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Endoscopic Submucosal Dissection (ESD) of the rectum for a large rectal polypoid lesion: a live educational procedure
Endoscopic Submucosal Dissection (ESD) is an endoscopic technique which allows ‘en bloc’ resection of early stage tumors and polyps in the gastrointestinal tract. In this case, Professor Yahagi presents the case of a 67-year-old male patient with an incidental finding of a large rectal polyp during an MRI study. Colonoscopy revealed a 5cm laterally spreading tumor granular type (LST-G) of the rectum, extending to one fourth of the rectal circumference. The ESD was performed with a dual channel gastroscope in retrovision due to the proximity of the LST-G to the anal verge. Glycerol and indigo carmine were injected into the submucosal plane to lift the target lesion. The mucosal incision followed by submucosal dissection was performed with a 1.5mm DualKnife™ (Olympus) using a swift coag electrosurgical setting. Hemostasis of large vessels was performed switching to the forced coag effect. The vascular submucosal network has been carefully assessed. All critical steps are evaluated during the procedure.
N Yahagi, R Rodriguez Luna, M Pizzicannella
Surgical intervention
2 months ago
789 views
10 likes
2 comments
43:23
Endoscopic Submucosal Dissection (ESD) of the rectum for a large rectal polypoid lesion: a live educational procedure
Endoscopic Submucosal Dissection (ESD) is an endoscopic technique which allows ‘en bloc’ resection of early stage tumors and polyps in the gastrointestinal tract. In this case, Professor Yahagi presents the case of a 67-year-old male patient with an incidental finding of a large rectal polyp during an MRI study. Colonoscopy revealed a 5cm laterally spreading tumor granular type (LST-G) of the rectum, extending to one fourth of the rectal circumference. The ESD was performed with a dual channel gastroscope in retrovision due to the proximity of the LST-G to the anal verge. Glycerol and indigo carmine were injected into the submucosal plane to lift the target lesion. The mucosal incision followed by submucosal dissection was performed with a 1.5mm DualKnife™ (Olympus) using a swift coag electrosurgical setting. Hemostasis of large vessels was performed switching to the forced coag effect. The vascular submucosal network has been carefully assessed. All critical steps are evaluated during the procedure.
Laparoscopic TME - The 6-step procedure
In this key lecture, Dr. Rullier describes a clear 6-step approach to perform a laparoscopic total mesorectal excision (TME).
The first step is posterior dissection of the TME plane in the presacral space. Hereafter, a right lateral dissection is performed with sparing of the hypogastric nerves followed by anterior dissection and identification of the seminal vesicles and pelvic plexus. A left lateral dissection is then performed whereafter the planes are connected.
In this procedure, the 6 essential landmarks are the following: ''the presacral space, hypogastric nerves, seminal vesicles, pelvic plexus, levator ani muscles, and Denonvilliers' fascia and the prostate.’
E Rullier
Lecture
4 months ago
1433 views
20 likes
0 comments
09:16
Laparoscopic TME - The 6-step procedure
In this key lecture, Dr. Rullier describes a clear 6-step approach to perform a laparoscopic total mesorectal excision (TME).
The first step is posterior dissection of the TME plane in the presacral space. Hereafter, a right lateral dissection is performed with sparing of the hypogastric nerves followed by anterior dissection and identification of the seminal vesicles and pelvic plexus. A left lateral dissection is then performed whereafter the planes are connected.
In this procedure, the 6 essential landmarks are the following: ''the presacral space, hypogastric nerves, seminal vesicles, pelvic plexus, levator ani muscles, and Denonvilliers' fascia and the prostate.’
Skeletons in the cupboard: MY mistakes
Professor Heald teaches us the importance of learning from our mistakes and from other people so as not to commit them again, he emphasizes lessons to learn where he tells us not only about the challenges of pelvic, oncological surgery, and possible mistakes to be made. We advise you to feel free to say what we think in the surgery room, you can help in difficult situations and proper planning prior to all surgeries.
Beautiful lesson of the day: to fail to prepare is to prepare to fail.
In this outstanding didactic lecture, Professor Heald explains part of his great experience and the experiences of a career of more than 50 years, truly amazing! and life lessons he now shares with us, where he shows a clear example that “we must be our own sternest critics” and have the “courage to fail”.
in conclusion: beware of Panic Factor, and you can always call a friend, talk to patients, forget your own pride, learn to apologize.
Remember: there are things under your control and others that are not!
Thank you Professor Heald for these great teachings.
RJ Heald
Lecture
4 months ago
513 views
5 likes
1 comment
31:37
Skeletons in the cupboard: MY mistakes
Professor Heald teaches us the importance of learning from our mistakes and from other people so as not to commit them again, he emphasizes lessons to learn where he tells us not only about the challenges of pelvic, oncological surgery, and possible mistakes to be made. We advise you to feel free to say what we think in the surgery room, you can help in difficult situations and proper planning prior to all surgeries.
