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surgical intervention video

Procedimiento Collis Nissen en formato de cuña en paciente con una gran hernia paraestomal tipo III


楔形Collis Nissen手术在患有大型III型食管旁疝的患者中使用


This video shows our standardized approach to the wedge-shaped Collis Nissen procedure. The patient is a 69-year-old woman with a large type III paraesophageal hernia. After extensive mediastinal dissection of the esophagus, there was no sufficient intra-abdominal esophageal length to perform a standard fundoplication. That was the reason why we decided to perform the Collis Nissen procedure.

Wedge-shaped Collis Nissen procedure in a patient with a large type III paraesophageal hernia

Procedimento Collis Nissen em formato de cunha em paciente com uma grande hérnia paraestomal tipo III


Фундопликация по Collis-Nissen у пациента с большой параэзофагеальной грыжой 3 типа


Intervention de Collis Nissen cunéiforme chez une patiente porteuse d'une volumineuse hernie para-œsophagienne de type III


This video shows the laparoscopic repair of a large type III paraesophageal hernia in a 55-year-old woman. After dissection of the hernia sac, partial resection is performed. Very high intramediastinal dissection of the esophagus is performed, taking special care not to injure the posterior and anterior vagal trunk. First, as the hiatal defect is very large, a right relaxing incision is performed. The crural repair is performed by interrupted Ethibond® 2/0 stitches buttressed with a polypropylene mesh. Finally, the diaphragmatic defect is covered with a non-reabsorbable mesh (Physiomesh™) and a 180-degree posterior fundoplication is performed. 

Relaxing incision for crural repair in type III paraesophageal hernia	

Incisão relaxante para reparo dos pilares em hérnia paraesofágica tipo III


放松切口进行III型食管旁疝气管修复


Incisión relajante para reparación de los pilares en hernia paraesofágica tipo III


Incision de relaxation pour cure crurale de hernie para-œsophagienne de type III


Послабляющие разрезы при круропластике по поводу параэзофагеальной грыже 3 типа


Chirurgie robotique : gastrectomie distale avec le système d’hémostase EndoWrist® One


EndoWrist®机器人远端胃切除术一个容器封口机


Gastrectomia distal robótica com a Seladora de Vaso EndoWrist® One


Gastrectomía distal robótica con la Selladora de Vaso EndoWrist® One


The EndoWrist® One vessel sealer is a wristed, single-use instrument of the da Vinci surgical robotic system intended for bipolar coagulation and mechanical transection of vessels up to 7mm in diameter and tissue bundles. It could be a potential instrument to overcome the limitation of straight energy-based devices. Although it has the advantage of having an endowrist function which allows easy access to the surgical planes in ideal directions, it requires special caution and know-how to use the device safely and effectively, because of a relatively blunt tip and the absence of an active blade at the tip. 

This video of the robotic distal gastrectomy for early gastric cancer shows how to harmonize the use of a sharp instrument with conventional bipolar electricity and of the vessel sealer device to maximize the advantages of such devices and to ensure safety. A conventional bipolar forceps is used to make entrance holes on the tissue for a safe application of the vessel sealer, and to perform fine dissections of small tissues, which are difficult to manage using a vessel sealer. Once the access hole has been made, the vessel sealer is applied in an ideal axis to the avascular tissue plane, thanks to the free wrist function. This technique combined with a sharp instrument using conventional bipolar electricity seems to be helpful for a safe and effective operation, which can use the benefit of the vessel sealer to its full potential, for instance with a high degree of freedom of the movement and secure sealing of lymphovascular structures. 

Robotic distal gastrectomy with the EndoWrist® One Vessel Sealer

Роботическая дистальная субтотальная резекция желудка с использованием аппарата для заваривания сосудов EndoWrist® One 


胸腔镜食管憩室切除术和肌切开术


Diverticulectomia esofágica toracoscópica e miotomia


The indication for the surgical management of a thoracic esophageal diverticulum is fairly rare (approximately 10%). It is motivated by the symptomatology, mainly dysphagia and pain which may be induced not only by the size of the diverticulum but also by esophageal motility disorders which are observed in 50 to 100% of patients. The treatment consists in a diverticulectomy combined with an esophageal myotomy, which aims to treat motor disorders and to prevent fistula at the level of the diverticulectomy area. 

