Monthly Archives: September 2026

Print Release, Surgical Technology

PUBLISHED: Cystoscope Assembly and Preparation for a Cystoscopy

Cystoscope Assembly and Preparation for a Cystoscopy
Cindy Fletcher, M.Ed., CST
North Shore Community College, Danvers, MA

Cystoscopy is a fundamental diagnostic and therapeutic urological procedure. The patient’s safety is protected and the procedural flow is improved when the table and instrument setups are performed efficiently using sterile technique. This educational video demonstrates the preparation of the surgical field and step-by-step assembly of a standard rigid cystoscope, including the recommended workflow for sterile table arrangement, fluid management, and connection of the assembled cystoscope.

Orthopedic Trauma, Orthopedics, Print Release

PUBLISHED: Single-Incision Retrograde SIGN Nailing of the Femur and Antegrade SIGN Nailing of the Tibia for a Delayed-Presentation Floating Knee Injury

Single-Incision Retrograde SIGN Nailing of the Femur and Antegrade SIGN Nailing of the Tibia for a Delayed-Presentation Floating Knee Injury
Donald L. Fejfar, MD1; Samhita Kadiyala, BA1; Nikhil Gattu, MD1; Emily S. Powis, BS1; Elizabeth Rich, MD2; Ridwan M. Saeed, MD3; Hizkyas Kassaye, MD4; Pierre M. Woolley, MD5; Bitiel Banda, MD6; Kiran J. Agarwal-Harding, MD, MPH7
1Harvard Global Orthopaedics Collaborative, Boston, MA
2Walter Reed National Military Medical Center, Bethesda, MD
3Muhimbili Orthopaedic Institute, Dar es Salaam, Tanzania
4Hawassa University Comprehensive Specialized Hospital, Hawassa, Ethiopia
5Hôpital Universitaire La Paix, Port au Prince, Haiti
6Mzuzu Central Hospital, Mzuzu, Malawi
7Beth Israel Deaconess Medical Center, Boston, MA

Floating knee injury, defined as ipsilateral femoral and tibial shaft fractures, is a high-energy traumatic injury frequently seen following road traffic accidents (RTAs), which disproportionately burden low- and middle-income countries. Definitive treatment of this complex injury typically involves internal fixation, and the commonly accepted preferred method is intramedullary nailing of both fractures. This video article describes the surgical technique for managing a floating knee using retrograde Surgical Implant Generation Network (SIGN) nailing of the femur and antegrade SIGN nailing of the tibia through a single infrapatellar incision in a single anesthesia event.

The case involves a 28-year-old female patient in rural Malawi with a floating knee injury sustained in a motorbike RTA, notable for her delayed presentation of three weeks. The key procedural steps, performed under spinal anesthesia, began with a single infrapatellar incision for the subsequent retrograde nailing of the midshaft femur. Due to delayed presentation (22 days from the date of injury to the first exam in the hospital, with 2 more days before surgery) and callus formation, intraoperative fracture fragment mobilization via a second lateral incision was required before securing the femoral nail. The same infrapatellar incision was then used to perform antegrade nailing of the proximal tibial shaft fracture, which was secured after a closed reduction. This single-incision approach provides a definitive, robust fixation solution appropriate for a resource-constrained setting where challenges include delayed patient presentation and limited imaging infrastructure.

Print Release, Vascular Surgery

PUBLISHED: Snuffbox Radiocephalic Arteriovenous Fistula Creation for End-Stage Kidney Disease

Snuffbox Radiocephalic Arteriovenous Fistula Creation for End-Stage Kidney Disease
Brett J. Salomon, MD1; Christopher Holden-Wingate2,3; Mohamad A. Hussain, MD, PhD1,2; C. Keith Ozaki, MD1
1Mass General Brigham
2Harvard Medical School
3University of Illinois College of Medicine

The snuffbox arteriovenous fistula (SBAVF) is a distal-first dialysis access strategy connecting the posterior branch of the radial artery and cephalic vein within the anatomical snuffbox to preserve proximal vascular sites for patients requiring long-term hemodialysis (HD). This low-flow forearm fistula, which represents only 4% of forearm access creations in a contemporary large registry, provides significant clinical advantages over high-flow alternatives. These benefits include a significantly lower risk of high-output heart failure (HOHF) and negligible rates of access-related hand ischemia (ARHI). Contemporary literature confirms that SBAVF offers primary and secondary patency rates comparable to wrist AVFs at 18 months, supporting a “snuffbox first” approach for eligible candidates.

This case details successful SBAVF creation in a 38-year-old male with end-stage kidney disease (ESKD), which was selected to maximize vessel preservation given his prolonged expected duration of HD. Postoperatively, the patient was discharged without complication and subsequently cleared to trial HD after successful maturation. Although it is common for SBAVFs to require adjunctive procedures and more time to achieve maturation, long-term durability (5–9 years) remains outstanding, reinforcing the value of this technically precise procedure as a safe and durable primary access option.

Anesthesiology, Print Release

PUBLISHED: Ultrasound-Guided Radial Artery Catheterization in a Four-Month-Old Boy

Ultrasound-Guided Radial Artery Catheterization in a Four-Month-Old Boy
Jun Takeshita, MD, PhD
Osaka Women’s and Children’s Hospital

Ultrasound-guided radial artery catheterization is increasingly used in pediatric patients because it improves procedural accuracy and may enhance first-pass success in infants and small children with small-caliber arteries. Dynamic needle tip positioning (DNTP), a short-axis out-of-plane ultrasound-guided technique, facilitates repeated identification of the true needle tip during needle advancement and enables precise catheter placement.

This video demonstrates ultrasound-guided radial artery catheterization using the DNTP technique in a 4-month-old, 5.5-kg infant with tetralogy of Fallot undergoing a right-sided systemic-to-pulmonary shunt procedure. Because ipsilateral shunt flow may interfere with accurate arterial pressure monitoring, the left radial artery was selected for cannulation. The video illustrates key technical aspects of DNTP, including stepwise needle and probe advancement to maintain visualization of the true needle tip, as well as practical considerations for minimizing complications. It also emphasizes strict aseptic technique, including maximal sterile barrier precautions, a sterile ultrasound probe cover, and sterile ultrasound gel.

The arterial catheter was successfully placed without immediate complications and functioned appropriately throughout the procedure. This video provides a practical demonstration of DNTP and highlights procedural planning and infection prevention strategies for safe and effective pediatric radial artery catheterization.