3D Virtual Reality Imaging of Major Aortopulmonary Collateral Arteries: A Novel Diagnostic Modality

Background Major aortopulmonary collateral arteries (MAPCAs), as seen in patients with pulmonary atresia, are arteries that supply blood from the aorta to the lungs and often require surgical intervention. To achieve complete repair in the least number of interventions, optimal imaging of the pulmonary arterial anatomy and MAPCAs is critical. 3D virtual reality (3D-VR) is a promising and upcoming new technology that could potentially ameliorate current imaging shortcomings. Methods A retrospective, proof-of-concept study was performed of all operated patients with pulmonary atresia and MAPCAs at our center between 2010 and 2020 with a preoperative computed tomography (CT) scan. CT images were reviewed by two congenital cardiac surgeons in 3D-VR to determine additional value of VR for MAPCA imaging compared to conventional CT and for preoperative planning of MAPCA repair. Results 3D-VR visualizations were reconstructed from CT scans of seven newborns where the enhanced topographic anatomy resulted in improved visualization of MAPCA. In addition, surgical planning was improved since new observations or different preoperative plans were apparent in 4 out of 7 cases. After the initial setup, VR software and hardware was reported to be easy and intuitive to use. Conclusions This study showed technical feasibility of 3D-VR reconstruction of children with immersive visualization of topographic anatomy in an easy-to-use format leading to an improved surgical planning of MAPCA surgery. Future prospective studies are required to investigate the clinical benefits in larger populations.

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

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.

Posture-based Morphological Deformation of the Parotid Gland and its Clinical Implications for Minimally Invasive Procedures

Anatomical studies of the parotid gland are important for mid- and lower face filler, botulinum toxin, and thread lifting procedures. The purpose of this study was to observe the topographic anatomy of the parotid gland using cadaveric dissections. The superficial lobe of the parotid gland was studied in 30 hemisected heads. Reference lines were made on the lateral aspect of the face. A reference line (the line connecting the mandibular angle to the upper margin of the zygomatic arch, along the posterior margin of the ramus) was divided into four sections (P1, P2, P3, and P4). The superior, inferior, anterior, and posterior borders of the parotid gland were measured using the reference lines and sections. Using these measurements, we categorized the superficial lobe of the parotid gland into two types: type Ia, pistol-shaped; Ib, pistol-shaped with an accessory lobe; and type II, oval-shaped. The superior border of the parotid gland started just below the inferior margin of the zygomatic arch. The parotid gland covered the posterior part of the masseter muscle near P1 and P2, but at P3 and below P3, the tail of the parotid gland was located posterior to the ramus and covered the anterior part of the sternocleidomastoid muscle. The topographic anatomy of the parotid gland serves as a reliable reference for esthetic procedures in the lower face and neck region.

FEATURES OF THE TOPOGRAPHIC ANATOMY OF THE LYMPHATIC CENTERS AND COLLECTORS DURING SURGICAL OPERATIONS IN THE HEAD AREA IN DOGS

The article presents the features of the topographic anatomy of the lymphatic centers and collectors of the head area in dogs. The interrelationships of the cellular and vascular parts of the lymphatic system, as well as the organs associated with them, are established. The features of the structure of the mandibular, medial retropharyngeal and facial lymph nodes are described. Statistics on their availability are provided. The study also presents a detailed lymph supply to the orbital region and its significance in the pathogenesis of ophthalmopathies. Anatomical and topographic maps developed by the authors are of practical importance for all surgical interventions in the head area.

Case of a double upper hollow ox (vena cаѵаsuperior duplex)

Working for the last year at the Institute of Operative Surgery and Topographic Anatomy under prof. P. M. Krasin, on one old, already shriveled corpse of a man of about 45 who died from an unknown cause, I noticed an unusual arrangement of large vessels of the mediastinum.

INCREASING COGNITIVE ACTIVITY AND INDEPENDENCE OF STUDENTS WHILE TEACHING TOPOGRAPHIC ANATOMY AND OPERATIVE SURGERY TO THEM

Objectives. To identify possible pedagogical conditions and methodological techniques of effective teaching influence on the increasing of the cognitive activity and independence (CAI) of students while acquiring and deepening their knowledge in topographic anatomy and operative surgery. Scientific analysis of psychological, pedagogical literature and personal experience shows that the problem of improving the forms and methods of educational work aimed at the increasing of the CAI of students in the process of studying the discipline is always before the teachers. While solving it, there are certain difficulties that many teachers associate with a low level of secondary education obtained, the complexity of the material studied, the admission to the university by means of testing, laziness of students, etc. The experience of the methods used and analyzed by the author shows ample opportunities for improving the cognitive activity of students, taking into account their individual interests and abilities to accumulate professional knowledge. Attention is paid to the implementation of a practice-oriented approach in teaching in combination with a systematic, creative, research, individual one, etc. to ensure the proportionate development of students’ theoretical and practical level of knowledge. A certain range of components of the conditions and factors of the educational process, in which there will be a close, bilateral, interested and productive educational activity of a student and a teacher, promoting the achievement of high educational results is shown.