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Monthly publications

#July 2010
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Laparoscopic exploration after Roux-en-Y gastric bypass following intestinal obstruction
This video demonstrates a laparoscopic exploration in a female patient who had undergone a gastric bypass in 2002. Her BMI was 58 at that time. Now it is 20. She had been operated on for an incisional hernia that occurred at the level of the former umbilical optical port site. She suffered from several episodes of proven mechanical bowel obstruction and benefited from medical treatment.
However, despite a thorough preoperative work-up, including gastroscopy, colonoscopy and repeat CT-scan studies performed over 6 months, the mechanical origin of the bowel obstruction was difficult to demonstrate. Since the patient had chronic, cramp-like abdominal pain, the exploration of the abdominal cavity using the former port entry sites is decided upon.
F Costantino, M Vix, J Marescaux
Surgical intervention
8 years ago
179 views
2 likes
0 comments
06:17
Laparoscopic exploration after Roux-en-Y gastric bypass following intestinal obstruction
This video demonstrates a laparoscopic exploration in a female patient who had undergone a gastric bypass in 2002. Her BMI was 58 at that time. Now it is 20. She had been operated on for an incisional hernia that occurred at the level of the former umbilical optical port site. She suffered from several episodes of proven mechanical bowel obstruction and benefited from medical treatment.
However, despite a thorough preoperative work-up, including gastroscopy, colonoscopy and repeat CT-scan studies performed over 6 months, the mechanical origin of the bowel obstruction was difficult to demonstrate. Since the patient had chronic, cramp-like abdominal pain, the exploration of the abdominal cavity using the former port entry sites is decided upon.
Laparoscopic right hepatectomy for colorectal liver metastases
Major anatomical liver resections, initially considered to be unsuitable for laparoscopy, are increasingly reported by several centers worldwide. It is widely accepted that standards of open liver surgery should not be compromised during laparoscopic interventions. The video describes a totally laparoscopic right hepatectomy in an adipose patient (BMI of 44) for metastases of a rectal carcinoma.
24 months after sphincter-preserving radical rectal resection with TME (ypT3, ypN 0 (0/20), M0), metastases of the right liver were diagnosed during routine follow-up. According to MRI, endoscopy and PET-scan, metastases were limited to the right liver.
The procedure includes the following steps: positioning of the adipose patient, intermittent pneumatic calf compression for prevention of deep vein thrombosis, trocar placement, explorative laparoscopy, intraoperative diagnostic ultrasound, cholecystectomy, mobilization of the right liver, preparation of the hepatoduodenal ligament without Pringle’s maneuver, dissection and ligation of the right hepatic artery, right portal branch, and right hepatic duct, parenchymal dissection with ultrasonic surgical aspirator, a bipolar vessel-sealing device, vascular stapler only for larger vessels, ligation of right hepatic vein, sealing of the resection surface with bipolar coagulation, Argon beamer and fibrin glue, extraction of the resected specimen.
During surgery, the central venous pressure was kept low, no blood transfusions were performed and the postoperative course was uneventful. The pathological findings confirmed metastases of an adenocarcinoma with a maximal diameter of 6cm and clear resection margins. The patient was discharged 8 days after resection.
Laparoscopic right hepatectomy was carried out without compromising surgical principles established for open surgery. It is demonstrated that laparoscopic equipment such as intraoperative ultrasound, ultrasonic surgical aspirator, bipolar and Argon beamer coagulation and fibrin glue sealing can be used to their fullest extent. However, proficiency in both open liver surgery and advanced laparoscopy is compulsory.
M Schön
Surgical intervention
8 years ago
8701 views
31 likes
2 comments
16:10
Laparoscopic right hepatectomy for colorectal liver metastases
Major anatomical liver resections, initially considered to be unsuitable for laparoscopy, are increasingly reported by several centers worldwide. It is widely accepted that standards of open liver surgery should not be compromised during laparoscopic interventions. The video describes a totally laparoscopic right hepatectomy in an adipose patient (BMI of 44) for metastases of a rectal carcinoma.
