Carpal Tunnel Syndrome (CTS) and Dupuytren’s disease (DD) are two common hand conditions that can significantly impact a patient’s quality of life and hand function. In cases where both conditions coexist, as demonstrated in this video, a combined surgical approach is adopted in suitable candidates. Combining carpal tunnel release and fasciectomy in a single surgical setting is safe, cost-effective, and efficient, reducing recovery time and healthcare costs while achieving functional outcomes comparable to staged interventions. This video demonstration is particularly valuable for practicing hand surgeons and surgical trainees, offering detailed insights into technical challenges such as neurovascular bundle protection, management of retrovascular cord components, and the precise balance between complete disease excision and preservation of vital structures. The demonstrated solutions, including the use of vessel loops for nerve protection, staged fascia removal, and careful hemostasis management, provide practical guidance for similar cases.
This article describes a case of a 58-year-old male patient with a renal mass, which was incidentally discovered on an imaging of chest CT scan, without any signs and symptoms indicative for renal masses. The patient has no history of ureteroscopy before, and no prior history of urolithiasis. The multiphasic, contrast-enhanced abdominal CT scan shows 2.5-cm hyperattenuating enhancing mass in the upper pole of the right kidney. Transverse unenhanced CT image shows hyperattenuating mass with no evidence of fat. Transverse CT image shows enhancement of the mass from 60 HU to 116 HU. The chest CT scan showed no abnormalities. This video describes a complex urological procedure that initially aimed to perform diagnostic and potentially therapeutic intervention but was modified due to anatomical constraints. The procedure demonstrates the importance of surgical adaptability and the role of staged approaches in urological surgery.
Graves’ disease is an autoimmune condition that causes hyperthyroidism. There are several options for management which include medications, radioactive iodine ablation, and surgery. Over time, total or near-total thyroidectomy has become the gold standard in surgical management of this disease. Although there is a slightly higher risk of complications following total thyroidectomy in patients with Graves’ disease as compared to their non-Graves’ counterparts undergoing thyroidectomy, the absolute risk remains low, especially for high-volume endocrine surgeons.
An 80-year-old patient underwent an open onlay repair of a recurrent incisional hernia. This approach was chosen due to the patient’s prior retromuscular repair, age, history of adhesions, and religious preference against blood products. Following safe abdominal entry and adhesiolysis, a subcutaneous pocket extending 5 centimeters in all directions from the hernia was created. Fascia was closed using mesh-suture and a 12 x 12-centimeter macroporous, medium-weight polypropylene mesh was secured to the anterior fascia with staples and fibrin glue. A subcutaneous drain was placed. This case highlights the utility of an onlay approach for selected circumstances.
Hydrocelectomy is a common and effective surgical procedure used to treat hydrocele, a condition in males defined as an accumulation of benign peritoneal fluid between the layers of the scrotum. The indications for hydrocelectomy include pain, poor cosmetic appearance, or negative impact on patient quality of life. Surgical treatment of hydroceles aims to treat symptoms as well as prevent complications of hydroceles left untreated, including chronic pain or testicular ischemia. A scrotal incision is the most common approach for surgical management of non-communicating hydroceles. The hydrocele sac is isolated, the fluid is drained, and the sac is excised and closed to prevent recurrence. This video presents a case of a patient with a left sided non-communicating hydrocele that was treated with hydrocelectomy. As part of the procedure, a surgical drain was left in place.
Thoracentesis Alexandra J. Lopez, MD; Yu Maw Htwe, MD Penn State Health Milton S. Hershey Medical Center
Pleural effusions are a frequent problem encountered in pulmonary medicine. Some common causes of pleural effusion include chest infection, heart failure, liver failure, malignancy, and autoimmune diseases such as rheumatoid arthritis, to name a few. Often drainage of this fluid is required for both diagnostic and therapeutic purposes, which is called thoracentesis. For this procedure, a Safe-T-Centesis kit is used to place a temporary catheter in the pleural space and manually drain the fluid, which can then be sent to the lab for further testing, including cell counts, glucose, pH, protein levels, cytology, and bacterial cultures. Based on these results, it can be determined if the effusion is exudative or transudative, which helps guide further management. In this case, the patient has a recurrent left-sided exudative effusion of unknown cause with underlying history of colon cancer, and malignant effusion is a concern, so it was decided to perform both diagnostic and therapeutic ultrasound-guided thoracentesis.
Ganglion cysts (GCs) are common benign soft tissue tumors that when presenting near the nail bed of digits, are specifically termed digital mucous cysts (DMCs). The surgical excision of GCs near the nail bed requires precise technique and a thorough understanding of the anatomical relationships to prevent recurrence and minimize complications. This case report describes the surgical management of a GC located on the distal phalanx of the middle finger near the nail bed. The procedure demonstrates several key principles that are essential for successful outcomes, including the necessity of complete cyst excision to prevent recurrence, the importance of careful dissection near the germinal matrix to prevent permanent nail deformity, the value of a bloodless surgical field in maintaining precise visualization, and the significance of proper wound closure technique in ensuring optimal aesthetic and functional outcomes.
This video provides detailed step-by-step instruction for performing first dorsal compartment release in De Quervain’s tenosynovitis, with particular emphasis on anatomical landmarks, proper tissue handling, and identification of important neurovascular structures. The surgical release of the first extensor compartment for De Quervain’s tenosynovitis is a well-established procedure with consistently favorable outcomes when proper surgical technique is employed. When performed with attention to these technical details, the procedure provides reliable relief of symptoms with a low complication rate.
This surgical technique video would be particularly valuable for orthopaedic and hand surgery residents, as well as practicing surgeons who seek to refine their approach to first extensor compartment release. The detailed demonstration of nerve identification and the management of anatomical variations, especially the emphasis on finding accessory compartments, provides crucial technical aspects which help surgeons avoid complications and improve patient outcomes.
Robotic APR with bilateral gracilis flap reconstruction is a vital procedure for managing advanced and metastatic rectal cancer. It offers a precise, minimally-invasive approach that addresses both tumor removal and functional reconstruction, providing significant benefits for patients requiring complex oncological and reconstructive surgery. This step-by-step video guideline is crucial for advancing surgical techniques in complex rectal cancer treatment. It serves as a vital educational resource for surgeons at all levels, demonstrating the combination of APR with gracilis flap reconstruction. The video’s importance lies in its ability to standardize the procedure, showcase innovative techniques, and highlight critical aspects that are difficult to convey through text alone. Providing detailed visual instruction on navigating challenges helps prevent complications and improve patient outcomes.
The surgical management of posterior calcaneal osteophytes is a complex procedure that requires detailed surgical technique and precise anatomical understanding. Fluoroscopy serves as a real-time guidance tool, aiding in the visualization of the osteophyte during its removal. Specialized surgical instruments, primarily a sharp osteotome are utilized for initial bone removal, followed by a rongeur to refine and smooth any remaining sharp edges. This meticulous approach ensures the complete removal of the problematic bony proliferation while maintaining the surrounding tissue’s structural integrity. This surgical demonstration offers important educational value for multiple medical professionals involved in orthopaedic and musculoskeletal care. Orthopaedic surgeons, particularly those specializing in foot and ankle surgery, will find the detailed procedural technique useful for understanding nuanced surgical approaches to posterior calcaneal osteophytes. Orthopaedic residents and surgical trainees can benefit from the step-by-step demonstration of complex surgical techniques.
