We use cookies to offer you an optimal experience on our website. By browsing our website, you accept the use of cookies.

Monthly publications

#May 2013
Filter by
Clear filter Specialty
View more

Clear filter Media type
View more
Clear filter Category
View more
Robot-assisted revision of stenotic gastrojejunostomy after laparoscopic Roux-en-Y gastric bypass
This video presents the case of a 37-year-old woman who benefited from a laparoscopic Roux-en-Y gastric bypass with circular gastrojejunal anastomosis one year ago. An anastomotic stenosis rapidly occurred. It was managed conventionally by several endoscopic balloon dilatations without any stable results. It was found legitimate to offer the patient a revision of the gastrojejunostomy. Prior to performing the reintervention, a nasojejunal tube was placed in order to improve the patient’s enteral nutrition. Surgery consisted in the resection of the existing gastrojejunostomy and in the tailoring of a new manual anastomosis using the da Vinci™ robotic Surgical System. The postoperative outcome was uneventful. The patient no longer reports any dysphagia 3 months postoperatively.
M Vix, J Marescaux
Surgical intervention
5 years ago
1145 views
9 likes
0 comments
15:12
Robot-assisted revision of stenotic gastrojejunostomy after laparoscopic Roux-en-Y gastric bypass
This video presents the case of a 37-year-old woman who benefited from a laparoscopic Roux-en-Y gastric bypass with circular gastrojejunal anastomosis one year ago. An anastomotic stenosis rapidly occurred. It was managed conventionally by several endoscopic balloon dilatations without any stable results. It was found legitimate to offer the patient a revision of the gastrojejunostomy. Prior to performing the reintervention, a nasojejunal tube was placed in order to improve the patient’s enteral nutrition. Surgery consisted in the resection of the existing gastrojejunostomy and in the tailoring of a new manual anastomosis using the da Vinci™ robotic Surgical System. The postoperative outcome was uneventful. The patient no longer reports any dysphagia 3 months postoperatively.
Laparoscopic Roux-en-Y gastric bypass with linear gastrojejunostomy: occurrence of postsurgical complications
Roux-en-Y gastric bypass is a common procedure in bariatric surgery. It can be perfectly standardized in order to make it technically easier to perform and to reduce risks of postoperative complications. This video shows a conventional gastric bypass procedure with linear gastrojejunostomy. The intervention ran smoothly. Twenty-four hours postoperatively, the patient complained of abdominal pain. Serum chemistries demonstrated severe inflammatory signs. An emergency CT-scan demonstrated a gastrojejunal fistula. It was decided to perform an emergency laparoscopic reintervention. An anastomotic dehiscence was identified and sutured. The postoperative outcome was finally uneventful.
M Vix, G Sojod, J Marescaux
Surgical intervention
5 years ago
2407 views
21 likes
0 comments
22:50
Laparoscopic Roux-en-Y gastric bypass with linear gastrojejunostomy: occurrence of postsurgical complications
Roux-en-Y gastric bypass is a common procedure in bariatric surgery. It can be perfectly standardized in order to make it technically easier to perform and to reduce risks of postoperative complications. This video shows a conventional gastric bypass procedure with linear gastrojejunostomy. The intervention ran smoothly. Twenty-four hours postoperatively, the patient complained of abdominal pain. Serum chemistries demonstrated severe inflammatory signs. An emergency CT-scan demonstrated a gastrojejunal fistula. It was decided to perform an emergency laparoscopic reintervention. An anastomotic dehiscence was identified and sutured. The postoperative outcome was finally uneventful.
Laparoscopic hand-sewn re-gastrojejunostomy for complicated Roux-en-Y gastric bypass
Introduction: Laparoscopic Roux-en-Y gastric bypass (LRYGB) is a popular bariatric procedure associated with potential risk of late complications such as anastomotic stricture, marginal ulceration, fistula formation, weight gain, and nutritional deficiencies. A 48-year-old woman submitted to LRYGB 1.5 year before, presented a marginal ulcer of the gastrojejunostomy, non-responsive to medical therapy, associated with total dysphagia and cachexia. At the time of LRYGB, a linear stapled side-to-side gastrojejunostomy has been performed.

