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Monthly publications

#March 2012
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Laparoscopic simplified gastric bypass
Laparoscopic gastric bypass is currently the gold standard in bariatric surgery. This procedure is complex and yet, it can be perfectly standardized in order to shorten the learning curve. This video presents a well-standardized and easily reproducible technique. All operative steps have been systematized and unroll very naturally. Once the gastric pouch has been divided, the gastrojejunal anastomosis is performed by means of a linear stapler by calibrating a 3cm pouch. The jejunojejunal anastomosis is performed using a 45mm long linear stapler without any division of the alimentary loop. Consequently, it is easy to control the patency of the two anastomoses. Mesenteric defects are closed to avoid internal hernias. Reproducibility is the main advantage of this technique, which has been used by operators to train more than 700 surgeons in South America, Europe, and Asia.
M Galvao Neto, A Cardoso Ramos, M Vix, J Marescaux
Surgical intervention
6 years ago
4943 views
60 likes
0 comments
25:24
Laparoscopic simplified gastric bypass
Laparoscopic gastric bypass is currently the gold standard in bariatric surgery. This procedure is complex and yet, it can be perfectly standardized in order to shorten the learning curve. This video presents a well-standardized and easily reproducible technique. All operative steps have been systematized and unroll very naturally. Once the gastric pouch has been divided, the gastrojejunal anastomosis is performed by means of a linear stapler by calibrating a 3cm pouch. The jejunojejunal anastomosis is performed using a 45mm long linear stapler without any division of the alimentary loop. Consequently, it is easy to control the patency of the two anastomoses. Mesenteric defects are closed to avoid internal hernias. Reproducibility is the main advantage of this technique, which has been used by operators to train more than 700 surgeons in South America, Europe, and Asia.
Subtotal laparoscopic pancreatectomy for the treatment of hyperinsulinism in a 12-year-old girl
We present the case of a 12-year-old girl who presented with symptoms of dizziness and weakness for 4 months. Hyperinsulinemic hypoglycemia was found. Pancreatic PET-scan and CT-scan showed no focal lesions and a slightly increased volume of the pancreatic tail. After selective calcium stimulation of the pancreas, increased insulin was found from the body and tail. Laparoscopic pancreatectomy was scheduled. Failure with prednisone treatment indicated laparoscopic subtotal pancreatectomy.
Surgery was carried out using a four-trocar technique. The pancreas was approached through the greater omentum. Careful dissection of the small pancreatic vessels coming from the splenic vessels is performed. A subtotal pancreatectomy near the duodenum was carried out by means of the Endo-GIA® linear stapler in the head and ultrasonic scalpel and hook in the body and tail. Drainage was left in situ.
E Bracho, E Fernàndez, C Zalles
Surgical intervention
6 years ago
1805 views
10 likes
0 comments
09:00
Subtotal laparoscopic pancreatectomy for the treatment of hyperinsulinism in a 12-year-old girl
We present the case of a 12-year-old girl who presented with symptoms of dizziness and weakness for 4 months. Hyperinsulinemic hypoglycemia was found. Pancreatic PET-scan and CT-scan showed no focal lesions and a slightly increased volume of the pancreatic tail. After selective calcium stimulation of the pancreas, increased insulin was found from the body and tail. Laparoscopic pancreatectomy was scheduled. Failure with prednisone treatment indicated laparoscopic subtotal pancreatectomy.
Surgery was carried out using a four-trocar technique. The pancreas was approached through the greater omentum. Careful dissection of the small pancreatic vessels coming from the splenic vessels is performed. A subtotal pancreatectomy near the duodenum was carried out by means of the Endo-GIA® linear stapler in the head and ultrasonic scalpel and hook in the body and tail. Drainage was left in situ.
Principles of laparoscopic reproductive surgery
Professor Adamson exposes the rules for laparoscopic reproductive surgery. Laparoscopy is first part of the diagnosis, such as ultrasonography or hysterosalpingography. Preoperative principles rely on the informed and signed consent of the patient. Professor Adamson then covers intraoperative rules such as the importance of a good vizualisation (i.e., exposure), control of the surgical field, and proper use of energy sources. Prevention of adhesions is essential because the rate of adhesion is lower with laparoscopy than with laparotomy; it is however quite high (65-88%). A microsurgical technique associated with anti-adhesion barriers seems to be effective. At the end of laparoscopic surgery, the surgeon must give the patient a prognosis for fertility: the Endometriosis Fertility Index seems to be a very useful tool.
