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Hall of Fame

Participate in the Hall of Fame contest of WebSurg.

The last winner - 2017

Stelio RUA, MD
Aurillac, France
Laparoscopic appendectomy is not only the perfect technique to prevent the unnecessary trauma of a laparotomy, it also allows for a limited surgical cost. In the video "Low-cost laparoscopic appendectomy : how to teach" authored by Dr Stelio Rua (MD), one of our best contributors, the authors demonstrate that a laparoscopic appendectomy can be an affordable procedure and can be performed by skilled and proficient surgeons but also by residents operating with an expert. It is essential for residents to begin their learning curve in laparoscopy as soon as possible. Dr Stelio Rua has been an active WeBSurg contributor for more than 5 years. We are more than pleased to highlight one of his video contributions in our Hall of Fame contest. Dr Rua has been working for more than four years at the CUF Infante Santo Hospital, Lisbon, Portugal. He studied medicine in Clermont-Ferrand, France. His fields of interests include, among others, general surgery, minimally invasive procedures, and healthcare management.
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Suprapubic single-incision laparoscopic splenic flexure resection with hand-sewn intracorporeal anastomosis
Background: The authors report the case of a 30-year-old woman who consulted for episodes of diverticulitis due to segmental diverticulosis of the splenic flexure. The patient was scheduled for a suprapubic single incision laparoscopic splenic flexure resection.

Video: A right suprapubic incision was performed and allowed for the introduction of three abdominal trocars (11mm, and two 6mm ones). DAPRI curved reusable instruments (Karl Storz Endoskope, Tuttlingen, Germany) were used, in addition to a 10mm, 30-degree regular length scope. The mobilization of the left mesocolon as well as of the transverse mesocolon was performed. After having completely freed the splenic flexure from its attachments, the transverse colon and the left colon were divided using an articulating linear stapler, introduced into the abdomen under a 5mm, 30-degree long scope. An intracorporeal end-to-end transverse sigmoid anastomosis was performed using two converging running sutures. The mesocolic defect was closed. The specimen was removed through a single access and final scar appeared to be 4cm.

Results: Laparoscopic time was 165 minutes and time to perform the anastomosis was 60 minutes. Operative bleeding was 10cc. The patient was discharged after 4 days, and at visit consultations, the symptoms were resolved.

Conclusion: Single incision laparoscopic splenic flexure resection can be safely performed using a suprapubic access, which enhances cosmetic outcomes, in addition to the advantages of minimally invasive surgery. A laparoscopic intracorporeal anastomosis is mandatory and can be performed using a hand-sewn method.
G Dapri, L Cardinali, A Cadenas Febres, GB Cadière
Surgical intervention
1 year ago
1567 views
92 likes
0 comments
07:12
Suprapubic single-incision laparoscopic splenic flexure resection with hand-sewn intracorporeal anastomosis
Background: The authors report the case of a 30-year-old woman who consulted for episodes of diverticulitis due to segmental diverticulosis of the splenic flexure. The patient was scheduled for a suprapubic single incision laparoscopic splenic flexure resection.

Video: A right suprapubic incision was performed and allowed for the introduction of three abdominal trocars (11mm, and two 6mm ones). DAPRI curved reusable instruments (Karl Storz Endoskope, Tuttlingen, Germany) were used, in addition to a 10mm, 30-degree regular length scope. The mobilization of the left mesocolon as well as of the transverse mesocolon was performed. After having completely freed the splenic flexure from its attachments, the transverse colon and the left colon were divided using an articulating linear stapler, introduced into the abdomen under a 5mm, 30-degree long scope. An intracorporeal end-to-end transverse sigmoid anastomosis was performed using two converging running sutures. The mesocolic defect was closed. The specimen was removed through a single access and final scar appeared to be 4cm.

Results: Laparoscopic time was 165 minutes and time to perform the anastomosis was 60 minutes. Operative bleeding was 10cc. The patient was discharged after 4 days, and at visit consultations, the symptoms were resolved.

Conclusion: Single incision laparoscopic splenic flexure resection can be safely performed using a suprapubic access, which enhances cosmetic outcomes, in addition to the advantages of minimally invasive surgery. A laparoscopic intracorporeal anastomosis is mandatory and can be performed using a hand-sewn method.
Pure transanal laparoscopic repair of early rectovaginal fistula
Background: Rectovaginal fistula is an abnormal connection between the rectum and the vagina, with leakage of rectal contents through the vagina. Different surgeries have been attempted such as direct repair, plug placement, advancement flap, muscle interposition, colostomy, proctectomy or delayed pull-through colo-anal anastomosis. Recently, transanal minimally invasive surgery has been described amongst the surgical options.

Video: The authors present a pure transanal laparoscopic repair of early rectovaginal fistula in a 74-year-old lady, submitted 3 weeks before to a laparoscopic anterior resection of the rectum with ‘en bloc’ hysterectomy for rectal adenocarcinoma (pT4aN0M0). A protective ileostomy was performed at the time of rectal surgery, and the postoperative course was uneventful. After having positioned the patient in a gynecologic position, a new reusable transanal platform according to DAPRI (Karl Storz Endoskope, Tuttlingen, Germany) was adopted. The exploration of the lower rectum put in evidence a 2cm rectovaginal fistula, located at a 3 o’clock position and at a 12cm distance from the anal margin. Absorbable figure-of-8 sutures using Vicryl 2/0 were performed to close the defect. Thanks to the curves of the instruments, the surgeon worked under ergonomic positions, without clashing of the instruments’ tips and any conflict of the surgeon’s hands. At the end of the procedure, injection of methylene blue through the vagina did not show any passage of the product into the lower rectum.

Results: The operative time was 120 minutes and intraoperative bleeding was insignificant. The postoperative course was uneventful, and patient discharge was allowed after 6 days. Due to the reusable nature of all the material implemented, no supplementary cost was necessary. The gastrograffin enema after 2 months showed a complete healing of the fistula. As a result, the protective ileostomy was closed.
Conclusion: Rectovaginal fistula can be repaired through a pure transanal laparoscopy, which prevents complicated and demolition surgeries usually performed through the abdomen.
G Dapri, M Degueldre
Surgical intervention
1 year ago
1283 views
96 likes
0 comments
04:58
Pure transanal laparoscopic repair of early rectovaginal fistula
Background: Rectovaginal fistula is an abnormal connection between the rectum and the vagina, with leakage of rectal contents through the vagina. Different surgeries have been attempted such as direct repair, plug placement, advancement flap, muscle interposition, colostomy, proctectomy or delayed pull-through colo-anal anastomosis. Recently, transanal minimally invasive surgery has been described amongst the surgical options.

Video: The authors present a pure transanal laparoscopic repair of early rectovaginal fistula in a 74-year-old lady, submitted 3 weeks before to a laparoscopic anterior resection of the rectum with ‘en bloc’ hysterectomy for rectal adenocarcinoma (pT4aN0M0). A protective ileostomy was performed at the time of rectal surgery, and the postoperative course was uneventful. After having positioned the patient in a gynecologic position, a new reusable transanal platform according to DAPRI (Karl Storz Endoskope, Tuttlingen, Germany) was adopted. The exploration of the lower rectum put in evidence a 2cm rectovaginal fistula, located at a 3 o’clock position and at a 12cm distance from the anal margin. Absorbable figure-of-8 sutures using Vicryl 2/0 were performed to close the defect. Thanks to the curves of the instruments, the surgeon worked under ergonomic positions, without clashing of the instruments’ tips and any conflict of the surgeon’s hands. At the end of the procedure, injection of methylene blue through the vagina did not show any passage of the product into the lower rectum.

Results: The operative time was 120 minutes and intraoperative bleeding was insignificant. The postoperative course was uneventful, and patient discharge was allowed after 6 days. Due to the reusable nature of all the material implemented, no supplementary cost was necessary. The gastrograffin enema after 2 months showed a complete healing of the fistula. As a result, the protective ileostomy was closed.
Conclusion: Rectovaginal fistula can be repaired through a pure transanal laparoscopy, which prevents complicated and demolition surgeries usually performed through the abdomen.
Laparoscopic excision of a celiac paraganglioma
A 72-year-old woman was addressed to the endocrinologist for arterial hypertension and US finding of a 5cm nodule in the aortocaval space of the celiac region. The diagnostic workup revealed raised urinary metanephrines. A CT-scan confirmed the US findings, and the nodule was also positive at PET CT-scan. A fine needle biopsy was performed, which was suggestive of a paraganglioma.
Medical treatment with Doxazosine 44mg qd was required for the adequate control of hypertension, and surgical excision was required.
A laparoscopic lateral transabdominal approach was chosen, to displace the hepatoduodenal ligament and allow for a wide access to the inferior vena cava. The operative time was 75 minutes. The patient recovered with no complications and was discharged on postoperative day 3.
Her symptoms recovered and she was found with normal metanephrines at follow-up.
M Lotti, M Giulii Capponi, L Ansaloni
Surgical intervention
1 year ago
822 views
56 likes
0 comments
08:21
Laparoscopic excision of a celiac paraganglioma
A 72-year-old woman was addressed to the endocrinologist for arterial hypertension and US finding of a 5cm nodule in the aortocaval space of the celiac region. The diagnostic workup revealed raised urinary metanephrines. A CT-scan confirmed the US findings, and the nodule was also positive at PET CT-scan. A fine needle biopsy was performed, which was suggestive of a paraganglioma.
Medical treatment with Doxazosine 44mg qd was required for the adequate control of hypertension, and surgical excision was required.
A laparoscopic lateral transabdominal approach was chosen, to displace the hepatoduodenal ligament and allow for a wide access to the inferior vena cava. The operative time was 75 minutes. The patient recovered with no complications and was discharged on postoperative day 3.
Her symptoms recovered and she was found with normal metanephrines at follow-up.
Arcuate ligament syndrome: laparoscopic approach
Median arcuate ligament syndrome is caused by the extrinsic compression of the celiac trunk by the median arcuate ligament, prominent fibrous bands, and peri-aortic nodal tissue. In many cases, it is asymptomatic, even though postprandial abdominal pain or, during exercise, nauseas, vomiting, and weight loss could be found. Doppler ultrasound and angiotomography are used for diagnosis while arteriography is the gold standard. Only symptomatic patients might require surgical treatment, and the laparoscopic approach has been proposed as a safe and effective technique. We present a case of laparoscopic approach for the treatment of arcuate ligament syndrome.
F Moser, P Maldonado, F Signorini, V Gorodner, E Romero, A Vigilante, E Miranda, H Eynard, L Obeide
Surgical intervention
1 year ago
1285 views
83 likes
0 comments
07:28
Arcuate ligament syndrome: laparoscopic approach
Median arcuate ligament syndrome is caused by the extrinsic compression of the celiac trunk by the median arcuate ligament, prominent fibrous bands, and peri-aortic nodal tissue. In many cases, it is asymptomatic, even though postprandial abdominal pain or, during exercise, nauseas, vomiting, and weight loss could be found. Doppler ultrasound and angiotomography are used for diagnosis while arteriography is the gold standard. Only symptomatic patients might require surgical treatment, and the laparoscopic approach has been proposed as a safe and effective technique. We present a case of laparoscopic approach for the treatment of arcuate ligament syndrome.
Transumbilical single-access laparoscopic subxiphoidal incisional hernia repair
Background: In this video, the authors report the case of a 65-year-old man who consulted for a subxiphoidal incisional hernia after open cardiac surgery. A transumbilical single access laparoscopic repair was proposed.

