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Zineb CHERKAOUI

Hôpitaux Universitaires de Strasbourg
Strasbourg, France
MD
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Laparoscopic left lateral sectionectomy for hepatocarcinoma in a cirrhotic patient
This video demonstrates a laparoscopic left lateral sectionectomy for hepatocellular carcinoma (HCC) in a cirrhotic liver with hemochromatosis. This is the case of a 77-year-old patient who presented with a 40mm HCC located in Couinaud’s liver segment II and III. After left liver mobilization, parenchymal transection was initiated along the left side of the falciform ligament, mainly using the cavitron ultrasonic surgical aspirator (CUSA®). Tissue Select mode was used during the exposure of the vascular structure. The Glissonian pedicles of segments III and II were encircled and transected, and finally the suprahepatic vein was divided using an Endo GIA™ linear stapler. The specimen was extracted with a short suprapubic incision. The postoperative outcome was uneventful. Final pathological findings confirmed the diagnosis of a well-differentiated HCC.
Surgical intervention
3 months ago
1767 views
8 likes
0 comments
07:22
Laparoscopic left lateral sectionectomy for hepatocarcinoma in a cirrhotic patient
This video demonstrates a laparoscopic left lateral sectionectomy for hepatocellular carcinoma (HCC) in a cirrhotic liver with hemochromatosis. This is the case of a 77-year-old patient who presented with a 40mm HCC located in Couinaud’s liver segment II and III. After left liver mobilization, parenchymal transection was initiated along the left side of the falciform ligament, mainly using the cavitron ultrasonic surgical aspirator (CUSA®). Tissue Select mode was used during the exposure of the vascular structure. The Glissonian pedicles of segments III and II were encircled and transected, and finally the suprahepatic vein was divided using an Endo GIA™ linear stapler. The specimen was extracted with a short suprapubic incision. The postoperative outcome was uneventful. Final pathological findings confirmed the diagnosis of a well-differentiated HCC.
Robotic central pancreatectomy for a well-differentiated neuroendocrine tumor
In this video, we show a robotic central pancreatectomy for a well-differentiated neuroendocrine tumor. This is the case of a 50-year-old patient admitted to the emergency department for acute pancreatitis. CT-scan and MRI demonstrate the presence of a hypervascularized lesion of approximately 15mm in diameter, at the pancreatic isthmus. Scintigraphy does not evidence any intense uptake.
The colon and the omentum are detached and the stomach is suspended laparoscopically. The robot is docked using a lateral approach. A retropancreatic passage is achieved on the mesenteric-portal axis. An intraoperative ultrasonography is performed to visualize the tumor and delimitate the resection margins. After the dissection, the anastomosis is performed between the distal part of the pancreatic remnant and the posterior gastric wall.
A postoperative pancreatic fistula grade B was reported. It was successfully managed. The presence of a well-differentiated neuroendocrine tumor was confirmed. The patient was discharged on postoperative day 22.
Surgical intervention
3 months ago
2231 views
4 likes
3 comments
07:01
Robotic central pancreatectomy for a well-differentiated neuroendocrine tumor
In this video, we show a robotic central pancreatectomy for a well-differentiated neuroendocrine tumor. This is the case of a 50-year-old patient admitted to the emergency department for acute pancreatitis. CT-scan and MRI demonstrate the presence of a hypervascularized lesion of approximately 15mm in diameter, at the pancreatic isthmus. Scintigraphy does not evidence any intense uptake.
The colon and the omentum are detached and the stomach is suspended laparoscopically. The robot is docked using a lateral approach. A retropancreatic passage is achieved on the mesenteric-portal axis. An intraoperative ultrasonography is performed to visualize the tumor and delimitate the resection margins. After the dissection, the anastomosis is performed between the distal part of the pancreatic remnant and the posterior gastric wall.
A postoperative pancreatic fistula grade B was reported. It was successfully managed. The presence of a well-differentiated neuroendocrine tumor was confirmed. The patient was discharged on postoperative day 22.
Laparoscopic right hemihepatectomy
A laparoscopic right hemihepatectomy was performed for a gastric liver metastasis. After the dissection of the anatomical structure of the hepatic pedicle and an ultrasound examination, the right portal vein and the right branch of the hepatic artery were clamped, hence allowing to skeletonize the demarcation between the right liver and the left liver. The devascularization line was subsequently marked by means of electrocautery. The right hepatic branch and the right branch of the portal vein were divided between locked clips. The hepatotomy was started. The first very superficial centimeters were dissected using the Sonicision® Cordless Ultrasonic Dissection Device. No pedicular clamping was performed. The dissection followed the ischemic demarcation line between the right liver and the left liver. Hemostasis and biliostasis were completed using the Aquamantys® Bipolar Sealers. Once the first centimeters had been dissected, dissection was carried on using the CUSA™ ultrasonic dissector (Cavitron Ultrasonic Surgical Aspirator). Liver segment I was divided in order to open the posterior aspect of the hilar plate. The dissection was performed on the right border of the vena cava. The hilar plate was dissected, making it possible to control the right branch of the biliary tract intraparenchymally. The right hepatic vein was dissected and divided with an Endo GIA™ linear stapler. Makuuchi’s ligament was subsequently dissected and divided by means of a firing of the Endo GIA™ linear stapler, white cartridge. Mobilization of the right liver was completed by dividing the triangular ligament’s attachments at the level of the diaphragm. The right hepatectomy specimen was introduced into a bag, which was extracted through a suprapubic Pfannenstiel’s incision. Pneumoperitoneum pressure was diminished in order to control hemostasis and biliostasis.
