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Right laparoscopic ureteroureteroplasty
Lower ureteral strictures are commonly managed with ureteral reimplant surgeries. However, some patients still have a good distal ureteral stump, which can be used in the repair of these pathologies. In those cases, reimplant ureteral surgeries and their surgical maneuvers, e.g. psoas hitch, Boari flap, are not the best management options.
This video shows a ureteroureteroplasty in a 37-year-old female patient with ureteral stricture at the level of the crossing iliac vessels due to several previous endoscopic manipulations for the treatment of ureteral/kidney stones.
The ureteroureteroplasty technique was chosen since the proximal and distal parts of the ureter near the stenosed area were healthy.
At the end of the video, preoperative MRI and 1-year follow-up CT urogram 3D reconstructions are placed side by side, demonstrating the resolution of hydronephrosis.
B Lopes-Cançado Machado, V Chamum Costa
Surgical intervention
1 year ago
2604 views
5 likes
0 comments
08:39
Right laparoscopic ureteroureteroplasty
Lower ureteral strictures are commonly managed with ureteral reimplant surgeries. However, some patients still have a good distal ureteral stump, which can be used in the repair of these pathologies. In those cases, reimplant ureteral surgeries and their surgical maneuvers, e.g. psoas hitch, Boari flap, are not the best management options.
This video shows a ureteroureteroplasty in a 37-year-old female patient with ureteral stricture at the level of the crossing iliac vessels due to several previous endoscopic manipulations for the treatment of ureteral/kidney stones.
The ureteroureteroplasty technique was chosen since the proximal and distal parts of the ureter near the stenosed area were healthy.
At the end of the video, preoperative MRI and 1-year follow-up CT urogram 3D reconstructions are placed side by side, demonstrating the resolution of hydronephrosis.
Laparoscopic right colectomy for caecal cancer with prophylactic lighted ureteral stenting (LUS)
Identifying the ureter during colorectal surgery (CRS) is one of the most critical steps of the operation. Iatrogenic ureteral injury occurs very rarely, with an incidence ranging from 0.28 to 7.6%. However, this complication has the potential to be devastating and its prevention is a priority. Laparoscopic approach in CRS reduces the tactile feedback of the surgeon who has to rely only on visual identification to prevent iatrogenic injury. As a result, lighted ureteral stents (LUS) were devised to improve visual identification of ureters throughout the dissection.
This video presents the case of a 70-year-old woman presenting with a caecal adenocarcinoma. She underwent a laparoscopic right colectomy with intracorporeal anastomosis. A LUS (IRIS U-kit®, Stryker) was placed under general anesthesia, just before the beginning of the surgical procedure, requiring about 15 minutes to be accomplished. The stent was removed after the operation, before the end of anesthesia, with no postoperative sequelas.
In order to prevent any potential iatrogenic injury, the selective or routine use of LUS during laparoscopic CRS could well improve the identification of the ureter, with a negligible increase in the operative time.
E Soricelli, E Facchiano, L Leuratti, G Quartararo, N Console, P Tonelli, M Lucchese
Surgical intervention
1 year ago
4564 views
16 likes
0 comments
09:10
Laparoscopic right colectomy for caecal cancer with prophylactic lighted ureteral stenting (LUS)
Identifying the ureter during colorectal surgery (CRS) is one of the most critical steps of the operation. Iatrogenic ureteral injury occurs very rarely, with an incidence ranging from 0.28 to 7.6%. However, this complication has the potential to be devastating and its prevention is a priority. Laparoscopic approach in CRS reduces the tactile feedback of the surgeon who has to rely only on visual identification to prevent iatrogenic injury. As a result, lighted ureteral stents (LUS) were devised to improve visual identification of ureters throughout the dissection.
