basecamp

Endometriosis basecamp

Hysteroscopy basecamp

Wrist basecamp

Colorectal basecamp

Hernia basecamp

surgical intervention video

Laparoscopic right hemicolectomy with complete mesocolic excision for advanced ascending colon cancer

Hemicolectomie laparoscopique droite avec excision mésocolique complète pour cancer avancé du colon ascendant


腹腔镜右半结肠切除术治疗进展期结肠癌


Лапароскопическая правосторонняя гемиколэктомия с тотальной мезоколонэктомией по поводу рака восходящей кишки поздней стадии

Hemicolectomia direita laparoscópica com excisão completa do mesocólon para câncer avançado no cólon ascendente


Hemicolectomía derecha laparoscópica con escisión completa del mesocolon para cáncer avanzado en el colon ascendente


Laparoscopic complete mesocolic excision (CME) right hemicolectomy with intracorporeal anastomosis

Hemicolectomia direita com excisão completa do mesocólon (ECM) e anastomose intracorpórea


Лапароскопическая тотальная мезоколонэктомия, правосторонняя гемиколэктомия с интракорпоральным анастомозом

Hemicolectomía derecha con escisión completa del mesocolon (ECM) y anastomosis intracorpórea


Excision mésocolique laparoscopique complète (CME) hémicolectomie droite avec anastomose intracorporelle


腹腔镜完全鼻息肉切除术（CME）右半结肠切除术与体内吻合术


Gastrectomie radicale subtotale par voie ouverte pour cancer gastrique


开放性根治性胃大部切除术


Gastrectomía subtotal radical abierta para cáncer gástrico


Open radical subtotal gastrectomy for gastric cancer

Gastrectomia subtotal radical aberta para câncer gástrico


Открытая радикальная дистальаня субтотальная резекция желудка по поводу рака


Laparoscopic Nissen fundoplication: a perfect case to start

Fundoplicatura de Nissen Laparoscópico para RGE

Fundoplicatura de Nissen laparoscópica: um caso perfeito para começar


腹腔镜尼森胃底折叠术：一个完美的开始


Fundoplicature de Nissen laparoscopique : un cas idéal pour commencer


Key steps of laparoscopic TAPP inguinal hernia repair

Ключевые моменты выполнения лапароскопической ТАРР-герниопластики паховой грыжи


Pasos clave de la reparación de la hernia inguinal por TAPP laparoscópico


腹腔镜TAPP腹股沟疝修补的关键步骤


Etapes principales d'un TAPP laparoscopique pour cure de hernie inguinale


Passos-chave do reparo da hérnia inguinal por TAPP laparoscópico


LIVE INTERACTIVE SURGERY: left direct inguinal hernia: laparoscopic TAPP approach

CIRURGIA INTERATIVA AO VIVO: hérnia inguinal direta esquerda: abordagem TAPP laparoscópica


CHIRURGIE LIVE INTERACTIVE: hernie inguinale directe gauche: approche laparoscopique TAPP


实时交互式手术：直接腹股沟疝：腹腔镜TAPP手术


CIRUGÍA INTERACTIVA EN VIVO: hernia inguinal izquierda directa: abordaje TAPP laparoscópico


LIVE хирургия: левосторонняя паховая грыжа, лапароскопический ТАРР подход

Laparoscopic extended right hemicolectomy with intracorporeal anastomosis

Hémicolectomie droite laparoscopique étendue avec anastomose intracorporelle

Live interactive surgery: laparoscopic management of a bilateral inguinal hernia: TAPP approach 

Live interactive surgery: laparoscopic TEP approach for left inguinal hernia 

Principles of safe laparoscopic approach for "median arcuate ligament syndrome" (MALS)

Principes d'une approche laparoscopique sûre pour le « syndrome du ligament arqué médian »

Cure de hernie inguinale par voie d'abord laparoscopique : technique TAPP

Laparoscopic groin hernia repair: TAPP procedure

Minimally invasive surgery for deep infiltrating endometriosis: laparoscopic excision of an endometriotic nodule of posterolateral parametrium involving the ureter and the hypogastric nerve

Chirurgie mini-invasive pour endométriose profonde : excision laparoscopique d'un nodule endométriosique du paramètre postéro-latéral impliquant l'uretère et le nerf hypogastrique

video lecture

Recherche et publication en chirurgie : essais contrôlés randomisés (ECR) (partie 2 de 5) - Martyn Evans

Surgical research and publishing: randomized controlled trials (RCTs) (part 2 of 5) - Martyn Evans

Excision discale d'un nodule intestinal avec neuropréservation et myomectomie avec ligature temporaire de l'artère utérine dans un cas d'endométriose infiltrante profonde sévère

Nerve-sparing disc excision of endometriotic nodule and myomectomy using advanced techniques for severe deep infiltrating endometriosis

Endométriose profonde avec atteinte intestinale : hystérectomie laparoscopique modifiée « en bloc » pour nodules intestinaux #Enzian C1-C2

Deep endometriosis with intestinal involvement: laparoscopic modified 'en bloc' hysterectomy for #Enzian C1-C2 bowel nodules

Fertility preservation in endometriosis: a laparoscopic approach with Argon laser

Préservation de la fertilité dans l'endométriose : approche laparoscopique avec laser Argon

Laparoscopic hepaticojejunostomy for a Strasberg E3 bile duct injury (BDI) after a failed endoscopic treatment

Hépaticojéjunostomie laparoscopique pour une lésion de la voie biliaire de type Strasberg E3 après échec d'un traitement endoscopique

monthly focus

This video presents the case of a laparoscopic liver right sectionectomy in a 14-year-old girl. Laparoscopic liver resections are not well-reported in pediatric oncology due to the low frequency of liver tumors in children. Published data are limited by several case series, and left lateral sectionectomy represents the most common indication. The resection of central liver segments is believed to be the most difficult type of resection, especially using a minimally invasive approach. Glissonian pedicle isolation according to Takasaki’s technique allows to reduce intraoperative blood loss and to provide a more precise anatomical hepatectomy. This video may be useful to pediatric surgeons and oncologists.

Bibliography:

1\. Moritz Schmelzle, Felix Krenzien, Wenzel Schöning, Johann Pratschke. Laparoscopic liver resection: indications, limitations, and economic aspects. Langenbecks Arch Surg 2020 Sep;405(6):725-735. doi: 10.1007/s00423-020-01918-8. Epub 2020 Jul 1. PMID: 32607841 PMCID: PMC7471173 DOI: 10.1007/s00423-020-01918-8

2\. Maciej Murawski, Marcin Łosin, Andrzej Gołębiewski, Katarzyna Sinacka, Irena Zabolska, Ewa Iżycka-Świeszewska, Piotr Czauderna. Laparoscopic resection of liver tumors in children. J Pediatr Surg 2021 Feb;56(2):420-423. doi: 10.1016/j.jpedsurg.2020.08.037. Epub 2020 Sep 17. PMID: 33046224 DOI: 10.1016/j.jpedsurg.2020.08.037

3\. Gabriele Calaminus, Dominik T Schneider, Dietrich von Schweinitz, Heribert Jürgens, Nacera Infed, Stefan Schönberger, Thomas A Olson, Peter Albers, Christian Vokuhl, Raimund Stein, Leendert Looijenga, Jalid Sehouli, Martin Metzelder, Alexander Claviez, Michael Dworzak, Angelika Eggert, Birgit Fröhlich, Nicolas U Gerber, Christian P Kratz, Jörg Faber, Thomas Klingebiel, Dieter Harms, Ulrich Göbel. Age-Dependent Presentation and Clinical Course of 1465 Patients Aged 0 to Less than 18 Years with Ovarian or Testicular Germ Cell Tumors; Data of the MAKEI 96 Protocol Revisited in the Light of Prenatal Germ Cell Biology. Cancers (Basel) 2020 Mar 6;12(3):611. doi: 10.3390/cancers12030611. PMID: 32155835 PMCID: PMC7139559 DOI: 10.3390/cancers12030611

4\. Claudius Conrad, Satoshi Ogiso, Yosuke Inoue, Nairuthya Shivathirthan, Brice Gayet. Laparoscopic parenchymal-sparing liver resection of lesions in the central segments: feasible, safe, and effective. Surg Endosc 2015 Aug;29(8):2410-7. doi: 10.1007/s00464-014-3924-9. Epub 2014 Nov 13. PMID: 25391984 DOI: 10.1007/s00464-014-3924-9

Laparoscopic hepatic right anterior sectionectomy for a liver tumor in a 14-year-old child

Section antérieure droite hépatique par laparoscopie pour une tumeur du foie chez un enfant de 14 ans

Extraction de l'ascaridiose de la voie biliaire principale

Hepatobiliary ascariasis (HA) is a rare condition associated with significant morbidity. The laparoscopic extraction of Ascaris lumbricoides from the biliary tract is a safe approach in patients who do not improve with anthelminthic treatment and when endoscopic retrograde cholangiopancreatography (ERCP) is not feasible or when not all nematodes can be removed using this method. In this video, the author presents the technique used in pediatric patients with HA. 

