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

Monthly publications

#December 2014
Filter by
Specialty

Type
Category
Laparoscopic right hepatectomy using hanging maneuver and Glissonian approach
Background: In open surgery for major hepatectomies, the Glissonian approach and liver hanging maneuver have proven useful. However, these techniques are not routinely applied in a laparoscopic context due to some intrinsic difficulty. Published techniques for laparoscopic major hepatectomy generally involve hilar dissection with separate transection of vasculo-biliary elements and anatomical parenchymal transection along the demarcation line. This video demonstrates the feasibility of the Glissonian approach and liver hanging maneuver that were performed for total laparoscopic right hepatectomy.
Methods: A 57-year-old woman suffering from huge liver mass was referred for surgical treatment. A total laparoscopic right hepatectomy was performed for this lesion. The operation followed 5 distinct phases: early hanging maneuver, extrahepatic extrafascial access to the right portal pedicle, parenchymal transection, control and division of the right hepatic vein, and complete mobilization of the right liver.
Results: Operative time was 400 min. The estimated blood loss was 150mL and no need for blood transfusion. The pathological examination confirmed an 8 by 6 by 7cm HCC with clear surgical margins. Patient recovery was uneventful, and the patient was discharged on postoperative day 6.
Conclusions Glissonian approach and hanging maneuver have proven to be safe and useful procedures for performing precise laparoscopic right hepatectomy.
R Chanwat, C Bunchaliew
Surgical intervention
3 years ago
2898 views
65 likes
0 comments
07:27
Laparoscopic right hepatectomy using hanging maneuver and Glissonian approach
Background: In open surgery for major hepatectomies, the Glissonian approach and liver hanging maneuver have proven useful. However, these techniques are not routinely applied in a laparoscopic context due to some intrinsic difficulty. Published techniques for laparoscopic major hepatectomy generally involve hilar dissection with separate transection of vasculo-biliary elements and anatomical parenchymal transection along the demarcation line. This video demonstrates the feasibility of the Glissonian approach and liver hanging maneuver that were performed for total laparoscopic right hepatectomy.
Methods: A 57-year-old woman suffering from huge liver mass was referred for surgical treatment. A total laparoscopic right hepatectomy was performed for this lesion. The operation followed 5 distinct phases: early hanging maneuver, extrahepatic extrafascial access to the right portal pedicle, parenchymal transection, control and division of the right hepatic vein, and complete mobilization of the right liver.
Results: Operative time was 400 min. The estimated blood loss was 150mL and no need for blood transfusion. The pathological examination confirmed an 8 by 6 by 7cm HCC with clear surgical margins. Patient recovery was uneventful, and the patient was discharged on postoperative day 6.
Conclusions Glissonian approach and hanging maneuver have proven to be safe and useful procedures for performing precise laparoscopic right hepatectomy.
Acute gangrenous cholecystitis with biliary peritonitis in a diabetic patient: laparoscopic cholecystectomy
This video demonstrates an early laparoscopic cholecystectomy in a diabetic 49-year-old female patient with acute gangrenous cholecystitis and biliary peritonitis. She was admitted to the emergency department with retrosternal pain radiating towards the epigastrium associated with vomiting and fever for the past 3 days. During clinical examination, she had signs of acute cholecystitis without jaundice. Her blood tests showed an important systemic inflammatory reaction without alteration of liver function tests (LFT). Finally, imaging studies (ultrasound and CT-scan) confirmed an acute calculous cholecystitis with signs of gallbladder wall ischemia and peritoneal-free fluid.
A technically challenging early laparoscopic cholecystectomy with preoperative cholangiogram was performed. The disease was controlled and the postoperative course was uneventful with patient discharge 4 days after the operation.
Early laparoscopic cholecystectomy is the standard of care for patients with mild acute cholecystitis and an onset of symptoms of less than 72 hours (Tokyo Guidelines 2013, Recommendation 1, Level A) [1]. Patients with severe local inflammation of the gallbladder presenting factors such as >72 hours from the onset, a white blood cell count >18,000, and a palpable tender mass in the right upper abdominal quadrant have grade II (moderate) cholecystitis. For these patients, a conservative treatment with gallbladder drainage can be proposed followed by delayed cholecystectomy, as early cholecystectomy can be technically challenging. Early cholecystectomy for moderate (grade II) acute cholecystitis is recommended in experienced centers [2].
