Improving laparoscopy in embalmed cadavers: a new method with a lateral abdominal wall muscle section.

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.

Computer-assisted stereological analysis of gastric volume during the human embryonic period.

Morphometric data concerning human embryos and fetuses have become more clinically informative since ultrasound was employed to make prenatal measurements and software preprocessing techniques improved the previous fuzzy ultrasound signals (Mahoney, 1992). The aim of this study was to determine the volume of the human stomach during the embryonic period and to compare its rate of growth with that during the early fetal period. To calculate gastric volume, computer imaging techniques were applied on cross sections of a graded series of human embryos (from Carnegie stage 11) and fetuses. Gastric volume increased progressively, except for a decrease between stages 12 and 13 due principally to the reduction of the right gastric wall. The growth of the left wall of the stomach was predominant over that of the right. Until stage 20 the stomach volume increased due to the predominant growth of the walls, after this stage the gastric cavity volume increased rapidly, and the rate of growth of the gastric volume reached similar values to that of the early fetal period. We concluded that in the beginning the human stomach grows due to the predominant growth of its walls, chiefly of the left, and from stage 20 because of the predominant expansion of its cavity, which may be related to the capacity to swallow amniotic fluid at the end of the embryonic period. The diminution of the right gastric wall volume (stages 12-13) is consistent with an extension of the omental bursa into the mesodermal anlage of the stomach.