Rectal cancer with invasion of adjacent pelvic organs is uncommon and poses significant operative challenges. Multimodal treatment combining neoadjuvant therapy and precise surgical technique is often required to achieve negative margins while preserving function.
We present a video of an 80-year-old female with low rectal adenocarcinoma (ypT4bN0M0) invading the posterior vaginal wall following chemoradiotherapy. A laparoscopic abdominoperineal resection with en bloc partial vaginectomy was performed, followed by reconstruction using a left gracilis myocutaneous flap. The minimally invasive approach provided excellent pelvic exposure and facilitated accurate dissection despite post-radiation fibrosis.
The patient had an uneventful postoperative recovery and was discharged on postoperative day 14 with no complications. Pathology confirmed R0 resection with no nodal involvement. At 6-month follow-up, the patient remained disease-free with satisfactory functional recovery.
This case demonstrates that, in selected patients and experienced centers, laparoscopic APR combined with reconstructive techniques offers a safe and effective option for locally advanced rectal cancer invading the vagina.
Contributors: Marco P. Fisichella
65 year old man who underwent a laparoscopic Nissen fundoplication in August 2015. Preoperative manometry was normal and DeMeester score was 25. Two months later he began to experience difficulty of swallowing solid foods, then liquids. After 2 dilatations, dysphagia persisted.
DOI#: http://dx.doi.org/10.17797/egw2097cpq
Referred By: Jeffrey B. Matthews
Contributors: Reza Salabat and Marco P. Fisichella
Preoperative work-up and surgical technique of laparoscopic paraesophageal hernia repair.
DOI#: http://dx.doi.org/10.17797/c2kvm64ru5
Contributors: Bestoun Ahmed
Spleen preservation is advisable if feasible during distal pancreatectomy for benign pancreatic tumors. A 31 year old patient had a blunt abdominal injury. Computed Tomography (CT) scan showed an incidental tumor in the body of the pancreas. EUS-guided cytology revealed a solid pseudopapillary tumor with benign features.This video demonstrates the technical details during a minimally invasive excision of a rare tumor of the pancreas in a male patient. Very few cases have been reported in males.
Editor Recruited By: Jeffrey B. Matthews, MD
DOI: http://dx.doi.org/10.17797/cc7ot3ymd8
Contributors: Justin A. Maykel MD
The following video demonstrates a laparoscopic sigmoid colectomy for the treatment of complicated sigmoid diverticulitis. The patient was initially managed with intravenous antibiotics and allowed three months for the acute inflammatory process to resolve. Subsequently she was taken to operating room electively for an uncomplicated sigmoid colectomy with a primary anastomosis.
DOI: http://dx.doi.org/10.17797/xq6fosqsh3
Editor Recruited By: Jeffrey B. Matthews, MD
Contributors: Amy D. Lu and Diego Di Sabato
A right hepatic lobectomy with laparoscopic mobolization and division of the short hepatic veins and intraparenchymal division of the vasculature is depiected in this video.
Editor Recruited By: Jeffrey Matthews, MD
DOI: http://dx.doi.org/10.17797/i04zpfb2x3
Contributors: Anahita Jalilvand and Marco P. Fisichella
This video describes a laparoscopic-extracorporeal repair with mesh of a Morgagni diaphragmatic hernia in an 81 year old female.
We used Ventralight™ ST Mesh which is an uncoated lightweight monofilament polypropylene mesh on the anterior side with an absorbable hydrogel barrier based on Sepra® Technology on the posterior side for laparoscopic ventral hernia repair. The posterior side mesh does not cause adhesion with the abdominal organs.
DOI: https://doi.org/10.17797/k8ktfjncgn
A quick review of the literature of laparoscopic cases has shown that in a substantial amount of cases the hernia was reduced and the defect repaired with mesh placement without hernia sac resection . Therefore, non-resecting the sac is an acceptable option.
Contributors: Marco G. Patti
Laparoscopic Heller Myotomy and Anterior Partial Fundoplication
DOI: http://dx.doi.org/10.17797/m5v0f8xzp3
Contributors: Marco P. Fisichella
Laparoscopic Heller myotomy and Dor fundoplication for a patient with type 2 achalasia.
DOI: http://dx.doi.org/10.17797/seyyttx9lk
