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Monthly publications

#November 2014
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Laparoscopic interval appendectomy after conservative treatment of an appendiceal abscess
Appendectomy is the standard treatment for acute appendicitis in adults and children. However, more and more studies demonstrate that a conservative treatment with antibiotics and radiological drainage, if required, is effective and may be of importance in complicated cases and in older frail patients [1].
In the absence of randomized controlled trials, there is no consensus on whether an appendectomy at distance from the acute phase (interval appendectomy) is necessary for conservatively treated patients. A large observational study has shown that about 10% of these patients will require an appendectomy [2] over a period of several years. However, a histopathological study of appendices removed during interval appendectomy after conservative management of pediatric patients with acute appendicitis with an inflammatory mass or abscess concluded that more than half of the patients had strong histopathological changes in the appendix, thereby suggesting a high possibility of recurrence [3].
This is the case of a 58-year-old female patient presenting with a perforated appendix with an appendiceal abscess, treated by antibiotherapy and radiological drainage. She has a past history of uterine cancer treated by radiochemotherapy and total hysterectomy, complicated by bilateral ureteral stenoses after radiotherapy, treated by long-term pig-tail urinary catheters, as well as a postoperative abdominal hernia treated by means of an abdominal underlay mesh. Even though the initial non-surgical treatment of her complicated acute appendicitis was successful, an interval appendectomy was indicated because of persistent abdominal pain in the right lower quadrant (RLQ). The operation was performed laparoscopically with a simple postoperative course.
References:
1. Tannoury J. Abboud B. Treatment options of inflammatory appendiceal masses in adults. World J Gastroenterol 2013;19:3942-50.
2. McCutcheon BA, Chang DC, Marcus LP, Inui T, Noorbakhsh A, Schallhorn C, Parina R, Salazar FR, Talamini MA. Long-term outcomes of patients with nonsurgically managed uncomplicated appendicitis. J Am Coll Surg 2014;218:905-13.
3. Otake S, Suzuki N, Takahashi A, Toki F, Nishi A, Yamamoto H, Kuroiwa M, Kuwano H. Histological analysis of appendices removed during interval appendectomy after conservative management of pediatric patients with acute appendicitis with an inflammatory mass or abscess. Surg Today 2014;44:1400-5.
D Ntourakis, D Mutter, J Marescaux
Surgical intervention
4 years ago
5068 views
166 likes
0 comments
12:12
Laparoscopic interval appendectomy after conservative treatment of an appendiceal abscess
Appendectomy is the standard treatment for acute appendicitis in adults and children. However, more and more studies demonstrate that a conservative treatment with antibiotics and radiological drainage, if required, is effective and may be of importance in complicated cases and in older frail patients [1].
In the absence of randomized controlled trials, there is no consensus on whether an appendectomy at distance from the acute phase (interval appendectomy) is necessary for conservatively treated patients. A large observational study has shown that about 10% of these patients will require an appendectomy [2] over a period of several years. However, a histopathological study of appendices removed during interval appendectomy after conservative management of pediatric patients with acute appendicitis with an inflammatory mass or abscess concluded that more than half of the patients had strong histopathological changes in the appendix, thereby suggesting a high possibility of recurrence [3].
This is the case of a 58-year-old female patient presenting with a perforated appendix with an appendiceal abscess, treated by antibiotherapy and radiological drainage. She has a past history of uterine cancer treated by radiochemotherapy and total hysterectomy, complicated by bilateral ureteral stenoses after radiotherapy, treated by long-term pig-tail urinary catheters, as well as a postoperative abdominal hernia treated by means of an abdominal underlay mesh. Even though the initial non-surgical treatment of her complicated acute appendicitis was successful, an interval appendectomy was indicated because of persistent abdominal pain in the right lower quadrant (RLQ). The operation was performed laparoscopically with a simple postoperative course.
References:
1. Tannoury J. Abboud B. Treatment options of inflammatory appendiceal masses in adults. World J Gastroenterol 2013;19:3942-50.