D Adamson
Lecture
6 years ago
1170 views
4 likes
1 comment
29:56
Principles of laparoscopic reproductive surgery
Professor Adamson exposes the rules for laparoscopic reproductive surgery. Laparoscopy is first part of the diagnosis, such as ultrasonography or hysterosalpingography. Preoperative principles rely on the informed and signed consent of the patient. Professor Adamson then covers intraoperative rules such as the importance of a good vizualisation (i.e., exposure), control of the surgical field, and proper use of energy sources. Prevention of adhesions is essential because the rate of adhesion is lower with laparoscopy than with laparotomy; it is however quite high (65-88%). A microsurgical technique associated with anti-adhesion barriers seems to be effective. At the end of laparoscopic surgery, the surgeon must give the patient a prognosis for fertility: the Endometriosis Fertility Index seems to be a very useful tool.
Challenges of uterine fibroids - focus: endoscopic and hysteroscopic enucleation
25 to 30% of women are diagnosed with uterine myomas worldwide. Laparoscopic myomectomy has remarkable advantages for patients with less postoperative pain and shorter recovery time. The fibroid resection technique varies depending on the myoma’s size and position.
Pedunculated fibroids: The myoma’s pedicle is cauterized by means of the bipolar forceps and divided after loop placement.
Subserous and intramural myomas: An incision extended until the pseudo-capsule is made vertically or horizontally at the site of the underlying myoma. The dissection is performed strictly within the pseudo-capsule plane with the help of two pairs of grasping forceps using traction and counter-traction. After myoma enucleation, the uterus is sutured along a seromuscular plane using one or two layers of separate polydioxanon suture (PDS) stitches with extracorporeal or intracorporeal knots. Continuous suction and irrigation is performed to minimize adhesion formation. The myomas are then extracted by morcellation using an electric morcellator; an alternative method is to take it out by colpotomy, or to cut it in case of smaller pieces.
Cervical myomas: These can be easily reached and enucleated transvaginally.
Adenomyosis uteri: In case of dysmenorrhea resulting from well-discernible adenomyotic lesions, a careful resection is recommended by hysteroscopy or laparoscopy.
Adenomatoid tumors: They resemble fibroids with no clear cleavage plane. The exclusion from malignancy is only possible by histology which account for their necessary removal; they can also turn into malignancy.
Submucous myomas: They are located within the uterine cavity; their resection is performed hysteroscopically with the resectoscopic loop in a slicing manner with bipolar or monopolar current. Attention must be paid regarding resection if the distance between the myoma and the uterine serosa is less than 8mm. The laparotomic approach is preferably performed if the myoma is bigger than 20cm in diameter, located at very critical points, suspected of being a sarcoma, or if there are more than 10 fibroids. In any case when surgery is indicated, laparoscopic or hysteroscopic myomectomy is the primary choice according to the location. The results of many international series demonstrate the feasibility of laparoscopic and hysteroscopic myomectomy as a technique leading to a remission of symptoms with a low rate of complications and leading to an increased rate of fertility.
L Mettler
Lecture
6 years ago
2059 views
26 likes
0 comments
38:04
Challenges of uterine fibroids - focus: endoscopic and hysteroscopic enucleation
25 to 30% of women are diagnosed with uterine myomas worldwide. Laparoscopic myomectomy has remarkable advantages for patients with less postoperative pain and shorter recovery time. The fibroid resection technique varies depending on the myoma’s size and position.
Pedunculated fibroids: The myoma’s pedicle is cauterized by means of the bipolar forceps and divided after loop placement.
Subserous and intramural myomas: An incision extended until the pseudo-capsule is made vertically or horizontally at the site of the underlying myoma. The dissection is performed strictly within the pseudo-capsule plane with the help of two pairs of grasping forceps using traction and counter-traction. After myoma enucleation, the uterus is sutured along a seromuscular plane using one or two layers of separate polydioxanon suture (PDS) stitches with extracorporeal or intracorporeal knots. Continuous suction and irrigation is performed to minimize adhesion formation. The myomas are then extracted by morcellation using an electric morcellator; an alternative method is to take it out by colpotomy, or to cut it in case of smaller pieces.
