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Bernard DALLEMAGNE

Hôpitaux Universitaires de Strasbourg
Strasbourg, Франция
MD
22.7K лайка
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88 комментариев
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Minimally invasive Ivor-Lewis esophagectomy for end-stage achalasia
Achalasia is the most frequent esophageal motility disorder. Although Heller myotomy is the standard treatment, achieving good results in 90 to 95% of cases, esophagectomy could be the last surgical chance to treat end-stage achalasia and might be considered if severe symptomatic (dysphagia, regurgitation), anatomical (megaesophagus) or functional (esophagus aperistalses) disorders are not relieved with a more conservative approach.
Clinical case: We present the case of a 21-year-old female patient suffering from esophageal achalasia from the age of 3. After numerous attempts to grant her a good quality of life in a conservative way, when she gets to end-stage achalasia without any benefits from endoscopic therapies, a minimally invasive Ivor-Lewis esophagectomy is put forward to her in order to relieve her symptoms. Discussion/Conclusion: Esophagectomy could be performed in patients who are fit for major surgery and present with disabling symptoms, poor quality of life, and dolichomegaesophagus unresponsive to multiple endoscopic dilatations and/or surgical myotomies.
Хирургические операции
27 дней назад
993 просмотра
11 лайков
1 комментарий
13:39
Minimally invasive Ivor-Lewis esophagectomy for end-stage achalasia
Achalasia is the most frequent esophageal motility disorder. Although Heller myotomy is the standard treatment, achieving good results in 90 to 95% of cases, esophagectomy could be the last surgical chance to treat end-stage achalasia and might be considered if severe symptomatic (dysphagia, regurgitation), anatomical (megaesophagus) or functional (esophagus aperistalses) disorders are not relieved with a more conservative approach.
Clinical case: We present the case of a 21-year-old female patient suffering from esophageal achalasia from the age of 3. After numerous attempts to grant her a good quality of life in a conservative way, when she gets to end-stage achalasia without any benefits from endoscopic therapies, a minimally invasive Ivor-Lewis esophagectomy is put forward to her in order to relieve her symptoms. Discussion/Conclusion: Esophagectomy could be performed in patients who are fit for major surgery and present with disabling symptoms, poor quality of life, and dolichomegaesophagus unresponsive to multiple endoscopic dilatations and/or surgical myotomies.
Gastrojejunal anastomosis resizing with Argon Plasma Coagulation (APC) and Apollo OverStitch™ endoscopic suturing system: live procedure
In 2004, a 57-year-old lady underwent a Roux-en-Y gastric bypass (RYGB) for morbid obesity. After the surgical intervention, she lost 13Kg and she started to regain weight back with a current BMI of 41.
During this live procedure, Professor Perretta performs a gastroscopy that shows a normal gastric pouch and a gastrojejunal anastomosis increased in caliber. The operator does an endoscopic resizing of the anastomosis with Argon Plasma Coagulation (APC) followed by the placement of an endoscopic suture with the Apollo OverStitch™ endoscopic suturing system.
Хирургические операции
1 месяц назад
702 просмотра
4 лайка
3 комментария
30:14
Gastrojejunal anastomosis resizing with Argon Plasma Coagulation (APC) and Apollo OverStitch™ endoscopic suturing system: live procedure
In 2004, a 57-year-old lady underwent a Roux-en-Y gastric bypass (RYGB) for morbid obesity. After the surgical intervention, she lost 13Kg and she started to regain weight back with a current BMI of 41.
During this live procedure, Professor Perretta performs a gastroscopy that shows a normal gastric pouch and a gastrojejunal anastomosis increased in caliber. The operator does an endoscopic resizing of the anastomosis with Argon Plasma Coagulation (APC) followed by the placement of an endoscopic suture with the Apollo OverStitch™ endoscopic suturing system.
