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Laparoscopic excision of a celiac paraganglioma
A 72-year-old woman was addressed to the endocrinologist for arterial hypertension and US finding of a 5cm nodule in the aortocaval space of the celiac region. The diagnostic workup revealed raised urinary metanephrines. A CT-scan confirmed the US findings, and the nodule was also positive at PET CT-scan. A fine needle biopsy was performed, which was suggestive of a paraganglioma.
Medical treatment with Doxazosine 44mg qd was required for the adequate control of hypertension, and surgical excision was required.
A laparoscopic lateral transabdominal approach was chosen, to displace the hepatoduodenal ligament and allow for a wide access to the inferior vena cava. The operative time was 75 minutes. The patient recovered with no complications and was discharged on postoperative day 3.
Her symptoms recovered and she was found with normal metanephrines at follow-up.
M Lotti, L Ansaloni, M Giulii Capponi
Surgical intervention
2 years ago
1367 views
60 likes
2 comments
08:21
Laparoscopic excision of a celiac paraganglioma
A 72-year-old woman was addressed to the endocrinologist for arterial hypertension and US finding of a 5cm nodule in the aortocaval space of the celiac region. The diagnostic workup revealed raised urinary metanephrines. A CT-scan confirmed the US findings, and the nodule was also positive at PET CT-scan. A fine needle biopsy was performed, which was suggestive of a paraganglioma.
Medical treatment with Doxazosine 44mg qd was required for the adequate control of hypertension, and surgical excision was required.
A laparoscopic lateral transabdominal approach was chosen, to displace the hepatoduodenal ligament and allow for a wide access to the inferior vena cava. The operative time was 75 minutes. The patient recovered with no complications and was discharged on postoperative day 3.
Her symptoms recovered and she was found with normal metanephrines at follow-up.
Laparoscopic management of a catecholamine-secreting paraganglioma in a 15-year-old boy
We report the case of the surgical removal of a paravesical paraganglioma located on the right vesicoureteric junction in a 15-year-old boy who was screened positive for SDHB gene mutation, which his father suffers from. Indeed, his dad died of a metastatic paraganglioma, notably including bone and cerebral metastases.
The patient has been complaining of major headaches for some time, which were triggered off during urination to the point that he held in urine as long as possible during daytime in order to avoid urinating, and this seemed to be immediately related to the onset of severe headaches.
The tumor location allowed to correctly understand the phenomenon intraoperatively since every bladder mobilization would induce abrupt bouts of high blood pressure.
Resting blood pressure did not evidence any particular anomaly. However, there were high fluctuations in blood pressure, notably when headaches were reported. The tumor was located exactly at the vesicoureteric junction. It necessitated the resection of the lower ureter and the placement of a vesical patch.
Complete surgical resection allowed to eliminate all symptoms. The patient’s clinical and biological work-up is strictly normal more than one year after the intervention.
The resection was performed without paying attention to the potential difficulties related to the type of reconstructive surgery which entailed. Reconstruction of the vesicoureteric junction was achieved without any major problem on a slightly reduced bladder. A minimal vesicoureteric reimplantation was performed according to the Lich-Gregoir technique, with bladder closure onto a vesical drain and a vesicoureteric double J catheter.
Immediate outcomes were uneventful and control performed more than one year postoperatively testified to the absence of tumor recurrence and to the very good functioning of the vesicoureteric junction.
F Becmeur, S Soskin
Surgical intervention
3 years ago
422 views
16 likes
0 comments
04:08
Laparoscopic management of a catecholamine-secreting paraganglioma in a 15-year-old boy
We report the case of the surgical removal of a paravesical paraganglioma located on the right vesicoureteric junction in a 15-year-old boy who was screened positive for SDHB gene mutation, which his father suffers from. Indeed, his dad died of a metastatic paraganglioma, notably including bone and cerebral metastases.
The patient has been complaining of major headaches for some time, which were triggered off during urination to the point that he held in urine as long as possible during daytime in order to avoid urinating, and this seemed to be immediately related to the onset of severe headaches.
The tumor location allowed to correctly understand the phenomenon intraoperatively since every bladder mobilization would induce abrupt bouts of high blood pressure.
Resting blood pressure did not evidence any particular anomaly. However, there were high fluctuations in blood pressure, notably when headaches were reported. The tumor was located exactly at the vesicoureteric junction. It necessitated the resection of the lower ureter and the placement of a vesical patch.
Complete surgical resection allowed to eliminate all symptoms. The patient’s clinical and biological work-up is strictly normal more than one year after the intervention.
The resection was performed without paying attention to the potential difficulties related to the type of reconstructive surgery which entailed. Reconstruction of the vesicoureteric junction was achieved without any major problem on a slightly reduced bladder. A minimal vesicoureteric reimplantation was performed according to the Lich-Gregoir technique, with bladder closure onto a vesical drain and a vesicoureteric double J catheter.
Immediate outcomes were uneventful and control performed more than one year postoperatively testified to the absence of tumor recurrence and to the very good functioning of the vesicoureteric junction.
Laparoscopic resection of extra-adrenal paraganglioma
Introduction
Paragangliomas are rare tumors that arise from extra-adrenal chromaffin cells. These tumors arise from dispersed paraganglia that tend to be symmetrically distributed in close relation to the aorta and to the sympathetic nervous system. Paragangliomas have a higher malignancy potential than adrenal pheochromocytomas.
Laparoscopy has the advantage of optical magnification and provides better visualization of small vessels, which allows for meticulous dissection during tumor excision. Laparoscopic resections of such tumors have been described in isolated cases.

Material and methods
We present the case of a 16-year-old female patient who presents with repeated urinary tract infection. An ultrasound demonstrates the presence of a retropancreatic mass. The study was completed by abdominal CT-scan and PET-scan (123-MIBG) where a solid mass of 4.5cm in diameter, homogeneous, encapsulated, without calcifications, located between the third duodenal portion (which is displaced anteriorly) and the inferior vena cava from the level of the right renal vein to the level of the right renal lower pole, is found. The patient presents MIBG (metaiodobenzylguanidine) tracer uptake in the Iodine-123-MIBG scintigraphy, suggesting the diagnosis of adrenal medullary tumor. The hormonal study shows a significant increase in plasmatic normetanephrine (25 times the normal upper limit). A genetic study has found no mutation of the most frequent responsible genes.
Given radiological and hormonal findings, laparoscopic surgery is decided upon with suspected diagnosis of extra-adrenal paraganglioma.

Discussion
In this video, we present a laparoscopic approach to this mass, using an 11mm optical trocar and four 5mm working trocars. As can be appreciated, a very careful dissection is carried out to separate the mass from adjacent structures, dissecting small vessels that drain directly into the inferior vena cava.
