Hernia basecamp

Colorectal basecamp

Wrist basecamp

podcast

Introducing "Beyond IRCAD - Surgical Journeys". Join us on an inspiring and captivating monthly journey as we sit down with prestigious surgeons who have built remarkable careers in the field of medicine. In each episode, we explore the personal backgrounds and experiences of these exceptional individuals, as they share their inspiring stories of overcoming challenges, staying committed, and achieving success. Whether you're a medical professional, a student aspiring to be a surgeon, or simply someone looking for motivation from incredible human stories, this podcast is for you. 

Join us for a discussion with Professor Arnaud Wattiez, a world-leading gynecologic surgeon renowned for his dedication to excellence and mentorship. Professor Wattiez has not only advanced his field but also fostered a community of top surgeons through his teaching. We will also delve into his transformative journey from France to Dubai, exploring how this move profoundly impacted his personal and professional life, bringing him a newfound balance and contentment. Tune in for an inspiring tale of achievement and personal growth.

Beyond IRCAD - Surgical Journeys: Episode 8: Arnaud Wattiez

Beyond IRCAD - Surgical Journeys: Episode 8: A Wattiez

Beyond IRCAD - Surgical Journeys: Episode 7: M Galvao Neto

Introducing "Beyond IRCAD - Surgical Journeys". Join us on an inspiring and captivating monthly journey as we sit down with prestigious surgeons who have built remarkable careers in the field of medicine. In each episode, we explore the personal backgrounds and experiences of these exceptional individuals, as they share their inspiring stories of overcoming challenges, staying committed, and achieving success. Whether you're a medical professional, a student aspiring to be a surgeon, or simply someone looking for motivation from incredible human stories, this podcast is for you.

In this episode of "Beyond IRCAD", delve into Dr. Galvao Neto's journey as a modern surgeon, blending innovation with passion. Explore how he integrates music and dance into surgical preparation, highlighting the fusion of enjoyment and expertise. Discover the essential balance of surgical skills with empathy in the 21st century medical world, where active social media engagement is paramount.

Beyond IRCAD - Surgical Journeys: Episode 6: Nicolas Demartines

Introducing "Beyond IRCAD - Surgical Journeys". Join us on an inspiring and captivating monthly journey as we sit down with prestigious surgeons who have built remarkable careers in the field of medicine. In each episode, we explore the personal backgrounds and experiences of these exceptional individuals, as they share their inspiring stories of overcoming challenges, staying committed, and achieving success. Whether you're a medical professional, a student aspiring to be a surgeon, or simply someone looking for motivation from incredible human stories, this podcast is for you.

In this episode, Professor Nicolas Demartines discusses overcoming operating room challenges through humility, active listening, and humor. 

Explore the satisfaction of fostering empathy and giving back, as he emphasizes collaboration over competition in surgery for the benefit of the patient.

Beyond IRCAD - Surgical Journeys: Episode 5: Jacques Marescaux

Introducing "Beyond IRCAD - Surgical Journeys". Join us on an inspiring and captivating monthly journey as we sit down with prestigious surgeons who have built remarkable careers in the field of medicine. In each episode, we explore the personal backgrounds and experiences of these exceptional individuals, as they share their inspiring stories of overcoming challenges, staying committed, and achieving success. Whether you're a medical professional, a student aspiring to be a surgeon, or simply someone looking for motivation from incredible human stories, this podcast is for you.

In this episode of Beyond IRCAD, Professor Jacques Marescaux shares his keys to success. He talks about his wife’s essential role in the history of IRCAD, how he became a citizen of Rwanda, he reveals how WebSurg almost disappeared, and why Alsace was the perfect place for IRCAD. Discover how he managed to become not only a groundbreaking surgeon, but also a successful businessman.

Introducing "Beyond IRCAD - Surgical Journeys". Join us on an inspiring and captivating monthly journey as we sit down with prestigious surgeons who have built remarkable careers in the field of medicine. In each episode, we explore the personal backgrounds and experiences of these exceptional individuals, as they share their inspiring stories of overcoming challenges, staying committed, and achieving success. Whether you're a medical professional, a student aspiring to be a surgeon, or simply someone looking for motivation from incredible human stories, this podcast is for you.

In this episode, we interviewed Professor Mariano Gimenez, a globally renowned surgeon specializing in image-guided percutaneous surgery and HPB surgery. 

Join us for a unique perspective as Professor Gimenez emphasizes the personal dimensions that shape a distinguished surgical career, discussing the dangers of ego and the crucial role mentors play.

Beyond IRCAD - Surgical Journeys: Episode 4: Mariano Gimenez

Beyond IRCAD - Surgical Journeys: Episode 3: Sébastien Froelich

Introducing "Beyond IRCAD - Surgical Journeys". Join us on an inspiring and captivating monthly journey as we sit down with prestigious surgeons who have built remarkable careers in the field of medicine. In each episode, we explore the personal backgrounds and experiences of these exceptional individuals, as they share their inspiring stories of overcoming challenges, staying committed, and achieving success. Whether you're a medical professional, a student aspiring to be a surgeon, or simply someone looking for motivation from incredible human stories, this podcast is for you.

In our third episode, we interviewed Professor Sébastien Froelich, a world-renowned skull base surgeon from France. Hear about his unexpected journey into surgery, how his work became a passionate pursuit, and the unique, humbling experiences with his patients. 

Join us for a captivating insight into Professor Froelich’s extraordinary career in skull base surgery!

Introducing "Beyond IRCAD - Surgical Journeys". Join us on an inspiring and captivating monthly journey as we sit down with prestigious surgeons who have built remarkable careers in the field of medicine. In each episode, we explore the personal backgrounds and experiences of these exceptional individuals, as they share their inspiring stories of overcoming challenges, staying committed, and achieving success. Whether you're a medical professional, a student aspiring to be a surgeon, or simply someone looking for motivation from incredible human stories, this podcast is for you.

In our second episode, we are honored to feature the distinguished Dr. Xavier Serra Aracil, an innovative expert in the field of colorectal surgery from Spain. Tune in to gain insight into the remarkable path of Dr. Serra Aracil's outstanding career.



Discover the story behind his passion for surgery, the driving force that propels him forward, the values that guide his work and personal life, and explore the valuable advice he offers to the up-and-coming generation of aspiring surgeons.



Beyond IRCAD - Surgical Journeys: Episode 2: Xavier Serra Aracil

Introducing "Beyond IRCAD - Surgical Journeys". Join us on an inspiring and captivating monthly journey as we sit down with prestigious surgeons who have built remarkable careers in the field of medicine. In each episode, we explore the personal backgrounds and experiences of these exceptional individuals, as they share their inspiring stories of overcoming challenges, staying committed, and achieving success. Whether you're a medical professional, a student aspiring to be a surgeon, or simply someone looking for motivation from incredible human stories, this podcast is for you. 

In the very first episode, we have the privilege of hosting the renowned Dr. Armando Melani, a trailblazing colorectal surgeon hailing from Brazil. Join us as Dr. Melani takes us on a captivating exploration of his unique career path.



Discover the story behind his passion for surgery, the driving force that propels him forward, and the values that guide his work and life. Dr. Melani's dedication extends beyond the operating room, as he shares his profound commitment to passing on knowledge to the next generation of surgeons.



Stay tuned for an engaging conversation that goes "Beyond IRCAD”.

Beyond IRCAD - Surgical Journeys: Episode 1: Armando Melani

surgical intervention video

This video demonstrates a laparoscopic extrahepatic bile duct resection and a Roux-en-Y hepaticojejunostomy technique in a 48-year-old female patient for a choledochal cyst. Diagnostic imaging performed for abdominal pain was consistent with a Todani type Ic choledochal cyst. She had a surgical history of cholecystectomy for cholecystolithiasis and sleeve gastrectomy for morbid obesity. During the hepaticojejunostomy, tearing of the bile duct and its management are outlined in the video.



