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Laparoscopy and appendicitis
In this key lecture, Dr. Benoît Navez outlines the use of laparoscopy for the management of appendicitis, from diagnosis to surgical treatment, and postoperative complications of acute appendicitis.
He explains the best diagnostic modalities, providing an indication for each one. While performing a complete evaluation of the leading role of laparoscopy in this common entity and the advantages in challenge scenarios such as morbid obesity and pregnancy. Surgical technical pitfalls are pointed (e.g., standard trocar placement and best localization for additional port, types of mesoappendix control and its advantages, principal stump closure techniques such as endoloop and specific indications for stapler use, evidence-based recommendations to prevent stump appendicitis and avoid the risk of bacteremia during sepsis, evidence of intraperitoneal irrigation and its correlation with intra-abdominal postoperative abscess, and non-operative options such as Wait and See and interval appendectomy).

B Navez
Lecture
27 days ago
1949 views
24 likes
1 comment
29:19
Laparoscopy and appendicitis
In this key lecture, Dr. Benoît Navez outlines the use of laparoscopy for the management of appendicitis, from diagnosis to surgical treatment, and postoperative complications of acute appendicitis.
He explains the best diagnostic modalities, providing an indication for each one. While performing a complete evaluation of the leading role of laparoscopy in this common entity and the advantages in challenge scenarios such as morbid obesity and pregnancy. Surgical technical pitfalls are pointed (e.g., standard trocar placement and best localization for additional port, types of mesoappendix control and its advantages, principal stump closure techniques such as endoloop and specific indications for stapler use, evidence-based recommendations to prevent stump appendicitis and avoid the risk of bacteremia during sepsis, evidence of intraperitoneal irrigation and its correlation with intra-abdominal postoperative abscess, and non-operative options such as Wait and See and interval appendectomy).

Laparoscopic central pancreatectomy for renal cell carcinoma metastasis
Authors present the case of a laparoscopic central pancreatectomy in a patient with a clear cell renal cell carcinoma metastatic lesion to the pancreatic neck.
A 71-year old female patient was admitted with a pancreatic neck lesion detected by abdominal ultrasound performed for mild epigastric pain she has been suffering from for 3 months prior to admission. Her past medical history is significant for right nephrectomy performed 25 years ago. The patient stated that she had an acquired cystic kidney disease, but no medical records were available to confirm that. A multidisciplinary investigation was performed. Pancreatic protocol CT-scan revealed a 2.5cm hyper-enhancing round-shaped tumor, located within the pancreatic neck. The patient had no carcinoid syndrome, and levels of PNET specific markers (Chromogranin A, NSE, Insulin, 5-HIIA) were not elevated. CA 19-9 and CEA levels were also normal. The tumor was [111In]-octreotide negative on octreotide scan. As a result, a non-functioning pancreatic neuroendocrine tumor was suspected considering its CT-scan characteristics.
A laparoscopic pancreatic enucleation was planned with possible central pancreatectomy in case the enucleation would turn out to be unfeasible. The attempt to perform enucleation failed due to intensive bleeding from an intrapancreatic vessel, unclear borders of the tumor, and high risk of postoperative pancreatic fistula formation. It was decided to continue the surgery with central pancreatectomy.
The postoperative course was complicated by a postoperative pancreatic fistula (POPF) grade B (according to the ISGPF classification), which was managed successfully using interventional percutaneous drainage. Final histopathological examination revealed a clear cell renal cell carcinoma (RCC) metastatic lesion to the pancreas. A CT-scan performed 2 years after the surgery revealed no signs of disease progression. The pancreaticojejunostomy shows no signs of obstruction. The patient has neither exocrine nor endocrine pancreatic insufficiency.
The purpose of the video is to demonstrate the feasibility of laparoscopic central pancreatectomy, which is an organ-preserving procedure and is accompanied with better long-term results.
P Agami, M Baychorov, R Izrailov, I Khatkov
Surgical intervention
13 days ago
505 views
11 likes
0 comments
13:07
Laparoscopic central pancreatectomy for renal cell carcinoma metastasis
Authors present the case of a laparoscopic central pancreatectomy in a patient with a clear cell renal cell carcinoma metastatic lesion to the pancreatic neck.
