Minimally Invasive Parathyroidectomy
John C Watkinson, Raymond W Clarke, Louise Jayne Clark, Adam J Donne, R James A England, Hisham M Mehanna, Gerald William McGarry, Sean Carrie in Basic Sciences Endocrine Surgery Rhinology, 2018
The superior adenoma is usually located in an area above the intersection of the inferior thyroid artery with the RLN, posteriorly in the retropharyngeal or in the retro-oesophageal space. The thyroid gland is retracted medially and the inferior thyroid artery is identified along with the RLN. In the case of large adenomas the artery may need dividing, as they lie usually posteriorly. Once the adenoma is identified, the dissection is performed in the avascular plane posterolaterally and, using the vascular forceps, the gland is gently mobilized, taking care not to injure the RLN. The pedicle, located posteromedially, is identified, clipped and divided. If the adenoma cannot be located in the positions described, one may need to consider that the adenoma may be intra-thyroidal. In this scenario, a decision for open-neck exploration is advised.
Vaginectomy
J. Richard Smith, Giuseppe Del Priore, Robert L. Coleman, John M. Monaghan in An Atlas of Gynecologic Oncology, 2018
Incising the roof of the ureteric tunnel. The ureter can be identified as it passes into the bladder. If this is possible, Bonney scissors should be gently introduced over the upper surface of the ureter, and using a separating movement without cutting, the scissors are gently insinuated laterally to appear at the lateral end of the ureteric tunnel. This dissection may be performed from medial to lateral or in the reverse direction. It is important not to kink or to nip the ureter in the edges of the scissors; the simple maneuver of lifting the scissors while in the tunnel will allow a good view of the entire length of the ureter. A medium straight tissue forceps is then placed over the scissors and the ureteric tunnel and the scar tissue incised (Figure 16.3). The pedicle is then tied, as it carries some veins and small arteries to and from the bladder. At this point, there may still be a few strands of fascia passing across the ureter; these should be divided and the tissue plane between the ureter and the vagina identified. The cardinal ligament is now visible below and medial to the ureter. Sharp dissection may still be required if there has been extensive scarring from the previous surgery. The upper vagina is revealed very quickly and the ureters dislocated laterally. The firm pack in the vagina greatly facilitates this dissection.
Spinal Cord Angiography
Milosh Perovitch in Radiological Evaluation of the Spinal Cord, 2019
It is important to establish precisely, on angiograms, the number of arterial feeding pedicles, the level of their entrance into the spine, and the point of junction with the angioma. The number of feeding pedicles varies. Occasionally, a single pedicle feeds the malformation and, in other cases, multiple pedicles (two to six or more) supply the blood to the arteriovenous aneurysm. Multiple pedicles are either anterior or pos-terior arteries feeding the spinal cord.9 The origin of a pedicle may be quite distant from the angioma, which is often the case with those located partially in the spinal cord and fed from the more scattered contributors. Furthermore, angiography should clearly demonstrate the anterior or posterior location of a pedicle. Posterior arterial feeding pedicles are more common, as mentioned above. They originate from an inter-costal or lumbar artery, and occasionally, from the deep cervical, or vertebral arteries. An anterior radiculo-medullary artery is less often the source of a feeding pedicle, although the blood supply to the angioma may come from the Adamkiewicz artery in the lumbar region, or from the superior dorsal artery, artery of the cervical enlarge-ment, and the anterior spinal artery in the proximal cervical area. As already men-tioned, some vascular malformations can receive blood from both anterior and poste-rior arterial sources. Intramedullary angiomas supplied by the anterior spinal artery and its tributaries are not considered for surgical treatment (Figure 8).9
Inferior and Central Mound Pedicle Breast Reduction in Gigantomastia: A Safe Alternative?
Published in Journal of Investigative Surgery, 2021
Fatma Bilgen, Alper Ural, Mehmet Bekerecioğlu
In our study, 72 patients underwent reduction mammaplasty with inferior pyramidal pedicle technique in extreme gigantomastia. None of them required amputation of the breast and free nipple graft. This technique was applied particularly with the purpose of preserving NAC sensation and viability as well as cosmesis. Some noteworthy points may have contributed this technique to be used safely even in gigantic breasts and maintain satisfactory results with lower complications. First, the base of our pedicles along the inframammary fold has a width of 10–12 cm, compared with the typical 4–8 cm inferior pedicle width. Second, meticulous attention is given to the pedicle intraoperatively. This entails keeping the pedicle resting on the chest wall along the breast meridian, avoiding “dangling” onto the sides that may cause soft-tissue avulsion or small vessel thrombosis. Third, the posterior base of the pedicle is thicker, thereby maintaining more contact with the pectoralis muscle and preserving more of branches from the lateral and anterior intercostal nerves.
Development of a flexible instrumented lumbar spine finite element model and comparison with in-vitro experiments
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2022
Aleksander Leszczynski, Frank Meyer, Yann-Philippe Charles, Caroline Deck, Rémy Willinger
For the instrumented lumbo-pelvic FEMs, three different configurations of L2-Pelvis instrumentation were developed according to in-vitro experiments of Godzik et al. (2019): bilateral single rod (Config1), single rod with an interbody cage at L5-S1 (Config2) and bilateral double rods with interbody cage at L5-S1 (Config3). The configurations are shown in Figure 4 and are described below. Pedicle screws, connectors, rods and interbody cages were meshed with hexahedral elements. Pedicle screws were centered in the pedicles along the anatomical axis and penetrated the vertebral body. The two main rods (diameter 5.5 mm) were adapted to the profile of the spine; passing through the screw head centers. Double rods were positioned medially with a distance of 7.5 mm and connected to the main rods by side-to-side connectors between L3-4 and S1-ilium. Anterior lumbar interbody fusion (ALIF) cages were modeled using the L5-S1 NP mesh. The assumption was made that pedicle screws were rigidly fixed to the vertebrae and to the rods, thus restraining relative movements.
Device profile of the XVision-spine (XVS) augmented-reality surgical navigation system: overview of its safety and efficacy
Published in Expert Review of Medical Devices, 2021
Christopher F. Dibble, Camilo A. Molina
The accuracy, precision, and safety of this technology has been initially evaluated in the setting of inserting thoracolumbar pedicle screws. Pedicle screws cannulate the rigid cortical bone of the pedicle as well as the softer cancellous bone of the vertebral body and provide a rigid point of fixation for rods used in commonly performed procedures such as posterior spinal instrumentation and fusion. Pedicle screw instrumentation is technically demanding – spine surgeons often undergo years of intensive specialty training, and this is reflected by generally high accuracy in pedicle screw placement, with some studies showing as high as 98% [11–14]. But others have shown less favorable results, with insertion accuracy of only 75% [14–17]. In order to increase accuracy, efforts to increase the safety and efficacy of spine computer navigation assistance have yielded a number of new techniques including surgical navigation and then more recently robotic assisted pedicle screw insertion [18–22].
Related Knowledge Centers
- Bone
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- Irregular Bone
- Process
- Ligamenta Flava
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