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

Monthly publications

#May 2016
Filter by
Clear filter Specialty
View more

Clear filter Media type
View more
Clear filter Category
View more
Laparoscopic choledochal cyst excision with intraoperative cholangiogram, hepatic duct cholangioscopy, extracorporeal Roux-en-Y hepaticojejunostomy and closure of mesenteric defects
The laparoscopic treatment of a choledochal cyst begins with a careful preoperative understanding of the anatomy, including bile ducts, as well as the presence of any abnormal pancreatobiliary anatomy. If a hepaticojejunostomy using a Roux-en-Y anastomosis is performed, we prefer an extracorporeal, transumbilical anastomosis, with a retrocolic approach. A series of interrupted or continuous absorbable sutures can be used for the bilioenteric anastomosis. For the last part of the procedure, we emphasize the importance of closure of mesenteric defects with non-absorbable sutures, including both the retrocolic space and Petersen’s defect to prevent future internal herniations.
GA Villalona, D Ozgediz
Surgical intervention
2 years ago
1525 views
72 likes
0 comments
10:31
Laparoscopic choledochal cyst excision with intraoperative cholangiogram, hepatic duct cholangioscopy, extracorporeal Roux-en-Y hepaticojejunostomy and closure of mesenteric defects
The laparoscopic treatment of a choledochal cyst begins with a careful preoperative understanding of the anatomy, including bile ducts, as well as the presence of any abnormal pancreatobiliary anatomy. If a hepaticojejunostomy using a Roux-en-Y anastomosis is performed, we prefer an extracorporeal, transumbilical anastomosis, with a retrocolic approach. A series of interrupted or continuous absorbable sutures can be used for the bilioenteric anastomosis. For the last part of the procedure, we emphasize the importance of closure of mesenteric defects with non-absorbable sutures, including both the retrocolic space and Petersen’s defect to prevent future internal herniations.
Laparoscopic Mitrofanoff continent diversion in children
Neobladder surgery is often complex. It is readily proposed lately in a child’s life when he agrees to undergo a fairly heavy surgical operation, which will allow him to acquire a social body cleanliness. The poor vesical volume capacity may necessitate either a chemical enlargement with iterative Botox injections into the detrusor muscle, or a vesical enlargement surgery using a bowel segment.
Self-catheterization using natural orifices is often particularly uneasy in boys or in obese or handicapped patients. This mandates to leave an open vesicourethral neck, which however does not prevent potential urinary leaks. This mode of vesical voiding has an alternative, namely Mitrofanoff continent diversion using the appendix.
This procedure was described in 1980. The vesico-appendiceal junction is fashioned by means of an anatomical anti-reflux mechanism. The skin approximation onto the anterior abdominal wall can be performed either in the umbilicus, or in the inguinal region depending on different decisional criteria.
This procedure can now be envisaged laparoscopically. It is a demanding intervention, which requires advanced skills.
A El-Ghoneimi
Lecture
2 years ago
454 views
11 likes
0 comments
28:15
Laparoscopic Mitrofanoff continent diversion in children
Neobladder surgery is often complex. It is readily proposed lately in a child’s life when he agrees to undergo a fairly heavy surgical operation, which will allow him to acquire a social body cleanliness. The poor vesical volume capacity may necessitate either a chemical enlargement with iterative Botox injections into the detrusor muscle, or a vesical enlargement surgery using a bowel segment.
Self-catheterization using natural orifices is often particularly uneasy in boys or in obese or handicapped patients. This mandates to leave an open vesicourethral neck, which however does not prevent potential urinary leaks. This mode of vesical voiding has an alternative, namely Mitrofanoff continent diversion using the appendix.
This procedure was described in 1980. The vesico-appendiceal junction is fashioned by means of an anatomical anti-reflux mechanism. The skin approximation onto the anterior abdominal wall can be performed either in the umbilicus, or in the inguinal region depending on different decisional criteria.
This procedure can now be envisaged laparoscopically. It is a demanding intervention, which requires advanced skills.
