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Strategy for laparoscopic total hysterectomy with a big adnexal mass
Hysterectomy when managing a big adnexal mass has always been a challenging situation for laparoscopic surgeons. Complete preoperative assessment, surgical experience and strategy are fundamental to address adnexal pathology laparoscopicallly, both for benign and malignant conditions. Adequate trocar placement, full inspection of the abdominal cavity, comprehensive evaluation of the tumor’s surface, cytology and definition of the nature of the adnexal mass are truly essential. In addition, proper identification of standard anatomical landmarks is fundamental to perform hysterectomy with adnexectomy, which helps to prevent damage to surrounding structures. Final assessment of the vaginal cuff may lead to the diagnosis of pelvic floor disorders that should be repaired during vaginal cuff closure. In this video, we present a case of hysterectomy and adnexectomy by laparoscopy in a 46-year-old patient complaining of abdominal pain secondary to the presence of a 13cm simple adnexal cyst with normal CA 125 values.
A Wattiez, C Zacharopoulou, J Albornoz, M Puga, E Faller
Surgical intervention
7 years ago
4793 views
137 likes
0 comments
28:57
Strategy for laparoscopic total hysterectomy with a big adnexal mass
Hysterectomy when managing a big adnexal mass has always been a challenging situation for laparoscopic surgeons. Complete preoperative assessment, surgical experience and strategy are fundamental to address adnexal pathology laparoscopicallly, both for benign and malignant conditions. Adequate trocar placement, full inspection of the abdominal cavity, comprehensive evaluation of the tumor’s surface, cytology and definition of the nature of the adnexal mass are truly essential. In addition, proper identification of standard anatomical landmarks is fundamental to perform hysterectomy with adnexectomy, which helps to prevent damage to surrounding structures. Final assessment of the vaginal cuff may lead to the diagnosis of pelvic floor disorders that should be repaired during vaginal cuff closure. In this video, we present a case of hysterectomy and adnexectomy by laparoscopy in a 46-year-old patient complaining of abdominal pain secondary to the presence of a 13cm simple adnexal cyst with normal CA 125 values.
Laparoscopic partial splenectomy
A 39-year-old male patient was referred to our institution for a total laparoscopic splenectomy. The patient presented a CT-scan with a heterogeneous lesion in the lower aspect of the spleen. Two different hematologists-oncologists recommended a total splenectomy due the characteristics of the lesion. We discussed this recommendation during the oncological committee at our institution and due to the anatomical variation of the splenic artery and the absence of characterization of the lesion as 100% malignant, a laparoscopic partial splenectomy was decided upon with an intraoperative frozen analysis to determine if any further resection would be necessary. In this video, the authors present the technical aspects of a complex surgical resection.
D Awruch, M Grimoldi, M Blanco, R Sanchez Almeyra
Surgical intervention
2 years ago
3181 views
178 likes
0 comments
05:28
Laparoscopic partial splenectomy
A 39-year-old male patient was referred to our institution for a total laparoscopic splenectomy. The patient presented a CT-scan with a heterogeneous lesion in the lower aspect of the spleen. Two different hematologists-oncologists recommended a total splenectomy due the characteristics of the lesion. We discussed this recommendation during the oncological committee at our institution and due to the anatomical variation of the splenic artery and the absence of characterization of the lesion as 100% malignant, a laparoscopic partial splenectomy was decided upon with an intraoperative frozen analysis to determine if any further resection would be necessary. In this video, the authors present the technical aspects of a complex surgical resection.
SILS single port splenectomy in a woman diagnosed with idiopathic thrombocytopenia
Laparoscopic splenectomy (LS) has become the technique of choice for surgical removal of the spleen since its first description in 1991. Indications for LS have rapidly increased and LS is now considered the standard approach for the treatment of benign and malignant hematologic disorders, especially by young patients who find small scars cosmetically preferable.
Single incision laparoscopic surgery (SILS) is a rapidly evolving field as a bridge between traditional laparoscopic surgery and natural orifice transluminal endoscopic surgery. In this video, we present an original technique of SILS splenectomy in a woman diagnosed with idiopathic thrombocytopenia. A 2.2cm left subcostal incision lateral to the rectus muscles was used for the placement of the single port device with conventional laparoscopic instruments, using a Veress needle covered by a small sponge to lift the spleen that was removed through the same incision.
