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podcast

Beyond IRCAD - Surgical Journeys: Episode 8: A Wattiez

Introducing "Beyond IRCAD - Surgical Journeys". Join us on an inspiring and captivating monthly journey as we sit down with prestigious surgeons who have built remarkable careers in the field of medicine. In each episode, we explore the personal backgrounds and experiences of these exceptional individuals, as they share their inspiring stories of overcoming challenges, staying committed, and achieving success. Whether you're a medical professional, a student aspiring to be a surgeon, or simply someone looking for motivation from incredible human stories, this podcast is for you. 

Join us for a discussion with Professor Arnaud Wattiez, a world-leading gynecologic surgeon renowned for his dedication to excellence and mentorship. Professor Wattiez has not only advanced his field but also fostered a community of top surgeons through his teaching. We will also delve into his transformative journey from France to Dubai, exploring how this move profoundly impacted his personal and professional life, bringing him a newfound balance and contentment. Tune in for an inspiring tale of achievement and personal growth.

Beyond IRCAD - Surgical Journeys: Episode 8: Arnaud Wattiez

Introducing "Beyond IRCAD - Surgical Journeys". Join us on an inspiring and captivating monthly journey as we sit down with prestigious surgeons who have built remarkable careers in the field of medicine. In each episode, we explore the personal backgrounds and experiences of these exceptional individuals, as they share their inspiring stories of overcoming challenges, staying committed, and achieving success. Whether you're a medical professional, a student aspiring to be a surgeon, or simply someone looking for motivation from incredible human stories, this podcast is for you.

In this episode of "Beyond IRCAD", delve into Dr. Galvao Neto's journey as a modern surgeon, blending innovation with passion. Explore how he integrates music and dance into surgical preparation, highlighting the fusion of enjoyment and expertise. Discover the essential balance of surgical skills with empathy in the 21st century medical world, where active social media engagement is paramount.

Beyond IRCAD - Surgical Journeys: Episode 7: M Galvao Neto

Beyond IRCAD - Surgical Journeys: Episode 6: Nicolas Demartines

Introducing "Beyond IRCAD - Surgical Journeys". Join us on an inspiring and captivating monthly journey as we sit down with prestigious surgeons who have built remarkable careers in the field of medicine. In each episode, we explore the personal backgrounds and experiences of these exceptional individuals, as they share their inspiring stories of overcoming challenges, staying committed, and achieving success. Whether you're a medical professional, a student aspiring to be a surgeon, or simply someone looking for motivation from incredible human stories, this podcast is for you.

In this episode, Professor Nicolas Demartines discusses overcoming operating room challenges through humility, active listening, and humor. 

Explore the satisfaction of fostering empathy and giving back, as he emphasizes collaboration over competition in surgery for the benefit of the patient.

Beyond IRCAD - Surgical Journeys: Episode 5: Jacques Marescaux

Introducing "Beyond IRCAD - Surgical Journeys". Join us on an inspiring and captivating monthly journey as we sit down with prestigious surgeons who have built remarkable careers in the field of medicine. In each episode, we explore the personal backgrounds and experiences of these exceptional individuals, as they share their inspiring stories of overcoming challenges, staying committed, and achieving success. Whether you're a medical professional, a student aspiring to be a surgeon, or simply someone looking for motivation from incredible human stories, this podcast is for you.

In this episode of Beyond IRCAD, Professor Jacques Marescaux shares his keys to success. He talks about his wife’s essential role in the history of IRCAD, how he became a citizen of Rwanda, he reveals how WebSurg almost disappeared, and why Alsace was the perfect place for IRCAD. Discover how he managed to become not only a groundbreaking surgeon, but also a successful businessman.

Introducing "Beyond IRCAD - Surgical Journeys". Join us on an inspiring and captivating monthly journey as we sit down with prestigious surgeons who have built remarkable careers in the field of medicine. In each episode, we explore the personal backgrounds and experiences of these exceptional individuals, as they share their inspiring stories of overcoming challenges, staying committed, and achieving success. Whether you're a medical professional, a student aspiring to be a surgeon, or simply someone looking for motivation from incredible human stories, this podcast is for you.

In this episode, we interviewed Professor Mariano Gimenez, a globally renowned surgeon specializing in image-guided percutaneous surgery and HPB surgery. 

Join us for a unique perspective as Professor Gimenez emphasizes the personal dimensions that shape a distinguished surgical career, discussing the dangers of ego and the crucial role mentors play.

Beyond IRCAD - Surgical Journeys: Episode 4: Mariano Gimenez

Introducing "Beyond IRCAD - Surgical Journeys". Join us on an inspiring and captivating monthly journey as we sit down with prestigious surgeons who have built remarkable careers in the field of medicine. In each episode, we explore the personal backgrounds and experiences of these exceptional individuals, as they share their inspiring stories of overcoming challenges, staying committed, and achieving success. Whether you're a medical professional, a student aspiring to be a surgeon, or simply someone looking for motivation from incredible human stories, this podcast is for you.

In our third episode, we interviewed Professor Sébastien Froelich, a world-renowned skull base surgeon from France. Hear about his unexpected journey into surgery, how his work became a passionate pursuit, and the unique, humbling experiences with his patients. 

Join us for a captivating insight into Professor Froelich’s extraordinary career in skull base surgery!

Beyond IRCAD - Surgical Journeys: Episode 3: Sébastien Froelich

Introducing "Beyond IRCAD - Surgical Journeys". Join us on an inspiring and captivating monthly journey as we sit down with prestigious surgeons who have built remarkable careers in the field of medicine. In each episode, we explore the personal backgrounds and experiences of these exceptional individuals, as they share their inspiring stories of overcoming challenges, staying committed, and achieving success. Whether you're a medical professional, a student aspiring to be a surgeon, or simply someone looking for motivation from incredible human stories, this podcast is for you.

In our second episode, we are honored to feature the distinguished Dr. Xavier Serra Aracil, an innovative expert in the field of colorectal surgery from Spain. Tune in to gain insight into the remarkable path of Dr. Serra Aracil's outstanding career.



Discover the story behind his passion for surgery, the driving force that propels him forward, the values that guide his work and personal life, and explore the valuable advice he offers to the up-and-coming generation of aspiring surgeons.



Beyond IRCAD - Surgical Journeys: Episode 2: Xavier Serra Aracil

Introducing "Beyond IRCAD - Surgical Journeys". Join us on an inspiring and captivating monthly journey as we sit down with prestigious surgeons who have built remarkable careers in the field of medicine. In each episode, we explore the personal backgrounds and experiences of these exceptional individuals, as they share their inspiring stories of overcoming challenges, staying committed, and achieving success. Whether you're a medical professional, a student aspiring to be a surgeon, or simply someone looking for motivation from incredible human stories, this podcast is for you. 

In the very first episode, we have the privilege of hosting the renowned Dr. Armando Melani, a trailblazing colorectal surgeon hailing from Brazil. Join us as Dr. Melani takes us on a captivating exploration of his unique career path.



