We use cookies to offer you an optimal experience on our website. By browsing our website, you accept the use of cookies.
Filter by
Specialty
View more
Technologies
View more
Clear filter Media type
View more
Clear filter Category
View more
Publication date
Sort by:
Laparoscopic cholecystectomy: cystic duct stone management
This video demonstrates a laparoscopic cholecystectomy in a 69-year-old woman who had multiple episodes of biliary colic. Ultrasonography and MRI showed the presence of multiple gallbladder stones. MRI also showed a folded gallbladder infundibulum over the cystic duct, which is enlarged and contains a stone. The common bile duct is otherwise perfectly thin and free of stones. In this video, one can observe a stepwise cholecystectomy technique, with exposure, dissection of the serosa and of Calot’s triangle. Cystic artery division is first performed in order to allow complete cystic duct dissection obtaining the critical view of safety. The dissection of the dilated cystic duct is thoroughly demonstrated. A small stone is pushed back into the gallbladder; the cystic duct is opened and checked for residual stones, and the cystic duct convergence with the common bile duct is evidenced prior to clip positioning and duct division.
M Ignat, M Wehr, B Seeliger, D Mutter, J Marescaux
Surgical intervention
1 year ago
3282 views
19 likes
0 comments
10:44
Laparoscopic cholecystectomy: cystic duct stone management
This video demonstrates a laparoscopic cholecystectomy in a 69-year-old woman who had multiple episodes of biliary colic. Ultrasonography and MRI showed the presence of multiple gallbladder stones. MRI also showed a folded gallbladder infundibulum over the cystic duct, which is enlarged and contains a stone. The common bile duct is otherwise perfectly thin and free of stones. In this video, one can observe a stepwise cholecystectomy technique, with exposure, dissection of the serosa and of Calot’s triangle. Cystic artery division is first performed in order to allow complete cystic duct dissection obtaining the critical view of safety. The dissection of the dilated cystic duct is thoroughly demonstrated. A small stone is pushed back into the gallbladder; the cystic duct is opened and checked for residual stones, and the cystic duct convergence with the common bile duct is evidenced prior to clip positioning and duct division.
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
2576 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.
Accidental finding of Ascaris lumbricoides in the common bile duct during laparoscopic cholecystectomy transcystic exploration
This is the case of a 37-year-old woman, who had acute cholecystitis for 4 days, accompanied by nausea, vomiting, and abdominal pain in the right upper quadrant.
Physical exam demonstrated a soft abdomen with right upper quadrant pain, positive Murphy’s sign, and a palpable painful mass.
Complete blood count (CBC) reported 7,700/uL WBC, 4.235u/L neutrophils (55%), 1.463u/L lymphocytes (19%), and 1.540/uL eosinophils (20%).
Total bilirubin: 0.7mg/dL, direct bilirubin: 0.4mg/dL, indirect bilirubin: 0.3mg/dL, alkaline phosphatase: 184U/L.
Hepatobiliary ultrasound reports a thin-walled bladder with biliary sludge. The bile duct is not dilated. According to the results, there was no parasite on the bile duct.
Pain does not subside with antispasmodics, and the patient is sent to undergo a laparoscopic cholecystectomy.
In surgery, a hydropic gallbladder was evidenced. It was drained with a Veress needle. It was then found that the cystic duct was dilated and a transcystic exploration was performed with a No. 6 - 8- 10 French gastric tube.
An Ascaris lumbricoides of 25cm in length was extracted.
After exploration was completed with a Fogarty catheter, and no additional parasites were found, conventional cholecystectomy was completed. Antibiotic and anti-parasite treatment was prescribed. The patient was discharged 2 days after the procedure without any complications.
LE Becerra
Surgical intervention
3 years ago
2121 views
132 likes
0 comments
08:19
Accidental finding of Ascaris lumbricoides in the common bile duct during laparoscopic cholecystectomy transcystic exploration
This is the case of a 37-year-old woman, who had acute cholecystitis for 4 days, accompanied by nausea, vomiting, and abdominal pain in the right upper quadrant.
Physical exam demonstrated a soft abdomen with right upper quadrant pain, positive Murphy’s sign, and a palpable painful mass.
Complete blood count (CBC) reported 7,700/uL WBC, 4.235u/L neutrophils (55%), 1.463u/L lymphocytes (19%), and 1.540/uL eosinophils (20%).
Total bilirubin: 0.7mg/dL, direct bilirubin: 0.4mg/dL, indirect bilirubin: 0.3mg/dL, alkaline phosphatase: 184U/L.
Hepatobiliary ultrasound reports a thin-walled bladder with biliary sludge. The bile duct is not dilated. According to the results, there was no parasite on the bile duct.
Pain does not subside with antispasmodics, and the patient is sent to undergo a laparoscopic cholecystectomy.
In surgery, a hydropic gallbladder was evidenced. It was drained with a Veress needle. It was then found that the cystic duct was dilated and a transcystic exploration was performed with a No. 6 - 8- 10 French gastric tube.
An Ascaris lumbricoides of 25cm in length was extracted.
After exploration was completed with a Fogarty catheter, and no additional parasites were found, conventional cholecystectomy was completed. Antibiotic and anti-parasite treatment was prescribed. The patient was discharged 2 days after the procedure without any complications.
Robotic partial splenectomy for cystic lesion of the spleen
We report the case of a 21-year-old woman with a cystic lesion of the spleen treated with a robotic partial splenectomy. The patient is placed in a right lateral decubitus position. Four ports are introduced into the left hypochondrium. The robot is placed at the level of the patient’s left shoulder. The intervention is begun with a lowering of the splenic flexure. Dissection is initiated at the upper pole of the spleen by retracting the stomach and by progressively dividing the different short vessels. It is decided to start the parenchymotomy approximately 1cm from the devascularized area. Transection is begun using an ultrasonic dissector. Hemostasis is subsequently achieved progressively. Transection is completed by means of a firing of the Endo GIA™ linear stapler. Hemostasis is further completed using the Aquamantys® system and bipolar sealers. The specimen is fully mobilized and placed in a bag. It is extracted by means of a small suprapubic Pfannenstiel’s incision. Pathological findings demonstrate the presence of an epidermoid cyst. The postoperative outcome is uneventful. The patient is discharged on postoperative day 4.
P Pessaux, R Memeo, V De Blasi, N Ferreira, D Mutter, J Marescaux
Surgical intervention
3 years ago
1906 views
71 likes
1 comment
09:14
Robotic partial splenectomy for cystic lesion of the spleen
We report the case of a 21-year-old woman with a cystic lesion of the spleen treated with a robotic partial splenectomy. The patient is placed in a right lateral decubitus position. Four ports are introduced into the left hypochondrium. The robot is placed at the level of the patient’s left shoulder. The intervention is begun with a lowering of the splenic flexure. Dissection is initiated at the upper pole of the spleen by retracting the stomach and by progressively dividing the different short vessels. It is decided to start the parenchymotomy approximately 1cm from the devascularized area. Transection is begun using an ultrasonic dissector. Hemostasis is subsequently achieved progressively. Transection is completed by means of a firing of the Endo GIA™ linear stapler. Hemostasis is further completed using the Aquamantys® system and bipolar sealers. The specimen is fully mobilized and placed in a bag. It is extracted by means of a small suprapubic Pfannenstiel’s incision. Pathological findings demonstrate the presence of an epidermoid cyst. The postoperative outcome is uneventful. The patient is discharged on postoperative day 4.
Laparoscopic enucleation of a cystic tumor of the pancreas in a child
This short video describes the laparoscopic enucleation of a benign congenital excretory cyst of the pancreas in a 13-year-old girl.
No prenatal diagnosis had been envisaged and this teen girl was admitted in an emergency setting, with iterative abdominal pain followed by vomiting and weight loss (3Kg) over the last two months.
The entire work-up allowed to rule out the presence of parenchymal tumor involvement and the perfectly regular isolated and apparently normal nature of a cyst situated on the posterior aspect of the pancreatic head, which is totally separate from the biliary tract and from the duodenum.
In these conditions, the diagnosis of Frantz tumor was ruled out and the most probable hypothesis was that of a congenital cystic pancreatic tumor which had recently increased in size. The specificity of the technique used consisted in a pancreatic detachment using a Kocher’s maneuver. The posterior aspect of the pancreatic head was then detached in order to "plicate" or fold the pancreas upon itself.
Once turned over 180 degrees to the left, the posterior aspect of the pancreatic head was perfectly exposed. In addition, after puncture of the cyst, the clear fluid content of the cyst was replaced by a blue dye in order to perfectly identify it through a thin layer of pancreatic parenchyma.
The cyst’s enucleation was subsequently facilitated. No adhesion impaired its detachment from the remainder of the pancreatic tissue. Since the pericystic area was preserved, the risk of secondary pancreatic fistula was prevented, especially because the cyst had been previously opacified, which allowed to rule out any potential communication with the excretory ducts of the pancreas.
