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Robotic single site left dismembered pyeloplasty for ureteropelvic junction obstruction
This video demonstrates the surgical steps for a left ureteropelvic junction (UPJ) reconstruction performed by means of the new da Vinci® robotic single site platform.
This surgery can be achieved by a 2cm single incision made in the umbilicus.
The system provides 2 robotic instruments crossing into the trocar in order to have an adequate triangulation. In this set-up, the left robotic instrument is placed into the surgical field on the right side while the right robotic instrument is on the left side of the surgical field. The software of the da Vinci™ system allows for the control of the right robotic arm to the left master into the robotic console in order to have the instrument placed in the right part of the surgical field controlled by the right master. This allows for a direct and natural control of the instruments, hence solving the problem of the crossing of the instruments.
This is a great advantage when compared to standard laparoscopic single site surgery.
F Annino, T Verdacchi, M de Angelis
Surgical intervention
6 years ago
2279 views
50 likes
0 comments
05:40
Robotic single site left dismembered pyeloplasty for ureteropelvic junction obstruction
This video demonstrates the surgical steps for a left ureteropelvic junction (UPJ) reconstruction performed by means of the new da Vinci® robotic single site platform.
This surgery can be achieved by a 2cm single incision made in the umbilicus.
The system provides 2 robotic instruments crossing into the trocar in order to have an adequate triangulation. In this set-up, the left robotic instrument is placed into the surgical field on the right side while the right robotic instrument is on the left side of the surgical field. The software of the da Vinci™ system allows for the control of the right robotic arm to the left master into the robotic console in order to have the instrument placed in the right part of the surgical field controlled by the right master. This allows for a direct and natural control of the instruments, hence solving the problem of the crossing of the instruments.
This is a great advantage when compared to standard laparoscopic single site surgery.
Single incision right nephrectomy for severe hydrophrenosis in a transplanted patient
Laparoscopy is becoming the "gold standard" approach for nephrectomy when treating different benign and malignant diseases as well as for living donor transplantation.
During the last few months in both experimental and clinical settings, new techniques such as Natural Orifice Transluminal Endoscopic Surgery (NOTES™) and Single Incision Laparoscopic Surgery (SILS) or Single Port Laparoscopic Surgery (SPLS) have been attempted in order to reduce even more the surgical trauma in laparo-endoscopic procedures.
SPLS allows to perform different surgical procedures using the umbilicus as the only site to access the abdominal cavity and, by using special trocars and instruments, to perform the operation using the same techniques and principles of standard laparoscopic surgery.
The video describes our personal technique for totally single incision right nephrectomy for severe hydronephrosis in a patient who has undergone a kidney transplant a few years earlier.
A 62-year-old patient underwent a kidney transplant 5 years earlier due to a renal failure caused by a glomerular nephritis. The native kidneys were left in place.
Several admissions of patients presenting with recurrent sepsis were reported to the infectious disease department.
Recurrent sepsis was likely to be caused by the hydronephrosis induced by a large stone located in the middle part of the ureter.
The abdominal MRI showed the severe hydronephrosis of the native right kidney as well as a large stone.
A single incision nephrectomy was performed with no complications and the patient’s postoperative course was uneventful.
L Boni, G Dionigi, E Cassinotti, M Di Giuseppe, E Colombo, L Giavarini, SM Tenconi, F Cantore, M Tozzi, R Dionigi
Surgical intervention
9 years ago
3986 views
34 likes
0 comments
10:10
Single incision right nephrectomy for severe hydrophrenosis in a transplanted patient
Laparoscopy is becoming the "gold standard" approach for nephrectomy when treating different benign and malignant diseases as well as for living donor transplantation.
During the last few months in both experimental and clinical settings, new techniques such as Natural Orifice Transluminal Endoscopic Surgery (NOTES™) and Single Incision Laparoscopic Surgery (SILS) or Single Port Laparoscopic Surgery (SPLS) have been attempted in order to reduce even more the surgical trauma in laparo-endoscopic procedures.
SPLS allows to perform different surgical procedures using the umbilicus as the only site to access the abdominal cavity and, by using special trocars and instruments, to perform the operation using the same techniques and principles of standard laparoscopic surgery.
The video describes our personal technique for totally single incision right nephrectomy for severe hydronephrosis in a patient who has undergone a kidney transplant a few years earlier.
