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Monthly publications

#February 2013
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Video-assisted parathyroidectomy using augmented reality
The effectiveness of preoperative imaging to detect parathyroid adenomas allows for a targeted minimally invasive video-assisted approach. In our department, at the IRCAD, special software is used to virtually reconstruct the neck and its structures from mere CT-scan images of the cervicomediastinal region. This virtual reconstruction helps to precisely define the location of the parathyroid adenoma in relation to the superior part of the sternum, to the inferior thyroid artery and to the thyroid gland, hence guiding the surgeon in the proper identification of anatomical landmarks.
The reconstruction also helps to control the absence of "non-recurrent" recurrent nerves showing the presence of a right brachiocephalic arterial trunk.
M Vix, HA Mercoli, L Soler, J Marescaux
Surgical intervention
5 years ago
1296 views
17 likes
0 comments
06:14
Video-assisted parathyroidectomy using augmented reality
The effectiveness of preoperative imaging to detect parathyroid adenomas allows for a targeted minimally invasive video-assisted approach. In our department, at the IRCAD, special software is used to virtually reconstruct the neck and its structures from mere CT-scan images of the cervicomediastinal region. This virtual reconstruction helps to precisely define the location of the parathyroid adenoma in relation to the superior part of the sternum, to the inferior thyroid artery and to the thyroid gland, hence guiding the surgeon in the proper identification of anatomical landmarks.
The reconstruction also helps to control the absence of "non-recurrent" recurrent nerves showing the presence of a right brachiocephalic arterial trunk.
Thoracoscopic resection of an esophageal leiomyoma
Benign tumors of the esophagus are rare lesions that constitute less than 1% of esophageal neoplasms. Nearly two thirds of benign tumors are leiomyomas. They usually arise as intramural growths, most commonly along the distal two thirds of the esophagus. They have extremely small potential for malignant degeneration. Surgical excision is recommended for symptomatic great lesions. The video demonstrates the thoracoscopic resection of a leiomyoma on the upper thoracic third of the esophagus with the patient in a prone position, which brings an excellent exposure of the operative field and decreases lung injuries as we do not use any retractor.
J Torres Bermúdez, FC Becerra García, J Lopez Espejo, JL Martín, G Sánchez de la Villa
Surgical intervention
5 years ago
2090 views
18 likes
0 comments
07:22
Thoracoscopic resection of an esophageal leiomyoma
Benign tumors of the esophagus are rare lesions that constitute less than 1% of esophageal neoplasms. Nearly two thirds of benign tumors are leiomyomas. They usually arise as intramural growths, most commonly along the distal two thirds of the esophagus. They have extremely small potential for malignant degeneration. Surgical excision is recommended for symptomatic great lesions. The video demonstrates the thoracoscopic resection of a leiomyoma on the upper thoracic third of the esophagus with the patient in a prone position, which brings an excellent exposure of the operative field and decreases lung injuries as we do not use any retractor.
Transumbilical single incision laparoscopic pericystectomy of liver segment 7
Background: Transumbilical single incision laparoscopy has recently sparked interest mainly to improve cosmetic outcomes, while other potential advantages are currently under evaluation. This video presents a pericystectomy of liver segment 7 performed in a patient with a hydatic cyst.

Clinical case: A 26-year-old female, without any surgical history but with a body mass index of 20.6 kg/m2 consulted for a hepatic lesion. Preoperative work-up showed a hydatic cyst of liver segment 7 with renal adhesions. The procedure was performed using an 11mm reusable port to accommodate a 10mm, 30-degree standard length scope, reusable curved instruments according to Dapri (Karl Storz Endoskope), and a straight Ligasure™ V (Covidien). Intraoperative ultrasonography allowed to identify the edges of pericystectomy. The specimen was retrieved through the umbilicus in a custom-made plastic bag, and morcellated at that level.

Results: No conversion to open surgery nor insertion of additional ports were necessary. Laparoscopy took 160 minutes, and the final umbilical incision length was 16mm. Pathologic data confirmed the presence of a hydatic cyst. The patient was discharged on postoperative day 5.

Conclusions: Transumbilical single incision laparoscopy is beneficial in liver surgery for benign lesions, due to minimal final scar length, which has cosmetic as well as additional potential advantages that need to be further investigated.
G Dapri, V Donckier
Surgical intervention
5 years ago
2731 views
66 likes
0 comments
05:40
Transumbilical single incision laparoscopic pericystectomy of liver segment 7
Background: Transumbilical single incision laparoscopy has recently sparked interest mainly to improve cosmetic outcomes, while other potential advantages are currently under evaluation. This video presents a pericystectomy of liver segment 7 performed in a patient with a hydatic cyst.

Clinical case: A 26-year-old female, without any surgical history but with a body mass index of 20.6 kg/m2 consulted for a hepatic lesion. Preoperative work-up showed a hydatic cyst of liver segment 7 with renal adhesions. The procedure was performed using an 11mm reusable port to accommodate a 10mm, 30-degree standard length scope, reusable curved instruments according to Dapri (Karl Storz Endoskope), and a straight Ligasure™ V (Covidien). Intraoperative ultrasonography allowed to identify the edges of pericystectomy. The specimen was retrieved through the umbilicus in a custom-made plastic bag, and morcellated at that level.

