Laparoscopic Vaginal Top Closure

Endometrial Ablation

Total laparoscopic hysterectomy using staples to secure major blood vessels. Vaginal colpotomy and mobilization of bladder performed initally with suture line at junction of vagina and cervix visualized laparoscopically.

Repair performed with the PROLIFT Pelvic Floor Repair System - the total implant. The objective of the PROLIFT procedure is to achieve a a complete anatomic repair of pelvic floor defects in a standardized way. The repair is achieved by the placement of the synthetic non-absorbable polyprolylen mesh... implant via a vaginal approach.

We noticed a blue-line in the endometrial cavity between the tubal ostiae after injection of methylene blue (to determine tubal patency). We have seen this “blue-line” even in cases with normal or unicornuate uterus and/or in cases with patent or occluded fallopian tubes(Picture 1). So the be...st explanation of this finding may be the high speed jet or turbulence of dye in the top or the deepest part of endometrial cavity. We simply postulated that the zone which holds the methylene blue is the zone where the flashing dye strikes vertically over there and the dye penatrates into the endometrial epithelium and glands. We used this line as a guide that shows midline during operative hysteroscopy ( especially in cases with septate uterus) and we don’t ecxatly know reason why it occurs. It is necessary to perform histologic, molecular or clinical studies on this subject. It may have a multifactorial aetiology. We performed a prospective case control study and will publish it soon after when we get the results.

The infection prevention and control training DVD is based on international guidelines from The World Health Organisation and the Centres for Disease Control and Prevention. It sets out best practice in international standard precautions for infection prevention and control. Email hmi@shrc.ie for details.

Motor cortex stimulation for Chronic pain

The essential steps of a translaminaterminalis approach for removal of craniopharyngiomas

Access to processes within the skull base with lateral extension to the pterygopalatine fossa are reached by combined subfrontal osteotomy and Le Fort I osteotomy

trigeminal neuralgia can be caused by a vessel loop nearby the entry zone of the trigeminal nerve at the brainstem. a vessel loop is mobilized and transposed and secured with a teflon paddy. the paddy is fixed with tissucol , a fibrin glue without evident neurotoxicity. the long term result of the jannetta procedure regarding pain control is excellent

Acoustic Neuroma

Extradural approach via Orbito-Zygomatic Craniotomy

Resection of a glioblastoma multiforme, a very malignant, aggressive brain tumor.

Thoracoscopic Discectomy

ANEURYSMS OF THE CEREBRAL VESSELS CAUSE SUBARACHNOID HEMORRHAGE. MICRONEUROSURGICAL CLIPPING ELIMINATES DEFINITIVE THE RISK OF RERUPTURE, ENABLES TO TREAT VASOSPASMS AND ELIMINATES THE NEED FOR RE-ANGIOGRAPHIES. INTRAOPERATIVE PUNCTURE CHECKS IMMEDIATLY THE ELIMINATION OF THE ANEURYSM.

An older patient with stomach pain, and the typical heart burning. We did some biopsies for evaluation of dyplasia.

Endoscopic third ventriculostomy in a patient with obstructive hydrocephalus

lesions at the anterior skull base invading the paranasal area and the paracavernous area can be reached without brain retraction by the shown subfrontal approach. it enables to control the paranasal sinus, optic nerve, periorbital tissue, carotid artery and pituary gland. reconstruction is not easy... but cosmetically appealing. CSF leaks are rare with the use of fascia lata and tissucol ( fibrin glue). osseous reconstruction is done by microsrews and calciumpyrophosphate ( norian, synthes).

A quick look at an early stage stomach abnormality.

En Bloc Esophageal Mucosectomy, an experimental technique for the endolumenal management of Barrett's related dysplasia and neoplasia. High grade dysplasia is in indication for esophagectomy; however esophagectomy has a mortality rate up to 12 percent, and up to 56 percent of patients may develop s...erious post-operative complications. Multiple ablated lesions can progress under the neo-squamous layer, leading to buried Barrett's mucosa. With conventional piecemeal EMR, cautery effect limits evaluation in areas of interest, Barrett's epithelium is left behind, tissue is not evaluated in situ and invasive lesions may be missed due to incomplete sampling. A new technique, en bloc esophageal mucosectomy, or EEM, was developed. The technique begins with conventional EMR in the proximal esophagus to access the submucosal space. Conventional EMR is being performed here. The mucosa is resected using an electrothermal snare. The mucosal defect from the first EMR is seen here. EMR is then repeated on the opposing wall. Sequential EMR creates a complete concentric mucosal defect. In the following sequence the completely detached column of mucosa can be seen, bounded by submucosa and muscularis propria layers. Here in the stomach, the endoscope is retroflexed and is covered by a sleeve of esophageal mucosa which has been freed to the GE junction and inverted. This sequence demonstrates a double snare technique. This snare is alongside the endoscope. The snare has been passed through the working channel. The working channel snare is pulled back, and the snare alongside the scope is used to grasp the mucosal column. With tension on the column the working channel snare can be threatened and advanced. This sequence shows the snare as it is being passed down to the GE junction. At the GE junction, the snare is tightened and cautery is applied. This frees the column of mucosal tissue from the remaining attachment. The endoscope is then withdrawn. Then detached mucosal column can be grasped with a snare and retrieved. In the following sequence, the long column of mucosa is being withdrawn via the overtube. Here, endoscopic forceps have been passed through the column to demonstrates the concentric nature of the specimen. The length of mucosa can be seen here alongside 2 conventional EMR specimens. Approximately 15cm of tissues was removed in this case. On endoscopy immediately following the resection, there is no bleeding or evidence of perforation in the area of resection. The endoscope is advanced and the exposed submucosa can be appreciated down to the GE junction. This is the low power view of the histologic specimen generated by EEM. Metaplastic tissue adjacent to a dysplastic focus would be completely removed. With a high power view, the layers of the esophagus can be appreciated. The epithelium, lamina propria, muscularis mucosa and submucosa are visible, with no cautery artifact in the area of interest. The technique would remove metplasia, low grade dysplasia, high grade dysplasia, and intramucosal carcinoma, as well a T 1 a lesions. All the animals in this series tolerated the procedure well. A total of five non-survival procedures and 4 survival procedures were performed. In the survival procedures, all four swine thrived in the post-operative period. Two swine were then survived for 9 days following the procedure. On post —op day nine, after passing into the upper esophagus, the proximal margin of the mucosectomy is seen here. Healing appears to be occurring. There is no evidence of leak, and no stricting is seen at 9 days down to the GE junction Passing into the stomach, some residual feed can be seen. Two swine were then survived for 13 days. On this follow-up endoscopy, the area of the mucosectomy is again healing. There was a loose stricture in both animals and both were easily traversed with a 9.8 mm gastroscope. There was a gross appearance of re-epitheliazation in some areas. It is notable that the stricture was present in the proximal esophagus with no narrowing distally. At necropsy there was not eviden