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The vascular hitch: a simpler procedure for vascular pyeloureteral junction obstruction (PUJO)
Ureteropelvic junction obstruction may occur in about 10% of cases, the origin of which is not an intrinsic organic obstruction in this transitional area between the renal pelvis and the ureter, but it is rather secondary to an extrinsic obstruction, related to the presence of aberrant lower pole vessels.
It is an intermittent ureteropelvic junction obstruction syndrome, which is usually diagnosed late and in which renal function is most often preserved. The operating technique was already described more than 60 years ago. It is a simple technique.
The greatest difficulty is not technical but lies in the indication which must be relevant. The main difficulty is to preoperatively and intraoperatively evaluate either the totally extrinsic nature or conversely the mixed nature of the obstruction, which in that case requires a pyeloplasty according to Anderson-Hynes with division of the ureterovesical junction posteriorly to the vessels and reconstruction of the ureteropelvic junction once enlarged, anteriorly to the lower pole vessels.
I Mushtaq
Lecture
4 years ago
602 views
33 likes
1 comment
13:17
The vascular hitch: a simpler procedure for vascular pyeloureteral junction obstruction (PUJO)
Ureteropelvic junction obstruction may occur in about 10% of cases, the origin of which is not an intrinsic organic obstruction in this transitional area between the renal pelvis and the ureter, but it is rather secondary to an extrinsic obstruction, related to the presence of aberrant lower pole vessels.
It is an intermittent ureteropelvic junction obstruction syndrome, which is usually diagnosed late and in which renal function is most often preserved. The operating technique was already described more than 60 years ago. It is a simple technique.
The greatest difficulty is not technical but lies in the indication which must be relevant. The main difficulty is to preoperatively and intraoperatively evaluate either the totally extrinsic nature or conversely the mixed nature of the obstruction, which in that case requires a pyeloplasty according to Anderson-Hynes with division of the ureterovesical junction posteriorly to the vessels and reconstruction of the ureteropelvic junction once enlarged, anteriorly to the lower pole vessels.
Laparoscopic retroperitoneal pyeloplasty
Ureteropelvic junction obstruction repair can be performed in the first months of the infant’s life by means of videoscopic surgery. Two approaches can be used. First, the transperitoneal access offers a fairly large surgical space. On the other hand, it implies that the surgeon accesses a retroperitoneal organ by opening the posterior parietal peritoneum. To the right, kidney exposure may necessitate the detachment of the right colon and of the duodenum and the surgeon often has to lift up the right liver.
To the left, the exposure of the ureteropelvic junction may require either a colonic detachment, or a transmesocolic opening by respecting the vascular supply of the left colon. The retroperitoneal approach is direct. It helps to better manage any potential urinary leaks, which will never occur intraperitoneally. It prevents any intraperitoneal dissection. However, it is a demanding technique technically speaking.
A El-Ghoneimi
Lecture
4 years ago
1082 views
50 likes
0 comments
28:15
Laparoscopic retroperitoneal pyeloplasty
Ureteropelvic junction obstruction repair can be performed in the first months of the infant’s life by means of videoscopic surgery. Two approaches can be used. First, the transperitoneal access offers a fairly large surgical space. On the other hand, it implies that the surgeon accesses a retroperitoneal organ by opening the posterior parietal peritoneum. To the right, kidney exposure may necessitate the detachment of the right colon and of the duodenum and the surgeon often has to lift up the right liver.
To the left, the exposure of the ureteropelvic junction may require either a colonic detachment, or a transmesocolic opening by respecting the vascular supply of the left colon. The retroperitoneal approach is direct. It helps to better manage any potential urinary leaks, which will never occur intraperitoneally. It prevents any intraperitoneal dissection. However, it is a demanding technique technically speaking.
Robotic single site left dismembered pyeloplasty for ureteropelvic junction obstruction
This video demonstrates the surgical steps for a left ureteropelvic junction (UPJ) reconstruction performed by means of the new da Vinci® robotic single site platform.
This surgery can be achieved by a 2cm single incision made in the umbilicus.
The system provides 2 robotic instruments crossing into the trocar in order to have an adequate triangulation. In this set-up, the left robotic instrument is placed into the surgical field on the right side while the right robotic instrument is on the left side of the surgical field. The software of the da Vinci™ system allows for the control of the right robotic arm to the left master into the robotic console in order to have the instrument placed in the right part of the surgical field controlled by the right master. This allows for a direct and natural control of the instruments, hence solving the problem of the crossing of the instruments.
