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Pediatric surgery

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


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Laparoscopic repair of a congenital diaphragmatic hernia (CDH)
Eligibility criteria for the thoracoscopic approach in case of a congenital diaphragmatic hernia (CDH) in infants were jointly addressed at the ESPES/IPEG-ESPU Masterclass in March 2017 held at IRCAD, and also published on WeBSurg.
This video aims to show a series of technical details in case of thoracoscopy for CDH grade B according to the currently accepted international classification. At the beginning of the procedure, short intrathoracic low pressure carbon dioxide insufflation at 4mmHg and 1.5 Liter per minute was performed during hernia reduction. The posterior diaphragmatic border was then freed and a diaphragmatic suture was performed using non-absorbable separate 2/0 stitches. A GoreTex DualMesh® patch was used to complete the external suturing of the diaphragm and to achieve fixation stitches.
I Kauffmann, F Becmeur
Surgical intervention
4 days ago
55 views
0 likes
0 comments
04:17
Laparoscopic repair of a congenital diaphragmatic hernia (CDH)
Eligibility criteria for the thoracoscopic approach in case of a congenital diaphragmatic hernia (CDH) in infants were jointly addressed at the ESPES/IPEG-ESPU Masterclass in March 2017 held at IRCAD, and also published on WeBSurg.
This video aims to show a series of technical details in case of thoracoscopy for CDH grade B according to the currently accepted international classification. At the beginning of the procedure, short intrathoracic low pressure carbon dioxide insufflation at 4mmHg and 1.5 Liter per minute was performed during hernia reduction. The posterior diaphragmatic border was then freed and a diaphragmatic suture was performed using non-absorbable separate 2/0 stitches. A GoreTex DualMesh® patch was used to complete the external suturing of the diaphragm and to achieve fixation stitches.
Inanimate model to train for the thoracoscopic repair of all varieties of left congenital diaphragmatic hernia (CDH)
We present a new low-cost model designed for training skills and strategies for the thoracoscopic repair of left congenital diaphragmatic defects. We will present guidelines to make this type of models, the educational strategy that we use in our advanced training models, the defects that can be trained, and the scope of this model. Advanced training, learning tips and tricks from experts, and the use of innovative ideas from other authors used in our model are outlined. This educational tool was developed for pediatric surgeons requiring advanced training. It reinforces the concept of advanced and continuous training, in a safe environment, and it is assisted by experienced surgeons. This model shows a scenario where dimensions and anatomical repairs are carefully preserved.
We share our vision of continuous endosurgical education to encourage all enthusiastic surgeons to train in safe and controlled environments.
Materials and methods: The model consists in a plastic 3D printed left rib cage, extracted from a 6-month-old baby CT-scan combined with simulated mediastinal structures, diaphragm, bowel, lung, and spleen made of latex, silicone, and polyester sponge respectively. A self-adhesive film is used as parietal pleura. A removable part (spare part) represents the last three ribs where the diaphragm is partially inserted, and a base as the upper abdomen is assembled to the left rib cage (ribs 1 to 9). Abdominal viscera (plastic or animal) are placed in this base. The cost of materials is 150 US$.
The model is meant to simulate the most frequent diaphragmatic defects such as type A, B, and C, with or without sac. However, other rare defects can also be simulated. Live animal tissues such as diaphragm or intestine also can be used, as it was already published by other authors. However, the main characteristic of this model is to be inanimate, portable, and easily reloadable to be reused.
The video shows a junior surgeon in his advanced training process. In the model, we perform the reduction of the viscera slid to the thorax. In this case, it is the rabbit intestine, but we usually use latex simulated intestine. The spleen is completely synthetic and bleeds if the instruments damage it during the reduction.
We use 3mm regular instruments. The repair of the defect is made with separate stitches of 2/0 or 3/0 braided polyester as usual, and we encourage trainees to practice the intracorporeal sliding knot and running suture. We collect the performance data in a specially prepared form and carry out the debriefing.
Conclusions: With this model, we can reinforce the concept of low cost, but with a high precision environment simulation, included within a standardized training program in minimally invasive neonatal surgery. We believe that it is a very useful tool. In addition, this type of models allows the use of new surgical techniques, tips and tricks given by experienced surgeons who assist in the training process.
M Maricic, M Bailez
Surgical intervention
4 days ago
31 views
0 likes
0 comments
08:14
Inanimate model to train for the thoracoscopic repair of all varieties of left congenital diaphragmatic hernia (CDH)
