We use cookies to offer you an optimal experience on our website. By browsing our website, you accept the use of cookies.

Monthly publications

#June 2015
Filter by
Clear filter Specialty
View more

Clear filter Media type
View more
Clear filter Category
View more
Laparoscopic Roux-en-Y gastric bypass: live demonstration and technical details
Roux-en-Y gastric bypass (RYGB) has become a common procedure for the management of morbid obesity. However, learning to perform such a procedure may be difficult as it is made up of very technical operative steps in complex cases of overweight patients with a great amount of adipose tissue. In order to prevent complications, an operative strategy should be adopted, allowing for an easy and rapid acquisition of the technique. Each step is perfectly mastered and outlined.
This video demonstrates a laparoscopic Roux-en-Y gastric bypass performed live, showing all the preoperative and operative patient settings. The surgical technique is thoroughly explained.
M Vix, M Nedelcu, HA Mercoli, D Mutter, J Marescaux
Surgical intervention
3 years ago
6894 views
191 likes
0 comments
28:09
Laparoscopic Roux-en-Y gastric bypass: live demonstration and technical details
Roux-en-Y gastric bypass (RYGB) has become a common procedure for the management of morbid obesity. However, learning to perform such a procedure may be difficult as it is made up of very technical operative steps in complex cases of overweight patients with a great amount of adipose tissue. In order to prevent complications, an operative strategy should be adopted, allowing for an easy and rapid acquisition of the technique. Each step is perfectly mastered and outlined.
This video demonstrates a laparoscopic Roux-en-Y gastric bypass performed live, showing all the preoperative and operative patient settings. The surgical technique is thoroughly explained.
Laparoscopic Roux-en-Y gastric bypass after gastric band removal
This video demonstrates the case of a 50-year-old woman with morbid obesity (BMI of 39). She had a gastric banding placed 7 years before, which became ineffective 3 years after the primary surgery, resulting in band removal 2 years ago.
A secondary bariatric surgery was scheduled, with the decision to perform a laparoscopic Roux-en-Y gastric bypass. This video shows the surgical technique, with special emphasis on dissection of the cardia and lesser curvature, where the anatomy is altered as a result of the previous band. An interesting technical point occurs during the creation of the jejunojejunostomy, where a perforation of the biliary loop is accidentally made during the EndoGIATM linear stapler introduction.
M Vix, C Lebares, M Ignat, D Mutter, J Marescaux
Surgical intervention
3 years ago
2033 views
58 likes
0 comments
32:11
Laparoscopic Roux-en-Y gastric bypass after gastric band removal
This video demonstrates the case of a 50-year-old woman with morbid obesity (BMI of 39). She had a gastric banding placed 7 years before, which became ineffective 3 years after the primary surgery, resulting in band removal 2 years ago.
A secondary bariatric surgery was scheduled, with the decision to perform a laparoscopic Roux-en-Y gastric bypass. This video shows the surgical technique, with special emphasis on dissection of the cardia and lesser curvature, where the anatomy is altered as a result of the previous band. An interesting technical point occurs during the creation of the jejunojejunostomy, where a perforation of the biliary loop is accidentally made during the EndoGIATM linear stapler introduction.
Robot-assisted Roux-en-Y gastric bypass after band removal
Patients ask for a new weight loss surgical procedure after gastric band removal due to a lack of efficiency or to complications. Although gastric banding is a reversible procedure, perigastric adhesions located mostly in the upper part of the stomach can make new approaches to this area difficult.
We report the case of a woman who benefited from a gastric banding in 2006. This gastric band was removed in 2010. The patient developed a left subphrenic abscess, which was drained under CT-scan control postoperatively.
Two years after this procedure, the patient wishes to benefit from a new weight loss surgical procedure as she gained 10Kg since her gastric band removal. She has a BMI of 40 and presents with respiratory and rheumatological co-morbidities.
The preoperative work-up was uneventful, and this is particularly true for the esogastroduodenal contrast exam and the gastroscopy.
During the procedure, multiple omental parietal adhesions were found, as well as tight adhesions between the liver, the stomach, and the left crus.
Dissecting the stomach using a conventional approach was made difficult by the presence of these adhesions, and we had to perform an upper pole gastrectomy of the greater curvature in order to clearly identify the gastroesophageal junction’s anatomy. A complete dissection of the left subcardial area is necessary in order to prevent the formation of an excessively large gastric pouch, which could lead to a regain in weight.
This video covers the whole procedure in detail and highlights dissection challenges, which can occur in patients who had their gastric band removed.
The postoperative outcome was uneventful in this woman, with a significant weight loss at one year.
