Monthly publications : May 2015 | WebSurg, the online university of IRCAD

In this key lecture, Dr. Akladios outlines oncological situations in which laparoscopy should be considered. He shows the role of laparoscopy in advanced ovarian cancer, radical hysterectomy, and using a nerve-sparing approach, as well as in para-aortic lymphadenectomy.

CY Akladios, V Thoma, E Baulon, A Wattiez

Minimally invasive surgical oncology

In this key lecture, Dr. Akladios outlines oncological situations in which laparoscopy should be considered. He shows the role of laparoscopy in advanced ovarian cancer, radical hysterectomy, and using a nerve-sparing approach, as well as in para-aortic lymphadenectomy.

Transanal Endoscopic Surgery for cancer

In this key lecture, Dr. Whiteford outlines the transanal approach for early stage rectal cancer with current indications and video demonstrations.

Transanal Endoscopic Surgery for cancer

In this key lecture, Dr. Whiteford outlines the transanal approach for early stage rectal cancer with current indications and video demonstrations.

Transanal Endoscopic Surgery: complications

The transanal approach for early stage rectal cancer has been well established but some complications can sometimes occur. In this lecture, Dr. Whiteford demonstrates the complications related to this technique.

Transanal Endoscopic Surgery: complications

The transanal approach for early stage rectal cancer has been well established but some complications can sometimes occur. In this lecture, Dr. Whiteford demonstrates the complications related to this technique.

Comments from a beginner in robotic colorectal surgery

Laparoscopic colorectal surgery is currently a well-established approach. The robotic approach is emerging. In this lecture, Dr. Melani presents his early experience.

Comments from a beginner in robotic colorectal surgery

Laparoscopic colorectal surgery is currently a well-established approach. The robotic approach is emerging. In this lecture, Dr. Melani presents his early experience.

Obesity and laparoscopic colorectal surgery: what is different?

In the current surgical practice, surgeons are increasingly faced with obese patients in different conditions. In this lecture, Dr. Nahas presents the challenge of obesity in colorectal surgery.

Obesity and laparoscopic colorectal surgery: what is different?

In the current surgical practice, surgeons are increasingly faced with obese patients in different conditions. In this lecture, Dr. Nahas presents the challenge of obesity in colorectal surgery.

What impact has laparoscopy had on the Querleu classification of radical hysterectomy?

E Leblanc, F Kridelka

Laparoscopic resection for diverticulitis

In this authoritative lecture, Dr. Barry Salky reviews the laparoscopic management of sigmoid diverticulitis.

B Salky

Laparoscopic resection for diverticulitis

In this authoritative lecture, Dr. Barry Salky reviews the laparoscopic management of sigmoid diverticulitis.

Laparoscopic ventral mesh rectopexy in a male patient

Introduction
Ventral rectopexy, with or without mesh, has a lower recurrence rate than a perineal approach for rectal prolapse treatment. One of the techniques which are gaining a wider acceptance is the laparoscopic ventral mesh rectopexy, also called D'Hoore rectopexy. The unique feature of this technique is that it avoids any posterolateral dissection of the rectum. Clinical outcomes demonstrate that this technique present good results in terms of recurrence, a low rate of constipation induced by the procedure, as well a low risk of sexual dysfunction.

Clinical case
A 43-year-old man was admitted to our hospital with a one-year evolution of rectal prolapse with complaints of sporadic rectal bleeding and soiling. He reports daily bowel movements with a necessity of manual prolapse reduction. His past medical history includes follicular lymphoma. He has no history of previous surgeries.
After preoperative investigation with colonoscopy, a barium enema and anorectal function tests, a laparoscopic D’Hoore rectopexy was proposed to the patient.
In this video, we present the critical steps of the procedure with special attention to the preservation of the hypogastric nerves.
The postoperative outcome was uneventful. In the follow-up period, the patient reports a significant improvement of symptoms, without rectal prolapse at defecation, no constipation, and no change in sexual function.

