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Monthly publications

#September 2010
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Prevesical genetic paraganglioma and left adrenal mass: laparoscopic resection
Hereditary paraganglioma-pheochromocytoma syndromes are caused by genetic mutations, which lead to the development of multiple neuroendocrine tumors and paraganglioma tumors in the adrenal glands. We report the case of a young patient aged 13 who has been followed up routinely for a familial mutation of the SDHB gene. In this routine follow-up examination, an excessive plasma normetanephrine and norepinephrine secretion is evidenced. A genetic paraganglioma is diagnosed. Imaging studies are conducted to identify its location. A prevesical fixation is demonstrated by both the PET-scan and the MIBG scintigraphy. In this video, a laparoscopic resection of both lesions is demonstrated.
D Mutter, J Marescaux
Surgical intervention
8 years ago
1032 views
7 likes
0 comments
09:10
Prevesical genetic paraganglioma and left adrenal mass: laparoscopic resection
Hereditary paraganglioma-pheochromocytoma syndromes are caused by genetic mutations, which lead to the development of multiple neuroendocrine tumors and paraganglioma tumors in the adrenal glands. We report the case of a young patient aged 13 who has been followed up routinely for a familial mutation of the SDHB gene. In this routine follow-up examination, an excessive plasma normetanephrine and norepinephrine secretion is evidenced. A genetic paraganglioma is diagnosed. Imaging studies are conducted to identify its location. A prevesical fixation is demonstrated by both the PET-scan and the MIBG scintigraphy. In this video, a laparoscopic resection of both lesions is demonstrated.
Transumbilical single incision laparoscopic total colectomy and partial proctectomy with ileorectal anastomosis
This video demonstrates our transumbilical three-trocar technique for single incision total colectomy and partial proctectomy with intracorporeal side-to-end ileorectal anastomosis using standard laparoscopic instrumentation. The patient is a thin 19-year-old boy with a BMI of 19 presenting with familial adenomatous polyposis (FAP). The previous colonoscopy has shown 300 polyps in the colon and very few in the distal rectum.
Conventional trocars (5mm, 10mm, and 12mm) are used through a 3.5cm transumbilical incision. The ligation of the vessels is mostly carried out by the Ligasure-V vessel-sealing device using a medial-to-lateral approach. The specimen is extracted through the umbilical incision after removal of the 10mm and 12mm cannulas. The ileorectal anastomosis is carried out intracorporeally using a double stapling technique.
JR Ramos, R Mesquita Machado, EA Valory, AH Creiler
Surgical intervention
8 years ago
1356 views
13 likes
0 comments
11:14
Transumbilical single incision laparoscopic total colectomy and partial proctectomy with ileorectal anastomosis
This video demonstrates our transumbilical three-trocar technique for single incision total colectomy and partial proctectomy with intracorporeal side-to-end ileorectal anastomosis using standard laparoscopic instrumentation. The patient is a thin 19-year-old boy with a BMI of 19 presenting with familial adenomatous polyposis (FAP). The previous colonoscopy has shown 300 polyps in the colon and very few in the distal rectum.
Conventional trocars (5mm, 10mm, and 12mm) are used through a 3.5cm transumbilical incision. The ligation of the vessels is mostly carried out by the Ligasure-V vessel-sealing device using a medial-to-lateral approach. The specimen is extracted through the umbilical incision after removal of the 10mm and 12mm cannulas. The ileorectal anastomosis is carried out intracorporeally using a double stapling technique.
Single incision laparoscopic partial splenectomy for splenic hemangioma
Laparoscopy is now considered the "gold standard" approach for splenectomy when treating different benign and malignant diseases requiring the removal of the whole or part of the spleen.
During the last few months in both experimental and clinical settings, new techniques such as natural orifice transluminal endoscopic surgery (NOTES™) and single incision laparoscopic surgery (SILS) or single port laparoscopic surgery (SPLS) have been attempted in order to reduce even more the surgical trauma in laparo-endoscopic procedures.
SPLS allows to perform different surgical procedures using the umbilicus as the only site to access the abdominal cavity and, by using special trocars and instruments, to carry out the operation using the same techniques and principles of standard laparoscopic surgery.
