We use cookies to offer you an optimal experience on our website. By browsing our website, you accept the use of cookies.
Filter by
Specialty
View more
Technologies
View more
Clear filter Media type
View more
Clear filter Category
View more
Publication date
Sort by:
A stepwise personal technique of RYGB with hand-sewn gastrojejunostomy
With more than 25 years of experience, we have created a unique laparoscopic Roux-en-Y gastric bypass technique with hand-sewn gastrojejunostomy and several additional steps which offer our patients a safe and reliable procedure.
We routinely use 5 bladeless 12mm trocars. The procedure begins with the creation of a 15-20mL gastric pouch with a tilted orientation for the first stapling (not horizontal), and staple lines are oversewn for both gastric pouch and gastric remnant. A blue dye test is always performed at this stage. The second stage of the procedure includes the creation of a 75cm biliopancreatic limb with division of the mesentery and creation of a mechanical jejunojejunostomy with a 100cm alimentary limb, and hand-sewn closure of the enterotomy. Anti-torsion stitches are mandatory at this point. Closure of mesenteric defects (intermesenteric space and Petersen's space) is accomplished with non-absorbable sutures performed in a routine manner. The third and final stage of the procedure involves the creation of the hand-sewn gastrojejunostomy with an interposed limb and 4 layers of absorbable sutures over a 28-30 French bougie.
Closure of all trocar defects is performed in every patient.
L Zorrilla-Nunez, P Zorrilla
Surgical intervention
1 year ago
1446 views
219 likes
0 comments
10:05
A stepwise personal technique of RYGB with hand-sewn gastrojejunostomy
With more than 25 years of experience, we have created a unique laparoscopic Roux-en-Y gastric bypass technique with hand-sewn gastrojejunostomy and several additional steps which offer our patients a safe and reliable procedure.
We routinely use 5 bladeless 12mm trocars. The procedure begins with the creation of a 15-20mL gastric pouch with a tilted orientation for the first stapling (not horizontal), and staple lines are oversewn for both gastric pouch and gastric remnant. A blue dye test is always performed at this stage. The second stage of the procedure includes the creation of a 75cm biliopancreatic limb with division of the mesentery and creation of a mechanical jejunojejunostomy with a 100cm alimentary limb, and hand-sewn closure of the enterotomy. Anti-torsion stitches are mandatory at this point. Closure of mesenteric defects (intermesenteric space and Petersen's space) is accomplished with non-absorbable sutures performed in a routine manner. The third and final stage of the procedure involves the creation of the hand-sewn gastrojejunostomy with an interposed limb and 4 layers of absorbable sutures over a 28-30 French bougie.
Closure of all trocar defects is performed in every patient.
Hand-assisted laparoscopic live donor nephrectomy
Introduction and purpose: The shortage of cadaver donor organs and the progressive acceptation of laparoscopic procedures have significantly increased the number of living donor transplants. Laparoscopic nephrectomy has been rapidly and progressively incorporated as a therapeutic option in most hospitals. We describe the current surgical technique for living donor nephrectomy in our hospital.
Materials and methods: A 42-year-old woman with a medical history of hypertension and end-stage renal disease by IgA glomerulonephritis in predialysis program underwent a living donor transplantation. The donor was her sister, a woman aged 51, with no medical past history. We performed a left laparoscopic nephrectomy, and removal of the graft was performed using a hand-assisted device fixed in a supraumbilical 5cm laparotomy.
Results: Hospital stay was 3 days for the donor and 4 days for the receptor. The receptor had a postoperative creatinine of 1.76 mg/dL. In the third year of follow-up creatinine was 1.46 mg/dL.
Conclusions: Laparoscopic donor nephrectomy has proven to be a safe, less invasive, and effective technique for the renal graft. It has encouraged donation from living donors, given its esthetic results and comfort for the donor.
S Valverde-Martinez , A Martin-Parada, A Palacios-Hernandez, O Heredero-Zorzo, P Eguiluz-Lumbreras, J Garcia-Garcia, R Gomez-Zancajo, F Gomez-Veiga
Surgical intervention
2 years ago
1754 views
150 likes
0 comments
08:47
Hand-assisted laparoscopic live donor nephrectomy
Introduction and purpose: The shortage of cadaver donor organs and the progressive acceptation of laparoscopic procedures have significantly increased the number of living donor transplants. Laparoscopic nephrectomy has been rapidly and progressively incorporated as a therapeutic option in most hospitals. We describe the current surgical technique for living donor nephrectomy in our hospital.
Materials and methods: A 42-year-old woman with a medical history of hypertension and end-stage renal disease by IgA glomerulonephritis in predialysis program underwent a living donor transplantation. The donor was her sister, a woman aged 51, with no medical past history. We performed a left laparoscopic nephrectomy, and removal of the graft was performed using a hand-assisted device fixed in a supraumbilical 5cm laparotomy.
Results: Hospital stay was 3 days for the donor and 4 days for the receptor. The receptor had a postoperative creatinine of 1.76 mg/dL. In the third year of follow-up creatinine was 1.46 mg/dL.
Conclusions: Laparoscopic donor nephrectomy has proven to be a safe, less invasive, and effective technique for the renal graft. It has encouraged donation from living donors, given its esthetic results and comfort for the donor.
Suprapubic single-incision laparoscopic splenic flexure resection with hand-sewn intracorporeal anastomosis
Background: The authors report the case of a 30-year-old woman who consulted for episodes of diverticulitis due to segmental diverticulosis of the splenic flexure. The patient was scheduled for a suprapubic single incision laparoscopic splenic flexure resection.

