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Endoscopic sleeve gastroplasty (ESG): live procedure
In this live procedure, Professor Perretta performs an endoscopic sleeve gastroplasty (ESG) using the OverStitch™ endoscopic suturing system (Apollo Endosurgery) in a 50-year-old obese male patient (with a BMI of 35.3). In this particular case, preoperative esophagogastroduodenoscopy (EGD) showed a Barrett’s esophagus with positive histology for intestinal metaplasia, which is not a contraindication for this kind of endoscopic intervention. ESG is performed with the patient under general anesthesia and carbon dioxide insufflation. The supine position is preferred because it is safer than the left lateral decubitus position as it allows for a better exposure of the stomach. Sutures are placed in a U-shaped fashion from the incisura angularis to the fundus, which is spared using the OverStitch™ suturing system, mounted on a double channel Olympus scope. The system allows for the placement of durable full-thickness stitches to obtain gastric volume reduction and shrinking.
S Perretta, M Pizzicannella, B Dallemagne
Surgical intervention
1 month ago
447 views
5 likes
1 comment
38:23
Endoscopic sleeve gastroplasty (ESG): live procedure
In this live procedure, Professor Perretta performs an endoscopic sleeve gastroplasty (ESG) using the OverStitch™ endoscopic suturing system (Apollo Endosurgery) in a 50-year-old obese male patient (with a BMI of 35.3). In this particular case, preoperative esophagogastroduodenoscopy (EGD) showed a Barrett’s esophagus with positive histology for intestinal metaplasia, which is not a contraindication for this kind of endoscopic intervention. ESG is performed with the patient under general anesthesia and carbon dioxide insufflation. The supine position is preferred because it is safer than the left lateral decubitus position as it allows for a better exposure of the stomach. Sutures are placed in a U-shaped fashion from the incisura angularis to the fundus, which is spared using the OverStitch™ suturing system, mounted on a double channel Olympus scope. The system allows for the placement of durable full-thickness stitches to obtain gastric volume reduction and shrinking.
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
1 month ago
33 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
1 month ago
61 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 Biliopancreatic Diversion with Duodenal Switch (BPD/DS)
Morbid obesity has reached epidemic proportions. Biliopancreatic diversion with duodenal switch (BPD-DS) is the most effective bariatric surgery procedure for weight loss. This procedure was first described by Scopinaro in 1979. It consisted of a horizontal gastrectomy, a transection of the bowel halfway from the ligament of Treitz and the ileocecal junction, and a Roux-en-Y reconstruction with a 50cm common channel. This was later modified: the duodenal switch was added and the gastrectomy was performed in a vertical sleeve fashion, thereby preserving the pylorus and increasing the common channel to 100cm. This modification greatly reduced the incidence of marginal ulceration, dumping, and nutritional deficiencies. However, this operation is still uncommon due to the perceived technical difficulty and risk of nutritional morbidity. This video demonstrates a standardized technique for this complex procedure.
RC Pullatt
Surgical intervention
3 months ago
3891 views
13 likes
2 comments
13:00
Laparoscopic Biliopancreatic Diversion with Duodenal Switch (BPD/DS)
Morbid obesity has reached epidemic proportions. Biliopancreatic diversion with duodenal switch (BPD-DS) is the most effective bariatric surgery procedure for weight loss. This procedure was first described by Scopinaro in 1979. It consisted of a horizontal gastrectomy, a transection of the bowel halfway from the ligament of Treitz and the ileocecal junction, and a Roux-en-Y reconstruction with a 50cm common channel. This was later modified: the duodenal switch was added and the gastrectomy was performed in a vertical sleeve fashion, thereby preserving the pylorus and increasing the common channel to 100cm. This modification greatly reduced the incidence of marginal ulceration, dumping, and nutritional deficiencies. However, this operation is still uncommon due to the perceived technical difficulty and risk of nutritional morbidity. This video demonstrates a standardized technique for this complex procedure.
Fully robotic Roux-en-Y gastric bypass
Roux-en-Y gastric bypass is becoming increasingly popular. The use of the surgical robot is developing rapidly, and this is especially true for digestive surgery. The aim of this video is to show that Roux-en-Y gastric bypass can be performed using a totally robotic approach. When using the robot, one follows the same steps as for a conventional intervention. The 3D vision and the degrees of freedom of the instruments facilitate the dissection, especially around the cardia, and for suturing procedures. The surgeon takes advantage of the console's user friendly set-up which does not put his/her shoulders or back in a vulnerable position, as they sometimes are when using a laparoscopic approach.
M Vix, B Seeliger, D Mutter, J Marescaux
Surgical intervention
10 months ago
1649 views
7 likes
0 comments
12:00
Fully robotic Roux-en-Y gastric bypass
