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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
4950 views
140 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.
Robotic assisted ovary preserving excision of a benign serous cystadenoma in a prepubertal symptomatic girl
Symptomatic ovarian cysts or larger incidentally diagnosed ovarian cysts require treatment. If features of malignancy can be reasonably ruled out, minimally invasive procedures can be offered to not only excise the lesion but also preserve the ovary at the same time.
A 10-year-old female child was referred to our department with complaints of right lower abdominal pain which lasted for 6 months. She had no history of vomiting. On examination, her abdomen was soft, non-tender, with no palpable mass, and not distended. Abdominal sonography revealed a 5 by 4.5cm simple cyst in the right adnexa with a 1.7mm wall thickness, with no solid component or septation. Her right ovary was not seen separately. Her left ovary and uterus showed no abnormalities. Malignancy work-up revealed nothing suspicious (Beta-HCG: 2.9 IU/L, AFP: 1.3ng/mL, CA125: 10.9, all within normal range). A robotic-assisted complete cyst excision with preservation of the ovary was performed using 3 arms of the Da Vinci Xi™ robotic surgical system. The patient resumed oral food intake the same evening. He was discharged the following day within 24 hours of the procedure on paracetamol only. The patient was healthy and well. The biopsy reported a benign serous cystadenoma. At a 1-year follow-up, the child is asymptomatic and ovarian preservation was confirmed on postoperative ultrasound. While oophorectomy is eminently feasible with a minimally invasive approach, ovary preservation in benign lesions is quite challenging using pure laparoscopy. Robotic assistance, with its 3D binocular high-definition vision, articulating instruments, and availability of simultaneous energy in both arms, provides better precision and a maximum range of movements. It also helps to preserve the ovary while removing the cyst completely. The case report with a stepwise video of the procedure is demonstrated.
S Kumaravel, A Shenoy
Surgical intervention
5 months ago
1025 views
10 likes
1 comment
05:24
Robotic assisted ovary preserving excision of a benign serous cystadenoma in a prepubertal symptomatic girl
Symptomatic ovarian cysts or larger incidentally diagnosed ovarian cysts require treatment. If features of malignancy can be reasonably ruled out, minimally invasive procedures can be offered to not only excise the lesion but also preserve the ovary at the same time.
A 10-year-old female child was referred to our department with complaints of right lower abdominal pain which lasted for 6 months. She had no history of vomiting. On examination, her abdomen was soft, non-tender, with no palpable mass, and not distended. Abdominal sonography revealed a 5 by 4.5cm simple cyst in the right adnexa with a 1.7mm wall thickness, with no solid component or septation. Her right ovary was not seen separately. Her left ovary and uterus showed no abnormalities. Malignancy work-up revealed nothing suspicious (Beta-HCG: 2.9 IU/L, AFP: 1.3ng/mL, CA125: 10.9, all within normal range). A robotic-assisted complete cyst excision with preservation of the ovary was performed using 3 arms of the Da Vinci Xi™ robotic surgical system. The patient resumed oral food intake the same evening. He was discharged the following day within 24 hours of the procedure on paracetamol only. The patient was healthy and well. The biopsy reported a benign serous cystadenoma. At a 1-year follow-up, the child is asymptomatic and ovarian preservation was confirmed on postoperative ultrasound. While oophorectomy is eminently feasible with a minimally invasive approach, ovary preservation in benign lesions is quite challenging using pure laparoscopy. Robotic assistance, with its 3D binocular high-definition vision, articulating instruments, and availability of simultaneous energy in both arms, provides better precision and a maximum range of movements. It also helps to preserve the ovary while removing the cyst completely. The case report with a stepwise video of the procedure is demonstrated.
Minimal access surgery approach to benign biliary disease
The laparoscopic biliary approach for benign diseases has been discussed for a quarter of a century. However, there were few articles in the literature about laparoscopic bilioenteric anastomoses, such as choledochoduodenostomy and hepatico/choledochojejunostomy which require advanced laparoscopic skills and experience. In this key lecture, Dr. Asbun demonstrates his own laparoscopic techniques for bilioenteric anastomoses. For choledochal cysts representative of benign biliary diseases, cyst excision is required. The difficulty lies in the fact that the cyst extends towards the intrapancreatic portion. Dr. Asbun demonstrates the techniques for complete exposure of the intrapancreatic bile duct portion in such cases. Finally, Dr. Asbun shows bile duct injury cases managed using a hepaticojejunostomy.