The video describes our personal technique for totally single incision partial splenectomy for the treatment of splenic hemangioma.
A 44-year-old woman complained with recurrent abdominal pain in the left hypochondrium and flank and was referred to our department.
Abdominal US as well as CT-scan images demonstrated the presence of a large cystic-like lesion at the lower pole of the spleen. It presented some septal division with the cyst. Blood tests were normal and all markers were negative.
Single incision partial splenectomy was performed with no complications and the patient’s postoperative course was uneventful.
L Boni, G Dionigi, M Di Giuseppe, E Colombo, L Giavarini, F Cantore, R Dionigi
Surgical intervention
8 years ago
1563 views
12 likes
0 comments
04:58
Single incision laparoscopic partial splenectomy for splenic hemangioma
Laparoscopy is now considered the "gold standard" approach for splenectomy when treating different benign and malignant diseases requiring the removal of the whole or part of the spleen.
During the last few months in both experimental and clinical settings, new techniques such as natural orifice transluminal endoscopic surgery (NOTES™) and single incision laparoscopic surgery (SILS) or single port laparoscopic surgery (SPLS) have been attempted in order to reduce even more the surgical trauma in laparo-endoscopic procedures.
SPLS allows to perform different surgical procedures using the umbilicus as the only site to access the abdominal cavity and, by using special trocars and instruments, to carry out the operation using the same techniques and principles of standard laparoscopic surgery.
The video describes our personal technique for totally single incision partial splenectomy for the treatment of splenic hemangioma.
A 44-year-old woman complained with recurrent abdominal pain in the left hypochondrium and flank and was referred to our department.
Abdominal US as well as CT-scan images demonstrated the presence of a large cystic-like lesion at the lower pole of the spleen. It presented some septal division with the cyst. Blood tests were normal and all markers were negative.
Single incision partial splenectomy was performed with no complications and the patient’s postoperative course was uneventful.
Autonomic nerve-preserving laparoscopic total mesorectal excision in a male patient based on a new anatomical concept
Dr. Kinugasa proposed the new concept of surgical anatomy in the pelvis. In his concept, the pre-hypogastric nerve fascia is defined as a fibrous membrane, which covers the superior hypogastric nerve plexus, the hypogastric nerves and the pelvic nerve plexus. In this video, we present our procedure of laparoscopic Total Mesorectal Excision (TME) in a male patient, focusing on the relationship of the hypogastric nerve fascia, the Denonvilliers’ fascia and the nervous system in the pelvis. The technical characteristics of this procedure are as follows: sharp dissection with electrocautery through the entire procedure, posterior and lateral dissection along the pre-hypogastric nerve fascia, anterior dissection behind the Denonvilliers’ fascia (DVF), and unroofing of neurovascular bundles by the assistant in order to recognize and dissect the lowest part of the mesorectum in the antero-lateral corner of the pelvis.
Y Sakai, K Hida, K Kawada, JI Kawamura, A Nomura, S Nagayama, S Hasegawa
Surgical intervention
8 years ago
8908 views
44 likes
1 comment
14:29
Autonomic nerve-preserving laparoscopic total mesorectal excision in a male patient based on a new anatomical concept
Dr. Kinugasa proposed the new concept of surgical anatomy in the pelvis. In his concept, the pre-hypogastric nerve fascia is defined as a fibrous membrane, which covers the superior hypogastric nerve plexus, the hypogastric nerves and the pelvic nerve plexus. In this video, we present our procedure of laparoscopic Total Mesorectal Excision (TME) in a male patient, focusing on the relationship of the hypogastric nerve fascia, the Denonvilliers’ fascia and the nervous system in the pelvis. The technical characteristics of this procedure are as follows: sharp dissection with electrocautery through the entire procedure, posterior and lateral dissection along the pre-hypogastric nerve fascia, anterior dissection behind the Denonvilliers’ fascia (DVF), and unroofing of neurovascular bundles by the assistant in order to recognize and dissect the lowest part of the mesorectum in the antero-lateral corner of the pelvis.
