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Scaphoid Trapezium Pyrocarbon Implant (STPI) in scaphotrapeziotrapezoidal (STT) arthritis
STT arthritis is a well-known problem generated idiopathically or secondary to a greater mobility of the scaphoid, for example after scapho-lunate ligament lesions. In these cases, the pure resection of the STT joint would add more instability to the whole system. Therefore, alternatively to the simple resection arthroplasty, the prosthetic augmentation has been proposed. We report the experience with a pyrocarbone convex-concave-shaped prosthesis, which adapts anatomically in the STT joint. After the arthroscopic resection of the distal scaphoid pole, the pyrocarbone implant can be positioned. Three weeks of immobilization seem convenient. In a series of 15 Prof. Christophe Mathoulin’s patients, very good results were achieved after a 39-month follow-up period. Two cases failed because of incomplete resection, especially at the most medial side towards the capitate, which should be approached in this area with accuracy. Arthroscopic resection and pyrocarbone prosthesis have provided very good results in isolated STT arthritis, but remain a new therapeutic option whose validity will have to be proven over the next years.
M Haerle
Lecture
8 years ago
268 views
4 likes
0 comments
05:07
Scaphoid Trapezium Pyrocarbon Implant (STPI) in scaphotrapeziotrapezoidal (STT) arthritis
STT arthritis is a well-known problem generated idiopathically or secondary to a greater mobility of the scaphoid, for example after scapho-lunate ligament lesions. In these cases, the pure resection of the STT joint would add more instability to the whole system. Therefore, alternatively to the simple resection arthroplasty, the prosthetic augmentation has been proposed. We report the experience with a pyrocarbone convex-concave-shaped prosthesis, which adapts anatomically in the STT joint. After the arthroscopic resection of the distal scaphoid pole, the pyrocarbone implant can be positioned. Three weeks of immobilization seem convenient. In a series of 15 Prof. Christophe Mathoulin’s patients, very good results were achieved after a 39-month follow-up period. Two cases failed because of incomplete resection, especially at the most medial side towards the capitate, which should be approached in this area with accuracy. Arthroscopic resection and pyrocarbone prosthesis have provided very good results in isolated STT arthritis, but remain a new therapeutic option whose validity will have to be proven over the next years.
Arthroscopic scaphotrapeziotrapezoidal (STT) joint arthroplasty
Scaphotrapeziotrapezoid (STT) joint osteoarthritis is less known than other types of wrist arthritis.
This disease accounts for only 13% of all wrist arthritis sites. Isolated lesions of this joint are rare and their therapeutic management is complex.
The only treatment proposed used to be STT arthrodesis, a technically difficult procedure which caused numerous complications.
Pseudoarthrosis is common, and STT arthrodesis has been incriminated in the occurrence of radioscaphoid osteoarthritis. Techniques of distal resection combined with interposition of biological tissues such as tendons (flexor carpi radialis) was described in the 1990s. In this video, we present arthroscopic interposition of pyrocarbon implant, a safe and convenient technique for patients, with long-lasting favorable results.
C Mathoulin
Surgical intervention
1 year ago
168 views
1 like
0 comments
04:24
Arthroscopic scaphotrapeziotrapezoidal (STT) joint arthroplasty
Scaphotrapeziotrapezoid (STT) joint osteoarthritis is less known than other types of wrist arthritis.
This disease accounts for only 13% of all wrist arthritis sites. Isolated lesions of this joint are rare and their therapeutic management is complex.
The only treatment proposed used to be STT arthrodesis, a technically difficult procedure which caused numerous complications.
Pseudoarthrosis is common, and STT arthrodesis has been incriminated in the occurrence of radioscaphoid osteoarthritis. Techniques of distal resection combined with interposition of biological tissues such as tendons (flexor carpi radialis) was described in the 1990s. In this video, we present arthroscopic interposition of pyrocarbon implant, a safe and convenient technique for patients, with long-lasting favorable results.
