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Urologic procedures
Published in J. Richard Smith, Giuseppe Del Priore, Robert L. Coleman, John M. Monaghan, An Atlas of Gynecologic Oncology, 2018
Padraic O’Malley, Peter N. Schlegel
The Boari flap was first described in 1899 as a bladder flap substitution for the distal ureter (Boari 1899). The Boari flap provides an excellent substitute for the psoas hitch technique when ureteric defects of longer than 6 to 8 cm exist (Stein et al. 2013). It is important to mobilize the bladder with division and ligation of the median umbilical ligament (urachus) and both medial umbilical ligaments. If greater mobilization is required, the contralateral superior vesicle pedicle can be divided and ligated. Caution must be used in patients who have had previous radiation, and thought given to the functional capacity of their bladder. A rhomboid flap is raised from the dome of the bladder, keeping the base of the flap at least 1 to 2 cm wider than the tip of the flap, and the length-to-width ratio not more than 3:1 in order to ensure good vascular supply (Figure 30.3). The ipsilateral vesical pedicle supplies the flap. The spatulated ureter may be implanted using a tunneled intravesical anastomosis or an extravesical mucosa-to-mucosa anastomosis and closure of the remaining flap vertically. The Boari flap can provide between 10 and 15 cm in length and can even reach the proximal ureter in certain cases on the right-hand side.
Complications of Abdominal Wall Surgery and Hernia Repair
Published in Stephen M. Cohn, Matthew O. Dolich, Complications in Surgery and Trauma, 2014
Ethan A. Taub, Jane Kayle Lee, James C. Doherty
Bladder injury can occur with either TAPP or TEP, and occurs with an incidence of 0%–0.2%.48 Bladder injury during TAPP can be avoided by limiting dissection to the area lateral to the medial umbilical ligament. The management principles for bladder injuries sustained during laparoscopic herniorrhaphy are the same as those for bladder injuries that occur during open inguinal herniorrhaphy. The bladder should be repaired primarily by using laparoscopic techniques, and bladder decompression should be maintained postoperatively via an indwelling bladder catheter.
Pelvic Anatomy Through the Laparoscope
Published in Linda Cardozo, Staskin David, Textbook of Female Urology and Urogynecology - Two-Volume Set, 2017
The obliterAted umbilicAl Arteries Are remnAnts of the fetAl circulAtion. occAsionAlly, they will remAin pAtent even in Adults. They Are brAnches of the internAl iliAc Arteries. The obliterAted umbilicAl Arteries cAn be used As lAterAl mArkers for entry into the cAve of retzius; however, if they Are not AdequAtely diAthermied prior to cutting, they mAy retrAct And bleed extensively (Figure 97.11). There Are inconsistencies in textbooks About AlternAtive nAmes for the obliterAted umbilicAl Arteries. some refer to them As the mediAl umbilicAl ligAments [4] And others As the lAterAl umbilicAl ligAments [5]. The most logicAl nomenclAture would seem to be thAt lAterAl umbilicAl ligAments Are the condensAtion of peritoneum over the inferior epigAstric vessels, while the mediAl umbilicAl ligAments Are equivAlent to the obliterAted umbilicAl Arteries. The mediAn umbilicAl ligAment is Another remnAnt of A fetAl structure, the urAchus. It runs from the dome of the blAdder to the umbilicus. It cAn occAsionAlly remAin pAtent cAusing A urAchAl fistulA to the umbilicus. All the umbilicAl ligAments cAn bleed when surgicAlly divided. The retropubic spAce cAn be opened 2–4 cm Above the dome of the blAdder. sometimes, it is helpful to fill the blAdder with 200–300 mL sAline or methylene blue to enAble its mArgins to be seen. In the midline, Anterior to the blAdder At the level of the pelvic floor Are the urethrA And dorsAl vein of the clitoris thAt should be Avoided. The spAce is bound lAterAlly by the obturAtor cAnAl And the Arcus tendineus fAsciAe pelvis (white line) (Figure 97.12). The obturAtor Artery is A brAnch of the internAl iliAc thAt runs on the lAterAl wAll of the pelvis to the obturAtor cAnAl. In About 25% of the populAtion, An AberrAnt obturAtor Artery Arises from the inferior epigAstric or externAl iliAc Artery. In some cAses, both A normAl And An AberrAnt obturAtor Artery Are present; the AberrAnt Artery is then cAlled An Accessory obturAtor Artery (Figure 97.5). The superior boundAry is the symphysis pubis And the pectineAl ligAment (Cooper's ligAment) (Figure 97.13). The obturAtor nerve (Figure 97.12) Arises from the lumbAr plexus (L2–L4). It enters the true pelvis through the greAter sciAtic forAmen And then runs in the extrAperitoneAl fAt Along the lAterAl wAll to reAch the obturAtor cAnAl. It then divides
Extraperitoneal versus transperitoneal cesarean section: a retrospective study
Published in Postgraduate Medicine, 2023
Chao Ji, Meng Chen, Yichen Qin
All women shared the same spinal anesthesia protocol (depending on the patient’s height). They received bladder catheterization and intravenous infusion of cefazolin (1 g) half an hour before skin incision, and a Pfannenstiel incision was made in both groups. The rectus abdominis was spread apart at the linea alba by vascular clamps and extended in blunt dissection. In ECS, beneath the left recti muscle, the left medial umbilical ligament and the anterior bladder fascia were visualized and pulled medially and inferiorly to 2–3 cm below the top part of the bladder until a sufficiently large lower uterine segment was exposed. In TCS, the peritoneum was opened directly and the entire pelvic cavity was disclosed. After the fetus was delivered and its placenta was removed, the uterus was sutured continuously and reinforced with a horizontal mattress suture. The anatomical structure of the bladder was then reset in ECS, and the peritoneum was closed in TCS. All patients received a visually indistinguishable subcuticular absorbable suture for skin closure.
Robot-assisted radical prostatectomy in the Middle East: A report on the perioperative outcomes from a tertiary care centre in Lebanon
Published in Arab Journal of Urology, 2021
Muhieddine Labban, Muhammad Bulbul, Wassim Wazzan, Raja Khauli, Albert El Hajj
In case of bilateral extended pelvic lymph node dissection (PLND), access to the peritoneum is achieved lateral to the medial umbilical ligament. The lateral limit of the dissection is the genitofemoral nerve and the medial limit is the obturator nerve, while the distal limit is the inguinal ligament and the proximal limit is the aortic bifurcation.