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Objective: This study aims to define a set of related anatomical landmarks based on preoperative Magnetic Resonance Imaging (MRI) of patients with pituitary adenomas (PAs). It explores the impact of the dynamic relationships between different anatomical landmarks and the tumor on the resection rate and tumor progression/recurrence during the endoscopic endonasal approach (EEA). Methods: A single-center institutional database review was conducted, identifying patients with PAs treated with EEA from December 2018 to January 2023. Clinical data were reviewed, and anatomical landmarks were categorized into two regions: the suprasellar region and the cavernous sinus region. Following basic statistical and univariate logistic regression analyses, patients were randomly divided into training and validation sets. A nomogram was then established through the integration of least absolute shrinkage and selection operator (LASSO) regression and multivariable logistic regression analysis. The clinical prediction model was evaluated using the area under the receiver operating characteristic curve (AUC), calibration curves, and decision curve analysis. Kaplan-Meier curves were plotted for survival analysis. Results: A total of 626 patients with PAs were included in the study, with gross total resection (GTR) achieved in 570 cases (91.05%). Significant differences were observed in the distribution of age, Knosp grade, and tumor size between the GTR and near total resection (NTR) groups. LASSO regression identified 8 key anatomical landmarks. The resulting model demonstrated an AUC of 0.96 in both the training and validation sets. Calibration curves indicated a strong agreement between the nomogram model and actual observations. Survival analysis revealed that the extent of resection (EOR), age, Knosp grade, tumor size, and PAs extending beyond several anatomical landmarks identified were significantly associated with the progression or recurrence of PAs. Conclusion: This study proposes a model for adaptively assessing the resection rate of PAs by delineating relevant anatomical landmarks. The model comprehensively considers instrument manipulation angles, surgical accessibility during EEA procedures, anatomical variations, and the displacement of related anatomical structures in pathological states. This approach can assist neurosurgeons in preoperative planning and developing personalized surgical strategies. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the anatomical features of the femoral tunnel in anatomical and isometric single-bundle ACL reconstruction. Method: Thirty-two 3-dimensional knee models were reconstructed based on CT scan (average age: 26.5 ± 6.7 years, 18 males and 14 females, 17 left and 15 right). Multiple anatomical landmarks were identified. Virtual femoral tunnels were created at the deep and high portion of ACL footprint, close to the lateral intercondylar ridge to achieve best anatomy and isometry, simulating an anteromedial portal reconstruction. Anatomical features of the femoral tunnels were analyzed. The position of the femoral tunnel was quantified by the distance to anatomical landmarks and using quadrant methods. The spatial angles, length and outer opening of the femoral tunnels were also evaluated. Results: Acceptable tunnels were created in all models. The center of femoral tunnel was slightly higher than the apex of deep cartilage, near the deep one-third point across the shallow-deep dimension of the lateral femoral condyle. Using the quadrant method, the tunnel was located at 28.4% ± 2.2% and 22.2% ± 3.6%, parallel and perpendicular to the Blumensaat line, respectively. The spatial angles of the tunnel were 40°, 33.5° ± 4.1° and 38.2° ± 4.4° on the sagittal, transverse, and coronal planes, respectively. The average tunnel length was 34.8 mm ± 3.8 mm. The outer opening of the tunnels was located at the posterior one-third of the femoral metaphysis. Conclusion: The anatomical and isometric positioning of the femoral tunnel can be achieved through anteromedial portal with satisfied tunnel characteristics. The apex of deep cartilage may be used as an anatomical reference for tunnel positioning. When drilled at appropriate orientation, favorable tunnel length, integrity and position of the outer opening can be obtained. [ABSTRACT FROM AUTHOR]

Background: Left ventricular assist device (LVAD) malposition has been linked to hemocompatibility‐related adverse events (HRAEs). This study aimed to identify preoperative anatomical landmarks and postoperative pump position, associated with HRAEs during LVAD support. Methods: Pre‐ and postoperative chest X‐ray measures (≤14 days pre‐implantation, first postoperative standing, 6, 12, 18, and 24 months post‐implantation) were analyzed for their association with HRAEs over 24 months in 33 HeartMate 3 (HM3) patients (15.2% female, age 66 (9.5) years). Results: HM3 patients with any HRAE showed significantly lower preoperative distances between left ventricle and thoracic outline (dLVT) (25.3 ± 10.2 mm vs. 40.3 ± 15.5 mm, p = 0.004). A ROC‐derived cutoff dLVT ≤ 29.2 mm provided 85.7% sensitivity and 72.2% specificity predicting any HRAE during HM3 support (76.2% (>29.2 mm) vs. 16.7% (≤29.2 mm) freedom from HRAE, p < 0.001) and significant differences in cardiothoracic ratio (0.58 ± 0.04 vs. 0.62 ± 0.04, p = 0.045). Postoperative X‐rays indicated lower pump depths in patients with ischemic strokes (9.1 ± 16.2 mm vs. 38.0 ± 18.5 mm, p = 0.007), reduced freedom from any neurological event (pump depth ≤ 28.7 mm: 45.5% vs. 94.1%, p = 0.004), and a significant correlation between pump depth and inflow cannula angle (r = 0.66, p < 0.001). Longitudinal changes were observed in heart‐pump width (F(4,60) = 5.61, p < 0.001). Conclusion: Preoperative X‐ray markers are associated with postoperative HRAE occurrence. Applying this knowledge in clinical practice may enhance risk stratification, guide therapy optimization, and improve HM3 recipient management. [ABSTRACT FROM AUTHOR]

Purpose: The Madrid Posterior Component Separation technique (Madrid PCS) is an approach for abdominal wall reconstruction that leverages anatomical landmarks to optimize outcomes. This manuscript describes ten essential steps for performing the Madrid PCS, focusing on technique, safety, and efficiency. Methods: A comprehensive step-by-step approach is outlined, beginning with the initial incision and adhesiolysis, progressing through retromuscular dissection, and concluding with lateral release and subxiphoid dissection. Emphasis is placed on key anatomical landmarks, tissue planes, and surgical maneuvers critical for each phase. Detailed tips and tricks, challenging scenarios, and potential risks are provided to enhance the reproducibility and safety of the procedure. Results: Applying these ten steps provides an organized and methodical approach to the Madrid PCS. The focus on anatomical landmarks minimizes the risk of complications such as nerve injury, peritoneal tears, and inadvertent organ damage, while ensuring for the optimal placement of prosthetic materials. Conclusion: Adherence to these ten steps, based on anatomical landmarks, significantly improves the safety and effectiveness of the Madrid PCS technique. By understanding the nuances of the procedure, surgeons can achieve consistent and reproducible results in complex abdominal wall reconstructions. [ABSTRACT FROM AUTHOR]