This is a great advantage when compared to standard laparoscopic single site surgery.
F Annino, T Verdacchi, M de Angelis
Surgical intervention
6 years ago
2283 views
50 likes
0 comments
05:40
Robotic single site left dismembered pyeloplasty for ureteropelvic junction obstruction
This video demonstrates the surgical steps for a left ureteropelvic junction (UPJ) reconstruction performed by means of the new da Vinci® robotic single site platform.
This surgery can be achieved by a 2cm single incision made in the umbilicus.
The system provides 2 robotic instruments crossing into the trocar in order to have an adequate triangulation. In this set-up, the left robotic instrument is placed into the surgical field on the right side while the right robotic instrument is on the left side of the surgical field. The software of the da Vinci™ system allows for the control of the right robotic arm to the left master into the robotic console in order to have the instrument placed in the right part of the surgical field controlled by the right master. This allows for a direct and natural control of the instruments, hence solving the problem of the crossing of the instruments.
This is a great advantage when compared to standard laparoscopic single site surgery.
Laparoscopic management of small bowel obstruction and ileo-ileal intussusception
Meckel’s diverticulum is the most common congenital anomaly of the digestive tract, found in 2 to 3% of the population. It is usually detected in children. In adults, symptoms vary, and diagnosis is therefore uneasy to establish. The most common infectious complications include obstructions and bleedings, which account for approximately one third of overall complications. Obstructions may be caused by intussusception or by a band.
This video demonstrates a case of a 49-year-old male patient, who necessitated an emergency surgical procedure for the management of a small bowel obstruction induced by the presence of Meckel’s diverticulum and intussusception. Due to an underlying necrosis, a resection and an anastomosis of the small bowel were performed.
D Kadoche, M Ignat, D Mutter, J Marescaux
Surgical intervention
1 year ago
987 views
8 likes
0 comments
08:22
Laparoscopic management of small bowel obstruction and ileo-ileal intussusception
Meckel’s diverticulum is the most common congenital anomaly of the digestive tract, found in 2 to 3% of the population. It is usually detected in children. In adults, symptoms vary, and diagnosis is therefore uneasy to establish. The most common infectious complications include obstructions and bleedings, which account for approximately one third of overall complications. Obstructions may be caused by intussusception or by a band.
This video demonstrates a case of a 49-year-old male patient, who necessitated an emergency surgical procedure for the management of a small bowel obstruction induced by the presence of Meckel’s diverticulum and intussusception. Due to an underlying necrosis, a resection and an anastomosis of the small bowel were performed.
LIVE INTERACTIVE SURGERY: fully comprehensive demonstration of laparoscopic left hemicolectomy for synchronous adenocarcinoma of the sigmoid colon and rectosigmoid junction in an obese patient
In this live interactive surgery, Dr. Salvador Morales-Conde presents a case of synchronous sigmoid and rectosigmoid adenocarcinoma in an obese patient (BMI of 30). During mucosectomy of a sigmoid polyp at 20cm from the anal verge, a pTis adenocarcinoma was diagnosed when completely resected. A pT1 adenocarcinoma was biopsied at the rectosigmoid junction (12-15cm from the anal verge). Staging revealed no distant metastases. The operative technique shown consists in an oncological resection with mobilization of the splenic flexure.
S Morales-Conde, B Seeliger, D Mutter, J Marescaux
Surgical intervention
1 year ago
6848 views
17 likes
0 comments
43:25
LIVE INTERACTIVE SURGERY: fully comprehensive demonstration of laparoscopic left hemicolectomy for synchronous adenocarcinoma of the sigmoid colon and rectosigmoid junction in an obese patient
In this live interactive surgery, Dr. Salvador Morales-Conde presents a case of synchronous sigmoid and rectosigmoid adenocarcinoma in an obese patient (BMI of 30). During mucosectomy of a sigmoid polyp at 20cm from the anal verge, a pTis adenocarcinoma was diagnosed when completely resected. A pT1 adenocarcinoma was biopsied at the rectosigmoid junction (12-15cm from the anal verge). Staging revealed no distant metastases. The operative technique shown consists in an oncological resection with mobilization of the splenic flexure.