Cervical myomas: These can be easily reached and enucleated transvaginally.
Adenomyosis uteri: In case of dysmenorrhea resulting from well-discernible adenomyotic lesions, a careful resection is recommended by hysteroscopy or laparoscopy.
Adenomatoid tumors: They resemble fibroids with no clear cleavage plane. The exclusion from malignancy is only possible by histology which account for their necessary removal; they can also turn into malignancy.
Submucous myomas: They are located within the uterine cavity; their resection is performed hysteroscopically with the resectoscopic loop in a slicing manner with bipolar or monopolar current. Attention must be paid regarding resection if the distance between the myoma and the uterine serosa is less than 8mm. The laparotomic approach is preferably performed if the myoma is bigger than 20cm in diameter, located at very critical points, suspected of being a sarcoma, or if there are more than 10 fibroids. In any case when surgery is indicated, laparoscopic or hysteroscopic myomectomy is the primary choice according to the location. The results of many international series demonstrate the feasibility of laparoscopic and hysteroscopic myomectomy as a technique leading to a remission of symptoms with a low rate of complications and leading to an increased rate of fertility.
Laparoscopic excision of bladder endometriosis
This is the case of a 34-year-old woman, G1P0010, with a long standing history of chronic pelvic and bladder pain occurring on a monthly basis. The patient has had laparoscopic diagnosis of endometriosis in the past with no resection performed at that time. Given cyclic bladder pain, the patient also underwent cystoscopy, which revealed an implant of bladder endometriosis measuring approximately 2cm in diameter. She has failed medical therapy including oral contraceptives and Lupron from several months. Given her continued bladder pain and severe dysmenorrhea and dyspareunia for the last 5 years, the decision was made to proceed with a surgical intervention.
Operating room specificities:
The patient was positioned in the dorsal lithotomy position with arms tucked bilaterally.
A 12mm port was placed within the umbilicus for the laparoscope. A 5mm port was placed in the left lower quadrant about 2cm superior to the left anterior superior iliac spine. Another 5mm port was placed in the right upper quadrant about 8cm lateral and 2cm inferior to the umbilical port. A final 12mm port was placed in the right lower quadrant, about 2cm superior to the right anterior superior iliac spine. A 7cm clear view uterine manipulator was used.
The primary surgeon was positioned on the left side of the patient. The main surgical assistant, the resident, was positioned on the right side of the patient. The secondary surgical assistant, the fellow, was positioned between the patient’s legs.
M Milad, L Griffin, I Moy, S Bulun
Surgical intervention
6 years ago
1969 views
23 likes
0 comments
03:59
Laparoscopic excision of bladder endometriosis
This is the case of a 34-year-old woman, G1P0010, with a long standing history of chronic pelvic and bladder pain occurring on a monthly basis. The patient has had laparoscopic diagnosis of endometriosis in the past with no resection performed at that time. Given cyclic bladder pain, the patient also underwent cystoscopy, which revealed an implant of bladder endometriosis measuring approximately 2cm in diameter. She has failed medical therapy including oral contraceptives and Lupron from several months. Given her continued bladder pain and severe dysmenorrhea and dyspareunia for the last 5 years, the decision was made to proceed with a surgical intervention.
Operating room specificities:
The patient was positioned in the dorsal lithotomy position with arms tucked bilaterally.
A 12mm port was placed within the umbilicus for the laparoscope. A 5mm port was placed in the left lower quadrant about 2cm superior to the left anterior superior iliac spine. Another 5mm port was placed in the right upper quadrant about 8cm lateral and 2cm inferior to the umbilical port. A final 12mm port was placed in the right lower quadrant, about 2cm superior to the right anterior superior iliac spine. A 7cm clear view uterine manipulator was used.
The primary surgeon was positioned on the left side of the patient. The main surgical assistant, the resident, was positioned on the right side of the patient. The secondary surgical assistant, the fellow, was positioned between the patient’s legs.
