Category Archives: Announcement

PUBLISHED: Robotic Low Anterior Resection with Diverting Loop Ileostomy for Locally Advanced Rectal Cancertapedectomy

Robotic Low Anterior Resection with Diverting Loop Ileostomy for Locally Advanced Rectal Cancer

Todd Francone, MD
Massachusetts General Hospital, Newton-Wellesley Hospital

Jon Harrison, MD
Massachusetts General Hospital

In this video article, Dr. Todd Francone at Newton-Wellesley Hospital demonstrates and narrates a robotic low anterior resection for locally advanced rectal cancer after neoadjuvant FOLFOX-based chemoradiation treatment. Low anterior resection is recommended for rectal tumors in which a 1-cm distal margin is achievable without sphincter encroachment. A key component of this operation is a complete mesorectal dissection, which is highlighted with the robotic technique. In this case, the patient had a 2.6-cm tumor located 6 cm above the anal verge, which was treated with 8 cycles of FOLFOX followed by consolidative radiation therapy. A robotic low anterior resection was performed, and the final pathology revealed a complete pathologic response.

PUBLISHED: Open Distal Pancreatectomy for Pancreatic Cancer

 

Open Distal Pancreatectomy for Pancreatic Cancer

Carlos Fernandez-del Castillo, MD
Massachusetts General Hospital

Morgan L. Hennessy, MD, PhD
Massachusetts General Hospital

In this case, Dr. Carlos Fernandez-del Castillo at MGH performs and narrates an open distal pancreatectomy with splenectomy in a patient who has undergone neoadjuvant treatment for pancreatic adenocarcinoma. This is a unique case of a patient undergoing surgical resection after initial diagnosis of metastatic disease. The patient is a 69-year-old woman who initially presented with abdominal pain and bloating, and was found to have a 2-cm suspicious tumor in the body of her pancreas and biopsy-proven single liver metastasis. She was treated with an extended course of neoadjuvant chemotherapy, and re-staging scans showed significant response. Chemoradiation was completed, and the liver metastasis was no longer visible on imaging. 27 months after diagnosis she was taken to the operating room for distal pancreatectomy and splenectomy; no liver or peritoneal metastases were seen. Her postoperative course was overall uneventful, and she recovered well. Final surgical pathology demonstrated complete pathological response with no evidence of disease seen and 0/11 lymph nodes positive for malignancy.

 

PUBLISHED: Endoscopic Stapedectomy

 

 

Endoscopic Stapedectomy

Scott Brown, MD, FACS
University of Miami Miller School of Medicine

Michael E. Hoffer, MD
University of Miami Miller School of Medicine

Benjamin Park
Vanderbilt University School of Medicine

In this video, Dr. Scott Brown performs an endoscopic stapedectomy for the treatment of conductive hearing loss. He explains his technique and the advantages afforded by adoption of the endoscope in ear surgery.

 

PUBLISHED: De Quervain’s Release (Cadaver)

 

De Quervain’s Release (Cadaver)

Asif M. Ilyas, MD, FACS
Rothman Institute at Thomas Jefferson University

Irene Kalbianr
Rothman Institute at Thomas Jefferson University

De Quervain’s release is a surgical procedure performed to curatively treat stenosing extensor tenosynovitis of the first extensor compartment of the wrist after nonoperative management fails. This procedure involves surgical release of the first dorsal compartment with care taken to fully release the abductor pollicis longus (APL) and extensor pollicis brevis (EPB) tendons from their respective sheaths, while protecting the radial sensory nerve, in order to decompress the extensor tendons. This video outlines the operative technique used by Dr. Asif Ilyas at the Rothman Institute for performing a De Quervain’s release on a cadaveric wrist.

 

PUBLISHED: Flexor Tendon Repair for a Zone 2 FDP Tendon Laceration

 

Flexor Tendon Repair for a Zone 2 FDP Tendon Laceration

Asif M. Ilyas, MD, FACS
Rothman Institute at Thomas Jefferson University

Chaim Miller
Sidney Kimmel Medical College at Thomas Jefferson University

In this case, Dr. Asif Ilyas at the Rothman Institute presents a zone 2 flexor tendon repair with a 4-0 Ethibond suture with a modified Kessler stitch that resulted in an 8-core strand repair. The procedure was done under wide awake local anesthesia no tourniquet (WALANT) protocol, which among other strengths allows the surgeon to test the repair and set postrehabilitation expectations for the patient.

