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General and digestive surgery

Find all the surgical interventions, lectures, experts opinions, debates, webinars and operative techniques per specialty.
Laparoscopic distal pancreatectomy for intraductal papillary mucinous neoplasm (IPMN)
This is the case of a 76-year-old female patient who was referred to our hospital because of intraductal papillary mucinous neoplasm (IPMN). The patient has a medical history of renal insufficiency, sleep apnea syndrome, type 2 diabetes mellitus (T2DM), and hypertension. She has also a history of previous total hysterectomy.
MRI findings showed that the patient’s IPMN affected secondary pancreatic ducts entirely.
The main pancreatic duct is dilated, especially in the distal part at 6mm, but there are no remarkable findings of cystic wall thickening or intracystic nodules. A laparoscopic distal pancreatectomy was planned.
The postoperative course was uneventful and the patient was discharged on postoperative day 8.
Pathological findings showed that the intraductal papillary mucinous neoplasm was without any malignant component.
P Pessaux, E Felli, T Wakabayashi, D Mutter, J Marescaux
Surgical intervention
10 days ago
130 views
1 like
0 comments
13:26
Laparoscopic distal pancreatectomy for intraductal papillary mucinous neoplasm (IPMN)
This is the case of a 76-year-old female patient who was referred to our hospital because of intraductal papillary mucinous neoplasm (IPMN). The patient has a medical history of renal insufficiency, sleep apnea syndrome, type 2 diabetes mellitus (T2DM), and hypertension. She has also a history of previous total hysterectomy.
MRI findings showed that the patient’s IPMN affected secondary pancreatic ducts entirely.
The main pancreatic duct is dilated, especially in the distal part at 6mm, but there are no remarkable findings of cystic wall thickening or intracystic nodules. A laparoscopic distal pancreatectomy was planned.
The postoperative course was uneventful and the patient was discharged on postoperative day 8.
Pathological findings showed that the intraductal papillary mucinous neoplasm was without any malignant component.
Single incision laparoscopic gastrojejunal bypass with intraoperative ultrasonography for obstructive pancreatic head tumor
Background: Pancreatic head tumors can be diagnosed immediately as symptomatic although the biliary tract is not involved. Single incision laparoscopy can be proposed as a valid option to allow an early beginning of neo-adjuvant chemotherapy.

Video: A 56-year-old man was admitted to hospital for vomiting and weight loss. Preoperative work-up showed the presence of an advanced and obstructive pancreatic head adenocarcinoma, not interesting the biliary tract. A laparoscopic gastro-jejunal bypass with staging laparoscopy, through a transumbilical single-access, was proposed to the patient. The technique consisted in the insertion of an 11mm reusable trocar, two 6mm flexible reusable trocars, and curved reusable instruments according to DAPRI (Karl Storz Endoskope, Tüttlingen, Germany) through the same umbilical incision. The procedure started with the exploration of the parietal peritoneum, lavage of the cavity, opening of the lesser sac for perioperative ultrasonography, and ended with linear mechanical side-to-side gastrojejunostomy.

Results: The obstructive status of the patient resolved during the postoperative course and the patient started neo-adjuvant chemotherapy after 10 days.

Conclusions: Single incision laparoscopic gastrojejunostomy for obstructive pancreatic head tumor, after staging laparoscopy including perioperative ultrasonography, permits the resolution of the clinical status as well as an early beginning of neo-adjuvant chemotherapy.
G Dapri
Surgical intervention
5 years ago
2244 views
54 likes
0 comments
06:40
Single incision laparoscopic gastrojejunal bypass with intraoperative ultrasonography for obstructive pancreatic head tumor
Background: Pancreatic head tumors can be diagnosed immediately as symptomatic although the biliary tract is not involved. Single incision laparoscopy can be proposed as a valid option to allow an early beginning of neo-adjuvant chemotherapy.

Video: A 56-year-old man was admitted to hospital for vomiting and weight loss. Preoperative work-up showed the presence of an advanced and obstructive pancreatic head adenocarcinoma, not interesting the biliary tract. A laparoscopic gastro-jejunal bypass with staging laparoscopy, through a transumbilical single-access, was proposed to the patient. The technique consisted in the insertion of an 11mm reusable trocar, two 6mm flexible reusable trocars, and curved reusable instruments according to DAPRI (Karl Storz Endoskope, Tüttlingen, Germany) through the same umbilical incision. The procedure started with the exploration of the parietal peritoneum, lavage of the cavity, opening of the lesser sac for perioperative ultrasonography, and ended with linear mechanical side-to-side gastrojejunostomy.

Results: The obstructive status of the patient resolved during the postoperative course and the patient started neo-adjuvant chemotherapy after 10 days.

