Maggie L. Westfal, MD, MPH General Surgery Resident Massachusetts General Hospital
Nahel Elias, MD, FACS Transplant Surgery Department Massachusetts General Hospital
The patient in this case is a 56-year-old female with a past medical history of type I diabetes mellitus, hypertension, hypothyroidism, hyperlipidemia, and end stage renal disease secondary to diabetic and hypertensive nephropathies. In this video, Dr. Nahel Elias performs the recipient side of a living related kidney transplant from the patient’s sister.
Tobias Carling, MD, PhD, FACS Yale School of Medicine
Cortical-sparing adrenalectomy allows for the resection of adrenal tumors while preserving unaffected adrenal tissue to prevent adrenal insufficiency. This is especially important in patients with bilateral adrenal tumors, typically pheochromocytomas.
Posterior retroperitoneoscopic adrenalectomy (PRA) allows for a minimally invasive approach to adrenal gland resection compared with the more traditional laparoscopic transabdominal adrenalectomy and open approaches. This approach is ideal to address patients with bilateral disease and was used in this case of a 31-year-old female patient presenting with bilateral pheochromocytomas in the setting of multiple endocrine neoplasia 2A syndrome and coexisting medullary thyroid carcinoma of the right thyroid lobe. A close review of her imaging demonstrated normal-appearing adrenal cortex tissue on the right side that allowed for cortical-sparing adrenalectomy on that side.
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.
Rockson C. Liu, MD, FACS General Surgery, Epic Care, Alta Bates Summit Medical Center
In this case, Dr. Rockson Liu performs a robotic eTEP retrorectus Rives-Stoppa repair of an upper midline primary ventral hernia that was partially reducible but mostly incarcerated, and greater than 6 cm in a 63-year-old female. Robotic ports were placed directly into the retrorectus space. Using the crossover technique, the retrorectus spaces were combined with a preperitoneal bridge of the peritoneum. The defects were closed robotically, and a medium-weight, macroporous polypropylene mesh was placed within the retrorectus space.
Laura Celmins, PharmD, BCPS, BCCCP Clinical Pharmacy Specialist Emergency Medicine
In this video, Laura Celmins, a clinical pharmacist in the emergency department at UChicago Medicine, discusses rapid sequence intubation (RSI) medications as part of the airway management for trauma patients.
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.
Priya Prakash, MD Assistant Professor of Surgery Trauma, Critical Care, and Emergency Surgery UChicago Medicine
The patient in this case is a 17-year-old male who presented in stable condition with a minor, superficial, perforating saber wound. In this video article, Dr. Priya Prakash at UChicago Medicine demonstrates a trauma resuscitation and removes the saber.
Yoko Young Sang, MD Resident Physician General Surgery Louisiana State University Shreveport
Caroll Alvarado Lemus, MD Pediatric Surgery, Mario Catarino Rivas Hospital, Honduras San Pedro Sula, Honduras
Domingo Alvear, MD Founder World Surgical Foundation
The patient in this case is a 6-year-old boy who was born with Down syndrome and esophageal atresia. In this video article, Dr. Alvear performs a colonic interposition to replace the absent esophagus with part of the patient’s colon. This was performed during a global surgical mission in Honduras with the World Surgical Foundation.