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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
6 months ago
2900 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.
Principles of tubal surgery
This presentation focuses on the specific advantages of tubal surgery as compared to assisted reproductive techniques (ART).
Tubal surgery is a valid option in selected cases.
This selection is only possible through endoscopy and a precise knowledge of lesions is necessary. Three kinds of lesions have to be precisely known: pelvic adhesions and tubal lesions, either distal or proximal.
Nowadays, a special focus has to be made on subtle tubal lesions which were underestimated until recently.
Diagnosis and patient selection is a key factor and it is best achieved through transvaginal endoscopy such as fertiloscopy.
Even if today laparoscopy is the gold standard to treat tubal abnormalities, the principles of microsurgery which were defined a long time ago have to be strictly applied if one wants to get a pregnancy rate equivalent or superior to what is expected with in vitro fertilization (IVF).
A Watrelot
Lecture
4 years ago
1908 views
78 likes
0 comments
16:07
Principles of tubal surgery
This presentation focuses on the specific advantages of tubal surgery as compared to assisted reproductive techniques (ART).
Tubal surgery is a valid option in selected cases.
This selection is only possible through endoscopy and a precise knowledge of lesions is necessary. Three kinds of lesions have to be precisely known: pelvic adhesions and tubal lesions, either distal or proximal.
Nowadays, a special focus has to be made on subtle tubal lesions which were underestimated until recently.
Diagnosis and patient selection is a key factor and it is best achieved through transvaginal endoscopy such as fertiloscopy.
Even if today laparoscopy is the gold standard to treat tubal abnormalities, the principles of microsurgery which were defined a long time ago have to be strictly applied if one wants to get a pregnancy rate equivalent or superior to what is expected with in vitro fertilization (IVF).
Laparoscopic tubo-cornual anastomosis for reversal of sterilization
This video shows a case of tubo-cornual anastomosis for reversal after tubal sterilization. A 43-year-old patient has requested a reversal of sterilization. She already had 4 deliveries. On the hysterosalpingography, one can see that Hulka clips are really near the uterine horns.
The video demonstrates the removal of Hulka clips, the dissection of the interstitial part of the tube, the catheterization of a guide through the ostium in the proximal, then distal part of the tube hysteroscopically, and finally a tubo-cornual anastomosis. In our opinion, the quality of the anastomosis directly depends on the complete congruence of the two tubal stumps. Different prognostic factors have been discussed in previous studies (e.g., age, type of sterilization (clips or coagulation), length of remaining tube, and site of anastomosis). According to the literature, the best anastomotic site, in terms of successful pregnancy, would be the isthmic-isthmic position. In our experience, the use of a tubal hysteroscopic guide seems the best aid to obtain a luminal alignment and it is more comfortable for the suture.
O Garbin, L Schwartz
Surgical intervention
4 years ago
2858 views
108 likes
0 comments
08:01
Laparoscopic tubo-cornual anastomosis for reversal of sterilization
This video shows a case of tubo-cornual anastomosis for reversal after tubal sterilization. A 43-year-old patient has requested a reversal of sterilization. She already had 4 deliveries. On the hysterosalpingography, one can see that Hulka clips are really near the uterine horns.
The video demonstrates the removal of Hulka clips, the dissection of the interstitial part of the tube, the catheterization of a guide through the ostium in the proximal, then distal part of the tube hysteroscopically, and finally a tubo-cornual anastomosis. In our opinion, the quality of the anastomosis directly depends on the complete congruence of the two tubal stumps. Different prognostic factors have been discussed in previous studies (e.g., age, type of sterilization (clips or coagulation), length of remaining tube, and site of anastomosis). According to the literature, the best anastomotic site, in terms of successful pregnancy, would be the isthmic-isthmic position. In our experience, the use of a tubal hysteroscopic guide seems the best aid to obtain a luminal alignment and it is more comfortable for the suture.
Laparoscopic transhiatal esophagectomy with Akiyama tube reconstruction for a terminal achalasia
Introduction: Idiopathic achalasia is the most frequent esophageal motility disorder. Generally, treatment is the "palliation" of symptoms and improvement in quality of life. Although Heller myotomy is the standard treatment, achieving good results in 90 to 95% of cases, esophagectomy is required in 5 to 10% of cases.
The authors present a case of a laparoscopic transhiatal esophagectomy with Akiyama tube reconstruction in a woman with long-term achalasia and megaesophagus.
Clinical case: A 54-year-old woman, with a previous history of a "psychological eating disorder", was referred to the Emergency Department. She complained of epigastric pain and dysphagia. A thoraco-abdominal CT-scan was requested and revealed a dilated, tortuous, sigmoid esophagus, filled with food content, with no identifiable mass causing obstruction. The patient was admitted to hospital and further study was performed --esophagogastroscopy and esophageal manometry - which confirmed the diagnosis of achalasia with esophageal aperistalses.
The patient was proposed a laparoscopic transhiatal esophagectomy with Akiyama tube reconstruction.
No complications were reported in the postoperative period, and discharge was possible on postoperative day 7. Six months later, an esophagram showed adequate contrast passage and progression.
Discussion/Conclusion: Esophagectomy as a primary treatment of achalasia might be considered if severe symptomatic (dysphagia, regurgitation), anatomical (megaesophagus) or functional (esophagus aperistalses) disorders are contraindications to a more conservative approach.
AM Pereira, J Magalhães, R Ferreira de Almeida, G Gonçalves, M Nora
Surgical intervention
2 years ago
3817 views
291 likes
0 comments
09:29
Laparoscopic transhiatal esophagectomy with Akiyama tube reconstruction for a terminal achalasia
Introduction: Idiopathic achalasia is the most frequent esophageal motility disorder. Generally, treatment is the "palliation" of symptoms and improvement in quality of life. Although Heller myotomy is the standard treatment, achieving good results in 90 to 95% of cases, esophagectomy is required in 5 to 10% of cases.
The authors present a case of a laparoscopic transhiatal esophagectomy with Akiyama tube reconstruction in a woman with long-term achalasia and megaesophagus.
Clinical case: A 54-year-old woman, with a previous history of a "psychological eating disorder", was referred to the Emergency Department. She complained of epigastric pain and dysphagia. A thoraco-abdominal CT-scan was requested and revealed a dilated, tortuous, sigmoid esophagus, filled with food content, with no identifiable mass causing obstruction. The patient was admitted to hospital and further study was performed --esophagogastroscopy and esophageal manometry - which confirmed the diagnosis of achalasia with esophageal aperistalses.
The patient was proposed a laparoscopic transhiatal esophagectomy with Akiyama tube reconstruction.
No complications were reported in the postoperative period, and discharge was possible on postoperative day 7. Six months later, an esophagram showed adequate contrast passage and progression.
Discussion/Conclusion: Esophagectomy as a primary treatment of achalasia might be considered if severe symptomatic (dysphagia, regurgitation), anatomical (megaesophagus) or functional (esophagus aperistalses) disorders are contraindications to a more conservative approach.
Large vessels: what is the robot's place in vascular surgery?
Since 2006, our vascular surgery team has developed an original program in the field of minimally invasive aortic surgery; for all cases of aortic disease unsuitable for endovascular treatment, we propose an alternative way to open surgery: using the da Vinci® surgical robotic system to perform aorto-aortic, aortobi-iliac and aorto-bifemoral bypasses, in more than 95 patients to date.

