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Arnaud WATTIEZ

Hôpitaux Universitaires de Strasbourg
Strasbourg, France
MD
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Laparoscopic salpingotomy for tubal ectopic pregnancy
About 1 to 2% of all pregnancies are ectopic. Most ectopic pregnancies are located in the uterine tube, and surgery is often used as a treatment modality. Traditionally, salpingectomy has been the standard procedure, but salpingotomy provides a conservative option in women who wish to preserve future fertility, especially if the contralateral tube is absent or damaged. Many women do not have access to IVF for financial, geographical, or religious reasons. Having an intrauterine pregnancy after salpingotomy can reach up to 70%. In this video, we demonstrate this procedure in simple steps. The case was that of a 35-year-old lady, P0+1 with a previous right tubal pregnancy, which was treated with a partial salpingectomy through a mini-laparotomy 2 years before. She was admitted to the emergency department as she presented with a 6-week amenorrhea with left iliac fossa pain. Pelvic ultrasound showed left tubal ectopic pregnancy (4 by 3cm in size), with free fluid suggestive of hemoperitoneum. She opted for a conservative laparoscopic surgery as she was keen to have a spontaneous fertility.
Surgical intervention
5 days ago
425 views
17 likes
2 comments
07:34
Laparoscopic salpingotomy for tubal ectopic pregnancy
About 1 to 2% of all pregnancies are ectopic. Most ectopic pregnancies are located in the uterine tube, and surgery is often used as a treatment modality. Traditionally, salpingectomy has been the standard procedure, but salpingotomy provides a conservative option in women who wish to preserve future fertility, especially if the contralateral tube is absent or damaged. Many women do not have access to IVF for financial, geographical, or religious reasons. Having an intrauterine pregnancy after salpingotomy can reach up to 70%. In this video, we demonstrate this procedure in simple steps. The case was that of a 35-year-old lady, P0+1 with a previous right tubal pregnancy, which was treated with a partial salpingectomy through a mini-laparotomy 2 years before. She was admitted to the emergency department as she presented with a 6-week amenorrhea with left iliac fossa pain. Pelvic ultrasound showed left tubal ectopic pregnancy (4 by 3cm in size), with free fluid suggestive of hemoperitoneum. She opted for a conservative laparoscopic surgery as she was keen to have a spontaneous fertility.
Laparoscopic resection of endometriotic fibrotic nodule extending from the posterior lateral aspect of the uterus to the left pelvic sidewall, encasing the internal iliac vessels and adherent to the mid-sigmoid colon
Deep endometriosis is one of the most complex and risky surgeries. Its laparoscopic management requires a systematic approach, a good anatomical knowledge, and a high level of surgical competency.
This is the case of a 37-year-old lady presenting with a complex deep pelvic endometriosis. She had a long history of severe dysmenorrhea, colicky abdominal pain, back pain, and constipation. Imaging studies (MR) showed a large fibrotic endometriotic nodule extending from the posterior lateral aspect of the uterus to the left pelvic sidewall, encasing the internal iliac vessels, nerves, and adherent to a 4cm segment of the mid-sigmoid colon.
This patient has a complicated past history of left ureter ligation during a caesarean section (in 2011), which resulted in a left-sided nephrectomy in 2012. She got a pneumothorax complication, lung drainage, right-side thoracotomy in 2013, and finally a total pleurectomy in 2014.
Surgical intervention
2 years ago
5148 views
311 likes
0 comments
42:42
Laparoscopic resection of endometriotic fibrotic nodule extending from the posterior lateral aspect of the uterus to the left pelvic sidewall, encasing the internal iliac vessels and adherent to the mid-sigmoid colon
Deep endometriosis is one of the most complex and risky surgeries. Its laparoscopic management requires a systematic approach, a good anatomical knowledge, and a high level of surgical competency.
This is the case of a 37-year-old lady presenting with a complex deep pelvic endometriosis. She had a long history of severe dysmenorrhea, colicky abdominal pain, back pain, and constipation. Imaging studies (MR) showed a large fibrotic endometriotic nodule extending from the posterior lateral aspect of the uterus to the left pelvic sidewall, encasing the internal iliac vessels, nerves, and adherent to a 4cm segment of the mid-sigmoid colon.
This patient has a complicated past history of left ureter ligation during a caesarean section (in 2011), which resulted in a left-sided nephrectomy in 2012. She got a pneumothorax complication, lung drainage, right-side thoracotomy in 2013, and finally a total pleurectomy in 2014.