2. McCutcheon BA, Chang DC, Marcus LP, Inui T, Noorbakhsh A, Schallhorn C, Parina R, Salazar FR, Talamini MA. Long-term outcomes of patients with nonsurgically managed uncomplicated appendicitis. J Am Coll Surg 2014;218:905-13.
3. Otake S, Suzuki N, Takahashi A, Toki F, Nishi A, Yamamoto H, Kuroiwa M, Kuwano H. Histological analysis of appendices removed during interval appendectomy after conservative management of pediatric patients with acute appendicitis with an inflammatory mass or abscess. Surg Today 2014;44:1400-5.
Robot-assisted distal gastrectomy and D2 lymphadenectomy for early gastric cancer
We present the case of an early gastric cancer, which was located in the lower third of the stomach. The patient underwent a robot-assisted distal gastrectomy with D2 lymph node dissection. The da Vinci™ robotic system may provide some benefit to the operator in D2 dissection thanks to the articulating function of the arms, but the advantage for the patient has not been validated. The procedure was similar to a laparoscopic distal gastrectomy, starting from the omentectomy in the left side first and then the right side, followed by a lymphadenectomy around the infrapyloric and suprapyloric area. The lymphadenectomy is continued towards the suprapyloric area along the common hepatic artery and splenic artery, and the left gastric vein and artery are ligated. With a dissection of the lesser curvature aspect of the upper stomach, D2 dissection is completed “en bloc”.
HK Yang
Surgical intervention
4 years ago
1748 views
77 likes
0 comments
29:24
Robot-assisted distal gastrectomy and D2 lymphadenectomy for early gastric cancer
We present the case of an early gastric cancer, which was located in the lower third of the stomach. The patient underwent a robot-assisted distal gastrectomy with D2 lymph node dissection. The da Vinci™ robotic system may provide some benefit to the operator in D2 dissection thanks to the articulating function of the arms, but the advantage for the patient has not been validated. The procedure was similar to a laparoscopic distal gastrectomy, starting from the omentectomy in the left side first and then the right side, followed by a lymphadenectomy around the infrapyloric and suprapyloric area. The lymphadenectomy is continued towards the suprapyloric area along the common hepatic artery and splenic artery, and the left gastric vein and artery are ligated. With a dissection of the lesser curvature aspect of the upper stomach, D2 dissection is completed “en bloc”.
Endoscope-guided Nissen fundoplication
Gastroesophageal reflux (GERD) is a common and almost endemic problem in the Western world. Laparoscopic anti-reflux surgery is an effective and durable treatment for GERD in patients who are well-selected. Selection depends on a careful assessment of symptoms and a thorough physiologic evaluation with endoscopy, pH-monitoring and esophageal manometry. In more advanced and difficult cases, additional tests may be indicated. Cases encountered in practice range from straight forward and "everyday" to extremely complex and difficult; both in the decision-making, the operation, and the patient management. The common thread between all cases of anti-reflux surgery, complex or simple, is a stepwise and organized approach that takes into consideration the individual patient's disease and physiology. We present a case in this video that is not complex but which provides a good illustration of the technical steps required to recreate an effective gastroesophageal valve. We emphasize an atraumatic and efficient approach to the operation that ensures optimal outcomes and will minimize intraoperative complications. We discuss the characteristics of a properly formed fundoplication and debate with other experts some of the minor technical details such as suture patterns and materials. We also show how intraoperative endoscopy can serve as a powerful tool for quality control and postulate that surgeons can improve their results if they adopt routine interoperative control by endoscopy. We hope that you will enjoy and benefit from this case…
LL Swanström, A D'Urso, J Marescaux
Surgical intervention
4 years ago
2227 views
117 likes
0 comments
36:15
Endoscope-guided Nissen fundoplication
