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Single port laparoscopic assisted anorectal pull-through in anorectal malformation
This is the case of a 21-month-old male infant, referred from another center, with anorectal malformation and rectourethral fistula. The patient underwent a colostomy two months earlier and weighed 10Kg. On physical examination, the intergluteal cleft is evident, the infant has a good anal fovea, and his coccyx is palpable. In the distal colostogram, the distance between the rectum and the anus is approximately 2.7cm. The patient underwent single port laparoscopic anorectal pull-through, using the GelPOINT® Mini advanced access platform at umbilical level and a 3mm accessory port was placed at left upper quadrant level. Dissection of the distal part and division of the fistula by a white cartridge 45mm and 10mm ECHELON™ Hem-o-Lok® to remove the fistula at the level of the membranous urethra. A 5mm trocar was placed at the level of the fovea anal and rectum is lowered. The length of the procedure was approximately 3 hours and the patient was discharged on postoperative day 3, and progressed satisfactorily. One advantage of the use of the GelPOINT® Mini advanced access platform is that it allows the introduction of a larger number of instruments of different diameters (3 to 15mm) through the GelSeal® cap without placing other working ports. The single port laparoscopic anorectal pull-through procedure seems to be an efficient method that allows for adequate visualization and tissue manipulation in these patients.
A Parilli, J Mejías, W Salcedo, G Contreras
Surgical intervention
5 years ago
1451 views
23 likes
0 comments
09:55
Single port laparoscopic assisted anorectal pull-through in anorectal malformation
This is the case of a 21-month-old male infant, referred from another center, with anorectal malformation and rectourethral fistula. The patient underwent a colostomy two months earlier and weighed 10Kg. On physical examination, the intergluteal cleft is evident, the infant has a good anal fovea, and his coccyx is palpable. In the distal colostogram, the distance between the rectum and the anus is approximately 2.7cm. The patient underwent single port laparoscopic anorectal pull-through, using the GelPOINT® Mini advanced access platform at umbilical level and a 3mm accessory port was placed at left upper quadrant level. Dissection of the distal part and division of the fistula by a white cartridge 45mm and 10mm ECHELON™ Hem-o-Lok® to remove the fistula at the level of the membranous urethra. A 5mm trocar was placed at the level of the fovea anal and rectum is lowered. The length of the procedure was approximately 3 hours and the patient was discharged on postoperative day 3, and progressed satisfactorily. One advantage of the use of the GelPOINT® Mini advanced access platform is that it allows the introduction of a larger number of instruments of different diameters (3 to 15mm) through the GelSeal® cap without placing other working ports. The single port laparoscopic anorectal pull-through procedure seems to be an efficient method that allows for adequate visualization and tissue manipulation in these patients.
Laparoscopic ligation of middle sacral artery and dissection of sacrococcygeal teratoma to decrease intraoperative hemorrhagic risk
Sacrococcygeal teratomas are the most common teratomas presenting at birth. Life-threatening bleeding is a major complication during tumor excision in children. In this video, we demonstrate our technique for the laparoscopic division of the middle sacral artery during dissection of sacrococcygeal teratomas in two pediatric patients.
Two female infants diagnosed with type IV and type III sacrococcygeal teratomas underwent preoperative evaluation in the postnatal period. The first patient was an 18-month-old female patient who presented with a metastatic type IV teratoma resected after neoadjuvant therapy. The second patient was a 6-day-old female infant with a prenatal diagnosis of cystic type III teratoma. Using laparoscopy in both patients, the presacral space was reached by opening the peritoneal reflection with blunt dissection and the middle sacral artery was identified. It was then carefully isolated and divided with a 5mm LigaSure™ vessel-sealing device. The pelvic components of the tumors were partially dissected using laparoscopy. The first patient’s tumor resection was completed using a posterior sagittal approach and the second patient required a standard Chevron incision.
Both patients underwent a successful laparoscopic division of the middle sacral artery and resection of the sacrococcygeal teratomas without complications. As a result, laparoscopic middle sacral artery division before sacrococcygeal teratoma excision offers a safe approach which can reduce the risk of hemorrhage during surgery.
T Huy, H Osei, AS Munoz Abraham, R Damle, GA Villalona
Surgical intervention
1 year ago
913 views
6 likes
0 comments
05:33
Laparoscopic ligation of middle sacral artery and dissection of sacrococcygeal teratoma to decrease intraoperative hemorrhagic risk
Sacrococcygeal teratomas are the most common teratomas presenting at birth. Life-threatening bleeding is a major complication during tumor excision in children. In this video, we demonstrate our technique for the laparoscopic division of the middle sacral artery during dissection of sacrococcygeal teratomas in two pediatric patients.
Two female infants diagnosed with type IV and type III sacrococcygeal teratomas underwent preoperative evaluation in the postnatal period. The first patient was an 18-month-old female patient who presented with a metastatic type IV teratoma resected after neoadjuvant therapy. The second patient was a 6-day-old female infant with a prenatal diagnosis of cystic type III teratoma. Using laparoscopy in both patients, the presacral space was reached by opening the peritoneal reflection with blunt dissection and the middle sacral artery was identified. It was then carefully isolated and divided with a 5mm LigaSure™ vessel-sealing device. The pelvic components of the tumors were partially dissected using laparoscopy. The first patient’s tumor resection was completed using a posterior sagittal approach and the second patient required a standard Chevron incision.
Both patients underwent a successful laparoscopic division of the middle sacral artery and resection of the sacrococcygeal teratomas without complications. As a result, laparoscopic middle sacral artery division before sacrococcygeal teratoma excision offers a safe approach which can reduce the risk of hemorrhage during surgery.
Laparoscopic 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
2399 views
4 likes
1 comment
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.
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
2952 views
13 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.
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
2 years ago
1365 views
13 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)