Video: The umbilical scar was incised and, after having placed a fascial umbilical purse-string suture, an 11mm reusable trocar was introduced. DAPRI curved reusable instruments (Karl Storz Endoskope, Tuttlingen, Germany) were introduced. The subxiphoidal hernia was put in evidence. The fatty tissue covering the defect was freed and the hernia defect was measured to be 8cm cranio-caudally and 6cm latero-laterally. A dual face mesh of 15 and 14cm (Surgimesh XB, Aspide Medical, Saint-Etienne, France) was chosen and introduced into the cavity through the 11mm trocar. The mesh was fixed against the abdominal wall using absorbable tacks (Sorbafix, Bard Davol Inc., Warwick, RI, US), and against the pericardial sheet using a polypropylene suture, in order to prevent any potential cardiac tamponade.

Results: The final umbilical scar was 15mm. Operative time was 65 minutes, and operative bleeding was insignificant. The patient was discharged on postoperative day 1. At visit consultations, no recurrence was evidenced.

Conclusion: Subxiphoidal incisional hernia after open cardiac surgery can be treated successfully using a transumbilical single access laparoscopy.
G Dapri, A Cadenas Febres, L Cardinali, SH Sondji, I Surdeanu, GB Cadière
Surgical intervention
1 year ago
1339 views
132 likes
0 comments
06:30
Transumbilical single-access laparoscopic subxiphoidal incisional hernia repair
Background: In this video, the authors report the case of a 65-year-old man who consulted for a subxiphoidal incisional hernia after open cardiac surgery. A transumbilical single access laparoscopic repair was proposed.

Video: The umbilical scar was incised and, after having placed a fascial umbilical purse-string suture, an 11mm reusable trocar was introduced. DAPRI curved reusable instruments (Karl Storz Endoskope, Tuttlingen, Germany) were introduced. The subxiphoidal hernia was put in evidence. The fatty tissue covering the defect was freed and the hernia defect was measured to be 8cm cranio-caudally and 6cm latero-laterally. A dual face mesh of 15 and 14cm (Surgimesh XB, Aspide Medical, Saint-Etienne, France) was chosen and introduced into the cavity through the 11mm trocar. The mesh was fixed against the abdominal wall using absorbable tacks (Sorbafix, Bard Davol Inc., Warwick, RI, US), and against the pericardial sheet using a polypropylene suture, in order to prevent any potential cardiac tamponade.

Results: The final umbilical scar was 15mm. Operative time was 65 minutes, and operative bleeding was insignificant. The patient was discharged on postoperative day 1. At visit consultations, no recurrence was evidenced.

Conclusion: Subxiphoidal incisional hernia after open cardiac surgery can be treated successfully using a transumbilical single access laparoscopy.
Single incision laparoscopic cholecystectomy without special SILS port or roticulating instruments with routine ports and instruments
Conventional single incision laparoscopic surgery (SILS) with special ports and instruments has transformed the way people undergo cholecystectomy. However, it requires high costs as compared to routine laparoscopic cholecystectomies.
We present another way of performing a SILS cholecystectomy without any special SILS port or any special roticulating laparoscopic instruments.
One 10mm port is placed in the lower aspect of the umbilicus at a 6 o’clock position and the gallbladder is assessed for SILS suitability. Another 5mm port is placed at a 3 o’clock position through a separate incision. A mini-laparoscopic grasper (Mini-Lap Technologies) is inserted in the right subcostal region. Remaining operative steps are similar to the ones used for any standard laparoscopic cholecystectomy. Careful and skilful manipulation of the mini-laparoscopic grasper helps in anterior and posterior dissection of Calot’s triangle, while maintaining the triangle of instrumentation (which is not achievable in SILS port techniques). A critical view of safety is also nicely demonstrated before clipping and dividing any structure. For clipping the cystic artery (CA) and the cystic duct (CD), a 5mm scope is used through the 5mm port and a standard clip applicator is inserted through the 10mm port. The gallbladder is extracted through the 10mm port. The 10mm port fascia is closed.
N Jha
Surgical intervention
1 year ago
1798 views
158 likes
0 comments
09:55
Single incision laparoscopic cholecystectomy without special SILS port or roticulating instruments with routine ports and instruments
Conventional single incision laparoscopic surgery (SILS) with special ports and instruments has transformed the way people undergo cholecystectomy. However, it requires high costs as compared to routine laparoscopic cholecystectomies.
We present another way of performing a SILS cholecystectomy without any special SILS port or any special roticulating laparoscopic instruments.
One 10mm port is placed in the lower aspect of the umbilicus at a 6 o’clock position and the gallbladder is assessed for SILS suitability. Another 5mm port is placed at a 3 o’clock position through a separate incision. A mini-laparoscopic grasper (Mini-Lap Technologies) is inserted in the right subcostal region. Remaining operative steps are similar to the ones used for any standard laparoscopic cholecystectomy. Careful and skilful manipulation of the mini-laparoscopic grasper helps in anterior and posterior dissection of Calot’s triangle, while maintaining the triangle of instrumentation (which is not achievable in SILS port techniques). A critical view of safety is also nicely demonstrated before clipping and dividing any structure. For clipping the cystic artery (CA) and the cystic duct (CD), a 5mm scope is used through the 5mm port and a standard clip applicator is inserted through the 10mm port. The gallbladder is extracted through the 10mm port. The 10mm port fascia is closed.
Hand-assisted laparoscopic live donor nephrectomy
Introduction and purpose: The shortage of cadaver donor organs and the progressive acceptation of laparoscopic procedures have significantly increased the number of living donor transplants. Laparoscopic nephrectomy has been rapidly and progressively incorporated as a therapeutic option in most hospitals. We describe the current surgical technique for living donor nephrectomy in our hospital.
Materials and methods: A 42-year-old woman with a medical history of hypertension and end-stage renal disease by IgA glomerulonephritis in predialysis program underwent a living donor transplantation. The donor was her sister, a woman aged 51, with no medical past history. We performed a left laparoscopic nephrectomy, and removal of the graft was performed using a hand-assisted device fixed in a supraumbilical 5cm laparotomy.
Results: Hospital stay was 3 days for the donor and 4 days for the receptor. The receptor had a postoperative creatinine of 1.76 mg/dL. In the third year of follow-up creatinine was 1.46 mg/dL.
Conclusions: Laparoscopic donor nephrectomy has proven to be a safe, less invasive, and effective technique for the renal graft. It has encouraged donation from living donors, given its esthetic results and comfort for the donor.
S Valverde-Martinez , A Martin-Parada, A Palacios-Hernandez, O Heredero-Zorzo, P Eguiluz-Lumbreras, J Garcia-Garcia, R Gomez-Zancajo, F Gomez-Veiga
Surgical intervention
1 year ago
1478 views
148 likes
0 comments
08:47
Hand-assisted laparoscopic live donor nephrectomy
Introduction and purpose: The shortage of cadaver donor organs and the progressive acceptation of laparoscopic procedures have significantly increased the number of living donor transplants. Laparoscopic nephrectomy has been rapidly and progressively incorporated as a therapeutic option in most hospitals. We describe the current surgical technique for living donor nephrectomy in our hospital.
Materials and methods: A 42-year-old woman with a medical history of hypertension and end-stage renal disease by IgA glomerulonephritis in predialysis program underwent a living donor transplantation. The donor was her sister, a woman aged 51, with no medical past history. We performed a left laparoscopic nephrectomy, and removal of the graft was performed using a hand-assisted device fixed in a supraumbilical 5cm laparotomy.
Results: Hospital stay was 3 days for the donor and 4 days for the receptor. The receptor had a postoperative creatinine of 1.76 mg/dL. In the third year of follow-up creatinine was 1.46 mg/dL.
Conclusions: Laparoscopic donor nephrectomy has proven to be a safe, less invasive, and effective technique for the renal graft. It has encouraged donation from living donors, given its esthetic results and comfort for the donor.
Laparoscopic treatment of a giant mesenteric cyst
Mesenteric cysts are very rare entities (annually worldwide estimated incidence of 1/140 000 inhabitants). They do not have pathognomonic features and require a differential diagnosis with lymphangiomas, sarcomas, adenocarcinomas, and intestinal duplications. They typically appear more in women (twice the incidence) and are mostly benign swellings (malignancy rate of about 3%). The gold standard treatment is laparoscopic surgical resection.
The case is that of a 49-year-old female patient referred for an abdominal swelling in the periumbilical region, which was uncomfortable for the patient, namely in the contraction of the abdominals. She did not describe any changes in intestinal transit, anorexia, asthenia or associated weight loss. The imaging study by computer tomography documented a "cystic lesion of 13cm in the root of the mesentery in contact with great vessels and duodenum". The patient was resected laparoscopically in March 2016, discharged on the second postoperative day, without intercurrences. The video of the mesenteric cyst excision surgery demonstrates some of the risks of the laparoscopic approach of the mesentery and underlines the possibility of dissection of these cysts even when they are giant cysts and in close relation with vital structures such as the vena cava and the iliac arteries.
P Leão, H Cristino, JP Pinto
Surgical intervention
1 year ago
1214 views
93 likes
0 comments
04:09
Laparoscopic treatment of a giant mesenteric cyst
Mesenteric cysts are very rare entities (annually worldwide estimated incidence of 1/140 000 inhabitants). They do not have pathognomonic features and require a differential diagnosis with lymphangiomas, sarcomas, adenocarcinomas, and intestinal duplications. They typically appear more in women (twice the incidence) and are mostly benign swellings (malignancy rate of about 3%). The gold standard treatment is laparoscopic surgical resection.
The case is that of a 49-year-old female patient referred for an abdominal swelling in the periumbilical region, which was uncomfortable for the patient, namely in the contraction of the abdominals. She did not describe any changes in intestinal transit, anorexia, asthenia or associated weight loss. The imaging study by computer tomography documented a "cystic lesion of 13cm in the root of the mesentery in contact with great vessels and duodenum". The patient was resected laparoscopically in March 2016, discharged on the second postoperative day, without intercurrences. The video of the mesenteric cyst excision surgery demonstrates some of the risks of the laparoscopic approach of the mesentery and underlines the possibility of dissection of these cysts even when they are giant cysts and in close relation with vital structures such as the vena cava and the iliac arteries.
Laparoscopic distal pancreatectomy and splenectomy for a mucinous cystic neoplasm of the pancreas
This video shows a laparoscopic distal pancreatectomy and splenectomy.
This is the case of a woman with a cystic lesion in the body of the pancreas, diagnosed in the study of an abdominal pain.
She was submitted to a CT-scan which showed a regular, well-defined 45mm cystic lesion in the pancreatic body, with voluminous hepatic hemangiomas. The findings of endoscopic ultrasound-guided biopsy were inconclusive, with a CEA of 653ng/dL.
The patient underwent a laparoscopic distal pancreatectomy and splenectomy.
There were no postoperative complications. The patient was discharged on postoperative day 3.
Histological findings demonstrated the presence of a mucinous cystic neoplasm.
L Ferreira, N Vilela, O Oliveira, J Miranda
Surgical intervention
1 year ago
1865 views
147 likes
0 comments
10:35
Laparoscopic distal pancreatectomy and splenectomy for a mucinous cystic neoplasm of the pancreas
This video shows a laparoscopic distal pancreatectomy and splenectomy.
This is the case of a woman with a cystic lesion in the body of the pancreas, diagnosed in the study of an abdominal pain.
She was submitted to a CT-scan which showed a regular, well-defined 45mm cystic lesion in the pancreatic body, with voluminous hepatic hemangiomas. The findings of endoscopic ultrasound-guided biopsy were inconclusive, with a CEA of 653ng/dL.
The patient underwent a laparoscopic distal pancreatectomy and splenectomy.
There were no postoperative complications. The patient was discharged on postoperative day 3.
Histological findings demonstrated the presence of a mucinous cystic neoplasm.
Laparoscopic prosthetic parastomal and perineal hernias repair after abdominoperineal resection
Background: In this video, the authors report the case of a 74-year-old woman who consulted for episodes of intestinal occlusions following an abdomino-perineal resection for rectal adenocarcinoma (pT2N0M0), performed 6 years earlier. Abdomino-pelvic CT-scan showed a parastomal hernia with migrated small bowel loops and a perineal hernia with transposition of the caecum and bowel loops into the pelvis. Preoperative work-up was negative for tumor recurrence, hence a laparoscopic treatment using a double dual face prosthesis was proposed.

