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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
16 years ago
2661 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.
Radical cystoprostatectomy with intracorporeal orthotopic ileal neobladder reconstruction: 3D HD video laparoscopy
The author presents the case of a 64-year-old male patient with a high-grade urothelial carcinoma infiltrating the bladders (pT2-G2), with a CT-scan of the abdomen and thorax negative for secondary localizations. The patient was subjected to a radical cystoprostatectomy with intracorporeal orthotopic ileal neobladder reconstruction, performed entirely in 3D HD videolaparoscopy. After the intervention, the patient is mobilized early. Parenteral feeding is given until restoration of bowel peristalsis. The nasogastric tube is removed with restoration of bowel peristalsis. Continuous antibiotic treatment is administered for 7 days after surgery. Neobladder lavage is performed daily to evacuate mucus. Stents are inspected daily to ensure patency and sterile saline is used if there is any suspicion of obstruction. Deep vein thrombosis prophylaxis is continued. The drain is removed when the draining liquid is less than 50cc per day and when there is no urine leak. A cystogram is performed on postoperative day 14. The stents are removed sequentially at 24 hours of interval. The catheter is extracted from the neobladder 20 days after surgery. The patient is discharged from hospital 21 days after surgery. Two years after the intervention, he presents a negative oncology follow-up. The patient is in a satisfactory general health condition. He has fully recovered and returned to a normal professional life. He urinates regularly and empties his neobladder every 3 to 4 hours, with minimal stress incontinence, particularly in the evening when he is physically tired; he gains erectile activity with the use of medical devices, benefiting from a more effective intracavernous injection therapy and vacuum device, and pharmacotherapy proves less effective.
D Geddo
Surgical intervention
2 days ago
29 views
0 likes
0 comments
17:33
Radical cystoprostatectomy with intracorporeal orthotopic ileal neobladder reconstruction: 3D HD video laparoscopy
The author presents the case of a 64-year-old male patient with a high-grade urothelial carcinoma infiltrating the bladders (pT2-G2), with a CT-scan of the abdomen and thorax negative for secondary localizations. The patient was subjected to a radical cystoprostatectomy with intracorporeal orthotopic ileal neobladder reconstruction, performed entirely in 3D HD videolaparoscopy. After the intervention, the patient is mobilized early. Parenteral feeding is given until restoration of bowel peristalsis. The nasogastric tube is removed with restoration of bowel peristalsis. Continuous antibiotic treatment is administered for 7 days after surgery. Neobladder lavage is performed daily to evacuate mucus. Stents are inspected daily to ensure patency and sterile saline is used if there is any suspicion of obstruction. Deep vein thrombosis prophylaxis is continued. The drain is removed when the draining liquid is less than 50cc per day and when there is no urine leak. A cystogram is performed on postoperative day 14. The stents are removed sequentially at 24 hours of interval. The catheter is extracted from the neobladder 20 days after surgery. The patient is discharged from hospital 21 days after surgery. Two years after the intervention, he presents a negative oncology follow-up. The patient is in a satisfactory general health condition. He has fully recovered and returned to a normal professional life. He urinates regularly and empties his neobladder every 3 to 4 hours, with minimal stress incontinence, particularly in the evening when he is physically tired; he gains erectile activity with the use of medical devices, benefiting from a more effective intracavernous injection therapy and vacuum device, and pharmacotherapy proves less effective.
Combined abdominal - transanal laparoscopic approach (taTME) for low rectal cancers
Objective: to describe the TaTME surgical technique for the treatment of low rectal cancers.
Methods: The procedure was performed in two phases: first, by an abdominal laparoscopic approach consisting in the high ligation of the inferior mesenteric artery and vein, and complete splenic flexure mobilization. The pelvic dissection was continued in the Total Mesorectal Excision (TME) plane to the level of the puborectal sling posteriorly and of the seminal vesicles anteriorly.
Secondly, the procedure continued by transanal laparoscopic approach: A Lone Star® retractor was placed prior to the platform insertion (Gelpoint Path®). Under direct vision of the tumor, a purse-string suture was performed to obtain a secure distal margin and a completed closure of the lumen. It is essential to achieve a complete circumferential full-thickness rectotomy before facing the dissection cranially via the TME plane. Both planes, transanal and abdominal, are connected by the two surgical teams. The specimen was then extracted through a suprapubic incision. A circular end-to-end stapled anastomosis was made intracorporeally. Finally, a loop ileostomy was performed.
