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Joseph NASSIF

American University of Beirut Medical Center
Beirut, Lebanon
MD
3.5K likes
198.9K views
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Complications of endometriosis surgery
This lecture focuses on complications in laparoscopic surgery for endometriosis. First, the expert addresses how to define complications. Surgeons sometimes need to remove part of the adjacent structures such as bowel, vagina and ureter, which should be included in the surgery – to achieve a complete excision of the disease. Complications can always occur and the most important thing to be borne in mind is to know how to deal with them by laparoscopy.
Complications may include adhesions, bowel, ureter and vascular injuries. The rate of complications in rectal shaving ranges from 0.2 to 1.4%. In case of discoid bowel resection, the morbidity rate published in the literature is 13%. Regarding rectal segmental resection, the rate of complications in laparoscopy (4.25%) is similar to that of laparotomy (4.5%). The rate of rectovaginal fistula in case of rectal shaving is 8.3%, and in rectal segmental resection 3.1%, which is not associated with the distance between the anastomosis and the rectum. Voiding problems are frequent and the incidence of urinary retention ranges from 1 to 29% and depends on the interval of observation. Finally, in case of ureteral endometriosis, a double J catheter should be always placed in order to decrease the risk of ureteral fistula.
Lecture
7 years ago
1595 views
37 likes
0 comments
18:10
Complications of endometriosis surgery
This lecture focuses on complications in laparoscopic surgery for endometriosis. First, the expert addresses how to define complications. Surgeons sometimes need to remove part of the adjacent structures such as bowel, vagina and ureter, which should be included in the surgery – to achieve a complete excision of the disease. Complications can always occur and the most important thing to be borne in mind is to know how to deal with them by laparoscopy.
Complications may include adhesions, bowel, ureter and vascular injuries. The rate of complications in rectal shaving ranges from 0.2 to 1.4%. In case of discoid bowel resection, the morbidity rate published in the literature is 13%. Regarding rectal segmental resection, the rate of complications in laparoscopy (4.25%) is similar to that of laparotomy (4.5%). The rate of rectovaginal fistula in case of rectal shaving is 8.3%, and in rectal segmental resection 3.1%, which is not associated with the distance between the anastomosis and the rectum. Voiding problems are frequent and the incidence of urinary retention ranges from 1 to 29% and depends on the interval of observation. Finally, in case of ureteral endometriosis, a double J catheter should be always placed in order to decrease the risk of ureteral fistula.
Laparoscopic sacrocolpopexy with subtotal hysterectomy: the six points technique
Standardization means: implementing guidelines or measurements in order to obtain solutions to a disorganized system. Laparoscopic sacrocolpopexy is a long and complete surgical procedure that requires good knowledge of the anatomy and of the surgical technique, as well as advanced suturing skills. Laparoscopic sacrocolpopexy is also the gold standard procedure for POP repair, and its standardization is justified by its difficulty.
This video demonstrates the standard technique for laparoscopic sacrocolpopexy with sub-total hysterectomy. It is called “the six-point technique” due to the six stitches used to fix the meshes.
Surgical intervention
8 years ago
8519 views
102 likes
0 comments
28:50
Laparoscopic sacrocolpopexy with subtotal hysterectomy: the six points technique
Standardization means: implementing guidelines or measurements in order to obtain solutions to a disorganized system. Laparoscopic sacrocolpopexy is a long and complete surgical procedure that requires good knowledge of the anatomy and of the surgical technique, as well as advanced suturing skills. Laparoscopic sacrocolpopexy is also the gold standard procedure for POP repair, and its standardization is justified by its difficulty.
This video demonstrates the standard technique for laparoscopic sacrocolpopexy with sub-total hysterectomy. It is called “the six-point technique” due to the six stitches used to fix the meshes.
Laparoscopic hysterectomy: removal of a large (1300g) uterus
Some believe that laparoscopy is almost impossible to perform in cases of very big uterus or large adnexal masses that obstruct our view to the pelvis. However, if the same surgical steps are always followed and a specific strategy is determined, it is feasible and safe to choose laparoscopy even in the case of large organs. In this video, we present the case of a 45-year-old patient with a large fibromatous uterus, suffering from abdominal discomfort and bleeding. The patient was anemic and decision was made to perform a laparoscopic total hysterectomy. With the appropriate surgical steps and some safety tips, the operation took place quickly and with success. The weight of the specimen was 1300g.
