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podcast

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

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.

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

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 6: Nicolas Demartines

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.

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 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 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 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!

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

Лапароскопическая правосторонняя гемиколэктомия с тотальной мезоколонэктомией по поводу рака восходящей кишки поздней стадии

Hemicolectomia direita laparoscópica com excisão completa do mesocólon para câncer avançado no cólon ascendente


Complete mesocolic excision (CME) with central vascular ligation (CVL) is a potentially superior oncological technique in colon cancer surgery. The tenets of high vascular ligation at the origin and mesocolic dissection facilitate a greater lymph node yield. We present the case of a 70-year-old lady with chronic right iliac fossa discomfort. Computer tomographic scans showed a bulky ascending colon cancer with a 2.6cm right mesocolic lymph node. She underwent laparoscopic CME right hemicolectomy with CVL. Three operative trocars were used (a 12mm trocar in the left iliac fossa, 5mm ports in the left flank and right iliac fossa). Dissection begins in an inferior to superior approach, starting with mobilization of the ileocolic mesentery off the right common iliac vessels, then progressing to separate the mesentery off the duodenum and Gerota's fascia, exposing the head of the pancreas and the duodenal loop. CVL begins with the identification of the superior mesenteric vein (SMV). The vascular structures are isolated individually and ligated high at the level of the SMV, removing the metastatic right mesocolic node ‘en bloc’. Following proximal and distal transections, an intracorporeal ileo-transverse anastomosis is performed. Histology findings demonstrate the presence of a pT4a N2a M0 mucinous adenocarcinoma with 5 out of 17 lymph nodes (including the large mesocolic lymph node) positive for metastasis. 

Laparoscopic right hemicolectomy with complete mesocolic excision for advanced ascending colon cancer

Hemicolectomía derecha laparoscópica con escisión completa del mesocolon para cáncer avanzado en el colon ascendente


腹腔镜右半结肠切除术治疗进展期结肠癌


Hemicolectomie laparoscopique droite avec excision mésocolique complète pour cancer avancé du colon ascendant


Hemicolectomia direita com excisão completa do mesocólon (ECM) e anastomose intracorpórea


Excision mésocolique laparoscopique complète (CME) hémicolectomie droite avec anastomose intracorporelle


Complete mesocolic excision (CME) in colon cancer surgery has recently gained popularity as increasing evidence points to improved oncological clearance with superior lymph node yield, bigger tumor clearance margins, and higher quality surgical specimens. There are also some indications that it may lead to improved oncological outcomes. The tenets of CME include high vascular ligation at the root of the vessel, dissection along the embryological planes of the colonic mesentery, and adequate margins of bowel from the tumor. 

Although the technique was initially described and achieved via a laparotomy, laparoscopic CME was also performed, although it was noted to be technically challenging. The right colon and the variability of vascular anatomy add to the difficulty of the procedure. 

Extracorporeal anastomosis is commonly performed for right hemicolectomy in most centers. There are some reported advantages to the intracorporeal anastomosis, namely a potentially higher lymph node yield, a smaller skin incision, and the ability to extract the specimen via a Pfannenstiel’s incision, which has lower rates of incisional hernia. 

This video features a laparoscopic CME right hemicolectomy with intracorporeal anastomosis for a malignant polyp. 

Dr. Shen-Ann Eugene Yeo, MBBS, MMed (Surg), FRCS (Ed) does not have any conflicts of interest or financial ties to disclose.

Laparoscopic complete mesocolic excision (CME) right hemicolectomy with intracorporeal anastomosis

Hemicolectomía derecha con escisión completa del mesocolon (ECM) y anastomosis intracorpórea


腹腔镜完全鼻息肉切除术（CME）右半结肠切除术与体内吻合术


Лапароскопическая тотальная мезоколонэктомия, правосторонняя гемиколэктомия с интракорпоральным анастомозом

In this educational video, Dr. Armando Melani briefly demonstrates the main principles of laparoscopic sigmoidectomy for cancer in a 67-year-old female patient in a live interactive surgery. He highlights the technical aspects, anatomical landmarks, and key steps of lesser sac opening, vascular identification and division, splenic flexure mobilization, lateral mobilization, mesorectal transection, suprapubic incision for specimen removal, and end-to-end anastomosis (EEA).

 Laparoscopic sigmoidectomy for cancer

Sigmoidectomia laparoscópica para câncer


Sigmoidectomía laparoscópica para cáncer


Sigmoïdectomie laparoscopique pour cancer


Лапароскопическая сигмоидэктомия по поводу рака

腹腔镜乙状结肠切除术治疗癌症


Sigmoidectomía laparoscópica para diverticulitis


Sigmoidectomia laparoscópica para diverticulite


In this interactive live video, Dr. Melani briefly demonstrates the main principles, technical aspects, and key steps of a laparoscopic sigmoidectomy in a 34-year-old male patient presenting with diverticulitis. He describes the key maneuvers for correct plane dissection, mesenteric dissection preserving the vessels and the ureter, mobilization of colon, the EEA (end-to-end anastomosis) stapler technique, as well as complications. Dr. Melani also mentions his personal experience.

 Laparoscopic sigmoidectomy for diverticulitis

腹腔镜乙状结肠切除术治疗憩室炎


Лапароскопическая сигмоидэктомия по поводу дивертикулита

Sigmoïdectomie laparoscopique pour diverticulite 


This video of laparoscopic Nissen fundoplication is suitable for surgeons learning to perform this procedure. The patient is young with very few adhesions and the operative steps are very clearly presented by Dr. Dallemagne. Critical points and technical tips are emphasized throughout the procedure.



The author describes this as an ideal case for surgeons learning the procedure because this young patient with severe reflux has few adhesions. Working with a zero-degree scope, the author examines the peritoneal cavity. The dissection begins at the caudate lobe of the liver and moves toward the right crus of the diaphragm. After identifying the right and left crura, the author opens the lesser omentum to gain access to the right crus. It is important to identify the inferior vena cava as a landmark.

Laparoscopic Nissen fundoplication: a perfect case to start

Este vídeo de fundoplicatura Nissen laparoscópica es recomendado para cirujanos que estén comenzando en aprender este procedimiento.  El paciente es joven, con pocas adherencias.  Los pasos operatorios son claramente presentados por el Dr. Dallemagne.  Se enfatizan los puntos críticos y los consejos técnicos a través de todo el procedimiento.

Fundoplicatura de Nissen Laparoscópico para RGE

Fundoplicatura de Nissen laparoscópica: um caso perfeito para começar


Fundoplicature de Nissen laparoscopique : un cas idéal pour commencer


腹腔镜尼森胃底折叠术：一个完美的开始


Ключевые моменты выполнения лапароскопической ТАРР-герниопластики паховой грыжи


Pasos clave de la reparación de la hernia inguinal por TAPP laparoscópico


Passos-chave do reparo da hérnia inguinal por TAPP laparoscópico


Etapes principales d'un TAPP laparoscopique pour cure de hernie inguinale


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. 





Key steps of laparoscopic TAPP inguinal hernia repair

腹腔镜TAPP腹股沟疝修补的关键步骤


Bypass gastrique selon Roux assisté par robot avec gastrojéjunostomie et jéjunojéjunostomie manuelles

In this live educational video, Dr. Luiz Alfredo Vieira d'Almeida beautifully demonstrates a Roux-en-Y gastric bypass in a 58-year-old male patient using the da Vinci Xi™ robotic surgical system. The patient’s BMI decreased from 61 to 47. The dissection of the upper part of the stomach was difficult, and the expertise and know-how of Dr. Vieira d'Almeida contributed to the remarkable creation of the gastric pouch. During this procedure, a gastrojejunostomy and a jejunojejunostomy were performed manually in a stepwise fashion, which allowed for adequate procedural reproducibility. The operator also highlights the benefits of the robotic approach in a difficult case.

Robot-assisted Roux-en-Y gastric bypass (RYGB) with manual gastrojejunostomy and jejunojejunostomy: a live educational procedure

Bisegmentectomie laparoscopique des segments III et IV du foie (S3-S4) avec lymphadénectomie et vert d'indocyanine pour carcinome hépatocellulaire (CHC) 

Introduction: Liver cancer is globally the fifth most common cancer and the fourth most common cause of cancer-related death. Currently, surgical resection is still considered a curative option and is reserved for the early stages of hepatocellular carcinoma (HCC). Laparoscopy shows comparable results to open liver resection regarding long-term oncologic outcomes such as overall survival and disease-free survival, while delivering superior results in terms of morbidity and perioperative outcomes. Using indocyanine green (ICG) fluorescence makes it possible to accurately determine the boundaries of anatomical resections, improving the navigation and precision of surgical techniques.

Methods:

The authors demonstrate a laparoscopic left paramedian sectorectomy (S3-S4 bisegmentectomy) with lymphadenectomy using negative ICG staining in a 73-year-old male patient, with hepatitis C and Child-Pugh class A (score of 6 points) liver cirrhosis.

Results:

The operation lasted 180 minutes and total blood loss was 80mL. The postoperative period was uneventful, and the patient was discharged on postoperative day 6. The histological examination revealed the presence of a G2 HCC at the pT1aN0M0 stage, with tumor-free surgical margins.

Conclusion:

The combination of a minimally invasive approach with ICG negative staining for “small” anatomical liver resection, in a patient with chronic cirrhosis and early-stage HCC has shown good perioperative results and oncologic outcomes.