A 71-year old female patient was admitted with a pancreatic neck lesion detected by abdominal ultrasound performed for mild epigastric pain she has been suffering from for 3 months prior to admission. Her past medical history is significant for right nephrectomy performed 25 years ago. The patient stated that she had an acquired cystic kidney disease, but no medical records were available to confirm that. A multidisciplinary investigation was performed. Pancreatic protocol CT-scan revealed a 2.5cm hyper-enhancing round-shaped tumor, located within the pancreatic neck. The patient had no carcinoid syndrome, and levels of PNET specific markers (Chromogranin A, NSE, Insulin, 5-HIIA) were not elevated. CA 19-9 and CEA levels were also normal. The tumor was [111In]-octreotide negative on octreotide scan. As a result, a non-functioning pancreatic neuroendocrine tumor was suspected considering its CT-scan characteristics.
A laparoscopic pancreatic enucleation was planned with possible central pancreatectomy in case the enucleation would turn out to be unfeasible. The attempt to perform enucleation failed due to intensive bleeding from an intrapancreatic vessel, unclear borders of the tumor, and high risk of postoperative pancreatic fistula formation. It was decided to continue the surgery with central pancreatectomy.
The postoperative course was complicated by a postoperative pancreatic fistula (POPF) grade B (according to the ISGPF classification), which was managed successfully using interventional percutaneous drainage. Final histopathological examination revealed a clear cell renal cell carcinoma (RCC) metastatic lesion to the pancreas. A CT-scan performed 2 years after the surgery revealed no signs of disease progression. The pancreaticojejunostomy shows no signs of obstruction. The patient has neither exocrine nor endocrine pancreatic insufficiency.
The purpose of the video is to demonstrate the feasibility of laparoscopic central pancreatectomy, which is an organ-preserving procedure and is accompanied with better long-term results.
Laparoscopic Sugarbaker parastomal hernia repair
In this video, authors demonstrate a laparoscopic Sugarbaker technique for parastomal hernia repair using a Gore-Tex mesh in an 18-year-old man with a history of anal cancer status post-abdominoperineal resection with an end colostomy and known chronic parastomal hernia. His history also includes hypoplastic left heart syndrome status post-orthotopic cardiac transplant, DiGeorge syndrome, Hodgkin’s disease type post-transplant lymphoproliferative disease, and immune deficiency. He presented with abdominal pain, nausea, and vomiting secondary to small bowel obstruction at the site of his previous parastomal hernia. CT-scan showed a mesenteric swirl with a transition point. Upon laparoscopy, the parastomal hernia was identified. The bowel was reduced and hernia edges cauterized. Primary repair of the hernia defect was performed using a percutaneous technique. A Jackson-Pratt (JP) drain was left inside the hernia area and exited through a separate part of the abdomen. Following the Sugarbaker technique, a 16 by 20cm Gore-Tex dual mesh plus was used to reinforce the defect. Percutaneous sutures in the four corners secured the mesh. Once the mesh was in the desired location, absorbable tackers were used to attach the mesh to the anterior abdominal wall. Additional percutaneous sutures were added to the medial mesh. The patient recovered well. His nasogastric tube was removed on postoperative day (POD) 4. He was advanced to a regular diet and discharged on POD 7. Surveillance CT showed an intact repair with no recurrence a year after surgery. This case demonstrates a Sugarbaker technique for the closure of parastomal hernias using a Gore-Tex graft for parastomal hernias. The laparoscopic Sugarbaker technique is a safe procedure for the repair of parastomal hernias.
T Huy, A Bajinting, J Greenspon, GA Villalona
Surgical intervention
13 days ago
842 views
10 likes
0 comments
05:01
Laparoscopic Sugarbaker parastomal hernia repair
In this video, authors demonstrate a laparoscopic Sugarbaker technique for parastomal hernia repair using a Gore-Tex mesh in an 18-year-old man with a history of anal cancer status post-abdominoperineal resection with an end colostomy and known chronic parastomal hernia. His history also includes hypoplastic left heart syndrome status post-orthotopic cardiac transplant, DiGeorge syndrome, Hodgkin’s disease type post-transplant lymphoproliferative disease, and immune deficiency. He presented with abdominal pain, nausea, and vomiting secondary to small bowel obstruction at the site of his previous parastomal hernia. CT-scan showed a mesenteric swirl with a transition point. Upon laparoscopy, the parastomal hernia was identified. The bowel was reduced and hernia edges cauterized. Primary repair of the hernia defect was performed using a percutaneous technique. A Jackson-Pratt (JP) drain was left inside the hernia area and exited through a separate part of the abdomen. Following the Sugarbaker technique, a 16 by 20cm Gore-Tex dual mesh plus was used to reinforce the defect. Percutaneous sutures in the four corners secured the mesh. Once the mesh was in the desired location, absorbable tackers were used to attach the mesh to the anterior abdominal wall. Additional percutaneous sutures were added to the medial mesh. The patient recovered well. His nasogastric tube was removed on postoperative day (POD) 4. He was advanced to a regular diet and discharged on POD 7. Surveillance CT showed an intact repair with no recurrence a year after surgery. This case demonstrates a Sugarbaker technique for the closure of parastomal hernias using a Gore-Tex graft for parastomal hernias. The laparoscopic Sugarbaker technique is a safe procedure for the repair of parastomal hernias.