Video: Three trocars were placed into the abdomen. After adhesiolysis and removal of the viscera herniated into the hernia, the parastomal defect was exposed and measured intracorporeally 6cm (cranio-caudally) and 4cm (latero-laterally). An intracorporeal suture was used to close the defect, and a dual face prosthesis of 15cm in length and 10cm in width (Surgimesh XB, Aspide Medical, Saint-Etienne, France) was fixed by means of absorbable tacks (Sorbafix, Bard Davol Inc., Warwick, RI, US), according to the Sugarbaker technique. Successively, the pelvis was freed from adhesions, and the superior pelvic opening appeared to be 8cm (antero-posteriorly) and 7cm (latero-laterally). A dual face circular prosthesis of 10cm (Surgimesh XB, Aspide Medical) was fixed using two running sutures around the superior pelvic opening.

Results: Operative time was 72 minutes for parastomal hernia and 95 minutes for perineal hernia. Operative bleeding was unsignificant. The patient was discharged after 3 days, and at visit consultations, she did not present with any recurrence.

Conclusion: Prosthetic parastomal and perineal hernias repair can be performed simultaneously using laparoscopy with the same port positioning, adding the advantages of minimally invasive surgery and avoiding a large laparotomy.
G Dapri, L Gerard, L Cardinali, D Repullo, I Surdeanu, SH Sondji, GB Cadière
Surgical intervention
1 year ago
1020 views
116 likes
0 comments
07:20
Laparoscopic prosthetic parastomal and perineal hernias repair after abdominoperineal resection
Background: In this video, the authors report the case of a 74-year-old woman who consulted for episodes of intestinal occlusions following an abdomino-perineal resection for rectal adenocarcinoma (pT2N0M0), performed 6 years earlier. Abdomino-pelvic CT-scan showed a parastomal hernia with migrated small bowel loops and a perineal hernia with transposition of the caecum and bowel loops into the pelvis. Preoperative work-up was negative for tumor recurrence, hence a laparoscopic treatment using a double dual face prosthesis was proposed.

Video: Three trocars were placed into the abdomen. After adhesiolysis and removal of the viscera herniated into the hernia, the parastomal defect was exposed and measured intracorporeally 6cm (cranio-caudally) and 4cm (latero-laterally). An intracorporeal suture was used to close the defect, and a dual face prosthesis of 15cm in length and 10cm in width (Surgimesh XB, Aspide Medical, Saint-Etienne, France) was fixed by means of absorbable tacks (Sorbafix, Bard Davol Inc., Warwick, RI, US), according to the Sugarbaker technique. Successively, the pelvis was freed from adhesions, and the superior pelvic opening appeared to be 8cm (antero-posteriorly) and 7cm (latero-laterally). A dual face circular prosthesis of 10cm (Surgimesh XB, Aspide Medical) was fixed using two running sutures around the superior pelvic opening.

Results: Operative time was 72 minutes for parastomal hernia and 95 minutes for perineal hernia. Operative bleeding was unsignificant. The patient was discharged after 3 days, and at visit consultations, she did not present with any recurrence.

