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Laparoscopic treatment of a hydatid cyst of the liver in children
Introduction:
Hydatid cyst is a parasitic disease caused by the Echinococcus granulosus tapeworm. Laparoscopic treatment of a hydatid cyst of the liver remains controversial and few series have been published. The aim of this work is to present a case of liver hydatid cyst in an 8-year-old girl treated laparoscopically.
Case presentation:
An 8-year-old child was admitted to our department for the management of a voluminous liver hydatid cyst. The patient underwent a thoraco-abdominal CT-scan, which concluded to a left lobe liver hydatid cyst. The laparoscopic open access is achieved at the umbilicus using a 10mm port. Carbon dioxide pneumoperitoneum pressure is maintained at 10mmHg. Two other 5mm ports are introduced in the right and left hypochondrium. A 0-degree laparoscope is then used. The cyst is protected by means of pads filled with a 10% hypertonic saline solution. After we proceed to a puncture aspiration of the cyst, sterilization is achieved via injection of a hypertonic saline solution during 15 minutes, then reaspiration is performed with a Veress needle. The cyst is opened with a coagulating hook and the proligerous membrane is removed and put in a bag. The last step is the resection of the dome and the search for biliary fistula. We drained the residual cavity. The pads are removed. The Redon drain was removed on day 2 and the patient was discharged from hospital on postoperative day 3. Postoperatively, the patient was put on albendazole (10mg/kg) for one month.
Conclusion:
Laparoscopy stands for an excellent approach to the treatment of a hydatid cyst of the liver in children by respecting appropriate indications.
R Adjerid, F Sebaa, N Otsmane, A Khelifaoui
Surgical intervention
9 months ago
1714 views
9 likes
1 comment
05:13
Laparoscopic treatment of a hydatid cyst of the liver in children
Introduction:
Hydatid cyst is a parasitic disease caused by the Echinococcus granulosus tapeworm. Laparoscopic treatment of a hydatid cyst of the liver remains controversial and few series have been published. The aim of this work is to present a case of liver hydatid cyst in an 8-year-old girl treated laparoscopically.
Case presentation:
An 8-year-old child was admitted to our department for the management of a voluminous liver hydatid cyst. The patient underwent a thoraco-abdominal CT-scan, which concluded to a left lobe liver hydatid cyst. The laparoscopic open access is achieved at the umbilicus using a 10mm port. Carbon dioxide pneumoperitoneum pressure is maintained at 10mmHg. Two other 5mm ports are introduced in the right and left hypochondrium. A 0-degree laparoscope is then used. The cyst is protected by means of pads filled with a 10% hypertonic saline solution. After we proceed to a puncture aspiration of the cyst, sterilization is achieved via injection of a hypertonic saline solution during 15 minutes, then reaspiration is performed with a Veress needle. The cyst is opened with a coagulating hook and the proligerous membrane is removed and put in a bag. The last step is the resection of the dome and the search for biliary fistula. We drained the residual cavity. The pads are removed. The Redon drain was removed on day 2 and the patient was discharged from hospital on postoperative day 3. Postoperatively, the patient was put on albendazole (10mg/kg) for one month.
Conclusion:
Laparoscopy stands for an excellent approach to the treatment of a hydatid cyst of the liver in children by respecting appropriate indications.
Laparoscopic excision of urachal cyst - a minimally invasive approach of a rare cause of abdominal pain in adults
Congenital abnormalities of the urachus are rare, with an incidence of 2:300000 children and 1:5000 adults. The urachus is a fibrous remnant of the allantois, usually occluded in the 4-5th gestational months, with the descent of the bladder towards the pelvis. It lies in the space of Retzius, between the transverse fascia anteriorly and the peritoneum posteriorly. The absence of its obliteration can result in an urachal cyst in 36% of cases. The main complication of the cyst is focal infection with associated risks of rupture and intestinal involvement. Diagnosis relies on clinical history, abdominopelvic ultrasonography and CT-scan. The treatment consists in complete excision of abnormal tissue and a small portion of adjacent bladder wall, therefore reducing the risk of malignant degeneration of the entire remnant.
