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Luc SOLER

IRCAD-EITS
Strasbourg, France
PhD
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Fully robotically assisted transabdominal right adrenalectomy for a right adrenal incidentaloma
This video presents the case of a female patient in whom a right adrenal incidentaloma was found. It was 40mm in size and was found incidentally during a pancreatitis treatment.
Endocrinologists controlled the absence of abnormal secretion. The size of the lesion increased slightly over a period of 6 months and allowed to establish an indication for surgery. Our team performs adrenalectomies using a transabdominal laparoscopic approach with the patient in a lateral decubitus position. In order to facilitate the intervention, we asked the Visible Patient company to use the CT-scan images to make a 3D model. This reconstruction allowed to better indentify the relationships of the gland, to improve resection, and confirm the operative strategy. During the intervention, the surgeon can use it to better understand the anatomy hidden by peri-adrenal adipose tissue and operate accordingly. We now have a surgical robot (da Vinci Xi™ robotic surgical system, Intuitive Surgical) and we use it for most of the adrenalectomies we perform. It provides great stability of the operative field. The precise dissection is facilitated by the dexterity of the articulated instruments.
Surgical intervention
7 months ago
1226 views
2 likes
0 comments
11:41
Fully robotically assisted transabdominal right adrenalectomy for a right adrenal incidentaloma
This video presents the case of a female patient in whom a right adrenal incidentaloma was found. It was 40mm in size and was found incidentally during a pancreatitis treatment.
Endocrinologists controlled the absence of abnormal secretion. The size of the lesion increased slightly over a period of 6 months and allowed to establish an indication for surgery. Our team performs adrenalectomies using a transabdominal laparoscopic approach with the patient in a lateral decubitus position. In order to facilitate the intervention, we asked the Visible Patient company to use the CT-scan images to make a 3D model. This reconstruction allowed to better indentify the relationships of the gland, to improve resection, and confirm the operative strategy. During the intervention, the surgeon can use it to better understand the anatomy hidden by peri-adrenal adipose tissue and operate accordingly. We now have a surgical robot (da Vinci Xi™ robotic surgical system, Intuitive Surgical) and we use it for most of the adrenalectomies we perform. It provides great stability of the operative field. The precise dissection is facilitated by the dexterity of the articulated instruments.
LIVE INTERACTIVE SURGERY: robotic low anterior resection for a local recurrence of rectal cancer
In this live interactive surgery, Dr. Parra-Davila demonstrates a robotic low anterior resection for a local recurrence of transanally excised rectal cancer. The operative technique shown includes a robotic oncological ‘en bloc’ resection and intracorporeal anastomosis. In the patient’s history, an ulcerated villous polyp too large for endoscopic removal was addressed to surgery. Preoperative biopsies had failed to detect malignancy. The surgical procedure consisted in a transanal full-thickness resection including partial TME for lymph node sampling. Since the operative specimen revealed a pT2N1a (1/8) rectal adenocarcinoma, the patient underwent adjuvant radiochemotherapy. The following year, a single hepatic metastasis was resected, complemented by postoperative chemotherapy. After 7 years of uneventful follow-up, an anastomotic recurrence was diagnosed. Following oncologic committee discussion, the patient was advised to undergo surgery.
Surgical intervention
8 months ago
1530 views
2 likes
0 comments
32:48
LIVE INTERACTIVE SURGERY: robotic low anterior resection for a local recurrence of rectal cancer
In this live interactive surgery, Dr. Parra-Davila demonstrates a robotic low anterior resection for a local recurrence of transanally excised rectal cancer. The operative technique shown includes a robotic oncological ‘en bloc’ resection and intracorporeal anastomosis. In the patient’s history, an ulcerated villous polyp too large for endoscopic removal was addressed to surgery. Preoperative biopsies had failed to detect malignancy. The surgical procedure consisted in a transanal full-thickness resection including partial TME for lymph node sampling. Since the operative specimen revealed a pT2N1a (1/8) rectal adenocarcinoma, the patient underwent adjuvant radiochemotherapy. The following year, a single hepatic metastasis was resected, complemented by postoperative chemotherapy. After 7 years of uneventful follow-up, an anastomotic recurrence was diagnosed. Following oncologic committee discussion, the patient was advised to undergo surgery.