Conclusion: Prosthetic parastomal and perineal hernias repair can be performed simultaneously using laparoscopy with the same port positioning, adding the advantages of minimally invasive surgery and avoiding a large laparotomy.
Subtotal cystectomy with laparoscopic splenic preservation
Non-parasitic splenic lesions are a rare entity. Since they can generate signs and abdominal symptoms and cause many complications, their detection requires some form of treatment. The possibility of post-splenectomy fatal sepsis has led to the search for new therapeutic alternatives which simultaneously ensure the healing process and preserve the splenic tissue. The preservation of at least 25% of splenic tissue provides protection against pneumococcal bacteremia. One of the techniques used is partial cyst decapsulation with splenic preservation.
We report the case of a 17-year-old woman who was incidentally diagnosed with a 4cm splenic cystic with negative serological studies and tumor markers suggestive of an epidermal cyst. Radiological monitoring of the lesion is performed and a cystic growth of 7cm is observed. As a result, surgery is decided upon.
At laparoscopy, a splenic cyst of 7cm in diameter is found. However, it does not affect the splenic vessels. Lancing and draining the cyst is made and partial cyst decapsulation is performed with splenic preservation. The patient made an uneventful recovery.
Partial decapsulation of the cyst’s wall offers several advantages: it is technically easier to perform, involves minimal blood loss, it preserves the entire splenic tissue and has a high cure rate. It is an excellent therapeutic alternative for young people with splenic cysts because it eliminates the disease process without loss of splenic tissue and it is minimally invasive for the patient.
FE Viamontes Ugalde, A Abascal Amo, I García Sanz
Surgical intervention
1 year ago
808 views
30 likes
0 comments
09:32
Subtotal cystectomy with laparoscopic splenic preservation
Non-parasitic splenic lesions are a rare entity. Since they can generate signs and abdominal symptoms and cause many complications, their detection requires some form of treatment. The possibility of post-splenectomy fatal sepsis has led to the search for new therapeutic alternatives which simultaneously ensure the healing process and preserve the splenic tissue. The preservation of at least 25% of splenic tissue provides protection against pneumococcal bacteremia. One of the techniques used is partial cyst decapsulation with splenic preservation.
We report the case of a 17-year-old woman who was incidentally diagnosed with a 4cm splenic cystic with negative serological studies and tumor markers suggestive of an epidermal cyst. Radiological monitoring of the lesion is performed and a cystic growth of 7cm is observed. As a result, surgery is decided upon.
At laparoscopy, a splenic cyst of 7cm in diameter is found. However, it does not affect the splenic vessels. Lancing and draining the cyst is made and partial cyst decapsulation is performed with splenic preservation. The patient made an uneventful recovery.
Partial decapsulation of the cyst’s wall offers several advantages: it is technically easier to perform, involves minimal blood loss, it preserves the entire splenic tissue and has a high cure rate. It is an excellent therapeutic alternative for young people with splenic cysts because it eliminates the disease process without loss of splenic tissue and it is minimally invasive for the patient.
Combining VATS and laparoscopic approach in the resection of ovarian carcinoma metastasis
This is the case of a 64-year-old woman with a history of hysterectomy and left adnexectomy. In 2012, a vaginal ultrasound revealed a right ovarian mass diagnosed as a right ovarian cancer. In December 2012, she underwent a right adnexectomy with pelvic, lumbo-aortic lymphadenectomy and omentectomy. Final pathological staging of the ovarian cystadenocarcinoma was pT3cpN1Mx (IIIC). She completed 6 cycles of adjuvant chemotherapy with carboplatin and paclitaxel. During the follow-up exam, the patient remained symptom-free and presented with a stable perihepatic lesion. In 2015, two new lesions were found on CT-scan: one in the anterior mediastinum (14mm) and another in the abdominal diaphragm in contact with a liver segment VIII (19mm). In addition, CA 125 raised from 19 to 50kU/L. PET-scan only evidenced these two new lesions (SUV= 10). Taking into account the patient’s excellent performance status, long disease-free survival, stability of lesions, with CT-scans performed with a 3-month interval, and the possibility of video-assisted surgery, it was decided to use VATS and laparoscopy to remove the lesions. Final pathological findings showed ovarian cystadenocarcinoma metastases in 2 lesions (R0). The third perihepatic lesion was a cyst. The patient was discharged on postoperative day 4.
F Cabral, JA Pereira, P Calvinho, P Amado, R Maio
Surgical intervention
2 years ago
2656 views
91 likes
0 comments
11:33
Combining VATS and laparoscopic approach in the resection of ovarian carcinoma metastasis
This is the case of a 64-year-old woman with a history of hysterectomy and left adnexectomy. In 2012, a vaginal ultrasound revealed a right ovarian mass diagnosed as a right ovarian cancer. In December 2012, she underwent a right adnexectomy with pelvic, lumbo-aortic lymphadenectomy and omentectomy. Final pathological staging of the ovarian cystadenocarcinoma was pT3cpN1Mx (IIIC). She completed 6 cycles of adjuvant chemotherapy with carboplatin and paclitaxel. During the follow-up exam, the patient remained symptom-free and presented with a stable perihepatic lesion. In 2015, two new lesions were found on CT-scan: one in the anterior mediastinum (14mm) and another in the abdominal diaphragm in contact with a liver segment VIII (19mm). In addition, CA 125 raised from 19 to 50kU/L. PET-scan only evidenced these two new lesions (SUV= 10). Taking into account the patient’s excellent performance status, long disease-free survival, stability of lesions, with CT-scans performed with a 3-month interval, and the possibility of video-assisted surgery, it was decided to use VATS and laparoscopy to remove the lesions. Final pathological findings showed ovarian cystadenocarcinoma metastases in 2 lesions (R0). The third perihepatic lesion was a cyst. The patient was discharged on postoperative day 4.
Full laparoscopic repair of a post-traumatic diaphragmatic hernia with mesh insertion
This is the case of a 34-year-old man who suffered from a blunt trauma, 8 months before this surgery. He presented with oppressive chest pain, lasting for a week, increasing while exercising and decreasing when lying down. No history of chronic pathology or smoking was reported. He was admitted to hospital. CT-scan of the abdomen and thorax showed a left diaphragmatic hernia. A laparoscopic diaphragmatic hernioplasty was decided upon. The patient is placed in a right semi-lateral decubitus position, with a 45-degree tilt.
Three trocars were placed; two 5mm trocars in the left upper quadrant, in the anterior axillary line, and in the epigastrium, while a 12mm optical trocar is placed in the upper left quadrant, in the midclavicular line.
The left lung is collapsed. Laparoscopy revealed a left diaphragmatic defect, with a diaphragmatic hernia which contains the spleen, small bowel loops, and the omentum. The hernia contents are reduced into the abdominal cavity. The diaphragmatic defect is then sutured with non-absorbable material. A GORE® DUALMESH® biomaterial is placed over the previous defect and attached to the diaphragm with steel ENDO TACKERS™. A pleurostomy tube is placed and the lung is expanded. The patient outcome was uneventful and he was discharged 5 days after the procedure.
F Terrazas, J Lorenzo Silva, D Molina, A Gonzalez, H Bravo
Surgical intervention
2 years ago
2084 views
119 likes
1 comment
06:34
Full laparoscopic repair of a post-traumatic diaphragmatic hernia with mesh insertion
This is the case of a 34-year-old man who suffered from a blunt trauma, 8 months before this surgery. He presented with oppressive chest pain, lasting for a week, increasing while exercising and decreasing when lying down. No history of chronic pathology or smoking was reported. He was admitted to hospital. CT-scan of the abdomen and thorax showed a left diaphragmatic hernia. A laparoscopic diaphragmatic hernioplasty was decided upon. The patient is placed in a right semi-lateral decubitus position, with a 45-degree tilt.
Three trocars were placed; two 5mm trocars in the left upper quadrant, in the anterior axillary line, and in the epigastrium, while a 12mm optical trocar is placed in the upper left quadrant, in the midclavicular line.
The left lung is collapsed. Laparoscopy revealed a left diaphragmatic defect, with a diaphragmatic hernia which contains the spleen, small bowel loops, and the omentum. The hernia contents are reduced into the abdominal cavity. The diaphragmatic defect is then sutured with non-absorbable material. A GORE® DUALMESH® biomaterial is placed over the previous defect and attached to the diaphragm with steel ENDO TACKERS™. A pleurostomy tube is placed and the lung is expanded. The patient outcome was uneventful and he was discharged 5 days after the procedure.
Mixed robotic laparoscopic synchronous left colectomy and left renal tumor enucleation
A 45-year-old woman with abdominal pain and hematochezia was found with adenocarcinoma of the sigmoid colon causing incomplete obstruction. CT-scan revealed a 5cm exophytic tumor of the superior pole of the left kidney.
Synchronous Left Colectomy (LC) and Renal Tumor Enucleation (RTE) were scheduled. Robotic surgery was preferred for RTE, but when performed first, splenic flexure mobilization could well interfere with subsequent LC.

Starting with a standard robotic LC would make multiple dockings and patient position changes necessary.
To overcome these problems, we adapted the technique of LC to the lateral position required for RTE and performed robotic vascular ligation of the left colon first. Robotic left colon mobilization and RTE were then performed to finally achieve colectomy and colorectal anastomosis by means of laparoscopy with the patient in a standard lithotomy position.
The procedure required only one docking of the robot and only one change in patient position. A compromise in port site positioning was obtained between the two procedures. One short incision was performed to retrieve both specimens and the same robotic instruments were used for both procedures.
Operative time was 350 minutes. The patient recovered well and no complications were noted. She was discharged on postoperative day 7.
M Lotti, RLJ Naspro, L Rocchini, L Campanati, L Da Pozzo, L Ansaloni
Surgical intervention
2 years ago
1205 views
42 likes
0 comments
16:25
Mixed robotic laparoscopic synchronous left colectomy and left renal tumor enucleation
A 45-year-old woman with abdominal pain and hematochezia was found with adenocarcinoma of the sigmoid colon causing incomplete obstruction. CT-scan revealed a 5cm exophytic tumor of the superior pole of the left kidney.
Synchronous Left Colectomy (LC) and Renal Tumor Enucleation (RTE) were scheduled. Robotic surgery was preferred for RTE, but when performed first, splenic flexure mobilization could well interfere with subsequent LC.

