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Christian SAUSSINE

Hôpitaux Universitaires de Strasbourg
Strasbourg, France
MD
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Percutaneous nephrolithotomy
This is the case of a 60-year-old man with a large left kidney stone (>3cm) taking up the entire renal pelvis and lower calyceal cavities. Under general anesthesia, the patient is placed in a supine modified lithotomy position, with a 3L water bag underneath the left lumbar fossa to raise it. The left leg is straight whereas the right leg is put on a leg brace flexed.
A cystoscopy is performed in order to identify the left ureteral orifice and introduce a 7 French beveled ureteral stent. This stent is connected to a Foley catheter. A contrast agent is injected into the ureteral stent.
The kidney’s lower pole is punctured with an 18 Gauge hypodermic needle, making sure to stay in contact with the stone. A rigid Lunderquist® guidewire is passed into the needle. The pathway is dilated using metallic coaxial dilators and with a dilation balloon until an Amplatz® renal sheath is placed. The sheath will then be extended.
A nephroscopy is performed to identify the stone, fragment and aspirate it partially with the LithoClast Master® intracorporeal lithotripter. Some large fragments will be withdrawn with crocodile forceps. The lithotripter system fails to remove the residual stone. A Malecot®-type nephrostomy tube is used and the ureteral stent is replaced by means of a double J catheter.
Surgical intervention
1 year ago
1908 views
88 likes
0 comments
34:10
Percutaneous nephrolithotomy
This is the case of a 60-year-old man with a large left kidney stone (>3cm) taking up the entire renal pelvis and lower calyceal cavities. Under general anesthesia, the patient is placed in a supine modified lithotomy position, with a 3L water bag underneath the left lumbar fossa to raise it. The left leg is straight whereas the right leg is put on a leg brace flexed.
A cystoscopy is performed in order to identify the left ureteral orifice and introduce a 7 French beveled ureteral stent. This stent is connected to a Foley catheter. A contrast agent is injected into the ureteral stent.
The kidney’s lower pole is punctured with an 18 Gauge hypodermic needle, making sure to stay in contact with the stone. A rigid Lunderquist® guidewire is passed into the needle. The pathway is dilated using metallic coaxial dilators and with a dilation balloon until an Amplatz® renal sheath is placed. The sheath will then be extended.
A nephroscopy is performed to identify the stone, fragment and aspirate it partially with the LithoClast Master® intracorporeal lithotripter. Some large fragments will be withdrawn with crocodile forceps. The lithotripter system fails to remove the residual stone. A Malecot®-type nephrostomy tube is used and the ureteral stent is replaced by means of a double J catheter.
TAPP laparoscopic repair of right inguinal hernia after artificial sphincter placement for post-prostatectomy urinary incontinence
Incapacitating post-prostatectomy urinary incontinence may be managed by the placement of an artificial sphincter. This sphincter is composed of an inflatable circular tape (the sphincter itself), a remote control located in the scrotum, and of a reservoir connected to the sphincter by a catheter. This reservoir is positioned within the preperitoneal space using an anterior inguinal approach through a mini-incision in the transversalis fascia which weakens the posterior wall of the inguinal canal, hence increasing the risk of inguinal hernia.
This film demonstrates a typical case management of such hernia. The anterior approach is delicate as repair of the inguinal canal may well induce trauma to the catheter connected to the retromuscular balloon. The posterior approach is therefore valuable as it allows to see the balloon prior to dissecting the preperitoneal space. The film highlights the specific issues to be dealt with as well as the tips and tricks related to this approach.
Surgical intervention
5 years ago
5256 views
108 likes
0 comments
08:18
TAPP laparoscopic repair of right inguinal hernia after artificial sphincter placement for post-prostatectomy urinary incontinence
Incapacitating post-prostatectomy urinary incontinence may be managed by the placement of an artificial sphincter. This sphincter is composed of an inflatable circular tape (the sphincter itself), a remote control located in the scrotum, and of a reservoir connected to the sphincter by a catheter. This reservoir is positioned within the preperitoneal space using an anterior inguinal approach through a mini-incision in the transversalis fascia which weakens the posterior wall of the inguinal canal, hence increasing the risk of inguinal hernia.
This film demonstrates a typical case management of such hernia. The anterior approach is delicate as repair of the inguinal canal may well induce trauma to the catheter connected to the retromuscular balloon. The posterior approach is therefore valuable as it allows to see the balloon prior to dissecting the preperitoneal space. The film highlights the specific issues to be dealt with as well as the tips and tricks related to this approach.
Laparoscopic extraperitoneal and transperitoneal pelvic lymphadenectomies for prostate cancer
The description of the laparoscopic extraperitoneal and transperitoneal pelvic lymphadenectomies for prostate cancer covers all aspects of the surgical procedure used for the management of prostate cancer.
Operating room set up, position of patient and equipment, instruments used are thoroughly described. The technical key steps of the surgical procedure are presented in a step by step way: exposure, external limit, internal limit, inferior limit, posterior limit, superior limit, extraction, left lymphadenectomy, end of procedure.
Consequently, this operating technique is well standardized for the management of this condition.
Operative technique
16 years ago
2660 views
149 likes
0 comments
Laparoscopic extraperitoneal and transperitoneal pelvic lymphadenectomies for prostate cancer
The description of the laparoscopic extraperitoneal and transperitoneal pelvic lymphadenectomies for prostate cancer covers all aspects of the surgical procedure used for the management of prostate cancer.
Operating room set up, position of patient and equipment, instruments used are thoroughly described. The technical key steps of the surgical procedure are presented in a step by step way: exposure, external limit, internal limit, inferior limit, posterior limit, superior limit, extraction, left lymphadenectomy, end of procedure.
Consequently, this operating technique is well standardized for the management of this condition.