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Santiago AYORA GONZÁLEZ

Fundación Jiménez Díaz
Madrid, Spain
MD
195 likes
9939 views
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Insulinoma of the pancreatic tail: left pancreatic resection with preservation of the spleen
This video shows a left pancreatic resection with splenic preservation in a 56-year-old woman. The patient has a visible insulinoma (1cm in diameter) located at the lower border of the pancreatic tail. The pancreatic tail is 3 to 4cm distant to the splenic hilum, which facilitates the dissection. Trocar position is similar to the one used in gastric laparoscopic surgery. First, the gastrocolic ligament is divided, and the stomach is retracted to the right side of the patient, along with the left lobe of the liver. After dissection of retrogastric adhesions, the peritoneum is incised on the lower border of the pancreas to get access to the retropancreatic area. The splenic artery is dissected on the upper pancreatic border and encircled with a vessel loop. The last retropancreatic attachments are taken down and the splenic vein is dissected and encircled with a vessel loop. Once the splenic vessels are retracted, the pancreatic transection is performed with a linear stapler. The last adhesions from the pancreatic tail to the splenic vessels are dissected with the LigaSure™ vessel-sealing device, making sure to preserve the splenic vessels. Finally, the resected pancreatic tail is placed in a specimen retrieval bag (Endobag®) and extracted through the trocar incision in the upper left abdomen. Hemostasis is checked while making sure that splenic perfusion is adequate.
P Vorwald, A Celdrán, M Posada, G Salcedo, T Georgiev, ML Sánchez de Molina, R Restrepo, S Ayora González
Surgical intervention
3 years ago
1691 views
43 likes
0 comments
10:03
Insulinoma of the pancreatic tail: left pancreatic resection with preservation of the spleen
This video shows a left pancreatic resection with splenic preservation in a 56-year-old woman. The patient has a visible insulinoma (1cm in diameter) located at the lower border of the pancreatic tail. The pancreatic tail is 3 to 4cm distant to the splenic hilum, which facilitates the dissection. Trocar position is similar to the one used in gastric laparoscopic surgery. First, the gastrocolic ligament is divided, and the stomach is retracted to the right side of the patient, along with the left lobe of the liver. After dissection of retrogastric adhesions, the peritoneum is incised on the lower border of the pancreas to get access to the retropancreatic area. The splenic artery is dissected on the upper pancreatic border and encircled with a vessel loop. The last retropancreatic attachments are taken down and the splenic vein is dissected and encircled with a vessel loop. Once the splenic vessels are retracted, the pancreatic transection is performed with a linear stapler. The last adhesions from the pancreatic tail to the splenic vessels are dissected with the LigaSure™ vessel-sealing device, making sure to preserve the splenic vessels. Finally, the resected pancreatic tail is placed in a specimen retrieval bag (Endobag®) and extracted through the trocar incision in the upper left abdomen. Hemostasis is checked while making sure that splenic perfusion is adequate.
Laparoscopic resection of an epiphrenic diverticulum
This video shows a laparoscopic resection of a large epiphrenic diverticulum and an esophageal myotomy with partial posterior fundoplication. Abdominal obesity as well as an accessory left hepatic artery originating from the left gastric artery make dissection of the right para-esophageal area difficult. An anterior phrenotomy as well as the posterior retro-esophageal dissection towards the aorta make dissection of the diverticulum possible. The upper limit of the diverticulum is strongly attached to the esophagus and the pleura, and its dissection is difficult. After complete dissection of the diverticulum and with the guidance of an intraoperative endoscopy, resection is performed. As it is believed that an underlying motility disorder is present, a distal esophageal myotomy and partial fundoplication is added. The postoperative course was uneventful and the patient has no remaining symptoms.
P Vorwald, M Posada, S Ayora González, D Cortés, M de Vega Irañeta, C Ferrero, ML Sánchez de Molina
Surgical intervention
3 years ago
918 views
21 likes
0 comments
16:35
Laparoscopic resection of an epiphrenic diverticulum
This video shows a laparoscopic resection of a large epiphrenic diverticulum and an esophageal myotomy with partial posterior fundoplication. Abdominal obesity as well as an accessory left hepatic artery originating from the left gastric artery make dissection of the right para-esophageal area difficult. An anterior phrenotomy as well as the posterior retro-esophageal dissection towards the aorta make dissection of the diverticulum possible. The upper limit of the diverticulum is strongly attached to the esophagus and the pleura, and its dissection is difficult. After complete dissection of the diverticulum and with the guidance of an intraoperative endoscopy, resection is performed. As it is believed that an underlying motility disorder is present, a distal esophageal myotomy and partial fundoplication is added. The postoperative course was uneventful and the patient has no remaining symptoms.
Laparoscopic redo after failed Roux-en-Y gastric bypass
This video shows a reintervention after laparoscopic bypass in a 44-year-old woman presenting with a history of dysphagia which began shortly after surgery.
First, a dissection between the inferior surface of the left hepatic lobe and the gastrojejunal anastomosis is performed. The gastrojejunal anastomosis is then dissected on its posterior side and a scarry and stenotic anastomosis becomes visible with a chronic fistula to the excluded stomach.
