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#January 2012
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Management of a hiatal hernia during laparoscopic Roux-en-Y gastric bypass: be ready to repair
Here we show the case of a 44-year-old woman with a BMI of 40.5 and a history of gastroesophageal reflux disease. She was presented for a weight reductive surgery evaluation. Preoperative esophagogastroduodenoscopy, barium swallow and esophageal high resolution manometry were performed. They demonstrated a 3cm hiatal hernia as well as a hypotensive lower esophageal sphincter.
The presence of a large hiatal hernia (greater than 5cm) is problematic and may prevent successful weight reductive surgery. Laparoscopic Roux-en-Y gastric bypass is an effective procedure to control symptoms and GERD complications in morbidly obese patients. For this reason, Roux-en-Y gastric bypass is a valid alternative to manage morbidly obese patients with symptomatic hiatal hernia and GERD.
Bsed on the preoperative work-up, decision was made to perform a concomitant paraesophageal hernia repair and a laparoscopic Roux-en-Y gastric bypass.
S Perretta, J Marescaux
Surgical intervention
6 years ago
1782 views
15 likes
0 comments
14:28
Management of a hiatal hernia during laparoscopic Roux-en-Y gastric bypass: be ready to repair
Here we show the case of a 44-year-old woman with a BMI of 40.5 and a history of gastroesophageal reflux disease. She was presented for a weight reductive surgery evaluation. Preoperative esophagogastroduodenoscopy, barium swallow and esophageal high resolution manometry were performed. They demonstrated a 3cm hiatal hernia as well as a hypotensive lower esophageal sphincter.
The presence of a large hiatal hernia (greater than 5cm) is problematic and may prevent successful weight reductive surgery. Laparoscopic Roux-en-Y gastric bypass is an effective procedure to control symptoms and GERD complications in morbidly obese patients. For this reason, Roux-en-Y gastric bypass is a valid alternative to manage morbidly obese patients with symptomatic hiatal hernia and GERD.
Bsed on the preoperative work-up, decision was made to perform a concomitant paraesophageal hernia repair and a laparoscopic Roux-en-Y gastric bypass.
Paraesophageal hernias and controversies
There are several advanced situations in antireflux surgery: these include giant hiatal hernias (PEH), the short esophagus and the use of meshes to minimize recurrences.
PEH is a disease of the diaphragm more than one of the esophagus, recurrence rates at 5 to 10 years are very high (>50%) due to intrinsic defects of the connective tissue of the diaphragm. Keys to surgical repair include: reduction of the mediastinal hernia sac, extensive mobilization of the esophagus to bring the GE junction into the abdomen, reinforced repair of the diaphragm. Gastropexy can occasionally be a useful adjunct. Reinforced repair of the diaphragm can involve pledgets, relaxing incisions, or mesh. Mesh remains a controversial subject. The lowest reherniation rates in the literature are with plastic mesh but such a mesh is associated with esophageal erosions. The existence of the short esophagus is controversial, most agree it exists 3 to 5% of the time. The optimal treatment is extensive mediastinal mobilization and, if that fails, to perform a laparoscopic Collis gastroplasty. There are several techniques for Collis including transthoracic or wedge gastroplasty. All result in good functional results but the ectopic gastric mucosa that results often secretes acid and requires the patient to stay on anti-acid medication.
LL Swanström
Lecture
6 years ago
4693 views
28 likes
0 comments
42:08
Paraesophageal hernias and controversies
There are several advanced situations in antireflux surgery: these include giant hiatal hernias (PEH), the short esophagus and the use of meshes to minimize recurrences.
PEH is a disease of the diaphragm more than one of the esophagus, recurrence rates at 5 to 10 years are very high (>50%) due to intrinsic defects of the connective tissue of the diaphragm. Keys to surgical repair include: reduction of the mediastinal hernia sac, extensive mobilization of the esophagus to bring the GE junction into the abdomen, reinforced repair of the diaphragm. Gastropexy can occasionally be a useful adjunct. Reinforced repair of the diaphragm can involve pledgets, relaxing incisions, or mesh. Mesh remains a controversial subject. The lowest reherniation rates in the literature are with plastic mesh but such a mesh is associated with esophageal erosions. The existence of the short esophagus is controversial, most agree it exists 3 to 5% of the time. The optimal treatment is extensive mediastinal mobilization and, if that fails, to perform a laparoscopic Collis gastroplasty. There are several techniques for Collis including transthoracic or wedge gastroplasty. All result in good functional results but the ectopic gastric mucosa that results often secretes acid and requires the patient to stay on anti-acid medication.
