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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
1182 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)).
Transverse colectomy with total mesocolic excision for cancer - Safe Transverse
In this key lecture, Dr. Armando Melani explains how transverse colectomy with total mesocolic excision for cancer is a doable and safe surgery, in his opinion and according to his experience.
Dr. Melani outlines the recommendations for a safe transverse colectomy and teaches us how to avoid lesions in the superior mesenteric vessels, shows laparoscopic mobilization for resection of the transverse colon due to cancer, and demonstrates an excellent vascular approach.
Finally, Dr. Melani provides the rationale of the extension of the LND for right colon cancer and gives a didactic demonstration in this video.
In conclusion, transverse colectomy with total mesocolic excision for cancer is relatively difficult. The reasons for this are the anatomical variations of middle colic vessels, transverse mesocolon attachments with the pancreatic head, and venous communications. In this authoritative lecture, Dr. Melani demonstrates the laparoscopic approach and provides all recommendations to achieve a successful surgery.
A Melani
Lecture
6 months ago
888 views
1 like
0 comments
09:46
Transverse colectomy with total mesocolic excision for cancer - Safe Transverse
In this key lecture, Dr. Armando Melani explains how transverse colectomy with total mesocolic excision for cancer is a doable and safe surgery, in his opinion and according to his experience.
Dr. Melani outlines the recommendations for a safe transverse colectomy and teaches us how to avoid lesions in the superior mesenteric vessels, shows laparoscopic mobilization for resection of the transverse colon due to cancer, and demonstrates an excellent vascular approach.
Finally, Dr. Melani provides the rationale of the extension of the LND for right colon cancer and gives a didactic demonstration in this video.
In conclusion, transverse colectomy with total mesocolic excision for cancer is relatively difficult. The reasons for this are the anatomical variations of middle colic vessels, transverse mesocolon attachments with the pancreatic head, and venous communications. In this authoritative lecture, Dr. Melani demonstrates the laparoscopic approach and provides all recommendations to achieve a successful surgery.
A standardized approach for complete mesocolic excision (CME) for right colon cancer
In this key lecture, Dr. Antonello Forgione presents a clear and precise description of the most important anatomical points as well as the surgical technique for complete mesocolic excision (CME) during a right laparoscopic colectomy, in cases of cancer.
As described in the video, four ports are used, all located on the left flank. A caudocranial dissection of the mesocolon is performed along the superior mesenteric vein to the inferior margin of the pancreas, exposing, ligating and dividing the ileocolic, right and middle colic vessels in their origins. The gastrocolic trunk is completely dissected and the upper right colic vein is cut and divided. The transverse colon and the terminal ileum are divided, the colon is mobilized, and the ileo-transverse intracorporeal stapled anastomosis is fashioned.
Laparoscopic CME is feasible and very useful. However, it is necessary to have an extensive knowledge of the vascular anatomy of the right colon, as well as an experience in advanced laparoscopic techniques to obtain the expected outcomes.
Finally, Dr. Forgione provides recommendations to perform the surgery in obese patients.
A Forgione
Lecture
6 months ago
715 views
5 likes
0 comments
14:20
A standardized approach for complete mesocolic excision (CME) for right colon cancer
In this key lecture, Dr. Antonello Forgione presents a clear and precise description of the most important anatomical points as well as the surgical technique for complete mesocolic excision (CME) during a right laparoscopic colectomy, in cases of cancer.
As described in the video, four ports are used, all located on the left flank. A caudocranial dissection of the mesocolon is performed along the superior mesenteric vein to the inferior margin of the pancreas, exposing, ligating and dividing the ileocolic, right and middle colic vessels in their origins. The gastrocolic trunk is completely dissected and the upper right colic vein is cut and divided. The transverse colon and the terminal ileum are divided, the colon is mobilized, and the ileo-transverse intracorporeal stapled anastomosis is fashioned.
Laparoscopic CME is feasible and very useful. However, it is necessary to have an extensive knowledge of the vascular anatomy of the right colon, as well as an experience in advanced laparoscopic techniques to obtain the expected outcomes.
Finally, Dr. Forgione provides recommendations to perform the surgery in obese patients.
Laparoscopic complete mesocolic excision (CME) for right colon cancer
The aim of the video is to describe the anatomical landmarks and the surgical technique for complete mesocolic excision during a laparoscopic right colectomy for cancer.