M Manzanera Díaz, C Moreno Sanz, J De Pedro Conal, A Goulart, F Cortina Oliva

Surgical intervention

Laparoscopic ventral mesh rectopexy in a male patient

Introduction
Ventral rectopexy, with or without mesh, has a lower recurrence rate than a perineal approach for rectal prolapse treatment. One of the techniques which are gaining a wider acceptance is the laparoscopic ventral mesh rectopexy, also called D'Hoore rectopexy. The unique feature of this technique is that it avoids any posterolateral dissection of the rectum. Clinical outcomes demonstrate that this technique present good results in terms of recurrence, a low rate of constipation induced by the procedure, as well a low risk of sexual dysfunction.

Clinical case
A 43-year-old man was admitted to our hospital with a one-year evolution of rectal prolapse with complaints of sporadic rectal bleeding and soiling. He reports daily bowel movements with a necessity of manual prolapse reduction. His past medical history includes follicular lymphoma. He has no history of previous surgeries.
After preoperative investigation with colonoscopy, a barium enema and anorectal function tests, a laparoscopic D’Hoore rectopexy was proposed to the patient.
In this video, we present the critical steps of the procedure with special attention to the preservation of the hypogastric nerves.
The postoperative outcome was uneventful. In the follow-up period, the patient reports a significant improvement of symptoms, without rectal prolapse at defecation, no constipation, and no change in sexual function.

Gastrectomy for gastric cancer

In this key lecture, Dr. Hyung demonstrates his experience with the minimally invasive approach for gastric cancer, highlighting indications and video demonstrations of the procedure.

Gastrectomy for gastric cancer

In this key lecture, Dr. Hyung demonstrates his experience with the minimally invasive approach for gastric cancer, highlighting indications and video demonstrations of the procedure.

Laparoscopic treatment for pelvic organ prolapse

In this comprehensive lecture, Prof. Botchorishvili gives an overview of objectives, prerequisites, indications, limitations, preoperative work-up and technicalities of laparoscopic sacrocolpopexy.
Tips and tricks are addressed and focus on standard surgical steps and difficult cases. Outcomes are also underlined, with emphasis laid on postoperative recurrence rates.

Laparoscopic treatment for pelvic organ prolapse

In this comprehensive lecture, Prof. Botchorishvili gives an overview of objectives, prerequisites, indications, limitations, preoperative work-up and technicalities of laparoscopic sacrocolpopexy.
Tips and tricks are addressed and focus on standard surgical steps and difficult cases. Outcomes are also underlined, with emphasis laid on postoperative recurrence rates.

Duodenal mucosal resurfacing: a new procedural therapy for type 2 diabetes: safety and proof of principle, first in human clinical study

Bariatric surgery has emerged as a highly effective treatment for obesity and is increasingly recognized to have benefits for glycemic management in patients with pre-existing type 2 diabetes mellitus (T2DM). Understanding the efficacy and physiological effects of bariatric surgery on metabolism will push forward a novel approach to interventional procedures for diabetes treatment. In this key lecture, Dr. Galvao Neto presents the first result of a novel endoscopic approach to type 2 diabetes, namely duodenal mucosal resurfacing.

Duodenal mucosal resurfacing: a new procedural therapy for type 2 diabetes: safety and proof of principle, first in human clinical study

Bariatric surgery has emerged as a highly effective treatment for obesity and is increasingly recognized to have benefits for glycemic management in patients with pre-existing type 2 diabetes mellitus (T2DM). Understanding the efficacy and physiological effects of bariatric surgery on metabolism will push forward a novel approach to interventional procedures for diabetes treatment. In this key lecture, Dr. Galvao Neto presents the first result of a novel endoscopic approach to type 2 diabetes, namely duodenal mucosal resurfacing.

Endoscopic endonasal surgery in children

In this key lecture, Dr. Couloignier outlines endoscopic endonasal surgery in children.

Endoscopic endonasal surgery in children

In this key lecture, Dr. Couloignier outlines endoscopic endonasal surgery in children.

Strategy for laparoscopic total hysterectomy and bilateral salpingectomy in case of large uterus

This video demonstrates the case of a 46-year-old patient presented with menorrhagia and anemia.
Clinical examination revealed a large mass almost reaching the level of the umbilicus.
The uterus appeared much bigger than usual on MRI, with a large myoma coming out of the pelvis.
It was decided to perform total laparoscopic hysterectomy combined with bilateral salpingectomy.
This video demonstrates the appropriate strategy to safely perform total laparoscopic hysterectomy in case of large uterus, showing the appropriate surgical steps and providing safety tips. The specimen weighed more than 1kg.

