Abdominal lymph node dissection

Steps in the technique for abdominoperineal resection. (1) Treitzs angle exposure, retroperitoneal dissection on the anterior aspect of the Gerotas fascia; (2) inferior mesenteric artery dissection; (3) distal transection of the inferior mesenteric vein; (4) inferior mesenteric artery transection after the origin of the left colic branch; (5) medio to lateral dissection preserving left ureter and gonadal vessels; (6) lateral dissection of sigmoid and descending colon; (7) posterior rectal dissection; (8) right lateral dissection; (8) dissection of the right branches of the inferior hypogastric plexus; (9) left lateral dissection; (10) uterus suspension with T-Lift retractor; (11) anterior dissection, Douglas pouch incision and lower rectum dissection; (12) intracorporeal colon transection; (13) extraperitoneal colostomy; (14) perineal dissection; (15) posterior perineal dissection joining previous laparoscopic dissection; (16) lateral cilindric dissection; (17) anterior dissection, partial posterior vaginal wall resection; (18) specimen verification; (19) perineal wound closure.

Robotic conversion of an Adjustable Gastric Band to a Roux-En-Y gastric bypass. We demonstrate the key steps in converting a LAGB to a RYGB due to weight loss failure and GERD.

Laparoscopic conversion of an Adjustable Gastric Band to a Sleeve Gastrectomy. We demonstrate the key steps in converting a LAGB to a SG due to weight regain.

Anterior mobilization of the thoracic esophagus

Anterior sheath closure: The anterior sheath is reapproximated using a slowly absorbable barbed suture. Insufflation pressures can be decrease to 10-12mmg to facilitate defect closure. Additionally, the surgeon can incorporate the hernia sac to eliminate the dead space.

Artificial intelligence-based total mesorectal. (From Igaki T, Kitaguchi D, Kojima S, et al. Artificial Intelligence-Based Total Mesorectal Excision Plane Navigation in Laparoscopic Colorectal Surgery . Dis Colon Rectum 2022; 65: e329–e333. Video 1.)

Back table reconstruction of hepatic vein branches during ex vivo resection.

Bar bending

Biliary stent placement during Endoscopic retrograde cholangiopancreatography (ERCP). A guiding catheter system is introduced over the indwelling guidewire into the desired duct. Following this, the stent is advanced and deployed using the catheter system under endoscopic and fluoroscopic guidance.

Bronchoscopy and bronchoalveolar lavage. Bronchoscopy equipment and fundamentals are demonstrated in addition to bronchoalveolar lavage.  

Internal Jugular central venous line insertion. Central venous line equipment, preparation, and insertion are demonstrated, including ultrasound guidance and the Seldinger technique. 

A step-by-step demonstration of the CEGA.

This gunshot wound had a 2 cm full thickness component with a longer myocardial component. The first mattress suture in Video 2 controlled the bleeding while the second suture buttressed the repair. During the operation, the patient sustained multiple episodes of ventricular fibrillation and cardiac arrest requiring internal defibrillation, vasopressors, and amiodarone. The patient recovered with no neurologic or cardiac sequelae.

Pneumonectomytechnique(s) to limit persistent or recurrent hemorrhagic shock. The video shows individual control of the pulmonary artery and vein with standard vascular techniques coupled with staple closure of the bronchus.

Creation of the gastric tube

Cryoablation of breast cancer technique

Cryoanalgesia and counting ribs

Identification of the deep deformity and mediastinal dissection

Placement of deep dermal sutures. Closure of elliptical excision with deep dermal sutures.