 

Bibliography:

1\. Manon Allaire, Claire Goumard, Chetana Lim, Aline Le Cleach, Mathilde Wagner, Olivier Scatton. New frontiers in liver resection for hepatocellular carcinoma. JHEP Rep. 2020 Jun 4;2(4):100134. doi: 10.1016/j.jhepr.2020.100134. eCollection 2020 Aug. PMID: 32695968 PMCID: PMC7360891 DOI: 10.1016/j.jhepr.2020.100134

2\. Stefano Di Sandro, Maria Danieli, Fabio Ferla, Andrea Lauterio, Riccardo De Carlis, Laura Benuzzi, Vincenzo Buscemi, Isabella Pezzoli, Luciano De Carlis. The current role of laparoscopic resection for HCC: a systematic review of past ten years. Transl Gastroenterol Hepatol. 2018 Sep 18:3:68. doi: 10.21037/tgh.2018.08.05. eCollection 2018. PMID: 30363804 PMCID: PMC6182043 DOI: 10.21037/tgh.2018.08.05

3\. Junichi Kaneko, Takashi Kokudo, Yoshinori Inagaki, Kiyoshi Hasegawa. Innovative treatment for hepatocellular carcinoma (HCC). Transl Gastroenterol Hepatol. 2018 Oct 22;3:78. doi: 10.21037/tgh.2018.10.04. PMID: 30505965; PMCID: PMC6232072

Laparoscopic liver segment III and IV (S3-S4) bisegmentectomy with lymphadenectomy and indocyanine green (ICG) for hepatocellular carcinoma (HCC) 

Chronic calcific pancreatitis (CCP) is a debilitating condition, which often causes intractable pain unresponsive to conservative treatment. Conventional surgical interventions have limitations in achieving optimal outcomes, as they often lead to prolonged recovery and increased morbidity. Laparoscopic lateral pancreaticojejunostomy (LPJ) offers a minimally invasive surgical approach in such patients. The use of robotic technology enhances the precision and efficacy of pancreaticojejunostomy, offering patients a minimally invasive alternative with improved postoperative outcomes. This video showcases the key steps of the procedure, including patient set-up, robotic port placement, meticulous dissection of the pancreatic head, and creation of a side-to-side pancreaticojejunostomy. 

This video shows the case of a 27-year-old woman presenting with persistent abdominal pain, uncontrolled diabetes mellitus, and steatorrhea. Investigations revealed random plasma glucose at 390mg/dL and HbA1C at 8.6. Contrast-enhanced CT-scan of the abdomen showed an atrophic pancreas, a dilated main pancreatic duct (MPD) with a diameter of approximately 9mm filled with multiple calculi. The patient underwent a robotic assisted laparoscopic lateral pancreaticojejunostomy. The procedure was uneventful, and the patient was discharged on postoperative day 5. 

Bibliography: 

1. George Michel Eid, Fateh Entabi, Andrew R. Watson, Brian S. Zuckerbraun, Mark A. Wilson, Robotic-assisted laparoscopic side-to-side lateral pancreaticojejunostomy, Journal of Gastrointestinal Surgery, Volume 15, Issue 7, 2011, Page 1243, ISSN 1091-255X, https://doi.org/10.1007/s11605-011-1495-9.

2. Balduzzi A, Zwart MJW, Kempeneers RMA, Boermeester MA, Busch OR, Besselink MG. Robotic Lateral Pancreaticojejunostomy for Chronic Pancreatitis. J Vis Exp. 2019 Dec 14;(154). doi: 10.3791/60301. PMID: 31885388.

3. Nayak K, Shinde RK, Gattani RG, Thakor T. Surgical Perspectives of Open vs. Laparoscopic Approaches to Lateral Pancreaticojejunostomy: A Comprehensive Review. Cureus. 2024 Jan 6;16(1):e51769. doi: 10.7759/cureus.51769. PMID: 38322062; PMCID: PMC10844796.

4. Palanivelu C, Shetty R, Jani K, Rajan PS, Sendhilkumar K, Parthasarthi R, Malladi V. Laparoscopic lateral pancreaticojejunostomy: a new remedy for an old ailment. Surg Endosc. 2006 Mar;20(3):458-61. doi: 10.1007/s00464-005-0680-x. Epub 2006 Jan 19. PMID: 16424983.

Robotic assisted laparoscopic lateral pancreaticojejunostomy (LPJ) for chronic calcific pancreatitis (CCP)

Pancréaticojéjunostomie latérale assistée par robot pour pancréatite calcifiante chronique 

Impaction of a mechanical lithotripsy basket during endoscopic retrograde cholangiopancreatography (ERCP) is a rare, but serious complication resulting from technical failure. The authors present a video of lithotripsy basket retrieval assisted by means of laser fragmentation. It is the case of an 87-year-old man who underwent an emergency laparoscopic subtotal cholecystectomy, common bile duct (CBD) exploration, and laser lithotripsy. After attempts at endoscopic mechanical lithotripsy, a stone-basket complex became impacted within the CBD. In the absence of endoscopic salvage techniques, a laparoscopic common bile duct exploration (LCBDE) is a valid and safe option where surgical expertise permits.

Bibliography:

1\. Thomas M, Howell DA, Carr-Locke D, Mel Wilcox C, Chak A, Raijman I, et al. Mechanical lithotripsy of pancreatic and biliary stones: complications and available treatment options collected from expert centers. Am J Gastroenterol. 2007 Sep;102(9):1896-902. doi: 10.1111/j.1572-0241.2007.01350.x. Epub 2007 Jun 15. PMID: 17573790

2\. Garg PK, Tandon RK, Ahuja V, Makharia GK, Batra Y. Predictors of unsuccessful mechanical lithotripsy and endoscopic clearance of large bile duct stones. Gastrointest Endosc. 2004 May;59(6):601-5. doi: 10.1016/s0016-5107(04)00295-0. PMID: 15114300

3\. Yilmaz S, Ersen O, Ozkececi T, Turel KS, Kokulu S, Kacar E, et al. Results of the open surgery after endoscopic basket impaction during ERCP procedure. World J Gastrointest Surg. 2015 Feb 27;7(2):15-20. doi: 10.4240/wjgs.v7.i2.15. PMID: 25722797; PMCID: PMC4325280

Laparoscopic common bile duct exploration (CBDE) and retrieval of endoscopic lithotripsy basket

Exploration laparoscopique de la voie biliaire principale et récupération d'un panier de lithotripsie endoscopique

video lecture

In this educational lecture, Professor Ville Salinnen, MD, PhD, Editor-in-chief of BJS open, thoroughly describes how to conduct surgical research and get it published in a respectable journal. This Acta lecture was presented at the Swedish Surgical Week in 2024. Professor Salinnen notes that successful publication starts with a good study plan, completion of the study and then writing the paper. He offers a detailed explanation about how to construct and submit the paper for publication.

How to write a scientific surgical manuscript and be published? 

Traitement d'un neuroblastome du médiastin postérieur chez l'enfant par voie thoracique bilatérale

This video presents the case of a neuroblastoma of the posterior mediastinum. Neuroblastoma of the posterior mediastinum most often involves the thoracic aorta, intercostal arteries, and it often spreads into the spinal canal. This localization is classically the most frequent location site of neurogenic tumors. The patient underwent a one-step operation to remove a tumor from two hemithorax. This video may be useful to pediatric oncologists and surgeons.

Bibliography:

1\. Badiu Tișa I, Samașca G, Aldea C, Lupan I, Farcau D, Makovicky P. Ganglioneuroblastoma in children. Neurol Sci. 2019 Sep;40(9):1985-1989. doi: 10.1007/s10072-019-03932-1. Epub 2019 May 30. PMID: 31147856.

2\. Dingemann C, Ure B, Dingemann J. Thoracoscopic procedures in pediatric surgery: what is the evidence? Eur J Pediatr Surg. 2014 Feb;24(1):14-9. doi: 10.1055/s-0033-1350060. Epub 2013 Jul 12. PMID: 23852720.

Bilateral thoracoscopic approach in a child with posterior mediastinal neuroblastoma

Acute inguinal hernias are common surgical emergencies conventionally managed through open surgery. Although several authors advocated for the laparoscopic approach in recent years, controversy persists among surgeons. The benefits of the laparoscopic technique extend beyond the elective context. Apart from detecting hidden and visible hernias and covering the entire myopectineal orifice (MPO), it also makes precise diagnosis possible, lessens the necessity for laparotomy, and lowers the incidence of wound infections. In this approach, intestinal viability is evaluated once the hernia has been identified and the strangulated content has been reduced. Save from cases of gangrenous perforation necessitating immediate intervention, hernia repair ensues. The subsequent reassessment of the strangulated bowel allows for revascularization, often obviating the need for bowel resection and unnecessary laparotomy. In this educational video, the authors present a case study of a 61-year-old woman with a strangulated femoral hernia. A laparoscopic transabdominal preperitoneal (TAPP) repair was performed, requiring segmental bowel enterectomy due to non-reversible ischemia. 

Bibliography:

1. Claus C, Furtado M, Malcher F, Cavazzola LT, Felix E. Ten golden rules for a safe MIS inguinal hernia repair using a new anatomical concept as a guide. Surg Endosc. 2020 Apr;34(4):1458-1464. doi: 10.1007/s00464-020-07449-z. Epub 2020 Feb 19. PMID: 32076858

2. Yang, G. (2017). Laparoscopy in emergency hernia repair. Annals Of Laparoscopic And Endoscopic Surgery, 2(6). doi:10.21037/ales.2017.05.05

Inguinal TAPP repair for strangulated femoral hernia with enterectomy and primary anastomosis

Cure de hernie inguinale (technique TAPP) pour hernie fémorale étranglée avec entérectomie et anastomose primaire

Gastrectomie distale laparoscopique et curage ganglionnaire D2 avec reconstruction selon Billroth I modifiée en forme de delta

This video presents a laparoscopic distal gastrectomy with a Billroth I reconstruction procedure for gastric cancer patients, highlighting its notable benefits in the early postoperative period. Compared to Roux-en-Y reconstruction, Billroth I offers benefits such as shorter operative time, reduced blood loss, and notably shorter hospital stays (4). Laparoscopic surgery, renowned for its minimally invasive nature, has gained global recognition for its benefits including reduced postoperative pain, shorter hospital stays, and faster recovery times (1, 2). Among laparoscopic interventions for gastric cancer, the Billroth I procedure stands out for its simplicity and physiological food passage. To address specific concerns related to staple lines and the duodenal stump’s “dog ear”, the authors adopted the modified Billroth I reconstruction method proposed by J Harada and T Kinoshita (3). Further investigations are warranted to assess long-term outcomes and provide a comprehensive understanding of the lasting benefits of this surgical approach. The authors’ findings underscore the importance of ongoing research to refine and advance surgical strategies in the management of gastric cancer.

