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Laparoscopic total mesorectal excision (TME) for rectal cancer: live procedure
This video of a live surgery performed by Professor Chen (Associate Professor, China Medical University Taichung, Taiwan) during an IRCAD Taiwan course very clearly demonstrates the stepwise execution of a laparoscopic total mesorectal excision (TME) with all its tips and tricks.
This is the case of a 65-year-old woman, with a low rectal tumor (4cm) is operated on after a short chemoradiation course (2 weeks before) for a stage IIA cancer (cT3N0M0).
Professor Chen’s surgical skills and experience and the beauty of the procedure, associated with a dynamic Q&A and expert comments coming from the auditorium, make of this video a must see.
WTL Chen, J Verde
Surgical intervention
6 months ago
2848 views
13 likes
0 comments
47:24
Laparoscopic total mesorectal excision (TME) for rectal cancer: live procedure
This video of a live surgery performed by Professor Chen (Associate Professor, China Medical University Taichung, Taiwan) during an IRCAD Taiwan course very clearly demonstrates the stepwise execution of a laparoscopic total mesorectal excision (TME) with all its tips and tricks.
This is the case of a 65-year-old woman, with a low rectal tumor (4cm) is operated on after a short chemoradiation course (2 weeks before) for a stage IIA cancer (cT3N0M0).
Professor Chen’s surgical skills and experience and the beauty of the procedure, associated with a dynamic Q&A and expert comments coming from the auditorium, make of this video a must see.
Transanal minimally invasive surgery (TAMIS) for rectal cancer with transabdominal and transrectal ICG-guided sentinel node
Transanal minimally invasive surgery (TAMIS) for rectal cancer is gaining interest, with the objective of maximum sparing for physiological functions. Although this approach may be considered appropriate for treating stage T1m tumors, a large proportion of T1sm and T2 tumors could well benefit from this. The greatest limitation to the application of TAMIS is represented by the difficulty of obtaining an adequate lymph node sample of the mesorectum. The use of indocyanine green (ICG) has recently been suggested as a possible lymph node marker after peritumoral injection. The case described in this video presents an innovative proposal for the detection and removal of lymph nodes draining a tumor of the lower rectum, with the aim of obtaining an adequate lymph node staging. After endoscopic peritumoral ICG injection, we proceeded to the search and removal of sentinel lymph nodes both with a laparoscopic transabdominal approach and with a transrectal approach (after specimen removal). If validated in a prospective series, this technique could represent the best lymph node harvesting strategy during TAMIS for early stage rectal cancer.
G Baiocchi, R Nascimbeni, N Vettoretto, N de Manzini, M Morino
Surgical intervention
8 months ago
1822 views
5 likes
0 comments
09:24
Transanal minimally invasive surgery (TAMIS) for rectal cancer with transabdominal and transrectal ICG-guided sentinel node
Transanal minimally invasive surgery (TAMIS) for rectal cancer is gaining interest, with the objective of maximum sparing for physiological functions. Although this approach may be considered appropriate for treating stage T1m tumors, a large proportion of T1sm and T2 tumors could well benefit from this. The greatest limitation to the application of TAMIS is represented by the difficulty of obtaining an adequate lymph node sample of the mesorectum. The use of indocyanine green (ICG) has recently been suggested as a possible lymph node marker after peritumoral injection. The case described in this video presents an innovative proposal for the detection and removal of lymph nodes draining a tumor of the lower rectum, with the aim of obtaining an adequate lymph node staging. After endoscopic peritumoral ICG injection, we proceeded to the search and removal of sentinel lymph nodes both with a laparoscopic transabdominal approach and with a transrectal approach (after specimen removal). If validated in a prospective series, this technique could represent the best lymph node harvesting strategy during TAMIS for early stage rectal cancer.
Robotic triple docking ultralow anterior resection with intersphincteric resection and coloanal anastomosis
The da Vinci™ surgical robotic system with its increased instrument stability, magnified tridimensional view, and dexterity with 7 degrees of wristed motion of its instruments offers a distinct surgical advantage over traditional laparoscopic instruments. This is especially true in the deep pelvis, where the limited space and visibility make it extremely challenging to perform distal rectal dissection. Additionally, the complete control of the surgeon over the stable surgical platform allows fine and accurate dissection in this area.
For very low rectal tumors close to the anorectal junction, if a sphincter-saving procedure is to be attempted, surgeons will frequently perform an intersphincteric resection (ISR) with a handsewn coloanal anastomosis. If successful, the patient will be able to avoid an abdominoperineal resection and its resulting permanent stoma.
ISR is a technically challenging procedure to perform, especially in male and obese patients. It is because the approach to the intersphincteric plane from the abdominal approach is deep within the pelvis and frequently curves anteriorly, which makes the intersphincteric plane challenging to approach laparoscopically. In addition, ISR from the perineum is also difficult as the anus has a small opening; as a result, when the surgeon sits directly in front of the perineum, assistants will be unable to adequately visualize the operating field, making it very challenging to properly assist for the dissection. It may potentially result in some blind dissection, which may lead to entry into the wrong plane and a poor oncological specimen.
With the da Vinci™ surgical robotic system, this problem can potentially be minimized. First, via the transabdominal approach, the robotic system is able to access deep into the pelvic cavity and dissect down to the intersphincteric plane beyond the puborectalis sling. Secondly, docking the robot and approaching the ISR perineally, the robotic system can also provide a magnified vision, a fine dissection and allow the assistant a good viewing position sitting in front of the perineum to assist in a more productive manner. These advantages of the robotic system will facilitate ISR dissection and retrieval of a superior oncological specimen.
This video features a totally robotic triple docking approach for an ultralow anterior resection with intersphincteric resection and handsewn coloanal anastomosis in a male patient with a low rectal cancer.
SAE Yeo
Surgical intervention
1 year ago
1930 views
5 likes
0 comments
15:36
Robotic triple docking ultralow anterior resection with intersphincteric resection and coloanal anastomosis
The da Vinci™ surgical robotic system with its increased instrument stability, magnified tridimensional view, and dexterity with 7 degrees of wristed motion of its instruments offers a distinct surgical advantage over traditional laparoscopic instruments. This is especially true in the deep pelvis, where the limited space and visibility make it extremely challenging to perform distal rectal dissection. Additionally, the complete control of the surgeon over the stable surgical platform allows fine and accurate dissection in this area.
For very low rectal tumors close to the anorectal junction, if a sphincter-saving procedure is to be attempted, surgeons will frequently perform an intersphincteric resection (ISR) with a handsewn coloanal anastomosis. If successful, the patient will be able to avoid an abdominoperineal resection and its resulting permanent stoma.
ISR is a technically challenging procedure to perform, especially in male and obese patients. It is because the approach to the intersphincteric plane from the abdominal approach is deep within the pelvis and frequently curves anteriorly, which makes the intersphincteric plane challenging to approach laparoscopically. In addition, ISR from the perineum is also difficult as the anus has a small opening; as a result, when the surgeon sits directly in front of the perineum, assistants will be unable to adequately visualize the operating field, making it very challenging to properly assist for the dissection. It may potentially result in some blind dissection, which may lead to entry into the wrong plane and a poor oncological specimen.
