Dissection at sacral promontory

2020 ◽  
Author(s):  
Amita Jain
Keyword(s):  
Sacral Promontory

scholarly journals Iatrogenic endometriosis following apical pelvic organ prolapse surgery: a case report

2020 ◽  
Vol 14 (1) ◽  
Author(s):  
Alkan Cubuk ◽  
Orkunt Ozkaptan ◽  
Jörg Neymeyer
Keyword(s):  
Case Report ◽  
Pelvic Organ Prolapse ◽  
De Novo ◽  
Pelvic Organ ◽  
Prolapse Surgery ◽  
Uterine Disease ◽  
Apical Prolapse ◽  
Sacral Promontory ◽  
Laparoscopic Supracervical Hysterectomy ◽  
Supracervical Hysterectomy

Abstract Background Iatrogenic endometriosis is the presence of endometrial glands and stroma out of the uterus following certain surgical interventions. The rate of iatrogenic endometriosis after gynecologic surgeries due to benign uterine disease is 1–2%. Laparoscopic supracervical hysterectomy is also a part of frequently used surgical treatment of apical pelvic organ prolapse, which is followed by sacrocervicopexy. However, there are no data about iatrogenic endometriosis after apical prolapse surgery in the current literature. Herein, we present a case report of a patient diagnosed with de novo endometriosis 1 year after laparoscopic supracervical hysterectomy and sacrocervicopexy. Case presentation A 46-year-old parous Slavic woman who underwent laparoscopic supracervical hysterectomy and sacrocervicopexy secondary to grade 3 symptomatic apical prolapse 1 year earlier was admitted to the same clinic with pelvic pain that had started 6 months following surgery. Deep vaginal palpation was painful. Transvaginal ultrasonography revealed an area with hypervascularization on the sacral promontory. She was scheduled for diagnostic laparoscopy. A 2 × 2-cm solid, wine-colored, hypervascular hemorrhagic lesion was seen on the sacral promontory. The lesion and the peritoneal layer behind it were totally excised. The patient was discharged on the first postoperative day, without any complications. Pathologic examination revealed foci of endometriosis comprising endometrial glands and stroma within the connective tissue, along with hemosiderin-laden macrophages. The symptoms of the patient resolved after the surgery, and no further adjuvant treatment was needed. Conclusion Although the rate of iatrogenic endometriosis is low after laparoscopic supracervical hysterectomy and sacrocervicopexy, the possibility of the occurrence of iatrogenic endometriosis should be discussed with patients who are diagnosed with apical prolapse to determine the type of surgical intervention. Iatrogenic endometriosis should be kept in mind for differential diagnosis in case of pain after laparoscopic supracervical hysterectomy and sacrocervicopexy.

scholarly journals Assessing the extent of colon lengthening due to splenic flexure mobilization techniques: a cadaver study

2012 ◽  
Vol 49 (3) ◽  
pp. 219-222 ◽  
Author(s):  
Sergio Eduardo Alonso Araujo ◽  
Victor Edmond Seid ◽  
Nam Jin Kim ◽  
Alexandre Bruno Bertoncini ◽  
Sergio Carlos Nahas ◽  
...  
Keyword(s):  
Splenic Flexure ◽  
Colorectal Anastomosis ◽  
Rectal Surgery ◽  
Sao Paulo ◽  
Left Colon ◽  
São Paulo ◽  
Splenic Flexure Mobilization ◽  
Sacral Promontory ◽  
Colon Segment ◽  
The Impact