The vascular hitch: a simpler procedure for vascular pyeloureteral junction obstruction (PUJO)
Ureteropelvic junction obstruction may occur in about 10% of cases, the origin of which is not an intrinsic organic obstruction in this transitional area between the renal pelvis and the ureter, but it is rather secondary to an extrinsic obstruction, related to the presence of aberrant lower pole vessels.
It is an intermittent ureteropelvic junction obstruction syndrome, which is usually diagnosed late and in which renal function is most often preserved. The operating technique was already described more than 60 years ago. It is a simple technique.
The greatest difficulty is not technical but lies in the indication which must be relevant. The main difficulty is to preoperatively and intraoperatively evaluate either the totally extrinsic nature or conversely the mixed nature of the obstruction, which in that case requires a pyeloplasty according to Anderson-Hynes with division of the ureterovesical junction posteriorly to the vessels and reconstruction of the ureteropelvic junction once enlarged, anteriorly to the lower pole vessels.
I Mushtaq
Lecture
2 years ago
469 views
31 likes
0 comments
13:17
The vascular hitch: a simpler procedure for vascular pyeloureteral junction obstruction (PUJO)
Ureteropelvic junction obstruction may occur in about 10% of cases, the origin of which is not an intrinsic organic obstruction in this transitional area between the renal pelvis and the ureter, but it is rather secondary to an extrinsic obstruction, related to the presence of aberrant lower pole vessels.
It is an intermittent ureteropelvic junction obstruction syndrome, which is usually diagnosed late and in which renal function is most often preserved. The operating technique was already described more than 60 years ago. It is a simple technique.
The greatest difficulty is not technical but lies in the indication which must be relevant. The main difficulty is to preoperatively and intraoperatively evaluate either the totally extrinsic nature or conversely the mixed nature of the obstruction, which in that case requires a pyeloplasty according to Anderson-Hynes with division of the ureterovesical junction posteriorly to the vessels and reconstruction of the ureteropelvic junction once enlarged, anteriorly to the lower pole vessels.
Laparoscopic retroperitoneal pyeloplasty
Ureteropelvic junction obstruction repair can be performed in the first months of the infant’s life by means of videoscopic surgery. Two approaches can be used. First, the transperitoneal access offers a fairly large surgical space. On the other hand, it implies that the surgeon accesses a retroperitoneal organ by opening the posterior parietal peritoneum. To the right, kidney exposure may necessitate the detachment of the right colon and of the duodenum and the surgeon often has to lift up the right liver.
To the left, the exposure of the ureteropelvic junction may require either a colonic detachment, or a transmesocolic opening by respecting the vascular supply of the left colon. The retroperitoneal approach is direct. It helps to better manage any potential urinary leaks, which will never occur intraperitoneally. It prevents any intraperitoneal dissection. However, it is a demanding technique technically speaking.
A El-Ghoneimi
Lecture
2 years ago
864 views
48 likes
0 comments
28:15
Laparoscopic retroperitoneal pyeloplasty
Ureteropelvic junction obstruction repair can be performed in the first months of the infant’s life by means of videoscopic surgery. Two approaches can be used. First, the transperitoneal access offers a fairly large surgical space. On the other hand, it implies that the surgeon accesses a retroperitoneal organ by opening the posterior parietal peritoneum. To the right, kidney exposure may necessitate the detachment of the right colon and of the duodenum and the surgeon often has to lift up the right liver.
To the left, the exposure of the ureteropelvic junction may require either a colonic detachment, or a transmesocolic opening by respecting the vascular supply of the left colon. The retroperitoneal approach is direct. It helps to better manage any potential urinary leaks, which will never occur intraperitoneally. It prevents any intraperitoneal dissection. However, it is a demanding technique technically speaking.
Laparoscopic enucleation of a cystic tumor of the pancreas in a child
This short video describes the laparoscopic enucleation of a benign congenital excretory cyst of the pancreas in a 13-year-old girl.
No prenatal diagnosis had been envisaged and this teen girl was admitted in an emergency setting, with iterative abdominal pain followed by vomiting and weight loss (3Kg) over the last two months.
