We use cookies to offer you an optimal experience on our website. By browsing our website, you accept the use of cookies.

Monthly publications

#May 2018
Filter by
Clear filter Specialty
View more

Clear filter Media type
View more
Clear filter Category
View more
Arthroscopic Wafer procedure for ulnar carpal abutment
Ulnocarpal abutment is the inversion of the distal radio ulnar index with a positive ulnar variance (long ulna) and is most frequently secondary to distal radius fractures. The relative ‘shortening of the radius’ leads to a conflict between the ulnar head and the proximal lunatum. The natural evolution of this condition is usually a central perforation of the TFCC complex. This arthrogenic lesion eventually leads to arthritis of the medial proximal lunate as well as the ulnar head. Persistence of the abutment may further lead to lunotriquetral dissociation. There are many management options for the distal radioulnar component of distal radius malunions and the therapeutic choice depends on clinical evaluation and imaging of this joint. In this video, we present the arthroscopic treatment, which remains the simplest and best solution for the patients.
C Mathoulin
Surgical intervention
6 months ago
179 views
4 likes
0 comments
06:03
Arthroscopic Wafer procedure for ulnar carpal abutment
Ulnocarpal abutment is the inversion of the distal radio ulnar index with a positive ulnar variance (long ulna) and is most frequently secondary to distal radius fractures. The relative ‘shortening of the radius’ leads to a conflict between the ulnar head and the proximal lunatum. The natural evolution of this condition is usually a central perforation of the TFCC complex. This arthrogenic lesion eventually leads to arthritis of the medial proximal lunate as well as the ulnar head. Persistence of the abutment may further lead to lunotriquetral dissociation. There are many management options for the distal radioulnar component of distal radius malunions and the therapeutic choice depends on clinical evaluation and imaging of this joint. In this video, we present the arthroscopic treatment, which remains the simplest and best solution for the patients.
Triangular fibrocartilage complex (TFCC) dorsal distal repair
The triangular fibrocartilage complex (TFCC) is actually more complex than it appears to be. Arthroscopy of the wrist has helped to better understand the various insertions of this proximal and distal triangular complex and to detect these lesions. The adapted treatment of these lesions made it possible to prevent failures of the conventional arthroscopic reinsertions with the disappearance of the associated distal ulnar instabilities when only a part of the problem was treated.
The healing potential of the TFCC largely depends on its vascularization. This video shows the arthroscopic repair of a peripheral distal tear of the TFCC with the in-out technique.
C Mathoulin
Surgical intervention
6 months ago
263 views
5 likes
1 comment
04:08
Triangular fibrocartilage complex (TFCC) dorsal distal repair
The triangular fibrocartilage complex (TFCC) is actually more complex than it appears to be. Arthroscopy of the wrist has helped to better understand the various insertions of this proximal and distal triangular complex and to detect these lesions. The adapted treatment of these lesions made it possible to prevent failures of the conventional arthroscopic reinsertions with the disappearance of the associated distal ulnar instabilities when only a part of the problem was treated.
The healing potential of the TFCC largely depends on its vascularization. This video shows the arthroscopic repair of a peripheral distal tear of the TFCC with the in-out technique.
Arthroscopic interposition in scapholunate advanced collapse wrist arthritis, stage 2 (SLAC 2)
Scapholunate advanced collapse (SLAC) is a form of degenerative arthritis of the wrist which is commonly a sequela of scapholunate instability. SLAC follows a typical pattern which begins with arthritis of the radial styloid (stage 1). Stage 2 is marked by the involvement of the entire scaphoid fossa and the scaphoid while arthritic changes involve the midcarpal joint in stage 3. Stage 2 SLAC is typically managed with proximal row carpectomy (PRC), which preserves some degree of wrist flexion-extension arc and reduces pain. However, major drawbacks of this procedure are as follows: incongruence between lunate fossa and capitate, subsequent arthritic changes, and reduced grip strength originating from reduced carpal height. This video shows a recently described salvage procedure, namely arthroscopic interposition tendon arthroplasty (AITA), which attempts to preserve wrist motion and carpal height simultaneously restoring radiocarpal joint space and reducing pain, by interpositioning tendon graft in the radiocarpal joint.