Conclusions: Single incision laparoscopic gastrojejunostomy for obstructive pancreatic head tumor, after staging laparoscopy including perioperative ultrasonography, permits the resolution of the clinical status as well as an early beginning of neo-adjuvant chemotherapy.
Laparoscopic splenopancreatectomy for a solid pseudopapillary pancreatic tumor
The solid pseudopapillary tumor of the pancreas, also known as Frantz’s tumor, is an uncommon occurrence usually seen in younger women. It is usually of low grade malignity and most patients have no recurrence after successful surgical resection.
In the last few years, laparoscopic approach to resection procedures for benign pathologies or low-grade malignancies of the pancreas has been increasingly used. The traditional surgical approach to the distal pancreas requires large abdominal incisions because of the deep position of the gland, and entails possible postoperative complications such as wound infections and incisional hernia.
In this video, we present a laparoscopic distal pancreatectomy with splenectomy for a localized tumor of the tail of the pancreas. It shows some steps, which could simplify the technique and prevent some complications as bleeding or postoperative fistula.
J Torres Bermúdez, FC Becerra García, G Sánchez de la Villa, M Montoya Tabares, F González Sánchez, R Nehme, AA Carrillo Sánchez, JL Martín
Surgical intervention
8 years ago
7202 views
112 likes
0 comments
14:01
Laparoscopic splenopancreatectomy for a solid pseudopapillary pancreatic tumor
The solid pseudopapillary tumor of the pancreas, also known as Frantz’s tumor, is an uncommon occurrence usually seen in younger women. It is usually of low grade malignity and most patients have no recurrence after successful surgical resection.
In the last few years, laparoscopic approach to resection procedures for benign pathologies or low-grade malignancies of the pancreas has been increasingly used. The traditional surgical approach to the distal pancreas requires large abdominal incisions because of the deep position of the gland, and entails possible postoperative complications such as wound infections and incisional hernia.
In this video, we present a laparoscopic distal pancreatectomy with splenectomy for a localized tumor of the tail of the pancreas. It shows some steps, which could simplify the technique and prevent some complications as bleeding or postoperative fistula.
Laparoscopic distal pancreatectomy with spleen and vessel preservation
This is the case of a female patient presenting with a 12mm endocrine tumor located at the pancreatic isthmus. To manage this case, a distal pancreatectomy is decided upon. This tumor measures 16mm in its transverse diameter and it is located just above the portal vein. The CT-scan and its 3D reconstruction helps us to plan the surgical intervention. The whole pancreas along with the splenic vessels (splenic vein and artery) are reconstructed. The objective is to precisely locate the tumor in order to determine the resection modalities. A distal pancreatectomy with preservation of the splenic vessels is therefore decided upon.
D Mutter, L Soler, J Marescaux
Surgical intervention
8 years ago
1681 views
163 likes
0 comments
17:42
Laparoscopic distal pancreatectomy with spleen and vessel preservation
This is the case of a female patient presenting with a 12mm endocrine tumor located at the pancreatic isthmus. To manage this case, a distal pancreatectomy is decided upon. This tumor measures 16mm in its transverse diameter and it is located just above the portal vein. The CT-scan and its 3D reconstruction helps us to plan the surgical intervention. The whole pancreas along with the splenic vessels (splenic vein and artery) are reconstructed. The objective is to precisely locate the tumor in order to determine the resection modalities. A distal pancreatectomy with preservation of the splenic vessels is therefore decided upon.
Duodenopancreatectomy: potentialities of the laparoscopic approach in the mobilization, dissection, and resection stages of the procedure
This video demonstrates the laparoscopic approach of a cephalic
duodenopancreatectomy in a 70-year-old patient presenting with an
adenocarcinoma of the pancreatic head. Using 4 ports, the duodenum is completely detached. The unciform process is prepared posteriorly by dissecting the superior mesenteric artery and the portal vein in its right lower section. A total lymph node resection and an antrectomy have been performed, followed by the resection of the pancreatic body. Last but not least, the small bowel is divided and the duodenum is de-crossed. The dissection shows the different steps of the procedure with extra details.
B Ghavami
Surgical intervention
9 years ago
13304 views
192 likes
5 comments
17:55
Duodenopancreatectomy: potentialities of the laparoscopic approach in the mobilization, dissection, and resection stages of the procedure
This video demonstrates the laparoscopic approach of a cephalic
duodenopancreatectomy in a 70-year-old patient presenting with an
adenocarcinoma of the pancreatic head. Using 4 ports, the duodenum is completely detached. The unciform process is prepared posteriorly by dissecting the superior mesenteric artery and the portal vein in its right lower section. A total lymph node resection and an antrectomy have been performed, followed by the resection of the pancreatic body. Last but not least, the small bowel is divided and the duodenum is de-crossed. The dissection shows the different steps of the procedure with extra details.