Video: A right suprapubic incision was performed and allowed for the introduction of three abdominal trocars (11mm, and two 6mm ones). DAPRI curved reusable instruments (Karl Storz Endoskope, Tuttlingen, Germany) were used, in addition to a 10mm, 30-degree regular length scope. The mobilization of the left mesocolon as well as of the transverse mesocolon was performed. After having completely freed the splenic flexure from its attachments, the transverse colon and the left colon were divided using an articulating linear stapler, introduced into the abdomen under a 5mm, 30-degree long scope. An intracorporeal end-to-end transverse sigmoid anastomosis was performed using two converging running sutures. The mesocolic defect was closed. The specimen was removed through a single access and final scar appeared to be 4cm.

Results: Laparoscopic time was 165 minutes and time to perform the anastomosis was 60 minutes. Operative bleeding was 10cc. The patient was discharged after 4 days, and at visit consultations, the symptoms were resolved.

Conclusion: Single incision laparoscopic splenic flexure resection can be safely performed using a suprapubic access, which enhances cosmetic outcomes, in addition to the advantages of minimally invasive surgery. A laparoscopic intracorporeal anastomosis is mandatory and can be performed using a hand-sewn method.
G Dapri, L Cardinali, A Cadenas Febres, GB Cadière
Surgical intervention
2 years ago
1670 views
92 likes
0 comments
07:12
Suprapubic single-incision laparoscopic splenic flexure resection with hand-sewn intracorporeal anastomosis
Background: The authors report the case of a 30-year-old woman who consulted for episodes of diverticulitis due to segmental diverticulosis of the splenic flexure. The patient was scheduled for a suprapubic single incision laparoscopic splenic flexure resection.

Video: A right suprapubic incision was performed and allowed for the introduction of three abdominal trocars (11mm, and two 6mm ones). DAPRI curved reusable instruments (Karl Storz Endoskope, Tuttlingen, Germany) were used, in addition to a 10mm, 30-degree regular length scope. The mobilization of the left mesocolon as well as of the transverse mesocolon was performed. After having completely freed the splenic flexure from its attachments, the transverse colon and the left colon were divided using an articulating linear stapler, introduced into the abdomen under a 5mm, 30-degree long scope. An intracorporeal end-to-end transverse sigmoid anastomosis was performed using two converging running sutures. The mesocolic defect was closed. The specimen was removed through a single access and final scar appeared to be 4cm.

