# Laparoscopic Neonatal and Abdominal Surgery — GCMD Library living collection Updated: n/a · 23 episodes · 243 cited statements ## Episodes ### Intestinal atresia, malrotation and duplication - [Laparoscopic Jejunal Atresia Repair - Technique](https://library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-748) — video · 5:55 · [machine version](https://library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-748.md) - [Technique: Laparoscopic Repair of Duodenal Atresia, Ladd's Procedure, and...](https://library.globalcastmd.com/watch/technique-laparoscopic-repair-of-duodenal-atresia-ladd-s-procedure-and-761) — video · 15:01 · [machine version](https://library.globalcastmd.com/watch/technique-laparoscopic-repair-of-duodenal-atresia-ladd-s-procedure-and-761.md) - [Laparoscopic Duodenal Atresia Repair in a 1.5 kg Infant](https://library.globalcastmd.com/watch/laparoscopic-duodenal-atresia-repair-in-a-1-5-kg-infant-11930) — video · [machine version](https://library.globalcastmd.com/watch/laparoscopic-duodenal-atresia-repair-in-a-1-5-kg-infant-11930.md) - [Laparoscopic Ladd Procedure for Malrotation in an Infant](https://library.globalcastmd.com/watch/laparoscopic-ladd-procedure-for-malrotation-in-an-infant-11940) — video · 9:22 · [machine version](https://library.globalcastmd.com/watch/laparoscopic-ladd-procedure-for-malrotation-in-an-infant-11940.md) - [Laparoscopic Ladd Procedure for Midgut Volvulus in a 12-Year-Old Using CoolSeal Trinity](https://library.globalcastmd.com/watch/laparoscopic-ladd-procedure-for-midgut-volvulus-in-a-12-year-old-using-coolseal-11941) — video · 8:02 · [machine version](https://library.globalcastmd.com/watch/laparoscopic-ladd-procedure-for-midgut-volvulus-in-a-12-year-old-using-coolseal-11941.md) - [Laparoscopic Intestinal Duplication Cyst Repair - Technique](https://library.globalcastmd.com/watch/laparoscopic-intestinal-duplication-cyst-repair-technique-750) — video · 4:58 · [machine version](https://library.globalcastmd.com/watch/laparoscopic-intestinal-duplication-cyst-repair-technique-750.md) ### Hirschsprung disease and anorectal malformation - [Technique: Laparoscopic Assisted Pull-through for Hirschsprung's Disease](https://library.globalcastmd.com/watch/technique-laparoscopic-assisted-pull-through-for-hirschsprung-s-disease-760) — video · 10:48 · [machine version](https://library.globalcastmd.com/watch/technique-laparoscopic-assisted-pull-through-for-hirschsprung-s-disease-760.md) - [Technique: Laparoscopic-Assisted Pull-through for Imperforate Anus](https://library.globalcastmd.com/watch/technique-laparoscopic-assisted-pull-through-for-imperforate-anus-762) — video · 15:14 · [machine version](https://library.globalcastmd.com/watch/technique-laparoscopic-assisted-pull-through-for-imperforate-anus-762.md) ### Appendectomy - [Technique: Laparoscopic Appendectomy (Two incision)](https://library.globalcastmd.com/watch/technique-laparoscopic-appendectomy-757) — video · 10:18 · [machine version](https://library.globalcastmd.com/watch/technique-laparoscopic-appendectomy-757.md) - [Mini-Laparoscopic Appendectomy in a 16-Year-Old Using a 5 mm Stapler](https://library.globalcastmd.com/watch/mini-laparoscopic-appendectomy-in-a-16-year-old-using-a-5-mm-stapler-11943) — video · 4:50 · [machine version](https://library.globalcastmd.com/watch/mini-laparoscopic-appendectomy-in-a-16-year-old-using-a-5-mm-stapler-11943.md) - [Modified Single-Site Laparoscopic Appendectomy with a Suprapubic Port](https://library.globalcastmd.com/watch/modified-single-site-laparoscopic-appendectomy-with-a-suprapubic-port-11946) — video · 3:23 · [machine version](https://library.globalcastmd.com/watch/modified-single-site-laparoscopic-appendectomy-with-a-suprapubic-port-11946.md) - [Laparoscopic Retrograde Appendectomy](https://library.globalcastmd.com/watch/laparoscopic-retrograde-appendectomy-11958) — video · [machine version](https://library.globalcastmd.com/watch/laparoscopic-retrograde-appendectomy-11958.md) ### Bowel resection and anastomosis - [Laparoscopic Resection of a Crohn's Ileal Stricture Using the 5 mm CoolSeal Trinity](https://library.globalcastmd.com/watch/laparoscopic-resection-of-a-crohn-s-ileal-stricture-using-the-5-mm-coolseal-trin-11976) — video · 10:50 · [machine version](https://library.globalcastmd.com/watch/laparoscopic-resection-of-a-crohn-s-ileal-stricture-using-the-5-mm-coolseal-trin-11976.md) - [Laparoscopic Stapled Resection of a Post-NEC Ileal Stricture in a Preterm Infant](https://library.globalcastmd.com/watch/laparoscopic-stapled-resection-of-a-post-nec-ileal-stricture-in-a-preterm-infant-11945) — video · 7:47 · [machine version](https://library.globalcastmd.com/watch/laparoscopic-stapled-resection-of-a-post-nec-ileal-stricture-in-a-preterm-infant-11945.md) - [Open Stapled Bowel Anastomosis](https://library.globalcastmd.com/watch/open-stapled-bowel-anastomosis-11991) — video · [machine version](https://library.globalcastmd.com/watch/open-stapled-bowel-anastomosis-11991.md) - [Open Bowel Anastomosis](https://library.globalcastmd.com/watch/open-bowel-anastomosis-11992) — video · [machine version](https://library.globalcastmd.com/watch/open-bowel-anastomosis-11992.md) ### Solid organs, biliary, vascular and tumors - [Laparoscopic Liver Biopsy](https://library.globalcastmd.com/watch/laparoscopic-liver-biopsy-11934) — video · [machine version](https://library.globalcastmd.com/watch/laparoscopic-liver-biopsy-11934.md) - [Laparoscopic Right Adrenal Neuroblastoma Resection in a 3½-Year-Old Using CoolSeal Trinity](https://library.globalcastmd.com/watch/laparoscopic-right-adrenal-neuroblastoma-resection-in-a-3-year-old-using-coolsea-11947) — video · 8:34 · [machine version](https://library.globalcastmd.com/watch/laparoscopic-right-adrenal-neuroblastoma-resection-in-a-3-year-old-using-coolsea-11947.md) - [Laparoscopic Resection of a Paracaval Neuroblastoma](https://library.globalcastmd.com/watch/laparoscopic-resection-of-a-paracaval-neuroblastoma-11948) — video · [machine version](https://library.globalcastmd.com/watch/laparoscopic-resection-of-a-paracaval-neuroblastoma-11948.md) - [Laparoscopic Median Arcuate Ligament Division in a 17-Year-Old Using the CoolSeal Trinity](https://library.globalcastmd.com/watch/laparoscopic-median-arcuate-ligament-division-in-a-17-year-old-using-the-coolsea-11938) — video · 7:09 · [machine version](https://library.globalcastmd.com/watch/laparoscopic-median-arcuate-ligament-division-in-a-17-year-old-using-the-coolsea-11938.md) ### Hernia, continence procedures and small-access surgery - [Laparoscopic-Assisted Percutaneous Right Inguinal Hernia Repair](https://library.globalcastmd.com/watch/laparoscopic-assisted-percutaneous-right-inguinal-hernia-repair-11952) — video · [machine version](https://library.globalcastmd.com/watch/laparoscopic-assisted-percutaneous-right-inguinal-hernia-repair-11952.md) - [Robotic hernia repair](https://library.globalcastmd.com/watch/robotic-hernia-repair-11960) — article · [machine version](https://library.globalcastmd.com/watch/robotic-hernia-repair-11960.md) - [Open Malone and Mitrofanoff Procedure Using a Divided Appendix](https://library.globalcastmd.com/watch/open-malone-and-mitrofanoff-procedure-using-a-divided-appendix-11939) — video · 5:13 · [machine version](https://library.globalcastmd.com/watch/open-malone-and-mitrofanoff-procedure-using-a-divided-appendix-11939.md) ## Chapters - [0:00](https://library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-748?t=0) Case presentation and patient positioning (Ep 1) - [1:30](https://library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-748?t=90) Port placement and initial exploration (Ep 1) - [3:00](https://library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-748?t=180) Bowel examination and apple peel defect confirmation (Ep 1) - [4:00](https://library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-748?t=240) Resection of dilated proximal segment (Ep 1) - [5:00](https://library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-748?t=300) Anastomosis creation and procedure completion (Ep 1) - [0:00](https://library.globalcastmd.com/watch/laparoscopic-intestinal-duplication-cyst-repair-technique-750?t=0) Case presentation and initial exploration (Ep 6) - [1:30](https://library.globalcastmd.com/watch/laparoscopic-intestinal-duplication-cyst-repair-technique-750?t=90) Bowel division and mesenteric dissection (Ep 6) - [3:00](https://library.globalcastmd.com/watch/laparoscopic-intestinal-duplication-cyst-repair-technique-750?t=180) Anastomosis creation and closure (Ep 6) - [4:30](https://library.globalcastmd.com/watch/laparoscopic-intestinal-duplication-cyst-repair-technique-750?t=270) Specimen extraction and outcomes (Ep 6) - [0:14](https://library.globalcastmd.com/watch/technique-laparoscopic-appendectomy-757?t=14) Port placement and setup (Ep 9) - [2:23](https://library.globalcastmd.com/watch/technique-laparoscopic-appendectomy-757?t=143) Technique philosophy and instrument positioning (Ep 9) - [4:38](https://library.globalcastmd.com/watch/technique-laparoscopic-appendectomy-757?t=278) Mesoappendix dissection and appendiceal base management (Ep 9) - [7:30](https://library.globalcastmd.com/watch/technique-laparoscopic-appendectomy-757?t=450) Specimen extraction and closure (Ep 9) - [0:00](https://library.globalcastmd.com/watch/technique-laparoscopic-assisted-pull-through-for-hirschsprung-s-disease-760?t=0) Patient positioning and port placement (Ep 7) - [1:15](https://library.globalcastmd.com/watch/technique-laparoscopic-assisted-pull-through-for-hirschsprung-s-disease-760?t=75) Laparoscopic mesenteric dissection to pelvic floor (Ep 7) - [4:35](https://library.globalcastmd.com/watch/technique-laparoscopic-assisted-pull-through-for-hirschsprung-s-disease-760?t=275) Timing of surgery and completion of laparoscopic phase (Ep 7) - [5:10](https://library.globalcastmd.com/watch/technique-laparoscopic-assisted-pull-through-for-hirschsprung-s-disease-760?t=310) Transanal dissection and mucosal plane development (Ep 7) - [7:46](https://library.globalcastmd.com/watch/technique-laparoscopic-assisted-pull-through-for-hirschsprung-s-disease-760?t=466) Muscular cuff division and colon mobilization (Ep 7) - [8:57](https://library.globalcastmd.com/watch/technique-laparoscopic-assisted-pull-through-for-hirschsprung-s-disease-760?t=537) Coloanal anastomosis and postoperative course (Ep 7) - [0:00](https://library.globalcastmd.com/watch/technique-laparoscopic-repair-of-duodenal-atresia-ladd-s-procedure-and-761?t=0) Room Setup, Port Placement, and Initial Dissection (Ep 2) - [3:00](https://library.globalcastmd.com/watch/technique-laparoscopic-repair-of-duodenal-atresia-ladd-s-procedure-and-761?t=180) Ladd's Procedure and Identification of Malrotation (Ep 2) - [6:00](https://library.globalcastmd.com/watch/technique-laparoscopic-repair-of-duodenal-atresia-ladd-s-procedure-and-761?t=360) Duodenoduodenostomy (Ep 2) - [12:00](https://library.globalcastmd.com/watch/technique-laparoscopic-repair-of-duodenal-atresia-ladd-s-procedure-and-761?t=720) Resection of Meckel's Diverticulum and Appendix (Ep 2) - [0:00](https://library.globalcastmd.com/watch/technique-laparoscopic-assisted-pull-through-for-imperforate-anus-762?t=0) Patient positioning, trocar placement, and initial mesenteric mobilization technique (Ep 8) - [2:00](https://library.globalcastmd.com/watch/technique-laparoscopic-assisted-pull-through-for-imperforate-anus-762?t=120) Fistula dissection and division at bladder neck level (Ep 8) - [6:09](https://library.globalcastmd.com/watch/technique-laparoscopic-assisted-pull-through-for-imperforate-anus-762?t=369) Completion of laparoscopic mobilization (Ep 8) - [7:29](https://library.globalcastmd.com/watch/technique-laparoscopic-assisted-pull-through-for-imperforate-anus-762?t=449) Perineal dissection and pull-through using nerve stimulation guidance (Ep 8) - [11:10](https://library.globalcastmd.com/watch/technique-laparoscopic-assisted-pull-through-for-imperforate-anus-762?t=670) Anastomosis creation and presacral fixation (Ep 8) - [0:00](https://library.globalcastmd.com/watch/laparoscopic-median-arcuate-ligament-division-in-a-17-year-old-using-the-coolsea-11938?t=0) Case presentation and patient positioning (Ep 20) - [1:00](https://library.globalcastmd.com/watch/laparoscopic-median-arcuate-ligament-division-in-a-17-year-old-using-the-coolsea-11938?t=60) Initial