Pheochromocytoma: laparoscopic right adrenalectomy in a child
In the context of major headaches in a 9-year-old patient whose brother had been operated on for pheochromocytoma, a right adrenal pheochromocytoma with severe arterial hypertension was found.
The given video aims to demonstrate the usefulness of performing a 3D reconstruction of the tumor (using Visible Patient™ 3D reconstruction tool). It is essential to have precise preoperative information and work out a surgical strategy taking into account observed anatomical anomalies, since tumor and/or vascular anatomy may have numerous variations in case of pheochromocytomas.
A reconstruction model can be easily manipulated on a touch screen. It can be oriented in such a way that the angle of view changes allowing for a better understanding of the anatomy, so that an approach to vessels or neighboring organs is easily decided upon. Additionally, the option of adding or deleting this or that anatomical element allows for a simplified visual approach, which usually represents a potential difficulty during dissection.
Finally, the 3D reconstruction of this patient perfectly corresponds to her real anatomy. Thanks to a mere scanning based on the reconstruction, the vascularization mode of the tumor as well as the existence of a hidden part of healthy tissue can be verified.
Surgical intervention
1 year ago
2389 views
7 likes
0 comments
08:30
Pheochromocytoma: laparoscopic right adrenalectomy in a child
In the context of major headaches in a 9-year-old patient whose brother had been operated on for pheochromocytoma, a right adrenal pheochromocytoma with severe arterial hypertension was found.
The given video aims to demonstrate the usefulness of performing a 3D reconstruction of the tumor (using Visible Patient™ 3D reconstruction tool). It is essential to have precise preoperative information and work out a surgical strategy taking into account observed anatomical anomalies, since tumor and/or vascular anatomy may have numerous variations in case of pheochromocytomas.
A reconstruction model can be easily manipulated on a touch screen. It can be oriented in such a way that the angle of view changes allowing for a better understanding of the anatomy, so that an approach to vessels or neighboring organs is easily decided upon. Additionally, the option of adding or deleting this or that anatomical element allows for a simplified visual approach, which usually represents a potential difficulty during dissection.
Finally, the 3D reconstruction of this patient perfectly corresponds to her real anatomy. Thanks to a mere scanning based on the reconstruction, the vascularization mode of the tumor as well as the existence of a hidden part of healthy tissue can be verified.
Laparoscopic partial nephrectomy on non-functional, symptomatic right lower pole of the kidney
In this video, we present the case of a 13-year-old girl presenting with a complicated urological anomaly discovered very late. The lower part of her right kidney is dysplastic (or destroyed) with pseudocystic pyelocalyceal cavities filled with stones and cloudy urine. The first hypothesis is that we are dealing with a true renal duplicity with a destroyed non-functional inferior pole. In this case, there is one ureter per kidney pole. As a result, polar ureteronephrectomy does not cause any potential vascular problems.
In this case, thanks to 3D reconstruction (Visible Patient™, a spinoff of IRCAD), it is clear that there is no kidney duplicity, but a pyelic bifurcation. It means that we should manage the only ureter, which drains the superior and inferior pelvis. For that reason, the placement of a double J catheter is essential prior to partial nephrectomy. This catheter should be pulled up until the superior pelvis.
Tridimensional reconstruction of the CT-scan images of a patient with a malformation is extremely helpful to better understand the original and unique anatomy of the patient and to determine a tailored operative strategy.
This video demonstrates a laparoscopic partial nephrectomy on non-functional, symptomatic right lower pole of the kidney in a 13-year-old girl as an outpatient surgery.
Surgical intervention
1 year ago
1923 views
3 likes
0 comments
07:24
Laparoscopic partial nephrectomy on non-functional, symptomatic right lower pole of the kidney
In this video, we present the case of a 13-year-old girl presenting with a complicated urological anomaly discovered very late. The lower part of her right kidney is dysplastic (or destroyed) with pseudocystic pyelocalyceal cavities filled with stones and cloudy urine. The first hypothesis is that we are dealing with a true renal duplicity with a destroyed non-functional inferior pole. In this case, there is one ureter per kidney pole. As a result, polar ureteronephrectomy does not cause any potential vascular problems.