M Vix, D Mutter, J Marescaux
Surgical intervention
3 years ago
1332 views
46 likes
0 comments
25:55
Robot-assisted Roux-en-Y gastric bypass after band removal
Patients ask for a new weight loss surgical procedure after gastric band removal due to a lack of efficiency or to complications. Although gastric banding is a reversible procedure, perigastric adhesions located mostly in the upper part of the stomach can make new approaches to this area difficult.
We report the case of a woman who benefited from a gastric banding in 2006. This gastric band was removed in 2010. The patient developed a left subphrenic abscess, which was drained under CT-scan control postoperatively.
Two years after this procedure, the patient wishes to benefit from a new weight loss surgical procedure as she gained 10Kg since her gastric band removal. She has a BMI of 40 and presents with respiratory and rheumatological co-morbidities.
The preoperative work-up was uneventful, and this is particularly true for the esogastroduodenal contrast exam and the gastroscopy.
During the procedure, multiple omental parietal adhesions were found, as well as tight adhesions between the liver, the stomach, and the left crus.
Dissecting the stomach using a conventional approach was made difficult by the presence of these adhesions, and we had to perform an upper pole gastrectomy of the greater curvature in order to clearly identify the gastroesophageal junction’s anatomy. A complete dissection of the left subcardial area is necessary in order to prevent the formation of an excessively large gastric pouch, which could lead to a regain in weight.
This video covers the whole procedure in detail and highlights dissection challenges, which can occur in patients who had their gastric band removed.
The postoperative outcome was uneventful in this woman, with a significant weight loss at one year.
Robot-assisted gastric band removal
Adjustable gastric banding (AGB) is one of the surgical treatment modalities for morbid obesity. Over the years, popularity for this treatment increased. It has been by far the most performed bariatric procedure for years in Europe and in the United States. Many gastric band removals are linked to complications and weight loss failure, indicating a new bariatric procedure for some of the patients. Complications after AGB are not uncommon and consist mainly of gastroesophageal reflux disease, pouch dilatation, slippage of the band, and intragastric migration. The failure of the gastric band is multifactorial. Gastric band removal does not preclude a new bariatric procedure (the most common procedure performed in our department is Roux en-Y gastric bypass), which is feasible in the same operative time but the 2-step approach is suitable. The new bariatric procedure offers adequate surgical outcomes and satisfactory results in terms of weight loss.
M Nedelcu, A D'Urso, HA Mercoli, M Vix, D Mutter, J Marescaux
Surgical intervention
3 years ago
1027 views
36 likes
0 comments
08:14
Robot-assisted gastric band removal
Adjustable gastric banding (AGB) is one of the surgical treatment modalities for morbid obesity. Over the years, popularity for this treatment increased. It has been by far the most performed bariatric procedure for years in Europe and in the United States. Many gastric band removals are linked to complications and weight loss failure, indicating a new bariatric procedure for some of the patients. Complications after AGB are not uncommon and consist mainly of gastroesophageal reflux disease, pouch dilatation, slippage of the band, and intragastric migration. The failure of the gastric band is multifactorial. Gastric band removal does not preclude a new bariatric procedure (the most common procedure performed in our department is Roux en-Y gastric bypass), which is feasible in the same operative time but the 2-step approach is suitable. The new bariatric procedure offers adequate surgical outcomes and satisfactory results in terms of weight loss.
Suprapubic single incision laparoscopic segmental small bowel resection including 3 different intracorporeal anastomoses
Background: Single incision laparoscopy (SIL) can be offered to young ladies presenting with malignant digestive tumors since they can undergo surgery through a suprapubic access, with a final non-visible result because it is under the bikini line.
Video: A 40-year-old woman presenting with an unknown anemia was admitted to our department. Preoperative work-up evidenced an adenocarcinoma of the small bowel at 120cm from the pylorus. A suprapubic SIL segmental small bowel resection was proposed to the patient. The procedure was performed with the surgeon standing between the patient’s legs, using three reusable ports placed above the pubic bone. Curved reusable instruments according to DAPRI (Karl Storz Endoskope, Tuttlingen, Germany) allowed surgeons to work in good ergonomic conditions, maintaining a low cost for SIL. For the insertion of the linear stapler, a temporary 5mm scope was used and the intestinal continuity was established by a completely intracorporeal manual end-to-end anastomosis. Another option is to perform a completely intracorporeal manual end-to-side anastomosis (especially in case of obstructive tumor) or a linear mechanical side-to-side anastomosis. The mesenteric window was closed. The specimen was extracted suprapubically with a wound protection once the three windows of the ports have been joined together.
