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Mihaela IGNAT

Hôpitaux Universitaires de Strasbourg
Strasbourg, France
MD, PhD
3708 likes
35203 views
5 comments
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Laparoscopic ileocecal resection for unresectable appendix
This is the case of a 36-year-old woman who has had an exploratory laparoscopy in another institution 2 months earlier. Acute appendicitis was suspected, based on ultrasound exam. However, exploration has shown an inflammatory appendicular mass, impossible to dissect. The patient was administered antibiotics for a period of 3 weeks. A laparoscopic appendectomy was decided upon at an interval of 2 months. Work-up included CT-scan and colonoscopy, which did not demonstrate anything specific.
Laparoscopic exploration demonstrated important fibrotic and scarry tissues around the appendix and the cecum. Despite painstaking dissection, appendectomy was impossible. Ileocecal resection was decided upon. Operative steps, namely exposure, division of the last ileal loop, division of the meso, division of the right colon above the ampulla coli and the intracorporeal side-to-side stapled anastomosis are demonstrated. Pathological findings evidenced an endometriotic nodule. The postoperative course was uneventful.
D Mutter, M Ignat, J Marescaux
Surgical intervention
8 months ago
2333 views
323 likes
0 comments
08:23
Laparoscopic ileocecal resection for unresectable appendix
This is the case of a 36-year-old woman who has had an exploratory laparoscopy in another institution 2 months earlier. Acute appendicitis was suspected, based on ultrasound exam. However, exploration has shown an inflammatory appendicular mass, impossible to dissect. The patient was administered antibiotics for a period of 3 weeks. A laparoscopic appendectomy was decided upon at an interval of 2 months. Work-up included CT-scan and colonoscopy, which did not demonstrate anything specific.
Laparoscopic exploration demonstrated important fibrotic and scarry tissues around the appendix and the cecum. Despite painstaking dissection, appendectomy was impossible. Ileocecal resection was decided upon. Operative steps, namely exposure, division of the last ileal loop, division of the meso, division of the right colon above the ampulla coli and the intracorporeal side-to-side stapled anastomosis are demonstrated. Pathological findings evidenced an endometriotic nodule. The postoperative course was uneventful.
Laparoscopic appendectomy and fenestration of hemorrhagic ovarian cyst
This is the case of a 19-year-old female patient who was admitted to the emergency department for lower abdominal pain going on for 24 hours. No abdominal guarding was noted. Biological findings showed an inflammation with leukocytes at 16,000 and CRP levels at 112. CT-scan showed the presence of an enlarged appendix (9mm thick) along with a voluminous adnexal cyst, which may be suggestive of a tubo-ovarian abscess. Laparoscopic exploration is performed. Congestive appendicitis is confirmed, as well as the presence of a hemorrhagic right ovarian cyst. Laparoscopic appendectomy is performed and the hemorrhagic ovarian cyst is fenestrated.
M Ignat, D Mutter, J Marescaux
Surgical intervention
8 months ago
2181 views
407 likes
1 comment
04:57
Laparoscopic appendectomy and fenestration of hemorrhagic ovarian cyst
This is the case of a 19-year-old female patient who was admitted to the emergency department for lower abdominal pain going on for 24 hours. No abdominal guarding was noted. Biological findings showed an inflammation with leukocytes at 16,000 and CRP levels at 112. CT-scan showed the presence of an enlarged appendix (9mm thick) along with a voluminous adnexal cyst, which may be suggestive of a tubo-ovarian abscess. Laparoscopic exploration is performed. Congestive appendicitis is confirmed, as well as the presence of a hemorrhagic right ovarian cyst. Laparoscopic appendectomy is performed and the hemorrhagic ovarian cyst is fenestrated.
Laparoscopic appendectomy for appendicitis with peritonitis
This is the case of a 37-year-old male patient who presented with abdominal pain and fever at 39.4°C. The work-up demonstrated important inflammation with leukocytes at 16,000 and CRP levels at 169. CT-scan confirmed an acute appendicitis with an appendicolith at the base. The appendix is probably perforated as the CT-scan also demonstrated a pneumoperitoneum. Laparoscopic appendectomy is decided upon. The operative set-up is standard with an optical port placed at the umbilicus, a port in the left iliac fossa, and a suprapubic port. Exposure, appendectomy with stapling of the appendicular base, and cleansing of the peritoneal cavity are thoroughly demonstrated.