Results: No conversion to open surgery nor insertion of additional ports were necessary. Laparoscopy took 160 minutes, and the final umbilical incision length was 16mm. Pathologic data confirmed the presence of a hydatic cyst. The patient was discharged on postoperative day 5.

Conclusions: Transumbilical single incision laparoscopy is beneficial in liver surgery for benign lesions, due to minimal final scar length, which has cosmetic as well as additional potential advantages that need to be further investigated.
Radical nerve-sparing hysterectomy (type C1)
This video demonstrates a nerve-sparing radical hysterectomy (type C1).
During type C Radical Hysterectomy (RH), the uterus is removed en bloc with its ligaments along with a vaginal margin of 15 to 20mm. The uterosacral ligaments are transected from the level of the rectum and the vesicouterine ligament at the level of the bladder. The ureter is dissected until it enters the bladder. It is mobilized completely to resect the lateral parametrium from the lateral wall.

Radical hysterectomy type C1 implies the preservation of the hypogastric inferior nerve and the bladder branch of the hypogastric plexus during the resection of the parametrium.
During the surgery, the components of the hypogastric plexus are identified: the inferior hypogastric nerve running from the lateral wall of the rectum and the splanchnic nerves from S2-S4. The deep uterine vein is an essential landmark because we can find the first splanchnic nerve underneath it. Consequently, during the resection of the posterior parametrium, the uterosacral ligament can be completely resected while conserving the inferior hypogastric nerve. Division of the lateral parametrium is pursued without including the splanchnic nerves. During the transection of the caudal part of the paracervix and the paracolpium, attention must be paid not to include the vesical branch of the inferior hypogastric plexus that runs parallel to paravaginal vessels.
M Malzoni, A Ruggiero, M Puga
Surgical intervention
5 years ago
7994 views
149 likes
1 comment
20:14
Radical nerve-sparing hysterectomy (type C1)
This video demonstrates a nerve-sparing radical hysterectomy (type C1).
During type C Radical Hysterectomy (RH), the uterus is removed en bloc with its ligaments along with a vaginal margin of 15 to 20mm. The uterosacral ligaments are transected from the level of the rectum and the vesicouterine ligament at the level of the bladder. The ureter is dissected until it enters the bladder. It is mobilized completely to resect the lateral parametrium from the lateral wall.