We present a new low-cost model designed for training skills and strategies for the thoracoscopic repair of left congenital diaphragmatic defects. We will present guidelines to make this type of models, the educational strategy that we use in our advanced training models, the defects that can be trained, and the scope of this model. Advanced training, learning tips and tricks from experts, and the use of innovative ideas from other authors used in our model are outlined. This educational tool was developed for pediatric surgeons requiring advanced training. It reinforces the concept of advanced and continuous training, in a safe environment, and it is assisted by experienced surgeons. This model shows a scenario where dimensions and anatomical repairs are carefully preserved.
We share our vision of continuous endosurgical education to encourage all enthusiastic surgeons to train in safe and controlled environments.
Materials and methods: The model consists in a plastic 3D printed left rib cage, extracted from a 6-month-old baby CT-scan combined with simulated mediastinal structures, diaphragm, bowel, lung, and spleen made of latex, silicone, and polyester sponge respectively. A self-adhesive film is used as parietal pleura. A removable part (spare part) represents the last three ribs where the diaphragm is partially inserted, and a base as the upper abdomen is assembled to the left rib cage (ribs 1 to 9). Abdominal viscera (plastic or animal) are placed in this base. The cost of materials is 150 US$.
The model is meant to simulate the most frequent diaphragmatic defects such as type A, B, and C, with or without sac. However, other rare defects can also be simulated. Live animal tissues such as diaphragm or intestine also can be used, as it was already published by other authors. However, the main characteristic of this model is to be inanimate, portable, and easily reloadable to be reused.
The video shows a junior surgeon in his advanced training process. In the model, we perform the reduction of the viscera slid to the thorax. In this case, it is the rabbit intestine, but we usually use latex simulated intestine. The spleen is completely synthetic and bleeds if the instruments damage it during the reduction.
We use 3mm regular instruments. The repair of the defect is made with separate stitches of 2/0 or 3/0 braided polyester as usual, and we encourage trainees to practice the intracorporeal sliding knot and running suture. We collect the performance data in a specially prepared form and carry out the debriefing.
Conclusions: With this model, we can reinforce the concept of low cost, but with a high precision environment simulation, included within a standardized training program in minimally invasive neonatal surgery. We believe that it is a very useful tool. In addition, this type of models allows the use of new surgical techniques, tips and tricks given by experienced surgeons who assist in the training process.
Laparoscopic partial nephrectomy on non-functional, symptomatic right lower pole of the kidney
In this video, we present the case of a 13-year-old girl presenting with a complicated urological anomaly discovered very late. The lower part of her right kidney is dysplastic (or destroyed) with pseudocystic pyelocalyceal cavities filled with stones and cloudy urine. The first hypothesis is that we are dealing with a true renal duplicity with a destroyed non-functional inferior pole. In this case, there is one ureter per kidney pole. As a result, polar ureteronephrectomy does not cause any potential vascular problems.
In this case, thanks to 3D reconstruction (Visible Patient™, a spinoff of IRCAD), it is clear that there is no kidney duplicity, but a pyelic bifurcation. It means that we should manage the only ureter, which drains the superior and inferior pelvis. For that reason, the placement of a double J catheter is essential prior to partial nephrectomy. This catheter should be pulled up until the superior pelvis.
Tridimensional reconstruction of the CT-scan images of a patient with a malformation is extremely helpful to better understand the original and unique anatomy of the patient and to determine a tailored operative strategy.
This video demonstrates a laparoscopic partial nephrectomy on non-functional, symptomatic right lower pole of the kidney in a 13-year-old girl as an outpatient surgery.
F Becmeur, A Lachkar, L Soler
Surgical intervention
4 days ago
46 views
0 likes
0 comments
07:24
Laparoscopic partial nephrectomy on non-functional, symptomatic right lower pole of the kidney
In this video, we present the case of a 13-year-old girl presenting with a complicated urological anomaly discovered very late. The lower part of her right kidney is dysplastic (or destroyed) with pseudocystic pyelocalyceal cavities filled with stones and cloudy urine. The first hypothesis is that we are dealing with a true renal duplicity with a destroyed non-functional inferior pole. In this case, there is one ureter per kidney pole. As a result, polar ureteronephrectomy does not cause any potential vascular problems.
In this case, thanks to 3D reconstruction (Visible Patient™, a spinoff of IRCAD), it is clear that there is no kidney duplicity, but a pyelic bifurcation. It means that we should manage the only ureter, which drains the superior and inferior pelvis. For that reason, the placement of a double J catheter is essential prior to partial nephrectomy. This catheter should be pulled up until the superior pelvis.
