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Federico COSTANTINO

Hôpitaux Civils de Colmar
Colmar, France
MD
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Laparoscopic distal pancreatectomy for mucinous cystadenoma
This video presents the case of a 39-year-old woman complaining of epigastric and right upper quadrant pain with dorsal irradiation and postprandial pain without nausea or vomiting. Abdominal ultrasound showed the presence of a 21mm cystic mass with multi-lobulated appearance at the tail of the pancreas. MRI confirmed the cystic nature of this tumor lesion of the tail of the pancreas, which was probably compatible with a mucinous cystadenoma (with a 23mm long axis) without communication with Wirsung’s duct. Transgastric echo-endoscopy revealed an ovoid cystic lesion of the pancreatic tail, with clean wall, measuring 19 by 10mm with small septa and a 4mm thick mural nodule without communication with the pancreatic duct. A laparoscopic left pancreatectomy was indicated because of the presence of a mucinous cystadenoma. This video demonstrates a laparoscopic distal pancreatectomy approach. A spleen-preserving distal pancreatectomy by preserving the splenic vessels (Kimura technique) was decided upon.
Surgical intervention
3 years ago
2011 views
95 likes
0 comments
12:01
Laparoscopic distal pancreatectomy for mucinous cystadenoma
This video presents the case of a 39-year-old woman complaining of epigastric and right upper quadrant pain with dorsal irradiation and postprandial pain without nausea or vomiting. Abdominal ultrasound showed the presence of a 21mm cystic mass with multi-lobulated appearance at the tail of the pancreas. MRI confirmed the cystic nature of this tumor lesion of the tail of the pancreas, which was probably compatible with a mucinous cystadenoma (with a 23mm long axis) without communication with Wirsung’s duct. Transgastric echo-endoscopy revealed an ovoid cystic lesion of the pancreatic tail, with clean wall, measuring 19 by 10mm with small septa and a 4mm thick mural nodule without communication with the pancreatic duct. A laparoscopic left pancreatectomy was indicated because of the presence of a mucinous cystadenoma. This video demonstrates a laparoscopic distal pancreatectomy approach. A spleen-preserving distal pancreatectomy by preserving the splenic vessels (Kimura technique) was decided upon.
Right hemicolectomy for appendicular mucocele
The appendicular mucocele is defined by a dilation of the appendix and an unusual accumulation of mucus within its lumen. It is a rare pathology which affects 0.25% of the population.
Its histological discovery is made during the postoperative phase in nearly 70% of cases. Appendicular mucoceles, which are secondary to a muco-secretive tumor, can potentially be a problem if they are malignant, especially in case of preoperative or intraoperative rupture, with a risk of gelatinous disease of the peritoneum.
The positive diagnosis is based on a histological study, which must be systematic, for all appendectomy specimens. Preoperatively, it is essential to recognize an appendicular mucocele, in order to properly adapt the surgical technique, and to potentially envisage a more global surgical resection technique.
We present the case of a 70-year-old man, treated in our unit for right iliac fossa abscess in which an explorative laparoscopy was decided upon after one month of medical treatment.
Surgical intervention
5 years ago
5393 views
89 likes
0 comments
07:16
Right hemicolectomy for appendicular mucocele
The appendicular mucocele is defined by a dilation of the appendix and an unusual accumulation of mucus within its lumen. It is a rare pathology which affects 0.25% of the population.
Its histological discovery is made during the postoperative phase in nearly 70% of cases. Appendicular mucoceles, which are secondary to a muco-secretive tumor, can potentially be a problem if they are malignant, especially in case of preoperative or intraoperative rupture, with a risk of gelatinous disease of the peritoneum.
The positive diagnosis is based on a histological study, which must be systematic, for all appendectomy specimens. Preoperatively, it is essential to recognize an appendicular mucocele, in order to properly adapt the surgical technique, and to potentially envisage a more global surgical resection technique.
