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Jaime ALBORNOZ

Clinica Las Condes
Santiago, Chile
MD
3039 likes
114639 views
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How to improve exposure in laparoscopy: organ suspension with the T-Lift™ device
Organ suspension using a T-lift™ device is a simple method to enhance exposure in laparoscopic surgery, providing adequate vision and operating space and allowing the assistant to focus on helping the surgeon, thus reducing operative times, without the need for difficult intra-abdominal needle manipulation as well as the risk of bowel and vascular injury associated with that approach.
Several examples of organ suspension with the T-lift™ are demonstrated in this video, including suspension of the ovaries, sigmoid colon or vagina in simple procedures, as well as in more complex procedures, for instance by holding the anterior rectal wall for bowel resection with transanal specimen extraction.
A Wattiez, J Albornoz, E Faller, M Puga
Surgical intervention
5 years ago
6835 views
466 likes
1 comment
07:12
How to improve exposure in laparoscopy: organ suspension with the T-Lift™ device
Organ suspension using a T-lift™ device is a simple method to enhance exposure in laparoscopic surgery, providing adequate vision and operating space and allowing the assistant to focus on helping the surgeon, thus reducing operative times, without the need for difficult intra-abdominal needle manipulation as well as the risk of bowel and vascular injury associated with that approach.
Several examples of organ suspension with the T-lift™ are demonstrated in this video, including suspension of the ovaries, sigmoid colon or vagina in simple procedures, as well as in more complex procedures, for instance by holding the anterior rectal wall for bowel resection with transanal specimen extraction.
Laparoscopic partial cystectomy for big bladder endometriosis nodule
Bladder endometriosis is the most common presentation of urinary tract endometriosis and is frequently associated with specific symptoms such as dysuria, hematuria and recurrent urinary tract infections. Although it may be associated with ureteral endometriosis in severe cases, in most cases, it presents as an isolated disease.
The laparoscopic approach for bladder endometriosis nodule excision requires careful dissection of the paravesical spaces and identification of both ureters entering each ureteral tunnel. The shaving technique until healthy tissue is reached should be attempted, but if mucosal invasion is found, complete wall excision should be performed. In some occasions, when the nodule invades the bladder trigone, a double-J catheter may be inserted and left in place for 6 to 8 weeks.
In this video, we present the case of a 23-year-old woman complaining with significant dysuria associated with hematuria, dysmenorrhea, dyspareunia, and chronic pelvic pain. Magnetic resonance imaging described a 5cm nodule located in the bladder dome, and cystoscopy confirmed the diagnosis. The patient was referred to our Endometriosis Centre after diagnostic laparoscopy.
A Wattiez, J Albornoz, M Puga, E Faller
Surgical intervention
6 years ago
1695 views
24 likes
0 comments
32:41
Laparoscopic partial cystectomy for big bladder endometriosis nodule
Bladder endometriosis is the most common presentation of urinary tract endometriosis and is frequently associated with specific symptoms such as dysuria, hematuria and recurrent urinary tract infections. Although it may be associated with ureteral endometriosis in severe cases, in most cases, it presents as an isolated disease.
The laparoscopic approach for bladder endometriosis nodule excision requires careful dissection of the paravesical spaces and identification of both ureters entering each ureteral tunnel. The shaving technique until healthy tissue is reached should be attempted, but if mucosal invasion is found, complete wall excision should be performed. In some occasions, when the nodule invades the bladder trigone, a double-J catheter may be inserted and left in place for 6 to 8 weeks.
In this video, we present the case of a 23-year-old woman complaining with significant dysuria associated with hematuria, dysmenorrhea, dyspareunia, and chronic pelvic pain. Magnetic resonance imaging described a 5cm nodule located in the bladder dome, and cystoscopy confirmed the diagnosis. The patient was referred to our Endometriosis Centre after diagnostic laparoscopy.
Segmental bowel resection and transanal specimen extraction for Deep Infiltrating Endometriosis (DIE)
Endometriosis can affect the bowel in 5-15% of cases and the most common sites are the rectum, the sigmoid colon, the appendix, and the small bowel. Patients may present dysmenorrhea, dyspareunia and chronic pelvic pain, as well as digestive symptoms such as dyschezia, constipation and diarrhea during menstruation. Preoperative work-up includes transanal ultrasound and magnetic resonance imaging, which according to the nodule’s location, can accurately describe the lesions. The laparoscopic approach includes adhesiolysis (shaving), partial thickness wall excision (mucosal skinning), discoid resection, and segmental bowel resection. In this video, we present the case of a 30-year-old patient complaining from severe dysmenorrhea, dyspareunia and dyschezia associated with deep infiltrating endometriosis (DIE) of the sigmoid colon that was treated by means of nodule excision, segmental bowel resection, and transanal specimen extraction.