Discover the story behind his passion for surgery, the driving force that propels him forward, and the values that guide his work and life. Dr. Melani's dedication extends beyond the operating room, as he shares his profound commitment to passing on knowledge to the next generation of surgeons.



Stay tuned for an engaging conversation that goes "Beyond IRCAD”.

Beyond IRCAD - Surgical Journeys: Episode 1: Armando Melani

surgical intervention video

This is the case of a 75-year old female patient with a medical history of bilateral mastectomy due to cancer, which occurred 30 and 15 years before referral. She was treated using adjuvant chemotherapy (tamoxifen) and radiotherapy, and had a liver-related kidney donation. The patient was found asymptomatic when she underwent a control abdominal ultrasound, which showed a 6cm hepatic mass in liver segments V and VI. A hepatic MRI was performed and showed a single liver lesion (68mm in diameter) located in the right liver lobe, and a PET-CT-scan demonstrated an increased hypermetabolic activity of the lesion without other systemic tumor dissemination. A laparoscopic right hepatectomy was scheduled. A laparoscopic surgery was performed. Laparoscopic exploration revealed multiple bilateral lesions, and an intraoperative ultrasound demonstrated a lesion in liver segment IV. An ALPPS approach was considered. 

There were no complications and the patient was discharged on the third postoperative day.

Concurrent laparoscopic RYGB with a paraesophageal hernia (PEH) repair

BGYR laparoscópico concomitante com reparo de hérnia paraesofágica (REP)


Одновременное шунтирвоание желудка по Ру и пластика парапищеводной грыжи


并发腹腔镜RYGB伴食道疝（PEH）修复


BGYR laparoscópico concomitante con reparación de hernia paraesofágica


Bypass laparoscopique concomitant à cure de hernie para-œsophagienne


Mesh use in the laparoscopic repair of hiatal hernia is associated with fewer recurrences. However, it may cause some complications such as dysphagia, stenosis or even erosion with esophageal or gastric migration. 

A 61-year-old woman with a large type III hiatal hernia underwent a laparoscopic Toupet fundoplication with closure of the hiatal crura with a dual U-shaped mesh. 

She was symptom-free for 1 year, subsequently developing dysphagia and weight loss. An esophagogastric barium test revealed minimal contrast passage and endoscopy showed partial intragastric mesh migration. 

The patient was submitted to a laparoscopic removal of migrated mesh with a transgastric approach. Hiatus inspection demonstrated significant fibrosis, with plication integrity and no evidence of recurrent hernia. A gastrotomy was performed allowing to identify and remove a migrated intra-gastric mesh. Careful evaluation did not show any gastric fistula and pressure test with methylene blue showed no evidence of leak. 

This unusual approach avoided hiatus dissection, decreasing the risks of local complications such as perforation and bleeding. The patient had no postoperative complications, recovered well, and remained asymptomatic.

Surgical approach to intragastric migrated hiatal mesh

胃内迁移的裂孔网的手术方法


Хирургическое вмешательство по поводу мигрировавшего внутрижелудочного протеза после лечения грыжи пищеводного отверстия диафрагмы


Abordaje quirúrgico de la malla hiatal que migró hacia dentro del estómago


Approche chirurgicale suite à migration de prothèse hiatale intragastrique


Abordagem cirúrgica da tela hiatal que migrou para dentro do estômago


We present an esophagogastric disconnection and Roux-en-Y gastrojejunostomy as the fourth antireflux procedure in an obese patient with recurrent severe GERD despite high-dose PPI therapy. After previous Nissen fundoplications and a redo procedure with a partial posterior fundoplication, the patient now presented with an intrathoracic migration of the posterior fundoplication. In these complex redo scenarios in conjunction with a high BMI, the strategy of esophagogastric disconnection and Roux-en-Y reconstruction similarly to obesity surgery is increasingly being used.

Fourth antireflux procedure in a patient with a BMI of 35: esophagogastric disconnection and Roux-en-Y gastrojejunostomy  

4e intervention anti-reflux chez un patient avec un IMC de 35 : déconnexion gastro-œsophagienne et gastrojéjunostomie


Четвёртая антирефлюксная операция у пациента с ИМТ 35: разделение желудка и пищевода и гастроеюностомия по Ру


We present a Collis lengthening procedure followed by a Nissen fundoplication for a patient with severe gastroesophageal reflux disease (GERD) and sliding hiatal hernia with shortened esophagus. Intraoperative endoscopy shows the Z line at the level of the mediastinum, giving the indication for an esophageal lengthening procedure. The hiatal repair is reinforced by means of an absorbable mesh placement. 

HOW TO: Collis lengthening procedure for shortened esophagus

How to: удлиннение пищевода по Ру


HOW TO : gastroplastie selon Collis pour œsophage court


Bypass gástrico en Y de Roux laparoscópico (BGYRL) después de Nissen fallido


Pontage gastrique Roux-en-Y laparoscopique après l'échec d'un Nissen


This is the case of a 62-year old female patient with a BMI of 35 and a history of high blood pressure, dyslipidemia, and morbid obesity. She underwent a laparoscopic Nissen surgery 8 years earlier and presented with recurrent GERD symptoms. 



A CT-scan, an endoscopy, and a barium swallow showed a hiatal hernia. It was decided to perform a paraesophageal hernia repair as well as a gastric bypass. A laparoscopic surgery was performed.



There were no complications and the patient was discharged on the second postoperative day. An esogastroduodenal contrast examination was performed 1 month after the procedure. It showed the absence of hiatal hernia. The patient was controlled 3 months after surgery and was found asymptomatic with an Excess Weight Loss (EWL) of 42%.

Laparoscopic Roux-en-Y gastric bypass (RYGB) after failed Nissen

腹腔镜Roux-en-Y胃绕道手术（RYGB）失败Nissen后


Bypass gástrico em Y de Roux laparoscópico (BGYRL) após Nissen malsucedido


Лапароскопиеское шунтирование желудка по Ру после неудачной фундопликации по Ниссену

With more than 25 years of experience, we have created a unique laparoscopic Roux-en-Y gastric bypass technique with hand-sewn gastrojejunostomy and several additional steps which offer our patients a safe and reliable procedure. 

We routinely use 5 bladeless 12mm trocars. The procedure begins with the creation of a 15-20mL gastric pouch with a tilted orientation for the first stapling (not horizontal), and staple lines are oversewn for both gastric pouch and gastric remnant. A blue dye test is always performed at this stage. The second stage of the procedure includes the creation of a 75cm biliopancreatic limb with division of the mesentery and creation of a mechanical jejunojejunostomy with a 100cm alimentary limb, and hand-sewn closure of the enterotomy. Anti-torsion stitches are mandatory at this point. Closure of mesenteric defects (intermesenteric space and Petersen's space) is accomplished with non-absorbable sutures performed in a routine manner. The third and final stage of the procedure involves the creation of the hand-sewn gastrojejunostomy with an interposed limb and 4 layers of absorbable sutures over a 28-30 French bougie. 

Closure of all trocar defects is performed in every patient. 

