DOCSLIB.ORG

Intertransversalis Fascia Approach in Urologic Laparoscopic Operations

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Intertransversalis Fascia Approach in Urologic Laparoscopic Operations ORIGINAL ARTICLE Intertransversalis Fascia Approach in Urologic Laparoscopic Operations Gang Li, MD; Yeyong Qian, MM; Hongwei Bai, MD; Zhigang Song, MM; Baofa Hong, MB; Jinfeng Jia, MB; Bingyi Shi, MM; Xu Zhang, MD Objectives: To study the clinical anatomy of the trans- taken from the intertransversalis fascia approach in ULOs, versalis fascia (TF) and to explore the intertransversalis micrographs were obtained to examine the microscopic fascia approach in urologic laparoscopic operations structure of the TF, and the color atlas of TF anatomy (ULOs). (cross and sagittal sections) was drawn. Design: Prospective study. Results: The TF is a general plane of connective tissue lying between the inner surface of the transversus abdo- Setting: Two academic hospitals. minis and the extraperitoneal fat. It can be divided into 2 layers (superficial and deep), with an amorphous fi- Other Participants: Data from 1217 urologic laparo- broareolar space between them. The intertransversalis fas- scopic or open operations and 10 laparoscopic hernia cia approach in ULOs is the approach between the 2 lay- repairs were analyzed between January 1, 2009, and ers of the TF. April 30, 2011. Findings from 3 fresh autopsies were also included. Conclusions: The intertransversalis fascia approach is described for the first time, to our knowledge. Surgeons Main Outcome Measures: The anatomy of the TF was can obtain a clean, clear, and bloodless operating space studied and the intertransversalis fascia approach was ex- in ULOs using the intertransversalis fascia approach. plored in ULOs; furthermore, they were proved in the open operations and fresh autopsies. Photographs were Arch Surg. 2012;147(2):159-167 N UROLOGIC RETROPERITONEAL tablishment of the operating space for ret- and extraperitoneal laparo- roperitoneal and extraperitoneal laparo- scopic operations, surgeons need scopic operations. In this research, we to dilate the potential fascial space study the clinical anatomy of the TF and into a larger space for further op- explore the intertransversalis fascia ap- Ieration. Therefore, it is important to iden- proach for urologic laparoscopic opera- tify the retroperitoneal or extraperitoneal tions (ULOs). fascia and fascial spaces. If the balloon dissector is placed in the exact fascial space, METHODS See Invited Critique at end of article ENROLLMENT Between January 1, 2009, and April 30, 2011, a clean and clear space without hemorrhage in 309 and 301 Hospitals of PLA, data from can be achieved after balloon dilatation, 1217 urologic laparoscopic or open opera- which will undoubtedly benefit further op- tions and 10 laparoscopic hernia repairs were eration. Otherwise, the normal fascial lay- analyzed (Table). Findings from 3 fresh au- ers will be destroyed by the dilation, and topsies were also included. the fascial space will be filled with blood Author Affiliations: Institute of and fiber, which will affect the next ma- SURGICAL TECHNIQUE Organ Transplant of Chinese nipulation. PLA, 309 Hospital of PLA, According to Gray’s Anatomy, the trans- Intertransversalis Fascia Approach (Drs Li, Bai, and Jia and Messrs versalis fascia (TF) is a thin layer of con- During Retroperitoneal Laparoscopic Qian and Shi), and Departments Left Nephrectomy of Urology (Drs Li and Zhang nective tissue lying between the inner sur- and Mr Hong) and Pathology face of the transversus abdominis and the The patient is placed in the right lateral decu- (Mr Song), 301 Hospital of extraperitoneal fat.1 It is one of the most bitus position with overextension. A 2-cm in- PLA, Beijing, China. important anatomical markers during es- cision is