Monthly publications : November 2012 | WebSurg, the online university of IRCAD

In this lecture, Professor Didier Mutter, MD, PhD, FACS, explains the importance of collaboration between surgeons and endoscopists to improve combined minimally invasive techniques.

D Mutter

EMR/ESD: endoscopic/surgeon's point of view

In this lecture, Professor Didier Mutter, MD, PhD, FACS, explains the importance of collaboration between surgeons and endoscopists to improve combined minimally invasive techniques.

Challenges in GERD: Collis fundoplication in a patient with a BMI of 41

Obesity has long been considered a predisposing factor for gastroesophageal reflux. It is also thought to predispose patients to a poorer clinical outcome following antireflux surgery and some authors recommend gastric bypass in obese patient with symptomatic GERD. However, some studies reported that preoperative BMI does not influence the clinical outcome following laparoscopic antireflux surgery and concluded that obesity is not a contraindication for laparoscopic fundoplication (1, 2).
In this video, we present a Collis-Toupet gastroplasty in a woman with a BMI of 41.
References:
1. Winslow ER, Frisella MM, Soper NJ, Klingensmith ME. Obesity does not adversely affect the outcome of laparoscopic antireflux surgery (LARS). Surgical Endoscopy 2003;17:2003-11.
2. Chisholm JA, Jamieson GG, Lally CJ, Devitt PG, Game PA, Watson DI. The effect of obesity on the outcome of laparoscopic antireflux surgery. J Gastrointest Surg 2009;13:1064-70.

B Dallemagne, S Perretta, J Marescaux

Surgical intervention

Challenges in GERD: Collis fundoplication in a patient with a BMI of 41

Obesity has long been considered a predisposing factor for gastroesophageal reflux. It is also thought to predispose patients to a poorer clinical outcome following antireflux surgery and some authors recommend gastric bypass in obese patient with symptomatic GERD. However, some studies reported that preoperative BMI does not influence the clinical outcome following laparoscopic antireflux surgery and concluded that obesity is not a contraindication for laparoscopic fundoplication (1, 2).
In this video, we present a Collis-Toupet gastroplasty in a woman with a BMI of 41.
References:
1. Winslow ER, Frisella MM, Soper NJ, Klingensmith ME. Obesity does not adversely affect the outcome of laparoscopic antireflux surgery (LARS). Surgical Endoscopy 2003;17:2003-11.
2. Chisholm JA, Jamieson GG, Lally CJ, Devitt PG, Game PA, Watson DI. The effect of obesity on the outcome of laparoscopic antireflux surgery. J Gastrointest Surg 2009;13:1064-70.

Gastrointestinal reconstruction in a patient with intestinal malrotation

Rotational anomalies occur as a result of an arrest of normal rotation of the embryonic gut around the superior mesenteric artery. It occurs at a rate of 1 in 500 live births. Twenty-five percent of patients present after age 1 year and into late adulthood; many are recognized intraoperatively during other procedures or at autopsy. The video demonstrates a laparoscopic Roux-en-Y gastrointestinal reconstruction after distal gastrectomy for adenocarcinoma at the antrum in a patient with type IIc intestinal malrotation that was incidentally detected in the operation.

J Torres Bermúdez, S del Valle Ruiz , J Lopez Espejo, G Sánchez de la Villa

Surgical intervention

Gastrointestinal reconstruction in a patient with intestinal malrotation

Rotational anomalies occur as a result of an arrest of normal rotation of the embryonic gut around the superior mesenteric artery. It occurs at a rate of 1 in 500 live births. Twenty-five percent of patients present after age 1 year and into late adulthood; many are recognized intraoperatively during other procedures or at autopsy. The video demonstrates a laparoscopic Roux-en-Y gastrointestinal reconstruction after distal gastrectomy for adenocarcinoma at the antrum in a patient with type IIc intestinal malrotation that was incidentally detected in the operation.