Gastroesophageal reflux (GERD) is a common and almost endemic problem in the Western world. Laparoscopic anti-reflux surgery is an effective and durable treatment for GERD in patients who are well-selected. Selection depends on a careful assessment of symptoms and a thorough physiologic evaluation with endoscopy, pH-monitoring and esophageal manometry. In more advanced and difficult cases, additional tests may be indicated. Cases encountered in practice range from straight forward and "everyday" to extremely complex and difficult; both in the decision-making, the operation, and the patient management. The common thread between all cases of anti-reflux surgery, complex or simple, is a stepwise and organized approach that takes into consideration the individual patient's disease and physiology. We present a case in this video that is not complex but which provides a good illustration of the technical steps required to recreate an effective gastroesophageal valve. We emphasize an atraumatic and efficient approach to the operation that ensures optimal outcomes and will minimize intraoperative complications. We discuss the characteristics of a properly formed fundoplication and debate with other experts some of the minor technical details such as suture patterns and materials. We also show how intraoperative endoscopy can serve as a powerful tool for quality control and postulate that surgeons can improve their results if they adopt routine interoperative control by endoscopy. We hope that you will enjoy and benefit from this case…
Collis Nissen procedure after lung transplantation and laparoscopic management of mediastinal hematoma
After lung transplantation, GERD causes inflammatory reactions, increasing risks for obliterating bronchiolitis and dysfunctioning graft. Authors first present a laparoscopic Collis Nissen procedure for hiatal hernia and severe esophagitis in a grafted patient. Because of a short esophagus despite extended dissection, a Collis gastroplasty is required. After stapling, cruroplasty is performed, finally followed by a Nissen fundoplication. In case of severe esophagitis, a difficult dissection and inflammatory tissues can lead to more complications such as leak, hemorrhage, slippage, and abscess. Mediastinal hematoma is diagnosed on postoperative day 9, mandating a redo emergency intervention. This rare complication will be managed laparoscopically.
B Dallemagne, S Perretta, HA Mercoli, L Marx, J Marescaux
Surgical intervention
4 years ago
1670 views
58 likes
1 comment
21:07
Collis Nissen procedure after lung transplantation and laparoscopic management of mediastinal hematoma
After lung transplantation, GERD causes inflammatory reactions, increasing risks for obliterating bronchiolitis and dysfunctioning graft. Authors first present a laparoscopic Collis Nissen procedure for hiatal hernia and severe esophagitis in a grafted patient. Because of a short esophagus despite extended dissection, a Collis gastroplasty is required. After stapling, cruroplasty is performed, finally followed by a Nissen fundoplication. In case of severe esophagitis, a difficult dissection and inflammatory tissues can lead to more complications such as leak, hemorrhage, slippage, and abscess. Mediastinal hematoma is diagnosed on postoperative day 9, mandating a redo emergency intervention. This rare complication will be managed laparoscopically.
Can robotic navigation simplify challenging revascularization and embolization procedures?
The Magellan™ robotic system is a peripheral interventional platform that has the potential to provide precise endovascular navigation and therapy delivery using 3D control of robotically steerable catheters and guidewires (1), fast and predictable procedures (1), vessel navigation with less trauma than manual approaches (2), catheter stability during delivery and placement of therapeutic devices, physician protection from radiation exposure and procedural fatigue. It is designed to easily integrate into the hybrid operating room and interventional lab.

Our department started the study with the Magellan™ robotic system in November 2012. Up until a hybrid room became available in our institution, the system was set up in a catheterization lab where we were not allowed to perform any cutdowns.

Our study included 35 patients, including treated iliac and femoral revascularizations in 19 and 2 cases respectively, internal iliac aneurysms in 4 cases, splenic aneurysms in 3 cases, renal angioplasties in 3 cases, EVAR for contralateral limb catheterization in 2 cases, subclavian artery recanalization in 1 case, and ovarian vein embolization in one case.
Regarding iliac revascularization, as for others (3), we found that the robotic system was valuable for long recanalizations of either the common or external iliac arteries, and for multiple stenting of the aorto-iliac tree (up to 4 stents in the same patient for reconstructions of both iliac bifurcations) with one femoral access.

