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Monthly publications

#October 2011
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Single port appendectomy using the EK glove port: a cost-effective innovation
Single port laparoscopic surgery has emerged to enhance the cosmetic benefits and to decrease morbidity in minimally invasive surgery. However, this technique requires a specialized multichannel port (to introduce the laparoscope and instruments) which is very costly and not affordable for the majority of the population. We have improvised a single port access system using readily available materials like surgical gloves, the rigid plastic ring, the inner flexible ring and conventional laparoscopic trocars (the EK Port) with no added cost for the patient. This also eliminates the need for an Alexis® wound retractor. We have performed about 130 single port surgeries since September 2009 using this technique without any complications.
E Khiangte, I Newme
Surgical intervention
7 years ago
10624 views
59 likes
26 comments
05:09
Single port appendectomy using the EK glove port: a cost-effective innovation
Single port laparoscopic surgery has emerged to enhance the cosmetic benefits and to decrease morbidity in minimally invasive surgery. However, this technique requires a specialized multichannel port (to introduce the laparoscope and instruments) which is very costly and not affordable for the majority of the population. We have improvised a single port access system using readily available materials like surgical gloves, the rigid plastic ring, the inner flexible ring and conventional laparoscopic trocars (the EK Port) with no added cost for the patient. This also eliminates the need for an Alexis® wound retractor. We have performed about 130 single port surgeries since September 2009 using this technique without any complications.
Totally thoracoscopic and laparoscopic Ivor Lewis esophagectomy in obese patients
Totally thoracoscopic and laparoscopic Ivor Lewis esophagectomy using a circular stapler or manual anastomosis has recently been described by a few authors.
We performed this challenging technique with a completely thoracoscopic hand-sewn esophagogastric anastomosis in two obese patients in prone position (one female and one male), affected by an adenocarcinoma of the lower third of the esophagus without lymph node invasion (pT2 N0) and with a BMI of 35 and 32 respectively. The first female patient is the subject of this video.
Thoracoscopy lasted 150 minutes (anastomosis was 50 minutes long), laparoscopy lasted 130 minutes, and second laparoscopy lasted 20 minutes. Blood loss was estimated at 150 mL.
The gastrografin swallows (on postoperative day 7 in both patients) showed absence of stenosis and leak. The patients had an uneventful postoperative course and were discharged on postoperative day 12 and 10, respectively.
Thoracoscopy in prone position allows the surgeon to perform a thoracoscopic esophagogastric anastomosis completely hand-sewn without selective lung exclusion, and using only three trocars.
In obese patients, although the technique is foremost challenging, the advantages of minimally invasive surgery are undeniable —better intraoperative respiratory function (avoiding selective lung exclusion) and less complicated postoperative course.
P Ubiali, M Andretta, M Ciocca Vasino, A Mancin, S Pastori, F Maffeis
Surgical intervention
7 years ago
8123 views
132 likes
0 comments
18:36
Totally thoracoscopic and laparoscopic Ivor Lewis esophagectomy in obese patients
Totally thoracoscopic and laparoscopic Ivor Lewis esophagectomy using a circular stapler or manual anastomosis has recently been described by a few authors.
We performed this challenging technique with a completely thoracoscopic hand-sewn esophagogastric anastomosis in two obese patients in prone position (one female and one male), affected by an adenocarcinoma of the lower third of the esophagus without lymph node invasion (pT2 N0) and with a BMI of 35 and 32 respectively. The first female patient is the subject of this video.
Thoracoscopy lasted 150 minutes (anastomosis was 50 minutes long), laparoscopy lasted 130 minutes, and second laparoscopy lasted 20 minutes. Blood loss was estimated at 150 mL.
The gastrografin swallows (on postoperative day 7 in both patients) showed absence of stenosis and leak. The patients had an uneventful postoperative course and were discharged on postoperative day 12 and 10, respectively.
Thoracoscopy in prone position allows the surgeon to perform a thoracoscopic esophagogastric anastomosis completely hand-sewn without selective lung exclusion, and using only three trocars.
In obese patients, although the technique is foremost challenging, the advantages of minimally invasive surgery are undeniable —better intraoperative respiratory function (avoiding selective lung exclusion) and less complicated postoperative course.
Endoscopic resection of an endobronchial hamartoma
Invasion of the tracheo-bronchial tree by a malignant pulmonary lesion is the most frequent cause of bronchial obstruction in the adult. However, benign lesions, although rare, may also occur.
Hamartoma is amongst the most frequent benign endobronchial tumors. In many cases, these tumors are amenable to endoscopic treatment (either resection or laser ablation), thus sparing the patient the potential morbidity of a thoracotomy and bronchial or parenchymal resection.
We present a case of bronchoscopic resection of a hamartoma obstructing the left lower lobe bronchus in a 58-year-old patient who had presented with cough and post-obstructive pneumonia.
Key aspects of the procedure include:
- Optimal pre-operative evaluation with flexible bronchoscopy and computed tomography of the chest.
- Close collaboration between the surgical and anesthesia teams who are sharing responsibility for the airway.
