AIS CHANNEL

SADI-S Procedure

Single Anastomosis DuodenoIleal bypass with Sleeve (SADIS procedure)

Nissen Sleeve Gastrectomy

Releasing the lower part of the esophagus and treating a potential hiatal hernia, creating a Nissen fundoplication and performing a sleeve gastrectomy below the fundoplication.

Laparoscopic Roux-En-Y Gastric Bypass

Weight regain after gastric band removal and endoscopic Sleeve

Single port Sleeve Gastrectomy

First we will make a 2cm lateral incision inside the navel and a 3cm incision in the aponeurosis. Once we have our entry point, we introduce the single port device with the help of the rigid tube. When the ring is released inside the abdomen, we stretch the plastic to bring both rings as close as possible.

Left Hepatectomy

Laparoscopic left hepatectomy with partial resection of segment 5 performed by Professor Brice Gayet.

NOSE Lap Right Colectomy

NOSE Lap Right Colectomy performed by Professor Luigi Boni alongside Dr. Elisa Cassinotti and Dr. Massimiliano Della Porta. The surgery has a laparoscopic 4 trocar approach, high vessels ligation with SMV exposure, intracorporeal Anastomosis and colpotomy and transvaginal specimen extraction.

Transurethral Enucleation of the Prostate with Plasma

Dr. Jörg Rassler performs a Transurethral Enucleation of the Prostate with Plasma to a 68 years old patient with sever syduria, nycturia 3-4 times per nigh and a PSA of 2.51.

Thulium Fiber Laser Enucleation of the Prostate

Dr. Andreas Gross performs a Thulium Fiber Laser Enucleation of the Prostate surgery.

Living-Donor Nephrectomy

Dr. Antonio Alcaraz performs a Living-Donor Nephrectomy surgery to a 51 years old female, a candidate for living-doner nephrectomy from her son. It consists of a living-donor left laparoscopic nephrectomy with extraction through infraumbilical midline incision.

Transanal TME performed by two teams (Cecil Approach)

A transanal total mesorectal excision (TaTME) has been performed as a novel approach, two teams working simultaneously and using the latest technology.

POEM (Per-Oral Endoscopic Myotomy) for Treatment of Achalasia

The POEM (Per-Oral Endoscopic Myotomy ) is a highly specialized procedure performed through the esophagus in order to cut the innermost muscle layer of the lower esophageal sphincter. Professor Inoue Haruhiro from Showa University Hospital (Tokyo, Japan) was the first to perform this intervention and is the most experienced surgeon in this field.

Transanal TME by A.M. Lacy and S. Delgado

The full surgery, performed by Dr Lacy and Dr Delgado, can be seen with its main steps discussed by Professor Heald, Dr. Sylla and Dr. Wexner.

Sleeve Gastrectomy by A.M. Lacy and S. Delgado

A panel of experts including Michel Gagner discuss the key steps and controversies in sleeve gastrectomy.

Training for young surgeons: Sleeve Gastrectomy

Two residents assisted by a junior surgeon are scrubbed to perform a sleeve gastrectomy by laparoscopic approach while discussing the basic steps of the procedure and how to solve potential problems. The surgery is mentored by Antonio M. Lacy from the Hospital Clínic in Barcelona.

TME by Transanal approach (TaTME) performed by Dr. Lacy

A live surgery with special interest for surgeons starting their experience with the TaTME. The procedure focuses on the key points for transanal dissection.

TAMIS for the treatment of J Pouch complications by Willem Bemelman

Complications after a pouch surgery can be difficult to treat. They prolong the duration of a stoma and have an impact on patients’ quality of life. Willem Bemelman is an expert in minimally invasive and colorectal surgery and has extensive experience in treatment of its complications.

Laparoscopic Ventral Rectopexy for Rectal Prolapse

Rectal prolapse is a frequent and underdiagnosed pathology. Elderly female patients are the most affected ones. The surgery represents the most effective therapy and has evolved showing good results.