F Corcione, F Pirozzi, F Galante
Surgical intervention
7 years ago
2529 views
38 likes
0 comments
05:51
SILS single port splenectomy in a woman diagnosed with idiopathic thrombocytopenia
Laparoscopic splenectomy (LS) has become the technique of choice for surgical removal of the spleen since its first description in 1991. Indications for LS have rapidly increased and LS is now considered the standard approach for the treatment of benign and malignant hematologic disorders, especially by young patients who find small scars cosmetically preferable.
Single incision laparoscopic surgery (SILS) is a rapidly evolving field as a bridge between traditional laparoscopic surgery and natural orifice transluminal endoscopic surgery. In this video, we present an original technique of SILS splenectomy in a woman diagnosed with idiopathic thrombocytopenia. A 2.2cm left subcostal incision lateral to the rectus muscles was used for the placement of the single port device with conventional laparoscopic instruments, using a Veress needle covered by a small sponge to lift the spleen that was removed through the same incision.
Single incision laparoscopic partial splenectomy for splenic hemangioma
Laparoscopy is now considered the "gold standard" approach for splenectomy when treating different benign and malignant diseases requiring the removal of the whole or part of the spleen.
During the last few months in both experimental and clinical settings, new techniques such as natural orifice transluminal endoscopic surgery (NOTES™) and single incision laparoscopic surgery (SILS) or single port laparoscopic surgery (SPLS) have been attempted in order to reduce even more the surgical trauma in laparo-endoscopic procedures.
SPLS allows to perform different surgical procedures using the umbilicus as the only site to access the abdominal cavity and, by using special trocars and instruments, to carry out the operation using the same techniques and principles of standard laparoscopic surgery.
The video describes our personal technique for totally single incision partial splenectomy for the treatment of splenic hemangioma.
A 44-year-old woman complained with recurrent abdominal pain in the left hypochondrium and flank and was referred to our department.
Abdominal US as well as CT-scan images demonstrated the presence of a large cystic-like lesion at the lower pole of the spleen. It presented some septal division with the cyst. Blood tests were normal and all markers were negative.
Single incision partial splenectomy was performed with no complications and the patient’s postoperative course was uneventful.
L Boni, G Dionigi, M Di Giuseppe, E Colombo, L Giavarini, F Cantore, R Dionigi
Surgical intervention
9 years ago
1641 views
13 likes
0 comments
04:58
Single incision laparoscopic partial splenectomy for splenic hemangioma
Laparoscopy is now considered the "gold standard" approach for splenectomy when treating different benign and malignant diseases requiring the removal of the whole or part of the spleen.
During the last few months in both experimental and clinical settings, new techniques such as natural orifice transluminal endoscopic surgery (NOTES™) and single incision laparoscopic surgery (SILS) or single port laparoscopic surgery (SPLS) have been attempted in order to reduce even more the surgical trauma in laparo-endoscopic procedures.
SPLS allows to perform different surgical procedures using the umbilicus as the only site to access the abdominal cavity and, by using special trocars and instruments, to carry out the operation using the same techniques and principles of standard laparoscopic surgery.
The video describes our personal technique for totally single incision partial splenectomy for the treatment of splenic hemangioma.
A 44-year-old woman complained with recurrent abdominal pain in the left hypochondrium and flank and was referred to our department.
Abdominal US as well as CT-scan images demonstrated the presence of a large cystic-like lesion at the lower pole of the spleen. It presented some septal division with the cyst. Blood tests were normal and all markers were negative.
Single incision partial splenectomy was performed with no complications and the patient’s postoperative course was uneventful.
Laparoscopic distal gastrectomy with Billroth II reconstruction for peptic ulcer obstruction
This live surgery video demonstrates a laparoscopic distal gastrectomy with Billroth II reconstruction in a patient with pyloric stenosis which was caused by peptic ulcer. Treatment using balloon dilatation failed. The fibrotic area of the duodenal ulcer was approached by fine dissection and ligation of right gastro-epiploic and right gastric vessels. The dissection was performed around the duodenum until an adequate margin could be obtained in the healthy portion of the distal duodenum. The duodenum was then transected by means of a stapler. A relatively large dilated stomach including the antrum and part of the gastric body was transected, and a Billroth II gastrojejunostomy was performed.