dissection and gastropatic ligament opening (Ep 20) - [3:00](https://library.globalcastmd.com/watch/laparoscopic-median-arcuate-ligament-division-in-a-17-year-old-using-the-coolsea-11938?t=180) Hepatic artery dissection and management of inflammatory nodes (Ep 20) - [5:00](https://library.globalcastmd.com/watch/laparoscopic-median-arcuate-ligament-division-in-a-17-year-old-using-the-coolsea-11938?t=300) Celiac plexus and nerve fiber division (Ep 20) - [6:00](https://library.globalcastmd.com/watch/laparoscopic-median-arcuate-ligament-division-in-a-17-year-old-using-the-coolsea-11938?t=360) Median arcuate ligament division and completion (Ep 20) - [0:04](https://library.globalcastmd.com/watch/open-malone-and-mitrofanoff-procedure-using-a-divided-appendix-11939?t=4) Umbilical stoma creation and cecum delivery (Ep 23) - [1:00](https://library.globalcastmd.com/watch/open-malone-and-mitrofanoff-procedure-using-a-divided-appendix-11939?t=60) Appendix division and mesoappendix window (Ep 23) - [2:30](https://library.globalcastmd.com/watch/open-malone-and-mitrofanoff-procedure-using-a-divided-appendix-11939?t=150) Cecal plication around appendix base (Ep 23) - [4:00](https://library.globalcastmd.com/watch/open-malone-and-mitrofanoff-procedure-using-a-divided-appendix-11939?t=240) Catheterization testing and channel completion (Ep 23) - [0:00](https://library.globalcastmd.com/watch/laparoscopic-ladd-procedure-for-malrotation-in-an-infant-11940?t=0) Case presentation and room setup (Ep 4) - [0:47](https://library.globalcastmd.com/watch/laparoscopic-ladd-procedure-for-malrotation-in-an-infant-11940?t=47) Initial dissection and proximal duodenal mobilization (Ep 4) - [2:56](https://library.globalcastmd.com/watch/laparoscopic-ladd-procedure-for-malrotation-in-an-infant-11940?t=176) Division of Ladd bands and colonic mobilization (Ep 4) ## Statements Every statement is attributed, typed, and timestamped; the link is the citation. - The key to mesenteric dissection is staying exactly adjacent to the colon wall to prevent injury to surrounding structures. (clinical) [Ep 7 · 1:21](https://library.globalcastmd.com/watch/technique-laparoscopic-assisted-pull-through-for-hirschsprung-s-disease-760?t=81) - Because all heat and energy remains between the jaws of the sealer, there is no danger in injuring surrounding structures by brushing aside them with the sealer. (clinical) [Ep 7 · 1:32](https://library.globalcastmd.com/watch/technique-laparoscopic-assisted-pull-through-for-hirschsprung-s-disease-760?t=92) - Small perforating vessels are grasped, sealed, and then pulled down off the rectal wall during circumferential dissection. (clinical) [Ep 7 · 1:48](https://library.globalcastmd.com/watch/technique-laparoscopic-assisted-pull-through-for-hirschsprung-s-disease-760?t=108) - Dissection at the peritoneal reflection uses the same technique of grasping the peritoneal reflection and small perforating vessels and pulling them down off the colon. (clinical) [Ep 7 · 2:10](https://library.globalcastmd.com/watch/technique-laparoscopic-assisted-pull-through-for-hirschsprung-s-disease-760?t=130) - The 3 millimeter sealer allows dissection of vessels and mobilization of tissue around the colon without risk of pass-pointing, unlike the 3 millimeter hook which was previously the preferred mode of dissection. (clinical) [Ep 7 · 2:32](https://library.globalcastmd.com/watch/technique-laparoscopic-assisted-pull-through-for-hirschsprung-s-disease-760?t=152) - Using the 3 mm sealer eliminates the need for instrument changes with the right hand throughout the case. (clinical) [Ep 7 · 2:55](https://library.globalcastmd.com/watch/technique-laparoscopic-assisted-pull-through-for-hirschsprung-s-disease-760?t=175) - Carrying the laparoscopic dissection down to the pelvic floor limits the amount of transanal dissection necessary and decreases the risk of injury to the external sphincter. (clinical) [Ep 7 · 3:24](https://library.globalcastmd.com/watch/technique-laparoscopic-assisted-pull-through-for-hirschsprung-s-disease-760?t=204) - Because there is no energy spread from the tips of the 3 mm sealer, it is safe for the instrument to be adjacent to the bladder, vagina, prostate, and other surrounding structures. (clinical) [Ep 7 · 3:42](https://library.globalcastmd.com/watch/technique-laparoscopic-assisted-pull-through-for-hirschsprung-s-disease-760?t=222) - Energy being only between the jaws of the instrument diminishes the risk of injury to the ureters, vas deferens, and other vital structures. (clinical) [Ep 7 · 4:05](https://library.globalcastmd.com/watch/technique-laparoscopic-assisted-pull-through-for-hirschsprung-s-disease-760?t=245) - The preferred timing is to perform this operation in the newborn period prior to discharge to home, though it is acceptable if the child tolerates rectal irrigations to let them grow. (opinion) [Ep 7 · 4:35](https://library.globalcastmd.com/watch/technique-laparoscopic-assisted-pull-through-for-hirschsprung-s-disease-760?t=275) - With current technology, the operation is considered extremely safe in the newborn period. (opinion) [Ep 7 · 4:45](https://library.globalcastmd.com/watch/technique-laparoscopic-assisted-pull-through-for-hirschsprung-s-disease-760?t=285) - For the transanal dissection, traction stitches are placed inside the anus just proximal to the dentate line and then out to the skin, slightly inverting the anus so the dentate line can be clearly visualized. (clinical) [Ep 7 · 5:13](https://library.globalcastmd.com/watch/technique-laparoscopic-assisted-pull-through-for-hirschsprung-s-disease-760?t=313) - Between 4 to 8 sutures are used to evert the anus. (clinical) [Ep 7 · 5:38](https://library.globalcastmd.com/watch/technique-laparoscopic-assisted-pull-through-for-hirschsprung-s-disease-760?t=338) - A mucosal incision is made with hand cautery 2 to 3 millimeters proximal to the dentate line and crypt. (clinical) [Ep 7 · 5:53](https://library.globalcastmd.com/watch/technique-laparoscopic-assisted-pull-through-for-hirschsprung-s-disease-760?t=353) - The key to the transanal portion is that it should all take place externally to the anus. (clinical) [Ep 7 · 6:28](https://library.globalcastmd.com/watch/technique-laparoscopic-assisted-pull-through-for-hirschsprung-s-disease-760?t=388) - The laparoscopic dissection down to the pelvic floor allows the transanal dissection to be carried out outside of the anus, so no retractors are ever placed within the external sphincter which may cause these muscles to be damaged. (clinical) [Ep 7 · 6:36](https://library.globalcastmd.com/watch/technique-laparoscopic-assisted-pull-through-for-hirschsprung-s-disease-760?t=396) - Sharp dissection is preferred to mobilize the submucosal space, although blunt dissection can also be used. (opinion) [Ep 7 · 7:05](https://library.globalcastmd.com/watch/technique-laparoscopic-assisted-pull-through-for-hirschsprung-s-disease-760?t=425) - Performing the dissection external to the anus protects the external sphincter muscles and improves the chance of good continence. (clinical) [Ep 7 · 7:31](https://library.globalcastmd.com/watch/technique-laparoscopic-assisted-pull-through-for-hirschsprung-s-disease-760?t=451) - The colon is divided 5 to 6 centimeters above the biopsy site, which is 5 centimeters above the obvious transition zone. (clinical) [Ep 7 · 8:57](https://library.globalcastmd.com/watch/technique-laparoscopic-assisted-pull-through-for-hirschsprung-s-disease-760?t=537) - The coloanal anastomosis is performed with 12 to 16 sutures total, placing 3 to 4 additional sutures in each quadrant after the initial 4 quadrant stay sutures. (clinical) [Ep 7 · 9:19](https://library.globalcastmd.com/watch/technique-laparoscopic-assisted-pull-through-for-hirschsprung-s-disease-760?t=559) - Vicryl suture is used for the anastomosis in newborns. (clinical) [Ep 7 · 9:44](https://library.globalcastmd.com/watch/technique-laparoscopic-assisted-pull-through-for-hirschsprung-s-disease-760?t=584) - This operation took 70 minutes. (clinical) [Ep 7 · 9:57](https://library.globalcastmd.com/watch/technique-laparoscopic-assisted-pull-through-for-hirschsprung-s-disease-760?t=597) - The child was left without a nasogastric tube and started stooling the morning following surgery. (clinical) [Ep 7 · 10:00](https://library.globalcastmd.com/watch/technique-laparoscopic-assisted-pull-through-for-hirschsprung-s-disease-760?t=600) - The patient was started on feeds less than 24 hours after the procedure. (clinical) [Ep 7 · 10:07](https://library.globalcastmd.com/watch/technique-laparoscopic-assisted-pull-through-for-hirschsprung-s-disease-760?t=607) - The anastomosis is calibrated with a 12 Hegar dilator at the end of the procedure. (clinical) [Ep 7 · 10:36](https://library.globalcastmd.com/watch/technique-laparoscopic-assisted-pull-through-for-hirschsprung-s-disease-760?t=636) - Gauze packing is placed in the anus at the end of the procedure. (clinical) [Ep 7 · 10:45](https://library.globalcastmd.com/watch/technique-laparoscopic-assisted-pull-through-for-hirschsprung-s-disease-760?t=645) - The patient is placed transversely on the table with the surgeon standing at the head for laparoscopic pull-through for high imperforate anus. (clinical) [Ep 8 · 0:05](https://library.globalcastmd.com/watch/technique-laparoscopic-assisted-pull-through-for-imperforate-anus-762?t=5) - Three trocars are used: one umbilical for the scope, and 3mm and 5mm trocars in the right and left mid-quadrants just below the umbilicus. (clinical) [Ep 8 · 0:10](https://library.globalcastmd.com/watch/technique-laparoscopic-assisted-pull-through-for-imperforate-anus-762?t=10) - The mesenteric mobilization technique uses fine dissection just on the serosa of the bowel wall, with small vessels individually isolated, grasped with the sealer, sealed, and retracted away from the bowel. (clinical) [Ep 8 · 0:32](https://library.globalcastmd.com/watch/technique-laparoscopic-assisted-pull-through-for-imperforate-anus-762?t=32) - This vessel sealing technique is safer than using electrocautery in the pelvic area, which could spread to surrounding structures causing injury to the vas deferens, bladder, ureter, and other structures. (clinical) [Ep 8 · 0:50](https://library.globalcastmd.com/watch/technique-laparoscopic-assisted-pull-through-for-imperforate-anus-762?t=50) - Electrocautery could also damage surrounding nerves in the pelvic dissection. (clinical) [Ep 8 · 1:10](https://library.globalcastmd.com/watch/technique-laparoscopic-assisted-pull-through-for-imperforate-anus-762?t=70) - The 3mm sealer allows fine dissection completely around the circumference of the bowel with very limited heat spread. (clinical) [Ep 8 · 1:13](https://library.globalcastmd.com/watch/technique-laparoscopic-assisted-pull-through-for-imperforate-anus-762?t=73) - Using the sealer in the right hand allows the surgeon to dissect with both hands, providing traction with the left hand and doing fine dissection with the right. (clinical) [Ep 8 · 1:25](https://library.globalcastmd.com/watch/technique-laparoscopic-assisted-pull-through-for-imperforate-anus-762?t=85) - In this case, the rectourethral fistula is a high fistula at the level of the bladder neck. (clinical) [Ep 8 · 2:04](https://library.globalcastmd.com/watch/technique-laparoscopic-assisted-pull-through-for-imperforate-anus-762?t=124) - There is no bleeding during the dissection because each of the vessels is sealed before being divided. (clinical) [Ep 8 · 2:26](https://library.globalcastmd.com/watch/technique-laparoscopic-assisted-pull-through-for-imperforate-anus-762?t=146) - The posterior dissection goes quite quickly down to the level of the pelvic floor. (clinical) [Ep 8 · 2:40](https://library.globalcastmd.com/watch/technique-laparoscopic-assisted-pull-through-for-imperforate-anus-762?t=160) - The most difficult portion of the dissection is always anteriorly where the fistula comes up into the bladder, requiring careful technique to prevent injury to the prostate, seminal vesicles, or vas deferens. (clinical) [Ep 8 · 2:49](https://library.globalcastmd.com/watch/technique-laparoscopic-assisted-pull-through-for-imperforate-anus-762?t=169) - A hitch stitch is placed through the anterior abdominal wall down to the peritoneal reflection to retract the bladder up out of the way, exposing the anterior rectum more completely. (clinical) [Ep 8 · 