RESUMEN

INTRODUCTION AND HYPOTHESIS: The high prevalence of pelvic organ prolapse (POP) in women requires attention and constant review of treatment options. Sacrospinous ligament fixation (SSLF) for apical prolapse has benefits, high efficacy, and low cost. Our objective is to compare anterior and posterior vaginal approach in SSLF in relation to anatomical structures and to correlate them with body mass index (BMI). METHODS: Sacrospinous ligament fixation was performed in fresh female cadavers via anterior and posterior vaginal approaches, using the CAPIO®SLIM device (Boston Scientific, Natick, MA, USA). The distances from the point of fixation to the pudendal artery, pudendal nerve, and inferior gluteal artery were measured. RESULTS: We evaluated 11 cadavers with a mean age of 70.1 ± 9.9 years and mean BMI 22.4 ± 4.6 kg/m2. The mean distance from the posterior SSLF to the ischial spine, pudendal artery, pudendal nerve, and inferior gluteal artery were 21.18 ± 2.22 mm, 17.9 ± 7.3 mm, 19.2 ± 6.8 mm, and 18.9 ± 6.9 mm respectively. The same measurements relative to the anterior SSLF were 19.7 ± 2.7 mm, 18.6 ± 6.7 mm, 19.2 ± 6.9 mm, and 18.3 ± 6.7 mm. Statistical analysis showed no difference between the distances in the two approaches. The distances from the fixation point to the pudendal artery and nerve were directly proportional to the BMI. CONCLUSIONS: There was no difference in the measurements obtained in the anterior and posterior vaginal approaches. A direct correlation between BMI and the distances to the pudendal artery and pudendal nerve was found.

Asunto(s)

RESUMEN

A small amount of acetic acid (AA), a common preservative, has been shown to increase contamination in cadaveric tissue, while larger concentrations can lead to the tissue becoming hard, especially in fresh brains. This study attempted to optimize the concentration of AA to be used in the cranial cavity in order to produce the most realistic consistency and color. Six adult cadaveric heads were preserved with descending glacial AA at concentrations of 98.5 %, 80 %, 60 %, 40 %, 20 %, and 10 %. The samples were kept at 5 °C for 14 days. The brain cortex was then dissected with a suction tube and forceps to reveal the underlying brain tissue for inspection. Color change, cortical firmness, pia mater stickiness, and participant satisfaction were evaluated. The color of the brains in all concentrations was slightly yellow. However, the temporal area of the brain preserved using 20 % AA was significantly more pink. The pia mater of the brain cortex of all samples was firm and difficult to pry apart, with the firmest consistency being in the brain tissue preserved using 98.5 % AA. The brain tissue in all samples had a liquid-like consistency. The brains preserved in AA at a concentration greater than 60 % yielded higher satisfaction scores. We conclude that acetic acid has a role in brain preservation for skull base surgery training and recommend AA concentrations higher than 60 % for maximal participants satisfaction.

Se ha demostrado que una pequeña cantidad de ácido acético (AA), un preservante común, aumenta la contaminación en el tejido del cadáver, mientras que mayores concentraciones pueden endurecer el tejido, particularmente en cerebros frescos. Este estudio intentó optimizar la concentración de AA en la cavidad craneal para producir una consistencia y coloración cerebral más cercanos a la realidad. Seis cabezas cadavéricas adultas se conservaron con AA glacial descendente en concentraciones de 98,5 %, 80 %, 60 %, 40 %, 20 % y 10 %. Las muestras se mantuvieron a 5 °C durante 14 días. Luego se diseccó la corteza cerebral con un tubo de succión y pinzas para observar e inspeccionar el tejido cerebral subyacente. Se evaluaron el color, la firmeza cortical, la viscosidad y adherencia de la piamadre y la reacción de los participantes ante esta conservación. El color de los cerebros en todas las concentraciones fue ligeramente amarillo. Sin embargo, el área temporal del cerebro, conservada con un 20 % de AA, fue significativamente más rosada. La piamadre de la corteza de todas las muestras fue de consistencia firme y difícil de separar; una mayor resistencia se observó en el tejido cerebral preservado con 98,5 % de AA. La consistencia del tejido cerebral en todas las muestras era líquida. Los cerebros conservados en AA a una concentración superior al 60 % recibieron puntuaciones de satisfacción más elevadas. Concluimos que el ácido acético desempeña un papel en la preservación del cerebro, permitiendo el entrenamiento en cirugía de base de cráneo, por lo que recomendamos concentraciones de AA superiores al 60 % para una satisfacción máxima por parte de los participantes.

Asunto(s)

RESUMEN

OBJECTIVE: To demonstrate the needle positioning during three types of slings in relation to anatomical structures in fresh cadavers and to evaluate if this positioning is influenced by body mass index (BMI). METHODS: TVTr sling (retropubic), TVT-O sling (transobturator) and mini-sling (TVT-Secur™) were performed in ten fresh cadavers, followed by dissection of the pudendal (genital) area (external evaluation) and abdominal cavity (internal evaluation). The distance between the devices used in each technique and specific anatomical structures (vessels and bowel) was measured. RESULTS: The mean distance between TVTr needles and the closest segment of the bowel was 5.0±1.1cm. The mean distance between the TVTr needles and iliac vessels was 8.55±1.59cm, and this distance was inversely proportional to BMI. However, the both correlations were not significantly (p<0.05). The mean distance from TVT-O needle to obturator vessels and nerve was 2.25±0.34cm. This distance was inversely proportional to BMI, but it was not statistically significant. CONCLUSION: Our data suggested that BMI may be not an important factor for influencing the relationship between the devices and anatomical structures in three different slings in fresh cadavers.

Asunto(s)