Preoperative high-resolution CT-scan and 3D printed models of the patient’s vascular anatomy is obtained to study the peculiar vessels distribution. Four ports are used, all located in the left flank as described in the video. Dissection between the visceral fascia which covers the posterior layer of the mesocolon and the parietal fascia covering the retroperitoneum (Toldt’s fascia) is carried out by means of monopolar electrocautery and combined advanced bipolar and ultrasonic dissection device. Caudocranial dissection of the mesocolon along the route of the superior mesenteric vein is performed, up to the inferior margin of the pancreas, exposing, ligating and dividing the ileocolic, the right and middle colic vessels at their origins. The gastrocolic trunk is fully dissected and the superior right colic vein clipped and divided. The transverse colon and terminal ileum are divided, the colon is mobilized and ileo-transverse intracorporeal stapled anastomosis is fashioned.
Between April 2017 and December 2018, 46 laparoscopic right hemicolectomies with CME were performed. There were no major vascular lesions. All intraoperative bleedings in the peripancreatic area were controlled with bipolar instruments and hemostatic devices, and there was no need for intraoperative blood cell transfusions.
Laparoscopic CME is feasible, but extensive knowledge of the vascular anatomy of the right colon as well as experience in advanced laparoscopic technique is required.
S Macina, L Baldari, E Cassinotti, M Ballabio, A Spota, M de Francesco, L Boni
Surgical intervention
1 year ago
5594 views
28 likes
1 comment
07:10
Laparoscopic complete mesocolic excision (CME) for right colon cancer
The aim of the video is to describe the anatomical landmarks and the surgical technique for complete mesocolic excision during a laparoscopic right colectomy for cancer.
Preoperative high-resolution CT-scan and 3D printed models of the patient’s vascular anatomy is obtained to study the peculiar vessels distribution. Four ports are used, all located in the left flank as described in the video. Dissection between the visceral fascia which covers the posterior layer of the mesocolon and the parietal fascia covering the retroperitoneum (Toldt’s fascia) is carried out by means of monopolar electrocautery and combined advanced bipolar and ultrasonic dissection device. Caudocranial dissection of the mesocolon along the route of the superior mesenteric vein is performed, up to the inferior margin of the pancreas, exposing, ligating and dividing the ileocolic, the right and middle colic vessels at their origins. The gastrocolic trunk is fully dissected and the superior right colic vein clipped and divided. The transverse colon and terminal ileum are divided, the colon is mobilized and ileo-transverse intracorporeal stapled anastomosis is fashioned.
Between April 2017 and December 2018, 46 laparoscopic right hemicolectomies with CME were performed. There were no major vascular lesions. All intraoperative bleedings in the peripancreatic area were controlled with bipolar instruments and hemostatic devices, and there was no need for intraoperative blood cell transfusions.
Laparoscopic CME is feasible, but extensive knowledge of the vascular anatomy of the right colon as well as experience in advanced laparoscopic technique is required.
Laparoscopic right colectomy for caecal cancer with prophylactic lighted ureteral stenting (LUS)
Identifying the ureter during colorectal surgery (CRS) is one of the most critical steps of the operation. Iatrogenic ureteral injury occurs very rarely, with an incidence ranging from 0.28 to 7.6%. However, this complication has the potential to be devastating and its prevention is a priority. Laparoscopic approach in CRS reduces the tactile feedback of the surgeon who has to rely only on visual identification to prevent iatrogenic injury. As a result, lighted ureteral stents (LUS) were devised to improve visual identification of ureters throughout the dissection.
This video presents the case of a 70-year-old woman presenting with a caecal adenocarcinoma. She underwent a laparoscopic right colectomy with intracorporeal anastomosis. A LUS (IRIS U-kit®, Stryker) was placed under general anesthesia, just before the beginning of the surgical procedure, requiring about 15 minutes to be accomplished. The stent was removed after the operation, before the end of anesthesia, with no postoperative sequelas.
In order to prevent any potential iatrogenic injury, the selective or routine use of LUS during laparoscopic CRS could well improve the identification of the ureter, with a negligible increase in the operative time.