Tridimensional reconstruction of the CT-scan images of a patient with a malformation is extremely helpful to better understand the original and unique anatomy of the patient and to determine a tailored operative strategy.
This video demonstrates a laparoscopic partial nephrectomy on non-functional, symptomatic right lower pole of the kidney in a 13-year-old girl as an outpatient surgery.
Incidental finding of a voluminous bronchogenic cyst in a 13-year-old child
This rare case of a giant bronchogenic cyst in the lower right hemithorax allows to provide the following tips: patient positioning and port placement should allow for a 180-degree reversal of the screen and free movement of the surgical team; use of a LigaSure™ vessel-sealing device used as a dissection instrument in lung surgery is helpful but does not guarantee perfect aerostasis, which should be controlled by taking enough time at the end of the procedure when reventilating an excluded lobe intraoperatively; along with low intrathoracic carbon dioxide insufflation, the use of a blocker in pediatric thoracoscopic surgery is an unconditional factor, which contributes to a satisfactory operating field.
F Becmeur, L Donato
Surgical intervention
4 days ago
24 views
0 likes
0 comments
05:31
Incidental finding of a voluminous bronchogenic cyst in a 13-year-old child
This rare case of a giant bronchogenic cyst in the lower right hemithorax allows to provide the following tips: patient positioning and port placement should allow for a 180-degree reversal of the screen and free movement of the surgical team; use of a LigaSure™ vessel-sealing device used as a dissection instrument in lung surgery is helpful but does not guarantee perfect aerostasis, which should be controlled by taking enough time at the end of the procedure when reventilating an excluded lobe intraoperatively; along with low intrathoracic carbon dioxide insufflation, the use of a blocker in pediatric thoracoscopic surgery is an unconditional factor, which contributes to a satisfactory operating field.
Pheochromocytoma: laparoscopic right adrenalectomy in a child
In the context of major headaches in a 9-year-old patient whose brother had been operated on for pheochromocytoma, a right adrenal pheochromocytoma with severe arterial hypertension was found.
The given video aims to demonstrate the usefulness of performing a 3D reconstruction of the tumor (using Visible Patient™ 3D reconstruction tool). It is essential to have precise preoperative information and work out a surgical strategy taking into account observed anatomical anomalies, since tumor and/or vascular anatomy may have numerous variations in case of pheochromocytomas.
A reconstruction model can be easily manipulated on a touch screen. It can be oriented in such a way that the angle of view changes allowing for a better understanding of the anatomy, so that an approach to vessels or neighboring organs is easily decided upon. Additionally, the option of adding or deleting this or that anatomical element allows for a simplified visual approach, which usually represents a potential difficulty during dissection.
Finally, the 3D reconstruction of this patient perfectly corresponds to her real anatomy. Thanks to a mere scanning based on the reconstruction, the vascularization mode of the tumor as well as the existence of a hidden part of healthy tissue can be verified.
F Becmeur, A Lachkar, L Soler
Surgical intervention
4 days ago
69 views
1 like
0 comments
08:30
Pheochromocytoma: laparoscopic right adrenalectomy in a child
In the context of major headaches in a 9-year-old patient whose brother had been operated on for pheochromocytoma, a right adrenal pheochromocytoma with severe arterial hypertension was found.
The given video aims to demonstrate the usefulness of performing a 3D reconstruction of the tumor (using Visible Patient™ 3D reconstruction tool). It is essential to have precise preoperative information and work out a surgical strategy taking into account observed anatomical anomalies, since tumor and/or vascular anatomy may have numerous variations in case of pheochromocytomas.
A reconstruction model can be easily manipulated on a touch screen. It can be oriented in such a way that the angle of view changes allowing for a better understanding of the anatomy, so that an approach to vessels or neighboring organs is easily decided upon. Additionally, the option of adding or deleting this or that anatomical element allows for a simplified visual approach, which usually represents a potential difficulty during dissection.
Finally, the 3D reconstruction of this patient perfectly corresponds to her real anatomy. Thanks to a mere scanning based on the reconstruction, the vascularization mode of the tumor as well as the existence of a hidden part of healthy tissue can be verified.
IRCAD Webinar: Third ESPES/IPEG Masterclass with the participation of the ESPU
ACUTE APPENDICITIS and PERITONITIS
1. Laparoscopic vs. open appendectomy in children - Mark Wulkan (IPEG)
2. Single port vs. Multiport and the role of new technologies in the management of pediatric complicated appendicitis - Ciro Esposito (ESPES)

