Surgical anatomy of the upper esophagus related to robot-assisted cervical esophagectomy

2021 ◽  
Author(s):  
Thilo Wedel ◽  
Tillmann Heinze ◽  
Thorben Möller ◽  
Richard van Hillegersberg ◽  
Ronald L A W Bleys ◽  
...  
Keyword(s):  
Thoracic Duct ◽  
Bronchial Artery ◽  
Azygos Vein ◽  
Surgical Anatomy ◽  
Anatomical Landmarks ◽  
Robot Assisted ◽  
Topographic Anatomy ◽  
Anatomical Basis ◽  
Membranous Part ◽  
Cervical Esophagectomy

Abstract Robot-assisted cervical esophagectomy (RACE) enables radical surgery for tumors of the middle and upper esophagus, avoiding a transthoracic approach. However, the cervical access, narrow working space, and complex topographic anatomy make this procedure particularly demanding. Our study offers a stepwise description of appropriate dissection planes and anatomical landmarks to facilitate RACE. Macroscopic dissections were performed on formaldehyde-fixed body donors (three females, three males), according to the surgical steps during RACE. The topographic anatomy and surgically relevant structures related to the cervical access route to the esophagus were described and illustrated, along with the complete mobilization of the cervical and upper thoracic segment. The carotid sheath, intercarotid fascia, and visceral fascia were identified as helpful landmarks, used as optimal dissection planes to approach the cervical esophagus and preserve the structures at risk (trachea, recurrent laryngeal nerves, thoracic duct, sympathetic trunk). While ventral dissection involved detachment of the esophagus from the tracheal cartilage and membranous part, the dorsal dissection plane comprised the prevertebral compartment harboring the thoracic duct and right intercosto-bronchial artery. On the left side, the esophagus was attached to the aortic arch by the aorto-esophageal ligament; on the right side, the esophagus was bordered by the azygos vein, right vagus nerve, and cardiac nerves. The stepwise, illustrated topographic anatomy addressed specific surgical demands and perspectives related to the left cervical approach and dissection of the esophagus, providing an anatomical basis to facilitate and safely implement the RACE procedure.

Relational topographical anatomy between right bronchial artery and thoracic duct

Esophagus ◽  
2014 ◽  
Vol 12 (4) ◽  
pp. 398-400
Author(s):  
Yoshiaki Kajiyama ◽  
Yoshimi Iwanuma ◽  
Natsumi Tomita ◽  
Takayuki Amano ◽  
Fuyumi Isayama ◽  
...  
Keyword(s):  
Thoracic Duct ◽  
Bronchial Artery ◽  
Topographical Anatomy ◽  
Right Bronchial Artery

scholarly journals P138 PREPERITONEAL ENDOSCOPIC GROIN HERNIA SURGERY - REASSESSMENT OF TOPOGRAPHIC ANATOMY AS A BASIS FOR STANDARDIZED DESCRIPTION OF SURGICAL STEPS

2021 ◽  
Vol 108 (Supplement_8) ◽  
Author(s):  
Marvin Heimke ◽  
Tilmann Heinze ◽  
Andreas Kuthe ◽  
Thilo Wedel ◽  
Christoph W Strey
Keyword(s):  
Abdominal Wall ◽  
Groin Hernia ◽  
Histological Study ◽  
Learning Curves ◽  
Surgical Approaches ◽  
Anatomical Landmarks ◽  
Hernia Surgery ◽  
Mesh Placement ◽  
Topographic Anatomy ◽  
Total Extraperitoneal

