Brice Gayet - Academia.edu (original) (raw)

Papers by Brice Gayet

Research paper thumbnail of Repair of Esophageal Perforation: a New Technique

Canadian Journal of …, 2008

A 39-year-old woman was admitted to our shock trauma centre for the manage-ment of abdominal and ... more A 39-year-old woman was admitted to our shock trauma centre for the manage-ment of abdominal and thoracic trauma caused by penetrating gunshot wounds. Thoracic and abdominal computed to-mography showed multiple fractures of the spleen and hemoperitoneum, a small ...

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Research paper thumbnail of Embolie gazeuse veineuse massive mortelle au cours d’une endoscopie biliaire

Gastroenterologie Clinique Et Biologique, 2010

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Research paper thumbnail of Salvage oesophagoloplasty with a free jejunal transplant after repeated failures. 25 cases

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Research paper thumbnail of Comparable long-term oncologic outcomes of laparoscopic versus open pancreaticoduodenectomy for adenocarcinoma: a propensity score weighting analysis

Surgical endoscopy, Oct 15, 2017

To date, no study has reported long-term oncologic outcome for patients undergoing laparoscopic p... more To date, no study has reported long-term oncologic outcome for patients undergoing laparoscopic pancreaticoduodenectomy (LPD) compared to open surgery (OPD). The aim of this study is assess long-term oncologic outcomes for patients with adenocarcinoma undergoing LPD versus OPD using propensity score weighting modeling to minimize selection bias. All patients undergoing PD at Institut Mutualiste Montsouris between January 2000 and April 2010 were included. Propensity scores were calculated using multivariate logistic regression, relating preoperative covariates to surgical approach. Logistic regression was performed, and Cox proportional hazards models for postoperative outcomes were constructed, with and without adjustment for propensity scores weights. Among 87 patients who underwent PD, 40 underwent LPD and 25 OPD for confirmed adenocarcinoma. Preoperative covariates across both groups were comparable. The median follow-up time was 34.5 months. During follow-up, metastasis was ide...

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Research paper thumbnail of A comparison of laparoscopic resection of posterior segments with formal laparoscopic right hepatectomy for colorectal liver metastases: a single-institution study

Surgical endoscopy, Jan 17, 2016

The benefit of by laparoscopic resection for lesions located in postero-superior segments is uncl... more The benefit of by laparoscopic resection for lesions located in postero-superior segments is unclear. The present series aimed at comparing intraoperative and post-operative results in patients undergoing either laparoscopic RPS or laparoscopic RH for colorectal liver metastases located in the right postero-superior segments. From 2000 to 2015, patients who underwent laparoscopic resection of segment 6 and/or 7 (RPS group) were compared with those with right hepatectomy (RH group) in terms of tumour characteristics, surgical treatment, and short-term outcomes. Among the 177 selected patients, 78 (44.1 %) had laparoscopic RPS and 99 (55.9 %) a laparoscopic RH. Among RPS patients, 26 (33.3 %) underwent anatomical resection of either segment 7, 8 or both. Three (3 %) patients undergoing RH died in the post-operative course and none in the RPS group. Sixty-three (35.5 %) patients experienced post-operative complications, including major complications in 24 (13.5 %) patients. Liver failu...

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Research paper thumbnail of Salvage endoscopic ultrasound-radiologic rendezvous to re-establish biliary flow following duodenectomy with ablation of papilla

Endoscopy

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Research paper thumbnail of Diagnostic accuracy of confocal laser endomicroscopy for the ex vivo characterization of peritoneal nodules during laparoscopic surgery

Surgical endoscopy, Apr 17, 2016

Intraoperative characterization of peritoneal nodules can be challenging. Probe-based confocal la... more Intraoperative characterization of peritoneal nodules can be challenging. Probe-based confocal laser endomicroscopy (pCLE) is an innovative technique enabling real-time microscopic analysis. This study aimed to assess the role of pCLE in the discrimination of benign versus malignant peritoneal nodules during laparoscopic staging. During this prospective trial, pCLE was performed ex vivo on fresh samples of peritoneal nodules in 30 consecutive patients, after topical application of indocyanine green. The final diagnosis was obtained histologically, as per standard of care. pCLE image criteria for normal versus inflammatory versus malignant nodules were established (phase I); these criteria were tested retrospectively on selected videos by two examiners (phase II). The primary endpoints were values of accuracy in diagnosing malignant nodules. pCLE criteria for malignant nodules defined in phase I were: strongly fluorescent irregular clusters of cancerous cells, nonfluorescent nuclei o...

