PUBLISHED: Laparoscopic Resection of Gastric GIST Tumor

Laparoscopic Resection of Gastric GIST Tumor
Daniel Rice1David Rattner, MD2
1Lake Erie College of Osteopathic Medicine
2Massachusetts General Hospital

This case illustrates a laparoscopic resection of a gastrointestinal stromal tumor (GIST): the most common mesenchymal tumor found in the gastrointestinal tract. GISTs can be found anywhere along the gastrointestinal tract; however, they are most commonly found in the stomach and small intestine. These tumors are often associated with mutations in the KIT (receptor tyrosine kinase) and PDGFRA (platelet-derived growth factor receptor alpha) genes. Because it is difficult to achieve a permanent cure using protein tyrosine kinase inhibitors, such as imatinib, surgical resection is the recommended therapy in most cases. While the surgical approach may vary on tumor characteristics, the laparoscopic approach is associated with low perioperative morbidity and mortality.

PUBLISHED: Laparoscopic Instruments

Laparoscopic Instruments
Brandon Buckner, CST, CRCST
Lamar State College Port Arthur (TX)

The origins of laparoscopic surgery trace back to the introduction of diagnostic laparoscopy in the 1960s. Subsequently, the approach underwent a notable evolution, transitioning from a primarily diagnostic procedure to a surgical technique. Laparoscopy, a type of minimally invasive surgery, was introduced to address issues related to significant tissue trauma, large cosmetic scars, and prolonged hospitalizations. This video provides a step-by-step demonstration of the assembly, disassembly, use, and handling of laparoscopic tools on the example of a basic Karl Storz laparoscopy kit.

PUBLISHED: Transcervical Vocal Fold Injection (In-Office)

Transcervical Vocal Fold Injection (In-Office)
Seth M. Cohen, MD, MPHC. Scott Brown, MD
Duke University Medical Center

Vocal fold injection (VFI) is a treatment modality applicable to various laryngeal diseases and is successfully used as an alternative to laryngeal framework surgery. The indications for in-office VFI include vocal fold paralysis, paresis, atrophy, and scarring along with their sequelae. This video is a detailed demonstration of office-based VFI in a patient with unilateral vocal fold paralysis (UVFP), which is the most common neurologic disorder affecting the larynx.

PUBLISHED: Laparoscopic Subtotal Fenestrating Cholecystectomy in a Cirrhotic Patient

Laparoscopic Subtotal Fenestrating Cholecystectomy in a Cirrhotic Patient
Rachel M. Schneider, MPH; Nicole B. Cherng, MD
UMass Memorial Medical Center

In patients with difficult gallbladders due to anatomy prohibiting a clear critical view of safety, a subtotal cholecystectomy can be considered as a safer alternative to a total cholecystectomy. Subtotal cholecystectomies can be divided into “reconstituting” or “fenestrating.” Subtotal reconstituting cholecystectomies include closing off the lower end of the gallbladder to create a remnant gallbladder, while subtotal fenestrating cholecystectomies do not occlude the gallbladder and instead may involve suturing the cystic duct. The most common indication for subtotal fenestrating cholecystectomy is inflammation in the hepatocystic triangle, and subtotal fenestrating cholecystectomy has proven to be useful specifically for patients with a history of cirrhosis.

This case report describes the performance of a subtotal fenestrating cholecystectomy for the management of acute on chronic cholecystitis in a patient with cirrhosis initially managed with transcystic stent placement endoscopically. Management of this patient’s omental adhesions to the gallbladder required alterations to typical surgical technique, which will be described in this report. Additionally, the indications for subtotal fenestrating cholecystectomy will be discussed alongside the benefit of this technique to specific patient populations presenting with acute on chronic cholecystitis.

PUBLISHED: Rotator Cuff Repair (Cadaver Shoulder)

Rotator Cuff Repair (Cadaver Shoulder)
Patrick Vavken, MD1Sabah Ali2
1Smith and Nephew Endoscopy Laboratory
2University of Central Florida College of Medicine

Rotator cuff tears represent the vast majority of shoulder disorders treated by orthopaedic surgeons. From partial-thickness tears in overhead throwing athletes to full-thickness tears in the elderly, the prevalence of rotator cuff tears continues to increase over time. While some cases are asymptomatic, most patients with rotator cuff tears report shoulder pain, limited range of motion, and nighttime pain with difficulty sleeping on the affected shoulder. When nonsurgical treatment is insufficient in relieving the symptoms, arthroscopic rotator cuff repair becomes a viable option for many patients.

This is the case of a rotator cuff repair of a full-thickness tear that extends into the infraspinatus on a cadaver shoulder in the beach chair position. The tear was repaired by placing an anchor, retrieving and passing three suture arms, and tying the suture. This article outlines the natural history, preoperative care, intraoperative technique, and postoperative considerations of rotator cuff repairs.

PUBLISHED: Exploratory Laparotomy for Bowel Obstruction with Primary Repair of Two Diaphragmatic Hernias

Exploratory Laparotomy for Bowel Obstruction with Primary Repair of Two Diaphragmatic Hernias
Katherine H. Albutt, MD
Massachusetts General Hospital

A diaphragmatic hernia (DH) is characterized by protrusion of abdominal organs into the chest cavity through an opening in the diaphragm. A sliding or paraesophageal hernia is the most prevalent type, characterized by its occurrence near the esophageal hiatus. Typically present since birth, it can also develop later in life, occasionally arising as a result of severe trauma or iatrogenic injury. Less often, congenital DHs protrude through posterolateral or substernal diaphragmatic defects, referred to as Bochdalek and Morgagni hernias, respectively.

DH can remain asymptomatic and is commonly detected as an incidental finding during evaluation for other medical issues. Hiatal hernias differ from abdominal wall hernias in that they are influenced by the constant motion of the diaphragm, which exerts continuous friction and pressure changes on the esophagus and the stomach. As a result, hiatal hernias have a higher likelihood of recurrence following surgical correction in comparison to abdominal hernias.

This is the case of an exploratory laparotomy for bowel obstruction and primary pledgeted repair of two diaphragmatic hernias.

PUBLISHED: Opening Sterile Surgical Instrument Containers

Opening Sterile Surgical Instrument Containers
Brandon Buckner, CST, CRCSTCrystal Romero
Lamar State College Port Arthur (TX)

In contemporary healthcare settings, the need to balance efficiency, cost-effectiveness, and environmental responsibility has led to the widespread adoption of reusable containers for surgical instruments. This video demonstrates the advantages of employing reusable rigid containers for surgical instruments, using a laparoscopic set from Baptist Hospitals of Southeast Texas as a case study.