Roux-en-Y gastric bypass is becoming increasingly popular. The use of the surgical robot is developing rapidly, and this is especially true for digestive surgery. The aim of this video is to show that Roux-en-Y gastric bypass can be performed using a totally robotic approach. When using the robot, one follows the same steps as for a conventional intervention. The 3D vision and the degrees of freedom of the instruments facilitate the dissection, especially around the cardia, and for suturing procedures. The surgeon takes advantage of the console's user friendly set-up which does not put his/her shoulders or back in a vulnerable position, as they sometimes are when using a laparoscopic approach.
Laparoscopic revision of Nissen fundoplication to Roux-en-Y gastric bypass
Introduction: Obesity is a known etiological factor for gastroesophageal reflux disease (GERD) and is also a growing public health concern. Although Nissen fundoplication is a highly effective technique to treat GERD, it may fail in obese patients. Roux-en-Y gastric bypass provides excellent long-term control of GERD symptoms with the additional benefit of weight loss.
Clinical case: A 57-year-old woman underwent a laparoscopic Nissen fundoplication for GERD (BMI 30.0 Kg/m2) with excellent outcomes during the first postoperative year in 2011. Two years later, GERD symptoms recurred, and her weight increased progressively (BMI of 36.0 Kg/m2). The patient was proposed to a laparoscopic conversion of Nissen fundoplication to a Roux-en-Y gastric bypass. The procedure was uneventful, and the patient was discharged on postoperative day 4. One year later, she remained asymptomatic, off antacids medication, and with her weight decreased to 63.5Kg which corresponded to a BMI of 25.4 Kg/m2.
Discussion/conclusion: Roux-en-Y gastric bypass successfully reduces GERD symptoms by diverting bile away from the esophagus, decreasing acid production in the gastric pouch, therefore limiting the amount of acid reflux and by promoting weight loss decreases abdominal pressure over the lower esophageal sphincter and esophageal hiatus. In obese patients (BMI>35) with GERD, Roux-en-Y gastric bypass seems to be the most effective and advantageous treatment since it provides control of GERD symptoms with the additional benefit of weight loss. In patients who have previously undergone anti-reflux surgery, bariatric surgery can be technically demanding. However, if performed by high-volume surgeons in high-volume centers, it is perfectly feasible with low morbidity and excellent results.
J Magalhães, AM Pereira, T Fonseca, R Ferreira de Almeida, M Nora
Surgical intervention
10 months ago
1821 views
4 likes
0 comments
09:34
Laparoscopic revision of Nissen fundoplication to Roux-en-Y gastric bypass
Introduction: Obesity is a known etiological factor for gastroesophageal reflux disease (GERD) and is also a growing public health concern. Although Nissen fundoplication is a highly effective technique to treat GERD, it may fail in obese patients. Roux-en-Y gastric bypass provides excellent long-term control of GERD symptoms with the additional benefit of weight loss.
Clinical case: A 57-year-old woman underwent a laparoscopic Nissen fundoplication for GERD (BMI 30.0 Kg/m2) with excellent outcomes during the first postoperative year in 2011. Two years later, GERD symptoms recurred, and her weight increased progressively (BMI of 36.0 Kg/m2). The patient was proposed to a laparoscopic conversion of Nissen fundoplication to a Roux-en-Y gastric bypass. The procedure was uneventful, and the patient was discharged on postoperative day 4. One year later, she remained asymptomatic, off antacids medication, and with her weight decreased to 63.5Kg which corresponded to a BMI of 25.4 Kg/m2.
Discussion/conclusion: Roux-en-Y gastric bypass successfully reduces GERD symptoms by diverting bile away from the esophagus, decreasing acid production in the gastric pouch, therefore limiting the amount of acid reflux and by promoting weight loss decreases abdominal pressure over the lower esophageal sphincter and esophageal hiatus. In obese patients (BMI>35) with GERD, Roux-en-Y gastric bypass seems to be the most effective and advantageous treatment since it provides control of GERD symptoms with the additional benefit of weight loss. In patients who have previously undergone anti-reflux surgery, bariatric surgery can be technically demanding. However, if performed by high-volume surgeons in high-volume centers, it is perfectly feasible with low morbidity and excellent results.
Advanced bariatric surgery: reduced port simplified gastric bypass, a reproducible 3-port technique
Minimally invasive surgery is a field of continuous evolution and the advantages of this approach is no longer a matter of debate. The laparoscopic Roux-en-Y gastric bypass (LRYGB) has shown to be the cornerstone in the treatment of morbid obesity and so far all the efforts in this technique have been conducted to demonstrate safety and efficacy. Nowadays, reduced port surgery is regaining momentum as the evolution of minimally invasive surgery.
The purpose is to describe our technique of LRYGB, which mimics all the fundamental aspects of the “simplified gastric bypass” described by A. Cardoso Ramos et al. in a conventional laparoscopic surgical approach (5 ports) while incorporating some innovative technical features to reduce the quantity of ports. Despite the use of only three trocars, there is no problem with exposure or ergonomics, which represent major drawbacks when performing reduced port surgery.