made below the 12th rib in the pos- ARCH SURG/ VOL 147 (NO. 2), FEB 2012 WWW.ARCHSURG.COM 159 ©2012 American Medical Association. All rights reserved. Downloaded From: https://jamanetwork.com/ on 09/25/2021 Corrected on March 6, 2012 the laparoscopic view. Then, we divide the urachus high above Table. Operations Involved in This Study the bladder using a hook electrocautery device, identify the 2 layers of the TF, and separate the intertransversalis fascia space No. for further operation (Figure 1C). Operation Performed Urologic operations Obtaining a Sample for Histologic Examination Retroperitoneal laparoscopic adrenalectomy 233 Retroperitoneal laparoscopic (partial) nephrectomy 588 A piece of tissue was cut from the abdominal wall in the left Retroperitoneal laparoscopic nephroureterectomy 74 middle axillary line below the 12th rib (thickness from the peri- Retroperitoneal laparoscopic pelvilithotomy/ 15 toneum to the transversus abdominis) during fresh autopsy. ureterolithotomy Retroperitoneal laparoscopic nephropyeloplasty 34 Retroperitoneal laparoscopic unroofing of kidney cyst 80 OUTCOMES Extraperitoneal laparoscopic radical prostatectomy 76 Laparoscopic radical/partial cystectomy 32 Photographs of the intertransversalis fascia approach in ULOs Excision of carcinoma of urachus 1 were taken (Figures 2, 3, and 4). The color atlas of TF anatomy Lumbar nephrectomy 13 (cross and sagittal sections) was drawn (Figure 5). And the Laparonephrectomy 24 Kidney transplantation 35 microscopic structure of the TF was observed by microscope Radical/partial cystectomy 5 (Figure 6). Suprapubic prostatectomy 7 Total 1217 RESULTS Laparoscopic hernia repairs Transabdominal preperitoneal repair 8 Total extraperitoneal repair 2 COLOR ATLAS OF TF ANATOMY Total 10 The TF is a general plane of connective tissue lying be- tween the inner surface of the transversus abdominis and terior axillary line. The muscular layer, lumbodorsal fascia, and the extraperitoneal fat, and it can be divided into 2 layers: superficial layer of the TF are bluntly divided. Then, the fore- superficial and deep (Figure 5). The superficial layer of finger is inserted to separate the space between the 2 layers of the TF closely covers the internal surface of the transver- the TF bluntly. A balloon dissector is placed into the inter- sus abdominis and the aponeurosis; thus, dissection be- transversalis fascia space, and 600 mL of gas is infused to main- tain the balloon dilatation (Figure 1A). The gas is then evacu- tween them is relatively difficult. An amorphous fibro- ated, and the balloon dissector is removed. Under the guidance areolar space is filled with fat and loose fibrous tissue of the forefinger extending into the space through the inci- between the superficial and deep layers of the TF. The fi- sion, a 10-mm puncture cannula is inserted 2 cm above the su- ber matrix in the space becomes thick and dense in the perior border of the iliac crest in the midaxillary line. The lapa- region of the myopectineal orifice, and fatty tissue be- roscope is placed through the trocar, and the carbon dioxide comes abundant in the retroperitoneal region. There is also insufflator is connected with a pressure of 14 mm Hg. Other a loose amorphous fibroareolar space between the deep trocars are then inserted under the laparoscopic view. layer of the TF and the peritoneum, which is filled with fat and loose fibrous tissue and contains the medial um- Intertransversalis Fascia Approach During bilical ligament, median umbilical ligament, and bladder Extraperitoneal Laparoscopic Radical Prostatectomy in the central aspect of the lower anterior abdominal wall. Superiorly, the 2 layers of the TF fuse and blend with The patient is placed in a Trendelenburg position. A 1.5-cm the fasciae covering the inferior surface of the dia- incision is made at the base