This case illustrates a midshaft femoral fracture with an ipsilateral subtrochanteric fracture that is repaired with a retrograde femoral intramedullary nail technique. The annual incidence of midshaft femur fractures is approximately 10 per 100,000 person-years (most commonly low-energy falls in elderly females). Generally, these patients will present with pain, inflammation, and shortening of the leg.
Retrograde femoral intramedullary nail placement is one of the most prevalent methods for treatment. It was initially discovered in 1970 and refined in 1995 to have improved surgery time, bleeding, and postoperative adverse outcomes. This procedure has proven to be particularly beneficial in obese and non-ambulatory patients, and those with multisystem injuries; it also has shown some benefit in pregnant women due to decreased pelvic radiation exposure.
This case presents a woman with a femoral shaft fracture and an ipsilateral subtrochanteric fracture. Given this patient’s multiple ipsilateral femur fractures, it was favorable to intervene with a retrograde femoral intramedullary nail. The procedure was done in a supine position due to favorable imaging throughout the operation.
Colonic polyps are projections from the surface of the colonic mucosa. Most are asymptomatic and benign. Over time, some colonic polyps develop into cancers.
Carcinoid tumors develop from cells in the submucosa. They are slow-growing neoplasms. Carcinoid tumors of the colon are rare, comprising less than 11% of all carcinoid tumors and only 1% of colonic neoplasms. The majority of patients diagnosed with carcinoid tumors have no symptoms, and their tumors are found incidentally during endoscopy.
This is the case of a middle-aged male who had an unresectable polyp in the ascending colon and a carcinoid tumor in the ileocecal valve. The patient underwent laparoscopic right colectomy with ileocolic anastomosis to remove both lesions.
This is the case of a 66-year-old man with a history of colon polyps, who undergoes colonoscopy every 3 years for surveillance. During the last colonoscopy, he was found to have a polyp at the appendiceal orifice. The biopsy showed the presence of adenoma.
Therefore, the patient underwent a laparoscopic appendectomy with wedge resection of the cecum. The operation went well and took less than an hour. The specimen was opened, and the adenoma was found within the lumen of the appendix, with at least 1.5 cm of clear margin. The patient was sent home the same day, and resumed regular diet and physical activities the following morning.
Gunshot wounds to the abdomen are one of the most classic trauma cases a surgeon will come across in their career. The high velocity of a bullet can cause massive internal and external trauma to the abdomen. Exploration of the small bowel using laparotomy is often indicated after a penetrating traumatic injury or when peritoneal signs are present.
This video article shows the most common techniques for performing an exploratory laparotomy. In this case, the abdomen was explored and was revealed to show a through-and-through gunshot wound to the jejunum, as well as a partial-thickness tear of the proximal cecum; the abdomen was explored for any smaller bleeds or leaks, and the abdomen was closed.
Acute appendicitis is a medical condition where the appendix becomes inflamed and causes pain in the lower right quadrant of the abdomen. In addition to pain, appendicitis can cause peritonitis, perforations, and can lead to death if left untreated. Laparoscopic appendectomy is the standard surgical procedure to treat the symptoms of appendicitis as well as prevent further spread of infection. While appendicitis typically advances in an irreversible fashion necessitating surgery, conservative management with antibiotic therapy can sometimes resolve symptoms.
In this case, a 24-year-old patient had a delayed presentation with acute perforated appendicitis. Following successful non-operative treatment with antibiotics, she presented for a laparoscopic interval appendectomy. She also had a non-symptomatic umbilical hernia, which was repaired following removal of the laparoscopic ports for the appendectomy.
Subtrochanteric femoral fractures commonly present in two different populations under very different circumstances. The elderly are commonly affected by low-energy events, such as a simple fall to the floor, while younger populations are more likely to be involved in high-energy events such as motor vehicle accidents. The majority of elderly injuries can be attributed to fragility fractures due to loss of bone density, but it is important to note an atypical fracture pattern that is present in those who have been taking bisphosphonates.
This video demonstrates an intramedullary fixation of a reverse oblique subtrochanteric femoral fracture in the lateral position. There is a classic deformity seen in subtrochanteric fractures due to strong muscular attachments in the region. In this video, we show that while the lateral position may be more difficult for obtaining x-rays, it provides natural external forces that make reduction and fixation easier.
