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#June 2016
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Right and left adrenalectomy by transperitoneal approach
In this video, Professor Didier Mutter demonstrates different approaches for laparoscopic adrenalectomy. For a precise and fast dissection, the quality of camera and instruments is essential. Vascular landmarks are of paramount importance, Sometimes, there is a duplication of the adrenal vein, and any mistake in dissection can cause difficulty to control bleeding. 3D reconstruction helps to identify some original anatomical variations. In this lecture, Professor Mutter also discusses the robotic approach used to perform an adrenalectomy with 3D reconstruction for vascular exploration in order to prevent renal vascular damage. The laparoscopic approach is the gold standard for all types of glands. In some complicated cases, the procedure is converted to an open procedure. This does not mean that the technique has failed.
D Mutter
Lecture
2 years ago
2773 views
290 likes
1 comment
18:17
Right and left adrenalectomy by transperitoneal approach
In this video, Professor Didier Mutter demonstrates different approaches for laparoscopic adrenalectomy. For a precise and fast dissection, the quality of camera and instruments is essential. Vascular landmarks are of paramount importance, Sometimes, there is a duplication of the adrenal vein, and any mistake in dissection can cause difficulty to control bleeding. 3D reconstruction helps to identify some original anatomical variations. In this lecture, Professor Mutter also discusses the robotic approach used to perform an adrenalectomy with 3D reconstruction for vascular exploration in order to prevent renal vascular damage. The laparoscopic approach is the gold standard for all types of glands. In some complicated cases, the procedure is converted to an open procedure. This does not mean that the technique has failed.
Laparoscopic posterior retroperitoneoscopic adrenalectomy
In this video, Professor Martin Walz presents the main principles of laparoscopic retroperitoneoscopic adrenalectomy. The patient lies in a prone position with the adrenal gland being approached posteriorly beneath the 12th rib, thereby allowing for a direct access to the retroperitoneum and adrenal gland without the need for intra-abdominal organ mobilization. Carbon dioxide pressure and camera position play a key role for better exposure and imaging. High insufflation pressures in the retroperitoneal space can also reduce troublesome bleeding. This approach remains the best option with no blood loss and reduced postoperative pain, less morbidity, a shorter hospital stay, and an earlier return to normal activities.
M Walz
Lecture
2 years ago
1270 views
97 likes
0 comments
14:34
Laparoscopic posterior retroperitoneoscopic adrenalectomy
In this video, Professor Martin Walz presents the main principles of laparoscopic retroperitoneoscopic adrenalectomy. The patient lies in a prone position with the adrenal gland being approached posteriorly beneath the 12th rib, thereby allowing for a direct access to the retroperitoneum and adrenal gland without the need for intra-abdominal organ mobilization. Carbon dioxide pressure and camera position play a key role for better exposure and imaging. High insufflation pressures in the retroperitoneal space can also reduce troublesome bleeding. This approach remains the best option with no blood loss and reduced postoperative pain, less morbidity, a shorter hospital stay, and an earlier return to normal activities.
Robotic adrenalectomy for left adrenal Conn’s adenoma: live broadcast
According to recent studies, robotic adrenalectomy has proven to be superior to laparoscopic adrenalectomy, with a reduction of blood loss during procedure and a reduced operative time.
The robotic system provides an intraoperative stability to the surgeon, allowing for a perfect handling of sensitive functional adrenal tumors. The main advantage of robotics lies in the ease of dissection, aided by improved visualization, the EndoWrist®, articulated instruments, and reduction of tremors, allowing for more accurate movements.

Indications: hormone-secreting tumors, adrenal masses >5cm, smaller lesions suspicious for malignancy, and lesions increasing in size on serial imaging.
Contraindications: infiltrative adrenal masses and tumors of extremely large size, because the size of adrenal lesions correlates with the potential for adrenal carcinoma.
The da Vinci Robotic Surgical System (Intuitive Surgical Inc., Sunnyvale, CA, USA) and the following robotic instruments are used:30-degree scope, ProGrasp™ forceps, Hot Shears (monopolar curved scissors or a hook), and a Robotic Clip Applier. A monopolar cautery hook and Harmonic ACE® curved shears can also be used when deemed helpful by the surgeon.
Laparoscopic instruments that can be handled by the bedside assistant, a clip applier and a suction device are also used.
CN Tang
Surgical intervention
2 years ago
1673 views
132 likes
0 comments
24:47
Robotic adrenalectomy for left adrenal Conn’s adenoma: live broadcast
According to recent studies, robotic adrenalectomy has proven to be superior to laparoscopic adrenalectomy, with a reduction of blood loss during procedure and a reduced operative time.