of the umbilicus, the anterior rec- phragm. Anteriorly, the superficial layer of the TF forms tus sheath is incised transversely, and the rectus abdominis muscles are pulled aside bluntly. Using blunt forefinger dis- a continuous sheet covering the inner surface of the trans- section along the surface of the posterior rectus sheath, the su- versus abdominis and the posterior rectus sheath (or rec- perficial layer of the TF is torn, and then the space between tus abdominis), and the deep layer of the TF covers the the 2 layers of the TF is reached by the forefinger. A balloon outer surface of the peritoneum. Posteriorly, the 2 lay- dilator is inserted into the intertransversalis fascia space, and ers join together and form a continuous sheet anterior 1200 mL of gas is infused to develop the space (Figure 1B). The to the lumbar fascia, but the binding site of these 2 lay- gas is then evacuated, and the balloon dissector is removed. A ers keeps moving. For example, these 2 layers join to- 10-mm puncture cannula is inserted at the umbilicus inci- gether in the outer edge of the quadratus lumborum sion. The laparoscope is placed through the trocar, and the car- muscle on the renal hilum plane and in the outer edge bon dioxide insufflator is connected with a pressure of 14 of the psoas major muscle on the third lumbar vertebra mm Hg. Other trocars are then inserted under the laparo- scopic view. plane. Inferiorly, the TF is continuous with the pelvic fas- cia, which can also be divided into 2 layers. The super- Intertransversalis Fascia Approach During ficial layer covers the inner surface of the inguinal re- Transperitoneal Laparoscopic Partial Cystectomy gion, iliacus, psoas major muscle, and external iliac vessels and forms the opening of the deep inguinal ring. The deep Pneumoperitoneum is established using open trocar place- layer covers the former half of bladder and prostate and ment and the Hasson technique. The laparoscope is placed forms a conical sheath around the vas deferens and sper- through the trocar, and the insufflation pressure is
Load more

Recommended publications
  • The Subperitoneal Space and Peritoneal Cavity: Basic Concepts Harpreet K
    ª The Author(s) 2015. This article is published with Abdom Imaging (2015) 40:2710–2722 Abdominal open access at Springerlink.com DOI: 10.1007/s00261-015-0429-5 Published online: 26 May 2015 Imaging The subperitoneal space and peritoneal cavity: basic concepts Harpreet K. Pannu,1 Michael Oliphant2 1Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA 2Department of Radiology, Wake Forest University School of Medicine, Winston-Salem, NC, USA Abstract The peritoneum is analogous to the pleura which has a visceral layer covering lung and a parietal layer lining the The subperitoneal space and peritoneal cavity are two thoracic cavity. Similar to the pleural cavity, the peri- mutually exclusive spaces that are separated by the toneal cavity is visualized on imaging if it is abnormally peritoneum. Each is a single continuous space with in- distended by fluid, gas, or masses. terconnected regions. Disease can spread either within the subperitoneal space or within the peritoneal cavity to Location of the abdominal and pelvic organs distant sites in the abdomen and pelvis via these inter- connecting pathways. Disease can also cross the peri- There are two spaces in the abdomen and pelvis, the toneum to spread from the subperitoneal space to the peritoneal cavity (a potential space) and the subperi- peritoneal cavity or vice versa. toneal space, and these are separated by the peritoneum (Fig. 1). Regardless of the complexity of development in Key words: Subperitoneal space—Peritoneal the embryo, the subperitoneal space and the peritoneal cavity—Anatomy cavity remain separated from each other, and each re- mains a single continuous space (Figs.
