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Focus on Solid Organs Surgery - Second Part

Epublication, Jul 2016;16(07). URL: http://websurg.com/doi/fc01en2
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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
1722 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
1076 views
51 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.
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
1719 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
1377 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.
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
2895 views
291 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
1310 views
98 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.
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
1778 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
2491 views
128 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
3877 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.