Overview of laparoscopic feeding jejunostomy placement, including identification of jejunal segment, intracorporal placement of tacking sutures through jejunum and abdominal wall in diamond shape, and insertion of J-tube using Seldinger technique

Diagnostic laparoscopy and interoperative ultrasound of the liver

Demonstration of direct endoscopic necrosectomy

Direct-to-implant breast reconstruction with partial pectoralis muscle coverage and acellular dermal matrix

Dissection and division of the left gastric artery 

Dissection of the greater curve and mobilization of the gastrocolic ligament 

Dissection of the hiatus

Dissection of the left sided pleura and left inferior pulmonary ligament

Division of the azygous vein and posterior mobilization of the thoracic esophagus

Division of the esophagus and delivery of the gastric conduit into the chest

Division of the pars flaccida and mobilization of the crura from right to left

Dr. Geoffrey B. Thompson's technique for laparoscopic adrenalectomy, lateral approach

Intraductal electrohydraulic lithotripsy (EHL) for the management of large common bile duct stones. This video demonstrates a case of peroral cholangioscopy using EHL to assist with the endoscopic fragmentation of difficult bile duct stones prior to definitive stone extraction.

Pneumonectomytechnique(s) to limit persistent or recurrent hemorrhagic shock. En bloc staple control of the hilum.

Endoscopic ampullectomy. A needle is inserted to inject saline admixed with blue dye to achieve a submucosal lift. Following this, endoscopic resection of the ampullary adenoma is achieved with hot snare polypectomy. Following resection, ERCP is routinely performed to place a pancreatic duct stent for post-ERCP pancreatitis prophylaxis.

The video shows endoscopic features consistent with a complete clinical response after neoadjuvant treatment (video corresponds to post-treatment assessment of tumor illustrated in Video 1). A white scar is clearly identified with significant teleangiectasia. There are no signs of ulceration, residual mass or stenosis of the rectal lumen. Narrow-banded images clearly identify only scar tissue and no abnormal pit patterns. 

The video shows endoscopic findings of a near complete response in patient that has completed neoadjuvant therapy (12 weeks interval from the last date of radiation) showing a small area of irregularity/abnormal tissue suspicious for residual cancer. 

The video shows the endoscopic findings of rectal cancer located at the distal portion of the rectum. Both direct endoscopic and retroflexive views are available that should be useful for comparison when assessing tumor response after treatment

Summary video: endoscopic rectal cancer findings overview.

Endoscopic retrograde cholangiopancreatography (ERCP) with stone removal. This video demonstrates bile duct stone removal using an extraction basket.

Extended totally extraperitoneal repair (eTEP) approach to ventral hernia repair (VHR).

Fusiform ellipse excision, excision of fusiform ellipse with scalpel at 90 degrees to skin surface.

Fusiform ellipse excision, sharp undermining with electrofulguration

Fusiform ellipse excision, sharp undermining with 15 blade scalpel

Steps of Ex-vivo liver resection. (Originally presented at Hemming AW, Ex Vivo liver resection. International Hepatopancreatobiliary Association Meeting, Edinburgh, Scotland, September 2006.)

Fluoroscopic imaging of an air reduction enema

Gastrocolic dissection with elevation

Gastrojejunal anastomosis

Pancreatic necrosectomy and goals of pancreatic debridement

Hammock procedure for reinforcement of interspaces in adults

Variable findings in atypical malrotation associated with heterotaxy syndrome including attachments of the proximal bowel to the biliary structures.

Hybrid open and laparoscopic repair of umbilical hernia

IVC reconstruction during right hepatectomy.

Inguinal orchidopexy and herniorrhaphy: description of technique

Injection of Talimogene Laherparepvec (TVEC) in melanoma in-transit metastases. (Courtesy of Danielle K. DePalo, MD, and Jonathan S. Zager, MD, Moffitt Cancer Center.)

The surgeon's nondomimant hand and the assistant then proceed to lift the colonic mesentery off of the retroperitoneal structures as the surgeon's dominant hand sweeps the structures down until the IMA is reached. (From Acar N, Etlik M, Karaisli S, Acar T. Laparoscopic Extended Left Hemicolectomy With Deloyers Procedure. Dis Colon Rectum. 2022 Sep 1;65(9):e909. Video 1.)

Laparoscopic technique of peritoneal dialysis (PD) catheter insertion.

Laparoscopic sigmoid resection for diverticulitis. (From Bello, Brian L. Laparoscopic Sigmoid Resection for diverticulitis. Dis Colon Rectum. 2020. 63(7):e472. Video 1).