The robotic system provides an intraoperative stability to the surgeon, allowing for a perfect handling of sensitive functional adrenal tumors. The main advantage of robotics lies in the ease of dissection, aided by improved visualization, the EndoWrist®, articulated instruments, and reduction of tremors, allowing for more accurate movements.

Indications: hormone-secreting tumors, adrenal masses >5cm, smaller lesions suspicious for malignancy, and lesions increasing in size on serial imaging.
Contraindications: infiltrative adrenal masses and tumors of extremely large size, because the size of adrenal lesions correlates with the potential for adrenal carcinoma.
The da Vinci Robotic Surgical System (Intuitive Surgical Inc., Sunnyvale, CA, USA) and the following robotic instruments are used:30-degree scope, ProGrasp™ forceps, Hot Shears (monopolar curved scissors or a hook), and a Robotic Clip Applier. A monopolar cautery hook and Harmonic ACE® curved shears can also be used when deemed helpful by the surgeon.
Laparoscopic instruments that can be handled by the bedside assistant, a clip applier and a suction device are also used.
Robot-assisted ultrasound-guided transgastric cystogastrostomy
We report the case of a 57-year-old woman with a voluminous pseudocyst in the lesser sac after several episodes of acute pancreatitis of biliary origin managed by a robot-assisted transgastric cystogastrostomy. The patient is lying supine, legs apart. Five ports are positioned. The intervention is begun with an anterior gastrotomy, which allows to introduce a balloon-tipped trocar transgastrically. A second gastrotomy is performed in the prepyloric region. It allows to introduce a second transgastric trocar. Finally, a third gastrotomy is performed at the level of the fundus to introduce a third transgastric balloon-tipped trocar. After transgastric insufflation, the trocars are connected to the robot, which is positioned at the patient’s head. A transgastric ultrasonography is performed to visualize the pseudocyst, which has a heterogeneous content, with fibrotic debris. The gastrotomy is initiated with Ultracision™ at the posterior aspect of the stomach. The cyst is multilocular. The gastric wall is controlled by means of a Doppler ultrasound in order not to pass through the gastric varices, which had been identified on endoscopic ultrasound. A second cavity with some more heterogeneous content is subsequently opened. This cavity presents some pancreatic necrosis. The cystogastrostomy is enlarged at its most. Trocars are then removed to proceed intraperitoneally. The three anterior gastrotomy incisions are then sutured using the robot. The postoperative outcome is uneventful. The patient is discharged on postoperative day 4.
P Pessaux, R Memeo, V De Blasi, O Perotto, D Mutter, J Marescaux
Surgical intervention
2 years ago
1049 views
50 likes
0 comments
06:04
Robot-assisted ultrasound-guided transgastric cystogastrostomy
We report the case of a 57-year-old woman with a voluminous pseudocyst in the lesser sac after several episodes of acute pancreatitis of biliary origin managed by a robot-assisted transgastric cystogastrostomy. The patient is lying supine, legs apart. Five ports are positioned. The intervention is begun with an anterior gastrotomy, which allows to introduce a balloon-tipped trocar transgastrically. A second gastrotomy is performed in the prepyloric region. It allows to introduce a second transgastric trocar. Finally, a third gastrotomy is performed at the level of the fundus to introduce a third transgastric balloon-tipped trocar. After transgastric insufflation, the trocars are connected to the robot, which is positioned at the patient’s head. A transgastric ultrasonography is performed to visualize the pseudocyst, which has a heterogeneous content, with fibrotic debris. The gastrotomy is initiated with Ultracision™ at the posterior aspect of the stomach. The cyst is multilocular. The gastric wall is controlled by means of a Doppler ultrasound in order not to pass through the gastric varices, which had been identified on endoscopic ultrasound. A second cavity with some more heterogeneous content is subsequently opened. This cavity presents some pancreatic necrosis. The cystogastrostomy is enlarged at its most. Trocars are then removed to proceed intraperitoneally. The three anterior gastrotomy incisions are then sutured using the robot. The postoperative outcome is uneventful. The patient is discharged on postoperative day 4.
