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Monthly publications

#January 2019
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Laparoscopic treatment of primary omental infarction
A 53-year-old man was admitted to the emergency department for right hypochondrium pain, fever, and weight loss, with clinical evidence of an abdominal mass in his right lumbar region.
His white blood cell (WBC) count was 11.9x109/L and his C-reactive protein value was 11.7mg/dL.
His abdominal CT-scan and MRI showed a 12.5cm omental mass, suggestive of omental infarction with a hemorrhagic component. His gastroscopy and colonoscopy were negative, and the needle biopsy of the mass was not suggestive of malignancy. Exploratory laparoscopy with biopsy or resection of the omental lesion was indicated. The total duration of the operation was 1 hour, and the omental mass was resected. The patient completely recovered from his symptoms, and was discharged after two days. Final histology of his lesion demonstrated an omental infarction with thrombosis, hemorrhage, and fat cell necrosis.
M Lotti, M Marini, M Giulii Capponi
Surgical intervention
25 days ago
1065 views
5 likes
2 comments
14:43
Laparoscopic treatment of primary omental infarction
A 53-year-old man was admitted to the emergency department for right hypochondrium pain, fever, and weight loss, with clinical evidence of an abdominal mass in his right lumbar region.
His white blood cell (WBC) count was 11.9x109/L and his C-reactive protein value was 11.7mg/dL.
His abdominal CT-scan and MRI showed a 12.5cm omental mass, suggestive of omental infarction with a hemorrhagic component. His gastroscopy and colonoscopy were negative, and the needle biopsy of the mass was not suggestive of malignancy. Exploratory laparoscopy with biopsy or resection of the omental lesion was indicated. The total duration of the operation was 1 hour, and the omental mass was resected. The patient completely recovered from his symptoms, and was discharged after two days. Final histology of his lesion demonstrated an omental infarction with thrombosis, hemorrhage, and fat cell necrosis.
Pancreatic duplication associated with a gastric duplication cyst: laparoscopic approach
This video shows the case of a 48-year-old male patient with a history of epigastric pain for 20 days, with the presence of nausea and vomiting but no self-reported fever. The patient was presented at the ER for examination. Computerized tomography (CT) scanning revealed a very rare case of pancreatic duplication associated with a gastric duplication cyst. He was referred to our service and then treated by laparoscopic route with partial gastrectomy and pancreatic resection (pancreas horn). On the 2nd postoperative day, the patient was discharged and allowed for free oral feeding. This is the second study in the literature reporting a case of laparoscopic resection of a gastric duplication cyst together with pancreatic resection. Of note, this is the first study in which the accessory pancreas communicates with the pancreatic head.
F Freire Lisboa Junior, R de Lima França, A de Araujo Lima Liguori, AC de Medeiros Junior, M HSMP Tavares, F Medeiros de Azevedo, D Myller Barros Lima
Surgical intervention
25 days ago
727 views
3 likes
0 comments
14:36
Pancreatic duplication associated with a gastric duplication cyst: laparoscopic approach
This video shows the case of a 48-year-old male patient with a history of epigastric pain for 20 days, with the presence of nausea and vomiting but no self-reported fever. The patient was presented at the ER for examination. Computerized tomography (CT) scanning revealed a very rare case of pancreatic duplication associated with a gastric duplication cyst. He was referred to our service and then treated by laparoscopic route with partial gastrectomy and pancreatic resection (pancreas horn). On the 2nd postoperative day, the patient was discharged and allowed for free oral feeding. This is the second study in the literature reporting a case of laparoscopic resection of a gastric duplication cyst together with pancreatic resection. Of note, this is the first study in which the accessory pancreas communicates with the pancreatic head.