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Research paper thumbnail of Augmented Reality Navigation Surgery Facilitates Laparoscopic Rescue of Failed Portal Vein Embolization

Journal of the American College of Surgeons, Oct 19, 2016

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Research paper thumbnail of Outcomes of Laparoscopic Liver Resection for Patients with Large Colorectal Liver Metastases: A Case-Matched Analysis

World journal of surgery, 2016

Despite the expansion of laparoscopic approach in the treatment of liver tumors, limited data hav... more Despite the expansion of laparoscopic approach in the treatment of liver tumors, limited data have been reported regarding large colorectal liver metastases (CRLMs). This study aimed at assessing the short- and long-term outcomes after laparoscopic liver resection (LLR) for large (≥5 cm) CRLMs. This was a case-matched study (1:2) comparing patients with large (group L; ≥5 cm) and small (group S; <5 cm) CRLMs using demographic, tumor, and surgical characteristics as matching variables. Postoperative outcomes and survival data were compared in the 2 groups. Forty patients who underwent LLR for large CRLMs were matched with 80 patients with tumors <5 cm. Major hepatectomy was performed with 75.0 % of patients in Group L and 66.3 % in group S (p = 0.403). Operative time was 300 min in group L and 240 min in group S (p = 0.059). The postoperative mortality and overall morbidity rates were comparable in the 2 groups (p = 1.000 and 0.170, respectively). Postoperative major complicati...

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Research paper thumbnail of Etude anatomique des �sophagoplasties gastriques r�tro-sternales

Surg Radiol Anatomy, 1985

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Research paper thumbnail of Diverticules de l'�sophage

Emc Pneumologie, 2005

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Research paper thumbnail of Large gastrointestinal stromal tumours of the stomach: Is laparoscopy reasonable?

Journal of Minimal Access Surgery, 2015

Laparoscopic resection (LR) offers significant advantages compared to open resections for gastric... more Laparoscopic resection (LR) offers significant advantages compared to open resections for gastric gastrointestinal stromal tumours (GISTs). We aimed to evaluate whether LR outcomes jeopardised short and long-term outcomes of patients with large GISTs. Among 50 patients undergoing surgery for gastric GISTs, 12 underwent LR for large GISTs (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;5 cm). Their characteristics, perioperative results and survival were retrospectively compared to those of 22 patients who underwent LR for &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;small GIST&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;. The two groups were similar regarding demographics, rate of wedge resection and mean blood loss. No patient required transfusion or conversion. Operative time was significantly increased in the &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;large GIST&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; group (160 min vs 112 min, P = 0.001). Mean tumour size was significantly lower in the &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;small GIST&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; group (8.4 cm vs 2.4 cm, P = 0.0001). Resection margins were negative. The mortality rate was nil and the overall morbidity rates was similar in both groups. Median length of hospital stay was significantly increased in the &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;large GIST&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; group (7 days vs 5 days, P = 0.004). Median follow-up was 47 months and one patient in the &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;small GIST&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; group developed recurrence and died during follow-up 11 years after surgery. No patient died during follow-up. LR for large GISTs is safe and technically feasible and does not negatively influence the oncologic course. Prospective randomised trials should be performed before using this approach in routine surgical care.