We present the case of a 70-year-old man, treated in our unit for right iliac fossa abscess in which an explorative laparoscopy was decided upon after one month of medical treatment.
Laparoscopic exploration after Roux-en-Y gastric bypass following intestinal obstruction
This video demonstrates a laparoscopic exploration in a female patient who had undergone a gastric bypass in 2002. Her BMI was 58 at that time. Now it is 20. She had been operated on for an incisional hernia that occurred at the level of the former umbilical optical port site. She suffered from several episodes of proven mechanical bowel obstruction and benefited from medical treatment.
However, despite a thorough preoperative work-up, including gastroscopy, colonoscopy and repeat CT-scan studies performed over 6 months, the mechanical origin of the bowel obstruction was difficult to demonstrate. Since the patient had chronic, cramp-like abdominal pain, the exploration of the abdominal cavity using the former port entry sites is decided upon.
Surgical intervention
9 years ago
190 views
2 likes
0 comments
06:17
Laparoscopic exploration after Roux-en-Y gastric bypass following intestinal obstruction
This video demonstrates a laparoscopic exploration in a female patient who had undergone a gastric bypass in 2002. Her BMI was 58 at that time. Now it is 20. She had been operated on for an incisional hernia that occurred at the level of the former umbilical optical port site. She suffered from several episodes of proven mechanical bowel obstruction and benefited from medical treatment.
However, despite a thorough preoperative work-up, including gastroscopy, colonoscopy and repeat CT-scan studies performed over 6 months, the mechanical origin of the bowel obstruction was difficult to demonstrate. Since the patient had chronic, cramp-like abdominal pain, the exploration of the abdominal cavity using the former port entry sites is decided upon.
Perigastric band abscess: laparoscopic approach
Band infection after gastric banding is a relatively rare complication. In most cases, it manifests itself through abdominal pain associated with fever, and/or an abscess surrounding the access port. This is the case of a 37-year-old female patient in whom a gastric band was placed 5 years ago. The patient lost 60% of her excess weight; however, she complained that the gastric band was no longer as efficient. Imaging studies allowed to identify the existence of a 50mL supragastric pouch. A gastroscopy reveals nothing unusual.
Following this postoperative control, we decided to remove the patient’s gastric band as she was troubled by the superior gastric pouch.
Surgical intervention
9 years ago
231 views
21 likes
0 comments
06:13
Perigastric band abscess: laparoscopic approach
Band infection after gastric banding is a relatively rare complication. In most cases, it manifests itself through abdominal pain associated with fever, and/or an abscess surrounding the access port. This is the case of a 37-year-old female patient in whom a gastric band was placed 5 years ago. The patient lost 60% of her excess weight; however, she complained that the gastric band was no longer as efficient. Imaging studies allowed to identify the existence of a 50mL supragastric pouch. A gastroscopy reveals nothing unusual.
Following this postoperative control, we decided to remove the patient’s gastric band as she was troubled by the superior gastric pouch.
Laparoscopic total gastrectomy for pT2 N0 M0 adenocarcinoma of the lesser curvature of the stomach
Totally laparoscopic gastrectomy for cancer remains limited because of technical problems, expecially for lymphadenectomy. We present the case of a 75-year-old patient with no specific history in which an adenocarcinoma of the lesser curvature of the stomach was found. An endoscopic ultrasound had shown a UST3 N0 lesion. The CT-scan confirmed the absence of secondary lesion and a neoadjuvant chemotherapy was carried out. Following chemotherapy, a re-evaluation was performed and confirmed the 2 by 2cm lesion of the lesser curvature of the stomach without secondary lesion. The decision to perform a laparoscopic total gastrectomy was made.