- Careful use of energy sources within the airway.
- Adequate precautions in case of an unexpected major endobronchial bleed.
The prognosis of completely resected benign tumors is excellent.
Acknowledgment: we would like to thank Nathalie Leroux RN and Mélodie Leclerc RN for their continued support.
G Rakovich, D Ouellette, G Beauchamp
Surgical intervention
7 years ago
1397 views
12 likes
1 comment
03:33
Endoscopic resection of an endobronchial hamartoma
Invasion of the tracheo-bronchial tree by a malignant pulmonary lesion is the most frequent cause of bronchial obstruction in the adult. However, benign lesions, although rare, may also occur.
Hamartoma is amongst the most frequent benign endobronchial tumors. In many cases, these tumors are amenable to endoscopic treatment (either resection or laser ablation), thus sparing the patient the potential morbidity of a thoracotomy and bronchial or parenchymal resection.
We present a case of bronchoscopic resection of a hamartoma obstructing the left lower lobe bronchus in a 58-year-old patient who had presented with cough and post-obstructive pneumonia.
Key aspects of the procedure include:
- Optimal pre-operative evaluation with flexible bronchoscopy and computed tomography of the chest.
- Close collaboration between the surgical and anesthesia teams who are sharing responsibility for the airway.
- Careful use of energy sources within the airway.
- Adequate precautions in case of an unexpected major endobronchial bleed.
The prognosis of completely resected benign tumors is excellent.
Acknowledgment: we would like to thank Nathalie Leroux RN and Mélodie Leclerc RN for their continued support.
Endoscopic intragastric balloon as a bridge to bariatric surgery for the management of a superobese patient
The use of an air-filled intragastric balloon is effective in achieving a relevant loss of body weight. It is used as a bridge to definitive surgery in superobese patients for whom surgery is often associated with high risks. The balloon helps reduce the volume of the stomach and leads to a premature feeling of satiety. These endoscopic bariatric bridging procedures can reduce the overall risk related to the surgical intervention, as measured by the use of the American Society of Anesthesiologists Physical Status Classification System, and promote cardiopulmonary and metabolic improvement. By reducing truncal/visceral obesity, these endoscopic bariatric procedures can ease off technical difficulties related to subsequent surgical interventions.
In this video, we show the case of a 44-year-old superobese man with a BMI of 63, presenting with diabetes mellitus and obstructive sleep apnea, in which a Heliosphere® BAG Pre OP balloon was positioned with the objective of weight reduction.
The procedure is performed under general anesthesia with orotracheal intubation, and with the patient in supine position. Upper endoscopy did not show any lesions or any contraindications to the gastric balloon implantation.
All the procedure is carried out under endoscopic control. In retroversion, good positioning of the inflated balloon is controlled at the level of the fundus floating freely.
PPI drugs are administered throughout the procedure.
The patient is discharged on postoperative day one after starting a liquid diet, and on the following day, he is on a normal hypocaloric diet.
The patient is scheduled to have the Heliosphere® BAG Pre OP removed within six months.
Gf Donatelli, L Marx, C Callari
Surgical intervention
7 years ago
1278 views
9 likes
0 comments
02:14
Endoscopic intragastric balloon as a bridge to bariatric surgery for the management of a superobese patient
The use of an air-filled intragastric balloon is effective in achieving a relevant loss of body weight. It is used as a bridge to definitive surgery in superobese patients for whom surgery is often associated with high risks. The balloon helps reduce the volume of the stomach and leads to a premature feeling of satiety. These endoscopic bariatric bridging procedures can reduce the overall risk related to the surgical intervention, as measured by the use of the American Society of Anesthesiologists Physical Status Classification System, and promote cardiopulmonary and metabolic improvement. By reducing truncal/visceral obesity, these endoscopic bariatric procedures can ease off technical difficulties related to subsequent surgical interventions.
In this video, we show the case of a 44-year-old superobese man with a BMI of 63, presenting with diabetes mellitus and obstructive sleep apnea, in which a Heliosphere® BAG Pre OP balloon was positioned with the objective of weight reduction.
The procedure is performed under general anesthesia with orotracheal intubation, and with the patient in supine position. Upper endoscopy did not show any lesions or any contraindications to the gastric balloon implantation.
All the procedure is carried out under endoscopic control. In retroversion, good positioning of the inflated balloon is controlled at the level of the fundus floating freely.
PPI drugs are administered throughout the procedure.
The patient is discharged on postoperative day one after starting a liquid diet, and on the following day, he is on a normal hypocaloric diet.
The patient is scheduled to have the Heliosphere® BAG Pre OP removed within six months.
Right colon Dieulafoy's lesion: endoscopic treatment
A 78-year-old man presenting with chronic renal failure was admitted to the emergency department of our hospital for bleeding per rectum.
The hemoglobin level was 10.5 g/dL on admission. Given that the patient was hemodynamically stable, decision was made to perform an upper GI endoscopy and a total colonoscopy the following day after standard bowel preparation. Bleeding recurred during the night with a hemoglobin drop to 6.3g/dL, requiring transfusions of 3 Units of blood.
