Atrial Fibrillation (AF) is a common problem with profound medical and economic impact. For men and women 40 years of age or older, the lifetime risk for development of AF is roughly 25% with annual costs for treatment estimated at $6.65 Billion in the United States. AF increases the lifetime risk of stroke nearly 5-fold and the development of persistent (Pe) and long-standing persistent (LSPe) AF is associated with an 8% per patient-year mortality risk. Open surgical treatment of AF
The newest generation robotic surgical system offers several unique features that make it well suited to minimally invasive ventral hernia repairs. We performed the first minimally invasive ventral hernia repair with bilateral posterior componenet separation using the new system. The presented video documents the surgery and highlights the benefits of the system.
This is a video describing the new method of treating anastomotic leaks and perforations using endoluminal vacuum therapy. This video will describe its function, development and application. In addition, the results of some of our treated patients will be shown.
Transanal minimally invasive surgery (TAMIS) is a novel technique developed as an alternative to transanal excision and transanal endoscopic microsurgery for local excision of well selected rectal neoplasms. This approach makes use of a disposable flexible transanal platform and conventional laparoscopic instruments. TAMIS application has recently been extended to total mesorectal excision (TME) for rectal cancer. TAMIS-TME is a hybrid approach where transabdominal mobilization of the left colon
A 36-year-old male with nonspecific abdominal symptoms and a 4.5 cm mass in left retroperitoneal position, incidentally found during work up.
Paranganglioma was ruled out during the preoperative workup, and a percutaneous CT biopsy demonstrated a Schwannoma.
With a minimal invasive approach, the mass was safely dissected from the retroperitoneal structures and peripheral neural pedicles, without complications.
This is a case of a 60-year-old female with a significant surgical history of a trans-diaphragmatic cardiac ablation for atrial fibrillation 9 months prior, who presented to the emergency room with shortness of breath. A CT scan of the chest was obtained which showed the greater omentum and portions of the transverse colon extending from the abdomen into the pericardium through a peritoneopericardial diaghragmatic hernia. The patient was taken to the operating room for a laparoscopic repair of t
Retroperitoneal endoscopic adrenalectomy is being increasingly utilized for small to moderate size adrenal tumors. This technique requires a thorough understanding of the retroperitoneal anatomy due to the posterior approach and different anatomic orientation. The video demonstrates the technique for retroperitoneal endoscopic left adrenalectomy with a focus on these challenges.
Mycotic superior mesenteric artery aneurysms are extremely rare. Mycotic aneurysms represent approximately 50% of all superior mesenteric artery aneurysms (SMAAs). The majority of mycotic SMAAs are associated with recent infective endocarditis. Patients may present with fever, significant and progressive abdominal pain, and a pulsatile abdominal mass. Untreated mycotic aneurysms have a reported mortality rate of up to 67%, usually due to rupture. No prior published reports of laparoscopic resect
Objective: Case report describing a novel technique in an adult patient for the performance of laparoscopic splenopexy to treat wandering spleen.
Patient Background: A 27 year old woman with amedical history significant for omphalocele presented initially for evaluation of chronic abdominal pain. She had been experiencing worsening pain over the past 3 years requiring pain medication for adequate analgesia. Her abdominal discomfort was unaccompanied by any nausea, vomiting, or obstipation sugge
The Hydatid Liver cyst is a common disease in Argentina. The aim of this video is to present the alternative options of laparoscopic surgical treatment.
We present two cases.
The first one is a 55 years old male with abdominal pain and positive serology for hydatid disease. Ultrasound and MRI reveals one Hydatid liver cyst in segment II and another in segment V.
The second case is a 30 years old male who presents abdominal pain and nausea. Hydatid Serology was positive.
Percutaneous endoscopic gastrostomy (PEG) tube placement has become one of the mainstays for enteral nutrition in patients unable to tolerate oral feedings. Complications related to PEG tube placement are typically minor, however, major complications have been reported. One unique complication related to PEG placement involves the placement of the PEG transcolonic. Treatment strategies for managing transcolonic PEG placement vary as it is a rare complication and have not been well studied.
The Objective of this video is to present how a complex case of a Bismuth-Strasberg E2 biliary injury with an associated biliperitoneum was resolved with a pure laparoscopic two-stage approach starting at postoperative day 10. The surgical team involved in this case has over 10 years of advanced HBP laparoscopic experience.
Case: A 56-year-old female to whom a laparoscopic converted to open cholecystectomy for acute cholecystitis was performed. The patient was discharged at postoperative day 3
This is a video presentation of the repair of a large band slip into a giant paraesophageal hernia. Performance of this complex operation requires the utilization of both advanced Bariatric and Esophageal Surgery techniques. There is a paucity of videos demonstrating cases of this kind.
