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Monthly publications

#July 2012
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Laparoscopic right colectomy for caecal cancer using Sonicision™ cordless ultrasonic dissection device
The interest of this video is to demonstrate a fully laparoscopic oncologic right colectomy technique performed by means of novel dissection instruments such as the Sonicision™ cordless ultrasonic dissection device (Valleylab, Covidien) as well as stapling devices designed for anastomosis (Endo-GIA™ Tri-staple™ technology, Covidien). Regarding the Sonicision™ cordless ultrasonic dissection device, one may appreciate its efficacy, notably to achieve hemostasis of ileocolic and right colic vessels.
Its simplicity of use and safety in controlling the action to coagulate and divide tissues have been strongly appreciated from the operator’s side who is a regular user of the Ligasure™ technology. The great freedom of movement related to the absence of cable and to the lightness of the instrument accounts mostly for the almost immediate adoption of this novel laparoscopic instrument.
J Leroy, J Marescaux
Surgical intervention
6 years ago
5695 views
133 likes
0 comments
12:28
Laparoscopic right colectomy for caecal cancer using Sonicision™ cordless ultrasonic dissection device
The interest of this video is to demonstrate a fully laparoscopic oncologic right colectomy technique performed by means of novel dissection instruments such as the Sonicision™ cordless ultrasonic dissection device (Valleylab, Covidien) as well as stapling devices designed for anastomosis (Endo-GIA™ Tri-staple™ technology, Covidien). Regarding the Sonicision™ cordless ultrasonic dissection device, one may appreciate its efficacy, notably to achieve hemostasis of ileocolic and right colic vessels.
Its simplicity of use and safety in controlling the action to coagulate and divide tissues have been strongly appreciated from the operator’s side who is a regular user of the Ligasure™ technology. The great freedom of movement related to the absence of cable and to the lightness of the instrument accounts mostly for the almost immediate adoption of this novel laparoscopic instrument.
A laparoscopic right hemicolectomy with a primary vascular approach
Introduction:
We present the case of a 54-year-old male with a 5cm villous adenoma at the ileocaecal valve with a focus of invasive carcinoma. Previous attempts at endoscopic mucosal resection were unsuccessful.

Methods:
The set-up consisted of two 10/12mm ports (sub-umbilical and left iliac fossa) and three 5mm ports (right iliac fossa, supra-umbilical and epigastric). The primary vascular approach initially consists of identification, ligation and division of the vessels (ileocolic, right colic and right branch of the middle colic) at their origin, retroperitoneal mobilization of the mesocolon, taking down of the hepatic flexure and completion of the mobilization of the caecum and lateral attachments.

Conclusion:
The primary vascular approach to laparoscopic right hemi-colectomy is achievable.
M Walz, J Marescaux
Surgical intervention
6 years ago
10678 views
256 likes
0 comments
35:19
A laparoscopic right hemicolectomy with a primary vascular approach
Introduction:
We present the case of a 54-year-old male with a 5cm villous adenoma at the ileocaecal valve with a focus of invasive carcinoma. Previous attempts at endoscopic mucosal resection were unsuccessful.

Methods:
The set-up consisted of two 10/12mm ports (sub-umbilical and left iliac fossa) and three 5mm ports (right iliac fossa, supra-umbilical and epigastric). The primary vascular approach initially consists of identification, ligation and division of the vessels (ileocolic, right colic and right branch of the middle colic) at their origin, retroperitoneal mobilization of the mesocolon, taking down of the hepatic flexure and completion of the mobilization of the caecum and lateral attachments.