Bibliography:

1\. Huang C, Liu H, Hu Y, et al. Laparoscopic vs Open Distal Gastrectomy for Locally Advanced Gastric Cancer: Five-Year Outcomes From the CLASS-01 Randomized Clinical Trial. JAMA Surg 2022;157:1-9. PMID: 34668963 PMCID: PMC8529527 DOI: 10.1001/jamasurg.2021.5104

2\. Hyung WJ, Yang HK, Park YK, et al. Long-Term Outcomes of Laparoscopic Distal Gastrectomy for Locally Advanced Gastric Cancer: The KLASS-02-RCT Randomized Clinical Trial. J Clin Oncol 2020;38;28:3304-3313. PMID: 32816629 DOI: 10.1200/JCO.20.01210

3\. Harada J, Kinoshita T, Sato R et al. Delta-shaped gastroduodenostomy after totally laparoscopic distal gastrectomy for gastric cancer: comparative study of original and modified methods. Surg Endosc 2021;35;8:4167-4174. PMID: 32780239 DOI: 10.1007/s00464-020-07896-8

4\. Nishizaki D, Ganeko R, Hoshino N, et al. Roux-en-Y versus Billroth-I reconstruction after distal gastrectomy for gastric cancer. Cochrane Gut Group, ed. Cochrane Database Syst Rev 2021;2021;9. PMID: 34523717 PMCID: PMC8441595 DOI: 10.1002/14651858.CD012998.pub2

Laparoscopic distal gastrectomy and D2 lymphadenectomy with modified delta-shaped Billroth 1 reconstruction

Intervention de Whipple par voie d'abord laparoscopique pour prise en charge d'une tumeur de la tête du pancréas

The laparoscopic Whipple procedure for the treatment of a pancreatic head tumor appears to be a valid, safe, and feasible alternative. There has been increased awareness of structured training and patient selection for laparoscopic management. This case of a patient with a standard BMI and a tumor which allows for the adequate visualization of anatomical structures is valuable to recognize the resective steps, and to select a minimally invasive reconstructive option. As familiarity with the robotic platform increases, studies have shown an expansion of indications. 



Bibliography:

1. Comparison of safety and effectiveness between laparoscopic and open pancreatoduodenectomy: A systematic review and meta-analysis. Yin T, Qin T, Wei K, Shen M, Zhang Z, Wen J, Pan S, Guo X, Zhu F, Wang M, Zhang H, Hilal MA, Qin R. Int J Surg. 2022 Sep;105:106799. doi: 10.1016/j.ijsu.2022.106799. Epub 2022 Aug 19

2. Minimally invasive pancreatoduodenectomy. Kendrick ML, van Hilst J, Boggi U, de Rooij T, Walsh RM, Zeh HJ, Hughes SJ, Nakamura Y, Vollmer CM, Kooby DA, Asbun HJ; Minimally Invasive Pancreatic Resection Organizing Committee. HPB (Oxford). 2017 Mar;19(3):215-224. doi: 10.1016/j.hpb.2017.01.023

3. Laparoscopic pancreatoduodenectomy with open or laparoscopic reconstruction during the learning curve: a multicenter propensity score matched study. van Hilst J, de Rooij T, van den Boezem PB, Bosscha K, Busch OR, van Duijvendijk P, Festen S, Gerhards MF, de Hingh IH, Karsten TM, Kazemier G, Lips DJ, Luyer MD, Nieuwenhuijs VB, Patijn GA, Stommel MW, Zonderhuis BM, Daams F, Besselink MG; Dutch Pancreatic Cancer Group. HPB (Oxford). 2019 Jul;21(7):857-864. doi: 10.1016/j.hpb.2018.11.003. Epub 2018 Dec 5

Laparoscopic Whipple procedure for the management of a pancreatic head tumor

Deep endometriosis is a condition in which there is more than a 5mm depth of subperitoneal invasion. The bowel is involved in 5 to 12% of the overall endometriosis cases with sigmoid colon and rectum being the commonest, more than 90% (1). Rectal shaving, discoid resection, and segmental resection remain the standard technique for managing bowel endometriosis. Discoid resection is performed for lesions less than 3cm with less than a 50% involvement of bowel circumference. Rectal shaving performed in such cases is associated with medium-term recurrence rates of dysmenorrhea and dyspareunia (2). For a small nodule, full-thickness disc resection of the rectal wall can be performed safely. The rectal wall remains well vascularized and innervated after closure with sutures (3). Barbed sutures can be used safely to close the rectal wall in 2 layers without significantly increasing the rates of postoperative leak, abscess, and fistula formation (4).

Bibliography:

1. Meuleman C, Tomassetti C, D’Hoore A, et al. Surgical treatment of deeply infiltrating endometriosis with colorectal involvement. Hum Reprod Update. 2011;17(3):311–326. doi: 10.1093/humupd/dmq057
2. Afors K, Centini G, Fernandes R, et al. Segmental and discoid resection are preferential to bowel shaving for medium-term symptomatic relief in patients with bowel endometriosis. J Minim Invasive Gynecol. 2016;23:7. doi: 10.1016/j.jmig.2016.08.813
3. Roman H, Opris I, Resch B, Tuech JJ, Sabourin JC, Marpeau L. Histopathologic features of endometriotic rectal nodules and the implications for management by rectal nodule excision. Fertil Steril. 2009;92:1250-1252
4. Stuparich MA, Lee TTM. Discoid Resection of Rectosigmoid Endometriotic Nodules. J Minim Invasive Gynecol. 2018 Mar-Apr;25(3):388. doi: 10.1016/j.jmig.2017.09.024. Epub 2017 Oct 6. PMID: 28993241

Laparoscopic excision of rectovaginal endometriosis and discoid bowel resection

Excision laparoscopique d'une endométriose rectovaginale et résection intestinale discoïde

In this authoritative lecture, Dr. Filippo Annino, MD, outlines the technical principles of robotic urinary diversion after cystectomy. Step-by-step techniques for robotic urinary diversion after radical cystectomy are presented.&#x20;
The first focus is on the ERAS protocol for fast-track surgery, which facilitates a faster recovery for patients.
The author also details the operating room set-up, the port placement for pelvic surgery, and the techniques to improve bowel mobilization during the reconstruction phase.
In the reconstruction phase, the video demonstrates how to identify the precise point to cut the ileum, using specific landmarks to aid orientation and minimize the risk of errors. The proper orientation of the stapler (robotic or laparoscopic) is also explained.
Regarding urinary diversions, every step is meticulously detailed for both the ileal conduit and the neobladder, adhering to the Bordeaux technique.
This stepwise approach is systematically applied to all bladder cancer patients undergoing robotic cystectomy with urinary diversion. Performing this procedure with precision simplifies its execution, reducing the risk of intraoperative errors and decreasing surgical duration.

Technical principles of robotic urinary diversion after cystectomy

Principes techniques de la dérivation urinaire robotique après cystectomie

Prostatectomie radicale robotisée en post-brachythérapie à l'aide de la plateforme robotique chirurgicale Versius

Over the years, many therapies have been launched for prostate cancer. Brachytherapy has had great prominence in the recent past. In this video, the authors demonstrate rescue surgery after more than 15 years after the implantation of more than 80 implants in the prostate parenchyma and the recurrent changes of this radiation. Recent studies demonstrate a higher recurrence rate after this procedure when compared to other techniques. In addition to biochemical relapse, the patient presented symptoms and signs of lower urinary tract symptoms (LUTS), with a worsening in quality of life. 



Bibliography:

1. A Systematic Review and Meta-analysis of Local Salvage Therapies After Radiotherapy for Prostate Cancer (MASTER). Review Eur Urol. 2021 Sep;80(3):280-292. doi: 10.1016/j.eururo.2020.11.010. Epub 2020 Dec 11

2. Effect of Brachytherapy With External Beam Radiation Therapy Versus Brachytherapy Alone for Intermediate-Risk Prostate Cancer: NRG Oncology RTOG 0232 Randomized Clinical Trial. Randomized Controlled Trial J Clin Oncol. 2023 Aug 20;41(24):4035-4044. doi: 10.1200/JCO.22.01856. Epub 2023 Jun 14

3. Salvage Radical Prostatectomy for Recurrent Prostate Cancer: A Systematic Review (French ccAFU). Review Cancers (Basel). 2023 Nov 20;15(22):5485. doi: 10.3390/cancers15225485

4. Clinical Outcomes of Robotic Surgery Compared to Conventional Surgical Approaches (Laparoscopic or Open): A Systematic Overview of Reviews. Ann Surg. 2021 Mar 1;273(3):467-473. doi: 10.1097/SLA.0000000000003915

Robotic radical prostatectomy in post-brachytherapy using the Versius surgical robotic platform

Pylorus-preserving gastrectomy (PPG) has gained traction in Eastern Asian countries such as Japan and South Korea, showcasing promising results in patients with early-stage gastric cancer. Despite its potential benefits, PPG remains underused in European countries. This surgical intervention aims to mitigate post-resection complications and improve the quality of life in patients undergoing radical gastric surgeries. By preserving the pyloric function, PPG reduces the incidence of postoperative issues such as bile reflux gastritis, anemia, vitamin deficiency, and weight loss. In this clinical case presentation, the authors highlight the successful execution of a fully laparoscopic pylorus-preserving nerve-sparing gastrectomy with intracorporeal gastrogastrostomy. The procedure addresses the oncologic requirements and emphasizes the importance of preserving functional aspects of the stomach to improve patient outcomes and quality of life in the long term. With a growing body of evidence supporting its efficacy, PPG represents a valuable option in the surgical management of early gastric cancer, warranting further consideration and adoption in clinical practice.