Contrarily to laparoscopy, the robot provides operating conditions, namely more comfort with a 3D vision, and operative steps very similar to open surgery. These key points account for a learning curve that is shorter than laparoscopy for aortic procedures.

For the first time in the literature, the robot was used by our team to perform the entire procedure including the retroperitoneal approach, aortic exposure, and the prosthetic suture.

We respect TASC recommendations for revascularizations by aorto-bifemoral bypasses, and surgery is always decided upon after failure of endovascular treatment.

For aneurysms, robotic surgery is proposed if the case is not suitable for endograft, and after informed patient consent.

The new design of the operating room with the robot, the training of the surgical team, the original design of the technique with placement of robotic ports, explain a mean operative time exceeding 6 hours, and a conversion rate with mini-lumbotomy of 30% of our learning curve in the first 30 cases. Currently, we treat more than 20 patients per year, with an average operative time of less than 5 hours, and with only 5% of surgical conversions by mini-lumbotomies. The progression of technology now allows us to clamp the suprarenal aorta and to perform cases of aneurysms with tubes or bifurcated grafts if we need to go on the primitive iliac arteries.

Our clinical results show a primary patency rate of 96% at the first year, 94% at the third year, and 86% at the fifth year. No postoperative death was related to the aortic pathology, the mortality rate was 96% at the first year, 83% at the third year, and 76% at the fifth year.

In addition, new surgical indications provide the opportunity to use the da Vinci® robot to deal with complex arterial disease: our team was able to treat cases of splenic aneurysms, with direct arterial reconstructions, arterial sutures performed entirely with the robot.

