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Monthly publications

#October 2019
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Laparoscopic living donor right hepatectomy (LLDH) fully exposing the right hepatic vein (conventional approach)
Introduction:
Laparoscopic living donor hepatectomy (LLDH) has gradually become a widespread technique in high volume transplant centers over the last decade.
Right LLDH is considered as a procedure which requires an expert level in both living donor liver transplantation and laparoscopic liver resection.
In order to fully expose and encircle the right hepatic vein before parenchymal transection implies the full mobilization of the right liver lobe as well as the clipping and cutting of the short hepatic veins in a same way as in a conventional open approach, using the hanging maneuver.
This approach could be more applicable as an initial experience in centers introducing the right LLDH.
Method: Right LLDH was demonstrated in a 31-year-old woman with standard liver anatomy. The procedure was performed using five ports with the patient placed in the French position. The graft was transplanted to a 10-year-old girl with Wilson’s disease (PELD score of 19).
Result: Operating time was 420 min. Blood loss was 120mL. Donor and recipient were discharged on postoperative day 6 and 28 respectively without any complications.
Conclusion: Right LLDH is a feasible procedure. The technique shown is reproducible.
A Monakhov, K Semash, K Khizroev, M Voskanov, SV Gautier
Surgical intervention
1 month ago
1040 views
13 likes
2 comments
10:38
Laparoscopic living donor right hepatectomy (LLDH) fully exposing the right hepatic vein (conventional approach)
Introduction:
Laparoscopic living donor hepatectomy (LLDH) has gradually become a widespread technique in high volume transplant centers over the last decade.
Right LLDH is considered as a procedure which requires an expert level in both living donor liver transplantation and laparoscopic liver resection.
In order to fully expose and encircle the right hepatic vein before parenchymal transection implies the full mobilization of the right liver lobe as well as the clipping and cutting of the short hepatic veins in a same way as in a conventional open approach, using the hanging maneuver.
This approach could be more applicable as an initial experience in centers introducing the right LLDH.
Method: Right LLDH was demonstrated in a 31-year-old woman with standard liver anatomy. The procedure was performed using five ports with the patient placed in the French position. The graft was transplanted to a 10-year-old girl with Wilson’s disease (PELD score of 19).
Result: Operating time was 420 min. Blood loss was 120mL. Donor and recipient were discharged on postoperative day 6 and 28 respectively without any complications.
Conclusion: Right LLDH is a feasible procedure. The technique shown is reproducible.
Laparoscopic segment 7 resection with extracorporeal Pringle maneuver on a cirrhotic liver
This is the case of a 73-year-old man presenting with a 33mm hepatocellular carcinoma arising on a Hepatitis C virus-related well-compensated cirrhosis without portal hypertension. A laparoscopic segment 7 atypical resection was decided upon. Five ports are placed. The procedure begins with complete abdominal exploration and intraoperative liver ultrasonography. The right triangular and coronary ligaments are divided in order to mobilize the right lobe and gain access to liver segment 7. The hepatic hilum is encircled with an umbilical tape. The tape is passed percutaneously through a 24 French chest tube used as Rommel’s tourniquet to allow for a safe and fast extracorporeal Pringle maneuver. The transection plane is controlled using ultrasound. The first part of parenchymal transection is performed using Thunderbeat™ while an ultrasonic dissector (CUSA™) is used more deeply. Hemostasis is controlled with irrigated bipolar forceps and clips on major vessels. To allow for a bloodless parenchymal transection and a more precise isolation and clipping of the vessels, the hepatic hilum is clamped for 10 minutes. The chest tube is pushed towards the hilum and clamped extracorporeally. After 10 minutes, the Pringle maneuver is released for 5 minutes and then repeated for another 10 minutes until parenchymal transection is complete. No drains are placed. Operative time took 180 minutes and total blood loss was 50mL. The postoperative course was uneventful and the patient was discharged on postoperative day 3. The pathology confirmed a 3cm hepatocellular carcinoma without microvascular invasion. Resection margins were negative for tumor invasion.
