Diet & Health How-To Videos & Articles « Wonder How To

How to make a sploof that will hide the smell of marijuana smoke

Mon, 17 Jan 2011 21:03:22 GMT

If you like to smoke marijuana in places where you are not permitted to do so, concealing the smoke and smell of the smoke is key. This video will show you how to make a sploof, an ingenious device consisting only of dryer sheets, a paper towel tube, and a rubber band. When you exhale smoke into the device it will cleanse the air of smoke and smell before it comes out the other end, reducing your

Watch the how-to video for How to make a sploof that will hide the smell of marijuana smoke on WonderHowTo.

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How to give a relaxing body massage with four tips

Fri, 14 Jan 2011 22:03:51 GMT

This is the next best thing to having a live-in masseuse. Since your guy probably loves getting a rub down, why not do it right the next time you treat him to one by giving him this relaxing body massage?

Check out the video for four tips on how to massage using pressure points and finesse.

Your man (and friends) will love you for learning these expert techniques. Regular massages can relieve st

Watch the how-to video for How to give a relaxing body massage with four tips on WonderHowTo.

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How to shape up for the new year with Martha Stewart's whole living plan

Thu, 13 Jan 2011 23:24:19 GMT

Ah, the new year. Now that it's 2011, you probably have a long list of resolutions that you want to see through. And hopefully somewhere on the top of that list is detoxifying your body after all that heavy, trans fat-y holiday food and getting in shape.

Terri Trespicio introduces our Whole Living Action Plan, a 28-day jump-start to a year of total mind-body wellness.

Watch the how-to video for How to shape up for the new year with Martha Stewart's whole living plan on WonderHowTo.

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How to prepare a simple protein-filled chocolate meal replacement bar

Thu, 13 Jan 2011 23:21:37 GMT

If you're a college student, then you're super busy all the time. Between running around to classes, hanging around with friends, fraternity parties, volunteering, and work there's very little time to devote to preparing a healthy meal.

But if you want to stay trim and healthy on the go, there is a solution. Check out this video to learn an easy recipe for a chocolate and peanut butter protein ba

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How to gain muscle mass if you're a skinny guy

Thu, 13 Jan 2011 23:07:42 GMT

Fitness experts will always tell you that, above all, it takes consistent dedication, eating right, and hard work to gain muscle. But what if you're a skinny guy whose efforts just aren't paying off?

If you're currently in this kind of situation, check out this fitness video to learn how to gain muscle mass by adjusting a few factors.

-- Make sure you're eating plenty of calories...if you need t

Watch the how-to video for How to gain muscle mass if you're a skinny guy on WonderHowTo.

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How to put in temporary tooth cavity fillings yourself at home

Wed, 12 Jan 2011 23:59:00 GMT

Cavities are an unfortunate sideeffect of our sugar-infused society, and getting them filled is time-consuming, expensive, and requires a trip to the dentist. Do you have some serious courage and want your dental work done on the cheap? Watch this video for an amazing guide to filling your own tooth cavity at home using simple and cheap ingredients. It's amazing what you can do with a little DIY k

Watch the how-to video for How to put in temporary tooth cavity fillings yourself at home on WonderHowTo.

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How to achieve great health in the new year by cooking with 7 super spices

Sat, 08 Jan 2011 01:02:02 GMT

Did you know you can slim down during 2011 without having to starve yourself or log in countless hours at the gym? We're not advocating that you don't eat healthy and become a couch potato, but rather advising you that there are secret ways you can instantly improve your health.

Dr. Wendy Bazilian explains how cooking with 7 "Super Spices" can help you achieve a healthier lifestyle. And they may

Watch the how-to video for How to achieve great health in the new year by cooking with 7 super spices on WonderHowTo.

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How To Roll Your Own Cigars at Home

Mon, 03 Jan 2011 21:56:00 GMT

Cigar Rolling Instructions:

Step 1 Separate Leaves

Separate your dried tobacco leaves into those designated for filler, binders, and wrappers, saving the most pristine for your wrappers. The filler leaf is usually a blend of different types of tobacco, but if you’re growing your own and only have one, that will do.

Step 2 Moisten Leaves

Make sure all your leaves are moist, but not wet, and have a spray bottle on hand if the leaves become too dry.

Step 3 Remove Stems

Gently remove the stems from your leaves, all the way up the length of the leaf (i.e. the middle vein), which will separate them into two pieces. Smooth out your binder and wrapper leaves and set them aside. Make sure the leaves remain moist.

Step 4 Shred or Bundle Leaves

You can either shred your filler leaves into small pieces (like the smoking tobacco you can buy in the store), or just bundle them up into a cylinder that is about an inch longer than your fist on each side. Make sure to keep your filler moist, but NOT wet.

Step 5 Trim a Binder Leaf

Spread out a binder leaf on a smooth workstation (wood or stainless steel work best, if available) and trim a bit off the edges to straighten them out. Traditionally, a blade called a chaveta is used, but any sharp blade will do.

