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Current issue 26 media
Robotic Heller myotomy with Dor fundoplication for esophageal achalasia
Achalasia is an esophageal motility disorder characterized by an incomplete or absent esophagogastric junction (EGJ) relaxation associated with loss of peristalsis or uncoordinated contractions of the esophageal body in response to swallowing. All available treatments for achalasia are palliative, directed towards the elimination of the outflow resistance caused by abnormal lower esophageal sphincter (LES) function and aiming to improve the symptoms related to esophageal stasis, such as dysphagia and regurgitation. Laparoscopic Heller myotomy with partial fundoplication is the current standard of care for the treatment of achalasia. It is associated with symptom improvement or relief in about 90% of patients. However, it is a challenging procedure with the potential risk of esophageal perforation reported in up to 10% of cases. Interestingly, laparoscopic myotomy has some limitations which depend on the laparoscopic technique (bidimensional vision, poor range of movement) and on the surgeon’s experience. Recently, the use of the robotic technology has been proposed claiming that it might reduce intraoperative esophageal perforation rates and improve postoperative quality of life after Heller myotomy, mainly due to the 3D view and enhanced dexterity of the surgeon. Despite significant improvements in surgical treatment, the length of myotomy is still a matter of debate to date. Substantially, although some authors proposed a limited myotomy on the lower esophagus preserving a small portion of the LES to prevent postoperative reflux, most authors recommended a myotomy extending 4 to 6cm on the esophagus and 1 to 2cm on the gastric side. In this video, we performed a 6cm long esophagogastric myotomy, with a 2.5cm proximal extension above the Z-line (endoscopically recognized) and a 3.5cm distal extension below the same landmark. In a previous experimental study with intraoperative computerized manometry, we observed that myotomy of the esophageal portion of the LES (without dissection of the gastric fibers) did not lead to any significant variation in sphincteric pressure. Instead, the dissection of the gastric fibers for at least 2 to 2.5cm on the anterior gastric wall created a significant modification of the LES pressure profile. This may be due to the interruption of the anterior portion of gastric semicircular clasp and sling fibers, with consequent loss of their hook properties on the LES pressure profile.
L Marano, A Spaziani, G Castagnoli
POEM for scarless treatment of achalasia: live full uncut procedure update
In this live full uncut video demonstration authored by Dr. S Perretta and Dr. L. Swanström, peroral endoscopic myotomy (POEM) is performed for the treatment of achalasia. The technical aspects of the procedure and the preoperative settings are thoroughly described.
LL Swanström, S Perretta, M Ignat, SG Lim
Underwater endoscopic mucosal resection (EMR) of duodenal sessile polyp: live uncut procedure
In this video, we present the performance of piecemeal endoscopic mucosal resection (EMR) for a duodenal sessile polyp after filling the duodenal lumen with water. The technical aspects of the procedure and detailed explanation of the tumor appearance are provided.
N Yahagi, SG Lim
Live interactive surgery: POEM for achalasia in a patient with a surgical history of subtotal gastrectomy
In this live interactive video demonstration performed by Professor Inoue, a peroral endoscopic myotomy (POEM) is achieved for the treatment of achalasia in a patient who underwent a subtotal gastrectomy. The technical aspects of the procedure and discussion are provided.
H Inoue, I Crisan, SG Lim
Endoscopic ultrasound-guided drainage of pleural effusion and collection in the posterior mediastinum: live interactive procedure
In this video, we present the performance of an endoscopic ultrasound-guided drainage of pleural effusion and collection in the posterior mediastinum. The technical aspects of the procedure and a discussion are provided.
Gf Donatelli, M Ignat, B Dallemagne, SG Lim
Endoscopic submucosal dissection (ESD) of colonic sessile adenoma in the caecum: live uncut procedure
In this video, we present the performance of an endoscopic submucosal dissection (ESD) for a colonic sessile adenoma in the caecum. The technical aspects of the procedure and a detailed explanation of the tumor appearance are provided.
N Yahagi, J Hamanaka, M Morar, SG Lim
Endoscopic mucosal resection (EMR) of a colonic sessile tumor after mucosal incision and endoscopic polypectomy: live uncut procedure
In this video, we present the performance of an endoscopic mucosal resection (EMR) after mucosal incision around the tumor for a colonic sessile adenoma. The technical aspects of the procedure and detailed explanation of the tumor appearance are provided.
J Hamanaka, I Crisan, SG Lim
Endoscopic mucosal resection (EMR) for a colonic sessile adenoma: live uncut procedure
In this video, we present the performance of endoscopic mucosal resection for a colonic sessile adenoma. The technical aspects of the procedure and detailed explanation of the tumor appearance are provided.
A Lemmers, M Barthet, RA Ciurezu, SG Lim
EUS-guided transgastric drainage of a large peripancreatic collection: use of the HOT AXIOS™ covered metallic stent
We present the live case showing the management of a large collection in the context of a past surgical history of splenectomy and pancreatic fistula. The 13cm diameter collection was drained internally by means of an endoscopic ultrasound-guided placement of a metallic stent.
Gf Donatelli, S Perretta, B Seeliger
Apr 2018Omentum division to facilitate the passage of the alimentary limb in a Laparoscopic Roux-en-Y gastric bypass
Mar 2018Focus on Upper GI Surgeries: Redo Procedures after Failures of Hiatal Hernia and GERD treatments
Focus of the month
Apr 2016Focus on Rectal Surgery - TME for rectal cancer: combined transabdominal and transanal techniques (TATA) and full NOTES transanal TME (TaTME)
Focus of the month