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Minimally Invasive Surgery: Laparoscopy, Therapeutic Endoscopy and Notes
Daniel B Jones, Robert A Andrews, Jonathan F Critchlow, Benjamin E Schneider
CHAPTER 1:
Diagnostic laparoscopy
CHAPTER 2:
Cholecystectomy
INTRODUCTION
EPIDEMIOLOGY
SYMPTOMS AND CLINICAL PRESENTATION
MEDICAL THERAPY
SURGICAL THERAPY
Indications for cholecystectomy
PREOPERATIVE PREPARATION
Understanding the anatomy of the biliary tree
Surgical technique
Port placement
Exposure
Dissection
Intraoperative evaluation for common bile duct stones
Completion of cholecystectomy
Single incision laparoscopic surgery
Natural orifice translumenal endoscopic surgery
POSTOPERATIVE CARE
Management of complications
Arterial injury
Gallstone spillage
Conversion to an open procedure
CONCLUSION
CHAPTER 3:
Robotic-assisted single port cholecystectomy
INTRODUCTION
PREPARATION AND POSITIONING OF THE PATIENT
PLACEMENT OF THE SINGLE INCISION PORT
Docking the robot
SURGICAL TECHNIQUE
CONCLUSION
CHAPTER 4:
Common bile duct exploration
INTRODUCTION
INDICATIONS FOR INTRAOPERATIVE CHOLANGIOGRAM AND CBD EXPLORATION
OPTIONS FOR CBD EXPLORATION
Endoscopic retrograde cholangiopancreatography
Open CBD exploration
Laparoscopic CBD exploration
Percutaneous transhepatic cholangiography
OPERATIVE TECHNIQUES FOR CBD EXPLORATION
Open CBD exploration
Reconstruction options for open CBD exploration
Laparoscopic CBD exploration
Transcystic approach
CONCLUSION
CHAPTER 5:
Biliary bypass
INTRODUCTION
INDICATIONS
Benign
Common bile duct stones
BENIGN STRICTURE
Pediatrics
Other
Contraindications and cautions
OUTCOMES
Benign
Malignant
TECHNICAL CONSIDERATIONS
CONCLUSION
CHAPTER 6:
Laparoscopic gastrostomy and jejunostomy
INTRODUCTION
LAPAROSCOPIC GASTROSTOMY
Indications
OPERATIVE TECHNIQUE
LAPAROSCOPIC FEEDING JEJUNOSTOMY
Indications
Operative technique
CONCLUSION
CHAPTER 7:
Liver surgery
INTRODUCTION
INDICATIONS, PATIENT SELECTION AND THE LOUISVILLE STATEMENT
TECHNICAL CONSIDERATIONS
Transection equipment
Ultrasonic coagulation
Monopolar dissectors
Waterjet
Tissue link sealing hook
OUTCOMES
Intraoperative outcomes Operative time
Blood loss and transfusion requirements
Gas embolism
Conversion
POSTOPERATIVE OUTCOMES
Postoperative pain
Length of stay
Morbidity
MORTALITY
Oncologic outcomes
ECONOMICS OF LIVER RESECTION
SPECIAL TOPICS
Laparoscopic liver surgery in transplantation
Robotic liver surgery
Learning curve
CONCLUSION
CHAPTER 8:
Ventral hernia surgery
INTRODUCTION
Surgical considerations in ventral hernia repair
Patient factors
Laparoscopic versus open repair
Site of hernia
Size of hernia
Reducibility
Loss of domain
Plane of placement of prosthetic material
Optimization and patient related factors
INSTRUMENTS AND SETUP
Ergonomics
Standard laparoscopic instruments
Scopes
Tacking devices
Non-absorbable fixation
Protack fixation device (Covidien Plc)
Salute II (Davol Inc)
Endopath endoscopic multi-feed stapler (EMS)
Endoanchor (Ethicon Inc)
Absorbable fixation
Absorbatacks (Covidien Plc)
Permasorb fixation device (Davol Inc)
I clip tissue fixation system (Covidien Plc)
Easy Tac anchor device (Medchannel Llc)
Securestrap fixation device (Ethicon Inc)
Ultrasonic shears
PROSTHETIC REVIEW
Classification based on size of pores
Classification of mesh based on composition
Simple
Composite
Biologic
Issues
TECHNIQUES
Open repair
Laparoscopic repair
Patient position, bladder decompression, skin barrier and drapes
Special considerations
Repair of supra-pubic ventral hernia
Sub-xiphoid incisional hernia
PITFALLS AND TROUBLESHOOTING
Light issues
Video imaging problems