HJ Asbun
Lecture
1 year ago
1314 views
8 likes
2 comments
24:34
Minimal access surgery approach to benign biliary disease
The laparoscopic biliary approach for benign diseases has been discussed for a quarter of a century. However, there were few articles in the literature about laparoscopic bilioenteric anastomoses, such as choledochoduodenostomy and hepatico/choledochojejunostomy which require advanced laparoscopic skills and experience. In this key lecture, Dr. Asbun demonstrates his own laparoscopic techniques for bilioenteric anastomoses. For choledochal cysts representative of benign biliary diseases, cyst excision is required. The difficulty lies in the fact that the cyst extends towards the intrapancreatic portion. Dr. Asbun demonstrates the techniques for complete exposure of the intrapancreatic bile duct portion in such cases. Finally, Dr. Asbun shows bile duct injury cases managed using a hepaticojejunostomy.
Segmental left colectomy: a modified caudal-to-cranial approach
Note from the WeBSurg-IRCAD Scientific Committee:
This video entitled “Segmental left colectomy: a modified caudal-to-cranial approach" shows an original technique of segmental colonic resection for benign conditions. Although, in the present case, the indication is not specified, there seems to be a tattooing on a lesion, which would not correspond to the initial indication of benign conditions. The indication might be a polyp. Such indications remain rare. The given approach is difficult to perform for inflammatory pathologies generating significant adhesions. However, although the video quality is not ideal, it was decided to publish this film with a special mention “case for debate” stating that this is not the IRCAD position, but the technique can be discussed.
Note from the authors of the video:
We have designed a modified caudal-to-cranial approach to perform a laparoscopic left colectomy preserving the inferior mesenteric artery for benign colorectal diseases.
A dissection is performed to separate the descending mesocolon from the plane of Gerota's fascia from the medial aspect to the peritoneal lining to the left parietal gutter. The peritoneal layer is incised parallel to the vessel and close to the colonic wall. The dissection is continued anteriorly up to reach the resected parietal gutter. A passage into the mesentery of the upper rectum is created for the use of the stapler and the dissection of the rectum. These maneuvers allow to straighten the mesentery simplifying the identification and division of the sigmoid arteries. A caudal-to-cranial dissection of the mesentery is performed from the divided rectum to the proximal descending colon using a sealed envelope device. It can be very useful to mobilize the colon in any direction: laterally, medially, or upward. The dissection is performed along the course of the vessel up to the proximal colon, with progressive division of the sigmoid arterial branches. The specimen is extracted through a Pfannenstiel incision. The anastomosis is performed transanally with a circular stapler according to the Knight-Griffen technique.
M Milone, P Anoldo, M Manigrasso, F Milone
Surgical intervention
2 years ago
4667 views
506 likes
0 comments
09:27
Segmental left colectomy: a modified caudal-to-cranial approach
Note from the WeBSurg-IRCAD Scientific Committee:
This video entitled “Segmental left colectomy: a modified caudal-to-cranial approach" shows an original technique of segmental colonic resection for benign conditions. Although, in the present case, the indication is not specified, there seems to be a tattooing on a lesion, which would not correspond to the initial indication of benign conditions. The indication might be a polyp. Such indications remain rare. The given approach is difficult to perform for inflammatory pathologies generating significant adhesions. However, although the video quality is not ideal, it was decided to publish this film with a special mention “case for debate” stating that this is not the IRCAD position, but the technique can be discussed.
Note from the authors of the video:
We have designed a modified caudal-to-cranial approach to perform a laparoscopic left colectomy preserving the inferior mesenteric artery for benign colorectal diseases.
A dissection is performed to separate the descending mesocolon from the plane of Gerota's fascia from the medial aspect to the peritoneal lining to the left parietal gutter. The peritoneal layer is incised parallel to the vessel and close to the colonic wall. The dissection is continued anteriorly up to reach the resected parietal gutter. A passage into the mesentery of the upper rectum is created for the use of the stapler and the dissection of the rectum. These maneuvers allow to straighten the mesentery simplifying the identification and division of the sigmoid arteries. A caudal-to-cranial dissection of the mesentery is performed from the divided rectum to the proximal descending colon using a sealed envelope device. It can be very useful to mobilize the colon in any direction: laterally, medially, or upward. The dissection is performed along the course of the vessel up to the proximal colon, with progressive division of the sigmoid arterial branches. The specimen is extracted through a Pfannenstiel incision. The anastomosis is performed transanally with a circular stapler according to the Knight-Griffen technique.
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
4046 views
181 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.
Transanal circumferential mucosectomy for symptomatic benign rectal stenosis
Background: Transanal laparoscopy has been described for more than 30 years. In the presence of benign lesions, it gathers increasing interest, especially if such lesions are located in the low rectum or close to the anal margin.