3:12](https://library.globalcastmd.com/watch/technique-laparoscopic-assisted-pull-through-for-imperforate-anus-762?t=192) - The anterior dissection can be difficult as the tissue planes can be very dense and difficult to differentiate between the rectum and surrounding structures. (clinical) [Ep 8 · 3:26](https://library.globalcastmd.com/watch/technique-laparoscopic-assisted-pull-through-for-imperforate-anus-762?t=206) - The colon tapers relatively quickly as it enters down into the bladder neck in high fistulas. (clinical) [Ep 8 · 4:06](https://library.globalcastmd.com/watch/technique-laparoscopic-assisted-pull-through-for-imperforate-anus-762?t=246) - Most of the rectourethral fistulas dealt with in this procedure are closer to the level of the prostate rather than at the bladder neck. (epidemiological) [Ep 8 · 4:19](https://library.globalcastmd.com/watch/technique-laparoscopic-assisted-pull-through-for-imperforate-anus-762?t=259) - The fistula is taken using a 5mm stapler, with the best angle achieved by placing the stapler through the left-hand port in this case. (clinical) [Ep 8 · 5:05](https://library.globalcastmd.com/watch/technique-laparoscopic-assisted-pull-through-for-imperforate-anus-762?t=305) - Whether the left or right hand port is upsized to 5mm for the stapler depends on the particular anatomy of the child. (clinical) [Ep 8 · 5:22](https://library.globalcastmd.com/watch/technique-laparoscopic-assisted-pull-through-for-imperforate-anus-762?t=322) - The fistula is taken almost completely flush with the bladder neck to prevent any residual fistula and eliminate the chance of a diverticulum. (clinical) [Ep 8 · 5:32](https://library.globalcastmd.com/watch/technique-laparoscopic-assisted-pull-through-for-imperforate-anus-762?t=332) - In most cases, it is not necessary to mobilize the rectosigmoid much above the pelvic reflection. (clinical) [Ep 8 · 6:09](https://library.globalcastmd.com/watch/technique-laparoscopic-assisted-pull-through-for-imperforate-anus-762?t=369) - The dissection stays relatively close to the bowel wall to prevent devascularization of the colon and injury to surrounding structures. (clinical) [Ep 8 · 6:26](https://library.globalcastmd.com/watch/technique-laparoscopic-assisted-pull-through-for-imperforate-anus-762?t=386) - The vessel sealing and tearing technique prevents the need for changing to scissors to cut tissue and prevents the heat spread seen with monopolar hook cautery. (clinical) [Ep 8 · 7:00](https://library.globalcastmd.com/watch/technique-laparoscopic-assisted-pull-through-for-imperforate-anus-762?t=420) - The baby's feet and legs are prepped at the beginning of the procedure and retracted up toward the baby's head to expose the area of the external sphincter for the perineal portion. (clinical) [Ep 8 · 7:29](https://library.globalcastmd.com/watch/technique-laparoscopic-assisted-pull-through-for-imperforate-anus-762?t=449) - A nerve stimulator is used to identify the center of the external sphincter, which is marked just over 1 centimeter from a reference point. (clinical) [Ep 8 · 7:45](https://library.globalcastmd.com/watch/technique-laparoscopic-assisted-pull-through-for-imperforate-anus-762?t=465) - A skin incision is made in the center of the sphincter, and needle-tip cautery is used to gently divide the tissues in the midline. (clinical) [Ep 8 · 7:54](https://library.globalcastmd.com/watch/technique-laparoscopic-assisted-pull-through-for-imperforate-anus-762?t=474) - The nerve stimulator is used throughout the perineal dissection to ensure the dissection does not wander off to the right or left and stays in the center as close as possible. (clinical) [Ep 8 · 8:19](https://library.globalcastmd.com/watch/technique-laparoscopic-assisted-pull-through-for-imperforate-anus-762?t=499) - After dissecting through skin and subcutaneous tissue down to the sphincter level, blunt dissection is performed right in the center of the sphincter to preserve the circular fibers as much as possible. (clinical) [Ep 8 · 8:34](https://library.globalcastmd.com/watch/technique-laparoscopic-assisted-pull-through-for-imperforate-anus-762?t=514) - A Veress needle is inserted through the center of the external sphincter and into the center of the pelvic floor under direct laparoscopic visualization. (clinical) [Ep 8 · 8:53](https://library.globalcastmd.com/watch/technique-laparoscopic-assisted-pull-through-for-imperforate-anus-762?t=533) - It is important to visualize the tip of the Veress needle coming through the levator complex under laparoscopy, as it is possible to injure the urethra or bladder if not careful. (clinical) [Ep 8 · 9:07](https://library.globalcastmd.com/watch/technique-laparoscopic-assisted-pull-through-for-imperforate-anus-762?t=547) - A sheath is inserted over the Veress needle, and a series of serially expandable trocars are used to go from 5mm up to 10mm to create the anal canal. (clinical) [Ep 8 · 9:24](https://library.globalcastmd.com/watch/technique-laparoscopic-assisted-pull-through-for-imperforate-anus-762?t=564) - A Babcock clamp is passed through the 10mm trocar and used to grasp the rectum; because of the staple line, there is no spillage during this portion of the procedure. (clinical) [Ep 8 · 9:47](https://library.globalcastmd.com/watch/technique-laparoscopic-assisted-pull-through-for-imperforate-anus-762?t=587) - Care should be taken to ensure the orientation of the bowel is correct and that it does not get twisted or the mesentery kinked during pull-through. (clinical) [Ep 8 · 10:10](https://library.globalcastmd.com/watch/technique-laparoscopic-assisted-pull-through-for-imperforate-anus-762?t=610) - Occasionally there is too much tension during pull-through and more mobilization needs to be done, which can be achieved relatively easily laparoscopically. (clinical) [Ep 8 · 10:45](https://library.globalcastmd.com/watch/technique-laparoscopic-assisted-pull-through-for-imperforate-anus-762?t=645) - The staple line is resected from the exteriorized bowel end, and stay sutures are placed to give better exposure. (clinical) [Ep 8 · 11:18](https://library.globalcastmd.com/watch/technique-laparoscopic-assisted-pull-through-for-imperforate-anus-762?t=678) - A series of 4-0 interrupted absorbable sutures are used to create the neo-anus, going full-thickness through the colon and then through the skin. (clinical) [Ep 8 · 11:35](https://library.globalcastmd.com/watch/technique-laparoscopic-assisted-pull-through-for-imperforate-anus-762?t=695) - Because the patient has a diverting colostomy, it is only necessary to place about 12 to 16 sutures, as the anastomosis does not need to be airtight and should not be made ischemic. (clinical) [Ep 8 · 11:53](https://library.globalcastmd.com/watch/technique-laparoscopic-assisted-pull-through-for-imperforate-anus-762?t=713) - Anal calibration and dilations are started at approximately 2 weeks postoperatively and are often only necessary for a few weeks. (clinical) [Ep 8 · 12:57](https://library.globalcastmd.com/watch/technique-laparoscopic-assisted-pull-through-for-imperforate-anus-762?t=777) - Two to three stitches are placed in each quadrant after the four corner sutures are placed for the anastomosis. (clinical) [Ep 8 · 13:22](https://library.globalcastmd.com/watch/technique-laparoscopic-assisted-pull-through-for-imperforate-anus-762?t=802) - Once the anastomosis is complete, the anus already retracts somewhat, creating a more normal-appearing skin line and external column. (clinical) [Ep 8 · 13:59](https://library.globalcastmd.com/watch/technique-laparoscopic-assisted-pull-through-for-imperforate-anus-762?t=839) - Hitch stitches are placed in the colon, attaching the distal or mid-rectum to the presacral fascia to help prevent prolapse later on. (clinical) [Ep 8 · 14:17](https://library.globalcastmd.com/watch/technique-laparoscopic-assisted-pull-through-for-imperforate-anus-762?t=857) - Usually two presacral fixation stitches, one on each side, are sufficient to prevent prolapse. (clinical) [Ep 8 · 14:36](https://library.globalcastmd.com/watch/technique-laparoscopic-assisted-pull-through-for-imperforate-anus-762?t=876) - The key to this operation is to operate in front of the camera and run the bowel in front of the camera instead of chasing the bowel around the abdomen, which prevents disorientation and allows the surgeon to keep a clear view. (opinion) [Ep 5 · 2:52](https://library.globalcastmd.com/watch/laparoscopic-ladd-procedure-for-midgut-volvulus-in-a-12-year-old-using-coolseal-11941?t=172) - It is critical that the bowel be completely run from the duodenojejunal junction all the way to the ileocecal valve to ensure that all bands have been released. (opinion) [Ep 5 · 4:00](https://library.globalcastmd.com/watch/laparoscopic-ladd-procedure-for-midgut-volvulus-in-a-12-year-old-using-coolseal-11941?t=240) - The key to this operation is making sure that the mesentery has been broadly widened to prevent a twist in the future. (opinion) [Ep 5 · 6:29](https://library.globalcastmd.com/watch/laparoscopic-ladd-procedure-for-midgut-volvulus-in-a-12-year-old-using-coolseal-11941?t=389) - One should be able to see the superior mesenteric artery and vein coming straight down into the middle of the abdomen with no twists or obstruction. (opinion) [Ep 5 · 6:39](https://library.globalcastmd.com/watch/laparoscopic-ladd-procedure-for-midgut-volvulus-in-a-12-year-old-using-coolseal-11941?t=399) - The 3 millimeter sealer can be used to safely grasp the bowel and act as a forceps which is atraumatic to the bowel. (clinical) [Ep 4 · 1:00](https://library.globalcastmd.com/watch/laparoscopic-ladd-procedure-for-malrotation-in-an-infant-11940?t=60) - The first portion of the duodenum is extremely dilated. (clinical) [Ep 4 · 1:22](https://library.globalcastmd.com/watch/laparoscopic-ladd-procedure-for-malrotation-in-an-infant-11940?t=82) - Dense adhesions to the proximal duodenum can be safely taken down using the sealer by dissecting them off the bowel and then sealing and gently tearing them off the surface of the duodenum. (clinical) [Ep 4 · 1:33](https://library.globalcastmd.com/watch/laparoscopic-ladd-procedure-for-malrotation-in-an-infant-11940?t=93) - Because of the minimal energy spread of the sealer, it is very safe to dissect in this fashion. (clinical) [Ep 4 · 1:51](https://library.globalcastmd.com/watch/laparoscopic-ladd-procedure-for-malrotation-in-an-infant-11940?t=111) - The bowel can be grasped immediately after the sealer is activated without any evidence of any heat injury to the bowel. (clinical) [Ep 4 · 1:58](https://library.globalcastmd.com/watch/laparoscopic-ladd-procedure-for-malrotation-in-an-infant-11940?t=118) - The sealer is found to be much more useful than using a hook, which had significant energy spread and also could not be used to grasp the bowel. (opinion) [Ep 4 · 2:10](https://library.globalcastmd.com/watch/laparoscopic-ladd-procedure-for-malrotation-in-an-infant-11940?t=130) - As is common in these cases, the duodenum goes towards the retroperitoneum, and this is the most difficult part to mobilize. (clinical) [Ep 4 · 3:13](https://library.globalcastmd.com/watch/laparoscopic-ladd-procedure-for-malrotation-in-an-infant-11940?t=193) - Adhesions between the transverse colon and the duodenum, some of which are consistent with Ladd bands, can be extremely thick and dense and difficult to take down. (clinical) [Ep 4 · 3:35](https://library.globalcastmd.com/watch/laparoscopic-ladd-procedure-for-malrotation-in-an-infant-11940?t=215) - Complete mobilization of the transverse and proximal or ascending colon is necessary because of the posterior attachments. (clinical) [Ep 4 · 4:08](https://library.globalcastmd.com/watch/laparoscopic-ladd-procedure-for-malrotation-in-an-infant-11940?t=248) - The minimal energy spread from the sealer allows this device to be used in close proximity to the small bowel without any risk of injury to it. (clinical) [Ep 4 · 5:19](https://library.globalcastmd.com/watch/laparoscopic-ladd-procedure-for-malrotation-in-an-infant-11940?t=319) - Ladd bands can traverse across the duodenum causing proximal obstruction. (clinical) [Ep 4 · 5:35](https://library.globalcastmd.com/watch/laparoscopic-ladd-procedure-for-malrotation-in-an-infant-11940?t=335) - The posterior retroperitoneal attachment of the duodenum cannot be reached until the Ladd bands have been completely divided. (clinical) [Ep 4 · 