Monthly publications : June 2010 | WebSurg, the online university of IRCAD

Complete laparoscopic splenic flexure mobilization as the first step in anterior resection (medial to lateral approach)

This video shows a complete laparoscopic splenic flexure mobilization as the first step in anterior resection (medial to lateral approach). The advantage of routine specific flexure mobilization in an anterior resection is that sufficient length for a tension-free anastomosis is always assured and its completion early in the operation minimizes table adjustment and prevents its deliberation at the end of the procedure when the operator may be fatigued.

R Cahill, I Lindsey, C Cunningham

Surgical intervention

Complete laparoscopic splenic flexure mobilization as the first step in anterior resection (medial to lateral approach)

This video shows a complete laparoscopic splenic flexure mobilization as the first step in anterior resection (medial to lateral approach). The advantage of routine specific flexure mobilization in an anterior resection is that sufficient length for a tension-free anastomosis is always assured and its completion early in the operation minimizes table adjustment and prevents its deliberation at the end of the procedure when the operator may be fatigued.

Laparoscopic subtotal colectomy with ileo-sigmoid anastomosis for cancer in an elderly patient

Surgery in patients who have previously undergone abdominal operations is always difficult and the risk of complications is high. The objective of this film is to demonstrate a laparoscopic subtotal colectomy in an elderly female patient aged 89. This patient had undergone a laparoscopic right colectomy for cancer in previous years. The film also aims to show the possibilities of a laparoscopic re-intervention.

J Leroy, J Marescaux

Surgical intervention

Laparoscopic subtotal colectomy with ileo-sigmoid anastomosis for cancer in an elderly patient

Surgery in patients who have previously undergone abdominal operations is always difficult and the risk of complications is high. The objective of this film is to demonstrate a laparoscopic subtotal colectomy in an elderly female patient aged 89. This patient had undergone a laparoscopic right colectomy for cancer in previous years. The film also aims to show the possibilities of a laparoscopic re-intervention.

Laparoscopic left pancreatectomy with spleen preservation and splenic vessels resection

This film demonstrates the laparoscopic resection of a pancreatic tumor in a 47-year-old woman who consulted for epigastric pain. The preoperative exam showed a tumor larger than 4cm situated at the body of the pancreas.

B Dallemagne, S Perretta, L Soler, J Marescaux

Surgical intervention

Laparoscopic left pancreatectomy with spleen preservation and splenic vessels resection

This film demonstrates the laparoscopic resection of a pancreatic tumor in a 47-year-old woman who consulted for epigastric pain. The preoperative exam showed a tumor larger than 4cm situated at the body of the pancreas.

Laparoscopic treatment of a right indirect strangulated inguinal hernia: TAPP approach

Laparoscopic Trans-Abdominal PrePeritoneal (TAPP) hernia repair is a recognized procedure for inguinal hernia repair in patients undergoing elective surgery. There is a scarcity of data on TAPP repair in emergency situations such as those involving strangulated hernias. We report the laparoscopic treatment of a right indirect strangulated inguinal hernia in a young man aged 18.

F Costantino, J Leroy, J Marescaux

Surgical intervention

Laparoscopic treatment of a right indirect strangulated inguinal hernia: TAPP approach

Laparoscopic Trans-Abdominal PrePeritoneal (TAPP) hernia repair is a recognized procedure for inguinal hernia repair in patients undergoing elective surgery. There is a scarcity of data on TAPP repair in emergency situations such as those involving strangulated hernias. We report the laparoscopic treatment of a right indirect strangulated inguinal hernia in a young man aged 18.

Laparoscopic TME in a male patient with side-to-end low colorectal anastomosis and peroperative ultrasonography

Local control of rectal cancer and patient survival have improved remarkably with advances in surgical techniques. The objective of this film is to demonstrate a laparoscopic total mesorectal excision for a rectal adenocarcinoma situated in the upper rectum.

J Leroy, J Marescaux

Surgical intervention

Laparoscopic TME in a male patient with side-to-end low colorectal anastomosis and peroperative ultrasonography

Local control of rectal cancer and patient survival have improved remarkably with advances in surgical techniques. The objective of this film is to demonstrate a laparoscopic total mesorectal excision for a rectal adenocarcinoma situated in the upper rectum.

Giant hepatic cyst: laparoscopic fenestration and omentoplasty

Hepatic cysts are usually asymptomatic. Intervention is only indicated when they become symptomatic or when they grow at a rapid rate. This is the case of a patient presenting with a symptomatic giant hepatic cyst, a laparoscopic fenestration with omentoplasty is presented.

D Mutter, L Soler, J Marescaux

Surgical intervention

Giant hepatic cyst: laparoscopic fenestration and omentoplasty

Hepatic cysts are usually asymptomatic. Intervention is only indicated when they become symptomatic or when they grow at a rapid rate. This is the case of a patient presenting with a symptomatic giant hepatic cyst, a laparoscopic fenestration with omentoplasty is presented.