With the da Vinci™ surgical robotic system, this problem can potentially be minimized. First, via the transabdominal approach, the robotic system is able to access deep into the pelvic cavity and dissect down to the intersphincteric plane beyond the puborectalis sling. Secondly, docking the robot and approaching the ISR perineally, the robotic system can also provide a magnified vision, a fine dissection and allow the assistant a good viewing position sitting in front of the perineum to assist in a more productive manner. These advantages of the robotic system will facilitate ISR dissection and retrieval of a superior oncological specimen.
This video features a totally robotic triple docking approach for an ultralow anterior resection with intersphincteric resection and handsewn coloanal anastomosis in a male patient with a low rectal cancer.
Laparoscopic total D2 gastrectomy for cancer
Laparoscopic gastrectomy is accepted as a treatment of choice for gastric cancer due to low postoperative pain, faster recovery, shorter hospital stay, and a better cosmetic outcome as compared to open gastrectomy. Radical gastrectomy, with lymph node dissection, is essential to cure this type of cancer. This technique can be reproduced also in third world countries.
This is the case of a 74-year-old woman who was evaluated for dyspepsia and weight loss. Upper endoscopy found a tumor near the cardia on the lesser curvature. The biopsy study confirmed the presence of an adenocarcinoma. CT-scan showed no metastasis or lymph nodes affected. Surgical treatment was decided upon along with a laparoscopic total D2 gastrectomy.
F Signorini, S Reimondez, M España, L Obeide, F Moser
Surgical intervention
1 year ago
11436 views
433 likes
0 comments
06:41
Laparoscopic total D2 gastrectomy for cancer
Laparoscopic gastrectomy is accepted as a treatment of choice for gastric cancer due to low postoperative pain, faster recovery, shorter hospital stay, and a better cosmetic outcome as compared to open gastrectomy. Radical gastrectomy, with lymph node dissection, is essential to cure this type of cancer. This technique can be reproduced also in third world countries.
This is the case of a 74-year-old woman who was evaluated for dyspepsia and weight loss. Upper endoscopy found a tumor near the cardia on the lesser curvature. The biopsy study confirmed the presence of an adenocarcinoma. CT-scan showed no metastasis or lymph nodes affected. Surgical treatment was decided upon along with a laparoscopic total D2 gastrectomy.
Live interactive transanal TME (TaTME) with the TEO™ platform
Randomized clinical trials such as COLOR II, COREAN and CLASICC, have shown better results for laparoscopic total mesorectal excision (TME), in terms of short-term and long-term outcomes, when compared with open TME.
Laparoscopic TME presents some limitations such as low rectal cancer which has a high risk of leaving a positive circumferential resection margin (CRM) and a narrow pelvis. Conversion to open procedures remains unsatisfactory.
Transanal TME (taTME) has been proposed to give a new option in cases where laparoscopic TME is difficult.
In this video, we present the case of a transanal approach with the TEO™ platform for low rectal cancer.
A Melani, A D'Urso, D Mutter, J Marescaux
Surgical intervention
2 years ago
3920 views
324 likes
0 comments
45:51
Live interactive transanal TME (TaTME) with the TEO™ platform
Randomized clinical trials such as COLOR II, COREAN and CLASICC, have shown better results for laparoscopic total mesorectal excision (TME), in terms of short-term and long-term outcomes, when compared with open TME.
Laparoscopic TME presents some limitations such as low rectal cancer which has a high risk of leaving a positive circumferential resection margin (CRM) and a narrow pelvis. Conversion to open procedures remains unsatisfactory.
Transanal TME (taTME) has been proposed to give a new option in cases where laparoscopic TME is difficult.
In this video, we present the case of a transanal approach with the TEO™ platform for low rectal cancer.
Subtotal gastrectomy and D1+ lymphadenectomy for distal stage IB gastric cancer with preservation of an accessory left hepatic artery
This video shows a partial gastrectomy in a 63-year-old woman with a stage IB gastric cancer located at the distal third of the stomach. The lesion was located using intraoperatory endoscopy. We found an accessory left hepatic artery originating from the left gastric artery, which was preserved. The gastrojejunostomy was performed in a Roux-en-Y fashion. The alimentary limb was ascended through the transverse mesocolon. The jejunojejunostomy was performed in a latero-lateral fashion with closure of the ostium with simple Ethibond 2/0 stitches. The skin incision used for trocar placement in the upper left abdomen (right hand of the surgeon) was slightly enlarged to allow for specimen extraction.
P Vorwald, R Restrepo, G Salcedo, M Posada
Surgical intervention
2 years ago
3056 views
234 likes
0 comments
11:41
Subtotal gastrectomy and D1+ lymphadenectomy for distal stage IB gastric cancer with preservation of an accessory left hepatic artery
This video shows a partial gastrectomy in a 63-year-old woman with a stage IB gastric cancer located at the distal third of the stomach. The lesion was located using intraoperatory endoscopy. We found an accessory left hepatic artery originating from the left gastric artery, which was preserved. The gastrojejunostomy was performed in a Roux-en-Y fashion. The alimentary limb was ascended through the transverse mesocolon. The jejunojejunostomy was performed in a latero-lateral fashion with closure of the ostium with simple Ethibond 2/0 stitches. The skin incision used for trocar placement in the upper left abdomen (right hand of the surgeon) was slightly enlarged to allow for specimen extraction.
PerOral Endoscopic Thyroidectomy (POET), a novel pioneering technique
Thyroid surgery has evolved towards minimally invasive approaches to reduce or prevent cervical scars, which are potential seats for keloidal scarring. Several approaches have been put forward: video-assisted surgery via a reduced cervical scar, transaxillary access with or without robotic assistance, transoral retromandibular approach, retroauricular approach in keeping with a lifting procedure.
In this video, we present the case of an original transoral vestibular approach. This access is exclusively subcutaneous. No cervical scar is necessary. This technique allows for a unilateral or bilateral approach in excellent visualization conditions. Dissection is performed from cranially to caudally with the rapid identification of the inferior laryngeal nerve.
A Anuwong, M Vix, HS Wu
Surgical intervention
2 years ago
4775 views
322 likes
1 comment
25:34
PerOral Endoscopic Thyroidectomy (POET), a novel pioneering technique
Thyroid surgery has evolved towards minimally invasive approaches to reduce or prevent cervical scars, which are potential seats for keloidal scarring. Several approaches have been put forward: video-assisted surgery via a reduced cervical scar, transaxillary access with or without robotic assistance, transoral retromandibular approach, retroauricular approach in keeping with a lifting procedure.
In this video, we present the case of an original transoral vestibular approach. This access is exclusively subcutaneous. No cervical scar is necessary. This technique allows for a unilateral or bilateral approach in excellent visualization conditions. Dissection is performed from cranially to caudally with the rapid identification of the inferior laryngeal nerve.
Totally endoscopic left hemithyroidectomy: axillary approach for papillary carcinoma, including a critical analysis by M Vix, MD, and point by point answer by Dr. Shah
Introduction:
Endoscopic thyroidectomy is a novel approach used to avoid cervical scar, which represents sequelae of conventional thyroidectomies. This technique is feasible providing equal results under expert hands.
Case presentation:
This is the case of a 20 year-old woman with cervical swelling, a 3 by 3cm solitary nodule in the left thyroid lobe, which was evaluated clinically, radiologically, and withfine-needle aspiration cytology (FNAC). She was diagnosed with a low-risk papillary carcinoma.
Discussion:
The patient underwent an endoscopic transaxillary left hemithyroidectomy under general anesthesia. The recurrent laryngeal nerve and the parathyroid gland were preserved. The patient was discharged with a normal tone on postoperative day 1.
Conclusion:
Endoscopic transaxillary thyroidectomy is a feasible good technique with equal results, which can be considered for patients with small thyroid lesions. Conventional laparoscopic instruments are used without the need for extra instrumentation.

