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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_536_Библиотеки_им_академика_М_И_Перельмана.pdf
362 W. J. Hyung and I. G. Kwon
Fig. 42.22 a-f Types of anastomosis after minimally invasive gastrectomy (subtotal and total) (a, b, c, d, e, f)
36342 Laparoscopic Immunofluorescence-Guided Lymphadenectomy …
Fig. 42.24 Placement of trocars for surgeon and assistants for
robotic-assisted gastrectomy
References
Fig. 42.23 a, b, c Pathology of the case (a, b, c)
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Frangioni JV. Image-guided cancer surgery using near-infrared
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4. Miyashiro I, Kishi K, Yano M, et al. Laparoscopic detection of
sentinel node in gastric cancer surgery by indocyanine green fluorescence imaging. Surg Endosc. 2011;25(5):1672–6.
5. Tajima Y, Yamazaki K, Masuda Y, et al. Sentinel node mapping
guided by indocyanine green fluorescence imaging in gastric cancer. Ann Surg. 2009;249(1):58–62.
6. Miyashiro I, Miyoshi N, Hiratsuka M, et al. Detection of sentinel
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Version 3.2016, NCCN clinical practice guidelines in oncology. J
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guided lymphadenectomy during robotic radical gastrectomy for
gastric cancer. JAMA Surg. 2018.
10. Hu Y, Huang C, Sun Y, et al. Morbidity and mortality of lapa-
roscopic versus open D2 distal gastrectomy for advanced
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gastric cancer: a randomized controlled trial. J Clin Oncol.
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Final Considerations
M. Asunción Acosta, Miguel A. Cuesta and Marcos Bruna
43
The objective of this ATLAS was to depict the current situation of the Minimal Upper GI Surgery. Our philosophy
has been, that once a good indication exists for surgery,
a perfect preoperative preparation of the patient and the
approach by Minimally Invasive Surgery will achieve the
best outcome for the patient offering a high quality of life.
We explained how achieving an optimal operative technique by changing the functioning of an organ or by an
oncological resection; a perfect knowledge of the surgical
anatomy leads to performing the necessary steps for an adequate surgical technique.
We have made clear that an extensive knowledge of
the surgical anatomy requires information gathered on the
practice of minimally invasive surgery. This knowledge
gives the surgeon the best prospect for doing perfect surgery by being able to dissect through surgical planes. We
take into regard that MIS Upper GI procedures—benign
including the endoscopic but also the extensive bariatric
techniques and the oncological including esophageal and
gastric resections, but also the endoscopic techniques for
early cancers—are implemented less frequently than the
more frequent cholecystectomies and colorectal procedures
and are far more complex. We delineated that decisions
to implement these procedures can be based on the shortterm advantages obtained after a successfully conducted
minimally invasive procedure. The long-term advantages
including optimal functional results and survival and other
M. A. Acosta
Unidad de Cirugia Esofago-gàstrica, Hospital Universitario de
Gran Canaria “Dr. Negrìn”, Las Palmas, Gran Canaria, Spain
e-mail: maacosta03@yahoo.es
M. A. Cuesta (*)
Department of Surgery, Amsterdam UMC, Amsterdam, The
Netherlands
e-mail: ma.cuesta@amsterdamumc.nl
M. Bruna
Department of Surgery, Hospital Universitario y Politécnico La Fé,
Valencia, Spain
e-mail: drbruna@comv.es
oncological outcomes are already based on studies that confirm the efficacies of these MIS procedures.
Consequently, to operate correctly in the particular
MIS way as we have depicted, a surgeon’s gaining adequate training is paramount. Young surgeons and residents
need to learn and continue to relearn MIS proficiencies.
Accompanying implementation of Upper Abdominal MIS,
surgeons and their teams need to engender dedication to
these procedures as carried out in high-volume centers and
through continual training. This entails the need for initial training in the laboratory using models and cadavers
and then advancing in skills through adequate programs in
which the role of a mentor is crucial.
