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Laparoscopic repair of giant left Bochdalek hernia in adults: resolution of 2 cases
A Bochdalek hernia is a congenital diaphragmatic defect which results from the improper fusion of the septum transversum and of the pleuroperitoneal folds. It rarely persists asymptomatically until adulthood. The reported incidence is as low as 0.17%. Surgical repair of the defect can be performed through the abdomen or through the chest, and in both cases, using open surgery or laparoscopy/thoracoscopy.
We present two cases of fully laparoscopic repair of a giant Bochdalek hernia in adults. In both cases, we used a GORE® DUALMESH® biomaterial and we had no complications and no recurrence. It is worth mentioning that the hernia sac was not found in any of the cases. This has been described as a distinct characteristic, which confirms the diagnosis.
Bochdalek hernia in adults is a rare entity, which requires surgical treatment to prevent any complications.
F Signorini, S Reimondez, P Maldonado, V Gorodner, L Obeide, F Moser, N Bollati
Surgical intervention
1 year ago
2552 views
180 likes
0 comments
10:10
Laparoscopic repair of giant left Bochdalek hernia in adults: resolution of 2 cases
A Bochdalek hernia is a congenital diaphragmatic defect which results from the improper fusion of the septum transversum and of the pleuroperitoneal folds. It rarely persists asymptomatically until adulthood. The reported incidence is as low as 0.17%. Surgical repair of the defect can be performed through the abdomen or through the chest, and in both cases, using open surgery or laparoscopy/thoracoscopy.
We present two cases of fully laparoscopic repair of a giant Bochdalek hernia in adults. In both cases, we used a GORE® DUALMESH® biomaterial and we had no complications and no recurrence. It is worth mentioning that the hernia sac was not found in any of the cases. This has been described as a distinct characteristic, which confirms the diagnosis.
Bochdalek hernia in adults is a rare entity, which requires surgical treatment to prevent any complications.
Laparoscopic postpartum right diaphragmatic hernia reduction
A 35-year-old patient was referred to our emergency department for acute abdominal pain and respiratory distress. The patient gave natural childbirth three days before the episode, a childbirth without immediate complications.
Clinically, the patient presented with tachypnea, tachycardia, and desaturation, nauseas and constipation, depressible abdomen with generalized pain on palpation. The absence of vesicular murmur and right lung dullness were noted.
Blood lab findings showed increased inflammatory parameters.
An abdominothoracic CT-scan with contrast was performed. It showed a voluminous right diaphragmatic hernia containing the omentum, a distended colon and liver segment VIII with signs of hypoperfusion.
A surgical procedure was performed. A laparoscopic approach was performed and the patient’s hiatal hernia was reduced by closing the defect with a non-absorbable suture and by placing a Vicryl mesh.
The patient recovered with no complications and was discharged on postoperative day 3.
A D'Urso, P Saleg, D Mutter, J Marescaux
Surgical intervention
1 year ago
1783 views
112 likes
0 comments
09:10
Laparoscopic postpartum right diaphragmatic hernia reduction
A 35-year-old patient was referred to our emergency department for acute abdominal pain and respiratory distress. The patient gave natural childbirth three days before the episode, a childbirth without immediate complications.
Clinically, the patient presented with tachypnea, tachycardia, and desaturation, nauseas and constipation, depressible abdomen with generalized pain on palpation. The absence of vesicular murmur and right lung dullness were noted.
Blood lab findings showed increased inflammatory parameters.
An abdominothoracic CT-scan with contrast was performed. It showed a voluminous right diaphragmatic hernia containing the omentum, a distended colon and liver segment VIII with signs of hypoperfusion.
A surgical procedure was performed. A laparoscopic approach was performed and the patient’s hiatal hernia was reduced by closing the defect with a non-absorbable suture and by placing a Vicryl mesh.
The patient recovered with no complications and was discharged on postoperative day 3.
Laparoscopic repair of a diaphragmatic hernia after thoracic surgery with mesh insertion
Traumatic diaphragmatic hernias have been well described after blunt trauma. Diaphragmatic ruptures can occur in up to 0.8 to 7% of blunt abdominal trauma, with large left-sided defects being the most common. If the injury goes unrecognized, progressive herniation of abdominal contents may follow.
We report the case of a diaphragmatic hernia in a 48-year-old woman. The patient reports dyspnea and vomiting after left diaphragmatic node resection (diaphragmatic granuloma) one year ago.
A CT-scan demonstrated a large defect within the left hemi-diaphragm, associated with a herniation of the antrum, body of the stomach, colon, and spleen into the thoracic cavity.
At laparoscopy, a large rupture of the left hemi-diaphragm with a big herniation is shown. The hernia was reduced laparoscopically, and the defect was repaired with interrupted absorbable sutures and reinforced with continuous sutures. An intraperitoneal mesh was placed. The patient recovered uneventfully.
Diagnosis of a traumatic diaphragmatic hernia in the acute setting can be very challenging. In the chronic period, a myriad of symptoms and radiological findings may arise. Plain films, CT-scan, magnetic resonance imaging, and even diagnostic laparoscopy can help with the diagnosis. Laparoscopy is a safe and feasible method to repair traumatic diaphragmatic hernias, especially in the chronic setting, with the advantage of evaluating the entire abdomen and both hemi-diaphragms simultaneously.
FE Viamontes Ugalde, A Abascal Amo, J Delgado Valdueza
Surgical intervention
3 years ago
1563 views
64 likes
0 comments
12:52
Laparoscopic repair of a diaphragmatic hernia after thoracic surgery with mesh insertion
Traumatic diaphragmatic hernias have been well described after blunt trauma. Diaphragmatic ruptures can occur in up to 0.8 to 7% of blunt abdominal trauma, with large left-sided defects being the most common. If the injury goes unrecognized, progressive herniation of abdominal contents may follow.
We report the case of a diaphragmatic hernia in a 48-year-old woman. The patient reports dyspnea and vomiting after left diaphragmatic node resection (diaphragmatic granuloma) one year ago.
A CT-scan demonstrated a large defect within the left hemi-diaphragm, associated with a herniation of the antrum, body of the stomach, colon, and spleen into the thoracic cavity.
At laparoscopy, a large rupture of the left hemi-diaphragm with a big herniation is shown. The hernia was reduced laparoscopically, and the defect was repaired with interrupted absorbable sutures and reinforced with continuous sutures. An intraperitoneal mesh was placed. The patient recovered uneventfully.
Diagnosis of a traumatic diaphragmatic hernia in the acute setting can be very challenging. In the chronic period, a myriad of symptoms and radiological findings may arise. Plain films, CT-scan, magnetic resonance imaging, and even diagnostic laparoscopy can help with the diagnosis. Laparoscopy is a safe and feasible method to repair traumatic diaphragmatic hernias, especially in the chronic setting, with the advantage of evaluating the entire abdomen and both hemi-diaphragms simultaneously.
Laparoscopic repair of a congenital diaphragmatic hernia (CDH)
Eligibility criteria for the thoracoscopic approach in case of a congenital diaphragmatic hernia (CDH) in infants were jointly addressed at the ESPES/IPEG-ESPU Masterclass in March 2017 held at IRCAD, and also published on WeBSurg.
This video aims to show a series of technical details in case of thoracoscopy for CDH grade B according to the currently accepted international classification. At the beginning of the procedure, short intrathoracic low pressure carbon dioxide insufflation at 4mmHg and 1.5 Liter per minute was performed during hernia reduction. The posterior diaphragmatic border was then freed and a diaphragmatic suture was performed using non-absorbable separate 2/0 stitches. A GoreTex DualMesh® patch was used to complete the external suturing of the diaphragm and to achieve fixation stitches.