Results: Laparoscopic time was 165 minutes and time to perform the anastomosis was 60 minutes. Operative bleeding was 10cc. The patient was discharged after 4 days, and at visit consultations, the symptoms were resolved.

Conclusion: Single incision laparoscopic splenic flexure resection can be safely performed using a suprapubic access, which enhances cosmetic outcomes, in addition to the advantages of minimally invasive surgery. A laparoscopic intracorporeal anastomosis is mandatory and can be performed using a hand-sewn method.
Robotics in hand and peripheral nerve surgery: Brazilian experience (3 years)
Our Brazilian experience using the da Vinci® robot in hand surgery and peripheral nerve starts in 2010. The first case was that of a male patient with brachial plexus upper roots injury in a motorcycle accident. The classical supraclavicular open approach was performed and the da Vinci® robot was used as a substitute of the microscope. Repair was performed by means of a sural nerve graft.
Another brachial plexus injury was treated with the same method. Two ulnar nerves transposition at elbow level was performed with endoscopic approach and using the da Vinci® robot. One digital nerve lesion was repaired with neural conduit using the da Vinci® robot as a substitute of the microscope. The main reasons for the few number of cases in Brazil are as follows:
- few numbers of hand and peripheral nerve surgeons with valid Intuitive Certificate of da Vinci® training;
- high costs and Brazilian economy problems;
- lack of evidence of better results with robotic surgery;
- only 6 da Vinci® robots in Brazil.
L Alves de Mendonça Jr.
Lecture
5 years ago
98 views
6 likes
0 comments
06:42
Robotics in hand and peripheral nerve surgery: Brazilian experience (3 years)
Our Brazilian experience using the da Vinci® robot in hand surgery and peripheral nerve starts in 2010. The first case was that of a male patient with brachial plexus upper roots injury in a motorcycle accident. The classical supraclavicular open approach was performed and the da Vinci® robot was used as a substitute of the microscope. Repair was performed by means of a sural nerve graft.
Another brachial plexus injury was treated with the same method. Two ulnar nerves transposition at elbow level was performed with endoscopic approach and using the da Vinci® robot. One digital nerve lesion was repaired with neural conduit using the da Vinci® robot as a substitute of the microscope. The main reasons for the few number of cases in Brazil are as follows:
- few numbers of hand and peripheral nerve surgeons with valid Intuitive Certificate of da Vinci® training;
- high costs and Brazilian economy problems;
- lack of evidence of better results with robotic surgery;
- only 6 da Vinci® robots in Brazil.
Laparoscopic hand-sewn re-gastrojejunostomy for complicated Roux-en-Y gastric bypass
Introduction: Laparoscopic Roux-en-Y gastric bypass (LRYGB) is a popular bariatric procedure associated with potential risk of late complications such as anastomotic stricture, marginal ulceration, fistula formation, weight gain, and nutritional deficiencies. A 48-year-old woman submitted to LRYGB 1.5 year before, presented a marginal ulcer of the gastrojejunostomy, non-responsive to medical therapy, associated with total dysphagia and cachexia. At the time of LRYGB, a linear stapled side-to-side gastrojejunostomy has been performed.

Video: The revision was completed using 4 abdominal trocars and consisted in these successive steps: adhesiolysis between the left liver lobe, gastrojejunostomy and gastric pouch; identification of right crus and lower esophagus; mobilization of the stoma and gastric pouch from both crura, transverse colon and gastric remnant; division of the gastric pouch above the stoma with preservation of the left gastric vessels; division of the proximal alimentary limb under the stoma; new double-layer hand-sewn gastrojejunostomy (PDS 1 externally, PDS 2/0 internally); hiatoplasty; leak test; specimen’s removal through trocar enlargement.