CONTEXT: Failure of a colorectal anastomosis represents a life-threatening complication of colorectal surgery. Splenic flexure mobilization may contribute to reduce the occurrence of anastomotic complications due to technical flaws. There are no published reports measuring the impact of splenic flexure mobilization on the length of mobilized colon viable to construct a safe colorectal anastomosis. OBJECTIVE: The aim of the present study was to determine the effect of two techniques for splenic flexure mobilization on colon lengthening during open left-sided colon surgery using a cadaver model. DESIGN: Anatomical dissections for left colectomy and colorectal anastomosis at the sacral promontory level were conducted in 20 fresh cadavers by the same team of four surgeons. The effect of partial and full splenic flexure mobilization on the extent of mobilized left colon segment was determined. SETTING: University of Sao Paulo Medical School, Sao Paulo, SP, Brazil. Tertiary medical institution and university hospital. PARTICIPANTS: A team of four surgeons operated on 20 fresh cadavers. RESULTS: The length of resected left colon enabling a tension-free colorectal anastomosis at the level of sacral promontory achieved without mobilizing the splenic flexure was 46.3 (35-81) cm. After partial mobilization of the splenic flexure, an additionally mobilized colon segment measuring 10.7 (2-30) cm was obtained. After full mobilization of the distal transverse colon, a mean 28.3 (10-65) cm segment was achieved. CONCLUSION: Splenic flexure mobilization techniques are associated to effective left colon lengthening for colorectal anastomosis. This result may contribute to decision-making during rectal surgery and low colorectal and coloanal anastomosis.

scholarly journals Laparoscopic monolateral suspension for vaginal vault prolapse: a report of an exit surgical strategy during sacralcolpopexy

BMC Surgery ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Federico Romano ◽  
Andrea Sartore ◽  
Denise Mordeglia ◽  
Giovanni Di Lorenzo ◽  
Guglielmo Stabile ◽  
...  
Keyword(s):  
Laparoscopic Approach ◽  
Vaginal Vault Prolapse ◽  
Surgical Strategy ◽  
Vaginal Vault ◽  
Limiting Factor ◽  
Sacral Colpopexy ◽  
Sacral Promontory ◽  
Vault Prolapse ◽  
New Horizons

Abstract Background Vaginal vault prolapse is the most frequent long-term complication in patients undergoing hysterectomy and sacralcolpopexy is considered the gold standard. We report our surgical strategy maintaining single-arm mesh when the sacral promontory is not accessible to fix the mesh for an unknown sacral osteophytosis during a laparoscopic sacralcolpopexy. This is significant because, to our knowledge, the bone variant as a procedure limiting factor has never been described before. This opens new horizons for the sacralcolpopexy surgery, because it becomes necessary to know of a valid surgical alternative with mesh maintenance if this complication occurs again or to perform an assessment of the accessibility of the sacral promontory immediately after its dissection. Case presentation We present a case of a 75-year-old woman with recurrence of vaginal vault prolapse. A laparoscopic sacralcolpopexy was recommended. During surgery, we found that the procedure was not feasible due to the presence of an unknown osteophytosis of the sacrum which prevented the fixing of the mesh to the sacral promontory. We decided to proceed with a single-arm lateral suspension by using a modified approach of the original technique, maintaining the mesh originally shaped for the sacral colpopexy. At follow-up, the vaginal vault is well suspended. Conclusion This exit strategy may represent a valid surgical alternative when laparoscopic sacral colpopexy is not possible for anatomical variants, allowing to keep the laparoscopic approach using mesh. To our knowledge, cases in which the anatomical bone variant prevented access to the sacral promontory have never been described in the literature, as bone evaluation has never been considered a limiting element of this procedure.

scholarly journals The Effects of Moderate Neuromuscular Blockade Combined with Transverse Abdominal Plane Block on Surgical Space Conditions During Laparoscopic Colorectal Surgery: A Randomised Clinical Study

2021 ◽  
Author(s):  
Fang Ke ◽  
Zijin Shen ◽  
Cheng Wu ◽  
Lin Zhang ◽  
Rong Dong
Keyword(s):  
Colorectal Cancer ◽  
Laparoscopic Surgery ◽  
Neuromuscular Blockade ◽  
Intervention Group ◽  
Ordinal Scale ◽  
Control Group ◽  
Sacral Promontory ◽  
Pain Scores ◽  
Significant Difference ◽  
Space Conditions

