The online university of IRCAD

Laparoscopic uterine artery clipping can be managed at its origin as opposed to uterus level. There is no current evidence to support the superiority of one technique over another (1). There is a higher chance of successful uterine artery ligation after the appropriate dissection of retroperitoneal spaces with a significant reduction in mean blood loss (2). The learning curve is not steep, and ideally a trained laparoscopic surgeon can easily reproduce this technique after performing one case under guidance. Exercising this for every hysterectomy performed for uterine leiomyoma or adenomyosis is not associated with increased surgical time. It is considered a safe procedure with no increased risk of bleeding or complications (3). Total laparoscopic hysterectomy (TLH) requires the highest degree of laparoscopic surgical skills, and a good knowledge of the pelvic anatomy defines a safe space for sharp entry into the retroperitoneum, as well as a safe identification of pelvic vasculature. The author would recommend that every gynecologist should understand the principle of opening the retroperitoneum and maintain skills (4).

Bibliography:
1. Uccella S, Garzon S, Lanzo G, et al. Uterine artery closure at the origin vs at the uterus level in total laparoscopic hysterectomy: A randomized controlled trial. Acta Obstet Gynecol Scand. 2021; 100: 1840–1848. https://doi.org/10.1111/aogs.14238
2. Hyun Jin Choi, Myeong Seon Kim, Tae-Joong Kim,Uterine artery ligation at its origin following retroperitoneal space development decreases blood loss during single-port total laparoscopic hysterectomy,Taiwanese Journal of Obstetrics and Gynecology,Volume 59, Issue 2,2020, Pages 262-268, https://doi.org/10.1016/j.tjog.2020.01.015
3. Abo-Hashem, U., Rashed, R., El-Bassioune, W., & Abdou, H. (2021). Laparoscopic Hysterectomy with Prior Uterine Artery Ligation versus Conventional Laparoscopic Hysterectomy. International Journal of Medical Arts, 3(4), 1879-1883. doi: 10.21608/ijma.2021.91017.1352
4. Gueli Alletti S, Restaino S, Finelli A, et al. Step by Step Total Laparoscopic Hysterectomy with Uterine Arteries Ligation at the Origin. Journal of Minimally Invasive Gynecology. 2020 Jan;27(1):22-23. DOI: 10.1016/j.jmig.2019.06.001. PMID: 31201941.

Innovative minimally invasive approaches to guide liver resections are widely recognized for their safety and potential advantages over open surgery, such as reduced morbidity, blood loss, and postoperative hospital stay (1). The translaparoscopic liver ultrasound can also detect additional tumors in 10% of cases, with the highest efficacy observed in obese patients and with a history of exposure to chemotherapy (2).
The use of translaparoscopic liver ultrasound requires a solid knowledge of ultrasound liver anatomy. With proper training, it allows for the delineation of liver segments and for the exposure of reference hepatic veins during parenchymal dissection. It also helps to minimize the risk of injury to crucial structures (3)(4), and it is an invaluable tool to improve the accuracy and safety of the procedure. It also provides personalized and efficient liver management.

Bibliography:
1. Ferrero A, Lo Tesoriere R, Russolillo N. Ultrasound Liver Map Technique for Laparoscopic Liver Resections. World J Surg. 2019;43(10):2607-2611. doi:10.1007/s00268-019-05046-3 Link: https://pubmed.ncbi.nlm.nih.gov/31161357/
2. Kose E, Kahramangil B, Purysko AS, et al. The utility of laparoscopic ultrasound during minimally invasive liver procedures in patients with malignant liver tumors who have undergone preoperative magnetic resonance imaging. Surg Endosc. 2022;36(7):4939-4945. doi:10.1007/s00464-021-08849-5 Link: https://pubmed.ncbi.nlm.nih.gov/34734301/#similar
3. Ishizawa T, Gumbs AA, Kokudo N, Gayet B. Laparoscopic segmentectomy of the liver: from segment I to VIII. Ann Surg. 2012;256(6):959-964. doi:10.1097/SLA.0b013e31825ffed3 Link: https://pubmed.ncbi.nlm.nih.gov/22968066/
4. Cassese G, Han HS, Yoon YS, et al. Evolution of laparoscopic liver resection in the last two decades: lessons from 2000 cases at a referral Korean center. Surg Endosc. Published online December 12, 2023. doi:10.1007/s00464-023-10580-2 Link: https://pubmed.ncbi.nlm.nih.gov/38087108/

