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Rodrigo FERNANDES

MD
Instituto do Cancer do Estado de São Paulo
São Paulo, Brazil
37 videos
160.7K views
28 comments
4.7K likes
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In bag morcellation of a uterine fibroid
For a long time, morcellation of an undiagnosed malignancy, an old and frightening topic, has been a matter of extensive discussions. Clinicians and pathologists still lack instruments to clearly diagnose specific pathologies such as leiomyosarcomas. Minimally invasive surgery brought numerous advantages for the patient. However, morcellation is a key issue for the extraction of a large uterus and myomas. In this video, we present an option for the extraction of myomas. By insufflating a large Endobag®, a virtual abdominal cavity is created, and the mass is morcellated under direct vision. The resistant bag works not only as a protection for the abdominal cavity in case of an undiagnosed malignancy, but also serves to deviate organs from the morcellator.
Surgical intervention
4 years ago
3514 views
132 likes
0 comments
06:37
In bag morcellation of a uterine fibroid
For a long time, morcellation of an undiagnosed malignancy, an old and frightening topic, has been a matter of extensive discussions. Clinicians and pathologists still lack instruments to clearly diagnose specific pathologies such as leiomyosarcomas. Minimally invasive surgery brought numerous advantages for the patient. However, morcellation is a key issue for the extraction of a large uterus and myomas. In this video, we present an option for the extraction of myomas. By insufflating a large Endobag®, a virtual abdominal cavity is created, and the mass is morcellated under direct vision. The resistant bag works not only as a protection for the abdominal cavity in case of an undiagnosed malignancy, but also serves to deviate organs from the morcellator.
Laparoscopic ileocaecal and sigmoid resection with transanal natural orifice specimen extraction (NOSE) for endometriosis
In 12 to 30% of endometriosis cases, the disease is located in the bowel. Caecum and small bowel endometriosis are found in only 3.6% and 7% respectively of those cases while the sigmoid colon and the rectum are most commonly affected in 85% of cases. The laparoscopic management of this disease has evolved drastically over the last decade, and even delicate cases such as small bowel endometriosis can be completely managed by laparoscopy. It is key to be locally invasive towards the disease but conservative with regards to organ function preservation. The specimen will be extracted through natural orifices and without any ileostomy. Our patients are commonly young and healthy women who will certainly benefit from a tailored surgery with immediate symptom relief in addition to minimum abdominal scarring can have a significant positive impact on patient’s psychological well-being and subsequent recovery.
In the present case, we present a 36-year old woman who was diagnosed with endometriosis and presented with 3 episodes of bowel pseudo-obstruction and dyschezia, and put under medical treatment. She was found to have multiple endometriotic nodules, with concurrent ileocaecal and rectosigmoid disease, for which a double bowel resection with transanal natural orifice specimen extraction (NOSE) was performed without complications.
Surgical intervention
5 years ago
1994 views
46 likes
0 comments
38:15
Laparoscopic ileocaecal and sigmoid resection with transanal natural orifice specimen extraction (NOSE) for endometriosis
In 12 to 30% of endometriosis cases, the disease is located in the bowel. Caecum and small bowel endometriosis are found in only 3.6% and 7% respectively of those cases while the sigmoid colon and the rectum are most commonly affected in 85% of cases. The laparoscopic management of this disease has evolved drastically over the last decade, and even delicate cases such as small bowel endometriosis can be completely managed by laparoscopy. It is key to be locally invasive towards the disease but conservative with regards to organ function preservation. The specimen will be extracted through natural orifices and without any ileostomy. Our patients are commonly young and healthy women who will certainly benefit from a tailored surgery with immediate symptom relief in addition to minimum abdominal scarring can have a significant positive impact on patient’s psychological well-being and subsequent recovery.
In the present case, we present a 36-year old woman who was diagnosed with endometriosis and presented with 3 episodes of bowel pseudo-obstruction and dyschezia, and put under medical treatment. She was found to have multiple endometriotic nodules, with concurrent ileocaecal and rectosigmoid disease, for which a double bowel resection with transanal natural orifice specimen extraction (NOSE) was performed without complications.
Bowel obstruction: a late complication after laparoscopic colposacropexy
This video illustrates the case of a patient with bowel adherent to an exposed portion of mesh used for treatment of a previous apical prolapse. The patient presents with abdominal symptoms following a laparoscopic sacrocolpopexy.
In this video, Professor Wattiez performs an extensive pelvic adhesiolysis, detaching the bowel from the mesh, and identifying adequate correction of vaginal prolapse, without any sign of infection. Reperitonization of the vaginal vault and the long arm (sacrum arm) of the mesh was also performed.
This unique case highlights the importance of peritonization when using mesh. Complications such as mesh exposure may occur, however this can be appropriately managed laparoscopically.
Surgical intervention
6 years ago
1890 views
37 likes
0 comments
23:25
Bowel obstruction: a late complication after laparoscopic colposacropexy
This video illustrates the case of a patient with bowel adherent to an exposed portion of mesh used for treatment of a previous apical prolapse. The patient presents with abdominal symptoms following a laparoscopic sacrocolpopexy.
In this video, Professor Wattiez performs an extensive pelvic adhesiolysis, detaching the bowel from the mesh, and identifying adequate correction of vaginal prolapse, without any sign of infection. Reperitonization of the vaginal vault and the long arm (sacrum arm) of the mesh was also performed.
This unique case highlights the importance of peritonization when using mesh. Complications such as mesh exposure may occur, however this can be appropriately managed laparoscopically.