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Stelio RUA

CMC de Tronquières
Aurillac, France
MD
1.8K like
59.2K views
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Laparoscopic left hemicolectomy in a thin patient, including anastomotic control using intraoperative fluorescence
Usually, Body Mass Index (BMI) is correlated to the difficulty in performing the surgery. Obesity is associated with a more complex surgery and a longer operative time due to difficulties in finding the right plane of dissection and identifying the structures. However, treating a thin patient may also be dangerous because the planes of dissection are more adherent, which makes it harder to identify the real embryological dissection plane.
This video shows the danger of dissection when the mesocolon is very thin and adherent to Toldt’s fascia or Gerota’s fascia.

The nightmare of colon and rectum surgery is the leak of the anastomosis. It may occur also with all precaution: no anastomotic tension, the evaluation of the vascularization may be difficult because macroscopic lesion, when there is an ischemia, would appear after some hours; the use of the ICG test is a good tool to control the poor vascularization of the anastomosis earlier and to correct it, hence avoiding the drama of the leak.
S Rua
Surgical intervention
6 months ago
2849 views
10 likes
0 comments
13:14
Laparoscopic left hemicolectomy in a thin patient, including anastomotic control using intraoperative fluorescence
Usually, Body Mass Index (BMI) is correlated to the difficulty in performing the surgery. Obesity is associated with a more complex surgery and a longer operative time due to difficulties in finding the right plane of dissection and identifying the structures. However, treating a thin patient may also be dangerous because the planes of dissection are more adherent, which makes it harder to identify the real embryological dissection plane.
This video shows the danger of dissection when the mesocolon is very thin and adherent to Toldt’s fascia or Gerota’s fascia.

The nightmare of colon and rectum surgery is the leak of the anastomosis. It may occur also with all precaution: no anastomotic tension, the evaluation of the vascularization may be difficult because macroscopic lesion, when there is an ischemia, would appear after some hours; the use of the ICG test is a good tool to control the poor vascularization of the anastomosis earlier and to correct it, hence avoiding the drama of the leak.
Low-cost laparoscopic appendectomy: how to teach
Laparoscopic appendectomy must be the gold standard. Nowadays, many centers still continue to go on with McBurney’s incisions. Why? Expensive devices may be a reason. Low cost appendectomy allows for a diagnostic laparoscopy and offers a therapeutic option with the lowest price.
On the other hand, residents must begin the learning curve in laparoscopy as soon as possible not only with a training center (training in cadaveric or animals) but they must also start practicing on humans with watchful surgeon/teacher’s eyes.
The aim of this video is to demonstrate that low-cost laparoscopic appendectomy is feasible not only for surgeons but also for residents operating with an expert.
S Rua, G Machado , P Mira
Surgical intervention
2 years ago
9304 views
560 likes
1 comment
08:49
Low-cost laparoscopic appendectomy: how to teach
Laparoscopic appendectomy must be the gold standard. Nowadays, many centers still continue to go on with McBurney’s incisions. Why? Expensive devices may be a reason. Low cost appendectomy allows for a diagnostic laparoscopy and offers a therapeutic option with the lowest price.
On the other hand, residents must begin the learning curve in laparoscopy as soon as possible not only with a training center (training in cadaveric or animals) but they must also start practicing on humans with watchful surgeon/teacher’s eyes.
The aim of this video is to demonstrate that low-cost laparoscopic appendectomy is feasible not only for surgeons but also for residents operating with an expert.
Minimally invasive surgical approach to small bowel obstruction
Due to the lack of laparoscopic experience to work in a small space (small bowel distension), small bowel obstruction seems to be a relative contraindication for a minimally invasive approach. In other hands, many patients have co-morbidities, and consequently it is key to work with a low intra-abdominal pressure to prevent any conversion for pneumoperitoneum intolerance. Small bowel obstruction must be resolved by experts in order to prevent any excessive mobilization and iatrogenic perforation.

