We use cookies to offer you an optimal experience on our website. By browsing our website, you accept the use of cookies.

Nigel Antonio BASCOMBE

Saint-Pierre University Hospital
Brussels, Belgium
MD
587 likes
7.9K views
2 comments
Filter by
Clear filter Specialty
View more

Clear filter Media type
View more
Clear filter Category
View more
The 3 approaches to splenic flexure mobilization
Background: The mobilization of the splenic flexure during laparoscopic colorectal surgery can be a challenge, especially in anatomically difficult patients. In this video, the inframesocolic, the supramesocolic, and lateral-to-medial approaches are demonstrated.

Video: The first part of the video shows the inframesocolic approach where the opening of the transverse mesocolon, above the pancreatic body and tail, allows access to the lesser sac and the exposure of the spleen. The second part of the video shows the supramesocolic approach where reaching Gerota’s fascia allows the flexure to be taken down. The third part of the video shows the lateral-to-medial approach where opening the lesser sac allows the flexure to be mobilized.

Results: All three approaches are laparoscopically feasible and safe. The goal remains similar, that is to avoid anastomotic tension. The operative time for this step, during the entire colorectal procedure, is influenced by the patient’s characteristics (previous surgery, high splenic flexure, short mesentery, etc.) and obviously, by the surgeon’s learning curve.

Conclusions: The choice between the three approaches depends on the patient’s characteristics and on the surgeon’s habits.
G Dapri, NA Bascombe, GB Cadière, J Marks
Surgical intervention
1 year ago
4531 views
342 likes
0 comments
11:51
The 3 approaches to splenic flexure mobilization
Background: The mobilization of the splenic flexure during laparoscopic colorectal surgery can be a challenge, especially in anatomically difficult patients. In this video, the inframesocolic, the supramesocolic, and lateral-to-medial approaches are demonstrated.

Video: The first part of the video shows the inframesocolic approach where the opening of the transverse mesocolon, above the pancreatic body and tail, allows access to the lesser sac and the exposure of the spleen. The second part of the video shows the supramesocolic approach where reaching Gerota’s fascia allows the flexure to be taken down. The third part of the video shows the lateral-to-medial approach where opening the lesser sac allows the flexure to be mobilized.

Results: All three approaches are laparoscopically feasible and safe. The goal remains similar, that is to avoid anastomotic tension. The operative time for this step, during the entire colorectal procedure, is influenced by the patient’s characteristics (previous surgery, high splenic flexure, short mesentery, etc.) and obviously, by the surgeon’s learning curve.

Conclusions: The choice between the three approaches depends on the patient’s characteristics and on the surgeon’s habits.
Reduced port laparoscopic pyloroduodenectomy with handsewn Roux-en-Y reconstruction
Background: Reduced port laparoscopic surgery (RPLS) is an evolution of conventional laparoscopic surgery, allowing for enhanced cosmetic outcomes, in addition to a reduced abdominal wall trauma. Tips and tricks are required to complete a procedure using a RPLS.

Video: This video shows a 55-year-old lady who underwent a laparoscopic pyloro-duodenectomy for a duodenal bulb lesion increased in size at endoscopic follow-up. Three trocars were used (a 12mm one in the umbilicus, a 5mm one in the right flank, a 5mm one in the left flank). The exposure of the operative field was enhanced thanks to a temporary percutaneous suture placed into the hepatic round ligament. Perioperative gastroscopy allowed for an adequate resection without too much distance from the margins, and preservation of the entire gastric antrum. The reconstruction was performed through a handsewn end-to-end gastrojejunostomy, with a 50cm alimentary limb, and a semi-mechanical side-to-side jejunojejunostomy. Finally, a gastroscopy was used to test the gastrojejunostomy.

Results: Total operative time was 190 minutes. Perioperative bleeding was 50cc. Postoperative course was uneventful, and the patient was discharged on postoperative day 7. Pathological findings demonstrated a Brunner’s gland hamartoma, with safe distance from the margins.

Conclusions: RPLS is a step forward of conventional laparoscopy. Perioperative gastroscopy is essential to perform safe upper GI resections. br>
G Dapri, NA Bascombe, S Targa
Surgical intervention
1 year ago
779 views
25 likes
0 comments
09:01
Reduced port laparoscopic pyloroduodenectomy with handsewn Roux-en-Y reconstruction
Background: Reduced port laparoscopic surgery (RPLS) is an evolution of conventional laparoscopic surgery, allowing for enhanced cosmetic outcomes, in addition to a reduced abdominal wall trauma. Tips and tricks are required to complete a procedure using a RPLS.