HK Yang
Surgical intervention
4 years ago
3556 views
157 likes
0 comments
21:58
Laparoscopic distal gastrectomy with Billroth II reconstruction for peptic ulcer obstruction
This live surgery video demonstrates a laparoscopic distal gastrectomy with Billroth II reconstruction in a patient with pyloric stenosis which was caused by peptic ulcer. Treatment using balloon dilatation failed. The fibrotic area of the duodenal ulcer was approached by fine dissection and ligation of right gastro-epiploic and right gastric vessels. The dissection was performed around the duodenum until an adequate margin could be obtained in the healthy portion of the distal duodenum. The duodenum was then transected by means of a stapler. A relatively large dilated stomach including the antrum and part of the gastric body was transected, and a Billroth II gastrojejunostomy was performed.
Hysteroscopic myomectomy and ART
Fibroids represent an extremely common benign uterine pathology, the incidence of which increases with age, and approximately 10% of women with infertility problems will present a myoma. The association between uterine myoma and infertility is still controversial. Evidence exists that subserosal myomas do not impair the pregnancy rate in IVF whereas submucous myomas significantly decrease the implantation rate. Unfortunately, the effect of intramural myomas upon reproduction outcomes remains unknown, and until now no adequate diagnostic and therapeutic guidelines have been established.
Magnetic resonance imaging (MRI) imaging has redefined the functional anatomy of the uterus. Contrarily to ultrasound, MRI demonstrates that the non-pregnant myometrium is not a homogeneous smooth muscle mass but consists of two different structural and functional entities. The myometrium adjacent to the endometrium is a different hormone-dependent uterine compartment called junctional zone (JZ) myometrium. It is a functionally important entity in reproduction and it is ontogenetically related to the endometrium. Submucosal fibroids originate from this JZ myometrium and differ from subserosal fibroids as they have less cytogenetic abnormalities, less expression of Sex Steroid Hormone receptors, and they are more responsive to GnRH analog treatment and provide fewer recurrences after surgery.
Despite the lack of randomized studies, the sharp decline in pregnancy rates in case of submucous myoma is quite convincing and it is based on the existing evidence that myomectomy should be performed prior to ART for junctional zone myomas which protrude into the uterine cavity.
We demonstrate the different modern techniques of hysteroscopic myomectomy, the new instrumentation, the tips and tricks, the possible complications and clinical outcome.
R Campo
Lecture
4 years ago
2140 views
102 likes
0 comments
27:15
Hysteroscopic myomectomy and ART
Fibroids represent an extremely common benign uterine pathology, the incidence of which increases with age, and approximately 10% of women with infertility problems will present a myoma. The association between uterine myoma and infertility is still controversial. Evidence exists that subserosal myomas do not impair the pregnancy rate in IVF whereas submucous myomas significantly decrease the implantation rate. Unfortunately, the effect of intramural myomas upon reproduction outcomes remains unknown, and until now no adequate diagnostic and therapeutic guidelines have been established.
Magnetic resonance imaging (MRI) imaging has redefined the functional anatomy of the uterus. Contrarily to ultrasound, MRI demonstrates that the non-pregnant myometrium is not a homogeneous smooth muscle mass but consists of two different structural and functional entities. The myometrium adjacent to the endometrium is a different hormone-dependent uterine compartment called junctional zone (JZ) myometrium. It is a functionally important entity in reproduction and it is ontogenetically related to the endometrium. Submucosal fibroids originate from this JZ myometrium and differ from subserosal fibroids as they have less cytogenetic abnormalities, less expression of Sex Steroid Hormone receptors, and they are more responsive to GnRH analog treatment and provide fewer recurrences after surgery.
Despite the lack of randomized studies, the sharp decline in pregnancy rates in case of submucous myoma is quite convincing and it is based on the existing evidence that myomectomy should be performed prior to ART for junctional zone myomas which protrude into the uterine cavity.
We demonstrate the different modern techniques of hysteroscopic myomectomy, the new instrumentation, the tips and tricks, the possible complications and clinical outcome.
Hybrid laparoscopic transgastric GIST resection
Gastrointestinal Stromal Tumors (GIST) are rare digestive tract tumors with an annual incidence of 6.5 to 14.5 cases per million, accounting for less than 1% of gastrointestinal tumors. They are the most common mesenchymal neoplasms with a biological behavior that is dictated by their size and histological grade and ranging between benign and malignant. They are of particular interest for being the first tumors to have a molecular targeted therapy custom made for them, Imatinib mesylate.