Results: A 75-year-old man with low rectal cancer (uT3N1-Rullier’s I-II classification), was treated with neoadjuvant chemoradiotherapy and TaTME. Operative time was 240 minutes, including 90 minutes for the perineal phase. There were no postoperative complications and the patient was discharged on postoperative day 5. The pathology report showed a complete mesorectum excision and free margins (ypT1N1a).
Conclusions: The TaTME technique is a safe option for the treatment of low rectal cancers, especially in male patients with a narrow pelvis. It is a feasible and reproducible technique for surgeons with previous experience in advanced laparoscopic procedures and transanal surgery.
S Qian, P Tejedor, M Leon, M Ortega, C Pastor
Surgical intervention
9 months ago
3904 views
5 likes
0 comments
06:45
Combined abdominal - transanal laparoscopic approach (taTME) for low rectal cancers
Objective: to describe the TaTME surgical technique for the treatment of low rectal cancers.
Methods: The procedure was performed in two phases: first, by an abdominal laparoscopic approach consisting in the high ligation of the inferior mesenteric artery and vein, and complete splenic flexure mobilization. The pelvic dissection was continued in the Total Mesorectal Excision (TME) plane to the level of the puborectal sling posteriorly and of the seminal vesicles anteriorly.
Secondly, the procedure continued by transanal laparoscopic approach: A Lone Star® retractor was placed prior to the platform insertion (Gelpoint Path®). Under direct vision of the tumor, a purse-string suture was performed to obtain a secure distal margin and a completed closure of the lumen. It is essential to achieve a complete circumferential full-thickness rectotomy before facing the dissection cranially via the TME plane. Both planes, transanal and abdominal, are connected by the two surgical teams. The specimen was then extracted through a suprapubic incision. A circular end-to-end stapled anastomosis was made intracorporeally. Finally, a loop ileostomy was performed.
Results: A 75-year-old man with low rectal cancer (uT3N1-Rullier’s I-II classification), was treated with neoadjuvant chemoradiotherapy and TaTME. Operative time was 240 minutes, including 90 minutes for the perineal phase. There were no postoperative complications and the patient was discharged on postoperative day 5. The pathology report showed a complete mesorectum excision and free margins (ypT1N1a).
Conclusions: The TaTME technique is a safe option for the treatment of low rectal cancers, especially in male patients with a narrow pelvis. It is a feasible and reproducible technique for surgeons with previous experience in advanced laparoscopic procedures and transanal surgery.
Robotic triple docking ultralow anterior resection with intersphincteric resection and coloanal anastomosis
The da Vinci™ surgical robotic system with its increased instrument stability, magnified tridimensional view, and dexterity with 7 degrees of wristed motion of its instruments offers a distinct surgical advantage over traditional laparoscopic instruments. This is especially true in the deep pelvis, where the limited space and visibility make it extremely challenging to perform distal rectal dissection. Additionally, the complete control of the surgeon over the stable surgical platform allows fine and accurate dissection in this area.
For very low rectal tumors close to the anorectal junction, if a sphincter-saving procedure is to be attempted, surgeons will frequently perform an intersphincteric resection (ISR) with a handsewn coloanal anastomosis. If successful, the patient will be able to avoid an abdominoperineal resection and its resulting permanent stoma.
ISR is a technically challenging procedure to perform, especially in male and obese patients. It is because the approach to the intersphincteric plane from the abdominal approach is deep within the pelvis and frequently curves anteriorly, which makes the intersphincteric plane challenging to approach laparoscopically. In addition, ISR from the perineum is also difficult as the anus has a small opening; as a result, when the surgeon sits directly in front of the perineum, assistants will be unable to adequately visualize the operating field, making it very challenging to properly assist for the dissection. It may potentially result in some blind dissection, which may lead to entry into the wrong plane and a poor oncological specimen.
With the da Vinci™ surgical robotic system, this problem can potentially be minimized. First, via the transabdominal approach, the robotic system is able to access deep into the pelvic cavity and dissect down to the intersphincteric plane beyond the puborectalis sling. Secondly, docking the robot and approaching the ISR perineally, the robotic system can also provide a magnified vision, a fine dissection and allow the assistant a good viewing position sitting in front of the perineum to assist in a more productive manner. These advantages of the robotic system will facilitate ISR dissection and retrieval of a superior oncological specimen.
