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Laparoscopic left hemicolectomy with manual intracorporeal anastomosis
The best surgical approach for splenic flexure tumors is not well defined yet.
The distal third of the transverse colon has an embryological origin in the hindgut, and the splenic flexure classically shows a dual lymphatic drainage, the proximal retropancreatic and the distal to the lymphatic pedicle of both the inferior mesenteric artery (IMA) and the inferior mesenteric vein (IMV). Nakagoe et al. showed that the majority of positive nodes have distal lymphatic spread to the paracolic archway and up to the origin of the left colic artery. Lymph nodes of the middle colic artery and its left branch are positive in a small percentage (0 and 4.2% respectively).
As a result, a left segmental colectomy is a valid option for splenic flexure and distal transverse colon tumors because it allows vascular ligation at the root of the vessels, dissection along the embryological planes, and adequate bowel margins from the tumor. The preservation of the IMV should reduce impaired venous drainage of the sigmoid colon, which can be associated with anastomotic leakage, without compromising complete mesocolic excision.
An intracorporeal anastomosis for left colonic resection may have the same advantages as for a right hemicolectomy, but can be technically more challenging.
This video shows a laparoscopic left hemicolectomy with manual intracorporeal anastomosis and preservation of the IMV for a tumor of the distal transverse colon.
A Canaveira Manso, M Rosete, R Nemésio, M Fernandes
Surgical intervention
21 days ago
496 views
6 likes
0 comments
16:43
Laparoscopic left hemicolectomy with manual intracorporeal anastomosis
The best surgical approach for splenic flexure tumors is not well defined yet.
The distal third of the transverse colon has an embryological origin in the hindgut, and the splenic flexure classically shows a dual lymphatic drainage, the proximal retropancreatic and the distal to the lymphatic pedicle of both the inferior mesenteric artery (IMA) and the inferior mesenteric vein (IMV). Nakagoe et al. showed that the majority of positive nodes have distal lymphatic spread to the paracolic archway and up to the origin of the left colic artery. Lymph nodes of the middle colic artery and its left branch are positive in a small percentage (0 and 4.2% respectively).
As a result, a left segmental colectomy is a valid option for splenic flexure and distal transverse colon tumors because it allows vascular ligation at the root of the vessels, dissection along the embryological planes, and adequate bowel margins from the tumor. The preservation of the IMV should reduce impaired venous drainage of the sigmoid colon, which can be associated with anastomotic leakage, without compromising complete mesocolic excision.
An intracorporeal anastomosis for left colonic resection may have the same advantages as for a right hemicolectomy, but can be technically more challenging.
This video shows a laparoscopic left hemicolectomy with manual intracorporeal anastomosis and preservation of the IMV for a tumor of the distal transverse colon.
Laparoscopic gastrectomy for gastric cancer after liver transplantation
It has already been demonstrated that laparoscopic gastrectomy is a safe approach for early gastric cancer. It can provide the same oncological outcomes as open gastrectomy with the benefit of fewer complications and early recovery.
Liver transplantation has a high incidence rate in the Korean population, just like gastric cancer. Additionally, South Korea has the highest incidence of this type of cancer worldwide. Patients who had received a liver transplant might benefit from a better recovery thanks to laparoscopic gastrectomy, and this approach can be performed by experienced surgeons.
Please add in the text narrative how you performed the anastomosis.
F Signorini, DJ Park, HK Yang
Surgical intervention
1 month ago
1058 views
5 likes
0 comments
09:23
Laparoscopic gastrectomy for gastric cancer after liver transplantation
It has already been demonstrated that laparoscopic gastrectomy is a safe approach for early gastric cancer. It can provide the same oncological outcomes as open gastrectomy with the benefit of fewer complications and early recovery.
Liver transplantation has a high incidence rate in the Korean population, just like gastric cancer. Additionally, South Korea has the highest incidence of this type of cancer worldwide. Patients who had received a liver transplant might benefit from a better recovery thanks to laparoscopic gastrectomy, and this approach can be performed by experienced surgeons.
Please add in the text narrative how you performed the anastomosis.
Minimally invasive Ivor-Lewis esophagectomy for end-stage achalasia
Achalasia is the most frequent esophageal motility disorder. Although Heller myotomy is the standard treatment, achieving good results in 90 to 95% of cases, esophagectomy could be the last surgical chance to treat end-stage achalasia and might be considered if severe symptomatic (dysphagia, regurgitation), anatomical (megaesophagus) or functional (esophagus aperistalses) disorders are not relieved with a more conservative approach.
Clinical case: We present the case of a 21-year-old female patient suffering from esophageal achalasia from the age of 3. After numerous attempts to grant her a good quality of life in a conservative way, when she gets to end-stage achalasia without any benefits from endoscopic therapies, a minimally invasive Ivor-Lewis esophagectomy is put forward to her in order to relieve her symptoms. Discussion/Conclusion: Esophagectomy could be performed in patients who are fit for major surgery and present with disabling symptoms, poor quality of life, and dolichomegaesophagus unresponsive to multiple endoscopic dilatations and/or surgical myotomies.
S Perretta, B Dallemagne, G Laracca, A Spota, D Mutter, J Marescaux
Surgical intervention
1 month ago
1109 views
13 likes
1 comment
13:39
Minimally invasive Ivor-Lewis esophagectomy for end-stage achalasia
Achalasia is the most frequent esophageal motility disorder. Although Heller myotomy is the standard treatment, achieving good results in 90 to 95% of cases, esophagectomy could be the last surgical chance to treat end-stage achalasia and might be considered if severe symptomatic (dysphagia, regurgitation), anatomical (megaesophagus) or functional (esophagus aperistalses) disorders are not relieved with a more conservative approach.
Clinical case: We present the case of a 21-year-old female patient suffering from esophageal achalasia from the age of 3. After numerous attempts to grant her a good quality of life in a conservative way, when she gets to end-stage achalasia without any benefits from endoscopic therapies, a minimally invasive Ivor-Lewis esophagectomy is put forward to her in order to relieve her symptoms. Discussion/Conclusion: Esophagectomy could be performed in patients who are fit for major surgery and present with disabling symptoms, poor quality of life, and dolichomegaesophagus unresponsive to multiple endoscopic dilatations and/or surgical myotomies.
Laparoscopic right hemicolectomy with excision of a pancreatic neuroendocrine tumor (pNET)
Pancreatic neuroendocrine tumors (pNETs) are rare neoplasms, which account for less than 5% of all pancreatic tumors, with an incidence of 0.48 cases/100,000. They may be benign or malignant and tend to grow slower than exocrine tumors. They develop from the abnormal growth of endocrine cells in the pancreas and are either functional or nonfunctional, and may or may not cause signs or symptoms. Pancreatic NETs that have not spread outside the pancreas should be completely removed, if possible, because these tumors are more likely to be cured with surgery. This video shows a case of a pNET of the uncinate process, discovered in the study of a right colon cancer. Because of the small size of the pNET and its location, the association of a right laparoscopic hemicolectomy with a pancreatic tumor excision was deemed feasible. The mobilization of the mesenteric root allowed to identify the uncinate process and to prepare for the pNET excision. After the exposure of the duodenum and the retroperitoneal plane, the surgery continued with a right hemicolectomy and a complete mesocolic excision. An intracorporeal anastomosis was constructed and the surgical specimen was retrieved through a suprapubic incision. The pathological report revealed a T2N1 caecal adenocarcinoma and a G2 pNET.