This video is commented upon by Dr. M Vix, MD (University Hospital, Strasbourg, France), providing a comprehensive outline of Dr. Shah's original technique.


Point by point answer by Dr. Shah:

1. Carbon dioxide causing surgical emphysema, especially of an incapacitating nature, has not been experienced since intracavitary pressures are generally maintained at a low level by the almost continuous low-grade suction used throughout the surgery.

2. In our experience, adequate visualization of the thyroid pedicles in close proximity to the gland precludes the need for a deeper and more lateral dissection to identify the jugulocarotid vessels. This potentially decreases the risk of a major vascular mishap.

3. As is the norm with open thyroidectomy, division of the superior thyroid pedicle close to the gland usually does not require the identification of the superior laryngeal nerve.

4. In this approach, the recurrent laryngeal nerve is identified very early on in the dissection. Subsequent dissection is performed in a plane anterior to the visualized nerve, hence preventing any injuries. The recurrent laryngeal nerve is visualized in its entire extent up to Berry's ligament.



AR Shah
Surgical intervention
2 years ago
1145 views
117 likes
0 comments
11:09
Totally endoscopic left hemithyroidectomy: axillary approach for papillary carcinoma, including a critical analysis by M Vix, MD, and point by point answer by Dr. Shah
Introduction:
Endoscopic thyroidectomy is a novel approach used to avoid cervical scar, which represents sequelae of conventional thyroidectomies. This technique is feasible providing equal results under expert hands.
Case presentation:
This is the case of a 20 year-old woman with cervical swelling, a 3 by 3cm solitary nodule in the left thyroid lobe, which was evaluated clinically, radiologically, and withfine-needle aspiration cytology (FNAC). She was diagnosed with a low-risk papillary carcinoma.
Discussion:
The patient underwent an endoscopic transaxillary left hemithyroidectomy under general anesthesia. The recurrent laryngeal nerve and the parathyroid gland were preserved. The patient was discharged with a normal tone on postoperative day 1.
Conclusion:
Endoscopic transaxillary thyroidectomy is a feasible good technique with equal results, which can be considered for patients with small thyroid lesions. Conventional laparoscopic instruments are used without the need for extra instrumentation.

This video is commented upon by Dr. M Vix, MD (University Hospital, Strasbourg, France), providing a comprehensive outline of Dr. Shah's original technique.


Point by point answer by Dr. Shah:

1. Carbon dioxide causing surgical emphysema, especially of an incapacitating nature, has not been experienced since intracavitary pressures are generally maintained at a low level by the almost continuous low-grade suction used throughout the surgery.

2. In our experience, adequate visualization of the thyroid pedicles in close proximity to the gland precludes the need for a deeper and more lateral dissection to identify the jugulocarotid vessels. This potentially decreases the risk of a major vascular mishap.

3. As is the norm with open thyroidectomy, division of the superior thyroid pedicle close to the gland usually does not require the identification of the superior laryngeal nerve.

4. In this approach, the recurrent laryngeal nerve is identified very early on in the dissection. Subsequent dissection is performed in a plane anterior to the visualized nerve, hence preventing any injuries. The recurrent laryngeal nerve is visualized in its entire extent up to Berry's ligament.