Video: The revision was completed using 4 abdominal trocars and consisted in these successive steps: adhesiolysis between the left liver lobe, gastrojejunostomy and gastric pouch; identification of right crus and lower esophagus; mobilization of the stoma and gastric pouch from both crura, transverse colon and gastric remnant; division of the gastric pouch above the stoma with preservation of the left gastric vessels; division of the proximal alimentary limb under the stoma; new double-layer hand-sewn gastrojejunostomy (PDS 1 externally, PDS 2/0 internally); hiatoplasty; leak test; specimen’s removal through trocar enlargement.

Results: No perioperative complications or additional trocars were registered. Operative time was 157 minutes and estimated blood loss 20 cc. The postoperative course was uneventful and patient was discharged on postoperative day 3. After 1 year, the patient is well and tolerates a regular diet.

Conclusions: Postoperative complications after LRYGB, such as marginal ulcer, can be safely treated by laparoscopy. New hand-sewn anastomosis permits to control the stoma openings and to calibrate the anastomosis size, especially in case of small gastric pouch.
G Dapri
Surgical intervention
5 years ago
1335 views
14 likes
0 comments
09:18
Laparoscopic hand-sewn re-gastrojejunostomy for complicated Roux-en-Y gastric bypass
Introduction: Laparoscopic Roux-en-Y gastric bypass (LRYGB) is a popular bariatric procedure associated with potential risk of late complications such as anastomotic stricture, marginal ulceration, fistula formation, weight gain, and nutritional deficiencies. A 48-year-old woman submitted to LRYGB 1.5 year before, presented a marginal ulcer of the gastrojejunostomy, non-responsive to medical therapy, associated with total dysphagia and cachexia. At the time of LRYGB, a linear stapled side-to-side gastrojejunostomy has been performed.

Video: The revision was completed using 4 abdominal trocars and consisted in these successive steps: adhesiolysis between the left liver lobe, gastrojejunostomy and gastric pouch; identification of right crus and lower esophagus; mobilization of the stoma and gastric pouch from both crura, transverse colon and gastric remnant; division of the gastric pouch above the stoma with preservation of the left gastric vessels; division of the proximal alimentary limb under the stoma; new double-layer hand-sewn gastrojejunostomy (PDS 1 externally, PDS 2/0 internally); hiatoplasty; leak test; specimen’s removal through trocar enlargement.

Results: No perioperative complications or additional trocars were registered. Operative time was 157 minutes and estimated blood loss 20 cc. The postoperative course was uneventful and patient was discharged on postoperative day 3. After 1 year, the patient is well and tolerates a regular diet.

