Lateral abdominal wall hernias refer to structural weaknesses in the muscles and fascia along the side of the abdomen. These defects are relatively rare and can be challenging to diagnose due to their location and often subtle presentation. Patients may experience localized pain or discomfort.
The aim of this presentation is to describe a case of a patient with a lateral Spigelian hernia and to demonstrate a minimally invasive technique for its correction.
We present the case of a 70-year-old male with a presacral tumor known to be recurrent prostate cancer with an operative plan of a low anterior resection versus abdominoperineal resection. Intraoperatively, the presacral tumor was adherent to both the sacrum and rectum. Careful dissection of the tumor off of the sacrum allowed for full mobilization of the colon and rectum, which in turn allowed for a stapled coloanal anastomosis with preservation of the sphincter complex and restoration of function.
We present a case of a 60-year-old male with low-lying rectal cancer initially staged as a T4b tumor with concern for seminal vesicle invasion. A multidisciplinary decision was made to proceed with a jejunal-sparing operation, resecting only the seminal vesicles to preserve urinary continence. The anatomy of the Denonvilliers’ fascia remains controversial, with important implications for the surgical management of rectal cancers affecting adjacent urogenital structures. The anterior and posterior layers of the Denonvilliers’ fascia were successfully dissected, preserving the seminal vesicles and prostate. Pathology confirmed a mucinous adenocarcinoma with negative margins, and the patient is scheduled for ileostomy reversal. This case highlights how meticulous robotic-assisted dissection of the Denonvilliers’ fascia can avoid the need for urostomy and colostomy, preserving urinary function and demonstrating the potential benefits of improved anatomical understanding in pelvic surgery.
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 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.
In this video we present the case of a 98 year old chinese gentleman who presented to the emergency department for 2 days of painful right groin lump. He has a history of bilateral inguinal hernia for many years, but declined surgery. Otherwise, his past medical history includes degenerative disc disease, osteoporosis and hearing impairment. On presentation, he was able to tolerate oral feeding with no nausea or vomiting and still able to pass stools. On examination, there was a large and tender right irreducible inguinal hernia with overlying erythema and warmth. There was also a small left inguinal hernia that was reducible. CT Abdomen-Pelvis was done and showed an incarcerated right inguinal hernia containing a loop of sigmoid colon with poor enhancement of the bowel wall. The colon proximal to the incarcerated segment was also mildly dilated.
Patient underwent urgent repair of the strangulated right inguinal hernia via laparoscopic, transabdominal preperitoneal (TAPP) approach. Intra-operatively, a loop of sigmoid colon was incarcerated within a direct right inguinal hernia. A small colotomy had to be made to decompress the incarcerated loop in view of difficulty in reducing the sigmoid colon. After reduction, the incarcerated segment was gangrenous and non-viable requiring sigmoid colectomy with primary anastomosis. Pantaloon inguinal hernias with femoral hernias were seen over bilateral groins. An Ultrapro 10x15cm composite mesh was inserted over bilateral groins with adequate medial overlap ensured.
The operation took three hours and fifty minutes with minimal blood loss. Drain was removed and feeding was escalated to diet on post-operative day four. Patient was able to pass stools and then discharged on post-operative day six. His case was complicated with a small 2cm seroma at the right groin.
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.
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.
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.
This video demonstrates how to place the pelvic binder quickly and correctly, which may be life-saving in cases of pelvic ring fractures with associated potential massive bleeding. Proper pelvic binder placement technique requires attention to some details, including the 5Ps (pulses, penis, pockets, pain and pulses), horizontal force application in opposing vectors and ensuring the pelvic binder is locked.
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