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Research paper thumbnail of Laparoscopic distal pancreatectomy for pancreatic ductal adenocarcinoma: results of a multicenter cohort study on 196 patients

Surgical Endoscopy, 2015

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Research paper thumbnail of Hemorrhage control for laparoscopic hepatectomy: technical details and predictive factors for intraoperative blood loss

Surgical Endoscopy

Controlling bleeding during laparoscopic hepatectomy (LH) is technically demanding, but reportedl... more Controlling bleeding during laparoscopic hepatectomy (LH) is technically demanding, but reportedly associated with less estimated blood loss (EBL) than open surgery. The present study aimed to describe and evaluate hemorrhage control techniques during LH and identify predictors of high intraoperative EBL. The data of 438 consecutive patients undergoing LH between 1995 and 2012 were reviewed. Bleeding control was facilitated by the proper use of hemostatic devices and surgical maneuvers unique to LH and by preserving intra-abdominal pressure. EBL was evaluated among three groups of 146 patients in each group: 1995-2006 (group A), 2006-2009 (group B), and 2009-2012 (group C). We also sought factors that predicted EBL ≥800 mL. Mean EBL decreased overtime from groups A to C: group A, 378 ± 619 mL; group B, 293 ± 391 mL; groups C, 257 ± 366 mL; P = 0.127. Transfusion rate was 6.7 % in group A, 5.5 % in group B, and 4.8 % in group C (P = 0.743). Hypertension (odds ratio (OR) 2.82, 95 % confidence interval CI 1.37-5.78; P = 0.006), preoperative chemotherapy (OR 2.55, 95 % CI 1.26-5.31; P = 0.009), resection of posterosuperior segments (OR 3.73, 95 % CI 1.33-12.17; P = 0.012), and major hepatectomy (OR 4.21, 95 % CI 1.64-13.02; P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) independently predicted high EBL. Improvements in bleeding control techniques over time have reduced EBL during LH. The use of these techniques and an understanding of the predictive factors for high EBL will help surgeons improve outcomes after LH.

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Research paper thumbnail of The place of enucleation and enucleo-resection in the treatment of pancreatic metastasis of renal cell carcinoma

JOP: Journal of the pancreas

Renal cell carcinoma has shown less response to systemic therapies including chemotherapy, radiot... more Renal cell carcinoma has shown less response to systemic therapies including chemotherapy, radiotherapy and immunotherapy than other cancers. Metastasis of renal cell carcinoma to the pancreas occurs, even after long term radical nephrectomy, surgical resection remains the only potentially curative intervention. We performed surgery for pancreatic metastatic renal cell carcinoma and analyzed the results. We retrospectively analyzed 11 patients who had undergone pancreatic resection or metastasectomy at our hospital from January 1994 to January 2010. Patient&amp;amp;amp;amp;amp;amp;amp;amp;#39;s demographics, clinical variables, types of pancreatic resections (standard or atypical resection), primary histopathology, surgical outcomes, survival and disease free interval were examined. We compared the standard pancreatic resection to atypical resection (enucleation or enucleo-resection). Eleven patients underwent 14 pancreatic resections or metastasectomy (3 pancreaticoduodenectomy, 4 distal pancreatectomy, 1 completion of pancreatectomy, 4 enucleations and two enucleo-resections) for pancreatic renal cell carcinoma metastasis. The median age was 73 years, the median time period between nephrectomy and finding of pancreatic metastasis was 11.4 years. One patient showed synchronous pancreatic metastatic lesions on radiology. One patient died from a splenic artery pseudoaneurysm rupture 35 days after the surgery. Major complications occurred in 4 patients with standard resection (one hemoperitoneum, three pancreatic fistulas), and in one patient with atypical resection (duodenal fistula); six patients with standard resection presented postoperative diabetes mellitus. Median survival age was 6.5 years (range 1-9 years). Two patients died of metastatic disease 5 to 6 years, while 7 patients are alive and well 1 to 9 years after surgery. According to these results and regardless of the small number of cases, atypical resection of metastatic renal cell carcinoma has a high median survival rate even after pancreatic recurrence or distant metastasis. It seems reasonable to favor a good quality of life and less diabetes with a limited atypical resection.

