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Monthly publications

#April 2009
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Totally endoscopic right basilar segmentectomy for stage I lung carcinoma
Pulmonary segmentectomy was originally introduced nearly 70 years ago for the treatment of benign lung conditions. Later, Jensik and colleagues as well as Peters independently suggested that anatomic pulmonary segmentectomy could be effectively applied to small primary lung cancers when good margins were achievable. Today, this is possible thanks to recognition of early lung cancer by high-resolution computed tomography scan. Futhermore, lung-sparing procedures are advocated in those with small, early-stage primary lung cancers so that additional resections for bilateral synchronous or metachronous primaries are facilitated.
Several advantages to endoscopic procedures relative to open procedures have been identified and include decreased postoperative pain, shortened chest tube duration and length of stay, faster return to preoperative activity levels, preserved pulmonary function, and decreased inflammatory response.
This video demonstrates the main steps of a totally endoscopic right basilar segmentectomy for stage I lung carcinoma.

This technique is presented in the book :
D. Gossot Atlas of endoscopic major pulmonary resections
(2010) Springer-Verlag France
www.springer.com/978-2-287-99776-1
D Gossot
Surgical intervention
9 years ago
1814 views
25 likes
1 comment
04:14
Totally endoscopic right basilar segmentectomy for stage I lung carcinoma
Pulmonary segmentectomy was originally introduced nearly 70 years ago for the treatment of benign lung conditions. Later, Jensik and colleagues as well as Peters independently suggested that anatomic pulmonary segmentectomy could be effectively applied to small primary lung cancers when good margins were achievable. Today, this is possible thanks to recognition of early lung cancer by high-resolution computed tomography scan. Futhermore, lung-sparing procedures are advocated in those with small, early-stage primary lung cancers so that additional resections for bilateral synchronous or metachronous primaries are facilitated.
Several advantages to endoscopic procedures relative to open procedures have been identified and include decreased postoperative pain, shortened chest tube duration and length of stay, faster return to preoperative activity levels, preserved pulmonary function, and decreased inflammatory response.
This video demonstrates the main steps of a totally endoscopic right basilar segmentectomy for stage I lung carcinoma.

This technique is presented in the book :
D. Gossot Atlas of endoscopic major pulmonary resections
(2010) Springer-Verlag France
www.springer.com/978-2-287-99776-1
Stepwise approach for laparoscopic reversal of Hartmann's procedure
Restoration of intestinal continuity following reversal of Hartmann's procedure is an operation associated with a lengthy hospital stay, protracted convalescence, and a high morbidity rate. The advantages of minimally invasive surgery such as rapid mobilization, less postoperative pain, early restoration of bowel function, and a rapid return to a normal diet, and reduced morbidity are very useful in this procedure. Furthermore, laparoscopic reversal of Hartmann's has a comparable operative time with the open technique when performed by experienced surgeons like in this case. This interesting video shows each step of the procedure clearly. Three ports are used and the colon is divided intra-abdominally.
J Leroy, F Costantino, J Marescaux
Surgical intervention
9 years ago
2158 views
114 likes
0 comments
10:05
Stepwise approach for laparoscopic reversal of Hartmann's procedure
Restoration of intestinal continuity following reversal of Hartmann's procedure is an operation associated with a lengthy hospital stay, protracted convalescence, and a high morbidity rate. The advantages of minimally invasive surgery such as rapid mobilization, less postoperative pain, early restoration of bowel function, and a rapid return to a normal diet, and reduced morbidity are very useful in this procedure. Furthermore, laparoscopic reversal of Hartmann's has a comparable operative time with the open technique when performed by experienced surgeons like in this case. This interesting video shows each step of the procedure clearly. Three ports are used and the colon is divided intra-abdominally.
Laparoscopic Roux-en-Y gastric bypass after vertical banded gastroplasty
Patients who have undergone bariatric surgery and present with upper abdominal symptoms pose a diagnostic and management challenge.
Laparoscopic vertical banded gastroplasty (VBG) is associated with high revisional rates. In the case of failed VBG, repeat VBG seems to be a poor option and conversion to gastric bypass yields better results.
This is the case of a 35-year-old female patient who underwent a vertical banded gastroplasty by laparotomy 8 years ago and presents with dysphagia. A gastroscopy and a contrast swallow exam using radio-opaque markers do not show any fistulas, but peroperative surgical exploration discovers a gastro-gastric fistula. This video clearly shows all the technical aspects of a revisional bariatric procedure.