    [Show full text]
  • CHAPTER 6 Perineum and True Pelvis
    193 CHAPTER 6 Perineum and True Pelvis THE PELVIC REGION OF THE BODY Posterior Trunk of Internal Iliac--Its Iliolumbar, Lateral Sacral, and Superior Gluteal Branches WALLS OF THE PELVIC CAVITY Anterior Trunk of Internal Iliac--Its Umbilical, Posterior, Anterolateral, and Anterior Walls Obturator, Inferior Gluteal, Internal Pudendal, Inferior Wall--the Pelvic Diaphragm Middle Rectal, and Sex-Dependent Branches Levator Ani Sex-dependent Branches of Anterior Trunk -- Coccygeus (Ischiococcygeus) Inferior Vesical Artery in Males and Uterine Puborectalis (Considered by Some Persons to be a Artery in Females Third Part of Levator Ani) Anastomotic Connections of the Internal Iliac Another Hole in the Pelvic Diaphragm--the Greater Artery Sciatic Foramen VEINS OF THE PELVIC CAVITY PERINEUM Urogenital Triangle VENTRAL RAMI WITHIN THE PELVIC Contents of the Urogenital Triangle CAVITY Perineal Membrane Obturator Nerve Perineal Muscles Superior to the Perineal Sacral Plexus Membrane--Sphincter urethrae (Both Sexes), Other Branches of Sacral Ventral Rami Deep Transverse Perineus (Males), Sphincter Nerves to the Pelvic Diaphragm Urethrovaginalis (Females), Compressor Pudendal Nerve (for Muscles of Perineum and Most Urethrae (Females) of Its Skin) Genital Structures Opposed to the Inferior Surface Pelvic Splanchnic Nerves (Parasympathetic of the Perineal Membrane -- Crura of Phallus, Preganglionic From S3 and S4) Bulb of Penis (Males), Bulb of Vestibule Coccygeal Plexus (Females) Muscles Associated with the Crura and PELVIC PORTION OF THE SYMPATHETIC
    [Show full text]
  • Unit #2 - Abdomen, Pelvis and Perineum
    UNIT #2 - ABDOMEN, PELVIS AND PERINEUM 1 UNIT #2 - ABDOMEN, PELVIS AND PERINEUM Reading Gray’s Anatomy for Students (GAFS), Chapters 4-5 Gray’s Dissection Guide for Human Anatomy (GDGHA), Labs 10-17 Unit #2- Abdomen, Pelvis, and Perineum G08- Overview of the Abdomen and Anterior Abdominal Wall (Dr. Albertine) G09A- Peritoneum, GI System Overview and Foregut (Dr. Albertine) G09B- Arteries, Veins, and Lymphatics of the GI System (Dr. Albertine) G10A- Midgut and Hindgut (Dr. Albertine) G10B- Innervation of the GI Tract and Osteology of the Pelvis (Dr. Albertine) G11- Posterior Abdominal Wall (Dr. Albertine) G12- Gluteal Region, Perineum Related to the Ischioanal Fossa (Dr. Albertine) G13- Urogenital Triangle (Dr. Albertine) G14A- Female Reproductive System (Dr. Albertine) G14B- Male Reproductive System (Dr. Albertine) 2 G08: Overview of the Abdomen and Anterior Abdominal Wall (Dr. Albertine) At the end of this lecture, students should be able to master the following: 1) Overview a) Identify the functions of the anterior abdominal wall b) Describe the boundaries of the anterior abdominal wall 2) Surface Anatomy a) Locate and describe the following surface landmarks: xiphoid process, costal margin, 9th costal cartilage, iliac crest, pubic tubercle, umbilicus 3 3) Planes and Divisions a) Identify and describe the following planes of the abdomen: transpyloric, transumbilical, subcostal, transtu- bercular, and midclavicular b) Describe the 9 zones created by the subcostal, transtubercular, and midclavicular planes c) Describe the 4 quadrants created
    [Show full text]
  • Anatomy and Physiology of the Abdominal Wall 0011 CHAPTER Internal Oblique Some Inferior fi Bers Form the Cremaster Muscle at the Level of the Inguinal Canal
    Handbook of Complex Abdominal Wall Anatomy and physiology of the abdominal wall 0011 CHAPTER Álvaro Robín Valle de Lersundi, MD, PhD Arturo Cruz Cidoncha, MD, PhD 11.1..1. Anatomy of the abdominal wall 1.1.1. Introduction The abdominal wall is delimited by muscle structures than can be classifi ed in 5 ana- tomical areas: lateral, anterior, posterior, diaphragmatic and perineal (Table 1.1). We will describe the fi rst four due to their relevance in surgical repair of complex abdom- inal wall. These groups of muscles are enclosed by several bone structures: last ribs, chondrocostal joints, xyphoid, pelvis and costal apophysis of lumbar vertebrae. Layers of the anterior and lateral abdominal wall include skin, subcutaneous tissue, super- fi cial fascia, deep fascia, muscles, extraperitoneal fascia and peritoneum. Table 1.1. Muscular limits of the abdominal wall ∙ Quadratus lumborum POSTERIOR ∙ Psoas ∙ Iliac muscle ∙ External oblique LATERAL ∙ Internal oblique ∙ Transversus abdominis ∙ Rectus abdominis ANTERIOR ∙ Piramidalis CONTENTS SUPERIOR ∙ Diaphragm 1.1. Anatomy of the abdominal INFERIOR ∙ Perineal muscles wall 1.1.2. Muscles of the abdominal wall 1.2. Physiologyygy Muscles of the anterolateral wall Rectus abdominis The rectus abdominis (m. rectus abdominis) is a long and thick muscle that is extended from the anterolateral thorax to the pubis close to the midline (Figure 1.1). 1 Figure External oblique 1.1. Rectus abdominis The external oblique muscle (m. obliquus externus abdominis) is the most superfi cial and thickest of the three lateral abdominal wall muscles (Figure 1.2). Figure 1.2. External oblique muscle Handbook of Complex Abdominal Wall Handbook of Complex Cranially, the rectus abdominis muscles originates from 3 dig- itations that insert on the 5th-7th costal cartilages, the xyphoid process and costoxyphoid ligament.