A recent Cochrane meta-analysis of 5 RCTs demonstrated that there was no significant difference in the proportion of people who developed bile duct injury, nor in the proportion of people who required conversion to open cholecystectomy in patients with acute cholecystitis. Total hospital stay was 4 days shorter in the early cholecystectomy group as compared to the delayed cholecystectomy group. About 20% of the people belonging to the delayed cholecystectomy group had either non-resolution of symptoms or recurrence of symptoms before their planned operation and had to undergo emergency laparoscopic cholecystectomy. However, since the incidence of major complications is rare (about 0.2%) in cholecystectomy, a trial would have to include 50,000 patients to have sufficient power for this endpoint [3].
References:
1. Yamashita Y, Takada T, Strasberg SM, Pitt HA, Gouma DJ, Garden OJ, Büchler MW, Gomi H, Dervenis C, Windsor JA, Kim SW, de Santibanes E, Padbury R, Chen XP, Chan AC, Fan ST, Jagannath P, Mayumi T, Yoshida M, Miura F, Tsuyuguchi T, Itoi T, Supe AN; Tokyo Guideline Revision Committee. TG13 surgical management of acute cholecystitis. J Hepatobiliary Pancreat Sci 2013;20:89-96.
2. Yokoe M, Takada T, Strasberg SM, Solomkin JS, Mayumi T, Gomi H, Pitt HA, Garden OJ, Kiriyama S, Hata J, Gabata T, Yoshida M, Miura F, Okamoto K, Tsuyuguchi T, Itoi T, Yamashita Y, Dervenis C, Chan AC, Lau WY, Supe AN, Belli G, Hilvano SC, Liau KH, Kim MH, Kim SW, Ker CG; Tokyo Guidelines Revision Committee. TG13 diagnostic criteria and severity grading of acute cholecystitis (with videos). J Hepatobiliary Pancreat Sci 2013;20:35-46.
3. Gurusamy KS, Nagendran M, Davidson BR. Early versus delayed laparoscopic cholecystectomy for acute gallstone pancreatitis. Cochrane Database Syst Rev 2013;9:CD010326.
D Ntourakis, D Mutter, J Marescaux
Surgical intervention
3 years ago
2826 views
120 likes
1 comment
20:03
Acute gangrenous cholecystitis with biliary peritonitis in a diabetic patient: laparoscopic cholecystectomy
This video demonstrates an early laparoscopic cholecystectomy in a diabetic 49-year-old female patient with acute gangrenous cholecystitis and biliary peritonitis. She was admitted to the emergency department with retrosternal pain radiating towards the epigastrium associated with vomiting and fever for the past 3 days. During clinical examination, she had signs of acute cholecystitis without jaundice. Her blood tests showed an important systemic inflammatory reaction without alteration of liver function tests (LFT). Finally, imaging studies (ultrasound and CT-scan) confirmed an acute calculous cholecystitis with signs of gallbladder wall ischemia and peritoneal-free fluid.
A technically challenging early laparoscopic cholecystectomy with preoperative cholangiogram was performed. The disease was controlled and the postoperative course was uneventful with patient discharge 4 days after the operation.
Early laparoscopic cholecystectomy is the standard of care for patients with mild acute cholecystitis and an onset of symptoms of less than 72 hours (Tokyo Guidelines 2013, Recommendation 1, Level A) [1]. Patients with severe local inflammation of the gallbladder presenting factors such as >72 hours from the onset, a white blood cell count >18,000, and a palpable tender mass in the right upper abdominal quadrant have grade II (moderate) cholecystitis. For these patients, a conservative treatment with gallbladder drainage can be proposed followed by delayed cholecystectomy, as early cholecystectomy can be technically challenging. Early cholecystectomy for moderate (grade II) acute cholecystitis is recommended in experienced centers [2].
A recent Cochrane meta-analysis of 5 RCTs demonstrated that there was no significant difference in the proportion of people who developed bile duct injury, nor in the proportion of people who required conversion to open cholecystectomy in patients with acute cholecystitis. Total hospital stay was 4 days shorter in the early cholecystectomy group as compared to the delayed cholecystectomy group. About 20% of the people belonging to the delayed cholecystectomy group had either non-resolution of symptoms or recurrence of symptoms before their planned operation and had to undergo emergency laparoscopic cholecystectomy. However, since the incidence of major complications is rare (about 0.2%) in cholecystectomy, a trial would have to include 50,000 patients to have sufficient power for this endpoint [3].
References:
