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podcast

Beyond IRCAD - Surgical Journeys: Episode 8: A Wattiez

Introducing "Beyond IRCAD - Surgical Journeys". Join us on an inspiring and captivating monthly journey as we sit down with prestigious surgeons who have built remarkable careers in the field of medicine. In each episode, we explore the personal backgrounds and experiences of these exceptional individuals, as they share their inspiring stories of overcoming challenges, staying committed, and achieving success. Whether you're a medical professional, a student aspiring to be a surgeon, or simply someone looking for motivation from incredible human stories, this podcast is for you. 

Join us for a discussion with Professor Arnaud Wattiez, a world-leading gynecologic surgeon renowned for his dedication to excellence and mentorship. Professor Wattiez has not only advanced his field but also fostered a community of top surgeons through his teaching. We will also delve into his transformative journey from France to Dubai, exploring how this move profoundly impacted his personal and professional life, bringing him a newfound balance and contentment. Tune in for an inspiring tale of achievement and personal growth.

Beyond IRCAD - Surgical Journeys: Episode 8: Arnaud Wattiez

Introducing "Beyond IRCAD - Surgical Journeys". Join us on an inspiring and captivating monthly journey as we sit down with prestigious surgeons who have built remarkable careers in the field of medicine. In each episode, we explore the personal backgrounds and experiences of these exceptional individuals, as they share their inspiring stories of overcoming challenges, staying committed, and achieving success. Whether you're a medical professional, a student aspiring to be a surgeon, or simply someone looking for motivation from incredible human stories, this podcast is for you.

In this episode of "Beyond IRCAD", delve into Dr. Galvao Neto's journey as a modern surgeon, blending innovation with passion. Explore how he integrates music and dance into surgical preparation, highlighting the fusion of enjoyment and expertise. Discover the essential balance of surgical skills with empathy in the 21st century medical world, where active social media engagement is paramount.

Beyond IRCAD - Surgical Journeys: Episode 7: M Galvao Neto

Introducing "Beyond IRCAD - Surgical Journeys". Join us on an inspiring and captivating monthly journey as we sit down with prestigious surgeons who have built remarkable careers in the field of medicine. In each episode, we explore the personal backgrounds and experiences of these exceptional individuals, as they share their inspiring stories of overcoming challenges, staying committed, and achieving success. Whether you're a medical professional, a student aspiring to be a surgeon, or simply someone looking for motivation from incredible human stories, this podcast is for you.

In this episode, Professor Nicolas Demartines discusses overcoming operating room challenges through humility, active listening, and humor. 

Explore the satisfaction of fostering empathy and giving back, as he emphasizes collaboration over competition in surgery for the benefit of the patient.

Beyond IRCAD - Surgical Journeys: Episode 6: Nicolas Demartines

Beyond IRCAD - Surgical Journeys: Episode 5: Jacques Marescaux

Introducing "Beyond IRCAD - Surgical Journeys". Join us on an inspiring and captivating monthly journey as we sit down with prestigious surgeons who have built remarkable careers in the field of medicine. In each episode, we explore the personal backgrounds and experiences of these exceptional individuals, as they share their inspiring stories of overcoming challenges, staying committed, and achieving success. Whether you're a medical professional, a student aspiring to be a surgeon, or simply someone looking for motivation from incredible human stories, this podcast is for you.

In this episode of Beyond IRCAD, Professor Jacques Marescaux shares his keys to success. He talks about his wife’s essential role in the history of IRCAD, how he became a citizen of Rwanda, he reveals how WebSurg almost disappeared, and why Alsace was the perfect place for IRCAD. Discover how he managed to become not only a groundbreaking surgeon, but also a successful businessman.

Introducing "Beyond IRCAD - Surgical Journeys". Join us on an inspiring and captivating monthly journey as we sit down with prestigious surgeons who have built remarkable careers in the field of medicine. In each episode, we explore the personal backgrounds and experiences of these exceptional individuals, as they share their inspiring stories of overcoming challenges, staying committed, and achieving success. Whether you're a medical professional, a student aspiring to be a surgeon, or simply someone looking for motivation from incredible human stories, this podcast is for you.

In this episode, we interviewed Professor Mariano Gimenez, a globally renowned surgeon specializing in image-guided percutaneous surgery and HPB surgery. 

Join us for a unique perspective as Professor Gimenez emphasizes the personal dimensions that shape a distinguished surgical career, discussing the dangers of ego and the crucial role mentors play.

Beyond IRCAD - Surgical Journeys: Episode 4: Mariano Gimenez

Introducing "Beyond IRCAD - Surgical Journeys". Join us on an inspiring and captivating monthly journey as we sit down with prestigious surgeons who have built remarkable careers in the field of medicine. In each episode, we explore the personal backgrounds and experiences of these exceptional individuals, as they share their inspiring stories of overcoming challenges, staying committed, and achieving success. Whether you're a medical professional, a student aspiring to be a surgeon, or simply someone looking for motivation from incredible human stories, this podcast is for you.

In our third episode, we interviewed Professor Sébastien Froelich, a world-renowned skull base surgeon from France. Hear about his unexpected journey into surgery, how his work became a passionate pursuit, and the unique, humbling experiences with his patients. 

Join us for a captivating insight into Professor Froelich’s extraordinary career in skull base surgery!

Beyond IRCAD - Surgical Journeys: Episode 3: Sébastien Froelich

Beyond IRCAD - Surgical Journeys: Episode 2: Xavier Serra Aracil

Introducing "Beyond IRCAD - Surgical Journeys". Join us on an inspiring and captivating monthly journey as we sit down with prestigious surgeons who have built remarkable careers in the field of medicine. In each episode, we explore the personal backgrounds and experiences of these exceptional individuals, as they share their inspiring stories of overcoming challenges, staying committed, and achieving success. Whether you're a medical professional, a student aspiring to be a surgeon, or simply someone looking for motivation from incredible human stories, this podcast is for you.

In our second episode, we are honored to feature the distinguished Dr. Xavier Serra Aracil, an innovative expert in the field of colorectal surgery from Spain. Tune in to gain insight into the remarkable path of Dr. Serra Aracil's outstanding career.



Discover the story behind his passion for surgery, the driving force that propels him forward, the values that guide his work and personal life, and explore the valuable advice he offers to the up-and-coming generation of aspiring surgeons.



Introducing "Beyond IRCAD - Surgical Journeys". Join us on an inspiring and captivating monthly journey as we sit down with prestigious surgeons who have built remarkable careers in the field of medicine. In each episode, we explore the personal backgrounds and experiences of these exceptional individuals, as they share their inspiring stories of overcoming challenges, staying committed, and achieving success. Whether you're a medical professional, a student aspiring to be a surgeon, or simply someone looking for motivation from incredible human stories, this podcast is for you. 

In the very first episode, we have the privilege of hosting the renowned Dr. Armando Melani, a trailblazing colorectal surgeon hailing from Brazil. Join us as Dr. Melani takes us on a captivating exploration of his unique career path.



Discover the story behind his passion for surgery, the driving force that propels him forward, and the values that guide his work and life. Dr. Melani's dedication extends beyond the operating room, as he shares his profound commitment to passing on knowledge to the next generation of surgeons.



Stay tuned for an engaging conversation that goes "Beyond IRCAD”.

Beyond IRCAD - Surgical Journeys: Episode 1: Armando Melani

surgical intervention video

Complete mesocolic excision (CME) in colon cancer surgery has recently gained popularity as increasing evidence points to improved oncological clearance with superior lymph node yield, bigger tumor clearance margins, and higher quality surgical specimens. There are also some indications that it may lead to improved oncological outcomes. The tenets of CME include high vascular ligation at the root of the vessel, dissection along the embryological planes of the colonic mesentery, and adequate margins of bowel from the tumor. 

Although the technique was initially described and achieved via a laparotomy, laparoscopic CME was also performed, although it was noted to be technically challenging. The right colon and the variability of vascular anatomy add to the difficulty of the procedure. 

Extracorporeal anastomosis is commonly performed for right hemicolectomy in most centers. There are some reported advantages to the intracorporeal anastomosis, namely a potentially higher lymph node yield, a smaller skin incision, and the ability to extract the specimen via a Pfannenstiel’s incision, which has lower rates of incisional hernia. 

This video features a laparoscopic CME right hemicolectomy with intracorporeal anastomosis for a malignant polyp. 

Dr. Shen-Ann Eugene Yeo, MBBS, MMed (Surg), FRCS (Ed) does not have any conflicts of interest or financial ties to disclose.

Laparoscopic complete mesocolic excision (CME) right hemicolectomy with intracorporeal anastomosis

腹腔镜完全鼻息肉切除术（CME）右半结肠切除术与体内吻合术


Hemicolectomía derecha con escisión completa del mesocolon (ECM) y anastomosis intracorpórea


Hemicolectomia direita com excisão completa do mesocólon (ECM) e anastomose intracorpórea


Excision mésocolique laparoscopique complète (CME) hémicolectomie droite avec anastomose intracorporelle


Лапароскопическая тотальная мезоколонэктомия, правосторонняя гемиколэктомия с интракорпоральным анастомозом

This video of laparoscopic Nissen fundoplication is suitable for surgeons learning to perform this procedure. The patient is young with very few adhesions and the operative steps are very clearly presented by Dr. Dallemagne. Critical points and technical tips are emphasized throughout the procedure.



The author describes this as an ideal case for surgeons learning the procedure because this young patient with severe reflux has few adhesions. Working with a zero-degree scope, the author examines the peritoneal cavity. The dissection begins at the caudate lobe of the liver and moves toward the right crus of the diaphragm. After identifying the right and left crura, the author opens the lesser omentum to gain access to the right crus. It is important to identify the inferior vena cava as a landmark.

Laparoscopic Nissen fundoplication: a perfect case to start

Fundoplicatura de Nissen laparoscópica: um caso perfeito para começar


Fundoplicature de Nissen laparoscopique : un cas idéal pour commencer


腹腔镜尼森胃底折叠术：一个完美的开始


Este vídeo de fundoplicatura Nissen laparoscópica es recomendado para cirujanos que estén comenzando en aprender este procedimiento.  El paciente es joven, con pocas adherencias.  Los pasos operatorios son claramente presentados por el Dr. Dallemagne.  Se enfatizan los puntos críticos y los consejos técnicos a través de todo el procedimiento.

Fundoplicatura de Nissen Laparoscópico para RGE

Полностью экстраперитонеальная эндоскопическая герниопластика: 10 этапов

Reparación endoscópica totalmente extraperitoneal (TEP) de la hernia inguinal en 10 pasos


This video describes our technique for a totally extraperitoneal endoscopic inguinal hernia repair or TEP procedure in a male patient with a right inguinal hernia. In some cases, short clips of other patients are inserted as intermezzo for better understanding. 

The technique consists of 10 consecutive steps of which steps 1, 2, 4, 8 and 10 are more basic and steps 3, 5, 6, 7 and 9 more advanced. 

Totally extraperitoneal endoscopic inguinal hernia repair (TEP) in 10 steps

完全腹膜外腹股沟疝修补术（TEP）10步


Reparo endoscópico totalmente extraperitoneal (TEP) da hérnia inguinal em 10 passos


Cure de hernie inguinale totalement extrapéritonéale endoscopique en 10 étapes


We present the clinical case of a 57-year old male patient managed for a bilateral reducible inguinal hernia. The patient’s history included a right inguinal hernia repair in his childhood. A first port was inserted 1cm above the umbilicus and two 5mm ports were placed 7cm away from the umbilicus on the right and left side. Peritoneal dissection starts with a horizontal incision and parietalization is performed carefully to avoid injury to the vessels and deferent duct. After the myopectineal orifice has been sufficiently exposed, polypropylene meshes (Parietene™) trimmed to a 13 by 12cm size are inserted into the preperitoneal cavity and fixed using absorbable tacks. Finally, the meshes are fully covered using peritoneal flaps.

Laparoscopic TAPP approach to bilateral reducible inguinal hernia: live interactive procedure

Intervention interactive live : voie d’abord transabdominale prépéritonéale (TAPP) laparoscopique pour hernie inguinale bilatérale réductible

Лапароскопическая TAPP пластика двусторонней паховой грыжи: интерактивная LIVE процедура

Cholécystite aiguë, Parkland 5 : stratégie de sauvetage

The authors present the case of a 75-year-old man who underwent an elective surgery for chronic cholecystitis. He had a history of high blood pressure under medical treatment. During surgery, a PAECOF systematic dissection technique was performed, leading to a subtotal fenestrating cholecystectomy for a Parkland 5 acute cholecystitis. Using this approach, the authors want to show that even in such cases, laparoscopy is decisive, feasible, and safe with a low complication rate and no bile duct injury. 

Bibliography:

1. Dissanaike, Sharmila MD, FACS*. A Step-by-Step Guide to Laparoscopic Subtotal Fenestrating Cholecystectomy: A Damage Control Approach to the Difficult Gallbladder. Journal of the American College of Surgeons 223(2):p e15-e18, August 2016. | DOI: 10.1016/j.jamcollsurg.2016.05.006.