Surgical intervention
9 years ago
5388 views
54 likes
0 comments
10:21
Laparoscopic hysterectomy: removal of a large (1300g) uterus
Some believe that laparoscopy is almost impossible to perform in cases of very big uterus or large adnexal masses that obstruct our view to the pelvis. However, if the same surgical steps are always followed and a specific strategy is determined, it is feasible and safe to choose laparoscopy even in the case of large organs. In this video, we present the case of a 45-year-old patient with a large fibromatous uterus, suffering from abdominal discomfort and bleeding. The patient was anemic and decision was made to perform a laparoscopic total hysterectomy. With the appropriate surgical steps and some safety tips, the operation took place quickly and with success. The weight of the specimen was 1300g.
Laparoscopic myomectomy: tips 'n tricks
Surgery is the treatment of choice for myomas. Myomectomy has undergone a dramatic evolution over the years. Laparoscopic myomectomy provides a preferable alternative to abdominal myomectomy for women with symptomatic fibroids who desire uterine preservation. It is also an excellent method for women who have infertility primarily related to fibroids. A lot of patients prefer myomectomy over hysterectomy even if they do not desire pregnancy. However, laparoscopic myomectomy is not easy and needs some practice. Together with the basic steps, some tips and tricks are provided to make this technique even more safe and feasible for surgeons. For good results, the use of a few technical tricks provides an optimal solution for all issues.
Surgical intervention
9 years ago
10090 views
192 likes
0 comments
08:35
Laparoscopic myomectomy: tips 'n tricks
Surgery is the treatment of choice for myomas. Myomectomy has undergone a dramatic evolution over the years. Laparoscopic myomectomy provides a preferable alternative to abdominal myomectomy for women with symptomatic fibroids who desire uterine preservation. It is also an excellent method for women who have infertility primarily related to fibroids. A lot of patients prefer myomectomy over hysterectomy even if they do not desire pregnancy. However, laparoscopic myomectomy is not easy and needs some practice. Together with the basic steps, some tips and tricks are provided to make this technique even more safe and feasible for surgeons. For good results, the use of a few technical tricks provides an optimal solution for all issues.
Laparoscopic total hysterectomy and unilateral adnexectomy with resection of urinary bladder nodule for endometriosis
This video demonstrates the technique of a total laparoscopic hysterectomy with unilateral adnexectomy and the excision of a vesical endometriotic nodule.
This patient is a 46-year-old lady with a previous surgical history of one laparotomy for a hemoperitoneum (endometriotic ovarian cyst rupture) and 6 laparoscopies because of endometriosis, the last one 3 years ago with a segmental sigmoid resection. After this last surgery, the patient starts to complain of dysmenorrhea, chronic pelvic pain and dysuria. She has never had any urinary infection.
Because of urinary stress incontinence, she had botulinic toxin injection and underwent a cystoscopy, which revealed a bladder nodule.
Surgical intervention
9 years ago
614 views
31 likes
0 comments
10:14
Laparoscopic total hysterectomy and unilateral adnexectomy with resection of urinary bladder nodule for endometriosis
This video demonstrates the technique of a total laparoscopic hysterectomy with unilateral adnexectomy and the excision of a vesical endometriotic nodule.
This patient is a 46-year-old lady with a previous surgical history of one laparotomy for a hemoperitoneum (endometriotic ovarian cyst rupture) and 6 laparoscopies because of endometriosis, the last one 3 years ago with a segmental sigmoid resection. After this last surgery, the patient starts to complain of dysmenorrhea, chronic pelvic pain and dysuria. She has never had any urinary infection.
Because of urinary stress incontinence, she had botulinic toxin injection and underwent a cystoscopy, which revealed a bladder nodule.
Laparoscopic treatment of a chronic mesh infection 4 years after sacral colpopexy
In this video, we present the case of a late infectious complication after abdominal hysterectomy and sacral colpopexy using mesh interposition. We demonstrate the complete laparoscopic removal of the infected mesh, including excision of all the affected surrounding tissue. This is the case of a 57-year-old patient who had a total hysterectomy with bilateral adnexectomy and sacrocolpopexy in 2005. In 2009, she started to complain of an abundant, continuous and smelly vaginal discharge. The microbiological exam revealed a vaginal infection by Proteus mirabilis and the gynecologic examination showed a painful vaginal tumor with a drainage hole.