A Wattiez, F Asencio, J Faria, I Argay, L Schwartz

Surgical intervention

Strategy for laparoscopic total hysterectomy and bilateral salpingectomy in case of large uterus

This video demonstrates the case of a 46-year-old patient presented with menorrhagia and anemia.
Clinical examination revealed a large mass almost reaching the level of the umbilicus.
The uterus appeared much bigger than usual on MRI, with a large myoma coming out of the pelvis.
It was decided to perform total laparoscopic hysterectomy combined with bilateral salpingectomy.
This video demonstrates the appropriate strategy to safely perform total laparoscopic hysterectomy in case of large uterus, showing the appropriate surgical steps and providing safety tips. The specimen weighed more than 1kg.

Principles of intracorporeal suturing

In this key lecture, Dr. Patkowski focuses on the principles of intracorporeal suturing.

Principles of intracorporeal suturing

In this key lecture, Dr. Patkowski focuses on the principles of intracorporeal suturing.

Virtual reality for paediatric surgery

In this key lecture, Dr. Soler covers the virtual reality for paediatric surgery.

L Soler

Virtual reality for paediatric surgery

In this key lecture, Dr. Soler covers the virtual reality for paediatric surgery.

Endoscopic solutions to bariatric complications

Bariatric surgery is widely performed and some specific complications are related to bariatric procedures. In this lecture, Dr. Galvao Neto looks into the endoscopic approach for different complications.

Endoscopic solutions to bariatric complications

Bariatric surgery is widely performed and some specific complications are related to bariatric procedures. In this lecture, Dr. Galvao Neto looks into the endoscopic approach for different complications.

Key steps of laparoscopic TAPP inguinal hernia repair

The transabdominal preperitoneal (TAPP) approach is the most frequently used laparoscopic technique for inguinal hernia repair. In this video, key steps of the procedures are demonstrated. Patient and port positioning, anatomical landmarks, and subtle technical tricks are provided by J Leroy, MD, FRCS, one of the pioneers of the technique. Interaction with the audience during this live demonstration addresses important issues of the technique.

J Leroy, M Bailey, D Mutter, J Marescaux

Surgical intervention

Key steps of laparoscopic TAPP inguinal hernia repair

The transabdominal preperitoneal (TAPP) approach is the most frequently used laparoscopic technique for inguinal hernia repair. In this video, key steps of the procedures are demonstrated. Patient and port positioning, anatomical landmarks, and subtle technical tricks are provided by J Leroy, MD, FRCS, one of the pioneers of the technique. Interaction with the audience during this live demonstration addresses important issues of the technique.

Epigastric hernia repair using laparoscopy

An 8-year-old girl was transferred to our hospital due to a localized abdominal midline protrusion. An epigastric defect was identified in the linea alba. It measured around 0.5cm in the largest diameter. Upon parental agreement, we proposed a laparoscopic repair.

J Correia-Pinto, J Moreira-Pinto, C Sousa

Surgical intervention

Epigastric hernia repair using laparoscopy

An 8-year-old girl was transferred to our hospital due to a localized abdominal midline protrusion. An epigastric defect was identified in the linea alba. It measured around 0.5cm in the largest diameter. Upon parental agreement, we proposed a laparoscopic repair.

Laparoscopic right hemihepatectomy with augmented reality

We report the case of a 42-year-old woman who underwent a laparoscopic right hemihepatectomy for a hepatic metastasis. The intervention is begun with the exploration of the entire peritoneal cavity and an intraoperative ultrasound exam of the liver. The lesion is identified by means of augmented reality. Dissection of the different vascular structures is then performed at the level of the hepatic pedicle. A clamping test of the right branches is achieved. The right branch of the hepatic artery and the right portal vein are clamped, hence creating the demarcation area, which is identified by means of the coagulating hook. Declamping of portal and arterial structures coursing towards the right liver is achieved. The right branch of the portal vein is divided between two clips. The right branch of the hepatic vein is also divided between two clips. After mobilization of the right liver, the hepatotomy is begun. The first superficial centimeters are divided using an ultrasonic dissector (Ultracision®). Dissection is then carried on by means of a Cusa® Dissectron® Ultrasonic Surgical Aspirator. The largest structures are subsequently dissected intraparenchymally, and then clipped and divided. Hemostasis is completed using a radiofrequency instrument. The right biliary tract is dissected intraparenchymally, clipped and divided. The right hepatic vein is divided by means of a stapler. The specimen is placed in a bag, which is extracted by means of a small Pfannenstiel incision. Hemostasis is controlled as the pneumoperitoneum is reduced. A blade is positioned in the hepatectomy area.