A 62-year-old patient underwent a kidney transplant 5 years earlier due to a renal failure caused by a glomerular nephritis. The native kidneys were left in place.
Several admissions of patients presenting with recurrent sepsis were reported to the infectious disease department.
Recurrent sepsis was likely to be caused by the hydronephrosis induced by a large stone located in the middle part of the ureter.
The abdominal MRI showed the severe hydronephrosis of the native right kidney as well as a large stone.
A single incision nephrectomy was performed with no complications and the patient’s postoperative course was uneventful.
Winslow's hiatal hernia: laparoscopic treatment
Less than 200 cases of internal hernia have been described through the hiatus of Winslow, usually related to congenital or acquired anatomical defects. The most frequent affectation corresponds to the colon, small intestine and, rarely, to the gallbladder. There is usually occlusion with variable grade ischemia, but it can also occur as obstructive jaundice, biliary colic, secondary pancreatitis and non-symptomatic herniation.
The association of Winslow’s hiatus hernia with various anatomical abnormalities (high or subhepatic caecum, mobile ascending colon, large and long colonic mesentery, etc.) may actually correspond to different degrees of intestinal malrotation and, although the diagnosis of “malrotation” is not usually specified, we believe that this could underlie part of Winslow’s hiatus hernia associated with non-acquired anatomical defects.
Hiatal hernia corresponds to 0.2-0.9% of all cases of intestinal obstruction, of which 8% are from Winslow’s hiatus. If pre-surgical diagnosis is difficult, it occurs in less than 10% of cases.
Mortality is around 50% when it has vascular implication. We have not thought of applying the omentum to seal the defect because we did not have adequate surgical anchor sites since we were working millimeters from the vena cava, extrahepatic bile duct, duodenum, and perirenal area. We decided to fix the colon from the hepatic flexure to the right iliac fossa with continuous stitches, from the colonic serosa to Toldt’s fascia, as it is from the embryonic stage.
JL Limon Aguilar, CO Castillo Cabrera
Surgical intervention
6 months ago
1648 views
17 likes
2 comments
09:56
Winslow's hiatal hernia: laparoscopic treatment
Less than 200 cases of internal hernia have been described through the hiatus of Winslow, usually related to congenital or acquired anatomical defects. The most frequent affectation corresponds to the colon, small intestine and, rarely, to the gallbladder. There is usually occlusion with variable grade ischemia, but it can also occur as obstructive jaundice, biliary colic, secondary pancreatitis and non-symptomatic herniation.
The association of Winslow’s hiatus hernia with various anatomical abnormalities (high or subhepatic caecum, mobile ascending colon, large and long colonic mesentery, etc.) may actually correspond to different degrees of intestinal malrotation and, although the diagnosis of “malrotation” is not usually specified, we believe that this could underlie part of Winslow’s hiatus hernia associated with non-acquired anatomical defects.
Hiatal hernia corresponds to 0.2-0.9% of all cases of intestinal obstruction, of which 8% are from Winslow’s hiatus. If pre-surgical diagnosis is difficult, it occurs in less than 10% of cases.
Mortality is around 50% when it has vascular implication. We have not thought of applying the omentum to seal the defect because we did not have adequate surgical anchor sites since we were working millimeters from the vena cava, extrahepatic bile duct, duodenum, and perirenal area. We decided to fix the colon from the hepatic flexure to the right iliac fossa with continuous stitches, from the colonic serosa to Toldt’s fascia, as it is from the embryonic stage.
Fully laparoscopic right colectomy for caecal tumor with “vessels first’ approach
Over the last few years, laparoscopic colorectal surgery has increased exponentially worldwide. When combined with an enhanced recovery program, a significant reduction in the length of hospital stay can be achieved, coupled with an early return to normal activities for the patient.
This is the case of a 68-year-old obese woman with a BMI of 30 presenting with a caecal tumor. Her major co-morbidities are chronic obstructive pulmonary disease (COPD) and high blood pressure. The patient complained of chronic abdominal pain and presented a positive fecal occult blood test. Colonoscopy showed a caecal tumor. Biopsy confirmed an adenocarcinoma. CT-scan did not show any distant metastasis. A full laparoscopic approach with a medial-to-lateral and ‘vessels first’ approach is shown.
