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Textbook of Practical Laparoscopic Surgery
RK Mishra
SECTION 1: ESSENTIALS OF LAPAROSCOPY
CHAPTER 1:
Chronological Advances in Minimal Access Surgery
CHAPTER 2:
Laparoscopic Imaging Systems
LAPAROSCOPIC TROLLEY
IMAGING SYSTEMS
LIGHT SOURCE
Lamp (Bulb)
I-Halogen Bulbs (150-watt) or Tungsten-halogen Bulb
II-Xenon Lamps (300-watt)
III-Metal Halide Vapor Arc Lamp (250-watt)
Heat Filter
Condensing Lens
Manual or Automatic Intensity Control Circuit (Shutter)
LIGHT CABLE
Total Internal Reflection
Fiberoptic Cable
Liquid Crystal Gel Cable
Liquid Crystal
Attachment of the Light Cable to the Light Source
Maintenance of Light Cable
TELESCOPE
The Angle of View
The Diameter
The Lens System
Telescope Fiber Bundle
LAPAROSCOPIC CAMERA
Why Coupled?
Chip on Stick Technology
Focusing of Laparoscopic Camera
White Balancing of Camera
LAPAROSCOPIC VIDEO MONITOR
Endoscopic Vision (Video) Technology Evolution
TELEVISION SYSTEMS
The Formation of the Color Image
Monitor Connecting Cables
Frames of Reference in Vision
Drawbacks with the Monitor
Imaging Technical Terms
Modulation Transfer Function
Temporal Aliasing
Gaze-Down Position
THREE-DIMENSIONAL VISION
Stereopsis (3D Perception)
Binocular Vision
Physiology of Three-dimensional Vision
INVENTION OF IDEAL SHADOW IN LAPAROSCOPIC SURGERY
THREE-DIMENSIONAL VIDEO SYSTEMS
The 3D Technology Systems
New 3D Techniques
Suspended Image System
Advancement in TV System Technology
High Definition Television
Palplus
CHAPTER 3:
Laparoscopic Equipment and Instrument
INSUFFLATION SYSTEM
Laproflattor
SUCTION/IRRIGATION SYSTEM
Irrigation and Suction Tube
ENERGY SOURCE SYSTEM
Coagulating and Dissecting Electrodes
Bipolar Forceps
LAPAROSCOPIC WORKING INSTRUMENT
Disposable or Reusable Instrument
Insufflation Cannulas
Veress Needle
Hasson Cannula
PORT ACCESS INSTRUMENT
Trocar and Cannula
LAPAROSCOPIC HAND INSTRUMENTS
Different Handles of Hand Instrument
OUTER SHEATH OF HAND INSTRUMENT
Insert of Hand Instrument
Single Action Jaw Graspers
Double Action Jaw Graspers
INSTRUMENTS FOR SHARP DISSECTION
Scissors
Mechanism of Cutting
Engagement
Elastic Deformation
Plastic Deformation
Fracture
Separation
Histology of the Tissue After Cutting
TYPES OF LAPAROSCOPIC SCISSORS
Straight Scissor
Curved Scissor
Serrated Scissor
Hook Scissor
Micro-Tip Scissor
Insulated Scissors
ENDOKNIFE (SCALPEL)
Biopsy Forceps
COAGULATING AND DISSECTING ELECTRODES
Monopolar Forceps
Spatula and Hook
Ball Shaped, Barrel Shaped or Straight Coagulation Electrodes
Bipolar Forceps
Aspiration Needle
Fan Retractor
NEEDLE HOLDERS
KNOT PUSHER
LAPAROSCOPIC CLIP APPLICATOR
Cystic Duct Clip Stone
Fallop Ring Applicator
Myoma Fixation Screw
Uterine Manipulator
Tissue Morcellator
Hernia Stapler, Endoanchor and Tacker
Complication of the Use of Laparoscopic Instruments
CHAPTER 4:
Sterilization of Laparoscopic Instruments
HISTORY OF STERILIZATION
LEGISLATION IN STERILIZATION
Cleaning
ULTRASONIC TECHNOLOGY FOR CLEANING
Sterilization
Ethylene Oxide
Hydrogen Peroxide Gas Plasma
Peracetic Acid
Glutaraldehyde
Orthophthalaldehyde
Formaldehyde
Other Chemical Disinfectant
CONCLUSION
CHAPTER 5:
Anesthesia in Laparoscopic Surgery
EVALUATION AND PREPARATION OF PATIENT FOR LAPAROSCOPIC SURGERY
PHYSIOLOGICAL CHANGES DURING LAPAROSCOPY
REGIONAL ANESTHESIA
GENERAL ANESTHESIA
LOCAL ANESTHESIA
Anesthetist's Role in Laparoscopy
INTRAOPERATIVE COMPLICATIONS
Patient Selection
Monitoring
Routine Monitoring
Cardiovascular Monitoring
Respiratory Monitoring
Postoperative Considerations
CHAPTER 6:
Abdominal Access Techniques
CLOSED ACCESS
OPEN ACCESS
Anatomy of Anterior Abdominal Wall
CLOSED ACCESS TECHNIQUE
Veress Needle Insertion
Preparation of Patient
Operating Room Set-up
Patient Position
Position of Surgical Team
Preparation for Access
Choice of Gas for Pneumoperitoneum
Site of Veress Needle Entry
Where in Umbilicus?
