Researching anatomy of renal pelvis for removal renal intrasinal calculi. From 1/1998 to 6/1999, 44 kidneys of adult were researched by classical dissection, plastic cast, selective arteriogram and 45 cases of renal intrasinusal calculi were removed: 30 lower partial nephrectomy, 3 upper partial nephrectomy, 12 pyelonephrectomy (resnick or extended Gil - Vernet) with the result: non nephrectomy, non mortality. The placement of pelvis and advantage, disadvantage of each operative technique in this procedure has been shown.
Pelvis ; Surgery

In the radical resection of mid-low rectal cancer, due to the narrow pelvic space and thick mesorectum, it is difficult to expose the operation field. In recent years, with the development of laparoscopic surgery and surgical instruments, the surgeons' requirements for precise anatomical planes, neuroprotection, and functional preservation have become higher and higher. Colorectal surgeons will face more "difficult pelvic" challenges during surgery. Therefore, this article reviews the related research progress of "difficult pelvis" in radical resection of rectal cancer, analyzes the possible anatomical factors leading to the occurrence of "difficult pelvis", and explains the clinical significance of the researches on "difficult pelvis".
Humans ; Laparoscopy ; Pelvis/surgery* ; Rectal Neoplasms/surgery*

Radical cystectomy for bladder cancer was preformed in total of 68 consecutive patients (53 males and 15 females) at Binh Dan hospital from August 2001 to August 2003. Histopathological examination revealed that the tumor grade was 1 in 19 patients (2 with positive node), grade 2 in 20 patients (10 positive node) and grade 3 in 28 patients (15 positive node). The pathological stage was pT1 in 2 patients (no positive node), pT2 in 50 patients (17 positive node), pT3 in 15 patients (12 positive node) and pT4 in 1 patient (positive node). Among 68 patients underwent radical cystectomy, 35 patients had cultaneous ureterostomy, 26 patients had a Carmey II plasty with ileal-conduct uriary diversion, 5 patients with urinary diversion of Kock plasty and 2 patients had a Bricker operation
Urinary Bladder Neoplasms ; surgery ; cystectomy ; pathology ; Pelvis

BACKGROUNDOpen pyeloplasty has been historically described as the gold standard for the surgical treatment of ureteropelvic junction obstruction (UPJO), even if new techniques have recently gained a prominent role in this field. Laparoscopic pyeloplasty (LP) is not widely prevelant because of the technically challenging nature and it represents the gold standard for UPJO only in expert hands. To overcome some difficulties and technical challenges encountered during pure laparoscopic pyeloplasty, we designed a set of new instruments and assessed them using porcine model.

METHODSAccording to the ideas from the surgeons, our medical engineer designed three new instruments, including the right angle laparoscopy scissors, the petal-shape ureter dilator and the guide tube. Four experienced laparoscopic experts were involved in a no survival porcine study to assess the help of these new instruments. Four experiments were conducted on live pigs that weighed 22 to 25 kg at the same time. After general anesthesia was administered, transperitoneal ureteroureterostomy was performed using standard laparoscopic instruments, including placing the double J stent anterograde. Then, the opposite lateral was done by the same surgeon plus these new devices for side-by-side comparative analysis. All experts were interviewed to assess these new instruments by the questionnaire based on the visual analog scale (VAS) from 1 (none) to 10 (very much).

RESULTSThe procedures were all technically successful. The right angle laparoscopy scissors and the guide tube were accepted by all participants and the Help Score were 6.75 and 4.25 respectively, at the same time the New Difficulty Score 1.25 and 1.75. However, the petal-shape ureter dilator got 1.5 Help Score and 6.5 New Difficulty Score. These surgeons made a negative comment and one of surgeons recommended the stone basket was more suitable.

CONCLUSIONThe right angle laparoscopy scissors and the guide tube may be helpful to minimize some difficulties in pure laparoscopic pyeloplasty.

Animals ; Kidney Pelvis ; surgery ; Laparoscopy ; instrumentation ; methods ; Stents ; Swine

Humans ; Consensus ; Leiomyomatosis/surgery* ; Pelvis/diagnostic imaging* ; China

The optimal goals in the surgical treatment of rectal cancer are curative resection, anal sphincter preservation, and preservation of sexual and voiding functions. The quality of complete resection of rectal cancer and the surrounding mesorectum can determine the prognosis of patients and their quality of life. With the emergence of total mesorectal excision in the field of rectal cancer surgery, anatomical sharp pelvic dissection has been emphasized to achieve these therapeutic goals. In the past, the rates of local recurrence and sexual/ voiding dysfunction have been high. However, with sharp pelvic dissection based on the pelvic anatomy, local recurrence has decreased to less than 10%, and the preservation rate of sexual and voiding function is high. Improved surgical techniques have created much interest in the surgical anatomy related to curative rectal cancer surgery, with particular focus on the fascial planes and nerve plexuses and their relationship to the surgical planes of dissection. A complete understanding of rectum anatomy and the adjacent pelvic organs are essential for colorectal surgeons who want optimal oncologic outcomes and safety in the surgical treatment of rectal cancer.
Rectum/pathology/*surgery ; Rectal Neoplasms/pathology/*surgery ; Pelvis/*surgery ; Magnetic Resonance Imaging ; Humans ; Dissection/methods