Bibliography: 

1. Khuroo MS, Rather AA, Khuroo NS, Khuroo MS. Hepatobiliary and pancreatic ascariasis, World J Gastroenterol. 2016 Sep 7;22(33):7507-17. doi: 10.3748/wjg.v22.i33.7507. PMID: 27672273 PMCID: PMC5011666.

2. Canes M, Seaton C, Mawson J, Goldfarb DM, Kang KT. Biliary ascariasis and trisomy 21 in a child newly arrived to Canada. CMAJ. 2022 Oct 3;194(38):E1318-E1321. doi: 10.1503/cmaj.220089. PMID: 36191940 PMCID: PMC9529569.

3. Roy K, Das J, Mukherjee D, Kundu R. Pancreatic-Biliary Ascariasis in an Infant. Journal of Nepal Paediatric Society, October 2017, 37(1), 98-100. https://doi.org/10.3126/jnps.v37i1.16501

4. Hajaji K, Aljohary H, Althani H. Laparoscopic Management of Billiary Ascariasis: A Case Report and Review of Literature. World Journal of Laparoscopic Surgery. September-December 2010;3(3):113-115. doi: 10.5005/jp-journals-10007-1094

Laparoscopic extraction of Ascaris lumbricoides from the biliary tract

Traitement d'un neuroblastome du médiastin postérieur chez l'enfant par voie thoracique bilatérale

This video presents the case of a neuroblastoma of the posterior mediastinum. Neuroblastoma of the posterior mediastinum most often involves the thoracic aorta, intercostal arteries, and it often spreads into the spinal canal. This localization is classically the most frequent location site of neurogenic tumors. The patient underwent a one-step operation to remove a tumor from two hemithorax. This video may be useful to pediatric oncologists and surgeons.

Bibliography:

1\. Badiu Tișa I, Samașca G, Aldea C, Lupan I, Farcau D, Makovicky P. Ganglioneuroblastoma in children. Neurol Sci. 2019 Sep;40(9):1985-1989. doi: 10.1007/s10072-019-03932-1. Epub 2019 May 30. PMID: 31147856.

2\. Dingemann C, Ure B, Dingemann J. Thoracoscopic procedures in pediatric surgery: what is the evidence? Eur J Pediatr Surg. 2014 Feb;24(1):14-9. doi: 10.1055/s-0033-1350060. Epub 2013 Jul 12. PMID: 23852720.

Bilateral thoracoscopic approach in a child with posterior mediastinal neuroblastoma

Cure d'une hernie de Morgagni-Larrey assistée par robot  chez une fillette de 17 mois

Introduction:

Morgagni hernia is a rare congenital defect of the anteromedial portion of the diaphragm. This video demonstrates the robot-assisted repair of a Morgagni-Larrey diaphragmatic hernia using a laparoscopic approach.

Materials and methods:

The patient was a 17-month-old girl, weighing 11 kg. She was found to have a Morgagni-Larrey diaphragmatic hernia discovered as an incidental finding.

A thoracic radiography demonstrated the presence of an anterior diaphragmatic hernia, which was confirmed with a barium enema and a CT-scan.

The child underwent a laparoscopic repair of the hernia with the assistance of a robotic system.

The hernia sac contents were reduced. The diaphragmatic defect was then primarily closed using a 2/0 Ethibond suture in an interrupted fashion.

Results:

There was no intraoperative complication. Operating time was 3 hours. Oral intake was authorized on postoperative day (POD) 1. She was discharged on POD2. There was no recurrence at 6 months of follow-up.

Conclusion:

Robotic assistance offers improved vision and most particularly easiness for suturing and knot-tying. Despite the low weight of the child, the limited intra-abdominal space and decreased distance between ports did not pose any problem.

 

Bibliography:

1\. C Nistri, L Marinelli, A Di Giacomo, L Bonariol, M Massani. Robotic repair of a giant Larrey-type congenital left-sided diaphragmatic hernia in a young woman. A case report and literature review. Int J Surg Case Rep. 2022 Sep:98:107507. doi: 10.1016/j.ijscr.2022.107507. Epub 2022 Aug 13. PMID: 36027832 PMCID: PMC9424357 DOI: 10.1016/j.ijscr.2022.107507

2\. Colin G Knight, Kelly M Gidell, David Lanning, Attila Lorincz, Scott E Langenburg, Michael D Klein. Laparoscopic Morgagni hernia repair in children using robotic instruments. J Laparoendosc Adv Surg Tech A 2005 Oct;15(5):482-6. doi: 10.1089/lap.2005.15.482. PMID: 16185121 DOI: 10.1089/lap.2005.15.482

3\. M Anderberg, C Clementson Kockum, E Arnbjornsson. Morgagni hernia repair in a small child using da Vinci robotic instruments--a case report. Eur J Pediatr Surg 2009 Apr;19(2):110-2. doi: 10.1055/s-2008-1038500. Epub 2008 Jul 15. PMID: 18629776 DOI: 10.1055/s-2008-1038500

Robotic assisted repair of Morgagni-Larrey hernia in a 17-month-old girl

Traitement thoracoscopique d'un chylothorax postopératoire

Introduction: 

Chylothorax is a rare postoperative complication of congenital heart surgery. A staged treatment is the general principle to manage this serious complication. However, a failure of conservative therapy requires surgical ligation to prevent continued fluid and protein losses. 

Materials and methods:

This is the case of an 8-month-old girl with Down syndrome, weighing 7.7 Kg. She presented with chylothorax following a cardiac procedure, refractory to conservative management. 

Surgery was facilitated using a selective endotracheal intubation. 

A methylene blue colored cream was administered preoperatively to visualize the thoracic duct during the surgical procedure. 

A video-assisted thoracoscopic surgery was performed to treat the chylothorax in our patient. The procedure was performed in the right chest using four ports. 

The duct was controlled via a direct thoracoscopic application of clips and fibrin glue, at the level of the diaphragm, and using a mechanical and chemical pleurodesis. 

Postoperative outcomes:

No intraoperative complication was observed. Operating time was 2 hours. Oral intake was allowed on postoperative day 5. Chest tubes were removed on postoperative day 7. There was no recurrence at 2 months of follow-up. 

Conclusion:

Thoracoscopic duct ligation is a safe and effective procedure, facilitated by means of selective intubation in our case. 



Bibliography:

1. Thoracoscopic Thoracic Duct Ligation: How I Teach It. Evgeny V Arshava , Kalpaj R Parekh. Ann Thorac Surg, 2020 May;109(5):1330-1334. PMID: 32035916 DOI: 10.1016/j.athoracsur.2020.01.004 

2. Talc Pleurodesis: A Medical, Medicolegal, and Socioeconomic Review. Ioana Baiu, MD, MPH, Elorm Yevudza, BS, and Joseph B. Shrager, MD. Ann Thorac Surg, 2020 Apr;109(4):1294-1301. PMID: 31593652 DOI: 10.1016/j.athoracsur.2019.08.104 

3. Thoracoscopic pleural clipping for the management of congenital chylothorax. Margaret E Clark, Russell K Woo, Sidney M Johnson. Pediatr Surg Int, 2015 Dec;31(12):1133-7. PMID: 26276425 DOI: 10.1007/s00383-015-3760-6 

Thoracoscopic management of postoperative chylothorax

Traitement laparoscopique d'une perforation gastrique après traumatisme contondant chez un adolescent à l'aide du système d'insufflation AirSeal® : rapport de cas et revue de la littérature

A teenage boy presented with abdominal pain and a 3cm non-transfixing wound in the right umbilical region. He had fallen on his bike’s handlebars while cycling down a slope at high speed, without a helmet.