Stabilization of Umbilicus and Incision
INTRODUCTION OF VERESS NEEDLE
Indicators of Safe Veress Needle Insertion
Needle Movement Test
Irrigation Test
Aspiration Test
Hanging Drop Test
Insufflation of Gas Test, Quadro-manometric Test
Quadro-manometric Indicators of Insufflator (Figs 6.20A and B)
Preset Pressure
Actual Pressure
Flow Rate
Total Gas Used
PRIMARY TROCAR INSERTION
Steps of Primary Trocar Insertion
Patient Position
Site
Introduction of Primary Trocar
Angle of Insertion
Confirmation of Entry of Primary Trocar
Working Ports
Subsequent Ports
Slipping of Port
Advantages of Open Technique
Steps of Open Access Technique
Transverse Incision for Open Access
Open Fielding Technique
The Scarred Abdomen
Contraindications of Umbilical Entry
PNEUMOPERITONEUM IN SPECIAL CONDITIONS
Palmer's Technique
Diagnostic Laparoscopy may be Performed Under Local Anesthesia
Obese Patients
ENTRY IN CASES OF MORBID OBESITY
Ultrasound Visceral Slide
Sounding Test
Visually Guided Entry
Postoperative Chest and Shoulder Pain After Laparoscopy
Complications of Access Technique
Visceral Injuries
Incidence of Injury of Hollow Viscus
Solid Organs
Vessel Injury
Other Complications
Mild-to-Moderate Hypotension
Withdrawal of Instruments and Ports
PORT CLOSURE TECHNIQUES
Gasless Laparoscopic Surgery
Three Basic Types
Disadvantages of Gasless Laparoscopic Surgery
CHAPTER 7:
Principle of Laparoscopic Port Position
PRIMARY PORT POSITION
SECONDARY PORT POSITION
Baseball Diamond Concept of Port Position
FIRST DECIDE THE TARGET
Draw the Line of Optimum Area
Telescope and Instruments
Rule of Diamond for LAVH
PORT POSITION IN VARIOUS SURGERIES
DRAWBACKS OF INCORRECT PORT POSITION
Swording
CHAPTER 8:
Laparoscopic Dissection Techniques
TYPES OF LAPAROSCOPIC DISSECTION
BLUNT DISSECTION
Instrument Used
Methods
Pledget Dissection
Tissue Stripping and Tissue Distraction
SHARP DISSECTION
SCISSORS DISSECTION
Electrosurgical Dissection
HIGH FREQUENCY ELECTROSURGICAL DISSECTION
HF Monopolar Electrosurgery
Patient Return Electrodes
Choose
Avoid
Consider
Bipolar Diathermy
Bipolar Electrosurgery
Tripolar Electrosurgery
USE OF THE DIATHERMY HOOK
Electrosurgical Hooks (Fig. 8.15)
Fulguration
Desiccation
Safety During Electrosurgery
Safety Considerations in MAS
Overshooting
Overcooking
Direct Coupling
Capacitive Coupling
Insulation Failure
Surgical Smoke
Argon Beamer Coagulator
ULTRASONIC DISSECTION
HIGH VELOCITY WATER JET DISSECTION
Hydrodissection
LASER DISSECTION
CRYOTHERAPY AND RADIOFREQUENCY ABLATION
Tissue Response Electrosurgical Generator
CHAPTER 9:
Laparoscopic Tissue Approximation Techniques
LAPAROSCOPIC SUTURING AND KNOTTING
Choice of Suture Material
Ideal Suture Characteristics
Types of Sutures
Absorbable Sutures
Nonabsorbable Sutures
Suture Size
Knots
LAPAROSCOPIC NEEDLE
Endoski Needle
Laparoscopic Suture Material
Types of Laparoscopic Surgical Knots
ROEDER'S KNOT (FIGS 9.2A TO U)
THE MELTZER SLIP KNOT
Tying a Meltzer knot
Applications
THE TAYSIDE KNOT (FIGS 9.4A TO O)
Applications
USING A PRETIED LOOP (FIG. 9.5)
Clinical Uses
EXTRACORPOREAL KNOT FOR CONTINUOUS STRUCTURE
Clipping
CAT EYE STONE
LAPAROSCOPIC INTERNAL SUTURING
INSTRUMENTATION
The Needle
Endoski Needle
Needle Holders
Needle Control
Introduction into the Body Cavity
To Insert the Needle
Manipulation
Position
Passage Through the Tissues
Tensioning
Microsurgical Tying
Steps of Surgeons Knot (Figs 9.10A to H)
Tumble Square Knot (Figs 9.11A to G)
CONTINUOUS SUTURING
Dundee Jamming Slip Knot
Starting a Continuous Suture
Applications
Aberdeen Termination
INTERRUPTED SUTURES
Interrupted Knots
Applications of Interrupted Sutures
Stapled Anastomosis
Clinical Applications
Sutured Anastomosis
Direction of Suturing
TECHNIQUES TO ASSIST IN CONTROL OF BLEEDING
Methods of Securing Hemostasis
