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Monthly publications

#June 2007
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Laparoscopic sigmoidectomy for sigmoid diverticulitis in an obese (BMI=39) female patient
This video demonstrates the laparoscopic approach to sigmoid resection following previous attacks of diverticulitis. The medial vascular approach is employed, although in this case the inferior mesenteric artery is preserved. Obesity presents particular problems of reduced space and difficulty in identification of structures because of visceral adiposity. This video is suitable for advanced laparoscopic digestive surgeons.

The authors use the medial vascular approach, preserving the inferior mesenteric artery. The obese patient presents the dual challenge of reduced space and difficulty in identifying structures. The authors gain exposure of the mesosigmoid, and initially incise the peritoneum to divide the vessels, respecting the superior rectal vessels. They divide only the sigmoid vessels to preserve the superior rectal artery and vein.
J Leroy, J Marescaux
Surgical intervention
11 years ago
1289 views
10 likes
0 comments
21:15
Laparoscopic sigmoidectomy for sigmoid diverticulitis in an obese (BMI=39) female patient
This video demonstrates the laparoscopic approach to sigmoid resection following previous attacks of diverticulitis. The medial vascular approach is employed, although in this case the inferior mesenteric artery is preserved. Obesity presents particular problems of reduced space and difficulty in identification of structures because of visceral adiposity. This video is suitable for advanced laparoscopic digestive surgeons.

