Monthly publications : March 2007 | WebSurg, the online university of IRCAD

Laparoscopic appendectomy for abscessed and necrotic appendix

This video of an emergency appendectomy demonstrates some of the advantages of the laparoscopic approach. Multiple abscess cavities are identified by a thorough exploration, including the necrotic appendix. Control of bleeding from the appendiceal artery and control of a gangrenous base of the appendix are clearly shown.

This male patient had emergency surgery after a 1-week history of diffuse abdominal pain with signs of inflammatory syndrome. CT showed a pelvic abscess.

The author begins the laparoscopic approach with a 1-cm incision just above the umbilicus and establishes pneumoperitoneum with the open technique. Dissection of the abscess must proceed cautiously. A suction device in tandem with a probe prove useful for continuing dissection to help mobilize the cecum.

As the appendix comes into view, the author identifies the mesoappendix to begin dissection. Significant edema makes it difficult to continue dissection with the blunt probe, so the author uses bipolar cautery to begin dissection of the mesoappendix.

A Rossini

Surgical intervention

Laparoscopic appendectomy for abscessed and necrotic appendix

This video of an emergency appendectomy demonstrates some of the advantages of the laparoscopic approach. Multiple abscess cavities are identified by a thorough exploration, including the necrotic appendix. Control of bleeding from the appendiceal artery and control of a gangrenous base of the appendix are clearly shown.

This male patient had emergency surgery after a 1-week history of diffuse abdominal pain with signs of inflammatory syndrome. CT showed a pelvic abscess.

The author begins the laparoscopic approach with a 1-cm incision just above the umbilicus and establishes pneumoperitoneum with the open technique. Dissection of the abscess must proceed cautiously. A suction device in tandem with a probe prove useful for continuing dissection to help mobilize the cecum.

As the appendix comes into view, the author identifies the mesoappendix to begin dissection. Significant edema makes it difficult to continue dissection with the blunt probe, so the author uses bipolar cautery to begin dissection of the mesoappendix.

Laparoscopic reoperation for severe dysphagia after two previous open fundoplications

This live demonstration emphasizes the problems encountered during re-operation for gastroesophageal reflux disease (GERD). The wrap is dissected off the gastroesophageal junction (GEJ) with great difficulty and on-table gastroscopy is performed.

B Dallemagne, J Marescaux

Surgical intervention

Laparoscopic reoperation for severe dysphagia after two previous open fundoplications

This live demonstration emphasizes the problems encountered during re-operation for gastroesophageal reflux disease (GERD). The wrap is dissected off the gastroesophageal junction (GEJ) with great difficulty and on-table gastroscopy is performed.

What are the risks of laparoscopic colorectal surgery?

Mobilization of the splenic flexure: medial route during left colectomy

This video highlights the critical steps in mobilization of the splenic flexure of the colon using the medial approach.

The author carries out the division of the left colic vessels and gains entry to the lesser sac. The tail of the pancreas, mesocolon, stomach, and posterior aspect of splenic flexure provide landmarks.

The author completes the dissection laterally and division of posterior attachment before commencing the freeing of the lateral structures. This provides access to the posterior dissection completed earlier.

J Leroy

Surgical intervention

Mobilization of the splenic flexure: medial route during left colectomy

This video highlights the critical steps in mobilization of the splenic flexure of the colon using the medial approach.

The author carries out the division of the left colic vessels and gains entry to the lesser sac. The tail of the pancreas, mesocolon, stomach, and posterior aspect of splenic flexure provide landmarks.

The author completes the dissection laterally and division of posterior attachment before commencing the freeing of the lateral structures. This provides access to the posterior dissection completed earlier.

Tips and tricks for plexus dissection in laparoscopic TME for rectal cancer in a female patient

This is a detailed demonstration of an anterior resection, specifically highlighting the key steps to prevent nerve injury at various stages.

J Leroy

Surgical intervention

Tips and tricks for plexus dissection in laparoscopic TME for rectal cancer in a female patient

This is a detailed demonstration of an anterior resection, specifically highlighting the key steps to prevent nerve injury at various stages.

Laparoscopic low anterior resection with TME and medial mobilization of the splenic flexure in a female patient

This video shows the case of a female patient presenting with a low rectal cancer for which neoadjuvant therapy is used. The author performs a totally laparoscopic TME using a medial approach. A colorectal anastomosis without bowel protection is performed.

