Objective: To show the technique of robotic repair of pelvic floor defect including apical and anterior compartment defect and enterocele. To emphasize the importance of management of enterocele with apical suspension procedure. Design: A video demonstrating the step by step technique of mid-uterosacral ligament suspension procedure. Settings: University Affiliated Teaching Hospital with MIGS fellowship program. Patients: Pelvic organ prolapse patients with previous hysterectomy. Interventions: Robotic repair of pelvic floor defect in multiple compartments using a permanent suture. Measurements/Results: Pelvic floor defects can be efficiently managed with robotic apical suspension procedure in a patient with previous hysterectomy. We simultaneously address the enterocele as well as anterior and posterior compartment defect laparoscopically. Isolated anterior or posterior repair is rarely useful unless the apical defect is addressed. If the native uterosacral ligament has good strength to hold the suspension stitch, mesh use can be precluded. Minimally invasive gynecologic surgeons can gain proficiency in this surgery by utilizing the key techniques and steps mentioned in this video. This procedure is very useful as it repairs defects in multiple compartments without using a mesh. Conclusions: Pelvic organ prolapse consisting of apical, anterior, posterior defect and enterocele can be effectively managed with robotic miduterosacral ligament suspension using a permanent suture, if native tissue has good strength; thus precluding the use of a mesh.
Although various studies have proposed vascular and mechanical factors, the etiology of Kienböck disease is unknown. Kienböck theorized that lunatomalacia resulted from traumatic disruption of blood supply and bony nutrition to the lunate. Extraosseous supply to the lunate, as far as volar or dorsal vessels are concerned, is still controversial. This study evaluated the extraosseous nutrient foramina from the dorsal and volar aspects of lunate specimens. A total of 913 specimens from the Hamann-Todd Osteological Collection in Cleveland, Ohio, were examined. The nutrient artery foramina on left and right lunate specimens were examined from dorsal and volar aspects. The number of nutrient artery foramen was tabulated. Age, sex, and race data were collected. Specimens were divided into groups according to the number of nutrient artery foramina, and the dorsal and volar foramina were compared. The average number of foramina on the dorsal aspect of the lunate (1.71) was greater than the volar aspect (1.64), except in specimens younger than 35 years. A greater number of specimens had 3 or more foramina on the dorsal side compared with the volar aspect. Based on this study, there was significant contribution of dorsal arterial vessels to the blood supply of lunate specimens older than 35 years, which contrasts with findings in earlier studies. The disruption of dorsal intercarpal and radiocarpal ligaments leading to the disruption of the dorsal arterial arches may contribute to vascular insufficiency of the lunate and should be evaluated further in the etiopathogenesis of Kienböck disease. [ Orthopedics . 2021;44(2):e243–e247.]
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