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Monthly publications

#April 2015
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Four different intracorporeal ileocolic anastomoses during suprapubic single incision laparoscopic right hemicolectomy
Background: Single incision laparoscopic right hemicolectomy is a feasible procedure. Suprapubic access allows to offer satisfactory cosmetic results in case of extended scar due to a large tumor. Intracorporeal anastomosis is mandatory through a suprapubic access, because it prevents traction on the mesentery and on the transverse mesocolon.
Video: This video shows four different types of intracorporeal ileocolic anastomoses.
1) Linear mechanical side-to-side
2) Completely manual side-to-side
3) Completely manual end-to-side
4) Completely manual end-to-end
At the end of each type of anastomosis, mesenteric defect closure is mandatory, to prevent intestinal obstruction caused by internal hernia.
Results: After an appropriate learning curve, time to perform linear mechanical anastomosis is 25 minutes and manual anastomosis takes 40 minutes.
Conclusions: Different ileocolic anastomoses can be performed and the surgeon has to choose the appropriate one, case by case.
To watch the video demonstrating the entire right hemicolectomy, please click here.
G Dapri
Surgical intervention
3 years ago
3632 views
177 likes
0 comments
07:58
Four different intracorporeal ileocolic anastomoses during suprapubic single incision laparoscopic right hemicolectomy
Background: Single incision laparoscopic right hemicolectomy is a feasible procedure. Suprapubic access allows to offer satisfactory cosmetic results in case of extended scar due to a large tumor. Intracorporeal anastomosis is mandatory through a suprapubic access, because it prevents traction on the mesentery and on the transverse mesocolon.
Video: This video shows four different types of intracorporeal ileocolic anastomoses.
1) Linear mechanical side-to-side
2) Completely manual side-to-side
3) Completely manual end-to-side
4) Completely manual end-to-end
At the end of each type of anastomosis, mesenteric defect closure is mandatory, to prevent intestinal obstruction caused by internal hernia.
Results: After an appropriate learning curve, time to perform linear mechanical anastomosis is 25 minutes and manual anastomosis takes 40 minutes.
Conclusions: Different ileocolic anastomoses can be performed and the surgeon has to choose the appropriate one, case by case.
To watch the video demonstrating the entire right hemicolectomy, please click here.
Laparoscopic cholecystectomy for phlegmonous acute cholecystitis
This video demonstrates the early surgical management of a 3-day history of acute cholecystitis in an 83-year-old patient. This patient was admitted to the emergency department for epigastric and right hypochondrium pain, without any other symptoms. Clinically, the patient presented with a localized abdominal guarding; Murphy’s sign was positive. Blood chemistries demonstrated the presence of an inflammatory syndrome and liver function tests were normal. The ultrasound exam confirmed the diagnosis of acute cholecystitis. A laparoscopic cholecystectomy was decided upon. The postoperative outcome was uneventful and the patient was discharged on postoperative day 3. Laparoscopic cholecystectomy is the gold standard for the early treatment of acute cholecystitis with an onset of symptoms less than 72 hours (Tokyo Guidelines 2013, recommendation 1, grade A).
O Perotto, H Jeddou, D Mutter, J Marescaux
Surgical intervention
3 years ago
6583 views
269 likes
2 comments
10:57
Laparoscopic cholecystectomy for phlegmonous acute cholecystitis
This video demonstrates the early surgical management of a 3-day history of acute cholecystitis in an 83-year-old patient. This patient was admitted to the emergency department for epigastric and right hypochondrium pain, without any other symptoms. Clinically, the patient presented with a localized abdominal guarding; Murphy’s sign was positive. Blood chemistries demonstrated the presence of an inflammatory syndrome and liver function tests were normal. The ultrasound exam confirmed the diagnosis of acute cholecystitis. A laparoscopic cholecystectomy was decided upon. The postoperative outcome was uneventful and the patient was discharged on postoperative day 3. Laparoscopic cholecystectomy is the gold standard for the early treatment of acute cholecystitis with an onset of symptoms less than 72 hours (Tokyo Guidelines 2013, recommendation 1, grade A).
Unintentional dissection of the common bile duct
This video demonstrates the case of an 81-year-old woman with chronic cholecystitis. She has had several episodes of right hypochondrium pain with altered liver tests, which spontaneously got back to normal values. Ultrasound and CT-scan demonstrated the presence of uncomplicated gallstones and a slightly hypotonic common bile duct (8mm in diameter). No obstacle was visualized in the common bile duct. A delayed laparoscopic cholecystectomy was scheduled. This video shows how some inaccuracies in the dissection technique and the presence of an altered anatomy have led to a circumferential dissection of the common bile duct. Common bile duct injury was avoided and the importance of an intraoperative cholangiography is emphasized.