Arthroscopic interposition in scapholunate advanced collapse wrist arthritis, stage 2 (SLAC 2)
Scapholunate advanced collapse (SLAC) is a form of degenerative arthritis of the wrist which is commonly a sequela of scapholunate instability. SLAC follows a typical pattern which begins with arthritis of the radial styloid (stage 1). Stage 2 is marked by the involvement of the entire scaphoid fossa and the scaphoid while arthritic changes involve the midcarpal joint in stage 3. Stage 2 SLAC is typically managed with proximal row carpectomy (PRC), which preserves some degree of wrist flexion-extension arc and reduces pain. However, major drawbacks of this procedure are as follows: incongruence between lunate fossa and capitate, subsequent arthritic changes, and reduced grip strength originating from reduced carpal height. This video shows a recently described salvage procedure, namely arthroscopic interposition tendon arthroplasty (AITA), which attempts to preserve wrist motion and carpal height simultaneously restoring radiocarpal joint space and reducing pain, by interpositioning tendon graft in the radiocarpal joint.
C Mathoulin
Surgical intervention
1 year ago
182 views
2 likes
0 comments
17:40
Arthroscopic interposition in scapholunate advanced collapse wrist arthritis, stage 2 (SLAC 2)
Scapholunate advanced collapse (SLAC) is a form of degenerative arthritis of the wrist which is commonly a sequela of scapholunate instability. SLAC follows a typical pattern which begins with arthritis of the radial styloid (stage 1). Stage 2 is marked by the involvement of the entire scaphoid fossa and the scaphoid while arthritic changes involve the midcarpal joint in stage 3. Stage 2 SLAC is typically managed with proximal row carpectomy (PRC), which preserves some degree of wrist flexion-extension arc and reduces pain. However, major drawbacks of this procedure are as follows: incongruence between lunate fossa and capitate, subsequent arthritic changes, and reduced grip strength originating from reduced carpal height. This video shows a recently described salvage procedure, namely arthroscopic interposition tendon arthroplasty (AITA), which attempts to preserve wrist motion and carpal height simultaneously restoring radiocarpal joint space and reducing pain, by interpositioning tendon graft in the radiocarpal joint.
Arthroscopic interposition in SLAC 2 wrist arthritis
Scapholunate dissociation is the most common carpal instability. Scapholunate instability is associated with increased scaphoid flexion and pronation with associated lunate extension. The abnormal kinematics leads to a decrease in surface area contact at the radioscaphoid joint. This abnormal articulation causes an increased concentration of load, leading to the development of degenerative arthritis. In late chronic scapholunate ligament dissociation, when the arthritis appeared (SLAC 2-SLAC 3), treatment often involves heavy palliative techniques such as resection of the first row or four bones fusion. We propose a simpler technique of arthroscopic interposition of a palmaris longus tendon, combined with a wide styloidectomy of scaphoid fossea of distal radius and a dorsal capsuloligamentous repair to stabilize the scapholunate dissociation.
C Mathoulin
Surgical intervention
6 years ago
474 views
6 likes
0 comments
06:26
Arthroscopic interposition in SLAC 2 wrist arthritis
Scapholunate dissociation is the most common carpal instability. Scapholunate instability is associated with increased scaphoid flexion and pronation with associated lunate extension. The abnormal kinematics leads to a decrease in surface area contact at the radioscaphoid joint. This abnormal articulation causes an increased concentration of load, leading to the development of degenerative arthritis. In late chronic scapholunate ligament dissociation, when the arthritis appeared (SLAC 2-SLAC 3), treatment often involves heavy palliative techniques such as resection of the first row or four bones fusion. We propose a simpler technique of arthroscopic interposition of a palmaris longus tendon, combined with a wide styloidectomy of scaphoid fossea of distal radius and a dorsal capsuloligamentous repair to stabilize the scapholunate dissociation.
Arthroscopic Wafer procedure for ulnar carpal abutment
Ulnocarpal abutment is the inversion of the distal radio ulnar index with a positive ulnar variance (long ulna) and is most frequently secondary to distal radius fractures. The relative ‘shortening of the radius’ leads to a conflict between the ulnar head and the proximal lunatum. The natural evolution of this condition is usually a central perforation of the TFCC complex. This arthrogenic lesion eventually leads to arthritis of the medial proximal lunate as well as the ulnar head. Persistence of the abutment may further lead to lunotriquetral dissociation. There are many management options for the distal radioulnar component of distal radius malunions and the therapeutic choice depends on clinical evaluation and imaging of this joint. In this video, we present the arthroscopic treatment, which remains the simplest and best solution for the patients.
