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Laparoscopic enucleation of a horseshoe-shaped leiomyoma of the distal esophagus
This is the case of a 17-year-old girl, complaining of weight loss and dysphagia. In the preoperative work-up, gastroscopy and endoscopic ultrasonography revealed a 3-4cm multilobulated submucosal mass. Computed tomography and MRI showed a distal esophageal mass of 4cm in diameter. Fine needle aspiration biopsy was compatible with a leiomyoma. The patient was admitted to hospital for surgery, and a laparoscopic transhiatal enucleation of the esophageal leiomyoma was performed. The patient was placed in a gynecologic position, with the surgeon standing between the patient’s legs. The first assistant stood on the right side of the patient and the second assistant on the left. The procedure was performed using 5 trocars. The phrenoesophageal membrane was divided. The distal esophagus was circumferentially mobilized. Dissection was started by separating the layer over the tumor. Blunt dissection was preferred. The use of energy devices discouraged to prevent any delayed mucosal burn injury. The leiomyoma was completely enucleated. Esophageal muscle layers were closed. The postoperative period was uneventful. This video demonstrates technical details of a laparoscopic enucleation of a hoseshoe-shaped leiomyoma of the distal esophagus.
K Karabulut, S Usta, E Sahin, Z Cetinkaya
Surgical intervention
1 year ago
625 views
43 likes
0 comments
11:21
Laparoscopic enucleation of a horseshoe-shaped leiomyoma of the distal esophagus
This is the case of a 17-year-old girl, complaining of weight loss and dysphagia. In the preoperative work-up, gastroscopy and endoscopic ultrasonography revealed a 3-4cm multilobulated submucosal mass. Computed tomography and MRI showed a distal esophageal mass of 4cm in diameter. Fine needle aspiration biopsy was compatible with a leiomyoma. The patient was admitted to hospital for surgery, and a laparoscopic transhiatal enucleation of the esophageal leiomyoma was performed. The patient was placed in a gynecologic position, with the surgeon standing between the patient’s legs. The first assistant stood on the right side of the patient and the second assistant on the left. The procedure was performed using 5 trocars. The phrenoesophageal membrane was divided. The distal esophagus was circumferentially mobilized. Dissection was started by separating the layer over the tumor. Blunt dissection was preferred. The use of energy devices discouraged to prevent any delayed mucosal burn injury. The leiomyoma was completely enucleated. Esophageal muscle layers were closed. The postoperative period was uneventful. This video demonstrates technical details of a laparoscopic enucleation of a hoseshoe-shaped leiomyoma of the distal esophagus.
Laparoscopic transhiatal resection of giant esophageal leiomyoma
This is the case of a 36-year-old male patient who had slowly progressing symptoms for 10 years. These symptoms were the following: hiccups, progressive dysphagia, first for solids, and then for liquids, and gastro-esophageal reflux. In 2003, the patient was first evaluated in a private clinic and diagnosed with esophageal wall hernia. In 2010, his symptoms were still present and he was evaluated by a physician who performed a new endoscopy, which demonstrated a 90% obstruction of the esophageal lumen. A biopsy was also performed. It was negative for malignancy, hence providing the diagnosis of esophageal leiomyoma.
In December 2011, a CT-scan and endoscopic ultrasound were performed leading to the conclusion of an esophageal leiomyoma. A laparoscopic transhiatal resection of the esophageal leiomyoma was decided upon in July 2012.
This case is essential because it shows the usefulness of a hook clamp to facilitate traction of the leiomyoma. Additionally, it shows an intraoperative complication consisting in a perforation of the esophageal mucosa, which was sutured by means of Vicryl 4/0.
DU Castro Nuñez, L Bao Romero, L Belloni Caceres
Surgical intervention
4 years ago
524 views
4 likes
0 comments
09:57
Laparoscopic transhiatal resection of giant esophageal leiomyoma
This is the case of a 36-year-old male patient who had slowly progressing symptoms for 10 years. These symptoms were the following: hiccups, progressive dysphagia, first for solids, and then for liquids, and gastro-esophageal reflux. In 2003, the patient was first evaluated in a private clinic and diagnosed with esophageal wall hernia. In 2010, his symptoms were still present and he was evaluated by a physician who performed a new endoscopy, which demonstrated a 90% obstruction of the esophageal lumen. A biopsy was also performed. It was negative for malignancy, hence providing the diagnosis of esophageal leiomyoma.