1. Yamashita Y, Takada T, Strasberg SM, Pitt HA, Gouma DJ, Garden OJ, Büchler MW, Gomi H, Dervenis C, Windsor JA, Kim SW, de Santibanes E, Padbury R, Chen XP, Chan AC, Fan ST, Jagannath P, Mayumi T, Yoshida M, Miura F, Tsuyuguchi T, Itoi T, Supe AN; Tokyo Guideline Revision Committee. TG13 surgical management of acute cholecystitis. J Hepatobiliary Pancreat Sci 2013;20:89-96.
2. Yokoe M, Takada T, Strasberg SM, Solomkin JS, Mayumi T, Gomi H, Pitt HA, Garden OJ, Kiriyama S, Hata J, Gabata T, Yoshida M, Miura F, Okamoto K, Tsuyuguchi T, Itoi T, Yamashita Y, Dervenis C, Chan AC, Lau WY, Supe AN, Belli G, Hilvano SC, Liau KH, Kim MH, Kim SW, Ker CG; Tokyo Guidelines Revision Committee. TG13 diagnostic criteria and severity grading of acute cholecystitis (with videos). J Hepatobiliary Pancreat Sci 2013;20:35-46.
3. Gurusamy KS, Nagendran M, Davidson BR. Early versus delayed laparoscopic cholecystectomy for acute gallstone pancreatitis. Cochrane Database Syst Rev 2013;9:CD010326.
Laparoscopic transcystic and hybrid transgastric rendezvous technique for common bile duct lithiasis after gastric bypass
Common bile duct lithiasis has become a challenging problem in patients who have undergone a laparoscopic Roux-en-Y gastric bypass for morbid obesity. Altered anatomy due to gastric diversion and biliary limb reconstruction leads to a prolonged and complex access to the ampulla of Vater. Consequently, experienced endoscopists and double-balloon endoscopes are required, often making it impossible to successfully perform an endoscopic sphincterotomy as in this case.
Here, we describe the case of a patient who had already been operated on for a gastric bypass and who presented with multiple past episodes of cholangitis because of common bile duct stones. A double-balloon endoscopic sphincterotomy failed leading to the decision of surgical treatment combining a hybrid technique of laparoscopic transgastric sphincterotomy with a transcystic common bile duct exploration.
L Marx, S Tzedakis, P Pessaux, M Delvaux, D Mutter, J Marescaux
Surgical intervention
3 years ago
1031 views
43 likes
0 comments
11:34
Laparoscopic transcystic and hybrid transgastric rendezvous technique for common bile duct lithiasis after gastric bypass
Common bile duct lithiasis has become a challenging problem in patients who have undergone a laparoscopic Roux-en-Y gastric bypass for morbid obesity. Altered anatomy due to gastric diversion and biliary limb reconstruction leads to a prolonged and complex access to the ampulla of Vater. Consequently, experienced endoscopists and double-balloon endoscopes are required, often making it impossible to successfully perform an endoscopic sphincterotomy as in this case.
Here, we describe the case of a patient who had already been operated on for a gastric bypass and who presented with multiple past episodes of cholangitis because of common bile duct stones. A double-balloon endoscopic sphincterotomy failed leading to the decision of surgical treatment combining a hybrid technique of laparoscopic transgastric sphincterotomy with a transcystic common bile duct exploration.
eTEP (extended view) repair of a direct and a femoral hernia
The eTEP (extended view totally extraperitoneal) technique, a modification of the conventional TEP technique, is based on the anatomical fact that the inguinal preperitoneal space can be reached from almost anywhere on the abdominal wall. The camera port can be placed higher in the abdomen. Its most evident effect is the creation of a larger surgical field. It also allows for a more flexible distribution of ports.
In the case presented here, the patient has a midline infra-umbilical laparotomy and a post-bariatric surgery pendulous abdomen. The eTEP technique facilitated the creation of the preperitoneal space in this difficult abdomen, allowing for the diagnosis and repair of the patient’s femoral and direct hernias.
J Daes, B Jacob
Surgical intervention
3 years ago
3708 views
182 likes
2 comments
08:13
eTEP (extended view) repair of a direct and a femoral hernia
The eTEP (extended view totally extraperitoneal) technique, a modification of the conventional TEP technique, is based on the anatomical fact that the inguinal preperitoneal space can be reached from almost anywhere on the abdominal wall. The camera port can be placed higher in the abdomen. Its most evident effect is the creation of a larger surgical field. It also allows for a more flexible distribution of ports.
In the case presented here, the patient has a midline infra-umbilical laparotomy and a post-bariatric surgery pendulous abdomen. The eTEP technique facilitated the creation of the preperitoneal space in this difficult abdomen, allowing for the diagnosis and repair of the patient’s femoral and direct hernias.
Laparoscopic pyloroplasty for gastroparesis after Nissen fundoplication
