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Monthly publications

#July 2015
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Cystic pheochromocytoma: anatomical landmarks for laparoscopic resection
Surgery for pheochromocytoma is often considered difficult due to local anatomical conditions which are often associated with a hypervascularization and inflammatory reaction. This video demonstrates the case of a patient presenting with a 5cm pheochromocytoma with a necrotic core. Because the patient has a low BMI, the intraoperative anatomy is magnified and all anatomical landmarks are perfectly identified right before dissection. The lesion is eventually embedded in the liver. Its approach and dissection allow to determine the constraints related to adrenal surgery, and particularly regarding the impossibility to manipulate the lesion other than with soft retraction.
D Mutter, J Marescaux
Surgical intervention
3 years ago
2012 views
103 likes
0 comments
15:04
Cystic pheochromocytoma: anatomical landmarks for laparoscopic resection
Surgery for pheochromocytoma is often considered difficult due to local anatomical conditions which are often associated with a hypervascularization and inflammatory reaction. This video demonstrates the case of a patient presenting with a 5cm pheochromocytoma with a necrotic core. Because the patient has a low BMI, the intraoperative anatomy is magnified and all anatomical landmarks are perfectly identified right before dissection. The lesion is eventually embedded in the liver. Its approach and dissection allow to determine the constraints related to adrenal surgery, and particularly regarding the impossibility to manipulate the lesion other than with soft retraction.
Laparoscopic treatment of parastomal hernia and concomitant midline incisional hernia
An individual approach to the treatment of patients with incisional hernia is essential. The objective of this video is to demonstrate the advantages of a laparoscopic parastomal hernia repair in a selected patient.
This video demonstrates the case of a 61-year-old female patient (BMI of 28.4 kg/m2) with a huge parastomal hernia compromising the stoma care, and with a suspected midline incisional hernia. After a complete adhesiolysis, we were able to detect and measure both abdominal wall defects. After narrowing the parastomal defect, a local hernioplasty was performed by applying the Sugarbaker technique with a Parietex™ Parastomal Mesh (PCOPM15). For a midline incisional hernia, we used a Parietex™ composite mesh (PPC1510). Both prostheses were fixed to the abdominal wall with transfascial sutures and tacks (ProTack™). Both operative and postoperative periods were uneventful.
The laparoscopic treatment of a parastomal hernia should be considered as a first option because it endeavors to join the advantages of a minimally invasive approach with a low incidence of infection and recurrence rate, and offers the opportunity of repairing a concomitant incisional hernia, if present.
M Panovski, I Roso Sazdovska
Surgical intervention
3 years ago
2192 views
71 likes
0 comments
10:13
Laparoscopic treatment of parastomal hernia and concomitant midline incisional hernia
An individual approach to the treatment of patients with incisional hernia is essential. The objective of this video is to demonstrate the advantages of a laparoscopic parastomal hernia repair in a selected patient.
This video demonstrates the case of a 61-year-old female patient (BMI of 28.4 kg/m2) with a huge parastomal hernia compromising the stoma care, and with a suspected midline incisional hernia. After a complete adhesiolysis, we were able to detect and measure both abdominal wall defects. After narrowing the parastomal defect, a local hernioplasty was performed by applying the Sugarbaker technique with a Parietex™ Parastomal Mesh (PCOPM15). For a midline incisional hernia, we used a Parietex™ composite mesh (PPC1510). Both prostheses were fixed to the abdominal wall with transfascial sutures and tacks (ProTack™). Both operative and postoperative periods were uneventful.
The laparoscopic treatment of a parastomal hernia should be considered as a first option because it endeavors to join the advantages of a minimally invasive approach with a low incidence of infection and recurrence rate, and offers the opportunity of repairing a concomitant incisional hernia, if present.
Transanal laparoscopic TME with a new port assisted by single incision
Background: Rectal resection with total mesorectal excision (TME) can be performed through the anus going up into the abdominal cavity. This approach has to be performed using a transanal device in order to create a retroperitoneum, allowing the surgeon to perform a TME similar to the one performed from the abdomen going down to the anus. A new reusable port named DAPRI Port or D-Port (Karl Storz Endoskope, Tuttlingen, Germany) has been developed, and a new platform together with curved reusable instruments according to DAPRI (Karl Storz Endoskope) has been created. The D-Port allows to maintain one of the rules of laparoscopy, which is the optical system in the middle of the two ancillary operative tools. In addition, the cost of the procedure is not increased, due to the reusable material.
Video: This video shows a down-to-up rectal resection assisted by single incision laparoscopy, in a 65-year old man presenting with a rectal adenocarcinoma 4cm away from the anal margin. Preoperative work-up showed a T2N0M0 tumor, after radiochemotherapy. The procedure was performed transabdominally for the vascular dissection and transanally for the TME. The abdominal single site was then used for the placement of the temporary ileostomy.
Results: Total operative time was 301 minutes, and partial transanal laparoscopy was 145 minutes. Perioperative bleeding was 50cc. The final scar length was 2.5cm, and the patient was discharged after 5 days. The pathological report confirmed a pT2N0M0 tumor (15 negative nodes).
Conclusions: Down-to-up rectal resection is an interesting procedure, and when associated with single incision laparoscopy, it offers the possibility to use the single site as the site for temporary ileostomy.