A stepwise personal technique of RYGB with hand-sewn gastrojejunostomy

Una técnica personal paso a paso del BGYR con gastroyeyunostomía por sutura manual


Uma técnica pessoal passo-a-passo do BGYR com gastrojejunostomia por sutura manual


RYGB手工缝合胃空肠吻合术的逐步个人化技术


Technique de bypass gastrique personnelle par étapes avec gastrojéjunostomie suturée manuellement


Пошаговая техника шунтирования желудка по Ру с ручным формированием гастроэнтеронастомоза


Лапароскопическая трансдиафрагмальная эзофагэктомия по поводу ахалазии

Introduction: Idiopathic achalasia is the most frequent esophageal motility disorder. Generally, treatment is the "palliation" of symptoms and improvement in quality of life. Although Heller myotomy is the standard treatment, achieving good results in 90 to 95% of cases, esophagectomy is required in 5 to 10% of cases. 

The authors present a case of a laparoscopic transhiatal esophagectomy with Akiyama tube reconstruction in a woman with long-term achalasia and megaesophagus.

Clinical case: A 54-year-old woman, with a previous history of a "psychological eating disorder", was referred to the Emergency Department. She complained of epigastric pain and dysphagia. A thoraco-abdominal CT-scan was requested and revealed a dilated, tortuous, sigmoid esophagus, filled with food content, with no identifiable mass causing obstruction. The patient was admitted to hospital and further study was performed --esophagogastroscopy and esophageal manometry - which confirmed the diagnosis of achalasia with esophageal aperistalses.

The patient was proposed a laparoscopic transhiatal esophagectomy with Akiyama tube reconstruction. 

No complications were reported in the postoperative period, and discharge was possible on postoperative day 7. Six months later, an esophagram showed adequate contrast passage and progression. 

Discussion/Conclusion: Esophagectomy as a primary treatment of achalasia might be considered if severe symptomatic (dysphagia, regurgitation), anatomical (megaesophagus) or functional (esophagus aperistalses) disorders are contraindications to a more conservative approach. 

Laparoscopic transhiatal esophagectomy with Akiyama tube reconstruction for a terminal achalasia

腹腔镜食管切开术治疗终末贲门失弛缓症


Esofagectomía transhiatal laparoscópica con reconstrucción con tubo de Akiyama para acalasia terminal


Oesophagectomie laparoscopique transhiatale avec reconstruction du tube d'Akiyama pour achalasie terminale


Esofagectomia trans-hiatal laparoscópica com reconstrução com tubo de Akiyama para acalasia terminal


A 65-year-old woman was referred to our hospital with complaints of dysphagia. She had a surgical history of cesarean section and cholecystectomy. Esophageal motility examination showed a normal lower esophageal sphincter (LES), and the absence of hiatal hernia and spasm in the distal part of the esophagus. The barium X-ray showed a bulky diverticulum in the middle thoracic esophagus and barium collecting inside the diverticulum without obstruction. The 3D-CT image also showed a giant diverticulum in the middle esophagus. The diverticulum was located below the azygos vein and carina of the bronchus and was sticking out from the middle esophagus in the contralateral side of the thoracic aorta. The diverticulum does not invade other organs. The patient was then proposed for an elective surgery, a thoracoscopic esophageal diverticulectomy and myotomy in a prone position.

LIVE INTERACTIVE SURGERY: thoracoscopic esophageal diverticulectomy and myotomy

实时交互式手术：胸腔镜食管憩室切除术和肌切开术


CIRUGÍA INTERACTIVA EN VIVO: diverticulectomía esofágica toracoscópica y miotomía 


CHIRURGIE LIVE INTERACTIVE: diverticulectomie et myotomie oesophagienne par thoracoscpie 


CIRURGIA INTERATIVA AO VIVO: diverticulectomia esofágica toracoscópica e miotomia 


LIVE хирургия: торакоскопическая дивертикулэктомия пищевода и миотомия

Percutaneous transhepatic biliary drainage is an effective method for the primary or palliative treatment of many biliary strictures. It is a procedure which includes the cannulation of an intrahepatic biliary tree using image-guided wire and catheter manipulation, and placement of a tube or stent for external and/or internal drainage. This video shows this technique applied in a patient with a pancreatic tumor. 

This is the case of an 80-year-old male patient with signs of jaundice and a diagnosis of intrahepatic and extrahepatic bile duct dilatation and pancreatic tumor. 

A transhepatic percutaneous biliary tract drainage was the therapeutic strategy. 

Transhepatic percutaneous biliary tract drainage

Drainage percutané trans-hépatique des voies biliaires 


Drenagem percutânea trans-hepática do trato biliar


Drenaje percutáneo transhepático del tracto biliar


经肝胆道引流


Транспечёночное чрескожное дренирование желчных путей

Gastrostomy tube placement is a common procedure in the pediatric population. We present an alternative surgical approach. This approach simplifies the technical aspects of gastrostomy tube placement, and reduces complications rates by means of direct laparoscopic and endoscopic visualization of the gastrostomy tube placement.

Laparoscopic-assisted gastrostomy with upper endoscopy

腹腔镜辅助胃造瘘术与上部内窥镜检查


Gastrostomía asistida por laparoscopia con endoscopia superior


Gastrostomia assistida por laparoscopia com endoscopia superior


Лапароскопическая гастростомия с верхней эндоскопией

Gastrostomie assistée par laparoscopie avec endoscopie haute




This video presents the case of a 67-year-old man who was referred for surgical resection of a metachronous colorectal liver metastasis in liver segment 1, in contact with the inferior vena cava. The diagnosis of a 50mm mass was established after a 20-month oncological follow-up. The patient was asymptomatic. His CEA level was 6.9µg/L. Neoadjuvant chemotherapy with FOLFIRI-bevacizumab was administered but no downsizing was observed after six cycles. As a result, a surgical resection was decided upon. 

The first step of the procedure was a laparoscopic ultrasonographic assessment of the extension of vascular invasion. The evaluation revealed a preserved surface between the tumor and the inferior vena cava. Consequently, the procedure was continued laparoscopically. Liver segment 1 was resected and the inferior vena cava was completely exposed. No vascular resection was required. The postoperative period was uneventful, and the patient was discharged on postoperative day 3. 

Laparoscopic liver surgery offers many advantages when compared to open liver surgery. However, laparoscopy has still not proven its added value in vascular invasion and vascular reconstruction settings. This video aims to show how a stepwise approach with detailed perioperative ultrasonographic evaluation helps to refine the preoperative iconography and tailor the surgical strategy. The value of a meticulous anatomical dissection in laparoscopic liver surgery becomes more evident in cases of possible vascular invasion when precision surgery is vital. 



Bibliography:

1. Ferrero A, Russolillo N, Langella S, Forchino F, Stasi M, Fazio F, Lo Tesoriere R. Ultrasound liver map technique for laparoscopic liver resections: perioperative outcomes are not impaired by technical complexity. Updates Surg. 2019 Mar;71(1):49-56. doi: 10.1007/s13304-019-00646-z. Epub 2019 Mar 27. PMID: 30919242.

