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Robot Assisted Laparoscopic Partial Nephrectomy: The University of California - Irvine Technique

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Laparoscopic Roux-en-y Stapled Cystojejunostomy

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Vladov Nikola,
Military Medical Academy,
Sofia

PERSONAL COMMENTS:
We present a laparoscopic Roux-en-Y cystojeunostomy in a 40 years old women with large, symptomatic pancreatic pseudocyst located in the body and tail. The diameter of the pseudocyst is approximately 90 mm. Unsuccessful 2 way percutaneus drainage was performed 4 and 2 months ago. The patient has undergone 2 abdominal procedures – laparoscopic cholecystectomy in 2005 and sectio Cesareae in 1993.

ABSTRACT:
Positon of the patient is supine with legs spread. The main trocar – 12 mm is placed just above the umbilicus. Usually we use 30 degrees angled laparoscope. You see the placement of working ports – 10 mm trocar is placed in the right medioclavicular line, 10 mm trocar is also placed in the left anterior axillary line and 5 mm trocar is placed in the epicastric midline just before the xiphoid. We entered in the lesser sac by dividing the gastrocolic omentum using harmonic scalpel, staying outside the gastroepiploic vessels. Wide mobilization of gastrocolic omentum for full visualization of the pancreas is recommended. This is facilitated by superior retraction of the stomach.
Now we see the bulging pancreatic pseudocyst. Later the pseudocyst was perforated and its consistence was removed by aspiration.
After that we prepare jeunal Ruox-en-Y loop – identifying the ligament of Treitz and divide the jeunum 30 cm distally by using harmonic scalpel, endoscopic stapler 35 mm and 10 mm Liga-sure device. We prefer the retrocolic route for Roux limb and we create an opening in the transverse mesocolon and pass the Roux limb so that it reaches the pseudocyst without tension. Now we open the wall of jeunal limb and create latero-lateral cystojeunoanastomosis using endoscopic linear stapler. After the staple line has been inspected for hemostasis, the enterotomy and cystotomy are closed with single suture.
The Roux-en-Y limb is created using a linear stapler 35 mm. The jeunostomy is completed by closing the enterotomies with two runig sutures.
After irrigation and thorough check for haemostasis we place two contact drains via 10 mm trocars.
Laparoscopic Ureteroureterostomy: Right Retrocaval Ureter
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