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Marius NEDELCU

Sfantul Constantin Hospital
Brasov, Romania
MD
1.4K like
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Laparoscopic subtotal cholecystectomy
Laparoscopic cholecystectomy is a hazardous operation when the anatomy of Calot’s triangle is distorted by acute inflammation or any other factor (in our case, adhesions due to the recent surgery, and especially due to radiotherapy). In these difficult situations, the intraoperative decision to use a protective surgical technique as subtotal cholecystectomy is made with the purpose to prevent any injury to the biliary tree.
This video demonstrates the case of a 69-year-old woman with morbid obesity (BMI of 55) and diagnosed with acute cholecystitis. Her past medical history is relevant for right nephrectomy for renal carcinoma using a right subcostal laparotomy followed by radiochemotherapy completed 3 months earlier.
Subtotal cholecystectomy is a procedure which aims to remove portions of the gallbladder when structures of Calot’s triangle cannot be safely identified in "difficult gallbladders". The conversion rate to open surgery was higher among this category of patients. We describe our experience with a technical change, namely, a tactical laparoscopic subtotal cholecystectomy which almost always prevents conversion at the end of the procedures, and prevents both the risk of injury to the common bile duct and the risk of hemorrhage. In such cases, there is a need for rigor and prudence in order to return to the traditional technique in real time, if necessary.
Laparoscopic subtotal cholecystectomy can be considered a safe and feasible alternative to conversion to open surgery. Subtotal cholecystectomy is an essential technique to be used in difficult gallbladders. It achieves morbidity rates comparable to those reported for total cholecystectomy in simple cases.
Surgical intervention
3 years ago
5004 views
286 likes
0 comments
20:31
Laparoscopic subtotal cholecystectomy
Laparoscopic cholecystectomy is a hazardous operation when the anatomy of Calot’s triangle is distorted by acute inflammation or any other factor (in our case, adhesions due to the recent surgery, and especially due to radiotherapy). In these difficult situations, the intraoperative decision to use a protective surgical technique as subtotal cholecystectomy is made with the purpose to prevent any injury to the biliary tree.
This video demonstrates the case of a 69-year-old woman with morbid obesity (BMI of 55) and diagnosed with acute cholecystitis. Her past medical history is relevant for right nephrectomy for renal carcinoma using a right subcostal laparotomy followed by radiochemotherapy completed 3 months earlier.
Subtotal cholecystectomy is a procedure which aims to remove portions of the gallbladder when structures of Calot’s triangle cannot be safely identified in "difficult gallbladders". The conversion rate to open surgery was higher among this category of patients. We describe our experience with a technical change, namely, a tactical laparoscopic subtotal cholecystectomy which almost always prevents conversion at the end of the procedures, and prevents both the risk of injury to the common bile duct and the risk of hemorrhage. In such cases, there is a need for rigor and prudence in order to return to the traditional technique in real time, if necessary.
Laparoscopic subtotal cholecystectomy can be considered a safe and feasible alternative to conversion to open surgery. Subtotal cholecystectomy is an essential technique to be used in difficult gallbladders. It achieves morbidity rates comparable to those reported for total cholecystectomy in simple cases.
Laparoscopic Roux-en-Y gastric bypass: live demonstration and technical details
Roux-en-Y gastric bypass (RYGB) has become a common procedure for the management of morbid obesity. However, learning to perform such a procedure may be difficult as it is made up of very technical operative steps in complex cases of overweight patients with a great amount of adipose tissue. In order to prevent complications, an operative strategy should be adopted, allowing for an easy and rapid acquisition of the technique. Each step is perfectly mastered and outlined.
This video demonstrates a laparoscopic Roux-en-Y gastric bypass performed live, showing all the preoperative and operative patient settings. The surgical technique is thoroughly explained.
Surgical intervention
4 years ago
7469 views
199 likes
1 comment
28:09
Laparoscopic Roux-en-Y gastric bypass: live demonstration and technical details
Roux-en-Y gastric bypass (RYGB) has become a common procedure for the management of morbid obesity. However, learning to perform such a procedure may be difficult as it is made up of very technical operative steps in complex cases of overweight patients with a great amount of adipose tissue. In order to prevent complications, an operative strategy should be adopted, allowing for an easy and rapid acquisition of the technique. Each step is perfectly mastered and outlined.
This video demonstrates a laparoscopic Roux-en-Y gastric bypass performed live, showing all the preoperative and operative patient settings. The surgical technique is thoroughly explained.
