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Cynthia SOLANO

Hôpitaux Universitaires de Strasbourg
Strasbourg, France
MD
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Dealing with vascular variation: laparoscopic cholecystectomy
This video describes the technique of laparoscopic cholecystectomy for symptomatic cholelithiasis with intraoperative cholangiography.
The key steps are presented: exploration, exposure, dissection of Calot’s triangle, intraoperative cholangiography, clipping and division, gallbladder bed dissection.
This technique is well standardized for the management of this condition.
The authors use intraoperative cholangiography for symptomatic cholelithiasis. To dissect Calot’s triangle, the authors first place grasping forceps through the epigastric trocar to grasp the gallbladder’s fundus and retract it cephalad and toward the patient’s right shoulder. They use a second grasping forceps on the infundibulum and retract the gallbladder laterally and caudally, thus opening Calot’s triangle. They start the dissection close at the junction of the infundibulum with the cystic duct, then incise the anterior and posterior peritoneal leaflets to access the vascular and biliary elements of Calot’s triangle. They then skeletonize the cystic duct and cystic artery.
Surgical intervention
11 years ago
3363 views
127 likes
0 comments
09:14
Dealing with vascular variation: laparoscopic cholecystectomy
This video describes the technique of laparoscopic cholecystectomy for symptomatic cholelithiasis with intraoperative cholangiography.
The key steps are presented: exploration, exposure, dissection of Calot’s triangle, intraoperative cholangiography, clipping and division, gallbladder bed dissection.
This technique is well standardized for the management of this condition.
The authors use intraoperative cholangiography for symptomatic cholelithiasis. To dissect Calot’s triangle, the authors first place grasping forceps through the epigastric trocar to grasp the gallbladder’s fundus and retract it cephalad and toward the patient’s right shoulder. They use a second grasping forceps on the infundibulum and retract the gallbladder laterally and caudally, thus opening Calot’s triangle. They start the dissection close at the junction of the infundibulum with the cystic duct, then incise the anterior and posterior peritoneal leaflets to access the vascular and biliary elements of Calot’s triangle. They then skeletonize the cystic duct and cystic artery.
Laparoscopic Collis-Nissen procedure for failed fundoplication
This video shows a laparoscopic Collis-Nissen gastroplasty in a patient with a previous Nissen fundoplication which was performed using an open approach.
Despite an extensive mobilization, it was not possible to achieve an adequate length of intra-abdominal esophagus. A short esophagus was diagnosed and the surgeon performs a Collis gastroplasty. The hiatus is repaired with interrupted non-absorbable sutures. A Nissen fundoplication is performed.
This patient had a previous Nissen fundoplication using an open approach. After extensive mobilization, the surgeons diagnose a short esophagus and perform a Collis gastroplasty. They repair the hiatus with interrupted non-absorbable sutures, and perform a Nissen fundoplication. Once they complete the dissection, the authors assess the length of the esophagus. The video shows the authors placing tape around the gastroesophageal junction at the level of the hiatus. The junction between the stomach and the esophagus is at the level of the hiatus, a sign evocative of a short esophagus.
Surgical intervention
11 years ago
2291 views
11 likes
0 comments
14:36
Laparoscopic Collis-Nissen procedure for failed fundoplication
This video shows a laparoscopic Collis-Nissen gastroplasty in a patient with a previous Nissen fundoplication which was performed using an open approach.
Despite an extensive mobilization, it was not possible to achieve an adequate length of intra-abdominal esophagus. A short esophagus was diagnosed and the surgeon performs a Collis gastroplasty. The hiatus is repaired with interrupted non-absorbable sutures. A Nissen fundoplication is performed.
This patient had a previous Nissen fundoplication using an open approach. After extensive mobilization, the surgeons diagnose a short esophagus and perform a Collis gastroplasty. They repair the hiatus with interrupted non-absorbable sutures, and perform a Nissen fundoplication. Once they complete the dissection, the authors assess the length of the esophagus. The video shows the authors placing tape around the gastroesophageal junction at the level of the hiatus. The junction between the stomach and the esophagus is at the level of the hiatus, a sign evocative of a short esophagus.