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Research paper thumbnail of Usefulness of Intraoperative Real-Time Tissue Elastography During Laparoscopic Hepatectomy

Journal of the American College of Surgeons, 2015

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Research paper thumbnail of Single-site laparoscopic approach of Kraske procedure for a presacral local recurrence of rectal adenocarcinoma

Surgical Endoscopy, 2015

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Research paper thumbnail of M-elopee: a CASE tool for software reliability study

Proceedings of Sixth International Symposium on Software Reliability Engineering. ISSRE'95, 1995

To support software project managers for reliability evaluation, the company Mathix and the Frenc... more To support software project managers for reliability evaluation, the company Mathix and the French telecommunications agency (France Telecom) have developed a CASE tool named M-elopee. The purpose of this tool is not only to provide some reliability growth model computations but, more generally, to propose an approach to do reliability studies, and therefore to offer all the features needed to

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Research paper thumbnail of A novel technique for reducing pancreatic fistulas after pancreaticojejunostomy

Journal of surgical case reports, Jan 9, 2015

Risk factors for anastomotic leaks of pancreaticojejunostomy have been well described. We present... more Risk factors for anastomotic leaks of pancreaticojejunostomy have been well described. We present a technique using indocyanine green dye (ICG) and a near-infrared (NIR) capable laparoscope to assess blood supply to the transected margin of the pancreas before pancreaticojejunal anastomosis. A 39-year-old female patient underwent a laparoscopic-assisted pancreaticoduodenectomy (Whipple's procedure) for an invasive ampullary adenocarcinoma. Before construction of the pancreaticojejunal anastomosis, the viability of the margin of the remnant pancreas was assessed with infrared scanning of injected ICG. The NIR identified an ischaemic segment of the margin, which was further resected. The patient had no postoperative evidence of a pancreatic leak and was discharged home on postoperative day 18. Ischaemia of the remnant pancreas is a risk factor for pancreaticojejunostomy leak. Infrared ICG testing might help to identify these ischaemic segments, which can be excised before anastomo...

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Research paper thumbnail of Evaluation of the effect of a laparoscopic robotized needle holder on ergonomics and skills

Surgical Endoscopy, 2015

Laparoscopy generates technical and ergonomics difficulties due to limited degrees of freedom (DO... more Laparoscopy generates technical and ergonomics difficulties due to limited degrees of freedom (DOF) of forceps. To reduce this limitation, a new 5-mm robotized needle holder with two intracorporeal DOF, Jaimy(®), has been developed. The aim of this study was to evaluate its effects on ergonomics and skills. Fourteen surgeons including eight senior and six residents were crossover randomized and stratified based on experience. Three suturing tasks were performed with both Jaimy(®) and a classic needle holder (NH): task 1: Peg-Board; task 2: hexagonal suture; task 3: frontal suture. Postural ergonomics of the dominant arm were evaluated with an ergonomics score (RULA score) thanks to motion capture, and muscular ergonomics with electromyography of six muscular groups (flexor and extensor carpis, biceps, triceps, deltoid, trapeze). Performance outcomes are a quantitative and qualitative score, and skills outcomes are the measurement of the number of movements and the path length travelled by the instrument. The RULA score showed a statistically improved posture with Jaimy(®) (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). The cumulative muscular workload (CMW) of four muscles was not different. However, the CMW was in favor of the NH for the flexor carpi ulnaris (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) and the triceps (p = 0.027). The number of movements was not different (p = 0.39) although the path length was shorter with Jaimy(®) (p = 0.012). The score for task 1 was in favor of the NH (p = 0.006) with a higher quantity score. Task 2 score was not different (p = 0.086): The quality part of the score was in favor of Jaimy(®) (p = 0.009) and the quantity part was higher with the NH (p = 0.04). The score for task 3 was higher with Jaimy(®) (p = 0.001). This study suggests that the use of a robotized needle holder improves both posture and the quality of laparoscopic sutures.

