Hysteroscopy basecamp

Wrist basecamp

Colorectal basecamp

Hernia basecamp

podcast

Beyond IRCAD - Surgical Journeys: Episode 8: A Wattiez

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

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 7: M Galvao Neto

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.

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.

Beyond IRCAD - Surgical Journeys: Episode 5: Jacques Marescaux

Beyond IRCAD - Surgical Journeys: Episode 4: Mariano Gimenez

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.

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!

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 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

Beyond IRCAD - Surgical Journeys: Episode 1: Armando Melani

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”.

surgical intervention video

Complete mesocolic excision (CME) in colon cancer surgery has recently gained popularity as increasing evidence points to improved oncological clearance with superior lymph node yield, bigger tumor clearance margins, and higher quality surgical specimens. There are also some indications that it may lead to improved oncological outcomes. The tenets of CME include high vascular ligation at the root of the vessel, dissection along the embryological planes of the colonic mesentery, and adequate margins of bowel from the tumor. 

Although the technique was initially described and achieved via a laparotomy, laparoscopic CME was also performed, although it was noted to be technically challenging. The right colon and the variability of vascular anatomy add to the difficulty of the procedure. 

Extracorporeal anastomosis is commonly performed for right hemicolectomy in most centers. There are some reported advantages to the intracorporeal anastomosis, namely a potentially higher lymph node yield, a smaller skin incision, and the ability to extract the specimen via a Pfannenstiel’s incision, which has lower rates of incisional hernia. 

This video features a laparoscopic CME right hemicolectomy with intracorporeal anastomosis for a malignant polyp. 

Dr. Shen-Ann Eugene Yeo, MBBS, MMed (Surg), FRCS (Ed) does not have any conflicts of interest or financial ties to disclose.

Laparoscopic complete mesocolic excision (CME) right hemicolectomy with intracorporeal anastomosis

腹腔镜完全鼻息肉切除术（CME）右半结肠切除术与体内吻合术


Excision mésocolique laparoscopique complète (CME) hémicolectomie droite avec anastomose intracorporelle


Hemicolectomia direita com excisão completa do mesocólon (ECM) e anastomose intracorpórea


Лапароскопическая тотальная мезоколонэктомия, правосторонняя гемиколэктомия с интракорпоральным анастомозом

Hemicolectomía derecha con escisión completa del mesocolon (ECM) y anastomosis intracorpórea


Лапароскопическая сигмоидэктомия по поводу рака

腹腔镜乙状结肠切除术治疗癌症


Sigmoidectomía laparoscópica para cáncer


Sigmoïdectomie laparoscopique pour cancer


Sigmoidectomia laparoscópica para câncer


In this educational video, Dr. Armando Melani briefly demonstrates the main principles of laparoscopic sigmoidectomy for cancer in a 67-year-old female patient in a live interactive surgery. He highlights the technical aspects, anatomical landmarks, and key steps of lesser sac opening, vascular identification and division, splenic flexure mobilization, lateral mobilization, mesorectal transection, suprapubic incision for specimen removal, and end-to-end anastomosis (EEA).

 Laparoscopic sigmoidectomy for cancer

This video of laparoscopic Nissen fundoplication is suitable for surgeons learning to perform this procedure. The patient is young with very few adhesions and the operative steps are very clearly presented by Dr. Dallemagne. Critical points and technical tips are emphasized throughout the procedure.



The author describes this as an ideal case for surgeons learning the procedure because this young patient with severe reflux has few adhesions. Working with a zero-degree scope, the author examines the peritoneal cavity. The dissection begins at the caudate lobe of the liver and moves toward the right crus of the diaphragm. After identifying the right and left crura, the author opens the lesser omentum to gain access to the right crus. It is important to identify the inferior vena cava as a landmark.

Laparoscopic Nissen fundoplication: a perfect case to start

Fundoplicatura de Nissen laparoscópica: um caso perfeito para começar


Fundoplicature de Nissen laparoscopique : un cas idéal pour commencer


腹腔镜尼森胃底折叠术：一个完美的开始


Este vídeo de fundoplicatura Nissen laparoscópica es recomendado para cirujanos que estén comenzando en aprender este procedimiento.  El paciente es joven, con pocas adherencias.  Los pasos operatorios son claramente presentados por el Dr. Dallemagne.  Se enfatizan los puntos críticos y los consejos técnicos a través de todo el procedimiento.

Fundoplicatura de Nissen Laparoscópico para RGE

The transabdominal preperitoneal (TAPP) approach is the most frequently used laparoscopic technique for inguinal hernia repair. In this video, key steps of the procedures are demonstrated. Patient and port positioning, anatomical landmarks, and subtle technical tricks are provided by J Leroy, MD, FRCS, one of the pioneers of the technique. Interaction with the audience during this live demonstration addresses important issues of the technique. 





Key steps of laparoscopic TAPP inguinal hernia repair

Passos-chave do reparo da hérnia inguinal por TAPP laparoscópico


Etapes principales d'un TAPP laparoscopique pour cure de hernie inguinale


Pasos clave de la reparación de la hernia inguinal por TAPP laparoscópico


Ключевые моменты выполнения лапароскопической ТАРР-герниопластики паховой грыжи


腹腔镜TAPP腹股沟疝修补的关键步骤


We present the clinical case of a 50-year-old patient managed for a left direct symptomatic reducible inguinal hernia, with a palpable impulse on examination. The patient’s history included a left indirect inguinal hernia repair in his childhood.



The procedure begins conventionally with an open laparoscopy with the introduction of a supra-umbilical port. The exploration confirms the presence of a left hernia and rules out the diagnosis of right hernia. Dissection starts with a horizontal peritoneal incision, which allows to progressively parietalize all elements of the cord, making sure to stay in contact with the peritoneum. Dissection of the previously operated hernia dating back to the patient’s childhood is slightly more painstaking and constraining due to the presence of adhesion-related scars. However, the parietalization of the peritoneum is carried on without any particular problem, and considering that it is a direct hernia, the deferent duct is very easily identified and parietalized. Reduction of the direct hernia is performed easily with the reintroduction of the transversalis fascia. Given the small size of the hernia, the fascia will not be exteriorized.



After complete lowering, a 15 X 15cm polypropylene mesh (Parietene™) is recut to a 13 X 12cm size with external trimming. The mesh is positioned in order to cover all direct and internal hernial orifices. It is only fixed to Cooper’s ligament, to the anterior superior iliac spine, and to the anterior abdominal wall so as to prevent any early mobilization postoperatively. Reperitonization is then performed with peritoneal fixation using absorbable staples (of the AbsorbaTack™ type). Exsufflation is achieved under visual guidance.