The rhomboid fossa (RF) is a crucial anatomical region in brainstem surgery as it contains essential structures such as the reticular formation and cranial nerve nuclei. This study aimed to provide a detailed understanding of the complex microsurgical anatomy of the RF, which is vital for the safe execution of neurosurgical procedures. Morphometric analysis was conducted on 45 adult human brainstems preserved in 10% formalin. Under 20× magnification, 13 linear measurements were performed using a millimeter graph to identify key anatomical landmarks. The RF measured 34.65 mm in length and 22.61 mm in width. The facial colliculus measured 4.26 mm in length on the left and 4.45 mm on the right, with corresponding widths of 3.77 mm and 3.50 mm. The distance between the sulcus limitans incisures was 9.52 mm, and the distance from the upper border of the medullary striae to obex was 11.53 mm. The proximity of the facial colliculus to the median sulcus was measured at 0.86 mm on the right and 0.96 mm on the left. Additionally, 2 safe entry zones—the suprafacial and infrafacial triangles—were identified, offering pathways to reach dorsal pons lesions through the RF. This comprehensive morphometric analysis of the RF enhances the understanding of its intricate anatomy. By describing safe entry zones, the suprafacial and infrafacial triangles, and providing precise measurements of key anatomical features, this study serves as a valuable resource for neurosurgeons in planning and executing brainstem surgeries. [ABSTRACT FROM AUTHOR]

Bile duct injury rates in laparoscopic cholecystectomy remain higher than during open cholecystectomy. Intraoperative injuries are mostly the result of a misinterpretation of anatomical structures due to severe inflammation or topographical variations. Standard laparoscopic cholecystectomy requires proper dissection of Calot’s triangle to achieve the critical view of safety (CVS). The CVS is the end product of dissection, and bile duct injuries occur before the conclusion of that process. The CVS cannot always be achieved in cases of severe cholecystitis because of technical difficulties. A complete strategy of safety should therefore include early recognition of difficulties and identification of cholecystectomies, when the CVS cannot be achieved, in order to utilize new intraoperative technologies to clarify the anatomy. Fixed anatomical landmarks can help in proper orientation to ascertain the surgical anatomy correctly during surgery. Encompassed within the review are insights into identifying critical landmarks for assessing the positioning of vital structures in compromised anatomical conditions.

Background/Objectives: Rock climbing is becoming more popular, leading to an increased focus on diagnosing and treating related injuries. Finger pulley and flexor tendon injuries are common among climbers, with the A2 pulley being the most frequently affected. High-resolution ultrasound (US) is the preferred method for detecting pulley injuries. This study aimed to determine the reliability and validity of US in identifying anatomical landmarks for diagnosing A2 pulley ruptures. Methods: This study was cross-sectional, involving 36 fingers from 4 cadaver arms. A Canon Aplio i800 US machine was used to measure two anatomical landmarks: the midpoint of the proximal phalanx and the distal edge of the A2 pulley. For the first anatomical landmark, the length of the proximal phalanx (PP distance), and for the second landmark, the distance between the distal edges of the proximal phalanx and the A2 pulley ("A" distance), were measured. Measurements were performed by two sonographers and compared to a digital caliper measurement taken post-cadaver dissection. Observers were blinded during measurements to ensure unbiased results. Results: Overall PP distance measured by US (O1: 37.5 ± 5.3 mm, O2: 37.8 ± 5.4 mm) tended to be shorter than caliper measurements (O3: 39.5 ± 5.5 mm). The differences between sonographers were minimal, but larger when compared to caliper measurements. High reliability for PP distance measurement was observed, especially between sonographers, with an ICC average of 0.99 (0.98, 1.00). However, reliability was lower for the "A" distance, with significant differences between US and caliper measurements. Regarding validity, US measurements were valid when compared to caliper measurements for PP distance, but not as reliable for the "A" due to wider confidence intervals. While US can substitute caliper measurements for PP distance (LR, Y:O2, X:O3, −0.70 (−3.28–1.38), 0.98 (0.93 ± 1.04)), its validity for "A" distance is lower (LR, Y:O2, X:O3, −2.37 (−13.53–4.83), 1.02 (0.62–1.75)). Conclusions: US is a reliable and valid tool in identifying anatomical landmarks for diagnosing A2 pulley ruptures, particularly for detecting the midpoint of the proximal phalanx. This is important to differentiate between complete and partial A2 pulley tears. However, the measurement of the "A" distance requires further refinement. These findings support efforts to standardize US examination protocols and promote consensus in diagnostic methodology, though further research is needed to address the remaining challenges. [ABSTRACT FROM AUTHOR]

Introduction: More personalized alignment techniques in total knee arthroplasty (TKA) have recently been described particularly for the young and active patients. Performing the ideal tibial cut might be challenging with a conventional ancillary. Therefore the aims of this study were: (1) to describe specific tibial landmarks to optimize the tibial cut in TKA; (2) to compare the accuracy of the tibial cut with these landmarks compared to a conventional technique. Methods: This retrospective case–control study compared primary TKAs performed using a conventional technique with extramedullary guide associated with specific tibial landmarks. For each case, one control patient was matched based on body mass index (BMI), age, preoperative Hip Knee Ankle (HKA) angle, and Medial Proximal Tibial Angle (MPTA). All control patients were operated by the same surgeon and similar conventional technique but without landmarks. The MPTA target was to reproduce preoperative deformity with a 3° of varus limit. 34 TKA were included in each group. There was no preoperative difference between both groups. Mean age was 63 years old ± 8. Mean BMI was 32 kg/m2 ± 5. Mean HKA was 170.6° ± 2.5. Mean MPTA was 85.1° ± 2.3. The radiographic assessment was performed preoperatively and at 2 months: HKA, mechanical Medial Distal Femoral Angle (mMDFA), MPTA, tibial slope, restoration of the joint line-height. Results: The tibial landmarks corresponded to the line of insertion of the deep medial collateral ligament fibers extended to the capsular insertion above the Gerdy tubercle. The postoperative MPTA was significantly more varus (87.2° ± 1.6 in landmark group versus 88.3° ± 2.2; p = 0.027) and closer to preoperative bone deformity in landmark group (p = 0.002) with significantly less outliers than in the conventional group. There was no significant difference between both groups postoperatively for HKA (175.4° ± 2.3 versus 175.9° ± 2.5; p = 0.42); mMDFA (88.9° ± 2.3 versus 88.2° ± 2.1; p = 0.18); tibial slope (82.6° ± 1.9 versus 82.4° ± 2.6; p = 0.67), the restoration of the joint line-height (1.5 mm ± 2 versus 1.8 mm ± 2; p = 0.56). Conclusion: Specific tibial landmarks during TKA can be used to increase the accuracy of the tibial cut when using personalized alignment techniques in TKA. Level of evidence: IV. [ABSTRACT FROM AUTHOR]

