We use cookies to offer you an optimal experience on our website. By browsing our website, you accept the use of cookies.
Filter by
Specialty
View more
Clear filter Media type
View more
Clear filter Category
View more
Publication date
Sort by:
Laparoscopic prosthetic parastomal and perineal hernias repair after abdominoperineal resection
Background: In this video, the authors report the case of a 74-year-old woman who consulted for episodes of intestinal occlusions following an abdomino-perineal resection for rectal adenocarcinoma (pT2N0M0), performed 6 years earlier. Abdomino-pelvic CT-scan showed a parastomal hernia with migrated small bowel loops and a perineal hernia with transposition of the caecum and bowel loops into the pelvis. Preoperative work-up was negative for tumor recurrence, hence a laparoscopic treatment using a double dual face prosthesis was proposed.

Video: Three trocars were placed into the abdomen. After adhesiolysis and removal of the viscera herniated into the hernia, the parastomal defect was exposed and measured intracorporeally 6cm (cranio-caudally) and 4cm (latero-laterally). An intracorporeal suture was used to close the defect, and a dual face prosthesis of 15cm in length and 10cm in width (Surgimesh XB, Aspide Medical, Saint-Etienne, France) was fixed by means of absorbable tacks (Sorbafix, Bard Davol Inc., Warwick, RI, US), according to the Sugarbaker technique. Successively, the pelvis was freed from adhesions, and the superior pelvic opening appeared to be 8cm (antero-posteriorly) and 7cm (latero-laterally). A dual face circular prosthesis of 10cm (Surgimesh XB, Aspide Medical) was fixed using two running sutures around the superior pelvic opening.

Results: Operative time was 72 minutes for parastomal hernia and 95 minutes for perineal hernia. Operative bleeding was unsignificant. The patient was discharged after 3 days, and at visit consultations, she did not present with any recurrence.

Conclusion: Prosthetic parastomal and perineal hernias repair can be performed simultaneously using laparoscopy with the same port positioning, adding the advantages of minimally invasive surgery and avoiding a large laparotomy.
G Dapri, L Gerard, L Cardinali, D Repullo, I Surdeanu, SH Sondji, GB Cadière
Surgical intervention
2 years ago
1208 views
118 likes
0 comments
07:20
Laparoscopic prosthetic parastomal and perineal hernias repair after abdominoperineal resection
Background: In this video, the authors report the case of a 74-year-old woman who consulted for episodes of intestinal occlusions following an abdomino-perineal resection for rectal adenocarcinoma (pT2N0M0), performed 6 years earlier. Abdomino-pelvic CT-scan showed a parastomal hernia with migrated small bowel loops and a perineal hernia with transposition of the caecum and bowel loops into the pelvis. Preoperative work-up was negative for tumor recurrence, hence a laparoscopic treatment using a double dual face prosthesis was proposed.

Video: Three trocars were placed into the abdomen. After adhesiolysis and removal of the viscera herniated into the hernia, the parastomal defect was exposed and measured intracorporeally 6cm (cranio-caudally) and 4cm (latero-laterally). An intracorporeal suture was used to close the defect, and a dual face prosthesis of 15cm in length and 10cm in width (Surgimesh XB, Aspide Medical, Saint-Etienne, France) was fixed by means of absorbable tacks (Sorbafix, Bard Davol Inc., Warwick, RI, US), according to the Sugarbaker technique. Successively, the pelvis was freed from adhesions, and the superior pelvic opening appeared to be 8cm (antero-posteriorly) and 7cm (latero-laterally). A dual face circular prosthesis of 10cm (Surgimesh XB, Aspide Medical) was fixed using two running sutures around the superior pelvic opening.

Results: Operative time was 72 minutes for parastomal hernia and 95 minutes for perineal hernia. Operative bleeding was unsignificant. The patient was discharged after 3 days, and at visit consultations, she did not present with any recurrence.