Sleeve Gastrectomy by Antonio M. Lacy and his Team

The most popular surgical procedure for treatment of morbid obese patients was performed live. The annual meeting of the Spanish Society of Bariatric Surgery and Metabolic Diseases - SECO was held from May 27 to May 29, 2015. A number of live surgical procedures were performed during the meeting. Dr Antonio M. Lacy and Dr Raquel Bravo from the Hospital Clinic of Barcelona performed a Sleeve Gastrectomy by laparoscopic approach. Learn the essential steps and the tips and tricks of the operation directly from the experts.

Step by step for a Transanal TME (TaTME) by Antonio M. Lacy

The most innovative approach for the treatment of rectal cancer performed by experts. The standard of care for rectal cancer is the TME, described by Professor Heald at 1982. The laparoscopic approach has several advantages with respect to the open approach. However, there are several issues that need to be solved. The transanal approach provides many improvements, such as better control of the distal and circumferential margins. Dr. Antonio M Lacy and Dr. Salvadora Delgado performed a live case and commented on the basics steps of the most innovative approach for the treatment of rectal cancer.

Step by step for a Gastric Bypass by Antonio M. Lacy

The gold standard for the surgical treatment of morbid obese patients performed and commented by Dr. Antonio M Lacy and Dr. Dulce Momblán. The Roux-n-Y gastric bypass has proven to be safe with good long terms outcomes for the treatment of morbid obese patients, it is feasible and safe to perform it by laparoscopic approach. The incidence of Roux-n-Y has decreased due to its technical difficulties when compared to the sleeve gastrectomy. Learn the essential steps, the tips and the tricks of the operation directly from the experts!

Ileocecal Valve Polyp Endoscopic Mucosal Resection by Michael Bourke

Endoscopic mucosal resection (EMR) is an effective alternative to surgery for laterally spreading and sessile polyps up to 120mm in size. Endoscopic removal of polyps involving the ileocecal valve (ICV) is difficult due to a major risk of complications. Thus surgical treatment is often recommended despite a benign histology. Improvements in the EMR technique now make the successful endoscopic removal of most of these polyps possible. Dr. Michael Bourke, a leading global expert in the endoscopic mucosal resection technique, performed the procedure in a complex case live for the entire AIS Channel Community. He provided tips and show the limitations of EMR when facing an ICV polyp.

Second Step for Bariatric Surgery by Antonio M. Lacy

What to do with patients with failed sleeve gastrectomies due to EWL <50% & GERD? The proportion of sleeve gastrectomies performed around the world continuously grows as it is fast to perform and has a low postoperative complication rate. The results in terms of excess weight loss and resolution of comorbidities are good during the first two years. Actual data reflect that up to 30% of patients experience <50% EWL in the long term and other patients develop hiatal hernia and GERD. There is an ideal surgical procedure for each one of these problems. But, what to do with patients who have both of them? or in cases of severe adhesions due to previous surgeries? Dr. Antonio M. Lacy and Dr. Dulce Momblán dealt with this issue in the operating room Live for the AIS Channel community. Learn the essential steps, the tips and tricks of the operation directly from the experts.

Proctoring for residents: Laparoscopic Sigmoid Resection

The ideal training model of surgical residents and young surgeons is a current issue. The teaching of laparoscopic assisted colonic surgical resections requires a standardized methodology supervised by experts in order to complete an appropriate learning curve and develop adequate surgical skills. Modern young surgeons must be prepared to deliver the best treatment to its patients. Dr. Antonio Lacy and Dr. Raquel Bravo proctored a surgical resident during a laparoscopic sigmoid resection.

Surgical Management after failed LRYGBP

Up to 20% of patients may present insufficient weight loss or weight regain after LRYGBP. Revision of the pouch, revision of the jejuno-jejunal anastomosis and conversion into other procedures have been described as solutions. Pouch revision and conversions may be technically demanding and can lead to an increased rate of complications, with excludes a group of patients from these surgical treatments. Dr. Ricard Corcelles and Dr. Ainitze Ibarzabal provide a surgical option for a patient with insufficient weight loss after a Roux-en-Y Gastric Bypass.