A D'Urso, M Rodriguez, D Mutter, J Marescaux
Surgical intervention
6 months ago
3673 views
37 likes
4 comments
13:27
Fully laparoscopic right colectomy for caecal tumor with “vessels first’ approach
Over the last few years, laparoscopic colorectal surgery has increased exponentially worldwide. When combined with an enhanced recovery program, a significant reduction in the length of hospital stay can be achieved, coupled with an early return to normal activities for the patient.
This is the case of a 68-year-old obese woman with a BMI of 30 presenting with a caecal tumor. Her major co-morbidities are chronic obstructive pulmonary disease (COPD) and high blood pressure. The patient complained of chronic abdominal pain and presented a positive fecal occult blood test. Colonoscopy showed a caecal tumor. Biopsy confirmed an adenocarcinoma. CT-scan did not show any distant metastasis. A full laparoscopic approach with a medial-to-lateral and ‘vessels first’ approach is shown.
Laparoscopic Beger procedure with Roux-en-Y hepaticojejunostomy
This is the case of a 49-year-old male patient presenting with recurrent intractable abdominal pain. The patient had a history of obstructive jaundice and underwent biliary decompression provided by a percutaneous cholecystostomy. CT-scan showed signs of chronic pancreatitis, multiple stones in the pancreatic parenchyma, a compressed portal vein and biliary obstruction. The patient underwent a laparoscopic duodenum-preserving pancreatic head resection (DPPHR) – a technique known as the Beger procedure. It is recognized as an effective therapeutic option for the surgical treatment of patients with persistent pain, combined with portal and biliary compression caused by severe chronic pancreatitis. The surgical procedure preserves the stomach, the duodenum, and the biliary tree unlike standard duodenopancreatectomy (Whipple procedure), which is the other option for these patients. As Beger himself stated: “Preservation of the duodenum and the biliary system has major advantages for patients regarding short- and long-term outcome as compared to the Kausch-Whipple resection and pylorus-preserving resection”.
In this case, after completing the pancreatic head resection and fashioning the distal and proximal pancreaticojejunal anastomosis, a hepaticojejunostomy was performed. It was necessary due to the stenosis of the intrapancreatic segment of the common bile duct.
The purpose of this video is to demonstrate that the laparoscopic Beger procedure is safe and feasible, and provides all the well-known advantages of the minimally invasive approach, particularly lower postoperative pain, earlier functional recovery, and shorter hospital stay.
P Agami, A Andrianov, M Baychorov, R Izrailov
Surgical intervention
10 months ago
2907 views
17 likes
3 comments
17:23
Laparoscopic Beger procedure with Roux-en-Y hepaticojejunostomy
This is the case of a 49-year-old male patient presenting with recurrent intractable abdominal pain. The patient had a history of obstructive jaundice and underwent biliary decompression provided by a percutaneous cholecystostomy. CT-scan showed signs of chronic pancreatitis, multiple stones in the pancreatic parenchyma, a compressed portal vein and biliary obstruction. The patient underwent a laparoscopic duodenum-preserving pancreatic head resection (DPPHR) – a technique known as the Beger procedure. It is recognized as an effective therapeutic option for the surgical treatment of patients with persistent pain, combined with portal and biliary compression caused by severe chronic pancreatitis. The surgical procedure preserves the stomach, the duodenum, and the biliary tree unlike standard duodenopancreatectomy (Whipple procedure), which is the other option for these patients. As Beger himself stated: “Preservation of the duodenum and the biliary system has major advantages for patients regarding short- and long-term outcome as compared to the Kausch-Whipple resection and pylorus-preserving resection”.
In this case, after completing the pancreatic head resection and fashioning the distal and proximal pancreaticojejunal anastomosis, a hepaticojejunostomy was performed. It was necessary due to the stenosis of the intrapancreatic segment of the common bile duct.
The purpose of this video is to demonstrate that the laparoscopic Beger procedure is safe and feasible, and provides all the well-known advantages of the minimally invasive approach, particularly lower postoperative pain, earlier functional recovery, and shorter hospital stay.
Single incision laparoscopic gastrojejunal bypass with intraoperative ultrasonography for obstructive pancreatic head tumor
Background: Pancreatic head tumors can be diagnosed immediately as symptomatic although the biliary tract is not involved. Single incision laparoscopy can be proposed as a valid option to allow an early beginning of neo-adjuvant chemotherapy.

