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LL Swanström (United states) / A D'Urso (France) / J Marescaux (France)
36:15 - 2014 Nov
Gastroesophageal reflux (GERD) is a common and almost endemic problem in the Western world. Laparoscopic anti-reflux surgery is an effective and durable treatment for GERD in patients who are well-selected. Selection depends on a careful assessment of symptoms and a thorough physiologic evaluation with endoscopy, pH-monitoring and esophageal manometry. In more advanced and difficult cases, additional tests may be indicated. Cases encountered in practice range from straight forward and "everyday" to extremely complex and difficult; both in the decision-making, the operation, and the patient management. The common thread between all cases of anti-reflux surgery, complex or simple, is a stepwise and organized approach that takes into consideration the individual patient's disease and physiology. We present a case in this video that is not complex but which provides a good illustration of the technical steps required to recreate an effective gastroesophageal valve. We emphasize an atraumatic and efficient approach to the operation that ensures optimal outcomes and will minimize intraoperative complications. We discuss the characteristics of a properly formed fundoplication and debate with other experts some of the minor technical details such as suture patterns and materials. We also show how intraoperative endoscopy can serve as a powerful tool for quality control and postulate that surgeons can improve their results if they adopt routine interoperative control by endoscopy. We hope that you will enjoy and benefit from this case…

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L Marx (France) / S Tzedakis (France) / S Perretta (France) / B Dallemagne (France) / J Marescaux (France)
26:00 - 2014 Nov
To date, the surgical treatment of morbid obesity has been well standardized. Preoperative work-up in its whole (using radiology and endoscopy) helps us to demonstrate anatomical anomalies requiring specific surgical interventions. Here, we present the case of a morbidly obese female patient with a BMI of 46. A voluminous hiatal hernia was found during the preoperative work-up. A laparoscopic Roux-en-Y gastric bypass combined with hiatal hernia repair is indicated.

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M Vix (France) / J Marescaux (France)
20:19 - 2014 Oct
After gastric band removal, a laparoscopic Roux-en-Y gastric bypass is rendered more difficult by the existence of adhesions between the liver, the superior part of the stomach, and potentially the spleen. This video describes how to handle difficulties in dissecting the superior part of the stomach. Dissection of the cardia and left crus are required to allow for an appropriate calibration of the gastric pouch. The difficulty is subsequently increased in this patient as there are dense small bowel adhesions related to a previous history of gynecologic peritonitis. The intervention has been entirely performed laparoscopically. Small bowel adhesions have been taken down in order to obtain a sufficient free length (approximately 2 meters) and perform a jejunojejunostomy in adequate conditions.

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P Pessaux (France) / J Teyssedou (France) / D Ntourakis (France) / M Vix (France) / J Marescaux (France)
09:22 - 2014 Sep
We report the case of a 43-year-old male patient who was diagnosed with insulinoma and had a robotic enucleation of an isthmic pancreatic tumor in November 2012. However, the patient presents with clinical recurrences of hypoglycemia 18 months later. Re-evaluation studies demonstrated a local recurrence. A laparoscopic central pancreatectomy was indicated. The procedure started with the opening of the lesser sac. The splenic vessels were dissected and controlled. A retropancreatic passage along the venous mesenterico-portal axis was performed. Ultrasonography was carried out to assess the pancreatic recurrence area. The pancreas isthmus was transected. A pancreaticogastric anastomosis was performed at the posterior aspect of the stomach. The resected specimen confirms the recurrence of an insulinoma, which has been entirely removed.

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LL Swanström (United states) / S Perretta (France) / B Dallemagne (France) / J Marescaux (France)
19:23 - 2014 Jul
POEM (PerOral Endoscopic Myotomy) is an emerging technique for the treatment of esophageal achalasia. Introduced in 2011 by Doctor Inoue, this technique consists in a selective myotomy of the inner circular muscular layer of the esophageal wall. Access to the muscular wall is achieved by an incision of the esophageal mucosa and by a submucosal tunneling, the closure of which must be performed at the end of the procedure, in order to ensure patency. Three years later, this intervention proves to offer clinical results comparable to conventional surgical techniques.

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P Pessaux (France) / D Ntourakis (France) / M Shen (France) / J Marescaux (France)
10:25 - 2014 Jun
We report the case of a 73-year old patient presenting with a Child-Pugh class A5, post-viral B cirrhosis, with no portal hypertension in which a laparoscopic left lateral sectionectomy is performed for hepatocarcinoma. Four ports are placed. Parenchymal transection is marked approximately 1cm to the left of the falciform ligament and parenchymal transection is initiated. With intermittent clamping, hepatotomy is performed painstakingly and progressively, and every vascular or biliary structure that one comes across is either clipped, or coagulated. The specimen is extracted using a suprapubic Pfannenstiel’s incision. Pathological findings confirm the presence of a hepatocarcinoma on a cirrhotic liver. No drainage was used. The postoperative outcome was uneventful. The patient was discharged on postoperative day 6.

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B Dallemagne (France) / S Perretta (France) / LL Swanström (United states) / J Marescaux (France)
41:35 - 2014 May
Intrathoracic migration of the fundoplication is one of the most common causes of failure after antireflux surgery. When the patient develops symptoms related to the volume of intramediastinal hernia, the only option is to reoperate. Such redos are complex and necessitate a thorough and painstaking approach to the potential underlying mechanisms causing intrathoracic migration, namely the length of the esophagus and cruroplasty.

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B Dallemagne (France) / S Perretta (France) / D Ntourakis (France) / J Marescaux (France)
38:24 - 2014 Apr
Paraesophageal hernia (PEH) repair is challenging. Repositioning of the herniated stomach, and occasionally other organs, must also include reduction of the hernia sac in order to diminish the risk of recurrence. Recurrence is also linked to the type of crural repair performed, some authors advocating the systematic use of prosthetic or biological reinforcement. Reinforcement is not without risks (stenosis, erosion, migration). In this video, we present a PEH repair and cruroplasty protected with a temporary absorbable reinforcement material.

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D Mutter (France) / M Ignat (France) / J Marescaux (France)
17:11 - 2014 Feb
A patient was admitted with dysphagia, nausea and postoperative vomiting. These symptoms were associated with a more typical GERD. Exploration demonstrated the presence of a rare disease: a gastric diverticulum. It was typically located at the upper and posterior part of the greater curvature of the stomach. A typical GERD disease was demonstrated by pH-monitoring. It was proposed to manage both diseases simultaneously by laparoscopic resection of the diverticulum and Nissen fundoplication.

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J Leroy (France) / A Melani (Brazil) / J Marescaux (France)
33:07 - 2014 Jan
Dr. Armando Melani beautifully demonstrates a laparoscopic sigmoidectomy technique for a benign diverticular condition. He provides tips and tricks to perfectly expose the operating field and recommends an extensive approach to the left colon with primary mobilization of the splenic flexure using a posterior medial approach with a late vascular approach. The technique and its performance is amply discussed by the panel of experts present, hence providing a very instructive demonstration. The operator also discusses the different types of energy devices available as well as the tricks to safely perform an upper colorectal anastomosis. This film provides plenty of detailed information for beginners and experts alike to allow them to perform a laparoscopic sigmoidectomy in a perfect fashion.

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F Corcione (Italy) / J Leroy (France) / J Marescaux (France)
29:11 - 2013 Dec
In this video, the author demonstrates the possibilities of an laparoscopic oncologic approach to perform a right colectomy in an obese patient. After a primary vascular approach, the colon is freed from its posterior and lateral attachments prior to being resected. The intracorporeal anastomosis is beautifully described and substantiated here. Finally, the author underlines the benefit of using dissection instruments recently developed by the medical device Industry (Sonicision™, V-Loc™, and Tri-Staple™ Technology by Covidien).

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J Leroy (France) / J Marescaux (France)
21:56 - 2013 Nov
The objective of this video is to demonstrate a sigmoid colectomy technique for a diverticular sigmoiditis with a transanal extraction of the resected colonic segment. The goal of this video is to demonstrate the feasibility of this technique by means of only 3 trocars to further reduce parietal damage. The author reveals his tips and tricks for a perfectly standardized minimally invasive operative technique. In addition to colonic extraction, the different stages of mechanical anastomosis are perfectly outlined. This team recommends that this type of intervention should be used for benign pathologies.

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B Dallemagne (France) / S Perretta (France) / J Marescaux (France)
27:11 - 2013 Oct
This video describes an esophagectomy performed laparoscopically and thoracoscopically in a 53-year-old male patient presenting with an epidermoid esophageal carcinoma. The patient had previously undergone neoadjuvant chemoradiotherapy with poor results. Restoration of digestive continuity was achieved through an intrathoracic esophagogastric anastomosis once the stomach has been tubulized. This intervention was complicated by a delayed anastomotic fistula which was treated by endoscopy combined with percutaneous drainage.

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B Dallemagne (France) / S Perretta (France) / J Marescaux (France)
19:24 - 2013 Sep
Currently, endoscopic submucosal dissection (ESD) is considered the first therapeutic option in the treatment of superficial cancer developed on Barrett’s metaplasia. There is no formal recommendation as to the treatment of associated gastroesophageal reflux. In this video, we show a fundoplication performed in a patient who benefited from an ‘en bloc’ resection of a pT1a Barrett’s esophagus adenocarcinoma one year earlier.

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B Dallemagne (France) / D Mutter (France) / L Soler (France) / J Marescaux (France)
35:53 - 2013 Sep
Insulinoma is the most common functional neuroendocrine tumor of the pancreas. Most insulinomas are benign and solitary. Surgical resection is preferred for insulinomas and cure is achieved in more than 90% of the patients. Successful surgery requires accurate localization based on contrast enhanced CT-scan, PET-scan, and intraoperative ultrasound. This video shows a laparoscopic left pancreatectomy in a young patient presenting with typical symptoms evocative of Whipple's triad. Preoperative imaging studies identified two pancreatic tumors. Laparoscopic exploration and ultrasound identified four distinct tumors, all of them expressing somatostatin and insulin. This clinical case highlights the necessity and value of ultrasound exploration during surgery for neuroendocrine tumors.

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B Dallemagne (France) / S Perretta (France) / J Marescaux (France)
31:15 - 2013 Jun
Nissen fundoplication is the most commonly performed antireflux operation. An alternative is the partial fundoplication, either anterior or posterior to the esophagus, which provides adequate control of reflux. The anterior valve is effective, provided that it is properly constructed. It is not a simple fundic plication but it implies precise dissection parameters to create an effective antireflux mechanism. This video shows a redo fundoplication in a patient with an anterior fundoplication that never controlled GERD, because it was built as a simple fundic plication. This cause of failure is typical in inexperienced surgeons, who are afraid of doing a posterior dissection of the gastroesophageal junction. The video also demonstrates the management of a peri-splenic hemorrhage.

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A Talvane Torres de Oliveira (Brazil) / C Lacerda (Brazil) / PA Bertolucci (Brazil)
25:53 - 2013 Jun
Total gastrectomy with D2 lymphadenectomy is recommended for T1-T2 gastric cancer. The laparoscopic approach for this procedure has been validated by extensive clinical randomized trials in Asia, leading to fewer postoperative complications and morbidity and identical oncological outcome. This video presents a laparoscopic total gastrectomy with D2 lymphadenectomy in a 54-year-old woman presenting with a T1-T2 poorly differentiated adenocarcinoma of the lesser curvature of the stomach. Due to the location of the tumor, lymphadenectomy of stations 10 and 11d are not performed. An original technique of circular eso-jejunal anastomosis is described.

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A Talvane Torres de Oliveira (Brazil) / C Lacerda (Brazil) / PA Bertolucci (Brazil)
40:40 - 2013 May
In the first description of Laparoscopic PancreaticoDuodenectomy (LPD) by Gagner and Pomp in 1994, the authors reported the technical feasibility of the procedure, but questioned its advantages as compared with the open approach. Recent reports on large series of LPD demonstrated that the procedure might not only be feasible, but that it might have advantages as compared with open pancreaticoduodenectomy. Blood loss, ICU length of stay and overall hospital length of stay were shorter in the LPD group at the cost of significantly higher operative times. This video demonstrates a full LPD performed for a malignant ampulloma. All major steps of the procedure are extensively and clearly demonstrated.

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J Leroy (France) / D Ntourakis (France) / D Mutter (France) / J Marescaux (France)
16:04 - 2013 Apr
The objective of this video is to demonstrate the laparoscopic management of complicated sigmoiditis. A persisting chronic abscess between the sigmoid loop and the bladder does not represent a contraindication to this minimally invasive approach. The authors outline the different technical points that will allow to resect the rectosigmoid and control the abscessed area as well as the bladder wall.

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B Dallemagne (France) / S Perretta (France) / S Mandala (France) / J Marescaux (France)
26:11 - 2013 Apr
GISTs are rare neoplasms that account for less than 1% of all gastrointestinal malignancies. GISTs have the capability to become malignant and then metastasize, whereas leiomyomas are almost invariably benign. In clinical practice, preoperative differentiation between GISTs and leiomyomas is usually difficult, even if EUS-guided fine-needle aspiration or trucut biopsy is performed. Leiomyomas are rare in the stomach and duodenum while GIST are more frequent in the stomach. This patient presented with a 6cm submucosal tumor below the gastroesophageal junction. This video demonstrates the stepwise laparoscopic approach taking into consideration the potentially (pre-)malignant nature of the tumor.

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KD Higa (United states)
26:14 - 2013 Mar
In this highly educational live video, Dr. Kelvin Higa demonstrates a laparoscopic Roux-en-Y gastric bypass using a hand-sewn gastrojejunal anastomosis. This technical maneuver seems extremely simple. However, it necessitates great dexterity and reflects long experience. All operative steps are organized around a rigorous strategy where nothing is left to chance. This video demonstrates the perfect command of all technical steps.

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J Leroy (France) / L Marx (France) / J Marescaux (France)
14:20 - 2013 Mar
Sigmoiditis complicated by the presence of chronic sigmoido-vaginal fistula has become increasingly rare. Its laparoscopic management has long been considered to be a contraindication. This film demonstrates that surgery is feasible and a laparotomy can be avoided as the extraction of the sigmoid colon and the anastomosis are performed transvaginally. The outstanding quality of HD images enhances the visualization of all anatomical structures.