I Kauffmann, F Becmeur
Surgical intervention
1 year ago
2949 views
14 likes
0 comments
04:17
Laparoscopic repair of a congenital diaphragmatic hernia (CDH)
Eligibility criteria for the thoracoscopic approach in case of a congenital diaphragmatic hernia (CDH) in infants were jointly addressed at the ESPES/IPEG-ESPU Masterclass in March 2017 held at IRCAD, and also published on WeBSurg.
This video aims to show a series of technical details in case of thoracoscopy for CDH grade B according to the currently accepted international classification. At the beginning of the procedure, short intrathoracic low pressure carbon dioxide insufflation at 4mmHg and 1.5 Liter per minute was performed during hernia reduction. The posterior diaphragmatic border was then freed and a diaphragmatic suture was performed using non-absorbable separate 2/0 stitches. A GoreTex DualMesh® patch was used to complete the external suturing of the diaphragm and to achieve fixation stitches.
Inanimate model to train for the thoracoscopic repair of all varieties of left congenital diaphragmatic hernia (CDH)
We present a new low-cost model designed for training skills and strategies for the thoracoscopic repair of left congenital diaphragmatic defects. We will present guidelines to make this type of models, the educational strategy that we use in our advanced training models, the defects that can be trained, and the scope of this model. Advanced training, learning tips and tricks from experts, and the use of innovative ideas from other authors used in our model are outlined. This educational tool was developed for pediatric surgeons requiring advanced training. It reinforces the concept of advanced and continuous training, in a safe environment, and it is assisted by experienced surgeons. This model shows a scenario where dimensions and anatomical repairs are carefully preserved.
We share our vision of continuous endosurgical education to encourage all enthusiastic surgeons to train in safe and controlled environments.
Materials and methods: The model consists in a plastic 3D printed left rib cage, extracted from a 6-month-old baby CT-scan combined with simulated mediastinal structures, diaphragm, bowel, lung, and spleen made of latex, silicone, and polyester sponge respectively. A self-adhesive film is used as parietal pleura. A removable part (spare part) represents the last three ribs where the diaphragm is partially inserted, and a base as the upper abdomen is assembled to the left rib cage (ribs 1 to 9). Abdominal viscera (plastic or animal) are placed in this base. The cost of materials is 150 US$.
The model is meant to simulate the most frequent diaphragmatic defects such as type A, B, and C, with or without sac. However, other rare defects can also be simulated. Live animal tissues such as diaphragm or intestine also can be used, as it was already published by other authors. However, the main characteristic of this model is to be inanimate, portable, and easily reloadable to be reused.
The video shows a junior surgeon in his advanced training process. In the model, we perform the reduction of the viscera slid to the thorax. In this case, it is the rabbit intestine, but we usually use latex simulated intestine. The spleen is completely synthetic and bleeds if the instruments damage it during the reduction.
We use 3mm regular instruments. The repair of the defect is made with separate stitches of 2/0 or 3/0 braided polyester as usual, and we encourage trainees to practice the intracorporeal sliding knot and running suture. We collect the performance data in a specially prepared form and carry out the debriefing.
Conclusions: With this model, we can reinforce the concept of low cost, but with a high precision environment simulation, included within a standardized training program in minimally invasive neonatal surgery. We believe that it is a very useful tool. In addition, this type of models allows the use of new surgical techniques, tips and tricks given by experienced surgeons who assist in the training process.
M Maricic, M Bailez
Surgical intervention
1 year ago
1497 views
8 likes
1 comment
08:14
Inanimate model to train for the thoracoscopic repair of all varieties of left congenital diaphragmatic hernia (CDH)
We present a new low-cost model designed for training skills and strategies for the thoracoscopic repair of left congenital diaphragmatic defects. We will present guidelines to make this type of models, the educational strategy that we use in our advanced training models, the defects that can be trained, and the scope of this model. Advanced training, learning tips and tricks from experts, and the use of innovative ideas from other authors used in our model are outlined. This educational tool was developed for pediatric surgeons requiring advanced training. It reinforces the concept of advanced and continuous training, in a safe environment, and it is assisted by experienced surgeons. This model shows a scenario where dimensions and anatomical repairs are carefully preserved.
We share our vision of continuous endosurgical education to encourage all enthusiastic surgeons to train in safe and controlled environments.
Materials and methods: The model consists in a plastic 3D printed left rib cage, extracted from a 6-month-old baby CT-scan combined with simulated mediastinal structures, diaphragm, bowel, lung, and spleen made of latex, silicone, and polyester sponge respectively. A self-adhesive film is used as parietal pleura. A removable part (spare part) represents the last three ribs where the diaphragm is partially inserted, and a base as the upper abdomen is assembled to the left rib cage (ribs 1 to 9). Abdominal viscera (plastic or animal) are placed in this base. The cost of materials is 150 US$.
The model is meant to simulate the most frequent diaphragmatic defects such as type A, B, and C, with or without sac. However, other rare defects can also be simulated. Live animal tissues such as diaphragm or intestine also can be used, as it was already published by other authors. However, the main characteristic of this model is to be inanimate, portable, and easily reloadable to be reused.
The video shows a junior surgeon in his advanced training process. In the model, we perform the reduction of the viscera slid to the thorax. In this case, it is the rabbit intestine, but we usually use latex simulated intestine. The spleen is completely synthetic and bleeds if the instruments damage it during the reduction.
We use 3mm regular instruments. The repair of the defect is made with separate stitches of 2/0 or 3/0 braided polyester as usual, and we encourage trainees to practice the intracorporeal sliding knot and running suture. We collect the performance data in a specially prepared form and carry out the debriefing.
Conclusions: With this model, we can reinforce the concept of low cost, but with a high precision environment simulation, included within a standardized training program in minimally invasive neonatal surgery. We believe that it is a very useful tool. In addition, this type of models allows the use of new surgical techniques, tips and tricks given by experienced surgeons who assist in the training process.
Full laparoscopic repair of a post-traumatic diaphragmatic hernia with mesh insertion
This is the case of a 34-year-old man who suffered from a blunt trauma, 8 months before this surgery. He presented with oppressive chest pain, lasting for a week, increasing while exercising and decreasing when lying down. No history of chronic pathology or smoking was reported. He was admitted to hospital. CT-scan of the abdomen and thorax showed a left diaphragmatic hernia. A laparoscopic diaphragmatic hernioplasty was decided upon. The patient is placed in a right semi-lateral decubitus position, with a 45-degree tilt.
Three trocars were placed; two 5mm trocars in the left upper quadrant, in the anterior axillary line, and in the epigastrium, while a 12mm optical trocar is placed in the upper left quadrant, in the midclavicular line.
The left lung is collapsed. Laparoscopy revealed a left diaphragmatic defect, with a diaphragmatic hernia which contains the spleen, small bowel loops, and the omentum. The hernia contents are reduced into the abdominal cavity. The diaphragmatic defect is then sutured with non-absorbable material. A GORE® DUALMESH® biomaterial is placed over the previous defect and attached to the diaphragm with steel ENDO TACKERS™. A pleurostomy tube is placed and the lung is expanded. The patient outcome was uneventful and he was discharged 5 days after the procedure.
F Terrazas, J Lorenzo Silva, D Molina, A Gonzalez, H Bravo
Surgical intervention
2 years ago
2274 views
120 likes
0 comments
06:34
Full laparoscopic repair of a post-traumatic diaphragmatic hernia with mesh insertion
This is the case of a 34-year-old man who suffered from a blunt trauma, 8 months before this surgery. He presented with oppressive chest pain, lasting for a week, increasing while exercising and decreasing when lying down. No history of chronic pathology or smoking was reported. He was admitted to hospital. CT-scan of the abdomen and thorax showed a left diaphragmatic hernia. A laparoscopic diaphragmatic hernioplasty was decided upon. The patient is placed in a right semi-lateral decubitus position, with a 45-degree tilt.
