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Bile duct injury: what to do?
In this key lecture, Dr. Soubrane outlines the various types of bile duct injuries and demonstrates how to manage them, classifying them into bile duct injuries during or after index surgery. When injuries are detected during index surgery, surgeons either have to add stitches combined with drainage in case of minor injuries or create an anastomosis in case of complete common bile duct division. When injuries are detected after index surgery, surgeons may either solve them with endoscopic stenting in case of minor injuries or have to wait at least 2 months in case of complete common bile duct division. As an example of major liver resection for severe bile duct injuries, Dr. Soubrane also shows a case of right liver resection for severe bile duct injury with concomitant arterial interruption and massive portal vein thrombosis after laparoscopic cholecystectomy.
O Soubrane
Lecture
9 months ago
2444 views
19 likes
1 comment
31:48
Bile duct injury: what to do?
In this key lecture, Dr. Soubrane outlines the various types of bile duct injuries and demonstrates how to manage them, classifying them into bile duct injuries during or after index surgery. When injuries are detected during index surgery, surgeons either have to add stitches combined with drainage in case of minor injuries or create an anastomosis in case of complete common bile duct division. When injuries are detected after index surgery, surgeons may either solve them with endoscopic stenting in case of minor injuries or have to wait at least 2 months in case of complete common bile duct division. As an example of major liver resection for severe bile duct injuries, Dr. Soubrane also shows a case of right liver resection for severe bile duct injury with concomitant arterial interruption and massive portal vein thrombosis after laparoscopic cholecystectomy.
Laparoscopic cholecystectomy - Basic rules - Bile duct injury
There is twice as much risk of incidental biliary injuries in laparoscopic cholecystectomy than in open cholecystectomy.
About half of surgeons will cause a bile duct injury during their careers. In this lecture, Dr. Dallemagne provides key national data of bile duct injury and explains that the lack of surgical experience or visual misperception leads to an increase in the rate of incidental injuries, mentioning his own cases. Dr. Dallemagne also outlines the fundamental techniques to prevent injuries and use bailout procedures (partial and subtotal cholecystectomy) in laparoscopic cholecystectomy, according to the latest version of the Tokyo guidelines.
B Dallemagne
Lecture
9 months ago
6216 views
48 likes
2 comments
22:02
Laparoscopic cholecystectomy - Basic rules - Bile duct injury
There is twice as much risk of incidental biliary injuries in laparoscopic cholecystectomy than in open cholecystectomy.
About half of surgeons will cause a bile duct injury during their careers. In this lecture, Dr. Dallemagne provides key national data of bile duct injury and explains that the lack of surgical experience or visual misperception leads to an increase in the rate of incidental injuries, mentioning his own cases. Dr. Dallemagne also outlines the fundamental techniques to prevent injuries and use bailout procedures (partial and subtotal cholecystectomy) in laparoscopic cholecystectomy, according to the latest version of the Tokyo guidelines.
Laparoscopic complete parametrectomy associated with upper vaginectomy and bilateral pelvic lymphadenectomy
This video shows a reproducible approach to complete parametrectomy in a patient who had had a hysterectomy. The procedure begins with adhesiolysis and dissection of the lateral pelvic spaces in order to identify and isolate the parametrium. The paravesical fossa is then dissected medially and laterally using the umbilical artery as a landmark. The surgeon identifies the uterine artery and parametrium by following the umbilical artery. Using the uterine artery as a landmark of the parametrium, dissection is continued posteriorly developing the pararectal spaces in order to isolate the posterior part of the parametrium. The ureter is dissected towards the ureteral channel and unroofed. The procedure is carried on with the complete isolation of the ureter in its anterior aspect between the parametrium and the bladder. The bladder pillar is then transected at the level of the bladder. The rectal pillar is transected at the level of the rectum, paying attention to isolate the inferior hypogastric nerve. The parametrium is then cut at the level of the hypogastric vessel. The vagina is cut with ultrasonic scissors using a cap of RUMI II as a guide, and the specimen is extracted vaginally. The surgeon performs a bilateral lymphadenectomy. In this step, the obturator nerve is dissected to prevent injuries at the medial aspect of the obturator artery. The vagina is closed with continued stitches vaginally using an extracorporeal knotting technique.