2. Strasberg, S. M., Pucci, M. J., Brunt, L. M., & Deziel, D. J. Subtotal Cholecystectomy-"Fenestrating" vs "Reconstituting" Subtypes and the Prevention of Bile Duct Injury: Definition of the Optimal Procedure in Difficult Operative Conditions. J Am Coll Surg 2016. 222(1), 89-96. https://doi.org/10.1016/j.jamcollsurg.2015.09.019

3. Zaragoza, Noe MD. Parkland 4 acute cholecystitis PAECIF/PAECOF https://websurg.com/doi/vd01en6684

4. Navez, B. Prevention of bile duct injury (BDI) during cholecystectomy. Acta Chir Belg 2003 Apr;103(2):151-3. doi: 10.1080/00015458.2003.11679399. PMID: 12768856 DOI: 10.1080/00015458.2003.11679399

Parkland 5 acute cholecystitis: bailout strategy 

Chronic calcific pancreatitis (CCP) is a debilitating condition, which often causes intractable pain unresponsive to conservative treatment. Conventional surgical interventions have limitations in achieving optimal outcomes, as they often lead to prolonged recovery and increased morbidity. Laparoscopic lateral pancreaticojejunostomy (LPJ) offers a minimally invasive surgical approach in such patients. The use of robotic technology enhances the precision and efficacy of pancreaticojejunostomy, offering patients a minimally invasive alternative with improved postoperative outcomes. This video showcases the key steps of the procedure, including patient set-up, robotic port placement, meticulous dissection of the pancreatic head, and creation of a side-to-side pancreaticojejunostomy. 

This video shows the case of a 27-year-old woman presenting with persistent abdominal pain, uncontrolled diabetes mellitus, and steatorrhea. Investigations revealed random plasma glucose at 390mg/dL and HbA1C at 8.6. Contrast-enhanced CT-scan of the abdomen showed an atrophic pancreas, a dilated main pancreatic duct (MPD) with a diameter of approximately 9mm filled with multiple calculi. The patient underwent a robotic assisted laparoscopic lateral pancreaticojejunostomy. The procedure was uneventful, and the patient was discharged on postoperative day 5. 

Bibliography: 

1. George Michel Eid, Fateh Entabi, Andrew R. Watson, Brian S. Zuckerbraun, Mark A. Wilson, Robotic-assisted laparoscopic side-to-side lateral pancreaticojejunostomy, Journal of Gastrointestinal Surgery, Volume 15, Issue 7, 2011, Page 1243, ISSN 1091-255X, https://doi.org/10.1007/s11605-011-1495-9.

2. Balduzzi A, Zwart MJW, Kempeneers RMA, Boermeester MA, Busch OR, Besselink MG. Robotic Lateral Pancreaticojejunostomy for Chronic Pancreatitis. J Vis Exp. 2019 Dec 14;(154). doi: 10.3791/60301. PMID: 31885388.

3. Nayak K, Shinde RK, Gattani RG, Thakor T. Surgical Perspectives of Open vs. Laparoscopic Approaches to Lateral Pancreaticojejunostomy: A Comprehensive Review. Cureus. 2024 Jan 6;16(1):e51769. doi: 10.7759/cureus.51769. PMID: 38322062; PMCID: PMC10844796.

4. Palanivelu C, Shetty R, Jani K, Rajan PS, Sendhilkumar K, Parthasarthi R, Malladi V. Laparoscopic lateral pancreaticojejunostomy: a new remedy for an old ailment. Surg Endosc. 2006 Mar;20(3):458-61. doi: 10.1007/s00464-005-0680-x. Epub 2006 Jan 19. PMID: 16424983.

Robotic assisted laparoscopic lateral pancreaticojejunostomy (LPJ) for chronic calcific pancreatitis (CCP)

Pancréaticojéjunostomie latérale assistée par robot pour pancréatite calcifiante chronique 

Cure de hernie inguinale (technique TAPP) pour hernie fémorale étranglée avec entérectomie et anastomose primaire

Acute inguinal hernias are common surgical emergencies conventionally managed through open surgery. Although several authors advocated for the laparoscopic approach in recent years, controversy persists among surgeons. The benefits of the laparoscopic technique extend beyond the elective context. Apart from detecting hidden and visible hernias and covering the entire myopectineal orifice (MPO), it also makes precise diagnosis possible, lessens the necessity for laparotomy, and lowers the incidence of wound infections. In this approach, intestinal viability is evaluated once the hernia has been identified and the strangulated content has been reduced. Save from cases of gangrenous perforation necessitating immediate intervention, hernia repair ensues. The subsequent reassessment of the strangulated bowel allows for revascularization, often obviating the need for bowel resection and unnecessary laparotomy. In this educational video, the authors present a case study of a 61-year-old woman with a strangulated femoral hernia. A laparoscopic transabdominal preperitoneal (TAPP) repair was performed, requiring segmental bowel enterectomy due to non-reversible ischemia. 

Bibliography:

1. Claus C, Furtado M, Malcher F, Cavazzola LT, Felix E. Ten golden rules for a safe MIS inguinal hernia repair using a new anatomical concept as a guide. Surg Endosc. 2020 Apr;34(4):1458-1464. doi: 10.1007/s00464-020-07449-z. Epub 2020 Feb 19. PMID: 32076858

2. Yang, G. (2017). Laparoscopy in emergency hernia repair. Annals Of Laparoscopic And Endoscopic Surgery, 2(6). doi:10.21037/ales.2017.05.05

Inguinal TAPP repair for strangulated femoral hernia with enterectomy and primary anastomosis

This video presents a laparoscopic distal gastrectomy with a Billroth I reconstruction procedure for gastric cancer patients, highlighting its notable benefits in the early postoperative period. Compared to Roux-en-Y reconstruction, Billroth I offers benefits such as shorter operative time, reduced blood loss, and notably shorter hospital stays (4). Laparoscopic surgery, renowned for its minimally invasive nature, has gained global recognition for its benefits including reduced postoperative pain, shorter hospital stays, and faster recovery times (1, 2). Among laparoscopic interventions for gastric cancer, the Billroth I procedure stands out for its simplicity and physiological food passage. To address specific concerns related to staple lines and the duodenal stump’s “dog ear”, the authors adopted the modified Billroth I reconstruction method proposed by J Harada and T Kinoshita (3). Further investigations are warranted to assess long-term outcomes and provide a comprehensive understanding of the lasting benefits of this surgical approach. The authors’ findings underscore the importance of ongoing research to refine and advance surgical strategies in the management of gastric cancer.

Bibliography:

1\. Huang C, Liu H, Hu Y, et al. Laparoscopic vs Open Distal Gastrectomy for Locally Advanced Gastric Cancer: Five-Year Outcomes From the CLASS-01 Randomized Clinical Trial. JAMA Surg 2022;157:1-9. PMID: 34668963 PMCID: PMC8529527 DOI: 10.1001/jamasurg.2021.5104

2\. Hyung WJ, Yang HK, Park YK, et al. Long-Term Outcomes of Laparoscopic Distal Gastrectomy for Locally Advanced Gastric Cancer: The KLASS-02-RCT Randomized Clinical Trial. J Clin Oncol 2020;38;28:3304-3313. PMID: 32816629 DOI: 10.1200/JCO.20.01210

3\. Harada J, Kinoshita T, Sato R et al. Delta-shaped gastroduodenostomy after totally laparoscopic distal gastrectomy for gastric cancer: comparative study of original and modified methods. Surg Endosc 2021;35;8:4167-4174. PMID: 32780239 DOI: 10.1007/s00464-020-07896-8

4\. Nishizaki D, Ganeko R, Hoshino N, et al. Roux-en-Y versus Billroth-I reconstruction after distal gastrectomy for gastric cancer. Cochrane Gut Group, ed. Cochrane Database Syst Rev 2021;2021;9. PMID: 34523717 PMCID: PMC8441595 DOI: 10.1002/14651858.CD012998.pub2

Laparoscopic distal gastrectomy and D2 lymphadenectomy with modified delta-shaped Billroth 1 reconstruction

Gastrectomie distale laparoscopique et curage ganglionnaire D2 avec reconstruction selon Billroth I modifiée en forme de delta

Impaction of a mechanical lithotripsy basket during endoscopic retrograde cholangiopancreatography (ERCP) is a rare, but serious complication resulting from technical failure. The authors present a video of lithotripsy basket retrieval assisted by means of laser fragmentation. It is the case of an 87-year-old man who underwent an emergency laparoscopic subtotal cholecystectomy, common bile duct (CBD) exploration, and laser lithotripsy. After attempts at endoscopic mechanical lithotripsy, a stone-basket complex became impacted within the CBD. In the absence of endoscopic salvage techniques, a laparoscopic common bile duct exploration (LCBDE) is a valid and safe option where surgical expertise permits.

Bibliography:

1\. Thomas M, Howell DA, Carr-Locke D, Mel Wilcox C, Chak A, Raijman I, et al. Mechanical lithotripsy of pancreatic and biliary stones: complications and available treatment options collected from expert centers. Am J Gastroenterol. 2007 Sep;102(9):1896-902. doi: 10.1111/j.1572-0241.2007.01350.x. Epub 2007 Jun 15. PMID: 17573790

2\. Garg PK, Tandon RK, Ahuja V, Makharia GK, Batra Y. Predictors of unsuccessful mechanical lithotripsy and endoscopic clearance of large bile duct stones. Gastrointest Endosc. 2004 May;59(6):601-5. doi: 10.1016/s0016-5107(04)00295-0. PMID: 15114300

3\. Yilmaz S, Ersen O, Ozkececi T, Turel KS, Kokulu S, Kacar E, et al. Results of the open surgery after endoscopic basket impaction during ERCP procedure. World J Gastrointest Surg. 2015 Feb 27;7(2):15-20. doi: 10.4240/wjgs.v7.i2.15. PMID: 25722797; PMCID: PMC4325280

Laparoscopic common bile duct exploration (CBDE) and retrieval of endoscopic lithotripsy basket

Exploration laparoscopique de la voie biliaire principale et récupération d'un panier de lithotripsie endoscopique

Although complete mesocolic excision has oncological importance for colon cancer surgery, there are some difficulties in right hemicolectomy due to variations in the vascular anatomy around the gastrocolic trunk (1-3). Recently, in a study including 38,030 cases of right hemicolectomy from the Japanese national database, the 30-day postoperative mortality rate was 1.2% (4). In the video, we presented the advantages of the cranial-first approach for right-sided colon cancer. This procedure comprised three steps. First, the omentum was dissected and the transverse mesocolon was taken down. The right gastroepiploic vein and the anterior superior pancreaticoduodenal vein were preserved, and the accessory right colic vein (ARCV) was dissected at its root. The pancreatic head and the horizontal duodenal leg were exposed extensively. Secondly, the patient’s head was lowered, and the ileocecum was detached from the caudal side for complete mobilization of the right-sided colon. Finally, the patient was changed to a horizontal position, and lymphadenectomy was performed depending on the tumor’s location. In this case, the ileocolic artery (ICA) and ileocolic vein (ICV) and the right branches of the middle colic artery (MCA) and of the middle colic vein (MCV) were divided. The MCV was mostly divided from the cranial side. However, as the case could be easily treated from the medial side, the MCV was divided consistently using a medial approach. The major advantages of this technique were to safely dissect the ARCV at its origin while clearly visualizing the right gastroepiploic vein and the anterior superior pancreaticoduodenal vein and to recognize the dissection line around the gastrocolic trunk (GCT). Another advantage was to easily perform lymph nodes dissection in the dorsal side of the superior mesenteric vein (SMV), visualizing the right lateral border of the nerves around the superior mesenteric artery (SMA). 



Bibliography: 

1. Hohenberger, W., Weber, K., Matzel, K., Papadopoulos, T. and Merkel, S. (2009) Standardized surgery for colonic cancer: complete mesocolic excision and central ligation--technical notes and outcome. Colorectal Dis, 11: 354-364; discussion 364-355. doi: 10.1111/j.1463-1318.2008.01735.x

2. West, N. P., Hohenberger, W., Weber, K., Perrakis, A., Finan, P. J. and Quirke, P. (2010) Complete mesocolic excision with central vascular ligation produces an oncologically superior specimen compared with standard surgery for carcinoma of the colon. J Clin Oncol, 28: 272-278. doi: 10.1200/JCO.2009.24.1448

3. De Simoni, O., Barina, A., Sommariva, A., Tonello, M., Gruppo, M., Mattara, G., et al. (2021) Complete mesocolic excision versus conventional hemicolectomy in patients with right colon cancer: a systematic review and meta-analysis. Int J Colorectal Dis, 36: 881-892. doi: 10.1007/s00384-020-03797-3

4. Yoshida, T., Miyata, H., Konno, H., Kumamaru, H., Tangoku, A., Furukita, Y., et al. (2018) Risk assessment of morbidities after right hemicolectomy based on the National Clinical Database in Japan. Ann Gastroenterol Surg, 2: 220-230. doi: 10.1002/ags3.12067

Advantages of the cranial-first approach in laparoscopic surgery for right-sided colon cancer

Avantages de l'abord supérieur premier dans la chirurgie laparoscopique du cancer du côlon droit

Nowadays, endoscopic ultrasound-guided radiofrequency ablation has become increasingly accepted for the treatment of different precancerous and neoplastic lesions of the pancreas, particularly in patients who are unfit for surgery. However, thermal ablation has long been suspected to induce pancreatitis or to injure adjacent structures. Published case reports and case series on this topic are of limited size and are often based on a heterogeneous study population, reporting on functional and nonfunctional pancreatic neuroendocrine tumors (pNETs). Nevertheless, the overall results are promising, with high technical success and relatively low complication rates.

Recently, there has been growing interest in investigating endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) for the management of small non-functional pancreatic neuroendocrine tumors (nf pNETs).

A bicentric retrospective study was performed. It included patients with histologically confirmed nonfunctional pNETs who were consecutively treated by means of EUS-RFA at two tertiary referral centers between December 2015 and March 2021. In 27 patients (mean age: 65.0 years, 52% male), EUS-RFA was successfully performed. All patients had sporadic G1 lesions (mean size: 14.0 plus-minus 4.6mm, 7% uncinated process, 22% head, 11% body, 19% body/tail junction, and 41% tail). Overall, 9/27 lesions (33%) were cystic. Mean hospital stay was 3.2 days. Complete treatment response was confirmed in 25/27 patients (93%) on cross-sectional imaging (mean follow-up: 15.7 plus-minus 12.2 months, range: 2-41 months). Two patients had two EUS-RFA sessions until complete necrosis was observed. Periprocedural acute pancreatitis occurred in 4/27 patients (14.8%), three of them were treated by means of endoscopic cystogastrostomy (11.1%). One patient underwent secondary surgery. The histopathology of the resected specimen revealed 3mm of residual tumor tissue.