Step 6 Glue

You will need some sort of glue to hold the cigar together. Tragacanth and guam gum are often used, but cheap and accessible alternative are egg whites or ¼ tsp. flour with 2-3 tsp. water.

Step 7 Fill the Binder Leaf

Fill the binder leaf with the fill tobacco and roll it into a cylinder. Make sure to add a little bit of your glue along the edge of the binder leaf, and a bit at the end when you finish the wrap. It may be easier to use the long bunched filler leaver instead of shredding it, as you can just roll it up the leaves at an angle, sort of like candy cane striping.

Step 8 Mold the Cigar

Place the rolled cigar body in a mold and let it sit, heat it at a low temperature, or press it to give the cigar a more perfect shape. Cigars should stay in the mold for an hour or two. However, if you are just rolling for fun and don’t have a mold, it isn’t necessary.

Step 9 Make the Shell

After the cigar has been molded, lay out the wrapper with the veins up and going away from you and smooth it out gently. Be sure to keep it moist, as if the leaf is too dry it will crack, and too wet it will tear. This is the outermost shell of your cigar so be careful!

Step 10 Trim the Shell Edges

Cut away the edges of the wrapper like you did for the binder leaf but make sure the top cut is impeccable. Straight across with no bumps or dips.

Step 11 Roll the Wrapper onto the Body Mold

Place the bottom of your molded cigar body at one end of the wrapper with a bit of extra at the bottom (i.e. not completely flush with the bottom of the wrapper) and roll the body along the rolling paper keeping it on the rolling surface. Put a bit of your glue on the edge of the wrapper, and at the end when you finish the wrap as well. You can pull it back or move it around on the surface to get more tension or space, but don’t dry to roll the wrapper up the body while holding it up in the air. Roll the wrapper up at an angle, in the same candy cane stripe fashion.

Step 12 Finish the Cigar

Once the body is wrapped, you will have excess wrapping leaf at both ends of the cigar. There are many ways to finish a cigar, and how you choose to is up to you. The bottom end is usually just cut flush (preferably with a cigar cutter), and the top is often twisted up, cut just at the tip, and then an extra circular piece of leaf is added as a cap. There are other variations, such as the pig’s tail or the torpedo, but if you are a beginning wrapper, you can always just twist it up and cut it. Not as pretty, but it will do the job.

Step 13 Age Your Cigar

Your cigar is finished! Put it in a humidor (if you have one, it is a cigar box that maintains the right temperature and humidity), or make sure to store the cigar(s) somewhere that has a moderate temperature and humidity, such as your living room. Your cigar will take a while to age, but it would probably be best to wait a minimum of a couple of months before smoking, to allow the tobacco to mellow and blend.

Via How To Roll Your Own Cigars at Home on WonderHowTo.

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How to lose weight this holiday season with a full body workout

Thu, 23 Dec 2010 01:17:49 GMT

To lose weight and stay in shape this holiday season, Alycia from Empower Your Body demonstrates a 5-minute full body workout (no equipment needed!) that focuses on the abs, chest and legs. In addition, Alycia discusses how to lose weight by drinking less, and provides some motivation on how to aspire higher by being nice on the holidays.

Watch the how-to video for How to lose weight this holiday season with a full body workout on WonderHowTo.

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How to prevent excess gas with home remedies and over-the-counter treatments

Tue, 21 Dec 2010 15:46:36 GMT

We've all done it. It's nothing to be embarrassed about, yet we all get red-faced when we let some gas go in a public place. Passing gas is a normal body function, but the more you have, the more embarrassed you are. But there are some ways you can reduce that flatulence, and in this video, you'll learn what some non-pharmacological treatments are, as well as over-the-counter treatments, to help y

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How to treat and reduce the number and severity of coughing episodes

Mon, 13 Dec 2010 03:37:02 GMT

Coughing can't be cured 100%, so don't expect to find some miracle drug that can instantly stop your coughing episodes, because it doesn't exist. The only thing you can hope for is to reduce the number and severity of those coughing episodes, to help lessen the pain and aggravation during the healing process. Cough treatment is symptomatic and the underlying disorder must be treated to stop the ca

Watch the how-to video for How to treat and reduce the number and severity of coughing episodes on WonderHowTo.

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How to lose weight fast using Jedi mind tricks (and without lifting a finger)

Mon, 13 Dec 2010 02:02:42 GMT

Everyone could benefit from shedding a few pounds, but what about those who need to lose a little bit more weight? Exercise isn't an option for everyone, with as busy as our lives are right now. It's hard to go running and do a few pushups when you have a hard enough time scheduling your day already. But if you're looking to shed a couple pounds here and there— without lifting a finger— this two-p

Watch the how-to video for How to lose weight fast using Jedi mind tricks (and without lifting a finger) on WonderHowTo.

