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Laparoscopic sleeve gastrectomy: surgical pitfalls in a live educational procedure
In this live educational video, Professor Himpens presents the case of a 34-year-old female patient (BMI of 41) with a history of morbid obesity since adolescence. She will undergo a laparoscopic sleeve gastrectomy (LSG). The preoperative work-up was normal. She had lost 2Kg six months before the procedure. Nowadays, laparoscopic sleeve gastrectomy (LSG) is one of the most commonly performed bariatric procedures. Surgical pitfalls are emphasized during the video to make sure that LSG is achieved adequately and to prevent any potential complications. In addition, trocars placement, location of the first firing of the linear stapler, the reasons why oversewing of the staple line is not performed, and thrombosis prophylaxis are also discussed during the procedure.
J Himpens, M Ignat, R Rodriguez Luna
Surgical intervention
3 months ago
2479 views
33 likes
1 comment
39:06
Laparoscopic sleeve gastrectomy: surgical pitfalls in a live educational procedure
In this live educational video, Professor Himpens presents the case of a 34-year-old female patient (BMI of 41) with a history of morbid obesity since adolescence. She will undergo a laparoscopic sleeve gastrectomy (LSG). The preoperative work-up was normal. She had lost 2Kg six months before the procedure. Nowadays, laparoscopic sleeve gastrectomy (LSG) is one of the most commonly performed bariatric procedures. Surgical pitfalls are emphasized during the video to make sure that LSG is achieved adequately and to prevent any potential complications. In addition, trocars placement, location of the first firing of the linear stapler, the reasons why oversewing of the staple line is not performed, and thrombosis prophylaxis are also discussed during the procedure.
Robot-assisted Roux-en-Y gastric bypass using the latest generation of robotic surgical system: a live educational procedure
In this live educational video, Dr. Vieira d'Almeida outlines surgical pitfalls when performing a 5-port Roux-en-Y gastric bypass (RYGB) using the da Vinci Xi™ robotic surgical system (Intuitive Surgical). During the video, a comparison is made with other robotic platforms (e.g. da Vinci Si™ system) regarding trocar placement, robotic docking, dexterity, instruments quality, and the introduction of fluorescence systems. Technical steps are provided to create a RYGB with a 100cm alimentary limb and a 150cm biliary limb, transection of the greater omentum, Petersen’s defect and mesenteric defect closure, which are performed routinely.
LA Vieira d'Almeida, M Ignat, R Rodriguez Luna
Surgical intervention
3 months ago
1043 views
13 likes
0 comments
09:59
Robot-assisted Roux-en-Y gastric bypass using the latest generation of robotic surgical system: a live educational procedure
In this live educational video, Dr. Vieira d'Almeida outlines surgical pitfalls when performing a 5-port Roux-en-Y gastric bypass (RYGB) using the da Vinci Xi™ robotic surgical system (Intuitive Surgical). During the video, a comparison is made with other robotic platforms (e.g. da Vinci Si™ system) regarding trocar placement, robotic docking, dexterity, instruments quality, and the introduction of fluorescence systems. Technical steps are provided to create a RYGB with a 100cm alimentary limb and a 150cm biliary limb, transection of the greater omentum, Petersen’s defect and mesenteric defect closure, which are performed routinely.
A standardized step-by-step description of a laparoscopic Roux-en-Y gastric bypass: a live educational procedure
In this live educational video, Dr. Almino Cardoso Ramos shows the case of a morbidly obese 42-year-old woman with a BMI of 41. In the preoperative work-up, the patient lost 4kg. Imaging studies showed normal anatomy and did not evidence any hiatal hernia or GERD. Manometry did not show any motility disorders.
During the procedure, surgical pitfalls are highlighted and discussed in order to create a standardized Roux-en-Y gastric bypass (RYGB) with a biliopancreatic limb of 150cm and an alimentary limb of 100cm. Anatomical landmarks for gastric pouch creation are demonstrated. Emphasis is put on the adequate length measurement for both the biliopancreatic and alimentary limbs in order to ensure weight loss. The author also stresses the necessity to use appropriate staplers along with the ways to prevent stapler-related complications. He outlines his preference for specific suture material to close the enterotomy, and provides tips and tricks for the closure of the mesenteric defect and of Petersen’s space.
A Cardoso Ramos, M Ignat, R Rodriguez Luna
Surgical intervention
3 months ago
1961 views
16 likes
0 comments
12:49
A standardized step-by-step description of a laparoscopic Roux-en-Y gastric bypass: a live educational procedure
In this live educational video, Dr. Almino Cardoso Ramos shows the case of a morbidly obese 42-year-old woman with a BMI of 41. In the preoperative work-up, the patient lost 4kg. Imaging studies showed normal anatomy and did not evidence any hiatal hernia or GERD. Manometry did not show any motility disorders.
