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NOTES

Find all the surgical interventions, lectures, experts opinions, debates, webinars and operative techniques per specialty.


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Pure NOTES: Transvaginal tubal sterilization with flexible endoscope
Tubal sterilization is a permanent method of contraception, performed using several current approaches, including laparotomy, mini-laparotomy, colpotomy, laparoscopy and hysteroscopy. Two new approaches, LESS and transgastric or transvaginal NOTES, are being used today. This video shows our surgical technique for pure NOTES transvaginal sterilization. Tubal sterilization is a permanent method of contraception, performed using several current approaches, including laparotomy, mini-laparotomy, colpotomy, laparoscopy and hysteroscopy. Two new approaches, LESS and transgastric or transvaginal NOTES, are being used today. This video shows our surgical technique for pure NOTES transvaginal sterilization. The patient is 32 years old with a history of one previous vaginal delivery and one previous cesarean delivery. Her BMI is 20. The procedure was fully explained to the patient and written consent was obtained.
J Mejías, H Almau, P Rosales, R de la Fuente, N García, C Bravo
Surgical intervention
7 years ago
426 views
13 likes
0 comments
07:05
Pure NOTES: Transvaginal tubal sterilization with flexible endoscope
Tubal sterilization is a permanent method of contraception, performed using several current approaches, including laparotomy, mini-laparotomy, colpotomy, laparoscopy and hysteroscopy. Two new approaches, LESS and transgastric or transvaginal NOTES, are being used today. This video shows our surgical technique for pure NOTES transvaginal sterilization. Tubal sterilization is a permanent method of contraception, performed using several current approaches, including laparotomy, mini-laparotomy, colpotomy, laparoscopy and hysteroscopy. Two new approaches, LESS and transgastric or transvaginal NOTES, are being used today. This video shows our surgical technique for pure NOTES transvaginal sterilization. The patient is 32 years old with a history of one previous vaginal delivery and one previous cesarean delivery. Her BMI is 20. The procedure was fully explained to the patient and written consent was obtained.
Transvaginal hybrid sleeve gastrectomy in a patient with a BMI of 40: live surgery during a NOTES course
Laparoscopic sleeve gastrectomy is a relatively new procedure, which is gaining popularity for the treatment of morbid obesity. In this live video demonstration from the March 2009 NOTES Advanced Course at IRCAD in Strasbourg, Dr. Michel Vix performs a hybrid natural orifice transluminal endoscopic sleeve gastrectomy using the vagina as the natural orifice and only two operative 5mm ports. It is a very interesting video demonstration showing that sleeve gastrectomy for the treatment of morbid obesity is feasible and safe in selected patients using the hybrid transvaginal mini-laparoscopic-assisted natural orifice surgery.
M Vix, B Dallemagne, D Coumaros, Gf Donatelli
Surgical intervention
9 years ago
426 views
9 likes
0 comments
15:54
Transvaginal hybrid sleeve gastrectomy in a patient with a BMI of 40: live surgery during a NOTES course
Laparoscopic sleeve gastrectomy is a relatively new procedure, which is gaining popularity for the treatment of morbid obesity. In this live video demonstration from the March 2009 NOTES Advanced Course at IRCAD in Strasbourg, Dr. Michel Vix performs a hybrid natural orifice transluminal endoscopic sleeve gastrectomy using the vagina as the natural orifice and only two operative 5mm ports. It is a very interesting video demonstration showing that sleeve gastrectomy for the treatment of morbid obesity is feasible and safe in selected patients using the hybrid transvaginal mini-laparoscopic-assisted natural orifice surgery.
First NOTES cholecystectomy
This video shows the first totally NOTES cholecystectomy via a transvaginal approach in a 30-year-old woman with symptomatic cholelithiasis. The operation was performed by a multidisciplinary team, which included a gynecologist who performed and closed the colpotomy. The peritoneal cavity was entered through an incision in the posterior vaginal cul-de-sac. The transvaginal access to the peritoneal cavity and the introduction of the double channel gastroscope (KARL STORZ-Endoskope®, Germany) were performed under laparoscopic control by a 2 mm needle-scope.
The placement of this 2 mm needle-port was mandatory to insufflate CO2 and to monitor the pneumoperitoneum and it turned out helpful for further retraction of the gallbladder. Complete identification of the structures of Calot’s triangle was achieved. The dissection began in close proximity of the gallbladder at the junction between the infundibulum and the cystic duct. The peritoneum covering the cystic duct was incised anteriorly and posteriorly and gently brushed away with blunt dissection. Once sufficiently skeletonized, the cystic duct and artery were clipped twice on patient side and once on gallbladder side and divided with endoscopic scissors. Using an endoscopic grasper and a Storz unipolar round-tip electrode, the gallbladder was dissected away from the intrahepatic fossa and placed in a specimen retrieval bag prior to removal through the vagina. The operative site was checked to ensure hemostasis and rule out any inadvertent injury to the adjacent organs. The colpotomy was closed with interrupted 2/0 Vicryl stitches.
All the procedure was carried out using a standard double channel video flexible gastroscope and standard endoscopic instruments. All the principles of laparoscopic cholecystectomy were strictly respected. At no stage of the procedure there was a need of laparoscopic assistance. No complications occurred during the procedure. The advantages of laparoscopy, namely minimal postoperative pain and abdominal scarring appeared to be enhanced by this approach. The patient had no postoperative pain, “no scars” and was discharged on the second postoperative day.
J Marescaux, B Dallemagne, S Perretta, D Mutter, A Wattiez, D Coumaros
Surgical intervention
11 years ago
785 views
17 likes
0 comments
04:09
First NOTES cholecystectomy
This video shows the first totally NOTES cholecystectomy via a transvaginal approach in a 30-year-old woman with symptomatic cholelithiasis. The operation was performed by a multidisciplinary team, which included a gynecologist who performed and closed the colpotomy. The peritoneal cavity was entered through an incision in the posterior vaginal cul-de-sac. The transvaginal access to the peritoneal cavity and the introduction of the double channel gastroscope (KARL STORZ-Endoskope®, Germany) were performed under laparoscopic control by a 2 mm needle-scope.
The placement of this 2 mm needle-port was mandatory to insufflate CO2 and to monitor the pneumoperitoneum and it turned out helpful for further retraction of the gallbladder. Complete identification of the structures of Calot’s triangle was achieved. The dissection began in close proximity of the gallbladder at the junction between the infundibulum and the cystic duct. The peritoneum covering the cystic duct was incised anteriorly and posteriorly and gently brushed away with blunt dissection. Once sufficiently skeletonized, the cystic duct and artery were clipped twice on patient side and once on gallbladder side and divided with endoscopic scissors. Using an endoscopic grasper and a Storz unipolar round-tip electrode, the gallbladder was dissected away from the intrahepatic fossa and placed in a specimen retrieval bag prior to removal through the vagina. The operative site was checked to ensure hemostasis and rule out any inadvertent injury to the adjacent organs. The colpotomy was closed with interrupted 2/0 Vicryl stitches.
All the procedure was carried out using a standard double channel video flexible gastroscope and standard endoscopic instruments. All the principles of laparoscopic cholecystectomy were strictly respected. At no stage of the procedure there was a need of laparoscopic assistance. No complications occurred during the procedure. The advantages of laparoscopy, namely minimal postoperative pain and abdominal scarring appeared to be enhanced by this approach. The patient had no postoperative pain, “no scars” and was discharged on the second postoperative day.