ObjectiveThis study aims to define a set of related anatomical landmarks based on preoperative Magnetic Resonance Imaging (MRI) of patients with pituitary adenomas (PAs). It explores the impact of the dynamic relationships between different anatomical landmarks and the tumor on the resection rate and tumor progression/recurrence during the endoscopic endonasal approach (EEA).MethodsA single-center institutional database review was conducted, identifying patients with PAs treated with EEA from December 2018 to January 2023. Clinical data were reviewed, and anatomical landmarks were categorized into two regions: the suprasellar region and the cavernous sinus region. Following basic statistical and univariate logistic regression analyses, patients were randomly divided into training and validation sets. A nomogram was then established through the integration of least absolute shrinkage and selection operator (LASSO) regression and multivariable logistic regression analysis. The clinical prediction model was evaluated using the area under the receiver operating characteristic curve (AUC), calibration curves, and decision curve analysis. Kaplan-Meier curves were plotted for survival analysis.ResultsA total of 626 patients with PAs were included in the study, with gross total resection (GTR) achieved in 570 cases (91.05%). Significant differences were observed in the distribution of age, Knosp grade, and tumor size between the GTR and near total resection (NTR) groups. LASSO regression identified 8 key anatomical landmarks. The resulting model demonstrated an AUC of 0.96 in both the training and validation sets. Calibration curves indicated a strong agreement between the nomogram model and actual observations. Survival analysis revealed that the extent of resection (EOR), age, Knosp grade, tumor size, and PAs extending beyond several anatomical landmarks identified were significantly associated with the progression or recurrence of PAs.ConclusionThis study proposes a model for adaptively assessing the resection rate of PAs by delineating relevant anatomical landmarks. The model comprehensively considers instrument manipulation angles, surgical accessibility during EEA procedures, anatomical variations, and the displacement of related anatomical structures in pathological states. This approach can assist neurosurgeons in preoperative planning and developing personalized surgical strategies.

Introduction: The present study evaluated the consistency and reliability of five anatomical landmarks in the external auditory meatus using CBCT (cone beam computed tomography) scans. The goal was to determine if these landmarks could reliably replace the commonly used point Porion for superimposing CBCT scans in clinical practice. Consistent anatomical features in the external auditory meatus are essential for accurate cranial assessments in dentistry and medicine. Despite their importance, these features have been underexplored, making this study a valuable contribution to improving clinical evaluation accuracy. Materials and methods: 22 CBCT scans were analyzed using ITK-Snap software. The shape of the External Auditory Meatus had been rendered by segmentation. These segmentations were used as a basis to locate the landmarks. The spread in location of the suggested landmarks concerning a reference coordinate system was treated as a measure for consistency. For that purpose, the absolute mean distance from all registered landmarks to the center of the location cloud was calculated for each dataset. Results: The smallest spread in locations was measured for the so-called Epitympanic Notch, with 4.3 mm on average (SD 1.7). However, recognizing this landmark in the segmented images appeared to be relatively difficult. The landmark with the second smallest spread in locations (4.4 mm (SD 2.2)) and an easier recognition in the segmented image was the most superior point of the external auditory meatus. The most inferior point appeared to be the least reliable of all five landmarks. Conclusion: Based on the present study, a consistently reliable landmark in the External Auditory Meatus to replace point Porion could not be identified. The hypothesis that any landmark could suffice for superimposing CBCT scans was not confirmed.

Study Design: Review. Objective: Unilateral Biportal Endoscopy (UBE) is a minimally invasive surgery that is gaining recognition and being employed in clinical practice. Nevertheless, the precise method for determining UBE portals' location varies depending on the originator's preferences or the anatomical structure's proximity to the portal positions. Consequently, the relationship among UBE portals' locations is messy. This study aims to elaborate on the specific portal localization and explore the positional association and commonality among different UBE approaches' portals. Methods: The following keywords are used to search in the PubMed, Ovid, Web of Science, ScienceDirect, SpringerLink, Scopus, CNKI, and Wanfang database: "Biportal endoscopic spinal surgery", "Two portal endoscopic spinal surgery", "Percutaneous biportal endoscopic decompression", "Unilateral biportal endoscopy", "Irrigation endoscopic discectomy", "UBE" and "BESS". Results: After screening, 29 pieces of literature are included. The study summarizes different UBE approach portal localizations, categorized by fusion or non-fusion surgery and pathological classification. The study presents an inaugural method for categorizing the lumber into four surgical intervals based on bone landmarks and assigns different UBE approaches to the appropriate intervals based on their characteristics, making the selection of UBE surgical approaches' portal locations more flexible. Additionally, the study provides an overview of the indications, complications, and distinct benefits associated with each interval, further refining the novel UBE portal interval localization method. Conclusion: The study clarifies the interrelationship and commonality between the portals of different UBE approaches and proposes a new UBE portal interval localization method to enhance surgeons' understanding and proficiency in UBE procedures. [ABSTRACT FROM AUTHOR]

Surgical management of a diseased thyroid depends on sonological and pathological evaluation and thereby, planning of the surgery. The definite surgery has two objectives: removal of the diseased gland and preservation of the nerves, namely EBSLN (External Branch of Superior Laryngeal Nerve) and RLN (Recurrent Laryngeal Nerve) and the Parathyroid glands. The objectives of the study were: (1) To identify the course of the RLN and EBSLN of both sides, during Thyroidectomy. (2) To discern various anatomical landmarks, the relations of the two nerves with them and anatomical variations, if any. In this Prospective observational study, fifty selected goitre patients underwent various types of thyroidectomies based on sonological and cytological criteria. The course and anatomical variations of EBSLN and RLN were photo-documented and results were analysed. Most of the EBSLN were found as Cernea type 1 type (25 out of 50), followed by Cernea type 2a (comprising 36%). The least common was type 2b. It was found that 36 out of 50 (72%) of RLN passed posterior to Inferior Thyroid Artery (ITA). Moreover, before piercing cricothyroid joint, the RLN showed bifurcation in 13 out of 50 subjects (26%), 1 participant had trifurcation and the remaining 36 (72%) had a single trunk. The EBSLN shows relation to the horizontal plane passing through the upper pole of the thyroid gland and it is more prone to get damaged when it passes within less than 1 cm to the plane. The RLN has various relations to the distinct anatomical landmarks thereby helping in safe dissection of the nerve. The study also noted the RLN in relation to ITA and branching before entering into the cricothyroid joint. [ABSTRACT FROM AUTHOR]

