Surgical oncology Professional page of Dr. Ilya Gotsadze

25/06/2024

Surgical Removal of Giant Liposarcoma ( Tumor Mass -22 kg)

Retroperitoneal liposarcoma is a relatively rare pathology. Unfortunately, many patients seek help late, and some are denied surgical tumor removal. The patient presented in this video underwent surgery in June 2022.

She endured a challenging journey, was deemed palliative, and underwent an exploratory laparotomy. As of the publication of this video (June 2024), she is alive and living without recurrence.

We continue to monitor her. In this video, we discuss the surgical planning and detail the steps of the operation.

Retroperitoneal liposarcoma is a relatively rare pathology. Unfortunately, many patients seek help late, and some are denied surgical tumor removal. The pati...

20/06/2024

Radical Removal of GIANT LIPOSARCOMA (tumor mass - 27 KG, 41% of patient's weight ) with Multivisceral Resection ( distal pancreatosplenectomy, left nephrectomy, left colectomy, resection of jejunum. atypical stomach resection) with following reconstruction

This young woman, 31 years old, underwent an exploratory laparotomy and was deemed inoperable in September 2023. Morphologically, a LIPOSARCOMA was confirmed. Her condition was extremely bad; she was practically condemned to death, having been declared a palliative patient. Radiological imaging revealed a giant neoplasm of the retroperitoneal space, originating from the left side.As we evaluated, the inferior vena cava and abdominal aorta were intact, and it’s a crucial issue for that kind of patient. The right kidney and its vessels were also free. The superior mesenteric vessels are also intact, and the mesentery of the small intestine was shifted to the right in iliac region Elements of the hepatoduodenal ligament are also free from malignant mass The left kidney and its vessels were completely covered by the tumor and could not be preserved. So a left nephrectomy is needed in this situation. The body of the pancreas and the spleen, as well as the splenic vessels, were completely involved in the tumor and could not be preserved either.However, the Treitz ligament and the initial segments of the jejunum were not distinguishable because of tumor involvement. Thus, resection of the proximal part of the small intestine is inevitable. Regarding the large intestine, the left sections of the mesocolon are likely involved in the tumor process, but the ascending colon and the re**um in the pelvis were well differentiated and absolutely free from tumor mass. Therefore, the radical extent of surgery in this clinical case was to remove the tumor with multivisceral resection.

SURGERY WAS PERFORMED IN APRIL 2024

https://youtu.be/LoczKTH2BfE?si=x7Y-0aOXSkria4wr

This young woman, 31 years old, underwent an exploratory laparotomy and was deemed inoperable in September 2023. Morphologically, a LIPOSARCOMA was confirmed...

27/11/2023

SURGERY for PRIMARY GIANT LEIOMYOSARCOMA of Right Commom Iliac Vein

Our next surgical film is about highly uncommon and challenging case: the resection of a primary leiomyosarcoma of the common iliac vein. Leiomyosarcomas, particularly those arising from veins, represent an extraordinary rarity in surgical oncology, with sarcomas of the iliac vein being exceptionally scarce in medical literature.

This film showcases our meticulous surgical approach to a giant primary leiomyosarcoma. The complexity of this case lies not only in the tumor's rarity but also in its precarious anatomical location, which presents significant surgical challenges. And also one challenge was that patient was about 80 years old with comorbidities

As you watch, you'll observe the critical steps of our procedure, starting with a thorough pre-operative assessment. We emphasize the importance of detailed radiological examinations in understanding the tumor's relationship with vital structures, particularly the inferior vena cava and left common iliac vein.

The video begins with the initial dissection, carefully navigating around vital vascular structures. We illustrate the challenges in isolating the tumor from these critical veins, maintaining a keen focus on preserving the integrity of the vascular system while ensuring complete tumor resection.

One of the pivotal moments in this surgery is the management of the right common iliac artery. Our team demonstrates the fine balance required in separating the tumor from this artery, emphasizing precision and delicacy to prevent damage and ensure patient safety.

A significant highlight of this operation is the venous resection. The film details how we approached the inferior vena cava and the left common iliac vein, showcasing our strategy for vascular control. We decided against a circular resection of the vena cava bifurcation, instead opting for a direct resection and suturing of the vein, a decision shaped by the tumor's boundaries and our commitment to minimizing surgical risks.

Our film offers insight into the complexities of such a rare tumor, from the planning stages through to the meticulous ex*****on of the surgical procedure. The intricacies of operating in such a sensitive area, where major blood vessels converge, are thoroughly explored.