Laparoscopic excision of a large leiomyoma of the esophagogastric junction
Esophageal leiomyomas represent a benign pathology that usually affects the distal third and the esophagogastric junction, and that is perfectly suitable for a laparoscopic enucleation. A correct preoperative diagnosis is mandatory, as the most common differential diagnosis in this localization is represented by gastrointestinal stromal tumors (GIST), a pathology that could benefit from neo-adjuvant therapy. Occasionally, leiomyomas can be adherent to the mucosal layer, in which case-limited mucosal excision is necessary.
We present a laparoscopic enucleation of a large leiomyoma of the esophagogastric junction, requiring the use of an endostapler for complete resection.
C Balagué Ponz, EM Targarona Soler, S Mocanu, S Fernandez Ananin, F Marinello, M Trías Folch
Surgical intervention
6 years ago
1479 views
7 likes
0 comments
09:00
Laparoscopic excision of a large leiomyoma of the esophagogastric junction
Esophageal leiomyomas represent a benign pathology that usually affects the distal third and the esophagogastric junction, and that is perfectly suitable for a laparoscopic enucleation. A correct preoperative diagnosis is mandatory, as the most common differential diagnosis in this localization is represented by gastrointestinal stromal tumors (GIST), a pathology that could benefit from neo-adjuvant therapy. Occasionally, leiomyomas can be adherent to the mucosal layer, in which case-limited mucosal excision is necessary.
We present a laparoscopic enucleation of a large leiomyoma of the esophagogastric junction, requiring the use of an endostapler for complete resection.
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.
G Dapri, V Donckier, J Himpens, GB Cadière
Surgical intervention
6 years ago
2664 views
24 likes
2 comments
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.
Laparoscopic duodenal derotation due to superior mesenteric artery syndrome
Introduction: Wilkie’s Syndrome, also called the Superior Mesenteric Artery Syndrome (SMA) is a clinical entity characterized by compression of the 3rd portion of the duodenum between the aorta and the emergence of the SMA. It is a rare cause of duodenal obstruction with around 400 cases reported in the literature.
Methods: this video illustrates the case of a 50 year-old patient with a history of ankylosing spondylitis and cholecystectomy by laparotomy. She was admitted at the Emergency Room with a story suggestive of high intestinal obstruction. During hospitalization, a CT-scan was performed suggesting the existence of a mesenteric clamp. This etiology was confirmed after evaluation of the abdomen with Magnetic Resonance Imaging the next day.
Results: the patient was subjected to a laparoscopic duodenal derotation, with resolution of clinical symptoms.
Conclusions: duodenal derotation can be sufficient to treat this pathology. The laparoscopic approach, when performed by an experienced laparoscopic surgeon and using the same principles of laparotomy, should be preferred. It allows a better visualization of anatomical structures and a better patient recovery.
M Nora, G Gonçalves, T Ferreira
Surgical intervention
6 years ago
3686 views
61 likes
1 comment
06:57
Laparoscopic duodenal derotation due to superior mesenteric artery syndrome
Introduction: Wilkie’s Syndrome, also called the Superior Mesenteric Artery Syndrome (SMA) is a clinical entity characterized by compression of the 3rd portion of the duodenum between the aorta and the emergence of the SMA. It is a rare cause of duodenal obstruction with around 400 cases reported in the literature.
Methods: this video illustrates the case of a 50 year-old patient with a history of ankylosing spondylitis and cholecystectomy by laparotomy. She was admitted at the Emergency Room with a story suggestive of high intestinal obstruction. During hospitalization, a CT-scan was performed suggesting the existence of a mesenteric clamp. This etiology was confirmed after evaluation of the abdomen with Magnetic Resonance Imaging the next day.
Results: the patient was subjected to a laparoscopic duodenal derotation, with resolution of clinical symptoms.
Conclusions: duodenal derotation can be sufficient to treat this pathology. The laparoscopic approach, when performed by an experienced laparoscopic surgeon and using the same principles of laparotomy, should be preferred. It allows a better visualization of anatomical structures and a better patient recovery.