Laparoscopic excision of urachal cyst - a minimally invasive approach of a rare cause of abdominal pain in adults
Congenital abnormalities of the urachus are rare, with an incidence of 2:300000 children and 1:5000 adults. The urachus is a fibrous remnant of the allantois, usually occluded in the 4-5th gestational months, with the descent of the bladder towards the pelvis. It lies in the space of Retzius, between the transverse fascia anteriorly and the peritoneum posteriorly. The absence of its obliteration can result in an urachal cyst in 36% of cases. The main complication of the cyst is focal infection with associated risks of rupture and intestinal involvement. Diagnosis relies on clinical history, abdominopelvic ultrasonography and CT-scan. The treatment consists in complete excision of abnormal tissue and a small portion of adjacent bladder wall, therefore reducing the risk of malignant degeneration of the entire remnant.
A twenty-year-old healthy woman was referred to the emergency department with localized discomfort and a foul smelling purulent discharge from the umbilicus with three days of evolution. The patient was afebrile with periumbilical inflammatory signs, without signs of peritoneal irritation on physical exam. Blood tests were all normal, apart from a raised C-reactive protein (2.52mg/dL). Abdominal ultrasound was suggestive of an infected urachal cyst with umbilical fistulization. Empirical treatment with antibiotics was started and an abdominopelvic CT-scan, made as outpatient surgery, showed a probable 26mm urachal cyst, posterior and adjacent to the umbilicus, without bladder attachment.
The patient was treated surgically with a laparoscopic excision of the remainder of the urachus, without intraoperative complications. A good clinical evolution was observed during the hospital stay, and the patient was discharged on the fourth postoperative day. On follow-up, the patient did not complain of anything.
This clinical case emphasizes the importance of the high index of diagnostic suspicion in the management and treatment of the rare causes of abdominal pain, often with the possibility of a minimally invasive approach.
A Tojal, AR Loureiro, B Prata, R Patrão, N Carrilho, C Casimiro
Surgical intervention
26 days ago
513 views
2 likes
1 comment
10:34
Laparoscopic excision of urachal cyst - a minimally invasive approach of a rare cause of abdominal pain in adults
Congenital abnormalities of the urachus are rare, with an incidence of 2:300000 children and 1:5000 adults. The urachus is a fibrous remnant of the allantois, usually occluded in the 4-5th gestational months, with the descent of the bladder towards the pelvis. It lies in the space of Retzius, between the transverse fascia anteriorly and the peritoneum posteriorly. The absence of its obliteration can result in an urachal cyst in 36% of cases. The main complication of the cyst is focal infection with associated risks of rupture and intestinal involvement. Diagnosis relies on clinical history, abdominopelvic ultrasonography and CT-scan. The treatment consists in complete excision of abnormal tissue and a small portion of adjacent bladder wall, therefore reducing the risk of malignant degeneration of the entire remnant.
A twenty-year-old healthy woman was referred to the emergency department with localized discomfort and a foul smelling purulent discharge from the umbilicus with three days of evolution. The patient was afebrile with periumbilical inflammatory signs, without signs of peritoneal irritation on physical exam. Blood tests were all normal, apart from a raised C-reactive protein (2.52mg/dL). Abdominal ultrasound was suggestive of an infected urachal cyst with umbilical fistulization. Empirical treatment with antibiotics was started and an abdominopelvic CT-scan, made as outpatient surgery, showed a probable 26mm urachal cyst, posterior and adjacent to the umbilicus, without bladder attachment.
The patient was treated surgically with a laparoscopic excision of the remainder of the urachus, without intraoperative complications. A good clinical evolution was observed during the hospital stay, and the patient was discharged on the fourth postoperative day. On follow-up, the patient did not complain of anything.
This clinical case emphasizes the importance of the high index of diagnostic suspicion in the management and treatment of the rare causes of abdominal pain, often with the possibility of a minimally invasive approach.
Laparoscopic total gastrectomy
A multimodality approach remains the only potential treatment for advanced gastric cancer. Oncological outcomes seem to be equivalent either in open surgery or in minimally invasive surgery. Therefore, laparoscopic gastric resection is expanding in expert centers.
