monthly focus

surgical intervention video

Leiomyomas are the most common pelvic tumors in women. They are detected in approximately 20 to 30% of women older than 35 years of age. Leiomyomas may rarely have an extrauterine localization. Although fibroid degeneration is common, myxoid degeneration is a rare type of leiomyoma degeneration. In the evaluation of this 65-year-old patient who came to our clinic with pelvic pain and urinary incontinence, a 5cm mass was detected between the vagina and the bladder, palpable on vaginal touch. A total laparoscopic hysterectomy and Burch colposuspension were planned for the patient who also had stress urinary incontinence (SUI). At the same time, the patient’s myoma was removed laparoscopically by entering through the retropubic (Retzius) space. The mass removed during the operation was reported as a solid cystic myxoid leiomyoma by the pathologists. A myxoid leiomyoma localized in the Retzius space was not previously described in the literature. In this video, a laparoscopic removal of a myxoid leiomyoma between the vagina and the bladder from the Retzius space is described in a stepwise fashion. 

Laparoscopic treatment of pelvic myxoid leiomyoma mass between vagina and bladder

Traitement laparoscopique d'une masse de léiomyome pelvien avec dégénérescence myxoïde entre le vagin et la vessie

Néphrectomie partielle gauche par laparoscopie pour tumeur hilaire

In this didactic video, authors demonstrate a partial nephrectomy for a left posterior hilar tumor with emphasis on the technique of hemostasis and renal reconstruction. 

Laparoscopic left partial nephrectomy for hilar tumor

In this educational video, authors provide the strategy to perform a subcapsular window, preventing tumor violation, when the adherent perinephretic fat prevents the proper identification of the lesion. 

Subcapsular window in laparoscopic partial nephrectomy to supplant adherent perinephretic fat

Fenêtre sous-capsulaire dans la néphrectomie partielle laparoscopique pour supprimer la graisse périrénale adhérentielle

Uropéritoine après excision paramétriale endométriosique droite : réimplantation urétérale droite

This is the case of a 29-year-old woman who was admitted to the emergency room for acute pelvic pain. Her past surgical history included a pelvic excision for a pelvic endometriosis of both uterosacral ligaments (USL), as well as a right parametrial endometriosis excision with an extensive right ureteral dissection. CT-scan and ultrasound revealed the presence of free fluid in the abdominal and pelvic cavity, with a suspicion of peritonitis in the context of a urinary fistula or uroperitoneum. An exploratory laparoscopy was performed and confirmed the presence of a right ureteral lesion. A right ureteral reimplantation was achieved using a psoas hitch technique. A right ureteral reimplantation was performed after complete mobilization of the bladder, right pelvic, and abdominal ureter. The ureter was sutured with 4/0 Vicryl after creating an anti-reflux mechanism. The right ureter was catheterized using a double-J stent. 

Uroperitoneum after right endometriotic parametrial excision: right ureteral reimplantation

In this educational video, authors demonstrate a laparoscopic right radical nephrectomy and level IV thrombectomy with circulatory assistance, without cardiopulmonary bypass, with veno-arterial bypass, through the cannulation of the femoral vein and artery. 

Scientific committee’s comments: 

It is a high risk surgery. The only key concern is about the removal of the thrombus, which was spilled in the abdominal cavity, and which could have been placed inside a bag. 

Laparoscopic right radical nephrectomy and level IV thrombectomy with circulatory assistance

Néphrectomie radicale droite par laparoscopie et thrombectomie de niveau IV avec assistance circulatoire

Remplacement de l'uretère gauche par l'iléon - procédure entièrement laparoscopique avec suture manuelle 

In this educational video, the authors demonstrate a left ureteral replacement through the interposition of a terminal ileum loop after complete ureteral avulsion, which is a complication of a rigid ureterorenolithotripsy. The avulsed segment measured more or less 20cm and other techniques (e.g., psoas hitch, Boari flap, etc.) were not possible. As a result, the technique adopted was a left ureteral replacement with interposition of a transmesocolic terminal ileum loop totally laparoscopic and with manual suture. 

Left ureteral replacement with ileum - fully laparoscopic procedure with manual suture 

Réanastomose laparoscopique pour sténose anastomotique vésico-uréthrale hautement récidivante après prostatectomie radicale

In this educational video, authors demonstrate a laparoscopic reanastomosis for the treatment of vesicourethral anastomotic stenosis after open radical prostatectomy refractory to endoscopic treatment. 

Focus on urological and gynecologic surgery