Our technique can be a useful and feasible tool in selected patients in order to minimize parietal trauma and its possible complications, to improve cosmetic results, and to indirectly avoid the need for a second assistant, thereby improving the logistics, team dynamics, and economic aspects of the procedure.

In our experience, this technique is indicated as primary surgery in patients without previous surgery and with a BMI ranging from 35 to 50. Major contraindications are liver steatosis, superobese patients, and potentially revisional surgery. Although based on the experience of the team, we had also to perform revisional surgery mostly from ring vertical gastroplasty.

From January 2015 to June 2017, we analyzed 72 consecutive cases in our institution with a mean initial BMI of 43.12 (range: 30.1-58.7) using this approach, and the mean operative time was 64.77 minutes (range: 30-155, n=72) and excluding revisional cases or cases associated with cholecystectomy (58.72 min, range: 30-104, n=62).

This approach should be performed by highly skilled surgeons experienced with conventional Roux-en-Y gastric bypass and with one of the patients feeling particularly comfortable. We strongly suggest using additional trocars if patient safety is jeopardized.
D Lipski, D Garcilazo Arismendi, S Targa
Surgical intervention
1 year ago
3824 views
428 likes
0 comments
07:37
Advanced bariatric surgery: reduced port simplified gastric bypass, a reproducible 3-port technique
Minimally invasive surgery is a field of continuous evolution and the advantages of this approach is no longer a matter of debate. The laparoscopic Roux-en-Y gastric bypass (LRYGB) has shown to be the cornerstone in the treatment of morbid obesity and so far all the efforts in this technique have been conducted to demonstrate safety and efficacy. Nowadays, reduced port surgery is regaining momentum as the evolution of minimally invasive surgery.
The purpose is to describe our technique of LRYGB, which mimics all the fundamental aspects of the “simplified gastric bypass” described by A. Cardoso Ramos et al. in a conventional laparoscopic surgical approach (5 ports) while incorporating some innovative technical features to reduce the quantity of ports. Despite the use of only three trocars, there is no problem with exposure or ergonomics, which represent major drawbacks when performing reduced port surgery.

Our technique can be a useful and feasible tool in selected patients in order to minimize parietal trauma and its possible complications, to improve cosmetic results, and to indirectly avoid the need for a second assistant, thereby improving the logistics, team dynamics, and economic aspects of the procedure.

In our experience, this technique is indicated as primary surgery in patients without previous surgery and with a BMI ranging from 35 to 50. Major contraindications are liver steatosis, superobese patients, and potentially revisional surgery. Although based on the experience of the team, we had also to perform revisional surgery mostly from ring vertical gastroplasty.

From January 2015 to June 2017, we analyzed 72 consecutive cases in our institution with a mean initial BMI of 43.12 (range: 30.1-58.7) using this approach, and the mean operative time was 64.77 minutes (range: 30-155, n=72) and excluding revisional cases or cases associated with cholecystectomy (58.72 min, range: 30-104, n=62).

