Joel Leroy

Transatlantic robot-assisted telesurgery

The introduction of robotic and computer technology into surgical operations allows dexterity to be increased and surgical procedures to be carried out from a distance (telesurgery). But until now, the distance feasible for remote telesurgery was considered to be limited to a few hundred miles by the time lag of existing telecommunication lines. Here we show that robot-assisted remote telesurgery can be safely carried out across transoceanic distances. The ability to perform complex surgical manipulations from remote locations will eliminate geographical constraints and make surgical expertise available throughout the world, improving patient treatment and surgical training.

Laparoscopic total mesorectal excision (TME) for rectal cancer surgery: long-term outcomes

Background: Total mesorectal excision (TME) offers the lowest reported rates of local recurrence and the best survival results in patients with rectal cancer. However, the laparoscopic approach to resection for colorectal cancer remains controversial due to fears that oncologic principles will be compromised. We assessed the feasibility, safety and long-term outcome of laparoscopic rectal cancer resections following the principles of TME. The aim of this study was to evaluate the perioperative outcome and long-term results of laparoscopic TME. Methods: We reviewed the prospective database of 102 consecutive unselected patients undergoing laparoscopic TME for rectal cancer between November 1991 and December 2000. Follow-up was done through office charts or direct patient contact. Recurrence and survival curves were generated by the Kaplan-Meier method. Results: Laparoscopic TME was completed successfully in 99 patients, whereas conversion to an open approach was required in three cases (3%). The overall morbidity and mortality rates were 27% and 2%, respectively, with an overall anastomotic leak rate of 17%. Of the 102 patients, four were excluded from the oncologic evaluation because final pathology was not confirmatory (two had anal canal squamous cell carcinoma and two had villous adenoma with dysplasia). In 90 of the 98 remaining patients (91.8%), the resection was considered curative. The remainder had a palliative resection due to synchronous metastatic disease or locally advanced disease. Mean follow-up was 36 months (range, 6–96). There were no trocar site recurrences. The local recurrence rate was 6%, and the cancer-specific survival of all curatively resected patients was 75% at 5 years. The overall survival rate of all curatively resected patients was 65% at 5 years; mean survival time was 6.23 years (95% confidence interval [CI], 5.39–7.07). Conclusion: Laparoscopic TME is feasible and safe. The laparoscopic approach to the surgical treatment of operable rectal cancer does not seem to entail any oncologic disadvantages.

Left Hemicolectomy and Sigmoid Colon

This chapter delineates the key steps to perform a laparoscopic sigmoidectomy for cancer as it has been standardized in our department. It includes full discussion of each of the most salient technical aspects of the surgery and of the various controversies and pitfalls associated with it. Therefore, it provides, along with the associated video, a comprehensive overview of this procedure.

Technique Du 4Ddome® Prothese Partiellement Resorbable

Le 4DDOME® est une procedure de cure pour la hernie inguinale par voie anterieure. L’objectif de la technique est d’obturer l’orifice herniaire profond avec une prothese de forme nouvelle et d’un nouveau composite. Ensuite mettre une plaque anterieure pour le renfort.