In December 2011, a CT-scan and endoscopic ultrasound were performed leading to the conclusion of an esophageal leiomyoma. A laparoscopic transhiatal resection of the esophageal leiomyoma was decided upon in July 2012.
This case is essential because it shows the usefulness of a hook clamp to facilitate traction of the leiomyoma. Additionally, it shows an intraoperative complication consisting in a perforation of the esophageal mucosa, which was sutured by means of Vicryl 4/0.
Robot-assisted thoracic resection of an extended esophageal leiomyoma
Objective:
Leiomyomas represent approximately 70% of all benign esophageal tumors. In most cases, patients are asymptomatic, but others can present chest pain, dysphagia or weight loss. Even if malignization is rare, surgery is indicated. Laparoscopy is the most common approach because of the frequency of leiomyoma localization on the lower esophagus. However, thoracoscopy is also commonly performed with some difficulties in case of large tumors.
Our objective is to demonstrate the robotic approach and the bipolar Maryland forceps used for such a specific lesion.

Case presentation:
We present the case of a 58-year-old woman with no particular co-morbidity. On CT-scan, she was incidentally diagnosed with a leiomyoma for Guillain-Barre syndrome. A homogeneous 7cm tumor was found on the left side of the middle esophagus with a horseshoe-shaped aspect typical of leiomyoma. Check-up was completed by MRI and endoscopic ultrasonography, which tended to confirm the diagnosis.
In this video, the robot-assisted thoracic enucleation of the tumor performed by a left approach shows the quality of esophageal exposure and tumor dissection by means of a bipolar Maryland forceps. Blood loss was less than 30mL, and the postoperative period was uneventful. Histological analysis confirmed the diagnosis of leiomyoma.

Conclusion:
Robot-assisted resection of benign esophageal tumors is a safe procedure, especially for intrathoracic tumors. This technique provides a better view and easier dissection. The use of a bipolar Maryland forceps allows for a safer procedure. Day care surgery could then be expected for smaller lesions.
C Peillon, G Philouze, JM Baste
Surgical intervention
4 years ago
615 views
14 likes
0 comments
09:09
Robot-assisted thoracic resection of an extended esophageal leiomyoma
Objective:
Leiomyomas represent approximately 70% of all benign esophageal tumors. In most cases, patients are asymptomatic, but others can present chest pain, dysphagia or weight loss. Even if malignization is rare, surgery is indicated. Laparoscopy is the most common approach because of the frequency of leiomyoma localization on the lower esophagus. However, thoracoscopy is also commonly performed with some difficulties in case of large tumors.
Our objective is to demonstrate the robotic approach and the bipolar Maryland forceps used for such a specific lesion.

Case presentation:
We present the case of a 58-year-old woman with no particular co-morbidity. On CT-scan, she was incidentally diagnosed with a leiomyoma for Guillain-Barre syndrome. A homogeneous 7cm tumor was found on the left side of the middle esophagus with a horseshoe-shaped aspect typical of leiomyoma. Check-up was completed by MRI and endoscopic ultrasonography, which tended to confirm the diagnosis.
In this video, the robot-assisted thoracic enucleation of the tumor performed by a left approach shows the quality of esophageal exposure and tumor dissection by means of a bipolar Maryland forceps. Blood loss was less than 30mL, and the postoperative period was uneventful. Histological analysis confirmed the diagnosis of leiomyoma.

Conclusion:
Robot-assisted resection of benign esophageal tumors is a safe procedure, especially for intrathoracic tumors. This technique provides a better view and easier dissection. The use of a bipolar Maryland forceps allows for a safer procedure. Day care surgery could then be expected for smaller lesions.