Bibliography:

1. Xiao J, Chen M, Hong T, Qu Q, Li B, Liu W, He X. Surgical Management and Prognosis of Congenital Choledochal Cysts in Adults: A Single Asian Center Cohort of 69 Cases. J Oncol. 2022 Jan 21;2022:9930710. doi: 10.1155/2022/9930710. PMID: 35096065

2. Zhang K, Zhao D, Xie X, Wang W, Xiang B. Laparoscopic surgery versus robot-assisted surgery for choledochal cyst excision: A systematic review and meta-analysis. Front Pediatr. 2022 Oct 26;10:987789. doi: 10.3389/fped.2022.987789. PMID: 36389347

3. Yin T, Chen S, Li Q, Huang T, Li L, Diao M. Comparison of outcomes and safety of laparoscopic and robotic-assisted cyst excision and hepaticojejunostomy for choledochal cysts: A systematic review and meta-analysis. Ann Med Surg (Lond). 2022 Feb 26;75:103412. doi: 10.1016/j.amsu.2022.103412. PMID: 35386800



Laparoscopic extrahepatic bile duct resection and Roux-en-Y hepaticojejunostomy for choledochal cyst

Résection extrahépatique de la voie biliaire principale par laparoscopie et hépaticojéjunostomie selon Roux pour kyste du cholédoque

video lecture

In this key lecture, Dr. Bernard Dallemagne outlines the surgical and endoscopic management of Zenker's diverticulum.

Zenker's diverticulum: surgical and endoscopic treatment

Diverticule de Zenker : traitement chirurgical et endoscopique

The authors present a didactic video highlighting the use of a surgical sponge in laparoscopic surgery with various surgical demonstrations and examples.

The video shows clips from various pelvic gynecologic procedures demonstrating the versatility and spectrum of applications of the surgical sponge to increase the efficiency of the surgical procedure. 



Bibliography:

1. Bariol SV, Heng CT, Lau HM. Intracorporeal ribbon gauze in laparoscopic surgery. ANZ J Surg. 2004 Jan-Feb;74(1-2):68. doi: 10.1046/j.1445-1433.2003.02890.x. PMID: 14725709.

2. Gholami SS, Shekarriz B, Rudnick D, Duh QY, Stoller ML. The laparoscopic cigarette sponge. J Urol. 2001 Jul;166(1):194. PMID: 11435855.

3. Maccabee D, Sheppard BC. The laparoscopic sponge. Surg Endosc. 2003 Aug;17(8):1320-1. doi: 10.1007/s00464-002-8779-9. Epub 2003 Apr 28. PMID: 15039864.



Role of surgical sponge (gauze) in laparoscopic surgery

Rôle de la compresse chirurgicale en chirurgie laparoscopique

Traitement laparoscopique d'une péritonite biliaire post-cholécystectomie

In this video, the authors present the case of a patient admitted to hospital with biliary peritonitis following a laparoscopic cholecystectomy. The patient was operated on again using a laparoscopic approach and a biliary peritonitis was found in relation to a leak through an aberrant duct. Peritoneal lavage was performed, and the aberrant duct was sutured. Nowadays, the laparoscopic approach is increasingly used in the management of biliary complications secondary to cholecystectomy.



Bibliography: 

Dokmak S, Amharar N, Aussilhou B, Cauchy F, Sauvanet A, Belghiti J, Soubrane O. Laparoscopic Repair of Post-cholecystectomy Bile Duct Injury: an Advance in Surgical Management. J Gastrointest Surg. 2017 Aug;21(8):1368-1372. doi: 10.1007/s11605-017-3400-7. Epub 2017 Mar 27. PMID: 28349333. 



Laparoscopic treatment of post-cholecystectomy biliary peritonitis

Chirurgie percutanée et e-mentoring : l'apprentissage à distance est-il possible ?

In this authoritative lecture, Professor Mariano Giménez looks into percutaneous surgery and e-mentoring and the possibilities of remote training.

Percutaneous surgery and e-mentoring: is it possible to train remotely?

In this authoritative lecture, Dr. Steven Rothenberg considers the evolution of a technique, providing an update on thoracoscopic repair of esophageal atresia and tracheoesophageal fistula (TEF), 24 years after the first thoracoscopic approach.

Update on thoracoscopic repair of esophageal atresia and tracheoesophageal fistula (TEF), 24 years after the first thoracoscopic approach: evolution of a technique

Prise en charge thoracoscopique de l'atrésie de l'œsophage et de la fistule trachéo-œsophagienne, 24 ans après la première approche thoracoscopique : évolution d'une technique

Prostatectomie radicale assistée par robot pour prostate hypertrophique avec lobe médian à l'aide du système chirurgical robotisé Versius

Prostate cancer surgeons are commonly faced by a technically challenging situation dealing with prostate cancer having large median lobes. Patients with large median lobes often have larger prostates, which makes it difficult to visualize anatomical planes during robot-assisted radical prostatectomy (RARP) (1). The general consensus in the literature is that robotic assisted radical prostatectomy (RARP) for patients with a protruded median lobe (PML) poses a true technical challenge (2). A PML causes various degrees of distortion for bladder neck anatomy. Bladder neck resection in large median lobes involves a higher risk of ureteral orifice injury being too close to the bladder neck edge (3). PML has been associated with a longer operative time and hospital stay, and more blood loss. Additionally, poor recovery of urinary continence and higher positive surgical margins (PSMs) have been reported with PML (4). 

In this video, we present the case of a 59-year-old patient with an enlarged prostate and a protruded median lobe. The authors describe the steps and good results obtained from this challenging approach with the recent Versius surgical robotic system (manufactured by CMR surgical).



Bibliography: 

(1) Wagaskar VG, Zaytoun O, Kale P, Pedraza A, Busby D, Reddy A, Tewari A. Technical Tips in Managing Large Median Lobes During Robot-assisted Radical Prostatectomy. Eur Urol Open Sci. 2022 Sep 23;45:32-37.

(2) Huang A.C., Kowalczyk K.J., Hevelone N.D., et al. The impact of prostate size, median lobe, and prior benign prostatic hyperplasia intervention on robot-assisted laparoscopic prostatectomy: technique and outcomes. Eur Urol. 2011;59:595–603.

(3) Bedir F., Keske M., Demirdogen S.O., Kocaturk H., Atmaca A.F., Canda A.E. Diagnosis and conservative management of ureteral orifice injury during robotic prostatectomy for a large prostate with a prominent median lobe. J Endourol Case Rep. 2019;5:39–41. 

(4) Jung H., Ngor E., Slezak J.M., Chang A., Chien G.W. Impact of median lobe anatomy: does its presence affect surgical margin rates during robot-assisted laparoscopic prostatectomy? J Endourol. 2012;26:457-460.

Robotic assisted radical prostatectomy  in a patient with a large prostate with median lobe using the Versius robotic surgical system

Nouveaux robots chirurgicaux à l'horizon

In this authoritative lecture, Prof. Barbara Seeliger gives an overview of current and new surgical robotic systems on the horizon and their emerging applications.

Robotically assisted approaches to thoracoabdominal diseases have gained increasing momentum over the last two decades. More than 100 companies offer robotic systems for all surgical disciplines worldwide, and technological progress is driving the adoption of procedures that are challenging with standard instrumentation. Of note, progress in endoluminal surgery will be accelerated with the use of flexible robots, and the treatment of small tumors in the liver and lungs using robotic systems for percutaneous image-guided surgery. Surgical robotic systems as digital interfaces with computer assistance and image guidance will provide connectivity between experts and decision-making support, and enhance training and teaching via the integration of machine learning-based diagnostic systems and advanced telecommunications infrastructures (5G today and 6G tomorrow). As a surgical community, we can continue to shape the future of minimally invasive surgery with clinical trials, research/development projects, and Industry collaborations on an internatinal scale.

New surgical robots on the horizon

Prostatectomie radicale robotisée avec ultra-préservation nerveuse : approches antérieures et antérogrades

In this key lecture, Prof. Thierry Piéchaud, MD, PhD, addresses ultrapreservation in robotic radical prostatectomy outlining anterior, antegrade approaches.

