Dissection Series: Margaret (10 HR/CE)

Welcome

Orientation: Through recording of a video livestream, students will be introduced to the lab environment. They will learn appropriate lab safety protocols, what to expect, attitudes for success, and be introduced to faculty.

• Course Overview 
• Syllabus
• PDF: Course Quiz to use as a study guide
• Continuing Education Credits
• Required Participant Agreement

Dissection Sessions

• Text: Overview of Sessions
• Video: Welcome to the Lab! Orientation (58:00)
• 1:45: Acknowledgement and identification of Livestream team members
• 3:11 Impact of the lab environment and recommendations for self-care while viewing
• 6:15 Accelerated nature of the livestream viewing experience
• 7:10 About the lab at The Institute for Anatomical Research
• 11:16 Gil’s current project (Anatomy A to Z)
• 13:50 Development of Livestream class
• 14:40 Fixed vs. unfixed forms
• 18:06 Portions of lab being included and excluded in Livestream
• 21:00 Integral anatomy vs. regional anatomy
• 23:00 Tour of the lab space
• 23:52 Teachers/donors and donor families
• 27:52 Continuation of tour
• 30:31 Q&A from live participants
• 30:31 Recordings of live sessions
• 32:52 Programs at The Institute for Anatomical Research
• 34:57 Direct donation process at The Institute for Anatomical Research
• 37:08 Local willed body donation programs
• 37:52 Donating a body directly to Gil
• 39:19 What information is known about the donors
• 40:10 What Gil is looking for in a dissection
• 41:36 Communication with donor families about dissection
• 42:46 Recommended reading for course
• 45:26 Gil’s mission to de-problematize the human body
• 47:56 Suggested viewing to ease into course material
• 50:11 Further online education from Gil in development
• 52:45 Where to look for links related to this course
• 53:50 What else happens in the lab when the livestream ends
• 55:54 How livestream participants can submit questions

Video: Day 1 -  Introduction to the Donor Form and Skin Layer (1:02:00)

Day 1: Through recording of a video livestream, students will be introduced to the donor forms and survey the organ of the skin. Through dissection and discussion, students will learn to assess thickness, relationships, and function.

• 00:06 Note that video quality will improve at 6 minutes in
• 00:12 Requirement to prohibit from screenshots or screen recording
• 1:00 Gil welcomes the livestream participants to what’s happening in person
• 1:43 Circle of appreciation
• 8:39 This lab dissection as a “viewing” for the donor
• 9:34 Pause for technical adjustment in lab
• 11:04 Acknowledgement of online team helping make livestream happen
• 11:50 “Viewing” for the donor (cont.)
• 13:44 Uncovering the donor for the first time
• 15:26 Encountering mortality in the lab
• 16:16 Lab team touching the donor for the first time
• 16:40 Review of fixed vs. unfixed tissue
• 17:19 Initial observations 
• 24:39 Considering contributing factors to the observations we make
• 27:05 Donor form as a “model”
• 29:20 Dissection progression stages
• 30:05 Naming the donor: Margaret
• 31:17 How to handle a scalpel and hemostat
• 39:50 Differentiation of the Skin
• 52:57 Observation of different textural layers on abdomen
• 55:22 Quality of skin of unfixed form
• 57:52 Feeling the quality of connection in order to embody our own connections
• 58:59 Closing for Day 1

Video: Day 2 - Superficial Fascia Tour (1:01:00)

Day 2: Through recording of a video livestream, students will be introduced to the superficial fascia layer of the body. Through dissection and discussion, students will learn to assess thickness, relationships, movement properties, and function.