Adnexal masses: techniques, principles
When dealing with adnexal masses, it is fundamental to learn how to diagnose them, to exclude functional cysts, and to address benign and malignant conditions properly. Looking back on past history, the main factor is the patient’s age, considering that the risk of malignancy increases significantly after menopause. An appropriate selection of patients has helped in the reduction of occurrence of unexpected cancer managed by laparoscopy to 4-6/1000 women with adnexal masses. The operator should always follow surgical principles which include careful examination of the external surface of the tumor, peritoneal cytology, prevention of cyst rupture, prevention of contact between the cyst and the abdominal wall and frozen section examination in case of suspicious lesion. The dermoid cyst is the most common type of ovarian germ cell tumor and the recommended treatment is cystectomy following conventional principles: ovarian capsule incision, cyst wall dissection (making sure not to open it), selective coagulation of bleeders and ovarian closure according to the case. In the case of endometriotic cysts it is recommended to preserve as much ovarian tissue as possible and to preserve the vascularization in the ovarian hilus. Finally during cyst removal from the abdominal cavity, the use of plastic bags has been associated with the lowest rate of cyst spillage.
B Van Herendael
Lecture
6 years ago
4501 views
94 likes
0 comments
29:56
Adnexal masses: techniques, principles
When dealing with adnexal masses, it is fundamental to learn how to diagnose them, to exclude functional cysts, and to address benign and malignant conditions properly. Looking back on past history, the main factor is the patient’s age, considering that the risk of malignancy increases significantly after menopause. An appropriate selection of patients has helped in the reduction of occurrence of unexpected cancer managed by laparoscopy to 4-6/1000 women with adnexal masses. The operator should always follow surgical principles which include careful examination of the external surface of the tumor, peritoneal cytology, prevention of cyst rupture, prevention of contact between the cyst and the abdominal wall and frozen section examination in case of suspicious lesion. The dermoid cyst is the most common type of ovarian germ cell tumor and the recommended treatment is cystectomy following conventional principles: ovarian capsule incision, cyst wall dissection (making sure not to open it), selective coagulation of bleeders and ovarian closure according to the case. In the case of endometriotic cysts it is recommended to preserve as much ovarian tissue as possible and to preserve the vascularization in the ovarian hilus. Finally during cyst removal from the abdominal cavity, the use of plastic bags has been associated with the lowest rate of cyst spillage.
Gastric mucosal laceration managed with endoscopic clipping during ESD in a patient with Child Class A liver cirrhosis
Patients with liver cirrhosis present with portal hypertension (PHT), which causes various pathological changes in the entire gastrointestinal tract (from esophagus to anus). In this video, the Mallory Weiss tear (MWT) occurred accidentally during ESD of a gastric antral adenoma in a cirrhotic patient. It was successfully managed by means of endoscopic clipping. The patient had two episodes of retching during endoscopy, which might have contributed to gastric over-distension. With esophagogastroduodenoscopy (EGD) being so commonly performed in cirrhotic patients and ESD being more and more commonly used for treatment of gastric mucosal lesions, this case report should serve as a precautionary reminder in such case scenarios.
Gf Donatelli, P Dhumane, L Marx, B Dallemagne, J Marescaux
Surgical intervention
6 years ago
756 views
11 likes
0 comments
02:57
Gastric mucosal laceration managed with endoscopic clipping during ESD in a patient with Child Class A liver cirrhosis
Patients with liver cirrhosis present with portal hypertension (PHT), which causes various pathological changes in the entire gastrointestinal tract (from esophagus to anus). In this video, the Mallory Weiss tear (MWT) occurred accidentally during ESD of a gastric antral adenoma in a cirrhotic patient. It was successfully managed by means of endoscopic clipping. The patient had two episodes of retching during endoscopy, which might have contributed to gastric over-distension. With esophagogastroduodenoscopy (EGD) being so commonly performed in cirrhotic patients and ESD being more and more commonly used for treatment of gastric mucosal lesions, this case report should serve as a precautionary reminder in such case scenarios.