Ultrapreservation in robotic radical prostatectomy: anterior, antegrade approaches 

In this key lecture, Dr. Rafael F. Coelho, MD, PhD outlines inferior vena cava (IVC) thrombus management during minimally invasive radical nephrectomy.

Management of inferior vena cava (IVC) thrombus during minimally invasive radical nephrectomy 

Prise en charge de thrombus de la veine cave inférieure au cours de la néphrectomie radicale mini-invasive

The critical view of the myopectineal orifice (MPO) is defined as the appropriate exposure of the anatomical area that must be obtained before placing the mesh during laparoscopic and robotic inguinal hernia repair. This concept is a consolidation of recommendations shown to reduce hernia recurrence and postoperative complications and standardizes the teaching and evaluation of minimally invasive inguinal hernia repair.

This video presents the case of a right-sided indirect inguinal hernia. The authors demonstrate here the steps to achieve the critical view of the MPO in an extended totally extraperitoneal (eTEP) inguinal hernia repair, followed by mesh placement.

Bibliography:

1. Daes J, Felix E. Critical view of the myopectineal orifice. Annals of surgery. 2017 Jul 1;266(1):e1-2.
2. Claus C, Furtado M, Malcher F, Cavazzola LT, Felix E. Ten golden rules for a safe MIS inguinal hernia repair using a new anatomical concept as a guide. Surgical endoscopy. 2020 Apr;34:1458-64.
3. Felix E, Lourié D, Daes J. Understanding the Critical View of the Myopectineal Orifice (MPO) for Safe Minimally Invasive Surgical Inguinal Hernia Repair. In Newer Concepts and Procedures in Hernia Surgery-An Atlas 2023 Jan 1 (pp. 3-10). Singapore: Springer Nature Singapore.

Extended totally extraperitoneal (eTEP) repair of right-sided inguinal hernia demonstrating the critical view (CV) of the myopectineal orifice (MPO)

Cure de hernie inguinale droite totalement extrapéritonéale étendue (eTEP) avec identification formelle de l'orifice musculo-pectinéal

The video presents the clinical case of a 49-year-old male patient who had undergone a laparoscopic TAPP repair for a right inguinal hernia one year earlier. He presented with an internal recurrence of his right inguinal hernia and with a voluminous left inguinal hernia. On clinical exam and imaging, a 2 to 3cm direct hernia protrusion, Nyhus type IIIa, was found. It was decided to perform a laparoscopic repair for the left inguinal hernia and to explore the right inguinal hernia. Based on anatomical aspects, a laparoscopic redo was performed.

It is usually recommended to treat inguinal hernia recurrence after a laparoscopic transabdominal preperitoneal approach (TAPP) using an anterior approach to work on a non-operated site. In this video, it was decided to manage the patient’s contralateral hernia laparoscopically, and to simultaneously explore the hernia recurrence.

Laparoscopic management of a recurrent right inguinal hernia after primary laparoscopic TAPP repair

Prise en charge laparoscopique d'une récidive de hernie inguinale droite après cure laparoscopique par voie d'abord transabdominoprépéritonéale (TAPP) 

There is evidence in the literature supporting that postoperative complications in colorectal surgery can be handled laparoscopically. Many cases of reoperative surgery will be described in the video. Most of them are due to anastomotic leakage evidenced during the early postoperative days. Depending on the size of the anastomotic defect, an anastomosis takedown or proximal ostomy may be performed. Lavage of the entire abdomen can be performed using a minimally invasive approach. Patients may keep the benefits of the initial laparoscopic surgery with the management of this potentially lethal complication using a reoperative laparoscopic surgery.

Bibliography:

1\. Rotholtz NA, Laporte M, Matzner M, Schlottmann F, Bun ME. "Relaparoscopy" to treat early complications following colorectal surgery. Surg Endosc. 2022 May;36(5):3136-3140. doi: 10.1007/s00464-021-08616-6. Epub 2021 Jun 22. PMID: 34159459.

2\. Rotholtz NA, Angeramo CA, Laporte M, Matzner Perfumo M, Schlottmann F, Bun ME. "Early" Reoperation to Treat Complications Following Laparoscopic Colorectal Surgery: The Sooner the Better. Surg Laparosc Endosc Percutan Tech. 2021 Aug 18;31(6):756-759. doi: 10.1097/SLE.0000000000000984. PMID: 34406166.

Laparoscopic reoperation for early postoperative complications after colorectal surgery

Réopération laparoscopique en cas de complications postopératoires précoces après chirurgie colorectale

In this educational video, the authors demonstrate the laparoscopic repair of recurrent umbilical and epigastric hernias with an extended totally extraperitoneal (eTEP) retromuscular technique. The authors perform this approach using 6 trocars: one 12mm balloon trocar, one 11mm trocar, and four 5mm trocars. Anatomical landmarks were marked with a skin marking pen on the patient’s abdomen. The authors performed the open insertion of a 12mm disposable trocar using a cylindrical balloon for the initial dissection performed from the retromuscular space to the left rectus abdominis muscle. The procedure was pursued while the authors dissected the pelvic preperitoneal space and performed a crossover dissection from the left to the right retromuscular space through the preperitoneal space. An incision to the medial edge of the left posterior rectus aponeurosis was subsequently performed. The upper crossover to the right was performed before the incision of the medial edge of the right posterior rectus aponeurosis and the dissection of the right retromuscular space with the reduction of the hernia sac. The right-sided dissection was advanced to the right preperitoneal space and ended with the dissection of the right inguinal hernia. Peritoneal tears were sutured and the rectus abdominis diastasis repaired with a continuous barbed suture, including the closure of the ventral hernia defect with plication of the hernia sac. A medium-weight polypropylene mesh of 25 by 15cm was placed in the retrorectus space, which was drained with a suction drain. 



References:

Morrell ALG, Morrell A, Morrell-Junior AC, Mendes JMF, Morrell AG. Standardization and ten essential steps in the lateral robotic extended totally extraperitoneal (eTEP) repair of ventral hernias. Rev Col Bras Cir. 2020 Oct 7;47:e20202622. English, Portuguese. doi: 10.1590/0100-6991e-20202622. PMID: 33053065.

Ramana B, Arora E, Belyansky I. Signs and landmarks in eTEP Rives-Stoppa repair of ventral hernias. Hernia. 2021 Apr;25(2):545-550. doi: 10.1007/s10029-020-02216-4. Epub 2020 May 18. PMID: 32424727.

Mitura K, Rzewuska A, Skolimowska-Rzewuska M, Romańczuk M, Kisielewski K, Wyrzykowska D. Laparoscopic enhanced-view totally extraperitoneal Rives-Stoppa repair (eTEP-RS) for ventral and incisional hernias - early operative outcomes and technical remarks on a novel retromuscular approach. Wideochir Inne Tech Maloinwazyjne. 2020 Dec;15(4):533-545. doi: 10.5114/wiitm.2020.99371. Epub 2020 Sep 25. PMID: 33294067; PMCID: PMC7687670.

Belyansky I, Daes J, Radu VG, Balasubramanian R, Reza Zahiri H, Weltz AS, Sibia US, Park A, Novitsky Y. A novel approach using the enhanced-view totally extraperitoneal (eTEP) technique for laparoscopic retromuscular hernia repair. Surg Endosc. 2018 Mar;32(3):1525-1532. doi: 10.1007/s00464-017-5840-2. Epub 2017 Sep 15. PMID: 28916960.

Enhanced-view totally extraperitoneal (eTEP) retromuscular repair for ventral (umbilical and epigastric) recurrent hernia and right inguinal hernia

Technique eTEP pour cure rétromusculaire de hernie ventrale (ombilicale et épigastrique) récidivante et hernie inguinale droite

Gregory Randolph, Professor of Otolaryngology at Harvard University gives the 2023 BJS Lecture for the European Society of Oncology on management of advanced thyroid malignancy. He will bring you up to date with surgical, chemotherapy and genetic treatments for this condition.

