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Biliary access techniques in patients with surgically altered anatomy
Iatrogenic bile duct injuries following surgery are associated with life-threatening complications.
Most injuries occur following open or laparoscopic cholecystectomies. The incidence of bile duct injury (BDI) has increased when a laparoscopic approach is used.
The current incidence of BDI using a laparoscopic approach is comprised between 0.5 and 2.7%.
The presented clinical cases include bile leakage, bilioma, peritonitis or a local abscess, and only 30% of cases are recognized intraoperatively.
The main modality of treatment is surgery. However, endoscopic management is a current alternative.
This video highlights the various methods for the management of biliary leaks and postoperative biliary strictures.
M Perez-Miranda
Lecture
3 years ago
1042 views
31 likes
0 comments
26:31
Biliary access techniques in patients with surgically altered anatomy
Iatrogenic bile duct injuries following surgery are associated with life-threatening complications.
Most injuries occur following open or laparoscopic cholecystectomies. The incidence of bile duct injury (BDI) has increased when a laparoscopic approach is used.
The current incidence of BDI using a laparoscopic approach is comprised between 0.5 and 2.7%.
The presented clinical cases include bile leakage, bilioma, peritonitis or a local abscess, and only 30% of cases are recognized intraoperatively.
The main modality of treatment is surgery. However, endoscopic management is a current alternative.
This video highlights the various methods for the management of biliary leaks and postoperative biliary strictures.
Vascular anatomy of left and right colon: standard vs. variations
The vascular anatomy of the colon has some anatomical variations [1]. In this video, starting from the normal surgical anatomy of the colon, authors show many vascular anomalies of surgical interest, which should be known in order to avoid intraoperative complications. In the right colon, the ileocolic artery and the middle colic artery are constantly present in all patients as they arise from the superior mesenteric vessels [2]. Right colic vessels are present only in 80% of cases. The position of ileocolic vessels related to the superior mesenteric vein (SMV) is a key landmark. In this video, starting from the normal surgical anatomy of the right colon, authors show variant ileocolic vessels position defined type A pattern, with ileocolic artery (ICA) which lies in the anterior position in respect to the ileocolic vein (ICV). Authors also show an anomalous origin of the ileocolic vessels, which are more upper in respect to their standard position. Commonly, the ileocolic artery (ICA) lies posterior to the SMV (83%, type B). However, the ICA sometimes lies anteriorly to the SMV (17%, type A) [1]. The vascular system of the left colon has fewer variations in terms of position and origin, contrarily to the right colon. The most frequent variations of the inferior mesenteric artery (IMA) supply involve the division of the sigmoid arteries, as classified by Latarjet in two different types, depending on the anatomical relationship between the left colic and sigmoid arteries [3]. However, in this video authors show a rare case of IMA arising from the superior mesenteric artery [4].
References:
1. Milsom JW, Böhm B, Nakajima K. Laparoscopic Colorectal Surgery 2006, Springer.
2. Wu C, Ye K, Wu Y, Chen Q, Xu J, Lin J, Kang W. Variations in right colic vascular anatomy observed during laparoscopic right colectomy. World J Surg Oncol 2019;17:16.
3. Patroni A, Bonnet S, Bourillon C, Bruzzi M, Zinzindohoue F, Chevallier JM, Douard R, Berger A. Technical difficulties of left colic artery preservation during left colectomy for colon cancer. Surg Radiol Anat 2016;38:477-84.
4. Yoo SJ, Ku MJ, Cho SS, Yoon SP. A case of the inferior mesenteric artery arising from the superior mesenteric artery in a Korean woman. J Korean Med Sci 2011;26:1382-5.
F Corcione, E Pontecorvi, V Silvestri, G Merola, U Bracale
Surgical intervention
2 months ago
1766 views
19 likes
0 comments
21:44
Vascular anatomy of left and right colon: standard vs. variations
The vascular anatomy of the colon has some anatomical variations [1]. In this video, starting from the normal surgical anatomy of the colon, authors show many vascular anomalies of surgical interest, which should be known in order to avoid intraoperative complications. In the right colon, the ileocolic artery and the middle colic artery are constantly present in all patients as they arise from the superior mesenteric vessels [2]. Right colic vessels are present only in 80% of cases. The position of ileocolic vessels related to the superior mesenteric vein (SMV) is a key landmark. In this video, starting from the normal surgical anatomy of the right colon, authors show variant ileocolic vessels position defined type A pattern, with ileocolic artery (ICA) which lies in the anterior position in respect to the ileocolic vein (ICV). Authors also show an anomalous origin of the ileocolic vessels, which are more upper in respect to their standard position. Commonly, the ileocolic artery (ICA) lies posterior to the SMV (83%, type B). However, the ICA sometimes lies anteriorly to the SMV (17%, type A) [1]. The vascular system of the left colon has fewer variations in terms of position and origin, contrarily to the right colon. The most frequent variations of the inferior mesenteric artery (IMA) supply involve the division of the sigmoid arteries, as classified by Latarjet in two different types, depending on the anatomical relationship between the left colic and sigmoid arteries [3]. However, in this video authors show a rare case of IMA arising from the superior mesenteric artery [4].
References:
1. Milsom JW, Böhm B, Nakajima K. Laparoscopic Colorectal Surgery 2006, Springer.
2. Wu C, Ye K, Wu Y, Chen Q, Xu J, Lin J, Kang W. Variations in right colic vascular anatomy observed during laparoscopic right colectomy. World J Surg Oncol 2019;17:16.
3. Patroni A, Bonnet S, Bourillon C, Bruzzi M, Zinzindohoue F, Chevallier JM, Douard R, Berger A. Technical difficulties of left colic artery preservation during left colectomy for colon cancer. Surg Radiol Anat 2016;38:477-84.
4. Yoo SJ, Ku MJ, Cho SS, Yoon SP. A case of the inferior mesenteric artery arising from the superior mesenteric artery in a Korean woman. J Korean Med Sci 2011;26:1382-5.
Surgical technique of tubal reanastomosis
