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Monthly publications

#April 2011
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Video-assisted thoracoscopic (VATS) lobectomy: right upper lobe
Standard treatment of early-stage non-small cell lung cancer involves anatomic pulmonary lobectomy and mediastinal lymph node dissection. Traditionally, this procedure has been carried out via posterolateral thoracotomy, requiring division of chest wall muscles and rib spreading. This is frequently associated with chronic postoperative pain, which may become incapacitating in 5% of patients.

One of the major potential advantages of video-assisted thoracoscopic (VATS) lobectomy is decreasing the incidence of chronic post-thoracotomy pain.

Key aspects of the procedure include:
- proper patient positioning;
- access to the pleural cavity and appropriate positioning of operating incisions*;
- careful dissection of pulmonary arterial branches, using a “fissure-sparing” technique whenever possible to decrease the incidence of prolonged postoperative air leaks;
- division of lung parenchyma, blood vessels, and bronchus using endoscopic staplers.

The VATS approach can be carried out with similar morbidity and similar oncologic outcome to traditional open surgery. We present VATS lobectomy for neuro-endocrine carcinoma of the right upper lobe in a 71-year-old patient (the video emphasizes the steps of lobe resection —mediastinal lymph node dissection was effected, but is not shown).
Acknowledgment: we would like to thank Nathalie Leroux RN, Francine Martin RN, and Mélodie Leclerc RN for their continued support.
*The figure used to illustrate the positioning of operating incisions was adapted with permission from: «Handbook of perioperative care in general thoracic surgery», Deslauriers J, Mehran R, eds. Positioning and incisions, pages 206-227, fig 5-19, Copyright Elsevier, 2005.
G Rakovich, D Ouellette, G Beauchamp
Surgical intervention
7 years ago
633 views
93 likes
0 comments
08:01
Video-assisted thoracoscopic (VATS) lobectomy: right upper lobe
Standard treatment of early-stage non-small cell lung cancer involves anatomic pulmonary lobectomy and mediastinal lymph node dissection. Traditionally, this procedure has been carried out via posterolateral thoracotomy, requiring division of chest wall muscles and rib spreading. This is frequently associated with chronic postoperative pain, which may become incapacitating in 5% of patients.

One of the major potential advantages of video-assisted thoracoscopic (VATS) lobectomy is decreasing the incidence of chronic post-thoracotomy pain.

Key aspects of the procedure include:
- proper patient positioning;
- access to the pleural cavity and appropriate positioning of operating incisions*;
- careful dissection of pulmonary arterial branches, using a “fissure-sparing” technique whenever possible to decrease the incidence of prolonged postoperative air leaks;
- division of lung parenchyma, blood vessels, and bronchus using endoscopic staplers.

The VATS approach can be carried out with similar morbidity and similar oncologic outcome to traditional open surgery. We present VATS lobectomy for neuro-endocrine carcinoma of the right upper lobe in a 71-year-old patient (the video emphasizes the steps of lobe resection —mediastinal lymph node dissection was effected, but is not shown).
Acknowledgment: we would like to thank Nathalie Leroux RN, Francine Martin RN, and Mélodie Leclerc RN for their continued support.
*The figure used to illustrate the positioning of operating incisions was adapted with permission from: «Handbook of perioperative care in general thoracic surgery», Deslauriers J, Mehran R, eds. Positioning and incisions, pages 206-227, fig 5-19, Copyright Elsevier, 2005.
Laparoscopic anterior rectopexy for rectal prolapse
This video demonstrates the technique and steps required to perform a laparoscopic anterior rectopexy for the successful treatment of rectal prolapse. The treatment of rectal prolapse with a laparoscopic trans-abdominal approach is well-established and has resulted in reduced morbidity and shorter hospital stay. It is also well-tolerated in the elderly and shows an improvement in incontinence and a low recurrence rate. This procedure can be enhanced by using a purely anterior (ventral) approach. The dissection is kept anterior to the rectum, by opening the rectovaginal septum and then continuing down to the pelvic floor where a mesh rectopexy is then performed. This avoids posterior rectal dissection and spares the autonomic pelvic nerves; it keeps morbidity low and improves constipation.
J Saunders, P Thomas, K Badrinath
Surgical intervention
7 years ago
13106 views
229 likes
1 comment
06:56
Laparoscopic anterior rectopexy for rectal prolapse
This video demonstrates the technique and steps required to perform a laparoscopic anterior rectopexy for the successful treatment of rectal prolapse. The treatment of rectal prolapse with a laparoscopic trans-abdominal approach is well-established and has resulted in reduced morbidity and shorter hospital stay. It is also well-tolerated in the elderly and shows an improvement in incontinence and a low recurrence rate. This procedure can be enhanced by using a purely anterior (ventral) approach. The dissection is kept anterior to the rectum, by opening the rectovaginal septum and then continuing down to the pelvic floor where a mesh rectopexy is then performed. This avoids posterior rectal dissection and spares the autonomic pelvic nerves; it keeps morbidity low and improves constipation.
Pure NOTES: Transvaginal tubal sterilization with flexible endoscope
Tubal sterilization is a permanent method of contraception, performed using several current approaches, including laparotomy, mini-laparotomy, colpotomy, laparoscopy and hysteroscopy. Two new approaches, LESS and transgastric or transvaginal NOTES, are being used today. This video shows our surgical technique for pure NOTES transvaginal sterilization. Tubal sterilization is a permanent method of contraception, performed using several current approaches, including laparotomy, mini-laparotomy, colpotomy, laparoscopy and hysteroscopy. Two new approaches, LESS and transgastric or transvaginal NOTES, are being used today. This video shows our surgical technique for pure NOTES transvaginal sterilization. The patient is 32 years old with a history of one previous vaginal delivery and one previous cesarean delivery. Her BMI is 20. The procedure was fully explained to the patient and written consent was obtained.
J Mejías, H Almau, P Rosales, R de la Fuente, N García, C Bravo
Surgical intervention
7 years ago
413 views
13 likes
0 comments
07:05
Pure NOTES: Transvaginal tubal sterilization with flexible endoscope
Tubal sterilization is a permanent method of contraception, performed using several current approaches, including laparotomy, mini-laparotomy, colpotomy, laparoscopy and hysteroscopy. Two new approaches, LESS and transgastric or transvaginal NOTES, are being used today. This video shows our surgical technique for pure NOTES transvaginal sterilization. Tubal sterilization is a permanent method of contraception, performed using several current approaches, including laparotomy, mini-laparotomy, colpotomy, laparoscopy and hysteroscopy. Two new approaches, LESS and transgastric or transvaginal NOTES, are being used today. This video shows our surgical technique for pure NOTES transvaginal sterilization. The patient is 32 years old with a history of one previous vaginal delivery and one previous cesarean delivery. Her BMI is 20. The procedure was fully explained to the patient and written consent was obtained.