The entire work-up allowed to rule out the presence of parenchymal tumor involvement and the perfectly regular isolated and apparently normal nature of a cyst situated on the posterior aspect of the pancreatic head, which is totally separate from the biliary tract and from the duodenum.
In these conditions, the diagnosis of Frantz tumor was ruled out and the most probable hypothesis was that of a congenital cystic pancreatic tumor which had recently increased in size. The specificity of the technique used consisted in a pancreatic detachment using a Kocher’s maneuver. The posterior aspect of the pancreatic head was then detached in order to "plicate" or fold the pancreas upon itself.
Once turned over 180 degrees to the left, the posterior aspect of the pancreatic head was perfectly exposed. In addition, after puncture of the cyst, the clear fluid content of the cyst was replaced by a blue dye in order to perfectly identify it through a thin layer of pancreatic parenchyma.
The cyst’s enucleation was subsequently facilitated. No adhesion impaired its detachment from the remainder of the pancreatic tissue. Since the pericystic area was preserved, the risk of secondary pancreatic fistula was prevented, especially because the cyst had been previously opacified, which allowed to rule out any potential communication with the excretory ducts of the pancreas.
I Kauffmann, F Becmeur
Surgical intervention
2 years ago
606 views
13 likes
0 comments
02:59
Laparoscopic enucleation of a cystic tumor of the pancreas in a child
This short video describes the laparoscopic enucleation of a benign congenital excretory cyst of the pancreas in a 13-year-old girl.
No prenatal diagnosis had been envisaged and this teen girl was admitted in an emergency setting, with iterative abdominal pain followed by vomiting and weight loss (3Kg) over the last two months.
The entire work-up allowed to rule out the presence of parenchymal tumor involvement and the perfectly regular isolated and apparently normal nature of a cyst situated on the posterior aspect of the pancreatic head, which is totally separate from the biliary tract and from the duodenum.
In these conditions, the diagnosis of Frantz tumor was ruled out and the most probable hypothesis was that of a congenital cystic pancreatic tumor which had recently increased in size. The specificity of the technique used consisted in a pancreatic detachment using a Kocher’s maneuver. The posterior aspect of the pancreatic head was then detached in order to "plicate" or fold the pancreas upon itself.
Once turned over 180 degrees to the left, the posterior aspect of the pancreatic head was perfectly exposed. In addition, after puncture of the cyst, the clear fluid content of the cyst was replaced by a blue dye in order to perfectly identify it through a thin layer of pancreatic parenchyma.
The cyst’s enucleation was subsequently facilitated. No adhesion impaired its detachment from the remainder of the pancreatic tissue. Since the pericystic area was preserved, the risk of secondary pancreatic fistula was prevented, especially because the cyst had been previously opacified, which allowed to rule out any potential communication with the excretory ducts of the pancreas.
Laparoscopic management of a catecholamine-secreting paraganglioma in a 15-year-old boy
We report the case of the surgical removal of a paravesical paraganglioma located on the right vesicoureteric junction in a 15-year-old boy who was screened positive for SDHB gene mutation, which his father suffers from. Indeed, his dad died of a metastatic paraganglioma, notably including bone and cerebral metastases.
The patient has been complaining of major headaches for some time, which were triggered off during urination to the point that he held in urine as long as possible during daytime in order to avoid urinating, and this seemed to be immediately related to the onset of severe headaches.
The tumor location allowed to correctly understand the phenomenon intraoperatively since every bladder mobilization would induce abrupt bouts of high blood pressure.
Resting blood pressure did not evidence any particular anomaly. However, there were high fluctuations in blood pressure, notably when headaches were reported. The tumor was located exactly at the vesicoureteric junction. It necessitated the resection of the lower ureter and the placement of a vesical patch.
Complete surgical resection allowed to eliminate all symptoms. The patient’s clinical and biological work-up is strictly normal more than one year after the intervention.