E Soricelli, E Facchiano, L Leuratti, G Quartararo, N Console, P Tonelli, M Lucchese
Surgical intervention
1 year ago
4430 views
15 likes
0 comments
09:10
Laparoscopic right colectomy for caecal cancer with prophylactic lighted ureteral stenting (LUS)
Identifying the ureter during colorectal surgery (CRS) is one of the most critical steps of the operation. Iatrogenic ureteral injury occurs very rarely, with an incidence ranging from 0.28 to 7.6%. However, this complication has the potential to be devastating and its prevention is a priority. Laparoscopic approach in CRS reduces the tactile feedback of the surgeon who has to rely only on visual identification to prevent iatrogenic injury. As a result, lighted ureteral stents (LUS) were devised to improve visual identification of ureters throughout the dissection.
This video presents the case of a 70-year-old woman presenting with a caecal adenocarcinoma. She underwent a laparoscopic right colectomy with intracorporeal anastomosis. A LUS (IRIS U-kit®, Stryker) was placed under general anesthesia, just before the beginning of the surgical procedure, requiring about 15 minutes to be accomplished. The stent was removed after the operation, before the end of anesthesia, with no postoperative sequelas.
In order to prevent any potential iatrogenic injury, the selective or routine use of LUS during laparoscopic CRS could well improve the identification of the ureter, with a negligible increase in the operative time.
Laparoscopic gastrectomy for gastric cancer after liver transplantation
It has already been demonstrated that laparoscopic gastrectomy is a safe approach for early gastric cancer. It can provide the same oncological outcomes as open gastrectomy with the benefit of fewer complications and early recovery.
Liver transplantation has a high incidence rate in the Korean population, just like gastric cancer. Additionally, South Korea has the highest incidence of this type of cancer worldwide. Patients who had received a liver transplant might benefit from a better recovery thanks to laparoscopic gastrectomy, and this approach can be performed by experienced surgeons.
Please add in the text narrative how you performed the anastomosis.
F Signorini, DJ Park, HK Yang
Surgical intervention
6 months ago
1597 views
9 likes
0 comments
09:23
Laparoscopic gastrectomy for gastric cancer after liver transplantation
It has already been demonstrated that laparoscopic gastrectomy is a safe approach for early gastric cancer. It can provide the same oncological outcomes as open gastrectomy with the benefit of fewer complications and early recovery.
Liver transplantation has a high incidence rate in the Korean population, just like gastric cancer. Additionally, South Korea has the highest incidence of this type of cancer worldwide. Patients who had received a liver transplant might benefit from a better recovery thanks to laparoscopic gastrectomy, and this approach can be performed by experienced surgeons.
Please add in the text narrative how you performed the anastomosis.
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
1 year ago
2183 views
7 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.
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
1 year ago
4418 views
18 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.
ERCP in a patient with previous subtotal gastrectomy for cancer: hybrid approach with transjejunal access
Endoscopic retrograde cholangiopancreatography (ERCP) in patients with prior gastric surgery (Roux-en-Y gastric bypass, partial or subtotal gastrectomy) is a challenging procedure. Despite technological advances in endoscopy, reaching the duodenum and entering the bile duct remains difficult. Laparoscopic assisted ERCP (LAERCP) allows the duodenum to be accessed through the excluded stomach in case of previous RYGB or through the proximal jejunum in case of gastric resection. The objective of this video is to demonstrate the hybrid approach in a patient with a previous subtotal gastrectomy for gastric cancer.
A D'Urso, Gf Donatelli, B Dallemagne, D Mutter, J Marescaux
Surgical intervention
1 year ago
222 views
4 likes
0 comments
12:02
ERCP in a patient with previous subtotal gastrectomy for cancer: hybrid approach with transjejunal access
Endoscopic retrograde cholangiopancreatography (ERCP) in patients with prior gastric surgery (Roux-en-Y gastric bypass, partial or subtotal gastrectomy) is a challenging procedure. Despite technological advances in endoscopy, reaching the duodenum and entering the bile duct remains difficult. Laparoscopic assisted ERCP (LAERCP) allows the duodenum to be accessed through the excluded stomach in case of previous RYGB or through the proximal jejunum in case of gastric resection. The objective of this video is to demonstrate the hybrid approach in a patient with a previous subtotal gastrectomy for gastric cancer.