3D laparoscopic left colectomy with intraoperative colonoscopy: a live educational procedure
In this live educational procedure, Dr. Armando Melani presents the case of a 70-year-old female patient with a previous history of inferior right lobectomy secondary to T2 carcinoma. In 2018, during postoperative surveillance, PET-scan showed a left colon fixation. Colonoscopy revealed a polypoid lesion located 40cm away from the anal verge. Biopsy showed severe dysplasia. Endoscopic clips were placed for marking purposes. Three additional adenomatous polyps in the right, transverse, and left colon were found and removed. Preoperative abdominal X-ray showed the presence of clips at the level of the left pelvic bone. Since colonoscopy was performed more than two weeks before surgery, intraoperative colonoscopy was used to ensure tumor location.

During the video, surgical pitfalls were highlighted, and the author showed the importance of preoperative tumor tattooing, demonstrated anatomical landmarks, and the starting point of mesenteric dissection for left colectomy at the superior mesenteric vein (IMV). Recommendations for inferior mesenteric artery (IMA) ligation, hypogastric nerve preservation, splenic flexure mobilization, stapling recommendations during colon transection, colorectal anastomosis, and means to prevent postoperative complications were provided. The value of leak test, endoscopic anastomosis evaluation, and the use of indocyanine green (ICG) were also emphasized.
A Melani, A D'Urso, R Rodriguez Luna, D Mutter, J Marescaux
Surgical intervention
13 days ago
369 views
10 likes
0 comments
17:09
3D laparoscopic left colectomy with intraoperative colonoscopy: a live educational procedure
In this live educational procedure, Dr. Armando Melani presents the case of a 70-year-old female patient with a previous history of inferior right lobectomy secondary to T2 carcinoma. In 2018, during postoperative surveillance, PET-scan showed a left colon fixation. Colonoscopy revealed a polypoid lesion located 40cm away from the anal verge. Biopsy showed severe dysplasia. Endoscopic clips were placed for marking purposes. Three additional adenomatous polyps in the right, transverse, and left colon were found and removed. Preoperative abdominal X-ray showed the presence of clips at the level of the left pelvic bone. Since colonoscopy was performed more than two weeks before surgery, intraoperative colonoscopy was used to ensure tumor location.

During the video, surgical pitfalls were highlighted, and the author showed the importance of preoperative tumor tattooing, demonstrated anatomical landmarks, and the starting point of mesenteric dissection for left colectomy at the superior mesenteric vein (IMV). Recommendations for inferior mesenteric artery (IMA) ligation, hypogastric nerve preservation, splenic flexure mobilization, stapling recommendations during colon transection, colorectal anastomosis, and means to prevent postoperative complications were provided. The value of leak test, endoscopic anastomosis evaluation, and the use of indocyanine green (ICG) were also emphasized.
Colonic perforation: laparoscopic approach
An 89-year-old man was admitted to hospital because of complaints of abdominal pain and diarrhea with a one-month evolution. His medical history included atrial fibrillation for which he was on anticoagulants, type 2 diabetes mellitus, and recurrent syncopes. The patient’s surgical history included cholecystectomy, right inguinal hernioplasty, and prostatectomy. During the performance of a colonoscopy, the patient had an onset of intense and widespread abdominal pain. Colonoscopy showed a suspicion of perforation at the level of the sigmoid colon, without any evidence of tumor-like lesions. CT-scan showed a pneumoperitoneum and perforation at the level of the distal sigmoid colon. It was decided to perform a laparoscopic approach. A perforation was identified in the rectosigmoid junction. The perforation was sutured.
