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Monthly publications

#November 2009
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Laparoscopic total gastrectomy for pT2 N0 M0 adenocarcinoma of the lesser curvature of the stomach
Totally laparoscopic gastrectomy for cancer remains limited because of technical problems, expecially for lymphadenectomy. We present the case of a 75-year-old patient with no specific history in which an adenocarcinoma of the lesser curvature of the stomach was found. An endoscopic ultrasound had shown a UST3 N0 lesion. The CT-scan confirmed the absence of secondary lesion and a neoadjuvant chemotherapy was carried out. Following chemotherapy, a re-evaluation was performed and confirmed the 2 by 2cm lesion of the lesser curvature of the stomach without secondary lesion. The decision to perform a laparoscopic total gastrectomy was made.
B Dallemagne, F Costantino, J Marescaux
Surgical intervention
9 years ago
7514 views
22 likes
0 comments
15:53
Laparoscopic total gastrectomy for pT2 N0 M0 adenocarcinoma of the lesser curvature of the stomach
Totally laparoscopic gastrectomy for cancer remains limited because of technical problems, expecially for lymphadenectomy. We present the case of a 75-year-old patient with no specific history in which an adenocarcinoma of the lesser curvature of the stomach was found. An endoscopic ultrasound had shown a UST3 N0 lesion. The CT-scan confirmed the absence of secondary lesion and a neoadjuvant chemotherapy was carried out. Following chemotherapy, a re-evaluation was performed and confirmed the 2 by 2cm lesion of the lesser curvature of the stomach without secondary lesion. The decision to perform a laparoscopic total gastrectomy was made.
Single port cholecystectomy: impact of instrumentation in getting the critical view of safety
Single port access surgery may be the next generation of minimally invasive surgery thanks to the obvious advantages (e.g., scarless surgery, lesser pain, and faster postoperative recovery). Performing a cholecystectomy via a single trocar imposes a few technical constraints. The first is the necessity of correctly exposing the gallbladder, the second is to find the instrumentation that allows to perform the different dissection stages, ligature of the cystic duct and artery, but also to obtain an acceptable visualization of the Calot’s triangle. Various methods are proposed at the moment, along with different instruments: rigid, articulated, curved ones. In this video, we present two cholecystectomies, one is performed with conventional laparoscopic instruments, the other with curved instruments especially adapted for a unique trocar.
B Dallemagne, J Leroy, J Marescaux
Surgical intervention
9 years ago
1024 views
42 likes
0 comments
07:41
Single port cholecystectomy: impact of instrumentation in getting the critical view of safety
Single port access surgery may be the next generation of minimally invasive surgery thanks to the obvious advantages (e.g., scarless surgery, lesser pain, and faster postoperative recovery). Performing a cholecystectomy via a single trocar imposes a few technical constraints. The first is the necessity of correctly exposing the gallbladder, the second is to find the instrumentation that allows to perform the different dissection stages, ligature of the cystic duct and artery, but also to obtain an acceptable visualization of the Calot’s triangle. Various methods are proposed at the moment, along with different instruments: rigid, articulated, curved ones. In this video, we present two cholecystectomies, one is performed with conventional laparoscopic instruments, the other with curved instruments especially adapted for a unique trocar.
Laparoscopic appendectomy following transparietal drainage of an abscess
Patients presenting with complicated appendicitis represent a common and challenging problem. Conflicting data exist concerning optimal treatment of these patients with primary versus delayed appendectomy. This video shows the case of a 48-year-old female patient operated upon previously for a collection at the rectouterine (Douglas') pouch following a suspected acute appendicitis. A laparoscopic exploration was performed along with a laparoscopic drainage of the collection, but the appendix had not been identified. Fifteen days later and the patient presents with a 15cm residual collection for which we performed a puncture under CT-scan guidance. Following a 3-month interval, the patient is admitted to our Department to perform an appendectomy.
F Costantino, J Marescaux
Surgical intervention
9 years ago
2738 views
20 likes
0 comments
04:05
Laparoscopic appendectomy following transparietal drainage of an abscess
Patients presenting with complicated appendicitis represent a common and challenging problem. Conflicting data exist concerning optimal treatment of these patients with primary versus delayed appendectomy. This video shows the case of a 48-year-old female patient operated upon previously for a collection at the rectouterine (Douglas') pouch following a suspected acute appendicitis. A laparoscopic exploration was performed along with a laparoscopic drainage of the collection, but the appendix had not been identified. Fifteen days later and the patient presents with a 15cm residual collection for which we performed a puncture under CT-scan guidance. Following a 3-month interval, the patient is admitted to our Department to perform an appendectomy.
An original technique of liver retraction in laparoscopic esophagogastric surgery
Adequate exposure enables an operation to be performed safely and with precision. In most of the upper abdominal operations, good retraction of the hepatic lobe is necessary. A simple, effective and inexpensive method of liver retraction is clearly described in this video. We apply a hand-made liver retractor for access and visualization particularly around lesser curve and esophageal hiatus. A 17cm long and 6mm large penrose drain is used. Our hand-made drain is prepared preoperatively by fixing 3 heavy ties along its length. The middle tie is passed superiorly through a dissected gap in the left triangular ligament while the other ties are separated laterally for retraction of the left lobe of liver.
Fine adjustments are made to achieve adequate exposure of the lesser curve and diaphragmatic hiatus.
N Tanigawa
Surgical intervention
9 years ago
4738 views
5 likes
0 comments
06:35
An original technique of liver retraction in laparoscopic esophagogastric surgery
Adequate exposure enables an operation to be performed safely and with precision. In most of the upper abdominal operations, good retraction of the hepatic lobe is necessary. A simple, effective and inexpensive method of liver retraction is clearly described in this video. We apply a hand-made liver retractor for access and visualization particularly around lesser curve and esophageal hiatus. A 17cm long and 6mm large penrose drain is used. Our hand-made drain is prepared preoperatively by fixing 3 heavy ties along its length. The middle tie is passed superiorly through a dissected gap in the left triangular ligament while the other ties are separated laterally for retraction of the left lobe of liver.
Fine adjustments are made to achieve adequate exposure of the lesser curve and diaphragmatic hiatus.
Duodenopancreatectomy: potentialities of the laparoscopic approach in the mobilization, dissection, and resection stages of the procedure
This video demonstrates the laparoscopic approach of a cephalic
duodenopancreatectomy in a 70-year-old patient presenting with an
adenocarcinoma of the pancreatic head. Using 4 ports, the duodenum is completely detached. The unciform process is prepared posteriorly by dissecting the superior mesenteric artery and the portal vein in its right lower section. A total lymph node resection and an antrectomy have been performed, followed by the resection of the pancreatic body. Last but not least, the small bowel is divided and the duodenum is de-crossed. The dissection shows the different steps of the procedure with extra details.
B Ghavami
Surgical intervention
9 years ago
13237 views
190 likes
3 comments
17:55
Duodenopancreatectomy: potentialities of the laparoscopic approach in the mobilization, dissection, and resection stages of the procedure
This video demonstrates the laparoscopic approach of a cephalic
duodenopancreatectomy in a 70-year-old patient presenting with an
adenocarcinoma of the pancreatic head. Using 4 ports, the duodenum is completely detached. The unciform process is prepared posteriorly by dissecting the superior mesenteric artery and the portal vein in its right lower section. A total lymph node resection and an antrectomy have been performed, followed by the resection of the pancreatic body. Last but not least, the small bowel is divided and the duodenum is de-crossed. The dissection shows the different steps of the procedure with extra details.