Cardiovascular disease is a leading cause of morbidity and mortality in the United States and abroad, manifesting as shortness of breath, exercise intolerance, palpitations, and chest pain. While the majority of cases are treated medically, more advanced or severe cases are treated surgically or endovascularly, warranting an open discussion between the provider and the patient to decide the most appropriate treatment modality given the specific characteristics and preferences of the procedure and the patient.
The Cox-MAZE IV combined with CABG and Mitral Valve Replacement is a singular surgical procedure that is carefully planned and executed to address arrhythmic, coronary, and valvular disease while minimizing time on cardiopulmonary bypass with an arrested heart.
Central venous access is a crucial aspect in the management of patients requiring long-term therapies, particularly surgical patients. These therapies include the administration of therapeutic agents, fluid administration, antibiotic therapy, parenteral nutrition, etc. The procedure involves the placement of a catheter into a venous great vessel. Three main sites for central venous access are: internal jugular vein, common femoral vein, and subclavian veins.
In resource-constrained settings, healthcare professionals must rely on their clinical practice and proficiency in performing procedures without the aid of advanced imaging modalities. One such procedure is the infraclavicular subclavian vein cannulation, which can be performed without ultrasonographic guidance, providing a reliable means of obtaining central venous access. Here, this is demonstrated on a pediatric preoperative patient during a surgical mission in Honduras.
Laryngeal granulomas present with clinical signs and symptoms including dysphonia, hoarseness, discomfort or pain in the throat, and dyspnea. Notably, vocal granuloma, despite its name, pathologically is not a true granulomatous process. Instead, it is characterized as a reactive/reparative process where intact or ulcerated squamous epithelium is underlaid by granulation tissue or fibrosis. Although granulomas are typically of benign nature, they often require surgical treatment. Other options for treatment include proton-pump inhibitors (PPIs) and steroid inhalations, botulinum neurotoxin injection, and phonotherapy. Nearly half of the cases usually remit through clinical management involving PPIs, topical inhalant steroids, and phonotherapy.
The following case describes a 91-year-old woman with no significant past medical history who presented to her primary care physician with several months of cough and progressive dyspnea. After appropriate workup she was found to have a stage IVa lung adenocarcinoma with an associated malignant pleural effusion that contributed to her symptoms. There are several therapeutic options for treating a malignant pleural effusion. An indwelling tunneled pleural catheter (PleurX catheter) is a reliable way to manage a chronic pleural effusion. The device is most commonly used to manage malignant pleural effusions, but the same technique may be applied for a range of benign, non-infectious indications as well.
PleurX catheters may be inserted in an outpatient clinic, interventional radiology suite, inpatient setting, or operating room under local or general anesthesia. Once in place, they are designed to be managed in an outpatient setting either by the patient’s caregivers or by the patient themselves and serve to palliate the respiratory symptoms of a large effusion without the need for repeated thoracenteses. They can remain in place for several months, and removal in an outpatient setting with local anesthetic is trivial. Following placement of the PleurX catheter, the patient reported symptomatic improvement in her dyspnea, and she was started on dose-reduced Mobocertinib under the guidance of thoracic oncology.
Coronal Approach (Cadaver) Felix L. Hong, DDS; Mark R. Rowan, MD, DDS; R. John Tannyhill, III, MD, DDS, FACS Harvard Medical School
For treatment of facial trauma such as a frontal sinus fracture, orbital fractures, or zygoma fractures, the coronal or bi-temporal approach is used. The approach can also be used for superficial temporal artery biopsy. This approach exposes the anterior cranial vault, forehead, and upper and middle regions of the facial skeleton including the zygomatic arch. It provides access to these areas with minimal complications and cosmetically acceptable hidden scars. The subperiosteal or subgaleal planes are commonly used for coronal flap dissection. This article presents a demonstration of the coronal approach to exposing the upper or middle facial skeleton in a cadaver.
Open Distal Gastrectomy Andrea L. Merrill, MD; John T. Mullen, MD Massachusetts General Hospital
A complete margin-negative (R0) resection remains the only potentially curative treatment for gastric adenocarcinoma. The choice of operation depends on the location of the tumor as well as the stage of disease. This patient presented with symptomatic anemia, and workup demonstrated gastritis and a small tumor in the distal stomach. Biopsies confirmed adenocarcinoma, and an endoscopic ultrasound (EUS) staged this tumor as T2 N0. Staging scans showed no evidence of distant metastatic disease. Given that this patient had a relatively early stage tumor, they elected to proceed with upfront surgery, which in this case entailed a distal gastrectomy. This video shows an experienced gastric surgeon’s technique for performing an open distal gastrectomy with an “extended” D1 lymph node dissection.
Proper wound closure techniques are essential for promoting healing, minimizing scarring, and reducing postoperative complications. By providing a detailed, step-by-step guide to various suturing methods, this video serves as an invaluable tool for surgical training programs and continuing medical education. The detailed explanation of each technique, coupled with practical demonstrations, provides a valuable resource for both beginner and experienced practitioners. By emphasizing proper technique, instrument handling, and tissue management, this demonstration contributes significantly to the development of essential surgical skills.
Knot tying is a fundamental skill in the surgical field, essential for securing sutures, ligating vessels, and creating secure anastomoses. The art of knot tying requires precision, dexterity, and a thorough understanding of suture materials and techniques. This article aims to provide a comprehensive overview and demonstration of surgical knot tying.
Pediatric burns are one of the most common forms of injury affecting children worldwide. Of these, hand involvement occurs in 80–90% of such incidents. With the skin in children already diffusely thinner throughout the body than adults, this provides a particular challenge for areas naturally possessing thinner skin, such as the dorsal hand. There, the cutaneous tissue is the only protection for vital structures in the hand that allow full function, such as extensor tendons, nerves, and vessels. Injury to this area early in life can have a detrimental impact on how the survivor interacts with the physical world, affecting their functional capacity and quality of life.
Here presents a case of burn contractures on the right hand of an 8-year-old boy that will be released using a split-thickness graft, along with a pigment transfer graft for his left knee and fractional CO2 laser therapy over areas of hypertrophic scar tissue on his bilateral upper extremities. The split-thickness graft will greatly decrease the tension built up from the burn contracture, while the fractional CO2 laser procedure can soften the surrounding scar, allowing mild remodeling and increased range of motion.
Surgical instrument tables are considered as basic furniture for the operating room (OR). The largest table, typically rectangular or “L”-shaped, serves as a central hub for arranging and storing sterile supplies until needed during surgical procedures. The Mayo stand is an extension of the large table. It is small, height-adjustable, and intended to hang over the operating table and hold instruments and other sterile items for immediate use and within easy reach for the scrub nurse. Both the large table and the smaller Mayo stand are often referred to as back tables.
The specific equipment and arrangement of the back table may vary depending on the type of surgery and the surgeon’s preferences. This video provides a detailed, step-by-step guide to the back table setup for an open umbilical hernia repair surgery. It covers the preparation of the surgical field, the handling of sterile supplies, and the organization of the surgical tray. Additionally, it discusses the importance of adhering to sterile technique and the surgeon’s preferences during the procedure.