This video presents the case of a 70-year-old woman presenting with a caecal adenocarcinoma. She underwent a laparoscopic right colectomy with intracorporeal anastomosis. A LUS (IRIS U-kit®, Stryker) was placed under general anesthesia, just before the beginning of the surgical procedure, requiring about 15 minutes to be accomplished. The stent was removed after the operation, before the end of anesthesia, with no postoperative sequelas.
In order to prevent any potential iatrogenic injury, the selective or routine use of LUS during laparoscopic CRS could well improve the identification of the ureter, with a negligible increase in the operative time.
Postoperative CBD stenosis
Benign biliary strictures are often a consequence of iatrogenic injury during laparoscopic cholecystectomy or they may arise after liver transplantation or hepatic resection with duct-to-duct biliary anastomosis. Other etiologies of benign biliary strictures are primary sclerosing cholangitis, chronic pancreatitis, and autoimmune cholangitis. In the past, surgical repair was the treatment of choice. Today, ERCP has a pivotal role in the treatment of the vast majority of these lesions. Up to 80% of postoperative benign biliary strictures develop within 6 to 12 months after surgery with symptoms as pruritus, jaundice, abdominal pain, alterations of liver function tests and recurrent cholangitis. Prompt identification of these lesions is essential because long-standing cholestasis can lead to secondary biliary cirrhosis. MRCP with cholangiographic sequences is the preferred non-invasive method for diagnostic cholangiography. In particular, this imaging method can be useful in hilar strictures and in patients with suspected anastomotic biliary stricture after liver transplantation.
I Boškoski, RA Ciurezu, M Morar, L Guerriero, F Habersetzer, M Bouhadjar, D Mutter, J Marescaux
Surgical intervention
2 years ago
1376 views
68 likes
0 comments
11:04
Postoperative CBD stenosis
Benign biliary strictures are often a consequence of iatrogenic injury during laparoscopic cholecystectomy or they may arise after liver transplantation or hepatic resection with duct-to-duct biliary anastomosis. Other etiologies of benign biliary strictures are primary sclerosing cholangitis, chronic pancreatitis, and autoimmune cholangitis. In the past, surgical repair was the treatment of choice. Today, ERCP has a pivotal role in the treatment of the vast majority of these lesions. Up to 80% of postoperative benign biliary strictures develop within 6 to 12 months after surgery with symptoms as pruritus, jaundice, abdominal pain, alterations of liver function tests and recurrent cholangitis. Prompt identification of these lesions is essential because long-standing cholestasis can lead to secondary biliary cirrhosis. MRCP with cholangiographic sequences is the preferred non-invasive method for diagnostic cholangiography. In particular, this imaging method can be useful in hilar strictures and in patients with suspected anastomotic biliary stricture after liver transplantation.
Transperitoneal ureteric reimplantation Lich-Gregoir technique for vesicoureteral reflux (VUR) in children
The Lich-Gregoir technique, still currently used in prominent Northern American centers in the nineties, had more or less fallen into disuse. Currently, the scarcity of operative indications for ureterovesical reimplantation, with the advent of the STING procedure, the real technical difficulties found during pneumovesicoscopy for Cohen procedure, the debates on long-term difficulties (e.g., in adult life) to undergo a ureteral endoluminal surgery after a previous Cohen procedure, all these reasons have led to vested and renewed interest in performing the Lich-Gregoir technique laparoscopically. The rigorous evaluation of potential functional vesical disorders is indispensable in case of bilateral surgery.
F Varlet
Lecture
4 years ago
848 views
50 likes
0 comments
14:58
Transperitoneal ureteric reimplantation Lich-Gregoir technique for vesicoureteral reflux (VUR) in children
The Lich-Gregoir technique, still currently used in prominent Northern American centers in the nineties, had more or less fallen into disuse. Currently, the scarcity of operative indications for ureterovesical reimplantation, with the advent of the STING procedure, the real technical difficulties found during pneumovesicoscopy for Cohen procedure, the debates on long-term difficulties (e.g., in adult life) to undergo a ureteral endoluminal surgery after a previous Cohen procedure, all these reasons have led to vested and renewed interest in performing the Lich-Gregoir technique laparoscopically. The rigorous evaluation of potential functional vesical disorders is indispensable in case of bilateral surgery.
