Laparoscopic Appendectomy
VA Boston Healthcare System
Marco Fisichella, MD, MBA, FACS
Assistant Professor of Surgery, Harvard Medical School
Associate Chief of Surgery, VA Boston Healthcare System
A 66-year-old man with a history of polyps has undergone colonoscopic surveillance every 3 years. After the recent discovery of an adenoma at the patient’s appendiceal orifice, Dr. Marco Fisichella performs a laparoscopic appendectomy.
Partial Glossectomy
Duke University Medical Center
Liana Puscas, MD, MHS
Associate Director, Otolaryngology Residency Program
Associate Professor of Surgery
C. Scott Brown, MD
Department of Surgery
Division of Head and Neck Surgery & Communication Sciences
A patient presented with a well-circumscribed lesion of her tongue that had been interfering with eating as it grew. After an in-office biopsy that diagnosed it as metastatic breast cancer, Dr. Liana Puscas and her resident perform a partial glossectomy to alleviate the patient’s symptoms.
Leiomyosarcoma of the Inferior Vena Cava: Resection and Reconstruction
Massachusetts General Hospital
Madhukar S. Patel, MD, MBA, ScM
Department of Surgery, MGH
Jahan Mohebali, MD, MPH
Department of Surgery, Division of Vascular and Endovascular Surgery, MGH
Parsia A. Vagefi, MD, FACS
Department of Surgery, Division of Transplant Surgery, MGH
Alex B. Haynes, MD, MPH, FACS
Department of Surgery, Division of Surgical Oncology, MGH
A woman presented with back pain, and when biopsied, she was found to have an inferior vena cava leiomyosarcoma - specifically involving the infrahepatic vena cava, the origin of the left renal vein, and the hilum of the right kidney. After undergoing preoperative proton beam radiation, the patient has her tumor resected en bloc by Dr. Vagefi and Dr. Haynes. They will also reconstruct the vena cava with a ringed synthetic graft covered by an omental pedicle flap.
Open Lobectomy
Massachusetts General Hospital
Christopher R. Morse, M.D.
Assistant Professor of Surgery, Harvard Medical School
Co-Director, Gastroesophageal Surgery Program
An adult male with cystic fibrosis (CF) presents with a chronically damaged left upper lung lobe that Dr. Christopher Morse decides to treat with an open lobectomy given that the patient was not going to heal from antibiotic therapy and still had mild preserved pulmonary function. Two unusual things in this procedure are the dense inflammatory changes at the hilum and the use of muscle from chest wall to reinforce the bronchial closure because of the patient’s recurrent and chronic pulmonary infections due to CF.
Endolymphatic Sac Decompression
Duke University Medical Center
Calhoun D. Cunningham III, MD
C. Scott Brown, MD
Department of Surgery
Division of Head and Neck Surgery & Communication Sciences
A patient with intractable Meniere’s disease presents for decompression of the endolymphatic sac. Dr. Calhoun Cunningham demonstrates the anatomical boundaries of the sac and explains his approach of stenting the sac open in order to alleviate the patient’s symptoms.
Minimally Invasive Direct Coronary Artery Bypass (MIDCAB)
VA Boston Healthcare System
Marco Zenati, MD
Chief of Cardiothoracic Surgery, VA Boston Healthcare System & Professor of Surgery, Harvard Medical School
After experiencing chest pressure while exercising, a 72-year-old patient tested positive in both a stress test and nuclear medicine study, triggering a left heart catheterization that revealed a high grade lesion of the proximal left anterior descending coronary artery. His cardiologist determined the lesion would not be amenable to angioplasty or stenting, so Dr. Marco Zenati performs a minimally invasive coronary artery bypass (MIDCAB).
Cox-MAZE IV with Coronary Artery Bypass Graft and Mitral Valve Replacement
VA Boston Healthcare System
Marco Zenati, MD
Chief of Cardiothoracic Surgery, VA Boston Healthcare System & Professor of Surgery, Harvard Medical School
In this long and complicated case, Dr. Marco Zenati performs a full, biatrial Cox-MAZE IV procedure with coronary artery bypass grafting (CABG) and a mitral valve replacement (MVR), moving between the three procedures as necessary to minimize time on the ischemic heart. The patient suffers from congestive heart failure that recently escalated from class II to class III.
Distal Gastrectomy (Open)
John T. Mullen, MD
Director, General Surgery Resident Program
Massachusetts General Hospital
An 80-year-old patient with anemia undergoes an upper endoscopy that reveals inflammation in the distal stomach. Biopsies identify it as an early intramucosal adenocarcinoma while an endoscopic ultrasound shows the tumor invading the muscle of the stomach. Given that there are no signs of metastasis, the patient presents for a potentially curative gastrectomy where Dr. John Mullen removes the distal two-thirds of the stomach, performs a D1 lymph node dissection and a partial D2 lymph node dissection, and reconstructs in a Billroth II fashion.
Posterior Cruciate-Retaining Total Knee Arthroplasty
Richard Scott, MD
Professor of Orthopaedic Surgery, Emeritus
Harvard Medical School
Abstract: Total knee arthroplasty has evolved into a very successful procedure to relieve pain and restore function in the arthritic knee with advanced structural damage. Optimal results are dependent on the restoration of alignment and ligament stability. Operative techniques involve either preservation of the posterior cruciate ligament or substitution of its function through increased prosthetic constraint. The vast majority of knees do not require cruciate substitution to establish appropriate stability and function. This video outlines the operative technique used by the author for posterior cruciate-retaining total knee arthroplasty in a patient with a preoperative varus deformity.
Laser Stapedotomy for Otosclerosis
Duke University Medical Center
Calhoun D. Cunningham III, MD
C. Scott Brown, MD
Department of Surgery
Division of Head and Neck Surgery & Communication Sciences
In a staple surgery for conductive hearing loss, Dr. Calhoun Cunningham III performs a laser stapedotomy and prosthesis placement via transcanal approach. A thickened footplate does not preclude its success in alleviating the patient's longstanding hearing loss.