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B Dallemagne (France) / S Perretta (France) / J Marescaux (France)
22:02 - 2013 Mar
This video shows a live broadcast demonstration of a Nissen fundoplication for gastroesophageal reflux disease. The different steps of the operation are commented upon and interaction between the surgeon and the audience of the Insubria International Summer School in Varese (Italy) provides additional information on the use of mesh, choice of the antireflux procedure, materials, etc.

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D Mutter (France) / J Marescaux (France)
23:26 - 2013 Feb
Laparoscopic cholecystectomy in cirrhotic patients may be associated with several difficulties. These include a more difficult mobilization of the rigid fibrotic liver as well as the increased risk of bleeding due to associated portal hypertension. This video shows that the mere respect of basic rules for the performance of a cholecystectomy allows to safely manage associated problems. Child A cirrhosis is not a contraindication for the laparoscopic approach to the gallbladder.

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J Leroy (France) / D Ntourakis (France) / J Marescaux (France)
18:34 - 2013 Feb
The authors demonstrate how to perform a transanal total mesorectal excision using the TEO® device (Karl Storz) as well as a hemorrhoid stapler in a stepwise manner. This pure transanal approach was performed because of a suspicion of a T2 lesion on a large villous rectal tumor at 10/12 cm from the anal verge. The originality of the technique is shown with exceptional quality views during the posterior and lateral mobilization of the root of the sigmoid mesocolon. A mechanical side-to-end pure transanal coloanal anastomosis is also perfectly shown.

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J Leroy (France) / J Marescaux (France)
09:37 - 2013 Feb
For the authors of this film, the objective is to present the tips and tricks of their laparoscopic repair for rectal prolapse with elytrocele and rectocele. The procedure is outlined in a stepwise fashion and explained meticulously.

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D Mutter (France) / J Marescaux (France)
21:48 - 2013 Jan
A 50-year-old patient was admitted in an emergency 8 days ago for spontaneous hematomas, consciousness disorders and mucosal bleeding. Diagnosis of acute thrombocytopenia was established (1000 platelets/mm3). Medical treatment was started, including transfusion of platelets, gammaglobulins, corticosteroids) but the platelet count never went over 10,000 and after 2 days, it fell down again at 1000 platelets. It was decided to rapidly perform a splenectomy. The patient has a BMI of 30. The size of the spleen was estimated at 12cm. A laparoscopic approach was proposed.

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J Leroy (France) / J Marescaux (France)
27:07 - 2013 Jan
The authors demonstrate their technique of laparoscopic total colectomy indicated for T3 tumors of the right transverse colon in a 40-year-old man with a family history of Lynch syndrome. Colonoscopy performed 3 years earlier ruled out the presence of polyps. Due to the tumor's invasiveness and the necessity to perform repeated endoscopic monitoring, it was decided to perform a total colectomy. The intervention is begun to the right and is completed to the left making sure to avoid any tumor manipulation. The different steps of the procedure are clearly outlined with images of outstanding quality. The vascular approach, especially to the right along the superior mesenteric axis, is beautifully exposed.

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B Dallemagne (France) / C Lacerda (Brazil) / A Melani (Brazil)
14:48 - 2012 Dec
Laparoscopic Common Bile Duct (CBD) clearance for stones can be performed through the cystic duct or through a choledochotomy, the choice being mainly guided by the size of the CBD stone as well as the size of the cystic and common bile duct. In this young patient with an enlarged CBD and multiple large stones, we have opted for a choledochotomy assisted with intraoperative choledochoscopy. Direct closure of the choledochotomy was protected by an internal drainage, thanks to the repositionning of an endoscopic stent that was used during emergency ERCP biliary drainage.

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M Vix (France) / A D'Urso (France) / J Marescaux (France)
22:47 - 2012 Dec
Gastric bypass is a standard procedure in bariatric surgery. Indeed, all operative steps can be standardized, hence improving the performance of the procedure and its teaching. Here, we present a technique adapted from a simplified gastric bypass procedure demonstrated by Dr. Almino Ramos in Brazil. The interest of this technique lies in its reproducibility. The different steps can be easily standardized and can then be applied to patients of almost all body types. No detail should be overlooked. Standardization takes place as soon as trocars have been placed, until they are removed.

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D Mutter (France) / J Marescaux (France)
19:23 - 2012 Dec
A young lady was admitted for acute pain in the left hypochondrium. She has no significant past medical history, and no trauma. Imaging studies demonstrated the presence of a heterogeneous splenic cyst of 17cm in diameter. The diagnosis of hemorrhagic cyst with potential infection was established and the patient was scheduled for a laparoscopic splenectomy.

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B Dallemagne (France) / S Perretta (France) / J Marescaux (France)
25:14 - 2012 Nov
Obesity has long been considered a predisposing factor for gastroesophageal reflux. It is also thought to predispose patients to a poorer clinical outcome following antireflux surgery and some authors recommend gastric bypass in obese patient with symptomatic GERD. However, some studies reported that preoperative BMI does not influence the clinical outcome following laparoscopic antireflux surgery and concluded that obesity is not a contraindication for laparoscopic fundoplication (1, 2). In this video, we present a Collis-Toupet gastroplasty in a woman with a BMI of 41. References: 1. Winslow ER, Frisella MM, Soper NJ, Klingensmith ME. Obesity does not adversely affect the outcome of laparoscopic antireflux surgery (LARS). Surgical Endoscopy 2003;17:2003-11. 2. Chisholm JA, Jamieson GG, Lally CJ, Devitt PG, Game PA, Watson DI. The effect of obesity on the outcome of laparoscopic antireflux surgery. J Gastrointest Surg 2009;13:1064-70.

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J Leroy (France) / CY Akladios (France) / V Thoma (France) / A Wattiez (France) / J Marescaux (France)
21:33 - 2012 Nov
The authors demonstrate a rectovaginal resection technique for invasive endometriosis. The original nature of this approach hinges on the mesorectum dissection technique in contact with the rectal wall in order to preserve rectal vascularization and innervation. Additionally, rectal exteriorization through the vagina to prepare for the colorectal anastomosis using a mechanical circular stapling without any abdominal incision is truly original as it contributes to limiting parietal trauma and improving cosmesis. The film truly focuses on the digestive approach just after anterior pelvic dissection has been completed by the team of gynecologic surgeons.

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A Melani (Brazil) / J Marescaux (France)
35:10 - 2012 Oct
The author presents his left colectomy technique for diffuse diverticulosis of the left colon. He uses an oncological dissection technique with a vascular approach starting with the vein and then moving on to the inferior mesenteric artery. He continues the technique with the mobilization of the splenic flexure with a posterior medial approach which is followed by a mobilization of the sigmoid and the colorectal junction, and finally by a colorectal anastomosis.

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M Li (China) / J Marescaux (France)
19:36 - 2012 Oct
Dr. Michael LI (Pamela Youde Nethersole Eastern Hospital, Hong Kong) demonstrates his approach to laparoscopic sigmoidectomy in a case of sigmoid diverticulitis with an audience made up of renowned experts in colorectal surgery. Discussions around appropriate strategies for the management of non-oncologic disease between the operating surgeon and the experts are moderated by Professor Nicolas Demartines (Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland). A brand-new dissecting instrument, the Sonicision™ cordless ultrasonic dissection device (Covidien, Valleylab) is also used during specific steps of the procedure.

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J Leroy (France) / J Marescaux (France)
26:39 - 2012 Oct
The objective of this film is to show the possibilities of the laparoscopic approach after percutaneous treatment of a pelvic abscess on a perforated sigmoid diverticulitis. After exploration of the abdominal cavity, the author demonstrates the interest of using new energy devices for the dissection of inflammatory tissues.

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B Dallemagne (France) / S Perretta (France) / J D'Agostino (France) / J Marescaux (France)
29:04 - 2012 Sep
Redo surgery is technically more demanding than primary fundoplication. In addition, anatomical defects that caused failure may increase technical difficulties. A recent review found that the average success rate after laparoscopic redo operations ranged from 65 to 100 per cent (van Beek D, Auyang E, Soper N. A comprehensive review of laparoscopic redo fundoplication. Surgical Endoscopy: Springer New York; 2010. p 1-7). However, our recent study showed that the failure rate after re-operation is increasing with time, and highlighted the need for accurate preoperative and intraoperative assessment of the causes of failure (Dallemagne B, Arenas Sanchez M, Francart D, Perretta S, Weerts J, Markiewicz S, et al. Long-term results after laparoscopic reoperation for failed antireflux procedures. Br J Surg 2011;98:1581-7). This video shows a third antireflux procedure in a patient presenting with slippage of the fundoplication.

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J Leroy (France) / J Marescaux (France)
14:19 - 2012 Sep
Coloproctectomy is a challenging surgical procedure, whether open or laparoscopic, particularly when an ileoanal anastomosis with pouch is performed. The objective of this film is to provide some tricks to perform this surgical procedure laparoscopically. The main trick is probably the preservation of the right and ileocolic vessels and of the right Drummond marginal vascular arcade that later allows for a division of the superior mesenteric vessels, if necessary to gain a length of 2 to 3cm in the pelvis. The use of new sealing devices such as the Ligasure™ blunt tip facilitated the standardization of the procedure.

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M Walz (Germany) / J Marescaux (France)
35:19 - 2012 Jul
Introduction: We present the case of a 54-year-old male with a 5cm villous adenoma at the ileocaecal valve with a focus of invasive carcinoma. Previous attempts at endoscopic mucosal resection were unsuccessful. Methods: The set-up consisted of two 10/12mm ports (sub-umbilical and left iliac fossa) and three 5mm ports (right iliac fossa, supra-umbilical and epigastric). The primary vascular approach initially consists of identification, ligation and division of the vessels (ileocolic, right colic and right branch of the middle colic) at their origin, retroperitoneal mobilization of the mesocolon, taking down of the hepatic flexure and completion of the mobilization of the caecum and lateral attachments. Conclusion: The primary vascular approach to laparoscopic right hemi-colectomy is achievable.

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J Leroy (France) / J Marescaux (France)
12:28 - 2012 Jul
The interest of this video is to demonstrate a fully laparoscopic oncologic right colectomy technique performed by means of novel dissection instruments such as the Sonicision™ cordless ultrasonic dissection device (Valleylab, Covidien) as well as stapling devices designed for anastomosis (Endo-GIA™ Tri-staple™ technology, Covidien). Regarding the Sonicision™ cordless ultrasonic dissection device, one may appreciate its efficacy, notably to achieve hemostasis of ileocolic and right colic vessels. Its simplicity of use and safety in controlling the action to coagulate and divide tissues have been strongly appreciated from the operator’s side who is a regular user of the Ligasure™ technology. The great freedom of movement related to the absence of cable and to the lightness of the instrument accounts mostly for the almost immediate adoption of this novel laparoscopic instrument.

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B Dallemagne (France) / S Perretta (France) / T Piardi (France) / J Marescaux (France)
18:17 - 2012 Jun
Dysphagia is a normal observation after fundoplication for GERD. It usually lasts for 4 to 6 weeks and results from esophageal motility disorders related to the esophageal dissection and to the outlet obstruction created by the fundoplication. It is managed by appropriate diet. When dysphagia persists after 3 months, there is some concern and need for objective evaluation. This video shows the management of this type of persisting dysphagia after laparoscopic Nissen fundoplication, during which a big hematoma developed on the wrap. This usually does not lead to any long-term problems but, in this patient, dysphagia persisted over a 3-month period of time and led to re-operation.

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J Leroy (France) / B Barry (Ireland) / J Marescaux (France)
21:53 - 2012 Jun
Introduction We present the case of a 32-year-old female patient with recurrent episodes of diverticulitis. She underwent an elective sigmoidectomy using the new Sonicision™ cordless ultrasonic dissection device. Methods Our set-up consisted of a standard three-port technique with one umbilical optical 10mm port with 1x5mm and 1x12mm right iliac fossa (RIF) ports. After initial peritoneoscopy, the sigmoid mesocolon was divided close to the bowel using the new Sonicision™ cordless ultrasonic dissection device. The mesocolic window was continued distally to the rectosigmoid junction and proximally to the descending colon. The lateral attachments were then mobilized. After rectal washout, the rectum was divided and the sigmoid colon extracted transanally. A colotomy was then made above the inflamed area, the anvil of a circular stapler introduced into the colonic lumen and then advanced up to the proximal bowel (with the aid of a bowel grasper sheathed in a flexible plastic tubing). The proximal sigmoid colon was then divided with a linear stapling device, the specimen removed transanally and the rectum closed. The spike of the anvil was then delivered through the proximal colon using the fishing technique. The colorectal anastomosis was then fashioned in the usual technique with a circular stapler. A leak test was performed thereafter. Results The procedure was successfully completed. The Sonicision™ cordless ultrasonic dissection device performed similarly to other power sources but without the impedance of additional wires. It allows for ease of use and quick changing of instruments and ports without the potential of snagging the wire. Conclusion The Sonicision™ cordless ultrasonic dissection device performed excellently for laparoscopic colorectal surgery. Cordless dissectors and vessel-sealing devices will be an excellent adjunct to minimally invasive surgery of the future.

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B Dallemagne (France) / E Marzano (France) / S Perretta (France) / J Marescaux (France)
21:44 - 2012 May
Type 4 giant hiatal hernias are not common. The stomach is herniated, as well as viscera in the mediastinum, colon, spleen, and even sometimes in the pancreas. Repair is challenging for different reasons. This type of hernia is frequent in older and fragile patients. Reduction of the sac from the mediastinum is mandatory and must be carried out following stepwise and precise dissection rules: it has to be done outside of the sac, in an anatomical cleavage plane. Crural repair is challenging and must be tailored on the quality of the diaphragmatic musculature and size of the orifice. Anti-reflux repair must be performed as well. The laparoscopic approach has radically improved the clinical outcome of this procedure in old patients.

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J Leroy (France) / J D'Agostino (France) / B Barry (Ireland) / J Marescaux (France)
20:24 - 2012 May
This video demonstrates a total laparoscopic colectomy technique with a new single port device (S-Port™ from Karl Storz). After a brief description of this device, the authors outline their surgical strategy and present anatomical plane images of outstanding quality as well as the excellent ergonomics resulting from the S-Port™, the S-Portal™ instruments, and their respective use into port introduction sites.

