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Monthly publications

#October 2015
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Uniportal video-assisted thoracoscopic left lower lobectomy and lingular segmentectomy for bronchiectasis
As thoracoscopic surgical techniques are getting increasingly advanced, some thoracic surgeons are dissatisfied with the use of 3 or 4 ports to perform lobectomy. They start to try biportal or uniportal lobectomy in order to make it increasingly less invasive. As compared to 3-portal VATS lobectomy, the literature showed that uniportal VATS lobectomies have even more decreased postoperative pain, without significantly lengthening operative time, increasing blood loss or complications. After acquiring uniportal VATS techniques by adjusting the angle of view, by reorganizing the positions of the instruments, and by updating the anatomical concepts and dissecting process, lobectomy, and even composite-lobe resection, can be managed as a regular procedure.
We present the case of a 52-year-old man with a left lower lobe and lingular segment bronchiectasis. The patient underwent a left lower lobectomy and lingular segmentectomy using a uniportal video-assisted thoracoscopic approach.
J He, DJ Ma
Surgical intervention
3 years ago
956 views
31 likes
0 comments
09:45
Uniportal video-assisted thoracoscopic left lower lobectomy and lingular segmentectomy for bronchiectasis
As thoracoscopic surgical techniques are getting increasingly advanced, some thoracic surgeons are dissatisfied with the use of 3 or 4 ports to perform lobectomy. They start to try biportal or uniportal lobectomy in order to make it increasingly less invasive. As compared to 3-portal VATS lobectomy, the literature showed that uniportal VATS lobectomies have even more decreased postoperative pain, without significantly lengthening operative time, increasing blood loss or complications. After acquiring uniportal VATS techniques by adjusting the angle of view, by reorganizing the positions of the instruments, and by updating the anatomical concepts and dissecting process, lobectomy, and even composite-lobe resection, can be managed as a regular procedure.
We present the case of a 52-year-old man with a left lower lobe and lingular segment bronchiectasis. The patient underwent a left lower lobectomy and lingular segmentectomy using a uniportal video-assisted thoracoscopic approach.
Transanal circumferential mucosectomy for symptomatic benign rectal stenosis
Background: Transanal laparoscopy has been described for more than 30 years. In the presence of benign lesions, it gathers increasing interest, especially if such lesions are located in the low rectum or close to the anal margin.
Video: This video demonstrates the case of a 38-year-old man presented with a circumferential rectal stenosis due to a rectal ulcer. The patient underwent a transanal mucosectomy using laparoscopy, after a sequence of unsuccessful endoscopic dilatations. Preoperative work-up showed a circumferential benign stenosis, 2.5cm away from the anal margin. The procedure was entirely performed with a new reusable transanal platform made up by the DAPRI-Port and DAPRI curved instruments (Karl Storz Endoskope, Tuttlingen, Germany). Once the 360-degree mucosectomy had been completed, the mucosal layer was repaired using separate absorbable sutures.
Results: The operative length was 163 minutes, and peroperative bleeding was unsignificant. The patient was discharged on postoperative day 2. The pathological report confirmed the benign nature of the lesion.
Conclusions: Although transanal laparoscopy has been documented for years, it gathers increasing interest and should be considered as the technique of choice for the treatment of benign rectal lesions, which can be difficult to treat using other methods.
G Dapri, N Bachir, L Antolino, K Grozdev, D Guta, K Jottard, GB Cadière
Surgical intervention
3 years ago
1017 views
13 likes
0 comments
08:37
Transanal circumferential mucosectomy for symptomatic benign rectal stenosis
Background: Transanal laparoscopy has been described for more than 30 years. In the presence of benign lesions, it gathers increasing interest, especially if such lesions are located in the low rectum or close to the anal margin.
Video: This video demonstrates the case of a 38-year-old man presented with a circumferential rectal stenosis due to a rectal ulcer. The patient underwent a transanal mucosectomy using laparoscopy, after a sequence of unsuccessful endoscopic dilatations. Preoperative work-up showed a circumferential benign stenosis, 2.5cm away from the anal margin. The procedure was entirely performed with a new reusable transanal platform made up by the DAPRI-Port and DAPRI curved instruments (Karl Storz Endoskope, Tuttlingen, Germany). Once the 360-degree mucosectomy had been completed, the mucosal layer was repaired using separate absorbable sutures.