Final pathology reports a 5cm retroperitoneal paraganglioma, with vascular invasion. In the immunohistochemical study, cells are positive for Synaptophysin and Chromogranin A. The postoperative course was uneventful, and the patient was discharged on postoperative day 4.
The laparoscopic excision of paraganglioma is safe and feasible, reduces postoperative pain, facilitates early recovery, and shortens hospital stay as compared to open surgery.
As a general conclusion, it is essential to diagnose, localize, and treat paragangliomas, because of the potential cure of symptoms associated with functional tumors, prevention of a lethal hypertensive paroxysm, and early diagnosis of malignant tumors.
Laparoscopy has the advantage of optical magnification and provides better visualization of small vessels, which allows for meticulous dissection during tumor excision. Tumors located between major vessels rarely invade these vessels, but careful and meticulous dissection of the surrounding small vessels is necessary.
The laparoscopic excision of paraganglioma reduces postoperative pain, facilitates early recovery, and shortens hospital stay as compared to open surgery.
C Rodríguez-Otero Luppi, M Rodríguez Blanco, V Artigas Raventós, M Trías Folch
Surgical intervention
5 years ago
1040 views
34 likes
0 comments
12:04
Laparoscopic resection of extra-adrenal paraganglioma
Introduction
Paragangliomas are rare tumors that arise from extra-adrenal chromaffin cells. These tumors arise from dispersed paraganglia that tend to be symmetrically distributed in close relation to the aorta and to the sympathetic nervous system. Paragangliomas have a higher malignancy potential than adrenal pheochromocytomas.
Laparoscopy has the advantage of optical magnification and provides better visualization of small vessels, which allows for meticulous dissection during tumor excision. Laparoscopic resections of such tumors have been described in isolated cases.

Material and methods
We present the case of a 16-year-old female patient who presents with repeated urinary tract infection. An ultrasound demonstrates the presence of a retropancreatic mass. The study was completed by abdominal CT-scan and PET-scan (123-MIBG) where a solid mass of 4.5cm in diameter, homogeneous, encapsulated, without calcifications, located between the third duodenal portion (which is displaced anteriorly) and the inferior vena cava from the level of the right renal vein to the level of the right renal lower pole, is found. The patient presents MIBG (metaiodobenzylguanidine) tracer uptake in the Iodine-123-MIBG scintigraphy, suggesting the diagnosis of adrenal medullary tumor. The hormonal study shows a significant increase in plasmatic normetanephrine (25 times the normal upper limit). A genetic study has found no mutation of the most frequent responsible genes.
Given radiological and hormonal findings, laparoscopic surgery is decided upon with suspected diagnosis of extra-adrenal paraganglioma.

Discussion
In this video, we present a laparoscopic approach to this mass, using an 11mm optical trocar and four 5mm working trocars. As can be appreciated, a very careful dissection is carried out to separate the mass from adjacent structures, dissecting small vessels that drain directly into the inferior vena cava.
Final pathology reports a 5cm retroperitoneal paraganglioma, with vascular invasion. In the immunohistochemical study, cells are positive for Synaptophysin and Chromogranin A. The postoperative course was uneventful, and the patient was discharged on postoperative day 4.
The laparoscopic excision of paraganglioma is safe and feasible, reduces postoperative pain, facilitates early recovery, and shortens hospital stay as compared to open surgery.
As a general conclusion, it is essential to diagnose, localize, and treat paragangliomas, because of the potential cure of symptoms associated with functional tumors, prevention of a lethal hypertensive paroxysm, and early diagnosis of malignant tumors.
Laparoscopy has the advantage of optical magnification and provides better visualization of small vessels, which allows for meticulous dissection during tumor excision. Tumors located between major vessels rarely invade these vessels, but careful and meticulous dissection of the surrounding small vessels is necessary.
The laparoscopic excision of paraganglioma reduces postoperative pain, facilitates early recovery, and shortens hospital stay as compared to open surgery.
Laparoscopic gastrectomy for gastric cancer after liver transplantation
It has already been demonstrated that laparoscopic gastrectomy is a safe approach for early gastric cancer. It can provide the same oncological outcomes as open gastrectomy with the benefit of fewer complications and early recovery.
Liver transplantation has a high incidence rate in the Korean population, just like gastric cancer. Additionally, South Korea has the highest incidence of this type of cancer worldwide. Patients who had received a liver transplant might benefit from a better recovery thanks to laparoscopic gastrectomy, and this approach can be performed by experienced surgeons.
Please add in the text narrative how you performed the anastomosis.
F Signorini, DJ Park, HK Yang
Surgical intervention
2 months ago
1243 views
6 likes
0 comments
09:23
Laparoscopic gastrectomy for gastric cancer after liver transplantation
It has already been demonstrated that laparoscopic gastrectomy is a safe approach for early gastric cancer. It can provide the same oncological outcomes as open gastrectomy with the benefit of fewer complications and early recovery.
Liver transplantation has a high incidence rate in the Korean population, just like gastric cancer. Additionally, South Korea has the highest incidence of this type of cancer worldwide. Patients who had received a liver transplant might benefit from a better recovery thanks to laparoscopic gastrectomy, and this approach can be performed by experienced surgeons.
Please add in the text narrative how you performed the anastomosis.
Pylorus-preserving laparoscopic gastrectomy with pyloric balloon dilatation
Gastric cancer screening programs implemented by Japan and South Korea have shown impressive results in terms of the increasing proportion of early gastric cancer diagnosis. Because of this, more interest has been focused on preserving the organ function in order to improve postoperative quality of life aiming to reduce complications or sequelae and avoiding large resections. Pylorus-preserving gastrectomy (PPG) was first introduced by Maki et al. and it is probably the most representative technique of function-preserving gastrectomy. It has been reported that, due to an impaired pyloric function, patients may occasionally experience a sensation of gastric fullness after food intake as well as long-term food retention in the remnant stomach. This delayed gastric emptying caused by pyloric spasms has been shown to decrease the patient’s quality of life. There is no standardized management strategy at present, and consequently gastric surgeons have often found themselves hesitant to perform this minimally invasive, function-preserving surgery. Here, we present a PPG case followed by a pyloric spasm, which was successfully treated with balloon dilatation.
