The incidence of porcelain gallbladder is low but carries a potential risk of malignancy. Large gallstones pose technical obstacles for minimally invasive surgical procedures. In this case, a 72-year-old woman undergoes a robotic cholecystectomy because of her porcelain gallbladder and a 6.8-cm gallstone. The surgical procedure involved appropriately addressing two major concerns: obtaining sufficient gallbladder retraction because of the large size of the stone, and the presence of hepatic steatosis. Key modifications included strategic port placement, utilizing stone position for retraction, and early cystic artery division. The procedure finished without any issues. The frozen section analysis results showed benign pathology. The patient recovered from surgery without any complications. Key takeaways are that robotic cholecystectomy can be safely performed for a porcelain gallbladder with large gallstones using appropriate technical modifications, and that flexibility in the operating room is crucial in cases where standard methods become impractical.
Ectropion is a common eyelid malposition characterized by outward turning of the eyelid margin, resulting in conjunctival exposure, epiphora, and potential corneal damage. The most common form of ectropion that needs surgical intervention affects elderly patients through horizontal eyelid laxity. This video article demonstrates the lateral tarsal strip (LTS) procedure, which corrects horizontal eyelid laxity by repositioning and reinforcing the lower eyelid, resulting in durable outcomes with minimal postoperative discomfort and low recurrence rates. The LTS procedure stands as the preferred surgical method for treating involutional ectropion because of its straightforward technique and excellent outcomes.
Patients with severe peripheral arterial disease and critical limb-threatening ischemia are at high risk for limb loss. This video presents a 76-year-old male with extensive comorbidities who underwent above-knee amputation after failed healing of a below-knee amputation. Despite patent inflow vessels, poor distal perfusion led to non-healing wounds. The patient tolerated the above-knee amputation well, with an uneventful recovery and discharge to rehabilitation on postoperative day five. This case illustrates the role of above-knee amputation in patients with severe peripheral arterial disease and non-healing below-knee amputation, emphasizing technical steps and perioperative management.
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).
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.
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.
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.
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.
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.