Conclusion:
The primary vascular approach to laparoscopic right hemi-colectomy is achievable.
Segmental bowel resection and transanal specimen extraction for Deep Infiltrating Endometriosis (DIE)
Endometriosis can affect the bowel in 5-15% of cases and the most common sites are the rectum, the sigmoid colon, the appendix, and the small bowel. Patients may present dysmenorrhea, dyspareunia and chronic pelvic pain, as well as digestive symptoms such as dyschezia, constipation and diarrhea during menstruation. Preoperative work-up includes transanal ultrasound and magnetic resonance imaging, which according to the nodule’s location, can accurately describe the lesions. The laparoscopic approach includes adhesiolysis (shaving), partial thickness wall excision (mucosal skinning), discoid resection, and segmental bowel resection. In this video, we present the case of a 30-year-old patient complaining from severe dysmenorrhea, dyspareunia and dyschezia associated with deep infiltrating endometriosis (DIE) of the sigmoid colon that was treated by means of nodule excision, segmental bowel resection, and transanal specimen extraction.
A Wattiez, J Leroy, J Albornoz, E Faller, M Puga
Surgical intervention
6 years ago
2412 views
15 likes
0 comments
10:12
Segmental bowel resection and transanal specimen extraction for Deep Infiltrating Endometriosis (DIE)
Endometriosis can affect the bowel in 5-15% of cases and the most common sites are the rectum, the sigmoid colon, the appendix, and the small bowel. Patients may present dysmenorrhea, dyspareunia and chronic pelvic pain, as well as digestive symptoms such as dyschezia, constipation and diarrhea during menstruation. Preoperative work-up includes transanal ultrasound and magnetic resonance imaging, which according to the nodule’s location, can accurately describe the lesions. The laparoscopic approach includes adhesiolysis (shaving), partial thickness wall excision (mucosal skinning), discoid resection, and segmental bowel resection. In this video, we present the case of a 30-year-old patient complaining from severe dysmenorrhea, dyspareunia and dyschezia associated with deep infiltrating endometriosis (DIE) of the sigmoid colon that was treated by means of nodule excision, segmental bowel resection, and transanal specimen extraction.
Endoscopic microsurgery: a new concept
In this authoritative lecture, Dr. Philippe Liverneaux focuses on endoscopic microsurgery. Conventional microsurgery requires large incisions and extensive dissections while it is performed in a small operating field. In this context, the concept of endoscopic microsurgery appears to be a logical way to be put to the test.
We rely on four years of practical experience using the Da Vinci™ robot at the European Institute of Telesurgery in Strasbourg, France. To-date, 40 patients have been operated on by our Hand Surgery and Peripheral Nerve Department.
Endoscopic Microsurgery combines the properties of microsurgery, endoscopic surgery, and telesurgery. Not only does it allow to magnify the vision of the operating field, but it also allows to multiply the operator's hand movements, and all the more so by means of minimally invasive approaches. Its evolution necessitates the development of a dedicated robot and specific instrumentation capable of handling such procedures.
P Liverneaux
Lecture
6 years ago
441 views
2 likes
0 comments
19:34
Endoscopic microsurgery: a new concept
In this authoritative lecture, Dr. Philippe Liverneaux focuses on endoscopic microsurgery. Conventional microsurgery requires large incisions and extensive dissections while it is performed in a small operating field. In this context, the concept of endoscopic microsurgery appears to be a logical way to be put to the test.
We rely on four years of practical experience using the Da Vinci™ robot at the European Institute of Telesurgery in Strasbourg, France. To-date, 40 patients have been operated on by our Hand Surgery and Peripheral Nerve Department.
Endoscopic Microsurgery combines the properties of microsurgery, endoscopic surgery, and telesurgery. Not only does it allow to magnify the vision of the operating field, but it also allows to multiply the operator's hand movements, and all the more so by means of minimally invasive approaches. Its evolution necessitates the development of a dedicated robot and specific instrumentation capable of handling such procedures.
Totally laparoscopic single port hepatic left lobectomy and cholecystectomy for cholangiocarcinoma
Background: Single port (SP) hepatic resection presents a few examples in the recent literature which suggest a clear possibility for better cosmetic results and shorter hospital stay. This video presents a patient who has undergone totally laparoscopic SP left hepatic lobectomy for cholangiocarcinoma and cholecystectomy for cholelitiasis.

The present case shows a 70-year-old woman with a BMI of 26 kg/m2 with documented 45mm hepatic mass and irregular margins involving segment III suggesting intrahepatic cholangiocarcinoma. A 40mm peri-umbilical incision was performed. SP hepatic left lobectomy was performed using a 4-access OCTO™ port (High-Tech Center, Seoul, Korea), with a 30-degree scope, a curved grasping forceps, and Atlas Ligasure™ (Covidien, USA) and Vascular Endo GIA™ (Covidien, USA); specimen retrieval was performed through the right periumbilical incision.

