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Video abstract summary Hysterectomies are the most commonly performed surgical procedure by Obstetricians and Gynecologists in women aged between 40 and 69.Vaginal hysterectomies are the most commonly performed hysterectomy as women get older, often in combination with prolapse repairs1. Despite this, there are no comprehensive, reliable educational videos for teaching this procedure. With the decrease in resident work hours and increased emphasis on patient safety, there is a focus on moving the initial stages of learning outside of the operating room. Curated instructional videos to teach surgical procedures are one way to accomplish this. This video is an excerpt from a full length teaching video demonstrating the key steps important for performing a vaginal hysterectomy including patient positioning, relevant anatomy, and surgical technique. The video combines real-time operating room footage with high fidelity 3-D animation. This video can be used to enhance the learning of medical trainees and other allied health professionals.

SummaryTertiary lymphoid tissues (TLTs) have been observed in the meninges of multiple sclerosis (MS) patients, but the stromal cells and molecular signals that support TLTs remain unclear. Here, we show that T helper 17 (Th17) cells induced robust TLTs within the brain meninges that were associated with local demyelination during experimental autoimmune encephalitis (EAE). Th17-cell-induced TLTs were underpinned by a network of stromal cells producing extracellular matrix proteins and chemokines, enabling leukocytes to reside within, rather than simply transit through, the meninges. Within the CNS, interactions between lymphotoxin αβ (LTαβ) on Th17 cells and LTβR on meningeal radio-resistant cells were necessary for the propagation of de novo interleukin-17 responses, and activated T cells from MS patients expressed elevated levels of LTβR ligands. Therefore, input from both Th17 cells and the lymphotoxin pathway induce the formation of an immune-competent stromal cell niche in the meninges.

Visualizing the complex anatomy of vascular and biliary structures of the liver on a case-by-case basis has been challenging. A living donor liver transplant (LDLT) right hepatectomy case, with focus on the porta hepatis, was used to demonstrate an innovative method to visualize anatomy with the purpose of refining preoperative planning and teaching of complex surgical procedures. The production of an animation-enhanced video consisted of many stages including the integration of pre-surgical planning; case-specific footage and 3D models of the liver and associated vasculature, reconstructed from contrast-enhanced CTs. Reconstructions of the biliary system were modeled from intraoperative cholangiograms. The distribution of the donor portal veins, hepatic arteries and bile ducts was defined from the porta hepatis intrahepatically to the point of surgical division. Each step of the surgery was enhanced with 3D animation to provide sequential and seamless visualization from pre-surgical planning to outcome. Use of visualization techniques such as transparency and overlays allows viewers not only to see the operative field, but also the origin and course of segmental branches and their spatial relationships. This novel educational approach enables integrating case-based operative footage with advanced editing techniques for visualizing not only the surgical procedure, but also complex anatomy such as vascular and biliary structures. The surgical team has found this approach to be beneficial for preoperative planning and clinical teaching, especially for complex cases. Each animation-enhanced video case is posted to the open-access Toronto Video Atlas of Surgery (TVASurg), an education resource with a global clinical and patient user base. The novel educational system described in this paper enables integrating operative footage with 3D animation and cinematic editing techniques for seamless sequential organization from pre-surgical planning to outcome.

Video abstract summary Caesarean section is one of the most commonly performed surgical procedures by Obstetricians and Gynecologists. Despite this, there are no comprehensive, reliable educational videos for teaching this procedure. With the decrease in resident work hours and increased emphasis on patient safety, there is a focus on moving the initial stages of learning outside of the operating room. Curated instructional videos to teach surgical procedures are one way to accomplish this. This video is an excerpt from a full length teaching video demonstrating the key steps important for performing a primary vertex caesarean section including patient positioning, relevant anatomy, and surgical technique. The video combines real-time operating room footage with high fidelity 3-D animation. This video can be used to enhance the learning of medical trainees and other allied health professionals such as nurses or midwives.