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Porzionato A, Macchi V, Stecco C, Loukas M, Tubbs RS, De Caro R. Forensic clinical anatomy: A new field of study with application to medicolegal issues. Clin Anat 2016; 30:2-5. [PMID: 27646460 DOI: 10.1002/ca.22796] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Accepted: 09/12/2016] [Indexed: 11/11/2022]
Abstract
Forensic clinical anatomy is a new practical application of the discipline of Clinical Anatomy for ascertaining and evaluating medicolegal questions. In particular, individual anatomy (normal anatomy, anatomical variations, age-, disease-, or surgery-related modifications) can acquire significant relevance in various fields of legal medicine such as child abuse, sudden death, medical responsibility and/or liability, personal injury and damage. Anatomical data of forensic interest frequently arise from the correct application of methods of ascertainment; anatomical methods may then be required for further comprehensive analysis. The rigorous interpretation of anatomical data, derived from the ascertainment phase and analyzed on the basis of pertinent literature, can be pivotal for the correct application of evaluation criteria in various forensic contexts. Clin. Anat. 30:2-5, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
| | | | - Carla Stecco
- Section of Anatomy, University of Padova, Padova, Italy
| | - Marios Loukas
- Department of Anatomical Sciences, St. George's University, True Blue, Grenada, West Indies
| | - R Shane Tubbs
- Department of Anatomical Sciences, St. George's University, True Blue, Grenada, West Indies.,Seattle Science Foundation, Seattle, Washington
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Kim SJ, Choi BJ, Lee SC. A novel single-port laparoscopic operation for colorectal cancer with transanal specimen extraction: a comparative study. BMC Surg 2015; 15:10. [PMID: 25633605 PMCID: PMC4328051 DOI: 10.1186/1471-2482-15-10] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Accepted: 11/28/2014] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Extension of a single incision for the purpose of specimen extraction in single-port laparoscopic surgery (SPLS) can undermine the merits of SPLS, either by hurting cosmesis or by increasing wound morbidity. METHODS We retrospectively analyzed the clinical outcomes of patients undergoing SPLS sigmoidectomy, either with transanal specimen extraction (TASE, n = 15) or transumbilical specimen extraction (TUSE, n = 68), for colorectal cancer between March 2009 and March 2013. The inclusion criterion was a tumor diameter of ≤ 5 cm. The median follow-up was 93 months (range 13 - 149). RESULTS Most of intraoperative and postoperative variables were comparable between the two groups, except for lengthening of operation time in TASE (287 ± 87 min vs. 226 ± 78 min, P = 0.011). TUSE did not lengthen the duration of postoperative recovery, hospital stay, or pain, or increase the incidence of postoperative complications. Whereas TUSE showed 8.8% (6/68) of wound-related complications, TASE did not show wound-related complications during follow-up period (P = 0.586). CONCLUSION With the exception of a prolonged operation time, TASE showed equivalent surgical outcomes as TUSE in SPLS sigmoidectomy. Thus, the implement of TASE is expected to provide one way of reducing wound-related complications in SPLS in patients with a tumor diameter of ≤5 cm.
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Affiliation(s)
- Say-June Kim
- Department of Surgery, Daejeon St. Mary's Hospital, The Catholic University of Korea, Daeheung-dong 520-2, Daejeon, Jung-gu, Republic of Korea.
| | - Byung-Jo Choi
- Department of Surgery, Daejeon St. Mary's Hospital, The Catholic University of Korea, Daeheung-dong 520-2, Daejeon, Jung-gu, Republic of Korea.
| | - Sang Chul Lee
- Department of Surgery, Daejeon St. Mary's Hospital, The Catholic University of Korea, Daeheung-dong 520-2, Daejeon, Jung-gu, Republic of Korea.
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Comparison and efficacy of LigaSure and rubber band ligature in closing the inflamed cecal stump in a rat model of acute appendicitis. BIOMED RESEARCH INTERNATIONAL 2015; 2015:260312. [PMID: 25699264 PMCID: PMC4324495 DOI: 10.1155/2015/260312] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Accepted: 10/17/2014] [Indexed: 02/06/2023]
Abstract
Safety of either LigaSure or rubber band in closing inflamed appendiceal stump in acute appendicitis has been less investigated. In this study, cecal ligation followed by resecting inflamed cecum was performed to mimic appendectomy in a rat model of acute appendicitis. Rats were sacrificed immediately (Group A) and 7 days (Group B) after cecal resection, respectively. The cecal stumps were closed by silk ligature (S), 5 mm LigaSure (L), or rubber band (R). Seven days after cecal resection, the LigaSure (BL) and silk subgroups (BS) had significantly less intra-abdominal adhesion and better laparotomy wound healing than rubber band subgroup (BR). The initial bursting pressure at cecal stump was comparable among the three methods; along with tissue healing process, both BL and BS provided a higher bursting pressure than BR 7 days after appendectomy. BL subgroup had more abundant hydroxyproline deposition than BS and BR subgroup. Furthermore, serum TNF-α in BR group kept persistently increasing along with time after cecal resection. Thus, the finding that LigaSure but not rubber band is safe in sealing off the inflamed cecal stump in rat model of acute appendicitis suggests the possibility of applying LigaSure for appendectomy via single port procedure or natural orifice transluminal endoscopic surgery (NOTES).
