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Laparoscopic anterior rectopexy for rectal prolapse
This video demonstrates the technique and steps required to perform a laparoscopic anterior rectopexy for the successful treatment of rectal prolapse. The treatment of rectal prolapse with a laparoscopic trans-abdominal approach is well-established and has resulted in reduced morbidity and shorter hospital stay. It is also well-tolerated in the elderly and shows an improvement in incontinence and a low recurrence rate. This procedure can be enhanced by using a purely anterior (ventral) approach. The dissection is kept anterior to the rectum, by opening the rectovaginal septum and then continuing down to the pelvic floor where a mesh rectopexy is then performed. This avoids posterior rectal dissection and spares the autonomic pelvic nerves; it keeps morbidity low and improves constipation.
J Saunders, P Thomas, K Badrinath
Surgical intervention
8 years ago
13645 views
230 likes
0 comments
06:56
Laparoscopic anterior rectopexy for rectal prolapse
This video demonstrates the technique and steps required to perform a laparoscopic anterior rectopexy for the successful treatment of rectal prolapse. The treatment of rectal prolapse with a laparoscopic trans-abdominal approach is well-established and has resulted in reduced morbidity and shorter hospital stay. It is also well-tolerated in the elderly and shows an improvement in incontinence and a low recurrence rate. This procedure can be enhanced by using a purely anterior (ventral) approach. The dissection is kept anterior to the rectum, by opening the rectovaginal septum and then continuing down to the pelvic floor where a mesh rectopexy is then performed. This avoids posterior rectal dissection and spares the autonomic pelvic nerves; it keeps morbidity low and improves constipation.
Laparoscopic indirect ventral rectopexy with sigmoidectomy for rectal prolapse in a young female patient
The aim of surgical treatment of rectal prolapse is to anatomically restore prolapse and functionally remedy fecal incontinence and disorder of rectal emptying. There is not yet sufficient evidence-based knowledge of the advantages and disadvantages of various surgical methods. In practice, trans-abdominal surgery is recommended for patients in good conditions and perineal surgery for elderly and frail patients suffering from associated diseases. The progress of laparoscopic surgery has, however, made the trans-abdominal operation possible also for those in increasingly poor condition. With this procedure a significant improvement of defecation disorder is achieved in over 80% of patients. This video demonstrates the laparoscopic management of a rectal prolapse associated with constipation and a posterior enterocele.
J Leroy, J Marescaux
Surgical intervention
10 years ago
3368 views
140 likes
0 comments
15:44
Laparoscopic indirect ventral rectopexy with sigmoidectomy for rectal prolapse in a young female patient
The aim of surgical treatment of rectal prolapse is to anatomically restore prolapse and functionally remedy fecal incontinence and disorder of rectal emptying. There is not yet sufficient evidence-based knowledge of the advantages and disadvantages of various surgical methods. In practice, trans-abdominal surgery is recommended for patients in good conditions and perineal surgery for elderly and frail patients suffering from associated diseases. The progress of laparoscopic surgery has, however, made the trans-abdominal operation possible also for those in increasingly poor condition. With this procedure a significant improvement of defecation disorder is achieved in over 80% of patients. This video demonstrates the laparoscopic management of a rectal prolapse associated with constipation and a posterior enterocele.
Laparoscopic sigmoidectomy with ventral and posterior indirect rectopexy for rectal prolapse in a female patient
Rectal prolapse is an uncommon disease mainly seen in patients of advanced age.
In the last few years, the laparoscopic route has been shown to be feasible and has the advantage of being a minimally invasive technique. The objective of this film is to demonstrate a technique for the repair of rectal prolapse with sigmoidectomy. This is the case of a 72-year-old woman with a previous history of hysterectomy presenting also with dyschezia and moderate incontinence and a grade III rectal prolapse. Defecography showed a prolapse of the upper rectum with an enterocele without any associated rectocele in spite of the hysterectomy.
J Leroy, D Mutter, F Costantino, J Marescaux
Surgical intervention
10 years ago
2542 views
135 likes
0 comments
10:26
Laparoscopic sigmoidectomy with ventral and posterior indirect rectopexy for rectal prolapse in a female patient
Rectal prolapse is an uncommon disease mainly seen in patients of advanced age.