    [Show full text]
  • Anterior Abdominal Wall
    Abdominal wall Borders of the Abdomen • Abdomen is the region of the trunk that lies between the diaphragm above and the inlet of the pelvis below • Borders Superior: Costal cartilages 7-12. Xiphoid process: • Inferior: Pubic bone and iliac crest: Level of L4. • Umbilicus: Level of IV disc L3-L4 Abdominal Quadrants Formed by two intersecting lines: Vertical & Horizontal Intersect at umbilicus. Quadrants: Upper left. Upper right. Lower left. Lower right Abdominal Regions Divided into 9 regions by two pairs of planes: 1- Vertical Planes: -Left and right lateral planes - Midclavicular planes -passes through the midpoint between the ant.sup.iliac spine and symphysis pupis 2- Horizontal Planes: -Subcostal plane - at level of L3 vertebra -Joins the lower end of costal cartilage on each side -Intertubercular plane: -- At the level of L5 vertebra - Through tubercles of iliac crests. Abdominal wall divided into:- Anterior abdominal wall Posterior abdominal wall What are the Layers of Anterior Skin Abdominal Wall Superficial Fascia - Above the umbilicus one layer - Below the umbilicus two layers . Camper's fascia - fatty superficial layer. Scarp's fascia - deep membranous layer. Deep fascia : . Thin layer of C.T covering the muscle may absent Muscular layer . External oblique muscle . Internal oblique muscle . Transverse abdominal muscle . Rectus abdominis Transversalis fascia Extraperitoneal fascia Parietal Peritoneum Superficial Fascia . Camper's fascia - fatty layer= dartos muscle in male . Scarpa's fascia - membranous layer. Attachment of scarpa’s fascia= membranous fascia INF: Fascia lata Sides: Pubic arch Post: Perineal body - Membranous layer in scrotum referred to as colle’s fascia - Rupture of penile urethra lead to extravasations of urine into(scrotum, perineum, penis &abdomen) Muscles .
    [Show full text]
  • Rectus Abdominis Flap Technique for Head and Neck Reconstruction
    OPEN ACCESS ATLAS OF OTOLARYNGOLOGY, HEAD & NECK OPERATIVE SURGERY RECTUS ABDOMINIS FLAP FOR HEAD & NECK RECONSTRUCTION Patrik Pipkorn, Brian Nussenbaum The rectus abdominis flap is based on the Surgical anatomy deep inferior epigastric artery. It is a com- posite flap and comprises muscle, over- Rectus sheath (Figures 1-5) lying fascia and skin. It is versatile and provides a large volume of soft tissue and The rectus sheath is an aponeurosis arising is technically straightforward to raise. from the external oblique, internal oblique Many variations based on the inferior epi- and transversus abdominis muscles (Figure gastric artery, including perforator flaps, 1). It encircles the paired rectus muscles. have been described. The anterior and posterior rectus sheaths merge in the midline to form the linea alba In the head and neck it is typically used to that separates the paired rectus muscles reconstruct large oral defects, skull base (Figure 1). defects, maxillectomy defects or whenever a large volume of soft tissue is required. In the head and neck it has more recently been largely supplanted by the antero- lateral thigh free flap. Benefits of the rectus flap include • Technically straightforward and quick to harvest • Constant anatomy with anatomic varia- tions being rare • Harvesting in a supine position makes a two-team approach feasible • Provides the largest volume of soft tis- sue based on a single pedicle • Long pedicle and 2-4mm diameter Figure 1: Anterior abdominal wall artery crossectional anatomy and arcuate line • Reliable perforators that do not need to be dissected or visualised When harvesting a rectus flap, the anterior • Low donor site morbidity rectus sheath is incised vertically over the midportion of the rectus muscle, whereas Caveats include the posterior sheath is preserved.