Results: No conversion to open surgery was necessary, neither were additional trocars. Total operative time was 120 minutes and laparoscopic time 80 minutes; liver transection time was 24 minutes. Final umbilical incision length was 40mm. Blood loss was lower than 40cc, no transfusion or abdominal drainage was required. The postoperative course was uneventful and the patient was discharged on postoperative day 2.

Conclusions: Left hepatic lobectomy for localized intrahepatic cholangiocarcinoma and associated cholecystectomy can be safely performed with a periumbilical SP procedure, with macro- and microscopically neoplasia-free margins.
U Cillo, E Gringeri, R Boetto, G Zanus
Surgical intervention
6 years ago
3858 views
30 likes
1 comment
05:20
Totally laparoscopic single port hepatic left lobectomy and cholecystectomy for cholangiocarcinoma
Background: Single port (SP) hepatic resection presents a few examples in the recent literature which suggest a clear possibility for better cosmetic results and shorter hospital stay. This video presents a patient who has undergone totally laparoscopic SP left hepatic lobectomy for cholangiocarcinoma and cholecystectomy for cholelitiasis.

The present case shows a 70-year-old woman with a BMI of 26 kg/m2 with documented 45mm hepatic mass and irregular margins involving segment III suggesting intrahepatic cholangiocarcinoma. A 40mm peri-umbilical incision was performed. SP hepatic left lobectomy was performed using a 4-access OCTO™ port (High-Tech Center, Seoul, Korea), with a 30-degree scope, a curved grasping forceps, and Atlas Ligasure™ (Covidien, USA) and Vascular Endo GIA™ (Covidien, USA); specimen retrieval was performed through the right periumbilical incision.

Results: No conversion to open surgery was necessary, neither were additional trocars. Total operative time was 120 minutes and laparoscopic time 80 minutes; liver transection time was 24 minutes. Final umbilical incision length was 40mm. Blood loss was lower than 40cc, no transfusion or abdominal drainage was required. The postoperative course was uneventful and the patient was discharged on postoperative day 2.

Conclusions: Left hepatic lobectomy for localized intrahepatic cholangiocarcinoma and associated cholecystectomy can be safely performed with a periumbilical SP procedure, with macro- and microscopically neoplasia-free margins.
Laparoscopic augmentation enterocystoplasty and Mitrofanoff for neurogenic bladder
As a complementary video to the Mitrofanoff technique, we present the case of a patient with neurogenic bladder secondary to spina bifida. This video demonstrates augmentation ileocystoplasty complementary to Mitrofanoff appendicovesicostomy performed laparoscopically. Preoperative bowel preparation was not performed. Average operative time was 4.30 hours. This video shows that it is a safe, feasible and effective laparoscopic procedure with shorter recovery time and good cosmesis.

