Anatomy is the foundation of surgery. However, traditional anatomical concepts based on autopsy are no longer sufficient to guide the development of modern surgery. With the advancement of histology and embryology and application of high-resolution laparoscopic technology, surgical anatomy has gradually developed. Meanwhile, some important concepts and terms used to guide surgery have emerged, including: mesentery, fascia, and space. The confusing, controversial, and even inaccurate definitions and anatomical terms related to colorectal surgery seriously affect academic communication and the training of young surgeons. Therefore, the Chinese Society of Colorectal Surgeons, the Chinese Society of Colorectal Surgery, National Health Commission Capacity Building and Continuing Education Center, and China Sexology Association of Colorectal Functional Surgery organized colorectal surgeons to make consensus on the definition and terminology of mesentery, fascia, and space related to colon and rectum, to promote surgeons' understanding of modern anatomy related to colorectal surgery and promote academic communication.
Humans ; Rectum/surgery* ; Consensus ; Mesentery/anatomy & histology* ; Fascia/anatomy & histology* ; Colorectal Neoplasms

Understanding of a variety of membranous structures throughout the body,such as the fascia,the serous membrane,is of great importance to surgeons. This is especially valuable in abdominal surgery. With the rise of membrane theory in recent years,membrane anatomy has been widely recognized in the treatment of abdominal tumors,especially of gastrointestinal tumors. In clinical practice. The appropriate choice of intramembranous or extramembranous anatomy is appropriate to achieve precision surgery. Based on the current research results,this article described the application of membrane anatomy in the field of hepatobiliary surgery,pancreatic surgery,and splenic surgery,with the aim of blazed the path from modest beginnings.
Humans ; Mesentery/surgery* ; Digestive System Surgical Procedures ; Fascia/anatomy & histology*

The successful report of total mesorectal excision (TME)/complete mesocolic excision (CME) has encouraged people to apply this concept beyond colorectal surgery. However, the negative results of the JCOG1001 trial denied the effect of complete resection of the "mesogastrium" including the greater omentum on the oncological survival of gastric cancer patients. People even believe that the mesentery is unique in the intestine, because they have a vague understanding of the structure of the mesentery. The discovery of proximal segment of the dorsal mesogastrium (PSDM) proved that the greater omentum is not the mesogastrium, and further revised the structure (definition) of the mesentery and revealed its container characteristics, i.e. the mesentery is an envelope-like structure, which is formed by the primary fascia (and serosa) that enclose the tissue/organ/system and its feeding structures, leading to and suspended on the posterior wall of the body. Breakdown of this structure leads to the simultaneous reduction of surgical and oncological effects of surgery. People quickly realized the universality of this structure and causality which cannot be matched by the existing theories of organ anatomy and vascular anatomy, so a new theory and surgical map- membrane anatomy began to form, which led to radical surgery upgraded from histological en bloc resection to anatomic en bloc resection.
Humans ; Fascia/anatomy & histology* ; Laparoscopy ; Lymph Node Excision/methods* ; Mesentery/surgery* ; Mesocolon/surgery* ; Omentum ; Serous Membrane ; Clinical Trials as Topic

