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Armando MELANI

IRCAD América Latina (Unit of Barretos and Unit of Rio de Janeiro)
Barretos - Rio de Janeiro, Brazil
MD
6525 likes
88142 views
9 comments
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Live interactive transanal TME (TaTME) with the TEO™ platform
Randomized clinical trials such as COLOR II, COREAN and CLASICC, have shown better results for laparoscopic total mesorectal excision (TME), in terms of short-term and long-term outcomes, when compared with open TME.
Laparoscopic TME presents some limitations such as low rectal cancer which has a high risk of leaving a positive circumferential resection margin (CRM) and a narrow pelvis. Conversion to open procedures remains unsatisfactory.
Transanal TME (taTME) has been proposed to give a new option in cases where laparoscopic TME is difficult.
In this video, we present the case of a transanal approach with the TEO™ platform for low rectal cancer.
A Melani, A D'Urso, D Mutter, J Marescaux
Surgical intervention
1 year ago
2985 views
324 likes
0 comments
45:51
Live interactive transanal TME (TaTME) with the TEO™ platform
Randomized clinical trials such as COLOR II, COREAN and CLASICC, have shown better results for laparoscopic total mesorectal excision (TME), in terms of short-term and long-term outcomes, when compared with open TME.
Laparoscopic TME presents some limitations such as low rectal cancer which has a high risk of leaving a positive circumferential resection margin (CRM) and a narrow pelvis. Conversion to open procedures remains unsatisfactory.
Transanal TME (taTME) has been proposed to give a new option in cases where laparoscopic TME is difficult.
In this video, we present the case of a transanal approach with the TEO™ platform for low rectal cancer.
Laparoscopic sigmoidectomy for benign diverticular disease
Dr. Armando Melani beautifully demonstrates a laparoscopic sigmoidectomy technique for a benign diverticular condition. He provides tips and tricks to perfectly expose the operating field and recommends an extensive approach to the left colon with primary mobilization of the splenic flexure using a posterior medial approach with a late vascular approach. The technique and its performance is amply discussed by the panel of experts present, hence providing a very instructive demonstration.
The operator also discusses the different types of energy devices available as well as the tricks to safely perform an upper colorectal anastomosis. This film provides plenty of detailed information for beginners and experts alike to allow them to perform a laparoscopic sigmoidectomy in a perfect fashion.
J Leroy, A Melani, J Marescaux
Surgical intervention
4 years ago
5760 views
137 likes
3 comments
33:07
Laparoscopic sigmoidectomy for benign diverticular disease
Dr. Armando Melani beautifully demonstrates a laparoscopic sigmoidectomy technique for a benign diverticular condition. He provides tips and tricks to perfectly expose the operating field and recommends an extensive approach to the left colon with primary mobilization of the splenic flexure using a posterior medial approach with a late vascular approach. The technique and its performance is amply discussed by the panel of experts present, hence providing a very instructive demonstration.
The operator also discusses the different types of energy devices available as well as the tricks to safely perform an upper colorectal anastomosis. This film provides plenty of detailed information for beginners and experts alike to allow them to perform a laparoscopic sigmoidectomy in a perfect fashion.
Laparoscopic sigmoidectomy for T3N2M1 sigmoid cancer
Introduction:
This is the case of a 65-year-old gentleman who presented with blood per rectum (PR) and symptoms of subacute obstruction. He was diagnosed with a stenotic invasive adenocarcinoma at 15cm from the anal verge and with liver metastases. After discussion at our multidisclipinary meeting, he was recommended to undergo palliative chemotherapy in the form of FOLFIRI and Avastin. Unfortunately, his symptoms of subacute obstruction worsened and it was recommended that he undergo a palliative resection.

Methods:
He underwent a palliative Laparoscopic Anterior Resection (LAR). Professor Armondo Melani utilized a 4-port technique with a 10mm umbilical optical port and 3 by 5mm working ports (2 on the right-hand side and one on the left). He used a medial to lateral approach starting with the splenic flexure takedown. This was achieved by entering the retroperitoneal plane cephalad to the inferior mesenteric artery (IMA) and inferior to the inferior mesenteric vein (IMV). Once the correct plane has been entered, the IMV was skeletonized and divided with a Ligasure® vessel-sealing device. The lesser sac was then entered superior and cephalad to the IMV, superior to the pancreas and to the left of the middle colic vessels. This novel approach allowed for easy identification of the pancreas and retroperitoneal mobilization of the mesocolon from the pancreas. The lesser sac was then entered above the transverse colon, the omental attachments divided and splenic flexure mobilization completed. The retroperitoneal plane was then entered caudally to the IMA, which was subsequently skeletonized and divided after identification of the left ureter and gonadal vessels. The rectum was then mobilized to >5cm below the tumor, the mesorectum divided, the rectum transected with an articulating linear stapling device. The specimen was delivered through a Pfannenstiel incision (with a wound protector). The specimen was transected and the anvil of a circular stapler inserted into the proximal colon with a purse-string suture. The colon was returned to the abdomen and the colorectal anastomosis was completed with the insertion of the circular stapler transanally.
A Melani, J Marescaux
Surgical intervention
6 years ago
8297 views
128 likes
0 comments
28:38
Laparoscopic sigmoidectomy for T3N2M1 sigmoid cancer
Introduction:
This is the case of a 65-year-old gentleman who presented with blood per rectum (PR) and symptoms of subacute obstruction. He was diagnosed with a stenotic invasive adenocarcinoma at 15cm from the anal verge and with liver metastases. After discussion at our multidisclipinary meeting, he was recommended to undergo palliative chemotherapy in the form of FOLFIRI and Avastin. Unfortunately, his symptoms of subacute obstruction worsened and it was recommended that he undergo a palliative resection.

Methods:
He underwent a palliative Laparoscopic Anterior Resection (LAR). Professor Armondo Melani utilized a 4-port technique with a 10mm umbilical optical port and 3 by 5mm working ports (2 on the right-hand side and one on the left). He used a medial to lateral approach starting with the splenic flexure takedown. This was achieved by entering the retroperitoneal plane cephalad to the inferior mesenteric artery (IMA) and inferior to the inferior mesenteric vein (IMV). Once the correct plane has been entered, the IMV was skeletonized and divided with a Ligasure® vessel-sealing device. The lesser sac was then entered superior and cephalad to the IMV, superior to the pancreas and to the left of the middle colic vessels. This novel approach allowed for easy identification of the pancreas and retroperitoneal mobilization of the mesocolon from the pancreas. The lesser sac was then entered above the transverse colon, the omental attachments divided and splenic flexure mobilization completed. The retroperitoneal plane was then entered caudally to the IMA, which was subsequently skeletonized and divided after identification of the left ureter and gonadal vessels. The rectum was then mobilized to >5cm below the tumor, the mesorectum divided, the rectum transected with an articulating linear stapling device. The specimen was delivered through a Pfannenstiel incision (with a wound protector). The specimen was transected and the anvil of a circular stapler inserted into the proximal colon with a purse-string suture. The colon was returned to the abdomen and the colorectal anastomosis was completed with the insertion of the circular stapler transanally.