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Monthly publications

#October 2014
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Laparoscopy-assisted pylorus-preserving gastrectomy using near-infrared imaging combined with indocyanine green (ICG) submucosal injection - (LAPPG - Near-infrared ICG camera)
Using a near infrared camera, lymph nodes can be visualized. For early gastric cancer located in the middle third of the stomach, laparoscopy-assisted pylorus-preserving gastrectomy (LAPPG) can be performed. Approximately, a 3cm cuff of distal antrum is preserved. Technically speaking, the preservation of infrapyloric vessels and of the hepatic branch of the vagus nerve represents the technical difference as compared to conventional radical distal gastrectomy. In this video, the audience can see how a near-infrared camera can be used to assist lymph node dissection.
HK Yang
Surgical intervention
4 years ago
1757 views
37 likes
0 comments
22:18
Laparoscopy-assisted pylorus-preserving gastrectomy using near-infrared imaging combined with indocyanine green (ICG) submucosal injection - (LAPPG - Near-infrared ICG camera)
Using a near infrared camera, lymph nodes can be visualized. For early gastric cancer located in the middle third of the stomach, laparoscopy-assisted pylorus-preserving gastrectomy (LAPPG) can be performed. Approximately, a 3cm cuff of distal antrum is preserved. Technically speaking, the preservation of infrapyloric vessels and of the hepatic branch of the vagus nerve represents the technical difference as compared to conventional radical distal gastrectomy. In this video, the audience can see how a near-infrared camera can be used to assist lymph node dissection.
Laparoscopic management of a type III Mirizzi syndrome: cholecystectomy with flag technique and ideal suture of a cholecystobiliary fistula
In this video, authors demonstrate the laparoscopic management of a Mirizzi syndrome. Due to a cholecystocholedochal fistula and to a difficult dissection of Calot’s triangle, authors decided to modify the dissection technique by performing a primary freeing of the gallblader as described by Jean Mouiel. In order to prevent any further biliary damage, a subtotal cholecystectomy is also achieved by means of an EndoGia™ linear stapler. Cholecystobiliary fistula is repaired using an absorbable running suture protected by an internal choledochal drain placed thanks to preoperative endoscopic catheterization.
HA Mercoli, L Marx, J Leroy, P Pessaux, J Marescaux
Surgical intervention
4 years ago
5579 views
172 likes
0 comments
07:11
Laparoscopic management of a type III Mirizzi syndrome: cholecystectomy with flag technique and ideal suture of a cholecystobiliary fistula
In this video, authors demonstrate the laparoscopic management of a Mirizzi syndrome. Due to a cholecystocholedochal fistula and to a difficult dissection of Calot’s triangle, authors decided to modify the dissection technique by performing a primary freeing of the gallblader as described by Jean Mouiel. In order to prevent any further biliary damage, a subtotal cholecystectomy is also achieved by means of an EndoGia™ linear stapler. Cholecystobiliary fistula is repaired using an absorbable running suture protected by an internal choledochal drain placed thanks to preoperative endoscopic catheterization.
Endoscopic extraction of a giant cystic duct stone to treat type I Mirizzi syndrome
Mirizzi syndrome (MS) is characterized by common hepatic duct obstruction due to mechanical compression and surrounding inflammation by a gallstone impacted in the cystic duct (type I) or at the gallbladder neck (type II). Preoperative diagnosis of the syndrome is mandatory and associated with a decrease of complication rate of surgical management. Endoscopic therapies like ERCP with lithotripsy or endoscopic extraction of cystic duct calculi followed by laparoscopic cholecystectomy have been described. Here we report successful endoscopic stone-clearance using double-cannulation and large balloon dilatation of the papilla for giant biliary stone impacted in the cystic duct inserted low in the common hepatic duct causing type I MS.
Bibliographic reference:
Double-cannulation and large papillary balloon dilation: key to successful endoscopic treatment of mirizzi syndrome in low insertion of cystic duct. Donatelli G, Dhumane P, Dallemagne B, Marx L, Delvaux M, Gay G, Marescaux J. Dig Endosc 2012;24:466-9.
Gf Donatelli, P Dhumane, S Perretta, BM Vergeau, JL Dumont, T Tuszynski, B Meduri
Surgical intervention
4 years ago
846 views
13 likes
0 comments
04:09
Endoscopic extraction of a giant cystic duct stone to treat type I Mirizzi syndrome
Mirizzi syndrome (MS) is characterized by common hepatic duct obstruction due to mechanical compression and surrounding inflammation by a gallstone impacted in the cystic duct (type I) or at the gallbladder neck (type II). Preoperative diagnosis of the syndrome is mandatory and associated with a decrease of complication rate of surgical management. Endoscopic therapies like ERCP with lithotripsy or endoscopic extraction of cystic duct calculi followed by laparoscopic cholecystectomy have been described. Here we report successful endoscopic stone-clearance using double-cannulation and large balloon dilatation of the papilla for giant biliary stone impacted in the cystic duct inserted low in the common hepatic duct causing type I MS.
Bibliographic reference:
Double-cannulation and large papillary balloon dilation: key to successful endoscopic treatment of mirizzi syndrome in low insertion of cystic duct. Donatelli G, Dhumane P, Dallemagne B, Marx L, Delvaux M, Gay G, Marescaux J. Dig Endosc 2012;24:466-9.
Laparoscopic Roux-en-Y gastric bypass after gastric band removal with severe small bowel adhesions
After gastric band removal, a laparoscopic Roux-en-Y gastric bypass is rendered more difficult by the existence of adhesions between the liver, the superior part of the stomach, and potentially the spleen. This video describes how to handle difficulties in dissecting the superior part of the stomach. Dissection of the cardia and left crus are required to allow for an appropriate calibration of the gastric pouch. The difficulty is subsequently increased in this patient as there are dense small bowel adhesions related to a previous history of gynecologic peritonitis. The intervention has been entirely performed laparoscopically. Small bowel adhesions have been taken down in order to obtain a sufficient free length (approximately 2 meters) and perform a jejunojejunostomy in adequate conditions.
M Vix, J Marescaux
Surgical intervention
4 years ago
914 views
7 likes
0 comments
20:19
Laparoscopic Roux-en-Y gastric bypass after gastric band removal with severe small bowel adhesions
After gastric band removal, a laparoscopic Roux-en-Y gastric bypass is rendered more difficult by the existence of adhesions between the liver, the superior part of the stomach, and potentially the spleen. This video describes how to handle difficulties in dissecting the superior part of the stomach. Dissection of the cardia and left crus are required to allow for an appropriate calibration of the gastric pouch. The difficulty is subsequently increased in this patient as there are dense small bowel adhesions related to a previous history of gynecologic peritonitis. The intervention has been entirely performed laparoscopically. Small bowel adhesions have been taken down in order to obtain a sufficient free length (approximately 2 meters) and perform a jejunojejunostomy in adequate conditions.
Onset of internal hernia after Roux-en-Y gastric bypass: laparoscopic management
Laparoscopic Roux-en-Y gastric bypass (LRYGB) represents the gold standard of treatment for morbidly obese patients. While the laparoscopic approach offers many advantages in terms of fewer wound complications, decreased length of hospital stay, and decreased postoperative pain, certain complications of this operation present difficult clinical problems. The most challenging complication to determine is internal hernia through one of the mesenteric defects.