Authors demonstrate the management of laparoscopic pyloroplasty in a diabetic female patient presenting with severe gastroparesis after Nissen fundoplication. Gastroparesis is often known to be caused by a vagal nerve lesion during fundoplication, and can be improved by diabetes mellitus. If medical treatment is unsuccessful, a surgical approach is mandatory. Various techniques are described such as pyloroplasty, gastroenterostomy or gastric neurostimulation. We chose the procedure with minimal complications and best postoperative quality of life results as the first-line surgical treatment, namely laparoscopic pyloroplasty.
D Mutter, HA Mercoli, J Marescaux
Surgical intervention
3 years ago
2034 views
47 likes
0 comments
07:06
Laparoscopic pyloroplasty for gastroparesis after Nissen fundoplication
Authors demonstrate the management of laparoscopic pyloroplasty in a diabetic female patient presenting with severe gastroparesis after Nissen fundoplication. Gastroparesis is often known to be caused by a vagal nerve lesion during fundoplication, and can be improved by diabetes mellitus. If medical treatment is unsuccessful, a surgical approach is mandatory. Various techniques are described such as pyloroplasty, gastroenterostomy or gastric neurostimulation. We chose the procedure with minimal complications and best postoperative quality of life results as the first-line surgical treatment, namely laparoscopic pyloroplasty.
Video-assisted thoracoscopic (VATS) lobectomy: left lower lobe
Standard treatment of early-stage non-small cell lung cancer (NSCLC) involves anatomic pulmonary lobectomy and mediastinal lymph node dissection. Traditionally, this procedure has been carried out via a posterior lateral thoracotomy, requiring division of chest wall muscles and rib spreading. This is frequently associated with chronic postoperative pain, which may become incapacitating in 5% of patients.
One of the major potential advantages of video-assisted thoracoscopic (VATS) lobectomy is decreasing the incidence of chronic post-thoracotomy pain.
Key aspects of the procedure include the following:
- proper patient positioning;
- access to the pleural cavity and appropriate positioning of operating incisions;
- careful dissection of pulmonary arterial branches, using a “fissure-sparing” technique whenever possible to decrease the incidence of prolonged postoperative air leaks;
- division of lung parenchyma, blood vessels, and bronchus using endoscopic staplers.
The VATS approach can be performed with lower morbidity and an equivalent or better oncologic outcome to traditional open surgery. We present a VATS lobectomy for a carcinoid tumor of the left lower lobe in a 42-year-old patient. The video lays emphasis on the steps of lobe resection; mediastinal lymph node dissection was performed but is not shown.
Acknowledgment: we would like to thank Nathalie Leroux RN and Suzanne Desbiens for their continued support.
G Rakovich
Surgical intervention
3 years ago
623 views
84 likes
0 comments
08:05
Video-assisted thoracoscopic (VATS) lobectomy: left lower lobe
Standard treatment of early-stage non-small cell lung cancer (NSCLC) involves anatomic pulmonary lobectomy and mediastinal lymph node dissection. Traditionally, this procedure has been carried out via a posterior lateral thoracotomy, requiring division of chest wall muscles and rib spreading. This is frequently associated with chronic postoperative pain, which may become incapacitating in 5% of patients.
One of the major potential advantages of video-assisted thoracoscopic (VATS) lobectomy is decreasing the incidence of chronic post-thoracotomy pain.
Key aspects of the procedure include the following:
- proper patient positioning;
- access to the pleural cavity and appropriate positioning of operating incisions;
- careful dissection of pulmonary arterial branches, using a “fissure-sparing” technique whenever possible to decrease the incidence of prolonged postoperative air leaks;
- division of lung parenchyma, blood vessels, and bronchus using endoscopic staplers.
The VATS approach can be performed with lower morbidity and an equivalent or better oncologic outcome to traditional open surgery. We present a VATS lobectomy for a carcinoid tumor of the left lower lobe in a 42-year-old patient. The video lays emphasis on the steps of lobe resection; mediastinal lymph node dissection was performed but is not shown.
Acknowledgment: we would like to thank Nathalie Leroux RN and Suzanne Desbiens for their continued support.
Techniques for dissection and haemostasis
Not only does surgical tissue dissection require control of main vessels but it also mandates hemostasis of capillaries located in dissection areas. Surgeons can use mechanical means of tissue control, clips, staples, and sutures. They can also use physical means including radiofrequency-induced tissue fusion (electrocautery to achieve division and coagulation) and ultrasound.

