Mini-Laparoscopic Cholecystectomy with Intraoperative Cholangiogram for Symptomatic Cholelithiasis (Gallstones) - Extended
Authors: Brunt LM1, Singh R1, Yee A2
Published: September 26, 2017

AUTHOR INFORMATION
1 Department of Surgery, Washington University, St. Louis, Missouri
2 Division of Plastic and Reconstructive Surgery, Washington University, St. Louis, Missouri

DISCLOSURE
No authors have a financial interest in any of the products, devices, or drugs mentioned in this production or publication.

ABSTRACT
Minimal invasive laparoscopic cholecystectomy is the typical surgical treatment for cholelithiasis (gallstones), where patients present with a history of upper abdominal pain and episodes of biliary colic. The classic technique for minimal invasive laparoscopic cholecystectomy involves four ports: one umbilicus port, two subcostal ports, and a single epigastric port. The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) has instituted a six-step strategy to foster a universal culture of safety for cholecystectomy and minimize risk of bile duct injury. The technical steps are documented within the context of the surgical video for (1) achieving a critical view of safety for identification of the cystic duct and artery, (2) intraoperative time-out prior to management of the ductal structures, (3) recognizing the zone of significant risk of injury, and (4) routine intraoperative cholangiography for imaging of the biliary tree. In this case, the patient presented with symptomatic biliary colic due to a gallstone seen on the ultrasound in the gallbladder. The patient was managed a mini-laparoscopic cholecystectomy using 3mm ports for the epigastric and subcostal port sites with intraoperative fluoroscopic cholangiogram. Specifically, the senior author encountered a tight cystic duct preventing the insertion of the cholangiocatheter and the surgical video describes how the author managed the cystic duct for achieving a cholangiogram, in addition to the entire technical details of laparoscopic cholecystectomy.

An animation showing vaginal childbirth (delivery)

Worst Nail Infection: Paronychia

Learn how to give an intramuscular injection

While in residency, Marc Pelletier, MD, helped in a bypass surgery and knew it was the field in which he would excel. Watch as the Chief of Cardiac Surgery for University Hospitals Harrington Heart & Vascular Institute in Cleveland, Ohio explains, in detail, what happens in preparation for heart surgery, in the operating room and the feeling he experiences after surgery.

How does a heart-lung machine work? What is 'efficiency of motion'? These questions and more are answered in this compelling, dramatic look at heart surgery.

To learn more about heart surgery at University Hospitals: https://www.uhhospitals.org/fo....r-clinicians/special

University Hospitals is one of the nation’s leading health care systems, providing patient-centered care that meets the highest standards for quality and patient safety and have received numerous awards and recognitions from some of the most prestigious institutions in the country for our leadership and exceptional patient outcomes. As an accountable care organization, we foster long-term patient-provider relationships that help promote preventive care, increase wellness and healthy behaviors, decrease emergency episodes, and prevent hospitalizations. To learn more: https://www.uhhospitals.org

High blood pressure is a common condition in which the long-term force of the blood against your artery walls is high enough that it may eventually cause health problems, such as heart disease. Blood pressure is determined both by the amount of blood your heart pumps and the amount of resistance to blood flow in your arteries. The more blood your heart pumps and the narrower your arteries, the higher your blood pressure. You can have high blood pressure (hypertension) for years without any symptoms. Even without symptoms, damage to blood vessels and your heart continues and can be detected. Uncontrolled high blood pressure increases your risk of serious health problems, including heart attack and stroke. High blood pressure generally develops over many years, and it affects nearly everyone eventually. Fortunately, high blood pressure can be easily detected. And once you know you have high blood pressure, you can work with your doctor to control it.

It used to be when a woman needed a hysterectomy she could expect full abdominal surgery with a long recovery time. Dr. Melissa Lee uses less invasive methods that can cut the patients downtime in half.

"We were trained in more laparoscopic and minimally invasive cases so of course that's what I'm more comfortable with doing right now."

She sees a new generation of patients opting for laparoscopic surgery.

