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Monthly publications

#December 2015
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The VERSA LIFTER BAND™: a new option for liver retraction in laparoscopic Roux-en-Y gastric bypass for morbid obesity
During laparoscopic bariatric procedures in morbidly obese patients, the surgeon's operative view is often obscured by the hypertrophic adipose left lobe of the liver.
To provide adequate operative views and working space, an appropriate retraction of the left liver lobe is required.
The use of a conventional liver retractor mandates an additional subxiphoid wound, resulting in patient discomfort for pain and scar formation, with the additional risk of iatrogenic liver injury during retraction maneuvers.
To overcome these limitations, we present the use of a simple, rapid, and safe technique for liver retraction using the VERSA LIFTER™ Band disposable liver suspension system or retractor.
A D'Urso, M Vix, B Dallemagne, HA Mercoli, D Mutter, J Marescaux
Surgical intervention
2 years ago
1629 views
37 likes
0 comments
03:48
The VERSA LIFTER BAND™: a new option for liver retraction in laparoscopic Roux-en-Y gastric bypass for morbid obesity
During laparoscopic bariatric procedures in morbidly obese patients, the surgeon's operative view is often obscured by the hypertrophic adipose left lobe of the liver.
To provide adequate operative views and working space, an appropriate retraction of the left liver lobe is required.
The use of a conventional liver retractor mandates an additional subxiphoid wound, resulting in patient discomfort for pain and scar formation, with the additional risk of iatrogenic liver injury during retraction maneuvers.
To overcome these limitations, we present the use of a simple, rapid, and safe technique for liver retraction using the VERSA LIFTER™ Band disposable liver suspension system or retractor.
Single incision laparoscopic non-traumatic left lateral diaphragmatic hernia repair
Background: A diaphragmatic hernia is a quite uncommon disease, being congenital or post-traumatic. Its diagnosis is frequently incidental. The surgical treatment can be performed through the abdomen as well as through the chest. Laparoscopy and thoracoscopy offer a surgical benefit, because of reduced abdominal wall trauma and added advantages provided by minimally invasive surgery (MIS). Transumbilical single incision laparoscopy (TSIL), in addition to improved cosmetic results, can offer other advantages to MIS such as reduced postoperative pain, a shorter hospital stay, and improved patient comfort.
Video: The authors report the case of a 45-year-old man who consulted for a non-traumatic left lateral diaphragmatic hernia, which was discovered incidentally, and which was treated using TSIL suture and mesh reinforcement.
Results: Laparoscopic time was 104 minutes and perioperative bleeding was insignificant. The final umbilical scar was 15mm. During the postoperative course, only 4 grams of paracetamol were used. The patient was discharged on the 1st postoperative day, after chest X-ray control. At consultation, the patient did not report the use of painkillers and, at 1, 6, and 12 months, the chest X-ray control was negative for recurrence.
Conclusions: Uncommon conditions, such as a lateral diaphragmatic hernia, can be approached using TSIL, because this technique adds an improved cosmetic result, a reduced postoperative pain, a shorter hospital stay, and an improved patient comfort.
G Dapri, K Jottard, K Grozdev, D Guta, GB Cadière
Surgical intervention
2 years ago
924 views
30 likes
0 comments
07:14
Single incision laparoscopic non-traumatic left lateral diaphragmatic hernia repair
Background: A diaphragmatic hernia is a quite uncommon disease, being congenital or post-traumatic. Its diagnosis is frequently incidental. The surgical treatment can be performed through the abdomen as well as through the chest. Laparoscopy and thoracoscopy offer a surgical benefit, because of reduced abdominal wall trauma and added advantages provided by minimally invasive surgery (MIS). Transumbilical single incision laparoscopy (TSIL), in addition to improved cosmetic results, can offer other advantages to MIS such as reduced postoperative pain, a shorter hospital stay, and improved patient comfort.
Video: The authors report the case of a 45-year-old man who consulted for a non-traumatic left lateral diaphragmatic hernia, which was discovered incidentally, and which was treated using TSIL suture and mesh reinforcement.
Results: Laparoscopic time was 104 minutes and perioperative bleeding was insignificant. The final umbilical scar was 15mm. During the postoperative course, only 4 grams of paracetamol were used. The patient was discharged on the 1st postoperative day, after chest X-ray control. At consultation, the patient did not report the use of painkillers and, at 1, 6, and 12 months, the chest X-ray control was negative for recurrence.
Conclusions: Uncommon conditions, such as a lateral diaphragmatic hernia, can be approached using TSIL, because this technique adds an improved cosmetic result, a reduced postoperative pain, a shorter hospital stay, and an improved patient comfort.
Full thoracoscopic left 6 segmentectomy for invasive pulmonary aspergillosis (IPA)
This video summarizes the main steps of a thoracoscopic left S6 segmentectomy whose indication was a high suspicion of invasive pulmonary aspergillosis (IPA) in a female patient presenting with an acute myeloid leukemia. IPA was resistant to antifungal therapy. A resection was rapidly required as an allogenic bone marrow transplantation was pending.
A full thoracoscopic technique, i.e., with access incision, was used. As for all anatomical segmentectomies performed in our department, a tridimensional reconstruction was carried out preoperatively. A high-definition camera system, a deflectable scope, as well as dedicated thoracoscopic instruments were used.