In the last few years, the laparoscopic route has been shown to be feasible and has the advantage of being a minimally invasive technique. The objective of this film is to demonstrate a technique for the repair of rectal prolapse with sigmoidectomy. This is the case of a 72-year-old woman with a previous history of hysterectomy presenting also with dyschezia and moderate incontinence and a grade III rectal prolapse. Defecography showed a prolapse of the upper rectum with an enterocele without any associated rectocele in spite of the hysterectomy.
Acute small bowel obstruction two months after laparoscopic rectal prolapse surgery: laparoscopic management
Acute small bowel obstruction (SBO) is an ever-increasing clinical problem. In this video, the authors demonstrate the laparoscopic management of acute small bowel obstruction. Its successful management depends on a comprehensive knowledge of the etiology and pathophysiology of obstruction, familiarity with imaging methods, good clinical judgment, and sound technical skills. The adoption of laparoscopy in the treatment of SBO has been slow because of concerns for iatrogenic bowel injury and working space issues related to bowel distension.
In this film, the authors demonstrate that it is essential to rapidly manage the patient after the first acute attack.
Although there is an inherent appeal for laparoscopy in its potential to minimize short- and long-term wound complications and perioperative laparotomy-related morbidity and to theoretically induce fewer subsequent adhesions than a traditional laparotomy incision would.

Small bowel obstruction is a pathology commonly found in the current practice of surgical emergencies. The main cause stems from surgical history with a variable onset of symptoms. The introduction of laparoscopic surgery helped to slightly reduce the number of patients presenting with occlusive syndromes. The rapid management of occlusive patients is one of the keys to success. Consequently, once diagnosis has been evoked, imaging studies must be performed, and especially CT-scan, in order to determine the type of obstruction, its mechanism and its severity. After work-up, either a conservative medical treatment or surgery will be decided upon.
L Marx, J Leroy, J Marescaux
Surgical intervention
6 years ago
2984 views
20 likes
0 comments
04:19
Acute small bowel obstruction two months after laparoscopic rectal prolapse surgery: laparoscopic management
Acute small bowel obstruction (SBO) is an ever-increasing clinical problem. In this video, the authors demonstrate the laparoscopic management of acute small bowel obstruction. Its successful management depends on a comprehensive knowledge of the etiology and pathophysiology of obstruction, familiarity with imaging methods, good clinical judgment, and sound technical skills. The adoption of laparoscopy in the treatment of SBO has been slow because of concerns for iatrogenic bowel injury and working space issues related to bowel distension.
In this film, the authors demonstrate that it is essential to rapidly manage the patient after the first acute attack.
Although there is an inherent appeal for laparoscopy in its potential to minimize short- and long-term wound complications and perioperative laparotomy-related morbidity and to theoretically induce fewer subsequent adhesions than a traditional laparotomy incision would.

Small bowel obstruction is a pathology commonly found in the current practice of surgical emergencies. The main cause stems from surgical history with a variable onset of symptoms. The introduction of laparoscopic surgery helped to slightly reduce the number of patients presenting with occlusive syndromes. The rapid management of occlusive patients is one of the keys to success. Consequently, once diagnosis has been evoked, imaging studies must be performed, and especially CT-scan, in order to determine the type of obstruction, its mechanism and its severity. After work-up, either a conservative medical treatment or surgery will be decided upon.
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
4637 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.
Laparoscopic anatomy of the pelvic floor involved in laparoscopic surgery for pelvic organ prolapse (POP) and urinary incontinence
In this key lecture, Professor Jean-Bernard Dubuisson delineates the laparoscopic pelvic floor anatomy involved in surgical procedures for the management of pelvic organ prolapse (POP) and urinary incontinence. Traditional anatomy considers three levels: pelvic and perineal muscles, ligaments, and the space between all fascias covering the organs. Visceral ligaments occupy an anteroposterior axis (pubovesical ligaments, bladder pillars, and uterosacral ligaments) and a transverse axis (lateral bladder ligaments, cardinal ligaments, paracervix and rectal pillars). The four attachment sites which may be used by the surgeon for fascia and pelvic organ attachment in POP surgery are discussed-- Cooper’s ligament, white line, ischial spine, and sacral promontory. Approximately 90 laparoscopic anatomy pictures are presented in this authoritative lecture. The dissection planes and the different pelvic spaces used for surgery are explained, insisting on the main vessels, nerves, plexus, ureters which are obstacles to bear in mind and to avoid.