Our experience shows that arterial surgery for large vessels is entirely feasible with the da Vinci® robot. This opens valuable future perspectives, which will depend on the improvement of surgical robotic systems available.
F Thaveau
Lecture
5 years ago
182 views
1 like
0 comments
09:41
Large vessels: what is the robot's place in vascular surgery?
Since 2006, our vascular surgery team has developed an original program in the field of minimally invasive aortic surgery; for all cases of aortic disease unsuitable for endovascular treatment, we propose an alternative way to open surgery: using the da Vinci® surgical robotic system to perform aorto-aortic, aortobi-iliac and aorto-bifemoral bypasses, in more than 95 patients to date.

Contrarily to laparoscopy, the robot provides operating conditions, namely more comfort with a 3D vision, and operative steps very similar to open surgery. These key points account for a learning curve that is shorter than laparoscopy for aortic procedures.

For the first time in the literature, the robot was used by our team to perform the entire procedure including the retroperitoneal approach, aortic exposure, and the prosthetic suture.

We respect TASC recommendations for revascularizations by aorto-bifemoral bypasses, and surgery is always decided upon after failure of endovascular treatment.

For aneurysms, robotic surgery is proposed if the case is not suitable for endograft, and after informed patient consent.

The new design of the operating room with the robot, the training of the surgical team, the original design of the technique with placement of robotic ports, explain a mean operative time exceeding 6 hours, and a conversion rate with mini-lumbotomy of 30% of our learning curve in the first 30 cases. Currently, we treat more than 20 patients per year, with an average operative time of less than 5 hours, and with only 5% of surgical conversions by mini-lumbotomies. The progression of technology now allows us to clamp the suprarenal aorta and to perform cases of aneurysms with tubes or bifurcated grafts if we need to go on the primitive iliac arteries.

Our clinical results show a primary patency rate of 96% at the first year, 94% at the third year, and 86% at the fifth year. No postoperative death was related to the aortic pathology, the mortality rate was 96% at the first year, 83% at the third year, and 76% at the fifth year.

In addition, new surgical indications provide the opportunity to use the da Vinci® robot to deal with complex arterial disease: our team was able to treat cases of splenic aneurysms, with direct arterial reconstructions, arterial sutures performed entirely with the robot.