Laparoscopic transhiatal resection of horseshoe-shaped leiomyoma of the thoracic esophagus
This is the case of a 36-year-old woman with symptoms which have been present for 18 months. Her main symptoms were the following: difficulty to swallow food accompanied by retrosternal discomfort. Upper endoscopy performed on September 29, 2011 found an extrinsic compression of the esophageal wall located 28cm away from the upper dental arcade with a mucosa which appeared to be normal. That extrinsic compression goes until 33cm from the upper dental arcade. The patient was evaluated by a gastroenterologist who performed an echo-endoscopy on March 7, 2012. The gastroenterologist observed a heterogeneous hypo-echoic mass coming from the muscular layer, 25 to 33cm away from the esophagus. The diagnosis of esophageal leiomyoma was established. The patient was admitted to hospital for surgery, and a laparoscopic transhiatal resection of the esophageal leiomyoma was performed on May 22, 2012.
This case is essential because it shows the excision of a horseshoe-shaped leiomyoma of the thoracic esophagus. In addition, it shows a transfixing stitch, which is performed to exert traction on the tumor.
DU Castro Nuñez
Surgical intervention
4 years ago
759 views
4 likes
0 comments
10:18
Laparoscopic transhiatal resection of horseshoe-shaped leiomyoma of the thoracic esophagus
This is the case of a 36-year-old woman with symptoms which have been present for 18 months. Her main symptoms were the following: difficulty to swallow food accompanied by retrosternal discomfort. Upper endoscopy performed on September 29, 2011 found an extrinsic compression of the esophageal wall located 28cm away from the upper dental arcade with a mucosa which appeared to be normal. That extrinsic compression goes until 33cm from the upper dental arcade. The patient was evaluated by a gastroenterologist who performed an echo-endoscopy on March 7, 2012. The gastroenterologist observed a heterogeneous hypo-echoic mass coming from the muscular layer, 25 to 33cm away from the esophagus. The diagnosis of esophageal leiomyoma was established. The patient was admitted to hospital for surgery, and a laparoscopic transhiatal resection of the esophageal leiomyoma was performed on May 22, 2012.
This case is essential because it shows the excision of a horseshoe-shaped leiomyoma of the thoracic esophagus. In addition, it shows a transfixing stitch, which is performed to exert traction on the tumor.
Thoracoscopic enucleation of a middle esophagus leiomyoma
Leiomyoma is the most frequent esophageal benign tumor. It represents 70% of these tumors and 1 to 8% of all esophageal tumors. The most frequent location is the distal esophagus. The majority of cases are asymptomatic and are discovered by chance in endoscopic or radiologic examinations. An endoscopic or surgical treatment can be applied in symptomatic cases (mainly dysphagia), basically depending on its size.
We present a thoracoscopic enucleation of a milddle esophagus leiomyoma in a 41-year-old woman. The operation was performed using a thoracoscopic approach. The patient was placed in a prone decubitus position. The tumor was enucleated by myotomy with subsequent suturing of the muscular gap through three trocars. There were no complications. After 48 hours postoperatively, a water-soluble contrast gastroduodenal study revealed normal passage through the esophageal lumen. The pathologist's diagnosis was esophageal leiomyoma.
F Ochando Cerdan, JM Fernandez Cebrian, L Vega Lopez
Surgical intervention
5 years ago
1282 views
16 likes
0 comments
16:15
Thoracoscopic enucleation of a middle esophagus leiomyoma
Leiomyoma is the most frequent esophageal benign tumor. It represents 70% of these tumors and 1 to 8% of all esophageal tumors. The most frequent location is the distal esophagus. The majority of cases are asymptomatic and are discovered by chance in endoscopic or radiologic examinations. An endoscopic or surgical treatment can be applied in symptomatic cases (mainly dysphagia), basically depending on its size.
We present a thoracoscopic enucleation of a milddle esophagus leiomyoma in a 41-year-old woman. The operation was performed using a thoracoscopic approach. The patient was placed in a prone decubitus position. The tumor was enucleated by myotomy with subsequent suturing of the muscular gap through three trocars. There were no complications. After 48 hours postoperatively, a water-soluble contrast gastroduodenal study revealed normal passage through the esophageal lumen. The pathologist's diagnosis was esophageal leiomyoma.
LIVE INTERACTIVE SURGERY: POEM for type 2 achalasia and incidental esophageal leiomyoma
POEM (peroral endoscopic myotomy) is an emerging procedure, which has evolved from the era of NOTES. The most cardinal indication for POEM is achalasia of the cardia. Other indications include diffuse esophageal spasm, jackhammer esophagus, and surgically failed cases.
