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Laparoscopic Conventional Abdominoperineal (CAPE) and Extra-Levator Abdominoperineal Resection (ELAPE)
Published in Haribhakti Sanjiv, Laparoscopic Colorectal Surgery, 2020
Sanjiv Haribhakti, Deepak Govil
It is also possible to perform the ELAPE in a lithotomy position, but a prone jack-knife position is always preferred. The lithotomy position may result in poor visualization of the anatomy of the region, which may contribute to the increased risk of perforation of the specimen and a positive resection margin. With the patient in the prone position, these hazards may be easier to avoid. Any bleeding from the prostatic bed or vaginal wall is easy to control in prone position. Perhaps the prone dissection may reduce the incidence of sexual dysfunction, which is known to be higher after APE in the lithotomy position compared with low anterior resection (LAR). This may be partly related to the difficulty in visualizing the nerves in the lithotomy position. The prone position improves visualization of the operative field, and allows clear demonstration of the surgical anatomy for teaching [14].
Interventional Ultrasound in Diagnosis and Treatment of Female Infertility
Published in Asim Kurjak, Ultrasound and Infertility, 2020
The perurethral route for oocyte aspiration has been first described by Parsons et al.17 in 1985. The patient with a full urinary bladder is also placed in the lithotomy position. The needle is introduced through the urethra into the bladder, and sterilization of the abdominal wall or the probe is unnecessary. There is also no need for local anesthesia. The needle is introduced into the bladder via the urethra by means of a metal introducer with a side longitudinal groove for the needle. After passing the internal orifice of the urethra, the needle is easily separated from the introducer and remains inside the bladder. The introducer is then immediately removed. If the introducer is not available, a self-retaining catheter can serve the purpose of urethral protection during the needle introduction. As in transvaginal puncture, the operator holds the probe with one hand and the needle with the other. By performing a longitudinal scan, the needle is clearly seen inside the fluid-filled bladder. As the angle between the needle and ultrasound beam is almost 90°, this accounts for superior needle visualization and easy orientation about the needle position and direction (Figure 4E).
Bladder cancer: superficial
Published in J Kellogg Parsons, E James Wright, The Brady Urology Manual, 2019
Lithotomy position (complications and prevention): Sciatic nerve injury: inability to flex knee – avoid excessive external hip rotationFemoral nerve injury: inability to flex hip or extend knee – avoid excessive external hip rotationCommon peroneal nerve: foot drop – avoid compression of lateral knee at the fibular headObturator reflex: stimulated by electrocautery, especially along lateral bladder wall.
Clearance of HR-HPV within one year after focused ultrasound or loop electrosurgical excision procedure in patients with HSIL under 30
Published in International Journal of Hyperthermia, 2022
Yi Qin, Qing Li, Xunyu Ke, Yan Zhang, Xiaoling Shen, Wenping Wang, Qiuling Shi, Chengzhi Li
FUS group: FUS treatment was performed using the Model-CZF Ultrasound Therapeutic Device (Chongqing Haifu Medical Technology Co., Ltd, Chongqing, China) with the therapeutic power of 3.5–4.5 W and working frequency of 9.8 MHz and impulse of 1000 Hz. Certified doctors trained in FUS treatment technology performed the procedure. Patients were in the lithotomy position. Their cervixes were disinfected and fully exposed with a speculum. The surface of the cervix was coated with ultrasound coupling gel prior to treatment. The treatment probe was placed in close contact with the cervix and moved around continuously with the cervix as the center and against the skin over the diseased area with 2 mm more of healthy tissue at a speed of 5–10 mm/s, using the uniform linear or circular irradiation mode. The treatment lasted until the lesion presented as a depressed area and the external cervical aperture was moderately introverted.
The effect of stone size on the results of extracorporeal shockwave lithotripsy versus semi-rigid ureteroscopic lithotripsy in the management of upper ureteric stones
Published in Arab Journal of Urology, 2022
Ahmed S. El-Abd, Ahmed M. Tawfeek, Shawky A. El-Abd, Tarik A. Gameel, Hasan H. El-Tatawy, Magdy A. El-Sabaa, Mohamed G. Soliman
Various treatment modalities have been reported for management of upper ureteric stones. The decision of which treatment to implement depends on many factors, e.g. stone size, degree of the proximal backpressure, presence of distal obstruction, the available technology, and surgical experience. All of these are important for selecting the most suitable technique for the best SFR and minimal morbidity. The treatment options vary from direct contact lithotripsy to in situ non-contact ESWL for medium size stones, up to laparoscopic or open uretero-lithotomy for complicated cases with large stones [5]. In recent years, new generations of ESWL machines are associated with minimal tissue damage, less anaesthesia, and higher re-treatment rate [6]. However, as a non-invasive treatment it can be done as an outpatient procedure with high patient tolerance even on re-treatment, and no need for theatres or prior stenting and stent removal. This is reflected on the overall costs and time for stone clearance [7]. ESWL has a high success rate of 85–96% for small proximal ureteric stones after prior JJ stenting, but this success rate is lower for larger stones [8]. We performed a prospective randomised study of ESWL vs URSL of 0.5–1.5 cm stones in the upper ureter using ultrasonic disintegration without prior stenting.
Differential diagnosis of knee pain following a surgically induced lumbosacral plexus stretch injury. A case report
Published in Physiotherapy Theory and Practice, 2019
William R. VanWye, Harvey W. Wallmann, Elizabeth S. Norris, Karen E. Furgal
The onset of the patient’s symptoms coincided with the recent D&C procedure, which was performed in the lithotomy position. Lithotomy positioning can result in stretch injuries to the femoral, lateral femoral cutaneous, obturator, sciatic, or common peroneal nerves (Barnett et al, 2007). It can also result in a lumbosacral plexus stretch injury, which is more consistent with the patient’s presentation (Flanagan, Webster, Brown, and Massey, 1985). Identifying the pattern of weakness and numbness clinically after a lumbosacral plexus injury may be difficult (Flanagan, Webster, Brown, and Massey, 1985; Preston and Shapiro, 2013). The patient exhibited hamstring weakness, which is innervated by the sciatic nerve, as well as weakness of the left ankle plantarflexors (i.e. gastrocnemius and soleus muscles), which are innervated by the tibial branch of the sciatic nerve (Kendall, McCreary, Provance, and Kendall, 1999). Yet, the patient also had left gluteus maximus and medius weakness, which are innervated by the inferior and superior gluteal nerve, respectively. The potential pattern in this case; each of these muscles is partially supplied by the S1 nerve root (Kendall, McCreary, Provance, and Kendall, 1999).