Neuraxial Ultrasound and Spinal Anesthesia for Cesarean Delivery
Fatine Karkri, MD; Lauren Blake, MD; Brendan Carvalho, MBBCh, FRCA, MDCH, FASA
Stanford University School of Medicine
This video provides a step-by-step demonstration of preprocedural neuraxial ultrasound for lumbar neuraxial procedures. The film shows probe selection and orientation, sonoanatomy landmarks (sagittal and transverse views), measurement of skin-to-posterior complex depth, and skin marking. Indications and evidence for improved procedural accuracy and reduced needle passes are discussed. The technique is applicable to routine obstetric neuraxial procedures and is especially useful in patients with challenging surface landmarks or a history of difficult neuraxial placement.
Robotic-Assisted Transabdominal Preperitoneal (rTAPP) Repair for Ventral Hernias
Daphne Y. Lu, MD, MPH, MBA; Olivia Ziegler, MD; Saamia Shaikh, DO, JD; Jerome R. Lyn-Sue, MD, FACS
Penn State Health Milton S. Hershey Medical Center
This case describes a 58-year-old man who developed a symptomatic incisional ventral hernia following a trauma laparotomy and left nephrectomy after a motor vehicle collision. The patient presented with multiple midline hernia defects associated with bulging and discomfort. This video demonstrates a robotic transabdominal preperitoneal (rTAPP) repair with mesh. The case highlights practical strategies for managing intra-abdominal adhesions and a prior gastrostomy site, while outlining alternative operative approaches for cases in which preperitoneal flap development is technically challenging.
Robotic Retromuscular eTEP Repair of Ventral Incisional Hernias and Diastasis
Benjamin S. C. Fung, MD, FRCSC1; Eric M. Pauli, MD, FACS, FASGE2
1North York General Hospital, University of Toronto
2Penn State Health Milton S. Hershey Medical Center
A 55-year-old female has a history of multiple abdominal surgeries including laparoscopic cholecystectomy, appendectomy, laparoscopic hysterectomy, tubal ligations, and multiple cesarean sections through a low transverse (Pfannensteil) incision. Cross-sectional imaging demonstrated multiple midline hernias ranging from 1–3 cm, a rectus diastasis measuring 4 cm wide, and intraparietal cesarean section (C-section) hernia (Zanellato Type II). She underwent a robotic retromuscular extended totally extraperitoneal (eTEP) repair wherein her ventral midline hernias, rectus diastasis, and intraparietal hernia were all repaired and reinforced with wide mesh overlap. This case highlights the strengths of an eTEP approach, the decision making behind considering all of a patient’s abdominal wall pathology, and the considerations with intraparietal hernias post C-section.
Setup for an Open Total Thyroidectomy (Ivy Tech Community College, Indianapolis, IN)
David Wiseman, AAS, CST
Ivy Tech Community College, Indianapolis, IN
Open total thyroidectomy is a commonly performed endocrine surgery. Using a standardized protocol for back table and Mayo stand setup can improve surgical efficiency and boost patient safety. The protocol demonstrated in this educational video covers instrument arrangement, specialized equipment preparation, and safety considerations specific to thyroid surgery. The setup includes organization of forceps, specialized bipolar energy devices, clip appliers, nerve monitoring equipment, and self-retaining retractors. Key safety measures include dual towel protection layers, separation of toothed versus smooth instruments, and sharps management. This protocol provides surgical technology students with a comprehensive framework for thyroidectomy setup and reinforces the fundamental principles of patient safety and procedural efficiency.
Excision of Suspected Chronic Infected Suture Sinus
Benjamin S. C. Fung, MD, FRCSC1; Eric M. Pauli, MD, FACS, FASGE2
1North York General Hospital, University of Toronto
2Penn State Health Milton S. Hershey Medical Center
A 65-year-old female with a history of a left deep inferior epigastric perforator (DIEP) flap for breast reconstruction presented with an incisional hernia and a draining sinus tract overlying the site for her DIEP flap harvest confirmed on physical exam and cross-section imaging. She underwent a wound exploration where the entire suture sinus was excised, and it was confirmed that there was no residual foreign material left in the area. This case highlights the importance of staged abdominal wall reconstruction and addressing chronic infection before proceeding with surgery.
Excision of Infected Onlay Mesh
Benjamin S. C. Fung, MD, FRCSC1; Eric M. Pauli, MD, FACS, FASGE2
1North York General Hospital, University of Toronto
2Penn State Health Milton S. Hershey Medical Center
A 73-year-old female has a history of ventral hernia repair with onlay mesh complicated by mesh infection requiring multiple debridement. She later underwent additional laparotomies for other procedures that led to her previous mesh being chronically infected and exposed to air. Multiple office debridement did not successfully remove all of the mesh. She was taken to the operating room where her onlay mesh was completely excised. This case highlights the importance of complete foreign body excision when dealing with infected prostheses of the abdominal wall.
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