Severe complex endometriosis with ascites: laparoscopic management
Frozen pelvis due to endometriosis is one of the most complex and risky situations which surgeons sometimes face. Its laparoscopic management requires a systematic approach, a good anatomical knowledge and a high level of surgical competency. This is a frozen pelvis case secondary to a complicated severe endometriosis in a young nulliparous lady. She had hemorrhagic abdominal ascites secondary to endometriosis, with a sub-occlusive syndrome. Her disease was further complicated with upper abdominal and pelvic fibrosis with a large umbilical endometriotic nodule as well as splenic, omental and sigmoid endometriosis. This video demonstrates the strategy of the laparoscopic management of this condition.
Surgical intervention
3 years ago
3874 views
161 likes
0 comments
31:22
Severe complex endometriosis with ascites: laparoscopic management
Frozen pelvis due to endometriosis is one of the most complex and risky situations which surgeons sometimes face. Its laparoscopic management requires a systematic approach, a good anatomical knowledge and a high level of surgical competency. This is a frozen pelvis case secondary to a complicated severe endometriosis in a young nulliparous lady. She had hemorrhagic abdominal ascites secondary to endometriosis, with a sub-occlusive syndrome. Her disease was further complicated with upper abdominal and pelvic fibrosis with a large umbilical endometriotic nodule as well as splenic, omental and sigmoid endometriosis. This video demonstrates the strategy of the laparoscopic management of this condition.
Anterior and posterior laparoscopic mesh removal due to pelvic pain, subtotal hysterectomy, mesh replacement, and Burch procedure
This is the case of a 69-year-old woman presenting with pelvic pain after laparoscopic sacrocolpopexy. The patient has a history of one vaginal birth, laparoscopic sacrocolpopexy with uterine preservation combined with a transobturator tape (TOT) sling procedure performed in 2013.
The following symptoms appeared after surgery: invalidating pelvic pain, especially in an upright position, severe terminal constipation, worsening of a previously mild stress urinary incontinence.
On clinical examination, a high rectocele (grade 2/3), a cystocele, and elective pain at the level of the TOT sling were observed. MRI revealed a perineal inflammation between the anterior aspect of the vagina and the urethra, at the level of the lower third of the urethra. A fibrotic area can be noted at the level of the rectovaginal space.
Her TOT sling was partially resected in January 2014.
Cystoscopy ruled out the presence of mesh erosion. Hysteroscopy was normal.
Endometrial biopsy demonstrated an atrophic endometrium.
In this surgery, the anterior and posterior meshes are removed. A subtotal hysterectomy combined with the replacement of meshes were performed, followed by a Burch procedure.
Surgical intervention
4 years ago
1807 views
64 likes
0 comments
33:56
Anterior and posterior laparoscopic mesh removal due to pelvic pain, subtotal hysterectomy, mesh replacement, and Burch procedure
This is the case of a 69-year-old woman presenting with pelvic pain after laparoscopic sacrocolpopexy. The patient has a history of one vaginal birth, laparoscopic sacrocolpopexy with uterine preservation combined with a transobturator tape (TOT) sling procedure performed in 2013.
The following symptoms appeared after surgery: invalidating pelvic pain, especially in an upright position, severe terminal constipation, worsening of a previously mild stress urinary incontinence.
On clinical examination, a high rectocele (grade 2/3), a cystocele, and elective pain at the level of the TOT sling were observed. MRI revealed a perineal inflammation between the anterior aspect of the vagina and the urethra, at the level of the lower third of the urethra. A fibrotic area can be noted at the level of the rectovaginal space.
Her TOT sling was partially resected in January 2014.
Cystoscopy ruled out the presence of mesh erosion. Hysteroscopy was normal.
Endometrial biopsy demonstrated an atrophic endometrium.
In this surgery, the anterior and posterior meshes are removed. A subtotal hysterectomy combined with the replacement of meshes were performed, followed by a Burch procedure.
Laparoscopic type C radical hysterectomy and pelvic lymphadenectomy for cervical cancer
This video shows a standardized and reproducible approach to radical hysterectomy. The procedure begins with the dissection of the lateral pelvic spaces in order to identify and isolate the paracervix. After coagulation and division of the round ligament, the surgeon performs a T-shape incision until the psoas muscles to expose the field for the ilio-obturator lymphadenectomy. The paravesical fossa is then dissected in its medial and lateral aspect using the umbilical artery as a landmark. Following the umbilical artery in a ventral to dorsal direction, the surgeon identifies the uterine artery and the paracervix. Using the uterine artery as a landmark of the paracervix, dissection is continued posteriorly developing the Latzko and Okabayashi spaces in order to isolate the paracervix. Once the spaces have been developed, the lymphadenectomy is performed separating the external iliac vessels from the psoas muscle to reach the obturator fossa. During this step, the obturator nerve is identified to avoid injuries and to mark the caudal limit of the lymphadenectomy.