Endoscopic endonasal approach to the cranio-cervical junction
There exists a variety of pathological processes involving the craniocervical junction (CCJ): tumors (e.g. primary bone tumors, chordomas, metastases), infections (e.g. tuberculoma), malformations and rheumatoid arthritis. Instability—either induced by the pathology itself or after surgery— is often associated with these diseases and has to be addressed. For a long time, the transoral approach (TOA) has been the gold standard for anterior surgical decompression at the CCJ. Over the last years, the endoscopic endonasal approach (EEA) has become a valuable alternative. In order to work efficiently and safely via the EEA, there are some prerequisites: a thorough knowledge of the endoscopic anatomy, careful preoperative planning based on radiology, adequate endoscopic technique (ideally a team of neurosurgeons and ENT specialists), dedicated endoscopic instrumentation and intraoperative navigation and the ability to perform occipitocervical stabilization. Finally, for successful patient management, it is crucial to learn about the possibilities and limits of this approach - or when to choose it and when not.
JF Cornelius
Lecture
6 years ago
475 views
1 like
0 comments
11:02
Endoscopic endonasal approach to the cranio-cervical junction
There exists a variety of pathological processes involving the craniocervical junction (CCJ): tumors (e.g. primary bone tumors, chordomas, metastases), infections (e.g. tuberculoma), malformations and rheumatoid arthritis. Instability—either induced by the pathology itself or after surgery— is often associated with these diseases and has to be addressed. For a long time, the transoral approach (TOA) has been the gold standard for anterior surgical decompression at the CCJ. Over the last years, the endoscopic endonasal approach (EEA) has become a valuable alternative. In order to work efficiently and safely via the EEA, there are some prerequisites: a thorough knowledge of the endoscopic anatomy, careful preoperative planning based on radiology, adequate endoscopic technique (ideally a team of neurosurgeons and ENT specialists), dedicated endoscopic instrumentation and intraoperative navigation and the ability to perform occipitocervical stabilization. Finally, for successful patient management, it is crucial to learn about the possibilities and limits of this approach - or when to choose it and when not.
Endoscopic endonasal approach to pituitary adenomas
The endoscopic endonasal approach is a continuously evolving speciality of modern neurosurgery, which requires precise anatomical knowledge, technical skills and integrated appreciation of the pathology to be treated.
This technique is a minimally invasive approach that allows the surgeon to deal with several diseases, especially entire skull base obviating brain retraction. The endoscopic endonasal approach offers some advantages arising from the use of the endoscope itself: a superior close-up view of the relevant anatomy and an enlarged working angle with an increased panoramic vision within the surgical area. Indeed, it offers the opportunity to safely and effectively visualize the surgical field, which as a result provides a corridor through the nasal cavity to reach the brain with its neurovascular structures.
Most pituitary adenomas can be managed and removed through a standard transsphenoidal approach either microscopically or endoscopically. More recently, the introduction of the endoscope in the extended endoscopic endonasal approach has made this technique more popular, and today this technique can be considered suitable for the removal of lesions extending beyond the sellar area such as parasellar, suprasellar and/or retrosellar spaces.
We have been using the endoscopic endonasal technique since 1997 on more than 1000 patients, aiming to remove first sellar lesions and more recently skull base lesions applying the so-called extended endonasal approach.
We report our experience through a step-by-step depiction of the surgical techniques to access the different compartments, detailing the anatomy as seen from the endonasal perspective, focusing on dangerous landmarks, describing possible complications and techniques used to manage this kind of lesions.
D Solari
Lecture
6 years ago
657 views
6 likes
0 comments
19:31
Endoscopic endonasal approach to pituitary adenomas
The endoscopic endonasal approach is a continuously evolving speciality of modern neurosurgery, which requires precise anatomical knowledge, technical skills and integrated appreciation of the pathology to be treated.
This technique is a minimally invasive approach that allows the surgeon to deal with several diseases, especially entire skull base obviating brain retraction. The endoscopic endonasal approach offers some advantages arising from the use of the endoscope itself: a superior close-up view of the relevant anatomy and an enlarged working angle with an increased panoramic vision within the surgical area. Indeed, it offers the opportunity to safely and effectively visualize the surgical field, which as a result provides a corridor through the nasal cavity to reach the brain with its neurovascular structures.
Most pituitary adenomas can be managed and removed through a standard transsphenoidal approach either microscopically or endoscopically. More recently, the introduction of the endoscope in the extended endoscopic endonasal approach has made this technique more popular, and today this technique can be considered suitable for the removal of lesions extending beyond the sellar area such as parasellar, suprasellar and/or retrosellar spaces.
