Tag Archives: oncology

General Surgery, Otolaryngology, Print Release

PUBLISHED: Right Hemithyroidectomy

Right Hemithyroidectomy
TK Pandian; Roy Phitayakorn, MD
Massachusetts General Hospital

Hemithyroidectomy, or unilateral thyroid lobectomy, refers to removal of half the thyroid gland. The procedure is typically performed for suspicious thyroid nodules or small differentiated thyroid cancers based on biopsy via fine needle aspiration (FNA) and occasionally for symptomatic benign thyroid nodules.

At most institutions the operation can be completed safely in an outpatient fashion with patient discharge from the hospital the same day. It is typically performed via a transcervical collar incision, but endoscopic, transoral routes and remote access approach with robotic instrumentation have been described. The procedure involves mobilization of the thyroid lobe, ligation of thyroid vessels, preservation of parathyroids, protection of the recurrent laryngeal nerve, and dissection away from the trachea. In this patient, a thyroid nodule was detected and found to have indeterminate features on biopsy via FNA. A hemithyroidectomy was then performed for diagnostic purposes.

Print Release, Urology

PUBLISHED: Cystoscopy and Transurethral Resection of Bladder Tumors with Stent and Foley Catheter Placement

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.

General Surgery, Print Release, Thoracic Surgery

PUBLISHED: Bilateral Indwelling Pleural Catheter Placement for Advanced Non-small Cell Lung Cancer with Recurrent Pleural Effusion

Bilateral Indwelling Pleural Catheter Placement for Advanced Non-small Cell Lung Cancer with Recurrent Pleural Effusion
Kathleen M. Twomey, MD; Yu Maw Htwe, MD
Penn State Health Milton S. Hershey Medical Center

Pleural effusions are frequently observed in a variety of conditions. Reasons for intervention include obtaining an underlying diagnosis as to the cause and providing symptom relief. One of the most frequent causes of a recurrent pleural effusion is malignancy, which will typically continue to accumulate for as long as the cancer is progressing. When patients have a rapidly recurring effusion, requiring frequent intervention by way of thoracentesis or chest tube, other options for management are considered. An indwelling pleural catheter (IPC) can be offered to a patient to help drain the effusion on a regular basis, without requiring repeat thoracentesis. The goal of the drain placement is to provide symptom relief, and it is often in place for as long as the patient has an appreciable effusion that can be drained intermittently by vacuum canisters.

General Surgery, Print Release

PUBLISHED: Lumpectomy and Sentinel Lymph Node Biopsy Using Lumicell System for Intraoperative Detection of Residual Cancer

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.

General Surgery, Print Release

PUBLISHED: Open Radical Cholecystectomy with Partial Hepatectomy for Gallbladder Cancer

Open Radical Cholecystectomy with Partial Hepatectomy for Gallbladder Cancer
Shoichi Irie, MD; Mamiko Miyashita, MD; Yu Takahashi, MD; Hiromichi Ito, MD
Cancer Institute Hospital of JFCR, Tokyo

Gallbladder cancer (GBCA) is a relatively uncommon disease with dismal prognosis. As the symptoms associated with GBCA are vague and non-specific, most patients present when the disease is at an advanced stage and the majority are diagnosed when the disease is beyond the possibility of resection. On the other hand, GBCA can be discovered incidentally and appropriate oncologic surgery provides a great chance of cure for patients with GBCA. We present a case of incidentally-diagnosed GBCA and describe the surgical management for operable GBCA with a focus on the operative technique and perioperative management. A 60-year-old male presented with incidentally-discovered GBCA during a follow-up imaging study for his previously treated bladder cancer. The patient had been asymptomatic, and CT showed a growing mass in the gallbladder without evidence of metastatic disease. GBCA was suspected, and resection was recommended. He underwent extended cholecystectomy including cholecystectomy en bloc with partial hepatectomy at segment IVb and 5 and portal lymphadenectomy. His postoperative course was uneventful, and histologic examination confirmed the diagnosis of GBCA, pT3N1M0, stage IIIB.

General Surgery, Print Release, Vascular Surgery

PUBLISHED: Leiomyosarcoma of Inferior Vena Cava: Resection and Reconstruction

Leiomyosarcoma of Inferior Vena Cava: Resection and Reconstruction
Madhukar S. Patel, MD, MBA, ScM; Jahan Mohebali, MD, MPH; Parsia A. Vagefi, MD, FACS; Alex B. Haynes, MD, MPH, FACS
Massachusetts General Hospital

Primary leiomyosarcomas of the inferior vena cava (IVC) are rare tumors with complex anatomical relationships. Surgical resection remains the primary approach for management, with selective use of preoperative radiation and chemotherapy. Given the propensity for local invasion of these tumors, radical resection of surrounding structures is often required.

