Mastering the Techniques of Laparoscopic Suturing and Knotting RK Mishra
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1Mastering the Techniques of Laparoscopic Suturing and Knotting
2Mastering the Techniques of Laparoscopic Suturing and Knotting
RK Mishra Director Laparoscopy Hospital, New Delhi, India Chairman Delhi Laparoscopy Hospital Private Limited Member World Association of Laparoscopic Surgeons (WALS) Member European Association for Transluminal Surgery (EATS) Member Indian Association of Gastrointestinal Endosurgeons (IAGES) Member Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) Formerly at Ninewells Hospital and Medical School University of Dundee, United Kingdom Foreword by Ray L Green
3Published by
Jitendar P Vij
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Mastering the Techniques of Laparoscopic Suturing and Knotting
© 2009, Jaypee Brothers Medical Publishers
All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the author and the publisher.
First Edition: 2009
Typeset at JPBMP typesetting unit
Printed at Ajanta Offset
Great Surgeon and my Loving Father
5Foreword …………………….
It is with great pleasure and pride to write the foreword of this second book of Prof Mishra. This book Mastering the Techniques of Laparoscopic Suturing and Knotting provides an authoritative synopsis of the laparoscopic suturing and knotting skill. Sadly, but for different reasons, in the whole world, the subject of suturing and knotting in minimal access surgery is neglected due to the promotion of staplers and auto suture devices by instrument companies. Surgeons are also reluctant in learning suturing skill due to high learning curve and this skill had to be relearned in the specialist units. The principles of suturing and knotting is an absolutely must have skill for the general surgeon and gynecologists before they start advanced minimal access surgical procedures. The entire major and emerging laparoscopic knot tying skill used in gynecological and general surgical procedures is included in this book and information on indications, patient preparation and position, and the step-by-step suturing techniques are featured for each minimal access surgeries commonly performed.
Just as a musician must learn scales and arpeggios before performing flawless concertos, even with an all-electronic piano, so the surgeon must study and learn suturing skills with anatomic relations, basic techniques, hand-eye coordination. Every surgeon should learn the technique presented in this book before performing the virtuoso operations possible with laparoscopy.
The purpose of any medical text is to deliver a consensus report that permits a greater understanding of the topical issues. This book accomplishes that goal. It helps us to refine our technique, to make wise use of our skills of knotting, and to provide the best possible care to our patients in economical way.
The book has much to commend it. The chapters are comprehensive, well written and up-to-date. The quality of the illustrations, both photographs and line drawings, is superb. The chapters are short, sub-headings are used to advantage, and is well referenced. Each section begins with a very balanced account of the clinical illustration of the knots in relation to the laparoscopic procedure.
I hope the readers of this excellent book will approach this new art with all the respect, humility and enjoyment that minimal access surgery deserve. It is a pleasure to read this remarkable resource. Its design, style, and content will certainly evoke the same satisfaction for anyone considering surgical intervention as part of the remedy for any surgical disorder. Prof Mishra has produced an excellent and state of the art review of the suturing techniques in this field of laparoscopy and the book can be well recommended to all practising minimal access surgeons.
Ray L Green
Diplomate of American Board of Obstetrics and Gynecology
Fellow American College of Obstetricians and Gynecologists
President, World Association of Laparoscopic Surgeons (USA)
6Acknowledgements ……..
I would like to express my gratitude to all those who gave me the possibility to complete this book Mastering the Techniques of Laparoscopic Suturing and Knotting. I want to thank the Department of Minimal Access Surgery of the University of Dundee, United Kingdom for giving me encouragement to commence this book in scientific way.
I am also thankful to all the staff of Laparoscopy Hospital, New Delhi, to do the necessary research work and to use departmental data. Furthermore, I have to thank the young and dynamic surgeon Dr Rajeev Kumar Mishra who has helped me as editorial board and encouraged me to go ahead with this work in structured way. I am bound to give honour to all my students for their continuous stimulating support.