Robot-assisted gastric band removal
Adjustable gastric banding (AGB) is one of the surgical treatment modalities for morbid obesity. Over the years, popularity for this treatment increased. It has been by far the most performed bariatric procedure for years in Europe and in the United States. Many gastric band removals are linked to complications and weight loss failure, indicating a new bariatric procedure for some of the patients. Complications after AGB are not uncommon and consist mainly of gastroesophageal reflux disease, pouch dilatation, slippage of the band, and intragastric migration. The failure of the gastric band is multifactorial. Gastric band removal does not preclude a new bariatric procedure (the most common procedure performed in our department is Roux en-Y gastric bypass), which is feasible in the same operative time but the 2-step approach is suitable. The new bariatric procedure offers adequate surgical outcomes and satisfactory results in terms of weight loss.
Surgical intervention
4 years ago
1102 views
36 likes
0 comments
08:14
Robot-assisted gastric band removal
Adjustable gastric banding (AGB) is one of the surgical treatment modalities for morbid obesity. Over the years, popularity for this treatment increased. It has been by far the most performed bariatric procedure for years in Europe and in the United States. Many gastric band removals are linked to complications and weight loss failure, indicating a new bariatric procedure for some of the patients. Complications after AGB are not uncommon and consist mainly of gastroesophageal reflux disease, pouch dilatation, slippage of the band, and intragastric migration. The failure of the gastric band is multifactorial. Gastric band removal does not preclude a new bariatric procedure (the most common procedure performed in our department is Roux en-Y gastric bypass), which is feasible in the same operative time but the 2-step approach is suitable. The new bariatric procedure offers adequate surgical outcomes and satisfactory results in terms of weight loss.
Laparoscopic and endoscopic treatment of a complicated candy cane syndrome after Roux-en-Y gastric bypass
A “Candy Cane” Roux syndrome represents an excessive length of non-functional Roux limb proximal to the gastrojejunostomy, which can cause abnormal upper gastrointestinal symptoms of postprandial epigastric discomfort that is relieved by vomiting. Symptoms of reflux, loss of satiety, and nausea are also common. The length of the blind loop is the essential factor to explain these symptoms, but the orientation of the gastrojejunal anastomosis is equally important to facilitate the emptying of the gastric pouch.
Scarce data can be found in the literature --a case report (1) and a case series (2) with a number of limitations. It is not possible to determine a critical excess length of Roux limb at which symptoms would become evident, nor were we able to determine whether all patients, or just a small minority, would develop symptoms, even with a seemingly excessive Roux limb.
Patients who underwent a gastric bypass technique with a gastrojejunal anastomosis using a circular stapler seem to be more likely to develop this anomaly. All 3 patients described by Cottam et al. (2) have their primary procedure performed by means of a circular stapler.
A long, non-functional Roux limb tip may cause persistent nausea, postprandial epigastric pain, and even a lack of satiety. Surgeons should attempt to minimize redundancy in the Roux limb during the primary procedure. Limiting the length and orientating the Roux limb to aid in gravity and drainage during the initial operation may prevent this syndrome.
References:
1. Dallal RM, Cottam D. "Candy cane" Roux syndrome--a possible complication after gastric bypass surgery. Surg Obes Relat Dis 2007;3:408-10.
2. Romero-Mejía C, Camacho-Aguilera JF, Paipilla-Monroy O. "Candy cane" Roux syndrome in laparoscopic gastric by-pass. Cir Cir 2010;78:347-51.
Surgical intervention
5 years ago
1509 views
10 likes
0 comments
05:57
Laparoscopic and endoscopic treatment of a complicated candy cane syndrome after Roux-en-Y gastric bypass
A “Candy Cane” Roux syndrome represents an excessive length of non-functional Roux limb proximal to the gastrojejunostomy, which can cause abnormal upper gastrointestinal symptoms of postprandial epigastric discomfort that is relieved by vomiting. Symptoms of reflux, loss of satiety, and nausea are also common. The length of the blind loop is the essential factor to explain these symptoms, but the orientation of the gastrojejunal anastomosis is equally important to facilitate the emptying of the gastric pouch.
Scarce data can be found in the literature --a case report (1) and a case series (2) with a number of limitations. It is not possible to determine a critical excess length of Roux limb at which symptoms would become evident, nor were we able to determine whether all patients, or just a small minority, would develop symptoms, even with a seemingly excessive Roux limb.
