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Rafael RESTREPO

Fundación Jiménez Díaz, Madrid, Universidad Autónoma
Madrid, Spain
MD
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Subtotal gastrectomy and D1+ lymphadenectomy for distal stage IB gastric cancer with preservation of an accessory left hepatic artery
This video shows a partial gastrectomy in a 63-year-old woman with a stage IB gastric cancer located at the distal third of the stomach. The lesion was located using intraoperatory endoscopy. We found an accessory left hepatic artery originating from the left gastric artery, which was preserved. The gastrojejunostomy was performed in a Roux-en-Y fashion. The alimentary limb was ascended through the transverse mesocolon. The jejunojejunostomy was performed in a latero-lateral fashion with closure of the ostium with simple Ethibond 2/0 stitches. The skin incision used for trocar placement in the upper left abdomen (right hand of the surgeon) was slightly enlarged to allow for specimen extraction.
Surgical intervention
2 years ago
2779 views
233 likes
0 comments
11:41
Subtotal gastrectomy and D1+ lymphadenectomy for distal stage IB gastric cancer with preservation of an accessory left hepatic artery
This video shows a partial gastrectomy in a 63-year-old woman with a stage IB gastric cancer located at the distal third of the stomach. The lesion was located using intraoperatory endoscopy. We found an accessory left hepatic artery originating from the left gastric artery, which was preserved. The gastrojejunostomy was performed in a Roux-en-Y fashion. The alimentary limb was ascended through the transverse mesocolon. The jejunojejunostomy was performed in a latero-lateral fashion with closure of the ostium with simple Ethibond 2/0 stitches. The skin incision used for trocar placement in the upper left abdomen (right hand of the surgeon) was slightly enlarged to allow for specimen extraction.
Laparoscopic gastric bypass after open vertical banded gastroplasty
This video shows a laparoscopic reintervention after an open vertical banded gastroplasty in a 51-year-old woman presenting with untreatable gastroesophageal reflux disease (GERD). GERD originated from gastric remnant outlet obstruction. For that reason, we decided to perform a laparoscopic Roux-en-Y gastric bypass. First, very intense adhesions of the greater omentum and the stomach to the parietal peritoneum and the left lobe of the liver are dissected. The gastric remnant is dissected in order to transect it proximally to the stenotic, banded segment. A Roux-en-Y gastric bypass with a 50cm alimentary limb using the OrVil™ orogastric tube and the DST Series™ EEA™ 25mm circular stapling device is performed.
Surgical intervention
3 years ago
1648 views
36 likes
0 comments
12:54
Laparoscopic gastric bypass after open vertical banded gastroplasty
This video shows a laparoscopic reintervention after an open vertical banded gastroplasty in a 51-year-old woman presenting with untreatable gastroesophageal reflux disease (GERD). GERD originated from gastric remnant outlet obstruction. For that reason, we decided to perform a laparoscopic Roux-en-Y gastric bypass. First, very intense adhesions of the greater omentum and the stomach to the parietal peritoneum and the left lobe of the liver are dissected. The gastric remnant is dissected in order to transect it proximally to the stenotic, banded segment. A Roux-en-Y gastric bypass with a 50cm alimentary limb using the OrVil™ orogastric tube and the DST Series™ EEA™ 25mm circular stapling device is performed.
Relaxing incision for crural repair in type III paraesophageal hernia
This video shows the laparoscopic repair of a large type III paraesophageal hernia in a 55-year-old woman. After dissection of the hernia sac, partial resection is performed. Very high intramediastinal dissection of the esophagus is performed, taking special care not to injure the posterior and anterior vagal trunk. First, as the hiatal defect is very large, a right relaxing incision is performed. The crural repair is performed by interrupted Ethibond® 2/0 stitches buttressed with a polypropylene mesh. Finally, the diaphragmatic defect is covered with a non-reabsorbable mesh (Physiomesh™) and a 180-degree posterior fundoplication is performed.
Surgical intervention
3 years ago
2095 views
79 likes
0 comments
09:13
Relaxing incision for crural repair in type III paraesophageal hernia
This video shows the laparoscopic repair of a large type III paraesophageal hernia in a 55-year-old woman. After dissection of the hernia sac, partial resection is performed. Very high intramediastinal dissection of the esophagus is performed, taking special care not to injure the posterior and anterior vagal trunk. First, as the hiatal defect is very large, a right relaxing incision is performed. The crural repair is performed by interrupted Ethibond® 2/0 stitches buttressed with a polypropylene mesh. Finally, the diaphragmatic defect is covered with a non-reabsorbable mesh (Physiomesh™) and a 180-degree posterior fundoplication is performed.
Laparoscopic repair of a giant type III paraesophageal hernia with mesenteric-axial gastric volvulus
This video demonstrates a laparoscopic repair of a giant type III paraesophageal hernia with an associated mesenteric-axial gastric volvulus in a 61-year-old woman. Dissection of the hernia sac was difficult because the esophageal hiatus was not very enlarged and the overlying peritoneum was very thickened because of chronic hernia incarceration. Once the stomach was replaced into the peritoneal cavity, mediastinal mobilization of the esophagus up to the pulmonary vein was performed. After crural repair, a standard posterior fundoplication was performed, as the intra-abdominal esophageal length was adequate.