JB Dubuisson
Lecture
1 year ago
4758 views
612 likes
0 comments
24:09
Laparoscopic anatomy of the pelvic floor involved in laparoscopic surgery for pelvic organ prolapse (POP) and urinary incontinence
In this key lecture, Professor Jean-Bernard Dubuisson delineates the laparoscopic pelvic floor anatomy involved in surgical procedures for the management of pelvic organ prolapse (POP) and urinary incontinence. Traditional anatomy considers three levels: pelvic and perineal muscles, ligaments, and the space between all fascias covering the organs. Visceral ligaments occupy an anteroposterior axis (pubovesical ligaments, bladder pillars, and uterosacral ligaments) and a transverse axis (lateral bladder ligaments, cardinal ligaments, paracervix and rectal pillars). The four attachment sites which may be used by the surgeon for fascia and pelvic organ attachment in POP surgery are discussed-- Cooper’s ligament, white line, ischial spine, and sacral promontory. Approximately 90 laparoscopic anatomy pictures are presented in this authoritative lecture. The dissection planes and the different pelvic spaces used for surgery are explained, insisting on the main vessels, nerves, plexus, ureters which are obstacles to bear in mind and to avoid.
Stomal prolapse and parastomal incisional hernia treatment using laparoscopic Sugarbaker modified technique with intraperitoneal onlay mesh repair
Introduction: Prolapse stands for one of the most common complications of colostomy (>10%). Parastomal incisional hernia also represents 10 to 50% of complications. When both are present, the Sugarbaker technique represents a good indication due to mesh repair and pseudo-subperitonization, which can manage both prolapse and hernia. The laparoscopic modified Sugarbaker technique can be performed laparoscopically even in case of multiple previous laparotomies.
Clinical case: We report the case of a 71-year-old male patient presenting with parastomal incisional hernia and stomal prolapse after multiple abdominal procedures for ulcerative colitis, including rectosigmoidectomy, Hartmann procedure for anastomotic leak, left extended colectomy and stomal transposition for ischemic necrosis. An intra-abdominal proctectomy was attempted to manage the recurrence of colitis on the rectal stump. However, this attempt proved unsuccessful, and a local abdominoperineal resection was performed. Due to symptomatic hernia and prolapse, the laparoscopic Sugarbaker modified surgical technique with intraperitoneal onlay mesh (IPOM) repair is performed to manage prolapse by pseudo-subperitonization and to manage hernia using an IPOM repair. As shown in this video, this technique is safe, reproducible, and effective.
J Leroy, HA Mercoli, S Tzedakis, A D'Urso, D Mutter, J Marescaux
Surgical intervention
4 years ago
2333 views
99 likes
0 comments
10:54
Stomal prolapse and parastomal incisional hernia treatment using laparoscopic Sugarbaker modified technique with intraperitoneal onlay mesh repair
Introduction: Prolapse stands for one of the most common complications of colostomy (>10%). Parastomal incisional hernia also represents 10 to 50% of complications. When both are present, the Sugarbaker technique represents a good indication due to mesh repair and pseudo-subperitonization, which can manage both prolapse and hernia. The laparoscopic modified Sugarbaker technique can be performed laparoscopically even in case of multiple previous laparotomies.
Clinical case: We report the case of a 71-year-old male patient presenting with parastomal incisional hernia and stomal prolapse after multiple abdominal procedures for ulcerative colitis, including rectosigmoidectomy, Hartmann procedure for anastomotic leak, left extended colectomy and stomal transposition for ischemic necrosis. An intra-abdominal proctectomy was attempted to manage the recurrence of colitis on the rectal stump. However, this attempt proved unsuccessful, and a local abdominoperineal resection was performed. Due to symptomatic hernia and prolapse, the laparoscopic Sugarbaker modified surgical technique with intraperitoneal onlay mesh (IPOM) repair is performed to manage prolapse by pseudo-subperitonization and to manage hernia using an IPOM repair. As shown in this video, this technique is safe, reproducible, and effective.
PROGRESS - Transanal TME with colo-anal anastomosis without trans-abdominal assistance for rectal cancer in a male patient
The authors put forward an original oncologic Total Mesorectal Excision (TME) technique combined with distal sigmoidectomy followed by a mechanical colo-anal side-to-end anastomosis using a purely transanal route.
The originality of this technique lies in the strictly transanal approach without any laparoscopic assistance as well as in the oncologic dissection of the rectum around its fascia propria. In addition, the technique is outstanding in the mobilization of the sigmoid mesocolon’s root as well as in the retroperitoneal mobilization of the vascular inferior mesenteric axis, hence avoiding contact with intra-abdominal organs.