7:01](https://library.globalcastmd.com/watch/laparoscopic-ladd-procedure-for-malrotation-in-an-infant-11940?t=421) - The bowel is run from proximal to distal to completely derotate the bowel and eliminate the risk of volvulus in the future. (clinical) [Ep 4 · 6:50](https://library.globalcastmd.com/watch/laparoscopic-ladd-procedure-for-malrotation-in-an-infant-11940?t=410) - The sealer can act as an atraumatic bowel grasper during bowel running, though the jaws are not quite as large as the 3 millimeter bowel grasper. (clinical) [Ep 4 · 7:39](https://library.globalcastmd.com/watch/laparoscopic-ladd-procedure-for-malrotation-in-an-infant-11940?t=459) - The sealer is used during bowel running because other bands are often encountered, and this allows immediate sealing and division. (clinical) [Ep 4 · 7:56](https://library.globalcastmd.com/watch/laparoscopic-ladd-procedure-for-malrotation-in-an-infant-11940?t=476) - Enlarged lymph nodes in the mesentery and the chylous appearance within the bowel show evidence of chronic mild obstruction. (clinical) [Ep 4 · 8:29](https://library.globalcastmd.com/watch/laparoscopic-ladd-procedure-for-malrotation-in-an-infant-11940?t=509) - At the completion of the Ladd procedure, all of the colon is on the left and the small bowel is on the right. (clinical) [Ep 4 · 8:56](https://library.globalcastmd.com/watch/laparoscopic-ladd-procedure-for-malrotation-in-an-infant-11940?t=536) - In a small infant with a small appendix, the appendix can be brought out through the right trocar site and amputated extracorporeally. (clinical) [Ep 4 · 9:06](https://library.globalcastmd.com/watch/laparoscopic-ladd-procedure-for-malrotation-in-an-infant-11940?t=546) - A newborn with prenatal diagnosis of bowel obstruction was found to have jejunal atresia on upper GI study (clinical) [Ep 1 · 0:00](https://library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-748?t=0) - The surgeon stands at the baby's feet with the cameraman on the baby's right and the scrub tech on the patient's left for this procedure (clinical) [Ep 1 · 0:30](https://library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-748?t=30) - A 3-port technique was used with a 4 mm 30-degree scope for visualization and two 3 mm ports for dissection (clinical) [Ep 1 · 0:50](https://library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-748?t=50) - The left mid-quadrant port was later changed to a 5 mm port for the stapler (clinical) [Ep 1 · 1:10](https://library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-748?t=70) - The Veress needle is inserted below the umbilicus to avoid injury to the umbilical vessels and prevent CO2 embolism (clinical) [Ep 1 · 1:20](https://library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-748?t=80) - There was a complete gap between the proximal jejunum and the distal bowel, with visualization of appendix and cecum suggesting an apple peel defect (clinical) [Ep 1 · 2:00](https://library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-748?t=120) - The bowel was run from proximal to distal to ensure there were no other areas of obstruction or kinking (clinical) [Ep 1 · 2:30](https://library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-748?t=150) - Running the bowel distally confirmed an apple peel defect, as the bowel could be seen twisting around the mesentery (clinical) [Ep 1 · 2:50](https://library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-748?t=170) - Because there was no evidence of a kink or significant obstruction, the mesentery was not further manipulated (clinical) [Ep 1 · 3:10](https://library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-748?t=190) - A decision was made to remove the proximal dilated segment in the hopes of improving bowel motility following surgery, because it was relatively short and significantly dilated (clinical) [Ep 1 · 3:40](https://library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-748?t=220) - The mesentery is taken down using a 3 mm bipolar vessel sealer, with vessels clamped, sealed, and then teased off the mesenteric border of the bowel (clinical) [Ep 1 · 4:10](https://library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-748?t=250) - The dissection was carried back almost to the ligament of Treitz and encompassed approximately 10 cm length of bowel (clinical) [Ep 1 · 4:30](https://library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-748?t=270) - A 5 mm endoscopic stapler was used to divide the bowel, laying down 4 rows of staples and dividing between them (clinical) [Ep 1 · 4:50](https://library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-748?t=290) - Two applications of the stapler were required because the bowel was so dilated, with a diameter of almost 4 cm (clinical) [Ep 1 · 5:10](https://library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-748?t=310) - The distal jejunal segment was anastomosed to the proximal dilated segment in an end-to-side fashion (clinical) [Ep 1 · 5:30](https://library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-748?t=330) - An enterotomy was made in the proximal dilated bowel using a 3 mm hook cautery and then decompressed with a 3 mm sucker (clinical) [Ep 1 · 5:45](https://library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-748?t=345) - A similar enterotomy was made in the distal jejunal segment and slightly dilated to allow access of the stapler (clinical) [Ep 1 · 6:00](https://library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-748?t=360) - The anastomosis was approximately 2.5 cm in length (clinical) [Ep 1 · 6:15](https://library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-748?t=375) - The resultant enterotomy was closed with a running absorbable suture (clinical) [Ep 1 · 6:25](https://library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-748?t=385) - Previous to having the stapler, an end-to-end anastomosis would have been performed with multiple interrupted or running sutures (clinical) [Ep 1 · 6:35](https://library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-748?t=395) - After completion of the enterotomy, there was no evidence of significant mesenteric defect or any gap in the anatomy (clinical) [Ep 1 · 6:50](https://library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-748?t=410) - The procedure took 80 minutes and was tolerated well by the infant (clinical) [Ep 1 · 7:05](https://library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-748?t=425) - The patient had diminishing NG aspirates over the next week (clinical) [Ep 1 · 7:20](https://library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-748?t=440) - An upper GI obtained one week postoperatively showed a widely patent anastomosis (clinical) [Ep 1 · 5:55](https://library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-748?t=355) - The resected specimen measured 10 cm (clinical) [Ep 1 · 5:55](https://library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-748?t=355) - A full-term infant with a prenatally diagnosed abdominal cyst underwent ultrasound which confirmed the presence of a duplication cyst. (clinical) [Ep 6 · 0:00](https://library.globalcastmd.com/watch/laparoscopic-intestinal-duplication-cyst-repair-technique-750?t=0) - At 3 weeks of age, the patient underwent laparoscopic exploration. (clinical) [Ep 6 · 0:20](https://library.globalcastmd.com/watch/laparoscopic-intestinal-duplication-cyst-repair-technique-750?t=20) - The surgeon is positioned at the patient's feet for this procedure. (clinical) [Ep 6 · 0:30](https://library.globalcastmd.com/watch/laparoscopic-intestinal-duplication-cyst-repair-technique-750?t=30) - 3 ports were used with ports in the right and left mid quadrant used for the manipulation and resection. (clinical) [Ep 6 · 0:40](https://library.globalcastmd.com/watch/laparoscopic-intestinal-duplication-cyst-repair-technique-750?t=40) - The initial maneuver was to elevate the transverse colon in order to run the bowel. (clinical) [Ep 6 · 0:50](https://library.globalcastmd.com/watch/laparoscopic-intestinal-duplication-cyst-repair-technique-750?t=50) - The intestinal duplication cyst appeared to be mid-jejunal. (clinical) [Ep 6 · 1:00](https://library.globalcastmd.com/watch/laparoscopic-intestinal-duplication-cyst-repair-technique-750?t=60) - The left mid quadrant port was upsized to a 5 millimeter port to allow for placement of the endoscopic stapler. (clinical) [Ep 6 · 1:50](https://library.globalcastmd.com/watch/laparoscopic-intestinal-duplication-cyst-repair-technique-750?t=110) - A single load of the stapler was used to divide the bowel both on the proximal and then on the distal end. (clinical) [Ep 6 · 2:05](https://library.globalcastmd.com/watch/laparoscopic-intestinal-duplication-cyst-repair-technique-750?t=125) - This allowed for division of the bowel without any intraabdominal contamination from the bowel contents. (clinical) [Ep 6 · 2:20](https://library.globalcastmd.com/watch/laparoscopic-intestinal-duplication-cyst-repair-technique-750?t=140) - The 3 millimeter vessel sealer was used to seal the mesentery and then it was stripped off the cyst in the bowel without any bleeding or other issues. (clinical) [Ep 6 · 2:35](https://library.globalcastmd.com/watch/laparoscopic-intestinal-duplication-cyst-repair-technique-750?t=155) - For vessels of this size, this maneuver is extremely efficient as it allows for rapid sealing and division of the mesentery without the repeated placement of endoscopic scissors. (opinion) [Ep 6 · 2:55](https://library.globalcastmd.com/watch/laparoscopic-intestinal-duplication-cyst-repair-technique-750?t=175) - A 3-0 Prolene stitch was placed through the anterior abdominal wall and then placed through first the distal limb and then the proximal limb of the bowel to align the two segments for the side to side anastomosis. (clinical) [Ep 6 · 3:30](https://library.globalcastmd.com/watch/laparoscopic-intestinal-duplication-cyst-repair-technique-750?t=210) - A Vicryl suture is placed intracorporeally to align the proximal segments of the two pieces of bowel to facilitate the side to side anastomosis. (clinical) [Ep 6 · 4:00](https://library.globalcastmd.com/watch/laparoscopic-intestinal-duplication-cyst-repair-technique-750?t=240) - Two enterotomies were then made side by side in each limb of the bowel to allow for placement of the 5 millimeter stapler. (clinical) [Ep 6 · 4:15](https://library.globalcastmd.com/watch/laparoscopic-intestinal-duplication-cyst-repair-technique-750?t=255) - A side to side anastomosis was completed with a single application of the stapler. (clinical) [Ep 6 · 4:30](https://library.globalcastmd.com/watch/laparoscopic-intestinal-duplication-cyst-repair-technique-750?t=270) - The resultant enterotomy was then closed with a running 4-0 Vicryl suture. (clinical) [Ep 6 · 4:45](https://library.globalcastmd.com/watch/laparoscopic-intestinal-duplication-cyst-repair-technique-750?t=285) - This was a very fast and efficient way of closing the small enterotomy. (opinion) [Ep 6 · 4:55](https://library.globalcastmd.com/watch/laparoscopic-intestinal-duplication-cyst-repair-technique-750?t=295) - The surgeon can follow himself, keeping adequate tension on the running suture line to prevent any gaps. (clinical) [Ep 6 · 5:05](https://library.globalcastmd.com/watch/laparoscopic-intestinal-duplication-cyst-repair-technique-750?t=305) - A small specimen bag was placed into the abdomen, which was the thumb of a #8 glove. (clinical) [Ep 6 · 5:35](https://library.globalcastmd.com/watch/laparoscopic-intestinal-duplication-cyst-repair-technique-750?t=335) - The cyst was decompressed using cautery and suction to allow the bowel to fit in the specimen bag. (clinical) [Ep 6 · 5:50](https://library.globalcastmd.com/watch/laparoscopic-intestinal-duplication-cyst-repair-technique-750?t=350) - The specimen was brought out through the left mid quadrant trocar site. (clinical) [Ep 6 · 6:05](https://library.globalcastmd.com/watch/laparoscopic-intestinal-duplication-cyst-repair-technique-750?t=365) - The patient is a 1 day old infant who had a prenatal diagnosis of duodenal atresia (clinical) [Ep 2 · 0:00](https://library.globalcastmd.com/watch/technique-laparoscopic-repair-of-duodenal-atresia-ladd-s-procedure-and-761?t=0) - Port placements consist of a 4 millimeter scope in the umbilicus, a 3 millimeter port in the left mid quadrant, and a 3 millimeter