A Wattiez, J Leroy, J Albornoz, E Faller, M Puga
Surgical intervention
6 years ago
2400 views
15 likes
0 comments
10:12
Segmental bowel resection and transanal specimen extraction for Deep Infiltrating Endometriosis (DIE)
Endometriosis can affect the bowel in 5-15% of cases and the most common sites are the rectum, the sigmoid colon, the appendix, and the small bowel. Patients may present dysmenorrhea, dyspareunia and chronic pelvic pain, as well as digestive symptoms such as dyschezia, constipation and diarrhea during menstruation. Preoperative work-up includes transanal ultrasound and magnetic resonance imaging, which according to the nodule’s location, can accurately describe the lesions. The laparoscopic approach includes adhesiolysis (shaving), partial thickness wall excision (mucosal skinning), discoid resection, and segmental bowel resection. In this video, we present the case of a 30-year-old patient complaining from severe dysmenorrhea, dyspareunia and dyschezia associated with deep infiltrating endometriosis (DIE) of the sigmoid colon that was treated by means of nodule excision, segmental bowel resection, and transanal specimen extraction.
Strategy for laparoscopic total hysterectomy with a big adnexal mass
Hysterectomy when managing a big adnexal mass has always been a challenging situation for laparoscopic surgeons. Complete preoperative assessment, surgical experience and strategy are fundamental to address adnexal pathology laparoscopicallly, both for benign and malignant conditions. Adequate trocar placement, full inspection of the abdominal cavity, comprehensive evaluation of the tumor’s surface, cytology and definition of the nature of the adnexal mass are truly essential. In addition, proper identification of standard anatomical landmarks is fundamental to perform hysterectomy with adnexectomy, which helps to prevent damage to surrounding structures. Final assessment of the vaginal cuff may lead to the diagnosis of pelvic floor disorders that should be repaired during vaginal cuff closure. In this video, we present a case of hysterectomy and adnexectomy by laparoscopy in a 46-year-old patient complaining of abdominal pain secondary to the presence of a 13cm simple adnexal cyst with normal CA 125 values.
A Wattiez, C Zacharopoulou, J Albornoz, M Puga, E Faller
Surgical intervention
6 years ago
4560 views
136 likes
0 comments
28:57
Strategy for laparoscopic total hysterectomy with a big adnexal mass
Hysterectomy when managing a big adnexal mass has always been a challenging situation for laparoscopic surgeons. Complete preoperative assessment, surgical experience and strategy are fundamental to address adnexal pathology laparoscopicallly, both for benign and malignant conditions. Adequate trocar placement, full inspection of the abdominal cavity, comprehensive evaluation of the tumor’s surface, cytology and definition of the nature of the adnexal mass are truly essential. In addition, proper identification of standard anatomical landmarks is fundamental to perform hysterectomy with adnexectomy, which helps to prevent damage to surrounding structures. Final assessment of the vaginal cuff may lead to the diagnosis of pelvic floor disorders that should be repaired during vaginal cuff closure. In this video, we present a case of hysterectomy and adnexectomy by laparoscopy in a 46-year-old patient complaining of abdominal pain secondary to the presence of a 13cm simple adnexal cyst with normal CA 125 values.
Mucosal skinning for bowel endometriosis: standard technique
Bowel endometriosis is described in 3% to 37% of patients with endometriosis. In 90% of these cases, the rectum, the sigmoid colon or both are involved. It is the most severe form of the disease and its surgical management is complex. Surgery is very challenging and the degree of radical excision should always be counterbalanced with the risk of complications and functional disorders. Four types of surgery can be chosen: superficial excision or shaving, mucosal skinning, discoid excision, and segmental bowel resection. We believe that bowel resection can be avoided in some cases if mucosal skinning is first attempted. This video shows 2 endometriotic lesions of the rectosigmoid junction that were treated by mucosal skinning, hence avoiding an unnecessary segmental resection. The final result was satisfactory and postoperative outcome was uneventful. In 2008, the patient underwent a laparoscopic intervention, which revealed the presence of a deep infiltrating endometriosis and bilateral endometriotic cysts. Bilateral ovarian cystectomy was performed. Postoperative MRI for pelvic pains revealed a persistent lesion of the recto-vaginal septum. The patient then presented with persistent dysmenorrhea (8/10), chronic pelvic pain (8/10), dyschezia (6/10) without dyspareunia or bladder-related symptoms. Clinical examination showed a mobile anteverted uterus without clear evidence of a nodule lesion at the rectovaginal septum neither was it at the level of uterosacral ligaments, but most probably the presence of adhesions between the uterus and the rectosigmoid junction. Despite treatment with GnRH agonist, the patient was referred to the emergency department several times for bouts of intense pain.