Many women who undergo tubal ligation surgery later decide to have children again. One option available to these women is tubal ligation reversal, or tubal reanastomosis. In this microsurgery, the two separated parts of a uterine tube are surgically reunited. It is ideally performed in younger women under 39 years of age with good ovarian reserve. Depending on the previously used tubal ligation method, it may be necessary to first perform a diagnostic laparoscopy to check the condition of the uterus, the uterine tubes, and the ovaries and to make sure that the tubal length is sufficient for reversal. Following the proper principles of microsurgery, this procedure can yield very good results and offer a more economical option to women desirous of childbearing if the tubal pathology related to tubal sterilization is the only cause of infertility.
H Grover, A Padmawar
Surgical intervention
8 months ago
3049 views
22 likes
0 comments
08:48
Surgical technique of tubal reanastomosis
Many women who undergo tubal ligation surgery later decide to have children again. One option available to these women is tubal ligation reversal, or tubal reanastomosis. In this microsurgery, the two separated parts of a uterine tube are surgically reunited. It is ideally performed in younger women under 39 years of age with good ovarian reserve. Depending on the previously used tubal ligation method, it may be necessary to first perform a diagnostic laparoscopy to check the condition of the uterus, the uterine tubes, and the ovaries and to make sure that the tubal length is sufficient for reversal. Following the proper principles of microsurgery, this procedure can yield very good results and offer a more economical option to women desirous of childbearing if the tubal pathology related to tubal sterilization is the only cause of infertility.
Robotic Nissen fundoplication with the da Vinci Xi robotic surgical system
For a long time, laparoscopic Nissen fundoplication has been used to treat gastroesophageal reflux disease (GERD). The main challenges of laparoscopic Nissen fundoplication involve the 2-dimensional visualization, exposure of complex gastroesophageal anatomy, and suturing of the wrap fundoplication. In 1999, robotic Nissen fundoplication, a completely new technique, was introduced, demonstrating advantages over conventional laparoscopic surgery due to improved manual dexterity, ergonomics, and 3-dimensional visualization. However, time spent on robotic platform docking and arm clashing during the procedure are factors that surgeons often find cumbersome and time-consuming. The newest surgical platform, the da Vinci Xi surgical robotic system, can help to overcome such problems. This video shows a stepwise approach of the da Vinci Xi docking process and surgical technique demonstrating fundoplication according to the Nissen technique.
L Marano, A Spaziani, G Castagnoli
Surgical intervention
1 year ago
1908 views
14 likes
0 comments
07:00
Robotic Nissen fundoplication with the da Vinci Xi robotic surgical system
For a long time, laparoscopic Nissen fundoplication has been used to treat gastroesophageal reflux disease (GERD). The main challenges of laparoscopic Nissen fundoplication involve the 2-dimensional visualization, exposure of complex gastroesophageal anatomy, and suturing of the wrap fundoplication. In 1999, robotic Nissen fundoplication, a completely new technique, was introduced, demonstrating advantages over conventional laparoscopic surgery due to improved manual dexterity, ergonomics, and 3-dimensional visualization. However, time spent on robotic platform docking and arm clashing during the procedure are factors that surgeons often find cumbersome and time-consuming. The newest surgical platform, the da Vinci Xi surgical robotic system, can help to overcome such problems. This video shows a stepwise approach of the da Vinci Xi docking process and surgical technique demonstrating fundoplication according to the Nissen technique.
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
2 years ago
5279 views
615 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.
Surgical approach to intragastric migrated hiatal mesh
Mesh use in the laparoscopic repair of hiatal hernia is associated with fewer recurrences. However, it may cause some complications such as dysphagia, stenosis or even erosion with esophageal or gastric migration.
A 61-year-old woman with a large type III hiatal hernia underwent a laparoscopic Toupet fundoplication with closure of the hiatal crura with a dual U-shaped mesh.
She was symptom-free for 1 year, subsequently developing dysphagia and weight loss. An esophagogastric barium test revealed minimal contrast passage and endoscopy showed partial intragastric mesh migration.
The patient was submitted to a laparoscopic removal of migrated mesh with a transgastric approach. Hiatus inspection demonstrated significant fibrosis, with plication integrity and no evidence of recurrent hernia. A gastrotomy was performed allowing to identify and remove a migrated intra-gastric mesh. Careful evaluation did not show any gastric fistula and pressure test with methylene blue showed no evidence of leak.
This unusual approach avoided hiatus dissection, decreasing the risks of local complications such as perforation and bleeding. The patient had no postoperative complications, recovered well, and remained asymptomatic.
A Trovão, L Costa, M Costa, R Ferreira de Almeida, M Nora
Surgical intervention
2 years ago
696 views
105 likes
0 comments
09:55
Surgical approach to intragastric migrated hiatal mesh
Mesh use in the laparoscopic repair of hiatal hernia is associated with fewer recurrences. However, it may cause some complications such as dysphagia, stenosis or even erosion with esophageal or gastric migration.
A 61-year-old woman with a large type III hiatal hernia underwent a laparoscopic Toupet fundoplication with closure of the hiatal crura with a dual U-shaped mesh.
She was symptom-free for 1 year, subsequently developing dysphagia and weight loss. An esophagogastric barium test revealed minimal contrast passage and endoscopy showed partial intragastric mesh migration.
The patient was submitted to a laparoscopic removal of migrated mesh with a transgastric approach. Hiatus inspection demonstrated significant fibrosis, with plication integrity and no evidence of recurrent hernia. A gastrotomy was performed allowing to identify and remove a migrated intra-gastric mesh. Careful evaluation did not show any gastric fistula and pressure test with methylene blue showed no evidence of leak.
This unusual approach avoided hiatus dissection, decreasing the risks of local complications such as perforation and bleeding. The patient had no postoperative complications, recovered well, and remained asymptomatic.
Transanal minimally invasive surgical anal canal polyp resection
Background: Endoscopic submucosal dissection (ESD) has been known for a long time. Recently, transanal minimally invasive surgery (TAMIS) started to be popularized and it can be used in front of difficult cases for ESD.