Proctocolectomy by Transanal & Transabdominal Approach (Cecil Approach)

Minimal invasive surgery has been accepted by the colorectal surgical community. In most patients it makes it possible to reproduce the surgical dissection performed using an open approach. Advantages such as faster recovery, less pain, and fewer complications are evident. Complex colorectal procedures can also be performed by laparoscopic surgery after an adequate learning curve. The transanal approach combined with the transabdominal laparoscopic dissection (The Cecil Approach) enhances patients benefits in terms of quality of dissection and surgical time. Antonio M. Lacy, Maria Fernandez-Hevia and Raquel Bravo exhibited all the benefits of the Cecil Approach during a total proctocolectomy.

Endoscopic revision for weight regain after Gastric Gypass

Advanced endoscopy to treat weight regain after Roux-en-Y Gastric Bypass: Stoma dilation is the most cited cause of insufficient weight loss or weight regain after a Roux-en-Y Gastric Bypass (RYGB). Surgical revision to restore its baseline restriction characteristic may be technically demanding and associated with increased morbidity. Stoma remodeling by means of advanced endoscopic instruments represents a valid and less aggressive option. Gloria Fernandez and Oriol Sendino, from Hospital Clinic of Barcelona, were proctored by Matthew Kroh, from Cleveland Clinic Ohio, during the endoscopic revision of a dilated stoma.

New tools to perform the ideal Sleeve Gastrectomy

The ideal sleeve gastrectomy for a patient with a high risk of hypoglycemia. RYGBP is not suitable for all morbid obese patients. The sleeve gastrectomy is a valid option that should be performed properly to avoid complications and ensure the best long-term result for our patients. Antonio M. Lacy, Ricard Corcelles and Maria F Hevia used new tools to perform the ideal sleeve gastrectomy.

Mesenteric gap repair

Herniation through the mesenteric gaps is the most common cause of small bowel obstruction after Roux-en-Y Gastric Bypass (RYGB) and a frequent cause of abdominal pain. A high degree of suspicion and an assertive diagnosis are required to prevent severe complications. Surgical revision is the optimal treatment and can be performed by MIS. Ricard Corcelles performed surgical revision of a patient with this problem.

Right Colectomy for Young Surgeons

Training young surgeons in MIS: Teaching young surgeons to perform minimally invasive approaches is a significant task in any surgical program. This training should be delivered by experienced hands that can teach the tips and tricks than will complete a surgeon's specialized preparation.

Sleeved Gastric Bypass

Emergent surgical treatment for morbid obese patients: Several modifications have been proposed to the standard surgical treatment of morbid obese patients. The goal is to achieve improvement of surgical outcomes and provide better results for the patients. Rui Ribeiro from Curry Cabral Hospital (Centro Hospitalar de Lisboa Central) performed a Sleeved Gastric Bypass for the entire AIS Community.

Surgical treatment of T2DM

There is enough data to support surgery as the best treatment of morbid obese patients with type 2 diabetes mellitus (T2DM). The Laparoscopic Roux-en-Y Gastric Bypass (LRYGB) is the gold standard surgical procedure. However, the sleeve gastrectomy is also being considered among the bariatric community. On June 21th, the 18th National Congress of the Spanish Society of Surgery of Morbid Obesity and its Metabolic Diseases (SECO) was held in Barcelona. On its first day Camilo Boza (Chile), Luigi Angrisani (Italy) and Antonio M. Lacy (Spain) performed 3 simultaneous live surgical procedures for the treatment of T2DM for the entire AIS Community: LRYGB, sleeve gastrectomy and conversion of a sleeve gastrectomy into LRYGB.

Proctoring for young surgeons: Laparoscopic Roux-en-Y Gastric Bypass

AIS Channel maintains its commitment to surgical education: so far we have broadcast several colorectal and bariatric procedures focusing on the training of surgical residents and young surgeons. It's time for a new live surgery in this area! On September 14th at 12:30pm (UTC+02), Antonio M. Lacy and Ricard Corcelles from the Hospital Clinic of Barcelona guided Ana Otero in the performance of a Laparoscopic Roux-en-Y Gastric Bypass.

Ileosigmoidal fistula complicating diverticular disease

Complications secondary to diverticular disease can still pose a surgical challenge regarding surgery timinig, the selected approach, or the indicated technique. Antonio M. Lacy and Ana Otero, from the Optimus ISE OR in Hospital Clinic Barcelona, were broadcast live in an ileosigmoidal fistula secondary to diverticular disease treatment. In addition, our team worked with 4K technology on a 85" monitor (courtesy of SONY), which optimized the endoscopic view of minimally invasive procedures.