Bibliography:

1. Bang Wool Eom, Boram Park, Hong Man Yoon, Keun Won Ryu, Young-Woo Kim. Laparoscopy-assisted pylorus-preserving gastrectomy for early gastric cancer: A retrospective study of long-term functional outcomes and quality of life, World J Gastroenterol. 2019 Sep 28;25(36):5494-5504. doi: 10.3748/wjg.v25.i36.5494. PMID: 31576095 PMCID: PMC6767989

2. Hiroki Harada, Kojiro Eto, Manabu Ohashi, Nozomi Kurihara, Motonari Ri, Rie Makuuchi, Satoshi Ida, Masaru Hayami, Koshi Kumagai, Takeshi Sano, Souya Nunobe, Equal short-term outcomes of intracorporeal mechanical gastrogastrostomy in laparoscopic pylorus-preserving gastrectomy for cT1N0 gastric cancer in the middle stomach compared with the extracorporeal hand-sewing method. Surg endosc. 2024 Apr 15. doi: 10.1007/s00464-024-10823-w. PMID: 38619559

3. Ke-Kang Sun, Yong-You Wu. Pylorus-preserving gastrectomy for early gastric cancer. World J Gastrointest Oncol. 2024 Mar 15;16(3):653-658. doi: 10.4251/wjgo.v16.i3.653. PMID: 38577445 PMCID: PMC10989389

Totally laparoscopic pylorus-preserving gastrectomy for early gastric cancer

Gastrectomie conservant le pylore par laparoscopie totale en cas de cancer gastrique précoce

This lecture by Dr. Teresa LaMasters from Iowa, USA, past President of ASNVS, discusses surgical burnout. It was originally given as the BJS lecture for the International Bariatric Club in 2023, but is still very relevant. Burnout is a problem among surgeons, and importantly, can affect patient safety. Dr. LaMasters looks at the causes, those most at risk, how to recognize burnout, and how to help an affected individual. She reminds us that surgeons need to work together.

Surgeon burnout: causes and implications for patient safety - Teresa LaMasters, MD, FACS, FASMBS, DABOM, DABS-FPMBS

monthly focus

In this authoritative lecture, Dr. Simone Crivellaro, MD, MHA outlines the role of single port robotic surgery in urology.&#x20;

Role of single port robotic surgery in urology 

Rôle de la chirurgie robotique à trocart unique en urologie

In this educational video, the authors demonstrate a laparoscopic Boari flap and psoas hitch for the treatment of a left middle ureter injury in a patient undergoing Hartman sigmoidectomy and colostomy for the treatment of a complicated diverticulitis. The combination of the two techniques, Boari flap and psoas hitch, was first described by Kelâmi et al. (3). This technique can bridge up to 18cm of missing ureter with tension-free anastomosis (2). Some authors have reported that the length/width of the bladder flap should be no more than 3:1, and that the base of the flap should be no less than 4cm (1). Laparoscopy offers similar results to the open technique with a shorter hospital stay (4). Closing the colostomy with a gauze pad and nylon suture leaves the abdominal wall with more space for placing the trocars. Using a Foley catheter with the tip cut off facilitates the passage of the double-J catheter.

Bibliography:

1\. Guangpu Ding, Sida Cheng, Xinfei Li, Dong Fang, Kunlin Yang, Qi Tang, Peng Zhang, Han Hao, Xuesong Li, Liqun Zhou. Experience managing distal ureteral strictures with Boari flap-psoas hitch and comparison of open and laparoscopic procedures. Transl Androl Urol 2021;10(1):56-65 | [http://dx.doi.org/10.21037/tau-20-789.](http://dx.doi.org/10.21037/tau-20-789.) PMID: 33532296

2\. Ankur Bansal, Rahul Janak Sinha, Ankur Jhanwar, Gaurav Prakash, Bimalesh Purkait, Vishwajeet Singh. Laparoscopic ureteral reimplantation with Boari flap for the management of long- segment ureteral defect: A case series with review of the literature. Turk J Urol 2017; 43(3): 313-8. DOI: 10.5152/tud.2017.44520. PMID: 28861304

3\. A. Kelâmi, U. Fiedler, V. Schmidt, A. Rost, M. Richter-Reichhelm, H. H. Hildebrand, and F. Weichler-Wolfgramm. Replacement of the Ureter Using the Urinary Bladder. Urol Res. 1973 Dec;1(4):161-5. DOI: 10.1007/BF00256617. PMID: 4789024

4\. Fugita OE, Dinlenc C, Kavoussi L. The laparoscopic Boari flap. J Urol. 2001 Jul;166(1):51-3. PMID: 11435821.

Laparoscopic Boari flap and psoas hitch for the management of a left mid-ureter injury

Confection d'un lambeau de Boari sur vessie psoïque par voie d'abord laparoscopique pour prise en charge d'une lésion de l'uretère moyen

The authors demonstrate a right nephroureterectomy with bladder cuff excision and retroperitoneal lymph node dissection (LND) performed in a strictly laparoscopic fashion. The European Association of Urology (EAU) guidelines recommend template-based lymph node dissection in all patients who plan to undergo radical nephroureterectomy, due to the inaccuracy of preoperative tumor staging (1). The right-side template is renal hilar, paracaval, retrocaval, and intra-aortocaval lymph nodes (2). The frequency of regional lymph node metastasis is as high as 20 to 30%. Lymphadenectomy does not increase overall and serious postoperative complication rates (3). In patients undergoing a laparoscopic nephroureterectomy, open excision of the bladder cuff is associated with a higher risk of intravesical recurrence (4).

Bibliography:

1\. Rouprêt M, Seisen T, Birtle AJ, Capoun O, Compérat EM, Dominguez-Escrig JL, Gürses Andersson I, Liedberg F, Mariappan P, Hugh Mostafid A, Pradere B, van Rhijn BWG, Shariat SF, Rai BP, Soria F, Soukup V, Wood RG, Xylinas EN, Masson-Lecomte A, Gontero P. European Association of Urology Guidelines on Upper Urinary Tract Urothelial Carcinoma: 2023 Update. Eur Urol. 2023 Jul;84(1):49-64. doi: 10.1016/j.eururo.2023.03.013. Epub 2023 Mar 24. PMID: 36967359.

2\. Kondo T, Nakazawa H, Ito F, Hashimoto Y, Toma H, Tanabe K. Primary site and incidence of lymph node metastases in urothelial carcinoma of upper urinary tract. Urology. 2007 Feb;69(2):265-9. doi: 10.1016/j.urology.2006.10.014. PMID: 17320661.

3\. Kanno T, Kobori G, Ito K, Nakagawa H, Takahashi T, Takaoka N, Somiya S, Nagahama K, Ito M, Megumi Y, Higashi Y, Moroi S, Akao T, Yamada H. Complications and their management following retroperitoneal lymph node dissection in conjunction with retroperitoneal laparoscopic radical nephroureterectomy. Int J Urol. 2022 May;29(5):455-461. doi: 10.1111/iju.14814. Epub 2022 Feb 10. PMID: 35144321.

4\. Huang EY, Tai MC, Chung HJ, Chang YH, Huang WJ. Effects of different combinations of radical nephroureterectomy and bladder cuff excision procedures for upper tract urothelial carcinoma on bladder recurrence. Int Braz J Urol. 2023 Jul-Aug;49(4):469-478. doi: 10.1590/S1677-5538.IBJU.2023.0031. PMID: 37267612; PMCID: PMC10482446.

Laparoscopic right nephroureterectomy with bladder cuff excision and lymph node dissection

Néphro-urétérectomie droite laparoscopique avec excision du collet vésical et dissection des ganglions lymphatiques

Prostatectomie radicale robotisée après prostatectomie simple selon la technique de Millin 

In this educational video, the authors demonstrate a robotic radical prostatectomy using the da Vinci X™ surgical robotic platform in a patient who had had a simple prostatectomy surgery using the conventional Millin technique 7 years earlier. The case is interesting due to the large amount of fibrosis, scars, and local adhesions, distinct from other cases such as post-TURP, radiotherapy, HIFU or even cases of patients after laparoscopic herniorrhaphy surgery. Of note, in our case, the patient has a large abdominal circumference. Despite a greater technical difficulty, the robotic route proved to be of great value. The patient presented excellent postoperative outcomes.

