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surgical intervention video

This video presents the experience of the authors in retroperitoneoscopic enucleation of a right renal cystic tumor. A right renal cystic tumor of 25 by 27 by 24mm was incidentally found in a 57-year-old male patient. A 3D retroperitoneoscopic surgery was recommended to remove the tumor. The patient was placed in a full lateral left decubitus position under general anesthesia. The retroperitoneal space was accessed with 4 trocars and developed with a custom-made retroperitoneal balloon dilator constructed by attaching a glove finger to the tip of a Nelaton catheter. After accessing the renal artery, the tumor was dissected, revealed, and demarcated. The renal artery was then clamped with a bulldog clamp and the tumor was meticulously dissected from the surrounding tissue using monopolar scissors combined with bipolar cautery When the tumor was completely resected, the first layer of renal renorrhaphy was performed with continuous absorbable suturing to control the bleeding of the nephrectomy bed. Hem-o-lok® clips were applied to tighten the suture without the need for knot tying. The bulldog clamp was then removed. A second layer of renal renorrhaphy was performed in the same manner. Blood loss was minimal and the postoperative stay was 2 days. Histological examination of the tumor indicated a renal cell carcinoma with safe margins. 

3D retroperitoneoscopic enucleation of a right renal cystic tumor

Enucléation par rétropéritonéoscopie 3D d'une tumeur kystique rénale droit

Authors present the case of a 21-year-old female patient who presented for excessive sweating of the hands and armpits since puberty. The patient received multiple medical treatments without success. Diagnosis of primary hyperhidrosis was made after excluding other secondary causes. A bilateral VATS sympathectomy was chosen as the surgical strategy. The postoperative period was uneventful. The patient was discharged on postoperative day 1. The control on postoperative day 30 was uneventful.

Bilateral VATS sympathectomy for primary hyperhidrosis

Sympathectomie bilatérale thoracique par vidéothoracoscopie pour hyperhidrose primaire

Cervical insufficiency (CI) has been defined as the cervical incapability to preserve an intrauterine pregnancy in the second trimester, with no apparent signs or symptoms of contractions, or labor. Aiming to decrease the incidence of fetal loss, several management options are available for CI, such as cervical cerclage. The transvaginal approach, secondary to ease of placement, is the most frequently used procedure for the placement of a cervical cerclage during pregnancy. In many cases, however, a vaginal cerclage will fail, and in other circumstances it may not be technically feasible to perform. As a result, an abdominal cerclage using laparoscopy or laparotomy may be an effective alternative. It consists of the circumferential insertion of a stitch around the cervix at the level of the junction of the cervix and uterine body (internal cervical os) and medially to the uterine arteries, which cannot be reached with a transvaginal approach. This can provide greater structural support to the cervix, and the absence of a foreign body in the vagina may also reduce the risk of ascending infection. High rates of success in preventing preterm birth are reported for both the open and laparoscopic approaches, with laparoscopy offering the advantages of minimally invasive surgery. The authors present a laparoscopic cerclage before pregnancy in a 41-year-old woman with a past history of second trimester pregnancy losses and a failed vaginal cerclage. Alternative to the conventional technique, the authors opted to perform the cerclage removing the needles and passing the suture with an endoscopic suturing device (Endo Close™, Covidien), as described by Al Fadhi in 2004 (R. Al-Fadhli, T. Tulandi. Obstet Gynecol Clin N Am 2004: 497-504).

Laparoscopic cervical cerclage: an alternative to the conventional technique

Cerclage cervical laparoscopique : une alternative à la technique classique 

Cerclage cervical de secours par laparoscopie pour insuffisance cervicale au 2è trimestre de grossesse 

This is a surgical demonstration highlighting the important aspects of laparoscopic cervical cerclage using a Mersilene® tape at the level of the internal os of the cervix. The procedure is performed under general anesthesia and authors used an ipsilateral port placement. A single needle is used in this demonstration, but one may even use a double needle if required. This patient was not eligible for induced or augmented labor, and she was instead offered an elective lower segment caesarean section (LSCS) upon completion of term. The tape can be cut during the caesarean section, or one may make the uterine incision above the Mersilene® tape to leave it in place. 

Laparoscopic rescue cervical cerclage for cervical insufficiency in 2nd trimester of pregnancy

Congenital diaphragmatic eventration results in the thinning and elevation of part or all of the affected diaphragm, due to a failure of myoblast migration during development (1). Diaphragmatic eventration may also be acquired by impairment of, or injury to the phrenic nerve (1). The effects may include reduced respiratory motion and poor lung expansion leading to hypoxia (1). The need for surgical intervention depends on the symptomatology of the child. The most commonly used surgical technique is the thoracoscopic Schwartz-Filler plication. It consists of a series of non-absorbable sutures, which fold and effectively flatten the diaphragm. This abolishes paradoxical breathing and improves lung expansion. 

Bibliography: (1) Carrasco A, Castro R. Right Diaphragmatic Eventration with an Intrathoracic Kidney: Case Report and Review of the Literature. Case Rep Surg. 2018 Dec 6;2018:2631391. doi: 10.1155/2018/2631391. PMID: 30631630; PMCID: PMC6304889.

Thoracoscopic diaphragmatic plication in an infant with right congenital diaphragmatic eventration

 Plicature diaphragmatique par thoracoscopie chez un nourrisson présentant une éventration diaphragmatique congénitale droite

Hystérectomie totale et salpingo-ovariectomie bilatérale assistées par robot pour cancer de l'utérus

This video shows a robot-assisted total hysterectomy and bilateral salpingo-oophorectomy for endometrial cancer. This patient is morbidly obese with a BMI of 51.4, which complicates the surgical intervention. With the robotic approach, the authors managed to perform the surgery with an intra-abdominal pressure of 8mmHg.

Multispecialty focus

3D retroperitoneoscopic enucleation of a right renal cystic tumor

Bilateral VATS sympathectomy for primary hyperhidrosis

Laparoscopic rescue cervical cerclage for cervical insufficiency in 2nd trimester of pregnancy

Laparoscopic cervical cerclage: an alternative to the conventional technique

Thoracoscopic diaphragmatic plication in an infant with right congenital diaphragmatic eventration

Robot-assisted total hysterectomy and bilateral salpingo-oophorectomy of grade 1 uterine cancer