Avoid Blind Coagulation
Suction and Irrigation
CHAPTER 10:
Hand-assisted Laparoscopic Surgery
INTRODUCTION
HAND PORT DEVICES
OMNI PORT
INDICATION OF HALS
ADVANTAGE OF HALS
LIMITATIONS OF HALS
LAPDISC HAND ACCESS DEVICE
Indications
WARNINGS AND PRECAUTIONS
LD111-Precaution
LD112-Precaution
FUTURE PROSPECT OF HALS
CHAPTER 11:
Tissue Retrieval Technique
ENDOBAGS
COLPOTOMY
HAND-ASSISTED LAPAROSCOPIC SURGERY
MORCELLATOR
CHAPTER 12:
Laparoscopic Port Closure Technique
WITHDRAWAL OF INSTRUMENT AND PORTS
Laparoscopic Port Closure Instruments
Port Closure Needle
SECTION 2: LAPAROSCOPIC GENERAL SURGICAL PROCEDURES
CHAPTER 13:
Laparoscopic Cholecystectomy
INDICATIONS (FIG. 13.1)
Contraindications
ADVANTAGE OF LAPAROSCOPIC APPROACH
Preoperative Investigations
Patient Position
Position of Surgical Team (Fig. 13.2)
Tasks Analysis
Port Location (Figs 13.3A to C)
Laparoscopic Anatomy (Fig. 13.4)
EXPOSURE OF GALLBLADDER AND CYSTIC PEDICLE (FIGS 13.5A TO D)
ADHESIOLYSIS (FIGS 13.6A TO D)
DISSECTION OF CYSTIC PEDICLE (FIGS 13.8A TO D)
Separation of Cystic Duct from Artery (Figs 13.9A to D)
Clipping and division of Cystic Duct (Figs 13.10A to H)
Clipping and Division of Cystic Artery (Figs 13.11A to F)
Operative Cholangiogram (Fig. 13.12)
INTRAOPERATIVE ULTRASONOGRAPHY
Ligation of Cystic Duct
Dissection of Gallbladder from Liver Bed (Fig. 13.13)
Extraction of Gallbladder (Figs 13.15A to D)
Ending of the Operation
Three-port Cholecystectomy
Laparoscopic Cholecystectomy in Acute Cholecystitis
Laparoscopic Cholecystectomy During Pregnancy
Postoperative Care
COMPLICATIONS OF LAPAROSCOPIC CHOLECYSTECTOMY
Early Complication
Late Complication
LAP CHOLE AND CBD INJURY
Common Cause of CBD Injury
TYPE OF CBD INJURY
Bismuth Classification
Strategy to Handle Complication Recognized Postoperatively
HOW TO AVOID INJURY
CHAPTER 14:
Laparoscopic CBD Exploration
INTRAOPERATIVE CHOLANGIOGRAPHY (IOC)
Techniques of Cholangiography
LAPAROSCOPIC ULTRASONOGRAPHY (LUS)
Criteria for Routine Intraoperative Cholangiography
Preoperative Factors
Intraoperative Factors
LAPAROSCOPIC EXTRACTION OF COMMON BILE DUCT STONES
Study of European Association for Endoscopic Surgery (EAES)
PROCEDURE
Patient Position
Port Position
CHAPTER 15:
Laparoscopic Appendicectomy
LAPAROSCOPIC ANATOMY
ADVANTAGE OF LAPAROSCOPIC APPENDECTOMY
Indications
Relative Contraindications
Patient Position
Port Position
ALTERNATIVE PORT AND THEATER SET-UP
Operative Technique
Retraction of Appendix
Stapler Appendicectomy
Extraction of Appendix
RISK FACTORS IN LAPAROSCOPIC APPENDECTOMY
Missed Diagnosis
Bleeding
Visceral Injury
Wound Infection
Incomplete Appendectomy
Leakage of Purulent Exudates
Intra-abdominal Abscess
Hernia
Laparoscopic Assisted Appendectomy
Discussion
CHAPTER 16:
Laparoscopic Repair of Inguinal Hernia
LAPAROSCOPIC ANATOMY
One Median Umbilical Ligament
Two Medial Umbilical Ligament One on Either Side
Two Lateral Umbilical Ligaments
Triangle of Doom (Fig. 16.5)
Triangle of Pain
Circle of Death
INDICATIONS OF LAPAROSCOPIC REPAIR OF HERNIA
Contraindications of Laparoscopic Repair of Hernia
ADVANTAGES OF LAPAROSCOPIC APPROACH
DISADVANTAGES OF OPEN METHOD
Types of Laparoscopic Hernia Repair
Patient Selection
TRANSABDOMINAL PREPERITONEAL REPAIR OF INGUINAL HERNIA
Position of Surgical Team
Port Position
PROCEDURE OF TAPP
Placement of the Mesh
Implant for Fixing Mesh
Repair of Bilateral Inguinal Hernia
Repair of Recurrent Inguinal Hernia
Laparoscopic Hernia in Children
Ending of the Operation
TOTALLY EXTRAPERITONEAL HERNIA REPAIR
ADVANTAGE OF TEP
DISADVANTAGE OF PREPERITONEAL REPAIR
Preparation of the Patient
Approach to Preperitoneal Space
Insertion of Port
Sweeping Movement of Telescope
Dissection of Preperitoneal Space and Cord Structures in TEP