P Pessaux, J Hallet, R Memeo, X Untereiner, L Soler, D Mutter, J Marescaux

Surgical intervention

Laparoscopic right hemihepatectomy with augmented reality

We report the case of a 42-year-old woman who underwent a laparoscopic right hemihepatectomy for a hepatic metastasis. The intervention is begun with the exploration of the entire peritoneal cavity and an intraoperative ultrasound exam of the liver. The lesion is identified by means of augmented reality. Dissection of the different vascular structures is then performed at the level of the hepatic pedicle. A clamping test of the right branches is achieved. The right branch of the hepatic artery and the right portal vein are clamped, hence creating the demarcation area, which is identified by means of the coagulating hook. Declamping of portal and arterial structures coursing towards the right liver is achieved. The right branch of the portal vein is divided between two clips. The right branch of the hepatic vein is also divided between two clips. After mobilization of the right liver, the hepatotomy is begun. The first superficial centimeters are divided using an ultrasonic dissector (Ultracision®). Dissection is then carried on by means of a Cusa® Dissectron® Ultrasonic Surgical Aspirator. The largest structures are subsequently dissected intraparenchymally, and then clipped and divided. Hemostasis is completed using a radiofrequency instrument. The right biliary tract is dissected intraparenchymally, clipped and divided. The right hepatic vein is divided by means of a stapler. The specimen is placed in a bag, which is extracted by means of a small Pfannenstiel incision. Hemostasis is controlled as the pneumoperitoneum is reduced. A blade is positioned in the hepatectomy area.

Monopolar laparoscopic appendectomy

The laparoscopic approach is the gold standard for acute appendicitis. There are several surgical devices to achieve hemostatic control of the appendicular artery (monopolar electrocautery, endoclip, endostapler, ultrasonic scalpel, and LigaSure™ vessel-sealing device), which vary widely according to the surgeon’s preference and availability in the institution. All devices are effective and safe, but monopolar electrocautery systems are the most cost-effective ones.
A 24-year-old woman was admitted to our emergency department with a 24-hour evolution of right iliac fossa pain. No other symptoms were noted. An abdominal ultrasound was suggestive of an acute appendicitis.
This full length surgical movie shows the feasibility and safety of monopolar electrocautery for meso-appendiceal dissection. The intra-abdominal procedure was achieved in 5 minutes 30 seconds.
No complications were observed and the patient was discharged home on the next postoperative day.

P Leão, A Goulart

Surgical intervention

Monopolar laparoscopic appendectomy

The laparoscopic approach is the gold standard for acute appendicitis. There are several surgical devices to achieve hemostatic control of the appendicular artery (monopolar electrocautery, endoclip, endostapler, ultrasonic scalpel, and LigaSure™ vessel-sealing device), which vary widely according to the surgeon’s preference and availability in the institution. All devices are effective and safe, but monopolar electrocautery systems are the most cost-effective ones.
A 24-year-old woman was admitted to our emergency department with a 24-hour evolution of right iliac fossa pain. No other symptoms were noted. An abdominal ultrasound was suggestive of an acute appendicitis.
This full length surgical movie shows the feasibility and safety of monopolar electrocautery for meso-appendiceal dissection. The intra-abdominal procedure was achieved in 5 minutes 30 seconds.
No complications were observed and the patient was discharged home on the next postoperative day.

Endoscopic anatomy of the nasal cavities

In this key lecture, Dr. Debry outlines the endoscopic anatomy of nasal cavities.

C Debry

Endoscopic anatomy of the nasal cavities

In this key lecture, Dr. Debry outlines the endoscopic anatomy of nasal cavities.

Endoscopic anatomy of the ICA: its course and relationships to the Turky chair

In this key lecture, Dr. Keller outlines the endoscopic anatomy of the ICA, its course and relationships to the Turky chair.