We have been using the endoscopic endonasal technique since 1997 on more than 1000 patients, aiming to remove first sellar lesions and more recently skull base lesions applying the so-called extended endonasal approach.
We report our experience through a step-by-step depiction of the surgical techniques to access the different compartments, detailing the anatomy as seen from the endonasal perspective, focusing on dangerous landmarks, describing possible complications and techniques used to manage this kind of lesions.
Laparoscopic Nissen fundoplication for atypical symptoms
Patients with gastro-esophageal reflux sometimes present with conflicting preoperative studies or atypical symptoms. This case had a primary complaint of pain and a normal 24-hour pH study. In this case, there were other indications for surgery - esophagitis and a type I hiatal hernia. Because medications offered no relief, it was elected to proceed with a Nissen fundoplication. A standard 2cm floppy fundoplication and repair of the hiatal hernia was performed in a stepwise fashion: hiatal dissection, esophageal mobilization, gastric fundus mobilization, posterior crural closure, and finally a short 360-degree fundoplication well fixed to the esophagus.
LL Swanström, J Marescaux
Surgical intervention
6 years ago
6834 views
104 likes
0 comments
16:36
Laparoscopic Nissen fundoplication for atypical symptoms
Patients with gastro-esophageal reflux sometimes present with conflicting preoperative studies or atypical symptoms. This case had a primary complaint of pain and a normal 24-hour pH study. In this case, there were other indications for surgery - esophagitis and a type I hiatal hernia. Because medications offered no relief, it was elected to proceed with a Nissen fundoplication. A standard 2cm floppy fundoplication and repair of the hiatal hernia was performed in a stepwise fashion: hiatal dissection, esophageal mobilization, gastric fundus mobilization, posterior crural closure, and finally a short 360-degree fundoplication well fixed to the esophagus.
Mucosal skinning for bowel endometriosis: standard technique
Bowel endometriosis is described in 3% to 37% of patients with endometriosis. In 90% of these cases, the rectum, the sigmoid colon or both are involved. It is the most severe form of the disease and its surgical management is complex. Surgery is very challenging and the degree of radical excision should always be counterbalanced with the risk of complications and functional disorders. Four types of surgery can be chosen: superficial excision or shaving, mucosal skinning, discoid excision, and segmental bowel resection. We believe that bowel resection can be avoided in some cases if mucosal skinning is first attempted. This video shows 2 endometriotic lesions of the rectosigmoid junction that were treated by mucosal skinning, hence avoiding an unnecessary segmental resection. The final result was satisfactory and postoperative outcome was uneventful. In 2008, the patient underwent a laparoscopic intervention, which revealed the presence of a deep infiltrating endometriosis and bilateral endometriotic cysts. Bilateral ovarian cystectomy was performed. Postoperative MRI for pelvic pains revealed a persistent lesion of the recto-vaginal septum. The patient then presented with persistent dysmenorrhea (8/10), chronic pelvic pain (8/10), dyschezia (6/10) without dyspareunia or bladder-related symptoms. Clinical examination showed a mobile anteverted uterus without clear evidence of a nodule lesion at the rectovaginal septum neither was it at the level of uterosacral ligaments, but most probably the presence of adhesions between the uterus and the rectosigmoid junction. Despite treatment with GnRH agonist, the patient was referred to the emergency department several times for bouts of intense pain.
A Wattiez, E Faller, J Albornoz, P Messori, T Boisramé
Surgical intervention
6 years ago
1383 views
74 likes
0 comments
11:40
Mucosal skinning for bowel endometriosis: standard technique
Bowel endometriosis is described in 3% to 37% of patients with endometriosis. In 90% of these cases, the rectum, the sigmoid colon or both are involved. It is the most severe form of the disease and its surgical management is complex. Surgery is very challenging and the degree of radical excision should always be counterbalanced with the risk of complications and functional disorders. Four types of surgery can be chosen: superficial excision or shaving, mucosal skinning, discoid excision, and segmental bowel resection. We believe that bowel resection can be avoided in some cases if mucosal skinning is first attempted. This video shows 2 endometriotic lesions of the rectosigmoid junction that were treated by mucosal skinning, hence avoiding an unnecessary segmental resection. The final result was satisfactory and postoperative outcome was uneventful. In 2008, the patient underwent a laparoscopic intervention, which revealed the presence of a deep infiltrating endometriosis and bilateral endometriotic cysts. Bilateral ovarian cystectomy was performed. Postoperative MRI for pelvic pains revealed a persistent lesion of the recto-vaginal septum. The patient then presented with persistent dysmenorrhea (8/10), chronic pelvic pain (8/10), dyschezia (6/10) without dyspareunia or bladder-related symptoms. Clinical examination showed a mobile anteverted uterus without clear evidence of a nodule lesion at the rectovaginal septum neither was it at the level of uterosacral ligaments, but most probably the presence of adhesions between the uterus and the rectosigmoid junction. Despite treatment with GnRH agonist, the patient was referred to the emergency department several times for bouts of intense pain.
