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Guillaume PHILOUZE

NHC
Strasbourg, Франция
MD
149 лайков
26.9K просмотров
22 комментариев
Фильтр
Хирургические специальности
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LIVE UNCUT SURGERY: laparoscopic cholecystectomy for cholelithiasis, a gold standard procedure
This video describes an "ideal" cholecystectomy, with a stepwise approach to the cystic pedicle and the dissection of the gallbladder. This video emphasizes the key points of dissection necessary to perform a safe cholecystectomy.
The initial approach aims to expose the infundibulum and to successively dissect the anterior and posterior reflection of the peritoneum. It provides a safe view of the cystic duct and the cystic artery which can be dissected in order to secure the “critical view of safety”, exposing the cystic artery clearly away from the common bile duct and the right hepatic artery. This highlights the risky parts of the dissection when rules are not respected.
After complete control of the pedicle, freeing of the gallbladder in the appropriate plane avoids any oozing, keeping the operative field totally clear and safe.
Finally, the video shows the extraction method for the gallbladder, allowing the procedure to be performed with three 5mm ports and one 10-12mm port, thereby limiting the risk of postoperative port-site hernia.
This 20-minute live uncut video is a demonstration of a gold standard procedure.
Хирургические операции
6 месяцев назад
12062 просмотров
65 лайков
7 комментариев
30:23
LIVE UNCUT SURGERY: laparoscopic cholecystectomy for cholelithiasis, a gold standard procedure
This video describes an "ideal" cholecystectomy, with a stepwise approach to the cystic pedicle and the dissection of the gallbladder. This video emphasizes the key points of dissection necessary to perform a safe cholecystectomy.
The initial approach aims to expose the infundibulum and to successively dissect the anterior and posterior reflection of the peritoneum. It provides a safe view of the cystic duct and the cystic artery which can be dissected in order to secure the “critical view of safety”, exposing the cystic artery clearly away from the common bile duct and the right hepatic artery. This highlights the risky parts of the dissection when rules are not respected.
After complete control of the pedicle, freeing of the gallbladder in the appropriate plane avoids any oozing, keeping the operative field totally clear and safe.
Finally, the video shows the extraction method for the gallbladder, allowing the procedure to be performed with three 5mm ports and one 10-12mm port, thereby limiting the risk of postoperative port-site hernia.
This 20-minute live uncut video is a demonstration of a gold standard procedure.
Laparoscopic cholecystectomy for cholelithiasis, a gold standard procedure
This video describes an "ideal" cholecystectomy, with a stepwise approach to the cystic pedicle and the dissection of the gallbladder. This video emphasizes the key points of dissection necessary to perform a safe cholecystectomy. The initial approach aims to expose the infundibulum and to successively dissect the anterior and posterior reflection of the peritoneum. It provides a safe view of the cystic duct and the cystic artery which can be dissected in order to secure the “critical view of safety”, exposing the cystic artery clearly away from the common bile duct and the right hepatic artery. This highlights the risky parts of the dissection when rules are not respected. After complete control of the pedicle, freeing of the gallbladder in the appropriate plane avoids any oozing, keeping the operative field totally clear and safe. Finally, the video shows the extraction method for the gallbladder, allowing the procedure to be performed with three 5mm ports and one 10-12mm port, thereby limiting the risk of postoperative port-site hernia. This 20-minute live uncut video is a demonstration of a gold standard procedure.
How to
6 месяцев назад
12032 просмотров
65 лайков
0 комментариев
00:30:23
Laparoscopic cholecystectomy for cholelithiasis, a gold standard procedure
This video describes an "ideal" cholecystectomy, with a stepwise approach to the cystic pedicle and the dissection of the gallbladder. This video emphasizes the key points of dissection necessary to perform a safe cholecystectomy. The initial approach aims to expose the infundibulum and to successively dissect the anterior and posterior reflection of the peritoneum. It provides a safe view of the cystic duct and the cystic artery which can be dissected in order to secure the “critical view of safety”, exposing the cystic artery clearly away from the common bile duct and the right hepatic artery. This highlights the risky parts of the dissection when rules are not respected. After complete control of the pedicle, freeing of the gallbladder in the appropriate plane avoids any oozing, keeping the operative field totally clear and safe. Finally, the video shows the extraction method for the gallbladder, allowing the procedure to be performed with three 5mm ports and one 10-12mm port, thereby limiting the risk of postoperative port-site hernia. This 20-minute live uncut video is a demonstration of a gold standard procedure.
Robot-assisted thoracic resection of an extended esophageal leiomyoma
Objective:
Leiomyomas represent approximately 70% of all benign esophageal tumors. In most cases, patients are asymptomatic, but others can present chest pain, dysphagia or weight loss. Even if malignization is rare, surgery is indicated. Laparoscopy is the most common approach because of the frequency of leiomyoma localization on the lower esophagus. However, thoracoscopy is also commonly performed with some difficulties in case of large tumors.
Our objective is to demonstrate the robotic approach and the bipolar Maryland forceps used for such a specific lesion.

Case presentation:
We present the case of a 58-year-old woman with no particular co-morbidity. On CT-scan, she was incidentally diagnosed with a leiomyoma for Guillain-Barre syndrome. A homogeneous 7cm tumor was found on the left side of the middle esophagus with a horseshoe-shaped aspect typical of leiomyoma. Check-up was completed by MRI and endoscopic ultrasonography, which tended to confirm the diagnosis.
In this video, the robot-assisted thoracic enucleation of the tumor performed by a left approach shows the quality of esophageal exposure and tumor dissection by means of a bipolar Maryland forceps. Blood loss was less than 30mL, and the postoperative period was uneventful. Histological analysis confirmed the diagnosis of leiomyoma.

Conclusion:
Robot-assisted resection of benign esophageal tumors is a safe procedure, especially for intrathoracic tumors. This technique provides a better view and easier dissection. The use of a bipolar Maryland forceps allows for a safer procedure. Day care surgery could then be expected for smaller lesions.
Хирургические операции
4 лет назад
609 просмотров
14 лайков
0 комментариев
09:09
Robot-assisted thoracic resection of an extended esophageal leiomyoma
Objective:
Leiomyomas represent approximately 70% of all benign esophageal tumors. In most cases, patients are asymptomatic, but others can present chest pain, dysphagia or weight loss. Even if malignization is rare, surgery is indicated. Laparoscopy is the most common approach because of the frequency of leiomyoma localization on the lower esophagus. However, thoracoscopy is also commonly performed with some difficulties in case of large tumors.
Our objective is to demonstrate the robotic approach and the bipolar Maryland forceps used for such a specific lesion.

Case presentation:
We present the case of a 58-year-old woman with no particular co-morbidity. On CT-scan, she was incidentally diagnosed with a leiomyoma for Guillain-Barre syndrome. A homogeneous 7cm tumor was found on the left side of the middle esophagus with a horseshoe-shaped aspect typical of leiomyoma. Check-up was completed by MRI and endoscopic ultrasonography, which tended to confirm the diagnosis.
In this video, the robot-assisted thoracic enucleation of the tumor performed by a left approach shows the quality of esophageal exposure and tumor dissection by means of a bipolar Maryland forceps. Blood loss was less than 30mL, and the postoperative period was uneventful. Histological analysis confirmed the diagnosis of leiomyoma.

Conclusion:
Robot-assisted resection of benign esophageal tumors is a safe procedure, especially for intrathoracic tumors. This technique provides a better view and easier dissection. The use of a bipolar Maryland forceps allows for a safer procedure. Day care surgery could then be expected for smaller lesions.