Results: No perioperative complications or additional trocars were registered. Operative time was 157 minutes and estimated blood loss 20 cc. The postoperative course was uneventful and patient was discharged on postoperative day 3. After 1 year, the patient is well and tolerates a regular diet.

Conclusions: Postoperative complications after LRYGB, such as marginal ulcer, can be safely treated by laparoscopy. New hand-sewn anastomosis permits to control the stoma openings and to calibrate the anastomosis size, especially in case of small gastric pouch.
G Dapri
Surgical intervention
6 years ago
1380 views
15 likes
0 comments
09:18
Laparoscopic hand-sewn re-gastrojejunostomy for complicated Roux-en-Y gastric bypass
Introduction: Laparoscopic Roux-en-Y gastric bypass (LRYGB) is a popular bariatric procedure associated with potential risk of late complications such as anastomotic stricture, marginal ulceration, fistula formation, weight gain, and nutritional deficiencies. A 48-year-old woman submitted to LRYGB 1.5 year before, presented a marginal ulcer of the gastrojejunostomy, non-responsive to medical therapy, associated with total dysphagia and cachexia. At the time of LRYGB, a linear stapled side-to-side gastrojejunostomy has been performed.

Video: The revision was completed using 4 abdominal trocars and consisted in these successive steps: adhesiolysis between the left liver lobe, gastrojejunostomy and gastric pouch; identification of right crus and lower esophagus; mobilization of the stoma and gastric pouch from both crura, transverse colon and gastric remnant; division of the gastric pouch above the stoma with preservation of the left gastric vessels; division of the proximal alimentary limb under the stoma; new double-layer hand-sewn gastrojejunostomy (PDS 1 externally, PDS 2/0 internally); hiatoplasty; leak test; specimen’s removal through trocar enlargement.

Results: No perioperative complications or additional trocars were registered. Operative time was 157 minutes and estimated blood loss 20 cc. The postoperative course was uneventful and patient was discharged on postoperative day 3. After 1 year, the patient is well and tolerates a regular diet.

