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Monthly publications

#July 2011
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Treitz laparoscopic resection with intracorporeal anastomosis with a new barbed suture
Gastrointestinal stromal tumors (GISTs) are rare mesenchymal neoplasms of the gastrointestinal tract. Life-threatening hemorrhage or intestinal obstruction are the most common presenting symptoms. In the last year, we observed four patients affected by GIST of the small bowel presenting with a massive bleeding. After the endoscopic diagnosis, all the neoplasms were ink marked.
We present a video showing a Treitz’s GIST treated with a laparoscopic resection, followed by a mechanical latero-lateral intracorporeal anastomosis and enterotomy closure using a new kind of self-anchoring barbed suture (V-Loc® advanced wound closure device-Covidien, Mansfield, MA).
M Scatizzi, E Lenzi, M Baraghini, KC Kröning, F Menici, S Cantafio, F Feroci
Surgical intervention
7 years ago
2287 views
16 likes
0 comments
07:26
Treitz laparoscopic resection with intracorporeal anastomosis with a new barbed suture
Gastrointestinal stromal tumors (GISTs) are rare mesenchymal neoplasms of the gastrointestinal tract. Life-threatening hemorrhage or intestinal obstruction are the most common presenting symptoms. In the last year, we observed four patients affected by GIST of the small bowel presenting with a massive bleeding. After the endoscopic diagnosis, all the neoplasms were ink marked.
We present a video showing a Treitz’s GIST treated with a laparoscopic resection, followed by a mechanical latero-lateral intracorporeal anastomosis and enterotomy closure using a new kind of self-anchoring barbed suture (V-Loc® advanced wound closure device-Covidien, Mansfield, MA).
Fully laparoscopic segmental rectosigmoid resection with Natural Orifice Specimen Extraction (NOSE) for bowel endometriosis
We report the case of a 45-year-old woman, G2P2, who presents with rectal bleeding, constipation and subocclusive syndrome caused by rectosigmoid endometriosis. The laparoscopic exploration revealed a sigmoid stuck by a few adhesions to the lateral abdominal wall underneath the left ovary and obliteration of the left uterosacral ligament and rectovaginal septum. A segmental bowel resection was performed with all necessary steps for mechanical bowel anastomosis carried out laparoscopically. The transvaginal specimen extraction obviated the need to create an abdominal incision. There were no complications and the patient presented a clinical remission following surgery. This surgical technique has the advantage of a shorter division of the mesentery, which enables a better vascularization of the bowel.
A Wattiez, J Leroy, S Maia, A Vázquez Rodriguez, P Trompoukis, J Alcocer
Surgical intervention
7 years ago
2350 views
10 likes
1 comment
08:03
Fully laparoscopic segmental rectosigmoid resection with Natural Orifice Specimen Extraction (NOSE) for bowel endometriosis
We report the case of a 45-year-old woman, G2P2, who presents with rectal bleeding, constipation and subocclusive syndrome caused by rectosigmoid endometriosis. The laparoscopic exploration revealed a sigmoid stuck by a few adhesions to the lateral abdominal wall underneath the left ovary and obliteration of the left uterosacral ligament and rectovaginal septum. A segmental bowel resection was performed with all necessary steps for mechanical bowel anastomosis carried out laparoscopically. The transvaginal specimen extraction obviated the need to create an abdominal incision. There were no complications and the patient presented a clinical remission following surgery. This surgical technique has the advantage of a shorter division of the mesentery, which enables a better vascularization of the bowel.
Retroperitoneal laparoscopic para-aortic lymphadenectomy: stage IIB cervical carcinoma
This video demonstrates a retroperitoneal para-aortic lymphadenectomy for stage IIB epidermoid cervical carcinoma. This procedure allows to identify patients who should undergo extended field radiotherapy. The intervention is pursued with the dissection of the lympho-adipose tissue situated in the following anatomical boundaries: ureters and psoas muscles laterally, the iliac artery bifurcation —lower limit— and the left renal vein —superior limit. A diagnostic laparoscopy is first performed to rule out metastasis. A 10mm, 0-degree scope is used. An umbilical Hasson trocar is placed to explore the abdominal cavity. A left McBurney’s incision is then made, and the retroperitoneal space is created digitally. The Hasson trocar is placed with a 10mm balloon through the anterior incision. Two additional ports are placed in the anterior axillary line, a 12mm one and a 5mm one. The 5mm Ligasure™ V device and a grasping forceps are used throughout the whole intervention. At the end of the procedure, the lympho-adipose tissue is extracted using an Endobag through an enlarged peritoneal opening.