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Research paper thumbnail of Repair of Esophageal Perforation: a New Technique

Canadian Journal of …, 2008

A 39-year-old woman was admitted to our shock trauma centre for the manage-ment of abdominal and ... more A 39-year-old woman was admitted to our shock trauma centre for the manage-ment of abdominal and thoracic trauma caused by penetrating gunshot wounds. Thoracic and abdominal computed to-mography showed multiple fractures of the spleen and hemoperitoneum, a small ...

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Research paper thumbnail of Embolie gazeuse veineuse massive mortelle au cours d’une endoscopie biliaire

Gastroenterologie Clinique Et Biologique, 2010

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Research paper thumbnail of Salvage oesophagoloplasty with a free jejunal transplant after repeated failures. 25 cases

Bookmarks Related papers MentionsView impact

Research paper thumbnail of Comparable long-term oncologic outcomes of laparoscopic versus open pancreaticoduodenectomy for adenocarcinoma: a propensity score weighting analysis

Surgical endoscopy, Oct 15, 2017

To date, no study has reported long-term oncologic outcome for patients undergoing laparoscopic p... more To date, no study has reported long-term oncologic outcome for patients undergoing laparoscopic pancreaticoduodenectomy (LPD) compared to open surgery (OPD). The aim of this study is assess long-term oncologic outcomes for patients with adenocarcinoma undergoing LPD versus OPD using propensity score weighting modeling to minimize selection bias. All patients undergoing PD at Institut Mutualiste Montsouris between January 2000 and April 2010 were included. Propensity scores were calculated using multivariate logistic regression, relating preoperative covariates to surgical approach. Logistic regression was performed, and Cox proportional hazards models for postoperative outcomes were constructed, with and without adjustment for propensity scores weights. Among 87 patients who underwent PD, 40 underwent LPD and 25 OPD for confirmed adenocarcinoma. Preoperative covariates across both groups were comparable. The median follow-up time was 34.5 months. During follow-up, metastasis was ide...

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Research paper thumbnail of A comparison of laparoscopic resection of posterior segments with formal laparoscopic right hepatectomy for colorectal liver metastases: a single-institution study

Surgical endoscopy, Jan 17, 2016

The benefit of by laparoscopic resection for lesions located in postero-superior segments is uncl... more The benefit of by laparoscopic resection for lesions located in postero-superior segments is unclear. The present series aimed at comparing intraoperative and post-operative results in patients undergoing either laparoscopic RPS or laparoscopic RH for colorectal liver metastases located in the right postero-superior segments. From 2000 to 2015, patients who underwent laparoscopic resection of segment 6 and/or 7 (RPS group) were compared with those with right hepatectomy (RH group) in terms of tumour characteristics, surgical treatment, and short-term outcomes. Among the 177 selected patients, 78 (44.1 %) had laparoscopic RPS and 99 (55.9 %) a laparoscopic RH. Among RPS patients, 26 (33.3 %) underwent anatomical resection of either segment 7, 8 or both. Three (3 %) patients undergoing RH died in the post-operative course and none in the RPS group. Sixty-three (35.5 %) patients experienced post-operative complications, including major complications in 24 (13.5 %) patients. Liver failu...

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Research paper thumbnail of Salvage endoscopic ultrasound-radiologic rendezvous to re-establish biliary flow following duodenectomy with ablation of papilla

Endoscopy

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Research paper thumbnail of Diagnostic accuracy of confocal laser endomicroscopy for the ex vivo characterization of peritoneal nodules during laparoscopic surgery

Surgical endoscopy, Apr 17, 2016

Intraoperative characterization of peritoneal nodules can be challenging. Probe-based confocal la... more Intraoperative characterization of peritoneal nodules can be challenging. Probe-based confocal laser endomicroscopy (pCLE) is an innovative technique enabling real-time microscopic analysis. This study aimed to assess the role of pCLE in the discrimination of benign versus malignant peritoneal nodules during laparoscopic staging. During this prospective trial, pCLE was performed ex vivo on fresh samples of peritoneal nodules in 30 consecutive patients, after topical application of indocyanine green. The final diagnosis was obtained histologically, as per standard of care. pCLE image criteria for normal versus inflammatory versus malignant nodules were established (phase I); these criteria were tested retrospectively on selected videos by two examiners (phase II). The primary endpoints were values of accuracy in diagnosing malignant nodules. pCLE criteria for malignant nodules defined in phase I were: strongly fluorescent irregular clusters of cancerous cells, nonfluorescent nuclei o...