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How to work the arms in massage

Sat, 11 Dec 2010 00:33:01 GMT

When you're doing a massage, certain areas may tend to get neglected. Don't forget about the arms! In this video, licensed massage therapist Athena shows you how you can work the arms in massage and help your massagee to relax.

Watch the how-to video for How to work the arms in massage on WonderHowTo.

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How to massage the legs and thighs properly

Sat, 11 Dec 2010 00:29:57 GMT

Feeling the need to chill out and relax? Grab your loved one, and watch this tutorial. You'll learn from licensed massage therapist Athena on the right way to massage the legs and thighs. Once you get up, you'll feel much more refreshed.

Watch the how-to video for How to massage the legs and thighs properly on WonderHowTo.

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How to massage the lower back and hips properly

Sat, 11 Dec 2010 00:24:34 GMT

Not feeling your best? Tired of all the stress piling upon you at work or school or home? Take a few minutes, breathe, and relax. Licensed massage therapist Athena shows you how to properly massage the lower back and hips so you can relax.

Watch the how-to video for How to massage the lower back and hips properly on WonderHowTo.

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How to massage the upper back and shoulders properly

Sat, 11 Dec 2010 00:22:51 GMT

Feeling a bit tired and stressed out? Try a massage. In this video, licensed massage therapist Athena shows you how to get all the knots and kinks out of your upper back and shoulders with proper massage techniques. Have a loved one watch with you so you can help each other out!

Watch the how-to video for How to massage the upper back and shoulders properly on WonderHowTo.

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How to use cups in massage to relax muscles

Fri, 10 Dec 2010 23:54:33 GMT

You may think using cups for massage is weird, but it's actually very relaxing. In this video, licensed massage therapist Athena shows you how to use the cups to effectively relax the muscles in the back. You'll come out of it feeling much less stress.

Watch the how-to video for How to use cups in massage to relax muscles on WonderHowTo.

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How to stretch the hips with massage therapy

Fri, 10 Dec 2010 23:45:43 GMT

In this video, you'll be shown how to open up and stretch the hips using massage therapy. Follow along with licensed massage therapist Athena as she shows you how to work out the kinks and knots of the body. Afterwards, you'll be feeling much more relaxed.

Watch the how-to video for How to stretch the hips with massage therapy on WonderHowTo.

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How to unwind the neck using massage therapy

Fri, 10 Dec 2010 23:38:50 GMT

Feeling the need to unwind? We do, too. In this video, Athena, a licensed massage therapist, shows you how to gently unwind the neck with massage therapy techniques. It's a great way to relax, and to start the day off right.

Watch the how-to video for How to unwind the neck using massage therapy on WonderHowTo.

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How to remove knots out of a back without using deep forceful pressure

Fri, 10 Dec 2010 23:33:37 GMT

Are you terrified of massages because of the deep pressure applied to your body? Don't be afraid. There are gentler ways of removing tense knots from your back. In this video, Athena shows you how to gently remove knots without using deep pressure.

Watch the how-to video for How to remove knots out of a back without using deep forceful pressure on WonderHowTo.

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How To Smoke and Trip Out on Salvia à la Miley Cyrus

Fri, 10 Dec 2010 18:53:12 GMT

For those of you afraid to try marijuana, you have a viable alternative— Salvia. Unlike weed, it's totally legal (in most states), and Miley Cyrus knows this, and that's why her best friend isn't Mary Jane, it's Salvia divinorum.

After an embarrassing video leaked of Miley smoking what some people claimed was pot, she quickly responded that it was Salvia, the psychoactive plant that induces dissociative effects, and of course— laughter. Lot's of it.

Watch Miley Cyrus smoking Salvia on TMZ here

Salvia has many names— Diviner's Sage, ska María Pastora, Seer's Sage— and is traditionally used in spiritual religions. Mazatec shamans are known to use the herbal drug to facilitate visionary states of consciousness during spiritual healing sessions. But nowadays, it's a popular substitute for ganja amongst teenagers who want to hallucinate, like Miley Cyrus, who just turned 18.

If you want to experience the same kind of trip that Miley experienced (along with the guffaw), then these two girls in this video will show you how it's done. They show you not only how to have a pleasurable experience smoking Salvia, but how to do it safely, as well. Learn everything, from start to finish— what you need, how to set it up with a hookah (or bong, if you prefer), and how to make sure you have a great trip to la-la land.

PS: They like the brand Salvia Zone. But maybe there will be a Miley Cyrus Salvia one day.

Smoke Salvia with a hookah for the most pleasurable trip

Via How To Smoke and Trip Out on Salvia à la Miley Cyrus on WonderHowTo.

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How to smoke Salvia with a hookah for the most pleasurable trip

Fri, 10 Dec 2010 18:31:52 GMT

Experience the joy of Salvia. It's the next best thing compared to marijuana, mainly because it's legal in most states. To see the best way to smoke it and trip, these two girls take you through every single detail, to make sure you have the most enjoyable trip.

