Robot-Assisted One Anastomosis Gastric Bypass: 10 Steps Standardized Technique

Step into the world of advanced surgical procedures with our comprehensive video on Robot-Assisted One Anastomosis Gastric Bypass. This meticulously edited video guides you through each of the 10 standardized steps employed in our high-volume surgical unit, showcasing a state-of-the-art approach to gastric bypass surgery. The steps are:

Treitz Ligament Identification;
Biliary Loop Measurement;
His angle dissection;
Lesser Sac Opening;
Gastric Pouch Creation;
Gastrojejunostomy;
Gastrojejunostomy Fixation;
Methylene Blue Test;
Alimentary Loop Fixation;
Petersen Defect Closure.

This video provides an invaluable resource for surgeons, medical professionals, and enthusiasts interested in the intricacies of Robot-Assisted One Anastomosis Gastric Bypass. Our standardized technique aims to contribute to the advancement of knowledge and skills in the field of bariatric surgery. Embrace innovation and precision in every step of this transformative surgical journey.

Laparoscopic Low Anterior Resection – A Stepwise Approach

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 imperative.

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 15 cm from the anal verge, occupying ~1/2 of the lumen. Biopsy and distal tattooing were performed. Pathology study confirmed the presence of a moderately differentiated adenocarcinoma.
The CT-scan showed no lung or liver metastasis. MRI revealed an upper rectal cancer, 11.4 cm from the anal verge, with no pathological lymph nodes, staged as cT2 N0 Mx CRM-.

After discussion in a multidisciplinary meeting, a laparoscopic anterior rectal resection was proposed.

By segmentation of the surgery into well-organized stages, this video demonstrates all the important technical steps to fasten the learning curve and master the procedure without compromising the oncologic principles.

LAPAROSCOPIC HEPATIC S5-6 SEGMENTECTOMY FOR BLEEDING HCC

A 75-year-old male with history of chronic HCV- related hepatitis, in regular follow-up and sustained viral response (SVR), presented at our Emergency Department for sudden epigastric pain. Urgency CT scan and subsequent abdominal MRI revealed a 2,5cm monofocal HCC in S5 with surrounding hepatic hematoma (7cm of extension) and hemoperitoneum layer. The procedure consisted in laparoscopic exploration, lysis of tenacious adhesions between hepatic hematoma and the right colic flexure, intraoperative ultrasound to assess tumor extension, preparation of Pringle Maneuver and parenchyma transection with ultrasound dissector combined with colecistectomy.

Laparoscopic Coledocoscopy

A 47-year-old male, with a history of multiple cholelithiasis and multiple choledochal lithiasis, who presented with multiple episodes of cholangitis for which endoscopic treatment (ERCP + stenting) was performed. After 4 unsuccessful attempts to resolve the bile duct by endoscopic approach, it was decided to perform minimally invasive laparoscopic surgery. 

In this video we can observe the Choledochotomy, followed by extraction of stones and biliary mud. Subsequently, a choledochoscopy is performed with the laparoscopic camera (10 mm) with infusion of sterile Physiological Solution since the patient had a very dilated bile duct. Choledochorrhaphy is then performed.

Rectovaginal Fistula Repair with a Vascularized Gracilis Muscle Interposition Flap

The surgical management of rectovaginal fistulas remains difficult, as they tend to be recurrent and vary widely in location and complexity. We present a case of a 63-year-old woman with a low-lying rectovaginal fistula who initially underwent chemoradiation and a Low Anterior Resection for a low-lying rectal cancer. Her course was uneventful until two years post-operatively, at which time her anastomotic staple line became stenotic with associated bleeding. This was initially addressed by Gastroenterology who executed a dilation and achieved hemostasis with Argon Plasma Coagulation. This remedied the stenosis, however, it was complicated by the formation of a rectovaginal fistula. Due to the low-lying location and its presence in an irradiated field, a transvaginal approach with an interposed gracilis flap was elected for repair.

A Novel Technique for Reconstruction of Right and Left Hepatic Arteries in Pancreaticoduodenectomy

A 55yo lady undergoing open pancreaticoduodenectomy for duodenal adenocarcinoma was intra-operatively found to have macroscopic tumour involvement of the proper hepatic artery and its bifurcation. The diseased segment was resected and a novel technique for reconstruction was performed- the remnant common hepatic artery was anastomosed to the remnant right hepatic artery, and the left gastric to the remnant left hepatic artery. Doppler ultrasound confirmed  patency of all anastomoses prior to closure. Synthetic function of the liver and bilirubin recovered to appropriate levels postoperatively, and the patient was planned for adjuvant chemotherapy.

Reoperative Laparoscopic Anti-Reflux Surgery

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

LINX Procedure for GERD

This video depicts the procedure for the implantation of a LINX implant for augmentation of the LES for refractory GERD.

DOI:http://dx.doi.org/10.17797/69av5w723r

Editor Recruited by: Dr. H. Leon Pachter

Laparoscopic Paraesophageal Hernia Repair

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

Laparoscopic Portal Vein Resection

Key aspects of vascular isolation and control for en bloc PV resection during laparoscopic whipple.  Xenograft vein patch is used for reconstruction

DOI: http://dx.doi.org/10.17797/ee9p182opy

Editor Recruited by: H. Leon Pachter

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