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#May 2007
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Laparoscopic gastric banding in a female patient with a BMI=40
This video demonstrates the elegant pars flaccida approach to place an adjustable gastric band around the cardia of the stomach. A retrogastric tunnel is created by blunt dissection but always under visual control to minimize complications such as vascular and gastric injury. This video is suitable for digestive and bariatric surgeons. This video shows the case of a patient with a BMI of 40 and a long history of morbid obesity despite numerous diets and behavioral studies that have all failed. The preoperative assessment was performed by associating endocrine, cardiac and psychiatric evaluations. The procedure consists in fitting an inflatable gastric band (BioEnterics® Lap-Band® System) around the superior portion of the stomach. Five trocars are used (1 of 12 mm and 4 of 5 mm). A 15 mL bag must be left touching the esophagus. This video describes the dissection of a retrogastric tunnel entirely under visual control, followed by the gastric band fitting and the covering of the band by a gastric wrap.

This video demonstrates an elegant approach for placing a gastric band around the cardia. The patient is a woman with a BMI of 40. Using 5 trocars (1 of 12-mm, 4 of 5-mm), the author describes the dissection of a retrogastric tunnel under visual control. After creating the retrogastric tunnel, the author places the noninsufflated gastric band (Lap-Band System, Allergan, Inc, Irvine, CA) in the abdomen. Using a lateral trocar through the camera port, the author gently pulls the tip of the catheter and then the band through the posterior gastric channel with the grasper. The procedure continues with the use of a gastric wrap to cover the band.
M Vix
Surgical intervention
11 years ago
1018 views
19 likes
0 comments
09:16
Laparoscopic gastric banding in a female patient with a BMI=40
This video demonstrates the elegant pars flaccida approach to place an adjustable gastric band around the cardia of the stomach. A retrogastric tunnel is created by blunt dissection but always under visual control to minimize complications such as vascular and gastric injury. This video is suitable for digestive and bariatric surgeons. This video shows the case of a patient with a BMI of 40 and a long history of morbid obesity despite numerous diets and behavioral studies that have all failed. The preoperative assessment was performed by associating endocrine, cardiac and psychiatric evaluations. The procedure consists in fitting an inflatable gastric band (BioEnterics® Lap-Band® System) around the superior portion of the stomach. Five trocars are used (1 of 12 mm and 4 of 5 mm). A 15 mL bag must be left touching the esophagus. This video describes the dissection of a retrogastric tunnel entirely under visual control, followed by the gastric band fitting and the covering of the band by a gastric wrap.

This video demonstrates an elegant approach for placing a gastric band around the cardia. The patient is a woman with a BMI of 40. Using 5 trocars (1 of 12-mm, 4 of 5-mm), the author describes the dissection of a retrogastric tunnel under visual control. After creating the retrogastric tunnel, the author places the noninsufflated gastric band (Lap-Band System, Allergan, Inc, Irvine, CA) in the abdomen. Using a lateral trocar through the camera port, the author gently pulls the tip of the catheter and then the band through the posterior gastric channel with the grasper. The procedure continues with the use of a gastric wrap to cover the band.
Laparoscopic adrenalectomy for a bilateral large (10 cm) pheochromocytoma
This is a laparoscopic bilateral adrenalectomy performed for bilateral pheochromocytoma. Although the right gland was 10 cm in size, Prof. Targarona demonstrates skillfully how such a resection can be successfully performed laparoscopically if approached in a stepwise and meticulous fashion. This video is suitable for advanced laparoscopic surgeons.

Once the author identifies the inferior vena cava, he carefully carries out the dissection along its right border to expose the right adrenal vein. He then retracts the adrenal gland in an atraumatic fashion with a peanut gauze, being careful not to rupture the gland. Using gentle retraction with right-angle forceps, the author isolates the right adrenal vein. It is double-clipped then divided. This enables mobilization of the gland. The author then uses the harmonic scalpel to dissect around the gland. The tool can also be used to clip or divide the pedicles often encountered in this step. Once the gland is completely mobilized, one must still handle it with care. The author placed it in an extraction bag.
EM Targarona Soler
Surgical intervention
11 years ago
263 views
34 likes
0 comments
09:26
Laparoscopic adrenalectomy for a bilateral large (10 cm) pheochromocytoma
This is a laparoscopic bilateral adrenalectomy performed for bilateral pheochromocytoma. Although the right gland was 10 cm in size, Prof. Targarona demonstrates skillfully how such a resection can be successfully performed laparoscopically if approached in a stepwise and meticulous fashion. This video is suitable for advanced laparoscopic surgeons.

Once the author identifies the inferior vena cava, he carefully carries out the dissection along its right border to expose the right adrenal vein. He then retracts the adrenal gland in an atraumatic fashion with a peanut gauze, being careful not to rupture the gland. Using gentle retraction with right-angle forceps, the author isolates the right adrenal vein. It is double-clipped then divided. This enables mobilization of the gland. The author then uses the harmonic scalpel to dissect around the gland. The tool can also be used to clip or divide the pedicles often encountered in this step. Once the gland is completely mobilized, one must still handle it with care. The author placed it in an extraction bag.
Laparoscopic sigmoidectomy for sigmoid diverticulitis in an obese (BMI=30) male patient
This is a didactic video demonstrating laparoscopic sigmoidectomy for diverticular disease. A combined medial and lateral approach is employed in the dissection of the sigmoid vessels, preserving the IMA. The use of the LigaSure device greatly facilitates the dissection. This approach is suitable for general and digestive surgeons.