Bibliography:

1\. Creta M, Manfredi C, Arcaniolo D, Spirito L, A Kaplan S, H Woo H, De Nunzio C, Gilling P, Bach T, De Sio M, Imbimbo C, Mirone V, Longo N, Fusco F. Functional and oncological outcomes after radical prostatectomy in patients with history of surgery for lower urinary tract symptoms related to benign prostatic enlargement: A systematic review with meta-analysis. Prostate Cancer Prostatic Dis. 2024 Sep;27(3):367-384. doi: 10.1038/s41391-023-00678-y. Epub 2023 May 27. PMID: 37244971

2\. Gacci M, Sebastianelli A, Salvi M, De Nunzio C, Tubaro A, Gravas S, Moncada I, Serni S, Maggi M, Vignozzi L. The Impact of Central Obesity on Storage Luts and Urinary Incontinence After Prostatic Surgery. Curr Urol Rep. 2016 Sep;17(9):61. doi: 10.1007/s11934-016-0620-4. PMID: 27432378

3\. Su YK, F Katz B, S Sehgal S, S Yu SJ, Su YC, Lightfoot A, Lee Z, Llukani E, Monahan K, I Lee K. Does previous transurethral prostate surgery affect oncologic and continence outcomes after RARP? J Robot Surg. 2015 Dec;9(4):291-7. doi: 10.1007/s11701-015-0529-9. Epub 2015 Aug 8. PMID: 26530840

4\. Tugcu V, Atar A, Sahin S, Kargi T, Gokhan Seker K, Ilker Comez Y, IhsanTasci A. Robot-Assisted Radical Prostatectomy After Previous Prostate Surgery. JSLS. 2015 Sep-Dec;19(4):e2015.00080. doi: 10.4293/JSLS.2015.00080. PMID: 26648678 PMCID: PMC4653581

Robotic radical prostatectomy after simple prostatectomy with Millin technique 

Cystectomie radicale assistée par robot

In this authoritative lecture, Professor Rafael Coelho, MD, PhD outlines robot-assisted radical cystectomy (RARC).

Robotic assisted radical cystectomy (RARC)

Focus on laparoscopic and robotic urologic surgery

Focus sur la chirurgie urologique laparoscopique et robotique

Restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the operation of choice for patients with ulcerative colitis (UC) (1). The most common type of IPAA is achieved with a J pouch, where the ileal pouch is anastomosed with the rectal cuff, a 2 to 3cm string of anal canal which can include a few millimeters of rectal mucosa. This tiny portion of the rectum and anal canal is necessary for the stapled anastomosis. The ileorectal anastomosis is a totally different procedure, where the rectum is kept in place (while it is removed in the IPAA) and connected to the ileum, with no creation of an ileal pouch. 

This video presents the case of a laparoscopic proctectomy with a J-pouch construction as the second stage of a modified two-staged procedure (subtotal colectomy with end ileostomy, proctectomy, and IPAA). The two-staged approach for the restoration of intestinal continuity in UC patients is one of the most used approaches, given its safety in terms of postoperative complications and overall quality of life for patients who are diagnosed with acute severe colitis and who undergo total colectomy as an emergency surgery, and after 3 to 6 months are fit and ready for intestinal reconstruction through the IPAA without a protective stoma (5, 6). 

The procedure was divided into two major steps. The first one was a laparoscopic proctectomy, performed with a close rectal dissection (CRD), also known as "incomplete TME approach", to minimize the risks of neuromuscular injury (2). An image at the beginning of the video compares the two approaches for laparoscopic proctectomy. 

The second step was the extracorporeal J-pouch construction using an endoscopic stapling device and an ileal pouch-anal anastomosis creation using a 31mm circular stapler. 

Randomized clinical trials results showed how an incomplete TME leads to a lower rate of severe complications and better short-term quality of life when compared to TME (3). This video presents the authors’ standardized approach. 

Close rectal dissection, or incomplete TME, is a safe approach for laparoscopic proctectomy given the good results obtained in terms of protecting autonomic nerve function (4). This technique may be more challenging than TME if the surgeon is used to oncological dissections. A standardized technique for CRD is crucial to have the best outcomes in terms of sexual and urinary functions. 



Bibliography:

1. Parks AG, Nicholls RJ. Proctocolectomy without ileostomy for ulcerative colitis. Br Med J. 1978 Jul 8;2(6130):85-8. doi: 10.1136/bmj.2.6130.85. PMID: 667572; PMCID: PMC1605901.

2. Reijntjes MA, de Jong DC, Bartels S, Wessels EM, Bocharewicz EK, Hompes R, Buskens CJ, d'Haens GR, Duijvestein M, Bemelman WA. Long-term outcomes after close rectal dissection and total mesorectal excision in ileal pouch-anal anastomosis for ulcerative colitis. Tech Coloproctol. 2023  Apr;27(4):297-307. doi: 10.1007/s10151-022-02713-x. Epub 2022 Nov 6. PMID: 36336745; PMCID: PMC10008209.

3. Capelli, G., De Simone, I., Spolverato, G. et al. Non-Operative Management Versus Total Mesorectal Excision for Locally Advanced Rectal Cancer with Clinical Complete Response After Neoadjuvant Chemoradiotherapy: a GRADE Approach by the Rectal Cancer Guidelines Writing Group of the Italian Association of Medical Oncology (AIOM). J Gastrointest Surg 24, 2150–2159 (2020). https://doi.org/10.1007/s11605-020-04635-1

4. Garcia-Granero A, Pellino G, Fletcher-Sanfeliu D, Millan M, Primo-Romaguera V, Garcia-Gausí M, Fernandez M, Gonzalez-Argente X, Spinelli A, Valverde-Navarro A, Garcia-Granero E. "Near-TME": proposed standardisation of the technique for proctectomy in male patients with ulcerative colitis. Tech Coloproctol. 2022 Mar;26(3):217-226. doi: 10.1007/s10151-022-02579-z. Epub 2022 Feb 1. PMID: 35103902; PMCID: PMC8857132.

5. Maspero, M., Hull, T.L. Clinical approach to patients with an ileal pouch. Abdom Radiol 48, 2918–2929 (2023). https://doi.org/10.1007/s00261-023-03888-z

6. Luo, W.Y., Singh, S., Cuomo, R. et al. Modified two-stage restorative proctocolectomy with ileal pouch-anal anastomosis for ulcerative colitis: a systematic review and meta-analysis of observational research. Int J Colorectal Dis 35, 1817–1830 (2020). https://doi.org/10.1007/s00384-020-03696-7



Completion proctectomy and J-pouch construction for ulcerative colitis (UC)

Proctectomie complète et création d'une poche en J pour colite ulcéreuse 

Excision mésorectale totale transanale (TaTME) pour adénocarcinome avancé du bas rectum

Colorectal cancer is the fourth most common malignancy and the second main cause of cancer-related mortality in the world. Transanal total mesorectal excision (TaTME) was first described by Lacy and Sylla in 2010. As this new surgical technique is increasingly adopted by surgeons (2), a comparable rate of intraoperative complications and a significantly lower incidence of postoperative complications were noted in the TaTME approach as compared with the laparoscopic TME (LaTME) approach (2). Indeed, many surgeons adopted the TaTME surgical technique because the use of LaTME is limited in low rectal cancer patients, who require surgeons with experience in ultralow sphincter-saving laparoscopic surgery, that has a high risk of leaving a positive circumferential resection margin. Aubert et al. confirmed that TaTME for low and middle rectal cancer is safe, feasible, and can lead to a high quality of rectal cancer resection specimen, with a shorter length of stay, and a lower readmission rate, as well as a lower rate of overall and major morbidities, anastomotic leakage, and circumferential resection margin involvement, as opposed to the standard laparoscopic total mesorectal excision (3).

This video presents the case of a 50-year-old man with a history of Parkinson’s disease who presented with proctorrhagia without any other symptoms. On medical exam, a rectal tumor was diagnosed 2cm away from the anal verge. It was decided to manage it with chemoradiotherapy. An assessment control was performed, and a complete tumor regression was observed. It was decided to perform a transanal total mesorectal excision.

Bibliography:

1\. Lei PR, Ruan Y, Yang X, Fang J, Chen T. Trans-anal or trans-abdominal total mesorectal excision? A systematic review and meta-analysis of recent comparative studies on perioperative outcomes and pathological result. Int J Surg. 2018;60(November):113- 119. doi:10.1016/j.ijsu.2018.11.003

2\. Ma B, Gao P, Song Y, et al. Transanal total mesorectal excision (taTME) for rectal cancer: A systematic review and meta-analysis of oncological and perioperative outcomes compared with laparoscopic total mesorectal excision. BMC Cancer. 2016;16(1). doi:10.1186/s12885-016-2428-5

3\. Aubert M, Mege D, Panis Y. Total mesorectal excision for low and middle rectal cancer: laparoscopic versus transanal approach—a meta-analysis. Surg Endosc. 2020;34(9):3908-3919. doi:10.1007/s00464-019-07160-8

Transanal total mesorectal excision (TaTME) for advanced low rectal adenocarcinoma



Bibliography:

1. Paquette, I. M., Madoff, R. D., Sigurdson, E. R., & Chang, G. J. (2018). Impact of proximal vascular ligation on survival of patients with colon cancer. Annals of Surgical Oncology, 25(1), 38‑45. https://doi.org/10.1245/s10434-016-5720-3 

2. Perrakis, A., Weber, K., Merkel, S., Matzel, K., Agaimy, A., Gebbert, C., & Hohenberger, W. (2014). Lymph node metastasis of carcinomas of transverse colon including flexures. Consideration of the extramesocolic lymph node stations. International Journal of Colorectal Disease, 29(10), 1223‑1229. https://doi.org/10.1007/s00384-014-1971-2 

3. Kotake, K., Mizuguchi, T., Moritani, K., Wada, O., Ozawa, H., Oki, I., & Sugihara, K. (2014). Impact of D3 lymph node dissection on survival for patients with T3 and T4 colon cancer. International Journal of Colorectal Disease, 29(7), 847‑852. https://doi.org/10.1007/s00384-014-1885-z 

Laparoscopic extended right hemicolectomy with D3 lymphadenectomy

Hémicolectomie droite élargie laparoscopique avec curage ganglionnaire D3

There is evidence in the literature supporting that postoperative complications in colorectal surgery can be handled laparoscopically. Many cases of reoperative surgery will be described in the video. Most of them are due to anastomotic leakage evidenced during the early postoperative days. Depending on the size of the anastomotic defect, an anastomosis takedown or proximal ostomy may be performed. Lavage of the entire abdomen can be performed using a minimally invasive approach. Patients may keep the benefits of the initial laparoscopic surgery with the management of this potentially lethal complication using a reoperative laparoscopic surgery.