With the growing demand for orthognathic surgery and other facial treatments, the accurate identification of anatomical landmarks has become crucial. Recent advancements have shifted towards using three-dimensional radiologic analysis instead of traditional two-dimensional methods, as it allows for more precise treatment planning, primarily relying on direct identification by clinicians. However, manual tracing can be time-consuming, mainly when dealing with a large number of patients. This study compared the accuracy and reliability of identifying anatomical landmarks using artificial intelligence (AI) and manual identification. Thirty patients over 19 years old who underwent pre-orthodontic and orthognathic surgery treatment and had pre-orthodontic three-dimensional radiologic scans were selected. Thirteen anatomical indicators were identified using both AI and manual methods. The landmarks were identified by AI and four experienced clinicians, and multiple ANOVA was performed to analyze the results. The study results revealed minimal significant differences between AI and manual tracing, with a maximum deviation of less than 2.83 mm. This indicates that utilizing AI to identify anatomical landmarks can be a reliable method in planning orthognathic surgery. Our findings suggest that using AI for anatomical landmark identification can enhance treatment accuracy and reliability, ultimately benefiting clinicians and patients. [ABSTRACT FROM AUTHOR]

(1) Background: The morphology of the pelvic cavity is important for decision-making in obstetrics. This study aimed to estimate the accuracy and reliability of pelvimetry measures obtained when radiologists manually label anatomical landmarks on three-dimensional (3D) pelvic models. A second objective was to design an automatic labeling method. (2) Methods: Three operators segmented 10 computed tomography scans each. Three radiologists then labeled 12 anatomical landmarks on the pelvic models, which allowed for the calculation of 15 pelvimetry measures. Additionally, an automatic labeling method was developed based on a reference pelvic model, including reference anatomical landmarks, matching the individual pelvic models. (3) Results: Heterogeneity among landmarks in radiologists' labeling accuracy was observed, with some landmarks being rarely mislabeled by more than 4 mm and others being frequently mislabeled by 10 mm or more. The propagation to the pelvimetry measures was limited; only one out of the 15 measures reported a median error above 5 mm or 5°, and all measures showed moderate to excellent inter-radiologist reliability. The automatic method outperformed manual labeling. (4) Conclusions: This study confirmed the suitability of pelvimetry measures based on manual labeling of 3D pelvic models. Automatic labeling offers promising perspectives to decrease the demand on radiologists, standardize the labeling, and describe the pelvic cavity in more detail. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to evaluate the knowledge level of dental students and newly graduated dentists concerning anatomical landmarks identified on panoramic radiographs. Methods: This study was conducted as a web-based survey. Students continuing their education in the 4th and 5th grades of dentistry faculties and dentists who graduated within the last one year were included in our study. The answers given to the anatomical points on the panoramic radiograph were recorded as "true" and "false". SPSS was used to analyse the data. The data obtained were analysed by Kolmogorov-Smirnov test and Mann-Whitney U Test. p<0.05 was considered statistically significant. Results: 300 people participated of which 59.6% of the participants were female and 40.4% were male. The answers given to a total of 18 anatomical point questions did not show a significant difference according to gender (p=0.469). There was no question that all participants answered correctly. The highest correct answer rate was found for the anatomical point 'Mental foramen' with 289 (96.3%) participants. The lowest correct answer rate was found for the anatomical point 'Soft palate' with 48 (16%) participants. According to educational status, 5th grade students were the group with statistically significantly lower correct answers (p=0.017) Conclusions: These results indicate that training approaches should be developed for anatomical landmarks with lower correct response rates. Dentists working on a complicated structure should have a good command of this anatomy, and for this purpose, efforts should be made during the teaching program on anatomical structures that are difficult to identify and keep their knowledge up to date. [ABSTRACT FROM AUTHOR]

Purpose: Our study aimed to illustrate the positional relationship of the two branches of the saphenous nerve: the infrapatellar branch of the saphenous nerve (IPBSN) and medial crural cutaneous nerve (MCCN), as well as the anatomical landmarks using high-resolution ultrasound (HRUS) to help prevent iatrogenic nerve injury. Methods: We used HRUS to explore the positional relationships among the anatomical landmarks, IPBSN, and MCCN in 40 knees of 20 participants. The distances from these branches to key reference points were recorded. Using the ultrasound caliper mode, we measured the depth from the skin surface to the nerves at four distinct points. Results: The average distances between IPBSN and medial border of patella (MBP) and IPBSN and medial border of patellar ligament (MBPL) were 47 ± 7 mm and 42 ± 9 mm, respectively. MCCN showed mean distances of 94 ± 9 mm and 96 ± 9 mm to MBP and MBPL, respectively. The mean distance from the upper edge of pes anserine to IPBSN at the patellar apex (PA) level was 24 ± 10 mm and to MCCN was 34 ± 9 mm. Conclusion: We used high-resolution ultrasound to evaluate IPBSN and MCCN and their positions relative to anatomical landmarks. The study results offer valuable insights into the course of these nerves, which can help establish a safety zone to prevent accidental nerve injuries during knee surgeries and injections. [ABSTRACT FROM AUTHOR]

The primary objective of this study was to examine the glenohumeral subluxation index (GHSI) in a large general population cohort and to define reference values. Glenohumeral subluxation is important in the development and prediction of pathological states of the shoulder joint and in total shoulder arthroplasty. Therefore, another objective was to examine the influence of age, sex, body mass index, and body height and weight on GHSI. GHSI according to Walch was measured on bilateral magnetic resonance imaging of 3004 participants of the Study of Health in Pomerania (SHIP, aged 21-90 years). SHIP drew a sample of the adult general population of Pomerania (Northeastern Germany). Reference values for GHSI were assessed by quantile regression models. Associations of sex, age, and anthropometric markers with the GHSI were calculated by linear regression models. A reference range between 42% and 55% for men with a mean of 49% ± 4% was defined, while the upper reference limit for women was 1% higher (mean, 50% ± 4%). Age was inversely associated with the GHSI in males (P < 0.001), while no significant association in females was observed (P =.625). Body weight and body mass index were positively associated (P <.001) without effect modification by sex. Heavy mechanical oscillations on the upper extremity showed no significant association with GHSI (P =.268). The reference values for GHSI were expanded to a range of 42%-57% on magnetic resonance imaging. Several associations between GHSI and anthropometric properties are present. According to these associations, adjusted formulas are provided to enable individual, patient-specific diagnostics and therapy. Nevertheless, the clinical picture cannot be neglected. [ABSTRACT FROM AUTHOR]

