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Robotic redo sleeve gastrectomy for weight regain
Robotic repeat liver resection for recurrent CRLM: experience of real life
Intraglissonian extraparenchymal vascular control for robotic right hepatectomy
Robotic splenopancreatectomy with unusual complication
Robotic splenectomy for symptomatic splenic cyst
Robotic excision of gastric GIST of the lesser curve
Robotic CBD resection, hepatic pedicle lymph nodes dissection and double loop Roux-en-Y HepJej
Lymph node dissection of the hepatic pedicle during robotic pancreatoduodenectomy
Laparoscopic excision of a bleeding gastric GIST
Timing of ICG injection in fluorescence guided laparoscopic cholecystectomy
Robotic Whipple's procedure with Blumgart pancreatojejunostomy
Robotic low anterior resection
Emergency laparoscopic Toupet funduplication to repair a giant hiatus hernia with gastric volvulus
Emergency robotic cholecystectomy for acute cholecystitis
Emergency laparoscopic repair of obstructed post-traumatic diaphragmatic hernia
Laparoscopy in penetrating abdominal trauma
Laparoscopy in pelvic endometriosis
Laparoscopic recurrent incisional hernia repair
Laparoscopic incisional hernia
Laparoscopic appendicectomy for peritonitis
Lap repair of perforated peptic ulcer
Lap treatment of mesenteric cyst
Lap repair of rectal perforation during colonoscopy
Laparoscopic repair of right inguinal hernia - TAPP
Laparoscopic repair of bilateral inguinal hernia (TAPP) and right iliac fossa incisional hernia
laparoscopic cholecystectomy with ICG fluorescence for acute cholecystitis
ICG-guided laparoscopic cholecystectomy
Emergency laparoscopic cholecystectomy for acute cholecystitis with cholecystogastric fistula
ICG-fluorescence guided laparoscopic cholecystectomy for acute biliary pancreatitis
Laparohernioscopic right hemicolectomy for strangulated right inguinal hernia
Emergency laparoscopic sigmoid resection for recurrent acute diverticulitis
Emergency laparoscopic sigmoid resection for recurrent volvulus
Educational video - Rectal bleeding
Educational video - Hernia surgery
This short video shows a case of robotic redo sleeve gastrectomy in a patient who regained weight after a previous sleeve but did not accept gastric bypass.
The video shows the case of a 55yo patient who was referred for epigastric pain and dyspepsia. OGD showed a 4 cm tumour of the greater curve and CTscan showed no mets and no enlarged nodes. Evidence of left sided IVC and CHA arising from the SMA.
The patient was staged as cT2N0M0 and upfront surgery was planned.
The operation was a near total gastrectomy with D2 lymph node dissection. The video shows a typical double loop reconstruction.
The patient recovered well and was discharged on POD5. He was alive and disease-free at 12-month follow up.
The video reports the case of a 76yo man who ad emergency resection of the splenic flexure for bleeding cancer, followed by left lobectomy for metastasis and a few months later repeat liver resection of S5-S6 for recurrent CRLM.
The video reports the case of a 65yo man who was referred for mass of the caecum.
Previously he had been treated for squamous cell carcinoma of the tongue and a follow-up PET-CT scan showed a locally advanced hypermetabolic lesion of the caecum. cT3N0M0.
He underwent robotic bottom-up right hemicolectomy and pressurised intraperitoneal aerosol chemotherapy (PIPAC). Histo: goblet cell carcinoma of the appendix with peritoneal implants. pT4cN0M0. Subsequently he had adjuvant chemotherapy and follow-up CT scan showed peritoneal recurrence.
3 months after the first operation he underwent cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS+HIPEC).
The video shows the technique of intraglissonian vascular control for right hemihepatectomy.
1. preparation for hepatic pedicle clamping
2. posterior mobilisation of the right hemiliver
3. division of dorsal hepatic veins
4. preparation of the right arterial and portal branches at the hepatic pedicle
5. liver ischaemia confirmation
6. division of the right arterial and portal branches
The video depicts the case of a 65yo woman who underwent robotic splenopancreatectomy for tumour of the body-tail of the pancreas.
