We use cookies to offer you an optimal experience on our website. By browsing our website, you accept the use of cookies.

Monthly publications

#March 2010
Filter by
Specialty

Type
Category
Perigastric band abscess: laparoscopic approach
Band infection after gastric banding is a relatively rare complication. In most cases, it manifests itself through abdominal pain associated with fever, and/or an abscess surrounding the access port. This is the case of a 37-year-old female patient in whom a gastric band was placed 5 years ago. The patient lost 60% of her excess weight; however, she complained that the gastric band was no longer as efficient. Imaging studies allowed to identify the existence of a 50mL supragastric pouch. A gastroscopy reveals nothing unusual.
Following this postoperative control, we decided to remove the patient’s gastric band as she was troubled by the superior gastric pouch.
M Vix, F Costantino, J Marescaux
Surgical intervention
8 years ago
218 views
21 likes
0 comments
06:13
Perigastric band abscess: laparoscopic approach
Band infection after gastric banding is a relatively rare complication. In most cases, it manifests itself through abdominal pain associated with fever, and/or an abscess surrounding the access port. This is the case of a 37-year-old female patient in whom a gastric band was placed 5 years ago. The patient lost 60% of her excess weight; however, she complained that the gastric band was no longer as efficient. Imaging studies allowed to identify the existence of a 50mL supragastric pouch. A gastroscopy reveals nothing unusual.
Following this postoperative control, we decided to remove the patient’s gastric band as she was troubled by the superior gastric pouch.
Thoracoscopic left superior segmentectomy for primary lung adenocarcinoma
This 59-old male patient, smoker, has a previous history of thymoma that was operated upon 15 years ago by sternotomy. He presented with a large nodule in the superior segment of the left lower lobe. Bronchoscopy was normal. A biopsy was performed under CT-scan control and revealed a primary adenocarcinoma TTF1+. 18-FDG scintigraphy showed a significant and isolated fixation. Because of the impaired respiratory function, a limited resection was decided upon, i.e, a resection of the superior segment of the left lower lobe with radical lymph node dissection.

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
8 years ago
2233 views
14 likes
0 comments
07:01
Thoracoscopic left superior segmentectomy for primary lung adenocarcinoma
This 59-old male patient, smoker, has a previous history of thymoma that was operated upon 15 years ago by sternotomy. He presented with a large nodule in the superior segment of the left lower lobe. Bronchoscopy was normal. A biopsy was performed under CT-scan control and revealed a primary adenocarcinoma TTF1+. 18-FDG scintigraphy showed a significant and isolated fixation. Because of the impaired respiratory function, a limited resection was decided upon, i.e, a resection of the superior segment of the left lower lobe with radical lymph node dissection.

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
Endoscopic mediastinal lymph node dissection for stage I lung carcinoma
In this video, we will focus on mediastinal lymph node dissection as defined by the American College of Surgeons Oncology Group, i.e.: for right-sided tumors: removal of all lymphatic tissue bounded by the right upper bronchus, the right subclavian artery, the superior vena cava and the trachea (stations 2R and 4R); for left-sided tumors: removal of all lymphatic tissue bounded by the phrenic nerve, the vagus nerve and the top of the aortic arch (stations 5 and 6); and for both sides, removal of lymph nodes from stations 7, 8, 9, 10 and 11.
A perfect vision is necessary during mediastinal lymph node dissection. An oblique viewing 30 degree scope or a deflectable thoracoscope is almost essential to avoid the drawbacks linked to tangential vision, as it frequently occurs with a low inserted scope.
During open or video-assisted lymphadenectomy, it is usual to control small vessels by a combination of clipping and transection. This is time-consuming and it can be replaced by either bipolar cautery or ultrasonic shears or a vessel-sealing device, which both allow coagulating and transecting with a single tool.

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
8 years ago
3092 views
17 likes
0 comments
09:36
Endoscopic mediastinal lymph node dissection for stage I lung carcinoma
In this video, we will focus on mediastinal lymph node dissection as defined by the American College of Surgeons Oncology Group, i.e.: for right-sided tumors: removal of all lymphatic tissue bounded by the right upper bronchus, the right subclavian artery, the superior vena cava and the trachea (stations 2R and 4R); for left-sided tumors: removal of all lymphatic tissue bounded by the phrenic nerve, the vagus nerve and the top of the aortic arch (stations 5 and 6); and for both sides, removal of lymph nodes from stations 7, 8, 9, 10 and 11.
A perfect vision is necessary during mediastinal lymph node dissection. An oblique viewing 30 degree scope or a deflectable thoracoscope is almost essential to avoid the drawbacks linked to tangential vision, as it frequently occurs with a low inserted scope.
During open or video-assisted lymphadenectomy, it is usual to control small vessels by a combination of clipping and transection. This is time-consuming and it can be replaced by either bipolar cautery or ultrasonic shears or a vessel-sealing device, which both allow coagulating and transecting with a single tool.

