Close-up of a peripheral nerve surgery


Lights—camera—action! A peripheral nerve surgery begins, videotaped and photographed so that others can study innovative techniques without traveling to St. Louis.

Photo by Robert Boston



IN THE WORLD OF SURGERY, the peripheral nerve specialty has been called an orphan child. Many surgeons, including plastic surgeons, orthopedic surgeons, neurosurgeons and general surgeons, encounter injuries to peripheral nerves in their practices, but few devote their careers to understanding these injuries and finding the best ways to treat the patients who have them.

To fill such gaps in surgical know-how, the physicians of Washington University’s Division of Plastic and Reconstructive Surgery — world leaders in the repair and management of peripheral nerve injuries — are trying to spread their extensive knowledge using what is perhaps an obvious, yet largely untapped surgical resource: the Internet.


Medical team assesses neuromuscular function

Out of the O.R. and into cyberspace

Ida K. Fox, MD

Ida K. Fox, MD

In addition to their extensive work in the laboratory and operating room, these doctors have embarked on an ambitious and highly technical effort to catalog, video and disseminate the latest information about peripheral nerve surgery. Ever a work in progress, the site is

The brainchild of surgeon Ida K. Fox, MD, assistant professor of plastic and reconstructive surgery, the website is intended to help practicing surgeons better treat injuries to peripheral nerves.

“By providing this resource, we hope to improve the approach to complicated nerve injuries, resulting in better patient outcomes,” Fox says. “We started work on the site four years ago, overcoming many obstacles inherent in teaching surgery over the Internet. We plan to continue this work and make the site as complete and useful as possible.”

Among others collaborating with Fox in this endeavor is Susan E. Mackinnon, MD, the Shoenberg Professor and chief of the Division of Plastic and Reconstructive Surgery. Mackinnon, a pioneer in managing peripheral nerve injuries, performs many of the surgeries featured on the website.

Andrew Yee

Andrew Yee

And the award for best director goes to...

Andrew Yee, senior research technician and perhaps the technical “nerve” center of the website, films the surgeries, edits and produces the videos, manages the content of the site, and monitors the “hits,” keeping track of visitors.

“Andrew videotapes all of these surgeries, edits them and gets them online so that surgeons who know how to operate can see our techniques,” Mackinnon says.

In 2007, armed with a biotechnology degree from the Rochester Institute of Technology, Yee joined Mackinnon’s lab, which is devoted to research designed to support her peripheral nerve surgical practice.

Knowing of Yee’s interest in technology, Fox soon approached Yee with the idea of producing an educational website.

“I liked the whole IT element of developing the website,” Yee says. “I also have a deep interest in film. I host our surgery videos on a site called Vimeo, which is a community of documentary filmmakers.”


A resource for surgeons, the website offers information on anatomy and physiology, evaluation and management, and surgical options.

Distance learning

Anyone may visit this open-access website and watch the videos, but its intended audience is practicing surgeons. Heavy in technical jargon, Yee says even members of the medical community have commented on the intensity of the material.

Yee is especially interested in those visitors to the site who watch entire videos, as they are the ones most likely to be surgeons using the resource to actually learn the surgery. The site launched in January 2011 and since then has received more than 12,000 unique visitors, with almost 30 percent of those returning for more in-depth viewing. Most visitors are from North America and Europe, but word is spreading.

“Recently, we gave permission to an orthopedic group in India to link to our videos from their educational website,” Yee says. “So, there has been a large uptick in traffic from the medical community in India. But we get comments from all over the world as well.”

A major target audience of the website — and a major source of its funding — is the military, especially those surgeons treating soldiers who have served in Iraq and Afghanistan. With support from the Henry M. Jackson Foundation for the Advancement of Military Medicine, among others, Mackinnon, Fox, Yee and their colleagues hope the site will help meet the urgent need to treat wounded veterans.

Andrew Yee films a peripheral nerve surgery

Capturing complex procedures on video expands the typical way of learning surgery.


Telling the story

Yee produces two videos for each procedure, a long and short version, both narrated by Mackinnon or Fox, depending on who performed the surgery. Yee cuts out what he calls “boring” portions of the video — parts of the procedure that surgeons should know how to do, including cauterizing and clamping vessels to prevent bleeding. Such edits might bring the raw footage of a 3-hour procedure down to 20 or 30 minutes. Then Yee produces an even shorter version, perhaps 5 to 10 minutes, highlighting the most important parts.

“I’m literally looking over Dr. Mackinnon’s shoulder as she performs the surgery,” Yee says. “There are a lot of surgery videos online, but they don’t really tell a story. Cutting between scenes, it may be difficult to know how they got from one part to another. I’ve been working with Dr. Mackinnon for so long now, I really know where she’s going with the surgery and I can build the video so it tells the story in a linear fashion.”

The quality of the video instruction is evident in the statistics. The most popular video is the ulnar nerve transposition. Combined, the long and short versions have been played more than 600 times over the past 11 months.

Yee calls the videos the shining stars of the website. But the video collection is only one of four sections packed with information. The site includes an extensive area focusing on the anatomy and physiology of peripheral nerves. There is also an evaluation and management section offering a guide to diagnosis. Such guides may even help doctors to determine that surgery is not the best option. And a section on case studies highlights unique situations and how they were handled, including follow-up and physical therapy after surgery.

“We’re trying to break the boundaries of the typical way of learning surgery,” Yee says. “I’ve gotten plenty of email saying this is such a great resource. It’s wonderful to hear that it helped a doctor do a successful procedure without coming to our center. We love getting that kind of feedback.”

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