They show you not only how to have a pleasurable experience smoking Salvia, but how to do it safely

Watch the how-to video for How to smoke Salvia with a hookah for the most pleasurable trip on WonderHowTo.

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How To Transition Smoothly To Vegetarianism

Fri, 10 Dec 2010 15:51:53 GMT

So you've found yourself opting to be a vegetarian. The transition into a new way of eating and living is not always easy and as a result people often ditch their vegetarian goals and revert back to their previous eating habits. Here are some steps to ensure a successful transition to vegetarianism:

Step 1 Find Your Own Reason

Becoming vegetarian for no particular reason can leave one with a lack of motivational force; finding a passionate reason for giving up meat can make all the difference. Do some research into the topic and you will find there are plenty of reasons to switch. Some to consider are:

Conscience - A strong motivation for becoming vegetarian is the animal cruelty taking place in the meat industries. People who have strong beliefs in the equal rights of animals or are just plain animal lovers use the good feeling of saving animals lives to drive their dedication. If you are unaware of the animal cruelty associated in the meat industry, do some research. A popular video that has been known to change minds about meat is a video called "Meet your Meat".

Doing some light research about slaughterhouses on the Internet can result in a change of heart about meat. Try checking out PETA.

Weight Loss - Many people stop eating meat to encourage weight loss and promote health. A vegetarian diet cuts the fat intake drastically, which in turn causes weight loss. Be careful though, as it is easy to instead put on weight because of eating too many carbs (e.g. pastas, breads). As long as you have a healthy balance of vegetables and starches, weight gain should not be an issue. In regards to health, becoming vegetarian drastically reduces the risk of cancer, diabetes, and heart disease. In addition to lowering risk of disease, being vegetarian also can lower cholesterol levels. For more health benefits, click here.

Environmental Impact - Believe it or not, the meat industry is a top contributor to global degradation. Meat production is a huge source of pollution as well as waste of natural resources such as land, water, and food. By not eating meat you are lessening the demand of meat production. If you are passionate about the environment, use this as a motivation, starting a vegetarian lifestyle can help your cause. To find some more startling facts about meat based diets impact on the environment, glance over this article.

Remember to find a reason that YOU believe in - something that makes you really want to change.

Step 2 Slowly Lessen Meat Intake

Now that you have a driving force to success, it is time to actually put the works in motion: rid your life of meat! Going completely cold tofurky is not the best way to adapt to being a vegetarian. When people rid meat all at once they often find themselves struggling more than they have to, which is quite discouraging. The key is to gradually eliminate your meat intake. A good plan is to give yourself a week to wean yourself from meat and get used to alternative meals.

Recommended schedule for your meat-reduction week:

Day 1: Eat naturally, eat exactly what you would typically. At the end of the day take note of how much meat you consumed (measured in how many servings, or meals, whatever works for you).

Day 2 - 4: Start to make conscious decisions of avoiding meat. On these days, reduce your usual meat intake by 1/3. So if you eat meat 3 times a day, change out one meal for a vegetarian option...a bountiful salad or pasta loaded with veggies.

Day 5 - 6: Begin to look for vegetarian alternatives for every meal while still allowing yourself a serving of meat if completely necessary.

Day 7: Say goodbye to meat altogether. Consciously make decisions to eat healthy non-meat entrees and snacks. For some, when the time comes to give up meat all together it can leaves feelings of "I cannot do this" but just remind yourself of that driving reason you have for starting a better lifestyle.

Step 3 Explore Vegetarianism

Now that you are committed to being a vegetarian, it is time to find some fun, delicious vegetarian food! Being programmed to make and eat meat based meals, it can be hard to find vegetarian meals that are just as satisfying, and we all know you can't live off salads forever.

Search around for a grocery store that accommodates your new eating habits. The perfect way to do this is to go to Yelp.com, enter "vegetarian grocery store", and then enter your location. You can read reviews and ratings along with descriptions before selecting a few to try out. If you lack specifically vegetarian grocery stores in your area, try a more organic one such as Whole Foods or Trader Joes.

Once you make your first visit to the grocery store, do not get overwhelmed. Take your time exploring the shelves and do not be afraid to pick things up to examine them further. If you have really been craving a meat product such as turkey for a turkey sandwhich, ask a grocer for recommendations regarding an imitation meat. Just remember to be open to trying new things. Eventually you will find things you love.
After trying some new alternatives you can find yourself finding what you like and dislike. To explore further start looking into vegetarian recipes by searching the internet or even picking up a vegetarian cookbook. Either way, attempt to make at least one new vegetarian dish a week. Eventually you will have a whole new list of recipes that you can enjoy without the need for meat.
In addition to your own preparing of vegetarian meals, try some vegetarian restaurants. The majority of restaurants provide vegetarian options, but since that is not their focus the meals usually are lack-luster. Just like for the grocery store, search Yelp.com for vegetarian restaurants and decide on one that entices you while still fitting your budget. You may even find that vegetarian restaurant menus give you inspiration for your own dish at home.