F Signorini, HK Yang
Surgical intervention
6 months ago
2230 views
6 likes
1 comment
10:02
Pylorus-preserving laparoscopic gastrectomy with pyloric balloon dilatation
Gastric cancer screening programs implemented by Japan and South Korea have shown impressive results in terms of the increasing proportion of early gastric cancer diagnosis. Because of this, more interest has been focused on preserving the organ function in order to improve postoperative quality of life aiming to reduce complications or sequelae and avoiding large resections. Pylorus-preserving gastrectomy (PPG) was first introduced by Maki et al. and it is probably the most representative technique of function-preserving gastrectomy. It has been reported that, due to an impaired pyloric function, patients may occasionally experience a sensation of gastric fullness after food intake as well as long-term food retention in the remnant stomach. This delayed gastric emptying caused by pyloric spasms has been shown to decrease the patient’s quality of life. There is no standardized management strategy at present, and consequently gastric surgeons have often found themselves hesitant to perform this minimally invasive, function-preserving surgery. Here, we present a PPG case followed by a pyloric spasm, which was successfully treated with balloon dilatation.
Robotic distal pancreatectomy with splenectomy
This is the case of a 73-year-old asymptomatic female patient who presented with an incidental pancreatic lesion on CT-scan. Her previous medical history was relevant for systemic lupus erythematosus. On the CT-scan, a single hypervascular lesion in the arterial phase was identified in the distal pancreas. The lesion size was 3.1 by 3.3 by 4.3cm. Neither suspicious nodes nor distant metastases were found. The patient was considered to be ASA2 and ECOG0.
The patient was placed in a reverse Trendelenburg position. A 12mm port was placed in the umbilicus for the camera, and three 8mm ports were inserted to accommodate the robotic arms, and another 12mm auxiliary port was used.
The greater curvature of the stomach was released from the transverse colon to expose the supramesocolic area. The neck of the pancreas was dissected close to the splenic-mesenteric confluence. The inferior mesenteric vein opening to the splenic vein was identified, clipped and cut. The splenic artery was dissected, clipped and cut close to the celiac trunk. A stapler was placed in the neck of the pancreas and it was safely stapled. The splenic vein was dissected close to the confluence, and then clipped and cut. The distal pancreas and splenic ligaments were cut and . detached. The specimen was removed using a Pfannenstiel’s incision.
The duration of the procedure was 255 minutes. The estimated blood loss was 100mL. The patient was discharged on postoperative day 5 and no complication was observed over a period of 90 days. Pathology confirmed the presence of a neuroendocrine tumor (grade 2) as a 4cm single lesion and negative margins. One positive node was detected among 10 nodes harvested.
R Araujo, MA Sanctis, F Felippe, D Burgardt, D Wohnrath
Surgical intervention
10 months ago
1640 views
6 likes
1 comment
08:04
Robotic distal pancreatectomy with splenectomy
This is the case of a 73-year-old asymptomatic female patient who presented with an incidental pancreatic lesion on CT-scan. Her previous medical history was relevant for systemic lupus erythematosus. On the CT-scan, a single hypervascular lesion in the arterial phase was identified in the distal pancreas. The lesion size was 3.1 by 3.3 by 4.3cm. Neither suspicious nodes nor distant metastases were found. The patient was considered to be ASA2 and ECOG0.
The patient was placed in a reverse Trendelenburg position. A 12mm port was placed in the umbilicus for the camera, and three 8mm ports were inserted to accommodate the robotic arms, and another 12mm auxiliary port was used.
The greater curvature of the stomach was released from the transverse colon to expose the supramesocolic area. The neck of the pancreas was dissected close to the splenic-mesenteric confluence. The inferior mesenteric vein opening to the splenic vein was identified, clipped and cut. The splenic artery was dissected, clipped and cut close to the celiac trunk. A stapler was placed in the neck of the pancreas and it was safely stapled. The splenic vein was dissected close to the confluence, and then clipped and cut. The distal pancreas and splenic ligaments were cut and . detached. The specimen was removed using a Pfannenstiel’s incision.
The duration of the procedure was 255 minutes. The estimated blood loss was 100mL. The patient was discharged on postoperative day 5 and no complication was observed over a period of 90 days. Pathology confirmed the presence of a neuroendocrine tumor (grade 2) as a 4cm single lesion and negative margins. One positive node was detected among 10 nodes harvested.
Laparoscopic total gastrectomy
A multimodality approach remains the only potential treatment for advanced gastric cancer. Oncological outcomes seem to be equivalent either in open surgery or in minimally invasive surgery. Therefore, laparoscopic gastric resection is expanding in expert centers.
The authors present a clinical case of a 70-year-old woman with no relevant clinical past. She presented with a 1-month complaint of epigastric pain and melena. She underwent an upper endoscopy, which showed an ulcerated gastric lesion at the lesser curvature. Biopsy revealed a poorly cohesive gastric carcinoma with signet ring cells. Thoraco-abdominal-pelvic CT-scan revealed a thickening of the gastric wall associated with multiple perigastric and celiac trunk lymph nodes. She was proposed for perioperative chemotherapy. On the restaging CT-scan, there was no evidence of disease progression and therefore she underwent a laparoscopic radical total gastrectomy.
The benefits of minimally invasive surgery, combined with the increasing evidence of oncological results overlapping with open surgery, have contributed to the progressive implementation of laparoscopic surgery in the treatment of malignant gastric pathology.
J Magalhães, C Osorio, L Frutuoso, AM Pereira, A Trovão, R Ferreira de Almeida, M Nora
Surgical intervention
1 year ago
5655 views
22 likes
1 comment
09:44
Laparoscopic total gastrectomy
A multimodality approach remains the only potential treatment for advanced gastric cancer. Oncological outcomes seem to be equivalent either in open surgery or in minimally invasive surgery. Therefore, laparoscopic gastric resection is expanding in expert centers.
The authors present a clinical case of a 70-year-old woman with no relevant clinical past. She presented with a 1-month complaint of epigastric pain and melena. She underwent an upper endoscopy, which showed an ulcerated gastric lesion at the lesser curvature. Biopsy revealed a poorly cohesive gastric carcinoma with signet ring cells. Thoraco-abdominal-pelvic CT-scan revealed a thickening of the gastric wall associated with multiple perigastric and celiac trunk lymph nodes. She was proposed for perioperative chemotherapy. On the restaging CT-scan, there was no evidence of disease progression and therefore she underwent a laparoscopic radical total gastrectomy.
The benefits of minimally invasive surgery, combined with the increasing evidence of oncological results overlapping with open surgery, have contributed to the progressive implementation of laparoscopic surgery in the treatment of malignant gastric pathology.
Laparoscopic total D2 gastrectomy for cancer
Laparoscopic gastrectomy is accepted as a treatment of choice for gastric cancer due to low postoperative pain, faster recovery, shorter hospital stay, and a better cosmetic outcome as compared to open gastrectomy. Radical gastrectomy, with lymph node dissection, is essential to cure this type of cancer. This technique can be reproduced also in third world countries.
This is the case of a 74-year-old woman who was evaluated for dyspepsia and weight loss. Upper endoscopy found a tumor near the cardia on the lesser curvature. The biopsy study confirmed the presence of an adenocarcinoma. CT-scan showed no metastasis or lymph nodes affected. Surgical treatment was decided upon along with a laparoscopic total D2 gastrectomy.