The entire procedure is performed as an outpatient surgery. The patient was admitted to our unit just before the intervention. He is discharged a few hours later. 

LIVE INTERACTIVE SURGERY: left direct inguinal hernia: laparoscopic TAPP approach

实时交互式手术：直接腹股沟疝：腹腔镜TAPP手术


CIRURGIA INTERATIVA AO VIVO: hérnia inguinal direta esquerda: abordagem TAPP laparoscópica


LIVE хирургия: левосторонняя паховая грыжа, лапароскопический ТАРР подход

CHIRURGIE LIVE INTERACTIVE: hernie inguinale directe gauche: approche laparoscopique TAPP


CIRUGÍA INTERACTIVA EN VIVO: hernia inguinal izquierda directa: abordaje TAPP laparoscópico


This video demonstrates a standard technique of laparoscopic left adrenalectomy for a pheochromocytoma in a 33-year-old pregnant woman who was admitted for an episode of tachycardia and hypertension. At emergency admission, she presented with a left ventricular failure, which required cardiac assistance. Etiological work-up showed a left adrenal tumor and biological findings confirmed a hypersecretion of urinary normetanephrines and metanephrines. MIBG scintigraphy confirmed the presence of an 8cm left adrenal tumor. 

Laparoscopic left adrenalectomy for pheochromocytoma

Лапароскопическая адреналэктомия слева по поводу феохромоцитомы

Surrénalectomie gauche laparoscopique pour phéochromocytome

Este vídeo demonstra uma técnica padrão de adrenalectomia esquerda laparoscópica para feocromocitoma em uma mulher grávida de 33 anos que foi internada por um episódio de taquicardia e hipertensão. Na emergência, ela apresentou uma falha no ventrículo esquerdo, que demandou assistência cardíaca. A abordagem etiológica mostrou um tumor adrenal esquerdo e os achados biológicos confirmaram um hipersecreção de normetanefrinas e metanefrinas na urina. A cintilografia com MIBG confirmou a presença de um tumor adrenal esquerdo de 8 cm.


Adrenalectomia esquerda laparoscópica para feocromocitoma

We present the clinical case of a 57-year old male patient managed for a bilateral reducible inguinal hernia. The patient’s history included a right inguinal hernia repair in his childhood. A first port was inserted 1cm above the umbilicus and two 5mm ports were placed 7cm away from the umbilicus on the right and left side. Peritoneal dissection starts with a horizontal incision and parietalization is performed carefully to avoid injury to the vessels and deferent duct. After the myopectineal orifice has been sufficiently exposed, polypropylene meshes (Parietene™) trimmed to a 13 by 12cm size are inserted into the preperitoneal cavity and fixed using absorbable tacks. Finally, the meshes are fully covered using peritoneal flaps.

Laparoscopic TAPP approach to bilateral reducible inguinal hernia: live interactive procedure

Intervention interactive live : voie d’abord transabdominale prépéritonéale (TAPP) laparoscopique pour hernie inguinale bilatérale réductible

Лапароскопическая TAPP пластика двусторонней паховой грыжи: интерактивная LIVE процедура

Hystérectomie laparoscopique totale : approche par étapes

Laparoscopic hysterectomy is considered one of the main gynecological endoscopic surgeries. However, this percentage is still in a plateau phase, which could be explained by the surgical skills, proper anatomical knowledge, and unnecessary limitations to the laparoscopic approach; such as uterine size and previous scars. In this video, we demonstrate a stepwise approach for a total laparoscopic hysterectomy (TLH) for a large uterus, in order to demonstrate that by following standard steps surgeons can easily manage hysterectomy in an effective, safe, and reproducible way. 

Total laparoscopic hysterectomy: stepwise approach

webinar

Watch the replay of the last Medtronic hernia basecamp webinar dedicated to the following topic: Key steps in preventing incisional hernia for all surgeons (October 11, 2023) presented by Prof. F Berrevoet, MD, PhD, FEBS, FACS (University Hospital Ghent, Ghent, Belgium), including questions and answers with Dr. A. De Beaux, MD, FRCS, MBChB and Dr. B. East, MD, PhD.

Prof. F Berrevoet, MD, PhD, FEBS, FACS has the following potential conflict of interest to disclose, receiving honoraria for participating in the sponsored speaker’s bureau of Medtronic and Becton Dickinson, and receiving honoraria from Medtronic, Becton Dickinson, and Tissium as advisory board. However, these industrial companies were never committed to the elaboration and running organization of this webinar. There is neither commercial publicity nor commercial promotion in this educational lecture.

Prof. F Berrevoet, MD, PhD, FEBS, FACS declares that he is fully committed to maintaining professional autonomy and independence in relation with the medical device Industry.

This webinar is aimed to promote education among its learners, and Prof. F Berrevoet, MD, PhD, FEBS, FACS declares that this webinar is fair, balanced, and free of commercial bias.

Dr. A. de Beaux  and Dr. B. East have no financial affiliations that would affect the content of their talks.

Key steps in preventing incisional hernia for all surgeons



Bibliography:

1. Paquette, I. M., Madoff, R. D., Sigurdson, E. R., & Chang, G. J. (2018). Impact of proximal vascular ligation on survival of patients with colon cancer. Annals of Surgical Oncology, 25(1), 38‑45. https://doi.org/10.1245/s10434-016-5720-3 

2. Perrakis, A., Weber, K., Merkel, S., Matzel, K., Agaimy, A., Gebbert, C., & Hohenberger, W. (2014). Lymph node metastasis of carcinomas of transverse colon including flexures. Consideration of the extramesocolic lymph node stations. International Journal of Colorectal Disease, 29(10), 1223‑1229. https://doi.org/10.1007/s00384-014-1971-2 

3. Kotake, K., Mizuguchi, T., Moritani, K., Wada, O., Ozawa, H., Oki, I., & Sugihara, K. (2014). Impact of D3 lymph node dissection on survival for patients with T3 and T4 colon cancer. International Journal of Colorectal Disease, 29(7), 847‑852. https://doi.org/10.1007/s00384-014-1885-z 

Laparoscopic extended right hemicolectomy with D3 lymphadenectomy

Hémicolectomie droite élargie laparoscopique avec curage ganglionnaire D3

Recent studies highlight the effectiveness of laparoscopic cholecystectomy (LC) and laparoscopic common bile duct exploration (LCBDE) in managing cholecystocholedocholithiasis (1). Standard treatments involve preoperative endoscopic procedures. However, advances in laparoscopy have reintroduced one-stage approaches, particularly LCBDE alongside LC (2). Transcystic (TC) and transductal (TD) routes influence outcomes whereas the literature showed that the TC extraction is deemed safer, with comparable stone clearance rates (3). 

