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 cadaveric study aims to provide a detailed overview of the key steps involved in the dissection of the frontal sinus, including the identification of anatomical landmarks, performing of Draf I, II-A, II-B, and III procedures, and the preservation of mucosal structures. The meticulous identification and preservation of crucial anatomical landmarks, such as the frontal sinus outflow tract, the agger nasi, and the vertical lamella of the middle turbinate, are essential for avoiding complications, including injury to the AEA or inadvertent penetration of the cribriform plate.
By familiarizing themselves with the step-by-step approach outlined in this text and the accompanying video, surgeons can enhance their technical proficiency and improve patient outcomes in the management of frontal sinus-related conditions. For medical students and trainees, this video offers an invaluable learning opportunity to develop a deep understanding of frontal sinus anatomy and the nuances of endoscopic dissection techniques. By using this knowledge, healthcare professionals can enhance their surgical skills, improve patient care, and contribute to the advancement of the field of endoscopic sinus surgery.
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.
Tympanoplasty (Revision) C. Scott Brown, MD1; Alex J. Carsel2; Calhoun D. Cunningham III, MD1 1Duke University Medical Center 2University of Toledo College of Medicine
The tympanic membrane (eardrum) acts as a protective barrier between the middle and external ear, guarding the middle ear against infection. Additionally, it plays a crucial role in hearing by facilitating impedance matching between the air in the external canal and the fluid in the inner ear. Disruption of the tympanic membrane can lead to hearing loss, recurrent infections, and ear drainage. Common etiologies of perforations include infection and trauma. When perforations persist and cause symptomatic hearing loss or recurrent infections, surgical repair by an otolaryngologist becomes necessary. Although primary tympanoplasty has high success rates (75–95%), failures can complicate subsequent repair attempts. This case study presents a 61-year-old female who underwent two prior tympanoplasties without success. Dr. Cunningham demonstrates intraoperative decision-making and surgical techniques for repair in challenging cases.
This article present the case of a female patient in her early 20’s who was seen for follow up after 5 months of rehabilitation following surgical procedures to address instability in both the medial and lateral sides of her right ankle. This patient reported achieving an excellent outcome, and her subjective sense of significant improvement after rehabilitation was aligned with her physical exam and radiographic evaluation. This case documents the improvements made by the patient during the rehabilitation process and outlines essential steps to be performed by the practitioner in the clinical examination and radiographic follow up after surgery for ankle instability.
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.
The ethmoid arteries, comprising the anterior and posterior branches, are integral vascular structures that hold immense significance in the realm of sinus and skull base surgery. Originating from the third segment of the ophthalmic artery, these arteries traverse through the medial orbit before passing through the respective ethmoidal canals and entering the ethmoid air cells. Understanding the anatomical significance and clinical implications of the anterior and posterior ethmoid arteries is paramount in ensuring safe and effective management of sinus pathologies and associated complications. Accurate preoperative assessment, appropriate surgical techniques, and a thorough knowledge of these vascular structures are essential for optimizing patient outcomes and minimizing the risk of adverse events during surgical interventions.