F Signorini, S Reimondez, M España, L Obeide, F Moser
Surgical intervention
1 year ago
12448 views
437 likes
1 comment
06:41
Laparoscopic total D2 gastrectomy for cancer
Laparoscopic gastrectomy is accepted as a treatment of choice for gastric cancer due to low postoperative pain, faster recovery, shorter hospital stay, and a better cosmetic outcome as compared to open gastrectomy. Radical gastrectomy, with lymph node dissection, is essential to cure this type of cancer. This technique can be reproduced also in third world countries.
This is the case of a 74-year-old woman who was evaluated for dyspepsia and weight loss. Upper endoscopy found a tumor near the cardia on the lesser curvature. The biopsy study confirmed the presence of an adenocarcinoma. CT-scan showed no metastasis or lymph nodes affected. Surgical treatment was decided upon along with a laparoscopic total D2 gastrectomy.
Subtotal gastrectomy and D1+ lymphadenectomy for distal stage IB gastric cancer with preservation of an accessory left hepatic artery
This video shows a partial gastrectomy in a 63-year-old woman with a stage IB gastric cancer located at the distal third of the stomach. The lesion was located using intraoperatory endoscopy. We found an accessory left hepatic artery originating from the left gastric artery, which was preserved. The gastrojejunostomy was performed in a Roux-en-Y fashion. The alimentary limb was ascended through the transverse mesocolon. The jejunojejunostomy was performed in a latero-lateral fashion with closure of the ostium with simple Ethibond 2/0 stitches. The skin incision used for trocar placement in the upper left abdomen (right hand of the surgeon) was slightly enlarged to allow for specimen extraction.
P Vorwald, R Restrepo, G Salcedo, M Posada
Surgical intervention
2 years ago
3216 views
235 likes
0 comments
11:41
Subtotal gastrectomy and D1+ lymphadenectomy for distal stage IB gastric cancer with preservation of an accessory left hepatic artery
This video shows a partial gastrectomy in a 63-year-old woman with a stage IB gastric cancer located at the distal third of the stomach. The lesion was located using intraoperatory endoscopy. We found an accessory left hepatic artery originating from the left gastric artery, which was preserved. The gastrojejunostomy was performed in a Roux-en-Y fashion. The alimentary limb was ascended through the transverse mesocolon. The jejunojejunostomy was performed in a latero-lateral fashion with closure of the ostium with simple Ethibond 2/0 stitches. The skin incision used for trocar placement in the upper left abdomen (right hand of the surgeon) was slightly enlarged to allow for specimen extraction.
Completely intracorporeal handsewn laparoscopic anastomoses during Whipple procedure
Background: Since 1935, the Whipple procedure was described, using conventional open surgery. With the advent of minimally invasive surgery (MIS), it was reported to be feasible also using the latest technology. In this video, the authors demonstrate a full laparoscopic Whipple procedure, performing the three anastomoses using an intracorporeal handsewn method.

Video: A 70-year-old man presenting with an adenocarcinoma of the ampulla of Vater, infiltrating the pancreatic parenchyma, underwent a laparoscop ic Whipple procedure. Preoperative work-up showed a T3N1M0 tumor.

Results: Total operative time was 8 hours 20minutes; time for the dissection was 6 hours 20 minutes; time for specimen extraction was 20 minutes, and time for the three laparoscopic intracorporeal handsewn anastomoses was 1 hour 40 minutes. Operative bleeding was 350cc. The patient was discharged on postoperative day 9. Pathological findings confirmed a moderately differentiated adenocarcinoma of the ampulla of Vater, with perinervous infiltration and lymphovascular emboli, free margins, 2 metastatic lymph nodes on 23 isolated; 7 edition UICC stage: pT4N1.

Conclusions: The laparoscopic Whipple procedure remains an advanced procedure to be performed laparoscopically and/or using open surgery. All the advantages of MIS such as reduced abdominal trauma, less postoperative pain, shorter hospital stay, improved patient’s comfort, and enhanced cosmesis are offered using laparoscopy.
G Dapri, NA Bascombe, L Gerard, C Samaniego Ballar, C Jiménez Viñas
Surgical intervention
2 years ago
3094 views
236 likes
1 comment
10:22
Completely intracorporeal handsewn laparoscopic anastomoses during Whipple procedure
Background: Since 1935, the Whipple procedure was described, using conventional open surgery. With the advent of minimally invasive surgery (MIS), it was reported to be feasible also using the latest technology. In this video, the authors demonstrate a full laparoscopic Whipple procedure, performing the three anastomoses using an intracorporeal handsewn method.

Video: A 70-year-old man presenting with an adenocarcinoma of the ampulla of Vater, infiltrating the pancreatic parenchyma, underwent a laparoscop ic Whipple procedure. Preoperative work-up showed a T3N1M0 tumor.

Results: Total operative time was 8 hours 20minutes; time for the dissection was 6 hours 20 minutes; time for specimen extraction was 20 minutes, and time for the three laparoscopic intracorporeal handsewn anastomoses was 1 hour 40 minutes. Operative bleeding was 350cc. The patient was discharged on postoperative day 9. Pathological findings confirmed a moderately differentiated adenocarcinoma of the ampulla of Vater, with perinervous infiltration and lymphovascular emboli, free margins, 2 metastatic lymph nodes on 23 isolated; 7 edition UICC stage: pT4N1.

Conclusions: The laparoscopic Whipple procedure remains an advanced procedure to be performed laparoscopically and/or using open surgery. All the advantages of MIS such as reduced abdominal trauma, less postoperative pain, shorter hospital stay, improved patient’s comfort, and enhanced cosmesis are offered using laparoscopy.
Spleen and splenic vessel preserving distal pancreatectomy for bifocal PNET in a young patient with MEN1
In this key lecture, Dr. Conrad outlines key steps related to spleen and splenic vessel preserving distal pancreatectomy, laparoscopic insulinoma enucleation of the posterior pancreatic neck, and laparoscopic partial splenectomy. He stresses the technical aspects of intraoperative ultrasonography, celiac trunk dissection, and gives some recommendations with regards to leak reduction, vascular dissection, and energy device use. He provides tips and tricks for insulinoma dissection and emphasizes key concepts and technical points for main pancreatic duct preservation, hilum dissection, and spleen transection.