The steps of POEM include the following: mucosotomy, submucous tunnelling, myotomy, closure of mucosotomy.
The myotomy is started 2 to 3cm distal to the mucosotomy and is continued to the end of the tunnel at 2 to 3cm distally to the gastroesophageal junction (GEJ). A partial myotomy is most commonly performed by means of careful dissection of circular fibers, hence avoiding longitudinal fibers to prevent entry into the mediastinum. The mucosotomy is then closed to prevent any leakage with the use of endoscopic clips or of an endoscopic suturing device. About the EndoFLIP™ (Endolumenal Functional Lumen Imaging Probe) Imaging System: this is a functional endoluminal imaging probe, which helps in the assessment of gastroesophageal junction distensibility and compliance after the procedure.
Complications of POEM:
Inadvertent mucosotomy is the most common complication.
Complications due to insufflation (pneumomediastinum, pneumoperitoneum) can be controlled by using carbon dioxide for insufflation. Esophageal leak is the most dreaded complication with rates ranging from 0 to 5.6%.
H Inoue, S Perretta
Surgical intervention
3 years ago
1011 views
32 likes
0 comments
31:42
LIVE INTERACTIVE SURGERY: POEM for type 2 achalasia and incidental esophageal leiomyoma
POEM (peroral endoscopic myotomy) is an emerging procedure, which has evolved from the era of NOTES. The most cardinal indication for POEM is achalasia of the cardia. Other indications include diffuse esophageal spasm, jackhammer esophagus, and surgically failed cases.
The steps of POEM include the following: mucosotomy, submucous tunnelling, myotomy, closure of mucosotomy.
The myotomy is started 2 to 3cm distal to the mucosotomy and is continued to the end of the tunnel at 2 to 3cm distally to the gastroesophageal junction (GEJ). A partial myotomy is most commonly performed by means of careful dissection of circular fibers, hence avoiding longitudinal fibers to prevent entry into the mediastinum. The mucosotomy is then closed to prevent any leakage with the use of endoscopic clips or of an endoscopic suturing device. About the EndoFLIP™ (Endolumenal Functional Lumen Imaging Probe) Imaging System: this is a functional endoluminal imaging probe, which helps in the assessment of gastroesophageal junction distensibility and compliance after the procedure.
Complications of POEM:
Inadvertent mucosotomy is the most common complication.
Complications due to insufflation (pneumomediastinum, pneumoperitoneum) can be controlled by using carbon dioxide for insufflation. Esophageal leak is the most dreaded complication with rates ranging from 0 to 5.6%.
Laparoscopic enucleation of horseshoe-shaped esophageal leiomyoma: use of mini-instruments
Introduction:
Leiomyoma is the most common benign tumor of the esophagus, usually arising in the inner circular muscle layer of the distal esophagus. Middle-aged men are most frequently affected. Most patients remain asymptomatic and when they become symptomatic, the main signs are usually dysphagia and epigastric pain, but they are not specific to the disease. Malignization is rare but should not be ignored.
The minimally invasive approach to these tumors allows for complete extirpation with minimal morbidity and provides excellent results.

Materials and methods:
We present the case of a 31-year-old woman with no medical history, who underwent a CT-scan for other reasons, namely for urinary symptoms. A 3cm homogeneous, low attenuated mass was found at the gastroesophageal junction. Endoscopic ultrasound is performed and showed a 50mm horseshoe-shaped tumor affecting three quarters of the esophageal circumference. Because of clinical deterioration, and mainly of dysphagia, elective surgery was decided upon.

Results:
In this video, it is possible to appreciate the laparoscopic enucleation of this horseshoe-shaped tumor, which depends on the distal esophageal wall, mainly using blunt dissection. The intervention is completed with a Toupet fundoplication. The postoperative course was uneventful, and the patient is discharged on the third postoperative day, and symptoms are resolved.

Conclusions:
Minimally invasive laparoscopic resection of distal esophageal benign tumors is technically safe and provides the well-known advantages of laparoscopic access, achieving quick patient recovery and a short hospital stay.
Some authors recommend to perform an anti-reflux procedure in order to protect the surgical resection area and therefore prevent complications due to the weakening of the lower esophageal sphincter, such as reflux symptoms.