CONGENITAL DIAPHRAGMATIC HERNIA (CDH)
1. Open approach for the treatment of CDH - François Becmeur (ESPES)
2. Minimally invasive management of pediatric CDH - Holger Till (IPEG)

VESICOURETERAL REFLUX (VUR)
1. Open, endourological, and robotic management of pediatric VUR - Ramnath Subramaniam (ESPU)
2. Laparoscopic management of VUR according to Lich-Gregoir procedure - François Varlet (ESPES)

Masters of ceremonies:
François Becmeur (IRCAD-Strasbourg)
Philippe Montupet (APHP-Paris)

Chairmen:
Mario Mendoza Sagaon (ESPES)
Alaa El Ghoneimi (ESPU)
Philippe Szavay (IPEG)
F Becmeur, P Montupet, A El-Ghoneimi, P Szavay, M Mendoza Sagaon, M Wulkan, C Esposito, H Till, R Subramaniam, F Varlet
Surgical intervention
4 months ago
352 views
86 likes
0 comments
11:17
IRCAD Webinar: Third ESPES/IPEG Masterclass with the participation of the ESPU
ACUTE APPENDICITIS and PERITONITIS
1. Laparoscopic vs. open appendectomy in children - Mark Wulkan (IPEG)
2. Single port vs. Multiport and the role of new technologies in the management of pediatric complicated appendicitis - Ciro Esposito (ESPES)

CONGENITAL DIAPHRAGMATIC HERNIA (CDH)
1. Open approach for the treatment of CDH - François Becmeur (ESPES)
2. Minimally invasive management of pediatric CDH - Holger Till (IPEG)

VESICOURETERAL REFLUX (VUR)
1. Open, endourological, and robotic management of pediatric VUR - Ramnath Subramaniam (ESPU)
2. Laparoscopic management of VUR according to Lich-Gregoir procedure - François Varlet (ESPES)

Masters of ceremonies:
François Becmeur (IRCAD-Strasbourg)
Philippe Montupet (APHP-Paris)

Chairmen:
Mario Mendoza Sagaon (ESPES)
Alaa El Ghoneimi (ESPU)
Philippe Szavay (IPEG)
IRCAD Webinar: Third ESPES/IPEG Masterclass with the participation of the ESPU
ACUTE APPENDICITIS and PERITONITIS
1. Laparoscopic vs. open appendectomy in children - Mark Wulkan (IPEG)
2. Single port vs. Multiport and the role of new technologies in the management of pediatric complicated appendicitis - Ciro Esposito (ESPES)

CONGENITAL DIAPHRAGMATIC HERNIA (CDH)
1. Open approach for the treatment of CDH - François Becmeur (ESPES)
2. Minimally invasive management of pediatric CDH - Holger Till (IPEG)

VESICOURETERAL REFLUX (VUR)
1. Open, endourological, and robotic management of pediatric VUR - Ramnath Subramaniam (ESPU)
2. Laparoscopic management of VUR according to Lich-Gregoir procedure - François Varlet (ESPES)

Masters of ceremonies:
François Becmeur (IRCAD-Strasbourg)
Philippe Montupet (APHP-Paris)

Chairmen:
Mario Mendoza Sagaon (ESPES)
Alaa El Ghoneimi (ESPU)
Philippe Szavay (IPEG)
F Becmeur, P Montupet, A El-Ghoneimi, P Szavay, M Mendoza Sagaon, M Wulkan, C Esposito, H Till, R Subramaniam, F Varlet
Webinar
4 months ago
219 views
3 likes
0 comments
11:17
IRCAD Webinar: Third ESPES/IPEG Masterclass with the participation of the ESPU
ACUTE APPENDICITIS and PERITONITIS
1. Laparoscopic vs. open appendectomy in children - Mark Wulkan (IPEG)
2. Single port vs. Multiport and the role of new technologies in the management of pediatric complicated appendicitis - Ciro Esposito (ESPES)

CONGENITAL DIAPHRAGMATIC HERNIA (CDH)
1. Open approach for the treatment of CDH - François Becmeur (ESPES)
2. Minimally invasive management of pediatric CDH - Holger Till (IPEG)

VESICOURETERAL REFLUX (VUR)
1. Open, endourological, and robotic management of pediatric VUR - Ramnath Subramaniam (ESPU)
2. Laparoscopic management of VUR according to Lich-Gregoir procedure - François Varlet (ESPES)

Masters of ceremonies:
François Becmeur (IRCAD-Strasbourg)
Philippe Montupet (APHP-Paris)