In this case, thanks to 3D reconstruction (Visible Patient™, a spinoff of IRCAD), it is clear that there is no kidney duplicity, but a pyelic bifurcation. It means that we should manage the only ureter, which drains the superior and inferior pelvis. For that reason, the placement of a double J catheter is essential prior to partial nephrectomy. This catheter should be pulled up until the superior pelvis.
Tridimensional reconstruction of the CT-scan images of a patient with a malformation is extremely helpful to better understand the original and unique anatomy of the patient and to determine a tailored operative strategy.
This video demonstrates a laparoscopic partial nephrectomy on non-functional, symptomatic right lower pole of the kidney in a 13-year-old girl as an outpatient surgery.
LIVE INTERACTIVE SURGERY: laparoscopic right hepatectomy in a patient with hepatocellular carcinoma (HCC) and metabolic syndrome
In this live interactive video, Professor Luc Soler provided a brief introduction of 3D reconstruction and modeling for precise tumor localization and future liver remnant before and after chemoembolization and right portal vein embolization. Dr. Soubrane briefly described the main principles, key steps, and preoperative planning in a 62-year-old male patient with hepatocellular carcinoma (HCC) and metabolic syndrome. He demonstrated the main technical aspects of port placement, hepatic pedicle dissection, exploration and dissection of vessels, and transection of liver parenchyma.
Surgical intervention
1 year ago
4437 views
570 likes
0 comments
51:19
LIVE INTERACTIVE SURGERY: laparoscopic right hepatectomy in a patient with hepatocellular carcinoma (HCC) and metabolic syndrome
In this live interactive video, Professor Luc Soler provided a brief introduction of 3D reconstruction and modeling for precise tumor localization and future liver remnant before and after chemoembolization and right portal vein embolization. Dr. Soubrane briefly described the main principles, key steps, and preoperative planning in a 62-year-old male patient with hepatocellular carcinoma (HCC) and metabolic syndrome. He demonstrated the main technical aspects of port placement, hepatic pedicle dissection, exploration and dissection of vessels, and transection of liver parenchyma.
LIVE INTERACTIVE SURGERY: laparoscopic left adrenalectomy: retroperitoneal access
Retroperitoneal adrenalectomy (posterior approach) provides a direct access to the adrenal gland, hence preventing the risk of injury to intraperitoneal organs. The retroperitoneoscopic approach shortens the mean operative time and it is critical in cases of pheochromocytoma. Consequently, it is the recommended treatment for pheochromocytoma. Blood loss and the convalescence period are also shortened with this approach. The surgical principles of retroperitoneal adrenalectomy according to Professor Martin Walz are as follows: ‘en bloc’ resection, start of dissection with the upper pole of kidney, lower pole of the adrenal gland next, control of the main adrenal vein without clips, and morcellation of the gland if necessary in a bag.
Surgical intervention
3 years ago
2122 views
182 likes
0 comments
39:46
LIVE INTERACTIVE SURGERY: laparoscopic left adrenalectomy: retroperitoneal access
Retroperitoneal adrenalectomy (posterior approach) provides a direct access to the adrenal gland, hence preventing the risk of injury to intraperitoneal organs. The retroperitoneoscopic approach shortens the mean operative time and it is critical in cases of pheochromocytoma. Consequently, it is the recommended treatment for pheochromocytoma. Blood loss and the convalescence period are also shortened with this approach. The surgical principles of retroperitoneal adrenalectomy according to Professor Martin Walz are as follows: ‘en bloc’ resection, start of dissection with the upper pole of kidney, lower pole of the adrenal gland next, control of the main adrenal vein without clips, and morcellation of the gland if necessary in a bag.
