Continuous Connell Pattern Suture

Vertical Mattress Pattern Suture

Use of Skin Stapler

Sentinel Lymph Node removal in breast Cancer en Français

The colonoscope is slowly withdrawn during this screening colonoscopy down from the transverse colon, back around the splenic flexure, and down the descending colon, and reveals this finding a colonic diverticula. Diverticulosis is a common, acquired, age-related occurrence affecting over 50% of the... western adult population over the age of 50. It is seen rarely in Africa and Asia where the dietary fiber content is traditionally higher. Thus most investigators feel that low fiber diets are related to the development of this condition. Ironically, colonic diverticula are not true diverticula but rather pseudodiverticula in that the sac includes layers of the mucosa and submucosa that push through rather than include the outer muscular layer. As with the small bowel the colon has an inner circular muscular layer, but the outer longitudinal layer is composed of three bands of muscle that run the length of the colon known as teniae. Diverticula occur in rows between the mesenteric and two antimesenteric teniae where the colonic wall is further weakened by the defect caused by the perforating vasa recti artery which supplies the colonic mucosa. Occasionally, the anatomic propensity of diverticula to form in rows is quite apparent as seen when this clip is replayed in slow motion. Most often, however, the arrangement of the diverticula appears random due to the angulation of the bowel and thickening of the semi lunar folds. The conditions that cause these pulsion diverticula are not know with certainty but may include high intrahaustral pressures, muscular hypertrophy, and age related alterations in collagen cross linking. Diverticula can bleed or can abscess and perforate. The incidence of diverticulitis or diverticular bleeding is in the range of 1:1,000 patients with diverticulosis.

Surgical technique: A 3cm skin incision under spinal or general anesthesia, depending on the patients’ preference, starts half way the line between the superior anterior iliac spine towards the midline in a 30° angle to the pubic tubercle. Scarpa’s fascia is opened as well as the external obliq...ue aponeurosis. By using this skin line incision the internal ring will be immediately visualized. Although it is important to look for both direct and indirect hernias evaluating the groin, we do not taper the cord and directly evaluate the ring for indirect hernias. In case of an indirect hernia the sac is reduced or resected according to the preference of the surgeon and the preperitoneal space is entered bluntly through the dilated internal ring. In case of a direct hernia the approach slightly differs. One could prefer to open the transversalis fascia through the internal ring over a few centimeters or you can open the fascia more medially, at the site of the direct hernia. As primary point of concern the epigastric vessels should be identified and retracted softly upwards. Then a gauze can be introduced into the preperitoneal space and by doing so most of the space needed medially will be created. Then one can already palpate Cooper’s ligament and the pubic bone. Laterally to the internal ring more digital dissection is needed to create just the appropriate space for the mesh. By placing the mesh it is important not to introduce the mesh too medially. Laterally of the internal ring an adequate overlap of the mesh is necessary, especially in indirect hernias. No splitting of the mesh seems necessary. The patient will be asked to strain and push on the ring to control its place and to check adequate spreading of the mesh to cover the whole myopectineum of Fruchaud. One single stitch of vicryl 3/0 is placed taking both the fascia transversalis and the mesh.

Endoscopic third ventriculostomy in a patient with obstructive hydrocephalus

A video showing how to draw blood for sampling

TRAM only in cases where a Diep or Gracilis is not applicable

Two Step Adult CPR Video Demonstration

University Hospitals Neurological Institute will host a live webcast to demonstrate the removal of a brain tumor that doctors believe is causing epileptic seizures in a middle-aged man.

An MRI showed what appears to be a glioma (tumor) near a part of the brain that controls muscle movement, called the motor strip. Studies have shown that complete removal can cure the seizures and improve quality of life and survival, but this is difficult to do with conventional technology without harming the surrounding normal brain because it's difficult to determine where tumor ends and normal brain begins.

Combined Spinal-Epidural Obstetric Anesthesia

This video demonstrates the approach to a large base of tongue tumor, which was invading the ramus of the mandible. The procedure, named after Dr. Trotter, is really a median labiomandibuloglossotomy. In this case this poorly differentiated tumor was resected along with a portion of the floor of mouth. The entire area was reconstructed with a pectoralis major myocutaneous flap.

Diagnose an abusive relationship and you will be on your way to ending domestic abuse. Getting a definitive, objective diagnosis can put you in the "stop-guessing" mode and into the "start-treating" mode in moments.

Voice annotated arthroscopic surgery on the right shoulder to perform a subacromial decompression.
Surgery was performed by Dr. Lamont Cardo

Beating heart or "off pump" coronary artery surgery is the latest revolution in the management coronary disease. It is being embraced world-wide by increasing numbers of surgeons. Many of the advantages are subtle but reduced mortality, stroke, and bleeding as well as earlier discharge are well-established benefits. A cardiac stabiliser is mandatory for this surgery, most are single use only and very expensive, this one is multiple use and is saving many healthcare dollars

This high technology apparatus for the forearm is helping to restore hand movement in stroke patients. ~ Detroit Medical Center

This minimally invasive procedure cures acid reflux without resorting to a large abdominal incision. It also decreases recovery time. ~ Detroit Medical Center

This video show a lip biopsy on a 38-year old man with a swelling of the lower lip of unknown origin.

Bloodless accurate atraumatic and efficient strengthening of a medial rectus.Non magnetic steel sutures used.All cutting is done by Fugo blade.Postoperative reaction is nil.The child goes to school 2 days after surgery.