Regarding iliac recanalization, the system allows to navigate inside the internal iliac artery aneurysmal sac, to perform embolizations of multiple branches, and also to close the proximal iliac neck of the internal iliac artery above an aneurysm, thereby avoiding coverage with an iliac covering stent.

In one case, we performed a distal gonadal vein embolization one day after renal vein transposition performed laparoscopically using the Da Vinci™ robot (4).

To conclude, our initial experience with challenging revascularization and embolization procedures demonstrated that robotic technology is both effective and safe in the iliac arterial tree. Although robotics provides superior maneuverability as compared to current techniques, the endovascular experience is crucial to take full benefit of extra capabilities.
References:
1. Bismuth J, Stankovic M, Gerzak B, Lumsden AM. The role of flexible robotics in overcoming navigation challenges in the iliofemoral arteries: a first in man study. 69th SVS Annual Meeting, June 2011. Chicago, USA.
2. Bismuth J, Kashef E, Cheshire N, Lumsden A. Feasibility and safety of remote endovascular catheter navigation in a porcine model. J Endovasc Ther 2011;18:243-9.
3. Bismuth J, Duran C, Stankovic M, Gersak B, Lumsden AB. A first-in-man study of the role of flexible robotics in overcoming navigation challenges in the iliofemoral arteries. J Vasc Surg 2013;57:14S-9S.
4. Thaveau F, Nicolini P, Lucereau B, Georg Y, Lejay A, Chakfé N. Associated Da Vinci and Magellan robotic systems for successful treatment of Nutcracker syndrome. J Laparoendos Adv Surg Tech, in correction.
N Chakfé
Lecture
4 years ago
85 views
5 likes
0 comments
11:20
Can robotic navigation simplify challenging revascularization and embolization procedures?
The Magellan™ robotic system is a peripheral interventional platform that has the potential to provide precise endovascular navigation and therapy delivery using 3D control of robotically steerable catheters and guidewires (1), fast and predictable procedures (1), vessel navigation with less trauma than manual approaches (2), catheter stability during delivery and placement of therapeutic devices, physician protection from radiation exposure and procedural fatigue. It is designed to easily integrate into the hybrid operating room and interventional lab.

Our department started the study with the Magellan™ robotic system in November 2012. Up until a hybrid room became available in our institution, the system was set up in a catheterization lab where we were not allowed to perform any cutdowns.

Our study included 35 patients, including treated iliac and femoral revascularizations in 19 and 2 cases respectively, internal iliac aneurysms in 4 cases, splenic aneurysms in 3 cases, renal angioplasties in 3 cases, EVAR for contralateral limb catheterization in 2 cases, subclavian artery recanalization in 1 case, and ovarian vein embolization in one case.
Regarding iliac revascularization, as for others (3), we found that the robotic system was valuable for long recanalizations of either the common or external iliac arteries, and for multiple stenting of the aorto-iliac tree (up to 4 stents in the same patient for reconstructions of both iliac bifurcations) with one femoral access.

Regarding iliac recanalization, the system allows to navigate inside the internal iliac artery aneurysmal sac, to perform embolizations of multiple branches, and also to close the proximal iliac neck of the internal iliac artery above an aneurysm, thereby avoiding coverage with an iliac covering stent.

In one case, we performed a distal gonadal vein embolization one day after renal vein transposition performed laparoscopically using the Da Vinci™ robot (4).

To conclude, our initial experience with challenging revascularization and embolization procedures demonstrated that robotic technology is both effective and safe in the iliac arterial tree. Although robotics provides superior maneuverability as compared to current techniques, the endovascular experience is crucial to take full benefit of extra capabilities.
References:
1. Bismuth J, Stankovic M, Gerzak B, Lumsden AM. The role of flexible robotics in overcoming navigation challenges in the iliofemoral arteries: a first in man study. 69th SVS Annual Meeting, June 2011. Chicago, USA.