24 months after sphincter-preserving radical rectal resection with TME (ypT3, ypN 0 (0/20), M0), metastases of the right liver were diagnosed during routine follow-up. According to MRI, endoscopy and PET-scan, metastases were limited to the right liver.
The procedure includes the following steps: positioning of the adipose patient, intermittent pneumatic calf compression for prevention of deep vein thrombosis, trocar placement, explorative laparoscopy, intraoperative diagnostic ultrasound, cholecystectomy, mobilization of the right liver, preparation of the hepatoduodenal ligament without Pringle’s maneuver, dissection and ligation of the right hepatic artery, right portal branch, and right hepatic duct, parenchymal dissection with ultrasonic surgical aspirator, a bipolar vessel-sealing device, vascular stapler only for larger vessels, ligation of right hepatic vein, sealing of the resection surface with bipolar coagulation, Argon beamer and fibrin glue, extraction of the resected specimen.
During surgery, the central venous pressure was kept low, no blood transfusions were performed and the postoperative course was uneventful. The pathological findings confirmed metastases of an adenocarcinoma with a maximal diameter of 6cm and clear resection margins. The patient was discharged 8 days after resection.
Laparoscopic right hepatectomy was carried out without compromising surgical principles established for open surgery. It is demonstrated that laparoscopic equipment such as intraoperative ultrasound, ultrasonic surgical aspirator, bipolar and Argon beamer coagulation and fibrin glue sealing can be used to their fullest extent. However, proficiency in both open liver surgery and advanced laparoscopy is compulsory.
Minimally invasive Ivor Lewis esophagectomy for cancer
Minimally invasive Ivor Lewis esophagectomy is technically challenging but feasible in experienced minimally invasive surgery centers. This video illustrates the surgical approach of an Ivor-Lewis esophagectomy. This surgery was carried out in a patient presenting with a type 2 cardia tumor according to Siewert’s classification. The preoperative workup confirmed the presence of an adenocarcinoma with locoregional lymph nodes. After neoadjuvant chemotherapy, a massive melt of the tumor was evidenced without any residual lesion or any local or distant metastasis. In this context, a curative resection has been proposed. Considering the tumor’s type, a resection combining an abdominal with a thoracic approach was decided upon.
B Dallemagne, J Marescaux
Surgical intervention
8 years ago
2828 views
224 likes
0 comments
18:46
Minimally invasive Ivor Lewis esophagectomy for cancer
Minimally invasive Ivor Lewis esophagectomy is technically challenging but feasible in experienced minimally invasive surgery centers. This video illustrates the surgical approach of an Ivor-Lewis esophagectomy. This surgery was carried out in a patient presenting with a type 2 cardia tumor according to Siewert’s classification. The preoperative workup confirmed the presence of an adenocarcinoma with locoregional lymph nodes. After neoadjuvant chemotherapy, a massive melt of the tumor was evidenced without any residual lesion or any local or distant metastasis. In this context, a curative resection has been proposed. Considering the tumor’s type, a resection combining an abdominal with a thoracic approach was decided upon.
Single incision right nephrectomy for severe hydrophrenosis in a transplanted patient
Laparoscopy is becoming the "gold standard" approach for nephrectomy when treating different benign and malignant diseases as well as for living donor transplantation.
During the last few months in both experimental and clinical settings, new techniques such as Natural Orifice Transluminal Endoscopic Surgery (NOTES™) and Single Incision Laparoscopic Surgery (SILS) or Single Port Laparoscopic Surgery (SPLS) have been attempted in order to reduce even more the surgical trauma in laparo-endoscopic procedures.
SPLS allows to perform different surgical procedures using the umbilicus as the only site to access the abdominal cavity and, by using special trocars and instruments, to perform the operation using the same techniques and principles of standard laparoscopic surgery.
The video describes our personal technique for totally single incision right nephrectomy for severe hydronephrosis in a patient who has undergone a kidney transplant a few years earlier.
A 62-year-old patient underwent a kidney transplant 5 years earlier due to a renal failure caused by a glomerular nephritis. The native kidneys were left in place.
Several admissions of patients presenting with recurrent sepsis were reported to the infectious disease department.