A CT-scan of the chest and abdomen found single air bubbles, intraperitoneal effusion, right common iliac artery dissection with focal subocclusive tight stenosis. The radiologists assured that the air bubbles were not specific; as a result, the patient was admitted to the pediatric surgery department. However, after a 2-day monitoring, and as strong pain persisted, a new CT-scan of the chest and abdomen showed a large amount of pneumoperitoneum, increased diffuse peritoneal effusion, perforation of the lower gastric wall, and a large left pneumothorax. An exploratory laparoscopy using the AirSeal® insufflation system, a valveless low-pressure device, highlighted a 3cm long open wound in the lower gastric wall. The stomach was sutured, and the abdominal and left pleural cavities were drained. The child was discharged home on postoperative day 14. After a 6-week and a 4-month follow-up, postoperative outcomes were uneventful.

Bibliography:

1\. Koirala DP, Shrestha BM, Kansal A, Poudel D, Neupane S, Dahal GR. Perforation of gastroesophageal junction, stomach, and diaphragm following blunt abdominal trauma: A near miss: A case report. Int J Surg Case Rep. 2021 Mar 17;81:105786. PMID: 33887842 PMCID: PMC8041729 DOI: 10.1016/j.ijscr.2021.105786

2\. Stringel G, Xu ML, Lopez J. Minimally Invasive Surgery in Pediatric Trauma: One Institution’s 20-Year Experience. JSLS 2016 Jan-Mar;20(1):e2015.00111. doi: 10.4293/JSLS.2015.00111. PMID: 26877626 PMCID: PMC4744998 DOI: 10.4293/JSLS.2015.00111

3\. George AK, Wimhofer R, Viola KV, Pernegger M, Costamoling W, Kavoussi LR, Loidl W. Utilization of a novel valveless trocar system during robotic-assisted laparoscopic prostatectomy. World J Urol. 2015 Nov;33(11):1695-9. PMID: 25725807 DOI: 10.1007/s00345-015-1521-8

4\. Tytgat SHAJ, Zwaveling S, Kramer WLM, van der Zee DC. Laparoscopic treatment of gastric and duodenal perforation in children after blunt abdominal trauma. Injury. 2012 Sep;43(9):1442-4. PMID: 21129741 DOI: 10.1016/j.injury.2010.11.002

Laparoscopic repair of gastric perforation after blunt trauma in an adolescent using the AirSeal® insufflation system: a case report and literature review

 Blocage rétropéritonéal du sympathique lombaire dans une hyperhidrose plantaire primaire chez l'enfant

Primary hyperhidrosis is an idiopathic condition characterized by excessive sweat secretion, which has a significant impact on psychosocial well-being and overall quality of life. The palms, axillae, and soles are areas that are most commonly affected.

The authors report the clinical case and video of a 15-year-old girl followed in outpatient consultation for primary palmar and plantar hyperhidrosis. She underwent a thoracoscopic bilateral sympathectomy at the age of 14, targeting the T3-T4 levels, which resulted in significant improvement of palmar hyperhidrosis. However, due to persistent plantar hyperhidrosis, which continued to significantly affect her quality of life, a bilateral retroperitoneal lumbar sympathetic blockade was proposed and performed.

The retroperitoneal space was created and insufflated on both the right and left sides of the patient, and the sympathetic chain was identified at the L3 and L4 levels, along the medial aspect of the psoas muscle. The blockade was then performed using the Hem-o-Lok™ polymer ligation system. There were no intraoperative or postoperative complications, with minimal blood loss estimated. The patient presented with dry feet immediately after surgery.

Retroperitoneal lumbar sympathetic blockade is a safe and effective procedure for pediatric patients with plantar primary hyperhidrosis.

Bibliography:

1\. Retroperitoneoscopic lumbar sympathectomy for plantar hyperhidrosis. Sonia O Lima, Vanessa R de Santana, Daisy P Valido, Renata L B de Andrade, Leticia M Fontes, Victor Hugo O Leite, José M Neto, Jéssica M Santos, Lucas L Varjão, Francisco P Reis. J Vasc Surg 2017 Dec;66(6):1806-1813. doi: 10.1016/j.jvs.2017.05.126. PMID: 29169540 DOI: 10.1016/j.jvs.2017.05.126

2\. Retroperitoneoscopic lumbar sympathectomy for the treatment of primary plantar hyperhidrosis. Kyung Jae Hur, Hyong Woo Moon, Yong Hyun Park, Woong Jin Bae, Hyuk Jin Cho, U-Syn Ha, Ji Youl Lee, Sae Woong Kim, Sung-Hoo Hong. BMC Surg 2021 Nov 12;21(1):397. doi: 10.1186/s12893-021-01393-y. PMID: 34772374 PMCID: PMC8590320 DOI: 10.1186/s12893-021-01393-y

Retroperitoneal lumbar sympathetic blockage in a pediatric primary plantar hyperhidrosis

Congenital solitary liver cysts are rare conditions, typically asymptomatic in infancy, and often discovered incidentally during imaging studies. The etiology remains unclear. However, hypotheses suggest that obstruction of aberrant bile ducts, possibly due to infection or vascular disruption during the fetal period, may contribute to cyst formation. Such cysts may present as simple cysts or intrahepatic biliary cysts.

The authors report the case of a full-term female infant with an antenatal suspicion of choledochal cyst. Postnatal abdominal ultrasound and MRI revealed an intrahepatic cystic mass crossing liver segments IVa, VII, and Vb, raising questions about a possible connection between the cyst and the right intrahepatic bile duct. The cyst could not be classified under the Todani classification. The infant remained asymptomatic since birth, with no abnormalities on physical examination.

At 20 months of age, the patient underwent a laparoscopic intervention. Intraoperative cholangiography confirmed the diagnosis of a solitary intrahepatic biliary cyst. A Roux-en-Y cystojejunostomy was performed. The procedure was uneventful, and the patient was discharged on postoperative day 3, remaining asymptomatic thereafter.

This case highlights the diagnostic challenges of congenital solitary liver cysts. Intraoperative cholangiography is crucial to define the anatomical relationship between the cyst and the biliary tree. Total excision is recommended for accessible solitary cysts, while internal drainage procedures, such as cysto-enterostomy or Roux-en-Y hepaticojejunostomy, are effective alternatives when excision is not feasible. These approaches ensure a safe and effective biliary system reconstruction.

Bibliography:

1\. Tutku Soyer 1, Ibrahim Karnak, Mehmet Emin Senocak. Congenital solitary intrahepatic biliary cyst in a newborn: report of a case. Surg Today 2007;37(6):521-4. doi: 10.1007/s00595-006-3442-z. Epub 2007 May 28. [https://pubmed.ncbi.nlm.nih.gov/17522776/](https://pubmed.ncbi.nlm.nih.gov/17522776/) PMID: 17522776 DOI: 10.1007/s00595-006-3442-z

2\. Anil Kumar Yadav, Jianghua Zhan, Shujian Zhang, Nita Yadav. Congenital solitary intrahepatic biliary cyst in infant: A rare case report. Journal of Pediatric Surgery Case Reports Volume 30, March 2018, Pages 64-67. [https://www.sciencedirect.com/science/article/pii/S2213576617302348?via%3Dihub](https://www.sciencedirect.com/science/article/pii/S2213576617302348?via%3Dihub)

3\. M B Macken, J R Wright Jr, H Lau, M C Cooper, E B Grantmyre, D L Thompson, M K O'Brien. Prenatal sonographic detection of congenital hepatic cyst in third trimester after normal second-trimester sonographic examination. J Clin Ultrasound 2000 Jul-Aug;28(6):307-10. doi: 10.1002/1097-0096(200007/08)28:6\<307::aid-jcu8>3.0.co;2-7. [https://pubmed.ncbi.nlm.nih.gov/10867671/](https://pubmed.ncbi.nlm.nih.gov/10867671/) PMID: 10867671 DOI: 10.1002/1097-0096(200007/08)28:6\<307::aid-jcu8>3.0.co;2-7

Laparoscopic Roux-en-Y cystojejunostomy for a congenital solitary intrahepatic biliary cyst in a 1-year-old infant

Cystojéjunostomie par voie d'abord laparoscopique pour kyste biliaire intrahépatique solitaire congénital chez un nourrisson d'un an

Focus on pediatric surgery

The authors present the case of a 33-year-old female patient. The patient has a previous medical history of hypothyroidism, insulin resistance, and acute pancreatitis. She presented with upper abdominal pain and did not report any other associated symptoms. A CT-scan, MRI, and EUS were performed, establishing the diagnosis of mucinous cystic neoplasm, for which the surgical team decided to perform a distal pancreatectomy using the clockwise modified technique. The patient presented a grade B pancreatic fistula and was discharged on postoperative day 3. The objective of the authors was to demonstrate the advantage of the laparoscopic approach in pancreatic laparoscopic surgery. 

