Distal humeral fractures are injuries worldwide with operative fixation being the preferred method of treatment. Ulnar neuropathy is one of the possible complications of surgery, and may require an additional surgery to achieve symptom resolution. In this video, Dr. Agarwal-Harding manages a patient who was previously treated with open reduction and internal fixation of a distal humerus fracture, but his recovery was complicated by ulnar neuropathy. He performs an ulnar neurolysis, hardware removal from the medial column of the distal humerus, and anterior transposition of the ulnar nerve with an adipofascial flap. Surgical considerations, including rationale and treatment options, are discussed.
This surgical video article offers a comprehensive demonstration of the colon interposition procedure, highlighting the critical operative steps and technical nuances involved in performing a successful esophageal replacement, particularly in resource-limited settings, where advanced treatment options such as gastric pull-up or jejunal interposition may be limited. Colon interposition remains a viable solution for restoring swallowing function in patients with EA or other esophageal disorders requiring esophageal replacement.
By providing a detailed visual representation of the surgical process, this video serves as a valuable educational resource for surgeons and healthcare professionals involved in the care of patients with EA or related conditions. It underscores the importance of meticulous surgical technique, vascular preservation, and careful planning to ensure successful outcomes. Moreover, the video emphasizes the crucial role of multidisciplinary care in managing these complex cases. The involvement of specialists in pediatric surgery, anesthesiology, and intensive care is essential for optimizing patient outcomes and addressing potential complications.
Hemithyroidectomy, or unilateral thyroid lobectomy, refers to removal of half the thyroid gland. The procedure is typically performed for suspicious thyroid nodules or small differentiated thyroid cancers based on biopsy via fine needle aspiration (FNA) and occasionally for symptomatic benign thyroid nodules.
At most institutions the operation can be completed safely in an outpatient fashion with patient discharge from the hospital the same day. It is typically performed via a transcervical collar incision, but endoscopic, transoral routes and remote access approach with robotic instrumentation have been described. The procedure involves mobilization of the thyroid lobe, ligation of thyroid vessels, preservation of parathyroids, protection of the recurrent laryngeal nerve, and dissection away from the trachea. In this patient, a thyroid nodule was detected and found to have indeterminate features on biopsy via FNA. A hemithyroidectomy was then performed for diagnostic purposes.
Diagnostic shoulder arthroscopy or arthroscopic shoulder stabilization procedures can be performed with the patient in the beach chair or lateral decubitus (LD) position. Patient positioning may be dictated by surgeon preference or the specific intended procedure; however, LD setup has been found to result in lower rates of recurrent instability in cases of anterior arthroscopic stabilization procedures. The lateral and axial traction provided by the LD setup allows for lower suture anchor placement on the anterior-inferior aspect of the glenoid, as the surgeon has increased visualization and working room within the glenohumeral joint.
Prior to placing the patient in the LD position, meticulous care must be taken to properly position the beanbag device and set up the lateral traction device. Next, a coordinated team approach should be used to roll the patient into the LD position and to ensure that all bony prominences are adequately padded. The shoulder is then placed in 40° of abduction, 20° of forward flexion, with 10–15 pounds of balanced traction. Finally, the shoulder is prepped and draped in the usual sterile fashion and the surgeon is then able to proceed with the necessary arthroscopic procedure.
Laparoscopic appendectomy (LA) is a minimally-invasive technique distinguished by the utilization of small incisions through which an endoscopic camera and specialized instruments are introduced to facilitate the excision of an inflamed vermiform appendix. This LA video serves as an educational tool, offering unique insights into complex surgical scenarios. It demonstrates real-time decision-making in the face of adhesions from previous surgery, showcasing how to adapt standard techniques to challenging anatomy. The video provides a clear visualization of advanced laparoscopic skills, including safe adhesiolysis, cautious dissection, and proper use of surgical devices. It emphasizes critical aspects of surgical safety, team communication, and complication management.
Percutaneous Endoscopic Gastrostomy (PEG) is a minimally-invasive medical procedure that creates a safe and effective route for enteral nutrition, fluid administration, and medication delivery. PEG tubes are primarily used for long-term enteral nutrition in patients with impaired swallowing or inadequate oral intake, decompression of the gastrointestinal tract, and administration of medications. This detailed video demonstration of the PEG tube placement procedure is a crucial educational resource for medical professionals. It provides comprehensive visualization of a complex procedure, demonstrates real-time problem-solving, emphasizes safety considerations, and offers valuable tips for practitioners.
