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Laparoscopic wedge resection following endoscopic caecal perforation

The objective of this film is to demonstrate the management of a right colon perforation after an endoscopic submucosal dissection (ESD) performed 48 hours before.

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Laparoscopic wedge resection following endoscopic caecal perforation

作者群

J Leroy, Gf Donatelli, J Marescaux

摘要

The objective of this film is to demonstrate the management of a right colon perforation after an endoscopic submucosal dissection (ESD) performed 48 hours before.

關鍵字

Laparoscopic wedge resection, endoscopic caecal perforation

媒體類型

手術影片

期間

04'52''

刊物

2011-02

普通的

最愛

Favorites Media

音訊

副標題

數位出版

WeBSurg.com, Feb 2011;11(02).
URL: http://www.websurg.com/doi-vd01en3062.htm

Laparoscopic wedge resection following endoscopic caecal perforation

1. Introduction 00'10''

The objective of this film is to demonstrate the management of a right colon perforation after an endoscopic submucosal dissection (ESD) performed 48 hours before. This was followed by a micro-perforation associated with a local abscess, as can be seen here.

2. Identification of perforation 00'34''

The perforation is first identified laparoscopically.

3. Abdominal cavity lavage 00'41''

A complete lavage of the abdominal cavity is carried out. No diffuse adhesions are evidenced but a serohematic fluid is merely found. The rigid area is first evaluated. It seems to be easily resectable and the size of the colon seems to be sufficiently large.

4. Stitch placement for colonic wall traction 01'10''

Next, once the caecum and the right colon have been mobilized laterally, several stitches are placed for identification and traction purposes at the level of the external and internal angles of the inflammatory area. A third stitch will then be placed half-way between the first two landmark stitches in order to bring the edges of the inflammatory area close together superiorly and inferiorly. This also allows for a better traction of the entire inflammatory area anteriorly. It makes it possible to introduce a stapler through a 12mm port. This port also allows to better control the resection area.

5. Wedge resection 02'13''

The stapler is placed in a healthy area, and the anterior lateral wall of the right colon just above the caecum is resected in a wedge fashion. This is facilitated by the stapling using the Endo-GIA device.

6. Running suture on stapled area 02'33''

Due to safety reasons, the everted stapled area –performed with the EndoGIA, blue cartridge, is covered by a running suture of PDS 3/0 material, which is performed intra-abdominally. The stapling area is progressively covered, as can be seen here. The monofilament has one major advantage: it allows to pass several stitches before exerting traction, and it avoids any cutting effect of the tissues, which could occur if using a multifilament braided suture. The end of the suture covering the stapling area can be seen here. The final stitch will allow to tie an intracorporeal knot, as can be seen in these pictures, by using the penultimate loop as a strand, and the terminal thread as a second strand. The resected segment is placed in a plastic bag, which is introduced through the 12mm trocar. This segment is then removed.