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Research paper thumbnail of Augmented Reality Navigation Surgery Facilitates Laparoscopic Rescue of Failed Portal Vein Embolization

Journal of the American College of Surgeons, Oct 19, 2016

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Research paper thumbnail of Outcomes of Laparoscopic Liver Resection for Patients with Large Colorectal Liver Metastases: A Case-Matched Analysis

World journal of surgery, 2016

Despite the expansion of laparoscopic approach in the treatment of liver tumors, limited data hav... more Despite the expansion of laparoscopic approach in the treatment of liver tumors, limited data have been reported regarding large colorectal liver metastases (CRLMs). This study aimed at assessing the short- and long-term outcomes after laparoscopic liver resection (LLR) for large (≥5 cm) CRLMs. This was a case-matched study (1:2) comparing patients with large (group L; ≥5 cm) and small (group S; <5 cm) CRLMs using demographic, tumor, and surgical characteristics as matching variables. Postoperative outcomes and survival data were compared in the 2 groups. Forty patients who underwent LLR for large CRLMs were matched with 80 patients with tumors <5 cm. Major hepatectomy was performed with 75.0 % of patients in Group L and 66.3 % in group S (p = 0.403). Operative time was 300 min in group L and 240 min in group S (p = 0.059). The postoperative mortality and overall morbidity rates were comparable in the 2 groups (p = 1.000 and 0.170, respectively). Postoperative major complicati...

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Research paper thumbnail of Etude anatomique des �sophagoplasties gastriques r�tro-sternales

Surg Radiol Anatomy, 1985

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Research paper thumbnail of Diverticules de l'�sophage

Emc Pneumologie, 2005

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Research paper thumbnail of Large gastrointestinal stromal tumours of the stomach: Is laparoscopy reasonable?

Journal of Minimal Access Surgery, 2015

Laparoscopic resection (LR) offers significant advantages compared to open resections for gastric... more Laparoscopic resection (LR) offers significant advantages compared to open resections for gastric gastrointestinal stromal tumours (GISTs). We aimed to evaluate whether LR outcomes jeopardised short and long-term outcomes of patients with large GISTs. Among 50 patients undergoing surgery for gastric GISTs, 12 underwent LR for large GISTs (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;5 cm). Their characteristics, perioperative results and survival were retrospectively compared to those of 22 patients who underwent LR for &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;small GIST&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;. The two groups were similar regarding demographics, rate of wedge resection and mean blood loss. No patient required transfusion or conversion. Operative time was significantly increased in the &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;large GIST&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; group (160 min vs 112 min, P = 0.001). Mean tumour size was significantly lower in the &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;small GIST&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; group (8.4 cm vs 2.4 cm, P = 0.0001). Resection margins were negative. The mortality rate was nil and the overall morbidity rates was similar in both groups. Median length of hospital stay was significantly increased in the &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;large GIST&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; group (7 days vs 5 days, P = 0.004). Median follow-up was 47 months and one patient in the &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;small GIST&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; group developed recurrence and died during follow-up 11 years after surgery. No patient died during follow-up. LR for large GISTs is safe and technically feasible and does not negatively influence the oncologic course. Prospective randomised trials should be performed before using this approach in routine surgical care.