Laparoscopic rectovaginal resection for endometriosis: transvaginal specimen extraction and anastomosis

The authors demonstrate a rectovaginal resection technique for invasive endometriosis. The original nature of this approach hinges on the mesorectum dissection technique in contact with the rectal wall in order to preserve rectal vascularization and innervation. Additionally, rectal exteriorization through the vagina to prepare for the colorectal anastomosis using a mechanical circular stapling without any abdominal incision is truly original as it contributes to limiting parietal trauma and improving cosmesis. The film truly focuses on the digestive approach just after anterior pelvic dissection has been completed by the team of gynecologic surgeons.

J Leroy, CY Akladios, V Thoma, A Wattiez, J Marescaux

Surgical intervention

Laparoscopic rectovaginal resection for endometriosis: transvaginal specimen extraction and anastomosis

The authors demonstrate a rectovaginal resection technique for invasive endometriosis. The original nature of this approach hinges on the mesorectum dissection technique in contact with the rectal wall in order to preserve rectal vascularization and innervation. Additionally, rectal exteriorization through the vagina to prepare for the colorectal anastomosis using a mechanical circular stapling without any abdominal incision is truly original as it contributes to limiting parietal trauma and improving cosmesis. The film truly focuses on the digestive approach just after anterior pelvic dissection has been completed by the team of gynecologic surgeons.

Middle lobectomy for a typical carcinoid tumor using 4 robotic arms

We present the case of a 78-year-old woman with a typical carcinoid tumor of the middle lobe of the lung. Bronchoscopy was carried out. A tumor lying in the deep segment of the middle lobe bronchus was identified by biopsy as a typical carcinoid tumor. We decided to perform middle lobectomy using a four-arm robotic assistance as it allows for a minimally invasive surgery.

The patient is intubated with a double lumen tracheal tube. The patient is placed in a left-sided decubitus with the right arm hanging. Anesthesiologists and mechanical ventilation need to be placed on the patient’s right side. This will provide sufficient room to approach the robot on the left side with a 30-degree angulation to the patient’s head.

The robotic procedure was uneventful and was fully carried out. Chest tube drainage was removed on postoperative day 2 and the patient was discharged on postoperative day 7.

N Santelmo, A Olland

Surgical intervention

Middle lobectomy for a typical carcinoid tumor using 4 robotic arms

We present the case of a 78-year-old woman with a typical carcinoid tumor of the middle lobe of the lung. Bronchoscopy was carried out. A tumor lying in the deep segment of the middle lobe bronchus was identified by biopsy as a typical carcinoid tumor. We decided to perform middle lobectomy using a four-arm robotic assistance as it allows for a minimally invasive surgery.

The patient is intubated with a double lumen tracheal tube. The patient is placed in a left-sided decubitus with the right arm hanging. Anesthesiologists and mechanical ventilation need to be placed on the patient’s right side. This will provide sufficient room to approach the robot on the left side with a 30-degree angulation to the patient’s head.

The robotic procedure was uneventful and was fully carried out. Chest tube drainage was removed on postoperative day 2 and the patient was discharged on postoperative day 7.

Technique for endoscopic resection of obstructive endobronchial malignancy

Invasion of the tracheo-bronchial tree by a malignant pulmonary lesion is the most frequent cause of bronchial obstruction in the adult. Malignant obstruction of major airways may require endoscopic resection for rapid palliation of dyspnea and obstructive pneumonitis.
Patients should be evaluated with flexible bronchoscopy and computed tomography of the chest to assess the anatomy of the obstruction and demonstrate patent airway distally. This criterion is critical for optimal selection.
Resection is carried out in the operating room under general anesthesia. It is important to emphasize that close collaboration between the surgical and anesthesia teams is essential at all times, as they are sharing responsibility for the airway. We use rigid bronchoscopy for piecemeal extraction of the lesion. Since moderate bleeding may be encountered, the clinician should be familiar with hemostatic manoeuvres including dabbing raw bronchial surfaces using the rigid bronchoscope, the use of epinephrine soaked pledgets, and irrigation using epinephrine solution. Hemostasis may also be accomplished using energy sources delivered through a flexible bronchoscope, including electrocautery, argon beam, and Nd:YAG laser. All energy sources should be used with caution within the airway to minimize the risk of complications.
Depending on the individual patient, endobronchial resection may be combined with airway stenting and/or postoperative chemoradiotherapy. In carefully selected patients, this will result in adequate palliation of symptoms.
Acknowledgment: we would like to thank Nathalie Leroux RN and Suzanne Desbiens RN for their continued support.