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Bai Y, Qiao WG, Zhu HM, He Q, Wang N, Cai JQ, Jiang B, Zhi FC. Role of transgastric natural orifice transluminal endoscopic surgery in the diagnosis of ascites of unknown origin (with videos). Gastrointest Endosc 2014; 80:807-16. [PMID: 24818547 DOI: 10.1016/j.gie.2014.03.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2013] [Accepted: 03/14/2014] [Indexed: 12/25/2022]
Abstract
BACKGROUND Natural orifice transluminal endoscopic surgery (NOTES) has been established in animal models and human studies. OBJECTIVE The aim of this study was to assess the feasibility and efficacy of applying transgastric NOTES to diagnose patients with ascites of unknown origin. DESIGN Prospective study. SETTING Two university and teaching hospitals. PATIENTS Patients with ascites of unknown origin. INTERVENTIONS Diagnostic transgastric NOTES. MAIN OUTCOME MEASUREMENTS Characteristic of ascites cases, conditions of the abdominal cavity, diagnostic accuracy, adverse events, and follow-up time. RESULTS Transgastric NOTES was performed successfully in 78 patients with ascites of unknown origin, and 72 cases (92.3%) were clearly diagnosed. They included malignant tumors (39 cases), tuberculous peritonitis (28 cases), chronic hepatic inflammation (3 cases), necrotizing lymphadenitis (1 case), and eosinophilic serositis of the small intestine (1 case). In addition, there were 6 nondiagnostic cases, and no severe adverse events were found. LIMITATIONS Nonrandomized control analysis. CONCLUSION Transgastric NOTES in combination with biopsy can elucidate the causes of ascites of unknown origin in the majority of cases. Therefore, it is a feasible and effective approach to access the peritoneal cavity and also a valuable modality to detect the cause of diseases with ascites of unknown origin.
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Affiliation(s)
- Yang Bai
- Guangdong Provincial Key Laboratory of Gastroenterology, Guangdong, China; Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Wei-guang Qiao
- Guangdong Provincial Key Laboratory of Gastroenterology, Guangdong, China; Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Hui-ming Zhu
- Department of Gastroenterology, The Second Affiliated Clinical Medical College, Shenzhen People's Hospital, Shenzhen, China
| | - Qiong He
- Department of Gastroenterology, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Na Wang
- Department of Gastroenterology, The Second Affiliated Clinical Medical College, Shenzhen People's Hospital, Shenzhen, China
| | - Jian-qun Cai
- Guangdong Provincial Key Laboratory of Gastroenterology, Guangdong, China; Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Bo Jiang
- Guangdong Provincial Key Laboratory of Gastroenterology, Guangdong, China; Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Fa-chao Zhi
- Guangdong Provincial Key Laboratory of Gastroenterology, Guangdong, China; Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China
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Porzionato A, Polese L, Lezoche E, Macchi V, Lezoche G, Da Dalt G, Stecco C, Norberto L, Merigliano S, De Caro R. On the suitability of Thiel cadavers for natural orifice transluminal endoscopic surgery (NOTES): surgical training, feasibility studies, and anatomical education. Surg Endosc 2014; 29:737-46. [PMID: 25060684 DOI: 10.1007/s00464-014-3734-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2013] [Accepted: 07/07/2014] [Indexed: 12/15/2022]
Abstract
BACKGROUND Surgical training in virtual, animal and cadaver models is essential for minimally invasive surgery. Thiel cadavers are suitable for laparoscopy, but there are few data about the use of embalmed (Tutsch method) and slightly embalmed (Thiel method) cadavers in procedures of Natural Orifice Transluminal Endoscopic Surgery (NOTES), which are usually developed and learned on swine models and fresh frozen cadavers. The aim of this study was thus to assess the use of these cadavers for NOTES approaches. METHODS The following surgical procedures were evaluated: transanal total mesorectal excision (four cadavers: one Tutsch, two Thiel, one fresh frozen), transanal ileorectal bypass (five cadavers: one Tutsch, three Thiel, one fresh frozen), and transvaginal appendectomy (two Tutsch cadaver). RESULTS The Thiel method ensured tissue flexibility and consistency suitable for performing the above surgical procedures with good results and without complications, with only a small increase in rigidity with respect to fresh specimens. Cadavers embalmed with higher formalin concentrations (Tutsch method) were more difficult to use, due to high tissue rigidity and resistance of the abdominal wall to pneumoperitoneum, although NOTES accesses were possible. CONCLUSIONS Thiel cadavers are suitable for transanal/transrectal and transvaginal NOTES approaches, for training surgical residents/specialists and also for surgical research. In minimally invasive surgery (and particularly in NOTES), integration between cadaver (fresh frozen and/or Thiel) and animal models would represent the gold standard, allowing guaranteed knowledge of and respect for human surgical anatomy and correct management of surgery on living subjects. NOTES approaches to human cadavers may also be proposed for the anatomical education of medical students.