Totally laparoscopic total gastrectomy for stage IIIA (cT3 cN1 cM0) advanced gastric carcinoma

A 66-year-old man was admitted to our hospital with complaints of epigastric pain. His hemoglobin level was 9.3g/dL. Endoscopy of the upper gastrointestinal tract (EGD) showed an advanced gastric carcinoma that had invaded the middle and lower third of the stomach. A biopsy specimen revealed a moderately differentiated adenocarcinoma. Abdominal computed tomography (CT) showed that the tumor had invaded the stomach wall. Enlarged lymph nodes were present only around the lesser curvature (regional lymph nodes No. 3). The patient was diagnosed with stage IIIA (cT3 cN1 cM0) advanced gastric carcinoma according to the Japanese classification of gastric carcinoma1. The patient was then taken to the operating room for exploratory laparoscopy and laparoscopic total gastrectomy with D2 lymphadenectomy. The operation time was 260 minutes. No further evidence of intra-abdominal disease or liver involvement was noted. The patient did well postoperatively and was subsequently discharged home on postoperative day 9. Four metastatic lymph nodes/twenty eight regional lymph nodes were found; so the pathological findings confirmed stage IIIA. The patient is disease-free at 10 months. Japanese Classification of Gastric Carcinoma - 2nd English Edition. Gastric Cancer 1998;1:10-24.

G Pignata, M Barone, U Bracale, E Gianetta, F Badessi

Surgical intervention

Totally laparoscopic total gastrectomy for stage IIIA (cT3 cN1 cM0) advanced gastric carcinoma

A 66-year-old man was admitted to our hospital with complaints of epigastric pain. His hemoglobin level was 9.3g/dL. Endoscopy of the upper gastrointestinal tract (EGD) showed an advanced gastric carcinoma that had invaded the middle and lower third of the stomach. A biopsy specimen revealed a moderately differentiated adenocarcinoma. Abdominal computed tomography (CT) showed that the tumor had invaded the stomach wall. Enlarged lymph nodes were present only around the lesser curvature (regional lymph nodes No. 3). The patient was diagnosed with stage IIIA (cT3 cN1 cM0) advanced gastric carcinoma according to the Japanese classification of gastric carcinoma1. The patient was then taken to the operating room for exploratory laparoscopy and laparoscopic total gastrectomy with D2 lymphadenectomy. The operation time was 260 minutes. No further evidence of intra-abdominal disease or liver involvement was noted. The patient did well postoperatively and was subsequently discharged home on postoperative day 9. Four metastatic lymph nodes/twenty eight regional lymph nodes were found; so the pathological findings confirmed stage IIIA. The patient is disease-free at 10 months. Japanese Classification of Gastric Carcinoma - 2nd English Edition. Gastric Cancer 1998;1:10-24.

Mesenteric lengthening plasty with multiple vascular divisions to perform ileoanal anastomosis and J pouch reservoir

Total coloproctectomy with ileal pouch-anal anastomosis is the operation of choice for both ulcerative colitis and familial adenomatous polyposis. The objective of this film is to demonstrate the benefits of mesenteric lengthening using vascular divisions in order to perform an ileoanal anastomosis after a total coloproctectomy.

J Leroy, J Marescaux

Surgical intervention

Mesenteric lengthening plasty with multiple vascular divisions to perform ileoanal anastomosis and J pouch reservoir

Total coloproctectomy with ileal pouch-anal anastomosis is the operation of choice for both ulcerative colitis and familial adenomatous polyposis. The objective of this film is to demonstrate the benefits of mesenteric lengthening using vascular divisions in order to perform an ileoanal anastomosis after a total coloproctectomy.

Arthroscopic removal of volar ganglia

Arthroscopic removal of volar ganglia is a reasonable and safe approach, which requires understanding of specific technical gestures. The main indication being esthetic, the use of wrist arthroscopy is perfect. This video will show you how to perform this reliable procedure in a safe way. This young woman has a small volar ganglion, causing pain by creating pressure difference in the radiocarpal joint. Removing this kind of volar ganglion can be satisfied only by the radiocarpal joint. We will use a 3-4 portal for the scope and a 1-2 instrumental portal. Locating the origin of the ganglion can be assisted by external manipulation. It is usually located between the scapho radio-capitate ligaments and long radiolunate ligaments. Ganglion removal is carried out from the inside of the joint using a shaver. The operation may be considered completed when the anterior capsulectomy is performed and, possibly when we see the tendons. It is not necessary to close the portals, a simple dressing will be applied, and the patient may be able to totally use her hand and wrist the same day.