Surgical distal pancreatic resection has the best chance to cure a disease of the pancreatic body and tail, including malignancy, precancerous lesions, and inflammatory involvement (1, 2). Laparoscopic distal pancreatic resection requires excellent surgical skills, training experience with proctors, and case-load concentration in high-volume hospitals with the best resources (1). 

In cases of a premalignant and symptomatic benign condition, the spleen must be preserved either using Kimura’s splenic vessel preservation technique or Warshaw’s splenic vessel resection technique (2). 

Laparoscopic distal pancreatectomy is a safe and feasible treatment for left pancreatic malignancies, with the same surgical efficacy as open distal pancreatectomy. Laparoscopic distal pancreatectomy has also the advantages of minimally invasive surgery, such as minimal trauma and enhanced recovery after surgery (3). 

A laparoscopic distal pancreatectomy performed using the clockwise technique provides satisfactory outcomes (4). However, in this approach, a modified clockwise technique was used. 



Take-home messages:

Patients with a pancreatic cyst tumor can be treated using a laparoscopic modified clockwise technique even with a previous medical history of acute pancreatitis. This surgery can be performed as it offers safe, optimal results, as well as excellent postoperative outcomes. 



Bibliography:

1. Bencini L, Minuzzo A. Distal pancreatectomy with or without radical approach, vascular resections and splenectomy: Easier does not always mean easy. World J Gastrointest Surg. 2023;15(6):1020-1032. doi:10.4240/wjgs.v15.i6.1020

2. Coco D, Leanza S, Schillaci R, Reina GA. Laparoscopic distal pancreatectomy for benign and malignant disease: a review of techniques and results. Prz Gastroenterol. 2022;17(2):103-109. doi:10.5114/pg.2021.109625

3. Hao T, Shiming J, Yong C. Analysis of safety and efficacy of laparoscopic distal pancreatectomy in the treatment of left pancreatic malignant tumors. J Int Med Res. 2021;49(12). doi:10.1177/03000605211063098

4. Gamo GDO, Reichardt GS, Guetter CR, et al. Esofagogástrica e esplenectomia influencia a variação. 2022;34(2):1-5.



Laparoscopic distal splenopancreatectomy for mucinous cystic neoplasm: modified clockwise technique

Splénopancréatectomie distale laparoscopique pour néoplasme kystique mucineux : technique dans le sens horaire modifiée 

Splénopancréatectomie gauche laparoscopique pour le traitement d'une tumeur kystique

This video presents the management of a pancreatic tumor with a left splenopancreatectomy. The aim of this video is to present the ‘clockwise’ technique in a laparoscopic distal pancreatectomy setting. 



Bibliography:

Asbun, H. J., Van Hilst, J., Tsamalaidze, L., Kawaguchi, Y., Sanford, D., Pereira, L., Besselink, M. G., & Stauffer, J. A. (2020). Technique and audited outcomes of laparoscopic distal pancreatectomy combining the clockwise approach, progressive stepwise compression technique, and staple line reinforcement. Surgical Endoscopy, 34(1), 231‑239. https://doi.org/10.1007/s00464-019-06757-3



Laparoscopic left splenopancreatectomy for a cystic tumor

Cholangioscopie laparoscopique transcystique des voies biliaires : simulation

Recent studies highlight the effectiveness of laparoscopic cholecystectomy (LC) and laparoscopic common bile duct exploration (LCBDE) in managing cholecystocholedocholithiasis (1). Standard treatments involve preoperative endoscopic procedures. However, advances in laparoscopy have reintroduced one-stage approaches, particularly LCBDE alongside LC (2). Transcystic (TC) and transductal (TD) routes influence outcomes whereas the literature showed that the TC extraction is deemed safer, with comparable stone clearance rates (3). 

Laparoscopic transcystic CBD techniques (LTCBDE) have been developed to treat CBD stones in one session, minimizing complications with an applicability reaching over 85% of cases, and success rates of 85 to 95%, proving their cost-effectiveness as compared to postoperative endoscopic procedures (3, 4). Ongoing technological advances, including robot-assisted surgery and advanced imaging methods, such as laparoscopic CT cholangioscopy, enhance this approach to CBD treatment, becoming the primary strategy for most patients.

Bibliography:

1. Durán M, Silvestre J, Hernández J, Briceño J, Martínez-Isla A, Martínez-Cecilia D. Learning curve for performing laparoscopic common bile duct exploration in biliary surgery 2.0 era. J Hepatobiliary Pancreat Sci. 2023;30(3):374-382. doi:10.1002/jhbp.1228. Link: https://pubmed.ncbi.nlm.nih.gov/35947065/

2. Zhou Y, Wu XD, Zha WZ, et al. Three modalities on common bile duct exploration. Drei Modalitäten für das Management der Choledocholithiasis. Z Gastroenterol. 2017;55(9):856-860. doi:10.1055/s-0043-112655. Link: https://pubmed.ncbi.nlm.nih.gov/28763814/

3. Reinders JS, Gouma DJ, Ubbink DT, van Ramshorst B, Boerma D. Transcystic or transductal stone extraction during single-stage treatment of choledochocystolithiasis: a systematic review. World J Surg. 2014;38(9):2403-2411. doi:10.1007/s00268-014-2537-8. Link: https://pubmed.ncbi.nlm.nih.gov/24705779/

Transcystic laparoscopic bile duct cholangioscopy: simulation

Ablation de tumeurs hépatiques

In this authoritative lecture, Professor Mariano Giménez outlines the management of liver tumors considering their ablation.

Liver tumor ablation

Impaction of a mechanical lithotripsy basket during endoscopic retrograde cholangiopancreatography (ERCP) is a rare, but serious complication resulting from technical failure. The authors present a video of lithotripsy basket retrieval assisted by means of laser fragmentation. It is the case of an 87-year-old man who underwent an emergency laparoscopic subtotal cholecystectomy, common bile duct (CBD) exploration, and laser lithotripsy. After attempts at endoscopic mechanical lithotripsy, a stone-basket complex became impacted within the CBD. In the absence of endoscopic salvage techniques, a laparoscopic common bile duct exploration (LCBDE) is a valid and safe option where surgical expertise permits.

Bibliography:

1\. Thomas M, Howell DA, Carr-Locke D, Mel Wilcox C, Chak A, Raijman I, et al. Mechanical lithotripsy of pancreatic and biliary stones: complications and available treatment options collected from expert centers. Am J Gastroenterol. 2007 Sep;102(9):1896-902. doi: 10.1111/j.1572-0241.2007.01350.x. Epub 2007 Jun 15. PMID: 17573790

2\. Garg PK, Tandon RK, Ahuja V, Makharia GK, Batra Y. Predictors of unsuccessful mechanical lithotripsy and endoscopic clearance of large bile duct stones. Gastrointest Endosc. 2004 May;59(6):601-5. doi: 10.1016/s0016-5107(04)00295-0. PMID: 15114300

3\. Yilmaz S, Ersen O, Ozkececi T, Turel KS, Kokulu S, Kacar E, et al. Results of the open surgery after endoscopic basket impaction during ERCP procedure. World J Gastrointest Surg. 2015 Feb 27;7(2):15-20. doi: 10.4240/wjgs.v7.i2.15. PMID: 25722797; PMCID: PMC4325280

Laparoscopic common bile duct exploration (CBDE) and retrieval of endoscopic lithotripsy basket

Exploration laparoscopique de la voie biliaire principale et récupération d'un panier de lithotripsie endoscopique

The laparoscopic Whipple procedure for the treatment of a pancreatic head tumor appears to be a valid, safe, and feasible alternative. There has been increased awareness of structured training and patient selection for laparoscopic management. This case of a patient with a standard BMI and a tumor which allows for the adequate visualization of anatomical structures is valuable to recognize the resective steps, and to select a minimally invasive reconstructive option. As familiarity with the robotic platform increases, studies have shown an expansion of indications. 