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
Small sphincterotomy and balloon sphincteroplasty for extraction of a common bile duct stone in a patient with juxtapapillary diverticulum
Duodenal diverticula have a prevalence of 9 to 32%. Usually, they are within 2cm of the major duodenal papilla and for that are called juxtapapillary diverticula. They are acquired and their incidence increases with age. Biliary and pancreatic disease is often associated with juxtapapillary diverticula, in particular common bile duct stones. They are directly associated with the outcome of Endoscopic Retrograde Cholangio-Pancreatography (due to the complexity of cannulation) and with an increased rate of complications, in particular bleeding. Various techniques are described to increase the success rate, such as clip-assisted biliary cannulation, endoscopic ultrasound-guided bile duct access, main pancreatic duct stent placement followed by pre-cut biliary sphincterotomy. The success rate, independently of these techniques, varies from 61% to 95%.
In this video, we show a case of a patient with angiocholitis secondary to choledocholithiasis, and several cardiovascular co-morbidities, having the papilla of Vater on the edge of a diverticulum. A small sphincterotomy was performed as shown and then bleeding risk was evaluated (the patient being on anticoagulants) and because of the important size of the impacted stone, a sphincteroplasty with dilatation of the papilla with a balloon expanded to 15mm was performed, along with stone extraction using a Dormia basket.
The patient was discharged on postoperative day 2 with normal liver function tests and no inflammation.
Gf Donatelli, C Callari, S Perretta, B Dallemagne
Surgical intervention
8 years ago
1309 views
19 likes
0 comments
05:50
Small sphincterotomy and balloon sphincteroplasty for extraction of a common bile duct stone in a patient with juxtapapillary diverticulum
Duodenal diverticula have a prevalence of 9 to 32%. Usually, they are within 2cm of the major duodenal papilla and for that are called juxtapapillary diverticula. They are acquired and their incidence increases with age. Biliary and pancreatic disease is often associated with juxtapapillary diverticula, in particular common bile duct stones. They are directly associated with the outcome of Endoscopic Retrograde Cholangio-Pancreatography (due to the complexity of cannulation) and with an increased rate of complications, in particular bleeding. Various techniques are described to increase the success rate, such as clip-assisted biliary cannulation, endoscopic ultrasound-guided bile duct access, main pancreatic duct stent placement followed by pre-cut biliary sphincterotomy. The success rate, independently of these techniques, varies from 61% to 95%.
In this video, we show a case of a patient with angiocholitis secondary to choledocholithiasis, and several cardiovascular co-morbidities, having the papilla of Vater on the edge of a diverticulum. A small sphincterotomy was performed as shown and then bleeding risk was evaluated (the patient being on anticoagulants) and because of the important size of the impacted stone, a sphincteroplasty with dilatation of the papilla with a balloon expanded to 15mm was performed, along with stone extraction using a Dormia basket.
The patient was discharged on postoperative day 2 with normal liver function tests and no inflammation.
Heller myotomy and intraluminal fundoplication: a NOTES technique
Background and study aims: It is generally accepted that the most effective method of treating achalasia is a surgical myotomy. Nevertheless, if a myotomy alone is performed, reflux may occur in up to 50% of patients. This video demonstrates a transoral incisionless stepwise approach to both esophageal Heller myotomy and partial fundoplication.
Materials and methods: The first step in this experiment consisted in creating the esophageal myotomy. Under general anesthesia, with the pig supine, endoscopy was performed to assess the location of the EGJ. The mucosa on the right postero-lateral esophageal wall was cut with the needle-knife 15cm above the LES. The initial incision was dilated with blunt dissection and the scope eased into the submucosal space. A submucosal tunnel was created with the assistance of CO2 and blunt dissection and extended distally toward the LES. Once the GEJ was clearly identified, the muscular layer was incised in a distal-to-proximal fashion using the IT knife. The scope was then withdrawn back into the lumen and the mucosal flap sealed by the application of endoscopic clips. The adequacy of endoscopic myotomy was evaluated assessing manometric lower esophageal sphincter (LES) profile and postoperative LES pressure fall and evaluated by comparing the EGJ diameter and volume profile before, after and during the division of the esophageal muscular fibers using the Functional Lumen Imaging Probe "endoflip”. The second step of the treatment consisted in building a transoral incisionless fundoplication. Four weeks later, a gastroesophageal valve was created endoscopically using the EsophyX device (EsophyX™, EndoGastric Solutions).