Cecil Approach in Proctectomy for Ulcerative Colitis

Patients with Ulcerative Colitis and lack of response to medical treatments require surgical intervention. This is usually performed in three stages (Total Colectomy, Proctectomy plus J Pouch, and finally bowel transit restorance) and can be fully performed by minimally invasive surgery. Technological improvements and current experience in TaTME make it possible to extend the indications of the transanal approach to the IBD field. Antonio M. Lacy and Dulce Momblan from Hospital Clinic Barcelona, demonstrated the advantages of the Cecil Approach to perform a Proctectomy in a case of Ulcerative Colitis.

Rectosigmoid Cancer by Transanal Approach (Cecil)

Transanal approach for rectal cancer can be helpful not only on a mid and low rectal cancer, but also on a high rectum neoplasias. A precise distal margin from the tumor will ensure an adequate oncologic resection leaving the anastomosis at a height of 8 to 10 cm from the anal verge. From the Hospital Clinic in Barcelona, a TaTME by Cecil Approach by Dr. Antonio M. Lacy for neoplasia at the level of the peritoneal reflexion, was broadcasted, 14 cm from the anal verge, demonstrating the results of a high rectal anastomosis from a transanal approach.

2nd step SADI-S

Single-anastomosis duodenal-ileal bypass (SADI) can be considered a valid option for patients with insufficient weight loss after sleeve gastrectomy (SG) or in super obese individuals as a 2nd stage procedure. It can be described as a simplified duodenal switch that offers both biliopancreatic diversion metabolic effects and easier performance. Moreover, pylorus preservation has been given as a possible benefit. When SADI and SG are performed together as a primary operation, results are excellent in terms of weight loss and comorbidity resolution. Hence, it has been hypothesized that SADI could be successful a second-step operation. Recently published short and mid-term results indicate that it is a safe, feasible and effective second-stage procedure. The procedure was performed by Dr. José M. Balibrea and Dr. José M. Fort from the Hospital Vall d'Hebron in Barcelona.

Revisional surgery after POSE technique

Several endoscopic procedures are proposed as an alternative to formal surgical treatment for morbid obesity. Some advantages are that it less aggressive and can be performed under sedation. Some data shows good outcomes in the short term. However, in daily practice there is an increasing number of patients who require conversion into surgical treatment. Antonio M. Lacy and Ricard Corcelles performed from the Hospital Clinic in Barcelona, a revisional bariatric surgery with 3D technology on a morbid obese patient with a failure after a POSE procedure.

Sleeve Gastrectomy: Not as easy as it seems

During the 13th AIS World Live Congress, the live surgery session involved 3 simultaneous cases operated simultaneously in separate theaters from Barcelona (Dr. Lacy), Montreal (Dr. Gagner) and Bruges (Dr. Dillemans): primary Sleeve Gastrectomy, and 2 revisions after Sleeve Gastrectomy.

2nd SurgEndocrine event: a global call for endocrine surgery techniques

The 2nd AIS SurgEndocrine Event was devoted to parathyroid gland handling during a total thyroidectomy. Two live total thyroidectomies were performed with a specific focus on parathyroid gland preservation. Faculty and viewers across the world interacted with the surgeons during the procedure, and a debriefing session between chairs and faculty took place at the end of the meeting. Parathyroid gland management issues regarding to postoperative hypocalcemia and hypoparathyroidism were discussed.

New tools to perform the ideal Sleeve Gastrectomy

Laparoscopic Sleeve Gastrectomy was performed by Dr. Antonio M. Lacy and Dr. Ricard Corcelles from the Hospital Clinic Barcelona. During the live surgery, new technologies were used in front of the entire AIS World Community. Laparoscopic Sleeve Gastrectomy (LSG) has become the most commonly performed bariatric operation in recent years. LSG has increased in popularity as a primary procedure due to its simplicity, relative safety, and effectiveness to achieve sustained weight loss over time compared to gastric bypass. We have recently witnessed a surge in new technologies whose purpose is to increase the safety and efficiency of surgical interventions. The aim of these advanced tools is to facilitate the surgeon's work by decreasing the number of perioperative complications. However, new tools must be validated to gain universal acceptance. The field of bariatric surgery is constantly evolving. In LSG procedures, several new devices have appeared and may play a crucial role in the near future. Some of these new tools will be introduced during the live surgery, such as new retractors, ICG for vascularization of gastric remnant and new stapling devices combining Tri-Staple technology with real time feedback.

