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Federico COSTANTINO

Hôpitaux Civils de Colmar
Colmar, France
MD
3.2K likes
138.2K views
8 comments
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Laparoscopic distal pancreatectomy for mucinous cystadenoma
This video presents the case of a 39-year-old woman complaining of epigastric and right upper quadrant pain with dorsal irradiation and postprandial pain without nausea or vomiting. Abdominal ultrasound showed the presence of a 21mm cystic mass with multi-lobulated appearance at the tail of the pancreas. MRI confirmed the cystic nature of this tumor lesion of the tail of the pancreas, which was probably compatible with a mucinous cystadenoma (with a 23mm long axis) without communication with Wirsung’s duct. Transgastric echo-endoscopy revealed an ovoid cystic lesion of the pancreatic tail, with clean wall, measuring 19 by 10mm with small septa and a 4mm thick mural nodule without communication with the pancreatic duct. A laparoscopic left pancreatectomy was indicated because of the presence of a mucinous cystadenoma. This video demonstrates a laparoscopic distal pancreatectomy approach. A spleen-preserving distal pancreatectomy by preserving the splenic vessels (Kimura technique) was decided upon.
F Costantino, M Shahbaz, D Mutter, J Marescaux
Surgical intervention
2 years ago
1935 views
94 likes
0 comments
12:01
Laparoscopic distal pancreatectomy for mucinous cystadenoma
This video presents the case of a 39-year-old woman complaining of epigastric and right upper quadrant pain with dorsal irradiation and postprandial pain without nausea or vomiting. Abdominal ultrasound showed the presence of a 21mm cystic mass with multi-lobulated appearance at the tail of the pancreas. MRI confirmed the cystic nature of this tumor lesion of the tail of the pancreas, which was probably compatible with a mucinous cystadenoma (with a 23mm long axis) without communication with Wirsung’s duct. Transgastric echo-endoscopy revealed an ovoid cystic lesion of the pancreatic tail, with clean wall, measuring 19 by 10mm with small septa and a 4mm thick mural nodule without communication with the pancreatic duct. A laparoscopic left pancreatectomy was indicated because of the presence of a mucinous cystadenoma. This video demonstrates a laparoscopic distal pancreatectomy approach. A spleen-preserving distal pancreatectomy by preserving the splenic vessels (Kimura technique) was decided upon.
Right hemicolectomy for appendicular mucocele
The appendicular mucocele is defined by a dilation of the appendix and an unusual accumulation of mucus within its lumen. It is a rare pathology which affects 0.25% of the population.
Its histological discovery is made during the postoperative phase in nearly 70% of cases. Appendicular mucoceles, which are secondary to a muco-secretive tumor, can potentially be a problem if they are malignant, especially in case of preoperative or intraoperative rupture, with a risk of gelatinous disease of the peritoneum.
The positive diagnosis is based on a histological study, which must be systematic, for all appendectomy specimens. Preoperatively, it is essential to recognize an appendicular mucocele, in order to properly adapt the surgical technique, and to potentially envisage a more global surgical resection technique.
We present the case of a 70-year-old man, treated in our unit for right iliac fossa abscess in which an explorative laparoscopy was decided upon after one month of medical treatment.
L Marx, F Costantino, J Marescaux
Surgical intervention
5 years ago
5187 views
89 likes
1 comment
07:16
Right hemicolectomy for appendicular mucocele
The appendicular mucocele is defined by a dilation of the appendix and an unusual accumulation of mucus within its lumen. It is a rare pathology which affects 0.25% of the population.
Its histological discovery is made during the postoperative phase in nearly 70% of cases. Appendicular mucoceles, which are secondary to a muco-secretive tumor, can potentially be a problem if they are malignant, especially in case of preoperative or intraoperative rupture, with a risk of gelatinous disease of the peritoneum.
The positive diagnosis is based on a histological study, which must be systematic, for all appendectomy specimens. Preoperatively, it is essential to recognize an appendicular mucocele, in order to properly adapt the surgical technique, and to potentially envisage a more global surgical resection technique.
We present the case of a 70-year-old man, treated in our unit for right iliac fossa abscess in which an explorative laparoscopy was decided upon after one month of medical treatment.
Laparoscopic exploration after Roux-en-Y gastric bypass following intestinal obstruction
This video demonstrates a laparoscopic exploration in a female patient who had undergone a gastric bypass in 2002. Her BMI was 58 at that time. Now it is 20. She had been operated on for an incisional hernia that occurred at the level of the former umbilical optical port site. She suffered from several episodes of proven mechanical bowel obstruction and benefited from medical treatment.
