Category Archives: Content

PUBLISHED: Robotic eTEP Retrorectus Rives-Stoppa Repair for Ventral Hernia

Robotic eTEP Retrorectus Rives-Stoppa Repair for Ventral Hernia
Alta Bates Summit Medical Center

Rockson C. Liu, MD, FACS

In this case, Dr. Rockson Liu with Epic Care at Alta Bates Summit Medical Center 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.

PUBLISHED: Thumb Ulnar Collateral Ligament Tear Repair

Thumb Ulnar Collateral Ligament Tear Repair
Rothman Institute at Thomas Jefferson University

Asif M. Ilyas, MD, MBA, FACS
Rothman Institute at Thomas Jefferson University

Alexander D. Selsky, BS
Lake Erie College of Osteopathic Medicine

The patient in this case was a 35-year-old male who presented to the clinic with pain of the right thumb but no numbness after a fall onto an outstretched hand that resulted in a forced hyperabduction of the thumb. There was mild weakness with thumb adduction due to significant pain, but there was no evidence of median or radial nerve injury, and the radial pulses were intact. A palpable mass was identified along the medial side of the MCP, suggestive of a Stener’s lesion, and he was ultimately found to have a complete UCL tear of the right thumb.

Here, Dr. Asif Ilyas at the Rothman Institute performs a repair of the UCL with the use of a 3-0 suture anchor placed in the anatomical footprint and a temporary 0.045 K-wire placed across the MCP joint for reinforcement.

Preview of the case: https://www.youtube.com/watch?v=JxdoYtjgZBE&ab_channel=JOMI-JournalofMedicalInsight

Preprint Release: Bilobed Nasolabial and Rhomboid Flaps for Repair of a Left Nasal Ala Defect Following Basal Cell Cancer Excision

Bilobed Nasolabial and Rhomboid Flaps for Repair of a Left Nasal Ala Defect Following Basal Cell Cancer Excision
UPMC Hamot

Ajaipal S. Kang, MD
Cosmetic, Plastic & Reconstructive Surgery Specialist
UPMC Hamot

In this case, Dr. Ajaipal Kang at UPMC Hamot performs a bilobed nasolabial flap and a rhomboid flap to close a left nasal ala defect that remained following an excision of a basal cell cancer.

PUBLISHED: Subcutaneous Ulnar Nerve Transposition

Subcutaneous Ulnar Nerve Transposition
Rothman Institute at Thomas Jefferson University

Jasmine Phun
Sidney Kimmel Medical College

Asif M. Ilyas, MD, MBA, FACS
Rothman Institute at Thomas Jefferson University

In this case, Dr. Ilyas at the Rothman Institute performs a subcutaneous anterior transposition on a patient with cubital tunnel syndrome. The patient’s ulnar nerve subluxed upon elbow flexion and extension upon physical examination, which was a primary indication for choosing this surgical approach over other techniques.

This procedure not only decompresses the affected nerve but also transposes the nerve anterior to the medial epicondyle so as to relieve strain on the nerve upon the full range of motion of the elbow.

Preprint Release: Recipient Kidney Transplant from a Living Donor

Recipient Kidney Transplant from a Living Donor
Massachusetts General Hospital

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.

PUBLISHED: Jersey Finger Repair

Jersey Finger Repair
Rothman Institute at Thomas Jefferson University

Rachel M. Drummey, MSc
University of Central Florida College of Medicine

Asif M. Ilyas, MD, MBA, FACS
Rothman Institute at Thomas Jefferson University

Jersey finger refers to an avulsion of the flexor digitorum profundus (FDP) at its insertion on the distal phalanx, the weakest point of the tendon. The injury frequently occurs during contact sports while grabbing the jersey of an opposing player as the player pulls or runs away. Surgical repair is the definitive treatment for all cases of complete rupture of the FDP tendon.

In this video article, Dr. Ilyas at the Rothman Institute demonstrates the suture anchor technique to repair a jersey finger. This approach was selected in place of the more traditional pull-out button technique for potentially stronger repair, no presence of external fixation devices, avoidance of button-related complications, and ease of rehabilitation.

PUBLISHED: Bilateral Posterior Retroperitoneoscopic Adrenalectomy with Cortical Sparing on Right Side

Bilateral Posterior Retroperitoneoscopic Adrenalectomy with Cortical Sparing on Right Side
Yale School of Medicine

Taylor C Brown, MD, MHS
Yale School of Medicine

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.

PREPRINT RELEASE: AIRWAY TECHNIQUES AND EQUIPMENT

Airway Techniques and Equipment
UChicago Medicine

Dany Accilien, MD
Emergency Medicine Resident
The University of Chicago Pritzker School of Medicine

Dexter C. Graves, MD
Emergency Medicine Resident
The University of Chicago Pritzker School of Medicine

Nicholas Ludmer, MD
Assistant Professor of Emergency Medicine
The University of Chicago Pritzker School of Medicine

Stephen Estime, MD
Assistant Professor of Anesthesiology and Critical Care
The University of Chicago Pritzker School of Medicine

Abdullah Hasan Pratt, MD
Assistant Professor of Emergency Medicine
The University of Chicago Pritzker School of Medicine

In this video, Dr. Pratt goes over airway management techniques in trauma resuscitation. It outlines the preparation and equipment used in patients with impending airway failure that require manual or mechanical ventilation. Also discussed are the innovative airway towers used in the University of Chicago emergency room as well as the general approach to airway management. The different types of laryngoscopy, assist devices, and cricothyroidotomy surgical airway procedures are also presented.

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.