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Lower Limb Muscles
Published in Eve K. Boyle, Vondel S. E. Mahon, Rui Diogo, Handbook of Muscle Variations and Anomalies in Humans, 2022
Eve K. Boyle, Vondel S. E. Mahon, Rui Diogo, Malynda Williams
Obturator internus originates from bony surfaces that surround the obturator foramen including the inferior pubic ramus, the ischial ramus, the pelvic surface of the ilium, and the greater sciatic foramen (Standring 2016). It also originates from the obturator membrane and the obturator fascia (Standring 2016). Its fibers converge into four or five tendinous bands that pass through the lesser sciatic foramen to insert as a single tendon onto the greater trochanter (Standring 2016). The superior gemellus and inferior gemellus fuse with this tendon prior to insertion (Standring 2016).
Embryology, Anatomy, and Physiology of the Bladder
Published in Karl H. Pang, Nadir I. Osman, James W.F. Catto, Christopher R. Chapple, Basic Urological Sciences, 2021
Allan Johnston, Tarik Amer, Omar Aboumarzouk, Hashim Hashim
Obturator arteryPasses immediately from the lateral pelvic wall to the upper aspect of the obturator foramen.Leaves the true pelvis via the obturator foramen.Crossed on its most medial aspect by the ureter (and the vas deferens in the male).Provides a vesical branch to the bladder.
Ultrasound in Colorectal 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
The funnel of the levator ani separates the extraperitoneal pelvis into an infraperitoneal or pelvirectal space and a subcutaneous or ischiorectal space. The lateral border corresponds to the obturator internus muscle, with the obturator foramen. At this point, which is endosonographically distinctly marked by the U-shaped hyperechoic puborectalis sling, the anal canal terminates and the distal rectum begins.
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.
Contralateral obturator nerve transfer for femoral nerve restoration: a case report
Published in British Journal of Neurosurgery, 2021
Yu Cao, Yuehong Li, Youlai Zhang, Shulin Li, Junjian Jiang, Yudong Gu, Lei Xu
Usually, a nerve graft or obturator transfer would have been considered for such a case. The surgery was performed under general anesthesia and we made a standard oblique incision. The lumbar plexus was clearly shown and the L2 and L3 nerves were found to have ruptured near their foraminae. The proximal ends were not identifiable and when the distal stumps of the femoral nerve were explored and separated from the fibrotic tissue, (see Figure 1) it was decided that a contralateral obturator nerve transfer would be an option. A symmetrical incision was made on the contralateral side, and the contralateral obturator nerve was explored by the medial side of iliopsoas (see Figure 2). The contralateral obturator nerve was then fully harvested at the point where the nerve entered the obturator foramen. The transferable length of the obturator nerve was approximately 10cm and the nerve was then transferred beneath the peritoneum (see Figure 3). Finally, the distal end of femoral nerve was anastomosed to the obturator nerve.
An update on research and outcomes in surgical management of vaginal mesh complications
Published in Expert Review of Medical Devices, 2019
Dominic Lee, Philippe E. Zimmern
Pelvic MRI with a mesh protocol is sometimes indicated when the site of lateral prolapse mesh anchors needs to be identified prior to a possible vaginal exploration for pain or vaginal discharge or when the location of retropubic MUS arms is questioned to explain suprapubic or groin pain or a bladder perforation is suspected. Khatri et al. observed in series of patients with mesh implants that MRI imaging is better than the US for depiction of the arms in the retropubic space and obturator foramen, in addition to imaging the distal arms of the mesh traversing the sacrospinous ligaments or within the ischiorectal fossae (ischioanal fossae) (Figure 5). MRI imaging was also superior to the US for depiction of sacrocolpopexy mesh and associated complications [24].