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Monthly publications

#June 2009
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Three trocar sigmoidectomy for diverticulitis with transanal extraction
The combination of laparoscopy and specimen extraction through a natural orifice has the potential to decrease wound complications and to improve postoperative recovery.
The objective of this film is to demonstrate the possibilities of specimen extraction of a sigmoid diverticulitis transanally with reduction of abdominal openings that may sometimes induce incisional hernias and postoperative pain.
In this case, a laparoscopic three-port technique is performed: one 12mm optical port situated in the umbilicus, and two right iliac fossa ports (one 5mm port placed in the right flank, and a 12mm port in the right iliac fossa for introduction of staplers).
J Leroy, J Marescaux
Surgical intervention
9 years ago
232 views
23 likes
0 comments
09:26
Three trocar sigmoidectomy for diverticulitis with transanal extraction
The combination of laparoscopy and specimen extraction through a natural orifice has the potential to decrease wound complications and to improve postoperative recovery.
The objective of this film is to demonstrate the possibilities of specimen extraction of a sigmoid diverticulitis transanally with reduction of abdominal openings that may sometimes induce incisional hernias and postoperative pain.
In this case, a laparoscopic three-port technique is performed: one 12mm optical port situated in the umbilicus, and two right iliac fossa ports (one 5mm port placed in the right flank, and a 12mm port in the right iliac fossa for introduction of staplers).
Laparoscopic treatment of a recurrent colostomy prolapse
The creation of a colostomy is a frequent procedure in visceral surgery. Despite new operative techniques, the stoma formation remains an often necessary surgical procedure, which results in a dramatic change in the patients' life. Many complications, such as stoma necrosis, stoma retraction or stoma prolapse can occur.
The objective of this video is to demonstrate the various ways in which a laparoscopic subperitoneal colostomy can be performed. This is the case of a female patient presenting a mental handicap and a chronic renal insufficiency with hemodialysis 3 times a week. She has had a definite colostomy for the treatment of anal incontinence, with complete sphincteric destruction.
The colostomy was associated with recurrent episodes of prolapse. A laparoscopic approach is worth performing here in order to have a preperitoneal, subperitoneal tunnel between the right hypochondrium and the left subcostal area where the colostomy is located.
J Leroy, J Marescaux
Surgical intervention
9 years ago
646 views
72 likes
0 comments
06:59
Laparoscopic treatment of a recurrent colostomy prolapse
The creation of a colostomy is a frequent procedure in visceral surgery. Despite new operative techniques, the stoma formation remains an often necessary surgical procedure, which results in a dramatic change in the patients' life. Many complications, such as stoma necrosis, stoma retraction or stoma prolapse can occur.
The objective of this video is to demonstrate the various ways in which a laparoscopic subperitoneal colostomy can be performed. This is the case of a female patient presenting a mental handicap and a chronic renal insufficiency with hemodialysis 3 times a week. She has had a definite colostomy for the treatment of anal incontinence, with complete sphincteric destruction.
The colostomy was associated with recurrent episodes of prolapse. A laparoscopic approach is worth performing here in order to have a preperitoneal, subperitoneal tunnel between the right hypochondrium and the left subcostal area where the colostomy is located.
Laparoscopic left adrenalectomy for Conn's adenoma: three trocar technique
Conn's disease is a condition in which the adrenal glands produce too much aldosterone. Prevalence estimates for Conn's syndrome is about 0.03-1.2% of the population with hypertension.
Many patients with Conn's disease have a high blood pressure that is difficult to control. This increases the risk of stroke, heart disease and kidney failure. When Conn's disease is caused by a tumor (benign adrenal adenoma), surgical resection is advised. This video demonstrates the case of a woman presenting with Conn’s disease. The preoperative work-up demonstrated a tumor located on the left adrenal gland. The patient presented an elevated aldosteronemia and the CT-scan demonstrated a 2cm left adrenal tumor. The patient is placed in a full lateral position, on the right side.
D Mutter, L Soler, J Marescaux
Surgical intervention
9 years ago
1506 views
108 likes
0 comments
15:51
Laparoscopic left adrenalectomy for Conn's adenoma: three trocar technique
Conn's disease is a condition in which the adrenal glands produce too much aldosterone. Prevalence estimates for Conn's syndrome is about 0.03-1.2% of the population with hypertension.
Many patients with Conn's disease have a high blood pressure that is difficult to control. This increases the risk of stroke, heart disease and kidney failure. When Conn's disease is caused by a tumor (benign adrenal adenoma), surgical resection is advised. This video demonstrates the case of a woman presenting with Conn’s disease. The preoperative work-up demonstrated a tumor located on the left adrenal gland. The patient presented an elevated aldosteronemia and the CT-scan demonstrated a 2cm left adrenal tumor. The patient is placed in a full lateral position, on the right side.
