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Monthly publications

#July 2013
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Typical laparoscopic four-trocar transabdominal adrenalectomy for a 5cm right-sided pheochromocytoma
This is the case of a female patient presenting with a typical 5cm right-sided pheochromocytoma was operated on laparoscopically. Preoperative 3D MRI reconstruction allowed to precisely identify surgical landmarks. The procedure was carried out typically. Four ports were used, and dissection aimed to first mobilize the liver. Control of the main adrenal vein was achieved as the first operative step. Medial, superior, and inferior arteries were dissected and controlled successively. Total freeing of the gland was performed with no manipulation or effraction of the gland's capsule. The postoperative course was uneventful. Small-sized pheochromocytomas are excellent indications for a laparoscopic approach with early control of the vein.
D Mutter, M Vix, L Soler, J Marescaux
Surgical intervention
5 years ago
3179 views
77 likes
0 comments
23:50
Typical laparoscopic four-trocar transabdominal adrenalectomy for a 5cm right-sided pheochromocytoma
This is the case of a female patient presenting with a typical 5cm right-sided pheochromocytoma was operated on laparoscopically. Preoperative 3D MRI reconstruction allowed to precisely identify surgical landmarks. The procedure was carried out typically. Four ports were used, and dissection aimed to first mobilize the liver. Control of the main adrenal vein was achieved as the first operative step. Medial, superior, and inferior arteries were dissected and controlled successively. Total freeing of the gland was performed with no manipulation or effraction of the gland's capsule. The postoperative course was uneventful. Small-sized pheochromocytomas are excellent indications for a laparoscopic approach with early control of the vein.
Robot-assisted mini gastric bypass in a patient with a huge liver
This video demonstrates our mini gastric bypass technique using the da Vinci™ robotic surgical system. This intervention may be suggested in all morbidly obese patients without any major gastroesophageal reflux. One of the interests of this film lies in that the patient has a huge liver requiring delicate dissection and division of the superior gastric pouch. The biliary loop typically measures 200cm, and we systematically close Petersen’s defect in order to prevent internal hernias. The use of the surgical robot allows to perform an easier hand-assisted gastrojejunostomy. None of the preparatory maneuvers rely on the surgical robot as it is currently not equipped with mechanical staplers.
M Vix, J Marescaux
Surgical intervention
5 years ago
2072 views
10 likes
0 comments
15:19
Robot-assisted mini gastric bypass in a patient with a huge liver
This video demonstrates our mini gastric bypass technique using the da Vinci™ robotic surgical system. This intervention may be suggested in all morbidly obese patients without any major gastroesophageal reflux. One of the interests of this film lies in that the patient has a huge liver requiring delicate dissection and division of the superior gastric pouch. The biliary loop typically measures 200cm, and we systematically close Petersen’s defect in order to prevent internal hernias. The use of the surgical robot allows to perform an easier hand-assisted gastrojejunostomy. None of the preparatory maneuvers rely on the surgical robot as it is currently not equipped with mechanical staplers.
Laparoscopic resection of gastric gastrointestinal stromal tumours
We demonstrate two minimally invasive approaches for the management of gastric gastrointestinal stromal tumours (GIST). GISTs are the most common mesenchymal neoplasms of the gastroinstestinal tract. About 50% of GISTs are located in the stomach which makes it the most frequent location. GISTs can be totally intraluminal or extraluminal. In this film, we demonstrate two approaches for the removal of gastric GIST, depending upon the site of tumour. The majority of patients are diagnosed incidentally or present with vague symptoms. GISTs can also present with upper gastrointestinal bleeding as in our first case. We demonstrate that laparoscopic GIST resection is safe and effective.
SA Naqi, S Rajendran, M Arumugasamy
Surgical intervention
5 years ago
3434 views
91 likes
1 comment
13:47
Laparoscopic resection of gastric gastrointestinal stromal tumours
We demonstrate two minimally invasive approaches for the management of gastric gastrointestinal stromal tumours (GIST). GISTs are the most common mesenchymal neoplasms of the gastroinstestinal tract. About 50% of GISTs are located in the stomach which makes it the most frequent location. GISTs can be totally intraluminal or extraluminal. In this film, we demonstrate two approaches for the removal of gastric GIST, depending upon the site of tumour. The majority of patients are diagnosed incidentally or present with vague symptoms. GISTs can also present with upper gastrointestinal bleeding as in our first case. We demonstrate that laparoscopic GIST resection is safe and effective.
Laparoscopic repair of a large right-sided Morgagni’s hernia
Morgagni’s hernias are rare congenital anterior diaphragmatic hernias for which the optimal method of repair is unknown. This video presents a morbidly obese woman with oxygen-dependent chronic obstructive pulmonary disease (COPD) along with a Morgagni’s hernia that compresses her entire right lung. Omentum and colon are seen herniating through the 10 by 15 centimeter defect. Through a laparoscopic approach, the intra-abdominal contents were reduced, the defect primarily closed, and reinforced with mesh. After the repair, the patient had significant improvements in her pulmonary status. Laparoscopic repair with mesh reinforcement is a viable and easily accomplished approach for Morgagni’s hernia repair.
D Lawrence, YV Wu, MJ Rosen
Surgical intervention
5 years ago
3547 views
72 likes
1 comment
08:45
Laparoscopic repair of a large right-sided Morgagni’s hernia
Morgagni’s hernias are rare congenital anterior diaphragmatic hernias for which the optimal method of repair is unknown. This video presents a morbidly obese woman with oxygen-dependent chronic obstructive pulmonary disease (COPD) along with a Morgagni’s hernia that compresses her entire right lung. Omentum and colon are seen herniating through the 10 by 15 centimeter defect. Through a laparoscopic approach, the intra-abdominal contents were reduced, the defect primarily closed, and reinforced with mesh. After the repair, the patient had significant improvements in her pulmonary status. Laparoscopic repair with mesh reinforcement is a viable and easily accomplished approach for Morgagni’s hernia repair.
Suprapubic single incision laparoscopic left hemicolectomy (SILLH): an alternative to the umbilical access
Background: Single incision laparoscopy (SIL) has been described for colorectal surgery because it mainly provides an improved cosmetic outcome. A suprapubic access can be considered an alternative to the umbilical site for left hemicolectomy (LH) because the scar remains under the bikini line and can be considered cosmetically acceptable.