Transoral endoscopic thyroidectomy: vestibular approach
In this state-of-the-art lecture, Dr. Anuwong briefly describes the historical developments of thyroidectomy with various approaches, emphasizing natural orifice thyroid surgery with an overview of the first report in animal models, cadaveric models, and human patients in different countries as it happened over time. He describes the key steps, main principles, and complications of TOVANS, ETOA, and TOPOT with their drawbacks. He also introduces his technique of transoral endoscopic thyroidectomy: vestibular approach (TOETVA) with the brief concept of mental nerve injury. He demonstrates his experience in a case report of right lobectomy using TOETVA with postoperative management and impressive results achieved with no infection and no scar. The TOETVA technique proves to be promising as it is safe, feasible, comparable to other approaches, and has excellent cosmetic results.
A Anuwong
Lecture
2 years ago
1830 views
130 likes
0 comments
28:41
Transoral endoscopic thyroidectomy: vestibular approach
In this state-of-the-art lecture, Dr. Anuwong briefly describes the historical developments of thyroidectomy with various approaches, emphasizing natural orifice thyroid surgery with an overview of the first report in animal models, cadaveric models, and human patients in different countries as it happened over time. He describes the key steps, main principles, and complications of TOVANS, ETOA, and TOPOT with their drawbacks. He also introduces his technique of transoral endoscopic thyroidectomy: vestibular approach (TOETVA) with the brief concept of mental nerve injury. He demonstrates his experience in a case report of right lobectomy using TOETVA with postoperative management and impressive results achieved with no infection and no scar. The TOETVA technique proves to be promising as it is safe, feasible, comparable to other approaches, and has excellent cosmetic results.
Role of laparoscopy in treating ovarian cancer
Borderline ovarian tumors (BOTs) represent about 10 to 20% of all ovarian malignancies and differ from invasive ovarian cancers (IOCs) by many characters. The standard management of BOT is peritoneal washing cytology, hysterectomy, bilateral salpingo-oophorectomy, omentectomy, complete peritoneal resection of macroscopic lesions; in case of mucinous BOTs, appendectomy should be performed. Because BOTs are often diagnosed at an earlier stage, in younger women and have a better prognosis and a higher survival rate than IOCs, fertility-sparing surgery is one of the options to preserve a childbearing capacity. However, conservative surgery is still controversial.
So far, postoperative chemotherapy, radiotherapy, and hormone therapy are not recommended. BOTs are characteristically difficult to diagnose using preoperative radiological methods, exhibit inconsistencies in expression of tumor markers, and are often inaccurately identified using frozen sections. In these slides, Dr. Marco Puga will discuss the controversial issues of BOTs and will present the management of BOTs.
M Puga
Lecture
2 years ago
2780 views
168 likes
0 comments
31:15
Role of laparoscopy in treating ovarian cancer
Borderline ovarian tumors (BOTs) represent about 10 to 20% of all ovarian malignancies and differ from invasive ovarian cancers (IOCs) by many characters. The standard management of BOT is peritoneal washing cytology, hysterectomy, bilateral salpingo-oophorectomy, omentectomy, complete peritoneal resection of macroscopic lesions; in case of mucinous BOTs, appendectomy should be performed. Because BOTs are often diagnosed at an earlier stage, in younger women and have a better prognosis and a higher survival rate than IOCs, fertility-sparing surgery is one of the options to preserve a childbearing capacity. However, conservative surgery is still controversial.
So far, postoperative chemotherapy, radiotherapy, and hormone therapy are not recommended. BOTs are characteristically difficult to diagnose using preoperative radiological methods, exhibit inconsistencies in expression of tumor markers, and are often inaccurately identified using frozen sections. In these slides, Dr. Marco Puga will discuss the controversial issues of BOTs and will present the management of BOTs.
Combining VATS and laparoscopic approach in the resection of ovarian carcinoma metastasis
This is the case of a 64-year-old woman with a history of hysterectomy and left adnexectomy. In 2012, a vaginal ultrasound revealed a right ovarian mass diagnosed as a right ovarian cancer. In December 2012, she underwent a right adnexectomy with pelvic, lumbo-aortic lymphadenectomy and omentectomy. Final pathological staging of the ovarian cystadenocarcinoma was pT3cpN1Mx (IIIC). She completed 6 cycles of adjuvant chemotherapy with carboplatin and paclitaxel. During the follow-up exam, the patient remained symptom-free and presented with a stable perihepatic lesion. In 2015, two new lesions were found on CT-scan: one in the anterior mediastinum (14mm) and another in the abdominal diaphragm in contact with a liver segment VIII (19mm). In addition, CA 125 raised from 19 to 50kU/L. PET-scan only evidenced these two new lesions (SUV= 10). Taking into account the patient’s excellent performance status, long disease-free survival, stability of lesions, with CT-scans performed with a 3-month interval, and the possibility of video-assisted surgery, it was decided to use VATS and laparoscopy to remove the lesions. Final pathological findings showed ovarian cystadenocarcinoma metastases in 2 lesions (R0). The third perihepatic lesion was a cyst. The patient was discharged on postoperative day 4.
F Cabral, JA Pereira, P Calvinho, P Amado, R Maio
Surgical intervention
3 years ago
2788 views
91 likes
0 comments
11:33
Combining VATS and laparoscopic approach in the resection of ovarian carcinoma metastasis
This is the case of a 64-year-old woman with a history of hysterectomy and left adnexectomy. In 2012, a vaginal ultrasound revealed a right ovarian mass diagnosed as a right ovarian cancer. In December 2012, she underwent a right adnexectomy with pelvic, lumbo-aortic lymphadenectomy and omentectomy. Final pathological staging of the ovarian cystadenocarcinoma was pT3cpN1Mx (IIIC). She completed 6 cycles of adjuvant chemotherapy with carboplatin and paclitaxel. During the follow-up exam, the patient remained symptom-free and presented with a stable perihepatic lesion. In 2015, two new lesions were found on CT-scan: one in the anterior mediastinum (14mm) and another in the abdominal diaphragm in contact with a liver segment VIII (19mm). In addition, CA 125 raised from 19 to 50kU/L. PET-scan only evidenced these two new lesions (SUV= 10). Taking into account the patient’s excellent performance status, long disease-free survival, stability of lesions, with CT-scans performed with a 3-month interval, and the possibility of video-assisted surgery, it was decided to use VATS and laparoscopy to remove the lesions. Final pathological findings showed ovarian cystadenocarcinoma metastases in 2 lesions (R0). The third perihepatic lesion was a cyst. The patient was discharged on postoperative day 4.
Laparoscopic total gastrectomy guided by fluorescent lymphangiography using ICG injection around a tumor, followed by an intracorporeal double stapling esophagojejunostomy
Injecting indocyanine green (ICG) around the tumor enables the operators to identify the lymphatic channels and the lymph nodes in which the cancer cells can spread. It also allows them to decide on the extent of the dissection and validate the completeness of lymph node dissection. In this video, a laparoscopic near-infrared fluorescent camera was used, showing the fluorescent signal in diverse modes. A total gastrectomy with D1+ dissection is performed. The fluorescent signal shows the possible lymphatic pathways during the operation. An intracorporeal esophagojejunostomy was performed in a double stapling fashion; a round needle and a surgical thread are attached to the plastic part of the anvil of the circular stapler.
HK Yang, SH Kong
Surgical intervention
3 years ago
1861 views
79 likes
0 comments
15:56
Laparoscopic total gastrectomy guided by fluorescent lymphangiography using ICG injection around a tumor, followed by an intracorporeal double stapling esophagojejunostomy
Injecting indocyanine green (ICG) around the tumor enables the operators to identify the lymphatic channels and the lymph nodes in which the cancer cells can spread. It also allows them to decide on the extent of the dissection and validate the completeness of lymph node dissection. In this video, a laparoscopic near-infrared fluorescent camera was used, showing the fluorescent signal in diverse modes. A total gastrectomy with D1+ dissection is performed. The fluorescent signal shows the possible lymphatic pathways during the operation. An intracorporeal esophagojejunostomy was performed in a double stapling fashion; a round needle and a surgical thread are attached to the plastic part of the anvil of the circular stapler.
Robotic adrenalectomy for left adrenal Conn’s adenoma: live broadcast
According to recent studies, robotic adrenalectomy has proven to be superior to laparoscopic adrenalectomy, with a reduction of blood loss during procedure and a reduced operative time.
The robotic system provides an intraoperative stability to the surgeon, allowing for a perfect handling of sensitive functional adrenal tumors. The main advantage of robotics lies in the ease of dissection, aided by improved visualization, the EndoWrist®, articulated instruments, and reduction of tremors, allowing for more accurate movements.