NA same as video title

Laparoscopic transabdominal preperitoneal inguinal hernia repair

Lateral internal sphincterotomy. (From Elias AW, Albert MR. Lateral internal sphincterotomy. Dis Colon Rectum. 64(8):e471. Video 1.)

Lateral pelvic lymph node dissection. (From Siddiqi NN, Stefan SS, Khan JS. Robotic Abdominoperineal Excision with Lateral Pelvic Lymph Node Dissection. Dis Colon Rectum. 2021; 64(3):e58-e59. Video 1.)

Left congenital diaphragmatic herinia (CDH) repair, laparotomy

Left congenital diaphragmatic hernia (CDH) repair, thoracoscopy

Level 1 and level 2 axillary lymph node dissection for melanoma (ALND)

Ligation of left gastric artery (LGA) and coronary vein

Steps in the technique for low anterior resection. (1)Treitzs angle exposure, retroperitoneal dissection; (2) on the anterior aspect of Gerotas fascia; (3) inferior mesenteric vein section; (4) dissection along the superior border of the pancreas; (5) colo-epiploic dissection; (6) splenic flexure complete freeing; (7) peritoneal dissection at the level of the sacral promontory; (8) inferior mesenteric artery skeletonization; (9) inferior mesenteric artery transection; (10) lateral dissection of sigmoid and descending colon; (11) sigmoido-rectal junction mobilization; (12) rectal posterior dissection; (13) lateral rectal dissection; (14) anterior rectal dissection; (15) complete lower rectum freeing; (16) rectal transection; (17) intracorporeal mesocolic dissection; (18) suprapubic extraction; (19) anvil insertion for a side anastomosis; (20) side to end colorectal anastomosis.

Laparoscopic pancreatoduodenectomy (LPD) techniques.

Lumen-apposing metal stent insertion. Demonstration of insertion of a lumen-apposing metal stent for drainage of WOPN.

Magseed lumpectomy technique

Findings of typical malrotation including narrow mesenteric pedicle and Ladd’s bands.

Minimally invasive esophagectomy (MIE) anastomosis

Minimally invasive esophagectomy (MIE) conduit cormation

Minimally invasive esophagectomy (MIE) esophageal mobilization

Minimally invasive esophagectomy (MIE) gastric mobilization

Minimally invasive esophagectomy (MIE) hiatal dissection

Minimally invasive esophagectomy (MIE) lymph node dissection

Summary video: minimally invasive esophagectomy overview.

Mobilization of the esophagus from the trachea and carina

Magnetic sphincter augmentation (MSA) minimal hiatal dissection

Multiple-gateway technique. Demonstration of the multiple-gateway technique for draining large WOPN collections.

Necrosectomy morcellator. Demonstration of the use of a morcellator device during necrosectomy (Courtesy of Dr. Joo Ha Hwang)

Neurovascular bundles: The retrorectus dissection is completed when the surgeon has identified the neurovascular bundles. These are found just medial to the linea semilunaris and mark the lateral extent of the retrorectus space.

Nuss bar rotation

Operative video of open cholecystectomy technique including: incision placement, opening of abdominal wall, placement of retractors, dissection of the gallbladder and ligation of the cystic artery and cystic duct

Open j-pouch pars. (From Justiniano CF, Bhama AR, Holubar SD. Open J-Pouch Pearls. Dis Colon Rectum. 2022 Jul 1;65(7):e743-e744. Video 1.)

Once the vessels are isolated and the ureter is indentified, a high ligation of the vessels as per CME principles is performed. (From Samalavicius NE, Klimasauskiene V, Dulskas A. Open Left Hemicolectomy for Proximal Sigmoid Cancer. Dis Colon Rectum. 2022 Jan 1;65(1):e14-e15. Video 1.)

Open technique of peritoneal dialysis (PD) catheter insertion.