Laparoscopic resection of colorectal liver metastasis in segment VII with transthoracic port-site insertion using ultrasonography and augmented reality
We report the case of a laparoscopic resection in a patient presenting with a colorectal liver metastasis in segment VII of the liver, with transthoracic trocar insertion. The patient is placed in a lateral decubitus position. Four ports are introduced. After exploration of the peritoneal cavity and ultrasound examination, the intervention is begun with the control of the hepatic pedicle. The right liver is mobilized. As the position of the scope is not ideal, an improved vision is searched for using simulation tools. The subcostal port allows for an optimal view. The 5mm port is switched to a 12mm port, allowing for the placement of the scope. A 5mm port is then placed transthoracically in order to start the hepatotomy. The hepatotomy is performed under a full pedicular clamping, which takes 20 minutes. Dissection is started 2cm around the lesion. The specimen is placed in a bag and extracted through a slightly enlarged 12mm port. After hemostatic control, the tape around the pedicle is removed. The cavity is extensively cleansed. The pneumoperitoneum is reduced and one can observe that there is no bleeding. A thoracic drain is positioned at the level of the 5mm port placed transthoracically. The diaphragmatic port opening site is closed.
Surgical intervention
3 years ago
1698 views
58 likes
0 comments
13:06
Laparoscopic resection of colorectal liver metastasis in segment VII with transthoracic port-site insertion using ultrasonography and augmented reality
We report the case of a laparoscopic resection in a patient presenting with a colorectal liver metastasis in segment VII of the liver, with transthoracic trocar insertion. The patient is placed in a lateral decubitus position. Four ports are introduced. After exploration of the peritoneal cavity and ultrasound examination, the intervention is begun with the control of the hepatic pedicle. The right liver is mobilized. As the position of the scope is not ideal, an improved vision is searched for using simulation tools. The subcostal port allows for an optimal view. The 5mm port is switched to a 12mm port, allowing for the placement of the scope. A 5mm port is then placed transthoracically in order to start the hepatotomy. The hepatotomy is performed under a full pedicular clamping, which takes 20 minutes. Dissection is started 2cm around the lesion. The specimen is placed in a bag and extracted through a slightly enlarged 12mm port. After hemostatic control, the tape around the pedicle is removed. The cavity is extensively cleansed. The pneumoperitoneum is reduced and one can observe that there is no bleeding. A thoracic drain is positioned at the level of the 5mm port placed transthoracically. The diaphragmatic port opening site is closed.
Laparoscopic right hepatectomy on cirrhotic liver after transarterial chemoembolization (TACE) and portal vein embolization (PVE) for hepatocellular carcinoma (HCC)
We reported the case of a 70-year-old man in whom an F4 cirrhosis and a well-differentiated hepatocellular carcinoma were evidenced and managed by a laparoscopic right hepatectomy after transarterial chemoembolization and portal vein embolization. The operation starts with the control of the hepatic pedicle. A Doppler ultrasound is performed. It will reveal the relation of the lesion with the vein. The different right hepatic structures are identified, clipped and divided. Mobilization of the right liver is then initiated. The gallbladder, which is kept in place, is used for traction purposes. Parenchymal transection is begun with the assistance of Ultracision®, Aquamantys®, and Dissectron®. The portal structure and the hepatic vein are identified. The parenchymotomy is carried on and the identification of the right hepatic vein is going to be achieved. The origin of the right hepatic vein is dissected at its upper part and its lower part, in order to encircle it with a tape and divide it with a stapler. Once completed, the medial part of the right triangular ligament is further divided. Mobilization is continued on the same part from both sides, changing traction. The right liver is placed in a bag and removed. The cavity is cleansed. The hemostasis and biliostasis are controlled on the transection.
Surgical intervention
3 years ago
2060 views
42 likes
0 comments
08:07
Laparoscopic right hepatectomy on cirrhotic liver after transarterial chemoembolization (TACE) and portal vein embolization (PVE) for hepatocellular carcinoma (HCC)
We reported the case of a 70-year-old man in whom an F4 cirrhosis and a well-differentiated hepatocellular carcinoma were evidenced and managed by a laparoscopic right hepatectomy after transarterial chemoembolization and portal vein embolization. The operation starts with the control of the hepatic pedicle. A Doppler ultrasound is performed. It will reveal the relation of the lesion with the vein. The different right hepatic structures are identified, clipped and divided. Mobilization of the right liver is then initiated. The gallbladder, which is kept in place, is used for traction purposes. Parenchymal transection is begun with the assistance of Ultracision®, Aquamantys®, and Dissectron®. The portal structure and the hepatic vein are identified. The parenchymotomy is carried on and the identification of the right hepatic vein is going to be achieved. The origin of the right hepatic vein is dissected at its upper part and its lower part, in order to encircle it with a tape and divide it with a stapler. Once completed, the medial part of the right triangular ligament is further divided. Mobilization is continued on the same part from both sides, changing traction. The right liver is placed in a bag and removed. The cavity is cleansed. The hemostasis and biliostasis are controlled on the transection.