The principles of these systems rely on an increased temperature of tissues through a molecular agitation or mechanical means conducive to the dessication of tissues, the fusion of proteins, and to a series of coagulations and divisions.

The use of such effective systems can be associated with specific complications. Consequently, it is mandatory for surgeons to know the principles and risks related to their use. Indeed, surgeons will be the end-users of such devices and of their effects.
They must be able to inform their patients and prevent the occurrence of accidents which may result in intraoperative or postoperative complications for which they can be directly blamed.

In this presentation, the principles of tissue control systems, their potential risks, as well as the prevention of any related accidents are outlined. Electrosurgery and ultrasound use will be respectively addressed along with indications and specific risks associated with their use.

Techniques and principles of the new applications of electrocautery controlled by electronic systems (e.g., LigaSure™ vessel-sealing device, Covidien-Valleylab, ultrasound fusion devices such as Sonicision™, Covidien-Valleylab) are described, as well as their benefits and limitations. The specificities and privileged indications for the use of such systems will be detailed. Finally, standard instruments indispensable for laparoscopic interventions will be addressed.
D Mutter
Lecture
3 years ago
3019 views
112 likes
0 comments
41:05
Techniques for dissection and haemostasis
Not only does surgical tissue dissection require control of main vessels but it also mandates hemostasis of capillaries located in dissection areas. Surgeons can use mechanical means of tissue control, clips, staples, and sutures. They can also use physical means including radiofrequency-induced tissue fusion (electrocautery to achieve division and coagulation) and ultrasound.

The principles of these systems rely on an increased temperature of tissues through a molecular agitation or mechanical means conducive to the dessication of tissues, the fusion of proteins, and to a series of coagulations and divisions.

The use of such effective systems can be associated with specific complications. Consequently, it is mandatory for surgeons to know the principles and risks related to their use. Indeed, surgeons will be the end-users of such devices and of their effects.
They must be able to inform their patients and prevent the occurrence of accidents which may result in intraoperative or postoperative complications for which they can be directly blamed.

In this presentation, the principles of tissue control systems, their potential risks, as well as the prevention of any related accidents are outlined. Electrosurgery and ultrasound use will be respectively addressed along with indications and specific risks associated with their use.

Techniques and principles of the new applications of electrocautery controlled by electronic systems (e.g., LigaSure™ vessel-sealing device, Covidien-Valleylab, ultrasound fusion devices such as Sonicision™, Covidien-Valleylab) are described, as well as their benefits and limitations. The specificities and privileged indications for the use of such systems will be detailed. Finally, standard instruments indispensable for laparoscopic interventions will be addressed.
Instrumentation for laparoscopic surgery in 2014
The performance of surgical procedures using laparoscopy changes the surgeon’s vision of the operative field. The surgeon works with direct vision using a monitor, hence visualizing the operative field in optimal conditions. The surgeon’s working space is limited to the abdominal cavity, and the surgeon no longer has to focus on the entire operating theater.

This implies that an original operative area made up of the abdominal cavity, for digestive surgeons, must be created. The creation of this working space is achieved by means of controlled carbon dioxide insufflation into the abdominal cavity.

The operative image will be conveyed once the operative field has been lit up using a white light source (named cold light as it provides a 6000K color corresponding to sunlight color). The image is first captured by a camera which transforms colors into digital data through Charge-Coupled Device (CCD) captors. It will then be transmitted through a digital screen. This method of image creation depends on the quality and technique of each part of this chain. The quality of surgical video images has evolved rapidly over the years as there have been tremendous advances in computer science and video technologies. In 2014, the current standard is the HD camera, which conveys an accurate image through a HD monitor. Scopes have been steadily improving, image quality has been enhanced, especially when it comes to brightness and definition. Tomorrow, the image will be stereoscopic and 4K, hence pushing the standards of image-guided surgery forward.