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B Dallemagne (France) / S Perretta (France) / Gf Donatelli (France) / J Marescaux (France)
24:49 - 2012 Apr
This video presents a laparoscopic Collis-Nissen procedure performed in a 64-year-old man presenting with long-standing reflux disease and esophageal peptic stricture. The patient underwent several (>15) endoscopic dilatations that elicit only temporary improvement of dysphagia. Two esophageal stents were placed without significant improvement after removal. The patient was then referred to surgery. The treatment alternatives were esophagectomy or anti-reflux surgery associated with postoperative dilatations. The first choice was to perform an anti-reflux procedure in order to stop a mixed pathological reflux and reduce the risk of re-stricture. Three months after the procedure, an esophageal stent was placed to dilate the stricture.

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KD Higa (United states) / M Vix (France) / J Marescaux (France)
36:38 - 2012 Apr
Nowadays, the Roux-en-Y gastric bypass has become a gold standard in bariatric surgery. In this procedure, the stomach is divided into a small gastric pouch and a Y-shaped section of the intestine is then fashioned and joined to the gastric pouch. A jejunojejunal anastomosis allows for a restoration of the duodenal continuity. This video demonstrates several technical options for these two anastomoses. Dr. Higa has an outstanding experience in the field and has subsequently been able to ergonomically improve every operative step, which is being shown in detail in the video. Authoritative interaction of the expert with the operating room staff is ideal to promote clear and stepwise explanations throughout the procedure. Antecolic or retrocolic approaches, the necessity to look for a hiatal hernia as well as which type of gastrojejunal anastomosis is required are being discussed. This intervention allows for a true teaching lesson in the field of morbid obesity surgery.

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B Dallemagne (France) / J D'Agostino (France) / L Marx (France) / J Marescaux (France)
24:46 - 2012 Apr
The majority of insulinomas are benign, solitary, and are located within the pancreatic parenchyma. Because of the characteristic clinical presentation of hypoglycemia, they are usually diagnosed when they are still small (<20mm in size) and resectable. Approximately 10% of insulinomas are malignant. Surgical resection is preferred for insulinomas and cure is achieved in more than 90% of the patients. Surgical procedures include tumor enucleation, partial or total pancreatic resection, and pancreatoduodenectomy (Whipple’s operation). Enucleation is indicated for small, benign lesions located at least 2 to 3mm from the main pancreatic duct. This video presents a laparoscopic enucleation of a solitary, presumably benign insulinoma located in the isthmus of the pancreas in a young female patient presenting with typical symptoms evocative of Whipple's triad.

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M Galvao Neto (Brazil) / A Cardoso Ramos (Brazil) / M Vix (France) / J Marescaux (France)
25:25 - 2012 Mar
Laparoscopic gastric bypass is currently the gold standard in bariatric surgery. This procedure is complex and yet, it can be perfectly standardized in order to shorten the learning curve. This video presents a well-standardized and easily reproducible technique. All operative steps have been systematized and unroll very naturally. Once the gastric pouch has been divided, the gastrojejunal anastomosis is performed by means of a linear stapler by calibrating a 3cm pouch. The jejunojejunal anastomosis is performed using a 45mm long linear stapler without any division of the alimentary loop. Consequently, it is easy to control the patency of the two anastomoses. Mesenteric defects are closed to avoid internal hernias. Reproducibility is the main advantage of this technique, which has been used by operators to train more than 700 surgeons in South America, Europe, and Asia.

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LL Swanström (United states) / J Marescaux (France)
16:36 - 2012 Mar
Patients with gastro-esophageal reflux sometimes present with conflicting preoperative studies or atypical symptoms. This case had a primary complaint of pain and a normal 24-hour pH study. In this case, there were other indications for surgery - esophagitis and a type I hiatal hernia. Because medications offered no relief, it was elected to proceed with a Nissen fundoplication. A standard 2cm floppy fundoplication and repair of the hiatal hernia was performed in a stepwise fashion: hiatal dissection, esophageal mobilization, gastric fundus mobilization, posterior crural closure, and finally a short 360-degree fundoplication well fixed to the esophagus.

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B Dallemagne (France) / S Perretta (France) / J Marescaux (France)
35:37 - 2012 Mar
This video presents the management of an early recurrence after Nissen fundoplication related to a valve slippage in a 54-year-old man. Intraoperative findings demonstrate that the failure originates from a shortened esophagus. Treatment consists in an esophageal lengthening procedure associated with a new Nissen fundoplication.

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B Dallemagne (France) / J Marescaux (France)
13:18 - 2012 Mar
Laparoscopic totally extraperitoneal (TEP) repair has been accepted as a popular procedure for inguinal hernia repair, but surgeons still encounter technical difficulties owing to unfamiliar pelvic anatomy and limited working space. This video demonstrates the technique in a young patient with bilateral direct inguinal hernia.

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J Leroy (France) / J Marescaux (France)
16:53 - 2012 Feb
The video demonstrates the case of a woman with recurrent diverticulitis, BMI 30. She has a background of a previous hysterectomy via a Pfannenstiel incision. A three-port sigmoidectomy with transanal excision was carried out. Methods The set up consisted of a 12mm umbilical optical port, a 12mm port in the right iliac fossa, and a 5mm operating port in the right flank. After initial peritoneoscopy, any abnormal adhesions were divided. The sigmoid colon mesentery was divided high, near the sigmoid colon in order to preserve the mesenteric vasculature. The mesentery was divided to the level of the rectum, which was then skeletonized. The proximal colon was mobilized free up to the level of the splenic flexure. The rectum was then ligated, washed out with betadine and transected. A Vicryl Loop was attached to the proximal stump which was then removed transanally. A colotomy was created above the level of the diverticula and the anvil of a circular stapler introduced into the proximal colon. The proximal sigmoid colon mesentery was divided and the sigmoid transected with a linear stapler. The specimen was then fully removed transanally. The anvil was then delivered through the colon via the fishing technique. The rectal stump was closed with a linear stapler. A colorectal anastomosis was fashioned with a circular stapler. After verifying that the colon was not twisted, an air test was performed. Conclusion The video demonstrates a three-port technique for laparoscopic sigmoidectomy with natural orifice specimen extraction (NOSE).

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D Mutter (France) / M Vix (France) / J Marescaux (France)
19:03 - 2012 Feb
This film shows the case of a robot-assisted distal splenopancreatectomy in a 56-year-old woman diagnosed with distal pancreatic cancer. The video highlights the advantages of the robotic assistance to standard laparoscopy.

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B Dallemagne (France) / S Perretta (France) / J Marescaux (France)
20:03 - 2012 Feb
This video demonstrates a combined thoracoscopic and laparoscopic esophagectomy for the treatment of a lower third esophageal cancer. The case is that of a 76-year-old man presenting with dysphagia and weight loss. The preoperative work-up demonstrated a T3 large esophageal tumor, poorly differentiated. Three cycles of neo-adjuvant chemotherapy were performed before surgery was scheduled.

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J Leroy (France) / J Marescaux (France)
20:23 - 2012 Jan
This video provides an excellent teaching demonstration of a laparoscopic transabdominal preperitoneal (TAPP) hernia repair.

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J Leroy (France) / J Marescaux (France)
19:04 - 2012 Jan
Laparoscopic colectomy is performed widely all around the world, and some institutions perform more laparoscopic operations than conventional open operations. Skin incision is required to remove the resected colon. This video shows a laparoscopic sigmoidectomy, which involves transanal specimen extraction.

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J Leroy (France) / C Callari (France) / J Marescaux (France)
11:39 - 2012 Jan
The objective of this film is to demonstrate a laparoscopic sigmoidectomy for acute sigmoid diverticulitis in a male patient, and more specifically to highlight all the errors that led to a ureteral injury, which was identified and managed immediately intraoperatively.

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S Perretta (France) / J Marescaux (France)
14:28 - 2012 Jan
Here we show the case of a 44-year-old woman with a BMI of 40.5 and a history of gastroesophageal reflux disease. She was presented for a weight reductive surgery evaluation. Preoperative esophagogastroduodenoscopy, barium swallow and esophageal high resolution manometry were performed. They demonstrated a 3cm hiatal hernia as well as a hypotensive lower esophageal sphincter. The presence of a large hiatal hernia (greater than 5cm) is problematic and may prevent successful weight reductive surgery. Laparoscopic Roux-en-Y gastric bypass is an effective procedure to control symptoms and GERD complications in morbidly obese patients. For this reason, Roux-en-Y gastric bypass is a valid alternative to manage morbidly obese patients with symptomatic hiatal hernia and GERD. Bsed on the preoperative work-up, decision was made to perform a concomitant paraesophageal hernia repair and a laparoscopic Roux-en-Y gastric bypass.

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A Melani (Brazil) / J Marescaux (France)
28:38 - 2011 Dec
Introduction: This is the case of a 65-year-old gentleman who presented with blood per rectum (PR) and symptoms of subacute obstruction. He was diagnosed with a stenotic invasive adenocarcinoma at 15cm from the anal verge and with liver metastases. After discussion at our multidisclipinary meeting, he was recommended to undergo palliative chemotherapy in the form of FOLFIRI and Avastin. Unfortunately, his symptoms of subacute obstruction worsened and it was recommended that he undergo a palliative resection. Methods: He underwent a palliative Laparoscopic Anterior Resection (LAR). Professor Armondo Melani utilized a 4-port technique with a 10mm umbilical optical port and 3 by 5mm working ports (2 on the right-hand side and one on the left). He used a medial to lateral approach starting with the splenic flexure takedown. This was achieved by entering the retroperitoneal plane cephalad to the inferior mesenteric artery (IMA) and inferior to the inferior mesenteric vein (IMV). Once the correct plane has been entered, the IMV was skeletonized and divided with a Ligasure® vessel-sealing device. The lesser sac was then entered superior and cephalad to the IMV, superior to the pancreas and to the left of the middle colic vessels. This novel approach allowed for easy identification of the pancreas and retroperitoneal mobilization of the mesocolon from the pancreas. The lesser sac was then entered above the transverse colon, the omental attachments divided and splenic flexure mobilization completed. The retroperitoneal plane was then entered caudally to the IMA, which was subsequently skeletonized and divided after identification of the left ureter and gonadal vessels. The rectum was then mobilized to >5cm below the tumor, the mesorectum divided, the rectum transected with an articulating linear stapling device. The specimen was delivered through a Pfannenstiel incision (with a wound protector). The specimen was transected and the anvil of a circular stapler inserted into the proximal colon with a purse-string suture. The colon was returned to the abdomen and the colorectal anastomosis was completed with the insertion of the circular stapler transanally.

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B Dallemagne (France) / S Perretta (France) / J Marescaux (France)
35:11 - 2011 Dec
Antireflux operations are commonly performed. Nissen fundoplication is the “gold standard” antireflux procedure. Some problems could be encountered when a short esophagus is found. This is the case of patient with reflux disease in which a short esophagus is found during the surgical procedure. A Collis Nissen operation is performed.

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B Dallemagne (France) / J Marescaux (France)
24:17 - 2011 Dec
Cholecystectomy is the most common laparoscopic procedure performed worldwide. This authoritative and instructive video shows a laparoscopic cholecystectomy with intraoperative cholangiogram.

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J Leroy (France) / J Marescaux (France)
21:29 - 2011 Nov
This is the case of a patient presenting with a Nyhus IIIb right inguinal hernia. The surgical technique is explained live in a stepwise fashion starting from the introduction of the first port until closure of the peritoneum. The major anatomical landmarks are highlighted. The dissection technique as well as the positioning of the Parietene® mesh fixed by absorbable staples (AbsorbaTack™) is demonstrated.

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D Mutter (France) / L Soler (France) / J Marescaux (France)
12:05 - 2011 Nov
Insulinoma is the most common functional neuroendocrine tumor of the pancreas. Laparoscopic resection of insulinomas is feasible and safe. Laparoscopic ultrasound contributes to successful insulinoma localization and laparoscopic resection. This video shows a laparoscopic resection of an insulinoma located in the uncinate process of the pancreas.

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F Costantino (France) / D Mutter (France) / Gf Donatelli (France) / J Marescaux (France)
13:23 - 2011 Oct
Cholecystectomy for symptomatic gallstones is one of the mostly performed laparoscopic procedures. Early laparoscopic cholecystectomy during acute cholecystitis appears to be safe and shortens the total hospital stay. This video shows a cholecystectomy for acute cholecystitis associated with an intraoperative ERCP for common biliary duct stone.

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D Mutter (France) / L Soler (France) / J Marescaux (France)
27:17 - 2011 Oct
Laparoscopic splenectomy is currently the procedure of choice for elective splenectomy. The indications for this procedure are the same as with open procedures, they range from idiopathic thrombocytopenic purpura, and unresponsive hemolytic anemia to staging procedures and to primary splenic cysts.

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J Leroy (France) / J Marescaux (France)
24:04 - 2011 Oct
This video, performed during a live demonstration, shows a laparoscopic TME for upper rectal cancer.

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M Vix (France) / J Marescaux (France)
28:13 - 2011 Oct
Gastric bypass is the most frequently performed bariatric surgery nowadays. This video clearly shows all steps of this procedure.

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J Leroy (France) / F Costantino (France) / J Marescaux (France)
22:56 - 2011 Sep
The objective of this film is to demonstrate how to perform a laparoscopic redo of a recurrence after carrying out a low colorectal anastomosis through open surgery to manage a cancer of the mid-upper rectum following radiochemotherapy.

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J Leroy (France) / J Marescaux (France)
16:34 - 2011 Sep
This video shows a fully laparoscopic right colectomy with intracorporeal anastomosis for a caecal cancer in an obese female patient with a BMI higher than 34.

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B Dallemagne (France) / J Marescaux (France)
13:40 - 2011 Sep
This video presents the case of a 29-year-old female patient presenting with abdominal pain at the epigastrium. CT-scan and magnetic resonance imaging demonstrated a septated cystic lesion at the tail of the pancreas. This lesion is about 5cm in diameter. It is incarcerated in the hilum of the spleen. Echo-endoscopy confirmed the cystic nature of the lesion and fine-needle aspiration showed mucinous fluid with a clearly pathological CEA evocative of a mucinous cystic lesion. A laparoscopic distal splenopancreatectomy is demonstrated.

