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Monthly publications

#November 2006
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Laparoscopic short floppy Nissen fundoplication for gastroesophageal reflux disease
The original fundoplication technique as described by Rudolf Nissen in 1955 consisted in wrapping the fundus of the stomach around the esophagus, while leaving the gastrosplenic vessels and the diaphragmatic hiatus intact. Additionally, the vagus nerves were little or not preserved.
The basic principles of a fundoplication are:
- tension-free repositioning of the gastroesophageal junction (along with 2 cm of lower esophagus in a subphrenic position);
- use the gastric fundus to create the fundoplication;
- make sure that the resistance generated by the anti-reflux mechanism matches the preoperative assessment of esophageal peristalsis.
B Dallemagne, Y Freund
Operative technique
12 years ago
7258 views
176 likes
2 comments
Laparoscopic short floppy Nissen fundoplication for gastroesophageal reflux disease
The original fundoplication technique as described by Rudolf Nissen in 1955 consisted in wrapping the fundus of the stomach around the esophagus, while leaving the gastrosplenic vessels and the diaphragmatic hiatus intact. Additionally, the vagus nerves were little or not preserved.
The basic principles of a fundoplication are:
- tension-free repositioning of the gastroesophageal junction (along with 2 cm of lower esophagus in a subphrenic position);
- use the gastric fundus to create the fundoplication;
- make sure that the resistance generated by the anti-reflux mechanism matches the preoperative assessment of esophageal peristalsis.
Virtual reality applied to video-assisted left superior parathyroidectomy
This video demonstrates how virtual reality is applied to video-assisted left superior parathyroidectomy. The virtual reconstruction is done from a preoperative contrast CT scan. The anatomy is then recreated layer by layer starting from the skin to the bone. Every anatomical structure can be removed or added back, in order to visualize areas that are normally not easily accessible and therefore difficult to identify. The relation with the adjacent vascular structures, arteries and veins, can also be very precisely established. A two cm horizontal neck incision is made below the sternal notch. The surgeons demonstrates a careful dissection of the anterior and lateral aspect of the thyroid. This manoeuvre allows to easily reach the area that had been previously virtually reconstructed. Once the gland is freed from its attachment the vascular pedicle is identified, isolated and clipped.
J Marescaux, M Vix, L Soler
Surgical intervention
12 years ago
451 views
2 likes
0 comments
03:49
Virtual reality applied to video-assisted left superior parathyroidectomy
This video demonstrates how virtual reality is applied to video-assisted left superior parathyroidectomy. The virtual reconstruction is done from a preoperative contrast CT scan. The anatomy is then recreated layer by layer starting from the skin to the bone. Every anatomical structure can be removed or added back, in order to visualize areas that are normally not easily accessible and therefore difficult to identify. The relation with the adjacent vascular structures, arteries and veins, can also be very precisely established. A two cm horizontal neck incision is made below the sternal notch. The surgeons demonstrates a careful dissection of the anterior and lateral aspect of the thyroid. This manoeuvre allows to easily reach the area that had been previously virtually reconstructed. Once the gland is freed from its attachment the vascular pedicle is identified, isolated and clipped.
Redo Nissen fundoplication with stapled-wedge Collis gastroplasty
This video demonstrates a redo laparoscopic Collis-Nissen gastroplasty in a patient with recurrent gastroesophageal reflux symptoms and short esophagus. The first step of this redo procedure consists in taking down the previous fundoplication in order to identify the mechanism underlying the failure of the initial repair. The surgeon demonstrates an extensive mobilization of the esophagus through the hiatus to achieve an adequate length of intra-abdominal esophagus. Despite this, the esophagus was too short and the surgeon performs a Collis gastroplasty using the wedge gastrectomy technique over a 50 French bougie. A 2.5cm of tension-free intra-abdominal esophagus is achieved. The hiatus is repaired with interrupted non-absorbable sutures. A standard Nissen fundoplication is performed.
B Dallemagne
Surgical intervention
12 years ago
1135 views
9 likes
0 comments
12:05
Redo Nissen fundoplication with stapled-wedge Collis gastroplasty
This video demonstrates a redo laparoscopic Collis-Nissen gastroplasty in a patient with recurrent gastroesophageal reflux symptoms and short esophagus. The first step of this redo procedure consists in taking down the previous fundoplication in order to identify the mechanism underlying the failure of the initial repair. The surgeon demonstrates an extensive mobilization of the esophagus through the hiatus to achieve an adequate length of intra-abdominal esophagus. Despite this, the esophagus was too short and the surgeon performs a Collis gastroplasty using the wedge gastrectomy technique over a 50 French bougie. A 2.5cm of tension-free intra-abdominal esophagus is achieved. The hiatus is repaired with interrupted non-absorbable sutures. A standard Nissen fundoplication is performed.