This video features a totally robotic triple docking approach for an ultralow anterior resection with intersphincteric resection and handsewn coloanal anastomosis in a male patient with a low rectal cancer.
SAE Yeo
Surgical intervention
10 months ago
1718 views
5 likes
0 comments
15:36
Robotic triple docking ultralow anterior resection with intersphincteric resection and coloanal anastomosis
The da Vinci™ surgical robotic system with its increased instrument stability, magnified tridimensional view, and dexterity with 7 degrees of wristed motion of its instruments offers a distinct surgical advantage over traditional laparoscopic instruments. This is especially true in the deep pelvis, where the limited space and visibility make it extremely challenging to perform distal rectal dissection. Additionally, the complete control of the surgeon over the stable surgical platform allows fine and accurate dissection in this area.
For very low rectal tumors close to the anorectal junction, if a sphincter-saving procedure is to be attempted, surgeons will frequently perform an intersphincteric resection (ISR) with a handsewn coloanal anastomosis. If successful, the patient will be able to avoid an abdominoperineal resection and its resulting permanent stoma.
ISR is a technically challenging procedure to perform, especially in male and obese patients. It is because the approach to the intersphincteric plane from the abdominal approach is deep within the pelvis and frequently curves anteriorly, which makes the intersphincteric plane challenging to approach laparoscopically. In addition, ISR from the perineum is also difficult as the anus has a small opening; as a result, when the surgeon sits directly in front of the perineum, assistants will be unable to adequately visualize the operating field, making it very challenging to properly assist for the dissection. It may potentially result in some blind dissection, which may lead to entry into the wrong plane and a poor oncological specimen.
With the da Vinci™ surgical robotic system, this problem can potentially be minimized. First, via the transabdominal approach, the robotic system is able to access deep into the pelvic cavity and dissect down to the intersphincteric plane beyond the puborectalis sling. Secondly, docking the robot and approaching the ISR perineally, the robotic system can also provide a magnified vision, a fine dissection and allow the assistant a good viewing position sitting in front of the perineum to assist in a more productive manner. These advantages of the robotic system will facilitate ISR dissection and retrieval of a superior oncological specimen.
This video features a totally robotic triple docking approach for an ultralow anterior resection with intersphincteric resection and handsewn coloanal anastomosis in a male patient with a low rectal cancer.
Robot-assisted cystoprostatectomy with intracorporeal urinary diversion using a Hautmann technique
It is the case of a 62-year-old man diagnosed with a T2bN0M0 transitional cell adenocarcinoma, which was evidenced by pathological findings after resection of a bladder tumor.
Seven ports are required prior to the installation of the DaVinci® robotic system:
- 12mm port on superior border of umbilicus.
- Right robotic port at the midline between anterior superior iliac spine and umbilicus. - Two 5mm ports on both sides of right robotic port.
- Additional 12mm port between the two 5mm ports once dissection of bladder pedicles has been started.
- Two left robotic ports in left iliac fossa and anterior axillary line.
This video demonstrates the cystoprostatectomy technique with a W-pouch intracorporeal neobladder (Hautmann ileal neobladder), which is feasible in specialized centers.
References:
1. Kaufman DS, Shipley WU, Feldman AS. Bladder cancer. Lancet 2009;374(9685):239-49.
2. Lee DJ, Rothberg MB, McKiernan JM, Benson MC, Badani KK. Robot-assisted radical cystoprostatectomy in complex surgical patients: single institution report. Can J Urol 2009;16(3):4664-9.
3. Tunuguntla HS, Nieder AM, Manoharan M. Neobladder reconstruction following radical cystoprostatectomy for invasive bladder cancer. Minerva Urol Nefrol 2009;61(1):41-54.
4. Barocas DA, Patel SG, Chang SS, Clark PE, Smith JA Jr, Cookson MS. Outcomes of patients undergoing radical cystroprostatectomy for bladder cancer with prostatic involvement on final pathology. BJU Int 2009;104(8):1091-7.
5. Pruthi RS, Stefaniak H, Hubbard JS, Wallen EM. Robotic anterior pelvic exenteration for bladder cancer in the female: outcomes and comparisons to their male counterparts. J Laparoendosc Adv Surg Tech A 2009;19(1):23-7.
