Partial mastectomy of the breast, also known as lumpectomy, is a breast-conserving procedure performed to remove many different types of masses and irregularities in the breast tissue. This involves a small incision concealed at the nipple borders or along the natural breast contours, followed by dissection of the area of concern. The excised tissue is then sent to pathology for final tissue diagnosis and, if applicable, to determine if appropriate margins have been achieved. Furthermore, Savi Scout utilization may help to localize the mass when it otherwise would be difficult to identify or locate. Many different breast pathologies can be removed in this fashion, both benign and malignant, depending on both biological and patient-specific details. In the case presented, a nonpalpable papilloma—typically found to be a benign breast lesion with an increased risk of harboring occult premalignant ductal carcinoma in situ (DCIS)—is surgically excised due to the presence of associated concerning symptoms in the patient.
This video is a comprehensive step-by-step demonstration of laparoscopic inguinal hernia repair using the TEP method. It features a middle-aged male with bilateral inguinal hernias who has experienced left groin pain for several years. This case is significant as it showcases the efficiency of laparoscopic techniques in addressing bilateral hernias, which are relatively common, through a single surgical procedure. The detailed description of the procedure provides valuable insights for surgeons at various stages of their careers. For novice surgeons, it offers a step-by-step guide to the TEP technique, highlighting critical anatomical landmarks and potential pitfalls. Experienced surgeons may benefit from the nuanced discussions on tissue handling, dissection techniques, and mesh placement.
Papillary thyroid cancer is the most common type of thyroid malignancy. While prognosis is overall favorable, many patients present with clinically positive lymph nodes, most commonly in the central neck compartment. Total thyroidectomy with central lymph node dissection is the treatment of choice in these patients.
Robotic paraesophageal hernia repair with concurrent LINX device placement represents an evolutionary step in the surgical management of complex hiatal pathology. When performed with appropriate patient selection and attention to technical detail, the procedure offers excellent outcomes with acceptable morbidity. This instructional video will be particularly beneficial for surgeons, surgical trainees, and advanced practice providers seeking to enhance their understanding of the technical aspects of robotic paraesophageal hernia repair with LINX placement, as well as for medical educators teaching complex, minimally-invasive upper gastrointestinal procedures.
Accurate diagnosis and monitoring of GERD are crucial for appropriate patient management and treatment selection. This demonstration highlights the advantages of the Bravo wireless system over traditional catheter-based methods for pH monitoring. The procedure proves particularly valuable in post-bariatric surgery patients, as illustrated in this case of a patient with previous sleeve gastrectomy, where GERD symptoms frequently require thorough evaluation. The extended 96-hour monitoring period provides comprehensive data regarding reflux patterns and symptom correlation, facilitating evidence-based decisions about medical or surgical management.
Yuri Novitsky’s description of the posterior component separation in 2012 has revolutionized the world of ventral hernia repairs. While large hernia defects above 10 to 12 centimeters seemed impossible to close primarily without tension, the technique of transversus abdominis release as described helped achieve posture as well as anterior abdominal wall closure without tension in addition to providing a highly vascularized medium for mesh integration in between these layers. Not only does the posterior component separation allow for medialization of the posterior rectus sheath to be closed in the midline, but it also gives a release to the anterior components of the abdominal wall to allow for recreation of the linea alba without tension.
Laparoscopic-Assisted Right Hemicolectomy Anthony D. Douglas II, MD; Derrius Anderson, MD; Jelani Williams, MD; Rowan Hussein; Ashley Russell; Konstantin Umanskiy, MD UChicago Medicine
The patient-centered environment of the operating room often precludes extensive intraoperative discussions or detailed explanations between a resident and the attending surgeon. This constraint in real-time feedback poses a challenge for surgical residents to refine their surgical skills. Implementation of a structured case review between attendings and senior residents at interval timepoints of their rotations could support addressing this gap. This case presents a laparoscopic right hemicolectomy. This procedure removes a portion of the colon and is commonly indicated for colon cancer. In this video article, a senior general surgery resident participates in the procedure and then engages in a structured case review with their attending, analyzing the fundamental steps of the procedure as well as identifying opportunities for technical improvement and enhancement of intraoperative decision-making.
Graves’ disease is an autoimmune condition that causes hyperthyroidism. There are several options for management which include medications, radioactive iodine ablation, and surgery. Over time, total or near-total thyroidectomy has become the gold standard in surgical management of this disease. Although there is a slightly higher risk of complications following total thyroidectomy in patients with Graves’ disease as compared to their non-Graves’ counterparts undergoing thyroidectomy, the absolute risk remains low, especially for high-volume endocrine surgeons.
An 80-year-old patient underwent an open onlay repair of a recurrent incisional hernia. This approach was chosen due to the patient’s prior retromuscular repair, age, history of adhesions, and religious preference against blood products. Following safe abdominal entry and adhesiolysis, a subcutaneous pocket extending 5 centimeters in all directions from the hernia was created. Fascia was closed using mesh-suture and a 12 x 12-centimeter macroporous, medium-weight polypropylene mesh was secured to the anterior fascia with staples and fibrin glue. A subcutaneous drain was placed. This case highlights the utility of an onlay approach for selected circumstances.
Robotic APR with bilateral gracilis flap reconstruction is a vital procedure for managing advanced and metastatic rectal cancer. It offers a precise, minimally-invasive approach that addresses both tumor removal and functional reconstruction, providing significant benefits for patients requiring complex oncological and reconstructive surgery. This step-by-step video guideline is crucial for advancing surgical techniques in complex rectal cancer treatment. It serves as a vital educational resource for surgeons at all levels, demonstrating the combination of APR with gracilis flap reconstruction. The video’s importance lies in its ability to standardize the procedure, showcase innovative techniques, and highlight critical aspects that are difficult to convey through text alone. Providing detailed visual instruction on navigating challenges helps prevent complications and improve patient outcomes.