Conclusions: Postoperative complications after LRYGB, such as marginal ulcer, can be safely treated by laparoscopy. New hand-sewn anastomosis permits to control the stoma openings and to calibrate the anastomosis size, especially in case of small gastric pouch.
Hand-sewn retrogastric retrocolic gastric bypass
Nowadays, the Roux-en-Y gastric bypass has become a gold standard in bariatric surgery. In this procedure, the stomach is divided into a small gastric pouch and a Y-shaped section of the intestine is then fashioned and joined to the gastric pouch. A jejunojejunal anastomosis allows for a restoration of the duodenal continuity. This video demonstrates several technical options for these two anastomoses. Dr. Higa has an outstanding experience in the field and has subsequently been able to ergonomically improve every operative step, which is being shown in detail in the video. Authoritative interaction of the expert with the operating room staff is ideal to promote clear and stepwise explanations throughout the procedure. Antecolic or retrocolic approaches, the necessity to look for a hiatal hernia as well as which type of gastrojejunal anastomosis is required are being discussed. This intervention allows for a true teaching lesson in the field of morbid obesity surgery.
KD Higa, M Vix, J Marescaux
Surgical intervention
7 years ago
2158 views
23 likes
0 comments
36:38
Hand-sewn retrogastric retrocolic gastric bypass
Nowadays, the Roux-en-Y gastric bypass has become a gold standard in bariatric surgery. In this procedure, the stomach is divided into a small gastric pouch and a Y-shaped section of the intestine is then fashioned and joined to the gastric pouch. A jejunojejunal anastomosis allows for a restoration of the duodenal continuity. This video demonstrates several technical options for these two anastomoses. Dr. Higa has an outstanding experience in the field and has subsequently been able to ergonomically improve every operative step, which is being shown in detail in the video. Authoritative interaction of the expert with the operating room staff is ideal to promote clear and stepwise explanations throughout the procedure. Antecolic or retrocolic approaches, the necessity to look for a hiatal hernia as well as which type of gastrojejunal anastomosis is required are being discussed. This intervention allows for a true teaching lesson in the field of morbid obesity surgery.
Pancreatic duplication associated with a gastric duplication cyst: laparoscopic approach
This video shows the case of a 48-year-old male patient with a history of epigastric pain for 20 days, with the presence of nausea and vomiting but no self-reported fever. The patient was presented at the ER for examination. Computerized tomography (CT) scanning revealed a very rare case of pancreatic duplication associated with a gastric duplication cyst. He was referred to our service and then treated by laparoscopic route with partial gastrectomy and pancreatic resection (pancreas horn). On the 2nd postoperative day, the patient was discharged and allowed for free oral feeding. This is the second study in the literature reporting a case of laparoscopic resection of a gastric duplication cyst together with pancreatic resection. Of note, this is the first study in which the accessory pancreas communicates with the pancreatic head.
F Freire Lisboa Junior, R de Lima França, A de Araujo Lima Liguori, AC de Medeiros Junior, M HSMP Tavares, F Medeiros de Azevedo, D Myller Barros Lima
Surgical intervention
6 months ago
1121 views
5 likes
0 comments
14:36
Pancreatic duplication associated with a gastric duplication cyst: laparoscopic approach
This video shows the case of a 48-year-old male patient with a history of epigastric pain for 20 days, with the presence of nausea and vomiting but no self-reported fever. The patient was presented at the ER for examination. Computerized tomography (CT) scanning revealed a very rare case of pancreatic duplication associated with a gastric duplication cyst. He was referred to our service and then treated by laparoscopic route with partial gastrectomy and pancreatic resection (pancreas horn). On the 2nd postoperative day, the patient was discharged and allowed for free oral feeding. This is the second study in the literature reporting a case of laparoscopic resection of a gastric duplication cyst together with pancreatic resection. Of note, this is the first study in which the accessory pancreas communicates with the pancreatic head.
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.
Laparoscopic en bloc splenopancreatectomy with left adrenalectomy and para-aortic lymphadenectomy
The objective of this video is to present a surgical approach to a left adrenal mass caused by the invasion of a pancreatic lesion. A pulmonary lesion was also found. However, a preoperative biopsy of that lesion was impossible to perform. In order to distinguish the primary origin of this lung lesion, a laparoscopic ‘en bloc’ splenopancreatectomy combined with a left adrenalectomy and a para-aortic lymphadenectomy were planned.
Retrograde distal pancreatectomy with splenectomy is the standard procedure for cancers of the body and tail of the pancreas. In the literature, fewer studies describe the feasibility and the oncological safety of the laparoscopic approach.
This video aims to show the different operative steps of the procedure beginning with laparoscopic adrenalectomy followed by distal pancreatectomy and para-aortic lympadenectomy.
R Romito, L Portigliotti, G Bondonno, M Zacchero, A Volpe
Surgical intervention
5 months ago
1183 views
11 likes
0 comments
13:28
Laparoscopic en bloc splenopancreatectomy with left adrenalectomy and para-aortic lymphadenectomy
The objective of this video is to present a surgical approach to a left adrenal mass caused by the invasion of a pancreatic lesion. A pulmonary lesion was also found. However, a preoperative biopsy of that lesion was impossible to perform. In order to distinguish the primary origin of this lung lesion, a laparoscopic ‘en bloc’ splenopancreatectomy combined with a left adrenalectomy and a para-aortic lymphadenectomy were planned.
Retrograde distal pancreatectomy with splenectomy is the standard procedure for cancers of the body and tail of the pancreas. In the literature, fewer studies describe the feasibility and the oncological safety of the laparoscopic approach.
This video aims to show the different operative steps of the procedure beginning with laparoscopic adrenalectomy followed by distal pancreatectomy and para-aortic lympadenectomy.