6. Kefer JC, Campbell SC. Current status of prostate-sparing cystectomy. Urol Oncol 2008;26(5):486-93.
7. Rawal S, Raghunath SK, Khanna S, Jain D, Kaul R, Kumar P, Chhabra R, Brushan K. Minilaparotomy radical cystoprostatectomy (Minilap RCP) in the surgical management of urinary bladder carcinoma: early experience. Jpn J Clin Oncol 2008;38(9):611-6.
8. Park SY, Cho KS, Ham WS, Choi HM, Hong SJ, Rha KH. Robot-assisted laparoscopic radical cystoprostatectomy with ileal conduit urinary diversion: initial experience in Korea. J Laparoendosc Adv Surg Tech A 2008;18(3):401-4.
9. Gregori A, Galli S, Goumas I, Scieri F, Stener S, Gaboardi F. A cost comparison of laparoscopic versus open radical cystoprostatectomy and orthotopic ileal neobladder at a single institution. Arch Ital Urol Androl 2007;79(3):127-9.
10. Young JL, Finley DS, Ornstein DD. Robotic-assisted laparoscopic cystoprostatectomy for prostatic carcinosarcoma. JSLS 2007;11(1)109-
12.
11. Nuñez-Mora C, Cabrera P, Garcia-Mediero JM, de Fata FR, Gonzalez J, Angulo J. Laparoscopic radical cystectomy and orthotopic urinary diversion in the malepatient: technique. Arch Esp Urol 2011;64(3):195-206.
12. Rehman J, Sangalli MN, Guru K, de Naeyer G, Schatteman P, Carpentier P, Mottrie A. Total intracorporeal robot-assisted laparoscopic ileal conduit (Bricker) urinary diversion: technique and outcomes. Can J Urol 2011;18(1):5548-56.
13. Canda AE, Asil E, Balbay MD. An unexpected resident in the ileum detected during robot-assisted laparoscopic radical cystoprostatectomy and intracorporeal Studer pouch formation: Taenia saginata parasite. J Endourol 2011;25(2):301-3.
14. Lin T, Huang J, Han J, Xu K, Huang H, Jiang C, Liu H, Zhang C, Yao Y, Xie W, Shah AK, Huang L. Hybrid laparoscopic endoscopic single-site surgery for radical cystoprostatectomy and orthotopic ileal neobladder: an initial experience of 12 cases. J Endourol 2011;25(1):57-63.
15. Josephson DY, Chen JA, Chan KG, Lau CS, Nelson RA, Wilson TG. Robotic-assisted laparoscopic radical cystoprostatectomy and extracorporeal continent urinary diversion: highlight of surgical techniques and outcomes. Int J Med Robot 2010;6(3):315-23.
16. Kasraeian A, Barret E, Cathelineau X, Rozet F, Galiano M, Sánchez-Salas R, Vallancien G. Robot-assisted laparoscopic cystoprostatectomy with extended pelvic lymphadenectomy, extracorporeal enterocystoplasty, and intracorporeal enterourethral anastomosis: initial Montsouris Experience. J Endourol 2010;24(3):409-13.
17. Varinot J, Camparo P, Roupret M, Bitker MO, Capron F, Cussenot O, Witjes JA, Compérat E. Full analysis of the prostatic urethra at the time of radical cystoprostatectomy for bladder cancer: impact on final disease stage. Virchows Arch 2009;455(5):449-53.
18. Palou Redorta J, Gaya Sopena JM, Gausa Gascon K, Sanchez-Martin F, Rosales Bordes A, Rodriguez Faba O, Villavicencio Mavrich H. Robotic radical cystoprostatectomy: oncological and functional analysis. Actas Urol Esp 2009;33(7):759-66.
D Rey, VE Corona Montes, T Piéchaud
Surgical intervention
7 years ago
4878 views
100 likes
0 comments
10:22
Robot-assisted cystoprostatectomy with intracorporeal urinary diversion using a Hautmann technique
It is the case of a 62-year-old man diagnosed with a T2bN0M0 transitional cell adenocarcinoma, which was evidenced by pathological findings after resection of a bladder tumor.
Seven ports are required prior to the installation of the DaVinci® robotic system:
- 12mm port on superior border of umbilicus.
- Right robotic port at the midline between anterior superior iliac spine and umbilicus. - Two 5mm ports on both sides of right robotic port.
- Additional 12mm port between the two 5mm ports once dissection of bladder pedicles has been started.
- Two left robotic ports in left iliac fossa and anterior axillary line.
This video demonstrates the cystoprostatectomy technique with a W-pouch intracorporeal neobladder (Hautmann ileal neobladder), which is feasible in specialized centers.