Radical neck dissection was once the standard of care for the surgical management of patients with thyroid cancer and cervical lymph node metastases. However, due to the significant morbidity of this procedure, the development of cervical lymphadenectomy procedures that could provide oncologic cure while minimizing morbidity was undertaken by many surgeons. Such an investigation has led to the development of the modified radical neck dissection (MRND). Still, many institutions are not familiar with performing a comprehensive MRND in the setting of thyroid cancer metastatic to the lateral lymph node compartments. This article presents such an operation under general anesthesia.
Transcervical Open Repair of Extracranial Internal Carotid Artery Aneurysm Miguel Angel Mendoza Romo-Ramírez, MD1; Jasanai Sausameda-García, MD2; Silverio Gutiérrez-Cruz, MD2; Kevin Johnson-Molina, MD2; Carlos Flores-Ramirez, MD1 1Hospital Central del Estado, Chihuahua, Mexico 2Hospital General Regional #1. IMSS. Chihuahua, Mexico
This article presents the case of a 1.8-cm carotid saccular aneurysm dependent on the left internal carotid, limited to the proximal portion of the bifurcation in a 66-year-old male with a history of hypertension and diabetes mellitus, successfully managed with an open surgical technique. Extracranial aneurysms of the carotid artery are rare and may be caused by atherosclerosis, trauma, infection, or other factors. These aneurysms are characterized by an increase in the diameter of the carotid artery and may require treatment to prevent complications such as embolism or rupture.
Treatment may include open surgery or endovascular techniques, and the choice of treatment depends on several factors, such as the location and size of the aneurysm. Medical management may also be considered in selected cases. Diagnosis is made through imaging tests such as duplex ultrasound, computed tomography, or magnetic resonance imaging. It is important to perform a careful evaluation to determine the best treatment option and prevent complications.
Uterine fibroids, also known as leiomyomas, are usually benign masses that are most commonly found in women of reproductive age. Fibroids are usually asymptomatic and tend to be incidental findings on ultrasound. When clinically relevant, however, patients report symptoms such as menorrhagia, pelvic pain, and bulk-related symptoms.
Treatment of symptomatic fibroids may be pharmaceutical with gonadotropin-releasing hormone agonists, radiological using MRI-guided focused ultrasound surgery (or magnetic resonance-guided focused ultrasound), or minimally-invasive uterine artery embolization, but the treatment is largely surgical.
There are many different surgical approaches that can be utilized, including myomectomy or hysterectomy. Treatment of choice depends on multiple factors, including the severity of symptoms, size of fibroids, and patient’s desire to preserve fertility. However, out of all of the different surgical techniques available, hysterectomy is the only definitive treatment for these patients. Here, an abdominal hysterectomy was performed on a 45-year-old patient with symptomatic uterine fibroids.
An inguinal hernia (IH) is a protrusion of intra-abdominal contents through the inguinal canal that can arise at any time from infancy to adulthood. It is more common in males with a lifetime risk of 27% as compared to 3% in females. Most pediatric IHs are congenital and caused by failure of the peritoneum to close, resulting in a patent processus vaginalis (PPV). IH present as a bulge in the groin area that can become more prominent when crying, coughing, straining, or standing up, and disappears when lying down. Diagnosis is based on a thorough medical history and physical examination, but imaging tests such as ultrasound can be used when the diagnosis is not readily apparent. IHs are generally classified as indirect, direct, and femoral based on the site of herniation relative to surrounding structures. Indirect hernias protrude lateral to the inferior epigastric vessels, through the deep inguinal ring. Direct hernias protrude medial to the inferior epigastric vessels, within Hesselbach’s triangle. Femoral hernias protrude through the small and inflexible femoral ring. In infants and children, IH are always operated on to prevent incarceration.
Surgical correction in infants and children is done by high ligation of the hernia sac only, called a herniotomy. Here, we present a female infant with bilateral IH. Upon exploration, a hernia sac was found, and ligation was performed bilaterally. In female patients, it is believed that failure of the closure of the canal of Nuck alongside the round ligament of the uterus is the etiology. Oftentimes there is a “sliding hernia” where the ovary and or the fallopian tube is attached to the sac, sometimes the uterus itself is attached.
