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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
8 months ago
674 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.
Pheochromocytoma: laparoscopic right adrenalectomy in a child
In the context of major headaches in a 9-year-old patient whose brother had been operated on for pheochromocytoma, a right adrenal pheochromocytoma with severe arterial hypertension was found.
The given video aims to demonstrate the usefulness of performing a 3D reconstruction of the tumor (using Visible Patient™ 3D reconstruction tool). It is essential to have precise preoperative information and work out a surgical strategy taking into account observed anatomical anomalies, since tumor and/or vascular anatomy may have numerous variations in case of pheochromocytomas.
A reconstruction model can be easily manipulated on a touch screen. It can be oriented in such a way that the angle of view changes allowing for a better understanding of the anatomy, so that an approach to vessels or neighboring organs is easily decided upon. Additionally, the option of adding or deleting this or that anatomical element allows for a simplified visual approach, which usually represents a potential difficulty during dissection.
Finally, the 3D reconstruction of this patient perfectly corresponds to her real anatomy. Thanks to a mere scanning based on the reconstruction, the vascularization mode of the tumor as well as the existence of a hidden part of healthy tissue can be verified.
F Becmeur, A Lachkar, L Soler
Surgical intervention
1 year ago
2579 views
10 likes
0 comments
08:30
Pheochromocytoma: laparoscopic right adrenalectomy in a child
In the context of major headaches in a 9-year-old patient whose brother had been operated on for pheochromocytoma, a right adrenal pheochromocytoma with severe arterial hypertension was found.
The given video aims to demonstrate the usefulness of performing a 3D reconstruction of the tumor (using Visible Patient™ 3D reconstruction tool). It is essential to have precise preoperative information and work out a surgical strategy taking into account observed anatomical anomalies, since tumor and/or vascular anatomy may have numerous variations in case of pheochromocytomas.
A reconstruction model can be easily manipulated on a touch screen. It can be oriented in such a way that the angle of view changes allowing for a better understanding of the anatomy, so that an approach to vessels or neighboring organs is easily decided upon. Additionally, the option of adding or deleting this or that anatomical element allows for a simplified visual approach, which usually represents a potential difficulty during dissection.
Finally, the 3D reconstruction of this patient perfectly corresponds to her real anatomy. Thanks to a mere scanning based on the reconstruction, the vascularization mode of the tumor as well as the existence of a hidden part of healthy tissue can be verified.
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
2014 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.
IRCAD Webinar: Third ESPES/IPEG Masterclass with the participation of the ESPU
ACUTE APPENDICITIS and PERITONITIS
1. Laparoscopic vs. open appendectomy in children - Mark Wulkan (IPEG)
2. Single port vs. Multiport and the role of new technologies in the management of pediatric complicated appendicitis - Ciro Esposito (ESPES)

CONGENITAL DIAPHRAGMATIC HERNIA (CDH)
1. Open approach for the treatment of CDH - François Becmeur (ESPES)
2. Minimally invasive management of pediatric CDH - Holger Till (IPEG)

VESICOURETERAL REFLUX (VUR)
1. Open, endourological, and robotic management of pediatric VUR - Ramnath Subramaniam (ESPU)
2. Laparoscopic management of VUR according to Lich-Gregoir procedure - François Varlet (ESPES)

Masters of ceremonies:
François Becmeur (IRCAD-Strasbourg)
Philippe Montupet (APHP-Paris)

Chairmen:
Mario Mendoza Sagaon (ESPES)
Alaa El Ghoneimi (ESPU)
Philippe Szavay (IPEG)
F Becmeur, P Montupet, A El-Ghoneimi, P Szavay, M Mendoza Sagaon, M Wulkan, C Esposito, H Till, R Subramaniam, F Varlet
Surgical intervention
1 year ago
1784 views
89 likes
0 comments
11:17
IRCAD Webinar: Third ESPES/IPEG Masterclass with the participation of the ESPU
ACUTE APPENDICITIS and PERITONITIS
1. Laparoscopic vs. open appendectomy in children - Mark Wulkan (IPEG)
2. Single port vs. Multiport and the role of new technologies in the management of pediatric complicated appendicitis - Ciro Esposito (ESPES)

CONGENITAL DIAPHRAGMATIC HERNIA (CDH)
1. Open approach for the treatment of CDH - François Becmeur (ESPES)
2. Minimally invasive management of pediatric CDH - Holger Till (IPEG)

VESICOURETERAL REFLUX (VUR)
1. Open, endourological, and robotic management of pediatric VUR - Ramnath Subramaniam (ESPU)
2. Laparoscopic management of VUR according to Lich-Gregoir procedure - François Varlet (ESPES)