Abstract Background Deep neuromuscular blockade may be beneficial on surgical space conditions during laparoscopic surgery. The effects of moderate neuromuscular blockade combined with transverse abdominal plane block (TAPB) on the surgical space conditions during laparoscopic surgery has not been described. We investigated if moderate neuromuscular blockade combined with TAPB would be associated with similar surgical space conditions compared with deep neuromuscular blockade. Methods Eighty patients undergoing elective laparoscopic surgery for colorectal cancer were randomly divided into two groups. The intervention group was treated with moderate neuromuscular blockade (train-of-four (TOF) count between 1 and 3) combined with TAPB (M group), while the control group was treated with deep neuromuscular blockade (D group), with a TOF count of 0 and a post-tetanic count (PTC) ≥ 1. Both groups received the same anesthesia management. The distance between the sacral promontory and the umbilical skin during the operation was compared between the two groups. The surgeon scored the surgical space conditions according to a five-point ordinal scale. Patients’ pain scores were evaluated eight hours after the operation. Results The 95% confidence intervals of the difference in the distance from the sacral promontory to the umbilical skin between the groups were − 1.45–0.77cm. According to the preset non-inferior standard of 1.5cm, (-1.45, ∞) completely fell within (-1.50, ∞), and the non-inferior effect test was qualified. There was no significant difference in the surgical rating score between the two groups. The dosage of rocuronium in group D was significantly higher than that in group M (P < 0.01). The M group had significantly lower pain scores than the D group eight hours after the operation (P < 0.05). Conclusions In laparoscopic colorectal cancer surgery, moderate neuromuscular blockade combined with TAPB can provide surgical space conditions similar to those of deep neuromuscular blockade, and at the same time, reduces the use of muscle relaxants, relieves postoperative pain within 4 hours after operation, shorten the time to extubation and stay in PACU. Trial registration: chictr.org.cn (ChiCTR2000034621), registered on 12, July, 2020

Neoadjuvant capecitabine, oxliplatin, and bevacizumab (CAPOX-B) in intermediate-risk rectal cancer (RC) patients defined by magnetic resonance (MR): GEMCAD 0801 trial.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 3586-3586 ◽  
Author(s):  
Carlos Fernandez-Martos ◽  
Rafael Estevan ◽  
Antonia Salud ◽  
Carles Pericay ◽  
Manuel Gallen ◽  
...  
Keyword(s):  
Tumor Response ◽  
Phase Ii Trial ◽  
Anal Verge ◽  
Rectal Adenocarcinoma ◽  
Intermediate Risk ◽  
Sacral Promontory ◽  
Safety And Efficacy ◽  
Multicenter Phase ◽  
Report Data ◽  
Distal Border

3586 Background: Retrospective data suggest that RT might not be needed in all patients with stage II/III RC. Modern systemic therapy might have local efficacy similar to chemoradiation (CRT). Methods: A multicenter phase II trial was undertaken to evaluate safety and efficacy of neoadjuvant CAPOX-B in patients with T3 middle third rectal adenocarcinoma. Eligible patients (pts) had measurable disease at the baseline and candidate for R0 total mesorectal escision (TME) with intermediate-risk defined by pelvic MR a) T3 with distal border of tumor > 5 cm from the anal verge and below the sacral promontory. b) tumor ≥2 mm from the mesorectal fascia. Pts received 4 cycles of Cap 2000 mg/m2 (d1-14), Ox 130 mg/m2 (d1) and B 7.5 mg/kg (d1) every 3 weeks (last cycle without B). Pts undergo re-staging with MR. One radiologist reviewed all pre- and post-treatment MR scans independently. Pts without progression proceed to TME 4-6 weeks from the last cycle. If progression, pts were to be referred for pre-op cap/RT followed by TME. 1º Endpoint: Tumor Response (RECIST). Design: Simon 2-stage; 28 pts 1st stage and 46 pts 2nd stage. We report data on the planned analysis of pts included for 1st stage. Results: 28 eligible pts (10F/18M) were enrolled from 7/09-5/11. Tumor response, compliance and toxicity details are shown in table below. Two pN2 pts received postop Cap/RT. Conclusions: Neoadjuvant CAPOX-B is active and safe. Early parameters of efficacy are encouraging and seem similar to those observed with CRT. [Table: see text]

Prediction, prevention and management of shoulder dystocia

2012 ◽  
Vol 153 (20) ◽  
pp. 763-767
Author(s):  
Roland Csorba
Keyword(s):  
Risk Factors ◽  
Perinatal Mortality ◽  
Maternal Morbidity ◽  
Shoulder Dystocia ◽  
Current Evidence ◽  
Sacral Promontory ◽  
Fourth Degree ◽  
Mortality And Morbidity ◽  
Perineal Tears ◽  
Fetal Complications