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Research paper thumbnail of Laparoscopic distal pancreatectomy for pancreatic ductal adenocarcinoma: results of a multicenter cohort study on 196 patients

Surgical Endoscopy, 2015

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Research paper thumbnail of Hemorrhage control for laparoscopic hepatectomy: technical details and predictive factors for intraoperative blood loss

Surgical Endoscopy

Controlling bleeding during laparoscopic hepatectomy (LH) is technically demanding, but reportedl... more Controlling bleeding during laparoscopic hepatectomy (LH) is technically demanding, but reportedly associated with less estimated blood loss (EBL) than open surgery. The present study aimed to describe and evaluate hemorrhage control techniques during LH and identify predictors of high intraoperative EBL. The data of 438 consecutive patients undergoing LH between 1995 and 2012 were reviewed. Bleeding control was facilitated by the proper use of hemostatic devices and surgical maneuvers unique to LH and by preserving intra-abdominal pressure. EBL was evaluated among three groups of 146 patients in each group: 1995-2006 (group A), 2006-2009 (group B), and 2009-2012 (group C). We also sought factors that predicted EBL ≥800 mL. Mean EBL decreased overtime from groups A to C: group A, 378 ± 619 mL; group B, 293 ± 391 mL; groups C, 257 ± 366 mL; P = 0.127. Transfusion rate was 6.7 % in group A, 5.5 % in group B, and 4.8 % in group C (P = 0.743). Hypertension (odds ratio (OR) 2.82, 95 % confidence interval CI 1.37-5.78; P = 0.006), preoperative chemotherapy (OR 2.55, 95 % CI 1.26-5.31; P = 0.009), resection of posterosuperior segments (OR 3.73, 95 % CI 1.33-12.17; P = 0.012), and major hepatectomy (OR 4.21, 95 % CI 1.64-13.02; P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) independently predicted high EBL. Improvements in bleeding control techniques over time have reduced EBL during LH. The use of these techniques and an understanding of the predictive factors for high EBL will help surgeons improve outcomes after LH.

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Research paper thumbnail of The place of enucleation and enucleo-resection in the treatment of pancreatic metastasis of renal cell carcinoma

JOP: Journal of the pancreas

Renal cell carcinoma has shown less response to systemic therapies including chemotherapy, radiot... more Renal cell carcinoma has shown less response to systemic therapies including chemotherapy, radiotherapy and immunotherapy than other cancers. Metastasis of renal cell carcinoma to the pancreas occurs, even after long term radical nephrectomy, surgical resection remains the only potentially curative intervention. We performed surgery for pancreatic metastatic renal cell carcinoma and analyzed the results. We retrospectively analyzed 11 patients who had undergone pancreatic resection or metastasectomy at our hospital from January 1994 to January 2010. Patient&amp;amp;amp;amp;amp;amp;amp;amp;#39;s demographics, clinical variables, types of pancreatic resections (standard or atypical resection), primary histopathology, surgical outcomes, survival and disease free interval were examined. We compared the standard pancreatic resection to atypical resection (enucleation or enucleo-resection). Eleven patients underwent 14 pancreatic resections or metastasectomy (3 pancreaticoduodenectomy, 4 distal pancreatectomy, 1 completion of pancreatectomy, 4 enucleations and two enucleo-resections) for pancreatic renal cell carcinoma metastasis. The median age was 73 years, the median time period between nephrectomy and finding of pancreatic metastasis was 11.4 years. One patient showed synchronous pancreatic metastatic lesions on radiology. One patient died from a splenic artery pseudoaneurysm rupture 35 days after the surgery. Major complications occurred in 4 patients with standard resection (one hemoperitoneum, three pancreatic fistulas), and in one patient with atypical resection (duodenal fistula); six patients with standard resection presented postoperative diabetes mellitus. Median survival age was 6.5 years (range 1-9 years). Two patients died of metastatic disease 5 to 6 years, while 7 patients are alive and well 1 to 9 years after surgery. According to these results and regardless of the small number of cases, atypical resection of metastatic renal cell carcinoma has a high median survival rate even after pancreatic recurrence or distant metastasis. It seems reasonable to favor a good quality of life and less diabetes with a limited atypical resection.