The pelvic floor - muscles, fasciae, ligaments
In this lecture, the anatomy of the female pelvic floor is presented laying the emphasis on pelvic floor muscles, fasciae, and ligaments. The anatomical terms “fasciae” and “ligaments” are scrutinized critically in this context, and the different levels of pelvic floor support are presented from a clinical point of view. An answer is provided on where the “White line” is and what exactly constitutes the “endopelvic fascia”. Clinical examples for pelvic floor defects considering the different levels of support are shown. The summary points out that pelvic floor reconstructive surgery should not only restore the anatomy, but also the primary function.
B Gabriel
Lecture
8 years ago
1465 views
18 likes
0 comments
28:46
The pelvic floor - muscles, fasciae, ligaments
In this lecture, the anatomy of the female pelvic floor is presented laying the emphasis on pelvic floor muscles, fasciae, and ligaments. The anatomical terms “fasciae” and “ligaments” are scrutinized critically in this context, and the different levels of pelvic floor support are presented from a clinical point of view. An answer is provided on where the “White line” is and what exactly constitutes the “endopelvic fascia”. Clinical examples for pelvic floor defects considering the different levels of support are shown. The summary points out that pelvic floor reconstructive surgery should not only restore the anatomy, but also the primary function.
Surgical tutorial: laparoscopic prolapse repair
In this lecture, Dr. Ted Lee, MD, director of the department of minimally invasive gynecologic surgery in Pittsburgh, Pennsylvania, USA, focuses on the sacrocolpopexy procedure in relation to his experience in the treatment of genital organ prolapse. He highlights some important key steps of the procedure, together with some tips and tricks on optimizing exposure, facilitating dissection, suturing of the mesh and how to minimize complications.
The first step of the procedure is an adequate exposure with bowel retraction in order to have sufficient space to work in the sacral promontory area.
The next step is the rectovaginal dissection, with caution to keep the dissection close to the vagina, leave enough adipose tissue to the rectum, and dissect the pararectal spaces until the levator ani muscles. Dr. Lee stresses the fact that the depth of the dissection depends on the posterior wall defect. So in patients with a posterior defect not protruding outside the hymen, the dissection should stop at the level of the midvagina. This is in order to avoid future constipation with deep dissection. Only in patients with large posterior wall defects, the dissection should be performed at the level of the levator ani. Dr. Lee indicates some surgical instruments, such as the rectal probes and retractors, that are useful for the dissection of the rectovaginal space.
Next step is the vesicovaginal dissection, which can be very challenging, especially in patients with previous hysterectomy. Some tips and tricks such as the use of a Foley catheter or the use of a large probe to distend the vagina in order to facilitate dissection are demonstrated.
Next is the presacral dissection with skeletonization of the fibrofatty tissue, dissection from right to left to preserve the hypogastric nerve, and identification of a good plane of dissection to avoid bleeding, especially from the left common iliac vein, but also from sacral vessels, which can be dissected.
The last step is the suturing of the mesh. He explains that there is no longer the need to use non-absorbable sutures together with the use of tackers in order to secure the mesh to the sacrum without complications. A nice technique of suturing and knotting is demonstrated during mesh peritonization.
Finally, in patients where the uterus needs to be preserved for fertility purposes (sacrohysteropexy), Dr. Lee explains an alternative method to place the mesh medial to the uterine vessels in order to perform, if need be, a hysterectomy more easily later on. He also demonstrates a nice uterosacral suspension technique used in patients who do not wish to be treated with a mesh for their prolapse.
T Lee
Lecture
8 years ago
2581 views
64 likes
0 comments
25:34
Surgical tutorial: laparoscopic prolapse repair
In this lecture, Dr. Ted Lee, MD, director of the department of minimally invasive gynecologic surgery in Pittsburgh, Pennsylvania, USA, focuses on the sacrocolpopexy procedure in relation to his experience in the treatment of genital organ prolapse. He highlights some important key steps of the procedure, together with some tips and tricks on optimizing exposure, facilitating dissection, suturing of the mesh and how to minimize complications.
The first step of the procedure is an adequate exposure with bowel retraction in order to have sufficient space to work in the sacral promontory area.