Three trocars were placed; two 5mm trocars in the left upper quadrant, in the anterior axillary line, and in the epigastrium, while a 12mm optical trocar is placed in the upper left quadrant, in the midclavicular line.
The left lung is collapsed. Laparoscopy revealed a left diaphragmatic defect, with a diaphragmatic hernia which contains the spleen, small bowel loops, and the omentum. The hernia contents are reduced into the abdominal cavity. The diaphragmatic defect is then sutured with non-absorbable material. A GORE® DUALMESH® biomaterial is placed over the previous defect and attached to the diaphragm with steel ENDO TACKERS™. A pleurostomy tube is placed and the lung is expanded. The patient outcome was uneventful and he was discharged 5 days after the procedure.
Single incision laparoscopic non-traumatic left lateral diaphragmatic hernia repair
Background: A diaphragmatic hernia is a quite uncommon disease, being congenital or post-traumatic. Its diagnosis is frequently incidental. The surgical treatment can be performed through the abdomen as well as through the chest. Laparoscopy and thoracoscopy offer a surgical benefit, because of reduced abdominal wall trauma and added advantages provided by minimally invasive surgery (MIS). Transumbilical single incision laparoscopy (TSIL), in addition to improved cosmetic results, can offer other advantages to MIS such as reduced postoperative pain, a shorter hospital stay, and improved patient comfort.
Video: The authors report the case of a 45-year-old man who consulted for a non-traumatic left lateral diaphragmatic hernia, which was discovered incidentally, and which was treated using TSIL suture and mesh reinforcement.
Results: Laparoscopic time was 104 minutes and perioperative bleeding was insignificant. The final umbilical scar was 15mm. During the postoperative course, only 4 grams of paracetamol were used. The patient was discharged on the 1st postoperative day, after chest X-ray control. At consultation, the patient did not report the use of painkillers and, at 1, 6, and 12 months, the chest X-ray control was negative for recurrence.
Conclusions: Uncommon conditions, such as a lateral diaphragmatic hernia, can be approached using TSIL, because this technique adds an improved cosmetic result, a reduced postoperative pain, a shorter hospital stay, and an improved patient comfort.
G Dapri, K Jottard, K Grozdev, D Guta, GB Cadière
Surgical intervention
3 years ago
1021 views
32 likes
0 comments
07:14
Single incision laparoscopic non-traumatic left lateral diaphragmatic hernia repair
Background: A diaphragmatic hernia is a quite uncommon disease, being congenital or post-traumatic. Its diagnosis is frequently incidental. The surgical treatment can be performed through the abdomen as well as through the chest. Laparoscopy and thoracoscopy offer a surgical benefit, because of reduced abdominal wall trauma and added advantages provided by minimally invasive surgery (MIS). Transumbilical single incision laparoscopy (TSIL), in addition to improved cosmetic results, can offer other advantages to MIS such as reduced postoperative pain, a shorter hospital stay, and improved patient comfort.
Video: The authors report the case of a 45-year-old man who consulted for a non-traumatic left lateral diaphragmatic hernia, which was discovered incidentally, and which was treated using TSIL suture and mesh reinforcement.
Results: Laparoscopic time was 104 minutes and perioperative bleeding was insignificant. The final umbilical scar was 15mm. During the postoperative course, only 4 grams of paracetamol were used. The patient was discharged on the 1st postoperative day, after chest X-ray control. At consultation, the patient did not report the use of painkillers and, at 1, 6, and 12 months, the chest X-ray control was negative for recurrence.
Conclusions: Uncommon conditions, such as a lateral diaphragmatic hernia, can be approached using TSIL, because this technique adds an improved cosmetic result, a reduced postoperative pain, a shorter hospital stay, and an improved patient comfort.
Laparoscopic management of right hydrothorax following peritoneal dialysis (PD)
Hydrothorax due to migration of dialysis fluid across the diaphragm and into the pleural space creates a serious complication of peritoneal dialysis (PD) but generally does not threaten life. The most current surgical option is the thoracoscopic approach. In this video, we propose an alternative treatment through an abdominal laparoscopic approach.
Hydrothorax occurs rarely but represents a well-recognized complication of peritoneal dialysis (PD). The incidence of this condition ranges between 1.6% and 10% of peritoneal dialysis patients. Patients typically present with respiratory symptoms associated with reduction of dialysis fluid. The presence of pleuroperitoneal communication has been identified as the most common reason explaining hydrothorax in peritoneal dialysis.
Conservative medical treatment is not effective. Surgical approaches range from open repair through a thoracotomy to video-assisted thoracoscopy surgery (VATS) with or without chemical or mechanical pleurodesis.
A D'Urso, D Mutter, J Marescaux
Surgical intervention
4 years ago
699 views
10 likes
0 comments
04:02
Laparoscopic management of right hydrothorax following peritoneal dialysis (PD)
Hydrothorax due to migration of dialysis fluid across the diaphragm and into the pleural space creates a serious complication of peritoneal dialysis (PD) but generally does not threaten life. The most current surgical option is the thoracoscopic approach. In this video, we propose an alternative treatment through an abdominal laparoscopic approach.
Hydrothorax occurs rarely but represents a well-recognized complication of peritoneal dialysis (PD). The incidence of this condition ranges between 1.6% and 10% of peritoneal dialysis patients. Patients typically present with respiratory symptoms associated with reduction of dialysis fluid. The presence of pleuroperitoneal communication has been identified as the most common reason explaining hydrothorax in peritoneal dialysis.
Conservative medical treatment is not effective. Surgical approaches range from open repair through a thoracotomy to video-assisted thoracoscopy surgery (VATS) with or without chemical or mechanical pleurodesis.
Thoracoscopic Bochdalek hernia repair in a newborn
Congenital diaphragmatic hernias (CDH) occur when muscle portions of the diaphragm fail to develop normally, resulting in the displacement of abdominal components into the thoracic cavity.
CDHs occur mainly during the eighth to the tenth weeks of fetal life. Bochdalek hernias, caused by posterolateral defects of diaphragm, usually present with severe respiratory distress immediately after birth, which is life-threatening. Once diagnosed, Bochdalek hernias should be surgically treated during the neonatal period.
We present a clinical case of a newborn with 38 weeks of gestation with the prenatal diagnosis of left diaphragmatic hernia. A thoracoscopic repair was performed with parent agreement.
C Sousa, A Coelho, F Carvalho
Surgical intervention
3 years ago
1447 views
71 likes
0 comments
02:43
Thoracoscopic Bochdalek hernia repair in a newborn
Congenital diaphragmatic hernias (CDH) occur when muscle portions of the diaphragm fail to develop normally, resulting in the displacement of abdominal components into the thoracic cavity.
CDHs occur mainly during the eighth to the tenth weeks of fetal life. Bochdalek hernias, caused by posterolateral defects of diaphragm, usually present with severe respiratory distress immediately after birth, which is life-threatening. Once diagnosed, Bochdalek hernias should be surgically treated during the neonatal period.
We present a clinical case of a newborn with 38 weeks of gestation with the prenatal diagnosis of left diaphragmatic hernia. A thoracoscopic repair was performed with parent agreement.
