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#April 2018
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Transanal minimally invasive full-thickness middle rectum polyp resection with the patient in a prone position
Background: Nowadays, rectal preservation has gained popularity when it comes to the management of degenerated rectal polyps or early rectal cancer (1, 2). Tis/T1 rectal lesions can be safely treated without chemoradiation (3). Treatment via transanal minimally invasive surgery (TAMIS) offers more advantages than endoscopic submucosal dissection (ESD) (4). The authors report the case of a 60-year-old woman who underwent a TAMIS procedure for a large polyp located anteriorly in the middle rectum, which was 7cm away from the pectineal line and staged as uTisN0M0 preoperatively.
Video: The patient was placed in a prone position with a split-leg kneeling position. A reusable transanal D-Port (Karl Storz Endoskope, Tuttlingen, Germany) was introduced into the anus together with DAPRI monocurved instruments (Figure 1). The polyp was put in evidence (Figure 2) and resection margins were defined circumferentially using the monocurved coagulating hook. A full-thickness resection was performed with a complete removal of the rectal serosa and exposure of the peritoneal cavity, due to the anatomical polyp positioning (Figure 3). The rectal opening was subsequently closed using two converging full-thickness running sutures using 3/0 V-loc™ sutures (Figure 4a). The two sutures were started laterally and joined together medially (Figure 4b).
Results: Total operative time was 60 minutes whereas suturing time was 35 minutes. There was no perioperative bleeding. The postoperative course was uneventful, and the patient was discharged after 2 days. The pathological report showed a tubular adenoma with high-grade dysplasia and clear margins.
Conclusions: In the presence of degenerated rectal polyps, full-thickness TAMIS is oncologically safe and feasible. The final rectal flap can be safely closed by means of laparoscopic endoluminal sutures.
G Dapri, S Mantoo
Surgical intervention
5 months ago
623 views
194 likes
0 comments
05:53
Transanal minimally invasive full-thickness middle rectum polyp resection with the patient in a prone position
Background: Nowadays, rectal preservation has gained popularity when it comes to the management of degenerated rectal polyps or early rectal cancer (1, 2). Tis/T1 rectal lesions can be safely treated without chemoradiation (3). Treatment via transanal minimally invasive surgery (TAMIS) offers more advantages than endoscopic submucosal dissection (ESD) (4). The authors report the case of a 60-year-old woman who underwent a TAMIS procedure for a large polyp located anteriorly in the middle rectum, which was 7cm away from the pectineal line and staged as uTisN0M0 preoperatively.
Video: The patient was placed in a prone position with a split-leg kneeling position. A reusable transanal D-Port (Karl Storz Endoskope, Tuttlingen, Germany) was introduced into the anus together with DAPRI monocurved instruments (Figure 1). The polyp was put in evidence (Figure 2) and resection margins were defined circumferentially using the monocurved coagulating hook. A full-thickness resection was performed with a complete removal of the rectal serosa and exposure of the peritoneal cavity, due to the anatomical polyp positioning (Figure 3). The rectal opening was subsequently closed using two converging full-thickness running sutures using 3/0 V-loc™ sutures (Figure 4a). The two sutures were started laterally and joined together medially (Figure 4b).
Results: Total operative time was 60 minutes whereas suturing time was 35 minutes. There was no perioperative bleeding. The postoperative course was uneventful, and the patient was discharged after 2 days. The pathological report showed a tubular adenoma with high-grade dysplasia and clear margins.
Conclusions: In the presence of degenerated rectal polyps, full-thickness TAMIS is oncologically safe and feasible. The final rectal flap can be safely closed by means of laparoscopic endoluminal sutures.
Laparoscopic repair of giant left Bochdalek hernia in adults: resolution of 2 cases
A Bochdalek hernia is a congenital diaphragmatic defect which results from the improper fusion of the septum transversum and of the pleuroperitoneal folds. It rarely persists asymptomatically until adulthood. The reported incidence is as low as 0.17%. Surgical repair of the defect can be performed through the abdomen or through the chest, and in both cases, using open surgery or laparoscopy/thoracoscopy.
We present two cases of fully laparoscopic repair of a giant Bochdalek hernia in adults. In both cases, we used a GORE® DUALMESH® biomaterial and we had no complications and no recurrence. It is worth mentioning that the hernia sac was not found in any of the cases. This has been described as a distinct characteristic, which confirms the diagnosis.
Bochdalek hernia in adults is a rare entity, which requires surgical treatment to prevent any complications.
F Signorini, S Reimondez, P Maldonado, V Gorodner, L Obeide, F Moser
Surgical intervention
5 months ago
1480 views
175 likes
0 comments
10:10
Laparoscopic repair of giant left Bochdalek hernia in adults: resolution of 2 cases
A Bochdalek hernia is a congenital diaphragmatic defect which results from the improper fusion of the septum transversum and of the pleuroperitoneal folds. It rarely persists asymptomatically until adulthood. The reported incidence is as low as 0.17%. Surgical repair of the defect can be performed through the abdomen or through the chest, and in both cases, using open surgery or laparoscopy/thoracoscopy.
We present two cases of fully laparoscopic repair of a giant Bochdalek hernia in adults. In both cases, we used a GORE® DUALMESH® biomaterial and we had no complications and no recurrence. It is worth mentioning that the hernia sac was not found in any of the cases. This has been described as a distinct characteristic, which confirms the diagnosis.
Bochdalek hernia in adults is a rare entity, which requires surgical treatment to prevent any complications.
Laparoscopic total D2 gastrectomy for cancer
Laparoscopic gastrectomy is accepted as a treatment of choice for gastric cancer due to low postoperative pain, faster recovery, shorter hospital stay, and a better cosmetic outcome as compared to open gastrectomy. Radical gastrectomy, with lymph node dissection, is essential to cure this type of cancer. This technique can be reproduced also in third world countries.
This is the case of a 74-year-old woman who was evaluated for dyspepsia and weight loss. Upper endoscopy found a tumor near the cardia on the lesser curvature. The biopsy study confirmed the presence of an adenocarcinoma. CT-scan showed no metastasis or lymph nodes affected. Surgical treatment was decided upon along with a laparoscopic total D2 gastrectomy.
F Signorini, S Reimondez, L Obeide, F Moser
Surgical intervention
5 months ago
4367 views
413 likes
3 comments
06:41
Laparoscopic total D2 gastrectomy for cancer
Laparoscopic gastrectomy is accepted as a treatment of choice for gastric cancer due to low postoperative pain, faster recovery, shorter hospital stay, and a better cosmetic outcome as compared to open gastrectomy. Radical gastrectomy, with lymph node dissection, is essential to cure this type of cancer. This technique can be reproduced also in third world countries.
This is the case of a 74-year-old woman who was evaluated for dyspepsia and weight loss. Upper endoscopy found a tumor near the cardia on the lesser curvature. The biopsy study confirmed the presence of an adenocarcinoma. CT-scan showed no metastasis or lymph nodes affected. Surgical treatment was decided upon along with a laparoscopic total D2 gastrectomy.