2. Kumon M, Kumon T, Tsutsui E, Ebashi C, Namikawa T, Ito K, Sakamoto Y. Definition of the caudate lobe of the liver based on portal segmentation. Glob Health Med. 2020 Oct 31;2(5):328-336. doi: 10.35772/ghm.2020.01088. PMID: 33330828; PMCID: PMC7731356.

Laparoscopic liver segment I resection of colorectal liver metastasis in contact with the inferior vena cava

Segmentectomie hépatique laparoscopique (segment 1) pour métastase hépatique colorectale en contact avec la veine cave inférieure

Lobectomie gauche laparoscopique pour la prise en charge d’une tumeur des cellules épithélioïdes périvasculaires (PECome) 

Laparoscopic left lobectomy for liver perivascular epithelioid cell neoplasm (PEComa) 

Œsophagectomie selon Ivor-Lewis par voies d'abord laparoscopique puis thoracoscopique avec anastomose par agrafage linéaire pour adénocarcinome de la jonction œso-gastrique

This is the case of a 74-year-old male patient who admitted to the hospital due to two episodes of melena over the last 3 months. Esophagogastroduodenoscopy (EGD) showed a Siewert II ulcerated lesion in the esophagogastric junction. Endoscopic ultrasound (EUS) revealed an ulcerative mucosal lesion, which infiltrated the submucosa. Biopsy revealed a moderately differentiated invasive adenocarcinoma. It was decided to perform a laparoscopic and thoracoscopic Ivor-Lewis esophagectomy. 

The postoperative period was uneventful. The patient was discharged on postoperative day 7 without pleural drainage. Pathological findings revealed a 2cm moderately differentiated adenocarcinoma. The pathological stage was E2B (T2N1M0). 

The intrathoracic stapled side-to-side anastomosis technique seemed feasible, safe, and easy to perform with a limited post-surgical complication rate and good functional outcomes (1, 2). Early leakage occurs in 5.1% of patients, none requiring surgical intervention. Anastomotic strictures were diagnosed in 5.1% of patients and such patients required endoscopic dilatation only and presented good outcomes (3).

Minimally invasive Ivor-Lewis esophagectomy showed significantly less severe perioperative morbidity than McKeown esophagectomy, although both procedures had similar rates of severe pulmonary complications and anastomotic leaks. These findings confirm the safety of minimally invasive Ivor-Lewis esophagectomies for esophageal cancer when it is oncologically and clinically appropriate (4).



Take-home message: 

Patients with esophagogastric junction cancer can be treated with a laparoscopic and thoracoscopic Ivor-Lewis esophagectomy with linear-stapled anastomosis due to the safety and the optimal results of this surgical technique.



Bibliography:

1. Irino T, Tsai JA, Ericson J, Nilsson M, Lundell L, Rouvelas I. Thoracoscopic side-to-side esophagogastrostomy by use of linear stapler—a simplified technique facilitating a minimally invasive Ivor-Lewis operation. Langenbeck’s Arch Surg. 2016;401(3):315-322. doi:10.1007/s00423-016-1396-1

2. Fabbi M, van Berge Henegouwen MI, Fumagalli Romario U, et al. End-to-side circular stapled versus side-to-side linear stapled intrathoracic esophagogastric anastomosis following minimally invasive Ivor–Lewis esophagectomy: comparison of short-term outcomes. Langenbeck’s Arch Surg. 2022;407(7):2681-2692. doi:10.1007/S00423-022-02567-9/METRICS

3. Kukar M, Ben-David K, Peng JS, et al. Minimally Invasive Ivor-Lewis Esophagectomy with Linear Stapled Anastomosis Associated with Low Leak and Stricture Rates. J Gastrointest Surg. 2020;24(8):1729-1735. doi:10.1007/s11605-019-04320-y

4. Brown AM, Pucci MJ, Berger AC, et al. A standardized comparison of peri-operative complications after minimally invasive esophagectomy: Ivor-Lewis versus McKeown. Surg Endosc. 2018;32(1):204-211. doi:10.1007/s00464-017-5660-4



Laparoscopic and thoracoscopic Ivor-Lewis esophagectomy with linear-stapled anastomosis for esophagogastric junction adenocarcinoma

video lecture

Professors Julie Hallett, MD, MSc, FRCSC and Jenny Meng Shao Kashmanian, MD, FACS are experts in surgical ergonomics, and here they explain how robotic surgeons can avoid musculoskeletal pain and injury using simple practical changes.

Best ergonomic practices: robotic surgery

Meilleures pratiques ergonomiques : chirurgie robotique

Résection laparoscopique du duodénum distal avec préservation du pancréas pour adénome duodénal

Introduction

Small bowel (SB) malignant tumors are rare and cause non-specific symptoms, often leading to a late diagnosis. Most SB adenocarcinomas are found in the duodenum and arise from adenomas. Surgery is usually reserved for endoscopically non-excisable adenomas.



Materials and methods

It is the case of a patient with a D3 duodenal adenoma who underwent a laparoscopic duodenectomy.



Results

This is the case of a 58-year-old woman without any relevant personal medical history. Due to dyspepsia and heartburn, an endoscopy was performed and showed an irregular sessile polyp in the duodenum (D3) located 5cm away from the ampulla of Vater and not excisable endoscopically. A tattoo was performed. Biopsies revealed an adenomatous polyp with low-grade dysplasia (LGD). CT-scan showed a 15 by 13mm polypoid focal parietal thickening in D3, without extraparietal extension. No other changes were noted.

MRI revealed a 19 by 13 by 28mm polypoid lesion in D3 to the right and anteriorly to the abdominal aorta, without invasion of adjacent structures.

A laparoscopic D3-D4 duodenectomy with a mechanical intracorporeal side-to-side duodenojejunostomy were performed uneventfully. Preservation of the ampulla of Vater was confirmed via intraoperative endoscopy. An intraoperative methylene blue test was performed and did not reveal any leaks. The postoperative period was uneventful, and the patient was discharged on postoperative day 5. Histological exam revealed a 45 by 15mm tubulovillous adenoma with low-grade dysplasia. The patient was asymptomatic and was followed up.



Conclusion

SB adenomas are benign lesions with a significant potential to become malignant and develop into villous adenomas. Duodenal adenomas larger than 2cm and with ampullary location carry a higher risk of malignancy. Upper endoscopy is performed either for diagnostic or therapeutic purposes. Endoscopic resection must be performed in experienced centers. Surgery is indicated in cases of endoscopic unresectability. The laparoscopic approach offers the best outcomes.



Bibliography

1. Chathadi K., et al. The role of endoscopy in ampullary and duodenal adenomas. Gastrointest Endosc 2015 Nov;82(5):773-81.

2. Kemp C., et al. Resection of benign duodenal neoplasms. Am Surg. 2007 Nov;73(11):1086-91.

3. Talamonti MS., et al. Primary cancers of the small bowel: analysis of prognostic factors and results of surgical management. Arch Surg. 2002;137(5):564. 

