Dissection Series: Jerry (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: Orientation: Welcome to the Lab! Lab Orientation (45:11)
  • 00:16 Reminder to prohibit from screenshots or screen recording
  • 00:40 Gil’s welcome outside the doors of the Institute for Anatomical Research, part 1
  • 1:20 Livestream tech team with tips and tricks for livestream participants to navigate the course as smoothly as possible
  • 7:23 Gil’s welcome, part 2
  • 8:00 Acknowledgement of the Institute and Bonnie Thompson
  • 9:14 Entering the lab space
  • 10:10 The unique gift of this particular lab
  • 12:02 Introduction of Jim Pulciani, Executive Director and Kelly, treasurer and Director of Operation at the Institute for Anatomical Research, and Kelly 
  • 14:48 A poem from Gil
  • 17:28 Dissection as a process of self-exposure
  • 20:15 An invitation to be fully present
  • 21:39 Where do the donor forms come from?
  • 23:56 Appreciation for donors
  • 25:25 Fixed vs. unfixed forms in dissection
  • 27:48 Physical tour of the lab space
  • 29:10 “Teachers’ Lounge”
  • 34:35 Thank you and acknowledgement of Rachel and Madhav
  • 35:19 A note about cameras for the livestream
  • 39:45 What to expect for Day 1
  • 40:38 An invitation to share your viewing experience with reverence  and appreciation 
  • 42:26 Thank you for being here

Video: Day 1- Donor acknowledgement and skin overview (1:02:08)

Day 1: 60 min: Through 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.

• 00:16 Reminder to prohibit from screenshots or screen recording 
• 00:38 Welcome to Day 1
• 2:01 Circle of appreciation and preparing to meet our donor
• 7:09 Appreciation for donor’s family
• 9:10 Acknowledgement of participants’ families and community
• 10:08 Acknowledgement of unseen helpers
• 12:10 Body and donor form as a book to be read 
• 13:46 Uncovering our donor for the first time
• 14:25 Human form vs. “person”
• 15:17 Anonymity of donor
• 15:40 The dissection progression: observe, palpate, differentiate, reflect, remove
• 17:10 Initial observations of donor by participants
• 17:26 Reasons for bruising
• 19:00 Wrinkles of skin as artifact of embalming
• 20:54 Stitching from embalming incision
• 23:15 What is anatomy vs.what is an artifact of death/embalming/time?
• 26:00 Which layer is presenting in a given form?
• 27:38 External rotation of lower extremities
• 29:28 Scar at midline on chest
• 30:50 Absence of scar of circumcision (i.e. foreskin is intact)
• 33:32 Absence of coloration from viscera on abdomen
• 35:10 How long ago has death occurred?
• 36:33 General morphology of this form
• 38:17 Acknowledgement of vulnerability of donor
• 40:05 Making the first incision on the skin layer
• 40:47 Starting at the middle and high point
• 41:25 Palpating before making an incision
• 42:00 Creating the skin as a textural layer
• 44:15 First incision on the midline of the abdomen
• 47:01 Using the scalpel and hemostat to differentiating the skin from the superficial fascia
• 48:23 Explaining the difference between epidermis, dermis, and hypodermis
• 50:13 Perceiving the continuity of the tissues through the act of differentiation
• 52:33 Circular pattern of the connective tissue, collagen fiber matrix on the deep side of the dermis
• 55:58 Illusion of a planar surface created with the scalpel
• 56:30 Relationship of the dermal patterning to the lobular surface of the superficial fascia
• 59:33 Closing for Day 1, “homework” before Day 2 

Video: Day 2 - Superficial Fascia, Perifascia, and Male Genitalia Overview – (1:30:00)

Day 2: 90 min: Through 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. Students will be introduced to the male “pars intima” to learn about its function and the impact of circumcision.