Surgical intervention
9 years ago
7617 views
24 likes
0 comments
15:53
Laparoscopic total gastrectomy for pT2 N0 M0 adenocarcinoma of the lesser curvature of the stomach
Totally laparoscopic gastrectomy for cancer remains limited because of technical problems, expecially for lymphadenectomy. We present the case of a 75-year-old patient with no specific history in which an adenocarcinoma of the lesser curvature of the stomach was found. An endoscopic ultrasound had shown a UST3 N0 lesion. The CT-scan confirmed the absence of secondary lesion and a neoadjuvant chemotherapy was carried out. Following chemotherapy, a re-evaluation was performed and confirmed the 2 by 2cm lesion of the lesser curvature of the stomach without secondary lesion. The decision to perform a laparoscopic total gastrectomy was made.
Laparoscopic appendectomy following transparietal drainage of an abscess
Patients presenting with complicated appendicitis represent a common and challenging problem. Conflicting data exist concerning optimal treatment of these patients with primary versus delayed appendectomy. This video shows the case of a 48-year-old female patient operated upon previously for a collection at the rectouterine (Douglas') pouch following a suspected acute appendicitis. A laparoscopic exploration was performed along with a laparoscopic drainage of the collection, but the appendix had not been identified. Fifteen days later and the patient presents with a 15cm residual collection for which we performed a puncture under CT-scan guidance. Following a 3-month interval, the patient is admitted to our Department to perform an appendectomy.
Surgical intervention
9 years ago
3127 views
23 likes
2 comments
04:05
Laparoscopic appendectomy following transparietal drainage of an abscess
Patients presenting with complicated appendicitis represent a common and challenging problem. Conflicting data exist concerning optimal treatment of these patients with primary versus delayed appendectomy. This video shows the case of a 48-year-old female patient operated upon previously for a collection at the rectouterine (Douglas') pouch following a suspected acute appendicitis. A laparoscopic exploration was performed along with a laparoscopic drainage of the collection, but the appendix had not been identified. Fifteen days later and the patient presents with a 15cm residual collection for which we performed a puncture under CT-scan guidance. Following a 3-month interval, the patient is admitted to our Department to perform an appendectomy.
Laparoscopic sigmoidectomy with ventral and posterior indirect rectopexy for rectal prolapse in a female patient
Rectal prolapse is an uncommon disease mainly seen in patients of advanced age.
In the last few years, the laparoscopic route has been shown to be feasible and has the advantage of being a minimally invasive technique. The objective of this film is to demonstrate a technique for the repair of rectal prolapse with sigmoidectomy. This is the case of a 72-year-old woman with a previous history of hysterectomy presenting also with dyschezia and moderate incontinence and a grade III rectal prolapse. Defecography showed a prolapse of the upper rectum with an enterocele without any associated rectocele in spite of the hysterectomy.
Surgical intervention
10 years ago
2575 views
136 likes
0 comments
10:26
Laparoscopic sigmoidectomy with ventral and posterior indirect rectopexy for rectal prolapse in a female patient
Rectal prolapse is an uncommon disease mainly seen in patients of advanced age.
In the last few years, the laparoscopic route has been shown to be feasible and has the advantage of being a minimally invasive technique. The objective of this film is to demonstrate a technique for the repair of rectal prolapse with sigmoidectomy. This is the case of a 72-year-old woman with a previous history of hysterectomy presenting also with dyschezia and moderate incontinence and a grade III rectal prolapse. Defecography showed a prolapse of the upper rectum with an enterocele without any associated rectocele in spite of the hysterectomy.
Stepwise approach for laparoscopic reversal of Hartmann's procedure
Restoration of intestinal continuity following reversal of Hartmann's procedure is an operation associated with a lengthy hospital stay, protracted convalescence, and a high morbidity rate. The advantages of minimally invasive surgery such as rapid mobilization, less postoperative pain, early restoration of bowel function, and a rapid return to a normal diet, and reduced morbidity are very useful in this procedure. Furthermore, laparoscopic reversal of Hartmann's has a comparable operative time with the open technique when performed by experienced surgeons like in this case. This interesting video shows each step of the procedure clearly. Three ports are used and the colon is divided intra-abdominally.