Ureteral endometriosis: general outcomes, our experience
This lecture presents ureteral endometriosis, which is a rare pathology (0.1% of cases). In 50% of cases, the condition is asymptomatic and can lead to loss of renal functions. In the literature, ureteral endometriosis increases with the presence of rectovaginal endometriosis, which does not appear in the study presented (221 cases of endometriosis, 19.5% of which are ureteral tract endometriosis). It seems to be significantly associated with uterosacral ligament (USL) endometriosis (p=0.01) but not with bladder endometriosis. Medical treatment is not indicated and conservative laparoscopic surgical management shows a long-term relief of symptoms and a low rate of anatomical recurrence (0-11%).
B Gabriel
Lecture
6 years ago
511 views
6 likes
0 comments
14:29
Ureteral endometriosis: general outcomes, our experience
This lecture presents ureteral endometriosis, which is a rare pathology (0.1% of cases). In 50% of cases, the condition is asymptomatic and can lead to loss of renal functions. In the literature, ureteral endometriosis increases with the presence of rectovaginal endometriosis, which does not appear in the study presented (221 cases of endometriosis, 19.5% of which are ureteral tract endometriosis). It seems to be significantly associated with uterosacral ligament (USL) endometriosis (p=0.01) but not with bladder endometriosis. Medical treatment is not indicated and conservative laparoscopic surgical management shows a long-term relief of symptoms and a low rate of anatomical recurrence (0-11%).
Complications of endometriosis surgery
This lecture focuses on complications in laparoscopic surgery for endometriosis. First, the expert addresses how to define complications. Surgeons sometimes need to remove part of the adjacent structures such as bowel, vagina and ureter, which should be included in the surgery – to achieve a complete excision of the disease. Complications can always occur and the most important thing to be borne in mind is to know how to deal with them by laparoscopy.
Complications may include adhesions, bowel, ureter and vascular injuries. The rate of complications in rectal shaving ranges from 0.2 to 1.4%. In case of discoid bowel resection, the morbidity rate published in the literature is 13%. Regarding rectal segmental resection, the rate of complications in laparoscopy (4.25%) is similar to that of laparotomy (4.5%). The rate of rectovaginal fistula in case of rectal shaving is 8.3%, and in rectal segmental resection 3.1%, which is not associated with the distance between the anastomosis and the rectum. Voiding problems are frequent and the incidence of urinary retention ranges from 1 to 29% and depends on the interval of observation. Finally, in case of ureteral endometriosis, a double J catheter should be always placed in order to decrease the risk of ureteral fistula.
J Nassif
Lecture
6 years ago
1460 views
36 likes
0 comments
18:10
Complications of endometriosis surgery
This lecture focuses on complications in laparoscopic surgery for endometriosis. First, the expert addresses how to define complications. Surgeons sometimes need to remove part of the adjacent structures such as bowel, vagina and ureter, which should be included in the surgery – to achieve a complete excision of the disease. Complications can always occur and the most important thing to be borne in mind is to know how to deal with them by laparoscopy.
Complications may include adhesions, bowel, ureter and vascular injuries. The rate of complications in rectal shaving ranges from 0.2 to 1.4%. In case of discoid bowel resection, the morbidity rate published in the literature is 13%. Regarding rectal segmental resection, the rate of complications in laparoscopy (4.25%) is similar to that of laparotomy (4.5%). The rate of rectovaginal fistula in case of rectal shaving is 8.3%, and in rectal segmental resection 3.1%, which is not associated with the distance between the anastomosis and the rectum. Voiding problems are frequent and the incidence of urinary retention ranges from 1 to 29% and depends on the interval of observation. Finally, in case of ureteral endometriosis, a double J catheter should be always placed in order to decrease the risk of ureteral fistula.
Contemporary aspects on etiopathogenesis: strategies on diagnosis
This lecture addresses the etiopathogenesis of endometriosis, as defined by the presence of endometrial glands and stroma out of the uterine cavity. Endometriosis is present in 6-10% of women worldwide, 50-70% of women with pelvic pain and 30-50% of women with infertility. The main risk factors are early menarche, nulliparity and family history. Diagnosis frequently takes a long time from the onset of the first symptoms and constitutes a major healthcare problem in the United States. The most popular theory is retrograde menstruation, but other explanations are coelomic metaplasia, genetic predisposition, immune system dysfunction and environmental factors, which by means of inflammation, prostaglandin production and nerve regeneration could lead to pain and infertility. Endometriosis lesions have a known dependence with ovarian estrogens, but local conversion of androstenedione to estradiol inside the implants has been demonstrated, leading to proliferation of nerve fibers even after oophorectomy. Medical treatment aims to decrease inflammation, estrogen synthesis and local conversion of androgens to estrogens for a limited period of time. Surgical treatment aims to remove lesions and disrupt nerve production in the tissue, but there is a high percentage of symptom recurrence. Regarding infertility, endometriosis can cause adhesions affecting the ovary and the tube, but can also affect spermatozoa motility, migration of the embryo and prevent implantation, accounting for poor pregnancy outcomes in women with endometriosis.