The procedure is carried on with the isolation of the ureter in its anterior aspect between the paracervix and the bladder. To do so, the bladder pillar is identified and the dissection is pursued between its medial and lateral aspect developing the so-called space of Yabuki. The bladder pillar is then transected at the level of the bladder. The rectal pillar is transected at the level of the rectum paying attention to isolate the inferior hypogastric nerve. The paracervix is then cut at the level of the hypogastric vessel and the ureter is unroofed.
The vagina is cut with monopolar energy using a vaginal valve as a guide and the specimen is extracted vaginally.
The vagina is closed with three stitches using an extracorporeal knotting technique.
Surgical intervention
4 years ago
10537 views
345 likes
0 comments
07:20
Laparoscopic type C radical hysterectomy and pelvic lymphadenectomy for cervical cancer
This video shows a standardized and reproducible approach to radical hysterectomy. The procedure begins with the dissection of the lateral pelvic spaces in order to identify and isolate the paracervix. After coagulation and division of the round ligament, the surgeon performs a T-shape incision until the psoas muscles to expose the field for the ilio-obturator lymphadenectomy. The paravesical fossa is then dissected in its medial and lateral aspect using the umbilical artery as a landmark. Following the umbilical artery in a ventral to dorsal direction, the surgeon identifies the uterine artery and the paracervix. Using the uterine artery as a landmark of the paracervix, dissection is continued posteriorly developing the Latzko and Okabayashi spaces in order to isolate the paracervix. Once the spaces have been developed, the lymphadenectomy is performed separating the external iliac vessels from the psoas muscle to reach the obturator fossa. During this step, the obturator nerve is identified to avoid injuries and to mark the caudal limit of the lymphadenectomy.
The procedure is carried on with the isolation of the ureter in its anterior aspect between the paracervix and the bladder. To do so, the bladder pillar is identified and the dissection is pursued between its medial and lateral aspect developing the so-called space of Yabuki. The bladder pillar is then transected at the level of the bladder. The rectal pillar is transected at the level of the rectum paying attention to isolate the inferior hypogastric nerve. The paracervix is then cut at the level of the hypogastric vessel and the ureter is unroofed.
The vagina is cut with monopolar energy using a vaginal valve as a guide and the specimen is extracted vaginally.
The vagina is closed with three stitches using an extracorporeal knotting technique.
Laparoscopic ileocaecal and sigmoid resection with transanal natural orifice specimen extraction (NOSE) for endometriosis
In 12 to 30% of endometriosis cases, the disease is located in the bowel. Caecum and small bowel endometriosis are found in only 3.6% and 7% respectively of those cases while the sigmoid colon and the rectum are most commonly affected in 85% of cases. The laparoscopic management of this disease has evolved drastically over the last decade, and even delicate cases such as small bowel endometriosis can be completely managed by laparoscopy. It is key to be locally invasive towards the disease but conservative with regards to organ function preservation. The specimen will be extracted through natural orifices and without any ileostomy. Our patients are commonly young and healthy women who will certainly benefit from a tailored surgery with immediate symptom relief in addition to minimum abdominal scarring can have a significant positive impact on patient’s psychological well-being and subsequent recovery.
In the present case, we present a 36-year old woman who was diagnosed with endometriosis and presented with 3 episodes of bowel pseudo-obstruction and dyschezia, and put under medical treatment. She was found to have multiple endometriotic nodules, with concurrent ileocaecal and rectosigmoid disease, for which a double bowel resection with transanal natural orifice specimen extraction (NOSE) was performed without complications.
Surgical intervention
4 years ago
1894 views
46 likes
0 comments
38:15
Laparoscopic ileocaecal and sigmoid resection with transanal natural orifice specimen extraction (NOSE) for endometriosis
In 12 to 30% of endometriosis cases, the disease is located in the bowel. Caecum and small bowel endometriosis are found in only 3.6% and 7% respectively of those cases while the sigmoid colon and the rectum are most commonly affected in 85% of cases. The laparoscopic management of this disease has evolved drastically over the last decade, and even delicate cases such as small bowel endometriosis can be completely managed by laparoscopy. It is key to be locally invasive towards the disease but conservative with regards to organ function preservation. The specimen will be extracted through natural orifices and without any ileostomy. Our patients are commonly young and healthy women who will certainly benefit from a tailored surgery with immediate symptom relief in addition to minimum abdominal scarring can have a significant positive impact on patient’s psychological well-being and subsequent recovery.
In the present case, we present a 36-year old woman who was diagnosed with endometriosis and presented with 3 episodes of bowel pseudo-obstruction and dyschezia, and put under medical treatment. She was found to have multiple endometriotic nodules, with concurrent ileocaecal and rectosigmoid disease, for which a double bowel resection with transanal natural orifice specimen extraction (NOSE) was performed without complications.