Laparoscopic procedures

Description

Foreword Preface Acknowledgements Contents Contributors 1: The Anatomy of the Small Intestine 1.1 Duodenum 1.1.1 Vascular Supply, Lymphatic Drainage and Innervation of the Duodenum 1.1.1.1 Arteries 1.1.1.2 Veins 1.1.1.3 Lymphatic Drainage 1.1.1.4 Innervation 1.2 Jejunum 1.3 Ileum 1.4 Vascular Supply, Lymphatic Drainage and Innervation of the Small Bowel 1.4.1 Arterial Supply 1.4.2 Venous Drainage 1.4.3 Lymphatic Drainage 1.4.4 Innervation References 2: The Anatomy of the Large Intestine 2.1 Midgut Region of the Large Intestine 2.1.1 Ileocolic Junction 2.1.2 Caecum 2.1.3 Appendix 2.1.4 Ascending Colon 2.1.5 Hepatic Flexure 2.1.6 Transverse Colon 2.1.7 Vascular Supply and Lymphatic Drainage of the Midgut 2.1.7.1 Arterial Supply 2.1.7.2 Venous Drainage 2.1.7.3 Lymphatic Drainage 2.1.8 Innervation 2.2 Hindgut Region of the Large Intestine 2.2.1 Splenic Flexure 2.2.2 Descending Colon 2.2.3 Mesocolon 2.2.4 Sigmoid Colon 2.2.5 Anorectum: Rectum and Anal Canal 2.2.5.1 Rectum 2.2.6 Mesorectum and Rectal Fasciae 2.2.7 Anal Canal 2.2.8 Vascular Supply and Lymphatic Drainage of the Hindgut 2.2.8.1 Arterial Supply 2.2.8.2 Venous Drainage 2.2.8.3 Lymphatic Drainage 2.2.9 Innervation References 3: Laparoscopic Appendicectomy 3.1 Introduction 3.2 Anatomical Considerations 3.3 Operative Approach: Open Appendicectomy 3.3.1 Classic Gridiron Exposure 3.3.2 Incision in Peritoneum 3.3.3 Devascularisation of the Appendix 3.3.4 Burial of the Appendix Stump 3.4 Operative Approach: Laparoscopic Appendicectomy 3.4.1 Visualisation and Retraction of the Appendix 3.4.2 Entering the Avascular Window at the Base of the Mesentery 3.4.3 Transection of the Appendix 3.4.4 Transection of the Mesoappendix 3.4.5 Retrieval of the Appendix 3.5 Results 3.5.1 Laparoscopic Versus Open Appendicectomy 3.5.2 Have Surgical Trends Changed? 3.6 Conclusion References 4: Laparoscopic Ileostomy and Colostomy for Faecal Diversion 4.1 Introduction 4.2 Preoperative Considerations 4.3 Operative Steps 4.3.1 Laparoscopic Loop Ileostomy 4.3.1.1 Aqueous Povidone Solution 4.3.1.2 Entry Technique and Port Placement 4.3.1.3 Locating Terminal Ileum 4.3.1.4 Ileal Loop Selection 4.3.1.5 Internal Loop Orientation 4.3.1.6 Creation of the Stoma Aperture 4.3.1.7 External Loop Orientation 4.3.1.8 Loop Ileostomy Formation 4.4 Laparoscopic End Ileostomy 4.5 Laparoscopic End Colostomy 4.5.1 Alcoholic Chlorhexidine Solution 4.5.2 Entry Technique and Port Placement 4.5.3 Dissection and Mobilisation 4.5.4 Transection Technique 4.5.5 Delivering the Proximal End of Bowel 4.5.6 Creation of the Stoma Aperture 4.6 Laparoscopic Loop Colostomy 4.7 Postoperative Management 4.7.1 High-Output Stomas 4.7.2 Parastomal Hernia 4.7.3 Mucocutaneous Separation 4.7.4 Stoma Retraction 4.7.5 Stomal Stenosis 4.7.6 Peristomal Pyoderma Gangrenosum References 5: Oncological Right Colectomy by Laparoscopic Medial-to-Lateral Approach with Total Mesocolic Excision 5.1 Technique 5.1.1 General Considerations 5.1.2 Medial-to-Lateral Dissection: Five Steps 5.1.3 Side-to-Side Stapled Ileocolic Anastomosis: Three Steps 5.1.4 Essentials 5.2 Conclusions References 6: Laparoscopic Extended Right Colectomy 6.1 Indications 6.2 Preoperative Assessment and Preparation 6.3 Anaesthesia 6.4 Procedure: Key Steps 6.5 Patient Positioning 6.6 Instrument Positioning 6.7 Umbilical Port Insertion 6.8 Laparoscopy and Insertion of Remaining Ports 6.9 Definitive Laparoscopic Setup 6.10 Defining and Dividing the Ileocolic Pedicle 6.11 Mobilisation of the Hepatic Flexure 6.12 Division of Middle Colic Vessels 6.13 Mobilisation of the Ileocaecal Junction 6.14 Specimen Extraction 6.15 Conclusion 7: The Initial Retrocolic Endoscopic Tunnel Approach (IRETA) to a Laparoscopic-Assisted Radical