G Rakovich

Surgical intervention

Technique for endoscopic resection of obstructive endobronchial malignancy

Invasion of the tracheo-bronchial tree by a malignant pulmonary lesion is the most frequent cause of bronchial obstruction in the adult. Malignant obstruction of major airways may require endoscopic resection for rapid palliation of dyspnea and obstructive pneumonitis.
Patients should be evaluated with flexible bronchoscopy and computed tomography of the chest to assess the anatomy of the obstruction and demonstrate patent airway distally. This criterion is critical for optimal selection.
Resection is carried out in the operating room under general anesthesia. It is important to emphasize that close collaboration between the surgical and anesthesia teams is essential at all times, as they are sharing responsibility for the airway. We use rigid bronchoscopy for piecemeal extraction of the lesion. Since moderate bleeding may be encountered, the clinician should be familiar with hemostatic manoeuvres including dabbing raw bronchial surfaces using the rigid bronchoscope, the use of epinephrine soaked pledgets, and irrigation using epinephrine solution. Hemostasis may also be accomplished using energy sources delivered through a flexible bronchoscope, including electrocautery, argon beam, and Nd:YAG laser. All energy sources should be used with caution within the airway to minimize the risk of complications.
Depending on the individual patient, endobronchial resection may be combined with airway stenting and/or postoperative chemoradiotherapy. In carefully selected patients, this will result in adequate palliation of symptoms.
Acknowledgment: we would like to thank Nathalie Leroux RN and Suzanne Desbiens RN for their continued support.

Transumbilical single incision laparoscopic left ovariectomy

Background: Transumbilical single incision laparoscopy has been reported to be a feasible and safe procedure to treat gynecologic diseases. This video presents a left ovariectomy performed in a patient with a symptomatic giant ovarian cyst.

Clinical case: A 56-year-old female with a body mass index of 20.5 kg/m2, was consulted for abdominal pain localized in the left iliac fossa. Preoperative work-up showed a left ovarian cyst of 12cm in diameter. The cyst appeared to be round, with smooth walls, homogenic liquid, and without intracystic proliferations. The procedure was performed using an 11mm reusable port for a 10mm, 30-degree standard length scope, and curved reusable instruments according to Dapri (Karl Storz Endoskope). The specimen was extracted through the umbilicus in a custom-made plastic bag.

Results: No conversion to open surgery nor additional ports were necessary. The laparoscopy lasted 37 minutes and the final umbilical incision length was 15mm. Pathological data revealed a serous cystadenoma. The patient was discharged on postoperative day 1. At 7-month follow-up, no late complications were found and the patient was asymptomatic.

Conclusions: Transumbilical single incision laparoscopy is beneficial for gynecologic diseases and this technique allow for a final scar of minimal size. The cost of the procedure is similar to that of multi-port laparoscopy.

G Dapri, M Degueldre

Surgical intervention

Transumbilical single incision laparoscopic left ovariectomy

Background: Transumbilical single incision laparoscopy has been reported to be a feasible and safe procedure to treat gynecologic diseases. This video presents a left ovariectomy performed in a patient with a symptomatic giant ovarian cyst.

Clinical case: A 56-year-old female with a body mass index of 20.5 kg/m2, was consulted for abdominal pain localized in the left iliac fossa. Preoperative work-up showed a left ovarian cyst of 12cm in diameter. The cyst appeared to be round, with smooth walls, homogenic liquid, and without intracystic proliferations. The procedure was performed using an 11mm reusable port for a 10mm, 30-degree standard length scope, and curved reusable instruments according to Dapri (Karl Storz Endoskope). The specimen was extracted through the umbilicus in a custom-made plastic bag.