Bibliography:

1. Comparison of safety and effectiveness between laparoscopic and open pancreatoduodenectomy: A systematic review and meta-analysis. Yin T, Qin T, Wei K, Shen M, Zhang Z, Wen J, Pan S, Guo X, Zhu F, Wang M, Zhang H, Hilal MA, Qin R. Int J Surg. 2022 Sep;105:106799. doi: 10.1016/j.ijsu.2022.106799. Epub 2022 Aug 19

2. Minimally invasive pancreatoduodenectomy. Kendrick ML, van Hilst J, Boggi U, de Rooij T, Walsh RM, Zeh HJ, Hughes SJ, Nakamura Y, Vollmer CM, Kooby DA, Asbun HJ; Minimally Invasive Pancreatic Resection Organizing Committee. HPB (Oxford). 2017 Mar;19(3):215-224. doi: 10.1016/j.hpb.2017.01.023

3. Laparoscopic pancreatoduodenectomy with open or laparoscopic reconstruction during the learning curve: a multicenter propensity score matched study. van Hilst J, de Rooij T, van den Boezem PB, Bosscha K, Busch OR, van Duijvendijk P, Festen S, Gerhards MF, de Hingh IH, Karsten TM, Kazemier G, Lips DJ, Luyer MD, Nieuwenhuijs VB, Patijn GA, Stommel MW, Zonderhuis BM, Daams F, Besselink MG; Dutch Pancreatic Cancer Group. HPB (Oxford). 2019 Jul;21(7):857-864. doi: 10.1016/j.hpb.2018.11.003. Epub 2018 Dec 5

Laparoscopic Whipple procedure for the management of a pancreatic head tumor

Intervention de Whipple par voie d'abord laparoscopique pour prise en charge d'une tumeur de la tête du pancréas

Introduction: Liver cancer is globally the fifth most common cancer and the fourth most common cause of cancer-related death. Currently, surgical resection is still considered a curative option and is reserved for the early stages of hepatocellular carcinoma (HCC). Laparoscopy shows comparable results to open liver resection regarding long-term oncologic outcomes such as overall survival and disease-free survival, while delivering superior results in terms of morbidity and perioperative outcomes. Using indocyanine green (ICG) fluorescence makes it possible to accurately determine the boundaries of anatomical resections, improving the navigation and precision of surgical techniques.

Methods:

The authors demonstrate a laparoscopic left paramedian sectorectomy (S3-S4 bisegmentectomy) with lymphadenectomy using negative ICG staining in a 73-year-old male patient, with hepatitis C and Child-Pugh class A (score of 6 points) liver cirrhosis.

Results:

The operation lasted 180 minutes and total blood loss was 80mL. The postoperative period was uneventful, and the patient was discharged on postoperative day 6. The histological examination revealed the presence of a G2 HCC at the pT1aN0M0 stage, with tumor-free surgical margins.

Conclusion:

The combination of a minimally invasive approach with ICG negative staining for “small” anatomical liver resection, in a patient with chronic cirrhosis and early-stage HCC has shown good perioperative results and oncologic outcomes.

 

Bibliography:

1\. Manon Allaire, Claire Goumard, Chetana Lim, Aline Le Cleach, Mathilde Wagner, Olivier Scatton. New frontiers in liver resection for hepatocellular carcinoma. JHEP Rep. 2020 Jun 4;2(4):100134. doi: 10.1016/j.jhepr.2020.100134. eCollection 2020 Aug. PMID: 32695968 PMCID: PMC7360891 DOI: 10.1016/j.jhepr.2020.100134

2\. Stefano Di Sandro, Maria Danieli, Fabio Ferla, Andrea Lauterio, Riccardo De Carlis, Laura Benuzzi, Vincenzo Buscemi, Isabella Pezzoli, Luciano De Carlis. The current role of laparoscopic resection for HCC: a systematic review of past ten years. Transl Gastroenterol Hepatol. 2018 Sep 18:3:68. doi: 10.21037/tgh.2018.08.05. eCollection 2018. PMID: 30363804 PMCID: PMC6182043 DOI: 10.21037/tgh.2018.08.05

3\. Junichi Kaneko, Takashi Kokudo, Yoshinori Inagaki, Kiyoshi Hasegawa. Innovative treatment for hepatocellular carcinoma (HCC). Transl Gastroenterol Hepatol. 2018 Oct 22;3:78. doi: 10.21037/tgh.2018.10.04. PMID: 30505965; PMCID: PMC6232072

Laparoscopic liver segment III and IV (S3-S4) bisegmentectomy with lymphadenectomy and indocyanine green (ICG) for hepatocellular carcinoma (HCC) 

Bisegmentectomie laparoscopique des segments III et IV du foie (S3-S4) avec lymphadénectomie et vert d'indocyanine pour carcinome hépatocellulaire (CHC) 

Chronic calcific pancreatitis (CCP) is a debilitating condition, which often causes intractable pain unresponsive to conservative treatment. Conventional surgical interventions have limitations in achieving optimal outcomes, as they often lead to prolonged recovery and increased morbidity. Laparoscopic lateral pancreaticojejunostomy (LPJ) offers a minimally invasive surgical approach in such patients. The use of robotic technology enhances the precision and efficacy of pancreaticojejunostomy, offering patients a minimally invasive alternative with improved postoperative outcomes. This video showcases the key steps of the procedure, including patient set-up, robotic port placement, meticulous dissection of the pancreatic head, and creation of a side-to-side pancreaticojejunostomy. 

This video shows the case of a 27-year-old woman presenting with persistent abdominal pain, uncontrolled diabetes mellitus, and steatorrhea. Investigations revealed random plasma glucose at 390mg/dL and HbA1C at 8.6. Contrast-enhanced CT-scan of the abdomen showed an atrophic pancreas, a dilated main pancreatic duct (MPD) with a diameter of approximately 9mm filled with multiple calculi. The patient underwent a robotic assisted laparoscopic lateral pancreaticojejunostomy. The procedure was uneventful, and the patient was discharged on postoperative day 5. 

Bibliography: 

1. George Michel Eid, Fateh Entabi, Andrew R. Watson, Brian S. Zuckerbraun, Mark A. Wilson, Robotic-assisted laparoscopic side-to-side lateral pancreaticojejunostomy, Journal of Gastrointestinal Surgery, Volume 15, Issue 7, 2011, Page 1243, ISSN 1091-255X, https://doi.org/10.1007/s11605-011-1495-9.

2. Balduzzi A, Zwart MJW, Kempeneers RMA, Boermeester MA, Busch OR, Besselink MG. Robotic Lateral Pancreaticojejunostomy for Chronic Pancreatitis. J Vis Exp. 2019 Dec 14;(154). doi: 10.3791/60301. PMID: 31885388.

3. Nayak K, Shinde RK, Gattani RG, Thakor T. Surgical Perspectives of Open vs. Laparoscopic Approaches to Lateral Pancreaticojejunostomy: A Comprehensive Review. Cureus. 2024 Jan 6;16(1):e51769. doi: 10.7759/cureus.51769. PMID: 38322062; PMCID: PMC10844796.

4. Palanivelu C, Shetty R, Jani K, Rajan PS, Sendhilkumar K, Parthasarthi R, Malladi V. Laparoscopic lateral pancreaticojejunostomy: a new remedy for an old ailment. Surg Endosc. 2006 Mar;20(3):458-61. doi: 10.1007/s00464-005-0680-x. Epub 2006 Jan 19. PMID: 16424983.

Robotic assisted laparoscopic lateral pancreaticojejunostomy (LPJ) for chronic calcific pancreatitis (CCP)

Pancréaticojéjunostomie latérale assistée par robot pour pancréatite calcifiante chronique 

Cholécystectomie laparoscopique pour cholécystite chronique avec mucocèle en cas de situs inversus avec dextrocardie

The authors present the case of a 74-year-old male patient with situs inversus totalis (SIT), undergoing laparoscopic cholecystectomy for persistent severe symptomatic gallstone disease. Situs inversus totalis is a rare congenital condition, with incidence estimates ranging from 1 in 5,000 to 1 in 20,000, and effectively results in a mirror image transposition of thoracic and abdominal organs. This gentleman had initially presented with left upper quadrant pain and fever, with CT imaging confirming both situs inversus and inflammation of the gallbladder. His only other past medical history of note was Kartagener’s syndrome, which is often associated with SIT. The procedure was performed with port placement mirroring that of a typical laparoscopic cholecystectomy set-up, with the surgeon, assistant, and scrub nurse standing to the patient’s right, screen on the patient’s left, and port placement again mirroring that of the usual set-up. The procedure was slightly complicated by the acute on chronic presentation of cholecystitis. However, it was successfully performed with careful consideration of mirrored anatomical landmarks and accounting for this in a right-handed surgeon. The case underscores the importance of preoperative planning and the technical modifications required in laparoscopic surgery for patients with situs inversus totalis.

 

Bibliography:

1\. Eitler K, Bibok A, Telkes G. Situs Inversus Totalis: A Clinical Review. Int J Gen Med. 2022 Mar 3;15:2437-2449. doi: 10.2147/IJGM.S295444. PMID: 35264880; PMCID: PMC8901252.