During the procedure, surgical pitfalls are highlighted and discussed in order to create a standardized Roux-en-Y gastric bypass (RYGB) with a biliopancreatic limb of 150cm and an alimentary limb of 100cm. Anatomical landmarks for gastric pouch creation are demonstrated. Emphasis is put on the adequate length measurement for both the biliopancreatic and alimentary limbs in order to ensure weight loss. The author also stresses the necessity to use appropriate staplers along with the ways to prevent stapler-related complications. He outlines his preference for specific suture material to close the enterotomy, and provides tips and tricks for the closure of the mesenteric defect and of Petersen’s space.
Endoscopic sleeve gastroplasty (ESG): live educational procedure with resolution of device-related complication
Endoscopic sleeve gastroplasty (ESG) is a novel endobariatric procedure with a mechanism of action totally different from the one used for a standard sleeve gastrectomy. An over-the-scope suturing system (OverStitch™, Apollo Endosurgery, Austin, TX) mounted on a dual-channel gastroscope (GIF- 2TH180, Olympus, Center Valley, PA) allowed to place full-thickness sutures in order to obtain gastric volume reduction and shrinking. The number of applied sutures relies on the gastric volume. Sutures are placed starting from the incisura to the fundus that is spared in a U-shaped fashion. A tissue-retracting helix device is used to grab the gastric wall. In this live educational video, Professor Silvana Perretta presented the case of a morbidly obese 38-year-old female patient with a BMI of 36.72kg/m2.
The procedure was performed with the patient under general anesthesia and carbon dioxide insufflation. An Overtube™ (Apollo Endosurgery, Austin, TX) was placed at the beginning of the procedure to protect the airways, the esophagus, and the hypopharynx. Each purse-string suture consisted of 6 to 8 full-thickness bites starting first on the anterior gastric wall, then on the greater curvature, and the posterior wall and moving backward in the opposite direction. Once completed, the suture was tied and knotted using a cinching device (EndoCinch™). During the live procedure, a complication occurred due to an excessive pressure placed on the EndoCinch™ handle which caused a break of the collar part of the cinch. The management of this complication was achieved by cutting the suture, so that the collar part of the cinch which grasped the mucosa could be detached with a grasper to allow for suture replacement. A total of 4 sutures were applied in order to obtain gastric tubulization.
S Perretta, L Guerriero, M Pizzicannella, R Rodriguez Luna, B Dallemagne
Surgical intervention
4 months ago
536 views
8 likes
3 comments
52:53
Endoscopic sleeve gastroplasty (ESG): live educational procedure with resolution of device-related complication
Endoscopic sleeve gastroplasty (ESG) is a novel endobariatric procedure with a mechanism of action totally different from the one used for a standard sleeve gastrectomy. An over-the-scope suturing system (OverStitch™, Apollo Endosurgery, Austin, TX) mounted on a dual-channel gastroscope (GIF- 2TH180, Olympus, Center Valley, PA) allowed to place full-thickness sutures in order to obtain gastric volume reduction and shrinking. The number of applied sutures relies on the gastric volume. Sutures are placed starting from the incisura to the fundus that is spared in a U-shaped fashion. A tissue-retracting helix device is used to grab the gastric wall. In this live educational video, Professor Silvana Perretta presented the case of a morbidly obese 38-year-old female patient with a BMI of 36.72kg/m2.
The procedure was performed with the patient under general anesthesia and carbon dioxide insufflation. An Overtube™ (Apollo Endosurgery, Austin, TX) was placed at the beginning of the procedure to protect the airways, the esophagus, and the hypopharynx. Each purse-string suture consisted of 6 to 8 full-thickness bites starting first on the anterior gastric wall, then on the greater curvature, and the posterior wall and moving backward in the opposite direction. Once completed, the suture was tied and knotted using a cinching device (EndoCinch™). During the live procedure, a complication occurred due to an excessive pressure placed on the EndoCinch™ handle which caused a break of the collar part of the cinch. The management of this complication was achieved by cutting the suture, so that the collar part of the cinch which grasped the mucosa could be detached with a grasper to allow for suture replacement. A total of 4 sutures were applied in order to obtain gastric tubulization.
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
6 months ago
1612 views
9 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.
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
6 months ago
775 views
10 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
6 months ago
1061 views
19 likes
3 comments
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.
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
6 months ago
3273 views
43 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.
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
8 months ago
157 views
2 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
8 months ago
308 views
2 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.