Insufflation problems
Electrosurgical devices
CONCLUSION
CHAPTER 9:
Paraesophageal hiatal hernia and Nissen fundoplication
INTRODUCTION
Patient selection and preoperative evaluation
Special considerations
Non-acid reflux
Eosinophilic esophagitis (EE)
Barrett's esophagitis
Morbid obesity
Patient selection for repair of hiatal hernias
Instruments and setup
TECHNIQUES
Mobilization
Hiatal hernia repair
Fundoplication
Large hiatal hernia or paraesophageal hernia
PROSTHETIC REVIEW
PITFALLS, POINTERS AND TROUBLESHOOTING
Replaced left hepatic artery
Large falciform ligament
Intraoperative pneumothorax
Shortened esophagus
Recurrence or re-herniation of the hiatus
Esophageal injury/leak
Endolumenal fundoplication therapies
CONCLUSION
CHAPTER 10:
Laparoscopic Heller myotomy
INTRODUCTION
HISTORY
PATIENT SELECTION AND PREOPERATIVE EVALUATION
PREPARATION, INSTRUMENTATION AND SET-UP
TECHNIQUE
POSTOPERATIVE CARE
COMPLICATIONS, PITFALLS AND POINTERS
CONCLUSIONS
CHAPTER 11:
Peptic ulcer disease
INTRODUCTION
Patient selection
INSTRUMENTS/SET UP
Instruments
Preoperative preparation
Operating room setup
TECHNIQUES
Access and port placement
Procedure
Exposure
Laparoscopic repair of perforated duodenal ulcer
Exposure of the hiatus (Figure 11.5)
Posterior truncal vagotomy
Anterior vagal nerve management
Postoperative care
troubleshooting
CONCLUSION
CHAPTER 12:
Gastrectomy
INTRODUCTION
MINIMALLY INVASIVE TECHNIQUES FOR MALIGNANCY
OTHER INDICATIONS
PREOPERATIVE WORK UP/PATIENT SELECTION
TECHNIQUES
PITFALLS/POINTERS/TROUBLESHOOTING
CONCLUSION
CHAPTER 13:
Laparoscopic inguinal hernia repair
INTRODUCTION
INDICATIONS AND PATIENT SELECTION
PREOPERATIVE MANAGEMENT
Diagnosis
Patient consent
PATIENT PREPARATION
OPERATING ROOM SETUP
SURGICAL TECHNIQUE
Anatomy of the inguinal preperitoneal space
Operative steps for the TAPP approach
Operative steps for the TEP approach
SINGLE-INCISION LAPAROSCOPIC SURGERY AND NATURAL ORIFICE TECHNIQUES
PROSTHETIC CHOICE AND PLACEMENT
POSTOPERATIVE MANAGEMENT
Pitfalls, pointers and troubleshooting
CONCLUSION
CHAPTER 14:
Appendectomy
INTRODUCTION
Pathophysiology and historic perspective
LAPAROSCOPIC VERSUS OPEN APPENDECTOMY
LAPAROSCOPIC APPROACH FOR INTERVAL APPENDECTOMY
PATIENT SELECTION
DIAGNOSIS
TECHNIQUES
Patient positioning
Operative techniques
PITFALLS, POINTERS AND TROUBLESHOOTING
Imaging
TECHNICAL POINTERS
Stapling the appendix (or cecum)
Inadequate cleansing of the abdomen
Inadequate equipment
Evidence-based decisions on surgical care
CONCLUSIONS
CHAPTER 15:
Colon and rectal surgery
INTRODUCTION
LAPAROSCOPIC COLECTOMY
SINGLE-INCISION LAPAROSCOPIC COLECTOMY
MINIMALLY INVASIVE COLECTOMY FOR COLON AND RECTAL MALIGNANCY
PATIENT SELECTION
Indications
Contraindications
ADOPTION INTO PRACTICE
TECHNIQUES
Operating room
Optics, instruments and access devices
Port placement
Procedures
RIGHT COLECTOMY
Lateral-to-medial approach
Medial-to-lateral approach
Inferior approach
SIGMOID AND LEFT COLECTOMY
LATERAL-TO-MEDIAL APPROACH
MEDIAL-TO-LATERAL APPROACH
Hand-assisted technique
TRANSVERSE AND TOTAL ABDOMINAL COLECTOMY
LOW ANTERIOR RESECTION
Abdominal perineal resection
Colostomy
POSTOPERATIVE MANAGEMENT AND COMPLICATIONS
CONCLUSION
CHAPTER 16:
Splenectomy
REVIEW OF ANATOMY
Recognizing accessory spleens
Indications for laparoscopic splenectomy
Role of preoperative embolization in laparoscopic splenectomy
Preoperative preparation
Laparoscopic splenectomy (lateral approach)
Patient positioning
Access and port placement
Dividing the ligamentous attachments
Splenocolic ligament
Splenorenal ligament
Gastrosplenic ligament (short gastric vessels)
Dividing the splenic hilum