Laparoscopic right hemihepatectomy with augmented reality
We report the case of a 42-year-old woman who underwent a laparoscopic right hemihepatectomy for a hepatic metastasis. The intervention is begun with the exploration of the entire peritoneal cavity and an intraoperative ultrasound exam of the liver. The lesion is identified by means of augmented reality. Dissection of the different vascular structures is then performed at the level of the hepatic pedicle. A clamping test of the right branches is achieved. The right branch of the hepatic artery and the right portal vein are clamped, hence creating the demarcation area, which is identified by means of the coagulating hook. Declamping of portal and arterial structures coursing towards the right liver is achieved. The right branch of the portal vein is divided between two clips. The right branch of the hepatic vein is also divided between two clips. After mobilization of the right liver, the hepatotomy is begun. The first superficial centimeters are divided using an ultrasonic dissector (Ultracision®). Dissection is then carried on by means of a Cusa® Dissectron® Ultrasonic Surgical Aspirator. The largest structures are subsequently dissected intraparenchymally, and then clipped and divided. Hemostasis is completed using a radiofrequency instrument. The right biliary tract is dissected intraparenchymally, clipped and divided. The right hepatic vein is divided by means of a stapler. The specimen is placed in a bag, which is extracted by means of a small Pfannenstiel incision. Hemostasis is controlled as the pneumoperitoneum is reduced. A blade is positioned in the hepatectomy area.
Surgical intervention
4 years ago
2485 views
68 likes
0 comments
12:53
Laparoscopic right hemihepatectomy with augmented reality
We report the case of a 42-year-old woman who underwent a laparoscopic right hemihepatectomy for a hepatic metastasis. The intervention is begun with the exploration of the entire peritoneal cavity and an intraoperative ultrasound exam of the liver. The lesion is identified by means of augmented reality. Dissection of the different vascular structures is then performed at the level of the hepatic pedicle. A clamping test of the right branches is achieved. The right branch of the hepatic artery and the right portal vein are clamped, hence creating the demarcation area, which is identified by means of the coagulating hook. Declamping of portal and arterial structures coursing towards the right liver is achieved. The right branch of the portal vein is divided between two clips. The right branch of the hepatic vein is also divided between two clips. After mobilization of the right liver, the hepatotomy is begun. The first superficial centimeters are divided using an ultrasonic dissector (Ultracision®). Dissection is then carried on by means of a Cusa® Dissectron® Ultrasonic Surgical Aspirator. The largest structures are subsequently dissected intraparenchymally, and then clipped and divided. Hemostasis is completed using a radiofrequency instrument. The right biliary tract is dissected intraparenchymally, clipped and divided. The right hepatic vein is divided by means of a stapler. The specimen is placed in a bag, which is extracted by means of a small Pfannenstiel incision. Hemostasis is controlled as the pneumoperitoneum is reduced. A blade is positioned in the hepatectomy area.
Laparoscopic left pancreatectomy with spleen preservation for multiple neuroendocrine tumors
Insulinoma is the most common functional neuroendocrine tumor of the pancreas. Most insulinomas are benign and solitary. Surgical resection is preferred for insulinomas and cure is achieved in more than 90% of the patients. Successful surgery requires accurate localization based on contrast enhanced CT-scan, PET-scan, and intraoperative ultrasound. This video shows a laparoscopic left pancreatectomy in a young patient presenting with typical symptoms evocative of Whipple's triad. Preoperative imaging studies identified two pancreatic tumors. Laparoscopic exploration and ultrasound identified four distinct tumors, all of them expressing somatostatin and insulin. This clinical case highlights the necessity and value of ultrasound exploration during surgery for neuroendocrine tumors.