To better visualize the expert's powerpoint presentation, please click here.
Ceana Nezhat
Lecture
6 years ago
1978 views
57 likes
1 comment
21:58
Contemporary aspects on etiopathogenesis: strategies on diagnosis
This lecture addresses the etiopathogenesis of endometriosis, as defined by the presence of endometrial glands and stroma out of the uterine cavity. Endometriosis is present in 6-10% of women worldwide, 50-70% of women with pelvic pain and 30-50% of women with infertility. The main risk factors are early menarche, nulliparity and family history. Diagnosis frequently takes a long time from the onset of the first symptoms and constitutes a major healthcare problem in the United States. The most popular theory is retrograde menstruation, but other explanations are coelomic metaplasia, genetic predisposition, immune system dysfunction and environmental factors, which by means of inflammation, prostaglandin production and nerve regeneration could lead to pain and infertility. Endometriosis lesions have a known dependence with ovarian estrogens, but local conversion of androstenedione to estradiol inside the implants has been demonstrated, leading to proliferation of nerve fibers even after oophorectomy. Medical treatment aims to decrease inflammation, estrogen synthesis and local conversion of androgens to estrogens for a limited period of time. Surgical treatment aims to remove lesions and disrupt nerve production in the tissue, but there is a high percentage of symptom recurrence. Regarding infertility, endometriosis can cause adhesions affecting the ovary and the tube, but can also affect spermatozoa motility, migration of the embryo and prevent implantation, accounting for poor pregnancy outcomes in women with endometriosis.
To better visualize the expert's powerpoint presentation, please click here.
Urinary complications during deep endometriosis surgery
During deep endometriosis surgery, bladder and ureter lesions are the most frequent complications.
Bladder lesions. The cystoscopy must be first carried out to assess the location of the endometriosis. If the nodule is close to the ureter, a stent is needed. To prevent lesion to the intramural part of the ureter, it is advisable to enter the bladder at its upper part. To minimize complications, an adequate surgical technique is necessary, a catheter must be placed for 1 to 3 weeks, a large catheter must be placed to drain clots, and control cystoscopy must be achieved before catheter removal. Intraoperative bladder lesions are never a major problem since the bladder wall heals well. Late complications are as follows: vesicovaginal fistula, rare but more frequent after hysterectomy, and the clinical sign is continuous leakage from the vagina, and the treatment is laparoscopy immediately or 50 days after surgery (with, in the last case, treatment with antibiotics until laparoscopic treatment begins). In addition, urinary retention is another late complication, more frequent, especially after resection of large nodules with lateral extension; it is due to parasympathetic nerve injury. Nerve-sparing prevention in endometriosis is not possible; the important thing is not to resect bilaterally. If injury is monolateral, it heals spontaneously in 3 months, rarely longer than 6-12 months.
Ureteral lesions. They occur mainly in cases of hydronephrosis or nodules bigger than 3 centimeters. In case of hydronephrosis, it is necessary to stent the patient before surgery; in all cases, especially when dealing with a nodule, the ureter should be isolated. After surgery a control cystoscopy must be carried out if the ureter works properly. It is important to monitor drain volume and CRP daily. CRP increases on the second day, and decreases on the third day. If CRP increases again, it means there is a complication (infection, ureteral lesion, leakage from rectum). Treatment is immediate laparoscopy with stitch and stent. Another complication is urinoma; symptoms are pain, diarrhea and high temperature. In these cases laparoscopy should be repeated. In case of ureterovaginal fistula, the leakage is intermittent. It usually becomes evident after 1 to 3 weeks. The diagnosis is made by intravenous pyelogram (IVP); treatment is carried out through laparoscopy. In case of unrecognized ureteral transection, there is a late ureteral leak (even after 25 days); ureteral re-anastomosis is the first-line treatment.
A Ussia
Lecture
6 years ago
891 views
17 likes
0 comments
17:28
Urinary complications during deep endometriosis surgery
During deep endometriosis surgery, bladder and ureter lesions are the most frequent complications.