TaTME Cecil Approach 2

The gold standard approach for rectal cancer is still under debate. Transabdominal-Transanal surgery (the Cecil Approach) is in the spotlight as it helps overcome technical difficulties in rectal cancer surgery, particularly in mid and low rectal cancer, but also in high rectal cancer. Once the mesorectal excision has been completed, a hand-swen or stapled anastomosis is created at the tumor level. For mid-rectal cancers, a stapled anastomosis may be fashioned either transabdominally or transanally. During the live surgery, the Cecil Approach for mid rectal cancer and stapled anastomosis were demonstrated by Dr. Antonio Lacy and his team from Hospital Clinic in Barcelona. The different steps of the technique were discussed, as well as tips and tricks.

Nissen Fundoplication

The management of paraesophageal hernia is one of the most discussed topics in surgical forums. Most surgeons currently take a laparoscopic approach with the excision of the sac and the addition of an anti-reflux procedure to treat coexistent reflux. A total fundoplication (Nissen Fundoplication) is the preferred approach to patients with gastroesophageal reflux as it provides better control of the reflux compared to partial fundoplications. Whether placement of a mesh is necessary or not is still under debate.

Total Colectomy with Transanal Retrieval

Prophylactic surgery for cancer prevention of familial adenomatous polyposis yields good short-term surgical outcomes, with low morbidity rates, good functional outcomes, and excellent overall survival rates. Rectal preservation is the surgical choice when the rectal lesions are endoscopically addressable. Furthermore, transanal retrieval of the specimen may prevent additional abdominal incisions and their associated complications. On June 8th 2017 at 3:30pm (Barcelona Time), Dr. Antonio Lacy and his team from Hospital Clinic in Barcelona performed a live total colectomy with rectal preservation for a familial adenomatous polyposis. Join us and discover the tips and tricks for this technique step by step!

Proctectomy & Ileal Pouch by Transanal Approach

In selected cases of ulcerative colitis (UC), restorative proctocolectomy with a J-pouch and ileo-anal anastomosis (IPAA) is the treatment of choice. Total mesorectal excision has been preferred when performing the proctectomy, although a close rectal dissection (CRD), without following the "holy plane", has also been described. The transanal approach has evolved, and it is no longer limited to local excision of rectal neoplasms, with total mesorectal excision having currently become one of its main indications. Furthermore, this approach can also be used in cases of UC requiring surgery. Hybrid transanal CRD appears to be the next step in the evolution of minimally invasive transanal surgery.

Sigmoidectomy: Robotic vs. Laparoscopic

Minimally invasive colorectal surgery is a challenging procedure. Surgical practice has changed since the introduction of robotic techniques, and robotic colorectal surgery is an emerging field. Robotic surgery for colorectal cancer has several advantages over conventional laparoscopic surgery when performing precise dissection and was proved to be safe and effective in previous studies. The combination of 3D visualization, a stable camera and articulated instruments that simulate the movements of the human wrist are the features that seem to provide greater surgical precision. However, the comparison between laparoscopic and robotic colorectal resection has yielded contradictory results. The balance between costs and benefits, as well as some specific indications, remain controversial. Two consecutive procedures, a laparoscopic and a robotic sigmoidectomy, were performed LIVE, showing our search for excellence in terms of surgical techniques and new technologies such as laparoscopy and robotics to treat colorectal cancer. On August 23rd 2017, Dr. Antonio Lacy and Dr. Raquel Bravo demonstrated, from Hospital Clinic Barcelona, all these benefits and controversies for the AIS Community during consecutive laparoscopic and robotic sigmoid resections.