H Camuzcuoglu, B Sezgin
Surgical intervention
1 year ago
5665 views
454 likes
1 comment
11:55
Laparoscopic complete parametrectomy associated with upper vaginectomy and bilateral pelvic lymphadenectomy
This video shows a reproducible approach to complete parametrectomy in a patient who had had a hysterectomy. The procedure begins with adhesiolysis and dissection of the lateral pelvic spaces in order to identify and isolate the parametrium. The paravesical fossa is then dissected medially and laterally using the umbilical artery as a landmark. The surgeon identifies the uterine artery and parametrium by following the umbilical artery. Using the uterine artery as a landmark of the parametrium, dissection is continued posteriorly developing the pararectal spaces in order to isolate the posterior part of the parametrium. The ureter is dissected towards the ureteral channel and unroofed. The procedure is carried on with the complete isolation of the ureter in its anterior aspect between the parametrium and the bladder. The bladder pillar is then transected at the level of the bladder. The rectal pillar is transected at the level of the rectum, paying attention to isolate the inferior hypogastric nerve. The parametrium is then cut at the level of the hypogastric vessel. The vagina is cut with ultrasonic scissors using a cap of RUMI II as a guide, and the specimen is extracted vaginally. The surgeon performs a bilateral lymphadenectomy. In this step, the obturator nerve is dissected to prevent injuries at the medial aspect of the obturator artery. The vagina is closed with continued stitches vaginally using an extracorporeal knotting technique.
Laparoscopic cholecystectomy: basic rules
In this key lecture, Dr. Dallemagne provides a brief overview of basic rules for a safe laparoscopic cholecystectomy. He demonstrates the incidence, different causes, and impact of biliary injuries in open, laparoscopic, and single port surgery. He describes the main criteria of dissection with the principle of critical view of safety and highlights the Tokyo and SAGES guidelines in relation to the optimal surgical timing. He mentions the recommended surgical techniques, main maneuvers of the technique with modified cholecystectomy, and when the decision to convert is made depending on complications. He also presents alternative methods for the intraoperative imaging of bile ducts, including the role of cholangiography, near-infrared and fluorescence-guided cholecystectomy.
B Dallemagne
Lecture
2 years ago
6896 views
878 likes
0 comments
39:17
Laparoscopic cholecystectomy: basic rules
In this key lecture, Dr. Dallemagne provides a brief overview of basic rules for a safe laparoscopic cholecystectomy. He demonstrates the incidence, different causes, and impact of biliary injuries in open, laparoscopic, and single port surgery. He describes the main criteria of dissection with the principle of critical view of safety and highlights the Tokyo and SAGES guidelines in relation to the optimal surgical timing. He mentions the recommended surgical techniques, main maneuvers of the technique with modified cholecystectomy, and when the decision to convert is made depending on complications. He also presents alternative methods for the intraoperative imaging of bile ducts, including the role of cholangiography, near-infrared and fluorescence-guided cholecystectomy.
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
2 years ago
1869 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.
Totally endoscopic left hemithyroidectomy: axillary approach for papillary carcinoma, including a critical analysis by M Vix, MD, and point by point answer by Dr. Shah
Introduction:
Endoscopic thyroidectomy is a novel approach used to avoid cervical scar, which represents sequelae of conventional thyroidectomies. This technique is feasible providing equal results under expert hands.
Case presentation:
This is the case of a 20 year-old woman with cervical swelling, a 3 by 3cm solitary nodule in the left thyroid lobe, which was evaluated clinically, radiologically, and withfine-needle aspiration cytology (FNAC). She was diagnosed with a low-risk papillary carcinoma.
Discussion:
The patient underwent an endoscopic transaxillary left hemithyroidectomy under general anesthesia. The recurrent laryngeal nerve and the parathyroid gland were preserved. The patient was discharged with a normal tone on postoperative day 1.
Conclusion:
Endoscopic transaxillary thyroidectomy is a feasible good technique with equal results, which can be considered for patients with small thyroid lesions. Conventional laparoscopic instruments are used without the need for extra instrumentation.