C Conrad
Lecture
2 years ago
1003 views
67 likes
0 comments
15:24
Spleen and splenic vessel preserving distal pancreatectomy for bifocal PNET in a young patient with MEN1
In this key lecture, Dr. Conrad outlines key steps related to spleen and splenic vessel preserving distal pancreatectomy, laparoscopic insulinoma enucleation of the posterior pancreatic neck, and laparoscopic partial splenectomy. He stresses the technical aspects of intraoperative ultrasonography, celiac trunk dissection, and gives some recommendations with regards to leak reduction, vascular dissection, and energy device use. He provides tips and tricks for insulinoma dissection and emphasizes key concepts and technical points for main pancreatic duct preservation, hilum dissection, and spleen transection.
Arcuate ligament syndrome: laparoscopic approach
Median arcuate ligament syndrome is caused by the extrinsic compression of the celiac trunk by the median arcuate ligament, prominent fibrous bands, and peri-aortic nodal tissue. In many cases, it is asymptomatic, even though postprandial abdominal pain or, during exercise, nauseas, vomiting, and weight loss could be found. Doppler ultrasound and angiotomography are used for diagnosis while arteriography is the gold standard. Only symptomatic patients might require surgical treatment, and the laparoscopic approach has been proposed as a safe and effective technique. We present a case of laparoscopic approach for the treatment of arcuate ligament syndrome.
F Moser, P Maldonado, F Signorini, V Gorodner, E Romero, A Vigilante, E Miranda, H Eynard, L Obeide
Surgical intervention
2 years ago
2162 views
94 likes
1 comment
07:28
Arcuate ligament syndrome: laparoscopic approach
Median arcuate ligament syndrome is caused by the extrinsic compression of the celiac trunk by the median arcuate ligament, prominent fibrous bands, and peri-aortic nodal tissue. In many cases, it is asymptomatic, even though postprandial abdominal pain or, during exercise, nauseas, vomiting, and weight loss could be found. Doppler ultrasound and angiotomography are used for diagnosis while arteriography is the gold standard. Only symptomatic patients might require surgical treatment, and the laparoscopic approach has been proposed as a safe and effective technique. We present a case of laparoscopic approach for the treatment of arcuate ligament syndrome.
Prevesical genetic paraganglioma and left adrenal mass: laparoscopic resection
Hereditary paraganglioma-pheochromocytoma syndromes are caused by genetic mutations, which lead to the development of multiple neuroendocrine tumors and paraganglioma tumors in the adrenal glands. We report the case of a young patient aged 13 who has been followed up routinely for a familial mutation of the SDHB gene. In this routine follow-up examination, an excessive plasma normetanephrine and norepinephrine secretion is evidenced. A genetic paraganglioma is diagnosed. Imaging studies are conducted to identify its location. A prevesical fixation is demonstrated by both the PET-scan and the MIBG scintigraphy. In this video, a laparoscopic resection of both lesions is demonstrated.
D Mutter, J Marescaux
Surgical intervention
9 years ago
1055 views
7 likes
0 comments
09:10
Prevesical genetic paraganglioma and left adrenal mass: laparoscopic resection
Hereditary paraganglioma-pheochromocytoma syndromes are caused by genetic mutations, which lead to the development of multiple neuroendocrine tumors and paraganglioma tumors in the adrenal glands. We report the case of a young patient aged 13 who has been followed up routinely for a familial mutation of the SDHB gene. In this routine follow-up examination, an excessive plasma normetanephrine and norepinephrine secretion is evidenced. A genetic paraganglioma is diagnosed. Imaging studies are conducted to identify its location. A prevesical fixation is demonstrated by both the PET-scan and the MIBG scintigraphy. In this video, a laparoscopic resection of both lesions is demonstrated.
Laparoscopic total gastrectomy guided by fluorescent lymphangiography using ICG injection around a tumor, followed by an intracorporeal double stapling esophagojejunostomy
Injecting indocyanine green (ICG) around the tumor enables the operators to identify the lymphatic channels and the lymph nodes in which the cancer cells can spread. It also allows them to decide on the extent of the dissection and validate the completeness of lymph node dissection. In this video, a laparoscopic near-infrared fluorescent camera was used, showing the fluorescent signal in diverse modes. A total gastrectomy with D1+ dissection is performed. The fluorescent signal shows the possible lymphatic pathways during the operation. An intracorporeal esophagojejunostomy was performed in a double stapling fashion; a round needle and a surgical thread are attached to the plastic part of the anvil of the circular stapler.
HK Yang, SH Kong
Surgical intervention
3 years ago
1924 views
79 likes
0 comments
15:56
Laparoscopic total gastrectomy guided by fluorescent lymphangiography using ICG injection around a tumor, followed by an intracorporeal double stapling esophagojejunostomy
Injecting indocyanine green (ICG) around the tumor enables the operators to identify the lymphatic channels and the lymph nodes in which the cancer cells can spread. It also allows them to decide on the extent of the dissection and validate the completeness of lymph node dissection. In this video, a laparoscopic near-infrared fluorescent camera was used, showing the fluorescent signal in diverse modes. A total gastrectomy with D1+ dissection is performed. The fluorescent signal shows the possible lymphatic pathways during the operation. An intracorporeal esophagojejunostomy was performed in a double stapling fashion; a round needle and a surgical thread are attached to the plastic part of the anvil of the circular stapler.
Totally laparoscopic gastrectomy and D2 lymphadenectomy with repair of a positive leak test
The objective of this video is to demonstrate a laparoscopic total gastrectomy with D2 lymphadenectomy for antral gastric cancer. The patient we present is a 40 year-old gentleman who presented with epigastric pain. Endoscopy revealed a neoplastic lesion at the gastric antrum. Biopsies confirmed the presence of an adenocarcinoma. This was staged as a T2 lesion and there was no distant metastasis. A total gastrectomy was planned using a total laparoscopic approach. For reconstruction, the authors used a Roux En Y esophagojejunal anastomosis using the transoral delivery of the OrVil® device (Covidien, Mansfield, MA, USA). We also demonstrate how to deal with a positive intraoperative leak test at the end of the procedure.
AE Salih, S Smolarek, SA Naqi, M Arumugasamy
Surgical intervention
3 years ago
6790 views
407 likes
0 comments
12:35
Totally laparoscopic gastrectomy and D2 lymphadenectomy with repair of a positive leak test
The objective of this video is to demonstrate a laparoscopic total gastrectomy with D2 lymphadenectomy for antral gastric cancer. The patient we present is a 40 year-old gentleman who presented with epigastric pain. Endoscopy revealed a neoplastic lesion at the gastric antrum. Biopsies confirmed the presence of an adenocarcinoma. This was staged as a T2 lesion and there was no distant metastasis. A total gastrectomy was planned using a total laparoscopic approach. For reconstruction, the authors used a Roux En Y esophagojejunal anastomosis using the transoral delivery of the OrVil® device (Covidien, Mansfield, MA, USA). We also demonstrate how to deal with a positive intraoperative leak test at the end of the procedure.