Step 4 Note Changes

Since you are now a fairly adjusted vegetarian, think about how you felt before making the switch. Think about how you feel now in comparison. Note all the positive side affects that vegetarianism has had on you. For example: a clear conscience, a slimmer figure, maybe an energy boost. Use these constructive changes to motivate yourself further to keep up with your new diet. When you're feeling discouraged, remind yourself of these subtle changes and your desire for more.

Step 5 Have Fun

The most important thing to making a smooth transition that will last is to have fun with it! If you go in perceiving this new, life changing experience as a chore, chances are you will revert right back to eating dead animals. Let yourself view your transition as a fun experience of bettering yourself while getting to explore a whole new way of eating and living.

Via How To Transition Smoothly To Vegetarianism on WonderHowTo.

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How To Cut Out the Thymus Gland with 3 Different Thymectomy Procedures

Thu, 09 Dec 2010 17:50:07 GMT

Jennifer Hopkins. She's a swimmer, a cycling master and a superstar runner— she's an Ironwoman. She's also a victim of multiple sclerosis, lupus and myasthenia gravis, three rare autoimmune diseases that would ruin the best of us.

But Jennifer Hopkins keeps fighting and is currently training for her second Ironman Triathlon. Yes... second. In 2009, she successfully completed the Ironman Triathlon— which consisted of a 3.86-kilometre swim, 180.25-km bicycle ride and 42.19-km run— without a break. That's a feat to be celebrated by any athlete, but for this Canadian lawyer, it's a remarkable achievement.

“I had always wanted to do the Ironman and said that I would do it when I was healthier,” says Hopkins, who was diagnosed with myasthenia gravis, a chronic autoimmune neuromuscular disease, as a teenager and warned she was unlikely to be able to continue participating in most sports.

Yet, she's still training and still surviving— better than most of us. How many of us actually go to the gym? Or run at all?

See her full story @ the Montreal Gazette.

But when it comes to myasthenia gravis, there's actually one way to combat the rare neurologic disease—

A thymectomy.

To give you a little bit more information, myasthenia gravis is a rare medical condition that causes abnormal weakness of certain muscles, muscular weakness without atrophy, and caused by a defect in the action of acetylcholine at neuromuscular junctions.

The thymus gland in front of the heart is usually removed via a thymectomy when tumors are present, but it's also a very common surgery for patients with myasthenia gravis. In the case of myasthenia gravis, the thymus begins to produce antibodies that interfere with the muscle's ability to contract— particularly the eyes, face, throat, legs and arms. Those suffering from the disease may also have difficulty speaking, swallowing or chewing, and maybe even notice droopy eyelids, blurred vision or difficulty making facial expressions.

There's many ways to perform a thymectomy.

You can go straight at it via an incision from the cervical notch to xiphoid notch [1], removing the hyperplastic thymus gland, or you can go the VATS approach [2], which stands for video-assisted thoracoscopic surgery (in this case, a thoracoscopic thymectomy). You can also try a video-assisted extended transcervical thymectomy [3].

This article will show you all three methods for this surgical procedure.

Step 1 Thymectomy (Cervical / Xiphoid Approach)

This surgical video outlines the complete process of removing the hyperplastic thymus gland in a patient with myasthenia gravis. If you're a surgeon, this video should help you out with techniques of the medical procedure. If you're not a doctor, it's simply interesting to watch.

Remove the hyperplastic thymus gland with a thymectomy for myasthenia gravis

Step 2 Thymectomy (Video-Assisted Thoracoscopic Surgery)

This surgical video outlines the step-by-step anatomical approach for doing the thoracoscopic surgery from the right side in a patient with myasthenia gravis, via VATS, by Dr. Arun Prasad MS, FRCS at the Apollo Hospital in New Delhi, India.

Perform a thoracoscopic thymectomy (VATS) on myasthenia gravis patients

Step 3 Video-Assisted Extended Transcervical Thymectomy

This procedure comes straight from CTSNet, the Cardiothoracic Surgery Network, by Christopher B. Komanapalli, MD, James I. Cohen, MD, PhD and Mithran S. Sukumar, MD. There's detailed steps, pictures and links to demonstration videos.

Patient Selection

Thymectomy for myasthenia gravis, thymic cysts, thymoma less than two centimeters in size, and mediastinal parathyroid adenoma within the thymus are all indications for a video-assisted extended transcervical thymectomy (Figure 1). Thin, young female patients may be best suited for this approach, as they have a more pliable thoracic cage and less muscular chest wall compared to males. Patients who have had median sternotomy or prior radiation to the anterior mediastinum are not suitable for this approach due to adhesions that are present that prevent expansion of the anterior mediastinal space after placement of the sternal retractor, which is a requirement to perform the operation safely. Obesity is a relative contraindication to this approach, as the anterior mediastinal exposure is limited by body shape and fat and the ability of the sternal retractor to provide adequate exposure.