Surgical resection with curative intent is the primary treatment for all patients with localized and potentially resectable GIST. A complete excision of the lesion should be intended and a R0 microscopic limit verified. Minimally invasive procedures are especially of interest in order to achieve the best oncologic and functional results for the patient.

In this video, we present a hybrid endoscopic/laparoscopic excision of a gastric GIST in an elderly and frail patient. Its location in the posterior gastric wall near the lesser curvature made a local excision by laparoscopy uncertain for injury of the coronary gastric vessels. It would be also difficult to evaluate the properness of the resection margin. The procedure was safely performed by a combined surgical team working in parallel laparoscopically and endoscopically. The functional result was excellent and the pathology confirmed the complete R0 resection of the GIST.
S Perretta, D Ntourakis, J Marescaux
Surgical intervention
5 years ago
1928 views
54 likes
0 comments
06:43
Hybrid laparoscopic transgastric GIST resection
Gastrointestinal Stromal Tumors (GIST) are rare digestive tract tumors with an annual incidence of 6.5 to 14.5 cases per million, accounting for less than 1% of gastrointestinal tumors. They are the most common mesenchymal neoplasms with a biological behavior that is dictated by their size and histological grade and ranging between benign and malignant. They are of particular interest for being the first tumors to have a molecular targeted therapy custom made for them, Imatinib mesylate.

Surgical resection with curative intent is the primary treatment for all patients with localized and potentially resectable GIST. A complete excision of the lesion should be intended and a R0 microscopic limit verified. Minimally invasive procedures are especially of interest in order to achieve the best oncologic and functional results for the patient.

In this video, we present a hybrid endoscopic/laparoscopic excision of a gastric GIST in an elderly and frail patient. Its location in the posterior gastric wall near the lesser curvature made a local excision by laparoscopy uncertain for injury of the coronary gastric vessels. It would be also difficult to evaluate the properness of the resection margin. The procedure was safely performed by a combined surgical team working in parallel laparoscopically and endoscopically. The functional result was excellent and the pathology confirmed the complete R0 resection of the GIST.
Laparoscopic resection of giant hepatic cystadenoma
This is the case of a 22-month-old female infant. The pathology started two weeks before with a gradual increase of abdominal circumference and intermittent hypo-colic stools. A CT-scan of the abdomen showed a large cystic tumor with interior partitions measuring 16.5 in width by 10.6 in length by 12.1cm in depth, originating in segments V and VI of the liver, displacing the remaining liver to the left and compressing the right kidney, bowel, celiac artery, gallbladder, and pancreas. A laparoscopic approach for tumor resection was decided on due to the scarce tumor vascularization and entirely cystic consistency. The procedure required 4 ports, three of 5mm and one of 3mm, emptying the cystic content of approximately 2 liters of citrine fluid. Dissection was performed using the Ligasure™ vessel-sealing device and monopolar cautery, preserving adjacent vital structures and preventing bleeding. The surgical specimen was removed through the umbilical scar. No transfusion was required and surgery lasted four hours. There were no postoperative complications. As a result, laparoscopic surgery is considered a safe procedure for the excision of large tumors in children provided they are cystic and benign, as emptying the cyst gives broader visualization of the area and permits better tissue handling.
A Parilli, W Garcia, I Galdon, G Contreras
Surgical intervention
7 years ago
1145 views
10 likes
0 comments
08:03
Laparoscopic resection of giant hepatic cystadenoma
This is the case of a 22-month-old female infant. The pathology started two weeks before with a gradual increase of abdominal circumference and intermittent hypo-colic stools. A CT-scan of the abdomen showed a large cystic tumor with interior partitions measuring 16.5 in width by 10.6 in length by 12.1cm in depth, originating in segments V and VI of the liver, displacing the remaining liver to the left and compressing the right kidney, bowel, celiac artery, gallbladder, and pancreas. A laparoscopic approach for tumor resection was decided on due to the scarce tumor vascularization and entirely cystic consistency. The procedure required 4 ports, three of 5mm and one of 3mm, emptying the cystic content of approximately 2 liters of citrine fluid. Dissection was performed using the Ligasure™ vessel-sealing device and monopolar cautery, preserving adjacent vital structures and preventing bleeding. The surgical specimen was removed through the umbilical scar. No transfusion was required and surgery lasted four hours. There were no postoperative complications. As a result, laparoscopic surgery is considered a safe procedure for the excision of large tumors in children provided they are cystic and benign, as emptying the cyst gives broader visualization of the area and permits better tissue handling.
