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According to recent studies, robotic adrenalectomy has proven to be superior to laparoscopic adrenalectomy, with a reduction of blood loss during procedure and a reduced operative time. 

The robotic system provides an intraoperative stability to the surgeon, allowing for a perfect handling of sensitive functional adrenal tumors. The main advantage of robotics lies in the ease of dissection, aided by improved visualization, the EndoWrist®, articulated instruments, and reduction of tremors, allowing for more accurate movements. 



Indications: hormone-secreting tumors, adrenal masses >5cm, smaller lesions suspicious for malignancy, and lesions increasing in size on serial imaging. 

Contraindications: infiltrative adrenal masses and tumors of extremely large size, because the size of adrenal lesions correlates with the potential for adrenal carcinoma. 

The da Vinci Robotic Surgical System (Intuitive Surgical Inc., Sunnyvale, CA, USA) and the following robotic instruments are used:30-degree scope, ProGrasp™ forceps, Hot Shears (monopolar curved scissors or a hook), and a Robotic Clip Applier. A monopolar cautery hook and Harmonic ACE® curved shears can also be used when deemed helpful by the surgeon. 

Laparoscopic instruments that can be handled by the bedside assistant, a clip applier and a suction device are also used. 

Robotic adrenalectomy for left adrenal Conn’s adenoma: live broadcast

Adrenalectomia robótica para adenoma de Conn na suprarrenal esquerda: transmissão ao vivo


Surrénalectomie robotique pour adénome de Conn surrénalien gauche : retransmission en direct


Adrenalectomía robótica para adenoma de Conn en la suprarrenal izquierda: transmisión en vivo


机器人肾上腺切除术治疗左肾上腺康恩氏腺瘤：直播


Роботическая адреналэктомия по поводу аденомы левого надпочечника


A 45-year-old woman with abdominal pain and hematochezia was found with adenocarcinoma of the sigmoid colon causing incomplete obstruction. CT-scan revealed a 5cm exophytic tumor of the superior pole of the left kidney.

Synchronous Left Colectomy (LC) and Renal Tumor Enucleation (RTE) were scheduled. Robotic surgery was preferred for RTE, but when performed first, splenic flexure mobilization could well interfere with subsequent LC. 



Starting with a standard robotic LC would make multiple dockings and patient position changes necessary. 

To overcome these problems, we adapted the technique of LC to the lateral position required for RTE and performed robotic vascular ligation of the left colon first.  Robotic left colon mobilization and RTE were then performed to finally achieve colectomy and colorectal anastomosis by means of laparoscopy with the patient in a standard lithotomy position. 

The procedure required only one docking of the robot and only one change in patient position. A compromise in port site positioning was obtained between the two procedures. One short incision was performed to retrieve both specimens and the same robotic instruments were used for both procedures.

Operative time was 350 minutes. The patient recovered well and no complications were noted. She was discharged on postoperative day 7.

Mixed robotic laparoscopic synchronous left colectomy and left renal tumor enucleation

Colectomía izquierda y enucleación de tumor renal izquierdo en procedimiento sincrónico laparoscópico robótico 


Синхронная роботическая левосторонняя гемиколэктомия и энуклеация опухоли левого надпочечника


Colectomia esquerda e enucleação de tumor renal esquerdo em procedimento sincrônico laparoscópico-robótico 


混合机器人腹腔镜同步左半结肠切除术与左肾肿瘤摘除术


Colectomie gauche synchrone laparoscopique et robotique et énucléation de tumeur rénale gauche


We present an operative video of a 61-year-old Chinese gentleman with locally advanced sigmoid carcinoma. Preoperative histology from endoscopy revealed an adenocarcinoma. The patient underwent laparoscopic anterior resection. Intraoperatively, the sigmoid tumor was adherent to the bladder with surrounding inflammation and edema. The colectomy had to be performed with an ‘en bloc’ excision of a bladder cuff. The bladder defect was repaired laparoscopically in two layers. Operative time was 4 hours 15 minutes and total blood loss was less than 100mL. The patient was discharged in good health conditions, four days after the operation with an outpatient cystogram performed before subsequent successful removal of the indwelling catheter. Final histology was pT4bN0 (0/31 lymph nodes) with clear margins. This case demonstrates that laparoscopic colectomy with ‘en bloc’ bladder cuff excision and subsequent laparoscopic repair of bladder defect are both feasible and safe.