D Citterio, C Battiston, C Sposito, M Altomare, A Benedetti, V Mazzaferro
Surgical intervention
1 month ago
1164 views
9 likes
2 comments
10:10
Laparoscopic segment 7 resection with extracorporeal Pringle maneuver on a cirrhotic liver
This is the case of a 73-year-old man presenting with a 33mm hepatocellular carcinoma arising on a Hepatitis C virus-related well-compensated cirrhosis without portal hypertension. A laparoscopic segment 7 atypical resection was decided upon. Five ports are placed. The procedure begins with complete abdominal exploration and intraoperative liver ultrasonography. The right triangular and coronary ligaments are divided in order to mobilize the right lobe and gain access to liver segment 7. The hepatic hilum is encircled with an umbilical tape. The tape is passed percutaneously through a 24 French chest tube used as Rommel’s tourniquet to allow for a safe and fast extracorporeal Pringle maneuver. The transection plane is controlled using ultrasound. The first part of parenchymal transection is performed using Thunderbeat™ while an ultrasonic dissector (CUSA™) is used more deeply. Hemostasis is controlled with irrigated bipolar forceps and clips on major vessels. To allow for a bloodless parenchymal transection and a more precise isolation and clipping of the vessels, the hepatic hilum is clamped for 10 minutes. The chest tube is pushed towards the hilum and clamped extracorporeally. After 10 minutes, the Pringle maneuver is released for 5 minutes and then repeated for another 10 minutes until parenchymal transection is complete. No drains are placed. Operative time took 180 minutes and total blood loss was 50mL. The postoperative course was uneventful and the patient was discharged on postoperative day 3. The pathology confirmed a 3cm hepatocellular carcinoma without microvascular invasion. Resection margins were negative for tumor invasion.
Laparoscopic pancreaticoduodenectomy with venous reconstruction
Laparoscopic pancreaticoduodenectomy is an alternative to open surgery, which offers equivalent oncological results with a faster recovery associated with the minimally invasive approach. In cases of venous invasion, laparoscopic reconstruction with graft interposition is technically demanding. Nevertheless, good results can be achieved. This is the case of a 79-year-old man who was evaluated for jaundice. CT-scan found a tumor in the head of the pancreas with a 180-degree infiltration of the portal vein. After neoadjuvant chemotherapy with volumetric shrinking, but persistence of venous infiltration, a laparoscopic pancreaticoduodenectomy with venous reconstruction was decided upon.
E Giordano, A Alcaraz, S Reimondez, M Marani, W Salinas, R Pereyra, F Signorini, M Maraschio, L Obeide
Surgical intervention
1 month ago
1479 views
13 likes
1 comment
08:05
Laparoscopic pancreaticoduodenectomy with venous reconstruction
Laparoscopic pancreaticoduodenectomy is an alternative to open surgery, which offers equivalent oncological results with a faster recovery associated with the minimally invasive approach. In cases of venous invasion, laparoscopic reconstruction with graft interposition is technically demanding. Nevertheless, good results can be achieved. This is the case of a 79-year-old man who was evaluated for jaundice. CT-scan found a tumor in the head of the pancreas with a 180-degree infiltration of the portal vein. After neoadjuvant chemotherapy with volumetric shrinking, but persistence of venous infiltration, a laparoscopic pancreaticoduodenectomy with venous reconstruction was decided upon.
Revisional surgery: analysis of technical errors during failed bile duct injury repair
This is the case of a 42-year-old woman who suffered from bile duct injury during an elective cholecystectomy. Immediate repair was performed by means of an open Roux-en-Y hepaticojejunostomy. Five months later, she developed cholangitis. Critical stenosis of the anastomosis was demonstrated with percutaneous transhepatic cholangiography. She was transferred to our unit to address the failed reconstruction. Many clues on why the initial attempt at reconstruction failed were found during our surgery. Discussion of these errors and how to avoid them is the main objective of the video. Secondary learning objectives are to highlight the principles of high quality bilioenteric anastomosis and demonstration of our standard technique for bile duct injury repair.
JM Cabada-Lee
Surgical intervention
1 month ago
728 views
9 likes
1 comment
08:00
Revisional surgery: analysis of technical errors during failed bile duct injury repair
This is the case of a 42-year-old woman who suffered from bile duct injury during an elective cholecystectomy. Immediate repair was performed by means of an open Roux-en-Y hepaticojejunostomy. Five months later, she developed cholangitis. Critical stenosis of the anastomosis was demonstrated with percutaneous transhepatic cholangiography. She was transferred to our unit to address the failed reconstruction. Many clues on why the initial attempt at reconstruction failed were found during our surgery. Discussion of these errors and how to avoid them is the main objective of the video. Secondary learning objectives are to highlight the principles of high quality bilioenteric anastomosis and demonstration of our standard technique for bile duct injury repair.
Spleen-preserving total laparoscopic pancreatoduodenectomy
A 68-year-old woman was referred to us for multiple pancreatic cysts incidentally discovered on a routine ultrasound. An MRI was performed showing multiple cystic tumors throughout the pancreas, the largest of which was 15mm. This led to a suspicion of multifocal, side-branch intraductal papillary mucinous neoplasm (IPMN), with minimal dilatation of the main pancreatic duct. An echo-endoscopy was subsequently performed indicating the presence of a multifocal IPMN. A fine-needle aspiration (FNA) was performed during this procedure, with aspiration of cystic content which was sent for CEA analysis and cytology. Cytology was compatible with a mucinous neoplasm with mild atypia and CEA at 98 IU/mL.