Laparoscopic repair of a large right-sided Morgagni’s hernia
Morgagni’s hernias are rare congenital anterior diaphragmatic hernias for which the optimal method of repair is unknown. This video presents a morbidly obese woman with oxygen-dependent chronic obstructive pulmonary disease (COPD) along with a Morgagni’s hernia that compresses her entire right lung. Omentum and colon are seen herniating through the 10 by 15 centimeter defect. Through a laparoscopic approach, the intra-abdominal contents were reduced, the defect primarily closed, and reinforced with mesh. After the repair, the patient had significant improvements in her pulmonary status. Laparoscopic repair with mesh reinforcement is a viable and easily accomplished approach for Morgagni’s hernia repair.
D Lawrence, YV Wu, MJ Rosen
Surgical intervention
6 years ago
3653 views
72 likes
0 comments
08:45
Laparoscopic repair of a large right-sided Morgagni’s hernia
Morgagni’s hernias are rare congenital anterior diaphragmatic hernias for which the optimal method of repair is unknown. This video presents a morbidly obese woman with oxygen-dependent chronic obstructive pulmonary disease (COPD) along with a Morgagni’s hernia that compresses her entire right lung. Omentum and colon are seen herniating through the 10 by 15 centimeter defect. Through a laparoscopic approach, the intra-abdominal contents were reduced, the defect primarily closed, and reinforced with mesh. After the repair, the patient had significant improvements in her pulmonary status. Laparoscopic repair with mesh reinforcement is a viable and easily accomplished approach for Morgagni’s hernia repair.
Laparoscopic repair of post-traumatic diaphragmatic hernia with mesh insertion
Traumatic injuries of the diaphragm are rare (0.8%-5.8% of all blunt trauma). Early diagnosis is difficult, and many reports have described delayed presentation of diaphragmatic hernia with subsequent significant morbidity and mortality.

We report a case of an acute diaphragmatic hernia in a 47-year-old male presenting 4 years after the traumatic episode (significant fall from a ladder). The patient was admitted to the emergency department with severe vomiting and dehydration. Once the patient was stabilised with fluid resuscitation and nasogastric tube aspiration, an urgent CT-scan was performed. This demonstrated a large defect within the left hemi-diaphragm, associated with herniation of both the antrum and body of the stomach, into the thoracic cavity.
At laparoscopy, a large rupture of the left hemi-diaphragm with herniation and rotation of the stomach was confirmed. The hernia was reduced laparoscopically, and the defect repaired with interrupted, non-absorbable polyester sutures (Ethibond 2/0, Ethicon) and a composite mesh (Proceed™, Ethicon). The patient made an uneventful recovery.
Emergency repair of the diaphragm is usually performed via a thoracotomy or/and laparotomy. In our experience, if the patient is haemodynamically stable and major organ injuries have been excluded, a laparoscopic approach can be considered safe and effective.
A Rotundo, T Knowles, S Kadirkamanathan, M Harvey
Surgical intervention
7 years ago
4579 views
46 likes
0 comments
10:21
Laparoscopic repair of post-traumatic diaphragmatic hernia with mesh insertion
Traumatic injuries of the diaphragm are rare (0.8%-5.8% of all blunt trauma). Early diagnosis is difficult, and many reports have described delayed presentation of diaphragmatic hernia with subsequent significant morbidity and mortality.

We report a case of an acute diaphragmatic hernia in a 47-year-old male presenting 4 years after the traumatic episode (significant fall from a ladder). The patient was admitted to the emergency department with severe vomiting and dehydration. Once the patient was stabilised with fluid resuscitation and nasogastric tube aspiration, an urgent CT-scan was performed. This demonstrated a large defect within the left hemi-diaphragm, associated with herniation of both the antrum and body of the stomach, into the thoracic cavity.
At laparoscopy, a large rupture of the left hemi-diaphragm with herniation and rotation of the stomach was confirmed. The hernia was reduced laparoscopically, and the defect repaired with interrupted, non-absorbable polyester sutures (Ethibond 2/0, Ethicon) and a composite mesh (Proceed™, Ethicon). The patient made an uneventful recovery.
Emergency repair of the diaphragm is usually performed via a thoracotomy or/and laparotomy. In our experience, if the patient is haemodynamically stable and major organ injuries have been excluded, a laparoscopic approach can be considered safe and effective.
Laparoscopic management of a left diaphragmatic hernia in a newborn
Laparoscopic treatment of delayed diaphragmatic hernias in children has been described in 1995 by Klaas Bax and David Van der Zee. Since 2001, we managed to convince the community of pediatric surgeons that it was probably easier to choose a thoracoscopic approach. In some particular conditions, newborns with a congenital diaphragmatic hernia could be treated by thoracoscopy. Until now, more than 400 newborns have been operated on by thoracoscopy to treat a diaphragmatic hernia. Guidelines to specify the appropriate group of newborns for this approach remain discussed in the literature.
Reference:
Congenital diaphragmatic hernia: an evaluation of risk factors for failure of thoracoscopic primary repair in neonates. Gomes Ferreira C, Kuhn P, Lacreuse I, Kasleas C, Philippe P, Podevin G, Bonnard A, Lopez M, De Lagausie P, Petit T, Lardy H, Becmeur F. J Pediatr Surg 2013;48:488-95.
F Becmeur, C Gomes Ferreira
Surgical intervention
5 years ago
2036 views
51 likes
0 comments
03:45
Laparoscopic management of a left diaphragmatic hernia in a newborn
Laparoscopic treatment of delayed diaphragmatic hernias in children has been described in 1995 by Klaas Bax and David Van der Zee. Since 2001, we managed to convince the community of pediatric surgeons that it was probably easier to choose a thoracoscopic approach. In some particular conditions, newborns with a congenital diaphragmatic hernia could be treated by thoracoscopy. Until now, more than 400 newborns have been operated on by thoracoscopy to treat a diaphragmatic hernia. Guidelines to specify the appropriate group of newborns for this approach remain discussed in the literature.
Reference:
Congenital diaphragmatic hernia: an evaluation of risk factors for failure of thoracoscopic primary repair in neonates. Gomes Ferreira C, Kuhn P, Lacreuse I, Kasleas C, Philippe P, Podevin G, Bonnard A, Lopez M, De Lagausie P, Petit T, Lardy H, Becmeur F. J Pediatr Surg 2013;48:488-95.
Minimally invasive surgery for esophagectomy and tubularized gastric pull-up
The accidental ingestion of caustic agents is a common problem in pediatric emergency units. These agents can cause a series of damage to the upper gastrointestinal tract and can lead to an esophageal stricture. We present the case of a 4-year-old girl who was referred to our hospital for vomiting and hematemesis after ingesting a caustic solution. Physical examination revealed tongue edema and denuded buccal mucosa. Friable mucosa and esophageal ulceration were observed in the endoscopy. The patient was administered omeprazole and a nasogastric tube was placed for a week. Two esophageal strictures were observed after 3 weeks of the ingestion. The patient underwent esophageal dilatation once or twice a month during 21 months depending on the symptoms. Due to the refractory stricture, we decided to perform an esophagectomy and tubularized gastric pull-up by combining thoracoscopy, laparoscopy, and cervicotomy. In addition, we performed a jejunostomy to provide sufficient nutritional support. The patient started feeding on postoperative day 7 and she is currently asymptomatic.