Chairmen:
Mario Mendoza Sagaon (ESPES)
Alaa El Ghoneimi (ESPU)
Philippe Szavay (IPEG)
Thoracoscopic repair of pure esophageal atresia
A full-term baby weighing 2.8 kg was diagnosed with pure esophageal atresia. No other associated anomalies were found by abdominal sonography and echocardiography. The primary anastomosis was completed thoracoscopically after mobilization of both esophageal pouches. The patient was placed in a prone position at the edge of the operating table. A 5mm, 30-degree angled scope was introduced one fingerbreadth below the lower angle of the scapula. Two 3mm working ports were also inserted; the first in the same costal space as the camera port 3cm from the middle line and the second as high as possible in the axilla. A thin fibrous strand was found connecting both ends of the esophagus. The azygos vein was left intact. Blunt dissection was used throughout the whole procedure to preserve the aortic branches to the lower pouch, dissecting in between them. Without traction, the distance between both pouches was approximately 4cm or 4 vertebral bodies. No tracheoesophageal fistula (TEF) was identified. Nine polyglactin 5/0 sliding tumble square knots were used to complete the anastomosis. The operative time was 85 minutes. The postoperative period was uneventful. Nasogatric tube feeding started on postoperative day 2, and the patient was discharged on postoperative day 6 after performing a contrast swallow test ensuring that there is no leakage.
MM Elbarbary, KHK Bahaaeldin, AE Fares, H Seleim, A Shalaby, M Elseoudi, MM Ragab
Surgical intervention
7 months ago
657 views
226 likes
0 comments
18:13
Thoracoscopic repair of pure esophageal atresia
A full-term baby weighing 2.8 kg was diagnosed with pure esophageal atresia. No other associated anomalies were found by abdominal sonography and echocardiography. The primary anastomosis was completed thoracoscopically after mobilization of both esophageal pouches. The patient was placed in a prone position at the edge of the operating table. A 5mm, 30-degree angled scope was introduced one fingerbreadth below the lower angle of the scapula. Two 3mm working ports were also inserted; the first in the same costal space as the camera port 3cm from the middle line and the second as high as possible in the axilla. A thin fibrous strand was found connecting both ends of the esophagus. The azygos vein was left intact. Blunt dissection was used throughout the whole procedure to preserve the aortic branches to the lower pouch, dissecting in between them. Without traction, the distance between both pouches was approximately 4cm or 4 vertebral bodies. No tracheoesophageal fistula (TEF) was identified. Nine polyglactin 5/0 sliding tumble square knots were used to complete the anastomosis. The operative time was 85 minutes. The postoperative period was uneventful. Nasogatric tube feeding started on postoperative day 2, and the patient was discharged on postoperative day 6 after performing a contrast swallow test ensuring that there is no leakage.
Thoracoscopic treatment of pulmonary hydatid cyst in children
Introduction: The hydatid cyst is an anthropozoonosis caused by the development of the Echinococcus granulosus tapeworm larva in humans. It is endemic in the Mediterranean, South America, Middle East, Australia, New Zealand, and India. Lung localization is ranked second in order of frequency for all age groups after liver localization.
Treatment is mainly surgical and consists in the resection of the protruding dome after cyst puncture, suction, and sterilization using a Scolicide solution followed by proligerous membrane extraction and bronchial fistulas obstruction. This surgery can be performed through a thoracotomy or a thoracoscopy.
We report the highlights of a thoracoscopic surgical management of a bilateral pulmonary hydatid cyst in a 6-year-old boy. The cyst was discovered following exploration for chest pain associated with a dry cough, as demonstrated by chest CT-scan findings and confirmed by serum chemistries positive for pulmonary hydatid cyst.
Materials and methods: The patient was first operated on for his two hydatid cysts of the right lung, followed by another left-side intervention a month later. Intubation was selective and was performed with a standard intubation cannula.
The patient was placed in a strict lateral decubitus position.
Four ports (10, 5, 5, and 5mm in size) were used for the right lung and three ports (10, 5, and 5mm) were used for the left lung, making sure to respect the rule of triangulation.
After partial filling of the pleural cavity with a 10% hypertonic saline solution, the surgical principles of the thoracoscopic treatment of pulmonary hydatid cysts are performed as follows: puncture of the cyst at its dome using a Veress needle, suction, and sterilization with a 10% hypertonic saline solution for 15 minutes; resection of the protruding dome; extraction of the proligerous membrane through an Endobag®; closure of bronchial fistulas by means of intracorporeal stitches; no padding necessary; double chest drainage (anterior and posterior).
Results: Immediate postoperative outcomes were uneventful. Paracetamol was sufficient to manage postoperative pain in the first 24 hours. Chest drains were removed on postoperative day 3, and the patient was discharged on postoperative day 4.
After 5 years, late postoperative outcomes were extremely favorable clinically, radiologically, and cosmetically speaking.
Conclusion: The thoracoscopic approach to the management of pulmonary hydatid cysts is feasible. It completely changed the postoperative evolution of thoracotomy, which causes pain and parietal sequelae in children.
