Cesarean sections, often referred to as c-sections, are the most common operation performed for pregnant people across the US. They are viewed as a safe mode of fetal delivery. While there are many indications for planned, non-elective primary cesarean deliveries, there are growing numbers of planned, elective primary c-sections in the US. Vaginal delivery should still be considered in all cases in which an elective c-section is requested. The decision regarding mode of delivery often involves an interdisciplinary discussion between obstetrical, anesthesia, and specialty teams as well as joint decision making between a patient and their provider, taking into consideration their concerns and long-term goals.
In this case, an elective primary c-section was performed on a 31-year-old gravida 1 para 0 patient with a term, singleton gestation in the setting of prior lumbar sacral fusion and pelvic fixation surgeries.
This is the case of a 74-year-old female who presented with bothersome stage III pelvic organ prolapse. She desired definitive surgical management for her prolapse and opted for total vaginal hysterectomy, uterosacral ligament suspension, and anterior/posterior vaginal repairs. She had urodynamic testing before the surgery that showed no stress urinary incontinence, no detrusor overactivity, and normal bladder capacity. The surgery was uncomplicated. She was discharged home the same day as surgery, and her postoperative recovery was unremarkable.
Crohn’s disease is a type of inflammatory bowel disease that can chronically affect the entire gastrointestinal tract, with a propensity for the distal ileum. It causes transmural inflammation of the intestines, where it can cause abdominal pain, severe diarrhea, fatigue, weight loss, and malnutrition.
There is no cure for Crohn’s disease; the goal of treatment is to palliate symptoms, accomplished with both medical and surgical options. Surgery is generally reserved for patients who are unresponsive to aggressive medical therapy or those who develop complications.
Here, we present the case of a 59-year-old male with chronic gastrointestinal problems thought to be Crohn’s colitis. Colonoscopy with biopsy of multiple areas showed dysplasia, prompting surgical resection. In this case, the entire colon was affected with rectal sparing; therefore, a total abdominal colectomy with ileorectal anastomosis was performed.
Endolymphatic sac (ELS) decompression can be performed for patients with Meniere’s disease who have failed conservative treatment such as dietary changes and medical therapy. The full pathophysiological mechanisms that result in Meniere’s disease are not entirely understood. The variation in techniques for performing ELS decompression support this; there is no concrete data to justify one approach over another. Regardless, in the correct patient, ELS decompression can significantly alleviate the patient’s symptoms. To do so, a mastoidectomy is performed to expose the bony labyrinth as well as the bone overlying the sigmoid sinus. Decompression of the sac can be accomplished by removing overlying bone, incising the dura, or stenting the dura open.
Superior semicircular canal dehiscence (SSCD) is associated with conductive hearing loss, autophony, and pressure/sound induced vertigo. Patients who are symptomatic may elect to undergo surgical intervention.
Here, Dr. Kaylie demonstrates the transmastoid approach to repairing SSCD. This approach affords the opportunity for an outpatient procedure to expose and plug the canal around the defect.
Ulnar nerve transposition is a surgical procedure performed to treat ulnar nerve compression of the elbow, also known as cubital tunnel syndrome. This procedure is utilized after both non-operative management and in situ decompression fails, or if these procedures are deemed inappropriate based on patient pathology or ulnar nerve instability.
Transposition of the ulnar nerve involves not only decompression of the nerve but also its anterior repositioning to reduce compression and irritation while maintaining nerve integrity. This video demonstrates, on a cadaver arm, the operative technique for performing an ulnar nerve transposition using either a subcutaneous or a submuscular technique.
Sagittal band rupture leads to subluxation of the EDC tendon at the MCP joint. The common presentation involves pain and swelling at the MCP joint, visualization of extensor tendon subluxation during flexion, and inability to actively extend the MCP joint from a flexed position.
The treatment for chronic rupture, as in this case, involves surgical repair followed by six weeks in a relative motion splint, in which the injured MCP joint is placed in greater extension relative to adjacent joints. The video here demonstrates direct repair of a chronic degenerative sagittal band rupture of the right ring finger.
Cataract is a leading cause of treatable blindness in the world. The diagnosis is made through assessment of visual acuity, visual disability, and slit lamp biomicroscopy. In the US, the standard for cataract extraction has become phacoemulsification.
This article demonstrates and reviews the technique of cataract extraction using phacoemulsification with intraocular lens implantation using the divide-and-conquer technique.
Lateral Epicondylitis Debridement
Keenan R. Sobol, BS¹; Asif M. Ilyas, MD, MBA, FACS¹² ¹Sidney Kimmel Medical College at Thomas Jefferson University ²Rothman Institute at Thomas Jefferson University
Lateral epicondylitis (LE), commonly referred to as “tennis elbow,” is a common condition of the extensor tendons of the forearm that can lead to pain along the lateral epicondyle with radiation into the forearm, decreased grip strength, and difficulty lifting objects. When LE symptoms progress and can no longer be managed with non-operative measures, LE debridement may be indicated.
The approach presented here is an open debridement of the extensor carpi radialis brevis (ECRB) tendon origin. A 3–4-cm longitudinal incision was placed longitudinally over the lateral epicondyle, radial head, and capitellum. The ECRB was exposed then debrided, the lateral epicondyle was decorticated, the lateral collateral ligament was repaired, the wound was closed in layers, and a soft dressing and splint were placed.
Robotic right hemicolectomy is a minimally invasive technique for right colon resections. The technique utilizes a robotic laparoscopic instrument to perform dissection of the right colon and to perform intracorporeal anastomoses, allowing for smaller abdominal incisions, quicker recovery times, and decreased short- and long-term complications.
In this case, a robotic right hemicolectomy was performed to remove an endoscopically unresectable mass at the ileocecal valve. An intracorporeal-stapled ileocolic anastomosis was performed, and the colon was removed through a trocar insertion site. The robotic-assisted minimally invasive technique allows for clear visualization of the dissection planes and facilitates intracorporeal anastomoses that would otherwise be difficult to perform using traditional laparoscopy.