A Wattiez, E Faller, J Albornoz, P Messori, T Boisramé
Surgical intervention
6 years ago
1383 views
74 likes
0 comments
11:40
Mucosal skinning for bowel endometriosis: standard technique
Bowel endometriosis is described in 3% to 37% of patients with endometriosis. In 90% of these cases, the rectum, the sigmoid colon or both are involved. It is the most severe form of the disease and its surgical management is complex. Surgery is very challenging and the degree of radical excision should always be counterbalanced with the risk of complications and functional disorders. Four types of surgery can be chosen: superficial excision or shaving, mucosal skinning, discoid excision, and segmental bowel resection. We believe that bowel resection can be avoided in some cases if mucosal skinning is first attempted. This video shows 2 endometriotic lesions of the rectosigmoid junction that were treated by mucosal skinning, hence avoiding an unnecessary segmental resection. The final result was satisfactory and postoperative outcome was uneventful. In 2008, the patient underwent a laparoscopic intervention, which revealed the presence of a deep infiltrating endometriosis and bilateral endometriotic cysts. Bilateral ovarian cystectomy was performed. Postoperative MRI for pelvic pains revealed a persistent lesion of the recto-vaginal septum. The patient then presented with persistent dysmenorrhea (8/10), chronic pelvic pain (8/10), dyschezia (6/10) without dyspareunia or bladder-related symptoms. Clinical examination showed a mobile anteverted uterus without clear evidence of a nodule lesion at the rectovaginal septum neither was it at the level of uterosacral ligaments, but most probably the presence of adhesions between the uterus and the rectosigmoid junction. Despite treatment with GnRH agonist, the patient was referred to the emergency department several times for bouts of intense pain.
Deep endometriosis excision with ureteral anastomosis followed by segmental rectosigmoid resection, transvaginal specimen extraction, and a transanal colorectal anastomosis
We present the case of a 29-year-old nulligest woman. Four years ago, she had a previous surgery with a rectovaginal nodule removed both by laparoscopy and vaginal approach. She has complained of dyspareunia (8/10), dysmenorrhea (8/10), dyschezia (8/10) and infertility over the last 2 years, but she also suffers from bladder dysfunction requiring urinary self-catheterization during her menstrual periods. The laparoscopic exploration revealed a big fibrotic nodule located in the right pelvic sidewall involving the right ureter and the rectum. Right ureter resection and anastomosis were performed. Segmental rectosigmoid resection was followed by transvaginal specimen extraction and a transanal colorectal anastomosis. The intracorporeal laparoscopic technique allows for a limited bowel devascularization and for an appropriate anastomosis with no need for extra abdominal incisions. No complications were noted and the patient had a good clinical evolution.
A Wattiez, J Leroy, E Faller, J Albornoz, P Messori
Surgical intervention
6 years ago
2496 views
20 likes
0 comments
30:14
Deep endometriosis excision with ureteral anastomosis followed by segmental rectosigmoid resection, transvaginal specimen extraction, and a transanal colorectal anastomosis
We present the case of a 29-year-old nulligest woman. Four years ago, she had a previous surgery with a rectovaginal nodule removed both by laparoscopy and vaginal approach. She has complained of dyspareunia (8/10), dysmenorrhea (8/10), dyschezia (8/10) and infertility over the last 2 years, but she also suffers from bladder dysfunction requiring urinary self-catheterization during her menstrual periods. The laparoscopic exploration revealed a big fibrotic nodule located in the right pelvic sidewall involving the right ureter and the rectum. Right ureter resection and anastomosis were performed. Segmental rectosigmoid resection was followed by transvaginal specimen extraction and a transanal colorectal anastomosis. The intracorporeal laparoscopic technique allows for a limited bowel devascularization and for an appropriate anastomosis with no need for extra abdominal incisions. No complications were noted and the patient had a good clinical evolution.