Bladder lesions. The cystoscopy must be first carried out to assess the location of the endometriosis. If the nodule is close to the ureter, a stent is needed. To prevent lesion to the intramural part of the ureter, it is advisable to enter the bladder at its upper part. To minimize complications, an adequate surgical technique is necessary, a catheter must be placed for 1 to 3 weeks, a large catheter must be placed to drain clots, and control cystoscopy must be achieved before catheter removal. Intraoperative bladder lesions are never a major problem since the bladder wall heals well. Late complications are as follows: vesicovaginal fistula, rare but more frequent after hysterectomy, and the clinical sign is continuous leakage from the vagina, and the treatment is laparoscopy immediately or 50 days after surgery (with, in the last case, treatment with antibiotics until laparoscopic treatment begins). In addition, urinary retention is another late complication, more frequent, especially after resection of large nodules with lateral extension; it is due to parasympathetic nerve injury. Nerve-sparing prevention in endometriosis is not possible; the important thing is not to resect bilaterally. If injury is monolateral, it heals spontaneously in 3 months, rarely longer than 6-12 months.
Ureteral lesions. They occur mainly in cases of hydronephrosis or nodules bigger than 3 centimeters. In case of hydronephrosis, it is necessary to stent the patient before surgery; in all cases, especially when dealing with a nodule, the ureter should be isolated. After surgery a control cystoscopy must be carried out if the ureter works properly. It is important to monitor drain volume and CRP daily. CRP increases on the second day, and decreases on the third day. If CRP increases again, it means there is a complication (infection, ureteral lesion, leakage from rectum). Treatment is immediate laparoscopy with stitch and stent. Another complication is urinoma; symptoms are pain, diarrhea and high temperature. In these cases laparoscopy should be repeated. In case of ureterovaginal fistula, the leakage is intermittent. It usually becomes evident after 1 to 3 weeks. The diagnosis is made by intravenous pyelogram (IVP); treatment is carried out through laparoscopy. In case of unrecognized ureteral transection, there is a late ureteral leak (even after 25 days); ureteral re-anastomosis is the first-line treatment.
Surgical complications - it is possible to prevent them
Complications after laparoscopic surgery for endometriosis may occur even with a skilled surgeon and ideal circumstances. Success is linked to many factors, and not only to the surgeon’s experience. It is necessary to inform the patient in order to avoid medico-legal problems. An appropriate diagnosis must be performed, including clinical examination and all other necessary investigations. Proper instruments, anatomical knowledge, and exposure help to prevent severe complications. Make sure that you visualize the ureters at the beginning of the surgery as they always tend to go medially. In addition, ureterosacral resection should be avoided in order to prevent bladder dysfunction. Always prefer discoid excision of the bowel rather than bowel resection and make sure the suture does not exceed 3cm on the bowel, and avoid any vertical suturing when possible. If there is a history of surgery or a lesion near the ostia or a ureteral stenosis, ureteral stents should be placed. At the end of the procedure, it is recommended to carry out a blue dye or an air test, a cystoscopy or to place drains. A postoperative consultation is essential.
JM Wenger
Lecture
6 years ago
8366 views
442 likes
0 comments
24:53
Surgical complications - it is possible to prevent them
Complications after laparoscopic surgery for endometriosis may occur even with a skilled surgeon and ideal circumstances. Success is linked to many factors, and not only to the surgeon’s experience. It is necessary to inform the patient in order to avoid medico-legal problems. An appropriate diagnosis must be performed, including clinical examination and all other necessary investigations. Proper instruments, anatomical knowledge, and exposure help to prevent severe complications. Make sure that you visualize the ureters at the beginning of the surgery as they always tend to go medially. In addition, ureterosacral resection should be avoided in order to prevent bladder dysfunction. Always prefer discoid excision of the bowel rather than bowel resection and make sure the suture does not exceed 3cm on the bowel, and avoid any vertical suturing when possible. If there is a history of surgery or a lesion near the ostia or a ureteral stenosis, ureteral stents should be placed. At the end of the procedure, it is recommended to carry out a blue dye or an air test, a cystoscopy or to place drains. A postoperative consultation is essential.
Deep endometriosis excision with ureteral anastomosis followed by segmental rectosigmoid resection, transvaginal specimen extraction, and a transanal colorectal anastomosis
We present the case of a 29-year-old nulligest woman. Four years ago, she had a previous surgery with a rectovaginal nodule removed both by laparoscopy and vaginal approach. She has complained of dyspareunia (8/10), dysmenorrhea (8/10), dyschezia (8/10) and infertility over the last 2 years, but she also suffers from bladder dysfunction requiring urinary self-catheterization during her menstrual periods. The laparoscopic exploration revealed a big fibrotic nodule located in the right pelvic sidewall involving the right ureter and the rectum. Right ureter resection and anastomosis were performed. Segmental rectosigmoid resection was followed by transvaginal specimen extraction and a transanal colorectal anastomosis. The intracorporeal laparoscopic technique allows for a limited bowel devascularization and for an appropriate anastomosis with no need for extra abdominal incisions. No complications were noted and the patient had a good clinical evolution.
