Cardiac Surgery, Print Release

PUBLISHED: Combined Replacement of Aortic Valve and Ascending Aorta with Patent Foramen Ovale (PFO) Closure

Combined Replacement of Aortic Valve and Ascending Aorta with Patent Foramen Ovale (PFO) Closure
David W. Miranda, MD, MS; Jordan P. Bloom, MD, MPH
Massachusetts General Hospital

Aortic valve disease in adults has many etiologies and requires careful operative planning when severe enough to require intervention. A common cause of aortic valve dysfunction in adults is a congenitally bicuspid valve that may also be associated with aortic aneurysm. Here, we describe the presentation and management of a middle-aged woman with symptomatic severe aortic stenosis due to a bicuspid aortic valve. She required an aortic valve replacement as well as replacement of an aneurysmal ascending aorta and closure of a patent foramen ovale (PFO).

JoMI in Surgical Education

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General Surgery, Print Release

Laparoscopic-Assisted Takedown of a Gastrocutaneous Fistula

Laparoscopic-Assisted Takedown of a Gastrocutaneous Fistula
Victoria J. Grille, MD1; Eric M. Pauli, MD, FACS, FASGE2
1Jersey Shore University Medical Center
2Penn State Milton S. Hershey Medical Center

A gastrocutaneous fistula is an abnormal connection between the stomach and skin, most commonly occurring after removal of a gastrostomy feeding tube. This video demonstrates the surgical technique of laparoscopic takedown of a gastrocutaneous fistula, performed in conjunction with upper endoscopy. The patient is a pediatric patient with a history of gastrostomy tube placement and Nissen fundoplication for reflux during infancy. Despite removal of the tube, the fistula persisted. Prior endoscopic interventions, including over-the-scope clip placement, were unsuccessful. Due to ongoing drainage and patient preference for definitive closure, surgical intervention was pursued.

General Surgery, Ob/Gyn, Plastic Surgery, Print Release

PUBLISHED: Extralevator Abdominoperineal Resection (APR) for Recurrent Anal Cancer With an En Bloc Total Abdominal Hysterectomy and Bilateral Salpingo-Oophorectomy and Total Vaginectomy With Permanent Colostomy Formation and Pelvic Floor Reconstruction Using a Right Rectus Abdominis Flap

Extralevator Abdominoperineal Resection (APR) for Recurrent Anal Cancer With an En Bloc Total Abdominal Hysterectomy and Bilateral Salpingo-Oophorectomy and Total Vaginectomy With Permanent Colostomy Formation and Pelvic Floor Reconstruction Using a Right Rectus Abdominis Flap
Zoe Garoufalia, MD; Steven D. Wexner, MD, FACS
Cleveland Clinic Florida

This video provides a step-by-step, detailed demonstration of this extensive surgical procedure performed on a 53-year-old female patient with recurrent anal cancer after initial chemoradiotherapy. The surgical technique is thoroughly illustrated, emphasizing the importance of proper anatomical planes, multidisciplinary coordination, and reconstructive considerations.

General Surgery, Print Release

PUBLISHED: Diagnostic Laparoscopy and Small Bowel Resection for a Large Meckel’s Diverticulum in Adult with Persistent GI Bleed

Diagnostic Laparoscopy and Small Bowel Resection for a Large Meckel’s Diverticulum in Adult with Persistent GI Bleed
Julie Thomann, MD; Nicole B. Cherng, MD, FACS, FASMBS
UMass Memorial Medical Center

Symptomatic Meckel’s diverticulum is a diagnosis most commonly associated with male children under two years old. It typically presents with painless hematochezia and is diagnosed with a Meckel’s scan, which uses Technetium-99 to detect ectopic gastric tissue. In an adult with gastrointestinal bleeding, the differential is far broader, including an extensive and at times, inconclusive, work-up. Here, we describe a diagnostic laparoscopy for suspicion of Meckel’s diverticulum in a young adult male whose work-up showed evidence of small bowel bleeding without a definitive source. A large 6.2-cm, broad-based Meckel’s diverticulum was identified about 90 cm proximal to the ileocecal valve and resected via small bowel resection.

General Surgery, Print Release

PUBLISHED: Reversal of a Diversion Loop Ileostomy in a Patient with a Prior Gracilis Transposition Flap for Rectovaginal Fistula Due to Crohn’s Disease

Reversal of a Diversion Loop Ileostomy in a Patient with a Prior Gracilis Transposition Flap for Rectovaginal Fistula Due to Crohn’s Disease
Zoe Garoufalia, MD; Steven D. Wexner, MD, FACS
Cleveland Clinic Florida

This case takes an in-depth look at the reversal of a diverting loop ileostomy performed for a patient who had received a prior gracilis transposition flap for a rectovaginal fistula due to Crohn’s disease. This video provides a detailed step-by-step demonstration of the reversal of this diverting loop ileostomy. It serves as an excellent educational resource for surgeons learning how to close loop ileostomies.