The authors use a medial approach to divide the branches of the sigmoid vessels. In performing the medial resection for cancer, the authors caution to avoid contact with the colon. The approach may involve a combination of medial and lateral techniques. Monopolar shears help carry out the dissection using traction. Freeing the vessels laterally enables visualization of the mesocolon.
J Leroy
Surgical intervention
11 years ago
978 views
22 likes
0 comments
17:22
Laparoscopic sigmoidectomy for sigmoid diverticulitis in an obese (BMI=30) male patient
This is a didactic video demonstrating laparoscopic sigmoidectomy for diverticular disease. A combined medial and lateral approach is employed in the dissection of the sigmoid vessels, preserving the IMA. The use of the LigaSure device greatly facilitates the dissection. This approach is suitable for general and digestive surgeons.

The authors use a medial approach to divide the branches of the sigmoid vessels. In performing the medial resection for cancer, the authors caution to avoid contact with the colon. The approach may involve a combination of medial and lateral techniques. Monopolar shears help carry out the dissection using traction. Freeing the vessels laterally enables visualization of the mesocolon.
Laparoscopic Nissen fundoplication: a perfect case to start
This video of laparoscopic Nissen fundoplication is suitable for surgeons learning to perform this procedure. The patient is young with very few adhesions and the operative steps are very clearly presented by Dr. Dallemagne. Critical points and technical tips are emphasized throughout the procedure.

The author describes this as an ideal case for surgeons learning the procedure because this young patient with severe reflux has few adhesions. Working with a zero-degree scope, the author examines the peritoneal cavity. The dissection begins at the caudate lobe of the liver and moves toward the right crus of the diaphragm. After identifying the right and left crura, the author opens the lesser omentum to gain access to the right crus. It is important to identify the inferior vena cava as a landmark.
B Dallemagne, J Marescaux
Surgical intervention
11 years ago
8753 views
202 likes
1 comment
17:29
Laparoscopic Nissen fundoplication: a perfect case to start
This video of laparoscopic Nissen fundoplication is suitable for surgeons learning to perform this procedure. The patient is young with very few adhesions and the operative steps are very clearly presented by Dr. Dallemagne. Critical points and technical tips are emphasized throughout the procedure.

The author describes this as an ideal case for surgeons learning the procedure because this young patient with severe reflux has few adhesions. Working with a zero-degree scope, the author examines the peritoneal cavity. The dissection begins at the caudate lobe of the liver and moves toward the right crus of the diaphragm. After identifying the right and left crura, the author opens the lesser omentum to gain access to the right crus. It is important to identify the inferior vena cava as a landmark.
Laparoscopic splenectomy for splenomegaly: anterior posterior approach and ‘hanged technique’
This video demonstrates a simple yet elegant technique for laparoscopic splenectomy which emphasizes the rotation of the table to obtain the best operative angle. The technique of splenic artery ligation in order to decompress the spleen and reduce its size is demonstrated. The supero-lateral attachments of the spleen are left intact until the very end in order to aid in its retraction. This approach is suitable for intermediate laparoscopic surgeons.

The author dissects the splenic artery out in the splenic hilum. Right-angle forceps enable vascular dissection and passage of a silk ligature around the splenic artery. The splenic vein is left intact. As the second phase of operation is completed, the table is rotated to the right for the third phase. In this phase, the author uses the posterior approach to divide the spleno-parietal attachments, then divides the lateral, inferior, and posterior attachments of the spleen with the harmonic scalpel. The spleen is liberated from Gerota’s fascia inferiorly and posteriorly, then gradually rotated anteriorly and to the right. Some cases may also require mobilization of the tail of the pancreas.
EM Targarona Soler
Surgical intervention
11 years ago
524 views
119 likes
0 comments
08:27
Laparoscopic splenectomy for splenomegaly: anterior posterior approach and ‘hanged technique’
This video demonstrates a simple yet elegant technique for laparoscopic splenectomy which emphasizes the rotation of the table to obtain the best operative angle. The technique of splenic artery ligation in order to decompress the spleen and reduce its size is demonstrated. The supero-lateral attachments of the spleen are left intact until the very end in order to aid in its retraction. This approach is suitable for intermediate laparoscopic surgeons.

The author dissects the splenic artery out in the splenic hilum. Right-angle forceps enable vascular dissection and passage of a silk ligature around the splenic artery. The splenic vein is left intact. As the second phase of operation is completed, the table is rotated to the right for the third phase. In this phase, the author uses the posterior approach to divide the spleno-parietal attachments, then divides the lateral, inferior, and posterior attachments of the spleen with the harmonic scalpel. The spleen is liberated from Gerota’s fascia inferiorly and posteriorly, then gradually rotated anteriorly and to the right. Some cases may also require mobilization of the tail of the pancreas.