Surgical intervention
1 year ago
6987 views
939 likes
0 comments
32:12
Laparoscopic right hemihepatectomy
A laparoscopic right hemihepatectomy was performed for a gastric liver metastasis. After the dissection of the anatomical structure of the hepatic pedicle and an ultrasound examination, the right portal vein and the right branch of the hepatic artery were clamped, hence allowing to skeletonize the demarcation between the right liver and the left liver. The devascularization line was subsequently marked by means of electrocautery. The right hepatic branch and the right branch of the portal vein were divided between locked clips. The hepatotomy was started. The first very superficial centimeters were dissected using the Sonicision® Cordless Ultrasonic Dissection Device. No pedicular clamping was performed. The dissection followed the ischemic demarcation line between the right liver and the left liver. Hemostasis and biliostasis were completed using the Aquamantys® Bipolar Sealers. Once the first centimeters had been dissected, dissection was carried on using the CUSA™ ultrasonic dissector (Cavitron Ultrasonic Surgical Aspirator). Liver segment I was divided in order to open the posterior aspect of the hilar plate. The dissection was performed on the right border of the vena cava. The hilar plate was dissected, making it possible to control the right branch of the biliary tract intraparenchymally. The right hepatic vein was dissected and divided with an Endo GIA™ linear stapler. Makuuchi’s ligament was subsequently dissected and divided by means of a firing of the Endo GIA™ linear stapler, white cartridge. Mobilization of the right liver was completed by dividing the triangular ligament’s attachments at the level of the diaphragm. The right hepatectomy specimen was introduced into a bag, which was extracted through a suprapubic Pfannenstiel’s incision. Pneumoperitoneum pressure was diminished in order to control hemostasis and biliostasis.
Laparoscopic distal pancreatectomy with spleen resection
We reported a laparoscopic distal pancreatectomy with spleen resection for a mucinous cystic lesion. Four ports were positioned. The greater omentum was retracted to the superior part of the abdomen in order to detach the colon from the omentum and approach the lesser sac. The stomach was dissected. A tape was placed around the stomach through the abdominal wall, making it possible to retract the stomach at the level of the pyloric junction towards the upper part of the abdomen. A second tape was placed at the antral part in order to achieve a retraction towards the left hypochondrium at the superior part of the abdomen. The mesentericoportal axis was identified and dissected at the inferior border of the pancreas. The right gastroepiploic vein was one of the landmarks. The superior border of the pancreas was dissected in order to identify the splenic artery and a tape was positioned around it. The dissection was performed progressively at the anterior aspect of the mesentericoportal axis through an avascular channel. A tape was subsequently positioned around the pancreatic isthmus. The pancreas was divided with a stapler. The stapling was performed very progressively to avoid crushing the pancreas. The splenic vein was dissected in order to preserve the left gastric vein and a tape was positioned around it. The splenic artery was first divided between two clips on the remaining surface. The splenic vein was also divided. Dissection was pursued from the right to the left, making it possible to mobilize the pancreas. The inferior mesenteric vein was dissected and divided. Dissection of the posterior mesogastrium was initiated, making it possible to mobilize the splenopancreatic block. The dissection was performed anteriorly to the plane of Gerota’s fascia, anteriorly to the kidney. Since the posterior dissection was almost complete, our attention was turned to the superior part to complete the dissection of lesser sac adhesions at the superior border of the pancreas. It was necessary to divide the greater omentum by gradually dividing the short gastric vessels. Due to venous derivations linked to segmental portal hypertension, this dissection was performed through the application of the Endo GIA™ linear stapler. Since the entire specimen had been divided and freed, it was placed in a bag to be extracted through a suprapubic Pfannenstiel’s incision.
Surgical intervention
1 year ago
5011 views
604 likes
0 comments
45:34
Laparoscopic distal pancreatectomy with spleen resection
We reported a laparoscopic distal pancreatectomy with spleen resection for a mucinous cystic lesion. Four ports were positioned. The greater omentum was retracted to the superior part of the abdomen in order to detach the colon from the omentum and approach the lesser sac. The stomach was dissected. A tape was placed around the stomach through the abdominal wall, making it possible to retract the stomach at the level of the pyloric junction towards the upper part of the abdomen. A second tape was placed at the antral part in order to achieve a retraction towards the left hypochondrium at the superior part of the abdomen. The mesentericoportal axis was identified and dissected at the inferior border of the pancreas. The right gastroepiploic vein was one of the landmarks. The superior border of the pancreas was dissected in order to identify the splenic artery and a tape was positioned around it. The dissection was performed progressively at the anterior aspect of the mesentericoportal axis through an avascular channel. A tape was subsequently positioned around the pancreatic isthmus. The pancreas was divided with a stapler. The stapling was performed very progressively to avoid crushing the pancreas. The splenic vein was dissected in order to preserve the left gastric vein and a tape was positioned around it. The splenic artery was first divided between two clips on the remaining surface. The splenic vein was also divided. Dissection was pursued from the right to the left, making it possible to mobilize the pancreas. The inferior mesenteric vein was dissected and divided. Dissection of the posterior mesogastrium was initiated, making it possible to mobilize the splenopancreatic block. The dissection was performed anteriorly to the plane of Gerota’s fascia, anteriorly to the kidney. Since the posterior dissection was almost complete, our attention was turned to the superior part to complete the dissection of lesser sac adhesions at the superior border of the pancreas. It was necessary to divide the greater omentum by gradually dividing the short gastric vessels. Due to venous derivations linked to segmental portal hypertension, this dissection was performed through the application of the Endo GIA™ linear stapler. Since the entire specimen had been divided and freed, it was placed in a bag to be extracted through a suprapubic Pfannenstiel’s incision.