C Mathoulin
Surgical intervention
6 months ago
124 views
1 like
0 comments
17:40
Arthroscopic interposition in scapholunate advanced collapse wrist arthritis, stage 2 (SLAC 2)
Scapholunate advanced collapse (SLAC) is a form of degenerative arthritis of the wrist which is commonly a sequela of scapholunate instability. SLAC follows a typical pattern which begins with arthritis of the radial styloid (stage 1). Stage 2 is marked by the involvement of the entire scaphoid fossa and the scaphoid while arthritic changes involve the midcarpal joint in stage 3. Stage 2 SLAC is typically managed with proximal row carpectomy (PRC), which preserves some degree of wrist flexion-extension arc and reduces pain. However, major drawbacks of this procedure are as follows: incongruence between lunate fossa and capitate, subsequent arthritic changes, and reduced grip strength originating from reduced carpal height. This video shows a recently described salvage procedure, namely arthroscopic interposition tendon arthroplasty (AITA), which attempts to preserve wrist motion and carpal height simultaneously restoring radiocarpal joint space and reducing pain, by interpositioning tendon graft in the radiocarpal joint.
Arthroscopic scaphotrapeziotrapezoidal (STT) joint arthroplasty
Scaphotrapeziotrapezoid (STT) joint osteoarthritis is less known than other types of wrist arthritis.
This disease accounts for only 13% of all wrist arthritis sites. Isolated lesions of this joint are rare and their therapeutic management is complex.
The only treatment proposed used to be STT arthrodesis, a technically difficult procedure which caused numerous complications.
Pseudoarthrosis is common, and STT arthrodesis has been incriminated in the occurrence of radioscaphoid osteoarthritis. Techniques of distal resection combined with interposition of biological tissues such as tendons (flexor carpi radialis) was described in the 1990s. In this video, we present arthroscopic interposition of pyrocarbon implant, a safe and convenient technique for patients, with long-lasting favorable results.
C Mathoulin
Surgical intervention
6 months ago
102 views
1 like
0 comments
04:24
Arthroscopic scaphotrapeziotrapezoidal (STT) joint arthroplasty
Scaphotrapeziotrapezoid (STT) joint osteoarthritis is less known than other types of wrist arthritis.
This disease accounts for only 13% of all wrist arthritis sites. Isolated lesions of this joint are rare and their therapeutic management is complex.
The only treatment proposed used to be STT arthrodesis, a technically difficult procedure which caused numerous complications.
Pseudoarthrosis is common, and STT arthrodesis has been incriminated in the occurrence of radioscaphoid osteoarthritis. Techniques of distal resection combined with interposition of biological tissues such as tendons (flexor carpi radialis) was described in the 1990s. In this video, we present arthroscopic interposition of pyrocarbon implant, a safe and convenient technique for patients, with long-lasting favorable results.
Three-trocar laparoscopic right ileocolectomy for advanced small bowel neuroendocrine tumor
Background: Minimally invasive surgery (MIS) was shown to offer advantages in general and oncologic surgery (1). Over the last decade, reduced port laparoscopy (RPL) has been introduced to reduce the risks related to ports and abdominal wall trauma, with enhanced cosmetic outcomes (2). In this video, the authors report the case of a 59-year-old man with a small bowel neuroendocrine tumor, and who underwent a three-trocar right ileocolectomy.
