PUBLISHED: Microscope Drape for Aerosol-Generating Procedures During COVID-19 Pandemic

Microscope Drape for Aerosol-Generating Procedures During COVID-19 Pandemic
C. Scott Brown, MD1Paulo Dominaitis, CST2Fred F. Telischi, MEE, MD, FACS1
1 University of Miami Miller School of Medicine
2 Bascom Palmer Eye Institute

Coronavirus disease 2019 (COVID-19) has emerged as a worldwide pandemic, profoundly impacting healthcare systems. Despite the use of personal protective equipment, concerns remain over the potential transmission of SARS-CoV-2 for otolaryngologists. Transmission occurs via respiratory droplets and aerosolized virus particles, which are generated during specific interventions such suctioning, bone drilling, and the application of diathermy. The mastoid and middle ear mucosa are connected to the nasopharyngeal mucosa and can serve as a potential source of viral particles in an infected patient. This highlights the need for the development and implementation of strategies that minimize aerosol spread.

PUBLISHED: Contracture Release and Full-Thickness Skin Graft to Volar Index Finger with K-Wire Insertion

Contracture Release and Full-Thickness Skin Graft to Volar Index Finger with K-Wire Insertion
Ryan P. Boyle1Jonah Poster2Jonathan Friedstat, MD3
1Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine
2Icahn School of Medicine at Mount Sinai
3Shriners Hospitals for Children – Boston

The complications stemming from a poorly-healed burn wound can lead to functional deficits and overall aesthetically unfavorable results leading to psychological distress. Due to the inquisitive nature of infants and toddlers, and their nature to learn the world with their hands, their sensitive regions like the hands become likely targets for burns.

Superficial burns can be managed on an outpatient basis with spontaneous healing expected in 2 or 3 days with minimal scarring. Deep burns, particularly in pediatric populations, need considerable attention to avoid secondary contracture that leads to deformity.

Many treatment options exist, but in sensitive areas like the hands and face, full-thickness skin grafts are favored due to their superior healing and decreased likelihood of secondary contracture. This article aims to guide the surgeon in managing a pediatric burn wound with an arsenal of treatment options with the goal of achieving full mobility and functionality of the hand.

PUBLISHED: Flexible Bronchoscopy and Bronchoalveolar Lavage (BAL)

Flexible Bronchoscopy and Bronchoalveolar Lavage (BAL)
Marcus S. Alpert, MDYu Maw Htwe, MD
Penn State Health Milton S. Hershey Medical Center

Flexible bronchoscopy is a commonly utilized endoscopic procedure allowing for direct visualization of the airways, as well as a variety of therapeutic and diagnostic interventions. Common indications of flexible bronchoscopy include evaluation of pulmonary infiltrates, hemoptysis, airway obstruction, foreign body aspiration, tracheal stenosis, bronchopleural fistula, and post-lung transplant.

The procedure involves the insertion of a flexible bronchoscope through the vocal cords and into the lumen of the trachea and bronchi. Direct visualization is provided by fiberoptic video imaging. Bronchoalveolar lavage (BAL) further refers to instillation and subsequent recovery of sterile saline into the airways. In this article, we will detail the technique, considerations, and complications of flexible bronchoscopy and BAL.

PUBLISHED: Acute Subdural Hematoma Evacuation

Acute Subdural Hematoma Evacuation
Vincent Prinz, MDMarcus Czabanka, MD
Charite Hospital Berlin

Subdural hematoma (SDH) is a type of intracranial bleeding that occurs between the dura and the arachnoid membrane surrounding the brain. This video is a step-by-step demonstration of a hematoma evacuation by craniotomy performed on an elderly female patient with an acute-on-chronic SDH.

PUBLISHED: Robotic-Assisted Laparoscopic Left Donor Nephrectomy for Living Kidney Donation

Robotic-Assisted Laparoscopic Left Donor Nephrectomy for Living Kidney Donation
Srilakshmi Atthota, MBBS; Jessica Grasso, PA-C; Leigh Anne Dageforde, MD, MPH
Massachusetts General Hospital

Kidney transplantation is the preferred treatment for patients with end-stage renal disease and is associated with a better quality of life and survival compared to other renal replacement therapies. Compared to deceased donor kidneys, living donor kidney donation is associated with shorter wait times, improved patient and graft survival, and the possibility of preemptive transplantation.