Starting with a standard robotic LC would make multiple dockings and patient position changes necessary.
To overcome these problems, we adapted the technique of LC to the lateral position required for RTE and performed robotic vascular ligation of the left colon first. Robotic left colon mobilization and RTE were then performed to finally achieve colectomy and colorectal anastomosis by means of laparoscopy with the patient in a standard lithotomy position.
The procedure required only one docking of the robot and only one change in patient position. A compromise in port site positioning was obtained between the two procedures. One short incision was performed to retrieve both specimens and the same robotic instruments were used for both procedures.
Operative time was 350 minutes. The patient recovered well and no complications were noted. She was discharged on postoperative day 7.
Laparoscopic anterior resection for locally advanced sigmoid cancer with 'en bloc' excision of bladder cuff
We present an operative video of a 61-year-old Chinese gentleman with locally advanced sigmoid carcinoma. Preoperative histology from endoscopy revealed an adenocarcinoma. The patient underwent laparoscopic anterior resection. Intraoperatively, the sigmoid tumor was adherent to the bladder with surrounding inflammation and edema. The colectomy had to be performed with an ‘en bloc’ excision of a bladder cuff. The bladder defect was repaired laparoscopically in two layers. Operative time was 4 hours 15 minutes and total blood loss was less than 100mL. The patient was discharged in good health conditions, four days after the operation with an outpatient cystogram performed before subsequent successful removal of the indwelling catheter. Final histology was pT4bN0 (0/31 lymph nodes) with clear margins. This case demonstrates that laparoscopic colectomy with ‘en bloc’ bladder cuff excision and subsequent laparoscopic repair of bladder defect are both feasible and safe.
S Mantoo, E Yong
Surgical intervention
2 years ago
3129 views
139 likes
0 comments
07:26
Laparoscopic anterior resection for locally advanced sigmoid cancer with 'en bloc' excision of bladder cuff
We present an operative video of a 61-year-old Chinese gentleman with locally advanced sigmoid carcinoma. Preoperative histology from endoscopy revealed an adenocarcinoma. The patient underwent laparoscopic anterior resection. Intraoperatively, the sigmoid tumor was adherent to the bladder with surrounding inflammation and edema. The colectomy had to be performed with an ‘en bloc’ excision of a bladder cuff. The bladder defect was repaired laparoscopically in two layers. Operative time was 4 hours 15 minutes and total blood loss was less than 100mL. The patient was discharged in good health conditions, four days after the operation with an outpatient cystogram performed before subsequent successful removal of the indwelling catheter. Final histology was pT4bN0 (0/31 lymph nodes) with clear margins. This case demonstrates that laparoscopic colectomy with ‘en bloc’ bladder cuff excision and subsequent laparoscopic repair of bladder defect are both feasible and safe.
Laparoscopic excision of a gastric duplication cyst
Duplication cysts are rare benign congenital anomalies, located predominantly at the proximal small intestine, emerging in the stomach in about 2 to 4% of all cases. Usually diagnosed in the pediatric age, they are commonly asymptomatic in adulthood and found incidentally on endoscopic or radiological exams. The therapeutic management of asymptomatic cysts is usually expectant. However, a surgical resection is recommended based on the potential risk of complications, such as malignant transformation.
Clinical case: This is the case of a 44-year-old woman, who had an incidental diagnosis of an intra-abdominal cyst on ultrasound examination. CT-scan and MRI revealed the presence of a 6x4cm cystic mass located between the posterior wall of the stomach and the anterior wall of the pancreas, assuming the differential diagnosis of enteric duplication cyst or pancreatic cystic lesion. A laparoscopic exploration is decided upon. She underwent a laparoscopic excision of cystic lesion of the gastric wall, without complications. The patient was discharged home on the third postoperative day. The pathological examination confirmed the diagnosis of enteric duplication cyst. Histology showed a cystic lesion composed of smooth muscle tissue and partially covered by gastric antral-type mucosa.
C Branco, C Viana, H Cristino, S Vilaça, J Falcão
Surgical intervention
2 years ago
820 views
32 likes
0 comments
06:07
Laparoscopic excision of a gastric duplication cyst
Duplication cysts are rare benign congenital anomalies, located predominantly at the proximal small intestine, emerging in the stomach in about 2 to 4% of all cases. Usually diagnosed in the pediatric age, they are commonly asymptomatic in adulthood and found incidentally on endoscopic or radiological exams. The therapeutic management of asymptomatic cysts is usually expectant. However, a surgical resection is recommended based on the potential risk of complications, such as malignant transformation.
Clinical case: This is the case of a 44-year-old woman, who had an incidental diagnosis of an intra-abdominal cyst on ultrasound examination. CT-scan and MRI revealed the presence of a 6x4cm cystic mass located between the posterior wall of the stomach and the anterior wall of the pancreas, assuming the differential diagnosis of enteric duplication cyst or pancreatic cystic lesion. A laparoscopic exploration is decided upon. She underwent a laparoscopic excision of cystic lesion of the gastric wall, without complications. The patient was discharged home on the third postoperative day. The pathological examination confirmed the diagnosis of enteric duplication cyst. Histology showed a cystic lesion composed of smooth muscle tissue and partially covered by gastric antral-type mucosa.
Laparoscopic total gastrectomy guided by fluorescent lymphangiography using ICG injection around a tumor, followed by an intracorporeal double stapling esophagojejunostomy
Injecting indocyanine green (ICG) around the tumor enables the operators to identify the lymphatic channels and the lymph nodes in which the cancer cells can spread. It also allows them to decide on the extent of the dissection and validate the completeness of lymph node dissection. In this video, a laparoscopic near-infrared fluorescent camera was used, showing the fluorescent signal in diverse modes. A total gastrectomy with D1+ dissection is performed. The fluorescent signal shows the possible lymphatic pathways during the operation. An intracorporeal esophagojejunostomy was performed in a double stapling fashion; a round needle and a surgical thread are attached to the plastic part of the anvil of the circular stapler.
HK Yang, SH Kong
Surgical intervention
2 years ago
1536 views
73 likes
0 comments
15:56
Laparoscopic total gastrectomy guided by fluorescent lymphangiography using ICG injection around a tumor, followed by an intracorporeal double stapling esophagojejunostomy
Injecting indocyanine green (ICG) around the tumor enables the operators to identify the lymphatic channels and the lymph nodes in which the cancer cells can spread. It also allows them to decide on the extent of the dissection and validate the completeness of lymph node dissection. In this video, a laparoscopic near-infrared fluorescent camera was used, showing the fluorescent signal in diverse modes. A total gastrectomy with D1+ dissection is performed. The fluorescent signal shows the possible lymphatic pathways during the operation. An intracorporeal esophagojejunostomy was performed in a double stapling fashion; a round needle and a surgical thread are attached to the plastic part of the anvil of the circular stapler.
Laparoscopic extraction of gastric denture
A 49-year-old generally fit man presented with abdominal pain following accidental swallowing of his denture 2 weeks previously. He looked well and his abdomen was soft and non-tender. A CT-scan showed a denture in the pyloric antrum of the stomach.
Gastroenterologists thought that it would be too large to be removed endoscopically. Laparoscopy was performed and the denture could be easily felt with a laparoscopic forceps. The denture was extracted in an Albert bag via the umbilical port after longitudinal gastrotomy. The gastrotomy was closed with 2/0 Vicryl continuous suture in 2 layers intracorporeally as shown on the video.
The patient was discharged on postoperative day 2 and remains well at 6 weeks of follow-up. Laparoscopic extraction of the gastric foreign body has the advantage of quicker recovery and better cosmesis as compared to the open technique.
K Aryal
Surgical intervention
2 years ago
1063 views
14 likes
0 comments
06:18
Laparoscopic extraction of gastric denture
A 49-year-old generally fit man presented with abdominal pain following accidental swallowing of his denture 2 weeks previously. He looked well and his abdomen was soft and non-tender. A CT-scan showed a denture in the pyloric antrum of the stomach.
Gastroenterologists thought that it would be too large to be removed endoscopically. Laparoscopy was performed and the denture could be easily felt with a laparoscopic forceps. The denture was extracted in an Albert bag via the umbilical port after longitudinal gastrotomy. The gastrotomy was closed with 2/0 Vicryl continuous suture in 2 layers intracorporeally as shown on the video.
The patient was discharged on postoperative day 2 and remains well at 6 weeks of follow-up. Laparoscopic extraction of the gastric foreign body has the advantage of quicker recovery and better cosmesis as compared to the open technique.
Sutures transfixing bladder as a complication of laparoscopic burch colposuspension
Laparoscopic Burch colposuspension may be difficult in cases of stress urinary incontinence (SUI) associated with large lateral cystocele. In these cases, complications may occur. However, they are rare.
This video shows the cystoscopic treatment of intravesical adhesions, secondary to sutures transfixing the bladder during the Burch laparoscopic procedure and lateral suspension, without perioperative use of control cystoscopy. An office cystoscopy was performed after the operation, nine months later, because of gradual onset of entirely isolated pelvic pain at the end of urination. It showed intravesical synechia as bilateral pillars. The different steps of the operation are the following:
1) Diagnostic laparoscopy with a good status of the lateral suspension without mesh migration.
2) Operative laparoscopy with opening of Retzius’s space, dissection, adhesiolysis, and division of the non-absorbable sutures of the past colposuspension in order to mobilize the bladder, followed by reperitonization of Retzius’s space.
3) Diagnostic cystoscopy confirming adhesions as bilateral pillars, laterally to the trigone with normal ejaculation of both ureteral ostia.
4) Operative cystoscopy after catheterization of both ureters: division of the pillars with the monopolar electrode without visualization of the Burch sutures, as they probably migrated upward in the first postoperative months.
In the postoperative period, ureteral catheters are removed 48 hours after surgery. Pain resolves completely during urination. Normal kidneys and ureters are observed at ultrasound.
This video clearly demonstrates the advantages related to the routine use of cystoscopy at the end of the laparoscopic Burch procedure, especially in cases of large lateral cystocele.
JB Dubuisson, J Dubuisson, JM Wenger, A Caviezel
Surgical intervention
2 years ago
2208 views
94 likes
0 comments
07:41
Sutures transfixing bladder as a complication of laparoscopic burch colposuspension