Internal hernias occur more frequently in LRYGB than in the open procedure. This is a significant clinical problem since internal hernia is the most common cause of small bowel obstruction (SBO) after LRYGB, which can result in ischemia or infarction and often requires a reoperation.

The incidence of SBO after LGBP is reported to be between 1.8 and 9.7%. The most common site of internal hernia after LGBP is at Petersen’s space.
In this video, we present the laparoscopic management of a complete small bowel herniation at Petersen’s space.
A D'Urso, S Perretta, M Vix, D Mutter, J Marescaux
Surgical intervention
4 years ago
1222 views
17 likes
0 comments
11:25
Onset of internal hernia after Roux-en-Y gastric bypass: laparoscopic management
Laparoscopic Roux-en-Y gastric bypass (LRYGB) represents the gold standard of treatment for morbidly obese patients. While the laparoscopic approach offers many advantages in terms of fewer wound complications, decreased length of hospital stay, and decreased postoperative pain, certain complications of this operation present difficult clinical problems. The most challenging complication to determine is internal hernia through one of the mesenteric defects.

Internal hernias occur more frequently in LRYGB than in the open procedure. This is a significant clinical problem since internal hernia is the most common cause of small bowel obstruction (SBO) after LRYGB, which can result in ischemia or infarction and often requires a reoperation.