M Vix, F Costantino, J Marescaux
Surgical intervention
9 years ago
682 views
30 likes
0 comments
12:17
Laparoscopic Roux-en-Y gastric bypass after vertical banded gastroplasty
Patients who have undergone bariatric surgery and present with upper abdominal symptoms pose a diagnostic and management challenge.
Laparoscopic vertical banded gastroplasty (VBG) is associated with high revisional rates. In the case of failed VBG, repeat VBG seems to be a poor option and conversion to gastric bypass yields better results.
This is the case of a 35-year-old female patient who underwent a vertical banded gastroplasty by laparotomy 8 years ago and presents with dysphagia. A gastroscopy and a contrast swallow exam using radio-opaque markers do not show any fistulas, but peroperative surgical exploration discovers a gastro-gastric fistula. This video clearly shows all the technical aspects of a revisional bariatric procedure.
Laparoscopic excision of a horseshoe-shaped leiomyoma of the lower esophagus
Esophageal leiomyomas are approximately 50 times less common than carcinomas, but they represent 80% of benign tumors of the lower esophagus.
An esophageal leiomyoma can be enucleated safely and effectively through minimally invasive surgery. The laparoscopic approach is a conventional option for this kind of tumor (located near or at the esophagogastric (EG) junction). Laparoscopic transhiatal enucleation is a safe and feasible procedure. This video demonstrates all the technical details of a laparoscopic excision of a large horseshoe-shaped leiomyoma of the lower esophagus. A conventional port placement is used to approach the hiatal region.
B Dallemagne, J Marescaux
Surgical intervention
9 years ago
752 views
13 likes
0 comments
13:18
Laparoscopic excision of a horseshoe-shaped leiomyoma of the lower esophagus
Esophageal leiomyomas are approximately 50 times less common than carcinomas, but they represent 80% of benign tumors of the lower esophagus.
An esophageal leiomyoma can be enucleated safely and effectively through minimally invasive surgery. The laparoscopic approach is a conventional option for this kind of tumor (located near or at the esophagogastric (EG) junction). Laparoscopic transhiatal enucleation is a safe and feasible procedure. This video demonstrates all the technical details of a laparoscopic excision of a large horseshoe-shaped leiomyoma of the lower esophagus. A conventional port placement is used to approach the hiatal region.
Laparoscopic splenopancreatectomy assisted by augmented reality for pancreatic cancer
Soper et al. in 1994 were able to establish the safety and efficacy of laparoscopic distal pancreatectomy in an animal model, with no evidence of pancreatic leaks or fistulas. Later, in 1996, Cuschieri et al. described the technique they used to perform laparoscopic distal 70–80% pancreatectomy with en-bloc splenectomy in a group of five patients with intractable pain due to chronic pancreatitis. The authors demonstrated that this operation can be performed laparoscopically within an acceptable operating time and without major complications with advantages that include smaller incisions, less pain, and shorter postoperative recovery.
Identification of anatomical landmarks is crucial for this kind of procedure expecially when treating cancer. Augmented reality is a new tool to improve oncological safety, confirming the ideal dissection plane and anatomical landmarks, and to maximize functional preservation. The objective of this video is to demonstrate how to perform a splenopancreatectomy with removal of pancreatic cancer while keeping sufficient safety margins. Augmented reality is used in order to clearly identify the position of the anatomical landmarks: the splenic vein and artery, as well as the exact position of the tumor so that a sufficient resection margin can be identified.
D Mutter, J Marescaux, L Soler
Surgical intervention
9 years ago
1278 views
40 likes
0 comments
18:27
Laparoscopic splenopancreatectomy assisted by augmented reality for pancreatic cancer
Soper et al. in 1994 were able to establish the safety and efficacy of laparoscopic distal pancreatectomy in an animal model, with no evidence of pancreatic leaks or fistulas. Later, in 1996, Cuschieri et al. described the technique they used to perform laparoscopic distal 70–80% pancreatectomy with en-bloc splenectomy in a group of five patients with intractable pain due to chronic pancreatitis. The authors demonstrated that this operation can be performed laparoscopically within an acceptable operating time and without major complications with advantages that include smaller incisions, less pain, and shorter postoperative recovery.
Identification of anatomical landmarks is crucial for this kind of procedure expecially when treating cancer. Augmented reality is a new tool to improve oncological safety, confirming the ideal dissection plane and anatomical landmarks, and to maximize functional preservation. The objective of this video is to demonstrate how to perform a splenopancreatectomy with removal of pancreatic cancer while keeping sufficient safety margins. Augmented reality is used in order to clearly identify the position of the anatomical landmarks: the splenic vein and artery, as well as the exact position of the tumor so that a sufficient resection margin can be identified.