This technique is called PROGRESS (Peri Rectal Oncologic Gateway for Retroperitoneal EndoScopic Surgery) due to the retroperitoneal endoscopic dissection using a perirectal access.
The video shows images of remarkable quality, especially of anatomical nerve structures, due to the use of a 4mm, 30-degree scope and a Karl Storz High-Definition camera introduced through the TEO™ device.
J Leroy, D Ntourakis, J Marescaux
Surgical intervention
6 years ago
5945 views
34 likes
0 comments
18:55
PROGRESS - Transanal TME with colo-anal anastomosis without trans-abdominal assistance for rectal cancer in a male patient
The authors put forward an original oncologic Total Mesorectal Excision (TME) technique combined with distal sigmoidectomy followed by a mechanical colo-anal side-to-end anastomosis using a purely transanal route.
The originality of this technique lies in the strictly transanal approach without any laparoscopic assistance as well as in the oncologic dissection of the rectum around its fascia propria. In addition, the technique is outstanding in the mobilization of the sigmoid mesocolon’s root as well as in the retroperitoneal mobilization of the vascular inferior mesenteric axis, hence avoiding contact with intra-abdominal organs.
This technique is called PROGRESS (Peri Rectal Oncologic Gateway for Retroperitoneal EndoScopic Surgery) due to the retroperitoneal endoscopic dissection using a perirectal access.
The video shows images of remarkable quality, especially of anatomical nerve structures, due to the use of a 4mm, 30-degree scope and a Karl Storz High-Definition camera introduced through the TEO™ device.
Laparoscopic sacrocolpopexy with subtotal hysterectomy: the six points technique
Standardization means: implementing guidelines or measurements in order to obtain solutions to a disorganized system. Laparoscopic sacrocolpopexy is a long and complete surgical procedure that requires good knowledge of the anatomy and of the surgical technique, as well as advanced suturing skills. Laparoscopic sacrocolpopexy is also the gold standard procedure for POP repair, and its standardization is justified by its difficulty.
This video demonstrates the standard technique for laparoscopic sacrocolpopexy with sub-total hysterectomy. It is called “the six-point technique” due to the six stitches used to fix the meshes.
A Wattiez, E Baulon, J Nassif, S Maia, P Trompoukis, J Alcocer, A Vázquez Rodriguez
Surgical intervention
8 years ago
8365 views
101 likes
0 comments
28:50
Laparoscopic sacrocolpopexy with subtotal hysterectomy: the six points technique
Standardization means: implementing guidelines or measurements in order to obtain solutions to a disorganized system. Laparoscopic sacrocolpopexy is a long and complete surgical procedure that requires good knowledge of the anatomy and of the surgical technique, as well as advanced suturing skills. Laparoscopic sacrocolpopexy is also the gold standard procedure for POP repair, and its standardization is justified by its difficulty.
This video demonstrates the standard technique for laparoscopic sacrocolpopexy with sub-total hysterectomy. It is called “the six-point technique” due to the six stitches used to fix the meshes.
Surgical tutorial: laparoscopic prolapse repair
In this lecture, Dr. Ted Lee, MD, director of the department of minimally invasive gynecologic surgery in Pittsburgh, Pennsylvania, USA, focuses on the sacrocolpopexy procedure in relation to his experience in the treatment of genital organ prolapse. He highlights some important key steps of the procedure, together with some tips and tricks on optimizing exposure, facilitating dissection, suturing of the mesh and how to minimize complications.
The first step of the procedure is an adequate exposure with bowel retraction in order to have sufficient space to work in the sacral promontory area.
The next step is the rectovaginal dissection, with caution to keep the dissection close to the vagina, leave enough adipose tissue to the rectum, and dissect the pararectal spaces until the levator ani muscles. Dr. Lee stresses the fact that the depth of the dissection depends on the posterior wall defect. So in patients with a posterior defect not protruding outside the hymen, the dissection should stop at the level of the midvagina. This is in order to avoid future constipation with deep dissection. Only in patients with large posterior wall defects, the dissection should be performed at the level of the levator ani. Dr. Lee indicates some surgical instruments, such as the rectal probes and retractors, that are useful for the dissection of the rectovaginal space.