Radical hysterectomy type C1 implies the preservation of the hypogastric inferior nerve and the bladder branch of the hypogastric plexus during the resection of the parametrium.
During the surgery, the components of the hypogastric plexus are identified: the inferior hypogastric nerve running from the lateral wall of the rectum and the splanchnic nerves from S2-S4. The deep uterine vein is an essential landmark because we can find the first splanchnic nerve underneath it. Consequently, during the resection of the posterior parametrium, the uterosacral ligament can be completely resected while conserving the inferior hypogastric nerve. Division of the lateral parametrium is pursued without including the splanchnic nerves. During the transection of the caudal part of the paracervix and the paracolpium, attention must be paid not to include the vesical branch of the inferior hypogastric plexus that runs parallel to paravaginal vessels.
Simultaneous robotic right partial nephrectomy and right adrenalectomy
Robot-assisted partial nephrectomy has become a safe procedure if standardized surgical steps are followed [1]. The same goes for robot-assisted adrenalectomy, with the robot offering the possibility to manage complex cases that are considered technically challenging for traditional laparoscopy [2].
A combined laparoscopic partial nephrectomy and an ipsilateral adrenalectomy have been described for upper pole renal tumors contiguously involving the adrenal gland [3].
In this video, we describe the surgical steps for a simultaneous robotic right partial nephrectomy and right adrenalectomy for two distinct renal and adrenal tumors.
References:
[1] Kaouk JH, Khalifeh A, Hillyer S, Haber GP, Stein RJ, Autorino R. Robot-assisted laparoscopic partial nephrectomy: step-by-step contemporary technique and surgical outcomes at a single high-volume institution. Eur Urol 2012;62:553-61.
[2] D’Annibale A, Lucandri G, Monsellato I, De Angelis M, Pernazza G, Alfano G, Mazzocchi P, Pende V. Robotic adrenalectomy: technical aspects, early results and learning curve. Int J Med Robot 2012;8:483-90.
[3] Ramani AP, Abreu SC, Desai MM, Steinberg AP, Ng C, Lin CH, Kaouk JH, Gill IS. Laparoscopic upper pole partial nephrectomy with concomitant en bloc adrenalectomy. Urology 2003;62:223-6.
D Rey, E El Helou, M Oderda, T Piéchaud
Surgical intervention
5 years ago
5222 views
85 likes
0 comments
13:06
Simultaneous robotic right partial nephrectomy and right adrenalectomy
Robot-assisted partial nephrectomy has become a safe procedure if standardized surgical steps are followed [1]. The same goes for robot-assisted adrenalectomy, with the robot offering the possibility to manage complex cases that are considered technically challenging for traditional laparoscopy [2].
A combined laparoscopic partial nephrectomy and an ipsilateral adrenalectomy have been described for upper pole renal tumors contiguously involving the adrenal gland [3].
In this video, we describe the surgical steps for a simultaneous robotic right partial nephrectomy and right adrenalectomy for two distinct renal and adrenal tumors.
References:
[1] Kaouk JH, Khalifeh A, Hillyer S, Haber GP, Stein RJ, Autorino R. Robot-assisted laparoscopic partial nephrectomy: step-by-step contemporary technique and surgical outcomes at a single high-volume institution. Eur Urol 2012;62:553-61.
[2] D’Annibale A, Lucandri G, Monsellato I, De Angelis M, Pernazza G, Alfano G, Mazzocchi P, Pende V. Robotic adrenalectomy: technical aspects, early results and learning curve. Int J Med Robot 2012;8:483-90.
[3] Ramani AP, Abreu SC, Desai MM, Steinberg AP, Ng C, Lin CH, Kaouk JH, Gill IS. Laparoscopic upper pole partial nephrectomy with concomitant en bloc adrenalectomy. Urology 2003;62:223-6.
Lengthening of extensor muscle origin as treatment of lateral epicondylitis
Lateral epicondylitis (tennis elbow) is the most common affliction of the elbow. It is an inflammatory condition producing pain localized around the lateral elbow and dorsal forearm region. Though often put in the category of tendinitis, it is actually a result of an injury to the extensor musculotendinous origin at the lateral humoral epicondyle. It usually responds to non-surgical treatment. In case of failure, a surgical treatment is requested. It consists in the lengthening of the extensor muscle origin. This original technique allows a prompt recovery of full range of motion.
This video was captured using the VITOM system from KARL STORZ.
C Mathoulin
Surgical intervention
5 years ago
829 views
20 likes
0 comments
05:18
Lengthening of extensor muscle origin as treatment of lateral epicondylitis
Lateral epicondylitis (tennis elbow) is the most common affliction of the elbow. It is an inflammatory condition producing pain localized around the lateral elbow and dorsal forearm region. Though often put in the category of tendinitis, it is actually a result of an injury to the extensor musculotendinous origin at the lateral humoral epicondyle. It usually responds to non-surgical treatment. In case of failure, a surgical treatment is requested. It consists in the lengthening of the extensor muscle origin. This original technique allows a prompt recovery of full range of motion.
This video was captured using the VITOM system from KARL STORZ.
Full endoscopic robotic assisted upper left lung lobectomy for a suspicious lesion
Objective:
To present a complete endoscopic approach for thoracic resection using the Da Vinci™ robotic device (Ninan M, MR Dylewski. Total port-access robot-assisted pulmonary lobectomy without utility thoracotomy. Eur J Cardiothorac Surg 2010;38:231-2).
Methods:
A 62-year-old man was a former smoker with an accumulated dose of 70 packs of cigarettes a year and had a history of rheumatic polyarthritis under immunotherapy. He presented a deterioration of his overall health condition and a CT-scan was performed. The CT-scan showed a ground-glass opacity (GGO) in the left upper lobe. Functional respiratory tests were the following: FEV1 51% and DLCO 65%, and the patient completed 4 floors at the stair-climbing test. An upper left lobectomy using a Da Vinci™ robotic system was performed with a high level of safety.
Results: The postoperative course was uneventful. Pathological findings confirmed the diagnosis of a benign granuloma. Our patient has not shown any incidence during a one-month follow-up and his physician reintroduced his immunosuppressive treatment.
Conclusion: Complete and precise lobectomy can be performed safely by means of the Da Vinci™ robotic system with low morbidity.
JM Baste, V Díaz-Ravetllat, C Peillon
Surgical intervention
5 years ago
1222 views
17 likes
0 comments
07:10
Full endoscopic robotic assisted upper left lung lobectomy for a suspicious lesion
Objective:
To present a complete endoscopic approach for thoracic resection using the Da Vinci™ robotic device (Ninan M, MR Dylewski. Total port-access robot-assisted pulmonary lobectomy without utility thoracotomy. Eur J Cardiothorac Surg 2010;38:231-2).
Methods:
A 62-year-old man was a former smoker with an accumulated dose of 70 packs of cigarettes a year and had a history of rheumatic polyarthritis under immunotherapy. He presented a deterioration of his overall health condition and a CT-scan was performed. The CT-scan showed a ground-glass opacity (GGO) in the left upper lobe. Functional respiratory tests were the following: FEV1 51% and DLCO 65%, and the patient completed 4 floors at the stair-climbing test. An upper left lobectomy using a Da Vinci™ robotic system was performed with a high level of safety.
Results: The postoperative course was uneventful. Pathological findings confirmed the diagnosis of a benign granuloma. Our patient has not shown any incidence during a one-month follow-up and his physician reintroduced his immunosuppressive treatment.
Conclusion: Complete and precise lobectomy can be performed safely by means of the Da Vinci™ robotic system with low morbidity.