C Mathoulin
Surgical intervention
1 year ago
287 views
6 likes
1 comment
06:03
Arthroscopic Wafer procedure for ulnar carpal abutment
Ulnocarpal abutment is the inversion of the distal radio ulnar index with a positive ulnar variance (long ulna) and is most frequently secondary to distal radius fractures. The relative ‘shortening of the radius’ leads to a conflict between the ulnar head and the proximal lunatum. The natural evolution of this condition is usually a central perforation of the TFCC complex. This arthrogenic lesion eventually leads to arthritis of the medial proximal lunate as well as the ulnar head. Persistence of the abutment may further lead to lunotriquetral dissociation. There are many management options for the distal radioulnar component of distal radius malunions and the therapeutic choice depends on clinical evaluation and imaging of this joint. In this video, we present the arthroscopic treatment, which remains the simplest and best solution for the patients.
Arthroscopic interposition arthroplasty: preliminary results
Purpose. – In carpometacarpal (CMC) arthritis of the thumb, the use of interposition techniques (polylactic acid, pyrocarbon, dacron) has been increasing recently. These techniques are most often combined with open or arthroscopic complete or partial trapeziectomy. This article reports the
results at one year of the arthroscopic interposition of an absorbable implant performed without trapeziectomy.
Methods. – Our series included 25 patients aged 60.5 years on average, presenting with osteoarthritis of the trapeziometacarpal joint that had been medically treated for 18.5 months on average. All patients were operated using 1-ulnar (U) and 1-radial (R) portals. After joint debridement, a polylactic acid implant was inserted under arthroscopic control. Outcome evaluation consisted of the assessment of pain intensity, grip strength, pinch strength, opposition, thumb abduction and Dell radiological staging.
Results. – The average follow-up was 14 months. Postoperative radiological data showed significant differences from baseline clinical data regarding all evaluated variables: 0.68 vs. 3.5 for pain, 24.76 Kg vs. 16.64 Kg for grip strength, 6.44 Kg vs. 3.64 Kg for pinch strength, 8.6 vs. 7.28 for opposition, 81.28 vs. 69.68 for thumb abduction, and 1.08 vs. 2.88 on the Dell stage. Eleven complications occurred, including a type 1 complex regional pain syndrome, one sepsis, and nine inflammatory reactions that resolved after an average of 3 weeks.
Conclusions. – Our technique is simple, rapid, cost-effective, and does not necessitate trapeziectomy, even partial. It has the same indications as other non-radical interventions. The follow-up duration of our study was too short for long-term evaluation but short-term outcome appeared superior to that in other published series. The regional inflammatory reactions that occurred in our series were transient and probably related to implant resorption. Our promising results suggest extending the indication of arthroscopic interposition to more advanced stages of proximal joint osteoarthritis.
P Liverneaux
Lecture
7 years ago
270 views
3 likes
0 comments
11:20
Arthroscopic interposition arthroplasty: preliminary results
Purpose. – In carpometacarpal (CMC) arthritis of the thumb, the use of interposition techniques (polylactic acid, pyrocarbon, dacron) has been increasing recently. These techniques are most often combined with open or arthroscopic complete or partial trapeziectomy. This article reports the
results at one year of the arthroscopic interposition of an absorbable implant performed without trapeziectomy.
Methods. – Our series included 25 patients aged 60.5 years on average, presenting with osteoarthritis of the trapeziometacarpal joint that had been medically treated for 18.5 months on average. All patients were operated using 1-ulnar (U) and 1-radial (R) portals. After joint debridement, a polylactic acid implant was inserted under arthroscopic control. Outcome evaluation consisted of the assessment of pain intensity, grip strength, pinch strength, opposition, thumb abduction and Dell radiological staging.