However, despite a thorough preoperative work-up, including gastroscopy, colonoscopy and repeat CT-scan studies performed over 6 months, the mechanical origin of the bowel obstruction was difficult to demonstrate. Since the patient had chronic, cramp-like abdominal pain, the exploration of the abdominal cavity using the former port entry sites is decided upon.
F Costantino, M Vix, J Marescaux
Surgical intervention
8 years ago
186 views
2 likes
0 comments
06:17
Laparoscopic exploration after Roux-en-Y gastric bypass following intestinal obstruction
This video demonstrates a laparoscopic exploration in a female patient who had undergone a gastric bypass in 2002. Her BMI was 58 at that time. Now it is 20. She had been operated on for an incisional hernia that occurred at the level of the former umbilical optical port site. She suffered from several episodes of proven mechanical bowel obstruction and benefited from medical treatment.
However, despite a thorough preoperative work-up, including gastroscopy, colonoscopy and repeat CT-scan studies performed over 6 months, the mechanical origin of the bowel obstruction was difficult to demonstrate. Since the patient had chronic, cramp-like abdominal pain, the exploration of the abdominal cavity using the former port entry sites is decided upon.
Perigastric band abscess: laparoscopic approach
Band infection after gastric banding is a relatively rare complication. In most cases, it manifests itself through abdominal pain associated with fever, and/or an abscess surrounding the access port. This is the case of a 37-year-old female patient in whom a gastric band was placed 5 years ago. The patient lost 60% of her excess weight; however, she complained that the gastric band was no longer as efficient. Imaging studies allowed to identify the existence of a 50mL supragastric pouch. A gastroscopy reveals nothing unusual.
Following this postoperative control, we decided to remove the patient’s gastric band as she was troubled by the superior gastric pouch.
M Vix, F Costantino, J Marescaux
Surgical intervention
9 years ago
225 views
21 likes
0 comments
06:13
Perigastric band abscess: laparoscopic approach
Band infection after gastric banding is a relatively rare complication. In most cases, it manifests itself through abdominal pain associated with fever, and/or an abscess surrounding the access port. This is the case of a 37-year-old female patient in whom a gastric band was placed 5 years ago. The patient lost 60% of her excess weight; however, she complained that the gastric band was no longer as efficient. Imaging studies allowed to identify the existence of a 50mL supragastric pouch. A gastroscopy reveals nothing unusual.
Following this postoperative control, we decided to remove the patient’s gastric band as she was troubled by the superior gastric pouch.
Laparoscopic total gastrectomy for pT2 N0 M0 adenocarcinoma of the lesser curvature of the stomach
Totally laparoscopic gastrectomy for cancer remains limited because of technical problems, expecially for lymphadenectomy. We present the case of a 75-year-old patient with no specific history in which an adenocarcinoma of the lesser curvature of the stomach was found. An endoscopic ultrasound had shown a UST3 N0 lesion. The CT-scan confirmed the absence of secondary lesion and a neoadjuvant chemotherapy was carried out. Following chemotherapy, a re-evaluation was performed and confirmed the 2 by 2cm lesion of the lesser curvature of the stomach without secondary lesion. The decision to perform a laparoscopic total gastrectomy was made.
B Dallemagne, F Costantino, J Marescaux
Surgical intervention
9 years ago
7549 views
23 likes
0 comments
15:53
Laparoscopic total gastrectomy for pT2 N0 M0 adenocarcinoma of the lesser curvature of the stomach
Totally laparoscopic gastrectomy for cancer remains limited because of technical problems, expecially for lymphadenectomy. We present the case of a 75-year-old patient with no specific history in which an adenocarcinoma of the lesser curvature of the stomach was found. An endoscopic ultrasound had shown a UST3 N0 lesion. The CT-scan confirmed the absence of secondary lesion and a neoadjuvant chemotherapy was carried out. Following chemotherapy, a re-evaluation was performed and confirmed the 2 by 2cm lesion of the lesser curvature of the stomach without secondary lesion. The decision to perform a laparoscopic total gastrectomy was made.