Ending of the Operation
LAPAROSCOPIC REPAIR OF FEMORAL HERNIA
COMPLICATIONS OF LAPAROSCOPIC HERNIA REPAIR
Relative Contraindication for Laparoscopic Approach
Inguinal Hernia Repair in Pediatric Patients
Inguinal Hernia Repair in Obese Patients
Inguinal Hernia Repair in Recurrence
Operating Time
Postoperative Pain and Amount of Narcotics Used
Complication Rates
INTRAOPERATIVE COMPLICATIONS AND PRECAUTION
During Creation of Preperitoneal Space
Precautions During Port Placement
Correct Identification of the Anatomical Landmarks
Bladder Injuries
Bowel Injuries
Vascular Injury
Injury to Vas Deferens
Pneumoperitoneum
POSTOPERATIVE COMPLICATIONS
Seroma/Hematoma Formation
Urinary Retention
Vascular Injury
Nerve Entrapment and Injury
Other Complications
Neuralgias
Testicular Pain and Swelling
Mesh Infection and Wound Infection
Recurrence
POSTOPERATIVE RECOVERY
RECURRENCE
CAUSES OF RECURRENCE IN LAPAROSCOPIC INGUINAL HERNIA REPAIR
Mesh Size
Mesh Material
Fixation of the Mesh
Technical Experience
Collagen Status
Other Factors
Bilateral Assessment and Treatment
Cost Effectiveness
Learning Curve
RECOMMENDATION
CHAPTER 17:
Laparoscopic Repair of Ventral Hernia
INTRODUCTION
LAPAROSCOPIC ANATOMY
OPERATIVE PROCEDURE
Position of Surgical Team
Port Position
CHOICE OF MESH IN VENTRAL HERNIA
Synthetic Materials
SURGISIS
ALLODERM
PROCEED
THE SECOND TECHNIQUE
Preperitoneal Repair of Ventral Hernia
COMPLICATIONS
DISCUSSION
MESH PLACEMENT AND FIXATION
BOWEL INJURY
ADHESION
INFECTION
SEROMA
POSTOPERATIVE PAIN
OBESITY
RECURRENCE
CHAPTER 18:
Laparoscopic Repair of Hiatus Hernia
INTRODUCTION
Type I or Sliding Hernia
Type II or Paraesophageal
Type III or Mixed Hernia
SYMPTOMS OF TYPE II HIATUS HERNIA
Preoperative Evaluation
Mandatory
Selective
Port Position
OPERATIVE PROCEDURE OF GIANT PARAESOPHAGEAL HERNIA
RECOMMENDATION TO AVOID COMPLICATION
CHAPTER 19:
Laparoscopic Repair of Duodenal Perforation
INTRODUCTION
LAPAROSCOPIC APPROACH HAS ADVANTAGES
Patient Selection
OPERATIVE TECHNIQUE
Patient Position
Anesthesia
Creation of Pneumoperitoneum
Port Location
Locating the Perforation
Cleaning the Abdomen
Closure of the Perforation with an Omental Patch
Ending of the Operation
DISCUSSION
Laparoscopic Closure of Perforation Offers Important Advantages
CHAPTER 20:
Laparoscopic Fundoplication
PATHOPHYSIOLOGY
Symptoms
Diagnostic Test
Treatment of GERD
Indications for Surgical Treatment
Methods of Fundoplication
Types of Fundoplication Surgery
Patient Selection
OPERATIVE TECHNIQUE
Patient Position
Port Position
PROCEDURE
Tissue Dissection and Mobilization
Lesser Sac Opened
Fundus Pull
Crural Approximation
Fundoplication
Ending of the Operation
CHAPTER 21:
Sleeve Gastrectomy
INTRODUCTION
Ghrelin Hormone
Advantages of Sleeve Gastrectomy
Disadvantages of Sleeve Gastrectomy
The Risks and Complications of the Sleeve Gastrectomy
Complications include:
Surgical Technique
WEIGHT LOSS
CHAPTER 22:
Laparoscopic Splenectomy
OPERATING ROOM SET-UP AND PATIENT POSITION
Port Position
Operative Procedure
CHAPTER 23:
Laparoscopic Management of Hepaticopancreatic Diseases
TECHNIQUE OF LAPAROSCOPIC MANAGEMENT OF HYDATID CYSTIC LIVER
LAPAROSCOPIC LIVER RESECTION
Laparoscopic Staging of Tumors
HEPATIC RESECTIONS
Approaches
Component Tasks in Laparoscopic Hepatic Resections
Contact Ultrasound Localization and Mapping of the Intended Resection
Division of Falciform Ligament
Exposure of Suprahepatic Inferior Vena Cava and Main Hepatic Veins
Exposure of Infrahepatic Inferior Vena Cava and Division of the Posterior Minor Hepatic Veins
Opening the Cave of Retius
Hilar Dissection
Removal of the Gallbladder
Inflow Occlusion Prior to Hepatic Resection
Transection of the Hepatic Parenchyma
Hemostasis of the Cut Liver Surface
Insertion of Drains
Postoperative Management