2\. Shah AY, Patel BC, Panchal BA. Laparoscopic cholecystectomy in-patient with situs inversus. *J Minim Access Surg.* (2006) 2:27–28. 10.4103/0972-9941.25674

3\. AlKhlaiwy O, AlMuhsin AM, Zakarneh E, Taha MY. Laparoscopic cholecystectomy in situs inversus totalis: Case report with review of techniques. Int J Surg Case Rep. 2019;59:208-212. doi: 10.1016/j.ijscr.2019.05.050. Epub 2019 May 31. PMID: 31181389; PMCID: PMC6556755.

Laparoscopic cholecystectomy for chronic cholecystitis with mucocele in situs inversus totalis

In 0.4 to 4.5% of individuals, the common hepatic artery arises from the superior mesenteric artery instead of the celiac trunk. It is a type IX anomaly, commonly referred to as hepatomesenteric trunk, according to the Michels’s comprehensive classification of hepatic arterial anatomy. The surgical strategy should take into account the variations in the vascular pattern of the celiac trunk and its branches. This hepatomesenteric trunk originates from the anterior aspect of the aorta, coursing inferiorly and to the right behind the portal vein to reach the superior border of the superior part of the duodenum, where it divides into the common hepatic artery and into the superior mesenteric artery. In the lesser omentum, after a small course, the common hepatic artery gives off the gastroduodenal artery that continues as the proper hepatic artery. This video aims to highlight a dissection in a patient with a hepatomesenteric trunk anomaly undergoing a laparoscopic pylorus-preserving pancreaticoduodenectomy for an ampullary adenocarcinoma. 

This is the case of 73-year-old man who was evaluated for jaundice. Pancreatic protocol CT-scan showed a periampullary lesion with a dilated biliary tract. Side-viewing endoscopy and endoscopic ultrasound biopsy confirmed the diagnosis, revealing an ampullary adenocarcinoma. On imaging, it was found to be resectable. The tumor board team decided to go for an upfront surgery. Preoperative biliary plastic stenting was performed for cholangitis. A laparoscopic pylorus-preserving pancreaticoduodenectomy with a feeding jejunostomy was performed. The procedure was uneventful, and the patient was discharged on postoperative day 6. Pathological findings revealed please complete 



Bibliography:

1. Kahraman G, Marur T, Tanyeli E, Yildirim M. Hepatomesenteric trunk. Surg Radiol Anat. 2001;23(6):433-5. doi: 10.1007/s00276-001-0433-z. PMID: 11963627.

2. Ramanadham S, Toomay SM, Yopp AC, Balch GC, Sharma R, Schwarz RE, Mansour JC. Rare hepatic arterial anatomic variants in patients requiring pancreatoduodenectomy and review of the literature. Case Rep Surg. 2012;2012:953195. doi: 10.1155/2012/953195. Epub 2012 Jul 30. PMID: 22900221; PMCID: PMC3413978.

3. Noussios G, Dimitriou I, Chatzis I, Katsourakis A. The Main Anatomic Variations of the Hepatic Artery and Their Importance in Surgical Practice: Review of the Literature. J Clin Med Res. 2017 Apr;9(4):248-252. doi: 10.14740/jocmr2902w. Epub 2017 Feb 21. PMID: 28270883; PMCID: PMC5330766.

Laparoscopic pylorus-preserving pancreaticoduodenectomy in a patient with hepatomesenteric trunk anomaly for ampullary adenocarcinoma

Pancréaticoduodénectomie laparoscopique avec préservation du pylore chez un patient présentant une anomalie du tronc hépatomésentérique pour adénocarcinome ampullaire

The most common etiology of pancreatic pseudocyst is acute pancreatitis and exacerbations of chronic pancreatitis, presenting a spontaneous resolution in approximately 50% of cases. Treatment is indicated in persistent symptomatic or complicated pseudocysts. Endoscopic and surgical approaches can be performed (1).

Two treatment options are available: endoscopic treatment, in cysts adjacent to the gastric or duodenal wall, or surgical treatment, which is more invasive, but with a low rate of recurrence and complications, even surpassing endoscopic management.

The video shows the case of a previously healthy 54-year-old male patient with a surgical history of cholecystectomy 14 years earlier. In 2022, he presented two episodes of pancreatitis treated in another institution, which required an endoscopic retrograde cholangiopancreatography (ERCP) to manage the choledocholithiasis in the last episode. The patient complained of abdominal pain. In a follow-up exam and MRI, a 7cm pancreatic pseudocyst was found. Significant oral intolerance was developed by the patient and a new CT-scan was performed. An increase in the cyst’s volume was observed.

The multidisciplinary committee decided to perform an endoscopic ultrasound-guided cystogastrostomy with stent placement. The procedure was complicated with upper gastrointestinal bleeding, which accounts for stent removal. Multiple subsequent endoscopies were performed due to a persistent collection with pigtail placement and necrosectomies.

The patient had an initial good response. However, two months later, he presented with severe abdominal pain associated with vomiting. A control CT-scan showed a cystic recurrence with total disruption of Wirsung’s duct. Due to the failure of the endoscopic treatment, a videolaparoscopic cystogastrostomy was subsequently performed. The patient was discharged on postoperative day 5, and postoperative outcomes were uneventful.

 

<u>Bibliography:</u>

1\. Clark CJ, Ray JW, Pawa S, et al. A location-based anatomic classification system for acute pancreatic fluid collections: Roadmap for optimal intervention in the step-up era. Surg Open Sci. 2024 Jan 15;18:1-5. doi: 10.1016/j.sopen.2024.01.008. PMID: 38312303; PMCID: PMC10831243.

2\. José Luis Martínez-Ordaz, Carlos Toledo-Toral, Norma Franco-Guerrero, Mauro Tun-Abraham, Luis Manuel Souza-Gallardo. Tratamiento quirúrgico del seudoquiste de páncreas \[Surgical treatment of pancreatic pseudocysts]. Cir Cir. 2016 Jul-Aug;84(4):288-92. doi: 10.1016/j.circir.2015.09.001. Epub 2015 Dec 19. PMID: 26707249.

3\. B A Crisanto-Campos, E Arce-Liévano, L E Cárdenas-Lailson, L S Romero-Loera, M E Rojano-Rodríguez, M A Gallardo-Ramírez, J Cabral-Oliver, M Moreno-Portillo. Laparoscopic management of pancreatic pseudocysts: experience at a general hospital in Mexico City. Rev Gastroenterol Mex. 2015 Jul-Sep;80(3):198-204. doi: 10.1016/j.rgmx.2015.05.003. Epub 2015 Aug 3. PMID: 26249139

Laparoscopic cystogastrostomy for pancreatic pseudocyst

Cystogastrostomie laparoscopique pour pseudokyste pancréatique

Video-assisted retroperitoneal debridement (VARD) is a minimally invasive surgical procedure for the management of severe pancreatitis, especially in cases of necrotizing pancreatitis characterized by significant tissue necrosis and infection (1). This technique entails the access to the retroperitoneal space via small incisions in the lumbar region through percutaneous drain guidance and using video-assisted methodologies for the removal of necrotic tissue and for the drainage of fluid collections. VARD presents several potential advantages as compared to conventional open surgical methods, including reduced invasiveness and recovery times. In addition, when associated with the anterior transabdominal approach, it prevents abdominal cavity contamination, hence reducing the risk of open abdomen and enterocutaneous fistulas (2). However, managing patients is challenging. In this video, the authors present the case of a 65-year-old male patient with severe acute pancreatitis complicated by an infected necrosis. A step-up approach was performed using VARD for control after percutaneous drainage failure.&#x20;

Bibliography:

1\. Wei W, Tang Y, Peng Z, Xie J, Deng Z, Yuan T, Tang C, Pi R, Wang S, Zhao S, Wang L, Li C, Wang Y, Zhang P, Wu Z, Wan Y, Ma Y, Tang W, Liang X, Liu K, Wang W, Liang X, Zeng D, Li S, Liu H. Minimal-access video-assisted retroperitoneal and/or transperitoneal debridement (VARTD) in the management of infected walled-off pancreatic necrosis with deep extension: initial experience from a prospective single-arm study. Eur J Med Res. 2023 Feb 9;28(1):72. doi: 10.1186/s40001-023-01030-9. PMID: 36755332; PMCID: PMC9909852.