A Canaveira Manso, M Rosete, R Nemésio, R Martins
Surgical intervention
21 days ago
240 views
1 like
0 comments
17:16
Laparoscopic right hemicolectomy with excision of a pancreatic neuroendocrine tumor (pNET)
Pancreatic neuroendocrine tumors (pNETs) are rare neoplasms, which account for less than 5% of all pancreatic tumors, with an incidence of 0.48 cases/100,000. They may be benign or malignant and tend to grow slower than exocrine tumors. They develop from the abnormal growth of endocrine cells in the pancreas and are either functional or nonfunctional, and may or may not cause signs or symptoms. Pancreatic NETs that have not spread outside the pancreas should be completely removed, if possible, because these tumors are more likely to be cured with surgery. This video shows a case of a pNET of the uncinate process, discovered in the study of a right colon cancer. Because of the small size of the pNET and its location, the association of a right laparoscopic hemicolectomy with a pancreatic tumor excision was deemed feasible. The mobilization of the mesenteric root allowed to identify the uncinate process and to prepare for the pNET excision. After the exposure of the duodenum and the retroperitoneal plane, the surgery continued with a right hemicolectomy and a complete mesocolic excision. An intracorporeal anastomosis was constructed and the surgical specimen was retrieved through a suprapubic incision. The pathological report revealed a T2N1 caecal adenocarcinoma and a G2 pNET.
Winslow's hiatal hernia: laparoscopic treatment
Less than 200 cases of internal hernia have been described through the hiatus of Winslow, usually related to congenital or acquired anatomical defects. The most frequent affectation corresponds to the colon, small intestine and, rarely, to the gallbladder. There is usually occlusion with variable grade ischemia, but it can also occur as obstructive jaundice, biliary colic, secondary pancreatitis and non-symptomatic herniation.
The association of Winslow’s hiatus hernia with various anatomical abnormalities (high or subhepatic caecum, mobile ascending colon, large and long colonic mesentery, etc.) may actually correspond to different degrees of intestinal malrotation and, although the diagnosis of “malrotation” is not usually specified, we believe that this could underlie part of Winslow’s hiatus hernia associated with non-acquired anatomical defects.
Hiatal hernia corresponds to 0.2-0.9% of all cases of intestinal obstruction, of which 8% are from Winslow’s hiatus. If pre-surgical diagnosis is difficult, it occurs in less than 10% of cases.
Mortality is around 50% when it has vascular implication. We have not thought of applying the omentum to seal the defect because we did not have adequate surgical anchor sites since we were working millimeters from the vena cava, extrahepatic bile duct, duodenum, and perirenal area. We decided to fix the colon from the hepatic flexure to the right iliac fossa with continuous stitches, from the colonic serosa to Toldt’s fascia, as it is from the embryonic stage.
JL Limon Aguilar, CO Castillo Cabrera
Surgical intervention
1 month ago
1015 views
11 likes
2 comments
09:56
Winslow's hiatal hernia: laparoscopic treatment
Less than 200 cases of internal hernia have been described through the hiatus of Winslow, usually related to congenital or acquired anatomical defects. The most frequent affectation corresponds to the colon, small intestine and, rarely, to the gallbladder. There is usually occlusion with variable grade ischemia, but it can also occur as obstructive jaundice, biliary colic, secondary pancreatitis and non-symptomatic herniation.
The association of Winslow’s hiatus hernia with various anatomical abnormalities (high or subhepatic caecum, mobile ascending colon, large and long colonic mesentery, etc.) may actually correspond to different degrees of intestinal malrotation and, although the diagnosis of “malrotation” is not usually specified, we believe that this could underlie part of Winslow’s hiatus hernia associated with non-acquired anatomical defects.
Hiatal hernia corresponds to 0.2-0.9% of all cases of intestinal obstruction, of which 8% are from Winslow’s hiatus. If pre-surgical diagnosis is difficult, it occurs in less than 10% of cases.
Mortality is around 50% when it has vascular implication. We have not thought of applying the omentum to seal the defect because we did not have adequate surgical anchor sites since we were working millimeters from the vena cava, extrahepatic bile duct, duodenum, and perirenal area. We decided to fix the colon from the hepatic flexure to the right iliac fossa with continuous stitches, from the colonic serosa to Toldt’s fascia, as it is from the embryonic stage.
Leiomyosarcoma paracaval laparoscopic resection
Primary retroperitoneal tumors are rare, usually malignant and of mesenchymal origin. Surgery is the treatment of choice and complete tumor excision is the main factor which determines the prognosis. They represent between 0.3 and 0.8% of all neoplasms.
The most frequent tumors are sarcomas in their different varieties (totaling 83.7%), mainly liposarcomas (6-20%) and leiomyosarcomas (8-10%); 85% of retroperitoneal tumors are malignant and, of these, about 50% are sarcomas.
The involvement of the inferior vena cava in different tumor processes has long represented a criterion of inoperability and unresectability.
Extirpative surgery of the entire lesion is the treatment of choice for retroperitoneal tumors, but it is not always possible due to the infiltrative commitment of vital structures, despite the possibility of large visceral resections (stomach, kidney, spleen, tail of the pancreas, duodenum, colon, abdominal cava, etc.) and in which case we will not talk about recurrence but about residual tumor.
The laparoscopic approach performed by a multidisciplinary team with experience and expertise can help establish a correct diagnosis and achieve a fine dissection of the lesion, even if it is in difficult anatomical regions.
The video shows a laparoscopic resection of a paracaval mass of unknown origin. This is the case of a 39-year-old female patient who presents with abdominal pain in the epigastrium and right hypochondrium with 2 weeks of evolution. She receives analgesic treatment without any improvement accompanied by vomiting of gastrobiliary content, exacerbation of pain (VAS of 9/10). Hematic biometrics and blood chemistry demonstrated normal results. Ultrasound, CT-scan of the abdomen, and magnetic resonance cholangiography showed a pericaval tumor of about 6 or 4cm, not compromising the inferior vena cava with intimate interphase. After an appropriate assessment by the multidisciplinary team, it is decided to perform a laparoscopic resection.
Operating time was 110 minutes with insignificant blood loss. The procedure is performed successfully without any complications. There were no intraoperative complications. Oral feeding was reintroduced on the first postoperative day and the patient was discharged on postoperative day 2, without complications. Histopathological examination revealed a low-grade leiomyosarcoma. 5 years of follow-up without adjacent lesions.
JL Limon Aguilar, CO Castillo Cabrera
Surgical intervention
1 month ago
539 views
8 likes
0 comments
12:31
Leiomyosarcoma paracaval laparoscopic resection
Primary retroperitoneal tumors are rare, usually malignant and of mesenchymal origin. Surgery is the treatment of choice and complete tumor excision is the main factor which determines the prognosis. They represent between 0.3 and 0.8% of all neoplasms.
The most frequent tumors are sarcomas in their different varieties (totaling 83.7%), mainly liposarcomas (6-20%) and leiomyosarcomas (8-10%); 85% of retroperitoneal tumors are malignant and, of these, about 50% are sarcomas.