Endoscopic sleeve gastroplasty (ESG): live procedure
In this live procedure, Professor Perretta performs an endoscopic sleeve gastroplasty (ESG) using the OverStitch™ endoscopic suturing system (Apollo Endosurgery) in a 50-year-old obese male patient (with a BMI of 35.3). In this particular case, preoperative esophagogastroduodenoscopy (EGD) showed a Barrett’s esophagus with positive histology for intestinal metaplasia, which is not a contraindication for this kind of endoscopic intervention. ESG is performed with the patient under general anesthesia and carbon dioxide insufflation. The supine position is preferred because it is safer than the left lateral decubitus position as it allows for a better exposure of the stomach. Sutures are placed in a U-shaped fashion from the incisura angularis to the fundus, which is spared using the OverStitch™ suturing system, mounted on a double channel Olympus scope. The system allows for the placement of durable full-thickness stitches to obtain gastric volume reduction and shrinking.
Хирургические операции
1 месяц назад
490 просмотров
5 лайков
1 комментарий
38:23
Endoscopic sleeve gastroplasty (ESG): live procedure
In this live procedure, Professor Perretta performs an endoscopic sleeve gastroplasty (ESG) using the OverStitch™ endoscopic suturing system (Apollo Endosurgery) in a 50-year-old obese male patient (with a BMI of 35.3). In this particular case, preoperative esophagogastroduodenoscopy (EGD) showed a Barrett’s esophagus with positive histology for intestinal metaplasia, which is not a contraindication for this kind of endoscopic intervention. ESG is performed with the patient under general anesthesia and carbon dioxide insufflation. The supine position is preferred because it is safer than the left lateral decubitus position as it allows for a better exposure of the stomach. Sutures are placed in a U-shaped fashion from the incisura angularis to the fundus, which is spared using the OverStitch™ suturing system, mounted on a double channel Olympus scope. The system allows for the placement of durable full-thickness stitches to obtain gastric volume reduction and shrinking.
Laparoscopic cholecystectomy - Basic rules - Bile duct injury
There is twice as much risk of incidental biliary injuries in laparoscopic cholecystectomy than in open cholecystectomy.
About half of surgeons will cause a bile duct injury during their careers. In this lecture, Dr. Dallemagne provides key national data of bile duct injury and explains that the lack of surgical experience or visual misperception leads to an increase in the rate of incidental injuries, mentioning his own cases. Dr. Dallemagne also outlines the fundamental techniques to prevent injuries and use bailout procedures (partial and subtotal cholecystectomy) in laparoscopic cholecystectomy, according to the latest version of the Tokyo guidelines.
Лекции
9 месяцев назад
6216 просмотров
48 лайков
2 комментария
22:02
Laparoscopic cholecystectomy - Basic rules - Bile duct injury
There is twice as much risk of incidental biliary injuries in laparoscopic cholecystectomy than in open cholecystectomy.
About half of surgeons will cause a bile duct injury during their careers. In this lecture, Dr. Dallemagne provides key national data of bile duct injury and explains that the lack of surgical experience or visual misperception leads to an increase in the rate of incidental injuries, mentioning his own cases. Dr. Dallemagne also outlines the fundamental techniques to prevent injuries and use bailout procedures (partial and subtotal cholecystectomy) in laparoscopic cholecystectomy, according to the latest version of the Tokyo guidelines.
Laparoscopic management of perforated ulcer of the stomach
A 43-year-old woman with a history of chronic use of NSAIDs was admitted to the emergency care unit for acute abdominal epigastric pain. CT-scan showed both free air and fluid in the peritoneal cavity with marked thickening and irregularity at the level of the gastric antrum and the duodenal bulb. The patient underwent emergency laparoscopy. A large amount of purulent fluid was found in the peritoneal cavity and evacuated. The gastric defect was identified at the level of the anterior wall of the gastric antrum. A 2/0 Vicryl suture is used to oversew the perforation. As an additional protection, an omental patch was brought in place and fixed against the sutured lesion. Abundant peritoneal lavage was performed. The patient was discharged on postoperative day 5. One month later, esophagogastroduodenoscopies (EGDs) with biopsies of the ulcer’s margins were performed.