Current state and future prospects in the management of advanced thyroid malignancies

État actuel et perspectives d'avenir dans la prise en charge des tumeurs malignes de la thyroïde à un stade avancé

In this authoritative lecture, Dr. Michiel Cromheecke, MD gives an overview of the ultrasound-guided intervention for trigger finger.

Ultrasound-guided trigger finger release for long fingers

Traitement échoguidé du doigt à ressaut pour doigts longs

Systématisation des étapes opératoires dans le traitement endoscopique du diastasis recti

In recent years, diastasis recti has become a condition that has sparked interest among general surgeons. Minimally invasive treatment has become a safe and effective alternative for resolving diastasis recti. Various techniques have been described between 2012 and 2020. Endoscopic repair through rectus muscle re-approximation and placement of a supra-aponeurotic mesh is the most widely used technique. 



References:



Hernández-Granados P, Henriksen NA, Berrevoet F, Cuccurullo D, López-Cano M, Nienhuijs S, Ross D, Montgomery A. European Hernia Society guidelines on management of rectus diastasis. Br J Surg. 2021 Oct 23;108(10):1189-1191. doi: 10.1093/bjs/znab128. PMID: 34595502.



Claus CM, Malcher F, Totti Cavazzola L, Furtado M, Morrell A, Azevedo M, Meirelles L, Santos H y Garcia R. Subcutaneous onlay laparoscopic approach (SCOLA) for ventral hernia and rectus abdominis diastasis repair: technical description and initial results. ABCD Arq Bras Cir Dig 2018;31(4):e1399.



Juárez Muas D. Preaponeurotic Endoscopic repair (REPA) of diastasis recti associated or not to midline hernias. Surg Endosc. 2018. https://doi.org/10.1007/s00464-018-6450-3.



Reinpold W, Köckerling F, Bittner R, Conze J, Fortelny R, Koch A, Kukleta J, Kuthe A, Lorenz R, Stechemesser B. Classification of Rectus Diastasis-A Proposal by the German Hernia Society (DHG) and the International Endohernia Society (IEHS). Front Surg. 2019 Jan 28;6:1. doi: 10.3389/fsurg.2019.00001. PMID: 30746364; PMCID: PMC6360174.



Malcher F, Lima DL, Lima RNCL, Cavazzola LT, Claus C, Dong CT, Sreeramoju P. Endoscopic onlay repair for ventral hernia and rectus abdominis diastasis repair: Why so many different names for the same procedure? A qualitative systematic review. Surg Endosc. 2021 Oct;35(10):5414-5421. doi: 10.1007/s00464-021-08560-5. Epub 2021 May 24. PMID: 34031740.

Systematization of technical steps in the endoscopic treatment of diastasis recti

Abdominal wall surgery is in constant evolution. Complications related to surgical wounds and postoperative pain have been the subject of various analyses for many years, leading to the emergence of new techniques to address them. Laparoscopic hernia surgery emerged with the aim of improving postoperative pain and reducing wound complications (1). When the IPOM technique was initially described, it was observed that pain indeed decreases, but the high seroma rate may complicate the postoperative period (2). It appeared that closing the hernia defect provided clear benefits (3), and the LIRA (laparoscopic intracorporeal rectus aponeuroplasty) technique allowed for a tension-free closure of the defect and appropriate mesh integration, with positive results to date (3). It is a reproducible technique that allows progression to more complex techniques such as extended totally extraperitoneal repair (eTEP). The authors present the case of a male patient with a recurrent M2W2 hernia, in whom a LIRA technique was performed. In this video, key steps were demonstrated to facilitate the learning of the technique. The main objective of this video is to help novice surgeons to understand this technique. 

Bibliography:

1. Zhang Y, Zhou H, Chai Y, Cao C, Jin K, Hu Z (2014) Laparoscopic versus open incisional and ventral hernia repair: a systematic review and meta-analysis. World J Surg 38(9):2233–2240. https://doi.org/10.1007/s00268-014-2578-z

2. Van Hoef S, Tollens T (2019) Primary non-complicated midline ventral hernia: is laparoscopic IPOM still a reasonable approach? Hernia 23(5):915–925. https://doi.org/10.1007/s10029-019-02031-6

3. Suwa K, Okamoto T, Yanaga K (2016) Closure versus non-closure of fascial defects in laparoscopic ventral and incisional hernia repairs: a review of the literature. Surg Today 46(7):764–773. https://doi.org/10.1007/s00595-015- 1219-y

4. Gómez-Menchero J, Balla A, García Moreno JL, Gila Bohorquez A, Bellido-Luque JA, Morales-Conde S. Laparoscopic intracorporeal rectus aponeuroplasty (LIRA) technique versus intraperitoneal onlay mesh (IPOM plus) for ventral hernia repair: a comparative analysis. Hernia. 2023 Aug 17. doi: 10.1007/s10029-023- 02858-0. Epub ahead of print. PMID: 37592164

LIRA (laparoscopic intracorporeal rectus aponeuroplasty) technique for recurrent epigastric hernia

Technique LIRA par voie d'abord laparoscopique pour hernies épigastriques récurrentes

Mini cure de hernie ventrale de petite taille (M2W1) par voie d'abord transabdominale prépéritonéale (technique TAPP) chez une patiente en surpoids

Abstract:

The transabdominal preperitoneal (TAPP) technique in ventral hernia repair allows for the placement of a much larger mesh than in the anterior surgical approach. It is also closer to current recommendations, especially for patients with additional risk factors, such as obesity without diastasis recti. The TAPP technique allows for mesh introduction into the preperitoneal space, which prevents direct contact between the mesh and the intestines. The mini ventral TAPP approach is feasible and safe.



Bibliographic references:

1. I.F. Megas, et al. A propensity‐score matched analysis of ventral‐TAPP vs. laparoscopic IPOM for small and mid‐sized ventral hernias. Comparison of perioperative data, surgical outcome and cost‐effectiveness. https://doi.org/10.1007/s10029-022-02586-x 

2. Muysoms, F.E., et al., Classication of primary and incisional abdominal wall hernias. https://doi.org/10.1007/s10029-009-0518-x 

3. Skolimowska-Rzewuska M., Romańczuk M., Mitura B., Wyrzykowska D., Mitura K. Laparoscopic transabdominal preperitoneal repair (umbilical TAPP) versus open ventral patch repair for medium size umbilical hernias in overweight and obese patients. https://doi.org/10.5114/wiitm.2021.110415 

4. Gillies M., Anthony L., Al-Roubaie A., Rockliff A., Phong J. Trends in Incisional and Ventral Hernia Repair: A Population Analysis From 2001 to 2021. https://doi.org/10.7759/cureus.35744 

5. Daes Jorge. Evolución de la reparación laparoscópica de las hernias ventrales y del sitio de la incisión. https://10.1016/j.rehah.2016.05.001 





Mini ventral transabdominal preperitoneal (TAPP) repair for small size ventral hernia (M2W1) in an overweight patient

Splénopancréatectomie gauche laparoscopique pour le traitement d'une tumeur kystique

This video presents the management of a pancreatic tumor with a left splenopancreatectomy. The aim of this video is to present the ‘clockwise’ technique in a laparoscopic distal pancreatectomy setting. 



Bibliography:

Asbun, H. J., Van Hilst, J., Tsamalaidze, L., Kawaguchi, Y., Sanford, D., Pereira, L., Besselink, M. G., & Stauffer, J. A. (2020). Technique and audited outcomes of laparoscopic distal pancreatectomy combining the clockwise approach, progressive stepwise compression technique, and staple line reinforcement. Surgical Endoscopy, 34(1), 231‑239. https://doi.org/10.1007/s00464-019-06757-3



Laparoscopic left splenopancreatectomy for a cystic tumor

monthly focus

Usually, medium-sized umbilical hernias are treated with an open approach since it is the most used technique. However, in situations of increased risk of surgical wound complications, such as immunosuppression, corticosteroid therapy, obesity or diabetes, as well as other associated hernia defects or diastasis of the rectus and in large hernias (>4cm), the use of the minimally invasive approach is indicated (1, 2). 