EUS-RFA seems to be a promising treatment strategy for the management of small nonfunctional pNETs with excellent efficacy. Further evidence focusing on long-term survival, safety profile, and recurrence is required.

Bibliography:

1\. Elia Armellini, Antonio Facciorusso, Stefano Francesco Crinò. Efficacy and Safety of Endoscopic Ultrasound-Guided Radiofrequency Ablation for Pancreatic Neuroendocrine Tumors: A Systematic Review and Metanalysis. Medicina (Kaunas) 2023 Feb 14;59(2):359. doi: 10.3390/medicina59020359. PMID: 36837560 PMCID: PMC9963038 DOI: 10.3390/medicina59020359

2\. Fadi Younis, Dana Ben-Ami Shor, Nir Lubezky, Ravit Geva, Esther Osher, Oren Shibolet, Adam Phillips, Erez Scapa. Endoscopic ultrasound-guided radiofrequency ablation of premalignant pancreatic-cystic neoplasms and neuroendocrine tumors: prospective study. Eur J Gastroenterol Hepatol 2022 Nov 1;34(11):1111-1115. doi: 10.1097/MEG.0000000000002422. Epub 2022 Sep 10. PMID: 36170679 DOI: 10.1097/MEG.0000000000002422

3\. Mihai Rimbaș, Giulia Tripodi, Alberto Larghi. Endoscopic ultrasound-guided radiofrequency ablation for nonfunctional pancreatic neuroendocrine tumors: Put the gun away or keep shooting? Dig Endosc 2022 Sep;34(6):1257. doi: 10.1111/den.14349. Epub 2022 Jun 27. PMID: 35545866 DOI: 10.1111/den.14349

4\. Mihai Rimbaş, Mihaela Horumbă, Gianenrico Rizzatti, Stefano Francesco Crinò, Antonio Gasbarrini, Guido Costamagna, Alberto Larghi. Interventional endoscopic ultrasound for pancreatic neuroendocrine neoplasms. Dig Endosc 2020 Nov;32(7):1031-1041. doi: 10.1111/den.13635. Epub 2020 Mar 20. PMID: 31995848 DOI: 10.1111/den.13635

5\. Tawfik Khoury, Wisam Sbeit, Pietro Fusaroli, Davide Campana, Nicole Brighi, Bertrand Napoleon, Andrea Lisotti. Safety and efficacy of endoscopic ultrasound-guided radiofrequency ablation for pancreatic neuroendocrine neoplasms: Systematic review and meta-analysis. Dig Endosc 2024 Apr;36(4):395-405. doi: 10.1111/den.14681. Epub 2023 Oct 11. PMID: 37702096 DOI: 10.1111/den.14681

6\. Radhika Chavan, Nirav Thosani, Shivangi Kothari. Role of Endoscopic Ultrasound-Guided Radiofrequency Ablation in Pancreatic Lesions: Where Are We Now and What Does the Future Hold? Cancers (Basel) 2024 Oct 30;16(21):3662. doi: 10.3390/cancers16213662. PMID: 39518100 PMCID: PMC11544980 DOI: 10.3390/cancers16213662

Endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) of pancreatic neuroendocrine tumor (pNET)

Ablation par radiofréquence guidée par écho-endoscopie d'une tumeur neuroendocrine du pancréas

Cholécystectomie laparoscopique pour cholécystite chronique avec mucocèle en cas de situs inversus avec dextrocardie

The authors present the case of a 74-year-old male patient with situs inversus totalis (SIT), undergoing laparoscopic cholecystectomy for persistent severe symptomatic gallstone disease. Situs inversus totalis is a rare congenital condition, with incidence estimates ranging from 1 in 5,000 to 1 in 20,000, and effectively results in a mirror image transposition of thoracic and abdominal organs. This gentleman had initially presented with left upper quadrant pain and fever, with CT imaging confirming both situs inversus and inflammation of the gallbladder. His only other past medical history of note was Kartagener’s syndrome, which is often associated with SIT. The procedure was performed with port placement mirroring that of a typical laparoscopic cholecystectomy set-up, with the surgeon, assistant, and scrub nurse standing to the patient’s right, screen on the patient’s left, and port placement again mirroring that of the usual set-up. The procedure was slightly complicated by the acute on chronic presentation of cholecystitis. However, it was successfully performed with careful consideration of mirrored anatomical landmarks and accounting for this in a right-handed surgeon. The case underscores the importance of preoperative planning and the technical modifications required in laparoscopic surgery for patients with situs inversus totalis.

 

Bibliography:

1\. Eitler K, Bibok A, Telkes G. Situs Inversus Totalis: A Clinical Review. Int J Gen Med. 2022 Mar 3;15:2437-2449. doi: 10.2147/IJGM.S295444. PMID: 35264880; PMCID: PMC8901252.

2\. Shah AY, Patel BC, Panchal BA. Laparoscopic cholecystectomy in-patient with situs inversus. *J Minim Access Surg.* (2006) 2:27–28. 10.4103/0972-9941.25674

3\. AlKhlaiwy O, AlMuhsin AM, Zakarneh E, Taha MY. Laparoscopic cholecystectomy in situs inversus totalis: Case report with review of techniques. Int J Surg Case Rep. 2019;59:208-212. doi: 10.1016/j.ijscr.2019.05.050. Epub 2019 May 31. PMID: 31181389; PMCID: PMC6556755.

Laparoscopic cholecystectomy for chronic cholecystitis with mucocele in situs inversus totalis

video lecture

Ablation de tumeurs hépatiques

In this authoritative lecture, Professor Mariano Giménez outlines the management of liver tumors considering their ablation.

Liver tumor ablation

EUS-guided biliary drainage is an option to treat obstructive jaundice when ERCP drainage fails. Such a procedure represents an alternative to surgery and to percutaneous transhepatic biliary drainage. It has also been made possible through the continuous development and improvement of endoscopic ultrasound (EUS) scopes and accessories. The development of linear sectorial array EUS scopes in the early 1990s brought a new approach to the diagnostic and therapeutic dimensions of endoscopic ultrasound capabilities, opening the possibility to perform a puncture over a direct ultrasonographic view. Despite the high success rate and the low morbidity of biliary drainage obtained via ERCP, difficulty may arise with an ingrown stent tumor, tumor gut compression, periampullary diverticula, and anatomic variations. The EUS-guided technique requires puncture and contrast of the left biliary tree. When performed from the gastric wall, access is obtained through liver segment III. Direct common bile duct puncture is achieved from the duodenum. Diathermic dilation of the puncturing tract is performed using a 6 French cystotome and a plastic or metallic stent. The technical success of hepaticogastrostomy nears 98%, and complications are present in 20% of cases. The most common complications include pneumoperitoneum, bilioperitoneum, infection and stent dysfunction. To prevent bile leakage, the authors used a special partially covered stent (70% covered and 30% uncovered). The overall success rate for choledochoduodenostomy is 92%. The described complications include, in decreasing order of frequency, the following: pneumoperitoneum and focal bile peritonitis, present in 14% of cases. Over the last 15 years, the technique has typically been performed in reference centers, by groups experienced with ERCP. This seems to be a general guideline guaranteeing the safer execution of the procedure.

Bibliography:

1\. Giovannini M. EUS-guided hepaticogastrostomy. Endosc Ultrasound. 2019 Nov 28;8(Suppl 1):S35-S39. doi: 10.4103/eus.eus\_47\_19. eCollection 2019 Nov. PMID: 31897377. PMCID: PMC6896433 DOI: 10.4103/eus.eus\_47\_19

2\. Koutlas NJ, Pawa S, Russell G, Ferris T, Ponnatapura J, Pawa R. EUS-guided hepaticogastrostomy versus percutaneous transhepatic biliary drainage after failed ERCP: A propensity score-matched analysis. Endosc Int Open 2024 Jan 19;12(1):E108-E115. doi: 10.1055/a-2220-2740. eCollection 2024 Jan. PMID: 38250165 PMCID: PMC10798845 DOI: 10.1055/a-2220-2740

3\. Ishiwatari H, Ogura T, Hijioka S, Iwashita T, Matsubara S, Ishikawa K, Niiya F, Sato J, Okuda A, Ueno S, Nagashio Y, Maruki Y, Uemura S, Notsu A. EUS-guided hepaticogastrostomy versus EUS-guided hepaticogastrostomy with antegrade stent placement in patients with unresectable malignant distal biliary obstruction: a propensity score-matched case-control study. Gastrointest Endosc 2024 Jul;100(1):66-75. doi: 10.1016/j.gie.2024.02.012. Epub 2024 Feb 19. PMID: 38382887 DOI: 10.1016/j.gie.2024.02.012

4\. Ogura T, Ishiwatari H, Hijioka S, Takeshita K, Sato J, Takenaka M, Fukunaga T, Omoto S, Fujimori N, Ohno A, Hatamaru K, Tamura T, Imai H, Yamada M, Hakoda A, Nishikawa H, Kitano M. Multicenter study comparing EUS-guided hepaticogastrostomy and ERCP for malignant biliary obstruction in patients with accessible papillae. J Hepatobiliary Pancreat Sci 2024 Sep;31(9):680-687. doi: 10.1002/jhbp.12055. Epub 2024 Jul 18.. PMID: 39022838 DOI: 10.1002/jhbp.12055

5\. Takeshita K, Hijioka S, Nagashio Y, Maruki Y, Ohba A, Kawasaki Y, Takasaki T, Yagi S, Agarie D, Hara H, Hagiwara Y, Yamashige D, Okamoto K, Fukuda S, Kuwada M, Chatto M, Kondo S, Morizane C, Ueno H, Saito Y, Okusaka T. Comparison of stent patency between EUS-guided hepaticogastrostomy with bridging and endoscopic transpapillary biliary drainage for hilar obstruction. Endosc Int Open 2024 Jul 10;12(7):E875-E886. doi: 10.1055/a-2333-7898. eCollection 2024 Jul. PMID: 38989254 PMCID: PMC11236478 DOI: 10.1055/a-2333-7898

EUS-guided biliary drainage for obstructive jaundice due to advanced pancreatic cancer in a patient with a previous duodenal stent for duodenal tumoral obstruction: EUS hepaticogastrostomy

Drainage biliaire sous échoendoscopie pour le traitement d'un ictère obstructif dû à un cancer pancréatique de stade avancé chez un patient pris en charge par prothèse biliaire pour obstruction duodénale tumorale : hépaticogastrostomie guidée sous échoendoscopie

In this educational lecture, Professor Ville Salinnen, MD, PhD, Editor-in-chief of BJS open, thoroughly describes how to conduct surgical research and get it published in a respectable journal. This Acta lecture was presented at the Swedish Surgical Week in 2024. Professor Salinnen notes that successful publication starts with a good study plan, completion of the study and then writing the paper. He offers a detailed explanation about how to construct and submit the paper for publication.

How to write a scientific surgical manuscript and be published? 

Introduction: Liver cancer is globally the fifth most common cancer and the fourth most common cause of cancer-related death. Currently, surgical resection is still considered a curative option and is reserved for the early stages of hepatocellular carcinoma (HCC). Laparoscopy shows comparable results to open liver resection regarding long-term oncologic outcomes such as overall survival and disease-free survival, while delivering superior results in terms of morbidity and perioperative outcomes. Using indocyanine green (ICG) fluorescence makes it possible to accurately determine the boundaries of anatomical resections, improving the navigation and precision of surgical techniques.

Methods:

The authors demonstrate a laparoscopic left paramedian sectorectomy (S3-S4 bisegmentectomy) with lymphadenectomy using negative ICG staining in a 73-year-old male patient, with hepatitis C and Child-Pugh class A (score of 6 points) liver cirrhosis.

Results:

The operation lasted 180 minutes and total blood loss was 80mL. The postoperative period was uneventful, and the patient was discharged on postoperative day 6. The histological examination revealed the presence of a G2 HCC at the pT1aN0M0 stage, with tumor-free surgical margins.

Conclusion:

The combination of a minimally invasive approach with ICG negative staining for “small” anatomical liver resection, in a patient with chronic cirrhosis and early-stage HCC has shown good perioperative results and oncologic outcomes.

 

Bibliography:

1\. Manon Allaire, Claire Goumard, Chetana Lim, Aline Le Cleach, Mathilde Wagner, Olivier Scatton. New frontiers in liver resection for hepatocellular carcinoma. JHEP Rep. 2020 Jun 4;2(4):100134. doi: 10.1016/j.jhepr.2020.100134. eCollection 2020 Aug. PMID: 32695968 PMCID: PMC7360891 DOI: 10.1016/j.jhepr.2020.100134

2\. Stefano Di Sandro, Maria Danieli, Fabio Ferla, Andrea Lauterio, Riccardo De Carlis, Laura Benuzzi, Vincenzo Buscemi, Isabella Pezzoli, Luciano De Carlis. The current role of laparoscopic resection for HCC: a systematic review of past ten years. Transl Gastroenterol Hepatol. 2018 Sep 18:3:68. doi: 10.21037/tgh.2018.08.05. eCollection 2018. PMID: 30363804 PMCID: PMC6182043 DOI: 10.21037/tgh.2018.08.05

3\. Junichi Kaneko, Takashi Kokudo, Yoshinori Inagaki, Kiyoshi Hasegawa. Innovative treatment for hepatocellular carcinoma (HCC). Transl Gastroenterol Hepatol. 2018 Oct 22;3:78. doi: 10.21037/tgh.2018.10.04. PMID: 30505965; PMCID: PMC6232072

Laparoscopic liver segment III and IV (S3-S4) bisegmentectomy with lymphadenectomy and indocyanine green (ICG) for hepatocellular carcinoma (HCC) 

Bisegmentectomie laparoscopique des segments III et IV du foie (S3-S4) avec lymphadénectomie et vert d'indocyanine pour carcinome hépatocellulaire (CHC) 

This video presents the reverse technique (RT) in laparoscopic surgery for deep endometriosis, highlighting its benefits over conventional techniques. Deep endometriosis, involving structures such as the rectum, poses significant surgical challenges. The RT begins with a dissection from healthy tissue towards diseased areas, enhancing precision and reducing complications. In this educational video, the authors demonstrate this technique showing the case of a 39-year-old woman with deep endometriosis involving the rectal wall. Surgery led to significant symptoms improvement and helped to reduce operative time and bowel injury. The RT, requiring specialized training, offers a promising approach to the management of complex endometriosis with improved outcomes and recovery.