Our experience shows that arterial surgery for large vessels is entirely feasible with the da Vinci® robot. This opens valuable future perspectives, which will depend on the improvement of surgical robotic systems available.
Transvaginal laparoscopy: subtle lesions and infertility
Transvaginal laparoscopy is performed as a simple needle puncture technique of the pouch of Douglas in patients without an obvious pelvic pathology. An obliterated pouch of Douglas and acute situations such as bleeding and infections are contraindications. As a distension medium, a watery solution such as Ringer lactate is used. This keeps organs afloat. Without extra manipulation, ovaries and tubes can be inspected in their natural position. In absence of a high intra-abdominal pressure as in standard laparoscopy, subtle lesions are not masked but become clearly visible due to the watery distension medium. The transvaginal approach also provides easy access to perform a salpingoscopy and allows the detection of subtle tubal mucosal lesions. The technique allows early detection of peritoneal and ovarian endometriosis with the possibility of early treatment.
S Gordts
Lecture
5 years ago
816 views
27 likes
0 comments
23:35
Transvaginal laparoscopy: subtle lesions and infertility
Transvaginal laparoscopy is performed as a simple needle puncture technique of the pouch of Douglas in patients without an obvious pelvic pathology. An obliterated pouch of Douglas and acute situations such as bleeding and infections are contraindications. As a distension medium, a watery solution such as Ringer lactate is used. This keeps organs afloat. Without extra manipulation, ovaries and tubes can be inspected in their natural position. In absence of a high intra-abdominal pressure as in standard laparoscopy, subtle lesions are not masked but become clearly visible due to the watery distension medium. The transvaginal approach also provides easy access to perform a salpingoscopy and allows the detection of subtle tubal mucosal lesions. The technique allows early detection of peritoneal and ovarian endometriosis with the possibility of early treatment.
Thoracoscopic management of empyema
From the mid-1990s, thoracoscopic treatment of empyemas has gained a wide acceptance. Potential advantages of video-assisted thoracoscopic surgery (VATS) include improved visualization, less surgical trauma and improved quality of life. VATS was initially used in early stage empyema to debride purulent collections and resect fibrin septae that failed to resolve with antibiotics and chest tube drainage (with or without fibrinolytic therapy).
The goals of the thoracoscopic treatment of empyema are as follows: 1) the debridement of purulent collections and fibrin, 2) the evacuation of necrotic material, 3) the breakdown of loculations, 4) to obtain adequate lung re-expansion, and 5) optimal chest tube placement for drainage.
Several reports have demonstrated that VATS debridement is a valid treatment option for stage II empyema, which allows an appropriate control of infection and a complete restoration of pulmonary function in early stage empyemas. Formal exclusion criteria for a primary VATS approach are suspicion of lung abscess, bronchopleural fistula, tumor at initial work-up or the need of muscle flaps with or without thoracoplasty. Presumed stage III empyema with pleural thickening and signs of restriction on CT-scan no longer are formal contraindications, but the conversion rate to decortications via thoracotomy is higher.
M Gonzalez, JY Perentes, T Krueger
Surgical intervention
6 years ago
3204 views
105 likes
0 comments
07:09
Thoracoscopic management of empyema
From the mid-1990s, thoracoscopic treatment of empyemas has gained a wide acceptance. Potential advantages of video-assisted thoracoscopic surgery (VATS) include improved visualization, less surgical trauma and improved quality of life. VATS was initially used in early stage empyema to debride purulent collections and resect fibrin septae that failed to resolve with antibiotics and chest tube drainage (with or without fibrinolytic therapy).
The goals of the thoracoscopic treatment of empyema are as follows: 1) the debridement of purulent collections and fibrin, 2) the evacuation of necrotic material, 3) the breakdown of loculations, 4) to obtain adequate lung re-expansion, and 5) optimal chest tube placement for drainage.
Several reports have demonstrated that VATS debridement is a valid treatment option for stage II empyema, which allows an appropriate control of infection and a complete restoration of pulmonary function in early stage empyemas. Formal exclusion criteria for a primary VATS approach are suspicion of lung abscess, bronchopleural fistula, tumor at initial work-up or the need of muscle flaps with or without thoracoplasty. Presumed stage III empyema with pleural thickening and signs of restriction on CT-scan no longer are formal contraindications, but the conversion rate to decortications via thoracotomy is higher.
Occurrence of a rare complication during laparoscopic sleeve gastrectomy
Nowadays, sleeve gastrectomy is a common procedure frequently performed laparoscopically in the management of morbid obesity. This intervention as proven to be efficient in comparison to laparoscopic Roux-en-Y gastric bypass (LRYGB) regarding weight loss and revision of obesity-related co-morbidities such as diabetes mellitus and high blood pressure. Today, in France, selection of the surgical technique (e.g., sleeve gastrectomy, LRYGB) depends on the patient should preoperative work-up be strictly normal. If not, the surgeon will have to make a decision as to which technique should be used. Postoperative complications related to bariatric surgery are currently well-known (fistula, bleeding, abscess) and are managed in a multidisciplinary way by radiologists, endoscopists and surgeons. Here, we present the case of a rare perioperative complication related to the incidental stapling of the nasogastric tube during gastric division. This complication mainly highlights shortcomings in the interaction between the surgical team and anesthesiologists during placement and retrieval of calibration and nasogastric tubes. In the present case, this complication was immediately demonstrated and it was managed laparoscopically.
L Marx, M Vix, J Marescaux
Surgical intervention
6 years ago
2958 views
26 likes
0 comments
08:29
Occurrence of a rare complication during laparoscopic sleeve gastrectomy
Nowadays, sleeve gastrectomy is a common procedure frequently performed laparoscopically in the management of morbid obesity. This intervention as proven to be efficient in comparison to laparoscopic Roux-en-Y gastric bypass (LRYGB) regarding weight loss and revision of obesity-related co-morbidities such as diabetes mellitus and high blood pressure. Today, in France, selection of the surgical technique (e.g., sleeve gastrectomy, LRYGB) depends on the patient should preoperative work-up be strictly normal. If not, the surgeon will have to make a decision as to which technique should be used. Postoperative complications related to bariatric surgery are currently well-known (fistula, bleeding, abscess) and are managed in a multidisciplinary way by radiologists, endoscopists and surgeons. Here, we present the case of a rare perioperative complication related to the incidental stapling of the nasogastric tube during gastric division. This complication mainly highlights shortcomings in the interaction between the surgical team and anesthesiologists during placement and retrieval of calibration and nasogastric tubes. In the present case, this complication was immediately demonstrated and it was managed laparoscopically.
Robotic assisted thymectomy for the management of autoimmune myasthenia gravis
We present the case of a 16-year-old female patient who has had an autoimmune myasthenia gravis for 8 months.

Symptoms are generalized to her four arms. Anti-acetylcholine antibodies and the therapeutic test of Mestinon® (Pyridostigmine) are positive.
In recent months, her symptoms worsened with the onset of swallowing disorders.

Immunoglobulin treatment was poorly effective and was complicated by the appearance of jaundice. CT-scan showed a mediastinal thymic hyperplasia.
Thymectomy is indicated. To do so, a left thoracoscopy is performed and assisted by means of the Da Vinci™ robot.

Pathological findings demonstrated the presence of a lymphoid thymic hyperplasia.

