monthly focus

surgical intervention video

腹腔镜下修补腹腔镜疝修补术DynaMesh®


Cure laparoscopique de hernie parastomale avec Dynamesh


Лапароскопическая пластика парастомальной грыжи сеткой DynaMesh®


The incidence rate of parastomal hernias ranges from 10 to 50%, and repair of the symptomatic cases is usually challenging. The use of a prosthetic mesh demonstrated good results, reducing recurrences. The laparoscopic approach is feasible and has shown lower morbidity rates as compared to the conventional technique. 

This is the case of a 64-year-old man, who underwent a parastomal hernia repair using Berger’s technique with a laparoscopic approach.

Laparoscopic repair of parastomal hernia with DynaMesh®

Reparo laparoscópico de hérnia paraestomal com DynaMesh®


Reparación laparoscópica de hernia paraestomal con DynaMesh®


LIVE-хирургия: лапароскопическая герниопластика послеоперационной грыжи у неоднократно оперированного пациента


CIRUGÍA INTERACTIVA EN VIVO: Manejo laparoscópico de una hernia incisional en paciente con múltiples cirugías


CHIRURGIE LIVE INTERACTIVE: Prise en charge laparoscopique d'une hernie inguinale bilatérale: approche TEP


CIRURGIA INTERATIVA AO VIVO: Manejo laparoscópico de uma hérnia incisional em paciente com múltiplas cirurgias


In this video, Dr. Adrian Park demonstrates the laparoscopic management of an incisional hernia in a multi-operated patient. The operator indicates the main steps of the procedure with pros and cons of trocar placement in relation to hernia repair. Once adhesions have been taken down, the fascial closure is performed by means of an intracorporeal suturing. The tackers are used to secure the mesh, which is sufficiently large to cover the defect, and transmural sutures are used to anchor the mesh. 

LIVE INTERACTIVE SURGERY: Laparoscopic management of an incisional hernia in a multi-operated patient

实时交互式手术：腹腔镜手术治疗多位手术患者的切口疝


CIRUGÍA INTERACTIVA EN VIVO: Manejo laparoscópico de una hernia inguinal bilateral: abordaje TEP


In this video, Dr. Bernard Dallemagne briefly outlilnes the main steps of bilateral inguinal hernia repair by Totally extraperitoneal inguinal hernia repair or TEP repair. After the insertion of the trocars the anatomical landmarks are identified.The direct and indirect hernia contents are dissected and reduced ,lipoma is dissected .Finally the mesh are inserted and the defects are covered bilaterally and the abdominal cavity is desufflated to complete the procedure.

LIVE INTERACTIVE SURGERY: Laparoscopic management of a bilateral inguinal hernia: TEP approach

实时交互式手术：腹腔镜治疗双侧腹股沟疝：TEP方法


LIVE-хирургия: лапароскопическая ТЕР-герниопластика двусторонней паховой грыжи


CIRURGIA INTERATIVA AO VIVO: Manejo laparoscópico de uma hérnia inguinal bilateral: abordagem TEP


Spiegelian hernias are quite rare and account for 1 to 2% of all abdominal wall hernias. In this video, Dr. Joel Leroy demonstrates the key steps of the laparoscopic management of inguinal and Spiegelian hernia using a transabdominal preperitoneal (TAPP) approach. The operator briefly outlines the basic rules for port placement and dissection based on anatomical landmarks. In addition, he introduced the main points related to mesh fixation and closure in Spiegelian hernias. 

LIVE INTERACTIVE SURGERY: Laparoscopic management of inguinal and Spiegelian hernia: TAPP approach

实时交互式手术：腹股沟管理腹股沟和Spigelian疝：TAPP方法


Chirurgie interactive live : cure laparoscopique de hernie inguinale et Spiegelienne, technique TAPP


CIRURGIA INTERATIVA AO VIVO: Manejo laparoscópico de uma hérnia inguinal e de Spiegel: abordagem TAPP


LIVE-хирургия: лапароскопическая ТАРР-герниопластика паховой грыжи и грыжи спигелиевой линии


CIRUGÍA INTERACTIVA EN VIVO: Manejo laparoscópico de una hernia inguinal y de Spiegel: abordaje TAPP


This is the case of a 64-year-old woman with a history of hysterectomy and left adnexectomy. In 2012, a vaginal ultrasound revealed a right ovarian mass diagnosed as a right ovarian cancer. In December 2012, she underwent a right adnexectomy with pelvic, lumbo-aortic lymphadenectomy and omentectomy. Final pathological staging of the ovarian cystadenocarcinoma was pT3cpN1Mx (IIIC). She completed 6 cycles of adjuvant chemotherapy with carboplatin and paclitaxel. During the follow-up exam, the patient remained symptom-free and presented with a stable perihepatic lesion. In 2015, two new lesions were found on CT-scan: one in the anterior mediastinum (14mm) and another in the abdominal diaphragm in contact with a liver segment VIII (19mm). In addition, CA 125 raised from 19 to 50kU/L. PET-scan only evidenced these two new lesions (SUV= 10). Taking into account the patient’s excellent performance status, long disease-free survival, stability of lesions, with CT-scans performed with a 3-month interval, and the possibility of video-assisted surgery, it was decided to use VATS and laparoscopy to remove the lesions. Final pathological findings showed ovarian cystadenocarcinoma metastases in 2 lesions (R0). The third perihepatic lesion was a cyst. The patient was discharged on postoperative day 4.