Transanal circumferential mucosectomy for symptomatic benign rectal stenosis
Background: Transanal laparoscopy has been described for more than 30 years. In the presence of benign lesions, it gathers increasing interest, especially if such lesions are located in the low rectum or close to the anal margin.
Video: This video demonstrates the case of a 38-year-old man presented with a circumferential rectal stenosis due to a rectal ulcer. The patient underwent a transanal mucosectomy using laparoscopy, after a sequence of unsuccessful endoscopic dilatations. Preoperative work-up showed a circumferential benign stenosis, 2.5cm away from the anal margin. The procedure was entirely performed with a new reusable transanal platform made up by the DAPRI-Port and DAPRI curved instruments (Karl Storz Endoskope, Tuttlingen, Germany). Once the 360-degree mucosectomy had been completed, the mucosal layer was repaired using separate absorbable sutures.
Results: The operative length was 163 minutes, and peroperative bleeding was unsignificant. The patient was discharged on postoperative day 2. The pathological report confirmed the benign nature of the lesion.
Conclusions: Although transanal laparoscopy has been documented for years, it gathers increasing interest and should be considered as the technique of choice for the treatment of benign rectal lesions, which can be difficult to treat using other methods.
G Dapri, N Bachir, L Antolino, K Grozdev, D Guta, K Jottard, GB Cadière
Surgical intervention
4 years ago
1078 views
13 likes
0 comments
08:37
Transanal circumferential mucosectomy for symptomatic benign rectal stenosis
Background: Transanal laparoscopy has been described for more than 30 years. In the presence of benign lesions, it gathers increasing interest, especially if such lesions are located in the low rectum or close to the anal margin.
Video: This video demonstrates the case of a 38-year-old man presented with a circumferential rectal stenosis due to a rectal ulcer. The patient underwent a transanal mucosectomy using laparoscopy, after a sequence of unsuccessful endoscopic dilatations. Preoperative work-up showed a circumferential benign stenosis, 2.5cm away from the anal margin. The procedure was entirely performed with a new reusable transanal platform made up by the DAPRI-Port and DAPRI curved instruments (Karl Storz Endoskope, Tuttlingen, Germany). Once the 360-degree mucosectomy had been completed, the mucosal layer was repaired using separate absorbable sutures.
Results: The operative length was 163 minutes, and peroperative bleeding was unsignificant. The patient was discharged on postoperative day 2. The pathological report confirmed the benign nature of the lesion.
Conclusions: Although transanal laparoscopy has been documented for years, it gathers increasing interest and should be considered as the technique of choice for the treatment of benign rectal lesions, which can be difficult to treat using other methods.
Right thoracoscopic mediastinal mass resection and bronchial injury repair
The objective is to demonstrate our technique for thoracoscopic mediastinal mass excision with concomitant bronchial injury repair.
A 13-year-old boy presented with one-month of dysphagia and a history of a recent tick bite prophylactically treated. Esophagram showed a mid-esophageal externally compressing mass confirmed by endoscopy. Chest MRI showed a 5cm mediastinal mass. Differential diagnosis included infected esophageal duplication cyst versus histoplasmoma. A thoracoscopic mass resection was scheduled.
Upon accessing the right chest, a mid-thoracic lesion next to the esophagus was noted. The mass was adherent to the esophageal wall during dissection. Intraoperative biopsy revealed a cottage cheese-like substance in the mass. Frozen section suspected a duplication cyst in the esophageal musculature. As a result, we proceeded with the resection. The cavity was then irrigated and some fluid was noted at the endotracheal tube. A 5mm right mainstem bronchus tear was found. Flexible bronchoscopy was used to repair the injury with absorbable sutures. The mass was removed from the esophageal wall and repaired with absorbable sutures. A small pleural flap was created to prevent the sutures from communicating. The patient had a small persistent pneumothorax several days postoperatively. Repeat flexible bronchoscopy showed no leak or narrowing on postoperative day (POD) 7. The patient was discharged home on POD 8. Final pathology showed a mediastinal lymph node with a non-caseating granuloma. He had positive antibodies to Francisella tularensis (tularemia Ab). His final diagnosis was mediastinal tularemia.