• 00:06 Note that video quality will improve at 3 minutes in
• 00:10 requirement to prohibit from screenshots or screen recording
• 2:11 Overview of what has happened since yesterday’s livestream session
• 5:00 Reveal of Margaret’s superficial fascia layer
• 6:35 Addressing whether Margaret has lipedema
• 8:19 How Gil defines superficial fascia
• 9:02 Variability of superficial fascia in its structure
• 10:36 Differentiating between “lobules” and fat cells
• 12:15 Superficial fascia as endocrine organ
• 13:36 Superficial fascia as lymphoid organ
• 15:47 Superficial fascia as sensual, sensory organ
• 18:33 Superficial fascia as a whole body layer
• 18:59 Reiterations of adipose tissue at layers deeper in the body
• 21:08 Adipose as resonant communication system throughout the body
• 23:37 Adipose as resource for survival
• 24:47 Depth and distribution of superficial fascia on Margaret
• 26:04 Backlit skin layer revealing patterned impressions of superficial fascia
• 28:01 Demonstration of stretching of skin layer
• 29:19 Circular pattern of dermis facilitating ability of skin to stretch
• 30:25 Elasticity of skin as result of the weave of the collagen matrix in the dermis
• 32:33 Description of the process of differentiating the skin from superficial fascia 
• 35:17 Superficial fascia as a force conductor 
• 37:17 Superficial fascia dissected as a continuous fabric
• 38:54 Multiple layers within superficial fascia
• 40:15 Breast tissue as specialized tissue within the superficial fascia
• 41:52 Contractility of superficial fascia
• 43:04 Superficial fascia as an organ
• 44:26 Dissecting/differentiating the superficial fascia from the deep fascia of the anterior torso/abdomen
• 57:34 Backlit superficial fascia layer
• 58:30 Closing for Day 2

Video: Day 3 - Perifascia, Deep Fascia, and Muscle Differentiation (1:01:00)

Day 3: Through recording of a video livestream, students will be introduced to the deep fascia layer and perifascial membranes that facilitate differential movement. Students will be introduced to the muscle layer of the body, as well as to assess the quality of relationship that the muscle tissue may have to its surrounding tissues.

• 00:05 requirement to prohibit from screenshots or screen recording
• 00:30 Expression of gratitude for Livestream crew, participants, and team members
• 2:30 Reveal of Margaret’s superficial fascia (ex situ) side by side with deep fascia layer (in situ)
• 4:35 Personal preference and aversion for particular body layers over others
• 6:49 “Where’s the blood?”
• 7:18 Varying relationships between the superficial fascia and deep fascia
• 10:08 Note on filming of the Livestream dissection and video quality
• 11:45 Observation of Margaret’s deep fascia layer
• 14:07 Dissection of perifascia membranes from the deep fascia layer
• 19:07 Fibrous arrangement in perifascia within the membrane allowing for differential movement
• 22:11 Perifascia aka membrane system, filmy fascia, loose areolar connective tissue
• 22:48 Perifascia on anterior thigh
• 24:25 Bilateral herniations presenting at inguinal canals
• 25:45 Explanation of inguinal rings in the abdominal wall
• 28:15 Demonstration of inguinal lymph nodes
• 30:14 Tying off of the great saphenous vein
• 30:52 Further observations of deep fascia/fascia lata on thigh
• 35:24 Difference in texture of tissue layers
• 37:58 Ability to change our  tissue tone in vivo
• 38:57 Muscle layer as a continuous functional unit
• 39:35 Functionality of the motor unit
• 40:38 Named muscles are conceptual, not functional units themselves
• 41:37 Muscle layer, perifascia, and deep fascia of upper arm
• 42:53 Muscle “fluffing” as blunt differentiation of muscle tissue within the muscle layer
• 43:16 Integral anatomy definitions of muscle attachments 
• 45:28 Neurovascular bundles deep to biceps brachii
• 50:49 Muscle layer of thigh
• 57:14 Differentiation of sartorius
• 59:14 Closing for Day 3

Video: Day 4 - Abdominal Viscera (In Situ) (1:29:00)

Day 4: Through recording of a video livestream and a dissection demonstration, students will learn about the general positioning and relationship of the abdominal organs to each other, including functional relationships as well as dysfunctional presentations (adhesions). In-situ.