Objective: This video aims to show how deep intestinal endometriosis (DIE) can be managed safely and effectively through intestinal resection with terminal anastomosis without the need for an ostomy using laparoscopy with nerve sparing.
Design: The procedure is performed in a stepwise fashion with narrated video footage.
Setting: The surgical management of deep endometriosis infiltrating the rectum necessitates either colorectal segmental resection or conservative techniques (i.e., shaving and discoid resection). When the intestinal nodule is extensive or involves two distant portions of the bowel, as in this case, decision is made to perform an intestinal resection with nerve sparing. For this surgery, the patient was placed in a dorsal modified lithotomy position. The surgeon stood on the patient’s left side, the first assistant on the right, and the second assistant between the patient’s legs.
Clinical case presentation: The authors present the case of a nulligravida 41-year-old patient with no relevant medical history. She was referred to our center due to dysmenorrhea, dyspareunia, dyschezia, and chronic pelvic pain. The patient was under hormone treatment with Dienogest 2mg for 24 months, without any response. On physical exam, she presented with a fixed uterus in the anterior vaginal fornix. A mild thickening of the anterior vaginal fornix was observed. In the posterior cul-de-sac, there was a palpable painful nodule. On MRI, a nodule involving the upper rectal wall, measuring 26mm in length and 11mm in thickness, located 12cm from the anal margin, was observed. It infiltrated the outer myometrium of the uterus. Lamellar fibrotic tissue was found at the level of the rectouterine pouch, blocking it. Another nodule was found in the sigmoid colon, measuring 14mm in length and 9mm in thickness, leaving an impression in the lumen. The vesicouterine space presented with endometriotic tissue, which did not involve the bladder. It had a cystic component with infiltration of the outer myometrium. A bilateral hematosalpinx was noted. There were endometriomas in both ovaries.
Interventions: A laparoscopic approach with intestinal resection and nerve sparing was decided upon to treat deep infiltrating endometriosis. In this video, the authors demonstrated a stepwise surgical demonstration with key steps through a narrated video.
Measurements and main results: Postoperative outcomes were uneventful. She was discharged on postoperative day 3. At the 3-month follow-up, the patient was symptom-free.
Conclusion: In cases where the intestinal disease is extensive and conservative treatment (shaving or discal) is not possible, it is necessary to perform intestinal resection with terminal anastomosis. Nerve sparing in such cases is crucial to prevent evacuatory disorders.

Bibliography:
1. Donnez O, Roman H. Choosing the right surgical technique for deep endometriosis: shaving, disc excision, or bowel resection? Fertil Steril. 2017 Dec;108(6):931-942. doi: 10.1016/j.fertnstert.2017.09.006. PMID: 29202966.
2. Nezhat C, Li A, Falik R, Copeland D, Razavi G, Shakib A, Mihailide C, Bamford H, DiFrancesco L, Tazuke S, Ghanouni P, Rivas H, Nezhat A, Nezhat C, Nezhat F. Bowel endometriosis: diagnosis and management. Am J Obstet Gynecol. 2018 Jun;218(6):549-562. doi: 10.1016/j.ajog.2017.09.023. Epub 2017 Oct 13. PMID: 29032051.
3. Roman H, Vassilieff M, Gourcerol G, Savoye G, Leroi AM, Marpeau L, Michot F, Tuech JJ. Surgical management of deep infiltrating endometriosis of the rectum: pleading for a symptom-guided approach. Hum Reprod. 2011 Feb;26(2):274-81. doi: 10.1093/humrep/deq332. Epub 2010 Dec 2. PMID: 21131296.
4. Alabiso G, Alio L, Arena S, di Prun AB, Bergamini V, Berlanda N, Busacca M, Candiani M, Centini G, Di Cello A, Exacoustos C, Fedele L, Gabbi L, Geraci E, Lavarini E, Incandela D, Lazzeri L, Luisi S, Maiorana A, Maneschi F, Mattei A, Muzii L, Pagliardini L, Perandini A, Perelli F, Pinzauti S, Remorgida V, Sanchez AM, Seracchioli R, Somigliana E, Tosti C, Venturella R, Vercellini P, Viganò P, Vignali M, Zullo F, Zupi E. How to Manage Bowel Endometriosis: The ETIC Approach. J Minim Invasive Gynecol. 2015 May-Jun;22(4):517-29. doi: 10.1016/j.jmig.2015.01.021. Epub 2015 Feb 10. PMID: 25678420.