A twenty-year-old healthy woman was referred to the emergency department with localized discomfort and a foul smelling purulent discharge from the umbilicus with three days of evolution. The patient was afebrile with periumbilical inflammatory signs, without signs of peritoneal irritation on physical exam. Blood tests were all normal, apart from a raised C-reactive protein (2.52mg/dL). Abdominal ultrasound was suggestive of an infected urachal cyst with umbilical fistulization. Empirical treatment with antibiotics was started and an abdominopelvic CT-scan, made as outpatient surgery, showed a probable 26mm urachal cyst, posterior and adjacent to the umbilicus, without bladder attachment.
The patient was treated surgically with a laparoscopic excision of the remainder of the urachus, without intraoperative complications. A good clinical evolution was observed during the hospital stay, and the patient was discharged on the fourth postoperative day. On follow-up, the patient did not complain of anything.
This clinical case emphasizes the importance of the high index of diagnostic suspicion in the management and treatment of the rare causes of abdominal pain, often with the possibility of a minimally invasive approach.
A Tojal, AR Loureiro, B Prata, R Patrão, N Carrilho, C Casimiro
Surgical intervention
8 months ago
1050 views
3 likes
0 comments
10:34
Laparoscopic excision of urachal cyst - a minimally invasive approach of a rare cause of abdominal pain in adults
Congenital abnormalities of the urachus are rare, with an incidence of 2:300000 children and 1:5000 adults. The urachus is a fibrous remnant of the allantois, usually occluded in the 4-5th gestational months, with the descent of the bladder towards the pelvis. It lies in the space of Retzius, between the transverse fascia anteriorly and the peritoneum posteriorly. The absence of its obliteration can result in an urachal cyst in 36% of cases. The main complication of the cyst is focal infection with associated risks of rupture and intestinal involvement. Diagnosis relies on clinical history, abdominopelvic ultrasonography and CT-scan. The treatment consists in complete excision of abnormal tissue and a small portion of adjacent bladder wall, therefore reducing the risk of malignant degeneration of the entire remnant.
A twenty-year-old healthy woman was referred to the emergency department with localized discomfort and a foul smelling purulent discharge from the umbilicus with three days of evolution. The patient was afebrile with periumbilical inflammatory signs, without signs of peritoneal irritation on physical exam. Blood tests were all normal, apart from a raised C-reactive protein (2.52mg/dL). Abdominal ultrasound was suggestive of an infected urachal cyst with umbilical fistulization. Empirical treatment with antibiotics was started and an abdominopelvic CT-scan, made as outpatient surgery, showed a probable 26mm urachal cyst, posterior and adjacent to the umbilicus, without bladder attachment.
The patient was treated surgically with a laparoscopic excision of the remainder of the urachus, without intraoperative complications. A good clinical evolution was observed during the hospital stay, and the patient was discharged on the fourth postoperative day. On follow-up, the patient did not complain of anything.
This clinical case emphasizes the importance of the high index of diagnostic suspicion in the management and treatment of the rare causes of abdominal pain, often with the possibility of a minimally invasive approach.
Pancreatic duplication associated with a gastric duplication cyst: laparoscopic approach
This video shows the case of a 48-year-old male patient with a history of epigastric pain for 20 days, with the presence of nausea and vomiting but no self-reported fever. The patient was presented at the ER for examination. Computerized tomography (CT) scanning revealed a very rare case of pancreatic duplication associated with a gastric duplication cyst. He was referred to our service and then treated by laparoscopic route with partial gastrectomy and pancreatic resection (pancreas horn). On the 2nd postoperative day, the patient was discharged and allowed for free oral feeding. This is the second study in the literature reporting a case of laparoscopic resection of a gastric duplication cyst together with pancreatic resection. Of note, this is the first study in which the accessory pancreas communicates with the pancreatic head.
F Freire Lisboa Junior, R de Lima França, A de Araujo Lima Liguori, AC de Medeiros Junior, M HSMP Tavares, F Medeiros de Azevedo, D Myller Barros Lima
Surgical intervention
8 months ago
1153 views
5 likes
0 comments
14:36
Pancreatic duplication associated with a gastric duplication cyst: laparoscopic approach
This video shows the case of a 48-year-old male patient with a history of epigastric pain for 20 days, with the presence of nausea and vomiting but no self-reported fever. The patient was presented at the ER for examination. Computerized tomography (CT) scanning revealed a very rare case of pancreatic duplication associated with a gastric duplication cyst. He was referred to our service and then treated by laparoscopic route with partial gastrectomy and pancreatic resection (pancreas horn). On the 2nd postoperative day, the patient was discharged and allowed for free oral feeding. This is the second study in the literature reporting a case of laparoscopic resection of a gastric duplication cyst together with pancreatic resection. Of note, this is the first study in which the accessory pancreas communicates with the pancreatic head.