2. Bismuth J, Kashef E, Cheshire N, Lumsden A. Feasibility and safety of remote endovascular catheter navigation in a porcine model. J Endovasc Ther 2011;18:243-9.
3. Bismuth J, Duran C, Stankovic M, Gersak B, Lumsden AB. A first-in-man study of the role of flexible robotics in overcoming navigation challenges in the iliofemoral arteries. J Vasc Surg 2013;57:14S-9S.
4. Thaveau F, Nicolini P, Lucereau B, Georg Y, Lejay A, Chakfé N. Associated Da Vinci and Magellan robotic systems for successful treatment of Nutcracker syndrome. J Laparoendos Adv Surg Tech, in correction.
Microvascular robotic assisted anastomosis of the brain
Robotic microsurgery is a new medical field which finds its place amongst medical specialties, since it applies to any that benefits from precision, tremor filtration and minimally invasive approaches.
Microsurgical techniques applied to robotic surgery are well-known and described in the medical literature, especially in urology, orthopedics, and hand surgery, traditional medical specialties which have some microsurgical procedures.
The objective of the author was to investigate a new and exciting field, which is robotic microneurosurgery.
Neurosurgery uses microsurgical techniques in every single procedure, from brain to spine surgery, demands very precise movements, has a very small and straight working space and still cannot access some parts of the brain.
It seems very reasonable that robotics can help the specialty which demands all that it can offer. Besides that, places known before as no man’s land can finally be approached.
This presentation shows the current state-of-the-art research in robotic microneurosurgery, including microvascular cerebral anastomosis.
PM Porto de Melo
Lecture
4 years ago
224 views
11 likes
0 comments
12:14
Microvascular robotic assisted anastomosis of the brain
Robotic microsurgery is a new medical field which finds its place amongst medical specialties, since it applies to any that benefits from precision, tremor filtration and minimally invasive approaches.
Microsurgical techniques applied to robotic surgery are well-known and described in the medical literature, especially in urology, orthopedics, and hand surgery, traditional medical specialties which have some microsurgical procedures.
The objective of the author was to investigate a new and exciting field, which is robotic microneurosurgery.
Neurosurgery uses microsurgical techniques in every single procedure, from brain to spine surgery, demands very precise movements, has a very small and straight working space and still cannot access some parts of the brain.
It seems very reasonable that robotics can help the specialty which demands all that it can offer. Besides that, places known before as no man’s land can finally be approached.
This presentation shows the current state-of-the-art research in robotic microneurosurgery, including microvascular cerebral anastomosis.
Interactive robotics: challenges for assistance, healthcare & service applications
We have designed a new high-performance integrated electro-hydraulic actuator (IEHA). We propose a new solution robotics question which has remained unanswered, to provide an efficient and compliant actuation. The proposed actuator, which is dedicated to independently motorizing each joint of a robotic system, is designed to be fixed as close as possible to the joint itself, thus enhancing performance while reducing the usual drawbacks of conventional hydraulic actuation. The novel IEHA contains an integrated micro-pump with a floating barrel, allowing the inversion of the flow direction without inverting the rotation of the input electric motor. The integration of a micro-valve and a rotary hydraulic distributor ensure the compactness of the proposed solution. In this paper, the proposed hydraulic actuation principle is first outlined in detail. The designed prototype and the first experiments are then presented, demonstrating the novelty and the efficiency of our solution.
FB Ben Ouezdou
Lecture
4 years ago
42 views
1 like
0 comments
18:11
Interactive robotics: challenges for assistance, healthcare & service applications
We have designed a new high-performance integrated electro-hydraulic actuator (IEHA). We propose a new solution robotics question which has remained unanswered, to provide an efficient and compliant actuation. The proposed actuator, which is dedicated to independently motorizing each joint of a robotic system, is designed to be fixed as close as possible to the joint itself, thus enhancing performance while reducing the usual drawbacks of conventional hydraulic actuation. The novel IEHA contains an integrated micro-pump with a floating barrel, allowing the inversion of the flow direction without inverting the rotation of the input electric motor. The integration of a micro-valve and a rotary hydraulic distributor ensure the compactness of the proposed solution. In this paper, the proposed hydraulic actuation principle is first outlined in detail. The designed prototype and the first experiments are then presented, demonstrating the novelty and the efficiency of our solution.