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B Dallemagne (France) / S Perretta (France) / J Wall (United states) / J Marescaux (France)
29:23 - 2011 Jul

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J Leroy (France) / J Marescaux (France)
20:46 - 2011 Jul
This is the case of a patient presenting with a big polyp located 20cm away from the anal margin. It is a degenerated polyp, and a submucosal and lymphatic invasion can be noted. An oncologic resection of the sigmoid colon has been decided upon after the polyp was removed and localized by a clip.

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B Salky (United states) / J Marescaux (France)
32:50 - 2011 Jul
This video shows a laparoscopic right colectomy performed during an IRCAD course.

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J Leroy (France) / J Marescaux (France)
28:05 - 2011 Jul
Total mesorectal excision (TME) offers the lowest reported rates of local recurrence and the best survival results in patients with rectal cancer. This video shows a laparoscopic TME 10 weeks after radiochemotherapy for T3N+ rectal cancer.

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B Dallemagne (France) / S Perretta (France) / J Marescaux (France)
12:48 - 2011 Jun
This is the case of a 60-year-old woman with a chief complaint of dysphagia for solids and liquids, regurgitation, and chest pain. An initial diagnosis of achalasia was made in 2007 with the manometry showing a high hypertonic low esophageal sphincter which failed to relax and respond to swallowing. Upper GI series showed a severe dilatation of the esophagus and narrowing at the gastroesophageal junction. An endoscopic dilatation was attempted, but failed. Decision was made to perform a laparoscopic Heller myotomy together with a Dor fundoplication.

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J Leroy (France) / J Marescaux (France)
34:03 - 2011 Jun
This video demonstrates a laparoscopic abdominoperineal resection for T4 ultralow rectal tumor with involvement of the sphincter and limited downstaging with a neo-adjuvant radiochemotherapy.

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F Corcione (Italy) / J Marescaux (France)
27:02 - 2011 Jun
Carcinoma of the splenic flexure is a rare condition accounting for approximately 3 to 8% of colon cancers. The surgical treatment is challenging and not fully standardized. This video demonstrates a laparoscopic segmental oncologic splenic flexure colonic resection for cancer.

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J Leroy (France) / J Marescaux (France)
23:36 - 2011 Jun
This is a live demonstration of a laparoscopic anterior rectal resection for a T1 rectal cancer.

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B Dallemagne (France) / S Perretta (France) / J Marescaux (France)
21:34 - 2011 May
This video shows a laparoscopic reoperation for slipped fundoplication with intraoperative endoscopic monitoring during a live demonstration.

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J Leroy (France) / C Callari (France) / J Marescaux (France)
14:30 - 2011 May
This video shows a live right laparoscopic colectomy for the management of cancer of the ascending colon.

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D Mutter (France) / F Costantino (France) / L Soler (France) / J Marescaux (France)
27:06 - 2011 May
This the case of a 32-year-old lady who went to see her medical practitioner for a back pain and a calcification was discovered in the left upper quadrant of the abdomen. A CT-scan was performed and provided the diagnosis of a cyst of the spleen with a lot of calcifications. This cyst does not allow to perform a partial splenectomy, which is sometimes an indication if we have a cyst located at the upper or at the lower pole of the cyst. A laparoscopic live total splenectomy is presented.

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KD Higa (United states)
29:25 - 2011 Apr
Over the last 20 years, the Roux-en-Y gastric bypass has been successfully used as one of many surgical treatments to achieve significant long-term weight loss. This video demonstrates a hand-sewn laparoscopic Roux-en-Y gastric bypass.

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J Leroy (France) / J Marescaux (France)
15:45 - 2011 Apr
Laparoscopic surgery for colorectal cancer requires an abdominal incision to extract the resected specimen. Transanal extraction avoids the need to make any additional abdominal incisions for specimen retrieval. This video demonstrates various tricks for the removal of a huge specimen.

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WJ Lee (Taiwan)
22:01 - 2011 Apr
Mini gastric bypass procedure is a minimally invasive, short, simple, and successful laparoscopic weight loss surgery. This video shows a live procedure performed by Professor Lee.

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V Podelski (France) / M Vix (France) / J Marescaux (France)
08:22 - 2011 Apr
This is the case of a 40-year-old female patient who had a gastric band placed in 2000. A few years later, after failure of the band, complementary examinations were carried out. They raised the suspicion of an intragastric migration of the band. The laparoscopic removal of this migrated band is presented.

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J Leroy (France) / J Marescaux (France)
14:46 - 2011 Apr
The objective of this film is to demonstrate a completely laparoscopic technique for left colon resection and for cancer of the descending portion of the splenic flexure.

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B Dallemagne (France) / S Perretta (France) / J Marescaux (France)
14:44 - 2011 Mar
This video shows the laparoscopic treatment of a rolling hiatal hernia in a 71-year-old female patient with a previous history of upper GI symptoms. Teflon pledgets cruroplasty and vicryl mesh reinforcement are demonstrated.

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B Dallemagne (France) / S Perretta (France) / J Marescaux (France)
23:00 - 2011 Mar
This video shows a live case of laparoscopic floppy Nissen fundoplication for GERD in which all surgical steps are accurately described. This is a perfect teaching case.

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J Leroy (France) / J Marescaux (France)
21:53 - 2011 Mar
The objective of this film is to demonstrate a laparoscopic coloproctectomy technique for the treatment of an invalidating ulcerative colitis evolving over several years and resisting to the different medical treatments.

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B Dallemagne (France) / S Perretta (France) / Gf Donatelli (France) / J Marescaux (France)
16:28 - 2011 Feb
Diverticula of the distal esophagus, epiphrenic diverticula, are relatively rare. They have a tendency to enlarge and are frequently associated with neuromuscular dysfunction of the esophagus. In this video, we show the case of an 84-year-old lady referred to our surgical unit with symptoms of recurrent respiratory infection —including pneumonia—, severe regurgitation, food retention and chest pain.

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J Leroy (France) / J Marescaux (France)
09:10 - 2011 Feb
Total mesorectal excision (TME) offers the lowest reported rates of local recurrence and the best survival results in patients with rectal cancer. Laparoscopic TME can be performed only by very expert surgeons; the introduction of new devices could help the surgeon during this challening dissection. This video shows a laparoscopic TME in a female patient; the advantage of the latest generation of energy source devices, retractors and staplers is demonstrated.

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J Leroy (France) / J Marescaux (France)
18:50 - 2011 Feb
This is the case of a woman who had several attacks of diverticulitis with abscess confirmed by CT-scan. A laparoscopic sigmoidectomy using three trocars and a transanal extraction is shown.

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B Dallemagne (France) / S Perretta (France) / J Marescaux (France)
16:14 - 2011 Feb
Esophageal leiomyomas probably account for 70% of all benign tumors of the esophagus. Surgical removal is indicated for symptomatic patients or for a tumor with a progressive increase in size. This is the case of a 36-year-old patient, who had previously undergone a laparoscopic operation for Nissen fundoplication for GERD, in whom an incidental leiomyoma of the distal esophagus was discovered.

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B Dallemagne (France) / S Perretta (France) / J Marescaux (France)
17:25 - 2011 Jan
This video demonstrates a laparoscopic Collis esophageal lengthening procedure in a 65-year-old man with a 15 years' history of typical GERD symptoms and Barrett’s esophagus. The identification and surgical management of the short esophagus are discussed as well as the technical steps required for a Collis gastroplasty. Given that the most common mode of failure of a laparoscopic Nissen fundoplication is herniation of the fundoplication into the chest, as our experience increases, we recognize that reduction of the gastroesophageal junction below the diaphragmatic hiatus without tension is problematic and foreshortening of the esophagus is a real entity. Patients who have Barrett’s esophagus must be considered at risk for having a short esophagus.

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M Vix (France) / J Marescaux (France)
23:26 - 2011 Jan
Gastric bypass is the most frequently performed bariatric surgery. It provides long-term and consistent weight loss. This video shows a laparoscopic gastric bypass in a 49-year-old woman with a BMI of 42.

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B Dallemagne (France) / S Perretta (France) / L Soler (France) / J Marescaux (France)
26:06 - 2011 Jan
Insulinomas are rare tumors of the islet cells of the pancreas. They are solitary, small and benign. They may occur anywhere within the pancreatic gland. This video shows a laparoscopic pancreatectomy for insulinoma in a 52-year-old man with a BMI of 25.

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J Leroy (France) / J Marescaux (France)
24:47 - 2010 Dec
In this video, we show the case of a 70-year-old male patient who had several attacks during the last weeks, abdominal pain, and fever. After CT-scan, he was diagnosed a perisigmoid abscess. We diagnosed a lot of diverticula and we made a diagnosis of sigmoiditis with perisigmoid abscess. So this is the Hinchey II two pelvic abscess. We began the medical treatment and finally we had several attacks and did a new examination, a new CT-scan, and an endoscopy and not a sigmoid abscess, but a voluminous diverticulum with an abscess, was diagnosed. So it was decided to operate on the patient.

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J Leroy (France) / J Marescaux (France)
14:58 - 2010 Dec
The objective of this film is to demonstrate how to perform a total colectomy by means of the new Ligasure Atlas Blunt Tip® vessel-sealing device, which allows for a perfect hemostasis and can be used for dissection like the finger of one’s hand.

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J Leroy (France) / J Marescaux (France)
09:35 - 2010 Dec
Reversal of Hartmann's procedure is a major undertaking and due to its associated morbidity and mortality, many patients are left with permanent colostomy and many others elect not to have the reversal. The advances in laparoscopy and stapler anastomosis have made the reversal simpler and easier. The objective of this film is to show how to carry out a laparoscopic re-intervention of a stenosis of a colorectal anastomosis performed some months before for the restoration of the colorectal continuity after a laparoscopic reversal of Hartmann’s procedure that was performed to manage a perforated sigmoid diverticulitis.

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B Dallemagne (France) / S Perretta (France) / J Marescaux (France)
09:41 - 2010 Dec
This video demonstrates a redo laparoscopic Nissen fundoplication in a 34-year-old man with recurrent gastroesophageal reflux symptoms. A first laparoscopic Nissen-Rossetti procedure was performed ten years ago, and was taken down 2 months after surgery for severe dysphagia and important weight loss. The success rate of laparoscopic Nissen fundoplication depends on the proper creation of a floppy and symmetric wrap together with a suitable crural repair. Most failures and complications due to technical mistakes during antireflux surgeries are related to an incomplete or inadequate intraoperative evaluation of the wrap and crural repair. Development or persistence of dysphagia after fundoplication is among the most common complications occurring in up to 30% of patients. Surgical factors responsible for de novo dysphagia are mainly related to the degree, tightness, length of the fundoplication and technical errors leading to wrap misconstruction -below the anatomical gastroesophageal junction or by a distortion of the esophageal diameter and orientation at the level of the crural repair.

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D Mutter (France) / J Marescaux (France)
17:58 - 2010 Nov
This video shows detailed steps when performing laparoscopic cholecystectomy.

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B Dallemagne (France) / J Marescaux (France)
16:40 - 2010 Nov
Nissen fundoplication is a commonly used antireflux operation. After this operation, symptoms such as dysphagia, inability to belch and vomit, and gas bloating are frequently reported in the literature. The objective of this film is to demonstrate a surgical intervention carried out in a 78-year-old patient who had benefited from a Nissen-Rossetti fundoplication for the management of a gastroesophageal reflux disease associated to a voluminous type I hiatal hernia 15 years ago.

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F Costantino (France) / B Dallemagne (France) / J Marescaux (France)
14:14 - 2010 Nov
Different studies have shown that revision of antireflux procedures to RYGB is safe and feasible for morbidly obese patients with weight gain or recurrent GERD symptoms. This video demonstrates a laparoscopic gastric bypass in a 56-year-old patient who had benefited from a laparoscopic Nissen fundoplication in 1999. The patient presents with a BMI of 40 and a diabetes mellitus resistant to treatment.

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J Leroy (France) / A Wattiez (France) / J Marescaux (France)
14:26 - 2010 Nov
The objective of this film is to demonstrate the management of a rectovaginal fistula in a woman in her thirties. Three months before, she had benefited from the resection of a nodule of the rectovaginal septum, along with the vaginal resection of the posterior Douglas’ pouch and the anterior resection of the rectum using the wedge technique with circular stapling. The fistula can be well identified in the clinical examination. A laparoscopic low anterior resection with transvaginal extraction is presented.

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J Leroy (France) / J Marescaux (France)
12:03 - 2010 Oct
The objective of this film is to show the totalization of a left partial colectomy performed one year ago and the possibility of doing a transmesenteric laparoscopic colorectal anastomosis. This patient had undergone a sigmoidectomy for sigmoid diverticulitis with a colorectal anastomosis one year ago. During the postoperative period, the patient had several subocclusive episodes and suffered from pain related to an ischemic stenosis of the lowered colon with no necrosis. The stenosis has become increasingly incapacitating, not only at the level of the anastomosis but especially at the level of the left colon, which has been getting narrower.

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J Leroy (France) / J Marescaux (France)
13:48 - 2010 Oct
The objective of this film is to demonstrate the limits of laparoscopic surgery in lower rectal cancer. This is the case of a 52-year-old patient in whom a voluminous T3/T4 tumor of the mid-rectum was found in association with liver metastases.

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M Vix (France) / J Marescaux (France)
15:26 - 2010 Oct
This video shows a laparoscopic gastric banding in a 26-year-old woman. She presents with a BMI of 40. She has a history of dieting with some success but no long-term success with weight loss. All steps are presented in this video recorded at the IRCAD Advanced course in laparoscoic bariatric and metabolic surgery held last September 17-18, 2010.

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J Leroy (France) / J Marescaux (France)
14:15 - 2010 Sep
Gastrointestinal duplications are rare congenital anomalies, usually detected prenatally or in the first two years of life, although they can be diagnosed even in older age. Small bowel location is the most frequent (more than 50% of cases). The objective of this film is to demonstrate an ileocaeal resection for duplication of the terminal small bowel, which has been suggested during the CT-scan examination. It will be confirmed by the pathological examination and the histological study.

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J Leroy (France) / J Marescaux (France)
07:23 - 2010 Sep
Laparoscopic resection of the sigmoid colon is currently considered a feasible option for open surgery. Many attempts have been made to reduce scars. The objective of this film is to demonstrate a transanal extraction technique for the laparoscopic management of sigmoid diverticulitis using three trocars.