References:
1. Kaufman DS, Shipley WU, Feldman AS. Bladder cancer. Lancet 2009;374(9685):239-49.
2. Lee DJ, Rothberg MB, McKiernan JM, Benson MC, Badani KK. Robot-assisted radical cystoprostatectomy in complex surgical patients: single institution report. Can J Urol 2009;16(3):4664-9.
3. Tunuguntla HS, Nieder AM, Manoharan M. Neobladder reconstruction following radical cystoprostatectomy for invasive bladder cancer. Minerva Urol Nefrol 2009;61(1):41-54.
4. Barocas DA, Patel SG, Chang SS, Clark PE, Smith JA Jr, Cookson MS. Outcomes of patients undergoing radical cystroprostatectomy for bladder cancer with prostatic involvement on final pathology. BJU Int 2009;104(8):1091-7.
5. Pruthi RS, Stefaniak H, Hubbard JS, Wallen EM. Robotic anterior pelvic exenteration for bladder cancer in the female: outcomes and comparisons to their male counterparts. J Laparoendosc Adv Surg Tech A 2009;19(1):23-7.
6. Kefer JC, Campbell SC. Current status of prostate-sparing cystectomy. Urol Oncol 2008;26(5):486-93.
7. Rawal S, Raghunath SK, Khanna S, Jain D, Kaul R, Kumar P, Chhabra R, Brushan K. Minilaparotomy radical cystoprostatectomy (Minilap RCP) in the surgical management of urinary bladder carcinoma: early experience. Jpn J Clin Oncol 2008;38(9):611-6.
8. Park SY, Cho KS, Ham WS, Choi HM, Hong SJ, Rha KH. Robot-assisted laparoscopic radical cystoprostatectomy with ileal conduit urinary diversion: initial experience in Korea. J Laparoendosc Adv Surg Tech A 2008;18(3):401-4.
9. Gregori A, Galli S, Goumas I, Scieri F, Stener S, Gaboardi F. A cost comparison of laparoscopic versus open radical cystoprostatectomy and orthotopic ileal neobladder at a single institution. Arch Ital Urol Androl 2007;79(3):127-9.
10. Young JL, Finley DS, Ornstein DD. Robotic-assisted laparoscopic cystoprostatectomy for prostatic carcinosarcoma. JSLS 2007;11(1)109-
12.
11. Nuñez-Mora C, Cabrera P, Garcia-Mediero JM, de Fata FR, Gonzalez J, Angulo J. Laparoscopic radical cystectomy and orthotopic urinary diversion in the malepatient: technique. Arch Esp Urol 2011;64(3):195-206.
12. Rehman J, Sangalli MN, Guru K, de Naeyer G, Schatteman P, Carpentier P, Mottrie A. Total intracorporeal robot-assisted laparoscopic ileal conduit (Bricker) urinary diversion: technique and outcomes. Can J Urol 2011;18(1):5548-56.
13. Canda AE, Asil E, Balbay MD. An unexpected resident in the ileum detected during robot-assisted laparoscopic radical cystoprostatectomy and intracorporeal Studer pouch formation: Taenia saginata parasite. J Endourol 2011;25(2):301-3.
14. Lin T, Huang J, Han J, Xu K, Huang H, Jiang C, Liu H, Zhang C, Yao Y, Xie W, Shah AK, Huang L. Hybrid laparoscopic endoscopic single-site surgery for radical cystoprostatectomy and orthotopic ileal neobladder: an initial experience of 12 cases. J Endourol 2011;25(1):57-63.
15. Josephson DY, Chen JA, Chan KG, Lau CS, Nelson RA, Wilson TG. Robotic-assisted laparoscopic radical cystoprostatectomy and extracorporeal continent urinary diversion: highlight of surgical techniques and outcomes. Int J Med Robot 2010;6(3):315-23.
16. Kasraeian A, Barret E, Cathelineau X, Rozet F, Galiano M, Sánchez-Salas R, Vallancien G. Robot-assisted laparoscopic cystoprostatectomy with extended pelvic lymphadenectomy, extracorporeal enterocystoplasty, and intracorporeal enterourethral anastomosis: initial Montsouris Experience. J Endourol 2010;24(3):409-13.