During the operation an unusual complication occurred leading to splenic rupture and significant bleeding.
The operation and postop period were otherwise uneventful. The patient was discharged on POD6.
Histo was pancreatic adenocarcinoma pT3N2 (7/48).
2 months CT follow-up showed no recurrence.
28yo woman referred for LUQ pain.
USS,CT, MRI: 9 cm splenic cyst, almost doubled in the last 2 years.
Robotic splenectomy performed.
Man, 79yo at the time of the present operation
May 2022: cT3N1M0 adenocarcinoma of the gastric antrum
7.6.2022 – Laparoscopic D2 subtotal gastrectomy – Histo: adenocarcinoma pT3N0
At 2 y follow-up: adenomatous lesion with HGD at the anastomotic site. CT negative.
Tumour Board recommended degastro-gastrectomy
The video reports the case of a 72yo man with gastric GIST of the lesser curve.
Robotic excision of the GIST and manual double layer closure of the gastric defect.
The video reports the case of a mid CBD cholangiocarcinoma in an elderly and significantly comorbid patient, not fit for Whipple’s.
After extensive evaluation and MDT discussion, we opted for a radical resection of the CBD with hepatic pedicle lymphadenectomy and reconstruction by a double-loop Roux-en-Y hepatic-jejunostomy.
Patient discharged on POD 4 and alive and disease-free at 12-month follow up.
The video shows our technique of lymph node dissection of the hepatic pedicle during robotic pancreatoduodenectomy.
The video reports on a case of emergency laparoscopic removal of a bleeding gastric GIST through the transgastric approach.
The video depicts the two different intraop views of the biliary tract in ICG-fluorescence guided lap chole according to timing of injection of ICG. Best view is with dye injected 24 h before the operation. but this is not always possible.
Our technique of robotic splenopancreatectomy for cancer of the body of the pancreas is shown.
77 yo woman with 2.5 x 2.3 cm solid mass of the body of the pancreas.
Past medical history not relevant.
Our technique of Whipple’s pancreatoduodenectomy is shown.
Essential points:
65 yo man diagnosed with T3N2M0 mid-rectal cancer.
Long course neoadjuvant chemoradiation
Restaging yT2N0M0
Robotic low anterior resection
No complications. Discharged on POD 3.
Final histology pyT2N0M0
72 yo male patient presented with dysphagia and chest pain. CT showed giant hiatus hernia with gastric volvulus. Emergency laparoscopic antireflux surgery was performed in the form of a 270-degree posterior funduplication. A bleeding from the spleen has been successfully controlled with Surgiflo.
54 yo man admitted for acute cholecystitis, confirmed by blood tests and USS and CT-scan. Robotic cholecystectomy performed on day 3 from the admission. Patient discharged on day 2 in good general and local conditions.
37 yo patient undergoing laparoscopic right hemicolectomy for goblet cell carcinoma of the appendix.
The patient had been treated eight months before with transcatheter trombolysis and TIPPS for SMV thrombosis. After 2 months operation of limited small bowel resection for residue ischaemic stricture. Subsequent admission for abdominal pain and CT findings of enlarged appendix. Laparoscopic appendicectomy performed. Histology finding of GCC of the appendix. Completion laparoscopic right hemicolectomy offered and accepted.
The duodenum-first approach is presented along with the use of ICG-fluorescence to verify the blood supply to the anastomosis.
74 yo patient admitted for chest pain and bowel obstruction. History of blunt abdominal trauma 9 months before.
At CT-scan obstructed diaphragmatic hernia. Emergency operation offered and accepted.
The video shows the laparoscopic repair with suture and mesh of the diaphragmatic hernia.
32 yo woman admitted to the ED after road traffic accident. She was unrestrained passenger in a car which collided with a tree at high speed. Driver of the car in poor conditions due to head, chest and pelvic trauma, transferred to tertiary trauma center directly from the scene. Patient was alert and responsive at her arrival. She was on a long spine board, with two large bore cannulas but no oxygen mask.
