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Monthly publications

#September 2013
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Transumbilical single access laparoscopic left adrenalectomy for symptomatic pheochromocytoma
Background: Single access laparoscopy has been reported for adrenal gland surgery. This technique can also be applied for patients presenting non-small lesions and symptomatic diseases such as pheochromocytoma.

Video: A 17-year-old woman was admitted to hospital for severe headaches, palpitations, and tachycardia along with tremulousness, dizziness, and vomiting. A symptomatic left-side single location adrenal pheochromocytoma was diagnosed and a transumbilical single access laparoscopic left adrenalectomy was proposed. The patient was placed in a semi-lateral right-sided decubitus. The technique was performed using an 11mm reusable trocar to accommodate a 10mm, 30-degree rigid and regular length scope in addition to curved reusable instruments according to DAPRI (Karl Storz Endoskope, Tüttlingen, Germany). The procedure started with the opening of the splenocolic ligament and, after mobilization of the splenopancreatic block medially, the adrenal lesion was demonstrated. Probably due to the size of the lesion, only two main adrenal vessels were found: vein and mid-artery. Both vessels were dissected and divided between 5mm non-absorbable clips. The specimen was retrieved transumbilically in a custom-made plastic bag.

Results: Laparoscopic time was 129 minutes, estimated blood loss 20cc, and the final scar length measured 16mm. The symptomatic status of the patient was resolved immediately. The patient was discharged from the intensive care unit after 3 days and from the hospital after 6 days.

Conclusions: Transumbilical single access laparoscopic left adrenalectomy for symptomatic pheochromocytoma is feasible and safe. In young ladies, it offers an excellent cosmetic result, avoiding abdominal trauma.
G Dapri, V Zulian, M Bortes, P Mathonet, GB Cadière
Surgical intervention
5 years ago
1454 views
13 likes
0 comments
07:29
Transumbilical single access laparoscopic left adrenalectomy for symptomatic pheochromocytoma
Background: Single access laparoscopy has been reported for adrenal gland surgery. This technique can also be applied for patients presenting non-small lesions and symptomatic diseases such as pheochromocytoma.

Video: A 17-year-old woman was admitted to hospital for severe headaches, palpitations, and tachycardia along with tremulousness, dizziness, and vomiting. A symptomatic left-side single location adrenal pheochromocytoma was diagnosed and a transumbilical single access laparoscopic left adrenalectomy was proposed. The patient was placed in a semi-lateral right-sided decubitus. The technique was performed using an 11mm reusable trocar to accommodate a 10mm, 30-degree rigid and regular length scope in addition to curved reusable instruments according to DAPRI (Karl Storz Endoskope, Tüttlingen, Germany). The procedure started with the opening of the splenocolic ligament and, after mobilization of the splenopancreatic block medially, the adrenal lesion was demonstrated. Probably due to the size of the lesion, only two main adrenal vessels were found: vein and mid-artery. Both vessels were dissected and divided between 5mm non-absorbable clips. The specimen was retrieved transumbilically in a custom-made plastic bag.

Results: Laparoscopic time was 129 minutes, estimated blood loss 20cc, and the final scar length measured 16mm. The symptomatic status of the patient was resolved immediately. The patient was discharged from the intensive care unit after 3 days and from the hospital after 6 days.

