Laparoscopic small bowel resection for cavernous hemangioma

The purpose of this video is to show a technique of laparoscopic exploration for a vascular lesion of the upper GI tract, responsible for recurring hemorrhages and anemia in a young patient with no significant medical history. This video shows a totally laparoscopic resection of the jejunum with closure of the mesenteric gap and a mechanically stapled anisoperistaltic side-to-side type of anastomosis.

Créer un compte gratuit

l'Université Virtuelle

Google translate

Résumé
Chapitres
Vos Commentaires
Interrogez les Experts

Vous devez vous identifier pour accéder à cette partie du site !

Laparoscopic small bowel resection for cavernous hemangioma

Authors

J Leroy, D Coumaros, J Marescaux

Abstract

The purpose of this video is to show a technique of laparoscopic exploration for a vascular lesion of the upper GI tract, responsible for recurring hemorrhages and anemia in a young patient with no significant medical history.
This video shows a totally laparoscopic resection of the jejunum with closure of the mesenteric gap and a mechanically stapled anisoperistaltic side-to-side type of anastomosis.

Catégorie

complex cases

Mots-clés

Laparoscopic small bowel resection, cavernous hemangioma

Type de vidéo

Vidéo chirurgicale

Durée

05'12''

Publication

2009-09

Popularité

Favoris

Favorites Media

Audio

Sous-titres

E-publication

WeBSurg.com, Sept 2009;9(09).
URL: http://www.websurg.com/doi-vd01en2717.htm

Laparoscopic small bowel resection for cavernous hemangioma

1. Introduction 00'16''

The purpose of this video is to show a technique of laparoscopic exploration for a vascular lesion of the digestive tube, responsible for recurring hemorrhages and anemia in a young female patient with no significant medical history. This video shows a totally laparoscopic resection of the small bowel, as there is no exteriorization of the small bowel, following identification of the lesion. The localization is performed quite easily, with complete exploration of the small bowel, but also of the colon to try and identify other lesions. After endoscopic explorations via a double-balloon enteroscopy that had identified the lesion as being situated around 1 meter from the duodenojejunal angle, and once the laparoscopic exploration confirms that there is only one lesion, we perform a loop in order to resect the area in which the lesion is situated.

2. Intestinal loop fixation and division 01'19''

After having fixed the two feet of the jejunal loop, we perform an incision with the Ligasure Advance’s monopolar electrode that allows the use of “intelligent” monopolar current, also called “Valleylab current”, enabling to adapt the current’s intensity to the tissue that needs to be resected.

3. Side-to-side anastomosis 01'57''

Once both small bowel segments have been incised, we introduce a 60mm blue cartridge Endo-GIA linear stapler to perform a side-to-side end anisoperistaltic anastomosis. Following the stapling, we check that there is no hemorrhage at the level of the endoluminal stapling via an endoluminal exploration. We then complete the stapling by resecting the area in which the two incisions had been performed and continue the division on the mesentery, which will allow to close the mesenteric breach automatically. The advantage of this technique is to perform a resection by a totally laparoscopic approach with a side-to-side end anisoperistaltic anastomosis, thus achieving a perfect triangulation at the level of the stapling zone and a mesenteric closure. The exteriorization of bowel segment containing the suspected lesion remains to be performed.

4. Specimen extraction 03'29''

We push the segment in a plastic extraction bag that had been introduced through one of the trocars sites. Three trocars are sufficient to perform this procedure: a 12mm optical trocar subumbilically, and two working trocars, including a 12mm one to introduce the instruments, in particular the linear stapler. Once the bag has been extracted, we remove the bowel segment without risking a contamination of the incision and without having to enlarge it. Through an incision in the bowel segment, we explore the latter and find the lesion along with scar tissue and white necrotic deposits, which corresponds etiologically to a hemangioma type of vascular lesion.

5. View of lesion 04'42''

We can see on this picture the small ulcerated and hemorrhagic areas responsible for the recurring hemorrhages, the melena and the anemia. This technique is interesting as it allows a complete laparoscopic resection with closure of the breach and a mechanically stapled anisoperistaltic side-to-side type of anastomosis.