Video: Preoperative work-up, including endoscopic ultrasound, octreoscan, PET-scan, and FDG PET-CT, showed a 15mm small bowel tumor with mesenteric and transverse mesocolic extension, until the muscularis propria of the third portion of the duodenum. The biopsy revealed a low-grade well-differentiated neuroendocrine tumor. The procedure was performed using three abdominal trocars: a 12mm one in the umbilicus, a 5mm one in the right flank, and a 5mm port in the left flank (Figure 1). Abdominal cavity exploration demonstrated the presence of a tumor located in the mesentery of the last small bowel loop, with consequent bowel retraction, dislocation of the caecum and appendix, located under the right lobe of the liver, and tumoral extension into the proximal transverse mesocolon. After mobilization of the right colon from laterally to medially, the second and third duodenal segments were exposed, showing tumor extension towards the anterior duodenal wall of these segments. After encircling the anterior aspect of the duodenal wall with a piece of cotton tape (Figure 2), an endoscopic linear stapler was inserted through the umbilical trocar under the visual guidance of a 5mm scope in the left flank (Figure 3a), and it was fired (Figure 3b). The specimen was removed through a suprapubic access. Perioperative frozen section biopsy showed a free duodenal margin, and the procedure was subsequently completed with an ileocolic anastomosis, performed in a side-to-side handsewn intracorporeal fashion. At the end, the mesocolic defect was closed.

Results: Operative time was 4 hours. No added trocars were necessary. The postoperative course was uneventful and the patient was discharged on postoperative day 4. Pathological findings showed a grade I well-differentiated small bowel neuroendocrine tumor, with lymphovascular emboli and perinervous infiltration (1/20 metastatic nodes, free margins, stage: pT3N1 (8 UICC edition). A follow-up under somatostatin therapy was put forward.

Conclusions: RPL is a feasible option when performing advanced oncological surgery. Patients benefit from all MIS advantages, including reduced trocar complications and enhanced cosmetic outcomes.
G Dapri
Surgical intervention
6 months ago
4578 views
91 likes
2 comments
11:10
Three-trocar laparoscopic right ileocolectomy for advanced small bowel neuroendocrine tumor
Background: Minimally invasive surgery (MIS) was shown to offer advantages in general and oncologic surgery (1). Over the last decade, reduced port laparoscopy (RPL) has been introduced to reduce the risks related to ports and abdominal wall trauma, with enhanced cosmetic outcomes (2). In this video, the authors report the case of a 59-year-old man with a small bowel neuroendocrine tumor, and who underwent a three-trocar right ileocolectomy.
Video: Preoperative work-up, including endoscopic ultrasound, octreoscan, PET-scan, and FDG PET-CT, showed a 15mm small bowel tumor with mesenteric and transverse mesocolic extension, until the muscularis propria of the third portion of the duodenum. The biopsy revealed a low-grade well-differentiated neuroendocrine tumor. The procedure was performed using three abdominal trocars: a 12mm one in the umbilicus, a 5mm one in the right flank, and a 5mm port in the left flank (Figure 1). Abdominal cavity exploration demonstrated the presence of a tumor located in the mesentery of the last small bowel loop, with consequent bowel retraction, dislocation of the caecum and appendix, located under the right lobe of the liver, and tumoral extension into the proximal transverse mesocolon. After mobilization of the right colon from laterally to medially, the second and third duodenal segments were exposed, showing tumor extension towards the anterior duodenal wall of these segments. After encircling the anterior aspect of the duodenal wall with a piece of cotton tape (Figure 2), an endoscopic linear stapler was inserted through the umbilical trocar under the visual guidance of a 5mm scope in the left flank (Figure 3a), and it was fired (Figure 3b). The specimen was removed through a suprapubic access. Perioperative frozen section biopsy showed a free duodenal margin, and the procedure was subsequently completed with an ileocolic anastomosis, performed in a side-to-side handsewn intracorporeal fashion. At the end, the mesocolic defect was closed.

Results: Operative time was 4 hours. No added trocars were necessary. The postoperative course was uneventful and the patient was discharged on postoperative day 4. Pathological findings showed a grade I well-differentiated small bowel neuroendocrine tumor, with lymphovascular emboli and perinervous infiltration (1/20 metastatic nodes, free margins, stage: pT3N1 (8 UICC edition). A follow-up under somatostatin therapy was put forward.

Conclusions: RPL is a feasible option when performing advanced oncological surgery. Patients benefit from all MIS advantages, including reduced trocar complications and enhanced cosmetic outcomes.