I Kauffmann, F Becmeur
Surgical intervention
3 years ago
675 views
13 likes
0 comments
02:59
Laparoscopic enucleation of a cystic tumor of the pancreas in a child
This short video describes the laparoscopic enucleation of a benign congenital excretory cyst of the pancreas in a 13-year-old girl.
No prenatal diagnosis had been envisaged and this teen girl was admitted in an emergency setting, with iterative abdominal pain followed by vomiting and weight loss (3Kg) over the last two months.
The entire work-up allowed to rule out the presence of parenchymal tumor involvement and the perfectly regular isolated and apparently normal nature of a cyst situated on the posterior aspect of the pancreatic head, which is totally separate from the biliary tract and from the duodenum.
In these conditions, the diagnosis of Frantz tumor was ruled out and the most probable hypothesis was that of a congenital cystic pancreatic tumor which had recently increased in size. The specificity of the technique used consisted in a pancreatic detachment using a Kocher’s maneuver. The posterior aspect of the pancreatic head was then detached in order to "plicate" or fold the pancreas upon itself.
Once turned over 180 degrees to the left, the posterior aspect of the pancreatic head was perfectly exposed. In addition, after puncture of the cyst, the clear fluid content of the cyst was replaced by a blue dye in order to perfectly identify it through a thin layer of pancreatic parenchyma.
The cyst’s enucleation was subsequently facilitated. No adhesion impaired its detachment from the remainder of the pancreatic tissue. Since the pericystic area was preserved, the risk of secondary pancreatic fistula was prevented, especially because the cyst had been previously opacified, which allowed to rule out any potential communication with the excretory ducts of the pancreas.
Cystic pheochromocytoma: anatomical landmarks for laparoscopic resection
Surgery for pheochromocytoma is often considered difficult due to local anatomical conditions which are often associated with a hypervascularization and inflammatory reaction. This video demonstrates the case of a patient presenting with a 5cm pheochromocytoma with a necrotic core. Because the patient has a low BMI, the intraoperative anatomy is magnified and all anatomical landmarks are perfectly identified right before dissection. The lesion is eventually embedded in the liver. Its approach and dissection allow to determine the constraints related to adrenal surgery, and particularly regarding the impossibility to manipulate the lesion other than with soft retraction.
D Mutter, J Marescaux
Surgical intervention
4 years ago
2235 views
107 likes
0 comments
15:04
Cystic pheochromocytoma: anatomical landmarks for laparoscopic resection
Surgery for pheochromocytoma is often considered difficult due to local anatomical conditions which are often associated with a hypervascularization and inflammatory reaction. This video demonstrates the case of a patient presenting with a 5cm pheochromocytoma with a necrotic core. Because the patient has a low BMI, the intraoperative anatomy is magnified and all anatomical landmarks are perfectly identified right before dissection. The lesion is eventually embedded in the liver. Its approach and dissection allow to determine the constraints related to adrenal surgery, and particularly regarding the impossibility to manipulate the lesion other than with soft retraction.
Hybrid lung malformation with intralobar pulmonary sequestration and congenital cystic adenomatoid malformation (CCAM): thoracoscopic left lower lobectomy (LLL)
This is the case of an infant presenting with a hybrid left lower lung malformation with intralobar pulmonary sequestration and congenital cystic adenomatoid malformation (CCAM).
The systemic arterial vascularization of the sequestration originated from the thoracic aorta. The infant was 8 months old when the thoracoscopic procedure was performed. Prenatal diagnosis helped to identify the uncomplicated lung malformation. A CT-scan was performed when the patient was 6 months old before surgery was scheduled. The surgical intervention, a left lower lobectomy, was immediately preceded by a bronchial endoscopy in order to control the anatomy, the good health of the airway tree, and to place a blocker in the left main bronchus. The first operative step consisted in a ligation-division of the systemic artery as close to the diaphragm as possible. The second operative step consisted in a conventional left lower lobectomy with primary treatment of pulmonary arteries, veins, and bronchi.
F Becmeur, A Schneider, I Lacreuse
Surgical intervention
4 years ago
1366 views
55 likes
0 comments
06:25
Hybrid lung malformation with intralobar pulmonary sequestration and congenital cystic adenomatoid malformation (CCAM): thoracoscopic left lower lobectomy (LLL)
This is the case of an infant presenting with a hybrid left lower lung malformation with intralobar pulmonary sequestration and congenital cystic adenomatoid malformation (CCAM).
The systemic arterial vascularization of the sequestration originated from the thoracic aorta. The infant was 8 months old when the thoracoscopic procedure was performed. Prenatal diagnosis helped to identify the uncomplicated lung malformation. A CT-scan was performed when the patient was 6 months old before surgery was scheduled. The surgical intervention, a left lower lobectomy, was immediately preceded by a bronchial endoscopy in order to control the anatomy, the good health of the airway tree, and to place a blocker in the left main bronchus. The first operative step consisted in a ligation-division of the systemic artery as close to the diaphragm as possible. The second operative step consisted in a conventional left lower lobectomy with primary treatment of pulmonary arteries, veins, and bronchi.
Laparoscopic distal splenopancreatectomy for a caudal cystic pancreatic lesion
We report the case of a 51-year-old woman who underwent laparoscopic left splenopancreatectomy for a caudal cystic pancreatic lesion evocative of a mucinous cyst.
The patient is placed in a right lateral supine position, legs apart. A reverse Trendelenburg position is used. Four ports are placed. After the colon has been detached from the omentum, the dissection is begun at the superior border of the pancreas. It makes it possible to dissect the splenic artery, which is placed on a tape. The dissection is carried on at the inferior border of the pancreas in order to identify the venous mesentericoportal axis. A retropancreatic passage is achieved along the mesentericoportal axis, and a tape is passed around the pancreatic isthmus, which was immediately divided by means of a stapler. The splenic vein is identified at the posterior border of the pancreas. It is dissected and placed on a tape. The splenic artery is divided between two clips. The splenic vein is divided. It is freed from attachments, then clipped, and finally divided. The distal pancreas with the spleen was dissected to perform an ‘en-bloc’ left splenopancreatectomy. The specimen is placed in a bag and extracted through a Pfannenstiel incision, with an extemporaneous exam on the slice, which allows to rule out any neoplastic infiltration. A blade is placed in the left hypochondrium with an amylase activity assay performed on postoperative day 3. The blade is extracted through the leftmost port.
P Pessaux, R Memeo, H Jeddou, X Untereiner, S Tzedakis, D Mutter, J Marescaux
Surgical intervention
4 years ago
2179 views
57 likes
0 comments
10:52
Laparoscopic distal splenopancreatectomy for a caudal cystic pancreatic lesion
We report the case of a 51-year-old woman who underwent laparoscopic left splenopancreatectomy for a caudal cystic pancreatic lesion evocative of a mucinous cyst.
The patient is placed in a right lateral supine position, legs apart. A reverse Trendelenburg position is used. Four ports are placed. After the colon has been detached from the omentum, the dissection is begun at the superior border of the pancreas. It makes it possible to dissect the splenic artery, which is placed on a tape. The dissection is carried on at the inferior border of the pancreas in order to identify the venous mesentericoportal axis. A retropancreatic passage is achieved along the mesentericoportal axis, and a tape is passed around the pancreatic isthmus, which was immediately divided by means of a stapler. The splenic vein is identified at the posterior border of the pancreas. It is dissected and placed on a tape. The splenic artery is divided between two clips. The splenic vein is divided. It is freed from attachments, then clipped, and finally divided. The distal pancreas with the spleen was dissected to perform an ‘en-bloc’ left splenopancreatectomy. The specimen is placed in a bag and extracted through a Pfannenstiel incision, with an extemporaneous exam on the slice, which allows to rule out any neoplastic infiltration. A blade is placed in the left hypochondrium with an amylase activity assay performed on postoperative day 3. The blade is extracted through the leftmost port.
Laparoscopic transcystic and hybrid transgastric rendezvous technique for common bile duct lithiasis after gastric bypass
Common bile duct lithiasis has become a challenging problem in patients who have undergone a laparoscopic Roux-en-Y gastric bypass for morbid obesity. Altered anatomy due to gastric diversion and biliary limb reconstruction leads to a prolonged and complex access to the ampulla of Vater. Consequently, experienced endoscopists and double-balloon endoscopes are required, often making it impossible to successfully perform an endoscopic sphincterotomy as in this case.
Here, we describe the case of a patient who had already been operated on for a gastric bypass and who presented with multiple past episodes of cholangitis because of common bile duct stones. A double-balloon endoscopic sphincterotomy failed leading to the decision of surgical treatment combining a hybrid technique of laparoscopic transgastric sphincterotomy with a transcystic common bile duct exploration.
L Marx, S Tzedakis, P Pessaux, M Delvaux, D Mutter, J Marescaux
Surgical intervention
5 years ago
1180 views
45 likes
0 comments
11:34
Laparoscopic transcystic and hybrid transgastric rendezvous technique for common bile duct lithiasis after gastric bypass
Common bile duct lithiasis has become a challenging problem in patients who have undergone a laparoscopic Roux-en-Y gastric bypass for morbid obesity. Altered anatomy due to gastric diversion and biliary limb reconstruction leads to a prolonged and complex access to the ampulla of Vater. Consequently, experienced endoscopists and double-balloon endoscopes are required, often making it impossible to successfully perform an endoscopic sphincterotomy as in this case.