The use of the Da Vinci® robot for this type of intervention has been recognized many years ago now with the works of Federico Rea and Jens Ruckert among others. The advantage of this technique is the possibility to proceed with a radical thymectomy enlarged to the mediastinal fat exactly in the same way as for a median sternotomy, which is the standard technique. When compared to thoracoscopy, the advantage stems from 3D vision, segmentation of the operator’s movements, and exceptional maneuverability of the instruments which have 7 degrees of freedom. These instruments allow for an access to the lower cervical area without the use of a cervicotomy. The choice of the left side is explained by the need to identify the phrenic nerve’s position, which is more difficult to predict than the right nerve’s position, which can be easily identified on the right lateral aspect of the superior vena cava.
N Santelmo, A Olland
Surgical intervention
6 years ago
1859 views
23 likes
0 comments
11:26
Robotic assisted thymectomy for the management of autoimmune myasthenia gravis
We present the case of a 16-year-old female patient who has had an autoimmune myasthenia gravis for 8 months.

Symptoms are generalized to her four arms. Anti-acetylcholine antibodies and the therapeutic test of Mestinon® (Pyridostigmine) are positive.
In recent months, her symptoms worsened with the onset of swallowing disorders.

Immunoglobulin treatment was poorly effective and was complicated by the appearance of jaundice. CT-scan showed a mediastinal thymic hyperplasia.
Thymectomy is indicated. To do so, a left thoracoscopy is performed and assisted by means of the Da Vinci™ robot.

Pathological findings demonstrated the presence of a lymphoid thymic hyperplasia.

The use of the Da Vinci® robot for this type of intervention has been recognized many years ago now with the works of Federico Rea and Jens Ruckert among others. The advantage of this technique is the possibility to proceed with a radical thymectomy enlarged to the mediastinal fat exactly in the same way as for a median sternotomy, which is the standard technique. When compared to thoracoscopy, the advantage stems from 3D vision, segmentation of the operator’s movements, and exceptional maneuverability of the instruments which have 7 degrees of freedom. These instruments allow for an access to the lower cervical area without the use of a cervicotomy. The choice of the left side is explained by the need to identify the phrenic nerve’s position, which is more difficult to predict than the right nerve’s position, which can be easily identified on the right lateral aspect of the superior vena cava.
Video-assisted thoracoscopic (VATS) lobectomy: left upper lobe
Standard treatment of early stage non-small cell lung cancer involves anatomic pulmonary lobectomy and mediastinal lymph node dissection. Traditionally, this procedure has been carried out via a posterior lateral thoracotomy, requiring division of chest wall muscles and rib spreading. This is frequently associated with chronic postoperative pain, which may become incapacitating in 5% of patients.
One of the major potential advantages of video-assisted thoracoscopic (VATS) lobectomy is decreasing the incidence of chronic post-thoracotomy pain.

Key aspects of the procedure include:
Proper patient positioning:
- access to the pleural cavity and appropriate positioning of operating incisions*;
- careful dissection of pulmonary arterial branches, using a “fissure-sparing” technique whenever possible to decrease the incidence of prolonged postoperative air-leaks;
- division of lung parenchyma, blood vessels, and bronchus using endoscopic staplers.

The VATS approach can be carried out with similar morbidity and similar oncologic outcome to traditional open surgery. We present VATS lobectomy for an adenocarcinoma of the left upper lobe in a 66-year-old patient (the video emphasizes the steps of lobe resection – complete mediastinal lymph node dissection was effected but is not shown).

Acknowledgment: we would like to thank Nathalie Leroux RN and Suzanne Desbiens RN for their continued support.
G Rakovich
Surgical intervention
7 years ago
3444 views
21 likes
0 comments
10:02
Video-assisted thoracoscopic (VATS) lobectomy: left upper lobe
Standard treatment of early stage non-small cell lung cancer involves anatomic pulmonary lobectomy and mediastinal lymph node dissection. Traditionally, this procedure has been carried out via a posterior lateral thoracotomy, requiring division of chest wall muscles and rib spreading. This is frequently associated with chronic postoperative pain, which may become incapacitating in 5% of patients.
One of the major potential advantages of video-assisted thoracoscopic (VATS) lobectomy is decreasing the incidence of chronic post-thoracotomy pain.

Key aspects of the procedure include:
Proper patient positioning:
- access to the pleural cavity and appropriate positioning of operating incisions*;
- careful dissection of pulmonary arterial branches, using a “fissure-sparing” technique whenever possible to decrease the incidence of prolonged postoperative air-leaks;
- division of lung parenchyma, blood vessels, and bronchus using endoscopic staplers.