Cylindrical abdominoperineal resection (CAPR), also known as extralevator abdominoperineal excision (ELAPE), has been described as a method for improving the outcome of APR for advanced low rectal cancer, probably because of more pelvic dissection and less positive circumferential resection margin (CRM). Recently, there have been some hot issues associated with CAPR/ELAPE, such as pelvic floor reconstruction methods, prone or lithotomy positioning during pelvic procedure, postoperative chronic perineal pain, postoperative sexual and urinary nerves damage, etc. Individual cylindrical procedure based on clinical and anatomic research may be as effective as CAPR/ELAPE while minimizing the operative trauma and the damage to the nerves of the genital and urinary organs.
Abdomen ; surgery ; Digestive System Surgical Procedures ; Humans ; Pelvis ; surgery ; Reconstructive Surgical Procedures ; Rectal Neoplasms ; surgery

Total mesorectal excision (TME) is the gold standard of surgical treatment for mid and low rectal cancer. It aims to improve the oncological outcomes as well as preserve anal sphincter, sexual and urinary function. Compared with sympathetic nerve injury alone, pelvic plexus and neurovascular bundle (NVB) injury has significant effect on postoperative sexual dysfunction, especially erectile function. Since the lateral surgical plane of TME is narrow and densely packed, dissecting outside the plane causes pelvic plexus injury, while dissecting inside it results in residual mesorectum. In this commentary, we review the research progress of lateral fascial anatomy of TME, and describe the anatomical characteristics of rectosacral fascia based on our previous research results. The prehypogastric fascia acts as a "fascia barrier" when dissecting the lateral space constantly from posterior to anterior. In addition, the pelvic plexus fuses with the prehypogastric fascia which is considered as the outer side layer of rectosacral fascia laterally. Thus, the rectosacral fascia should be dissected at the level of S4 vertebral body posterior to the rectum in an arc shape and then enter the superior-levator space. Before dissecting the lateral spaces, the anterior space of the rectum should be dissected first. After an "U" shape cutting of the Denonvilliers' fascia, the lateral space should be dissected from anterior to posterior. Finally, the lateral attachment of rectosacral fascia is transected to ensure the integrity of the mesorectum without damaging the pelvic plexus.
Fascia ; Humans ; Hypogastric Plexus ; Laparoscopy ; Male ; Pelvis/surgery* ; Rectal Neoplasms/surgery* ; Rectum/surgery*

Rectal cancer is a common malignant tumor of the digestive tract, and surgery is the main treatment strategy. Disorders of bowel, anorectal and urogenital function remain common problems after total mesorectal resection (TME), which seriously decreases the quality of life of patients. Surgical nerve damage is one of the main causes of the complications, while TME with pelvic autonomic nerve preservation is an effective way to reduce the occurrence of adverse outcomes. Intraoperative nerve monitoring (IONM) is a promising method to assist the surgeon to identify and protect the pelvic autonomic nerves. Nevertheless, the monitoring methods and technical standards vary, and the clinical use of IONM is still limited. This review aims to summarize the researches on IONM in rectal and pelvic surgery. The electrical nerve stimulation technique and different methods of IONM in rectal cancer surgery are introduced. Also, the authors discuss the limitations of current researches, including methodological disunity and lack of equipment, then prospect the future direction in this field.
Autonomic Pathways ; Humans ; Pelvis/surgery* ; Quality of Life ; Rectal Neoplasms/surgery* ; Rectum/surgery*

OBJECTIVETo study the relationship of mesorectum with fasciae and nerves in the pelvic cavity and to specify the proper planes of dissection in total mesorectal excision.

METHODSTwenty-four pelvises (12 males and 12 females) harvested from cadavers were studied by dissection.

RESULTSThere were three planes surrounding the rectum as the visceral fascia, vesicohypogastric fascia and parietal fascia. The pelvic plexus and its branches situated between the visceral fascia and the vesicohypogastric fascia. Pelvic splanchnic nerves and hypogastric nerves were observed between the visceral fascia and the parietal fascia.

CONCLUSIONSThe posterior plane of total mesorectal excision lies between the visceral fascia and the parietal fascia. The lateral dissection should be conducted in a plane between the visceral fascia and the vesicohypogastric fascia. The proper planes for posterior and lateral resection can be identified by the hypogastric nerve and the pelvic plexus respectively.

Fascia ; anatomy & histology ; Fasciotomy ; Female ; Humans ; Male ; Mesentery ; anatomy & histology ; surgery ; Pelvis ; anatomy & histology ; surgery