A Novel Approach to Gross Dissection of the Human Pelvis and Perineum

Abstract

INTRODUCTION Understanding the gross anatomy of the pelvis and perineum has been a challenge for professional students for years. Dissection of this region is hampered by the complex spatial orientation of the pelvis and perineum, limited access for dissection, structural density and ambiguity as well as low anatomic efficiency (i.e. time dissecting versus number of structures identified). These limitations often result in programs minimizing dissection of the pelvis and perineum by utilizing prosected specimens as well as anatomic and computer models. RESOURCES At The Ohio State University, we have developed a novel approach to the cadaveric dissection of the pelvis and perineum that we implemented in the laboratory this past year with medical, dental and graduate students. DESCRIPTION Our approach involves the en bloc removal of the perineum from the cadaver followed by excision of the symphysis pubis. This approach closely mimics pelvic exenteration, a surgical salvage procedure used for recurrent pelvic cancers. It permits autonomous dissection of the perineal bloc while providing open access to all of the organs in the pelvis still intact. Following the examination and dissection of the midline pelvic organs, the pelvis is hemisected permitting removal of a single leg for continued dissection of the internal iliac vessels and pelvic nerves. SIGNIFICANCE We have developed and successfully piloted a novel approach to the dissection of the pelvis and perineum that appears to resolve many of the prior difficulties associated with this region. The majority of dissecting tables were able to successfully complete the new dissection approach on their first try, albeit with significant prelab preparation and GTA/faculty guidance in the lab. This approach appears to significantly improve the anatomic efficiency of pelvis and perineum dissections and provides professional students with a much better understanding of this complex region of human anatomy. Support or Funding Information (Supported by Department of Biomedical Education and Anatomy, The Ohio State University.) This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

An Open-Book Approach to Pelvic Dissection for the Male Genitourinary System

“…A thorough posterior view of the pelvis has traditionally required this sacrifice. Steinke et al and Hunter et al have described modifications to the hemi-section, in which they keep midline structures intact [ 7 - 8 ]. These approaches involve either dissecting the pelvic soft tissues off to one side or removing the soft tissue en bloc, followed by mid-sagittal hemi-section of the pelvis.…”

“…This approach involves dividing the pubic symphysis and sacrum in the median plane after shifting all internal organs to one side, sparing them from transection. Additionally, Hunter et al performed an en bloc dissection of the pelvic visceral organs followed by a midsagittal hemi-section of the bony pelvis [ 8 ]. Both of these modified hemi-section dissections improve visualization without bisecting the soft tissue structures, but they also lose the in-situ relationships of those structures to the bony pelvis.…”

The question of dissection in medical training: Not just “if,” but “when”? A student perspective

“…Building in time efficiencies may help to overcome this issue. This can be achieved by adopting approaches that preserve (Kim et al, 2019 ; Hunter et al, 2020 ) rather than replace the hands‐on experience of dissection (Granger & Calleson, 2007 ; Mahmud et al, 2011 ). However, it is recognized that during the Covid‐19 pandemic digital alternatives to dissection became a necessity in order to maintain continuity of education during emergency remote learning (Pather et al, 2020 ; Harmon et al, 2020 ).…”