Here, we describe the case of a patient who had already been operated on for a gastric bypass and who presented with multiple past episodes of cholangitis because of common bile duct stones. A double-balloon endoscopic sphincterotomy failed leading to the decision of surgical treatment combining a hybrid technique of laparoscopic transgastric sphincterotomy with a transcystic common bile duct exploration.
Endoscopic extraction of a giant cystic duct stone to treat type I Mirizzi syndrome
Mirizzi syndrome (MS) is characterized by common hepatic duct obstruction due to mechanical compression and surrounding inflammation by a gallstone impacted in the cystic duct (type I) or at the gallbladder neck (type II). Preoperative diagnosis of the syndrome is mandatory and associated with a decrease of complication rate of surgical management. Endoscopic therapies like ERCP with lithotripsy or endoscopic extraction of cystic duct calculi followed by laparoscopic cholecystectomy have been described. Here we report successful endoscopic stone-clearance using double-cannulation and large balloon dilatation of the papilla for giant biliary stone impacted in the cystic duct inserted low in the common hepatic duct causing type I MS.
Bibliographic reference:
Double-cannulation and large papillary balloon dilation: key to successful endoscopic treatment of mirizzi syndrome in low insertion of cystic duct. Donatelli G, Dhumane P, Dallemagne B, Marx L, Delvaux M, Gay G, Marescaux J. Dig Endosc 2012;24:466-9.
Gf Donatelli, P Dhumane, S Perretta, BM Vergeau, JL Dumont, T Tuszynski, B Meduri
Surgical intervention
5 years ago
896 views
13 likes
0 comments
04:09
Endoscopic extraction of a giant cystic duct stone to treat type I Mirizzi syndrome
Mirizzi syndrome (MS) is characterized by common hepatic duct obstruction due to mechanical compression and surrounding inflammation by a gallstone impacted in the cystic duct (type I) or at the gallbladder neck (type II). Preoperative diagnosis of the syndrome is mandatory and associated with a decrease of complication rate of surgical management. Endoscopic therapies like ERCP with lithotripsy or endoscopic extraction of cystic duct calculi followed by laparoscopic cholecystectomy have been described. Here we report successful endoscopic stone-clearance using double-cannulation and large balloon dilatation of the papilla for giant biliary stone impacted in the cystic duct inserted low in the common hepatic duct causing type I MS.
Bibliographic reference:
Double-cannulation and large papillary balloon dilation: key to successful endoscopic treatment of mirizzi syndrome in low insertion of cystic duct. Donatelli G, Dhumane P, Dallemagne B, Marx L, Delvaux M, Gay G, Marescaux J. Dig Endosc 2012;24:466-9.
Spleen-preserving total laparoscopic pancreatoduodenectomy
A 68-year-old woman was referred to us for multiple pancreatic cysts incidentally discovered on a routine ultrasound. An MRI was performed showing multiple cystic tumors throughout the pancreas, the largest of which was 15mm. This led to a suspicion of multifocal, side-branch intraductal papillary mucinous neoplasm (IPMN), with minimal dilatation of the main pancreatic duct. An echo-endoscopy was subsequently performed indicating the presence of a multifocal IPMN. A fine-needle aspiration (FNA) was performed during this procedure, with aspiration of cystic content which was sent for CEA analysis and cytology. Cytology was compatible with a mucinous neoplasm with mild atypia and CEA at 98 IU/mL.
A spleen-preserving total laparoscopic pancreatoduodenectomy was proposed. The procedure was uneventful and the patient was discharged on postoperative day 5. Pathology revealed a 19mm IPMN, with severe dysplasia and 3 foci of micro-invasive ductal adenocarcinoma of 1mm - pT1N0R0.
H Cristino, M Almeida, V Gomes, J Costa Maia
Surgical intervention
3 months ago
764 views
6 likes
2 comments
07:41
Spleen-preserving total laparoscopic pancreatoduodenectomy
A 68-year-old woman was referred to us for multiple pancreatic cysts incidentally discovered on a routine ultrasound. An MRI was performed showing multiple cystic tumors throughout the pancreas, the largest of which was 15mm. This led to a suspicion of multifocal, side-branch intraductal papillary mucinous neoplasm (IPMN), with minimal dilatation of the main pancreatic duct. An echo-endoscopy was subsequently performed indicating the presence of a multifocal IPMN. A fine-needle aspiration (FNA) was performed during this procedure, with aspiration of cystic content which was sent for CEA analysis and cytology. Cytology was compatible with a mucinous neoplasm with mild atypia and CEA at 98 IU/mL.
A spleen-preserving total laparoscopic pancreatoduodenectomy was proposed. The procedure was uneventful and the patient was discharged on postoperative day 5. Pathology revealed a 19mm IPMN, with severe dysplasia and 3 foci of micro-invasive ductal adenocarcinoma of 1mm - pT1N0R0.
All you need to know to perform an ERCP for biliary stones extraction: live procedure
An 82-year-old man underwent an emergency endoscopic retrograde cholangiopancreatography (ERCP) for acute cholangitis secondary to choledocholithiasis 11 days earlier. At that time, since the patient was under Clopidogrel, the sphincterotomy was not performed and a plastic stent was released in the common bile duct (CBD) to bypass the stones. In this live procedure, Dr. Boškoski performs an ERCP with sphincterotomy and biliary stones extraction. During the procedure, the operator gives every fundamental tips and tricks to perform the correct procedure. At the end of the intervention, a 3D cholangiography is performed to confirm complete biliary stones extraction.
I Boškoski, M Pizzicannella
Surgical intervention
3 months ago
685 views
12 likes
1 comment
35:21
All you need to know to perform an ERCP for biliary stones extraction: live procedure
An 82-year-old man underwent an emergency endoscopic retrograde cholangiopancreatography (ERCP) for acute cholangitis secondary to choledocholithiasis 11 days earlier. At that time, since the patient was under Clopidogrel, the sphincterotomy was not performed and a plastic stent was released in the common bile duct (CBD) to bypass the stones. In this live procedure, Dr. Boškoski performs an ERCP with sphincterotomy and biliary stones extraction. During the procedure, the operator gives every fundamental tips and tricks to perform the correct procedure. At the end of the intervention, a 3D cholangiography is performed to confirm complete biliary stones extraction.
Laparoscopic common bile duct exploration using a disposable fiber-optic bonchoscope (Ambu® aScope™)
Background: Laparoscopic common bile duct (CBD) exploration can be performed following choledochotomy or via the trancystic approach. Laparoscopic CBD exploration is limited in some benign upper gastrointestinal units due to the cost of sterilization of the reusable choledochoscope.
We have recently published a case series confirming the safety and efficacy of the 5mm reusable bronchoscope for CBD exploration. This case series evaluates a single-use bronchochoscope (Ambu® aScope™) for laparoscopic CBD exploration.
Method: A retrospective study was conducted from January 2015 to December 2016. Data was collected from electronic records of the patients. All cases confirmed the presence of CBD stones using USS and MRCP. The disposable bronchoscope is introduced via an epigastric port. Choledochotomy is performed using a choledochotome, and a transcystic approach is used after cystic duct dilatation, if required. The Ambu® aScope™ 2 (Ambu UK Ltd, Cambridgeshire) is a sterile and single-use flexible bronchoscope, which is normally used by anesthesiologists for difficult tracheal intubation. A disposable bronchoscope is available in two sizes (3.8mm and 5mm). It is a one-piece unit with a single dimensional flexible tip manipulated with a handpiece (150-degree flex in the 5mm model and 130-degree flex in the 3.8mm model). There is a single instrument channel with a 2.2mm diameter, which allows for the passage of standard endoscopic baskets for CBD stone retrieval. The image is projected to a high-resolution 6.5” LCD screen with a resolution of 640x480 pixels. The bronchoscope handpiece includes a suction port, which is used as an irrigation source for CBD dilatation. It requires the use of a standard 3-way connector.
Results: Twenty nine patients had CBD exploration using the disposable bronchochoscope. There were 10 male and 19 female patients (median age: 42). Ten procedures were performed as emergencies and 19 were performed electively. All cases were managed laparoscopically except one, which was planned as an open procedure due to previous extensive open surgery.
Twenty eight patients had their CBD cleared using a disposable bronchoscope and two needed subsequent ERCP. Choledochotomy was performed in 15 patients and a transcystic approach was used in 6 patients. No T-tube was used in the laparoscopic cases. Two cases were performed as day case surgery. Median postoperative hospital stay was 2.5 days.
Conclusion: The disposable bronchoscope is a safe and effective instrument for CBD exploration, with results comparable to our previously published case series. It has guaranteed sterility and is cost-effective compared to the reusable bronchoscope, especially when initial capital outlay, sterile processing and maintenance costs are considered.