Laparoscopic anterior resection for locally advanced sigmoid cancer with 'en bloc' excision of bladder cuff

Лапароскопическая передняя резекция прямой кишки с 'en bloc' резекцией мочевого пузыря по поводу местно-распространенного рака сигмовидной кишки


Résection antérieure laparoscopique pour cancer du côlon sigmoïde localement avancé et excision en bloc de collerette vésicale


Resección anterior laparoscópica para cáncer del sigmoides localmente avanzado con escisión en bloque de la vaina vesical


腹腔镜前切除术治疗局部晚期乙状结肠癌'en bloc'切除膀胱袖口


Ressecção anterior laparoscópica para câncer do sigmoide localmente avançado com excisão em bloco da bainha vesical


A 49-year-old generally fit man presented with abdominal pain following accidental swallowing of his denture 2 weeks previously. He looked well and his abdomen was soft and non-tender. A CT-scan showed a denture in the pyloric antrum of the stomach. 

Gastroenterologists thought that it would be too large to be removed endoscopically. Laparoscopy was performed and the denture could be easily felt with a laparoscopic forceps. The denture was extracted in an Albert bag via the umbilical port after longitudinal gastrotomy. The gastrotomy was closed with 2/0 Vicryl continuous suture in 2 layers intracorporeally as shown on the video. 

The patient was discharged on postoperative day 2 and remains well at 6 weeks of follow-up. Laparoscopic extraction of the gastric foreign body has the advantage of quicker recovery and better cosmesis as compared to the open technique. 

Laparoscopic extraction of gastric denture

Лапароскопическое извлечение инородного тела желудка (зубного протеза)


Extração laparoscópica de dentadura no estômago


Extraction laparoscopique de dentier dans l'estomac


Extracción laparoscópica de dentadura en el estómago


腹腔镜提取胃义齿


Background: Laparoscopic inguinal hernia repair offers various advantages both to the patient and the surgeon. Transabdominal preperitoneal (TAPP) and total extraperitoneal (TEP) repairs represent the two laparoscopic options. A personal technique of single incision laparoscopic TEP has already been published on WebSurg (Link: http://www.websurg.com/MEDIA/?noheader=1&doi=vd01en4054). 

Video: This video demonstrates the single incision laparoscopic treatment of a peritoneal hole, which occurred accidentally during a right TEP procedure. 

Results: The TEP procedure lasted 41 minutes and the peritoneal repair 8 minutes. The final umbilical scar length was 10mm and the patient was discharged within 24 hours. 

Conclusions: Peroperative complications can occur during single incision laparoscopy, as well as during conventional laparoscopy and open surgery. The procedure can be performed without conversion or additional trocars, depending on the complications which occurred. 

Single incision laparoscopic peritoneal hole repair during right TEP procedure

Однопортовая лапароскопическая ТЕР-герниопластика справа с ушиванием дефекта брюшины


单次切口腹腔镜下右侧TEP术中腹膜孔修复


Reparación del orificio peritoneal por laparoscopia de puerto único durante procedimiento TEP derecho


Cure de hernie laparoscopique droite par une seule incision pendant intervention TEP


Reparo do orifício peritoneal por laparoscopia de portal único durante procedimento TEP direito


Лапароскопическая субтотальная холецистэктомия


腹腔镜下次全切除胆囊切除术


Cholecystectomie subtotale laparoscopique


Colecistectomia subtotal laparoscópica


Colecistectomía subtotal laparoscópica


Laparoscopic cholecystectomy is a hazardous operation when the anatomy of Calot’s triangle is distorted by acute inflammation or any other factor (in our case, adhesions due to the recent surgery, and especially due to radiotherapy). In these difficult situations, the intraoperative decision to use a protective surgical technique as subtotal cholecystectomy is made with the purpose to prevent any injury to the biliary tree. 

This video demonstrates the case of a 69-year-old woman with morbid obesity (BMI of 55) and diagnosed with acute cholecystitis. Her past medical history is relevant for right nephrectomy for renal carcinoma using a right subcostal laparotomy followed by radiochemotherapy completed 3 months earlier. 

Subtotal cholecystectomy is a procedure which aims to remove portions of the gallbladder when structures of Calot’s triangle cannot be safely identified in "difficult gallbladders". The conversion rate to open surgery was higher among this category of patients. We describe our experience with a technical change, namely, a tactical laparoscopic subtotal cholecystectomy which almost always prevents conversion at the end of the procedures, and prevents both the risk of injury to the common bile duct and the risk of hemorrhage. In such cases, there is a need for rigor and prudence in order to return to the traditional technique in real time, if necessary.

Laparoscopic subtotal cholecystectomy can be considered a safe and feasible alternative to conversion to open surgery. Subtotal cholecystectomy is an essential technique to be used in difficult gallbladders. It achieves morbidity rates comparable to those reported for total cholecystectomy in simple cases. 

Laparoscopic subtotal cholecystectomy

Laparoscopic Burch colposuspension may be difficult in cases of stress urinary incontinence (SUI) associated with large lateral cystocele. In these cases, complications may occur. However, they are rare. 