Three-trocar laparoscopic total gastrectomy and D2 lymphadenectomy with intracorporeal manual esophagojejunostomy
Background: Minimally invasive surgery (MIS) has proven to be oncologically feasible and safe. Over the last decade, a new philosophy of MIS reducing abdominal trauma and improving cosmetic results has been made popular. The authors report a three-trocar laparoscopic total gastrectomy combined with a D2 lymphadenectomy for smaller curvature gastric adenocarcinoma.
Video: A 52-year-old woman presenting with a non-differentiated gastric adenocarcinoma at the incisura angularis was admitted to our department. Preoperative work-up showed a T3N+M0 tumor. After neoadjuvant chemotherapy, laparoscopy was scheduled. Three ports (5mm, 12mm, 5mm) were placed in the abdomen. Exposure of the operative field was improved with percutaneous sutures. En-bloc total gastrectomy and omentectomy were performed with a D2 lymphadenectomy, including the nodes of stations 1, 2, 3, 4, 5, 6, 7, 8a, 8p, 9, 10, 11p, 11d, and 12a. A completely manual end-to-side esophagojejunostomy, and a linear mechanical side-to-side jejunojejunostomy were performed, with closure of both mesenteric and mesocolic defects. The specimen was retrieved through a suprapubic access.
Results: Operative time was 4 hours and 45 minutes (anastomosis: 30) and perioperative bleeding amounted to 100cc. The pathological report confirmed the presence of a non-differentiated adenocarcinoma, mucinous, G3, interesting the gastric wall completely, with 63 (4 positive) nodes removed; 7 edition UICC stage: pT4aN2aM0; keratine AE1/AE3 negative, HER2/neu and HER2/CEP17 non-amplified. During the postoperative follow-up, no recurrence was demonstrated at 12 months.
Conclusions: Reduced port laparoscopic surgery provides the same quality of oncologic surgery as conventional multiport laparoscopy. However, a superior cosmesis and a reduced abdominal trauma are offered.
G Dapri, HK Yang
Surgical intervention
3 years ago
3183 views
97 likes
0 comments
11:03
Three-trocar laparoscopic total gastrectomy and D2 lymphadenectomy with intracorporeal manual esophagojejunostomy
Background: Minimally invasive surgery (MIS) has proven to be oncologically feasible and safe. Over the last decade, a new philosophy of MIS reducing abdominal trauma and improving cosmetic results has been made popular. The authors report a three-trocar laparoscopic total gastrectomy combined with a D2 lymphadenectomy for smaller curvature gastric adenocarcinoma.
Video: A 52-year-old woman presenting with a non-differentiated gastric adenocarcinoma at the incisura angularis was admitted to our department. Preoperative work-up showed a T3N+M0 tumor. After neoadjuvant chemotherapy, laparoscopy was scheduled. Three ports (5mm, 12mm, 5mm) were placed in the abdomen. Exposure of the operative field was improved with percutaneous sutures. En-bloc total gastrectomy and omentectomy were performed with a D2 lymphadenectomy, including the nodes of stations 1, 2, 3, 4, 5, 6, 7, 8a, 8p, 9, 10, 11p, 11d, and 12a. A completely manual end-to-side esophagojejunostomy, and a linear mechanical side-to-side jejunojejunostomy were performed, with closure of both mesenteric and mesocolic defects. The specimen was retrieved through a suprapubic access.
Results: Operative time was 4 hours and 45 minutes (anastomosis: 30) and perioperative bleeding amounted to 100cc. The pathological report confirmed the presence of a non-differentiated adenocarcinoma, mucinous, G3, interesting the gastric wall completely, with 63 (4 positive) nodes removed; 7 edition UICC stage: pT4aN2aM0; keratine AE1/AE3 negative, HER2/neu and HER2/CEP17 non-amplified. During the postoperative follow-up, no recurrence was demonstrated at 12 months.
Conclusions: Reduced port laparoscopic surgery provides the same quality of oncologic surgery as conventional multiport laparoscopy. However, a superior cosmesis and a reduced abdominal trauma are offered.
Laparoscopic median arcuate ligament release
The video demonstrates the case of a laparoscopic median arcuate ligament release for a patient presenting with median arcuate ligament syndrome. This is a 37-year-old woman who was admitted to our clinic with complaints of intermittent abdominal pain, especially with meals, for 3 years’ duration. Her physical examination was unremarkable, except for an epigastric bruit detected on auscultation. Investigations included a duplex ultrasound, which showed increased hemodynamic velocities in the celiac trunk. In addition, CT-angiogram of the abdomen revealed an 80% luminal narrowing and extrinsic compression of the celiac artery at its origin. Her symptoms could be a result of foregut ischemia caused by the vessel’s narrowing. A potential anatomical factor contributing to extrinsic compression is the median arcuate ligament. This video explains our operative approach and technique used to dissect the esophagus at the hiatus, creating a subsequent pathway to identify the median arcuate ligament inferiorly and transect it down to the level of the celiac trunk’s origin. This will allow for relief of the external vascular compression and increased blood flow to the foregut and relief of her abdominal pain. Postoperatively, the patient had complete resolution of her abdominal symptoms.
N De La Cruz-Munoz, K Mohammad
Surgical intervention
4 years ago
1532 views
37 likes
0 comments
13:19
Laparoscopic median arcuate ligament release
The video demonstrates the case of a laparoscopic median arcuate ligament release for a patient presenting with median arcuate ligament syndrome. This is a 37-year-old woman who was admitted to our clinic with complaints of intermittent abdominal pain, especially with meals, for 3 years’ duration. Her physical examination was unremarkable, except for an epigastric bruit detected on auscultation. Investigations included a duplex ultrasound, which showed increased hemodynamic velocities in the celiac trunk. In addition, CT-angiogram of the abdomen revealed an 80% luminal narrowing and extrinsic compression of the celiac artery at its origin. Her symptoms could be a result of foregut ischemia caused by the vessel’s narrowing. A potential anatomical factor contributing to extrinsic compression is the median arcuate ligament. This video explains our operative approach and technique used to dissect the esophagus at the hiatus, creating a subsequent pathway to identify the median arcuate ligament inferiorly and transect it down to the level of the celiac trunk’s origin. This will allow for relief of the external vascular compression and increased blood flow to the foregut and relief of her abdominal pain. Postoperatively, the patient had complete resolution of her abdominal symptoms.
Laparoscopic spleen-preserving distal pancreatectomy for mucinous cystadenoma (Warshaw’s technique)
The video presents the case of a surgical procedure performed in a 58-year old woman presenting with mucinous cystadenoma in the left pancreas. The patient complained of early satiety and her CT-scan demonstrated the existence of a huge cystic tumor replacing her pancreatic body and tail. The tumor involved the splenic vein and artery, resulting in a left segmental portal hypertension. Preoperative CT-scan showed that collaterals from the short gastric vessels maintained splenic vascularization.