Surgical intervention
5 years ago
2661 views
76 likes
0 comments
35:52
Laparoscopic left pancreatectomy with spleen preservation for multiple neuroendocrine tumors
Insulinoma is the most common functional neuroendocrine tumor of the pancreas. Most insulinomas are benign and solitary. Surgical resection is preferred for insulinomas and cure is achieved in more than 90% of the patients. Successful surgery requires accurate localization based on contrast enhanced CT-scan, PET-scan, and intraoperative ultrasound. This video shows a laparoscopic left pancreatectomy in a young patient presenting with typical symptoms evocative of Whipple's triad. Preoperative imaging studies identified two pancreatic tumors. Laparoscopic exploration and ultrasound identified four distinct tumors, all of them expressing somatostatin and insulin. This clinical case highlights the necessity and value of ultrasound exploration during surgery for neuroendocrine tumors.
Typical laparoscopic four-trocar transabdominal adrenalectomy for a 5cm right-sided pheochromocytoma
This is the case of a female patient presenting with a typical 5cm right-sided pheochromocytoma was operated on laparoscopically. Preoperative 3D MRI reconstruction allowed to precisely identify surgical landmarks. The procedure was carried out typically. Four ports were used, and dissection aimed to first mobilize the liver. Control of the main adrenal vein was achieved as the first operative step. Medial, superior, and inferior arteries were dissected and controlled successively. Total freeing of the gland was performed with no manipulation or effraction of the gland's capsule. The postoperative course was uneventful. Small-sized pheochromocytomas are excellent indications for a laparoscopic approach with early control of the vein.
Surgical intervention
6 years ago
3304 views
78 likes
0 comments
23:50
Typical laparoscopic four-trocar transabdominal adrenalectomy for a 5cm right-sided pheochromocytoma
This is the case of a female patient presenting with a typical 5cm right-sided pheochromocytoma was operated on laparoscopically. Preoperative 3D MRI reconstruction allowed to precisely identify surgical landmarks. The procedure was carried out typically. Four ports were used, and dissection aimed to first mobilize the liver. Control of the main adrenal vein was achieved as the first operative step. Medial, superior, and inferior arteries were dissected and controlled successively. Total freeing of the gland was performed with no manipulation or effraction of the gland's capsule. The postoperative course was uneventful. Small-sized pheochromocytomas are excellent indications for a laparoscopic approach with early control of the vein.
Video-assisted parathyroidectomy using augmented reality
The effectiveness of preoperative imaging to detect parathyroid adenomas allows for a targeted minimally invasive video-assisted approach. In our department, at the IRCAD, special software is used to virtually reconstruct the neck and its structures from mere CT-scan images of the cervicomediastinal region. This virtual reconstruction helps to precisely define the location of the parathyroid adenoma in relation to the superior part of the sternum, to the inferior thyroid artery and to the thyroid gland, hence guiding the surgeon in the proper identification of anatomical landmarks.
The reconstruction also helps to control the absence of "non-recurrent" recurrent nerves showing the presence of a right brachiocephalic arterial trunk.
Surgical intervention
6 years ago
1317 views
17 likes
0 comments
06:14
Video-assisted parathyroidectomy using augmented reality
The effectiveness of preoperative imaging to detect parathyroid adenomas allows for a targeted minimally invasive video-assisted approach. In our department, at the IRCAD, special software is used to virtually reconstruct the neck and its structures from mere CT-scan images of the cervicomediastinal region. This virtual reconstruction helps to precisely define the location of the parathyroid adenoma in relation to the superior part of the sternum, to the inferior thyroid artery and to the thyroid gland, hence guiding the surgeon in the proper identification of anatomical landmarks.
The reconstruction also helps to control the absence of "non-recurrent" recurrent nerves showing the presence of a right brachiocephalic arterial trunk.
Robot-assisted left adrenalectomy for Conn's adenoma
As laparoscopy is the standard approach to perform an adrenalectomy, robotic assistance is considered as an effective tool to perform this resection. Surgical steps follow those established for laparoscopy (i.e., mobilization of the spleen and of the pancreas in a patient placed in a lateral position, identification of the renal vein, control and division of the adrenal vein, successive freeing of the medial, external, inferior, and finally posterior aspects of the gland. The sealing devices such as ultrasonic dissectors are well adapted to perform this resection, and to safely control adrenal arteries. Robotic assistance takes full benefit from the degrees of freedom of the tips of the instruments and allows for an easy adrenal gland mobilization and removal.
