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Laura ANTOLINO

Department of Gastrointestinal Surgery, European School of Laparoscopic Surgery, Saint-Pierre University Hospital
Brussels, Belgium
MD
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Laparoscopic total mesorectal excision (TME) through single right iliac fossa (RIF) incision
Background: Single incision laparoscopy is worth of interest during up-to-down rectal resection because it allows to use the single site as the site of temporary ileostomy placement at the end of the procedure.
Video: This video shows an up-to-down single incision laparoscopic rectal resection in a 49-year-old woman presenting with a rectal adenocarcinoma located 12cm away from the anal margin. Preoperative work-up showed a T2N0M0 tumor. The procedure was entirely performed with curved reusable instruments according to DAPRI (Karl Storz Endoskope, Tuttlingen, Germany), inserted in the right flank. The uterus and the peritoneal sheet covering the vagina were retrieved using percutaneous sutures. A circular mechanical colorectal anastomosis was performed and a final temporary ileostomy was placed at the site of the single access.
Results: The procedure duration was 297 minutes, and peroperative bleeding was unsignificant. The final scar length was 2.5cm, and the patient was discharged on postoperative day 5. The pathological report confirmed a pT2N0M0 tumor (20 negative nodes).
Conclusions: Up-to-down single incision laparoscopic rectal resection allows to place the temporary ileostomy at the single incision site, offering oncological results comparable to conventional laparoscopy.
G Dapri, N Bachir, L Antolino, K Grozdev, D Guta, K Jottard, GB Cadière
Surgical intervention
2 years ago
2135 views
107 likes
0 comments
09:22
Laparoscopic total mesorectal excision (TME) through single right iliac fossa (RIF) incision
Background: Single incision laparoscopy is worth of interest during up-to-down rectal resection because it allows to use the single site as the site of temporary ileostomy placement at the end of the procedure.
Video: This video shows an up-to-down single incision laparoscopic rectal resection in a 49-year-old woman presenting with a rectal adenocarcinoma located 12cm away from the anal margin. Preoperative work-up showed a T2N0M0 tumor. The procedure was entirely performed with curved reusable instruments according to DAPRI (Karl Storz Endoskope, Tuttlingen, Germany), inserted in the right flank. The uterus and the peritoneal sheet covering the vagina were retrieved using percutaneous sutures. A circular mechanical colorectal anastomosis was performed and a final temporary ileostomy was placed at the site of the single access.
Results: The procedure duration was 297 minutes, and peroperative bleeding was unsignificant. The final scar length was 2.5cm, and the patient was discharged on postoperative day 5. The pathological report confirmed a pT2N0M0 tumor (20 negative nodes).
Conclusions: Up-to-down single incision laparoscopic rectal resection allows to place the temporary ileostomy at the single incision site, offering oncological results comparable to conventional laparoscopy.
Transanal circumferential mucosectomy for symptomatic benign rectal stenosis
Background: Transanal laparoscopy has been described for more than 30 years. In the presence of benign lesions, it gathers increasing interest, especially if such lesions are located in the low rectum or close to the anal margin.
Video: This video demonstrates the case of a 38-year-old man presented with a circumferential rectal stenosis due to a rectal ulcer. The patient underwent a transanal mucosectomy using laparoscopy, after a sequence of unsuccessful endoscopic dilatations. Preoperative work-up showed a circumferential benign stenosis, 2.5cm away from the anal margin. The procedure was entirely performed with a new reusable transanal platform made up by the DAPRI-Port and DAPRI curved instruments (Karl Storz Endoskope, Tuttlingen, Germany). Once the 360-degree mucosectomy had been completed, the mucosal layer was repaired using separate absorbable sutures.
Results: The operative length was 163 minutes, and peroperative bleeding was unsignificant. The patient was discharged on postoperative day 2. The pathological report confirmed the benign nature of the lesion.