All the components of this "image sequence" will be taken into consideration in order to offer surgeons not only the possibility to have basic knowledge of instrumentation to maximize their choice of brand-new armamentarium but also to understand the technical malfunctions likely to alter surgical image quality so as to make up for such shortcomings.
D Mutter
Lecture
3 years ago
4083 views
71 likes
0 comments
34:47
Instrumentation for laparoscopic surgery in 2014
The performance of surgical procedures using laparoscopy changes the surgeon’s vision of the operative field. The surgeon works with direct vision using a monitor, hence visualizing the operative field in optimal conditions. The surgeon’s working space is limited to the abdominal cavity, and the surgeon no longer has to focus on the entire operating theater.

This implies that an original operative area made up of the abdominal cavity, for digestive surgeons, must be created. The creation of this working space is achieved by means of controlled carbon dioxide insufflation into the abdominal cavity.

The operative image will be conveyed once the operative field has been lit up using a white light source (named cold light as it provides a 6000K color corresponding to sunlight color). The image is first captured by a camera which transforms colors into digital data through Charge-Coupled Device (CCD) captors. It will then be transmitted through a digital screen. This method of image creation depends on the quality and technique of each part of this chain. The quality of surgical video images has evolved rapidly over the years as there have been tremendous advances in computer science and video technologies. In 2014, the current standard is the HD camera, which conveys an accurate image through a HD monitor. Scopes have been steadily improving, image quality has been enhanced, especially when it comes to brightness and definition. Tomorrow, the image will be stereoscopic and 4K, hence pushing the standards of image-guided surgery forward.

