Pancreatic pseudocyst drainage was the first therapeutic application of EUS. The cyst is punctured under ultrasound guidance, contrast injected, and a guidewire inserted. Initial dilation to 8mm is performed over the wire The EUS scope is then exchanged over the wire for a forward viewing endoscope.... A second dilation to 18mm is performed. This enables entry of the endoscope into the cyst perform cystoscopy, debridement if necessary, and insertion of multiple large bore double pigtail stents. The curved linear array-or CLA—echoendoscope has oblique viewing optics located proximal to an oblique scanning transducer. The accessory exits from the shaft of the echoendoscope at an ablique angle, adjustable between 15 and 30 degrees. There are several technical limitations using this echoendoscope. The oblique angle of exit results in a weekend transfer of force when advancing the accessory, difficult deployment of larger bore accessories, and in instrument tunneling effect relative to the bowel wall. There is the potential loss of access during endoscope exchange. A novel CLA echoendoscope was developed by the Olympus Corporation that shifts the orientation of endoscopic and ultrasound views from oblique to forward viewing. The channel is therapeutic at 3.7mm Note that the working channel is located adjacent to the ultrasound transducer at the endoscope tip. The accessory exits the working channel in the axis of the shaft. Shown here are balloon inflation and deployment of a Dormia basket. We report on the use of the prototype forward viewing echoendoscope in six consecutive patients who were referred for pancreatic cyst drainage. Here you see endoscopic view-indistinguisable from that of a gastroscope-showing a bulge where the cyst impinges against the posterior gastric wall. Power Doppler is switched on and highlights multiple vessels interposed in the wall This allows selection of a safe vessel-free window for a cyst puncture A 19 G needle is advanced into the cyst lumen. A sample of contents is aspirated for fluid analysis. A guidewire under ultrasound guidance into the cyst. An 18mm balloon is coaxially thread over the wire and advanced across the cyst wall, Note that resistance is encountered, but the forward transfer of force overcome this. The dilation is performed under forward viewing endoscopuc and ultrasound guidance. As the balloon is maximally inflated we see the cystgastrostomy open up. The balloon is then deflated while simultaneously advancing the scope into the cyst cavity. Cystoscopy isnow performed showing the cyst contents to be filled with pasty wall-adherent necroses. Pulsed power Doppler is switched on we can see and hear arterial flow vessels within the wall of the cyst. This identifies sensitive areas at bleeding risk when performing debridement In this case vigorous water jet irrigation is performed through an accessory water irrigation channel built into the echoendoscope. This issued to clear nonadherent debris. Our experience has shown that it is not necessary to actively remove wall-adherent debris using extraction tools as such Dormia or Roth net basket to achieve cyst resolution. Three large bore 10 Fr double pigtail stents are now inserted into the cyst under direct endoscopic guidance. The first stent is delivered over a guide catheter. The second stent. And the third stent All three stents are deployed. Finally, a nasocystic catheter is inserted for maintenance irrigation. In another patient we used the Cook Cystome to perform cystgastrostomy. We have found the Cystotome easy to delivery through the forward viewing echoendoscope. As shown, we advance the Cystotome into the cyst while applying diathermy. This is performed under and endoscopic guidance, entering the cyst at a near perpendicular orientation. After entry, the Cystotome is removed and cyst fluid gushes from the cystagastrotomy site.

Recommendations for clipping in endoscopic stomach surgery

This video clip shows an upper track endoscopy of A 75 year-old female, presented with severe adominal pain since three days. Endoscopy displays a deep ulcer at the lesser curvature of the stomach. This patient has a klatskin´s tumor (bile duct bifurcation).

The Pulsed Electron Avalanche Knife, a new electrosurgical knife for “cold” and traction-less cutting, was successfully used for a variety of surgical maneuvers commonly encountered in patients undergoing ocular surgery.

Robotic Prostatectomy: Cornell Athermal Robotic Technique

Fibroma Excision in the Cheek

Cataract surgery with dense arcus

Types of breast cancer. The different types of breast cancer carry with them different prognosis and different treatment options

Animated video on otitis media, infection of the middle ear, which is common in children.

Needle Insertion Transversus Abdominus Block

Adult CPR Video Demonstration

Mesenteric Vessel Ligation

Dr.Vijay C. Bose from Apollo Speciality Hospital chennai perform Birmingham Hip Resurfacing Surgery procedure for a case of Avascular necrosis.The NCP ( Neck Capsule Preserving) approach is being used. Total hip replacement, hip resurfacing simply shaves and caps a few centimeters of bone within the joint. The bone-conserving approach of the Birmingham Hip Resurfacing System.

A knee replacement operation from India shows a Gender specific knee replacement implanted through a subvastus approach. Surgery performed by Dr.Venkatachalam of Madras Joint Replacement center www.kneeindia.com

Intercostal Tube Insertion in case of pneumothorax

A unique look into laboratory techniques for egg freezing, also known as oocyte cyropreservation. Take an exclusive look inside one of the most advanced, state-of-the-art in vitro fertilization (IVF) laboratories to see how RMA of New York performs egg freezing procedures using strict identification standards. Medical and laboratory video footage documents egg retrieval, egg identification from follicular fluid, preparation for preservation, and the cyropreservation and storage process for egg freezing. RMA of New York is proud to partner with Extend Fertility ™ to offer egg freezing services. To learn more, please visit Reproductive Medicine Associates of New York www.rmany.com/fertility-hope Or Extend Fertility http://www.extendfertility.com 635 Madison Avenue, 10th floor New York, New York 10022 Telephone: (212) 756-5777 Facsimile: (212) 756-5770 15 North Broadway, Garden Level - Suite G White Plains, New York 10601 Telephone: (914) 997-6200 Facsimile: (914) 997-8111 Reproductive Medicine Associates of New York, Long Island 400 Garden City Plaza, Suite 107 Garden City, NY 11530 Telephone: (516) 746-3633 Facsimile: (516) 746-3622 Reproductive Medicine Associates International Mexico, S.C. Prolongacion Paseo de la Reforma 1232, Oficina 1213 Colonia Lomas de Bezares Delegacion Miguel Hidalgo Mexico, Distrito Federal 11910 Telephone: 011-52-55-2167-2515 Fax: 011-52-55-2167-6434

Catheterization of the Pulmonary Artery through the internal jugular vein

Acute Myocardial Infarction - Heart Attack

Video demonstrates the action of the isolated lumbar multifidis muscle

Interlocking Continuous Suture