Laparoscopic transcystic CBD techniques (LTCBDE) have been developed to treat CBD stones in one session, minimizing complications with an applicability reaching over 85% of cases, and success rates of 85 to 95%, proving their cost-effectiveness as compared to postoperative endoscopic procedures (3, 4). Ongoing technological advances, including robot-assisted surgery and advanced imaging methods, such as laparoscopic CT cholangioscopy, enhance this approach to CBD treatment, becoming the primary strategy for most patients.

Bibliography:

1. Durán M, Silvestre J, Hernández J, Briceño J, Martínez-Isla A, Martínez-Cecilia D. Learning curve for performing laparoscopic common bile duct exploration in biliary surgery 2.0 era. J Hepatobiliary Pancreat Sci. 2023;30(3):374-382. doi:10.1002/jhbp.1228. Link: https://pubmed.ncbi.nlm.nih.gov/35947065/

2. Zhou Y, Wu XD, Zha WZ, et al. Three modalities on common bile duct exploration. Drei Modalitäten für das Management der Choledocholithiasis. Z Gastroenterol. 2017;55(9):856-860. doi:10.1055/s-0043-112655. Link: https://pubmed.ncbi.nlm.nih.gov/28763814/

3. Reinders JS, Gouma DJ, Ubbink DT, van Ramshorst B, Boerma D. Transcystic or transductal stone extraction during single-stage treatment of choledochocystolithiasis: a systematic review. World J Surg. 2014;38(9):2403-2411. doi:10.1007/s00268-014-2537-8. Link: https://pubmed.ncbi.nlm.nih.gov/24705779/

Transcystic laparoscopic bile duct cholangioscopy: simulation

Cholangioscopie laparoscopique transcystique des voies biliaires : simulation

Traitement thoracoscopique d'un chylothorax postopératoire

Introduction: 

Chylothorax is a rare postoperative complication of congenital heart surgery. A staged treatment is the general principle to manage this serious complication. However, a failure of conservative therapy requires surgical ligation to prevent continued fluid and protein losses. 

Materials and methods:

This is the case of an 8-month-old girl with Down syndrome, weighing 7.7 Kg. She presented with chylothorax following a cardiac procedure, refractory to conservative management. 

Surgery was facilitated using a selective endotracheal intubation. 

A methylene blue colored cream was administered preoperatively to visualize the thoracic duct during the surgical procedure. 

A video-assisted thoracoscopic surgery was performed to treat the chylothorax in our patient. The procedure was performed in the right chest using four ports. 

The duct was controlled via a direct thoracoscopic application of clips and fibrin glue, at the level of the diaphragm, and using a mechanical and chemical pleurodesis. 

Postoperative outcomes:

No intraoperative complication was observed. Operating time was 2 hours. Oral intake was allowed on postoperative day 5. Chest tubes were removed on postoperative day 7. There was no recurrence at 2 months of follow-up. 

Conclusion:

Thoracoscopic duct ligation is a safe and effective procedure, facilitated by means of selective intubation in our case. 



Bibliography:

1. Thoracoscopic Thoracic Duct Ligation: How I Teach It. Evgeny V Arshava , Kalpaj R Parekh. Ann Thorac Surg, 2020 May;109(5):1330-1334. PMID: 32035916 DOI: 10.1016/j.athoracsur.2020.01.004 

2. Talc Pleurodesis: A Medical, Medicolegal, and Socioeconomic Review. Ioana Baiu, MD, MPH, Elorm Yevudza, BS, and Joseph B. Shrager, MD. Ann Thorac Surg, 2020 Apr;109(4):1294-1301. PMID: 31593652 DOI: 10.1016/j.athoracsur.2019.08.104 

3. Thoracoscopic pleural clipping for the management of congenital chylothorax. Margaret E Clark, Russell K Woo, Sidney M Johnson. Pediatr Surg Int, 2015 Dec;31(12):1133-7. PMID: 26276425 DOI: 10.1007/s00383-015-3760-6 

Thoracoscopic management of postoperative chylothorax

video lecture

This keynote lecture was delivered by Stephen Wigmore, KHS, FRCSEd, FRCPE, FRSE at the Surgical Research Society’s Annual Meeting held at St Catharine’s College in Cambridge (United Kingdom) from January 11 to 12, 2024.&#x20;

The development of novel cell- and tissue-derived therapies has placed a particular responsibility on the surgical community to understand the regulations, which have been designed to apply to such treatment approaches. Surgeons may be involved in almost every step of the pathway to develop and use cell- and tissue-derived treatments. Regulations have been designed to protect patients and cover the licensing, safety, and use of novel technologies. In this key lecture, I will present real-world examples of the use of advanced therapy medicinal products and other cell-based surgically applied therapies and show how mistakes can be made leading to unsafe products and patient harm. Regulation is not just limited to cell-based therapies, but also extends to mathematical or artificial intelligence driven algorithms, which are used to assist clinical decision-making. Again, an example of an algorithm in clinical use, which has suffered criticism for inherent bias has been given.

The confusion that exists in regulatory pathways is highlighted, and the explosion of products for surgical placement using tissue scaffolds, autologous or allogeneic and even manufactured cells demands a rethink of how regulatory approval is achieved for new products and treatments. A case is made for linking research and regulatory milestones so that regulatory approval becomes an intrinsic component of product development rather than an afterthought once development has already occurred. Staying on the right side of the law and protecting patients are critical requirements for all surgeons, and thought needs to be given about education in this rapidly developing area.

Future surgical innovation and the importance of regulation

Cure vidéolaparoscopique d'une hernie d'éventration à l'aide d'une prothèse rétromusculaire (technique eRives)

The authors present their technique of videolaparoscopic repair of incisional hernia with a retromuscular mesh, an endoscopic approach to perform the conventional Rives operation. Although this technique is frequently called “eTEP”, the authors prefer to call it “eRives”, since it follows the principles of the open Rives technique, and it is not preperitoneal, strictly speaking. The principles stated by Rives and Stoppa more than 50 years ago are still valid, namely midline reconstruction and implantation of a mesh in the retrorectus space are the pillars of a successful repair of a midline hernia. This video demonstrates a stepwise approach to an eRives operation for a M23W2R2 incisional hernia in a 63-year-old physically active man.