With no further delay, endoscopy was performed. The gastroscopy was normal but at colonoscopy old blood was visualized in the rectum, the sigmoid, and the left and transverse colon. Additional bright red blood was observed at the level of the right colon.
Gf Donatelli, S Perretta, B Dallemagne
Surgical intervention
7 years ago
1569 views
16 likes
1 comment
02:32
Right colon Dieulafoy's lesion: endoscopic treatment
A 78-year-old man presenting with chronic renal failure was admitted to the emergency department of our hospital for bleeding per rectum.
The hemoglobin level was 10.5 g/dL on admission. Given that the patient was hemodynamically stable, decision was made to perform an upper GI endoscopy and a total colonoscopy the following day after standard bowel preparation. Bleeding recurred during the night with a hemoglobin drop to 6.3g/dL, requiring transfusions of 3 Units of blood.
With no further delay, endoscopy was performed. The gastroscopy was normal but at colonoscopy old blood was visualized in the rectum, the sigmoid, and the left and transverse colon. Additional bright red blood was observed at the level of the right colon.
Arthroscopic proximal pole resection, partial scaphoid implant
Proximal pole necrosis of the scaphoid can occur after scaphoid fractures. The replacement of the proximal pole has been tried using many different materials for many years, according to the literature. This technique consists in an arthroscopic debridement of the proximal scaphoid pole, leaving the local ligaments as intact as possible. The proximal pole is substituted by a pyrolitic carbon implant, which has an ovoid shape and fits well into this position. We present the technique and the results of 23 of Prof. Christophe Mathoulin’s patients treated between 1998 and 2007 with 21 good results and only one palmar implant dislocation. Even though good results have been already published in the literature, these results seem closely related to the degree of instability, created by the ligament damage in the scapho-lunate area.

This treatment is therefore a salvage procedure more indicated in elderly people than in young people. On the other hand, it can be a simple and convenient waiting therapy option in other cases.
M Haerle
Lecture
7 years ago
195 views
0 likes
0 comments
07:15
Arthroscopic proximal pole resection, partial scaphoid implant
Proximal pole necrosis of the scaphoid can occur after scaphoid fractures. The replacement of the proximal pole has been tried using many different materials for many years, according to the literature. This technique consists in an arthroscopic debridement of the proximal scaphoid pole, leaving the local ligaments as intact as possible. The proximal pole is substituted by a pyrolitic carbon implant, which has an ovoid shape and fits well into this position. We present the technique and the results of 23 of Prof. Christophe Mathoulin’s patients treated between 1998 and 2007 with 21 good results and only one palmar implant dislocation. Even though good results have been already published in the literature, these results seem closely related to the degree of instability, created by the ligament damage in the scapho-lunate area.

This treatment is therefore a salvage procedure more indicated in elderly people than in young people. On the other hand, it can be a simple and convenient waiting therapy option in other cases.
Scaphoid Trapezium Pyrocarbon Implant (STPI) in scaphotrapeziotrapezoidal (STT) arthritis
STT arthritis is a well-known problem generated idiopathically or secondary to a greater mobility of the scaphoid, for example after scapho-lunate ligament lesions. In these cases, the pure resection of the STT joint would add more instability to the whole system. Therefore, alternatively to the simple resection arthroplasty, the prosthetic augmentation has been proposed. We report the experience with a pyrocarbone convex-concave-shaped prosthesis, which adapts anatomically in the STT joint. After the arthroscopic resection of the distal scaphoid pole, the pyrocarbone implant can be positioned. Three weeks of immobilization seem convenient. In a series of 15 Prof. Christophe Mathoulin’s patients, very good results were achieved after a 39-month follow-up period. Two cases failed because of incomplete resection, especially at the most medial side towards the capitate, which should be approached in this area with accuracy. Arthroscopic resection and pyrocarbone prosthesis have provided very good results in isolated STT arthritis, but remain a new therapeutic option whose validity will have to be proven over the next years.
M Haerle
Lecture
7 years ago
256 views
4 likes
0 comments
05:07
Scaphoid Trapezium Pyrocarbon Implant (STPI) in scaphotrapeziotrapezoidal (STT) arthritis
STT arthritis is a well-known problem generated idiopathically or secondary to a greater mobility of the scaphoid, for example after scapho-lunate ligament lesions. In these cases, the pure resection of the STT joint would add more instability to the whole system. Therefore, alternatively to the simple resection arthroplasty, the prosthetic augmentation has been proposed. We report the experience with a pyrocarbone convex-concave-shaped prosthesis, which adapts anatomically in the STT joint. After the arthroscopic resection of the distal scaphoid pole, the pyrocarbone implant can be positioned. Three weeks of immobilization seem convenient. In a series of 15 Prof. Christophe Mathoulin’s patients, very good results were achieved after a 39-month follow-up period. Two cases failed because of incomplete resection, especially at the most medial side towards the capitate, which should be approached in this area with accuracy. Arthroscopic resection and pyrocarbone prosthesis have provided very good results in isolated STT arthritis, but remain a new therapeutic option whose validity will have to be proven over the next years.