The authors present a clinical case of a 70-year-old woman with no relevant clinical past. She presented with a 1-month complaint of epigastric pain and melena. She underwent an upper endoscopy, which showed an ulcerated gastric lesion at the lesser curvature. Biopsy revealed a poorly cohesive gastric carcinoma with signet ring cells. Thoraco-abdominal-pelvic CT-scan revealed a thickening of the gastric wall associated with multiple perigastric and celiac trunk lymph nodes. She was proposed for perioperative chemotherapy. On the restaging CT-scan, there was no evidence of disease progression and therefore she underwent a laparoscopic radical total gastrectomy.
The benefits of minimally invasive surgery, combined with the increasing evidence of oncological results overlapping with open surgery, have contributed to the progressive implementation of laparoscopic surgery in the treatment of malignant gastric pathology.
J Magalhães, C Osorio, L Frutuoso, AM Pereira, A Trovão, R Ferreira de Almeida, M Nora
Surgical intervention
27 days ago
876 views
6 likes
2 comments
09:44
Laparoscopic total gastrectomy
A multimodality approach remains the only potential treatment for advanced gastric cancer. Oncological outcomes seem to be equivalent either in open surgery or in minimally invasive surgery. Therefore, laparoscopic gastric resection is expanding in expert centers.
The authors present a clinical case of a 70-year-old woman with no relevant clinical past. She presented with a 1-month complaint of epigastric pain and melena. She underwent an upper endoscopy, which showed an ulcerated gastric lesion at the lesser curvature. Biopsy revealed a poorly cohesive gastric carcinoma with signet ring cells. Thoraco-abdominal-pelvic CT-scan revealed a thickening of the gastric wall associated with multiple perigastric and celiac trunk lymph nodes. She was proposed for perioperative chemotherapy. On the restaging CT-scan, there was no evidence of disease progression and therefore she underwent a laparoscopic radical total gastrectomy.
The benefits of minimally invasive surgery, combined with the increasing evidence of oncological results overlapping with open surgery, have contributed to the progressive implementation of laparoscopic surgery in the treatment of malignant gastric pathology.
Laparoscopic distal splenopancreatectomy for pancreatic cystadenoma: clockwise technique assisted with T’Lift device
Serous cystic neoplasm is a cystic neoplasm of the pancreas, which is increasingly detected at an asymptomatic stage. Serous cystadenomas are benign cystic tumors which occur more often in women than in men, and particularly in the seventh decade of life. Despite this, in the literature, three patients were reported to have malignant serous cystadenomas, with sizes greater than 7cm. The serous cystic neoplasm was confirmed by an imaging characteristic appearance, with multiple small or different-sized cysts, but when the diagnosis is doubtful, which often leads to surgery.
The clinical case is the one of a 79-year-old woman with a cystadenoma of the pancreas. She had a history of partial cystectomy for bladder neoplasia and recently (in 2017), she was submitted to laparoscopic focal cryotherapy for the treatment of a left unilateral renal tumor. At that time, she underwent a CT-can, which found a cystic neoplasm of the tail of the pancreas. A heterogeneous 5cm lesion appeared in the left hypochondrium, near the lower pole of the spleen, with no evidence of adenopathies highly suggestive of a serous cystadenoma of the pancreas.
In October 2018, in a follow-up CT-scan, there was an increase in size of the lesion (6.6cm) and a surgical resection was planned. A distal splenopancreatectomy using a clockwise technique was performed using the Signia™ stapling system with no complications. Histological examination confirmed a serous cystadenoma of the pancreas.
