Hereditary Diffuse Gastric Cancer (HDGC) syndrome is due to a mutation in the CDH1 gene that predisposes patients to a high lifetime risk of developing gastric cancer. As such, a total gastrectomy is typically recommended for patients with this syndrome. In this case, the patient presented with an incidentally discovered CDH1 mutation on genetic testing obtained after she was diagnosed with early-onset rectal cancer. In this video, Dr. Mullen at MGH demonstrates his technique for performing an open prophylactic total gastrectomy with a Roux-en-Y esophagojejunostomy reconstruction.
Full-thickness rectal prolapse occurs when the rectum invaginates into the anal canal and beyond the anal sphincters. The only definitive treatment for rectal prolapse is surgery. Here, Dr. Brooke Gurland at Stanford University Medical Center presents an Altemeier proctosigmoidectomy on an 80-year-old female with full-thickness rectal prolapse. The redundant rectum is delivered and then excised through a transanal approach, and the proximal colon is sutured to the distal end of the rectum.
Naomi Sell, MD, MHS Massachusetts General Hospital
Denise W. Gee, MD Operating Surgeon, MGH
The patient in this case is a 32-year-old female with recurrent episodes of biliary colic. An ultrasound revealed numerous gallstones within the gallbladder. Because the patient has had recurrent symptoms for the past six months, surgical removal of her gallbladder was the best option to relieve her recurrent pain and prevent future development of acute cholecystitis. Here, Dr. Denise Gee at Massachusetts General Hospital performs a laparoscopic cholecystectomy to remove the patient’s gallbladder.
In this case, Dr. Rockson Liu with Epic Care at Alta Bates Summit Medical Center performs a robotic eTEP retrorectus Rives-Stoppa repair of an upper midline primary ventral hernia that was partially reducible but mostly incarcerated, and greater than 6 cm in a 63-year-old female. Robotic ports were placed directly into the retrorectus space. Using the crossover technique, the retrorectus spaces were combined with a preperitoneal bridge of the peritoneum. The defects were closed robotically, and a medium-weight, macroporous polypropylene mesh was placed within the retrorectus space.
Daven Patel, MD, MPH Resident Physician Emergency Medicine
Kristin Lewis, MD, MA Resident Physician Emergency Medicine
Allyson Peterson, MD Resident Physician Emergency Medicine
Nadim Michael Hafez, MD Assistant Professor of Medicine Emergency Medicine
This video covers information related to the FAST exam, which evaluates the pericardial, hepatorenal, splenorenal, and suprapubic regions for free fluid in a trauma patient as well as the extended version, which includes an additional evaluation of the pleural spaces for a pneumothorax. It goes through probe selection, probe placement and image acquisition, image optimization, and pitfalls and pearls for the subxiphoid/subcostal, right upper quadrant, left upper quadrant, suprapubic, and pleural views.
Rockson C. Liu, MD, FACS General Surgery, Epic Care, Alta Bates Summit Medical Center
In this case, Dr. Rockson Liu performs a robotic eTEP retrorectus Rives-Stoppa repair of an upper midline primary ventral hernia that was partially reducible but mostly incarcerated, and greater than 6 cm in a 63-year-old female. Robotic ports were placed directly into the retrorectus space. Using the crossover technique, the retrorectus spaces were combined with a preperitoneal bridge of the peritoneum. The defects were closed robotically, and a medium-weight, macroporous polypropylene mesh was placed within the retrorectus space.
Peter Fagenholz, MD Assistant Professor of Surgery Massachusetts General Hospital Harvard Medical School
This patient is a 58-year-old male who was in a motor vehicle accident and developed a persistent necrotic collection adjacent to the pancreatic tail that did not improve with percutaneous drainage. Here, Dr. Peter Fagenholz at MGH performs a pancreatic debridement using sinus tract endoscopy (STE), a minimally-invasive technique for debridement of dead or infected tissue.
STE and other minimally-invasive techniques have significantly decreased morbidity and mortality for patients undergoing intervention for infected pancreatic necrosis. Common management principles include early non-interventional management to allow the necrosis to wall off, initial intervention with minimally-invasive drainage, and minimally-invasive necrosectomy addressing clearly demarcated necrosis.
STE involves the placement of a percutaneous drain followed by fluoroscopically-guided dilation of the drain tract to allow for placement of a working sheath, through which an endoscope can be introduced to debride the peripancreatic necrosis. After debridement, a drain is then replaced through the same tract.
Priya Prakash, MD Assistant Professor of Surgery Trauma, Critical Care, and Emergency Surgery UChicago Medicine
The patient in this case is a 17-year-old male who presented in stable condition with a minor, superficial, perforating saber wound. In this video article, Dr. Priya Prakash at UChicago Medicine demonstrates a trauma resuscitation and removes the saber.
Yoko Young Sang, MD Resident Physician General Surgery Louisiana State University Shreveport
Caroll Alvarado Lemus, MD Pediatric Surgery, Mario Catarino Rivas Hospital, Honduras San Pedro Sula, Honduras
Domingo Alvear, MD Founder World Surgical Foundation
The patient in this case is a 6-year-old boy who was born with Down syndrome and esophageal atresia. In this video article, Dr. Alvear performs a colonic interposition to replace the absent esophagus with part of the patient’s colon. This was performed during a global surgical mission in Honduras with the World Surgical Foundation.