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Intrafascial dissection

Masakazu Yamamoto, Shun-Ichi Ariizumi
Glisson's capsule was discovered by Johannis Walaeus in 1640 and described by Francis Glisson in 1654. The capsule wraps the hepatic artery, the portal vein and the bile duct in the liver and forms bundles at the hepatic hilus and in the liver as the Glissonean pedicle tree. Glisson's capsule does not connect to the proper membrane of the liver, which was discovered by Laennec; therefore, the Glissonean pedicles can be detached from the liver parenchyma without liver dissection. Couinaud described three main approaches to control the inflow system at the hepatic hilus in liver surgery; the intrafascial approach, the extrafascial and transfissural approach, and the extrafascial approach...
March 2018: Annals of gastroenterological surgery
Hasan Hüseyin Tavukçu, Ömer Aytaç, Numan Cem Balcı, Haluk Kulaksızoğlu, Fatih Atuğ
Objective: We investigated the effect of the use of multiparametric prostate magnetic resonance imaging (mp-MRI) on the dissection plan of the neurovascular bundle and the oncological results of our patients who underwent robot-assisted radical prostatectomy. Material and methods: We prospectively evaluated 60 consecutive patients, including 30 patients who had (Group 1), and 30 patients who had not (Group 2) mp-MRI before robot-assisted radical prostatectomy. Based on the findings of mp-MRI, the dissection plan was changed as intrafascial, interfascial, and extrafascial in the mp-MRI group...
December 2017: Turkish Journal of Urology
Anastasios D Asimakopoulos, Roberto Miano, Antonio Galfano, Aldo Massimo Bocciardi, Giuseppe Vespasiani, Enrico Spera, Richard Gaston
To provide an overview of the anatomical landmarks needed to guide a retropubic (Retzius)-sparing robot-assisted laparoscopic prostatectomy (RALP), and a step-by-step description of the surgical technique that maximizes preservation of the periprostatic neural network. The anatomy of the pelvic fossae is presented, including the recto-vesical pouch (pouch of Douglas) created by the reflections of the peritoneum. The actual technique of the trans-Douglas, intrafascial nerve-sparing robotic radical prostatectomy is described...
October 2015: Clinical Anatomy
Gunnar Steineck, Anders Bjartell, Jonas Hugosson, Elin Axén, Stefan Carlsson, Johan Stranne, Anna Wallerstedt, Josefin Persson, Ulrica Wilderäng, Thordis Thorsteinsdottir, Ove Gustafsson, Mikael Lagerkvist, Thomas Jiborn, Eva Haglind, Peter Wiklund
BACKGROUND: Many elderly or impotent men with prostate cancer may not receive a bundle-preserving radical prostatectomy as a result of uncertainty regarding the effect on urinary incontinence. OBJECTIVE: We searched for predictors of urinary incontinence 1 yr after surgery among surgical steps during radical prostatectomy. DESIGN, SETTING, AND PARTICIPANTS: More than 100 surgeons in 14 centers prospectively collected data on surgical steps during an open or robot-assisted laparoscopic radical prostatectomy...
March 2015: European Urology
Aleksandar Karamarković, Krstina Doklestić
BACKGROUND/AIMS: We are evaluated technique of anatomic major and minor hepatic resections using suprahilar-extrafascial dissection of Glissonean pedicle with vascular stapling device for transection of hepatic vessels intending to minimize operative time, and blood loss. METHODOLOGY: We prospectively analyzed the clinical records of 170 patients who underwent hepatic resection by suprahilar-extrafascial pedicle isolation and stapling technique in our clinic for emergency surgery in Belgrade...
October 2014: Hepatobiliary Surgery and Nutrition
S A Al-Mamari, H Quintens, N Mentine, C Burté, N Rouyer, G Jacob, J Amiel
INTRODUCTION: Due to its technical ease and greater precision Robotic Assisted Laparoscopic radical Prostatectomy (RALP) allows a better preservation of the neurovascular bundles, thereby improving functional outcomes. The intrafascial dissection has been proposed to allow a more complete preservation of these bundles. However, this technique harbors a high rate of positive surgical margins, justifying another trend: the interfascial approach. To date, there are still few publications directly comparing these 2 techniques and our study is the first to offer a 2-year follow-up...
January 2015: Progrès en Urologie
L Cormier, C Bastide, P Beuzeboc, G Fromont, C Hennequin, P Mongiat-Artus, M Peyromaure, G Ploussard, R Renard-Penna, P Richaud, F Rozet, M Soulié, L Salomon
OBJECTIVE: Literature showed the impact of surgical margin status on prognosis after radical prostatectomy (mostly on biochemical survival). Margin status is an easy self-evaluation of surgical practice to assess. The aim of this paper was to define what a positive surgical margin (PSM) is and how to prevent the occurrence, to precise the impact on survival and how to treat. METHOD: A literature analysis with Pubmed has been performed to 2012, furthermore conclusions of the main congresses with selection committee and review publication have also been studied...