Steps in the technique for a parathyroidectomy lateral approach. (1) All three trocars are positioned on the line of the anterior border of the sternocleidomastoid muscle. Main trocar (A) is placed at the level of the thyroid isthmus. Trocars B and C should be 3 to 4 cm apart and will be used for the 2-mm instruments. A pneumocervicotomy is established using insufflation with carbon dioxide at low pressure. (2) Dissection of the upper two-thirds of posterior aspect of the thyroid lobe allows to identify first the recurrent nerve and after the parathyroid adenoma. (3) Parathyroid adenoma is completely mobilized, the vascular pedicle is isolated and the terminal vascular branches are grasped, skeletonized, and electrocoagulated with the 3-mm diathermy hook.

Passage of the bar introducer and Nuss bar

Summary video: pectus repair overview.

Pericostal rib fixation of the bar

Video showing key steps of per oral endoscopic myotomy: submucosal injection of methylene blue, mucosotomy creation, submucosal tunnel dissection, myotomy, and mucosotomy closure.

Per-oral pyloromyotomy technical pearls

Portal vein resection /reconstruction demonstrating reconstruction of the portal vein to left portal vein for hilar cholangiocarcinoma. 

Posterior sheath closure: Upon completion of the TAR, the posterior sheath and all rents are closed to completely exclude the viscera from the preperitoneal pocket. This is done utilizing a slowly absorbable barbed suture.

Preparation of the gastrohepatic ligament and lesser curve tissues in preparation for gastric conduit formation

Management of patient with prolapsed ileostomy. (From Colwell JC, Williams T. Management of the Patient With a Prolapsed Ileostomy. Dis Colon Rectum. 2022 Dec 1;65(12):e1073. Video 1)

Proximal division of stomach

Pseudoaneurysm of femoral artery

Pulmonary arterial catheter insertion. Placement of a pulmonary arterial catheter, including ultrasound-guided insertion of a right internal jugular introducer is demonstrated. The components of the pulmonary arterial catheter and waveforms during catheter advancement are shown. 

Radial arterial line insertion. A radial arterial line can be inserted using palpation or ultrasound guidance. Both approaches are demonstrated using the “over-the-wire” technique. The radial artery is accessed with a catheter-sheathed needle at a 45-degree angle. When pulsatile blood returns, the guidewire is advanced through the needle and the catheter is threaded over it into the arterial lumen. The device in this video is designed with an in-line guidewire, which is removed with the needle as one piece after the catheter is in appropriate position

Reconstruction of a segment 6 vein during left trisectionectomy.

Rectopexy and repair of the pouch of douglas for rectal intussusception and enterocele. (From Sobrado LF, Nahas SC, Sobrado CW. Suture Rectopexy and Repair of the Pouch of Douglas for Rectal Intussusception and Enterocele. Dis Colon Rectum. 2022; 65(6):e661. Video 1.)

Step-by-step instructions of a rectus diastasis repair with method B.

This patient presented in extremis after gunshot wound to the left chest with massive left hemothorax. A left chest tube was placed in the trauma bay and left anterolateral thoracotomy performed in the operating room. The cardiac injury was controlled with digital pressure and repaired using the described technique.

Management of a retracted loop ileostomy. (From Colwell JC. Management of the Patient With a Retracted Loop Ileostomy Located in a Crease. Dis Colon Rectum. 2022 Mar 1;65(3):e182-e183. Video 1)

Retrorectus dissection. The initiation of the posterior component separation beings with identification and division of the posterior sheath. This is done just lateral to the hernia defect. Dissection is carried cranially and caudally to expose the rectus muscle.

Intraoperative video of right chest port placement

Robot-assisted laparoscopic orchidopexy: description of surgical technique for primary and second-stage Fowler-Stephens orchidopexy 

Robotic abdominoperineal resection. (From Wright JP, Sawh-Martinez RF, Monson JRT. V-Y Gluteal Fasciocutaneous Advancement FlapAfter Robotic Abdominoperineal Resection. Dis Colon Rectum. 2021; 64(9):e526-e527. Video 1.)

This narrated video highlights the critical portions of the Robotic Assisted Minimally Invasive Esophagectomy (RAMIE) technique (note: placeement of the feeding jejunostomy, performed laparoscopically at the end of the abdominal phase, is excluded from this video). 