LAPAROSCOPIC PANCREATIC SURGERY
Anatomic Considerations
Laparoscopic Staging of Pancreatic Malignancy
Staging Laparoscopy Technique
Bilioenteric or Gastroenteric Anastomosis for Pancreatic Malignancy
Biliary and Gastric Bypass
Laparoscopic Pancreatic Resection
Laparoscopic Management of Pancreatic Pseudocyst
LAPAROSCOPIC PSEUDOCYST DRAINAGE
CONCLUSION
CHAPTER 24:
Diagnostic Laparoscopy
INDICATIONS
Non-traumatic, Non-gynecological Acute Abdomen Like
Gynecological Abdominal Emergencies Like
CONTRAINDICATIONS
Choice of Anesthesia
LAPAROSCOPIC ANATOMY
Patient Position
Position of the Surgical Team
Port Position
Operative Procedure
Systemic Plan of Inspection in Mid Abdomen
Inspection of Pelvis
ROLE OF LAPAROSCOPY IN ASCITES
The Value of Laparoscopic Diagnosis of TB
Role of Laparoscopy in Carcinoma Assessment
Dialysis Catheter and Laparoscopy
Port-site Metastasis
Laparoscopy and Ascites
DIAGNOSTIC LAPAROSCOPY
Ending of the Operation
Laparoscopy for Abdominal Trauma
Complications
CONCLUSION
CHAPTER 25:
Laparoscopic Small Bowel Surgery
LAPAROSCOPIC RESECTION OF SMALL BOWEL
Indications
Patient Positioning and Operating Room Setup
Port Position
Operative Technique
ILEOCOLECTOMY
Indications
Operative Technique
CHAPTER 26:
Laparoscopic Colorectal Surgery
INTRODUCTION
Port Site Metastasis
Bowel Preparation in Colorectal Surgery
Elemental Diets
Whole Gut Irrigation
Antibiotic Bowel Preparations
Oral Antibiotics
Parenteral Antibiotics
Right Colectomy
Indications
Contraindications
Equipment and Instruments
Patient Positioning and Operating Room Setup
Operative Technique
Conclusion
SIGMOIDECTOMY
Patient Positioning and Operating Room Setup
Cannula Positioning
Operative Technique
Exposure
Sigmoid Colon Resection for Cancer
Primary Vascular Approach (Medial Approach)
Peritoneal Incision
Identification of the Inferior Mesenteric Artery
Identification of the Inferior Mesenteric Vein
Mobilization of the Sigmoid and Descending Colon
Posterior Detachment
Lateral Mobilization
Dissection of the Upper Mesorectum
Resection of the Specimen
Division of the Rectum
Proximal Division
Mobilization of the Splenic Flexure
Lateral Mobilization of the Splenic Flexure
Medial Mobilization
Extraction of Colon
Incision to Extract the Specimen
Anastomosis
Wound Closure
Sigmoidectomy for Diverticular Disease
Peritoneal Incision
Resection of the Specimen
Extraction of the Specimen
Special Considerations
LOW ANTERIOR RESECTION
Patient Positioning
Position of Surgical Team
Port Position
Defining and Dividing the Inferior Mesenteric Pedicle
Mobilization of the Lateral Attachments of the Rectosigmoid and Descending Colon
Mobilization of the Splenic Flexure
Rectal Mobilization
Division of Rectum
Extraction and Anastomosis
ABDOMINOPERINEAL RESECTION
Patient Position
Position of Surgical Team
Port Position
Exposure and Dissection of Retroperitoneum
Division of the Left Colon
Rectal Mobilization
Formation of Trephine Left Iliac Fossa Colostomy
Perineal Dissection
HARTMANN REVERSAL
Patient Position
Position of Surgical Team
Left Colon Mobilization
Mobilization of Rectum
Specimen Extraction and Anastomosis
Conclusion
RESECTION RECTOPEXY
Patient Position
Position of Surgical Team
Port Position
Dissection
Division of Inferior Mesenteric Vessel
Mobilization of the Lateral Attachmentsof the Rectosigmoid
Mobilization of Rectum
Rectal Division
Specimen Extraction and Anastomosis
Rectopexy (Figs 26.45A and B)
WELLS OR MARLEX RECTOPEXY
Mobilization of the Lateral Attachments of the Rectosigmoid
Rectal Mobilization
Rectopexy
Complication of Colorectal Surgery
Wound Infection
Anastomotic Leak
Early Postoperative Small Bowel Obstruction
TIPS AND TRICKS
CONCLUSION
CHAPTER 27:
Laparoscopic Adhesiolysis
CONTRAINDICATIONS
Patient Position