Beautiful lesson of the day: to fail to prepare is to prepare to fail.
In this outstanding didactic lecture, Professor Heald explains part of his great experience and the experiences of a career of more than 50 years, truly amazing! and life lessons he now shares with us, where he shows a clear example that “we must be our own sternest critics” and have the “courage to fail”.
in conclusion: beware of Panic Factor, and you can always call a friend, talk to patients, forget your own pride, learn to apologize.
Remember: there are things under your control and others that are not!
Thank you Professor Heald for these great teachings.
Redo laparoscopic anterior resection
The reported incidence rates of regional recurrence for colorectal cancer after oncologic resection ranged between 5% and 19%. Locoregional recurrence occurs in the anastomotic site, the remnant colon, the peritoneal surface (nodal or soft tissue), or the retroperitoneum. As reported in the literature, in colorectal cancers, mucinous differentiation, lymphovascular invasion and anastomotic leakage are independent risk factors for anastomotic recurrence.
We present the case of an 86 year-old female patient. In 2014, the patient underwent a laparoscopic left colectomy for a Haggitt level 4 sigmoid polyp. The definitive histologic features showed a T2N0M0 mucinous adenocarcinoma. During the postoperative follow-up, 46 months after the left colectomy, an anastomotic recurrence was found. The patient underwent a laparoscopic colorectal resection for anastomotic recurrence. The operative time was 220 minutes. The patient was discharged on postoperative day 6. No complications occurred intraoperatively and postoperatively.
References:
1. Gopalan S, Bose JC, Periasamy S (2015) Anastomotic Recurrence of Colon Cancer-is it a Local Recurrence, a Second Primary, or a Metastatic Disease (Local Manifestation of Systemic Disease)? Indian J Surg 77:232-236.
2. Ramphal W, Boeding JRE, Gobardhan PD, Rutten HJT, de Winter L, Crolla R, Schreinemakers JMJ (2018) Oncologic outcome and recurrence rate following anastomotic leakage after curative resection for colorectal cancer. Surg Oncol 27:730-736.
3. Jung WB, Yu CS, Lim SB, Park IJ, Yoon YS, Kim JC (2017) Anastomotic Recurrence After Curative Resection for Colorectal Cancer. World J Surg 41:285-294.
F Corcione, M D'Ambra, U Bracale, S Dilillo, G Luglio
Surgical intervention
8 months ago
3157 views
4 likes
1 comment
23:20
Redo laparoscopic anterior resection
The reported incidence rates of regional recurrence for colorectal cancer after oncologic resection ranged between 5% and 19%. Locoregional recurrence occurs in the anastomotic site, the remnant colon, the peritoneal surface (nodal or soft tissue), or the retroperitoneum. As reported in the literature, in colorectal cancers, mucinous differentiation, lymphovascular invasion and anastomotic leakage are independent risk factors for anastomotic recurrence.
We present the case of an 86 year-old female patient. In 2014, the patient underwent a laparoscopic left colectomy for a Haggitt level 4 sigmoid polyp. The definitive histologic features showed a T2N0M0 mucinous adenocarcinoma. During the postoperative follow-up, 46 months after the left colectomy, an anastomotic recurrence was found. The patient underwent a laparoscopic colorectal resection for anastomotic recurrence. The operative time was 220 minutes. The patient was discharged on postoperative day 6. No complications occurred intraoperatively and postoperatively.
References:
1. Gopalan S, Bose JC, Periasamy S (2015) Anastomotic Recurrence of Colon Cancer-is it a Local Recurrence, a Second Primary, or a Metastatic Disease (Local Manifestation of Systemic Disease)? Indian J Surg 77:232-236.
2. Ramphal W, Boeding JRE, Gobardhan PD, Rutten HJT, de Winter L, Crolla R, Schreinemakers JMJ (2018) Oncologic outcome and recurrence rate following anastomotic leakage after curative resection for colorectal cancer. Surg Oncol 27:730-736.
3. Jung WB, Yu CS, Lim SB, Park IJ, Yoon YS, Kim JC (2017) Anastomotic Recurrence After Curative Resection for Colorectal Cancer. World J Surg 41:285-294.
Low rectal resection with transanal total mesorectal excision (TaTME) performed with standard laparoscopic instrumentation
This is the case of a 62-year-old woman with rectal bleeding. She underwent a colonoscopy which showed a low rectal adenocarcinoma, 6cm from the anal margin. A CT-scan revealed the absence of metastasis and pelvic MRI showed a cT3N1 tumor.