The VATS approach can be carried out with similar morbidity and similar oncologic outcome to traditional open surgery. We present VATS lobectomy for an adenocarcinoma of the left upper lobe in a 66-year-old patient (the video emphasizes the steps of lobe resection – complete mediastinal lymph node dissection was effected but is not shown).

Acknowledgment: we would like to thank Nathalie Leroux RN and Suzanne Desbiens RN for their continued support.
Pure NOTES: Transvaginal tubal sterilization with flexible endoscope
Tubal sterilization is a permanent method of contraception, performed using several current approaches, including laparotomy, mini-laparotomy, colpotomy, laparoscopy and hysteroscopy. Two new approaches, LESS and transgastric or transvaginal NOTES, are being used today. This video shows our surgical technique for pure NOTES transvaginal sterilization. Tubal sterilization is a permanent method of contraception, performed using several current approaches, including laparotomy, mini-laparotomy, colpotomy, laparoscopy and hysteroscopy. Two new approaches, LESS and transgastric or transvaginal NOTES, are being used today. This video shows our surgical technique for pure NOTES transvaginal sterilization. The patient is 32 years old with a history of one previous vaginal delivery and one previous cesarean delivery. Her BMI is 20. The procedure was fully explained to the patient and written consent was obtained.
J Mejías, H Almau, P Rosales, R de la Fuente, N García, C Bravo
Surgical intervention
8 years ago
462 views
13 likes
0 comments
07:05
Pure NOTES: Transvaginal tubal sterilization with flexible endoscope
Tubal sterilization is a permanent method of contraception, performed using several current approaches, including laparotomy, mini-laparotomy, colpotomy, laparoscopy and hysteroscopy. Two new approaches, LESS and transgastric or transvaginal NOTES, are being used today. This video shows our surgical technique for pure NOTES transvaginal sterilization. Tubal sterilization is a permanent method of contraception, performed using several current approaches, including laparotomy, mini-laparotomy, colpotomy, laparoscopy and hysteroscopy. Two new approaches, LESS and transgastric or transvaginal NOTES, are being used today. This video shows our surgical technique for pure NOTES transvaginal sterilization. The patient is 32 years old with a history of one previous vaginal delivery and one previous cesarean delivery. Her BMI is 20. The procedure was fully explained to the patient and written consent was obtained.
Completely thoracoscopic segmentectomy: apical segment, right upper lobe
Standard treatment of early-stage non-small cell lung cancer involves anatomic pulmonary lobectomy and mediastinal lymph node dissection. In patients with compromised lung function, anatomic segmentectomy may be an acceptable alternative to lobectomy. Traditionally, this procedure has been carried out via postero-lateral thoracotomy, requiring division of chest wall muscles and rib spreading. This is frequently associated with disturbed respiratory mechanics in the postoperative period, as well as chronic postoperative pain which may become incapacitating in 5% of patients.
One of the major potential advantages of thoracoscopic approaches is decreasing the incidence of post-thoracotomy pain.
Key aspects of thoracoscopic segmentectomy include:
Proper patient positioning.
Access to the pleural cavity and appropriate positioning of operating incisions.
Careful dissection of segmental branches of the pulmonary artery and bronchus.
Division of blood vessels and bronchus using endoscopic staplers.
Division of lung parenchyma along intersegmental planes.

The thoracoscopic approach can be carried out with similar morbidity and similar oncologic outcome to traditional open surgery. We present a completely thoracoscopic resection of the apical segment of the right upper lobe for a small T1 adenocarcinoma in a 78-year-old patient. The video emphasizes the steps of segmental resection —mediastinal lymph node dissection was effected but is not shown.

Acknowledgment: we would like to thank Nathalie Leroux RN, Francine Martin RN, and Mélodie Leclerc RN for their continued support. Additionally, the figure used to illustrate the positioning of operating incisions was adapted with permission from: «Handbook of perioperative care in general thoracic surgery», Deslauriers J, Mehran R, eds. Positioning and incisions, pages 206-227, fig 5-19, Copyright Elsevier, 2005.
G Rakovich, J Forcillo, D Ouellette, G Beauchamp
Surgical intervention
8 years ago
655 views
22 likes
0 comments
09:44
Completely thoracoscopic segmentectomy: apical segment, right upper lobe
Standard treatment of early-stage non-small cell lung cancer involves anatomic pulmonary lobectomy and mediastinal lymph node dissection. In patients with compromised lung function, anatomic segmentectomy may be an acceptable alternative to lobectomy. Traditionally, this procedure has been carried out via postero-lateral thoracotomy, requiring division of chest wall muscles and rib spreading. This is frequently associated with disturbed respiratory mechanics in the postoperative period, as well as chronic postoperative pain which may become incapacitating in 5% of patients.
One of the major potential advantages of thoracoscopic approaches is decreasing the incidence of post-thoracotomy pain.
Key aspects of thoracoscopic segmentectomy include:
Proper patient positioning.
Access to the pleural cavity and appropriate positioning of operating incisions.
Careful dissection of segmental branches of the pulmonary artery and bronchus.
Division of blood vessels and bronchus using endoscopic staplers.
Division of lung parenchyma along intersegmental planes.