Laparoscopic distal pancreatectomy with spleen preservation
Distal pancreatectomy is the standard curative treatment for symptomatic benign, premalignant, and malignant disease of the pancreatic body and tail. Nowadays, more than 80% of distal pancreatectomies are performed laparoscopically. The basic advantages of this approach over the open approach are the following: reduced blood loss, fewer complications, and shorter hospital stay. Pancreatic neoplasms, chronic pancreatitis, and pancreatic cysts are the main indications for laparoscopic distal pancreatectomy. Distal pancreatosplenectomy and spleen-preserving pancreatectomy are contraindicated in metastatic diseases, peritoneal carcinosis, vascular invasion, and pancreatitis involving the entire pancreas. Spleen-preserving distal pancreatectomy should be attempted in case of benign disease. Spleen preservation should preferably be achieved by preserving the splenic vessels (Kimura technique), but also by resecting the splenic vessels and maintaining vascularity through the short gastric vessels and the left gastroepiploic artery (Warshaw’s technique).
AM Cury
Lecture
2 years ago
1733 views
70 likes
0 comments
11:42
Laparoscopic distal pancreatectomy with spleen preservation
Distal pancreatectomy is the standard curative treatment for symptomatic benign, premalignant, and malignant disease of the pancreatic body and tail. Nowadays, more than 80% of distal pancreatectomies are performed laparoscopically. The basic advantages of this approach over the open approach are the following: reduced blood loss, fewer complications, and shorter hospital stay. Pancreatic neoplasms, chronic pancreatitis, and pancreatic cysts are the main indications for laparoscopic distal pancreatectomy. Distal pancreatosplenectomy and spleen-preserving pancreatectomy are contraindicated in metastatic diseases, peritoneal carcinosis, vascular invasion, and pancreatitis involving the entire pancreas. Spleen-preserving distal pancreatectomy should be attempted in case of benign disease. Spleen preservation should preferably be achieved by preserving the splenic vessels (Kimura technique), but also by resecting the splenic vessels and maintaining vascularity through the short gastric vessels and the left gastroepiploic artery (Warshaw’s technique).
Total laparoscopic pancreatico-duodenectomy
Laparoscopic pancreatectomy has recently emerged as one of the most advanced applications of surgery and total laparoscopic pancreaticoduodenectomy (TLPD) has proven to be among one of the most advanced laparoscopic procedures. The evolution in laparoscopic technology and instrumentation within the past decade has let laparoscopic pancreaticoduodenectomy gain wider acceptance. Also known as the Whipple procedure, it was first performed laparoscopically in 1994. It consists of a biliary-enteric and of a gastro-enteric anastomosis. It is a two-step procedure: dissection is performed first, reconstruction follows. The laparoscopic approach requires comparatively longer operative times and necessitates advanced laparoscopic skills and hybrid approaches. Bleeding is a severe complication. People die of gastroduodenal and hepatic artery bleeding. The retroperitoneal part of the pancreas is involved in 51 to 93% of cases. Bleeding is a major complication during this procedure, which can be controlled by compressing, inserting another port, clamping, and stitching.
AM Cury
Lecture
2 years ago
2370 views
127 likes
0 comments
24:39
Total laparoscopic pancreatico-duodenectomy
Laparoscopic pancreatectomy has recently emerged as one of the most advanced applications of surgery and total laparoscopic pancreaticoduodenectomy (TLPD) has proven to be among one of the most advanced laparoscopic procedures. The evolution in laparoscopic technology and instrumentation within the past decade has let laparoscopic pancreaticoduodenectomy gain wider acceptance. Also known as the Whipple procedure, it was first performed laparoscopically in 1994. It consists of a biliary-enteric and of a gastro-enteric anastomosis. It is a two-step procedure: dissection is performed first, reconstruction follows. The laparoscopic approach requires comparatively longer operative times and necessitates advanced laparoscopic skills and hybrid approaches. Bleeding is a severe complication. People die of gastroduodenal and hepatic artery bleeding. The retroperitoneal part of the pancreas is involved in 51 to 93% of cases. Bleeding is a major complication during this procedure, which can be controlled by compressing, inserting another port, clamping, and stitching.
Laparoscopic splenectomy
In this video, Professor Martin Walz provides an overview of laparoscopic splenectomy. Since the first laparoscopic splenectomy in 1991, the procedure has become increasingly precise. The main indications for laparoscopic splenectomy are hypersplenism, splenomegaly, and associated diseases. Splenomegaly (> 20-25cm or > 1,000g) is the main contraindication. Immunization is essential for splenectomy. The patient is either placed in a left decubitus position with a 45-degree rotation or in a right decubitus position with a 90-degree rotation. The main steps of laparoscopic splenectomy are briefly demonstrated in this video. Laparoscopic splenectomy is the gold standard in small tumors with lower blood loss, low morbidity and mortality with a shorter hospital stay.
