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Luigi BONI

University of Insubria – Minimally Invasive Surgery Research Center
Varese, Italy
MD, FACS
406 likes
20.8K views
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Laparoscopic complete mesocolic excision (CME) for right colon cancer
The aim of the video is to describe the anatomical landmarks and the surgical technique for complete mesocolic excision during a laparoscopic right colectomy for cancer.
Preoperative high-resolution CT-scan and 3D printed models of the patient’s vascular anatomy is obtained to study the peculiar vessels distribution. Four ports are used, all located in the left flank as described in the video. Dissection between the visceral fascia which covers the posterior layer of the mesocolon and the parietal fascia covering the retroperitoneum (Toldt’s fascia) is carried out by means of monopolar electrocautery and combined advanced bipolar and ultrasonic dissection device. Caudocranial dissection of the mesocolon along the route of the superior mesenteric vein is performed, up to the inferior margin of the pancreas, exposing, ligating and dividing the ileocolic, the right and middle colic vessels at their origins. The gastrocolic trunk is fully dissected and the superior right colic vein clipped and divided. The transverse colon and terminal ileum are divided, the colon is mobilized and ileo-transverse intracorporeal stapled anastomosis is fashioned.
Between April 2017 and December 2018, 46 laparoscopic right hemicolectomies with CME were performed. There were no major vascular lesions. All intraoperative bleedings in the peripancreatic area were controlled with bipolar instruments and hemostatic devices, and there was no need for intraoperative blood cell transfusions.
Laparoscopic CME is feasible, but extensive knowledge of the vascular anatomy of the right colon as well as experience in advanced laparoscopic technique is required.
Surgical intervention
3 months ago
2980 views
17 likes
0 comments
07:10
Laparoscopic complete mesocolic excision (CME) for right colon cancer
The aim of the video is to describe the anatomical landmarks and the surgical technique for complete mesocolic excision during a laparoscopic right colectomy for cancer.
Preoperative high-resolution CT-scan and 3D printed models of the patient’s vascular anatomy is obtained to study the peculiar vessels distribution. Four ports are used, all located in the left flank as described in the video. Dissection between the visceral fascia which covers the posterior layer of the mesocolon and the parietal fascia covering the retroperitoneum (Toldt’s fascia) is carried out by means of monopolar electrocautery and combined advanced bipolar and ultrasonic dissection device. Caudocranial dissection of the mesocolon along the route of the superior mesenteric vein is performed, up to the inferior margin of the pancreas, exposing, ligating and dividing the ileocolic, the right and middle colic vessels at their origins. The gastrocolic trunk is fully dissected and the superior right colic vein clipped and divided. The transverse colon and terminal ileum are divided, the colon is mobilized and ileo-transverse intracorporeal stapled anastomosis is fashioned.
Between April 2017 and December 2018, 46 laparoscopic right hemicolectomies with CME were performed. There were no major vascular lesions. All intraoperative bleedings in the peripancreatic area were controlled with bipolar instruments and hemostatic devices, and there was no need for intraoperative blood cell transfusions.
Laparoscopic CME is feasible, but extensive knowledge of the vascular anatomy of the right colon as well as experience in advanced laparoscopic technique is required.
Single incision laparoscopic partial splenectomy for splenic hemangioma
Laparoscopy is now considered the "gold standard" approach for splenectomy when treating different benign and malignant diseases requiring the removal of the whole or part of the spleen.
During the last few months in both experimental and clinical settings, new techniques such as natural orifice transluminal endoscopic surgery (NOTES™) and single incision laparoscopic surgery (SILS) or single port laparoscopic surgery (SPLS) have been attempted in order to reduce even more the surgical trauma in laparo-endoscopic procedures.
SPLS allows to perform different surgical procedures using the umbilicus as the only site to access the abdominal cavity and, by using special trocars and instruments, to carry out the operation using the same techniques and principles of standard laparoscopic surgery.
The video describes our personal technique for totally single incision partial splenectomy for the treatment of splenic hemangioma.
A 44-year-old woman complained with recurrent abdominal pain in the left hypochondrium and flank and was referred to our department.
Abdominal US as well as CT-scan images demonstrated the presence of a large cystic-like lesion at the lower pole of the spleen. It presented some septal division with the cyst. Blood tests were normal and all markers were negative.