The next step is the rectovaginal dissection, with caution to keep the dissection close to the vagina, leave enough adipose tissue to the rectum, and dissect the pararectal spaces until the levator ani muscles. Dr. Lee stresses the fact that the depth of the dissection depends on the posterior wall defect. So in patients with a posterior defect not protruding outside the hymen, the dissection should stop at the level of the midvagina. This is in order to avoid future constipation with deep dissection. Only in patients with large posterior wall defects, the dissection should be performed at the level of the levator ani. Dr. Lee indicates some surgical instruments, such as the rectal probes and retractors, that are useful for the dissection of the rectovaginal space.
Next step is the vesicovaginal dissection, which can be very challenging, especially in patients with previous hysterectomy. Some tips and tricks such as the use of a Foley catheter or the use of a large probe to distend the vagina in order to facilitate dissection are demonstrated.
Next is the presacral dissection with skeletonization of the fibrofatty tissue, dissection from right to left to preserve the hypogastric nerve, and identification of a good plane of dissection to avoid bleeding, especially from the left common iliac vein, but also from sacral vessels, which can be dissected.
The last step is the suturing of the mesh. He explains that there is no longer the need to use non-absorbable sutures together with the use of tackers in order to secure the mesh to the sacrum without complications. A nice technique of suturing and knotting is demonstrated during mesh peritonization.
Finally, in patients where the uterus needs to be preserved for fertility purposes (sacrohysteropexy), Dr. Lee explains an alternative method to place the mesh medial to the uterine vessels in order to perform, if need be, a hysterectomy more easily later on. He also demonstrates a nice uterosacral suspension technique used in patients who do not wish to be treated with a mesh for their prolapse.
Surgical strategies and techniques for difficult hysterectomy
In gynecologic surgery, hysterectomy is the most important procedure. Sometimes, however, hysterectomy can be a very difficult and challenging operation, and even more so if performed laparoscopically. Situations that distort the pelvic anatomy such as large fibroids, severe endometriosis, postoperative adhesions and morbid obesity make surgery much more difficult. Dr Lee analyses in a very didactic way all these situations, gives valuable directions and surgical strategies in order to overcome difficulties, and uses specific rules to obtain the best result as much safely as possible. Very useful are the different approaches, namely anterior, posterior and lateral, for patients with big fibroids, for adhesions and for fibrosis originating from severe endometriosis respectively.
T Lee
Lecture
8 years ago
2905 views
48 likes
0 comments
25:34
Surgical strategies and techniques for difficult hysterectomy
In gynecologic surgery, hysterectomy is the most important procedure. Sometimes, however, hysterectomy can be a very difficult and challenging operation, and even more so if performed laparoscopically. Situations that distort the pelvic anatomy such as large fibroids, severe endometriosis, postoperative adhesions and morbid obesity make surgery much more difficult. Dr Lee analyses in a very didactic way all these situations, gives valuable directions and surgical strategies in order to overcome difficulties, and uses specific rules to obtain the best result as much safely as possible. Very useful are the different approaches, namely anterior, posterior and lateral, for patients with big fibroids, for adhesions and for fibrosis originating from severe endometriosis respectively.
Double loop for arthroscopic repair of large triangular fibrocartilage complex (TFCC) tear
The triangular fibrocartilage complex (TFCC) has an important biomechanical function for the carpus and the distal radioulnar joint. TFCC lesions are responsible for ulnar side wrist pain and need to be repaired in order to restore a normal wrist. In some cases, TFCC lesions range from ulnar styloid to radial insertion. Wrist arthroscopy makes diagnosis and treatment possible in the least invasive way. The surgical treatment consists in reinserting the TFCC using the new double loop suture with absorbable PDS material. The film describes how to place a double suture of the entire TFCC tear by using an only one-way suture technique.
C Mathoulin
Surgical intervention
8 years ago
809 views
13 likes
1 comment
08:19
Double loop for arthroscopic repair of large triangular fibrocartilage complex (TFCC) tear
The triangular fibrocartilage complex (TFCC) has an important biomechanical function for the carpus and the distal radioulnar joint. TFCC lesions are responsible for ulnar side wrist pain and need to be repaired in order to restore a normal wrist. In some cases, TFCC lesions range from ulnar styloid to radial insertion. Wrist arthroscopy makes diagnosis and treatment possible in the least invasive way. The surgical treatment consists in reinserting the TFCC using the new double loop suture with absorbable PDS material. The film describes how to place a double suture of the entire TFCC tear by using an only one-way suture technique.