• 00:16 Reminder to prohibit from screenshots or screen recording
• 00:32 Welcome for Day 2 and recap for what has happened in lab since the last livestream
• 02:12 Reveal of Jerry’ superficial fascia in situ
• 3:26 Acknowledging the relationship of the superficial fascia layer to the skin
• 5:55 The pars intima
• 6:02 Defining the term “intact” as related to pars intima
• 7:34 Function of the foreskin
• 11:03 Mons pubis
• 12:12 The foreskin’s role in facilitating movement of the shaft of the penis when erect
• 15:16  Dissection of the foreskin to reveal the shaft of the penis
• 17:28 Foreskin is adherent in a newborn, and differentiates from the shaft naturally with developmental maturation
• 20:51 Circumcision--history and difference between traditional Jewish circumcision and modern American medical circumcision
• 29:10 The myth of circumcision serving a hygienic purpose
• 32:00 De-adhering the foreskin from the glans in circumcision 
• 35:35 Impact of routine infant circumcision on culture
• 39:06 Foreskin restoration
• 44:06 Intersex bodies
• 46:55 Superficial fascia
• 47:20 Varying nomenclature for this layer
• 49:07 Superficial fascia as a metabolic resource
• 50:15 Superficial fascia as an endocrine organ
• 53:35 Contractile property of superficial fascia
• 54:25 Superficial fascia as a lymphoid organ
• 55:27 Superficial fascia as a sensory organ
• 56:06 Health is possible at any size body
• 58:56 Superficial fascia as an organ of resonance
• 1:00:28 Differentiating the superficial fascia from the deep fascia
• 1:00:57 Palpation of the superficial fascia
• 1:01:28 Differential movement within the superficial fascia layer
• 1:02:44 A word about the dartos muscle
• 1:04:34  Making an incision at the midline of the lower abdomen
• 1:05:17 Lobules are not fat cells 
• 1:08:05 Fibrous nature of the superficial fascia in depth
• 1:09:26 Creating the “fleece”
• 1:11:00 First view of perifascia on the deep side of the superficial fascia
• 1:12:19 Strength of superficial fascia
• 1:15:43 Liposuction
• 1:19:45 Breast implants
• 1:24:47 Bruising in the superficial fascia
• 1:25:57 Manual tools that increase inflammation to decrease the appearance of cellulite
• 1:25:55 Transparency of the skin to reveal the texture of underlying layers
• 1:29:01 Closing for Day 2

Video: Day 3 - Overview of Muscles; anterior muscle overview, gluteal dissection (1:15:18)

Day 3: 75 min: Through 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. Students will explore the anterior muscle layer of the body, then dive deeper into a dissection exploration of the lateral hip and deep six rotators.

• 00:16 Reminder to prohibit from screenshots or screen recording 
• 00:33 Welcome to Day 3, update on what has happened since the last livestream
• 1:33 Reveal of Jerry’s muscle layer, anterior view
• 2:30 Fascia lata
• 4:10 Different fiber directions of fascia lata serving different purposes
• 5:43 Anterior rectus sheath, removed on life and  intact on right
• 6:25 As shared tendon of external oblique and internal oblique Video: 
• 7:43 Rectus abdominis
  • 10:40 Tendinous attachment
  • 10:49 Visceral attachment
  • 11:23 Perifascial attachment
  • 12:02 Muscle attaching directly to bone
• 9:32 Attachment of muscle tissue to other surrounding tissues
• 14:38 Posterior rectus sheath
• 15:00 Example of perifascia
• 15:58 As deeper layer of internal oblique and tendon of transversus abdominis
• 16:40 Better example of perifascia
• 17:30 Arcuate line
• 18:01 Transversalis fascia
• 19:03 Pacemaker on chest encapsulated in fascia
• 20:45 Evidence of open heart surgery
• 21:17 Wires at sternum
• 23:11 Testicle, spermatic cord, inguinal lymph nodes
• 24:06 Penis
• 25:47 Muscles of lower extremities
• 26:23 Sartorius
• 26:52 Gracilis and tendon of semitendinosus
• 27:52 Gastrocnemius, plantaris tendon, and soleus
• 28:31 Achilles tendon
• 29:31 Muscles of upper extremities
  • 29:54 Perifascia between long and short head of biceps
• 29:44 Biceps brachii
• 31:45 Perifacsia between tendons of forearm
• 34:09 Historical nomenclature for what Gil calls perifascia
• 35:49 Jerry’s muscle layer, posterior view
• 36:36 Lumbodorsal fascia
• 37:20 Differing fiber directions of lumbodorsal fascia
• 37:08 Trapezius
• 38:35 Gluteus maximus
• 38:52 Superior border near gluteus medius
• 39:32 Change of contours of muscle presentation with removal of superficial fascia
• 40:29 Attachment of gluteus maximus at sacrum
• 40:44 Adipose deposition between fasciculi of gluteus maximus
• 41:50 Attachment of gluteus maximus into fascia lata 
• 42:36 Gluteal fold fibrous attachment to ischium
• 47:35 Inferior border of gluteus maximus
• 48:35 Superior border of gluteus maximus
• 49:46 Differentiating gluteus maximus from the sacrum
• 51:00 Superior gluteal artery, vein, and nerve
• 53:30 Sacrotuberous ligament
• 54:54 Reflecting the gluteus maximus
• 56:36 Gluteus medius
• 58:30 Piriformis
• 1:00:12 Differentiation of sciatic nerve
• 1:03:11 Differentiation of quadratus femoris
• 1:06:47 Differentiation of gemelli inferior, gemelli superior, and tendon of obturator internus
• 1:11:11 Where is the obturator externus?
• 1:12:58 Shared tendinous insertion of long head of biceps femoris and semitendinosus
• 1:14:19 Closing for Day 3

