Stapedotomy (Endaural) David M. Kaylie, MD, MS1; Trey A. Thompson2; C. Scott Brown, MD1 1Duke University Medical Center 2University of Washington School of Medicine
Otosclerosis is a condition characterized by abnormal bone growth that inhibits the movement of the stapes, leading to a gradual conductive hearing loss. The treatment options encompass observation, the use of hearing aids, and surgical intervention. If the patient opts for surgery, either a stapedotomy or a stapedectomy can be executed to liberate the stapes from the sclerotic bone.
In the case of a stapedotomy performed with an endaural approach, access to the middle ear is gained through a minor incision extending from the anterior ear canal to the incisura, also known as the intertragal notch. The surgeon then proceeds to remove the superstructure of the stapes, create an opening in the footplate of the stapes, and subsequently place a prosthesis into the opening, which is then connected to the incus. The outcomes of this procedure are generally positive, with 90–95% of patients experiencing an improvement in hearing.
Minor lower extremity amputations typically involve either toe or ray resections. The first ray is an essential component in the normal anatomy and biomechanics of the foot. By definition, the first ray consists of the hallux and the first metatarsal. The surgical procedure discussed in this educational video is a left first toe ray amputation on a cadaver. Toe amputation is a significant predictor of future limb loss. Ray amputation appears to be preferred over finger amputation in selected cases. However, the literature does not provide precise indications on when to consider a ray over a toe amputation. The choice is therefore left to the operating surgeon, based on their clinical expertise and the patient’s conditions and expectations, taking into account the underlying pathology.
Open Proctocolectomy for Hirschsprung’s Disease Mudassir Shah Akhter, MD1; Marcus Lester R. Suntay, MD, FPCS, FPSPS, FPALES2 1Oregon Health and Science University 2Philippine Children’s Medical Center
Hirschsprung’s disease is the main genetic cause of functional intestinal obstruction. Most cases are diagnosed in the first few months of life given classical presentation and ease of testing with rectal suction biopsy. The disease is due to the absence of enteric ganglion cells in the distal colon that results in functional constipation. Resection of the affected segment and bringing the normal bowel close to the anus has been the mainstay of treatment. Due to advances in surgical treatment over the past decades, a significant reduction in morbidity and mortality has been observed, and the previously multistage procedure can now be completed in one stage, as presented here.
Primary leiomyosarcomas of the inferior vena cava (IVC) are rare tumors with complex anatomical relationships. Surgical resection remains the primary approach for management, with selective use of preoperative radiation and chemotherapy. Given the propensity for local invasion of these tumors, radical resection of surrounding structures is often required.
This article describes the presentation, work-up, operative management, and outcomes of these lesions through the case of a patient with a tumor involving the middle segment of the IVC. Given the extent of involvement, IVC resection with en bloc right nephrectomy, right adrenalectomy, and partial left renal vein resection was performed with vascular reconstruction using a prosthetic graft. With appropriate preoperative planning and a well-coordinated multidisciplinary approach, aggressive surgical resection can be safely performed and patients can benefit from favorable long-term survival.
Proper wound closure techniques are essential for promoting healing, minimizing scarring, and reducing postoperative complications. By providing a detailed, step-by-step guide to various suturing methods, this video serves as an invaluable tool for surgical training programs and continuing medical education. The detailed explanation of each technique, coupled with practical demonstrations, provides a valuable resource for both beginner and experienced practitioners. By emphasizing proper technique, instrument handling, and tissue management, this demonstration contributes significantly to the development of essential surgical skills.
The primary survey of every trauma patient begins with ABC: airway, breathing, circulation. If the patient is deemed to require airway management, endotracheal intubation may be performed utilizing rapid sequence intubation (RSI). In RSI, an induction agent and a rapid-acting neuromuscular blocking agent (NMBA or paralytic) are administered and intubation is performed as soon as unconsciousness and paralysis are achieved. Trauma patients may require intubation for a number of reasons. This video review focuses on the pharmacology, dosing, and other considerations for use of common medications for pretreatment, paralysis with induction, and post-intubation management in trauma patients.
A hemothorax is a collection of blood within the pleural cavity. Blood can accumulate within this space as a sequelae of chest trauma (penetrating or blunt), iatrogenic injury (e.g., vascular access injuries), or spontaneously (e.g., due to malignancy). To treat the condition, a chest tube is inserted into the thoracic cavity on the affected side of the body. In addition to evacuating blood from the pleural cavity, a chest tube can also be used to treat pneumothorax (air in the pleural space) and pleural effusion (e.g., empyema or chylothorax), and to insert medications into the pleural space. Depending on the specific pathology, a tube or catheter may be utilized.
Ganglion cysts are benign, mucinous-filled swellings that overly tendons and joints. They are the most common soft tissue mass found in the hand and wrist but also commonly encountered in the knee and foot. Presenting as a palpable knot, the cyst is asymptomatic until it impinges on local neurovasculature causing pain, numbness, tingling, and/or motor deficits. Pediatric ganglion cysts have different epidemiological characteristics than adults, with the majority found on the volar aspect on the wrist.
Treatment of ganglion cysts is most often observation due to the 50% chance of resolution over time. Activity causes the cyst to increase in size, and thus more aggressive treatment is often desirable. If the cyst recurs or symptoms are not relieved with observation alone, a more aggressive treatment such as surgical excision is often desirable. This article presents a female pediatric patient undergoing surgical excision of a large ganglion cyst on the dorsum of her right wrist. With the treatment options explained to her, she chose excision for the lower rate of recurrence.
Deltoid Ligament Repair William B. Hogan1; Eric M. Bluman, MD, PhD2 1Warren Alpert Medical School of Brown University 2Brigham and Women’s Hospital
Injury to the medial deltoid ligament complex is rare as it is the strongest of the ankle ligaments. However, damage to this structure can occur, often in association with an avulsion fracture of the medial malleolus due to the ligamentous strength of the complex. Deltoid ligament repair remains a primary option for patients with severe acute injuries, or patients with chronic instability who have failed conservative measures.
Repair of the medial ankle ligaments provides improved stability with reduced risk of recurrent sprains and potential damage to local cartilage. This article presents a case of a young woman with concomitant medial and lateral ankle instability who successfully underwent deltoid ligament repair for her medial ligament injury.
Robotic Thymectomy for Myasthenia Gravis Constantine M. Poulos, MD1; Tong-Yan Chen, MD2; Lana Schumacher, MD, MS, FACS1 1Tufts Medical Center 2Massachusetts General Hospital
Myasthenia gravis is an autoimmune disease affecting acetylcholine transmission involved in skeletal muscle contraction. The approach to myasthenic patients is complex as optimal treatment involves a multidisciplinary technique of combined medical and surgical therapies. Medical therapy with acetylcholinesterases and immunomodulators can provide symptom relief and eliminate feelings of fatigue and weakness.
Surgical thymectomy can help by reducing symptoms, preventing recurrence, and reducing daily medication requirements. Thymectomy was traditionally performed via a transsternal approach, but minimally invasive and robotic techniques have become increasingly common. This article presents a robotic total thymectomy through a left-sided approach.
