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Jacques HIMPENS

Hôpital Universitaire St Pierre
Brussels, Бельгия
MD
1 лайк
100.4K просмотров
29 комментариев
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Хирургические специальности
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Single incision transumbilical laparoscopic left hepatic lobectomy
Background: Single-incision laparoscopy (SIL) recently gained interest mainly to improve the cosmetic outcomes. This video shows a patient submitted to left hepatic lobectomy by transumbilical SIL.

Video: A 24 year-old woman with a BMI of 24.4 kg/m2 consulted for a hydatid cyst of the II-III hepatic segments. Preoperative work-up showed a hepatic hydatid cyst of the segment III, partially involving the segment II. A transumbilical SIL was performed using an 11mm trocar for a 10mm, standard length, 30-degree scope, and a curved grasping forceps, and Ligasure V. At the end of the resection, a custom-made plastic bag was inserted in the abdomen through the 11mm trocar, and the specimen was morcellated at the umbilicus inside it without tearing.

Results: No conversion to open surgery or additional trocars were necessary. Total operative time was 114 minutes and laparoscopic time 96 minutes. Final umbilical incision length was 20mm. The patient’s pain medication could be kept low and the patient was discharged on the 5th postoperative day. After 6 months, the patient was well with no visible scar.

Conclusion: Left hepatic lobectomy for benign lesions can safely be performed through transumbilical SIL. In the absence of malignancy, the final incision length can be kept minimal.
Хирургические операции
7 лет назад
2712 просмотров
25 лайков
0 комментариев
05:12
Single incision transumbilical laparoscopic left hepatic lobectomy
Background: Single-incision laparoscopy (SIL) recently gained interest mainly to improve the cosmetic outcomes. This video shows a patient submitted to left hepatic lobectomy by transumbilical SIL.

Video: A 24 year-old woman with a BMI of 24.4 kg/m2 consulted for a hydatid cyst of the II-III hepatic segments. Preoperative work-up showed a hepatic hydatid cyst of the segment III, partially involving the segment II. A transumbilical SIL was performed using an 11mm trocar for a 10mm, standard length, 30-degree scope, and a curved grasping forceps, and Ligasure V. At the end of the resection, a custom-made plastic bag was inserted in the abdomen through the 11mm trocar, and the specimen was morcellated at the umbilicus inside it without tearing.

Results: No conversion to open surgery or additional trocars were necessary. Total operative time was 114 minutes and laparoscopic time 96 minutes. Final umbilical incision length was 20mm. The patient’s pain medication could be kept low and the patient was discharged on the 5th postoperative day. After 6 months, the patient was well with no visible scar.

Conclusion: Left hepatic lobectomy for benign lesions can safely be performed through transumbilical SIL. In the absence of malignancy, the final incision length can be kept minimal.
Transumbilical single-access perforated gastric ulcer repair
Background: Single-access laparoscopy (SAL) can be proposed in patients presenting peritonitis both for diagnosis and treatment. This video shows a transumbilical SAL performed for perforated gastric ulcer.

Video: A 30 year-old woman with a body mass index of 22.9 kg/m2 was admitted to the emergency room for diffuse abdominal pain. Preoperative work-up showed a pneumoperitoneum, hence a SAL was proposed to the patient. The procedure was performed using a standard 11mm reusable trocar for a 10mm, standard length, 30-degree scope, and curved reusable instruments inserted transumbilically without trocars. The cavity exploration showed a perforated gastric ulcer at the anterior surface of the prepyloric area. A suture repair, omentoplasty and lavage of the cavity was performed.

Results: No conversion to open surgery or additional trocars were necessary. Total operative time was 108 minutes and laparoscopic time 86 minutes. Final umbilical incision length was 15mm. The patient’s pain medication could be kept low and the patient was allowed to be discharged on the 5th postoperative day. After 6 months, the patient was well with no visible umbilical scar.

Conclusion: Transumbilical SAL can be proposed in selected patients for suspicion of perforated gastric ulcer, with the main advantage of cosmetic result.
Хирургические операции
7 лет назад
3853 просмотров
50 лайков
0 комментариев
05:17
Transumbilical single-access perforated gastric ulcer repair
Background: Single-access laparoscopy (SAL) can be proposed in patients presenting peritonitis both for diagnosis and treatment. This video shows a transumbilical SAL performed for perforated gastric ulcer.

Video: A 30 year-old woman with a body mass index of 22.9 kg/m2 was admitted to the emergency room for diffuse abdominal pain. Preoperative work-up showed a pneumoperitoneum, hence a SAL was proposed to the patient. The procedure was performed using a standard 11mm reusable trocar for a 10mm, standard length, 30-degree scope, and curved reusable instruments inserted transumbilically without trocars. The cavity exploration showed a perforated gastric ulcer at the anterior surface of the prepyloric area. A suture repair, omentoplasty and lavage of the cavity was performed.

Results: No conversion to open surgery or additional trocars were necessary. Total operative time was 108 minutes and laparoscopic time 86 minutes. Final umbilical incision length was 15mm. The patient’s pain medication could be kept low and the patient was allowed to be discharged on the 5th postoperative day. After 6 months, the patient was well with no visible umbilical scar.