2\. Horvath K, Freeny P, Escallon J, Heagerty P, Comstock B, Glickerman DJ, Bulger E, Sinanan M, Langdale L, Kolokythas O, Andrews RT. Safety and efficacy of video-assisted retroperitoneal debridement for infected pancreatic collections: a multicenter, prospective, single-arm phase 2 study. Arch Surg. 2010 Sep;145(9):817-25. doi: 10.1001/archsurg.2010.178. PMID: 20855750.

Video-assisted retroperitoneal debridement (VARD) for severe pancreatitis

Débridement rétropéritonéal vidéo-assisté pour pancréatite sévère

Colorectal cancer is the third most common neoplasm worldwide (1). The liver is its main site of metastasis, and 20 to 30% of patients will develop colorectal liver metastasis (2).

The treatment for colorectal cancer with liver metastasis has evolved into a multidisciplinary approach, such as chemotherapy, local ablation, portal vein embolization. However, survival increases dramatically with surgery, and it is therefore considered the gold standard (1, 2).

Radiofrequency ablation or microwave ablation (3) could well be an alternative to deep lesions or lesions which are difficult to access.

Associated liver tourniquet and portal vein ligation for staged hepatectomy (ALTPS) is indicated in cases of unresectable tumors or extensive bilobar disease, as it provides excellent results (4).

The video shows the case of a 38-year-old female patient who was diagnosed with colorectal liver metastases. The primary cancer was resected, and subsequent control chemotherapy and reduction of liver lesions were performed.

Initially, it was decided to perform multiple hepatectomies with parenchyma preservation. Due to the intraoperative discovery of more lesions than expected, it was decided to perform a laparoscopic ALTPS.

 

Bibliography:

1\. Kristel Mils, Laura Lladó, Josefina López-Domínguez, Oriana Barrios, David Leiva, Cristina Santos, Teresa Serrano, Emilio Ramos. Have we improved postoperative and long-term outcomes of liver surgery for colorectal cancer metastasis? Analysis of 1736 hepatectomies performed over 3 decades in a single center. Cir Esp (Engl Ed). 2024 Feb 10:S2173-5077(24)00044-9. doi: 10.1016/j.cireng.2023.11.025. PMID: 38346559.

2\. Pratik Chandra, Greg D Sacks. Contemporary surgical management of colorectal liver metastases. Cancers (Basel). 2024 Feb 26;16(5):941. doi: 10.3390/cancers16050941. PMID: 38473303; PMCID: PMC10930601. PMID: 38473303 PMCID: PMC10930601.

3\. Okan Akhan, Ahmet Gürkan Erdemir, Sevilay Karahan, Emre Ünal, Türkmen Turan Çiftçi, Devrim Akıncı, Şuayib Yalçın. Long-term results of liver thermal ablation in patients with hepatocellular carcinoma and colorectal cancer liver metastasis regarding spatial features and tumor-specific variables. Diagn Interv Radiol 2024 May 13;30(3):183-192. doi: 10.4274/dir.2023.221986. Epub 2023 Mar 20. PMID: 36994643; PMCID: PMC11095064.

4\. Mohammad Golriz, Ali Ramouz, Ahmed Hammad , Ehsan Aminizadeh, Nastaran Sabetkish, Elias Khajeh, Omid Ghamarnejad, Carlos Carvalho, Hugo Rio-Tinto, De-Hua Chang, Ana Alagoa Joao, Gil Goncalves, Arianeb Mehrabi. Promising results of associating liver partition and portal vein ligation for staged hepatectomy for perihilar cholangiocarcinoma in a systematic review and single-arm meta-analysis. Cancers (Basel). 2024 Feb 13;16(4):771. doi: 10.3390/cancers16040771. PMID: 38398162. PMCID: PMC10887221.

Laparoscopic associating liver tourniquet and portal vein ligation for staged hepatectomy (ALTPS) technique for colorectal liver metastases

Technique laparoscopique associant garrot hépatique et ligature de la veine porte pour une hépatectomie par étapes pour métastases hépatiques colorectales

The authors present the case of a 75-year-old man who underwent an elective surgery for chronic cholecystitis. He had a history of high blood pressure under medical treatment. During surgery, a PAECOF systematic dissection technique was performed, leading to a subtotal fenestrating cholecystectomy for a Parkland 5 acute cholecystitis. Using this approach, the authors want to show that even in such cases, laparoscopy is decisive, feasible, and safe with a low complication rate and no bile duct injury. 

Bibliography:

1. Dissanaike, Sharmila MD, FACS*. A Step-by-Step Guide to Laparoscopic Subtotal Fenestrating Cholecystectomy: A Damage Control Approach to the Difficult Gallbladder. Journal of the American College of Surgeons 223(2):p e15-e18, August 2016. | DOI: 10.1016/j.jamcollsurg.2016.05.006.

2. Strasberg, S. M., Pucci, M. J., Brunt, L. M., & Deziel, D. J. Subtotal Cholecystectomy-"Fenestrating" vs "Reconstituting" Subtypes and the Prevention of Bile Duct Injury: Definition of the Optimal Procedure in Difficult Operative Conditions. J Am Coll Surg 2016. 222(1), 89-96. https://doi.org/10.1016/j.jamcollsurg.2015.09.019

3. Zaragoza, Noe MD. Parkland 4 acute cholecystitis PAECIF/PAECOF https://websurg.com/doi/vd01en6684

4. Navez, B. Prevention of bile duct injury (BDI) during cholecystectomy. Acta Chir Belg 2003 Apr;103(2):151-3. doi: 10.1080/00015458.2003.11679399. PMID: 12768856 DOI: 10.1080/00015458.2003.11679399

Parkland 5 acute cholecystitis: bailout strategy 

Cholécystite aiguë, Parkland 5 : stratégie de sauvetage

Focus on hepatobiliary and pancreatic (HPB) surgery

The authors demonstrate a right nephroureterectomy with bladder cuff excision and retroperitoneal lymph node dissection (LND) performed in a strictly laparoscopic fashion. The European Association of Urology (EAU) guidelines recommend template-based lymph node dissection in all patients who plan to undergo radical nephroureterectomy, due to the inaccuracy of preoperative tumor staging (1). The right-side template is renal hilar, paracaval, retrocaval, and intra-aortocaval lymph nodes (2). The frequency of regional lymph node metastasis is as high as 20 to 30%. Lymphadenectomy does not increase overall and serious postoperative complication rates (3). In patients undergoing a laparoscopic nephroureterectomy, open excision of the bladder cuff is associated with a higher risk of intravesical recurrence (4).

Bibliography:

1\. Rouprêt M, Seisen T, Birtle AJ, Capoun O, Compérat EM, Dominguez-Escrig JL, Gürses Andersson I, Liedberg F, Mariappan P, Hugh Mostafid A, Pradere B, van Rhijn BWG, Shariat SF, Rai BP, Soria F, Soukup V, Wood RG, Xylinas EN, Masson-Lecomte A, Gontero P. European Association of Urology Guidelines on Upper Urinary Tract Urothelial Carcinoma: 2023 Update. Eur Urol. 2023 Jul;84(1):49-64. doi: 10.1016/j.eururo.2023.03.013. Epub 2023 Mar 24. PMID: 36967359.

2\. Kondo T, Nakazawa H, Ito F, Hashimoto Y, Toma H, Tanabe K. Primary site and incidence of lymph node metastases in urothelial carcinoma of upper urinary tract. Urology. 2007 Feb;69(2):265-9. doi: 10.1016/j.urology.2006.10.014. PMID: 17320661.

3\. Kanno T, Kobori G, Ito K, Nakagawa H, Takahashi T, Takaoka N, Somiya S, Nagahama K, Ito M, Megumi Y, Higashi Y, Moroi S, Akao T, Yamada H. Complications and their management following retroperitoneal lymph node dissection in conjunction with retroperitoneal laparoscopic radical nephroureterectomy. Int J Urol. 2022 May;29(5):455-461. doi: 10.1111/iju.14814. Epub 2022 Feb 10. PMID: 35144321.

4\. Huang EY, Tai MC, Chung HJ, Chang YH, Huang WJ. Effects of different combinations of radical nephroureterectomy and bladder cuff excision procedures for upper tract urothelial carcinoma on bladder recurrence. Int Braz J Urol. 2023 Jul-Aug;49(4):469-478. doi: 10.1590/S1677-5538.IBJU.2023.0031. PMID: 37267612; PMCID: PMC10482446.