Intraoperative technicalities
Preparing the specimen for extraction
Laparoscopic splenectomy (anterior-posterior approach)
Laparoscopic partial splenectomy
Single-incision laparoscopic splenectomy
Hand-assisted laparoscopic splenectomy
Natural orifice TRANSLUMENAL endoscopic surgery (NOTES)-assisted splenectomy
Robotic-assisted splenectomy
Conversion to open splenectomy
Postoperative care
Postoperative complications
Conclusion
CHAPTER 17:
Adrenalectomy
Introduction
Patient selection and preoperative evaluation
Evaluation of patients with functioning adrenal tumors
Conn's syndrome
Pheochromocytoma
Cushing's syndrome
Evaluation of patients with nonfunctioning adrenal tumors
Laparoscopic surgery for malignant adrenal tumors
Laparoscopic adrenalectomy for large tumors
Technical aspects
Left lateral transperitoneal laparoscopic adrenalectomy
Right lateral transperitoneal laparoscopic adrenalectomy
Retroperitoneal minimally invasive adrenalectomy
Special considerations in minimally invasive adrenalectomy
Bilateral adrenalectomy
Subtotal (cortical-sparing) adrenalectomy
Laparoscopic adrenalectomy as a same-day procedure
Robotic adrenalectomy
Single-incision laparoscopic surgery (SILS) for adrenalectomy
Natural orifice translumenal endoscopic surgery (NOTES)-assisted laparoscopic adrenalectomy
Complications
Conclusion
CHAPTER 18:
Pancreatic surgery
Introduction
Laparoscopic distal pancreatectomy
Laparoscopic cystgastrostomy
Video-assisted pancreatic debridement
Total laparoscopic pancreaticoduodenectomy
Robotic-assisted minimally invasive pancreatectomy
Preparation
Steps
Conclusion
CHAPTER 19:
Esophagectomy
Introduction
History
Patient selection/preoperative evaluation
The tumor, node and metastasis (TNM) staging of esophageal cancer
Staging work-up
Indications and contraindications for esophagectomy
Instruments/set up
Techniques
Ivor Lewis minimally invasive esophagectomy
Laparoscopic construction of the gastric conduit
Thoracoscopic mobilization of the esophagus and intrathoracic esophagogastric anastomosis
McKeown minimally invasive esophagectomy
Laparoscopic transhiatal esophagectomy
Robotic esophagectomy
Reconstruction
Pitfalls/pointers/troubleshooting
Obese patients
Pyloric drainage
Esophagogastric anastomosis
Thoracoscopic mobilization of the esophagus
Late complications
Conclusion
CHAPTER 20:
Video-assisted thoracoscopic surgery
Introduction
Definition
Potential advantages of VATS versus thoracotomy
Patient selection
Preoperative testing
Preoperative staging
Indications and contraindications
Techniques
Anesthesia
Technical considerations
Instruments
Patient positioning
Basic surgical technique
Right upper lobe
Right middle lobe
Right lower lobe
Left upper lobe
Left lower lobe
Lymph node dissection
Pitfalls/pointers/troubleshooting
Learning curve
Tactile feedback
Control of bleeding
Tumor implantation
Air leak
Indications for conversion to thoracotomy
Conclusion
CHAPTER 21:
Obesity surgery
Introduction
Weight loss surgery centers
Medical treatment
Surgical treatment
Laparoscopic Roux-en-Y gastric bypass
Access
Jejuno-jejunostomy
Gastrojejunostomy
Completion
Laparoscopic gastric sleeve
Laparoscopic adjustable gastric band
Conclusion
CHAPTER 22:
Surgical robots and telesurgery
Introduction
History
Developmental driving forces
From outside the medical community
From within the medical community: identifying the obstacles of traditional MIS
Evolution of surgical robots
Passive robots
Semiactive robots
Active robots
Advantages of using robotic assistance in MIS
Clinical applications of robotic assisted MIS
Urology
Robotic-assisted radical prostatectomy