The involvement of the inferior vena cava in different tumor processes has long represented a criterion of inoperability and unresectability.
Extirpative surgery of the entire lesion is the treatment of choice for retroperitoneal tumors, but it is not always possible due to the infiltrative commitment of vital structures, despite the possibility of large visceral resections (stomach, kidney, spleen, tail of the pancreas, duodenum, colon, abdominal cava, etc.) and in which case we will not talk about recurrence but about residual tumor.
The laparoscopic approach performed by a multidisciplinary team with experience and expertise can help establish a correct diagnosis and achieve a fine dissection of the lesion, even if it is in difficult anatomical regions.
The video shows a laparoscopic resection of a paracaval mass of unknown origin. This is the case of a 39-year-old female patient who presents with abdominal pain in the epigastrium and right hypochondrium with 2 weeks of evolution. She receives analgesic treatment without any improvement accompanied by vomiting of gastrobiliary content, exacerbation of pain (VAS of 9/10). Hematic biometrics and blood chemistry demonstrated normal results. Ultrasound, CT-scan of the abdomen, and magnetic resonance cholangiography showed a pericaval tumor of about 6 or 4cm, not compromising the inferior vena cava with intimate interphase. After an appropriate assessment by the multidisciplinary team, it is decided to perform a laparoscopic resection.
Operating time was 110 minutes with insignificant blood loss. The procedure is performed successfully without any complications. There were no intraoperative complications. Oral feeding was reintroduced on the first postoperative day and the patient was discharged on postoperative day 2, without complications. Histopathological examination revealed a low-grade leiomyosarcoma. 5 years of follow-up without adjacent lesions.
Proximal gastrectomy with stapled circular esophagogastrostomy: manual purse-string technique
Early tumors of the esophagogastric junction can be managed with a minimally invasive proximal gastrectomy. This operation has recently been reevaluated for early-stage tumors since it offers a good postoperative quality of life with oncological outcomes equivalent to more extended procedures. In this video, we present the case of a 72-year-old man presenting with a 2cm adenocarcinoma of the esophagogastric junction. The clinical stage of the lesion was T1N0. A laparoscopic proximal gastrectomy with stapled circular esophagogastrostomy was decided upon. Five ports were placed. The left trocar incision was enlarged to introduce the circular stapler for the anastomoses and for specimen extraction. The procedure began with a complete abdominal exploration to rule out peritoneal metastases. The gastrocolic and gastrosplenic ligaments were divided with an ultrasonic scalpel. Short splenic vessels were clipped and divided and the greater curvature completely isolated with careful preservation of the gastroepiploic arcade and of the right gastroepiploic artery and vein. Left gastric vessels were divided at their origin with a vascular stapler and the distal esophagus was isolated through the diaphragmatic hiatus. A gastric tube was created with multiple applications of a linear stapler. The anvil of the circular stapler was secured to the esophageal stump with a hand-sewn purse-string suture in order to avoid the overlap of two suture lines. The esophagogastric anastomosis was then achieved with a circular stapler.
C Battiston, D Citterio, L Conti, M Virdis, V Mazzaferro
Surgical intervention
1 month ago
620 views
11 likes
1 comment
11:43
Proximal gastrectomy with stapled circular esophagogastrostomy: manual purse-string technique
Early tumors of the esophagogastric junction can be managed with a minimally invasive proximal gastrectomy. This operation has recently been reevaluated for early-stage tumors since it offers a good postoperative quality of life with oncological outcomes equivalent to more extended procedures. In this video, we present the case of a 72-year-old man presenting with a 2cm adenocarcinoma of the esophagogastric junction. The clinical stage of the lesion was T1N0. A laparoscopic proximal gastrectomy with stapled circular esophagogastrostomy was decided upon. Five ports were placed. The left trocar incision was enlarged to introduce the circular stapler for the anastomoses and for specimen extraction. The procedure began with a complete abdominal exploration to rule out peritoneal metastases. The gastrocolic and gastrosplenic ligaments were divided with an ultrasonic scalpel. Short splenic vessels were clipped and divided and the greater curvature completely isolated with careful preservation of the gastroepiploic arcade and of the right gastroepiploic artery and vein. Left gastric vessels were divided at their origin with a vascular stapler and the distal esophagus was isolated through the diaphragmatic hiatus. A gastric tube was created with multiple applications of a linear stapler. The anvil of the circular stapler was secured to the esophageal stump with a hand-sewn purse-string suture in order to avoid the overlap of two suture lines. The esophagogastric anastomosis was then achieved with a circular stapler.
Robotically assisted right colectomy with fluorescence-guided complete mesocolon excision
In robotic right hemicolectomy for cancer, appropriate lymphadenectomy and anastomotic leak prevention are critical. Visualization of draining lymph nodes, of primary tumor site and blood flow using the near-infrared (NIR) fluorescence da Vinci® imaging system is a recent development.
We present the technique of robotic right colectomy with complete mesocolic excision (CME) and D3 lymphadenectomy using Indocyanine Green (ICG) fluorescence.
The day before surgery, a colonoscopy was performed and ICG was injected around the tumor in the submucosa.
Robotic right hemicolectomy was performed with suprapubic trocars layout and bottom to up dissection, with CME, central vessel ligation, and D3 lymphadenectomy.
ICG was intraoperatively administered intravenously to assess bowel perfusion before anastomosis. The identification of the primary tumor site and of bowel stumps perfusion were possible and the accuracy in identifying the D3 lymphatic basin was high, allowing for an image-guided radical lymphadenectomy. Fluorescent technology represents a valuable innovation to improve colon cancer surgery.
W Petz, E Bertani, D Ribero, D Lo Conte, A Mellano, A Piccioli, S Borin, G Spinoglio
Surgical intervention
21 days ago
186 views
1 like
0 comments
08:43
Robotically assisted right colectomy with fluorescence-guided complete mesocolon excision
In robotic right hemicolectomy for cancer, appropriate lymphadenectomy and anastomotic leak prevention are critical. Visualization of draining lymph nodes, of primary tumor site and blood flow using the near-infrared (NIR) fluorescence da Vinci® imaging system is a recent development.
We present the technique of robotic right colectomy with complete mesocolic excision (CME) and D3 lymphadenectomy using Indocyanine Green (ICG) fluorescence.
The day before surgery, a colonoscopy was performed and ICG was injected around the tumor in the submucosa.
Robotic right hemicolectomy was performed with suprapubic trocars layout and bottom to up dissection, with CME, central vessel ligation, and D3 lymphadenectomy.
ICG was intraoperatively administered intravenously to assess bowel perfusion before anastomosis. The identification of the primary tumor site and of bowel stumps perfusion were possible and the accuracy in identifying the D3 lymphatic basin was high, allowing for an image-guided radical lymphadenectomy. Fluorescent technology represents a valuable innovation to improve colon cancer surgery.
Fully laparoscopic right colectomy for caecal tumor with “vessels first’ approach
Over the last few years, laparoscopic colorectal surgery has increased exponentially worldwide. When combined with an enhanced recovery program, a significant reduction in the length of hospital stay can be achieved, coupled with an early return to normal activities for the patient.