Video: A 56-year-old man was admitted to hospital for vomiting and weight loss. Preoperative work-up showed the presence of an advanced and obstructive pancreatic head adenocarcinoma, not interesting the biliary tract. A laparoscopic gastro-jejunal bypass with staging laparoscopy, through a transumbilical single-access, was proposed to the patient. The technique consisted in the insertion of an 11mm reusable trocar, two 6mm flexible reusable trocars, and curved reusable instruments according to DAPRI (Karl Storz Endoskope, Tüttlingen, Germany) through the same umbilical incision. The procedure started with the exploration of the parietal peritoneum, lavage of the cavity, opening of the lesser sac for perioperative ultrasonography, and ended with linear mechanical side-to-side gastrojejunostomy.

Results: The obstructive status of the patient resolved during the postoperative course and the patient started neo-adjuvant chemotherapy after 10 days.

Conclusions: Single incision laparoscopic gastrojejunostomy for obstructive pancreatic head tumor, after staging laparoscopy including perioperative ultrasonography, permits the resolution of the clinical status as well as an early beginning of neo-adjuvant chemotherapy.
G Dapri
Surgical intervention
6 years ago
2318 views
54 likes
0 comments
06:40
Single incision laparoscopic gastrojejunal bypass with intraoperative ultrasonography for obstructive pancreatic head tumor
Background: Pancreatic head tumors can be diagnosed immediately as symptomatic although the biliary tract is not involved. Single incision laparoscopy can be proposed as a valid option to allow an early beginning of neo-adjuvant chemotherapy.

Video: A 56-year-old man was admitted to hospital for vomiting and weight loss. Preoperative work-up showed the presence of an advanced and obstructive pancreatic head adenocarcinoma, not interesting the biliary tract. A laparoscopic gastro-jejunal bypass with staging laparoscopy, through a transumbilical single-access, was proposed to the patient. The technique consisted in the insertion of an 11mm reusable trocar, two 6mm flexible reusable trocars, and curved reusable instruments according to DAPRI (Karl Storz Endoskope, Tüttlingen, Germany) through the same umbilical incision. The procedure started with the exploration of the parietal peritoneum, lavage of the cavity, opening of the lesser sac for perioperative ultrasonography, and ended with linear mechanical side-to-side gastrojejunostomy.

Results: The obstructive status of the patient resolved during the postoperative course and the patient started neo-adjuvant chemotherapy after 10 days.

Conclusions: Single incision laparoscopic gastrojejunostomy for obstructive pancreatic head tumor, after staging laparoscopy including perioperative ultrasonography, permits the resolution of the clinical status as well as an early beginning of neo-adjuvant chemotherapy.
Laparoscopic revision of Nissen fundoplication to Roux-en-Y gastric bypass
Introduction: Obesity is a known etiological factor for gastroesophageal reflux disease (GERD) and is also a growing public health concern. Although Nissen fundoplication is a highly effective technique to treat GERD, it may fail in obese patients. Roux-en-Y gastric bypass provides excellent long-term control of GERD symptoms with the additional benefit of weight loss.
Clinical case: A 57-year-old woman underwent a laparoscopic Nissen fundoplication for GERD (BMI 30.0 Kg/m2) with excellent outcomes during the first postoperative year in 2011. Two years later, GERD symptoms recurred, and her weight increased progressively (BMI of 36.0 Kg/m2). The patient was proposed to a laparoscopic conversion of Nissen fundoplication to a Roux-en-Y gastric bypass. The procedure was uneventful, and the patient was discharged on postoperative day 4. One year later, she remained asymptomatic, off antacids medication, and with her weight decreased to 63.5Kg which corresponded to a BMI of 25.4 Kg/m2.
Discussion/conclusion: Roux-en-Y gastric bypass successfully reduces GERD symptoms by diverting bile away from the esophagus, decreasing acid production in the gastric pouch, therefore limiting the amount of acid reflux and by promoting weight loss decreases abdominal pressure over the lower esophageal sphincter and esophageal hiatus. In obese patients (BMI>35) with GERD, Roux-en-Y gastric bypass seems to be the most effective and advantageous treatment since it provides control of GERD symptoms with the additional benefit of weight loss. In patients who have previously undergone anti-reflux surgery, bariatric surgery can be technically demanding. However, if performed by high-volume surgeons in high-volume centers, it is perfectly feasible with low morbidity and excellent results.