May 2014: Progrès en Urologie
Chang-Ming Huang, Qi-Yue Chen, Jian-Xian Lin, Chao-Hui Zheng, Ping Li, Jian-Wei Xie, Jia-Bin Wang, Jun Lu
BACKGROUND: Laparoscopic spleen-preserving Splenic hilar lymphadenectomy (LSPL) is required in laparoscopy-assisted total gastrectomy for advanced proximal gastric cancer. However, it is considerably difficult and risk in clinical practice. Thus, we explore the application of LSPL performed by following the perigastric fascias and the intrafascial space in D2 radical gastrectomy for advanced upper-third gastric cancer. METHODS: From July 2010 to December 2012, 109 patients with T2-3 upper-third gastric cancer underwent LSPL...
2014: PloS One
Murat M Rifaioglu, Mursel Davarci, Tumay Ozgur, Seyma Ozkanli, Taskin Ozdes, Mehmet Inci, Kadir Onem, M Derya Balbay
OBJECTIVE: To compare interfascial (IEF) or intrafascial (IAF) periprostatic nerve dissection technique in prostate tissue using immunohistochemical methods in fresh cadavers. MATERIALS AND METHODS: Prostate tissues of 25 fresh cadavers were removed from rectum and other surrounding structures. IEF nerve dissection (n = 25) was performed on the right and IAF nerve (n = 25) dissection on the left side of each prostate under direct visualization. The base, center, and apex of each prostate lobes and fascia dissected were sampled for blind histopathologic evaluation...
October 2013: Urology
Eugene Maida, James C Presley, Naveen Murthy, Wojciech Pawlina, Jay Smith
OBJECTIVES: To determine the distribution of sonographically guided deep plantar fascia injections in an unembalmed cadaveric model. METHODS: A single experienced operator completed 10 sonographically guided deep plantar fascia injections in 10 unembalmed cadaveric specimens (5 right and 5 left) obtained from 6 donors (2 male and 4 female) aged 49 to 95 years (mean, 77.5 years) with a mean body mass index of 23.2 kg/m(2) (range, 18.4-26.3 kg/m(2)). A 12-3-MHz linear array transducer was used to direct a 22-gauge, 38-mm stainless steel needle deep to the plantar fascia at the anterior aspect of the calcaneus using an in-plane, medial-to-lateral approach...
August 2013: Journal of Ultrasound in Medicine: Official Journal of the American Institute of Ultrasound in Medicine
Young Hoon Choi, Jeong Zoo Lee, Moon Kee Chung, Hong Koo Ha
PURPOSE: We present our initial experience and surgical outcomes for the most recent refinement of bilateral intrafascial nerve-sparing extraperitoneal laparoscopic radical prostatectomy (nsELRP). MATERIALS AND METHODS: Among 62 patients who underwent laparoscopic radical prostatectomy, 50 patients underwent intrafascial nsELRP by a single surgeon at Pusan National University Hospital from November 2011 to April 2012. As part of the intrafascial technique, the dissection plane is directly on the prostatic capsule to preserve most of the periprostatic fascia containing small vessels and nerves, endopelvic fascia, neurovascular bundle, and puboprostatic ligament...
December 2012: Korean Journal of Urology
Guillaume Ploussard, Laurent Salomon, Bastien Parier, Claude Clément Abbou, Alexandre de la Taille
OBJECTIVES: To report our surgical technique and outcomes after extraperitoneal robot-assisted laparoscopic radical prostatectomy (RALRP). MATERIALS AND METHODS: At Henri Mondor's Hospital, we performed the first RALRP in 2001 and started to perform routinely RALRP since 2006. Preoperative characteristics, perioperative parameters, functional and oncological outcomes were collected in a prospective database and studied. All parameters were tested in patients undergoing RALRP beyond the learning curve of each surgeon...
June 2013: World Journal of Urology
Takanori Sakaguchi, Shohachi Suzuki, Takanori Hiraide, Yasushi Shibasaki, Yoshifumi Morita, Atsushi Suzuki, Kazuhiko Fukumoto, Keisuke Inaba, Yasuo Takehara, Hatsuko Nasu, Mika Kamiya, Shuhei Yamashita, Takasuke Ushio, Hiroyuki Konno
PURPOSE: The aim of this study was to investigate whether individual arterial and portal venous division during hepatectomy is always safe by examining the presence of the anomalous arterial ramification in the right liver. METHODS: The ramifications of the right hepatic artery (RHA) were investigated by three-dimensional (3D) reconstruction imaging using a computer software program in 87 patients undergoing computed tomography during angiography as a preoperative assessment of intrahepatic tumors...