I Cano Novillo, A García Vázquez, F de la Cruz Vigo, B Aneiros Castro
Surgical intervention
2 months ago
692 views
3 likes
1 comment
12:40
Minimally invasive surgery for esophagectomy and tubularized gastric pull-up
The accidental ingestion of caustic agents is a common problem in pediatric emergency units. These agents can cause a series of damage to the upper gastrointestinal tract and can lead to an esophageal stricture. We present the case of a 4-year-old girl who was referred to our hospital for vomiting and hematemesis after ingesting a caustic solution. Physical examination revealed tongue edema and denuded buccal mucosa. Friable mucosa and esophageal ulceration were observed in the endoscopy. The patient was administered omeprazole and a nasogastric tube was placed for a week. Two esophageal strictures were observed after 3 weeks of the ingestion. The patient underwent esophageal dilatation once or twice a month during 21 months depending on the symptoms. Due to the refractory stricture, we decided to perform an esophagectomy and tubularized gastric pull-up by combining thoracoscopy, laparoscopy, and cervicotomy. In addition, we performed a jejunostomy to provide sufficient nutritional support. The patient started feeding on postoperative day 7 and she is currently asymptomatic.
Thoracoscopy for voluminous left thoracic neuroblastoma in a 2-year-old girl
Video-assisted oncological surgery should be performed in strict compliance with surgical oncology requisites: complete excision, no risk of cancer cell dissemination, and no additional operative risks. Radical surgery requirements must be respected and adjacent organs must be preserved. Our team contributed to research articles on neurogenic tumor surgery, published in international medical journals in 2007 (J Pediatr Surg, 2007; 42 (10): 1725-8 and J Laparoendosc Adv Surg Tech A 2007; 17 (6): 825-9).
Our case study further demonstrates that the thoracoscopic resection of neurogenic tumors perfectly meets oncological surgery requirements, offering the parietal benefits of minimally invasive surgery. A magnified operative field is a major asset because it allows performing surgery safely. It is now possible to gain a perfect knowledge of the patient and tumor anatomy preoperatively by using a 3D modeling tool and preoperative CT-scan images of the patient.
C Klipfel, A Lachkar, F Becmeur
Surgical intervention
2 months ago
275 views
1 like
0 comments
04:32
Thoracoscopy for voluminous left thoracic neuroblastoma in a 2-year-old girl
Video-assisted oncological surgery should be performed in strict compliance with surgical oncology requisites: complete excision, no risk of cancer cell dissemination, and no additional operative risks. Radical surgery requirements must be respected and adjacent organs must be preserved. Our team contributed to research articles on neurogenic tumor surgery, published in international medical journals in 2007 (J Pediatr Surg, 2007; 42 (10): 1725-8 and J Laparoendosc Adv Surg Tech A 2007; 17 (6): 825-9).
Our case study further demonstrates that the thoracoscopic resection of neurogenic tumors perfectly meets oncological surgery requirements, offering the parietal benefits of minimally invasive surgery. A magnified operative field is a major asset because it allows performing surgery safely. It is now possible to gain a perfect knowledge of the patient and tumor anatomy preoperatively by using a 3D modeling tool and preoperative CT-scan images of the patient.
Laparoscopic left hepatectomy with extrahepatic inflow and outflow exclusion
This is the case of a 72-year-old woman presenting with a 5cm intrahepatic cholangiocarcinoma arising on an HCV-related well-compensated chronic liver disease without portal hypertension. Laparoscopic left hepatectomy (liver segments 2, 3, and 4) was decided upon. Four ports were placed. The procedure began with a complete abdominal exploration and intraoperative liver ultrasonography, which allowed to identify the tumor between liver segments 2 and 4a in close contact with the left hepatic vein.
Hilar dissection was performed with lymphadenectomy of the common hepatic artery and left hepatic artery.
Before parenchymal transection, both inflow and outflow of the left liver were interrupted. The left hepatic artery and the left portal vein were isolated and divided between clips. The left hepatic vein was isolated after division of the Arantius’ ligament and clamped by means of a laparoscopic vascular clamp. Parenchymal transection was carried out using an ultrasonic dissector (CUSA™), and hemostasis was controlled with a radiofrequency bipolar hemostatic sealer (Aquamantys™) and clips. The biliary duct and the left hepatic vein were managed with vascular staplers. At the end of the operation, a tubular drain was placed. Operative time accounted for 240 minutes and total blood loss was 100mL.
The postoperative course was uneventful and the patient was discharged on postoperative day 6.
The pathology confirmed a 5cm G3 cholangiocarcinoma with invasion of the left hepatic vein and of segment 2 portal branch. Resection margins were negative for tumor invasion and for all lymph nodes retrieved.
C Sposito, D Citterio, C Battiston, V Mazzaferro
Surgical intervention
11 months ago
2611 views
8 likes
0 comments
10:57
Laparoscopic left hepatectomy with extrahepatic inflow and outflow exclusion
This is the case of a 72-year-old woman presenting with a 5cm intrahepatic cholangiocarcinoma arising on an HCV-related well-compensated chronic liver disease without portal hypertension. Laparoscopic left hepatectomy (liver segments 2, 3, and 4) was decided upon. Four ports were placed. The procedure began with a complete abdominal exploration and intraoperative liver ultrasonography, which allowed to identify the tumor between liver segments 2 and 4a in close contact with the left hepatic vein.
Hilar dissection was performed with lymphadenectomy of the common hepatic artery and left hepatic artery.
Before parenchymal transection, both inflow and outflow of the left liver were interrupted. The left hepatic artery and the left portal vein were isolated and divided between clips. The left hepatic vein was isolated after division of the Arantius’ ligament and clamped by means of a laparoscopic vascular clamp. Parenchymal transection was carried out using an ultrasonic dissector (CUSA™), and hemostasis was controlled with a radiofrequency bipolar hemostatic sealer (Aquamantys™) and clips. The biliary duct and the left hepatic vein were managed with vascular staplers. At the end of the operation, a tubular drain was placed. Operative time accounted for 240 minutes and total blood loss was 100mL.
The postoperative course was uneventful and the patient was discharged on postoperative day 6.
The pathology confirmed a 5cm G3 cholangiocarcinoma with invasion of the left hepatic vein and of segment 2 portal branch. Resection margins were negative for tumor invasion and for all lymph nodes retrieved.
Fully robotically assisted transabdominal right adrenalectomy for a right adrenal incidentaloma
This video presents the case of a female patient in whom a right adrenal incidentaloma was found. It was 40mm in size and was found incidentally during a pancreatitis treatment.
Endocrinologists controlled the absence of abnormal secretion. The size of the lesion increased slightly over a period of 6 months and allowed to establish an indication for surgery. Our team performs adrenalectomies using a transabdominal laparoscopic approach with the patient in a lateral decubitus position. In order to facilitate the intervention, we asked the Visible Patient company to use the CT-scan images to make a 3D model. This reconstruction allowed to better indentify the relationships of the gland, to improve resection, and confirm the operative strategy. During the intervention, the surgeon can use it to better understand the anatomy hidden by peri-adrenal adipose tissue and operate accordingly. We now have a surgical robot (da Vinci Xi™ robotic surgical system, Intuitive Surgical) and we use it for most of the adrenalectomies we perform. It provides great stability of the operative field. The precise dissection is facilitated by the dexterity of the articulated instruments.
M Vix, B Seeliger, L Soler, D Mutter, J Marescaux
Surgical intervention
8 months ago
1262 views
2 likes
0 comments
11:41
Fully robotically assisted transabdominal right adrenalectomy for a right adrenal incidentaloma
This video presents the case of a female patient in whom a right adrenal incidentaloma was found. It was 40mm in size and was found incidentally during a pancreatitis treatment.
