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Monthly publications

#June 2011
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Robotic abdominoperineal resection with sacrectomy in obese male patients
This video presents a robotic abdominoperineal resection with sacrectomy in an obese male patient.
The patient has a BMI of 37 and a locally advanced rectal cancer invading the sacrum. After preoperative chemoradiation therapy, he developed a localized abscess within the mesorectum.
He subsequently underwent a combined procedure, which included robotic total mesorectal excision followed by the perineal dissection that involved sacrectomy at the S3/S4 level. The specimen was removed through the perineum.
The purpose of this video is to demonstrate the potential role of robotic technology in surgical treatment of advanced rectal cancer. The potential role of this technology is also noticed when treating obese individuals.
S Marecik, A deSouza, C Corning, J Park, L Prasad
Surgical intervention
7 years ago
2234 views
18 likes
0 comments
06:30
Robotic abdominoperineal resection with sacrectomy in obese male patients
This video presents a robotic abdominoperineal resection with sacrectomy in an obese male patient.
The patient has a BMI of 37 and a locally advanced rectal cancer invading the sacrum. After preoperative chemoradiation therapy, he developed a localized abscess within the mesorectum.
He subsequently underwent a combined procedure, which included robotic total mesorectal excision followed by the perineal dissection that involved sacrectomy at the S3/S4 level. The specimen was removed through the perineum.
The purpose of this video is to demonstrate the potential role of robotic technology in surgical treatment of advanced rectal cancer. The potential role of this technology is also noticed when treating obese individuals.
Completely thoracoscopic segmentectomy: apical segment, right upper lobe
Standard treatment of early-stage non-small cell lung cancer involves anatomic pulmonary lobectomy and mediastinal lymph node dissection. In patients with compromised lung function, anatomic segmentectomy may be an acceptable alternative to lobectomy. Traditionally, this procedure has been carried out via postero-lateral thoracotomy, requiring division of chest wall muscles and rib spreading. This is frequently associated with disturbed respiratory mechanics in the postoperative period, as well as chronic postoperative pain which may become incapacitating in 5% of patients.
One of the major potential advantages of thoracoscopic approaches is decreasing the incidence of post-thoracotomy pain.
Key aspects of thoracoscopic segmentectomy include:
Proper patient positioning.
Access to the pleural cavity and appropriate positioning of operating incisions.
Careful dissection of segmental branches of the pulmonary artery and bronchus.
Division of blood vessels and bronchus using endoscopic staplers.
Division of lung parenchyma along intersegmental planes.

The thoracoscopic approach can be carried out with similar morbidity and similar oncologic outcome to traditional open surgery. We present a completely thoracoscopic resection of the apical segment of the right upper lobe for a small T1 adenocarcinoma in a 78-year-old patient. The video emphasizes the steps of segmental resection —mediastinal lymph node dissection was effected but is not shown.

Acknowledgment: we would like to thank Nathalie Leroux RN, Francine Martin RN, and Mélodie Leclerc RN for their continued support. Additionally, the figure used to illustrate the positioning of operating incisions was adapted with permission from: «Handbook of perioperative care in general thoracic surgery», Deslauriers J, Mehran R, eds. Positioning and incisions, pages 206-227, fig 5-19, Copyright Elsevier, 2005.
G Rakovich, J Forcillo, D Ouellette, G Beauchamp
Surgical intervention
7 years ago
591 views
22 likes
0 comments
09:44
Completely thoracoscopic segmentectomy: apical segment, right upper lobe
Standard treatment of early-stage non-small cell lung cancer involves anatomic pulmonary lobectomy and mediastinal lymph node dissection. In patients with compromised lung function, anatomic segmentectomy may be an acceptable alternative to lobectomy. Traditionally, this procedure has been carried out via postero-lateral thoracotomy, requiring division of chest wall muscles and rib spreading. This is frequently associated with disturbed respiratory mechanics in the postoperative period, as well as chronic postoperative pain which may become incapacitating in 5% of patients.
One of the major potential advantages of thoracoscopic approaches is decreasing the incidence of post-thoracotomy pain.
Key aspects of thoracoscopic segmentectomy include:
Proper patient positioning.
Access to the pleural cavity and appropriate positioning of operating incisions.
Careful dissection of segmental branches of the pulmonary artery and bronchus.
Division of blood vessels and bronchus using endoscopic staplers.
Division of lung parenchyma along intersegmental planes.

The thoracoscopic approach can be carried out with similar morbidity and similar oncologic outcome to traditional open surgery. We present a completely thoracoscopic resection of the apical segment of the right upper lobe for a small T1 adenocarcinoma in a 78-year-old patient. The video emphasizes the steps of segmental resection —mediastinal lymph node dissection was effected but is not shown.

Acknowledgment: we would like to thank Nathalie Leroux RN, Francine Martin RN, and Mélodie Leclerc RN for their continued support. Additionally, the figure used to illustrate the positioning of operating incisions was adapted with permission from: «Handbook of perioperative care in general thoracic surgery», Deslauriers J, Mehran R, eds. Positioning and incisions, pages 206-227, fig 5-19, Copyright Elsevier, 2005.
Round table: TFCC tears: a complex system for complex lesions
The TFCC is an essential structure in the stability of the distal radio-ulnar joint (DRUJ). What we took for a simple suspensory ligament has actually become a complex structure than previously thought since the work of Palmer in 1981. Some members of the EWAS, first and foremost Toshiyasu Nakamura, has helped to better understand this essential component as well as the damage it may suffer. Thanks to Andrea Atzei, Francisco Del Pinal and Tommy Lindau, the TFCC is now a well understood and well-known entity. Having them together in a round table on this topic answering a flow of questions asked by our two famous chairmen, Diego Fernandez and Laurent Obert, allows to better understand the problems caused by the lesion of this structure.
D Fernandez, L Obert, A Atzei, TR Lindau, F del Piñal, T Nakamura
Lecture
7 years ago
193 views
2 likes
0 comments
20:12
Round table: TFCC tears: a complex system for complex lesions
The TFCC is an essential structure in the stability of the distal radio-ulnar joint (DRUJ). What we took for a simple suspensory ligament has actually become a complex structure than previously thought since the work of Palmer in 1981. Some members of the EWAS, first and foremost Toshiyasu Nakamura, has helped to better understand this essential component as well as the damage it may suffer. Thanks to Andrea Atzei, Francisco Del Pinal and Tommy Lindau, the TFCC is now a well understood and well-known entity. Having them together in a round table on this topic answering a flow of questions asked by our two famous chairmen, Diego Fernandez and Laurent Obert, allows to better understand the problems caused by the lesion of this structure.