Surgical intervention
6 years ago
1714 views
24 likes
0 comments
16:19
Robot-assisted left adrenalectomy for Conn's adenoma
As laparoscopy is the standard approach to perform an adrenalectomy, robotic assistance is considered as an effective tool to perform this resection. Surgical steps follow those established for laparoscopy (i.e., mobilization of the spleen and of the pancreas in a patient placed in a lateral position, identification of the renal vein, control and division of the adrenal vein, successive freeing of the medial, external, inferior, and finally posterior aspects of the gland. The sealing devices such as ultrasonic dissectors are well adapted to perform this resection, and to safely control adrenal arteries. Robotic assistance takes full benefit from the degrees of freedom of the tips of the instruments and allows for an easy adrenal gland mobilization and removal.
Primary hyperparathyroidism cure using 3D CT-scan reconstruction
Parathyroid surgery has largely benefited from advances in preoperative imaging modalities allowing to determine potential adenomas. Conventionally, ultrasonography and scintigraphy with 99mTc-sestamibi (MIBI) provide sufficient information to guide the surgical procedure. Specific software has been developed at the IRCAD to allow for the 3D reconstruction of the entire cervical structures. The handling of such reconstruction helps to perform a precise preoperative assessment. Arterial reconstruction allows to predict the existence of an arteria lusoria and of a non-recurrent recurrent nerve. In this case, the position of a potential adenoma in relation to the inferior thyroid artery allows to anticipate that it is not an adenoma but a thyroid nodule. A second potential target is visualized inferiorly. These two potential locations will be explored during the video-assisted surgical intervention.
Surgical intervention
6 years ago
4847 views
6 likes
0 comments
05:46
Primary hyperparathyroidism cure using 3D CT-scan reconstruction
Parathyroid surgery has largely benefited from advances in preoperative imaging modalities allowing to determine potential adenomas. Conventionally, ultrasonography and scintigraphy with 99mTc-sestamibi (MIBI) provide sufficient information to guide the surgical procedure. Specific software has been developed at the IRCAD to allow for the 3D reconstruction of the entire cervical structures. The handling of such reconstruction helps to perform a precise preoperative assessment. Arterial reconstruction allows to predict the existence of an arteria lusoria and of a non-recurrent recurrent nerve. In this case, the position of a potential adenoma in relation to the inferior thyroid artery allows to anticipate that it is not an adenoma but a thyroid nodule. A second potential target is visualized inferiorly. These two potential locations will be explored during the video-assisted surgical intervention.
Posterior approach to laparoscopic left adrenalectomy including virtual reality simulation
Since M. Gagner published the first case of a transperitoneal laparoscopic adrenalectomy in 1992, the laparoscopic adrenalectomy has gradually become the standard operation for removing adrenal tumors. Compared to a traditional adrenalectomy, a laparoscopic adrenalectomy has a number of advantages, including less blood loss, a shorter hospital stay, a quicker recovery, and fewer complications. There are many ways to approach the adrenal gland laparoscopically, such as by a lateral transperitoneal approach, anterior transperitoneal approach, lateral retroperitoneal approach, and posterior retroperitoneal approach. This video shows a posterior left adrenalectomy using virtual reality simulation.
Surgical intervention
7 years ago
1923 views
30 likes
0 comments
25:24
Posterior approach to laparoscopic left adrenalectomy including virtual reality simulation
Since M. Gagner published the first case of a transperitoneal laparoscopic adrenalectomy in 1992, the laparoscopic adrenalectomy has gradually become the standard operation for removing adrenal tumors. Compared to a traditional adrenalectomy, a laparoscopic adrenalectomy has a number of advantages, including less blood loss, a shorter hospital stay, a quicker recovery, and fewer complications. There are many ways to approach the adrenal gland laparoscopically, such as by a lateral transperitoneal approach, anterior transperitoneal approach, lateral retroperitoneal approach, and posterior retroperitoneal approach. This video shows a posterior left adrenalectomy using virtual reality simulation.