Laparoscopic Appendectomy
VA Boston Healthcare System
Marco Fisichella, MD, MBA, FACS
Assistant Professor of Surgery, Harvard Medical School
Associate Chief of Surgery, VA Boston Healthcare System
A 66-year-old man with a history of polyps has undergone colonoscopic surveillance every 3 years. After the recent discovery of an adenoma at the patient’s appendiceal orifice, Dr. Marco Fisichella performs a laparoscopic appendectomy.
Leiomyosarcoma of the Inferior Vena Cava: Resection and Reconstruction
Massachusetts General Hospital
Madhukar S. Patel, MD, MBA, ScM
Department of Surgery, MGH
Jahan Mohebali, MD, MPH
Department of Surgery, Division of Vascular and Endovascular Surgery, MGH
Parsia A. Vagefi, MD, FACS
Department of Surgery, Division of Transplant Surgery, MGH
Alex B. Haynes, MD, MPH, FACS
Department of Surgery, Division of Surgical Oncology, MGH
A woman presented with back pain, and when biopsied, she was found to have an inferior vena cava leiomyosarcoma - specifically involving the infrahepatic vena cava, the origin of the left renal vein, and the hilum of the right kidney. After undergoing preoperative proton beam radiation, the patient has her tumor resected en bloc by Dr. Vagefi and Dr. Haynes. They will also reconstruct the vena cava with a ringed synthetic graft covered by an omental pedicle flap.
Open Lobectomy
Massachusetts General Hospital
Christopher R. Morse, M.D.
Assistant Professor of Surgery, Harvard Medical School
Co-Director, Gastroesophageal Surgery Program
An adult male with cystic fibrosis (CF) presents with a chronically damaged left upper lung lobe that Dr. Christopher Morse decides to treat with an open lobectomy given that the patient was not going to heal from antibiotic therapy and still had mild preserved pulmonary function. Two unusual things in this procedure are the dense inflammatory changes at the hilum and the use of muscle from chest wall to reinforce the bronchial closure because of the patient’s recurrent and chronic pulmonary infections due to CF.
Distal Gastrectomy (Open)
John T. Mullen, MD
Director, General Surgery Resident Program
Massachusetts General Hospital
An 80-year-old patient with anemia undergoes an upper endoscopy that reveals inflammation in the distal stomach. Biopsies identify it as an early intramucosal adenocarcinoma while an endoscopic ultrasound shows the tumor invading the muscle of the stomach. Given that there are no signs of metastasis, the patient presents for a potentially curative gastrectomy where Dr. John Mullen removes the distal two-thirds of the stomach, performs a D1 lymph node dissection and a partial D2 lymph node dissection, and reconstructs in a Billroth II fashion.
Wedge Resection of the Lung and Thymectomy by Thoracoscopy
Massachusetts General Hospital
Henning A. Gaissert, MD
Lucia Madariaga, MD
Visiting Surgeon, MGH & Associate Professor of Surgery, Harvard Medical School
Fellow in Thoracic Surgery, MGH
A patient with myasthenia gravis undergoes a procedure meant to originally be a lobectomy and thymectomy. Henning Gaissert, MD decides to do a lobe wedge resection instead given the tumor’s positioning and carcinoid nature before proceeding with the thymectomy. Please note that the patient had to return to the OR the following day due to bleeding near the internal mammary vein.
Laparoscopic Adrenalectomy
Massachusetts General Hospital
Richard Hodin, M.D.
Professor of Surgery, Harvard Medical School
After visiting an endocrinologist who diagnosed her with aldosteronism, the patient takes a CT scan that reveals a 8mm nodule in the left adrenal gland. Dr. Hodin performs a laparoscopic adrenalectomy to remove it.
Laparoscopic Resection of Gastrointestinal Stromal Tumor
Massachusetts General Hospital
David Rattner, M.D.
Chief of Gastrointestinal and General Surgery
After a patient is found to have a gastrointestinal stromal tumor (GIST), David Rattner, MD performs a laparoscopic resection, carefully avoiding the nerves of Latarjet. He then confirms the success of the procedure with an upper GI endoscopy.
Minimally Invasive Ivor Lewis Esophagectomy
Massachusetts General Hospital
Christopher R. Morse, M.D.
Assistant Professor of Surgery, Harvard Medical School
Co-Director, Gastroesophageal Surgery Program
A patient presents with dysphagia and is found to have a locally advanced distal esophageal adenocarcinoma. She is treated with neoadjuvant chemoradiotherapy and Christopher R. Morse MD performs a minimally invasive Ivor Lewis esophagectomy.
Left Laparoscopic Donor Nephrectomy
Massachusetts General Hospital
Tatsuo Kawai, MD, PhD
Extraction of donor kidneys is transitioning from an open to a laparoscopic procedure. Professor of Surgery Dr. Tatsuo Kawai walks us through this minimally invasive technique.
Laparoscopic Sleeve Gastrectomy
Massachusetts General Hospital
Ozanan R Meireles MD
General and Gastrointestinal Surgeon
Dr. Meireles expertly conducts the world’s most commonly performed bariatric surgery for weight loss in this JoMI production on textbook sleeve gastrectomies.