Results: Laparoscopy took 160 minutes and perioperative bleeding was 20cc. No postoperative complications were noted and the use of minimal pain killers allowed for patient discharge after four days. Pathological findings demonstrated a poorly differentiated adenocarcinoma of the jejunum, with 17 negative nodes (pT3N0Mx). The postoperative follow-up, including blood tests and PET-scan, did not show any recurrence at 12 months.
Conclusions: In addition to the known advantages of conventional multiport laparoscopy, the SIL technique allows to offer satisfying oncological results in addition to a non-visible surgical scar, because it is localized under the bikini line. Additionally, abdominal trauma and the final scar length can be reduced, since they are related to the tumor’s size.
G Dapri, K Grozdev, GB Cadière
Surgical intervention
3 years ago
855 views
23 likes
0 comments
11:21
Suprapubic single incision laparoscopic segmental small bowel resection including 3 different intracorporeal anastomoses
Background: Single incision laparoscopy (SIL) can be offered to young ladies presenting with malignant digestive tumors since they can undergo surgery through a suprapubic access, with a final non-visible result because it is under the bikini line.
Video: A 40-year-old woman presenting with an unknown anemia was admitted to our department. Preoperative work-up evidenced an adenocarcinoma of the small bowel at 120cm from the pylorus. A suprapubic SIL segmental small bowel resection was proposed to the patient. The procedure was performed with the surgeon standing between the patient’s legs, using three reusable ports placed above the pubic bone. Curved reusable instruments according to DAPRI (Karl Storz Endoskope, Tuttlingen, Germany) allowed surgeons to work in good ergonomic conditions, maintaining a low cost for SIL. For the insertion of the linear stapler, a temporary 5mm scope was used and the intestinal continuity was established by a completely intracorporeal manual end-to-end anastomosis. Another option is to perform a completely intracorporeal manual end-to-side anastomosis (especially in case of obstructive tumor) or a linear mechanical side-to-side anastomosis. The mesenteric window was closed. The specimen was extracted suprapubically with a wound protection once the three windows of the ports have been joined together.
Results: Laparoscopy took 160 minutes and perioperative bleeding was 20cc. No postoperative complications were noted and the use of minimal pain killers allowed for patient discharge after four days. Pathological findings demonstrated a poorly differentiated adenocarcinoma of the jejunum, with 17 negative nodes (pT3N0Mx). The postoperative follow-up, including blood tests and PET-scan, did not show any recurrence at 12 months.
Conclusions: In addition to the known advantages of conventional multiport laparoscopy, the SIL technique allows to offer satisfying oncological results in addition to a non-visible surgical scar, because it is localized under the bikini line. Additionally, abdominal trauma and the final scar length can be reduced, since they are related to the tumor’s size.
Stomal prolapse and parastomal incisional hernia treatment using laparoscopic Sugarbaker modified technique with intraperitoneal onlay mesh repair
Introduction: Prolapse stands for one of the most common complications of colostomy (>10%). Parastomal incisional hernia also represents 10 to 50% of complications. When both are present, the Sugarbaker technique represents a good indication due to mesh repair and pseudo-subperitonization, which can manage both prolapse and hernia. The laparoscopic modified Sugarbaker technique can be performed laparoscopically even in case of multiple previous laparotomies.
Clinical case: We report the case of a 71-year-old male patient presenting with parastomal incisional hernia and stomal prolapse after multiple abdominal procedures for ulcerative colitis, including rectosigmoidectomy, Hartmann procedure for anastomotic leak, left extended colectomy and stomal transposition for ischemic necrosis. An intra-abdominal proctectomy was attempted to manage the recurrence of colitis on the rectal stump. However, this attempt proved unsuccessful, and a local abdominoperineal resection was performed. Due to symptomatic hernia and prolapse, the laparoscopic Sugarbaker modified surgical technique with intraperitoneal onlay mesh (IPOM) repair is performed to manage prolapse by pseudo-subperitonization and to manage hernia using an IPOM repair. As shown in this video, this technique is safe, reproducible, and effective.
J Leroy, HA Mercoli, S Tzedakis, A D'Urso, D Mutter, J Marescaux
Surgical intervention
3 years ago
2130 views
98 likes
0 comments
10:54
Stomal prolapse and parastomal incisional hernia treatment using laparoscopic Sugarbaker modified technique with intraperitoneal onlay mesh repair
Introduction: Prolapse stands for one of the most common complications of colostomy (>10%). Parastomal incisional hernia also represents 10 to 50% of complications. When both are present, the Sugarbaker technique represents a good indication due to mesh repair and pseudo-subperitonization, which can manage both prolapse and hernia. The laparoscopic modified Sugarbaker technique can be performed laparoscopically even in case of multiple previous laparotomies.
