Elbow arthroscopy is a technically demanding procedure but it is very useful to evaluate the entire elbow joint for pathology with minimal surgical exposure and faster recovery than a traditional arthrotomy. The neurovascular structures of the elbow joint are in close proximity to the joint, thus there is a risk of injury to these structures, so care must be taken to fully understand elbow anatomy and to be prepared for aberrations. Elbow arthroscopy can be used diagnostically, as in this video article, or to surgically treat a variety of conditions including ligamentous tears, loose bodies, capsular stiffness, osteochondritis dissecans of the elbow, osteophyte debridement, and lateral epicondylitis. A patient with a previous ulnar nerve transposition is a relative contraindication to elbow arthroscopy, as there is a high risk of injury to the ulnar nerve during portal placement.
Thyroidectomy (Cadaver) Kristen L. Zayan, BS1; Adam Honeybrook, MBBS2; C. Scott Brown, MD2; Daniel J. Rocke MD, JD2 1University of Miami Miller School of Medicine 2Duke University Medical Center
Thyroidectomy may be performed for various pathologies, consisting of either thyroid lobectomy or total gland removal. Both benign and malignant disease processes necessitate surgical intervention. Thyroid nodules, compressive thyroid goiter, or persistent thyrotoxicosis represent some of the benign indications. Malignant conditions affecting the thyroid include papillary, follicular, medullary, and anaplastic carcinomas. In the present case, a thyroidectomy via standard cervical incision is performed on a cadaver with overlying animations to emphasize the key anatomy. The discussion is in relation to a patient with obstructive goiter presenting with worsening wheezing, cough, and dysphagia, with the ultimate goal of relieving the compressive symptoms through the removal of the gland.
Pleural effusions are frequently observed in a variety of conditions. Reasons for intervention include obtaining an underlying diagnosis as to the cause and providing symptom relief. One of the most frequent causes of a recurrent pleural effusion is malignancy, which will typically continue to accumulate for as long as the cancer is progressing. When patients have a rapidly recurring effusion, requiring frequent intervention by way of thoracentesis or chest tube, other options for management are considered. An indwelling pleural catheter (IPC) can be offered to a patient to help drain the effusion on a regular basis, without requiring repeat thoracentesis. The goal of the drain placement is to provide symptom relief, and it is often in place for as long as the patient has an appreciable effusion that can be drained intermittently by vacuum canisters.
As arthroscopic and minimally-invasive procedures have become increasingly more common over the past decade, a versatile understanding of several arthroscopic knot tying techniques is essential for reproducible and reliable repairs. While there are numerous descriptions of unique arthroscopic knots, selection and correct implementation is critical for adequate soft tissue fixation and successful patient outcomes. Specifically, the Roeder knot, a type of locking sliding knot, with 3 alternating half hitches, has been described to provide the loop and knot security among other sliding knot techniques. Therefore, the Roeder knot has emerged as a preferred knot tying technique amongst orthopedic surgeons, especially in the setting of arthroscopic shoulder stabilization procedures. In this case, we describe the basic fundamentals of performing a Roeder knot with 3 alternating half hitches to anchor the labrum to the glenoid in the setting of an arthroscopic Bankart repair.
This case presentation involved a female patient with breast cancer who underwent a lumpectomy and sentinel lymph node biopsy using the Lumicell system for intraoperative detection of residual cancer. The aim was to detect residual tumor cells during the initial operation and avoid subsequent surgeries. This video provides a thorough presentation of lumpectomy and sentinel lymph node biopsy utilizing the Lumicell system to detect any remaining cancer during surgery. The video covers the entire process, from preoperative preparation to the final step of skin closure.
Cystic Fibrosis (CF) is an autosomal recessive genetic disorder characterized by mutations in the cystic fibrosis transmembrane regulator gene. The pathophysiology is based on abnormal chloride secretion from columnar epithelial cells. As a result, patients with CF have symptoms related to their inability to hydrate secretions in the respiratory tract, pancreas, and intestine, among other organs. In the lung, thick, inspissated secretions give rise to chronic obstructive pulmonary disease characterized by severe pulmonary infections, culminating in respiratory failure. Subacute exacerbations of CF lung disease are treated with antibiotics and various forms of chest physiotherapy. When large areas of the lung develop abscesses or necrosis, surgical treatment is often indicated. Options include lobectomy as a temporizing measure and lung transplantation for end-stage CF lung disease.
This article presents an unusual case of a man with CF whose lung function had remained relatively good until adulthood. His left upper lobe became chronically infected and progressively non-functional. Because the patient’s overall lung function was moderately preserved, an open left upper lobectomy was performed to prevent recurrences of subacute infections and subsequent damage to the left lung.
Left Hip Hemiarthroplasty for Femoral Neck Fracture Michael Akodu, MBBS; Elyse J. Berlinberg, MD; Miles Batty, MD; Michael McTague, MPH; Kiran J. Agarwal-Harding, MD, MPH Beth Israel Deaconess Medical Center
Hip fractures are a major cause of morbidity and mortality, especially among older patients. They also account for a significant portion of healthcare spending and other non-medical costs. These fractures can be classified into various types based on the parts of the femoral head and neck affected, and fixation options are dependent on both patient and injury characteristics. In this video, Dr. Agarwal-Harding takes us through a hip hemiarthroplasty for a left femoral neck fracture, highlighting various guiding principles and surgical considerations.
Femoral fractures typically occur in two major settings: high-energy mechanisms related to trauma and low-energy mechanisms in insufficiency fractures observed in elderly patients with osteopenia. Patients present with pain, swelling, and limited range of motion.
Intramedullary nailing is the definitive surgical treatment for femoral fractures to allow secondary healing of bone. Such a repair is performed here on a patient with a diaphyseal femoral fracture. Surgeon preference was to perform a closed cephalomedullary nailing with the patient supine on a radiolucent fracture table for traction.
The case demonstrates the use of ureteroscopy with laser lithotripsy in the treatment of an obstructed left proximal ureteral stone with forniceal rupture. The patient presented to the emergency department with the signs and symptoms of a ureteral stone and was taken for imaging and a diagnostic ureteroscopy. Following confirmation of the diagnosis, the patient was scheduled for ureteroscopy with laser lithotripsy.
A guidewire was placed, followed by visualization with a retrograde pyelogram and a subsequent flexible ureteroscopy. Laser lithotripsy was performed to fragment the stone. Following fragmentation, the renal pelvis and calyces were visualized to examine for retrograde movement of stone fragments. A confirmatory retrograde pyelogram was then performed, followed by placement of a temporary stent for fluid drainage. The patient was then discharged with opioids for pain medication and prophylactic antibiotics to prevent urinary tract infections and the subsequent risk of urosepsis.
Cryptorchidism, or undescended testis, is a condition in which one or both testes fail to descend from the abdomen into the scrotum during fetal development. Phimosis, on the other hand, is a condition characterized by the inability to retract the foreskin over the glans penis.
This video serves as a step-by-step guide on orchiopexy to correct an undescended testicle and circumcision to correct phimosis. The importance of this surgical intervention lies in the preservation of testicular function, fertility potential, and the prevention of long-term complications associated with cryptorchidism. Early treatment is crucial, as it significantly reduces the risk of testicular damage and associated complications.