This video is commented upon by Dr. M Vix, MD (University Hospital, Strasbourg, France), providing a comprehensive outline of Dr. Shah's original technique.


Point by point answer by Dr. Shah:

1. Carbon dioxide causing surgical emphysema, especially of an incapacitating nature, has not been experienced since intracavitary pressures are generally maintained at a low level by the almost continuous low-grade suction used throughout the surgery.

2. In our experience, adequate visualization of the thyroid pedicles in close proximity to the gland precludes the need for a deeper and more lateral dissection to identify the jugulocarotid vessels. This potentially decreases the risk of a major vascular mishap.

3. As is the norm with open thyroidectomy, division of the superior thyroid pedicle close to the gland usually does not require the identification of the superior laryngeal nerve.

4. In this approach, the recurrent laryngeal nerve is identified very early on in the dissection. Subsequent dissection is performed in a plane anterior to the visualized nerve, hence preventing any injuries. The recurrent laryngeal nerve is visualized in its entire extent up to Berry's ligament.



AR Shah
Surgical intervention
2 years ago
1171 views
117 likes
0 comments
11:09
Totally endoscopic left hemithyroidectomy: axillary approach for papillary carcinoma, including a critical analysis by M Vix, MD, and point by point answer by Dr. Shah
Introduction:
Endoscopic thyroidectomy is a novel approach used to avoid cervical scar, which represents sequelae of conventional thyroidectomies. This technique is feasible providing equal results under expert hands.
Case presentation:
This is the case of a 20 year-old woman with cervical swelling, a 3 by 3cm solitary nodule in the left thyroid lobe, which was evaluated clinically, radiologically, and withfine-needle aspiration cytology (FNAC). She was diagnosed with a low-risk papillary carcinoma.
Discussion:
The patient underwent an endoscopic transaxillary left hemithyroidectomy under general anesthesia. The recurrent laryngeal nerve and the parathyroid gland were preserved. The patient was discharged with a normal tone on postoperative day 1.
Conclusion:
Endoscopic transaxillary thyroidectomy is a feasible good technique with equal results, which can be considered for patients with small thyroid lesions. Conventional laparoscopic instruments are used without the need for extra instrumentation.

This video is commented upon by Dr. M Vix, MD (University Hospital, Strasbourg, France), providing a comprehensive outline of Dr. Shah's original technique.


Point by point answer by Dr. Shah:

1. Carbon dioxide causing surgical emphysema, especially of an incapacitating nature, has not been experienced since intracavitary pressures are generally maintained at a low level by the almost continuous low-grade suction used throughout the surgery.

2. In our experience, adequate visualization of the thyroid pedicles in close proximity to the gland precludes the need for a deeper and more lateral dissection to identify the jugulocarotid vessels. This potentially decreases the risk of a major vascular mishap.

3. As is the norm with open thyroidectomy, division of the superior thyroid pedicle close to the gland usually does not require the identification of the superior laryngeal nerve.

4. In this approach, the recurrent laryngeal nerve is identified very early on in the dissection. Subsequent dissection is performed in a plane anterior to the visualized nerve, hence preventing any injuries. The recurrent laryngeal nerve is visualized in its entire extent up to Berry's ligament.