Surgical intervention
3 years ago
1739 views
54 likes
0 comments
13:44
Laparoscopic repair of a giant type III paraesophageal hernia with mesenteric-axial gastric volvulus
This video demonstrates a laparoscopic repair of a giant type III paraesophageal hernia with an associated mesenteric-axial gastric volvulus in a 61-year-old woman. Dissection of the hernia sac was difficult because the esophageal hiatus was not very enlarged and the overlying peritoneum was very thickened because of chronic hernia incarceration. Once the stomach was replaced into the peritoneal cavity, mediastinal mobilization of the esophagus up to the pulmonary vein was performed. After crural repair, a standard posterior fundoplication was performed, as the intra-abdominal esophageal length was adequate.
Insulinoma of the pancreatic tail: left pancreatic resection with preservation of the spleen
This video shows a left pancreatic resection with splenic preservation in a 56-year-old woman. The patient has a visible insulinoma (1cm in diameter) located at the lower border of the pancreatic tail. The pancreatic tail is 3 to 4cm distant to the splenic hilum, which facilitates the dissection. Trocar position is similar to the one used in gastric laparoscopic surgery. First, the gastrocolic ligament is divided, and the stomach is retracted to the right side of the patient, along with the left lobe of the liver. After dissection of retrogastric adhesions, the peritoneum is incised on the lower border of the pancreas to get access to the retropancreatic area. The splenic artery is dissected on the upper pancreatic border and encircled with a vessel loop. The last retropancreatic attachments are taken down and the splenic vein is dissected and encircled with a vessel loop. Once the splenic vessels are retracted, the pancreatic transection is performed with a linear stapler. The last adhesions from the pancreatic tail to the splenic vessels are dissected with the LigaSure™ vessel-sealing device, making sure to preserve the splenic vessels. Finally, the resected pancreatic tail is placed in a specimen retrieval bag (Endobag®) and extracted through the trocar incision in the upper left abdomen. Hemostasis is checked while making sure that splenic perfusion is adequate.
Surgical intervention
4 years ago
1803 views
44 likes
0 comments
10:03
Insulinoma of the pancreatic tail: left pancreatic resection with preservation of the spleen
This video shows a left pancreatic resection with splenic preservation in a 56-year-old woman. The patient has a visible insulinoma (1cm in diameter) located at the lower border of the pancreatic tail. The pancreatic tail is 3 to 4cm distant to the splenic hilum, which facilitates the dissection. Trocar position is similar to the one used in gastric laparoscopic surgery. First, the gastrocolic ligament is divided, and the stomach is retracted to the right side of the patient, along with the left lobe of the liver. After dissection of retrogastric adhesions, the peritoneum is incised on the lower border of the pancreas to get access to the retropancreatic area. The splenic artery is dissected on the upper pancreatic border and encircled with a vessel loop. The last retropancreatic attachments are taken down and the splenic vein is dissected and encircled with a vessel loop. Once the splenic vessels are retracted, the pancreatic transection is performed with a linear stapler. The last adhesions from the pancreatic tail to the splenic vessels are dissected with the LigaSure™ vessel-sealing device, making sure to preserve the splenic vessels. Finally, the resected pancreatic tail is placed in a specimen retrieval bag (Endobag®) and extracted through the trocar incision in the upper left abdomen. Hemostasis is checked while making sure that splenic perfusion is adequate.
Laparoscopic redo Nissen posterior fundoplication
This video shows a reintervention after laparoscopic Nissen-Rossetti due to failure of the technique in a 70-year-old woman presenting with a history of dysphagia and weight loss beginning short after surgery.
First, dissection of the fundic wrap and esophageal hiatus are completed in order to expose specific anatomical landmarks that would help us understand the possible causes for the failure of the first procedure.
The original fundoplication is then unwrapped, rearranging it to the original anatomical position. This maneuver allows us to understand the causes for the technique’s failure, which can be accounted for by the asymmetrical position of the fundoplication caused by a series of elements. First, the short gastric vessels were not dissected during the first surgery, this probably contributed to the malposition of the right flap, which emerges from the posterior mid-stomach wall, distal to the fundus. On the other hand, the right flap emerges from the para-esophageal proximal edge of the lesser curvature; this causes the “valve” to be angulated and rotated clockwise, “hiding” the fundoplication on the posterior gastric wall.
To complete the procedure, a Toupet fundoplication is performed as a substituting anti-reflux technique.
Surgical intervention
5 years ago
3605 views
75 likes
0 comments
10:37
Laparoscopic redo Nissen posterior fundoplication
This video shows a reintervention after laparoscopic Nissen-Rossetti due to failure of the technique in a 70-year-old woman presenting with a history of dysphagia and weight loss beginning short after surgery.
First, dissection of the fundic wrap and esophageal hiatus are completed in order to expose specific anatomical landmarks that would help us understand the possible causes for the failure of the first procedure.
The original fundoplication is then unwrapped, rearranging it to the original anatomical position. This maneuver allows us to understand the causes for the technique’s failure, which can be accounted for by the asymmetrical position of the fundoplication caused by a series of elements. First, the short gastric vessels were not dissected during the first surgery, this probably contributed to the malposition of the right flap, which emerges from the posterior mid-stomach wall, distal to the fundus. On the other hand, the right flap emerges from the para-esophageal proximal edge of the lesser curvature; this causes the “valve” to be angulated and rotated clockwise, “hiding” the fundoplication on the posterior gastric wall.
To complete the procedure, a Toupet fundoplication is performed as a substituting anti-reflux technique.