Video: This video shows a 55-year-old lady who underwent a laparoscopic pyloro-duodenectomy for a duodenal bulb lesion increased in size at endoscopic follow-up. Three trocars were used (a 12mm one in the umbilicus, a 5mm one in the right flank, a 5mm one in the left flank). The exposure of the operative field was enhanced thanks to a temporary percutaneous suture placed into the hepatic round ligament. Perioperative gastroscopy allowed for an adequate resection without too much distance from the margins, and preservation of the entire gastric antrum. The reconstruction was performed through a handsewn end-to-end gastrojejunostomy, with a 50cm alimentary limb, and a semi-mechanical side-to-side jejunojejunostomy. Finally, a gastroscopy was used to test the gastrojejunostomy.

Results: Total operative time was 190 minutes. Perioperative bleeding was 50cc. Postoperative course was uneventful, and the patient was discharged on postoperative day 7. Pathological findings demonstrated a Brunner’s gland hamartoma, with safe distance from the margins.

Conclusions: RPLS is a step forward of conventional laparoscopy. Perioperative gastroscopy is essential to perform safe upper GI resections. br>
Completely intracorporeal handsewn laparoscopic anastomoses during Whipple procedure
Background: Since 1935, the Whipple procedure was described, using conventional open surgery. With the advent of minimally invasive surgery (MIS), it was reported to be feasible also using the latest technology. In this video, the authors demonstrate a full laparoscopic Whipple procedure, performing the three anastomoses using an intracorporeal handsewn method.

Video: A 70-year-old man presenting with an adenocarcinoma of the ampulla of Vater, infiltrating the pancreatic parenchyma, underwent a laparoscop ic Whipple procedure. Preoperative work-up showed a T3N1M0 tumor.

Results: Total operative time was 8 hours 20minutes; time for the dissection was 6 hours 20 minutes; time for specimen extraction was 20 minutes, and time for the three laparoscopic intracorporeal handsewn anastomoses was 1 hour 40 minutes. Operative bleeding was 350cc. The patient was discharged on postoperative day 9. Pathological findings confirmed a moderately differentiated adenocarcinoma of the ampulla of Vater, with perinervous infiltration and lymphovascular emboli, free margins, 2 metastatic lymph nodes on 23 isolated; 7 edition UICC stage: pT4N1.

Conclusions: The laparoscopic Whipple procedure remains an advanced procedure to be performed laparoscopically and/or using open surgery. All the advantages of MIS such as reduced abdominal trauma, less postoperative pain, shorter hospital stay, improved patient’s comfort, and enhanced cosmesis are offered using laparoscopy.
G Dapri, NA Bascombe, L Gerard, C Samaniego Ballar, C Jiménez Viñas
Surgical intervention
1 year ago
2627 views
220 likes
2 comments
10:22
Completely intracorporeal handsewn laparoscopic anastomoses during Whipple procedure
Background: Since 1935, the Whipple procedure was described, using conventional open surgery. With the advent of minimally invasive surgery (MIS), it was reported to be feasible also using the latest technology. In this video, the authors demonstrate a full laparoscopic Whipple procedure, performing the three anastomoses using an intracorporeal handsewn method.

Video: A 70-year-old man presenting with an adenocarcinoma of the ampulla of Vater, infiltrating the pancreatic parenchyma, underwent a laparoscop ic Whipple procedure. Preoperative work-up showed a T3N1M0 tumor.

Results: Total operative time was 8 hours 20minutes; time for the dissection was 6 hours 20 minutes; time for specimen extraction was 20 minutes, and time for the three laparoscopic intracorporeal handsewn anastomoses was 1 hour 40 minutes. Operative bleeding was 350cc. The patient was discharged on postoperative day 9. Pathological findings confirmed a moderately differentiated adenocarcinoma of the ampulla of Vater, with perinervous infiltration and lymphovascular emboli, free margins, 2 metastatic lymph nodes on 23 isolated; 7 edition UICC stage: pT4N1.

Conclusions: The laparoscopic Whipple procedure remains an advanced procedure to be performed laparoscopically and/or using open surgery. All the advantages of MIS such as reduced abdominal trauma, less postoperative pain, shorter hospital stay, improved patient’s comfort, and enhanced cosmesis are offered using laparoscopy.