water under the bridge - ANATOMICAL CONUNDRUM

[deleted29780]

Water under the bridge.
Report ---- It has happened in many an operating room.
During resection of the uterus, this unfortunate mistake is made by surgeons. They usually forget this basic anatomical relationship and cut this important structure with a lumen.
* They cut the uterine artery , and clamp the stump
knowingly or unknowingly this structure is also severed.

what is this structure? what can we do as future medics to stop this problem.

GOLDEN RULE NUMBER 1 . "the answer to the question is in the question"


This is not a question to test ur basic anatomy guys. Just wanted to know ur thoughts thats all. 😉

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[souljah1]

I think it is the ureter

 

[joshua_msu]

any more brain busters?

 

[doc05]

of course it is the ureter. the reason is that ob-gyn's aren't properly trained in surgery, not to mention the confusing anatomy.

 

[jbish]

Now come on, that's a bit of a broad statement (saying OBs aren't trained for surgery or the confusing anatomy). I'm a Med-1 and I've already learned the water/bridge thing for renal anatomy.

 

[docmartin]

I agree with the OP, this is a common mistake made, not just in OB but Gen Surg. I am doing my surgery rotation now and I was 2nd assist on a sigmoid colectomy and the surgeon (one of the smartest docs I've seen so far, I might add) pointed out that you need to be careful in that area b/c the uterine artery and ureter are commonly severed or cauterized by mistake. So even though we were there just to resect the sigmoid, he still double checked to make sure we had done no harm.

Good surgeons (OB or general) are aware of the common mistakes made by others. Cool surgery by the way!

 

[deleted29780]

it's very refreshing to know that, we all know this simple relationship.
How come surgeons keep cutting it?
It's too basic a relationship... u must not forget it.

I severed the ureter during a session in the dissecting room. We were supposed to remove the uterus and study it.
Hopefully i will never sever the ureter in future. I will always remember this simple anatomical relationship.
So what i am trying to say is this, first yr. med students should be
made to remove the uterus in order to examine it , without pointing out the relationship to them.
After that they should be made to understand this simple relationship . It will stick in their minds forever.

Hope y'all relate. Chao.

😉 😉 😉 😉

 

[droliver]

Originally posted by Akuffo
How come surgeons keep cutting it?
It's too basic a relationship... u must not forget it.

Nobody forgets it, but doing some of these operations on living tissue is a good deal different. Throw in large abdomens, retoperitoneal inflamation (be it from bleeding, cancer, retroperitoneal fibrosis, scar from previous operations, etc...), concominant bleeding, etc... and it (the ureter) sneaks up on you real quick even when you're looking for it. Many times during operations for IBD the scarring is so bad that you have no idea where the ureters are & might consider stenting them preoperatively so you can feel the stents to find them. I never managed to transect one (it happens very rarely) during my training, but I came close to cooking one with an electrocautery during an emergent exposure of the Illiac Artery & Vein which had been transected by a 9 mm round.

Dr. Bob Acland, a famous anatomist and plastic surgeon, has a n appropriate saying that real-life "anatomy is under no obligation to have read the textbook"