• 00:05 Requirement to prohibit from screenshots or screen recording
• 00:20 Gratitude for Livestream crew
• 1:10 Update on current state of dissection after Day 3 livestream
• 1:45 Reveal of Margaret’s posterior muscle layer in situ
• 2:50 Trapezius asymmetry, variations as typical
• 3:54 Latissimus dorsi
• 4:18 Cleaning up the latissimus dorsi tendon
• 8:12 Gluteus maximus, gluteus medius, iliac crest in situ
• 9:25 Reflection of gluteus maximus 
• 10:08 Sacrotuberous ligament
• 11:08 Sciatic nerve
• 12:01 Bifurcation of sciatic nerve around piriformis
• 13:26 Variations of sciatic nerve in relation to piriformis
• 15:03 Branching of sciatic nerve at posterior knee
• 15:07 Common fibular nerve
• 15:45 Tibial nerve
• 16:15 Hamstrings
• 16:46 Sits bones/ischial tuberosities
• 17:06 Common head of semitendinosus and long head of biceps femoris
• 18:35 Semimembranosus dissection
• 20:27 Reflection of trapezius to reveal rhomboids and levator scapulae, bottom of splenius capitis
• 23:23 Introduction to the viscera
• 23:32 What are viscera?
• 26:03 Reveal of Margaret’s anterior muscle layer
• 26:54 Reflection of anterior rectus sheath/tendon of external oblique
• 27:28 Rectus abdominis and pyramidalis
• 30:48 Reflection of rectus abdominis
• 31:01 arcuate line
• 31:50 Dissection of transversalis fascia
• 34:04 Differentiation of transversalis fascia and peritoneum
• 37:08 Further reflection of rectus abdominus to reveal posterior rectus sheath and fibers of transversus abdominis
• 40:32 Dissecting the posterior rectus sheath and peritoneum to enter the abdominal cavity
• 42:41 Abdominal Viscera
• 42:48 Round ligament of the liver
• 44:10 Surface presentations: Greater omentum, large intestine, liver
• 45:36 Greater omentum as a lymphoid organ
• 47:03 adhesion of greater omentum to colon
• 48:20 adhesion of greater omentum to cecum
• 49:24 Stomach
• 50:20 Transverse colon
• 50:56 Transverse mesocolon
• 51:40 Small intestine
• 54:14 Mesocolon
• 54:35 Descending colon and epiploic appendages
• 55:34 Ascending colon
• 55:53 Gathering small intestines into bouquet
• 56:47 Backlighting the mesentery
• 59:24 Small intestine and enteric nervous system
• 1:02:07 Pelvic bowl and sigmoid colon
• 1:02:32 Uterus
• 1:04:02 Ovaries
• 1:04:45 Explanation of how ovary is an abdominal organ and the uterus is a pelvic organ
• 1:05:40 Uterine tube
• 1:06:44 Round ligament and salpingo ligament 
• 1:07:13 Second ovary
• 1:08:09 Round ligament
• 1:08:58 Uterine fibroid 
• 1:09:42 Rectum, sigmoid and descending colon
• 1:10:22 Spleen
• 1:11:07 Splenic flexure and transverse colon
• 1:12:13 Hepatic flexure, liver and ascending colon
• 1:13:35 Cecum
• 1:15:40 “Running the bowel”: following the length of the small intestine
• 1:16:53 Duodenal jejunal junction
• 1:18:16 Stomach and lesser omentum
• 1:21:21 Lesser omental bursa
• 1:22:21 Pancreas
• 1:23:17 Left lobe of the liver, triangular ligament
• 1:24:15 Falciform ligament
• 1:24:56 Right lobe of the liver
• 1:25:11 Gallbladder
• 1:26:04 gallstones 
• 1:28:00 Closing for Day 4

Video: Day 5  -Thoracic Viscera (In Situ) (1:24:00)

Day 5: Through recording of a video livestream and a dissection demonstration, students will learn about the general positioning and relationship of the thoracic viscera to each other, including their membranous connections. In-situ.