Objective: At present, surgeons do not know enough about the mesenteric morphology of the colonic splenic flexure, resulting in many problems in the complete mesenteric resection of cancer around the splenic flexure. In this study, the morphology of the mesentery during the mobilization of the colonic splenic flexure was continuously observed in vivo, and from the embryological point of view, the unique mesenteric morphology of the colonic splenic flexure was reconstructed in three dimensions to help surgeons further understand the mesangial structure of the region. Methods: A total of 9 patients with left colon cancer who underwent laparoscopic radical resection with splenic flexure mobilization by the same group of surgeons in Union Hospital of Fujian Medical University from January 2018 to June 2019 were enrolled. The splenic flexure was mobilized using a "three-way approach" strategy based on a middle-lateral approach. During the process of splenic flexure mobilization, the morphology of the transverse mesocolon and descending mesocolon were observed and reconstructed from the embryological point of view. The lower margin of the pancreas was set as the axis, and 4 pictures for each patient (section 1-section 4) were taken during middle-lateral mobilization. Results: The median operation time of the splenic flexure mobilization procedure was 31 (12-55) minutes, and the median bleeding volume was 5 (2-30) ml. One patient suffered from lower splenic vessel injury during the operation and the bleeding was stopped successfully after hemostasis with an ultrasound scalpel. The transverse mesocolon root was observed in all 9 (100%) patients, locating under pancreas, whose inner side was more obvious and tough, and the structure gradually disappeared in the tail of the pancreatic body, replaced by smooth inter-transitional mesocolon and dorsal lobes of the descending colon. The mesenteric morphology of the splenic flexure was reconstructed by intraoperative observation. The transverse mesocolon was continuous with a fan-shaped descending mesocolon. During the embryonic stage, the medial part (section 1-section 2) of the transverse mesocolon and the descending mesocolon were pulled and folded by the superior mesenteric artery (SMA). Then, the transverse mesocolon root was formed by compression of the pancreas on the folding area of the transverse mesocolon and the descending mesocolon. The lateral side of the transverse mesocolon root (section 3-section 4) was distant from the mechanical traction of the SMA, and the corresponding folding area was not compressed by the tail of the pancreas. The posterior mesangial lobe of the transverse mesocolon and the descending mesocolon were continuous with each other, forming a smooth lobe. This smooth lobe laid flat on the corresponding membrane bed composed of the tail of pancreas, Gerota's fascia and inferior pole of the spleen. Conclusions: From an embryological point of view, this study reconstructs the mesenteric morphology of the splenic flexure and proposes a transverse mesocolon root structure that can be observed consistently intraopertively. Cutting the transverse mesocolon root at the level of Gerota's fascia can ensure the complete resection of the mesentery of the transverse colon.
Colectomy/methods* ; Colon, Transverse/surgery* ; Colonic Neoplasms/surgery* ; Dissection ; Fascia/anatomy & histology* ; Humans ; Laparoscopy ; Mesentery/surgery* ; Mesocolon/surgery* ; Pancreas/surgery* ; Photography ; Spleen/surgery*

Denonvilliers fascia is a dense structure between the rectum and the genitourinary system, and plays as a barrier. In recent years, along with in-depth study of TME, scholars have taken many discussions on Denonvilliers fascia structure and the dissection plane. On the one hand, some consensus have been made on Denonvilliers fascia structure, but still needs to further clarify its microstructure. On the other hand, scholars have generally recognized the neurovascular bundles are on Denonvilliers fascia sides. They should be protected during rectal surgery, however, the details should be clarified. Based on "Fascial Surgery" theory, this article describes Denonvilliers fascia structure and clinical application combined with previous research and our research results.
Digestive System Surgical Procedures ; Dissection ; Fascia ; anatomy & histology ; Fasciotomy ; Humans ; Male ; Rectum ; anatomy & histology ; surgery

Anatomy is the foundation of surgical techniques. With the development of surgery, anatomy also divided into traditional anatomy, surgical anatomy and embryonic development anatomy. Complete mesocolic excision (CME) is one of classic radical operation for colon cancer, based on the modern anatomy. CME advocates correct operation plane, and describes the mobilization and separation of the colon together with the entire regional mesocolon. With the evolution of anatomy, the definition and content of CME-related anatomic landmarks such as mesentery, fascia and space have been changed. This article elaborates theses anatomical structures and their distribution, in order to improve the understanding of colorectal surgeons on CME-related traditional anatomy, surgical anatomy and embryonic developmental anatomy.
Colectomy ; Colonic Neoplasms ; surgery ; Digestive System Surgical Procedures ; Fascia ; anatomy & histology ; Fasciotomy ; Humans ; Mesentery ; Mesocolon ; anatomy & histology ; surgery