C Rodríguez-Otero Luppi, EM Targarona Soler, C Balagué Ponz, JL Pallarés Segura, M Trías Folch
Surgical intervention
5 years ago
781 views
4 likes
0 comments
08:45
Laparoscopic enucleation of horseshoe-shaped esophageal leiomyoma: use of mini-instruments
Introduction:
Leiomyoma is the most common benign tumor of the esophagus, usually arising in the inner circular muscle layer of the distal esophagus. Middle-aged men are most frequently affected. Most patients remain asymptomatic and when they become symptomatic, the main signs are usually dysphagia and epigastric pain, but they are not specific to the disease. Malignization is rare but should not be ignored.
The minimally invasive approach to these tumors allows for complete extirpation with minimal morbidity and provides excellent results.

Materials and methods:
We present the case of a 31-year-old woman with no medical history, who underwent a CT-scan for other reasons, namely for urinary symptoms. A 3cm homogeneous, low attenuated mass was found at the gastroesophageal junction. Endoscopic ultrasound is performed and showed a 50mm horseshoe-shaped tumor affecting three quarters of the esophageal circumference. Because of clinical deterioration, and mainly of dysphagia, elective surgery was decided upon.

Results:
In this video, it is possible to appreciate the laparoscopic enucleation of this horseshoe-shaped tumor, which depends on the distal esophageal wall, mainly using blunt dissection. The intervention is completed with a Toupet fundoplication. The postoperative course was uneventful, and the patient is discharged on the third postoperative day, and symptoms are resolved.

Conclusions:
Minimally invasive laparoscopic resection of distal esophageal benign tumors is technically safe and provides the well-known advantages of laparoscopic access, achieving quick patient recovery and a short hospital stay.
Some authors recommend to perform an anti-reflux procedure in order to protect the surgical resection area and therefore prevent complications due to the weakening of the lower esophageal sphincter, such as reflux symptoms.
Thoracoscopic resection of an esophageal leiomyoma
Benign tumors of the esophagus are rare lesions that constitute less than 1% of esophageal neoplasms. Nearly two thirds of benign tumors are leiomyomas. They usually arise as intramural growths, most commonly along the distal two thirds of the esophagus. They have extremely small potential for malignant degeneration. Surgical excision is recommended for symptomatic great lesions. The video demonstrates the thoracoscopic resection of a leiomyoma on the upper thoracic third of the esophagus with the patient in a prone position, which brings an excellent exposure of the operative field and decreases lung injuries as we do not use any retractor.
J Torres Bermúdez, FC Becerra García, J Lopez Espejo, JL Martín, G Sánchez de la Villa
Surgical intervention
6 years ago
2204 views
19 likes
0 comments
07:22
Thoracoscopic resection of an esophageal leiomyoma
Benign tumors of the esophagus are rare lesions that constitute less than 1% of esophageal neoplasms. Nearly two thirds of benign tumors are leiomyomas. They usually arise as intramural growths, most commonly along the distal two thirds of the esophagus. They have extremely small potential for malignant degeneration. Surgical excision is recommended for symptomatic great lesions. The video demonstrates the thoracoscopic resection of a leiomyoma on the upper thoracic third of the esophagus with the patient in a prone position, which brings an excellent exposure of the operative field and decreases lung injuries as we do not use any retractor.
Laparoscopic resection of an esophageal leiomyoma
Leiomyomas represent a hyperproliferation of interlacing bundles of smooth muscle cells that are well demarcated by adjacent tissue or by a smooth connective tissue capsule. They usually arise as intramural growths and rarely cause symptoms when they are smaller than 5cm in diameter. In the distal esophagus, they may reach large proportions and may encroach on the cardia of the stomach. The majority of leiomyomas have been discovered during evaluation for dysphagia.
The traditional open thoracotomy for the enucleation of larger symptomatic esophageal leiomyomas has been gradually replaced by thoracoscopic or laparoscopic approaches. The video demonstrates the laparoscopic resection of a leiomyoma in a 50-year-old woman with a history of reflux esophagitis presenting with dysphagia.
