Peter Fagenholz, MD Assistant Professor of Surgery Massachusetts General Hospital Harvard Medical School
This patient is a 58-year-old male who was in a motor vehicle accident and developed a persistent necrotic collection adjacent to the pancreatic tail that did not improve with percutaneous drainage. Here, Dr. Peter Fagenholz at MGH performs a pancreatic debridement using sinus tract endoscopy (STE), a minimally-invasive technique for debridement of dead or infected tissue.
STE and other minimally-invasive techniques have significantly decreased morbidity and mortality for patients undergoing intervention for infected pancreatic necrosis. Common management principles include early non-interventional management to allow the necrosis to wall off, initial intervention with minimally-invasive drainage, and minimally-invasive necrosectomy addressing clearly demarcated necrosis.
STE involves the placement of a percutaneous drain followed by fluoroscopically-guided dilation of the drain tract to allow for placement of a working sheath, through which an endoscope can be introduced to debride the peripancreatic necrosis. After debridement, a drain is then replaced through the same tract.
J. Corbin Norton, MD Department of Urology University of Arkansas for Medical Sciences
Stephen J. Canon, MD Department of Pediatric Urology Arkansas Children’s Hospital
Amrit Singh, MD Department of Pathology University of Arkansas for Medical Sciences / Arkansas Children’s Hospital
Laura L. Hollenbach, MD Department of Obstetrics and Gynecology University of Arkansas for Medical Sciences
Georgia Gamble, MD Department of Obstetrics and Gynecology University of Arkansas for Medical Sciences
Laura A. Gonzalez-Krellwitz, MD Department of Pathology University of Arkansas for Medical Sciences / Arkansas Children’s Hospital
The patient, in this case, is a 15-year-old female who presented with primary amenorrhea and who on work-up was found to have complete androgen insensitivity syndrome. Here, Dr. Canon at the University of Arkansas for Medical Sciences performs a prophylactic laparoscopic bilateral gonadectomy to reduce her future risk for intra-abdominal testicular malignancies. Final pathology results showed a rare case of bilateral germ cell neoplasia in situ and bilateral paratesticular leiomyomas and reinforced the decision to intervene early allowing for the removal of the gonads prior to their conversion to formal germ cell tumors.
Michael J. Weaver, MD Associate Orthopaedic Surgeon, Brigham and Women’s Hospital Assistant Professor of Orthopedic Surgery, Harvard Medical School Brigham and Women’s Hospital
The patient in this case is an 81-year-old male with dementia who sustained an unwitnessed fall that resulted in a displaced intra-articular distal femur fracture. Here, Dr. Weaver at Brigham and Women’s Hospital repairs the fracture by performing an open reduction and internal fixation with a LISS plate. An anterolateral approach was used to visualize the joint surface and obtain an anatomic reduction of the articular surface, and a percutaneously-placed lateral lock plate was used to bridge the area of comminution while restoring length, alignment, and rotation to hopefully allow for biologic fixation that permits the bone to heal well.
AV fistulas provide the crucial vascular access required for patients receiving hemodialysis, a life-saving procedure for end-stage renal disease. Such patients have irreversible kidney damage and must receive a new kidney. While waiting, patients rely on hemodialysis to filter their blood to stay alive, and AV fistulas provide the sustainable vascular access required for hemodialysis.
Surgical videos are a valuable resource in medical education – they help residents and students prepare for the operating room.
Dr. Scott Brown, the medical editor responsible for the creation of the Otolaryngology Section at JOMI, has published in OTO-Open an article “Development of a Surgical Video Atlas for Resident Education: 3-Year Experience“. In this article, Dr. Brown discusses his journey, selection of cases, filming processes and challenges, and adoption of the content by residents and students. Dr. Brown also discusses how surgical video atlases impact surgical training and the role they will play for ENT and other surgical residencies in the coming years.