M Ignat, N Malibary, D Mutter, J Marescaux
Surgical intervention
3 years ago
3620 views
135 likes
1 comment
06:50
Unintentional dissection of the common bile duct
This video demonstrates the case of an 81-year-old woman with chronic cholecystitis. She has had several episodes of right hypochondrium pain with altered liver tests, which spontaneously got back to normal values. Ultrasound and CT-scan demonstrated the presence of uncomplicated gallstones and a slightly hypotonic common bile duct (8mm in diameter). No obstacle was visualized in the common bile duct. A delayed laparoscopic cholecystectomy was scheduled. This video shows how some inaccuracies in the dissection technique and the presence of an altered anatomy have led to a circumferential dissection of the common bile duct. Common bile duct injury was avoided and the importance of an intraoperative cholangiography is emphasized.
Diagnosis and treatment of symptomatic common bile duct stones following cholecystectomy by means of EUS and ERCP
A post-cholecystectomy syndrome is a well-known condition, which includes dyspepsia and biliary-like abdominal pain coupled with deterioration of liver enzymes. Biliary factors responsible for a post-cholecystectomy syndrome could be the following: biliary iatrogenic duct strictures, retained stones in the common bile duct (CBD), cystic stump, or even a gallbladder remnant.
The diagnosis of stones is difficult to establish considering that even trans-abdominal ultrasonography has a diagnostic sensitivity of only 27%. Conversely, endoscopic ultrasound (EUS) is a very useful tool to diagnose stones in such situations, allowing to perform subsequent ERCP and stone extraction during the same anesthetic session. Here, we report the case of a 69-year-old man who underwent laparoscopic cholecystectomy and who was referred to us after 24 hours of abdominal colic pain and cholestasis. He underwent EUS, which diagnosed residual common bile duct stones. As a result, treatment was performed by means of ERCP during the same session.
Gf Donatelli, F Cereatti, B Meduri
Surgical intervention
3 years ago
1396 views
62 likes
0 comments
03:26
Diagnosis and treatment of symptomatic common bile duct stones following cholecystectomy by means of EUS and ERCP
A post-cholecystectomy syndrome is a well-known condition, which includes dyspepsia and biliary-like abdominal pain coupled with deterioration of liver enzymes. Biliary factors responsible for a post-cholecystectomy syndrome could be the following: biliary iatrogenic duct strictures, retained stones in the common bile duct (CBD), cystic stump, or even a gallbladder remnant.
The diagnosis of stones is difficult to establish considering that even trans-abdominal ultrasonography has a diagnostic sensitivity of only 27%. Conversely, endoscopic ultrasound (EUS) is a very useful tool to diagnose stones in such situations, allowing to perform subsequent ERCP and stone extraction during the same anesthetic session. Here, we report the case of a 69-year-old man who underwent laparoscopic cholecystectomy and who was referred to us after 24 hours of abdominal colic pain and cholestasis. He underwent EUS, which diagnosed residual common bile duct stones. As a result, treatment was performed by means of ERCP during the same session.
Laparoscopic total gastrectomy and D2 dissection guided by fluorescence imaging system, followed by esophagojejunostomy using an intracorporeal purse-string suture method
This video demonstrates a case of gastric cancer, which is located at the cardia, and a total gastrectomy was planned. For D2 dissection in a total gastrectomy, lymph node dissection around the splenic artery and splenic hilum is one of the most challenging area. Here, we present an example of complete dissection by following the plane around the splenic vessels.
Fluorescence imaging using indocyanine green (ICG) is a promising technology not only for sentinel node navigation surgery but it is also a guide for extensive lymph node dissection. The laparoscopic fluorescence imaging system was used here as a guidance and assessment tool for complete lymph node dissection. Also, an original method for intracorporeal esophagojejunal anastomosis is introduced, which enables purse-string suture and insertion of the anvil of the circular stapler in a quite stable manner, and reproduces conventional esophagojejunostomy without specialized devices.
HK Yang, SH Kong
Surgical intervention
3 years ago
2650 views
49 likes
1 comment
28:29
Laparoscopic total gastrectomy and D2 dissection guided by fluorescence imaging system, followed by esophagojejunostomy using an intracorporeal purse-string suture method
This video demonstrates a case of gastric cancer, which is located at the cardia, and a total gastrectomy was planned. For D2 dissection in a total gastrectomy, lymph node dissection around the splenic artery and splenic hilum is one of the most challenging area. Here, we present an example of complete dissection by following the plane around the splenic vessels.