This video demonstrates a stepwise TARUP (transabdominal retromuscular umbilical prosthetic hernia repair) technique for hernia repair with mesh placement, with the use of the da Vinci Xi™ surgical robotic system, which offers a certain number of benefits.



References:

1. Henriksen NA, Montgomery A, Kaufmann R, Berrevoet F, East B, Fischer J, et al. Guidelines for treatment of umbilical and epigastric hernias from the European Hernia Society and Americas Hernia Society. British Journal of Surgery 2020; 107:171–90.

2. Rodrigues V, López-Cano M. Técnica TARUP. Ventajas de la cirugía mínimamente invasiva de la pared abdominal asistida por robot. Cirugía Española 2021; 99:302–5.



Robotic transabdominal retromuscular umbilical prosthetic hernia repair (TARUP)

Cure d'éventration ombilicale par technique robot-assistée de type r-TARUP avec renforcement prothétique 

Since its first description in 2017, the enhanced-view totally extraperitoneal (eTEP) approach for laparoscopic retromuscular hernia repair has gained popularity as it combines the advantages of a retromuscular mesh placement according to the Rives-Stoppa technique, with the benefits of minimally invasive hernia surgery (1). This approach is technically challenging with a long learning curve. However, it seemingly offers several advantages as compared to the laparoscopic intraperitoneal onlay mesh placement technique (IPOM) (2).

This video presents the case of a 57-year-old female patient presenting with multiple midline incarcerated postoperative hernias after an emergency midline laparotomy. The multiple ‘Swiss cheese’ hernia defects started from the epigastrium, spanning all the way to the hypogastrium for a total length of 22cm and a maximum width of 4.5cm (M2-3-4, W2, according to the EHS classification). The patient had a BMI of 26 and was a heavy smoker with a 30 pack per year smoking history.

Three ports were placed laterally in the left side for the left retrorectus space dissection with the addition of two more ports for the dissection of the right retrorectus space and for the suturing of the abdominal wall. A 30 by 15cm macroporous polyvinylidene fluoride (PVDF) mesh was placed behind the rectus abdominis muscle and fixed with cyanoacrylate glue (3). No drain was used.

The patient was discharged on the first postoperative day (POD 1) and resumed work on POD 3. Four months after surgery, she had excellent cosmetic and functional results.

In spite of its technical challenges, the eTEP approach should be considered for patients with complex abdominal wall hernias.



Bibliographic references: 

1. A novel approach using the enhanced-view totally extraperitoneal (eTEP) technique for laparoscopic retromuscular hernia repair. Igor Belyansky, Jorge Daes, Victor Gheorghe Radu, Ramana Balasubramanian, H Reza Zahiri, Adam S Weltz, Udai S Sibia, Adrian Park, Yuri Novitsky. Surg Endosc 2018;32(3):1525-32. doi: 10.1007/s00464-017-5840-2. Epub 2017 Sep 15. https://pubmed.ncbi.nlm.nih.gov/28916960/ 

2. Comparison of outcomes of the extended-view totally extraperitoneal rives-stoppa (eTEP-RS) and the intraperitoneal onlay mesh with defect closure (IPOM-plus) for W1-W2 midline incisional hernia repair-a single-center experience. Halil Afşin Taşdelen. Surg Endosc 2023;37(4):3260-71. doi: 10.1007/s00464-023-09922-x. Epub 2023 Feb 10. https://pubmed.ncbi.nlm.nih.gov/36764936/ 

3. Degradation resistance of PVDF mesh in vivo in comparison to PP mesh. Hongshi Wang, Bernd Klosterhalfen, Andreas Müllen, Thomas Otto, Axel Dievernich, Stefan Jockenhövel. J Mech Behav Biomed Mater 2021;119:104490. doi: 10.1016/j.jmbbm.2021.104490. Epub 2021 Mar 23. https://pubmed.ncbi.nlm.nih.gov/33780848/ 

eTEP Rives-Stoppa repair for M2-3-4, W2 postoperative ventral hernia

Technique eTEP selon Rives-Stoppa pour hernie ventrale postopératoire M2-3-4W2

Focus on abdominal wall hernia repair (AWHR)

Focus sur la cure de hernies de la paroi abdominale

Cholécystite aiguë avec moignon de vésicule biliaire restant après cholécystectomie subtotale reconstituante 

The author presents the case of a 35-year-old male patient who underwent a laparoscopic re-exploration after a laparoscopic subtotal cholecystectomy. Initially, the patient had an acute cholecystitis and a high suspicion of common bile duct lithiasis. He had been managed in another facility with endoscopic retrograde cholangiopancreatography (ERCP). He had a sphincterotomy and 2 stones extracted. He underwent a laparoscopic subtotal cholecystectomy. Following this, the patient complained of right upper quadrant pain. Six weeks later, as an outpatient he was diagnosed with remnant cholecystitis after subtotal reconstituting cholecystectomy.



Take-home messages:

Subtotal cholecystectomy is an appropriate exit strategy to resolve acute biliary pathology and prevent bile duct injury. Although reconstructive subtotal cholecystectomy has a lower rate of bile leak, it has a higher incidence of cholecystitis recurrence. Given the persistence or recurrence of digestive symptoms after a subtotal cholecystectomy, the possibility of recurrence of cholecystitis and the feasibility of cholecystectomy of the gallbladder remnant must be evaluated. 



Bibliography:

1. Jayant M, Kaushik R. Presentation and management of gallbladder remnant after partial cholecystectomy. Trop Gastroenterol. 2013 Apr-Jun;34(2):99-103. doi: 10.7869/tg.2012.106. PMID: 24377158.

2. Henneman, D., da Costa, D.W., Vrouenraets, B.C. et al. Laparoscopic partial cholecystectomy for the difficult gallbladder: a systematic review. Surg Endosc 27, 351–358 (2013). https://doi.org/10.1007/s00464-012-2458-2

3. Teshima, T., Nitta, H., Mitsuura, C. et al. How to treat remnant cholecystitis after subtotal cholecystectomy: two case reports. surg case rep 7, 109 (2021). https://doi.org/10.1186/s40792-021-01183-x

4. Parkland 4 acute cholecystitis: PAECIF/PAECOF systematic dissection technique, a new proposal for a 100% safe cholecystectomy. N Zaragoza Arias, MD, FJ Martínez Jiménez, MD. Epublication WebSurg.com, Jun 2022;22(06). URL: http://websurg.com/doi/vd01en6684



Gallbladder remnant acute cholecystitis after subtotal reconstituting cholecystectomy

This video presents the case of a 50-year-old woman who underwent a laparoscopic pylorus-preserving pancreaticoduodenectomy (PPPD) for a 4cm mucinous cystic pancreatic neoplasm (MCPN). The authors demonstrate the key steps of this operation using a 3D laparoscopic technique. The pancreaticojejunostomy (PJ) was performed using a duct-to-mucosa technique in the setting of a soft pancreas and small 2mm pancreatic duct. The video shows that the duct-to-mucosa technique for PJ is technically feasible and safe, even in the setting of a soft pancreas and small pancreatic duct – traditionally known as risk factors for post-operative pancreatic fistulae (1). 



Take-home messages:

Our video shows that the duct-to-mucosa technique for pancreaticojejunostomy is technically feasible and safe, even in the setting of a soft pancreas and small pancreatic duct. 



