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Monthly publications

#September 2007
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Laparoscopic TAPP for bilateral inguinal hernia
This video, recorded live during a surgical course, demonstrates the TAPP approach to bilateral hernia repair. Dr. Joel Leroy performs the repair using two separate meshes, one side at a time. This procedure is recommended to a general surgical audience.
The author uses a 3-trocar approach with a 0-degree 10mm optical scope. Exploration reveals some vivid landmarks, including abdominal wall adhesions from a previous appendectomy. The midline of the urinary bladder, umbilical ligament, vas deferens duct crossing behind the umbilical artery from behind —a key landmark the author will use during dissection of the peritoneum — and spermatic vessels all come into view. The direct hernia is visible between the epigastric vessels, retracted medially, and the umbilical ligament, retracted into the sac. When the author tries to reduce the sac, pressure pushes it back.
J Leroy
Surgical intervention
11 years ago
5281 views
130 likes
0 comments
12:37
Laparoscopic TAPP for bilateral inguinal hernia
This video, recorded live during a surgical course, demonstrates the TAPP approach to bilateral hernia repair. Dr. Joel Leroy performs the repair using two separate meshes, one side at a time. This procedure is recommended to a general surgical audience.
The author uses a 3-trocar approach with a 0-degree 10mm optical scope. Exploration reveals some vivid landmarks, including abdominal wall adhesions from a previous appendectomy. The midline of the urinary bladder, umbilical ligament, vas deferens duct crossing behind the umbilical artery from behind —a key landmark the author will use during dissection of the peritoneum — and spermatic vessels all come into view. The direct hernia is visible between the epigastric vessels, retracted medially, and the umbilical ligament, retracted into the sac. When the author tries to reduce the sac, pressure pushes it back.
Anatomical landmarks and TAPP approach for right inguinal hernia
This video, recorded live during a surgical course, demonstrates the TAPP approach to unilateral hernia repair. A detailed discussion of the technique is presented by Dr. Joel Leroy. This procedure is recommended to a general surgical audience.
The author carries out this transabdominal preperitoneal approach using 3 trocars: a 12mm (for mesh and camera), and two 5mm trocars. After exploration to assess the anatomy, the author proceeds to determine the landmarks. With the left trocar, he takes down adhesions from a previous appendectomy. Using low-energy coagulation, he carries out the vertical incision. The procedure continues as he carries out the dissection laterally and then places the mesh.
J Leroy
Surgical intervention
11 years ago
6418 views
202 likes
3 comments
12:55
Anatomical landmarks and TAPP approach for right inguinal hernia
This video, recorded live during a surgical course, demonstrates the TAPP approach to unilateral hernia repair. A detailed discussion of the technique is presented by Dr. Joel Leroy. This procedure is recommended to a general surgical audience.
The author carries out this transabdominal preperitoneal approach using 3 trocars: a 12mm (for mesh and camera), and two 5mm trocars. After exploration to assess the anatomy, the author proceeds to determine the landmarks. With the left trocar, he takes down adhesions from a previous appendectomy. Using low-energy coagulation, he carries out the vertical incision. The procedure continues as he carries out the dissection laterally and then places the mesh.
Laparoscopic appendectomy in a young woman, 22 weeks pregnant
This video is one of a series of laparoscopic appendicectomies. Additional pathologies are sometimes discovered during an appendectomy. One should be equally skilled to perform the necessary exploration and intervention by laparoscopy.
The authors use a few technical modifications in this 22-week pregnant patient. They place the left working trocar in the left flank, and the right in the right upper quadrant to avoid the gravid uterus, which occupies most of pelvis and lower abdomen. They examine the uterus and adnexa carefully to rule out any pathology before exposing the appendix. After they reach the base of the appendix and completely dissect the mesoappendix, they ligate the base of the appendix stump with two Vicryl loops. They place the extraction bag in the peritoneal cavity and divide the appendix at the base. Just before retrieving the appendix, the authors cauterize the appendicular stump.
The authors modify their typical laparoscopic approach to accommodate the pregnant woman’s anatomy. As they gain exposure of the appendix, the mesoappendix comes into view. They control the appendicular artery with bipolar coagulation. Sequential application of bipolar cautery and incision with scissors allows them to reach the base of the appendix. Once the authors completely dissect the mesoappendix, they ligate the base of the stump with a Vicryl loop.
D Varela, J Marescaux
Surgical intervention
11 years ago
880 views
157 likes
1 comment
05:00
Laparoscopic appendectomy in a young woman, 22 weeks pregnant
This video is one of a series of laparoscopic appendicectomies. Additional pathologies are sometimes discovered during an appendectomy. One should be equally skilled to perform the necessary exploration and intervention by laparoscopy.