The resection was performed without paying attention to the potential difficulties related to the type of reconstructive surgery which entailed. Reconstruction of the vesicoureteric junction was achieved without any major problem on a slightly reduced bladder. A minimal vesicoureteric reimplantation was performed according to the Lich-Gregoir technique, with bladder closure onto a vesical drain and a vesicoureteric double J catheter.
Immediate outcomes were uneventful and control performed more than one year postoperatively testified to the absence of tumor recurrence and to the very good functioning of the vesicoureteric junction.
F Becmeur, S Soskin
Surgical intervention
2 years ago
400 views
16 likes
0 comments
04:08
Laparoscopic management of a catecholamine-secreting paraganglioma in a 15-year-old boy
We report the case of the surgical removal of a paravesical paraganglioma located on the right vesicoureteric junction in a 15-year-old boy who was screened positive for SDHB gene mutation, which his father suffers from. Indeed, his dad died of a metastatic paraganglioma, notably including bone and cerebral metastases.
The patient has been complaining of major headaches for some time, which were triggered off during urination to the point that he held in urine as long as possible during daytime in order to avoid urinating, and this seemed to be immediately related to the onset of severe headaches.
The tumor location allowed to correctly understand the phenomenon intraoperatively since every bladder mobilization would induce abrupt bouts of high blood pressure.
Resting blood pressure did not evidence any particular anomaly. However, there were high fluctuations in blood pressure, notably when headaches were reported. The tumor was located exactly at the vesicoureteric junction. It necessitated the resection of the lower ureter and the placement of a vesical patch.
Complete surgical resection allowed to eliminate all symptoms. The patient’s clinical and biological work-up is strictly normal more than one year after the intervention.
The resection was performed without paying attention to the potential difficulties related to the type of reconstructive surgery which entailed. Reconstruction of the vesicoureteric junction was achieved without any major problem on a slightly reduced bladder. A minimal vesicoureteric reimplantation was performed according to the Lich-Gregoir technique, with bladder closure onto a vesical drain and a vesicoureteric double J catheter.
Immediate outcomes were uneventful and control performed more than one year postoperatively testified to the absence of tumor recurrence and to the very good functioning of the vesicoureteric junction.
Laparoscopic management of a pediatric bronchogenic cyst in a 6-year-old boy
We report the case of a 6-year-old boy who presented with an infectious bronchopulmonary episode during which a plain anterior chest X-ray was performed. The X-ray showed an opacity at the right apex. A thoracic CT-scan allowed to demonstrate the presence of a right superior and posterior mediastinal cystic structure, which could be either a non-communicating cystic duplication of the esophagus, or a bronchogenic cyst.
The 3D CT-scan image modeling analysis allowed the surgeon to become familiar with a benign superior mediastinal cystic tumor including its surrounding anatomical structures. The tumor was immediately found above the arch of the azygos vein laterally to the superior vena cava and to the right phrenic nerve, and anteriorly to the right vagus nerve.
The resection was performed thoracoscopically, without any difficulty after a small opening of the mediastinal pleura in order to provide direct access to the paramedian cyst.
Pathological findings demonstrated the presence of a bronchogenic cyst without any communication with the airway tree or the esophagus. Postoperative outcomes were uneventful and the patient was rapidly discharged from hospital.
F Becmeur, C Boff
Surgical intervention
2 years ago
766 views
43 likes
0 comments
04:49
Laparoscopic management of a pediatric bronchogenic cyst in a 6-year-old boy
We report the case of a 6-year-old boy who presented with an infectious bronchopulmonary episode during which a plain anterior chest X-ray was performed. The X-ray showed an opacity at the right apex. A thoracic CT-scan allowed to demonstrate the presence of a right superior and posterior mediastinal cystic structure, which could be either a non-communicating cystic duplication of the esophagus, or a bronchogenic cyst.
The 3D CT-scan image modeling analysis allowed the surgeon to become familiar with a benign superior mediastinal cystic tumor including its surrounding anatomical structures. The tumor was immediately found above the arch of the azygos vein laterally to the superior vena cava and to the right phrenic nerve, and anteriorly to the right vagus nerve.
