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General and digestive surgery

Find all the surgical interventions, lectures, experts opinions, debates, webinars and operative techniques per specialty.
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
2 months ago
1705 views
9 likes
3 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.
Totally laparoscopic gastrectomy and D2 lymphadenectomy with repair of a positive leak test
The objective of this video is to demonstrate a laparoscopic total gastrectomy with D2 lymphadenectomy for antral gastric cancer. The patient we present is a 40 year-old gentleman who presented with epigastric pain. Endoscopy revealed a neoplastic lesion at the gastric antrum. Biopsies confirmed the presence of an adenocarcinoma. This was staged as a T2 lesion and there was no distant metastasis. A total gastrectomy was planned using a total laparoscopic approach. For reconstruction, the authors used a Roux En Y esophagojejunal anastomosis using the transoral delivery of the OrVil® device (Covidien, Mansfield, MA, USA). We also demonstrate how to deal with a positive intraoperative leak test at the end of the procedure.
AE Salih, S Smolarek, SA Naqi, M Arumugasamy
Surgical intervention
3 years ago
6539 views
403 likes
1 comment
12:35
Totally laparoscopic gastrectomy and D2 lymphadenectomy with repair of a positive leak test
The objective of this video is to demonstrate a laparoscopic total gastrectomy with D2 lymphadenectomy for antral gastric cancer. The patient we present is a 40 year-old gentleman who presented with epigastric pain. Endoscopy revealed a neoplastic lesion at the gastric antrum. Biopsies confirmed the presence of an adenocarcinoma. This was staged as a T2 lesion and there was no distant metastasis. A total gastrectomy was planned using a total laparoscopic approach. For reconstruction, the authors used a Roux En Y esophagojejunal anastomosis using the transoral delivery of the OrVil® device (Covidien, Mansfield, MA, USA). We also demonstrate how to deal with a positive intraoperative leak test at the end of the procedure.
Robot-assisted distal gastrectomy and D2 lymphadenectomy for early gastric cancer
We present the case of an early gastric cancer, which was located in the lower third of the stomach. The patient underwent a robot-assisted distal gastrectomy with D2 lymph node dissection. The da Vinci™ robotic system may provide some benefit to the operator in D2 dissection thanks to the articulating function of the arms, but the advantage for the patient has not been validated. The procedure was similar to a laparoscopic distal gastrectomy, starting from the omentectomy in the left side first and then the right side, followed by a lymphadenectomy around the infrapyloric and suprapyloric area. The lymphadenectomy is continued towards the suprapyloric area along the common hepatic artery and splenic artery, and the left gastric vein and artery are ligated. With a dissection of the lesser curvature aspect of the upper stomach, D2 dissection is completed “en bloc”.
HK Yang
Surgical intervention
4 years ago
1818 views
77 likes
0 comments
29:24
Robot-assisted distal gastrectomy and D2 lymphadenectomy for early gastric cancer
We present the case of an early gastric cancer, which was located in the lower third of the stomach. The patient underwent a robot-assisted distal gastrectomy with D2 lymph node dissection. The da Vinci™ robotic system may provide some benefit to the operator in D2 dissection thanks to the articulating function of the arms, but the advantage for the patient has not been validated. The procedure was similar to a laparoscopic distal gastrectomy, starting from the omentectomy in the left side first and then the right side, followed by a lymphadenectomy around the infrapyloric and suprapyloric area. The lymphadenectomy is continued towards the suprapyloric area along the common hepatic artery and splenic artery, and the left gastric vein and artery are ligated. With a dissection of the lesser curvature aspect of the upper stomach, D2 dissection is completed “en bloc”.
Laparoscopy-assisted pylorus-preserving gastrectomy using near-infrared imaging combined with indocyanine green (ICG) submucosal injection - (LAPPG - Near-infrared ICG camera)
Using a near infrared camera, lymph nodes can be visualized. For early gastric cancer located in the middle third of the stomach, laparoscopy-assisted pylorus-preserving gastrectomy (LAPPG) can be performed. Approximately, a 3cm cuff of distal antrum is preserved. Technically speaking, the preservation of infrapyloric vessels and of the hepatic branch of the vagus nerve represents the technical difference as compared to conventional radical distal gastrectomy. In this video, the audience can see how a near-infrared camera can be used to assist lymph node dissection.