A spleen-preserving distal pancreatectomy, sacrificing splenic vessels, according to Warshaw’s technique was decided upon.
Fa Madureira, Fe Madureira, D Madureira
Surgical intervention
5 years ago
3138 views
52 likes
0 comments
10:43
Laparoscopic spleen-preserving distal pancreatectomy for mucinous cystadenoma (Warshaw’s technique)
The video presents the case of a surgical procedure performed in a 58-year old woman presenting with mucinous cystadenoma in the left pancreas. The patient complained of early satiety and her CT-scan demonstrated the existence of a huge cystic tumor replacing her pancreatic body and tail. The tumor involved the splenic vein and artery, resulting in a left segmental portal hypertension. Preoperative CT-scan showed that collaterals from the short gastric vessels maintained splenic vascularization.
A spleen-preserving distal pancreatectomy, sacrificing splenic vessels, according to Warshaw’s technique was decided upon.
Laparoscopic D2 lymphadenectomy with preservation of an aberrant left hepatic artery during distal gastric resection for cancer
During laparoscopic D2 lymphadenectomy for gastric cancer, an aberrant left hepatic artery (ALHA) can be found arising from the left gastric artery (LGA). It is recommended to preserve this vessel since it is impossible to intraoperatively determine whether it is a “replaced” or “accessory” left hepatic artery. In the present video, we show the technique to preserve the ALHA during a laparoscopic distal gastrectomy performed for a cancer of the antrum in a 78-year-old male patient.
A typical D2 laparoscopic lymphadenectomy is performed until the division of the left gastric vein and the identification of the LGA: the ALHA is identified at this time and the anterior side of the LGA is exposed towards its origin; the branch of the LGA towards the stomach is clipped and resected and the lymph nodes located posterior to the ALHA are then dissected completely. Lymphadenectomy is then completed with the dissection of the lymph nodes along the lesser curvature and the right cardiac nodes.
Pathological examination revealed a T2N0M0 tumor with 56 lymph nodes examined. The present video demonstrates that preservation of the ALHA is laparoscopically feasible and does not decrease the extent of D2 lymph node dissection.
B Badii, F Staderini, I Skalamera, G Fiorenza, G Perigli, F Cianchi
Surgical intervention
5 years ago
3403 views
98 likes
0 comments
16:07
Laparoscopic D2 lymphadenectomy with preservation of an aberrant left hepatic artery during distal gastric resection for cancer
During laparoscopic D2 lymphadenectomy for gastric cancer, an aberrant left hepatic artery (ALHA) can be found arising from the left gastric artery (LGA). It is recommended to preserve this vessel since it is impossible to intraoperatively determine whether it is a “replaced” or “accessory” left hepatic artery. In the present video, we show the technique to preserve the ALHA during a laparoscopic distal gastrectomy performed for a cancer of the antrum in a 78-year-old male patient.
A typical D2 laparoscopic lymphadenectomy is performed until the division of the left gastric vein and the identification of the LGA: the ALHA is identified at this time and the anterior side of the LGA is exposed towards its origin; the branch of the LGA towards the stomach is clipped and resected and the lymph nodes located posterior to the ALHA are then dissected completely. Lymphadenectomy is then completed with the dissection of the lymph nodes along the lesser curvature and the right cardiac nodes.
Pathological examination revealed a T2N0M0 tumor with 56 lymph nodes examined. The present video demonstrates that preservation of the ALHA is laparoscopically feasible and does not decrease the extent of D2 lymph node dissection.
Laparoscopic resection of giant hepatic cystadenoma
This is the case of a 22-month-old female infant. The pathology started two weeks before with a gradual increase of abdominal circumference and intermittent hypo-colic stools. A CT-scan of the abdomen showed a large cystic tumor with interior partitions measuring 16.5 in width by 10.6 in length by 12.1cm in depth, originating in segments V and VI of the liver, displacing the remaining liver to the left and compressing the right kidney, bowel, celiac artery, gallbladder, and pancreas. A laparoscopic approach for tumor resection was decided on due to the scarce tumor vascularization and entirely cystic consistency. The procedure required 4 ports, three of 5mm and one of 3mm, emptying the cystic content of approximately 2 liters of citrine fluid. Dissection was performed using the Ligasure™ vessel-sealing device and monopolar cautery, preserving adjacent vital structures and preventing bleeding. The surgical specimen was removed through the umbilical scar. No transfusion was required and surgery lasted four hours. There were no postoperative complications. As a result, laparoscopic surgery is considered a safe procedure for the excision of large tumors in children provided they are cystic and benign, as emptying the cyst gives broader visualization of the area and permits better tissue handling.
A Parilli, W Garcia, I Galdon, G Contreras
Surgical intervention
7 years ago
1159 views
10 likes
0 comments
08:03
Laparoscopic resection of giant hepatic cystadenoma
This is the case of a 22-month-old female infant. The pathology started two weeks before with a gradual increase of abdominal circumference and intermittent hypo-colic stools. A CT-scan of the abdomen showed a large cystic tumor with interior partitions measuring 16.5 in width by 10.6 in length by 12.1cm in depth, originating in segments V and VI of the liver, displacing the remaining liver to the left and compressing the right kidney, bowel, celiac artery, gallbladder, and pancreas. A laparoscopic approach for tumor resection was decided on due to the scarce tumor vascularization and entirely cystic consistency. The procedure required 4 ports, three of 5mm and one of 3mm, emptying the cystic content of approximately 2 liters of citrine fluid. Dissection was performed using the Ligasure™ vessel-sealing device and monopolar cautery, preserving adjacent vital structures and preventing bleeding. The surgical specimen was removed through the umbilical scar. No transfusion was required and surgery lasted four hours. There were no postoperative complications. As a result, laparoscopic surgery is considered a safe procedure for the excision of large tumors in children provided they are cystic and benign, as emptying the cyst gives broader visualization of the area and permits better tissue handling.
Totally thoracoscopic and laparoscopic Ivor Lewis esophagectomy in obese patients
Totally thoracoscopic and laparoscopic Ivor Lewis esophagectomy using a circular stapler or manual anastomosis has recently been described by a few authors.
We performed this challenging technique with a completely thoracoscopic hand-sewn esophagogastric anastomosis in two obese patients in prone position (one female and one male), affected by an adenocarcinoma of the lower third of the esophagus without lymph node invasion (pT2 N0) and with a BMI of 35 and 32 respectively. The first female patient is the subject of this video.
Thoracoscopy lasted 150 minutes (anastomosis was 50 minutes long), laparoscopy lasted 130 minutes, and second laparoscopy lasted 20 minutes. Blood loss was estimated at 150 mL.