A Wattiez, J Leroy, E Faller, J Albornoz, P Messori
Surgical intervention
6 years ago
2505 views
20 likes
0 comments
30:14
Deep endometriosis excision with ureteral anastomosis followed by segmental rectosigmoid resection, transvaginal specimen extraction, and a transanal colorectal anastomosis
We present the case of a 29-year-old nulligest woman. Four years ago, she had a previous surgery with a rectovaginal nodule removed both by laparoscopy and vaginal approach. She has complained of dyspareunia (8/10), dysmenorrhea (8/10), dyschezia (8/10) and infertility over the last 2 years, but she also suffers from bladder dysfunction requiring urinary self-catheterization during her menstrual periods. The laparoscopic exploration revealed a big fibrotic nodule located in the right pelvic sidewall involving the right ureter and the rectum. Right ureter resection and anastomosis were performed. Segmental rectosigmoid resection was followed by transvaginal specimen extraction and a transanal colorectal anastomosis. The intracorporeal laparoscopic technique allows for a limited bowel devascularization and for an appropriate anastomosis with no need for extra abdominal incisions. No complications were noted and the patient had a good clinical evolution.
Loop-and-let-go technique for symptomatic descending colonic lipoma
Large symptomatic colonic lipomas require treatment, but resection of lipomas by means of endoscopic cautery snare carries some risk of colonic perforation. The loop-and-let-go technique described here is technically simple; anyone who is well acquainted with the snare cautery technique can do it. It looks safer than the conventionally employed snare cautery technique, as no current is used with the loop-and-let-go technique. It causes selective occlusive ischemia of mucosa and submucosa without causing any transmural damage. The total duration needed for the lipoma to slough off depends on the quality of endoloop occlusion and the type of lipoma (narrow-based vs wide-based).
Gf Donatelli, P Dhumane, L Marx, J D'Agostino, D Mutter, J Marescaux
Surgical intervention
6 years ago
890 views
3 likes
0 comments
02:16
Loop-and-let-go technique for symptomatic descending colonic lipoma
Large symptomatic colonic lipomas require treatment, but resection of lipomas by means of endoscopic cautery snare carries some risk of colonic perforation. The loop-and-let-go technique described here is technically simple; anyone who is well acquainted with the snare cautery technique can do it. It looks safer than the conventionally employed snare cautery technique, as no current is used with the loop-and-let-go technique. It causes selective occlusive ischemia of mucosa and submucosa without causing any transmural damage. The total duration needed for the lipoma to slough off depends on the quality of endoloop occlusion and the type of lipoma (narrow-based vs wide-based).
Wrist arthroscopy: e-learning
Performing wrist arthroscopy requires a good knowledge of anatomy, arthroscopic equipment and patient positioning.
E-learning has been developed to teach this basic knowledge to residents in orthopedic or plastic surgery who wish to perform wrist arthroscopies.
The subjects of this module are proper positioning of the patient, names and use of arthroscopic instruments, relevant anatomy, creation of portals and a description of the diagnostic inspection of the wrist.
After having assimilated the facts of this e-learning lecture, a resident should be able to perform his or her first arthroscopy in a cadaver or a wrist arthroscopy simulator.

To better visualize the expert's powerpoint presentation, please click here.
M Obdeijn
Lecture
6 years ago
741 views
2 likes
0 comments
20:28
Wrist arthroscopy: e-learning
Performing wrist arthroscopy requires a good knowledge of anatomy, arthroscopic equipment and patient positioning.
E-learning has been developed to teach this basic knowledge to residents in orthopedic or plastic surgery who wish to perform wrist arthroscopies.
The subjects of this module are proper positioning of the patient, names and use of arthroscopic instruments, relevant anatomy, creation of portals and a description of the diagnostic inspection of the wrist.
After having assimilated the facts of this e-learning lecture, a resident should be able to perform his or her first arthroscopy in a cadaver or a wrist arthroscopy simulator.

To better visualize the expert's powerpoint presentation, please click here.