M Ignat, D Mutter, J Marescaux
Surgical intervention
8 months ago
2740 views
469 likes
0 comments
05:03
Laparoscopic appendectomy for appendicitis with peritonitis
This is the case of a 37-year-old male patient who presented with abdominal pain and fever at 39.4°C. The work-up demonstrated important inflammation with leukocytes at 16,000 and CRP levels at 169. CT-scan confirmed an acute appendicitis with an appendicolith at the base. The appendix is probably perforated as the CT-scan also demonstrated a pneumoperitoneum. Laparoscopic appendectomy is decided upon. The operative set-up is standard with an optical port placed at the umbilicus, a port in the left iliac fossa, and a suprapubic port. Exposure, appendectomy with stapling of the appendicular base, and cleansing of the peritoneal cavity are thoroughly demonstrated.
Laparoscopic Roux-en-Y gastric bypass after gastric band removal
This video demonstrates the case of a 50-year-old woman with morbid obesity (BMI of 39). She had a gastric banding placed 7 years before, which became ineffective 3 years after the primary surgery, resulting in band removal 2 years ago.
A secondary bariatric surgery was scheduled, with the decision to perform a laparoscopic Roux-en-Y gastric bypass. This video shows the surgical technique, with special emphasis on dissection of the cardia and lesser curvature, where the anatomy is altered as a result of the previous band. An interesting technical point occurs during the creation of the jejunojejunostomy, where a perforation of the biliary loop is accidentally made during the EndoGIATM linear stapler introduction.
M Vix, C Lebares, M Ignat, D Mutter, J Marescaux
Surgical intervention
3 years ago
1988 views
58 likes
0 comments
32:11
Laparoscopic Roux-en-Y gastric bypass after gastric band removal
This video demonstrates the case of a 50-year-old woman with morbid obesity (BMI of 39). She had a gastric banding placed 7 years before, which became ineffective 3 years after the primary surgery, resulting in band removal 2 years ago.
A secondary bariatric surgery was scheduled, with the decision to perform a laparoscopic Roux-en-Y gastric bypass. This video shows the surgical technique, with special emphasis on dissection of the cardia and lesser curvature, where the anatomy is altered as a result of the previous band. An interesting technical point occurs during the creation of the jejunojejunostomy, where a perforation of the biliary loop is accidentally made during the EndoGIATM linear stapler introduction.
Unintentional dissection of the common bile duct
This video demonstrates the case of an 81-year-old woman with chronic cholecystitis. She has had several episodes of right hypochondrium pain with altered liver tests, which spontaneously got back to normal values. Ultrasound and CT-scan demonstrated the presence of uncomplicated gallstones and a slightly hypotonic common bile duct (8mm in diameter). No obstacle was visualized in the common bile duct. A delayed laparoscopic cholecystectomy was scheduled. This video shows how some inaccuracies in the dissection technique and the presence of an altered anatomy have led to a circumferential dissection of the common bile duct. Common bile duct injury was avoided and the importance of an intraoperative cholangiography is emphasized.
M Ignat, N Malibary, D Mutter, J Marescaux
Surgical intervention
3 years ago
3554 views
135 likes
1 comment
06:50
Unintentional dissection of the common bile duct
This video demonstrates the case of an 81-year-old woman with chronic cholecystitis. She has had several episodes of right hypochondrium pain with altered liver tests, which spontaneously got back to normal values. Ultrasound and CT-scan demonstrated the presence of uncomplicated gallstones and a slightly hypotonic common bile duct (8mm in diameter). No obstacle was visualized in the common bile duct. A delayed laparoscopic cholecystectomy was scheduled. This video shows how some inaccuracies in the dissection technique and the presence of an altered anatomy have led to a circumferential dissection of the common bile duct. Common bile duct injury was avoided and the importance of an intraoperative cholangiography is emphasized.