Bibliography:

1\. 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. [https://doi.org/10.1007/s00464-017-5840-2](https://doi.org/10.1007/s00464-017-5840-2)

2\. Salido Fernandez S, Fraile Vilarrasa M, Osorio Silla I, Georgiev Hristov T, Bernar de Oriol J, González-Ayora S, Pardo García R, Guadalajara Labajo H. Extended Totally Extraperitoneal (eTEP) Approach for Ventral Hernia Repair: Initial Results. Cir Esp (Engl Ed) 2020 May;98(5):260-266. doi: 10.1016/j.ciresp.2020.01.006. Epub 2020 Mar 12.PMID: 32172955. [https://doi.org/10.1016/j.cireng.2020.04.013](https://doi.org/10.1016/j.cireng.2020.04.013)

3\. Andre Luiz Gioia Morrell, Alexander Morrell, Alexander Charles Morrell-Junior, Jose Mauricio DE Freitas Mendes, Allan Gioia Morrell. 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. doi: 10.1590/0100-6991e-20202622. eCollection 2020. PMID: 33053065 DOI: 10.1590/0100-6991e-20202622. [https://doi.org/10.1590/0100-6991e-20202622](https://doi.org/10.1590/0100-6991e-20202622)

Videolaparoscopic repair of incisional hernia with retromuscular mesh (eRives)

Splénopancréatectomie distale laparoscopique pour néoplasme kystique mucineux : technique dans le sens horaire modifiée 

The authors present the case of a 33-year-old female patient. The patient has a previous medical history of hypothyroidism, insulin resistance, and acute pancreatitis. She presented with upper abdominal pain and did not report any other associated symptoms. A CT-scan, MRI, and EUS were performed, establishing the diagnosis of mucinous cystic neoplasm, for which the surgical team decided to perform a distal pancreatectomy using the clockwise modified technique. The patient presented a grade B pancreatic fistula and was discharged on postoperative day 3. The objective of the authors was to demonstrate the advantage of the laparoscopic approach in pancreatic laparoscopic surgery. 

Surgical distal pancreatic resection has the best chance to cure a disease of the pancreatic body and tail, including malignancy, precancerous lesions, and inflammatory involvement (1, 2). Laparoscopic distal pancreatic resection requires excellent surgical skills, training experience with proctors, and case-load concentration in high-volume hospitals with the best resources (1). 

In cases of a premalignant and symptomatic benign condition, the spleen must be preserved either using Kimura’s splenic vessel preservation technique or Warshaw’s splenic vessel resection technique (2). 

Laparoscopic distal pancreatectomy is a safe and feasible treatment for left pancreatic malignancies, with the same surgical efficacy as open distal pancreatectomy. Laparoscopic distal pancreatectomy has also the advantages of minimally invasive surgery, such as minimal trauma and enhanced recovery after surgery (3). 

A laparoscopic distal pancreatectomy performed using the clockwise technique provides satisfactory outcomes (4). However, in this approach, a modified clockwise technique was used. 



Take-home messages:

Patients with a pancreatic cyst tumor can be treated using a laparoscopic modified clockwise technique even with a previous medical history of acute pancreatitis. This surgery can be performed as it offers safe, optimal results, as well as excellent postoperative outcomes. 



Bibliography:

1. Bencini L, Minuzzo A. Distal pancreatectomy with or without radical approach, vascular resections and splenectomy: Easier does not always mean easy. World J Gastrointest Surg. 2023;15(6):1020-1032. doi:10.4240/wjgs.v15.i6.1020

2. Coco D, Leanza S, Schillaci R, Reina GA. Laparoscopic distal pancreatectomy for benign and malignant disease: a review of techniques and results. Prz Gastroenterol. 2022;17(2):103-109. doi:10.5114/pg.2021.109625

3. Hao T, Shiming J, Yong C. Analysis of safety and efficacy of laparoscopic distal pancreatectomy in the treatment of left pancreatic malignant tumors. J Int Med Res. 2021;49(12). doi:10.1177/03000605211063098

4. Gamo GDO, Reichardt GS, Guetter CR, et al. Esofagogástrica e esplenectomia influencia a variação. 2022;34(2):1-5.



Laparoscopic distal splenopancreatectomy for mucinous cystic neoplasm: modified clockwise technique

Excision mésorectale totale transanale (TaTME) pour adénocarcinome avancé du bas rectum

Colorectal cancer is the fourth most common malignancy and the second main cause of cancer-related mortality in the world. Transanal total mesorectal excision (TaTME) was first described by Lacy and Sylla in 2010. As this new surgical technique is increasingly adopted by surgeons (2), a comparable rate of intraoperative complications and a significantly lower incidence of postoperative complications were noted in the TaTME approach as compared with the laparoscopic TME (LaTME) approach (2). Indeed, many surgeons adopted the TaTME surgical technique because the use of LaTME is limited in low rectal cancer patients, who require surgeons with experience in ultralow sphincter-saving laparoscopic surgery, that has a high risk of leaving a positive circumferential resection margin. Aubert et al. confirmed that TaTME for low and middle rectal cancer is safe, feasible, and can lead to a high quality of rectal cancer resection specimen, with a shorter length of stay, and a lower readmission rate, as well as a lower rate of overall and major morbidities, anastomotic leakage, and circumferential resection margin involvement, as opposed to the standard laparoscopic total mesorectal excision (3).

This video presents the case of a 50-year-old man with a history of Parkinson’s disease who presented with proctorrhagia without any other symptoms. On medical exam, a rectal tumor was diagnosed 2cm away from the anal verge. It was decided to manage it with chemoradiotherapy. An assessment control was performed, and a complete tumor regression was observed. It was decided to perform a transanal total mesorectal excision.