Combining VATS and laparoscopic approach in the resection of ovarian carcinoma metastasis

Combinaison de VATS et d'approche laparoscopique pour le résection de métastase de carcinome ovarien


Abordaje combinado VATS-laparoscópico en la resección de la metástasis de carcinoma ovárico


合并VATS 和腹腔镜手术在卵巢癌转移中的应用


Резекция метастазов рака яичников комбинированным (VATS и лапароскопическим) доступом


Abordagem combinada VATS-laparoscópica na ressecção da metástase de carcinoma ovariano


This is the case of a 34-year-old man who suffered from a blunt trauma, 8 months before this surgery. He presented with oppressive chest pain, lasting for a week, increasing while exercising and decreasing when lying down. No history of chronic pathology or smoking was reported. He was admitted to hospital. CT-scan of the abdomen and thorax showed a left diaphragmatic hernia. A laparoscopic diaphragmatic hernioplasty was decided upon. The patient is placed in a right semi-lateral decubitus position, with a 45-degree tilt.

Three trocars were placed; two 5mm trocars in the left upper quadrant, in the anterior axillary line, and in the epigastrium, while a 12mm optical trocar is placed in the upper left quadrant, in the midclavicular line. 

The left lung is collapsed. Laparoscopy revealed a left diaphragmatic defect, with a diaphragmatic hernia which contains the spleen, small bowel loops, and the omentum. The hernia contents are reduced into the abdominal cavity. The diaphragmatic defect is then sutured with non-absorbable material. A GORE® DUALMESH® biomaterial is placed over the previous defect and attached to the diaphragm with steel ENDO TACKERS™. A pleurostomy tube is placed and the lung is expanded. The patient outcome was uneventful and he was discharged 5 days after the procedure. 

Full laparoscopic repair of a post-traumatic diaphragmatic hernia with mesh insertion

Лапароскопическое ликвидирование посттравматической диафрагмальной грыжи с использованием сетки


Réparation totalement laparoscopique d'une hernie diaphragmatique post-traumatique avec insertion de prothèse 


Reparo totalmente laparoscópico de um hérnia diafragmática pós-traumática com inserção de tela


全网腹腔镜修补创伤性膈疝网片插入


Reparación totalmente laparoscópica de una hernia diafragmática post traumática con inserción de malla


In this video, Dr. Morales Conde outlines the main principles of strangulated umbilical hernia repair. After reduction of the contents of the hernia defect, adhesions are taken down and detached. The hernia defect is closed by means of a double loop suture and a piece of mesh which is sufficiently large to cover the hernia defect with a 5cm overlap of surrounding abdominal wall. The mesh is inserted and secured into position with two rows of tackers inserted concentrically. 

LIVE INTERACTIVE SURGERY: Laparoscopic management of a strangulated umbilical hernia: double-crown technique

CIRURGIA INTERATIVA AO VIVO: Manejo laparoscópico de uma hérnia umbilical estrangulada: técnica da coroa dupla


LIVE-хирургия: лапароскопическое вправление ущемленной пупочной грыжи, техника double-crown 


Chirurgie interactive live : cure laparoscopique de hernie ombilicale étranglée : technique en double couronne


实时交互式手术：腹腔镜管理绞窄脐疝：双冠技术


CIRUGÍA INTERACTIVA EN VIVO: Manejo laparoscópico de una hernia umbilical estrangulada: técnica de la doble corona


video lecture

In this lecture, Dr. Devinder Singh highlights complications related to ventral hernia repair. Skin perfusion zones in the abdominal wall can be healed using a device called SPY Elite. This device allows to perform ICG angiography which can be used in clinical and lab research. Dr. Singh also outlines the ICG safety profile as compared to other dyes available on the market. He describes the use of the SPY Elite device to accurately excise tissues in hernia repair. He also compares postoperative results in different cases with or without the use of the SPY Elite device and GI indications related to the use of this device. 