Endocrinologists controlled the absence of abnormal secretion. The size of the lesion increased slightly over a period of 6 months and allowed to establish an indication for surgery. Our team performs adrenalectomies using a transabdominal laparoscopic approach with the patient in a lateral decubitus position. In order to facilitate the intervention, we asked the Visible Patient company to use the CT-scan images to make a 3D model. This reconstruction allowed to better indentify the relationships of the gland, to improve resection, and confirm the operative strategy. During the intervention, the surgeon can use it to better understand the anatomy hidden by peri-adrenal adipose tissue and operate accordingly. We now have a surgical robot (da Vinci Xi™ robotic surgical system, Intuitive Surgical) and we use it for most of the adrenalectomies we perform. It provides great stability of the operative field. The precise dissection is facilitated by the dexterity of the articulated instruments.
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
1 year ago
7129 views
940 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.
Mobilization of the right colon for Chilaiditi syndrome in a 38-year-old patient
This video demonstrates our laparoscopic approach to the right colon for Chilaiditi syndrome with recurrent episodes of bowel obstruction.
A 38-year-old man with Down syndrome was admitted to our emergency department for acute abdominal pain and vomiting. The objective signs and radiographic findings were indicative of bowel obstruction. In his last few years, he was admitted multiple times to the emergency department for mechanical bowel obstruction. Both CT-scan and MRI showed medial dislocation of the liver and transposition of the right colon and small bowel loops in between the diaphragm and the liver. We propose a specific port-site layout and a counterclockwise approach, to allow for the correct triangulation of surgical instruments especially during the mobilization of the hepatic flexure, which is often the most critical phase of the operation. Starting from the mobilization of the transverse colon and proceeding towards the caecum we take advantage of gravity in handling the right colon. The operative time was 90 minutes. The patient recovered with no complications and was discharged on postoperative day 6. His symptoms disappeared completely.
M Lotti, E Poiasina, G Panyor, M Giulii Capponi
Surgical intervention
1 year ago
2781 views
443 likes
0 comments
11:18
Mobilization of the right colon for Chilaiditi syndrome in a 38-year-old patient
This video demonstrates our laparoscopic approach to the right colon for Chilaiditi syndrome with recurrent episodes of bowel obstruction.
A 38-year-old man with Down syndrome was admitted to our emergency department for acute abdominal pain and vomiting. The objective signs and radiographic findings were indicative of bowel obstruction. In his last few years, he was admitted multiple times to the emergency department for mechanical bowel obstruction. Both CT-scan and MRI showed medial dislocation of the liver and transposition of the right colon and small bowel loops in between the diaphragm and the liver. We propose a specific port-site layout and a counterclockwise approach, to allow for the correct triangulation of surgical instruments especially during the mobilization of the hepatic flexure, which is often the most critical phase of the operation. Starting from the mobilization of the transverse colon and proceeding towards the caecum we take advantage of gravity in handling the right colon. The operative time was 90 minutes. The patient recovered with no complications and was discharged on postoperative day 6. His symptoms disappeared completely.
Pediatric laparoscopic floppy Nissen fundoplication
Surgical therapy is well-established in children with gastroesophageal reflux disease (GERD). It is known that the laparoscopic approach is safe and effective. We tailored our surgical strategy based on two main studies which we conducted: one observational long-term follow-up and the other one related to the effect of Thal fundoplication on pulmonary affections. Our conclusions are summarized as follows:
- no surgery in the first 12 months,
- indications determined together with the consent of parents,
- a radiological contrast study should always be performed preoperatively,
- history taking and at least two positive objective diagnoses leading to indication,
- for neurologically impaired patients, a Nissen fundoplication is selected,
- first-line treatment: percutaneous endoscopic gastrostomy (PEG) implantation, second step: fundoplication if necessary,
- for neurologically healthy patients without inborn anatomical diseases, a Thal fundoplication is selected,
- postoperative diagnoses in the follow-up period are only performed if necessary.
For this personal experience and in comparison with the established approach in the current literature, we have only poor evidence. It is due to the lack of prospective studies available and to an inadequate number of patients, which is typical in pediatric studies.
S Holland-Cunz
Surgical intervention
2 years ago
2083 views
208 likes
0 comments
03:54
Pediatric laparoscopic floppy Nissen fundoplication
Surgical therapy is well-established in children with gastroesophageal reflux disease (GERD). It is known that the laparoscopic approach is safe and effective. We tailored our surgical strategy based on two main studies which we conducted: one observational long-term follow-up and the other one related to the effect of Thal fundoplication on pulmonary affections. Our conclusions are summarized as follows:
- no surgery in the first 12 months,
- indications determined together with the consent of parents,
- a radiological contrast study should always be performed preoperatively,
- history taking and at least two positive objective diagnoses leading to indication,
- for neurologically impaired patients, a Nissen fundoplication is selected,
- first-line treatment: percutaneous endoscopic gastrostomy (PEG) implantation, second step: fundoplication if necessary,
- for neurologically healthy patients without inborn anatomical diseases, a Thal fundoplication is selected,
- postoperative diagnoses in the follow-up period are only performed if necessary.
For this personal experience and in comparison with the established approach in the current literature, we have only poor evidence. It is due to the lack of prospective studies available and to an inadequate number of patients, which is typical in pediatric studies.
Laparoscopy for peritonitis of gynecological origin, how far can we go?
This video shows the second and final laparoscopic treatment of a generalized peritonitis. The case is that of a 38-year-old woman who was initially managed with a first laparoscopy for peritonitis due to a pyosalpinx with left salpingectomy, adhesiolysis, and lavage. In the postoperative course, despite medical treatment, she continues to complain of a persistent severe biologic inflammatory syndrome (multidrug-resistant Bacteroides fragilis). At day 8, a second laparoscopy was decided upon, with suction, lavage, collapse, and lavage of residual pockets, adhesiolysis of bowel and both ovaries and remnant tube, and drainage. The patient recovered quickly.
JB Dubuisson
Surgical intervention
1 year ago
4833 views
587 likes
0 comments
08:01
Laparoscopy for peritonitis of gynecological origin, how far can we go?
This video shows the second and final laparoscopic treatment of a generalized peritonitis. The case is that of a 38-year-old woman who was initially managed with a first laparoscopy for peritonitis due to a pyosalpinx with left salpingectomy, adhesiolysis, and lavage. In the postoperative course, despite medical treatment, she continues to complain of a persistent severe biologic inflammatory syndrome (multidrug-resistant Bacteroides fragilis). At day 8, a second laparoscopy was decided upon, with suction, lavage, collapse, and lavage of residual pockets, adhesiolysis of bowel and both ovaries and remnant tube, and drainage. The patient recovered quickly.
Laparoscopic Roux-en-Y gastric bypass (RYGB) after failed Nissen
This is the case of a 62-year old female patient with a BMI of 35 and a history of high blood pressure, dyslipidemia, and morbid obesity. She underwent a laparoscopic Nissen surgery 8 years earlier and presented with recurrent GERD symptoms.

A CT-scan, an endoscopy, and a barium swallow showed a hiatal hernia. It was decided to perform a paraesophageal hernia repair as well as a gastric bypass. A laparoscopic surgery was performed.

There were no complications and the patient was discharged on the second postoperative day. An esogastroduodenal contrast examination was performed 1 month after the procedure. It showed the absence of hiatal hernia. The patient was controlled 3 months after surgery and was found asymptomatic with an Excess Weight Loss (EWL) of 42%.
A Duro, V Cano Busnelli, A Beskow, D Cavadas, F Wright, P Saleg, PJ Castellaro
Surgical intervention
1 year ago
2195 views
171 likes
0 comments
06:12
Laparoscopic Roux-en-Y gastric bypass (RYGB) after failed Nissen
This is the case of a 62-year old female patient with a BMI of 35 and a history of high blood pressure, dyslipidemia, and morbid obesity. She underwent a laparoscopic Nissen surgery 8 years earlier and presented with recurrent GERD symptoms.