M Rui Martins, J Correia, D Jordão, S Martins, H Ferrão
Surgical intervention
27 days ago
414 views
3 likes
0 comments
20:59
Laparoscopic distal splenopancreatectomy for pancreatic cystadenoma: clockwise technique assisted with T’Lift device
Serous cystic neoplasm is a cystic neoplasm of the pancreas, which is increasingly detected at an asymptomatic stage. Serous cystadenomas are benign cystic tumors which occur more often in women than in men, and particularly in the seventh decade of life. Despite this, in the literature, three patients were reported to have malignant serous cystadenomas, with sizes greater than 7cm. The serous cystic neoplasm was confirmed by an imaging characteristic appearance, with multiple small or different-sized cysts, but when the diagnosis is doubtful, which often leads to surgery.
The clinical case is the one of a 79-year-old woman with a cystadenoma of the pancreas. She had a history of partial cystectomy for bladder neoplasia and recently (in 2017), she was submitted to laparoscopic focal cryotherapy for the treatment of a left unilateral renal tumor. At that time, she underwent a CT-can, which found a cystic neoplasm of the tail of the pancreas. A heterogeneous 5cm lesion appeared in the left hypochondrium, near the lower pole of the spleen, with no evidence of adenopathies highly suggestive of a serous cystadenoma of the pancreas.
In October 2018, in a follow-up CT-scan, there was an increase in size of the lesion (6.6cm) and a surgical resection was planned. A distal splenopancreatectomy using a clockwise technique was performed using the Signia™ stapling system with no complications. Histological examination confirmed a serous cystadenoma of the pancreas.
Wilkie's syndrome surgery
Wilkie’s syndrome (or superior mesenteric artery syndrome) was first described by Von Rokitansky in 1861. It consists in an extrinsic pressure over the third duodenal portion originating from an uncertain cause. Wilkie found a decreased angle (25 degrees, or less) between the superior mesenteric artery and the aorta, conditioning a duodenal (3rd portion) obstruction of vascular origin. It is associated with weight loss. The real incidence remains unknown due to the lack of diagnosis. However, the estimated incidence varies between 0.013 to 1% of the population. The male/female ratio is 2:3, ranging age between 10 and 39 years old.
Symptoms include postprandial abdominal pain, nausea and vomiting, weight loss, early gastric fullness and anorexia (acute high gastroduodenal obstruction).
Diagnostic studies include barium esophageal gastroduodenal series, CT-scan, MRI, high endoscopy (peptic esophagitis, ulcer). Endoscopic studies must come together with barium esophageal gastroduodenal X-ray studies.
Surgical treatment is performed when there is no response to medical treatment, consisting in duodenojejunal anastomoses, with Treitz’s ligament division. Gastrojejunal anastomosis is an alternative option. Laparoscopic surgical treatment can be performed.
G Lozano Dubernard, R Gil-Ortiz Mejía, B Rueda Torres, J López Gutiérrez
Surgical intervention
27 days ago
454 views
4 likes
1 comment
13:16
Wilkie's syndrome surgery
Wilkie’s syndrome (or superior mesenteric artery syndrome) was first described by Von Rokitansky in 1861. It consists in an extrinsic pressure over the third duodenal portion originating from an uncertain cause. Wilkie found a decreased angle (25 degrees, or less) between the superior mesenteric artery and the aorta, conditioning a duodenal (3rd portion) obstruction of vascular origin. It is associated with weight loss. The real incidence remains unknown due to the lack of diagnosis. However, the estimated incidence varies between 0.013 to 1% of the population. The male/female ratio is 2:3, ranging age between 10 and 39 years old.
Symptoms include postprandial abdominal pain, nausea and vomiting, weight loss, early gastric fullness and anorexia (acute high gastroduodenal obstruction).
Diagnostic studies include barium esophageal gastroduodenal series, CT-scan, MRI, high endoscopy (peptic esophagitis, ulcer). Endoscopic studies must come together with barium esophageal gastroduodenal X-ray studies.
Surgical treatment is performed when there is no response to medical treatment, consisting in duodenojejunal anastomoses, with Treitz’s ligament division. Gastrojejunal anastomosis is an alternative option. Laparoscopic surgical treatment can be performed.