Bibliography:

1\. Cabrera R, Tessmann Zomer M, Larrain D, Bourdel N, Canis M, Kondo W. Laparoscopic reverse technique for posterior rectovaginal deep endometriosis nodule step by step. J Minim Invasive Gynecol 2020. Mar-Apr;27(3):577-578. doi: 10.1016/j.jmig.2019.07.018. Epub 2019 Jul 25. PMID: 31352071

2\. Bendifallah S, Ballester M, Darai E. Surgical management of deep infiltrating endometriosis with bowel involvement and urinary tract involvement. Presse Med. 2017 Dec;46(12 Pt 1):1212-1217. doi: 10.1016/j.lpm.2017.09.006. Epub 2017 Nov 10. PMID: 29129414

Revolutionizing deep endometriosis surgery: the reverse technique approach

Révolutionner la chirurgie de l'endométriose profonde : approche par technique inversée

Traitement d'un neuroblastome du médiastin postérieur chez l'enfant par voie thoracique bilatérale

This video presents the case of a neuroblastoma of the posterior mediastinum. Neuroblastoma of the posterior mediastinum most often involves the thoracic aorta, intercostal arteries, and it often spreads into the spinal canal. This localization is classically the most frequent location site of neurogenic tumors. The patient underwent a one-step operation to remove a tumor from two hemithorax. This video may be useful to pediatric oncologists and surgeons.

Bibliography:

1\. Badiu Tișa I, Samașca G, Aldea C, Lupan I, Farcau D, Makovicky P. Ganglioneuroblastoma in children. Neurol Sci. 2019 Sep;40(9):1985-1989. doi: 10.1007/s10072-019-03932-1. Epub 2019 May 30. PMID: 31147856.

2\. Dingemann C, Ure B, Dingemann J. Thoracoscopic procedures in pediatric surgery: what is the evidence? Eur J Pediatr Surg. 2014 Feb;24(1):14-9. doi: 10.1055/s-0033-1350060. Epub 2013 Jul 12. PMID: 23852720.

Bilateral thoracoscopic approach in a child with posterior mediastinal neuroblastoma

Excision laparoscopique d'une endométriose rectovaginale et résection intestinale discoïde

Deep endometriosis is a condition in which there is more than a 5mm depth of subperitoneal invasion. The bowel is involved in 5 to 12% of the overall endometriosis cases with sigmoid colon and rectum being the commonest, more than 90% (1). Rectal shaving, discoid resection, and segmental resection remain the standard technique for managing bowel endometriosis. Discoid resection is performed for lesions less than 3cm with less than a 50% involvement of bowel circumference. Rectal shaving performed in such cases is associated with medium-term recurrence rates of dysmenorrhea and dyspareunia (2). For a small nodule, full-thickness disc resection of the rectal wall can be performed safely. The rectal wall remains well vascularized and innervated after closure with sutures (3). Barbed sutures can be used safely to close the rectal wall in 2 layers without significantly increasing the rates of postoperative leak, abscess, and fistula formation (4).

Bibliography:

1. Meuleman C, Tomassetti C, D’Hoore A, et al. Surgical treatment of deeply infiltrating endometriosis with colorectal involvement. Hum Reprod Update. 2011;17(3):311–326. doi: 10.1093/humupd/dmq057
2. Afors K, Centini G, Fernandes R, et al. Segmental and discoid resection are preferential to bowel shaving for medium-term symptomatic relief in patients with bowel endometriosis. J Minim Invasive Gynecol. 2016;23:7. doi: 10.1016/j.jmig.2016.08.813
3. Roman H, Opris I, Resch B, Tuech JJ, Sabourin JC, Marpeau L. Histopathologic features of endometriotic rectal nodules and the implications for management by rectal nodule excision. Fertil Steril. 2009;92:1250-1252
4. Stuparich MA, Lee TTM. Discoid Resection of Rectosigmoid Endometriotic Nodules. J Minim Invasive Gynecol. 2018 Mar-Apr;25(3):388. doi: 10.1016/j.jmig.2017.09.024. Epub 2017 Oct 6. PMID: 28993241

Laparoscopic excision of rectovaginal endometriosis and discoid bowel resection

Principes techniques de la dérivation urinaire robotique après cystectomie

In this authoritative lecture, Dr. Filippo Annino, MD, outlines the technical principles of robotic urinary diversion after cystectomy. Step-by-step techniques for robotic urinary diversion after radical cystectomy are presented.&#x20;
The first focus is on the ERAS protocol for fast-track surgery, which facilitates a faster recovery for patients.
The author also details the operating room set-up, the port placement for pelvic surgery, and the techniques to improve bowel mobilization during the reconstruction phase.
In the reconstruction phase, the video demonstrates how to identify the precise point to cut the ileum, using specific landmarks to aid orientation and minimize the risk of errors. The proper orientation of the stapler (robotic or laparoscopic) is also explained.
Regarding urinary diversions, every step is meticulously detailed for both the ileal conduit and the neobladder, adhering to the Bordeaux technique.
This stepwise approach is systematically applied to all bladder cancer patients undergoing robotic cystectomy with urinary diversion. Performing this procedure with precision simplifies its execution, reducing the risk of intraoperative errors and decreasing surgical duration.

Technical principles of robotic urinary diversion after cystectomy

monthly focus

The laparoscopic Whipple procedure for the treatment of a pancreatic head tumor appears to be a valid, safe, and feasible alternative. There has been increased awareness of structured training and patient selection for laparoscopic management. This case of a patient with a standard BMI and a tumor which allows for the adequate visualization of anatomical structures is valuable to recognize the resective steps, and to select a minimally invasive reconstructive option. As familiarity with the robotic platform increases, studies have shown an expansion of indications. 



Bibliography:

1. Comparison of safety and effectiveness between laparoscopic and open pancreatoduodenectomy: A systematic review and meta-analysis. Yin T, Qin T, Wei K, Shen M, Zhang Z, Wen J, Pan S, Guo X, Zhu F, Wang M, Zhang H, Hilal MA, Qin R. Int J Surg. 2022 Sep;105:106799. doi: 10.1016/j.ijsu.2022.106799. Epub 2022 Aug 19

2. Minimally invasive pancreatoduodenectomy. Kendrick ML, van Hilst J, Boggi U, de Rooij T, Walsh RM, Zeh HJ, Hughes SJ, Nakamura Y, Vollmer CM, Kooby DA, Asbun HJ; Minimally Invasive Pancreatic Resection Organizing Committee. HPB (Oxford). 2017 Mar;19(3):215-224. doi: 10.1016/j.hpb.2017.01.023

3. Laparoscopic pancreatoduodenectomy with open or laparoscopic reconstruction during the learning curve: a multicenter propensity score matched study. van Hilst J, de Rooij T, van den Boezem PB, Bosscha K, Busch OR, van Duijvendijk P, Festen S, Gerhards MF, de Hingh IH, Karsten TM, Kazemier G, Lips DJ, Luyer MD, Nieuwenhuijs VB, Patijn GA, Stommel MW, Zonderhuis BM, Daams F, Besselink MG; Dutch Pancreatic Cancer Group. HPB (Oxford). 2019 Jul;21(7):857-864. doi: 10.1016/j.hpb.2018.11.003. Epub 2018 Dec 5

Laparoscopic Whipple procedure for the management of a pancreatic head tumor

Intervention de Whipple par voie d'abord laparoscopique pour prise en charge d'une tumeur de la tête du pancréas

Pancréaticoduodénectomie laparoscopique avec préservation du pylore chez un patient présentant une anomalie du tronc hépatomésentérique pour adénocarcinome ampullaire

In 0.4 to 4.5% of individuals, the common hepatic artery arises from the superior mesenteric artery instead of the celiac trunk. It is a type IX anomaly, commonly referred to as hepatomesenteric trunk, according to the Michels’s comprehensive classification of hepatic arterial anatomy. The surgical strategy should take into account the variations in the vascular pattern of the celiac trunk and its branches. This hepatomesenteric trunk originates from the anterior aspect of the aorta, coursing inferiorly and to the right behind the portal vein to reach the superior border of the superior part of the duodenum, where it divides into the common hepatic artery and into the superior mesenteric artery. In the lesser omentum, after a small course, the common hepatic artery gives off the gastroduodenal artery that continues as the proper hepatic artery. This video aims to highlight a dissection in a patient with a hepatomesenteric trunk anomaly undergoing a laparoscopic pylorus-preserving pancreaticoduodenectomy for an ampullary adenocarcinoma. 

This is the case of 73-year-old man who was evaluated for jaundice. Pancreatic protocol CT-scan showed a periampullary lesion with a dilated biliary tract. Side-viewing endoscopy and endoscopic ultrasound biopsy confirmed the diagnosis, revealing an ampullary adenocarcinoma. On imaging, it was found to be resectable. The tumor board team decided to go for an upfront surgery. Preoperative biliary plastic stenting was performed for cholangitis. A laparoscopic pylorus-preserving pancreaticoduodenectomy with a feeding jejunostomy was performed. The procedure was uneventful, and the patient was discharged on postoperative day 6. Pathological findings revealed please complete 



Bibliography:

1. Kahraman G, Marur T, Tanyeli E, Yildirim M. Hepatomesenteric trunk. Surg Radiol Anat. 2001;23(6):433-5. doi: 10.1007/s00276-001-0433-z. PMID: 11963627.

2. Ramanadham S, Toomay SM, Yopp AC, Balch GC, Sharma R, Schwarz RE, Mansour JC. Rare hepatic arterial anatomic variants in patients requiring pancreatoduodenectomy and review of the literature. Case Rep Surg. 2012;2012:953195. doi: 10.1155/2012/953195. Epub 2012 Jul 30. PMID: 22900221; PMCID: PMC3413978.

3. Noussios G, Dimitriou I, Chatzis I, Katsourakis A. The Main Anatomic Variations of the Hepatic Artery and Their Importance in Surgical Practice: Review of the Literature. J Clin Med Res. 2017 Apr;9(4):248-252. doi: 10.14740/jocmr2902w. Epub 2017 Feb 21. PMID: 28270883; PMCID: PMC5330766.

Laparoscopic pylorus-preserving pancreaticoduodenectomy in a patient with hepatomesenteric trunk anomaly for ampullary adenocarcinoma

The most common etiology of pancreatic pseudocyst is acute pancreatitis and exacerbations of chronic pancreatitis, presenting a spontaneous resolution in approximately 50% of cases. Treatment is indicated in persistent symptomatic or complicated pseudocysts. Endoscopic and surgical approaches can be performed (1).

Two treatment options are available: endoscopic treatment, in cysts adjacent to the gastric or duodenal wall, or surgical treatment, which is more invasive, but with a low rate of recurrence and complications, even surpassing endoscopic management.

The video shows the case of a previously healthy 54-year-old male patient with a surgical history of cholecystectomy 14 years earlier. In 2022, he presented two episodes of pancreatitis treated in another institution, which required an endoscopic retrograde cholangiopancreatography (ERCP) to manage the choledocholithiasis in the last episode. The patient complained of abdominal pain. In a follow-up exam and MRI, a 7cm pancreatic pseudocyst was found. Significant oral intolerance was developed by the patient and a new CT-scan was performed. An increase in the cyst’s volume was observed.

The multidisciplinary committee decided to perform an endoscopic ultrasound-guided cystogastrostomy with stent placement. The procedure was complicated with upper gastrointestinal bleeding, which accounts for stent removal. Multiple subsequent endoscopies were performed due to a persistent collection with pigtail placement and necrosectomies.

The patient had an initial good response. However, two months later, he presented with severe abdominal pain associated with vomiting. A control CT-scan showed a cystic recurrence with total disruption of Wirsung’s duct. Due to the failure of the endoscopic treatment, a videolaparoscopic cystogastrostomy was subsequently performed. The patient was discharged on postoperative day 5, and postoperative outcomes were uneventful.

 

<u>Bibliography:</u>

1\. Clark CJ, Ray JW, Pawa S, et al. A location-based anatomic classification system for acute pancreatic fluid collections: Roadmap for optimal intervention in the step-up era. Surg Open Sci. 2024 Jan 15;18:1-5. doi: 10.1016/j.sopen.2024.01.008. PMID: 38312303; PMCID: PMC10831243.

2\. José Luis Martínez-Ordaz, Carlos Toledo-Toral, Norma Franco-Guerrero, Mauro Tun-Abraham, Luis Manuel Souza-Gallardo. Tratamiento quirúrgico del seudoquiste de páncreas \[Surgical treatment of pancreatic pseudocysts]. Cir Cir. 2016 Jul-Aug;84(4):288-92. doi: 10.1016/j.circir.2015.09.001. Epub 2015 Dec 19. PMID: 26707249.

