Acute Subdural Hematoma Evacuation
Vincent Prinz, MD; Marcus Czabanka, MD
Charite Hospital Berlin
Subdural hematoma (SDH) is a type of intracranial bleeding that occurs between the dura and the arachnoid membrane surrounding the brain. This video is a step-by-step demonstration of a hematoma evacuation by craniotomy performed on an elderly female patient with an acute-on-chronic SDH.
Robotic-Assisted Laparoscopic Left Donor Nephrectomy for Living Kidney Donation
Srilakshmi Atthota, MBBS; Jessica Grasso, PA-C; Leigh Anne Dageforde, MD, MPH
Massachusetts General Hospital
Kidney transplantation is the preferred treatment for patients with end-stage renal disease and is associated with a better quality of life and survival compared to other renal replacement therapies. Compared to deceased donor kidneys, living donor kidney donation is associated with shorter wait times, improved patient and graft survival, and the possibility of preemptive transplantation.
After the initial learning curve, robotic-assisted living donor nephrectomy has similar outcomes compared to open and laparoscopic nephrectomy, and in some settings an overall decreased length of stay. This article presents the case of a robotic-assisted living donor nephrectomy, including evaluation, technique, and considerations for the surgeon preoperatively and intraoperatively.
Partial Glossectomy
Liana Puscas, MD, MHS1; C. Scott Brown, MD1; Vahagn G. Hambardzumyan, MD2
1Duke University Medical Center
2Yerevan State Medical University, Heratsi Hospital Complex
In this clinical case, a patient presented with a well-circumscribed lesion on her tongue, causing interference with eating as it grew. Despite its benign appearance, an initial in-office biopsy was performed and metastatic breast cancer was found.
Jaw and oral cavity involvement by metastatic disease is very rare, occurring in less than 1% of all oral malignancies. In this video, a partial glossectomy was performed to remove the lesion.
Robotic-Assisted Proximal Gastrectomy with a Laparoscopic-Assisted Double-Tract Reconstruction for Proximal Early Gastric Cancer
Raja R. Narayan, MD, MPH1,2,3; Jane C. Kim, MD1; Do Joong Park, MD, PhD1
1Seoul National University Hospital
2Dana-Farber Cancer Institute
3Brigham and Women’s Hospital
At most institutions caring for patients with early gastric cancer (EGC), tumors arising in the upper third of the stomach are usually managed with total gastrectomy and Roux-en-Y esophagojejunostomy. Given the impaired quality of life related to associated reflux and vitamin deficiencies, several high-volume centers have sought alternative gastrectomy and reconstruction strategies to total gastrectomy.
In this case, a patient with EGC in the cardia found on screening endoscopy undergoes robotic proximal gastrectomy with double-tract reconstruction. His postoperative course was unremarkable, and he was discharged on postoperative day 7. His pathology demonstrated no residual tumor after preoperative endoscopic submucosal dissection. This video demonstrates the technique of an experienced surgeon performing robotic proximal gastrectomy with double-tract reconstruction.
Vacuum-Assisted Closure (VAC) Change for a Complex Right Hip Wound
Joshua Ng-Kamstra, MD, MPH
Massachusetts General Hospital
Vacuum-assisted closure (VAC) is a method of wound management commonly employed as an adjunct to surgery that uses negative pressure to accelerate healing. This video is a comprehensive step-by-step demonstration of VAC change for a complex right hip wound. The patient is a male in his fourth decade with a history of paralysis beginning in childhood due to a spinal tumor. He was admitted to the hospital with a right hip joint infection complicated by methicillin-sensitive Staphylococcus aureus (MSSA) bacteremia. Given his immobility at baseline, the patient was deemed a suitable candidate for a Girdlestone procedure, which involved resection of the femoral head and proximal aspect of the femur, resulting in a complex wound with exposed bone.
Trauma Resuscitation Demonstration in a Stable Patient with a Minor Perforating Wound
Priya Prakash, MD
UChicago Medicine
This is the case study of a 17-year-old male Reserve Officers’ Training Corps (ROTC) cadet who suffered a superficial perforating saber wound to the medial part of the right knee during a routine practice session. This video demonstrates the step-by-step patient assessment process and subsequent saber removal.
Laparoscopic Resection of Gastric GIST Tumor
Daniel Rice1; David 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.
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.
Transcervical Vocal Fold Injection (In-Office)
Seth M. Cohen, MD, MPH; C. 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.
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.