Thoracoscopic esophageal diverticulectomy and myotomy

L’indication d’un traitement chirurgical d’un diverticule de l’œsophage thoracique est relativement rare, de l’ordre de 10 %. Elle est motivée par la symptomatologie, principalement la dysphagie et la douleur qui peuvent être provoquées par la taille du diverticule, mais également par les troubles moteurs œsophagiens qui sont observés chez 50 à 100 % des patients. Le traitement consiste en une diverticulectomie associée à une myotomie œsophagienne qui traite les troubles moteurs, mais prévient également les fuites au niveau de la zone de diverticulectomie. 

Diverticulectomie œsophagienne thoracoscopique et myotomie

Торакоскопическая эзофагомиотомия и иссечение дивертикула


Diverticulectomía esofágica toracoscópica y miotomía


Ressecção laparoscópica em cunha do Tumor Estromal Gastrointestinal (GIST) com grampeadores lineares em direção transversa


腹腔镜楔形切除的胃肠道间质瘤（GIST）与线性吻合器横向


Resección laparoscópica en cuña del Tumor Estromal Gastrointestinal (GIST) con engrapadores lineales en dirección transversa


This video presents a case of laparoscopic wedge resection for a gastric gastrointestinal stromal tumor (GIST). Exogastric resection using a stapler is effective for most GIST cases. However, there is a risk of gastric lumen narrowing after stapling in case of endophytically growing tumor unless the direction of the stapler is aligned transversely, which means in a perpendicular direction to the long axis of the stomach. This video shows how to access the tumor located at the posterior wall of the stomach, usefulness of the intraoperative endoscopy to identify the location of the tumor, and the presence of intraluminal bleeding from the staple line, and how to apply the linear stapler in a transverse direction in a laparoscopic wedge resection for gastric GIST. 

Laparoscopic wedge resection of gastric gastrointestinal stromal tumor (GIST) with linear staplers in a transverse direction

Лапароскопическая атипичная резекция желудка по поводу гастроинтестинальной стромальной опухоли (ГИСО) с помощью линейного степлера в поперечном направлении


Résection cunéiforme laparoscopique pour une tumeur stromale gastro-intestinale gastrique (GIST) : agrafeuses linéaires transversales


Cure laparoscopique de hernie para-œsophagienne géante de type III avec volvulus gastrique mésentérico-axial


腹腔镜修补肠系膜 - 胃扭转型巨大III型食管旁疝


This video demonstrates a laparoscopic repair of a giant type III paraesophageal hernia with an associated mesenteric-axial gastric volvulus in a 61-year-old woman. Dissection of the hernia sac was difficult because the esophageal hiatus was not very enlarged and the overlying peritoneum was very thickened because of chronic hernia incarceration. Once the stomach was replaced into the peritoneal cavity, mediastinal mobilization of the esophagus up to the pulmonary vein was performed. After crural repair, a standard posterior fundoplication was performed, as the intra-abdominal esophageal length was adequate. 

Laparoscopic repair of a giant type III paraesophageal hernia with mesenteric-axial gastric volvulus

Reparo laparoscópico de uma hérnia gigante paraesofágica do tipo III com vôlvulo gástrico mesentérico axial


Лапароскопическая пластика гигансткой параэзофагеальной грыжи 3 типа с перекрутом желудка


Reparación laparoscópica de una hernia gigante paraesofágica del tipo III con vólvulo gástrico mesentérico axial


Gastrectomía total laparoscópica para cáncer del cardias Siewert tipo III


Le traitement du cancer du cardia reste un sujet de controverse. La classification communément admise est celle de Siewert qui détermine le type de chirurgie à réaliser sur la base du point de départ de la tumeur. Le type 3 comprend les tumeurs qui se développent entre 2 et 5 cm en-dessous de la ligne Z. Cette localisation est considérée comme un cancer gastrique s’étendant au cardia et doit être traitée par une gastrectomie totale. 

Gastrectomie totale laparoscopique pour cancer du cardia, classification de Siewert type 3

Лапароскопическая гастрэктомия по поводу рака кардии тип III по Siewert


Gastrectomia total laparoscópica para câncer da cárdia Siewert tipo III


腹腔镜全胃切除术治疗SiewertⅢ型贲门癌




The treatment of cancer of the gastric cardia remains a matter of controversy. The widely accepted Siewert classification of gastroesophageal junction adenocarcinomas helps to determine the type of surgery based on the anatomical location of the tumor. Siewert type 3 includes tumors developing between 2 and 5cm underneath the Z line. This location is considered as a gastric cancer which extends to the cardia. It should be treated by means of a total gastrectomy. 