Хирургические операции
9 месяцев назад
5771 просмотр
21 лайк
2 комментария
06:55
Laparoscopic management of perforated ulcer of the stomach
A 43-year-old woman with a history of chronic use of NSAIDs was admitted to the emergency care unit for acute abdominal epigastric pain. CT-scan showed both free air and fluid in the peritoneal cavity with marked thickening and irregularity at the level of the gastric antrum and the duodenal bulb. The patient underwent emergency laparoscopy. A large amount of purulent fluid was found in the peritoneal cavity and evacuated. The gastric defect was identified at the level of the anterior wall of the gastric antrum. A 2/0 Vicryl suture is used to oversew the perforation. As an additional protection, an omental patch was brought in place and fixed against the sutured lesion. Abundant peritoneal lavage was performed. The patient was discharged on postoperative day 5. One month later, esophagogastroduodenoscopies (EGDs) with biopsies of the ulcer’s margins were performed.
Laparoscopic TEP unilateral inguinal hernia repair: a live interactive procedure
We present the clinical case of a 45-year old male patient managed for a right direct inguinal hernia. The patient’s history included a former approach for right inguinal hernia in his childhood and a laparoscopic left inguinal hernia repair. A first port was inserted below the umbilicus and access to the pubic bone was gained on the midline without using balloon. In this case, dissection of adhesions related to the previous operation was required. Attempts were made to identify anatomical landmarks after insertion of 5mm ports. The direct hernia content was dissected and reduced with blunt dissection. Once anatomical landmarks including pubic symphysis, Cooper’s ligament, epigastric vessels, spermatic cord, and psoas muscle were identified, a trimmed polypropylene mesh was inserted and the myopectineal orifice was sufficiently covered without fixation. Finally, the preperitoneal cavity was desufflated to complete the procedure.
Хирургические операции
9 месяцев назад
2617 просмотров
23 лайка
1 комментарий
39:46
Laparoscopic TEP unilateral inguinal hernia repair: a live interactive procedure
We present the clinical case of a 45-year old male patient managed for a right direct inguinal hernia. The patient’s history included a former approach for right inguinal hernia in his childhood and a laparoscopic left inguinal hernia repair. A first port was inserted below the umbilicus and access to the pubic bone was gained on the midline without using balloon. In this case, dissection of adhesions related to the previous operation was required. Attempts were made to identify anatomical landmarks after insertion of 5mm ports. The direct hernia content was dissected and reduced with blunt dissection. Once anatomical landmarks including pubic symphysis, Cooper’s ligament, epigastric vessels, spermatic cord, and psoas muscle were identified, a trimmed polypropylene mesh was inserted and the myopectineal orifice was sufficiently covered without fixation. Finally, the preperitoneal cavity was desufflated to complete the procedure.
ERCP in a patient with previous subtotal gastrectomy for cancer: hybrid approach with transjejunal access
Endoscopic retrograde cholangiopancreatography (ERCP) in patients with prior gastric surgery (Roux-en-Y gastric bypass, partial or subtotal gastrectomy) is a challenging procedure. Despite technological advances in endoscopy, reaching the duodenum and entering the bile duct remains difficult. Laparoscopic assisted ERCP (LAERCP) allows the duodenum to be accessed through the excluded stomach in case of previous RYGB or through the proximal jejunum in case of gastric resection. The objective of this video is to demonstrate the hybrid approach in a patient with a previous subtotal gastrectomy for gastric cancer.
Хирургические операции
9 месяцев назад
156 просмотров
2 лайка
0 комментариев
12:02
ERCP in a patient with previous subtotal gastrectomy for cancer: hybrid approach with transjejunal access
Endoscopic retrograde cholangiopancreatography (ERCP) in patients with prior gastric surgery (Roux-en-Y gastric bypass, partial or subtotal gastrectomy) is a challenging procedure. Despite technological advances in endoscopy, reaching the duodenum and entering the bile duct remains difficult. Laparoscopic assisted ERCP (LAERCP) allows the duodenum to be accessed through the excluded stomach in case of previous RYGB or through the proximal jejunum in case of gastric resection. The objective of this video is to demonstrate the hybrid approach in a patient with a previous subtotal gastrectomy for gastric cancer.