3\. B A Crisanto-Campos, E Arce-Liévano, L E Cárdenas-Lailson, L S Romero-Loera, M E Rojano-Rodríguez, M A Gallardo-Ramírez, J Cabral-Oliver, M Moreno-Portillo. Laparoscopic management of pancreatic pseudocysts: experience at a general hospital in Mexico City. Rev Gastroenterol Mex. 2015 Jul-Sep;80(3):198-204. doi: 10.1016/j.rgmx.2015.05.003. Epub 2015 Aug 3. PMID: 26249139

Laparoscopic cystogastrostomy for pancreatic pseudocyst

Cystogastrostomie laparoscopique pour pseudokyste pancréatique

Video-assisted retroperitoneal debridement (VARD) is a minimally invasive surgical procedure for the management of severe pancreatitis, especially in cases of necrotizing pancreatitis characterized by significant tissue necrosis and infection (1). This technique entails the access to the retroperitoneal space via small incisions in the lumbar region through percutaneous drain guidance and using video-assisted methodologies for the removal of necrotic tissue and for the drainage of fluid collections. VARD presents several potential advantages as compared to conventional open surgical methods, including reduced invasiveness and recovery times. In addition, when associated with the anterior transabdominal approach, it prevents abdominal cavity contamination, hence reducing the risk of open abdomen and enterocutaneous fistulas (2). However, managing patients is challenging. In this video, the authors present the case of a 65-year-old male patient with severe acute pancreatitis complicated by an infected necrosis. A step-up approach was performed using VARD for control after percutaneous drainage failure.&#x20;

Bibliography:

1\. Wei W, Tang Y, Peng Z, Xie J, Deng Z, Yuan T, Tang C, Pi R, Wang S, Zhao S, Wang L, Li C, Wang Y, Zhang P, Wu Z, Wan Y, Ma Y, Tang W, Liang X, Liu K, Wang W, Liang X, Zeng D, Li S, Liu H. Minimal-access video-assisted retroperitoneal and/or transperitoneal debridement (VARTD) in the management of infected walled-off pancreatic necrosis with deep extension: initial experience from a prospective single-arm study. Eur J Med Res. 2023 Feb 9;28(1):72. doi: 10.1186/s40001-023-01030-9. PMID: 36755332; PMCID: PMC9909852.

2\. Horvath K, Freeny P, Escallon J, Heagerty P, Comstock B, Glickerman DJ, Bulger E, Sinanan M, Langdale L, Kolokythas O, Andrews RT. Safety and efficacy of video-assisted retroperitoneal debridement for infected pancreatic collections: a multicenter, prospective, single-arm phase 2 study. Arch Surg. 2010 Sep;145(9):817-25. doi: 10.1001/archsurg.2010.178. PMID: 20855750.

Video-assisted retroperitoneal debridement (VARD) for severe pancreatitis

Débridement rétropéritonéal vidéo-assisté pour pancréatite sévère

Colorectal cancer is the third most common neoplasm worldwide (1). The liver is its main site of metastasis, and 20 to 30% of patients will develop colorectal liver metastasis (2).

The treatment for colorectal cancer with liver metastasis has evolved into a multidisciplinary approach, such as chemotherapy, local ablation, portal vein embolization. However, survival increases dramatically with surgery, and it is therefore considered the gold standard (1, 2).

Radiofrequency ablation or microwave ablation (3) could well be an alternative to deep lesions or lesions which are difficult to access.

Associated liver tourniquet and portal vein ligation for staged hepatectomy (ALTPS) is indicated in cases of unresectable tumors or extensive bilobar disease, as it provides excellent results (4).

The video shows the case of a 38-year-old female patient who was diagnosed with colorectal liver metastases. The primary cancer was resected, and subsequent control chemotherapy and reduction of liver lesions were performed.

Initially, it was decided to perform multiple hepatectomies with parenchyma preservation. Due to the intraoperative discovery of more lesions than expected, it was decided to perform a laparoscopic ALTPS.

 

Bibliography:

1\. Kristel Mils, Laura Lladó, Josefina López-Domínguez, Oriana Barrios, David Leiva, Cristina Santos, Teresa Serrano, Emilio Ramos. Have we improved postoperative and long-term outcomes of liver surgery for colorectal cancer metastasis? Analysis of 1736 hepatectomies performed over 3 decades in a single center. Cir Esp (Engl Ed). 2024 Feb 10:S2173-5077(24)00044-9. doi: 10.1016/j.cireng.2023.11.025. PMID: 38346559.

2\. Pratik Chandra, Greg D Sacks. Contemporary surgical management of colorectal liver metastases. Cancers (Basel). 2024 Feb 26;16(5):941. doi: 10.3390/cancers16050941. PMID: 38473303; PMCID: PMC10930601. PMID: 38473303 PMCID: PMC10930601.

3\. Okan Akhan, Ahmet Gürkan Erdemir, Sevilay Karahan, Emre Ünal, Türkmen Turan Çiftçi, Devrim Akıncı, Şuayib Yalçın. Long-term results of liver thermal ablation in patients with hepatocellular carcinoma and colorectal cancer liver metastasis regarding spatial features and tumor-specific variables. Diagn Interv Radiol 2024 May 13;30(3):183-192. doi: 10.4274/dir.2023.221986. Epub 2023 Mar 20. PMID: 36994643; PMCID: PMC11095064.

4\. Mohammad Golriz, Ali Ramouz, Ahmed Hammad , Ehsan Aminizadeh, Nastaran Sabetkish, Elias Khajeh, Omid Ghamarnejad, Carlos Carvalho, Hugo Rio-Tinto, De-Hua Chang, Ana Alagoa Joao, Gil Goncalves, Arianeb Mehrabi. Promising results of associating liver partition and portal vein ligation for staged hepatectomy for perihilar cholangiocarcinoma in a systematic review and single-arm meta-analysis. Cancers (Basel). 2024 Feb 13;16(4):771. doi: 10.3390/cancers16040771. PMID: 38398162. PMCID: PMC10887221.

Laparoscopic associating liver tourniquet and portal vein ligation for staged hepatectomy (ALTPS) technique for colorectal liver metastases

Technique laparoscopique associant garrot hépatique et ligature de la veine porte pour une hépatectomie par étapes pour métastases hépatiques colorectales

Splénopancréatectomie distale laparoscopique pour néoplasme kystique mucineux : technique dans le sens horaire modifiée 

The authors present the case of a 33-year-old female patient. The patient has a previous medical history of hypothyroidism, insulin resistance, and acute pancreatitis. She presented with upper abdominal pain and did not report any other associated symptoms. A CT-scan, MRI, and EUS were performed, establishing the diagnosis of mucinous cystic neoplasm, for which the surgical team decided to perform a distal pancreatectomy using the clockwise modified technique. The patient presented a grade B pancreatic fistula and was discharged on postoperative day 3. The objective of the authors was to demonstrate the advantage of the laparoscopic approach in pancreatic laparoscopic surgery. 

Surgical distal pancreatic resection has the best chance to cure a disease of the pancreatic body and tail, including malignancy, precancerous lesions, and inflammatory involvement (1, 2). Laparoscopic distal pancreatic resection requires excellent surgical skills, training experience with proctors, and case-load concentration in high-volume hospitals with the best resources (1). 

In cases of a premalignant and symptomatic benign condition, the spleen must be preserved either using Kimura’s splenic vessel preservation technique or Warshaw’s splenic vessel resection technique (2). 

Laparoscopic distal pancreatectomy is a safe and feasible treatment for left pancreatic malignancies, with the same surgical efficacy as open distal pancreatectomy. Laparoscopic distal pancreatectomy has also the advantages of minimally invasive surgery, such as minimal trauma and enhanced recovery after surgery (3). 

A laparoscopic distal pancreatectomy performed using the clockwise technique provides satisfactory outcomes (4). However, in this approach, a modified clockwise technique was used. 



Take-home messages:

Patients with a pancreatic cyst tumor can be treated using a laparoscopic modified clockwise technique even with a previous medical history of acute pancreatitis. This surgery can be performed as it offers safe, optimal results, as well as excellent postoperative outcomes. 



Bibliography:

1. Bencini L, Minuzzo A. Distal pancreatectomy with or without radical approach, vascular resections and splenectomy: Easier does not always mean easy. World J Gastrointest Surg. 2023;15(6):1020-1032. doi:10.4240/wjgs.v15.i6.1020

2. Coco D, Leanza S, Schillaci R, Reina GA. Laparoscopic distal pancreatectomy for benign and malignant disease: a review of techniques and results. Prz Gastroenterol. 2022;17(2):103-109. doi:10.5114/pg.2021.109625

3. Hao T, Shiming J, Yong C. Analysis of safety and efficacy of laparoscopic distal pancreatectomy in the treatment of left pancreatic malignant tumors. J Int Med Res. 2021;49(12). doi:10.1177/03000605211063098

4. Gamo GDO, Reichardt GS, Guetter CR, et al. Esofagogástrica e esplenectomia influencia a variação. 2022;34(2):1-5.



Laparoscopic distal splenopancreatectomy for mucinous cystic neoplasm: modified clockwise technique

Splénopancréatectomie gauche laparoscopique pour le traitement d'une tumeur kystique

This video presents the management of a pancreatic tumor with a left splenopancreatectomy. The aim of this video is to present the ‘clockwise’ technique in a laparoscopic distal pancreatectomy setting. 



Bibliography:

Asbun, H. J., Van Hilst, J., Tsamalaidze, L., Kawaguchi, Y., Sanford, D., Pereira, L., Besselink, M. G., & Stauffer, J. A. (2020). Technique and audited outcomes of laparoscopic distal pancreatectomy combining the clockwise approach, progressive stepwise compression technique, and staple line reinforcement. Surgical Endoscopy, 34(1), 231‑239. https://doi.org/10.1007/s00464-019-06757-3



Laparoscopic left splenopancreatectomy for a cystic tumor

Recent studies highlight the effectiveness of laparoscopic cholecystectomy (LC) and laparoscopic common bile duct exploration (LCBDE) in managing cholecystocholedocholithiasis (1). Standard treatments involve preoperative endoscopic procedures. However, advances in laparoscopy have reintroduced one-stage approaches, particularly LCBDE alongside LC (2). Transcystic (TC) and transductal (TD) routes influence outcomes whereas the literature showed that the TC extraction is deemed safer, with comparable stone clearance rates (3). 

Laparoscopic transcystic CBD techniques (LTCBDE) have been developed to treat CBD stones in one session, minimizing complications with an applicability reaching over 85% of cases, and success rates of 85 to 95%, proving their cost-effectiveness as compared to postoperative endoscopic procedures (3, 4). Ongoing technological advances, including robot-assisted surgery and advanced imaging methods, such as laparoscopic CT cholangioscopy, enhance this approach to CBD treatment, becoming the primary strategy for most patients.

Bibliography:

1. Durán M, Silvestre J, Hernández J, Briceño J, Martínez-Isla A, Martínez-Cecilia D. Learning curve for performing laparoscopic common bile duct exploration in biliary surgery 2.0 era. J Hepatobiliary Pancreat Sci. 2023;30(3):374-382. doi:10.1002/jhbp.1228. Link: https://pubmed.ncbi.nlm.nih.gov/35947065/

2. Zhou Y, Wu XD, Zha WZ, et al. Three modalities on common bile duct exploration. Drei Modalitäten für das Management der Choledocholithiasis. Z Gastroenterol. 2017;55(9):856-860. doi:10.1055/s-0043-112655. Link: https://pubmed.ncbi.nlm.nih.gov/28763814/

3. Reinders JS, Gouma DJ, Ubbink DT, van Ramshorst B, Boerma D. Transcystic or transductal stone extraction during single-stage treatment of choledochocystolithiasis: a systematic review. World J Surg. 2014;38(9):2403-2411. doi:10.1007/s00268-014-2537-8. Link: https://pubmed.ncbi.nlm.nih.gov/24705779/

Transcystic laparoscopic bile duct cholangioscopy: simulation

Cholangioscopie laparoscopique transcystique des voies biliaires : simulation

Focus on hepatobiliary and pancreatic (HPB) surgery

In this educational video, the authors demonstrate a laparoscopic Boari flap and psoas hitch for the treatment of a left middle ureter injury in a patient undergoing Hartman sigmoidectomy and colostomy for the treatment of a complicated diverticulitis. The combination of the two techniques, Boari flap and psoas hitch, was first described by Kelâmi et al. (3). This technique can bridge up to 18cm of missing ureter with tension-free anastomosis (2). Some authors have reported that the length/width of the bladder flap should be no more than 3:1, and that the base of the flap should be no less than 4cm (1). Laparoscopy offers similar results to the open technique with a shorter hospital stay (4). Closing the colostomy with a gauze pad and nylon suture leaves the abdominal wall with more space for placing the trocars. Using a Foley catheter with the tip cut off facilitates the passage of the double-J catheter.

Bibliography:

1\. Guangpu Ding, Sida Cheng, Xinfei Li, Dong Fang, Kunlin Yang, Qi Tang, Peng Zhang, Han Hao, Xuesong Li, Liqun Zhou. Experience managing distal ureteral strictures with Boari flap-psoas hitch and comparison of open and laparoscopic procedures. Transl Androl Urol 2021;10(1):56-65 | [http://dx.doi.org/10.21037/tau-20-789.](http://dx.doi.org/10.21037/tau-20-789.) PMID: 33532296

2\. Ankur Bansal, Rahul Janak Sinha, Ankur Jhanwar, Gaurav Prakash, Bimalesh Purkait, Vishwajeet Singh. Laparoscopic ureteral reimplantation with Boari flap for the management of long- segment ureteral defect: A case series with review of the literature. Turk J Urol 2017; 43(3): 313-8. DOI: 10.5152/tud.2017.44520. PMID: 28861304

3\. A. Kelâmi, U. Fiedler, V. Schmidt, A. Rost, M. Richter-Reichhelm, H. H. Hildebrand, and F. Weichler-Wolfgramm. Replacement of the Ureter Using the Urinary Bladder. Urol Res. 1973 Dec;1(4):161-5. DOI: 10.1007/BF00256617. PMID: 4789024

4\. Fugita OE, Dinlenc C, Kavoussi L. The laparoscopic Boari flap. J Urol. 2001 Jul;166(1):51-3. PMID: 11435821.