D Gossot, A Seguin-Givelet, E Brian, M Grigoroiu, D Mayeur, J Lutz
Surgical intervention
2 years ago
739 views
40 likes
0 comments
08:39
Full thoracoscopic left 6 segmentectomy for invasive pulmonary aspergillosis (IPA)
This video summarizes the main steps of a thoracoscopic left S6 segmentectomy whose indication was a high suspicion of invasive pulmonary aspergillosis (IPA) in a female patient presenting with an acute myeloid leukemia. IPA was resistant to antifungal therapy. A resection was rapidly required as an allogenic bone marrow transplantation was pending.
A full thoracoscopic technique, i.e., with access incision, was used. As for all anatomical segmentectomies performed in our department, a tridimensional reconstruction was carried out preoperatively. A high-definition camera system, a deflectable scope, as well as dedicated thoracoscopic instruments were used.
Severe complex endometriosis with ascites: laparoscopic management
Frozen pelvis due to endometriosis is one of the most complex and risky situations which surgeons sometimes face. Its laparoscopic management requires a systematic approach, a good anatomical knowledge and a high level of surgical competency. This is a frozen pelvis case secondary to a complicated severe endometriosis in a young nulliparous lady. She had hemorrhagic abdominal ascites secondary to endometriosis, with a sub-occlusive syndrome. Her disease was further complicated with upper abdominal and pelvic fibrosis with a large umbilical endometriotic nodule as well as splenic, omental and sigmoid endometriosis. This video demonstrates the strategy of the laparoscopic management of this condition.
A Wattiez, R Nasir, A Host
Surgical intervention
2 years ago
3592 views
160 likes
1 comment
31:22
Severe complex endometriosis with ascites: laparoscopic management
Frozen pelvis due to endometriosis is one of the most complex and risky situations which surgeons sometimes face. Its laparoscopic management requires a systematic approach, a good anatomical knowledge and a high level of surgical competency. This is a frozen pelvis case secondary to a complicated severe endometriosis in a young nulliparous lady. She had hemorrhagic abdominal ascites secondary to endometriosis, with a sub-occlusive syndrome. Her disease was further complicated with upper abdominal and pelvic fibrosis with a large umbilical endometriotic nodule as well as splenic, omental and sigmoid endometriosis. This video demonstrates the strategy of the laparoscopic management of this condition.
Laparoscopic management of extrauterine leiomyomas
Uterine leiomyomas affect 20 to 30% of women older than 35 years. Extrauterine leiomyomas are rarer, and they present a greater diagnostic challenge. These histologically benign leiomyomas occasionally occur with unusual growth patterns or in unusual locations which make their identification more challenging both clinically and radiologically. Unusual growth patterns may be seen, including benign metastasizing leiomyoma, disseminated peritoneal leiomyomatosis, intravenous leiomyomatosis, parasitic leiomyoma, and retroperitoneal growth. Diffuse peritoneal leiomyomatosis manifests as innumerable peritoneal nodules resembling those in peritoneal carcinomatosis. Parasitic leiomyoma and retroperitoneal leiomyomatosis usually manifest as single or multiple pelvic or retroperitoneal masses. Retroperitoneal growth is yet another unusual growth pattern of leiomyomas. Multiple leiomyomatous masses are usually seen in the pelvic retroperitoneum in women with a concurrent uterine leiomyoma or a history of uterine leiomyoma. Rarely, the extrauterine masses may extend to the upper retroperitoneum, as high as the level of the renal hilum. Occasionally, leiomyomas become adherent to surrounding structures (e.g., broad ligament, omentum, or retroperitoneal connective tissue), develop an auxiliary blood supply, and lose their original attachment to the uterus, hence becoming “parasitic.” We are presenting a case of extrauterine leiomyoma, which was operated for laparoscopic myomectomy for huge cervical leiomyoma 4 years back but was converted to an abdominal myomectomy.
D Limbachiya
Surgical intervention
2 years ago
2669 views
172 likes
0 comments
09:11
Laparoscopic management of extrauterine leiomyomas
Uterine leiomyomas affect 20 to 30% of women older than 35 years. Extrauterine leiomyomas are rarer, and they present a greater diagnostic challenge. These histologically benign leiomyomas occasionally occur with unusual growth patterns or in unusual locations which make their identification more challenging both clinically and radiologically. Unusual growth patterns may be seen, including benign metastasizing leiomyoma, disseminated peritoneal leiomyomatosis, intravenous leiomyomatosis, parasitic leiomyoma, and retroperitoneal growth. Diffuse peritoneal leiomyomatosis manifests as innumerable peritoneal nodules resembling those in peritoneal carcinomatosis. Parasitic leiomyoma and retroperitoneal leiomyomatosis usually manifest as single or multiple pelvic or retroperitoneal masses. Retroperitoneal growth is yet another unusual growth pattern of leiomyomas. Multiple leiomyomatous masses are usually seen in the pelvic retroperitoneum in women with a concurrent uterine leiomyoma or a history of uterine leiomyoma. Rarely, the extrauterine masses may extend to the upper retroperitoneum, as high as the level of the renal hilum. Occasionally, leiomyomas become adherent to surrounding structures (e.g., broad ligament, omentum, or retroperitoneal connective tissue), develop an auxiliary blood supply, and lose their original attachment to the uterus, hence becoming “parasitic.” We are presenting a case of extrauterine leiomyoma, which was operated for laparoscopic myomectomy for huge cervical leiomyoma 4 years back but was converted to an abdominal myomectomy.