J Nebot-Cegarra1, E Macarulla-Sanz. 1. Anatomy and Embryology Unit, Department of Morphological Sciences, School of Medicine, Universitat Autònoma de Barcelona, Edifici M, 08193, Bellaterra, Barcelona, Spain. Josep.Nebot@uab.es
Abstract
BACKGROUND: Rigor mortis can be a problem when laparoscopy is performed in embalmed cadavers for surgical training. METHODS: To improve the laparoscopic view, a new technique for managing the abdominal wall with a cutaneous-subcutaneous flap, pneumoperitoneum (14-15 mmHg), and a progressive (step-by-step) bilateral section of the lateral muscles of the abdomen was attempted in 10 embalmed cadavers. The degree of abdominal wall increase was calculated by measuring changes in the size of the abdominal wall after each step. Improvement in the peritoneal laparoscopic view was also assessed. RESULTS: For abdominal wall size, no constant relationship was observed between initial (after creation of the pneumoperitoneum) and final increment (after each muscular layer section). Cumulative degrees of increase in the dimensions of the abdominal wall were the only parameters that showed a significant difference among the four groups of cadavers. Bilateral sectioning of both oblique muscles was sufficient to obtain an adequate view of the abdominopelvic cavity; thus, the risk of an unexpected peritoneal opening during sectioning of the transversum abdominis muscle was obviated. CONCLUSIONS: In embalmed cadavers, the laparoscopic view in the presence of a pneumoperitoneum can be facilitated by a section of the lateral muscles of the abdomen, with a previous cutaneous-subcutaneous flap. To obviate an incidental opening of the peritoneum, resulting in air leakage, preservation of the deep muscular layer is advisable.
BACKGROUND: Rigor mortis can be a problem when laparoscopy is performed in embalmed cadavers for surgical training. METHODS: To improve the laparoscopic view, a new technique for managing the abdominal wall with a cutaneous-subcutaneous flap, pneumoperitoneum (14-15 mmHg), and a progressive (step-by-step) bilateral section of the lateral muscles of the abdomen was attempted in 10 embalmed cadavers. The degree of abdominal wall increase was calculated by measuring changes in the size of the abdominal wall after each step. Improvement in the peritoneal laparoscopic view was also assessed. RESULTS: For abdominal wall size, no constant relationship was observed between initial (after creation of the pneumoperitoneum) and final increment (after each muscular layer section). Cumulative degrees of increase in the dimensions of the abdominal wall were the only parameters that showed a significant difference among the four groups of cadavers. Bilateral sectioning of both oblique muscles was sufficient to obtain an adequate view of the abdominopelvic cavity; thus, the risk of an unexpected peritoneal opening during sectioning of the transversum abdominis muscle was obviated. CONCLUSIONS: In embalmed cadavers, the laparoscopic view in the presence of a pneumoperitoneum can be facilitated by a section of the lateral muscles of the abdomen, with a previous cutaneous-subcutaneous flap. To obviate an incidental opening of the peritoneum, resulting in air leakage, preservation of the deep muscular layer is advisable.