This is the case of a 68-year-old obese woman with a BMI of 30 presenting with a caecal tumor. Her major co-morbidities are chronic obstructive pulmonary disease (COPD) and high blood pressure. The patient complained of chronic abdominal pain and presented a positive fecal occult blood test. Colonoscopy showed a caecal tumor. Biopsy confirmed an adenocarcinoma. CT-scan did not show any distant metastasis. A full laparoscopic approach with a medial-to-lateral and ‘vessels first’ approach is shown.
A D'Urso, M Rodriguez, D Mutter, J Marescaux
Surgical intervention
21 days ago
583 views
3 likes
0 comments
13:27
Fully laparoscopic right colectomy for caecal tumor with “vessels first’ approach
Over the last few years, laparoscopic colorectal surgery has increased exponentially worldwide. When combined with an enhanced recovery program, a significant reduction in the length of hospital stay can be achieved, coupled with an early return to normal activities for the patient.
This is the case of a 68-year-old obese woman with a BMI of 30 presenting with a caecal tumor. Her major co-morbidities are chronic obstructive pulmonary disease (COPD) and high blood pressure. The patient complained of chronic abdominal pain and presented a positive fecal occult blood test. Colonoscopy showed a caecal tumor. Biopsy confirmed an adenocarcinoma. CT-scan did not show any distant metastasis. A full laparoscopic approach with a medial-to-lateral and ‘vessels first’ approach is shown.
Laparoscopic distal gastrectomy with Roux-en-Y reconstruction for a prepyloric lesion: a live educational procedure
This is the case of a 70-year-old patient who underwent an esophagogastroduodenoscopy for gastric pain. The exam showed a 0.5cm prepyloric ulcerated lesion with Helicobacter pylori infection. After Helicobacter pylori eradication and a CT-scan negative for secondary lesions, the patient was scheduled for a distal gastrectomy with perioperative gastroscopy.
In this original live educational video, Dr. Woo Jin Hyung describes his technique of laparoscopic distal gastrectomy with Roux-en-Y reconstruction and discusses several topics such as the comparison between laparoscopic and robotic gastrectomy, the indication for omentectomy, the choice of the surgical strategy considering the tumor location, the benefit of fluorescence in lymphatic mapping, the type of lymphadenectomy, the comparison of different energy devices and the choice of the reconstruction technique.
WJ Hyung, S Perretta, A Spota, D Mutter, J Marescaux
Surgical intervention
1 month ago
1379 views
20 likes
0 comments
57:00
Laparoscopic distal gastrectomy with Roux-en-Y reconstruction for a prepyloric lesion: a live educational procedure
This is the case of a 70-year-old patient who underwent an esophagogastroduodenoscopy for gastric pain. The exam showed a 0.5cm prepyloric ulcerated lesion with Helicobacter pylori infection. After Helicobacter pylori eradication and a CT-scan negative for secondary lesions, the patient was scheduled for a distal gastrectomy with perioperative gastroscopy.
In this original live educational video, Dr. Woo Jin Hyung describes his technique of laparoscopic distal gastrectomy with Roux-en-Y reconstruction and discusses several topics such as the comparison between laparoscopic and robotic gastrectomy, the indication for omentectomy, the choice of the surgical strategy considering the tumor location, the benefit of fluorescence in lymphatic mapping, the type of lymphadenectomy, the comparison of different energy devices and the choice of the reconstruction technique.
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
21 days ago
365 views
12 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
21 days ago
166 views
3 likes
0 comments
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.
Transverse colectomy with total mesocolic excision for cancer - Safe Transverse
In this key lecture, Dr. Armando Melani explains how transverse colectomy with total mesocolic excision for cancer is a doable and safe surgery, in his opinion and according to his experience.
Dr. Melani outlines the recommendations for a safe transverse colectomy and teaches us how to avoid lesions in the superior mesenteric vessels, shows laparoscopic mobilization for resection of the transverse colon due to cancer, and demonstrates an excellent vascular approach.
Finally, Dr. Melani provides the rationale of the extension of the LND for right colon cancer and gives a didactic demonstration in this video.
In conclusion, transverse colectomy with total mesocolic excision for cancer is relatively difficult. The reasons for this are the anatomical variations of middle colic vessels, transverse mesocolon attachments with the pancreatic head, and venous communications. In this authoritative lecture, Dr. Melani demonstrates the laparoscopic approach and provides all recommendations to achieve a successful surgery.
A Melani
Lecture
21 days ago
196 views
1 like
0 comments
09:46
Transverse colectomy with total mesocolic excision for cancer - Safe Transverse
In this key lecture, Dr. Armando Melani explains how transverse colectomy with total mesocolic excision for cancer is a doable and safe surgery, in his opinion and according to his experience.
Dr. Melani outlines the recommendations for a safe transverse colectomy and teaches us how to avoid lesions in the superior mesenteric vessels, shows laparoscopic mobilization for resection of the transverse colon due to cancer, and demonstrates an excellent vascular approach.
Finally, Dr. Melani provides the rationale of the extension of the LND for right colon cancer and gives a didactic demonstration in this video.
In conclusion, transverse colectomy with total mesocolic excision for cancer is relatively difficult. The reasons for this are the anatomical variations of middle colic vessels, transverse mesocolon attachments with the pancreatic head, and venous communications. In this authoritative lecture, Dr. Melani demonstrates the laparoscopic approach and provides all recommendations to achieve a successful surgery.
A standardized approach for complete mesocolic excision (CME) for right colon cancer
In this key lecture, Dr. Antonello Forgione presents a clear and precise description of the most important anatomical points as well as the surgical technique for complete mesocolic excision (CME) during a right laparoscopic colectomy, in cases of cancer.
As described in the video, four ports are used, all located on the left flank. A caudocranial dissection of the mesocolon is performed along the superior mesenteric vein to the inferior margin of the pancreas, exposing, ligating and dividing the ileocolic, right and middle colic vessels in their origins. The gastrocolic trunk is completely dissected and the upper right colic vein is cut and divided. The transverse colon and the terminal ileum are divided, the colon is mobilized, and the ileo-transverse intracorporeal stapled anastomosis is fashioned.
Laparoscopic CME is feasible and very useful. However, it is necessary to have an extensive knowledge of the vascular anatomy of the right colon, as well as an experience in advanced laparoscopic techniques to obtain the expected outcomes.
Finally, Dr. Forgione provides recommendations to perform the surgery in obese patients.
A Forgione
Lecture
21 days ago
99 views
1 like
0 comments
14:20
A standardized approach for complete mesocolic excision (CME) for right colon cancer
In this key lecture, Dr. Antonello Forgione presents a clear and precise description of the most important anatomical points as well as the surgical technique for complete mesocolic excision (CME) during a right laparoscopic colectomy, in cases of cancer.
As described in the video, four ports are used, all located on the left flank. A caudocranial dissection of the mesocolon is performed along the superior mesenteric vein to the inferior margin of the pancreas, exposing, ligating and dividing the ileocolic, right and middle colic vessels in their origins. The gastrocolic trunk is completely dissected and the upper right colic vein is cut and divided. The transverse colon and the terminal ileum are divided, the colon is mobilized, and the ileo-transverse intracorporeal stapled anastomosis is fashioned.
Laparoscopic CME is feasible and very useful. However, it is necessary to have an extensive knowledge of the vascular anatomy of the right colon, as well as an experience in advanced laparoscopic techniques to obtain the expected outcomes.