Bibliography:

1. Hassan, R. A., Zidan, A. M., Jabir, M. A., Abdelshafy, M., Abdallah, M., & Taha, A. (2022, August 1). Risk factors predicting the development of a pancreatic fistula following pancreaticoduodenectomy: A retrospective cohort study. International Journal of Surgery Open. https://doi.org/10.1016/j.ijso.2022.100509

Laparoscopic pylorus-preserving pancreaticoduodenectomy for mucinous cystic neoplasm

Lobectomie gauche laparoscopique pour la prise en charge d’une tumeur des cellules épithélioïdes périvasculaires (PECome) 

Laparoscopic left lobectomy for liver perivascular epithelioid cell neoplasm (PEComa) 

Résection laparoscopique du duodénum distal avec préservation du pancréas pour adénome duodénal

Introduction

Small bowel (SB) malignant tumors are rare and cause non-specific symptoms, often leading to a late diagnosis. Most SB adenocarcinomas are found in the duodenum and arise from adenomas. Surgery is usually reserved for endoscopically non-excisable adenomas.



Materials and methods

It is the case of a patient with a D3 duodenal adenoma who underwent a laparoscopic duodenectomy.



Results

This is the case of a 58-year-old woman without any relevant personal medical history. Due to dyspepsia and heartburn, an endoscopy was performed and showed an irregular sessile polyp in the duodenum (D3) located 5cm away from the ampulla of Vater and not excisable endoscopically. A tattoo was performed. Biopsies revealed an adenomatous polyp with low-grade dysplasia (LGD). CT-scan showed a 15 by 13mm polypoid focal parietal thickening in D3, without extraparietal extension. No other changes were noted.

MRI revealed a 19 by 13 by 28mm polypoid lesion in D3 to the right and anteriorly to the abdominal aorta, without invasion of adjacent structures.

A laparoscopic D3-D4 duodenectomy with a mechanical intracorporeal side-to-side duodenojejunostomy were performed uneventfully. Preservation of the ampulla of Vater was confirmed via intraoperative endoscopy. An intraoperative methylene blue test was performed and did not reveal any leaks. The postoperative period was uneventful, and the patient was discharged on postoperative day 5. Histological exam revealed a 45 by 15mm tubulovillous adenoma with low-grade dysplasia. The patient was asymptomatic and was followed up.



Conclusion

SB adenomas are benign lesions with a significant potential to become malignant and develop into villous adenomas. Duodenal adenomas larger than 2cm and with ampullary location carry a higher risk of malignancy. Upper endoscopy is performed either for diagnostic or therapeutic purposes. Endoscopic resection must be performed in experienced centers. Surgery is indicated in cases of endoscopic unresectability. The laparoscopic approach offers the best outcomes.



Bibliography

1. Chathadi K., et al. The role of endoscopy in ampullary and duodenal adenomas. Gastrointest Endosc 2015 Nov;82(5):773-81.

2. Kemp C., et al. Resection of benign duodenal neoplasms. Am Surg. 2007 Nov;73(11):1086-91.

3. Talamonti MS., et al. Primary cancers of the small bowel: analysis of prognostic factors and results of surgical management. Arch Surg. 2002;137(5):564. 

4. Amitabh Yadav, Samiran Nundy. Case series of non-ampullary duodenal adenomas. Annals of Medicine and Surgery, Volume 69, 2021, 102730, ISSN 2049-0801.

Laparoscopic distal duodenal resection with pancreatic preservation for duodenal adenoma

Polycystic liver disease (PLD) is a rare genetic disease. It is caused by mutations in genes that encode proteins involved in the transport of fluid and growth of hepatic epithelial cells. Such mutations lead to the replacement of normal liver tissue by fluid-filled liver cysts (1). Most patients with PLD are asymptomatic and diagnosed incidentally on imaging (3). Symptomatic patients with PLD that are good surgical candidates should be treated surgically (2) (4). The main goal in such patients is to reduce the intracystic pressure. This can be achieved with unroofing and fenestration of the cysts where possible or with excision of the entire involved liver part (1). Both procedures have a high risk of recurrence, since new cysts could be induced, and some patients may even need liver transplantation (1). 

During surgery, the first step involves the marking of the unroofing line. The excision of the entire cyst’s wall is not the main goal of the procedure, due to a high risk for portal or hepatic vessel injury. When the cyst wall is excised, the omentum should be placed within the cyst’s cavity to prevent recurrence, a technique called omentoplasty. Although uncommon, complications of this procedure include trocar-site infection, bile leakage from cut edges of the cyst, and vascular injuries (2). 



Bibliography: 

1. Kothadia JP, Kreitman K, Shah JM. Polycystic Liver Disease. 2023 Feb 6. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 31751072. 

2. Tanaka M, Inoue Y, Mise Y, Ishizawa T, Arita J, Takahashi Y, Saiura A. Laparoscopic deroofing for polycystic liver disease using laparoscopic fusion indocyanine green fluorescence imaging. Surg Endosc. 2016 Jun;30(6):2620-3. doi: 10.1007/s00464-015-4526-x. Epub 2015 Sep 28. PMID: 26416378. 

3. Kaul V V, Friedenberg F, Rothstein KD. Hepatic Cysts. Curr Treat Options Gastroenterol. 2000 Dec;3(6):439-444. doi: 10.1007/s11938-000-0031-x. PMID: 11096603. 

4. Robert E Glasgow, M. (2022a) Hepatic cysts guidelines, EASL Guidelines on Cystic Liver Disease. Available at: https://emedicine.medscape.com/article/190818-guidelines (Accessed: 24 September 2023). 

Laparoscopic liver cyst unroofing in a patient with polycystic liver disease

Résection d'un kyste hépatique par laparoscopie chez un patient atteint d'une maladie polykystique du foie

Points importants lors d’un curage ganglionnaire D2 : replacement de l'artère hépatique

A good knowledge of hepatic vascular distribution, both classical and its variations, is essential to plan and perform all surgical and radiological procedures in the upper abdomen. Total replaced hepatic arteries coming from the superior mesenteric artery represent 3 to 5% of all patients and this must be taken into consideration for an adequate periarterial lymphatic adipose tissue dissection and to avoid complications. 



Bibliography:

1. Japanese Gastric Cancer Association. Japanese Gastric Cancer Treatment Guidelines 2021 (6th edition). Gastric Cancer 26, 1–25 (2023). https://pubmed.ncbi.nlm.nih.gov/36342574/.

2. Staśkiewicz, G., Torres, K., Denisow, M. et al. Clinically relevant anatomical parameters of the replaced right hepatic artery (RRHA). Surg Radiol Anat 37, 1225–1231 (2015). https://pubmed.ncbi.nlm.nih.gov/25982897/.

3. Huang CM, Chen RF, Chen QY, Wei J, Zheng CH, Li P, Xie JW, Wang JB, Lin JX, Lu J, Cao LL, Lin M. Application Value of a 6-Type Classification System for Common Hepatic Artery Absence During Laparoscopic Radical Resections for Gastric Cancer: A Large-Scale Single-Center Study. Medicine (Baltimore). 2015 https://pubmed.ncbi.nlm.nih.gov/26266363/.

Considerations in D2 lymphadenectomy: replaced hepatic artery 

This video presents the case of a 48-year-old male patient who presented with diarrhea. Colonoscopy showed two ulcerative adenocarcinomas in the descending colon and splenic flexure. CT-scan revealed two liver metastases. It was decided to perform a preoperative chemotherapy to reduce the liver metastases. A hepatectomy and a left colectomy were also performed simultaneously. 