Laparoscopic Burch colposuspension may be difficult in cases of stress urinary incontinence (SUI) associated with large lateral cystocele. In these cases, complications may occur. However, they are rare.
This video shows the cystoscopic treatment of intravesical adhesions, secondary to sutures transfixing the bladder during the Burch laparoscopic procedure and lateral suspension, without perioperative use of control cystoscopy. An office cystoscopy was performed after the operation, nine months later, because of gradual onset of entirely isolated pelvic pain at the end of urination. It showed intravesical synechia as bilateral pillars. The different steps of the operation are the following:
1) Diagnostic laparoscopy with a good status of the lateral suspension without mesh migration.
2) Operative laparoscopy with opening of Retzius’s space, dissection, adhesiolysis, and division of the non-absorbable sutures of the past colposuspension in order to mobilize the bladder, followed by reperitonization of Retzius’s space.
3) Diagnostic cystoscopy confirming adhesions as bilateral pillars, laterally to the trigone with normal ejaculation of both ureteral ostia.
4) Operative cystoscopy after catheterization of both ureters: division of the pillars with the monopolar electrode without visualization of the Burch sutures, as they probably migrated upward in the first postoperative months.
In the postoperative period, ureteral catheters are removed 48 hours after surgery. Pain resolves completely during urination. Normal kidneys and ureters are observed at ultrasound.
This video clearly demonstrates the advantages related to the routine use of cystoscopy at the end of the laparoscopic Burch procedure, especially in cases of large lateral cystocele.
Single incision laparoscopic peritoneal hole repair during right TEP procedure
Background: Laparoscopic inguinal hernia repair offers various advantages both to the patient and the surgeon. Transabdominal preperitoneal (TAPP) and total extraperitoneal (TEP) repairs represent the two laparoscopic options. A personal technique of single incision laparoscopic TEP has already been published on WebSurg (Link: http://www.websurg.com/MEDIA/?noheader=1&doi=vd01en4054).
Video: This video demonstrates the single incision laparoscopic treatment of a peritoneal hole, which occurred accidentally during a right TEP procedure.
Results: The TEP procedure lasted 41 minutes and the peritoneal repair 8 minutes. The final umbilical scar length was 10mm and the patient was discharged within 24 hours.
Conclusions: Peroperative complications can occur during single incision laparoscopy, as well as during conventional laparoscopy and open surgery. The procedure can be performed without conversion or additional trocars, depending on the complications which occurred.
G Dapri
Surgical intervention
2 years ago
2095 views
148 likes
0 comments
04:03
Single incision laparoscopic peritoneal hole repair during right TEP procedure
Background: Laparoscopic inguinal hernia repair offers various advantages both to the patient and the surgeon. Transabdominal preperitoneal (TAPP) and total extraperitoneal (TEP) repairs represent the two laparoscopic options. A personal technique of single incision laparoscopic TEP has already been published on WebSurg (Link: http://www.websurg.com/MEDIA/?noheader=1&doi=vd01en4054).
Video: This video demonstrates the single incision laparoscopic treatment of a peritoneal hole, which occurred accidentally during a right TEP procedure.
Results: The TEP procedure lasted 41 minutes and the peritoneal repair 8 minutes. The final umbilical scar length was 10mm and the patient was discharged within 24 hours.
Conclusions: Peroperative complications can occur during single incision laparoscopy, as well as during conventional laparoscopy and open surgery. The procedure can be performed without conversion or additional trocars, depending on the complications which occurred.
Laparoscopic subtotal cholecystectomy
Laparoscopic cholecystectomy is a hazardous operation when the anatomy of Calot’s triangle is distorted by acute inflammation or any other factor (in our case, adhesions due to the recent surgery, and especially due to radiotherapy). In these difficult situations, the intraoperative decision to use a protective surgical technique as subtotal cholecystectomy is made with the purpose to prevent any injury to the biliary tree.
This video demonstrates the case of a 69-year-old woman with morbid obesity (BMI of 55) and diagnosed with acute cholecystitis. Her past medical history is relevant for right nephrectomy for renal carcinoma using a right subcostal laparotomy followed by radiochemotherapy completed 3 months earlier.
Subtotal cholecystectomy is a procedure which aims to remove portions of the gallbladder when structures of Calot’s triangle cannot be safely identified in "difficult gallbladders". The conversion rate to open surgery was higher among this category of patients. We describe our experience with a technical change, namely, a tactical laparoscopic subtotal cholecystectomy which almost always prevents conversion at the end of the procedures, and prevents both the risk of injury to the common bile duct and the risk of hemorrhage. In such cases, there is a need for rigor and prudence in order to return to the traditional technique in real time, if necessary.
Laparoscopic subtotal cholecystectomy can be considered a safe and feasible alternative to conversion to open surgery. Subtotal cholecystectomy is an essential technique to be used in difficult gallbladders. It achieves morbidity rates comparable to those reported for total cholecystectomy in simple cases.
A Cotirlet, M Nedelcu
Surgical intervention
2 years ago
4348 views
284 likes
0 comments
20:31
Laparoscopic subtotal cholecystectomy
Laparoscopic cholecystectomy is a hazardous operation when the anatomy of Calot’s triangle is distorted by acute inflammation or any other factor (in our case, adhesions due to the recent surgery, and especially due to radiotherapy). In these difficult situations, the intraoperative decision to use a protective surgical technique as subtotal cholecystectomy is made with the purpose to prevent any injury to the biliary tree.
This video demonstrates the case of a 69-year-old woman with morbid obesity (BMI of 55) and diagnosed with acute cholecystitis. Her past medical history is relevant for right nephrectomy for renal carcinoma using a right subcostal laparotomy followed by radiochemotherapy completed 3 months earlier.
Subtotal cholecystectomy is a procedure which aims to remove portions of the gallbladder when structures of Calot’s triangle cannot be safely identified in "difficult gallbladders". The conversion rate to open surgery was higher among this category of patients. We describe our experience with a technical change, namely, a tactical laparoscopic subtotal cholecystectomy which almost always prevents conversion at the end of the procedures, and prevents both the risk of injury to the common bile duct and the risk of hemorrhage. In such cases, there is a need for rigor and prudence in order to return to the traditional technique in real time, if necessary.
Laparoscopic subtotal cholecystectomy can be considered a safe and feasible alternative to conversion to open surgery. Subtotal cholecystectomy is an essential technique to be used in difficult gallbladders. It achieves morbidity rates comparable to those reported for total cholecystectomy in simple cases.
Accidental finding of Ascaris lumbricoides in the common bile duct during laparoscopic cholecystectomy transcystic exploration
This is the case of a 37-year-old woman, who had acute cholecystitis for 4 days, accompanied by nausea, vomiting, and abdominal pain in the right upper quadrant.
Physical exam demonstrated a soft abdomen with right upper quadrant pain, positive Murphy’s sign, and a palpable painful mass.
Complete blood count (CBC) reported 7,700/uL WBC, 4.235u/L neutrophils (55%), 1.463u/L lymphocytes (19%), and 1.540/uL eosinophils (20%).
Total bilirubin: 0.7mg/dL, direct bilirubin: 0.4mg/dL, indirect bilirubin: 0.3mg/dL, alkaline phosphatase: 184U/L.
Hepatobiliary ultrasound reports a thin-walled bladder with biliary sludge. The bile duct is not dilated. According to the results, there was no parasite on the bile duct.
Pain does not subside with antispasmodics, and the patient is sent to undergo a laparoscopic cholecystectomy.
In surgery, a hydropic gallbladder was evidenced. It was drained with a Veress needle. It was then found that the cystic duct was dilated and a transcystic exploration was performed with a No. 6 - 8- 10 French gastric tube.
An Ascaris lumbricoides of 25cm in length was extracted.
After exploration was completed with a Fogarty catheter, and no additional parasites were found, conventional cholecystectomy was completed. Antibiotic and anti-parasite treatment was prescribed. The patient was discharged 2 days after the procedure without any complications.
LE Becerra
Surgical intervention
2 years ago
1889 views
113 likes
0 comments
08:19
Accidental finding of Ascaris lumbricoides in the common bile duct during laparoscopic cholecystectomy transcystic exploration
This is the case of a 37-year-old woman, who had acute cholecystitis for 4 days, accompanied by nausea, vomiting, and abdominal pain in the right upper quadrant.
Physical exam demonstrated a soft abdomen with right upper quadrant pain, positive Murphy’s sign, and a palpable painful mass.
Complete blood count (CBC) reported 7,700/uL WBC, 4.235u/L neutrophils (55%), 1.463u/L lymphocytes (19%), and 1.540/uL eosinophils (20%).
Total bilirubin: 0.7mg/dL, direct bilirubin: 0.4mg/dL, indirect bilirubin: 0.3mg/dL, alkaline phosphatase: 184U/L.
Hepatobiliary ultrasound reports a thin-walled bladder with biliary sludge. The bile duct is not dilated. According to the results, there was no parasite on the bile duct.
Pain does not subside with antispasmodics, and the patient is sent to undergo a laparoscopic cholecystectomy.
In surgery, a hydropic gallbladder was evidenced. It was drained with a Veress needle. It was then found that the cystic duct was dilated and a transcystic exploration was performed with a No. 6 - 8- 10 French gastric tube.
An Ascaris lumbricoides of 25cm in length was extracted.
After exploration was completed with a Fogarty catheter, and no additional parasites were found, conventional cholecystectomy was completed. Antibiotic and anti-parasite treatment was prescribed. The patient was discharged 2 days after the procedure without any complications.
Laparoscopic resection of a splenic artery aneurysm with splenic preservation
This video illustrates the laparoscopic resection of a splenic artery aneurysm with splenic preservation in a young lady.
The lesion was discovered fortuitously by ultrasound for an unrelated cause. Embolization was unsuccessful because of the inability of our interventional radiology team to reach the aneurysm itself for coiling.
It is thought that splenic artery aneurysms are present in 1% of the population (1), and coiling/resection is often advocated, especially in young women in childbearing age.
The aneurysm was isolated and its multiple feeding vessels clipped before complete resection. The spleen remained well vascularized through the short gastric vessels and was left in situ.
1. Ayalon A, Wiesner RH, Perkins JD, Tominaga S, Hayes DH, Krom RA. Splenic artery aneurysms in liver transplant patients. Transplantation 1988;45:386-9.
Y Bendavid, B Montreuil
Surgical intervention
2 years ago
1378 views
49 likes
0 comments
07:55
Laparoscopic resection of a splenic artery aneurysm with splenic preservation
This video illustrates the laparoscopic resection of a splenic artery aneurysm with splenic preservation in a young lady.
The lesion was discovered fortuitously by ultrasound for an unrelated cause. Embolization was unsuccessful because of the inability of our interventional radiology team to reach the aneurysm itself for coiling.
