With improvement in both preoperative parathyroid tumor identification and the use of intraoperative parathyroid hormone assay, minimally invasive parathyroidectomy (MIP) is now performed more frequently in patients with primary hyperparathyroidism (pHPT). Still, many institutions are not familiar with performing MIP under regional or local anesthesia. Here, Dr. Tobias Carling presents an MIP performed under local cervical block anesthesia on a patient with pHPT and parathryoid adenoma.
1Duke University Medical Center 2College of Osteopathic Medicine, Touro University California
In this case, a patient with a symptomatic Zenker’s diverticulum is treated with an endoscopic staple-assisted diverticulotomy. The clinical presentation, diagnostic criteria, surgical procedure, and postoperative care are highlighted.
Naomi Sell, MD, MHS Massachusetts General Hospital
Denise W. Gee, MD Operating Surgeon, MGH
The patient in this case is a 32-year-old female with recurrent episodes of biliary colic. An ultrasound revealed numerous gallstones within the gallbladder. Because the patient has had recurrent symptoms for the past six months, surgical removal of her gallbladder was the best option to relieve her recurrent pain and prevent future development of acute cholecystitis. Here, Dr. Denise Gee at Massachusetts General Hospital performs a laparoscopic cholecystectomy to remove the patient’s gallbladder.
M. Grant Liska, BS University of Central Florida College of Medicine
Asif M. Ilyas, MD, MBA, FACS Rothman Institute at Thomas Jefferson University
Dr. Asif Ilyas at the Rothman Institute presents the case of a proximal pole scaphoid fracture repaired with ORIF via a dorsal approach. After dissection through the joint capsule and exposure of the base of the scaphoid, a headless compression screw is placed anterograde in line with the thumb in all planes. This procedure provides increased stability and improved rate of the union in correlation with the accuracy of intraoperative reduction, leading to improved outcomes for surgical candidates over more conservative approaches.
In this case, Dr. Asif Ilyas at the Rothman Institute presents the case of an adult female presenting with a dorsally displaced and angulated fracture of the distal radius after a fall on the outstretched hand. The fracture was treated by open reduction and internal fixation with a volar locking plate, and the natural history, preoperative care, intraoperative technique, and postoperative considerations of distal radial fractures are outlined.
Epidermal inclusion cysts, also called keratin or epithelial cysts, are benign lumps that develop beneath the skin. They present as a slow-growing, painless lumps, usually with a punctum in the middle that represents the blockage of keratin excretion. Here, Dr. Lester Suntay with the World Surgical Foundation presents the case of a 64-year-old male with a mass on his upper back. It was noted to be gradually enlarging, and thus excision was performed in order to prevent further growth and infection.
Richard Hodin, MD Chief, Division of Gastrointestinal and Oncologic Surgery, Massachusetts General Hospital
The patient in this case is a 29-year-old female who had a long history of medically refractory ulcerative colitis. Three months previously, she had undergone a laparoscopic proctocolectomy with ileoanal J-pouch reconstruction and loop ileostomy. Here, Dr. Richard Hodin at MGH reverses the ileostomy.
J. Corbin Norton Department of Urology, University of Arkansas for Medical Sciences
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
Stephen J. Canon, MD Department of Pediatric Urology, 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.
Stenosing flexor tenosynovitis of the digital flexor tendon sheath, also known as trigger finger, occurs when there is a size mismatch between the flexor tendon and the surrounding retinacular pulley system at the first annular (A1) pulley. When the flexor tendon thickens or becomes inflamed, its ability to properly glide through the flexor tendon sheath becomes impaired. Thus, the tendon catches as the finger is flexed and extended. Conservative management includes activity modification, splinting, short-term NSAIDs, corticosteroid injection, and other adjuvant therapies. In this video, Dr. Asif Ilyas at the Rothman Institute demonstrates a surgical approach to the treatment of trigger finger via the open A1 pulley release procedure on a cadaver.
In this case, Dr. Tobias Carling and Dr. Courtney Gibson at Smilow Cancer Hospital at Yale New Haven perform a TOETVA on a 45-year-old patient who presented with a growing thyroid nodule that was shown to be a Hurthle cell neoplasm on fine-needle aspiration.
Numerous minimally-invasive approaches to thyroidectomy have been developed over the years to minimize the neck surgical scar, many of which are performed using endoscopic or robotic assistance. However, a more diminutive anterior cervical scar still remains a problem for some patients, as well as more extensive dissections for remote access operations. Therefore, natural orifice surgery was adopted at select institutions in an effort to perform a truly scarless thyroidectomy. Trans-oral endoscopic thyroidectomy has been the latest approach developed, known as the natural orifice transluminal endoscopic thyroidectomy, which is categorized as a natural orifice transluminal endoscopic surgery (NOTES) procedure. There are several ways to perform the natural orifice transluminal endoscopic thyroidectomy. Here, the authors present the TOETVA under general anesthesia.