The resection was performed thoracoscopically, without any difficulty after a small opening of the mediastinal pleura in order to provide direct access to the paramedian cyst.
Pathological findings demonstrated the presence of a bronchogenic cyst without any communication with the airway tree or the esophagus. Postoperative outcomes were uneventful and the patient was rapidly discharged from hospital.
Minimally invasive management of vesicoureteric reflux (VUR) and related anomalies
Operative indications in case of vesicorenal reflux in children have become increasingly rare. The true minimally invasive spirit first necessitates an endoscopic treatment, also called the STING procedure. A ureterovesical reimplantation is required in the presence of clinical or anatomical circumstances. Dr. Paul Philippe describes the operative pneumovesicoscopy developed by CK Yeung and Jeff Valla more than 15 years ago. Despite brilliant presentations, this technique has remained very confidential, probably because of the difficulties come across by the operators when performing the procedure. It is undoubtedly a very demanding technique as far as manual expertise is concerned.
The scarcity of operative indications and the difficulties met in the realization of this surgery render the acquisition of an expertise in the field difficult. However, the technique and the tricks described by Paul Philippe are absolutely remarkable and postoperative outcomes are particularly interesting. We are truly in the context which was initially described 25 years ago when laparoscopic surgery barely started to develop. It is key to reproduce exactly what was previously performed in open surgery in a laparoscopic fashion (or in the present case using pneumovesicoscopy).
P Philippe
Lecture
2 years ago
406 views
21 likes
0 comments
15:24
Minimally invasive management of vesicoureteric reflux (VUR) and related anomalies
Operative indications in case of vesicorenal reflux in children have become increasingly rare. The true minimally invasive spirit first necessitates an endoscopic treatment, also called the STING procedure. A ureterovesical reimplantation is required in the presence of clinical or anatomical circumstances. Dr. Paul Philippe describes the operative pneumovesicoscopy developed by CK Yeung and Jeff Valla more than 15 years ago. Despite brilliant presentations, this technique has remained very confidential, probably because of the difficulties come across by the operators when performing the procedure. It is undoubtedly a very demanding technique as far as manual expertise is concerned.
The scarcity of operative indications and the difficulties met in the realization of this surgery render the acquisition of an expertise in the field difficult. However, the technique and the tricks described by Paul Philippe are absolutely remarkable and postoperative outcomes are particularly interesting. We are truly in the context which was initially described 25 years ago when laparoscopic surgery barely started to develop. It is key to reproduce exactly what was previously performed in open surgery in a laparoscopic fashion (or in the present case using pneumovesicoscopy).
Transperitoneal ureteric reimplantation Lich-Gregoir technique for vesicoureteral reflux (VUR) in children
The Lich-Gregoir technique, still currently used in prominent Northern American centers in the nineties, had more or less fallen into disuse. Currently, the scarcity of operative indications for ureterovesical reimplantation, with the advent of the STING procedure, the real technical difficulties found during pneumovesicoscopy for Cohen procedure, the debates on long-term difficulties (e.g., in adult life) to undergo a ureteral endoluminal surgery after a previous Cohen procedure, all these reasons have led to vested and renewed interest in performing the Lich-Gregoir technique laparoscopically. The rigorous evaluation of potential functional vesical disorders is indispensable in case of bilateral surgery.
F Varlet
Lecture
2 years ago
710 views
48 likes
0 comments
14:58
Transperitoneal ureteric reimplantation Lich-Gregoir technique for vesicoureteral reflux (VUR) in children
The Lich-Gregoir technique, still currently used in prominent Northern American centers in the nineties, had more or less fallen into disuse. Currently, the scarcity of operative indications for ureterovesical reimplantation, with the advent of the STING procedure, the real technical difficulties found during pneumovesicoscopy for Cohen procedure, the debates on long-term difficulties (e.g., in adult life) to undergo a ureteral endoluminal surgery after a previous Cohen procedure, all these reasons have led to vested and renewed interest in performing the Lich-Gregoir technique laparoscopically. The rigorous evaluation of potential functional vesical disorders is indispensable in case of bilateral surgery.