Robotic dissection of the uncinate and resection of the tumor of the vein using staples

Robotic intraperitoneal onlay mesh (IPOM) ventral hernia repair (VHR).

Robotic modified Blumgart end-to-side, duct-to-mucosa pancreatojejunostomy

Robotic pancreaticoduodenectomy, resection. After entering the lesser sac and mobilizing the colon mesentery and right colon, a complete Kocher maneuver is performed and the inferior vena cava is visualized. The ligament of Treitz is taken down from the patients right side and the proximal jejunum is delivered into the right upper quadrant. A mesenteric window is created using the bipolar energy device and divided with a stapler.

The porta hepatis dissection begins with identification and removal of the hepatic artery lymph node, which is a consistent landmark to start the dissection. The right gastric vessels are taken with the bipolar energy device and/or clips. After the gastroduodenal artery is identified and dissected, a test clamp is performed and an adequate pulse is confirmed in the hepatic artery proper. The GDA is then divided with a stapler. The portal vein is identified and separated from the bile duct. The bile duct is then dissected and divided with a stapler to prevent bile leakage for the remainder of the resection portion.

The inferior border of the pancreas is identified and a retropancreatic tunnel is created after dissection of the superior mesenteric vein.

Using an instrument to elevate the pancreatic neck off of the portal/superior mesenteric vein, the pancreas is divided using cauterized scissors with sharp division of the pancreatic duct. The pancreatic head is then retracted laterally and the robotic hook and bipolar energy device are used to complete the uncinated and retroperitoneal dissection.

Robotic right colectomy with intracorporeal.(From Francone TD. Robotic right colectomy with With intracorporeal anastomosis. Dis Colon Rectum 2020; 63(From 8):e486. Video 1.)

Robotic right hemicolectomy with complete. (From Hameed I, Aggarwal P, Weiser M. Robotic Right Hemicolectomy with Complete Mesocolic Excision and D3 Lymph Node Dissection. Dis Colon Rectum 2020 63(1):115-6). Video 1.)

Steps in the technique (robotic right hepatectomy): (1) right lobe mobilization; (2) division of short hepatic veins; (3) right hepatic artery dissection; (4) right portal vein dissection; (5) superficial parenchymal transection; (6) right hepatic duct transection; (7) right hepatic vein transection; (8) specimen removal.

NA same as video title

Robotic transabdominal approach to retrorectal. (From Sell NM, Mattia AR, Francone, TD. Robotic Transabdominal Approach to Retrorectal Mass. Dis Colon Rectum. 2021; 64(5):e94. Video 1.)

Robotic transabdominal preperitoneal inguinal hernia repair for a right sided indirect inguinal hernia with a cord lipoma. Trocars are positioned 2cm above the umbilicus. All 8mm robotic trocars in the midline, right and left midclavicular lines. The camera is placed in the midline, the right hand a monopolar scissors and the left hand a fenestrated bipolar.  

Robotic ventral mesh rectopexy and sacrocolpopexy. (From Brady JT, Kow N, deBeche-Adams T. Robotic Ventral Mesh Rectopexy and Sacrocolpopexy. Dis Colon Rectum 2022; 65(1):e16-e17. Video 1.)

Resection or reconstruction pancreaticoduodenectomy (RPD) techniques.

Repair of a femoral hernia using a Shouldice repair and demonstrating the techniques of a McVey repair

Shouldice repair for left direct inguinal hernia. (From Agarwal D, Ott L, Reinhorn M. Shouldice repair for left direct inguinal hernia. J Med Insight. 2022;2022(340). doi:10.24296/jomi/340.)

Simple mastectomy technique

Stapled esophagogastric anastomosis using EEA 

Stereotactic pelvic navigation with augmented. (From Kwak JM, Romagnolo L, Wijsmuller A, et al. Stereotactic Pelvic Navigation With Augmented Reality for Transanal Total Mesorectal Excision. Dis Colon Rectum 2019; 62: 123–129. Video 1.)