Laparoscopic right nephroureterectomy with bladder cuff excision and lymph node dissection

Néphro-urétérectomie droite laparoscopique avec excision du collet vésical et dissection des ganglions lymphatiques

In this educational video, the authors demonstrate a robotic radical prostatectomy using the da Vinci X™ surgical robotic platform in a patient who had had a simple prostatectomy surgery using the conventional Millin technique 7 years earlier. The case is interesting due to the large amount of fibrosis, scars, and local adhesions, distinct from other cases such as post-TURP, radiotherapy, HIFU or even cases of patients after laparoscopic herniorrhaphy surgery. Of note, in our case, the patient has a large abdominal circumference. Despite a greater technical difficulty, the robotic route proved to be of great value. The patient presented excellent postoperative outcomes.

Bibliography:

1\. Creta M, Manfredi C, Arcaniolo D, Spirito L, A Kaplan S, H Woo H, De Nunzio C, Gilling P, Bach T, De Sio M, Imbimbo C, Mirone V, Longo N, Fusco F. Functional and oncological outcomes after radical prostatectomy in patients with history of surgery for lower urinary tract symptoms related to benign prostatic enlargement: A systematic review with meta-analysis. Prostate Cancer Prostatic Dis. 2024 Sep;27(3):367-384. doi: 10.1038/s41391-023-00678-y. Epub 2023 May 27. PMID: 37244971

2\. Gacci M, Sebastianelli A, Salvi M, De Nunzio C, Tubaro A, Gravas S, Moncada I, Serni S, Maggi M, Vignozzi L. The Impact of Central Obesity on Storage Luts and Urinary Incontinence After Prostatic Surgery. Curr Urol Rep. 2016 Sep;17(9):61. doi: 10.1007/s11934-016-0620-4. PMID: 27432378

3\. Su YK, F Katz B, S Sehgal S, S Yu SJ, Su YC, Lightfoot A, Lee Z, Llukani E, Monahan K, I Lee K. Does previous transurethral prostate surgery affect oncologic and continence outcomes after RARP? J Robot Surg. 2015 Dec;9(4):291-7. doi: 10.1007/s11701-015-0529-9. Epub 2015 Aug 8. PMID: 26530840

4\. Tugcu V, Atar A, Sahin S, Kargi T, Gokhan Seker K, Ilker Comez Y, IhsanTasci A. Robot-Assisted Radical Prostatectomy After Previous Prostate Surgery. JSLS. 2015 Sep-Dec;19(4):e2015.00080. doi: 10.4293/JSLS.2015.00080. PMID: 26648678 PMCID: PMC4653581

Robotic radical prostatectomy after simple prostatectomy with Millin technique 

Prostatectomie radicale robotisée après prostatectomie simple selon la technique de Millin 

In this authoritative lecture, Dr. Filippo Annino, MD, outlines the technical principles of robotic urinary diversion after cystectomy. Step-by-step techniques for robotic urinary diversion after radical cystectomy are presented.&#x20;
The first focus is on the ERAS protocol for fast-track surgery, which facilitates a faster recovery for patients.
The author also details the operating room set-up, the port placement for pelvic surgery, and the techniques to improve bowel mobilization during the reconstruction phase.
In the reconstruction phase, the video demonstrates how to identify the precise point to cut the ileum, using specific landmarks to aid orientation and minimize the risk of errors. The proper orientation of the stapler (robotic or laparoscopic) is also explained.
Regarding urinary diversions, every step is meticulously detailed for both the ileal conduit and the neobladder, adhering to the Bordeaux technique.
This stepwise approach is systematically applied to all bladder cancer patients undergoing robotic cystectomy with urinary diversion. Performing this procedure with precision simplifies its execution, reducing the risk of intraoperative errors and decreasing surgical duration.

Technical principles of robotic urinary diversion after cystectomy

Principes techniques de la dérivation urinaire robotique après cystectomie

In this authoritative lecture, Professor Rafael Coelho, MD, PhD outlines robot-assisted radical cystectomy (RARC).

Robotic assisted radical cystectomy (RARC)

Cystectomie radicale assistée par robot

In this authoritative lecture, Dr. Simone Crivellaro, MD, MHA outlines the role of single port robotic surgery in urology.&#x20;

Role of single port robotic surgery in urology 

Rôle de la chirurgie robotique à trocart unique en urologie

Over the years, many therapies have been launched for prostate cancer. Brachytherapy has had great prominence in the recent past. In this video, the authors demonstrate rescue surgery after more than 15 years after the implantation of more than 80 implants in the prostate parenchyma and the recurrent changes of this radiation. Recent studies demonstrate a higher recurrence rate after this procedure when compared to other techniques. In addition to biochemical relapse, the patient presented symptoms and signs of lower urinary tract symptoms (LUTS), with a worsening in quality of life. 



Bibliography:

1. A Systematic Review and Meta-analysis of Local Salvage Therapies After Radiotherapy for Prostate Cancer (MASTER). Review Eur Urol. 2021 Sep;80(3):280-292. doi: 10.1016/j.eururo.2020.11.010. Epub 2020 Dec 11

2. Effect of Brachytherapy With External Beam Radiation Therapy Versus Brachytherapy Alone for Intermediate-Risk Prostate Cancer: NRG Oncology RTOG 0232 Randomized Clinical Trial. Randomized Controlled Trial J Clin Oncol. 2023 Aug 20;41(24):4035-4044. doi: 10.1200/JCO.22.01856. Epub 2023 Jun 14

3. Salvage Radical Prostatectomy for Recurrent Prostate Cancer: A Systematic Review (French ccAFU). Review Cancers (Basel). 2023 Nov 20;15(22):5485. doi: 10.3390/cancers15225485

4. Clinical Outcomes of Robotic Surgery Compared to Conventional Surgical Approaches (Laparoscopic or Open): A Systematic Overview of Reviews. Ann Surg. 2021 Mar 1;273(3):467-473. doi: 10.1097/SLA.0000000000003915

Robotic radical prostatectomy in post-brachytherapy using the Versius surgical robotic platform

Prostatectomie radicale robotisée en post-brachythérapie à l'aide de la plateforme robotique chirurgicale Versius

In this educational video, the authors demonstrate a laparoscopic Boari flap and psoas hitch for the treatment of a left middle ureter injury in a patient undergoing Hartman sigmoidectomy and colostomy for the treatment of a complicated diverticulitis. The combination of the two techniques, Boari flap and psoas hitch, was first described by Kelâmi et al. (3). This technique can bridge up to 18cm of missing ureter with tension-free anastomosis (2). Some authors have reported that the length/width of the bladder flap should be no more than 3:1, and that the base of the flap should be no less than 4cm (1). Laparoscopy offers similar results to the open technique with a shorter hospital stay (4). Closing the colostomy with a gauze pad and nylon suture leaves the abdominal wall with more space for placing the trocars. Using a Foley catheter with the tip cut off facilitates the passage of the double-J catheter.

Bibliography:

1\. Guangpu Ding, Sida Cheng, Xinfei Li, Dong Fang, Kunlin Yang, Qi Tang, Peng Zhang, Han Hao, Xuesong Li, Liqun Zhou. Experience managing distal ureteral strictures with Boari flap-psoas hitch and comparison of open and laparoscopic procedures. Transl Androl Urol 2021;10(1):56-65 | [http://dx.doi.org/10.21037/tau-20-789.](http://dx.doi.org/10.21037/tau-20-789.) PMID: 33532296

2\. Ankur Bansal, Rahul Janak Sinha, Ankur Jhanwar, Gaurav Prakash, Bimalesh Purkait, Vishwajeet Singh. Laparoscopic ureteral reimplantation with Boari flap for the management of long- segment ureteral defect: A case series with review of the literature. Turk J Urol 2017; 43(3): 313-8. DOI: 10.5152/tud.2017.44520. PMID: 28861304

3\. A. Kelâmi, U. Fiedler, V. Schmidt, A. Rost, M. Richter-Reichhelm, H. H. Hildebrand, and F. Weichler-Wolfgramm. Replacement of the Ureter Using the Urinary Bladder. Urol Res. 1973 Dec;1(4):161-5. DOI: 10.1007/BF00256617. PMID: 4789024

4\. Fugita OE, Dinlenc C, Kavoussi L. The laparoscopic Boari flap. J Urol. 2001 Jul;166(1):51-3. PMID: 11435821.

Laparoscopic Boari flap and psoas hitch for the management of a left mid-ureter injury

Confection d'un lambeau de Boari sur vessie psoïque par voie d'abord laparoscopique pour prise en charge d'une lésion de l'uretère moyen

Focus sur la chirurgie urologique laparoscopique et robotique

Focus on laparoscopic and robotic urologic surgery

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