TAMIS Pouch

Transanal close rectum restorative proctocolectomy with a pouch is a novel approach to perform the completion proctectomy and pouch in patients who had emergency colectomy for ulcerative colitis. Since most patients currently have a laparoscopic emergency colectomy with specimen extraction via the stoma site or a small Pfannenstiel incision, a double single port approach (transstomal site abdominal single port and transanal TAMIS port) is feasible. Possible advantages are a more tailored transection of the distal rectum, easy close rectal dissection, avoidance of additional abdominal incisions, single stapling anastomosis, and working in two teams. The first collaboration data from Aarhus, Leuven and Amsterdam published in Annals of Surgery (de Buck et al. Ann Surg 2017 online) showed favorable results.

Laparoscopic Nissen Fundoplication

In a time of rapid growth and advances in modern technology, a need for the adoption of new surgical and anaesthetic approaches to the Laparoscopic Nissen Fundoplication has become apparent. This procedure has evolved to one that is simplistic in its approach, using an opiate-free anaesthetic aimed at reducing post-operative diaphragmatic stressors, with an easy OR set up and a more efficient OR change-over time. It can be performed with just one surgical assistant / camera operator and is cost-effective whilst providing reproducible results, without sacrificing the three crucial steps when performing a laparoscopic anti-reflux procedure, and, most importantly, achieving the goals of surgery.

Winter Event 2017

During the AIS Winter Event 2017, AIS Channel broadcasted LIVE the following surgeries: ESD colon/rectal by A. Haji / P. Bhandari, Lap Right Hemicolectomy (4K Surgery) by AM Lacy / B. De Lacy and Robotic Right Hemicolectomy by V. Obias / C. Johnson

Laparoscopic Left Colectomy

Francesco Corcione, Vania Silvestri, Emanuele Pontecorvi and Umberto Bracale perform a Laparoscopic Left Colectomy to a 57 years old female with a BMI 28.3.

Transanal Proctectomy and J pouch

Ulcerative colitis (UC) usually involves the rectum and may extend proximally to the rest of the colon. In an emergency setting, total colectomy with a terminal ileostomy is usually performed. In selected cases, the emergency surgery is followed by further completion of the proctectomy with a J-pouch and an ileal pouch-anal anastomosis (IPAA). Total mesorectal excision has been the preferred way to perform the proctectomy, although a close rectal dissection (CRD), without following the holy plane, has also been described and has the potential to better preserve the autonomic function. The transanal approach has evolved and is no longer limited to oncological indications, but can also be used in cases of UC requiring surgery. Hybrid transanal CRD seems to be a valid alternative for proctectomy.

New tricks in TaTME

Minimal invasive surgery for locally advanced rectal cancer is challenging and requires advanced technological assistance to make the procedure feasible and safe. The Transanal Total Mesorectal Excision is an innovative approach for rectal cancer. It provides several advantages compared to the fully laparoscopic technique. Issues such as transection of the distal margin and difficult cases may have found a solution with this procedure. You have been able to see this procedure many times on AIS Channel. This time we want to show you transanal surgery from another point of view. This surgery will focus on the main steps for the combined transanal and transabdominal approach (Cecil approach) for rectal cancer, highlighting the most frequent mistakes and how to prevent them.

Retroperitoneoscopic Adrenalectomy

Two Retroperitoneoscopic Adrenalectomies performed by Dr. Martin K. Walz and Dr. Pier F. Alesina at the Kiliniken Essen-Mitte (Germany) were broadcasted on May 11th. During the live surgery this wonderful procedure was described in detail to the entire AIS World Community. The Retroperitoneoscopic Adrenalectomy combines the advantages of minimally invasive surgery with a direct approach to the adrenal glands. Having the patient in the prone position makes a fast and extremely safe operation possible. As the whole procedure is extraperitoneal, patient morbidity is far lower than in transperitoneal techniques. Thus, the retroperitoneoscopic adrenalectomy is the ideal option. Having performed more than 2,000 procedures, Martin Walz and his team presented two cases. One patient suffering from a right-sided Conn adenoma. The second patient has a left-sided adrenal metastasis after a contralateral nephrectomy and adrenalectomy for renal cell cancer.

Large Intrapapillary Stones treatment using Thulium Fiber Laser

Dr. Palle Osther, Professor at Department of Urology Director of Urological Research Center at Lillebaelt Hospital, Director of Urological Research Center at Lillebaelt Hospital, Kolding, Denmark