 In this section of our website we present videos of laparoscopic procedures reviewed for their quality and filtered to meet the highest scientific standard. The videos are selected from video sharing services such as youtube and google videos.
A short description of the procedure is presented for each case along with interesting remarks and teaching points.
For questions and/or comments please communicate with Matthew E. Falagas, MD, MSc, DSc, at m.falagas@aibs.gr or with Vangelis G. Alexiou, MD at administrator@e-meducation.org
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Laparoscopic Nephrectomy |
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Description:
Indications for nephrectomy include kidney cancer, severe trauma to the kidney and benign disease such as symptomatic hydronephrosis, chronic infection, polycystic kidney disease, shrunken kidney, hypertension or renal calculus. The most common type of kidney cancer is renal cell cancer. Other types include Wilm’s tumour (a childhood cancer) and transitional cell cancer.
The standard treatment for an irreversibly damaged kidney or localised kidney cancer is an open nephrectomy. Under general anaesthesia, the kidney is removed through a large incision that may be made in the side of the body, in the front of the abdomen or in the back. A simple nephrectomy is the removal of just the kidney whereas a radical nephrectomy also involves the removal of the adrenal gland and sometimes the lymph nodes.
A laparoscopic nephrectomy is performed under a general anaesthetic. Three or four small abdominal incisions are made in the abdomen to provide access for surgical instruments that are used to detach the kidney and to ligate the blood vessels. The intact kidney is enclosed in a bag and removed through an incision or it may be placed in an impermeable sack, morcellated and removed through one of the port sites.
Hand-assisted laparoscopic nephrectomy allows the surgeon to place one hand in the abdomen while maintaining the pneumoperitoneum required for laparoscopy. A small incision is made which is just large enough for the surgeon’s hand and an airtight ‘sleeve’ device is used to form a seal around the incision. At the end of the procedure, the intact kidney can be removed through the same incision.
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Laparoscopic Ventral Hernial repair |
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Description:
The principle of surgical repair entails the use of prosthetic mesh to repair large defects in order to minimize tension on the repair. A tension free repair has a lesser chance of hernia recurrence. Traditionally, the old scar is incised and removed, and the entire length of the incision inspected. Generally, there are multiple hernia defects other than the one(s) discovered by physical examination. The area requiring coverage is usually large and requires much surgical dissection. A prosthetic mesh is used to cover the defect(s), and the wound closed. This is a major surgical procedure and often complicated. Infection rates following repair may be as high a 7.0%. Recurrence can be up to 5%, or higher, depending on the patient’s preoperative risk factors. While the use of prosthetic mesh has decreased the number of recurrences, it has also been implicated in increased infection rates, adhesion or scar formation of the abdominal contents to the anterior abdominal wall leading to intestinal obstruction and fistula formation. However, overall, recovery is usually excellent and patients return to normal activity within a matter of weeks.
The laparoscopic repair of ventral hernias was designed to minimize operative trauma to the patient. As mentioned, these are often complicated repairs requiring large incisions and extensive tissue dissection. The principles governing a laparoscopic ventral hernia repair are based on those of open Stoppa ventral hernia repair. A large piece of prosthetic mesh is placed under the hernia defect with a wide margin of mesh outside the defect (see figure). The mesh is anchored in to place with eight full thickness sutures and secured to the anterior abdominal wall with a varying number of tacs, placed laparoscopically.
A patient is a candidate for laparoscopic incisional hernia repair if they are medically able to undergo general anesthesia. Also, the defect must "allow" the surgeon to place the laparoscopic trocars in such positions that repair are ergonomically possible. In some very large or giant hernias, the abdominal wall is distorted to such a degree that it is impossible to safely place laparoscopic trocars. Ancillary studies, such as CT scan of the abdomen and pelvis are helpful in making this decision. Patients are also given a bowel preparation to evacuate the colon and decrease the number of intestinal bacteria prior to surgery.
To learn more for the techniques In laparoscopic Ventral Hernia repair download the detailed pdf from Gore medical
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Laparoscopic Appendectomy |
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The advent of high definition video-laparoscopy has transformed the laparoscopic appendectomy into an elegant, reliable procedure which can be easily performed. Laparoscopic appendectomies can be completed within 20 to 30 minutes. Most cases of acute appendicitis can be treated laparoscopically. The first reported laparoscopic appendectomy was done in 1982. The main advantages are:
- Less post-operative pain
- Faster recovery and return to normal activity
- Shorter hospital stay
- Less post-operative complications
- Minimally sized incisions
Laparoscopic appendectomies and open appendectomies are comparable for complications, postoperative pain control, length of hospitalization, and recovery time. However patients who undergo an open appendectomy have a shorter operative time and lower operating room and hospital charges. Laparoscopic appendectomy has gained acceptance more slowly than laparoscopic cholecystectomy, perhaps because the advantages are much less clear-cut over the open procedure.
To read in detail about the technique used click here
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