stab wound in the right mid quadrant, triangulated towards the right upper quadrant (clinical) [Ep 2 · 0:30](https://library.globalcastmd.com/watch/technique-laparoscopic-repair-of-duodenal-atresia-ladd-s-procedure-and-761?t=30) - The 3 millimeter sealer is an excellent dissecting device and can be used in safe energy in close approximation to both the gallbladder and the small bowel (opinion) [Ep 2 · 1:00](https://library.globalcastmd.com/watch/technique-laparoscopic-repair-of-duodenal-atresia-ladd-s-procedure-and-761?t=60) - A transabdominal stitch using a 30 Prolene on an RB1 needle is placed through the anterior abdominal wall in the right upper quadrant to retract the gallbladder superiorly (clinical) [Ep 2 · 2:00](https://library.globalcastmd.com/watch/technique-laparoscopic-repair-of-duodenal-atresia-ladd-s-procedure-and-761?t=120) - The child is malrotated with a complete duodenal atresia (clinical) [Ep 2 · 2:30](https://library.globalcastmd.com/watch/technique-laparoscopic-repair-of-duodenal-atresia-ladd-s-procedure-and-761?t=150) - The bowel is run from proximal to distally to ensure that there are no further Ladd's bands and to completely de-rotate the bowel (clinical) [Ep 2 · 3:00](https://library.globalcastmd.com/watch/technique-laparoscopic-repair-of-duodenal-atresia-ladd-s-procedure-and-761?t=180) - A Meckel's diverticulum is found in the distal ileum during the procedure (clinical) [Ep 2 · 3:30](https://library.globalcastmd.com/watch/technique-laparoscopic-repair-of-duodenal-atresia-ladd-s-procedure-and-761?t=210) - All of the small bowel is placed on the patient's right and the large bowel on the patient's left (clinical) [Ep 2 · 4:00](https://library.globalcastmd.com/watch/technique-laparoscopic-repair-of-duodenal-atresia-ladd-s-procedure-and-761?t=240) - Widening the mesenteric base should diminish the chance of volvulus in the future (clinical) [Ep 2 · 4:30](https://library.globalcastmd.com/watch/technique-laparoscopic-repair-of-duodenal-atresia-ladd-s-procedure-and-761?t=270) - A transverse enterotomy is made at the most dependent portion of the dilated proximal segment (clinical) [Ep 2 · 5:00](https://library.globalcastmd.com/watch/technique-laparoscopic-repair-of-duodenal-atresia-ladd-s-procedure-and-761?t=300) - The enterotomy in the distal segment is longitudinal (clinical) [Ep 2 · 5:30](https://library.globalcastmd.com/watch/technique-laparoscopic-repair-of-duodenal-atresia-ladd-s-procedure-and-761?t=330) - There is increased smoke and debris from using electrocautery compared to the 3 millimeter sealer (clinical) [Ep 2 · 6:00](https://library.globalcastmd.com/watch/technique-laparoscopic-repair-of-duodenal-atresia-ladd-s-procedure-and-761?t=360) - A transabdominal stitch aligns the two sides of the bowel to perform the side to side anastomosis (clinical) [Ep 2 · 6:30](https://library.globalcastmd.com/watch/technique-laparoscopic-repair-of-duodenal-atresia-ladd-s-procedure-and-761?t=390) - A pre-cut Vicryl suture approximately 10 to 12 centimeters in length is used to run the back row of the anastomosis (clinical) [Ep 2 · 7:00](https://library.globalcastmd.com/watch/technique-laparoscopic-repair-of-duodenal-atresia-ladd-s-procedure-and-761?t=420) - In some cases, the distal duodenal segment is more fixed to the retroperitoneum, making this part of the procedure more difficult, but the same technique is used with excellent result (clinical) [Ep 2 · 8:00](https://library.globalcastmd.com/watch/technique-laparoscopic-repair-of-duodenal-atresia-ladd-s-procedure-and-761?t=480) - The surgeon prefers running suture over interrupted suture as it works extremely well and is more efficient (opinion) [Ep 2 · 9:00](https://library.globalcastmd.com/watch/technique-laparoscopic-repair-of-duodenal-atresia-ladd-s-procedure-and-761?t=540) - The entire procedure took approximately 50 minutes (clinical) [Ep 2 · 9:30](https://library.globalcastmd.com/watch/technique-laparoscopic-repair-of-duodenal-atresia-ladd-s-procedure-and-761?t=570) - Approximately 10% of patients undergoing laparoscopic repair of duodenal atresia have malrotation (epidemiological) [Ep 2 · 10:00](https://library.globalcastmd.com/watch/technique-laparoscopic-repair-of-duodenal-atresia-ladd-s-procedure-and-761?t=600) - A nasogastric tube is left to suction for approximately 3 to 4 days, and in most cases feeds are started by the 5th day (clinical) [Ep 2 · 10:30](https://library.globalcastmd.com/watch/technique-laparoscopic-repair-of-duodenal-atresia-ladd-s-procedure-and-761?t=630) - This child started eating on the 5th postoperative day and was on full feeds by the 8th postoperative day (clinical) [Ep 2 · 11:00](https://library.globalcastmd.com/watch/technique-laparoscopic-repair-of-duodenal-atresia-ladd-s-procedure-and-761?t=660) - The base of the Meckel's diverticulum could adequately be divided without compromising the lumen of the bowel, so a decision was made to remove it using the 5 millimeter stapler (clinical) [Ep 2 · 12:00](https://library.globalcastmd.com/watch/technique-laparoscopic-repair-of-duodenal-atresia-ladd-s-procedure-and-761?t=720) - The left quadrant 3 millimeter port was changed to a 5 millimeter port to allow insertion of the endoscopic stapler (clinical) [Ep 2 · 13:00](https://library.globalcastmd.com/watch/technique-laparoscopic-repair-of-duodenal-atresia-ladd-s-procedure-and-761?t=780) - Because of the malrotation, the appendix was also removed (clinical) [Ep 2 · 13:30](https://library.globalcastmd.com/watch/technique-laparoscopic-repair-of-duodenal-atresia-ladd-s-procedure-and-761?t=810) - The child was discharged to home on the 10th postoperative day (clinical) [Ep 2 · 14:00](https://library.globalcastmd.com/watch/technique-laparoscopic-repair-of-duodenal-atresia-ladd-s-procedure-and-761?t=840) - The patient is a 2.8 kg child (clinical) [Ep 2 · 10:00](https://library.globalcastmd.com/watch/technique-laparoscopic-repair-of-duodenal-atresia-ladd-s-procedure-and-761?t=600) - This modification of single site appendectomy allows for 90 degree retraction using two umbilical ports (either 2.5 mm or 2 mm and 4 mm) through a 10 mm incision and a single 3 mm port in the suprapubic area below the bikini line. (clinical) [Ep 11 · 0:00](https://library.globalcastmd.com/watch/modified-single-site-laparoscopic-appendectomy-with-a-suprapubic-port-11946?t=0) - The small suprapubic incision results in an almost scarless defect. (clinical) [Ep 11 · 0:40](https://library.globalcastmd.com/watch/modified-single-site-laparoscopic-appendectomy-with-a-suprapubic-port-11946?t=40) - A 4 mm 30 degree lens is used for the procedure and the Maryland dissector has almost complete range of motion without conflict with the scope. (clinical) [Ep 11 · 1:20](https://library.globalcastmd.com/watch/modified-single-site-laparoscopic-appendectomy-with-a-suprapubic-port-11946?t=80) - A 5 mm hook is generally adequate to take the appendiceal mesentery in almost all cases. (clinical) [Ep 11 · 1:40](https://library.globalcastmd.com/watch/modified-single-site-laparoscopic-appendectomy-with-a-suprapubic-port-11946?t=100) - The mesentery is addressed near the base of the appendix to prevent excess cauterization and re-cauterizing the appendiceal artery numerous times. (clinical) [Ep 11 · 1:55](https://library.globalcastmd.com/watch/modified-single-site-laparoscopic-appendectomy-with-a-suprapubic-port-11946?t=115) - This procedure took just 10 minutes and the video is relatively unedited. (clinical) [Ep 11 · 2:15](https://library.globalcastmd.com/watch/modified-single-site-laparoscopic-appendectomy-with-a-suprapubic-port-11946?t=135) - The base of the appendix is compressed to ensure there is no fecolith at the base and that the tissue is adequately compressible to allow for use of the 5 mm stapler. (clinical) [Ep 11 · 2:45](https://library.globalcastmd.com/watch/modified-single-site-laparoscopic-appendectomy-with-a-suprapubic-port-11946?t=165) - It is important to apply the 5 mm stapler and allow it to compress for a full 10 seconds prior to firing to allow the 2 mm staplers to adequately get through the tissue and provide a safe seal. (clinical) [Ep 11 · 3:10](https://library.globalcastmd.com/watch/modified-single-site-laparoscopic-appendectomy-with-a-suprapubic-port-11946?t=190) - The 5 mm endoscopic specimen bag does not fit through a true 5 mm port. (clinical) [Ep 11 · 3:40](https://library.globalcastmd.com/watch/modified-single-site-laparoscopic-appendectomy-with-a-suprapubic-port-11946?t=220) - The 5 and 4 mm trocar sites are connected to remove the specimen through the umbilical site. (clinical) [Ep 11 · 4:00](https://library.globalcastmd.com/watch/modified-single-site-laparoscopic-appendectomy-with-a-suprapubic-port-11946?t=240) - At 2 weeks postoperatively, the scars are almost scarless. (clinical) [Ep 11 · 4:10](https://library.globalcastmd.com/watch/modified-single-site-laparoscopic-appendectomy-with-a-suprapubic-port-11946?t=250) - The patient is a 16-year-old female who presented with a 24 hour history of increasing right lower quadrant pain. (clinical) [Ep 10 · 0:00](https://library.globalcastmd.com/watch/mini-laparoscopic-appendectomy-in-a-16-year-old-using-a-5-mm-stapler-11943?t=0) - Two ports are placed through a 1 centimeter umbilical incision, and a single 3 millimeter incision is made in the suprapubic area for the left hand retracting port. (clinical) [Ep 10 · 0:30](https://library.globalcastmd.com/watch/mini-laparoscopic-appendectomy-in-a-16-year-old-using-a-5-mm-stapler-11943?t=30) - The child weighs 65 kg and it is possible to use this technique in patients up to 100 kg. (clinical) [Ep 10 · 1:10](https://library.globalcastmd.com/watch/mini-laparoscopic-appendectomy-in-a-16-year-old-using-a-5-mm-stapler-11943?t=70) - A 1 centimeter incision is made within the umbilicus so that the scar will not be visible postoperatively. (clinical) [Ep 10 · 1:35](https://library.globalcastmd.com/watch/mini-laparoscopic-appendectomy-in-a-16-year-old-using-a-5-mm-stapler-11943?t=95) - The abdomen is insufflated to a pressure of 15 mmHg using a closed Veress needle technique in all cases. (clinical) [Ep 10 · 1:50](https://library.globalcastmd.com/watch/mini-laparoscopic-appendectomy-in-a-16-year-old-using-a-5-mm-stapler-11943?t=110) - A 4 millimeter trochar is inserted for a 4 millimeter 30 degree scope; in larger patients, a 5 millimeter 30 degree scope is often used. (clinical) [Ep 10 · 2:10](https://library.globalcastmd.com/watch/mini-laparoscopic-appendectomy-in-a-16-year-old-using-a-5-mm-stapler-11943?t=130) - A second trochar is inserted through the same incision but through a separate fascial defect for the 5 millimeter Maryland, hook cautery, and eventually the 5 millimeter stapler. (clinical) [Ep 10 · 2:30](https://library.globalcastmd.com/watch/mini-laparoscopic-appendectomy-in-a-16-year-old-using-a-5-mm-stapler-11943?t=150) - A 3 millimeter incision is made just above the pubic bone, below the pubic hairline, for a 3 millimeter Babcock which provides right angle retraction. (clinical) [Ep 10 · 2:45](https://library.globalcastmd.com/watch/mini-laparoscopic-appendectomy-in-a-16-year-old-using-a-5-mm-stapler-11943?t=165) - The appendix was mildly inflamed. (clinical) [Ep 10 · 3:05](https://library.globalcastmd.com/watch/mini-laparoscopic-appendectomy-in-a-16-year-old-using-a-5-mm-stapler-11943?t=185) - Hook cautery is used to take the appendiceal mesentery; there is significant energy spread and smoke, but this is acceptable because the appendix is being removed. (clinical) [Ep 10 · 3:10](https://library.globalcastmd.com/watch/mini-laparoscopic-appendectomy-in-a-16-year-old-using-a-5-mm-stapler-11943?t=190) - Monopolar cautery is used in this case; the dissection can also be done using a 3 millimeter sealer or other energy devices, but a reusable hook cautery is generally adequate. (clinical) [Ep 10 · 3:30](https://library.globalcastmd.com/watch/mini-laparoscopic-appendectomy-in-a-16-year-old-using-a-5-mm-stapler-11943?t=210) - It is important to not leave the appendiceal artery patent next to the appendix when using the 5 millimeter stapler, as sometimes the vessel is so small the staples do not adequately capture it. (clinical) [Ep 10 · 3:45](https://library.globalcastmd.com/watch/mini-laparoscopic-appendectomy-in-a-16-year-old-using-a-5-mm-stapler-11943?t=225) - In patients with a thicker mesentery, the staple load can