PREPRINT RELEASE: Open Lobectomy

Open Lobectomy
Massachusetts General Hospital
Christopher R. Morse, M.D.
Assistant Professor of Surgery, Harvard Medical School
Co-Director, Gastroesophageal Surgery Program

An adult male with cystic fibrosis (CF) presents with a chronically damaged left upper lung lobe that Dr. Christopher Morse decides to treat with an open lobectomy given that the patient was not going to heal from antibiotic therapy and still had mild preserved pulmonary function. Two unusual things in this procedure are the dense inflammatory changes at the hilum and the use of muscle from chest wall to reinforce the bronchial closure because of the patient’s recurrent and chronic pulmonary infections due to CF.

PREPRINT RELEASE: Endolymphatic Sac Decompression

Endolymphatic Sac Decompression
Duke University Medical Center
Calhoun D. Cunningham III, MD
C. Scott Brown, MD
Department of Surgery
Division of Head and Neck Surgery & Communication Sciences

A patient with intractable Meniere’s disease presents for decompression of the endolymphatic sac. Dr. Calhoun Cunningham demonstrates the anatomical boundaries of the sac and explains his approach of stenting the sac open in order to alleviate the patient’s symptoms.

PREPRINT RELEASE: Minimally Invasive Direct Coronary Artery Bypass (MIDCAB)

Minimally Invasive Direct Coronary Artery Bypass (MIDCAB)
VA Boston Healthcare System
Marco Zenati, MD
Chief of Cardiothoracic Surgery, VA Boston Healthcare System & Professor of Surgery, Harvard Medical School

After experiencing chest pressure while exercising, a 72-year-old patient tested positive in both a stress test and nuclear medicine study, triggering a left heart catheterization that revealed a high grade lesion of the proximal left anterior descending coronary artery. His cardiologist determined the lesion would not be amenable to angioplasty or stenting, so Dr. Marco Zenati performs a minimally invasive coronary artery bypass (MIDCAB).

PREPRINT RELEASE: Cox-MAZE IV with Coronary Artery Bypass Graft (CABG) & Mitral Valve Replacement (MVR)

Cox-MAZE IV with Coronary Artery Bypass Graft and Mitral Valve Replacement
VA Boston Healthcare System
Marco Zenati, MD
Chief of Cardiothoracic Surgery, VA Boston Healthcare System & Professor of Surgery, Harvard Medical School

In this long and complicated case, Dr. Marco Zenati performs a full, biatrial Cox-MAZE IV procedure with coronary artery bypass grafting (CABG) and a mitral valve replacement (MVR), moving between the three procedures as necessary to minimize time on the ischemic heart. The patient suffers from congestive heart failure that recently escalated from class II to class III.

PREPRINT RELEASE: Distal Gastrectomy (Open)

Distal Gastrectomy (Open)
John T. Mullen, MD
Director, General Surgery Resident Program
Massachusetts General Hospital

 

An 80-year-old patient with anemia undergoes an upper endoscopy that reveals inflammation in the distal stomach. Biopsies identify it as an early intramucosal adenocarcinoma while an endoscopic ultrasound shows the tumor invading the muscle of the stomach. Given that there are no signs of metastasis, the patient presents for a potentially curative gastrectomy where Dr. John Mullen removes the distal two-thirds of the stomach, performs a D1 lymph node dissection and a partial D2 lymph node dissection, and reconstructs in a Billroth II fashion.

PUBLISHED: Posterior Cruciate-Retaining Total Knee Arthroplasty

0062Posterior Cruciate-Retaining Total Knee Arthroplasty
Richard Scott, MD
Professor of Orthopaedic Surgery, Emeritus
Harvard Medical School

Abstract: Total knee arthroplasty has evolved into a very successful procedure to relieve pain and restore function in the arthritic knee with advanced structural damage. Optimal results are dependent on the restoration of alignment and ligament stability. Operative techniques involve either preservation of the posterior cruciate ligament or substitution of its function through increased prosthetic constraint. The vast majority of knees do not require cruciate substitution to establish appropriate stability and function. This video outlines the operative technique used by the author for posterior cruciate-retaining total knee arthroplasty in a patient with a preoperative varus deformity.

PREPRINT RELEASE: Laser Stapedotomy for Otosclerosis

Laser Stapedotomy for Otosclerosis
Duke University Medical Center
Calhoun D. Cunningham III, MD
C. Scott Brown, MD
Department of Surgery
Division of Head and Neck Surgery & Communication Sciences

In a staple surgery for conductive hearing loss, Dr. Calhoun Cunningham III performs a laser stapedotomy and prosthesis placement via transcanal approach. A thickened footplate does not preclude its success in alleviating the patient's longstanding hearing loss.

PREPRINT RELEASE: Wedge Resection of the Lung and Thymectomy by Thoracoscopy

Wedge Resection of the Lung and Thymectomy by Thoracoscopy
Massachusetts General Hospital
Henning A. Gaissert, MD
Lucia Madariaga, MD

Visiting Surgeon, MGH & Associate Professor of Surgery, Harvard Medical School
Fellow in Thoracic Surgery, MGH

A patient with myasthenia gravis undergoes a procedure meant to originally be a lobectomy and thymectomy. Henning Gaissert, MD decides to do a lobe wedge resection instead given the tumor’s positioning and carcinoid nature before proceeding with the thymectomy. Please note that the patient had to return to the OR the following day due to bleeding near the internal mammary vein. 

PREPRINT RELEASE: Middle Fossa Approach to Repair Cerebrospinal Fluid Leak

Middle Fossa Approach to Repair Cerebrospinal Fluid Leak
Duke University Medical Center
Calhoun D. Cunningham III, MD
C. Scott Brown, MD
Department of Surgery
Division of Head and Neck Surgery & Communication Sciences

Dr. Calhoun Cunningham III performs a repair of a cerebrospinal fluid leak into the mastoid cavity by way of a middle fossa craniotomy. His novel use of bone and fascia grafts allows for autologous closure. 

PREPRINT RELEASE: Laparoscopic Adrenalectomy

Laparoscopic Adrenalectomy
Massachusetts General Hospital
Richard Hodin, M.D.
Professor of Surgery, Harvard Medical School

After visiting an endocrinologist who diagnosed her with aldosteronism, the patient takes a CT scan that reveals a 8mm nodule in the left adrenal gland. Dr. Hodin performs a laparoscopic adrenalectomy to remove it.