C Mathoulin, P Liverneaux

Surgical intervention

Arthroscopic removal of volar ganglia

Arthroscopic removal of volar ganglia is a reasonable and safe approach, which requires understanding of specific technical gestures. The main indication being esthetic, the use of wrist arthroscopy is perfect. This video will show you how to perform this reliable procedure in a safe way. This young woman has a small volar ganglion, causing pain by creating pressure difference in the radiocarpal joint. Removing this kind of volar ganglion can be satisfied only by the radiocarpal joint. We will use a 3-4 portal for the scope and a 1-2 instrumental portal. Locating the origin of the ganglion can be assisted by external manipulation. It is usually located between the scapho radio-capitate ligaments and long radiolunate ligaments. Ganglion removal is carried out from the inside of the joint using a shaver. The operation may be considered completed when the anterior capsulectomy is performed and, possibly when we see the tendons. It is not necessary to close the portals, a simple dressing will be applied, and the patient may be able to totally use her hand and wrist the same day.

Laparoscopic pericystectomy for an 8cm hepatic hydatid cyst with 3D reconstruction

This is the case of a female patient presenting with epigastric pain. An 8cm liver cyst is identified on the examination. Given her previous medical and clinical history, the patient has a hydatid cyst. Serologic tests remain negative. This hydatid cyst is no longer active. Surgery is indicated given the symptomatology and the patient’s strong desire for the intervention. Indications for the surgical resection of non-active hydatid cysts remain rare. They mainly concern big cysts that may generate typical clinical signs of pain, heaviness and epigastric impairment. A standard pericystectomy performed in a stepwise manner should allow to resect this cyst without any resection of the liver parenchyma.

D Mutter, L Soler, J Marescaux

Surgical intervention

Laparoscopic pericystectomy for an 8cm hepatic hydatid cyst with 3D reconstruction

This is the case of a female patient presenting with epigastric pain. An 8cm liver cyst is identified on the examination. Given her previous medical and clinical history, the patient has a hydatid cyst. Serologic tests remain negative. This hydatid cyst is no longer active. Surgery is indicated given the symptomatology and the patient’s strong desire for the intervention. Indications for the surgical resection of non-active hydatid cysts remain rare. They mainly concern big cysts that may generate typical clinical signs of pain, heaviness and epigastric impairment. A standard pericystectomy performed in a stepwise manner should allow to resect this cyst without any resection of the liver parenchyma.

Ventral and umbilical hernia: simultaneous laparoscopic management

The laparoscopic repair of abdominal wall hernias to treat both spontaneous and incisional hernias has good results. We report the case of a patient presenting with two concomitant pathologies, an umbilical hernia and a linea alba hernia situated on a previous incision’s scar that were treated simultaneously. Currently this patient has a heart transplant.

C Callari, D Mutter, J Marescaux

Surgical intervention

Ventral and umbilical hernia: simultaneous laparoscopic management

The laparoscopic repair of abdominal wall hernias to treat both spontaneous and incisional hernias has good results. We report the case of a patient presenting with two concomitant pathologies, an umbilical hernia and a linea alba hernia situated on a previous incision’s scar that were treated simultaneously. Currently this patient has a heart transplant.

Laparoscopic total hysterectomy and unilateral adnexectomy with resection of urinary bladder nodule for endometriosis

This video demonstrates the technique of a total laparoscopic hysterectomy with unilateral adnexectomy and the excision of a vesical endometriotic nodule.
This patient is a 46-year-old lady with a previous surgical history of one laparotomy for a hemoperitoneum (endometriotic ovarian cyst rupture) and 6 laparoscopies because of endometriosis, the last one 3 years ago with a segmental sigmoid resection. After this last surgery, the patient starts to complain of dysmenorrhea, chronic pelvic pain and dysuria. She has never had any urinary infection.
Because of urinary stress incontinence, she had botulinic toxin injection and underwent a cystoscopy, which revealed a bladder nodule.

A Wattiez, S Barata, AM Furtado Lima, P Trompoukis, B Gabriel, J Nassif

Surgical intervention

Laparoscopic total hysterectomy and unilateral adnexectomy with resection of urinary bladder nodule for endometriosis

This video demonstrates the technique of a total laparoscopic hysterectomy with unilateral adnexectomy and the excision of a vesical endometriotic nodule.
This patient is a 46-year-old lady with a previous surgical history of one laparotomy for a hemoperitoneum (endometriotic ovarian cyst rupture) and 6 laparoscopies because of endometriosis, the last one 3 years ago with a segmental sigmoid resection. After this last surgery, the patient starts to complain of dysmenorrhea, chronic pelvic pain and dysuria. She has never had any urinary infection.
Because of urinary stress incontinence, she had botulinic toxin injection and underwent a cystoscopy, which revealed a bladder nodule.