Moreover, the surgical robot has been implemented in
many fields of complex MIS and provides important advantages when performing difficult dissections in difficult
places and in difficult anastomoses.
All authors and contributors to this ATLAS demonstrated
success with MIS, thereby prompting some considerations
regarding proficiencies, permanent learning, and progress,
which I would like to share.
43.1 Proficiencies
The model adopted in this ATLAS encompasses what we
think are the most appropriate proficiencies to perform
complex surgery once a good indication comes about.
Foremost is the aptitude of wanting to know and being passionate about surgical anatomy of a specific area, in this
case, the upper abdomen. We encourage this propensity
strongly for without adequate knowledge it is impossible
to do a good surgical intervention through adequate planes,
thus preventing avoidable risks. Such good practice is based
on a description of surgical anatomy as portrayed in this
book and which was carried out mainly in the Department
of Anatomy in Utrecht Medical Center (UMC), by Dr. R.
Bleys. Moreover, the recent surgical insight into the anatomy of the esophagus has been depicted by Dr. Daiko and
© Springer Nature Switzerland AG 2021
M. Asunción Acosta et al. (eds.), Atlas of Minimally Invasive Techniques in Upper Gastrointestinal Surgery,
https://doi.org/10.1007/978-3-030-55176-6_43
365
366 M. A. Acosta et al.
Dr. Cuesta. An adequate MIS technique for a correct antireflux surgery is treated by Dr. Broeders, Dr. Dallemagne,
and Dr. Morales. Other esophageal benign diseases, such
as benign tumors and achalasia have been treated by Dr.
van der Peet and Dr. Fockens. Description of specific minimally invasive procedures have been treated by surgeons
and their teams with a long-time dedication to these procedures, such as Dr. B. Weusten, describing endoscopic
treatments for early esophageal cancers, being the rest of
the chapters about benign and malignant diseases treated
by Drs. Osugi, Fujiwara, Reddy, Mingol, Gisbertz, van
Berge Henegouwen, Cadiere, Ramirez, Luyer, Diez del Val,
Rosman, Moreno Sanz, Ramirez, Ponce, Gagner, Sanchez
Pernaute, Himpens, van Hillegersberg, Talvane, Inaki,
Kinoshita, Azagra, Kim, Yang, and Hyung.
43.2 Permanent Learning
An ATLAS on surgical practice will be dedicated extensively to the operative technique. This will be given by
explanatory text, including the key steps, illustrations, pictures, and videos. Remarkably, all authors expressed their
willingness to engage in permanent learning regarding
all aspects of surgery. Our shared philosophy is that continual changes in surgery require an augmented search for
minimizing the operative trauma, increasing its oncological efficiency, and decreasing the complication rate. All the
while, a (re)learning of MIS continuously seeks high evidence. Fitting this aim, the inclusion of videos per chapter
of all procedures has added important information regarding MIS. The paramount quality of the videos is magnificent and is conducive for continual learning.
43.3 Progress
Reflecting on this development, we consider this ATLAS as
a good summary of the progress of surgery; yet we are aware
that in the coming years the contents of this ATLAS will
undergo changes. Our advice for residents and young surgeons is to learn the techniques we covered in this ATLAS
and to do so deeply by drawing on the motivation to improve
the life expectations of our patients and to reduce their
suffering.
Finally, we must recognize with distinction the essential role of the anesthesia and intensive-care personnel on
whom all of us rely day in and day out for performing the
challenges of major surgery. Our communal effort, made
manifest by authors and contributors to this ATLAS, continues to inspire us to persevere in gaining the best outcome
for the patient offering a high quality of life.