Totally laparoscopic splenic flexure resection for cancer
The objective of this video is to demonstrate a laparoscopic segmental oncological splenic flexure colonic resection for cancer. Splenic flexure carcinoma is a rare condition, as it represents 3 to 8% of all colon cancers. It is associated with a high risk of obstruction and a poor prognosis. The surgical approach is challenging and not fully standardized. The resected area must include the mesocolon with major vessels ligation at their origin, in order to reduce local recurrence via the complete removal of potentially involved lymph node stations.
The oncological effectiveness of a segmental resection could be determined by the peculiar lymphatic spread of splenic flexure cancers. Different studies showed that the majority of positive lymph nodes among patients with splenic flexure carcinoma are distributed along the paracolic arcade and the left colic artery. As a result, a segmental resection associated with a medial-to-lateral approach could be safe and effective. The experience with a totally laparoscopic approach with intracorporeal anastomosis is well described in the current literature. Additionally, an intracorporeal anastomosis minimizes the risk of bowel twisting, preventing the exteriorization of the stumps, and reducing bowel traction, which can affect anastomotic irrigation, especially in obese patients. In a setting of surgeons experienced with laparoscopic colorectal surgery, the outcomes of laparoscopic segmental resection of splenic flexure are similar to those of laparoscopic resections for cancer in other locations.
G Basili, D Pietrasanta, N Romano, AF Costa
Surgical intervention
1 year ago
3148 views
10 likes
0 comments
10:12
Totally laparoscopic splenic flexure resection for cancer
The objective of this video is to demonstrate a laparoscopic segmental oncological splenic flexure colonic resection for cancer. Splenic flexure carcinoma is a rare condition, as it represents 3 to 8% of all colon cancers. It is associated with a high risk of obstruction and a poor prognosis. The surgical approach is challenging and not fully standardized. The resected area must include the mesocolon with major vessels ligation at their origin, in order to reduce local recurrence via the complete removal of potentially involved lymph node stations.
The oncological effectiveness of a segmental resection could be determined by the peculiar lymphatic spread of splenic flexure cancers. Different studies showed that the majority of positive lymph nodes among patients with splenic flexure carcinoma are distributed along the paracolic arcade and the left colic artery. As a result, a segmental resection associated with a medial-to-lateral approach could be safe and effective. The experience with a totally laparoscopic approach with intracorporeal anastomosis is well described in the current literature. Additionally, an intracorporeal anastomosis minimizes the risk of bowel twisting, preventing the exteriorization of the stumps, and reducing bowel traction, which can affect anastomotic irrigation, especially in obese patients. In a setting of surgeons experienced with laparoscopic colorectal surgery, the outcomes of laparoscopic segmental resection of splenic flexure are similar to those of laparoscopic resections for cancer in other locations.
Laparoscopic TME - The 6-step procedure
In this key lecture, Dr. Rullier describes a clear 6-step approach to perform a laparoscopic total mesorectal excision (TME).
The first step is posterior dissection of the TME plane in the presacral space. Hereafter, a right lateral dissection is performed with sparing of the hypogastric nerves followed by anterior dissection and identification of the seminal vesicles and pelvic plexus. A left lateral dissection is then performed whereafter the planes are connected.
In this procedure, the 6 essential landmarks are the following: ''the presacral space, hypogastric nerves, seminal vesicles, pelvic plexus, levator ani muscles, and Denonvilliers' fascia and the prostate.’
E Rullier
Lecture
6 months ago
1800 views
28 likes
0 comments
09:16
Laparoscopic TME - The 6-step procedure
In this key lecture, Dr. Rullier describes a clear 6-step approach to perform a laparoscopic total mesorectal excision (TME).
The first step is posterior dissection of the TME plane in the presacral space. Hereafter, a right lateral dissection is performed with sparing of the hypogastric nerves followed by anterior dissection and identification of the seminal vesicles and pelvic plexus. A left lateral dissection is then performed whereafter the planes are connected.
In this procedure, the 6 essential landmarks are the following: ''the presacral space, hypogastric nerves, seminal vesicles, pelvic plexus, levator ani muscles, and Denonvilliers' fascia and the prostate.’
Robotically assisted right colectomy with fluorescence-guided complete mesocolon excision
In robotic right hemicolectomy for cancer, appropriate lymphadenectomy and anastomotic leak prevention are critical. Visualization of draining lymph nodes, of primary tumor site and blood flow using the near-infrared (NIR) fluorescence da Vinci® imaging system is a recent development.