Video: This video demonstrates the case of a 38-year-old man presented with a circumferential rectal stenosis due to a rectal ulcer. The patient underwent a transanal mucosectomy using laparoscopy, after a sequence of unsuccessful endoscopic dilatations. Preoperative work-up showed a circumferential benign stenosis, 2.5cm away from the anal margin. The procedure was entirely performed with a new reusable transanal platform made up by the DAPRI-Port and DAPRI curved instruments (Karl Storz Endoskope, Tuttlingen, Germany). Once the 360-degree mucosectomy had been completed, the mucosal layer was repaired using separate absorbable sutures.
Results: The operative length was 163 minutes, and peroperative bleeding was unsignificant. The patient was discharged on postoperative day 2. The pathological report confirmed the benign nature of the lesion.
Conclusions: Although transanal laparoscopy has been documented for years, it gathers increasing interest and should be considered as the technique of choice for the treatment of benign rectal lesions, which can be difficult to treat using other methods.
G Dapri, N Bachir, L Antolino, K Grozdev, D Guta, K Jottard, GB Cadière
Surgical intervention
4 years ago
1078 views
13 likes
0 comments
08:37
Transanal circumferential mucosectomy for symptomatic benign rectal stenosis
Background: Transanal laparoscopy has been described for more than 30 years. In the presence of benign lesions, it gathers increasing interest, especially if such lesions are located in the low rectum or close to the anal margin.
Video: This video demonstrates the case of a 38-year-old man presented with a circumferential rectal stenosis due to a rectal ulcer. The patient underwent a transanal mucosectomy using laparoscopy, after a sequence of unsuccessful endoscopic dilatations. Preoperative work-up showed a circumferential benign stenosis, 2.5cm away from the anal margin. The procedure was entirely performed with a new reusable transanal platform made up by the DAPRI-Port and DAPRI curved instruments (Karl Storz Endoskope, Tuttlingen, Germany). Once the 360-degree mucosectomy had been completed, the mucosal layer was repaired using separate absorbable sutures.
Results: The operative length was 163 minutes, and peroperative bleeding was unsignificant. The patient was discharged on postoperative day 2. The pathological report confirmed the benign nature of the lesion.
Conclusions: Although transanal laparoscopy has been documented for years, it gathers increasing interest and should be considered as the technique of choice for the treatment of benign rectal lesions, which can be difficult to treat using other methods.
Endoscopy-assisted laparoscopic intragastric resection of early gastric cancer
In the minimally invasive approach to a gastric pathology, the association of laparoscopy with endoscopy (also called hybrid or collaborative surgery) emerges as an advanced therapeutic option for the surgical treatment of both benign and malignant intragastric lesions in selected patients.
We present the case of an elderly patient aged 86 with a serious medical history. She is endoscopically diagnosed with a gastric lesion located in the incisura angularis with a biopsy of high-grade dysplasia/carcinoma “in situ”.
Given the patient's age and her medical history, the multidisciplinary committee decided to perform a minimally invasive surgery. Submucosal dissection of the lesion using a hybrid approach (intragastric endoscopy/laparoscopy) was proposed.
The pathological area was marked and stained by endoscopy, followed by intragastric submucosal dissection with laparoscopic instruments assisted by means of endoscopy.
The surgery went smoothly and the patient could be discharged 48 hours after surgery.
Final pathological findings reported a well-differentiated tubular adenocarcinoma infiltrating the lamina propria and surgical resection margins free of tumor infiltration (pT1a Nx Mx (TNM 8th Ed. 2017)).
JD Sánchez López, L García-Sancho Téllez, E Ferrero Celemín, C Rodríguez Haro, S Núñez O'Sullivan, M García Virosta, R Honrubia López, AL Picardo Nieto
Surgical intervention
4 months ago
1203 views
4 likes
0 comments
12:38
Endoscopy-assisted laparoscopic intragastric resection of early gastric cancer
In the minimally invasive approach to a gastric pathology, the association of laparoscopy with endoscopy (also called hybrid or collaborative surgery) emerges as an advanced therapeutic option for the surgical treatment of both benign and malignant intragastric lesions in selected patients.
We present the case of an elderly patient aged 86 with a serious medical history. She is endoscopically diagnosed with a gastric lesion located in the incisura angularis with a biopsy of high-grade dysplasia/carcinoma “in situ”.
Given the patient's age and her medical history, the multidisciplinary committee decided to perform a minimally invasive surgery. Submucosal dissection of the lesion using a hybrid approach (intragastric endoscopy/laparoscopy) was proposed.
The pathological area was marked and stained by endoscopy, followed by intragastric submucosal dissection with laparoscopic instruments assisted by means of endoscopy.
The surgery went smoothly and the patient could be discharged 48 hours after surgery.
Final pathological findings reported a well-differentiated tubular adenocarcinoma infiltrating the lamina propria and surgical resection margins free of tumor infiltration (pT1a Nx Mx (TNM 8th Ed. 2017)).