Conclusions: Postoperative complications after LRYGB, such as marginal ulcer, can be safely treated by laparoscopy. New hand-sewn anastomosis permits to control the stoma openings and to calibrate the anastomosis size, especially in case of small gastric pouch.
Laparoscopic management of small bowel perforation induced by foreign body
Ingested foreign bodies are a common cause for emergency hospital admission. A precise interview of the patient often allows to establish the diagnosis. In 90% of cases, the foreign body is spontaneously eliminated without inducing any particular symptoms. In less than 10% of cases, it requires non-surgical extraction maneuvers (enemas, endoscopy). Only 1% of cases are treated surgically. Modern imaging frequently allows to establish a precise topographic diagnosis based on aspect, size and density. Coupled with laparoscopic surgery, it allows for an early, targeted and minimally invasive management. In this video, we show the case of a patient presenting with typical signs of peritonitis along with the incidental discovery of an intraluminal foreign body in the small bowel which brought about a micro-perforation.
L Marx, M Raharimanantsoa, J Marescaux
Surgical intervention
5 years ago
1775 views
12 likes
0 comments
10:15
Laparoscopic management of small bowel perforation induced by foreign body
Ingested foreign bodies are a common cause for emergency hospital admission. A precise interview of the patient often allows to establish the diagnosis. In 90% of cases, the foreign body is spontaneously eliminated without inducing any particular symptoms. In less than 10% of cases, it requires non-surgical extraction maneuvers (enemas, endoscopy). Only 1% of cases are treated surgically. Modern imaging frequently allows to establish a precise topographic diagnosis based on aspect, size and density. Coupled with laparoscopic surgery, it allows for an early, targeted and minimally invasive management. In this video, we show the case of a patient presenting with typical signs of peritonitis along with the incidental discovery of an intraluminal foreign body in the small bowel which brought about a micro-perforation.
Full laparoscopic pancreaticoduodenectomy for malignant ampulloma
In the first description of Laparoscopic PancreaticoDuodenectomy (LPD) by Gagner and Pomp in 1994, the authors reported the technical feasibility of the procedure, but questioned its advantages as compared with the open approach. Recent reports on large series of LPD demonstrated that the procedure might not only be feasible, but that it might have advantages as compared with open pancreaticoduodenectomy. Blood loss, ICU length of stay and overall hospital length of stay were shorter in the LPD group at the cost of significantly higher operative times. This video demonstrates a full LPD performed for a malignant ampulloma. All major steps of the procedure are extensively and clearly demonstrated.
A Talvane Torres de Oliveira, C Lacerda, PA Bertulucci
Surgical intervention
5 years ago
7021 views
72 likes
2 comments
40:39
Full laparoscopic pancreaticoduodenectomy for malignant ampulloma
In the first description of Laparoscopic PancreaticoDuodenectomy (LPD) by Gagner and Pomp in 1994, the authors reported the technical feasibility of the procedure, but questioned its advantages as compared with the open approach. Recent reports on large series of LPD demonstrated that the procedure might not only be feasible, but that it might have advantages as compared with open pancreaticoduodenectomy. Blood loss, ICU length of stay and overall hospital length of stay were shorter in the LPD group at the cost of significantly higher operative times. This video demonstrates a full LPD performed for a malignant ampulloma. All major steps of the procedure are extensively and clearly demonstrated.
Full endoscopic robot-assisted trisegmentectomy of the pulmonary left upper lobe for diagnosis and treatment
Objective:
When small pulmonary lesions are discovered on CT-scan during cancer surveillance, the differentiation between primary cancer metastasis and another metachronous carcinoma is impossible on frozen section. In this context, segmentectomy as sparing-lung resection is probably a valuable option to treat both lesions. However, segmentectomy is a complex procedure when using video thoracoscopy. Robotic segmentectomy, as described by Ninan (1) and Melfi (2), could be a more accurate and easier approach. Our objective is to show this reproducible technique.

Bibliographic references:
1. Ninan M, Dylewski MR. Total port-access robot-assisted pulmonary lobectomy without utility thoracotomy. Eur J Cardiothorac Surg 2010;38:231-2.
2. Melfi FM, Menconi GF, Mariani AM, Angeletti CA. Early experience with robotic technology for thoracoscopic surgery. Eur J Cardiothorac Surg 2002;21:864-8.
Materials and methods:
In 2006, a 78-year-old man was found with a medical history of asbestos exposure and colonic adenocarcinoma with lymph node metastasis treated by hemi-colectomy and adjuvant chemotherapy. During colon cancer surveillance, a centrimetric pulmonary mass of the left upper lobe was found on CT-scan in September 2012. In this context, the lesion was suggestive of metastasis, but primary lung cancer could not be ruled out (due to the patient’s history of smoking). As a result, trisegmentectomy of the left upper lobe was decided upon instead of wedge resection, for diagnosis and treatment of the lesion.
Results: The postoperative course was uneventful, with a medical discharge on the fourth day following trisegmentectomy. Pathological findings concluded to a primary lung carcinoma without lymph node invasion.
Conclusion: Complete and precise segmentectomy can be performed safely by means of the da Vinci™ robotic system, without using a utility thoracotomy. This diagnostic and therapeutic option must be considered in case of small pulmonary lesions occurring during cancer surveillance.
JM Baste, M Renaux-Petel, C Peillon
Surgical intervention
5 years ago
1109 views
6 likes
0 comments
11:42
Full endoscopic robot-assisted trisegmentectomy of the pulmonary left upper lobe for diagnosis and treatment
Objective:
When small pulmonary lesions are discovered on CT-scan during cancer surveillance, the differentiation between primary cancer metastasis and another metachronous carcinoma is impossible on frozen section. In this context, segmentectomy as sparing-lung resection is probably a valuable option to treat both lesions. However, segmentectomy is a complex procedure when using video thoracoscopy. Robotic segmentectomy, as described by Ninan (1) and Melfi (2), could be a more accurate and easier approach. Our objective is to show this reproducible technique.