Endoscopic anatomy of the ICA: its course and relationships to the Turky chair

In this key lecture, Dr. Keller outlines the endoscopic anatomy of the ICA, its course and relationships to the Turky chair.

Manual colorectal anastomosis during suprapubic single incision laparoscopic left hemicolectomy

Background: Single incision laparoscopic left hemicolectomy is a feasible procedure. A suprapubic access allows to offer satisfactory cosmetic results in case of an extended scar due to a large tumor. An intracorporeal circular mechanical anastomosis is the most common type. A manual anastomosis is feasible and allows to control lumen opening, potential bleeding, and overall to overcome the difficulty of transanal stapler insertion in case of high rectal transection.
Video: This video shows two different types of manual colorectal anastomosis, through a right suprapubic access.
1) Double-layer end-to-end
2) Monolayer end-to-end
Results: After an appropriate learning curve, time to perform the manual anastomosis is 40 minutes.
Conclusions: Different colorectal anastomoses can be performed and the surgeon has to choose the appropriate one, case by case.
To watch the video demonstrating the entire left hemicolectomy, please click here.

G Dapri

Surgical intervention

Manual colorectal anastomosis during suprapubic single incision laparoscopic left hemicolectomy

Background: Single incision laparoscopic left hemicolectomy is a feasible procedure. A suprapubic access allows to offer satisfactory cosmetic results in case of an extended scar due to a large tumor. An intracorporeal circular mechanical anastomosis is the most common type. A manual anastomosis is feasible and allows to control lumen opening, potential bleeding, and overall to overcome the difficulty of transanal stapler insertion in case of high rectal transection.
Video: This video shows two different types of manual colorectal anastomosis, through a right suprapubic access.
1) Double-layer end-to-end
2) Monolayer end-to-end
Results: After an appropriate learning curve, time to perform the manual anastomosis is 40 minutes.
Conclusions: Different colorectal anastomoses can be performed and the surgeon has to choose the appropriate one, case by case.
To watch the video demonstrating the entire left hemicolectomy, please click here.

Duodenal atresia: laparoscopy

In this key lecture, Dr. Becmeur looks into the laparoscopic management of duodenal atresia.

Duodenal atresia: laparoscopy

In this key lecture, Dr. Becmeur looks into the laparoscopic management of duodenal atresia.

Duodenal atresia repair: in vivo experimental model

In this key lecture, Dr. Correia-Pinto focuses on duodenal atresia repair using an in vivo experimental model.

Duodenal atresia repair: in vivo experimental model

In this key lecture, Dr. Correia-Pinto focuses on duodenal atresia repair using an in vivo experimental model.

Duodenal atresia and stenosis: technical details

In this key lecture, Dr Patkowski covers technical details related to duodenal atresia and stenosis.

Duodenal atresia and stenosis: technical details

In this key lecture, Dr Patkowski covers technical details related to duodenal atresia and stenosis.

Dorsal capsulo-scapholunate septum (DCSS): what’s up?

In this key lecture, Dr. van Overstraeten focuses on the dorsal capsulo-scapholunate septum (DCSS).

Dorsal capsulo-scapholunate septum (DCSS): what’s up?

In this key lecture, Dr. van Overstraeten focuses on the dorsal capsulo-scapholunate septum (DCSS).

Endoscopic approach to craniopharyngiomas

In this key lecture, Dr. Dufour focuses on the endoscopic approach to craniopharyngiomas.

Endoscopic approach to craniopharyngiomas

In this key lecture, Dr. Dufour focuses on the endoscopic approach to craniopharyngiomas.

Management of associated lesions in distal radius fracture

In this key lecture, Dr. van Overstraeten focuses on the management of associated lesions in distal radius fractures.

Management of associated lesions in distal radius fracture

In this key lecture, Dr. van Overstraeten focuses on the management of associated lesions in distal radius fractures.

Pure NOTES total transanal caudal-to-cranial low rectal resection

A 37-year-old female patient underwent a pure NOTES transanal rectal resection without transabdominal laparoscopic assistance for a rectal lesion located 5cm away from the anal verge (cT2N0M0 adenocarcinoma). All oncologic principles were fulﬁlled.
A GelPOINT Path Transanal® access platform was used. The procedure was achieved with no-flexible cameras and straight laparoscopic instruments. An Ultracision® device was used for dissection. A circular stapler with a long anvil was selected because it helped to achieve the anastomosis.
No complications were observed and the patient was discharged home on the third postoperative day.