Masters of ceremonies:
François Becmeur (IRCAD-Strasbourg)
Philippe Montupet (APHP-Paris)

Chairmen:
Mario Mendoza Sagaon (ESPES)
Alaa El Ghoneimi (ESPU)
Philippe Szavay (IPEG)
IRCAD Webinar: Third ESPES/IPEG Masterclass with the participation of the ESPU
ACUTE APPENDICITIS and PERITONITIS
1. Laparoscopic vs. open appendectomy in children - Mark Wulkan (IPEG)
2. Single port vs. Multiport and the role of new technologies in the management of pediatric complicated appendicitis - Ciro Esposito (ESPES)

CONGENITAL DIAPHRAGMATIC HERNIA (CDH)
1. Open approach for the treatment of CDH - François Becmeur (ESPES)
2. Minimally invasive management of pediatric CDH - Holger Till (IPEG)

VESICOURETERAL REFLUX (VUR)
1. Open, endourological, and robotic management of pediatric VUR - Ramnath Subramaniam (ESPU)
2. Laparoscopic management of VUR according to Lich-Gregoir procedure - François Varlet (ESPES)

Masters of ceremonies:
François Becmeur (IRCAD-Strasbourg)
Philippe Montupet (APHP-Paris)

Chairmen:
Mario Mendoza Sagaon (ESPES)
Alaa El Ghoneimi (ESPU)
Philippe Szavay (IPEG)
F Becmeur, P Montupet, A El-Ghoneimi, P Szavay, M Mendoza Sagaon, M Wulkan, C Esposito, H Till, R Subramaniam, F Varlet
Webinar
1 year ago
1192 views
12 likes
0 comments
11:17
IRCAD Webinar: Third ESPES/IPEG Masterclass with the participation of the ESPU
ACUTE APPENDICITIS and PERITONITIS
1. Laparoscopic vs. open appendectomy in children - Mark Wulkan (IPEG)
2. Single port vs. Multiport and the role of new technologies in the management of pediatric complicated appendicitis - Ciro Esposito (ESPES)

CONGENITAL DIAPHRAGMATIC HERNIA (CDH)
1. Open approach for the treatment of CDH - François Becmeur (ESPES)
2. Minimally invasive management of pediatric CDH - Holger Till (IPEG)

VESICOURETERAL REFLUX (VUR)
1. Open, endourological, and robotic management of pediatric VUR - Ramnath Subramaniam (ESPU)
2. Laparoscopic management of VUR according to Lich-Gregoir procedure - François Varlet (ESPES)

Masters of ceremonies:
François Becmeur (IRCAD-Strasbourg)
Philippe Montupet (APHP-Paris)

