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Andrea SPOTA

Università degli studi di Milano
Milan, Italy
MD
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Minimally invasive Ivor-Lewis esophagectomy for end-stage achalasia
Achalasia is the most frequent esophageal motility disorder. Although Heller myotomy is the standard treatment, achieving good results in 90 to 95% of cases, esophagectomy could be the last surgical chance to treat end-stage achalasia and might be considered if severe symptomatic (dysphagia, regurgitation), anatomical (megaesophagus) or functional (esophagus aperistalses) disorders are not relieved with a more conservative approach.
Clinical case: We present the case of a 21-year-old female patient suffering from esophageal achalasia from the age of 3. After numerous attempts to grant her a good quality of life in a conservative way, when she gets to end-stage achalasia without any benefits from endoscopic therapies, a minimally invasive Ivor-Lewis esophagectomy is put forward to her in order to relieve her symptoms. Discussion/Conclusion: Esophagectomy could be performed in patients who are fit for major surgery and present with disabling symptoms, poor quality of life, and dolichomegaesophagus unresponsive to multiple endoscopic dilatations and/or surgical myotomies.
Surgical intervention
2 months ago
1281 views
15 likes
1 comment
13:39
Minimally invasive Ivor-Lewis esophagectomy for end-stage achalasia
Achalasia is the most frequent esophageal motility disorder. Although Heller myotomy is the standard treatment, achieving good results in 90 to 95% of cases, esophagectomy could be the last surgical chance to treat end-stage achalasia and might be considered if severe symptomatic (dysphagia, regurgitation), anatomical (megaesophagus) or functional (esophagus aperistalses) disorders are not relieved with a more conservative approach.
Clinical case: We present the case of a 21-year-old female patient suffering from esophageal achalasia from the age of 3. After numerous attempts to grant her a good quality of life in a conservative way, when she gets to end-stage achalasia without any benefits from endoscopic therapies, a minimally invasive Ivor-Lewis esophagectomy is put forward to her in order to relieve her symptoms. Discussion/Conclusion: Esophagectomy could be performed in patients who are fit for major surgery and present with disabling symptoms, poor quality of life, and dolichomegaesophagus unresponsive to multiple endoscopic dilatations and/or surgical myotomies.
Laparoscopic distal gastrectomy with Roux-en-Y reconstruction for a prepyloric lesion: a live educational procedure
This is the case of a 70-year-old patient who underwent an esophagogastroduodenoscopy for gastric pain. The exam showed a 0.5cm prepyloric ulcerated lesion with Helicobacter pylori infection. After Helicobacter pylori eradication and a CT-scan negative for secondary lesions, the patient was scheduled for a distal gastrectomy with perioperative gastroscopy.
In this original live educational video, Dr. Woo Jin Hyung describes his technique of laparoscopic distal gastrectomy with Roux-en-Y reconstruction and discusses several topics such as the comparison between laparoscopic and robotic gastrectomy, the indication for omentectomy, the choice of the surgical strategy considering the tumor location, the benefit of fluorescence in lymphatic mapping, the type of lymphadenectomy, the comparison of different energy devices and the choice of the reconstruction technique.
Surgical intervention
2 months ago
1914 views
29 likes
0 comments
57:00
Laparoscopic distal gastrectomy with Roux-en-Y reconstruction for a prepyloric lesion: a live educational procedure
This is the case of a 70-year-old patient who underwent an esophagogastroduodenoscopy for gastric pain. The exam showed a 0.5cm prepyloric ulcerated lesion with Helicobacter pylori infection. After Helicobacter pylori eradication and a CT-scan negative for secondary lesions, the patient was scheduled for a distal gastrectomy with perioperative gastroscopy.
In this original live educational video, Dr. Woo Jin Hyung describes his technique of laparoscopic distal gastrectomy with Roux-en-Y reconstruction and discusses several topics such as the comparison between laparoscopic and robotic gastrectomy, the indication for omentectomy, the choice of the surgical strategy considering the tumor location, the benefit of fluorescence in lymphatic mapping, the type of lymphadenectomy, the comparison of different energy devices and the choice of the reconstruction technique.
Laparoscopic complete mesocolic excision (CME) for right colon cancer
The aim of the video is to describe the anatomical landmarks and the surgical technique for complete mesocolic excision during a laparoscopic right colectomy for cancer.
Preoperative high-resolution CT-scan and 3D printed models of the patient’s vascular anatomy is obtained to study the peculiar vessels distribution. Four ports are used, all located in the left flank as described in the video. Dissection between the visceral fascia which covers the posterior layer of the mesocolon and the parietal fascia covering the retroperitoneum (Toldt’s fascia) is carried out by means of monopolar electrocautery and combined advanced bipolar and ultrasonic dissection device. Caudocranial dissection of the mesocolon along the route of the superior mesenteric vein is performed, up to the inferior margin of the pancreas, exposing, ligating and dividing the ileocolic, the right and middle colic vessels at their origins. The gastrocolic trunk is fully dissected and the superior right colic vein clipped and divided. The transverse colon and terminal ileum are divided, the colon is mobilized and ileo-transverse intracorporeal stapled anastomosis is fashioned.
Between April 2017 and December 2018, 46 laparoscopic right hemicolectomies with CME were performed. There were no major vascular lesions. All intraoperative bleedings in the peripancreatic area were controlled with bipolar instruments and hemostatic devices, and there was no need for intraoperative blood cell transfusions.
Laparoscopic CME is feasible, but extensive knowledge of the vascular anatomy of the right colon as well as experience in advanced laparoscopic technique is required.
Surgical intervention
9 months ago
4626 views
22 likes
1 comment
07:10
Laparoscopic complete mesocolic excision (CME) for right colon cancer
The aim of the video is to describe the anatomical landmarks and the surgical technique for complete mesocolic excision during a laparoscopic right colectomy for cancer.
Preoperative high-resolution CT-scan and 3D printed models of the patient’s vascular anatomy is obtained to study the peculiar vessels distribution. Four ports are used, all located in the left flank as described in the video. Dissection between the visceral fascia which covers the posterior layer of the mesocolon and the parietal fascia covering the retroperitoneum (Toldt’s fascia) is carried out by means of monopolar electrocautery and combined advanced bipolar and ultrasonic dissection device. Caudocranial dissection of the mesocolon along the route of the superior mesenteric vein is performed, up to the inferior margin of the pancreas, exposing, ligating and dividing the ileocolic, the right and middle colic vessels at their origins. The gastrocolic trunk is fully dissected and the superior right colic vein clipped and divided. The transverse colon and terminal ileum are divided, the colon is mobilized and ileo-transverse intracorporeal stapled anastomosis is fashioned.
Between April 2017 and December 2018, 46 laparoscopic right hemicolectomies with CME were performed. There were no major vascular lesions. All intraoperative bleedings in the peripancreatic area were controlled with bipolar instruments and hemostatic devices, and there was no need for intraoperative blood cell transfusions.
Laparoscopic CME is feasible, but extensive knowledge of the vascular anatomy of the right colon as well as experience in advanced laparoscopic technique is required.