Renal cancer in children and laparoscopy
Dr. François Varlet reflected on the laparoscopic management of Wilms’ tumors.
The framework of existing possibilities to perform such interventions is extremely limited and would concern 5 to 10% of patients that we currently manage. Dr. François Varlet has undertaken a prospective study on a national scale, in France, and he supervises every proposal for laparoscopic surgery to manage Wilms’ tumors. The rigorous and thorough nature of his work, the caution he takes in his work are truly outstanding.
In France, any proposal for a laparoscopic surgery to manage nephroblastoma will be discussed at national level, and the intraoperative conditions and long-term follow-up are meticulously reported, in the framework of the prospective study undertaken by François Varlet.
F Varlet
Lecture
2 years ago
246 views
14 likes
0 comments
15:45
Renal cancer in children and laparoscopy
Dr. François Varlet reflected on the laparoscopic management of Wilms’ tumors.
The framework of existing possibilities to perform such interventions is extremely limited and would concern 5 to 10% of patients that we currently manage. Dr. François Varlet has undertaken a prospective study on a national scale, in France, and he supervises every proposal for laparoscopic surgery to manage Wilms’ tumors. The rigorous and thorough nature of his work, the caution he takes in his work are truly outstanding.
In France, any proposal for a laparoscopic surgery to manage nephroblastoma will be discussed at national level, and the intraoperative conditions and long-term follow-up are meticulously reported, in the framework of the prospective study undertaken by François Varlet.
Laparoscopic pylorus-preserving pancreaticoduodenectomy for Gruber-Frantz tumor
This video demonstrates our technique for laparoscopic pylorus-preserving pancreaticoduodenectomy performed in a 15-year-old girl presenting with a history of episodic mild abdominal colic pain and right upper quadrant mass.
The preoperative diagnosis of a solid pseudo-papillary tumor (Gruber-Frantz tumor) was made, based on ultrasonography and computed tomography.
Laparoscopic resection was decided upon based on the fact that there were clearly defined surgical planes despite of the size of the mass. The usual sequence of steps for a pancreaticoduodenectomy was altered in this particular case because of tumor dimensions.
The procedure was carried out in 438 minutes without complications. There were no symptoms of delayed gastric emptying, and the patient was discharged on postoperative day 5. The microscopic study of the tumor confirmed a 10.5 by 9 by 5.5cm solid pseudo-papillary tumor of the pancreatic head.
JM Cabada Lee
Surgical intervention
2 years ago
725 views
24 likes
0 comments
09:00
Laparoscopic pylorus-preserving pancreaticoduodenectomy for Gruber-Frantz tumor
This video demonstrates our technique for laparoscopic pylorus-preserving pancreaticoduodenectomy performed in a 15-year-old girl presenting with a history of episodic mild abdominal colic pain and right upper quadrant mass.
The preoperative diagnosis of a solid pseudo-papillary tumor (Gruber-Frantz tumor) was made, based on ultrasonography and computed tomography.
Laparoscopic resection was decided upon based on the fact that there were clearly defined surgical planes despite of the size of the mass. The usual sequence of steps for a pancreaticoduodenectomy was altered in this particular case because of tumor dimensions.
The procedure was carried out in 438 minutes without complications. There were no symptoms of delayed gastric emptying, and the patient was discharged on postoperative day 5. The microscopic study of the tumor confirmed a 10.5 by 9 by 5.5cm solid pseudo-papillary tumor of the pancreatic head.
Bronchoscopy for thoracic surgeons
The idea of this lecture originated from the fact that there is very little teaching material which described bronchoscopy as practiced by the thoracic surgeon. Chest physicians (pulmonologists) perform flexible bronchoscopy on a sedated patient, and they get up-side-down views to that obtained by the surgeons. Bronchoscopy at our department is performed under general anaesthesia, usually in the anaesthetic room just before the operation. We introduce a rigid bronchoscope first, and then a flexible fibre optic 5mm bronchoscope through the rigid scope into the trachea. This arrangement enables precise diagnosis due to excellent vision, with the ability to transform the procedure into a therapeutic session, for example, to take large biopsies, and decide to laser a lesion or to put in a central airway stent. Controlled breathing makes it safer to control significant bleeding during the procedure, and it is understandable that chest physicians shy away from biopsying carcinoid tumours.