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Research paper thumbnail of Usefulness of Intraoperative Real-Time Tissue Elastography During Laparoscopic Hepatectomy

Journal of the American College of Surgeons, 2015

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Research paper thumbnail of Single-site laparoscopic approach of Kraske procedure for a presacral local recurrence of rectal adenocarcinoma

Surgical Endoscopy, 2015

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Research paper thumbnail of M-elopee: a CASE tool for software reliability study

Proceedings of Sixth International Symposium on Software Reliability Engineering. ISSRE'95, 1995

To support software project managers for reliability evaluation, the company Mathix and the Frenc... more To support software project managers for reliability evaluation, the company Mathix and the French telecommunications agency (France Telecom) have developed a CASE tool named M-elopee. The purpose of this tool is not only to provide some reliability growth model computations but, more generally, to propose an approach to do reliability studies, and therefore to offer all the features needed to

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Research paper thumbnail of A novel technique for reducing pancreatic fistulas after pancreaticojejunostomy

Journal of surgical case reports, Jan 9, 2015

Risk factors for anastomotic leaks of pancreaticojejunostomy have been well described. We present... more Risk factors for anastomotic leaks of pancreaticojejunostomy have been well described. We present a technique using indocyanine green dye (ICG) and a near-infrared (NIR) capable laparoscope to assess blood supply to the transected margin of the pancreas before pancreaticojejunal anastomosis. A 39-year-old female patient underwent a laparoscopic-assisted pancreaticoduodenectomy (Whipple's procedure) for an invasive ampullary adenocarcinoma. Before construction of the pancreaticojejunal anastomosis, the viability of the margin of the remnant pancreas was assessed with infrared scanning of injected ICG. The NIR identified an ischaemic segment of the margin, which was further resected. The patient had no postoperative evidence of a pancreatic leak and was discharged home on postoperative day 18. Ischaemia of the remnant pancreas is a risk factor for pancreaticojejunostomy leak. Infrared ICG testing might help to identify these ischaemic segments, which can be excised before anastomo...

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Research paper thumbnail of Evaluation of the effect of a laparoscopic robotized needle holder on ergonomics and skills

Surgical Endoscopy, 2015

Laparoscopy generates technical and ergonomics difficulties due to limited degrees of freedom (DO... more Laparoscopy generates technical and ergonomics difficulties due to limited degrees of freedom (DOF) of forceps. To reduce this limitation, a new 5-mm robotized needle holder with two intracorporeal DOF, Jaimy(®), has been developed. The aim of this study was to evaluate its effects on ergonomics and skills. Fourteen surgeons including eight senior and six residents were crossover randomized and stratified based on experience. Three suturing tasks were performed with both Jaimy(®) and a classic needle holder (NH): task 1: Peg-Board; task 2: hexagonal suture; task 3: frontal suture. Postural ergonomics of the dominant arm were evaluated with an ergonomics score (RULA score) thanks to motion capture, and muscular ergonomics with electromyography of six muscular groups (flexor and extensor carpis, biceps, triceps, deltoid, trapeze). Performance outcomes are a quantitative and qualitative score, and skills outcomes are the measurement of the number of movements and the path length travelled by the instrument. The RULA score showed a statistically improved posture with Jaimy(®) (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). The cumulative muscular workload (CMW) of four muscles was not different. However, the CMW was in favor of the NH for the flexor carpi ulnaris (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) and the triceps (p = 0.027). The number of movements was not different (p = 0.39) although the path length was shorter with Jaimy(®) (p = 0.012). The score for task 1 was in favor of the NH (p = 0.006) with a higher quantity score. Task 2 score was not different (p = 0.086): The quality part of the score was in favor of Jaimy(®) (p = 0.009) and the quantity part was higher with the NH (p = 0.04). The score for task 3 was higher with Jaimy(®) (p = 0.001). This study suggests that the use of a robotized needle holder improves both posture and the quality of laparoscopic sutures.

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