Bibliography:

1\. Rotholtz NA, Laporte M, Matzner M, Schlottmann F, Bun ME. "Relaparoscopy" to treat early complications following colorectal surgery. Surg Endosc. 2022 May;36(5):3136-3140. doi: 10.1007/s00464-021-08616-6. Epub 2021 Jun 22. PMID: 34159459.

2\. Rotholtz NA, Angeramo CA, Laporte M, Matzner Perfumo M, Schlottmann F, Bun ME. "Early" Reoperation to Treat Complications Following Laparoscopic Colorectal Surgery: The Sooner the Better. Surg Laparosc Endosc Percutan Tech. 2021 Aug 18;31(6):756-759. doi: 10.1097/SLE.0000000000000984. PMID: 34406166.

Laparoscopic reoperation for early postoperative complications after colorectal surgery

Réopération laparoscopique en cas de complications postopératoires précoces après chirurgie colorectale

The patient was a 84-year-old woman with no history of perianal abscess and sigmoid diverticulosis. She had episodes of rectal bleeding, weight loss, and previous endoscopic resection for adenomatous polyps with high-grade dysplasia in the sigmoid and right colon. Her family history included colorectal cancer. She underwent an endoscopic dissection for an adenomatous polyp with low-grade dysplasia in the right colon and for a 15mm laterally spreading tumor (LST) in the transverse colon with a grade III (dysplasia?) according to Kudo’s classification and with SCAD-like (please clarify) inflammation in the descending and sigmoid colon. After 8 months, she underwent another endoscopic dissection for a recurrent LST on the distal transverse colon, which was positive for a pT1 adenocarcinoma, and for adenomatous tubular villous polyps in the ascending colon with low-grade dysplasia. CT-scan showed a concentric thickening of a 2.5cm tract near the splenic flexure. A laparoscopic total colectomy was performed to manage the pT1N0 colonic adenocarcinoma (please confirm). The transverse colon cancer can be treated with different kinds of colonic resections, but when it appears with multiple conditions such as colitis and recurrent dysplastic lesions, or with a strong family history of colon cancers, total colectomy should be considered. Laparoscopy in elderly patients is always carefully considered due to the increasing physiological demands. However, it is a feasible and safe approach with potential short-term benefits. The literature shows no significant differences in overall morbidity and mortality between laparoscopic and open surgery in old patients. However, some pooled analyses are starting to show a slightly reduced morbidity in the laparoscopic approach, even in elderly patients, with a reduced risk of surgical site infections, a faster recovery time inducing a shorter hospital stay, and less need for rehabilitation.



Bibliography:

1. Devoto L, Celentano V, Cohen R, Khan J, Chand M. Colorectal cancer surgery in the very elderly patient: a systematic review of laparoscopic versus open colorectal resection. Int J Colorectal Dis. 2017 Sep;32(9):1237-1242. doi: 10.1007/s00384-017-2848-y. Epub 2017 Jun 30. PMID: 28667498.

2. Passuello N, Polese L, Ometto G, Grossi U, Mammano E, Vittadello F, Frasson A, Tessari E, Bartolotta P, Gregori D, et al. Outcomes of Laparoscopic Surgery in Very Elderly Patients with Colorectal Cancer: A Survival Analysis and Comparative Study. Journal of Clinical Medicine. 2023; 12(22):7122. https://doi.org/10.3390/jcm12227122

3. Ueda, Y., Shiraishi, N., Kawasaki, T. et al. Short- and long-term outcomes of laparoscopic surgery for colorectal cancer in the elderly aged over 80 years old versus non-elderly: a retrospective cohort study. BMC Geriatr 20, 445 (2020). https://doi.org/10.1186/s12877-020-01779-2

4. Chern, YJ., Hung, HY., You, JF. et al. Advantage of laparoscopy surgery for elderly colorectal cancer patients without compromising oncologic outcome. BMC Surg 20, 294 (2020). https://doi.org/10.1186/s12893-020-00967-6



Laparoscopic total colectomy for transverse colon adenocarcinoma in an elderly woman

Colectomie totale laparoscopique pour adénocarcinome du côlon transverse chez une femme âgée

This educational video presents the case of a laparoscopic subtotal colectomy for severe acute colitis with a bottom-up approach to detach the right colon which requires the placement of a suprapubic optical port as in the laparoscopic ileocecal resection technique.



Bibliography:

1. Chebbi F, Ayadi MS, Rhaiem R, Daghfous A, Makni A, Rebaϊ W, Ksantini R, Ftirich F, Jouini M, Kacem M, Ben Safta Z. Laparoscopic ileo-cecal resection: the total retro-mesenteric approach. Surg Endosc. 2015 Jan;29(1):245-51. doi: 10.1007/s00464-014-3666-8. Epub 2014 Jul 10. PMID: 25007973.

2. Mege D, Stellingwerf ME, Germain A, Colombo F, Pellino G, Di Candido F, Maggiori L, Foschi D, Buskens CJ, Adegbola S, Spinelli A, Warusavitarne J, Bemelman WA, Sampietro G, D'Hoore A, Panis Y. Management of Rectal Stump During Laparoscopic Subtotal Colectomy for Inflammatory Bowel Disease: A Comparative Cohort Study from Six Referral Centres. J Crohns Colitis. 2020 Sep 16;14(9):1214-1221. doi: 10.1093/ecco-jcc/jjaa046. PMID: 32191295.

3. Antonino Spinelli, Stefanos Bonovas, Johan Burisch, Torsten Kucharzik, Michel Adamina, Vito Annese, Oliver Bachmann, Dominik Bettenworth, Maria Chaparro, Wladyslawa Czuber-Dochan, Piotr Eder, Pierre Ellul, Catarina Fidalgo, Gionata Fiorino, Paolo Gionchetti, Javier P Gisbert, Hannah Gordon, Charlotte Hedin, Stefan Holubar, Marietta Iacucci, Konstantinos Karmiris, Konstantinos Katsanos, Uri Kopylov, Peter L Lakatos, Theodore Lytras, Ivan Lyutakov, Nurulamin Noor, Gianluca Pellino, Daniele Piovani, Edoardo Savarino, Francesco Selvaggi, Bram Verstockt, Glen Doherty, Tim Raine, Yves Panis, ECCO Guidelines on Therapeutics in Ulcerative Colitis: Surgical Treatment, Journal of Crohn's and Colitis, Volume 16, Issue 2, February 2022, Pages 179–189



Laparoscopic subtotal colectomy for severe acute colitis 

Colectomie subtotale laparoscopique pour colite aiguë grave

Colectomie gauche laparoscopique à trois trocarts pour une tumeur de l'angle colique gauche

This is the case of a 36-year-old woman with no relevant personal or family history. She presented with anemia and changes in bowel habits over a 3-month period. CT-scan revealed a marked concentric thickening of the colonic wall at the splenic flexure with an inflammation of the surrounding adipose tissue. Videocolonoscopy described a neoproliferative nipple-like ulcerated friable lesion located 30cm away from the anal margin. Biopsy was performed and the lesion was marked with Indian ink. 

Three 10mm trocars were placed in the epigastrium, right hypochondrium, and right iliac fossa, respectively. Medial and lateral approaches were used. Through an anterior trans-omental approach, the greater omentum was separated from the transverse colon. The dissection of the omentum was continued to the left and mobilization was completed. Once complete mobilization was achieved, the distal division was performed using a 60mm mechanical suture. A colorectal anastomosis was then performed using a circular mechanical suture. The pneumatic test was negative. 



Bibliography:

1. Roscio F, Bertoglio C, De Luca A, Frattini P, Clerici F, Scandroglio I. Totally laparoscopic resection of the splenic flexure for tumor. Updates Surg. 2012 Sep;64(3):185-90. doi: 10.1007/s13304-012-0162-3. Epub 2012 Jun 28. PMID: 22739994.

2. Cirocco WC. The optimal extent of colectomy for splenic flexure carcinoma - Extended vs segmental? Less is best! Am J Surg. 2023 Mar;225(3):452-453. doi: 10.1016/j.amjsurg.2022.10.054. Epub 2022 Nov 15. PMID: 36402619.

3. Hashida H, Kondo M, Kita R, Kitamura K, Uryuhara K, Kobayashi H, Kaihara S. Laparoscopic Colectomy for Splenic Flexure Cancer Approached from Four Directions. J Laparoendosc Adv Surg Tech A. 2021 Sep;31(9):1014-1018. doi: 10.1089/lap.2020.0709. Epub 2020 Nov 23. PMID: 33226876.

4. Rondelli F, Pasculli A, De Rosa M, Avenia S, Bugiantella W. Is routine splenic flexure mobilization always necessary in laparotomic or laparoscopic anterior rectal resection? A systematic review and comprehensive meta-analysis. Updates Surg. 2021 Oct;73(5):1643-1661. doi: 10.1007/s13304-021-01135-y. Epub 2021 Jul 24. PMID: 34302604.

Three-port laparoscopic left colectomy for splenic flexure tumor

Although complete mesocolic excision has oncological importance for colon cancer surgery, there are some difficulties in right hemicolectomy due to variations in the vascular anatomy around the gastrocolic trunk (1-3). Recently, in a study including 38,030 cases of right hemicolectomy from the Japanese national database, the 30-day postoperative mortality rate was 1.2% (4). In the video, we presented the advantages of the cranial-first approach for right-sided colon cancer. This procedure comprised three steps. First, the omentum was dissected and the transverse mesocolon was taken down. The right gastroepiploic vein and the anterior superior pancreaticoduodenal vein were preserved, and the accessory right colic vein (ARCV) was dissected at its root. The pancreatic head and the horizontal duodenal leg were exposed extensively. Secondly, the patient’s head was lowered, and the ileocecum was detached from the caudal side for complete mobilization of the right-sided colon. Finally, the patient was changed to a horizontal position, and lymphadenectomy was performed depending on the tumor’s location. In this case, the ileocolic artery (ICA) and ileocolic vein (ICV) and the right branches of the middle colic artery (MCA) and of the middle colic vein (MCV) were divided. The MCV was mostly divided from the cranial side. However, as the case could be easily treated from the medial side, the MCV was divided consistently using a medial approach. The major advantages of this technique were to safely dissect the ARCV at its origin while clearly visualizing the right gastroepiploic vein and the anterior superior pancreaticoduodenal vein and to recognize the dissection line around the gastrocolic trunk (GCT). Another advantage was to easily perform lymph nodes dissection in the dorsal side of the superior mesenteric vein (SMV), visualizing the right lateral border of the nerves around the superior mesenteric artery (SMA). 