Results: The operative length was 163 minutes, and peroperative bleeding was unsignificant. The patient was discharged on postoperative day 2. The pathological report confirmed the benign nature of the lesion.
Conclusions: Although transanal laparoscopy has been documented for years, it gathers increasing interest and should be considered as the technique of choice for the treatment of benign rectal lesions, which can be difficult to treat using other methods.
VATS right upper lobectomy with en bloc chest wall resection
The optimal treatment of lung cancer invading the chest wall is complete surgical resection via lobectomy and en bloc chest wall resection, which has a 40 to 50% 5-year survival when there is no lymph node involvement.
VATS lobectomy is currently preferred as a standard approach in selected cases for pulmonary resections, especially for early stage non-small cell lung cancer with acceptable safety, successful surgical outcomes, and oncological efficacy. With recent advances in both equipment and technique, VATS is being applied to more complex conditions by some experienced thoracic surgeons.
We present the case of a 68-year-old man with pulmonary squamous cells carcinoma of the right upper lobe invading chest wall on the level of posterolateral part of the 3rd and 4th ribs. Right upper lobectomy with en bloc chest wall resection was finally performed by VATS.
M Gonzalez, JY Perentes, T Krueger
Surgical intervention
3 years ago
1031 views
40 likes
1 comment
12:29
VATS right upper lobectomy with en bloc chest wall resection
The optimal treatment of lung cancer invading the chest wall is complete surgical resection via lobectomy and en bloc chest wall resection, which has a 40 to 50% 5-year survival when there is no lymph node involvement.
VATS lobectomy is currently preferred as a standard approach in selected cases for pulmonary resections, especially for early stage non-small cell lung cancer with acceptable safety, successful surgical outcomes, and oncological efficacy. With recent advances in both equipment and technique, VATS is being applied to more complex conditions by some experienced thoracic surgeons.
We present the case of a 68-year-old man with pulmonary squamous cells carcinoma of the right upper lobe invading chest wall on the level of posterolateral part of the 3rd and 4th ribs. Right upper lobectomy with en bloc chest wall resection was finally performed by VATS.
Robotic assisted thoracoscopic lingulectomy
A 67-year-old otherwise healthy woman presented to her primary care physician with complaints of dyspnea. Her primary care physician obtained a chest X-ray, which revealed a left upper lobe abnormality. A follow-up chest CT revealed a 16mm left upper lobe mass concerning for malignancy in the lingula. A bronchoscopy with brushings was performed and pathology was positive for a well-differentiated adenocarcinoma. As part of a clinical staging, a PET-CT was obtained and demonstrated no FDG avid disease in the thorax or elsewhere. Pulmonary function tests revealed an FEV1 of 2.28 L (122% predicted) and DLCO of 19.05 (112% predicted). The therapeutic objectives were to perform an oncologically sound anatomic lung resection and lymph node dissection for the patients early stage biopsy proven lung cancer. The robotic platform was used in this case and we aimed to demonstrate our approach to a robotic assisted thoracoscopic lingulectomy for lung cancer.
HJ Feldman, M Kent, J Wilson
Surgical intervention
3 years ago
406 views
16 likes
0 comments
10:55
Robotic assisted thoracoscopic lingulectomy
A 67-year-old otherwise healthy woman presented to her primary care physician with complaints of dyspnea. Her primary care physician obtained a chest X-ray, which revealed a left upper lobe abnormality. A follow-up chest CT revealed a 16mm left upper lobe mass concerning for malignancy in the lingula. A bronchoscopy with brushings was performed and pathology was positive for a well-differentiated adenocarcinoma. As part of a clinical staging, a PET-CT was obtained and demonstrated no FDG avid disease in the thorax or elsewhere. Pulmonary function tests revealed an FEV1 of 2.28 L (122% predicted) and DLCO of 19.05 (112% predicted). The therapeutic objectives were to perform an oncologically sound anatomic lung resection and lymph node dissection for the patients early stage biopsy proven lung cancer. The robotic platform was used in this case and we aimed to demonstrate our approach to a robotic assisted thoracoscopic lingulectomy for lung cancer.
Laparoscopic omentoplasty to support anastomotic urethroplasty in complex and redo pelvic fracture urethral injury patient
Introduction:
The aim of this film was to test the feasibility, safety and efficiency of a new surgical technique using elaborated perineal anastomotic urethroplasty combined with laparoscopic omentoplasty for patients with complex pelvic fracture and for whom a previous urethral defect repair failed.

