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Amane LACHKAR

University Hospital of Strasbourg
Strasbourg, France
MD
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Pheochromocytoma: laparoscopic right adrenalectomy in a child
In the context of major headaches in a 9-year-old patient whose brother had been operated on for pheochromocytoma, a right adrenal pheochromocytoma with severe arterial hypertension was found.
The given video aims to demonstrate the usefulness of performing a 3D reconstruction of the tumor (using Visible Patient™ 3D reconstruction tool). It is essential to have precise preoperative information and work out a surgical strategy taking into account observed anatomical anomalies, since tumor and/or vascular anatomy may have numerous variations in case of pheochromocytomas.
A reconstruction model can be easily manipulated on a touch screen. It can be oriented in such a way that the angle of view changes allowing for a better understanding of the anatomy, so that an approach to vessels or neighboring organs is easily decided upon. Additionally, the option of adding or deleting this or that anatomical element allows for a simplified visual approach, which usually represents a potential difficulty during dissection.
Finally, the 3D reconstruction of this patient perfectly corresponds to her real anatomy. Thanks to a mere scanning based on the reconstruction, the vascularization mode of the tumor as well as the existence of a hidden part of healthy tissue can be verified.
Surgical intervention
11 months ago
2300 views
6 likes
0 comments
08:30
Pheochromocytoma: laparoscopic right adrenalectomy in a child
In the context of major headaches in a 9-year-old patient whose brother had been operated on for pheochromocytoma, a right adrenal pheochromocytoma with severe arterial hypertension was found.
The given video aims to demonstrate the usefulness of performing a 3D reconstruction of the tumor (using Visible Patient™ 3D reconstruction tool). It is essential to have precise preoperative information and work out a surgical strategy taking into account observed anatomical anomalies, since tumor and/or vascular anatomy may have numerous variations in case of pheochromocytomas.
A reconstruction model can be easily manipulated on a touch screen. It can be oriented in such a way that the angle of view changes allowing for a better understanding of the anatomy, so that an approach to vessels or neighboring organs is easily decided upon. Additionally, the option of adding or deleting this or that anatomical element allows for a simplified visual approach, which usually represents a potential difficulty during dissection.
Finally, the 3D reconstruction of this patient perfectly corresponds to her real anatomy. Thanks to a mere scanning based on the reconstruction, the vascularization mode of the tumor as well as the existence of a hidden part of healthy tissue can be verified.
Laparoscopic partial nephrectomy on non-functional, symptomatic right lower pole of the kidney
In this video, we present the case of a 13-year-old girl presenting with a complicated urological anomaly discovered very late. The lower part of her right kidney is dysplastic (or destroyed) with pseudocystic pyelocalyceal cavities filled with stones and cloudy urine. The first hypothesis is that we are dealing with a true renal duplicity with a destroyed non-functional inferior pole. In this case, there is one ureter per kidney pole. As a result, polar ureteronephrectomy does not cause any potential vascular problems.
In this case, thanks to 3D reconstruction (Visible Patient™, a spinoff of IRCAD), it is clear that there is no kidney duplicity, but a pyelic bifurcation. It means that we should manage the only ureter, which drains the superior and inferior pelvis. For that reason, the placement of a double J catheter is essential prior to partial nephrectomy. This catheter should be pulled up until the superior pelvis.
Tridimensional reconstruction of the CT-scan images of a patient with a malformation is extremely helpful to better understand the original and unique anatomy of the patient and to determine a tailored operative strategy.
This video demonstrates a laparoscopic partial nephrectomy on non-functional, symptomatic right lower pole of the kidney in a 13-year-old girl as an outpatient surgery.
Surgical intervention
11 months ago
1878 views
2 likes
0 comments
07:24
Laparoscopic partial nephrectomy on non-functional, symptomatic right lower pole of the kidney
In this video, we present the case of a 13-year-old girl presenting with a complicated urological anomaly discovered very late. The lower part of her right kidney is dysplastic (or destroyed) with pseudocystic pyelocalyceal cavities filled with stones and cloudy urine. The first hypothesis is that we are dealing with a true renal duplicity with a destroyed non-functional inferior pole. In this case, there is one ureter per kidney pole. As a result, polar ureteronephrectomy does not cause any potential vascular problems.
In this case, thanks to 3D reconstruction (Visible Patient™, a spinoff of IRCAD), it is clear that there is no kidney duplicity, but a pyelic bifurcation. It means that we should manage the only ureter, which drains the superior and inferior pelvis. For that reason, the placement of a double J catheter is essential prior to partial nephrectomy. This catheter should be pulled up until the superior pelvis.
Tridimensional reconstruction of the CT-scan images of a patient with a malformation is extremely helpful to better understand the original and unique anatomy of the patient and to determine a tailored operative strategy.
This video demonstrates a laparoscopic partial nephrectomy on non-functional, symptomatic right lower pole of the kidney in a 13-year-old girl as an outpatient surgery.