Bibliography: 

1. Hohenberger, W., Weber, K., Matzel, K., Papadopoulos, T. and Merkel, S. (2009) Standardized surgery for colonic cancer: complete mesocolic excision and central ligation--technical notes and outcome. Colorectal Dis, 11: 354-364; discussion 364-355. doi: 10.1111/j.1463-1318.2008.01735.x

2. West, N. P., Hohenberger, W., Weber, K., Perrakis, A., Finan, P. J. and Quirke, P. (2010) Complete mesocolic excision with central vascular ligation produces an oncologically superior specimen compared with standard surgery for carcinoma of the colon. J Clin Oncol, 28: 272-278. doi: 10.1200/JCO.2009.24.1448

3. De Simoni, O., Barina, A., Sommariva, A., Tonello, M., Gruppo, M., Mattara, G., et al. (2021) Complete mesocolic excision versus conventional hemicolectomy in patients with right colon cancer: a systematic review and meta-analysis. Int J Colorectal Dis, 36: 881-892. doi: 10.1007/s00384-020-03797-3

4. Yoshida, T., Miyata, H., Konno, H., Kumamaru, H., Tangoku, A., Furukita, Y., et al. (2018) Risk assessment of morbidities after right hemicolectomy based on the National Clinical Database in Japan. Ann Gastroenterol Surg, 2: 220-230. doi: 10.1002/ags3.12067

Advantages of the cranial-first approach in laparoscopic surgery for right-sided colon cancer

Avantages de l'abord supérieur premier dans la chirurgie laparoscopique du cancer du côlon droit

Segmentectomie laparoscopique du segment hépatique VII pour cancer colorectal métastatique

Colorectal cancer is the third most common type of cancer in the world. Approximately 35 to 55% of patients will develop liver metastases in the course of the disease. Surgical resection is the only option for long-term survival. The laparoscopic approach for lesions located in the superior segments of the posterior liver is still challenging. 

This video aims to demonstrate a laparoscopic resection of the metastasis located in liver segment VII as performed at the authors’ institution. 

The authors present the case of a 65-year-old man diagnosed with a cancer of the splenic flexure of the colon, occlusive, and with a single synchronous metastasis in liver segment VII. 

Initially, the patient underwent a laparoscopic segmental colectomy for a cancer in the splenic flexure of the colon. It was then decided to perform a laparoscopic segment VII atypical resection. Five ports were placed. The procedure began with a complete abdominal exploration and no other lesions were observed macroscopically. The right triangular and coronary ligaments were divided. The left triangular ligament was also divided to medialize the right liver and to access liver segment VII. The extension of the lesion was identified via intraoperative ultrasound and the limits of the resection were marked. It was confirmed by fluoroscopy that the margins were free (indocyanine green (ICG) was administered 20 hours earlier). The hepatic pedicle was looped and the gastric antrum exited through the left flank. Hepatotomy was started and continued until the complete release of the lesion. Hemostasis was controlled with a bipolar irrigation forceps and clips on major vessels. The resection margins were confirmed using fluorescein and a small fragment was enlarged on the lower margins. Hemostasis and bilistasis were controlled. 

The postoperative course was uneventful, and the patient was discharged on postoperative day 5. Pathological findings confirmed a 2.2 by 1.5cm hepatic metastasis of adenocarcinoma compatible with colorectal primary cancer. 

Despite the various obstacles and challenges, the laparoscopic approach has obvious advantages: less tissue damage associated with lower levels of postoperative pain, fewer peritoneal adhesions, a shorter hospital stay, and an earlier return to daily activities. Recent studies also add to these advantages less blood loss and no differences in the recurrence rate or long-term survival rate in malignant conditions. 



Bibliography:

1. Gon, Hidetoshi et al. Suitability of Laparoscopic Liver Resection of Segment VII: a Retrospective Two-Center Study. J Gastrointest Surg. 2022 Nov;26(11):2274-2281. doi: 10.1007/s11605-022-05389-8. Epub 2022 Jun 17.

2. S R Coles et al. Total laparoscopic management of lesions involving liver segment 7. Surg Endosc. 2015 Nov;29(11):3190-5. doi: 10.1007/s00464-014-4052-2. Epub 2015 Jan 13.

3. Engstrand, Jennie et al. Colorectal cancer liver metastases - a population-based study on incidence, management and survival. BMC Cancer. 2018 Jan 15;18(1):78. doi: 10.1186/s12885-017-3925-x.



Laparoscopic resection of liver segment VII for metastatic colorectal cancer

Biopsie ganglionnaire laparoscopique en cas de pathologie hématologique mal diagnostiquée : prélèvement du groupe de ganglions péri-aortiques

This video shows the case of a 73-year-old female patient who was admitted to the emergency department for abdominal pain. Through the anamnesis she did not report any past medical condition. CT-scan of the abdomen showed a diffuse lymphadenomegaly. Blood tests did not identify any significant changes that might be suggestive of a hematologic disease. A bone marrow biopsy was performed without any diagnostic finding. A full body 18F-FDG PET/CT-scan was performed and showed increased metabolism at the periaortic lymph node package and near the left renal vein. After a multidisciplinary case discussion, surgery was indicated. A laparoscopic lymph node sampling was decided upon. 

The patient was placed supine in a left lateral Trendelenburg position. Four 12mm trocars were placed according to the Hasson technique. The first trocar was placed supraumbilically. The second trocar was placed in the epigastric region. Two additional trocars were inserted in the left and right midclavicular line respectively.

The procedure began with the takedown of the hepatic flexure. As a result, a disconnection was performed between Toldt’s fascia and Gerota’s fascia, exposing the renal fascia and medializing the ascending colon. The upper knee of the duodenum was identified and mobilized according to the Kocher maneuver. This maneuver ended when the duodenal block was verticalized and the left margin of the aorta was uncovered. At the end of the maneuver, lymph nodes with potential pathological significance were discovered with 18F-FDG PET/CT imaging. The first lymph node identified on the aortic plane was sampled, and after discovering the left renal vein, the lymph node identified with 18F-FDG PET/CT imaging was harvested. 

The patient resumed oral feeding rapidly and was discharged home on POD 3. Histological and cytofluorimetric analyses confirmed the presence of a marginal-type low-grade B-cell non-Hodgkin lymphoma.

Immunophenotyping evidenced the following tumor markers as such: CD20 positive, PAX5 positive, BCL2 positive, CD10 negative, and CD200 negative B cells.



Laparoscopy usually plays a marginal role in the diagnosis of hematologic diseases.

The authors reported the clinical case of a female patient with a new-onset hematologic disease which could not be determined via classical diagnostic markers performed using serum chemistries and with bone marrow biopsy. Following a multidisciplinary case discussion, surgery was indicated and a diagnostic laparoscopy was performed with sampling of the periaortic lymph nodes. 



Bibliography:

1. Nevler, A., Har-Zahav, G., Abraham, A., Schiby, G., Zmora, O., Shabtai, M., Gutman, M., & Rosin, D. (2017). Laparoscopic lymph node biopsy : Efficacy and advantages. The Israel Medical Association Journal: IMAJ, 19(4), 231 233.



Laparoscopic lymph node biopsy in misdiagnosed hematologic disease: sampling of the periaortic lymph node group

Laparoscopic surgery is a technically demanding procedure that requires a significant level of experience and expertise. Since surgery is the mainstay treatment of rectal cancer, comprehending the complexities of multilaminar structures and interfascial spaces is mandatory.

This is the case of a 68-year-old woman who was evaluated for a positive fecal occult blood test. Colonoscopy found a vegetative lesion 15cm away from the anal verge, occupying approximately half of the lumen. Biopsy and distal tattooing were performed. The biopsy study confirmed the presence of a moderately differentiated adenocarcinoma. CT-scan showed no lung nor liver metastasis. MRI revealed an upper rectal cancer, 11.4cm away from the anal verge, with no pathological lymph nodes. It was a T2 N0 Mx negative CRM tumor. Surgical treatment was decided upon along with a laparoscopic anterior rectal resection. This video demonstrates all the important technical steps to fasten the learning curve and master the procedure in a stepwise approach, without compromising the oncologic principles.