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Affiliation(s)
- Andrea Porzionato
- Section of Anatomy, Department of Molecular Medicine, University of Padova, Via A. Gabelli 65, 35127, Padua, Italy
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Heidary B, Phang TP, Raval MJ, Brown CJ. Transanal endoscopic microsurgery: a review. Can J Surg 2014; 57:127-38. [PMID: 24666451 PMCID: PMC3968206 DOI: 10.1503/cjs.022412] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2013] [Indexed: 12/18/2022] Open
Abstract
Rectal adenomas and cancers occur frequently. Small adenomas can be removed colonoscopically, whereas larger polyps are removed via conventional transanal excision. Owing to technical difficulties, adenomas of the mid- and upper rectum require radical resection. Transanal endoscopic microsurgery (TEM) was first designed as an alternative treatment for these lesions. However, since its development TEM has been also used for a variety of rectal lesions, including carcinoids, rectal prolapse and diverticula, early stage carcinomas and palliative resection of rectal cancers. The objective of this review is to describe the current status of TEM in the treatment of rectal lesions. Since the 1980s, TEM has advanced substantially. With low recurrence rates, it is the method of choice for resection of endoscopically unresectable adenomas. Some studies have shown benefits to its use in treating early T1 rectal cancers compared with radical surgery in select patients. However, for more advanced rectal cancers TEM should be considered palliative or experimental. This technique has also been shown to be safe for the treatment of other uncommon rectal tumours, such as carcinoids. Transanal endoscopic microsurgery may allow for new strategies in the treatment of rectal pathology where technical limitations of transanal techniques have limited endoluminal surgical innovations.
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Affiliation(s)
- Behrouz Heidary
- From the Department of Surgery, St. Paul’s Hospital, University of British Columbia, Vancouver, BC
| | - Terry P. Phang
- From the Department of Surgery, St. Paul’s Hospital, University of British Columbia, Vancouver, BC
| | - Manoj J. Raval
- From the Department of Surgery, St. Paul’s Hospital, University of British Columbia, Vancouver, BC
| | - Carl J. Brown
- From the Department of Surgery, St. Paul’s Hospital, University of British Columbia, Vancouver, BC
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Liu L, Chiu PWY, Reddy N, Ho KY, Kitano S, Seo DW, Tajiri H. Natural orifice transluminal endoscopic surgery (NOTES) for clinical management of intra-abdominal diseases. Dig Endosc 2013; 25:565-77. [PMID: 23967798 DOI: 10.1111/den.12154] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Accepted: 07/04/2013] [Indexed: 12/20/2022]
Abstract
Clinical research on natural orifice transluminal endoscopic surgery (NOTES) has been increasingly reported over the past 5 years and more than 1200 patients have received various NOTES procedures. The present article reviews the clinical practice of NOTES for the treatment of intra-abdominal diseases, and was carried out through systematic search with specific keywords in major databases for NOTES-related clinical literature. The last date of the search was 15 August, 2012. Transvaginal cholecystectomy is the commonest NOTES procedure reported, and its clinical feasibility and safety was established through prospective case series and randomized trials. There is a regional difference in NOTES development with the majority of NOTES fromCaucasian countries being transvaginal cholecystectomy and most reports from Asian countries being NOTES-related procedures. Safe closure of gastrointestinal access remains challenging, and novel endoscopic instruments are essential to enhance future development of NOTES.