A spleen-preserving total laparoscopic pancreatoduodenectomy was proposed. The procedure was uneventful and the patient was discharged on postoperative day 5. Pathology revealed a 19mm IPMN, with severe dysplasia and 3 foci of micro-invasive ductal adenocarcinoma of 1mm - pT1N0R0.
H Cristino, M Almeida, V Gomes, J Costa Maia
Surgical intervention
1 month ago
687 views
4 likes
1 comment
07:41
Spleen-preserving total laparoscopic pancreatoduodenectomy
A 68-year-old woman was referred to us for multiple pancreatic cysts incidentally discovered on a routine ultrasound. An MRI was performed showing multiple cystic tumors throughout the pancreas, the largest of which was 15mm. This led to a suspicion of multifocal, side-branch intraductal papillary mucinous neoplasm (IPMN), with minimal dilatation of the main pancreatic duct. An echo-endoscopy was subsequently performed indicating the presence of a multifocal IPMN. A fine-needle aspiration (FNA) was performed during this procedure, with aspiration of cystic content which was sent for CEA analysis and cytology. Cytology was compatible with a mucinous neoplasm with mild atypia and CEA at 98 IU/mL.
A spleen-preserving total laparoscopic pancreatoduodenectomy was proposed. The procedure was uneventful and the patient was discharged on postoperative day 5. Pathology revealed a 19mm IPMN, with severe dysplasia and 3 foci of micro-invasive ductal adenocarcinoma of 1mm - pT1N0R0.
Gastrojejunal anastomosis resizing with Argon Plasma Coagulation (APC) and Apollo OverStitch™ endoscopic suturing system: live procedure
In 2004, a 57-year-old lady underwent a Roux-en-Y gastric bypass (RYGB) for morbid obesity. After the surgical intervention, she lost 13Kg and she started to regain weight back with a current BMI of 41.
During this live procedure, Professor Perretta performs a gastroscopy that shows a normal gastric pouch and a gastrojejunal anastomosis increased in caliber. The operator does an endoscopic resizing of the anastomosis with Argon Plasma Coagulation (APC) followed by the placement of an endoscopic suture with the Apollo OverStitch™ endoscopic suturing system.
S Perretta, M Pizzicannella, B Dallemagne
Surgical intervention
2 months ago
710 views
4 likes
3 comments
30:14
Gastrojejunal anastomosis resizing with Argon Plasma Coagulation (APC) and Apollo OverStitch™ endoscopic suturing system: live procedure
In 2004, a 57-year-old lady underwent a Roux-en-Y gastric bypass (RYGB) for morbid obesity. After the surgical intervention, she lost 13Kg and she started to regain weight back with a current BMI of 41.
During this live procedure, Professor Perretta performs a gastroscopy that shows a normal gastric pouch and a gastrojejunal anastomosis increased in caliber. The operator does an endoscopic resizing of the anastomosis with Argon Plasma Coagulation (APC) followed by the placement of an endoscopic suture with the Apollo OverStitch™ endoscopic suturing system.
All you need to know to perform an ERCP for biliary stones extraction: live procedure
An 82-year-old man underwent an emergency endoscopic retrograde cholangiopancreatography (ERCP) for acute cholangitis secondary to choledocholithiasis 11 days earlier. At that time, since the patient was under Clopidogrel, the sphincterotomy was not performed and a plastic stent was released in the common bile duct (CBD) to bypass the stones. In this live procedure, Dr. Boškoski performs an ERCP with sphincterotomy and biliary stones extraction. During the procedure, the operator gives every fundamental tips and tricks to perform the correct procedure. At the end of the intervention, a 3D cholangiography is performed to confirm complete biliary stones extraction.
I Boškoski, M Pizzicannella
Surgical intervention
2 months ago
627 views
11 likes
1 comment
35:21
All you need to know to perform an ERCP for biliary stones extraction: live procedure
An 82-year-old man underwent an emergency endoscopic retrograde cholangiopancreatography (ERCP) for acute cholangitis secondary to choledocholithiasis 11 days earlier. At that time, since the patient was under Clopidogrel, the sphincterotomy was not performed and a plastic stent was released in the common bile duct (CBD) to bypass the stones. In this live procedure, Dr. Boškoski performs an ERCP with sphincterotomy and biliary stones extraction. During the procedure, the operator gives every fundamental tips and tricks to perform the correct procedure. At the end of the intervention, a 3D cholangiography is performed to confirm complete biliary stones extraction.