Conclusions: Although transanal laparoscopy has been documented for years, it gathers increasing interest and should be considered as the technique of choice for the treatment of benign rectal lesions, which can be difficult to treat using other methods.
G Dapri, N Bachir, L Antolino, K Grozdev, D Guta, K Jottard, GB Cadière
Surgical intervention
3 years ago
1002 views
13 likes
0 comments
08:37
Transanal circumferential mucosectomy for symptomatic benign rectal stenosis
Background: Transanal laparoscopy has been described for more than 30 years. In the presence of benign lesions, it gathers increasing interest, especially if such lesions are located in the low rectum or close to the anal margin.
Video: This video demonstrates the case of a 38-year-old man presented with a circumferential rectal stenosis due to a rectal ulcer. The patient underwent a transanal mucosectomy using laparoscopy, after a sequence of unsuccessful endoscopic dilatations. Preoperative work-up showed a circumferential benign stenosis, 2.5cm away from the anal margin. The procedure was entirely performed with a new reusable transanal platform made up by the DAPRI-Port and DAPRI curved instruments (Karl Storz Endoskope, Tuttlingen, Germany). Once the 360-degree mucosectomy had been completed, the mucosal layer was repaired using separate absorbable sutures.
Results: The operative length was 163 minutes, and peroperative bleeding was unsignificant. The patient was discharged on postoperative day 2. The pathological report confirmed the benign nature of the lesion.
Conclusions: Although transanal laparoscopy has been documented for years, it gathers increasing interest and should be considered as the technique of choice for the treatment of benign rectal lesions, which can be difficult to treat using other methods.
Laparoscopic repair of colorectal leak and fistula using a new transanal reusable platform
Background: Transanal minimally invasive surgery has triggered much interest and investment in research over the last decade. This approach can be used not only to perform primary procedures (e.g., polypectomy, TME), but also to manage intraoperative complications such as leaks, bleedings, and late complications such as fistulas.
Video: The first part of the video shows the repair of an immediate colorectal leak using transanal laparoscopy, in a 50-year-old woman who underwent a laparoscopic anterior resection of the rectum. During anastomotic control, a posterior leak 4cm away from the anal margin was found. A new transanal reusable port, named DAPRI Port or D-Port (Karl Storz Endoskope, Tuttlingen, Germany), along with DAPRI monocurved reusable instruments, was implemented. The second part of the video shows a persisting and symptomatic colorectal fistula, located posteriorly 11cm away from the anal margin, in a 65-year-old man who had undergone a laparoscopic anterior resection of the rectum 4 weeks earlier.
Results: Operative time was 60 and 45 minutes respectively. Patients were discharged after 5 and 2 days respectively. Controls at 2 months (before ileostomy closure) showed a complete healing of the defects.
Conclusions: Complications after anterior resection of the rectum, such as intraoperative leak and late colorectal fistula, can be treated using transanal laparoscopy. This new transanal platform offers surgeons the possibility to work in ergonomic positions without increasing the cost of the procedure thanks to the reusable nature of the material adopted.
G Dapri, D Guta, K Grozdev, L Antolino, K Jottard, GB Cadière
Surgical intervention
3 years ago
1600 views
33 likes
0 comments
05:55
Laparoscopic repair of colorectal leak and fistula using a new transanal reusable platform
Background: Transanal minimally invasive surgery has triggered much interest and investment in research over the last decade. This approach can be used not only to perform primary procedures (e.g., polypectomy, TME), but also to manage intraoperative complications such as leaks, bleedings, and late complications such as fistulas.
Video: The first part of the video shows the repair of an immediate colorectal leak using transanal laparoscopy, in a 50-year-old woman who underwent a laparoscopic anterior resection of the rectum. During anastomotic control, a posterior leak 4cm away from the anal margin was found. A new transanal reusable port, named DAPRI Port or D-Port (Karl Storz Endoskope, Tuttlingen, Germany), along with DAPRI monocurved reusable instruments, was implemented. The second part of the video shows a persisting and symptomatic colorectal fistula, located posteriorly 11cm away from the anal margin, in a 65-year-old man who had undergone a laparoscopic anterior resection of the rectum 4 weeks earlier.
