Roman Izrailov Gastrectomia totale

And two additional 5-millimeter ports near the coaster line, yes.

And additional, we have a Nathanson retractor for better view of the operation field.

So, we are going to start.

Sir, did I understand right?

Right, it's an M1 tumor, M1.

No, sorry, sorry, M0 tumor, not distal metastasis.

Okay, okay, no problem, sir. Thank you, sir.

That's okay.

So, I'm using a harmonic scalpel for mobilization, as usual.

Three-fourths centimeter from stomach away,

transect the gastrocolic ligament.

No amentectomy in this case.

I prefer this one.

I was yesterday with a colleague of yours performing a Whipple procedure just from the same center.

Yeah.

Yeah.

Professor Petkov.

Right.

Yeah.

And so, I already know that the population referring to the hospital should be something

like all Moscow, I mean 12 millions, but he told me that there are several hospitals performing

the same operation.

I don't know about the stomachs, he told me something about pancreas.

And how many procedures like this are you performing each year?

In our center, it's about 120 cases per year.

Great. And how many surgeons?

Yes, it's a radical reduction of the stomach, not only total gastrectomy,

and also distal reduction of the stomach and proximal reduction.

Yes, it's around 120 for the year.

Great.

And how many surgeons as a first operator, I mean?

It's one, two, three.

I think it's five surgeons can do this operation.

But maybe a little different here because some of them can perform now

Now, distal gastrectomy and try to start total gastrectomy

because necessary to understand that the total gastrectomy

is a more challenging procedure.

So they started to do it, but not routinely.

Okay, thank you.

But five sessions, yes, can do it.

I would like to say for a mental branch of the vessels,

I would like to use a double clips.

So now we're going to perform lymphodendectomy of the lymph nodes, group 6.

So you're performing lymphodendectomy of group 4, just below the pylorus.

I think patient and sometimes it's not very good for surgery.

You can see that I am using just only tips of the harmonic scalpel, tips of branch.

So this is vein, pancreas.

Not necessary to remove protein B lymph node group here,

but mesenteric, superior mesenteric vein is in this zone.

And so we can see we are starting to remove lymph nodes group number 6V, yes, is here, head of the pancreas.

Gastroepipleric vein here.

We are going to prepare it for transaction.

Necessary to be very careful because the pancreas is very close to us.

Let me see, let me see.

No, no, on the other side.

Here, Kolya, now a little bit.

Closer.

And this hand here, Kolya.

This hand here.

Oh, great.

Good.

Well, a little to the right.

Kolya, put your hand here more.

That's it.

Now stop.

Back of the camera.

Back of the camera.

Kolya, put your hand there more.

Don't go too far there.

Back of the camera.

Great exposures of all the anatomical structures and good images. Thank you.

Yes, yes, I absolutely agree. Thank you, my assistant, and three-dimension camera.

Are you going to change your position during the procedure? I mean, you are on the right

side of the patient. No? No. Okay.

Gastrododonulatory.

Get the rag ready.

The rag.

Faster.

Lower this hand a little bit.

Down.

Yes, like this.

And take the other hand here.

The other hand closer.

No, Kolya, your hands are confused.

This hand goes here.

Here.

Let go.

Let go.

Let go.

Let go.

Calmly.

Don't say anything.

Anthropologic artery.

Gastropeplioic artery.

Right.

Right gastropulmonary cartilage and intrapulmonary cartilage, we are going to transect it.

You can see here, right, gastropulmonary cartilage and intrapulmonary cartilage.

The dissection is so precise that everything is perfectly clear.

Yeah.

common hepatic artery and the appropriate hepatic artery gastrointestinal artery and

And Odeno, prepare Odeno for transecting.

Let's go to the other side.

Wait, let's clean up a little bit here.

A little bit.

A small one, a small one.

I think we'll take it here.

Left gas recline, yes.

Let's go there.

Maybe we'll go there first, no?

Or from this side we'll go there first?

Okay, let's go.

Let's clean the stomach one by one.

If it's enough.

No, if you take it from the edge, as we usually do.

Here.

Here.

Here.

The second hand here.

Carefully.

Carefully.

So that it doesn't stick.

That's it.

You take it roughly.

At the tip.

You pull it.

You have to pull it with your hand.

Yes.

We need to clean up a little here.

Or we need enough space.

Of course, enough.

Here we will put it normally.

I think it will fit.

Come on, let it go.

Let's wash your voice.

Let's wash your voice.

Blue 60, are you ready?

Turn around.

Move your stomach there.

Not too much, be careful.

Stomach all the way there.

What's going on here?