J Torres Bermúdez, FC Becerra García, S del Valle Ruiz , AA Carrillo Sánchez, G Sánchez de la Villa
Surgical intervention
6 years ago
1243 views
8 likes
0 comments
09:13
Laparoscopic resection of an esophageal leiomyoma
Leiomyomas represent a hyperproliferation of interlacing bundles of smooth muscle cells that are well demarcated by adjacent tissue or by a smooth connective tissue capsule. They usually arise as intramural growths and rarely cause symptoms when they are smaller than 5cm in diameter. In the distal esophagus, they may reach large proportions and may encroach on the cardia of the stomach. The majority of leiomyomas have been discovered during evaluation for dysphagia.
The traditional open thoracotomy for the enucleation of larger symptomatic esophageal leiomyomas has been gradually replaced by thoracoscopic or laparoscopic approaches. The video demonstrates the laparoscopic resection of a leiomyoma in a 50-year-old woman with a history of reflux esophagitis presenting with dysphagia.
Laparoscopic excision of a large leiomyoma of the esophagogastric junction
Esophageal leiomyomas represent a benign pathology that usually affects the distal third and the esophagogastric junction, and that is perfectly suitable for a laparoscopic enucleation. A correct preoperative diagnosis is mandatory, as the most common differential diagnosis in this localization is represented by gastrointestinal stromal tumors (GIST), a pathology that could benefit from neo-adjuvant therapy. Occasionally, leiomyomas can be adherent to the mucosal layer, in which case-limited mucosal excision is necessary.
We present a laparoscopic enucleation of a large leiomyoma of the esophagogastric junction, requiring the use of an endostapler for complete resection.
C Balagué Ponz, EM Targarona Soler, S Mocanu, S Fernandez Ananin, F Marinello, M Trías Folch
Surgical intervention
7 years ago
1506 views
7 likes
0 comments
09:00
Laparoscopic excision of a large leiomyoma of the esophagogastric junction
Esophageal leiomyomas represent a benign pathology that usually affects the distal third and the esophagogastric junction, and that is perfectly suitable for a laparoscopic enucleation. A correct preoperative diagnosis is mandatory, as the most common differential diagnosis in this localization is represented by gastrointestinal stromal tumors (GIST), a pathology that could benefit from neo-adjuvant therapy. Occasionally, leiomyomas can be adherent to the mucosal layer, in which case-limited mucosal excision is necessary.
We present a laparoscopic enucleation of a large leiomyoma of the esophagogastric junction, requiring the use of an endostapler for complete resection.
Laparoscopic excision of a horseshoe-shaped leiomyoma of the lower esophagus
Esophageal leiomyomas are approximately 50 times less common than carcinomas, but they represent 80% of benign tumors of the lower esophagus.
An esophageal leiomyoma can be enucleated safely and effectively through minimally invasive surgery. The laparoscopic approach is a conventional option for this kind of tumor (located near or at the esophagogastric (EG) junction). Laparoscopic transhiatal enucleation is a safe and feasible procedure. This video demonstrates all the technical details of a laparoscopic excision of a large horseshoe-shaped leiomyoma of the lower esophagus. A conventional port placement is used to approach the hiatal region.
B Dallemagne, J Marescaux
Surgical intervention
10 years ago
766 views
14 likes
0 comments
13:18
Laparoscopic excision of a horseshoe-shaped leiomyoma of the lower esophagus
Esophageal leiomyomas are approximately 50 times less common than carcinomas, but they represent 80% of benign tumors of the lower esophagus.
An esophageal leiomyoma can be enucleated safely and effectively through minimally invasive surgery. The laparoscopic approach is a conventional option for this kind of tumor (located near or at the esophagogastric (EG) junction). Laparoscopic transhiatal enucleation is a safe and feasible procedure. This video demonstrates all the technical details of a laparoscopic excision of a large horseshoe-shaped leiomyoma of the lower esophagus. A conventional port placement is used to approach the hiatal region.
