monthly focus

surgical intervention video

This video presents the case of a 62-year-old woman with a BMI of 23.1 and a past medical history of dyslipidemia. The patient underwent a routine upper endoscopy, which revealed a gastric wall bulging suggestive of extrinsic gastric compression. Abdominal CT-scan revealed a nodule compressing the gastric wall and then, for better clarification, the patient underwent an MRI, showing a 5cm splenic nodule, described as a potential hemangioma or angiosarcoma. The PET/CT-scan showed the spleen without areas of increased metabolic activity. The case was discussed in an oncological multidisciplinary team, and due to the suspicion of malignancy, a laparoscopic splenectomy was decided upon, after pre-splenectomy vaccination. Surgery was performed with the patient placed in a right semi-lateral decubitus position placing trocars in a subcostal location. During the procedure, there was a small laceration of the diaphragm that was promptly sutured. The whole procedure lasted 120 minutes and had a total blood loss of 50mL. The postoperative period was uneventful, and the patient was discharged on postoperative day 1. Pathological examination revealed a splenic angioma with no other anomalies. At one month of postoperative follow-up, there were no surgical complications. Although rare, hemangiomas are the most common benign splenic neoplasms, and their natural course is asymptomatic slow growth. Treatment for large splenic hemangiomas has been recommended due to the risk of complications. In our case, imaging results created suspicion of malignancy, making the splenectomy the treatment of choice.

Laparoscopic splenectomy in a suspected angiosarcoma 

Splénectomie laparoscopique pour suspicion d'angiosarcome 

Pancreatic tail serous cystadenomas are benign lesions which can cause symptoms related to their size and mass compressive effects. In the case of symptomatic individuals, surgery is indicated. If technically possible, the choice for a spleen-preserving surgical approach is often preferred, as it would prevent the potential complications that could arise post-splenectomy. 

In this video, the authors performed a reduced port laparoscopic spleen-saving distal pancreatectomy (also known as the Kimura technique). This is the case of a 69-year-old female patient who presented with symptoms of abdominal discomfort. Her comorbidities included diabetes mellitus, hypertension, hyperlipidemia, and heart block. Cross-sectional abdominal imaging revealed a 3.6cm cystic mass at the tail of the pancreas. The patient underwent surgery. Postoperatively, she recovered well and was ready to be discharged on postoperative day 5. 

Technical pointers for surgery: 

1. Adequacy of stomach retraction allowing for reduced port surgery

2. Distal to proximal retrograde dissection, with alternating inferior and superior dissection to trace splenic vessels

3. Control of splenic vascular inflow, segmental venous occlusion with the use of laparoscopic bulldog clamps when dissecting between the cyst and the splenic vein

Reduced port laparoscopic spleen-saving distal pancreatectomy (Kimura technique) for pancreatic tail serous cystadenoma

Pancréatectomie distale laparoscopique avec préservation de la rate et trocarts réduits (technique de Kimura) pour cystadénome séreux de la queue du pancréas

Pancréaticoduodénectomie laparoscopique (intervention de Whipple) pour adénocarcinome périampullaire

In this video, the authors demonstrate their approach to a laparoscopic Whipple’s surgery in a 64-year-old male patient with newly diagnosed periampullary adenocarcinoma. The video demonstrates the use of the falciform ligament to retract the liver, the use of lymph node station 8a to identify the common hepatic artery, early dissection of the gastroduodenal artery, as well as clipping of the common bile duct (CBD) to prevent bile contamination of the operative field.

Laparoscopic pancreaticoduodenectomy (Whipple's procedure) for periampullary adenocarcinoma

This video demonstrates a laparoscopic common bile duct exploration (CBDE) performed using a transcholedochal approach in a 76-year-old male patient presenting with cholecystocholedocholithiasis. Multiple endoscopic retrograde cholangiopancreatography (ERCP) attempts failed due to a history of gastrectomy, and a cholecystectomy attempt also failed due to extensive intra-abdominal adhesions. These characteristics made this procedure challenging and specific.

Laparoscopic transcholedochal common bile duct exploration (CBDE) in a patient with cholecystocholedocholithiasis

video lecture

In this key lecture, Prof. Guido Costamagna outlines endoscopic papillectomy.

Endoscopic papillectomy 

La papillectomie endoscopique

Résection endoscopique des adénomes duodénaux

In this key lecture, Prof. Guido Costamagna outlines the endoscopic resection of duodenal adenomas.

Endoscopic resection of duodenal adenomas

Prise en charge endoscopique des complications hépato-pancréato-biliaires (HPB) 

In this key lecture, Dr. Gianfranco Donatelli outlines the endoscopic management of hepato-pancreato-biliary (HPB) complications.

Focus on surgery and endoscopy for HPB conditions