The thoracoscopic approach can be carried out with similar morbidity and similar oncologic outcome to traditional open surgery. We present a completely thoracoscopic resection of the apical segment of the right upper lobe for a small T1 adenocarcinoma in a 78-year-old patient. The video emphasizes the steps of segmental resection —mediastinal lymph node dissection was effected but is not shown.

Acknowledgment: we would like to thank Nathalie Leroux RN, Francine Martin RN, and Mélodie Leclerc RN for their continued support. Additionally, the figure used to illustrate the positioning of operating incisions was adapted with permission from: «Handbook of perioperative care in general thoracic surgery», Deslauriers J, Mehran R, eds. Positioning and incisions, pages 206-227, fig 5-19, Copyright Elsevier, 2005.
Video-assisted thoracoscopic (VATS) lobectomy: right upper lobe
Standard treatment of early-stage non-small cell lung cancer involves anatomic pulmonary lobectomy and mediastinal lymph node dissection. Traditionally, this procedure has been carried out via posterolateral thoracotomy, requiring division of chest wall muscles and rib spreading. This is frequently associated with chronic postoperative pain, which may become incapacitating in 5% of patients.

One of the major potential advantages of video-assisted thoracoscopic (VATS) lobectomy is decreasing the incidence of chronic post-thoracotomy pain.

Key aspects of the procedure include:
- proper patient positioning;
- access to the pleural cavity and appropriate positioning of operating incisions*;
- careful dissection of pulmonary arterial branches, using a “fissure-sparing” technique whenever possible to decrease the incidence of prolonged postoperative air leaks;
- division of lung parenchyma, blood vessels, and bronchus using endoscopic staplers.

The VATS approach can be carried out with similar morbidity and similar oncologic outcome to traditional open surgery. We present VATS lobectomy for neuro-endocrine carcinoma of the right upper lobe in a 71-year-old patient (the video emphasizes the steps of lobe resection —mediastinal lymph node dissection was effected, but is not shown).
Acknowledgment: we would like to thank Nathalie Leroux RN, Francine Martin RN, and Mélodie Leclerc RN for their continued support.
*The figure used to illustrate the positioning of operating incisions was adapted with permission from: «Handbook of perioperative care in general thoracic surgery», Deslauriers J, Mehran R, eds. Positioning and incisions, pages 206-227, fig 5-19, Copyright Elsevier, 2005.
G Rakovich, D Ouellette, G Beauchamp
Surgical intervention
8 years ago
798 views
93 likes
0 comments
08:01
Video-assisted thoracoscopic (VATS) lobectomy: right upper lobe
Standard treatment of early-stage non-small cell lung cancer involves anatomic pulmonary lobectomy and mediastinal lymph node dissection. Traditionally, this procedure has been carried out via posterolateral thoracotomy, requiring division of chest wall muscles and rib spreading. This is frequently associated with chronic postoperative pain, which may become incapacitating in 5% of patients.

One of the major potential advantages of video-assisted thoracoscopic (VATS) lobectomy is decreasing the incidence of chronic post-thoracotomy pain.

Key aspects of the procedure include:
- proper patient positioning;
- access to the pleural cavity and appropriate positioning of operating incisions*;
- careful dissection of pulmonary arterial branches, using a “fissure-sparing” technique whenever possible to decrease the incidence of prolonged postoperative air leaks;
- division of lung parenchyma, blood vessels, and bronchus using endoscopic staplers.