Clinical case: We report the case of a 71-year-old male patient presenting with parastomal incisional hernia and stomal prolapse after multiple abdominal procedures for ulcerative colitis, including rectosigmoidectomy, Hartmann procedure for anastomotic leak, left extended colectomy and stomal transposition for ischemic necrosis. An intra-abdominal proctectomy was attempted to manage the recurrence of colitis on the rectal stump. However, this attempt proved unsuccessful, and a local abdominoperineal resection was performed. Due to symptomatic hernia and prolapse, the laparoscopic Sugarbaker modified surgical technique with intraperitoneal onlay mesh (IPOM) repair is performed to manage prolapse by pseudo-subperitonization and to manage hernia using an IPOM repair. As shown in this video, this technique is safe, reproducible, and effective.
Laparoscopic enucleation of a pancreatic tumor: posterior approach
We report the case of a 55-year-old woman with a hypervascularized lesion at the posterior aspect of the pancreatic tail, which is evocative of an endocrine tumor of the pancreas. We decided to perform a laparoscopic enucleation of this tumor using a posterior approach. The patient is positioned in a right lateral decubitus. The intervention begins with the opening of the posterior mesogastrium, which allows to tilt the entire splenopancreatic block to the right. The tumor located on the posterior aspect clearly appears. An enucleation of the tumor is then performed using the monopolar cautery hook. In order to facilitate the lesion's exposure, a traction suture will be placed. This helps to expose the tumor. The inferior border of the tumor is freed from the splenic vein and the monopolar hook allows to perform a step-by-step enucleation. An intrapancreatic freeing of the lesion's deep plane is achieved using the Sonicision™ device. The tumor is placed into a bag and extracted through a port. The extemporaneous exam confirms the diagnosis of an endocrine tumor. Hemostasis is controlled. The splenopancreatic block is put back in its original anatomical position. There is no pancreatic fistula. The patient is discharged on postoperative day 5. The final diagnosis confirms a G1 endocrine tumor.
P Pessaux, R Memeo, D Ntourakis, H Jeddou, D Mutter, J Marescaux
Surgical intervention
3 years ago
1210 views
45 likes
0 comments
11:04
Laparoscopic enucleation of a pancreatic tumor: posterior approach
We report the case of a 55-year-old woman with a hypervascularized lesion at the posterior aspect of the pancreatic tail, which is evocative of an endocrine tumor of the pancreas. We decided to perform a laparoscopic enucleation of this tumor using a posterior approach. The patient is positioned in a right lateral decubitus. The intervention begins with the opening of the posterior mesogastrium, which allows to tilt the entire splenopancreatic block to the right. The tumor located on the posterior aspect clearly appears. An enucleation of the tumor is then performed using the monopolar cautery hook. In order to facilitate the lesion's exposure, a traction suture will be placed. This helps to expose the tumor. The inferior border of the tumor is freed from the splenic vein and the monopolar hook allows to perform a step-by-step enucleation. An intrapancreatic freeing of the lesion's deep plane is achieved using the Sonicision™ device. The tumor is placed into a bag and extracted through a port. The extemporaneous exam confirms the diagnosis of an endocrine tumor. Hemostasis is controlled. The splenopancreatic block is put back in its original anatomical position. There is no pancreatic fistula. The patient is discharged on postoperative day 5. The final diagnosis confirms a G1 endocrine tumor.
Insulinoma of the pancreatic tail: left pancreatic resection with preservation of the spleen
This video shows a left pancreatic resection with splenic preservation in a 56-year-old woman. The patient has a visible insulinoma (1cm in diameter) located at the lower border of the pancreatic tail. The pancreatic tail is 3 to 4cm distant to the splenic hilum, which facilitates the dissection. Trocar position is similar to the one used in gastric laparoscopic surgery. First, the gastrocolic ligament is divided, and the stomach is retracted to the right side of the patient, along with the left lobe of the liver. After dissection of retrogastric adhesions, the peritoneum is incised on the lower border of the pancreas to get access to the retropancreatic area. The splenic artery is dissected on the upper pancreatic border and encircled with a vessel loop. The last retropancreatic attachments are taken down and the splenic vein is dissected and encircled with a vessel loop. Once the splenic vessels are retracted, the pancreatic transection is performed with a linear stapler. The last adhesions from the pancreatic tail to the splenic vessels are dissected with the LigaSure™ vessel-sealing device, making sure to preserve the splenic vessels. Finally, the resected pancreatic tail is placed in a specimen retrieval bag (Endobag®) and extracted through the trocar incision in the upper left abdomen. Hemostasis is checked while making sure that splenic perfusion is adequate.
