Category Archives: General Surgery

General Surgery, Print Release

PUBLISHED: Right Posterior Retroperitoneoscopic Adrenalectomy (PRA) for Adrenocortical Adenoma

Right Posterior Retroperitoneoscopic Adrenalectomy (PRA) for Adrenocortical Adenoma
Neeta Erinjeri, MD; Tobias Carling, MD, PhD, FACS
Yale School of Medicine

Posterior retroperitoneoscopic adrenalectomy (PRA) allows the surgeon to approach the adrenal gland through the back rather than the more traditional laparoscopic transabdominal adrenalectomy (LTA) approach. This technique was popularized in Germany but is being used increasingly throughout the United States. Smilow Cancer Hospital at Yale New Haven was one of the early adopters of this technique in the US, and Dr. Tobias Carling presents the operation here.

General Surgery, Print Release

PUBLISHED: Robotic Low Anterior Resection with Diverting Loop Ileostomy for Locally Advanced Rectal Cancertapedectomy

Robotic Low Anterior Resection with Diverting Loop Ileostomy for Locally Advanced Rectal Cancer

Todd Francone, MD
Massachusetts General Hospital, Newton-Wellesley Hospital

Jon Harrison, MD
Massachusetts General Hospital

In this video article, Dr. Todd Francone at Newton-Wellesley Hospital demonstrates and narrates a robotic low anterior resection for locally advanced rectal cancer after neoadjuvant FOLFOX-based chemoradiation treatment. Low anterior resection is recommended for rectal tumors in which a 1-cm distal margin is achievable without sphincter encroachment. A key component of this operation is a complete mesorectal dissection, which is highlighted with the robotic technique. In this case, the patient had a 2.6-cm tumor located 6 cm above the anal verge, which was treated with 8 cycles of FOLFOX followed by consolidative radiation therapy. A robotic low anterior resection was performed, and the final pathology revealed a complete pathologic response.

General Surgery, Print Release

PUBLISHED: Open Distal Pancreatectomy for Pancreatic Cancer

 

Open Distal Pancreatectomy for Pancreatic Cancer

Carlos Fernandez-del Castillo, MD
Massachusetts General Hospital

Morgan L. Hennessy, MD, PhD
Massachusetts General Hospital

In this case, Dr. Carlos Fernandez-del Castillo at MGH performs and narrates an open distal pancreatectomy with splenectomy in a patient who has undergone neoadjuvant treatment for pancreatic adenocarcinoma. This is a unique case of a patient undergoing surgical resection after initial diagnosis of metastatic disease. The patient is a 69-year-old woman who initially presented with abdominal pain and bloating, and was found to have a 2-cm suspicious tumor in the body of her pancreas and biopsy-proven single liver metastasis. She was treated with an extended course of neoadjuvant chemotherapy, and re-staging scans showed significant response. Chemoradiation was completed, and the liver metastasis was no longer visible on imaging. 27 months after diagnosis she was taken to the operating room for distal pancreatectomy and splenectomy; no liver or peritoneal metastases were seen. Her postoperative course was overall uneventful, and she recovered well. Final surgical pathology demonstrated complete pathological response with no evidence of disease seen and 0/11 lymph nodes positive for malignancy.

 

General Surgery, Print Release, Uncategorized

PUBLISHED: Altemeier Perineal Proctosigmoidectomy for Rectal Prolapse

 

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.

 

General Surgery, Ob/Gyn, Print Release, Uncategorized

PUBLISHED: Site-Specific Posterior Colporrhaphy and Perineorrhaphy for Rectocele

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.

General Surgery, Print Release

PUBLISHED: Shouldice Repair for Left Direct Inguinal Hernia

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.

General Surgery, Ob/Gyn, Print Release, Uncategorized

PUBLISHED: Laparoscopic Suture Rectopexy with Culdoplasty, Vaginal Wall Repair, and Perineorrhaphy for Rectal Prolapse

Laparoscopic Suture Rectopexy with Culdoplasty, Vaginal Wall Repair, and Perineorrhaphy for Rectal Prolapse

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.

General Surgery, Pediatrics, Plastic Surgery, Print Release

PUBLISHED: Bilateral Dorsal Foot Scar Contracture Release with Split-Thickness Skin Grafts from the Anterior Thigh

Bilateral Dorsal Foot Scar Contracture Release with Split-Thickness Skin Grafts from the Anterior Thigh

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.

General Surgery, Print Release

PUBLISHED: Peroral Endoscopic Myotomy (POEM) for Achalasia

Peroral Endoscopic Myotomy (POEM) for Achalasia

Daniel Hashimoto; Ozanan R Meireles, MD; David Rattner, MD
Massachusetts General Hospital

Impaired transit of food and liquid from the esophagus to the stomach results in symptoms of dysphagia, regurgitation, retrosternal fullness/pain, and weight loss. Symptoms can be managed with a range of medical or procedural therapy. However, the best results are obtained from surgical management with myotomy. Here, Drs. Rattner, Meireles, and Hashimoto at MGH perform and demonstrate a peroral endoscopic myotomy (POEM), which emerged as a less invasive manner through which to perform a myotomy and provides relief of dysphagia comparable to laparoscopic Heller myotomy – the current standard of surgical therapy for achalasia.

General Surgery, Otolaryngology, Print Release

PUBLISHED: Minimally Invasive Parathyroidectomy Under Local Cervical Block Anesthesia for Primary Hyperparathyroidism and Parathyroid Adenoma

Minimally Invasive Parathyroidectomy Under Local Cervical Block Anesthesia for Primary Hyperparathyroidism and Parathyroid Adenoma

Tobias Carling, MD, PhD, FACS
Yale School of Medicine

With improvement in both preoperative parathyroid tumor identification and the use of intraoperative parathyroid hormone assay, minimally invasive parathyroidectomy (MIP) is now performed more frequently in patients with primary hyperparathyroidism (pHPT). Still, many institutions are not familiar with performing MIP under regional or local anesthesia. Here, Dr. Tobias Carling presents an MIP performed under local cervical block anesthesia on a patient with pHPT and parathryoid adenoma.