Y Aawsaj, I Ibrahim, A Mitchell, A Gilliam
Surgical intervention
6 months ago
964 views
15 likes
2 comments
10:08
Laparoscopic common bile duct exploration using a disposable fiber-optic bonchoscope (Ambu® aScope™)
Background: Laparoscopic common bile duct (CBD) exploration can be performed following choledochotomy or via the trancystic approach. Laparoscopic CBD exploration is limited in some benign upper gastrointestinal units due to the cost of sterilization of the reusable choledochoscope.
We have recently published a case series confirming the safety and efficacy of the 5mm reusable bronchoscope for CBD exploration. This case series evaluates a single-use bronchochoscope (Ambu® aScope™) for laparoscopic CBD exploration.
Method: A retrospective study was conducted from January 2015 to December 2016. Data was collected from electronic records of the patients. All cases confirmed the presence of CBD stones using USS and MRCP. The disposable bronchoscope is introduced via an epigastric port. Choledochotomy is performed using a choledochotome, and a transcystic approach is used after cystic duct dilatation, if required. The Ambu® aScope™ 2 (Ambu UK Ltd, Cambridgeshire) is a sterile and single-use flexible bronchoscope, which is normally used by anesthesiologists for difficult tracheal intubation. A disposable bronchoscope is available in two sizes (3.8mm and 5mm). It is a one-piece unit with a single dimensional flexible tip manipulated with a handpiece (150-degree flex in the 5mm model and 130-degree flex in the 3.8mm model). There is a single instrument channel with a 2.2mm diameter, which allows for the passage of standard endoscopic baskets for CBD stone retrieval. The image is projected to a high-resolution 6.5” LCD screen with a resolution of 640x480 pixels. The bronchoscope handpiece includes a suction port, which is used as an irrigation source for CBD dilatation. It requires the use of a standard 3-way connector.
Results: Twenty nine patients had CBD exploration using the disposable bronchochoscope. There were 10 male and 19 female patients (median age: 42). Ten procedures were performed as emergencies and 19 were performed electively. All cases were managed laparoscopically except one, which was planned as an open procedure due to previous extensive open surgery.
Twenty eight patients had their CBD cleared using a disposable bronchoscope and two needed subsequent ERCP. Choledochotomy was performed in 15 patients and a transcystic approach was used in 6 patients. No T-tube was used in the laparoscopic cases. Two cases were performed as day case surgery. Median postoperative hospital stay was 2.5 days.
Conclusion: The disposable bronchoscope is a safe and effective instrument for CBD exploration, with results comparable to our previously published case series. It has guaranteed sterility and is cost-effective compared to the reusable bronchoscope, especially when initial capital outlay, sterile processing and maintenance costs are considered.
Laparoscopic central hepatectomy for hepatoma using a Glissonian approach
Introduction: Although laparoscopic liver resection has been widely adopted, performing a total laparoscopic central hepatectomy remains a challenging and technically demanding procedure because it requires two transection planes. This video illustrates a useful technique for laparoscopic central hepatectomy, which was successfully performed in a cirrhotic patient with hepatoma. Method: We demonstrated a total laparoscopic central hepatectomy which was performed in a 65-year-old woman who had a centrally located hepatoma, and this tumor was in contact with the middle hepatic vein. The operative procedure was performed by using five ports with the patient placed in a low lithotomy position. Results: The technique was successfully performed without any complications. The operative time was 380 min. Intraoperative blood loss was 60mL. The length of hospital stay was 5 days. The pathological report was well-differentiated HCC and free surgical margins. Conclusions: Laparoscopic central hepatectomy for hepatoma by using a Glissonian approach is feasible and safe.
R Chanwat, C Bunchaliew
Surgical intervention
6 months ago
5023 views
35 likes
6 comments
10:01
Laparoscopic central hepatectomy for hepatoma using a Glissonian approach
Introduction: Although laparoscopic liver resection has been widely adopted, performing a total laparoscopic central hepatectomy remains a challenging and technically demanding procedure because it requires two transection planes. This video illustrates a useful technique for laparoscopic central hepatectomy, which was successfully performed in a cirrhotic patient with hepatoma. Method: We demonstrated a total laparoscopic central hepatectomy which was performed in a 65-year-old woman who had a centrally located hepatoma, and this tumor was in contact with the middle hepatic vein. The operative procedure was performed by using five ports with the patient placed in a low lithotomy position. Results: The technique was successfully performed without any complications. The operative time was 380 min. Intraoperative blood loss was 60mL. The length of hospital stay was 5 days. The pathological report was well-differentiated HCC and free surgical margins. Conclusions: Laparoscopic central hepatectomy for hepatoma by using a Glissonian approach is feasible and safe.
Laparoscopic Beger procedure with Roux-en-Y hepaticojejunostomy
This is the case of a 49-year-old male patient presenting with recurrent intractable abdominal pain. The patient had a history of obstructive jaundice and underwent biliary decompression provided by a percutaneous cholecystostomy. CT-scan showed signs of chronic pancreatitis, multiple stones in the pancreatic parenchyma, a compressed portal vein and biliary obstruction. The patient underwent a laparoscopic duodenum-preserving pancreatic head resection (DPPHR) – a technique known as the Beger procedure. It is recognized as an effective therapeutic option for the surgical treatment of patients with persistent pain, combined with portal and biliary compression caused by severe chronic pancreatitis. The surgical procedure preserves the stomach, the duodenum, and the biliary tree unlike standard duodenopancreatectomy (Whipple procedure), which is the other option for these patients. As Beger himself stated: “Preservation of the duodenum and the biliary system has major advantages for patients regarding short- and long-term outcome as compared to the Kausch-Whipple resection and pylorus-preserving resection”.
In this case, after completing the pancreatic head resection and fashioning the distal and proximal pancreaticojejunal anastomosis, a hepaticojejunostomy was performed. It was necessary due to the stenosis of the intrapancreatic segment of the common bile duct.
The purpose of this video is to demonstrate that the laparoscopic Beger procedure is safe and feasible, and provides all the well-known advantages of the minimally invasive approach, particularly lower postoperative pain, earlier functional recovery, and shorter hospital stay.
P Agami, A Andrianov, M Baychorov, R Izrailov
Surgical intervention
6 months ago
2164 views
14 likes
3 comments
17:23
Laparoscopic Beger procedure with Roux-en-Y hepaticojejunostomy
This is the case of a 49-year-old male patient presenting with recurrent intractable abdominal pain. The patient had a history of obstructive jaundice and underwent biliary decompression provided by a percutaneous cholecystostomy. CT-scan showed signs of chronic pancreatitis, multiple stones in the pancreatic parenchyma, a compressed portal vein and biliary obstruction. The patient underwent a laparoscopic duodenum-preserving pancreatic head resection (DPPHR) – a technique known as the Beger procedure. It is recognized as an effective therapeutic option for the surgical treatment of patients with persistent pain, combined with portal and biliary compression caused by severe chronic pancreatitis. The surgical procedure preserves the stomach, the duodenum, and the biliary tree unlike standard duodenopancreatectomy (Whipple procedure), which is the other option for these patients. As Beger himself stated: “Preservation of the duodenum and the biliary system has major advantages for patients regarding short- and long-term outcome as compared to the Kausch-Whipple resection and pylorus-preserving resection”.
In this case, after completing the pancreatic head resection and fashioning the distal and proximal pancreaticojejunal anastomosis, a hepaticojejunostomy was performed. It was necessary due to the stenosis of the intrapancreatic segment of the common bile duct.
The purpose of this video is to demonstrate that the laparoscopic Beger procedure is safe and feasible, and provides all the well-known advantages of the minimally invasive approach, particularly lower postoperative pain, earlier functional recovery, and shorter hospital stay.
Laparoscopic cholecystectomy - Basic rules - Bile duct injury
There is twice as much risk of incidental biliary injuries in laparoscopic cholecystectomy than in open cholecystectomy.
About half of surgeons will cause a bile duct injury during their careers. In this lecture, Dr. Dallemagne provides key national data of bile duct injury and explains that the lack of surgical experience or visual misperception leads to an increase in the rate of incidental injuries, mentioning his own cases. Dr. Dallemagne also outlines the fundamental techniques to prevent injuries and use bailout procedures (partial and subtotal cholecystectomy) in laparoscopic cholecystectomy, according to the latest version of the Tokyo guidelines.
B Dallemagne
Lecture
10 months ago
6687 views
53 likes
2 comments
22:02
Laparoscopic cholecystectomy - Basic rules - Bile duct injury
There is twice as much risk of incidental biliary injuries in laparoscopic cholecystectomy than in open cholecystectomy.
About half of surgeons will cause a bile duct injury during their careers. In this lecture, Dr. Dallemagne provides key national data of bile duct injury and explains that the lack of surgical experience or visual misperception leads to an increase in the rate of incidental injuries, mentioning his own cases. Dr. Dallemagne also outlines the fundamental techniques to prevent injuries and use bailout procedures (partial and subtotal cholecystectomy) in laparoscopic cholecystectomy, according to the latest version of the Tokyo guidelines.