M Walz
Lecture
2 years ago
3725 views
218 likes
0 comments
19:41
Laparoscopic splenectomy
In this video, Professor Martin Walz provides an overview of laparoscopic splenectomy. Since the first laparoscopic splenectomy in 1991, the procedure has become increasingly precise. The main indications for laparoscopic splenectomy are hypersplenism, splenomegaly, and associated diseases. Splenomegaly (> 20-25cm or > 1,000g) is the main contraindication. Immunization is essential for splenectomy. The patient is either placed in a left decubitus position with a 45-degree rotation or in a right decubitus position with a 90-degree rotation. The main steps of laparoscopic splenectomy are briefly demonstrated in this video. Laparoscopic splenectomy is the gold standard in small tumors with lower blood loss, low morbidity and mortality with a shorter hospital stay.
Robotic partial splenectomy for cystic lesion of the spleen
We report the case of a 21-year-old woman with a cystic lesion of the spleen treated with a robotic partial splenectomy. The patient is placed in a right lateral decubitus position. Four ports are introduced into the left hypochondrium. The robot is placed at the level of the patient’s left shoulder. The intervention is begun with a lowering of the splenic flexure. Dissection is initiated at the upper pole of the spleen by retracting the stomach and by progressively dividing the different short vessels. It is decided to start the parenchymotomy approximately 1cm from the devascularized area. Transection is begun using an ultrasonic dissector. Hemostasis is subsequently achieved progressively. Transection is completed by means of a firing of the Endo GIA™ linear stapler. Hemostasis is further completed using the Aquamantys® system and bipolar sealers. The specimen is fully mobilized and placed in a bag. It is extracted by means of a small suprapubic Pfannenstiel’s incision. Pathological findings demonstrate the presence of an epidermoid cyst. The postoperative outcome is uneventful. The patient is discharged on postoperative day 4.
P Pessaux, R Memeo, V De Blasi, N Ferreira, D Mutter, J Marescaux
Surgical intervention
2 years ago
1692 views
69 likes
0 comments
09:14
Robotic partial splenectomy for cystic lesion of the spleen
We report the case of a 21-year-old woman with a cystic lesion of the spleen treated with a robotic partial splenectomy. The patient is placed in a right lateral decubitus position. Four ports are introduced into the left hypochondrium. The robot is placed at the level of the patient’s left shoulder. The intervention is begun with a lowering of the splenic flexure. Dissection is initiated at the upper pole of the spleen by retracting the stomach and by progressively dividing the different short vessels. It is decided to start the parenchymotomy approximately 1cm from the devascularized area. Transection is begun using an ultrasonic dissector. Hemostasis is subsequently achieved progressively. Transection is completed by means of a firing of the Endo GIA™ linear stapler. Hemostasis is further completed using the Aquamantys® system and bipolar sealers. The specimen is fully mobilized and placed in a bag. It is extracted by means of a small suprapubic Pfannenstiel’s incision. Pathological findings demonstrate the presence of an epidermoid cyst. The postoperative outcome is uneventful. The patient is discharged on postoperative day 4.
Laparoscopic resection of a splenic artery aneurysm with splenic preservation
This video illustrates the laparoscopic resection of a splenic artery aneurysm with splenic preservation in a young lady.
The lesion was discovered fortuitously by ultrasound for an unrelated cause. Embolization was unsuccessful because of the inability of our interventional radiology team to reach the aneurysm itself for coiling.
It is thought that splenic artery aneurysms are present in 1% of the population (1), and coiling/resection is often advocated, especially in young women in childbearing age.
The aneurysm was isolated and its multiple feeding vessels clipped before complete resection. The spleen remained well vascularized through the short gastric vessels and was left in situ.
1. Ayalon A, Wiesner RH, Perkins JD, Tominaga S, Hayes DH, Krom RA. Splenic artery aneurysms in liver transplant patients. Transplantation 1988;45:386-9.
Y Bendavid, B Montreuil
Surgical intervention
2 years ago
1349 views
49 likes
0 comments
07:55
Laparoscopic resection of a splenic artery aneurysm with splenic preservation
This video illustrates the laparoscopic resection of a splenic artery aneurysm with splenic preservation in a young lady.
The lesion was discovered fortuitously by ultrasound for an unrelated cause. Embolization was unsuccessful because of the inability of our interventional radiology team to reach the aneurysm itself for coiling.
It is thought that splenic artery aneurysms are present in 1% of the population (1), and coiling/resection is often advocated, especially in young women in childbearing age.
The aneurysm was isolated and its multiple feeding vessels clipped before complete resection. The spleen remained well vascularized through the short gastric vessels and was left in situ.