Laparoscopic treatment of a hydatid cyst of the liver in children
Introduction:
Hydatid cyst is a parasitic disease caused by the Echinococcus granulosus tapeworm. Laparoscopic treatment of a hydatid cyst of the liver remains controversial and few series have been published. The aim of this work is to present a case of liver hydatid cyst in an 8-year-old girl treated laparoscopically.
Case presentation:
An 8-year-old child was admitted to our department for the management of a voluminous liver hydatid cyst. The patient underwent a thoraco-abdominal CT-scan, which concluded to a left lobe liver hydatid cyst. The laparoscopic open access is achieved at the umbilicus using a 10mm port. Carbon dioxide pneumoperitoneum pressure is maintained at 10mmHg. Two other 5mm ports are introduced in the right and left hypochondrium. A 0-degree laparoscope is then used. The cyst is protected by means of pads filled with a 10% hypertonic saline solution. After we proceed to a puncture aspiration of the cyst, sterilization is achieved via injection of a hypertonic saline solution during 15 minutes, then reaspiration is performed with a Veress needle. The cyst is opened with a coagulating hook and the proligerous membrane is removed and put in a bag. The last step is the resection of the dome and the search for biliary fistula. We drained the residual cavity. The pads are removed. The Redon drain was removed on day 2 and the patient was discharged from hospital on postoperative day 3. Postoperatively, the patient was put on albendazole (10mg/kg) for one month.
Conclusion:
Laparoscopy stands for an excellent approach to the treatment of a hydatid cyst of the liver in children by respecting appropriate indications.
R Adjerid, F Sebaa, N Otsmane, A Khelifaoui
Surgical intervention
27 days ago
656 views
3 likes
4 comments
05:13
Laparoscopic treatment of a hydatid cyst of the liver in children
Introduction:
Hydatid cyst is a parasitic disease caused by the Echinococcus granulosus tapeworm. Laparoscopic treatment of a hydatid cyst of the liver remains controversial and few series have been published. The aim of this work is to present a case of liver hydatid cyst in an 8-year-old girl treated laparoscopically.
Case presentation:
An 8-year-old child was admitted to our department for the management of a voluminous liver hydatid cyst. The patient underwent a thoraco-abdominal CT-scan, which concluded to a left lobe liver hydatid cyst. The laparoscopic open access is achieved at the umbilicus using a 10mm port. Carbon dioxide pneumoperitoneum pressure is maintained at 10mmHg. Two other 5mm ports are introduced in the right and left hypochondrium. A 0-degree laparoscope is then used. The cyst is protected by means of pads filled with a 10% hypertonic saline solution. After we proceed to a puncture aspiration of the cyst, sterilization is achieved via injection of a hypertonic saline solution during 15 minutes, then reaspiration is performed with a Veress needle. The cyst is opened with a coagulating hook and the proligerous membrane is removed and put in a bag. The last step is the resection of the dome and the search for biliary fistula. We drained the residual cavity. The pads are removed. The Redon drain was removed on day 2 and the patient was discharged from hospital on postoperative day 3. Postoperatively, the patient was put on albendazole (10mg/kg) for one month.
Conclusion:
Laparoscopy stands for an excellent approach to the treatment of a hydatid cyst of the liver in children by respecting appropriate indications.
Laparoscopic ligation of middle sacral artery and dissection of sacrococcygeal teratoma to decrease intraoperative hemorrhagic risk
Sacrococcygeal teratomas are the most common teratomas presenting at birth. Life-threatening bleeding is a major complication during tumor excision in children. In this video, we demonstrate our technique for the laparoscopic division of the middle sacral artery during dissection of sacrococcygeal teratomas in two pediatric patients.