Surgical or local anatomy consists of two components conventionally, organs and their blood supply. In fact, they are enveloped by the fascia membrane and serous membrane. This is the third component in surgical or local anatomy, which is omitted by surgeons for many years. The omitted reasons are failed recognition and unknown function. Re-understanding of the third component in surgical or local anatomy will make some changes in the local anatomy, tumor pathology, oncology surgery and operations. Firstly, the third component makes surgical anatomy developed from organ anatomy, blood vessel anatomy to membrane anatomy, which consists of the mesentery in broad sense and its bed, both include serous membrane and fascia membrane. Secondly, the third component provides the basic membrane anatomy of envelop cavity of metastasis V, and the impairment of its integrity will induce the mesentery cancer leakage of metastasis V in the operation field. Thirdly, based on the development of anatomy and pathology of the third component, cancer of alimentary tract can be divided into 3 types, the cancer in the mesentery, the cancer at the mesentery edge and the cancer outside the mesentery. Cancer outside the mesentery is in the field of oncology except complication of primary lesion, such as bleeding, perforation and obstruction. The main task of surgeons is to prevent the cancer leakage during operation, improve the cancer at the mesentery edge and perform radical operation for the cancer in the mesentery. Finally, the principle of radical operation for the cancer of alimentary tract should include the primary lesion resection, systematical lymphadenectomy and complete mesentery excision. Therefore, these principles should be classified into three kinds:(1) D type operation, which is only the concern about lymphadenectomy at D2 or D3 level and does not care about the completeness of the mesentery; (2) C type operation, which is only the concern about completeness of the mesentery, with only high tie of blood vessels, which does not care about ligation at the bifurcation; (3) D+C type operation, which is not only the concern about ligation at the bifurcation, but also about the completeness of the mesentery. Many aspects will change with surgical developments, especially with the membrane anatomy, the third component.
Digestive System Surgical Procedures ; Fascia ; anatomy & histology ; Humans ; Ligation ; Lymph Node Excision ; Mesentery ; anatomy & histology ; surgery

OBJECTIVETo explore the effects of acupuncture with different filiform needles on structure of fascial connective tissues, cellular activity, arrangement and content of collagen fibers in acupoint area of rats.

METHODSA total of 32 SD rats were randomly divided into a blank group, a thin needle group, a medium needle group and a thick needle group, 8 rats in each one. Except for the blank group, rats in the remaining groups were treated with horizontal acupuncture at "Zhongwan" (CV 12) towards Conception Vessel with different filiform needles, and twirling mild reinforcing-reducing method was applied, once a day. Rats in the blank group were treated with identical anesthesia, grasping and fixation. After 3-day intervention, the fascial connective tissue of acupoint area was collected. HE staining, immumohistochemical staining of proliferating cell nuclear antigen (PCNA) and MASSON staining were adopted to observe the morphology of fascial connective tissues, expression of PCNA in cells and arrangement and expression of collagenous fiber.

RESULTSAfter acupuncture in each group, the consistency of morphology of fascial connective tissues and arrangement of collagenous fiber were changed; the expression of PCNA protein in the fascial connective tissue in each group was significantly increased (P<0. 01, P<0. 05). The area distribution of collagenous fiber were changed, and that in the thin needle group was insignificantly increased compared with that in the blank group (P>0. 05), and that in the medium needle group and thick needle group were reduced compared with that in the blank group (both P<0. 05).

CONCLUSIONSAcupuncture with different filiform needles can change the local tissue morphology of acupoints, strengthen cell activity and adjust the exyression of collagenous fiber protein, which may be one of the cellular biomechanics principles of the acupuncture therapy's "regulating meridians" effects. However, the stimulation is produced by different fifiform needles, and the complex relationships exist between cells and collagen fibers.

