Bilateral Modified Radical Neck Dissection for Metastatic Papillary Thyroid Carcinoma
Courtney Gibson, MD, MS, FACS; Tobias Carling, MD, PhD, FACS
Yale School of Medicine
Radical neck dissection was once the standard of care for the surgical management of patients with thyroid cancer and cervical lymph node metastases. However, due to the significant morbidity of this procedure, the development of cervical lymphadenectomy procedures that could provide oncologic cure while minimizing morbidity was undertaken by many surgeons. Such an investigation has led to the development of the modified radical neck dissection (MRND). Still, many institutions are not familiar with performing a comprehensive MRND in the setting of thyroid cancer metastatic to the lateral lymph node compartments. This article presents such an operation under general anesthesia.
Cystoscopy and Transurethral Resection of Bladder Tumors with Stent and Foley Catheter Placement
Austin Bramwell, MD; Tullika Garg, MD, MPH, FACS
Penn State Health Milton S. Hershey Medical Center
Bladder cancer is the sixth most common cancer in the United States. Transurethral resection of bladder tumor (TURBT) is a common urologic surgical procedure used to diagnose, stage, and treat bladder cancer. This article presents a patient who had multiple episodes of gross hematuria and was found to have multifocal bladder tumors. In this case, TURBT was performed to confirm the diagnosis of bladder cancer, remove all visible bladder tumors, and prevent further episodes of gross hematuria.
Lumpectomy and Sentinel Lymph Node Biopsy Using Lumicell System for Intraoperative Detection of Residual Cancer
Barbara Smith, MD, PhD
Massachusetts General Hospital
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.
Open Antrectomy and Duodenal Resection for Neuroendocrine Tumor
Derek J. Erstad, MD; David L. Berger, MD
Massachusetts General Hospital
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.
Robotic Thyroidectomy: A Bilateral Axillo-Breast Approach (BABA)
Hyunsuk Suh, MD
The Mount Sinai Hospital
Bilateral axillo-breast approach (BABA) is a contemporary technique for remote-access thyroidectomy. BABA robotic thyroidectomy (RT) offers a number of benefits over other remote-access thyroidectomy techniques, such as provision of a three-dimensional symmetric view of bilateral thyroid lobes and optimal visualization of important anatomical landmarks, including the recurrent laryngeal nerve (RLN), thyroidal vessels, parathyroid glands, and the trachea.
This educational video is a thorough demonstration of BABA RT performed on a young female patient diagnosed with a left-sided thyroid nodule in her early thirties. The thyroid fine needle aspiration biopsy of the 4-cm nodule was indeterminate. Additional molecular testing of the specimen had revealed one of the mutations associated with thyroid cancer. Therefore, a diagnostic thyroid lobectomy was planned. The patient had expressed a strong desire to avoid an obvious neck scar, and therefore, the BABA RT was offered.
Resection of a Sphenoid Wing Meningioma
Stefanie Miller1; Marcus Czabanka, MD1
1University of Central Florida College of Medicine
2Charite Hospital Berlin
Sphenoid wing meningiomas are typically benign, slow-growing tumors that may be identified incidentally on imaging or due to a symptomatic presentation from compression of a nearby structure. Located along the sphenoid wing, these tumors may infiltrate or compress the optic nerve, oculomotor nerve, cavernous sinus, or internal carotid artery, causing neurologic deficits such as visual disturbances, headache, paresis, and diplopia.
Surgical resection is considered the first-line treatment for a symptomatic meningioma, but is often challenging due to tumor proximity to these critical neurovascular structures. The most important prognostic factor for recurrence is the completeness of the surgical removal of the tumor, but this goal must be adapted to preserve neurologic function based on individual tumor location and invasion. Here we present a case of a 43-year-old patient diagnosed with a sphenoid wing meningioma after presenting with episodic difficulty speaking and aura-like symptoms who underwent total neurosurgical resection of the tumor via craniotomy.
Partial Glossectomy
Liana Puscas, MD, MHS1; C. Scott Brown, MD1; Vahagn 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.
Brain Biopsy of a Suspected Cerebellar Lymphoma
Martin Misch Dr. med.
Charite Hospital Berlin
Dr. Misch utilizes a frameless stereotactic navigation system to locate and guide a needle biopsy of a suspected cerebellar lymphoma.
The New Gold Standard for Surgical Videos