Finally, Dr. Forgione provides recommendations to perform the surgery in obese patients.
Vascular anatomy of left and right colon: standard vs. variations
The vascular anatomy of the colon has some anatomical variations [1]. In this video, starting from the normal surgical anatomy of the colon, authors show many vascular anomalies of surgical interest, which should be known in order to avoid intraoperative complications. In the right colon, the ileocolic artery and the middle colic artery are constantly present in all patients as they arise from the superior mesenteric vessels [2]. Right colic vessels are present only in 80% of cases. The position of ileocolic vessels related to the superior mesenteric vein (SMV) is a key landmark. In this video, starting from the normal surgical anatomy of the right colon, authors show variant ileocolic vessels position defined type A pattern, with ileocolic artery (ICA) which lies in the anterior position in respect to the ileocolic vein (ICV). Authors also show an anomalous origin of the ileocolic vessels, which are more upper in respect to their standard position. Commonly, the ileocolic artery (ICA) lies posterior to the SMV (83%, type B). However, the ICA sometimes lies anteriorly to the SMV (17%, type A) [1]. The vascular system of the left colon has fewer variations in terms of position and origin, contrarily to the right colon. The most frequent variations of the inferior mesenteric artery (IMA) supply involve the division of the sigmoid arteries, as classified by Latarjet in two different types, depending on the anatomical relationship between the left colic and sigmoid arteries [3]. However, in this video authors show a rare case of IMA arising from the superior mesenteric artery [4].
References:
1. Milsom JW, Böhm B, Nakajima K. Laparoscopic Colorectal Surgery 2006, Springer.
2. Wu C, Ye K, Wu Y, Chen Q, Xu J, Lin J, Kang W. Variations in right colic vascular anatomy observed during laparoscopic right colectomy. World J Surg Oncol 2019;17:16.
3. Patroni A, Bonnet S, Bourillon C, Bruzzi M, Zinzindohoue F, Chevallier JM, Douard R, Berger A. Technical difficulties of left colic artery preservation during left colectomy for colon cancer. Surg Radiol Anat 2016;38:477-84.
4. Yoo SJ, Ku MJ, Cho SS, Yoon SP. A case of the inferior mesenteric artery arising from the superior mesenteric artery in a Korean woman. J Korean Med Sci 2011;26:1382-5.
F Corcione, E Pontecorvi, V Silvestri, G Merola, U Bracale
Surgical intervention
21 days ago
841 views
13 likes
0 comments
21:44
Vascular anatomy of left and right colon: standard vs. variations
The vascular anatomy of the colon has some anatomical variations [1]. In this video, starting from the normal surgical anatomy of the colon, authors show many vascular anomalies of surgical interest, which should be known in order to avoid intraoperative complications. In the right colon, the ileocolic artery and the middle colic artery are constantly present in all patients as they arise from the superior mesenteric vessels [2]. Right colic vessels are present only in 80% of cases. The position of ileocolic vessels related to the superior mesenteric vein (SMV) is a key landmark. In this video, starting from the normal surgical anatomy of the right colon, authors show variant ileocolic vessels position defined type A pattern, with ileocolic artery (ICA) which lies in the anterior position in respect to the ileocolic vein (ICV). Authors also show an anomalous origin of the ileocolic vessels, which are more upper in respect to their standard position. Commonly, the ileocolic artery (ICA) lies posterior to the SMV (83%, type B). However, the ICA sometimes lies anteriorly to the SMV (17%, type A) [1]. The vascular system of the left colon has fewer variations in terms of position and origin, contrarily to the right colon. The most frequent variations of the inferior mesenteric artery (IMA) supply involve the division of the sigmoid arteries, as classified by Latarjet in two different types, depending on the anatomical relationship between the left colic and sigmoid arteries [3]. However, in this video authors show a rare case of IMA arising from the superior mesenteric artery [4].
References:
1. Milsom JW, Böhm B, Nakajima K. Laparoscopic Colorectal Surgery 2006, Springer.
2. Wu C, Ye K, Wu Y, Chen Q, Xu J, Lin J, Kang W. Variations in right colic vascular anatomy observed during laparoscopic right colectomy. World J Surg Oncol 2019;17:16.
3. Patroni A, Bonnet S, Bourillon C, Bruzzi M, Zinzindohoue F, Chevallier JM, Douard R, Berger A. Technical difficulties of left colic artery preservation during left colectomy for colon cancer. Surg Radiol Anat 2016;38:477-84.
4. Yoo SJ, Ku MJ, Cho SS, Yoon SP. A case of the inferior mesenteric artery arising from the superior mesenteric artery in a Korean woman. J Korean Med Sci 2011;26:1382-5.
Laparoscopic segment 7 resection with extracorporeal Pringle maneuver on a cirrhotic liver
This is the case of a 73-year-old man presenting with a 33mm hepatocellular carcinoma arising on a Hepatitis C virus-related well-compensated cirrhosis without portal hypertension. A laparoscopic segment 7 atypical resection was decided upon. Five ports are placed. The procedure begins with complete abdominal exploration and intraoperative liver ultrasonography. The right triangular and coronary ligaments are divided in order to mobilize the right lobe and gain access to liver segment 7. The hepatic hilum is encircled with an umbilical tape. The tape is passed percutaneously through a 24 French chest tube used as Rommel’s tourniquet to allow for a safe and fast extracorporeal Pringle maneuver. The transection plane is controlled using ultrasound. The first part of parenchymal transection is performed using Thunderbeat™ while an ultrasonic dissector (CUSA™) is used more deeply. Hemostasis is controlled with irrigated bipolar forceps and clips on major vessels. To allow for a bloodless parenchymal transection and a more precise isolation and clipping of the vessels, the hepatic hilum is clamped for 10 minutes. The chest tube is pushed towards the hilum and clamped extracorporeally. After 10 minutes, the Pringle maneuver is released for 5 minutes and then repeated for another 10 minutes until parenchymal transection is complete. No drains are placed. Operative time took 180 minutes and total blood loss was 50mL. The postoperative course was uneventful and the patient was discharged on postoperative day 3. The pathology confirmed a 3cm hepatocellular carcinoma without microvascular invasion. Resection margins were negative for tumor invasion.
D Citterio, C Battiston, C Sposito, M Altomare, A Benedetti, V Mazzaferro
Surgical intervention
1 month ago
1164 views
9 likes
2 comments
10:10
Laparoscopic segment 7 resection with extracorporeal Pringle maneuver on a cirrhotic liver
This is the case of a 73-year-old man presenting with a 33mm hepatocellular carcinoma arising on a Hepatitis C virus-related well-compensated cirrhosis without portal hypertension. A laparoscopic segment 7 atypical resection was decided upon. Five ports are placed. The procedure begins with complete abdominal exploration and intraoperative liver ultrasonography. The right triangular and coronary ligaments are divided in order to mobilize the right lobe and gain access to liver segment 7. The hepatic hilum is encircled with an umbilical tape. The tape is passed percutaneously through a 24 French chest tube used as Rommel’s tourniquet to allow for a safe and fast extracorporeal Pringle maneuver. The transection plane is controlled using ultrasound. The first part of parenchymal transection is performed using Thunderbeat™ while an ultrasonic dissector (CUSA™) is used more deeply. Hemostasis is controlled with irrigated bipolar forceps and clips on major vessels. To allow for a bloodless parenchymal transection and a more precise isolation and clipping of the vessels, the hepatic hilum is clamped for 10 minutes. The chest tube is pushed towards the hilum and clamped extracorporeally. After 10 minutes, the Pringle maneuver is released for 5 minutes and then repeated for another 10 minutes until parenchymal transection is complete. No drains are placed. Operative time took 180 minutes and total blood loss was 50mL. The postoperative course was uneventful and the patient was discharged on postoperative day 3. The pathology confirmed a 3cm hepatocellular carcinoma without microvascular invasion. Resection margins were negative for tumor invasion.