Index
A
Achalasia, 51, 52, 55, 366
Anastomosis, 3, 13, 94, 96, 99, 104, 106, 107, 109, 111, 112,
B
Benign tumor, 47, 366
Biliopancreatic diversion, 243, 249
Billroth I, 272, 279, 291, 296, 297
C
Cancer, 5, 9, 10, 13, 17, 53, 61, 68, 71, 88, 89, 99, 109, 143, 150, 151,
Cervical anastomosis, 13, 94, 96, 143
Cervical approach, 71, 74, 84, 153
Circular stapler, 109, 159, 161, 175, 300, 307, 308, 317, 340–342
Circular stapler anastomosis, 109, 159, 300, 307, 308, 317
Complications, 29, 39, 40, 51, 63, 65, 71, 89, 121, 143, 151, 153, 215,
Concentric model, 9, 10
Cooperative surgery, 257, 266, 267
D
Delta-shaped, 279
Distal, 1, 13, 19, 23, 27, 41, 47, 50, 52–54, 62, 82, 83, 89, 93, 100,
Distal esophageal cancer, 13, 89
Duodenal switch, 237, 243, 249
Duodenoileal bypass, 249
E
Early cancer, 365
Early gastric cancer, 61, 257, 266, 285, 343
Endoloop, 132–134, 171, 176, 181, 184, 185, 313
Endoscopic submucosal dissection, 64, 65, 267
Endoscopic therapy, 61
Endoscopic treatment, 47, 61, 366
End-to-side anastomosis, 109, 150, 181, 317
Enucleation, 47, 50
117–119, 137, 141, 143, 148–150, 153–156, 158–161, 163,
166, 168, 169, 171, 180, 181, 187, 189, 191, 194–196, 198,
199, 203, 214, 217, 219, 220, 229, 232–235, 244, 247–251,
255, 263, 265, 272, 273, 277, 279, 283, 284, 291, 296, 297,
300, 307, 308, 317, 319, 320, 323, 324, 327, 328, 330, 332,
341, 342, 345, 349, 362
195, 257, 271, 299, 311, 323, 343, 365, 366
216, 221, 237, 249, 271, 299, 323, 366
103, 104, 106, 110–112, 119, 132, 133, 147, 148, 150, 163,
171, 196, 201, 204, 207, 208, 212–214, 216, 217, 219, 222,
224, 230, 232,
285, 286, 300, 304–307, 312, 317, 318, 320, 323, 328, 340,
341, 344, 345, 355
233, 238, 244, 257, 266, 267, 271, 273, 279,
Esophageal adventitia, 1
Esophageal anastomosis, 3, 13, 99, 106, 109, 112, 143, 147, 150, 153,
Esophageal cancer, 5, 9, 10, 13, 53, 61, 71, 88, 89, 99, 109, 143, 150,
Esophageal myotomy, 51
Esophagectomy, 5, 6, 9, 10, 13, 71, 73, 88, 99, 109, 121, 143, 144,
Esophagojejunal anastomosis, 307, 308, 323, 330
Esophago-jejunostomy, 323, 324
Esophagus, 1–7, 9, 10, 13–17, 29–33, 36, 37, 39–43, 45, 47, 50, 51,
G
Gastrectomy, 20, 207, 229, 237–239, 243, 244, 249, 250, 252, 257,
Gastric, 3–5, 19–22, 29, 30, 53, 55, 56, 58, 59, 85, 92–96, 99–101,
Gastric band, 221
Gastric bypass, 109, 221, 229, 234, 249
Gastric cancer, 5, 61, 73, 204, 205, 257, 266, 271, 285, 299, 311, 323,
Gastric conduit, 95, 96, 99, 102, 104–106, 110, 111, 113, 119, 137,
Gastroduodenal ulcer, 215
Gastro-esophageal cancer, 89
Gastroesophageal reflux, 29, 47, 51, 249
Gastroesophageal reflux disease, 19
Gastrojejunostomy, 234, 265, 272, 323
GE Junction cancer, 25
GERD, 51, 52, 54
GIST, 47, 207, 208, 210, 212
H
Hand sewn, 150, 154, 191, 244, 247, 248, 250, 255, 323, 324