H Di Fiore, O Martínez, I Pérez, I Borrego, A Cristóbal
Surgical intervention
7 years ago
770 views
51 likes
0 comments
14:47
Retroperitoneal laparoscopic para-aortic lymphadenectomy: stage IIB cervical carcinoma
This video demonstrates a retroperitoneal para-aortic lymphadenectomy for stage IIB epidermoid cervical carcinoma. This procedure allows to identify patients who should undergo extended field radiotherapy. The intervention is pursued with the dissection of the lympho-adipose tissue situated in the following anatomical boundaries: ureters and psoas muscles laterally, the iliac artery bifurcation —lower limit— and the left renal vein —superior limit. A diagnostic laparoscopy is first performed to rule out metastasis. A 10mm, 0-degree scope is used. An umbilical Hasson trocar is placed to explore the abdominal cavity. A left McBurney’s incision is then made, and the retroperitoneal space is created digitally. The Hasson trocar is placed with a 10mm balloon through the anterior incision. Two additional ports are placed in the anterior axillary line, a 12mm one and a 5mm one. The 5mm Ligasure™ V device and a grasping forceps are used throughout the whole intervention. At the end of the procedure, the lympho-adipose tissue is extracted using an Endobag through an enlarged peritoneal opening.
Arthroscopic resection of dorsal wrist ganglia
The origin and the physiopathology of wrist ganglia are still debated. We know for sure that most of them have a common origin on the dorsal aspect of the wrist capsule in correspondence to the scapholunate ligament. The most common explanation is that there is a valve mechanism at the base of the ganglion, which controls the variable volume of these ganglions.
Therefore, the ganglion can be healed by resecting this valve mechanism at the capsular level. Resecting greater parts of the dorsal wrist capsule can often lead to joint stiffness and secondary weakness of the dorsal capsule.
Therefore, the arthroscopic resection of the ganglion stalk will heal the ganglion using a minimally invasive technique and hence avoiding the disadvantages of open surgery.
Technically speaking, a diagnostic wrist arthroscopy is performed through the ulnocarpal portals. This allows to eliminate any co-existing pathology. It also allows to see whether the stalk of the ganglion is in an ulnocarpal or a radiocarpal position.
A shaver is then introduced through the ganglion itself into the stalk, and intensive shaving is performed at the dorsal capsule in correspondence to the origin of the ganglion. Complete resection can thereby be achieved. Special postoperative care or splinting is not necessary. Mobilization can be started immediately.
M Haerle
Surgical intervention
7 years ago
1042 views
14 likes
0 comments
05:22
Arthroscopic resection of dorsal wrist ganglia
The origin and the physiopathology of wrist ganglia are still debated. We know for sure that most of them have a common origin on the dorsal aspect of the wrist capsule in correspondence to the scapholunate ligament. The most common explanation is that there is a valve mechanism at the base of the ganglion, which controls the variable volume of these ganglions.
Therefore, the ganglion can be healed by resecting this valve mechanism at the capsular level. Resecting greater parts of the dorsal wrist capsule can often lead to joint stiffness and secondary weakness of the dorsal capsule.
Therefore, the arthroscopic resection of the ganglion stalk will heal the ganglion using a minimally invasive technique and hence avoiding the disadvantages of open surgery.
Technically speaking, a diagnostic wrist arthroscopy is performed through the ulnocarpal portals. This allows to eliminate any co-existing pathology. It also allows to see whether the stalk of the ganglion is in an ulnocarpal or a radiocarpal position.
A shaver is then introduced through the ganglion itself into the stalk, and intensive shaving is performed at the dorsal capsule in correspondence to the origin of the ganglion. Complete resection can thereby be achieved. Special postoperative care or splinting is not necessary. Mobilization can be started immediately.
Scapholunate tears: a new classification
Pathogenesis and treatment of scapholunate (SL) injuries are still under definition in the literature, especially in chronic cases. A two-stage mechanism able to create a chronic injury has been described by several authors. A partial initially asymptomatic injury to the SL ligament can later become symptomatic. The treatment of these injuries is not standardized in the different stages and not always satisfactory. Lack of early diagnosis of this injury can develop a chronic instability leading to degenerative arthritis and SLAC wrist. The aim of this study is to experimentally cut the different parts of the scapholunate ligament and extrinsic ligaments in cadaveric wrists and check the corresponding arthroscopic finding. The SL ligament was evaluated at the beginning of the dissections. Extrinsic ligament tension or laxity was also assessed arthroscopically and by specific tests. A new classification by the European Wrist Arthroscopy Society (EWAS) is proposed to better define the different stages and improve treatment.
J Messina
Lecture
7 years ago
265 views
1 like
0 comments
08:46
Scapholunate tears: a new classification
Pathogenesis and treatment of scapholunate (SL) injuries are still under definition in the literature, especially in chronic cases. A two-stage mechanism able to create a chronic injury has been described by several authors. A partial initially asymptomatic injury to the SL ligament can later become symptomatic. The treatment of these injuries is not standardized in the different stages and not always satisfactory. Lack of early diagnosis of this injury can develop a chronic instability leading to degenerative arthritis and SLAC wrist. The aim of this study is to experimentally cut the different parts of the scapholunate ligament and extrinsic ligaments in cadaveric wrists and check the corresponding arthroscopic finding. The SL ligament was evaluated at the beginning of the dissections. Extrinsic ligament tension or laxity was also assessed arthroscopically and by specific tests. A new classification by the European Wrist Arthroscopy Society (EWAS) is proposed to better define the different stages and improve treatment.