Operative Steps

General anesthesia via a double lumen endotracheal tube is used. The patient is positioned supine with an inflatable pressure bag placed horizontally or vertically behind the shoulders to extend the neck and to allow for improved exposure of the anterior mediastinum later in the procedure. (Figure 2 A, B). A large bore (16G) intravenous line is placed in a peripheral vein and an arterial line is also placed. The endotracheal tube is positioned to the left of the mouth and the head of the patient can be turned to the left to further improve access to the mediastinum. The entire neck and anterior chest are prepped and draped so that access to the sternum is easily available should conversion to sternotomy be required.

The surgeon wears a headlight to help with illumination of the mediastinum and loops to improve visualization when performing the cervical dissection as well as parts of the mediastinal dissection which are performed under direct vision. A thirty degree thoracoscope is used to provide illumination and visualization within the anterior mediastinum. Insertion of the scope through the cervical incision is done carefully to avoid smearing of the lens and it is maintained at the right end of the cervical incision while dissecting the left mediastinum and vice versa when dissecting the right. The surgeon is positioned at the head of the bed so a direct view of the mediastinum from superior to inferior is obtained. The assistant stands to the right or left of the surgeon, depending on the position of the thoracoscope. The video monitor is best positioned at the foot of the bed so that the surgeon and assistant have the same view of the mediastinum.

A transverse curved 5cm cervical incision is made 2 centimeters above the sternal notch between the sternocleidomastoid muscles and subplatysmal skin flaps are raised superiorly to the thyroid cartilage and inferiorly to the sternal notch (Figure 3, Video 1) . The strap muscles are dissected in the midline and down to the sternal notch. The upper poles of the thymus are identified on the posterior aspect of the strap muscles where they have the appearance of encapsulated fat and can be bluntly dissected with a “peanut” dissector from the surrounding tissue (Video 2). The thyrothymic ligaments at the superior extent of the poles are ligated and divided in between 2-0 silk ligatures which are left long on the thymic end. This allows for traction on the gland which facilitates the dissection into the superior mediastinum (Figure 4).

The plane just posterior to the sternum is developed bluntly with a finger and the Rultract retractor is placed and the skyhook used to elevate the sternum (Figure 5A & B, Video 3) [1]. The inflatable pressure bag posterior to the patient is now deflated, allowing the anterior mediastinum to further expand as the middle mediastinum falls away.

The thymus is dissected into the superior mediastinum using blunt, sharp and cautery dissection interchangeably (Video 4). The thymic veins are encountered posterior to the gland draining into the antero-inferior aspect of the left innominate vein. These are isolated and ligated using 2-0 silk ligatures (Video 5). Clips are not used as the repeated passage of instruments through this area during the operation may cause them to dislodge. Extension of the gland behind the innominate vein can be dissected at this time and the posterior surface of the gland is dissected to a level inferior to the vein.

The substernal plane is then created bluntly using a tonsil sponge on a curved ring clamp (Video 6). This dissection extends from the sternal notch to the domes of the diaphragm and laterally to the pleural reflections and separates the anterior surface of the thymus from the chest wall. This can be done under direct vision or with the thoracoscope, which is introduced through either end of the neck wound.

The left lung is deflated and the mediastinal pleura is widely opened sharply or with cautery starting from the diaphragm inferiorly to the level of the innominate vein (Video 7). Care is taken at the superior extent of this dissection to protect the phrenic nerve and internal mammary vessels; this portion of the dissection is done after the nerve has been visualized. The thoracoscope provides excellent illumination and improved visualization at this stage, but this dissection can also be done under direct vision. Use of a Yankauer sucker keeps the field free of smoke and it can be used to place tension on the cut pleural edge. Collapsing the left lung aids in the ease of performing this part of the dissection, allowing the phrenic nerve running over the lateral pericardial surface to be kept in view at all times and permitting a more complete mediastinal dissection (Video 8). Rolling the OR table to the contra-lateral side of the mediastinal dissection improves visualization and makes this part of the mediastinum more accessible.

The thymus is grasped and retracted to the right and dissected medial to the phrenic nerve using a combination of sharp (thoracoscopic scissors) and blunt techniques (“peanut” or tonsil sponge) starting superiorly below the AP window and continuing distally to the left inferior pole (Video 9). Small vessels that are encountered are clipped with a 5mm endoclip applier and divided. Once the left margin of the gland has been dissected this is continued medially, separating it from the anterior surface of the pericardium sharply or bluntly. The use of cautery on the pericardium should be minimized as this reduces the chance of pericarditis and pericardial effusion postoperatively. The diaphragmatic dissection of the mediastinal fat and gland is done in a similar fashion. This dissection is continued as far right of the midline as possible.

