In this video we present the case of a 98 year old chinese gentleman who presented to the emergency department for 2 days of painful right groin lump. He has a history of bilateral inguinal hernia for many years, but declined surgery. Otherwise, his past medical history includes degenerative disc disease, osteoporosis and hearing impairment. On presentation, he was able to tolerate oral feeding with no nausea or vomiting and still able to pass stools. On examination, there was a large and tender right irreducible inguinal hernia with overlying erythema and warmth. There was also a small left inguinal hernia that was reducible. CT Abdomen-Pelvis was done and showed an incarcerated right inguinal hernia containing a loop of sigmoid colon with poor enhancement of the bowel wall. The colon proximal to the incarcerated segment was also mildly dilated.
Patient underwent urgent repair of the strangulated right inguinal hernia via laparoscopic, transabdominal preperitoneal (TAPP) approach. Intra-operatively, a loop of sigmoid colon was incarcerated within a direct right inguinal hernia. A small colotomy had to be made to decompress the incarcerated loop in view of difficulty in reducing the sigmoid colon. After reduction, the incarcerated segment was gangrenous and non-viable requiring sigmoid colectomy with primary anastomosis. Pantaloon inguinal hernias with femoral hernias were seen over bilateral groins. An Ultrapro 10x15cm composite mesh was inserted over bilateral groins with adequate medial overlap ensured.
The operation took three hours and fifty minutes with minimal blood loss. Drain was removed and feeding was escalated to diet on post-operative day four. Patient was able to pass stools and then discharged on post-operative day six. His case was complicated with a small 2cm seroma at the right groin.
This video demonstrates how to place the pelvic binder quickly and correctly, which may be life-saving in cases of pelvic ring fractures with associated potential massive bleeding. Proper pelvic binder placement technique requires attention to some details, including the 5Ps (pulses, penis, pockets, pain and pulses), horizontal force application in opposing vectors and ensuring the pelvic binder is locked.
Donghang Huang’s procedure, also termed as direct-access single-port endoscopy assisted mini-incision thyroidectomy, is a hybrid surgery conducted in the following 3 major steps:
1.A mini-incision of approximately 2.5-3 cm long on the central neck is made. A working space under the platysmal muscle or strap muscles for single-port endoscopic surgery is constructed with carbon dioxide insufflation (performed under direct vision).
2.Mobilization of the superior and inferior pole of the thyroid lobe, and exposure of the recurrent laryngeal nerve (performed under single-port endoscopy).
3.Extraction and resection of the thyroid lobe. (performed under direct vision).
Donghang Huang’s procedure can provide shorter incision and better cosmetic results while maintaining adequate exposure.
Paediatric Tracheostomy
Position the child with chin extension appropriately
Drape the child as shown in the video
Mark the incision line
Use 15 number blade for skin incision
Remove the excessive subcutaneous fat tissue
Find the median raphe and strap muscles
Retract the strap muscles laterally
Identify the tracheal ring
Create the impression of tube for appropriate size incision
Place the stay sutures as shown in the video
incise the trachea with 11 number blade
Secure the maturation sutures
Insert the tracheostomy tube
Confirm the position and then inflate the cuff
Secure the ties and dressing at the end.
Contributors: Benjamin Biteman and Vincent Obias
Robotic Transanal minimally invasive surgical removal of 1.8cm villous adenoma with high grade dysplasia at 22cm.
DOI#:https://doi.org/10.17797/kzimoid3xj
Editor Recruited By: Vincent Obias
Contributors: Ben Biteman, MD
61 year old male with diverticulitis and colovesicular fistula. Patient underwent robotic sigmoid colectomy with takedown of fistula. Firefly used to help identify if fistula still present.
Editor Recruited By: Vincent Obias, MD, MS
DOI# http://dx.doi.org/10.17797/9qxwhlr1q5
David Schwartzberg MD, Tushar Samdani MD, FASCRS, Mario M. Leitao MD, FACOG, FACS, Garrett M. Nash MD, MPH, FACS, FASCRS
Recent data has shown an improved survival with metastasectomy for metastatic rectal cancer. Metastasectomy on a minimally invasive plateform (robotic) can be used for an R0 resection in patients who have retroperitoneal metastasis from rectal cancer after control of the primary tumor.
DOI # http://dx.doi.org/10.17797/wd7d09sjgc
Contributors: Nell Maloney Patel
We present a case of a seventy-two year old female found on colonoscopy to have multiple polyps and an ascending colon mass that was biopsy proven adenocarcinoma who underwent a robotic assisted right hemicolectomy with intracorporeal anastomosis.
DOI# http://dx.doi.org/10.17797/54hba94993
Editor Recruited by: Vincent Obias
Contributors: Craig Rezac, MD
Low anterior resection and rectopexy is the optimal treatment for well functioning patients with rectal prolapse. Reoperations for rectal prolapse may be challenging due to significant adhesions. Use of the robot for low anterior resection and rectopexy is safe, feasible and may be more useful than laparoscopy especially in challenging cases.
DOI:http://dx.doi.org/10.17797/vkp7axh60l
Contributors: Marco P. Fisichella
65 year old man who underwent a laparoscopic Nissen fundoplication in August 2015. Preoperative manometry was normal and DeMeester score was 25. Two months later he began to experience difficulty of swallowing solid foods, then liquids. After 2 dilatations, dysphagia persisted.
DOI#: http://dx.doi.org/10.17797/egw2097cpq
Referred By: Jeffrey B. Matthews