Laparoscopic appendectomy following transparietal drainage of an abscess
Patients presenting with complicated appendicitis represent a common and challenging problem. Conflicting data exist concerning optimal treatment of these patients with primary versus delayed appendectomy. This video shows the case of a 48-year-old female patient operated upon previously for a collection at the rectouterine (Douglas') pouch following a suspected acute appendicitis. A laparoscopic exploration was performed along with a laparoscopic drainage of the collection, but the appendix had not been identified. Fifteen days later and the patient presents with a 15cm residual collection for which we performed a puncture under CT-scan guidance. Following a 3-month interval, the patient is admitted to our Department to perform an appendectomy.
F Costantino, J Marescaux
Surgical intervention
9 years ago
2772 views
20 likes
0 comments
04:05
Laparoscopic appendectomy following transparietal drainage of an abscess
Patients presenting with complicated appendicitis represent a common and challenging problem. Conflicting data exist concerning optimal treatment of these patients with primary versus delayed appendectomy. This video shows the case of a 48-year-old female patient operated upon previously for a collection at the rectouterine (Douglas') pouch following a suspected acute appendicitis. A laparoscopic exploration was performed along with a laparoscopic drainage of the collection, but the appendix had not been identified. Fifteen days later and the patient presents with a 15cm residual collection for which we performed a puncture under CT-scan guidance. Following a 3-month interval, the patient is admitted to our Department to perform an appendectomy.
Laparoscopic sigmoidectomy with ventral and posterior indirect rectopexy for rectal prolapse in a female patient
Rectal prolapse is an uncommon disease mainly seen in patients of advanced age.
In the last few years, the laparoscopic route has been shown to be feasible and has the advantage of being a minimally invasive technique. The objective of this film is to demonstrate a technique for the repair of rectal prolapse with sigmoidectomy. This is the case of a 72-year-old woman with a previous history of hysterectomy presenting also with dyschezia and moderate incontinence and a grade III rectal prolapse. Defecography showed a prolapse of the upper rectum with an enterocele without any associated rectocele in spite of the hysterectomy.
J Leroy, D Mutter, F Costantino, J Marescaux
Surgical intervention
9 years ago
2473 views
135 likes
0 comments
10:26
Laparoscopic sigmoidectomy with ventral and posterior indirect rectopexy for rectal prolapse in a female patient
Rectal prolapse is an uncommon disease mainly seen in patients of advanced age.
In the last few years, the laparoscopic route has been shown to be feasible and has the advantage of being a minimally invasive technique. The objective of this film is to demonstrate a technique for the repair of rectal prolapse with sigmoidectomy. This is the case of a 72-year-old woman with a previous history of hysterectomy presenting also with dyschezia and moderate incontinence and a grade III rectal prolapse. Defecography showed a prolapse of the upper rectum with an enterocele without any associated rectocele in spite of the hysterectomy.
Laparoscopic treatment of an incarcerated right femoral hernia in a female patient
Femoral hernia is predominantly a female disorder. Incarcerated femoral hernia is a common surgical emergency condition. Diagnosis is always obvious and straightforward by clinical examination, and open surgical repair was the mainstay of treatment. In the era of minimally invasive surgery, laparoscopic repair of femoral hernia has been shown to be feasible and safe. This video shows the laparoscopic trans-abdominal preperitoneal repair of a right femoral hernia in a female patient who has had an appendectomy and who presented to emergencies with pain in the right inguinal region associated with nausea and vomiting. This procedure was performed by a skilled surgeon fellow telementored by Prof. Leroy, a world-renowned expert in laparoscopic hernia repair surgery.
F Costantino, J Leroy, J Marescaux
Surgical intervention
10 years ago
3018 views
215 likes
1 comment
05:53
Laparoscopic treatment of an incarcerated right femoral hernia in a female patient
Femoral hernia is predominantly a female disorder. Incarcerated femoral hernia is a common surgical emergency condition. Diagnosis is always obvious and straightforward by clinical examination, and open surgical repair was the mainstay of treatment. In the era of minimally invasive surgery, laparoscopic repair of femoral hernia has been shown to be feasible and safe. This video shows the laparoscopic trans-abdominal preperitoneal repair of a right femoral hernia in a female patient who has had an appendectomy and who presented to emergencies with pain in the right inguinal region associated with nausea and vomiting. This procedure was performed by a skilled surgeon fellow telementored by Prof. Leroy, a world-renowned expert in laparoscopic hernia repair surgery.