 

PUBLISHED: Bonebridge Implant

 

Bonebridge Implant

Scott Brown, MD
Duke University Medical Center

David M Kaylie, MD, MS
Duke University Medical Center

Cecilia G Freeman
Duke University Medical Center

Bone conduction implants can improve hearing in patients with conductive or mixed hearing loss as well as in cases of single-sided deafness (SSD). The patient in this case previously underwent resection of a vestibular schwannoma via a middle fossa craniotomy that ultimately resulted in SSD. Here, Dr. Kaylie at Duke University Medical Center demonstrates the step-by-step surgical technique for the Bonebridge implant to allow sound transmission from the patient’s deaf ear to the contralateral cochlea via bone conduction.

 

PUBLISHED: Altemeier Perineal Proctosigmoidectomy for Rectal Prolapse

 

Altemeier Perineal Proctosigmoidectomy for Rectal Prolapse

Madison S McCarthy
Stanford University School of Medicine

Charlotte M Rajasingh, MD
Stanford University School of Medicine

Brooke Gurland, MD
Stanford University School of Medicine

Full-thickness rectal prolapse occurs when the rectum invaginates into the anal canal and beyond the anal sphincters. The only definitive treatment for rectal prolapse is surgery. Here, Dr. Brooke Gurland at Stanford University Medical Center presents an Altemeier proctosigmoidectomy on an 80-year-old female with full-thickness rectal prolapse. The redundant rectum is delivered and then excised through a transanal approach, and the proximal colon is sutured to the distal end of the rectum.

 

PUBLISHED: Introduction to Bedside Cardiac Ultrasound

Introduction to Bedside Cardiac Ultrasound

Allyson Peterson, MD
UChicago Medicine

Nadim Michael Hafez, MD
UChicago Medicine

Point of care cardiac ultrasound is a key diagnostic tool in evaluating any patient who is in extremis. Indications for a bedside cardiac ultrasound include cardiac arrest, unexplained hypotension, syncope, shortness of breath, chest pain, and altered mental status. There are no absolute contraindications for a limited bedside cardiac ultrasound. Point of care cardiac ultrasound mainly consists of four views: the parasternal long, parasternal short, apical four chamber, and subxiphoid views. Here, Dr. Peterson and Dr. Hafez at UChicago Medicine discuss image acquisition, pearls and pitfalls, and pathology for each of these views as an introduction to the bedside cardiac ultrasound.

PUBLISHED: Site-Specific Posterior Colporrhaphy and Perineorrhaphy for Rectocele

Site-Specific Posterior Colporrhaphy and Perineorrhaphy for Rectocele

Lori R. Berkowitz, MD
Mass General Hospital

Patricia L. Hudson, MD
Massachusetts General Hospital

This patient is a 38-year-old female who presented with fecal incontinence, constipation, and stress urinary incontinence. She was found to have stage II posterior vaginal wall prolapse. She desired definitive surgical management of her prolapse and opted for posterior vaginal repair. Although stress urinary incontinence was demonstrated on urodynamic testing, the decision was made not to proceed with concurrent midurethral sling given her history of pelvic floor dyssynergia and intermittent urinary retention. Here, Dr. Berkowitz and Dr. Hudson at MGH present and demonstrate a site-specific posterior colporrhaphy and perineorrhaphy.

PUBLISHED: Shouldice Repair for Left Direct Inguinal Hernia

Shouldice Repair for Left Direct Inguinal Hernia

Michael Reinhorn, MD, FACS
Mass General Brigham – Newton-Wellesley Hospital
Boston Hernia and Pilonidal Center
Tufts University School of Medicine

Divyansh Agarwal, MD
Massachusetts General Hospital

Lauren Ott, PA-C
Mass General Brigham – Newton-Wellesley Hospital
Boston Hernia and Pilonidal Center
Tufts University School of Medicine

In this article, Dr. Michael Reinhorn shows the case of a 51-year-old male who presented with left groin pain and a bulge in the area, worsened while straining or after a long day of physical activity. The patient underwent a mesh-free hernia repair performed via the four-layer Shouldice technique as a 50-minute ambulatory/day-surgery procedure. This article and the associated video describe the pertinent history, evaluation, and operative steps of the procedure.