Chairmen:
Mario Mendoza Sagaon (ESPES)
Alaa El Ghoneimi (ESPU)
Philippe Szavay (IPEG)
Laparoscopic Mitrofanoff continent diversion in children
Neobladder surgery is often complex. It is readily proposed lately in a child’s life when he agrees to undergo a fairly heavy surgical operation, which will allow him to acquire a social body cleanliness. The poor vesical volume capacity may necessitate either a chemical enlargement with iterative Botox injections into the detrusor muscle, or a vesical enlargement surgery using a bowel segment.
Self-catheterization using natural orifices is often particularly uneasy in boys or in obese or handicapped patients. This mandates to leave an open vesicourethral neck, which however does not prevent potential urinary leaks. This mode of vesical voiding has an alternative, namely Mitrofanoff continent diversion using the appendix.
This procedure was described in 1980. The vesico-appendiceal junction is fashioned by means of an anatomical anti-reflux mechanism. The skin approximation onto the anterior abdominal wall can be performed either in the umbilicus, or in the inguinal region depending on different decisional criteria.
This procedure can now be envisaged laparoscopically. It is a demanding intervention, which requires advanced skills.
A El-Ghoneimi
Lecture
3 years ago
507 views
11 likes
0 comments
28:15
Laparoscopic Mitrofanoff continent diversion in children
Neobladder surgery is often complex. It is readily proposed lately in a child’s life when he agrees to undergo a fairly heavy surgical operation, which will allow him to acquire a social body cleanliness. The poor vesical volume capacity may necessitate either a chemical enlargement with iterative Botox injections into the detrusor muscle, or a vesical enlargement surgery using a bowel segment.
Self-catheterization using natural orifices is often particularly uneasy in boys or in obese or handicapped patients. This mandates to leave an open vesicourethral neck, which however does not prevent potential urinary leaks. This mode of vesical voiding has an alternative, namely Mitrofanoff continent diversion using the appendix.
This procedure was described in 1980. The vesico-appendiceal junction is fashioned by means of an anatomical anti-reflux mechanism. The skin approximation onto the anterior abdominal wall can be performed either in the umbilicus, or in the inguinal region depending on different decisional criteria.
This procedure can now be envisaged laparoscopically. It is a demanding intervention, which requires advanced skills.
The vascular hitch: a simpler procedure for vascular pyeloureteral junction obstruction (PUJO)
Ureteropelvic junction obstruction may occur in about 10% of cases, the origin of which is not an intrinsic organic obstruction in this transitional area between the renal pelvis and the ureter, but it is rather secondary to an extrinsic obstruction, related to the presence of aberrant lower pole vessels.
It is an intermittent ureteropelvic junction obstruction syndrome, which is usually diagnosed late and in which renal function is most often preserved. The operating technique was already described more than 60 years ago. It is a simple technique.
The greatest difficulty is not technical but lies in the indication which must be relevant. The main difficulty is to preoperatively and intraoperatively evaluate either the totally extrinsic nature or conversely the mixed nature of the obstruction, which in that case requires a pyeloplasty according to Anderson-Hynes with division of the ureterovesical junction posteriorly to the vessels and reconstruction of the ureteropelvic junction once enlarged, anteriorly to the lower pole vessels.
I Mushtaq
Lecture
3 years ago
543 views
32 likes
0 comments
13:17
The vascular hitch: a simpler procedure for vascular pyeloureteral junction obstruction (PUJO)
Ureteropelvic junction obstruction may occur in about 10% of cases, the origin of which is not an intrinsic organic obstruction in this transitional area between the renal pelvis and the ureter, but it is rather secondary to an extrinsic obstruction, related to the presence of aberrant lower pole vessels.
It is an intermittent ureteropelvic junction obstruction syndrome, which is usually diagnosed late and in which renal function is most often preserved. The operating technique was already described more than 60 years ago. It is a simple technique.
The greatest difficulty is not technical but lies in the indication which must be relevant. The main difficulty is to preoperatively and intraoperatively evaluate either the totally extrinsic nature or conversely the mixed nature of the obstruction, which in that case requires a pyeloplasty according to Anderson-Hynes with division of the ureterovesical junction posteriorly to the vessels and reconstruction of the ureteropelvic junction once enlarged, anteriorly to the lower pole vessels.
Laparoscopic retroperitoneal pyeloplasty
Ureteropelvic junction obstruction repair can be performed in the first months of the infant’s life by means of videoscopic surgery. Two approaches can be used. First, the transperitoneal access offers a fairly large surgical space. On the other hand, it implies that the surgeon accesses a retroperitoneal organ by opening the posterior parietal peritoneum. To the right, kidney exposure may necessitate the detachment of the right colon and of the duodenum and the surgeon often has to lift up the right liver.
To the left, the exposure of the ureteropelvic junction may require either a colonic detachment, or a transmesocolic opening by respecting the vascular supply of the left colon. The retroperitoneal approach is direct. It helps to better manage any potential urinary leaks, which will never occur intraperitoneally. It prevents any intraperitoneal dissection. However, it is a demanding technique technically speaking.
A El-Ghoneimi
Lecture
3 years ago
999 views
49 likes
0 comments
28:15
Laparoscopic retroperitoneal pyeloplasty
Ureteropelvic junction obstruction repair can be performed in the first months of the infant’s life by means of videoscopic surgery. Two approaches can be used. First, the transperitoneal access offers a fairly large surgical space. On the other hand, it implies that the surgeon accesses a retroperitoneal organ by opening the posterior parietal peritoneum. To the right, kidney exposure may necessitate the detachment of the right colon and of the duodenum and the surgeon often has to lift up the right liver.