Assessment of robotic assisted microsurgical skills: lessons learned from microsurgery simulation training
In recent years, training and education in surgery has evolved from a Halstedian apprenticeship model to a competency-based training model. This shift in training has sparked a myriad of research in education and simulation in surgery. The need for good training in microsurgery is evidenced by improved outcomes of microvascular procedures in patients by more experienced surgeons.
To develop a competency based training program, objective assessment tools have to be perfected, in order to understand learning curves in microsurgical skill acquisition. Once stage-specific learning curves in microsurgical skill acquisition have been developed, safe clinical thresholds can be identified to ensure that skills acquired in the simulation lab setting can be safely translated to the clinical setting. These same principles can be applied in developing a competency-based program for robotic microsurgery.
S Ramachandran
Lecture
4 years ago
98 views
2 likes
0 comments
10:14
Assessment of robotic assisted microsurgical skills: lessons learned from microsurgery simulation training
In recent years, training and education in surgery has evolved from a Halstedian apprenticeship model to a competency-based training model. This shift in training has sparked a myriad of research in education and simulation in surgery. The need for good training in microsurgery is evidenced by improved outcomes of microvascular procedures in patients by more experienced surgeons.
To develop a competency based training program, objective assessment tools have to be perfected, in order to understand learning curves in microsurgical skill acquisition. Once stage-specific learning curves in microsurgical skill acquisition have been developed, safe clinical thresholds can be identified to ensure that skills acquired in the simulation lab setting can be safely translated to the clinical setting. These same principles can be applied in developing a competency-based program for robotic microsurgery.
Laparoscopic diamond-shaped repair of duodenal atresia
This is the case of a female newborn weighing 1080 grams, delivered at 29 weeks of gestational age due to the premature rupture of membranes. An abdominal radiography was performed in the clinical setting of non-bilious vomiting and absence of meconium passage. It revealed the double bubble sign, pathognomonic for congenital duodenal obstruction. Laparoscopy showed a type I duodenal atresia and a diamond-shaped duodenal anastomosis was performed maintaining the minimally invasive approach. Duodenal atresia represents one of the most challenging conditions for a laparoscopic skilled pediatric surgeon. This video shows that the procedure is feasible even in a low-birth-weight (LBW) premature newborn.
J Correia-Pinto, AR Silva, V Trocado
Surgical intervention
4 years ago
989 views
28 likes
0 comments
08:31
Laparoscopic diamond-shaped repair of duodenal atresia
This is the case of a female newborn weighing 1080 grams, delivered at 29 weeks of gestational age due to the premature rupture of membranes. An abdominal radiography was performed in the clinical setting of non-bilious vomiting and absence of meconium passage. It revealed the double bubble sign, pathognomonic for congenital duodenal obstruction. Laparoscopy showed a type I duodenal atresia and a diamond-shaped duodenal anastomosis was performed maintaining the minimally invasive approach. Duodenal atresia represents one of the most challenging conditions for a laparoscopic skilled pediatric surgeon. This video shows that the procedure is feasible even in a low-birth-weight (LBW) premature newborn.
Robotic left adrenalectomy for Conn's syndrome
Introduction: Since the first robotic adrenalectomy by Piazza et al. in 1999, using both the ZEUS and AESOP systems, numerous series and case reports have been published describing both left and right adrenalectomies using both transperitoneal and retroperitoneal approaches. These studies demonstrate that the robotic approach is feasible and safe.
Methods: This is the case of a 43-year-old female patient who presented with weakness, muscular cramps and systemic arterial hypertension. Her blood tests revealed a high Na++, low K+, very low renin (inhibited) and high aldosterone dose levels. A CT-scan showed a unique adenoma within 2.6cm at the left adrenal gland. She was diagnosed with Conn’s syndrome.