ICG angiography in AWR

Nesta palestra, o Dr. Devinder Singh destaca as complicações relacionadas com o reparo da hérnia ventral. As áreas de perfusão da pele na parede abdominal podem ser curadas usando um dispositivo chamado SPY Elite. Esse dispositivo permite realizar uma angiografia com ICG, que pode ser usada na pesquisa clínica e laboratorial. O Dr. Singh também destaca o perfil de segurança do ICG comparado com outros corantes disponíveis no mercado. Ele descreve o uso do dispositivo SPY Elite para cortar acuradamente os tecidos no reparo da hérnia. Também compara os resultados pós-operatórios em diversos casos com ou sem o uso do dispositivo SPY Elite e as indicações gastrointestinais relacionadas ao uso desse dispositivo.


Angiografia com ICG na reconstrução da parede abdominal

Angiographie ICG pour AWR


In this lecture, Dr. Singh describes plastic surgery perspectives for abdominal wall reconstruction. He also compares the difference of approach for hernia repair between plastic surgeons and general surgeons. He also briefly describes the incision in different surgeries and their impact on skin perfusion zones with examples of different cases with postoperative complications. Dr. Singh also looks into microvascular surgery and abdominal wall free flap transplantation with regards to clinical outcomes. Finally, he provides a brief overview of tissue expanders used in different cases of abdominal wall repair.  Dr. Singh does not have any conflicts of interest or financial ties to disclose.

Plastic surgery perspectives on abdominal wall reconstruction

Nesta palestra, o Dr. Singh descreve as perspectivas da cirurgia plástica na reconstrução da parede abdominal. Ele também compara a diferença de abordagem para o reparo da hérnia entre os cirurgiões plásticos e os cirurgiões gerais. Também descreve brevemente a incisão em diferentes cirurgias e seu impacto nas áreas de perfusão da pele com exemplos de diversos casos com complicações pós-operatórias. Além disso, o Dr. Singh investiga a cirurgia microvascular e o transplante com retalho livre na parede abdominal no que se refere aos desfechos clínicos. Finalmente, proporciona um breve panorama dos expansores de tecido usados nos diferentes casos de reparo da parede abdominal.


Perspectivas da cirurgia plástica na reconstrução da parede abdominal

Perspectives de la chirurgie esthétique pour la reconstruction de la paroi abdominale


In this video, Dr. Morales Conde highlights different techniques for mesh fixation in laparoscopic ventral hernia repair. Factors influencing pain, recurrence and adhesions are also demonstrated. Different techniques and materials to decrease pain and adhesions are outlined. The ideal laparoscopic ventral hernia repair can be achieved by decreasing mechanical fixation and increasing biological fixation to reduce pain and adhesions while preventing recurrence. 

Mesh fixation: transfascial sutures, absorbable and non-absorbable peritoneal fixation, glues

Neste vídeo, o Dr. Morales Conde destaca as diversas técnicas para a fixação da tela no reparo da hérnia ventral por laparoscopia. São demonstrados também os fatores que influenciam a dor, a recidiva e as aderências. São ressaltadas as diversas técnicas e materiais para reduzir a dor e as aderências. O reparo laparoscópico ideal da hérnia ventral pode ser realizado reduzindo a fixação mecânica e aumentando a fixação biológica para diminuir a dor e as aderências ao mesmo tempo que previne a recorrência.


Fixação da tela: suturas transfasciais, fixação peritoneal absorvível e não absorvível, colas

Fixation de prothèse : sutures transfasciales, fixation péritonéale résorbable et non-résorbable, colle


In this lecture, Michel Therin provides a brief introduction of biomaterials along with key mesh properties for an optimized surgical hernia repair. He also describes potential clinical outcomes which can be influenced by mesh parameters. He concludes with the properties of the ideal mesh to prevent complications. 

Michel Therin does not have any conflicts of interest or financial ties to disclose. 

Biomaterials in hernia repair: key mesh properties for an optimized performance

Nesta palestra, Michel Therin fornece uma breve introdução aos biomateriais junto com as propriedades-chave das telas para um reparo cirúrgico otimizado das hérnias. Ele também descreve os possíveis resultados clínicos que podem ser influenciados pelos parâmetros das telas. E conclui com as propriedades da tela ideal para prevenir complicações.


Biomateriais no reparo da hérnia: propriedades-chave da tela para um desempenho otimizado

Biomatériels dans la cure de hernies : propriétés clés des prothèses pour une performance optimisée


Nesta palestra, o Dr. Bruce Ramshaw destaca brevemente os principais aspectos da prevenção do seroma inguinal. Ele também aborda o manejo do seroma escrotal grande e os tratamentos pós-operatórios em diversos casos. Descreve o seroma crônico e seu tratamento para prevenir a recidiva. Propõe adaptações à reconstrução da parede abdominal para eliminar os drenos, minimizar os seromas/hematomas e prevenir as complicações da ferida pós-operatória.