Indications: hormone-secreting tumors, adrenal masses >5cm, smaller lesions suspicious for malignancy, and lesions increasing in size on serial imaging.
Contraindications: infiltrative adrenal masses and tumors of extremely large size, because the size of adrenal lesions correlates with the potential for adrenal carcinoma.
The da Vinci Robotic Surgical System (Intuitive Surgical Inc., Sunnyvale, CA, USA) and the following robotic instruments are used:30-degree scope, ProGrasp™ forceps, Hot Shears (monopolar curved scissors or a hook), and a Robotic Clip Applier. A monopolar cautery hook and Harmonic ACE® curved shears can also be used when deemed helpful by the surgeon.
Laparoscopic instruments that can be handled by the bedside assistant, a clip applier and a suction device are also used.
CN Tang
Surgical intervention
3 years ago
1934 views
133 likes
0 comments
24:47
Robotic adrenalectomy for left adrenal Conn’s adenoma: live broadcast
According to recent studies, robotic adrenalectomy has proven to be superior to laparoscopic adrenalectomy, with a reduction of blood loss during procedure and a reduced operative time.
The robotic system provides an intraoperative stability to the surgeon, allowing for a perfect handling of sensitive functional adrenal tumors. The main advantage of robotics lies in the ease of dissection, aided by improved visualization, the EndoWrist®, articulated instruments, and reduction of tremors, allowing for more accurate movements.