This approach should be performed by highly skilled surgeons experienced with conventional Roux-en-Y gastric bypass and with one of the patients feeling particularly comfortable. We strongly suggest using additional trocars if patient safety is jeopardized.
Laparoscopic gastric bypass with unexpected intestinal malrotation
There are only a few descriptions of laparoscopic Roux-en-Y gastric bypass (LRYGB) in the setting of intestinal malrotation and these are limited to clinical case reports. Intestinal malrotations usually present in the first months of life with symptoms of bowel obstruction. However, in rare cases, it can persist undetected into adulthood when it could be incidentally identified. The anatomical abnormalities which should alert us to this possibility are an absent duodenojejunal angle, the small bowel on the right side of the abdomen, the caecum on the left, and the absence of a transverse colon crossing the abdomen. Identification and adjustment of the surgical technique at the time of laparoscopic Roux-en-Y gastric bypass (RYGB) is crucial to prevent a very distal RYGB or avoid confusion between the Roux limb and the common channel. The construction of the laparoscopic Roux limb can be safely performed with adjustments to the standard technique.
We present the case of a 45-year-old woman with a long history of morbid obesity, hypertension, and hyperlipidemia. The patient had no complaints and presented a normal preoperative evaluation. After a multidisciplinary evaluation, she was elected to undergo a LRYGB. We report an intestinal malrotation discovered at the time of LRYGB, and detail the incidental findings and the technical aspects which require to be incorporated in order to complete the operation safely.
A Laranjeira, S Silva, M Amaro, M Carvalho, J Caravana
Surgical intervention
1 year ago
2091 views
417 likes
0 comments
08:33
Laparoscopic gastric bypass with unexpected intestinal malrotation
There are only a few descriptions of laparoscopic Roux-en-Y gastric bypass (LRYGB) in the setting of intestinal malrotation and these are limited to clinical case reports. Intestinal malrotations usually present in the first months of life with symptoms of bowel obstruction. However, in rare cases, it can persist undetected into adulthood when it could be incidentally identified. The anatomical abnormalities which should alert us to this possibility are an absent duodenojejunal angle, the small bowel on the right side of the abdomen, the caecum on the left, and the absence of a transverse colon crossing the abdomen. Identification and adjustment of the surgical technique at the time of laparoscopic Roux-en-Y gastric bypass (RYGB) is crucial to prevent a very distal RYGB or avoid confusion between the Roux limb and the common channel. The construction of the laparoscopic Roux limb can be safely performed with adjustments to the standard technique.
We present the case of a 45-year-old woman with a long history of morbid obesity, hypertension, and hyperlipidemia. The patient had no complaints and presented a normal preoperative evaluation. After a multidisciplinary evaluation, she was elected to undergo a LRYGB. We report an intestinal malrotation discovered at the time of LRYGB, and detail the incidental findings and the technical aspects which require to be incorporated in order to complete the operation safely.
Bariatric and metabolic surgery
In this authoritative lecture, Dr. Michel Vix highlighted the indications related to metabolic and morbid obesity surgery. He presented key anatomical landmarks and operating room (OR) set-up depending on every patient. He briefly described the main principles of port placement and pneumoperitoneum, and demonstrated maneuvers, indications, and main key steps of morbid obesity procedures including LAGB, SBPD-DS, Scopinaro, RYGB, Mini Gastric Bypass, and Sleeve Gastrectomy, along with their technical aspects, mortality, morbidity, effectiveness, and results using different studies and meta-analyses. He also demonstrated the main principles and key steps of new trends and approaches in bariatric and metabolic surgery with complications and technical therapeutic aspects.
M Vix
Lecture
2 years ago
1543 views
272 likes
0 comments
04:52
Bariatric and metabolic surgery
In this authoritative lecture, Dr. Michel Vix highlighted the indications related to metabolic and morbid obesity surgery. He presented key anatomical landmarks and operating room (OR) set-up depending on every patient. He briefly described the main principles of port placement and pneumoperitoneum, and demonstrated maneuvers, indications, and main key steps of morbid obesity procedures including LAGB, SBPD-DS, Scopinaro, RYGB, Mini Gastric Bypass, and Sleeve Gastrectomy, along with their technical aspects, mortality, morbidity, effectiveness, and results using different studies and meta-analyses. He also demonstrated the main principles and key steps of new trends and approaches in bariatric and metabolic surgery with complications and technical therapeutic aspects.
Concurrent laparoscopic RYGB with a paraesophageal hernia (PEH) repair
This is the case of a 75-year old female patient with a medical history of bilateral mastectomy due to cancer, which occurred 30 and 15 years before referral. She was treated using adjuvant chemotherapy (tamoxifen) and radiotherapy, and had a liver-related kidney donation. The patient was found asymptomatic when she underwent a control abdominal ultrasound, which showed a 6cm hepatic mass in liver segments V and VI. A hepatic MRI was performed and showed a single liver lesion (68mm in diameter) located in the right liver lobe, and a PET-CT-scan demonstrated an increased hypermetabolic activity of the lesion without other systemic tumor dissemination. A laparoscopic right hepatectomy was scheduled. A laparoscopic surgery was performed. Laparoscopic exploration revealed multiple bilateral lesions, and an intraoperative ultrasound demonstrated a lesion in liver segment IV. An ALPPS approach was considered.
There were no complications and the patient was discharged on the third postoperative day.
A Duro, F Wright, PJ Castellaro, A Beskow, D Cavadas, J Montagné
Surgical intervention
2 years ago
1109 views
180 likes
0 comments
06:23
Concurrent laparoscopic RYGB with a paraesophageal hernia (PEH) repair
This is the case of a 75-year old female patient with a medical history of bilateral mastectomy due to cancer, which occurred 30 and 15 years before referral. She was treated using adjuvant chemotherapy (tamoxifen) and radiotherapy, and had a liver-related kidney donation. The patient was found asymptomatic when she underwent a control abdominal ultrasound, which showed a 6cm hepatic mass in liver segments V and VI. A hepatic MRI was performed and showed a single liver lesion (68mm in diameter) located in the right liver lobe, and a PET-CT-scan demonstrated an increased hypermetabolic activity of the lesion without other systemic tumor dissemination. A laparoscopic right hepatectomy was scheduled. A laparoscopic surgery was performed. Laparoscopic exploration revealed multiple bilateral lesions, and an intraoperative ultrasound demonstrated a lesion in liver segment IV. An ALPPS approach was considered.
There were no complications and the patient was discharged on the third postoperative day.
Laparoscopic Roux-en-Y gastric bypass (RYGB) after failed Nissen
This is the case of a 62-year old female patient with a BMI of 35 and a history of high blood pressure, dyslipidemia, and morbid obesity. She underwent a laparoscopic Nissen surgery 8 years earlier and presented with recurrent GERD symptoms.