Ophthalmology, Print Release

PUBLISHED: Lacrifill Injection into Punctum for Dry Eyes

Lacrifill Injection into Punctum for Dry Eyes
Alexander Martin, OD
Boston Vision

This detailed demonstration of the Lacrifill injection procedure, from patient preparation through to injection technique and follow-up care, provides valuable information for ophthalmologists, optometrists, and other eye care professionals who treat patients with dry eye disease and are seeking to expand their therapeutic options. As with any interventional procedure, appropriate training and careful patient selection are essential for optimal outcomes.

Print Release, Vascular Surgery

PUBLISHED: Supraceliac Aorta-to-SMA Bypass with Ileocecectomy for Acute-on-Chronic Mesenteric Ischemia Complicated by Bowel Necrosis and Perforation

Supraceliac Aorta-to-SMA Bypass with Ileocecectomy for Acute-on-Chronic Mesenteric Ischemia Complicated by Bowel Necrosis and Perforation
Benjamin J. Pearce, MD
UAB Hospital

This case involved a 63-year-old female with a history of chronic tobacco use, hypertension, and hyperlipidemia, who had undergone aortobifemoral bypass several months earlier at an outside institution. Shortly afterward, she developed progressive postprandial abdominal pain, alternating constipation and diarrhea, unintentional weight loss, and food fear. During a prolonged hospital admission, she underwent upper and lower endoscopy and autoimmune evaluation, none of which yielded a definitive diagnosis. She was dependent on total parenteral nutrition due to intolerance of enteral intake.

On transfer to our facility, she was found to have a high-grade occlusion of the superior mesenteric artery (SMA), beginning approximately 3–4 cm distal to the ostium, caused by a bulky, calcified atherosclerotic plaque. The SMA origin was patent but significantly narrowed, correlating with her chronic symptoms. Given her worsening condition, surgical exploration was undertaken and revealed necrotic terminal ileum, a contained perforation, and localized peritonitis. A supraceliac aorta-to-SMA bypass was performed using a cryopreserved superficial femoral artery (SFA) graft routed through a retropancreatic tunnel, followed by ileocecal resection.

This surgical video demonstrates critical aspects of complex mesenteric revascularization. The technical elements of supraceliac aortic exposure, retropancreatic tunnel creation, and management of bowel complications provide valuable insights for surgeons encountering similar challenging scenarios. This case demonstrates the continued importance of open surgical expertise alongside endovascular techniques.

General Surgery, Print Release

PUBLISHED: Partial Mastectomy (Lumpectomy) Utilizing Savi Scout for a Nonpalpable Papilloma

Partial Mastectomy (Lumpectomy) Utilizing Savi Scout for a Nonpalpable Papilloma
Olivia D. Flessland, DO; Libby A. Moberg, MD; Thais A. Fortes, MD
University of Michigan Health – Sparrow

Partial mastectomy of the breast, also known as lumpectomy, is a breast-conserving procedure performed to remove many different types of masses and irregularities in the breast tissue. This involves a small incision concealed at the nipple borders or along the natural breast contours, followed by dissection of the area of concern. The excised tissue is then sent to pathology for final tissue diagnosis and, if applicable, to determine if appropriate margins have been achieved. Furthermore, Savi Scout utilization may help to localize the mass when it otherwise would be difficult to identify or locate. Many different breast pathologies can be removed in this fashion, both benign and malignant, depending on both biological and patient-specific details. In the case presented, a nonpalpable papilloma—typically found to be a benign breast lesion with an increased risk of harboring occult premalignant ductal carcinoma in situ (DCIS)—is surgically excised due to the presence of associated concerning symptoms in the patient.

Print Release, Thoracic Surgery

PUBLISHED: Robotic Right Middle Lobectomy and Mediastinal Lymph Node Dissection for Adenocarcinoma

Robotic Right Middle Lobectomy and Mediastinal Lymph Node Dissection for Adenocarcinoma
Hugh G. Auchincloss, MD, MPH
Massachusetts General Hospital

This surgical video provides a comprehensive demonstration of advanced robotic-assisted thoracic surgical techniques, focusing specifically on right middle lobectomy for adenocarcinoma. It documents the strategic decision-making processes involved in complex thoracic interventions. It highlights how technological advancements can enhance patient outcomes. As an educational resource, the video bridges theoretical knowledge with practical application, providing surgeons and medical professionals with a nuanced understanding of advanced surgical techniques. It exemplifies how robotic assistance can enhance surgical precision, reduce invasiveness, and enable more comprehensive tissue management, ultimately representing a significant advancement in the field of oncological surgery.

The New Gold Standard for Surgical Videos