Acupuncture Points ; Acupuncture Therapy ; instrumentation ; methods ; Animals ; Cell Proliferation ; Collagen ; genetics ; metabolism ; Connective Tissue ; anatomy & histology ; metabolism ; Fascia ; anatomy & histology ; cytology ; metabolism ; Male ; Meridians ; Needles ; Proliferating Cell Nuclear Antigen ; metabolism ; Rats ; Rats, Sprague-Dawley

This study aims to explore the inferior adhesion of the renal fascia (RF), and the inferior connectivity of the perirenal spaces (PS) with multidetector computed tomography (MDCT), and to investigate the diagnostic value of CT for showing this anatomy. From May to July 2012, eighty-two patients with acute pancreatitis presented in our hospital were enrolled into this study and underwent contrast-enhanced CT scans. All the image data were used to perform three dimensional reconstruction to show the inferior attachment of RF and the inferior connectivity of PS. The fusion of anterior renal fascia (ARF) and posterior renal fascia (PRF) next to the plane of iliac fossa were found on the left in 71.95% (59/82) cases, and on the right in 75.61% (62/82). In these cases, bilateral perirenal spaces, and anterior and posterior pararenal spaces were not found to be connected with each other. No fusion of ARF and PRF below the level of bilateral kidneys occurred on the left side in 28.05% (23/82) cases and on the right side in 24.39% (20/82). In these patients, the PS extended to the extraperitoneal space of the pelvic cavity and further to the inguinal region, and bilateral anterior and posterior pararenal spaces were not found to be connected with each other. Three-dimensional reconstruction on contrast-enhanced MDCT could be a valuable procedure for depicting inferior attachment of RF, and the inferior connectivity of PS.
Abdominal Cavity ; anatomy & histology ; Adult ; Contrast Media ; Fascia ; anatomy & histology ; Humans ; Image Processing, Computer-Assisted ; Kidney ; anatomy & histology ; Multidetector Computed Tomography ; Pancreatitis ; pathology ; Pelvis ; anatomy & histology ; Tomography, X-Ray Computed

OBJECTIVE: To provide anantomical basis for the endoscope-assisted partial superficial parotidectomy via retroauricular hairline approach (EASPRHA) and assess its feasibility and safety. METHOD: The surgical anatomy of retroauricular hairline region and parotid gland region were observed in 15 fresh human cadavers (30 halves). The EASPRHA was performed on 5 human cadavers (10 halves). After the procedure, the related vascular and neural structures were evaluated. RESULT: The retroauricular hairline region extends between superficial musculoaponeurotic system and superficial cervical fascia. On the superficial surface of the upper sternocleidomastoid lie the lesser occipital nerve, the great auricular nerve and the external jugular vein. The bifurcation of great auricular nerve is(22.85 ± 2.01) mm from the bottom of earlobe. The parotid gland region extends between parotidomassteric fascia and parotid gland parenchyma. The facial nerve emerging from the stylomastoid foramen runs across the superficial surface of base of styloid process, passes through the interspace between cartilage of external acoustic meatus and posterior belly of digastric muscle, and enters the parotid gland. The bifurcation of facial nerve trunk is (19.10 ± 3.10)mm from the mastoidale and (39.49 ± 5.78) mm from the mandibular angle. Above the posterior belly of digastric muscle, the posterior auricular artery arises from the posterior wall of the external carotid artery with its main stem running over the superficial surface of facial nerve trunk. In all endoscope-assisted operations, the partial superficial parotidectomy was successful without the need for an additional incision. No major neurovascular damage wasobserved. CONCLUSION A thorough knowledge of the surgical anatomy of retroauricular hairline region and parotid gland region is an essential requirement in performing the safe and feasible EASPRHA.
Cranial Nerves ; anatomy & histology ; Endoscopes ; Endoscopy ; methods ; Facial Nerve ; anatomy & histology ; Fascia ; Feasibility Studies ; Humans ; Male ; Neck Muscles ; anatomy & histology ; Parotid Gland ; anatomy & histology ; surgery