Intra‐operative ultrasound of the small bowel in Crohn’s disease – a video vignette

Abstract

previous vogue for inserting a pelvic prosthesis which could prove imperfect and needs removal once therapy has been concluded [3,4]. Pelvic mesh placement is familiar to surgeons whose practice includes surgery for rectal prolapse. Whilst alternative methods of mesh fixation are used, many prefer the careful placement of sutures as gold standard. Precise suturing, however, can be tricky especially for those with lower volume experience in this task. This technical concern has led some to propose robotic assistance [5] although this adds considerable expense and some additional complexity, as well as being limited in availability. The FlexDex system (FlexDex Surgical, Brighton, Michigan, USA) is a solely mechanical articulating device that converts a surgeon's hand, wrist and arm movements into corresponding movements of the instrument's end-effector inside the patient [6]. It is a single use device that, with some prior training [7], enables ergonomic and accurate suturing via standard laparoscopic ports and without the need for any additional equipment. In the associated video (Video S1) we show the concept and practice of this device in assisting the correct placement of a mesh in a patient with prostatic cancer prior to therapeutic radiation. The patient made an uneventful recovery, and was able to be discharged on the first postoperative day and proceeded to radiotherapy 2 weeks later.

Feasibility of intraoperative ultrasound of the small bowel during Crohn’s disease surgery

“…The intervention assessed in the study was the use of intraoperative USS of the small bowel. A gastrointestinal consultant radiologist, with expertise in CD imaging and abdominal USS repeated the full intraoperative assessment of the small bowel, by applying directly on the bowel a sterile USS probe, prior to resection being performed by the surgeon [3]. Acoustic coupling was obtained by irrigating the bowel with sterile saline (Figs.…”