Results: No conversion to open surgery nor additional ports were necessary. The laparoscopy lasted 37 minutes and the final umbilical incision length was 15mm. Pathological data revealed a serous cystadenoma. The patient was discharged on postoperative day 1. At 7-month follow-up, no late complications were found and the patient was asymptomatic.

Conclusions: Transumbilical single incision laparoscopy is beneficial for gynecologic diseases and this technique allow for a final scar of minimal size. The cost of the procedure is similar to that of multi-port laparoscopy.

Total septate uterus: surgical management

In this video, Dr. Olivier Garbin demonstrates the management of total septate uterus in a stepwise fashion. The procedure starts with the vaginal septum, division of the cervix, and continues with hysteroscopic resection of the septum. A previous 3D ultrasound is mandatory to differentiate septate uterus from bicornuate uterus.

O Garbin, A Wattiez, E Faller, J Albornoz, M Puga

Surgical intervention

Total septate uterus: surgical management

In this video, Dr. Olivier Garbin demonstrates the management of total septate uterus in a stepwise fashion. The procedure starts with the vaginal septum, division of the cervix, and continues with hysteroscopic resection of the septum. A previous 3D ultrasound is mandatory to differentiate septate uterus from bicornuate uterus.

Robot-assisted left adrenalectomy for Conn's adenoma

As laparoscopy is the standard approach to perform an adrenalectomy, robotic assistance is considered as an effective tool to perform this resection. Surgical steps follow those established for laparoscopy (i.e., mobilization of the spleen and of the pancreas in a patient placed in a lateral position, identification of the renal vein, control and division of the adrenal vein, successive freeing of the medial, external, inferior, and finally posterior aspects of the gland. The sealing devices such as ultrasonic dissectors are well adapted to perform this resection, and to safely control adrenal arteries. Robotic assistance takes full benefit from the degrees of freedom of the tips of the instruments and allows for an easy adrenal gland mobilization and removal.

D Mutter, L Soler, J Marescaux

Surgical intervention

Robot-assisted left adrenalectomy for Conn's adenoma

As laparoscopy is the standard approach to perform an adrenalectomy, robotic assistance is considered as an effective tool to perform this resection. Surgical steps follow those established for laparoscopy (i.e., mobilization of the spleen and of the pancreas in a patient placed in a lateral position, identification of the renal vein, control and division of the adrenal vein, successive freeing of the medial, external, inferior, and finally posterior aspects of the gland. The sealing devices such as ultrasonic dissectors are well adapted to perform this resection, and to safely control adrenal arteries. Robotic assistance takes full benefit from the degrees of freedom of the tips of the instruments and allows for an easy adrenal gland mobilization and removal.

Laparoscopic gastric pull-up in long-gap esophageal atresia

This is the case of a 2-year-old male preschooler, diagnosed with type III esophageal atresia. During the neonatal period, the patient had a right thoracotomy. Ligation of a tracheo-esophageal fistula and an esophago-esophagostomy were carried out, but failed because there was a long gap atresia. The measured gap of four vertebrae confirmed the diagnosis of long gap esophageal atresia; upon its evaluation by a multidisciplinary team, a laparoscopic gastric pull-up was carried out using 4 trocars: one 12mm, two 5mm and one 3mm trocar. The 6-hour duration of surgery was due to a firm adhesion of the esophagus to the posterior mediastinum. The patient had a favorable outcome without major complications. He remained in PICU for 72 hours and was extubated 48 hours after surgery. This is the sixth case of this particular pediatric surgeon and although our follow-up is still underway, we believe that laparoscopic pediatric surgeons with a certain degree of experience would be able to reproduce this technique, which is an excellent therapeutic option for the management of long gap esophageal atresia with good postoperative results.