Bibliography:

1\. Park, Y. Y., & Lee, K. Y. (2021). Step-wise learning of laparoscopic low anterior resection. Journal of Minimally Invasive Surgery, 24(1), 56‑58. [https://doi.org/10.7602/jmis.2021.24.1.56](https://doi.org/10.7602/jmis.2021.24.1.56)

2\. Morino, M., Parini, U., Giraudo, G., Salval, M., Brachet Contul, R., & Garrone, C. (2003). Laparoscopic total mesorectal excision. Annals of Surgery, 237(3), 335‑342. [https://doi.org/10.1097/01.SLA.0000055270.48242.D2](https://doi.org/10.1097/01.SLA.0000055270.48242.D2)

3\. Mahmoud, A. M. A., & Moneer, M. M. (2017). Toward standardization of laparoscopic resection for colorectal cancer in developing countries : A step by step module. Journal of the Egyptian National Cancer Institute, 29(3), 135‑140. [https://doi.org/10.1016/j.jnci.2017.04.003](https://doi.org/10.1016/j.jnci.2017.04.003)

4\. Montroni, I., Mari, G., Boni, L., Maggioni, D., Crippa, J., Cocozza, E., Ferrari, G., Ugolini, G., Capelli, P., Berti, S., Pugliese, R., Spinelli, A., & AIMS Academy clinical research network. (2021). Surgical coaching applied to laparoscopic TME for continuous professional development in rectal surgery : Proof of concept. Updates in Surgery, 73(5), 1805‑1810. [https://doi.org/10.1007/s13304-021-01137-w](https://doi.org/10.1007/s13304-021-01137-w)

Laparoscopic low anterior resection (LAR): a stepwise approach

Résection laparoscopique antérieure basse : une approche par étapes

Essential surgical anatomy and step-by-step procedures in performing TaTME

TaTME for complex rectal cancers beyond the learning curve

Perineal hernia after abdominoperineal resection (APR) is a complication caused by the herniation of intra-abdominal organs through the pelvic floor. Although most patients are asymptomatic, some patients have complaints that significantly impact their quality of life. Management of such hernias is challenging. 

The authors present the case of a 58-year-old female patient under surveillance after a laparoscopic abdominoperineal resection for rectal adenocarcinoma. She developed a symptomatic perineal hernia for which a correction was proposed. Laparoscopic surgery and the postoperative period were uneventful and the patient was discharged on the first postoperative day. Six months later, the patient reported a marked improvement in her life quality and showed no signs of hernia recurrence. 



Laparoscopic repair for a perineal hernia after an abdominoperineal resection (APR)

Cure de hernie périnéale par voie d'abord laparoscopique après résection abdominopérinéale

Colectomie totale laparoscopique avec création d'une iléostomie terminale pour colite ulcéreuse réfractaire 

In this educational video, the authors demonstrate the laparoscopic total colectomy with end ileostomy formation in a patient refractory to medical treatment, with an acute flare-up of ulcerative colitis. The authors used the new LigaSure retractable L-hook laparoscopic sealer (Medtronic) with a Maryland tip, which allows effortless switch from fine sharp dissection to blunt dissection and vice versa. In this video, they demonstrate dissection of all inflamed colonic vessels, due to their prominence secondary to the pathophysiology of severe acute ulcerative colitis and provide tips and tricks on how to approach this common clinical situation. 

Bibliography:

1. Le Berre C, Honap S, Peyrin-Biroulet L. Ulcerative colitis. Lancet. 2023 Aug 12;402(10401):571-584. doi: 10.1016/S0140-6736(23)00966-2. PMID: 37573077. (https://pubmed.ncbi.nlm.nih.gov/37573077/)

2. Lamb CA, Kennedy NA, Raine T, Hendy PA, Smith PJ, Limdi JK, Hayee B, Lomer MCE, Parkes GC, Selinger C, Barrett KJ, Davies RJ, Bennett C, Gittens S, Dunlop MG, Faiz O, Fraser A, Garrick V, Johnston PD, Parkes M, Sanderson J, Terry H; IBD guidelines eDelphi consensus group; Gaya DR, Iqbal TH, Taylor SA, Smith M, Brookes M, Hansen R, Hawthorne AB. British Society of Gastroenterology consensus guidelines on the management of inflammatory bowel disease in adults. Gut. 2019 Dec;68(Suppl 3):s1-s106. doi: 10.1136/gutjnl-2019-318484. Epub 2019 Sep 27. Erratum in: Gut. 2021 Apr;70(4):1. PMID: 31562236; PMCID: PMC6872448. (https://pubmed.ncbi.nlm.nih.gov/31562236)

3. Spinelli A, Bonovas S, Burisch J, Kucharzik T, Adamina M, Annese V, Bachmann O, Bettenworth D, Chaparro M, Czuber-Dochan W, Eder P, Ellul P, Fidalgo C, Fiorino G, Gionchetti P, Gisbert JP, Gordon H, Hedin C, Holubar S, Iacucci M, Karmiris K, Katsanos K, Kopylov U, Lakatos PL, Lytras T, Lyutakov I, Noor N, Pellino G, Piovani D, Savarino E, Selvaggi F, Verstockt B, Doherty G, Raine T, Panis Y. ECCO Guidelines on Therapeutics in Ulcerative Colitis: Surgical Treatment. J Crohns Colitis. 2022 Feb 23;16(2):179-189. doi: 10.1093/ecco-jcc/jjab177. PMID: 34635910. (https://pubmed.ncbi.nlm.nih.gov/34635910/)

4. Ippolito C, Colucci R, Segnani C, Errede M, Girolamo F, Virgintino D, Dolfi A, Tirotta E, Buccianti P, Di Candio G, Campani D, Castagna M, Bassotti G, Villanacci V, Blandizzi C, Bernardini N. Fibrotic and Vascular Remodelling of Colonic Wall in Patients with Active Ulcerative Colitis. J Crohns Colitis. 2016 Oct;10(10):1194-204. doi: 10.1093/ecco-jcc/jjw076. Epub 2016 Mar 19. PMID: 26995183. (https://pubmed.ncbi.nlm.nih.gov/26995183/)

Laparoscopic total colectomy with end ileostomy formation for refractory ulcerative colitis 

Anastomose colo-anale de Turnbull-Cutait en deux étapes par voie d'abord laparoscopique pour cancer du bas rectum

This video presents the case of a 39-year-old female patient with no relevant medical history. The symptoms appeared one week before rectal bleeding and weight loss. Upon physical examination, a 3cm indurated bleeding mass was found in the anal margin. Colonoscopy showed a friable exophytic-looking tumor lesion located 3 to 5cm away from the anal verge and covering 30% of the circumference. Histopathological exam revealed a grade II invasive adenocarcinoma without lymphovascular invasion. Magnetic resonance imaging showed an inferior rectal neoplasm located 2.8cm away from the anal margin with an extension to the middle rectum (4.6cm) without sphincter involvement. No lymph nodes or metastasis were observed, conclusive for a rectal T2N0M0. As a result, it was decided to perform a laparoscopic two-stage Turnbull-Cutait pull-through coloanal anastomosis with ultralow anterior resection. 

A conventional ultra low anterior resection was performed, externalizing the colon through the anus and fixing it proximally to the skin. One week later, the anastomosis was completed manually.

The postoperative period was uneventful. The patient resumed oral intake one day after the second surgery. She was discharged on postoperative day 8. Histopathological findings showed that the surgical margins were negative for neoplasia, and 16 lymph nodes proved negative for dysplasia. 

Bibliography:

1. Biondo S, Trenti L, Espin E, Bianco F, Barrios O, Falato A, De Franciscis S, Solis A, Kreisler E; TURNBULL-BCN Study Group. Two-Stage Turnbull-Cutait Pull-Through Coloanal Anastomosis for Low Rectal Cancer: A Randomized Clinical Trial. JAMA Surg. 2020 Aug 1;155(8):e201625. doi: 10.1001/jamasurg.2020.1625. Epub 2020 Aug 19. PMID: 32492131; PMCID: PMC7270870.

2. Biondo S, Trenti L, Galvez A, Espin-Basany E, Bianco F, Romano G, Kreisler E; Turnbull-BCN study group. Two-stage Turnbull-Cutait pull-through coloanal anastomosis versus coloanal anastomosis with protective loop ileostomy for low rectal cancer. Protocol for a randomized controlled trial (Turnbull-BCN). Int J Colorectal Dis. 2017 Sep;32(9):1357-1362. doi: 10.1007/s00384-017-2842-4. Epub 2017 Jun 30. PMID: 28667499.

3. La Raja C, Foppa C, Maroli A, Kontovounisios C, Ben David N, Carvello M, Spinelli A. Surgical outcomes of Turnbull-Cutait delayed coloanal anastomosis with pull-through versus immediate coloanal anastomosis with diverting stoma after total mesorectal excision for low rectal cancer: a systematic review and meta-analysis. Tech Coloproctol. 2022 Aug;26(8):603-613. doi: 10.1007/s10151-022-02601-4. Epub 2022 Mar 28. PMID: 35344150.

4. Melka D, Leiritz E, Labiad C, Blondeau M, Frontali A, Giacca M, Monsinjon M, Panis Y. Delayed pull-through coloanal anastomosis without temporary stoma: an alternative to the standard manual side-to-end coloanal anastomosis with temporary stoma? A comparative study in 223 patients with low rectal cancer. Colorectal Dis. 2022 May;24(5):587-593. doi: 10.1111/codi.16069. Epub 2022 Feb 10. PMID: 35094470.

Laparoscopic two-stage Turnbull-Cutait pull-through coloanal anastomosis for low rectal cancer

Focus on colorectal surgery

Tendinite de De Quervain

In this authoritative lecture, Prof. Francisco Javier Ferreira Villanova, MD, PhD outlines the surgical management of De Quervain tendinitis.

De Quervain tendinitis

Infiltration échoguidée du membre supérieur

In this authoritative lecture, Dr. Carla Nunes, MD focuses on ultrasound-guided infiltration of the upper limb.

Ultrasound-guided infiltration of the upper limb

Technique antégrade guidée par ultrasons pour syndrome du canal carpien 

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 

In this authoritative lecture, Dr. Michiel Cromheecke, MD gives an overview of the ultrasound-guided intervention for trigger finger.

Ultrasound-guided trigger finger release for long fingers

Traitement échoguidé du doigt à ressaut pour doigts longs

In this key lecture, Dr. Brian Jurbala, MD highlights the ultrasound-assisted percutaneous fascial lengthening for lateral epicondylitis, focusing on the USA tennis elbow procedure.

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Focus on laparoscopic and robotic urologic surgery

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