The VATS approach can be carried out with similar morbidity and similar oncologic outcome to traditional open surgery. We present VATS lobectomy for neuro-endocrine carcinoma of the right upper lobe in a 71-year-old patient (the video emphasizes the steps of lobe resection —mediastinal lymph node dissection was effected, but is not shown).
Acknowledgment: we would like to thank Nathalie Leroux RN, Francine Martin RN, and Mélodie Leclerc RN for their continued support.
*The figure used to illustrate the positioning of operating incisions was adapted with permission from: «Handbook of perioperative care in general thoracic surgery», Deslauriers J, Mehran R, eds. Positioning and incisions, pages 206-227, fig 5-19, Copyright Elsevier, 2005.
Video-assisted thoracoscopic (VATS) lobectomy: right lower lobe
Standard treatment of early-stage non-small cell lung cancer involves anatomic pulmonary lobectomy and mediastinal lymph node dissection. Traditionally, this procedure has been carried out via postero-lateral thoracotomy, requiring division of chest wall muscles and rib spreading. This is frequently associated with chronic postoperative pain, which may become incapacitating in 5% of patients.
One of the major potential advantages of video-assisted thoracoscopic (VATS) lobectomy is decreasing the incidence of chronic post-thoracotomy pain.
Key aspects of the procedure include:
- proper patient positioning;
- access to the pleural cavity and appropriate positioning of operating incisions*;
- careful dissection of pulmonary arterial branches, using a “fissure-sparing” technique whenever possible to decrease the incidence of prolonged postoperative air-leaks;
- division of lung parenchyma, blood vessels, and bronchus using endoscopic staplers.
The VATS approach can be carried out with similar morbidity and similar oncologic outcome to traditional open surgery. We present VATS lobectomy for adenocarcinoma of the right lower lobe in a 78-year-old patient (the video emphasizes the steps of lobe resection - mediastinal lymph node dissection was effected but is not shown).
Acknowledgment: we would like to thank Nathalie Leroux RN, Francine Girard RN, and Mélodie Leclerc RN for their continued support.

*The figure used to illustrate the positioning of operating incisions was adapted with permission from: «Handbook of perioperative care in general thoracic surgery», Deslauriers J, Mehran R, eds. Positioning and incisions, pages 206-227, fig 5-19, Copyright Elsevier, 2005.
G Rakovich, D Ouellette, G Beauchamp
Surgical intervention
8 years ago
984 views
40 likes
0 comments
09:56
Video-assisted thoracoscopic (VATS) lobectomy: right lower lobe
Standard treatment of early-stage non-small cell lung cancer involves anatomic pulmonary lobectomy and mediastinal lymph node dissection. Traditionally, this procedure has been carried out via postero-lateral thoracotomy, requiring division of chest wall muscles and rib spreading. This is frequently associated with chronic postoperative pain, which may become incapacitating in 5% of patients.
One of the major potential advantages of video-assisted thoracoscopic (VATS) lobectomy is decreasing the incidence of chronic post-thoracotomy pain.
Key aspects of the procedure include:
- proper patient positioning;
- access to the pleural cavity and appropriate positioning of operating incisions*;
- careful dissection of pulmonary arterial branches, using a “fissure-sparing” technique whenever possible to decrease the incidence of prolonged postoperative air-leaks;
- division of lung parenchyma, blood vessels, and bronchus using endoscopic staplers.
The VATS approach can be carried out with similar morbidity and similar oncologic outcome to traditional open surgery. We present VATS lobectomy for adenocarcinoma of the right lower lobe in a 78-year-old patient (the video emphasizes the steps of lobe resection - mediastinal lymph node dissection was effected but is not shown).
Acknowledgment: we would like to thank Nathalie Leroux RN, Francine Girard RN, and Mélodie Leclerc RN for their continued support.

*The figure used to illustrate the positioning of operating incisions was adapted with permission from: «Handbook of perioperative care in general thoracic surgery», Deslauriers J, Mehran R, eds. Positioning and incisions, pages 206-227, fig 5-19, Copyright Elsevier, 2005.
Laparoscopic myomectomy: tips 'n tricks
Surgery is the treatment of choice for myomas. Myomectomy has undergone a dramatic evolution over the years. Laparoscopic myomectomy provides a preferable alternative to abdominal myomectomy for women with symptomatic fibroids who desire uterine preservation. It is also an excellent method for women who have infertility primarily related to fibroids. A lot of patients prefer myomectomy over hysterectomy even if they do not desire pregnancy. However, laparoscopic myomectomy is not easy and needs some practice. Together with the basic steps, some tips and tricks are provided to make this technique even more safe and feasible for surgeons. For good results, the use of a few technical tricks provides an optimal solution for all issues.
A Wattiez, P Trompoukis, AM Furtado Lima, J Nassif, B Gabriel
Surgical intervention
8 years ago
10073 views
192 likes
0 comments
08:35
Laparoscopic myomectomy: tips 'n tricks
Surgery is the treatment of choice for myomas. Myomectomy has undergone a dramatic evolution over the years. Laparoscopic myomectomy provides a preferable alternative to abdominal myomectomy for women with symptomatic fibroids who desire uterine preservation. It is also an excellent method for women who have infertility primarily related to fibroids. A lot of patients prefer myomectomy over hysterectomy even if they do not desire pregnancy. However, laparoscopic myomectomy is not easy and needs some practice. Together with the basic steps, some tips and tricks are provided to make this technique even more safe and feasible for surgeons. For good results, the use of a few technical tricks provides an optimal solution for all issues.