Laparoscopic pancreaticoduodenectomy with venous reconstruction
Laparoscopic pancreaticoduodenectomy is an alternative to open surgery, which offers equivalent oncological results with a faster recovery associated with the minimally invasive approach. In cases of venous invasion, laparoscopic reconstruction with graft interposition is technically demanding. Nevertheless, good results can be achieved. This is the case of a 79-year-old man who was evaluated for jaundice. CT-scan found a tumor in the head of the pancreas with a 180-degree infiltration of the portal vein. After neoadjuvant chemotherapy with volumetric shrinking, but persistence of venous infiltration, a laparoscopic pancreaticoduodenectomy with venous reconstruction was decided upon.
E Giordano, A Alcaraz, S Reimondez, M Marani, W Salinas, R Pereyra, F Signorini, M Maraschio, L Obeide
Surgical intervention
1 month ago
1479 views
13 likes
1 comment
08:05
Laparoscopic pancreaticoduodenectomy with venous reconstruction
Laparoscopic pancreaticoduodenectomy is an alternative to open surgery, which offers equivalent oncological results with a faster recovery associated with the minimally invasive approach. In cases of venous invasion, laparoscopic reconstruction with graft interposition is technically demanding. Nevertheless, good results can be achieved. This is the case of a 79-year-old man who was evaluated for jaundice. CT-scan found a tumor in the head of the pancreas with a 180-degree infiltration of the portal vein. After neoadjuvant chemotherapy with volumetric shrinking, but persistence of venous infiltration, a laparoscopic pancreaticoduodenectomy with venous reconstruction was decided upon.
Revisional surgery: analysis of technical errors during failed bile duct injury repair
This is the case of a 42-year-old woman who suffered from bile duct injury during an elective cholecystectomy. Immediate repair was performed by means of an open Roux-en-Y hepaticojejunostomy. Five months later, she developed cholangitis. Critical stenosis of the anastomosis was demonstrated with percutaneous transhepatic cholangiography. She was transferred to our unit to address the failed reconstruction. Many clues on why the initial attempt at reconstruction failed were found during our surgery. Discussion of these errors and how to avoid them is the main objective of the video. Secondary learning objectives are to highlight the principles of high quality bilioenteric anastomosis and demonstration of our standard technique for bile duct injury repair.
JM Cabada-Lee
Surgical intervention
1 month ago
728 views
9 likes
1 comment
08:00
Revisional surgery: analysis of technical errors during failed bile duct injury repair
This is the case of a 42-year-old woman who suffered from bile duct injury during an elective cholecystectomy. Immediate repair was performed by means of an open Roux-en-Y hepaticojejunostomy. Five months later, she developed cholangitis. Critical stenosis of the anastomosis was demonstrated with percutaneous transhepatic cholangiography. She was transferred to our unit to address the failed reconstruction. Many clues on why the initial attempt at reconstruction failed were found during our surgery. Discussion of these errors and how to avoid them is the main objective of the video. Secondary learning objectives are to highlight the principles of high quality bilioenteric anastomosis and demonstration of our standard technique for bile duct injury repair.
Spleen-preserving total laparoscopic pancreatoduodenectomy
A 68-year-old woman was referred to us for multiple pancreatic cysts incidentally discovered on a routine ultrasound. An MRI was performed showing multiple cystic tumors throughout the pancreas, the largest of which was 15mm. This led to a suspicion of multifocal, side-branch intraductal papillary mucinous neoplasm (IPMN), with minimal dilatation of the main pancreatic duct. An echo-endoscopy was subsequently performed indicating the presence of a multifocal IPMN. A fine-needle aspiration (FNA) was performed during this procedure, with aspiration of cystic content which was sent for CEA analysis and cytology. Cytology was compatible with a mucinous neoplasm with mild atypia and CEA at 98 IU/mL.
A spleen-preserving total laparoscopic pancreatoduodenectomy was proposed. The procedure was uneventful and the patient was discharged on postoperative day 5. Pathology revealed a 19mm IPMN, with severe dysplasia and 3 foci of micro-invasive ductal adenocarcinoma of 1mm - pT1N0R0.
H Cristino, M Almeida, V Gomes, J Costa Maia
Surgical intervention
1 month ago
687 views
4 likes
1 comment
07:41
Spleen-preserving total laparoscopic pancreatoduodenectomy
A 68-year-old woman was referred to us for multiple pancreatic cysts incidentally discovered on a routine ultrasound. An MRI was performed showing multiple cystic tumors throughout the pancreas, the largest of which was 15mm. This led to a suspicion of multifocal, side-branch intraductal papillary mucinous neoplasm (IPMN), with minimal dilatation of the main pancreatic duct. An echo-endoscopy was subsequently performed indicating the presence of a multifocal IPMN. A fine-needle aspiration (FNA) was performed during this procedure, with aspiration of cystic content which was sent for CEA analysis and cytology. Cytology was compatible with a mucinous neoplasm with mild atypia and CEA at 98 IU/mL.
A spleen-preserving total laparoscopic pancreatoduodenectomy was proposed. The procedure was uneventful and the patient was discharged on postoperative day 5. Pathology revealed a 19mm IPMN, with severe dysplasia and 3 foci of micro-invasive ductal adenocarcinoma of 1mm - pT1N0R0.
Laparoscopic living donor right hepatectomy (LLDH) fully exposing the right hepatic vein (conventional approach)
Introduction:
Laparoscopic living donor hepatectomy (LLDH) has gradually become a widespread technique in high volume transplant centers over the last decade.
Right LLDH is considered as a procedure which requires an expert level in both living donor liver transplantation and laparoscopic liver resection.
In order to fully expose and encircle the right hepatic vein before parenchymal transection implies the full mobilization of the right liver lobe as well as the clipping and cutting of the short hepatic veins in a same way as in a conventional open approach, using the hanging maneuver.
This approach could be more applicable as an initial experience in centers introducing the right LLDH.
Method: Right LLDH was demonstrated in a 31-year-old woman with standard liver anatomy. The procedure was performed using five ports with the patient placed in the French position. The graft was transplanted to a 10-year-old girl with Wilson’s disease (PELD score of 19).
Result: Operating time was 420 min. Blood loss was 120mL. Donor and recipient were discharged on postoperative day 6 and 28 respectively without any complications.
Conclusion: Right LLDH is a feasible procedure. The technique shown is reproducible.
A Monakhov, K Semash, K Khizroev, M Voskanov, SV Gautier
Surgical intervention
1 month ago
1040 views
13 likes
2 comments
10:38
Laparoscopic living donor right hepatectomy (LLDH) fully exposing the right hepatic vein (conventional approach)
Introduction:
Laparoscopic living donor hepatectomy (LLDH) has gradually become a widespread technique in high volume transplant centers over the last decade.