Conclusion: Prosthetic parastomal and perineal hernias repair can be performed simultaneously using laparoscopy with the same port positioning, adding the advantages of minimally invasive surgery and avoiding a large laparotomy.
Laparoscopic diagnosis in disorders of sex development: ovotesticular DSD
Background: A normal sex development and appropriate sex assignment take place when sex chromosomes, gonadal histology and genital phenotype are concordant.
A disorder of sex development (DSD) is defined whenever a discordance between two of the aforementioned features is found.
DSDs can be caused by an alteration in the chromosomal complement, or by an abnormal development of the gonads, by a defect in one of the enzymatic pathways for the synthesis of sex hormones or by the absence (or altered structure) of hormone receptors.
In the majority of cases, DSD is heralded by ambiguity of the external genitalia that generally speaking is the result either of a hypervirilization of a 46, XX individual or of a hypovirilization of a 46, XY individual. However, there are cases of DSD in which the genital phenotype is not ambiguous. Those cases are the most difficult to diagnose and are sometimes identified at puberty when unexpected development of secondary sexual characters or primary amenorrhea are observed.
When an obvious ambiguity of the external genitalia is not found, the presence of a DSD should be suspected whenever a newborn with apparent male phenotype shows one of the following features (bilateral impalpable gonads, unilateral undescended testis associated with hypospadias, isolated perineal hypospadias, bifid scrotum) or when an apparent female newborn shows a gonad palpable in a hernia sac, hypertrophied clitoris or fused small labia: such findings should prompt investigation in order to rule out a possible DSD.
Karyotype is key in the diagnosis of suspected DSD. Next step is defining the presence/absence of Müllerian remnants with ultrasound or MRI. At this point, most of the DSD due to an enzymatic defect can be identified by means of hormonal tests (either basal levels or stimulation tests). In the remaining cases in which hormonal tests are not diagnostic, a gonadal biopsy is mandatory to identify a gonadal dysgenesis, an ovotesticular DSD (former hermaphroditism), or a sex reversal.
In cases in which gonads are not palpable, laparoscopy is the gold standard to define their presence, site and macroscopic appearance. It is also very easy to perform a laparoscopic gonadal biopsy and gonadal removal in cases of streak gonads. Finally, laparoscopy is an invaluable tool for the examination of the internal genitalia: it adds useful information to the data obtained by imaging studies and consequently allowing for planning of the definitive treatment.
The video shows a DSD patient in whom laparoscopic gonadal biopsies and left gonadectomy were performed.

Video: A 9-month-old baby with ambiguous genitalia was referred to our centre for evaluation. A female sex assignment was given at birth. At clinical examination, clitoral hypertrophy was evidenced, with a single perineal orifice; the left gonad was palpable in the groin and the right one was non-palpable. No inguinal hernias were detected. Testosterone levels at birth were high (95.8ng/mL) and this finding persisted throughout infancy. The chromosomal complement was 46 XY. Analysis of the AR gene was negative. MRI examination showed the presence of uterus (35 x 10mm); both gonads were visualized in the inguinal region. Laparoscopic gonadal biopsy was decided upon. A 5mm port was placed at the umbilicus through an open access. Pneumoperitoneum was established: carbon dioxide was insufflated at 1L/min and intra-abdominal pressure was set at 8mmHg. Two 3mm operating ports were placed in the right and left iliac fossa.
The presence of a normally developed uterus was confirmed; the right gonad resembled a normal ovary; on the left side, a patent processus vaginalis and an atypical round gonad with a regular surface were observed. Both gonads were biopsied and frozen sections examinations revealed a normal ovary on the right and an ovotestis on the left. Left gonadectomy ensued after monopolar division of the gonadal vessels. The specimen was extracted through the umbilicus.

Results: No conversion to open surgery nor additional trocars were necessary. Total operative time was 120 minutes (including histological examination); biopsy time was 5 minutes for each side; gonadectomy took 15 minutes. No drainage was required. The postoperative course was uneventful and the patient was discharged on day 2.

Conclusion: Laparoscopy in DSD cases is a valuable diagnostic tool in selected patients. It allows gonadal visualization and biopsy together with complete examination of Müllerian derivatives.
L Nanni, G Marrocco, VD Catania
Surgical intervention
7 years ago
1608 views
26 likes
0 comments
05:03
Laparoscopic diagnosis in disorders of sex development: ovotesticular DSD
Background: A normal sex development and appropriate sex assignment take place when sex chromosomes, gonadal histology and genital phenotype are concordant.
A disorder of sex development (DSD) is defined whenever a discordance between two of the aforementioned features is found.
DSDs can be caused by an alteration in the chromosomal complement, or by an abnormal development of the gonads, by a defect in one of the enzymatic pathways for the synthesis of sex hormones or by the absence (or altered structure) of hormone receptors.
In the majority of cases, DSD is heralded by ambiguity of the external genitalia that generally speaking is the result either of a hypervirilization of a 46, XX individual or of a hypovirilization of a 46, XY individual. However, there are cases of DSD in which the genital phenotype is not ambiguous. Those cases are the most difficult to diagnose and are sometimes identified at puberty when unexpected development of secondary sexual characters or primary amenorrhea are observed.
When an obvious ambiguity of the external genitalia is not found, the presence of a DSD should be suspected whenever a newborn with apparent male phenotype shows one of the following features (bilateral impalpable gonads, unilateral undescended testis associated with hypospadias, isolated perineal hypospadias, bifid scrotum) or when an apparent female newborn shows a gonad palpable in a hernia sac, hypertrophied clitoris or fused small labia: such findings should prompt investigation in order to rule out a possible DSD.
Karyotype is key in the diagnosis of suspected DSD. Next step is defining the presence/absence of Müllerian remnants with ultrasound or MRI. At this point, most of the DSD due to an enzymatic defect can be identified by means of hormonal tests (either basal levels or stimulation tests). In the remaining cases in which hormonal tests are not diagnostic, a gonadal biopsy is mandatory to identify a gonadal dysgenesis, an ovotesticular DSD (former hermaphroditism), or a sex reversal.
In cases in which gonads are not palpable, laparoscopy is the gold standard to define their presence, site and macroscopic appearance. It is also very easy to perform a laparoscopic gonadal biopsy and gonadal removal in cases of streak gonads. Finally, laparoscopy is an invaluable tool for the examination of the internal genitalia: it adds useful information to the data obtained by imaging studies and consequently allowing for planning of the definitive treatment.
The video shows a DSD patient in whom laparoscopic gonadal biopsies and left gonadectomy were performed.