This video shows the cystoscopic treatment of intravesical adhesions, secondary to sutures transfixing the bladder during the Burch laparoscopic procedure and lateral suspension, without perioperative use of control cystoscopy. An office cystoscopy was performed after the operation, nine months later, because of gradual onset of entirely isolated pelvic pain at the end of urination. It showed intravesical synechia as bilateral pillars. The different steps of the operation are the following: 

1) Diagnostic laparoscopy with a good status of the lateral suspension without mesh migration. 

2) Operative laparoscopy with opening of Retzius’s space, dissection, adhesiolysis, and division of the non-absorbable sutures of the past colposuspension in order to mobilize the bladder, followed by reperitonization of Retzius’s space.

3) Diagnostic cystoscopy confirming adhesions as bilateral pillars, laterally to the trigone with normal ejaculation of both ureteral ostia. 

4) Operative cystoscopy after catheterization of both ureters: division of the pillars with the monopolar electrode without visualization of the Burch sutures, as they probably migrated upward in the first postoperative months. 

In the postoperative period, ureteral catheters are removed 48 hours after surgery. Pain resolves completely during urination. Normal kidneys and ureters are observed at ultrasound. 

This video clearly demonstrates the advantages related to the routine use of cystoscopy at the end of the laparoscopic Burch procedure, especially in cases of large lateral cystocele.



Sutures transfixing bladder as a complication of laparoscopic burch colposuspension

Подшитый мочевой пузырь как осложнение лапароскопической кольпопексии по Бёрчу


Sutures transfixiant la vessie : complication d'une colposuspension de Burch laparoscopique


缝合固定膀胱是一种并发症腹腔镜burch colposuspension


Vejiga con suturas transfixiantes como complicación de colposuspensión retropúbica (cirugía de Burch) laparoscópica


Bexiga com suturas transfixantes como complicação de colpossuspensão retropúbica (cirurgia de Burch) laparoscópica


Грыжи Морганьи: лапароскопическая пластика


Morgagni's hernia is a rare congenital and usually asymptomatic disorder. It may cause respiratory or gastrointestinal symptoms. We reviewed the clinical findings of a patient with a Morgagni's hernia, diagnosed and managed in our department. Morgagni's hernia caused various symptoms in our patient and surgery was performed via laparoscopy. A chest CT-scan established the diagnosis. The hernial defect was closed with a synthetic mesh. Our patient had an uneventful postoperative recovery. We believe that the laparoscopic approach is an effective way of repairing Morgagni's hernia. 

Morgagni's hernia: laparoscopic approach

Hernie de Morgagni: approche laparoscopique 


Hérnia de Morgagni: abordagem laparoscópica


Morgagni的疝气：腹腔镜手术


Hernia de Morgagni: abordaje laparoscópico


腹腔镜左半结肠切除术（内侧至外侧入路）


Hemicolectomia esquerda laparoscópica (abordagem de medial a lateral)


This video presents the case of a 62-year old Chinese woman with descending colon carcinoma. Preoperative histological exam through endoscopy revealed an adenocarcinoma.

The patient underwent a laparoscopic left hemicolectomy, using a medial to lateral approach. This technique allows for precise dissection, early identification of the inferior mesenteric artery, and identification of the left ureter through virgin planes.

The surgery was performed smoothly. Operative time was 3 hours 45 min, with a total blood loss of less than 100mL.

She was discharged on postoperative day 3 and final histology was pT3N0 (0 out of 19 lymph nodes).



Laparoscopic left hemicolectomy (medial to lateral approach)

Hémicolectomie laparoscopique gauche (approche médiale à latérale)


Hemicolectomía izquierda laparoscópica (abordaje de medial a lateral)


Лапароскопическая левосторонняя гемиколэктомия (медиа-латеральная методика)


Gastrectomía total laparoscópica guiada por linfangiografía fluorescente utilizando inyección de ICG alrededor del tumor, seguida de esofagoyeyunostomía con engrapado doble intracorpóreo


通过荧光淋巴管造影术引导腹腔镜全胃切除术，使用围绕肿瘤的ICG注射，然后进行体内双吻合器食管空肠吻合术


Gastrectomia total laparoscópica guiada por linfangiografia fluorescente usando injeção de ICG ao redor do tumor, seguida de esofagojejunostomia com grampeamento duplo intracorpóreo


Лапароскопическая гастрэктомия с флуоресцентной лимфангиографией (индоцианин зеленый) с интракорпоральным формированием двойного степлерного (double stapling) эзофагоеюноанастомоза


Gastrectomie totale laparoscopique guidée par lymphangiographie fluorescente via injection de vert d'indocyanine autour de la tumeur, suivi par œsophagogastrectomie intracorporelle par double agrafage


Injecting indocyanine green (ICG) around the tumor enables the operators to identify the lymphatic channels and the lymph nodes in which the cancer cells can spread. It also allows them to decide on the extent of the dissection and validate the completeness of lymph node dissection. In this video, a laparoscopic near-infrared fluorescent camera was used, showing the fluorescent signal in diverse modes. A total gastrectomy with D1+ dissection is performed. The fluorescent signal shows the possible lymphatic pathways during the operation. An intracorporeal esophagojejunostomy was performed in a double stapling fashion; a round needle and a surgical thread are attached to the plastic part of the anvil of the circular stapler. 