PURPOSE. This study aimed to predict the positional coordinates of incisor points from the scan data of conventional complete dentures and verify their accuracy. MATERIALS AND METHODS. The standard triangulated language (STL) data of the scanned 100 pairs of complete upper and lower dentures were imported into the computer-aided design software from which the position coordinates of the points corresponding to each landmark of the jaw were obtained. The x, y, and z coordinates of the incisor point (XP, YP, and ZP) were obtained from the maxillary and mandibular landmark coordinates using regression or calculation formulas, and the accuracy was verified to determine the deviation between the measured and predicted coordinate values. YP was obtained in two ways using the hamular-incisive-papilla plane (HIP) and facial measurements. Multiple regression analysis was used to predict ZP. The root mean squared error (RMSE) values were used to verify the accuracy of the XP and YP. The RMSE value was obtained after cross-validation using the remaining 30 cases of denture STL data to verify the accuracy of ZP. RESULTS. The RMSE was 2.22 for predicting XP. When predicting YP, the RMSE of the method using the HIP plane and facial measurements was 3.18 and 0.73, respectively. Cross-validation revealed the RMSE to be 1.53. CONCLUSION. YP and ZP could be predicted from anatomical landmarks of the maxillary and mandibular edentulous jaw, suggesting that YP could be predicted with better accuracy with the addition of the position of the lower border of the upper lip. [ABSTRACT FROM AUTHOR]

The suprascapular nerve block (SSNB) is a commonly used procedure for the management of pain in various shoulder pathologies. Both image-guided and landmark-based techniques have been utilized successfully for SSNB, though more consensus is needed regarding the optimal method of administration. This study aims to evaluate the theoretical effectiveness of a SSNB at 2 distinct anatomic landmarks and propose a simple, reliable way of administration for future clinical use. Fourteen upper extremity cadaveric specimens were randomly assigned to either receive an injection 1 cm medial to the posterior acromioclavicular (AC) joint vertex or 3 cm medial to the posterior AC joint vertex. Each shoulder was injected with a 10 ml methylene blue solution at the assigned location, and gross dissection was performed to evaluate the anatomic diffusion of the dye. The presence of dye was specifically assessed at the suprascapular notch, supraspinatus fossa, and spinoglenoid notch to determine the theoretic analgesic effectiveness of a SSNB at these 2 injection sites. Methylene blue diffused to the suprascapular notch in 57.1% of the 1-cm group and 100% of the 3-cm group, the supraspinatus fossa in 71.4% of the 1-cm group and 100% of the 3-cm group, and the spinoglenoid notch in 100% of the 1-cm group and 42.9% of the 3-cm group. Given its superior coverage at the more proximal sensory branches of the suprascapular nerve, a SSNB injection performed 3 cm medial to the posterior AC joint vertex provides more clinically adequate analgesia than an injection site 1 cm medial to the AC junction. Performing a SSNB injection at this location allows for an effective method of anesthetizing the suprascapular nerve. [ABSTRACT FROM AUTHOR]

The main goal of interventional spine treatment is to help back pain patients, who may even think about surgery, get over their pain peaks. Nerve root blocks, epidural injections, facet injections and sacroiliac joint injections are procedures that influence the pathological process directly in the spine motion segment and very often lead to a significant improvement in the findings. These spinal injections can be performed safely and effectively using anatomical landmarks. Above all, this is done radiation free, without the use of expensive equipment and with low organizational effort and time. [ABSTRACT FROM AUTHOR]

Purpose: This work aimed to utilize virtual reality (VR) in dental radiographic anatomical interpretation in junior dental students and test if it can enhance student learning, engagement, and performance. Methods: VR software for panoramic anatomy was developed. Sixty‐nine first‐year dental students were divided into a control group (lecture‐based) and an experimental group (VR) to learn panoramic radiographic anatomy. Both groups were then tested on knowledge via a 20‐question quiz. Student feedback on VR experience was collected via an online survey. Results: There was a statistically significant difference between lecture‐based and VR students in the correct identification of anatomical landmarks. Lecture‐based students scored higher in identifying the ear lobe, hyoid bone, condylar neck, and external oblique ridge, whereas VR students scored higher in identifying zygoma (Chi‐squared test, p < 0.005). The VR group reported high evaluation on all perception items of the online feedback survey on their experience (Student t‐test, p < 0.005). Conclusions: Lecture‐based students generally showed better performance in panoramic radiographic anatomy. Several structures were not correctly identified in both groups of novice students. The positive feedback of VR experience encourages future implementation in education to augment conventional methods of radiographic anatomy in dentistry with considerations to repeated exposures throughout undergraduate dental education. [ABSTRACT FROM AUTHOR]

The incidence of common bile duct injuries following laparoscopic cholecystectomy (LC) remains three times higher than that following open surgery despite numerous attempts to decrease intraoperative incidents by employing better training, superior surgical instruments, imaging techniques, or strategic concepts. This paper is a narrative review which discusses from a contextual point of view the need to standardise the surgical approach in difficult laparoscopic cholecystectomies, the main strategic operative concepts and techniques, complementary visualisation aids for the delineation of anatomical landmarks, and the importance of cognitive maps and algorithms in performing safer LC. Extensive research was carried out in the PubMed, Web of Science, and Elsevier databases using the terms "difficult cholecystectomy", "bile duct injuries", "safe cholecystectomy", and "laparoscopy in acute cholecystitis". The key content and findings of this research suggest there is high intersocietal variation in approaching and performing LC, in the use of visualisation aids, and in the application of safety concepts. Limited papers offer guidelines based on robust data and a timid recognition of the human factors and ergonomic concepts in improving the outcomes associated with difficult cholecystectomies. This paper highlights the most relevant recommendations for dealing with difficult laparoscopic cholecystectomies. [ABSTRACT FROM AUTHOR]

Abstract The distal great saphenous vein is a popular site for venous access by means of percutaneous cannulation or venous cutdown in a hemodynamically unstable patient. The aim of this study was to precisely define the surface anatomy and dimensions of the distal part of the great saphenous vein to facilitate the aforementioned procedures. Cross-sectional anatomy of the distal saphenous vein was studied in 24 cadaveric ankles sectioned at a horizontal plane across the most prominent points of the medial and lateral malleoli. The curvilinear distance from the most prominent point of the medial malleolus to the center of the saphenous vein, its widest collapsed diameter and skin depth were obtained. The great saphenous vein was located at a mean distance of 24.4 ± 7.9 mm anterior to the medial malleolus. The mean widest collapsed diameter was 3.8 ± 1.5 mm. The mean distance from the skin surface to the vein was 4.1 ± 1.2 mm. These measurements could be used to locate the saphenous vein accurately, particularly in hemodynamically unstable patients with visually indiscernible veins.