Incidental finding of a voluminous bronchogenic cyst in a 13-year-old child
This rare case of a giant bronchogenic cyst in the lower right hemithorax allows to provide the following tips: patient positioning and port placement should allow for a 180-degree reversal of the screen and free movement of the surgical team; use of a LigaSure™ vessel-sealing device used as a dissection instrument in lung surgery is helpful but does not guarantee perfect aerostasis, which should be controlled by taking enough time at the end of the procedure when reventilating an excluded lobe intraoperatively; along with low intrathoracic carbon dioxide insufflation, the use of a blocker in pediatric thoracoscopic surgery is an unconditional factor, which contributes to a satisfactory operating field.
F Becmeur, L Donato
Surgical intervention
1 year ago
877 views
0 likes
0 comments
05:31
Incidental finding of a voluminous bronchogenic cyst in a 13-year-old child
This rare case of a giant bronchogenic cyst in the lower right hemithorax allows to provide the following tips: patient positioning and port placement should allow for a 180-degree reversal of the screen and free movement of the surgical team; use of a LigaSure™ vessel-sealing device used as a dissection instrument in lung surgery is helpful but does not guarantee perfect aerostasis, which should be controlled by taking enough time at the end of the procedure when reventilating an excluded lobe intraoperatively; along with low intrathoracic carbon dioxide insufflation, the use of a blocker in pediatric thoracoscopic surgery is an unconditional factor, which contributes to a satisfactory operating field.
Thoracoscopic treatment of pulmonary hydatid cyst in children
Introduction: The hydatid cyst is an anthropozoonosis caused by the development of the Echinococcus granulosus tapeworm larva in humans. It is endemic in the Mediterranean, South America, Middle East, Australia, New Zealand, and India. Lung localization is ranked second in order of frequency for all age groups after liver localization.
Treatment is mainly surgical and consists in the resection of the protruding dome after cyst puncture, suction, and sterilization using a Scolicide solution followed by proligerous membrane extraction and bronchial fistulas obstruction. This surgery can be performed through a thoracotomy or a thoracoscopy.
We report the highlights of a thoracoscopic surgical management of a bilateral pulmonary hydatid cyst in a 6-year-old boy. The cyst was discovered following exploration for chest pain associated with a dry cough, as demonstrated by chest CT-scan findings and confirmed by serum chemistries positive for pulmonary hydatid cyst.
Materials and methods: The patient was first operated on for his two hydatid cysts of the right lung, followed by another left-side intervention a month later. Intubation was selective and was performed with a standard intubation cannula.
The patient was placed in a strict lateral decubitus position.
Four ports (10, 5, 5, and 5mm in size) were used for the right lung and three ports (10, 5, and 5mm) were used for the left lung, making sure to respect the rule of triangulation.
After partial filling of the pleural cavity with a 10% hypertonic saline solution, the surgical principles of the thoracoscopic treatment of pulmonary hydatid cysts are performed as follows: puncture of the cyst at its dome using a Veress needle, suction, and sterilization with a 10% hypertonic saline solution for 15 minutes; resection of the protruding dome; extraction of the proligerous membrane through an Endobag®; closure of bronchial fistulas by means of intracorporeal stitches; no padding necessary; double chest drainage (anterior and posterior).
Results: Immediate postoperative outcomes were uneventful. Paracetamol was sufficient to manage postoperative pain in the first 24 hours. Chest drains were removed on postoperative day 3, and the patient was discharged on postoperative day 4.
After 5 years, late postoperative outcomes were extremely favorable clinically, radiologically, and cosmetically speaking.
Conclusion: The thoracoscopic approach to the management of pulmonary hydatid cysts is feasible. It completely changed the postoperative evolution of thoracotomy, which causes pain and parietal sequelae in children.