P Leão, A Goulart, N Marcos, C Veiga, H Cristino

Surgical intervention

Pure NOTES total transanal caudal-to-cranial low rectal resection

A 37-year-old female patient underwent a pure NOTES transanal rectal resection without transabdominal laparoscopic assistance for a rectal lesion located 5cm away from the anal verge (cT2N0M0 adenocarcinoma). All oncologic principles were fulﬁlled.
A GelPOINT Path Transanal® access platform was used. The procedure was achieved with no-flexible cameras and straight laparoscopic instruments. An Ultracision® device was used for dissection. A circular stapler with a long anvil was selected because it helped to achieve the anastomosis.
No complications were observed and the patient was discharged home on the third postoperative day.

Laparoscopic resection of an epiphrenic diverticulum

This video shows a laparoscopic resection of a large epiphrenic diverticulum and an esophageal myotomy with partial posterior fundoplication. Abdominal obesity as well as an accessory left hepatic artery originating from the left gastric artery make dissection of the right para-esophageal area difficult. An anterior phrenotomy as well as the posterior retro-esophageal dissection towards the aorta make dissection of the diverticulum possible. The upper limit of the diverticulum is strongly attached to the esophagus and the pleura, and its dissection is difficult. After complete dissection of the diverticulum and with the guidance of an intraoperative endoscopy, resection is performed. As it is believed that an underlying motility disorder is present, a distal esophageal myotomy and partial fundoplication is added. The postoperative course was uneventful and the patient has no remaining symptoms.

P Vorwald, M Posada, S Ayora González, D Cortés, M de Vega Irañeta, C Ferrero, ML Sánchez de Molina

Surgical intervention

Laparoscopic resection of an epiphrenic diverticulum

This video shows a laparoscopic resection of a large epiphrenic diverticulum and an esophageal myotomy with partial posterior fundoplication. Abdominal obesity as well as an accessory left hepatic artery originating from the left gastric artery make dissection of the right para-esophageal area difficult. An anterior phrenotomy as well as the posterior retro-esophageal dissection towards the aorta make dissection of the diverticulum possible. The upper limit of the diverticulum is strongly attached to the esophagus and the pleura, and its dissection is difficult. After complete dissection of the diverticulum and with the guidance of an intraoperative endoscopy, resection is performed. As it is believed that an underlying motility disorder is present, a distal esophageal myotomy and partial fundoplication is added. The postoperative course was uneventful and the patient has no remaining symptoms.

Surgical approaches to the craniocervical junction

In this key lecture, Dr. Froelich outlines surgical approaches to the craniocervical junction.

Surgical approaches to the craniocervical junction

In this key lecture, Dr. Froelich outlines surgical approaches to the craniocervical junction.

Robot-assisted thoracic resection of an extended esophageal leiomyoma

Objective:
Leiomyomas represent approximately 70% of all benign esophageal tumors. In most cases, patients are asymptomatic, but others can present chest pain, dysphagia or weight loss. Even if malignization is rare, surgery is indicated. Laparoscopy is the most common approach because of the frequency of leiomyoma localization on the lower esophagus. However, thoracoscopy is also commonly performed with some difficulties in case of large tumors.
Our objective is to demonstrate the robotic approach and the bipolar Maryland forceps used for such a specific lesion.

Case presentation:
We present the case of a 58-year-old woman with no particular co-morbidity. On CT-scan, she was incidentally diagnosed with a leiomyoma for Guillain-Barre syndrome. A homogeneous 7cm tumor was found on the left side of the middle esophagus with a horseshoe-shaped aspect typical of leiomyoma. Check-up was completed by MRI and endoscopic ultrasonography, which tended to confirm the diagnosis.
In this video, the robot-assisted thoracic enucleation of the tumor performed by a left approach shows the quality of esophageal exposure and tumor dissection by means of a bipolar Maryland forceps. Blood loss was less than 30mL, and the postoperative period was uneventful. Histological analysis confirmed the diagnosis of leiomyoma.

Conclusion:
Robot-assisted resection of benign esophageal tumors is a safe procedure, especially for intrathoracic tumors. This technique provides a better view and easier dissection. The use of a bipolar Maryland forceps allows for a safer procedure. Day care surgery could then be expected for smaller lesions.