Indications: hormone-secreting tumors, adrenal masses >5cm, smaller lesions suspicious for malignancy, and lesions increasing in size on serial imaging.
Contraindications: infiltrative adrenal masses and tumors of extremely large size, because the size of adrenal lesions correlates with the potential for adrenal carcinoma.
The da Vinci Robotic Surgical System (Intuitive Surgical Inc., Sunnyvale, CA, USA) and the following robotic instruments are used:30-degree scope, ProGrasp™ forceps, Hot Shears (monopolar curved scissors or a hook), and a Robotic Clip Applier. A monopolar cautery hook and Harmonic ACE® curved shears can also be used when deemed helpful by the surgeon.
Laparoscopic instruments that can be handled by the bedside assistant, a clip applier and a suction device are also used.
LIVE INTERACTIVE SURGERY: laparoscopic left adrenalectomy for pheochromocytoma
Laparoscopic adrenalectomy was first described by Gagner et al. in 1992. It has become the procedure of choice for most benign adrenal lesions since then because of decreased blood loss, shorter hospital stay, faster recovery, and lower morbidity as compared to open surgery.
The indications for laparoscopic adrenalectomy are the same as for open surgery, except in cases of confirmed adrenocortical carcinomas.
Absolute contraindications for laparoscopic adrenalectomy are as follows: severe cardiopulmonary disease, locally advanced tumors, medically untreated pheochromocytoma, and uncontrolled coagulopathies. This is a live demonstration of a left adrenalectomy recorded during the Minimally Invasive Endocrine Surgery Course, which was held at IRCAD in May 2016.
D Mutter, P Donepudi, J Marescaux
Surgical intervention
3 years ago
4398 views
339 likes
0 comments
28:17
LIVE INTERACTIVE SURGERY: laparoscopic left adrenalectomy for pheochromocytoma
Laparoscopic adrenalectomy was first described by Gagner et al. in 1992. It has become the procedure of choice for most benign adrenal lesions since then because of decreased blood loss, shorter hospital stay, faster recovery, and lower morbidity as compared to open surgery.
The indications for laparoscopic adrenalectomy are the same as for open surgery, except in cases of confirmed adrenocortical carcinomas.
Absolute contraindications for laparoscopic adrenalectomy are as follows: severe cardiopulmonary disease, locally advanced tumors, medically untreated pheochromocytoma, and uncontrolled coagulopathies. This is a live demonstration of a left adrenalectomy recorded during the Minimally Invasive Endocrine Surgery Course, which was held at IRCAD in May 2016.
LIVE INTERACTIVE SURGERY: laparoscopic left adrenalectomy: retroperitoneal access
Retroperitoneal adrenalectomy (posterior approach) provides a direct access to the adrenal gland, hence preventing the risk of injury to intraperitoneal organs. The retroperitoneoscopic approach shortens the mean operative time and it is critical in cases of pheochromocytoma. Consequently, it is the recommended treatment for pheochromocytoma. Blood loss and the convalescence period are also shortened with this approach. The surgical principles of retroperitoneal adrenalectomy according to Professor Martin Walz are as follows: ‘en bloc’ resection, start of dissection with the upper pole of kidney, lower pole of the adrenal gland next, control of the main adrenal vein without clips, and morcellation of the gland if necessary in a bag.
M Walz, P Donepudi, L Soler, B Seeliger
Surgical intervention
3 years ago
2260 views
185 likes
1 comment
39:46
LIVE INTERACTIVE SURGERY: laparoscopic left adrenalectomy: retroperitoneal access
Retroperitoneal adrenalectomy (posterior approach) provides a direct access to the adrenal gland, hence preventing the risk of injury to intraperitoneal organs. The retroperitoneoscopic approach shortens the mean operative time and it is critical in cases of pheochromocytoma. Consequently, it is the recommended treatment for pheochromocytoma. Blood loss and the convalescence period are also shortened with this approach. The surgical principles of retroperitoneal adrenalectomy according to Professor Martin Walz are as follows: ‘en bloc’ resection, start of dissection with the upper pole of kidney, lower pole of the adrenal gland next, control of the main adrenal vein without clips, and morcellation of the gland if necessary in a bag.
Posterior retroperitoneoscopic revision of the right suprarenal space for recurrence of pheochromocytoma
A 36-year-old woman came to the attention of the endocrinologist for a recent onset of headache and tachycardia and an US finding of a 1.8cm nodule in the right suprarenal space.
At age 25, she was submitted to an anterior laparoscopic transperitoneal right adrenalectomy for a 5cm pheochromocytoma. At age 33, she underwent laparoscopic cholecystectomy.
The diagnostic work-up revealed raised urinary metanephrine and normetanephrine and an MRI finding of a 1.5cm nodule in the right suprarenal space, with smaller satellite nodules in the retrocaval space.
A surgical revision of the right suprarenal space was indicated and the posterior retroperitoneal approach was chosen, to warrant better reach of the nodules and allow direct exposure of the retrocaval and retrohepatic spaces.
The operative time was 210 minutes. The patient recovered with no major complications and was discharged on her 4th postoperative day. Her symptoms recovered and she was found with lowered metanephrines at follow-up. An 18-FDG PET-CT scan performed 6 months after the operation showed no abnormal metabolic activity within her body.
M Lotti, B Carrara, L Moroni, S Cassibba, D Gianola, M Giulii Capponi
Surgical intervention
3 years ago
858 views
40 likes
0 comments
16:24
Posterior retroperitoneoscopic revision of the right suprarenal space for recurrence of pheochromocytoma
