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.
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.
A patient suffering from an AV fistula fed by the external carotid artery, who has failed occlusion via embolization, is being operated on by Dr. Czabanka to definitively treat the fistula. With the help of CT navigation and ICG angiography, Dr. Czabanka is able to microscopically devascularize the problematic malformation.
Watch as Dr. Czabanka navigates delicate territory to expose and excise a meningioma from the sphenoid wing of a symptomatic patient. Use of the microscope becomes crucial to prevent damage to healthy tissue while devascularizing the tumor.