Results: Operative time was 60 and 45 minutes respectively. Patients were discharged after 5 and 2 days respectively. Controls at 2 months (before ileostomy closure) showed a complete healing of the defects.
Conclusions: Complications after anterior resection of the rectum, such as intraoperative leak and late colorectal fistula, can be treated using transanal laparoscopy. This new transanal platform offers surgeons the possibility to work in ergonomic positions without increasing the cost of the procedure thanks to the reusable nature of the material adopted.
Transanal laparoscopic TME with a new port assisted by single incision
Background: Rectal resection with total mesorectal excision (TME) can be performed through the anus going up into the abdominal cavity. This approach has to be performed using a transanal device in order to create a retroperitoneum, allowing the surgeon to perform a TME similar to the one performed from the abdomen going down to the anus. A new reusable port named DAPRI Port or D-Port (Karl Storz Endoskope, Tuttlingen, Germany) has been developed, and a new platform together with curved reusable instruments according to DAPRI (Karl Storz Endoskope) has been created. The D-Port allows to maintain one of the rules of laparoscopy, which is the optical system in the middle of the two ancillary operative tools. In addition, the cost of the procedure is not increased, due to the reusable material.
Video: This video shows a down-to-up rectal resection assisted by single incision laparoscopy, in a 65-year old man presenting with a rectal adenocarcinoma 4cm away from the anal margin. Preoperative work-up showed a T2N0M0 tumor, after radiochemotherapy. The procedure was performed transabdominally for the vascular dissection and transanally for the TME. The abdominal single site was then used for the placement of the temporary ileostomy.
Results: Total operative time was 301 minutes, and partial transanal laparoscopy was 145 minutes. Perioperative bleeding was 50cc. The final scar length was 2.5cm, and the patient was discharged after 5 days. The pathological report confirmed a pT2N0M0 tumor (15 negative nodes).
Conclusions: Down-to-up rectal resection is an interesting procedure, and when associated with single incision laparoscopy, it offers the possibility to use the single site as the site for temporary ileostomy.
G Dapri, L Antolino, N Bachir, D Guta, K Grozdev, B Nebbot, K Jottard, GB Cadière
Surgical intervention
3 years ago
2675 views
39 likes
0 comments
12:53
Transanal laparoscopic TME with a new port assisted by single incision
Background: Rectal resection with total mesorectal excision (TME) can be performed through the anus going up into the abdominal cavity. This approach has to be performed using a transanal device in order to create a retroperitoneum, allowing the surgeon to perform a TME similar to the one performed from the abdomen going down to the anus. A new reusable port named DAPRI Port or D-Port (Karl Storz Endoskope, Tuttlingen, Germany) has been developed, and a new platform together with curved reusable instruments according to DAPRI (Karl Storz Endoskope) has been created. The D-Port allows to maintain one of the rules of laparoscopy, which is the optical system in the middle of the two ancillary operative tools. In addition, the cost of the procedure is not increased, due to the reusable material.
Video: This video shows a down-to-up rectal resection assisted by single incision laparoscopy, in a 65-year old man presenting with a rectal adenocarcinoma 4cm away from the anal margin. Preoperative work-up showed a T2N0M0 tumor, after radiochemotherapy. The procedure was performed transabdominally for the vascular dissection and transanally for the TME. The abdominal single site was then used for the placement of the temporary ileostomy.
Results: Total operative time was 301 minutes, and partial transanal laparoscopy was 145 minutes. Perioperative bleeding was 50cc. The final scar length was 2.5cm, and the patient was discharged after 5 days. The pathological report confirmed a pT2N0M0 tumor (15 negative nodes).
Conclusions: Down-to-up rectal resection is an interesting procedure, and when associated with single incision laparoscopy, it offers the possibility to use the single site as the site for temporary ileostomy.