Results. – The average follow-up was 14 months. Postoperative radiological data showed significant differences from baseline clinical data regarding all evaluated variables: 0.68 vs. 3.5 for pain, 24.76 Kg vs. 16.64 Kg for grip strength, 6.44 Kg vs. 3.64 Kg for pinch strength, 8.6 vs. 7.28 for opposition, 81.28 vs. 69.68 for thumb abduction, and 1.08 vs. 2.88 on the Dell stage. Eleven complications occurred, including a type 1 complex regional pain syndrome, one sepsis, and nine inflammatory reactions that resolved after an average of 3 weeks.
Conclusions. – Our technique is simple, rapid, cost-effective, and does not necessitate trapeziectomy, even partial. It has the same indications as other non-radical interventions. The follow-up duration of our study was too short for long-term evaluation but short-term outcome appeared superior to that in other published series. The regional inflammatory reactions that occurred in our series were transient and probably related to implant resorption. Our promising results suggest extending the indication of arthroscopic interposition to more advanced stages of proximal joint osteoarthritis.
Endoscopic endonasal approach to the cranio-cervical junction
There exists a variety of pathological processes involving the craniocervical junction (CCJ): tumors (e.g. primary bone tumors, chordomas, metastases), infections (e.g. tuberculoma), malformations and rheumatoid arthritis. Instability—either induced by the pathology itself or after surgery— is often associated with these diseases and has to be addressed. For a long time, the transoral approach (TOA) has been the gold standard for anterior surgical decompression at the CCJ. Over the last years, the endoscopic endonasal approach (EEA) has become a valuable alternative. In order to work efficiently and safely via the EEA, there are some prerequisites: a thorough knowledge of the endoscopic anatomy, careful preoperative planning based on radiology, adequate endoscopic technique (ideally a team of neurosurgeons and ENT specialists), dedicated endoscopic instrumentation and intraoperative navigation and the ability to perform occipitocervical stabilization. Finally, for successful patient management, it is crucial to learn about the possibilities and limits of this approach - or when to choose it and when not.
JF Cornelius
Lecture
7 years ago
485 views
1 like
0 comments
11:02
Endoscopic endonasal approach to the cranio-cervical junction
There exists a variety of pathological processes involving the craniocervical junction (CCJ): tumors (e.g. primary bone tumors, chordomas, metastases), infections (e.g. tuberculoma), malformations and rheumatoid arthritis. Instability—either induced by the pathology itself or after surgery— is often associated with these diseases and has to be addressed. For a long time, the transoral approach (TOA) has been the gold standard for anterior surgical decompression at the CCJ. Over the last years, the endoscopic endonasal approach (EEA) has become a valuable alternative. In order to work efficiently and safely via the EEA, there are some prerequisites: a thorough knowledge of the endoscopic anatomy, careful preoperative planning based on radiology, adequate endoscopic technique (ideally a team of neurosurgeons and ENT specialists), dedicated endoscopic instrumentation and intraoperative navigation and the ability to perform occipitocervical stabilization. Finally, for successful patient management, it is crucial to learn about the possibilities and limits of this approach - or when to choose it and when not.
Surgical treatment of scaphoid fractures with arthroscopic control
The objective of this presentation is not to perform an exhaustive review of the surgical treatment of scaphoid fractures but to try to justify our choice to systematically associate an arthroscopic control in with a percutaneous fixation using a cannulated screw in all non- or minimally displaced scaphoid fractures. Scaphoid fractures are frequent but present unique challenges because of the particular geometry of the bone and the tenuous vascular pattern of the scaphoid. Delays in diagnosis and inadequate treatment for acute scaphoid fractures may lead to non-unions that can progress to carpal collapse and degenerative arthritis of the wrist.
Improvements in diagnosis, surgical treatment and implant materials have encouraged a trend towards early internal fixation even for non-displaced scaphoid fractures that could potentially be treated non-operatively. In our experience, wrist arthroscopy is a useful tool in the management of these fractures not only to assess the quality of reduction but also not to overlook severe carpal ligament injuries, which would be untreated and may lead to chronic and symptomatic carpal instability.