• 00:05 Requirement to prohibit from screenshots or screen recording
• 00:44 Welcome to Day 5, reflection on Day 4
• 3:30 Brief revisit of abdominal viscera, root of the mesentery
• 9:36 Why donor’s face is covered
• 10:01 Thyroid gland, goiter
• 11:54 Broken ribs from chest compressions
• 12:34 Rib Cage anatomy: costal cartilage, sternum, ribs, costochondral joints, intercostals
• 14:13 Dissecting the intercostals
• 25:17 Thyroid cartilage, cricoid cartilage, cricothyroid ligament
• 26:05 Cutting cricothyroid ligament to insert artificial airway
• 27:36 Artificial inflation of lungs in situ
• 30:13 Reflecting the clavicles by opening the sternoclavicular joint
• 34:22 Reflecting the right rib cage where the ribs are already broken
• 36:33 Cutting parietal pleura to reveal right lung
• 38:21 Small section of rib cage with 4 ribs ex situ
• 39:02 View of right lung in situ, ribs reflected
• 40:55 Relationship of pleura layers with heart, lungs, and mediastinum
• 42:50 Artificial inflation of right lung without constraint of ribcage or parietal pleura
• 44:18 Differential movement between parietal pleura and lungs
• 46:06 Entering the mediastinum
• 47:30 Reflecting the left rib cage
• 52:25 Surface presentation of lungs in situ, anterior ribcage removed
• 54:16 Relationship between heart and lungs
• 55:35 Mediastinum
• 59:31 Diaphragm, covered in parietal pleura
• 1:02:07 Pressure differential between abdominal cavity and thoracic cavity and contributing to levity of abdominal organs
• 1:06:03 The visceral space of the heart 
• 1:07:06 The heart center
• 1:08:24 Movement of the heart within the pericardial sac
• 1:09:44 Opening the pericardium
• 1:12:20 Holding the heart center
• 1:13:51 The heart as the place where the blood refreshes its movement
• 1:16:33 Allowing other lab participants to hold Margaret’s heart
• 1:21:15 Beauty and power of seeing ourselves reflected in the study of integral anatomy
•  

Video: Day 6 - Points of Interest (1:33:00)

Day 6: Through recording of a video livestream and a dissection demonstration, students will move into a deeper understanding of anatomical points of interest, including examining the kidneys, heart, psoas, and diaphragm.

• 00:05 Requirement to prohibit from screenshots or screen recording
• 00:40 Invitation to be fully present for the experience of the livestream
• 1:32 Update on the state Margaret’s form since the last livestream
• 2:34 View of anterior form, having been eviscerated
• 2:58 Diaphragm still intact, in situ
• 3:40 Inferior vena cava, abdominal aorta, left renal vein
• 4:32 Subserosal fascia/adipose capsule around kidneys, peritoneum, psoas
• 6:32 Blunt dissection of subserosal fascia to reveal left kidney
• 8:38 Common variations in kidney presentations
• 10:18 Renal artery, renal vein
• 11:15 Relationship between kidney, ovary, ovarian vein, and psoas
• 12:33 Dissection of right kidney
• 15:36 Psoas Major
• 26:45 Thoracic cavity and mediastinum
• 34:06 Abdominal aorta
• 42:37 Evidence of knee replacement
• 45:50 Transition to looking at Marget’s viscera ex situ
• 47:19 Viscera ex situ
• 1:29:25 Closing of Day 6 and of livestream lab

Post Course Quiz & Survey

• 60 min: Quiz Completion
• Course Survey

References, FAQ’s, etc.

• Frequently Asked Questions
• Shared Resources
• Gil’s Answer to Questions from Live Viewers