Position of the Surgical Team
Port Position
LAPAROSCOPIC ADHESIOLYSIS
SECTION 3: LAPAROSCOPIC GYNECOLOGICAL PROCEDURES
CHAPTER 28:
Laparoscopic Sterilization
LAPAROSCOPIC ANATOMY
CONTRAINDICATIONS
Patient Position
Port Position
Operative Procedure
Methods of Tubal Sterilization (Fig. 28.3)
BIPOLAR COAGULATION
FALOPE RING APPLICATION
Operative Technique
CHAPTER 29:
Laparoscopic Ovarian Surgery
LAPAROSCOPIC OVARIAN ANATOMY
LAPAROSCOPIC MANAGEMENT OF OVARIAN CYST
Patient Position
Port Position
Operative Procedure
Ovarian Cystectomy
Endometriomas
Benign Cystic Teratoma
LAPAROSCOPIC OOPHORECTOMY
Indications of Oophorectomy
CONTRAINDICATIONS
Operative Procedure
Dissection of the Infundibulopelvic Ligament
Salpingo-oophorectomy
Dysgenic Gonads
Ovarian Wedge Resection and Ovarian Drilling
Ovarian Torsion
Ovarian Remnant Syndrome
Par Ovarian Cysts
CHAPTER 30:
Laparoscopic Tubal Surgery
LAPAROSCOPIC TURBAL ANATOMY
Patient Position
Port Position
OPERATIVE PROCEDURE
Management of Acute PID
Laparoscopy for Adnexal Torsion
Laparoscopic Tubal Reconstruction and Anastomosis
Laparoscopic Management of Distal Tubal Occlusion
Neosalpingostomy
Salpingoscopy
Salpingectomy
CHAPTER 31:
Laparoscopic Management of Ectopic Pregnancy
ECTOPIC PREGNANCY
DISCUSSION
LAPAROSCOPY VS LAPAROTOMY IN TREATMENT OF ECTOPIC PREGNANCIES
CHAPTER 32:
Laparoscopic Surgery in Pregnancy: Precautions and Complications
PHYSIOLOGICAL CHANGES IN PREGNANCY
Gastrointestinal System
Cardiovascular and Hematological Changes
Respiratory System
Urinary System
Other Changes
FETAL CONSIDERATION
EFFECTS OF PNEUMOPERITONEUM IN PREGNANCY DURING LAPAROSCOPIC PROCEDURE
CRITERIA FOR PATIENT SELECTION
ADVANTAGES OF LAPAROSCOPY IN PREGNANCY
Risk of Laparoscopy in Pregnancy
Strategies for Safe Laparoscopic Surgery in Pregnancy
Society of American Gastrointestinal Endoscopic Surgery (SAGES) Recommendations
DISCUSSION
CONCLUSION
CHAPTER 33:
Laparoscopic Management of Endometriosis
INTRODUCTION
Lysis of Bowel Adhesions
PERITONEAL IMPLANTS
RESECTION OF OVARIAN ENDOMETRIOSIS
GENITOURINARY ENDOMETRIOSIS
GASTROINTESTINAL ENDOMETRIOSIS
DIAPHRAGMATIC ENDOMETRIOSIS
CHAPTER 34:
Laparoscopic Hysterectomy
LAPAROSCOPIC ANATOMY OF UTERUS
Indications of Laparoscopically Assisted Vaginal Hysterectomy
CLASSIFICATION
Garry and Reich Classification
Preoperative Measures
Patient Position
Position of Surgical Team (Fig. 34.4)
Port Position
Operative Technique
Colpotomy
Total Laparoscopic Hysterectomy
Subtotal Hysterectomy
Ending the Procedure
DISCUSSION
CHAPTER 35:
Laparoscopic Myomectomy
PROCEDURE
REMOVAL OF MYOMA
CHAPTER 36:
Laparoscopic Management of Stress Incontinence
PATHOPHYSIOLOGY
Laparoscopic Anatomy
Preoperative Evaluation
Operative Technique
CHAPTER 37:
Minimally Invasive Sling Operation for Stress Incontinence
TENSION-FREE VAGINAL TAPE
Surgical Technique
Transobturator Tape
Functional Theories and Comparison with Tension-free Vaginal Tape
Operative Technique of TVT-O
CONTRAINDICATIONS OF TENSION-FREE VAGINAL TAPE AND TRANSOBTURATOR TAPE
WARNINGS AND PRECAUTIONS
CHAPTER 38:
Laparoscopic Sacral Colpopexy
INDICATIONS
Symptomic Prolapse
OPERATIVE PROCEDURE
VESICOVAGINAL FISTULA REPAIR
TECHNIQUE
CONCLUSION
CHAPTER 39:
Essentials of Hysteroscopy
DEFINITION
INDICATIONS
CONTRAINDICATIONS
HISTORY (FIGS 39.2A AND B)
DELIVERY DEVICES
DISTENDING MEDIA
FLUID MONITORING
EXCESSIVE FLUID ABSORPTION
Resectoscope
Procedure
Complications of Operative Hysteroscopy
Safety Measures
Dilatation of the Cervix
Bleeding
Excessive Intravasation of Distending Media or CO2 Gas
Adhesions
Burn Injury to the Bowel
Infection
Hysteroscopy in Abnormal Uterine Bleeding (Fig. 39.6)
Hysteroscopy in Cases of Infertility
Tubal Cause of Infertility
Hysteroscopic Correlation and Diagnosis
Contraindications of Hysteroscopy