A CT-scan, an endoscopy, and a barium swallow showed a hiatal hernia. It was decided to perform a paraesophageal hernia repair as well as a gastric bypass. A laparoscopic surgery was performed.

There were no complications and the patient was discharged on the second postoperative day. An esogastroduodenal contrast examination was performed 1 month after the procedure. It showed the absence of hiatal hernia. The patient was controlled 3 months after surgery and was found asymptomatic with an Excess Weight Loss (EWL) of 42%.
Completely intracorporeal handsewn laparoscopic anastomoses during Whipple procedure
Background: Since 1935, the Whipple procedure was described, using conventional open surgery. With the advent of minimally invasive surgery (MIS), it was reported to be feasible also using the latest technology. In this video, the authors demonstrate a full laparoscopic Whipple procedure, performing the three anastomoses using an intracorporeal handsewn method.

Video: A 70-year-old man presenting with an adenocarcinoma of the ampulla of Vater, infiltrating the pancreatic parenchyma, underwent a laparoscop ic Whipple procedure. Preoperative work-up showed a T3N1M0 tumor.

Results: Total operative time was 8 hours 20minutes; time for the dissection was 6 hours 20 minutes; time for specimen extraction was 20 minutes, and time for the three laparoscopic intracorporeal handsewn anastomoses was 1 hour 40 minutes. Operative bleeding was 350cc. The patient was discharged on postoperative day 9. Pathological findings confirmed a moderately differentiated adenocarcinoma of the ampulla of Vater, with perinervous infiltration and lymphovascular emboli, free margins, 2 metastatic lymph nodes on 23 isolated; 7 edition UICC stage: pT4N1.

Conclusions: The laparoscopic Whipple procedure remains an advanced procedure to be performed laparoscopically and/or using open surgery. All the advantages of MIS such as reduced abdominal trauma, less postoperative pain, shorter hospital stay, improved patient’s comfort, and enhanced cosmesis are offered using laparoscopy.
G Dapri, NA Bascombe, L Gerard, C Samaniego Ballar, C Jiménez Viñas
Surgical intervention
2 years ago
2813 views
224 likes
1 comment
10:22
Completely intracorporeal handsewn laparoscopic anastomoses during Whipple procedure
Background: Since 1935, the Whipple procedure was described, using conventional open surgery. With the advent of minimally invasive surgery (MIS), it was reported to be feasible also using the latest technology. In this video, the authors demonstrate a full laparoscopic Whipple procedure, performing the three anastomoses using an intracorporeal handsewn method.

Video: A 70-year-old man presenting with an adenocarcinoma of the ampulla of Vater, infiltrating the pancreatic parenchyma, underwent a laparoscop ic Whipple procedure. Preoperative work-up showed a T3N1M0 tumor.

Results: Total operative time was 8 hours 20minutes; time for the dissection was 6 hours 20 minutes; time for specimen extraction was 20 minutes, and time for the three laparoscopic intracorporeal handsewn anastomoses was 1 hour 40 minutes. Operative bleeding was 350cc. The patient was discharged on postoperative day 9. Pathological findings confirmed a moderately differentiated adenocarcinoma of the ampulla of Vater, with perinervous infiltration and lymphovascular emboli, free margins, 2 metastatic lymph nodes on 23 isolated; 7 edition UICC stage: pT4N1.

Conclusions: The laparoscopic Whipple procedure remains an advanced procedure to be performed laparoscopically and/or using open surgery. All the advantages of MIS such as reduced abdominal trauma, less postoperative pain, shorter hospital stay, improved patient’s comfort, and enhanced cosmesis are offered using laparoscopy.
Combining VATS and laparoscopic approach in the resection of ovarian carcinoma metastasis
This is the case of a 64-year-old woman with a history of hysterectomy and left adnexectomy. In 2012, a vaginal ultrasound revealed a right ovarian mass diagnosed as a right ovarian cancer. In December 2012, she underwent a right adnexectomy with pelvic, lumbo-aortic lymphadenectomy and omentectomy. Final pathological staging of the ovarian cystadenocarcinoma was pT3cpN1Mx (IIIC). She completed 6 cycles of adjuvant chemotherapy with carboplatin and paclitaxel. During the follow-up exam, the patient remained symptom-free and presented with a stable perihepatic lesion. In 2015, two new lesions were found on CT-scan: one in the anterior mediastinum (14mm) and another in the abdominal diaphragm in contact with a liver segment VIII (19mm). In addition, CA 125 raised from 19 to 50kU/L. PET-scan only evidenced these two new lesions (SUV= 10). Taking into account the patient’s excellent performance status, long disease-free survival, stability of lesions, with CT-scans performed with a 3-month interval, and the possibility of video-assisted surgery, it was decided to use VATS and laparoscopy to remove the lesions. Final pathological findings showed ovarian cystadenocarcinoma metastases in 2 lesions (R0). The third perihepatic lesion was a cyst. The patient was discharged on postoperative day 4.
F Cabral, JA Pereira, P Calvinho, P Amado, R Maio
Surgical intervention
2 years ago
2749 views
91 likes
0 comments
11:33
Combining VATS and laparoscopic approach in the resection of ovarian carcinoma metastasis
This is the case of a 64-year-old woman with a history of hysterectomy and left adnexectomy. In 2012, a vaginal ultrasound revealed a right ovarian mass diagnosed as a right ovarian cancer. In December 2012, she underwent a right adnexectomy with pelvic, lumbo-aortic lymphadenectomy and omentectomy. Final pathological staging of the ovarian cystadenocarcinoma was pT3cpN1Mx (IIIC). She completed 6 cycles of adjuvant chemotherapy with carboplatin and paclitaxel. During the follow-up exam, the patient remained symptom-free and presented with a stable perihepatic lesion. In 2015, two new lesions were found on CT-scan: one in the anterior mediastinum (14mm) and another in the abdominal diaphragm in contact with a liver segment VIII (19mm). In addition, CA 125 raised from 19 to 50kU/L. PET-scan only evidenced these two new lesions (SUV= 10). Taking into account the patient’s excellent performance status, long disease-free survival, stability of lesions, with CT-scans performed with a 3-month interval, and the possibility of video-assisted surgery, it was decided to use VATS and laparoscopy to remove the lesions. Final pathological findings showed ovarian cystadenocarcinoma metastases in 2 lesions (R0). The third perihepatic lesion was a cyst. The patient was discharged on postoperative day 4.
Laparoscopic total gastrectomy guided by fluorescent lymphangiography using ICG injection around a tumor, followed by an intracorporeal double stapling esophagojejunostomy
Injecting indocyanine green (ICG) around the tumor enables the operators to identify the lymphatic channels and the lymph nodes in which the cancer cells can spread. It also allows them to decide on the extent of the dissection and validate the completeness of lymph node dissection. In this video, a laparoscopic near-infrared fluorescent camera was used, showing the fluorescent signal in diverse modes. A total gastrectomy with D1+ dissection is performed. The fluorescent signal shows the possible lymphatic pathways during the operation. An intracorporeal esophagojejunostomy was performed in a double stapling fashion; a round needle and a surgical thread are attached to the plastic part of the anvil of the circular stapler.
