Share your knowledge and know-how with the largest online community of surgeons!
You can contribute to WebSurg by submitting your minimally invasive surgery videos that will help us increase the scope of our educational content. This is a unique opportunity for you to share your surgical skills with the largest community of surgeons worldwide, and become part of our international Faculty.
You’re not an expert in video editing? No problem! Submit the video of your surgical procedure and our editorial and audiovisual team will take care of the rest for free.
Videos submitted to us are sent to a peer-review committee who will decide if the video can be published on WebSurg. This decision depends on the technical quality of the video and on its scientific relevance and compliance with international guidelines, but also on its originality. We remain at your disposal throughout this process to inform you on the status of your video publication.
Should your video not be validated by our editorial team, we will give you the reasons for this. However you are still more than welcome to send us more videos.
The latest contributions
In this video, we present the clinical case of a 66-year-old woman with a sigmoid-rectal junction early stage cancer submitted to laparoscopic resection. Before surgery, the patient was submitted to endoscopy with the objective to mark the distal margin of the neoplasia, and 2mL of ICG were injected into the mucosa of the rectum, 2cm distal to the inferior border of the tumor.
Thanks to the ICG’s fluorescence with the light emitted from the photodynamic eye of our laparoscopic system (Stryker 1588 camera system), it is possible to clearly visualize both the individual lymph nodes and the lymphatic collectors which drain ICG (and lymph) of the specific mucosal area previously marked with indocyanine green.
It was possible to verify the good perfusion of the proximal stump of the anastomosis before the Knight-Griffen anastomosis was performed, thanks to an intravenous injection of ICG.
This technique could allow for a more precise and radical nodal dissection, a safer work respecting vascular and nerve structures, and could be related with a lower risk of anastomotic fistula, controlling the adequate perfusion of the stump.
Methods: The procedure was performed in two phases: first, by an abdominal laparoscopic approach consisting in the high ligation of the inferior mesenteric artery and vein, and complete splenic flexure mobilization. The pelvic dissection was continued in the Total Mesorectal Excision (TME) plane to the level of the puborectal sling posteriorly and of the seminal vesicles anteriorly.
Secondly, the procedure continued by transanal laparoscopic approach: A Lone Star® retractor was placed prior to the platform insertion (Gelpoint Path®). Under direct vision of the tumor, a purse-string suture was performed to obtain a secure distal margin and a completed closure of the lumen. It is essential to achieve a complete circumferential full-thickness rectotomy before facing the dissection cranially via the TME plane. Both planes, transanal and abdominal, are connected by the two surgical teams. The specimen was then extracted through a suprapubic incision. A circular end-to-end stapled anastomosis was made intracorporeally. Finally, a loop ileostomy was performed.
Results: A 75-year-old man with low rectal cancer (uT3N1-Rullier’s I-II classification), was treated with neoadjuvant chemoradiotherapy and TaTME. Operative time was 240 minutes, including 90 minutes for the perineal phase. There were no postoperative complications and the patient was discharged on postoperative day 5. The pathology report showed a complete mesorectum excision and free margins (ypT1N1a).
Conclusions: The TaTME technique is a safe option for the treatment of low rectal cancers, especially in male patients with a narrow pelvis. It is a feasible and reproducible technique for surgeons with previous experience in advanced laparoscopic procedures and transanal surgery.
The clinical case is that of a 53-year-old woman with a stage TNM IIIb, AFIP 6b gastric GIST. In 2013, she underwent a sleeve gastrectomy followed by the daily administration of Imatinib (400mg). After 3 years of adjuvant therapy, she stopped treatment. In May 2017, in a follow-up CT-scan, a solid, heterogeneous 6.7cm lesion appeared in the left hypochondrium, separated from the metal suture, invading the lower pole of the spleen, with no evidence of adenopathies or free liquid.
Surgical resection was planned. A splenectomy with distal pancreatectomy, documented in the video, was performed with no complications. The histological examination confirmed a 5.8cm tumor implant, located in the splenic cord, compatible with GIST recurrence (>50 mitoses/50 fields, free margins, prognostic group 6b).