Atlas of Robotic General Surgery

Description

Atlas of Robotic General Surgery is a state-of-the-art reference in the rapidly changing field of robotic general surgery. It presents a comprehensive overview of current options across the entire spectrum of general surgery, with contributions by key opinion leaders in their respective fields. This unique text-atlas describes the latest trends and detailed technical modifications from the routine to the most complex procedures, highlighted by step-by-step, vividly illustrations instructions, intraoperative color photographs, and a unique narrated video collection. Atlas of Robotic General Surgery is an invaluable resource to residents, fellows, and practicing surgeons to help them successfully implement and apply robotics in their training and/or everyday practice. Provides detailed instruction on robotic procedures of the abdominal wall, foregut, bariatric, hepatobilliary, colorectal, and endocrine surgeries, for a unique, all-in-one surgical resource.  Offers vividly illustrated guidance on all current robotic procedures through step-by-step instructions, intraoperative color photographs, and expertly edited, narrated video clips.   Highlights the common technical pitfalls of each procedure as well as prevention and management of common perioperative complications.  Features expert contributions from key foregut, bariatric, oncologic, hepatobiliary, and colorectal surgeons.  Includes up-to-date coverage of the appropriate pathways for mastering robotics, practice optimization, and programmatic viability, as well as resident training curricula.  Enhanced eBook version included with purchase, which allows you to access all of the text, figures, and references from the book on a variety of devices  Cover Front matter Atlas of roboticgeneralsurgery Inside front cover Copyright Contents Section I: General issues in robotic surgery  1 Overview of existing robotic platforms1  2 Teaching robotic surgery11  3 Achieving proficiency: Mastering the learning curve17 Section II: Robotic hernia surgery  4 Clinical anatomy and physiology of the abdominal wall23  5 Preoperative imaging in hernia surgery31  6 Perioperative optimization of a hernia patient45  7 Robotic inguinal hernia repair with mesh55  8 Robotic inguinal hernia repair without mesh69  9 Anatomy of the groin and robotic neurectomies75 10 Robotic intraperitoneal hernia repair91 11 Robotic transabdominal preperitoneal (rtapp) ventral hernia repair99 12 Robotic transabdominal retrorectus repair107 13 Robotic totally extraperitoneal retrorectus repair117 14 Robotic transversus abdominis release (r-tar) procedure127 15 Robotic anterior component separation141 16 Robotic parastomal hernia repair147 Section III: Robotic bariatric and foregut surgery 17 Robotic gastrectomy157 18 Robotic sleeve gastrectomy167 19 Robotic gastric bypass175 20 Robotic hiatal hernia repair and antireflux surgery185 21 Robotic paraesophageal hernia repair193 22 Robotic heller myotomy203 23 Robotic transhiatal esophagectomy211 Section IV: Intestinal and colorectal surgery 24 Robotic right colectomy223 25 Robotic left hemicolectomy and low-anterior resection231 Section V: Robotic hepato-biliary and solid organ surgery 26 Robotic multiport cholecystectomy241 27 Robotic single-site cholecystectomy255 28 Robotic splenectomy265 29 Robotic hepatectomy275 30 Robotic distal pancreatectomy287 31 Robotic whipple procedure297 32 Robotic pylorus-preserving pancreaticoduodenectomy and cholecystectomy309 33 Robotic adrenalectomy – transabdominal approach323 Index 333 Foreword Dedication Preface List of contributors Disclosures Video table of contents 1 Overview of existing robotic platforms Introduction Da vinci surgical system Invendoscopy e210 Flex robotic system Senhance Versius surgical robot Mirosurge Miniature in vivo robots Master Medical microinstruments Discussion References 2 Teaching robotic surgery Introduction Robotic surgical training for residents Simulation Didactics and nontechnical training Technical training Bedside training Console training Opportunities for more advanced training Barriers to implementation Future of robotic training and coaching References 3 Achieving proficiency: Mastering the learning curve Introduction Initial robotic training Simulation Surgical volume Nontechnical skills Residency training Achieving proficiency Dilemmas and challenges Case-specific