Laparoscopic resection of inguinal recurrence of myxoid liposarcoma
This is the case of a laparoscopic resection of inguinal recurrence of myxoid liposarcoma (MLS). In 2003, a 29-year-old man presented with a 23cm right thigh mass, compatible with soft tissue sarcoma. He underwent radical surgery and the final pathological examination confirmed a grade 1 myxoid liposarcoma. He received adjuvant radiotherapy (70 Gy). Follow-up demonstrated that the patient was disease-free until 2015. In September 2017, he presented to the emergency room with a lower right extremity edema. Radiological examination demonstrated the presence of an 8cm inguinal mass compatible with a late inguinal recurrence of known sarcoma. Neoadjuvant chemotherapy was indicated and elective surgery was performed in January 2018. CT-scan revealed a mass in the preperitoneal space, displacing the urinary bladder medially, involving right external iliac vessels and getting into the femoral canal distally. A laparoscopic approach was decided upon.
C Rodríguez-Otero Luppi, M Rodríguez Blanco, E Ballester Vázquez, V Artigas Raventós
Surgical intervention
6 months ago
934 views
37 likes
2 comments
09:00
Laparoscopic resection of inguinal recurrence of myxoid liposarcoma
This is the case of a laparoscopic resection of inguinal recurrence of myxoid liposarcoma (MLS). In 2003, a 29-year-old man presented with a 23cm right thigh mass, compatible with soft tissue sarcoma. He underwent radical surgery and the final pathological examination confirmed a grade 1 myxoid liposarcoma. He received adjuvant radiotherapy (70 Gy). Follow-up demonstrated that the patient was disease-free until 2015. In September 2017, he presented to the emergency room with a lower right extremity edema. Radiological examination demonstrated the presence of an 8cm inguinal mass compatible with a late inguinal recurrence of known sarcoma. Neoadjuvant chemotherapy was indicated and elective surgery was performed in January 2018. CT-scan revealed a mass in the preperitoneal space, displacing the urinary bladder medially, involving right external iliac vessels and getting into the femoral canal distally. A laparoscopic approach was decided upon.
Endoscopic ultrasound-guided choledochoduodenostomy with a lumen-apposing metal stent
This video demonstrates a case of EUS-guided choledochoduodenostomy, emblematic of the latest cutting-edge technology.
A 86-year-old woman with recent abdominal pain and jaundice underwent a CT-scan, which showed an enlarged tumor of the second portion of the duodenum with biliary tree dilatation. Gastroscopy with biopsy confirmed the diagnosis of duodenal adenocarcinoma of the 2nd duodenum.
First, endoscopic retrograde cholangiopancreatography (ERCP) failed to achieve biliary drainage because of an inability to cannulate the papilla due to tumor infiltration. EUS-guided hepatogastrostomy (EUS-HGS) was not attempted because the left intra-hepatic bile ducts were minimally dilated (3mm). However, the common bile duct (CBD) was largely dilated (20 mm). A Hot AXIOS™ Stent and Electrocautery Enhanced Delivery System (stent of 8 by 6mm) was advanced through the bulb. Pure cut electrocautery current was then applied, allowing the device to reach the CBD. Next, the distal flange was opened and retracted towards the EUS transducer, and once a biliary and bulbar tissue apposition had been noted, the proximal flange was released. Good drainage of purulent bile was observed and no complications occurred during the procedure and one month afterwards.
A Sportes, G Airinei, R Kamel, R Benamouzig
Surgical intervention
6 months ago
221 views
6 likes
0 comments
03:09
Endoscopic ultrasound-guided choledochoduodenostomy with a lumen-apposing metal stent
This video demonstrates a case of EUS-guided choledochoduodenostomy, emblematic of the latest cutting-edge technology.
A 86-year-old woman with recent abdominal pain and jaundice underwent a CT-scan, which showed an enlarged tumor of the second portion of the duodenum with biliary tree dilatation. Gastroscopy with biopsy confirmed the diagnosis of duodenal adenocarcinoma of the 2nd duodenum.