AM Benaired
Surgical intervention
7 months ago
406 views
141 likes
0 comments
04:03
Thoracoscopic treatment of pulmonary hydatid cyst in children
Introduction: The hydatid cyst is an anthropozoonosis caused by the development of the Echinococcus granulosus tapeworm larva in humans. It is endemic in the Mediterranean, South America, Middle East, Australia, New Zealand, and India. Lung localization is ranked second in order of frequency for all age groups after liver localization.
Treatment is mainly surgical and consists in the resection of the protruding dome after cyst puncture, suction, and sterilization using a Scolicide solution followed by proligerous membrane extraction and bronchial fistulas obstruction. This surgery can be performed through a thoracotomy or a thoracoscopy.
We report the highlights of a thoracoscopic surgical management of a bilateral pulmonary hydatid cyst in a 6-year-old boy. The cyst was discovered following exploration for chest pain associated with a dry cough, as demonstrated by chest CT-scan findings and confirmed by serum chemistries positive for pulmonary hydatid cyst.
Materials and methods: The patient was first operated on for his two hydatid cysts of the right lung, followed by another left-side intervention a month later. Intubation was selective and was performed with a standard intubation cannula.
The patient was placed in a strict lateral decubitus position.
Four ports (10, 5, 5, and 5mm in size) were used for the right lung and three ports (10, 5, and 5mm) were used for the left lung, making sure to respect the rule of triangulation.
After partial filling of the pleural cavity with a 10% hypertonic saline solution, the surgical principles of the thoracoscopic treatment of pulmonary hydatid cysts are performed as follows: puncture of the cyst at its dome using a Veress needle, suction, and sterilization with a 10% hypertonic saline solution for 15 minutes; resection of the protruding dome; extraction of the proligerous membrane through an Endobag®; closure of bronchial fistulas by means of intracorporeal stitches; no padding necessary; double chest drainage (anterior and posterior).
Results: Immediate postoperative outcomes were uneventful. Paracetamol was sufficient to manage postoperative pain in the first 24 hours. Chest drains were removed on postoperative day 3, and the patient was discharged on postoperative day 4.
After 5 years, late postoperative outcomes were extremely favorable clinically, radiologically, and cosmetically speaking.
Conclusion: The thoracoscopic approach to the management of pulmonary hydatid cysts is feasible. It completely changed the postoperative evolution of thoracotomy, which causes pain and parietal sequelae in children.
Laparoscopic Ladd’s procedure for intestinal malrotation in an 18-month-old boy
Performing Ladd’s procedure for intestinal malrotation using a laparoscopic approach can be confusing and challenging. This can be attributed to the small working space in children as compared to the length of small and large bowel to be handled. The procedure also requires some understanding of the overall anatomical disorder in order to separate it into smaller steps of correction. The first step is to confirm the diagnosis. The operator has to identify the ligament of Treitz and the presence of Ladd’s bands stretching between the colon and the right abdomen. The bands are divided first to the left of the duodenum, and then between the duodenum and the colon. As a result, the mesentery is widened. Bowel derotation is then started placing the small bowel in the right side and the colon in the left side of the abdomen. The procedure is concluded with an appendectomy.
TA Wafa, S Abdelmaksoud
Surgical intervention
9 months ago
640 views
139 likes
0 comments
06:00
Laparoscopic Ladd’s procedure for intestinal malrotation in an 18-month-old boy
Performing Ladd’s procedure for intestinal malrotation using a laparoscopic approach can be confusing and challenging. This can be attributed to the small working space in children as compared to the length of small and large bowel to be handled. The procedure also requires some understanding of the overall anatomical disorder in order to separate it into smaller steps of correction. The first step is to confirm the diagnosis. The operator has to identify the ligament of Treitz and the presence of Ladd’s bands stretching between the colon and the right abdomen. The bands are divided first to the left of the duodenum, and then between the duodenum and the colon. As a result, the mesentery is widened. Bowel derotation is then started placing the small bowel in the right side and the colon in the left side of the abdomen. The procedure is concluded with an appendectomy.
Ovarian tissue cryopreservation
The French law on bioethics dated August 6 2004 now states the possibility for any person to benefit from a gamete or a germinal tissue collection as well as its preservation. Collection and preservation are planned when the patient’s management may induce a fertility alteration or when the patient’s fertility may be prematurely altered. Young girls who have not reached the age of puberty and who are about to undergo high-dose chemotherapy and/or major radiation therapy for cancer, can benefit from a cryopreservation of their ovarian tissue. It will allow to preserve fertility when these patients have a wish for pregnancy. Once collected, preserved ovarian cortical strips are systematically sent for frozen section to the pathology department in order to be processed for cryopreservation. Later on, when these young women have been healed and wish to become pregnant, the thawing of preserved ovarian cortical strips and the orthotopic autograft can take place. We suggest to collect the anterior cortex from both ovaries, which allows to preserve the two remaining ovaries. Another technique, which is performed by other teams, involves a unilateral oophorectomy for ovarian tissue preservation. A bilateral hemicortical sampling on both ovaries is well accepted by patients and their parents. Indeed, the video does not present an oophorectomy, which is considered as a definitive procedure, but a bilateral sampling which leaves two ovaries in place. The ovaries are reduced in size but are anatomically and functionally healthy.