EUS gastrojejunal anastomosis with HOT AXIOS® stent after Whipple pancreatectomy, filling blind loop through percutaneous transhepatic biliary drainage
A 67-year-old woman underwent a Whipple pancreatectomy for cancer one year earlier. She was readmitted to hospital for abdominal pain and subocclusion with jaundice. CT-scan showed a dilatation of the jejunal stump with associated biliary tree dilatation. Percutaneous biliary transhepatic drainage (PBTHD) was performed and a stenosis was diagnosed in the afferent loop, accountable for subocclusion and secondary jaundice. Two double pigtails were delivered by the interventional radiologist through PBTHD across the jejunal stricture without resolution of symptoms. Biliary drainage was left in place causing patient discomfort. EUS gastrojejunal anastomosis (GJA) using the HOT AXIOS® stent was attempted in order to bypass the stricture. EUS allows to find the jejunal stump, detected by mechanical staple line visualization. Additionally, the blind loop was detected as it was filled up with liquid and contrast through the PBTHD. The HOT AXIOS® stent was delivered without any complications (VIDEO). Afterwards, flow of bile and liquid was observed through the lumen-apposing metal stent (LAMS). PBTHD was immediately removed. Recovery was uneventful and the patient was discharged on a normal diet with no pain on the following day. EUS-GJA via a LAMS is a well-described technique in experts’ hands (Technical review of endoscopic ultrasonography-guided gastroenterostomy in 2017. Itoi T, Baron TH, Khashab MA, et al. Dig Endosc 2017;29:495-502). Special skills and techniques are necessary in order to recognize the exact small bowel loop to puncture (Endoscopic ultrasound-guided gastrojejunostomy with a lumen-apposing metal stent: a multicenter, international experience. Tyberg A, Perez-Miranda M, Sanchez-Ocaña R et al. Endosc Int Open 2016;4:E276-81). In that case, we show that filling this loop using a previous transhepatic access should be considered an alternative in case of alterated anatomy. Also direct EUS transgastric injection of contrast medium in the dilated biliary tree to fill up the jejunal stump could be considered an option to perform GJA by a single operator in a single session after safely recognizing the right loop. In addition, fluoroscopy helps to detect the exact loop puncture site. In conclusion, GJA using a LAMS is feasible, safe and useful, and transhepatic injection of liquid and contrast medium helps to adequately recognize the jejunal stump after biliopancreatic surgery.
Хирургические операции
9 месяцев назад
164 просмотра
2 лайка
0 комментариев
02:30
EUS gastrojejunal anastomosis with HOT AXIOS® stent after Whipple pancreatectomy, filling blind loop through percutaneous transhepatic biliary drainage
A 67-year-old woman underwent a Whipple pancreatectomy for cancer one year earlier. She was readmitted to hospital for abdominal pain and subocclusion with jaundice. CT-scan showed a dilatation of the jejunal stump with associated biliary tree dilatation. Percutaneous biliary transhepatic drainage (PBTHD) was performed and a stenosis was diagnosed in the afferent loop, accountable for subocclusion and secondary jaundice. Two double pigtails were delivered by the interventional radiologist through PBTHD across the jejunal stricture without resolution of symptoms. Biliary drainage was left in place causing patient discomfort. EUS gastrojejunal anastomosis (GJA) using the HOT AXIOS® stent was attempted in order to bypass the stricture. EUS allows to find the jejunal stump, detected by mechanical staple line visualization. Additionally, the blind loop was detected as it was filled up with liquid and contrast through the PBTHD. The HOT AXIOS® stent was delivered without any complications (VIDEO). Afterwards, flow of bile and liquid was observed through the lumen-apposing metal stent (LAMS). PBTHD was immediately removed. Recovery was uneventful and the patient was discharged on a normal diet with no pain on the following day. EUS-GJA via a LAMS is a well-described technique in experts’ hands (Technical review of endoscopic ultrasonography-guided gastroenterostomy in 2017. Itoi T, Baron TH, Khashab MA, et al. Dig Endosc 2017;29:495-502). Special skills and techniques are necessary in order to recognize the exact small bowel loop to puncture (Endoscopic ultrasound-guided gastrojejunostomy with a lumen-apposing metal stent: a multicenter, international experience. Tyberg A, Perez-Miranda M, Sanchez-Ocaña R et al. Endosc Int Open 2016;4:E276-81). In that case, we show that filling this loop using a previous transhepatic access should be considered an alternative in case of alterated anatomy. Also direct EUS transgastric injection of contrast medium in the dilated biliary tree to fill up the jejunal stump could be considered an option to perform GJA by a single operator in a single session after safely recognizing the right loop. In addition, fluoroscopy helps to detect the exact loop puncture site. In conclusion, GJA using a LAMS is feasible, safe and useful, and transhepatic injection of liquid and contrast medium helps to adequately recognize the jejunal stump after biliopancreatic surgery.
