Repeat Exploratory Laparotomy for Encapsulating Peritoneal Sclerosis
Joshua Ng-Kamstra, MD, MPH
Massachusetts General Hospital
Encapsulating peritoneal sclerosis (EPS), also known as encapsulating sclerosing peritonitis is a rare but serious condition that is characterized by the formation of a thick, fibrotic layer encasing the small bowel. The pathophysiology involves an inflammatory process that triggers excessive fibrin deposition and collagen production, resulting in the development of a thick, cocoon-like membrane around the intestines. This video is an in-depth demonstration of a complex surgical case involving a repeat exploratory laparotomy for bowel obstruction, with a focus on careful dissection of adhesions, managing serosal tears, and ensuring hemostasis. It is particularly valuable for surgeons, surgical trainees, and medical professionals specializing in emergency abdominal surgery.
Laparoscopic Appendectomy with Lysis of Adhesions for Appendicitis
Helen S. Wei, MD, PhD
Massachusetts General Hospital
Laparoscopic appendectomy (LA) is a minimally-invasive technique distinguished by the utilization of small incisions through which an endoscopic camera and specialized instruments are introduced to facilitate the excision of an inflamed vermiform appendix. This LA video serves as an educational tool, offering unique insights into complex surgical scenarios. It demonstrates real-time decision-making in the face of adhesions from previous surgery, showcasing how to adapt standard techniques to challenging anatomy. The video provides a clear visualization of advanced laparoscopic skills, including safe adhesiolysis, cautious dissection, and proper use of surgical devices. It emphasizes critical aspects of surgical safety, team communication, and complication management.
Airway Management: Techniques and Equipment
Dany Accilien, MD*, Dexter C. Graves, MD*, Nicholas Ludmer, MD†, Stephen Estime, MD†, Abdullah Hasan Pratt, MD
UChicago Medicine
This video article discusses airway management techniques in trauma resuscitation. It outlines the preparation and equipment used in patients with impending airway failure that require airway protection and ventilatory support. We discuss the innovative airway towers used in the University of Chicago emergency room as well as the general approach to airway management. We also go over the different types of laryngoscopy, assist devices, and cricothyroidotomy surgical airway procedures.
Laparoscopic Lysis of Adhesions for Closed Loop Small Bowel Obstruction
Jade Refuerzo, BS; Nicole B. Cherng, MD
UMass Memorial Medical Center
Laparoscopic lysis of adhesions is a minimally-invasive approach to the resolution of a closed loop small bowel obstruction (SBO) due to adhesions. A patient with an SBO can present with nausea, vomiting, abdominal pain, and obstipation. History of prior abdominal surgeries serves as a significant risk factor for development of intra-abdominal adhesions. Imaging using either plain abdominal radiography or computed tomography (CT) can be diagnostic for closed loop SBOs. Conservative management with gastrografin can be considered in some SBOs, but closed loop SBOs are considered surgical emergencies. Utilization of specific signs (two transition points, pneumoperitoneum, signs of bowel ischemia) on imaging and patient presentation can facilitate earlier intervention.
Laparoscopic lysis of adhesions can resolve symptoms through releasing the bowel from the adhesion to improve flow. Lysis of adhesions can be performed open, laparoscopically, or with robotic techniques. This case presents a laparoscopic lysis of adhesions in a patient with a closed loop small bowel obstruction.
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