Category Archives: Print Release

PUBLISHED: Left Lumpectomy with Wireless Seed Localization for Ductal Carcinoma In Situ

Left Lumpectomy with Wireless Seed Localization for Ductal Carcinoma In Situ
Massachusetts General Hospital

Bridget N. Kelly
MGH

Carson L. Brown
MGH

Michelle C. Specht, MD
Operating Surgeon, MGH

The patient in this case is a 58-year-old postmenopausal woman who was seen for consultation regarding the management of newly-diagnosed ductal carcinoma in situ (DCIS) of the left breast detected on routine screening mammogram with no clinical or radiological evidence of lymph node involvement.

Breast-conserving surgery with radiation for early-stage breast cancers provides equivalent survival rates to mastectomy when all surgical margins are clear of residual cancer. For patients whose tumors are not palpable upon physical examination, preoperative localization of the malignant tissue to be removed is necessary.

In this video, Dr. Specht at MGH performs and narrates a lumpectomy using wireless seed localization to target the lesion and taking shave margins to reduce the risk of recurrence.


PUBLISHED: Extended Focused Assessment with Sonography for Trauma (EFAST) Exam

Extended Focused Assessment with Sonography for Trauma (EFAST) Exam
UChicago Medicine

Daven Patel, MD, MPH
Resident Physician
Emergency Medicine

Kristin Lewis, MD, MA
Resident Physician
Emergency Medicine

Allyson Peterson, MD
Resident Physician
Emergency Medicine

Nadim Michael Hafez, MD
Assistant Professor of Medicine
Emergency Medicine

This video covers information related to the FAST exam, which evaluates the pericardial, hepatorenal, splenorenal, and suprapubic regions for free fluid in a trauma patient as well as the extended version, which includes an additional evaluation of the pleural spaces for a pneumothorax. It goes through probe selection, probe placement and image acquisition, image optimization, and pitfalls and pearls for the subxiphoid/subcostal, right upper quadrant, left upper quadrant, suprapubic, and pleural views.

PUBLISHED: Subtalar Arthrodesis for Post-Traumatic Subtalar Arthritis

Subtalar Arthrodesis for Post-Traumatic Subtalar Arthritis
Massachusetts General Hospital

Christopher W. DiGiovanni, MD
Chief of the Foot & Ankle Service
Vice Chair for Academic Affairs
Massachusetts General Hospital

Subtalar arthrodesis is currently the mainstay treatment option for the management of recalcitrant subtalar arthrosis.

The patient in this case is a 45-year-old male who developed post-traumatic arthritis of the subtalar joint 14 years following a work-related injury in which he sustained a comminuted, joint-depression type calcaneal fracture after a 10-foot fall from a ladder. Seven years after the initial injury, imaging prompted by progressive hindfoot pain during weight-bearing or following activity revealed progressive degeneration of the subtalar joint, for which he was treated with orthoses, corticosteroid injections, and arthroscopic debridement. After exhausting both conservative and minimally invasive treatment measures at 14 years post-injury, he finally elected to undergo subtalar arthrodesis.

This video article details the methods and techniques involved in subtalar arthrodesis. After an Ollier approach was used to expose the subtalar joint, the arthritic cartilage was removed and the subchondral plate was perforated. Finally, an autogenous bone graft was harvested from the proximal tibia and inserted into the joint space, and compression was achieved by two lag screws.

PUBLISHED: Cubital Tunnel Release (Cadaver)

Cubital Tunnel Release

Asif M. Ilyas, MD
Professor of Orthopaedic Surgery
Program Director of Hand Surgery
Rothman Institute, Thomas Jefferson University

Cubital tunnel syndrome is a condition that affects the ulnar nerve as it crosses the medial elbow through the retrocondylar groove. It is the second most common compressive neuropathy, causing tingling and numbness in the ring and small fingers. In advanced cases of symptomatic cubital tunnel syndrome, weakness, altered dexterity, and atrophy of the intrinsic muscles of the hand may develop. Cubital tunnel syndrome can be treated with either a cubital tunnel release or an ulnar transposition. In this case, the former is demonstrated on a cadaveric arm using the mini-open technique.

PUBLISHED: Carpal Tunnel Release (Cadaver)

Carpal Tunnel Release (Cadaver)

Asif M. Ilyas, MD
Professor of Orthopaedic Surgery
Program Director of Hand Surgery
Rothman Institute, Thomas Jefferson University

Carpal tunnel syndrome (CTS) is the most common peripheral compression neuropathy and results in symptoms of numbness and paresthesia in the thumb, index finger, middle finger, and half of the ring finger. When CTS symptoms progress and can no longer be managed with nonoperative measures, carpal tunnel release (CTR) surgery is indicated.

In this case, Dr. Asif Ilyas at the Rothman Institute performs CTR surgery on a cadaveric arm via the mini-open CTR technique. A 2-cm longitudinal incision was placed directly over the carpal tunnel, the transverse carpal ligament was exposed and then released, and the wound was closed. Patients are typically sent home with instructions to use their hand immediately postoperatively, while avoiding strenuous use until the incision has healed. Splinting and therapy are not required postoperatively.


Published: Pancreatic Debridement via Sinus Tract Endoscopy

Pancreatic Debridement via Sinus Tract Endoscopy
Massachusetts General Hospital

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.

PUBLISHED: Less Invasive Stabilization System (LISS) for Distal Femur Fracture Repair

Less Invasive Stabilization System (LISS) for Distal Femur Fracture Repair
Brigham and Women’s Hospital

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.

PUBLISHED: Creation Of A Radial-Cephalic Arteriovenous Fistula

Creation of a Radial-Cephalic Arteriovenous Fistula
Nahel Elias, MD FACS
Surgical Director
Kidney Transplantation
Massachusetts General Hospital

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. 

Continue reading PUBLISHED: Creation Of A Radial-Cephalic Arteriovenous Fistula

PUBLISHED: Whipple Procedure for Multiple Endocrine Neoplasia of the Pancreas

Whipple Procedure for Multiple Endocrine Neoplasia of the Pancreas
Keith Lillemoe, MD
Surgeon in Chief
Massachusetts General Hospital
Harvard Medical School

Participate in a masterclass with MGH Chief of Surgery, Dr. Keith Lillemoe, as he performs and narrates a complete Whipple procedure in the latest video-article published by JOMI.

The Whipple procedure, or pancreaticoduodenectomy, is most notably known for its use in the treatment of cancer that is confined to the head of the pancreas. Because of the intricate blood supply between the pancreas, duodenum, gallbladder, and common bile duct, these structures must be resected along with the head of the pancreas. The remaining structures must then be carefully and precisely anastomosed in order to preserve digestive functioning.

This procedure is a complex and difficult operation that can have serious risks; however, it is responsible for saving countless lives.

 

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.