In another one, probably.

Take it carefully.

Take it.

Put it here.

What are you doing?

Give me your hand, please.

I'm doing it.

Lift it up.

Lift it up.

Don't tear it.

so this is the right gastric artery i'm going to transect it right now

One more.

Daniel.

The evening has already passed.

Let's cross to the aden.

The clamp is normal for me.

One more.

Now I'll look at it.

Well, the strap was sticking out there already.

Oh, not completely yet?

Now stop.

Yes.

I didn't put it there yet.

Well, stop.

Back.

Back.

Let go, Kolya.

Clamp.

So, take it away, please.

Well, take the strap.

Take it away.

Just up.

Come to me.

More here.

You don't have to pull it away from me.

You're ready to transect the Judean?

Yes, I'm ready for transection of the Judean.

Okay, here we are.

I need to bend it.

Change the gas to Nikolay's.

The tip of the instrument.

It turns out.

The tip was perfect.

The tip can be bent a little more.

Just set it up.

Kolya, stop it.

Is it okay?

It's okay, everything is fine.

Dissector, get ready, please.

Harmonic at the beginning, stop.

You can give me the big one, please.

Harmonic.

Dissector, give it to me, please.

We'll examine it.

Now, walk a little bit.

Yes, relax there.

No, just don't move.

Great, keep your mouth shut.

Good.

so prepare left gastric artery for transsection a very precise dissection professor

really best compliments

Carefully.

Dissex.

Gastric.

Artery.

Posterior.

Short.

I don't have a knot.

Hold it.

Yes, here.

Press it a little.

Like this.

And a little more.

Ah, that's good.

Yes, this one.

I don't have a knot next to it.

So.

Clipse.

Harmony.

Clipse.

Get ready, please.

Small.

Yes, now let's clean it up a little here.

Down.

That's it.

Hand.

Let's throw it up.

Yes.

Clipse.

Give me the middle clip, please.

Middle.

Further, higher.

Well, clip.

Let's go up one more time.

It's here somewhere.

Lagos.

It's clear.

Well, well.

Good.

Let's go up.

Yes, yes, yes.

Get off, and then we'll go.

Back to the camera.

Back to the camera.

Uh-huh.

Up.

Hold it up.

Hold it up for now.

Forward, forward, camera.

Are you going to clip that hose?

Yes, you are clipping it.

Yes, harmonia. Closer.

Turn the stomach over here.

Turn the stomach over.

Don't tear off the brain.

We need to cover the brain a little bit.

Cover it here a little bit.

Cover it.

Just a little bit here.

Head a little bit higher and a little bit higher on me.

Stop. Stop.

On us. On us. On us.

Well, help me. No, there's nothing here.

Yes, I have had the question just before, but I thought you couldn't hear me.

Can you hear me now?

Yes, yes, yes.

Ah, okay, no problem, okay.

No, everything is perfectly clear, the images are great, and once again,

I'm astonished by the way you are performing these operations,

is precise I mean procedure it's it's really really fine and I know no problem

really it's not a compliment it's a it's it's really so precise a surgical

procedure that's great to see especially thinking about all the young surgeons

that are online now as you know we are not we are not in presence where we have

not like two years ago

2,500

people here in Rome

they are all home

getting

all the beautiful images

you are transmitting

in their home

their own home

everything

it looks like you are

finishing the

procedure, I mean the demolition procedure

It seems to me that it will be enough, since we will not be low.

Let's do it.

Well, a little bit, but I don't know.

Well, you've already started, let's finish.

Well, pull up for him then.

Oh, I think it's enough.

That's enough.

We cross.

So, hold on to the stomach.

Good.

Do you have a probe?

You turned it a little, right?

Forward, forward, forward.

Okay?

Not high.

Nose.

Harmonic.

Please.

Harmonic.

Head.

End.

Down.

Go away, Kolya.

Okay.

Stop.

Enough.

No need.

Leave it.

Good.

So, do you know?

If I show it up, yes or no?

We don't have time.

Yes.

No, wait, wait.

What is the white 60?

The beginning.

Blue.

Yes.

45.

Blue.

Interesting technique. I really think that especially the young soldiers can appreciate this so much.

Very simple and very safe technique. Thank you, Professor Heng, for that.

There is a comment from the audience. It says, congratulations, your technique is astonishing.

Well, that's the same thing, I told you something some time before.

And I haven't seen any blood, chapeau, Daniel says from home.

sorry I just told you there were some compliments from from home from probably

a young surgeon named the daniel for young surgeon yeah he told you

congratulation your technique is astonishing I haven't seen any blood

That's the comment from the audience from home.