Robot-assisted cystoprostatectomy with intracorporeal urinary diversion using a Hautmann technique
It is the case of a 62-year-old man diagnosed with a T2bN0M0 transitional cell adenocarcinoma, which was evidenced by pathological findings after resection of a bladder tumor.
Seven ports are required prior to the installation of the DaVinci® robotic system:
- 12mm port on superior border of umbilicus.
- Right robotic port at the midline between anterior superior iliac spine and umbilicus. - Two 5mm ports on both sides of right robotic port.
- Additional 12mm port between the two 5mm ports once dissection of bladder pedicles has been started.
- Two left robotic ports in left iliac fossa and anterior axillary line.
This video demonstrates the cystoprostatectomy technique with a W-pouch intracorporeal neobladder (Hautmann ileal neobladder), which is feasible in specialized centers.
References:
1. Kaufman DS, Shipley WU, Feldman AS. Bladder cancer. Lancet 2009;374(9685):239-49.
2. Lee DJ, Rothberg MB, McKiernan JM, Benson MC, Badani KK. Robot-assisted radical cystoprostatectomy in complex surgical patients: single institution report. Can J Urol 2009;16(3):4664-9.
3. Tunuguntla HS, Nieder AM, Manoharan M. Neobladder reconstruction following radical cystoprostatectomy for invasive bladder cancer. Minerva Urol Nefrol 2009;61(1):41-54.
4. Barocas DA, Patel SG, Chang SS, Clark PE, Smith JA Jr, Cookson MS. Outcomes of patients undergoing radical cystroprostatectomy for bladder cancer with prostatic involvement on final pathology. BJU Int 2009;104(8):1091-7.
5. Pruthi RS, Stefaniak H, Hubbard JS, Wallen EM. Robotic anterior pelvic exenteration for bladder cancer in the female: outcomes and comparisons to their male counterparts. J Laparoendosc Adv Surg Tech A 2009;19(1):23-7.
6. Kefer JC, Campbell SC. Current status of prostate-sparing cystectomy. Urol Oncol 2008;26(5):486-93.
7. Rawal S, Raghunath SK, Khanna S, Jain D, Kaul R, Kumar P, Chhabra R, Brushan K. Minilaparotomy radical cystoprostatectomy (Minilap RCP) in the surgical management of urinary bladder carcinoma: early experience. Jpn J Clin Oncol 2008;38(9):611-6.
8. Park SY, Cho KS, Ham WS, Choi HM, Hong SJ, Rha KH. Robot-assisted laparoscopic radical cystoprostatectomy with ileal conduit urinary diversion: initial experience in Korea. J Laparoendosc Adv Surg Tech A 2008;18(3):401-4.
9. Gregori A, Galli S, Goumas I, Scieri F, Stener S, Gaboardi F. A cost comparison of laparoscopic versus open radical cystoprostatectomy and orthotopic ileal neobladder at a single institution. Arch Ital Urol Androl 2007;79(3):127-9.
10. Young JL, Finley DS, Ornstein DD. Robotic-assisted laparoscopic cystoprostatectomy for prostatic carcinosarcoma. JSLS 2007;11(1)109-
12.
11. Nuñez-Mora C, Cabrera P, Garcia-Mediero JM, de Fata FR, Gonzalez J, Angulo J. Laparoscopic radical cystectomy and orthotopic urinary diversion in the malepatient: technique. Arch Esp Urol 2011;64(3):195-206.