J Magalhães, AM Pereira, T Fonseca, R Ferreira de Almeida, M Nora
Surgical intervention
1 year ago
2169 views
5 likes
0 comments
09:34
Laparoscopic revision of Nissen fundoplication to Roux-en-Y gastric bypass
Introduction: Obesity is a known etiological factor for gastroesophageal reflux disease (GERD) and is also a growing public health concern. Although Nissen fundoplication is a highly effective technique to treat GERD, it may fail in obese patients. Roux-en-Y gastric bypass provides excellent long-term control of GERD symptoms with the additional benefit of weight loss.
Clinical case: A 57-year-old woman underwent a laparoscopic Nissen fundoplication for GERD (BMI 30.0 Kg/m2) with excellent outcomes during the first postoperative year in 2011. Two years later, GERD symptoms recurred, and her weight increased progressively (BMI of 36.0 Kg/m2). The patient was proposed to a laparoscopic conversion of Nissen fundoplication to a Roux-en-Y gastric bypass. The procedure was uneventful, and the patient was discharged on postoperative day 4. One year later, she remained asymptomatic, off antacids medication, and with her weight decreased to 63.5Kg which corresponded to a BMI of 25.4 Kg/m2.
Discussion/conclusion: Roux-en-Y gastric bypass successfully reduces GERD symptoms by diverting bile away from the esophagus, decreasing acid production in the gastric pouch, therefore limiting the amount of acid reflux and by promoting weight loss decreases abdominal pressure over the lower esophageal sphincter and esophageal hiatus. In obese patients (BMI>35) with GERD, Roux-en-Y gastric bypass seems to be the most effective and advantageous treatment since it provides control of GERD symptoms with the additional benefit of weight loss. In patients who have previously undergone anti-reflux surgery, bariatric surgery can be technically demanding. However, if performed by high-volume surgeons in high-volume centers, it is perfectly feasible with low morbidity and excellent results.
Technique for endoscopic resection of obstructive endobronchial malignancy
Invasion of the tracheo-bronchial tree by a malignant pulmonary lesion is the most frequent cause of bronchial obstruction in the adult. Malignant obstruction of major airways may require endoscopic resection for rapid palliation of dyspnea and obstructive pneumonitis.
Patients should be evaluated with flexible bronchoscopy and computed tomography of the chest to assess the anatomy of the obstruction and demonstrate patent airway distally. This criterion is critical for optimal selection.
Resection is carried out in the operating room under general anesthesia. It is important to emphasize that close collaboration between the surgical and anesthesia teams is essential at all times, as they are sharing responsibility for the airway. We use rigid bronchoscopy for piecemeal extraction of the lesion. Since moderate bleeding may be encountered, the clinician should be familiar with hemostatic manoeuvres including dabbing raw bronchial surfaces using the rigid bronchoscope, the use of epinephrine soaked pledgets, and irrigation using epinephrine solution. Hemostasis may also be accomplished using energy sources delivered through a flexible bronchoscope, including electrocautery, argon beam, and Nd:YAG laser. All energy sources should be used with caution within the airway to minimize the risk of complications.
Depending on the individual patient, endobronchial resection may be combined with airway stenting and/or postoperative chemoradiotherapy. In carefully selected patients, this will result in adequate palliation of symptoms.
Acknowledgment: we would like to thank Nathalie Leroux RN and Suzanne Desbiens RN for their continued support.
G Rakovich
Surgical intervention
7 years ago
853 views
8 likes
0 comments
04:07
Technique for endoscopic resection of obstructive endobronchial malignancy
Invasion of the tracheo-bronchial tree by a malignant pulmonary lesion is the most frequent cause of bronchial obstruction in the adult. Malignant obstruction of major airways may require endoscopic resection for rapid palliation of dyspnea and obstructive pneumonitis.
Patients should be evaluated with flexible bronchoscopy and computed tomography of the chest to assess the anatomy of the obstruction and demonstrate patent airway distally. This criterion is critical for optimal selection.