F Becmeur
Surgical intervention
1 year ago
442 views
55 likes
0 comments
03:05
Ovarian tissue cryopreservation
The French law on bioethics dated August 6 2004 now states the possibility for any person to benefit from a gamete or a germinal tissue collection as well as its preservation. Collection and preservation are planned when the patient’s management may induce a fertility alteration or when the patient’s fertility may be prematurely altered. Young girls who have not reached the age of puberty and who are about to undergo high-dose chemotherapy and/or major radiation therapy for cancer, can benefit from a cryopreservation of their ovarian tissue. It will allow to preserve fertility when these patients have a wish for pregnancy. Once collected, preserved ovarian cortical strips are systematically sent for frozen section to the pathology department in order to be processed for cryopreservation. Later on, when these young women have been healed and wish to become pregnant, the thawing of preserved ovarian cortical strips and the orthotopic autograft can take place. We suggest to collect the anterior cortex from both ovaries, which allows to preserve the two remaining ovaries. Another technique, which is performed by other teams, involves a unilateral oophorectomy for ovarian tissue preservation. A bilateral hemicortical sampling on both ovaries is well accepted by patients and their parents. Indeed, the video does not present an oophorectomy, which is considered as a definitive procedure, but a bilateral sampling which leaves two ovaries in place. The ovaries are reduced in size but are anatomically and functionally healthy.
Pediatric laparoscopic floppy Nissen fundoplication
Surgical therapy is well-established in children with gastroesophageal reflux disease (GERD). It is known that the laparoscopic approach is safe and effective. We tailored our surgical strategy based on two main studies which we conducted: one observational long-term follow-up and the other one related to the effect of Thal fundoplication on pulmonary affections. Our conclusions are summarized as follows:
- no surgery in the first 12 months,
- indications determined together with the consent of parents,
- a radiological contrast study should always be performed preoperatively,
- history taking and at least two positive objective diagnoses leading to indication,
- for neurologically impaired patients, a Nissen fundoplication is selected,
- first-line treatment: percutaneous endoscopic gastrostomy (PEG) implantation, second step: fundoplication if necessary,
- for neurologically healthy patients without inborn anatomical diseases, a Thal fundoplication is selected,
- postoperative diagnoses in the follow-up period are only performed if necessary.
For this personal experience and in comparison with the established approach in the current literature, we have only poor evidence. It is due to the lack of prospective studies available and to an inadequate number of patients, which is typical in pediatric studies.
S Holland-Cunz
Surgical intervention
1 year ago
1399 views
205 likes
0 comments
03:54
Pediatric laparoscopic floppy Nissen fundoplication
Surgical therapy is well-established in children with gastroesophageal reflux disease (GERD). It is known that the laparoscopic approach is safe and effective. We tailored our surgical strategy based on two main studies which we conducted: one observational long-term follow-up and the other one related to the effect of Thal fundoplication on pulmonary affections. Our conclusions are summarized as follows:
- no surgery in the first 12 months,
- indications determined together with the consent of parents,
- a radiological contrast study should always be performed preoperatively,
- history taking and at least two positive objective diagnoses leading to indication,
- for neurologically impaired patients, a Nissen fundoplication is selected,
- first-line treatment: percutaneous endoscopic gastrostomy (PEG) implantation, second step: fundoplication if necessary,
- for neurologically healthy patients without inborn anatomical diseases, a Thal fundoplication is selected,
- postoperative diagnoses in the follow-up period are only performed if necessary.
For this personal experience and in comparison with the established approach in the current literature, we have only poor evidence. It is due to the lack of prospective studies available and to an inadequate number of patients, which is typical in pediatric studies.
Laparoscopic adrenalectomy (update of September 2014 presentation)
Laparoscopic adrenalectomy is an attractive alternative to open surgery in children as it is associated with less operative pain and a rapid resumption of diet and shorter operative time.
The relative contraindications are patients with malignancies which involve lymph nodes, highly vascular pheochromocytomas, and large tumors.