X Martinache
Lecture
8 years ago
187 views
5 likes
0 comments
10:12
Surgical treatment of scaphoid fractures with arthroscopic control
The objective of this presentation is not to perform an exhaustive review of the surgical treatment of scaphoid fractures but to try to justify our choice to systematically associate an arthroscopic control in with a percutaneous fixation using a cannulated screw in all non- or minimally displaced scaphoid fractures. Scaphoid fractures are frequent but present unique challenges because of the particular geometry of the bone and the tenuous vascular pattern of the scaphoid. Delays in diagnosis and inadequate treatment for acute scaphoid fractures may lead to non-unions that can progress to carpal collapse and degenerative arthritis of the wrist.
Improvements in diagnosis, surgical treatment and implant materials have encouraged a trend towards early internal fixation even for non-displaced scaphoid fractures that could potentially be treated non-operatively. In our experience, wrist arthroscopy is a useful tool in the management of these fractures not only to assess the quality of reduction but also not to overlook severe carpal ligament injuries, which would be untreated and may lead to chronic and symptomatic carpal instability.
Scapholunate tears: a new classification
Pathogenesis and treatment of scapholunate (SL) injuries are still under definition in the literature, especially in chronic cases. A two-stage mechanism able to create a chronic injury has been described by several authors. A partial initially asymptomatic injury to the SL ligament can later become symptomatic. The treatment of these injuries is not standardized in the different stages and not always satisfactory. Lack of early diagnosis of this injury can develop a chronic instability leading to degenerative arthritis and SLAC wrist. The aim of this study is to experimentally cut the different parts of the scapholunate ligament and extrinsic ligaments in cadaveric wrists and check the corresponding arthroscopic finding. The SL ligament was evaluated at the beginning of the dissections. Extrinsic ligament tension or laxity was also assessed arthroscopically and by specific tests. A new classification by the European Wrist Arthroscopy Society (EWAS) is proposed to better define the different stages and improve treatment.
J Messina
Lecture
8 years ago
268 views
1 like
0 comments
08:46
Scapholunate tears: a new classification
Pathogenesis and treatment of scapholunate (SL) injuries are still under definition in the literature, especially in chronic cases. A two-stage mechanism able to create a chronic injury has been described by several authors. A partial initially asymptomatic injury to the SL ligament can later become symptomatic. The treatment of these injuries is not standardized in the different stages and not always satisfactory. Lack of early diagnosis of this injury can develop a chronic instability leading to degenerative arthritis and SLAC wrist. The aim of this study is to experimentally cut the different parts of the scapholunate ligament and extrinsic ligaments in cadaveric wrists and check the corresponding arthroscopic finding. The SL ligament was evaluated at the beginning of the dissections. Extrinsic ligament tension or laxity was also assessed arthroscopically and by specific tests. A new classification by the European Wrist Arthroscopy Society (EWAS) is proposed to better define the different stages and improve treatment.
Arthroscopic dorsal capsuloplasty as treatment for chronic scapholunate tear
The sprain of the scapholunate ligament generates chronic instability, which leads to a chondral change with carpus arthritis. The use of wrist arthroscopy allows the diagnosis of these lesions, even at an early stage, and, sometimes, provides a therapeutic strategy by performing a stable fixation. In some chronic cases when the ligament cannot be repaired but the scapholunate space is reducible (stage 2 to 4 according to Garcia-Elias’ classification), a new arthroscopic dorsal capsuloplasty has been performed in order to avoid a complex reconstruction with common stiffness. The patients were operated on in outpatient settings under regional anesthesia using a pneumatic tourniquet. The capsuloplasty is arthroscopically performed between the dorsal capsule and the dorsal part of the scapholunate ligament, using a PDS suture loop. Scapholunate and scaphocapitate Kirschner wires are placed only at stage 4 after scaphoid reduction. A volar splint was placed for a period of 2 months.