Video: A 9-month-old baby with ambiguous genitalia was referred to our centre for evaluation. A female sex assignment was given at birth. At clinical examination, clitoral hypertrophy was evidenced, with a single perineal orifice; the left gonad was palpable in the groin and the right one was non-palpable. No inguinal hernias were detected. Testosterone levels at birth were high (95.8ng/mL) and this finding persisted throughout infancy. The chromosomal complement was 46 XY. Analysis of the AR gene was negative. MRI examination showed the presence of uterus (35 x 10mm); both gonads were visualized in the inguinal region. Laparoscopic gonadal biopsy was decided upon. A 5mm port was placed at the umbilicus through an open access. Pneumoperitoneum was established: carbon dioxide was insufflated at 1L/min and intra-abdominal pressure was set at 8mmHg. Two 3mm operating ports were placed in the right and left iliac fossa.
The presence of a normally developed uterus was confirmed; the right gonad resembled a normal ovary; on the left side, a patent processus vaginalis and an atypical round gonad with a regular surface were observed. Both gonads were biopsied and frozen sections examinations revealed a normal ovary on the right and an ovotestis on the left. Left gonadectomy ensued after monopolar division of the gonadal vessels. The specimen was extracted through the umbilicus.

Results: No conversion to open surgery nor additional trocars were necessary. Total operative time was 120 minutes (including histological examination); biopsy time was 5 minutes for each side; gonadectomy took 15 minutes. No drainage was required. The postoperative course was uneventful and the patient was discharged on day 2.

Conclusion: Laparoscopy in DSD cases is a valuable diagnostic tool in selected patients. It allows gonadal visualization and biopsy together with complete examination of Müllerian derivatives.
Laparoscopic extraperitoneal and transperitoneal pelvic lymphadenectomies for prostate cancer
The description of the laparoscopic extraperitoneal and transperitoneal pelvic lymphadenectomies for prostate cancer covers all aspects of the surgical procedure used for the management of prostate cancer.
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: exposure, external limit, internal limit, inferior limit, posterior limit, superior limit, extraction, left lymphadenectomy, end of procedure.
Consequently, this operating technique is well standardized for the management of this condition.
C Saussine, H Lang
Operative technique
17 years ago
2708 views
149 likes
0 comments
Laparoscopic extraperitoneal and transperitoneal pelvic lymphadenectomies for prostate cancer
The description of the laparoscopic extraperitoneal and transperitoneal pelvic lymphadenectomies for prostate cancer covers all aspects of the surgical procedure used for the management of prostate cancer.
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: exposure, external limit, internal limit, inferior limit, posterior limit, superior limit, extraction, left lymphadenectomy, end of procedure.
Consequently, this operating technique is well standardized for the management of this condition.
Morbid obesity surgery: laparoscopic gastric banding
The description of morbid obesity surgery: laparoscopic gastric banding covers all aspects of the surgical procedure used for the management of morbid obesity.
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: creation of pneumoperitoneum, trocar placement, Instruments, exposure, retrogastric tunnel, dissection/variation, intraoperative complications, band fixation, fixation/reservoir, postoperative period, band calibration.
Consequently, this operating technique is well standardized for the management of this condition.
C Desaive, JM Zimmermann, M Vix
Operative technique
18 years ago
1853 views
73 likes
0 comments
Morbid obesity surgery: laparoscopic gastric banding
The description of morbid obesity surgery: laparoscopic gastric banding covers all aspects of the surgical procedure used for the management of morbid obesity.
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: creation of pneumoperitoneum, trocar placement, Instruments, exposure, retrogastric tunnel, dissection/variation, intraoperative complications, band fixation, fixation/reservoir, postoperative period, band calibration.
Consequently, this operating technique is well standardized for the management of this condition.