Dr. Ludovica Baldari

Laparoscopic Cholecystectomy: Step-By-Step Technique

Laparoscopic cholecystectomy is the most common elective procedure in abdominal surgery and it is usually performed by surgeons in training. There are two different approaches to performing this procedure: the French position and the American one. These approaches differ in operative room setup, patient and surgeon position and port placement. There are no significant differences regarding operative time and intraoperative and postoperative outcomes, so the position is defined according to the surgeon’s choice. The steps of the surgery are the same in both the French and the American approaches.  Before starting the dissection, the anatomy should be assessed according to anatomical landmarks, like the Rouviere sulcus and the base of segment IV of the liver, that are the most important. Intraoperative imaging with indocyanine green fluorescence cholangiography allows the definition of the biliary anatomy and has been demonstrated to be associated with a higher rate of identification of the biliary structures.  The dissection begins by incising the peritoneum along the edge of the gallbladder on both sides to open up the hepatocystic triangle and carries on with the dissection of the triangle itself to identify the cystic duct and artery. Critical exposure and proper use of monopolar electrocautery are fundamental to avoid any damage to biliary structures. The critical view of safety (CVS) should be achieved whenever possible. However, in case of anatomical variation or acute inflammation, the dissection required to achieve the CVS can represent a risk itself and should be avoided. Cystic duct and arteries are divided between clips and the gallbladder is then dissected from the liver bed avoiding bleeding and /or bile leakage from the liver bed. The gallbladder is removed at the umbilical port through an endobag.

AIS Awards 2023

Welcome to the AIS Awards 2023! The event acknowledges the collective efforts of residents, surgeons, healthcare professionals, and the AIS Team in democratizing medical training through online content. With 11 awards across four categories and 45 nominees, the ceremony reflects the remarkable achievements of the AIS Community. Awards are based on real AIS Channel metrics, with two categories determined by audience votes. While celebrating winners, we also recognize the dedication of outstanding surgeons not nominated today. The prizes to be distributed will be as follows: Emerging KOLs Category Most Listened Podcast Most Viewed SOC Most Viewed ACW More Events Held KOL Category More Events Held Most Viewed OOO Live Webinar Category Most Viewed Live Surgery Greatest Social Impact Special Awards Category Best Academic Initiative Congress of the year Surgical Event of the year The virtual gathering provides a unique opportunity for professionals to connect, making the ceremony unforgettable. Join us in honoring the AIS Community's achievements this 2023!

Fluorescence-Guided Surgery From Theory to Perfect Clinical Applications

Fluorescence-guided surgery has swiftly transitioned from theoretical groundwork to seamless clinical implementation. This revolutionary approach employs fluorescent agents, particularly Near-Infrared (NIR) and Indocyanine Green (ICG), to illuminate target tissues, granting surgeons real-time, high-precision visuals. By bridging theory and practice, this technique enhances surgical accuracy, promising a future of minimally invasive, maximally effective interventions. In this event, featured by experts in the field, we will dive into the intricacies of NIR/ICG fluorescence-guided surgery and its profound impact on advancing colorectal and HPB procedures, unraveling the latest innovations and insights that are shaping the future of surgical excellence.

With International Society for Fluorescence Guided Surgery

How to prevent bile duct injuries during laparoscopic cholecystectomy

Bile duct injuries (BDIs) are the most serious complication of laparoscopic cholecystectomy with an incidence of 0.2-1.5% in elective cases. As BDIs are associated with high morbidity, mortality and costs, this complication should be prevented through safe surgical procedure and technologies. To date, we have several techniques and tools to perform a safe laparoscopic cholecystectomy.  The dissection should be started according to anatomical landmarks, like the Rouviere sulcus which is the most important one. Critical exposure and proper use of monopolar electrocautery are fundamental to avoid any damage of biliary structures. The critical view of safety (CVS) should be achieved whenever possible. However, in case of anatomical variation or acute inflammation, the dissection required to achieve the CVS can represent a risk itself and should be avoided.  Perioperative imaging for definition of the biliary anatomy has been demonstrated to be associated with lower incidence of BDIs and /or higher rate of identification of the biliary structures. Among the techniques, the most important ones are intraoperative cholangiography and indocyanine green fluorescence cholangiography.  The incidence of BDIs is higher in case of acute cholecystitis due to the process of inflammation and fibrosis. In the acute setting, it is of major importance to perform the surgical procedure within 10 days from the onset of symptoms or to adopt bail-out procedures, as subtotal cholecystectomy, when needed. 

Transanal Endoscopic Microsurgery (TEM) for Rectal Cancer

Transanal endoscopic microsurgery (TEM) is a surgical local excision technique for early stage rectal cancer. The main indication is represented by cT1N0 G1-2 rectal tumors with a maximum diameter of 3 cm, involving less than 30% of the rectal circumference, but it can be considered in case of T1-T3 lesions in high risk patients or in patients rejecting radical surgery. TEM is performed through dedicated instruments including a rigid rectoscope and angled instruments. Standard laparoscopic scope, camera and insufflator can be used. Technical principles include full-thickness excision of the tumor with at least 10 mm normal circumferential margin and 2 mm deep margin into the perirectal fact. After specimen extraction closure can be achieved using a running suture. Possible complications with this procedure could be intraoperative or postoperative bleeding, peritoneal perforation, urinary complications, infectious complications and stenosis. Adequate excision is defined by a T1 sm1, G1-2, rectal cancer without lymphovascular or perineural infiltration, without infiltration of the resection margin and no high tumor budding. In case of adverse histopathological adverse features, rectal resection with total mesorectal excision should be carried out.