A Parilli, W Garcia, I Galdon, G Contreras

Surgical intervention

Laparoscopic gastric pull-up in long-gap esophageal atresia

This is the case of a 2-year-old male preschooler, diagnosed with type III esophageal atresia. During the neonatal period, the patient had a right thoracotomy. Ligation of a tracheo-esophageal fistula and an esophago-esophagostomy were carried out, but failed because there was a long gap atresia. The measured gap of four vertebrae confirmed the diagnosis of long gap esophageal atresia; upon its evaluation by a multidisciplinary team, a laparoscopic gastric pull-up was carried out using 4 trocars: one 12mm, two 5mm and one 3mm trocar. The 6-hour duration of surgery was due to a firm adhesion of the esophagus to the posterior mediastinum. The patient had a favorable outcome without major complications. He remained in PICU for 72 hours and was extubated 48 hours after surgery. This is the sixth case of this particular pediatric surgeon and although our follow-up is still underway, we believe that laparoscopic pediatric surgeons with a certain degree of experience would be able to reproduce this technique, which is an excellent therapeutic option for the management of long gap esophageal atresia with good postoperative results.

Laparoscopic splenic cyst unroofing

This video shows the case of a young patient presenting with an 8cm splenic cyst associated with occasional left hypochondrium pain. A simple resection of the cyst dome is decided upon in order to heal the patient and preserve the spleen.

D Mutter, L Soler, J Marescaux

Surgical intervention

Laparoscopic splenic cyst unroofing

This video shows the case of a young patient presenting with an 8cm splenic cyst associated with occasional left hypochondrium pain. A simple resection of the cyst dome is decided upon in order to heal the patient and preserve the spleen.

Transumbilical laparoscopic total colectomy with S-Port™ and side-to-end ileorectal anastomosis for ulcerative colitis

The video entitled "Transumbilical laparoscopic total colectomy with S-Port™ and side-to-end ileorectal anastomosis for ulcerative colitis", authored by J Leroy, J D'Agostino, B Barry, and J Marescaux, is analyzed by Dr. Ronan Cahill, MD, FRCS (Beaumont Hospital, Dublin, Ireland), sharing in this way his own personal experience and highlighting the different surgical approaches available with tips and tricks.

R Cahill

Surgical intervention

Transumbilical laparoscopic total colectomy with S-Port™ and side-to-end ileorectal anastomosis for ulcerative colitis

The video entitled "Transumbilical laparoscopic total colectomy with S-Port™ and side-to-end ileorectal anastomosis for ulcerative colitis", authored by J Leroy, J D'Agostino, B Barry, and J Marescaux, is analyzed by Dr. Ronan Cahill, MD, FRCS (Beaumont Hospital, Dublin, Ireland), sharing in this way his own personal experience and highlighting the different surgical approaches available with tips and tricks.

Mucosal skinning for bladder endometriosis

Endometriosis of the bladder is mostly due to ademyosis of the isthmus uterinus involving the posterior wall of the bladder. Once the nodule has been detached from the anterior uterine wall, this video shows that a mucosal skinning or shaving of the bladder is possible and quite easy.

A Wattiez, E Faller, J Albornoz, M Puga

Surgical intervention

Mucosal skinning for bladder endometriosis

Endometriosis of the bladder is mostly due to ademyosis of the isthmus uterinus involving the posterior wall of the bladder. Once the nodule has been detached from the anterior uterine wall, this video shows that a mucosal skinning or shaving of the bladder is possible and quite easy.

Minimally invasive video-assisted parathyroidectomy (MIVAP): update on lecture given in November 2009

In this key lecture, Professor Paolo Miccoli gives an update of minimally invasive video-assisted parathyroidectomy. He presents some videos and reviews the literature presenting indications, contraindications as well as potential problems related to this technique.

Minimally invasive video-assisted parathyroidectomy (MIVAP): update on lecture given in November 2009

In this key lecture, Professor Paolo Miccoli gives an update of minimally invasive video-assisted parathyroidectomy. He presents some videos and reviews the literature presenting indications, contraindications as well as potential problems related to this technique.