Laparoscopic excision of a large leiomyoma of the esophagogastric junction
Esophageal leiomyomas represent a benign pathology that usually affects the distal third and the esophagogastric junction, and that is perfectly suitable for a laparoscopic enucleation. A correct preoperative diagnosis is mandatory, as the most common differential diagnosis in this localization is represented by gastrointestinal stromal tumors (GIST), a pathology that could benefit from neo-adjuvant therapy. Occasionally, leiomyomas can be adherent to the mucosal layer, in which case-limited mucosal excision is necessary.
We present a laparoscopic enucleation of a large leiomyoma of the esophagogastric junction, requiring the use of an endostapler for complete resection.
C Balagué Ponz, EM Targarona Soler, S Mocanu, S Fernandez Ananin, F Marinello, M Trías Folch
Surgical intervention
7 years ago
1506 views
7 likes
0 comments
09:00
Laparoscopic excision of a large leiomyoma of the esophagogastric junction
Esophageal leiomyomas represent a benign pathology that usually affects the distal third and the esophagogastric junction, and that is perfectly suitable for a laparoscopic enucleation. A correct preoperative diagnosis is mandatory, as the most common differential diagnosis in this localization is represented by gastrointestinal stromal tumors (GIST), a pathology that could benefit from neo-adjuvant therapy. Occasionally, leiomyomas can be adherent to the mucosal layer, in which case-limited mucosal excision is necessary.
We present a laparoscopic enucleation of a large leiomyoma of the esophagogastric junction, requiring the use of an endostapler for complete resection.
Laparoscopic coloproctectomy with ileoanal pouch anastomosis for familial adenomatous polyposis (FAP)
Coloproctectomy is a challenging surgical procedure, whether open or laparoscopic, particularly when an ileoanal anastomosis with pouch is performed. The objective of this film is to provide some tricks to perform this surgical procedure laparoscopically.
The main trick is probably the preservation of the right and ileocolic vessels and of the right Drummond marginal vascular arcade that later allows for a division of the superior mesenteric vessels, if necessary to gain a length of 2 to 3cm in the pelvis.
The use of new sealing devices such as the Ligasure™ blunt tip facilitated the standardization of the procedure.
J Leroy, J Marescaux
Surgical intervention
7 years ago
2852 views
76 likes
0 comments
14:18
Laparoscopic coloproctectomy with ileoanal pouch anastomosis for familial adenomatous polyposis (FAP)
Coloproctectomy is a challenging surgical procedure, whether open or laparoscopic, particularly when an ileoanal anastomosis with pouch is performed. The objective of this film is to provide some tricks to perform this surgical procedure laparoscopically.
The main trick is probably the preservation of the right and ileocolic vessels and of the right Drummond marginal vascular arcade that later allows for a division of the superior mesenteric vessels, if necessary to gain a length of 2 to 3cm in the pelvis.
The use of new sealing devices such as the Ligasure™ blunt tip facilitated the standardization of the procedure.
Laparoscopic three-trocar sigmoidectomy with transanal extraction and new Sonicision™ cordless ultrasonic dissection device
Introduction
We present the case of a 32-year-old female patient with recurrent episodes of diverticulitis. She underwent an elective sigmoidectomy using the new Sonicision™ cordless ultrasonic dissection device.

Methods
Our set-up consisted of a standard three-port technique with one umbilical optical 10mm port with 1x5mm and 1x12mm right iliac fossa (RIF) ports. After initial peritoneoscopy, the sigmoid mesocolon was divided close to the bowel using the new Sonicision™ cordless ultrasonic dissection device. The mesocolic window was continued distally to the rectosigmoid junction and proximally to the descending colon. The lateral attachments were then mobilized. After rectal washout, the rectum was divided and the sigmoid colon extracted transanally. A colotomy was then made above the inflamed area, the anvil of a circular stapler introduced into the colonic lumen and then advanced up to the proximal bowel (with the aid of a bowel grasper sheathed in a flexible plastic tubing). The proximal sigmoid colon was then divided with a linear stapling device, the specimen removed transanally and the rectum closed. The spike of the anvil was then delivered through the proximal colon using the fishing technique. The colorectal anastomosis was then fashioned in the usual technique with a circular stapler. A leak test was performed thereafter.

Results
The procedure was successfully completed. The Sonicision™ cordless ultrasonic dissection device performed similarly to other power sources but without the impedance of additional wires. It allows for ease of use and quick changing of instruments and ports without the potential of snagging the wire.