The video is divided into 6 chapters. Chapter one deals with the identification of the bronchopulmonary segments and a bit of history about the two systems of nomenclature. It describes in a simplified way the effects of the heart growing in the left chest and the results of fusion, rotation and delayed branching of bronchi. Chapter 2 deals with normal bronchoscopy and anatomy of trachea, main bronchi, and segmental bronchi. Chapter 3 deals with abnormalities of the upper airways and trachea. Chapter 4 deals with abnormalities of the right bronchial tree, and chapter 5 deals with abnormalities of the left bronchial tree. The emphasis is on surgical pathology, assessment of airway for resection and decision-making. The viewer is encouraged to take the test on chapter 6 to bolster his/her knowledge of the anatomy of the airways.

1. Objectives:
a. To identify the bronchopulmonary segments in a logical and easy way to recall.
b. To understand the embryological changes resulting from heart growing into left chest.
c. To state what the operator should look for, what is normal and what is abnormal.
d. To help decision-making at operation and in the perioperative period.

2. For whom is this video made:
a. Consultants and trainees in the specialty of cardiothoracic surgery, including paediatric thoracic surgeons.
b. Thoracic and general anaesthetists who are involved with single lung ventilation.
c. Chest physicians who perform bronchoscopy, to understand views and capabilities of flexible over rigid bronchoscopy, and to have a gist of what goes on the mind of a thoracic surgeon when performing bronchoscopy.
d. Intensivists who might perform bronchoscopy via an endotracheal tube for a ventilated patient in the intensive care unit (ICU).
e. Medical students interested in the detailed anatomy of the central airways.

3. What this video is not intended to do:
a. This is not a compendium of abnormalities and pathologies revealed by bronchoscopy.
K Amer
Lecture
2 years ago
943 views
39 likes
0 comments
59:32
Bronchoscopy for thoracic surgeons
The idea of this lecture originated from the fact that there is very little teaching material which described bronchoscopy as practiced by the thoracic surgeon. Chest physicians (pulmonologists) perform flexible bronchoscopy on a sedated patient, and they get up-side-down views to that obtained by the surgeons. Bronchoscopy at our department is performed under general anaesthesia, usually in the anaesthetic room just before the operation. We introduce a rigid bronchoscope first, and then a flexible fibre optic 5mm bronchoscope through the rigid scope into the trachea. This arrangement enables precise diagnosis due to excellent vision, with the ability to transform the procedure into a therapeutic session, for example, to take large biopsies, and decide to laser a lesion or to put in a central airway stent. Controlled breathing makes it safer to control significant bleeding during the procedure, and it is understandable that chest physicians shy away from biopsying carcinoid tumours.
The video is divided into 6 chapters. Chapter one deals with the identification of the bronchopulmonary segments and a bit of history about the two systems of nomenclature. It describes in a simplified way the effects of the heart growing in the left chest and the results of fusion, rotation and delayed branching of bronchi. Chapter 2 deals with normal bronchoscopy and anatomy of trachea, main bronchi, and segmental bronchi. Chapter 3 deals with abnormalities of the upper airways and trachea. Chapter 4 deals with abnormalities of the right bronchial tree, and chapter 5 deals with abnormalities of the left bronchial tree. The emphasis is on surgical pathology, assessment of airway for resection and decision-making. The viewer is encouraged to take the test on chapter 6 to bolster his/her knowledge of the anatomy of the airways.

1. Objectives:
a. To identify the bronchopulmonary segments in a logical and easy way to recall.
b. To understand the embryological changes resulting from heart growing into left chest.
c. To state what the operator should look for, what is normal and what is abnormal.
d. To help decision-making at operation and in the perioperative period.