C Mathoulin
Surgical intervention
9 years ago
863 views
5 likes
0 comments
12:38
Arthroscopic dorsal capsuloplasty as treatment for chronic scapholunate tear
The sprain of the scapholunate ligament generates chronic instability, which leads to a chondral change with carpus arthritis. The use of wrist arthroscopy allows the diagnosis of these lesions, even at an early stage, and, sometimes, provides a therapeutic strategy by performing a stable fixation. In some chronic cases when the ligament cannot be repaired but the scapholunate space is reducible (stage 2 to 4 according to Garcia-Elias’ classification), a new arthroscopic dorsal capsuloplasty has been performed in order to avoid a complex reconstruction with common stiffness. The patients were operated on in outpatient settings under regional anesthesia using a pneumatic tourniquet. The capsuloplasty is arthroscopically performed between the dorsal capsule and the dorsal part of the scapholunate ligament, using a PDS suture loop. Scapholunate and scaphocapitate Kirschner wires are placed only at stage 4 after scaphoid reduction. A volar splint was placed for a period of 2 months.
Arthroscopic radial styloidectomy: technique, indication, results
The first case of arthroscopic radial styloidectomy was reported by Ruch in 1998.
Indications of radial styloidectomy are relative to radioscaphoidal impingement without alteration of the mid-carpal joint by degenerative arthritis (SNAC and SLAC stage 1 and 2). Pseudarthrosis of the radial styloid is another rare indication of radial styloidectomy.
The quantity of radius to remove was evaluated in different studies between 3 and 4mm. Removing more than 4mm of radius may lead to a destabilization of the wrist due to the insertion of ligaments on the anterior marginal part of the radius. No case of carpal destabilization after radial styloidectomy was reported in the literature.
The design of osteotomy may be different depending on the origin of the conflict. SNAC and SLAC lead to different kinds of arthritis and impingement.
Arthrocopy is a very useful tool to carry out radial styloidectomy; it is a minimally invasive procedure with the possibility of early rehabilitation. In case of poor results, there is still a place for open surgery.
To better visualize the expert's powerpoint presentation, please click here.
JM Cognet
Lecture
9 years ago
364 views
2 likes
0 comments
12:16
Arthroscopic radial styloidectomy: technique, indication, results
The first case of arthroscopic radial styloidectomy was reported by Ruch in 1998.
Indications of radial styloidectomy are relative to radioscaphoidal impingement without alteration of the mid-carpal joint by degenerative arthritis (SNAC and SLAC stage 1 and 2). Pseudarthrosis of the radial styloid is another rare indication of radial styloidectomy.
The quantity of radius to remove was evaluated in different studies between 3 and 4mm. Removing more than 4mm of radius may lead to a destabilization of the wrist due to the insertion of ligaments on the anterior marginal part of the radius. No case of carpal destabilization after radial styloidectomy was reported in the literature.
The design of osteotomy may be different depending on the origin of the conflict. SNAC and SLAC lead to different kinds of arthritis and impingement.
Arthrocopy is a very useful tool to carry out radial styloidectomy; it is a minimally invasive procedure with the possibility of early rehabilitation. In case of poor results, there is still a place for open surgery.
To better visualize the expert's powerpoint presentation, please click here.
Tips 'n Tricks for wrist arthroscopy: installation, portals and exploration
Wrist arthroscopy allows a thorough exploration of the radiocarpal and midcarpal joints simply by carrying out small portals. This video shows how to achieve them and what can be seen in the wrist.
The purpose of this video is to understand the principle of wrist arthroscopy and how to perform the portals in the least invasive way. We can draw tendon-bone elements on the skin in order to create anatomical landmarks. Before using the knife, using a single needle is essential to identify the exact position of portals. We always start the exploration of the wrist with the radiocarpal joint, and the 3-4 portal. To find it, there are several simple ways. Once the scope is entered in the radiocarpal joint, it is possible only by this portal to explore all the articulation from radial styloid to ulnar styloid. Instrumental 6R portal will be performed. The midcarpal joint is narrower than the radiocarpal joint. We start with the ulnar midcarpal portal, the easiest to find, then an instrumental radiocarpal portal will be used. Placing the scope in a radial midcarpal position allows to explore the scapho-trapezoid-trapezium joint distally as well as the dorsal surface of the capitate bone.
C Mathoulin, P Liverneaux
Surgical intervention
9 years ago
1196 views
31 likes
0 comments
21:38
Tips 'n Tricks for wrist arthroscopy: installation, portals and exploration
Wrist arthroscopy allows a thorough exploration of the radiocarpal and midcarpal joints simply by carrying out small portals. This video shows how to achieve them and what can be seen in the wrist.