Endoscopic sleeve gastroplasty (ESG): live procedure
In this live procedure, Professor Perretta performs an endoscopic sleeve gastroplasty (ESG) using the OverStitch™ endoscopic suturing system (Apollo Endosurgery) in a 50-year-old obese male patient (with a BMI of 35.3). In this particular case, preoperative esophagogastroduodenoscopy (EGD) showed a Barrett’s esophagus with positive histology for intestinal metaplasia, which is not a contraindication for this kind of endoscopic intervention. ESG is performed with the patient under general anesthesia and carbon dioxide insufflation. The supine position is preferred because it is safer than the left lateral decubitus position as it allows for a better exposure of the stomach. Sutures are placed in a U-shaped fashion from the incisura angularis to the fundus, which is spared using the OverStitch™ suturing system, mounted on a double channel Olympus scope. The system allows for the placement of durable full-thickness stitches to obtain gastric volume reduction and shrinking.
S Perretta, M Pizzicannella, B Dallemagne
Surgical intervention
2 months ago
505 views
5 likes
1 comment
38:23
Endoscopic sleeve gastroplasty (ESG): live procedure
In this live procedure, Professor Perretta performs an endoscopic sleeve gastroplasty (ESG) using the OverStitch™ endoscopic suturing system (Apollo Endosurgery) in a 50-year-old obese male patient (with a BMI of 35.3). In this particular case, preoperative esophagogastroduodenoscopy (EGD) showed a Barrett’s esophagus with positive histology for intestinal metaplasia, which is not a contraindication for this kind of endoscopic intervention. ESG is performed with the patient under general anesthesia and carbon dioxide insufflation. The supine position is preferred because it is safer than the left lateral decubitus position as it allows for a better exposure of the stomach. Sutures are placed in a U-shaped fashion from the incisura angularis to the fundus, which is spared using the OverStitch™ suturing system, mounted on a double channel Olympus scope. The system allows for the placement of durable full-thickness stitches to obtain gastric volume reduction and shrinking.
Innovative technologies: robotic bariatric surgery
In this key lecture, Professor Leon Katz outlines innovative technologies in robotic bariatric surgery.
Dr. Leon Katz, a bariatric robotic surgeon, talks about the former limitations of robotic platforms and how recent technological developments have led to the creation of a new kind of platforms which offer a quick and simple docking process, greater flexibility of movements on surgical tables, less invasive accesses, and a greater versatility of instruments. Finally, with reference clinical cases, he illustrates the usefulness of robotic platforms in complex and challenging situations, in which they not only allow greater precision of surgical gestures, but also provide additional advantages for educational purposes.
L Katz
Lecture
2 months ago
62 views
0 likes
0 comments
12:46
Innovative technologies: robotic bariatric surgery
In this key lecture, Professor Leon Katz outlines innovative technologies in robotic bariatric surgery.
Dr. Leon Katz, a bariatric robotic surgeon, talks about the former limitations of robotic platforms and how recent technological developments have led to the creation of a new kind of platforms which offer a quick and simple docking process, greater flexibility of movements on surgical tables, less invasive accesses, and a greater versatility of instruments. Finally, with reference clinical cases, he illustrates the usefulness of robotic platforms in complex and challenging situations, in which they not only allow greater precision of surgical gestures, but also provide additional advantages for educational purposes.
Metabolic/bariatric surgery for type 2 diabetes
In this authoritative lecture, Dr. Buchwald focuses on metabolic and bariatric surgery for type 2 diabetes.
Through a valuable account of the historical evolution of the concept of metabolic surgery, Dr. Henry Buchwald, Professor of surgery and biomedical engineering as well as Owen and Sarah Davidson Wangensteen Chair in Experimental Surgery Emeritus at the University of Minnesota shows us the important role that different surgical procedures, both bariatric and non-bariatric, have played in the treatment of diverse metabolic pathologies, especially in the treatment of type 2 diabetes mellitus, emphasizing the rich and intense research activity which has generated this progress and the future of surgery in the treatment of chronic metabolic diseases.
H Buchwald
Lecture
2 months ago
113 views
0 likes
0 comments
23:01
Metabolic/bariatric surgery for type 2 diabetes
In this authoritative lecture, Dr. Buchwald focuses on metabolic and bariatric surgery for type 2 diabetes.
Through a valuable account of the historical evolution of the concept of metabolic surgery, Dr. Henry Buchwald, Professor of surgery and biomedical engineering as well as Owen and Sarah Davidson Wangensteen Chair in Experimental Surgery Emeritus at the University of Minnesota shows us the important role that different surgical procedures, both bariatric and non-bariatric, have played in the treatment of diverse metabolic pathologies, especially in the treatment of type 2 diabetes mellitus, emphasizing the rich and intense research activity which has generated this progress and the future of surgery in the treatment of chronic metabolic diseases.