Right LLDH is considered as a procedure which requires an expert level in both living donor liver transplantation and laparoscopic liver resection.
In order to fully expose and encircle the right hepatic vein before parenchymal transection implies the full mobilization of the right liver lobe as well as the clipping and cutting of the short hepatic veins in a same way as in a conventional open approach, using the hanging maneuver.
This approach could be more applicable as an initial experience in centers introducing the right LLDH.
Method: Right LLDH was demonstrated in a 31-year-old woman with standard liver anatomy. The procedure was performed using five ports with the patient placed in the French position. The graft was transplanted to a 10-year-old girl with Wilson’s disease (PELD score of 19).
Result: Operating time was 420 min. Blood loss was 120mL. Donor and recipient were discharged on postoperative day 6 and 28 respectively without any complications.
Conclusion: Right LLDH is a feasible procedure. The technique shown is reproducible.
Innovative technologies: robotic bariatric surgery
In this key lecture, Professor Leon Katz outlines innovative technologies in robotic bariatric surgery.
Dr. Leon Katz, a bariatric robotic surgeon, talks about the former limitations of robotic platforms and how recent technological developments have led to the creation of a new kind of platforms which offer a quick and simple docking process, greater flexibility of movements on surgical tables, less invasive accesses, and a greater versatility of instruments. Finally, with reference clinical cases, he illustrates the usefulness of robotic platforms in complex and challenging situations, in which they not only allow greater precision of surgical gestures, but also provide additional advantages for educational purposes.
L Katz
Lecture
2 months ago
62 views
0 likes
0 comments
12:46
Innovative technologies: robotic bariatric surgery
In this key lecture, Professor Leon Katz outlines innovative technologies in robotic bariatric surgery.
Dr. Leon Katz, a bariatric robotic surgeon, talks about the former limitations of robotic platforms and how recent technological developments have led to the creation of a new kind of platforms which offer a quick and simple docking process, greater flexibility of movements on surgical tables, less invasive accesses, and a greater versatility of instruments. Finally, with reference clinical cases, he illustrates the usefulness of robotic platforms in complex and challenging situations, in which they not only allow greater precision of surgical gestures, but also provide additional advantages for educational purposes.
Metabolic/bariatric surgery for type 2 diabetes
In this authoritative lecture, Dr. Buchwald focuses on metabolic and bariatric surgery for type 2 diabetes.
Through a valuable account of the historical evolution of the concept of metabolic surgery, Dr. Henry Buchwald, Professor of surgery and biomedical engineering as well as Owen and Sarah Davidson Wangensteen Chair in Experimental Surgery Emeritus at the University of Minnesota shows us the important role that different surgical procedures, both bariatric and non-bariatric, have played in the treatment of diverse metabolic pathologies, especially in the treatment of type 2 diabetes mellitus, emphasizing the rich and intense research activity which has generated this progress and the future of surgery in the treatment of chronic metabolic diseases.
H Buchwald
Lecture
2 months ago
113 views
0 likes
0 comments
23:01
Metabolic/bariatric surgery for type 2 diabetes
In this authoritative lecture, Dr. Buchwald focuses on metabolic and bariatric surgery for type 2 diabetes.
Through a valuable account of the historical evolution of the concept of metabolic surgery, Dr. Henry Buchwald, Professor of surgery and biomedical engineering as well as Owen and Sarah Davidson Wangensteen Chair in Experimental Surgery Emeritus at the University of Minnesota shows us the important role that different surgical procedures, both bariatric and non-bariatric, have played in the treatment of diverse metabolic pathologies, especially in the treatment of type 2 diabetes mellitus, emphasizing the rich and intense research activity which has generated this progress and the future of surgery in the treatment of chronic metabolic diseases.
Laparoscopic common bile duct exploration using a disposable fiber-optic bonchoscope (Ambu® aScope™)
Background: Laparoscopic common bile duct (CBD) exploration can be performed following choledochotomy or via the trancystic approach. Laparoscopic CBD exploration is limited in some benign upper gastrointestinal units due to the cost of sterilization of the reusable choledochoscope.
We have recently published a case series confirming the safety and efficacy of the 5mm reusable bronchoscope for CBD exploration. This case series evaluates a single-use bronchochoscope (Ambu® aScope™) for laparoscopic CBD exploration.
Method: A retrospective study was conducted from January 2015 to December 2016. Data was collected from electronic records of the patients. All cases confirmed the presence of CBD stones using USS and MRCP. The disposable bronchoscope is introduced via an epigastric port. Choledochotomy is performed using a choledochotome, and a transcystic approach is used after cystic duct dilatation, if required. The Ambu® aScope™ 2 (Ambu UK Ltd, Cambridgeshire) is a sterile and single-use flexible bronchoscope, which is normally used by anesthesiologists for difficult tracheal intubation. A disposable bronchoscope is available in two sizes (3.8mm and 5mm). It is a one-piece unit with a single dimensional flexible tip manipulated with a handpiece (150-degree flex in the 5mm model and 130-degree flex in the 3.8mm model). There is a single instrument channel with a 2.2mm diameter, which allows for the passage of standard endoscopic baskets for CBD stone retrieval. The image is projected to a high-resolution 6.5” LCD screen with a resolution of 640x480 pixels. The bronchoscope handpiece includes a suction port, which is used as an irrigation source for CBD dilatation. It requires the use of a standard 3-way connector.
Results: Twenty nine patients had CBD exploration using the disposable bronchochoscope. There were 10 male and 19 female patients (median age: 42). Ten procedures were performed as emergencies and 19 were performed electively. All cases were managed laparoscopically except one, which was planned as an open procedure due to previous extensive open surgery.
Twenty eight patients had their CBD cleared using a disposable bronchoscope and two needed subsequent ERCP. Choledochotomy was performed in 15 patients and a transcystic approach was used in 6 patients. No T-tube was used in the laparoscopic cases. Two cases were performed as day case surgery. Median postoperative hospital stay was 2.5 days.
Conclusion: The disposable bronchoscope is a safe and effective instrument for CBD exploration, with results comparable to our previously published case series. It has guaranteed sterility and is cost-effective compared to the reusable bronchoscope, especially when initial capital outlay, sterile processing and maintenance costs are considered.
Y Aawsaj, I Ibrahim, A Mitchell, A Gilliam
Surgical intervention
4 months ago
875 views
13 likes
1 comment
10:08
Laparoscopic common bile duct exploration using a disposable fiber-optic bonchoscope (Ambu® aScope™)
Background: Laparoscopic common bile duct (CBD) exploration can be performed following choledochotomy or via the trancystic approach. Laparoscopic CBD exploration is limited in some benign upper gastrointestinal units due to the cost of sterilization of the reusable choledochoscope.
We have recently published a case series confirming the safety and efficacy of the 5mm reusable bronchoscope for CBD exploration. This case series evaluates a single-use bronchochoscope (Ambu® aScope™) for laparoscopic CBD exploration.