AM Benaired
Surgical intervention
1 year ago
1196 views
142 likes
0 comments
04:03
Thoracoscopic treatment of pulmonary hydatid cyst in children
Introduction: The hydatid cyst is an anthropozoonosis caused by the development of the Echinococcus granulosus tapeworm larva in humans. It is endemic in the Mediterranean, South America, Middle East, Australia, New Zealand, and India. Lung localization is ranked second in order of frequency for all age groups after liver localization.
Treatment is mainly surgical and consists in the resection of the protruding dome after cyst puncture, suction, and sterilization using a Scolicide solution followed by proligerous membrane extraction and bronchial fistulas obstruction. This surgery can be performed through a thoracotomy or a thoracoscopy.
We report the highlights of a thoracoscopic surgical management of a bilateral pulmonary hydatid cyst in a 6-year-old boy. The cyst was discovered following exploration for chest pain associated with a dry cough, as demonstrated by chest CT-scan findings and confirmed by serum chemistries positive for pulmonary hydatid cyst.
Materials and methods: The patient was first operated on for his two hydatid cysts of the right lung, followed by another left-side intervention a month later. Intubation was selective and was performed with a standard intubation cannula.
The patient was placed in a strict lateral decubitus position.
Four ports (10, 5, 5, and 5mm in size) were used for the right lung and three ports (10, 5, and 5mm) were used for the left lung, making sure to respect the rule of triangulation.
After partial filling of the pleural cavity with a 10% hypertonic saline solution, the surgical principles of the thoracoscopic treatment of pulmonary hydatid cysts are performed as follows: puncture of the cyst at its dome using a Veress needle, suction, and sterilization with a 10% hypertonic saline solution for 15 minutes; resection of the protruding dome; extraction of the proligerous membrane through an Endobag®; closure of bronchial fistulas by means of intracorporeal stitches; no padding necessary; double chest drainage (anterior and posterior).
Results: Immediate postoperative outcomes were uneventful. Paracetamol was sufficient to manage postoperative pain in the first 24 hours. Chest drains were removed on postoperative day 3, and the patient was discharged on postoperative day 4.
After 5 years, late postoperative outcomes were extremely favorable clinically, radiologically, and cosmetically speaking.
Conclusion: The thoracoscopic approach to the management of pulmonary hydatid cysts is feasible. It completely changed the postoperative evolution of thoracotomy, which causes pain and parietal sequelae in children.
Laparoscopic appendectomy and fenestration of hemorrhagic ovarian cyst
This is the case of a 19-year-old female patient who was admitted to the emergency department for lower abdominal pain going on for 24 hours. No abdominal guarding was noted. Biological findings showed an inflammation with leukocytes at 16,000 and CRP levels at 112. CT-scan showed the presence of an enlarged appendix (9mm thick) along with a voluminous adnexal cyst, which may be suggestive of a tubo-ovarian abscess. Laparoscopic exploration is performed. Congestive appendicitis is confirmed, as well as the presence of a hemorrhagic right ovarian cyst. Laparoscopic appendectomy is performed and the hemorrhagic ovarian cyst is fenestrated.
M Ignat, D Mutter, J Marescaux
Surgical intervention
1 year ago
4106 views
411 likes
0 comments
04:57
Laparoscopic appendectomy and fenestration of hemorrhagic ovarian cyst
This is the case of a 19-year-old female patient who was admitted to the emergency department for lower abdominal pain going on for 24 hours. No abdominal guarding was noted. Biological findings showed an inflammation with leukocytes at 16,000 and CRP levels at 112. CT-scan showed the presence of an enlarged appendix (9mm thick) along with a voluminous adnexal cyst, which may be suggestive of a tubo-ovarian abscess. Laparoscopic exploration is performed. Congestive appendicitis is confirmed, as well as the presence of a hemorrhagic right ovarian cyst. Laparoscopic appendectomy is performed and the hemorrhagic ovarian cyst is fenestrated.
Laparoscopic treatment of a giant mesenteric cyst
Mesenteric cysts are very rare entities (annually worldwide estimated incidence of 1/140 000 inhabitants). They do not have pathognomonic features and require a differential diagnosis with lymphangiomas, sarcomas, adenocarcinomas, and intestinal duplications. They typically appear more in women (twice the incidence) and are mostly benign swellings (malignancy rate of about 3%). The gold standard treatment is laparoscopic surgical resection.