J Leroy

Surgical intervention

Laparoscopic low anterior resection with TME and medial mobilization of the splenic flexure in a female patient

This video shows the case of a female patient presenting with a low rectal cancer for which neoadjuvant therapy is used. The author performs a totally laparoscopic TME using a medial approach. A colorectal anastomosis without bowel protection is performed.

Laparoscopic technique of exposure for gynecological procedures

A short video showing the techniques of exposure for gynaecological procedures, explaining the rationale behind it and advantages. Simple techniques, such as ovarian and uterine suspension, uterine manipulation shown in the beginning followed by more complicated suspension. Tricks for aortic lymph node dissection and bladder resection.

A Wattiez

Surgical intervention

Laparoscopic technique of exposure for gynecological procedures

A short video showing the techniques of exposure for gynaecological procedures, explaining the rationale behind it and advantages. Simple techniques, such as ovarian and uterine suspension, uterine manipulation shown in the beginning followed by more complicated suspension. Tricks for aortic lymph node dissection and bladder resection.

Laparoscopic colpofixation for apical defect

A movie showing laparoscopic correction of uterine prolapse in a young patient with desire to preserve the uterus. Steps showing dissection techniques for anterior and posterior compartments; placement of the mesh paracervically and fixation of the mesh on the promontorium.

A Wattiez

Surgical intervention

Laparoscopic colpofixation for apical defect

A movie showing laparoscopic correction of uterine prolapse in a young patient with desire to preserve the uterus. Steps showing dissection techniques for anterior and posterior compartments; placement of the mesh paracervically and fixation of the mesh on the promontorium.

In what ways is the double crown technique a better treatment than using sutures in the repair of laparoscopic ventral hernia?

What is the incidence rate of seromas and how do you prevent and manage them?

What are the criteria that lead you to convert from laparoscopy to laparotomy?

What is the state of the art for incisional hernia repair?

In your opinion, what types of meshes are preferable (absorbable, double-layer, etc.) and what is the future of the meshes in the treatment of ventral hernia?

Do you think that transluminal surgery is a revolution in itself in the same way as laparoscopy was at the time?

Do you think it could be a faster revolution in terms of acceptance now that we have the experience with laparoscopic surgery?

Could you describe your experience with transgastric surgery?

In your opinion, what is the future of natural orifice transluminal endoscopic surgery (NOTES)?

What are the best indications for a laparoscopic hepatectomy?

B Topal

What are the poorest indications for a laparoscopic hepatectomy?

B Topal

What are the requested laparoscopic instruments to perform a safe laparoscopic hepatectomy?

B Topal

Is there a place for a systematic Pringle manoeuvre in laparoscopic hepatectomy?

B Topal

Is there a place for a selective vascular control of the sectorial branches in laparoscopic hepatectomy?

B Topal

What are the major risks and how do you prevent them for laparoscopic hepatectomy?

B Topal

Are there specific anesthesiological requirements for laparoscopic hepatectomy (pneumoperitoneal pressure, central venous blood pressure, etc.)?

B Topal

What is the future of laparoscopic hepatectomy?

B Topal

Could you please develop your surgical approach to choledochal cyst?

B Ure

Could you please develop your surgical approach to biliary atresia (classical Kasai procedure or hepaticojejunostomy)?

B Ure

Laparoscopic robotic-assisted partial nephrectomy

This video describes the procedure of partial nephrectomy performed with the DaVinci robot. The renal pedicle is first isolated and temporarily controlled with vascular clamps. The partial nephrectomy is then performed in a bloodless field.

J Hubert

Surgical intervention

Laparoscopic robotic-assisted partial nephrectomy

This video describes the procedure of partial nephrectomy performed with the DaVinci robot. The renal pedicle is first isolated and temporarily controlled with vascular clamps. The partial nephrectomy is then performed in a bloodless field.

Laparoscopic transperitoneal pyeloplasty using a remote-controlled robotic surgical system, ureteropyelic junction reconstruction

This surgical video demonstrates the advantages of using the DaVinci robot for dissection and anastomosis of the upper ureter to the renal pelvis. A potentially difficult procedure is simplified by the dexterity of the robotic instruments.

J Hubert

Surgical intervention

Laparoscopic transperitoneal pyeloplasty using a remote-controlled robotic surgical system, ureteropyelic junction reconstruction

This surgical video demonstrates the advantages of using the DaVinci robot for dissection and anastomosis of the upper ureter to the renal pelvis. A potentially difficult procedure is simplified by the dexterity of the robotic instruments.