Paraesophageal hernias (PHH) constitute approximately 5% of all hiatal hernias. Surgical management of a symptomatic PHH requires reduction of the stomach, closure of the hiatus and fundoplication. Gastric ischemia is a rare complication and difficult to manage. Prevention is the key, however a strategy must be in place if this devastating injury occurs.
This video highlights the finding of gastric ischemia, intraoperative decision-making and subsequent management.
BACKGROUND. Endoscopic Plication by POSE (Primary Obesity Surgery Endoluminal) procedure is a new endoscopic restrictive procedure. It may be indicated in patients with Grade I or II Obesity. Short term results are promising, but long term results and its efficacy in morbid obese patients it is unknown.
METHODS. This video shows two failure of weight loss after a POSE procedure in morbid obese patients. We show how a revisional bariatric surgery either to Roux-en-Y Gastric Bypass (RYGB) or Sl
The rectal cancer surgery has a risk of nerve injury. Total mesorectal excision (TME) has been a gold standard for rectal cancer surgery since 1990s by Prof healed. In this technique is complete excision of mesorectal tissue within the intact envelop of fascia propia of the rectum. Also, preservation of autonomic nerve is warranted to avoid genitourinary complication and sexual dysfunction. In the present, laparoscopic treatment is more popular and has benefit to identify the autonomic nerve by
OBJECTIVES: Peroral endoscopic myotomy (POEM) has been shown to be a new effective minimally invasive laparoendoscopic approach to achalasia. However, long-term outcomes of this procedure are yet to be determined. This is a case of a 74-year-old woman who underwent a POEM with complete resolution of dysphagia, but presented three months later with increasing gastroesophageal reflux that proved to be refractory to PPI therapy. Barium swallow demonstrated the presence of moderate spontaneous reflu
This is a video of a laparoscopic gastric bypass in a morbidly obese male with unknown intestinal nonrotation at the time of surgery. In order to complete the operation, lysis of Ladd’s bands and other abnormal adhesions was required. Due to the abnormal anatomy of the individual an appendectomy was also performed.
Today we discuss a patient with heterotaxy syndrome who presented for sleeve gastrectomy. She had a prior cholecystectomy at which situs inversus was noted, so CT scan was obtained for operative planning. We see dextrocardia with a left sided liver noting a prominent right lobe. We see the right sided gastric body without the normal duodenal sweep; we also note right sided polysplenia.
This guided trocar placement with a mirror image approach: we placed the 12mm trocar in the left upper quadran
Major injury to the common bile duct is a well-known complication of a cholecystectomy procedure. Because of the altered anatomy, procedures of the fore-gut after biliary reconstruction present a surgical challenge. Open Roux-en-Y gastric bypass following Roux-en-Y pancreaticojejunstomy has previously been described by Timmermans, et al. We report a case of laparoscopic Roux-en-Y high divided gastric bypass after Roux-en-Y hepaticojejunostomy and describe the operative technique and follow up.
The need for exploration of a patient who has had a Biliopancreatic Diversion with Duodenal Switch (BPD-DS) may present a challenge to surgeons who are not familiar with the procedure. We present a systematic approach to identification and reduction of internal hernia in a patient with BPD-DS.
Introduction: Intestinal malrotation is a congenital anomaly that results from inadequate rotation of the midgut during fetal development between weeks 5 and 12 of gestation. The incidence is 1 every 6000 live births. We present a case of intestinal malrotation incidentally found during gastric bypass surgery.
Description of contents: This was a 35 yo male, with BMI 43, referred to our clinic for the treatment of obesity. He did not have any comorbidities, and his past surgical history was nega
Intestinal malrotation (IM) occurs once in every 500 births. It can be a challenging situation to deal with while doing an anastomotic bariatric procedure, especially because it is discovered during the preoperative work-up of a bariatric patient. We describe a totally robotic duodenal switch (DS) performed for a patient in whom IM was detected intra-operatively.
The patient was 68 year old with a body mass index of 45 kg/m2. On initial laparoscopic survey, the cecum and te
The timing of the onset of dysphagia post Roux-en-Y gastric bypass usually helps determine the cause and therefore the treatment of the dysphagia. Dysphagia arising immediately after the procedure is usually due to edema and resolves spontaneously. When it begins 1-3 days after surgery, a mechanical reason should be suspected and treated. When the patient takes fluids for a week, is advanced to a soft diet but then develops dysphagia, the most common cause is stenosis. The dysphagia is diagnosed