SECTION 4: LAPAROSCOPIC UROLOGY
CHAPTER 40:
Ureteral Injury and Laparoscopy
URETERAL INJURIES
FREQUENCY OF URETERAL INJURY
Etiology
LEVEL OF URETERAL INJURIES
PREVENTION OF URETERAL INJURY
RECOGNITION OF URETERAL INJURY
Pathophysiology
Spontaneous Resolution and Healing
Hydronephrosis
Ureteral Necrosis with Urinary Extravasation
Ureteral Stricture
Uremia
Management
Observation
Ureteral Stenting with or without Ureterotomy
Ureteral Resection and Ureteroureterostomy
Transureteroureterostomy
Ureteroneocystostomy
Preoperative Details
Intraoperative Details
Ureteral Stent Placement with or without Ureterotomy
Ureteroureterostomy
Transureteroureterostomy
Psoas Hitch
Boari Flap
Postoperative Details
Ureteral Stent
Ureteroureterostomy, Transureteroureterostomy, Psoas Hitch and Boari Flap
Follow-up
CONCLUSION
CHAPTER 41:
Laparoscopic Urological Procedures
LAPAROSCOPIC NEPHRECTOMY
Operative Technique
LAPAROSCOPIC VARICOCELECTOMY
Operative Technique
LAPAROSCOPIC RETROPERITONEAL NODE DISSECTION
LAPAROSCOPIC MANAGEMENT OF LYMPHOCELES
Operative Technique
LAPAROSCOPIC URETEROLYSIS
LAPAROSCOPIC ILEAL CONDUIT
LAPAROSCOPIC PELVIC LYMPHADENECTOMY
Operative Technique
SECTION 5: PEDIATRIC LAPAROSCOPY
CHAPTER 42:
Laparoscopic Pediatric Surgery
LAPAROSCOPY IN INFANTS AND CHILDREN
Laparoscopic Appendicectomy in Children
Other Causes of Pain in Abdomen in Pediatric Age Group
Laparoscopic Cholecystectomy in Children
Laparoscopic Splenectomy in Children
LAPAROSCOPIC REPAIR OF PEDIATRIC HERNIA
Laparoscopic Pediatric Fundoplication
LAPAROSCOPIC PEDIATRIC UROLOGY
LAPAROSCOPY FOR THE IMPALPABLE UNDESCENDED TESTICLE OR INTERSEX EVALUATION
Operative Technique
OTHER LAPAROSCOPIC PEDIATRIC UROLOGICAL PROCEDURES
Laparoscopic Pediatric Nephrectomy
Stone Removal
Renal Biopsy
Adrenalectomy
Dismembered Pyeloplasty
Bladder Autoaugmentation
Ureteral Reimplantation
Excision of Prostatic Utricles
Complicated Urachal Disease
SECTION 6: MISCELLANEOUS
CHAPTER 43:
Other Minimal Access Surgical Procedures
TWO PORT CHOLECYSTECTOMY
Ending of the Operation
TWO PORT REPAIR OF VENTRAL HERNIA
Single Incision Laparoscopic Surgery
Synonym
Equipment
Advantage of SILS
Disadvantage of SILS
Retroperitoneoscopy
HISTORICAL PERSPECTIVE
SURGICAL TECHNIQUE
Retroperitoneoscopy through the Flank
Retroperitoneoscopy: Anterolateral
Retroperitoneoscopy for Pelvic Lymph Node
Conclusion
MINIMAL ACCESS NECK SURGERY
Background
Endoscopic Parathyroidectomy
Alternatives to Endoscopic Parathyroidectomy
Thoracoscopic Parathyroidectomy
Endoscopic Thyroidectomy
Conclusion
MINIMAL ACCESS SURGERY IN ORTHOPEDIC SURGERY
Introduction
History
ARTHROSCOPIC SURGERY IN SPORTS RELATED INJURIES AND OTHER PATHOLOGY
Knee Joint
Diagnosis
Trauma
Ligamentous Injury
Meniscal Injury
Chondral Injury
Osteoarthritis
Hip Joint
Ankle Joint
Shoulder Joint
Elbow Joint
Wrist Joint
MINIMAL ACCESS SURGERY IN ORTHOPEDIC TRAUMA
SPINE SURGERY AND ARTHROSCOPY
BONE ENDOSCOPY AND TUMORS
CHAPTER 44:
Minimal Access Bariatric Surgery
LAPAROSCOPIC TREATMENT FOR MORBID OBESITY
Results of Different Bariatric Surgery
Laparoscopic Vertical Banded Gastroplasty
Laparoscopic Roux-en-Y Gastric Bypass
Laparoscopic Adjustable Gastric Banding
SLEEVE GASTRECTOMY
CONCLUSION
CHAPTER 45:
Complications of Minimal Access Surgery
INTRODUCTION
ANESTHETIC AND MEDICAL COMPLICATIONS IN LAPAROSCOPY
Carbon Dioxide Embolism
Diagnosis of CO2 Embolism
Prevention of CO2 Embolism
Management of CO2 Embolism
Cardiovascular Complications
Gastric Reflux During Laparoscopy
Extraperitoneal Gas
Diagnosis
Prevention
Management
Electrosurgical Complications
Active Electrode Trauma
Diagnosis
Prevention
Management
Remote Injury
Insulation Failure
Direct Coupling
Capacitive Coupling
Dispersive Electrode Burns
Electrode Shields and Monitors