Seromas - Prevenção e tratamento no reparo da hérnia inguinal e ventral

In this lecture, Dr. Bruce Ramshaw briefly outlines the main aspects of inguinal seroma prevention. He also addresses the management of large scrotal seroma and postoperative treatments in different cases. He describes chronic seroma and its management to prevent recurrence. He puts forward AWR adaptations in order to eliminate abdominal wall drains, to minimize seromas/hematomas, and to prevent postoperative wound complications.

Seromas – Avoidance and management in inguinal and ventral hernia repair

Séromes - comment les éviter et les gérer dans la cure de hernie inguinale et ventrale


In this lecture, Dr. Bruce Ramshaw outlines the main risk factors which contribute to chronic pain in postoperative hernia repair along with means of prevention. The main topics addressed in the presentation include laparoscopic repair which might induce less pain, the choice of the mesh, the location and amount of fixation, and pain management. The technique used to decrease perioperative pain may be useful to prevent chronic pain. He also mentioned the non-operative and operative management of inguinodynia. Complications involved in management and prevention were also demonstrated. 

Inguinodynia: prevention and management

Nesta palestra, o Dr. Bruce Ramshaw destaca os principais fatores de risco que contribuem para a dor crônica no reparo pós-operatório da hérnia e também os meios de prevenção. Os principais tópicos abordados na apresentação incluem o reparo laparoscópico, que podem induzir a menos dor, a escolha da tela, a localização e a quantidade de fixação e o manejo da dor. A técnica utilizada para diminuir a dor perioperatória pode ser útil para prevenir a dor crônica. Ele também mencionou o tratamento não cirúrgico e cirúrgico da inguinodinia. As complicações envolvidas na prevenção e tratamento são também demonstradas.


Inguinodinia: prevenção e manejo

Inguinodynie : prévention et prise en charge


In this lecture, Dr. Adrian Park demonstrates the main indications of hernia repair surgery and also outlines the pros and cons of a surgical intervention. He looks into the safety of watchful waiting in asymptomatic or minimally symptomatic inguinal hernias and into delaying surgical repair until symptoms increase. He also highlights the technical easiness and benefits of elective interventions versus emergent repairs. 

Inguinal hernia: is surgery always necessary?

Hernie inguinale : la chirurgie est-elle toujours nécessaire ?


Nesta palestra, o Dr. Adrian Park demonstra as principais indicações da cirurgia de reparo da hérnia e também destaca os prós e contras de uma intervenção cirúrgica. Ele examina a segurança da espera com observação nas hérnias inguinais assintomáticas ou minimamente sintomáticas e da prorrogação do reparo cirúrgico até que os sintomas aumentem. Ele também destaca a facilidade técnica e os benefícios das intervenções eletivas versus os reparos emergentes.


Hérnia inguinal: a cirurgia é sempre necessária?

In this lecture, Dr. Morales Conde, MD, PhD briefly outlines laparoscopic ventral hernia repair in complex locations (including lumbar, suprapubic, subcostal, subxiphoid, and parastomal hernias). He presents technical difficulties and complex anatomy in the lumbar area. The importance of appropriate identification of all nerves for mesh fixation is essential to prevent inguinodynia. The author also develops this identification issue based on the experience of surgeons, taking into account the indications and diagnostic imaging techniques and corresponding defect reconstructions based on anatomical landmarks in order to prevent recurrence and avoid complications. 

Dr. Morales-Conde, MD, PhD does not have any conflicts of interest or financial ties to disclose.

Laparoscopic repair of ventral hernia in complex locations

Nesta palestra, o Dr. Morales Conde destaca brevemente o reparo da hérnia ventral laparoscópica em localizações complexas (incluindo as hérnias lombares, suprapúbicas, subcostais, subxifoides e parastomais). Ele apresenta dificuldades técnicas e anatomia complexa na área lombar. A importância da identificação apropriada de todos os nervos para a fixação da tela é essencial para prevenir a inguinodinia. O autor também desenvolve esse problema de identificação com base na experiência dos cirurgiões, levando em consideração as indicações e as técnicas de diagnóstico de imagem e as correspondentes reconstruções de defeitos baseadas nos pontos de referência anatômicos para prevenir a recorrência e evitar as complicações.


Reparo laparoscópico da hérnia ventral em localizações complexas

Cure laparoscopique de hernie ventrale dans des endroits complexes


special focus dedicated to minimally invasive inguinal and ventral hernia and complex abdominal wall repair (CAWR) surgeries, including authoritative lectures and live surgical demonstrations on different techniques, approaches to hernia repair, prevention and management of inguinodynia, the use of different mesh materials, and postoperative care, all excerpted from the "Minimally Invasive Inguinal - Ventral & CAWR Surgery" IRCAD course, which was held on September 8-9, 2016

Focus On Complex Abdominal Wall Reconstruction (CAWR)