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Affiliation(s)
- Liu Liu
- Department of Surgery, Chinese University of Hong Kong, Hong Kong, China
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Linke GR, Carstensen B, Kähler G, Zerz A, Shevchenko M, Warschkow R, Lasitschka F, Kenngott HG, Senft J, Müller-Stich BP. Endolumenal colon occlusion device for transanal and transrectal surgery--a porcine feasibility study. Langenbecks Arch Surg 2013; 398:595-601. [PMID: 23483227 DOI: 10.1007/s00423-013-1074-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Accepted: 02/25/2013] [Indexed: 01/29/2023]
Abstract
PURPOSE Although several studies have demonstrated the feasibility of transrectal natural orifice translumenal endoscopic surgery (NOTES), its clinical application has been hindered by concerns regarding potential infectious complications. The aim of this study was to evaluate the feasibility of a newly developed device for endolumenal colon occlusion (ColoShield) in an acute porcine model. METHODS The principle of the ColoShield device is based on two balloons, with negative pressure in between. The ColoShield device and a gauze tamponade as a control group were evaluated in a non-survival study on 16 pigs. The efficacy of the occlusion system in establishing a leak-proof pneumorectum and in sealing the colon from proximal (watertight sealing) was tested by a standardized study course. Finally, the colon/rectum was explanted for macroscopic and microscopic examination. RESULTS A 20-mmHg leak-proof pneumorectum over a period of 10 min could be achieved in seven of eight (87 %) animals with the ColoShield device and in none of eight (0 %) animals with gauze tamponade (p < 0.001). In the watertight sealing test, mean intracolonic pressures of 23.5 ± 18.1 (0-53) mmHg using the ColoShield device and 0 ± 1.1 (0-3) mmHg using gauze tamponade (p = 0.003) were documented proximal to the occlusion system before a leakage occurred. Macroscopic and histopathological examinations revealed no significant impairment of the colon specimen in either group. CONCLUSIONS ColoShield proved to be a safe and effective device for a reversible endolumenal colon occlusion. Further studies should evaluate its impact on procedural sterility during transrectal NOTES.
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Affiliation(s)
- Georg R Linke
- Department of General, Visceral and Transplant Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany.
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Sanchez JE, Marcet JE. Colorectal natural orifice transluminal endoscopic surgery (NOTES) and transvaginal/transrectal specimen extraction. Tech Coloproctol 2013; 17 Suppl 1:S69-73. [PMID: 23345040 DOI: 10.1007/s10151-012-0934-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2011] [Accepted: 10/20/2011] [Indexed: 12/13/2022]
Abstract
Advancements in minimally invasive surgery have both revolutionized laparoscopy and set the stage for the advancement of endoscopic surgery to the forefront of modern medicine. Natural orifice transluminal endoscopic surgery (NOTES) has now become a subject of great interest to surgeons worldwide who wish to reduce the morbidity associated with abdominal operations. However, the application of NOTES to colorectal surgery has thus far been limited due to the complex dissection, anastomosis and specimen extraction typically required when operating on the large bowel. For this reason, laparoscopic-assisted natural orifice surgery has been the means by which most surgeons have begun to incorporate natural orifice surgery into their established practices. Transanal endoscopic surgery, transvaginal-assisted laparoscopy and transrectal specimen extraction are all emerging techniques that may be currently employed, in a hybrid manner, with traditionally accepted laparoscopic operations in order to transition toward less invasive surgery and even pure NOTES. To this end, the vagina appears to be the most practical and widely used site of specimen extraction and adjunct access site for laparoscopic hybrid operations. An accompanying video demonstrates the authors' preferred technique for transvaginal and transrectal specimen extraction.
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Affiliation(s)
- J E Sanchez
- Division of Colon and Rectal Surgery, University of South Florida, 1 Tampa General Circle, Suite F-145, Tampa, FL 33602, USA
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NOTES transvaginal hybrid cholecystectomy: the United States human experience. Surg Endosc 2012; 27:514-7. [PMID: 22806528 DOI: 10.1007/s00464-012-2470-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Accepted: 06/18/2012] [Indexed: 12/11/2022]
Abstract
BACKGROUND "Pure" NOTES and "hybrid" NOTES procedures have gained popularity during the past few years. However, most of these published series have been documented outside the United States. METHODS This is a prospective, nonrandomized series of patients. Female subjects who presented to the University of California at San Diego surgery clinic for elective cholecystectomy were offered participation in this study. Patients met the following criteria: aged 18-75 years; diagnosis of gallbladder disease that required cholecystectomy and American Society of Anesthesiology (ASA) class 1. Hybrid NOTES transvaginal technique was used for cholecystectomy. RESULTS A total of 27 women underwent hybrid transvaginal NOTES cholecystectomy during a 43-month period. The median age was 40.1 (range 23-63) years. The mean body mass index was 25.2 (range 16.4-34.1). All patients had an ASA I-II classification. The mean operative time was 92 (range 38-165) min. There was no conversion to an open operation. The mean hospital stay was 1.07 (range 1-2) days. Patients were followed for a mean of 3.32 (range 0.06-12.2) months. There were no postoperative complications. No scars were visible on the abdominal wall. CONCLUSIONS This study is the largest series of hybrid transvaginal cholecystectomy published in the United States. With our experience, we demonstrate that this technique is safe and clinically viable.
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