Yes, I understand.

it's very important to understand that procedures should be very safe for the patient.

and so I think that our operation today will help him in it

and I think that mobilization and reconstruction stage

are absolutely feasible for such kind of procedure

but of course it is necessary to start this kind of operation

just only with mentors.

Dr. Shkuh has a good experience in this major challenging procedure

because a lot of operation, especially for the patient with obesity

or other comorbidity, very dangerous.

so be be careful and good luck in it thank you professor even though we have

to say that you didn't look to be in a hurry but anyway it's only a couple of

hours and that's really great best compliment it's a good time yeah but the

patient very comfortable for this procedure really yes i don't know about the bmi the bmi of this

It was 50 centimeters.

Here, take it.

Polar.

D-sector.

Apparatus 45.

White.

Come on.

Yes, yes, don't pull.

That's it.

Good.

Come on, come on.

To the road.

Forward.

Don't pull.

Don't.

Don't.

That's it, that's it.

Don't, I'm telling you.

Don't pull.

Yes, pull.

D-sector.

The main end is lower.

On Nikolay Evgenievich, a little tilt.

More, more, more, more.

Oh, don't pull.

Just under the root.

Stop.

Yes, one drain, drainage one.

Will you, are you going to put a tube to feed the patient?

No, the patient will start drink since third day.

And usually we discharge the patient from the clinic on the seventh post-operative day.

Okay.

Yes, the clamp.

Ah, open it.

Hang the monopolar.

Or maybe put the clip?

Yes.

Yes.

Open it a little, try.

Ah, like this, great.

Just open it a little.

A little like this.

There, dry your lips.

Did you spot a bleeding?

I couldn't see it.

It's okay, right?

Yes?

Okay.

Let go, let go.

even though it looks like

everything is going to finish

and it's a pleasure to see you

since the

very last maneuver

surgical maneuver

thank you

yes really we finish our procedure

I'm going to put the drainage

on drainage

behind the

oesophagus

and remove the specimen

yeah did you have

I'm only asking if you ever

put stitches on the upper

anastomosis, on the esophagus. Well, you performed it

by a stapler, of course, and it looks like it's safe

and fast. My question was...

Usually we reinforce

force yeah yeah usually we reinforce yes we reinforce linear stapler as usual with the stitch

A three-hands technique.

Great.

So, prepare another thread, just in case.

Yes, yes.

No, now I see it, I just had to hold it.

because maybe it will take longer.

Wait, wait, wait.

Forward camera.

Yes, another one.

Kolya, you're in my way.

No, no, no, double.

Do you see how wrongly we give? Do you see how wrongly we give?

Kolya, what are you doing?

Katya, come on, Kolya, turn it around as we agreed.

You need to take it there.

Kolya, you need to take it higher.

Higher, take it, yes.

Can you tie it like this?

Hold it, cut it.

What's wrong with you?

You can't go there.

You need to spread your stomach.

You see?

Yes.

Hold it then.

Here.

You need to take it from below.

Not from above.

Hold it.

You need to turn the curvature down.

You can.

So, one more thread.

Yes, Katya.

So, let's go there.

Olya, hold your stomach.

With that hand here.

Well, Katya.

I'll give you this.

This is about Lenin.

Don't forget to cook there.

Here you will need to help somehow.

For now.

Well, let it lie.

Who doesn't?

do you any do you have any any other surgical procedure to stream towards

Rome today and did you plan anything else no just only total that's like me

okay okay so again best compliments again some compliments came from the

the audience home taking advantage of the images you send us from their own home.

So thank you so much again on behalf of Professor Palacini and myself and all the people, all

the surgeons that were able to take a look of your really great surgical procedure.

My best compliments again.

Hope to see you in the near future.

Thank you, sir.

Thank you to all your helpers.

thank you again thank you for possibilities to be with you also okay it was a big pleasure for us

yeah why not next year thank you thank you again and best compliments thank you

Pull my left trachea, please.

Pull it together now.

Okay, stop.

Okay, I don't need it yet.

Wait, I don't need it yet.

Ready drainage.

Give me the scissors, then.

To the right.

Hold it, Katya.

Hold it.

No, no.

This way.

Yes, good.

Drainage.

Show me.

Show me here.

Show me.

Show me.

Let's go, Kolya.

Dear colleagues, thank you for your attention, and we're going to stop our procedure to put

the drainage and remove the specimen, and after that we stopped, and thank you very

much again for your attention, and it was a really great pleasure to be with you on

your conference, and have a good luck.

See you.

Bye.