Fluorescence imaging using indocyanine green (ICG) is a promising technology not only for sentinel node navigation surgery but it is also a guide for extensive lymph node dissection. The laparoscopic fluorescence imaging system was used here as a guidance and assessment tool for complete lymph node dissection. Also, an original method for intracorporeal esophagojejunal anastomosis is introduced, which enables purse-string suture and insertion of the anvil of the circular stapler in a quite stable manner, and reproduces conventional esophagojejunostomy without specialized devices.
Laparoscopic distal splenopancreatectomy for a caudal cystic pancreatic lesion
We report the case of a 51-year-old woman who underwent laparoscopic left splenopancreatectomy for a caudal cystic pancreatic lesion evocative of a mucinous cyst.
The patient is placed in a right lateral supine position, legs apart. A reverse Trendelenburg position is used. Four ports are placed. After the colon has been detached from the omentum, the dissection is begun at the superior border of the pancreas. It makes it possible to dissect the splenic artery, which is placed on a tape. The dissection is carried on at the inferior border of the pancreas in order to identify the venous mesentericoportal axis. A retropancreatic passage is achieved along the mesentericoportal axis, and a tape is passed around the pancreatic isthmus, which was immediately divided by means of a stapler. The splenic vein is identified at the posterior border of the pancreas. It is dissected and placed on a tape. The splenic artery is divided between two clips. The splenic vein is divided. It is freed from attachments, then clipped, and finally divided. The distal pancreas with the spleen was dissected to perform an ‘en-bloc’ left splenopancreatectomy. The specimen is placed in a bag and extracted through a Pfannenstiel incision, with an extemporaneous exam on the slice, which allows to rule out any neoplastic infiltration. A blade is placed in the left hypochondrium with an amylase activity assay performed on postoperative day 3. The blade is extracted through the leftmost port.
P Pessaux, R Memeo, H Jeddou, X Untereiner, S Tzedakis, D Mutter, J Marescaux
Surgical intervention
3 years ago
1991 views
55 likes
0 comments
10:52
Laparoscopic distal splenopancreatectomy for a caudal cystic pancreatic lesion
We report the case of a 51-year-old woman who underwent laparoscopic left splenopancreatectomy for a caudal cystic pancreatic lesion evocative of a mucinous cyst.
The patient is placed in a right lateral supine position, legs apart. A reverse Trendelenburg position is used. Four ports are placed. After the colon has been detached from the omentum, the dissection is begun at the superior border of the pancreas. It makes it possible to dissect the splenic artery, which is placed on a tape. The dissection is carried on at the inferior border of the pancreas in order to identify the venous mesentericoportal axis. A retropancreatic passage is achieved along the mesentericoportal axis, and a tape is passed around the pancreatic isthmus, which was immediately divided by means of a stapler. The splenic vein is identified at the posterior border of the pancreas. It is dissected and placed on a tape. The splenic artery is divided between two clips. The splenic vein is divided. It is freed from attachments, then clipped, and finally divided. The distal pancreas with the spleen was dissected to perform an ‘en-bloc’ left splenopancreatectomy. The specimen is placed in a bag and extracted through a Pfannenstiel incision, with an extemporaneous exam on the slice, which allows to rule out any neoplastic infiltration. A blade is placed in the left hypochondrium with an amylase activity assay performed on postoperative day 3. The blade is extracted through the leftmost port.
Complex left upper lobectomy with lymphadenectomy using a full endoscopic robotic technique
This is the case of a 72-year-old woman, followed up for chronic lymphocytic leukemia treated with chemotherapy.
During her follow-up, a nodule in the left upper lobe as well as multiple bulky lymph nodes were discovered.
The multidisciplinary meeting proposed a wedge resection more or less associated with a lobectomy depending on the results of frozen section.
The difficulty of this procedure lies in bulky lymph nodes around the pulmonary artery.
Due to the complexity of the case, we prefer to use a RATS approach rather than a VATS approach, as it allows for a sharp dissection using a bipolar Maryland forceps.
JM Baste, B Bottet, C Peillon
Surgical intervention
3 years ago
929 views
13 likes
0 comments
08:52
Complex left upper lobectomy with lymphadenectomy using a full endoscopic robotic technique
This is the case of a 72-year-old woman, followed up for chronic lymphocytic leukemia treated with chemotherapy.
During her follow-up, a nodule in the left upper lobe as well as multiple bulky lymph nodes were discovered.
The multidisciplinary meeting proposed a wedge resection more or less associated with a lobectomy depending on the results of frozen section.
The difficulty of this procedure lies in bulky lymph nodes around the pulmonary artery.
Due to the complexity of the case, we prefer to use a RATS approach rather than a VATS approach, as it allows for a sharp dissection using a bipolar Maryland forceps.