Laparoscopic distal pancreatectomy for intraductal papillary mucinous neoplasm (IPMN)
This is the case of a 76-year-old female patient who was referred to our hospital because of intraductal papillary mucinous neoplasm (IPMN). The patient has a medical history of renal insufficiency, sleep apnea syndrome, type 2 diabetes mellitus (T2DM), and hypertension. She has also a history of previous total hysterectomy.
MRI findings showed that the patient’s IPMN affected secondary pancreatic ducts entirely.
The main pancreatic duct is dilated, especially in the distal part at 6mm, but there are no remarkable findings of cystic wall thickening or intracystic nodules. A laparoscopic distal pancreatectomy was planned.
The postoperative course was uneventful and the patient was discharged on postoperative day 8.
Pathological findings showed that the intraductal papillary mucinous neoplasm was without any malignant component.
P Pessaux, E Felli, T Wakabayashi, D Mutter, J Marescaux
Surgical intervention
10 months ago
3536 views
7 likes
0 comments
13:26
Laparoscopic distal pancreatectomy for intraductal papillary mucinous neoplasm (IPMN)
This is the case of a 76-year-old female patient who was referred to our hospital because of intraductal papillary mucinous neoplasm (IPMN). The patient has a medical history of renal insufficiency, sleep apnea syndrome, type 2 diabetes mellitus (T2DM), and hypertension. She has also a history of previous total hysterectomy.
MRI findings showed that the patient’s IPMN affected secondary pancreatic ducts entirely.
The main pancreatic duct is dilated, especially in the distal part at 6mm, but there are no remarkable findings of cystic wall thickening or intracystic nodules. A laparoscopic distal pancreatectomy was planned.
The postoperative course was uneventful and the patient was discharged on postoperative day 8.
Pathological findings showed that the intraductal papillary mucinous neoplasm was without any malignant component.
Laparoscopic partial liver resection for hepatocellular adenoma
We report a laparoscopic partial liver resection for a large hepatocellular adenoma. This is the case of a 34-year-old patient with several small hepatic nodules. One out of three nodules was a 13cm hepatocellular adenoma, which was found to be located in Couinaud’s segments V and VI. After clamping via blood flow occlusion, parenchymal transection was performed along the outer edge of the tumor using a Sonicision™ Cordless Ultrasonic Dissection Device and an Endo GIA™ linear stapler. After liver resection, cholecystectomy was performed. The postoperative outcome was uneventful. Final pathological findings confirmed the diagnosis of an inflammatory type of hepatocellular adenoma.
P Pessaux, T Urade, T Wakabayashi, D Mutter, J Marescaux
Surgical intervention
10 months ago
1948 views
5 likes
0 comments
05:51
Laparoscopic partial liver resection for hepatocellular adenoma
We report a laparoscopic partial liver resection for a large hepatocellular adenoma. This is the case of a 34-year-old patient with several small hepatic nodules. One out of three nodules was a 13cm hepatocellular adenoma, which was found to be located in Couinaud’s segments V and VI. After clamping via blood flow occlusion, parenchymal transection was performed along the outer edge of the tumor using a Sonicision™ Cordless Ultrasonic Dissection Device and an Endo GIA™ linear stapler. After liver resection, cholecystectomy was performed. The postoperative outcome was uneventful. Final pathological findings confirmed the diagnosis of an inflammatory type of hepatocellular adenoma.
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
10 months ago
2390 views
5 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.
Laparoscopic central hepatectomy using a Glissonian approach for hepatocellular adenoma
A 32-year-old asymptomatic female patient presented an incidental finding of a liver mass during pregnancy. The mass grew during pregnancy, and a biopsy confirmed the diagnosis of hepatocellular adenoma. On MRI, a hypodense 7 by 6.1cm mass with adipose infiltration was identified. Previously, it was a 5.8 by 5.1cm mass, located in liver segments IV, V, and VIII inferiorly.
The cystic duct and its artery were ligated. However, the gallbladder was kept in place for traction. After dissection of the anterior pedicle, a linear stapler was applied. The right lobe was mobilized and the right transection line was made according to the ischemia line of the anterior sector.
During the liver transection of segment IVB, the pedicle was identified, and linear stapling helped to control it. The parenchymal transection was performed with an ultrasonic scalpel and bipolar cautery. The liver surface of the anterior sector was demarcated and transected. Both the left and the right plane of transection were inferiorly joined. The middle and right hepatic vein branches were stapled.
The specimen was mobilized. Argon beam and bipolar forceps provided the hemostasis. The specimen was removed via a Pfannenstiel’s incision and a drain was placed. The duration of the procedure was 345 minutes. The estimated blood loss was 1200mL.
The patient was discharged from the intensive care unit on postoperative day 1 and from hospital on postoperative day 4. No complication was noted in 90 days. Pathological findings showed a mass of 10.7 by 8.4 by 4.8cm. The lesion represented a hepatocellular adenoma with negative margins.
R Araujo, D Burgardt, V Vazquez, F Felippe, MA Sanctis, D Wohnrath
Surgical intervention
10 months ago
1027 views
5 likes
0 comments
09:00
Laparoscopic central hepatectomy using a Glissonian approach for hepatocellular adenoma
A 32-year-old asymptomatic female patient presented an incidental finding of a liver mass during pregnancy. The mass grew during pregnancy, and a biopsy confirmed the diagnosis of hepatocellular adenoma. On MRI, a hypodense 7 by 6.1cm mass with adipose infiltration was identified. Previously, it was a 5.8 by 5.1cm mass, located in liver segments IV, V, and VIII inferiorly.
The cystic duct and its artery were ligated. However, the gallbladder was kept in place for traction. After dissection of the anterior pedicle, a linear stapler was applied. The right lobe was mobilized and the right transection line was made according to the ischemia line of the anterior sector.
During the liver transection of segment IVB, the pedicle was identified, and linear stapling helped to control it. The parenchymal transection was performed with an ultrasonic scalpel and bipolar cautery. The liver surface of the anterior sector was demarcated and transected. Both the left and the right plane of transection were inferiorly joined. The middle and right hepatic vein branches were stapled.
The specimen was mobilized. Argon beam and bipolar forceps provided the hemostasis. The specimen was removed via a Pfannenstiel’s incision and a drain was placed. The duration of the procedure was 345 minutes. The estimated blood loss was 1200mL.
The patient was discharged from the intensive care unit on postoperative day 1 and from hospital on postoperative day 4. No complication was noted in 90 days. Pathological findings showed a mass of 10.7 by 8.4 by 4.8cm. The lesion represented a hepatocellular adenoma with negative margins.
ICG fluorescent cholangiography in difficult laparoscopic cholecystectomy with inflammatory biliary fusion post-cholecystitis and pancreatitis
Laparoscopic cholecystectomy in the presence of inflammatory billiary fusion is a technically challenging procedure associated with a 0.5% risk of injury to major extrahepatic bile ducts.
Preoperative planning and intraoperative visualization of the anatomy of the biliary tree using an intraoperative cholangiogram reduces the risk or the severity of injury to major biliary ducts.
Indocyanine green cholangiography has emerged as a promising non-invasive modality for visualization of extra-hepatic biliary ducts, having the advantage of very easy use repetitively at various stages of critical areas of dissection.
This video demonstrates a laparoscopic cholecystectomy in a patient who had an emergency admission for mild acute cholecystitis (as per Tokyo guidelines, 2018) and concomitant moderately severe acute gallstone pancreatitis (revised Atlanta classification) with a preoperative MRCP predictive of biliary inflammatory fusion between the gallbladder neck and the common hepatic duct.
Consequently, we planned and performed a laparoscopic cholecystectomy with an indocyanine green cholangiogram as a non-invasive method to help identify the intraoperative anatomy of the extra-hepatic biliary ducts.
The main feature of our video is the use of indocyanine green during the difficult dissection of the gallbladder neck and exposure of the critical view of safety in Calot’s triangle as cased with clear features of significant biliary inflammatory fusion between the cystic duct and the common hepatic duct.
ICG fluorescent demonstration of the extra-hepatic biliary tree is used in real time and with ease repeatedly at several stages of this difficult dissection, facilitating a safe completion of a difficult laparoscopic cholecystectomy and may become a standard practice.
G Kumar, S Ramachandran, M Paraoan
Surgical intervention
11 months ago
430 views
7 likes
2 comments
13:21
ICG fluorescent cholangiography in difficult laparoscopic cholecystectomy with inflammatory biliary fusion post-cholecystitis and pancreatitis
Laparoscopic cholecystectomy in the presence of inflammatory billiary fusion is a technically challenging procedure associated with a 0.5% risk of injury to major extrahepatic bile ducts.
Preoperative planning and intraoperative visualization of the anatomy of the biliary tree using an intraoperative cholangiogram reduces the risk or the severity of injury to major biliary ducts.
Indocyanine green cholangiography has emerged as a promising non-invasive modality for visualization of extra-hepatic biliary ducts, having the advantage of very easy use repetitively at various stages of critical areas of dissection.