Sternal elevation

Initial incision and start of submuscular dissection

This video demonstrates pericardial fluid anterior to the heart (black stripe). A positive subxiphoid FAST (Focused Assessment with Sonography in Trauma), like the image demonstrated here, in the setting of penetrating thoracoabdominal trauma is diagnostic of cardiac injury.

POEM for treatment of achalasia.

Surgically assisted endoscopic retrograde cholangiopancreatoscopy technqique. (Courtesy of Alexander Ayzengart, MD MPH FAC.)

Surgically assisted endoscopic retrograde cholangiopancreatoscopy technqique. (Courtesy of Alexander Ayzengart, MD MPH FAC.)

Impression of the mainscreen, video-in-video and annotations during laparoscopic splenic flexure mobilization 

Impression of the mainscreen and addition of externals sources during laparoscopic splenix flexure mobilization 

TAR-Down: If starting the transversus abdominis release (TAR) superiorly, the dissection is initiated by division of the posterior lamella of the internal oblique to expose the thick muscle belly of the transversus abdominis muscle. This muscle is then divided to transition from a retromuscular plane to a preperitoneal plan.

TAR-Up: This is the authors preferred approach for initiating the TAR. The arcuate line is identified and the transversus abdominis fascia is incised just inferior to this. Dissection is carried lateral to the retroperitoneal fat and the psoas muscle. The surgeon can the work lateral to medial to dissection the posterior components from the transversus abdominis fascia.

This video showcases briefly some of the techniques commonly used when investigating for internal hernia. You will see the location of both a jejunojejunostomy mesenteric defect and Petersen's defect.

Total mesorectal excision demonstrating posterior and anterior pelvic dissection

This demonstrates the transanal component of the taTME dissection, along with intersphincteric resection. (Courtesy of Dr. Sylla) 

Transanal endoscopic microsurgery for T1 rectal cancer. (From Samalavicius NE, Kavaliauskas P, Dulskas A. Transanal Endoscopic Microsurgery for T1 Rectal Cancer in a High-Risk Patient. Dis Colon Rectum. 64(2):e30-e31.)

Pelvic nerves revealed after internal iliac venous ligation. (From Kimura K, Ikeda M, Kataoka K, et al. Sacrectomy for recurrent rectal cancer using the transanal total mesorectum excision technique. Dis Colon Rectum. 2020;63(12):e566–e573. Video 1.)

Intraoperative use of AR with overlay of 3-D CT reconstruction in colorectal surgery using Microsoft Holens2.

Using indocyanine green (ICG) to help identify aberrant anatomy.

Using indocyanine green (ICG) to identify biliary anatomy

This video provides an overview of video-assisted thoracoscopic surgery (VATS) for retained hemothorax evacuation. The optimal patient positioning, port site selection and insertion, and several techniques for hematoma evacuation are presented with a concise, stepwise approach.

VATS Left Lower Lobectomy. This video demonstrates the key steps of a VATS left lower lobectomy. Dissecting the left inferior pulmonary vein, dissecting the interlobar pulmonary artery, including the basilar and superior segmental arteries, and stapling the lower lobe arteries, stapling the inferior pulmonary vein, dissecting the lower lobe bronchus, and stapling the lower lobe bronchus, and removing the specimen.

VATS Right Upper Lobectomy. This video demonstrates the key steps of a VATS right upper lobectomy. Placing the incisional ports, including a wound protector, dividing the inferior pulmonary ligament, removing station 9 lymph nodes, dissecting and stapling the right superior pulmonary vein, dissecting and stapling the truncus anterior segmental pulmonary artery, dissecting and stapling the posterior ascending segmental artery, dissecting the right upper lobe bronchus and bronchus intermedius, and stapling the right upper lobe bronchus, completing the fissures, and removing the specimen.

Step by step video-assisted thoracoscopic surgery (VATS) technique for esophageal diverticulectomy and esophagomyotomy

Veno venous bypass and ex vivo resection with IVC reconstruction for mixed hepatocellular -cholangiocarcinoma.