Method: A retrospective study was conducted from January 2015 to December 2016. Data was collected from electronic records of the patients. All cases confirmed the presence of CBD stones using USS and MRCP. The disposable bronchoscope is introduced via an epigastric port. Choledochotomy is performed using a choledochotome, and a transcystic approach is used after cystic duct dilatation, if required. The Ambu® aScope™ 2 (Ambu UK Ltd, Cambridgeshire) is a sterile and single-use flexible bronchoscope, which is normally used by anesthesiologists for difficult tracheal intubation. A disposable bronchoscope is available in two sizes (3.8mm and 5mm). It is a one-piece unit with a single dimensional flexible tip manipulated with a handpiece (150-degree flex in the 5mm model and 130-degree flex in the 3.8mm model). There is a single instrument channel with a 2.2mm diameter, which allows for the passage of standard endoscopic baskets for CBD stone retrieval. The image is projected to a high-resolution 6.5” LCD screen with a resolution of 640x480 pixels. The bronchoscope handpiece includes a suction port, which is used as an irrigation source for CBD dilatation. It requires the use of a standard 3-way connector.
Results: Twenty nine patients had CBD exploration using the disposable bronchochoscope. There were 10 male and 19 female patients (median age: 42). Ten procedures were performed as emergencies and 19 were performed electively. All cases were managed laparoscopically except one, which was planned as an open procedure due to previous extensive open surgery.
Twenty eight patients had their CBD cleared using a disposable bronchoscope and two needed subsequent ERCP. Choledochotomy was performed in 15 patients and a transcystic approach was used in 6 patients. No T-tube was used in the laparoscopic cases. Two cases were performed as day case surgery. Median postoperative hospital stay was 2.5 days.
Conclusion: The disposable bronchoscope is a safe and effective instrument for CBD exploration, with results comparable to our previously published case series. It has guaranteed sterility and is cost-effective compared to the reusable bronchoscope, especially when initial capital outlay, sterile processing and maintenance costs are considered.
Heller's cardiomyotomy for achalasia
Achalasia stems from Greek and means “a” (not) and “khálasis” (relaxation).
Idiopathic megaesophagus (achalasia) is an esophageal primary motor irregularity. It is characterized by the absence of esophageal peristalsis, together with incomplete relaxation of the lower esophageal sphincter after swallowing.
Differential diagnosis must be made between Chagas disease and esophageal squamous cell carcinoma. The incidence rate ranges from 0.5 to 1 per 100,000 persons-years of study. Although there are several theories, the etiology remains unknown.
The first clinical description was made by Sir Thomas Wills (1672). He used to treat the disease via dilation with a sponge attached to a whalebone. Arthur Hertz was the first to name the disease “achalasia”. Ernest Heller performed the first successful esophagectomy in 1913. Zaaijer was the first to describe the anterior myotomy in 1923.
Other therapeutic procedures include botulinum toxin injection into the lower esophageal sphincter. It has transient effects and patients can develop tolerance to the injections. Another option is endoscopic hydropneumatic dilation, which should be fluoroscopically-guided. When it fails, the efficacy of other therapeutic options decreases. The most serious complication is esophageal perforation.
The diagnostic criteria are based on endoscopic findings. Endoscopy reveals there are food remains as well as esophageal dilation, and decreased motility. X-ray exams show esophageal dilation and narrowing of the lower esophageal sphincter. Manometric findings show decreased esophageal motility, increased lower esophageal sphincter pressure, and incomplete relaxation of the lower esophageal sphincter.
The patient was operated on. Since there was no hiatal hernia, laparoscopic Toupet fundoplication was chosen, based on its efficacy in preventing reflux, as well as in keeping the myotomy free of a wrap.
G Lozano Dubernard, R Gil-Ortiz Mejía, B Rueda Torres, NS Gómez Peña-Alfaro
Surgical intervention
4 months ago
6879 views
25 likes
4 comments
12:40
Heller's cardiomyotomy for achalasia
Achalasia stems from Greek and means “a” (not) and “khálasis” (relaxation).
Idiopathic megaesophagus (achalasia) is an esophageal primary motor irregularity. It is characterized by the absence of esophageal peristalsis, together with incomplete relaxation of the lower esophageal sphincter after swallowing.
Differential diagnosis must be made between Chagas disease and esophageal squamous cell carcinoma. The incidence rate ranges from 0.5 to 1 per 100,000 persons-years of study. Although there are several theories, the etiology remains unknown.
The first clinical description was made by Sir Thomas Wills (1672). He used to treat the disease via dilation with a sponge attached to a whalebone. Arthur Hertz was the first to name the disease “achalasia”. Ernest Heller performed the first successful esophagectomy in 1913. Zaaijer was the first to describe the anterior myotomy in 1923.
Other therapeutic procedures include botulinum toxin injection into the lower esophageal sphincter. It has transient effects and patients can develop tolerance to the injections. Another option is endoscopic hydropneumatic dilation, which should be fluoroscopically-guided. When it fails, the efficacy of other therapeutic options decreases. The most serious complication is esophageal perforation.
The diagnostic criteria are based on endoscopic findings. Endoscopy reveals there are food remains as well as esophageal dilation, and decreased motility. X-ray exams show esophageal dilation and narrowing of the lower esophageal sphincter. Manometric findings show decreased esophageal motility, increased lower esophageal sphincter pressure, and incomplete relaxation of the lower esophageal sphincter.
The patient was operated on. Since there was no hiatal hernia, laparoscopic Toupet fundoplication was chosen, based on its efficacy in preventing reflux, as well as in keeping the myotomy free of a wrap.
Laparoscopic central hepatectomy for hepatoma using a Glissonian approach
Introduction: Although laparoscopic liver resection has been widely adopted, performing a total laparoscopic central hepatectomy remains a challenging and technically demanding procedure because it requires two transection planes. This video illustrates a useful technique for laparoscopic central hepatectomy, which was successfully performed in a cirrhotic patient with hepatoma. Method: We demonstrated a total laparoscopic central hepatectomy which was performed in a 65-year-old woman who had a centrally located hepatoma, and this tumor was in contact with the middle hepatic vein. The operative procedure was performed by using five ports with the patient placed in a low lithotomy position. Results: The technique was successfully performed without any complications. The operative time was 380 min. Intraoperative blood loss was 60mL. The length of hospital stay was 5 days. The pathological report was well-differentiated HCC and free surgical margins. Conclusions: Laparoscopic central hepatectomy for hepatoma by using a Glissonian approach is feasible and safe.
R Chanwat, C Bunchaliew
Surgical intervention
4 months ago
4840 views
33 likes
6 comments
10:01
Laparoscopic central hepatectomy for hepatoma using a Glissonian approach
Introduction: Although laparoscopic liver resection has been widely adopted, performing a total laparoscopic central hepatectomy remains a challenging and technically demanding procedure because it requires two transection planes. This video illustrates a useful technique for laparoscopic central hepatectomy, which was successfully performed in a cirrhotic patient with hepatoma. Method: We demonstrated a total laparoscopic central hepatectomy which was performed in a 65-year-old woman who had a centrally located hepatoma, and this tumor was in contact with the middle hepatic vein. The operative procedure was performed by using five ports with the patient placed in a low lithotomy position. Results: The technique was successfully performed without any complications. The operative time was 380 min. Intraoperative blood loss was 60mL. The length of hospital stay was 5 days. The pathological report was well-differentiated HCC and free surgical margins. Conclusions: Laparoscopic central hepatectomy for hepatoma by using a Glissonian approach is feasible and safe.