be used for the mesentery, although the hook cautery technique works quite well. (clinical) [Ep 10 · 4:05](https://library.globalcastmd.com/watch/mini-laparoscopic-appendectomy-in-a-16-year-old-using-a-5-mm-stapler-11943?t=245) - The base of the appendix is grasped and compressed to ensure it is not too thick for the 5 millimeter stapler. (clinical) [Ep 10 · 4:15](https://library.globalcastmd.com/watch/mini-laparoscopic-appendectomy-in-a-16-year-old-using-a-5-mm-stapler-11943?t=255) - The 5 millimeter stapler is compressed with checking to ensure excellent alignment of the two ends; if necessary, the stapler can be reapplied. (clinical) [Ep 10 · 4:25](https://library.globalcastmd.com/watch/mini-laparoscopic-appendectomy-in-a-16-year-old-using-a-5-mm-stapler-11943?t=265) - There is occasionally some very mild oozing at the staple line, which is insignificant. (clinical) [Ep 10 · 4:35](https://library.globalcastmd.com/watch/mini-laparoscopic-appendectomy-in-a-16-year-old-using-a-5-mm-stapler-11943?t=275) - The 5 millimeter trocar is removed and a 5 millimeter endoscopic bag is inserted through the fascial defect, opened in the abdominal cavity, and the appendix is placed within it. (clinical) [Ep 10 · 4:20](https://library.globalcastmd.com/watch/mini-laparoscopic-appendectomy-in-a-16-year-old-using-a-5-mm-stapler-11943?t=260) - The bag is removed through the umbilicus; if necessary, the fascial defect is widened or the two fascial defects are joined using a Kelly clamp, but the patient remains with a 1 centimeter skin incision. (clinical) [Ep 10 · 4:40](https://library.globalcastmd.com/watch/mini-laparoscopic-appendectomy-in-a-16-year-old-using-a-5-mm-stapler-11943?t=280) - The appearance of the umbilicus determines how the appendicostomy is fashioned. (clinical) [Ep 23 · 0:04](https://library.globalcastmd.com/watch/open-malone-and-mitrofanoff-procedure-using-a-divided-appendix-11939?t=4) - A chimney-like umbilicus allows creation of an easily catheterizable stoma by removing a circle of skin and the cicatrix down to the peritoneum. (clinical) [Ep 23 · 0:20](https://library.globalcastmd.com/watch/open-malone-and-mitrofanoff-procedure-using-a-divided-appendix-11939?t=20) - This is an open procedure performed when a child requires both a Malone and a Mitrofanoff. (clinical) [Ep 23 · 0:45](https://library.globalcastmd.com/watch/open-malone-and-mitrofanoff-procedure-using-a-divided-appendix-11939?t=45) - The appendix can be divided through a window in the mesoappendix where blood vessels supply the proximal and distal portions. (clinical) [Ep 23 · 1:20](https://library.globalcastmd.com/watch/open-malone-and-mitrofanoff-procedure-using-a-divided-appendix-11939?t=80) - The proximal portion of the divided appendix (in continuity with cecum) becomes the Malone channel. (clinical) [Ep 23 · 2:00](https://library.globalcastmd.com/watch/open-malone-and-mitrofanoff-procedure-using-a-divided-appendix-11939?t=120) - The distal portion of the divided appendix becomes the Mitrofanoff channel. (clinical) [Ep 23 · 2:15](https://library.globalcastmd.com/watch/open-malone-and-mitrofanoff-procedure-using-a-divided-appendix-11939?t=135) - A window is made in the mesentery to allow cecal plication around the appendix base to help reduce leakage. (clinical) [Ep 23 · 2:30](https://library.globalcastmd.com/watch/open-malone-and-mitrofanoff-procedure-using-a-divided-appendix-11939?t=150) - Great care must be taken not to interrupt the blood supply during cecal plication. (clinical) [Ep 23 · 2:55](https://library.globalcastmd.com/watch/open-malone-and-mitrofanoff-procedure-using-a-divided-appendix-11939?t=175) - The cecum is plicated with silk sutures around the base of the appendix. (clinical) [Ep 23 · 3:05](https://library.globalcastmd.com/watch/open-malone-and-mitrofanoff-procedure-using-a-divided-appendix-11939?t=185) - A superficial bite of the appendix is taken with each stitch to ensure the lumen is not narrowed. (clinical) [Ep 23 · 3:20](https://library.globalcastmd.com/watch/open-malone-and-mitrofanoff-procedure-using-a-divided-appendix-11939?t=200) - Gentle traction is applied to the appendix during suturing to ensure it remains straight. (clinical) [Ep 23 · 3:35](https://library.globalcastmd.com/watch/open-malone-and-mitrofanoff-procedure-using-a-divided-appendix-11939?t=215) - An 8 French feeding tube is passed through the appendix to ensure the channel is easily catheterizable. (clinical) [Ep 23 · 4:00](https://library.globalcastmd.com/watch/open-malone-and-mitrofanoff-procedure-using-a-divided-appendix-11939?t=240) - The appendix is delivered through the umbilicus and fashioned into a catheterizable stoma with the feeding tube left in situ. (clinical) [Ep 23 · 4:20](https://library.globalcastmd.com/watch/open-malone-and-mitrofanoff-procedure-using-a-divided-appendix-11939?t=260) - A 17 year old female with a 1 year history of chronic pain was found to have celiac artery compression and angulation on a CT angio (clinical) [Ep 20 · 0:00](https://library.globalcastmd.com/watch/laparoscopic-median-arcuate-ligament-division-in-a-17-year-old-using-the-coolsea-11938?t=0) - The procedure used 5 ports, 4 5-millimeter ports and 1 3-millimeter port (clinical) [Ep 20 · 0:45](https://library.globalcastmd.com/watch/laparoscopic-median-arcuate-ligament-division-in-a-17-year-old-using-the-coolsea-11938?t=45) - The ability to seal and cut safely with no heat spread is key for the entirety of the procedure (opinion) [Ep 20 · 1:00](https://library.globalcastmd.com/watch/laparoscopic-median-arcuate-ligament-division-in-a-17-year-old-using-the-coolsea-11938?t=60) - Identifying the right crus and where the right and left crus come together are critical for this procedure (clinical) [Ep 20 · 2:00](https://library.globalcastmd.com/watch/laparoscopic-median-arcuate-ligament-division-in-a-17-year-old-using-the-coolsea-11938?t=120) - There was unusually a large amount of inflammation in this area and a number of enlarged inflammatory nodes (clinical) [Ep 20 · 2:30](https://library.globalcastmd.com/watch/laparoscopic-median-arcuate-ligament-division-in-a-17-year-old-using-the-coolsea-11938?t=150) - Dissecting off inflamed nodes is critical in identifying the celiac trunk and to prevent inadvertent injury to the hepatic artery (clinical) [Ep 20 · 3:00](https://library.globalcastmd.com/watch/laparoscopic-median-arcuate-ligament-division-in-a-17-year-old-using-the-coolsea-11938?t=180) - The fibrous tissue in this area seemed to be impinging on the hepatic artery (clinical) [Ep 20 · 3:30](https://library.globalcastmd.com/watch/laparoscopic-median-arcuate-ligament-division-in-a-17-year-old-using-the-coolsea-11938?t=210) - A vessel loop was placed around the left gastric artery for traction and secured with 5 millimeter clips (clinical) [Ep 20 · 4:00](https://library.globalcastmd.com/watch/laparoscopic-median-arcuate-ligament-division-in-a-17-year-old-using-the-coolsea-11938?t=240) - It is necessary to divide celiac plexus nerve fibers to fully open up the area around the celiac trunk (clinical) [Ep 20 · 5:00](https://library.globalcastmd.com/watch/laparoscopic-median-arcuate-ligament-division-in-a-17-year-old-using-the-coolsea-11938?t=300) - All the energy is between the jaws and there is absolutely no heat spread outside of the jaws with the Trinity device (clinical) [Ep 20 · 5:30](https://library.globalcastmd.com/watch/laparoscopic-median-arcuate-ligament-division-in-a-17-year-old-using-the-coolsea-11938?t=330) - The lack of heat spread allows dissection, sealing, and dividing tissues while resting on the hepatic artery, celiac trunk, stomach, and other structures (clinical) [Ep 20 · 5:30](https://library.globalcastmd.com/watch/laparoscopic-median-arcuate-ligament-division-in-a-17-year-old-using-the-coolsea-11938?t=330) - The curved jaws allow better orientation to divide the fibers of the right crus and expose the median arcuate ligament (clinical) [Ep 20 · 6:00](https://library.globalcastmd.com/watch/laparoscopic-median-arcuate-ligament-division-in-a-17-year-old-using-the-coolsea-11938?t=360) - Two-hand dissection greatly enhances the surgery by allowing dissection, grasping tissue, and elevating planes with both hands (opinion) [Ep 20 · 6:00](https://library.globalcastmd.com/watch/laparoscopic-median-arcuate-ligament-division-in-a-17-year-old-using-the-coolsea-11938?t=360) - As the median arcuate ligament is divided, the celiac trunk expands and fills into view, showing significant compression of the structure (clinical) [Ep 20 · 6:30](https://library.globalcastmd.com/watch/laparoscopic-median-arcuate-ligament-division-in-a-17-year-old-using-the-coolsea-11938?t=390) - The ligament must be divided up to the insertion of the celiac trunk on the aorta to ensure complete division (clinical) [Ep 20 · 6:30](https://library.globalcastmd.com/watch/laparoscopic-median-arcuate-ligament-division-in-a-17-year-old-using-the-coolsea-11938?t=390) - The surgery lasted 90 minutes (clinical) [Ep 20 · 7:00](https://library.globalcastmd.com/watch/laparoscopic-median-arcuate-ligament-division-in-a-17-year-old-using-the-coolsea-11938?t=420) - The patient was discharged to home with complete resolution of her symptoms the following day (clinical) [Ep 20 · 7:00](https://library.globalcastmd.com/watch/laparoscopic-median-arcuate-ligament-division-in-a-17-year-old-using-the-coolsea-11938?t=420) - The umbilical incision is only about 10mm and all incisions are within the umbilicus. (clinical) [Ep 9 · 1:26](https://library.globalcastmd.com/watch/technique-laparoscopic-appendectomy-757?t=86) - The suprapubic port is placed just above the bladder and a 3mm port is generally sufficient for this position. (clinical) [Ep 9 · 2:03](https://library.globalcastmd.com/watch/technique-laparoscopic-appendectomy-757?t=123) - Maintaining a right angle between instruments makes the dissection easier. (opinion) [Ep 9 · 3:18](https://library.globalcastmd.com/watch/technique-laparoscopic-appendectomy-757?t=198) - The surgeon operates two-handed at 90 degrees, which is the same approach used for gallbladder surgery with two umbilical ports and a single 3mm suprapubic port. (clinical) [Ep 9 · 3:38](https://library.globalcastmd.com/watch/technique-laparoscopic-appendectomy-757?t=218) - The cameraman must work around the surgeon's left arm to accommodate the 90-degree instrument positioning. (clinical) [Ep 9 · 3:51](https://library.globalcastmd.com/watch/technique-laparoscopic-appendectomy-757?t=231) - A combination of mini laparoscopy and single site is where pediatric surgery is heading. (opinion) [Ep 9 · 4:12](https://library.globalcastmd.com/watch/technique-laparoscopic-appendectomy-757?t=252) - Trying to do everything through the umbilicus is too hard and not as safe for most surgeons, though some are very good at it. (opinion) [Ep 9 · 4:23](https://library.globalcastmd.com/watch/technique-laparoscopic-appendectomy-757?t=263) - The 3mm hook allows energy dissection throughout the mesoappendix. (clinical) [Ep 9 · 4:51](https://library.globalcastmd.com/watch/technique-laparoscopic-appendectomy-757?t=291) - If the appendiceal artery is not incorporated within the staple at the base, there is concern it may be too small to be adequately secured. (clinical) [Ep 9 · 5:13](https://library.globalcastmd.com/watch/technique-laparoscopic-appendectomy-757?t=313) - This two-incision technique is a good way to train residents and fellows. (opinion) [Ep 9 · 5:27](https://library.globalcastmd.com/watch/technique-laparoscopic-appendectomy-757?t=327) - Stripping the appendiceal artery down with a Maryland or sealer makes trainees do fine dissection. (clinical) [Ep 9 · 5:35](https://library.globalcastmd.com/watch/technique-laparoscopic-appendectomy-757?t=335) - Care must be taken at the base of the appendix during dissection. (clinical) [Ep 9 · 5:44](https://library.globalcastmd.com/watch/technique-laparoscopic-appendectomy-757?t=344) - The surgeon crushes the appendiceal base to assess tissue quality and compressibility before stapling. (clinical) [Ep 9 · 6:09](https://library.globalcastmd.com/watch/technique-laparoscopic-appendectomy-757?t=369) - When using energy near the appendiceal base, there is concern about catching a 1mm vessel with only one staple, which could cause bleeding. (clinical) [Ep 9 · 6:31](https://library.globalcastmd.com/watch/technique-laparoscopic-appendectomy-757?t=391) - If