The case is that of a 49-year-old female patient referred for an abdominal swelling in the periumbilical region, which was uncomfortable for the patient, namely in the contraction of the abdominals. She did not describe any changes in intestinal transit, anorexia, asthenia or associated weight loss. The imaging study by computer tomography documented a "cystic lesion of 13cm in the root of the mesentery in contact with great vessels and duodenum". The patient was resected laparoscopically in March 2016, discharged on the second postoperative day, without intercurrences. The video of the mesenteric cyst excision surgery demonstrates some of the risks of the laparoscopic approach of the mesentery and underlines the possibility of dissection of these cysts even when they are giant cysts and in close relation with vital structures such as the vena cava and the iliac arteries.
P Leão, H Cristino, JP Pinto
Surgical intervention
2 years ago
1377 views
95 likes
0 comments
04:09
Laparoscopic treatment of a giant mesenteric cyst
Mesenteric cysts are very rare entities (annually worldwide estimated incidence of 1/140 000 inhabitants). They do not have pathognomonic features and require a differential diagnosis with lymphangiomas, sarcomas, adenocarcinomas, and intestinal duplications. They typically appear more in women (twice the incidence) and are mostly benign swellings (malignancy rate of about 3%). The gold standard treatment is laparoscopic surgical resection.
The case is that of a 49-year-old female patient referred for an abdominal swelling in the periumbilical region, which was uncomfortable for the patient, namely in the contraction of the abdominals. She did not describe any changes in intestinal transit, anorexia, asthenia or associated weight loss. The imaging study by computer tomography documented a "cystic lesion of 13cm in the root of the mesentery in contact with great vessels and duodenum". The patient was resected laparoscopically in March 2016, discharged on the second postoperative day, without intercurrences. The video of the mesenteric cyst excision surgery demonstrates some of the risks of the laparoscopic approach of the mesentery and underlines the possibility of dissection of these cysts even when they are giant cysts and in close relation with vital structures such as the vena cava and the iliac arteries.
Laparoscopic choledochal cyst excision with intraoperative cholangiogram, hepatic duct cholangioscopy, extracorporeal Roux-en-Y hepaticojejunostomy and closure of mesenteric defects
The laparoscopic treatment of a choledochal cyst begins with a careful preoperative understanding of the anatomy, including bile ducts, as well as the presence of any abnormal pancreatobiliary anatomy. If a hepaticojejunostomy using a Roux-en-Y anastomosis is performed, we prefer an extracorporeal, transumbilical anastomosis, with a retrocolic approach. A series of interrupted or continuous absorbable sutures can be used for the bilioenteric anastomosis. For the last part of the procedure, we emphasize the importance of closure of mesenteric defects with non-absorbable sutures, including both the retrocolic space and Petersen’s defect to prevent future internal herniations.
GA Villalona, D Ozgediz
Surgical intervention
3 years ago
1740 views
74 likes
0 comments
10:31
Laparoscopic choledochal cyst excision with intraoperative cholangiogram, hepatic duct cholangioscopy, extracorporeal Roux-en-Y hepaticojejunostomy and closure of mesenteric defects
The laparoscopic treatment of a choledochal cyst begins with a careful preoperative understanding of the anatomy, including bile ducts, as well as the presence of any abnormal pancreatobiliary anatomy. If a hepaticojejunostomy using a Roux-en-Y anastomosis is performed, we prefer an extracorporeal, transumbilical anastomosis, with a retrocolic approach. A series of interrupted or continuous absorbable sutures can be used for the bilioenteric anastomosis. For the last part of the procedure, we emphasize the importance of closure of mesenteric defects with non-absorbable sutures, including both the retrocolic space and Petersen’s defect to prevent future internal herniations.
Laparoscopic excision of a gastric duplication cyst
Duplication cysts are rare benign congenital anomalies, located predominantly at the proximal small intestine, emerging in the stomach in about 2 to 4% of all cases. Usually diagnosed in the pediatric age, they are commonly asymptomatic in adulthood and found incidentally on endoscopic or radiological exams. The therapeutic management of asymptomatic cysts is usually expectant. However, a surgical resection is recommended based on the potential risk of complications, such as malignant transformation.