Material and methods:
We performed a prospective, observational, stage 2a study to observe treatment outcomes of combined perineal and laparoscopic approaches for urethroplasty in patients with complex and redo pelvic fracture urethral defects at a single center in Pune, India, between January 2012 and January 2013.
Anterior urethral strictures were excluded. The primary aim of the study was to evaluate the efficiency of the surgical technique and the secondary aim was to test the feasibility and safety of the procedure. The procedure was considered as ineffective if any additional postoperative procedure was required.

Results:
Fifteen male patients with a median age of 19 years old were included. Seven patients were adolescents (12-18 years of age) and 8 patients were adults (19-49 years of age). The mean number of prior urethroplasties was 1.8 (1-3). All patients underwent elaborated bulbomembranous anastomosis using a perineal approach with inferior pubectomy combined with laparoscopic mobilization of the omentum into the perineum to wrap the anastomosis.
In 15 patients, 14 (93.3%) had a successful outcome and the procedure failed in 1 patient (6.6%). A 14-year-old boy developed a recurrent stricture 2 months after the procedure, which was managed using an internal urethrotomy. Median follow-up was 18 months (13-24 months).

Conclusion:
Combining a laparoscopic omentoplasty with a membranobulbar anastomosis for complex and redo pelvic fracture urethral injury is a successful, feasible and safe technique, and with minimal additional morbidity for the patient. This technique offers the advantages of a perineal incision and allows to use the omentum in order to facilitate the anastomosis.
S Kulkarni, G Barbagli, J Kulkarni, S Surana, V Batra, P Joshi
Surgical intervention
3 years ago
1201 views
66 likes
0 comments
07:58
Laparoscopic omentoplasty to support anastomotic urethroplasty in complex and redo pelvic fracture urethral injury patient
Introduction:
The aim of this film was to test the feasibility, safety and efficiency of a new surgical technique using elaborated perineal anastomotic urethroplasty combined with laparoscopic omentoplasty for patients with complex pelvic fracture and for whom a previous urethral defect repair failed.

Material and methods:
We performed a prospective, observational, stage 2a study to observe treatment outcomes of combined perineal and laparoscopic approaches for urethroplasty in patients with complex and redo pelvic fracture urethral defects at a single center in Pune, India, between January 2012 and January 2013.
Anterior urethral strictures were excluded. The primary aim of the study was to evaluate the efficiency of the surgical technique and the secondary aim was to test the feasibility and safety of the procedure. The procedure was considered as ineffective if any additional postoperative procedure was required.

Results:
Fifteen male patients with a median age of 19 years old were included. Seven patients were adolescents (12-18 years of age) and 8 patients were adults (19-49 years of age). The mean number of prior urethroplasties was 1.8 (1-3). All patients underwent elaborated bulbomembranous anastomosis using a perineal approach with inferior pubectomy combined with laparoscopic mobilization of the omentum into the perineum to wrap the anastomosis.
In 15 patients, 14 (93.3%) had a successful outcome and the procedure failed in 1 patient (6.6%). A 14-year-old boy developed a recurrent stricture 2 months after the procedure, which was managed using an internal urethrotomy. Median follow-up was 18 months (13-24 months).

Conclusion:
Combining a laparoscopic omentoplasty with a membranobulbar anastomosis for complex and redo pelvic fracture urethral injury is a successful, feasible and safe technique, and with minimal additional morbidity for the patient. This technique offers the advantages of a perineal incision and allows to use the omentum in order to facilitate the anastomosis.