Right Colectomy: A (Modified) Lateral-to-Medial Technique for the Complete Mesocolic Excision of the Right Colon 7.1 Introduction 7.2 Advantages of the IRETA Technique 7.2.1 Aim 7.2.2 Objectives 7.2.3 Indications 7.2.4 Contraindications 7.2.5 Operative Theatre Setup 7.2.6 Patient Preparation 7.2.7 Patient Operative Position 7.2.8 Position of the Surgical Team and the Operative Equipment 7.2.9 Anaesthesia 7.2.10 Port Strategy 7.3 Phases of the Operation 7.3.1 Phase I: Diagnostic (Exploratory) Laparoscopy 7.3.2 Phase II: The Retrocolic Dissection 7.3.3 Phase III: Ileocolic Lymphovascular Pedicle Localisation and High Ligation 7.3.4 Phase IV: Right Colic Lymphovascular Pedicle Localisation and High Ligation 7.3.5 Phase V: Right Branch of Middle Colic/Middle Colic Lymphovascular Pedicle Localisation and High Ligation 7.3.6 Phase VI: Detachment of the Gastrocolic Ligament and Takedown of the Hepatic Flexure 7.3.7 Phase VII: Lateral Peritoneal Detachment and Extraction of the Mobilised Specimen 7.3.8 Phase VIII: Extracorporeal Bowel Resection-Anastomosis and Abdominal Closure 7.3.9 Phase IX: Check Laparoscopy 7.3.10 Phase X: Examination of the Specimen 7.4 Challenges and Solutions 7.4.1 Not Entering the Correct Plane in the Retrocolic Space 7.4.2 Trouble in Identifying the Ileocolic Pedicle 7.4.3 Trouble in Identifying the Middle Colic Pedicle 7.4.4 Mesenteric Twist 7.4.5 Mesenteric Hernia 7.5 Conclusion References 8: Laparoscopic Ileocolic/Right Hemicolectomy for Crohn’s Disease 8.1 Introduction 8.2 Pre Operative Steps 8.2.1 Patient Positioning 8.2.2 Trocar Positioning 8.3 Operative Steps 8.4 Results 8.5 Complications 8.6 Summary References 9: Laparoscopic Sigmoid Colectomy for Diverticular Disease 9.1 Procedure 9.2 Results 9.3 Conclusions References 10: Laparoscopic Left Hemicolectomy 10.1 Introduction 10.2 Procedure 10.3 Conclusions References 11: Laparoscopic Total Colectomy with Ileostomy for Benign Disease 11.1 The Technique: Preparation and Port Placement 11.2 Division of the Gastrocolic Ligament and the Transverse Mesocolon 11.3 The Right Colon 11.4 Important Vascular Anatomy on the Right Side 11.5 The Left Colon 11.6 Bringing Out the Terminal Ileum and Formation of the Ileostomy 11.7 Additional Comments on the Procedure 11.8 Conclusions 12: Laparoscopic Proctocolectomy and Ileoanal J Pouch Anastomosis 12.1 Introduction 12.2 Operative Steps 12.2.1 Patient Positioning and Draping 12.2.2 Port Placement 12.2.3 Dissection 12.2.4 Pouch Formation 12.2.5 Formation of Pouch Anal Anastomosis 12.3 Postoperative Care 12.4 Conclusions References 13: Robotic Total Mesorectal Excision 13.1 Introduction 13.2 The da Vinci® System 13.3 Operative Steps 13.3.1 Patient Positioning and Draping 13.3.2 Port Placement 13.3.3 Mobilisation of Left Colon; Division of Inferior Mesenteric Vessels; Mobilisation of Splenic Flexure 13.3.4 Preparation for Pelvic Dissection 13.3.5 Docking of the Robotic Patient-Side Cart 13.3.6 Initial Pelvic Dissection 13.3.7 Posterior Dissection 13.3.8 Right-Side Dissection 13.3.9 Anterior Dissection 13.3.9.1 Female Patient 13.3.9.2 Male Patient 13.3.10 Left-Side Dissection 13.3.11 Deep Dissection to Muscle Tube 13.3.12 Stapling 13.3.13 Extraction and Anastomosis 13.4 Results 13.5 Conclusions References 14: Laparoscopic Low Anterior Resection and Total Mesorectal Excision 14.1 Preoperative Considerations 14.2 Equipment 14.3 Patient Positioning and Draping 14.4 Port Placement 14.5 Operative Steps 14.5.1 Step 1: Positioning of Omentum and Small Bowel; Retraction of Uterus; Release of Adhesions 14.5.2 Step 2: Initial Dissection and Identification of Retroperitoneal Structures Including Hypogastric Nerves, Left Ureter and Left Gonadal Vessels Lying Under the Sigmoid Mesentery 14.5.3 Step 3: Vascular Division 14.5.4 Step 4: Medial-to-Lateral Dissection 14.5.5 Step 5: Lateral Dissection and Mobilisation of the Descending and Sigmoid Colon 14.5.6 Step 6: Pelvic Brim and Dissection into the Peritoneal Reflection 14.5.7 Step 7: TME: Laterally and Anteriorly 14.5.8 Step 8: Dissecting Mesorectum to Reach the Bowel Wall; Stapling the Rectum 14.5.9 Step 9: Splenic Flexure Mobilisation 14.5.10 Step 10: Extracting the Specimen 14.5.11 Step 11: Anastomosis and Closure 14.5.12 Step 12: Ileostomy Formation and Wound Closures 14.6 Postoperative Management Recommended Reading 15: Transanal Total Mesorectal Excision Assisted by Laparoscopy 15.1 Introduction 15.2 Indications 15.3 Technique 15.3.1 Surgery Preparation 15.3.1.1 Camera 15.3.1.2 Insufflator System 15.3.2 Abdominal Part 15.3.3 Transanal TME 15.3.3.1 Low Rectal Tumours with Perineal Dissection 15.3.3.2 Low or Mid Rectal Tumours Mesorectal Dissection Anterior Side Posterior Side Lateral Sides 15.3.3.3 High Rectal Tumours 15.3.4 Specimen Extraction 15.3.4.1 Transanal Extraction 15.3.4.2 Transabdominal Extraction 15.3.5 Anastomoses 15.3.5.1 Hand-Sewn Coloanal Anastomosis 15.3.5.2 Stapled Anastomosis 15.3.6 Other Considerations References 16: Laparoscopic Hartmann’s Procedure 16.1 Introduction 16.2 Operative Steps 16.2.1 Patient Positioning and Draping 16.2.2 Port Positioning 16.2.3 Lateral Mobilisation of the Colon 16.2.4 Medial Dissection and Ligation of Vessels 16.2.5 Bowel Resection 16.2.6 Colostomy Formation 16.2.7 Closure 16.3 Results 16.4 Conclusion References 17: Laparoscopic Reversal of Hartmann’s Procedure 17.1 Introduction 17.2 Operative Steps 17.2.1 Patient Positioning and Draping 17.2.2 Mobilisation of the Colostomy and Division of Local Adhesions 17.2.3 Division of Adhesions and Assessment of the Rectal Stump 17.2.4 Mobilisation of the Left Colon 17.2.5 Anastomosis 17.2.6 Closure 17.3 Results 17.4 Conclusion References 18: Laparoscopic Ventral Rectopexy for Rectal Prolapse 18.1 Operative Steps 18.1.1 Patient Position and Draping 18.1.2 Port Placement 18.1.3 Initial View of the Pelvis 18.1.4 Uterine Retraction 18.1.5 Sigmoid Retraction 18.1.6 Deep Pouch of Douglas 18.1.7 Peritoneal Incision 18.1.8 Recto-Vaginal Dissection 18.1.9 Mesh Preparation 18.1.10 Mesh Placement and Fixation to the Rectum 18.1.11 Colpopexy 18.1.12 Mesh Fixation to Sacral Promontory 18.1.13 Peritoneal Closure 18.1.14 Neo-pouch of Douglas 18.1.15 Uterine and Sigmoid Release and Final View of Pelvis 18.2 Results 18.2.1 Short-Term Outcomes 18.2.2 Functional Outcomes 18.2.3 Recurrence 18.2.4 Long-Term Complications 18.3 Conclusions References 19: Laparoscopic Posterior Rectopexy for Rectal Prolapse 19.1 Introduction 19.2 Operative Steps 19.2.1 Patient Position and Draping 19.2.2 Port Placement 19.2.3 Initial View of the Pelvis 19.2.4 Right-Side Peritoneal Incision 19.2.5 Posterior Dissection 19.2.6 Swab Placed Behind the Rectum 19.2.7 View of the Left Side of the Pelvis 19.2.8 Left-Side Peritoneal Incision 19.2.9 Identification of the Swab and Left Side Dissection 19.2.10 View of the Pelvis after Dissection Is Completed 19.2.11 Mesh Preparation 19.2.12 Mesh Placement 19.2.13 Mesh Fixation to the Sacrum 19.2.14 Mesh Fixation to the Rectum 19.2.15 Trim of the Mesh 19.2.16 Final View of the Pelvis 19.3 Results 19.3.1 Short-Term Outcomes 19.3.2 Recurrence 19.3.3 Functional Outcomes 19.4 Conclusions References 20: Laparoscopic Rectal Resection for Endometriosis 20.1 Introduction 20.2 Indications for Surgery 20.3 Operative Steps 20.3.1 Port Placements 20.3.2 Identifying the Ureters 20.3.3 The Ovaries and Salpinges 20.3.4 Front of the Rectum 20.3.5 Back of the Rectum 20.3.6 Dividing the Rectum 20.3.7 Removing the Endometriosis Infiltrate 20.3.8 The Anastomosis References