Robotic-assisted kidney surgery
Gynecology
Cardiac surgery
General surgery
Robotic surgery: limitations and controversies
Lack of haptic feedback
Cost, market forces and patient expectations
Future directions
Remote surgery
Haptic feedback
Other robotic approaches
Conclusion
CHAPTER 23:
Endolumenal surgery
Introduction
Background
Endolumenal surgery techniques
Suturing
Ligation
Dissection and resection
Hemostasis
Injection methods
Thermal methods
Mechanical methods
Stenting
Tissue ablation
Conclusion
CHAPTER 24:
Advanced therapeutic endoscopy
Introduction
Endoscopic treatment of Barrett's esophagus
Introduction
Patient selection
Endoscopic resection
Endoscopic mucosal resection
Endoscopic mucosal dissection
Endoscopic mucosal ablation
Photodynamic therapy
Radiofrequency ablation
Cryotherapy
Conclusions
Enteral stents
Types of stents
Esophageal stents
Gastroduodenal stents
Colonic stents
Future directions
Endoscopic retrograde cholangiopancreatography
Introduction
Indications for ERCP
ERCP for choledocholithiasis
Malignant and benign biliary strictures
Ampullary adenoma
The role of ERCP in the management of chronic pancreatitis
ERCP for the management of post surgical complications
ERCP for patients with surgically altered anatomy
Post-ERCP complications
Endoscopic ultrasonography
Technology
Indications
Clinical applications
Chronic pancreatitis
Submucosal lesions
Suspected biliary stones or microlithiasis
Cystic pancreatic lesions
Neuroendocrine tumors
Tumor staging
Therapeutic uses
Pancreatic pseudocysts drainage
Celiac plexus neurolysis and block
Fiducial placement for stereotactic body radiotherapy
Conclusion
CHAPTER 25:
Natural orifice translumenal endoscopic surgery
Introduction
Indications
Review of technology
Set-up
Techniques
Translumenal access
Transvaginal access
Transgastric access
Transcolonic or transanal/TEM access
Intraoperative considerations
Rigid vs flexible endoscopic operation
Visualization
Tissue dissection
Retraction
Ligation
Clip application
Organ or specimen retrieval
Closure of translumenal access site
Maintenance of sterility
Management of intraoperative complications
Hemodynamic changes
Intra-abdominal hemorrhage
Air embolism and pneumothorax
Anesthesia considerations
Pitfalls/pointers/troubleshooting
Conclusion
CHAPTER 26:
Advanced training and education
Introduction
Postgraduate training courses
Early training models
Virtual reality
Current state of affairs
Fundamentals of laparoscopic surgery
Current training in surgical residency
Recent developments
Endoscopic training
NOTES and single port laparoscopy training
Conclusion
CHAPTER 27:
Anesthetic issues for endoscopic and laparoscopic procedures
Introduction
Endoscopic cases
Sedation versus anesthesia
General considerations
Patient indications for anesthesia services
Obesity
Obstructive sleep apnea
Cardiovascular disease
The elderly
Cirrhosis
Anesthetic risks
Hypoxia and ‘losing the airway’
Aspiration risk
Hypotension and cardiac instability
Bradycardia
Remote locations
Recommendations for choosing the anesthetic for endoscopy cases
Laparoscopic surgical cases
General considerations
Intraoperative monitoring
Anesthetic techniques
Postoperative nausea and pain
Complications
Cardiac dysrhythmias
Hypertension
Hypotension
Hypoxemia
Hypercarbia
Venous gas embolus
Conclusion
CHAPTER 28:
Surgery for cancer
Introduction
Oncologic principles
Laparoscopic pancreaticoduodenectomy
History and evolution
Operative technique
Mobilization and resection
Reconstruction
Outcomes and moving forward
INDEX
TOC
Index
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