the appendiceal base tissue is thicker and the surgeon is uncertain about stapler compression, the stapler should be released and advanced to get more tissue in the jaws for better compression. (clinical) [Ep 9 · 7:00](https://library.globalcastmd.com/watch/technique-laparoscopic-appendectomy-757?t=420) - The surgeon counts to 10 after compressing tissue in the stapler before firing. (clinical) [Ep 9 · 7:19](https://library.globalcastmd.com/watch/technique-laparoscopic-appendectomy-757?t=439) - The surgeon does not like dragging a dirty appendix through the wound and prefers using a retrieval bag. (opinion) [Ep 9 · 8:21](https://library.globalcastmd.com/watch/technique-laparoscopic-appendectomy-757?t=501) - Stapling a 2mm appendiceal artery is unnecessary; if there is a big thick mesentery, stapling is appropriate, but otherwise energy dissection is preferred. (opinion) [Ep 9 · 8:37](https://library.globalcastmd.com/watch/technique-laparoscopic-appendectomy-757?t=517) - Taking the appendiceal artery with energy and dissection is a training method to improve skills for more complex procedures. (opinion) [Ep 9 · 8:44](https://library.globalcastmd.com/watch/technique-laparoscopic-appendectomy-757?t=524) - Most pediatric appendices do not have a really thick mesentery. (clinical) [Ep 9 · 9:09](https://library.globalcastmd.com/watch/technique-laparoscopic-appendectomy-757?t=549) - The 5mm retrieval bag is poorly designed because it is a 10mm bag crammed into a 5mm size, resulting in too much bag material that is tightly wrapped and difficult to unwind. (opinion) [Ep 9 · 7:59](https://library.globalcastmd.com/watch/technique-laparoscopic-appendectomy-757?t=479) - The procedure takes 5 minutes and results in no visible scars, which is as good as any single-site technique but much easier. (opinion) [Ep 9 · 9:49](https://library.globalcastmd.com/watch/technique-laparoscopic-appendectomy-757?t=589) - This technique requires no special trocars. (clinical) [Ep 9 · 9:52](https://library.globalcastmd.com/watch/technique-laparoscopic-appendectomy-757?t=592) - Teenage girls particularly appreciate this technique because they have no visible scars. (clinical) [Ep 9 · 9:52](https://library.globalcastmd.com/watch/technique-laparoscopic-appendectomy-757?t=592) - For a bigger patient, a 5mm scope would be used instead of the 4mm scope. (clinical) [Ep 9 · 10:09](https://library.globalcastmd.com/watch/technique-laparoscopic-appendectomy-757?t=609) ## Host summaries Recaps by a host of what the experts said — not the host's own clinical position. - The JRS 3 millimeter sealer is used as the primary mode of dissection for laparoscopic-assisted pull-through in Hirschsprung's disease. — The host summarizing the discussion [Ep 7 · 0:00](https://library.globalcastmd.com/watch/technique-laparoscopic-assisted-pull-through-for-hirschsprung-s-disease-760?t=0) - The patient was a newborn weighing 3.2 kg. — The host summarizing the discussion [Ep 7 · 0:32](https://library.globalcastmd.com/watch/technique-laparoscopic-assisted-pull-through-for-hirschsprung-s-disease-760?t=32) - A super umbilical ring incision is used for small newborns to place the Veress needle and 4 mm trocar, with care taken to avoid the umbilical vein by placing the trocar just to the left of midline. — The host summarizing the discussion [Ep 7 · 0:36](https://library.globalcastmd.com/watch/technique-laparoscopic-assisted-pull-through-for-hirschsprung-s-disease-760?t=36) - A full thickness biopsy is obtained from the muscular wall approximately 5 centimeters above the transition zone between the distal sigmoid and rectum. — The host summarizing the discussion [Ep 7 · 0:53](https://library.globalcastmd.com/watch/technique-laparoscopic-assisted-pull-through-for-hirschsprung-s-disease-760?t=53) - A 12-year-old female presented with a three-month history of intermittent pain and weight loss with acute worsening of symptoms. — The host summarizing a resource [Ep 5 · 0:08](https://library.globalcastmd.com/watch/laparoscopic-ladd-procedure-for-midgut-volvulus-in-a-12-year-old-using-coolseal-11941?t=8) - CT scan showed evidence of midgut volvulus. — The host summarizing a resource [Ep 5 · 0:15](https://library.globalcastmd.com/watch/laparoscopic-ladd-procedure-for-midgut-volvulus-in-a-12-year-old-using-coolseal-11941?t=15) - Patient was positioned in dorsal lithotomy position with surgeon positioned between patient's legs. — The host summarizing a resource [Ep 5 · 0:18](https://library.globalcastmd.com/watch/laparoscopic-ladd-procedure-for-midgut-volvulus-in-a-12-year-old-using-coolseal-11941?t=18) - 5 millimeter ports were used for the procedure. — The host summarizing a resource [Ep 5 · 0:29](https://library.globalcastmd.com/watch/laparoscopic-ladd-procedure-for-midgut-volvulus-in-a-12-year-old-using-coolseal-11941?t=29) - Upon entering abdomen, there was clear disorientation of the bowel with an internal hernia and complete twist of the bowel. — The host summarizing a resource [Ep 5 · 0:36](https://library.globalcastmd.com/watch/laparoscopic-ladd-procedure-for-midgut-volvulus-in-a-12-year-old-using-coolseal-11941?t=36) - The anatomy was confusing because of 360-degree twist of the bowel as well as the internal hernia. — The host summarizing a resource [Ep 5 · 2:38](https://library.globalcastmd.com/watch/laparoscopic-ladd-procedure-for-midgut-volvulus-in-a-12-year-old-using-coolseal-11941?t=158) - The superior mesenteric vessels were engorged because they had been twisted. — The host summarizing a resource [Ep 5 · 3:13](https://library.globalcastmd.com/watch/laparoscopic-ladd-procedure-for-midgut-volvulus-in-a-12-year-old-using-coolseal-11941?t=193) - Running the bowel from proximal to distal places all the small bowel on the patient's right and the colon on the patient's left. — The host summarizing a resource [Ep 5 · 7:11](https://library.globalcastmd.com/watch/laparoscopic-ladd-procedure-for-midgut-volvulus-in-a-12-year-old-using-coolseal-11941?t=431) - Using a 5mm stapler for appendix division allows keeping all ports at 5mm and not upsizing to a 12mm port for a larger stapler. — The host summarizing a resource [Ep 5 · 7:37](https://library.globalcastmd.com/watch/laparoscopic-ladd-procedure-for-midgut-volvulus-in-a-12-year-old-using-coolseal-11941?t=457) - The operation took approximately 90 minutes and the patient did well. — The host summarizing a resource [Ep 5 · 7:58](https://library.globalcastmd.com/watch/laparoscopic-ladd-procedure-for-midgut-volvulus-in-a-12-year-old-using-coolseal-11941?t=478) - The infant presented with repetitive bilious vomiting. — The host summarizing the discussion [Ep 4 · 0:00](https://library.globalcastmd.com/watch/laparoscopic-ladd-procedure-for-malrotation-in-an-infant-11940?t=0) - An upper GI series showed a redundant duodenum which did not cross the midline. — The host summarizing the discussion [Ep 4 · 0:09](https://library.globalcastmd.com/watch/laparoscopic-ladd-procedure-for-malrotation-in-an-infant-11940?t=9) - The surgeon is positioned at the end of the table with the baby brought down to the foot of the table to allow the surgeon to be in line with the foregut. — The host summarizing the discussion [Ep 4 · 0:16](https://library.globalcastmd.com/watch/laparoscopic-ladd-procedure-for-malrotation-in-an-infant-11940?t=16) - A 4 or 5 millimeter port is placed in the umbilicus, and right and left hand operating ports are placed either side of the umbilicus. — The host summarizing the discussion [Ep 4 · 0:28](https://library.globalcastmd.com/watch/laparoscopic-ladd-procedure-for-malrotation-in-an-infant-11940?t=28) - In a small infant, the right hand port is placed above the umbilicus so that the right hand does not conflict with the scope. — The host summarizing the discussion [Ep 4 · 0:36](https://library.globalcastmd.com/watch/laparoscopic-ladd-procedure-for-malrotation-in-an-infant-11940?t=36) - A 19 year old male presented with a 3 year history of medically managed Crohn's disease with increasing abdominal pain and intermittent vomiting — The host summarizing a resource [Ep 13 · 0:00](https://library.globalcastmd.com/watch/laparoscopic-resection-of-a-crohn-s-ileal-stricture-using-the-5-mm-coolseal-trin-11976?t=0) - MRI showed a fixed stricture of the terminal ileum with gross proximal dilatation — The host summarizing a resource [Ep 13 · 0:30](https://library.globalcastmd.com/watch/laparoscopic-resection-of-a-crohn-s-ileal-stricture-using-the-5-mm-coolseal-trin-11976?t=30) - There was approximately a 10 centimeter length of ileum proximal to the ileocecal valve which remained pliable and not grossly involved — The host summarizing a resource [Ep 13 · 1:30](https://library.globalcastmd.com/watch/laparoscopic-resection-of-a-crohn-s-ileal-stricture-using-the-5-mm-coolseal-trin-11976?t=90) - The decision was made to preserve the ileocecal valve based on finding 10 cm of relatively uninvolved distal ileum — The host summarizing a resource [Ep 13 · 1:50](https://library.globalcastmd.com/watch/laparoscopic-resection-of-a-crohn-s-ileal-stricture-using-the-5-mm-coolseal-trin-11976?t=110) - The 5 millimeter Cool Seal Trinity device can be used to dissect through thick mesentery and create mesenteric windows — The host summarizing a resource [Ep 13 · 2:20](https://library.globalcastmd.com/watch/laparoscopic-resection-of-a-crohn-s-ileal-stricture-using-the-5-mm-coolseal-trin-11976?t=140) - When mesentery is very thick, it can be taken in two separate leaflets (one proximal and one distal) while maintaining complete hemostasis — The host summarizing a resource [Ep 13 · 3:00](https://library.globalcastmd.com/watch/laparoscopic-resection-of-a-crohn-s-ileal-stricture-using-the-5-mm-coolseal-trin-11976?t=180) - A useful technique for thick mesentery is to make a proximal seal on the mesenteric base and then a more distal seal near the bowel wall, dividing tissue at this level to ensure no incomplete seal and maintain proximal vascular control — The host summarizing a resource [Ep 13 · 3:30](https://library.globalcastmd.com/watch/laparoscopic-resection-of-a-crohn-s-ileal-stricture-using-the-5-mm-coolseal-trin-11976?t=210) - The mesentery was almost 2 centimeters thick in this case — The host summarizing a resource [Ep 13 · 4:05](https://library.globalcastmd.com/watch/laparoscopic-resection-of-a-crohn-s-ileal-stricture-using-the-5-mm-coolseal-trin-11976?t=245) - By using the 5 mm device for mesenteric division, trocars could be limited to two 5 millimeter ports and one 12 millimeter port, which is cosmetically superior to requiring larger ports for 10 mm sealer or 12 mm stapler — The host summarizing a resource [Ep 13 · 4:30](https://library.globalcastmd.com/watch/laparoscopic-resection-of-a-crohn-s-ileal-stricture-using-the-5-mm-coolseal-trin-11976?t=270) - The mesenteric division portion of the operation took approximately 20 minutes with no significant blood loss and no unsealed vessels — The host summarizing a resource [Ep 13 · 5:20](https://library.globalcastmd.com/watch/laparoscopic-resection-of-a-crohn-s-ileal-stricture-using-the-5-mm-coolseal-trin-11976?t=320) - The 5 mm device has no heat spread and is immediately cool, allowing manipulation of bowel and surrounding structures using the grasper function without needing to exchange for a different grasping tool — The host summarizing a resource [Ep 13 · 7:20](https://library.globalcastmd.com/watch/laparoscopic-resection-of-a-crohn-s-ileal-stricture-using-the-5-mm-coolseal-trin-11976?t=440) - EndoGIA tan loads were used to divide the bowel both proximally and distally — The host summarizing a resource [Ep 13 · 7:00](https://library.globalcastmd.com/watch/laparoscopic-resection-of-a-crohn-s-ileal-stricture-using-the-5-mm-coolseal-trin-11976?t=420) - Two loads of the endoGIA were required to completely divide the grossly dilated proximal bowel — The host summarizing a resource [Ep 13 · 8:05](https://library.globalcastmd.com/watch/laparoscopic-resection-of-a-crohn-s-ileal-stricture-using-the-5-mm-coolseal-trin-11976?t=485) - A 60 millimeter load of the endoGIA was used to perform the side-to-side anastomosis — The host summarizing a resource [Ep 13 · 8:40](https://library.globalcastmd.com/watch/laparoscopic-resection-of-a-crohn-s-ileal-stricture-using-the-5-mm-coolseal-trin-11976?t=520) - The resultant enterotomy was closed with a running 2-0 Vicryl suture — The host summarizing a resource [Ep 13 · 9:00](https://library.globalcastmd.com/watch/laparoscopic-resection-of-a-crohn-s-ileal-stricture-using-the-5-mm-coolseal-trin-11976?t=540) - The operation took approximately 90 minutes — The host summarizing a resource [Ep 13 · 9:15](https://library.globalcastmd.com/watch/laparoscopic-resection-of-a-crohn-s-ileal-stricture-using-the-5-mm-coolseal-trin-11976?t=555) - The patient was left with an NG tube overnight which was removed the next morning — The host summarizing a resource [Ep 13 · 9:25](https://library.globalcastmd.com/watch/laparoscopic-resection-of-a-crohn-s-ileal-stricture-using-the-5-mm-coolseal-trin-11976?t=565) - The patient was started on a clear liquid diet on the 2nd postoperative day — The host summarizing a resource [Ep 13 · 9:40](https://library.globalcastmd.com/watch/laparoscopic-resection-of-a-crohn-s-ileal-stricture-using-the-5-mm-coolseal-trin-11976?t=580) - The patient was discharged to home on the 3rd postoperative day — The host summarizing a resource [Ep 13 · 9:55](https://library.globalcastmd.com/watch/laparoscopic-resection-of-a-crohn-s-ileal-stricture-using-the-5-mm-coolseal-trin-11976?t=595) - There was no blood loss during the procedure — The host summarizing a resource [Ep 13 · 10:30](https://library.globalcastmd.com/watch/laparoscopic-resection-of-a-crohn-s-ileal-stricture-using-the-5-mm-coolseal-trin-11976?t=630) - The patient weighs approximately 62 kg — The host summarizing a resource [Ep 13 · 6:45](https://library.globalcastmd.com/watch/laparoscopic-resection-of-a-crohn-s-ileal-stricture-using-the-5-mm-coolseal-trin-11976?t=405) - Patient was a 3½-year-old female who presented with chronic cough and chest pain, with CT scan showing right perirenal mass — The host summarizing a resource [Ep 18 · 0:00](https://library.globalcastmd.com/watch/laparoscopic-right-adrenal-neuroblastoma-resection-in-a-3-year-old-using-coolsea-11947?t=0) - The Cool Trinity 5 mm device has very low energy profile and heat spread, allowing dissection without worry of injury to the colon — The host summarizing a resource [Ep 18 · 0:30](https://library.globalcastmd.com/watch/laparoscopic-right-adrenal-neuroblastoma-resection-in-a-3-year-old-using-coolsea-11947?t=30) - The fine tips of the 5 mm jaw allow for both grasping and fine dissection between tissue planes — The host summarizing a resource [Ep 18 · 1:00](https://library.globalcastmd.com/watch/laparoscopic-right-adrenal-neuroblastoma-resection-in-a-3-year-old-using-coolsea-11947?t=60) - The tumor was directly on the inferior vena cava and densely adherent, as represented in the CT scan — The host summarizing a resource [Ep 18 · 2:30](https://library.globalcastmd.com/watch/laparoscopic-right-adrenal-neuroblastoma-resection-in-a-3-year-old-using-coolsea-11947?t=150) - The visualization afforded by the dual action and fine tips is better than all other tissue sealing devices and is equivalent to that of a 5 mm Maryland — The host summarizing a resource [Ep 18 · 3:30](https://library.globalcastmd.com/watch/laparoscopic-right-adrenal-neuroblastoma-resection-in-a-3-year-old-using-coolsea-11947?t=210) - At no time during this procedure was it necessary to remove the Trinity and insert a different grasping or dissecting device because of its ability to perform both functions — The host summarizing a resource [Ep 18 · 4:00](https://library.globalcastmd.com/watch/laparoscopic-right-adrenal-neuroblastoma-resection-in-a-3-year-old-using-coolsea-11947?t=240) - The device allows sealing and dividing tissues with separate actions, which is critically important for ensuring adequate hemostasis before division — The host summarizing a resource [Ep 18 · 5:00](https://library.globalcastmd.com/watch/laparoscopic-right-adrenal-neuroblastoma-resection-in-a-3-year-old-using-coolsea-11947?t=300) - The tissue between tumor and IVC was quite thick and inflamed, making the plane difficult to identify — The host summarizing a resource [Ep 18 · 5:30](https://library.globalcastmd.com/watch/laparoscopic-right-adrenal-neuroblastoma-resection-in-a-3-year-old-using-coolsea-11947?t=330) - The minimal heat spread ensures no damage to adjacent structures such as kidney, liver, bowel, or vena cava — The host summarizing a resource [Ep 18 · 6:30](https://library.globalcastmd.com/watch/laparoscopic-right-adrenal-neuroblastoma-resection-in-a-3-year-old-using-coolsea-11947?t=390) - There is minimal sticking following the sealing of tissues with the device — The host summarizing a resource [Ep 18 · 7:00](https://library.globalcastmd.com/watch/laparoscopic-right-adrenal-neuroblastoma-resection-in-a-3-year-old-using-coolsea-11947?t=420) - The device is taken out periodically to clean the jaws to remove any small amount of char — The host summarizing a resource [Ep 18 · 7:15](https://library.globalcastmd.com/watch/laparoscopic-right-adrenal-neuroblastoma-resection-in-a-3-year-old-using-coolsea-11947?t=435) - This procedure took under 2 hours — The host summarizing a resource [Ep 18 · 7:45](https://library.globalcastmd.com/watch/laparoscopic-right-adrenal-neuroblastoma-resection-in-a-3-year-old-using-coolsea-11947?t=465) - The tumor was placed in an endoscopic bag and brought out through an elongated umbilical incision, saving the child significant morbidity from a large open procedure — The host summarizing a resource [Ep 18 · 7:50](https://library.globalcastmd.com/watch/laparoscopic-right-adrenal-neuroblastoma-resection-in-a-3-year-old-using-coolsea-11947?t=470) - The child was discharged on the 2nd postoperative day — The host summarizing a resource [Ep 18 · 8:15](https://library.globalcastmd.com/watch/laparoscopic-right-adrenal-neuroblastoma-resection-in-a-3-year-old-using-coolsea-11947?t=495) - The pathology came back consistent with a neuroblastoma arising from the right adrenal gland — The host summarizing a resource [Ep 18 · 8:20](https://library.globalcastmd.com/watch/laparoscopic-right-adrenal-neuroblastoma-resection-in-a-3-year-old-using-coolsea-11947?t=500) - A 28-week premature infant weighing 900 g was born with a tracheoesophageal fistula — The host summarizing a resource [Ep 14 · 0:00](https://library.globalcastmd.com/watch/laparoscopic-stapled-resection-of-a-post-nec-ileal-stricture-in-a-preterm-infant-11945?t=0) - The patient underwent successful ligation and gastrostomy tube placement for TEF — The host summarizing a resource [Ep 14 · 0:30](https://library.globalcastmd.com/watch/laparoscopic-stapled-resection-of-a-post-nec-ileal-stricture-in-a-preterm-infant-11945?t=30) - The patient developed necrotizing enterocolitis 3 weeks after TEF repair — The host summarizing a resource [Ep 14 · 0:45](https://library.globalcastmd.com/watch/laparoscopic-stapled-resection-of-a-post-nec-ileal-stricture-in-a-preterm-infant-11945?t=45) - NEC was treated medically, but the child developed a stricture shown on upper GI at 8 weeks of age — The host summarizing a resource [Ep 14 · 1:00](https://library.globalcastmd.com/watch/laparoscopic-stapled-resection-of-a-post-nec-ileal-stricture-in-a-preterm-infant-11945?t=60) - Three ports were used: a 4 millimeter 30 degree scope and two 3 millimeter ports, with the right-handed port later changed to 5 mm for the stapler — The host summarizing a resource [Ep 14 · 1:30](https://library.globalcastmd.com/watch/laparoscopic-stapled-resection-of-a-post-nec-ileal-stricture-in-a-preterm-infant-11945?t=90) - A Meckel's diverticulum was discovered while running the bowel proximally from the ileocecal valve — The host summarizing a resource [Ep 14 · 2:30](https://library.globalcastmd.com/watch/laparoscopic-stapled-resection-of-a-post-nec-ileal-stricture-in-a-preterm-infant-11945?t=150) - The stricture was located at approximately mid ileum — The host summarizing a resource [Ep 14 · 3:00](https://library.globalcastmd.com/watch/laparoscopic-stapled-resection-of-a-post-nec-ileal-stricture-in-a-preterm-infant-11945?t=180) - A loop of bowel was densely adherent to the capsule of the spleen at the point of obstruction — The host summarizing a resource [Ep 14 · 3:30](https://library.globalcastmd.com/watch/laparoscopic-stapled-resection-of-a-post-nec-ileal-stricture-in-a-preterm-infant-11945?t=210) - The 3 millimeter sealer was used to gently dissect the bowel off the spleen, preserving the splenic capsule with no bleeding — The host summarizing a resource [Ep 14 · 4:00](https://library.globalcastmd.com/watch/laparoscopic-stapled-resection-of-a-post-nec-ileal-stricture-in-a-preterm-infant-11945?t=240) - A small enterotomy was made during mobilization, which was later used to show the exact site of the obstruction — The host summarizing a resource [Ep 14 · 4:40](https://library.globalcastmd.com/watch/laparoscopic-stapled-resection-of-a-post-nec-ileal-stricture-in-a-preterm-infant-11945?t=280) - Forceps passed through the enterotomy showed complete obstruction of the bowel at the stricture site — The host summarizing a resource [Ep 14 · 5:15](https://library.globalcastmd.com/watch/laparoscopic-stapled-resection-of-a-post-nec-ileal-stricture-in-a-preterm-infant-11945?t=315) - The 5 millimeter stapler lays down 2 millimeter staples in 4 rows which are then divided between two rows equally — The host summarizing a resource [Ep 14 · 5:45](https://library.globalcastmd.com/watch/laparoscopic-stapled-resection-of-a-post-nec-ileal-stricture-in-a-preterm-infant-11945?t=345) - A 3-0 Prolene stitch was passed through the anterior abdominal wall and then through the two ends of the bowel to set up a side to side anastomosis, providing excellent exposure and acting as a retractor — The host summarizing a resource [Ep 14 · 6:15](https://library.globalcastmd.com/watch/laparoscopic-stapled-resection-of-a-post-nec-ileal-stricture-in-a-preterm-infant-11945?t=375) - A 3-0 Vicryl suture was used intracorporeally to align the proximal end of the anastomosis — The host summarizing a resource [Ep 14 · 6:35](https://library.globalcastmd.com/watch/laparoscopic-stapled-resection-of-a-post-nec-ileal-stricture-in-a-preterm-infant-11945?t=395) - The residual enterotomy after stapled anastomosis was closed with a running 3-0 Vicryl suture — The host summarizing a resource [Ep 14 · 6:50](https://library.globalcastmd.com/watch/laparoscopic-stapled-resection-of-a-post-nec-ileal-stricture-in-a-preterm-infant-11945?t=410) - Because of the very small intraabdominal space, only a limited portion of the trocar can be inserted into the abdominal cavity — The host summarizing a resource [Ep 14 · 7:10](https://library.globalcastmd.com/watch/laparoscopic-stapled-resection-of-a-post-nec-ileal-stricture-in-a-preterm-infant-11945?t=430) - A 3 millimeter bowel clamp was used to compress the base of the Meckel's to ensure all gastric mucosa would be resected — The host summarizing a resource [Ep 14 · 7:30](https://library.globalcastmd.com/watch/laparoscopic-stapled-resection-of-a-post-nec-ileal-stricture-in-a-preterm-infant-11945?t=450) - The Meckel's diverticulum had normal mucosa — The host summarizing a resource [Ep 14 · 7:45](https://library.globalcastmd.com/watch/laparoscopic-stapled-resection-of-a-post-nec-ileal-stricture-in-a-preterm-infant-11945?t=465) - The thumb of a size 7 glove was used as a manufactured specimen bag for extraction through the 5 millimeter port — The host summarizing a resource [Ep 14 · 8:00](https://library.globalcastmd.com/watch/laparoscopic-stapled-resection-of-a-post-nec-ileal-stricture-in-a-preterm-infant-11945?t=480) - The entire operation took 75 minutes and the child tolerated the procedure extremely well — The host summarizing a resource [Ep 14 · 8:20](https://library.globalcastmd.com/watch/laparoscopic-stapled-resection-of-a-post-nec-ileal-stricture-in-a-preterm-infant-11945?t=500) - The resected specimen was approximately 3.5 centimeters in length — The host summarizing a resource [Ep 14 · 8:40](https://library.globalcastmd.com/watch/laparoscopic-stapled-resection-of-a-post-nec-ileal-stricture-in-a-preterm-infant-11945?t=520) - At one month after resection, the baby was tolerating feeds without problems — The host summarizing a resource [Ep 14 · 9:05](https://library.globalcastmd.com/watch/laparoscopic-stapled-resection-of-a-post-nec-ileal-stricture-in-a-preterm-infant-11945?t=545) --- Educational content from recorded physician discussions — not medical advice. Cite the canonical URL or the ?t= deep link. Policy: https://library.globalcastmd.com/ai