Bibliographic references:
1. Ninan M, Dylewski MR. Total port-access robot-assisted pulmonary lobectomy without utility thoracotomy. Eur J Cardiothorac Surg 2010;38:231-2.
2. Melfi FM, Menconi GF, Mariani AM, Angeletti CA. Early experience with robotic technology for thoracoscopic surgery. Eur J Cardiothorac Surg 2002;21:864-8.
Materials and methods:
In 2006, a 78-year-old man was found with a medical history of asbestos exposure and colonic adenocarcinoma with lymph node metastasis treated by hemi-colectomy and adjuvant chemotherapy. During colon cancer surveillance, a centrimetric pulmonary mass of the left upper lobe was found on CT-scan in September 2012. In this context, the lesion was suggestive of metastasis, but primary lung cancer could not be ruled out (due to the patient’s history of smoking). As a result, trisegmentectomy of the left upper lobe was decided upon instead of wedge resection, for diagnosis and treatment of the lesion.
Results: The postoperative course was uneventful, with a medical discharge on the fourth day following trisegmentectomy. Pathological findings concluded to a primary lung carcinoma without lymph node invasion.
Conclusion: Complete and precise segmentectomy can be performed safely by means of the da Vinci™ robotic system, without using a utility thoracotomy. This diagnostic and therapeutic option must be considered in case of small pulmonary lesions occurring during cancer surveillance.
Laparoscopic colposacropexy for the treatment of an apical defect in a patient with previous total hysterectomy
We present the case of a 69-year-old patient who suffered from an elytrocele. Previously, she had undergone a total hysterectomy with anterior and posterior colpoperineoplasty due to the presence of a grade 2 cystocele, without urinary incontinence. The management of genital prolapse requires a thorough knowledge of the anatomy and physiology of the female pelvic floor. This video outlines the main steps to follow for the repair of an apical defect with no true rectocele or cystocele. It also offers a very good insight of the specific issues to be considered when performing dissection and mesh fixation in specific situations, such as distortion of the normal anatomy due to the scarring process from a previous surgery and obesity. This surgery was performed and streamed live.
A Wattiez, C Redondo Guisasola, M Puga, F Asencio
Surgical intervention
5 years ago
4336 views
77 likes
0 comments
18:00
Laparoscopic colposacropexy for the treatment of an apical defect in a patient with previous total hysterectomy
We present the case of a 69-year-old patient who suffered from an elytrocele. Previously, she had undergone a total hysterectomy with anterior and posterior colpoperineoplasty due to the presence of a grade 2 cystocele, without urinary incontinence. The management of genital prolapse requires a thorough knowledge of the anatomy and physiology of the female pelvic floor. This video outlines the main steps to follow for the repair of an apical defect with no true rectocele or cystocele. It also offers a very good insight of the specific issues to be considered when performing dissection and mesh fixation in specific situations, such as distortion of the normal anatomy due to the scarring process from a previous surgery and obesity. This surgery was performed and streamed live.