Bibliography:

1\. Lei PR, Ruan Y, Yang X, Fang J, Chen T. Trans-anal or trans-abdominal total mesorectal excision? A systematic review and meta-analysis of recent comparative studies on perioperative outcomes and pathological result. Int J Surg. 2018;60(November):113- 119. doi:10.1016/j.ijsu.2018.11.003

2\. Ma B, Gao P, Song Y, et al. Transanal total mesorectal excision (taTME) for rectal cancer: A systematic review and meta-analysis of oncological and perioperative outcomes compared with laparoscopic total mesorectal excision. BMC Cancer. 2016;16(1). doi:10.1186/s12885-016-2428-5

3\. Aubert M, Mege D, Panis Y. Total mesorectal excision for low and middle rectal cancer: laparoscopic versus transanal approach—a meta-analysis. Surg Endosc. 2020;34(9):3908-3919. doi:10.1007/s00464-019-07160-8

Transanal total mesorectal excision (TaTME) for advanced low rectal adenocarcinoma

This is the case of a 21-year-old man who presented with retrosternal burning and dysphagia first to liquids, and then to solids. The patient experienced an unintentional weight loss during the year before surgery. An upper gastrointestinal endoscopy showed a dilated esophagus and a resistance to the passage of the endoscope through the cardia. Barium swallow showed a delayed passage of the contrast and its retention above the cardia with a dilated lower esophageal end. High-resolution esophageal manometry showed a type II achalasia of the cardia.

The patient had no surgical history and no chronic illness.

Preoperative routine laboratory investigations were performed. Anesthetic fitness was ensured. The patient was then prepared for surgery by fasting for 24 hours without solid food and 12 hours without liquid food.

A laparoscopic Heller’s cardiomyotomy and a Dor fundoplication were performed.

However, an inadvertent mucosal injury occurred during the procedure. The mucosa was repaired and the repair was covered with the gastric fundus using a Dor fundoplication.

The patient was placed in a reverse Trendelenburg position with his legs apart. The assistant stood to the patient’s left, and the camera man to the right. The monitor was placed above the patient’s head.

A total of 5 ports were used during this procedure. An 11mm port was inserted supraumbilically for the scope. The 2 working port were placed at the same level, both in the midclavicular line. A 12mm port was placed on the left side, and a 5mm port was placed on the right side. Another 5mm port was inserted in the left side, along the anterior axillary line and just below the costal margin for the assistant. A last 5mm port was inserted in the midline, just below the xiphoid process, for liver retraction.

The postoperative period was uneventful. The patient resumed oral intake on postoperative day 3 with a liquid diet. The patient then resumed a soft diet on postoperative day 5 and was discharged on postoperative day 7. He resumed a normal diet at the end of the second postoperative week.



Bibliography:

1. Tsuboi K, Omura N, Yano F, Hoshino M, Yamamoto SR, Akimoto S, et al. Identification of risk factors for mucosal injury during laparoscopic Heller myotomy for achalasia. Surg Endosc. 2016;30(2):706–714. doi: 10.1007/s00464-015-4264-0. 

2. Lynch KL, Pandolfino JE, Howden CW, Kahrilas PJ. Major complications of pneumatic dilation and Heller myotomy for achalasia: single-center experience and systematic review of the literature. Am J Gastroenterol. 2012;107(12):1817–1825. doi: 10.1038/ajg.2012.332. 

3. Salvador R, Spadotto L, Capovilla G, Voltarel G, Pesenti E, Longo C, et al. Mucosal perforation during laparoscopic Heller myotomy has no influence on final treatment outcome. J Gastrointest Surg. 2016;20(12):1923–1930. doi: 10.1007/s11605-016-3276-y.

4. Shemmeri E, Aye RW, Farivar AS, Bograd AJ, Louie BE. Use of a report card to evaluate outcomes of achalasia surgery: beyond the Eckardt score. Surg Endosc. 2020;34(4):1856–1862. doi: 10.1007/s00464-019-06952-2.



Mucosal injury during laparoscopic Heller’s cardiomyotomy and Dor fundoplication for esophageal achalasia

Lésions muqueuses au cours d'une cardiomyotomie de Heller et d'une fundoplication de Dor laparoscopiques pour achalasie de l'œsophage

Cholécystite aiguë, Parkland 5 : stratégie de sauvetage

The authors present the case of a 75-year-old man who underwent an elective surgery for chronic cholecystitis. He had a history of high blood pressure under medical treatment. During surgery, a PAECOF systematic dissection technique was performed, leading to a subtotal fenestrating cholecystectomy for a Parkland 5 acute cholecystitis. Using this approach, the authors want to show that even in such cases, laparoscopy is decisive, feasible, and safe with a low complication rate and no bile duct injury. 

Bibliography:

1. Dissanaike, Sharmila MD, FACS*. A Step-by-Step Guide to Laparoscopic Subtotal Fenestrating Cholecystectomy: A Damage Control Approach to the Difficult Gallbladder. Journal of the American College of Surgeons 223(2):p e15-e18, August 2016. | DOI: 10.1016/j.jamcollsurg.2016.05.006.

2. Strasberg, S. M., Pucci, M. J., Brunt, L. M., & Deziel, D. J. Subtotal Cholecystectomy-"Fenestrating" vs "Reconstituting" Subtypes and the Prevention of Bile Duct Injury: Definition of the Optimal Procedure in Difficult Operative Conditions. J Am Coll Surg 2016. 222(1), 89-96. https://doi.org/10.1016/j.jamcollsurg.2015.09.019

3. Zaragoza, Noe MD. Parkland 4 acute cholecystitis PAECIF/PAECOF https://websurg.com/doi/vd01en6684

4. Navez, B. Prevention of bile duct injury (BDI) during cholecystectomy. Acta Chir Belg 2003 Apr;103(2):151-3. doi: 10.1080/00015458.2003.11679399. PMID: 12768856 DOI: 10.1080/00015458.2003.11679399

Parkland 5 acute cholecystitis: bailout strategy 

Colectomie totale laparoscopique avec création d'une iléostomie terminale pour colite ulcéreuse réfractaire 

In this educational video, the authors demonstrate the laparoscopic total colectomy with end ileostomy formation in a patient refractory to medical treatment, with an acute flare-up of ulcerative colitis. The authors used the new LigaSure retractable L-hook laparoscopic sealer (Medtronic) with a Maryland tip, which allows effortless switch from fine sharp dissection to blunt dissection and vice versa. In this video, they demonstrate dissection of all inflamed colonic vessels, due to their prominence secondary to the pathophysiology of severe acute ulcerative colitis and provide tips and tricks on how to approach this common clinical situation. 