It is thought that splenic artery aneurysms are present in 1% of the population (1), and coiling/resection is often advocated, especially in young women in childbearing age.
The aneurysm was isolated and its multiple feeding vessels clipped before complete resection. The spleen remained well vascularized through the short gastric vessels and was left in situ.
1. Ayalon A, Wiesner RH, Perkins JD, Tominaga S, Hayes DH, Krom RA. Splenic artery aneurysms in liver transplant patients. Transplantation 1988;45:386-9.
Complex robotic resection of a large middle mediastinal thymoma
A 62-year-old man had an asymptomatic middle mediastinal tumor with a 4.5cm diameter, opposite to the superior vena cava and the azygos vein in the Barety’s space, which was discovered on thoracic CT-scan performed during an urothelial tumor follow-up.
Past history includes an urothelial carcinoma grade I treated with transurethral cystectomy, an ischemic cardiopathy with a single medical treatment, a prostate hypertrophy, and a sigmoid diverticulosis.
After a multidisciplinary review of the case, a mediastinoscopy was performed. It demonstrated the presence of a thymoma.
The patient was well informed of the operative risks and of the possibility of conversion, but thanks to our experience and national recommendations, we were able to perform a radical robotic assisted thymectomy.
The operation took during 3 hours with less than 100cc of bleeding.
The postoperative course was uneventful and the patient was discharged on postoperative day 3.
Histopathological analysis showed a type AB thymoma according to the OMS 2015 classification. The staging was IIb according to Masaoka. No adjuvant radiotherapy was indicated.
A Boutin, M Sarsam, M Lair, N Piton, C Peillon, JM Baste
Surgical intervention
2 years ago
648 views
64 likes
0 comments
07:38
Complex robotic resection of a large middle mediastinal thymoma
A 62-year-old man had an asymptomatic middle mediastinal tumor with a 4.5cm diameter, opposite to the superior vena cava and the azygos vein in the Barety’s space, which was discovered on thoracic CT-scan performed during an urothelial tumor follow-up.
Past history includes an urothelial carcinoma grade I treated with transurethral cystectomy, an ischemic cardiopathy with a single medical treatment, a prostate hypertrophy, and a sigmoid diverticulosis.
After a multidisciplinary review of the case, a mediastinoscopy was performed. It demonstrated the presence of a thymoma.
The patient was well informed of the operative risks and of the possibility of conversion, but thanks to our experience and national recommendations, we were able to perform a radical robotic assisted thymectomy.
The operation took during 3 hours with less than 100cc of bleeding.
The postoperative course was uneventful and the patient was discharged on postoperative day 3.
Histopathological analysis showed a type AB thymoma according to the OMS 2015 classification. The staging was IIb according to Masaoka. No adjuvant radiotherapy was indicated.
Total laparoscopic pancreaticoduodenectomy with pancreaticogastric anastomosis
The safe feasibility of total laparoscopic pancreaticoduodenectomy has been demonstrated by several authors. In order to achieve it, a 5-port approach is used. Kocher’s maneuver allows to access the inferior vena cava, the subrenal aorta, the posterior plate of the unciform process, and the superior mesenteric artery. Lymph node resection of the region may be performed completely, namely an interaorticocaval lymphadenectomy around the hepatoduodenal ligament and around the coeliac trunk and its branches. After portal vein dissection, the pancreas must be divided distally from the tumor, and its right part must be separated from the portal vein. The duodenal bulb and the first jejunal loop are divided using a linear stapler. After cholecystectomy, the hepatic duct is cut proximally to the cystic duct. Reconstruction will include three anastomoses, a telescoping posterior end-to-side pancreaticogastrostomy, an end-to-side duodenojejunostomy, and an end-to-side hepaticojejunostomy.
B Ghavami
Surgical intervention
2 years ago
1637 views
57 likes
0 comments
13:35
Total laparoscopic pancreaticoduodenectomy with pancreaticogastric anastomosis
The safe feasibility of total laparoscopic pancreaticoduodenectomy has been demonstrated by several authors. In order to achieve it, a 5-port approach is used. Kocher’s maneuver allows to access the inferior vena cava, the subrenal aorta, the posterior plate of the unciform process, and the superior mesenteric artery. Lymph node resection of the region may be performed completely, namely an interaorticocaval lymphadenectomy around the hepatoduodenal ligament and around the coeliac trunk and its branches. After portal vein dissection, the pancreas must be divided distally from the tumor, and its right part must be separated from the portal vein. The duodenal bulb and the first jejunal loop are divided using a linear stapler. After cholecystectomy, the hepatic duct is cut proximally to the cystic duct. Reconstruction will include three anastomoses, a telescoping posterior end-to-side pancreaticogastrostomy, an end-to-side duodenojejunostomy, and an end-to-side hepaticojejunostomy.
Laparoscopic choledochal cyst excision with intraoperative cholangiogram, hepatic duct cholangioscopy, extracorporeal Roux-en-Y hepaticojejunostomy and closure of mesenteric defects
The laparoscopic treatment of a choledochal cyst begins with a careful preoperative understanding of the anatomy, including bile ducts, as well as the presence of any abnormal pancreatobiliary anatomy. If a hepaticojejunostomy using a Roux-en-Y anastomosis is performed, we prefer an extracorporeal, transumbilical anastomosis, with a retrocolic approach. A series of interrupted or continuous absorbable sutures can be used for the bilioenteric anastomosis. For the last part of the procedure, we emphasize the importance of closure of mesenteric defects with non-absorbable sutures, including both the retrocolic space and Petersen’s defect to prevent future internal herniations.
GA Villalona, D Ozgediz
Surgical intervention
2 years ago
1524 views
72 likes
0 comments
10:31
Laparoscopic choledochal cyst excision with intraoperative cholangiogram, hepatic duct cholangioscopy, extracorporeal Roux-en-Y hepaticojejunostomy and closure of mesenteric defects
The laparoscopic treatment of a choledochal cyst begins with a careful preoperative understanding of the anatomy, including bile ducts, as well as the presence of any abnormal pancreatobiliary anatomy. If a hepaticojejunostomy using a Roux-en-Y anastomosis is performed, we prefer an extracorporeal, transumbilical anastomosis, with a retrocolic approach. A series of interrupted or continuous absorbable sutures can be used for the bilioenteric anastomosis. For the last part of the procedure, we emphasize the importance of closure of mesenteric defects with non-absorbable sutures, including both the retrocolic space and Petersen’s defect to prevent future internal herniations.
Laparoscopic enucleation of a cystic tumor of the pancreas in a child
This short video describes the laparoscopic enucleation of a benign congenital excretory cyst of the pancreas in a 13-year-old girl.
No prenatal diagnosis had been envisaged and this teen girl was admitted in an emergency setting, with iterative abdominal pain followed by vomiting and weight loss (3Kg) over the last two months.
The entire work-up allowed to rule out the presence of parenchymal tumor involvement and the perfectly regular isolated and apparently normal nature of a cyst situated on the posterior aspect of the pancreatic head, which is totally separate from the biliary tract and from the duodenum.
In these conditions, the diagnosis of Frantz tumor was ruled out and the most probable hypothesis was that of a congenital cystic pancreatic tumor which had recently increased in size. The specificity of the technique used consisted in a pancreatic detachment using a Kocher’s maneuver. The posterior aspect of the pancreatic head was then detached in order to "plicate" or fold the pancreas upon itself.
Once turned over 180 degrees to the left, the posterior aspect of the pancreatic head was perfectly exposed. In addition, after puncture of the cyst, the clear fluid content of the cyst was replaced by a blue dye in order to perfectly identify it through a thin layer of pancreatic parenchyma.
The cyst’s enucleation was subsequently facilitated. No adhesion impaired its detachment from the remainder of the pancreatic tissue. Since the pericystic area was preserved, the risk of secondary pancreatic fistula was prevented, especially because the cyst had been previously opacified, which allowed to rule out any potential communication with the excretory ducts of the pancreas.
I Kauffmann, F Becmeur
Surgical intervention
2 years ago
606 views
13 likes
0 comments
02:59
Laparoscopic enucleation of a cystic tumor of the pancreas in a child
This short video describes the laparoscopic enucleation of a benign congenital excretory cyst of the pancreas in a 13-year-old girl.
No prenatal diagnosis had been envisaged and this teen girl was admitted in an emergency setting, with iterative abdominal pain followed by vomiting and weight loss (3Kg) over the last two months.
The entire work-up allowed to rule out the presence of parenchymal tumor involvement and the perfectly regular isolated and apparently normal nature of a cyst situated on the posterior aspect of the pancreatic head, which is totally separate from the biliary tract and from the duodenum.
In these conditions, the diagnosis of Frantz tumor was ruled out and the most probable hypothesis was that of a congenital cystic pancreatic tumor which had recently increased in size. The specificity of the technique used consisted in a pancreatic detachment using a Kocher’s maneuver. The posterior aspect of the pancreatic head was then detached in order to "plicate" or fold the pancreas upon itself.
Once turned over 180 degrees to the left, the posterior aspect of the pancreatic head was perfectly exposed. In addition, after puncture of the cyst, the clear fluid content of the cyst was replaced by a blue dye in order to perfectly identify it through a thin layer of pancreatic parenchyma.
The cyst’s enucleation was subsequently facilitated. No adhesion impaired its detachment from the remainder of the pancreatic tissue. Since the pericystic area was preserved, the risk of secondary pancreatic fistula was prevented, especially because the cyst had been previously opacified, which allowed to rule out any potential communication with the excretory ducts of the pancreas.
Laparoscopic pylorus-preserving pancreaticoduodenectomy for Gruber-Frantz tumor
This video demonstrates our technique for laparoscopic pylorus-preserving pancreaticoduodenectomy performed in a 15-year-old girl presenting with a history of episodic mild abdominal colic pain and right upper quadrant mass.
The preoperative diagnosis of a solid pseudo-papillary tumor (Gruber-Frantz tumor) was made, based on ultrasonography and computed tomography.
Laparoscopic resection was decided upon based on the fact that there were clearly defined surgical planes despite of the size of the mass. The usual sequence of steps for a pancreaticoduodenectomy was altered in this particular case because of tumor dimensions.
The procedure was carried out in 438 minutes without complications. There were no symptoms of delayed gastric emptying, and the patient was discharged on postoperative day 5. The microscopic study of the tumor confirmed a 10.5 by 9 by 5.5cm solid pseudo-papillary tumor of the pancreatic head.
JM Cabada Lee
Surgical intervention
2 years ago
724 views
24 likes
0 comments
09:00