The incidence of SBO after LGBP is reported to be between 1.8 and 9.7%. The most common site of internal hernia after LGBP is at Petersen’s space.
In this video, we present the laparoscopic management of a complete small bowel herniation at Petersen’s space.
Laparoscopic management of right hydrothorax following peritoneal dialysis (PD)
Hydrothorax due to migration of dialysis fluid across the diaphragm and into the pleural space creates a serious complication of peritoneal dialysis (PD) but generally does not threaten life. The most current surgical option is the thoracoscopic approach. In this video, we propose an alternative treatment through an abdominal laparoscopic approach.
Hydrothorax occurs rarely but represents a well-recognized complication of peritoneal dialysis (PD). The incidence of this condition ranges between 1.6% and 10% of peritoneal dialysis patients. Patients typically present with respiratory symptoms associated with reduction of dialysis fluid. The presence of pleuroperitoneal communication has been identified as the most common reason explaining hydrothorax in peritoneal dialysis.
Conservative medical treatment is not effective. Surgical approaches range from open repair through a thoracotomy to video-assisted thoracoscopy surgery (VATS) with or without chemical or mechanical pleurodesis.
A D'Urso, D Mutter, J Marescaux
Surgical intervention
4 years ago
660 views
10 likes
0 comments
04:02
Laparoscopic management of right hydrothorax following peritoneal dialysis (PD)
Hydrothorax due to migration of dialysis fluid across the diaphragm and into the pleural space creates a serious complication of peritoneal dialysis (PD) but generally does not threaten life. The most current surgical option is the thoracoscopic approach. In this video, we propose an alternative treatment through an abdominal laparoscopic approach.
Hydrothorax occurs rarely but represents a well-recognized complication of peritoneal dialysis (PD). The incidence of this condition ranges between 1.6% and 10% of peritoneal dialysis patients. Patients typically present with respiratory symptoms associated with reduction of dialysis fluid. The presence of pleuroperitoneal communication has been identified as the most common reason explaining hydrothorax in peritoneal dialysis.
Conservative medical treatment is not effective. Surgical approaches range from open repair through a thoracotomy to video-assisted thoracoscopy surgery (VATS) with or without chemical or mechanical pleurodesis.
Laparoscopic type C radical hysterectomy and pelvic lymphadenectomy for cervical cancer
This video shows a standardized and reproducible approach to radical hysterectomy. The procedure begins with the dissection of the lateral pelvic spaces in order to identify and isolate the paracervix. After coagulation and division of the round ligament, the surgeon performs a T-shape incision until the psoas muscles to expose the field for the ilio-obturator lymphadenectomy. The paravesical fossa is then dissected in its medial and lateral aspect using the umbilical artery as a landmark. Following the umbilical artery in a ventral to dorsal direction, the surgeon identifies the uterine artery and the paracervix. Using the uterine artery as a landmark of the paracervix, dissection is continued posteriorly developing the Latzko and Okabayashi spaces in order to isolate the paracervix. Once the spaces have been developed, the lymphadenectomy is performed separating the external iliac vessels from the psoas muscle to reach the obturator fossa. During this step, the obturator nerve is identified to avoid injuries and to mark the caudal limit of the lymphadenectomy.
The procedure is carried on with the isolation of the ureter in its anterior aspect between the paracervix and the bladder. To do so, the bladder pillar is identified and the dissection is pursued between its medial and lateral aspect developing the so-called space of Yabuki. The bladder pillar is then transected at the level of the bladder. The rectal pillar is transected at the level of the rectum paying attention to isolate the inferior hypogastric nerve. The paracervix is then cut at the level of the hypogastric vessel and the ureter is unroofed.
The vagina is cut with monopolar energy using a vaginal valve as a guide and the specimen is extracted vaginally.
The vagina is closed with three stitches using an extracorporeal knotting technique.
G Centini, K Afors, J Castellano, C Meza Paul, R Murtada, A Wattiez
Surgical intervention
4 years ago
9983 views
342 likes
1 comment
07:20
Laparoscopic type C radical hysterectomy and pelvic lymphadenectomy for cervical cancer
This video shows a standardized and reproducible approach to radical hysterectomy. The procedure begins with the dissection of the lateral pelvic spaces in order to identify and isolate the paracervix. After coagulation and division of the round ligament, the surgeon performs a T-shape incision until the psoas muscles to expose the field for the ilio-obturator lymphadenectomy. The paravesical fossa is then dissected in its medial and lateral aspect using the umbilical artery as a landmark. Following the umbilical artery in a ventral to dorsal direction, the surgeon identifies the uterine artery and the paracervix. Using the uterine artery as a landmark of the paracervix, dissection is continued posteriorly developing the Latzko and Okabayashi spaces in order to isolate the paracervix. Once the spaces have been developed, the lymphadenectomy is performed separating the external iliac vessels from the psoas muscle to reach the obturator fossa. During this step, the obturator nerve is identified to avoid injuries and to mark the caudal limit of the lymphadenectomy.
The procedure is carried on with the isolation of the ureter in its anterior aspect between the paracervix and the bladder. To do so, the bladder pillar is identified and the dissection is pursued between its medial and lateral aspect developing the so-called space of Yabuki. The bladder pillar is then transected at the level of the bladder. The rectal pillar is transected at the level of the rectum paying attention to isolate the inferior hypogastric nerve. The paracervix is then cut at the level of the hypogastric vessel and the ureter is unroofed.
The vagina is cut with monopolar energy using a vaginal valve as a guide and the specimen is extracted vaginally.
The vagina is closed with three stitches using an extracorporeal knotting technique.