Laparoscopic management of extrauterine leiomyomas
Uterine leiomyomas affect 20 to 30% of women older than 35 years. Extrauterine leiomyomas are rarer, and they present a greater diagnostic challenge. These histologically benign leiomyomas occasionally occur with unusual growth patterns or in unusual locations which make their identification more challenging both clinically and radiologically. Unusual growth patterns may be seen, including benign metastasizing leiomyoma, disseminated peritoneal leiomyomatosis, intravenous leiomyomatosis, parasitic leiomyoma, and retroperitoneal growth. Diffuse peritoneal leiomyomatosis manifests as innumerable peritoneal nodules resembling those in peritoneal carcinomatosis. Parasitic leiomyoma and retroperitoneal leiomyomatosis usually manifest as single or multiple pelvic or retroperitoneal masses. Retroperitoneal growth is yet another unusual growth pattern of leiomyomas. Multiple leiomyomatous masses are usually seen in the pelvic retroperitoneum in women with a concurrent uterine leiomyoma or a history of uterine leiomyoma. Rarely, the extrauterine masses may extend to the upper retroperitoneum, as high as the level of the renal hilum. Occasionally, leiomyomas become adherent to surrounding structures (e.g., broad ligament, omentum, or retroperitoneal connective tissue), develop an auxiliary blood supply, and lose their original attachment to the uterus, hence becoming “parasitic.” We are presenting a case of extrauterine leiomyoma, which was operated for laparoscopic myomectomy for huge cervical leiomyoma 4 years back but was converted to an abdominal myomectomy.
D Limbachiya
Surgical intervention
3 years ago
2919 views
174 likes
0 comments
09:11
Laparoscopic management of extrauterine leiomyomas
Uterine leiomyomas affect 20 to 30% of women older than 35 years. Extrauterine leiomyomas are rarer, and they present a greater diagnostic challenge. These histologically benign leiomyomas occasionally occur with unusual growth patterns or in unusual locations which make their identification more challenging both clinically and radiologically. Unusual growth patterns may be seen, including benign metastasizing leiomyoma, disseminated peritoneal leiomyomatosis, intravenous leiomyomatosis, parasitic leiomyoma, and retroperitoneal growth. Diffuse peritoneal leiomyomatosis manifests as innumerable peritoneal nodules resembling those in peritoneal carcinomatosis. Parasitic leiomyoma and retroperitoneal leiomyomatosis usually manifest as single or multiple pelvic or retroperitoneal masses. Retroperitoneal growth is yet another unusual growth pattern of leiomyomas. Multiple leiomyomatous masses are usually seen in the pelvic retroperitoneum in women with a concurrent uterine leiomyoma or a history of uterine leiomyoma. Rarely, the extrauterine masses may extend to the upper retroperitoneum, as high as the level of the renal hilum. Occasionally, leiomyomas become adherent to surrounding structures (e.g., broad ligament, omentum, or retroperitoneal connective tissue), develop an auxiliary blood supply, and lose their original attachment to the uterus, hence becoming “parasitic.” We are presenting a case of extrauterine leiomyoma, which was operated for laparoscopic myomectomy for huge cervical leiomyoma 4 years back but was converted to an abdominal myomectomy.
Laparoscopic stepwise approach of a tumor of the gastroesophageal junction
GISTs are rare neoplasms that account for less than 1% of all gastrointestinal malignancies. GISTs have the capability to become malignant and then metastasize, whereas leiomyomas are almost invariably benign. In clinical practice, preoperative differentiation between GISTs and leiomyomas is usually difficult, even if EUS-guided fine-needle aspiration or trucut biopsy is performed. Leiomyomas are rare in the stomach and duodenum while GIST are more frequent in the stomach.
This patient presented with a 6cm submucosal tumor below the gastroesophageal junction. This video demonstrates the stepwise laparoscopic approach taking into consideration the potentially (pre-)malignant nature of the tumor.
B Dallemagne, S Perretta, S Mandala, J Marescaux
Surgical intervention
6 years ago
1818 views
17 likes
0 comments
26:11
Laparoscopic stepwise approach of a tumor of the gastroesophageal junction
GISTs are rare neoplasms that account for less than 1% of all gastrointestinal malignancies. GISTs have the capability to become malignant and then metastasize, whereas leiomyomas are almost invariably benign. In clinical practice, preoperative differentiation between GISTs and leiomyomas is usually difficult, even if EUS-guided fine-needle aspiration or trucut biopsy is performed. Leiomyomas are rare in the stomach and duodenum while GIST are more frequent in the stomach.
This patient presented with a 6cm submucosal tumor below the gastroesophageal junction. This video demonstrates the stepwise laparoscopic approach taking into consideration the potentially (pre-)malignant nature of the tumor.