Laparoscopic Boari flap and psoas hitch for the management of a left mid-ureter injury

Confection d'un lambeau de Boari sur vessie psoïque par voie d'abord laparoscopique pour prise en charge d'une lésion de l'uretère moyen

The authors demonstrate a right nephroureterectomy with bladder cuff excision and retroperitoneal lymph node dissection (LND) performed in a strictly laparoscopic fashion. The European Association of Urology (EAU) guidelines recommend template-based lymph node dissection in all patients who plan to undergo radical nephroureterectomy, due to the inaccuracy of preoperative tumor staging (1). The right-side template is renal hilar, paracaval, retrocaval, and intra-aortocaval lymph nodes (2). The frequency of regional lymph node metastasis is as high as 20 to 30%. Lymphadenectomy does not increase overall and serious postoperative complication rates (3). In patients undergoing a laparoscopic nephroureterectomy, open excision of the bladder cuff is associated with a higher risk of intravesical recurrence (4).

Bibliography:

1\. Rouprêt M, Seisen T, Birtle AJ, Capoun O, Compérat EM, Dominguez-Escrig JL, Gürses Andersson I, Liedberg F, Mariappan P, Hugh Mostafid A, Pradere B, van Rhijn BWG, Shariat SF, Rai BP, Soria F, Soukup V, Wood RG, Xylinas EN, Masson-Lecomte A, Gontero P. European Association of Urology Guidelines on Upper Urinary Tract Urothelial Carcinoma: 2023 Update. Eur Urol. 2023 Jul;84(1):49-64. doi: 10.1016/j.eururo.2023.03.013. Epub 2023 Mar 24. PMID: 36967359.

2\. Kondo T, Nakazawa H, Ito F, Hashimoto Y, Toma H, Tanabe K. Primary site and incidence of lymph node metastases in urothelial carcinoma of upper urinary tract. Urology. 2007 Feb;69(2):265-9. doi: 10.1016/j.urology.2006.10.014. PMID: 17320661.

3\. Kanno T, Kobori G, Ito K, Nakagawa H, Takahashi T, Takaoka N, Somiya S, Nagahama K, Ito M, Megumi Y, Higashi Y, Moroi S, Akao T, Yamada H. Complications and their management following retroperitoneal lymph node dissection in conjunction with retroperitoneal laparoscopic radical nephroureterectomy. Int J Urol. 2022 May;29(5):455-461. doi: 10.1111/iju.14814. Epub 2022 Feb 10. PMID: 35144321.

4\. Huang EY, Tai MC, Chung HJ, Chang YH, Huang WJ. Effects of different combinations of radical nephroureterectomy and bladder cuff excision procedures for upper tract urothelial carcinoma on bladder recurrence. Int Braz J Urol. 2023 Jul-Aug;49(4):469-478. doi: 10.1590/S1677-5538.IBJU.2023.0031. PMID: 37267612; PMCID: PMC10482446.

Laparoscopic right nephroureterectomy with bladder cuff excision and lymph node dissection

Néphro-urétérectomie droite laparoscopique avec excision du collet vésical et dissection des ganglions lymphatiques

Prostatectomie radicale robotisée après prostatectomie simple selon la technique de Millin 

In this educational video, the authors demonstrate a robotic radical prostatectomy using the da Vinci X™ surgical robotic platform in a patient who had had a simple prostatectomy surgery using the conventional Millin technique 7 years earlier. The case is interesting due to the large amount of fibrosis, scars, and local adhesions, distinct from other cases such as post-TURP, radiotherapy, HIFU or even cases of patients after laparoscopic herniorrhaphy surgery. Of note, in our case, the patient has a large abdominal circumference. Despite a greater technical difficulty, the robotic route proved to be of great value. The patient presented excellent postoperative outcomes.

Bibliography:

1\. Creta M, Manfredi C, Arcaniolo D, Spirito L, A Kaplan S, H Woo H, De Nunzio C, Gilling P, Bach T, De Sio M, Imbimbo C, Mirone V, Longo N, Fusco F. Functional and oncological outcomes after radical prostatectomy in patients with history of surgery for lower urinary tract symptoms related to benign prostatic enlargement: A systematic review with meta-analysis. Prostate Cancer Prostatic Dis. 2024 Sep;27(3):367-384. doi: 10.1038/s41391-023-00678-y. Epub 2023 May 27. PMID: 37244971

2\. Gacci M, Sebastianelli A, Salvi M, De Nunzio C, Tubaro A, Gravas S, Moncada I, Serni S, Maggi M, Vignozzi L. The Impact of Central Obesity on Storage Luts and Urinary Incontinence After Prostatic Surgery. Curr Urol Rep. 2016 Sep;17(9):61. doi: 10.1007/s11934-016-0620-4. PMID: 27432378

3\. Su YK, F Katz B, S Sehgal S, S Yu SJ, Su YC, Lightfoot A, Lee Z, Llukani E, Monahan K, I Lee K. Does previous transurethral prostate surgery affect oncologic and continence outcomes after RARP? J Robot Surg. 2015 Dec;9(4):291-7. doi: 10.1007/s11701-015-0529-9. Epub 2015 Aug 8. PMID: 26530840

4\. Tugcu V, Atar A, Sahin S, Kargi T, Gokhan Seker K, Ilker Comez Y, IhsanTasci A. Robot-Assisted Radical Prostatectomy After Previous Prostate Surgery. JSLS. 2015 Sep-Dec;19(4):e2015.00080. doi: 10.4293/JSLS.2015.00080. PMID: 26648678 PMCID: PMC4653581

Robotic radical prostatectomy after simple prostatectomy with Millin technique 

In this authoritative lecture, Professor Rafael Coelho, MD, PhD outlines robot-assisted radical cystectomy (RARC).

Robotic assisted radical cystectomy (RARC)

Cystectomie radicale assistée par robot

In this authoritative lecture, Dr. Simone Crivellaro, MD, MHA outlines the role of single port robotic surgery in urology.&#x20;

Role of single port robotic surgery in urology 

Rôle de la chirurgie robotique à trocart unique en urologie

Over the years, many therapies have been launched for prostate cancer. Brachytherapy has had great prominence in the recent past. In this video, the authors demonstrate rescue surgery after more than 15 years after the implantation of more than 80 implants in the prostate parenchyma and the recurrent changes of this radiation. Recent studies demonstrate a higher recurrence rate after this procedure when compared to other techniques. In addition to biochemical relapse, the patient presented symptoms and signs of lower urinary tract symptoms (LUTS), with a worsening in quality of life. 



Bibliography:

1. A Systematic Review and Meta-analysis of Local Salvage Therapies After Radiotherapy for Prostate Cancer (MASTER). Review Eur Urol. 2021 Sep;80(3):280-292. doi: 10.1016/j.eururo.2020.11.010. Epub 2020 Dec 11

2. Effect of Brachytherapy With External Beam Radiation Therapy Versus Brachytherapy Alone for Intermediate-Risk Prostate Cancer: NRG Oncology RTOG 0232 Randomized Clinical Trial. Randomized Controlled Trial J Clin Oncol. 2023 Aug 20;41(24):4035-4044. doi: 10.1200/JCO.22.01856. Epub 2023 Jun 14

3. Salvage Radical Prostatectomy for Recurrent Prostate Cancer: A Systematic Review (French ccAFU). Review Cancers (Basel). 2023 Nov 20;15(22):5485. doi: 10.3390/cancers15225485

4. Clinical Outcomes of Robotic Surgery Compared to Conventional Surgical Approaches (Laparoscopic or Open): A Systematic Overview of Reviews. Ann Surg. 2021 Mar 1;273(3):467-473. doi: 10.1097/SLA.0000000000003915

Robotic radical prostatectomy in post-brachytherapy using the Versius surgical robotic platform

Prostatectomie radicale robotisée en post-brachythérapie à l'aide de la plateforme robotique chirurgicale Versius

Focus on laparoscopic and robotic urologic surgery

Focus sur la chirurgie urologique laparoscopique et robotique

This educational video presents the case of a laparoscopic subtotal colectomy for severe acute colitis with a bottom-up approach to detach the right colon which requires the placement of a suprapubic optical port as in the laparoscopic ileocecal resection technique.



Bibliography:

1. Chebbi F, Ayadi MS, Rhaiem R, Daghfous A, Makni A, Rebaϊ W, Ksantini R, Ftirich F, Jouini M, Kacem M, Ben Safta Z. Laparoscopic ileo-cecal resection: the total retro-mesenteric approach. Surg Endosc. 2015 Jan;29(1):245-51. doi: 10.1007/s00464-014-3666-8. Epub 2014 Jul 10. PMID: 25007973.

2. Mege D, Stellingwerf ME, Germain A, Colombo F, Pellino G, Di Candido F, Maggiori L, Foschi D, Buskens CJ, Adegbola S, Spinelli A, Warusavitarne J, Bemelman WA, Sampietro G, D'Hoore A, Panis Y. Management of Rectal Stump During Laparoscopic Subtotal Colectomy for Inflammatory Bowel Disease: A Comparative Cohort Study from Six Referral Centres. J Crohns Colitis. 2020 Sep 16;14(9):1214-1221. doi: 10.1093/ecco-jcc/jjaa046. PMID: 32191295.

3. Antonino Spinelli, Stefanos Bonovas, Johan Burisch, Torsten Kucharzik, Michel Adamina, Vito Annese, Oliver Bachmann, Dominik Bettenworth, Maria Chaparro, Wladyslawa Czuber-Dochan, Piotr Eder, Pierre Ellul, Catarina Fidalgo, Gionata Fiorino, Paolo Gionchetti, Javier P Gisbert, Hannah Gordon, Charlotte Hedin, Stefan Holubar, Marietta Iacucci, Konstantinos Karmiris, Konstantinos Katsanos, Uri Kopylov, Peter L Lakatos, Theodore Lytras, Ivan Lyutakov, Nurulamin Noor, Gianluca Pellino, Daniele Piovani, Edoardo Savarino, Francesco Selvaggi, Bram Verstockt, Glen Doherty, Tim Raine, Yves Panis, ECCO Guidelines on Therapeutics in Ulcerative Colitis: Surgical Treatment, Journal of Crohn's and Colitis, Volume 16, Issue 2, February 2022, Pages 179–189



Laparoscopic subtotal colectomy for severe acute colitis 

Colectomie subtotale laparoscopique pour colite aiguë grave

Colectomie gauche laparoscopique à trois trocarts pour une tumeur de l'angle colique gauche

This is the case of a 36-year-old woman with no relevant personal or family history. She presented with anemia and changes in bowel habits over a 3-month period. CT-scan revealed a marked concentric thickening of the colonic wall at the splenic flexure with an inflammation of the surrounding adipose tissue. Videocolonoscopy described a neoproliferative nipple-like ulcerated friable lesion located 30cm away from the anal margin. Biopsy was performed and the lesion was marked with Indian ink. 

Three 10mm trocars were placed in the epigastrium, right hypochondrium, and right iliac fossa, respectively. Medial and lateral approaches were used. Through an anterior trans-omental approach, the greater omentum was separated from the transverse colon. The dissection of the omentum was continued to the left and mobilization was completed. Once complete mobilization was achieved, the distal division was performed using a 60mm mechanical suture. A colorectal anastomosis was then performed using a circular mechanical suture. The pneumatic test was negative. 



Bibliography:

1. Roscio F, Bertoglio C, De Luca A, Frattini P, Clerici F, Scandroglio I. Totally laparoscopic resection of the splenic flexure for tumor. Updates Surg. 2012 Sep;64(3):185-90. doi: 10.1007/s13304-012-0162-3. Epub 2012 Jun 28. PMID: 22739994.

2. Cirocco WC. The optimal extent of colectomy for splenic flexure carcinoma - Extended vs segmental? Less is best! Am J Surg. 2023 Mar;225(3):452-453. doi: 10.1016/j.amjsurg.2022.10.054. Epub 2022 Nov 15. PMID: 36402619.

3. Hashida H, Kondo M, Kita R, Kitamura K, Uryuhara K, Kobayashi H, Kaihara S. Laparoscopic Colectomy for Splenic Flexure Cancer Approached from Four Directions. J Laparoendosc Adv Surg Tech A. 2021 Sep;31(9):1014-1018. doi: 10.1089/lap.2020.0709. Epub 2020 Nov 23. PMID: 33226876.

4. Rondelli F, Pasculli A, De Rosa M, Avenia S, Bugiantella W. Is routine splenic flexure mobilization always necessary in laparotomic or laparoscopic anterior rectal resection? A systematic review and comprehensive meta-analysis. Updates Surg. 2021 Oct;73(5):1643-1661. doi: 10.1007/s13304-021-01135-y. Epub 2021 Jul 24. PMID: 34302604.

Three-port laparoscopic left colectomy for splenic flexure tumor

There is evidence in the literature supporting that postoperative complications in colorectal surgery can be handled laparoscopically. Many cases of reoperative surgery will be described in the video. Most of them are due to anastomotic leakage evidenced during the early postoperative days. Depending on the size of the anastomotic defect, an anastomosis takedown or proximal ostomy may be performed. Lavage of the entire abdomen can be performed using a minimally invasive approach. Patients may keep the benefits of the initial laparoscopic surgery with the management of this potentially lethal complication using a reoperative laparoscopic surgery.

Bibliography:

1\. Rotholtz NA, Laporte M, Matzner M, Schlottmann F, Bun ME. "Relaparoscopy" to treat early complications following colorectal surgery. Surg Endosc. 2022 May;36(5):3136-3140. doi: 10.1007/s00464-021-08616-6. Epub 2021 Jun 22. PMID: 34159459.