Resection is carried out in the operating room under general anesthesia. It is important to emphasize that close collaboration between the surgical and anesthesia teams is essential at all times, as they are sharing responsibility for the airway. We use rigid bronchoscopy for piecemeal extraction of the lesion. Since moderate bleeding may be encountered, the clinician should be familiar with hemostatic manoeuvres including dabbing raw bronchial surfaces using the rigid bronchoscope, the use of epinephrine soaked pledgets, and irrigation using epinephrine solution. Hemostasis may also be accomplished using energy sources delivered through a flexible bronchoscope, including electrocautery, argon beam, and Nd:YAG laser. All energy sources should be used with caution within the airway to minimize the risk of complications.
Depending on the individual patient, endobronchial resection may be combined with airway stenting and/or postoperative chemoradiotherapy. In carefully selected patients, this will result in adequate palliation of symptoms.
Acknowledgment: we would like to thank Nathalie Leroux RN and Suzanne Desbiens RN for their continued support.
Laparoscopic right colectomy: bottom-to-up approach with intracorporeal anastomosis
Introduction
Laparoscopic right colectomy (LRC) has become a well-established technique in colon cancer treatment achieving the same degree of radicality as open colectomy with the advantages of minimal invasion. A medial-to-lateral approach is the standard technique, but the bottom-to-up approach, with intracorporeal anastomosis (BTU), has recently gained popularity among surgeons.
Clinical case
The authors report the case of a 70-year-old male patient with persistent abdominal discomfort and a change in bowel habits. Preoperative staging revealed an adenocarcinoma at the hepatic flexure of the colon with no metastatic disease. The patient was proposed for a laparoscopic right colectomy.
A bottom-to-up approach was performed by opening an avascular plane posterior to the right mesocolon, creating a mesenteric route cranially along Gerota’s fascia until the duodenum and liver have been exposed. A side-to-side ileocolic intracorporeal stapled anastomosis was fashioned. The procedure and postoperative recovery were uneventful.
Discussion/Conclusion
LRC using a BTU approach is a feasible and safe alternative to the conventional medial-to-lateral approach. The main advantages are a short learning curve and an easy access to the retroperitoneal space with direct visualization and protection of retroperitoneal structures. The performance of an intracorporeal anastomosis offers the advantage of a smaller extraction incision, lower wound-related complications, and fast recovery.
J Magalhães, L Matos, J Costa, J Costa Pereira, G Gonçalves, M Nora
Surgical intervention
1 year ago
3704 views
16 likes
5 comments
10:31
Laparoscopic right colectomy: bottom-to-up approach with intracorporeal anastomosis
Introduction
Laparoscopic right colectomy (LRC) has become a well-established technique in colon cancer treatment achieving the same degree of radicality as open colectomy with the advantages of minimal invasion. A medial-to-lateral approach is the standard technique, but the bottom-to-up approach, with intracorporeal anastomosis (BTU), has recently gained popularity among surgeons.
Clinical case
The authors report the case of a 70-year-old male patient with persistent abdominal discomfort and a change in bowel habits. Preoperative staging revealed an adenocarcinoma at the hepatic flexure of the colon with no metastatic disease. The patient was proposed for a laparoscopic right colectomy.
A bottom-to-up approach was performed by opening an avascular plane posterior to the right mesocolon, creating a mesenteric route cranially along Gerota’s fascia until the duodenum and liver have been exposed. A side-to-side ileocolic intracorporeal stapled anastomosis was fashioned. The procedure and postoperative recovery were uneventful.
Discussion/Conclusion
LRC using a BTU approach is a feasible and safe alternative to the conventional medial-to-lateral approach. The main advantages are a short learning curve and an easy access to the retroperitoneal space with direct visualization and protection of retroperitoneal structures. The performance of an intracorporeal anastomosis offers the advantage of a smaller extraction incision, lower wound-related complications, and fast recovery.
Laparoscopic left hemicolectomy in a thin patient, including anastomotic control using intraoperative fluorescence
Usually, Body Mass Index (BMI) is correlated to the difficulty in performing the surgery. Obesity is associated with a more complex surgery and a longer operative time due to difficulties in finding the right plane of dissection and identifying the structures. However, treating a thin patient may also be dangerous because the planes of dissection are more adherent, which makes it harder to identify the real embryological dissection plane.
