONCLUSION
In our study, the branching and variability of posterior tibial artery on the plantar surface of the foot were described in detail with the determined parameters. In conditions that cause tissue and function loss and require reconstruction, such as diabetes mellitus and atherosclerosis, the most critical factor in increasing treatment success is a better understanding of the region's anatomy.
Topics: Female; Humans; Male; Tibial Arteries; Foot; Dissection; Cadaver; Tibial Nerve
PubMed: 37395357
DOI: 10.5152/j.aott.2023.22158 -
World Journal of Gastroenterology Aug 2011Endoscopic submucosal dissection (ESD) is currently widely accepted as a standard treatment option for early gastrointestinal neoplasms in Korea. However, ESD has... (Review)
Review
Endoscopic submucosal dissection (ESD) is currently widely accepted as a standard treatment option for early gastrointestinal neoplasms in Korea. However, ESD has technical difficulties and a longer procedure time than conventional endoscopic resection. So it may have a higher risk of complications than conventional endoscopic resection techniques. We, the ESD study group of Korean Society of Gastrointestinal Endoscopy, have experienced many complications, mostly treated by endoscopic or conservative management. Here, we introduce and share our experiences for management of post ESD complications and review published papers on the topic.
Topics: Dissection; Endoscopy, Gastrointestinal; Gastric Mucosa; Gastrointestinal Neoplasms; Humans; Treatment Outcome
PubMed: 21987602
DOI: 10.3748/wjg.v17.i31.3575 -
Journal of Visualized Experiments : JoVE Nov 2017The pituitary gland or hypophysis is an important endocrine organ secreting hormones essential for homeostasis. It consists of two glands with separate embryonic origins...
The pituitary gland or hypophysis is an important endocrine organ secreting hormones essential for homeostasis. It consists of two glands with separate embryonic origins and functions - the neurohypophysis and the adenohypophysis. The developing mouse pituitary gland is tiny and delicate with an elongated oval shape. A coronal section is preferred to display both the adenohypophysis and neurohypophysis in a single slice of the mouse pituitary. The goal of this protocol is to achieve proper pituitary coronal sections with well-preserved tissue architectures from developing mice. In this protocol, we describe in detail how to dissect and process pituitary glands properly from developing mice. First, mice are fixed by transcardial perfusion of formaldehyde prior to dissection. Then three different dissecting techniques are applied to obtain intact pituitary glands depending on the age of mice. For fetal mice aged embryonic days (E) 17.5 - 18.5 and neonates up to 4 days, the entire sella regions including the sphenoid bone, gland, and trigeminal nerves are dissected. For pups aged postnatal days (P) 5 - 14, the pituitary glands connected with trigeminal nerves are dissected as a whole. For mice over 3 weeks old, the pituitary glands are carefully dissected free from the surrounding tissues. We also display how to embed the pituitary glands in a proper orientation by using the surrounding tissues as landmarks to obtain satisfying coronal sections. These methods are useful in analyzing histological and developmental features of pituitary glands in developing mice.
Topics: Animals; Dissection; Embryo, Mammalian; Mice; Pituitary Gland
PubMed: 29286362
DOI: 10.3791/56356 -
Multimedia Manual of Cardiothoracic... Aug 2023A minimally invasive pulmonary segmentectomy allows adequate oncological treatment in selected cases while preserving lung parenchyma and minimizing perioperative...
A minimally invasive pulmonary segmentectomy allows adequate oncological treatment in selected cases while preserving lung parenchyma and minimizing perioperative morbidity and length of hospital stay. Most lung segments may be resected as segmentectomies or as part of bisegmentectomies (as is the case for the lingula). In the author's experience, left upper division resection (S1, S2, S3 trisegmentectomy) may be challenging. Because the lingula and lingular structures need to be preserved, they may obstruct visualization and hamper the movement of the dissecting instruments. This has been the author's experience using an anterior approach. In contradistinction, a posterior approach allows direct access to the artery and arterial branches and greatly facilitates access to the segmental bronchus. Dissection of the bronchus proceeds from back to front, away from the artery. In addition, when we are isolating and encircling the bronchus, we have already freed the artery from the bronchus and it is safely out of the way. The advantages of a posterior approach are particularly apparent when pathological nodes between the bronchus and artery make the dissection tedious, as in the case presented. Regardless of the surgical approach, S1/S2/S3 trisegmentectomy remains a challenging procedure that requires great care in its execution.
Topics: Humans; Dissection; Bronchi; Arteries; Length of Stay
PubMed: 37605931
DOI: 10.1510/mmcts.2023.061 -
JAMA Sep 2023
Topics: Humans; Anatomy; Cadaver; Dissection; Education, Medical; Texas
PubMed: 37616209
DOI: 10.1001/jama.2023.15132 -
Journal of the American College of... Apr 2021
Topics: Aortic Dissection; Aortic Aneurysm; Dissection; Fluoroquinolones; Gasoline; Humans
PubMed: 33858625
DOI: 10.1016/j.jacc.2021.03.004 -
Anatomical Science International Sep 2023The new coronavirus disease 2019 (COVID-19) has had a substantial impact on the Silent Mentor Programme (SMP), a programme in which members of the public may pledge...
The new coronavirus disease 2019 (COVID-19) has had a substantial impact on the Silent Mentor Programme (SMP), a programme in which members of the public may pledge their bodies to be used for medical training and research after their death. This study aimed to explore the conduct of body donations and simulation surgery training during the COVID-19 pandemic from the viewpoints of the committee members of the SMP and the next-of-kin of body donor pledgers. This study utilised a qualitative exploration method to seek an in-depth understanding of this phenomenon. In-depth individual interviews were carried out. Thematic analysis was used to identify patterns of themes. The COVID-19 polymerase chain reaction (RT-PCR) test is compulsory before accepting a body donation, and this resulted in the turning down of several donations. Being a donor is the final wish of pledgers and this turning down led to a negative emotional remorseful feeling in the next-of-kin of pledgers. From the perspective of students, it is feared that the conduct of the programme, particularly the home visit session being held online, has impeded teaching of humanistic values, compassion, and empathy, which is the prime philosophy of the programme. Previous to the pandemic, the programme ceremonies were well-attended, denoting the utmost respect and recognition of the mentors; however, travel restrictions due to the pandemic limiting in-person attendance resulted in ceremonies becoming less impactful. Continuous postponements of cadaveric dissection training also resulted in students missing training opportunities, hence potentially impairing their professional practice and humanistic values in the medical profession. Counselling interventions should be directed at easing the negative psychological impact on the next-of-kin of pledgers. As the COVID-19 pandemic may pose a significant impediment to achieving the educational outcomes of cadaveric dissection training, efforts to make up for these gaps are essential.
Topics: Humans; Pandemics; COVID-19; Dissection; Cadaver
PubMed: 37072599
DOI: 10.1007/s12565-023-00723-9