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Pedro LEÃO

University of Minho
Braga, Portugal
MD, PhD
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Laparoscopic treatment of a giant mesenteric cyst
Mesenteric cysts are very rare entities (annually worldwide estimated incidence of 1/140 000 inhabitants). They do not have pathognomonic features and require a differential diagnosis with lymphangiomas, sarcomas, adenocarcinomas, and intestinal duplications. They typically appear more in women (twice the incidence) and are mostly benign swellings (malignancy rate of about 3%). The gold standard treatment is laparoscopic surgical resection.
The case is that of a 49-year-old female patient referred for an abdominal swelling in the periumbilical region, which was uncomfortable for the patient, namely in the contraction of the abdominals. She did not describe any changes in intestinal transit, anorexia, asthenia or associated weight loss. The imaging study by computer tomography documented a "cystic lesion of 13cm in the root of the mesentery in contact with great vessels and duodenum". The patient was resected laparoscopically in March 2016, discharged on the second postoperative day, without intercurrences. The video of the mesenteric cyst excision surgery demonstrates some of the risks of the laparoscopic approach of the mesentery and underlines the possibility of dissection of these cysts even when they are giant cysts and in close relation with vital structures such as the vena cava and the iliac arteries.
Surgical intervention
2 years ago
1391 views
95 likes
0 comments
04:09
Laparoscopic treatment of a giant mesenteric cyst
Mesenteric cysts are very rare entities (annually worldwide estimated incidence of 1/140 000 inhabitants). They do not have pathognomonic features and require a differential diagnosis with lymphangiomas, sarcomas, adenocarcinomas, and intestinal duplications. They typically appear more in women (twice the incidence) and are mostly benign swellings (malignancy rate of about 3%). The gold standard treatment is laparoscopic surgical resection.
The case is that of a 49-year-old female patient referred for an abdominal swelling in the periumbilical region, which was uncomfortable for the patient, namely in the contraction of the abdominals. She did not describe any changes in intestinal transit, anorexia, asthenia or associated weight loss. The imaging study by computer tomography documented a "cystic lesion of 13cm in the root of the mesentery in contact with great vessels and duodenum". The patient was resected laparoscopically in March 2016, discharged on the second postoperative day, without intercurrences. The video of the mesenteric cyst excision surgery demonstrates some of the risks of the laparoscopic approach of the mesentery and underlines the possibility of dissection of these cysts even when they are giant cysts and in close relation with vital structures such as the vena cava and the iliac arteries.
Laparoscopic intraperitoneal mesh repair of a parastomal hernia
A 73-year-old male patient, previously submitted to a radical cystoprostatectomy with ileal conduit as urinary diversion for urothelial cancer, was admitted to the emergency department because of stomal tumefaction and malfunction. There was no evidence of oncologic relapse.
CT-scan revealed an abscess in the parastomal area as well as a parastomal hernia. The abscess was treated with percutaneous drainage and antibiotics. In a second time, he was submitted to a laparoscopic correction of the parastomal defect.
The procedure was performed with no-flexible cameras and straight laparoscopic instruments. For defect correction, a laparoscopic intraperitoneal mesh repair (IPOM) technique was used.
No complications were observed and the patient was discharged on postoperative day 6.
Surgical intervention
3 years ago
2522 views
78 likes
0 comments
08:27
Laparoscopic intraperitoneal mesh repair of a parastomal hernia
A 73-year-old male patient, previously submitted to a radical cystoprostatectomy with ileal conduit as urinary diversion for urothelial cancer, was admitted to the emergency department because of stomal tumefaction and malfunction. There was no evidence of oncologic relapse.
CT-scan revealed an abscess in the parastomal area as well as a parastomal hernia. The abscess was treated with percutaneous drainage and antibiotics. In a second time, he was submitted to a laparoscopic correction of the parastomal defect.
The procedure was performed with no-flexible cameras and straight laparoscopic instruments. For defect correction, a laparoscopic intraperitoneal mesh repair (IPOM) technique was used.
No complications were observed and the patient was discharged on postoperative day 6.
Monopolar laparoscopic appendectomy
The laparoscopic approach is the gold standard for acute appendicitis. There are several surgical devices to achieve hemostatic control of the appendicular artery (monopolar electrocautery, endoclip, endostapler, ultrasonic scalpel, and LigaSure™ vessel-sealing device), which vary widely according to the surgeon’s preference and availability in the institution. All devices are effective and safe, but monopolar electrocautery systems are the most cost-effective ones.
A 24-year-old woman was admitted to our emergency department with a 24-hour evolution of right iliac fossa pain. No other symptoms were noted. An abdominal ultrasound was suggestive of an acute appendicitis.
This full length surgical movie shows the feasibility and safety of monopolar electrocautery for meso-appendiceal dissection. The intra-abdominal procedure was achieved in 5 minutes 30 seconds.
No complications were observed and the patient was discharged home on the next postoperative day.
Surgical intervention
4 years ago
9843 views
333 likes
0 comments
06:14
Monopolar laparoscopic appendectomy
The laparoscopic approach is the gold standard for acute appendicitis. There are several surgical devices to achieve hemostatic control of the appendicular artery (monopolar electrocautery, endoclip, endostapler, ultrasonic scalpel, and LigaSure™ vessel-sealing device), which vary widely according to the surgeon’s preference and availability in the institution. All devices are effective and safe, but monopolar electrocautery systems are the most cost-effective ones.
A 24-year-old woman was admitted to our emergency department with a 24-hour evolution of right iliac fossa pain. No other symptoms were noted. An abdominal ultrasound was suggestive of an acute appendicitis.
This full length surgical movie shows the feasibility and safety of monopolar electrocautery for meso-appendiceal dissection. The intra-abdominal procedure was achieved in 5 minutes 30 seconds.
No complications were observed and the patient was discharged home on the next postoperative day.