Tracheomalacia is a rare congenital condition that results in incompetence of the trachea, the main airway, leading to collapse of the trachea during respiration. Most often this is due to inadequate bone formation in the trachea, and this causes it to be dynamically collapsed, which can result in breathing difficulties for the child. Upper respiratory infections can also be more common. While most cases of tracheomalacia resolve by 18 to 24 months of age, a small percentage either continue or cause such severe breathing or feeding issues that surgical intervention is warranted. In cases where the innominate artery is the cause of compression of the weakened trachea, an aortopexy to elevate the vessel up to the sternum and away from the trachea is performed.
This video presents a case of bilateral open indirect inguinal herniotomy. The patient, a 12-year-old male, presented to the medical facility with complaints of bilateral protruding masses in the inguinal regions. These masses have been causing him discomfort and pain, particularly during physical exertion. Upon palpation, the masses exhibited an elastic consistency, increased in size during bearing in a standing position, and were found to be reducible when the patient was in a supine position. The patient’s mother reported that these bulges have been present since his birth. Following a comprehensive clinical evaluation, a clinical diagnosis of congenital bilateral inguinal hernia was made. Consequently, a decision was made to perform a bilateral open inguinal herniotomy with high ligation of the hernia sac.
This video demonstrates the essential steps of a bilateral indirect inguinal herniotomy in a pediatric patient, highlighting the importance of proper anatomical dissection, identification of crucial structures, and the high ligation technique for successful hernia repair in children. The detailed procedural description, coupled with the emphasis on anatomical landmarks and technical nuances, makes this video a valuable educational resource for surgical trainees, who are learning the principles and techniques of pediatric inguinal hernia repair.
Surgical intervention for aortoiliac occlusive disease (AIOD) remains a vital tool in the management of AIOD. AIOD is caused by occlusion of the infrarenal and/or iliac arteries, often secondary to atherosclerosis. This article presents a case of a young, male patient with a history of familial hyperlipidemia and chronic tobacco use who underwent a thoracofemoral bypass (TFB) procedure via a retroperitoneal approach.
He presented with classic symptoms of bilateral leg pain when walking, nocturnal lower extremity pain, and correlated diminished lower extremity pulses. TFB was the preferred approach due to the aggressive, soft plaque burden extending into the suprarenal aorta, which precluded endovascular repair and would have increased risk for standard infrarenal aortofemoral bypass (AFB). This video and case report present a detailed explanation of a retroperitoneal approach to a TFB procedure.
This comprehensive video is intended to provide a detailed overview of the surgical technique used to repair a right inguinal hernia in Honduras on a 1-year-old boy who presented with a swelling in his scrotum, which had been present since he was two months old. The surgical procedure is narrated by an experienced pediatric surgeon, highlighting the unique challenges and innovative techniques employed in this case, which can be valuable for surgeons facing similar situations. The importance of this video lies in its educational value for surgeons, particularly those involved in surgical missions or practicing in resource-limited settings.
Carotid Endarterectomy (Cadaver) Meghan Robinson1; Laura Boitano, MD2; Samuel Schwartz, MD2 1Lake Erie College of Osteopathic Medicine 2Massachusetts General Hospital
Carotid stenosis is one of the leading causes of ischemic stroke worldwide. In the United States, nearly 800,000 strokes are reported each year, with ischemia accounting for 87% of them, and 15% traced to a carotid origin. Carotid endarterectomy represents an effective surgical treatment for carotid stenosis in preventing the risk of future ischemic stroke. This video-article demonstrates the surgical technique for carotid endarterectomy on a cadaver and discusses a typical case presentation of an individual who could potentially benefit from this procedure.
Current evidence supports the use of robotic surgery as a method of minimally-invasive treatment for adrenal masses. This article presents the case of a robotic adrenalectomy (RA) for an adrenal tumor. Upon examination of the extracted 1.5-cm specimen, it exhibited typical characteristics of aldosterone-producing adenoma, including a golden tan color, well-circumscribed borders, and surrounding normal adrenal gland tissue and fat. The detailed demonstration of this surgical procedure in the accompanying video provides a thorough understanding of the latest advancements in robotic adrenal surgery, offering comprehensive insights into the nuanced techniques and emerging trends in the field.
This video describes the surgical technique for an open duodenal resection and antrectomy, which was performed for a neuroendocrine tumor of the duodenal bulb. In this procedure, an upper midline laparotomy is first made, followed by mobilization of the distal stomach, duodenum, and head of the pancreas. Next is to Kocherize the duodenum, then ligate that right gastric artery and dissect the gastrohepatic ligament, followed by ligation of the right gastroepiploic vessels and taking down the gastrocolic ligament exposing the lesser sac. Once the structures are adequately mobilized, the first portion of the duodenum is dissected off of the head of the pancreas and transected with a TA stapler. The antrectomy is performed next, removing the specimen. For the reconstruction, a retrocolic end-to-side hand-sewn gastrojejunostomy was performed. This technique can be used for multiple indications, including peptic ulcer disease and other mass lesions of the antrum, pylorus, or duodenal bulb.
Patients who undergo longitudinal sleeve gastrectomy (LSG) may develop de novo or worsening of existing gastroesophageal reflux (GERD) symptoms, which include postprandial retrosternal burning, food refluxing, or dysphagia. Often patients with GERD following LSG present with a concomitant hiatal hernia. Workup serves to characterize a patient’s GERD disease burden by way of fluoroscopic upper gastrointestinal (UGI) series, pH studies, manometry, or esophagogastroduodenoscopy (EGD). Treatment first involves medical management with lifestyle modifications followed by use of pump inhibitors (PPIs) or Histamine H2-receptor antagonists (H2 Blockers or H2B). If GERD symptoms remain intractable to medical management, surgical intervention can be pursued.
Historically patients would undergo a conversion to a Roux-en-Y gastric bypass (RYGB). New data demonstrate comparable outcomes regarding GERD symptoms and improvements in anti-reflux medication use in patients status-post LSG who undergo ligamentum teres cardiopexy with hiatal hernia repair. This article describes a robotic ligamentum teres cardiopexy with hiatal hernia repair in an adult patient who previously underwent LSG and was experiencing intractable GERD symptoms despite lifestyle modification and optimization on anti-reflux medications.
Intraperitoneal Mesh Repair for Incisional Hernia William B. Hogan1; Yoko Young Sang, MD2; Shabir S. Abadin, MD, MPH3 1Warren Alpert Medical School of Brown University 2Louisiana State University Shreveport 3World Surgical Foundation
Incisional hernias remain an important postoperative complication of any procedure involving a laparotomy incision. Although most incisional hernias remain asymptomatic, incarceration and strangulation are emergent complications requiring prompt diagnosis and intervention. Mesh repair has become widely favored over simple suture repair of abdominal fascial defects in recent decades, though recurrence of incisional hernias remains high. Despite the advent of laparoscopic approaches to hernia repair, open approaches are utilized when numerous adhesions are encountered, laparoscopic access is unsafe, or when laparoscopy is not readily available. We present an open surgical repair of a large incisional hernia involving the abdominal midline and parastomal site in a woman with a history of laparotomy and colostomy with a subsequent reversal for a perforated colon.
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.