Conclusions: Transumbilical single access laparoscopic left adrenalectomy for symptomatic pheochromocytoma is feasible and safe. In young ladies, it offers an excellent cosmetic result, avoiding abdominal trauma.
Laparoscopic left pancreatectomy with spleen preservation for multiple neuroendocrine tumors
Insulinoma is the most common functional neuroendocrine tumor of the pancreas. Most insulinomas are benign and solitary. Surgical resection is preferred for insulinomas and cure is achieved in more than 90% of the patients. Successful surgery requires accurate localization based on contrast enhanced CT-scan, PET-scan, and intraoperative ultrasound. This video shows a laparoscopic left pancreatectomy in a young patient presenting with typical symptoms evocative of Whipple's triad. Preoperative imaging studies identified two pancreatic tumors. Laparoscopic exploration and ultrasound identified four distinct tumors, all of them expressing somatostatin and insulin. This clinical case highlights the necessity and value of ultrasound exploration during surgery for neuroendocrine tumors.
B Dallemagne, D Mutter, L Soler, J Marescaux
Surgical intervention
5 years ago
2517 views
76 likes
0 comments
35:52
Laparoscopic left pancreatectomy with spleen preservation for multiple neuroendocrine tumors
Insulinoma is the most common functional neuroendocrine tumor of the pancreas. Most insulinomas are benign and solitary. Surgical resection is preferred for insulinomas and cure is achieved in more than 90% of the patients. Successful surgery requires accurate localization based on contrast enhanced CT-scan, PET-scan, and intraoperative ultrasound. This video shows a laparoscopic left pancreatectomy in a young patient presenting with typical symptoms evocative of Whipple's triad. Preoperative imaging studies identified two pancreatic tumors. Laparoscopic exploration and ultrasound identified four distinct tumors, all of them expressing somatostatin and insulin. This clinical case highlights the necessity and value of ultrasound exploration during surgery for neuroendocrine tumors.
Full endoscopic robot-assisted basal segmentectomy for bronchiectasis
Objective
Surgical treatment of bronchiectasis is often proposed in complicated situations [1]. The development of minimally invasive surgery should allow us to propose a surgical curative treatment with preventative purposes. In this video, we describe a lung-sparing surgery using a full endoscopic robotic segmentectomy as described by Dylewsky [2] to deal with localized bronchiectasis.
Case presentation
This is the case of a 40-year-old man with bronchiectasis, colonized by Pseudomonas aeruginosa with antibiotic resistance. The patient suffered from recurrent infections. Bronchiectasis is localized in the left basal segments on CT-scan. Basal segmentectomy was decided upon using a robot-assisted procedure. This kind of patient is usually treated medically with iterative antibiotherapy until a new complication occurs.
Results
There was no postoperative complication and the patient was discharged on postoperative day 4. The patient resumed work after one month without any complaint.
Conclusion
When using a precise resection, basal segmentectomy seems to be feasible using a robot-assisted procedure, without increasing perioperative morbidity. This procedure should be proposed as a preventative surgery as it is a relatively new approach for benign or infectious lung disease.
Bibliographic references
1. Agasthian T. Results of surgery for bronchiectasis and pulmonary abscesses. Thorac Surg Clin. 2012;22:333-44.
2. Dylewski MR, Ohaeto AC, Pereira JF. Pulmonary resection using a total endoscopic robotic video-assisted approach. Semin Thorac Cardiovasc Surg. 2011;23:36-42.
JM Baste, P Rinieri, A Sebestyen
Surgical intervention
5 years ago
271 views
4 likes
0 comments
07:42
Full endoscopic robot-assisted basal segmentectomy for bronchiectasis
Objective
Surgical treatment of bronchiectasis is often proposed in complicated situations [1]. The development of minimally invasive surgery should allow us to propose a surgical curative treatment with preventative purposes. In this video, we describe a lung-sparing surgery using a full endoscopic robotic segmentectomy as described by Dylewsky [2] to deal with localized bronchiectasis.
Case presentation
This is the case of a 40-year-old man with bronchiectasis, colonized by Pseudomonas aeruginosa with antibiotic resistance. The patient suffered from recurrent infections. Bronchiectasis is localized in the left basal segments on CT-scan. Basal segmentectomy was decided upon using a robot-assisted procedure. This kind of patient is usually treated medically with iterative antibiotherapy until a new complication occurs.
Results
There was no postoperative complication and the patient was discharged on postoperative day 4. The patient resumed work after one month without any complaint.
Conclusion
When using a precise resection, basal segmentectomy seems to be feasible using a robot-assisted procedure, without increasing perioperative morbidity. This procedure should be proposed as a preventative surgery as it is a relatively new approach for benign or infectious lung disease.
Bibliographic references
1. Agasthian T. Results of surgery for bronchiectasis and pulmonary abscesses. Thorac Surg Clin. 2012;22:333-44.
2. Dylewski MR, Ohaeto AC, Pereira JF. Pulmonary resection using a total endoscopic robotic video-assisted approach. Semin Thorac Cardiovasc Surg. 2011;23:36-42.