LIVE INTERACTIVE SURGERY: robotic total gastrectomy highlighting esojejunal anastomosis
This video presents the case of a 71-year-old man with a BMI of 29. He was admitted to the emergency room for fatigue, severe anemia, and abdominal pain. His past medical history was significant for cardiac disease, aortic valve stenosis, and small adrenal adenoma. His past surgical history included a cholecystectomy and a prostatectomy. Work-up started with an endoscopy which showed an ulcer at the antrum, which was biopsied and showed signet cell adenocarcinoma. CT-scan confirmed the presence of a large bulky lesion and ruled out the presence of a metastatic disease. The patient was admitted again for bleeding and hematemesis and he was scheduled for a total gastrectomy. He had an exploratory laparoscopy which showed no signs of carcinomatosis. He also had preoperative chemotherapy.
This live interactive video demonstrates a robotic total gastrectomy for gastric cancer, including a stepwise lymphadenectomy and precise thorough description of esojejunal anastomosis.
Хирургические операции
11 месяцев назад
2495 просмотров
15 лайков
0 комментариев
04:27
LIVE INTERACTIVE SURGERY: robotic total gastrectomy highlighting esojejunal anastomosis
This video presents the case of a 71-year-old man with a BMI of 29. He was admitted to the emergency room for fatigue, severe anemia, and abdominal pain. His past medical history was significant for cardiac disease, aortic valve stenosis, and small adrenal adenoma. His past surgical history included a cholecystectomy and a prostatectomy. Work-up started with an endoscopy which showed an ulcer at the antrum, which was biopsied and showed signet cell adenocarcinoma. CT-scan confirmed the presence of a large bulky lesion and ruled out the presence of a metastatic disease. The patient was admitted again for bleeding and hematemesis and he was scheduled for a total gastrectomy. He had an exploratory laparoscopy which showed no signs of carcinomatosis. He also had preoperative chemotherapy.
This live interactive video demonstrates a robotic total gastrectomy for gastric cancer, including a stepwise lymphadenectomy and precise thorough description of esojejunal anastomosis.
Fourth antireflux procedure in a patient with a BMI of 35: esophagogastric disconnection and Roux-en-Y gastrojejunostomy
We present an esophagogastric disconnection and Roux-en-Y gastrojejunostomy as the fourth antireflux procedure in an obese patient with recurrent severe GERD despite high-dose PPI therapy. After previous Nissen fundoplications and a redo procedure with a partial posterior fundoplication, the patient now presented with an intrathoracic migration of the posterior fundoplication. In these complex redo scenarios in conjunction with a high BMI, the strategy of esophagogastric disconnection and Roux-en-Y reconstruction similarly to obesity surgery is increasingly being used.
Хирургические операции
1 год назад
1052 просмотра
352 лайка
0 комментариев
21:18
Fourth antireflux procedure in a patient with a BMI of 35: esophagogastric disconnection and Roux-en-Y gastrojejunostomy
We present an esophagogastric disconnection and Roux-en-Y gastrojejunostomy as the fourth antireflux procedure in an obese patient with recurrent severe GERD despite high-dose PPI therapy. After previous Nissen fundoplications and a redo procedure with a partial posterior fundoplication, the patient now presented with an intrathoracic migration of the posterior fundoplication. In these complex redo scenarios in conjunction with a high BMI, the strategy of esophagogastric disconnection and Roux-en-Y reconstruction similarly to obesity surgery is increasingly being used.
Laparoscopic pancreatectomy with preservation of splenic vessels: a live broadcast from IRCAD America Latina, Barretos, Brazil
In this instructional video, Dr. Bernard Dallemagne demonstrated the main principles and key steps of laparoscopic pancreatectomy with the preservation of splenic vessels (Kimura technique) in a 58-year-old woman with a complex cyst of the body and tail of the pancreas. He briefly described the technical aspects and maneuvers for a better exposure and dissection of the inferior and superior border of the pancreas. He highlighted the tips and tricks for opening the gastrocolic ligament, the identification and dissection of vessels, the mobilization of the pancreas, dissection line reinforcement, and specimen removal.