The patient was treated with neoadjuvant radiochemotherapy. She received 50 Gray and capecitabine after which a new MRI showed a partial tumor response. The patient underwent surgery 10 weeks after finishing neoadjuvant therapy.
We started the operation with a laparoscopic abdominal approach. Four ports were placed. Two 10mm ports were introduced in the umbilicus and the right iliac fossa. Two 5mm ports were inserted in the left and right lower quadrant. Transanal total mesorectal excision (TaTME) was performed with a 5mm, 30-degree scope, monopolar hook, and bipolar forceps. The rectum was dissected 1cm distally from the neoplasia. The specimen was extracted transanally. Anastomosis was carried out transanally using a 33mm EEA™ circular stapler, after examination of the frozen section margin. A protective ileostomy was performed through the 10mm port site in the right iliac fossa and a drainage was put in place in the pelvis through the 5mm port entry site into the left flank.
The patient resumed food intake on postoperative day 2 and she was discharged on postoperative day 7. A complete mesorectal excision was confirmed on pathological examination. Fifteen negative nodes were removed. Distal and circumferential margins were negative.
The coloanal anastomosis was controlled with colonoscopy one month later. No sign of leakage was detected, and the ileostomy was subsequently closed.
The patient reports an adequate continence to gas and feces with one or two bowel movements per day. After 15 months of follow-up, the patient is still disease-free.
Our video shows that TaTME is a technique which can be performed by surgeons who have experience in laparoscopic and colorectal surgery.
In our operation, we did not use any energy devices, 3D or 4K technology. This procedure can be performed without expensive equipment.
L Taglietti, G Baronio, L Lussardi, R Cazzaniga, S Dester, A Zanoletti
Surgical intervention
11 months ago
2967 views
9 likes
2 comments
09:56
Low rectal resection with transanal total mesorectal excision (TaTME) performed with standard laparoscopic instrumentation
This is the case of a 62-year-old woman with rectal bleeding. She underwent a colonoscopy which showed a low rectal adenocarcinoma, 6cm from the anal margin. A CT-scan revealed the absence of metastasis and pelvic MRI showed a cT3N1 tumor.
The patient was treated with neoadjuvant radiochemotherapy. She received 50 Gray and capecitabine after which a new MRI showed a partial tumor response. The patient underwent surgery 10 weeks after finishing neoadjuvant therapy.
We started the operation with a laparoscopic abdominal approach. Four ports were placed. Two 10mm ports were introduced in the umbilicus and the right iliac fossa. Two 5mm ports were inserted in the left and right lower quadrant. Transanal total mesorectal excision (TaTME) was performed with a 5mm, 30-degree scope, monopolar hook, and bipolar forceps. The rectum was dissected 1cm distally from the neoplasia. The specimen was extracted transanally. Anastomosis was carried out transanally using a 33mm EEA™ circular stapler, after examination of the frozen section margin. A protective ileostomy was performed through the 10mm port site in the right iliac fossa and a drainage was put in place in the pelvis through the 5mm port entry site into the left flank.
The patient resumed food intake on postoperative day 2 and she was discharged on postoperative day 7. A complete mesorectal excision was confirmed on pathological examination. Fifteen negative nodes were removed. Distal and circumferential margins were negative.
The coloanal anastomosis was controlled with colonoscopy one month later. No sign of leakage was detected, and the ileostomy was subsequently closed.
The patient reports an adequate continence to gas and feces with one or two bowel movements per day. After 15 months of follow-up, the patient is still disease-free.
Our video shows that TaTME is a technique which can be performed by surgeons who have experience in laparoscopic and colorectal surgery.
In our operation, we did not use any energy devices, 3D or 4K technology. This procedure can be performed without expensive equipment.
Laparoscopic total mesorectal excision (TME) for rectal cancer: live procedure
This video of a live surgery performed by Professor Chen (Associate Professor, China Medical University Taichung, Taiwan) during an IRCAD Taiwan course very clearly demonstrates the stepwise execution of a laparoscopic total mesorectal excision (TME) with all its tips and tricks.
This is the case of a 65-year-old woman, with a low rectal tumor (4cm) is operated on after a short chemoradiation course (2 weeks before) for a stage IIA cancer (cT3N0M0).
Professor Chen’s surgical skills and experience and the beauty of the procedure, associated with a dynamic Q&A and expert comments coming from the auditorium, make of this video a must see.
WTL Chen, J Verde
Surgical intervention
11 months ago
3902 views
15 likes
0 comments
47:24
Laparoscopic total mesorectal excision (TME) for rectal cancer: live procedure
This video of a live surgery performed by Professor Chen (Associate Professor, China Medical University Taichung, Taiwan) during an IRCAD Taiwan course very clearly demonstrates the stepwise execution of a laparoscopic total mesorectal excision (TME) with all its tips and tricks.