First, endoscopic retrograde cholangiopancreatography (ERCP) failed to achieve biliary drainage because of an inability to cannulate the papilla due to tumor infiltration. EUS-guided hepatogastrostomy (EUS-HGS) was not attempted because the left intra-hepatic bile ducts were minimally dilated (3mm). However, the common bile duct (CBD) was largely dilated (20 mm). A Hot AXIOS™ Stent and Electrocautery Enhanced Delivery System (stent of 8 by 6mm) was advanced through the bulb. Pure cut electrocautery current was then applied, allowing the device to reach the CBD. Next, the distal flange was opened and retracted towards the EUS transducer, and once a biliary and bulbar tissue apposition had been noted, the proximal flange was released. Good drainage of purulent bile was observed and no complications occurred during the procedure and one month afterwards.
Arthroscopic capsuloligamentous suture with anchor for scapholunate dissociation EWAS stage 4
An anatomical and biomechanical study has recently shown that detachment of the scapholunate (SL) ligament from the dorsal capsuloligamentous scapholunate septum (DCSS) and dorsal intercarpal ligament (DIC) worsens scapholunate dissociation. This knowledge has revolutionized the treatment of scapholunate dissociation and formed the basis of the arthroscopic repair of the scapholunate ligament complex. In some large dissociation, we can use a trick, catching a largest part of the dorsal capsule, proximally and distally, in order to help scapholunate reduction when the knot is tightened. Sometimes, the scapholunate ligament is avulsed from the dorsal proximal pole of the scaphoid, and it is necessary to put an anchor at the exact location of the scapholunate attachment into the dorsal scaphoid to allow a dorsal capsuloligamentous repair as for a classical scapholunate tear.
C Mathoulin
Surgical intervention
7 months ago
72 views
3 likes
0 comments
09:08
Arthroscopic capsuloligamentous suture with anchor for scapholunate dissociation EWAS stage 4
An anatomical and biomechanical study has recently shown that detachment of the scapholunate (SL) ligament from the dorsal capsuloligamentous scapholunate septum (DCSS) and dorsal intercarpal ligament (DIC) worsens scapholunate dissociation. This knowledge has revolutionized the treatment of scapholunate dissociation and formed the basis of the arthroscopic repair of the scapholunate ligament complex. In some large dissociation, we can use a trick, catching a largest part of the dorsal capsule, proximally and distally, in order to help scapholunate reduction when the knot is tightened. Sometimes, the scapholunate ligament is avulsed from the dorsal proximal pole of the scaphoid, and it is necessary to put an anchor at the exact location of the scapholunate attachment into the dorsal scaphoid to allow a dorsal capsuloligamentous repair as for a classical scapholunate tear.
Arthroscopic large dorsal capsuloligamentous suture for scapholunate dissociation EWAS stage 4
An anatomical and biomechanical study has recently shown that detachment of the scapholunate (SL) ligament from the dorsal capsuloligamentous scapholunate septum (DCSS) and dorsal intercarpal ligament (DIC) worsens scapholunate dissociation. This knowledge has revolutionized the treatment of scapholunate dissociation and formed the basis of the arthroscopic repair of the scapholunate ligament complex. SL ligament repair per se is not adequate; it has to be reattached to the dorsal capsule. This is enabled with an arthroscopic technique, which preserves the dorsal capsule. In some large dissociation, we can use a trick, catching a largest part of the dorsal capsule, proximally and distally, in order to help scapholunate reduction when the knot is tightened.
C Mathoulin
Surgical intervention
7 months ago
66 views
4 likes
0 comments
06:06
Arthroscopic large dorsal capsuloligamentous suture for scapholunate dissociation EWAS stage 4
An anatomical and biomechanical study has recently shown that detachment of the scapholunate (SL) ligament from the dorsal capsuloligamentous scapholunate septum (DCSS) and dorsal intercarpal ligament (DIC) worsens scapholunate dissociation. This knowledge has revolutionized the treatment of scapholunate dissociation and formed the basis of the arthroscopic repair of the scapholunate ligament complex. SL ligament repair per se is not adequate; it has to be reattached to the dorsal capsule. This is enabled with an arthroscopic technique, which preserves the dorsal capsule. In some large dissociation, we can use a trick, catching a largest part of the dorsal capsule, proximally and distally, in order to help scapholunate reduction when the knot is tightened.