This article describes the presentation, work-up, operative management, and outcomes of these lesions through the case of a patient with a tumor involving the middle segment of the IVC. Given the extent of involvement, IVC resection with en bloc right nephrectomy, right adrenalectomy, and partial left renal vein resection was performed with vascular reconstruction using a prosthetic graft. With appropriate preoperative planning and a well-coordinated multidisciplinary approach, aggressive surgical resection can be safely performed and patients can benefit from favorable long-term survival.

General Surgery, Print Release

PUBLISHED: Laparoscopic Low Anterior Resection with Diverting Loop Ileostomy for Rectal Cancer with Conversion to Open Approach

Laparoscopic Low Anterior Resection with Diverting Loop Ileostomy for Rectal Cancer with Conversion to Open Approach
Prabh R. Pannu, MD; David Berger, MD
Massachusetts General Hospital

Laparoscopic low anterior resection (LAR) is a complex surgical procedure used for resecting the distal sigmoid colon or rectum while preserving sphincter function. The patient is a 37-year-old, obese male with rectal cancer.

Abdominal access is gained through four laparoscopic port sites. The omentum is freed from the transverse colon to enter the lesser sac. The splenic flexure and descending colon are mobilized from the retroperitoneum. The left colic artery is identified and divided. Following proximal mobilization, the dissection is carried towards the pelvis. The sigmoid colon is mobilized, and the presacral space is entered. The inferior mesenteric artery is divided between clips. The dissection in this case could not be carried down low enough in a laparoscopic fashion, and a lower midline incision was made. A suitable area on the descending colon is identified and the marginal artery divided. The proximal bowel is then divided with a stapler. A flexible colonoscope is then used to confirm tumor location and the rectum is divided below the tumor. Finally, a Baker type side-to-end anastomosis is performed with a powered EEA stapler, and its integrity verified endoscopically under water. A diverting loop ileostomy is then created at a previously marked site and the abdomen closed.

In this video, the surgical steps of this procedure are demonstrated and insight is provided into intraoperative decisions.

Neurosurgery, Otolaryngology, Print Release

PUBLISHED: Anterior Skull Base Resection of Esthesioneuroblastoma (Endoscopic)

Anterior Skull Base Resection of Esthesioneuroblastoma (Endoscopic)
David W. Jang, MD¹; Ali R. Zomorodi, MD¹; Feras Ackall, MD¹; Josef Madrigal, BS²; C. Scott Brown, MD¹
¹Duke University Medical Center
²David Geffen School of Medicine at the University of California, Los Angeles

First described by Berger in 1924, esthesioneuroblastoma (ENB) remains a rare sinonasal tumor believed to originate from specialized sensory olfactory cells. To date, the literature includes 1,000 recorded cases of ENB. Patients with ENB often present with non-specific symptoms, most often chronic nasal obstruction or epistaxis. Careful examination may reveal a pink or brown polyploid mass in the nasal cavity. Overall, ENB may demonstrate various growth patterns ranging from slow, indolent progression to aggressive invasion with widespread metastasis.

Current literature indicates that ENB should be treated with a combination of surgical resection and postoperative radiation therapy with or without chemotherapy. However, significant controversy remains regarding the appropriate surgical approach. This video demonstrates a transnasal endoscopic approach, which has gained significant popularity over the previous two decades compared to classic “open” approaches. Although this approach demonstrates improved perioperative outcomes while still achieving oncologic margins, further work is required to evaluate long-term survival.

Announcement, General Surgery, Preprint Release

PREPRINT RELEASE: Wedge Resection of the Lung and Thymectomy by Thoracoscopy

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Wedge Resection of the Lung and Thymectomy by Thoracoscopy
Massachusetts General Hospital
Henning A. Gaissert, MD
Lucia Madariaga, MD

Visiting Surgeon, MGH & Associate Professor of Surgery, Harvard Medical School
Fellow in Thoracic Surgery, MGH

A patient with myasthenia gravis undergoes a procedure meant to originally be a lobectomy and thymectomy. Henning Gaissert, MD decides to do a lobe wedge resection instead given the tumor’s positioning and carcinoid nature before proceeding with the thymectomy. Please note that the patient had to return to the OR the following day due to bleeding near the internal mammary vein.
General Surgery, Preprint Release

PREPRINT RELEASE: Laparoscopic Adrenalectomy

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Laparoscopic Adrenalectomy
Massachusetts General Hospital
Richard Hodin, M.D.
Professor of Surgery, Harvard Medical School

After visiting an endocrinologist who diagnosed her with aldosteronism, the patient takes a CT scan that reveals a 8mm nodule in the left adrenal gland. Dr. Hodin performs a laparoscopic adrenalectomy to remove it.