The left lung is re-inflated. The right pleura is opened after collapsing the right lung. This opening is started inferiorly and continued superiorly, taking care to protect or divide the internal mammary vein at the upper extent of the opening if this facilitates further exposure (Video 10). The phrenic nerve running over the anterior hilum is visualized and avoided as the right margin of the gland is dissected after retracting it to the left, starting superiorly or inferiorly. The dissection is continued medially until all except the upper part of the gland is attached to the anterior surface of the pericardium.

The gland is grasped in the midline at the level of the innominate vein and retracted anteriorly and to the left and the posterior aspect of the gland dissected sharply to the AP window. Once this is complete the left upper margin of the gland is dissected anteriorly from the phrenic nerve in the region of the AP window. With this the gland is freed from the mediastinum and is removed through the cervical incision (Video 11, Figure 6). Any remaining anterior mediastinal and pericardial fat is removed (Video 12). At the conclusion of the operation the entire anterior mediastinum should be clear of thymic tissue and fat (Video 13). A medium sized Blake or JP drain is placed and the lung is re-inflated (Video 14).

Preference Card

Rultract retractor with ‘sky hook attachment’
Thirty degree thoracoscope
Thoracoscopic ring clamp, tonsil sponge and scissors
5 mm endo clip applier

Tips & Pitfalls

Select patients carefully.
The use of the inflatable pressure bag, specialized sternal retractor and single lung ventilation are essential to provide the optimal exposure.
Opening the pleura allows for the phrenic nerve to be easily identified and to perform a more extensive dissection.
Use the thoracoscope and direct vision to perform the operation using whichever modality offers the best visualization.
The thoracoscopic ring clamp, scissors and cautery with an extension are essential to perform the mediastinal dissection.
Be prepared to do a sternotomy if needed.

Results

Transcervical thymectomy was first performed by Sauerbruch in 1912 for myasthenia gravis [2] however it was not till the 1960’s that Crile [3] re-popularized the thymectomy via the transcervical route. In 1988 Jaretzki coined the term “maximal thymectomy,” which consisted of a cervical incision to completely dissect the gland in the neck and a sternotomy via which all anterior mediastinal tissue was removed between the phrenic nerves, the SVC and trachea, AP window [4]. He reported an improved remission rate for myasthenia and this became the standard against which other techniques have been measured [5]. In the same year Cooper reported a modified technique of transcervical thymectomy employing the use of a custom sternal retractor which allowed improved visualization of the mediastinum [6]. Subsequently, series employing this technique have reported comparable rates of remission to that of maximal thymectomy [7].

Thoracoscopy, and more recently robotics, have now been added to the techniques by which thymectomy can be accomplished with either a left or right chest approach, and series have reported a short term remission equivalent to previous techniques [8, 9]. In 2003, Keshavjee described the addition of thoracoscopy to the transcervical route which improved illumination and visualization of the mediastinum facilitating the transcervical thymectomy [10, 11].

There are now numerous series demonstrating the efficacy of the transcervical route for thymectomy in myasthenic patients, with complete remission rates similar to those of sternotomy but without the morbidity [12-16]. An initial series in 1994 [17] reported a 5-year complete remission rate of 43% which is supported by the largest series on transcervical thymectomies just published in 2006 [16]. The complication rate was 7% and the duration of hospital stay was zero to three days [16, 17]. Preoperative disease severity is predictive of postoperative remission, with more severe disease being associated with a lower chance of remission [16].

Thymectomy for thymoma via the neck is controversial, with little data regarding long term outcomes. If the technique is to be performed, patient selection should be limited to those with <2 cm well encapsulated tumors [7]. A recent study advocates addition of the transcervical approach for patients undergoing thymectomy by thoracoscopy to ensure a complete thymectomy, but other series report comparable remission rates to trans-sternal or cervical approaches [15]. The transcervical approach to thymectomy with video-assistance is a safe, reliable technique to perform a complete thymectomy with a low morbidity and hospital stay.

References

For a list of references used in the above article, Video-assisted Extended Transcervical Thymectomy, by Christopher B. Komanapalli, MD, James I. Cohen, MD, PhD and Mithran S. Sukumar, MD...

Click through to see the entire article on CTSNet.

There's also a really good article worth checking out on the Surgery of the Thyroid Gland over at Thyroid Disease Manager. You can also download the PDF here.

* References for this article on Thymectomies: CTSNet, Mayo Clinic, The Medical News, Montreal Gazette, Thyroid Manager

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How to Get Rid of Crabs

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Things you will need:

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Hand towel

Step 1 Buy Rid-X from a local drug store

It only cost about 8 or $9 at a drug store. This is a very affordable way to get rid of these tiny pests. Once you bring the box home, open it and get started with the steps.