Хирургические операции
1 год назад
5595 просмотров
600 лайков
0 комментариев
38:09
Laparoscopic pancreatectomy with preservation of splenic vessels: a live broadcast from IRCAD America Latina, Barretos, Brazil
In this instructional video, Dr. Bernard Dallemagne demonstrated the main principles and key steps of laparoscopic pancreatectomy with the preservation of splenic vessels (Kimura technique) in a 58-year-old woman with a complex cyst of the body and tail of the pancreas. He briefly described the technical aspects and maneuvers for a better exposure and dissection of the inferior and superior border of the pancreas. He highlighted the tips and tricks for opening the gastrocolic ligament, the identification and dissection of vessels, the mobilization of the pancreas, dissection line reinforcement, and specimen removal.
LIVE INTERACTIVE SURGERY: paraesophageal hernia repair: critical value of extrasaccular approach
Paraesophageal hernia (PEH) repair is a challenging procedure. Repositioning of the herniated stomach and the reduction of the sac from the mediastinum is mandatory in order to decrease the risk of recurrence. The dissection and reduction of the sac must be performed following stepwise and precise dissection rules: it must be carried out outside of the sac, in an anatomical cleavage plane. Recurrence is also related to the type of crural repair performed, some authors advocating the systematic use of prosthetic or biological reinforcement. In this video, we present a PEH repair and cruroplasty protected with an absorbable mesh and contemporary Nissen fundoplication.
Хирургические операции
2 года назад
6074 просмотра
441 лайк
0 комментариев
54:47
LIVE INTERACTIVE SURGERY: paraesophageal hernia repair: critical value of extrasaccular approach
Paraesophageal hernia (PEH) repair is a challenging procedure. Repositioning of the herniated stomach and the reduction of the sac from the mediastinum is mandatory in order to decrease the risk of recurrence. The dissection and reduction of the sac must be performed following stepwise and precise dissection rules: it must be carried out outside of the sac, in an anatomical cleavage plane. Recurrence is also related to the type of crural repair performed, some authors advocating the systematic use of prosthetic or biological reinforcement. In this video, we present a PEH repair and cruroplasty protected with an absorbable mesh and contemporary Nissen fundoplication.
LIVE INTERACTIVE SURGERY: thoracoscopic esophageal diverticulectomy and myotomy
A 65-year-old woman was referred to our hospital with complaints of dysphagia. She had a surgical history of cesarean section and cholecystectomy. Esophageal motility examination showed a normal lower esophageal sphincter (LES), and the absence of hiatal hernia and spasm in the distal part of the esophagus. The barium X-ray showed a bulky diverticulum in the middle thoracic esophagus and barium collecting inside the diverticulum without obstruction. The 3D-CT image also showed a giant diverticulum in the middle esophagus. The diverticulum was located below the azygos vein and carina of the bronchus and was sticking out from the middle esophagus in the contralateral side of the thoracic aorta. The diverticulum does not invade other organs. The patient was then proposed for an elective surgery, a thoracoscopic esophageal diverticulectomy and myotomy in a prone position.
Хирургические операции
2 года назад
1422 просмотра
112 лайков
0 комментариев
41:44
LIVE INTERACTIVE SURGERY: thoracoscopic esophageal diverticulectomy and myotomy
A 65-year-old woman was referred to our hospital with complaints of dysphagia. She had a surgical history of cesarean section and cholecystectomy. Esophageal motility examination showed a normal lower esophageal sphincter (LES), and the absence of hiatal hernia and spasm in the distal part of the esophagus. The barium X-ray showed a bulky diverticulum in the middle thoracic esophagus and barium collecting inside the diverticulum without obstruction. The 3D-CT image also showed a giant diverticulum in the middle esophagus. The diverticulum was located below the azygos vein and carina of the bronchus and was sticking out from the middle esophagus in the contralateral side of the thoracic aorta. The diverticulum does not invade other organs. The patient was then proposed for an elective surgery, a thoracoscopic esophageal diverticulectomy and myotomy in a prone position.