Video: Day 4 - Abdominal Viscera Tour (in situ)  (1:15:00)

Day 4: 90 min: Through 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.

• 00:16 Reminder to prohibit from screenshots or screen recording 
• 00:28 Welcome to Day 4, Introduction to the viscera
• 3:04 Correction from yesterday about anatomy of superior gluteal nerve
• 3:45 Evidence of chest compressions
• 4:27 Continuation of abdominal muscle dissection that began in Day 3
• 7:29 External oblique tendon relationship with spermatic cord 
• 9:27 Inguinal ligament
• 12:30 Perifascia over internal obliques
• 16:42 Differentiation and reflection of internal oblique 
• 19:26 Transversus abdominis
• 20:33 Differentiation and reflection of rectus sheath 
• 22:31 Relationship between rectus sheath and rectus abdominis
• 23:26 Arcuate line
• 24:38 Differentiation and reflection of peritoneum and transversalis fascia
• 27:08 Umbilical ligaments
• 27:52 Round ligament of the liver
• 30:16 Abdominal viscera in situ
• 30:16 Surface presentation
• 30:44 Small intestine and mesentery
• 31:18 Absence of greater omentum at surface
• 32:02 Stomach
• 32:23 Liver
• 32:50 Falciform ligament
• 33:28 Gallbladder
• 34:49 Looking for the greater omentum
• 36:54 Adherence to the descending colon
• 37:25 Epiploic appendages
• 39:29 Surprise! What Gil thought was the stomach is actually the transverse colon
• 42:43 Gathering the loops of the small intestine
• 43:29 Explanation of the enteric nervous system
• 46:26 Mesentery
• 47:50 Root of the mesentery
• 48:44 Absence of perifascia in the gut 
• 48:57 Peritoneum and serous fluid provides differential movement instead
• 50:07 “Fuzz” between abdominal viscera as pathology
• 51:19 Mesocolon 
• 51:51 Descending colon and epiploic appendages
• 53:41 Pressure differentials in the body contributing to levity of viscera
• 57:00 Cecum and ascending colon 
• 57:56 Appendix
• 59:27 Ileocecal valve
• 1:01:28 Liver
• 1:02:01 Bladder
• 1:03:01 Rectum
• 1:04:10 Sigmoid colon, descending colon
• 1:05:13 Spleen
• 1:05:59 Splenic flexure to transverse colon
• 1:06:38 Where’s the ascending colon?
• 1:08:42 Vermiform appendix
• 1:09:08 Following the length of the small intestine
• 1:10:20 Small intestine dives retroperitoneal as the duodenum
• 1:11:45 Pylorus of stomach
• 1:12:46 Plans for Day 5 to eviscerate abdominal viscera during livestream
• 1:13:36 Closing for Day 4

Video: Day 5 - Thoracic viscera overview and abdominal evisceration (1:37:00)

Day 5: 100 min: Through 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.