This video demonstrates a laparoscopic cholecystectomy in a patient who had an emergency admission for mild acute cholecystitis (as per Tokyo guidelines, 2018) and concomitant moderately severe acute gallstone pancreatitis (revised Atlanta classification) with a preoperative MRCP predictive of biliary inflammatory fusion between the gallbladder neck and the common hepatic duct.
Consequently, we planned and performed a laparoscopic cholecystectomy with an indocyanine green cholangiogram as a non-invasive method to help identify the intraoperative anatomy of the extra-hepatic biliary ducts.
The main feature of our video is the use of indocyanine green during the difficult dissection of the gallbladder neck and exposure of the critical view of safety in Calot’s triangle as cased with clear features of significant biliary inflammatory fusion between the cystic duct and the common hepatic duct.
ICG fluorescent demonstration of the extra-hepatic biliary tree is used in real time and with ease repeatedly at several stages of this difficult dissection, facilitating a safe completion of a difficult laparoscopic cholecystectomy and may become a standard practice.
Laparoscopic ligation of middle sacral artery and dissection of sacrococcygeal teratoma to decrease intraoperative hemorrhagic risk
Sacrococcygeal teratomas are the most common teratomas presenting at birth. Life-threatening bleeding is a major complication during tumor excision in children. In this video, we demonstrate our technique for the laparoscopic division of the middle sacral artery during dissection of sacrococcygeal teratomas in two pediatric patients.
Two female infants diagnosed with type IV and type III sacrococcygeal teratomas underwent preoperative evaluation in the postnatal period. The first patient was an 18-month-old female patient who presented with a metastatic type IV teratoma resected after neoadjuvant therapy. The second patient was a 6-day-old female infant with a prenatal diagnosis of cystic type III teratoma. Using laparoscopy in both patients, the presacral space was reached by opening the peritoneal reflection with blunt dissection and the middle sacral artery was identified. It was then carefully isolated and divided with a 5mm LigaSure™ vessel-sealing device. The pelvic components of the tumors were partially dissected using laparoscopy. The first patient’s tumor resection was completed using a posterior sagittal approach and the second patient required a standard Chevron incision.
Both patients underwent a successful laparoscopic division of the middle sacral artery and resection of the sacrococcygeal teratomas without complications. As a result, laparoscopic middle sacral artery division before sacrococcygeal teratoma excision offers a safe approach which can reduce the risk of hemorrhage during surgery.
T Huy, H Osei, AS Munoz Abraham, R Damle, GA Villalona
Surgical intervention
1 year ago
784 views
5 likes
0 comments
05:33
Laparoscopic ligation of middle sacral artery and dissection of sacrococcygeal teratoma to decrease intraoperative hemorrhagic risk
Sacrococcygeal teratomas are the most common teratomas presenting at birth. Life-threatening bleeding is a major complication during tumor excision in children. In this video, we demonstrate our technique for the laparoscopic division of the middle sacral artery during dissection of sacrococcygeal teratomas in two pediatric patients.
Two female infants diagnosed with type IV and type III sacrococcygeal teratomas underwent preoperative evaluation in the postnatal period. The first patient was an 18-month-old female patient who presented with a metastatic type IV teratoma resected after neoadjuvant therapy. The second patient was a 6-day-old female infant with a prenatal diagnosis of cystic type III teratoma. Using laparoscopy in both patients, the presacral space was reached by opening the peritoneal reflection with blunt dissection and the middle sacral artery was identified. It was then carefully isolated and divided with a 5mm LigaSure™ vessel-sealing device. The pelvic components of the tumors were partially dissected using laparoscopy. The first patient’s tumor resection was completed using a posterior sagittal approach and the second patient required a standard Chevron incision.
Both patients underwent a successful laparoscopic division of the middle sacral artery and resection of the sacrococcygeal teratomas without complications. As a result, laparoscopic middle sacral artery division before sacrococcygeal teratoma excision offers a safe approach which can reduce the risk of hemorrhage during surgery.
Laparoscopic distal splenopancreatectomy for pancreatic cystadenoma: clockwise technique assisted with T’Lift device
Serous cystic neoplasm is a cystic neoplasm of the pancreas, which is increasingly detected at an asymptomatic stage. Serous cystadenomas are benign cystic tumors which occur more often in women than in men, and particularly in the seventh decade of life. Despite this, in the literature, three patients were reported to have malignant serous cystadenomas, with sizes greater than 7cm. The serous cystic neoplasm was confirmed by an imaging characteristic appearance, with multiple small or different-sized cysts, but when the diagnosis is doubtful, which often leads to surgery.
The clinical case is the one of a 79-year-old woman with a cystadenoma of the pancreas. She had a history of partial cystectomy for bladder neoplasia and recently (in 2017), she was submitted to laparoscopic focal cryotherapy for the treatment of a left unilateral renal tumor. At that time, she underwent a CT-can, which found a cystic neoplasm of the tail of the pancreas. A heterogeneous 5cm lesion appeared in the left hypochondrium, near the lower pole of the spleen, with no evidence of adenopathies highly suggestive of a serous cystadenoma of the pancreas.
In October 2018, in a follow-up CT-scan, there was an increase in size of the lesion (6.6cm) and a surgical resection was planned. A distal splenopancreatectomy using a clockwise technique was performed using the Signia™ stapling system with no complications. Histological examination confirmed a serous cystadenoma of the pancreas.
M Rui Martins, J Correia, D Jordão, S Martins, H Ferrão
Surgical intervention
1 year ago
1601 views
6 likes
0 comments
20:59
Laparoscopic distal splenopancreatectomy for pancreatic cystadenoma: clockwise technique assisted with T’Lift device
Serous cystic neoplasm is a cystic neoplasm of the pancreas, which is increasingly detected at an asymptomatic stage. Serous cystadenomas are benign cystic tumors which occur more often in women than in men, and particularly in the seventh decade of life. Despite this, in the literature, three patients were reported to have malignant serous cystadenomas, with sizes greater than 7cm. The serous cystic neoplasm was confirmed by an imaging characteristic appearance, with multiple small or different-sized cysts, but when the diagnosis is doubtful, which often leads to surgery.
The clinical case is the one of a 79-year-old woman with a cystadenoma of the pancreas. She had a history of partial cystectomy for bladder neoplasia and recently (in 2017), she was submitted to laparoscopic focal cryotherapy for the treatment of a left unilateral renal tumor. At that time, she underwent a CT-can, which found a cystic neoplasm of the tail of the pancreas. A heterogeneous 5cm lesion appeared in the left hypochondrium, near the lower pole of the spleen, with no evidence of adenopathies highly suggestive of a serous cystadenoma of the pancreas.
In October 2018, in a follow-up CT-scan, there was an increase in size of the lesion (6.6cm) and a surgical resection was planned. A distal splenopancreatectomy using a clockwise technique was performed using the Signia™ stapling system with no complications. Histological examination confirmed a serous cystadenoma of the pancreas.
LIVE UNCUT SURGERY: laparoscopic cholecystectomy for cholelithiasis, a gold standard procedure
This video describes an "ideal" cholecystectomy, with a stepwise approach to the cystic pedicle and the dissection of the gallbladder. This video emphasizes the key points of dissection necessary to perform a safe cholecystectomy.
The initial approach aims to expose the infundibulum and to successively dissect the anterior and posterior reflection of the peritoneum. It provides a safe view of the cystic duct and the cystic artery which can be dissected in order to secure the “critical view of safety”, exposing the cystic artery clearly away from the common bile duct and the right hepatic artery. This highlights the risky parts of the dissection when rules are not respected.
After complete control of the pedicle, freeing of the gallbladder in the appropriate plane avoids any oozing, keeping the operative field totally clear and safe.
Finally, the video shows the extraction method for the gallbladder, allowing the procedure to be performed with three 5mm ports and one 10-12mm port, thereby limiting the risk of postoperative port-site hernia.
This 20-minute live uncut video is a demonstration of a gold standard procedure.
D Mutter, G Philouze, B Seeliger, J Marescaux
Surgical intervention
1 year ago
20475 views
164 likes
19 comments
30:23
LIVE UNCUT SURGERY: laparoscopic cholecystectomy for cholelithiasis, a gold standard procedure
This video describes an "ideal" cholecystectomy, with a stepwise approach to the cystic pedicle and the dissection of the gallbladder. This video emphasizes the key points of dissection necessary to perform a safe cholecystectomy.
The initial approach aims to expose the infundibulum and to successively dissect the anterior and posterior reflection of the peritoneum. It provides a safe view of the cystic duct and the cystic artery which can be dissected in order to secure the “critical view of safety”, exposing the cystic artery clearly away from the common bile duct and the right hepatic artery. This highlights the risky parts of the dissection when rules are not respected.
After complete control of the pedicle, freeing of the gallbladder in the appropriate plane avoids any oozing, keeping the operative field totally clear and safe.
Finally, the video shows the extraction method for the gallbladder, allowing the procedure to be performed with three 5mm ports and one 10-12mm port, thereby limiting the risk of postoperative port-site hernia.
This 20-minute live uncut video is a demonstration of a gold standard procedure.