A 36-year-old woman came to the attention of the endocrinologist for a recent onset of headache and tachycardia and an US finding of a 1.8cm nodule in the right suprarenal space.
At age 25, she was submitted to an anterior laparoscopic transperitoneal right adrenalectomy for a 5cm pheochromocytoma. At age 33, she underwent laparoscopic cholecystectomy.
The diagnostic work-up revealed raised urinary metanephrine and normetanephrine and an MRI finding of a 1.5cm nodule in the right suprarenal space, with smaller satellite nodules in the retrocaval space.
A surgical revision of the right suprarenal space was indicated and the posterior retroperitoneal approach was chosen, to warrant better reach of the nodules and allow direct exposure of the retrocaval and retrohepatic spaces.
The operative time was 210 minutes. The patient recovered with no major complications and was discharged on her 4th postoperative day. Her symptoms recovered and she was found with lowered metanephrines at follow-up. An 18-FDG PET-CT scan performed 6 months after the operation showed no abnormal metabolic activity within her body.
Laparoscopic total mesorectal excision (TME) through single right iliac fossa (RIF) incision
Background: Single incision laparoscopy is worth of interest during up-to-down rectal resection because it allows to use the single site as the site of temporary ileostomy placement at the end of the procedure.
Video: This video shows an up-to-down single incision laparoscopic rectal resection in a 49-year-old woman presenting with a rectal adenocarcinoma located 12cm away from the anal margin. Preoperative work-up showed a T2N0M0 tumor. The procedure was entirely performed with curved reusable instruments according to DAPRI (Karl Storz Endoskope, Tuttlingen, Germany), inserted in the right flank. The uterus and the peritoneal sheet covering the vagina were retrieved using percutaneous sutures. A circular mechanical colorectal anastomosis was performed and a final temporary ileostomy was placed at the site of the single access.
Results: The procedure duration was 297 minutes, and peroperative bleeding was unsignificant. The final scar length was 2.5cm, and the patient was discharged on postoperative day 5. The pathological report confirmed a pT2N0M0 tumor (20 negative nodes).
Conclusions: Up-to-down single incision laparoscopic rectal resection allows to place the temporary ileostomy at the single incision site, offering oncological results comparable to conventional laparoscopy.
G Dapri, N Bachir, L Antolino, K Grozdev, D Guta, K Jottard, GB Cadière
Surgical intervention
3 years ago
2336 views
110 likes
0 comments
09:22
Laparoscopic total mesorectal excision (TME) through single right iliac fossa (RIF) incision
Background: Single incision laparoscopy is worth of interest during up-to-down rectal resection because it allows to use the single site as the site of temporary ileostomy placement at the end of the procedure.
Video: This video shows an up-to-down single incision laparoscopic rectal resection in a 49-year-old woman presenting with a rectal adenocarcinoma located 12cm away from the anal margin. Preoperative work-up showed a T2N0M0 tumor. The procedure was entirely performed with curved reusable instruments according to DAPRI (Karl Storz Endoskope, Tuttlingen, Germany), inserted in the right flank. The uterus and the peritoneal sheet covering the vagina were retrieved using percutaneous sutures. A circular mechanical colorectal anastomosis was performed and a final temporary ileostomy was placed at the site of the single access.
Results: The procedure duration was 297 minutes, and peroperative bleeding was unsignificant. The final scar length was 2.5cm, and the patient was discharged on postoperative day 5. The pathological report confirmed a pT2N0M0 tumor (20 negative nodes).
Conclusions: Up-to-down single incision laparoscopic rectal resection allows to place the temporary ileostomy at the single incision site, offering oncological results comparable to conventional laparoscopy.
Cystic pheochromocytoma: anatomical landmarks for laparoscopic resection
Surgery for pheochromocytoma is often considered difficult due to local anatomical conditions which are often associated with a hypervascularization and inflammatory reaction. This video demonstrates the case of a patient presenting with a 5cm pheochromocytoma with a necrotic core. Because the patient has a low BMI, the intraoperative anatomy is magnified and all anatomical landmarks are perfectly identified right before dissection. The lesion is eventually embedded in the liver. Its approach and dissection allow to determine the constraints related to adrenal surgery, and particularly regarding the impossibility to manipulate the lesion other than with soft retraction.
D Mutter, J Marescaux
Surgical intervention
4 years ago
2207 views
106 likes
0 comments
15:04
Cystic pheochromocytoma: anatomical landmarks for laparoscopic resection
Surgery for pheochromocytoma is often considered difficult due to local anatomical conditions which are often associated with a hypervascularization and inflammatory reaction. This video demonstrates the case of a patient presenting with a 5cm pheochromocytoma with a necrotic core. Because the patient has a low BMI, the intraoperative anatomy is magnified and all anatomical landmarks are perfectly identified right before dissection. The lesion is eventually embedded in the liver. Its approach and dissection allow to determine the constraints related to adrenal surgery, and particularly regarding the impossibility to manipulate the lesion other than with soft retraction.
Transanal laparoscopic TME with a new port assisted by single incision