To the left, the exposure of the ureteropelvic junction may require either a colonic detachment, or a transmesocolic opening by respecting the vascular supply of the left colon. The retroperitoneal approach is direct. It helps to better manage any potential urinary leaks, which will never occur intraperitoneally. It prevents any intraperitoneal dissection. However, it is a demanding technique technically speaking.
Minimally invasive management of vesicoureteric reflux (VUR) and related anomalies
Operative indications in case of vesicorenal reflux in children have become increasingly rare. The true minimally invasive spirit first necessitates an endoscopic treatment, also called the STING procedure. A ureterovesical reimplantation is required in the presence of clinical or anatomical circumstances. Dr. Paul Philippe describes the operative pneumovesicoscopy developed by CK Yeung and Jeff Valla more than 15 years ago. Despite brilliant presentations, this technique has remained very confidential, probably because of the difficulties come across by the operators when performing the procedure. It is undoubtedly a very demanding technique as far as manual expertise is concerned.
The scarcity of operative indications and the difficulties met in the realization of this surgery render the acquisition of an expertise in the field difficult. However, the technique and the tricks described by Paul Philippe are absolutely remarkable and postoperative outcomes are particularly interesting. We are truly in the context which was initially described 25 years ago when laparoscopic surgery barely started to develop. It is key to reproduce exactly what was previously performed in open surgery in a laparoscopic fashion (or in the present case using pneumovesicoscopy).
P Philippe
Lecture
3 years ago
441 views
21 likes
0 comments
15:24
Minimally invasive management of vesicoureteric reflux (VUR) and related anomalies
Operative indications in case of vesicorenal reflux in children have become increasingly rare. The true minimally invasive spirit first necessitates an endoscopic treatment, also called the STING procedure. A ureterovesical reimplantation is required in the presence of clinical or anatomical circumstances. Dr. Paul Philippe describes the operative pneumovesicoscopy developed by CK Yeung and Jeff Valla more than 15 years ago. Despite brilliant presentations, this technique has remained very confidential, probably because of the difficulties come across by the operators when performing the procedure. It is undoubtedly a very demanding technique as far as manual expertise is concerned.
The scarcity of operative indications and the difficulties met in the realization of this surgery render the acquisition of an expertise in the field difficult. However, the technique and the tricks described by Paul Philippe are absolutely remarkable and postoperative outcomes are particularly interesting. We are truly in the context which was initially described 25 years ago when laparoscopic surgery barely started to develop. It is key to reproduce exactly what was previously performed in open surgery in a laparoscopic fashion (or in the present case using pneumovesicoscopy).
Transperitoneal ureteric reimplantation Lich-Gregoir technique for vesicoureteral reflux (VUR) in children
The Lich-Gregoir technique, still currently used in prominent Northern American centers in the nineties, had more or less fallen into disuse. Currently, the scarcity of operative indications for ureterovesical reimplantation, with the advent of the STING procedure, the real technical difficulties found during pneumovesicoscopy for Cohen procedure, the debates on long-term difficulties (e.g., in adult life) to undergo a ureteral endoluminal surgery after a previous Cohen procedure, all these reasons have led to vested and renewed interest in performing the Lich-Gregoir technique laparoscopically. The rigorous evaluation of potential functional vesical disorders is indispensable in case of bilateral surgery.
F Varlet
Lecture
3 years ago
789 views
48 likes
0 comments
14:58
Transperitoneal ureteric reimplantation Lich-Gregoir technique for vesicoureteral reflux (VUR) in children
The Lich-Gregoir technique, still currently used in prominent Northern American centers in the nineties, had more or less fallen into disuse. Currently, the scarcity of operative indications for ureterovesical reimplantation, with the advent of the STING procedure, the real technical difficulties found during pneumovesicoscopy for Cohen procedure, the debates on long-term difficulties (e.g., in adult life) to undergo a ureteral endoluminal surgery after a previous Cohen procedure, all these reasons have led to vested and renewed interest in performing the Lich-Gregoir technique laparoscopically. The rigorous evaluation of potential functional vesical disorders is indispensable in case of bilateral surgery.
Renal cancer in children and laparoscopy
Dr. François Varlet reflected on the laparoscopic management of Wilms’ tumors.
The framework of existing possibilities to perform such interventions is extremely limited and would concern 5 to 10% of patients that we currently manage. Dr. François Varlet has undertaken a prospective study on a national scale, in France, and he supervises every proposal for laparoscopic surgery to manage Wilms’ tumors. The rigorous and thorough nature of his work, the caution he takes in his work are truly outstanding.
In France, any proposal for a laparoscopic surgery to manage nephroblastoma will be discussed at national level, and the intraoperative conditions and long-term follow-up are meticulously reported, in the framework of the prospective study undertaken by François Varlet.
F Varlet
Lecture
3 years ago
272 views
15 likes
0 comments
15:45
Renal cancer in children and laparoscopy
Dr. François Varlet reflected on the laparoscopic management of Wilms’ tumors.
The framework of existing possibilities to perform such interventions is extremely limited and would concern 5 to 10% of patients that we currently manage. Dr. François Varlet has undertaken a prospective study on a national scale, in France, and he supervises every proposal for laparoscopic surgery to manage Wilms’ tumors. The rigorous and thorough nature of his work, the caution he takes in his work are truly outstanding.
In France, any proposal for a laparoscopic surgery to manage nephroblastoma will be discussed at national level, and the intraoperative conditions and long-term follow-up are meticulously reported, in the framework of the prospective study undertaken by François Varlet.