Background: According to the National Clinical Database of Japan, the incidence of bile duct injury (BDI) during laparoscopic cholecystectomy has hovered around 0.4% for the last 10 years and has not declined. On the other hand, it has been found that about 60% of BDI occurrences are due to misidentifying anatomical landmarks. However, the authors developed an artificial intelligence (AI) system that gave intraoperative data to recognize the extrahepatic bile duct (EHBD), cystic duct (CD), inferior border of liver S4 (S4), and Rouviere sulcus (RS). The purpose of this research was to evaluate how the AI system affects landmark identification. Methods: We prepared a 20-s intraoperative video before the serosal incision of Calot's triangle dissection and created a short video with landmarks overwritten by AI. The landmarks were defined as landmark (LM)-EHBD, LM-CD, LM-RS, and LM-S4. Four beginners and four experts were recruited as subjects. After viewing a 20-s intraoperative video, subjects annotated the LM-EHBD and LM-CD. Then, a short video is shown with the AI overwriting landmark instructions; if there is a change in each perspective, the annotation is changed. The subjects answered a three-point scale questionnaire to clarify whether the AI teaching data advanced their confidence in verifying the LM-RS and LM-S4. Four external evaluation committee members investigated the clinical importance. Results: In 43 of 160 (26.9%) images, the subjects transformed their annotations. Annotation changes were primarily observed in the gallbladder line of the LM-EHBD and LM-CD, and 70% of these shifts were considered safer changes. The AI-based teaching data encouraged both beginners and experts to affirm the LM-RS and LM-S4. Conclusion: The AI system provided significant awareness to beginners and experts and prompted them to identify anatomical landmarks linked to reducing BDI. [ABSTRACT FROM AUTHOR]

The purpose of this prospective ultrasound-based pilot study was to identify the most suitable tibial puncture site for intraosseous (IO) access in term and preterm neonates, describe tibial dimensions at this site, and provide anatomical landmarks for rapid localization. We measured the tibial dimensions and distances to anatomical landmarks at puncture sites A (proximal: 10 mm distal to the tibial tuberosity; distal: 10 mm proximal to the malleolus medialis) and B (chosen by palpation of the pediatrician), in 40 newborns in four weight groups (< 1000 g; 1000–2000 g, 2000–3000 g, and 3000–4000 g). Sites were rejected if they fell short of the assumed safety distance to the tibial growth plate of 10 mm. If both A and B were rejected, puncture site C was determined sonographically at the maximum tibial diameter while maintaining the safety distance. Puncture site A violated the safety distance in 53% and 85% (proximally and distally, respectively) and puncture site B in 38% and 33%. In newborns weighing 3000–4000 g, at median (IQR), the most suitable puncture site at the proximal tibia was 13.0 mm (12.0–15.8) distal to the tuberosity and 6.0 mm (4.0–8.0) medial to the anterior rim of the tibia. The median (IQR) diameters at this site were 8.3 mm (7.9–9.1) (transverse) and 9.2 mm (8.9–9.8) (anterior–posterior). The diameters increased significantly with increasing weight. Conclusion: This study adds concise, practical information on the implementation of IO access in neonatal patients: the tibial dimensions in newborns in four different weight groups and initial data on anatomical landmarks to easily locate the IO puncture site. The results may help implement IO access in newborns more safely. What is Known: • Intraosseous access is a feasible option for emergency administration of vital drugs and fluids in newborns undergoing resuscitation when an umbilical venous catheter is impossible to place. • Severe complications of IO access due to malpositioned IO needles have been reported in neonates. What is New: • This study reports the most suitable tibial puncture sites for IO access and the tibial dimensions, in newborns of four weight groups. • The results can help to implement safe IO access in newborns. [ABSTRACT FROM AUTHOR]

The extramedullary guides for the tibial resection during medial unicompartmental knee arthroplasty (UKA) are inaccurate, with an error risk in coronal and sagittal planes and cut thickness. It was our hypothesis that the use of anatomical landmarks for the tibial cut can help the surgeon to improve accuracy. The technique described in this paper is based on the use of a simple and reproducible anatomical landmark. This landmark is the line of insertion of the fibers of the deep medial collateral ligament (MCL) around the anterior half of the medial tibial plateau called the "Deep MCL insertion line". The used anatomical landmark determines the orientation (in the coronal and sagittal planes) and the thickness of the tibial cut. This landmark corresponds to the line of insertion of the fibers of the deep MCL around the anterior half of the medial tibial plateau. A consecutive series of patients who underwent primary medial UKA between 2019 and 2021 were retrospectively reviewed. A total of 50 UKA were included. The mean age at the time of surgery was 54.5 ± 6.6 years (44–79). The radiographic measurements showed very good to excellent intra-observer and inter-observer agreements. The limb and implant alignments and the tibial positioning were satisfying, with a low rate of outliers and good restoration of the native anatomy. The landmark of the insertion of deep MCL constitutes a reliable and reproducible reference for the tibial cut axis and thickness during medial UKA, independent of the wear severity. [ABSTRACT FROM AUTHOR]

Purpose: Anatomical knowledge of the hypoglossal canal is very important in relation to drilling of occipital condyle, jugular tubercle etc. So, this study was conducted to identify various morphometric and morphological features of the hypoglossal canal and its distance from adjacent structures relative to stable and reliable anatomic landmarks. Methods: The study was performed on 142 hypoglossal canals of 71 adult human dry skulls. The parameters measured were the transverse, vertical diameter, depth of the hypoglossal canal. The distances from the hypoglossal canal to the foramen magnum, occipital condyle and jugular foramen were also noted. In addition, the different locations of the hypoglossal canal orifices in relation to the occipital condyle were assessed. The different shapes and types of the hypoglossal canal were also noted. Results: There was significant difference (p < 0.05) in measurements taken on the right and left sides in males and females. The intracranial orifice of hypoglossal canal was present in middle 1/3rd in 100% of occipital condyle for both genders. The extracranial orifice of the hypoglossal canal was found to be in the anterior 1/3rd in 99% and 93.7% for male and female, respectively. Simple hypoglossal canal with no traces of partition was found to be more in males and females. The most common shape noted was oval both in males and females (71.8% and 68.7% respectively). Conclusion: The results of the dimensions of the hypoglossal canal and its distance from other bony landmarks will be helpful for neurosurgeons to plan which surgical approaches should be undertaken while doing various surgeries in posterior cranial fossa. [ABSTRACT FROM AUTHOR]