All the components of this "image sequence" will be taken into consideration in order to offer surgeons not only the possibility to have basic knowledge of instrumentation to maximize their choice of brand-new armamentarium but also to understand the technical malfunctions likely to alter surgical image quality so as to make up for such shortcomings.
Laparoscopic management of pelvic floor relaxation
In this key lecture, Professor JB Dubuisson discusses the indications, technique and results of surgical alternatives to sacrocolpopexy (namely the gold standard technique for POP surgery): laparoscopic lateral suspension with mesh (TiLOOP® mesh used) to treat cystocele and hysterocele or vaginal vault prolapse, (underlining the importance to associate, in these cases, a posterior compartment laparoscopic or vaginal procedure to avoid secondary rectocele); laparoscopic paravaginal repair for site-specific repair (cystocele/lateral cystocele), and finally, laparoscopic spinofixation for site-specific repair of isolated vaginal vault descent or post-prolapse treatment. Of note, a short consideration about titanized polypropylene meshes is made.
JB Dubuisson
Lecture
3 years ago
1106 views
29 likes
0 comments
22:01
Laparoscopic management of pelvic floor relaxation
In this key lecture, Professor JB Dubuisson discusses the indications, technique and results of surgical alternatives to sacrocolpopexy (namely the gold standard technique for POP surgery): laparoscopic lateral suspension with mesh (TiLOOP® mesh used) to treat cystocele and hysterocele or vaginal vault prolapse, (underlining the importance to associate, in these cases, a posterior compartment laparoscopic or vaginal procedure to avoid secondary rectocele); laparoscopic paravaginal repair for site-specific repair (cystocele/lateral cystocele), and finally, laparoscopic spinofixation for site-specific repair of isolated vaginal vault descent or post-prolapse treatment. Of note, a short consideration about titanized polypropylene meshes is made.
Laparoscopic tubo-cornual anastomosis for reversal of sterilization
This video shows a case of tubo-cornual anastomosis for reversal after tubal sterilization. A 43-year-old patient has requested a reversal of sterilization. She already had 4 deliveries. On the hysterosalpingography, one can see that Hulka clips are really near the uterine horns.
The video demonstrates the removal of Hulka clips, the dissection of the interstitial part of the tube, the catheterization of a guide through the ostium in the proximal, then distal part of the tube hysteroscopically, and finally a tubo-cornual anastomosis. In our opinion, the quality of the anastomosis directly depends on the complete congruence of the two tubal stumps. Different prognostic factors have been discussed in previous studies (e.g., age, type of sterilization (clips or coagulation), length of remaining tube, and site of anastomosis). According to the literature, the best anastomotic site, in terms of successful pregnancy, would be the isthmic-isthmic position. In our experience, the use of a tubal hysteroscopic guide seems the best aid to obtain a luminal alignment and it is more comfortable for the suture.
O Garbin, L Schwartz
Surgical intervention
3 years ago
2746 views
106 likes
1 comment
08:01
Laparoscopic tubo-cornual anastomosis for reversal of sterilization
This video shows a case of tubo-cornual anastomosis for reversal after tubal sterilization. A 43-year-old patient has requested a reversal of sterilization. She already had 4 deliveries. On the hysterosalpingography, one can see that Hulka clips are really near the uterine horns.
The video demonstrates the removal of Hulka clips, the dissection of the interstitial part of the tube, the catheterization of a guide through the ostium in the proximal, then distal part of the tube hysteroscopically, and finally a tubo-cornual anastomosis. In our opinion, the quality of the anastomosis directly depends on the complete congruence of the two tubal stumps. Different prognostic factors have been discussed in previous studies (e.g., age, type of sterilization (clips or coagulation), length of remaining tube, and site of anastomosis). According to the literature, the best anastomotic site, in terms of successful pregnancy, would be the isthmic-isthmic position. In our experience, the use of a tubal hysteroscopic guide seems the best aid to obtain a luminal alignment and it is more comfortable for the suture.
Endoscopic internal drainage (EID) for leaks following sleeve gastrectomy
Leaks following sleeve gastrectomy represent a serious problem for surgeons, since a standardized approach has not yet been established.
Usually laparoscopic exploration is necessary in order to achieve a diagnostic peritoneal lavage, and a surgical drain is left in place proximally to the suture line, at the level of the dehiscence (if visualized), jejunostomy is also frequently performed to ensure enteral alimentation. This treatment however, needs to be combined with an endoscopic treatment, in order to facilitate rapid closure of gastric staple line defects.
In this video we report our Endoscopic Internal Drainage (EID) technique by insertion of double pigtail stents combined for the firsts weeks with enteral nutrition, with the aim to create an internal fistula allowing to quickly remove the surgical drain, and promote the formation of granulation tissue at the level of the dehiscence.
Reference:
Endoscopic internal drainage with enteral nutrition (EDEN) for treatment of leaks following sleeve gastrectomy. Donatelli G, Ferretti S, Vergeau BM, Dhumane P, Dumont JL, Derhy S, Tuszynski T, Dritsas S, Carloni A, Catheline JM, Pourcher G, Dagher I, Meduri B. Obes Surg 2014;24:1400-7.
Gf Donatelli
Surgical intervention
3 years ago
885 views
22 likes
0 comments
06:33
Endoscopic internal drainage (EID) for leaks following sleeve gastrectomy
Leaks following sleeve gastrectomy represent a serious problem for surgeons, since a standardized approach has not yet been established.
Usually laparoscopic exploration is necessary in order to achieve a diagnostic peritoneal lavage, and a surgical drain is left in place proximally to the suture line, at the level of the dehiscence (if visualized), jejunostomy is also frequently performed to ensure enteral alimentation. This treatment however, needs to be combined with an endoscopic treatment, in order to facilitate rapid closure of gastric staple line defects.
In this video we report our Endoscopic Internal Drainage (EID) technique by insertion of double pigtail stents combined for the firsts weeks with enteral nutrition, with the aim to create an internal fistula allowing to quickly remove the surgical drain, and promote the formation of granulation tissue at the level of the dehiscence.
Reference:
