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–subcutaneus flap. To obviate an incidental opening of the peritoneum, resulting in air leakage, preservation of the deep muscular layer is advisable.
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Acknowledgments
We thank Miguel Martin-Mateo, Ph.D. (Biostatistics Unit, UAB), for assistance in the statistical analysis, Karl Storz Ltd., Barcelona, Spain, and Isabel Delgado and Manuel Querol (technical staff of the dissection room) for their technical support. We are also grateful to Servei de Traduccions i Revisions de Textos (Bellaterra) for assistance with the translation.
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Nebot-Cegarra, J., Macarulla-Sanz, E. Improving laparoscopy in embalmed cadavers: a new method with a lateral abdominal wall muscle section. Surg Endosc 18, 1058–1062 (2004). https://doi.org/10.1007/s00464-003-9229-z
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DOI: https://doi.org/10.1007/s00464-003-9229-z