References:
1. Bagrodia A,Gargollo P. Robot-assisted bladder neck reconstruction, bladder neck sling, and appendicovesicostomy in children: description of technique and initial results. J Endourol 2011:25;8:1299-305.
2. Farrugia MK, Malone PS. Educational article: The Mitrofanoff procedure. J Pediatr Urol 2010;6:330-7.
3. Berkowitz J, North AC, Tripp R, Gearhart JP, Laksmanan Y. Mitrofanoff continent catheterizable conduits: top down or bottom up? J Pediatr Urol 2009;5:122-5.
4. Arango Rave ME, Lince Varela LF, Salazar Sanín C, Hoyos Figueroa FC, Hurtado SN, Rendón Isaza JC. [Outcomes the Mitrofanoff technique in the management of patients with neurogenic bladder: the experience in the San Vicente de Paul Universitary Hospital]. Actas Urol Esp 2009;33:69-75.
5. Gundeti MS, Eng MK, Reynolds WS, Zagaja GP. Pediatric robotic-assisted laparoscopic augmentation ileocystoplasty and Mitrofanoff appendicovesicostomy: complete intracorporeal--initial case report. Urology 2008;72:1144-7.
6. Thakre AA, Yeung CK, Peters C. Robot-assisted Mitrofanoff and Malone antegrade continence enema reconstruction using divided appendix. J Endourol 2008;22:2393-6.
7. Sahadevan K, Pickard RS, Neal DE, Hasan TS. Is continent diversion using the Mitrofanoff principle a viable long-term option for adults requiring bladder replacement? BJU Int 2008;102:236-40.
8. Lendvay TS, Shnorhavorian M, Grady RW. Robotic-assisted laparoscopic Mitrofanoff appendicovesicostomy and antegrade continent enema colon tube creation in a pediatric spina bifida patient. J Laparoendosc Adv Surg Tech A 2008;18:310-2.
9. Mhiri MN, Bahloul A, Chabchoub K. [Mitrofanoff appendicovesicostomy in children: indication and results]. Prog Urol 2007;17:245-9.
10. Leslie JA, Dussinger AM, Meldrum KK. Creation of continence mechanisms (Mitrofanoff) without appendix: the Monti and spiral Monti procedures. Urol Oncol 2007;25:148-53.
11. Basavaraj DR, Harrison SC. The Mitrofanoff procedure in the management of intractable incontinence: a critical appraisal. Curr Opin Urol 2006;16:244-7.
12. Wille MA, Zagaja GP, Shalhav AL, Gundeti MS. Continence outcomes in patients undergoing robotic assisted laparoscopic mitrofanoff appendicovesicostomy. J Urol 2011;185:1438-43.
13. Wille MA,Jayram G,Gundeti MS Feasibility and early outcomes of robotic-assisted laparoscopic Mitrofanoffappendicovesicostomy in patients with prune belly syndrome BJU Int 2012;109:1:125-9.
14. Gundeti MS, Acharya SS, Zagaja GP, Shalhav AL. Paediatric robotic-assisted laparoscopic augmentation ileocystoplasty and Mitrofanoff appendicovesicostomy (RALIMA): feasibility of and initial experience with the University of Chicago technique. BJU Int 2011;107:962-9.
15. Chabchoub K, Ketata H, Fakhfakh H, Bahloul A, Mhiri MN. [Continent urinary diversion (Mitrofanoff principle). Physical mechanisms and urodynamic explanation of continence]. Prog Urol 2008;18:120-4.
16. Karsenty G, Chartier-Kastler E, Mozer P, Even-Schneider A, Denys P, Richard F. A novel technique to achieve cutaneous continent urinary diversion in spinal cord-injured patients unable to catheterize through native urethra. Spinal Cord 2008;46:305-10.
17. Nguyen HT, Passerotti CC, Penna FJ, Retik AB, Peters CA. Robotic assisted laparoscopic Mitrofanoff appendicovesicostomy: preliminary experience in a pediatric population. J Urol 2009;182:1528-34.
18. Vian E, Soustelle L, Viale S, Costa P. [A technique of continent vesicostomy with ileocystoplasty: study of 32 patients]. Prog Urol 2009;19:116-21.
19. Hsu TH, Shortliffe LD. Laparoscopic Mitrofanoff appendicovesicostomy. Urology 2004;64:802-4.
D Rey, VE Corona Montes, T Piéchaud
Surgical intervention
6 years ago
1950 views
31 likes
0 comments
09:45
Laparoscopic augmentation enterocystoplasty and Mitrofanoff for neurogenic bladder
As a complementary video to the Mitrofanoff technique, we present the case of a patient with neurogenic bladder secondary to spina bifida. This video demonstrates augmentation ileocystoplasty complementary to Mitrofanoff appendicovesicostomy performed laparoscopically. Preoperative bowel preparation was not performed. Average operative time was 4.30 hours. This video shows that it is a safe, feasible and effective laparoscopic procedure with shorter recovery time and good cosmesis.