Laparoscopic cholecystectomy: basic rules
In this key lecture, Dr. Dallemagne provides a brief overview of basic rules for a safe laparoscopic cholecystectomy. He demonstrates the incidence, different causes, and impact of biliary injuries in open, laparoscopic, and single port surgery. He describes the main criteria of dissection with the principle of critical view of safety and highlights the Tokyo and SAGES guidelines in relation to the optimal surgical timing. He mentions the recommended surgical techniques, main maneuvers of the technique with modified cholecystectomy, and when the decision to convert is made depending on complications. He also presents alternative methods for the intraoperative imaging of bile ducts, including the role of cholangiography, near-infrared and fluorescence-guided cholecystectomy.
Лекции
2 года назад
6896 просмотров
878 лайков
0 комментариев
39:17
Laparoscopic cholecystectomy: basic rules
In this key lecture, Dr. Dallemagne provides a brief overview of basic rules for a safe laparoscopic cholecystectomy. He demonstrates the incidence, different causes, and impact of biliary injuries in open, laparoscopic, and single port surgery. He describes the main criteria of dissection with the principle of critical view of safety and highlights the Tokyo and SAGES guidelines in relation to the optimal surgical timing. He mentions the recommended surgical techniques, main maneuvers of the technique with modified cholecystectomy, and when the decision to convert is made depending on complications. He also presents alternative methods for the intraoperative imaging of bile ducts, including the role of cholangiography, near-infrared and fluorescence-guided cholecystectomy.
The VERSA LIFTER BAND™: a new option for liver retraction in laparoscopic Roux-en-Y gastric bypass for morbid obesity
During laparoscopic bariatric procedures in morbidly obese patients, the surgeon's operative view is often obscured by the hypertrophic adipose left lobe of the liver.
To provide adequate operative views and working space, an appropriate retraction of the left liver lobe is required.
The use of a conventional liver retractor mandates an additional subxiphoid wound, resulting in patient discomfort for pain and scar formation, with the additional risk of iatrogenic liver injury during retraction maneuvers.
To overcome these limitations, we present the use of a simple, rapid, and safe technique for liver retraction using the VERSA LIFTER™ Band disposable liver suspension system or retractor.
Хирургические операции
3 года назад
1742 просмотра
38 лайков
0 комментариев
03:48
The VERSA LIFTER BAND™: a new option for liver retraction in laparoscopic Roux-en-Y gastric bypass for morbid obesity
During laparoscopic bariatric procedures in morbidly obese patients, the surgeon's operative view is often obscured by the hypertrophic adipose left lobe of the liver.
To provide adequate operative views and working space, an appropriate retraction of the left liver lobe is required.
The use of a conventional liver retractor mandates an additional subxiphoid wound, resulting in patient discomfort for pain and scar formation, with the additional risk of iatrogenic liver injury during retraction maneuvers.
To overcome these limitations, we present the use of a simple, rapid, and safe technique for liver retraction using the VERSA LIFTER™ Band disposable liver suspension system or retractor.
Mini-laparoscopic cholecystectomy using 3mm instruments: needlescopic surgery
Mini-laparoscopic surgery involves the usage of small trocars and instruments, ranging from 2 to 3.5mm in size.
The operative procedure is similar to that of a conventional laparoscopic cholecystectomy, except for the size of instruments.
The use of micro-instruments requires a selection of patients and a minor adaptation to the surgical steps as these instruments are more fragile and they require the use of micro-optics to apply clips to the cystic duct and artery.
The small trocars cause less tissue damage, and subsequently result in less postoperative pain, a faster recovery, and a better cosmesis.
Хирургические операции
3 года назад
2877 просмотров
122 лайка
0 комментариев
06:57
Mini-laparoscopic cholecystectomy using 3mm instruments: needlescopic surgery
Mini-laparoscopic surgery involves the usage of small trocars and instruments, ranging from 2 to 3.5mm in size.
The operative procedure is similar to that of a conventional laparoscopic cholecystectomy, except for the size of instruments.
The use of micro-instruments requires a selection of patients and a minor adaptation to the surgical steps as these instruments are more fragile and they require the use of micro-optics to apply clips to the cystic duct and artery.
The small trocars cause less tissue damage, and subsequently result in less postoperative pain, a faster recovery, and a better cosmesis.