Video: A 61-year-old man was admitted to hospital for adenocarcinoma of the sigmoid colon; preoperative work-up did not show the presence of secondary lesions. A suprapubic SILLH was proposed to the patient. The technique consisted in performing the procedure through an initial 3.5cm skin incision, localized suprapubically, with the insertion of 3 reusable trocars vertically in a pararectal axis along with DAPRI curved reusable instruments (Karl Storz Endoskope, Tüttlingen, Germany). The vascular plane was firstly controlled by clips and, after mobilization of the entire left colon, the upper rectum was transected and the specimen was removed using the same access; a conventional circular transanal anastomosis was performed.

Results: Laparoscopic time was 119 minutes, estimated blood loss was 20cc, and the final scar length measured 4.5cm. Pathology confirmed the presence of a colon adenocarcinoma (pT2N0Mx). Postoperative pain was minimal, allowing the patient to be discharged on postoperative day 4.

Conclusions: Suprapubic SILLH offers the option to enlarge the skin incision according to the specimen’s size without any cosmetic damage, because it remains under the bikini line. The dissection plane appears in front of the access and postoperative pain remains minimal.
G Dapri
Surgical intervention
5 years ago
4179 views
29 likes
1 comment
08:07
Suprapubic single incision laparoscopic left hemicolectomy (SILLH): an alternative to the umbilical access
Background: Single incision laparoscopy (SIL) has been described for colorectal surgery because it mainly provides an improved cosmetic outcome. A suprapubic access can be considered an alternative to the umbilical site for left hemicolectomy (LH) because the scar remains under the bikini line and can be considered cosmetically acceptable.

Video: A 61-year-old man was admitted to hospital for adenocarcinoma of the sigmoid colon; preoperative work-up did not show the presence of secondary lesions. A suprapubic SILLH was proposed to the patient. The technique consisted in performing the procedure through an initial 3.5cm skin incision, localized suprapubically, with the insertion of 3 reusable trocars vertically in a pararectal axis along with DAPRI curved reusable instruments (Karl Storz Endoskope, Tüttlingen, Germany). The vascular plane was firstly controlled by clips and, after mobilization of the entire left colon, the upper rectum was transected and the specimen was removed using the same access; a conventional circular transanal anastomosis was performed.

