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WebSurg外科影片
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English - 08'00''
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| 00'08'' | Case presentation and trocar placement
The patient is 30 years old with a problem of infertility due to endometriosis. Usually in colonic surgery, we use about 5 trocars as you will see. It’s particularly important in obese patients to have a better exposure. |
| 00'36'' | Exposure
We have a stenosis around 10cm in length at the top of the sigmoid loop and we have the same vision after we have exposed. The sigmoid colon loop is very compliant, proximal and distal. This is the rectum; we have the right ovary here. |
| 01'10'' | Colorectal dissection
We have found a small endometriotic nodule that we will strip at the end of the intervention. I’m dissecting close to the sigmoid colon because I want to respect the superior rectal vessels. 80% of the vascularization is due to the superior rectal vessels so in benign disease we respect this vascularization. It’s not only for the vascularization, it’s also for the innervation too because the nerves are around and functionally it’s probably better to keep the venous and arterial vascular supply. We’ve used only a conventional bowel preparation with no fibers during one week and one enema yesterday and this morning. If we encounter an abscess, we will use a postoperative treatment. In this case, we will use nothing else than a flash prophylaxis during the induction of the anesthesia. There’s a big hard nodule. We see the lesion. I’m using the instrument now.
I’m sure that the ureter is here now. You see it moving. This is the lumbo-ovarian ligament. Division may be performed lower down if I find more endometriosis.
I’m going slowly close to the rectum. This is the Douglas’ pouch. I’m not sure where the limit of the nodule is. I’ll resect this and probably I will perform division of the rectum just under this. We have chosen to perform a medial approach; we do first a vascular approach and afterwards, we continue the dissection opening the different planes that we discover using a medial approach. We don’t have to retract the colon because it is lateral. We don’t have to manipulate the colon. It’s better in case of tumor. I want to find the inferior limit of the rectum. To do so, it’s necessary to dissect the rectum laterally, at the limit between the rectum and the nodule. This is the big nodule. This is the rectum here. I’m back to the uterus probably here and I’m dissecting around. |
| 04'37'' | Rectal division
You’ve seen that we divided the rectum. The nodule is 1 to 2cm above. |
| 05'40'' | Exteriorization and colon division
We see vessels beating when we use the palpator. We have to respect a good vascularization. I’ll now do the exteriorization. There’s also endocolic endometriosis.
I apply the purse-string device. |
| 06'14'' | Anastomosis
We will introduce the circular stapler. We’ll use a 31mm anvil. We close the purse-string. It’s very important to prepare the stump.
Now let’s slide to the back. I push until I have locked the device. We tighten the device and verify that there’s no twist. We fire twice since we have to cut staples. The anastomosis is complete. |
| 07'50'' | Resection of ovarian cyst
We now insufflate. No bubbles are noted. We will now remove the endometriotic cyst. |
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Laparoscopic rectosigmoid resection for rectosigmoid endometriosis
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