2. For whom is this video made:
a. Consultants and trainees in the specialty of cardiothoracic surgery, including paediatric thoracic surgeons.
b. Thoracic and general anaesthetists who are involved with single lung ventilation.
c. Chest physicians who perform bronchoscopy, to understand views and capabilities of flexible over rigid bronchoscopy, and to have a gist of what goes on the mind of a thoracic surgeon when performing bronchoscopy.
d. Intensivists who might perform bronchoscopy via an endotracheal tube for a ventilated patient in the intensive care unit (ICU).
e. Medical students interested in the detailed anatomy of the central airways.

3. What this video is not intended to do:
a. This is not a compendium of abnormalities and pathologies revealed by bronchoscopy.
Intravesical mini-laparoscopic repair of vesicovaginal fistulas
Vesicovaginal fistulas (VVF) constitute the most common type of genitourinary fistulas. In developed countries, VVF are almost always iatrogenic and frequently a secondary complication of gynecologic surgery. Some minimally invasive techniques have been introduced to decrease morbidity related to standard open procedures for the treatment of VVF. One such procedure is the intravesical mini-laparoscopic approach. The aim of this was to present our initial clinical experience using this technique for transvesical VVF repair. In 2014, we carried out a mini-laparoscopic repair of VVF in two women who did not respond to conservative treatment with a Foley catheter. The procedure was performed transvesically with a 3mm instrument and a 5mm, 30-degree scope. The fistulous tract was dissected and partially excised. The bladder and vaginal wall defects were closed in two layers with two separate running barbed, absorbable 3/0 sutures. Median operative time was approximately 100 minutes, and blood loss was not significant. Patients were discharged from hospital 24 hours after surgery. A Foley catheter was left in place for 14 days. Imaging examinations performed 6 weeks postoperatively revealed no VVF. In patients with simple fistulas, this technique provides a minimally invasive easily reproducible approach with few associated complications.
The advantages of this technique as compared to the conventional laparoscopic approach are described as follows:
- the risk of bleeding is reduced because the size of the incision made is smaller and access to the fistula site is easier and direct without manipulating abdominal structures;
- the length of hospital stay required is significantly shorter with intravesical mini-laparoscopic than laparoscopic surgery conventional approach.
A Llueca, JL Herraiz, M Rodrigo, Y Maazouzi, D Piquer, M Guijarro, A Cañete, J Escrig
Surgical intervention
2 years ago
2995 views
122 likes
1 comment
07:16
Intravesical mini-laparoscopic repair of vesicovaginal fistulas
Vesicovaginal fistulas (VVF) constitute the most common type of genitourinary fistulas. In developed countries, VVF are almost always iatrogenic and frequently a secondary complication of gynecologic surgery. Some minimally invasive techniques have been introduced to decrease morbidity related to standard open procedures for the treatment of VVF. One such procedure is the intravesical mini-laparoscopic approach. The aim of this was to present our initial clinical experience using this technique for transvesical VVF repair. In 2014, we carried out a mini-laparoscopic repair of VVF in two women who did not respond to conservative treatment with a Foley catheter. The procedure was performed transvesically with a 3mm instrument and a 5mm, 30-degree scope. The fistulous tract was dissected and partially excised. The bladder and vaginal wall defects were closed in two layers with two separate running barbed, absorbable 3/0 sutures. Median operative time was approximately 100 minutes, and blood loss was not significant. Patients were discharged from hospital 24 hours after surgery. A Foley catheter was left in place for 14 days. Imaging examinations performed 6 weeks postoperatively revealed no VVF. In patients with simple fistulas, this technique provides a minimally invasive easily reproducible approach with few associated complications.
The advantages of this technique as compared to the conventional laparoscopic approach are described as follows:
- the risk of bleeding is reduced because the size of the incision made is smaller and access to the fistula site is easier and direct without manipulating abdominal structures;
- the length of hospital stay required is significantly shorter with intravesical mini-laparoscopic than laparoscopic surgery conventional approach.