Stepwise approach for laparoscopic reversal of Hartmann's procedure
Restoration of intestinal continuity following reversal of Hartmann's procedure is an operation associated with a lengthy hospital stay, protracted convalescence, and a high morbidity rate. The advantages of minimally invasive surgery such as rapid mobilization, less postoperative pain, early restoration of bowel function, and a rapid return to a normal diet, and reduced morbidity are very useful in this procedure. Furthermore, laparoscopic reversal of Hartmann's has a comparable operative time with the open technique when performed by experienced surgeons like in this case. This interesting video shows each step of the procedure clearly. Three ports are used and the colon is divided intra-abdominally.
J Leroy, F Costantino, J Marescaux
Surgical intervention
10 years ago
2291 views
116 likes
0 comments
10:05
Stepwise approach for laparoscopic reversal of Hartmann's procedure
Restoration of intestinal continuity following reversal of Hartmann's procedure is an operation associated with a lengthy hospital stay, protracted convalescence, and a high morbidity rate. The advantages of minimally invasive surgery such as rapid mobilization, less postoperative pain, early restoration of bowel function, and a rapid return to a normal diet, and reduced morbidity are very useful in this procedure. Furthermore, laparoscopic reversal of Hartmann's has a comparable operative time with the open technique when performed by experienced surgeons like in this case. This interesting video shows each step of the procedure clearly. Three ports are used and the colon is divided intra-abdominally.
Laparoscopic Roux-en-Y gastric bypass after vertical banded gastroplasty
Patients who have undergone bariatric surgery and present with upper abdominal symptoms pose a diagnostic and management challenge.
Laparoscopic vertical banded gastroplasty (VBG) is associated with high revisional rates. In the case of failed VBG, repeat VBG seems to be a poor option and conversion to gastric bypass yields better results.
This is the case of a 35-year-old female patient who underwent a vertical banded gastroplasty by laparotomy 8 years ago and presents with dysphagia. A gastroscopy and a contrast swallow exam using radio-opaque markers do not show any fistulas, but peroperative surgical exploration discovers a gastro-gastric fistula. This video clearly shows all the technical aspects of a revisional bariatric procedure.
M Vix, F Costantino, J Marescaux
Surgical intervention
10 years ago
701 views
30 likes
0 comments
12:17
Laparoscopic Roux-en-Y gastric bypass after vertical banded gastroplasty
Patients who have undergone bariatric surgery and present with upper abdominal symptoms pose a diagnostic and management challenge.
Laparoscopic vertical banded gastroplasty (VBG) is associated with high revisional rates. In the case of failed VBG, repeat VBG seems to be a poor option and conversion to gastric bypass yields better results.
This is the case of a 35-year-old female patient who underwent a vertical banded gastroplasty by laparotomy 8 years ago and presents with dysphagia. A gastroscopy and a contrast swallow exam using radio-opaque markers do not show any fistulas, but peroperative surgical exploration discovers a gastro-gastric fistula. This video clearly shows all the technical aspects of a revisional bariatric procedure.
Benefits of laparoscopy in the management of malfunctioning peritoneal dialysis catheters: 3 clinical cases
Laparoscopic techniques for placement of peritoneal dialysis catheters are becoming increasingly popular. There may be several problems related to the functioning of peritoneal dialysis catheters. This is a report of three cases illustrating the diagnostic and often therapeutic interest of laparoscopy in patients presenting with peritoneal dialysis catheter malfunction. Case one shows laparoscopic treatment for pleural leakage, case two catheter malposition due to inflammatory and hemorrhagic adhesions with the omentum and case three a total encapsulation of the dialysis catheter by fibrin.
D Mutter, F Costantino, J D'Agostino, J Marescaux
Surgical intervention
10 years ago
871 views
54 likes
0 comments
06:29
Benefits of laparoscopy in the management of malfunctioning peritoneal dialysis catheters: 3 clinical cases
Laparoscopic techniques for placement of peritoneal dialysis catheters are becoming increasingly popular. There may be several problems related to the functioning of peritoneal dialysis catheters. This is a report of three cases illustrating the diagnostic and often therapeutic interest of laparoscopy in patients presenting with peritoneal dialysis catheter malfunction. Case one shows laparoscopic treatment for pleural leakage, case two catheter malposition due to inflammatory and hemorrhagic adhesions with the omentum and case three a total encapsulation of the dialysis catheter by fibrin.
Minimally invasive video-assisted right parathyroidectomy: lateral approach, variation of Miccoli's technique
This video demonstrates how a slight modification of the standard video-assisted approach for parathyroidectomy can improve the visualization of the operative field.