This video shows the case of a female patient presenting with bladder endometriosis managed safely and effectively using laparoscopic surgery. The patient presented with urinary discomfort, primarily during the initiation of micturition. A magnetic resonance imaging was performed, revealing a fibrotic focus measuring approximately 20 by 14.5mm in relation to the cesarean scar. This focus involved the posterior and upper wall of the bladder in close vicinity with the distal left ureter and the ureteral meatus. This surgery was performed by gynecology surgeons with the assistance of urological surgeons. The video is a stepwise demonstration of the technique with narrated video footage. This procedure is recommended to a gynecological surgical audience.
Endometriosis is estimated to affect around 10% of women in their reproductive age. Bladder endometriosis is considered a relatively rare form of endometriosis, accounting for a small subset of all endometriosis cases. It is estimated that bladder involvement occurs in about 1 to 7% of women with endometriosis. The common symptoms of bladder endometriosis include chronic pelvic pain, urinary symptoms, and painful intercourse. The approach involves a combination of continued hormone therapy and surgical intervention, including nodule resection.

Bibliography:
1. Tomasi MC, Ribeiro PAA, Farah D, Vidoto Cervantes G, Nicola AL, Abdalla-Ribeiro HS. Symptoms and Surgical Technique of Bladder Endometriosis: A Systematic Review. J Minim Invasive Gynecol. 2022 Dec;29(12):1294-1302. doi: 10.1016/j.jmig.2022.10.003. Epub 2022 Oct 15. PMID: 36252916. https://pubmed.ncbi.nlm.nih.gov/36252916/

2. Allaire C, Bedaiwy MA, Yong PJ. Diagnosis and management of endometriosis. CMAJ. 2023 Mar 14;195(10):E363-E371. doi: 10.1503/cmaj.220637. PMID: 36918177; PMCID: PMC10120420. https://pubmed.ncbi.nlm.nih.gov/36918177/

3. Piriyev E, Schiermeier S, Römer T. Laparoscopic Approach in Bladder Endometriosis, Intraoperative and Postoperative Outcomes. In Vivo. 2023 Jan-Feb;37(1):357-365. doi: 10.21873/invivo.13086. PMID: 36593051; PMCID: PMC9843782. https://pubmed.ncbi.nlm.nih.gov/36593051/

4. Diniz ALL, Resende JAD Jr, de Andrade CM Jr, Brandão AC, Gasparoni MP Jr, Favorito LA. Urological knowledge and tools applied to diagnosis and surgery in deep infiltrating endometriosis - a narrative review. Int Braz J Urol. 2023 Sep-Oct;49(5):564-579. doi: 10.1590/S1677-5538.IBJU.2023.9907. PMID: 37450770; PMCID: PMC10482465. https://pubmed.ncbi.nlm.nih.gov/37450770/

Courtesy of BJS: This video is part of a series of four given by BJS and BJS Open Editors as a short introductory course on how to referee a clinical paper, focusing on how to undertake a peer-review. Although these are stand-alone videos that can be viewed individually, they are also used as an integral part of a longer taught online course in surgical publishing from the BJS Institute. Details of the courses and other tutorials are available on the BJS Academy website.
Here, BJS Editor, Paul Sutton, explains what to look for in a scientific article that will help judge whether or not it has scientific credibility sufficient for publication, and in which journal.

In this key educational lecture, Dr. Barbora East, MD, PhD outlines midline incisional hernia guidelines as published by the European Hernia Society (EHS) in 2023. She answers the following key questions, hence providing guidelines, in partnership with Dr. A De Beaux, MD, FRCS, MBChB and Prof. Dr. René Fortelny, MD, FEBS:
Q1. What are the risk factors for developing an incisional hernia after previous abdominal surgery?
Q2. Do all patients with an incisional hernia require imaging? and what is the best modality?
Q3. Is it possible to predict from imaging whether fascial closure will be possible?
Q4. Do all incisional hernias need surgical treatment? and what are the key outcome measures in the treatment of incisional hernias?
Q5. What are the important modifiable risk factors that should be optimized before surgery? and what is the effect of pre-optimization?
Q6. What is the difference in outcome for mesh versus suture repair in incisional hernia repair?
Q7. What is the difference in outcome considering different positions of mesh in incisional hernia repair?
Q8. What is the difference in outcome between techniques (open, laparoscopic, and robotic) for incisional hernia repair?
Q9. Is there a benefit of primary fascial closure in midline incisional hernia mesh repair?
Q10. What is the difference in the outcome using different techniques for mesh fixation in intraperitoneal and extraperitoneal mesh placement for incisional hernia repair?
Q11. What is the benefit of enhanced recovery after surgery (ERAS) in incisional hernia repair?
Q12. Should prophylactic antibiotics be used in the elective repair of incisional hernia in adult patients?
Q13. What information is essential for patients after incisional hernia repair? and what activities influence outcome?