Hand sewn anastomosis, 154, 323, 324
Hiatus hernia, 279
Hilar dissection, 311
195, 197, 203
151, 271, 299, 366
149–151, 195, 323
53, 55–57, 59, 61, 62, 71, 77–86, 88, 89, 91–94, 100, 101,
103, 104, 106, 107, 110–112, 115–117, 119, 127, 132,
134–137, 141, 144–151, 153–156, 159–161, 163, 171, 173,
175, 181–185, 191, 192, 196, 197, 201, 203, 204, 206, 219,
222, 224, 231, 240, 241, 291, 300, 304, 306, 307, 317–320,
323, 328, 329, 333, 339–341, 365
266, 267, 271–273, 279, 285, 299, 300, 317, 323, 324, 328,
329, 333, 343–345, 349, 355
104–106, 109–112, 117, 119, 136–138, 148, 150, 159–163,
165, 166, 171, 175, 177, 179–181, 188, 191, 192, 195–197,
199, 201, 203–209, 214–216, 221, 224, 226, 230, 232–235,
237–240, 249–251, 257, 259–263, 266, 267, 271–276, 281,
282, 285, 288,
335, 337–339, 343, 345, 347–349, 365
324, 333, 343
139–141, 143, 144, 147–150, 153–157, 160, 163, 171, 175,
177, 179–181, 186, 191, 194, 196, 197
290–296, 299, 300, 303, 304, 312–314, 333,
© Springer Nature Switzerland AG 2021
M. Asunción Acosta et al. (eds.), Atlas of Minimally Invasive Techniques in Upper Gastrointestinal Surgery,
https://doi.org/10.1007/978-3-030-55176-6
367
368 Index
I
Immunofluorescence-guided surgery, 343
Indocyanine green, 105, 267, 279, 343
Innervation lymph nodes, 6, 204
In prone, 5, 13, 47, 109, 111, 114, 143, 159, 171, 181, 191, 192, 323,
328, 331
Intrathoracic anastomosis, 13, 109, 143, 150, 191, 196, 332
Ivor Lewis, 13, 109, 143
J
Japanese classification, 279
L
Laparoscopic, 19, 22–24, 28, 38, 40, 51, 55, 71, 84, 88, 109, 137, 140,
143, 145, 148–151, 207, 215, 216, 221, 229, 234, 243, 257,
259, 261, 262, 266, 267, 271, 272, 279, 285–287, 299, 300,
317, 323, 324, 333, 340, 343, 344, 349, 355, 357
Laparoscopic correction, 40
Laparoscopic fundoplication, 27, 29, 38
Laparoscopic gastrectomy, 257, 272, 285–287, 300, 323, 333, 343,
346, 355, 357
Laparoscopic Nissen, 29
Laparoscopy, 47, 72, 109, 135, 137, 143, 148, 159, 195, 215, 257, 266,
268, 333
Lateral thoracoscopy, 47, 121
LECS, 257, 267
Left recurrent laryngeal nerve, 6, 77, 127, 128, 135, 137
Leiomyoma, 47, 48
, 50, 207
Lift-suck-cut technique, 62, 63
Ligate-and-cut technique, 62, 63
Linear esophagojejunal anastomosis, 308, 330
Linear stapler, 116, 137, 149, 150, 153–156, 159, 163, 164, 196, 198,
208, 213, 214, 259, 260, 263, 265, 273, 276, 279–281, 283,
291, 296, 297, 300, 306, 308, 317, 320, 324, 328, 335, 340,
342, 347
Lymphadenectomy, 9, 61, 71, 77, 80, 88, 89, 91, 92, 94, 109, 111, 112,
116, 121, 131, 132, 134–138, 143, 145, 146, 148, 149, 151,
159, 195, 263, 271–275, 279, 299, 300, 302–305, 315, 324,
338, 339, 343–345, 351, 355–360
Lymphatic stations, 5
Lymph nodes stations, 10
M
Manual, 109, 220
MATHE dissection, 71, 74
Mediastinum, 2, 4, 6, 9, 10, 13, 17, 21, 24, 28, 29, 41, 53, 55, 71, 72,