1. Ayalon A, Wiesner RH, Perkins JD, Tominaga S, Hayes DH, Krom RA. Splenic artery aneurysms in liver transplant patients. Transplantation 1988;45:386-9.
Laparoscopic adrenalectomy (update of September 2014 presentation)
Laparoscopic adrenalectomy is an attractive alternative to open surgery in children as it is associated with less operative pain and a rapid resumption of diet and shorter operative time.
The relative contraindications are patients with malignancies which involve lymph nodes, highly vascular pheochromocytomas, and large tumors.
Neuroblastoma, congenital adrenal hyperplasia, pheochromocytomas and adrenal cortical carcinomas are the main indications in children.
The transabdominal lateral approach is more commonly used in the pediatric population.
The tumors are incidental findings and 31% of them are malignant in children.
The various techniques of adrenalectomy, preoperative work-up, and indications are described in this lecture.
D Patkowski
Lecture
2 years ago
1228 views
89 likes
0 comments
16:05
Laparoscopic adrenalectomy (update of September 2014 presentation)
Laparoscopic adrenalectomy is an attractive alternative to open surgery in children as it is associated with less operative pain and a rapid resumption of diet and shorter operative time.
The relative contraindications are patients with malignancies which involve lymph nodes, highly vascular pheochromocytomas, and large tumors.
Neuroblastoma, congenital adrenal hyperplasia, pheochromocytomas and adrenal cortical carcinomas are the main indications in children.
The transabdominal lateral approach is more commonly used in the pediatric population.
The tumors are incidental findings and 31% of them are malignant in children.
The various techniques of adrenalectomy, preoperative work-up, and indications are described in this lecture.
Laparoscopic adrenalectomy
Retroperitoneoscopic adrenalectomy was developed in 1993, initially only for small benign lesions and recently for lesions superior to 5 cm and even malignancies.
This retroperitoneal technique has gained popularity since it allows for a direct access to the gland and prevents unexpected injuries to the intra-abdominal organs.
In this lecture, Dr. Mushtaq outlines the indications for adrenalectomy in children, patient set-up, trocar placement, and operative technique overview. The importance of resecting the gland ‘en bloc’ has been emphasized.
The retroperitoneal approach begins by placing the child in a prone position. The 12th rib, iliac crest, and paravertebral muscles are then marked on the patient. The first incision is made at the lateral border of the lateral vertebral muscles, halfway between the 12th rib and the iliac crest (Heloury et al., 2011).
This lecture was delivered during the pediatric urology course held at IRCAD in March 2016.
I Mushtaq
Lecture
2 years ago
1567 views
143 likes
0 comments
16:41
Laparoscopic adrenalectomy
Retroperitoneoscopic adrenalectomy was developed in 1993, initially only for small benign lesions and recently for lesions superior to 5 cm and even malignancies.
This retroperitoneal technique has gained popularity since it allows for a direct access to the gland and prevents unexpected injuries to the intra-abdominal organs.
In this lecture, Dr. Mushtaq outlines the indications for adrenalectomy in children, patient set-up, trocar placement, and operative technique overview. The importance of resecting the gland ‘en bloc’ has been emphasized.
The retroperitoneal approach begins by placing the child in a prone position. The 12th rib, iliac crest, and paravertebral muscles are then marked on the patient. The first incision is made at the lateral border of the lateral vertebral muscles, halfway between the 12th rib and the iliac crest (Heloury et al., 2011).
This lecture was delivered during the pediatric urology course held at IRCAD in March 2016.
LIVE INTERACTIVE SURGERY: laparoscopic left adrenalectomy for pheochromocytoma
Laparoscopic adrenalectomy was first described by Gagner et al. in 1992. It has become the procedure of choice for most benign adrenal lesions since then because of decreased blood loss, shorter hospital stay, faster recovery, and lower morbidity as compared to open surgery.
The indications for laparoscopic adrenalectomy are the same as for open surgery, except in cases of confirmed adrenocortical carcinomas.
Absolute contraindications for laparoscopic adrenalectomy are as follows: severe cardiopulmonary disease, locally advanced tumors, medically untreated pheochromocytoma, and uncontrolled coagulopathies. This is a live demonstration of a left adrenalectomy recorded during the Minimally Invasive Endocrine Surgery Course, which was held at IRCAD in May 2016.
D Mutter, P Donepudi, J Marescaux
Surgical intervention
2 years ago
3348 views
330 likes
0 comments
28:17
LIVE INTERACTIVE SURGERY: laparoscopic left adrenalectomy for pheochromocytoma
Laparoscopic adrenalectomy was first described by Gagner et al. in 1992. It has become the procedure of choice for most benign adrenal lesions since then because of decreased blood loss, shorter hospital stay, faster recovery, and lower morbidity as compared to open surgery.