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J Leroy (France) / J Marescaux (France)
27:39 - 2010 Sep
The advantages of a total intracorporeal anastomosis are as follows: no need to enlarge the incision and no traction of the pedicle during the extracorporeal anastomosis. This video shows a right colectomy for a polyp of the ascending colon in a 50-year-old female patient presenting with a Lynch syndrome.

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B Dallemagne (France) / J Marescaux (France)
15:22 - 2010 Sep
This is a live video recorded during an intensive IRCAD laparoscopic general surgery course. In this video, a TEP approach for inguinal hernia is presented. Live comments help understand the different aspects of this procedure.

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B Dallemagne (France) / S Perretta (France) / J Marescaux (France)
22:52 - 2010 Jul
This is the case of a 64-year-old man presenting with a complex history of symptoms of reflux and dysphagia for some years, with a combination of dysmotility, reflux and anatomical problems in terms of hiatal hernia. This video shows a laparoscopic Heller myotomy with an associated antireflux procedure.

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B Dallemagne (France) / J Marescaux (France)
18:46 - 2010 Jul
Minimally invasive Ivor Lewis esophagectomy is technically challenging but feasible in experienced minimally invasive surgery centers. This video illustrates the surgical approach of an Ivor-Lewis esophagectomy. This surgery was carried out in a patient presenting with a type 2 cardia tumor according to Siewert’s classification. The preoperative workup confirmed the presence of an adenocarcinoma with locoregional lymph nodes. After neoadjuvant chemotherapy, a massive melt of the tumor was evidenced without any residual lesion or any local or distant metastasis. In this context, a curative resection has been proposed. Considering the tumor’s type, a resection combining an abdominal with a thoracic approach was decided upon.

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M Vix (France) / J Marescaux (France)
17:01 - 2010 Jul
Laparoscopic sleeve gastrectomy has gained increasing popularity due to its simplicity and good results. Nowadays, many attempts are made to minimize port access, and sleeve gastrectomy is no exception for that. This video shows a laparoscopic single incision sleeve gastrectomy in a 40-year-old female patient with a BMI of 40.

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J Leroy (France) / J Marescaux (France)
17:54 - 2010 Jul
Laparoscopic hernia repair has become one of the most common laparoscopic operations. Several studies have demonstrated a definite advantage over open repair with regard to reduced postoperative pain and earlier return to work and normal activities, especially when treating bilateral hernias. This video shows the TAPP treatment of a bilateral direct hernia.

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C Callari (France) / D Mutter (France) / J Marescaux (France)
20:03 - 2010 Jun
The laparoscopic repair of abdominal wall hernias to treat both spontaneous and incisional hernias has good results. We report the case of a patient presenting with two concomitant pathologies, an umbilical hernia and a linea alba hernia situated on a previous incision’s scar that were treated simultaneously. Currently this patient has a heart transplant.

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B Dallemagne (France) / S Perretta (France) / L Soler (France) / J Marescaux (France)
22:07 - 2010 Jun
This film demonstrates the laparoscopic resection of a pancreatic tumor in a 47-year-old woman who consulted for epigastric pain. The preoperative exam showed a tumor larger than 4cm situated at the body of the pancreas.

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J Leroy (France) / J Marescaux (France)
20:52 - 2010 Jun
Surgery in patients who have previously undergone abdominal operations is always difficult and the risk of complications is high. The objective of this film is to demonstrate a laparoscopic subtotal colectomy in an elderly female patient aged 89. This patient had undergone a laparoscopic right colectomy for cancer in previous years. The film also aims to show the possibilities of a laparoscopic re-intervention.

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J Leroy (France) / J Marescaux (France)
29:39 - 2010 Jun
Local control of rectal cancer and patient survival have improved remarkably with advances in surgical techniques. The objective of this film is to demonstrate a laparoscopic total mesorectal excision for a rectal adenocarcinoma situated in the upper rectum.

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J Leroy (France) / B Dallemagne (France) / J Marescaux (France)
30:42 - 2010 May
This video shows the TransAbdominal PrePeritoneal (TAPP) and Totally ExtraPeritoneal (TEP) procedures for inguinal hernia repair. These are live operations performed by Professor Joel Leroy (TAPP procedure) and Doctor Bernard Dallemagne (TEP procedure). The different technical details for each procedure are clearly exposed.

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M Vix (France) / F Costantino (France) / J Marescaux (France)
18:53 - 2010 May
Sleeve gastrectomy after gastric band is a challenging procedure due to the alteration of anatomy caused by the band; the identification of anatomical landmarks is crucial. The objective of this video is to successively demonstrate two different sleeve gastrectomy cases after gastric band removal.

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J Leroy (France) / J Marescaux (France)
14:41 - 2010 May
The combination of standard laparoscopy and specimen extraction through a natural orifice has the potential to decrease wound-related complications. The objective of this film is to demonstrate a three-trocar sigmoidectomy technique performed without any abdominal incision and with transanal extraction of the sigmoid colon followed by a fully laparoscopic colorectal anastomosis. This procedure was used for benign inflammatory conditions but not for malignant tumoral conditions.

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B Dallemagne (France) / S Perretta (France) / J Marescaux (France)
10:52 - 2010 Apr
This video demonstrates a redo laparoscopic Nissen fundoplication in a 46-year-old woman with recurrent gastroesophageal reflux symptoms 10 years after the previous antireflux repair, in which a functional lumen imaging probe "the endoFLIP" was used.

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D Mutter (France) / L Soler (France) / J Marescaux (France)
17:42 - 2010 Apr
This is the case of a female patient presenting with a 12mm endocrine tumor located at the pancreatic isthmus. To manage this case, a distal pancreatectomy is decided upon. This tumor measures 16mm in its transverse diameter and it is located just above the portal vein. The CT-scan and its 3D reconstruction helps us to plan the surgical intervention. The whole pancreas along with the splenic vessels (splenic vein and artery) are reconstructed. The objective is to precisely locate the tumor in order to determine the resection modalities. A distal pancreatectomy with preservation of the splenic vessels is therefore decided upon.

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M Vix (France) / F Costantino (France) / J Marescaux (France)
06:13 - 2010 Mar
Band infection after gastric banding is a relatively rare complication. In most cases, it manifests itself through abdominal pain associated with fever, and/or an abscess surrounding the access port. This is the case of a 37-year-old female patient in whom a gastric band was placed 5 years ago. The patient lost 60% of her excess weight; however, she complained that the gastric band was no longer as efficient. Imaging studies allowed to identify the existence of a 50mL supragastric pouch. A gastroscopy reveals nothing unusual. Following this postoperative control, we decided to remove the patient’s gastric band as she was troubled by the superior gastric pouch.

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J Leroy (France) / J Marescaux (France)
25:34 - 2010 Mar
The objective of this film is to demonstrate a technique of coloproctectomy for disseminated polyposis in a young female patient who presented fairly massive bleedings. Her polyposis was discovered but did not have any known family history. Technical details and all steps of the dissection are clearly exposed.

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J Leroy (France) / L Soler (France) / J Marescaux (France)
15:25 - 2010 Mar
The aim of this video is to show the benefit of imaging when faced with anatomical abnormalities to avoid incidents during the surgical procedure. In this case, it is the left ureter that is abnormal, passing behind a section of the left iliac ureter, the latter being in fact an abnormally long left iliac artery and its course partially hiding the ureter. The procedure is a sigmoidectomy for cancer of the sigmoid colon in an averagely obese patient.

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D Mutter (France) / L Soler (France) / J Marescaux (France)
13:07 - 2010 Mar
This is the case of a patient presenting with a hepatocellular carcinoma, referred to the emergency department because of a hemorrhage. The first step consisted in an arterial embolization. The patient recovers from the embolization and two months later, a left lateral segmentectomy is decided upon. The tumor measures 8cm and is located in segment II and III of the liver. The procedure is performed laparoscopically, away from the digestive bleeding.

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B Dallemagne (France) / S Perretta (France) / L Soler (France) / J Marescaux (France)
19:27 - 2010 Feb
Laparoscopic distal pancreatectomy is suitable for benign and premalignant neoplasms located in the body and tail of the pancreas. Spleen preservation following distal pancreatectomy is known to be safe. There are two distinct approaches to preserve the spleen during the dissection of the distal pancreas. The classic design is to identify, isolate, and preserve the splenic artery and vein. Alternatively, the splenic artery and vein are ligated with the pancreas, and perfusion of the spleen is assured by the short gastric vessels. Both are accepted as appropriate techniques to address a mass in the tail of the pancreas. This video demonstrates a left pancreatic resection with spleen preservation and ligation of the splenic artery and vein.

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M Vix (France) / J Marescaux (France)
09:57 - 2010 Feb
With more and more bariatric procedures being performed, it is predictable that more patients will suffer from complications necessitating re-do surgery. We show the case of a laparoscopic sleeve gastrectomy being transformed into a laparoscopic Roux-en-Y gastric bypass.

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J Leroy (France) / J Marescaux (France)
18:03 - 2010 Feb
The laparoscopic approach for the treatment of splenic flexure (SF) colon cancer is not standardized and is a challenging procedure. The aim of this video is to show the possible segmental and oncological resections of a tumor of the splenic flexure.

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B Dallemagne (France) / S Perretta (France) / J Marescaux (France)
21:14 - 2010 Jan
Conventional esophagectomy requires either a laparotomy with a transhiatal dissection or a laparotomy combined with thoracotomy and it is associated with significant morbidity and mortality. In the attempt to decrease morbidity, some surgeons have reported the application of minimally invasive technique of resection of the esophagus. De Paula was the first to report a large series of 48 patients undergoing a total laparoscopic transhiatal esophagectomy (LTH). LTH may be used to treat patients with either benign or malignant esophageal disease because the reconstructive result cervical esophagogastric anastomosis yields good functional outcomes. Here we show the case of a LTH for adenocarcinoma of the lower esophagus.

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M Vix (France) / J Marescaux (France)
24:12 - 2010 Jan
This is the case of a 56-year-old woman with a BMI of 44. This patient wanted to have surgery for morbid obesity and after giving her explanations about the sleeve gastrectomy and gastric bypass, she preferred to have a sleeve gastrectomy. This is a real-time recorded video in which all aspects and tricks of a correct sleeve gastrectomy are clearly presented.

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B Dallemagne (France) / J Marescaux (France)
17:25 - 2010 Jan
Hiatal hernia recurrence is a dreaded postoperative complication after surgery for gastroesophageal reflux. This video presents a live surgery performed on a patient presenting with recurrent symptoms and dysphagia after previous Nissen fundoplication performed 5 years ago. All the preoperative work-up demonstrates the recurrent reflux, mixed ascites and alkaline reflux associated with an intrathoracic migration of the proximal stomach and probably a slippage of the valve on the upper part of the stomach. This patient has a manometry, which confirmed the weakness of the lower esophageal sphincter (LES) associated with some dysmotility disorders in the lower esophagus.

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F Corcione (Italy) / J Marescaux (France)
24:45 - 2009 Dec
The laparoscopic approach for colonic cancer has been shown to be feasible, safe and respects oncologic criteria for cancer surgery. In this video demonstration at the IRCAD Advanced Course in Laparoscopic Colorectal Surgery in November 2009, Prof. Francesco Corcione shows a laparoscopic left colectomy strictly respecting oncological principles.

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J Leroy (France) / J Marescaux (France)
28:22 - 2009 Dec
The laparoscopic approach is currently accepted for the treatment of colorectal malignancy. This video demonstrates a laparoscopic rectal resection for a large adenovillous tumor using five trocars. The patient’s right arm is alongside the body. All the team stands to the right, one assistant between the patient’s legs.

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C Huscher (Italy) / J Marescaux (France)
27:44 - 2009 Dec
Laparoscopic coloproctectomy for ulcerative colitis is a safe procedure and is associated with short-term benefits such as faster recovery and less pain. In this live video shot during the IRCAD Advanced Course in Laparoscopic Colorectal Surgery in November 2009, Prof. Cristiano Huscher shows a laparoscopic coloproctectomy for ulcerative colitis in a female patient.

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J Leroy (France) / J Marescaux (France)
11:33 - 2009 Dec
Transumbilical single incision laparoscopic sigmoidectomy is feasible by experienced laparoscopic surgeons using current available laparoscopic instruments and staplers. In this live video shot during the IRCAD Advanced Course in Laparoscopic Colorectal Surgery in November 2009, Prof. Leroy shows an extraordinary single port sigmoidectomy.

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J Leroy (France) / J Marescaux (France)
09:49 - 2009 Nov
The objective of this video is to demonstrate the laparoscopic sigmoidectomy using three ports with the transanal extraction of the sigmoid colon for the treatment of a diverticular sigmoiditis. The interest of this technique is the ability to limit the number of ports used; as a result, parietal trauma and morbidity may be reduced. In this case, two 12mm ports and one 5mm port are used.

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B Dallemagne (France) / J Leroy (France) / J Marescaux (France)
07:41 - 2009 Nov
Single port access surgery may be the next generation of minimally invasive surgery thanks to the obvious advantages (e.g., scarless surgery, lesser pain, and faster postoperative recovery). Performing a cholecystectomy via a single trocar imposes a few technical constraints. The first is the necessity of correctly exposing the gallbladder, the second is to find the instrumentation that allows to perform the different dissection stages, ligature of the cystic duct and artery, but also to obtain an acceptable visualization of the Calot’s triangle. Various methods are proposed at the moment, along with different instruments: rigid, articulated, curved ones. In this video, we present two cholecystectomies, one is performed with conventional laparoscopic instruments, the other with curved instruments especially adapted for a unique trocar.

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M Vix (France) / J Marescaux (France)
09:38 - 2009 Nov
Laparoscopic sleeve gastrectomy as a redo surgery after gastric band removal is a challenging operation. Many technical problems are encountered during this procedure. Care must be taken in finding anatomical planes, understanding the type of adhesions and avoiding a gastric injury, especially in the region of the lower end of the esophagus. This video shows a difficult case of laparoscopic sleeve gastrectomy two months after the removal of a gastric band that was placed 10 years ago.