    [Show full text]
  • Diastasis Recti Abdominus Association Spring Conference 2018
    Diagnosis and treatment of DRA. 4/13/18 MPTA Spring Conference 2018. Kansas City Jennifer Cumming, PT, MSPT, Diagnosis and treatment of CLT, WCS Missouri Physical Therapy No disclosures Diastasis Recti Abdominus Association Spring Conference 2018 Objective Case study #1 complaints 1. Understand anatomy of abdominal wall and deep motor control • Mrs. H is 37 year old who is 6 months post-partum system • Back pain since late pregnancy and postpartum period. 2. Understand the causes and prevalence of diastasis rectus • Pain not responding to traditional physical therapy abdominus (DRA) • Pain with transition movements and bending 3. Understand how to assess for DRA • Also c/o stress urinary incontinence and pain with intercourse 4. Understand basic treatment strategies for improving functionality of abdominal wall and deep motor control system Case study #1 orthopedic assessment Case study #2 complaints • 1 ½ finger diastasis rectus abdominus just inferior to umbilicus • Ms. S is a 20 year old elite college level athlete • Active straight leg raise (ASLR) with best correction at PSIS indicating • History of DRA developing with high level athletic training involvement of posterior deep motor control system • Complains of LBP with prolonged sitting, bending, and lifting activities • L3 right rotation at level of DRA • Hypertonicity B internal oblique muscles Property of J Cumming, PT, MSPT, CLT, WCS. Do not copy without permission. 1 Diagnosis and treatment of DRA. 4/13/18 MPTA Spring Conference 2018. Kansas City Case study #2 orthopedic assessment
    [Show full text]
  • The Female Pelvic Floor Fascia Anatomy: a Systematic Search and Review
    life Systematic Review The Female Pelvic Floor Fascia Anatomy: A Systematic Search and Review Mélanie Roch 1 , Nathaly Gaudreault 1, Marie-Pierre Cyr 1, Gabriel Venne 2, Nathalie J. Bureau 3 and Mélanie Morin 1,* 1 Research Center of the Centre Hospitalier Universitaire de Sherbrooke, Faculty of Medicine and Health Sciences, School of Rehabilitation, Université de Sherbrooke, Sherbrooke, QC J1H 5N4, Canada; [email protected] (M.R.); [email protected] (N.G.); [email protected] (M.-P.C.) 2 Anatomy and Cell Biology, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC H3A 0C7, Canada; [email protected] 3 Centre Hospitalier de l’Université de Montréal, Department of Radiology, Radio-Oncology, Nuclear Medicine, Faculty of Medicine, Université de Montréal, Montreal, QC H3T 1J4, Canada; [email protected] * Correspondence: [email protected] Abstract: The female pelvis is a complex anatomical region comprising the pelvic organs, muscles, neurovascular supplies, and fasciae. The anatomy of the pelvic floor and its fascial components are currently poorly described and misunderstood. This systematic search and review aimed to explore and summarize the current state of knowledge on the fascial anatomy of the pelvic floor in women. Methods: A systematic search was performed using Medline and Scopus databases. A synthesis of the findings with a critical appraisal was subsequently carried out. The risk of bias was assessed with the Anatomical Quality Assurance Tool. Results: A total of 39 articles, involving 1192 women, were included in the review. Although the perineal membrane, tendinous arch of pelvic fascia, pubourethral ligaments, rectovaginal fascia, and perineal body were the most frequently described structures, uncertainties were Citation: Roch, M.; Gaudreault, N.; identified in micro- and macro-anatomy.