Laparoscopic total gastrectomy for Siewert type III cancer of the cardia

腹腔镜下胃造瘘术在食管鳞状细胞癌患者


Лапароскопическая гастростомия у больного плоскоклеточным раком пищевода


Gastrostomia laparoscópica em paciente com carcinoma esofágico de células escamosas 


Percutaneous endoscopic gastrostomy (PEG) and self-expanding endoscopic prosthesis are considered to be the "gold standard" for patients with neurological or oncologic diseases, which do not allow feeding per os. When they fail, surgical gastrostomy is considered. Recent data suggest that the laparoscopic approach may be better regarding early complications as compared to PEG. 

We present the case of an 81-year-old male patient diagnosed with squamous cell carcinoma of the esophagus. The patient presented with total dysphagia. The attempt of placing a self-expanding endoscopic prosthesis was unsuccessful. The patient was then proposed for the placement of a feeding laparoscopic gastrostomy. The postoperative period was uneventful and the patient was discharged on day two. 

Surgical gastrostomy is associated with frequent complications, such as erythema, chronic suppuration, migration and complications associated with surgical access. Laparoscopic access and technical details of the procedure allowed to reduce such complications and to perform the main steps under direct visual control, making it very safe and easily reproducible. 

Laparoscopic gastrostomy in a patient with esophageal squamous cell carcinoma

Gastrostomía laparoscópica en paciente con carcinoma esofágico de células escamosas 


Gastrostomie laparoscopique chez un patient porteur de cancer de l'œsophage à cellules squameuses


video lecture

Minimally invasive techniques for esophageal resection have been reported to have acceptably reduced procedure-related morbidity without compromising disease-free survival rates. In this lecture, Dr. Law presents his technique and focuses on the  differences between the lateral and the prone approach.

Minimally invasive esophagectomy: how I do it?

As técnicas minimamente invasivas para a ressecção esofágica foram relatadas como tendo reduzido aceitavelmente a morbidade relacionada ao procedimento sem comprometer as taxas de sobrevida livre de doença. Nesta palestra, o Dr. Law apresenta sua técnica e se concentra nas diferenças entre a abordagem lateral e a prona.


Esofagectomia minimamente invasiva: como faço?

Œsophagectomie mini-invasive : comment je fais ?


Over the last few decades, upper gastrointestinal endoscopy has become the most complementary test for investigation of esophageal diseases. Its accessibility and safety guarantee wide clinical utilization in patients with suspected benign and malignant diseases of the esophagus. In this lecture, Dr. Law focuses on the different diagnostic and therapeutic options of endoscopy.

Esophageal pathologies: from endoscopic mucosal resection (EMR) to endoscopic submucosal dissection (ESD) to tunnel technology

Pathologies œsophagiennes : de la résection mucosale endoscopique à la dissection sous-mucosale endoscopique à la technologie tunnel


Ao longo das últimas décadas, a endoscopia gastrintestinal superior se tornou o exame mais complementar para a investigação das doenças esofágicas. Sua acessibilidade e segurança garantem uma ampla utilização clínica em pacientes com suspeita de doenças benignas e malignas do esôfago. Nesta palestra, o Dr. Law se concentra nas diferentes opções diagnósticas e terapêuticas da endoscopia.


Patologias esofágicas: da ressecção endoscópica da mucosa (EMR) à dissecção endoscópica da submucosa (ESD) à tecnologia do túnel

Esophageal diverticula are rare. They may occur in the pharyngoesophageal area (Zenker's), mid-esophagus, or distally (epiphrenic). Most patients with diverticula are asymptomatic. Fewer than one-third of the diverticula produce symptoms severe enough to seek medical attention or to warrant surgery.

Surgical treatment has changed significantly with the development of minimally invasive methods which have increasingly replaced open surgery. If certain indications persist for open surgery, Zenker’s diverticulum is mainly treated with transoral endoscopic flexible or rigid techniques. This approach, which consists of a marsupialization of the diverticulum, also treats the concomitant motor disorder. These esophageal motor disorders are also present in the vast majority of patients with mid-esophageal or epiphrenic diverticula. These diseases are also treated mainly using a minimally invasive approach which consists of a diverticulectomy associated with an esophageal myotomy, which is widely recommended.