Single port procedures: current state of the literature and contraindications

Single port surgery is currently feasible for different procedures but patients must be selected. In this lecture, Dr. Boni presents a large review of all the procedures that could be carried out using a single port access.

L Boni

Single port procedures: current state of the literature and contraindications

Single port surgery is currently feasible for different procedures but patients must be selected. In this lecture, Dr. Boni presents a large review of all the procedures that could be carried out using a single port access.

Single port right colectomy: surgical technique and results

In this lecture, Dr. Boni presents his experience in laparoscopic single port right colectomy. He shows his technique and presents the results of his series.

L Boni

Single port right colectomy: surgical technique and results

In this lecture, Dr. Boni presents his experience in laparoscopic single port right colectomy. He shows his technique and presents the results of his series.

Single port access

In this lecture, Dr. Bailez presents the indications of single port surgery in children. Benefits, indications and contraindications of this approach are discussed.

Single port access

In this lecture, Dr. Bailez presents the indications of single port surgery in children. Benefits, indications and contraindications of this approach are discussed.

Videosurgical treatment of pediatric varicocele

In this lecture, Professor Esposito presents the laparoscopic technique for varicocele treatment. Transperitonesl and retroperitoneal approaches are described. Functional results are also presented.

Videosurgical treatment of pediatric varicocele

In this lecture, Professor Esposito presents the laparoscopic technique for varicocele treatment. Transperitonesl and retroperitoneal approaches are described. Functional results are also presented.

Laparoscopic Mitrofanoff continent diversion in children

The Mitrofanoff principle represents a major contribution to continent urinary tract reconstruction in children and young adults. Since the original description by Mitrofanoff, many options have been reported for creating the catheterizable channel, including appendix, ureter, stomach tube, tapered ileum and tubularized bladder flap, and there are several anecdotal reports of using uterine (Fallopian) tube or vas deferens. In this lecture, Dr. El Ghoneimi presents his experience with this technique.

Laparoscopic Mitrofanoff continent diversion in children

The Mitrofanoff principle represents a major contribution to continent urinary tract reconstruction in children and young adults. Since the original description by Mitrofanoff, many options have been reported for creating the catheterizable channel, including appendix, ureter, stomach tube, tapered ileum and tubularized bladder flap, and there are several anecdotal reports of using uterine (Fallopian) tube or vas deferens. In this lecture, Dr. El Ghoneimi presents his experience with this technique.

Laser endomicroscopy in GI endoscopy: results and perspectives

Laser endomicroscopy (LE) has evolved to allow in vivo real-time biopsy for classification of digestive and other lesions. In this lecture, Dr. Moussata details the technique and presents her applications in gastrointestinal endoscopy.

Laser endomicroscopy in GI endoscopy: results and perspectives

Laser endomicroscopy (LE) has evolved to allow in vivo real-time biopsy for classification of digestive and other lesions. In this lecture, Dr. Moussata details the technique and presents her applications in gastrointestinal endoscopy.

Optimizing the endoscopy procedure towards EMR and ESD

Endoscopic submucosal dissection (ESD) of early gastrointestinal tumors has been shown to achieve complete resection rates superior to endoscopic mucosal resection (EMR), but at the cost of a higher risk. In this lecture, Dr. Schumacher explains how endoscopic techniques can be optimized.

Optimizing the endoscopy procedure towards EMR and ESD

Endoscopic submucosal dissection (ESD) of early gastrointestinal tumors has been shown to achieve complete resection rates superior to endoscopic mucosal resection (EMR), but at the cost of a higher risk. In this lecture, Dr. Schumacher explains how endoscopic techniques can be optimized.

Do we need to perform ESD for colorectal adenomas or can we continue to perform piecemeal EMR?