"Laparoscopy is the use of small cameras with small incisions and instruments that are guided by the hand, and you're able to see directly into the abdomen without actually fully opening the abdomen," says Dr. Lee, an obstetrician-gynecologist with Lee Memorial Health System.

Nowadays, even a large mass or uterus can be removed using the slender tools.

"There are multiple different laparoscopic instruments that you can use. Whether they're blunt dissections or just dissectors that hold and retract back or actual scissors or cutting instruments, there are multiple different options," says Dr. Lee.

While a standard abdominal hysterectomy requires a four to eight inch incision, the laparoscope needs only a quarter to half inch. It's enough to make a big difference in terms of recovery.

"They're able to get up and move around faster. They're able to recover faster, their pain level and their need for pain medicine is much lower," says Dr. Lee.

The laparoscopic procedure also cuts down on scarring and more importantly, shortens the hospital stay. The trend now is home within 24 hours.

"Where the patient is done early in the morning, they're doing well they're tolerating oral intake they're able to getup and move around. And those patients a lot of times will feel comfortable to go home that same nigh after a major surgery," says Dr. Lee.

New studies show women who've had a laparoscopic hysterectomy viewed their quality of life as better than those who had an open abdominal procedure, making this a good option for the right patient.

View More Health Matters video segments at leememorial.org/healthmatters/

Lee Memorial Health System in Fort Myers, FL is the largest network of medical care facilities in Southwest Florida and is highly respected for its expertise, innovation and quality of care. For nearly a century, we've been providing our community with everything from primary care treatment to highly specialized care services and robotic assisted surgeries.

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A distal radius fracture almost always occurs about 1 inch from the end of the bone. The break can occur in many different ways, however. One of the most common distal radius fractures is a Colles fracture, in which the broken fragment of the radius tilts upward. This fracture was first described in 1814 by an Irish surgeon and anatomist, Abraham Colles -- hence the name "Colles" fracture.

A spermatocele (SPUR-muh-toe-seel) is an abnormal sac (cyst) that develops in the epididymis — the small, coiled tube located on the upper testicle that collects and transports sperm. Noncancerous and generally painless, a spermatocele usually is filled with milky or clear fluid that might contain sperm. The exact cause of spermatoceles is unknown but might be due to a blockage in one of the tubes that transports sperm. Spermatoceles, sometimes called spermatic cysts, are common. They typically don't reduce fertility or require treatment. If a spermatocele grows large enough to cause discomfort, your doctor might suggest surgery.

Successful External Cephalic Version (ECV) - Turning a breech baby in less than 30 seconds!

A Cesarean section (C-section) is surgery to deliver a baby. The baby is taken out through the mother's abdomen. In the United States, almost one in three women has their babies this way. Some C-sections are planned, but many are done when unexpected problems happen during delivery. Reasons for a C-section may include Health problems in the mother The mother carrying more than one baby The size or position of the baby The baby's health is in danger Labor is not moving along as it should

Not every woman undergoes a traditional vaginal delivery with the birth of her child. Under conditions of fetal or maternal distress, or in the case of breech presentation (when a baby is turned feet first at the time of delivery), or if the woman’s first baby was born by cesarean delivery, a procedure called a cesarean section may be required. During a cesarean, a doctor will make either a lateral incision in the skin just above the pubic hair line, or a vertical incision below the navel. As the incision is made, blood vessels are cauterized to slow bleeding. After cutting through the skin, fat, and muscle of the abdomen, the membrane that covers the internal organs is opened, exposing the bladder and uterus. At this time the physician will generally insert his or her hands into the pelvis in order to determine the position of the baby and the placenta. Next, an incision is made into the uterus and any remaining fluids are suctioned from the uterus. The doctor then enlarges the incision with his or her fingers. The baby’s head is then grasped and gently pulled with the rest of its body from the mother’s uterus. Finally, the abdominal layers are sewn together in the reverse order that they were cut. The mother is allowed to recover for approximately three to five days in the hospital. She will also be quite sore and restricted from activity for the following several weeks. There are several potential complications associated with this procedure that should be discussed with a doctor prior to surgery.