17. Varinot J, Camparo P, Roupret M, Bitker MO, Capron F, Cussenot O, Witjes JA, Compérat E. Full analysis of the prostatic urethra at the time of radical cystoprostatectomy for bladder cancer: impact on final disease stage. Virchows Arch 2009;455(5):449-53.
18. Palou Redorta J, Gaya Sopena JM, Gausa Gascon K, Sanchez-Martin F, Rosales Bordes A, Rodriguez Faba O, Villavicencio Mavrich H. Robotic radical cystoprostatectomy: oncological and functional analysis. Actas Urol Esp 2009;33(7):759-66.
Complex robotic resection of a large middle mediastinal thymoma
A 62-year-old man had an asymptomatic middle mediastinal tumor with a 4.5cm diameter, opposite to the superior vena cava and the azygos vein in the Barety’s space, which was discovered on thoracic CT-scan performed during an urothelial tumor follow-up.
Past history includes an urothelial carcinoma grade I treated with transurethral cystectomy, an ischemic cardiopathy with a single medical treatment, a prostate hypertrophy, and a sigmoid diverticulosis.
After a multidisciplinary review of the case, a mediastinoscopy was performed. It demonstrated the presence of a thymoma.
The patient was well informed of the operative risks and of the possibility of conversion, but thanks to our experience and national recommendations, we were able to perform a radical robotic assisted thymectomy.
The operation took during 3 hours with less than 100cc of bleeding.
The postoperative course was uneventful and the patient was discharged on postoperative day 3.
Histopathological analysis showed a type AB thymoma according to the OMS 2015 classification. The staging was IIb according to Masaoka. No adjuvant radiotherapy was indicated.
A Boutin, M Sarsam, M Lair, N Piton, C Peillon, JM Baste
Surgical intervention
3 years ago
759 views
64 likes
0 comments
07:38
Complex robotic resection of a large middle mediastinal thymoma
A 62-year-old man had an asymptomatic middle mediastinal tumor with a 4.5cm diameter, opposite to the superior vena cava and the azygos vein in the Barety’s space, which was discovered on thoracic CT-scan performed during an urothelial tumor follow-up.
Past history includes an urothelial carcinoma grade I treated with transurethral cystectomy, an ischemic cardiopathy with a single medical treatment, a prostate hypertrophy, and a sigmoid diverticulosis.
After a multidisciplinary review of the case, a mediastinoscopy was performed. It demonstrated the presence of a thymoma.
The patient was well informed of the operative risks and of the possibility of conversion, but thanks to our experience and national recommendations, we were able to perform a radical robotic assisted thymectomy.
The operation took during 3 hours with less than 100cc of bleeding.
The postoperative course was uneventful and the patient was discharged on postoperative day 3.
Histopathological analysis showed a type AB thymoma according to the OMS 2015 classification. The staging was IIb according to Masaoka. No adjuvant radiotherapy was indicated.
Transanal laparoscopic TME with a new port assisted by single incision
Background: Rectal resection with total mesorectal excision (TME) can be performed through the anus going up into the abdominal cavity. This approach has to be performed using a transanal device in order to create a retroperitoneum, allowing the surgeon to perform a TME similar to the one performed from the abdomen going down to the anus. A new reusable port named DAPRI Port or D-Port (Karl Storz Endoskope, Tuttlingen, Germany) has been developed, and a new platform together with curved reusable instruments according to DAPRI (Karl Storz Endoskope) has been created. The D-Port allows to maintain one of the rules of laparoscopy, which is the optical system in the middle of the two ancillary operative tools. In addition, the cost of the procedure is not increased, due to the reusable material.
Video: This video shows a down-to-up rectal resection assisted by single incision laparoscopy, in a 65-year old man presenting with a rectal adenocarcinoma 4cm away from the anal margin. Preoperative work-up showed a T2N0M0 tumor, after radiochemotherapy. The procedure was performed transabdominally for the vascular dissection and transanally for the TME. The abdominal single site was then used for the placement of the temporary ileostomy.
Results: Total operative time was 301 minutes, and partial transanal laparoscopy was 145 minutes. Perioperative bleeding was 50cc. The final scar length was 2.5cm, and the patient was discharged after 5 days. The pathological report confirmed a pT2N0M0 tumor (15 negative nodes).
Conclusions: Down-to-up rectal resection is an interesting procedure, and when associated with single incision laparoscopy, it offers the possibility to use the single site as the site for temporary ileostomy.