The indications for laparoscopic adrenalectomy are the same as for open surgery, except in cases of confirmed adrenocortical carcinomas.
Absolute contraindications for laparoscopic adrenalectomy are as follows: severe cardiopulmonary disease, locally advanced tumors, medically untreated pheochromocytoma, and uncontrolled coagulopathies. This is a live demonstration of a left adrenalectomy recorded during the Minimally Invasive Endocrine Surgery Course, which was held at IRCAD in May 2016.
LIVE INTERACTIVE SURGERY: laparoscopic left adrenalectomy: retroperitoneal access
Retroperitoneal adrenalectomy (posterior approach) provides a direct access to the adrenal gland, hence preventing the risk of injury to intraperitoneal organs. The retroperitoneoscopic approach shortens the mean operative time and it is critical in cases of pheochromocytoma. Consequently, it is the recommended treatment for pheochromocytoma. Blood loss and the convalescence period are also shortened with this approach. The surgical principles of retroperitoneal adrenalectomy according to Professor Martin Walz are as follows: ‘en bloc’ resection, start of dissection with the upper pole of kidney, lower pole of the adrenal gland next, control of the main adrenal vein without clips, and morcellation of the gland if necessary in a bag.
M Walz, P Donepudi
Surgical intervention
2 years ago
1671 views
171 likes
0 comments
39:46
LIVE INTERACTIVE SURGERY: laparoscopic left adrenalectomy: retroperitoneal access
Retroperitoneal adrenalectomy (posterior approach) provides a direct access to the adrenal gland, hence preventing the risk of injury to intraperitoneal organs. The retroperitoneoscopic approach shortens the mean operative time and it is critical in cases of pheochromocytoma. Consequently, it is the recommended treatment for pheochromocytoma. Blood loss and the convalescence period are also shortened with this approach. The surgical principles of retroperitoneal adrenalectomy according to Professor Martin Walz are as follows: ‘en bloc’ resection, start of dissection with the upper pole of kidney, lower pole of the adrenal gland next, control of the main adrenal vein without clips, and morcellation of the gland if necessary in a bag.
Total laparoscopic pancreaticoduodenectomy with pancreaticogastric anastomosis
The safe feasibility of total laparoscopic pancreaticoduodenectomy has been demonstrated by several authors. In order to achieve it, a 5-port approach is used. Kocher’s maneuver allows to access the inferior vena cava, the subrenal aorta, the posterior plate of the unciform process, and the superior mesenteric artery. Lymph node resection of the region may be performed completely, namely an interaorticocaval lymphadenectomy around the hepatoduodenal ligament and around the coeliac trunk and its branches. After portal vein dissection, the pancreas must be divided distally from the tumor, and its right part must be separated from the portal vein. The duodenal bulb and the first jejunal loop are divided using a linear stapler. After cholecystectomy, the hepatic duct is cut proximally to the cystic duct. Reconstruction will include three anastomoses, a telescoping posterior end-to-side pancreaticogastrostomy, an end-to-side duodenojejunostomy, and an end-to-side hepaticojejunostomy.
B Ghavami
Surgical intervention
2 years ago
1579 views
56 likes
0 comments
13:35
Total laparoscopic pancreaticoduodenectomy with pancreaticogastric anastomosis
The safe feasibility of total laparoscopic pancreaticoduodenectomy has been demonstrated by several authors. In order to achieve it, a 5-port approach is used. Kocher’s maneuver allows to access the inferior vena cava, the subrenal aorta, the posterior plate of the unciform process, and the superior mesenteric artery. Lymph node resection of the region may be performed completely, namely an interaorticocaval lymphadenectomy around the hepatoduodenal ligament and around the coeliac trunk and its branches. After portal vein dissection, the pancreas must be divided distally from the tumor, and its right part must be separated from the portal vein. The duodenal bulb and the first jejunal loop are divided using a linear stapler. After cholecystectomy, the hepatic duct is cut proximally to the cystic duct. Reconstruction will include three anastomoses, a telescoping posterior end-to-side pancreaticogastrostomy, an end-to-side duodenojejunostomy, and an end-to-side hepaticojejunostomy.