Surgical intervention
9 years ago
3992 views
25 likes
0 comments
09:55
Laparoscopic treatment of a chronic mesh infection 4 years after sacral colpopexy
In this video, we present the case of a late infectious complication after abdominal hysterectomy and sacral colpopexy using mesh interposition. We demonstrate the complete laparoscopic removal of the infected mesh, including excision of all the affected surrounding tissue. This is the case of a 57-year-old patient who had a total hysterectomy with bilateral adnexectomy and sacrocolpopexy in 2005. In 2009, she started to complain of an abundant, continuous and smelly vaginal discharge. The microbiological exam revealed a vaginal infection by Proteus mirabilis and the gynecologic examination showed a painful vaginal tumor with a drainage hole.
Laparoscopic hysterectomy with adnexectomy
This video demonstrates the technique of a total laparoscopic hysterectomy with adnexectomy. Our patient is a 44-year-old lady with Tamoxifen-induced endometrial hyperplasia, which failed to respond to medical treatment.
Umbilical incision is made on the left internal border to give a more aesthetic scar.
Direct entry is performed. The assistant helps to lift the abdomen while the surgeon directs the trocar perpendicularly towards the rectus sheath first, then directs it towards the pelvis. The midline port is inserted: this should be at a slightly higher level than the lateral ports for better ergonomics. The uterine manipulator has a rotating ceramic valve for opening the vagina and a set of rings to maintain the pneumoperitoneum. The procedure is started by coagulating and cutting the round ligament on the left and opening the broad ligament. The broad ligament is opened parallel to the infundibulopelvic ligament for adnexectomy and a window is made over the grey area. The posterior leaf of the broad ligament is opened towards the left uterosacral ligament. The anterior leaf of the broad ligament is opened towards the vagina by dissecting the space and coagulating and cutting the tissues in between. The dissection is continued until the uterine artery is reached. The left infundibulopelvic ligament is coagulated and cut. The same procedure is done on the other side. Bladder dissection is performed with the help of the assistant holding up the bladder and entering the vesicovaginal space. The bladder is dissected away, beyond the valve of the manipulator. The left uterine artery is coagulated and cut. The left uterosacral ligament is coagulated and cut. The right uterine vessels are coagulated and cut followed by the uterosacral ligament. The vagina is now cut against the valve of the manipulator using a monopolar hook. Bleeding points are coagulated with a bipolar forceps. The vagina is sutured in two layers using extracorporeal knots. The procedure is now complete and hemostasis is confirmed. This patient had a favourable postoperative outcome and was discharged on postoperative day 1.
Surgical intervention
10 years ago
10086 views
96 likes
0 comments
23:00
Laparoscopic hysterectomy with adnexectomy
This video demonstrates the technique of a total laparoscopic hysterectomy with adnexectomy. Our patient is a 44-year-old lady with Tamoxifen-induced endometrial hyperplasia, which failed to respond to medical treatment.
Umbilical incision is made on the left internal border to give a more aesthetic scar.
Direct entry is performed. The assistant helps to lift the abdomen while the surgeon directs the trocar perpendicularly towards the rectus sheath first, then directs it towards the pelvis. The midline port is inserted: this should be at a slightly higher level than the lateral ports for better ergonomics. The uterine manipulator has a rotating ceramic valve for opening the vagina and a set of rings to maintain the pneumoperitoneum. The procedure is started by coagulating and cutting the round ligament on the left and opening the broad ligament. The broad ligament is opened parallel to the infundibulopelvic ligament for adnexectomy and a window is made over the grey area. The posterior leaf of the broad ligament is opened towards the left uterosacral ligament. The anterior leaf of the broad ligament is opened towards the vagina by dissecting the space and coagulating and cutting the tissues in between. The dissection is continued until the uterine artery is reached. The left infundibulopelvic ligament is coagulated and cut. The same procedure is done on the other side. Bladder dissection is performed with the help of the assistant holding up the bladder and entering the vesicovaginal space. The bladder is dissected away, beyond the valve of the manipulator. The left uterine artery is coagulated and cut. The left uterosacral ligament is coagulated and cut. The right uterine vessels are coagulated and cut followed by the uterosacral ligament. The vagina is now cut against the valve of the manipulator using a monopolar hook. Bleeding points are coagulated with a bipolar forceps. The vagina is sutured in two layers using extracorporeal knots. The procedure is now complete and hemostasis is confirmed. This patient had a favourable postoperative outcome and was discharged on postoperative day 1.