Nipple-Sparing Mastectomies (NSMs) with breast reconstruction are commonly performed for both breast cancer treatment or risk-reducing prophylactic mastectomies and have superior aesthetic results compared to total mastectomy or skin-sparing mastectomy. Preservation of the Nipple Areolar Complex (NAC) results in a more natural aesthetic appearance of the reconstructed breast, as well as greater patient satisfaction, as indicated by improved psychosocial and sexual well-being compared to total mastectomy. Preservation of vascular supply is of utmost importance for NAC and mastectomy skin flap viability after surgery, since postoperative ischemic complications can significantly undermine the aesthetic outcomes.
This report describes a contemporary NSM surgical technique developed by the senior author (MK), to preserve the dominant NAC vascular supply, and decrease postoperative ischemic complications. A total of 114 NSM were performed from 2018 to 2020 by the senior author. Based on preoperative breast MRI with contrast visualization of the vascular supply to the NAC, the Internal Mammary Perforator (IMP) vessels exiting the pectoralis major muscle at the sternal border were found to provide the dominant blood supply to the NAC in 92% and could be preserved in 89% of cases.
The Internal Mammary Perforator Preserving Nipple-Sparing Mastectomy (IMP-NSM) surgical technique was developed to preserve this important IMP blood supply to the NAC, resulting in decreased postoperative ischemic complications. Following implementation of this surgical technique, NAC necrosis requiring NAC removal occurred in 0.9%, and mastectomy skin necrosis requiring reoperation in 1.8% of cases, resulting in successful NAC preservation in the majority of patients. Furthermore, due to the consistent anatomical location of the IMP vascular supply to the NAC, this critical vascular supply can routinely be preserved even without preoperative MRI, thereby improving clinical outcomes. The IMP-NSM surgical technique is described in detail in this report with a case example.
Laparoscopic sigmoid resection is indicated for disease of the distal sigmoid or rectum that requires resection, most notably diverticulitis and colorectal cancer. Here, we perform a sigmoid resection for diverticular disease. In this procedure, we used four laparoscopic port sites.
In the first step, we mobilized the splenic flexure and left colon to allow for a tension-free colorectal anastomosis low in the pelvis. Second, the mesorectum was dissected to mobilize the rectum down to the level of the pelvic floor. Third, the left colic and inferior mesenteric arteries were ligated, the colonic mesentery was transected with an energy device, and the distal resection margin was stapled intracorporeally. Fourth, the specimen was extracorporealized through the umbilical port site, and the proximal transection was performed. Finally, an anvil was inserted, and the colon was placed back into the abdomen where a trans-anal, stapled end-to-side Baker-type anastomosis was performed and endoscopically tested for leaks.
A chalazion is a sterile granulomatous inflammation of the Meibomian or Zeiss glands. It results from the obstruction of gland orifices, which leads to accumulation of sebum in the tarsus and eyelid soft tissue. The resulting inflammation causes erythema, pain, and swelling. Patients may note a previous history of similar complaints, as well as a history of rosacea and chronic blepharitis.
Chalazion incision and curettage is a treatment of choice in unresolved chalazia or cases that do not respond to conservative treatments such as warm compress. Chalazion surgery aims to effectively drain the blocked gland and remove the inflamed tissue, providing relief to patients and restoring the natural appearance of the eyelid. This article discusses and demonstrates the preoperative assessment of the patient, the preparation, surgical procedure, and the postoperative care.
End stage renal disease (ESRD) is the final stage in the progression of chronic kidney disease (CKD). CKD has a multitude of etiologies, presents in a variety of ways, and progresses in a patient-dependent manner. Despite the heterogeneity of CKD, once ESRD ensues, patients require Renal Replacement Therapy (RRT). RRT is one of three prongs: hemodialysis, peritoneal dialysis, or kidney transplant.
Of these, kidney transplantation provides the patient with the best quality of life, an improved survival, and an opportunity for cure. However, the success of kidney transplantation with improved outcomes and tolerance to the required immunosuppression has led to an extreme organ shortage despite the increase in deceased organ donors. As a result, the push for living donors has become increasingly more important.
For recipients, the best outcomes are with transplants from a living donor due to superior graft quality and elimination of the need for waiting and dialysis. This article will present such a case and discuss the important considerations a physician must make preoperatively and intraoperatively when performing kidney transplantations.