Conclusion: Transumbilical SAL can be proposed in selected patients for suspicion of perforated gastric ulcer, with the main advantage of cosmetic result.
En bloc laparoscopic right hemicolectomy associated to atypical hepatectomy for advanced cancer of the hepatic flexure
Background: An adenocarcinoma of the hepatic colic flexure associated to liver invasion was diagnosed in a 55 year-old woman, who consulted for weight loss and anemia. The patient was submitted to neoadjuvant chemotherapy and, after 4 cycles, an en bloc laparoscopic right hemicolectomy and atypical hepatectomy of segment VI was proposed.
Video: The surgeon stood between the patient’s legs, and the cameraman to the patient’s left. Four trocars were placed in the abdomen. The right mesocolon was opened at the root of the ileocaecal vessels, which were meticulously dissected and clipped. The arterial and venous branch of the middle colic vessels were sectioned as well. The right mesocolon was freed from the duodenum respecting Toldt’s fascia. The proximal transverse colon and the distal ileum were divided by firing of a linear stapler (purple and white loads). Peroperative ultrasonography permitted exclusion of other hepatic lesions and the delimitation of the en bloc resection of segment VI. The hepatic parenchyma was transected using the coagulating hook. A laparoscopic manual side-to-side ileocolic anastomosis by 2 runnings sutures was performed. The mesocolic defect was closed, and the specimen was retrieved through a protected suprapubic incision.
Results: Operative time was 180 minutes and estimated blood loss 150 mL. The patient was discharged on the 5th postoperative day. Pathology evidenced a pT4N1 colic adenocarcinoma. She underwent additional adjuvant chemotherapy, and was doing well at the time of the last office visit.
Conclusion: Advanced colic cancer associated to hepatic invasion can be safely treated by laparoscopy.
Хирургические операции
7 лет назад
7101 просмотров
41 лайков
0 комментариев
10:17
En bloc laparoscopic right hemicolectomy associated to atypical hepatectomy for advanced cancer of the hepatic flexure
Background: An adenocarcinoma of the hepatic colic flexure associated to liver invasion was diagnosed in a 55 year-old woman, who consulted for weight loss and anemia. The patient was submitted to neoadjuvant chemotherapy and, after 4 cycles, an en bloc laparoscopic right hemicolectomy and atypical hepatectomy of segment VI was proposed.
Video: The surgeon stood between the patient’s legs, and the cameraman to the patient’s left. Four trocars were placed in the abdomen. The right mesocolon was opened at the root of the ileocaecal vessels, which were meticulously dissected and clipped. The arterial and venous branch of the middle colic vessels were sectioned as well. The right mesocolon was freed from the duodenum respecting Toldt’s fascia. The proximal transverse colon and the distal ileum were divided by firing of a linear stapler (purple and white loads). Peroperative ultrasonography permitted exclusion of other hepatic lesions and the delimitation of the en bloc resection of segment VI. The hepatic parenchyma was transected using the coagulating hook. A laparoscopic manual side-to-side ileocolic anastomosis by 2 runnings sutures was performed. The mesocolic defect was closed, and the specimen was retrieved through a protected suprapubic incision.
Results: Operative time was 180 minutes and estimated blood loss 150 mL. The patient was discharged on the 5th postoperative day. Pathology evidenced a pT4N1 colic adenocarcinoma. She underwent additional adjuvant chemotherapy, and was doing well at the time of the last office visit.
Conclusion: Advanced colic cancer associated to hepatic invasion can be safely treated by laparoscopy.
Minimally invasive esophagectomy in a patient in a prone position
This video demonstrates a total esophagectomy for a cancer of distal esophagus. The surgeon starts with right thoracoscopy with the patient in a prone position. The esophagus and adjoining lymphatics are mobilized and separated from the adjoining structures. The azygos vein is divided. Once full mobilization of the thoracic esophagus is achieved, a chest tube is inserted and the trocars are removed and the patient is put in a supine position. The surgeon now performs laparoscopic dissection of the left gastric vessels and lymphatics. A gastric tube is created and duodenum is kocherized. After full mobilization of the gastroesophageal junction and the tumor at the hiatus, a cervicotomy is carried out and the esophagus is pulled out through the cervical incision. The esophagus is resected and a side-to-side stapled anastomosis is made between the cervical esophagus and the gastric tube.
Хирургические операции
13 лет назад
515 просмотров
24 лайков
0 комментариев
11:57
Minimally invasive esophagectomy in a patient in a prone position
This video demonstrates a total esophagectomy for a cancer of distal esophagus. The surgeon starts with right thoracoscopy with the patient in a prone position. The esophagus and adjoining lymphatics are mobilized and separated from the adjoining structures. The azygos vein is divided. Once full mobilization of the thoracic esophagus is achieved, a chest tube is inserted and the trocars are removed and the patient is put in a supine position. The surgeon now performs laparoscopic dissection of the left gastric vessels and lymphatics. A gastric tube is created and duodenum is kocherized. After full mobilization of the gastroesophageal junction and the tumor at the hiatus, a cervicotomy is carried out and the esophagus is pulled out through the cervical incision. The esophagus is resected and a side-to-side stapled anastomosis is made between the cervical esophagus and the gastric tube.