Recurrent sepsis was likely to be caused by the hydronephrosis induced by a large stone located in the middle part of the ureter.
The abdominal MRI showed the severe hydronephrosis of the native right kidney as well as a large stone.
A single incision nephrectomy was performed with no complications and the patient’s postoperative course was uneventful.
L Boni, G Dionigi, E Cassinotti, M Di Giuseppe, E Colombo, L Giavarini, SM Tenconi, F Cantore, M Tozzi, R Dionigi
Surgical intervention
8 years ago
3801 views
34 likes
0 comments
10:10
Single incision right nephrectomy for severe hydrophrenosis in a transplanted patient
Laparoscopy is becoming the "gold standard" approach for nephrectomy when treating different benign and malignant diseases as well as for living donor transplantation.
During the last few months in both experimental and clinical settings, new techniques such as Natural Orifice Transluminal Endoscopic Surgery (NOTES™) and Single Incision Laparoscopic Surgery (SILS) or Single Port Laparoscopic Surgery (SPLS) have been attempted in order to reduce even more the surgical trauma in laparo-endoscopic procedures.
SPLS allows to perform different surgical procedures using the umbilicus as the only site to access the abdominal cavity and, by using special trocars and instruments, to perform the operation using the same techniques and principles of standard laparoscopic surgery.
The video describes our personal technique for totally single incision right nephrectomy for severe hydronephrosis in a patient who has undergone a kidney transplant a few years earlier.
A 62-year-old patient underwent a kidney transplant 5 years earlier due to a renal failure caused by a glomerular nephritis. The native kidneys were left in place.
Several admissions of patients presenting with recurrent sepsis were reported to the infectious disease department.
Recurrent sepsis was likely to be caused by the hydronephrosis induced by a large stone located in the middle part of the ureter.
The abdominal MRI showed the severe hydronephrosis of the native right kidney as well as a large stone.
A single incision nephrectomy was performed with no complications and the patient’s postoperative course was uneventful.
Arthroscopic radial styloidectomy: technique, indication, results
The first case of arthroscopic radial styloidectomy was reported by Ruch in 1998.
Indications of radial styloidectomy are relative to radioscaphoidal impingement without alteration of the mid-carpal joint by degenerative arthritis (SNAC and SLAC stage 1 and 2). Pseudarthrosis of the radial styloid is another rare indication of radial styloidectomy.
The quantity of radius to remove was evaluated in different studies between 3 and 4mm. Removing more than 4mm of radius may lead to a destabilization of the wrist due to the insertion of ligaments on the anterior marginal part of the radius. No case of carpal destabilization after radial styloidectomy was reported in the literature.
The design of osteotomy may be different depending on the origin of the conflict. SNAC and SLAC lead to different kinds of arthritis and impingement.
Arthrocopy is a very useful tool to carry out radial styloidectomy; it is a minimally invasive procedure with the possibility of early rehabilitation. In case of poor results, there is still a place for open surgery.
To better visualize the expert's powerpoint presentation, please click here.
JM Cognet
Lecture
8 years ago
356 views
2 likes
0 comments
12:16
Arthroscopic radial styloidectomy: technique, indication, results
The first case of arthroscopic radial styloidectomy was reported by Ruch in 1998.
Indications of radial styloidectomy are relative to radioscaphoidal impingement without alteration of the mid-carpal joint by degenerative arthritis (SNAC and SLAC stage 1 and 2). Pseudarthrosis of the radial styloid is another rare indication of radial styloidectomy.
The quantity of radius to remove was evaluated in different studies between 3 and 4mm. Removing more than 4mm of radius may lead to a destabilization of the wrist due to the insertion of ligaments on the anterior marginal part of the radius. No case of carpal destabilization after radial styloidectomy was reported in the literature.
The design of osteotomy may be different depending on the origin of the conflict. SNAC and SLAC lead to different kinds of arthritis and impingement.
Arthrocopy is a very useful tool to carry out radial styloidectomy; it is a minimally invasive procedure with the possibility of early rehabilitation. In case of poor results, there is still a place for open surgery.
To better visualize the expert's powerpoint presentation, please click here.