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B Dallemagne (France) / D Mutter (France) / L Soler (France) / J Marescaux (France)
10:40 - 2009 Oct
Laparoscopic liver resection in selected patients in highly specialized centers provides comparable oncological results to treatment with open liver resection for patients with colorectal liver metastases. In this video, we present the case of a patient who underwent the resection of two liver segments in the context of a colorectal pathology. Initially, this lesion was estimated as sitting in the liver’s segment IV, but using a specific software dedicated to reconstructions of CT-scan data, it was discovered that this lesion was situated across segment V and segment VIII. This reconstruction allows to obtain a perfect visualization of the different relationships between the vessels and also allows to guide the procedure and to simulate the operative maneuver.

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D Mutter (France) / L Soler (France) / J Marescaux (France)
10:06 - 2009 Oct
Splenic cysts are rare lesions. Splenectomy is the treatment of choice. This video demonstrates a totally laparoscopic splenectomy. The procedure is performed with the patient placed in a supine position with a slight right lateral tilt. An open laparoscopy is carried out systematically. Four ports are used: one port to retract, two operating ports and another port to accommodate a 5mm scope with a high definition camera.

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J Leroy (France) / F Costantino (France) / J Marescaux (France)
15:58 - 2009 Oct
Anastomotic stenosis and fistula after laparoscopic sigmoidectomy are a subject of interest in the literature. Most series reporting results on these complications are heterogeneous. In addition, the selection of patients for treatment vary considerably. The objective of this film is to show a complication, although exceptional, three months after a laparoscopic sigmoidectomy; this complication is a peri-anastomotic stenosis combined with potential rupture of the anastomosis, fistula and peri-anastomotic abscess.

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B Dallemagne (France) / S Perretta (France) / J Marescaux (France)
17:28 - 2009 Oct
In this video, we present the surgical treatment of a typical gastroesophageal reflux disease in a young woman. She suffers from PPI tolerance, regurgitation with ENT symptoms, some asthma that usually is an indirect sign of very important regurgitation problems. That’s probably the best indication for anti-reflux surgery because everything can be controlled by medication. This is a very teaching video in which all technical details and all landmarks of the procedure are well illustrated.

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B Dallemagne (France) / J Marescaux (France)
14:30 - 2009 Sep
This video shows the technical details of a laparoscopic TEP repair of a Nyhus type II left inguinal hernia in a male patient performed during an IRCAD-EITS course in Strasbourg.

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J Leroy (France) / J Marescaux (France)
17:26 - 2009 Sep
The laparoscopic approach for rectal tumors is a technically demanding procedure, but it is safe and it has the feature of an oncologic procedure. The objective of this video is to demonstrate a standardized technique for the treatment of cancers of the upper rectum in a female patient. The therapeutic strategy includes a partial rectal resection with total mesorectal excision followed by a colorectal anastomosis on the inferior third of the rectum.

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B Dallemagne (France) / L Soler (France) / J Marescaux (France)
10:02 - 2009 Sep
Pancreatic endocrine tumors (PETs) are uncommon but clinically challenging and fascinating tumors. Small, benign neoplasms are readily curable by surgical resection. This video presents the case of a 40-year-old woman with a tumor at the level of the pancreatic body. The patient’s virtual reconstruction is used during surgery to help the surgeon pinpoint the lesion accurately. A laparoscopic approach is used.

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J Leroy (France) / J Marescaux (France)
15:48 - 2009 Sep
An anastomotic stricture is a common clinical finding. Its management can be difficult. Major corrective surgery is possible; however, it is technically challenging and not risk-free. The purpose of this video is to show the feasibility of a laparoscopic re-intervention on a stenosis following a colorectal anastomosis performed 2 years previously during the treatment of a PT3N0M0 mid-rectal cancer.

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D Mutter (France) / J Marescaux (France)
12:24 - 2009 Sep
This video demonstrates a three-trocar laparoscopic splenectomy performed for atypical idiopathic thrombocytopenic purpura in a 33-year-old patient. An anterior approach, as in this case, is a very interesting one as the spleen does not need to be manipulated in this patient.

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M Vix (France) / D Mutter (France) / J Marescaux (France)
10:08 - 2009 Jul
Gastrogastric fistula (GGF) is a rare complication that occurs after a divided Roux-en-Y gastric bypass (RYGBP). The incidence can be as high as 49% in patients who undergo non-divided or partially divided RYGBP. This is the case of a 33-year-old female patient who benefited of a gastric bypass 4 months earlier. After the procedure, the patient suffered from dysphagia. During preoperative work-up, a gastrogastric fistula was discovered. This video shows the laparoscopic treatment of the gastrogastric fistula.

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M Li (China)
25:17 - 2009 Jul
Total mesorectal excision (TME) was described 20 years ago and is now recognized as the therapeutic gold standard for middle and lower third rectal cancers. This is the case of a 70-year-old man with a BMI of 24 presenting with multiple polyps of the sigmoid colon larger than 3cm at 10 to 30cm from the anal verge. He has no past surgical history and colonoscopy revealed 3 sessile polyps at 15, 20, and 30cm from the anal verge as well as a flat polyp at 10cm from the anal verge. The histological examination concluded in one adenomatous, one adenovillous with high-grade dysplasia and one hyperplastic lesion. A laparoscopic partial TME with intraoperative endoscopic control is performed.

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B Dallemagne (France) / S Perretta (France) / J Marescaux (France)
28:26 - 2009 Jul
Large paraesophageal hernias (PEHs) occur most commonly in an elderly, debilitated patient population with existing co-morbid conditions. The surgical approach to paraesophageal hernias (PEHs) has changed with the advent of laparoscopic techniques. This video presents the case of a 72-year-old male patient referred to our unit for epigastric pain. In this patient, the endoscopy showed nothing specific concerning this pain. The barium swallow showed no abnormality, but just a lateralization of the esophagus. The CT-scan demonstrated a large hiatal hernia. The laparoscopic repair is presented here.

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J Leroy (France) / J Marescaux (France)
19:46 - 2009 Jul
The purpose of this video is to show an anterior rectal resection technique for an adenocarcinoma of the rectosigmoid junction using the Ligasure Advance® device (Valleylab, Covidien, Boulder, CO).This video shows how this device can optimize efficiency and safety in the operating room and potentially reduce overall operating time.

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D Mutter (France) / J Marescaux (France)
07:28 - 2009 Jul
Single port access cholecystectomy is a new laparoscopic procedure using only one transumbilically placed port. This video shows a procedure performed using a Gelport® through a 2.5cm incision. This Gelport® is usually used to perform hand-assisted surgery. In this case, the incision used to introduce the hand was closed by a single suture and 3 ports are inserted in the gel. These 3 ports allow to insert a 5mm 30 degree optic and straight or angulated instruments into the abdomen.

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B Dallemagne (France) / S Perretta (France) / J Marescaux (France)
20:15 - 2009 Jul
Re-operative antireflux surgery represents a challenging and complex clinical undertaking requiring careful patient selection as well as a high level of technical expertise. The procedures themselves are associated with a high rate of morbidity. This video shows a laparoscopic Collis gastroplasty and partial fundoplication for the treatment of valve slippage.

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B Dallemagne (France) / J Marescaux (France)
14:17 - 2009 Jun
Laparoscopic fundoplication has revolutionized the surgical treatment of gastroesophageal reflux disease. Careful patient selection, identification of the short esophagus, and accurate construction of the fundoplication can lead to a decrease in the incidence of postoperative dysphagia. This is an interesting video in which a critical analysis in performing a redo operation is clearly given to each surgical step.

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M Vix (France) / J Marescaux (France)
14:01 - 2009 Jun
Laparoscopic sleeve gastrectomy (LSG) was initially introduced for super-obese patients in a two-step concept in order to reduce the perioperative risk. Presently, it is proposed as one of the effective standard procedures for surgical treatment of morbid obesity. This video shows a laparoscopic sleeve gastrectomy in a female patient with a BMI of 42.

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C Huscher (Italy) / J Marescaux (France)
24:52 - 2009 May
With advancing surgical technology and technique, truly minimally invasive surgical procedures are feasible. Three port laparoscopic colectomy should offer minimal scarring without compromising the surgical outcome. This video demonstrates the technical details in performing the three port colectomy in a 40-year-old man with a BMI of 29, with several episodes of diverticulitis of the left colon.

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F Corcione (Italy) / J Marescaux (France)
19:36 - 2009 May
The value and efficacy of laparoscopic colorectal surgery has been validated by large multicenter, randomized, controlled trials. This video shows a laparoscopic sigmoidectomy in a 74-year-old woman who underwent an incomplete endoscopic resection of a T1 adenocarcinoma tumor. Four trocars are used: two of 10mm and two of 5mm.

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J Leroy (France) / J Marescaux (France)
21:00 - 2009 May
Obesity is a modern-day phenomenon that is increasing throughout the world. Laparoscopic colorectal surgery is clearly more technically demanding in the obese patient. Apart from this, however, it is not associated with any increased risk of postoperative complications. This is the case of a 52-year-old man with a BMI of 30 who was admitted several times to the hospital because of diverticulitis. The video demonstrates the technical details in performing the laparoscopic sigmoidectomy using the triple stapling technique.

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J Leroy (France) / J Marescaux (France)
26:28 - 2009 May
Over the last decade, the surgical treatment of rectal cancer has witnessed various improvements. Total mesorectal excision (TME) became the standard procedure. The surgical quality of the TME has a high effect on prognosis. This is the case of a 60-year-old woman with a BMI of 38 in whom a totally laparoscopic TME for middle rectal cancer with a side-to-end colorectal anastomosis is performed.

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J Leroy (France) / J Marescaux (France)
17:11 - 2009 Apr
This video demonstrates the trans-abdominal preperitoneal (TAPP) approach to bilateral inguinal hernia in a male patient with a BMI of 55. The surgeon performs the repair using a non-woven, non-absorbable polypropylene mesh. The author uses a 3-trocar approach: the first one is a 12mm supra-umbilical port (i.e., the trocar for the scope), and two 5mm ports on the right and on the left approximately at the crossing between the umbilical line and the mid-clavicular line. A clear explanation of all surgical landmarks is offered. The main objectives when doing a TAPP dissection are well exposed.

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J Leroy (France) / J Marescaux (France)
19:33 - 2009 Apr
Total mesorectal excision (TME) of the rectum has been advocated as the gold surgical treatment of the middle and low third rectal cancer. This video clearly demonstrates a totally laparoscopic TME in a male patient with a side-to-end anastomosis according to the principle of TME as described by Professor Heald in open surgery.

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M Vix (France) / F Costantino (France) / J Marescaux (France)
12:17 - 2009 Apr
Patients who have undergone bariatric surgery and present with upper abdominal symptoms pose a diagnostic and management challenge. Laparoscopic vertical banded gastroplasty (VBG) is associated with high revisional rates. In the case of failed VBG, repeat VBG seems to be a poor option and conversion to gastric bypass yields better results. This is the case of a 35-year-old female patient who underwent a vertical banded gastroplasty by laparotomy 8 years ago and presents with dysphagia. A gastroscopy and a contrast swallow exam using radio-opaque markers do not show any fistulas, but peroperative surgical exploration discovers a gastro-gastric fistula. This video clearly shows all the technical aspects of a revisional bariatric procedure.

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D Mutter (France) / J Marescaux (France) / L Soler (France)
18:28 - 2009 Apr
Soper et al. in 1994 were able to establish the safety and efficacy of laparoscopic distal pancreatectomy in an animal model, with no evidence of pancreatic leaks or fistulas. Later, in 1996, Cuschieri et al. described the technique they used to perform laparoscopic distal 70–80% pancreatectomy with en-bloc splenectomy in a group of five patients with intractable pain due to chronic pancreatitis. The authors demonstrated that this operation can be performed laparoscopically within an acceptable operating time and without major complications with advantages that include smaller incisions, less pain, and shorter postoperative recovery. Identification of anatomical landmarks is crucial for this kind of procedure expecially when treating cancer. Augmented reality is a new tool to improve oncological safety, confirming the ideal dissection plane and anatomical landmarks, and to maximize functional preservation. The objective of this video is to demonstrate how to perform a splenopancreatectomy with removal of pancreatic cancer while keeping sufficient safety margins. Augmented reality is used in order to clearly identify the position of the anatomical landmarks: the splenic vein and artery, as well as the exact position of the tumor so that a sufficient resection margin can be identified.

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J Leroy (France) / J Marescaux (France)
19:11 - 2009 Apr
This video clearly demonstrates the technical details (exposure, vascular approach, colorectal dissection and anastomosis) to correctly perform a laparoscopic sigmoidectomy for cancer in a female patient.

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J Leroy (France) / J Marescaux (France)
14:07 - 2009 Mar
Total coloproctectomy with ileal pouch-anal anastomosis is the operation of choice for ulcerative colitis. The objective of this video is to demonstrate the technique used to perform a laparoscopic coloproctectomy for the treatment of inflammatory bowel disease (and particularly, ulcerative colitis) and to show the ileoanal anastomosis (with creation of an ileal J-pouch) that follows a total colectomy resection. In this case, only sample exteriorization and ileal J-pouch formation are performed using the temporary ileostomy opening situated in the right flank. All other steps are performed entirely laparoscopically. The dissection is carried out using the 10mm Ligasure Atlas device.

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B Dallemagne (France) / S Perretta (France) / J Marescaux (France)
15:57 - 2009 Mar
Complications related to prosthetic hiatoplasty for hiatal hernia repair are more common than previously reported with no apparent relationship between mesh type and mesh configuration. The aim of this video is to show a case of mesh repair complication. A 50-year-old woman presented with severe dysphagia and important weight loss one year after redo laparoscopic Nissen fundoplication with prosthetic crural repair. At re-operation, important esophageal stenosis and angulation was found arising from the key-hole-shaped polypropylene mesh with pseudodiverticular dilatation of the distal esophagus. The esophagus was freed from the dense fibrotic capsule surrounding the prosthesis and a myotomy was performed.