The authors use the medial vascular approach, preserving the inferior mesenteric artery. The obese patient presents the dual challenge of reduced space and difficulty in identifying structures. The authors gain exposure of the mesosigmoid, and initially incise the peritoneum to divide the vessels, respecting the superior rectal vessels. They divide only the sigmoid vessels to preserve the superior rectal artery and vein.
Laparoscopic gastric bypass in a patient with a BMI of 51
This video demonstrates the bariatric procedure of Roux-en-Y gastric bypass, with the Roux limb in the ante-colic position. The jejunojejunostomy is performed with a linear stapler, while the gastrojejunostomy is carried out with a circular stapler; the anvil having been passed down from the mouth into the stomach, attached to the end of a nasogastric tube. This video is suitable for bariatric surgeons.
The authors identify the duodenojejunal flexure (ligament of Treitz). They measure a biliary loop of 75cm, shelving that to the left and temporarily attaching it to the stomach before marking it. They then measure a 150cm alimentary limb and place it in the right side of the abdomen, and attach it with a suture to the end of the biliary loop. They create a minimal opening in the two loops with a cautery hook to allow passage of the linear stapler, using 2.5mm staples. They close the opening through which the linear stapler is introduced with an absorbable 2/0 braided running suture. The procedure continues with the closure of the mesenteric defect.
M Vix, J Marescaux
Surgical intervention
11 years ago
261 views
56 likes
0 comments
15:14
Laparoscopic gastric bypass in a patient with a BMI of 51
This video demonstrates the bariatric procedure of Roux-en-Y gastric bypass, with the Roux limb in the ante-colic position. The jejunojejunostomy is performed with a linear stapler, while the gastrojejunostomy is carried out with a circular stapler; the anvil having been passed down from the mouth into the stomach, attached to the end of a nasogastric tube. This video is suitable for bariatric surgeons.
The authors identify the duodenojejunal flexure (ligament of Treitz). They measure a biliary loop of 75cm, shelving that to the left and temporarily attaching it to the stomach before marking it. They then measure a 150cm alimentary limb and place it in the right side of the abdomen, and attach it with a suture to the end of the biliary loop. They create a minimal opening in the two loops with a cautery hook to allow passage of the linear stapler, using 2.5mm staples. They close the opening through which the linear stapler is introduced with an absorbable 2/0 braided running suture. The procedure continues with the closure of the mesenteric defect.
Removal of mesh plug and TEP repair of a recurrent left inguinal hernia in a 72-year-old man
This video demonstrates in great detail the laparoscopic TEP approach to recurrent hernia. The previously placed mesh plug is carefully dissected and removed. The preperitoneal space is thus created in order to place a mesh in the correct position. This video is suitable for experienced laparoscopic hernia surgeons.
The author begins the dissection lateral to the inferior epigastric vessels, then uses sharp dissection to take down the adhesions. This step requires caution because of the proximity of major vessels. The author then continues with sharp and blunt dissection to further develop the lateral peritoneal space. A few clean sweeps of the scissors or blunt forceps downward make adequate space lateral to the inferior epigastric vessels for mesh placement.
P Arora
Surgical intervention
11 years ago
820 views
35 likes
0 comments
11:28
Removal of mesh plug and TEP repair of a recurrent left inguinal hernia in a 72-year-old man
This video demonstrates in great detail the laparoscopic TEP approach to recurrent hernia. The previously placed mesh plug is carefully dissected and removed. The preperitoneal space is thus created in order to place a mesh in the correct position. This video is suitable for experienced laparoscopic hernia surgeons.
The author begins the dissection lateral to the inferior epigastric vessels, then uses sharp dissection to take down the adhesions. This step requires caution because of the proximity of major vessels. The author then continues with sharp and blunt dissection to further develop the lateral peritoneal space. A few clean sweeps of the scissors or blunt forceps downward make adequate space lateral to the inferior epigastric vessels for mesh placement.
Right inguinal hernia and intrafascial psoas hernia: TEP repair
This is a video demonstrating the laparoscopic preperitoneal approach to repair a right inguinal hernia. The Veress needle is used directly at the beginning of the procedure to create the preperitoneal space. Interestingly, a psoas herniation is also discovered during the dissection. This video is suitable for general surgeons with an interesting laparoscopic hernia surgery.
The authors gain view of the pubic bone, following it to the Cooper’s ligament. Their goal is to create space with blunt dissection and gentle traction only. They proceed with caution to avoid the epigastric vessels. The hernia comes into view, but the authors remain close to the hernia sac to avoid the epigastric vessels until they discern the exact anatomy. This guides the operators to the hernia, and they then continue to develop additional lateral space.
B Dallemagne, S Perretta, J Marescaux
Surgical intervention
11 years ago
1792 views
53 likes
0 comments
13:39
Right inguinal hernia and intrafascial psoas hernia: TEP repair
This is a video demonstrating the laparoscopic preperitoneal approach to repair a right inguinal hernia. The Veress needle is used directly at the beginning of the procedure to create the preperitoneal space. Interestingly, a psoas herniation is also discovered during the dissection. This video is suitable for general surgeons with an interesting laparoscopic hernia surgery.
The authors gain view of the pubic bone, following it to the Cooper’s ligament. Their goal is to create space with blunt dissection and gentle traction only. They proceed with caution to avoid the epigastric vessels. The hernia comes into view, but the authors remain close to the hernia sac to avoid the epigastric vessels until they discern the exact anatomy. This guides the operators to the hernia, and they then continue to develop additional lateral space.
Laparoscopic Heller-Dor procedure for pediatric esophageal achalasia
This is a pediatric surgical video demonstrating the technique of Heller myotomy. The procedure is then concluded with a Dor fundoplication, including an anterior gastropexy. It is suitable for pediatric surgeons with an interest in laparoscopic surgery.
This approach for the myotomy concludes with a fundoplication and an anterior gastropexy. The surgeon in this clip frees the anterior and lateral sides of the esophagus to proceed cranially into the mediastinum. Identification of the anterior vagus nerve is mandatory. The anterior surface of the esophagus must be almost completely free of tissue to enable this. Hook diathermy allows close dissection, retraction and coagulation. The operation continues with monopolar diathermy to clear the tissue from the anterior surface of the stomach.
V Jasonni, G Mattioli
Surgical intervention
11 years ago
319 views
46 likes
0 comments
07:08
Laparoscopic Heller-Dor procedure for pediatric esophageal achalasia
This is a pediatric surgical video demonstrating the technique of Heller myotomy. The procedure is then concluded with a Dor fundoplication, including an anterior gastropexy. It is suitable for pediatric surgeons with an interest in laparoscopic surgery.
This approach for the myotomy concludes with a fundoplication and an anterior gastropexy. The surgeon in this clip frees the anterior and lateral sides of the esophagus to proceed cranially into the mediastinum. Identification of the anterior vagus nerve is mandatory. The anterior surface of the esophagus must be almost completely free of tissue to enable this. Hook diathermy allows close dissection, retraction and coagulation. The operation continues with monopolar diathermy to clear the tissue from the anterior surface of the stomach.