Airways: patent and stable. Trachea in central position. C-Spine blocked with collar. No cervical pain.
Breathing: normal and bilateral breathing sounds, SaO2 96%. Pain at lower right ribs.
Circulation: no external bleeding, HR 120. BP 90/50. Abdomen: diffuse tenderness with guarding and rebound. Pelvis stable. Rectal tone normal. Perineal bruising. Vaginal examination normal, tenderness on the right side.
Disability: neuro examination normal. GCS 15.
Exposure: no evidence of penetrating injuries. No tenderness over the spine.
E-FAST-scan: free fluid in the splenorenal pouch, in the hepatorenal pouch and in the pelvis. No fluid in the pericardium. Small quantity of fluid in the right pleural space. No fluid in the left pleural space. No evidence of pneumothorax.
After 1 liter of fluids and oxygen through face mask: PA 110/80. HR 100. SaO2 100%.
After 2 liters of fluids: PA 110/80. HR 85. SaO2 100%.
Chest X-ray: negative.
Pelvic X-ray: fracture of the right inferior pubic ramus.
C-spine X-ray: normal
Blood tests: Hb 95 g/dl.
CT scan: Free fluid in the abdomen. No free air. No evidence of abdominal parenchymal injury. Fracture of the arch of the 7th and 8th right rib. Minimal pleural effusion on the right side. Non displaced fracture of the right inferior pubic ramus with pelvic and perineal haematoma.
Impression: pelvic fracture with intraabdominal injury
Indication to diagnostic laparoscopy to rule out intraabdominal injuries and active bleeding.
Outcome: pelvic fracture with pelvic haematoma, minimal intraperitoneal bleeding from liver superficial injuries. Conservative treatment. No complications.
23 yo man admitted in the ED after being stabbed at his right flank. Patient was alert and responsive at his arrival. Unrestrained on a long spine board.
Airways: patent and stable. Trachea in central position. No cervical collar. No cervical pain.
Breathing: normal and bilateral breathing sounds, SaO2 100%. No chest pain. No respiratory distress.
Circulation: clothes stained with blood, blood on the long spine board. Three centimeters bleeding wound at its right flank. HR 125. BP 110/85. Abdomen: diffuse tenderness with guarding and rebound. Pelvis stable. Rectal tone normal. Prostate normal. No perineal bruising. No bleeding from the urethra.
Disability: neuro examination normal. GCS 15.
Exposure: no evidence of other penetrating injuries. No tenderness over the spine.
E-FAST-scan: free fluid in the splenorenal pouch, in the hepatorenal pouch and in the pelvis. No fluid in the pericardium and in the pleural spaces. No evidence of pneumothorax.
After 1 liter of fluids and oxygen through face mask: PA 120/90. HR 90. SaO2 100%.
Examination of the wound: not sure evidence of direct penetration into the peritoneum.
Chest X-ray: negative.
Blood tests: Hb 128 g/dl.
Diagnostic Peritoneal Lavage: 5 ml of free blood aspirated. No evidence of enteric content.
Impression: penetrating abdominal injury with intraperitoneal bleeding.
Indication to diagnostic laparoscopy to rule out visceral injuries and active bleeding.
Outcome: penetrating abdominal wound with transverse track within the abdominal wall from the right flank to the right upper quadrant, small serosal tear of the small bowel repaired with intracorporeal stitch, no active bleeding. No postoperative complications. Discharged on postoperative day 3.
28 yo woman admitted through ED for acute pelvic pain. History of dysmenorrhea. No previous pregnancies. No other past medical history. No medications.
Abdomen tender, with guarding and rebound in the right and left iliac fossae. Vaginal examination: pelvic tenderness.
Blood tests: Hb 108 g/dl. WBC 11500. CRP 1.2. Pregnancy test negative.
US scan: free fluid in the pelvis, left ovarian cyst with hypoechoic content, appendix not seen.
Indication for diagnostic laparoscopy: acute pelvic pain with raised inflammatory markers. Acute appendicitis. Gynaecological issues.