After the initial learning curve, robotic-assisted living donor nephrectomy has similar outcomes compared to open and laparoscopic nephrectomy, and in some settings an overall decreased length of stay. This article presents the case of a robotic-assisted living donor nephrectomy, including evaluation, technique, and considerations for the surgeon preoperatively and intraoperatively.

PUBLISHED: Partial Glossectomy

Partial Glossectomy
Liana Puscas, MD, MHS1C. Scott Brown, MD1Vahagn G. Hambardzumyan, MD2
1Duke University Medical Center
2Yerevan State Medical University, Heratsi Hospital Complex

In this clinical case, a patient presented with a well-circumscribed lesion on her tongue, causing interference with eating as it grew. Despite its benign appearance, an initial in-office biopsy was performed and metastatic breast cancer was found.

Jaw and oral cavity involvement by metastatic disease is very rare, occurring in less than 1% of all oral malignancies. In this video, a partial glossectomy was performed to remove the lesion.

PUBLISHED: Robotic-Assisted Proximal Gastrectomy with a Laparoscopic-Assisted Double-Tract Reconstruction for Proximal Early Gastric Cancer

Robotic-Assisted Proximal Gastrectomy with a Laparoscopic-Assisted Double-Tract Reconstruction for Proximal Early Gastric Cancer
Raja R. Narayan, MD, MPH1,2,3; Jane C. Kim, MD1; Do Joong Park, MD, PhD1
1Seoul National University Hospital
2Dana-Farber Cancer Institute
3Brigham and Women’s Hospital

At most institutions caring for patients with early gastric cancer (EGC), tumors arising in the upper third of the stomach are usually managed with total gastrectomy and Roux-en-Y esophagojejunostomy. Given the impaired quality of life related to associated reflux and vitamin deficiencies, several high-volume centers have sought alternative gastrectomy and reconstruction strategies to total gastrectomy.

In this case, a patient with EGC in the cardia found on screening endoscopy undergoes robotic proximal gastrectomy with double-tract reconstruction. His postoperative course was unremarkable, and he was discharged on postoperative day 7. His pathology demonstrated no residual tumor after preoperative endoscopic submucosal dissection. This video demonstrates the technique of an experienced surgeon performing robotic proximal gastrectomy with double-tract reconstruction.

PUBLISHED: Vacuum-Assisted Closure (VAC) Change for a Complex Right Hip Wound

Vacuum-Assisted Closure (VAC) Change for a Complex Right Hip Wound
Joshua Ng-Kamstra, MD, MPH
Massachusetts General Hospital

Vacuum-assisted closure (VAC) is a method of wound management commonly employed as an adjunct to surgery that uses negative pressure to accelerate healing. This video is a comprehensive step-by-step demonstration of VAC change for a complex right hip wound. The patient is a male in his fourth decade with a history of paralysis beginning in childhood due to a spinal tumor. He was admitted to the hospital with a right hip joint infection complicated by methicillin-sensitive Staphylococcus aureus (MSSA) bacteremia. Given his immobility at baseline, the patient was deemed a suitable candidate for a Girdlestone procedure, which involved resection of the femoral head and proximal aspect of the femur, resulting in a complex wound with exposed bone.

PUBLISHED: Trauma Resuscitation Demonstration in a Stable Patient with a Minor Perforating Wound

Trauma Resuscitation Demonstration in a Stable Patient with a Minor Perforating Wound
Priya Prakash, MD
UChicago Medicine

This is the case study of a 17-year-old male Reserve Officers’ Training Corps (ROTC) cadet who suffered a superficial perforating saber wound to the medial part of the right knee during a routine practice session. This video demonstrates the step-by-step patient assessment process and subsequent saber removal.

PUBLISHED: Laparoscopic Resection of Gastric GIST Tumor

Laparoscopic Resection of Gastric GIST Tumor
Daniel Rice1David Rattner, MD2
1Lake Erie College of Osteopathic Medicine
2Massachusetts General Hospital

This case illustrates a laparoscopic resection of a gastrointestinal stromal tumor (GIST): the most common mesenchymal tumor found in the gastrointestinal tract. GISTs can be found anywhere along the gastrointestinal tract; however, they are most commonly found in the stomach and small intestine. These tumors are often associated with mutations in the KIT (receptor tyrosine kinase) and PDGFRA (platelet-derived growth factor receptor alpha) genes. Because it is difficult to achieve a permanent cure using protein tyrosine kinase inhibitors, such as imatinib, surgical resection is the recommended therapy in most cases. While the surgical approach may vary on tumor characteristics, the laparoscopic approach is associated with low perioperative morbidity and mortality.

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