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Rouba MURTADA

Hôpitaux Universitaires de Strasbourg
Strasbourg, Франция
MD
3.3K лайка
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Laparoscopic type C radical hysterectomy and pelvic lymphadenectomy for cervical cancer
This video shows a standardized and reproducible approach to radical hysterectomy. The procedure begins with the dissection of the lateral pelvic spaces in order to identify and isolate the paracervix. After coagulation and division of the round ligament, the surgeon performs a T-shape incision until the psoas muscles to expose the field for the ilio-obturator lymphadenectomy. The paravesical fossa is then dissected in its medial and lateral aspect using the umbilical artery as a landmark. Following the umbilical artery in a ventral to dorsal direction, the surgeon identifies the uterine artery and the paracervix. Using the uterine artery as a landmark of the paracervix, dissection is continued posteriorly developing the Latzko and Okabayashi spaces in order to isolate the paracervix. Once the spaces have been developed, the lymphadenectomy is performed separating the external iliac vessels from the psoas muscle to reach the obturator fossa. During this step, the obturator nerve is identified to avoid injuries and to mark the caudal limit of the lymphadenectomy.
The procedure is carried on with the isolation of the ureter in its anterior aspect between the paracervix and the bladder. To do so, the bladder pillar is identified and the dissection is pursued between its medial and lateral aspect developing the so-called space of Yabuki. The bladder pillar is then transected at the level of the bladder. The rectal pillar is transected at the level of the rectum paying attention to isolate the inferior hypogastric nerve. The paracervix is then cut at the level of the hypogastric vessel and the ureter is unroofed.
The vagina is cut with monopolar energy using a vaginal valve as a guide and the specimen is extracted vaginally.
The vagina is closed with three stitches using an extracorporeal knotting technique.
Хирургические операции
4 года назад
10818 просмотров
350 лайков
0 комментариев
07:20
Laparoscopic type C radical hysterectomy and pelvic lymphadenectomy for cervical cancer
This video shows a standardized and reproducible approach to radical hysterectomy. The procedure begins with the dissection of the lateral pelvic spaces in order to identify and isolate the paracervix. After coagulation and division of the round ligament, the surgeon performs a T-shape incision until the psoas muscles to expose the field for the ilio-obturator lymphadenectomy. The paravesical fossa is then dissected in its medial and lateral aspect using the umbilical artery as a landmark. Following the umbilical artery in a ventral to dorsal direction, the surgeon identifies the uterine artery and the paracervix. Using the uterine artery as a landmark of the paracervix, dissection is continued posteriorly developing the Latzko and Okabayashi spaces in order to isolate the paracervix. Once the spaces have been developed, the lymphadenectomy is performed separating the external iliac vessels from the psoas muscle to reach the obturator fossa. During this step, the obturator nerve is identified to avoid injuries and to mark the caudal limit of the lymphadenectomy.
The procedure is carried on with the isolation of the ureter in its anterior aspect between the paracervix and the bladder. To do so, the bladder pillar is identified and the dissection is pursued between its medial and lateral aspect developing the so-called space of Yabuki. The bladder pillar is then transected at the level of the bladder. The rectal pillar is transected at the level of the rectum paying attention to isolate the inferior hypogastric nerve. The paracervix is then cut at the level of the hypogastric vessel and the ureter is unroofed.
The vagina is cut with monopolar energy using a vaginal valve as a guide and the specimen is extracted vaginally.
The vagina is closed with three stitches using an extracorporeal knotting technique.
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
3220 просмотров
59 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
1920 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
3783 просмотра
116 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.