Throughout the video, we maintain a strong emphasis on patient safety and surgical precision. Our multidisciplinary team's expertise is on full display, highlighting the importance of collaborative efforts in tackling such complex surgical cases.

This surgical film is not just a showcase of a rare and complex procedure but also a testament to the advancements in surgical oncology. It serves as an educational tool for medical professionals and a beacon of hope for patients facing similar rare diagnoses.

Thank you for watching and for your interest in this fascinating aspect of surgical oncology. Please feel free to share your thoughts, questions, or insights in the comments section. Don't forget to subscribe for more insightful surgical content.

Our next surgical film is about highly uncommon and challenging case: the resection of a primary leiomyosarcoma of the common iliac vein. Leiomyosarcomas, p...

27/11/2023

Resection and Prosthetic Replacement of Infrarenal Part of Inferior Vena Cava for Leiomyosarcoma

Advanced Surgical Oncology Series

Primary Leiomyosarcoma of the inferior vena cava and its branches is an extremely rare condition. In the last 10 years, we have had 4 such cases. We will start with the most demonstrative one. These operations require skill in working with major blood vessels and meticulous planning of the surgery, as well as the coordinated work of the anesthesiology team. In this video, you will see an operation for a tumor of the infrarenal segment of the IVC. We performed a radical removal of the tumor and prosthetic replacement of the inferior vena cava in 2020

Primary Leiomyosarcoma of the inferior vena cava and its branches is an extremely rare condition. In the last 10 years, we have had 4 such cases. We will sta...

12/11/2023

RIGHT ADRENALECTOMY WITH TUMOR THROMBUS THROMBECTOMY FROM INFERIOR VENA CAVA
( exclusive oncological case)

Advanced Surgical Oncology Series

I haven't updated my channel for almost 7 years. I can't say exactly why. Probably, I wanted to reach a new level. During this time, a lot of interesting material has accumulated. And now, the time has come to publish the first video. The surgeries that will be presented were done over these years. What will be new is that they will all be voiced and explained in English. This is something I have been asked to do multiple times.

The first operation I will start with might not be the most complex, but the clinical case is truly exclusive. You may find descriptions of similar cases in the literature; I found only four.
I am not talking about adrenal cancer with a tumor thrombus in the inferior vena cava. Data regarding the possibilities of modern treatment methods for such patients are known and statistics are provided in scientific literature.

I won't reveal all the secrets here. I am sure oncologists and surgical oncologists will be sincerely surprised, as we have been surprised and joyful for the sixth year now.

I wanted to start publishing new videos on my channel with this clinical case. It is such joys that motivate us to move forward in our challenging specialty.

I dedicate my new project to the memory of my father. He was a surgical oncologist. This year he would have turned 70. And on the day of publication, November 13, 2008, exactly 15 years ago, he passed away.

I always dreamed of showing him what I learned, but I didn't have time.

Advanced Surgical Oncology SeriesI haven't updated my channel for almost 7 years. I can't say exactly why. Probably, I wanted to reach a new level. During th...

14/12/2016

Open Right Lower Bilobectomy for Non-Small Lung Cancer

Right Lower Bilobectomy performed to 48 years old male with lung adenocarcinoma (NSLC) after neoajuvant chemotherapy. We recieved only stabilization after neoadjuvant treatment. Surgical strategy was chosen because of chronic hemoptysis.

Right Lower Bilobectomy performed to 48 years old male with lung adenocarcinoma (NSLC) after neoajuvant chemotherapy. We recieved only stabilization after ne...

20/11/2016

Extended Transverse Colon CME (D3) for Locally Advanced Cancer ( invasion in stomach, urinary bladder and jejunum)

I could not even imagine such kind of local spread of transverse colon cancer. We operated the patient with the adenocarcinoma of Transverse Colon with invasion of stomach and urinary bladder walls and also infiltration of the jejunum.

Surgeons do not always agree about the amount of surgery for transverse colon cancer. As I see the safest option is the extended right hemicolectomy.

In this film we demonstrated D3 lymph node dissection and tumor removal in a single unit (en bloc)with the affected tissues.

Nice 2 - hour procedure despite of the tumor spread. I hope this is a rare clinical situation will be interesting for the audience.

https://youtu.be/TsmjE4_oC5w

I could not even imagine such kind of local spread of transverse colon cancer. We operated the patient with the adenocarcinoma of Transverse Colon with invas...