Abstract Aim Fascial groin anatomy remains a conundrum. In particular, a clear anatomical allocation of the correct extraperitoneal dissection planes and spaces in total extraperitoneal endoscopic hernia surgery (TEP) has not yet agreed upon. The differing anatomical concepts are reflected by the variability of surgical approaches, the considerably long learning curves and subsequent complications. Thus, the aim of this study was to reassess the topographic anatomy of the groin region providing a basis to standardize the surgical steps of TEP according to clearly defined anatomical landmarks. Material and Methods Video analysis of intraoperative surgical anatomy of groin hernia patients was correlated with the findings retrieved by macroscopic anatomical studies. The groin region of formalin fixed body donors was subjected to a stepwise dissection exposing the fascial system of the abdominal wall layer-by-layer and via different angles. Selected areas of interest were processed for histological study. Surgically relevant anatomical landmarks were defined and termed according to the most appropriate anatomical nomenclature. Results The essential surgical dissection steps during TEP could be related to specific anatomical landmarks extending within the extraperitoneal space of the ventral and dorsolateral abdominal wall. The definition of fascial structures and interfaces and the identification of structures at risk allowed the identification of correct dissection planes for mesh placement. Conclusions Our study helps to clarify the definition and nomenclature of anatomical key structures required for a standardized description of TEP in a simplified model. The data may contribute to reduce complications and improve surgical teaching and training.

Robot-assisted ligation of bronchial artery could be an alternative to embolization

2017 ◽  
Vol 53 (3) ◽  
pp. 686-688
Author(s):  
Bruno Pochulu ◽  
Omar Sarsam ◽  
Christophe Peillon ◽  
Jean-Marc Baste
Keyword(s):  
Bronchial Artery ◽  
Robot Assisted

scholarly journals Surgical Anatomy of the Orbit in Human Cadavers–An Endoscopic Pictorial Documentation

2017 ◽  
Vol 79 (02) ◽  
pp. 173-176
Author(s):  
Homajoun Maslehaty ◽  
Saskia Schultheiss ◽  
Martin Scholz ◽  
Athanasios Petridis
Keyword(s):  
Rectus Muscle ◽  
Surgical Anatomy ◽  
Anatomical Landmark ◽  
Inferior Rectus ◽  
Anatomical Structures ◽  
Topographic Anatomy ◽  
Endoscopic Anatomy ◽  
Human Cadavers ◽  
Formalin Fixed ◽  
Inferior Rectus Muscle

Background The aim of our study was a pictorial documentation of the anatomical structures of the orbit. Methods We performed a transmaxillary endoscopic approach in nine formalin-fixed human heads. We identified and documented the anatomy of the inferior part of the orbit. Results The first intraorbital anatomical landmark was the inferior rectus muscle, from which important structures medially and laterally could be identified. Anatomical structures and their relation to each other were documented and presented as illustrative figures. Conclusion Knowledge of the topographic anatomy of the inferior part of the orbit could be sufficiently imparted by our illustrations. The presented transmaxillary approach allowed a wide overview of the anatomical structures located in the inferior part of the orbit. Our pictorial documentation may provide neurosurgeons more safety and the opportunity to become familiar with the endoscopic anatomy.

scholarly journals Anastomosis of the thoracic duct and the azygos vein for the treatment of recurrent chylothoraxes

2017 ◽  
Vol 53 (5) ◽  
pp. 1093-1094 ◽  
Author(s):  
Hexiao Tang ◽  
Yuquan Bai ◽  
Wulin Shen ◽  
Jinping Zhao
Keyword(s):  
Thoracic Duct ◽  
Azygos Vein

scholarly journals Accuracy of robot-guided versus freehand fluoroscopy-assisted pedicle screw insertion in thoracolumbar spinal surgery

2017 ◽  
Vol 42 (5) ◽  
pp. E14 ◽  
Author(s):  
Granit Molliqaj ◽  
Bawarjan Schatlo ◽  
Awad Alaid ◽  
Volodymyr Solomiichuk ◽  
Veit Rohde ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Spinal Instrumentation ◽  
Pedicle Screws ◽  
Screw Placement ◽  
Robotic Assistance ◽  
Anatomical Landmarks ◽  
Pedicle Screw Placement ◽  
Robot Assisted ◽  
Screw Insertion ◽  
Freehand Technique