Single incision partial splenectomy was performed with no complications and the patient’s postoperative course was uneventful.
Surgical intervention
8 years ago
1632 views
13 likes
0 comments
04:58
Single incision laparoscopic partial splenectomy for splenic hemangioma
Laparoscopy is now considered the "gold standard" approach for splenectomy when treating different benign and malignant diseases requiring the removal of the whole or part of the spleen.
During the last few months in both experimental and clinical settings, new techniques such as natural orifice transluminal endoscopic surgery (NOTES™) and single incision laparoscopic surgery (SILS) or single port laparoscopic surgery (SPLS) have been attempted in order to reduce even more the surgical trauma in laparo-endoscopic procedures.
SPLS allows to perform different surgical procedures using the umbilicus as the only site to access the abdominal cavity and, by using special trocars and instruments, to carry out the operation using the same techniques and principles of standard laparoscopic surgery.
The video describes our personal technique for totally single incision partial splenectomy for the treatment of splenic hemangioma.
A 44-year-old woman complained with recurrent abdominal pain in the left hypochondrium and flank and was referred to our department.
Abdominal US as well as CT-scan images demonstrated the presence of a large cystic-like lesion at the lower pole of the spleen. It presented some septal division with the cyst. Blood tests were normal and all markers were negative.
Single incision partial splenectomy was performed with no complications and the patient’s postoperative course was uneventful.
Single incision right nephrectomy for severe hydrophrenosis in a transplanted patient
Laparoscopy is becoming the "gold standard" approach for nephrectomy when treating different benign and malignant diseases as well as for living donor transplantation.
During the last few months in both experimental and clinical settings, new techniques such as Natural Orifice Transluminal Endoscopic Surgery (NOTES™) and Single Incision Laparoscopic Surgery (SILS) or Single Port Laparoscopic Surgery (SPLS) have been attempted in order to reduce even more the surgical trauma in laparo-endoscopic procedures.
SPLS allows to perform different surgical procedures using the umbilicus as the only site to access the abdominal cavity and, by using special trocars and instruments, to perform the operation using the same techniques and principles of standard laparoscopic surgery.
The video describes our personal technique for totally single incision right nephrectomy for severe hydronephrosis in a patient who has undergone a kidney transplant a few years earlier.
A 62-year-old patient underwent a kidney transplant 5 years earlier due to a renal failure caused by a glomerular nephritis. The native kidneys were left in place.
Several admissions of patients presenting with recurrent sepsis were reported to the infectious disease department.
Recurrent sepsis was likely to be caused by the hydronephrosis induced by a large stone located in the middle part of the ureter.
The abdominal MRI showed the severe hydronephrosis of the native right kidney as well as a large stone.
A single incision nephrectomy was performed with no complications and the patient’s postoperative course was uneventful.
Surgical intervention
9 years ago
3884 views
34 likes
0 comments
10:10
Single incision right nephrectomy for severe hydrophrenosis in a transplanted patient
Laparoscopy is becoming the "gold standard" approach for nephrectomy when treating different benign and malignant diseases as well as for living donor transplantation.
During the last few months in both experimental and clinical settings, new techniques such as Natural Orifice Transluminal Endoscopic Surgery (NOTES™) and Single Incision Laparoscopic Surgery (SILS) or Single Port Laparoscopic Surgery (SPLS) have been attempted in order to reduce even more the surgical trauma in laparo-endoscopic procedures.
SPLS allows to perform different surgical procedures using the umbilicus as the only site to access the abdominal cavity and, by using special trocars and instruments, to perform the operation using the same techniques and principles of standard laparoscopic surgery.
The video describes our personal technique for totally single incision right nephrectomy for severe hydronephrosis in a patient who has undergone a kidney transplant a few years earlier.
A 62-year-old patient underwent a kidney transplant 5 years earlier due to a renal failure caused by a glomerular nephritis. The native kidneys were left in place.
Several admissions of patients presenting with recurrent sepsis were reported to the infectious disease department.
Recurrent sepsis was likely to be caused by the hydronephrosis induced by a large stone located in the middle part of the ureter.
The abdominal MRI showed the severe hydronephrosis of the native right kidney as well as a large stone.
A single incision nephrectomy was performed with no complications and the patient’s postoperative course was uneventful.