Endoscopic internal drainage with enteral nutrition (EDEN) for treatment of leaks following sleeve gastrectomy. Donatelli G, Ferretti S, Vergeau BM, Dhumane P, Dumont JL, Derhy S, Tuszynski T, Dritsas S, Carloni A, Catheline JM, Pourcher G, Dagher I, Meduri B. Obes Surg 2014;24:1400-7.
Robotics and eye surgery
The introduction of surgical robots revolutionized a number of specialties and the list of appropriate indications is growing rapidly. The number of procedures performed each year with the da Vinci™ Robotic Surgical System is also increasing rapidly, but the number of ophthalmological papers published has curiously remained very low since the first publication in 1997. The question of the role of robotics in ophthalmic surgery - already minimally invasive microsurgery with very good results – is legitimate. We had the opportunity to use the new da Vinci™ system at the IRCAD training center in 2012-2013. The new da Vinci™ Si HD robot has been available since 2009. It is similar to the previous version but presents several new or improved features. We performed various ocular surface surgeries on porcine eyes and were able to confirm the feasibility of the different surgical steps. Advantages and drawbacks of robotics are discussed in the presentation. It is important that continuing R&D bring about the specific improvements necessary for broader robot implication in ophthalmological surgery.
T Bourcier
Lecture
3 years ago
257 views
15 likes
0 comments
08:19
Robotics and eye surgery
The introduction of surgical robots revolutionized a number of specialties and the list of appropriate indications is growing rapidly. The number of procedures performed each year with the da Vinci™ Robotic Surgical System is also increasing rapidly, but the number of ophthalmological papers published has curiously remained very low since the first publication in 1997. The question of the role of robotics in ophthalmic surgery - already minimally invasive microsurgery with very good results – is legitimate. We had the opportunity to use the new da Vinci™ system at the IRCAD training center in 2012-2013. The new da Vinci™ Si HD robot has been available since 2009. It is similar to the previous version but presents several new or improved features. We performed various ocular surface surgeries on porcine eyes and were able to confirm the feasibility of the different surgical steps. Advantages and drawbacks of robotics are discussed in the presentation. It is important that continuing R&D bring about the specific improvements necessary for broader robot implication in ophthalmological surgery.
Nancy Robotic & Simulation Training Center: evaluation of surgical learning curves
The teaching of surgery, as in other medical disciplines, is currently undergoing a dramatically (r)evolution. As a result, the development of minimally invasive techniques (laparoscopic, robotic assisted devices, etc.) requires constant re-assessment and certification of surgical skills. This involves new educational strategies based on surgical simulation in order to improve technical and gestural techniques and ultimately patient’s safety.
We have developed a multidisciplinary center of simulation in surgical training and especially in robotics. Surgical simulators are becoming a credible alternative to practical surgery training. They can be used to train in a stepwise fashion in extremely realistic interventions (virtual reality) with the added bonus of measurable spatial and temporal parameters to gauge a user's performance. The latest generation of simulators can even reproduce a particular intervention based on patient imaging data prior to surgery in the operating room. We propose various workshops, each concentrating on one surgical specialty (ENT, gynecology, ophthalmology, implantology, vascular surgery, interventional cardiology and cardiac surgery, digestive surgery, orthopedic surgery, and arthroscopy).
Sessions are practice-based, with groundbreaking industrial equipment. Our aim is to study and apply the most innovative approaches in order to improve the relationship between coherence in learning practice and constant improvement in the measurable and quantifiable skills throughout the process from classroom to patients via the simulator. The programs will provide practical answers to questions about:
- the role of simulators in surgery and how it relates to the acquisition of increasingly complex psychomotor skills (e.g., constant re-adaptation of 3D perception based on 2D imaging, coordination of surgical gestures, understanding and mastering the new environment "tool-patient", etc.);
- the evolution of surgical certification.
Authors: N. Tran, P. Maureira, C. Perrenot, D. Joseph, J. Hubert, L. Bresler
N Tran
Lecture
3 years ago
217 views
13 likes
0 comments
14:32
Nancy Robotic & Simulation Training Center: evaluation of surgical learning curves
The teaching of surgery, as in other medical disciplines, is currently undergoing a dramatically (r)evolution. As a result, the development of minimally invasive techniques (laparoscopic, robotic assisted devices, etc.) requires constant re-assessment and certification of surgical skills. This involves new educational strategies based on surgical simulation in order to improve technical and gestural techniques and ultimately patient’s safety.
We have developed a multidisciplinary center of simulation in surgical training and especially in robotics. Surgical simulators are becoming a credible alternative to practical surgery training. They can be used to train in a stepwise fashion in extremely realistic interventions (virtual reality) with the added bonus of measurable spatial and temporal parameters to gauge a user's performance. The latest generation of simulators can even reproduce a particular intervention based on patient imaging data prior to surgery in the operating room. We propose various workshops, each concentrating on one surgical specialty (ENT, gynecology, ophthalmology, implantology, vascular surgery, interventional cardiology and cardiac surgery, digestive surgery, orthopedic surgery, and arthroscopy).
Sessions are practice-based, with groundbreaking industrial equipment. Our aim is to study and apply the most innovative approaches in order to improve the relationship between coherence in learning practice and constant improvement in the measurable and quantifiable skills throughout the process from classroom to patients via the simulator. The programs will provide practical answers to questions about:
- the role of simulators in surgery and how it relates to the acquisition of increasingly complex psychomotor skills (e.g., constant re-adaptation of 3D perception based on 2D imaging, coordination of surgical gestures, understanding and mastering the new environment "tool-patient", etc.);
- the evolution of surgical certification.
Authors: N. Tran, P. Maureira, C. Perrenot, D. Joseph, J. Hubert, L. Bresler