Laparoscopic pylorus-preserving pancreaticoduodenectomy for Gruber-Frantz tumor
This video demonstrates our technique for laparoscopic pylorus-preserving pancreaticoduodenectomy performed in a 15-year-old girl presenting with a history of episodic mild abdominal colic pain and right upper quadrant mass.
The preoperative diagnosis of a solid pseudo-papillary tumor (Gruber-Frantz tumor) was made, based on ultrasonography and computed tomography.
Laparoscopic resection was decided upon based on the fact that there were clearly defined surgical planes despite of the size of the mass. The usual sequence of steps for a pancreaticoduodenectomy was altered in this particular case because of tumor dimensions.
The procedure was carried out in 438 minutes without complications. There were no symptoms of delayed gastric emptying, and the patient was discharged on postoperative day 5. The microscopic study of the tumor confirmed a 10.5 by 9 by 5.5cm solid pseudo-papillary tumor of the pancreatic head.
Intravesical mini-laparoscopic repair of vesicovaginal fistulas
Vesicovaginal fistulas (VVF) constitute the most common type of genitourinary fistulas. In developed countries, VVF are almost always iatrogenic and frequently a secondary complication of gynecologic surgery. Some minimally invasive techniques have been introduced to decrease morbidity related to standard open procedures for the treatment of VVF. One such procedure is the intravesical mini-laparoscopic approach. The aim of this was to present our initial clinical experience using this technique for transvesical VVF repair. In 2014, we carried out a mini-laparoscopic repair of VVF in two women who did not respond to conservative treatment with a Foley catheter. The procedure was performed transvesically with a 3mm instrument and a 5mm, 30-degree scope. The fistulous tract was dissected and partially excised. The bladder and vaginal wall defects were closed in two layers with two separate running barbed, absorbable 3/0 sutures. Median operative time was approximately 100 minutes, and blood loss was not significant. Patients were discharged from hospital 24 hours after surgery. A Foley catheter was left in place for 14 days. Imaging examinations performed 6 weeks postoperatively revealed no VVF. In patients with simple fistulas, this technique provides a minimally invasive easily reproducible approach with few associated complications.
The advantages of this technique as compared to the conventional laparoscopic approach are described as follows:
- the risk of bleeding is reduced because the size of the incision made is smaller and access to the fistula site is easier and direct without manipulating abdominal structures;
- the length of hospital stay required is significantly shorter with intravesical mini-laparoscopic than laparoscopic surgery conventional approach.
A Llueca, JL Herraiz, M Rodrigo, Y Maazouzi, D Piquer, M Guijarro, A Cañete, J Escrig
Surgical intervention
2 years ago
2993 views
122 likes
1 comment
07:16
Intravesical mini-laparoscopic repair of vesicovaginal fistulas
Vesicovaginal fistulas (VVF) constitute the most common type of genitourinary fistulas. In developed countries, VVF are almost always iatrogenic and frequently a secondary complication of gynecologic surgery. Some minimally invasive techniques have been introduced to decrease morbidity related to standard open procedures for the treatment of VVF. One such procedure is the intravesical mini-laparoscopic approach. The aim of this was to present our initial clinical experience using this technique for transvesical VVF repair. In 2014, we carried out a mini-laparoscopic repair of VVF in two women who did not respond to conservative treatment with a Foley catheter. The procedure was performed transvesically with a 3mm instrument and a 5mm, 30-degree scope. The fistulous tract was dissected and partially excised. The bladder and vaginal wall defects were closed in two layers with two separate running barbed, absorbable 3/0 sutures. Median operative time was approximately 100 minutes, and blood loss was not significant. Patients were discharged from hospital 24 hours after surgery. A Foley catheter was left in place for 14 days. Imaging examinations performed 6 weeks postoperatively revealed no VVF. In patients with simple fistulas, this technique provides a minimally invasive easily reproducible approach with few associated complications.
The advantages of this technique as compared to the conventional laparoscopic approach are described as follows:
- the risk of bleeding is reduced because the size of the incision made is smaller and access to the fistula site is easier and direct without manipulating abdominal structures;
- the length of hospital stay required is significantly shorter with intravesical mini-laparoscopic than laparoscopic surgery conventional approach.
Laparoscopic retroperitoneal access to ovarian cysts fixed by severe pelvic adhesions: a case report
Left cystectomy or left adnexectomy can be difficult in cases of frozen pelvis, with an adnexa entirely covered with the sigmoid colon and stuck to the pelvic sidewall.
This video clearly demonstrates the advantages of the left retroperitoneal access to the adnexa, limiting the risks of injury of the ureter and the perforation of the sigmoid colon. The different steps of the operation are as follows: 1) Lysis of adhesions between the sigmoid colon and the left pelvic sidewall to visualize the tube. 2) Division of adhesions between the sigmoid colon and the uterus to visualize the left ovary. 3) Left retroperitoneal access to the ovary with a longitudinal incision of the peritoneum, laterally. 4) Division of the utero-ovarian pedicle. 5) Retroperitoneal dissection of the ureter to completely release the ovary from the ureter. 6) Lysis of the upper surface of the ovary from the sigmoid colon.
JB Dubuisson, J Dubuisson
Surgical intervention
2 years ago
5221 views
297 likes
0 comments
08:20
Laparoscopic retroperitoneal access to ovarian cysts fixed by severe pelvic adhesions: a case report
Left cystectomy or left adnexectomy can be difficult in cases of frozen pelvis, with an adnexa entirely covered with the sigmoid colon and stuck to the pelvic sidewall.
This video clearly demonstrates the advantages of the left retroperitoneal access to the adnexa, limiting the risks of injury of the ureter and the perforation of the sigmoid colon. The different steps of the operation are as follows: 1) Lysis of adhesions between the sigmoid colon and the left pelvic sidewall to visualize the tube. 2) Division of adhesions between the sigmoid colon and the uterus to visualize the left ovary. 3) Left retroperitoneal access to the ovary with a longitudinal incision of the peritoneum, laterally. 4) Division of the utero-ovarian pedicle. 5) Retroperitoneal dissection of the ureter to completely release the ovary from the ureter. 6) Lysis of the upper surface of the ovary from the sigmoid colon.
Low-cost laparoscopic appendectomy: how to teach
Laparoscopic appendectomy must be the gold standard. Nowadays, many centers still continue to go on with McBurney’s incisions. Why? Expensive devices may be a reason. Low cost appendectomy allows for a diagnostic laparoscopy and offers a therapeutic option with the lowest price.
On the other hand, residents must begin the learning curve in laparoscopy as soon as possible not only with a training center (training in cadaveric or animals) but they must also start practicing on humans with watchful surgeon/teacher’s eyes.
The aim of this video is to demonstrate that low-cost laparoscopic appendectomy is feasible not only for surgeons but also for residents operating with an expert.
S Rua, G Machado , P Mira
Surgical intervention
2 years ago
8991 views
557 likes
1 comment
08:49
Low-cost laparoscopic appendectomy: how to teach
Laparoscopic appendectomy must be the gold standard. Nowadays, many centers still continue to go on with McBurney’s incisions. Why? Expensive devices may be a reason. Low cost appendectomy allows for a diagnostic laparoscopy and offers a therapeutic option with the lowest price.
On the other hand, residents must begin the learning curve in laparoscopy as soon as possible not only with a training center (training in cadaveric or animals) but they must also start practicing on humans with watchful surgeon/teacher’s eyes.
The aim of this video is to demonstrate that low-cost laparoscopic appendectomy is feasible not only for surgeons but also for residents operating with an expert.
Small bowel obstruction and ileal strangulation by adhesions: role of laparoscopy in early diagnosis and treatment
Adhesive small bowel obstruction (ASBO) is a common surgical emergency, most frequently caused by adhesions. In the absence of signs of strangulations or CT-scan evidence (free fluid mesenteric edema, “small bowel faeces” sign, devascularization), a large portion of ASBO can be resolved using non-operative methods even if a significant number of patients will require an emergency surgery.
Laparoscopy in acute care surgery continues to expand even in cases of small bowel obstruction which were conventionally managed by means of laparotomy.
The authors report a case of a 45-year-old woman, completely laparoscopically treated, with a history of previous appendectomy with pelvic abscess, cholecystectomy and removal of right ovarian cysts. She was admitted to the emergency room five hours before surgery with severe acute abdominal pain which appeared 24 hours before.
CT-scan with oral administration of gastrografin showed signs of intestinal obstruction and adhesions were suspected. The exploratory laparoscopy revealed adhesive small bowel obstruction with ileal strangulation. The intestine was viable and resection was unnecessary.
The role of diagnostic imaging modalities is relevant to decrease ASBO-related morbidity and mortality. However, because of the lack of specific radiological signs and laboratory findings of bowel strangulation, the diagnosis requires, when it is not contraindicated, a timely laparoscopic exploration with both diagnostic and therapeutic purposes.
V Guarino, A Cappiello, N Perrotta, A Scotti, F Mastellone, D Loffredo
Surgical intervention
2 years ago
1806 views
87 likes
0 comments
08:20
Small bowel obstruction and ileal strangulation by adhesions: role of laparoscopy in early diagnosis and treatment
Adhesive small bowel obstruction (ASBO) is a common surgical emergency, most frequently caused by adhesions. In the absence of signs of strangulations or CT-scan evidence (free fluid mesenteric edema, “small bowel faeces” sign, devascularization), a large portion of ASBO can be resolved using non-operative methods even if a significant number of patients will require an emergency surgery.
Laparoscopy in acute care surgery continues to expand even in cases of small bowel obstruction which were conventionally managed by means of laparotomy.
The authors report a case of a 45-year-old woman, completely laparoscopically treated, with a history of previous appendectomy with pelvic abscess, cholecystectomy and removal of right ovarian cysts. She was admitted to the emergency room five hours before surgery with severe acute abdominal pain which appeared 24 hours before.
CT-scan with oral administration of gastrografin showed signs of intestinal obstruction and adhesions were suspected. The exploratory laparoscopy revealed adhesive small bowel obstruction with ileal strangulation. The intestine was viable and resection was unnecessary.
The role of diagnostic imaging modalities is relevant to decrease ASBO-related morbidity and mortality. However, because of the lack of specific radiological signs and laboratory findings of bowel strangulation, the diagnosis requires, when it is not contraindicated, a timely laparoscopic exploration with both diagnostic and therapeutic purposes.