Spatial normalization is an image registration method to coregister images to a previously defined template. It simplifies the analysis of images taken on the same patient or different patients, at different time points or captured with different imaging modalities. The paper presents a spatial normalization method for the human hand, together with a corresponding template of 21 manually and 242 automatically selected anatomical landmarks. Using landmarks and extrapolation technique, the method coregisters images to the template defined as an average position of individual landmarks on all images. The method is tested on 12 healthy human hands by evaluating the mismatch between the ground truth defined with ultrasound-determined landmarks and the ones defined visually using RGB images. The mean registration uncertainty over the hands was 1.4 ± 1.3 mm. The method utility is demonstrated by being successfully applied to 29 arthritic hands with a pathological finger and hand deformation. Spatial normalization of the hand images enables a pixel-wise analysis of multiple hand images of a same patient taken at different time points with the same modality, as well as images of the same patient taken with a different modality and inter-patient comparison. [ABSTRACT FROM AUTHOR]

Background: Obtaining central venous access is the basic requirement in patients undergoing cardiac surgery. Use of ultrasound (USG) for accessing IJV cannulation, improves the success rate and reduces the number of complications that may arise due to blind approach. Through this study we aimed to compare landmark vs real time USG guided IJV cannulation techniques. Methods: 190 adult patient’s undergoing cardiac surgery were randomly divided into two groups of 95 each. Patients in Group A (Landmark based approach) were being compared to Group B (USG based) in terms of – success rate, first attempt success rate, total cannulation time, number of attempts, complications and success rate among residents and consultants. Results: Success rate obtained in Group A was 89.4% compared to 100% in group B (P = 0.001). First attempt success rate was 67.36% in group A and 91.57% in group B (P < 0.001). Group B showed less number of attempts. Total cannulation time in group A (252.2 ± 66.4) sec was significantly higher (P

Introduction: The brachial plexus is a network of nerves originating in the periclavicular region and provides sensory and motor innervation to the upper extremity. The plexus is an important structure due to its anatomical location and vulnerability to damage. As such, surgeons need to be able to locate individual plexus segments or nerve branches when performing procedures. However, finding the sites of uniting and dividing points within the brachial plexus can prove challenging. Methods: Dissections were performed bilaterally on 30 formalin-fixed adult cadavers to expose the individual segments and branches of the brachial plexus. Subsequently, various measurements were taken. Measurements included the length of the roots, trunks, divisions, cords, and terminal branches (musculocutaneous, median, ulnar, radial, and axillary nerves). Results: The statistical test revealed the Mean±SD length of the middle and inferior trunk was 34.75±29.6 mm and 39.8±14.2 mm respectively. The Mean±SD of lateral cord was 47.75±14.98 mm, the posterior cord 45±13.20 mm, and the medial cord was 48.75±16.44 mm. The terminal branches were as follows: Musculocutaneous nerve 67±25.03 mm, median nerve 206.20±116 mm, ulnar nerve 219.70±29.70 mm, radial nerve 117.30±17 mm and axillary nerve 65.60±13.30 mm. Conclusion: A thorough understanding of all relevant anatomical landmarks is mandatory for any successful procedure. Common techniques, such as brachial plexus blocks, require detailed anatomical literature due to the complexity and variability of the plexus. Results from this study will add to the understanding of the anatomy of the brachial plexus and further assist clinicians in pre- and perioperative surgical planning.

Introduction: Resection of the pancreas is done for benign and malignant diseases. Distal pancreatectomy (DP) is defined as a resection of the body and tail of the pancreas which lie to the left of the superior mesenteric vein (SMV). The inferior mesenteric vein (IMV) is traditionally described to be draining into the splenic vein. This study aimed to determine the relationship of the IMV with respect to the distal pancreas to illustrate how it can be implemented as a landmark, especially to define the tail of the pancreas for parenchyma-sparing distal pancreatic resection. Methods: This study included the dissection of 50 cadavers, which were obtained from the Department of Clinical Anatomy at a higher education institution in South Africa. The sex of the cadavers and the drainage pattern of the IMV were documented, along with the distance from the confluence of the SMV and splenic vein. Descriptive statistics were used to summarise the results. [Ethical Approval Number: BE465/18]. Results: Wide variation in the drainage patterns of the IMV was noted, with overall 48% draining into the SMV, 36% in the splenic vein and the rest at the confluence of the SMV and splenic vein. The preferential pattern of the IMV draining into the SMV was more prominent in males, with females having been evenly distributed between the SMV and splenic vein. The distances measured were not statistically significant owing to the restricted sample size and outliers noted during data collection. Conclusion: This study confirmed the wide variation in drainage patterns of the IMV. Literature regarding limited pancreatic resections and the rate of pancreatic endocrine failure is increasing. The measured distances show some promise in using the IMV as a landmark for dividing the pancreas when it is draining directly into the splenic vein. However, larger cohort studies are required to validate this hypothesis.

The aim was to evaluate the morphology of maxillary second premolars. The root canal configurations were classified according to Vertucci and a new system by Ahmed et al. based on CBCT images. In addition, the number of roots and the level where they bifurcated were identified, and morphological measurements were performed based on anatomical landmarks. Single‐rooted forms were most common. Bifurcation occurred most often in the middle part of the root. The most common canal configuration was type I according to Vertucci and code 1SP1 according to the new classification. The measurements showing the results were as follows (mm): palatal cusp/buccal cusp/the lowest point of the occlusal surface to pulp chamber ceiling 6.18/6.54/4.77; the ceiling of the pulp chamber was found at the CEJ in 92.28% of the specimens. The maxillary second premolars tended to be single‐rooted and with one root canal. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this cross-sectional study was to assess the proximity of maxillary second molar (MSM) and maxillary tuberosity (MT) to mandibular foramen (MF) to perform successful Vazirani–Akinosi nerve block (VANB) technique. Methods: Cone beam computed tomography (CBCT) images of 2613 sides of the jaw were selected for the study. The vertical distance from MSM to the MF and the vertical distance from MT to the MF and from MT to the posterior border of the ramus (PR) were measured and compared between males and females using independent samples t test. Results: The mean values of all vertical measurements were higher in males than in females, and the difference was statistically significant in case of the vertical distance from MSM to the MF and the vertical distance from MT to the PR (P <.05). Conclusion: This study showed the gender differences in MSM and MT measurements used to locate MF in VANB technique. This fundamental knowledge should be considered in performing VANB technique. [ABSTRACT FROM AUTHOR]