Though the risk of HIV transmission through oral sex is very low, but several factors might increase the risk, including sores in the mouth or vagina or on the penis, bleeding gums, having an oral contact with menstrual blood, and the presence of other sexually transmitted diseases. But still the risk is low. by the way better to think twice before having the Oralsex with strangers. because you are not safe 100%.

Esophageal manometry is a test used to measure the function of the lower esophageal sphincter (the valve that prevents reflux of gastric acid into the esophagus) and the muscles of the esophagus (see diagram). This test will tell your doctor if your esophagus is able to move food to your stomach normally.

Bell's palsy is a form of facial paralysis resulting from damage or trauma to the facial nerves. The facial nerve-also called the 7th cranial nerve-travels through a narrow, bony canal (called the Fallopian canal) in the skull, beneath the ear, to the muscles on each side of the face. For most of its journey, the nerve is encased in this bony shell. Each facial nerve directs the muscles on one side of the face, including those that control eye blinking and closing, and facial expressions such as smiling and frowning. Additionally, the facial nerve carries nerve impulses to the lacrimal or tear glands, the saliva glands, and the muscles of a small bone in the middle of the ear called the stapes. The facial nerve also transmits taste sensations from the tongue. When Bell's palsy occurs, the function of the facial nerve is disrupted, causing an interruption in the messages the brain sends to the facial muscles. This interruption results in facial weakness or paralysis. Bell's palsy is named for Sir Charles Bell, a 19th century Scottish surgeon who described the facial nerve and its connection to the condition. The disorder, which is not related to stroke, is the most common cause of facial paralysis. Generally, Bell's palsy affects only one of the paired facial nerves and one side of the face, however, in rare cases, it can affect both sides.

Watch that video of Sperm Formation and Pathway Ejaculation

Purse String Suture

#anatomy #histology #bytesizemed

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📚Factual References & for Further Reading:
- DiFiore's Atlas of Histology
- Junqueira's Basic Histology
- Gartner's Concise Histology
- Openstax Anatomy and Physiology
https://openstax.org/details/b....ooks/anatomy-and-phy
- Openstax Biology
https://openstax.org/details/books/biology-2e
(The last two are links to open-source references. They are NOT affiliate links)

🌤 Note:
These are just a collection of my notes. So use them the way you would use borrowed notes from a friend. 📝
The images in this video are hand-drawn for illustration and explanation only.✍️ Hence, they may not be anatomically accurate. I am just one person making these videos. If there are any errors, that is unintentional. I try super hard to avoid them. Please let me know if you find any, so it gets clarified for other viewers. Science constantly evolves and changes. New discoveries are made everyday. So some of the information in these videos may become outdated. If you notice that, please let me know so I can update them.










⚡️Disclaimer:
These videos are NOT a substitute for a medical textbook. Textbooks are written by experts (which I do not claim to be), edited, proofread and referenced. Please use them.
The information has been sourced from multiple references as mentioned above. I draw all the pictures myself. But if I have inadvertently infringed on any copyright, that is completely unintentional. I only make these videos to impart education. If I have accidentally violated copyright in any way, do let me know so I can make the necessary changes or give credit to anyone who is owed the same.
These videos are NOT intended for patient education. They are NOT a substitute for diagnosis and treatment by a licensed medical professional. Always seek the advice of a qualified health care provider for any questions you may have regarding any medical condition, so that they can address your individual needs.

🔅They are ONLY meant to help students of medicine and health sciences with studying, and should be used for just that purpose and absolutely nothing else.


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Today on Crash Course Anatomy & Physiology, Hank breaks down the parts and functions of one of your body's unsung heroes: your epithelial tissue.

Pssst... we made flashcards to help you review the content in this episode! Find them on the free Crash Course App!
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Chapters:
Introduction 00:00
Proper Epithelium & Glandular Epithelium 1:38
We're All Just Tubes! 2:12
Cell Shapes: Squamous, Cuboidal, or Columnar 3:34
How Form Relates to Function 4:15
Layering: Simple or Stratified 5:26
Epithelial Cells: Apical & Basal Sides 7:06
Glandular Epithelial Tissue Forms Endocrine & Exocrine Glands 8:20
Review 9:16
Credits 9:54

***
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