Laparoscopic cholecystectomy in a patient with nonalcoholic steatohepatitis (NASH) and idiopathic thrombocytopenic purpura
Morbid obesity surgery, which induces a rapid weight loss, is a predisposing factor for the onset of gallstones. There are treatments which help to reduce this risk. However, the observance is poor and lithogenicity brings about risks of complications such as cholecystitis, stone migration, and acute pancreatitis.
This video demonstrates the case of a patient who underwent a sleeve gastrectomy with a substantial weight loss. Stone migration was found along with a less serious pancreatic response. During a blood test analysis, thrombocytopenia was found and investigated by hematologists. Besides a low platelet count, a qualitative anomaly was observed increasing the risk of bleeding. Despite of this, cholecystectomy was necessary to prevent any new stone migration.
The operator was skilled and used a conventional laparoscopic approach. The patient’s liver is the site of a nonalcoholic steatohepatitis (NASH), making the procedure even more complex. Four ports were placed to allow for an adequate gallbladder retraction and for a minute dissection. Calot’s triangle was classically approached first as soon as the adhesions between the omentum and the gallbladder were taken down. Due to a thickened and inflammatory cystic duct, the entire gallbladder was dissected before ligating the cystic duct with two ligatures, one of them being reinforced by means of a surgical loop.
M Vix, B Seeliger, D Mutter, J Marescaux
Surgical intervention
1 year ago
998 views
3 likes
0 comments
13:25
Laparoscopic cholecystectomy in a patient with nonalcoholic steatohepatitis (NASH) and idiopathic thrombocytopenic purpura
Morbid obesity surgery, which induces a rapid weight loss, is a predisposing factor for the onset of gallstones. There are treatments which help to reduce this risk. However, the observance is poor and lithogenicity brings about risks of complications such as cholecystitis, stone migration, and acute pancreatitis.
This video demonstrates the case of a patient who underwent a sleeve gastrectomy with a substantial weight loss. Stone migration was found along with a less serious pancreatic response. During a blood test analysis, thrombocytopenia was found and investigated by hematologists. Besides a low platelet count, a qualitative anomaly was observed increasing the risk of bleeding. Despite of this, cholecystectomy was necessary to prevent any new stone migration.
The operator was skilled and used a conventional laparoscopic approach. The patient’s liver is the site of a nonalcoholic steatohepatitis (NASH), making the procedure even more complex. Four ports were placed to allow for an adequate gallbladder retraction and for a minute dissection. Calot’s triangle was classically approached first as soon as the adhesions between the omentum and the gallbladder were taken down. Due to a thickened and inflammatory cystic duct, the entire gallbladder was dissected before ligating the cystic duct with two ligatures, one of them being reinforced by means of a surgical loop.
Laparoscopic cholecystectomy for cholelithiasis, a gold standard procedure
This video describes an "ideal" cholecystectomy, with a stepwise approach to the cystic pedicle and the dissection of the gallbladder. This video emphasizes the key points of dissection necessary to perform a safe cholecystectomy. The initial approach aims to expose the infundibulum and to successively dissect the anterior and posterior reflection of the peritoneum. It provides a safe view of the cystic duct and the cystic artery which can be dissected in order to secure the “critical view of safety”, exposing the cystic artery clearly away from the common bile duct and the right hepatic artery. This highlights the risky parts of the dissection when rules are not respected. After complete control of the pedicle, freeing of the gallbladder in the appropriate plane avoids any oozing, keeping the operative field totally clear and safe. Finally, the video shows the extraction method for the gallbladder, allowing the procedure to be performed with three 5mm ports and one 10-12mm port, thereby limiting the risk of postoperative port-site hernia. This 20-minute live uncut video is a demonstration of a gold standard procedure.
D Mutter, G Philouze, B Seeliger, J Marescaux
How to
1 year ago
20396 views
160 likes
0 comments
00:30:23
Laparoscopic cholecystectomy for cholelithiasis, a gold standard procedure
This video describes an "ideal" cholecystectomy, with a stepwise approach to the cystic pedicle and the dissection of the gallbladder. This video emphasizes the key points of dissection necessary to perform a safe cholecystectomy. The initial approach aims to expose the infundibulum and to successively dissect the anterior and posterior reflection of the peritoneum. It provides a safe view of the cystic duct and the cystic artery which can be dissected in order to secure the “critical view of safety”, exposing the cystic artery clearly away from the common bile duct and the right hepatic artery. This highlights the risky parts of the dissection when rules are not respected. After complete control of the pedicle, freeing of the gallbladder in the appropriate plane avoids any oozing, keeping the operative field totally clear and safe. Finally, the video shows the extraction method for the gallbladder, allowing the procedure to be performed with three 5mm ports and one 10-12mm port, thereby limiting the risk of postoperative port-site hernia. This 20-minute live uncut video is a demonstration of a gold standard procedure.
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
913 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.
Laparoscopic partial nephrectomy on non-functional, symptomatic right lower pole of the kidney
In this video, we present the case of a 13-year-old girl presenting with a complicated urological anomaly discovered very late. The lower part of her right kidney is dysplastic (or destroyed) with pseudocystic pyelocalyceal cavities filled with stones and cloudy urine. The first hypothesis is that we are dealing with a true renal duplicity with a destroyed non-functional inferior pole. In this case, there is one ureter per kidney pole. As a result, polar ureteronephrectomy does not cause any potential vascular problems.
In this case, thanks to 3D reconstruction (Visible Patient™, a spinoff of IRCAD), it is clear that there is no kidney duplicity, but a pyelic bifurcation. It means that we should manage the only ureter, which drains the superior and inferior pelvis. For that reason, the placement of a double J catheter is essential prior to partial nephrectomy. This catheter should be pulled up until the superior pelvis.
Tridimensional reconstruction of the CT-scan images of a patient with a malformation is extremely helpful to better understand the original and unique anatomy of the patient and to determine a tailored operative strategy.
This video demonstrates a laparoscopic partial nephrectomy on non-functional, symptomatic right lower pole of the kidney in a 13-year-old girl as an outpatient surgery.
F Becmeur, A Lachkar, L Soler
Surgical intervention
1 year ago
2179 views
4 likes
0 comments
07:24
Laparoscopic partial nephrectomy on non-functional, symptomatic right lower pole of the kidney
In this video, we present the case of a 13-year-old girl presenting with a complicated urological anomaly discovered very late. The lower part of her right kidney is dysplastic (or destroyed) with pseudocystic pyelocalyceal cavities filled with stones and cloudy urine. The first hypothesis is that we are dealing with a true renal duplicity with a destroyed non-functional inferior pole. In this case, there is one ureter per kidney pole. As a result, polar ureteronephrectomy does not cause any potential vascular problems.
In this case, thanks to 3D reconstruction (Visible Patient™, a spinoff of IRCAD), it is clear that there is no kidney duplicity, but a pyelic bifurcation. It means that we should manage the only ureter, which drains the superior and inferior pelvis. For that reason, the placement of a double J catheter is essential prior to partial nephrectomy. This catheter should be pulled up until the superior pelvis.
Tridimensional reconstruction of the CT-scan images of a patient with a malformation is extremely helpful to better understand the original and unique anatomy of the patient and to determine a tailored operative strategy.
This video demonstrates a laparoscopic partial nephrectomy on non-functional, symptomatic right lower pole of the kidney in a 13-year-old girl as an outpatient surgery.
Laparoscopic transcystic clearance of the common bile duct (CBD) during three-trocar cholecystectomy
Common bile duct stones are found in approximately 16% of patients undergoing laparoscopic cholecystectomy. If the diagnosis is established during intraoperative cholangiography, the surgeon is confronted with a therapeutic dilemma, namely the choice between laparoscopic common bile duct (CBD) exploration, conversion to open surgery, or postoperative endoscopic sphincterotomy. Laparoscopic CBD exploration can be performed through the cystic duct or through a choledochotomy, the choice being mainly guided by the size of the CBD stone and the size of the cystic duct and common bile duct. In this patient with a large cystic duct, small stone and normal CBD size, we have opted for the transcystic extraction, using the Dormia basket under fluoroscopic guidance. The procedure was performed using a three-trocar approach and a new internal retraction device that suspends the gallbladder.
B Dallemagne, T Piardi, J Marescaux
Surgical intervention
7 years ago
4098 views
21 likes
1 comment
12:26
Laparoscopic transcystic clearance of the common bile duct (CBD) during three-trocar cholecystectomy
Common bile duct stones are found in approximately 16% of patients undergoing laparoscopic cholecystectomy. If the diagnosis is established during intraoperative cholangiography, the surgeon is confronted with a therapeutic dilemma, namely the choice between laparoscopic common bile duct (CBD) exploration, conversion to open surgery, or postoperative endoscopic sphincterotomy. Laparoscopic CBD exploration can be performed through the cystic duct or through a choledochotomy, the choice being mainly guided by the size of the CBD stone and the size of the cystic duct and common bile duct. In this patient with a large cystic duct, small stone and normal CBD size, we have opted for the transcystic extraction, using the Dormia basket under fluoroscopic guidance. The procedure was performed using a three-trocar approach and a new internal retraction device that suspends the gallbladder.
