monthly focus

surgical intervention video

Introduction: Congenital seminal vesicle cysts with renal malformations are a rare association and are referred to as Zinner syndrome. Patients may be asymptomatic or may complain of urinary symptoms and pain. Authors report the case of a patient with a symptomatic right seminal vesicle cyst and right renal agenesis who underwent laparoscopic vesicle cyst excision. 

Patient and methods: A previously healthy 13-year-old male was referred to our pediatric urology department for a symptomatic retrovesical cystic lesion, identified on a transabdominal ultrasound. The patient complained of recurrent suprapubic pain but denied any other urinary or gastrointestinal symptoms. Physical examination was normal. Abdominopelvic CT-scan and MRI were performed, showing a right pelvic cyst compatible with a seminal cyst and right renal agenesis.

Results: We conducted a laparoscopic right seminal cyst excision. Total operative time was 140 minutes. Given that the cyst could not be disassociated from its ipsilateral vas deferens, a vasectomy was required for complete lesion removal after contralateral vesicle and vas inspection for normality. Histological examination was compatible with the suspected diagnosis of seminal cyst. After surgery, the patient experienced resolution of preoperative pain and remained asymptomatic four months later. 

Conclusions: Congenital seminal cysts are rare lesions that may cause troublesome symptoms. Zinner syndrome is suspected when they are associated with renal agenesis. Laparoscopic treatment of these lesions is a safe and effective procedure. Given the possible involvement of the vas deferens, caution is advised to carefully inspect the contralateral seminal vesicle to safeguard future fertility.



Laparoscopic seminal cyst excision in an adolescent with Zinner syndrome

Excision laparoscopique d'un kyste séminal chez un adolescent atteint du syndrome de Zinner

Aim

The appendicovesicostomy, or Mitrofanoff procedure, consists of a continent catheterizable stoma allowing intermittent bladder catheterization without urethral manipulation, enabling improved patient compliance. Laparoscopic appendicovesicostomy is a recent technical innovaction, associated with improved short-term outcomes, namely less post-operative pain and shorter hospital stay.



Case description

We present a case of an 8-year-old male with Ochoa syndrome, single right kidney, following left nephroureterectomy for severe reflux nephropathy with functional renal exclusion and neurogenic bladder needing intermittent bladder catheterization. Appendicovesicostomy was proposed and performed laparoscopically. Stoma location was discussed before surgery. Three 5mm ports were used. Appendiceal harvesting with mesoappendix preservation was followed by a 3 cm detrusor myotomy and appendicovesical anastomosis. Stoma opening was conducted on the right iliac fossa, after spatulation of the proximal appendix. Total operative time was 130 minutes. No operative or anesthesia-related incidents were recorded. A partial mucocutaneous dehiscence was noted, resolved with conservative treatment. No other complications were registered and the patient was discharged after 22 days. After 12 months, the patient performs autonomous daily self-catheterizations.



Conclusions

Laparoscopic appendicovesicostomy is a feasible and safe procedure and ensures autonomy in urinary self-care.



Laparoscopic Mitrofanoff procedure: a minimally invasive option for urinary continence

Dérivation urinaire continente de Mitrofanoff par approche laparoscopique

Ablation laparoscopique d'une corne utérine rudimentaire droite symptomatique non communicante 

Introduction: A rudimentary horn is a structure that develops from a Müllerian duct and makes up 10% of uterine malformations. Its incidence is estimated at 1 per 1,000 women. Around 75 to 90% of cases of unicornuate uterus with a rudimentary horn are non-communicating. 

Clinical case: In this video, the authors show the case of a 13-year-old female patient with a non-communicating right rudimentary horn. The laparoscopic management of this anomaly is demonstrated in a stepwise fashion. 

Conclusions: The laparoscopic management of a uterine rudimentary horn is feasible. 

Laparoscopic removal of symptomatic non-communicating right rudimentary horn

video lecture

Atrésie de l'œsophage

In this authoritative lecture, Professor Maud, MD, PhD Lindeboom outlines esophageal atresia and its treatment options.

Esophageal atresia (AE) is a common congenital anomaly. Clinical presentation and imaging features are well-known in the community of pediatric surgeons. Long-gap esophageal atresia represents only 10% of all AE cases. The management of long-gap esophageal atresia remains challenging with limited consensus on the definition, evaluation, and surgical approach to treat this condition. Efforts to preserve the native esophagus have been successful with delayed primary anastomosis and tension-based esophageal growth induction processes (internal and external traction). Esophageal replacement is necessary in a minority of cases, with the conduit of choice and patient outcomes largely dependent on institutional expertise. Postoperative complications include leakage, reflux, stenosis and tracheomalacia. Leakage is conservatively treated, reflux often needs anti-reflux surgery, stenosis is solved with repetitive endoscopic dilatation and tracheomalacia could be approached with a posterior tracheopexy.

Esophageal atresia

In this authoritative lecture, Professor Jorge Correia-Pinto, MD, PhD outlines esophageal atresia and its technical details.

Professor Correia-Pinto is one of the key opinion leaders in minimally invasive pediatric surgery, and in this lecture, he provides recommendations regarding the thoracoscopic treatment of esophageal atresia.

The advantages of minimally invasive surgery are well-known worldwide. However, in this particular case, the benefits are evident for the patient. Magnified vision helps to perform the procedure more neatly. The patient has reduced pain and can be discharged more quickly.

In this authoritative lecture, tips and tricks are given so that surgeons can feel more comfortable when managing esophageal atresia, even in difficult cases.

Esophageal atresia, technical details

Atrésie de l'œsophage, détails techniques

Atrésie de l'œsophage : trucs et astuces

In this authoritative lecture, Dr. Araceli García Vázquez, MD outlines esophageal atresia and its treatment options, and provides tips and tricks.

Esophageal atresia is a congenital malformation present in one per 2,500 – 4,000 births (85% of cases are type III, where prenatal diagnosis is made only in 40% of cases). 

The usual treatment consists of closing the tracheoesophageal fístula (TEF) and restoring esophageal continuity using an end-to-end anastomosis.

The technique has remained the same for the last 30 years. However, with the introduction of laparoscopy, better and amplified vision was achieved, along with better cosmetic results.

Today, the gold standard treatment is thoracoscopy, even if the procedure is stilll very demanding. Dr. Araceli Garcia Vázquez provides some tips and tricks to improve the surgical technique.

Esophageal atresia: tips and tricks        

In this authoritative lecture, Professor Becmeur, MD, PhD outlines small bowel volvulus in case of malrotation in newborns.

Small bowel volvulus secondary to malrotation is a surgical emergency. It could be recognized at X-ray as the absence of gas in the abdomen. It can be both conventionally and laparoscopically approached. Even if the laparoscopic approach is characterized by a conversion rate of 25%, the open approach more frequently needs a second surgery. In the laparoscopic approach, it is essential not to focus on bowel loops, but rather on the duodenum. The treatment consists in untwisting the volvulus and widening the mesentery.

The laparoscopic approach is feasible and safe for the correction of malrotation with volvulus, even in the neonatal population without additional risks as compared to the open Ladd’s procedure as long as surgeons may ensure a total release of the bands.

Focus on Pediatric surgery