monthly focus

surgical intervention video

Canal hépatique antérieur droit dans une cholécystectomie élective : technique de dissection systématique PAECIF/PAECOF, nouvelle stratégie pour une cholécystectomie sûre à 100%

In this educational video, authors present the case of a 47-year-old male patient who underwent elective surgery for a non-acute cholecystitis. During the dissection, an aberrant right anterior sectorial duct was found (segments V-VIII). Authors demonstrate the PAECIF technique or PAECIF systematic dissection to achieve a safe cholecystectomy using the Parkland grading scale from 1 to 3 and PAECOF technique using the Parkland grading scale from 4 to 5. It is a systematic way of dissection which Dr. Zaragoza Arias Noé named and proposed to guarantee a safer cholecystectomy. He believes that without such a systematic dissection, the patient would have had a major bile duct injury or would be more likely to have it, since the sectorial duct would have been misunderstood from a regular porta hepatis to fundus dissection instead of this medial-to-lateral or anterior-to-posterior approach at the level of the cystic plate. 

Right anterior hepatic duct in elective cholecystectomy: PAECIF/PAECOF systematic dissection technique, a new proposal for a 100% safe cholecystectomy

Cholécystite aiguë Parkland 4 : Technique de dissection systématique PAECIF/PAECOF, une nouvelle proposition pour une cholécystectomie sûre à 100 %

Authors present the case of a 75-year-old male patient who underwent elective surgery for acute cholecystitis. During the dissection, pus and impacted gallstones were evacuated. This video complements “Right anterior hepatic duct in elective cholecystectomy: PAECIF/PAECOF systematic dissection technique, a new proposal for a 100% safe cholecystectomy,” demonstrating the PAECOF technique using the Parkland grading scale from 4 to 5. It is a systematic method of dissection named by Dr. Zaragoza Arias and aims to ensure safer cholecystectomy. With such a systematic dissection, patients may be at a lower risk for major bile duct injury. Indeed, especially in complex cases such as Parkland 4-5, the anatomy is often misunderstood as a regular porta hepatis to fundus dissection instead of this medial-to-lateral or anterior-to-posterior approach at the level of the cystic plate.

Parkland 4 acute cholecystitis: PAECIF/PAECOF systematic dissection technique, a new proposal for a 100% safe cholecystectomy

Cholécystite chronique : trucs et astuces pour une dissection sûre, démonstration chirurgicale en direct

In this live educational video, Dr. Antonio D'Urso, MD, PhD provides several tips and tricks for the management of a difficult cholecystectomy due to chronic inflammation and large stone impaction in the infundibulum, necessitating a delicate manipulation and careful dissection technique. Several key steps of the procedure are commented upon and thoroughly outlined and explained.

Chronic cholecystitis: tips and tricks for safe dissection, live surgical demonstration

Cholécystite chronique avec exacerbation : comment disséquer soigneusement les structures vasculaires et biliaires par laparoscopie, démonstration chirurgicale en direct

Due to chronic cholecystitis, tissue has become hard or very hard to dissect. Delicate vascular and biliary structures may be harmed during the maneuvering performed to obtain the needed anatomical exposure. Blunt dissection may be almost impossible or poorly effective. In this live educational video, several tips and tricks are brilliantly shown and commented upon by Professor Didier Mutter, MD, PhD, FACS, FRSM, the operating surgeon.

During the surgical demonstration, one can see clear signs of acute cholecystitis with acute exacerbation, as testified by inflamed peritoneal layers and the need for gallbladder drainage.





Chronic cholecystitis with acute exacerbation: how to carefully dissect vascular and biliary structures laparoscopically, live surgical demonstration

This is a case of a 54-year-old female patient with a late bile duct injury, 3 years after a laparoscopic cholecystectomy with common bile duct exploration and infundibulum suturing for a grade IV Mirizzi syndrome. The patient presented with obstructive jaundice. Since the endoscopic retrograde cholangiopancreatography (ERCP) was unsuccessful, a percutaneous transhepatic cholangiodrainage (PTCD) was required. A Roux-en-Y hepaticojejunostomy was proposed. The great challenge to performing the surgery was the number of adhesions found in the cavity. 

Focus on bile duct surgery

Right anterior hepatic duct in elective cholecystectomy: PAECIF/PAECOF systematic dissection technique, a new proposal for a 100% safe cholecystectomy

Parkland 4 acute cholecystitis: PAECIF/PAECOF systematic dissection technique, a new proposal for a 100% safe cholecystectomy

Hepaticojejunostomy with a Roux-en-Y anastomosis for late bile duct injury (BDI)

Chronic cholecystitis: tips and tricks for safe dissection, live surgical demonstration

Chronic cholecystitis with acute exacerbation: how to carefully dissect vascular and biliary structures laparoscopically, live surgical demonstration