Conclusion
The Sonicision™ cordless ultrasonic dissection device performed excellently for laparoscopic colorectal surgery. Cordless dissectors and vessel-sealing devices will be an excellent adjunct to minimally invasive surgery of the future.
J Leroy, B Barry, J Marescaux
Surgical intervention
7 years ago
1720 views
5 likes
0 comments
21:52
Laparoscopic three-trocar sigmoidectomy with transanal extraction and new Sonicision™ cordless ultrasonic dissection device
Introduction
We present the case of a 32-year-old female patient with recurrent episodes of diverticulitis. She underwent an elective sigmoidectomy using the new Sonicision™ cordless ultrasonic dissection device.

Methods
Our set-up consisted of a standard three-port technique with one umbilical optical 10mm port with 1x5mm and 1x12mm right iliac fossa (RIF) ports. After initial peritoneoscopy, the sigmoid mesocolon was divided close to the bowel using the new Sonicision™ cordless ultrasonic dissection device. The mesocolic window was continued distally to the rectosigmoid junction and proximally to the descending colon. The lateral attachments were then mobilized. After rectal washout, the rectum was divided and the sigmoid colon extracted transanally. A colotomy was then made above the inflamed area, the anvil of a circular stapler introduced into the colonic lumen and then advanced up to the proximal bowel (with the aid of a bowel grasper sheathed in a flexible plastic tubing). The proximal sigmoid colon was then divided with a linear stapling device, the specimen removed transanally and the rectum closed. The spike of the anvil was then delivered through the proximal colon using the fishing technique. The colorectal anastomosis was then fashioned in the usual technique with a circular stapler. A leak test was performed thereafter.

Results
The procedure was successfully completed. The Sonicision™ cordless ultrasonic dissection device performed similarly to other power sources but without the impedance of additional wires. It allows for ease of use and quick changing of instruments and ports without the potential of snagging the wire.

Conclusion
The Sonicision™ cordless ultrasonic dissection device performed excellently for laparoscopic colorectal surgery. Cordless dissectors and vessel-sealing devices will be an excellent adjunct to minimally invasive surgery of the future.
Three trocar laparoscopic sigmoidectomy for diffuse diverticulosis with transanal specimen extraction: tips and tricks
The video demonstrates the case of a woman with recurrent diverticulitis, BMI 30. She has a background of a previous hysterectomy via a Pfannenstiel incision. A three-port sigmoidectomy with transanal excision was carried out.
Methods
The set up consisted of a 12mm umbilical optical port, a 12mm port in the right iliac fossa, and a 5mm operating port in the right flank. After initial peritoneoscopy, any abnormal adhesions were divided. The sigmoid colon mesentery was divided high, near the sigmoid colon in order to preserve the mesenteric vasculature. The mesentery was divided to the level of the rectum, which was then skeletonized. The proximal colon was mobilized free up to the level of the splenic flexure. The rectum was then ligated, washed out with betadine and transected. A Vicryl Loop was attached to the proximal stump which was then removed transanally. A colotomy was created above the level of the diverticula and the anvil of a circular stapler introduced into the proximal colon. The proximal sigmoid colon mesentery was divided and the sigmoid transected with a linear stapler. The specimen was then fully removed transanally. The anvil was then delivered through the colon via the fishing technique. The rectal stump was closed with a linear stapler. A colorectal anastomosis was fashioned with a circular stapler. After verifying that the colon was not twisted, an air test was performed.
Conclusion
The video demonstrates a three-port technique for laparoscopic sigmoidectomy with natural orifice specimen extraction (NOSE).
J Leroy, J Marescaux
Surgical intervention
7 years ago
2711 views
14 likes
0 comments
16:52
Three trocar laparoscopic sigmoidectomy for diffuse diverticulosis with transanal specimen extraction: tips and tricks
The video demonstrates the case of a woman with recurrent diverticulitis, BMI 30. She has a background of a previous hysterectomy via a Pfannenstiel incision. A three-port sigmoidectomy with transanal excision was carried out.