Endoscopic submucosal dissection (ESD) for colorectal lesions can achieve R0 excision. In this key lecture, Dr. Thierry Ponchon, MD, PhD, shows cases where it is preferable to perform the ESD technique and when EMR can be performed.

Do we need to perform ESD for colorectal adenomas or can we continue to perform piecemeal EMR?

Endoscopic submucosal dissection (ESD) for colorectal lesions can achieve R0 excision. In this key lecture, Dr. Thierry Ponchon, MD, PhD, shows cases where it is preferable to perform the ESD technique and when EMR can be performed.

Gastric mucosectomy: EMR? ESD?

Endoscopic mucosectomy is used for the management of different digestive lesions. In this lecture, Dr. Deprez presents the indications and contraindications of EMR and ESD in gastric lesions.

Gastric mucosectomy: EMR? ESD?

Endoscopic mucosectomy is used for the management of different digestive lesions. In this lecture, Dr. Deprez presents the indications and contraindications of EMR and ESD in gastric lesions.

ESD: technical definitions

Endoscopic submucosal dissection (ESD) is a technique for 'en bloc' resection of superficial tumors of the gastrointestinal tract. It is a more advanced procedure as compared to EMR. In this lecture, Dr. Deprez details the different aspects of this technique.

ESD: technical definitions

Endoscopic submucosal dissection (ESD) is a technique for 'en bloc' resection of superficial tumors of the gastrointestinal tract. It is a more advanced procedure as compared to EMR. In this lecture, Dr. Deprez details the different aspects of this technique.

New endoscopic approaches for obesity

In this lecture, Professor Deviere presents the different possible endoscopic techinques that could be currently proposed for the treatment of morbid obesity.

New endoscopic approaches for obesity

In this lecture, Professor Deviere presents the different possible endoscopic techinques that could be currently proposed for the treatment of morbid obesity.

Settings for an optimal use of the electrosurgical unit

In this lecture, Dr. Canard explains the importance of electrical settings when performing endoscopic procedures to avoid undesirable effects.

Settings for an optimal use of the electrosurgical unit

In this lecture, Dr. Canard explains the importance of electrical settings when performing endoscopic procedures to avoid undesirable effects.

Contrast-enhanced endoscopic ultrasound

Contrast-enhanced endoscopic ultrasonography (CE-EUS) was introduced in the early 1990s. After the advent of the first-generation contrast agent, high-frequency (12MHz) EUS brought about the enhancement of EUS images in the diagnosis of pancreatico-biliary diseases, upper gastrointestinal (GI) cancer, and submucosal tumors. In this lecture, Dr. Bories presents the different application of this technique.

Contrast-enhanced endoscopic ultrasound

Contrast-enhanced endoscopic ultrasonography (CE-EUS) was introduced in the early 1990s. After the advent of the first-generation contrast agent, high-frequency (12MHz) EUS brought about the enhancement of EUS images in the diagnosis of pancreatico-biliary diseases, upper gastrointestinal (GI) cancer, and submucosal tumors. In this lecture, Dr. Bories presents the different application of this technique.

Challenges of NOTES: from technical improvement to training and education

Surgical approches and technical instrumentations are in continuous development. In this lecture, Professor Didier Mutter, MD, PhD, FACS, presents the evolution of digestive surgery from open to minimally invasive approaches and presents the future perspectives of hybrid surgery.

Challenges of NOTES: from technical improvement to training and education

Surgical approches and technical instrumentations are in continuous development. In this lecture, Professor Didier Mutter, MD, PhD, FACS, presents the evolution of digestive surgery from open to minimally invasive approaches and presents the future perspectives of hybrid surgery.

Laparoscopic pullthrough for anorectal anomalies

This is an excellent lecture on anorectal malformations treated by the laparoscopic pull-through technique. The techniques, the indications and functional results are clearly presented by Dr. Bailez.

Laparoscopic pullthrough for anorectal anomalies

This is an excellent lecture on anorectal malformations treated by the laparoscopic pull-through technique. The techniques, the indications and functional results are clearly presented by Dr. Bailez.