Patients who underwent a gastric bypass technique with a gastrojejunal anastomosis using a circular stapler seem to be more likely to develop this anomaly. All 3 patients described by Cottam et al. (2) have their primary procedure performed by means of a circular stapler.
A long, non-functional Roux limb tip may cause persistent nausea, postprandial epigastric pain, and even a lack of satiety. Surgeons should attempt to minimize redundancy in the Roux limb during the primary procedure. Limiting the length and orientating the Roux limb to aid in gravity and drainage during the initial operation may prevent this syndrome.
References:
1. Dallal RM, Cottam D. "Candy cane" Roux syndrome--a possible complication after gastric bypass surgery. Surg Obes Relat Dis 2007;3:408-10.
2. Romero-Mejía C, Camacho-Aguilera JF, Paipilla-Monroy O. "Candy cane" Roux syndrome in laparoscopic gastric by-pass. Cir Cir 2010;78:347-51.
Transgastric laparoscopic resection of a GIST
Laparoscopic intragastric surgery (LIGS) represents a minimally invasive technique for lesions that mainly exist in the gastric lumen or at the gastroesophageal junction. Ohashi initially described this technique in 1995 to resect early gastric cancers that could not be treated by Endoscopic Mucosal Resection (EMR). Since then, it has evolved with respect to both technological advances (e.g., development of cuffed ports) and tactical innovations. As the peritoneal cavity represents the working space for laparoscopic surgeons, they have imagined to work directly into the stomach by respecting the same principles of basic laparoscopy, namely insufflation to create a new operating space, introduction of surgical instruments through working ports and the use of different techniques of dissection. The aim of this video is to describe the technical principles of this new approach as it offers a valuable option for the surgeon in the management of gastric tumors and early cancers. It may avoid major surgical procedures, especially for the management of lesions located at the esophagogastric junction. Selected indications have to be identified thanks to adequate preoperative workup including endoscopy, endoscopic ultrasonography, and conventional imaging (CT-scan and MRI).
Our standard approach for a laparoscopic intragastric surgery is represented by multiple intragastric ports approach. Resection can be performed as a standard submucosal dissection, but most of the time, the use of stapling is preferred for many reasons, including speed, safety and reliability as illustrated in this video. In well-selected cases (pedunculated tumors), the advantage of this technique is to obtain resection and hemostasis simultaneously, with the same instrument. However, achieving adequate margins can be difficult, and the risk of tumor rupture might be increased, particularly in case of gastrointestinal stromal tumors (GISTs).
When all inclusion criteria and technical principles are respected, this new minimally invasive approach offers major benefits for patients. It ensures the preservation of an almost normal anatomy by preserving the gastroesophageal junction as well as a simple postoperative course.
Surgical intervention
5 years ago
2714 views
50 likes
0 comments
06:36
Transgastric laparoscopic resection of a GIST
Laparoscopic intragastric surgery (LIGS) represents a minimally invasive technique for lesions that mainly exist in the gastric lumen or at the gastroesophageal junction. Ohashi initially described this technique in 1995 to resect early gastric cancers that could not be treated by Endoscopic Mucosal Resection (EMR). Since then, it has evolved with respect to both technological advances (e.g., development of cuffed ports) and tactical innovations. As the peritoneal cavity represents the working space for laparoscopic surgeons, they have imagined to work directly into the stomach by respecting the same principles of basic laparoscopy, namely insufflation to create a new operating space, introduction of surgical instruments through working ports and the use of different techniques of dissection. The aim of this video is to describe the technical principles of this new approach as it offers a valuable option for the surgeon in the management of gastric tumors and early cancers. It may avoid major surgical procedures, especially for the management of lesions located at the esophagogastric junction. Selected indications have to be identified thanks to adequate preoperative workup including endoscopy, endoscopic ultrasonography, and conventional imaging (CT-scan and MRI).
Our standard approach for a laparoscopic intragastric surgery is represented by multiple intragastric ports approach. Resection can be performed as a standard submucosal dissection, but most of the time, the use of stapling is preferred for many reasons, including speed, safety and reliability as illustrated in this video. In well-selected cases (pedunculated tumors), the advantage of this technique is to obtain resection and hemostasis simultaneously, with the same instrument. However, achieving adequate margins can be difficult, and the risk of tumor rupture might be increased, particularly in case of gastrointestinal stromal tumors (GISTs).
When all inclusion criteria and technical principles are respected, this new minimally invasive approach offers major benefits for patients. It ensures the preservation of an almost normal anatomy by preserving the gastroesophageal junction as well as a simple postoperative course.