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Rodrigo FERNANDES

MD
Instituto do Cancer do Estado de São Paulo
São Paulo, Бразилия
37 vidéos
159K просмотров
27 комментариев
4.7K лайков
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In bag morcellation of a uterine fibroid
For a long time, morcellation of an undiagnosed malignancy, an old and frightening topic, has been a matter of extensive discussions. Clinicians and pathologists still lack instruments to clearly diagnose specific pathologies such as leiomyosarcomas. Minimally invasive surgery brought numerous advantages for the patient. However, morcellation is a key issue for the extraction of a large uterus and myomas. In this video, we present an option for the extraction of myomas. By insufflating a large Endobag®, a virtual abdominal cavity is created, and the mass is morcellated under direct vision. The resistant bag works not only as a protection for the abdominal cavity in case of an undiagnosed malignancy, but also serves to deviate organs from the morcellator.
Хирургические операции
4 года назад
3489 просмотров
132 лайка
0 комментариев
06:37
In bag morcellation of a uterine fibroid
For a long time, morcellation of an undiagnosed malignancy, an old and frightening topic, has been a matter of extensive discussions. Clinicians and pathologists still lack instruments to clearly diagnose specific pathologies such as leiomyosarcomas. Minimally invasive surgery brought numerous advantages for the patient. However, morcellation is a key issue for the extraction of a large uterus and myomas. In this video, we present an option for the extraction of myomas. By insufflating a large Endobag®, a virtual abdominal cavity is created, and the mass is morcellated under direct vision. The resistant bag works not only as a protection for the abdominal cavity in case of an undiagnosed malignancy, but also serves to deviate organs from the morcellator.
Management of a severe bleeding during laparoscopy for recurrent rectovaginal endometriosis
This case demonstrates the potential danger of a repetitive surgery after an incomplete resection of rectovaginal endometriosis. A severe bleeding occurred during the dissection of the recurrent nodule. It was managed through multiple coagulations, which could only be performed safely and effectively because important landmarks had been identified and retracted prior to resecting the nodule. A key point in the surgery was also circumventing the nodule in order to pass in sano as the bleeding came from vessels entrapped in fibrosis and scarring tissue which could not be effectively coagulated.
Хирургические операции
5 лет назад
3328 просмотров
60 лайков
0 комментариев
08:06
Management of a severe bleeding during laparoscopy for recurrent rectovaginal endometriosis
This case demonstrates the potential danger of a repetitive surgery after an incomplete resection of rectovaginal endometriosis. A severe bleeding occurred during the dissection of the recurrent nodule. It was managed through multiple coagulations, which could only be performed safely and effectively because important landmarks had been identified and retracted prior to resecting the nodule. A key point in the surgery was also circumventing the nodule in order to pass in sano as the bleeding came from vessels entrapped in fibrosis and scarring tissue which could not be effectively coagulated.
Laparoscopic ileocaecal and sigmoid resection with transanal natural orifice specimen extraction (NOSE) for endometriosis
In 12 to 30% of endometriosis cases, the disease is located in the bowel. Caecum and small bowel endometriosis are found in only 3.6% and 7% respectively of those cases while the sigmoid colon and the rectum are most commonly affected in 85% of cases. The laparoscopic management of this disease has evolved drastically over the last decade, and even delicate cases such as small bowel endometriosis can be completely managed by laparoscopy. It is key to be locally invasive towards the disease but conservative with regards to organ function preservation. The specimen will be extracted through natural orifices and without any ileostomy. Our patients are commonly young and healthy women who will certainly benefit from a tailored surgery with immediate symptom relief in addition to minimum abdominal scarring can have a significant positive impact on patient’s psychological well-being and subsequent recovery.
In the present case, we present a 36-year old woman who was diagnosed with endometriosis and presented with 3 episodes of bowel pseudo-obstruction and dyschezia, and put under medical treatment. She was found to have multiple endometriotic nodules, with concurrent ileocaecal and rectosigmoid disease, for which a double bowel resection with transanal natural orifice specimen extraction (NOSE) was performed without complications.
Хирургические операции
5 лет назад
1980 просмотров
46 лайков
0 комментариев
38:15
Laparoscopic ileocaecal and sigmoid resection with transanal natural orifice specimen extraction (NOSE) for endometriosis
In 12 to 30% of endometriosis cases, the disease is located in the bowel. Caecum and small bowel endometriosis are found in only 3.6% and 7% respectively of those cases while the sigmoid colon and the rectum are most commonly affected in 85% of cases. The laparoscopic management of this disease has evolved drastically over the last decade, and even delicate cases such as small bowel endometriosis can be completely managed by laparoscopy. It is key to be locally invasive towards the disease but conservative with regards to organ function preservation. The specimen will be extracted through natural orifices and without any ileostomy. Our patients are commonly young and healthy women who will certainly benefit from a tailored surgery with immediate symptom relief in addition to minimum abdominal scarring can have a significant positive impact on patient’s psychological well-being and subsequent recovery.
In the present case, we present a 36-year old woman who was diagnosed with endometriosis and presented with 3 episodes of bowel pseudo-obstruction and dyschezia, and put under medical treatment. She was found to have multiple endometriotic nodules, with concurrent ileocaecal and rectosigmoid disease, for which a double bowel resection with transanal natural orifice specimen extraction (NOSE) was performed without complications.
Laparoscopic Burch procedure: colposuspension for stress urinary incontinence (SUI)
We present the case of a 53-year old patient diagnosed with stress urinary incontinence (SUI), who was initially managed by a tension-free vaginal tape obturator system (TVTO) operation one year earlier. Six months after the initial procedure, she reported a recurrence of her urinary symptoms. She was referred to our department and a urodynamic investigation revealed a type II SUI.