78, 84, 88, 89, 103–106, 121, 122, 124, 126, 131, 133, 149,
150, 319, 328
Mesh, 39, 40, 44, 45
Meso-esophagus, 3, 10, 14–17
Minimally invasive, 13, 51, 61, 71, 88, 99, 109, 131, 143, 151, 207,
266, 271, 299, 343, 344, 365, 366
Minimally invasive anastomosis, 13, 99, 109, 143, 195
Minimally invasive esophagectomy, 71, 109, 143, 195
Minimally Invasive Surgery (MIS), 88, 129, 271, 299, 365, 366
Muscular layer, 47–50, 116, 164, 191, 263, 324
N
95% gastrectomy, 323–325
Nissen, 19, 29, 37
O
Obesity, 39, 229
Oesophageal cancer, 13
Oesophagectomy, 129
Oesophagus, 3, 19, 21–25, 27, 28, 121–128, 132, 134, 163, 164, 166,
195
Omentum wrap, 162, 171, 181, 189
Orvil device
®
, 317
P
Paraesophageal hernia, 39, 40
Parietal layer, 9
Partial, 19, 54, 131, 249, 268, 269, 271, 272, 286, 299, 333, 344
Peroral endoscopic myotomy (POEM), 47, 51–55
Peroral treatment, 51
Pleura flap, 160, 162
Prone position, 9, 15, 47, 111, 121, 131, 144, 159, 171, 195
Proximal gastric cancer, 311, 323
R
RAMIE, 143, 144, 150, 151, 195, 196
RAMIE assisted, 150, 195
Recurrent laryngeal nerve lymphadenectomy, 137
Recurrent laryngeal nerves, 2, 3, 5, 6, 9, 10, 15, 71, 103, 121, 128, 153
Reflux disease, 19
Resection, 13, 15, 17, 47, 48, 50, 61–65, 67–70, 91, 99, 101, 103, 109,
111, 126, 128, 131, 137, 143, 149–151, 153, 171, 179, 195,
198, 204, 207, 208, 210, 237, 249, 257, 266–269, 271, 272,
279, 281, 288, 291, 294, 299, 323–325, 328, 333, 334, 345,
365
Robot assisted, 47, 148, 151, 195, 323, 344
Robotic surgery, 285, 333
S
Sentinel lymph node, 257, 266, 343
Single anastomosis, 249
Single port, 78, 79
Sleeve gastrectomy, 229, 237, 238, 243, 244, 249, 250, 252
Splenic preserving, 311
Stapled anastomosis, 153
Stomach, 1, 2, 19, 24, 29, 40, 51–54, 58, 59, 84, 85, 88, 89, 91–95, 99,
100, 102–104, 106, 107, 126, 135–138, 149, 159, 201–204,
206–208, 210, 213, 224, 230, 231, 237–239, 243, 244, 249,
250, 257, 259, 260, 262–264, 271–273, 276, 279–283, 286,
288, 291, 294, 299, 306, 311, 313, 317
, 324, 326, 333–335,
343–345, 349, 361
Subcarinal esophagus, 14, 134
Supracarinal lymphadenectomy, 121, 134
Surgery, 6, 9, 13, 17, 19, 29, 50, 52, 55, 59, 61, 72, 73, 75, 99, 109,
129, 143, 150, 151, 215, 221, 249, 257, 266–269, 285, 311,
323, 343, 344, 346, 365, 366
Surgical anatomy, 1, 9, 10, 13, 71, 121, 365
T
360 degrees, 19, 22, 32, 45
Thoracoscopic esophagojejunostomy, 323
Thoracoscopy, 13, 47, 109, 121, 129, 143, 150, 181, 191, 195, 323,
328, 331
Total gastrectomy, 271, 299, 300, 311, 317, 323, 324, 328, 333, 344,
349
369Index
Toupet fundoplication, 19, 55, 59
Transhiatal approach, 71, 88, 89, 99
Transhiatal esophagectomy, 71, 99, 109
Transhiatal resection, 99, 207, 323, 328
270 degrees, 19, 27, 59
V
Vascularization, 249
Vascular layer, 9, 10
Visceral layer, 9, 10