Laparoscopic total gastrectomy guided by fluorescent lymphangiography using ICG injection around a tumor, followed by an intracorporeal double stapling esophagojejunostomy

Gastrectomía total laparoscópica y esofagoyeyunostomía con engrapado doble intracorpóreo


This video presents a totally laparoscopic total gastrectomy and intracorporeal esophagojejunostomy. 

In this case, the aberrant left hepatic artery is found and preserved with sufficient lymph node dissection around the left gastric artery. 

The intracorporeal esophagojejunostomy is performed in a double stapling fashion using an anvil at the end of which a round needle and a surgical thread are attached. 

Laparoscopic total gastrectomy and intracorporeal double stapling esophagojejunostomy

腹腔镜全胃切除术和体内双吻合器食管空肠吻合术


Gastrectomia total laparoscópica e esofagojejunostomia com grampeamento duplo intracorpóreo


Лапароскопическая гастрэктомия с интракорпоральным формированием двойного степлерного (double stapling) эзофагоеюноанастомоза


Gastrectomie totalement laparoscopique et oesophagojéjunostomie intracorporelle à double agrafage


This video demonstrates a Boari flap ureteroneocystostomy using laparotomy in an oncological ureteral obstruction. This technique of urinary reconstruction is used to fix lumbar ureteral defects using the tubulization of a bladder flap, allowing for the extension of the ureter towards the bladder. 

The success rate of ureteral reimplantation can be higher than 85% and it is used for the treatment of ureteric lesions caused by traumatic, oncological or iatrogenic injuries. Psoas hitch is the usual technique for the treatment of most distal ureteric resections. However, an additional Boari flap is required to treat longer and higher resections. 

Boari flap ureteroneocystostomy

Уретеронеоцистостомия по Боари


膀胱瓣输尿管膀胱吻合术


Urétéronéocystostomie et lambeau de Boari


Ureteroneocistostomia com flap de Boari


Ureteroneocistostomía con flap de Boari


In this video, a 51-year-old man presenting with nausea, vomiting, weight loss, and abdominal pain was investigated. The preoperative work-up (gastroscopy and CT-scan) showed the presence of a giant diverticulum of the distal portion of the stomach (17cm). A laparoscopic gastroduodenal resection with gastrojejunal anastomosis was performed. An upper GI series was performed on postoperative day 3, showing regular transit. The postoperative course was uneventful and the patient was discharged on postoperative day 7. 

Symptomatic gastric pseudodiverticulum post-hypertrophic pyloric stenosis: laparoscopic 3D resection

Pseudodivertículo gástrico sintomático después de estenosis hipertórfica del píloro: resección laparoscópica en 3D


Résection laparoscopique 3D pour sténose pylorique post-hypertrophique et pseudodiverticule gastrique symptomatique


Pseudodivertículo gástrico sintomático após estenose hipertrófica do piloro: ressecção laparoscópica em 3D


症状性胃假性憩室后肥厚性幽门狭窄：腹腔镜三维切除


Лапароскопическая резекция желудка в режиме 3D по поводу симптомного псевдодивертикула желудка со стенозом выходного отдела 


Duplication cysts are rare benign congenital anomalies, located predominantly at the proximal small intestine, emerging in the stomach in about 2 to 4% of all cases. Usually diagnosed in the pediatric age, they are commonly asymptomatic in adulthood and found incidentally on endoscopic or radiological exams. The therapeutic management of asymptomatic cysts is usually expectant. However, a surgical resection is recommended based on the potential risk of complications, such as malignant transformation. 

Clinical case: This is the case of a 44-year-old woman, who had an incidental diagnosis of an intra-abdominal cyst on ultrasound examination. CT-scan and MRI revealed the presence of a 6x4cm cystic mass located between the posterior wall of the stomach and the anterior wall of the pancreas, assuming the differential diagnosis of enteric duplication cyst or pancreatic cystic lesion. A laparoscopic exploration is decided upon. She underwent a laparoscopic excision of cystic lesion of the gastric wall, without complications. The patient was discharged home on the third postoperative day. The pathological examination confirmed the diagnosis of enteric duplication cyst. Histology showed a cystic lesion composed of smooth muscle tissue and partially covered by gastric antral-type mucosa. 

Laparoscopic excision of a gastric duplication cyst

Excisão laparoscópica de um cisto de duplicação gástrica


腹腔镜切除胃重复囊肿


Лапароскопическое иссечение дупликационной кисты желудка


Selection of video contributions