Next step is the vesicovaginal dissection, which can be very challenging, especially in patients with previous hysterectomy. Some tips and tricks such as the use of a Foley catheter or the use of a large probe to distend the vagina in order to facilitate dissection are demonstrated.
Next is the presacral dissection with skeletonization of the fibrofatty tissue, dissection from right to left to preserve the hypogastric nerve, and identification of a good plane of dissection to avoid bleeding, especially from the left common iliac vein, but also from sacral vessels, which can be dissected.
The last step is the suturing of the mesh. He explains that there is no longer the need to use non-absorbable sutures together with the use of tackers in order to secure the mesh to the sacrum without complications. A nice technique of suturing and knotting is demonstrated during mesh peritonization.
Finally, in patients where the uterus needs to be preserved for fertility purposes (sacrohysteropexy), Dr. Lee explains an alternative method to place the mesh medial to the uterine vessels in order to perform, if need be, a hysterectomy more easily later on. He also demonstrates a nice uterosacral suspension technique used in patients who do not wish to be treated with a mesh for their prolapse.
T Lee
Lecture
8 years ago
2668 views
65 likes
0 comments
25:34
Surgical tutorial: laparoscopic prolapse repair
In this lecture, Dr. Ted Lee, MD, director of the department of minimally invasive gynecologic surgery in Pittsburgh, Pennsylvania, USA, focuses on the sacrocolpopexy procedure in relation to his experience in the treatment of genital organ prolapse. He highlights some important key steps of the procedure, together with some tips and tricks on optimizing exposure, facilitating dissection, suturing of the mesh and how to minimize complications.
The first step of the procedure is an adequate exposure with bowel retraction in order to have sufficient space to work in the sacral promontory area.
The next step is the rectovaginal dissection, with caution to keep the dissection close to the vagina, leave enough adipose tissue to the rectum, and dissect the pararectal spaces until the levator ani muscles. Dr. Lee stresses the fact that the depth of the dissection depends on the posterior wall defect. So in patients with a posterior defect not protruding outside the hymen, the dissection should stop at the level of the midvagina. This is in order to avoid future constipation with deep dissection. Only in patients with large posterior wall defects, the dissection should be performed at the level of the levator ani. Dr. Lee indicates some surgical instruments, such as the rectal probes and retractors, that are useful for the dissection of the rectovaginal space.
Next step is the vesicovaginal dissection, which can be very challenging, especially in patients with previous hysterectomy. Some tips and tricks such as the use of a Foley catheter or the use of a large probe to distend the vagina in order to facilitate dissection are demonstrated.
Next is the presacral dissection with skeletonization of the fibrofatty tissue, dissection from right to left to preserve the hypogastric nerve, and identification of a good plane of dissection to avoid bleeding, especially from the left common iliac vein, but also from sacral vessels, which can be dissected.
The last step is the suturing of the mesh. He explains that there is no longer the need to use non-absorbable sutures together with the use of tackers in order to secure the mesh to the sacrum without complications. A nice technique of suturing and knotting is demonstrated during mesh peritonization.
Finally, in patients where the uterus needs to be preserved for fertility purposes (sacrohysteropexy), Dr. Lee explains an alternative method to place the mesh medial to the uterine vessels in order to perform, if need be, a hysterectomy more easily later on. He also demonstrates a nice uterosacral suspension technique used in patients who do not wish to be treated with a mesh for their prolapse.
Richter's sacrospinous ligament fixation of the prolapsed vaginal vault
The description of the Richter's sacrospinous ligament fixation of the prolapsed vaginal vault covers all aspects of the surgical procedure used for the management of vaginal vault prolapse following hysterectomy.
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: posterior colpotomy, opening of fossae, exposure, sutures, checking the hemostasis, myorrhaphy, suspension of vaginal floor, end of procedure, complications.
Consequently, this operating technique is well standardized for the management of this condition.
M Cosson, B Occelli, D Querleu
Operative technique
17 years ago
3216 views
112 likes
1 comment
Richter's sacrospinous ligament fixation of the prolapsed vaginal vault
The description of the Richter's sacrospinous ligament fixation of the prolapsed vaginal vault covers all aspects of the surgical procedure used for the management of vaginal vault prolapse following hysterectomy.
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: posterior colpotomy, opening of fossae, exposure, sutures, checking the hemostasis, myorrhaphy, suspension of vaginal floor, end of procedure, complications.
Consequently, this operating technique is well standardized for the management of this condition.