HEMORRHAGIC COMPLICATIONS
Hemorrhage Associated with Access Technique
Great Vessel Injury
Diagnosis
Prevention
Management
Abdominal Wall Vessels
Diagnosis
Prevention
Management
Intraperitoneal Vessel Injury
Diagnosis
Prevention
Management
GASTROINTESTINAL COMPLICATIONS
Insufflation Needle Injuries
Recognition
Management
Trocar Injuries
Diagnosis
Prevention
Management
INJURY TO BLADDER
Diagnosis
Prevention
Treatment
NEUROLOGIC INJURY
Diagnosis
Prevention
Management
DISSECTION AND THERMAL INJURY
Recognition
Prevention
Management
INCISIONAL HERNIA
Diagnosis
Prevention
Management
INFECTION
CHAPTER 46:
Role of Training in Minimal Access Surgery
INTRODUCTION
Skill-based Behavior
Rule-based Behavior
Knowledge-based Behavior
TRAINING—OBJECTIVES, NEEDS, AND MEANS
PRESENT TRAINING IN LAPAROSCOPY
LEARNING CURVE IN LAPAROSCOPY
DEFINITION AND DESCRIPTION
THE DRAWING OF LEARNING CURVES
FACTORS AFFECTING LEARNING CURVES
STATISTICAL EVALUATION OF LEARNING CURVES
EFFECT OF LEARNING CURVE ON RANDOMIZED CONTROLLED TRIALS
IMPLICATIONS FOR PRACTICE AND TRAINING
WHAT ARE THE LIMITATIONS OR PITFALLS?
ETHICAL DILEMMAS
THE WAY FORWARD
CONCLUSION
IMPORTANT RESOURCES
CHAPTER 47:
Minimal Access Robotic Surgery
INSTRUMENTS OF ROBOTIC SURGERY
da Vinci Surgical System (Figs 47.9 to 47.20)
Core Technology
INSTRUMENTATION
INSTRUMENTS AND ACCESSORIES
OPERATING ROOM CONFIGURATION, PORT PLACEMENT AND DOCKING
Operating Room Configuration
Surgeon Console Position
Patient Cart Positioning
Motor Drive Operation
Shift Switches
Vision Cart Positioning
Steps of Docking
Port Placement
Working Ports
Remote Center Technology
Positioning the Patient Cart
Docking the Camera Arm
Docking of Instrument Arms
Check System Set-up
Endoscope Insertion and Removal
Instrument Insertion
Instrument Removal and Guided Tool Change
Guided Tool Change
ROBOTIC CHOLECYSTECTOMY
Introduction
SEGMENTS OF ROBOTIC CHOLECYSTECTOMY
Segment Operative Tasks
Preoperative Preparation
Patient Position
Port Position (Fig. 47.53)
DOCKING AND OPERATING ROOM SET-UP
OPERATIVE TECHNIQUE
Step 1 (Diagnostic Laparoscopy and Port Position)
Step 2 (Docking of Robotic Cart)
Step 3
Step 4
Step 5
Step 6
Step 7
Step 8
Step 9
Step 10
DISCUSSION
Advantages
Limitations
Conclusion
ROBOTIC CORONARY BYPASS SURGERY
ROBOTIC PROSTATECTOMY
Robotic Versus Laparoscopic Prostatectomy
CHAPTER 48:
Transanal Endoscopic Microsurgery
INDICATIONS OF TRANSANAL ENDOSCOPIC MICROSURGERY
Benign
Malignant
INSTRUMENTS
PATIENT POSITIONING IN TRANSANAL ENDOSCOPIC MICROSURGERY
TRANSANAL ENDOSCOPIC MICROSURGERY PROCEDURES (FIGS 48.11 TO 48.15)
COMMON COMPLICATIONS
CONCLUSION
CHAPTER 49:
Future of Minimal Access Surgery
MINIMAL ACCESS TECHNIQUES
Established
Under Evaluation
Prospects
NATURAL ORIFICE TRANSLUMINAL ENDOSCOPIC SURGERY
Safe Application of NOTES
CHAPTER 50:
Troubleshooting and Checklist
PROCEDURE CHECKLISTS: VERESS NEEDLE INSERTION
Check and Set the Insufflator
Pressure Level and Flow Rate
Check that the Needle is in the Correct Position
Insufflate
Use of the Diathermy Hook
Introduction of a Pledget into the Abdominal Cavity
Retrieval of a Pledget from the Abdominal Cavity
Application of Metal Clips
How do laparoscopy on the abdomen with previous scar?
Hasson's Technique
Open Fielding Technique
The Advantages of Using the Open Technique are Many
Alternative Sites for Introducing Veress Needle
For Previous Laparotomy with Midline Incision
For a Previous Laparotomy with Upper Midline Incision
For Previously Operated Abdomen with a Solitary Incision in an Upper or Lower Abdominal Quadrant
For Patient with Previously Operated Abdomen in Multiple Quadrants
Transvaginal or Transuterine Insufflation
Insufflation with an Optical Trocar (Visiport)
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