References:
1. Bagrodia A,Gargollo P. Robot-assisted bladder neck reconstruction, bladder neck sling, and appendicovesicostomy in children: description of technique and initial results. J Endourol 2011:25;8:1299-305.
2. Farrugia MK, Malone PS. Educational article: The Mitrofanoff procedure. J Pediatr Urol 2010;6:330-7.
3. Berkowitz J, North AC, Tripp R, Gearhart JP, Laksmanan Y. Mitrofanoff continent catheterizable conduits: top down or bottom up? J Pediatr Urol 2009;5:122-5.
4. Arango Rave ME, Lince Varela LF, Salazar Sanín C, Hoyos Figueroa FC, Hurtado SN, Rendón Isaza JC. [Outcomes the Mitrofanoff technique in the management of patients with neurogenic bladder: the experience in the San Vicente de Paul Universitary Hospital]. Actas Urol Esp 2009;33:69-75.
5. Gundeti MS, Eng MK, Reynolds WS, Zagaja GP. Pediatric robotic-assisted laparoscopic augmentation ileocystoplasty and Mitrofanoff appendicovesicostomy: complete intracorporeal--initial case report. Urology 2008;72:1144-7.
6. Thakre AA, Yeung CK, Peters C. Robot-assisted Mitrofanoff and Malone antegrade continence enema reconstruction using divided appendix. J Endourol 2008;22:2393-6.
7. Sahadevan K, Pickard RS, Neal DE, Hasan TS. Is continent diversion using the Mitrofanoff principle a viable long-term option for adults requiring bladder replacement? BJU Int 2008;102:236-40.
8. Lendvay TS, Shnorhavorian M, Grady RW. Robotic-assisted laparoscopic Mitrofanoff appendicovesicostomy and antegrade continent enema colon tube creation in a pediatric spina bifida patient. J Laparoendosc Adv Surg Tech A 2008;18:310-2.
9. Mhiri MN, Bahloul A, Chabchoub K. [Mitrofanoff appendicovesicostomy in children: indication and results]. Prog Urol 2007;17:245-9.
10. Leslie JA, Dussinger AM, Meldrum KK. Creation of continence mechanisms (Mitrofanoff) without appendix: the Monti and spiral Monti procedures. Urol Oncol 2007;25:148-53.
11. Basavaraj DR, Harrison SC. The Mitrofanoff procedure in the management of intractable incontinence: a critical appraisal. Curr Opin Urol 2006;16:244-7.
12. Wille MA, Zagaja GP, Shalhav AL, Gundeti MS. Continence outcomes in patients undergoing robotic assisted laparoscopic mitrofanoff appendicovesicostomy. J Urol 2011;185:1438-43.
13. Wille MA,Jayram G,Gundeti MS Feasibility and early outcomes of robotic-assisted laparoscopic Mitrofanoffappendicovesicostomy in patients with prune belly syndrome BJU Int 2012;109:1:125-9.
14. Gundeti MS, Acharya SS, Zagaja GP, Shalhav AL. Paediatric robotic-assisted laparoscopic augmentation ileocystoplasty and Mitrofanoff appendicovesicostomy (RALIMA): feasibility of and initial experience with the University of Chicago technique. BJU Int 2011;107:962-9.
15. Chabchoub K, Ketata H, Fakhfakh H, Bahloul A, Mhiri MN. [Continent urinary diversion (Mitrofanoff principle). Physical mechanisms and urodynamic explanation of continence]. Prog Urol 2008;18:120-4.
16. Karsenty G, Chartier-Kastler E, Mozer P, Even-Schneider A, Denys P, Richard F. A novel technique to achieve cutaneous continent urinary diversion in spinal cord-injured patients unable to catheterize through native urethra. Spinal Cord 2008;46:305-10.
17. Nguyen HT, Passerotti CC, Penna FJ, Retik AB, Peters CA. Robotic assisted laparoscopic Mitrofanoff appendicovesicostomy: preliminary experience in a pediatric population. J Urol 2009;182:1528-34.
18. Vian E, Soustelle L, Viale S, Costa P. [A technique of continent vesicostomy with ileocystoplasty: study of 32 patients]. Prog Urol 2009;19:116-21.
19. Hsu TH, Shortliffe LD. Laparoscopic Mitrofanoff appendicovesicostomy. Urology 2004;64:802-4.