Results: In this video showing a robotic left adrenalectomy, the patient was placed in a left lateral decubitus, jack-knife position. Four robotic arms were used. Dissection was performed by means of scissors and of a bipolar fenestrated forceps. Operative time took 95 minutes. No measurable bleeding was observed. No UCI stay was necessary and the patient was discharged 24 hours after the intervention.
Conclusion: In this case, adrenal surgery was performed using a robotic approach, which demonstrated that the procedure was feasible, safe, with a low morbidity and a short hospital stay.
Fe Madureira, Fa Madureira, E Parra-Davila, D Madureira
Surgical intervention
4 years ago
1611 views
63 likes
0 comments
08:20
Robotic left adrenalectomy for Conn's syndrome
Introduction: Since the first robotic adrenalectomy by Piazza et al. in 1999, using both the ZEUS and AESOP systems, numerous series and case reports have been published describing both left and right adrenalectomies using both transperitoneal and retroperitoneal approaches. These studies demonstrate that the robotic approach is feasible and safe.
Methods: This is the case of a 43-year-old female patient who presented with weakness, muscular cramps and systemic arterial hypertension. Her blood tests revealed a high Na++, low K+, very low renin (inhibited) and high aldosterone dose levels. A CT-scan showed a unique adenoma within 2.6cm at the left adrenal gland. She was diagnosed with Conn’s syndrome.
Results: In this video showing a robotic left adrenalectomy, the patient was placed in a left lateral decubitus, jack-knife position. Four robotic arms were used. Dissection was performed by means of scissors and of a bipolar fenestrated forceps. Operative time took 95 minutes. No measurable bleeding was observed. No UCI stay was necessary and the patient was discharged 24 hours after the intervention.
Conclusion: In this case, adrenal surgery was performed using a robotic approach, which demonstrated that the procedure was feasible, safe, with a low morbidity and a short hospital stay.
Full laparoscopic pediatric 2-port gastrostomy using the U-stitch technique
This video illustrates a 2-port laparoscopic technique for gastrostomy button placement in a 2-year-old boy with spastic quadriparesis secondary to prolonged cardiorespiratory arrest and hypothermia.
The laparoscopic approach for G-tube or G-button placement offers several advantages when compared to the percutaneous technique such as:
- an accurate choice of the site for tube placement (both on the gastric and on the abdominal wall);
- allows direct placement of a G-button, thus avoiding the need of an intragastric bumper and of a second anesthesia for its removal;
- additionally, it allows for blunt or sharp adhesiolysis when needed as for example in cases of previous abdominal surgery or when a ventriculoperitoneal shunt is in place.
The procedure is easily accomplished and requires a short learning curve to be reproduced. Additionally, it proves safer than the percutaneous techique particularly in patients with distorted anatomy due to kyphoscoliosis or visceromegaly, which entail the risk of injury to interposed organs.
L Nanni, VF Paradiso, A Inserra
Surgical intervention
4 years ago
1111 views
24 likes
0 comments
06:25
Full laparoscopic pediatric 2-port gastrostomy using the U-stitch technique
This video illustrates a 2-port laparoscopic technique for gastrostomy button placement in a 2-year-old boy with spastic quadriparesis secondary to prolonged cardiorespiratory arrest and hypothermia.
The laparoscopic approach for G-tube or G-button placement offers several advantages when compared to the percutaneous technique such as:
- an accurate choice of the site for tube placement (both on the gastric and on the abdominal wall);
- allows direct placement of a G-button, thus avoiding the need of an intragastric bumper and of a second anesthesia for its removal;
- additionally, it allows for blunt or sharp adhesiolysis when needed as for example in cases of previous abdominal surgery or when a ventriculoperitoneal shunt is in place.
The procedure is easily accomplished and requires a short learning curve to be reproduced. Additionally, it proves safer than the percutaneous techique particularly in patients with distorted anatomy due to kyphoscoliosis or visceromegaly, which entail the risk of injury to interposed organs.