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B Dallemagne (France) / S Perretta (France) / J Marescaux (France)
12:40 - 2009 Feb
Peptic ulcer disease is the major cause of benign gastro-duodenal obstruction or gastric outlet obstruction (GOO) in the adult population. Patients often present with abdominal pain and distension, vomiting, dehydration, and weight loss. Previous studies have demonstrated that the incidence of GOO varies from 5% to 10% of all hospital admissions for ulcer-related complications. Today surgeons are performing fewer elective ulcer surgeries, as H2 receptor blockers and the eradication of Helicobacter pylori represent a major step in the treatment of this disease. Nevertheless, patients with complications and those resistant to medical therapy can be offered surgical options. When surgery is required, a laparoscopic approach is possible with its well-known advantages. Surgical procedures include highly selective vagotomy with some form of pyloroplasty, truncal vagotomy and antrectomy, and truncal vagotomy with gastroenterostomy. Proponents of highly selective vagotomy advocate an acceptably low recurrence rate (0 to 5% at follow-up of 24 to 90 months) and a relative paucity of post-gastrectomy sequelae. Those recommending vagotomy and antrectomy stress the superiority of the acid-reducing procedure, the virtual absence of recurrent ulceration, and the rarity of postoperative symptoms other than post-vagotomy diarrhea, which is usually a self-limited process. Finally, truncal vagotomy with gastroenterostomy avoids what can be a treacherous duodenal stump, but can result in higher ulcer recurrence rates. We present the case of a young male patient not compliant to medical treatment who was referred to us for gastric outlet obstruction. The selected approach consisted in a laparoscopic Billroth II antrectomy and vagotomy using four ports.

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F Corcione (Italy) / J Marescaux (France)
17:52 - 2009 Feb
Colonic diverticulosis is an increasingly common condition in Western societies. Sigmoid colectomy for diverticulitis can be technically challenging because of severe inflammation in the left lower quadrant and pelvis. We here present a standard elective sigmoidectomy, after episodes of diverticulitis treated medically.

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C Huscher (Italy) / J Marescaux (France)
13:04 - 2009 Feb
This video demonstrates a laparoscopic three-port right hemicolectomy in an obese patient with a dysplastic adenoma. A stepwise approach including landmark identification is undertaken during the procedure. The specimen is extracted through a small laparotomy, which will be protected by a plastic bag. An extracorporeal mechanical side-to-side anastomosis using a 60mm Endo-GIA is made and the mesenteric window is closed using a monofilament 2/0 running suture. This video is a good demonstration of key anatomic landmarks, surgical planes, and surgical approach to a right hemicolectomy.

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B Dallemagne (France) / S Perretta (France) / J Marescaux (France)
31:44 - 2009 Jan
Open trans-thoracic surgery represents the traditional approach for the treatment of symptomatic esophageal diverticula. However, it should be noted that minimally invasive techniques, including the laparoscopic trans-hiatal approach has been reported with success. We present the case of a patient suffering from dysphagia and regurgitation due to an esophageal diverticulum, successfully treated through a laparoscopic approach.

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B Dallemagne (France) / S Perretta (France) / M Asakuma (France) / J Marescaux (France)
23:36 - 2009 Jan
The laparoscopic approach is considered the technique of choice for the repair of large hiatal hernia leading to low morbidity and mortality rates. We describe our approach for the laparoscopic repair of giant hiatus hernia. This entails full dissection of the hernia sac from the mediastinum, hiatal repair and the construction of a fundoplication.

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B Dallemagne (France) / S Perretta (France) / J Marescaux (France)
16:33 - 2009 Jan
Insulinoma is the most common pancreatic endocrine neoplasm. Treatment is by excision. In the pre-laparoscopic era, the enucleation was performed by laparotomy, but surgeons have shown that it can be performed laparoscopically. Preoperative localization is important in planning port placement and in guiding laparoscopic ultrasonography if necessary. When enucleation is performed, the pancreatectomy provides no oncologic advantage.

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D Mutter (France) / J Marescaux (France)
05:12 - 2008 Dec
We present the case of an inguinal hernia in a male patient, treated laparoscopically through a TAPP approach. The use of innovative absorbable tackers and its advantages are shown and thoroughly explained.

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B Dallemagne (France) / S Perretta (France) / J Marescaux (France)
12:52 - 2008 Dec
Patients who have Barrett’s esophagus are considered at risk for having a short esophagus. Routine intraoperative endoscopy and liberal addition of a Collis gastroplasty is a key factor to prevent recurrences.

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J Leroy (France) / J Marescaux (France)
27:09 - 2008 Dec
We present the case of a TME dissection performed with monopolar cautery. A good knowledge of the anatomy and adequate surgical skills permit to effectively complete the mesorectal excision. This video is recommended for advanced digestive surgeons.

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J Leroy (France) / J Marescaux (France)
21:09 - 2008 Nov
This patient presents with a perforation of a caecal diverticulum. The right parietocolic ridge is dissected, using the monopolar tip of the Ligasure Advance device. Hemostasis can be performed with the same instrument, using the bipolar sealing part. A classic ileocolectomy is carried out and a totally intracorporeal latero-lateral anastomosis is performed.

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D Mutter (France) / J Marescaux (France)
06:25 - 2008 Nov
The reduction of the number of trocars is one of the ways to minimize the invasiveness of the surgical intervention. This video shows a cholecystectomy with a single site access, using a Gelport. This device was designed for hand-assisted surgery. Standard laparoscopic trocars are inserted through the gel. Articulated instruments are used to recreate the triangulation of a standard laparoscopy. The intervention itself is performed in a standard way.

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J Leroy (France) / J Marescaux (France)
16:55 - 2008 Nov
This video presents the laparoscopic treatment of a perforated acute diverticulitis of the sigmoid colon. The patient has a Hinchey stage IIb peritonitis. Because of a stable clinical presentation, a laparoscopic treatment was offered. The cavity of the abscess is opened and cleaned. Local inflammation makes the dissection planes more difficult to define and the progression of the mobilization can be challenging. A sigmoidectomy is then carried out with a primary anastomosis.

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J Leroy (France) / J Marescaux (France)
18:48 - 2008 Nov
This video shows a standard oncological laparoscopic approach for T3 cancer of the colorectal junction. In this case, the patient presents a big tumor with a clinical sub-occlusion. A low anterior resection is performed by a medial to lateral approach, with a primary inferior mesenteric artery control. Splenic flexure mobilization was not necessary in this case. An end-to-end colo-anal anastomosis ends the procedure.

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J Leroy (France) / B Dallemagne (France) / D Mutter (France) / J Marescaux (France)
04:29 - 2008 Nov
Intragastric tumors represent a challenging pathology to treat with a minimally invasive approach because of their position and size. The possibility to combine both endoscopy and intragastric endoscopic surgery is of great value in these cases. This video shows such a combined endoscopic and laparoscopic approach to treat a stromal gastric tumor of the cardia. The endoscopy allows to choose a perfect position of laparoscopic access, depending on the tumor location. Furthermore, it provides the vision at the beginning of the intervention. After ablation of the tumor, a Triport is inserted into the stomach to close the gastric mucosa, allowing multiple transgastric access through a single gastrotomy.

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B Dallemagne (France) / S Perretta (France) / J Marescaux (France)
05:25 - 2008 Oct
A step-by-step approach is explained for the laparoscopic management of a diaphragmatic hernia in a patient with a past surgical history of Nissen fundoplication. Preoperative and postoperative CT-scans are shown.

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D Varela (France) / J Marescaux (France)
15:29 - 2008 Oct
This video presents the key steps to a gastric bypass procedure. This video is recommended for advanced laparoscopic surgeons.

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J Leroy (France) / J Marescaux (France)
06:47 - 2008 Oct
This video shows a unique procedure during which a sigmoidectomy was performed with a single trocar and entirely through the umbilicus. The principles applied to benign colonic resections are respected. An original colo-colonic anastomosis is presented with the use of external magnets to aid in with the totally intracorporeal anastomosis. The postoperative cosmetic results are shown.

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B Dallemagne (France) / J Marescaux (France)
15:21 - 2008 Oct
We present a laparoscopic Nissen technique for the surgical management of a hiatal hernia. In order to better understand the technique, a stepwise approach is performed and tips and tricks on how to avoid major problems are presented.

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J Leroy (France) / J Marescaux (France)
22:47 - 2008 Oct
This video presents the case of an obese male patient with rectorrhagia caused by disseminated polyposis. A stepwise approach is applied. The landmarks are identified in a detailed way.

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J Leroy (France) / J Marescaux (France)
24:51 - 2008 Sep
This video presents a TME with creation of a J-pouch for a coloanal anastomosis. A thorough description of the operative steps is presented. This video is recommended for digestive surgeons.

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J Leroy (France) / J Marescaux (France)
22:06 - 2008 Sep
This video shows a TME resection performed live at an EITS Course in Laparoscopic Colorectal Surgery. It shows the technical steps and relevant anatomy in a difficult case as the patient has a past surgical history and is predisposed to bleeding.

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B Salky (United states)
28:19 - 2008 Sep
This video presents the case of a right colectomy, with an intraoperative complication of the anastomosis, requiring a redo of the ileocolic isoperistaltic anastomosis.

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D Mutter (France) / J Marescaux (France) / L Soler (France)
08:24 - 2008 Sep
This video presents the case of a female patient with an ethylic cirrhosis, diagnosed with a hepatocellular carcinoma located in segment IVa of the liver. The laparoscopic approach helps preserve liver function in patients with precarious liver conditions.

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J Leroy (France) / J Marescaux (France)
04:55 - 2008 Sep
This video shows the laparoscopic treatment of an appendicular mucocele in a female patient who had had a hysterectomy.

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J Leroy (France) / J Marescaux (France)
09:50 - 2008 Sep
This video presents a totally laparoscopic reversal of Hartmann’s procedure in a patient with a surgical history of laparotomy for colorectal surgery.

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B Dallemagne (France) / J Marescaux (France)
13:35 - 2008 Sep
This video demonstrates all the important technical steps for a standard construction of a Nissen's fundoplication.

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D Mutter (France) / J Marescaux (France)
09:35 - 2008 Sep
This video demonstrates the feasibility and the challenges of a laparoscopic cholecystectomy using micro-instrumentation in an uncomplicated cholelithiasis.

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J Leroy (France) / J Marescaux (France)
10:42 - 2008 Jul
This edit of a case performed at a recent EITS Laparoscopic Course demonstrates the TAPP technique for a right inguinal hernia. As well as the technical steps, the relevant anatomy is expertly demonstrated.

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B Dallemagne (France) / J Marescaux (France)
15:24 - 2008 Jun
This video presents the management of a giant hiatal hernia by a laparoscopic Toupet fundoplication. We use a combination of pledgets and sutures as well as a mesh to close the crural defect. We recommend this video for advanced upper GI surgeons.

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J Leroy (France) / A Melani (Brazil) / A D'Urso (France) / D Mutter (France) / J Marescaux (France)
13:08 - 2014 Sep
Authors expose their pure NOTES transanal TME for early rectal cancer using oncologic dissection. The rationale, steps, tips and tricks to perform this new surgical procedure (called PROGRESS by authors) are clearly exposed using outstanding HD video pictures. This video completes the publication of the first world no-scar NOTES transanal TME in JAMA Surg (No-scar transanal total mesorectal excision: the last step to pure NOTES for colorectal surgery. Leroy J, Barry BD, Melani A, Mutter D, Marescaux J. JAMA Surg 2013;148:226-31).

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B Dallemagne (France) / J Marescaux (France)
15:45 - 2014 Feb
As a parenchyma-sparing procedure, enucleation can preserve normal pancreatic parenchyma and reduce the risk of endocrine and exocrine insufficiency. It has been proposed to be an alternative surgical procedure in neuroendocrine tumors. However, the postoperative rate of postoperative pancreatic fistula is significant, reported in up to 60% of patients. Some studies have demonstrated that a distance less than or equal to 2mm between the tumor and the main pancreatic duct is a risk factor for the development of fistula.

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M Vix (France) / J Marescaux (France)
16:06 - 2014 Jan
Basedow’s disease is an autoimmune disease characterized by a metabolic imbalance resulting from the overproduction of thyroid hormones (thyrotoxicosis). It is 8 times more common in women than in men, and occurs most frequently between the ages of 20 and 40, and has a familial tendency. This is the case of a 30-year-old woman presenting with Basedow’s disease who undergoes a classical thyroidectomy.

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D Mutter (France) / M Vix (France) / L Soler (France) / J Marescaux (France)
23:51 - 2013 Jul
This is the case of a female patient presenting with a typical 5cm right-sided pheochromocytoma was operated on laparoscopically. Preoperative 3D MRI reconstruction allowed to precisely identify surgical landmarks. The procedure was carried out typically. Four ports were used, and dissection aimed to first mobilize the liver. Control of the main adrenal vein was achieved as the first operative step. Medial, superior, and inferior arteries were dissected and controlled successively. Total freeing of the gland was performed with no manipulation or effraction of the gland's capsule. The postoperative course was uneventful. Small-sized pheochromocytomas are excellent indications for a laparoscopic approach with early control of the vein.

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D Mutter (France) / J Marescaux (France)
25:06 - 2013 Jan
We report the case of an obese patient (BMI of 40) presenting with a moderately secreting pheochromocytoma – Noradrenalin: 0.97micromol/L (N<05). She has a previous history of follicular thyroid cancer operated on 4 years ago, and imaging was performed in the follow-up of this cancer. Diagnosis was confirmed by serum chemistries and imaging studies: MIBG scintigraphy was positive on the right side, and a 4cm tumor was identified on CT-scan. The decision was made to perform a laparoscopic adrenalectomy.

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D Mutter (France) / L Soler (France) / J Marescaux (France)
16:19 - 2012 Nov
As laparoscopy is the standard approach to perform an adrenalectomy, robotic assistance is considered as an effective tool to perform this resection. Surgical steps follow those established for laparoscopy (i.e., mobilization of the spleen and of the pancreas in a patient placed in a lateral position, identification of the renal vein, control and division of the adrenal vein, successive freeing of the medial, external, inferior, and finally posterior aspects of the gland. The sealing devices such as ultrasonic dissectors are well adapted to perform this resection, and to safely control adrenal arteries. Robotic assistance takes full benefit from the degrees of freedom of the tips of the instruments and allows for an easy adrenal gland mobilization and removal.

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D Mutter (France) / J D'Agostino (France) / L Soler (France) / J Marescaux (France)
11:41 - 2012 May
The resection of adrenal tumors has several indications. In the present case, the patient’s request facing a significant increase in the size of a left adrenal tumor has led the team to propose the implementation of a partial adrenalectomy. The procedure was performed with robot assistance, using three trocars. Pathological findings confirmed a benign adrenal mass. The postoperative outcome was uneventful.

