Category Archives: General Surgery

PREPRINT RELEASE: Right Laparoscopic Adrenalectomy

Right Laparoscopic Adrenalectomy
Massachusetts General Hospital

Richard Hodin, MD
Professor of Surgery
Harvard Medical School

In this case, a 58-year-old female was found to have hyperaldosteronism, and a CT scan revealed bilateral cortical adenomas. Here, Dr. Richard Hodin, MD, walks the viewer through the analysis of adrenal vein sampling and performs a right laparoscopic adrenalectomy at MGH.

PREPRINT RELEASE: Right Posterior Retroperitoneoscopic Adrenalectomy

Right Posterior Retroperitoneoscopic Adrenalectomy
Smilow Cancer Hospital at Yale New Haven

Tobias Carling, MD, PhD, FACS
Associate Professor of Surgery
Yale School of Medicine

One of the early adaptors of the approach, Tobias Carling, MD, PhD, FACS, performs a right posterior retroperitoneoscopic adrenalectomy on a patient that presented with subclinical Cushing's syndrome. Specifically, she had elevated urinary cortisol, failed a dexamethasone suppression test, and had a growing adrenal tumor as revealed by serial imaging. Due to the patient’s anatomy, Dr. Carling used a lateral approach to ligating the right adrenal vein; this video includes his usual medial approach as an additional module.

PREPRINT RELEASE: Minimally Invasive Parathyroidectomy under Local Cervical Block

Minimally Invasive Parathyroidectomy under Local Cervical Block
Yale School of Medicine
Tobias Carling, MD, PhD, FACS
Associate Professor of Surgery

A 60-year-old female’s biochemical workup concluded she had primary hyperparathyroidism, and preoperative images suggested a left lower parathyroid lesion. Consequently, Dr. Tobias Carling performed a minimally invasive parathyroidectomy under local cervical anesthesia while preserving the esophagus and recurrent laryngeal nerve. Intraoperative PTH proved complete resection.

PREPRINT RELEASE: Revision Bascom Cleft Lift Pilonidal Cystectomy

Revision Bascom Cleft Lift Pilonidal Cystectomy
Tufts University School of Medicine
Michael Reinhorn, MD, MBA, FACS
Associate Clinical Professor of Surgery

Dr. Michael Reinhorn performs a pilonidal cleft lift procedure, thoroughly describing the pre-op, post-op, and intraoperative steps, on a young man who previously had surgery but experienced recurrence.

PREPRINT RELEASE: Laparoscopic Nissen Fundoplication

Laparoscopic Nissen Fundoplication
VA Boston Healthcare System
Marco Fisichella, MD, MBA, FACS
Assistant Professor of Surgery, Harvard Medical School
Associate Chief of Surgery, VA Boston Healthcare System

After medical management with high dose proton pump inhibitors proves to be refractory, a 63-year-old man with gastroesophageal reflux disease (GERD) presents for surgical management. Consequently, Dr. Marco Fisichella conducts a laparoscopic Nissen fundoplication.

PREPRINT RELEASE: Laparoscopic Appendectomy

Laparoscopic Appendectomy
VA Boston Healthcare System
Marco Fisichella, MD, MBA, FACS
Assistant Professor of Surgery, Harvard Medical School
Associate Chief of Surgery, VA Boston Healthcare System

A 66-year-old man with a history of polyps has undergone colonoscopic surveillance every 3 years. After the recent discovery of an adenoma at the patient’s appendiceal orifice, Dr. Marco Fisichella performs a laparoscopic appendectomy.

PREPRINT RELEASE: Leiomyosarcoma of the Inferior Vena Cava: Resection and Reconstruction

Leiomyosarcoma of the Inferior Vena Cava: Resection and Reconstruction
Massachusetts General Hospital
Madhukar S. Patel, MD, MBA, ScM

Department of Surgery, MGH
Jahan Mohebali, MD, MPH
Department of Surgery, Division of Vascular and Endovascular Surgery, MGH
Parsia A. Vagefi, MD, FACS
Department of Surgery, Division of Transplant Surgery, MGH
Alex B. Haynes, MD, MPH, FACS
Department of Surgery, Division of Surgical Oncology, MGH

A woman presented with back pain, and when biopsied, she was found to have an inferior vena cava leiomyosarcoma - specifically involving the infrahepatic vena cava, the origin of the left renal vein, and the hilum of the right kidney. After undergoing preoperative proton beam radiation, the patient has her tumor resected en bloc by Dr. Vagefi and Dr. Haynes. They will also reconstruct the vena cava with a ringed synthetic graft covered by an omental pedicle flap.

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: 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.