• 00:16 Reminder to prohibit from screenshots or screen recording 
• 00:26 Welcome to Day 5
• 1:27 Recounting the off-camera process the previous day to expose the thoracic viscera
• 3:00 Removal of breast plate and viewing of posterior aspect of anterior rib cage
• 3:12 Wire from open heart surgery
• 3:32 Parietal pleura and endothoracic fascia
• 4:47 Xiphoid process
• 5:13 Mammary artery/internal thoracic artery
• 6:30 Thoracic viscera
• 6:40 Surface presentation of lungs, heart, and mediastinum
• 8:18 Remnant lobules of the thymus
• 9:45 Evidence of coronary bypass
• 11:04 Palpating the coronary artery and evidence of calcification
• 12:35 Is it possible to heal heart disease?
• 15:08 Fibrous pericardium, parietal pericardium, and visceral pericardium disrupted in open heart surgery
• 16:54 The natural movement and autorhythmicity of the heart
• 20:43 How the tissues of the heart are attended to in open heart surgery
• 23:12 A second bypass vessel
• 25:15 Identifying the chambers of the heart and major vessels
• 26:25 Presence of adipose around the heart and other viscera
• 28:45 Revealing the aortic arch
• 29:30 Wire leading to right atrium from pacemaker
• 31:36 Rifling within the aorta serving to spin the blood
• 32:40 Vortex of the blood as related to carrying capacity of blood
• 36:45 Dissection of second bypass 
• 38:42 More about the construction and function of a pacemaker
• 40:24 Diaphragmatic relationship with the pericardium and heart
• 42:59 Inferior vena cava 
• 44:30 Heart’s relationship with the liver
• 45:17 The heart as the primary oscillator for the waves and rhythms of the body
• 46:26 Heart-brain coherence
• 47:47 The ability of the heart to sense and receive signals from the environment
• 50:17 Abdominal evisceration
• 50:28 Continuity of abdominal wall and transversus abdominis with diaphragm
• 51:44 Cutting the round ligament and falciform ligament to expose the liver
• 54:30 Reflecting the remainder of the abdominal wall
• 55:37 Eviscerating the abdominal organs
• 57:16 Cutting the rectum
• 59:30 Freeing the colon from its peritoneal attachments to the abdominal cavity
• 1:00:37 Spleen
• 1:01:10 Splenogastric ligament
• 1:04:54 Freeing the cecum
• 1:05:36 Mesentery and mesocolon
• 1:06:11 Freeing the root of the mesentery
• 1:07:36 Left triangular ligament and coronary ligament of the liver
• 1:08:32 Nature of ligaments in the viscera vs. ligaments in the musculoskeletal system
• 1:09:31 Freeing the liver at its ligaments
• 1:11:36 Lesser omental bursa
• 1:12:30 Dissection of portal vein, common bile duct, and hepatic artery
• 1:14:44 Freeing the liver from the inferior vena cava
• 1:17:47 Stomach
• 1:18:15 Hiatal hernias and heartburn
• 1:20:13 The vagus nerve
• 1:22:55 Cutting the lower esophagus
• 1:23:33 Viewing the duodenum and head of the pancreas
• 1:24:34 Cutting the inferior mesenteric artery
• 1:25:31 The solar plexus and the final vascular root to be cut to complete evisceration
• 1:29:44 Abdominal viscera ex situ
• 1:30:46 Abdominal space sans abdominal viscera
• 1:32:35 Crux of diaphragm, inferior vena cava, left renal vein
• 1:33:09 Celiac trunk, superior mesenteric artery, and celiac plexus
• 1:34:37 Backlit diaphragm
• 1:36:17 Closing for Day 5

Video: Day 6 - Central Nervous System – ex-situ (1:39:00)

Day 6: 100 min: Through livestream and a dissection demonstration, students will move into a deeper understanding of the central nervous system, including the structure of the brain as well as the spinal cord.