Critical comments:
This video presents the laparoscopic management of bowel obstruction. It demonstrates the feasibility of the identification and management of mechanical bowel obstruction. Several parts of the video can be discussed:
1. In their comments, the authors report that the whole bowel has to be explored in order to prevent the presence of a secondary band at the origin of the obstruction. This is absolutely mandatory. Usually, the recommendation is to start the exploration at the level of the caecum and to mobilize the whole non-dilated bowel in order to prevent a risk of bowel injury during this manipulation. Exploration of the dilated bowel is much more risky. The authors did not show this extensive and systematic exploration.
2. The authors reported that they used 5 to 10 liters of warm saline for abdominal lavage. Today, there is no evidence of the benefit of this major abdominal lavage including 5 to 10 liters. Selective lavage can be recommended in case of significant bacterial contamination.
3. The authors consider the potential benefit of irrigation of the ischemic bowel with hot water after band division. This indication can be considered as potentially efficient regarding the recommendations in open surgery. However, laparoscopy has a significant advantage to keep the internal temperature of 37°C at a minimum, and certainly hot lavage, which cannot be over 39°C to 40°C, will probably also have limited impact.
Despite these minor remarks, this video has a scientific value in demonstrating a safe approach to a small bowel obstruction related to a single band, which is, in this case, very safely resected.
One can also focus on the value of working with a high quality camera, which gives the surgeon the possibility to clearly evaluate the vitality of the small bowel after an ischemic period, which is well demonstrated in this video.
S Rua, F Silveira, P Mira
Surgical intervention
3 years ago
1269 views
60 likes
0 comments
06:59
Minimally invasive surgical approach to small bowel obstruction
Due to the lack of laparoscopic experience to work in a small space (small bowel distension), small bowel obstruction seems to be a relative contraindication for a minimally invasive approach. In other hands, many patients have co-morbidities, and consequently it is key to work with a low intra-abdominal pressure to prevent any conversion for pneumoperitoneum intolerance. Small bowel obstruction must be resolved by experts in order to prevent any excessive mobilization and iatrogenic perforation.

Critical comments:
This video presents the laparoscopic management of bowel obstruction. It demonstrates the feasibility of the identification and management of mechanical bowel obstruction. Several parts of the video can be discussed:
1. In their comments, the authors report that the whole bowel has to be explored in order to prevent the presence of a secondary band at the origin of the obstruction. This is absolutely mandatory. Usually, the recommendation is to start the exploration at the level of the caecum and to mobilize the whole non-dilated bowel in order to prevent a risk of bowel injury during this manipulation. Exploration of the dilated bowel is much more risky. The authors did not show this extensive and systematic exploration.
2. The authors reported that they used 5 to 10 liters of warm saline for abdominal lavage. Today, there is no evidence of the benefit of this major abdominal lavage including 5 to 10 liters. Selective lavage can be recommended in case of significant bacterial contamination.
3. The authors consider the potential benefit of irrigation of the ischemic bowel with hot water after band division. This indication can be considered as potentially efficient regarding the recommendations in open surgery. However, laparoscopy has a significant advantage to keep the internal temperature of 37°C at a minimum, and certainly hot lavage, which cannot be over 39°C to 40°C, will probably also have limited impact.
Despite these minor remarks, this video has a scientific value in demonstrating a safe approach to a small bowel obstruction related to a single band, which is, in this case, very safely resected.
One can also focus on the value of working with a high quality camera, which gives the surgeon the possibility to clearly evaluate the vitality of the small bowel after an ischemic period, which is well demonstrated in this video.
Laparoscopic partial gastrectomy with D1 beta lymphadenectomy for early gastric cancer
This is the case of a 75-year-old man, symptom-free, with a cT2N0M0 early cancer of the stomach. The lesion is located between the body and the antrum of the stomach.
The laparoscopic approach allows to carry out a partial gastrectomy with D1 beta lymphadenectomy (lymph nodes number: 1-3-4-5-6-7-8-9) with intraoperative gastroscopy.
A Roux-en-Y gastrojejunal anastomosis is performed (intracorporeal gastrojejunal anastomosis and extracorporeal jejunojejunal anastomosis).
Total surgery time was 5 hours and length of hospital stay was 6 days.
Histology shows pT2N0M0 with 25 lymph nodes.
D1 beta lymphadenectomy is an efficient and less aggressive alternative to treat cases of early gastric cancer.
S Rua, A Pinto, P Moura, C Sousa
Surgical intervention
6 years ago
3276 views
19 likes
0 comments
13:20
Laparoscopic partial gastrectomy with D1 beta lymphadenectomy for early gastric cancer
This is the case of a 75-year-old man, symptom-free, with a cT2N0M0 early cancer of the stomach. The lesion is located between the body and the antrum of the stomach.
The laparoscopic approach allows to carry out a partial gastrectomy with D1 beta lymphadenectomy (lymph nodes number: 1-3-4-5-6-7-8-9) with intraoperative gastroscopy.
A Roux-en-Y gastrojejunal anastomosis is performed (intracorporeal gastrojejunal anastomosis and extracorporeal jejunojejunal anastomosis).
Total surgery time was 5 hours and length of hospital stay was 6 days.
Histology shows pT2N0M0 with 25 lymph nodes.
D1 beta lymphadenectomy is an efficient and less aggressive alternative to treat cases of early gastric cancer.