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surgical intervention video

Cure laparoscopique d'une hernie diaphragmatique traumatique aiguë avec mise en place d'un filet

This is the case of a 29-year-old male patient who has had a car accident. He was admitted with a cervical collar of Philadelphia, a spinal board, a Glasgow Coma Score (GCS) of 15, and stable vital signs. On physical examination, there were no wounds or bruises on the chest or abdomen. The absence of vesicular breath sounds in the left hemithorax was observed. An anteroposterior pelvic radiograph, a cervical spine radiograph (lateral and frontal projection), and complete blood tests were performed, showing no alterations. A full-body CT-scan was performed, showing a left diaphragmatic hernia containing the greater omentum, stomach, and transverse colon, atelectasis of the lower lung lobe, and mild pleural effusion. An exploratory laparoscopy confirms the diaphragmatic hernia in the posterior region. With gentle maneuvers, the content is reduced until the organs return to their usual position, making it possible to visualize a defect of approximately 15 by 5cm. 300mL of serohematic fluid is visualized in the chest. The triangular ligament of the liver is divided to fully reveal the hernia defect. To close it, multiple sutures are made with 2/0 polyester. It is reinforced by placing a 15 by 7.5cm composite mesh which is fixed with 6 tackers. Hemostasis is controlled. Trocars are removed under direct vision. Subsequently, a 32 French pleural drainage tube was placed by means of a minimal thoracotomy in the 6th intercostal space of the mid-axillary line. The patient evolution was stable with little pain in the left hemithorax. At 48 hours, the pleural drainage tube was removed. The patient was discharged on postoperative day 3 without complications. Computed tomography was performed 12 months after surgery that showed no hernial recurrence. 

Laparoscopic repair of acute traumatic diaphragmatic hernia with mesh placement

Ampullectomie laparoscopique pour adénome ampullaire

Ampullary adenomas are precursors to carcinomas, and progression to malignancy can be halted if excised early. Established methods include endoscopic or surgical resection. Surgical resection involves a duodenotomy, excision of the adenoma, followed by anastomoses of the distal bile duct and pancreatic duct to the duodenal mucosa. 

Traditionally, an open approach has been undertaken as it can be technically challenging to perform these anastomoses in a minimally invasive manner. A robotic or hybrid technique has been used by many for the reconstruction phase. We present a video in which laparoscopic ampullectomy was performed successfully. The patient was an elderly gentleman with multiple comorbidities which presented with obstructive jaundice, and axial imaging and endoscopic investigations found him to have an ampullary adenoma with focal high-grade dysplasia. He had a prior upper midline laparotomy for a perforated peptic ulcer. He was offered laparoscopic ampullectomy instead of a pancreaticoduodenectomy. The patient could be progressed to diet by postoperative day 5 and he was discharged on postoperative day 7, with no evidence of leak. The final histology evidenced an adenoma with high-grade dysplasia and clear margins. 

Laparoscopic ampullectomy for ampullary adenoma

Total gastrectomy with a D2 lymphadenectomy is a procedure of great magnitude, with non-negligible morbimortality. As a result, it is of paramount importance to have a systematization and standardization of the technique in order to allow for a safe procedure. This procedure requires a multidisciplinary and multimodal approach. Teamwork is therefore essential. This video shows the case of a 44-year-old woman, with epigastric pain, accompanied by early fullness and weight loss in the last six months. Pathology confirmed the presence of a diffuse adenocarcinoma with signet ring cells. Computed tomography ruled out systemic spread. 

Laparoscopic gastrectomy with D2 lymphadenectomy for advanced gastric cancer: a step-by-step approach

Gastrectomie laparoscopique avec lymphadénectomie de type D2 pour cancer gastrique avancé : une approche par étapes

In the field of esophagogastric surgery, robot-assisted surgery facilitates maneuvers which may present specific difficulties laparoscopically, such as dissection of the esophagogastric junction and intracorporeal suturing, in addition to having the benefit of a 3-dimensional vision. The objective of the video is to show a stepwise robot-assisted Nissen fundoplication surgery in a 53-year-old female patient with GERD refractory to medical treatment and a type 1 hiatal hernia. Viewing the video can help resident surgeons and surgeons training in robotic surgery to perform this technique in a systematic way.

Robotic Nissen fundoplication for the treatment of a hiatal hernia and gastroesophageal reflux disease: a case for surgeons training in robotic surgery

Fundoplicature de Nissen robotisée pour traitement de hernie hiatale et de reflux gastro-œsophagien : un cas d'apprentissage en chirurgie robotisée 

 Cancer de la jonction œsogastrique de type II de Siewert : technique d'Ivor Lewis par laparoscopie et thoracoscopie

The incidence of esophagogastric junction adenocarcinoma in Western countries has been progressively increasing, in association with gastroesophageal reflux. This type of cancer has been classified from I to III (according to the Siewert classification), depending on its relationship with the dentate line, and type II stands for an adenocarcinoma centered on it. The treatment of such a tumor requires a multimodal approach by a multidisciplinary team, and a comprehensive knowledge of the pathology and thoraco-abdominal anatomy. 