Outcome: laparoscopic excision of left ovarian endometriosic cyst. Referred to the gynaecologists for medical treatment of her endometriosis.
44 yo man referred for recurrent non reducible hernia on umbilical port site.
Laparoscopic spermatic veins closure for bilateral varicocele 8 years before. Open mesh repair of port site hernia 3 years before.
Other past medical history not relevant.
Physical examination: non-reducible and mildly painful recurrent umbilical port-site hernia.
Outcome: laparoscopic repair of recurrent port-site hernia with excision of previous mesh. No postoperative complications. Same day discharge. Followup after 2 years: no recurrence.
68 yo man referred for incisional hernia. Accountant. Hobby: gardening and olive harvesting.
Open cholecystectomy for gallstones through transverse right subcostal laparotomy 18 years before.
Past medical history: hypertension and mild chronic obstructive/restrictive pulmonary disease.
Physical examination: Reducible lump on the medial side of the laparotomy scar, gradually enlarging and limiting his physical activities.
Outcome: Laparoscopic incisional hernia repair with mesh. No postoperative complications. Discharge in day 1. Postoperative followup at 6 months: no recurrence.
18 yo boy admitted through ED for right iliac fossa pain and vomiting.
Past medical history not relevant.
Abdomen: tenderness with guarding and rebound in the right iliac fossa
Blood tests: WBC 12500. CRP 1.5.
US scan: no free fluid, appendix not seen.
Working diagnosis: acute appendicitis
Outcome: laparoscopic appendicectomy. No postoperative complications. Drainage removed in day 1. Discharge in day 2.
32 yo woman admitted through ED for acute abdominal and pelvic pain, with nausea, vomiting and fever in the last 2 days.
Past medical history not relevant.
Abdomen: diffuse tenderness, guarding in the right and left iliac fossae with rebound.
Blood tests: WBC 23000. CRP 11.4. Pregnancy test negative.
US scan: free fluid in the pelvis, in the right iliac fossa and around the liver; enlarged and thick-walled appendix seen in the lower right iliac fossa.
Indication for emergency diagnostic laparoscopy: acute appendicitis
Outcome: laparoscopic appendicectomy. No postoperative complications. Drainage removed on day2. Discharge on day 2.
42 yo man admitted from ED for acute stabbing abdominal pain. History of recurrent epigastric pain. PPI treatment was prescribed by his GP several times but he never comply with GP’s suggestions. History of occasional social alcohol abuse and smoking.
Abdomen diffusely guarding and acutely tender. No bowel sounds.
Chest X-ray: left subdiaphragmatic air
Blood tests: WBC 2180. CRP 23.2.
US scan: free fluid in all abdominal quadrants.
Indication to laparoscopy: acute abdomen with suspected perforation
Outcome: laparoscopic repair of perforated peptic ulcer of the gastric antrum. No postoperative complications. Drainage removed on day 3. Discharge on day 5. Patient lost to followup.
58 yo man referred for chronic abdominal pain and palpable mass in his right iliac fossa
No change in bowel habits, no PR bleeding, no weight loss. No other symptoms
No family history of bowel cancer
Physical examination: palpable mass in the right iliac fossa Digital rectal examination negative
US, CT, MRI – 14x12x9 cm thickwalled mesenteric cyst
Blood tests and serology negative
Indication to operation: mesenteric cyst, probably chylous
Outcome: drain out on day 1, discharge on day 3. No postoperative complications. Follow up at 12 months: no recurrence, no symptoms
27 yo woman referred for dyspepsia and epigastric discomfort for 1 year. No heartburn, no acid reflux, no angina-like chest pain, no abdominal pain, no difficulty in swallowing, no vomiting, no nausea, no haematemesis, no maelena. No change in bowel habit, no PR bleeding. No family history of cancer.
History of insulin-dependent diabetes mellitus.
US/CT – 12 cm non parasitic splenic cyst with thick content
Blood tests normal
Indication for splenectomy: symptomatic large splenic cyst.
