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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
1381 views
22 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 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
2017 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.