This is the case of a 65-year-old woman, with a low rectal tumor (4cm) is operated on after a short chemoradiation course (2 weeks before) for a stage IIA cancer (cT3N0M0).
Professor Chen’s surgical skills and experience and the beauty of the procedure, associated with a dynamic Q&A and expert comments coming from the auditorium, make of this video a must see.
Transanal minimally invasive surgery (TAMIS) for rectal cancer with transabdominal and transrectal ICG-guided sentinel node
Transanal minimally invasive surgery (TAMIS) for rectal cancer is gaining interest, with the objective of maximum sparing for physiological functions. Although this approach may be considered appropriate for treating stage T1m tumors, a large proportion of T1sm and T2 tumors could well benefit from this. The greatest limitation to the application of TAMIS is represented by the difficulty of obtaining an adequate lymph node sample of the mesorectum. The use of indocyanine green (ICG) has recently been suggested as a possible lymph node marker after peritumoral injection. The case described in this video presents an innovative proposal for the detection and removal of lymph nodes draining a tumor of the lower rectum, with the aim of obtaining an adequate lymph node staging. After endoscopic peritumoral ICG injection, we proceeded to the search and removal of sentinel lymph nodes both with a laparoscopic transabdominal approach and with a transrectal approach (after specimen removal). If validated in a prospective series, this technique could represent the best lymph node harvesting strategy during TAMIS for early stage rectal cancer.
G Baiocchi, R Nascimbeni, N Vettoretto, N de Manzini, M Morino
Surgical intervention
1 year ago
2081 views
7 likes
0 comments
09:24
Transanal minimally invasive surgery (TAMIS) for rectal cancer with transabdominal and transrectal ICG-guided sentinel node
Transanal minimally invasive surgery (TAMIS) for rectal cancer is gaining interest, with the objective of maximum sparing for physiological functions. Although this approach may be considered appropriate for treating stage T1m tumors, a large proportion of T1sm and T2 tumors could well benefit from this. The greatest limitation to the application of TAMIS is represented by the difficulty of obtaining an adequate lymph node sample of the mesorectum. The use of indocyanine green (ICG) has recently been suggested as a possible lymph node marker after peritumoral injection. The case described in this video presents an innovative proposal for the detection and removal of lymph nodes draining a tumor of the lower rectum, with the aim of obtaining an adequate lymph node staging. After endoscopic peritumoral ICG injection, we proceeded to the search and removal of sentinel lymph nodes both with a laparoscopic transabdominal approach and with a transrectal approach (after specimen removal). If validated in a prospective series, this technique could represent the best lymph node harvesting strategy during TAMIS for early stage rectal cancer.
LIVE INTERACTIVE SURGERY: robotic low anterior resection for a local recurrence of rectal cancer
In this live interactive surgery, Dr. Parra-Davila demonstrates a robotic low anterior resection for a local recurrence of transanally excised rectal cancer. The operative technique shown includes a robotic oncological ‘en bloc’ resection and intracorporeal anastomosis. In the patient’s history, an ulcerated villous polyp too large for endoscopic removal was addressed to surgery. Preoperative biopsies had failed to detect malignancy. The surgical procedure consisted in a transanal full-thickness resection including partial TME for lymph node sampling. Since the operative specimen revealed a pT2N1a (1/8) rectal adenocarcinoma, the patient underwent adjuvant radiochemotherapy. The following year, a single hepatic metastasis was resected, complemented by postoperative chemotherapy. After 7 years of uneventful follow-up, an anastomotic recurrence was diagnosed. Following oncologic committee discussion, the patient was advised to undergo surgery.
E Parra-Davila, M Ignat, L Soler, B Seeliger, D Mutter, J Marescaux
Surgical intervention
1 year ago
1991 views
3 likes
0 comments
32:48
LIVE INTERACTIVE SURGERY: robotic low anterior resection for a local recurrence of rectal cancer
In this live interactive surgery, Dr. Parra-Davila demonstrates a robotic low anterior resection for a local recurrence of transanally excised rectal cancer. The operative technique shown includes a robotic oncological ‘en bloc’ resection and intracorporeal anastomosis. In the patient’s history, an ulcerated villous polyp too large for endoscopic removal was addressed to surgery. Preoperative biopsies had failed to detect malignancy. The surgical procedure consisted in a transanal full-thickness resection including partial TME for lymph node sampling. Since the operative specimen revealed a pT2N1a (1/8) rectal adenocarcinoma, the patient underwent adjuvant radiochemotherapy. The following year, a single hepatic metastasis was resected, complemented by postoperative chemotherapy. After 7 years of uneventful follow-up, an anastomotic recurrence was diagnosed. Following oncologic committee discussion, the patient was advised to undergo surgery.