The patient presented with an acute coronary syndrome in the immediate postoperative period, which was managed with medical treatment. Subsequently, the patient had symptoms of paralytic ileus, which were managed conservatively with subsequent recovery of bowel transit. The patient was discharged on postoperative day 10.
I Fraile Alonso, A Trinidad Borras, J Álvarez Martin
Surgical intervention
13 days ago
551 views
8 likes
1 comment
07:42
Colonic perforation: laparoscopic approach
An 89-year-old man was admitted to hospital because of complaints of abdominal pain and diarrhea with a one-month evolution. His medical history included atrial fibrillation for which he was on anticoagulants, type 2 diabetes mellitus, and recurrent syncopes. The patient’s surgical history included cholecystectomy, right inguinal hernioplasty, and prostatectomy. During the performance of a colonoscopy, the patient had an onset of intense and widespread abdominal pain. Colonoscopy showed a suspicion of perforation at the level of the sigmoid colon, without any evidence of tumor-like lesions. CT-scan showed a pneumoperitoneum and perforation at the level of the distal sigmoid colon. It was decided to perform a laparoscopic approach. A perforation was identified in the rectosigmoid junction. The perforation was sutured.
The patient presented with an acute coronary syndrome in the immediate postoperative period, which was managed with medical treatment. Subsequently, the patient had symptoms of paralytic ileus, which were managed conservatively with subsequent recovery of bowel transit. The patient was discharged on postoperative day 10.
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
1 month ago
1810 views
23 likes
0 comments
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
1 month ago
818 views
11 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
1 month ago
1216 views
11 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.
Laparoscopic left hemicolectomy with manual intracorporeal anastomosis
The best surgical approach for splenic flexure tumors is not well defined yet.
The distal third of the transverse colon has an embryological origin in the hindgut, and the splenic flexure classically shows a dual lymphatic drainage, the proximal retropancreatic and the distal to the lymphatic pedicle of both the inferior mesenteric artery (IMA) and the inferior mesenteric vein (IMV). Nakagoe et al. showed that the majority of positive nodes have distal lymphatic spread to the paracolic archway and up to the origin of the left colic artery. Lymph nodes of the middle colic artery and its left branch are positive in a small percentage (0 and 4.2% respectively).
As a result, a left segmental colectomy is a valid option for splenic flexure and distal transverse colon tumors because it allows vascular ligation at the root of the vessels, dissection along the embryological planes, and adequate bowel margins from the tumor. The preservation of the IMV should reduce impaired venous drainage of the sigmoid colon, which can be associated with anastomotic leakage, without compromising complete mesocolic excision.
An intracorporeal anastomosis for left colonic resection may have the same advantages as for a right hemicolectomy, but can be technically more challenging.
This video shows a laparoscopic left hemicolectomy with manual intracorporeal anastomosis and preservation of the IMV for a tumor of the distal transverse colon.
A Canaveira Manso, M Rosete, R Nemésio, M Fernandes
Surgical intervention
4 months ago
2655 views
24 likes
0 comments
16:43
Laparoscopic left hemicolectomy with manual intracorporeal anastomosis
The best surgical approach for splenic flexure tumors is not well defined yet.
The distal third of the transverse colon has an embryological origin in the hindgut, and the splenic flexure classically shows a dual lymphatic drainage, the proximal retropancreatic and the distal to the lymphatic pedicle of both the inferior mesenteric artery (IMA) and the inferior mesenteric vein (IMV). Nakagoe et al. showed that the majority of positive nodes have distal lymphatic spread to the paracolic archway and up to the origin of the left colic artery. Lymph nodes of the middle colic artery and its left branch are positive in a small percentage (0 and 4.2% respectively).
As a result, a left segmental colectomy is a valid option for splenic flexure and distal transverse colon tumors because it allows vascular ligation at the root of the vessels, dissection along the embryological planes, and adequate bowel margins from the tumor. The preservation of the IMV should reduce impaired venous drainage of the sigmoid colon, which can be associated with anastomotic leakage, without compromising complete mesocolic excision.
An intracorporeal anastomosis for left colonic resection may have the same advantages as for a right hemicolectomy, but can be technically more challenging.
This video shows a laparoscopic left hemicolectomy with manual intracorporeal anastomosis and preservation of the IMV for a tumor of the distal transverse colon.