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Cristina REDONDO GUISASOLA

Instituto Universitario Dexeus
Barcelona, Spain
MD
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Vascular anomalies found by retroperitoneal laparoscopic para-aortic lymphadenectomy
The retroperitoneum is an area of great interest in gynecologic oncology. The knowledge of the anatomy and potential vascular anomalies, which can be found, can help prevent complications.
The retroperitoneal vascular anomalies are often asymptomatic. Their prevalence ranges between 2.4 and 30% according to the published literature.
Its diagnosis includes imaging techniques or it can be made during surgery.
Although the presence of these variations may go unnoticed, different potential complications can be devastating (e.g., hemorrhage, loss of organs or even death).
In this video, the authors demonstrate some variations of retroperitoneal vessels diagnosed during the practice of retroperitoneal laparoscopic para-aortic lymphadenectomy performed in gynecologic cancer patients (advanced cervical cancer, endometrial carcinoma, and ovarian cancer in early stages).
In our case series of 60 procedures performed during 2011, 2012, and 2013, vascular anatomical anomalies are 33.33% (20 cases) and all of them were diagnosed during surgery.
First, the anomaly of the renal vascular territory (arterial or venous) was the most frequent, followed by anomalies which affect gonadal vessels, and finally by great vessel anomalies.
Surgical intervention
4 years ago
2144 views
61 likes
0 comments
13:28
Vascular anomalies found by retroperitoneal laparoscopic para-aortic lymphadenectomy
The retroperitoneum is an area of great interest in gynecologic oncology. The knowledge of the anatomy and potential vascular anomalies, which can be found, can help prevent complications.
The retroperitoneal vascular anomalies are often asymptomatic. Their prevalence ranges between 2.4 and 30% according to the published literature.
Its diagnosis includes imaging techniques or it can be made during surgery.
Although the presence of these variations may go unnoticed, different potential complications can be devastating (e.g., hemorrhage, loss of organs or even death).
In this video, the authors demonstrate some variations of retroperitoneal vessels diagnosed during the practice of retroperitoneal laparoscopic para-aortic lymphadenectomy performed in gynecologic cancer patients (advanced cervical cancer, endometrial carcinoma, and ovarian cancer in early stages).
In our case series of 60 procedures performed during 2011, 2012, and 2013, vascular anatomical anomalies are 33.33% (20 cases) and all of them were diagnosed during surgery.
First, the anomaly of the renal vascular territory (arterial or venous) was the most frequent, followed by anomalies which affect gonadal vessels, and finally by great vessel anomalies.
Laparoscopic treatment of a deep endometriotic nodule in the ischiatic tuberosity
In this challenging surgery performed by Professor Arnaud Wattiez, we present the case of a 39-year-old woman suffering from deep infiltrating endometriosis and infertility with no previous surgeries. The patient presented with chronic pelvic pain, dyschezia, and dyspareunia. Preoperative workup included MRI and rectosigmoidoscopy. MRI revealed a nodule at the level of the right uterosacral ligament. Rectosigmoidoscopy revealed a bulging of the anterior rectal wall located at 6cm from the anal verge where biopsy revealed fibrosis. The patient’s physical examination demonstrated the presence of a retrouterine nodule at the site of the right uterosacral ligament measuring 3cm.
Surgical intervention
6 years ago
2057 views
35 likes
0 comments
03:00
Laparoscopic treatment of a deep endometriotic nodule in the ischiatic tuberosity
In this challenging surgery performed by Professor Arnaud Wattiez, we present the case of a 39-year-old woman suffering from deep infiltrating endometriosis and infertility with no previous surgeries. The patient presented with chronic pelvic pain, dyschezia, and dyspareunia. Preoperative workup included MRI and rectosigmoidoscopy. MRI revealed a nodule at the level of the right uterosacral ligament. Rectosigmoidoscopy revealed a bulging of the anterior rectal wall located at 6cm from the anal verge where biopsy revealed fibrosis. The patient’s physical examination demonstrated the presence of a retrouterine nodule at the site of the right uterosacral ligament measuring 3cm.
Laparoscopic oophorectomy for solid ovarian mass
We present the case of a 28-year-old woman with no relevant previous surgical or medical history. The patient was addressed for the removal of a right ovarian mass. She presented with dysmenorrhea and occasional dyspareunia. There were no other symptoms. Her physical examination showed a right adnexal mass to the vaginal touch. Preoperative work-up included a pelvic ultrasound, which showed a tumor apparently originating from the right ovary, of solid homogeneous appearance. MRI confirmed the presence of the solid mass, measuring approximately 6cm. No other pathological findings were present in the rest of the abdominal cavity. Tumor markers were negative. The patient had not completed childbearing and desired a conservative surgical approach. The different aspects of the surgical management were explained, including the possibility of performing an oophorectomy if no healthy ovarian tissue could be identified.