A CT-scan, an endoscopy, and a barium swallow showed a hiatal hernia. It was decided to perform a paraesophageal hernia repair as well as a gastric bypass. A laparoscopic surgery was performed.

There were no complications and the patient was discharged on the second postoperative day. An esogastroduodenal contrast examination was performed 1 month after the procedure. It showed the absence of hiatal hernia. The patient was controlled 3 months after surgery and was found asymptomatic with an Excess Weight Loss (EWL) of 42%.
A Duro, V Cano Busnelli, A Beskow, D Cavadas, F Wright, P Saleg, PJ Castellaro
Surgical intervention
2 years ago
2350 views
171 likes
0 comments
06:12
Laparoscopic Roux-en-Y gastric bypass (RYGB) after failed Nissen
This is the case of a 62-year old female patient with a BMI of 35 and a history of high blood pressure, dyslipidemia, and morbid obesity. She underwent a laparoscopic Nissen surgery 8 years earlier and presented with recurrent GERD symptoms.

A CT-scan, an endoscopy, and a barium swallow showed a hiatal hernia. It was decided to perform a paraesophageal hernia repair as well as a gastric bypass. A laparoscopic surgery was performed.

There were no complications and the patient was discharged on the second postoperative day. An esogastroduodenal contrast examination was performed 1 month after the procedure. It showed the absence of hiatal hernia. The patient was controlled 3 months after surgery and was found asymptomatic with an Excess Weight Loss (EWL) of 42%.