Outcome: drain out on postoperative day 1, discharge on postoperative day 2. No postoperative complications. Followup at 12 months: patient is symptom-free.
78 yo man who underwent colonoscopy for rectal bleeding. At colonoscopy, difficult sigmoid. Perforation of the upper rectum.
Operation started 40′ after the injury. General conditions stable. Diffuse abdominal pain.
Bowel clean. No gross peritoneal contamination. >3/4 perforation of the upper rectum.
End to end double layer v-lock manual suture. Diverting loop ileostomy. Pelvic drain.
Patient recovered well and was discharged on day 5.
47 yo man, admitted for reducible left inguinal hernia.
Day-case laparoscopic TAPP repair under general anaesthesia.
No complications. Discharged 3 hours after surgery.
67 yo man, referred for US-demonstrated bilateral inguinal hernia and right iliac fossa incisional hernia (previous open appendicectomy).
Day-case laparoscopic repair (TAPP). The incisional hernia and the small right inguinal hernia have been repaired through the same incision with a properitoneal mesh. Separate mesh for the left inguinal hernia.
No complications. Discharged 3 hours after surgery.
57 yo man, admitted as emergency for right upper quadrant pain and fever. Blood tests + USS showed acute cholecystitis.
Emergency laparoscopic cholecystectomy offered and accepted.
Laparoscopic findings of acute cholecystitis with gangrenous wall and pericholecystic oedema and adhesions. Operation completed by laparoscopy with the help of ICG-fluorescence to identify the CBD.
Postop recovery uneventful. Patient discharged on day 2.
47yo woman, admitted as an emergency for upper abdominal pain. Blood tests showed high amylase level. USS: gallstones and cholecystitis.
Emergency laparoscopic cholecystectomy offered and accepted.
ICG-fluorescence used throughout the procedure to clearly demonstrate the anatomical landmarks.
Postoperative recovery uneventful. Discharged on day 2.
57yo woman, admitted for acute cholecystitis.
Laparoscopic exploration showed cholecystogastric fistula. Fistula prepared and divided with endo stapler. Cholecystectomy as usual.
Discharged on day 1.
How to explore the abdominal cavity in obstructed or strangulated inguinal hernias spontaneously reducing under general anaesthesia.
https://link.springer.com/article/10.1007%2Fs10029-019-01901-3
46 yo woman admitted for acute biliary pancreatitis and deranged liver function tests. USS confirmed gallstones, no cholecystitis. MRCP: no CBD stones. EUS: small obstructing stone at distal CBD. ERCP successful.
Emergency operation of ICG-fluorescence guided laparoscopic cholecystectomy.
Postop uneventful. Discharged on postoperative day 1.
70yo man admitted for bowel obstruction. Physical examination revealed a non reducible right inguinal hernia. CT scan showed strangulated right inguinal hernia containing ischaemic right colon.
At operation, the hernia sac reduced spontaneously after the induction of anaesthesia. Hernioscopy revealed ischaemic right colon, not recovering after 30 minutes.
A hybrid laparoscopic and hernioscopic right hemicolectomy was performed.
Postop was uneventful. Discharged on postop day 4.
40yo man admitted for recurrent acute diverticulitis, treated conservatively in the past. Still pain and signs of sepsis after 7 days of antibiotics.
CT scan shows acute non-complicated diverticulitis of the sigmoid.
Laparoscopic sigmoid resection with primary anastomosis performed.
Patient discharged on day 3 after uneventful recovery.
Female patient admitted several times for recurrent volvulus and treated conservatively. At last admission, immediate recurrence after endoscopic de-twisting.
Emergency laparoscopic sigmoid resection with intracorporeal anastomosis despite unprepared bowel.
Some basic information on what to do in case you bleed from your back passage.
Do you need to see a doctor? If so, how urgently?
Should you be utterly concerned? If so, why?
What is a hernia? What are its symptoms?
Is a surgical operation needed in every case?
What kind of surgery?
Can a hernia be fixed by keyhole surgery?
These and many more info in this brief and informal educational video.