The authors use a few technical modifications in this 22-week pregnant patient. They place the left working trocar in the left flank, and the right in the right upper quadrant to avoid the gravid uterus, which occupies most of pelvis and lower abdomen. They examine the uterus and adnexa carefully to rule out any pathology before exposing the appendix. After they reach the base of the appendix and completely dissect the mesoappendix, they ligate the base of the appendix stump with two Vicryl loops. They place the extraction bag in the peritoneal cavity and divide the appendix at the base. Just before retrieving the appendix, the authors cauterize the appendicular stump.
The authors modify their typical laparoscopic approach to accommodate the pregnant woman’s anatomy. As they gain exposure of the appendix, the mesoappendix comes into view. They control the appendicular artery with bipolar coagulation. Sequential application of bipolar cautery and incision with scissors allows them to reach the base of the appendix. Once the authors completely dissect the mesoappendix, they ligate the base of the stump with a Vicryl loop.
Benefit of laparoscopic approach in an appendicular purulent peritonitis
This video is one of a series of laparoscopic appendicectomies and shows the advantage of the videoscopic approach in accessing the entire peritoneal cavity in cases of diffuse peritonitis.
Blood tests revealed an inflammatory syndrome in a young woman with a 3-day history of diffuse abdominal pain and fever. Exploration of the abdominal cavity during emergency laparoscopy confirmed the clinical impressions. The authors performed aspiration and lavage of the peritoneal cavity. Thorough assessment revealed the omentum to be concentrated in the right iliac fossa, and gentle dissection uncovered a necrotic, perforated appendix. Dissection of the cecum and appendix was difficult because the tissues were friable and adherent. The usual tissue planes were not present, but the laparoscopic view allowed for a safe approach.
F Costantino, J Marescaux
Surgical intervention
11 years ago
573 views
95 likes
0 comments
04:04
Benefit of laparoscopic approach in an appendicular purulent peritonitis
This video is one of a series of laparoscopic appendicectomies and shows the advantage of the videoscopic approach in accessing the entire peritoneal cavity in cases of diffuse peritonitis.
Blood tests revealed an inflammatory syndrome in a young woman with a 3-day history of diffuse abdominal pain and fever. Exploration of the abdominal cavity during emergency laparoscopy confirmed the clinical impressions. The authors performed aspiration and lavage of the peritoneal cavity. Thorough assessment revealed the omentum to be concentrated in the right iliac fossa, and gentle dissection uncovered a necrotic, perforated appendix. Dissection of the cecum and appendix was difficult because the tissues were friable and adherent. The usual tissue planes were not present, but the laparoscopic view allowed for a safe approach.
Laparoscopic Collis Nissen: GERD with short esophagus
This live video demonstrates the Collis-Nissen procedure performed by Dr. Bernard Dallemagne during a surgical course. The patient presented with gastro-esophageal reflux disease and was only discovered intraoperatively to have a short esophagus. The confirmation of this diagnosis and the esophageal lengthening procedure are presented in detail. This video is recommended to surgeons with an interest in upper gastro-intestinal surgery.
The author places 5 trocars, directed by plain film findings that raise suspicion of a lipoma of the lower mediastinum. The author eschews the umbilical port for a port slightly above the umbilicus to accommodate the 0-degree scope. The optical port for the left hand is in the direction of hiatus. First, the author must gain traction on the gastroesophageal junction, then examine anatomy. He starts on the lesser omentum to help identify important landmarks, the first of which is the right crus.
B Dallemagne
Surgical intervention
11 years ago
2117 views
56 likes
0 comments
29:31
Laparoscopic Collis Nissen: GERD with short esophagus
This live video demonstrates the Collis-Nissen procedure performed by Dr. Bernard Dallemagne during a surgical course. The patient presented with gastro-esophageal reflux disease and was only discovered intraoperatively to have a short esophagus. The confirmation of this diagnosis and the esophageal lengthening procedure are presented in detail. This video is recommended to surgeons with an interest in upper gastro-intestinal surgery.
The author places 5 trocars, directed by plain film findings that raise suspicion of a lipoma of the lower mediastinum. The author eschews the umbilical port for a port slightly above the umbilicus to accommodate the 0-degree scope. The optical port for the left hand is in the direction of hiatus. First, the author must gain traction on the gastroesophageal junction, then examine anatomy. He starts on the lesser omentum to help identify important landmarks, the first of which is the right crus.