4. Amitabh Yadav, Samiran Nundy. Case series of non-ampullary duodenal adenomas. Annals of Medicine and Surgery, Volume 69, 2021, 102730, ISSN 2049-0801.

Laparoscopic distal duodenal resection with pancreatic preservation for duodenal adenoma

In this authoritative lecture, Dr. De Keating-Hart, MD focuses on the ultrasound-guided antegrade technique for carpal tunnel syndrome.

Ultrasound-guided antegrade technique for carpal tunnel syndrome 

Technique antégrade guidée par ultrasons pour syndrome du canal carpien 

Résection extrahépatique de la voie biliaire principale par laparoscopie et hépaticojéjunostomie selon Roux pour kyste du cholédoque

This video demonstrates a laparoscopic extrahepatic bile duct resection and a Roux-en-Y hepaticojejunostomy technique in a 48-year-old female patient for a choledochal cyst. Diagnostic imaging performed for abdominal pain was consistent with a Todani type Ic choledochal cyst. She had a surgical history of cholecystectomy for cholecystolithiasis and sleeve gastrectomy for morbid obesity. During the hepaticojejunostomy, tearing of the bile duct and its management are outlined in the video.



Bibliography:

1. Xiao J, Chen M, Hong T, Qu Q, Li B, Liu W, He X. Surgical Management and Prognosis of Congenital Choledochal Cysts in Adults: A Single Asian Center Cohort of 69 Cases. J Oncol. 2022 Jan 21;2022:9930710. doi: 10.1155/2022/9930710. PMID: 35096065

2. Zhang K, Zhao D, Xie X, Wang W, Xiang B. Laparoscopic surgery versus robot-assisted surgery for choledochal cyst excision: A systematic review and meta-analysis. Front Pediatr. 2022 Oct 26;10:987789. doi: 10.3389/fped.2022.987789. PMID: 36389347

3. Yin T, Chen S, Li Q, Huang T, Li L, Diao M. Comparison of outcomes and safety of laparoscopic and robotic-assisted cyst excision and hepaticojejunostomy for choledochal cysts: A systematic review and meta-analysis. Ann Med Surg (Lond). 2022 Feb 26;75:103412. doi: 10.1016/j.amsu.2022.103412. PMID: 35386800



Laparoscopic extrahepatic bile duct resection and Roux-en-Y hepaticojejunostomy for choledochal cyst

This video presents the case of a 48-year-old male patient who presented with diarrhea. Colonoscopy showed two ulcerative adenocarcinomas in the descending colon and splenic flexure. CT-scan revealed two liver metastases. It was decided to perform a preoperative chemotherapy to reduce the liver metastases. A hepatectomy and a left colectomy were also performed simultaneously. 



Bibliographic references: 

1. Krell, R. W., & D’Angelica, M. I. (2019). Treatment sequencing for simultaneous colorectal liver metastases. Journal of Surgical Oncology, 119(5), 583‑593. https://doi.org/10.1002/jso.25424 

2. Avella, P., Vaschetti, R., Cappuccio, M., Gambale, F., DE Meis, L., Rafanelli, F., Brunese, M. C., Guerra, G., Scacchi, A., & Rocca, A. (2022). The role of liver surgery in simultaneous synchronous colorectal liver metastases and colorectal cancer resections: A literature review of 1730 patients underwent open and minimally invasive surgery. Minerva Surgery, 77(6), 582 590. https://doi.org/10.23736/S2724-5691.22.09716-7 

3. Reddy, S. K., Pawlik, T. M., Zorzi, D., Gleisner, A. L., Ribero, D., Assumpcao, L., Barbas, A. S., Abdalla, E. K., Choti, M. A., Vauthey, J.-N., Ludwig, K. A., Mantyh, C. R., Morse, M. A., & Clary, B. M. (2007). Simultaneous resections of colorectal cancer and synchronous liver metastases: A multi-institutional analysis. Annals of Surgical Oncology, 14(12), 3481‑3491. https://doi.org/10.1245/s10434-007-9522-5 



Laparoscopic left colectomy and lateral left hepatectomy for colorectal cancer and liver metastasis

Colectomie gauche laparoscopique et hépatectomie latérale gauche pour le traitement d’un cancer colorectal et de métastases hépatiques

This video presents the case of a 50-year-old woman who underwent a laparoscopic pylorus-preserving pancreaticoduodenectomy (PPPD) for a 4cm mucinous cystic pancreatic neoplasm (MCPN). The authors demonstrate the key steps of this operation using a 3D laparoscopic technique. The pancreaticojejunostomy (PJ) was performed using a duct-to-mucosa technique in the setting of a soft pancreas and small 2mm pancreatic duct. The video shows that the duct-to-mucosa technique for PJ is technically feasible and safe, even in the setting of a soft pancreas and small pancreatic duct – traditionally known as risk factors for post-operative pancreatic fistulae (1). 



Take-home messages:

Our video shows that the duct-to-mucosa technique for pancreaticojejunostomy is technically feasible and safe, even in the setting of a soft pancreas and small pancreatic duct. 



Bibliography:

1. Hassan, R. A., Zidan, A. M., Jabir, M. A., Abdelshafy, M., Abdallah, M., & Taha, A. (2022, August 1). Risk factors predicting the development of a pancreatic fistula following pancreaticoduodenectomy: A retrospective cohort study. International Journal of Surgery Open. https://doi.org/10.1016/j.ijso.2022.100509

Laparoscopic pylorus-preserving pancreaticoduodenectomy for mucinous cystic neoplasm

Polycystic liver disease (PLD) is a rare genetic disease. It is caused by mutations in genes that encode proteins involved in the transport of fluid and growth of hepatic epithelial cells. Such mutations lead to the replacement of normal liver tissue by fluid-filled liver cysts (1). Most patients with PLD are asymptomatic and diagnosed incidentally on imaging (3). Symptomatic patients with PLD that are good surgical candidates should be treated surgically (2) (4). The main goal in such patients is to reduce the intracystic pressure. This can be achieved with unroofing and fenestration of the cysts where possible or with excision of the entire involved liver part (1). Both procedures have a high risk of recurrence, since new cysts could be induced, and some patients may even need liver transplantation (1). 

During surgery, the first step involves the marking of the unroofing line. The excision of the entire cyst’s wall is not the main goal of the procedure, due to a high risk for portal or hepatic vessel injury. When the cyst wall is excised, the omentum should be placed within the cyst’s cavity to prevent recurrence, a technique called omentoplasty. Although uncommon, complications of this procedure include trocar-site infection, bile leakage from cut edges of the cyst, and vascular injuries (2). 



Bibliography: 

1. Kothadia JP, Kreitman K, Shah JM. Polycystic Liver Disease. 2023 Feb 6. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 31751072. 

2. Tanaka M, Inoue Y, Mise Y, Ishizawa T, Arita J, Takahashi Y, Saiura A. Laparoscopic deroofing for polycystic liver disease using laparoscopic fusion indocyanine green fluorescence imaging. Surg Endosc. 2016 Jun;30(6):2620-3. doi: 10.1007/s00464-015-4526-x. Epub 2015 Sep 28. PMID: 26416378. 