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Warnings

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Tips

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How to familiarize yourself with America's most-abused drugs

Thu, 28 Oct 2010 18:53:42 GMT

In this brief health-minded video tutorial from the people at Health Guru, we learn about the most commonly abused drugs within the United States. For all of the details, and to learn more about these potential problem substances, watch this video guide.

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How to control your anger with five simple techniques

Thu, 28 Oct 2010 18:50:59 GMT

While there's nothing wrong with feeling anger, it's important that you be in control of the ways in which you manifest that anger. And this brief mental-health how-to from Health Guru will teach you five simple techniques that will help you to accomplish just that.

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How to light a cigarette with the matchstick trick

Tue, 26 Oct 2010 17:40:48 GMT

What's one of the hottest and coolest ways to light a cigarette? You'll see…

This video shows you how to set up this neat little trick, where the top stub of a matchstick is placed inside the tip of the cigarette and lit when struck against the specially prepared surface that was once on the match box, but now on the pack of cigarettes. It's a great way f

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How to improve your memory with association memory games

Fri, 22 Oct 2010 19:48:08 GMT

Do you have trouble remembering where you put your keys or what you need to buy at the grocery store? You're not alone, millions of Americans suffer from bad short-term memory, but there are ways to help improve your memory. Watch this video to learn how to play some easy memory games that will help you remember things.

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How to diagnose and treat the symptoms of herpes

Fri, 22 Oct 2010 17:54:38 GMT

In this medical-minded video tutorial from the folks at Mahalo, we learn how to diagnose and treat the most common symptoms of herpes, a common sexually-transmitted disease or STD. For all of the details, and to learn more about diagnosing and treating herpes, take a look.

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How to diagnose and treat the symptoms of hepatitis

Fri, 22 Oct 2010 17:53:31 GMT

In this medical-minded video tutorial from the folks at Mahalo, we learn how to diagnose and treat the most common symptoms of hepatitis, a common sexually-transmitted disease or STD. For all of the details, and to learn more about diagnosing and treating hepatitis, take a look.

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How to diagnose and treat the symptoms of gonorrhea

Fri, 22 Oct 2010 17:47:11 GMT

In this medical-minded video tutorial from the folks at Mahalo, we learn how to diagnose and treat the most common symptoms of gonorrhea, a common sexually-transmited disease or STD. For all of the details, and to learn more about diagnosing and treating gonorrhea, take a look.

Watch the how-to video for How to diagnose and treat the symptoms of gonorrhea on WonderHowTo.

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How to diagnose and treat the symptoms of chlamydia

Fri, 22 Oct 2010 17:46:10 GMT

In this medical-minded video tutorial from the folks at Mahalo, we learn how to diagnose and treat the most common symptoms of chlamydia, a common sexually-transmited disease or STD. For all of the details, and to learn more about diagnosing and treating chlamydia, take a look.

Watch the how-to video for How to diagnose and treat the symptoms of chlamydia on WonderHowTo.

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How to wrap up your broken toe at home

Mon, 18 Oct 2010 21:21:18 GMT

We all make the same mistake at some point. Walking around, minding your own business and then BAM you crush your toe right into a step, a wall, a small raise in the ground. Your toe is broken, you're shouting like a sailor, and your toe now looks like a swollen grape. Don't worry, you don't have to go to the hospital. Instead, check out this great video where you learn how to wrap your broken toe

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How to reduce and relieve ankle pain five different ways

Sat, 16 Oct 2010 00:11:18 GMT

Straight from behind the locker room doors, this video presents five easy methods for reducing tightness and strain of the foot, ankle and calf muscles. This can also provide relief to the hamstring and low back muscles.
Don't overdo it, start gradual with five repetitions and repeat a two to three times a week. Especially comforting for those who have been walking in high heels all day.

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How to become a stem cell or blood marrow donor in Canada

Sat, 16 Oct 2010 00:09:44 GMT

In this video tutorial, you'll learn how to become a stem cell or blood marrow donor in Canada. For all of the details, including detailed instructions on how you yourself can become a stem cell or blood marrow donor, watch this video guide from Food Facts.

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How to protect your health by avoiding polysorbate 80

Sat, 16 Oct 2010 00:02:21 GMT

In this video tutorial, you'll learn about the risks associated with polysorbate 80, a common food additive. For all of the details, including a list of foods in which the additive is present, watch this video guide from Food Facts.

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How to protect your health by avoiding polysorbate 60

Sat, 16 Oct 2010 00:01:58 GMT

In this video tutorial, you'll learn about the risks associated with polysorbate 60, a common food additive. For all of the details, including a list of foods in which the additive is present, watch this video guide from Food Facts.

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How to protect your health by avoiding polysorbate 65

Sat, 16 Oct 2010 00:01:41 GMT

In this video tutorial, you'll learn about the risks associated with polysorbate 65, a common food additive. For all of the details, including a list of foods in which the additive is present, watch this video guide from Food Facts.

Watch the how-to video for How to protect your health by avoiding polysorbate 65 on WonderHowTo.

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