Bibliography:

1. Le Berre C, Honap S, Peyrin-Biroulet L. Ulcerative colitis. Lancet. 2023 Aug 12;402(10401):571-584. doi: 10.1016/S0140-6736(23)00966-2. PMID: 37573077. (https://pubmed.ncbi.nlm.nih.gov/37573077/)

2. Lamb CA, Kennedy NA, Raine T, Hendy PA, Smith PJ, Limdi JK, Hayee B, Lomer MCE, Parkes GC, Selinger C, Barrett KJ, Davies RJ, Bennett C, Gittens S, Dunlop MG, Faiz O, Fraser A, Garrick V, Johnston PD, Parkes M, Sanderson J, Terry H; IBD guidelines eDelphi consensus group; Gaya DR, Iqbal TH, Taylor SA, Smith M, Brookes M, Hansen R, Hawthorne AB. British Society of Gastroenterology consensus guidelines on the management of inflammatory bowel disease in adults. Gut. 2019 Dec;68(Suppl 3):s1-s106. doi: 10.1136/gutjnl-2019-318484. Epub 2019 Sep 27. Erratum in: Gut. 2021 Apr;70(4):1. PMID: 31562236; PMCID: PMC6872448. (https://pubmed.ncbi.nlm.nih.gov/31562236)

3. Spinelli A, Bonovas S, Burisch J, Kucharzik T, Adamina M, Annese V, Bachmann O, Bettenworth D, Chaparro M, Czuber-Dochan W, Eder P, Ellul P, Fidalgo C, Fiorino G, Gionchetti P, Gisbert JP, Gordon H, Hedin C, Holubar S, Iacucci M, Karmiris K, Katsanos K, Kopylov U, Lakatos PL, Lytras T, Lyutakov I, Noor N, Pellino G, Piovani D, Savarino E, Selvaggi F, Verstockt B, Doherty G, Raine T, Panis Y. ECCO Guidelines on Therapeutics in Ulcerative Colitis: Surgical Treatment. J Crohns Colitis. 2022 Feb 23;16(2):179-189. doi: 10.1093/ecco-jcc/jjab177. PMID: 34635910. (https://pubmed.ncbi.nlm.nih.gov/34635910/)

4. Ippolito C, Colucci R, Segnani C, Errede M, Girolamo F, Virgintino D, Dolfi A, Tirotta E, Buccianti P, Di Candio G, Campani D, Castagna M, Bassotti G, Villanacci V, Blandizzi C, Bernardini N. Fibrotic and Vascular Remodelling of Colonic Wall in Patients with Active Ulcerative Colitis. J Crohns Colitis. 2016 Oct;10(10):1194-204. doi: 10.1093/ecco-jcc/jjw076. Epub 2016 Mar 19. PMID: 26995183. (https://pubmed.ncbi.nlm.nih.gov/26995183/)

Laparoscopic total colectomy with end ileostomy formation for refractory ulcerative colitis 

Allongement fascial percutané assisté par ultrasons pour épicondylite latérale : procédure américaine pour tennis elbow

In this key lecture, Dr. Brian Jurbala, MD highlights the ultrasound-assisted percutaneous fascial lengthening for lateral epicondylitis, focusing on the USA tennis elbow procedure.

Ultrasound-assisted percutaneous fascial lengthening for lateral epicondylitis: USA tennis elbow procedure 

monthly focus

Tendinite de De Quervain

In this authoritative lecture, Prof. Francisco Javier Ferreira Villanova, MD, PhD outlines the surgical management of De Quervain tendinitis.

De Quervain tendinitis

In this authoritative lecture, Dr. Carla Nunes, MD focuses on ultrasound-guided infiltration of the upper limb.

Ultrasound-guided infiltration of the upper limb

Infiltration échoguidée du membre supérieur

In this authoritative lecture, Dr. De Keating-Hart, MD focuses on the ultrasound-guided antegrade technique for carpal tunnel syndrome.

Ultrasound-guided antegrade technique for carpal tunnel syndrome 

Technique antégrade guidée par ultrasons pour syndrome du canal carpien 

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

Focus on ultrasound-guided upper limb surgery

Prise en charge robotique de maladie biliaire complexe : description vidéo de 3 cas

Complex gallstone disease is amongst the most challenging pathologies encountered by hepatobiliary and pancreatic (HBP) surgeons. Conventionally, this condition requires open procedures in patients with morbid obesity. In this video, we present 3 cases of patients, demonstrating a minimally invasive approach using the da Vinci Xi™ surgical robotic system for the management of complex gallstone disease. The first patient presented with dropped gallstone with fistulisation, the second patient had a Mirizzi syndrome, and the third patient a cholecystocolonic fistula.

Case 1: The patient was a 75-year-old man with a history of diabetes and hypertension. He had undergone a laparoscopic cholecystectomy in its acute presentation phase 6 years earlier, at one of our referral hospitals. Subsequently, he developed a recurrent abscess with chronic discharge in the right flank. After multiple local drainage procedures and endoscopic retrograde cholangiopancreatography (ERCP) procedures, he was sent to our centre for the management of a suspected biliocutaneous fistula. We first suspected a ‘dropped stone' with resultant fistulisation and, since the cutaneous component had been drained recently, we opted for a surgical exploration of the intra-abdominal component of the abscess cavity.

Case 2: The patient was a 36-year-old lady with a BMI of 43. She presented to one of our referral hospitals with cholecystitis during the first wave of the COVID-19 pandemic and she was managed with a cholecystostomy tube. Subsequently, she developed obstructive jaundice. Imaging studies demonstrated a Mirizzi syndrome and a stent was inserted during ERCP. She was then referred for ongoing surgical management.

Case 3: The patient was a 58-year-old lady referred after a laparoscopy, with intent to proceed to a cholecystectomy at one of our referral institutions. Due to a major inflammatory change around the gallbladder, the procedure was abandoned. A magnetic resonance cholangiopancreatography (MRCP) showed the presence of a cholecystocolonic fistula. She was referred for definitive management.

The video chapters are described in the video.





Bibliography:

- Indications and Outcomes of Completion Cholecystectomy: A 5-year Experience From a Rural Tertiary Center. Alser O et al. Am Surg 2023 Nov;89(11):4584-4589. doi: 10.1177/00031348221124331. https://pubmed.ncbi.nlm.nih.gov/36031961/

- Cost analysis of robot-assisted choledochotomy and common bile duct exploration as an option for complex choledocholithiasis. Almamar et al. Surg Endosc 2018 Mar;32(3):1223-1227. doi: 10.1007/s00464-017-5795-3. https://pubmed.ncbi.nlm.nih.gov/28812193/

Robotic management of complex gallstone disease: video description of 3 cases

This is the case of a 71-year-old female patient presenting with colorectal cancer and liver metastases. The patient had previously undergone a laparotomic subtotal colectomy to address intestinal occlusion caused by an adenocarcinoma located in the stenotic descending colon. Six suspected secondary liver lesions were identified in liver segments VII, VIII, IV, VI, and V.