HK Yang
Surgical intervention
4 years ago
1793 views
37 likes
0 comments
22:18
Laparoscopy-assisted pylorus-preserving gastrectomy using near-infrared imaging combined with indocyanine green (ICG) submucosal injection - (LAPPG - Near-infrared ICG camera)
Using a near infrared camera, lymph nodes can be visualized. For early gastric cancer located in the middle third of the stomach, laparoscopy-assisted pylorus-preserving gastrectomy (LAPPG) can be performed. Approximately, a 3cm cuff of distal antrum is preserved. Technically speaking, the preservation of infrapyloric vessels and of the hepatic branch of the vagus nerve represents the technical difference as compared to conventional radical distal gastrectomy. In this video, the audience can see how a near-infrared camera can be used to assist lymph node dissection.
Laparoscopic D2 lymphadenectomy with preservation of an aberrant left hepatic artery during distal gastric resection for cancer
During laparoscopic D2 lymphadenectomy for gastric cancer, an aberrant left hepatic artery (ALHA) can be found arising from the left gastric artery (LGA). It is recommended to preserve this vessel since it is impossible to intraoperatively determine whether it is a “replaced” or “accessory” left hepatic artery. In the present video, we show the technique to preserve the ALHA during a laparoscopic distal gastrectomy performed for a cancer of the antrum in a 78-year-old male patient.
A typical D2 laparoscopic lymphadenectomy is performed until the division of the left gastric vein and the identification of the LGA: the ALHA is identified at this time and the anterior side of the LGA is exposed towards its origin; the branch of the LGA towards the stomach is clipped and resected and the lymph nodes located posterior to the ALHA are then dissected completely. Lymphadenectomy is then completed with the dissection of the lymph nodes along the lesser curvature and the right cardiac nodes.
Pathological examination revealed a T2N0M0 tumor with 56 lymph nodes examined. The present video demonstrates that preservation of the ALHA is laparoscopically feasible and does not decrease the extent of D2 lymph node dissection.
B Badii, F Staderini, I Skalamera, G Fiorenza, G Perigli, F Cianchi
Surgical intervention
4 years ago
3286 views
96 likes
0 comments
16:07
Laparoscopic D2 lymphadenectomy with preservation of an aberrant left hepatic artery during distal gastric resection for cancer
During laparoscopic D2 lymphadenectomy for gastric cancer, an aberrant left hepatic artery (ALHA) can be found arising from the left gastric artery (LGA). It is recommended to preserve this vessel since it is impossible to intraoperatively determine whether it is a “replaced” or “accessory” left hepatic artery. In the present video, we show the technique to preserve the ALHA during a laparoscopic distal gastrectomy performed for a cancer of the antrum in a 78-year-old male patient.
A typical D2 laparoscopic lymphadenectomy is performed until the division of the left gastric vein and the identification of the LGA: the ALHA is identified at this time and the anterior side of the LGA is exposed towards its origin; the branch of the LGA towards the stomach is clipped and resected and the lymph nodes located posterior to the ALHA are then dissected completely. Lymphadenectomy is then completed with the dissection of the lymph nodes along the lesser curvature and the right cardiac nodes.
Pathological examination revealed a T2N0M0 tumor with 56 lymph nodes examined. The present video demonstrates that preservation of the ALHA is laparoscopically feasible and does not decrease the extent of D2 lymph node dissection.
Completion gastrectomy by laparoscopic approach for cancer of the gastric stump
This operative video demonstrates the performance of a completion gastrectomy in a patient who has had prior partial gastrectomy.
This patient had a previous partial gastrectomy. To mobilize the distal esophagus, the author divides the phrenoesophageal membrane, and then frees the esophagus of all its attachments in the lower mediastinum. This aids in retracting the esophagus into the abdomen. The author then carries out dissection with the ultrasonic scalpel, dividing the posterior and the anterior vagus nerves. To perform partial division of the esophagus, he uses the linear Endo-GIA (Covidien, North Haven, CT) and uses the stomach as a lever.
F Corcione
Surgical intervention
11 years ago
1436 views
55 likes
0 comments
11:21
Completion gastrectomy by laparoscopic approach for cancer of the gastric stump
This operative video demonstrates the performance of a completion gastrectomy in a patient who has had prior partial gastrectomy.
This patient had a previous partial gastrectomy. To mobilize the distal esophagus, the author divides the phrenoesophageal membrane, and then frees the esophagus of all its attachments in the lower mediastinum. This aids in retracting the esophagus into the abdomen. The author then carries out dissection with the ultrasonic scalpel, dividing the posterior and the anterior vagus nerves. To perform partial division of the esophagus, he uses the linear Endo-GIA (Covidien, North Haven, CT) and uses the stomach as a lever.