We present the case of a 61-year-old patient, smoker, with dysphagia and weight loss in the last 6 months. On upper endoscopy, the presence of a neoplastic lesion of the esophagogastric junction is shown. CT-scan confirms this lesion and rules out a systemic spread. The pathological anatomy demonstrates the presence of a moderately differentiated tubular adenocarcinoma. Concurrent neoadjuvant therapy is decided upon by the tumor committee. The post-treatment evaluation shows a very good response and surgery is scheduled. In this video, we show the surgical approach to a type II Siewert adenocarcinoma, using a thoracolaparoscopic Ivor-Lewis esophagogastrectomy, plus a two-field lymphadenectomy and intrathoracic anastomosis.

Siewert II adenocarcinoma: thoracolaparoscopic Ivor-Lewis approach

Epiphrenic diverticulum is a false pulsion diverticulum, which is considered to be caused by esophageal motor abnormalities such as achalasia, diffuse esophageal spasm (DES), hypertensive lower esophageal sphincter (LES), nutcracker esophagus, or nonspecific esophageal motility disorders. Epiphrenic diverticula are most frequently associated with achalasia. When achalasia is the cause of diverticulum, surgical treatment comprising diverticulectomy, myotomy, and fundoplication is required. 



In this video, authors present the case of a 74-year-old man with complaints of dysphagia, regurgitation, and weight loss (10Kg). During the preoperative work-up, barium swallow and EGD showed an epiphrenic diverticulum and a non-malignant narrowing of the lower esophagus. Due to the small dimension of the diverticulum, the decision is made to perform a myotomy only. During the video, technical steps to perform the myotomy are highlighted along with details of the instruments and energy devices used to complete it. In addition, important factors to prevent complications are stressed, The use of intraoperative EGD is also an important tool to verify mucosal integrity and stenosis release. The patient had an uneventful postoperative course with diet resumption after 24 hours. At 3 months of follow-up, the patient gained 8kg.

Non-resective management of an epiphrenic diverticulum

Chirurgie non-résective d'un diverticule épiphrénique

Traitement de la hernie hiatale (HH) et chirurgie bariatrique : révision de l'anastomose dans le cadre d'une dérivation gastrique de Roux-en-Y

In this video, authors present the case of a 44-year-old male patient who had undergone a Roux-en-Y gastric bypass (RYGB) in 2015. He developed an anastomotic ulcer and stenosis which were managed with six endoscopic dilations without any significant improvement. In addition, the patient presented with major dysphagia and gastroesophageal reflux disease (GERD). 



This video demonstrates a stepwise laparoscopic revision of a RYGB gastrojejunal anastomotic stenosis associated with a large hiatal hernia. The procedure includes the management of the herniated pouch with an intramediastinal dissection and a hiatoplasty. Technical steps during the resection of the gastrojejunal anastomosis including the enlarged gastric pouch are highlighted. The redo of the stapled gastrojejunostomy is also shown. During the procedure, fundamental laparoscopic skills required during revisional procedures are presented and the fundamental role of endoscopy to confirm anastomotic integrity is emphasized. 

Dealing with hiatal hernia (HH) and bariatric surgery: revision of anastomosis in Roux-en-Y gastric bypass

In this video, authors present the case of a 56-year-old male patient who had had a sleeve gastrectomy in 2012. He presented with weight regain and severe gastroesophageal reflux disease (GERD) and hiatal hernia (HH). Since the patient was morbidly obese (BMI of 46) and presented with obstructive sleep apnea, he was considered the best candidate for a Roux-en-Y gastric bypass (RYGB) and hiatal hernia repair. 

This video demonstrates the stepwise laparoscopic conversion of a laparoscopic sleeve gastrectomy (LSG) to a Roux-en-Y gastric bypass (RYGB) and hiatal hernia repair. The procedure includes hernia repair with transmediastinal dissection and hiatoplasty. Technical steps during the conversion such as adhesiolysis and the role of energy devices to prevent any complications are highlighted. After two months, the conversion allows the patient to benefit from the resolution of his reflux symptoms and to lose 13Kg. 

Dealing with hiatal hernia (HH) and bariatric surgery: conversion of laparoscopic sleeve gastrectomy (LSG) to Roux-en-Y gastric bypass

Traitement de la hernie hiatale (HH) et chirurgie bariatrique : conversion d'une sleeve gastrectomie laparoscopique en dérivation gastrique de Roux-en-Y

Focus on Upper GI surgery, miscellaneous GI procedures

Laparoscopic repair of acute traumatic diaphragmatic hernia with mesh placement

Siewert II adenocarcinoma: thoracolaparoscopic Ivor-Lewis approach

Robotic Nissen fundoplication for the treatment of a hiatal hernia and gastroesophageal reflux disease: a case for surgeons training in robotic surgery

Laparoscopic gastrectomy with D2 lymphadenectomy for advanced gastric cancer: a step-by-step approach

Laparoscopic ampullectomy for ampullary adenoma