Results: Both Heller myotomy and subsequent endoscopic fundoplication were successfully accomplished with an operative time of 45 min and 20 min respectively. No injury to the esophagus or breach of the esophageal mucosa occurred.
Conclusions: A stepwise transoral incisionless approach to esophageal Heller myotomy and partial fundoplication is feasible in the porcine model.
S Perretta, P Allemann, B Dallemagne, A Lobontiu, D Coumaros, J Marescaux
Surgical intervention
8 years ago
435 views
7 likes
0 comments
04:53
Heller myotomy and intraluminal fundoplication: a NOTES technique
Background and study aims: It is generally accepted that the most effective method of treating achalasia is a surgical myotomy. Nevertheless, if a myotomy alone is performed, reflux may occur in up to 50% of patients. This video demonstrates a transoral incisionless stepwise approach to both esophageal Heller myotomy and partial fundoplication.
Materials and methods: The first step in this experiment consisted in creating the esophageal myotomy. Under general anesthesia, with the pig supine, endoscopy was performed to assess the location of the EGJ. The mucosa on the right postero-lateral esophageal wall was cut with the needle-knife 15cm above the LES. The initial incision was dilated with blunt dissection and the scope eased into the submucosal space. A submucosal tunnel was created with the assistance of CO2 and blunt dissection and extended distally toward the LES. Once the GEJ was clearly identified, the muscular layer was incised in a distal-to-proximal fashion using the IT knife. The scope was then withdrawn back into the lumen and the mucosal flap sealed by the application of endoscopic clips. The adequacy of endoscopic myotomy was evaluated assessing manometric lower esophageal sphincter (LES) profile and postoperative LES pressure fall and evaluated by comparing the EGJ diameter and volume profile before, after and during the division of the esophageal muscular fibers using the Functional Lumen Imaging Probe "endoflip”. The second step of the treatment consisted in building a transoral incisionless fundoplication. Four weeks later, a gastroesophageal valve was created endoscopically using the EsophyX device (EsophyX™, EndoGastric Solutions).
Results: Both Heller myotomy and subsequent endoscopic fundoplication were successfully accomplished with an operative time of 45 min and 20 min respectively. No injury to the esophagus or breach of the esophageal mucosa occurred.
Conclusions: A stepwise transoral incisionless approach to esophageal Heller myotomy and partial fundoplication is feasible in the porcine model.
Tips 'n Tricks for wrist arthroscopy: installation, portals and exploration
Wrist arthroscopy allows a thorough exploration of the radiocarpal and midcarpal joints simply by carrying out small portals. This video shows how to achieve them and what can be seen in the wrist.
The purpose of this video is to understand the principle of wrist arthroscopy and how to perform the portals in the least invasive way. We can draw tendon-bone elements on the skin in order to create anatomical landmarks. Before using the knife, using a single needle is essential to identify the exact position of portals. We always start the exploration of the wrist with the radiocarpal joint, and the 3-4 portal. To find it, there are several simple ways. Once the scope is entered in the radiocarpal joint, it is possible only by this portal to explore all the articulation from radial styloid to ulnar styloid. Instrumental 6R portal will be performed. The midcarpal joint is narrower than the radiocarpal joint. We start with the ulnar midcarpal portal, the easiest to find, then an instrumental radiocarpal portal will be used. Placing the scope in a radial midcarpal position allows to explore the scapho-trapezoid-trapezium joint distally as well as the dorsal surface of the capitate bone.
C Mathoulin, P Liverneaux
Surgical intervention
8 years ago
1090 views
29 likes
0 comments
21:38
Tips 'n Tricks for wrist arthroscopy: installation, portals and exploration
Wrist arthroscopy allows a thorough exploration of the radiocarpal and midcarpal joints simply by carrying out small portals. This video shows how to achieve them and what can be seen in the wrist.
The purpose of this video is to understand the principle of wrist arthroscopy and how to perform the portals in the least invasive way. We can draw tendon-bone elements on the skin in order to create anatomical landmarks. Before using the knife, using a single needle is essential to identify the exact position of portals. We always start the exploration of the wrist with the radiocarpal joint, and the 3-4 portal. To find it, there are several simple ways. Once the scope is entered in the radiocarpal joint, it is possible only by this portal to explore all the articulation from radial styloid to ulnar styloid. Instrumental 6R portal will be performed. The midcarpal joint is narrower than the radiocarpal joint. We start with the ulnar midcarpal portal, the easiest to find, then an instrumental radiocarpal portal will be used. Placing the scope in a radial midcarpal position allows to explore the scapho-trapezoid-trapezium joint distally as well as the dorsal surface of the capitate bone.