3. Kaul V V, Friedenberg F, Rothstein KD. Hepatic Cysts. Curr Treat Options Gastroenterol. 2000 Dec;3(6):439-444. doi: 10.1007/s11938-000-0031-x. PMID: 11096603. 

4. Robert E Glasgow, M. (2022a) Hepatic cysts guidelines, EASL Guidelines on Cystic Liver Disease. Available at: https://emedicine.medscape.com/article/190818-guidelines (Accessed: 24 September 2023). 

Laparoscopic liver cyst unroofing in a patient with polycystic liver disease

Résection d'un kyste hépatique par laparoscopie chez un patient atteint d'une maladie polykystique du foie

monthly focus

The author presents the case of a 35-year-old male patient who underwent a laparoscopic re-exploration after a laparoscopic subtotal cholecystectomy. Initially, the patient had an acute cholecystitis and a high suspicion of common bile duct lithiasis. He had been managed in another facility with endoscopic retrograde cholangiopancreatography (ERCP). He had a sphincterotomy and 2 stones extracted. He underwent a laparoscopic subtotal cholecystectomy. Following this, the patient complained of right upper quadrant pain. Six weeks later, as an outpatient he was diagnosed with remnant cholecystitis after subtotal reconstituting cholecystectomy.



Take-home messages:

Subtotal cholecystectomy is an appropriate exit strategy to resolve acute biliary pathology and prevent bile duct injury. Although reconstructive subtotal cholecystectomy has a lower rate of bile leak, it has a higher incidence of cholecystitis recurrence. Given the persistence or recurrence of digestive symptoms after a subtotal cholecystectomy, the possibility of recurrence of cholecystitis and the feasibility of cholecystectomy of the gallbladder remnant must be evaluated. 



Bibliography:

1. Jayant M, Kaushik R. Presentation and management of gallbladder remnant after partial cholecystectomy. Trop Gastroenterol. 2013 Apr-Jun;34(2):99-103. doi: 10.7869/tg.2012.106. PMID: 24377158.

2. Henneman, D., da Costa, D.W., Vrouenraets, B.C. et al. Laparoscopic partial cholecystectomy for the difficult gallbladder: a systematic review. Surg Endosc 27, 351–358 (2013). https://doi.org/10.1007/s00464-012-2458-2

3. Teshima, T., Nitta, H., Mitsuura, C. et al. How to treat remnant cholecystitis after subtotal cholecystectomy: two case reports. surg case rep 7, 109 (2021). https://doi.org/10.1186/s40792-021-01183-x

4. Parkland 4 acute cholecystitis: PAECIF/PAECOF systematic dissection technique, a new proposal for a 100% safe cholecystectomy. N Zaragoza Arias, MD, FJ Martínez Jiménez, MD. Epublication WebSurg.com, Jun 2022;22(06). URL: http://websurg.com/doi/vd01en6684



Gallbladder remnant acute cholecystitis after subtotal reconstituting cholecystectomy

Cholécystite aiguë avec moignon de vésicule biliaire restant après cholécystectomie subtotale reconstituante 

A good knowledge of hepatic vascular distribution, both classical and its variations, is essential to plan and perform all surgical and radiological procedures in the upper abdomen. Total replaced hepatic arteries coming from the superior mesenteric artery represent 3 to 5% of all patients and this must be taken into consideration for an adequate periarterial lymphatic adipose tissue dissection and to avoid complications. 



Bibliography:

1. Japanese Gastric Cancer Association. Japanese Gastric Cancer Treatment Guidelines 2021 (6th edition). Gastric Cancer 26, 1–25 (2023). https://pubmed.ncbi.nlm.nih.gov/36342574/.

2. Staśkiewicz, G., Torres, K., Denisow, M. et al. Clinically relevant anatomical parameters of the replaced right hepatic artery (RRHA). Surg Radiol Anat 37, 1225–1231 (2015). https://pubmed.ncbi.nlm.nih.gov/25982897/.

3. Huang CM, Chen RF, Chen QY, Wei J, Zheng CH, Li P, Xie JW, Wang JB, Lin JX, Lu J, Cao LL, Lin M. Application Value of a 6-Type Classification System for Common Hepatic Artery Absence During Laparoscopic Radical Resections for Gastric Cancer: A Large-Scale Single-Center Study. Medicine (Baltimore). 2015 https://pubmed.ncbi.nlm.nih.gov/26266363/.

Considerations in D2 lymphadenectomy: replaced hepatic artery 

Points importants lors d’un curage ganglionnaire D2 : replacement de l'artère hépatique

Focus en chirurgie hépatobiliaire et pancréatique

Focus on HPB surgery

Prise en charge entièrement laparoscopique d'un mélanome métastatique rétrocave chez une jeune patiente

The retroperitoneum can host primary or metastatic lesions, and occasionally a complete surgical resection is the only potential curative treatment (1). The laparoscopic approach has proven feasible and safe for the removal of intra-abdominal lesions (2) including large lesions in close proximity to vital structures. However, the anatomical location impacts the feasibility of a minimally invasive approach for a central retroperitoneal lesion (3, 4). This video shows the management of a retrocaval lesion via a totally laparoscopic surgical approach. A 24-year-old female patient experienced episodes of early satiety and abdominal discomfort. Abdominal ultrasound and MRI revealed a solid mass in the right adrenal lodge, extending up to the region between the vena cava and the portal vein. The 55 by 44mm retrocaval lesion was suspected to be a retroperitoneal tumor, and an explorative laparoscopy was proposed. Despite the close proximity of the lesion to major vessels (i.e., vena cava, aorta, portal vein) and visceral organs (liver and duodenum), the surgeon performed a total laparoscopic wide radical resection. To obtain macroscopically complete clearance, the resection mandated a right adrenalectomy due to vascular supply involvement. Operative time was 95 minutes without intraoperative complications. Postoperative outcomes were uneventful. The patient rapidly recovered on postoperative day 3, with optimal cosmetic results. The final diagnosis was established through the histopathological analysis and evidenced metastatic melanoma with HMB and MART-1 positivity. This video showed that the laparoscopic approach was safe and feasible but challenging for retroperitoneal lesions, suggesting that a retrocaval location is not an absolute contraindication to this method if performed by an expert laparoscopic surgeon. The patient underwent endoscopic examinations for the lower and upper GI, as well as dermatological, ophthalmological, and gynecological examination. All tests proved negative and it was not possible to identify the primary site of the melanoma. Therefore, the oncology group proposed NED (non-evidence of disease) as the final diagnosis. The patient started immunotherapy and was followed up clinically.



Bibliography: 

1. Mota, M. M. D. S., Bezerra, R. O. F., & Garcia, M. R. T. (2018). Practical approach to primary retroperitoneal masses in adults. Radiologia brasileira, 51(6), 391–400. https://doi.org/10.1590/0100-3984.2017.0179.