2\. Rotholtz NA, Angeramo CA, Laporte M, Matzner Perfumo M, Schlottmann F, Bun ME. "Early" Reoperation to Treat Complications Following Laparoscopic Colorectal Surgery: The Sooner the Better. Surg Laparosc Endosc Percutan Tech. 2021 Aug 18;31(6):756-759. doi: 10.1097/SLE.0000000000000984. PMID: 34406166.

Laparoscopic reoperation for early postoperative complications after colorectal surgery

Réopération laparoscopique en cas de complications postopératoires précoces après chirurgie colorectale

The patient was a 84-year-old woman with no history of perianal abscess and sigmoid diverticulosis. She had episodes of rectal bleeding, weight loss, and previous endoscopic resection for adenomatous polyps with high-grade dysplasia in the sigmoid and right colon. Her family history included colorectal cancer. She underwent an endoscopic dissection for an adenomatous polyp with low-grade dysplasia in the right colon and for a 15mm laterally spreading tumor (LST) in the transverse colon with a grade III (dysplasia?) according to Kudo’s classification and with SCAD-like (please clarify) inflammation in the descending and sigmoid colon. After 8 months, she underwent another endoscopic dissection for a recurrent LST on the distal transverse colon, which was positive for a pT1 adenocarcinoma, and for adenomatous tubular villous polyps in the ascending colon with low-grade dysplasia. CT-scan showed a concentric thickening of a 2.5cm tract near the splenic flexure. A laparoscopic total colectomy was performed to manage the pT1N0 colonic adenocarcinoma (please confirm). The transverse colon cancer can be treated with different kinds of colonic resections, but when it appears with multiple conditions such as colitis and recurrent dysplastic lesions, or with a strong family history of colon cancers, total colectomy should be considered. Laparoscopy in elderly patients is always carefully considered due to the increasing physiological demands. However, it is a feasible and safe approach with potential short-term benefits. The literature shows no significant differences in overall morbidity and mortality between laparoscopic and open surgery in old patients. However, some pooled analyses are starting to show a slightly reduced morbidity in the laparoscopic approach, even in elderly patients, with a reduced risk of surgical site infections, a faster recovery time inducing a shorter hospital stay, and less need for rehabilitation.



Bibliography:

1. Devoto L, Celentano V, Cohen R, Khan J, Chand M. Colorectal cancer surgery in the very elderly patient: a systematic review of laparoscopic versus open colorectal resection. Int J Colorectal Dis. 2017 Sep;32(9):1237-1242. doi: 10.1007/s00384-017-2848-y. Epub 2017 Jun 30. PMID: 28667498.

2. Passuello N, Polese L, Ometto G, Grossi U, Mammano E, Vittadello F, Frasson A, Tessari E, Bartolotta P, Gregori D, et al. Outcomes of Laparoscopic Surgery in Very Elderly Patients with Colorectal Cancer: A Survival Analysis and Comparative Study. Journal of Clinical Medicine. 2023; 12(22):7122. https://doi.org/10.3390/jcm12227122

3. Ueda, Y., Shiraishi, N., Kawasaki, T. et al. Short- and long-term outcomes of laparoscopic surgery for colorectal cancer in the elderly aged over 80 years old versus non-elderly: a retrospective cohort study. BMC Geriatr 20, 445 (2020). https://doi.org/10.1186/s12877-020-01779-2

4. Chern, YJ., Hung, HY., You, JF. et al. Advantage of laparoscopy surgery for elderly colorectal cancer patients without compromising oncologic outcome. BMC Surg 20, 294 (2020). https://doi.org/10.1186/s12893-020-00967-6



Laparoscopic total colectomy for transverse colon adenocarcinoma in an elderly woman

Colectomie totale laparoscopique pour adénocarcinome du côlon transverse chez une femme âgée

Laparoscopic surgery is a technically demanding procedure that requires a significant level of experience and expertise. Since surgery is the mainstay treatment of rectal cancer, comprehending the complexities of multilaminar structures and interfascial spaces is mandatory.

This is the case of a 68-year-old woman who was evaluated for a positive fecal occult blood test. Colonoscopy found a vegetative lesion 15cm away from the anal verge, occupying approximately half of the lumen. Biopsy and distal tattooing were performed. The biopsy study confirmed the presence of a moderately differentiated adenocarcinoma. CT-scan showed no lung nor liver metastasis. MRI revealed an upper rectal cancer, 11.4cm away from the anal verge, with no pathological lymph nodes. It was a T2 N0 Mx negative CRM tumor. Surgical treatment was decided upon along with a laparoscopic anterior rectal resection. This video demonstrates all the important technical steps to fasten the learning curve and master the procedure in a stepwise approach, without compromising the oncologic principles.

Bibliography:

1\. Park, Y. Y., & Lee, K. Y. (2021). Step-wise learning of laparoscopic low anterior resection. Journal of Minimally Invasive Surgery, 24(1), 56‑58. [https://doi.org/10.7602/jmis.2021.24.1.56](https://doi.org/10.7602/jmis.2021.24.1.56)

2\. Morino, M., Parini, U., Giraudo, G., Salval, M., Brachet Contul, R., & Garrone, C. (2003). Laparoscopic total mesorectal excision. Annals of Surgery, 237(3), 335‑342. [https://doi.org/10.1097/01.SLA.0000055270.48242.D2](https://doi.org/10.1097/01.SLA.0000055270.48242.D2)

3\. Mahmoud, A. M. A., & Moneer, M. M. (2017). Toward standardization of laparoscopic resection for colorectal cancer in developing countries : A step by step module. Journal of the Egyptian National Cancer Institute, 29(3), 135‑140. [https://doi.org/10.1016/j.jnci.2017.04.003](https://doi.org/10.1016/j.jnci.2017.04.003)

4\. Montroni, I., Mari, G., Boni, L., Maggioni, D., Crippa, J., Cocozza, E., Ferrari, G., Ugolini, G., Capelli, P., Berti, S., Pugliese, R., Spinelli, A., & AIMS Academy clinical research network. (2021). Surgical coaching applied to laparoscopic TME for continuous professional development in rectal surgery : Proof of concept. Updates in Surgery, 73(5), 1805‑1810. [https://doi.org/10.1007/s13304-021-01137-w](https://doi.org/10.1007/s13304-021-01137-w)

Laparoscopic low anterior resection (LAR): a stepwise approach

Résection laparoscopique antérieure basse : une approche par étapes

This video shows the case of a 73-year-old female patient who was admitted to the emergency department for abdominal pain. Through the anamnesis she did not report any past medical condition. CT-scan of the abdomen showed a diffuse lymphadenomegaly. Blood tests did not identify any significant changes that might be suggestive of a hematologic disease. A bone marrow biopsy was performed without any diagnostic finding. A full body 18F-FDG PET/CT-scan was performed and showed increased metabolism at the periaortic lymph node package and near the left renal vein. After a multidisciplinary case discussion, surgery was indicated. A laparoscopic lymph node sampling was decided upon. 

The patient was placed supine in a left lateral Trendelenburg position. Four 12mm trocars were placed according to the Hasson technique. The first trocar was placed supraumbilically. The second trocar was placed in the epigastric region. Two additional trocars were inserted in the left and right midclavicular line respectively.

The procedure began with the takedown of the hepatic flexure. As a result, a disconnection was performed between Toldt’s fascia and Gerota’s fascia, exposing the renal fascia and medializing the ascending colon. The upper knee of the duodenum was identified and mobilized according to the Kocher maneuver. This maneuver ended when the duodenal block was verticalized and the left margin of the aorta was uncovered. At the end of the maneuver, lymph nodes with potential pathological significance were discovered with 18F-FDG PET/CT imaging. The first lymph node identified on the aortic plane was sampled, and after discovering the left renal vein, the lymph node identified with 18F-FDG PET/CT imaging was harvested. 

The patient resumed oral feeding rapidly and was discharged home on POD 3. Histological and cytofluorimetric analyses confirmed the presence of a marginal-type low-grade B-cell non-Hodgkin lymphoma.

Immunophenotyping evidenced the following tumor markers as such: CD20 positive, PAX5 positive, BCL2 positive, CD10 negative, and CD200 negative B cells.



Laparoscopy usually plays a marginal role in the diagnosis of hematologic diseases.

The authors reported the clinical case of a female patient with a new-onset hematologic disease which could not be determined via classical diagnostic markers performed using serum chemistries and with bone marrow biopsy. Following a multidisciplinary case discussion, surgery was indicated and a diagnostic laparoscopy was performed with sampling of the periaortic lymph nodes. 



Bibliography:

1. Nevler, A., Har-Zahav, G., Abraham, A., Schiby, G., Zmora, O., Shabtai, M., Gutman, M., & Rosin, D. (2017). Laparoscopic lymph node biopsy : Efficacy and advantages. The Israel Medical Association Journal: IMAJ, 19(4), 231 233.



Laparoscopic lymph node biopsy in misdiagnosed hematologic disease: sampling of the periaortic lymph node group

Biopsie ganglionnaire laparoscopique en cas de pathologie hématologique mal diagnostiquée : prélèvement du groupe de ganglions péri-aortiques

Colorectal cancer is the third most common type of cancer in the world. Approximately 35 to 55% of patients will develop liver metastases in the course of the disease. Surgical resection is the only option for long-term survival. The laparoscopic approach for lesions located in the superior segments of the posterior liver is still challenging. 

This video aims to demonstrate a laparoscopic resection of the metastasis located in liver segment VII as performed at the authors’ institution. 

The authors present the case of a 65-year-old man diagnosed with a cancer of the splenic flexure of the colon, occlusive, and with a single synchronous metastasis in liver segment VII. 

Initially, the patient underwent a laparoscopic segmental colectomy for a cancer in the splenic flexure of the colon. It was then decided to perform a laparoscopic segment VII atypical resection. Five ports were placed. The procedure began with a complete abdominal exploration and no other lesions were observed macroscopically. The right triangular and coronary ligaments were divided. The left triangular ligament was also divided to medialize the right liver and to access liver segment VII. The extension of the lesion was identified via intraoperative ultrasound and the limits of the resection were marked. It was confirmed by fluoroscopy that the margins were free (indocyanine green (ICG) was administered 20 hours earlier). The hepatic pedicle was looped and the gastric antrum exited through the left flank. Hepatotomy was started and continued until the complete release of the lesion. Hemostasis was controlled with a bipolar irrigation forceps and clips on major vessels. The resection margins were confirmed using fluorescein and a small fragment was enlarged on the lower margins. Hemostasis and bilistasis were controlled. 

The postoperative course was uneventful, and the patient was discharged on postoperative day 5. Pathological findings confirmed a 2.2 by 1.5cm hepatic metastasis of adenocarcinoma compatible with colorectal primary cancer. 

Despite the various obstacles and challenges, the laparoscopic approach has obvious advantages: less tissue damage associated with lower levels of postoperative pain, fewer peritoneal adhesions, a shorter hospital stay, and an earlier return to daily activities. Recent studies also add to these advantages less blood loss and no differences in the recurrence rate or long-term survival rate in malignant conditions. 



Bibliography:

1. Gon, Hidetoshi et al. Suitability of Laparoscopic Liver Resection of Segment VII: a Retrospective Two-Center Study. J Gastrointest Surg. 2022 Nov;26(11):2274-2281. doi: 10.1007/s11605-022-05389-8. Epub 2022 Jun 17.

2. S R Coles et al. Total laparoscopic management of lesions involving liver segment 7. Surg Endosc. 2015 Nov;29(11):3190-5. doi: 10.1007/s00464-014-4052-2. Epub 2015 Jan 13.

3. Engstrand, Jennie et al. Colorectal cancer liver metastases - a population-based study on incidence, management and survival. BMC Cancer. 2018 Jan 15;18(1):78. doi: 10.1186/s12885-017-3925-x.



Laparoscopic resection of liver segment VII for metastatic colorectal cancer

Segmentectomie laparoscopique du segment hépatique VII pour cancer colorectal métastatique

TaTME for complex rectal cancers beyond the learning curve

Essential surgical anatomy and step-by-step procedures in performing TaTME

Colectomie totale laparoscopique avec création d'une iléostomie terminale pour colite ulcéreuse réfractaire 

In this educational video, the authors demonstrate the laparoscopic total colectomy with end ileostomy formation in a patient refractory to medical treatment, with an acute flare-up of ulcerative colitis. The authors used the new LigaSure retractable L-hook laparoscopic sealer (Medtronic) with a Maryland tip, which allows effortless switch from fine sharp dissection to blunt dissection and vice versa. In this video, they demonstrate dissection of all inflamed colonic vessels, due to their prominence secondary to the pathophysiology of severe acute ulcerative colitis and provide tips and tricks on how to approach this common clinical situation. 