Methods
The set up consisted of a 12mm umbilical optical port, a 12mm port in the right iliac fossa, and a 5mm operating port in the right flank. After initial peritoneoscopy, any abnormal adhesions were divided. The sigmoid colon mesentery was divided high, near the sigmoid colon in order to preserve the mesenteric vasculature. The mesentery was divided to the level of the rectum, which was then skeletonized. The proximal colon was mobilized free up to the level of the splenic flexure. The rectum was then ligated, washed out with betadine and transected. A Vicryl Loop was attached to the proximal stump which was then removed transanally. A colotomy was created above the level of the diverticula and the anvil of a circular stapler introduced into the proximal colon. The proximal sigmoid colon mesentery was divided and the sigmoid transected with a linear stapler. The specimen was then fully removed transanally. The anvil was then delivered through the colon via the fishing technique. The rectal stump was closed with a linear stapler. A colorectal anastomosis was fashioned with a circular stapler. After verifying that the colon was not twisted, an air test was performed.
Conclusion
The video demonstrates a three-port technique for laparoscopic sigmoidectomy with natural orifice specimen extraction (NOSE).
Prevesical genetic paraganglioma and left adrenal mass: laparoscopic resection
Hereditary paraganglioma-pheochromocytoma syndromes are caused by genetic mutations, which lead to the development of multiple neuroendocrine tumors and paraganglioma tumors in the adrenal glands. We report the case of a young patient aged 13 who has been followed up routinely for a familial mutation of the SDHB gene. In this routine follow-up examination, an excessive plasma normetanephrine and norepinephrine secretion is evidenced. A genetic paraganglioma is diagnosed. Imaging studies are conducted to identify its location. A prevesical fixation is demonstrated by both the PET-scan and the MIBG scintigraphy. In this video, a laparoscopic resection of both lesions is demonstrated.
D Mutter, J Marescaux
Surgical intervention
9 years ago
1052 views
7 likes
0 comments
09:10
Prevesical genetic paraganglioma and left adrenal mass: laparoscopic resection
Hereditary paraganglioma-pheochromocytoma syndromes are caused by genetic mutations, which lead to the development of multiple neuroendocrine tumors and paraganglioma tumors in the adrenal glands. We report the case of a young patient aged 13 who has been followed up routinely for a familial mutation of the SDHB gene. In this routine follow-up examination, an excessive plasma normetanephrine and norepinephrine secretion is evidenced. A genetic paraganglioma is diagnosed. Imaging studies are conducted to identify its location. A prevesical fixation is demonstrated by both the PET-scan and the MIBG scintigraphy. In this video, a laparoscopic resection of both lesions is demonstrated.
Laparoscopic left pancreatectomy with spleen preservation for a suspicion of IPMN
Laparoscopic distal pancreatectomy is suitable for benign and premalignant neoplasms located in the body and tail of the pancreas. Spleen preservation following distal pancreatectomy is known to be safe. There are two distinct approaches to preserve the spleen during the dissection of the distal pancreas. The classic design is to identify, isolate, and preserve the splenic artery and vein. Alternatively, the splenic artery and vein are ligated with the pancreas, and perfusion of the spleen is assured by the short gastric vessels. Both are accepted as appropriate techniques to address a mass in the tail of the pancreas. This video demonstrates a left pancreatic resection with spleen preservation and ligation of the splenic artery and vein.
B Dallemagne, S Perretta, L Soler, J Marescaux
Surgical intervention
9 years ago
1042 views
48 likes
0 comments
19:27
Laparoscopic left pancreatectomy with spleen preservation for a suspicion of IPMN
Laparoscopic distal pancreatectomy is suitable for benign and premalignant neoplasms located in the body and tail of the pancreas. Spleen preservation following distal pancreatectomy is known to be safe. There are two distinct approaches to preserve the spleen during the dissection of the distal pancreas. The classic design is to identify, isolate, and preserve the splenic artery and vein. Alternatively, the splenic artery and vein are ligated with the pancreas, and perfusion of the spleen is assured by the short gastric vessels. Both are accepted as appropriate techniques to address a mass in the tail of the pancreas. This video demonstrates a left pancreatic resection with spleen preservation and ligation of the splenic artery and vein.
Laparoscopic transhiatal esophagectomy for adenocarcinoma of the lower esophagus
Conventional esophagectomy requires either a laparotomy with a transhiatal dissection or a laparotomy combined with thoracotomy and it is associated with significant morbidity and mortality. In the attempt to decrease morbidity, some surgeons have reported the application of minimally invasive technique of resection of the esophagus. De Paula was the first to report a large series of 48 patients undergoing a total laparoscopic transhiatal esophagectomy (LTH). LTH may be used to treat patients with either benign or malignant esophageal disease because the reconstructive result cervical esophagogastric anastomosis yields good functional outcomes. Here we show the case of a LTH for adenocarcinoma of the lower esophagus.