• 00:16 Reminder to prohibit from screenshots or screen recording 
• 00:26 Welcome to Day 6
• 1:15 Entering the cranium
• 1:50 What has been done so far
• 2:15 Speaking about the meninges, the fascia deep to the skull and surrounding the brain
• 3:00 Removing the top portion of the skull and viewing the deep side
• 4:30 Evidence of arachnoid granulations
• 6:12 Periosteal layer of the dura
• 6:42 Meningeal layer of the dura
• 8:18 Opening the sagittal sinus
• 10:21 Arachnoid layer
• 11:58 Subarachnoid space, and differentiating the arachnoid from the pia
• 13:50 Pia mater
• 14:36 Arachnoid trabeculae
• 15:34 Continued removal of arachnoid from pia
• 17:03 Gyri and sulci
• 17:46 Visual similarity to small intestines
• 19:40 Exposure of falx cerebri
• 21:52 Side-by-side comparison of meningeal layers
• 23:14 Exposure of the corpus callosum
• 24:36 Removing the falx
• 25:32 History of hierarchical importance of the human brain in physiology and medical science
• 29:29 Gil’s communitarian perspective on physiology
• 30:49 Relationship of the heart, the gut brain, and the brain in the cranium
• 32:16 A word about the brains of cetaceans
• 33:55 Lifting the brain out of the cranium
• 34:40 Remnant of falx
• 35:01 Olfactory bulbs
• 37:03 Optic chiasma (cranial nerve II)
• 39:20 Cerebral cortex ex situ
• 39:46 Falx in situ, tentorium cerebelli
• 40:08 Olfactory tract
• 40:35 Remainder of optic chiasma
• 40:43 Mammillary bodies
• 42:53 Tentorium cerebelli
• 46:43 Internal carotid artery
• 47:58 Blood-brain barrier
• 49:52 Oculomotor nerve (cranial nerve III)
• 50:54 Basilar artery
• 52:42 Removing the tentorium to expose the cerebellum
• 54:11 Vermes of the cerebellum
• 55:23 Cerebellum as center of coordinated movement (and probably more)
• 59:46 Trigeminal nerve (cranial nerve V)
• 1:01:19 Abducens nerve (cranial nerve VI)
• 1:02:15 Basilar artery and vertebral arteries
• 1:02:43 Facial nerve (cranial nerve
•  VII)
• 1:02:59 Vestibulocochlear nerve (cranial nerve VIII)
• 1:03:45 Glossopharyngeal nerve (cranial nerve IX)
• 1:04:05 Vagus nerve (cranial nerve X)
• 1:05:03 Accessory nerve (cranial nerve XI)
• 1:06:40 Hypoglossal nerve (cranial nerve XII)
• 1:07:19 Cerebellum/hindbrain ex situ
• 1:07:52 Whole brain ex situ
• 1:11:20 Spinal cord in situ
• 1:12:09 C1 and C2 still intact
• 1:13:28 Movement between C1 and C2
• 1:14:00 Removal of the dura of the spinal cord
• 1:15:24 Arachnoid and pia of the spinal cord visible
• 1:18:18 Cauda equina
• 1:19:01 Dorsal nerve roots
• 1:21:19 Cauda equina, connection to sciatic nerve
• 1:22:55 Filum terminale of the pia
• 1:24:25 Denticulate ligament
• 1:25:46 Removal of the spinal cord
• 1:28:10 Spinal cord with brain ex situ
• 1:29:11 Dividing the cerebellum
• 1:29:30 Pons, fourth ventricle, aqueduct of silvi
• 1:30:26 Dividing the cerebral cortex
• 1:30:38 Choroid plexus, cross section of corpus callosum, interthalamic adhesion
• 1:32:05 Septum pellucidum
• 1:33:05 Pineal gland
• 1:34:49 Position of pituitary relative to pineal gland
• 1:37:20 Closing for Day 6 and for the Livestream

Post Course Quiz & Survey

• 60 min: Quiz Completion
• Course Survey

References, FAQ’s, etc.

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