G Dapri, L Antolino, N Bachir, D Guta, K Grozdev, B Nebbot, K Jottard, GB Cadière
Surgical intervention
4 years ago
2797 views
40 likes
0 comments
12:53
Transanal laparoscopic TME with a new port assisted by single incision
Background: Rectal resection with total mesorectal excision (TME) can be performed through the anus going up into the abdominal cavity. This approach has to be performed using a transanal device in order to create a retroperitoneum, allowing the surgeon to perform a TME similar to the one performed from the abdomen going down to the anus. A new reusable port named DAPRI Port or D-Port (Karl Storz Endoskope, Tuttlingen, Germany) has been developed, and a new platform together with curved reusable instruments according to DAPRI (Karl Storz Endoskope) has been created. The D-Port allows to maintain one of the rules of laparoscopy, which is the optical system in the middle of the two ancillary operative tools. In addition, the cost of the procedure is not increased, due to the reusable material.
Video: This video shows a down-to-up rectal resection assisted by single incision laparoscopy, in a 65-year old man presenting with a rectal adenocarcinoma 4cm away from the anal margin. Preoperative work-up showed a T2N0M0 tumor, after radiochemotherapy. The procedure was performed transabdominally for the vascular dissection and transanally for the TME. The abdominal single site was then used for the placement of the temporary ileostomy.
Results: Total operative time was 301 minutes, and partial transanal laparoscopy was 145 minutes. Perioperative bleeding was 50cc. The final scar length was 2.5cm, and the patient was discharged after 5 days. The pathological report confirmed a pT2N0M0 tumor (15 negative nodes).
Conclusions: Down-to-up rectal resection is an interesting procedure, and when associated with single incision laparoscopy, it offers the possibility to use the single site as the site for temporary ileostomy.
Laparoscopic ventral mesh rectopexy in a male patient
Introduction
Ventral rectopexy, with or without mesh, has a lower recurrence rate than a perineal approach for rectal prolapse treatment. One of the techniques which are gaining a wider acceptance is the laparoscopic ventral mesh rectopexy, also called D'Hoore rectopexy. The unique feature of this technique is that it avoids any posterolateral dissection of the rectum. Clinical outcomes demonstrate that this technique present good results in terms of recurrence, a low rate of constipation induced by the procedure, as well a low risk of sexual dysfunction.

Clinical case
A 43-year-old man was admitted to our hospital with a one-year evolution of rectal prolapse with complaints of sporadic rectal bleeding and soiling. He reports daily bowel movements with a necessity of manual prolapse reduction. His past medical history includes follicular lymphoma. He has no history of previous surgeries.
After preoperative investigation with colonoscopy, a barium enema and anorectal function tests, a laparoscopic D’Hoore rectopexy was proposed to the patient.
In this video, we present the critical steps of the procedure with special attention to the preservation of the hypogastric nerves.
The postoperative outcome was uneventful. In the follow-up period, the patient reports a significant improvement of symptoms, without rectal prolapse at defecation, no constipation, and no change in sexual function.
M Manzanera Díaz, C Moreno Sanz, J De Pedro Conal, A Goulart, F Cortina Oliva
Surgical intervention
4 years ago
4600 views
247 likes
0 comments
07:35
Laparoscopic ventral mesh rectopexy in a male patient
Introduction
Ventral rectopexy, with or without mesh, has a lower recurrence rate than a perineal approach for rectal prolapse treatment. One of the techniques which are gaining a wider acceptance is the laparoscopic ventral mesh rectopexy, also called D'Hoore rectopexy. The unique feature of this technique is that it avoids any posterolateral dissection of the rectum. Clinical outcomes demonstrate that this technique present good results in terms of recurrence, a low rate of constipation induced by the procedure, as well a low risk of sexual dysfunction.

Clinical case
A 43-year-old man was admitted to our hospital with a one-year evolution of rectal prolapse with complaints of sporadic rectal bleeding and soiling. He reports daily bowel movements with a necessity of manual prolapse reduction. His past medical history includes follicular lymphoma. He has no history of previous surgeries.
After preoperative investigation with colonoscopy, a barium enema and anorectal function tests, a laparoscopic D’Hoore rectopexy was proposed to the patient.
In this video, we present the critical steps of the procedure with special attention to the preservation of the hypogastric nerves.
The postoperative outcome was uneventful. In the follow-up period, the patient reports a significant improvement of symptoms, without rectal prolapse at defecation, no constipation, and no change in sexual function.