2. Bracale, U., Pacelli, F., Milone, M., Bracale, U. M., Sodo, M., Merola, G., Troiani, T., & Di Salvo, E. (2017). Laparoscopic treatment of abdominal unicentric castleman's disease: a case report and literature review. BMC surgery, 17(1), 38. https://doi.org/10.1186/s12893-017-0238-6.



3. Strauss, D. C., Hayes, A. J., Thway, K., Moskovic, E. C., Fisher, C., & Thomas, J. M. (2010). Surgical management of primary retroperitoneal sarcoma. The British journal of surgery, 97(5), 698–706. https://doi.org/10.1002/bjs.6994.



4. Strauss, D. C., Hayes, A. J., & Thomas, J. M. (2011). Retroperitoneal tumours: review of management. Annals of the Royal College of Surgeons of England, 93(4), 275–280. https://doi.org/10.1308/003588411X571944.

Totally laparoscopic management of retrocaval metastatic melanoma in a young patient

Traitement laparoscopique d'une intussusception chez l'adulte

Adult intussusception is rare and often recognized as an abdominal emergency. Unlike children, adult intussusception is frequently associated with secondary causes such as benign and malignant tumors (Hirotaka Honjo. World J Surg. 2015 Jan;39 (1): 134-8). This video demonstrates the laparoscopic management of colonic intussusception in a young adult patient with severe acute abdominal pain, nausea, and vomiting. During the preoperative work-up, CT-scan revealed the “pseudokidney sign” and several enlarged lymph nodes around the loop (Anderson DR. The pseudokidney sign. (1999) Radiology. 211 (2): 395-7.). Since the patient was an adult and there were several enlarged mesenteric lymph nodes suggesting a possible malignant cause, an oncological right hemicolectomy with D3 lymphadenectomy was performed.

Laparoscopic management of an adult intussusception

Rôle de la compresse chirurgicale en chirurgie laparoscopique

The authors present a didactic video highlighting the use of a surgical sponge in laparoscopic surgery with various surgical demonstrations and examples.

The video shows clips from various pelvic gynecologic procedures demonstrating the versatility and spectrum of applications of the surgical sponge to increase the efficiency of the surgical procedure. 



Bibliography:

1. Bariol SV, Heng CT, Lau HM. Intracorporeal ribbon gauze in laparoscopic surgery. ANZ J Surg. 2004 Jan-Feb;74(1-2):68. doi: 10.1046/j.1445-1433.2003.02890.x. PMID: 14725709.

2. Gholami SS, Shekarriz B, Rudnick D, Duh QY, Stoller ML. The laparoscopic cigarette sponge. J Urol. 2001 Jul;166(1):194. PMID: 11435855.

3. Maccabee D, Sheppard BC. The laparoscopic sponge. Surg Endosc. 2003 Aug;17(8):1320-1. doi: 10.1007/s00464-002-8779-9. Epub 2003 Apr 28. PMID: 15039864.



Role of surgical sponge (gauze) in laparoscopic surgery

Hiatal hernia repair has witnessed significant advancements in recent years, with a paradigm shift towards a laparoscopic approach accompanied by the incorporation of intraoperative gastroscopy. This video delves into the pivotal role of laparoscopy in hiatal hernia surgical repair and underscores the added benefits conferred by real-time intraoperative gastroscopic guidance. The laparoscopic approach has revolutionized hiatal hernia repair, offering patients a less invasive alternative to traditional open surgeries. This technique involves smaller incisions, reduced postoperative pain, and shorter recovery times, presenting a paradigm shift that aligns with the principles of minimally invasive surgery. Moreover, laparoscopy provides superior visualization of the hiatal defect, enabling meticulous dissection and precise anatomical reconstruction. In conjunction with laparoscopy, the integration of intraoperative gastroscopy emerges as a valuable adjunct in hiatal hernia repair. Real-time visualization of the gastroesophageal junction during surgery allows for accurate identification of hiatal defects and assessment of the gastroesophageal valve. This dynamic approach facilitates tailored and patient-specific repairs, contributing to improved surgical outcomes and reduced rates of postoperative complications. 

Furthermore you will find a panel expert discussion about the use or not of absorbable and non absorbable mesh for the hiatal repair and indication about the extension of the dissection of the short gastric vessels are discussed. 

In conclusion, this video highlights the transformative impact of laparoscopic surgery on hiatal hernia repair, emphasizing its benefits in terms of reduced invasiveness and enhanced visualization. The synergistic integration of intraoperative gastroscopy further elevates the precision of the procedure, allowing surgeons to tailor interventions based on real-time insights. 



Bibliography: 

1. Hashemi M, Peters JH. "Current concepts in the management of paraesophageal hiatal hernia." Journal of Clinical Gastroenterology, 2008; 42(6): 594-601. 

2. Dallemagne B, Perretta S. Long-term Efficacy of Total and Partial Posterior Fundoplication to Treat Gastroesophageal Reflux Disease. JAMA Surg. 2022 Jun 1;157(6):480. doi: 10.1001/jamasurg.2022.0806. PMID: 35442405.

3. Watson DI, Pike GK, Baigrie RJ. "Prospective double-blind randomized trial of laparoscopic Nissen fundoplication with division and without division of short gastric vessels." Annals of Surgery, 1997; 226(5): 642–652. 

4. Swanström LL, Jobe BA, Kinzie LR. "Esophageal motility and outcomes following laparoscopic paraesophageal hernia repair and fundoplication." The American Journal of Surgery, 1999; 177(5): 359-363.

5. Luketich JD, Nason KS, Christie NA. "Outcomes after a decade of laparoscopic giant paraesophageal hernia repair." Journal of Thoracic and Cardiovascular Surgery, 2010; 139(2): 395-404. 



Advancing precision in hiatal hernia surgical repair: integration of laparoscopy and intraoperative gastroscopy for optimal outcomes 

Améliorer la précision de la cure chirurgicale de hernie hiatale : intégration de la laparoscopie et de la gastroscopie peropératoire pour des résultats optimaux

In this video, the authors present the case of a patient admitted to hospital with biliary peritonitis following a laparoscopic cholecystectomy. The patient was operated on again using a laparoscopic approach and a biliary peritonitis was found in relation to a leak through an aberrant duct. Peritoneal lavage was performed, and the aberrant duct was sutured. Nowadays, the laparoscopic approach is increasingly used in the management of biliary complications secondary to cholecystectomy.



Bibliography: 

Dokmak S, Amharar N, Aussilhou B, Cauchy F, Sauvanet A, Belghiti J, Soubrane O. Laparoscopic Repair of Post-cholecystectomy Bile Duct Injury: an Advance in Surgical Management. J Gastrointest Surg. 2017 Aug;21(8):1368-1372. doi: 10.1007/s11605-017-3400-7. Epub 2017 Mar 27. PMID: 28349333. 



Laparoscopic treatment of post-cholecystectomy biliary peritonitis

Traitement laparoscopique d'une péritonite biliaire post-cholécystectomie

This video presents the management of a choledocholithiasis in a patient who previously underwent a subtotal gastrectomy with a Roux-en-Y reconstruction for an oncologic condition. 