HK Yang, SH Kong
Surgical intervention
2 years ago
1770 views
78 likes
0 comments
15:56
Laparoscopic total gastrectomy guided by fluorescent lymphangiography using ICG injection around a tumor, followed by an intracorporeal double stapling esophagojejunostomy
Injecting indocyanine green (ICG) around the tumor enables the operators to identify the lymphatic channels and the lymph nodes in which the cancer cells can spread. It also allows them to decide on the extent of the dissection and validate the completeness of lymph node dissection. In this video, a laparoscopic near-infrared fluorescent camera was used, showing the fluorescent signal in diverse modes. A total gastrectomy with D1+ dissection is performed. The fluorescent signal shows the possible lymphatic pathways during the operation. An intracorporeal esophagojejunostomy was performed in a double stapling fashion; a round needle and a surgical thread are attached to the plastic part of the anvil of the circular stapler.
Robotic adrenalectomy for left adrenal Conn’s adenoma: live broadcast
According to recent studies, robotic adrenalectomy has proven to be superior to laparoscopic adrenalectomy, with a reduction of blood loss during procedure and a reduced operative time.
The robotic system provides an intraoperative stability to the surgeon, allowing for a perfect handling of sensitive functional adrenal tumors. The main advantage of robotics lies in the ease of dissection, aided by improved visualization, the EndoWrist®, articulated instruments, and reduction of tremors, allowing for more accurate movements.

Indications: hormone-secreting tumors, adrenal masses >5cm, smaller lesions suspicious for malignancy, and lesions increasing in size on serial imaging.
Contraindications: infiltrative adrenal masses and tumors of extremely large size, because the size of adrenal lesions correlates with the potential for adrenal carcinoma.
The da Vinci Robotic Surgical System (Intuitive Surgical Inc., Sunnyvale, CA, USA) and the following robotic instruments are used:30-degree scope, ProGrasp™ forceps, Hot Shears (monopolar curved scissors or a hook), and a Robotic Clip Applier. A monopolar cautery hook and Harmonic ACE® curved shears can also be used when deemed helpful by the surgeon.
Laparoscopic instruments that can be handled by the bedside assistant, a clip applier and a suction device are also used.
CN Tang
Surgical intervention
3 years ago
1893 views
133 likes
0 comments
24:47
Robotic adrenalectomy for left adrenal Conn’s adenoma: live broadcast
According to recent studies, robotic adrenalectomy has proven to be superior to laparoscopic adrenalectomy, with a reduction of blood loss during procedure and a reduced operative time.
The robotic system provides an intraoperative stability to the surgeon, allowing for a perfect handling of sensitive functional adrenal tumors. The main advantage of robotics lies in the ease of dissection, aided by improved visualization, the EndoWrist®, articulated instruments, and reduction of tremors, allowing for more accurate movements.

Indications: hormone-secreting tumors, adrenal masses >5cm, smaller lesions suspicious for malignancy, and lesions increasing in size on serial imaging.
Contraindications: infiltrative adrenal masses and tumors of extremely large size, because the size of adrenal lesions correlates with the potential for adrenal carcinoma.
The da Vinci Robotic Surgical System (Intuitive Surgical Inc., Sunnyvale, CA, USA) and the following robotic instruments are used:30-degree scope, ProGrasp™ forceps, Hot Shears (monopolar curved scissors or a hook), and a Robotic Clip Applier. A monopolar cautery hook and Harmonic ACE® curved shears can also be used when deemed helpful by the surgeon.
Laparoscopic instruments that can be handled by the bedside assistant, a clip applier and a suction device are also used.
LIVE INTERACTIVE SURGERY: laparoscopic left adrenalectomy for pheochromocytoma
Laparoscopic adrenalectomy was first described by Gagner et al. in 1992. It has become the procedure of choice for most benign adrenal lesions since then because of decreased blood loss, shorter hospital stay, faster recovery, and lower morbidity as compared to open surgery.
The indications for laparoscopic adrenalectomy are the same as for open surgery, except in cases of confirmed adrenocortical carcinomas.
Absolute contraindications for laparoscopic adrenalectomy are as follows: severe cardiopulmonary disease, locally advanced tumors, medically untreated pheochromocytoma, and uncontrolled coagulopathies. This is a live demonstration of a left adrenalectomy recorded during the Minimally Invasive Endocrine Surgery Course, which was held at IRCAD in May 2016.
D Mutter, P Donepudi, J Marescaux
Surgical intervention
3 years ago
4144 views
337 likes
0 comments
28:17
LIVE INTERACTIVE SURGERY: laparoscopic left adrenalectomy for pheochromocytoma
Laparoscopic adrenalectomy was first described by Gagner et al. in 1992. It has become the procedure of choice for most benign adrenal lesions since then because of decreased blood loss, shorter hospital stay, faster recovery, and lower morbidity as compared to open surgery.
The indications for laparoscopic adrenalectomy are the same as for open surgery, except in cases of confirmed adrenocortical carcinomas.
Absolute contraindications for laparoscopic adrenalectomy are as follows: severe cardiopulmonary disease, locally advanced tumors, medically untreated pheochromocytoma, and uncontrolled coagulopathies. This is a live demonstration of a left adrenalectomy recorded during the Minimally Invasive Endocrine Surgery Course, which was held at IRCAD in May 2016.
Laparoscopic right hepatectomy on cirrhotic liver after transarterial chemoembolization (TACE) and portal vein embolization (PVE) for hepatocellular carcinoma (HCC)
We reported the case of a 70-year-old man in whom an F4 cirrhosis and a well-differentiated hepatocellular carcinoma were evidenced and managed by a laparoscopic right hepatectomy after transarterial chemoembolization and portal vein embolization. The operation starts with the control of the hepatic pedicle. A Doppler ultrasound is performed. It will reveal the relation of the lesion with the vein. The different right hepatic structures are identified, clipped and divided. Mobilization of the right liver is then initiated. The gallbladder, which is kept in place, is used for traction purposes. Parenchymal transection is begun with the assistance of Ultracision®, Aquamantys®, and Dissectron®. The portal structure and the hepatic vein are identified. The parenchymotomy is carried on and the identification of the right hepatic vein is going to be achieved. The origin of the right hepatic vein is dissected at its upper part and its lower part, in order to encircle it with a tape and divide it with a stapler. Once completed, the medial part of the right triangular ligament is further divided. Mobilization is continued on the same part from both sides, changing traction. The right liver is placed in a bag and removed. The cavity is cleansed. The hemostasis and biliostasis are controlled on the transection.
P Pessaux, R Memeo, J Hargat, S Tzedakis, D Mutter, J Marescaux, L Soler
Surgical intervention
3 years ago
2065 views
42 likes
0 comments
08:07
Laparoscopic right hepatectomy on cirrhotic liver after transarterial chemoembolization (TACE) and portal vein embolization (PVE) for hepatocellular carcinoma (HCC)
We reported the case of a 70-year-old man in whom an F4 cirrhosis and a well-differentiated hepatocellular carcinoma were evidenced and managed by a laparoscopic right hepatectomy after transarterial chemoembolization and portal vein embolization. The operation starts with the control of the hepatic pedicle. A Doppler ultrasound is performed. It will reveal the relation of the lesion with the vein. The different right hepatic structures are identified, clipped and divided. Mobilization of the right liver is then initiated. The gallbladder, which is kept in place, is used for traction purposes. Parenchymal transection is begun with the assistance of Ultracision®, Aquamantys®, and Dissectron®. The portal structure and the hepatic vein are identified. The parenchymotomy is carried on and the identification of the right hepatic vein is going to be achieved. The origin of the right hepatic vein is dissected at its upper part and its lower part, in order to encircle it with a tape and divide it with a stapler. Once completed, the medial part of the right triangular ligament is further divided. Mobilization is continued on the same part from both sides, changing traction. The right liver is placed in a bag and removed. The cavity is cleansed. The hemostasis and biliostasis are controlled on the transection.