After undergoing 7 cycles of adjuvant chemotherapy, magnetic resonance imaging (MRI) showed a progression in hepatic lesions. A robotic extended right hepatectomy using the intrahepatic extra-Glissonian approach was therefore proposed to the patient.

This surgical technique allows precise control of the liver blood supply, minimizing the risks of bleeding and other surgical complications. Additionally, it provides improved visualization of the bile duct, helping to accurately identify and preserve biliary structures. The extra-Glissonian approach is complex and requires a specialized training and expertise. However, it can improve outcomes in patients undergoing a right hepatectomy.

**Bibliographic references:**

1\. Giordano M, Lopez-Ben S, Codina-Barreras A, Pardina B, Falgueras L, Torres-Bahi S, Albiol M, Castro E, Figueras J. Extra-Glissonian approach in liver resection. HPB (Oxford). 2010 Mar;12(2):94-100. doi: 10.1111/j.1477-2574.2009.00135.x. PMID: 20495652; PMCID: PMC2826666. Link: [https://pubmed.ncbi.nlm.nih.gov/20495652/](https://pubmed.ncbi.nlm.nih.gov/20495652/)

2\. Cresswell AB, Welsh FK, John TG, Rees M. Evaluation of intrahepatic, extra-Glissonian stapling of the right porta hepatis vs. classical extrahepatic dissection during right hepatectomy. HPB (Oxford). 2009 Sep;11(6):493-8. doi: 10.1111/j.1477-2574.2009.00083.x. PMID: 19816613; PMCID: PMC2756636. Link: [https://pubmed.ncbi.nlm.nih.gov/19816613/](https://pubmed.ncbi.nlm.nih.gov/19816613/)

Robotic right hepatectomy using the intrahepatic extra-Glissonian approach and indocyanine green (ICG) fluorescence

Hépatectomie droite robotisée en utilisant la voie d’abord extraglissonienne intrahépatique et la fluorescence au vert d'indocyanine 

Fenestration laparoscopique d'un kyste hépatique : utilisation de la fluorescence avec vert d'indocyanine

Background:

Laparoscopic fenestration (LF) for hepatic cysts is now considered a standard treatment for symptomatic and nonparasitic liver cysts. However, when resecting the cyst wall, it is difficult to identify all bile ducts, especially the smaller ones at risk for leakage. Indocyanine green-fluorescent cholangiography (ICG-FC) has recently been introduced intraoperatively to visualize and provide detailed information about the biliary tree. The authors report a case of LF with the intraoperative assistance of ICG-FC and three-dimensional multiparametric reconstruction (r3D).

Patient and methods:

This is the case of a 70-year-old male patient, ECOG 0, with a BMI of 21, Child-Pugh class A, and with a medical history of emphysema, chronic obstructive pulmonary disease (COPD), and Marfan’s syndrome with an endoscopically treated left aortoiliac aneurysm. In February 2021, shortness of breath, abdominal bloating, upper abdominal pain, and anorexia worsened. CT-scan showed multiple liver and splenic cysts. An r3D was acquired. ICG was administered intravenously at a dose of 0.3mg/kg one hour before surgery.

Results:

Intraperitoneal examination revealed three large cysts. There was a 10cm cyst in liver segments IV and V, another 16cm cyst in liver segments VI and VII, and another 22cm cyst in the left liver lobe, not at the level of the spleen, as erroneously shown on the preoperative CT-scan. The cysts were completely fenestrated. Intracystic bile ducts and bile leaks in the cysts were visualized with ICG-FC and clamping was achieved with a Hem-o-lok™ automatic clip applier. The patient was discharged early in good health condition.

Conclusions:

The use of ICG-FC in hepatobiliary surgery has become commonplace, and its use to identify the biliary tree is safe. ICG-FC and r3D play a key role in the prevention and treatment of bile duct injury during LF to minimize postoperative complications.

Bibliography:

1\. Boni L, David G, Mangano A, Dionigi G, Rausei S, Spampatti S, Cassinotti E, Fingerhut A. Clinical applications of indocyanine green (ICG) enhanced fluorescence in laparoscopic surgery. Surg Endosc 2015 Jul;29(7):2046-55. doi: 10.1007/s00464-014-3895-x. Epub 2014 Oct 11. PMID: 25303914 PMCID: PMC4471386 DOI: 10.1007/s00464-014-3895-x

2\. Hanaki T, Yagyu T, Uchinaka E, Morimoto M, Watanabe J, Tokuyasu N, Takano S, Sakamoto T, Honjo S, Fujiwara Y. Avoidance of bile duct injury during laparoscopic liver cyst fenestration using indocyanine green: A case report. Clin Case Rep 2020 Jun 10;8(8):1419-1424. doi: 10.1002/ccr3.2840. eCollection 2020 Aug. PMID: 32884766 PMCID: PMC7455442 DOI: 10.1002/ccr3.2840

3\. Une N, Fujio A, Mitsugashira H, Kanai N, Saitoh Y, Ohta M, Sasaki K, Miyazawa K, Kashiwadate T, Nakanishi W, Tokodai K, Miyagi S, Unno M, Kamei T. Laparoscopic liver cyst fenestration with real-time indocyanine green fluorescence-guided surgery: a case report. J Surg Case Rep 2021 May 17;2021(5):rjab196. doi: 10.1093/jscr/rjab196. eCollection 2021 May. PMID: 34025978 PMCID: PMC8128400 DOI: 10.1093/jscr/rjab196

4\. Wilhelm D, Vogel T, Ostler D, Marahrens N, Kohn N, Koller S, Friess H, Kranzfelder M. Enhanced Visualization: From Intraoperative Tissue Differentiation to Augmented Reality. Visc Med 2018 Feb;34(1):52-59. doi: 10.1159/000485940. Epub 2018 Feb 16. PMID: 29594170 PMCID: PMC5869373 DOI: 10.1159/000485940

Laparoscopic liver cyst fenestration: use of ICG fluorescence 

The advent of robotic systems has propelled minimally invasive surgery forward. However, the adoption of such systems in routine procedures is hindered by high costs and operational complexity (1). This mismatch between conventional telemanipulators and everyday surgical workflows demands innovative solutions to seamlessly integrate advanced robotics into the operating room.