We present the technique of robotic right colectomy with complete mesocolic excision (CME) and D3 lymphadenectomy using Indocyanine Green (ICG) fluorescence.
The day before surgery, a colonoscopy was performed and ICG was injected around the tumor in the submucosa.
Robotic right hemicolectomy was performed with suprapubic trocars layout and bottom to up dissection, with CME, central vessel ligation, and D3 lymphadenectomy.
ICG was intraoperatively administered intravenously to assess bowel perfusion before anastomosis. The identification of the primary tumor site and of bowel stumps perfusion were possible and the accuracy in identifying the D3 lymphatic basin was high, allowing for an image-guided radical lymphadenectomy. Fluorescent technology represents a valuable innovation to improve colon cancer surgery.
W Petz, E Bertani, D Ribero, D Lo Conte, A Mellano, A Piccioli, S Borin, G Spinoglio
Surgical intervention
6 months ago
848 views
3 likes
0 comments
08:43
Robotically assisted right colectomy with fluorescence-guided complete mesocolon excision
In robotic right hemicolectomy for cancer, appropriate lymphadenectomy and anastomotic leak prevention are critical. Visualization of draining lymph nodes, of primary tumor site and blood flow using the near-infrared (NIR) fluorescence da Vinci® imaging system is a recent development.
We present the technique of robotic right colectomy with complete mesocolic excision (CME) and D3 lymphadenectomy using Indocyanine Green (ICG) fluorescence.
The day before surgery, a colonoscopy was performed and ICG was injected around the tumor in the submucosa.
Robotic right hemicolectomy was performed with suprapubic trocars layout and bottom to up dissection, with CME, central vessel ligation, and D3 lymphadenectomy.
ICG was intraoperatively administered intravenously to assess bowel perfusion before anastomosis. The identification of the primary tumor site and of bowel stumps perfusion were possible and the accuracy in identifying the D3 lymphatic basin was high, allowing for an image-guided radical lymphadenectomy. Fluorescent technology represents a valuable innovation to improve colon cancer surgery.
LIVE INTERACTIVE SURGERY: robotic low anterior resection for a local recurrence of rectal cancer
In this live interactive surgery, Dr. Parra-Davila demonstrates a robotic low anterior resection for a local recurrence of transanally excised rectal cancer. The operative technique shown includes a robotic oncological ‘en bloc’ resection and intracorporeal anastomosis. In the patient’s history, an ulcerated villous polyp too large for endoscopic removal was addressed to surgery. Preoperative biopsies had failed to detect malignancy. The surgical procedure consisted in a transanal full-thickness resection including partial TME for lymph node sampling. Since the operative specimen revealed a pT2N1a (1/8) rectal adenocarcinoma, the patient underwent adjuvant radiochemotherapy. The following year, a single hepatic metastasis was resected, complemented by postoperative chemotherapy. After 7 years of uneventful follow-up, an anastomotic recurrence was diagnosed. Following oncologic committee discussion, the patient was advised to undergo surgery.
E Parra-Davila, M Ignat, L Soler, B Seeliger, D Mutter, J Marescaux
Surgical intervention
1 year ago
2115 views
3 likes
0 comments
32:48
LIVE INTERACTIVE SURGERY: robotic low anterior resection for a local recurrence of rectal cancer
In this live interactive surgery, Dr. Parra-Davila demonstrates a robotic low anterior resection for a local recurrence of transanally excised rectal cancer. The operative technique shown includes a robotic oncological ‘en bloc’ resection and intracorporeal anastomosis. In the patient’s history, an ulcerated villous polyp too large for endoscopic removal was addressed to surgery. Preoperative biopsies had failed to detect malignancy. The surgical procedure consisted in a transanal full-thickness resection including partial TME for lymph node sampling. Since the operative specimen revealed a pT2N1a (1/8) rectal adenocarcinoma, the patient underwent adjuvant radiochemotherapy. The following year, a single hepatic metastasis was resected, complemented by postoperative chemotherapy. After 7 years of uneventful follow-up, an anastomotic recurrence was diagnosed. Following oncologic committee discussion, the patient was advised to undergo surgery.
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
2 years ago
14763 views
448 likes
2 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.