Results: Laparoscopic time was 119 minutes, estimated blood loss was 20cc, and the final scar length measured 4.5cm. Pathology confirmed the presence of a colon adenocarcinoma (pT2N0Mx). Postoperative pain was minimal, allowing the patient to be discharged on postoperative day 4.

Conclusions: Suprapubic SILLH offers the option to enlarge the skin incision according to the specimen’s size without any cosmetic damage, because it remains under the bikini line. The dissection plane appears in front of the access and postoperative pain remains minimal.
Laparoscopic oophorectomy for solid ovarian mass
We present the case of a 28-year-old woman with no relevant previous surgical or medical history. The patient was addressed for the removal of a right ovarian mass. She presented with dysmenorrhea and occasional dyspareunia. There were no other symptoms. Her physical examination showed a right adnexal mass to the vaginal touch. Preoperative work-up included a pelvic ultrasound, which showed a tumor apparently originating from the right ovary, of solid homogeneous appearance. MRI confirmed the presence of the solid mass, measuring approximately 6cm. No other pathological findings were present in the rest of the abdominal cavity. Tumor markers were negative. The patient had not completed childbearing and desired a conservative surgical approach. The different aspects of the surgical management were explained, including the possibility of performing an oophorectomy if no healthy ovarian tissue could be identified.
A Wattiez, C Redondo Guisasola, M Puga, R Fernandes, J Alves
Surgical intervention
5 years ago
5012 views
79 likes
0 comments
08:33
Laparoscopic oophorectomy for solid ovarian mass
We present the case of a 28-year-old woman with no relevant previous surgical or medical history. The patient was addressed for the removal of a right ovarian mass. She presented with dysmenorrhea and occasional dyspareunia. There were no other symptoms. Her physical examination showed a right adnexal mass to the vaginal touch. Preoperative work-up included a pelvic ultrasound, which showed a tumor apparently originating from the right ovary, of solid homogeneous appearance. MRI confirmed the presence of the solid mass, measuring approximately 6cm. No other pathological findings were present in the rest of the abdominal cavity. Tumor markers were negative. The patient had not completed childbearing and desired a conservative surgical approach. The different aspects of the surgical management were explained, including the possibility of performing an oophorectomy if no healthy ovarian tissue could be identified.
Laparoscopic segmental resection in a patient with deep infiltrating endometriosis
We present the case of a 33-year-old-woman suffering from deep infiltrating endometriosis. In her previous history, three laparoscopies had been performed due to endometriosis. In the first two laparoscopies, bilateral ovarian cystectomies had been carried out while the third laparoscopy had been indicated to puncture the ovaries after hormonal stimulation for in vitro fertilization (IVF), due to the impossibility of reaching follicles transvaginally.
The patient presented with dysmenorrhea, dyspareunia and dyschezia, as well as rectorrhagia and diarrhea. The patient’s physical examination demonstrated the presence of a retrouterine mass suggestive of adhesions. Preoperative work-up included MRI and colonoscopy. MRI showed an endometriotic nodule affecting the rectosigmoid junction and infiltrating its wall. A colonoscopy was performed and allowed to visualize the endometriotic nodule.
A Wattiez, C Redondo Guisasola, M Puga, J Alves, R Fernandes
Surgical intervention
5 years ago
2580 views
30 likes
0 comments
18:50
Laparoscopic segmental resection in a patient with deep infiltrating endometriosis
We present the case of a 33-year-old-woman suffering from deep infiltrating endometriosis. In her previous history, three laparoscopies had been performed due to endometriosis. In the first two laparoscopies, bilateral ovarian cystectomies had been carried out while the third laparoscopy had been indicated to puncture the ovaries after hormonal stimulation for in vitro fertilization (IVF), due to the impossibility of reaching follicles transvaginally.
The patient presented with dysmenorrhea, dyspareunia and dyschezia, as well as rectorrhagia and diarrhea. The patient’s physical examination demonstrated the presence of a retrouterine mass suggestive of adhesions. Preoperative work-up included MRI and colonoscopy. MRI showed an endometriotic nodule affecting the rectosigmoid junction and infiltrating its wall. A colonoscopy was performed and allowed to visualize the endometriotic nodule.