This video demonstrates mediastinal mass diagnostic and treatment challenges. It also shows that concomitant bronchial injuries are safe and effective to repair thoracoscopically.
T Huy, AS Munoz Abraham, H Osei, C Cappiello, GA Villalona
Surgical intervention
5 months ago
899 views
8 likes
0 comments
05:17
Right thoracoscopic mediastinal mass resection and bronchial injury repair
The objective is to demonstrate our technique for thoracoscopic mediastinal mass excision with concomitant bronchial injury repair.
A 13-year-old boy presented with one-month of dysphagia and a history of a recent tick bite prophylactically treated. Esophagram showed a mid-esophageal externally compressing mass confirmed by endoscopy. Chest MRI showed a 5cm mediastinal mass. Differential diagnosis included infected esophageal duplication cyst versus histoplasmoma. A thoracoscopic mass resection was scheduled.
Upon accessing the right chest, a mid-thoracic lesion next to the esophagus was noted. The mass was adherent to the esophageal wall during dissection. Intraoperative biopsy revealed a cottage cheese-like substance in the mass. Frozen section suspected a duplication cyst in the esophageal musculature. As a result, we proceeded with the resection. The cavity was then irrigated and some fluid was noted at the endotracheal tube. A 5mm right mainstem bronchus tear was found. Flexible bronchoscopy was used to repair the injury with absorbable sutures. The mass was removed from the esophageal wall and repaired with absorbable sutures. A small pleural flap was created to prevent the sutures from communicating. The patient had a small persistent pneumothorax several days postoperatively. Repeat flexible bronchoscopy showed no leak or narrowing on postoperative day (POD) 7. The patient was discharged home on POD 8. Final pathology showed a mediastinal lymph node with a non-caseating granuloma. He had positive antibodies to Francisella tularensis (tularemia Ab). His final diagnosis was mediastinal tularemia.
This video demonstrates mediastinal mass diagnostic and treatment challenges. It also shows that concomitant bronchial injuries are safe and effective to repair thoracoscopically.
Revisional surgery: analysis of technical errors during failed bile duct injury repair
This is the case of a 42-year-old woman who suffered from bile duct injury during an elective cholecystectomy. Immediate repair was performed by means of an open Roux-en-Y hepaticojejunostomy. Five months later, she developed cholangitis. Critical stenosis of the anastomosis was demonstrated with percutaneous transhepatic cholangiography. She was transferred to our unit to address the failed reconstruction. Many clues on why the initial attempt at reconstruction failed were found during our surgery. Discussion of these errors and how to avoid them is the main objective of the video. Secondary learning objectives are to highlight the principles of high quality bilioenteric anastomosis and demonstration of our standard technique for bile duct injury repair.
JM Cabada-Lee
Surgical intervention
7 months ago
1032 views
13 likes
1 comment
08:00
Revisional surgery: analysis of technical errors during failed bile duct injury repair
This is the case of a 42-year-old woman who suffered from bile duct injury during an elective cholecystectomy. Immediate repair was performed by means of an open Roux-en-Y hepaticojejunostomy. Five months later, she developed cholangitis. Critical stenosis of the anastomosis was demonstrated with percutaneous transhepatic cholangiography. She was transferred to our unit to address the failed reconstruction. Many clues on why the initial attempt at reconstruction failed were found during our surgery. Discussion of these errors and how to avoid them is the main objective of the video. Secondary learning objectives are to highlight the principles of high quality bilioenteric anastomosis and demonstration of our standard technique for bile duct injury repair.