Decision is made to perform a laparoscopic Burch colposuspension to reinforce the urethral support. This procedure can be considered a therapeutic option in patients with recurrent symptoms of SUI following vaginal sling procedures.
Хирургические операции
5 лет назад
4074 просмотра
119 лайков
0 комментариев
13:33
Laparoscopic Burch procedure: colposuspension for stress urinary incontinence (SUI)
We present the case of a 53-year old patient diagnosed with stress urinary incontinence (SUI), who was initially managed by a tension-free vaginal tape obturator system (TVTO) operation one year earlier. Six months after the initial procedure, she reported a recurrence of her urinary symptoms. She was referred to our department and a urodynamic investigation revealed a type II SUI.

Decision is made to perform a laparoscopic Burch colposuspension to reinforce the urethral support. This procedure can be considered a therapeutic option in patients with recurrent symptoms of SUI following vaginal sling procedures.
Bowel obstruction: a late complication after laparoscopic colposacropexy
This video illustrates the case of a patient with bowel adherent to an exposed portion of mesh used for treatment of a previous apical prolapse. The patient presents with abdominal symptoms following a laparoscopic sacrocolpopexy.
In this video, Professor Wattiez performs an extensive pelvic adhesiolysis, detaching the bowel from the mesh, and identifying adequate correction of vaginal prolapse, without any sign of infection. Reperitonization of the vaginal vault and the long arm (sacrum arm) of the mesh was also performed.
This unique case highlights the importance of peritonization when using mesh. Complications such as mesh exposure may occur, however this can be appropriately managed laparoscopically.
Хирургические операции
6 лет назад
1883 просмотра
37 лайков
0 комментариев
23:25
Bowel obstruction: a late complication after laparoscopic colposacropexy
This video illustrates the case of a patient with bowel adherent to an exposed portion of mesh used for treatment of a previous apical prolapse. The patient presents with abdominal symptoms following a laparoscopic sacrocolpopexy.
In this video, Professor Wattiez performs an extensive pelvic adhesiolysis, detaching the bowel from the mesh, and identifying adequate correction of vaginal prolapse, without any sign of infection. Reperitonization of the vaginal vault and the long arm (sacrum arm) of the mesh was also performed.
This unique case highlights the importance of peritonization when using mesh. Complications such as mesh exposure may occur, however this can be appropriately managed laparoscopically.