The gastrografin swallows (on postoperative day 7 in both patients) showed absence of stenosis and leak. The patients had an uneventful postoperative course and were discharged on postoperative day 12 and 10, respectively.
Thoracoscopy in prone position allows the surgeon to perform a thoracoscopic esophagogastric anastomosis completely hand-sewn without selective lung exclusion, and using only three trocars.
In obese patients, although the technique is foremost challenging, the advantages of minimally invasive surgery are undeniable —better intraoperative respiratory function (avoiding selective lung exclusion) and less complicated postoperative course.
P Ubiali, M Andretta, M Ciocca Vasino, A Mancin, S Pastori, F Maffeis
Surgical intervention
8 years ago
8390 views
134 likes
0 comments
18:36
Totally thoracoscopic and laparoscopic Ivor Lewis esophagectomy in obese patients
Totally thoracoscopic and laparoscopic Ivor Lewis esophagectomy using a circular stapler or manual anastomosis has recently been described by a few authors.
We performed this challenging technique with a completely thoracoscopic hand-sewn esophagogastric anastomosis in two obese patients in prone position (one female and one male), affected by an adenocarcinoma of the lower third of the esophagus without lymph node invasion (pT2 N0) and with a BMI of 35 and 32 respectively. The first female patient is the subject of this video.
Thoracoscopy lasted 150 minutes (anastomosis was 50 minutes long), laparoscopy lasted 130 minutes, and second laparoscopy lasted 20 minutes. Blood loss was estimated at 150 mL.
The gastrografin swallows (on postoperative day 7 in both patients) showed absence of stenosis and leak. The patients had an uneventful postoperative course and were discharged on postoperative day 12 and 10, respectively.
Thoracoscopy in prone position allows the surgeon to perform a thoracoscopic esophagogastric anastomosis completely hand-sewn without selective lung exclusion, and using only three trocars.
In obese patients, although the technique is foremost challenging, the advantages of minimally invasive surgery are undeniable —better intraoperative respiratory function (avoiding selective lung exclusion) and less complicated postoperative course.
Laparoscopic splenopancreatectomy for a solid pseudopapillary pancreatic tumor
The solid pseudopapillary tumor of the pancreas, also known as Frantz’s tumor, is an uncommon occurrence usually seen in younger women. It is usually of low grade malignity and most patients have no recurrence after successful surgical resection.
In the last few years, laparoscopic approach to resection procedures for benign pathologies or low-grade malignancies of the pancreas has been increasingly used. The traditional surgical approach to the distal pancreas requires large abdominal incisions because of the deep position of the gland, and entails possible postoperative complications such as wound infections and incisional hernia.
In this video, we present a laparoscopic distal pancreatectomy with splenectomy for a localized tumor of the tail of the pancreas. It shows some steps, which could simplify the technique and prevent some complications as bleeding or postoperative fistula.
J Torres Bermúdez, FC Becerra García, G Sánchez de la Villa, M Montoya Tabares, F González Sánchez, R Nehme, AA Carrillo Sánchez, JL Martín
Surgical intervention
9 years ago
7299 views
113 likes
0 comments
14:01
Laparoscopic splenopancreatectomy for a solid pseudopapillary pancreatic tumor
The solid pseudopapillary tumor of the pancreas, also known as Frantz’s tumor, is an uncommon occurrence usually seen in younger women. It is usually of low grade malignity and most patients have no recurrence after successful surgical resection.
In the last few years, laparoscopic approach to resection procedures for benign pathologies or low-grade malignancies of the pancreas has been increasingly used. The traditional surgical approach to the distal pancreas requires large abdominal incisions because of the deep position of the gland, and entails possible postoperative complications such as wound infections and incisional hernia.
In this video, we present a laparoscopic distal pancreatectomy with splenectomy for a localized tumor of the tail of the pancreas. It shows some steps, which could simplify the technique and prevent some complications as bleeding or postoperative fistula.
Totally laparoscopic total gastrectomy for stage IIIA (cT3 cN1 cM0) advanced gastric carcinoma
A 66-year-old man was admitted to our hospital with complaints of epigastric pain. His hemoglobin level was 9.3g/dL. Endoscopy of the upper gastrointestinal tract (EGD) showed an advanced gastric carcinoma that had invaded the middle and lower third of the stomach. A biopsy specimen revealed a moderately differentiated adenocarcinoma. Abdominal computed tomography (CT) showed that the tumor had invaded the stomach wall. Enlarged lymph nodes were present only around the lesser curvature (regional lymph nodes No. 3). The patient was diagnosed with stage IIIA (cT3 cN1 cM0) advanced gastric carcinoma according to the Japanese classification of gastric carcinoma1. The patient was then taken to the operating room for exploratory laparoscopy and laparoscopic total gastrectomy with D2 lymphadenectomy. The operation time was 260 minutes. No further evidence of intra-abdominal disease or liver involvement was noted. The patient did well postoperatively and was subsequently discharged home on postoperative day 9. Four metastatic lymph nodes/twenty eight regional lymph nodes were found; so the pathological findings confirmed stage IIIA. The patient is disease-free at 10 months. Japanese Classification of Gastric Carcinoma - 2nd English Edition. Gastric Cancer 1998;1:10-24.
G Pignata, M Barone, U Bracale, E Gianetta, F Badessi
Surgical intervention
9 years ago
5410 views
34 likes
0 comments
26:02
Totally laparoscopic total gastrectomy for stage IIIA (cT3 cN1 cM0) advanced gastric carcinoma
A 66-year-old man was admitted to our hospital with complaints of epigastric pain. His hemoglobin level was 9.3g/dL. Endoscopy of the upper gastrointestinal tract (EGD) showed an advanced gastric carcinoma that had invaded the middle and lower third of the stomach. A biopsy specimen revealed a moderately differentiated adenocarcinoma. Abdominal computed tomography (CT) showed that the tumor had invaded the stomach wall. Enlarged lymph nodes were present only around the lesser curvature (regional lymph nodes No. 3). The patient was diagnosed with stage IIIA (cT3 cN1 cM0) advanced gastric carcinoma according to the Japanese classification of gastric carcinoma1. The patient was then taken to the operating room for exploratory laparoscopy and laparoscopic total gastrectomy with D2 lymphadenectomy. The operation time was 260 minutes. No further evidence of intra-abdominal disease or liver involvement was noted. The patient did well postoperatively and was subsequently discharged home on postoperative day 9. Four metastatic lymph nodes/twenty eight regional lymph nodes were found; so the pathological findings confirmed stage IIIA. The patient is disease-free at 10 months. Japanese Classification of Gastric Carcinoma - 2nd English Edition. Gastric Cancer 1998;1:10-24.