After resection of the “old” anastomosis, a new gastrojejunostomy is performed using the OrVil™ orogastric tube and the DST Series™ EEA™ 25mm circular stapling device.
P Vorwald, M Posada, D Cortés, S Ayora González, E Bernal, C Ferrero
Surgical intervention
3 years ago
875 views
21 likes
0 comments
14:04
Laparoscopic redo after failed Roux-en-Y gastric bypass
This video shows a reintervention after laparoscopic bypass in a 44-year-old woman presenting with a history of dysphagia which began shortly after surgery.
First, a dissection between the inferior surface of the left hepatic lobe and the gastrojejunal anastomosis is performed. The gastrojejunal anastomosis is then dissected on its posterior side and a scarry and stenotic anastomosis becomes visible with a chronic fistula to the excluded stomach.
After resection of the “old” anastomosis, a new gastrojejunostomy is performed using the OrVil™ orogastric tube and the DST Series™ EEA™ 25mm circular stapling device.
Laparoscopic redo Nissen posterior fundoplication
This video shows a reintervention after laparoscopic Nissen-Rossetti due to failure of the technique in a 70-year-old woman presenting with a history of dysphagia and weight loss beginning short after surgery.
First, dissection of the fundic wrap and esophageal hiatus are completed in order to expose specific anatomical landmarks that would help us understand the possible causes for the failure of the first procedure.
The original fundoplication is then unwrapped, rearranging it to the original anatomical position. This maneuver allows us to understand the causes for the technique’s failure, which can be accounted for by the asymmetrical position of the fundoplication caused by a series of elements. First, the short gastric vessels were not dissected during the first surgery, this probably contributed to the malposition of the right flap, which emerges from the posterior mid-stomach wall, distal to the fundus. On the other hand, the right flap emerges from the para-esophageal proximal edge of the lesser curvature; this causes the “valve” to be angulated and rotated clockwise, “hiding” the fundoplication on the posterior gastric wall.
To complete the procedure, a Toupet fundoplication is performed as a substituting anti-reflux technique.
P Vorwald, E York Pineda, E Bernal, M Posada, S Ayora González, R Restrepo
Surgical intervention
4 years ago
3394 views
74 likes
0 comments
10:37
Laparoscopic redo Nissen posterior fundoplication
This video shows a reintervention after laparoscopic Nissen-Rossetti due to failure of the technique in a 70-year-old woman presenting with a history of dysphagia and weight loss beginning short after surgery.
First, dissection of the fundic wrap and esophageal hiatus are completed in order to expose specific anatomical landmarks that would help us understand the possible causes for the failure of the first procedure.
The original fundoplication is then unwrapped, rearranging it to the original anatomical position. This maneuver allows us to understand the causes for the technique’s failure, which can be accounted for by the asymmetrical position of the fundoplication caused by a series of elements. First, the short gastric vessels were not dissected during the first surgery, this probably contributed to the malposition of the right flap, which emerges from the posterior mid-stomach wall, distal to the fundus. On the other hand, the right flap emerges from the para-esophageal proximal edge of the lesser curvature; this causes the “valve” to be angulated and rotated clockwise, “hiding” the fundoplication on the posterior gastric wall.
To complete the procedure, a Toupet fundoplication is performed as a substituting anti-reflux technique.
Total gastrectomy for early gastric cancer and giant paraesophageal hernia
This video shows a total gastrectomy in an 83-year-old woman with a giant type III paraesophageal hernia and an early gastric cancer located at the middle third of the stomach. First, type III paraesophageal hernia dissection with complete resection of the hernia sac is shown. A D1 lymphadenectomy is performed.
The esophagus is transected high in the posterior mediastinum and an end-to-side esophago-jejunostomy is performed using the Orvil™ orogastric tube and the EEA™ DST XL 25 circular stapling device. The esophago-jejunostomy is performed in a Roux-en-Y fashion. The alimentary limb is ascended through the transverse mesocolon. The skin incision used for trocar placement in the upper left abdomen (right hand of the surgeon) was slightly enlarged to allow for specimen extraction. Through this incision, the side-to-side jejuno-jejunostomy was performed extracorporeally.
P Vorwald, M de Vega Irañeta, E Bernal, D Cortés, S Ayora González, A Gomez Valdazo
Surgical intervention
4 years ago
3066 views
36 likes
1 comment
16:26
Total gastrectomy for early gastric cancer and giant paraesophageal hernia
This video shows a total gastrectomy in an 83-year-old woman with a giant type III paraesophageal hernia and an early gastric cancer located at the middle third of the stomach. First, type III paraesophageal hernia dissection with complete resection of the hernia sac is shown. A D1 lymphadenectomy is performed.
The esophagus is transected high in the posterior mediastinum and an end-to-side esophago-jejunostomy is performed using the Orvil™ orogastric tube and the EEA™ DST XL 25 circular stapling device. The esophago-jejunostomy is performed in a Roux-en-Y fashion. The alimentary limb is ascended through the transverse mesocolon. The skin incision used for trocar placement in the upper left abdomen (right hand of the surgeon) was slightly enlarged to allow for specimen extraction. Through this incision, the side-to-side jejuno-jejunostomy was performed extracorporeally.