Bibliographic references: 

1. Krell, R. W., & D’Angelica, M. I. (2019). Treatment sequencing for simultaneous colorectal liver metastases. Journal of Surgical Oncology, 119(5), 583‑593. https://doi.org/10.1002/jso.25424 

2. Avella, P., Vaschetti, R., Cappuccio, M., Gambale, F., DE Meis, L., Rafanelli, F., Brunese, M. C., Guerra, G., Scacchi, A., & Rocca, A. (2022). The role of liver surgery in simultaneous synchronous colorectal liver metastases and colorectal cancer resections: A literature review of 1730 patients underwent open and minimally invasive surgery. Minerva Surgery, 77(6), 582 590. https://doi.org/10.23736/S2724-5691.22.09716-7 

3. Reddy, S. K., Pawlik, T. M., Zorzi, D., Gleisner, A. L., Ribero, D., Assumpcao, L., Barbas, A. S., Abdalla, E. K., Choti, M. A., Vauthey, J.-N., Ludwig, K. A., Mantyh, C. R., Morse, M. A., & Clary, B. M. (2007). Simultaneous resections of colorectal cancer and synchronous liver metastases: A multi-institutional analysis. Annals of Surgical Oncology, 14(12), 3481‑3491. https://doi.org/10.1245/s10434-007-9522-5 



Laparoscopic left colectomy and lateral left hepatectomy for colorectal cancer and liver metastasis

Colectomie gauche laparoscopique et hépatectomie latérale gauche pour le traitement d’un cancer colorectal et de métastases hépatiques



This video presents the case of a 67-year-old man who was referred for surgical resection of a metachronous colorectal liver metastasis in liver segment 1, in contact with the inferior vena cava. The diagnosis of a 50mm mass was established after a 20-month oncological follow-up. The patient was asymptomatic. His CEA level was 6.9µg/L. Neoadjuvant chemotherapy with FOLFIRI-bevacizumab was administered but no downsizing was observed after six cycles. As a result, a surgical resection was decided upon. 

The first step of the procedure was a laparoscopic ultrasonographic assessment of the extension of vascular invasion. The evaluation revealed a preserved surface between the tumor and the inferior vena cava. Consequently, the procedure was continued laparoscopically. Liver segment 1 was resected and the inferior vena cava was completely exposed. No vascular resection was required. The postoperative period was uneventful, and the patient was discharged on postoperative day 3. 

Laparoscopic liver surgery offers many advantages when compared to open liver surgery. However, laparoscopy has still not proven its added value in vascular invasion and vascular reconstruction settings. This video aims to show how a stepwise approach with detailed perioperative ultrasonographic evaluation helps to refine the preoperative iconography and tailor the surgical strategy. The value of a meticulous anatomical dissection in laparoscopic liver surgery becomes more evident in cases of possible vascular invasion when precision surgery is vital. 



Bibliography:

1. Ferrero A, Russolillo N, Langella S, Forchino F, Stasi M, Fazio F, Lo Tesoriere R. Ultrasound liver map technique for laparoscopic liver resections: perioperative outcomes are not impaired by technical complexity. Updates Surg. 2019 Mar;71(1):49-56. doi: 10.1007/s13304-019-00646-z. Epub 2019 Mar 27. PMID: 30919242.

2. Kumon M, Kumon T, Tsutsui E, Ebashi C, Namikawa T, Ito K, Sakamoto Y. Definition of the caudate lobe of the liver based on portal segmentation. Glob Health Med. 2020 Oct 31;2(5):328-336. doi: 10.35772/ghm.2020.01088. PMID: 33330828; PMCID: PMC7731356.

Laparoscopic liver segment I resection of colorectal liver metastasis in contact with the inferior vena cava

Segmentectomie hépatique laparoscopique (segment 1) pour métastase hépatique colorectale en contact avec la veine cave inférieure

Focus en chirurgie hépatobiliaire et pancréatique

Focus on HPB surgery

The retroperitoneum can host primary or metastatic lesions, and occasionally a complete surgical resection is the only potential curative treatment (1). The laparoscopic approach has proven feasible and safe for the removal of intra-abdominal lesions (2) including large lesions in close proximity to vital structures. However, the anatomical location impacts the feasibility of a minimally invasive approach for a central retroperitoneal lesion (3, 4). This video shows the management of a retrocaval lesion via a totally laparoscopic surgical approach. A 24-year-old female patient experienced episodes of early satiety and abdominal discomfort. Abdominal ultrasound and MRI revealed a solid mass in the right adrenal lodge, extending up to the region between the vena cava and the portal vein. The 55 by 44mm retrocaval lesion was suspected to be a retroperitoneal tumor, and an explorative laparoscopy was proposed. Despite the close proximity of the lesion to major vessels (i.e., vena cava, aorta, portal vein) and visceral organs (liver and duodenum), the surgeon performed a total laparoscopic wide radical resection. To obtain macroscopically complete clearance, the resection mandated a right adrenalectomy due to vascular supply involvement. Operative time was 95 minutes without intraoperative complications. Postoperative outcomes were uneventful. The patient rapidly recovered on postoperative day 3, with optimal cosmetic results. The final diagnosis was established through the histopathological analysis and evidenced metastatic melanoma with HMB and MART-1 positivity. This video showed that the laparoscopic approach was safe and feasible but challenging for retroperitoneal lesions, suggesting that a retrocaval location is not an absolute contraindication to this method if performed by an expert laparoscopic surgeon. The patient underwent endoscopic examinations for the lower and upper GI, as well as dermatological, ophthalmological, and gynecological examination. All tests proved negative and it was not possible to identify the primary site of the melanoma. Therefore, the oncology group proposed NED (non-evidence of disease) as the final diagnosis. The patient started immunotherapy and was followed up clinically.



Bibliography: 

1. Mota, M. M. D. S., Bezerra, R. O. F., & Garcia, M. R. T. (2018). Practical approach to primary retroperitoneal masses in adults. Radiologia brasileira, 51(6), 391–400. https://doi.org/10.1590/0100-3984.2017.0179.



2. Bracale, U., Pacelli, F., Milone, M., Bracale, U. M., Sodo, M., Merola, G., Troiani, T., & Di Salvo, E. (2017). Laparoscopic treatment of abdominal unicentric castleman's disease: a case report and literature review. BMC surgery, 17(1), 38. https://doi.org/10.1186/s12893-017-0238-6.



3. Strauss, D. C., Hayes, A. J., Thway, K., Moskovic, E. C., Fisher, C., & Thomas, J. M. (2010). Surgical management of primary retroperitoneal sarcoma. The British journal of surgery, 97(5), 698–706. https://doi.org/10.1002/bjs.6994.



4. Strauss, D. C., Hayes, A. J., & Thomas, J. M. (2011). Retroperitoneal tumours: review of management. Annals of the Royal College of Surgeons of England, 93(4), 275–280. https://doi.org/10.1308/003588411X571944.

Totally laparoscopic management of retrocaval metastatic melanoma in a young patient

Prise en charge entièrement laparoscopique d'un mélanome métastatique rétrocave chez une jeune patiente

Traitement laparoscopique d'une intussusception chez l'adulte

Adult intussusception is rare and often recognized as an abdominal emergency. Unlike children, adult intussusception is frequently associated with secondary causes such as benign and malignant tumors (Hirotaka Honjo. World J Surg. 2015 Jan;39 (1): 134-8). This video demonstrates the laparoscopic management of colonic intussusception in a young adult patient with severe acute abdominal pain, nausea, and vomiting. During the preoperative work-up, CT-scan revealed the “pseudokidney sign” and several enlarged lymph nodes around the loop (Anderson DR. The pseudokidney sign. (1999) Radiology. 211 (2): 395-7.). Since the patient was an adult and there were several enlarged mesenteric lymph nodes suggesting a possible malignant cause, an oncological right hemicolectomy with D3 lymphadenectomy was performed.

Laparoscopic management of an adult intussusception

Améliorer la précision de la cure chirurgicale de hernie hiatale : intégration de la laparoscopie et de la gastroscopie peropératoire pour des résultats optimaux

Hiatal hernia repair has witnessed significant advancements in recent years, with a paradigm shift towards a laparoscopic approach accompanied by the incorporation of intraoperative gastroscopy. This video delves into the pivotal role of laparoscopy in hiatal hernia surgical repair and underscores the added benefits conferred by real-time intraoperative gastroscopic guidance. The laparoscopic approach has revolutionized hiatal hernia repair, offering patients a less invasive alternative to traditional open surgeries. This technique involves smaller incisions, reduced postoperative pain, and shorter recovery times, presenting a paradigm shift that aligns with the principles of minimally invasive surgery. Moreover, laparoscopy provides superior visualization of the hiatal defect, enabling meticulous dissection and precise anatomical reconstruction. In conjunction with laparoscopy, the integration of intraoperative gastroscopy emerges as a valuable adjunct in hiatal hernia repair. Real-time visualization of the gastroesophageal junction during surgery allows for accurate identification of hiatal defects and assessment of the gastroesophageal valve. This dynamic approach facilitates tailored and patient-specific repairs, contributing to improved surgical outcomes and reduced rates of postoperative complications. 