Clinical case: This is the case of a 44-year-old woman, who had an incidental diagnosis of an intra-abdominal cyst on ultrasound examination. CT-scan and MRI revealed the presence of a 6x4cm cystic mass located between the posterior wall of the stomach and the anterior wall of the pancreas, assuming the differential diagnosis of enteric duplication cyst or pancreatic cystic lesion. A laparoscopic exploration is decided upon. She underwent a laparoscopic excision of cystic lesion of the gastric wall, without complications. The patient was discharged home on the third postoperative day. The pathological examination confirmed the diagnosis of enteric duplication cyst. Histology showed a cystic lesion composed of smooth muscle tissue and partially covered by gastric antral-type mucosa.
C Branco, C Viana, H Cristino, S Vilaça, J Falcão
Surgical intervention
3 years ago
866 views
32 likes
0 comments
06:07
Laparoscopic excision of a gastric duplication cyst
Duplication cysts are rare benign congenital anomalies, located predominantly at the proximal small intestine, emerging in the stomach in about 2 to 4% of all cases. Usually diagnosed in the pediatric age, they are commonly asymptomatic in adulthood and found incidentally on endoscopic or radiological exams. The therapeutic management of asymptomatic cysts is usually expectant. However, a surgical resection is recommended based on the potential risk of complications, such as malignant transformation.
Clinical case: This is the case of a 44-year-old woman, who had an incidental diagnosis of an intra-abdominal cyst on ultrasound examination. CT-scan and MRI revealed the presence of a 6x4cm cystic mass located between the posterior wall of the stomach and the anterior wall of the pancreas, assuming the differential diagnosis of enteric duplication cyst or pancreatic cystic lesion. A laparoscopic exploration is decided upon. She underwent a laparoscopic excision of cystic lesion of the gastric wall, without complications. The patient was discharged home on the third postoperative day. The pathological examination confirmed the diagnosis of enteric duplication cyst. Histology showed a cystic lesion composed of smooth muscle tissue and partially covered by gastric antral-type mucosa.
Laparoscopic management of a pediatric bronchogenic cyst in a 6-year-old boy
We report the case of a 6-year-old boy who presented with an infectious bronchopulmonary episode during which a plain anterior chest X-ray was performed. The X-ray showed an opacity at the right apex. A thoracic CT-scan allowed to demonstrate the presence of a right superior and posterior mediastinal cystic structure, which could be either a non-communicating cystic duplication of the esophagus, or a bronchogenic cyst.
The 3D CT-scan image modeling analysis allowed the surgeon to become familiar with a benign superior mediastinal cystic tumor including its surrounding anatomical structures. The tumor was immediately found above the arch of the azygos vein laterally to the superior vena cava and to the right phrenic nerve, and anteriorly to the right vagus nerve.
The resection was performed thoracoscopically, without any difficulty after a small opening of the mediastinal pleura in order to provide direct access to the paramedian cyst.
Pathological findings demonstrated the presence of a bronchogenic cyst without any communication with the airway tree or the esophagus. Postoperative outcomes were uneventful and the patient was rapidly discharged from hospital.
F Becmeur, C Boff
Surgical intervention
3 years ago
857 views
44 likes
0 comments
04:49
Laparoscopic management of a pediatric bronchogenic cyst in a 6-year-old boy
We report the case of a 6-year-old boy who presented with an infectious bronchopulmonary episode during which a plain anterior chest X-ray was performed. The X-ray showed an opacity at the right apex. A thoracic CT-scan allowed to demonstrate the presence of a right superior and posterior mediastinal cystic structure, which could be either a non-communicating cystic duplication of the esophagus, or a bronchogenic cyst.
The 3D CT-scan image modeling analysis allowed the surgeon to become familiar with a benign superior mediastinal cystic tumor including its surrounding anatomical structures. The tumor was immediately found above the arch of the azygos vein laterally to the superior vena cava and to the right phrenic nerve, and anteriorly to the right vagus nerve.
The resection was performed thoracoscopically, without any difficulty after a small opening of the mediastinal pleura in order to provide direct access to the paramedian cyst.