This video shows the danger of dissection when the mesocolon is very thin and adherent to Toldt’s fascia or Gerota’s fascia.

The nightmare of colon and rectum surgery is the leak of the anastomosis. It may occur also with all precaution: no anastomotic tension, the evaluation of the vascularization may be difficult because macroscopic lesion, when there is an ischemia, would appear after some hours; the use of the ICG test is a good tool to control the poor vascularization of the anastomosis earlier and to correct it, hence avoiding the drama of the leak.
S Rua
Surgical intervention
1 year ago
4666 views
16 likes
0 comments
13:14
Laparoscopic left hemicolectomy in a thin patient, including anastomotic control using intraoperative fluorescence
Usually, Body Mass Index (BMI) is correlated to the difficulty in performing the surgery. Obesity is associated with a more complex surgery and a longer operative time due to difficulties in finding the right plane of dissection and identifying the structures. However, treating a thin patient may also be dangerous because the planes of dissection are more adherent, which makes it harder to identify the real embryological dissection plane.
This video shows the danger of dissection when the mesocolon is very thin and adherent to Toldt’s fascia or Gerota’s fascia.

The nightmare of colon and rectum surgery is the leak of the anastomosis. It may occur also with all precaution: no anastomotic tension, the evaluation of the vascularization may be difficult because macroscopic lesion, when there is an ischemia, would appear after some hours; the use of the ICG test is a good tool to control the poor vascularization of the anastomosis earlier and to correct it, hence avoiding the drama of the leak.
Endoscopic ultrasound-guided choledochoduodenostomy with a lumen-apposing metal stent
This video demonstrates a case of EUS-guided choledochoduodenostomy, emblematic of the latest cutting-edge technology.
A 86-year-old woman with recent abdominal pain and jaundice underwent a CT-scan, which showed an enlarged tumor of the second portion of the duodenum with biliary tree dilatation. Gastroscopy with biopsy confirmed the diagnosis of duodenal adenocarcinoma of the 2nd duodenum.
First, endoscopic retrograde cholangiopancreatography (ERCP) failed to achieve biliary drainage because of an inability to cannulate the papilla due to tumor infiltration. EUS-guided hepatogastrostomy (EUS-HGS) was not attempted because the left intra-hepatic bile ducts were minimally dilated (3mm). However, the common bile duct (CBD) was largely dilated (20 mm). A Hot AXIOS™ Stent and Electrocautery Enhanced Delivery System (stent of 8 by 6mm) was advanced through the bulb. Pure cut electrocautery current was then applied, allowing the device to reach the CBD. Next, the distal flange was opened and retracted towards the EUS transducer, and once a biliary and bulbar tissue apposition had been noted, the proximal flange was released. Good drainage of purulent bile was observed and no complications occurred during the procedure and one month afterwards.
A Sportes, G Airinei, R Kamel, R Benamouzig
Surgical intervention
2 years ago
300 views
8 likes
0 comments
03:09
Endoscopic ultrasound-guided choledochoduodenostomy with a lumen-apposing metal stent
This video demonstrates a case of EUS-guided choledochoduodenostomy, emblematic of the latest cutting-edge technology.
A 86-year-old woman with recent abdominal pain and jaundice underwent a CT-scan, which showed an enlarged tumor of the second portion of the duodenum with biliary tree dilatation. Gastroscopy with biopsy confirmed the diagnosis of duodenal adenocarcinoma of the 2nd duodenum.
First, endoscopic retrograde cholangiopancreatography (ERCP) failed to achieve biliary drainage because of an inability to cannulate the papilla due to tumor infiltration. EUS-guided hepatogastrostomy (EUS-HGS) was not attempted because the left intra-hepatic bile ducts were minimally dilated (3mm). However, the common bile duct (CBD) was largely dilated (20 mm). A Hot AXIOS™ Stent and Electrocautery Enhanced Delivery System (stent of 8 by 6mm) was advanced through the bulb. Pure cut electrocautery current was then applied, allowing the device to reach the CBD. Next, the distal flange was opened and retracted towards the EUS transducer, and once a biliary and bulbar tissue apposition had been noted, the proximal flange was released. Good drainage of purulent bile was observed and no complications occurred during the procedure and one month afterwards.