training Social media impact Summary References 4 Clinical anatomy and physiology of the abdominal wall Introduction Overview Anterolateral abdominal wall External oblique Internal oblique Transversus abdominis Linea semilunaris Anterior abdominal wall Rectus abdominis Linea alba Pyramidalis Neurovascular anatomy Spaces for mesh placement References 5 Preoperative imaging in hernia surgery Indication for preoperative imaging in hernia surgery General principles and indications Indications for imaging in incisional hernias Indications for imaging in parastomal hernias Indications for primary ventral hernias Indications for imaging in spigelian hernias Indications for imaging in lumbar hernias Indications for imaging in inguinal hernias Operative surgeon review of preoperative imaging Selection of imaging modality Computed tomography Magnetic resonance imaging Ultrasonography Correlating preoperative imaging to physical examination and operative reports Hernia-specific imaging findings Related imaging findings that may influence hernia repair Conclusion References 6 Perioperative optimization of a hernia patient Keywords: Indications Type of approach Patient preparation and preoperative optimization Smoking Obesity Diabetes Nutrition Perioperative and postoperative management and outcomes Surgical site infection Skin preparation and decolonization protocols Preoperative antibiotics Postoperative glucose control Multimodal pain control Early enteral feeding Conclusion References 7 Robotic inguinal hernia repair with mesh Introduction Indications Patient preparation Operating room setup and patient positioning List of tools (fig. 7.2) All key operative steps Pre-docking setup Peritoneal flap creation Dissection and exposure of myopectineal orifice Mesh placement Closure of peritoneal flap Trocar closure/case conclusion Postoperative instructions and outcomes Outcomes Vascular injury Urinary retention Bladder injury Recurrence Small bowel obstruction Chronic pain/nerve injury References 8 Robotic inguinal hernia repair without mesh Indications Patient preparation Operating room setup and patient positioning Key operative steps Tapp approach Indirect inguinal hernia Direct inguinal hernia Peritoneal closure Postoperative instructions and outcomes References 9 Anatomy of the groin and robotic neurectomies Background Anatomy of the groin Inguinal canal Neuroanatomy of the inguinal canal Lumbar plexus Iliohypogastric nerve Ilioinguinal nerve Genitofemoral nerve Lateral femoral cutaneous nerve Femoral nerve Autonomic and paravasal nerves to the testicle Robotic neurectomies Indications Patient preparation Operating room setup and patient positioning Key operative steps Robotic triple neurectomy Postoperative instructions and outcomes Conclusion References 10 Robotic intraperitoneal hernia repair Indications Patient preparation Operating room setup and patient positioning All key operative steps Postoperative instructions and outcomes References 11 Robotic transabdominal preperitoneal (rtapp) ventral hernia repair Preoperative considerations Indications Patient positioning and trocar placement Operative steps Adhesiolysis Dissection of the preperitoneal space Primary closure of the defect and mesh placement Re-peritonealization of mesh Postoperative instructions and outcomes Conclusion Further readings 12 Robotic transabdominal retrorectus repair Indications Patient preparation Operating room setup and patient positioning Key operative steps Postoperative instructions and outcomes Conclusion References 13 Robotic totally extraperitoneal retrorectus repair Introduction Patient preparation Operative technique Equipment Operating room setup and patient positioning Initial access Cross-over Dissection of the retrorectus space Transversus abdominis release Closure of hernia defects and mesh placement Postoperative care Postoperative complications References 14 Robotic transversus abdominis release (r-tar) procedure Introduction Indications Patient preparation Imaging Preoperative optimization Mesh choice Operating room setup and patient positioning Operative steps Step 1: Initial port placement and docking Step 2: Adhesiolysis Step 3: Rectus sheath release/retrorectus dissection Step 4: Exposure and division of the transversus abdominis muscle Step 5: Posterior component separation Step 6: Re-docking Step 7: Subxiphoid area Step 8: Contralateral retrorectus