P Vorwald, A Celdrán, M Posada, G Salcedo, T Georgiev, ML Sánchez de Molina, R Restrepo, S Ayora González
Surgical intervention
3 years ago
1729 views
44 likes
0 comments
10:03
Insulinoma of the pancreatic tail: left pancreatic resection with preservation of the spleen
This video shows a left pancreatic resection with splenic preservation in a 56-year-old woman. The patient has a visible insulinoma (1cm in diameter) located at the lower border of the pancreatic tail. The pancreatic tail is 3 to 4cm distant to the splenic hilum, which facilitates the dissection. Trocar position is similar to the one used in gastric laparoscopic surgery. First, the gastrocolic ligament is divided, and the stomach is retracted to the right side of the patient, along with the left lobe of the liver. After dissection of retrogastric adhesions, the peritoneum is incised on the lower border of the pancreas to get access to the retropancreatic area. The splenic artery is dissected on the upper pancreatic border and encircled with a vessel loop. The last retropancreatic attachments are taken down and the splenic vein is dissected and encircled with a vessel loop. Once the splenic vessels are retracted, the pancreatic transection is performed with a linear stapler. The last adhesions from the pancreatic tail to the splenic vessels are dissected with the LigaSure™ vessel-sealing device, making sure to preserve the splenic vessels. Finally, the resected pancreatic tail is placed in a specimen retrieval bag (Endobag®) and extracted through the trocar incision in the upper left abdomen. Hemostasis is checked while making sure that splenic perfusion is adequate.
Right upper lobectomy for large apical tuberculosis cavity using videothoracoscopy: focus on the use of curved endoscopic instruments
A 36-year-old patient was treated for tuberculosis for two years in Georgia. However, treatment failed. After a 3-month treatment in France, CT-scan showed a persistent tuberculous cavity in the right upper lobe, which seemed totally destroyed, associated with bilateral opacities. The patient was still multi-bacillary. A right upper lobectomy by videothoracoscopy was performed. Dissection of the right upper lobe, fully retracted on the apex, was facilitated by the use of an ENSEAL® G2 articulating tissue sealer (Ethicon Endosurgery), a curved vacuum, and the ENDOEYE FLEX 3D (Olympus) articulated camera. The ENSEAL® articulated bipolar forceps facilitated the perpendicular approach to the superior lobar vessels, which were all sheathed by inflamed tissues, and improved dissection of retractile adhesions to the pulmonary apex and mediastinum. It made the handling of hemorrhagic tissue easier. The 3D camera allowed an accurate visualization of these complex anatomical relationships. Drains were removed on postoperative day 6. The BK sputum was negative postoperatively and at 5 months. CT-scan at 2 months is satisfactory with a regression of bilateral opacities. Videothoracoscopy using articulated endoscopic instruments is a relevant technique for the resection of tuberculous lesions, even when lesions are large and retractile.
L Haddad, J Melki, P Rinieri, C Peillon, JM Baste
Surgical intervention
3 years ago
943 views
36 likes
0 comments
07:35
Right upper lobectomy for large apical tuberculosis cavity using videothoracoscopy: focus on the use of curved endoscopic instruments
A 36-year-old patient was treated for tuberculosis for two years in Georgia. However, treatment failed. After a 3-month treatment in France, CT-scan showed a persistent tuberculous cavity in the right upper lobe, which seemed totally destroyed, associated with bilateral opacities. The patient was still multi-bacillary. A right upper lobectomy by videothoracoscopy was performed. Dissection of the right upper lobe, fully retracted on the apex, was facilitated by the use of an ENSEAL® G2 articulating tissue sealer (Ethicon Endosurgery), a curved vacuum, and the ENDOEYE FLEX 3D (Olympus) articulated camera. The ENSEAL® articulated bipolar forceps facilitated the perpendicular approach to the superior lobar vessels, which were all sheathed by inflamed tissues, and improved dissection of retractile adhesions to the pulmonary apex and mediastinum. It made the handling of hemorrhagic tissue easier. The 3D camera allowed an accurate visualization of these complex anatomical relationships. Drains were removed on postoperative day 6. The BK sputum was negative postoperatively and at 5 months. CT-scan at 2 months is satisfactory with a regression of bilateral opacities. Videothoracoscopy using articulated endoscopic instruments is a relevant technique for the resection of tuberculous lesions, even when lesions are large and retractile.