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Related Concept Videos

Anatomical Positions01:11

Anatomical Positions

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In anatomy, several standard anatomical positions are used as references for describing the position and orientation of different body parts. These positions help provide a common frame of reference when discussing anatomical structures. The anatomical position is the standard reference point for describing the body's position and orientation. In this position:
The body is upright, facing forward, and standing erect.
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Sigmoidoscopy and laparoscopy are distinct medical procedures that enable physicians to internally inspect different parts of the GI tract. Although they serve different purposes, each is essential for diagnosing and, in some cases, treating various medical conditions.
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Surgical interventions for inflammatory bowel disease (IBD), which includes ulcerative colitis and Crohn's disease, are essential in managing symptoms and addressing complications. The selection of surgical procedures is contingent upon the specific conditions and complications that stem from these illnesses.
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Assessment of the Rectum and Anus01:25

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Evaluating the rectum and anus plays a crucial role in conducting a thorough physical examination of the gastrointestinal system. Although it may be uncomfortable and often embarrassing for the patient, it holds immense diagnostic value, particularly in detecting gastrointestinal diseases and abnormalities. This guide will explain how to perform this assessment using inspection and palpation methods.
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Updated: Jan 15, 2026

Surgical Approach and Complications of Stand-alone Lateral Trans-Psoas Interbody Fusion
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Bowel position does not preclude safe access in prone trans-psoas surgery.

Yi Yuen Wang1,2, Gabriel Pokorny3, Bryden Dawes1

  • 1St Vincent's Private Hospital, Melbourne, Australia.

Neurosurgical Review
|October 10, 2025
PubMed
Summary

Bowel overlay during prone transpsoas (PTP) surgery is not a contraindication. A new grading system found no bowel complications, regardless of bowel position, challenging prior radiological concerns.

Keywords:
Lateral lumbar interbody fusionProne trans-psoasRetro-peritonealSpinal fusion

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Area of Science:

  • Spinal surgery
  • Surgical safety
  • Gastrointestinal complications

Background:

  • Conflicting reports exist regarding the safety of the lateral spine surgical approach during prone transpsoas surgery.
  • Existing data is primarily based on cadaveric and radiological studies, lacking clinical evidence on safety.
  • A need exists for clinical data assessing the safety of the surgical corridor, particularly concerning bowel position.

Purpose of the Study:

  • To introduce a grading system for assessing the safety of the surgical approach corridor in prone transpsoas (PTP) surgery.
  • To evaluate the impact of bowel position on bowel complications following PTP surgery.
  • To determine if bowel overlay is a contraindication for the PTP approach.

Main Methods:

  • Retrospective review of prospectively collected data from patients undergoing PTP surgery.
  • Development and application of a 5-point grading system to assess bowel overlay.
  • Analysis of the correlation between bowel overlay grade, BMI, surgical side, and spinal levels.
  • Primary outcome measure was the incidence of bowel injury.

Main Results:

  • 140 patients were included, undergoing 207 spinal levels of PTP surgery.
  • A correlation was observed between higher bowel overlay grades and lower Body Mass Index (BMI).
  • No bowel complications were encountered across any grade of bowel overlay, including high-grade overlays (grades 3-5).

Conclusions:

  • The presence of bowel overlaying the lateral disc in the prone position is not a contraindication for the PTP approach.
  • Anatomical and radiological findings suggesting limited retroperitoneal space in prone positioning have minimal clinical relevance for PTP safety.
  • Clinical data supports the safety of the PTP approach irrespective of pre-operative bowel position.