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.
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.
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.
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.
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.
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.
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.
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.
Marcus V. Ortega, MD;Emily C. Von Bargen, DO; Liliana Bordeianou, MD
Massachusetts General Hospital
This is the case of an 87-year-old female who presented with a history of constipation and bothersome rectal prolapse that required manual rectal prolapse reduction. She had minimal constipation and minimal incontinence, and anorectal manometry revealed low rectal pressures. On exam, she was found to have full-thickness rectal prolapse and stage II posterior vaginal wall pelvic organ prolapse. Gynecological POP-Q exam showed mostly posterior prolapse and some apical prolapse, and urodynamic testing was negative. Defacography revealed an enterocele. Here, Dr. Bordeianou and Dr. Von Bargen at MGH discuss the decision-making process when treating rectal prolapse and perform a laparoscopic suture rectopexy with culdoplasty, vaginal wall repair, and perineorrhaphy with levator plication.
Jonah Poster
Shriners Hospitals for Children – Boston
Jonathan Friedstat, MD
Shriners Hospitals for Children – Boston
Massachusetts General Hospital
Burn scar contracture of the dorsal foot causes metatarsophalangeal joint hyperextension and interphalangeal joint hyperextension. In children, these issues only intensify over time as a child grows. Here, Dr. Friedstat at Shriners Hospitals for Children in Boston presents the case of a young boy who suffered a 32% total body surface area flame burn to his lower back, bilateral buttocks, legs, and feet. This patient had previously undergone a bilateral contracture release of the dorsum of the foot. Because the contractures recurred, another bilateral dorsal foot scar contracture release was performed using a split-thickness 1:1 meshed skin graft harvested from the anterior left thigh.