Nasal Encephalocele: Endoscopic Surgery

Contributors: Vincent Couloigner

We describe the excision of a nasal encephalocele obstructing the left nasal fossa with an anterior subcutaneous portion deforming the nasal pyramid in a four-year-old girl using endoscopic surgery combined to a Rethi approach. The anterior skull base defect was reconstructed using autologous conchal cartilage and temporal fascia.

Editor Recruited By: Sanjay Parikh, MD, FACS


Vocal Fold Cordectomy Type I (ELS classification) for Carcinoma In Situ of the Vocal Fold Using Carbon Dioxide Laser

Authors: Yonatan Lahav, MD, Doron Halperin, MD, Hagit Shoffel-Havakuk, MD.

Subepithelial vocal fold cordectomy (Type I cordectomy according to the ELS classification) for Carcinoma In Situ, performed under general anesthesia with direct microlaryngoscopy and suspension using a free beam CO2 Laser. The resection respects the layered structure of the vocal folds and preserves the superficial lamina propria and its vasculature. The video follows the procedure step by step and includes detailed instructions.

Primary Total Knee Replacement in Advanced Rheumatoid Arthritis with Over Thirty Degrees of Fixed Flexion Deformities

Standard Cemented knee using universal instruments. Intramedullary guife for femoral allignment, Extramedullary for tibial cut. Special tricks shown here are ligament balancing, and flexion deformity correction. Video shot and edited by Seshadri


Use of a Heineke-Mikulicz Like Stricturoplasty for Skin Level Anal Strictures in Children with Anorectal Malformations


Taiwo Lawal

Richard Wood

Victoria Lane

Alessandra Gasior

Karen Diefenbach

Marc Levitt

Anal strictures in children who have had anorectoplasties for anorectal malformation, although largely preventable, can be of two types; at the skin level or more extensive in nature. Skin level strictures are preventable and usually treatable by anal dilations but require surgery when intractable. We recently introduced a modification of the Heineke-Mikulicz technique to treat this problem, able to be performed in an ambulatory setting and without a protective colostomy. The aim of this article is to describe the technique and outcome in a series of patients.


Editor Recruited By: Robert C. Shamberger, MD

Endoscopic Removal of Suprastomal Granuloma Using a Flexible KTP laser

Surgical removal of suprastomal granuloma is a procedure performed prior to the probable decannulation of a tracheostomy. There are several ways of achieving this objective, but in certain cases, a KTP laser on a flexible delivery system offers a precise and controlled method to successful debulking of the granuloma with minimal risks of haemorrhage into the airway.


Editor Recruited By: Sanjay Parikh, MD, FACS

Laparoscopic Assisted Gastric Pull-up for Long-gap Esophageal Atresia – Technical Aspects

Contributors: Kamal Dev

Hans Joachim Kirschner, MD, Joerg Fuchs, MD.
University Children’s Hospital Tuebingen, Tuebingen, Germany.

We present the case of a four-month-old boy undergoing laparoscopic assisted gastric
pull-up for long-gap esophageal atresia without fistula. The patient was an extremely
low weight birth infant with a birth weight of 670 gr (gestational age 24 6/7 weeks).
Sump suction drainage of the upper pouch and gastrostomy were performed initially.
The esophageus showed no sufficient length after 4 months. Therefore, decision was
taken to perform a laparoscopic assisted gastric pull-up.

A three port technique was used for the minimal invasive approach. After abdominal
dissection of the stomach, the midline tunnel was created laparoscopically through the
hiatus window. The stomach was transferred through the extended subumbilical port
incision and was prepared for the pull-up extracorporeally. A dilatation balloon catheter
was inserted through the site of the gastrostomy for controlled dilatation of the pyloric
muscle to avoid pyloroplasty. The upper esophageal pouch was dissected and the
gastric pull-up and the anastomosis were performed through a cervical incision.

The postoperative course was uneventful. X-Ray contrast study and repeated
esophagogastroscopy showed an adequate opening of the pylorus and absence of
anastomosis stricture postoperatively. Oral feeding was uneventful after successful
physiotherapy for swallowing

Laparoscopic assisted gastric pull-up can be carried out safely in small infants. This
video highlights the essential steps of the procedure.


Immediate post natal myelomeningocele defect closure using rhomboid fasciocutaneous flaps

Myelomeningocele is the most common form of neural tube defect, developing after the 4th week of gestation. Although diagnosed prenatally, many patients did not have a chance to be treated before birth. The best approach in these situation is to perform surgical treatment at time zero. A multidisciplinary team must be prepared to perform dural repair and soft tissue coverage. This video illustrates our approach for soft tissue reconstruction using rhomboid fasciocutaneous flaps with maximal preservation of perforator vessels.

Dov Charles Goldenberg, MD Phd, Division of Plastic Surgery, Hospital das Clinicas, University of Sao Paulo Medical School
Vania Kharmandayan, MD, Division of Plastic Surgery, Hospital das Clinicas, University of Sao Paulo Medical School
Tatiana Moura, MD, MSc, Division of Plastic Surgery, Hospital das Clinicas, University of Sao Paulo Medical School

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