Follicle removal (Bascon's technique)

Ileocolectomy for Crohn's Disease

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Full Obstetric examination and normal delivery by Egyptian doctor Hussein Sulayman and the video is in English showing:

Obstetric Examination
Episiotomy
Obstetric Forceps
Obstetric Instruments

This endoscopy shows a patient with cancer of the larynx, Laryngeal cancer is the most common cancer of the upper respiratory tract. The incidence of laryngeal tumors is closely correlated with smoking, as head and neck tumors occur 6 times more often among cigarette smokers than among nonsmokers. The age-standardized risk of mortality from laryngeal cancer appears to have a linear relationship with increasing cigarette consumption. Death from laryngeal cancer is 20 times more likely for the heaviest smokers than for nonsmokers. It should be suspected in any patient with hoarseness of the voice for three weeks or longer until proven otherwise.

Removal of pregnancy within the fallopain tube using laparoscopic keyhole surgery. A segment of the tube together with the pregnancy within is removed video.

Interscalene Block

UltraSound-guided Sciatic nerve block by supra popliteal approach

Pectus excavatum (hollow chest) deformity is not uncommon (sometimes mild and other times severe in its form). The chest deformity is often the source of self-consciousness for the patients while growing up. Several surgical techniques (Nuss procedure, Ravitch procedure, etc) are available.

Polycystic ovary syndrome (PCOS, also known clinically as Stein-Leventhal syndrome), which is an endocrine disorder that affects 5--10% of women. It occurs amongst all races and nationalities, is the most common hormonal disorder among women of reproductive age, and is a leading cause of infertility. The symptoms and severity of the syndrome vary greatly between women. While the causes are unknown, insulin resistance (often secondary to obesity) is heavily correlated with PCOS.

An animation showing what PCO is

Scleral Buckling: Slinging Muscles & Marking Breaks VR1 Basic Techniques

Removal of adrenal gland

Robotic surgery was developed to facilitate endoscopic surgery and overcome its disadvantage. Thus, we performed robotic Total Mesorectal Excison (TME) in patient with rectal cancer by using the Intuitive Surgical® da Vinci surgicalTM system (Intuitive Surgical®, Sunnyvale, CA). To our knowledge, ...this is the first robotic low anterior resection base on standard TME principle with pelvic autonomic preservation. In conclusion, Robotic system is the best operative instrument for performing the standard TME procedure in rectal cancer patients.

The colonoscope is slowly withdrawn during this screening colonoscopy down from the transverse colon, back around the splenic flexure, and down the descending colon, and reveals this finding a colonic diverticula. Diverticulosis is a common, acquired, age-related occurrence affecting over 50% of the... western adult population over the age of 50. It is seen rarely in Africa and Asia where the dietary fiber content is traditionally higher. Thus most investigators feel that low fiber diets are related to the development of this condition. Ironically, colonic diverticula are not true diverticula but rather pseudodiverticula in that the sac includes layers of the mucosa and submucosa that push through rather than include the outer muscular layer. As with the small bowel the colon has an inner circular muscular layer, but the outer longitudinal layer is composed of three bands of muscle that run the length of the colon known as teniae. Diverticula occur in rows between the mesenteric and two antimesenteric teniae where the colonic wall is further weakened by the defect caused by the perforating vasa recti artery which supplies the colonic mucosa. Occasionally, the anatomic propensity of diverticula to form in rows is quite apparent as seen when this clip is replayed in slow motion. Most often, however, the arrangement of the diverticula appears random due to the angulation of the bowel and thickening of the semi lunar folds. The conditions that cause these pulsion diverticula are not know with certainty but may include high intrahaustral pressures, muscular hypertrophy, and age related alterations in collagen cross linking. Diverticula can bleed or can abscess and perforate. The incidence of diverticulitis or diverticular bleeding is in the range of 1:1,000 patients with diverticulosis.