The patient was a 75-year-old man who presented with abdominal pain originating from the upper quadrants with an onset of jaundice. 

Eighteen years earlier, the patient had undergone a laparoscopic subtotal gastrectomy performed with a Roux-en-Y reconstruction for gastric cancer. 

CT-scan revealed a dilatation of the intrahepatic and extrahepatic biliary duct due to the presence of a 15mm gallstone in the common bile duct. 

In this case, the authors were faced with a common pathology, usually treated with an endoscopic retrograde cholangiopancreatography (ERCP). They subsequently had to tailor a procedure fitting the patient’s altered anatomy. 

Two surgical strategies were proposed during the preoperative meeting: a combined laparoscopic and endoscopic approach, or a total laparoscopic bile duct clearance followed by a cholecystectomy. 

Since the authors were not able to clearly identify the biliary loop to be passed through the gastroscope, an intraoperative laparoscopic biliary duct exploration was performed. 



Laparoscopic treatment of choledocholithiasis in a patient who underwent subtotal gastrectomy

Traitement laparoscopique d'une cholédocholithiase chez un patient ayant subi une gastrectomie partielle

Gastrectomie totale par laparoscopie pour cancer gastrique, une approche par étapes

Introduction: 

Total gastrectomy is a complex and often difficult procedure to perform. It involves the removal of the entire stomach, including the gastroesophageal junction (GEJ). It is usually performed in patients with proximal gastric cancer, in whom a subtotal gastrectomy with a 5 to 6cm proximal margin does not leave a reasonable gastric remnant. The laparoscopic total gastrectomy technique has drawn increasing attention over the years.



Objectives: 

In this video, the authors present a laparoscopic radical gastrectomy with a Roux-en-Y reconstruction in a stepwise fashion. It is their procedure of choice in patients with proximal gastric cancer involving neoadjuvant therapy. 



Methodology: 

The patient was a 43-year-old woman with a T4N1M0 poorly cohesive cells gastric carcinoma invading the gastric body, as well as the lesser and greater curvature. A perioperative chemotherapy with 4 cycles of FLOT was proposed to the patient. CT-scan evaluation showed a favorable response to the treatment. The authors performed a laparoscopic radical total gastrectomy with a Roux-en-Y reconstruction. The patient had no major complications and was discharged on postoperative day 6.



Conclusion:

Laparoscopic total gastrectomy has been increasingly performed in many hospitals. Recent studies have shown that the laparoscopic technique, although complex and often difficult to perform, offers significant advantages. It has been shown that it decreases postoperative hospital stay, allows earlier gastric tube removal, and has similar postoperative complication rates and overall survival as compared to open total gastrectomy for patients with gastric cancer involving neoadjuvant therapy.

In conclusion, laparoscopic total gastrectomy can be considered a first-line surgical treatment in experienced centers, since it is an effective and safe curative procedure.



Bibliography:

1. Park, K. B., Kim, E. Y., & Song, K. Y. (2019). Esophagojejunal anastomosis after laparoscopic total gastrectomy for gastric cancer : Circular versus linear stapling. Journal of Gastric Cancer, 19(3), 344‑354. https://doi.org/10.5230/jgc.2019.19.e34

2. Hu, H.-T., Ma, F.-H., Xiong, J.-P., Li, Y., Jin, P., Liu, H., Ma, S., Kang, W.-Z., & Tian, Y.-T. (2022). Laparoscopic vs open total gastrectomy for advanced gastric cancer following neoadjuvant therapy : A propensity score matching analysis. World Journal of Gastrointestinal Surgery, 14(2), 161‑173. https://doi.org/10.4240/wjgs.v14.i2.161

3. Chan, B. Y. O., Yau, K. K. W., & Chan, C. K. O. (2019). Totally laparoscopic versus open gastrectomy for advanced gastric cancer : A matched retrospective cohort study. Hong Kong Medical Journal = Xianggang Yi Xue Za Zhi, 25(1), 30‑37. https://doi.org/10.12809/hkmj177150 

4. Mulholland, Michael W., et al., Operative Thechniques in Surgery, volume two, 2015, Wolters Kluwer Health



Laparoscopic total gastrectomy for gastric carcinoma, a stepwise approach

Echinococcosis is a parasitic infection caused by the larval stage of the Echinococcus tapeworm. The liver (70%) and lungs (25%) are the most commonly affected organs. Splenic involvement is rare with about 0.5-8% of cystic echinococcus (CE) cases. Cases of solitary splenic cyst are even rarer (0.5-4%). 

This video shows a hemisplenectomy performed using a fully laparoscopic approach for the management of a 7cm echinococcal solitary cyst located in the upper pole of the spleen. The patient, a 23-year-old male, presented with upper abdominal pain, nausea, and vomiting. Diagnosis was established through ultrasound monitoring and was confirmed via serological tests and magnetic resonance imaging. The postoperative period was uneventful, and the drain was removed on postoperative day 1. The patient was discharged on postoperative day 3. After 3 months of follow-up, no further issues were noted. This case emphasizes the safety and feasibility of the laparoscopic approach for spleen preservation. 



Bibliography

1. Akhan O, Koroglu M. Hydatid disease of the spleen. Semin Ultrasound CT MR. 2007;28(1):28-34. doi:10.1053/j.sult.2006.10.002

2. Yotsov TI, Dyulgerova S, Draganova D. Laparoscopic splenectomy for solitary splenic hydatid cyst: Case report. J Minim Access Surg. 2023;19(2):317-319. doi:10.4103/jmas.jmas_113_22

3. Akbulut S, Sogutcu N, Eris C. Hydatid disease of the spleen: single-center experience and a brief literature review. J Gastrointest Surg. 2013;17(10):1784-1795. doi:10.1007/s11605-013-2303-5

4. Rasheed K, Zargar SA, Telwani AA. Hydatid cyst of spleen: a diagnostic challenge. N Am J Med Sci. 2013;5(1):10-20. doi:10.4103/1947-2714.106184

Laparoscopic hemisplenectomy for solitary splenic hydatid cyst 

Hémisplénectomie laparoscopique pour kyste hydatique solitaire splénique

Focus en chirurgie générale 

Focus on general surgery

In this key lecture, Dr. Pieter Caekebeke, MD, PhD focuses on clinical elbow examination.

Clinical elbow examination: interactive session

Examen clinique du coude : session interactive

In this key lecture, Dr. Joideep Phadnis, MD outlines the indications of elbow arthroscopy and its clinical applications.

Elbow arthroscopy: indications and clinical applications

Arthroscopie du coude : indications et applications cliniques

In this key lecture, Dr. Marion Burnier, MD outlines the complications of elbow arthroscopy. 

Complications of elbow arthroscopy

Complications liées à l'arthroscopie du coude

In this key lecture, Dr. Adam Watts, MD focuses on the arthroscopic arthrolysis of the elbow, shedding light on his indications and technique.

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