Laparoscopic total hysterectomy and unilateral adnexectomy with resection of urinary bladder nodule for endometriosis

The video "Laparoscopic total hysterectomy and unilateral adnexectomy with resection of urinary bladder nodule for endometriosis" authored by A. Wattiez, J. Nassif and C. Zacharopoulou is analysed by Dr. Sara Brucker, sharing in this way her own personal experience and highlighting the different surgical approaches available with tips and tricks.

S Brucker

Surgical intervention

Laparoscopic total hysterectomy and unilateral adnexectomy with resection of urinary bladder nodule for endometriosis

The video "Laparoscopic total hysterectomy and unilateral adnexectomy with resection of urinary bladder nodule for endometriosis" authored by A. Wattiez, J. Nassif and C. Zacharopoulou is analysed by Dr. Sara Brucker, sharing in this way her own personal experience and highlighting the different surgical approaches available with tips and tricks.

Single access laparoscopic incisional hernia repair using curved and reusable instruments

This video demonstrates a laparoscopic single incision repair of an incisional hernia using bi-curved and reusable instruments.

G Dapri, J Bruyns, J Himpens, GB Cadière

Surgical intervention

Single access laparoscopic incisional hernia repair using curved and reusable instruments

This video demonstrates a laparoscopic single incision repair of an incisional hernia using bi-curved and reusable instruments.

Vaginal aplasia and reconstruction with sigmoid graft

This video shows the reconstruction of vagina with a colon graft in a female teenager who consulted for a primary amenorrhea. Her karyotype is 46, XY and the SRY gene is not expressed.

F Becmeur

Surgical intervention

Vaginal aplasia and reconstruction with sigmoid graft

This video shows the reconstruction of vagina with a colon graft in a female teenager who consulted for a primary amenorrhea. Her karyotype is 46, XY and the SRY gene is not expressed.

NOTES or Single Port? What is the goal?

In recent times, innovative techniques of Natural Orifice Transluminal Endoscopic Surgery (NOTES) and Single Incision Laparoscopic Surgery (SILS) have been applied as a step towards even more less invasive procedures. In this lecture, Doctor Brian Dunkin presents a critical review of all aspects of these two techniques and of the so-called LESS (Laparo-Endoscopic Single sight Surgery).

NOTES or Single Port? What is the goal?

In recent times, innovative techniques of Natural Orifice Transluminal Endoscopic Surgery (NOTES) and Single Incision Laparoscopic Surgery (SILS) have been applied as a step towards even more less invasive procedures. In this lecture, Doctor Brian Dunkin presents a critical review of all aspects of these two techniques and of the so-called LESS (Laparo-Endoscopic Single sight Surgery).

Robotic surgery in the kidney: a critical reflection

In this lecture, Doctor Alex Mottrie shows the current indications of urological robotic procedures, and presents the Guidelines on Renal Cell Carcinoma, the techniques of partial nephrectomy, tumor enucleation and renorrhaphy. He presents his experience and his results in a series of 62 patients.

Robotic surgery in the kidney: a critical reflection

In this lecture, Doctor Alex Mottrie shows the current indications of urological robotic procedures, and presents the Guidelines on Renal Cell Carcinoma, the techniques of partial nephrectomy, tumor enucleation and renorrhaphy. He presents his experience and his results in a series of 62 patients.

Minimally invasive alternative for treatment of kidney tumors: radiofrequency and cryoablation

Cryoablation and radiofrequency ablation represent a combination of two minimally invasive surgical technologies that can be used to treat kidney cancer. In this lecture, Professor Mejean presents an interesting lecture on the indications and treatment options for minimally invasive treatment of kidney tumors.

Minimally invasive alternative for treatment of kidney tumors: radiofrequency and cryoablation

Cryoablation and radiofrequency ablation represent a combination of two minimally invasive surgical technologies that can be used to treat kidney cancer. In this lecture, Professor Mejean presents an interesting lecture on the indications and treatment options for minimally invasive treatment of kidney tumors.

Transperitoneal nephrectomy

In this key lecture, Professor Roland van Velthoven discusses the carcinologic principles of laparoscopic radical nephrectomy. He presents data such as operative setting, team position and surgical instrumentation and shows the operative techniques.

Transperitoneal nephrectomy

In this key lecture, Professor Roland van Velthoven discusses the carcinologic principles of laparoscopic radical nephrectomy. He presents data such as operative setting, team position and surgical instrumentation and shows the operative techniques.

Extraperitoneal laparoscopic nephrectomy - 2010 update

In this lecture, Doctor Andras Hoznek clearly shows all steps and technical details of an extraperitoneal laparoscopic nephrectomy. He presents different clips on the surgical procedure.

Extraperitoneal laparoscopic nephrectomy - 2010 update

In this lecture, Doctor Andras Hoznek clearly shows all steps and technical details of an extraperitoneal laparoscopic nephrectomy. He presents different clips on the surgical procedure.