Laparoscopic distal pancreatectomy
Almost all lesions smaller than 7cm, which do not involve the coeliac or mesenteric vessels, should be considered for laparoscopic distal pancreatectomy. Several meta-analyses showed the clear benefits of laparoscopic distal pancreatectomy over open surgery regarding blood loss, hospital stay, morbidity, and wound infection. The comparison of open surgery vs. laparoscopic surgery in patients presenting with adenocarcinoma shows the benefits of laparoscopic surgery. It is much easier to learn this technique. In this lecture, the clockwise technique is briefly demonstrated. Gravity, ports position and instrumentation are essential. The key steps of the clockwise technique are as follows: mobilization of the splenic flexure and of the proximal descending colon, dissection from lateral to medial along the lower edge of the pancreas, determination of the point of division (stapled or hand-sewn), posterior dissection, mobilization of the spleen using gravity along the superior edge of the pancreas, and removal of the specimen.
HJ Asbun
Lecture
2 years ago
1772 views
57 likes
0 comments
13:55
Laparoscopic distal pancreatectomy
Almost all lesions smaller than 7cm, which do not involve the coeliac or mesenteric vessels, should be considered for laparoscopic distal pancreatectomy. Several meta-analyses showed the clear benefits of laparoscopic distal pancreatectomy over open surgery regarding blood loss, hospital stay, morbidity, and wound infection. The comparison of open surgery vs. laparoscopic surgery in patients presenting with adenocarcinoma shows the benefits of laparoscopic surgery. It is much easier to learn this technique. In this lecture, the clockwise technique is briefly demonstrated. Gravity, ports position and instrumentation are essential. The key steps of the clockwise technique are as follows: mobilization of the splenic flexure and of the proximal descending colon, dissection from lateral to medial along the lower edge of the pancreas, determination of the point of division (stapled or hand-sewn), posterior dissection, mobilization of the spleen using gravity along the superior edge of the pancreas, and removal of the specimen.
Laparoscopic distal pancreatectomy for mucinous cystadenoma
This video presents the case of a 39-year-old woman complaining of epigastric and right upper quadrant pain with dorsal irradiation and postprandial pain without nausea or vomiting. Abdominal ultrasound showed the presence of a 21mm cystic mass with multi-lobulated appearance at the tail of the pancreas. MRI confirmed the cystic nature of this tumor lesion of the tail of the pancreas, which was probably compatible with a mucinous cystadenoma (with a 23mm long axis) without communication with Wirsung’s duct. Transgastric echo-endoscopy revealed an ovoid cystic lesion of the pancreatic tail, with clean wall, measuring 19 by 10mm with small septa and a 4mm thick mural nodule without communication with the pancreatic duct. A laparoscopic left pancreatectomy was indicated because of the presence of a mucinous cystadenoma. This video demonstrates a laparoscopic distal pancreatectomy approach. A spleen-preserving distal pancreatectomy by preserving the splenic vessels (Kimura technique) was decided upon.
F Costantino, M Shahbaz, D Mutter, J Marescaux
Surgical intervention
2 years ago
1834 views
94 likes
0 comments
12:01
Laparoscopic distal pancreatectomy for mucinous cystadenoma
This video presents the case of a 39-year-old woman complaining of epigastric and right upper quadrant pain with dorsal irradiation and postprandial pain without nausea or vomiting. Abdominal ultrasound showed the presence of a 21mm cystic mass with multi-lobulated appearance at the tail of the pancreas. MRI confirmed the cystic nature of this tumor lesion of the tail of the pancreas, which was probably compatible with a mucinous cystadenoma (with a 23mm long axis) without communication with Wirsung’s duct. Transgastric echo-endoscopy revealed an ovoid cystic lesion of the pancreatic tail, with clean wall, measuring 19 by 10mm with small septa and a 4mm thick mural nodule without communication with the pancreatic duct. A laparoscopic left pancreatectomy was indicated because of the presence of a mucinous cystadenoma. This video demonstrates a laparoscopic distal pancreatectomy approach. A spleen-preserving distal pancreatectomy by preserving the splenic vessels (Kimura technique) was decided upon.
Right upper lobectomy: how I do it?
The anterior approach to right upper lobectomies is the most standard one, although it is not always the easiest one. As stressed by Dr. Baste, anterior dissection of the hilum can be hazardous and requires attention. Based on demonstrative pictures and videos, Dr. Baste outlines the global preoperative and intraoperative approach used routinely at Rouen’s Teaching Hospital. The description of the technique is mainly inspired from the Danish team (Hansen et al., Surgical Endoscopy). Surgical safety is one of the key objectives of this approach with preventative methods and intraoperative management techniques in case of injury. Preoperatively, CT-scan analysis is highlighted and patient set-up is described.