G Dapri, L Antolino, N Bachir, D Guta, K Grozdev, B Nebbot, K Jottard, GB Cadière
Surgical intervention
3 years ago
2677 views
39 likes
0 comments
12:53
Transanal laparoscopic TME with a new port assisted by single incision
Background: Rectal resection with total mesorectal excision (TME) can be performed through the anus going up into the abdominal cavity. This approach has to be performed using a transanal device in order to create a retroperitoneum, allowing the surgeon to perform a TME similar to the one performed from the abdomen going down to the anus. A new reusable port named DAPRI Port or D-Port (Karl Storz Endoskope, Tuttlingen, Germany) has been developed, and a new platform together with curved reusable instruments according to DAPRI (Karl Storz Endoskope) has been created. The D-Port allows to maintain one of the rules of laparoscopy, which is the optical system in the middle of the two ancillary operative tools. In addition, the cost of the procedure is not increased, due to the reusable material.
Video: This video shows a down-to-up rectal resection assisted by single incision laparoscopy, in a 65-year old man presenting with a rectal adenocarcinoma 4cm away from the anal margin. Preoperative work-up showed a T2N0M0 tumor, after radiochemotherapy. The procedure was performed transabdominally for the vascular dissection and transanally for the TME. The abdominal single site was then used for the placement of the temporary ileostomy.
Results: Total operative time was 301 minutes, and partial transanal laparoscopy was 145 minutes. Perioperative bleeding was 50cc. The final scar length was 2.5cm, and the patient was discharged after 5 days. The pathological report confirmed a pT2N0M0 tumor (15 negative nodes).
Conclusions: Down-to-up rectal resection is an interesting procedure, and when associated with single incision laparoscopy, it offers the possibility to use the single site as the site for temporary ileostomy.
Hybrid lung malformation with intralobar pulmonary sequestration and congenital cystic adenomatoid malformation (CCAM): thoracoscopic left lower lobectomy (LLL)
This is the case of an infant presenting with a hybrid left lower lung malformation with intralobar pulmonary sequestration and congenital cystic adenomatoid malformation (CCAM).
The systemic arterial vascularization of the sequestration originated from the thoracic aorta. The infant was 8 months old when the thoracoscopic procedure was performed. Prenatal diagnosis helped to identify the uncomplicated lung malformation. A CT-scan was performed when the patient was 6 months old before surgery was scheduled. The surgical intervention, a left lower lobectomy, was immediately preceded by a bronchial endoscopy in order to control the anatomy, the good health of the airway tree, and to place a blocker in the left main bronchus. The first operative step consisted in a ligation-division of the systemic artery as close to the diaphragm as possible. The second operative step consisted in a conventional left lower lobectomy with primary treatment of pulmonary arteries, veins, and bronchi.
F Becmeur, A Schneider, I Lacreuse
Surgical intervention
3 years ago
1113 views
55 likes
0 comments
06:25
Hybrid lung malformation with intralobar pulmonary sequestration and congenital cystic adenomatoid malformation (CCAM): thoracoscopic left lower lobectomy (LLL)
This is the case of an infant presenting with a hybrid left lower lung malformation with intralobar pulmonary sequestration and congenital cystic adenomatoid malformation (CCAM).
The systemic arterial vascularization of the sequestration originated from the thoracic aorta. The infant was 8 months old when the thoracoscopic procedure was performed. Prenatal diagnosis helped to identify the uncomplicated lung malformation. A CT-scan was performed when the patient was 6 months old before surgery was scheduled. The surgical intervention, a left lower lobectomy, was immediately preceded by a bronchial endoscopy in order to control the anatomy, the good health of the airway tree, and to place a blocker in the left main bronchus. The first operative step consisted in a ligation-division of the systemic artery as close to the diaphragm as possible. The second operative step consisted in a conventional left lower lobectomy with primary treatment of pulmonary arteries, veins, and bronchi.
Konnyaku shirataki model for training in robotic microsurgery anastomosis
The aim of this study was to test the feasibility of a type of Japanese noodle, named ‘shirataki konnyaku’, for microsurgery training in the operating room. Thirteen surgical residents without experience in microsurgery had to perform two microsurgical anastomoses: one in a model of a femoral artery of a rat (control) and one in a model of a konnyaku shirataki. Two quantitative variables (time in minutes and number of stitches to perform the anastomosis) and two qualitative variables (patency and tightness of the anastomosis) were measured. Sixty anastomoses were performed with the control model and 62 anastomoses with the konnyaku model. The time of the anastomosis was significantly higher in the control group. The number of stitches was similar in both groups. The patency of the anastomosis was significantly lower in the control group. The tightness (no leak) of the anastomosis was significantly higher in the control group. The ‘konnyaku shirataki’ model could improve the teaching of microsurgery due to its availability, low cost, and structural similarity to the animal model.
P Liverneaux, G Prunières
Surgical intervention
3 years ago
294 views
6 likes
0 comments
01:45
Konnyaku shirataki model for training in robotic microsurgery anastomosis
The aim of this study was to test the feasibility of a type of Japanese noodle, named ‘shirataki konnyaku’, for microsurgery training in the operating room. Thirteen surgical residents without experience in microsurgery had to perform two microsurgical anastomoses: one in a model of a femoral artery of a rat (control) and one in a model of a konnyaku shirataki. Two quantitative variables (time in minutes and number of stitches to perform the anastomosis) and two qualitative variables (patency and tightness of the anastomosis) were measured. Sixty anastomoses were performed with the control model and 62 anastomoses with the konnyaku model. The time of the anastomosis was significantly higher in the control group. The number of stitches was similar in both groups. The patency of the anastomosis was significantly lower in the control group. The tightness (no leak) of the anastomosis was significantly higher in the control group. The ‘konnyaku shirataki’ model could improve the teaching of microsurgery due to its availability, low cost, and structural similarity to the animal model.