Laparoscopic right hemihepatectomy
A laparoscopic right hemihepatectomy was performed for a gastric liver metastasis. After the dissection of the anatomical structure of the hepatic pedicle and an ultrasound examination, the right portal vein and the right branch of the hepatic artery were clamped, hence allowing to skeletonize the demarcation between the right liver and the left liver. The devascularization line was subsequently marked by means of electrocautery. The right hepatic branch and the right branch of the portal vein were divided between locked clips. The hepatotomy was started. The first very superficial centimeters were dissected using the Sonicision® Cordless Ultrasonic Dissection Device. No pedicular clamping was performed. The dissection followed the ischemic demarcation line between the right liver and the left liver. Hemostasis and biliostasis were completed using the Aquamantys® Bipolar Sealers. Once the first centimeters had been dissected, dissection was carried on using the CUSA™ ultrasonic dissector (Cavitron Ultrasonic Surgical Aspirator). Liver segment I was divided in order to open the posterior aspect of the hilar plate. The dissection was performed on the right border of the vena cava. The hilar plate was dissected, making it possible to control the right branch of the biliary tract intraparenchymally. The right hepatic vein was dissected and divided with an Endo GIA™ linear stapler. Makuuchi’s ligament was subsequently dissected and divided by means of a firing of the Endo GIA™ linear stapler, white cartridge. Mobilization of the right liver was completed by dividing the triangular ligament’s attachments at the level of the diaphragm. The right hepatectomy specimen was introduced into a bag, which was extracted through a suprapubic Pfannenstiel’s incision. Pneumoperitoneum pressure was diminished in order to control hemostasis and biliostasis.
P Pessaux, R Memeo, J Hallet, Z Cherkaoui, D Mutter, J Marescaux
Surgical intervention
2 years ago
7562 views
944 likes
0 comments
32:12
Laparoscopic right hemihepatectomy
A laparoscopic right hemihepatectomy was performed for a gastric liver metastasis. After the dissection of the anatomical structure of the hepatic pedicle and an ultrasound examination, the right portal vein and the right branch of the hepatic artery were clamped, hence allowing to skeletonize the demarcation between the right liver and the left liver. The devascularization line was subsequently marked by means of electrocautery. The right hepatic branch and the right branch of the portal vein were divided between locked clips. The hepatotomy was started. The first very superficial centimeters were dissected using the Sonicision® Cordless Ultrasonic Dissection Device. No pedicular clamping was performed. The dissection followed the ischemic demarcation line between the right liver and the left liver. Hemostasis and biliostasis were completed using the Aquamantys® Bipolar Sealers. Once the first centimeters had been dissected, dissection was carried on using the CUSA™ ultrasonic dissector (Cavitron Ultrasonic Surgical Aspirator). Liver segment I was divided in order to open the posterior aspect of the hilar plate. The dissection was performed on the right border of the vena cava. The hilar plate was dissected, making it possible to control the right branch of the biliary tract intraparenchymally. The right hepatic vein was dissected and divided with an Endo GIA™ linear stapler. Makuuchi’s ligament was subsequently dissected and divided by means of a firing of the Endo GIA™ linear stapler, white cartridge. Mobilization of the right liver was completed by dividing the triangular ligament’s attachments at the level of the diaphragm. The right hepatectomy specimen was introduced into a bag, which was extracted through a suprapubic Pfannenstiel’s incision. Pneumoperitoneum pressure was diminished in order to control hemostasis and biliostasis.
Laparoscopic distal pancreatectomy with spleen resection
We reported a laparoscopic distal pancreatectomy with spleen resection for a mucinous cystic lesion. Four ports were positioned. The greater omentum was retracted to the superior part of the abdomen in order to detach the colon from the omentum and approach the lesser sac. The stomach was dissected. A tape was placed around the stomach through the abdominal wall, making it possible to retract the stomach at the level of the pyloric junction towards the upper part of the abdomen. A second tape was placed at the antral part in order to achieve a retraction towards the left hypochondrium at the superior part of the abdomen. The mesentericoportal axis was identified and dissected at the inferior border of the pancreas. The right gastroepiploic vein was one of the landmarks. The superior border of the pancreas was dissected in order to identify the splenic artery and a tape was positioned around it. The dissection was performed progressively at the anterior aspect of the mesentericoportal axis through an avascular channel. A tape was subsequently positioned around the pancreatic isthmus. The pancreas was divided with a stapler. The stapling was performed very progressively to avoid crushing the pancreas. The splenic vein was dissected in order to preserve the left gastric vein and a tape was positioned around it. The splenic artery was first divided between two clips on the remaining surface. The splenic vein was also divided. Dissection was pursued from the right to the left, making it possible to mobilize the pancreas. The inferior mesenteric vein was dissected and divided. Dissection of the posterior mesogastrium was initiated, making it possible to mobilize the splenopancreatic block. The dissection was performed anteriorly to the plane of Gerota’s fascia, anteriorly to the kidney. Since the posterior dissection was almost complete, our attention was turned to the superior part to complete the dissection of lesser sac adhesions at the superior border of the pancreas. It was necessary to divide the greater omentum by gradually dividing the short gastric vessels. Due to venous derivations linked to segmental portal hypertension, this dissection was performed through the application of the Endo GIA™ linear stapler. Since the entire specimen had been divided and freed, it was placed in a bag to be extracted through a suprapubic Pfannenstiel’s incision.
P Pessaux, X Untereiner, Z Cherkaoui, V Louis, D Mutter, J Marescaux
Surgical intervention
2 years ago
5792 views
606 likes
0 comments
45:34
Laparoscopic distal pancreatectomy with spleen resection
We reported a laparoscopic distal pancreatectomy with spleen resection for a mucinous cystic lesion. Four ports were positioned. The greater omentum was retracted to the superior part of the abdomen in order to detach the colon from the omentum and approach the lesser sac. The stomach was dissected. A tape was placed around the stomach through the abdominal wall, making it possible to retract the stomach at the level of the pyloric junction towards the upper part of the abdomen. A second tape was placed at the antral part in order to achieve a retraction towards the left hypochondrium at the superior part of the abdomen. The mesentericoportal axis was identified and dissected at the inferior border of the pancreas. The right gastroepiploic vein was one of the landmarks. The superior border of the pancreas was dissected in order to identify the splenic artery and a tape was positioned around it. The dissection was performed progressively at the anterior aspect of the mesentericoportal axis through an avascular channel. A tape was subsequently positioned around the pancreatic isthmus. The pancreas was divided with a stapler. The stapling was performed very progressively to avoid crushing the pancreas. The splenic vein was dissected in order to preserve the left gastric vein and a tape was positioned around it. The splenic artery was first divided between two clips on the remaining surface. The splenic vein was also divided. Dissection was pursued from the right to the left, making it possible to mobilize the pancreas. The inferior mesenteric vein was dissected and divided. Dissection of the posterior mesogastrium was initiated, making it possible to mobilize the splenopancreatic block. The dissection was performed anteriorly to the plane of Gerota’s fascia, anteriorly to the kidney. Since the posterior dissection was almost complete, our attention was turned to the superior part to complete the dissection of lesser sac adhesions at the superior border of the pancreas. It was necessary to divide the greater omentum by gradually dividing the short gastric vessels. Due to venous derivations linked to segmental portal hypertension, this dissection was performed through the application of the Endo GIA™ linear stapler. Since the entire specimen had been divided and freed, it was placed in a bag to be extracted through a suprapubic Pfannenstiel’s incision.
Endoscopic management of cystic duct leakage after cholecystectomy
Biliary leaks still represent a significant problem following open or laparoscopic cholecystectomy. The incidence of bile duct leaks after such operations was reported to range between 0.3 and 1%. This video presents the case of a 75-year-old man who was referred to our department for fever, jaundice, and abdominal pain 12 days after laparoscopic cholecystectomy. A cholangio-MRI was carried out. It demonstrated an intra-abdominal biliary collection at the level of the gallbladder bed. A leak from the cystic duct was suspected. A radiological drainage of the collection was performed, and an endoscopic sphincterotomy with plastic stenting of the common bile duct was achieved. The patient went clinically well and at 2 months, the stent was removed. Two months after stent removal, he is totally symptom-free.
Gf Donatelli, L Marx, D Mutter, J Marescaux
Surgical intervention
8 years ago
1903 views
4 likes
0 comments
02:55
Endoscopic management of cystic duct leakage after cholecystectomy
Biliary leaks still represent a significant problem following open or laparoscopic cholecystectomy. The incidence of bile duct leaks after such operations was reported to range between 0.3 and 1%. This video presents the case of a 75-year-old man who was referred to our department for fever, jaundice, and abdominal pain 12 days after laparoscopic cholecystectomy. A cholangio-MRI was carried out. It demonstrated an intra-abdominal biliary collection at the level of the gallbladder bed. A leak from the cystic duct was suspected. A radiological drainage of the collection was performed, and an endoscopic sphincterotomy with plastic stenting of the common bile duct was achieved. The patient went clinically well and at 2 months, the stent was removed. Two months after stent removal, he is totally symptom-free.