12. Rehman J, Sangalli MN, Guru K, de Naeyer G, Schatteman P, Carpentier P, Mottrie A. Total intracorporeal robot-assisted laparoscopic ileal conduit (Bricker) urinary diversion: technique and outcomes. Can J Urol 2011;18(1):5548-56.
13. Canda AE, Asil E, Balbay MD. An unexpected resident in the ileum detected during robot-assisted laparoscopic radical cystoprostatectomy and intracorporeal Studer pouch formation: Taenia saginata parasite. J Endourol 2011;25(2):301-3.
14. Lin T, Huang J, Han J, Xu K, Huang H, Jiang C, Liu H, Zhang C, Yao Y, Xie W, Shah AK, Huang L. Hybrid laparoscopic endoscopic single-site surgery for radical cystoprostatectomy and orthotopic ileal neobladder: an initial experience of 12 cases. J Endourol 2011;25(1):57-63.
15. Josephson DY, Chen JA, Chan KG, Lau CS, Nelson RA, Wilson TG. Robotic-assisted laparoscopic radical cystoprostatectomy and extracorporeal continent urinary diversion: highlight of surgical techniques and outcomes. Int J Med Robot 2010;6(3):315-23.
16. Kasraeian A, Barret E, Cathelineau X, Rozet F, Galiano M, Sánchez-Salas R, Vallancien G. Robot-assisted laparoscopic cystoprostatectomy with extended pelvic lymphadenectomy, extracorporeal enterocystoplasty, and intracorporeal enterourethral anastomosis: initial Montsouris Experience. J Endourol 2010;24(3):409-13.
17. Varinot J, Camparo P, Roupret M, Bitker MO, Capron F, Cussenot O, Witjes JA, Compérat E. Full analysis of the prostatic urethra at the time of radical cystoprostatectomy for bladder cancer: impact on final disease stage. Virchows Arch 2009;455(5):449-53.
18. Palou Redorta J, Gaya Sopena JM, Gausa Gascon K, Sanchez-Martin F, Rosales Bordes A, Rodriguez Faba O, Villavicencio Mavrich H. Robotic radical cystoprostatectomy: oncological and functional analysis. Actas Urol Esp 2009;33(7):759-66.
D Rey, VE Corona Montes, T Piéchaud
Surgical intervention
6 years ago
4660 views
99 likes
0 comments
10:22
Robot-assisted cystoprostatectomy with intracorporeal urinary diversion using a Hautmann technique
It is the case of a 62-year-old man diagnosed with a T2bN0M0 transitional cell adenocarcinoma, which was evidenced by pathological findings after resection of a bladder tumor.
Seven ports are required prior to the installation of the DaVinci® robotic system:
- 12mm port on superior border of umbilicus.
- Right robotic port at the midline between anterior superior iliac spine and umbilicus. - Two 5mm ports on both sides of right robotic port.
- Additional 12mm port between the two 5mm ports once dissection of bladder pedicles has been started.
- Two left robotic ports in left iliac fossa and anterior axillary line.
This video demonstrates the cystoprostatectomy technique with a W-pouch intracorporeal neobladder (Hautmann ileal neobladder), which is feasible in specialized centers.
References:
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14. Lin T, Huang J, Han J, Xu K, Huang H, Jiang C, Liu H, Zhang C, Yao Y, Xie W, Shah AK, Huang L. Hybrid laparoscopic endoscopic single-site surgery for radical cystoprostatectomy and orthotopic ileal neobladder: an initial experience of 12 cases. J Endourol 2011;25(1):57-63.
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16. Kasraeian A, Barret E, Cathelineau X, Rozet F, Galiano M, Sánchez-Salas R, Vallancien G. Robot-assisted laparoscopic cystoprostatectomy with extended pelvic lymphadenectomy, extracorporeal enterocystoplasty, and intracorporeal enterourethral anastomosis: initial Montsouris Experience. J Endourol 2010;24(3):409-13.
17. Varinot J, Camparo P, Roupret M, Bitker MO, Capron F, Cussenot O, Witjes JA, Compérat E. Full analysis of the prostatic urethra at the time of radical cystoprostatectomy for bladder cancer: impact on final disease stage. Virchows Arch 2009;455(5):449-53.
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