dissection Step 9: Suprapubic dissection “bottom-to-top” tar Step 10: Completing the dissection Step 11: Closure of the posterior sheath Step 12: Closure of the hernia defect Step 13: Mesh placement Special considerations Suprapubic defects Subxiphoid defects Lateral defects Postoperative care and expectations Immediate postoperative care Hospital length of stay Postoperative complications Outpatient follow-up Conclusions References 15 Robotic anterior component separation Indications Description of technique Conclusion References 16 Robotic parastomal hernia repair Introduction Indications for possible repair Possible contraindications for repair Principles of parastomal hernia repair Minimally invasive versus open surgery Patient preparation Operating room setup and patient positioning Key operative steps Adhesiolysis and reduction of hernia contents Measurement of the hernia ring size Mesh selection Retrorectus and preperitoneal parastomal hernia repair Postoperative instructions and outcomes Complications Conclusion References 17 Robotic gastrectomy Introduction Some general thoughts Duodenal stump Gastrojejunostomy Techniques of reconstruction after partial/near-total gastric resection Patient positioning and trocar placement Tangential gastric resections Drainage operations for benign gastric outlet obstruction or peptic ulcer disease Truncal vagotomy and pyloroplasty Step 1. pyloroplasty Step 2. truncal vagotomy Truncal vagotomy and gastrojejunostomy Step 1. opening of the distal stomach/pylorus/duodenum Step 2. construction of gastrojejunostomy Step 3. truncal vagotomy Gastric resections for benign gastric outlet obstruction, peptic ulcer disease, or cancer Distal gastrectomy with truncal vagotomy for obstruction, ulcers, or cancer Step 1. gastric mobilization along the greater and lesser curvatures Step 2. duodenal dissection and transection Step 3. proximal gastric transection Step 4. specimen removal Step 5. gastrojejunal anastomosis Total gastrectomy Summary References 18 Robotic sleeve gastrectomy Indications Patient preparation Operating room setup and patient positioning Room setup Patient positioning Key operative steps Abdominal access and trocar placement System deployment and docking Suggested robotic sleeve gastrectomy steps Technical pitfalls Postoperative instructions Outcomes Conclusions References 19 Robotic gastric bypass Indications Patient selection Operating room setup and patient positioning Key operative steps Entry, port placement, and nathanson retractor The instruments we usually use Hiatal hernia repair (fig. 19.2) Constructing the pouch (fig. 19.3) Splitting the omentum (fig. 19.4) Bringing up an omega loop (fig. 19.5) Dividing the small bowel Jejunojejunostomy (fig. 19.6) Gastrojejunostomy (fig. 19.7) Postoperative instructions Postoperative outcomes Postoperative outcomes References 20 Robotic hiatal hernia repair and antireflux surgery Introduction Indications/workup Description of the procedures Robotic hiatal hernia repair with nissen fundoplication Operating room setup and patient positioning Port placement Key operative steps Postoperative care Robotic linx placement Operating room setup and patient positioning Port placement Key operative steps Linx postoperative care Outcomes Conclusion References 21 Robotic paraesophageal hernia repair Introduction Indications Patient preparation Presurgical care Preoperative preparation Operating room setup Patient positioning Port placement Reduction of the hernia and dissection of the hernia sac Esophageal mobilization Closure of the crura Mesh reinforcement Antireflux procedure Postoperative instructions Outcomes References 22 Robotic heller myotomy Indications Patient preparation Operating room setup and patient positioning Operative steps Port placement Robotic esophageal dissection and esophagomyotomy Intraoperative endoscopy and fundoplication Postoperative management References 23 Robotic transhiatal esophagectomy Introduction Indications Patient preparation Operating room setup and patient positioning Key operative steps Port placement Kocher maneuver Crural and gastric dissection Pyloromyotomy Division of the left gastric vessels and lymphadenectomy Mediastinal dissection Neck dissection Esophageal dissection Creation of gastric conduit and gastric pull-up Neck anastomosis and closure Postoperative management and guidelines Summary References 24 Robotic