A slight modification of the standard video-assisted approach for parathyroidectomy can improve visualization of the operative field. Cervical US confirmed the presence of a right superior parathyroid adenoma. The authors make a 2.5cm transverse neck incision 1cm above the sternal notch. In exposing the operative field, they divide the platysma and control the anterior jugular veins. They then dissect and retract the omohyoid muscle to quickly and precisely access the jugulocarotid groove.
F Costantino, M Vix, J Marescaux
Surgical intervention
11 years ago
887 views
20 likes
0 comments
08:20
Minimally invasive video-assisted right parathyroidectomy: lateral approach, variation of Miccoli's technique
This video demonstrates how a slight modification of the standard video-assisted approach for parathyroidectomy can improve the visualization of the operative field.
A slight modification of the standard video-assisted approach for parathyroidectomy can improve visualization of the operative field. Cervical US confirmed the presence of a right superior parathyroid adenoma. The authors make a 2.5cm transverse neck incision 1cm above the sternal notch. In exposing the operative field, they divide the platysma and control the anterior jugular veins. They then dissect and retract the omohyoid muscle to quickly and precisely access the jugulocarotid groove.
Laparoscopic treatment of acute small bowel obstruction: multiple cases of laparoscopic adhesiolysis
The video shows the laparoscopic management of three separate cases of acute small bowel obstruction secondary to adhesions. The difficulties and advantages of such an approach in this emergency scenario are discussed.
The author begins by inserting a trocar in the umbilicus. Upon exploration of the abdominal cavity, intestinal obstruction becomes clearly evident from the presence of dilated loops and flattened, collapsed loops. The author follows the collapsed loops until the transition zone is identified. The adhesions appear between the greater omentum and the mesentery. This band is divided. Further exploration leads to the finding of a second adhesion. This area shows no signs of occlusion. The author divides this adhesion. Exploration of the remainder of the small bowel continues to rule out further adhesions.
F Costantino, J Marescaux
Surgical intervention
11 years ago
3922 views
45 likes
0 comments
09:41
Laparoscopic treatment of acute small bowel obstruction: multiple cases of laparoscopic adhesiolysis
The video shows the laparoscopic management of three separate cases of acute small bowel obstruction secondary to adhesions. The difficulties and advantages of such an approach in this emergency scenario are discussed.
The author begins by inserting a trocar in the umbilicus. Upon exploration of the abdominal cavity, intestinal obstruction becomes clearly evident from the presence of dilated loops and flattened, collapsed loops. The author follows the collapsed loops until the transition zone is identified. The adhesions appear between the greater omentum and the mesentery. This band is divided. Further exploration leads to the finding of a second adhesion. This area shows no signs of occlusion. The author divides this adhesion. Exploration of the remainder of the small bowel continues to rule out further adhesions.
Benefit of laparoscopic approach in an appendicular purulent peritonitis
This video is one of a series of laparoscopic appendicectomies and shows the advantage of the videoscopic approach in accessing the entire peritoneal cavity in cases of diffuse peritonitis.
Blood tests revealed an inflammatory syndrome in a young woman with a 3-day history of diffuse abdominal pain and fever. Exploration of the abdominal cavity during emergency laparoscopy confirmed the clinical impressions. The authors performed aspiration and lavage of the peritoneal cavity. Thorough assessment revealed the omentum to be concentrated in the right iliac fossa, and gentle dissection uncovered a necrotic, perforated appendix. Dissection of the cecum and appendix was difficult because the tissues were friable and adherent. The usual tissue planes were not present, but the laparoscopic view allowed for a safe approach.
F Costantino, J Marescaux
Surgical intervention
11 years ago
703 views
97 likes
0 comments
04:04
Benefit of laparoscopic approach in an appendicular purulent peritonitis
This video is one of a series of laparoscopic appendicectomies and shows the advantage of the videoscopic approach in accessing the entire peritoneal cavity in cases of diffuse peritonitis.
Blood tests revealed an inflammatory syndrome in a young woman with a 3-day history of diffuse abdominal pain and fever. Exploration of the abdominal cavity during emergency laparoscopy confirmed the clinical impressions. The authors performed aspiration and lavage of the peritoneal cavity. Thorough assessment revealed the omentum to be concentrated in the right iliac fossa, and gentle dissection uncovered a necrotic, perforated appendix. Dissection of the cecum and appendix was difficult because the tissues were friable and adherent. The usual tissue planes were not present, but the laparoscopic view allowed for a safe approach.