24/10/2016

Surgery for the Tumor of Posterior Mediastinum

Patient is 53 y.o. female with a chronic pain in the right sholder area. During CT scan posterior mediastinal mass was found. It this video your can find her CT scans and also short movie of the surgical procedure

https://www.youtube.com/watch?v=58JkXke2YW0

25/09/2016

Extended Radical Antegrade Modular PancreatoSplenectomy (RAMPS)

In this very short video we describe the final part of mobilization stage of the surgery for locally advanced pancreatic cancer. It was the rare case when tumor had extended local growth in gastric wall. splenic gate, splenic flexure of the colon , left paranephron and adrenal gland but had no distant metastases. pancreatic resection was performed in antegrade mode with vessel control and lymphnode dissection.

In 4 weeks after surgery adjuvant treatment was begun

https://www.youtube.com/watch?v=_pVCR26Akj8&feature=youtu.be

In this very short video we describe the final part of mobilization stage of the surgery for locally advanced pancreatic cancer. It was the rare case when tu...

14/06/2016

Right Upper Lobectomy with Mediastinal Lymphadenectomy for Lung Cancer (NSLC)

This operation is performed for peripheral cancer of upper lobe of right lung. Regarding , directly to the extent of the surgery the the standard radical operation for pulmonary cancer with mediastinal lymph node dissection 2F was performed. However, we have met remarkable rare anatomy and it gave us an impulse to make surgical film about it. .

Despite considerable experience in studying of surgical anatomy of the lung in terms of my own experience operating on cadavers and also the particular surgical experience, I have not saw such variant anatomy. In the upper lobe of the right lung venous blood was delivered by branched arterial network that was composed of 4 segmental vessels. Three of them, actually replaced the front trunk of the pulmonary artery. Also an additional branch to the second segment (A2) has been allocated in the interlobar fissure, which occurs frequently, about 75% of cases. The anterior pulmonary trunk was absent.
One more interesting thing! We also met two equivalent upper lobe bronchi. They were the same caliber, so it would be wrong to call «additional» any of them. Several times I saw additional bronchus to right upper lobe from the trachea. If you see this video you will trust me that this situation different

The patient recovered without any postoperative problems and was discharged from the hospital on day 7.

I really tried to make the film understandable and I hope it will be useful


https://www.youtube.com/watch?v=Wg0pvQ86VxA

This operation is performed for peripheral cancer of upper lobe of right lung. Regarding , directly to the extent of the surgery the the standard radical ope...

16/03/2016

Left Hepatectomy for Hepatocellular Carcinoma
(supported with English audio)

This surgery was performed to the patient who was operated for lung cancer about 1,5 years ago. During CT scan we found liver malignant tumor that was verified as HCC. Open Anatomical standard left hepatectomy (2,3,4 segments) with good visualization of anatomical landmarks was performed.


https://www.youtube.com/watch?v=Fko8r2lrVKg

This surgery was performed to the patient who was operated for lung cancer about 1,5 years ago. During CT scan we found liver malignant tumor that was verifi...

28/12/2015

Open Left Upper Lobectomy in complicated patient

The non-standard patient and the difficult surgical case. A young man with a diagnosis of central cancer of the left lung B1 athelectasis and obstruction of B2 and B3 of the upper lobe of the left lung.

The patient was examined in another country and was scheduled chemoradiotherapy with clinical IIIA stage of NSLC (squamosus cell carcinoma). As he said, he passed several courses of RT, but his disease was suddenly complicated by acute pulmonary hemorrhage. Concomitant diseases: bronchial asthma, chronic form,

We decided to perform an left upper lobectomy for vital evidence, although, of course, pneumonectomy would be easier to perform in his case. But, perhaps, with his oncological prognosis and concomitant diseases lobectomy is better for his quality of life.

Непростой пациент и непростой хирургический случай. Молодой мужчина с диагнозом центральный рак левого легкого c ателектазом 1 и обструкцией 2 и 3 сегментов верхней доли левого легкого. Больной был обследован в другой стране. по результатам обследования была назначена химиолучевая терапия. Со слов больного , он прошел несколько курсов, однако течение заболевания осложнилось острым легочным кровотечением, купированным консервативно. Сопутствующие заболевания: бронхиальная астма, хроническая форма, Мы приняли решение выполнить ему верхнюю лобэктомию слева по витальным показаниям, хотя, естественно, пневмонэктомию было бы выполнить проще. В этой ситуации, как мне видится, лобэктомия выглядит более предпочтительной операцией ввиду сопутствующей патологии и распространенности опухолевого процесса. https://www.youtube.com/watch?v=ul-dKbnxYGs&feature=youtu.be

Open Left Upper Lobectomy in complicated patient The non-standard patient and the difficult surgical case. A young man with a diagnosis of central cancer of ...