The intraoperative step is also described meticulously, and notably the D-zone, which represents the most dangerous zone during the resection.
JM Baste
Lecture
2 years ago
967 views
87 likes
0 comments
13:30
Right upper lobectomy: how I do it?
The anterior approach to right upper lobectomies is the most standard one, although it is not always the easiest one. As stressed by Dr. Baste, anterior dissection of the hilum can be hazardous and requires attention. Based on demonstrative pictures and videos, Dr. Baste outlines the global preoperative and intraoperative approach used routinely at Rouen’s Teaching Hospital. The description of the technique is mainly inspired from the Danish team (Hansen et al., Surgical Endoscopy). Surgical safety is one of the key objectives of this approach with preventative methods and intraoperative management techniques in case of injury. Preoperatively, CT-scan analysis is highlighted and patient set-up is described.
The intraoperative step is also described meticulously, and notably the D-zone, which represents the most dangerous zone during the resection.
Alternative fissureless technique: VATS ‘tunnel’ and ‘fissure first’ technique with staplers
Over the last years, the fissureless technique for thoracoscopic major pulmonary resections has become very popular. In this technique, the surgeon does not care about the fissure and its contents and staples it “en bloc” at completion of the lobectomy. The main advantage is its relative ease and rapidity. However, some anatomical variations make this technique hazardous and some surgeons do prefer a “fissure-based” technique with first dissection of vascular elements in the fissure. When the fissure is fused, this technique is difficult and can lead to troublesome oozing and postoperative air leaks. In these cases, the “tunnel technique”, which is presented here by Dr. Decaluwe, is very helpful.
H Decaluwe
Lecture
2 years ago
656 views
41 likes
0 comments
15:00
Alternative fissureless technique: VATS ‘tunnel’ and ‘fissure first’ technique with staplers
Over the last years, the fissureless technique for thoracoscopic major pulmonary resections has become very popular. In this technique, the surgeon does not care about the fissure and its contents and staples it “en bloc” at completion of the lobectomy. The main advantage is its relative ease and rapidity. However, some anatomical variations make this technique hazardous and some surgeons do prefer a “fissure-based” technique with first dissection of vascular elements in the fissure. When the fissure is fused, this technique is difficult and can lead to troublesome oozing and postoperative air leaks. In these cases, the “tunnel technique”, which is presented here by Dr. Decaluwe, is very helpful.
Complex robotic resection of a large middle mediastinal thymoma
A 62-year-old man had an asymptomatic middle mediastinal tumor with a 4.5cm diameter, opposite to the superior vena cava and the azygos vein in the Barety’s space, which was discovered on thoracic CT-scan performed during an urothelial tumor follow-up.
Past history includes an urothelial carcinoma grade I treated with transurethral cystectomy, an ischemic cardiopathy with a single medical treatment, a prostate hypertrophy, and a sigmoid diverticulosis.
After a multidisciplinary review of the case, a mediastinoscopy was performed. It demonstrated the presence of a thymoma.
The patient was well informed of the operative risks and of the possibility of conversion, but thanks to our experience and national recommendations, we were able to perform a radical robotic assisted thymectomy.
The operation took during 3 hours with less than 100cc of bleeding.
The postoperative course was uneventful and the patient was discharged on postoperative day 3.
Histopathological analysis showed a type AB thymoma according to the OMS 2015 classification. The staging was IIb according to Masaoka. No adjuvant radiotherapy was indicated.
A Boutin, M Sarsam, M Lair, N Piton, C Peillon, JM Baste
Surgical intervention
2 years ago
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07:38
Complex robotic resection of a large middle mediastinal thymoma
A 62-year-old man had an asymptomatic middle mediastinal tumor with a 4.5cm diameter, opposite to the superior vena cava and the azygos vein in the Barety’s space, which was discovered on thoracic CT-scan performed during an urothelial tumor follow-up.
Past history includes an urothelial carcinoma grade I treated with transurethral cystectomy, an ischemic cardiopathy with a single medical treatment, a prostate hypertrophy, and a sigmoid diverticulosis.
After a multidisciplinary review of the case, a mediastinoscopy was performed. It demonstrated the presence of a thymoma.
The patient was well informed of the operative risks and of the possibility of conversion, but thanks to our experience and national recommendations, we were able to perform a radical robotic assisted thymectomy.
The operation took during 3 hours with less than 100cc of bleeding.
The postoperative course was uneventful and the patient was discharged on postoperative day 3.
Histopathological analysis showed a type AB thymoma according to the OMS 2015 classification. The staging was IIb according to Masaoka. No adjuvant radiotherapy was indicated.