Surgical intervention
6 years ago
5452 views
83 likes
0 comments
08:33
Laparoscopic oophorectomy for solid ovarian mass
We present the case of a 28-year-old woman with no relevant previous surgical or medical history. The patient was addressed for the removal of a right ovarian mass. She presented with dysmenorrhea and occasional dyspareunia. There were no other symptoms. Her physical examination showed a right adnexal mass to the vaginal touch. Preoperative work-up included a pelvic ultrasound, which showed a tumor apparently originating from the right ovary, of solid homogeneous appearance. MRI confirmed the presence of the solid mass, measuring approximately 6cm. No other pathological findings were present in the rest of the abdominal cavity. Tumor markers were negative. The patient had not completed childbearing and desired a conservative surgical approach. The different aspects of the surgical management were explained, including the possibility of performing an oophorectomy if no healthy ovarian tissue could be identified.
Laparoscopic segmental resection in a patient with deep infiltrating endometriosis
We present the case of a 33-year-old-woman suffering from deep infiltrating endometriosis. In her previous history, three laparoscopies had been performed due to endometriosis. In the first two laparoscopies, bilateral ovarian cystectomies had been carried out while the third laparoscopy had been indicated to puncture the ovaries after hormonal stimulation for in vitro fertilization (IVF), due to the impossibility of reaching follicles transvaginally.
The patient presented with dysmenorrhea, dyspareunia and dyschezia, as well as rectorrhagia and diarrhea. The patient’s physical examination demonstrated the presence of a retrouterine mass suggestive of adhesions. Preoperative work-up included MRI and colonoscopy. MRI showed an endometriotic nodule affecting the rectosigmoid junction and infiltrating its wall. A colonoscopy was performed and allowed to visualize the endometriotic nodule.
Surgical intervention
6 years ago
2680 views
31 likes
0 comments
18:50
Laparoscopic segmental resection in a patient with deep infiltrating endometriosis
We present the case of a 33-year-old-woman suffering from deep infiltrating endometriosis. In her previous history, three laparoscopies had been performed due to endometriosis. In the first two laparoscopies, bilateral ovarian cystectomies had been carried out while the third laparoscopy had been indicated to puncture the ovaries after hormonal stimulation for in vitro fertilization (IVF), due to the impossibility of reaching follicles transvaginally.
The patient presented with dysmenorrhea, dyspareunia and dyschezia, as well as rectorrhagia and diarrhea. The patient’s physical examination demonstrated the presence of a retrouterine mass suggestive of adhesions. Preoperative work-up included MRI and colonoscopy. MRI showed an endometriotic nodule affecting the rectosigmoid junction and infiltrating its wall. A colonoscopy was performed and allowed to visualize the endometriotic nodule.
Laparoscopic colposacropexy for the treatment of an apical defect in a patient with previous total hysterectomy
We present the case of a 69-year-old patient who suffered from an elytrocele. Previously, she had undergone a total hysterectomy with anterior and posterior colpoperineoplasty due to the presence of a grade 2 cystocele, without urinary incontinence. The management of genital prolapse requires a thorough knowledge of the anatomy and physiology of the female pelvic floor. This video outlines the main steps to follow for the repair of an apical defect with no true rectocele or cystocele. It also offers a very good insight of the specific issues to be considered when performing dissection and mesh fixation in specific situations, such as distortion of the normal anatomy due to the scarring process from a previous surgery and obesity. This surgery was performed and streamed live.
Surgical intervention
6 years ago
4588 views
79 likes
0 comments
18:00
Laparoscopic colposacropexy for the treatment of an apical defect in a patient with previous total hysterectomy
We present the case of a 69-year-old patient who suffered from an elytrocele. Previously, she had undergone a total hysterectomy with anterior and posterior colpoperineoplasty due to the presence of a grade 2 cystocele, without urinary incontinence. The management of genital prolapse requires a thorough knowledge of the anatomy and physiology of the female pelvic floor. This video outlines the main steps to follow for the repair of an apical defect with no true rectocele or cystocele. It also offers a very good insight of the specific issues to be considered when performing dissection and mesh fixation in specific situations, such as distortion of the normal anatomy due to the scarring process from a previous surgery and obesity. This surgery was performed and streamed live.
Lumbo-aortic lymphadenectomy: improving exposure with the T’lift™ device
Lymph node dissection in the lumbo-aortic area is a challenging procedure. The main concerns during surgery include the risk of major vascular injury and the potential lesion of other structures such as the ureter or the duodenum. A thorough surgical strategy and adequate exposure are mandatory to reduce the possibility of complications.
During this surgical demonstration, the most important aspects of the strategy are discussed. Special emphasis is put on exposure and the use of the T’lift™ device is shown. This simple technique allows for a fast and safe suspension of the peritoneum, improving the visualization of the operative field.
Surgical intervention
6 years ago
4386 views
60 likes
0 comments
15:01
Lumbo-aortic lymphadenectomy: improving exposure with the T’lift™ device
Lymph node dissection in the lumbo-aortic area is a challenging procedure. The main concerns during surgery include the risk of major vascular injury and the potential lesion of other structures such as the ureter or the duodenum. A thorough surgical strategy and adequate exposure are mandatory to reduce the possibility of complications.
During this surgical demonstration, the most important aspects of the strategy are discussed. Special emphasis is put on exposure and the use of the T’lift™ device is shown. This simple technique allows for a fast and safe suspension of the peritoneum, improving the visualization of the operative field.