The online university of IRCAD

This is the case of a 60-year-old man who underwent a bipolar transurethral resection of the prostate (TURP) two years earlier. The patient developed a bladder neck sclerosis with a serious urinary obstruction and failure which was treated with two endoscopic procedures. Cystoscopy revealed a normal urethra right up to the bladder union. It was decided to perform an anterior reconstruction using a buccal mucosa graft in a transvesical laparoscopic technique.

Introducing "Beyond IRCAD - Surgical Journeys". Join us on an inspiring and captivating monthly journey as we sit down with prestigious surgeons who have built remarkable careers in the field of medicine. In each episode, we explore the personal backgrounds and experiences of these exceptional individuals, as they share their inspiring stories of overcoming challenges, staying committed, and achieving success. Whether you're a medical professional, a student aspiring to be a surgeon, or simply someone looking for motivation from incredible human stories, this podcast is for you.
Join us for a discussion with Professor Arnaud Wattiez, a world-leading gynecologic surgeon renowned for his dedication to excellence and mentorship. Professor Wattiez has not only advanced his field but also fostered a community of top surgeons through his teaching. We will also delve into his transformative journey from France to Dubai, exploring how this move profoundly impacted his personal and professional life, bringing him a newfound balance and contentment. Tune in for an inspiring tale of achievement and personal growth.

In this key lecture, Dr. Rafael F. Coelho, MD, PhD outlines inferior vena cava (IVC) thrombus management during minimally invasive radical nephrectomy.

The authors demonstrate a laparoscopic ureterolysis with omental wrap for treatment of idiopathic retroperitoneal fibrosis refractory to conservative treatment with double-J placement and corticosteroid therapy for 12 months.

Bibliography:
1. Stein RJ, Patel NS, Quinn K, Berger M, Koff W, Shah G, Aron M, Berger AK. Laparoscopic ureterolysis with omental wrap for idiopathic retroperitoneal fibrosis. BJU Int. 2010 Sep;106(5):703-7. doi: 10.1111/j.1464-410X.2009.09186.x. PMID: 20128779.
2. Simone G, Leonardo C, Papalia R, Guaglianone S, Gallucci M. Laparoscopic ureterolysis and omental wrapping. Urology. 2008 Oct;72(4):853-8. doi: 10.1016/j.urology.2008.06.011. Epub 2008 Jul 31. PMID: 18674801.
3. Fong BC, Porter JR. Laparoscopic ureterolysis: technical alternatives. J Endourol. 2006 Oct;20(10):820-2. doi: 10.1089/end.2006.20.820. PMID: 17094761.
4. Cristian S, Cristian M, Cristian P, Constantin G, Savu C, Huri E, Sinescu I. Management of idiopathic retroperitoneal fibrosis from the urologist's perspective. Ther Adv Urol. 2015 Apr;7(2):85-99. doi: 10.1177/1756287214565637. Erratum in: Ther Adv Urol. 2016 Apr;8(2):161-2. PMID: 25829952; PMCID: PMC4372523.

Adrenocortical carcinoma (ACC) is a rare disease in which malignant cancer cells form in the outer layer of the adrenal gland. The worldwide incidence of ACC is 0.5 to 2 per 1 million people annually (1). Adrenocortical carcinoma is also called cancer of the adrenal cortex. A tumor of the adrenal cortex may be functioning (i.e., makes more hormones than normal) or nonfunctioning (i.e., does not make more hormones than normal). Most adrenocortical tumors are functioning. The hormones produced by functioning tumors may cause certain signs or symptoms of disease (2). ACC can have protean clinical manifestations, including symptoms and signs of hormone excess and nonspecific symptoms as a mass effect of local tumor growth (3). However, an increasing number of ACC are identified in asymptomatic patients, as an incidental finding on imaging performed for other reasons (i.e., adrenal incidentalomas). The main treatment in non-metastatic cases is surgery (4).
In this video, the authors present the case of a 58-year-old woman with a tumor identified in an adrenal topography as an incidental finding. The patient was oligosymptomatic since she presented with hypertension only. She also had undergone a robotic radical adrenalectomy using the Versius surgical robotic system (manufactured by CMR Surgical). Pathological findings revealed a massive lesion measuring 8.7 x 7.5 x 5.5cm, showing neoplasia of the adrenal cortex and suggesting a carcinoma with myxoid areas.