The purpose of this video is to understand the principle of wrist arthroscopy and how to perform the portals in the least invasive way. We can draw tendon-bone elements on the skin in order to create anatomical landmarks. Before using the knife, using a single needle is essential to identify the exact position of portals. We always start the exploration of the wrist with the radiocarpal joint, and the 3-4 portal. To find it, there are several simple ways. Once the scope is entered in the radiocarpal joint, it is possible only by this portal to explore all the articulation from radial styloid to ulnar styloid. Instrumental 6R portal will be performed. The midcarpal joint is narrower than the radiocarpal joint. We start with the ulnar midcarpal portal, the easiest to find, then an instrumental radiocarpal portal will be used. Placing the scope in a radial midcarpal position allows to explore the scapho-trapezoid-trapezium joint distally as well as the dorsal surface of the capitate bone.
Gastric bypass: surgical treatment of morbid obesity
Morbid obesity is a major health concern in so many countries. It is associated with severe life-threatening co-morbidities. Unfortunately, many studies have proven that non-surgical approaches to lose weight are doomed to fail. There is good evidence that bariatric surgery is the most enduring and efficacious means of tackling morbid obesity with regards to long-term weight loss.

Roux-en-Y gastric bypass is today one of the gold standard surgeries. It is based on several mechanisms: restriction, malabsorption, and changes in gut hormones secretions.
In this chapter, all aspects of this bariatric procedure such as anatomical details, indications, contraindications, surgical setting and technical details are carefully presented.
M Vix
Operative technique
10 years ago
7333 views
166 likes
0 comments
Gastric bypass: surgical treatment of morbid obesity
Morbid obesity is a major health concern in so many countries. It is associated with severe life-threatening co-morbidities. Unfortunately, many studies have proven that non-surgical approaches to lose weight are doomed to fail. There is good evidence that bariatric surgery is the most enduring and efficacious means of tackling morbid obesity with regards to long-term weight loss.

Roux-en-Y gastric bypass is today one of the gold standard surgeries. It is based on several mechanisms: restriction, malabsorption, and changes in gut hormones secretions.
In this chapter, all aspects of this bariatric procedure such as anatomical details, indications, contraindications, surgical setting and technical details are carefully presented.
Minimally invasive video-assisted parathyroidectomy for primary hyperparathyroidism
In recent years, the advances in preoperative localization studies, the availability of intraoperative parathyroid hormone (PTH) assay and the introduction of cervicoscopy revolutionized the surgical treatment of primary hyperparathyroidism (PHPT).
Minimally invasive video-assisted parathyroidectomy (MIVAP) is an efficacious and feasible procedure with the same complication rate as conventional surgery and has significant advantages in terms of cosmetic results, postoperative pain, recovery, and patient satisfaction. MIVAP should be considered a valid and validated option for the treatment of sporadic primary hyperparathyroidism, especially in case of a suspected single adenoma. This video demonstrates a minimally invasive approach for the excision of a right superior parathyroid adenoma in an inter-crico-thyroid position in a 65-year-old female patient.
M Vix, L Soler, J Marescaux
Surgical intervention
10 years ago
1521 views
29 likes
0 comments
04:46
Minimally invasive video-assisted parathyroidectomy for primary hyperparathyroidism
In recent years, the advances in preoperative localization studies, the availability of intraoperative parathyroid hormone (PTH) assay and the introduction of cervicoscopy revolutionized the surgical treatment of primary hyperparathyroidism (PHPT).
Minimally invasive video-assisted parathyroidectomy (MIVAP) is an efficacious and feasible procedure with the same complication rate as conventional surgery and has significant advantages in terms of cosmetic results, postoperative pain, recovery, and patient satisfaction. MIVAP should be considered a valid and validated option for the treatment of sporadic primary hyperparathyroidism, especially in case of a suspected single adenoma. This video demonstrates a minimally invasive approach for the excision of a right superior parathyroid adenoma in an inter-crico-thyroid position in a 65-year-old female patient.