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.
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.
Stoma prolapse is an increase in the size of the stoma secondary to intussusception of the proximal bowel segment. Strangulation and ischemia of the prolapsed segment have been reported as complications.
This is the case of a 58-year-old man with multiple comorbidities who was diagnosed with an adenocarcinoma of the ascending colon with hepatic metastasis. He was considered unable to start conversion chemotherapy because of his cardiovascular comorbidities and was therefore under paliative chemotherapy.
Patient came into emergency room with an acute bowel obstruction and underwent a loop ileostomy as a diversion procedure. Following up the procedure, the patient developed an acute on chronic kidney failure because of dehydration from high output ileostomy. In the postoperative day 17, patient presented with an acutely incarcerated prolapsed afferent limb of the loop ileostomy. Attempts at reduction were unsuccessful.
Herein we present a simple, safe, and fast approach for correcting a prolapsed loop or terminal stoma using a step-wise application of linear staplers.
When laparotomy and/or stoma reversal is not appropriate, local revision of stoma prolapse provides a low-risk and high-benefit alternative solution.
A 55yo lady undergoing open pancreaticoduodenectomy for duodenal adenocarcinoma was intra-operatively found to have macroscopic tumour involvement of the proper hepatic artery and its bifurcation. The diseased segment was resected and a novel technique for reconstruction was performed- the remnant common hepatic artery was anastomosed to the remnant right hepatic artery, and the left gastric to the remnant left hepatic artery. Doppler ultrasound confirmed patency of all anastomoses prior to closure. Synthetic function of the liver and bilirubin recovered to appropriate levels postoperatively, and the patient was planned for adjuvant chemotherapy.
Contributors: Benjamin Biteman and Vincent Obias
Robotic Transanal minimally invasive surgical removal of 1.8cm villous adenoma with high grade dysplasia at 22cm.
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
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.
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.
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.
Referred By: Jeffrey B. Matthews