Bibliography:
1. Lam AK. Update on Adrenal Tumours in 2017 World Health Organization (WHO) of Endocrine Tumours. Endocr Pathol. 2017 Sep;28(3):213-227.
2. PDQ® Adult Treatment Editorial Board. PDQ Adrenocortical Carcinoma Treatment. Bethesda, MD: National Cancer Institute. Updated . Available at: https://www.cancer.gov/types/adrenocortical/patient/adrenocortical-treatment-pdq. Accessed [PMID: 26389225]
3. Else T, Kim AC, Salboch A, Raymond VM, Kandathil A, Caoili EM, et al. Adrenocortical carcinoma. Endocr Rev. 2014 Apr. 35(2): 282-326
4. Kostianinen I, Hakaste L, Kejo P, Parviainen H, Laine T, Loyttyniemi E, et al. Adrenocortical carcinoma: presentation and outcome of a contemporary patient series. Endocrine. 2019 Jul. 65 (1): 166-174

Prostate cancer surgeons are commonly faced by a technically challenging situation dealing with prostate cancer having large median lobes. Patients with large median lobes often have larger prostates, which makes it difficult to visualize anatomical planes during robot-assisted radical prostatectomy (RARP) (1). The general consensus in the literature is that robotic assisted radical prostatectomy (RARP) for patients with a protruded median lobe (PML) poses a true technical challenge (2). A PML causes various degrees of distortion for bladder neck anatomy. Bladder neck resection in large median lobes involves a higher risk of ureteral orifice injury being too close to the bladder neck edge (3). PML has been associated with a longer operative time and hospital stay, and more blood loss. Additionally, poor recovery of urinary continence and higher positive surgical margins (PSMs) have been reported with PML (4).
In this video, we present the case of a 59-year-old patient with an enlarged prostate and a protruded median lobe. The authors describe the steps and good results obtained from this challenging approach with the recent Versius surgical robotic system (manufactured by CMR surgical).

Bibliography:
(1) Wagaskar VG, Zaytoun O, Kale P, Pedraza A, Busby D, Reddy A, Tewari A. Technical Tips in Managing Large Median Lobes During Robot-assisted Radical Prostatectomy. Eur Urol Open Sci. 2022 Sep 23;45:32-37.
(2) Huang A.C., Kowalczyk K.J., Hevelone N.D., et al. The impact of prostate size, median lobe, and prior benign prostatic hyperplasia intervention on robot-assisted laparoscopic prostatectomy: technique and outcomes. Eur Urol. 2011;59:595–603.
(3) Bedir F., Keske M., Demirdogen S.O., Kocaturk H., Atmaca A.F., Canda A.E. Diagnosis and conservative management of ureteral orifice injury during robotic prostatectomy for a large prostate with a prominent median lobe. J Endourol Case Rep. 2019;5:39–41.
(4) Jung H., Ngor E., Slezak J.M., Chang A., Chien G.W. Impact of median lobe anatomy: does its presence affect surgical margin rates during robot-assisted laparoscopic prostatectomy? J Endourol. 2012;26:457-460.

Aim: This video aims to present the laparoscopic technique for right radical nephrectomy in detail.
Case presentation: A 62-year-old man presented to our department with a one-week history of painless macroscopic hematuria. A preoperative abdominal CT-scan revealed a 6cm solid mass in the upper right kidney, originating from the renal cortex and extending into the renal pelvis. The patient was scheduled for a laparoscopic right radical nephrectomy.
Discussion: The laparoscopic approach for kidney surgery has been well described in the literature, both for total and partial nephrectomies. The indications for the laparoscopic approach in kidney surgery has expanded to include grossly advanced tumors even with renal vein thrombosis. Several key steps are crucial for a smooth intraoperative progression and for optimal postoperative outcomes.
Conclusions: The laparoscopic approach exhibits equivalent oncological outcomes, as well as a superior postoperative morbidity profile and should be the standard approach offered to all patients, especially with early carcinomas.

Bibliography:
1. Bollens, R., Rosenblatt, A., Espinoza, B. P., De Groote, A., Quackels, T., Roumeguere, T., Schulman, C. C. (2007, Sep). Laparoscopic partial nephrectomy with "on-demand" clamping reduces warm ischemia time. Eur Urol, 52(3), 804-809. doi:10.1016/j.eururo.2007.04.011
2. Dunn, M. D., Shalhav, A. L., McDougall, E. M., & Clayman, R. V. (2000, Sep). Laparoscopic nephrectomy and nephroureterectomy for renal and upper tract transitional cell cancer. Semin Laparosc Surg, 7(3), 200-10. Retrieved from https://pubmed.ncbi.nlm.nih.gov/11359244/
3. Garrett, J. E., & Rowland, R. G. (2005, Jul). Evolution of radical procedures for urologic cancer. Surg Oncol Clin N Am, 14(3), 553-68. doi:10.1016/j.soc.2005.05.004
4. Parsons, R. B., Canter, D., Kutikov, A., & Uzzo, R. G. (2012, Sep). RENAL nephrometry scoring system: the radiologist's perspective. AJR Am J Roentgenol, 199(3), W355-9. doi:10.2214/AJR.11.8355