right colectomy Indications Patient preparation Operating room setup and patient positioning Key operative steps Postoperative instructions and outcomes Conclusion References 25 Robotic left hemicolectomy and low-anterior resection Indications Patient preparation Preoperative preparation Surgical setup and patient positioning setup Key operative steps Initial mobilization Division of the inferior mesenteric artery Mesocolic vascular ligation and colon mobilization Splenic flexure mobilization Upper rectal mobilization Total mesorectal excision Distal transection Intracorporeal anastomosis Perfusion assessment (figs 25.20 and 25.21) Specimen extraction Postoperative care and expected outcomes Conclusion References 26 Robotic multiport cholecystectomy Indications Patient preparation Patient selection Operating room setup and patient positioning Required equipment Operative steps Operating room setup Rmpc port placement Retraction of the fundus Retraction of the gallbladder neck Dissection of calot’s triangle and the gallbladder fossa Wound closure Firefly cholangiography The obese patient Complex cholecystectomy Postoperative instructions and outcomes Instructions Outcomes Recovery References 27 Robotic single-site cholecystectomy Indications Patient preparation Operating room setup and patient positioning Key operative steps Postoperative instructions and outcomes A few considerations on outcomes Conclusion References 28 Robotic splenectomy Introduction Indications Patient preparation Operating room setup and patient positioning Technique (key operative steps) Postoperative course Outcomes References 29 Robotic hepatectomy Introduction Indications Preparation Operating room setup and patient positioning Operative steps Port placement Fundamental operative steps Indocyanine green fluorescence Pringle maneuver Energy settings Hepatectomy Specific hepatectomy procedures Left lateral sectionectomy Left hepatectomy Right hepatectomy Non-anatomic hepatectomy Conversion to laparotomy Postoperative care Outcomes Conclusions References 30 Robotic distal pancreatectomy Indications Operating room setup and patient positioning Key operative steps Port placement Dissection of the greater omentum Determining the pancreatic transection line using ultrasound Dissection of the inferior border of the pancreas to create a tunnel underneath Dissection and transection of the splenic artery Division of the splenic vein Transection of the pancreas Completing the resection of the specimen Considerations for spleen preservation Postoperative instructions and outcomes Conclusion References 31 Robotic whipple procedure Introduction Indications Patient preparation Operating room setup and patient positioning Patient positioning Port placement Key operative steps Resection Division of the gastrocolic ligament/kocher maneuver Porta hepatis dissection Pancreatic neck Ligament of treitz Division of the pancreatic neck and uncinate process Division of the bile duct and gallbladder Reconstruction Pancreatojejunostomy Hepaticojejunostomy Gastro-/duodenojejunostomy Completion, specimen extraction, and closure Controlled conversion Postoperative instructions and outcomes References 32 Robotic pylorus-preserving pancreaticoduodenectomy and cholecystectomy Introduction Indications Contraindications Preoperative planning Beginning the operation Initial steps 1) Kocher maneuver and division of the jejunum 2) Dividing the gastroduodenal artery 3) Dividing the gastrocolic omentum and the proximal duodenum 4) Identification of the superior mesenteric vein and transaction of the pancreatic neck 5) Division of the jejunal mesentery and uncinate process 6) Cholecystectomy and division of the hepatic duct 7) Handling of the specimen Reconstruction 8) Hepaticojejunostomy 9) Pancreaticojejunostomy 10) Reconstructing the ligament of treitz 11) Duodenojejunostomy 12) Completing the operation Postoperative care Conclusion References 33 Robotic adrenalectomy transabdominal approach Indications Work up of adrenal tumors Imaging studies Preoperative laboratory studies Patient preparation Operating room setup and patient positioning Patient positioning Key operative steps Right adrenalectomy Port placement Docking Intraoperative steps Left adrenalectomy Port placement Docking Intraoperative steps Postoperative instructions and outcomes Postoperative instructions Outcomes References Inside back cover