Video: A 36-year-old woman underwent a TAMIS resection, after unsuccessful ESD, for a 2cm polyp located anteriorly in the anal canal, just beside the pectineal line. Preoperative work-up showed a uT1m versus T1sm N0 M0 lesion. The patient was placed in a prone position with a split leg kneeling position. The procedure was performed with a new reusable transanal platform, a monocurved coagulating hook, and a grasping forceps. The mucosal flap was closed using two absorbable running sutures, a monocurved needle holder, and a grasping forceps.

Results: Operative time was 90 minutes, and perioperative bleeding was 20cc. No perioperative complications were noted, and the patient was discharged on postoperative day 1. Pathological findings showed a 2 by 1.3 by 0.5cm villotubular adenoma with high-grade dysplasia and free margins.

Conclusions: TAMIS anal canal polyp resection allows for a meticulous dissection under a magnified exposure of the operative field, with a final mucosal flap closure in adequate ergonomic conditions.
G Dapri
Surgical intervention
2 years ago
2244 views
103 likes
0 comments
05:13
Transanal minimally invasive surgical anal canal polyp resection
Background: Endoscopic submucosal dissection (ESD) has been known for a long time. Recently, transanal minimally invasive surgery (TAMIS) started to be popularized and it can be used in front of difficult cases for ESD.

Video: A 36-year-old woman underwent a TAMIS resection, after unsuccessful ESD, for a 2cm polyp located anteriorly in the anal canal, just beside the pectineal line. Preoperative work-up showed a uT1m versus T1sm N0 M0 lesion. The patient was placed in a prone position with a split leg kneeling position. The procedure was performed with a new reusable transanal platform, a monocurved coagulating hook, and a grasping forceps. The mucosal flap was closed using two absorbable running sutures, a monocurved needle holder, and a grasping forceps.

Results: Operative time was 90 minutes, and perioperative bleeding was 20cc. No perioperative complications were noted, and the patient was discharged on postoperative day 1. Pathological findings showed a 2 by 1.3 by 0.5cm villotubular adenoma with high-grade dysplasia and free margins.

Conclusions: TAMIS anal canal polyp resection allows for a meticulous dissection under a magnified exposure of the operative field, with a final mucosal flap closure in adequate ergonomic conditions.