    [Show full text]
  • Transcatheter Arterial Embolization of Spontaneous Soft Tissue Hematomas: a Systematic Review
    Cardiovasc Intervent Radiol (2019) 42:335–343 https://doi.org/10.1007/s00270-018-2086-x CLINICAL INVESTIGATION ARTERIAL INTERVENTIONS Transcatheter Arterial Embolization of Spontaneous Soft Tissue Hematomas: A Systematic Review 1 2,3 1,4 1 Lahoud Touma • Sarah Cohen • Christophe Cassinotto • Caroline Reinhold • 5 1 1 1 1 Alan Barkun • Vi Thuy Tran • Olivier Banon • David Valenti • Benoit Gallix • Anthony Dohan1,6 Received: 5 June 2018 / Accepted: 28 September 2018 / Published online: 11 October 2018 Ó Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2018 Abstract surgical management were excluded. For each publication, Background Severe spontaneous soft tissue hematomas clinical success based on the control of the bleed, (SSTH) are usually treated with transcatheter arterial rebleeding rates and complications (including mortality) embolization (TAE) although only limited retrospective was collected, as well as technical details. studies exist evaluating this treatment option. The aim of Results Sixty-three studies met the inclusion criteria, with this study was to systematically assess the efficacy and an aggregate total of 267 patients. Follow-up extended safety of TAE for the management of SSTH. from 1 day to 10 years. Bleeding was mainly localized to Methods Medline, EMBASE, PubMed and Cochrane the iliopsoas (n = 113/267, 42.3%) and anterior abdominal Library were searched from inception to July 2017 using wall (n = 145/266, 54.7%). When information was avail- MeSH headings and a combination of keywords. Eligibility able, 81.0% (n = 158/195) of patients were on anticoagu- was restricted to original studies with patients suffering lant therapy prior to the bleeding episode.
    [Show full text]
  • Suspensory Ligaments of the Female Genital Organs: MRI Evaluation with Intraoperative Correlation
    Zurich Open Repository and Archive University of Zurich Main Library Strickhofstrasse 39 CH-8057 Zurich www.zora.uzh.ch Year: 2018 Suspensory Ligaments of the Female Genital Organs: MRI Evaluation with Intraoperative Correlation Kaniewska, Malwina ; Gołofit, Piotr ; Heubner, Martin ; Maake, Caroline ; Kubik-Huch, RahelA Abstract: The uterus, which plays an important role in the reproductive process, provides a home for the developing fetus and so must be in a stable, though flexible, location. Various structures with suspensory ligaments help provide this berth. MRI with high spatial resolution allows us to detect and evaluate these relatively fine structures. Under physiologic conditions, MRI can be used to depict uterine andovarian ligaments (ie, the uterosacral, cardinal, and round ligaments, as well as the suspensory ligament of the ovary). In the presence of pathologic conditions (inflammation, endometriosis, tumors), the suspensory ligaments may appear thickened or invaded, which makes their delineation easier. Understanding the normal anatomy of the suspensory ligaments of the female genital organs and using a standardized nomenclature are essential for identifying and reporting related pathologic conditions. The female pelvic anatomy and the suspensory ligaments of the female genital organs are described as depicted with MRI. Also, the compartmental anatomy of the female pelvis is explained, including the extraperitoneal pelvic spaces. Finally, a checklist is provided for structured reporting of the MRI findings in the female pelvis. Online supplemental material is available for this article. ©RSNA, 2018. DOI: https://doi.org/10.1148/rg.2018180089 Posted at the Zurich Open Repository and Archive, University of Zurich ZORA URL: https://doi.org/10.5167/uzh-168344 Journal Article Published Version The following work is licensed under a Creative Commons: Attribution-NonCommercial 4.0 International (CC BY-NC 4.0) License.
