Flexible bronchoscopy is a commonly utilized endoscopic procedure allowing for direct visualization of the airways, as well as a variety of therapeutic and diagnostic interventions. Common indications of flexible bronchoscopy include evaluation of pulmonary infiltrates, hemoptysis, airway obstruction, foreign body aspiration, tracheal stenosis, bronchopleural fistula, and post-lung transplant.
The procedure involves the insertion of a flexible bronchoscope through the vocal cords and into the lumen of the trachea and bronchi. Direct visualization is provided by fiberoptic video imaging. Bronchoalveolar lavage (BAL) further refers to instillation and subsequent recovery of sterile saline into the airways. In this article, we will detail the technique, considerations, and complications of flexible bronchoscopy and BAL.
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.
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.
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) 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.
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.
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.
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.
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.
