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Anatomy of the Pelvis
Published in Gowri Dorairajan, Management of Normal and High Risk Labour During Childbirth, 2022
In early humans, there was an increase in the size of ischial spines, particularly in the above-mentioned obstructive position of the pelvic midplane. Although they constitute the most menacing bony projections during childbirth, they play a pivotal role in the establishment and resilience of the pelvic diaphragm [6].
Bernese periacetabular osteotomy
Published in K. Mohan Iyer, Hip Preservation Techniques, 2019
A blunt Homan tractor is placed along the lateral side of the iliac wing to protect the gluteus medius muscle. The medial surface of the quadrilateral bone is stripped subperiosteally. A reverse Homan tractor is placed on the ischial spine. The ischial spine is an important landmark and guidepost. Osteotomy anterior to the ischial spine can ensure that the posterior column of the hemipelvis is intact. A notch is made by wide curved osteotome on the arcuate line in the pelvis, about 1 cm lower than the sacroiliac joint, 3–4 mm superior to the top of the hip joint (Figure 9.1e). The iliac cut is made by oscillating saw from ASIS to the notch (Figure 9.1d).
Management of Locally Advanced and Recurrent Rectal Cancer
Published in Peter Sagar, Andrew G. Hill, Charles H. Knowles, Stefan Post, Willem A. Bemelman, Patricia L. Roberts, Susan Galandiuk, John R.T. Monson, Michael R.B. Keighley, Norman S. Williams, Keighley & Williams’ Surgery of the Anus, Rectum and Colon, 2019
Ligating the internal iliac vein will permit exposure of the lumbosacral trunk as well as the S1, S2 and S3 nerve roots which contribute to the sciatic nerve. The major anti-gravity motor fibres for proximal lower limb muscles are derived from the lumbosacral trunk. Therefore identification and preservation of this is important for lower limb function. The lumbosacral trunk as well as S1, S2 and S3 nerve roots exit the pelvis through the greater sciatic notch which is separated from the lesser sciatic notch by the ischial spine and sacrospinous ligament (Figure 36.4a and b). Both ischial spine and sacrospinous ligament can be identified by tracing the lumbosacral trunk caudally and may also be divided should even wider access to the pelvis be needed. From the ischial spine, arcus tendinous arises which gives rise to the origin of levator ani. Above arcus tendinous is obturator internus, which is lined by the endopelvic fascia anteriorly where it rests on either side of the bladder. Identification of the ischial spine provides a gateway into the anterior-caudal part of the pelvis.
Diagnosis and treatment of pudendal and inferior cluneal nerve entrapment syndrome: a narrative review
Published in Acta Chirurgica Belgica, 2022
Katleen Jottard, Pierre Bonnet, Viviane Thill, Stephane Ploteau, Stefan de Wachter
The PN has been referred to as the king of the perineum [3]. Indeed, the PN plays a major role in the fecal and urinary continence mechanisms and is important for normal sexual functioning. The PN has both motor and sensory functions and carries sympathetic fibers. It arises from the second, third, and fourth sacral ventral rami at the inferior edge of the piriformis muscle [4]. Before entering the gluteal region, the nerve passes through the infrapiriformis foramen, which is a part of the greater sciatic foramen. The nerve then passes posterior from the ischial spine or sacrospinous ligament (SSL), medial to the internal pudendal vessels, to finally enter the perineum through the Alcock’s canal, a fold of the obturator internus muscle fascia. It continues to course through the pudendal canal (Alcock’s canal), giving off three consecutive branches on its path: the inferior rectal (anal) nerve and its branches, the perineal nerve and its branches and the dorsal nerve of the penis or clitoris.
Postoperative indications for further surgery following post-transvaginal ProliftTM mesh repair after a two-year follow-up period: a single-centre study
Published in Journal of Obstetrics and Gynaecology, 2022
Hirotaka Sato, Katsuhiko Sato, Junichi Mochida, Satoru Takahashi, Sachiyuki Tsukada
Surgeries were performed at the hospital by a trained urologist, as previously described (Fatton et al. 2007). The surgical technique included a wide dimension, hydro-dissection of the vaginal wall overlying the bladder or rectum, using 50 mL of 1% adrenaline, diluted 1:1,000,000 in 500 mL of normosaline solution. The anterior incision was prolonged in the paravesical space, ischial spine, and arcus tendinous fasciae pelvis (ATFP). The anterior mesh was configured with its two lateral arms on either side, which perforated the obturator foramen at the ATFP level. The posterior mesh configuration consisted of a lateral arm on either side that perforated the sacrospinous ligaments. The artificial implant was a polypropylene mesh (ProliftTM Pelvic Floor Repair System; Ethicon). The vaginal epithelium was closed using continuous absorbable sutures. The ProliftTM surgery type (separated anterior, posterior, or total ProliftTM) was based on the prolapse stage and the compartment. Concomitant surgery including native-tissue repair (e.g. colporrhaphy and perineoplasty) was performed where necessary.
Prediction model for labour dystocia occurring in the active phase
Published in Journal of Obstetrics and Gynaecology, 2023
Yanqing Liu, Qingquan Gong, Yuhong Yuan, Qi Shi
Souka et al. reported that the anterior occipital position was the most common position during labour, followed by the posterior and transverse occipital positions (Souka et al.2003). These could be converted to the anterior occipital position during labour. However, the labour process, if stagnant, should be diagnosed as persistent occipital transverse or posterior position. In the first stage of labour, these were related to labour dystocia (Choi et al.2016, Tempest et al.2020). Abnormal foetal position can affect foetal head descent, making the head float high and resulting in labour dystocia. The foetal station was above the level of the ischial spine during the active phase, increasing the possibility of dystocia (Kimmich et al.2018).