Two female infants diagnosed with type IV and type III sacrococcygeal teratomas underwent preoperative evaluation in the postnatal period. The first patient was an 18-month-old female patient who presented with a metastatic type IV teratoma resected after neoadjuvant therapy. The second patient was a 6-day-old female infant with a prenatal diagnosis of cystic type III teratoma. Using laparoscopy in both patients, the presacral space was reached by opening the peritoneal reflection with blunt dissection and the middle sacral artery was identified. It was then carefully isolated and divided with a 5mm LigaSure™ vessel-sealing device. The pelvic components of the tumors were partially dissected using laparoscopy. The first patient’s tumor resection was completed using a posterior sagittal approach and the second patient required a standard Chevron incision.
Both patients underwent a successful laparoscopic division of the middle sacral artery and resection of the sacrococcygeal teratomas without complications. As a result, laparoscopic middle sacral artery division before sacrococcygeal teratoma excision offers a safe approach which can reduce the risk of hemorrhage during surgery.
T Huy, H Osei, AS Munoz Abraham, R Damle, GA Villalona
Surgical intervention
27 days ago
188 views
4 likes
0 comments
05:33
Laparoscopic ligation of middle sacral artery and dissection of sacrococcygeal teratoma to decrease intraoperative hemorrhagic risk
Sacrococcygeal teratomas are the most common teratomas presenting at birth. Life-threatening bleeding is a major complication during tumor excision in children. In this video, we demonstrate our technique for the laparoscopic division of the middle sacral artery during dissection of sacrococcygeal teratomas in two pediatric patients.
Two female infants diagnosed with type IV and type III sacrococcygeal teratomas underwent preoperative evaluation in the postnatal period. The first patient was an 18-month-old female patient who presented with a metastatic type IV teratoma resected after neoadjuvant therapy. The second patient was a 6-day-old female infant with a prenatal diagnosis of cystic type III teratoma. Using laparoscopy in both patients, the presacral space was reached by opening the peritoneal reflection with blunt dissection and the middle sacral artery was identified. It was then carefully isolated and divided with a 5mm LigaSure™ vessel-sealing device. The pelvic components of the tumors were partially dissected using laparoscopy. The first patient’s tumor resection was completed using a posterior sagittal approach and the second patient required a standard Chevron incision.
Both patients underwent a successful laparoscopic division of the middle sacral artery and resection of the sacrococcygeal teratomas without complications. As a result, laparoscopic middle sacral artery division before sacrococcygeal teratoma excision offers a safe approach which can reduce the risk of hemorrhage during surgery.
Endoscopic mucosal resection (EMR) of laterally spreading tumor in rectum and resolution of late bleeding
The objectives of this video are manifold, namely to present the totally endoscopic treatment of a laterally spreading tumor in the upper rectum with a piecemeal technique, and how to act against one of its most frequent complications, post-polypectomy bleeding.
Methods: The procedure was performed in an advanced flexible endoscopy unit, with the patient lying supine, with anesthesia (Propofol), and insufflation of carbon dioxide. A videocolonoscope was used, the lesion was identified and elevated with hydroxyethyl starch (Voluven). It was dried with a hot snare in parts ("piecemeal" technique), thereby achieving complete resection. The defect was closed with metal clips. The specimen was recovered for histopathological study.
Results: During screening colonoscopy, a 56-year-old patient was found with a 30mm granular laterally spreading tumor of the rectum (LST-G or nodular mixed type), located 15cm from the anal verge. Complete endoscopic resection of the lesion with a curative intent was performed. On postoperative day 5, proctorrhagia presented without hemodynamic alteration. Emergency endoscopy was decided upon. Upon entering with the colonoscope, we identified a clot attached to the surgical site. Once the bleeding had been confirmed, a saline solution with 1/20,000 adrenaline was injected. And then, with a hot snare, electrocoagulation was performed in the same area, combining an injection method with a thermal one and achieving a satisfying hemostasis. The patient was discharged on the same day without any other complications. The pathology report showed a villous adenoma with low-grade dysplasia, including patches of high-grade dysplasia, and injury-free resection margins.