(1) Background: Three-dimensional (3D) facial anatomical landmarks are the premise and foundation of facial morphology analysis. At present, there is no ideal automatic determination method for 3D facial anatomical landmarks. This research aims to realize the automatic determination of 3D facial anatomical landmarks based on the non-rigid registration algorithm developed by our research team and to evaluate its landmark localization accuracy. (2) Methods: A 3D facial scanner, Face Scan, was used to collect 3D facial data of 20 adult males without significant facial deformities. Using the radial basis function optimized non-rigid registration algorithm, TH-OCR, developed by our research team (experimental group: TH group) and the non-rigid registration algorithm, MeshMonk (control group: MM group), a 3D face template constructed in our previous research was deformed and registered to each participant's data. The automatic determination of 3D facial anatomical landmarks was realized according to the index of 32 facial anatomical landmarks determined on the 3D face template. Considering these 32 facial anatomical landmarks manually selected by experts on the 3D facial data as the gold standard, the distance between the automatically determined and the corresponding manually selected facial anatomical landmarks was calculated as the "landmark localization error" to evaluate the effect and feasibility of the automatic determination method (template method). (3) Results: The mean landmark localization error of all facial anatomical landmarks in the TH and MM groups was 2.34 ± 1.76 mm and 2.16 ± 1.97 mm, respectively. The automatic determination of the anatomical landmarks in the middle face was better than that in the upper and lower face in both groups. Further, the automatic determination of anatomical landmarks in the center of the face was better than in the marginal part. (4) Conclusions: In this study, the automatic determination of 3D facial anatomical landmarks was realized based on non-rigid registration algorithms. There is no significant difference in the automatic landmark localization accuracy between the TH-OCR algorithm and the MeshMonk algorithm, and both can meet the needs of oral clinical applications to a certain extent. [ABSTRACT FROM AUTHOR]

Background: We have implemented Smart Endoscopic Surgery (SES), a surgical system that uses artificial intelligence (AI) to detect the anatomical landmarks that expert surgeons base on to perform certain surgical maneuvers. No report has verified the use of AI-based support systems for surgery in clinical practice, and no evaluation method has been established. To evaluate the detection performance of SES, we have developed and established a new evaluation method by conducting a clinical feasibility trial. Methods: A single-center prospective clinical feasibility trial was conducted on 10 cases of LC performed at Oita University hospital. Subsequently, an external evaluation committee (EEC) evaluated the AI detection accuracy for each landmark using five-grade rubric evaluation and DICE coefficient. We defined LM-CBD as the expert surgeon's "judge" of the cystic bile duct in endoscopic images. Results: The average detection accuracy on the rubric by the EEC was 4.2 ± 0.8 for the LM-CBD. The DICE coefficient between the AI detection area of the LM-CBD and the EEC members' evaluation was similar to the mean value of the DICE coefficient between the EEC members. The DICE coefficient was high score for the case that was highly evaluated by the EEC on a five-grade scale. Conclusion: This is the first feasible clinical trial of an AI system designed for intraoperative use and to evaluate the AI system using an EEC. In the future, this concept of evaluation for the AI system would contribute to the development of new AI navigation systems for surgery. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to find out the correlation between different anatomical parameters of the mandible and the occurrence of a bad split in patients who had undergone bilateral split sagittal ramus osteotomy (BSSRO). Materials and method: At both the distal roots of the first molar (1) and the retromolar area (2), we measured the distance from the buccal margin of the inferior dental canal (IDC) to the buccal margin of the cortical bone (MCBC), the thickness of both buccal cortical (WBCB) and cancellous bone (WBCA), distance from the superior border of IDC to the alveolar crest (MCAC), buccolingual thickness (BLT), and thickness of cancellous bone (WCA). At the ramus, the distances between the sigmoid notch to the upper part of the lingula (SL) and the inferior border of the mandible (SIBM), the thickness of the ramus at the level of the lingula (BLTR), and the anteroposterior width of the ramus (APWR) were measured. The paired and independent t-tests were used when applicable, and a P-value < 0.05 was considered significant. Results: MCBC1 showed a significant difference between bad and non-bad split sides (P = 0.037). Both WBCA1 and WBCA2 show the same significant difference (P = 0.023, 0.024). Similarly, WCA1 and WCA2 showed a statistical difference between the bad and non-bad split sides (P = 0.027, 0.036). There were no statistically significant differences between the compared sides of WBCB1, WBCB2, MCAC1, MCAC2, SIBM, APWR, SL, and BLTR. Conclusion: Narrow space between IDC and the buccal cortical margin, along with the decrease in the thickness of both buccal cancellous bone and total cancellous bone at the inferior border of the mandible along the course of SSRO, has been implicated in the occurrence of bad split intraoperatively. [ABSTRACT FROM AUTHOR]

Background: Outflow control is difficult, and techniques required for effectively handling intraoperative hemorrhage during laparoscopic hepatectomy have not previously been adequately reported. Methods: Sixteen patients underwent surgery, of which 15 underwent laparoscopic left hepatectomy and one underwent laparoscopic partial hepatectomy of the caudate lobe. Encircling and taping of the common trunk of the middle (MHV) and left hepatic veins (LHV) was performed in 12 patients, and that of the LHV alone in four patients. Surgical techniques based on anatomical landmarks and histological findings are presented with videos. Histological confirmation of the anatomical landmarks for these procedures was performed in fresh cadavers to understand the anatomical structures and layers involved. Results: The median procedure duration was 15 (6‐25) minutes. All procedures were performed safely with no major bleeding. Histological findings showed fibrous connective tissue between the tunica adventitia of the inferior vena cava (IVC) and the Laennec's capsule of the liver. The layer of dissection was along the tunica adventitia of the IVC. Conclusions: The surgical techniques for encircling and taping of the common trunk of the MHV and LHV and the LHV alone based on anatomical landmarks were feasible and could allow for efficient outflow control in laparoscopic hepatectomy. [ABSTRACT FROM AUTHOR]

The reconstruction of the lower lip defects which may result from malignancy, trauma, and burn is necessary for mastication, oral competence, salivary retain, articulation, and aesthetic appearance of the face. While small (30% of the lower lip) and medium (30%–80% of the lower lip) size defects are reconstructed using primary repair and local flaps, reconstruction of the large defects including total and near-total of the lower lip is very challenging entity.

The distal great saphenous vein is a popular site for venous access by means of percutaneous cannulation or venous cutdown in a hemodynamically unstable patient. The aim of this study was to precisely define the surface anatomy and dimensions of the distal part of the great saphenous vein to facilitate the aforementioned procedures. Cross-sectional anatomy of the distal saphenous vein was studied in 24 cadaveric ankles sectioned at a horizontal plane across the most prominent points of the medial and lateral malleoli. The curvilinear distance from the most prominent point of the medial malleolus to the center of the saphenous vein, its widest collapsed diameter and skin depth were obtained. The great saphenous vein was located at a mean distance of 24.4 ± 7.9 mm anterior to the medial malleolus. The mean widest collapsed diameter was 3.8 ± 1.5 mm. The mean distance from the skin surface to the vein was 4.1 ± 1.2 mm. These measurements could be used to locate the saphenous vein accurately, particularly in hemodynamically unstable patients with visually indiscernible veins. [ABSTRACT FROM AUTHOR]