Dr. B East, MD, PhD has the following potential conflicts of interest to disclose, receiving research grants from AZV and EHS, as well as speakers' fees from Medtronic. However, industrial companies were never committed to the elaboration and running organization of this webinar. There is neither commercial publicity nor commercial promotion in this webinar. Dr. B East is Secretary for (e)Quality at the EHS and Secretary of the AWS section at the UEMS; she will be the EHS 2024 Conference President, and she is co-producer of the Hernia Basecamp.
Dr. B East declares that she is fully committed to maintaining professional autonomy and independence in relation with the medical device Industry.
This webinar is aimed to promote education among its learners, and Dr. B East, MD, PhD declares that this webinar is fair, balanced, and free of commercial bias.
Dr. B. East has no financial affiliations that would affect the content of her talks.
Dr. A De Beaux, MD, FRCS, MBChB has the following potential conflict of interest to disclose, receiving honoraria BBraun, BD Bard, Medtronic, CMR Surgical Proctor, and Tissium. He is the director of de Beaux Medical Services Ltd, Edinburgh Bariatric Surgeons LLC, British Journal of Surgery Society, the past president of British Hernia Society, the general secretary of the European Hernia Society, a council member of Scottish Intercollegiate Guidelines Network, an executive committee member of the UEMS AWS, and co-producer of Hernia Basecamp. However, these industrial companies were never committed to the elaboration and running organization of Dr. De Beaux's lectures and videos. There is neither commercial publicity nor commercial promotion in Dr. De Beaux's lectures and videos.
Dr. A De Beaux, MD, FRCS, MBChB declares that he is fully committed to maintaining professional autonomy and independence in relation with the medical device Industry.
Dr. Andrew Charles de Beaux has no financial affiliations that would affect the content of his presentations.
Prof. Dr. René Fortelny, MD, FEBS has no financial affiliations that would affect the content of his presentations.

This video presents the case of a 42-year-old female patient with a history of difficult birth, gravida 2, parity 2, and vaginal birth 2. She had no surgery or any significant medical history. She had a BMI of 29.8. The patient reported experiencing urinary leakage during coughing. A routine urinalysis was conducted; the result was normal. Valsalva and Boney tests were applied to the patient. A urodynamic test was performed. A diagnosis of type 2 stress urinary incontinence (SUI) was established, and it was decided to perform an extraperitoneal laparoscopic Burch colposuspension, which is a widely accepted technique for the treatment of stress urinary incontinence. Laparoscopic Burch colposuspension offers advantages over the open Burch colposuspension (i.e., reduced bleeding, shorter postoperative recovery time), and it is more minimally invasive. However, the surgery duration is longer. In our patient, we performed the extraperitoneal Burch colposuspension technique, and total surgical time was 37 minutes. Skipping the steps of opening and closing the peritoneum and directly entering the space of Retzius allow to save significant time. An appropriate dissection strategy allows to clearly visualize anatomical landmarks.

Bibliography:
1. Ye Y, Wang Y, Tian W, et al. Burch colposuspension for stress urinary
incontinence: a 14-year prospective follow-up. Sci China Life Sci. 2022;65(8):1667-
1672. doi:10.1007/s11427-021-2042-9

2. Bulent Tiras M, Sendag F, Dilek U, Guner H. Laparoscopic burch colposuspension:
comparison of effectiveness of extraperitoneal and transperitoneal techniques. Eur J
Obstet Gynecol Reprod Biol. 2004;116(1):79-84. doi:10.1016/j.ejogrb.2004.02.003

3. Obaid AA, Al-Hamzawi SA, Alwan AA. Laparoscopic and open burch
colposuspension for stress urinary incontinence: advantages and disadvantages. J
Popul Ther Clin Pharmacol. 2022;29(2):e20-e26. Published 2022 Jun 16.
doi:10.47750/jptcp.2022.926