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D Mutter (France) / L Soler (France) / J Marescaux (France)
21:03 - 2012 Feb
This video presents the case of a 57-year-old male patient who has undergone a laparoscopic right adrenalectomy for a pheochromocytoma. Decision as to when to convert into an open approach is considered.

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D Mutter (France) / L Soler (France) / J Marescaux (France)
22:22 - 2011 Nov
Laparoscopic adrenalectomy has become increasingly used and has now become the technique of choice for most benign adrenal lesions due to decreased blood loss, lower morbidity, shorter hospital stay, faster recovery, and overall cost-effectiveness as compared with the open approach. This video shows a laparoscopic live trans-abdominal right adrenalectomy.

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M Walz (Germany) / J Marescaux (France)
26:04 - 2011 Nov
Laparoscopic adrenalectomy has been shown to be safe and effective for a variety of benign adrenal tumors. The extraperitoneal approach with a minimal access procedure provides direct access to the adrenal glands without interfering with intraperitoneal organs. This video shows a live demonstration of an extraperitoneal access using a single port technique.

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M Walz (Germany) / L Soler (France) / J Marescaux (France)
25:24 - 2011 Sep
Since M. Gagner published the first case of a transperitoneal laparoscopic adrenalectomy in 1992, the laparoscopic adrenalectomy has gradually become the standard operation for removing adrenal tumors. Compared to a traditional adrenalectomy, a laparoscopic adrenalectomy has a number of advantages, including less blood loss, a shorter hospital stay, a quicker recovery, and fewer complications. There are many ways to approach the adrenal gland laparoscopically, such as by a lateral transperitoneal approach, anterior transperitoneal approach, lateral retroperitoneal approach, and posterior retroperitoneal approach. This video shows a posterior left adrenalectomy using virtual reality simulation.

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D Mutter (France) / L Soler (France) / J Marescaux (France)
15:51 - 2011 May
We present the case of a 43-year-old female patient in whom an adrenal tumor was incidentally found during a medical imaging study. As usually done, a 3D reconstruction of the lesion is performed in order to define the anatomical relationships and decide on the most appropriate surgical strategy. The excellent quality of the reconstruction will make it possible to envisage first the preservation of the adrenal gland and then the tumor resection during the intervention.

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D Mutter (France) / J Marescaux (France)
09:42 - 2011 Mar
We report the case of a female patient presenting with a Cushing's adenoma. It is located on the left side of the patient. This woman has a previous medical history of type II diabetes and obesity. She presents clinically with a typical Cushing’s syndrome. A laparoscopic three-port left adrenalectomy is demonstrated.

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D Mutter (France) / L Soler (France) / J Marescaux (France)
14:29 - 2010 Oct
Laparoscopic adrenalectomy is a well-established procedure. This is the case of a patient who has undergone a surgical laparoscopic procedure for a typical secreting right pheochromocytoma. The CT-scan shows a 6cm tumor. Preoperatively, virtual reality is used. The objective is to accurately locate the tumor, its relationships with the surrounding anatomical structures and the position of the adjacent organs, and to prepare the surgical intervention in ideal conditions.

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D Mutter (France) / L Soler (France) / J Marescaux (France)
10:00 - 2010 Feb
Laparoscopic adrenalectomy is now accepted as the procedure of choice for the resection of benign adrenocortical tumors. This video shows the laparoscopic approach for a 12cm right pheochromocytoma, demonstrating that the size is not a contraindication for laparoscopy.

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D Mutter (France) / L Soler (France) / J Marescaux (France)
18:32 - 2009 Nov
Laparoscopic adrenalectomy for large masses is a technically demanding procedure that should be undertaken by experienced laparoscopic surgeons familiar with retroperitoneal anatomy. In case of very large tumors, a primary vascular approach must prevail over any other types of dissection. This video shows the case of a patient presenting with a voluminous non-secreting adrenal tumor (with a diameter of 14cm) in which a primary laparoscopic approach is decided upon as performed conventionally.

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D Mutter (France) / L Soler (France) / J Marescaux (France)
15:51 - 2009 Jun
Conn's disease is a condition in which the adrenal glands produce too much aldosterone. Prevalence estimates for Conn's syndrome is about 0.03-1.2% of the population with hypertension. Many patients with Conn's disease have a high blood pressure that is difficult to control. This increases the risk of stroke, heart disease and kidney failure. When Conn's disease is caused by a tumor (benign adrenal adenoma), surgical resection is advised. This video demonstrates the case of a woman presenting with Conn’s disease. The preoperative work-up demonstrated a tumor located on the left adrenal gland. The patient presented an elevated aldosteronemia and the CT-scan demonstrated a 2cm left adrenal tumor. The patient is placed in a full lateral position, on the right side.

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D Mutter (France) / J Marescaux (France)
10:45 - 2009 Mar
Since it was first performed in 1992, laparoscopy has clearly become the procedure of choice for the removal of most functioning and non-functioning adrenal tumors. Compared with those who underwent a standard open approach, patients undergoing a laparoscopic adrenalectomy have demonstrated decreased perioperative morbidity, shorter hospital stay, and faster functional recovery. This video demonstrates how to perform a laparoscopic adrenalectomy showing the surgical landmarks for a correct vascular approach in a stepwise fashion.

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D Mutter (France) / J Marescaux (France)
08:08 - 2009 Feb
Laparoscopic adrenalectomy has now become the new "gold standard" for the surgical treatment of most adrenal lesions. Here we show a film of right adrenalectomy for pheochromocytoma, demonstrating the conventional "no touch technique" where the dissection takes place around the gland without really manipulating it. The film also demonstrates the anatomical landmarks as well as the principles and sequence of vascular control.

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A Wattiez (France) / M Puga (Chile) / C Redondo (Spain) / F Ruhlmann (Argentina) / J Leroy (France)
23:44 - 2013 May
Deep infiltrating endometriosis is a challenging surgical procedure. Even if preoperative work-up is of major importance, several decisions can only be made after surgical re-evaluation of the lesion. Both ureteral and bowel endometriosis are good instances of this philosophy. The conservative approach must be considered first whenever possible. However, in some cases, the success of the procedure combined with patient prognosis is unsatisfactory.

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A Wattiez (France) / J Albornoz (Chile) / M Puga (Chile) / E Faller (France)
32:41 - 2012 Oct
Bladder endometriosis is the most common presentation of urinary tract endometriosis and is frequently associated with specific symptoms such as dysuria, hematuria and recurrent urinary tract infections. Although it may be associated with ureteral endometriosis in severe cases, in most cases, it presents as an isolated disease. The laparoscopic approach for bladder endometriosis nodule excision requires careful dissection of the paravesical spaces and identification of both ureters entering each ureteral tunnel. The shaving technique until healthy tissue is reached should be attempted, but if mucosal invasion is found, complete wall excision should be performed. In some occasions, when the nodule invades the bladder trigone, a double-J catheter may be inserted and left in place for 6 to 8 weeks. In this video, we present the case of a 23-year-old woman complaining with significant dysuria associated with hematuria, dysmenorrhea, dyspareunia, and chronic pelvic pain. Magnetic resonance imaging described a 5cm nodule located in the bladder dome, and cystoscopy confirmed the diagnosis. The patient was referred to our Endometriosis Centre after diagnostic laparoscopy.

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A Wattiez (France) / M Puga (Chile) / E Faller (France) / J Albornoz (Chile) / CY Akladios (France)
20:22 - 2012 Sep
Several aspects are of utmost relevance to perform Pelvic Lymphadenectomy (PL) and Radical Modified Hysterectomy (RMH). This film presents a didactical presentation of RMH and PL performed in a 46-year-old woman with stage Ia2 cervical carcinoma. Oncological risks of the surgery, anatomical landmarks, the surgical technique and choice of instruments are discussed. Several tips and tricks are outlined by the surgeon during the different steps of the surgery.

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A Wattiez (France) / C Zacharopoulou (France) / J Albornoz (Chile) / M Puga (Chile) / E Faller (France)
28:58 - 2012 Jun
Hysterectomy when managing a big adnexal mass has always been a challenging situation for laparoscopic surgeons. Complete preoperative assessment, surgical experience and strategy are fundamental to address adnexal pathology laparoscopicallly, both for benign and malignant conditions. Adequate trocar placement, full inspection of the abdominal cavity, comprehensive evaluation of the tumor’s surface, cytology and definition of the nature of the adnexal mass are truly essential. In addition, proper identification of standard anatomical landmarks is fundamental to perform hysterectomy with adnexectomy, which helps to prevent damage to surrounding structures. Final assessment of the vaginal cuff may lead to the diagnosis of pelvic floor disorders that should be repaired during vaginal cuff closure. In this video, we present a case of hysterectomy and adnexectomy by laparoscopy in a 46-year-old patient complaining of abdominal pain secondary to the presence of a 13cm simple adnexal cyst with normal CA 125 values.

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A Wattiez (France) / I Miranda-Mendoza (Chile) / J Nassif (Lebanon) / E Kovoor (France) / M Hummel (France)
22:00 - 2009 Sep
Ovarian cancer usually affects women over age 50, but it can also occur in younger women. Its cause is unknown and is hard to detect early. We present a short video describing the technique of laparoscopic restaging for ovarian cancer with pelvic and lumbo-aortic lymphadenectomy.

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A Wattiez (France) / E Kovoor (France) / J Nassif (Lebanon) / I Miranda-Mendoza (Chile)
23:01 - 2009 Jul
This video demonstrates the technique of a total laparoscopic hysterectomy with adnexectomy. Our patient is a 44-year-old lady with Tamoxifen-induced endometrial hyperplasia, which failed to respond to medical treatment. Umbilical incision is made on the left internal border to give a more aesthetic scar. Direct entry is performed. The assistant helps to lift the abdomen while the surgeon directs the trocar perpendicularly towards the rectus sheath first, then directs it towards the pelvis. The midline port is inserted: this should be at a slightly higher level than the lateral ports for better ergonomics. The uterine manipulator has a rotating ceramic valve for opening the vagina and a set of rings to maintain the pneumoperitoneum. The procedure is started by coagulating and cutting the round ligament on the left and opening the broad ligament. The broad ligament is opened parallel to the infundibulopelvic ligament for adnexectomy and a window is made over the grey area. The posterior leaf of the broad ligament is opened towards the left uterosacral ligament. The anterior leaf of the broad ligament is opened towards the vagina by dissecting the space and coagulating and cutting the tissues in between. The dissection is continued until the uterine artery is reached. The left infundibulopelvic ligament is coagulated and cut. The same procedure is done on the other side. Bladder dissection is performed with the help of the assistant holding up the bladder and entering the vesicovaginal space. The bladder is dissected away, beyond the valve of the manipulator. The left uterine artery is coagulated and cut. The left uterosacral ligament is coagulated and cut. The right uterine vessels are coagulated and cut followed by the uterosacral ligament. The vagina is now cut against the valve of the manipulator using a monopolar hook. Bleeding points are coagulated with a bipolar forceps. The vagina is sutured in two layers using extracorporeal knots. The procedure is now complete and hemostasis is confirmed. This patient had a favourable postoperative outcome and was discharged on postoperative day 1.

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A Wattiez (France) / J Nassif (Lebanon) / C Zacharopoulou (France)
25:28 - 2008 Nov
This video shows a laparoscopic total hysterectomy and a bilateral pelvic lymphadenectomy for endometrial cancer. The patient is obese with a BMI of 34, which makes the surgical intervention more difficult. Anatomical landmarks are very well shown.

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A Wattiez (France) / J Nassif (Lebanon) / C Zacharopoulou (France)
24:27 - 2008 Oct
In this video, we present the case of a 49-year-old patient with menorrhagia caused by multiple uterine myomas. The technical aspects of a laparoscopic hysterectomy in the case of large uteri is also exposed. The video also presents tips and tricks to deal with such cases.

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M Vix (France) / KH Liu (Taiwan) / J Marescaux (France)
16:57 - 2012 Jul
Gastric bypass is one of the most common procedures in bariatric surgery. The main steps of this procedure are well codified, namely fashioning of a small-sized gastric pouch in contact with the esophagus, measuring of a biliary limb and of an alimentary limb, gastrojejunal anastomosis and jejunojejunal anastomosis at the foot of the loop. The Da Vinci™ robotic Surgical System is particularly suited for manual anastomoses. This video demonstrates the use of the robot to perform gastrojejunal and jejunojejunal anastomoses.

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D Mutter (France) / M Vix (France) / L Soler (France) / J Marescaux (France)
13:00 - 2012 Apr
This video presents the case of a patient presenting with a 7cm tumor that was diagnosed as a non-secreting adrenal tumor. An adrenalectomy was proposed after the CT-scan analysis. A robotic approach was performed. It allowed for the resection of a tumor located between the kidney and the adrenal gland. The adrenal gland was preserved. Pathological findings helped to evidence a schwannoma.

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E Mandron (France) / C Saussine (France)
26:31 - 2011 Dec
Mesh placement appears nowadays to be consensual upon treating genitourinary prolapse by the vaginal or abdominal approach. Laparoscopic sacral fixation with two meshes should be considered as a gold standard in terms of anatomical and functional long-term results. We present a case of cystocele and rectocele grade 2 treated laparoscopically with anterior and posterior sacral mesh fixation.

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E Mandron (France)
29:11 - 2009 Sep
Laparoscopic promontofixation is a feasible and highly effective technique that offers good long-term results. In this video, a sacral colpopexy with double promontofixation using a double mesh, anterior and posterior mesh is presented in a patient who had a previous hysterectomy.

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E Mandron (France) / C Saussine (France) / J Marescaux (France)
20:26 - 2009 Mar
Nowadays, there is a consensus upon treating genitourinary prolapse with mesh placement. Anterior and posterior mesh placement can be done by a transvaginal or an abdominal approach. Such a laparoscopic approach should be considered as a gold standard in terms of anatomical and functional long-term results. We present a case of laparoscopic prolapse treatment with double anterior and posterior sacral mesh fixation.

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E Mandron (France) / C Saussine (France)
23:33 - 2008 Dec
Pelvic organ prolapse is a common condition affecting many adult women today. Knowledge of the anatomy of the pelvis is essential to understanding prolapse; for this, the challenge to the pelvic surgeon is to recreate normal anatomy while maintaining normal function. We present a case of a genitourinary prolapse treated through a laparoscopic approach.

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