I am deeply indebted to my professor Sir Alfred Cuschieri whose help, stimulating suggestions and encouragement helped me in all the time of research for and writing of this book. My former colleagues from the Department of Surgery, Ninewells Hospital and Medical School University of Dundee, Scotland, United Kingdom have also supported me in my research work and getting some data in writing this book.
I also want to thank my best friend Prof Steven D Wexner, President SAGES 2007 and Professor of Surgery, Ohio State University, Ohio, USA, for his morale support in completing this book. I want to thank all my colleague surgeons and gynecologists for all their help, support, interest and valuable hints. I am also obliged to Mr Sumit Kumar Sinha for all his assistance on the proofreading of this book and he was of great help in difficult times when I was busy in my clinical and teaching work. My assistant Mr Raghubir Singh, Bubble and Naina has also looked closely at the final version of the book for English style and grammar, correcting both and offering suggestions for improvement. My sincere thanks to all the supporting staff of Laparoscopy Hospital, New Delhi, who have contributed to work on this book.
I am also thankful to the complete team of Jaypee Brothers Medical Publishers (P) Ltd. Jaypee has a work culture that is quite distinct from that of other publishing houses. I express my gratitude to Shri Jitendar P Vij (Chairman and Managing Director), Jaypee Brothers Medical Publishers (P) Ltd, New Delhi for his brotherly behaviour and his personal interest in making this book popular and presentable. I am also thankful to Mr Tarun Duneja (Director-Publishing) for his continuous feedback about the mistakes which was found during proofreading of this book. I am also thankful to Mr Raman who has given me continuous feedback regarding the formatting and designing of this book in a beautiful presentable way.
Especially, I would like to give my special thanks to my wife Sadhana whose unwearied love enabled me to complete this work.
7Preface ………………………..
I am very happy to present my second book Mastering the Techniques of Laparoscopic Suturing and Knotting to surgeons and gynecologists of the whole world. Although I have discussed laparoscopic suturing and knotting in my first book Textbook of Practical Laparoscopic Surgery but this book is a result of pressure and demand of my students from all over the world to write a book exclusively on suturing and knotting.
In less than fifteen years, so much has happened in the very young field of minimal access surgery. The gradual change from the large incision surgery, used successfully for over 100 years in providing access to internal organs and in treating disease, has paved the way for the use of laparoscopic surgeries and all the inherent advantages of minimal trauma to the body.
Every surgical specialty is seeing new and innovative methods using different types of surgical skills including scientific way of using suture and knots. Laparoscopic suturing and knotting is one of the most important skills for every laparoscopic surgeon and with this skill he can do proper tissue approximation. This is very true that there is no future without suture. Suturing and knotting is so important not only because of the benefit to patients in the form of better secured hemostasis but also because of the promise it holds in providing improved health care in a cost effective, outcome oriented way without the use of costly staplers and glue.
Many procedures that previously required a laparotomy are now performed using laparoscopy if the surgeon or gynecologist has confidence in suturing and knotting. Readers of this book will gain an understanding of advanced minimally invasive suturing and knotting techniques and learn about the development and delivery of relevant skill. I hope that the mastering suturing and knotting techniques in this book will be helpful in directing new frontier for surgeons and gynecologists.
The reader will also be able to review a procedure with full color photographs and then view selected procedures on video. The combination of photographs, written text, surgical footage and spoken commentary is one of the most realistic approaches to understanding a complex surgical skill without actually scrubbing into the case. This book represents an important work and is an excellent addition to any reference library.
In addition to the commonly performed major procedures using suture, I have also illustrated many advanced procedures currently performed only at specialized centres throughout the world. The text in this book is limited to procedural descriptions of suturing and knotting and succinct introductory paragraphs explaining general indications without a comprehensive review of the literature. This text is strictly focused on procedures, as will become apparent to the reader. We have attempted to design a high-quality, comprehensive book and hope that the reader appreciates its distinctiveness and merit.
Although I have taken every care to make this book error free, nonetheless grammatical mistakes may have been overlooked in this scientific book. I will be grateful for any constructive criticism.
RK Mishra