Laparoscopic myomectomy: tips 'n tricks
Surgery is the treatment of choice for myomas. Myomectomy has undergone a dramatic evolution over the years. Laparoscopic myomectomy provides a preferable alternative to abdominal myomectomy for women with symptomatic fibroids who desire uterine preservation. It is also an excellent method for women who have infertility primarily related to fibroids. A lot of patients prefer myomectomy over hysterectomy even if they do not desire pregnancy. However, laparoscopic myomectomy is not easy and needs some practice. Together with the basic steps, some tips and tricks are provided to make this technique even more safe and feasible for surgeons. For good results, the use of a few technical tricks provides an optimal solution for all issues.
A Wattiez, P Trompoukis, AM Furtado Lima, J Nassif, B Gabriel
Surgical intervention
8 years ago
9947 views
191 likes
0 comments
08:35
Laparoscopic myomectomy: tips 'n tricks
Surgery is the treatment of choice for myomas. Myomectomy has undergone a dramatic evolution over the years. Laparoscopic myomectomy provides a preferable alternative to abdominal myomectomy for women with symptomatic fibroids who desire uterine preservation. It is also an excellent method for women who have infertility primarily related to fibroids. A lot of patients prefer myomectomy over hysterectomy even if they do not desire pregnancy. However, laparoscopic myomectomy is not easy and needs some practice. Together with the basic steps, some tips and tricks are provided to make this technique even more safe and feasible for surgeons. For good results, the use of a few technical tricks provides an optimal solution for all issues.
Combined endoscopic and laparoscopic transgastric single port (TriPort) access for a gastric tumor
Intragastric tumors represent a challenging pathology to treat with a minimally invasive approach because of their position and size. The possibility to combine both endoscopy and intragastric endoscopic surgery is of great value in these cases. This video shows such a combined endoscopic and laparoscopic approach to treat a stromal gastric tumor of the cardia. The endoscopy allows to choose a perfect position of laparoscopic access, depending on the tumor location. Furthermore, it provides the vision at the beginning of the intervention. After ablation of the tumor, a Triport is inserted into the stomach to close the gastric mucosa, allowing multiple transgastric access through a single gastrotomy.
J Leroy, B Dallemagne, D Mutter, J Marescaux
Surgical intervention
10 years ago
356 views
21 likes
0 comments
04:23
Combined endoscopic and laparoscopic transgastric single port (TriPort) access for a gastric tumor
Intragastric tumors represent a challenging pathology to treat with a minimally invasive approach because of their position and size. The possibility to combine both endoscopy and intragastric endoscopic surgery is of great value in these cases. This video shows such a combined endoscopic and laparoscopic approach to treat a stromal gastric tumor of the cardia. The endoscopy allows to choose a perfect position of laparoscopic access, depending on the tumor location. Furthermore, it provides the vision at the beginning of the intervention. After ablation of the tumor, a Triport is inserted into the stomach to close the gastric mucosa, allowing multiple transgastric access through a single gastrotomy.
Technique: laparoscopic distal gastrectomy
The description of the technique of laparoscopic distal gastrectomy covers all aspects of the surgical procedure used for the management of chronic gastric ulcers.
Operating room set up, position of patient and equipment, instruments used are thoroughly described. The technical key steps of the surgical procedure are presented in a step by step way: surgical procedure, exploration, dissection of greater curvature, resection of the antrum, gastroduodenal anastomosis, Billroth II anastomosis, complications, intraoperative complications, postoperative complications, functional complications.
Consequently, this operating technique is well standardized for the management of this condition.
D Mutter
Operative technique
18 years ago
3934 views
124 likes
0 comments
Technique: laparoscopic distal gastrectomy
The description of the technique of laparoscopic distal gastrectomy covers all aspects of the surgical procedure used for the management of chronic gastric ulcers.
Operating room set up, position of patient and equipment, instruments used are thoroughly described. The technical key steps of the surgical procedure are presented in a step by step way: surgical procedure, exploration, dissection of greater curvature, resection of the antrum, gastroduodenal anastomosis, Billroth II anastomosis, complications, intraoperative complications, postoperative complications, functional complications.
Consequently, this operating technique is well standardized for the management of this condition.