Pancreatic pseudocyst drainage was the first therapeutic application of EUS. The cyst is punctured under ultrasound guidance, contrast injected, and a guidewire inserted. Initial dilation to 8mm is performed over the wire The EUS scope is then exchanged over the wire for a forward viewing endoscope.... A second dilation to 18mm is performed. This enables entry of the endoscope into the cyst perform cystoscopy, debridement if necessary, and insertion of multiple large bore double pigtail stents. The curved linear array-or CLA—echoendoscope has oblique viewing optics located proximal to an oblique scanning transducer. The accessory exits from the shaft of the echoendoscope at an ablique angle, adjustable between 15 and 30 degrees. There are several technical limitations using this echoendoscope. The oblique angle of exit results in a weekend transfer of force when advancing the accessory, difficult deployment of larger bore accessories, and in instrument tunneling effect relative to the bowel wall. There is the potential loss of access during endoscope exchange. A novel CLA echoendoscope was developed by the Olympus Corporation that shifts the orientation of endoscopic and ultrasound views from oblique to forward viewing. The channel is therapeutic at 3.7mm Note that the working channel is located adjacent to the ultrasound transducer at the endoscope tip. The accessory exits the working channel in the axis of the shaft. Shown here are balloon inflation and deployment of a Dormia basket. We report on the use of the prototype forward viewing echoendoscope in six consecutive patients who were referred for pancreatic cyst drainage. Here you see endoscopic view-indistinguisable from that of a gastroscope-showing a bulge where the cyst impinges against the posterior gastric wall. Power Doppler is switched on and highlights multiple vessels interposed in the wall This allows selection of a safe vessel-free window for a cyst puncture A 19 G needle is advanced into the cyst lumen. A sample of contents is aspirated for fluid analysis. A guidewire under ultrasound guidance into the cyst. An 18mm balloon is coaxially thread over the wire and advanced across the cyst wall, Note that resistance is encountered, but the forward transfer of force overcome this. The dilation is performed under forward viewing endoscopuc and ultrasound guidance. As the balloon is maximally inflated we see the cystgastrostomy open up. The balloon is then deflated while simultaneously advancing the scope into the cyst cavity. Cystoscopy isnow performed showing the cyst contents to be filled with pasty wall-adherent necroses. Pulsed power Doppler is switched on we can see and hear arterial flow vessels within the wall of the cyst. This identifies sensitive areas at bleeding risk when performing debridement In this case vigorous water jet irrigation is performed through an accessory water irrigation channel built into the echoendoscope. This issued to clear nonadherent debris. Our experience has shown that it is not necessary to actively remove wall-adherent debris using extraction tools as such Dormia or Roth net basket to achieve cyst resolution. Three large bore 10 Fr double pigtail stents are now inserted into the cyst under direct endoscopic guidance. The first stent is delivered over a guide catheter. The second stent. And the third stent All three stents are deployed. Finally, a nasocystic catheter is inserted for maintenance irrigation. In another patient we used the Cook Cystome to perform cystgastrostomy. We have found the Cystotome easy to delivery through the forward viewing echoendoscope. As shown, we advance the Cystotome into the cyst while applying diathermy. This is performed under and endoscopic guidance, entering the cyst at a near perpendicular orientation. After entry, the Cystotome is removed and cyst fluid gushes from the cystagastrotomy site.

For benign colorectal diseases, totally laparoscopic left-sided colectomy was already reported on some papers. Nowadays, there is increasingly demanded minimally invasive surgerys on malignant bowel diseases including colorectal cancers and so we developed the new techniques in that specimen is del...ivered through the open rectal stump, especially, using Sani Sleeve(TM). In this operation video, you can see that an anvil was fixed to proximal colonic stump with intracorporeal purse-string suture using Endo-stitch(TM). (SETA : Specimen Extraction Through Anus)

Laparoscopic Sleeve Gastrectomy Operation

Laparoscopic Roux-en-Y Gastric Bypass Operation

Mesh repair is based on the anatomical principle with associated complications of a foreign body and recurrence. Use of an un-detached strip of the external oblique aponeurosis in place of mesh between the muscle arch and the inguinal ligament gives a strong and physiologically dynamic posterior wal...l that gives radical cure.