Endoscopic palliative therapy of an obstructing rectal cancer
Fifteen per cent of rectal cancers are unresectable because of local extension or metastasis.
Endoscopic palliative treatments have been described to avoid surgical palliative procedures (ileostomy, colostomy), which inevitably affect the patient's quality of life.
Endoscopic electrocoagulation, laser therapy and cryotherapy have been used for this purpose, but they need multiple therapeutic sessions: these have a high cost and cause patient discomfort.
Permanent stenting with Self Expanding Metal Stents (SEMS) has been increasingly used for the palliative treatment of obstructing gastrointestinal tumors.
This is the case of a 74-year-old man with an adenocarcinoma of the rectum, T4 N+ M+, that was admitted to our surgical department with sub-occlusion and rectal bleeding.
Under endoscopic-fluoroscopic control, a SEMS was delivered with no complications and the patient was discharged the day after. He was scheduled for a palliative chemotherapy.
Endoscopic stent introduction is a safe palliative procedure performed to improve the quality of life of patients with inoperable tumors of the rectum.
Gf Donatelli, P Ruiz Rodriguez, D Coumaros
Surgical intervention
9 years ago
2394 views
12 likes
0 comments
02:30
Endoscopic palliative therapy of an obstructing rectal cancer
Fifteen per cent of rectal cancers are unresectable because of local extension or metastasis.
Endoscopic palliative treatments have been described to avoid surgical palliative procedures (ileostomy, colostomy), which inevitably affect the patient's quality of life.
Endoscopic electrocoagulation, laser therapy and cryotherapy have been used for this purpose, but they need multiple therapeutic sessions: these have a high cost and cause patient discomfort.
Permanent stenting with Self Expanding Metal Stents (SEMS) has been increasingly used for the palliative treatment of obstructing gastrointestinal tumors.
This is the case of a 74-year-old man with an adenocarcinoma of the rectum, T4 N+ M+, that was admitted to our surgical department with sub-occlusion and rectal bleeding.
Under endoscopic-fluoroscopic control, a SEMS was delivered with no complications and the patient was discharged the day after. He was scheduled for a palliative chemotherapy.
Endoscopic stent introduction is a safe palliative procedure performed to improve the quality of life of patients with inoperable tumors of the rectum.
Endoscopic metal stenting of common bile duct for unresectable pancreatic cancer
Obstructive jaundice occurs in many patients with unresectable pancreatic cancer.
Endoscopic therapy is the best palliative option for inoperable pancreatic cancers, either for the treatment of a potential duodenal stenosis or, in the majority of cases, for the treatment of the associated jaundice.
Metal stents are preferable to plastic stents in patients who have a life expectancy of more than 3 months. The obstruction of the common bile duct is due to cancer of the head of the pancreas that compresses the biliary tree. However, in a few cases, the mucosa of the ampulla is also involved with malignancy from the adjacent pancreas.
We present the case of two patients with unresectable pancreatic cancer, obstructive jaundice and pruritus, in which the drainage of the common bile duct was achieved with an Endoscopic Retrograde Cholangio-Pancreatography (ERCP) with insertion of an uncovered metal stent (Wallflex® type) with subsequent relief of the jaundice.
Endoscopic drainage of the common bile duct for obstructive jaundice for unresectable pancreatic cancer is the preferred palliative approach in this type of patient.
Gf Donatelli, M Gualtierotti, D Coumaros
Surgical intervention
9 years ago
2359 views
7 likes
0 comments
04:28
Endoscopic metal stenting of common bile duct for unresectable pancreatic cancer
Obstructive jaundice occurs in many patients with unresectable pancreatic cancer.
Endoscopic therapy is the best palliative option for inoperable pancreatic cancers, either for the treatment of a potential duodenal stenosis or, in the majority of cases, for the treatment of the associated jaundice.
Metal stents are preferable to plastic stents in patients who have a life expectancy of more than 3 months. The obstruction of the common bile duct is due to cancer of the head of the pancreas that compresses the biliary tree. However, in a few cases, the mucosa of the ampulla is also involved with malignancy from the adjacent pancreas.
We present the case of two patients with unresectable pancreatic cancer, obstructive jaundice and pruritus, in which the drainage of the common bile duct was achieved with an Endoscopic Retrograde Cholangio-Pancreatography (ERCP) with insertion of an uncovered metal stent (Wallflex® type) with subsequent relief of the jaundice.
Endoscopic drainage of the common bile duct for obstructive jaundice for unresectable pancreatic cancer is the preferred palliative approach in this type of patient.