Furthermore you will find a panel expert discussion about the use or not of absorbable and non absorbable mesh for the hiatal repair and indication about the extension of the dissection of the short gastric vessels are discussed. 

In conclusion, this video highlights the transformative impact of laparoscopic surgery on hiatal hernia repair, emphasizing its benefits in terms of reduced invasiveness and enhanced visualization. The synergistic integration of intraoperative gastroscopy further elevates the precision of the procedure, allowing surgeons to tailor interventions based on real-time insights. 



Bibliography: 

1. Hashemi M, Peters JH. "Current concepts in the management of paraesophageal hiatal hernia." Journal of Clinical Gastroenterology, 2008; 42(6): 594-601. 

2. Dallemagne B, Perretta S. Long-term Efficacy of Total and Partial Posterior Fundoplication to Treat Gastroesophageal Reflux Disease. JAMA Surg. 2022 Jun 1;157(6):480. doi: 10.1001/jamasurg.2022.0806. PMID: 35442405.

3. Watson DI, Pike GK, Baigrie RJ. "Prospective double-blind randomized trial of laparoscopic Nissen fundoplication with division and without division of short gastric vessels." Annals of Surgery, 1997; 226(5): 642–652. 

4. Swanström LL, Jobe BA, Kinzie LR. "Esophageal motility and outcomes following laparoscopic paraesophageal hernia repair and fundoplication." The American Journal of Surgery, 1999; 177(5): 359-363.

5. Luketich JD, Nason KS, Christie NA. "Outcomes after a decade of laparoscopic giant paraesophageal hernia repair." Journal of Thoracic and Cardiovascular Surgery, 2010; 139(2): 395-404. 



Advancing precision in hiatal hernia surgical repair: integration of laparoscopy and intraoperative gastroscopy for optimal outcomes 

Traitement laparoscopique d'une cholédocholithiase chez un patient ayant subi une gastrectomie partielle

This video presents the management of a choledocholithiasis in a patient who previously underwent a subtotal gastrectomy with a Roux-en-Y reconstruction for an oncologic condition. 

The patient was a 75-year-old man who presented with abdominal pain originating from the upper quadrants with an onset of jaundice. 

Eighteen years earlier, the patient had undergone a laparoscopic subtotal gastrectomy performed with a Roux-en-Y reconstruction for gastric cancer. 

CT-scan revealed a dilatation of the intrahepatic and extrahepatic biliary duct due to the presence of a 15mm gallstone in the common bile duct. 

In this case, the authors were faced with a common pathology, usually treated with an endoscopic retrograde cholangiopancreatography (ERCP). They subsequently had to tailor a procedure fitting the patient’s altered anatomy. 

Two surgical strategies were proposed during the preoperative meeting: a combined laparoscopic and endoscopic approach, or a total laparoscopic bile duct clearance followed by a cholecystectomy. 

Since the authors were not able to clearly identify the biliary loop to be passed through the gastroscope, an intraoperative laparoscopic biliary duct exploration was performed. 



Laparoscopic treatment of choledocholithiasis in a patient who underwent subtotal gastrectomy

Gastrectomie totale par laparoscopie pour cancer gastrique, une approche par étapes

Introduction: 

Total gastrectomy is a complex and often difficult procedure to perform. It involves the removal of the entire stomach, including the gastroesophageal junction (GEJ). It is usually performed in patients with proximal gastric cancer, in whom a subtotal gastrectomy with a 5 to 6cm proximal margin does not leave a reasonable gastric remnant. The laparoscopic total gastrectomy technique has drawn increasing attention over the years.



Objectives: 

In this video, the authors present a laparoscopic radical gastrectomy with a Roux-en-Y reconstruction in a stepwise fashion. It is their procedure of choice in patients with proximal gastric cancer involving neoadjuvant therapy. 



Methodology: 

The patient was a 43-year-old woman with a T4N1M0 poorly cohesive cells gastric carcinoma invading the gastric body, as well as the lesser and greater curvature. A perioperative chemotherapy with 4 cycles of FLOT was proposed to the patient. CT-scan evaluation showed a favorable response to the treatment. The authors performed a laparoscopic radical total gastrectomy with a Roux-en-Y reconstruction. The patient had no major complications and was discharged on postoperative day 6.



Conclusion:

Laparoscopic total gastrectomy has been increasingly performed in many hospitals. Recent studies have shown that the laparoscopic technique, although complex and often difficult to perform, offers significant advantages. It has been shown that it decreases postoperative hospital stay, allows earlier gastric tube removal, and has similar postoperative complication rates and overall survival as compared to open total gastrectomy for patients with gastric cancer involving neoadjuvant therapy.

In conclusion, laparoscopic total gastrectomy can be considered a first-line surgical treatment in experienced centers, since it is an effective and safe curative procedure.



Bibliography:

1. Park, K. B., Kim, E. Y., & Song, K. Y. (2019). Esophagojejunal anastomosis after laparoscopic total gastrectomy for gastric cancer : Circular versus linear stapling. Journal of Gastric Cancer, 19(3), 344‑354. https://doi.org/10.5230/jgc.2019.19.e34

2. Hu, H.-T., Ma, F.-H., Xiong, J.-P., Li, Y., Jin, P., Liu, H., Ma, S., Kang, W.-Z., & Tian, Y.-T. (2022). Laparoscopic vs open total gastrectomy for advanced gastric cancer following neoadjuvant therapy : A propensity score matching analysis. World Journal of Gastrointestinal Surgery, 14(2), 161‑173. https://doi.org/10.4240/wjgs.v14.i2.161

3. Chan, B. Y. O., Yau, K. K. W., & Chan, C. K. O. (2019). Totally laparoscopic versus open gastrectomy for advanced gastric cancer : A matched retrospective cohort study. Hong Kong Medical Journal = Xianggang Yi Xue Za Zhi, 25(1), 30‑37. https://doi.org/10.12809/hkmj177150 

4. Mulholland, Michael W., et al., Operative Thechniques in Surgery, volume two, 2015, Wolters Kluwer Health



Laparoscopic total gastrectomy for gastric carcinoma, a stepwise approach

Echinococcosis is a parasitic infection caused by the larval stage of the Echinococcus tapeworm. The liver (70%) and lungs (25%) are the most commonly affected organs. Splenic involvement is rare with about 0.5-8% of cystic echinococcus (CE) cases. Cases of solitary splenic cyst are even rarer (0.5-4%). 

This video shows a hemisplenectomy performed using a fully laparoscopic approach for the management of a 7cm echinococcal solitary cyst located in the upper pole of the spleen. The patient, a 23-year-old male, presented with upper abdominal pain, nausea, and vomiting. Diagnosis was established through ultrasound monitoring and was confirmed via serological tests and magnetic resonance imaging. The postoperative period was uneventful, and the drain was removed on postoperative day 1. The patient was discharged on postoperative day 3. After 3 months of follow-up, no further issues were noted. This case emphasizes the safety and feasibility of the laparoscopic approach for spleen preservation. 



Bibliography

1. Akhan O, Koroglu M. Hydatid disease of the spleen. Semin Ultrasound CT MR. 2007;28(1):28-34. doi:10.1053/j.sult.2006.10.002

2. Yotsov TI, Dyulgerova S, Draganova D. Laparoscopic splenectomy for solitary splenic hydatid cyst: Case report. J Minim Access Surg. 2023;19(2):317-319. doi:10.4103/jmas.jmas_113_22

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