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
1886 views
151 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.
Biliary access techniques in patients with surgically altered anatomy
Iatrogenic bile duct injuries following surgery are associated with life-threatening complications.
Most injuries occur following open or laparoscopic cholecystectomies. The incidence of bile duct injury (BDI) has increased when a laparoscopic approach is used.
The current incidence of BDI using a laparoscopic approach is comprised between 0.5 and 2.7%.
The presented clinical cases include bile leakage, bilioma, peritonitis or a local abscess, and only 30% of cases are recognized intraoperatively.
The main modality of treatment is surgery. However, endoscopic management is a current alternative.
This video highlights the various methods for the management of biliary leaks and postoperative biliary strictures.
M Perez-Miranda
Lecture
3 years ago
1038 views
31 likes
0 comments
26:31
Biliary access techniques in patients with surgically altered anatomy
Iatrogenic bile duct injuries following surgery are associated with life-threatening complications.
Most injuries occur following open or laparoscopic cholecystectomies. The incidence of bile duct injury (BDI) has increased when a laparoscopic approach is used.
The current incidence of BDI using a laparoscopic approach is comprised between 0.5 and 2.7%.
The presented clinical cases include bile leakage, bilioma, peritonitis or a local abscess, and only 30% of cases are recognized intraoperatively.
The main modality of treatment is surgery. However, endoscopic management is a current alternative.
This video highlights the various methods for the management of biliary leaks and postoperative biliary strictures.
Laparoscopic adrenalectomy
Retroperitoneoscopic adrenalectomy was developed in 1993, initially only for small benign lesions and recently for lesions superior to 5 cm and even malignancies.
This retroperitoneal technique has gained popularity since it allows for a direct access to the gland and prevents unexpected injuries to the intra-abdominal organs.
In this lecture, Dr. Mushtaq outlines the indications for adrenalectomy in children, patient set-up, trocar placement, and operative technique overview. The importance of resecting the gland ‘en bloc’ has been emphasized.
The retroperitoneal approach begins by placing the child in a prone position. The 12th rib, iliac crest, and paravertebral muscles are then marked on the patient. The first incision is made at the lateral border of the lateral vertebral muscles, halfway between the 12th rib and the iliac crest (Heloury et al., 2011).
This lecture was delivered during the pediatric urology course held at IRCAD in March 2016.
I Mushtaq
Lecture
3 years ago
1909 views
144 likes
0 comments
16:41
Laparoscopic adrenalectomy
Retroperitoneoscopic adrenalectomy was developed in 1993, initially only for small benign lesions and recently for lesions superior to 5 cm and even malignancies.
This retroperitoneal technique has gained popularity since it allows for a direct access to the gland and prevents unexpected injuries to the intra-abdominal organs.
In this lecture, Dr. Mushtaq outlines the indications for adrenalectomy in children, patient set-up, trocar placement, and operative technique overview. The importance of resecting the gland ‘en bloc’ has been emphasized.
The retroperitoneal approach begins by placing the child in a prone position. The 12th rib, iliac crest, and paravertebral muscles are then marked on the patient. The first incision is made at the lateral border of the lateral vertebral muscles, halfway between the 12th rib and the iliac crest (Heloury et al., 2011).
This lecture was delivered during the pediatric urology course held at IRCAD in March 2016.
How to manage EMR/ESD resection specimen for accurate histological assessment
In this lecture, Dr. Lehr outlines the various methods of handling the resected specimens. The importance of ‘en bloc’ resection over piecemeal resection is highlighted. ESD specimens are usually resected ‘en bloc’, hence 82% of the resections are R0, and the risk of recurrence is less than 1%.
As for EMR, 48% of specimens are piecemeal. Consequently, an accurate assessment of the resection margin cannot be achieved and the risk of recurrence is greater than 6%.
The true depth of the tumor can only be assessed when the lesion is resected in one piece and with the avoidance of electrocautery injuries inside or at the edges of the lesion. The specimen must be fixed on a Styrofoam or in specialized boxes to prevent it from curling up once put in formalin.
Specimen orientation is essential in order to help the pathologist for proper examination and reporting.
HA Lehr
Lecture
3 years ago
142 views
5 likes
0 comments
22:13
How to manage EMR/ESD resection specimen for accurate histological assessment
In this lecture, Dr. Lehr outlines the various methods of handling the resected specimens. The importance of ‘en bloc’ resection over piecemeal resection is highlighted. ESD specimens are usually resected ‘en bloc’, hence 82% of the resections are R0, and the risk of recurrence is less than 1%.
As for EMR, 48% of specimens are piecemeal. Consequently, an accurate assessment of the resection margin cannot be achieved and the risk of recurrence is greater than 6%.
The true depth of the tumor can only be assessed when the lesion is resected in one piece and with the avoidance of electrocautery injuries inside or at the edges of the lesion. The specimen must be fixed on a Styrofoam or in specialized boxes to prevent it from curling up once put in formalin.
Specimen orientation is essential in order to help the pathologist for proper examination and reporting.