OBJECTIVEThe quest to improve the safety and accuracy and decrease the invasiveness of pedicle screw placement in spine surgery has led to a markedly increased interest in robotic technology. The SpineAssist from Mazor is one of the most widely distributed robotic systems. The aim of this study was to compare the accuracy of robot-guided and conventional freehand fluoroscopy-guided pedicle screw placement in thoracolumbar surgery.METHODSThis study is a retrospective series of 169 patients (83 women [49%]) who underwent placement of pedicle screw instrumentation from 2007 to 2015 in 2 reference centers. Pathological entities included degenerative disorders, tumors, and traumatic cases. In the robot-assisted cohort (98 patients, 439 screws), pedicle screws were inserted with robotic assistance. In the freehand fluoroscopy-guided cohort (71 patients, 441 screws), screws were inserted using anatomical landmarks and lateral fluoroscopic guidance. Patients treated before 2009 were included in the fluoroscopy cohort, whereas those treated since mid-2009 (when the robot was acquired) were included in the robot cohort. Since then, the decision to operate using robotic assistance or conventional freehand technique has been based on surgeon preference and logistics. The accuracy of screw placement was assessed based on the Gertzbein-Robbins scale by a neuroradiologist blinded to treatment group. The radiological slice with the largest visible deviation from the pedicle was chosen for grading. A pedicle breach of 2 mm or less was deemed acceptable (Grades A and B) while deviations greater than 2 mm (Grades C, D, and E) were classified as misplacements.RESULTSIn the robot-assisted cohort, a perfect trajectory (Grade A) was observed for 366 screws (83.4%). The remaining screws were Grades B (n = 44 [10%]), C (n = 15 [3.4%]), D (n = 8 [1.8%]), and E (n = 6 [1.4%]). In the fluoroscopy-guided group, a completely intrapedicular course graded as A was found in 76% (n = 335). The remaining screws were Grades B (n = 57 [12.9%]), C (n = 29 [6.6%]), D (n = 12 [2.7%]), and E (n = 8 [1.8%]). The proportion of non-misplaced screws (corresponding to Gertzbein-Robbins Grades A and B) was higher in the robot-assisted group (93.4%) than the freehand fluoroscopy group (88.9%) (p = 0.005).CONCLUSIONSThe authors’ retrospective case review found that robot-guided pedicle screw placement is a safe, useful, and potentially more accurate alternative to the conventional freehand technique for the placement of thoracolumbar spinal instrumentation.

Endoscopic Transorbital Approaches to Anterior and Middle Cranial Fossa: A Laboratory Investigation on Surgical Anatomy and Potential Routes

2020 ◽  
Author(s):  
Beniamino A. Nannavecchia ◽  
Mario Ganau ◽  
Hélène Cebula ◽  
Antonino Scibilia ◽  
Maria T. Bozzi ◽  
...  
Keyword(s):  
Anatomical Study ◽  
Middle Cranial Fossa ◽  
Surgical Anatomy ◽  
Anatomical Landmarks ◽  
Orbital Cavity ◽  
New Horizons ◽  
Endoscopic Transorbital ◽  
Cranial Fossa ◽  
Alternative Routes ◽  
Anatomy Knowledge

Abstract Background Transorbital neuroendoscopic (TONES) approaches promise to open up new horizons for skull base surgery, offering alternative routes to reach the anterior and middle cranial fossa (ACF and MCF, respectively). Objective The aim of this anatomical study is to acquire new surgical anatomy knowledge and exploit it for the refinement of TONES approaches, as an alternative to open surgery, to reduce the distance to the target, and the risk of neurovascular lesions in pathological conditions extending beyond the orbital cavity. Materials and Methods Six head specimens (12 orbits) were studied/dissected. The orbit was approached and divided in a four clockwise quadrants manner to simulate three transconjunctival routes: the precaruncular (PC), preseptal (PS), and lateral retrocanthal (LRC), and one transpalpebral route—the superior eyelid crease (SLC). The boundaries and the most important anatomical landmarks were identified and are herein duly detailed with particular attention to the neurovascular structures encountered in each of those routes. Results The dissections showed that the PC approach facilitates the treatment of optic nerve and frontal sinus pathologies, whereas LRC appears safer to reach ACF and MCF allowing for a free multiplanar working channel (up to 180 degrees) to the floor, roof, and lateral-to-medial walls. Conclusion The plane of tendon lateral canthal's insertion and the sphenofrontal suture (SFS) were identified as the key anatomical landmarks for TONES approaches. Further studies are warranted to establish a practical clinical algorithm based on the anatomical four clockwise quadrants herein implemented/proposed, and the key surgical landmarks identified.

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