Pathological findings demonstrated the presence of a bronchogenic cyst without any communication with the airway tree or the esophagus. Postoperative outcomes were uneventful and the patient was rapidly discharged from hospital.
Laparoscopic pericystectomy for an 8cm hepatic hydatid cyst with 3D reconstruction
This is the case of a female patient presenting with epigastric pain. An 8cm liver cyst is identified on the examination. Given her previous medical and clinical history, the patient has a hydatid cyst. Serologic tests remain negative. This hydatid cyst is no longer active. Surgery is indicated given the symptomatology and the patient’s strong desire for the intervention. Indications for the surgical resection of non-active hydatid cysts remain rare. They mainly concern big cysts that may generate typical clinical signs of pain, heaviness and epigastric impairment. A standard pericystectomy performed in a stepwise manner should allow to resect this cyst without any resection of the liver parenchyma.
D Mutter, L Soler, J Marescaux
Surgical intervention
9 years ago
20349 views
94 likes
0 comments
08:03
Laparoscopic pericystectomy for an 8cm hepatic hydatid cyst with 3D reconstruction
This is the case of a female patient presenting with epigastric pain. An 8cm liver cyst is identified on the examination. Given her previous medical and clinical history, the patient has a hydatid cyst. Serologic tests remain negative. This hydatid cyst is no longer active. Surgery is indicated given the symptomatology and the patient’s strong desire for the intervention. Indications for the surgical resection of non-active hydatid cysts remain rare. They mainly concern big cysts that may generate typical clinical signs of pain, heaviness and epigastric impairment. A standard pericystectomy performed in a stepwise manner should allow to resect this cyst without any resection of the liver parenchyma.
Laparoscopic left hepatectomy for a suspected biliary cystadenoma
This is the case of a 69-year-old male patient presenting to the emergency department for abdominal pain and fever. After CT-scan and liver MRI, a biliary cystadenoma was suspected. CEA and CA 19-9 were normal. Hydatid cyst serology was negative. Considering the localization and the size of the tumor, a left laparoscopic hepatectomy was indicated. The patient’s surgical history included laparoscopic sigmoidectomy, intestinal occlusion for internal hernia, appendectomy, and bilateral inguinal hernia repair. Dissection of adhesions and cholecystectomy were performed first. After transection of the left hepatic artery and the left portal vein, parenchymal transection was performed by exposing the middle hepatic vein under intermittent clamping using blood flow occlusion. During parenchymal transection, the left hepatic duct and the left hepatic vein were divided. The specimen was extracted through a suprapubic incision. The postoperative outcome was uneventful. Pathological findings showed the presence of a biliary cyst communicating with the biliary system, without any malignant characteristics.
O Soubrane, P Pessaux, E Felli, T Urade, T Wakabayashi, D Mutter, J Marescaux
Surgical intervention
7 months ago
2108 views
4 likes
0 comments
34:11
Laparoscopic left hepatectomy for a suspected biliary cystadenoma
This is the case of a 69-year-old male patient presenting to the emergency department for abdominal pain and fever. After CT-scan and liver MRI, a biliary cystadenoma was suspected. CEA and CA 19-9 were normal. Hydatid cyst serology was negative. Considering the localization and the size of the tumor, a left laparoscopic hepatectomy was indicated. The patient’s surgical history included laparoscopic sigmoidectomy, intestinal occlusion for internal hernia, appendectomy, and bilateral inguinal hernia repair. Dissection of adhesions and cholecystectomy were performed first. After transection of the left hepatic artery and the left portal vein, parenchymal transection was performed by exposing the middle hepatic vein under intermittent clamping using blood flow occlusion. During parenchymal transection, the left hepatic duct and the left hepatic vein were divided. The specimen was extracted through a suprapubic incision. The postoperative outcome was uneventful. Pathological findings showed the presence of a biliary cyst communicating with the biliary system, without any malignant characteristics.
Subtotal cystectomy with laparoscopic splenic preservation
Non-parasitic splenic lesions are a rare entity. Since they can generate signs and abdominal symptoms and cause many complications, their detection requires some form of treatment. The possibility of post-splenectomy fatal sepsis has led to the search for new therapeutic alternatives which simultaneously ensure the healing process and preserve the splenic tissue. The preservation of at least 25% of splenic tissue provides protection against pneumococcal bacteremia. One of the techniques used is partial cyst decapsulation with splenic preservation.
