Contributor: John Zhao
Collagenase clostridium histolyticum (CCH) injections were FDA approved in 2010 for use in Dupuytren’s contracture. Interest among surgeons in this office-based treatment has rapidly increased in the past 5 years due to its shorter recovery time and limited complication rates compared to open fasciectomy.
Editor Recruited By: David Bozentka, MD
Critical elements of the technique for Laparoscopic Pancreatic anastamosis for MIS Whipple procedure are demonstrated.
This shows a 2 layered duct to mucosa anastamosis.
Deep Inferior Epigastric Perforator Flap: Abdominal Closure and Flap Inset
This video depicts the abdominal closure and DIEP flap inset for a delayed bilateral deep inferior epigastric perforator (DIEP) flap reconstruction in a 53-year-old patient status post bilateral mastectomy for breast cancer.
Authors: Eva Niklinska B.S., Vincent Riccelli M.D., Ashkan Afshari M.D., Stephane Braun M.D., Kent K. Higdon M.D., Galen Perdikis M.D., Julian Winocour M.D.
Affiliations: Vanderbilt University Medical Center
Corresponding Author: Eva Niklinska
Minimally Invasive Radioguided Parathyroidectomy
Author: Joshua Hagood
Performing surgeon/coauthor: Brendan C. Stack, Jr., M.D., FACS, FACE
Department of Otolaryngology – Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
Primary hyperparathyroidism is a disease caused by overproduction of parathyroid hormone (PTH). This condition is most commonly caused by a solitary, hyperfunctioning, adenoma among one of the four parathyroid glands. The hallmark finding of hyperparathyroidism is hypercalcemia which can manifest symptomatically as nephrolithiasis, diabetes insipidus, renal insufficiency, bone pathology, gastrointestinal symptoms, and neuropsychiatric disturbances (remembered as “Stones, Bones, Groans, and Psychiatric overtones”). Minimally invasive Radio guided Parathyroidectomy (MIRP) is a curative procedure for primary hyperparathyroidism that can use both radionuclide guidance and intraoperative PTH measurements to confirm the removal of the offending adenoma. Radionuclide guidance is performed via the injection of 99mTc-sestamibi, which is a radiomarker that sequesters within adenomatous/hypermetabolic parathyroid tissue. Intraoperatively, the amount of 99mTc-sestamibi within excised tissue can be measured with the use of a handheld gamma probe.
-Endotracheal Nerve Integrity Monitoring System (NIMS)
-Intraoperative PTH assay equipment
Deep Inferior Epigastric Perforator Flap: Abdominal Flap Dissection
This video depicts the abdominal flap dissection for a delayed bilateral deep inferior epigastric perforator (DIEP) flap reconstruction in a 53-year-old female patient status post bilateral mastectomy for breast cancer.
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