B Dallemagne, S Perretta, J Marescaux
Surgical intervention
9 years ago
5668 views
162 likes
0 comments
21:14
Laparoscopic transhiatal esophagectomy for adenocarcinoma of the lower esophagus
Conventional esophagectomy requires either a laparotomy with a transhiatal dissection or a laparotomy combined with thoracotomy and it is associated with significant morbidity and mortality. In the attempt to decrease morbidity, some surgeons have reported the application of minimally invasive technique of resection of the esophagus. De Paula was the first to report a large series of 48 patients undergoing a total laparoscopic transhiatal esophagectomy (LTH). LTH may be used to treat patients with either benign or malignant esophageal disease because the reconstructive result cervical esophagogastric anastomosis yields good functional outcomes. Here we show the case of a LTH for adenocarcinoma of the lower esophagus.
Laparoscopic antrectomy and vagotomy for stenotic pyloric peptic ulcer
Peptic ulcer disease is the major cause of benign gastro-duodenal obstruction or gastric outlet obstruction (GOO) in the adult population. Patients often present with abdominal pain and distension, vomiting, dehydration, and weight loss. Previous studies have demonstrated that the incidence of GOO varies from 5% to 10% of all hospital admissions for ulcer-related complications.
Today surgeons are performing fewer elective ulcer surgeries, as H2 receptor blockers and the eradication of Helicobacter pylori represent a major step in the treatment of this disease. Nevertheless, patients with complications and those resistant to medical therapy can be offered surgical options. When surgery is required, a laparoscopic approach is possible with its well-known advantages.
Surgical procedures include highly selective vagotomy with some form of pyloroplasty, truncal vagotomy and antrectomy, and truncal vagotomy with gastroenterostomy. Proponents of highly selective vagotomy advocate an acceptably low recurrence rate (0 to 5% at follow-up of 24 to 90 months) and a relative paucity of post-gastrectomy sequelae. Those recommending vagotomy and antrectomy stress the superiority of the acid-reducing procedure, the virtual absence of recurrent ulceration, and the rarity of postoperative symptoms other than post-vagotomy diarrhea, which is usually a self-limited process. Finally, truncal vagotomy with gastroenterostomy avoids what can be a treacherous duodenal stump, but can result in higher ulcer recurrence rates.
We present the case of a young male patient not compliant to medical treatment who was referred to us for gastric outlet obstruction. The selected approach consisted in a laparoscopic Billroth II antrectomy and vagotomy using four ports.
B Dallemagne, S Perretta, J Marescaux
Surgical intervention
10 years ago
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12:58
Laparoscopic antrectomy and vagotomy for stenotic pyloric peptic ulcer
Peptic ulcer disease is the major cause of benign gastro-duodenal obstruction or gastric outlet obstruction (GOO) in the adult population. Patients often present with abdominal pain and distension, vomiting, dehydration, and weight loss. Previous studies have demonstrated that the incidence of GOO varies from 5% to 10% of all hospital admissions for ulcer-related complications.
Today surgeons are performing fewer elective ulcer surgeries, as H2 receptor blockers and the eradication of Helicobacter pylori represent a major step in the treatment of this disease. Nevertheless, patients with complications and those resistant to medical therapy can be offered surgical options. When surgery is required, a laparoscopic approach is possible with its well-known advantages.
Surgical procedures include highly selective vagotomy with some form of pyloroplasty, truncal vagotomy and antrectomy, and truncal vagotomy with gastroenterostomy. Proponents of highly selective vagotomy advocate an acceptably low recurrence rate (0 to 5% at follow-up of 24 to 90 months) and a relative paucity of post-gastrectomy sequelae. Those recommending vagotomy and antrectomy stress the superiority of the acid-reducing procedure, the virtual absence of recurrent ulceration, and the rarity of postoperative symptoms other than post-vagotomy diarrhea, which is usually a self-limited process. Finally, truncal vagotomy with gastroenterostomy avoids what can be a treacherous duodenal stump, but can result in higher ulcer recurrence rates.
We present the case of a young male patient not compliant to medical treatment who was referred to us for gastric outlet obstruction. The selected approach consisted in a laparoscopic Billroth II antrectomy and vagotomy using four ports.