Background: Rectal resection with total mesorectal excision (TME) can be performed through the anus going up into the abdominal cavity. This approach has to be performed using a transanal device in order to create a retroperitoneum, allowing the surgeon to perform a TME similar to the one performed from the abdomen going down to the anus. A new reusable port named DAPRI Port or D-Port (Karl Storz Endoskope, Tuttlingen, Germany) has been developed, and a new platform together with curved reusable instruments according to DAPRI (Karl Storz Endoskope) has been created. The D-Port allows to maintain one of the rules of laparoscopy, which is the optical system in the middle of the two ancillary operative tools. In addition, the cost of the procedure is not increased, due to the reusable material.
Video: This video shows a down-to-up rectal resection assisted by single incision laparoscopy, in a 65-year old man presenting with a rectal adenocarcinoma 4cm away from the anal margin. Preoperative work-up showed a T2N0M0 tumor, after radiochemotherapy. The procedure was performed transabdominally for the vascular dissection and transanally for the TME. The abdominal single site was then used for the placement of the temporary ileostomy.
Results: Total operative time was 301 minutes, and partial transanal laparoscopy was 145 minutes. Perioperative bleeding was 50cc. The final scar length was 2.5cm, and the patient was discharged after 5 days. The pathological report confirmed a pT2N0M0 tumor (15 negative nodes).
Conclusions: Down-to-up rectal resection is an interesting procedure, and when associated with single incision laparoscopy, it offers the possibility to use the single site as the site for temporary ileostomy.
G Dapri, L Antolino, N Bachir, D Guta, K Grozdev, B Nebbot, K Jottard, GB Cadière
Surgical intervention
4 years ago
2839 views
40 likes
0 comments
12:53
Transanal laparoscopic TME with a new port assisted by single incision
Background: Rectal resection with total mesorectal excision (TME) can be performed through the anus going up into the abdominal cavity. This approach has to be performed using a transanal device in order to create a retroperitoneum, allowing the surgeon to perform a TME similar to the one performed from the abdomen going down to the anus. A new reusable port named DAPRI Port or D-Port (Karl Storz Endoskope, Tuttlingen, Germany) has been developed, and a new platform together with curved reusable instruments according to DAPRI (Karl Storz Endoskope) has been created. The D-Port allows to maintain one of the rules of laparoscopy, which is the optical system in the middle of the two ancillary operative tools. In addition, the cost of the procedure is not increased, due to the reusable material.
Video: This video shows a down-to-up rectal resection assisted by single incision laparoscopy, in a 65-year old man presenting with a rectal adenocarcinoma 4cm away from the anal margin. Preoperative work-up showed a T2N0M0 tumor, after radiochemotherapy. The procedure was performed transabdominally for the vascular dissection and transanally for the TME. The abdominal single site was then used for the placement of the temporary ileostomy.
Results: Total operative time was 301 minutes, and partial transanal laparoscopy was 145 minutes. Perioperative bleeding was 50cc. The final scar length was 2.5cm, and the patient was discharged after 5 days. The pathological report confirmed a pT2N0M0 tumor (15 negative nodes).
Conclusions: Down-to-up rectal resection is an interesting procedure, and when associated with single incision laparoscopy, it offers the possibility to use the single site as the site for temporary ileostomy.
Laparoscopic total gastrectomy and D2 dissection guided by fluorescence imaging system, followed by esophagojejunostomy using an intracorporeal purse-string suture method
This video demonstrates a case of gastric cancer, which is located at the cardia, and a total gastrectomy was planned. For D2 dissection in a total gastrectomy, lymph node dissection around the splenic artery and splenic hilum is one of the most challenging area. Here, we present an example of complete dissection by following the plane around the splenic vessels.
Fluorescence imaging using indocyanine green (ICG) is a promising technology not only for sentinel node navigation surgery but it is also a guide for extensive lymph node dissection. The laparoscopic fluorescence imaging system was used here as a guidance and assessment tool for complete lymph node dissection. Also, an original method for intracorporeal esophagojejunal anastomosis is introduced, which enables purse-string suture and insertion of the anvil of the circular stapler in a quite stable manner, and reproduces conventional esophagojejunostomy without specialized devices.
HK Yang, SH Kong
Surgical intervention
4 years ago
2865 views
52 likes
0 comments
28:29
Laparoscopic total gastrectomy and D2 dissection guided by fluorescence imaging system, followed by esophagojejunostomy using an intracorporeal purse-string suture method
This video demonstrates a case of gastric cancer, which is located at the cardia, and a total gastrectomy was planned. For D2 dissection in a total gastrectomy, lymph node dissection around the splenic artery and splenic hilum is one of the most challenging area. Here, we present an example of complete dissection by following the plane around the splenic vessels.
Fluorescence imaging using indocyanine green (ICG) is a promising technology not only for sentinel node navigation surgery but it is also a guide for extensive lymph node dissection. The laparoscopic fluorescence imaging system was used here as a guidance and assessment tool for complete lymph node dissection. Also, an original method for intracorporeal esophagojejunal anastomosis is introduced, which enables purse-string suture and insertion of the anvil of the circular stapler in a quite stable manner, and reproduces conventional esophagojejunostomy without specialized devices.