When and how to manage esophageal diverticula: surgical and endoscopic procedures

Os divertículos esofágicos são raros. Podem ocorrer na área faringoesofágica (de Zenker), no esófago médio ou distalmente (epifrênicos). A maioria dos pacientes com divertículos é assintomática. Menos de um terço dos divertículos produzem sintomas severos suficientes para demandar atenção médica ou para justificar a cirurgia.  O tratamento cirúrgico mudou significativamente com o desenvolvimento de métodos minimamente invasivos que têm cada vez mais substituído a cirurgia aberta. Se algumas indicações para a cirurgia aberta persistirem, o divertículo de Zenker é tratamento principalmente com técnicas rígidas ou de endoscopia flexível transoral. Esta abordagem, que consiste na marsupialização do divertículo, também trata o transtorno motor concomitante. Estes transtornos motores esofágicos estão também presentes na vasta maioria dos pacientes com divertículos epifrênicos ou do esôfago médio. Estas doenças são também tratadas principalmente usando uma abordagem minimamente invasiva, que consiste em uma diverticulectomia associada a uma miotomia esofágica, que é amplamente recomendada.


Quando e como lidar com os divertículos esofágicos: procedimentos cirúrgicos e endoscópicos

Quand et comment prendre en charge les diverticules œsophagiens : procédures chirurgicales et endoscopiques


O câncer de esôfago é uma malignidade virulenta associada a uma sobrevida global de cinco anos de aproximadamente 5%. O tratamento permanece controverso. Os benefícios e desvantagens das várias abordagens são discutidos nesta palestra.


A cirurgia na era do tratamento multimodal para câncer do esôfago

La chirurgie dans l'ère du traitement multimodal pour le cancer de l'œsophage


Esophageal cancer is a virulent malignancy associated with a 5-year overall survival of approximately 5%. Treatment remains controversial. The benefits and drawbacks of several approaches are discussed in this lecture.

Surgery in the era of multimodality treatment for cancer of the esophagus

Gastrointestinal stromal tumor (GIST) is the most common mesenchymal tumor, and the stomach is the most frequent location (50-60%). Gastric GIST presents as a submucosal tumor and is often found incidentally. Submucosal tumors greater than 2cm are indicated for resection. Indication for laparoscopic surgery is not strictly determined by the size, but whether surgery can follow resection principles, 1) R0 resection with histologically negative margins, 2) all efforts are made to prevent tumor rupture. Wedge resection using a linear stapler, also called “exogastric resection” is effective in most cases. However, the operator should pay attention to align the direction of the linear stapler “transversely” to the long axis of the stomach, otherwise it can cause gastric lumen narrowing after resection, especially in case of a relatively large tumor with endophytical growth. Endoscopy is very useful to identify and define tumor resection margins for endophytic tumor, and the “eversion” technique is one option to reduce the amount of normal mucosa resection. GIST cases located at the posterior wall of the upper stomach are technically challenging, and transgastric or intragastric techniques are suggested as good surgical options for such tumors. Laparoscopic or endoscopic “coring out” techniques can be dangerous, because of the high risk of tumor rupture and gastric wall perforation, which can cause peritoneal seeding when both take place simultaneously. 

Gastric GIST: minimally invasive surgical modalities

GIST gastrique : modalités chirurgicales mini-invasives


"O tumor estromal gastrointestinal (GIST) é o tumor mesenquimal mais comum, e o estômago é a localização mais frequente (50-60%). O GIST gástrico se apresenta como um tumor da submucosa e é encontrado incidentalmente com frequência. Os tumores da submucosa maiores do que 2 cm são indicados para ressecção. A indicação de cirurgia laparoscópica não é determinada estritamente pelo tamanho, mas se a cirurgia pode seguir os princípios da ressecção: 1) ressecção R0 com margens histológicas negativas, 2) todos os esforços são feitos para prevenir a ruptura do tumor. A ressecção em cunha usando um grampeador linear, também chamado ""ressecção exogástrica"" é efetiva na maioria dos casos. Contudo, o cirurgião deve prestar atenção para alinhar a direção do grampeador linear ""transversalmente"" até o eixo longo do estômago, do contrário pode causar estreitamento do lúmen gástrico após a ressecção, especialmente no caso de um tumor relativamente grande com crescimento endofítico. A endoscopia é muito útil para identificar e definir as margens de ressecção do tumor para tumor endofítico, e a técnica de ""eversão"" é um opção para reduzir a quantidade de ressecção da mucosa normal. Os casos de GIST localizados na parede posterior do estômago superior são tecnicamente desafiadores, e a técnica transgástrica ou a intragástrica são sugeridas como boas opções cirúrgicas para esses tumores. As técnicas de ""coring out"" (descaroçar) laparoscópicas ou endoscópicas podem ser perigosas, devido ao alto risco de ruptura do tumor e de perfuração da parede gástrica, o que pode causar difusão peritoneal quando ambas ocorrem simultaneamente."


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