TME for rectal cancer in a female patient: low rectal dissection
Total mesorectal excision (TME) has been established as a standardized radical surgical procedure in malignant tumors of the middle and lower rectal third. The objectives of TME are low rates of locoregional recurrences and good functional results. Total mesorectal excision in the radical surgical treatment of lower and middle third rectal carcinomas is the essential part of lymphatic dissection in these tumors. This film shows the low rectal dissection performed by a very experienced surgeon in a female patient presenting with cancer of the middle third of the rectum. Thanks to an adequate traction and counter-traction and thanks to the use of scissors (roticulator endo minishears), the rectum surrounded by its fascia propria is progressively divided.
J Leroy, J Marescaux
Surgical intervention
9 years ago
277 views
16 likes
0 comments
04:17
TME for rectal cancer in a female patient: low rectal dissection
Total mesorectal excision (TME) has been established as a standardized radical surgical procedure in malignant tumors of the middle and lower rectal third. The objectives of TME are low rates of locoregional recurrences and good functional results. Total mesorectal excision in the radical surgical treatment of lower and middle third rectal carcinomas is the essential part of lymphatic dissection in these tumors. This film shows the low rectal dissection performed by a very experienced surgeon in a female patient presenting with cancer of the middle third of the rectum. Thanks to an adequate traction and counter-traction and thanks to the use of scissors (roticulator endo minishears), the rectum surrounded by its fascia propria is progressively divided.
Laparoscopic treatment of an incarcerated right femoral hernia in a female patient
Femoral hernia is predominantly a female disorder. Incarcerated femoral hernia is a common surgical emergency condition. Diagnosis is always obvious and straightforward by clinical examination, and open surgical repair was the mainstay of treatment. In the era of minimally invasive surgery, laparoscopic repair of femoral hernia has been shown to be feasible and safe. This video shows the laparoscopic trans-abdominal preperitoneal repair of a right femoral hernia in a female patient who has had an appendectomy and who presented to emergencies with pain in the right inguinal region associated with nausea and vomiting. This procedure was performed by a skilled surgeon fellow telementored by Prof. Leroy, a world-renowned expert in laparoscopic hernia repair surgery.
F Costantino, J Leroy, J Marescaux
Surgical intervention
9 years ago
2792 views
214 likes
1 comment
05:53
Laparoscopic treatment of an incarcerated right femoral hernia in a female patient
Femoral hernia is predominantly a female disorder. Incarcerated femoral hernia is a common surgical emergency condition. Diagnosis is always obvious and straightforward by clinical examination, and open surgical repair was the mainstay of treatment. In the era of minimally invasive surgery, laparoscopic repair of femoral hernia has been shown to be feasible and safe. This video shows the laparoscopic trans-abdominal preperitoneal repair of a right femoral hernia in a female patient who has had an appendectomy and who presented to emergencies with pain in the right inguinal region associated with nausea and vomiting. This procedure was performed by a skilled surgeon fellow telementored by Prof. Leroy, a world-renowned expert in laparoscopic hernia repair surgery.
Benefits of laparoscopy in the management of malfunctioning peritoneal dialysis catheters: 3 clinical cases
Laparoscopic techniques for placement of peritoneal dialysis catheters are becoming increasingly popular. There may be several problems related to the functioning of peritoneal dialysis catheters. This is a report of three cases illustrating the diagnostic and often therapeutic interest of laparoscopy in patients presenting with peritoneal dialysis catheter malfunction. Case one shows laparoscopic treatment for pleural leakage, case two catheter malposition due to inflammatory and hemorrhagic adhesions with the omentum and case three a total encapsulation of the dialysis catheter by fibrin.
D Mutter, F Costantino, J D'Agostino, J Marescaux
Surgical intervention
9 years ago
805 views
53 likes
0 comments
06:29
Benefits of laparoscopy in the management of malfunctioning peritoneal dialysis catheters: 3 clinical cases
Laparoscopic techniques for placement of peritoneal dialysis catheters are becoming increasingly popular. There may be several problems related to the functioning of peritoneal dialysis catheters. This is a report of three cases illustrating the diagnostic and often therapeutic interest of laparoscopy in patients presenting with peritoneal dialysis catheter malfunction. Case one shows laparoscopic treatment for pleural leakage, case two catheter malposition due to inflammatory and hemorrhagic adhesions with the omentum and case three a total encapsulation of the dialysis catheter by fibrin.