This video showcases the Maestro System™ manufactured by Moon Surgical and its ScoPilot™ feature through a laparoscopic cholecystectomy use case. This dual arm system (2) reflects a significant progress in minimally invasive surgery as it allows for solo surgeries by providing real-time instrument tracking and enhanced ergonomics. First, a human study by Cadière et al. (3) showed surgical efficiency, safety, and surgeon satisfaction.

As artificial intelligence (AI) is gaining ground in the field of laparoscopic surgery with cholecystectomy as a largely studied use case (4), the ScoPilot™ feature, that allows the camera to follow instruments in real time, marks a pivotal shift toward highly efficient solo surgical procedures. By enabling precise real-time instrument tracking and reducing physical demands impacting surgical teams, it streamlines operations and surgical workflow. Its successful application in cholecystectomy cases underscores the system’s potential to improve standard procedures by reducing operative times and physical strain for surgical teams, promising a new era in digitally assisted solo surgeries.

Bibliography:

1. Higgins RM, Frelich MJ, Bosler ME, Gould JC. Cost analysis of robotic versus laparoscopic general surgery procedures. Surg Endosc. 2017 Jan;31(1):185-192. doi: 10.1007/s00464-016-4954-2. Epub 2016 May 2. PMID: 27139704.
2. Feasibility and safety study of the use of a new robot (MaestroTM) for laparoscopic surgery. \[Internet]. 2024 \[cited 2024 Mar 7]. Available from: [https://www.researchsquare.com](https://www.researchsquare.com)
3. Cadière GB, Himpens J, Poras M, Pau L, Boyer N, Cadière B. First human surgery using a surgical assistance robotics device for laparoscopic cholecystectomies. Surg Endosc. 2023 Oct;37(10):7812-7818. doi: 10.1007/s00464-023-10296-3. Epub 2023 Aug 21. PMID: 37605013; PMCID: PMC10520184.
4. Mascagni P, Vardazaryan A, Alapatt D, Urade T, Emre T, Fiorillo C, Pessaux P, Mutter D, Marescaux J, Costamagna G, Dallemagne B, Padoy N. Artificial Intelligence for Surgical Safety: Automatic Assessment of the Critical View of Safety in Laparoscopic Cholecystectomy Using Deep Learning. Ann Surg. 2022 May 1;275(5):955-961. doi: 10.1097/SLA.0000000000004351. Epub 2020 Nov 16. PMID: 33201104.

Empowered surgery using the Maestro System™ with its ScoPilot™ feature: a laparoscopic cholecystectomy use case

Chirurgie assistée par le Maestro System™ avec sa fonction ScoPilot™ : un cas d'utilisation lors d'une cholécystectomie laparoscopique

Cholangiocarcinome de la voie biliaire traité par hépaticojéjunostomie : intervention assistée par robot

In this educational video, the authors demonstrate a hepaticojejunostomy for an extrahepatic cholangiocarcinoma type 1 according to the Bismuth-Corlette classification. One of the limitations of robotic surgery is the difficulty in adjusting the operative field once the focus is fixed and the robotic arms are placed on the target anatomy. The technique performed here solves this problem. 

This video shows the case of a 59-year-old male patient with no relevant medical history. The patient presents with a clinical history of asthenia, weight loss, and analytic parameters of dissociated cholestasis (total bilirubin 1.5 mg/dL, direct bilirubin 1 mg/dL, GGT 1993 UI/l, FA 378 UI/l, GOT 274 UI/l, GPT 509 UI/l, CA 19-9 91 UI/l). MRCP and CT-scan show a tumor in the common bile duct of 1cm in size below the hepatic confluence that involves the cystic duct. No signs of distant disease were noted, neither in the abdomen or thorax.



Take-home messages:

It is critical to set all organs in the same working field before docking, in order to decrease the number of movements of the robotic arms. 

The specimen should be removed ‘en bloc’. The gallbladder may be useful to mobilize the common bile duct. 

Intraoperative pathology assessment is needed. A duodenopancreatectomy or hepatic resection should be prepared in case it is indicated. 



Bibliography:

1. Radtke A, Königsrainer A. Surgical Therapy of Cholangiocarcinoma. Visc Med. 2016 Dec;32(6):422-426. doi: 10.1159/000452921. Epub 2016 Nov 30. PMID: 28229077; PMCID: PMC5290435.

2. Guadagni S, Comandatore A, Furbetta N, Di Franco G, Carpenito C, Bechini B, Vagelli F, Ramacciotti N, Palmeri M, Di Candio G, Morelli L. Robotic Hepatectomy plus Biliary Reconstruction for Bismuth Type III and Type IV Hilar Cholangiocarcinoma: State of the Art and Literature Review. J Pers Med. 2023 Dec 21;14(1):12. doi: 10.3390/jpm14010012. PMID: 38276227; PMCID: PMC10817587.

3. Banales JM, Marin JJG, Lamarca A, Rodrigues PM, Khan SA, Roberts LR, Cardinale V, Carpino G, Andersen JB, Braconi C, Calvisi DF, Perugorria MJ, Fabris L, Boulter L, Macias RIR, Gaudio E, Alvaro D, Gradilone SA, Strazzabosco M, Marzioni M, Coulouarn C, Fouassier L, Raggi C, Invernizzi P, Mertens JC, Moncsek A, Rizvi S, Heimbach J, Koerkamp BG, Bruix J, Forner A, Bridgewater J, Valle JW, Gores GJ. Cholangiocarcinoma 2020: the next horizon in mechanisms and management. Nat Rev Gastroenterol Hepatol. 2020 Sep;17(9):557-588. doi: 10.1038/s41575-020-0310-z. Epub 2020 Jun 30. PMID: 32606456; PMCID: PMC7447603.

Common bile duct cholangiocarcinoma managed with hepaticojejunostomy: robotic assisted approach

In this authoritative lecture, Dr. Armando Melani looks into indocyanine green (ICG) fluorescence and 3D CT image-guided robotic colorectal surgery.&#x20;

ICG fluorescence – 3D CT image-guided robotic colorectal surgery

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 

Focus on innovative surgical techniques

Focus sur des techniques chirurgicales innovantes

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

Systématisation des étapes opératoires dans le traitement endoscopique du diastasis recti

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

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

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

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

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

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

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

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) 

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