Conclusions: EMR of laterally spreading tumors is safe, although it is not devoid of complications such as bleeding, which is present in up to 9.8 of every 100,000 polypectomies in some series (Reumkens et al., AJG 2016). It is essential to suspect and know how to solve it efficiently with the tools available at that time of emergency.
J Isaguirre, A Insausti
Surgical intervention
27 days ago
173 views
0 likes
0 comments
05:38
Endoscopic mucosal resection (EMR) of laterally spreading tumor in rectum and resolution of late bleeding
The objectives of this video are manifold, namely to present the totally endoscopic treatment of a laterally spreading tumor in the upper rectum with a piecemeal technique, and how to act against one of its most frequent complications, post-polypectomy bleeding.
Methods: The procedure was performed in an advanced flexible endoscopy unit, with the patient lying supine, with anesthesia (Propofol), and insufflation of carbon dioxide. A videocolonoscope was used, the lesion was identified and elevated with hydroxyethyl starch (Voluven). It was dried with a hot snare in parts ("piecemeal" technique), thereby achieving complete resection. The defect was closed with metal clips. The specimen was recovered for histopathological study.
Results: During screening colonoscopy, a 56-year-old patient was found with a 30mm granular laterally spreading tumor of the rectum (LST-G or nodular mixed type), located 15cm from the anal verge. Complete endoscopic resection of the lesion with a curative intent was performed. On postoperative day 5, proctorrhagia presented without hemodynamic alteration. Emergency endoscopy was decided upon. Upon entering with the colonoscope, we identified a clot attached to the surgical site. Once the bleeding had been confirmed, a saline solution with 1/20,000 adrenaline was injected. And then, with a hot snare, electrocoagulation was performed in the same area, combining an injection method with a thermal one and achieving a satisfying hemostasis. The patient was discharged on the same day without any other complications. The pathology report showed a villous adenoma with low-grade dysplasia, including patches of high-grade dysplasia, and injury-free resection margins.
Conclusions: EMR of laterally spreading tumors is safe, although it is not devoid of complications such as bleeding, which is present in up to 9.8 of every 100,000 polypectomies in some series (Reumkens et al., AJG 2016). It is essential to suspect and know how to solve it efficiently with the tools available at that time of emergency.
Arthroscopic reconstruction of the TFCC using a free tendon graft
Instability of the distal radioulnar joint (DRUJ) results from injury or laxity of the ligaments responsible for stabilizing the joint. Of note, the triangular fibrocartilage complex (TFCC) plays a crucial role in maintaining DRUJ stability. Sometimes, it may be impossible to repair the TFCC due to degenerative changes in the TFCC. In such cases, DRUJ reconstruction is possible provided that there are no arthritic changes in the DRUJ with the use of tendon graft. The aim of this procedure is to reconstruct the ligament and restore function, thus providing multidirectional stability. This procedure uses a tendon graft, preferably the Palmaris Longus (PL), which is woven through trans-osseous tunnels in the distal radius, converging at the fovea through a distal ulnar trans-osseous tunnel.
C Mathoulin
Surgical intervention
27 days ago
69 views
1 like
0 comments
12:20
Arthroscopic reconstruction of the TFCC using a free tendon graft
Instability of the distal radioulnar joint (DRUJ) results from injury or laxity of the ligaments responsible for stabilizing the joint. Of note, the triangular fibrocartilage complex (TFCC) plays a crucial role in maintaining DRUJ stability. Sometimes, it may be impossible to repair the TFCC due to degenerative changes in the TFCC. In such cases, DRUJ reconstruction is possible provided that there are no arthritic changes in the DRUJ with the use of tendon graft. The aim of this procedure is to reconstruct the ligament and restore function, thus providing multidirectional stability. This procedure uses a tendon graft, preferably the Palmaris Longus (PL), which is woven through trans-osseous tunnels in the distal radius, converging at the fovea through a distal ulnar trans-osseous tunnel.