C Peillon, G Philouze, JM Baste

Surgical intervention

Robot-assisted thoracic resection of an extended esophageal leiomyoma

Objective:
Leiomyomas represent approximately 70% of all benign esophageal tumors. In most cases, patients are asymptomatic, but others can present chest pain, dysphagia or weight loss. Even if malignization is rare, surgery is indicated. Laparoscopy is the most common approach because of the frequency of leiomyoma localization on the lower esophagus. However, thoracoscopy is also commonly performed with some difficulties in case of large tumors.
Our objective is to demonstrate the robotic approach and the bipolar Maryland forceps used for such a specific lesion.

Case presentation:
We present the case of a 58-year-old woman with no particular co-morbidity. On CT-scan, she was incidentally diagnosed with a leiomyoma for Guillain-Barre syndrome. A homogeneous 7cm tumor was found on the left side of the middle esophagus with a horseshoe-shaped aspect typical of leiomyoma. Check-up was completed by MRI and endoscopic ultrasonography, which tended to confirm the diagnosis.
In this video, the robot-assisted thoracic enucleation of the tumor performed by a left approach shows the quality of esophageal exposure and tumor dissection by means of a bipolar Maryland forceps. Blood loss was less than 30mL, and the postoperative period was uneventful. Histological analysis confirmed the diagnosis of leiomyoma.

Conclusion:
Robot-assisted resection of benign esophageal tumors is a safe procedure, especially for intrathoracic tumors. This technique provides a better view and easier dissection. The use of a bipolar Maryland forceps allows for a safer procedure. Day care surgery could then be expected for smaller lesions.

Drainage in hernia repair

In this key lecture, Dr. Nahabedian reviews the indications for drain placement after open ventral hernia repair.

Drainage in hernia repair

In this key lecture, Dr. Nahabedian reviews the indications for drain placement after open ventral hernia repair.

Management of rectus diastasis

Rectus muscle diastasis is not a pathological condition. In this key lecture, Dr. Nahabedian presents the anatomical details of this condition and the indications for surgery.

Management of rectus diastasis

Rectus muscle diastasis is not a pathological condition. In this key lecture, Dr. Nahabedian presents the anatomical details of this condition and the indications for surgery.

Mesh fundamentals

In this key lecture, Dr. Nahabedian presents the concept and mesh principles of ventral and incisional hernia repair.

Mesh fundamentals

In this key lecture, Dr. Nahabedian presents the concept and mesh principles of ventral and incisional hernia repair.

Negative pressure wound therapy

Negative pressure wound therapy improves wound healing. In this key lecture, Dr. Nahabedian presents all aspects of this treatment.

Negative pressure wound therapy

Negative pressure wound therapy improves wound healing. In this key lecture, Dr. Nahabedian presents all aspects of this treatment.

Abdominal wall reconstruction (AWR): panniculectomy and cosmetic results

In this key lecture, Dr. Nahabedian reviews the procedures of panniculectomy and abdominal wall reconstruction.

Abdominal wall reconstruction (AWR): panniculectomy and cosmetic results

In this key lecture, Dr. Nahabedian reviews the procedures of panniculectomy and abdominal wall reconstruction.

Anatomy and function of the abdominal wall

In this key lecture, Dr. Adrian Park presents an overview of abdominal wall anatomy, function, defects and their management.

A Park

Anatomy and function of the abdominal wall

In this key lecture, Dr. Adrian Park presents an overview of abdominal wall anatomy, function, defects and their management.

Hernia health: a look ahead

In this key lecture, Dr. Park presents an exhaustive overview of abdominal hernia repair.

A Park

Hernia health: a look ahead

In this key lecture, Dr. Park presents an exhaustive overview of abdominal hernia repair.

Tips’n tricks in hysterectomy: opening of the broad ligament

This video footage demonstrates how to perform the opening of the broad ligament during a hysterectomy with or without adnexectomy.

L Schwartz, F Asencio, I Argay, J Faria, A Wattiez

Surgical intervention

Tips’n tricks in hysterectomy: opening of the broad ligament

This video footage demonstrates how to perform the opening of the broad ligament during a hysterectomy with or without adnexectomy.