Surgical intervention
10 years ago
2389 views
117 likes
0 comments
10:05
Stepwise approach for laparoscopic reversal of Hartmann's procedure
Restoration of intestinal continuity following reversal of Hartmann's procedure is an operation associated with a lengthy hospital stay, protracted convalescence, and a high morbidity rate. The advantages of minimally invasive surgery such as rapid mobilization, less postoperative pain, early restoration of bowel function, and a rapid return to a normal diet, and reduced morbidity are very useful in this procedure. Furthermore, laparoscopic reversal of Hartmann's has a comparable operative time with the open technique when performed by experienced surgeons like in this case. This interesting video shows each step of the procedure clearly. Three ports are used and the colon is divided intra-abdominally.
Laparoscopic Roux-en-Y gastric bypass after vertical banded gastroplasty
Patients who have undergone bariatric surgery and present with upper abdominal symptoms pose a diagnostic and management challenge.
Laparoscopic vertical banded gastroplasty (VBG) is associated with high revisional rates. In the case of failed VBG, repeat VBG seems to be a poor option and conversion to gastric bypass yields better results.
This is the case of a 35-year-old female patient who underwent a vertical banded gastroplasty by laparotomy 8 years ago and presents with dysphagia. A gastroscopy and a contrast swallow exam using radio-opaque markers do not show any fistulas, but peroperative surgical exploration discovers a gastro-gastric fistula. This video clearly shows all the technical aspects of a revisional bariatric procedure.
Surgical intervention
10 years ago
715 views
30 likes
0 comments
12:17
Laparoscopic Roux-en-Y gastric bypass after vertical banded gastroplasty
Patients who have undergone bariatric surgery and present with upper abdominal symptoms pose a diagnostic and management challenge.
Laparoscopic vertical banded gastroplasty (VBG) is associated with high revisional rates. In the case of failed VBG, repeat VBG seems to be a poor option and conversion to gastric bypass yields better results.
This is the case of a 35-year-old female patient who underwent a vertical banded gastroplasty by laparotomy 8 years ago and presents with dysphagia. A gastroscopy and a contrast swallow exam using radio-opaque markers do not show any fistulas, but peroperative surgical exploration discovers a gastro-gastric fistula. This video clearly shows all the technical aspects of a revisional bariatric procedure.
Laparoscopic treatment of an incarcerated right femoral hernia in a female patient
Femoral hernia is predominantly a female disorder. Incarcerated femoral hernia is a common surgical emergency condition. Diagnosis is always obvious and straightforward by clinical examination, and open surgical repair was the mainstay of treatment. In the era of minimally invasive surgery, laparoscopic repair of femoral hernia has been shown to be feasible and safe. This video shows the laparoscopic trans-abdominal preperitoneal repair of a right femoral hernia in a female patient who has had an appendectomy and who presented to emergencies with pain in the right inguinal region associated with nausea and vomiting. This procedure was performed by a skilled surgeon fellow telementored by Prof. Leroy, a world-renowned expert in laparoscopic hernia repair surgery.
Surgical intervention
10 years ago
3150 views
215 likes
0 comments
05:53
Laparoscopic treatment of an incarcerated right femoral hernia in a female patient
Femoral hernia is predominantly a female disorder. Incarcerated femoral hernia is a common surgical emergency condition. Diagnosis is always obvious and straightforward by clinical examination, and open surgical repair was the mainstay of treatment. In the era of minimally invasive surgery, laparoscopic repair of femoral hernia has been shown to be feasible and safe. This video shows the laparoscopic trans-abdominal preperitoneal repair of a right femoral hernia in a female patient who has had an appendectomy and who presented to emergencies with pain in the right inguinal region associated with nausea and vomiting. This procedure was performed by a skilled surgeon fellow telementored by Prof. Leroy, a world-renowned expert in laparoscopic hernia repair surgery.