    [Show full text]
  • Hernias of the Abdominal Wall: Inguinal Anatomy in the Male
    Hernias of the Abdominal Wall: Inguinal Anatomy in the Male Bob Caruthers. CST. PhD The surgical repair of an inguinal hernia, although one of the in this discussion. The anterolateral group consists of two mus- most common of surgical procedures, presents a special chal- cle groups whose bodies are near the midline and whose fibers lenge: Groin anatomy remains one of the more difficult topics are oriented vertically in the standing human: the rectus abdo- to master for both the entry-level student and the first assistant. minis and the pyramidalis. The muscle bodies of the other This article reviews the relevant anatomy of the male groin. three groups are more lateral, have significantly larger aponeu- roses, and have obliquely oriented fibers. These three groups MAJOR FASClAL AND UGAMENTAL STRUCTURES contribute the major portion of the fascia1 and ligamental The abdominal wall contains muscle groups representing two structures in the groin area.',!.' broad areas: anterolateral and posterior (see Figure 1).The At the level of the inguinal canal, the layers of the abdomi- posterior muscles, the quadratus lumborum, do not concern us nal wall include skin, subcutaneous tissue (Camper's and aponeurosis (cut edge) Internal abdominal (cut and turned down) Lacunar (Gimbernatk) ligament Inguinal (Poupart k) 11ganenr Cremaster muscle (medial origin) Cremaster muscle [lateral origin) Falx inguinalis [conjoined tendon) Cremaster muscle and fascia Reflected inguinal ligament External spermatic fascia (cut) Figun, 1-Dissection of rhe anterior ahdominal wall. Rectus sheath (posterior layerl , Inferior epigastric vessels Deep inguinal ring , Transversalis fascia (cut away) '.,."" -- Rectus abdomlnls muscle \ Antenor-supenor 111acspme \ -. ,lliopsoas muscle Hesselbach'sl triangle inguinalis (conjoined) , Tesricular vessels and genital branch of genitofmoral Scarpa's fascia), external oblique fascia, from the upper six ribs course downward inguinal (Poupart's) ligament.
    [Show full text]
  • Ta2, Part Iii
    TERMINOLOGIA ANATOMICA Second Edition (2.06) International Anatomical Terminology FIPAT The Federative International Programme for Anatomical Terminology A programme of the International Federation of Associations of Anatomists (IFAA) TA2, PART III Contents: Systemata visceralia Visceral systems Caput V: Systema digestorium Chapter 5: Digestive system Caput VI: Systema respiratorium Chapter 6: Respiratory system Caput VII: Cavitas thoracis Chapter 7: Thoracic cavity Caput VIII: Systema urinarium Chapter 8: Urinary system Caput IX: Systemata genitalia Chapter 9: Genital systems Caput X: Cavitas abdominopelvica Chapter 10: Abdominopelvic cavity Bibliographic Reference Citation: FIPAT. Terminologia Anatomica. 2nd ed. FIPAT.library.dal.ca. Federative International Programme for Anatomical Terminology, 2019 Published pending approval by the General Assembly at the next Congress of IFAA (2019) Creative Commons License: The publication of Terminologia Anatomica is under a Creative Commons Attribution-NoDerivatives 4.0 International (CC BY-ND 4.0) license The individual terms in this terminology are within the public domain. Statements about terms being part of this international standard terminology should use the above bibliographic reference to cite this terminology. The unaltered PDF files of this terminology may be freely copied and distributed by users. IFAA member societies are authorized to publish translations of this terminology. Authors of other works that might be considered derivative should write to the Chair of FIPAT for permission to publish a derivative work. Caput V: SYSTEMA DIGESTORIUM Chapter 5: DIGESTIVE SYSTEM Latin term Latin synonym UK English US English English synonym Other 2772 Systemata visceralia Visceral systems Visceral systems Splanchnologia 2773 Systema digestorium Systema alimentarium Digestive system Digestive system Alimentary system Apparatus digestorius; Gastrointestinal system 2774 Stoma Ostium orale; Os Mouth Mouth 2775 Labia oris Lips Lips See Anatomia generalis (Ch.
    [Show full text]