Neuroblastoma, congenital adrenal hyperplasia, pheochromocytomas and adrenal cortical carcinomas are the main indications in children.
The transabdominal lateral approach is more commonly used in the pediatric population.
The tumors are incidental findings and 31% of them are malignant in children.
The various techniques of adrenalectomy, preoperative work-up, and indications are described in this lecture.
D Patkowski
Lecture
2 years ago
1120 views
88 likes
0 comments
16:05
Laparoscopic adrenalectomy (update of September 2014 presentation)
Laparoscopic adrenalectomy is an attractive alternative to open surgery in children as it is associated with less operative pain and a rapid resumption of diet and shorter operative time.
The relative contraindications are patients with malignancies which involve lymph nodes, highly vascular pheochromocytomas, and large tumors.
Neuroblastoma, congenital adrenal hyperplasia, pheochromocytomas and adrenal cortical carcinomas are the main indications in children.
The transabdominal lateral approach is more commonly used in the pediatric population.
The tumors are incidental findings and 31% of them are malignant in children.
The various techniques of adrenalectomy, preoperative work-up, and indications are described in this lecture.
Laparoscopic adrenalectomy
Retroperitoneoscopic adrenalectomy was developed in 1993, initially only for small benign lesions and recently for lesions superior to 5 cm and even malignancies.
This retroperitoneal technique has gained popularity since it allows for a direct access to the gland and prevents unexpected injuries to the intra-abdominal organs.
In this lecture, Dr. Mushtaq outlines the indications for adrenalectomy in children, patient set-up, trocar placement, and operative technique overview. The importance of resecting the gland ‘en bloc’ has been emphasized.
The retroperitoneal approach begins by placing the child in a prone position. The 12th rib, iliac crest, and paravertebral muscles are then marked on the patient. The first incision is made at the lateral border of the lateral vertebral muscles, halfway between the 12th rib and the iliac crest (Heloury et al., 2011).
This lecture was delivered during the pediatric urology course held at IRCAD in March 2016.
I Mushtaq
Lecture
2 years ago
1460 views
143 likes
0 comments
16:41
Laparoscopic adrenalectomy
Retroperitoneoscopic adrenalectomy was developed in 1993, initially only for small benign lesions and recently for lesions superior to 5 cm and even malignancies.
This retroperitoneal technique has gained popularity since it allows for a direct access to the gland and prevents unexpected injuries to the intra-abdominal organs.
In this lecture, Dr. Mushtaq outlines the indications for adrenalectomy in children, patient set-up, trocar placement, and operative technique overview. The importance of resecting the gland ‘en bloc’ has been emphasized.
The retroperitoneal approach begins by placing the child in a prone position. The 12th rib, iliac crest, and paravertebral muscles are then marked on the patient. The first incision is made at the lateral border of the lateral vertebral muscles, halfway between the 12th rib and the iliac crest (Heloury et al., 2011).
This lecture was delivered during the pediatric urology course held at IRCAD in March 2016.
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
1407 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
428 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
407 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
791 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
569 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
382 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
720 views
42 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
387 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
662 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
234 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
685 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.
Thoracoscopic Bochdalek hernia repair in a newborn
Congenital diaphragmatic hernias (CDH) occur when muscle portions of the diaphragm fail to develop normally, resulting in the displacement of abdominal components into the thoracic cavity.
CDHs occur mainly during the eighth to the tenth weeks of fetal life. Bochdalek hernias, caused by posterolateral defects of diaphragm, usually present with severe respiratory distress immediately after birth, which is life-threatening. Once diagnosed, Bochdalek hernias should be surgically treated during the neonatal period.
We present a clinical case of a newborn with 38 weeks of gestation with the prenatal diagnosis of left diaphragmatic hernia. A thoracoscopic repair was performed with parent agreement.
C Sousa, A Coelho, F Carvalho
Surgical intervention
2 years ago
1291 views
69 likes
0 comments
02:43
Thoracoscopic Bochdalek hernia repair in a newborn
Congenital diaphragmatic hernias (CDH) occur when muscle portions of the diaphragm fail to develop normally, resulting in the displacement of abdominal components into the thoracic cavity.
CDHs occur mainly during the eighth to the tenth weeks of fetal life. Bochdalek hernias, caused by posterolateral defects of diaphragm, usually present with severe respiratory distress immediately after birth, which is life-threatening. Once diagnosed, Bochdalek hernias should be surgically treated during the neonatal period.
We present a clinical case of a newborn with 38 weeks of gestation with the prenatal diagnosis of left diaphragmatic hernia. A thoracoscopic repair was performed with parent agreement.