We report the case of a 17-year-old woman who was incidentally diagnosed with a 4cm splenic cystic with negative serological studies and tumor markers suggestive of an epidermal cyst. Radiological monitoring of the lesion is performed and a cystic growth of 7cm is observed. As a result, surgery is decided upon.
At laparoscopy, a splenic cyst of 7cm in diameter is found. However, it does not affect the splenic vessels. Lancing and draining the cyst is made and partial cyst decapsulation is performed with splenic preservation. The patient made an uneventful recovery.
Partial decapsulation of the cyst’s wall offers several advantages: it is technically easier to perform, involves minimal blood loss, it preserves the entire splenic tissue and has a high cure rate. It is an excellent therapeutic alternative for young people with splenic cysts because it eliminates the disease process without loss of splenic tissue and it is minimally invasive for the patient.
FE Viamontes Ugalde, A Abascal Amo, I García Sanz
Surgical intervention
2 years ago
892 views
31 likes
0 comments
09:32
Subtotal cystectomy with laparoscopic splenic preservation
Non-parasitic splenic lesions are a rare entity. Since they can generate signs and abdominal symptoms and cause many complications, their detection requires some form of treatment. The possibility of post-splenectomy fatal sepsis has led to the search for new therapeutic alternatives which simultaneously ensure the healing process and preserve the splenic tissue. The preservation of at least 25% of splenic tissue provides protection against pneumococcal bacteremia. One of the techniques used is partial cyst decapsulation with splenic preservation.
We report the case of a 17-year-old woman who was incidentally diagnosed with a 4cm splenic cystic with negative serological studies and tumor markers suggestive of an epidermal cyst. Radiological monitoring of the lesion is performed and a cystic growth of 7cm is observed. As a result, surgery is decided upon.
At laparoscopy, a splenic cyst of 7cm in diameter is found. However, it does not affect the splenic vessels. Lancing and draining the cyst is made and partial cyst decapsulation is performed with splenic preservation. The patient made an uneventful recovery.
Partial decapsulation of the cyst’s wall offers several advantages: it is technically easier to perform, involves minimal blood loss, it preserves the entire splenic tissue and has a high cure rate. It is an excellent therapeutic alternative for young people with splenic cysts because it eliminates the disease process without loss of splenic tissue and it is minimally invasive for the patient.
Laparoscopic distal pancreatectomy and splenectomy for a mucinous cystic neoplasm of the pancreas
This video shows a laparoscopic distal pancreatectomy and splenectomy.
This is the case of a woman with a cystic lesion in the body of the pancreas, diagnosed in the study of an abdominal pain.
She was submitted to a CT-scan which showed a regular, well-defined 45mm cystic lesion in the pancreatic body, with voluminous hepatic hemangiomas. The findings of endoscopic ultrasound-guided biopsy were inconclusive, with a CEA of 653ng/dL.
The patient underwent a laparoscopic distal pancreatectomy and splenectomy.
There were no postoperative complications. The patient was discharged on postoperative day 3.
Histological findings demonstrated the presence of a mucinous cystic neoplasm.
L Ferreira, N Vilela, O Oliveira, J Miranda
Surgical intervention
2 years ago
2410 views
150 likes
0 comments
10:35
Laparoscopic distal pancreatectomy and splenectomy for a mucinous cystic neoplasm of the pancreas
This video shows a laparoscopic distal pancreatectomy and splenectomy.
This is the case of a woman with a cystic lesion in the body of the pancreas, diagnosed in the study of an abdominal pain.
She was submitted to a CT-scan which showed a regular, well-defined 45mm cystic lesion in the pancreatic body, with voluminous hepatic hemangiomas. The findings of endoscopic ultrasound-guided biopsy were inconclusive, with a CEA of 653ng/dL.
The patient underwent a laparoscopic distal pancreatectomy and splenectomy.
There were no postoperative complications. The patient was discharged on postoperative day 3.
Histological findings demonstrated the presence of a mucinous cystic neoplasm.