Shoulder dystocia is one of the most tragic, fatal and unexpected obstetrical events, which is mostly unpredictable and unpreventable. This clinical picture is defined as a delivery that requires additional obstetric maneuvers to release the shoulders after gentle downward traction has failed. Shoulder dystocia occurs when the fetal shoulder impacts on the maternal symphysis or sacral promontory. The incidence of shoulder dystocia is 0.2–0.6%. High perinatal mortality and morbidity is associated with the condition, even when it is managed appropriately. Obstetricians should be aware of the existing risk factors, but should always be alert to the possibility of shoulder dystocia in all labors. Maternal morbidity is also increased, particularly postpartum hemorrhage, rupture of the uterus, injury of the bladder, urethra and the bowels and fourth-degree perineal tears. Complications of the newborn include asphyxia, perinatal mortality, fracture of the clavicula and the humerus. Brachial plexus injuries are one of the most important fetal complications of shoulder dystocia, complicating 4–16% of such deliveries. The purpose of this article is to review the current evidence regarding the possible prediction, prevention and management of shoulder dystocia. Orv. Hetil., 2012, 153, 763–767.

scholarly journals Hypointensity on Postcontrast MR Imaging from Compression of the Sacral Promontory in Enlarged Uterus with Huge Leiomyoma and Adenomyosis

2007 ◽  
Vol 6 (2) ◽  
pp. 61-66 ◽  
Author(s):  
Kensuke UOTANI ◽  
Shuichi MONZAWA ◽  
Shuji ADACHI ◽  
Masayuki TAKEMORI ◽  
Yasushi KAJI ◽  
...  
Keyword(s):  
Mr Imaging ◽  
Sacral Promontory

Ultrasonographic and Radiographic Assessment of Prostate Gland in Perineal Hernia Dogs

2020 ◽  
Author(s):  
Vandana Sangwan ◽  
Ramandeep Singh ◽  
N Umeshwori Devi ◽  
Jitender Mohindroo ◽  
Devendra Pathak
Keyword(s):  
Urinary Bladder ◽  
Objective Assessment ◽  
Prostate Gland ◽  
Subjective Assessment ◽  
Perineal Hernia ◽  
Sacral Promontory ◽  
Intact Male ◽  
Normal Prostate ◽  
Radiography System ◽  
Diagnostic Modalities

Background: Prostate gland affections are considered as common cause for perineal hernia in intact male dogs. Normal prostate gland is usually less distinct, radiographically; however, when enlarged it alters the anatomical position of rectum and urinary bladder and can be distinguished for its objective assessment. Radiography fails to differentiate the parenchymal abnormalities of prostate however, ultrasonography can. Therefore, this study was aimed to assess the involvement of prostate gland using radiography and ultrasonography in perineal hernia affected dogs. Methods: Thirty-eight intact male dogs, suffering from perineal hernia and presented during the entire year of 2018, were investigated. Both radiographic (subjective and objective) and ultrasonographic modalities were applied to assess the enlargement of prostate gland. The subjective assessment parameters on radiography (n=38) included the lifting/displacement of rectum from normal position and cranial displacement of urinary bladder. The objective parameters (n=29) included the prostate length and depth measured using inbuilt calliper of computerized radiography system and ultrasonography and comparing it with 70% of the pubic brim to sacral promontory distance. Results: The mean prostatic length was significantly more than the prostate depth on both radiography and ultrasonography. There was a significant positive correlation between the radiographic pubic brim to sacral promontory distance and the prostate length and depth measured on both the diagnostic modalities. The subjective assessment of prostate over emphasized the prostate depth and under estimated the prostate length compared to objective measurements on radiography. There was a significant correlation between the prostate lengths measured on radiography and ultrasonography and the lengths were not significantly different on two diagnostic modalities. Objective analysis on radiography revealed the prostate length and or/depth of 54.72% perineal hernia dogs (15/29) to be more than 70% of pubic brim to sacral promontory distance. In conclusion, the prostate affections may not always be the primary aetiology in dogs suffering from perineal hernia and prior investigation of prostate is recommended as a deciding factor for whether castration should be done a few weeks prior to or simultaneously with the perineal herniorrhaphy. The increased length of the prostate is a better indicator of prostatomegaly than the depth.

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