November 2013: Surgery Today
Stacey Carter, Jesse D Le, Jim C Hu
PURPOSE OF REVIEW: Although cure of prostate cancer is the primary goal of radical prostatectomy, preserving erectile function is also tantamount, given the indolent clinical course of most prostate cancers, particularly low-risk disease. In order to optimize postprostatectomy erectile function during a robotic-assisted radical prostatectomy, there must be a detailed understanding of pelvic anatomy to recognize the optimal nerve-sparing plane and technical finesse to minimize stretch injury to the neurovascular bundle...
January 2013: Current Opinion in Urology
Anastasios D Asimakopoulos, Victor Enrique Corona Montes, Richard Gaston
The preservation of sexual potency after radical prostatectomy has always been the topic of much anxiety and debate. While cancer control and urinary continence are of supreme importance, the preservation of sexual function completes the trifecta that both patient and surgeon strive to achieve. The introduction of robotic assistance to modern laparoscopic surgery has provided many advantages, the two greatest being improved three-dimensional magnified vision and wristed instrumentation. These technical enhancements provide the surgeon with improved surgical tools that have the potential to facilitate a more precise surgical approach...
December 2012: Journal of Endourology
Jesse D Sammon, Pranav Sharma, Quoc-Dien Trinh, Khurshid R Ghani, Shyam Sukumar, Mani Menon
INTRODUCTION: Few studies have examined the patient characteristics that lead to early continence after robot-assisted radical prostatectomy (RARP), and to date, there has been no investigation into the predictors of immediate continence. In the current study, we examine a large multisurgeon population of patients undergoing RARP to assess for predictors of this outcome. PATIENTS AND METHODS: Between January 2008 and December 2010, 1270 patients who underwent RARP at our institution, with complete preoperative and follow-up data, were assessed for urinary function prospectively...
April 2013: Journal of Endourology
Woo Jin Ko, Gregory W Hruby, Andrew T Turk, Jaime Landman, Ketan K Badani
UNLABELLED: WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: Incremental nerve-sparing techniques (NSTs) improve postoperative erectile function after robot-assisted radical prostatectomy (RARP). However, there are no studies to date that histologically confirm the surgeon intended NST. Thus, in the present study, we histologically confirmed that the surgeon performed the nerve preservation as his intended NSTs during RARP. Also, we found that there was more variability in fascia width outcome on the left side compared with the right...
March 2013: BJU International
Katsumi Shigemura, Nozomu Yamanaka, Masuo Yamashita
PURPOSE: To introduce and evaluate our open antegrade radical prostatectomy (ARP) technique, a nerve-sparing technique which offers patients better postsurgical urinary continence by our technique of 'Veil of Aphrodite'. METHODS: Ninety consecutive bilateral nerve-sparing ARPs performed using the Veil technique (intrafascial dissection) were compared to control ARP cases using non- or unilateral nerve sparing. Correlation of urinary continence with immunohistochemical (IHC) stains of nerves (S-100) around the prostate capsule was investigated in 20 consecutive patients whose ARPs were performed by a single surgeon...
2012: Urologia Internationalis
Spyridon A Vourtsis, Apostolos E Papalois, George D Agrogiannis, Petros K Spyriounis, Efstratios Patsouris, Mihai Ionac
BACKGROUND: Vascular endothelial growth factor (VEGF) is a heparin-binding glycoprotein which plays a significant role in angiogenesis and vascular permeability. The effect of various ways of local administration of VEGF on random skin flap survival was studied, using flaps with a relatively high length (L) to width (W) ratio (5:1). MATERIALS AND METHODS: An 1.5 × 7.5 cm dorsal skin flap with the pedicle orientated, centered, and remaining attached between the lower angles of the scapulae was elevated in 45 Wistar rats in different phases, depending on the group...
January 2012: Indian Journal of Plastic Surgery: Official Publication of the Association of Plastic Surgeons of India
Ashkan Mortezavi, Thomas Hermanns, Hans-Helge Seifert, Peter J Wild, Daniel M Schmid, Tullio Sulser, Daniel Eberli
INTRODUCTION: Improved visualization and magnification in robot-assisted laparoscopic radical prostatectomy (RALRP) has tempted many urologists to dissect the neurovascular bundle closer to the prostate following the layers of the pseudo-capsule of the prostate. This might bear a higher risk of decreased tumor control. MATERIALS AND METHODS: An analysis of a consecutive series of 186 patients who underwent RALRP at our institution was performed. The outcome of patients with intrafascial nerve-sparing (INS) was compared with the outcome of patients who underwent interfascial, extrafascial or no nerve-sparing (non-INS)...
2012: Urologia Internationalis
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