Bibliography:

1. Le Berre C, Honap S, Peyrin-Biroulet L. Ulcerative colitis. Lancet. 2023 Aug 12;402(10401):571-584. doi: 10.1016/S0140-6736(23)00966-2. PMID: 37573077. (https://pubmed.ncbi.nlm.nih.gov/37573077/)

2. Lamb CA, Kennedy NA, Raine T, Hendy PA, Smith PJ, Limdi JK, Hayee B, Lomer MCE, Parkes GC, Selinger C, Barrett KJ, Davies RJ, Bennett C, Gittens S, Dunlop MG, Faiz O, Fraser A, Garrick V, Johnston PD, Parkes M, Sanderson J, Terry H; IBD guidelines eDelphi consensus group; Gaya DR, Iqbal TH, Taylor SA, Smith M, Brookes M, Hansen R, Hawthorne AB. British Society of Gastroenterology consensus guidelines on the management of inflammatory bowel disease in adults. Gut. 2019 Dec;68(Suppl 3):s1-s106. doi: 10.1136/gutjnl-2019-318484. Epub 2019 Sep 27. Erratum in: Gut. 2021 Apr;70(4):1. PMID: 31562236; PMCID: PMC6872448. (https://pubmed.ncbi.nlm.nih.gov/31562236)

3. Spinelli A, Bonovas S, Burisch J, Kucharzik T, Adamina M, Annese V, Bachmann O, Bettenworth D, Chaparro M, Czuber-Dochan W, Eder P, Ellul P, Fidalgo C, Fiorino G, Gionchetti P, Gisbert JP, Gordon H, Hedin C, Holubar S, Iacucci M, Karmiris K, Katsanos K, Kopylov U, Lakatos PL, Lytras T, Lyutakov I, Noor N, Pellino G, Piovani D, Savarino E, Selvaggi F, Verstockt B, Doherty G, Raine T, Panis Y. ECCO Guidelines on Therapeutics in Ulcerative Colitis: Surgical Treatment. J Crohns Colitis. 2022 Feb 23;16(2):179-189. doi: 10.1093/ecco-jcc/jjab177. PMID: 34635910. (https://pubmed.ncbi.nlm.nih.gov/34635910/)

4. Ippolito C, Colucci R, Segnani C, Errede M, Girolamo F, Virgintino D, Dolfi A, Tirotta E, Buccianti P, Di Candio G, Campani D, Castagna M, Bassotti G, Villanacci V, Blandizzi C, Bernardini N. Fibrotic and Vascular Remodelling of Colonic Wall in Patients with Active Ulcerative Colitis. J Crohns Colitis. 2016 Oct;10(10):1194-204. doi: 10.1093/ecco-jcc/jjw076. Epub 2016 Mar 19. PMID: 26995183. (https://pubmed.ncbi.nlm.nih.gov/26995183/)

Laparoscopic total colectomy with end ileostomy formation for refractory ulcerative colitis 

Colorectal cancer is the fourth most common malignancy and the second main cause of cancer-related mortality in the world. Transanal total mesorectal excision (TaTME) was first described by Lacy and Sylla in 2010. As this new surgical technique is increasingly adopted by surgeons (2), a comparable rate of intraoperative complications and a significantly lower incidence of postoperative complications were noted in the TaTME approach as compared with the laparoscopic TME (LaTME) approach (2). Indeed, many surgeons adopted the TaTME surgical technique because the use of LaTME is limited in low rectal cancer patients, who require surgeons with experience in ultralow sphincter-saving laparoscopic surgery, that has a high risk of leaving a positive circumferential resection margin. Aubert et al. confirmed that TaTME for low and middle rectal cancer is safe, feasible, and can lead to a high quality of rectal cancer resection specimen, with a shorter length of stay, and a lower readmission rate, as well as a lower rate of overall and major morbidities, anastomotic leakage, and circumferential resection margin involvement, as opposed to the standard laparoscopic total mesorectal excision (3).

This video presents the case of a 50-year-old man with a history of Parkinson’s disease who presented with proctorrhagia without any other symptoms. On medical exam, a rectal tumor was diagnosed 2cm away from the anal verge. It was decided to manage it with chemoradiotherapy. An assessment control was performed, and a complete tumor regression was observed. It was decided to perform a transanal total mesorectal excision.

Bibliography:

1\. Lei PR, Ruan Y, Yang X, Fang J, Chen T. Trans-anal or trans-abdominal total mesorectal excision? A systematic review and meta-analysis of recent comparative studies on perioperative outcomes and pathological result. Int J Surg. 2018;60(November):113- 119. doi:10.1016/j.ijsu.2018.11.003

2\. Ma B, Gao P, Song Y, et al. Transanal total mesorectal excision (taTME) for rectal cancer: A systematic review and meta-analysis of oncological and perioperative outcomes compared with laparoscopic total mesorectal excision. BMC Cancer. 2016;16(1). doi:10.1186/s12885-016-2428-5

3\. Aubert M, Mege D, Panis Y. Total mesorectal excision for low and middle rectal cancer: laparoscopic versus transanal approach—a meta-analysis. Surg Endosc. 2020;34(9):3908-3919. doi:10.1007/s00464-019-07160-8

Transanal total mesorectal excision (TaTME) for advanced low rectal adenocarcinoma

Excision mésorectale totale transanale (TaTME) pour adénocarcinome avancé du bas rectum

Cure de hernie périnéale par voie d'abord laparoscopique après résection abdominopérinéale

Perineal hernia after abdominoperineal resection (APR) is a complication caused by the herniation of intra-abdominal organs through the pelvic floor. Although most patients are asymptomatic, some patients have complaints that significantly impact their quality of life. Management of such hernias is challenging. 

The authors present the case of a 58-year-old female patient under surveillance after a laparoscopic abdominoperineal resection for rectal adenocarcinoma. She developed a symptomatic perineal hernia for which a correction was proposed. Laparoscopic surgery and the postoperative period were uneventful and the patient was discharged on the first postoperative day. Six months later, the patient reported a marked improvement in her life quality and showed no signs of hernia recurrence. 



Laparoscopic repair for a perineal hernia after an abdominoperineal resection (APR)

Restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the operation of choice for patients with ulcerative colitis (UC) (1). The most common type of IPAA is achieved with a J pouch, where the ileal pouch is anastomosed with the rectal cuff, a 2 to 3cm string of anal canal which can include a few millimeters of rectal mucosa. This tiny portion of the rectum and anal canal is necessary for the stapled anastomosis. The ileorectal anastomosis is a totally different procedure, where the rectum is kept in place (while it is removed in the IPAA) and connected to the ileum, with no creation of an ileal pouch. 

This video presents the case of a laparoscopic proctectomy with a J-pouch construction as the second stage of a modified two-staged procedure (subtotal colectomy with end ileostomy, proctectomy, and IPAA). The two-staged approach for the restoration of intestinal continuity in UC patients is one of the most used approaches, given its safety in terms of postoperative complications and overall quality of life for patients who are diagnosed with acute severe colitis and who undergo total colectomy as an emergency surgery, and after 3 to 6 months are fit and ready for intestinal reconstruction through the IPAA without a protective stoma (5, 6). 

The procedure was divided into two major steps. The first one was a laparoscopic proctectomy, performed with a close rectal dissection (CRD), also known as "incomplete TME approach", to minimize the risks of neuromuscular injury (2). An image at the beginning of the video compares the two approaches for laparoscopic proctectomy. 

The second step was the extracorporeal J-pouch construction using an endoscopic stapling device and an ileal pouch-anal anastomosis creation using a 31mm circular stapler. 

Randomized clinical trials results showed how an incomplete TME leads to a lower rate of severe complications and better short-term quality of life when compared to TME (3). This video presents the authors’ standardized approach. 

Close rectal dissection, or incomplete TME, is a safe approach for laparoscopic proctectomy given the good results obtained in terms of protecting autonomic nerve function (4). This technique may be more challenging than TME if the surgeon is used to oncological dissections. A standardized technique for CRD is crucial to have the best outcomes in terms of sexual and urinary functions. 



Bibliography:

1. Parks AG, Nicholls RJ. Proctocolectomy without ileostomy for ulcerative colitis. Br Med J. 1978 Jul 8;2(6130):85-8. doi: 10.1136/bmj.2.6130.85. PMID: 667572; PMCID: PMC1605901.

2. Reijntjes MA, de Jong DC, Bartels S, Wessels EM, Bocharewicz EK, Hompes R, Buskens CJ, d'Haens GR, Duijvestein M, Bemelman WA. Long-term outcomes after close rectal dissection and total mesorectal excision in ileal pouch-anal anastomosis for ulcerative colitis. Tech Coloproctol. 2023  Apr;27(4):297-307. doi: 10.1007/s10151-022-02713-x. Epub 2022 Nov 6. PMID: 36336745; PMCID: PMC10008209.

3. Capelli, G., De Simone, I., Spolverato, G. et al. Non-Operative Management Versus Total Mesorectal Excision for Locally Advanced Rectal Cancer with Clinical Complete Response After Neoadjuvant Chemoradiotherapy: a GRADE Approach by the Rectal Cancer Guidelines Writing Group of the Italian Association of Medical Oncology (AIOM). J Gastrointest Surg 24, 2150–2159 (2020). https://doi.org/10.1007/s11605-020-04635-1

4. Garcia-Granero A, Pellino G, Fletcher-Sanfeliu D, Millan M, Primo-Romaguera V, Garcia-Gausí M, Fernandez M, Gonzalez-Argente X, Spinelli A, Valverde-Navarro A, Garcia-Granero E. "Near-TME": proposed standardisation of the technique for proctectomy in male patients with ulcerative colitis. Tech Coloproctol. 2022 Mar;26(3):217-226. doi: 10.1007/s10151-022-02579-z. Epub 2022 Feb 1. PMID: 35103902; PMCID: PMC8857132.

5. Maspero, M., Hull, T.L. Clinical approach to patients with an ileal pouch. Abdom Radiol 48, 2918–2929 (2023). https://doi.org/10.1007/s00261-023-03888-z

6. Luo, W.Y., Singh, S., Cuomo, R. et al. Modified two-stage restorative proctocolectomy with ileal pouch-anal anastomosis for ulcerative colitis: a systematic review and meta-analysis of observational research. Int J Colorectal Dis 35, 1817–1830 (2020). https://doi.org/10.1007/s00384-020-03696-7



Completion proctectomy and J-pouch construction for ulcerative colitis (UC)

Proctectomie complète et création d'une poche en J pour colite ulcéreuse 

This video presents the case of a 39-year-old female patient with no relevant medical history. The symptoms appeared one week before rectal bleeding and weight loss. Upon physical examination, a 3cm indurated bleeding mass was found in the anal margin. Colonoscopy showed a friable exophytic-looking tumor lesion located 3 to 5cm away from the anal verge and covering 30% of the circumference. Histopathological exam revealed a grade II invasive adenocarcinoma without lymphovascular invasion. Magnetic resonance imaging showed an inferior rectal neoplasm located 2.8cm away from the anal margin with an extension to the middle rectum (4.6cm) without sphincter involvement. No lymph nodes or metastasis were observed, conclusive for a rectal T2N0M0. As a result, it was decided to perform a laparoscopic two-stage Turnbull-Cutait pull-through coloanal anastomosis with ultralow anterior resection. 

A conventional ultra low anterior resection was performed, externalizing the colon through the anus and fixing it proximally to the skin. One week later, the anastomosis was completed manually.

The postoperative period was uneventful. The patient resumed oral intake one day after the second surgery. She was discharged on postoperative day 8. Histopathological findings showed that the surgical margins were negative for neoplasia, and 16 lymph nodes proved negative for dysplasia. 

Bibliography:

1. Biondo S, Trenti L, Espin E, Bianco F, Barrios O, Falato A, De Franciscis S, Solis A, Kreisler E; TURNBULL-BCN Study Group. Two-Stage Turnbull-Cutait Pull-Through Coloanal Anastomosis for Low Rectal Cancer: A Randomized Clinical Trial. JAMA Surg. 2020 Aug 1;155(8):e201625. doi: 10.1001/jamasurg.2020.1625. Epub 2020 Aug 19. PMID: 32492131; PMCID: PMC7270870.

2. Biondo S, Trenti L, Galvez A, Espin-Basany E, Bianco F, Romano G, Kreisler E; Turnbull-BCN study group. Two-stage Turnbull-Cutait pull-through coloanal anastomosis versus coloanal anastomosis with protective loop ileostomy for low rectal cancer. Protocol for a randomized controlled trial (Turnbull-BCN). Int J Colorectal Dis. 2017 Sep;32(9):1357-1362. doi: 10.1007/s00384-017-2842-4. Epub 2017 Jun 30. PMID: 28667499.

3. La Raja C, Foppa C, Maroli A, Kontovounisios C, Ben David N, Carvello M, Spinelli A. Surgical outcomes of Turnbull-Cutait delayed coloanal anastomosis with pull-through versus immediate coloanal anastomosis with diverting stoma after total mesorectal excision for low rectal cancer: a systematic review and meta-analysis. Tech Coloproctol. 2022 Aug;26(8):603-613. doi: 10.1007/s10151-022-02601-4. Epub 2022 Mar 28. PMID: 35344150.

4. Melka D, Leiritz E, Labiad C, Blondeau M, Frontali A, Giacca M, Monsinjon M, Panis Y. Delayed pull-through coloanal anastomosis without temporary stoma: an alternative to the standard manual side-to-end coloanal anastomosis with temporary stoma? A comparative study in 223 patients with low rectal cancer. Colorectal Dis. 2022 May;24(5):587-593. doi: 10.1111/codi.16069. Epub 2022 Feb 10. PMID: 35094470.

Laparoscopic two-stage Turnbull-Cutait pull-through coloanal anastomosis for low rectal cancer

Anastomose colo-anale de Turnbull-Cutait en deux étapes par voie d'abord laparoscopique pour cancer du bas rectum

Hémicolectomie droite élargie laparoscopique avec curage ganglionnaire D3



Bibliography:

1. Paquette, I. M., Madoff, R. D., Sigurdson, E. R., & Chang, G. J. (2018). Impact of proximal vascular ligation on survival of patients with colon cancer. Annals of Surgical Oncology, 25(1), 38‑45. https://doi.org/10.1245/s10434-016-5720-3 

2. Perrakis, A., Weber, K., Merkel, S., Matzel, K., Agaimy, A., Gebbert, C., & Hohenberger, W. (2014). Lymph node metastasis of carcinomas of transverse colon including flexures. Consideration of the extramesocolic lymph node stations. International Journal of Colorectal Disease, 29(10), 1223‑1229. https://doi.org/10.1007/s00384-014-1971-2 

3. Kotake, K., Mizuguchi, T., Moritani, K., Wada, O., Ozawa, H., Oki, I., & Sugihara, K. (2014). Impact of D3 lymph node dissection on survival for patients with T3 and T4 colon cancer. International Journal of Colorectal Disease, 29(7), 847‑852. https://doi.org/10.1007/s00384-014-1885-z 

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