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#April 2007
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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
780 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.
Laparoscopic left adrenalectomy for Conn's disease: virtual reality and exposure for vascular approach
This is a very detailed and didactic video demonstrating laparoscopic left adrenalectomy. All the critical steps are presented clearly and the surgical approach is explained at each stage. All the dissection is performed with only a hook cautery and atraumatic graspers. This is an excellent video for laparoscopic surgeons interested in learning adrenalectomy.

Key landmarks in this step are the splenic, adrenal, and renal veins—and the three main arterial pedicles of the latter that supply the left adrenal gland. The steady mobilization of the pancreas with retraction to the left with the spleen allows the authors to identify the renal vein, clear identification of which is essential. Steady dissection of the superior border of the renal vein enables positive identification of the adrenal vein. The authors dissect it circumferentially from the superior border of the renal vein up to the origin of the phrenic vein.
D Mutter, J Marescaux, L Soler
Surgical intervention
11 years ago
3123 views
67 likes
0 comments
14:22
Laparoscopic left adrenalectomy for Conn's disease: virtual reality and exposure for vascular approach
This is a very detailed and didactic video demonstrating laparoscopic left adrenalectomy. All the critical steps are presented clearly and the surgical approach is explained at each stage. All the dissection is performed with only a hook cautery and atraumatic graspers. This is an excellent video for laparoscopic surgeons interested in learning adrenalectomy.

Key landmarks in this step are the splenic, adrenal, and renal veins—and the three main arterial pedicles of the latter that supply the left adrenal gland. The steady mobilization of the pancreas with retraction to the left with the spleen allows the authors to identify the renal vein, clear identification of which is essential. Steady dissection of the superior border of the renal vein enables positive identification of the adrenal vein. The authors dissect it circumferentially from the superior border of the renal vein up to the origin of the phrenic vein.