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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_874_Библиотеки_им_академика_М_И_Перельмана.pdf
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- •Contents
- •1.1 Introduction
- •1.2 Ancient Past
- •1.3 Modern Period
- •1.4 Robot
- •1.5 Contemporary Period
- •1.6 Healthcare Robotics
- •1.9 Robotic-Assisted Surgery Logistics
- •1.10 Future Directions
- •1.7 Twenty-First Century
- •1.8 Hernia Repair
- •References
- •2.1 Introduction
- •2.2 Advantages
- •2.3 Disadvantages/Barriers
- •2.4 Training Requirements
- •2.6 Conclusion
- •References
- •3: Enhanced Recovery After Hernia Repair
- •3.1 Introduction
- •3.2 Pre-Operative Measurements
- •3.2.1 Smoking Cessation
- •3.2.2 Weight Loss
- •3.2.3 Diabetes Optimization
- •3.2.4 Nutritional Optimization
- •3.2.5 Prehabilitation
- •3.3 Intra-operative Measures
- •3.3.2 Perioperative Antibiotics
- •3.3.3 Surgical-Site Infections (SSI)
- •3.3.4 Improving Postoperative Intestinal Function
- •3.4 Post-operative Measures
- •3.4.2 Multimodal Pain Control
- •3.4.3 Early Enteral Feeding
- •3.5 Discussion
- •References
- •4.1 Introduction
- •4.3 Prosthetic Materials: History
- •4.4 Absorbable Synthetic Biomaterials
- •4.5 Biologic Products
- •4.5.1 Bovine Products
- •4.5.2 Cadaveric Products
- •4.5.3 Porcine Products
- •4.6 Hybrid Products
- •4.7 Flat Prosthetic Products
- •4.8 Miscellaneous Flat Products
- •4.9 Combination Flat Synthetic Prosthetics
- •4.14 Hiatal Hernia Repair Products
- •4.15 Fixation Devices
- •4.16 Conclusion
- •References
- •5.1 Inguinal Hernia
- •5.1.2 Inguinal Preoperative Imaging
- •5.1.3 Operative Approach
- •5.1.4 Laparoscopic Inguinal Hernia Repairs
- •5.1.5 Bilateral Hernias
- •5.1.6 Obesity
- •5.1.7 Anticoagulated Patients
- •5.1.8 Medical Comorbidities
- •5.1.9 Women
- •5.1.10 Femoral Hernias
- •5.1.11 Preperitoneal Mesh/Lower Midline Surgery
- •5.1.12 Scrotal/Nonreducible Hernia
- •5.1.13 Summary
- •5.1.14 Ventral/Incisional Hernia
- •5.1.16 Preoperative Imaging
- •5.1.17 Prehabilitation
- •5.1.18 Operative Approach
- •5.1.19 Mesh Utilization
- •5.2 Conclusion
- •References
- •6.1 Background
- •6.2 Pain Classification
- •6.3 Anatomic Considerations
- •6.7 Chronic Pain After Ventral Hernia Repair
- •6.8 Chronic Pain After Inguinal Hernia Repair
- •6.10 Open Extended Triple Neurectomy
- •6.11 Laparoscopic Retroperitoneal Triple Neurectomy
- •6.12 Chronic Orchialgia
- •6.14 Conclusion
- •References
- •7.1 Introduction
- •7.3 The Robotic Equipment
- •7.4.1 Patient Positioning
- •7.4.2 Cannulas
- •7.4.3 Robot Docking
- •7.5 Conclusion
- •References
- •8.6 Controversies
- •8.6.1 Direct Hernia Defect Closure
- •8.6.2 Mesh Fixation
- •8.6.3 Non-Mesh Robotic TAPP Repairs
- •8.7 Conclusion
- •References
- •8: Routine Robotic Inguinal Hernia Repair
- •8.1 Introduction
- •8.2 Patient Selection
- •8.3 Surgical Technique
- •8.3.2 Dissection
- •8.3.3 Mesh Placement
- •8.3.4 Peritoneal Closure
- •8.4 Recovery
- •8.5 Adverse Events
- •8.5.1 Small Bowel Obstruction
- •8.5.2 Recurrence
- •8.5.3 Chronic Pain
- •9.1 Introduction
- •9.2 History
- •9.3 Pre-operative Preparation
- •9.4 Operative Techniques
- •9.6 Summary
- •References
- •10: Pelvic Hernias
- •10.1 Introduction
- •10.2 Technique
- •10.5 Docking
- •10.6 Surgical Technique
- •10.7 Dissection/Adhesiolysis
- •10.8 Defect Closure
- •10.10 Complications
- •10.12 Summary
- •10.13 Concluding Remarks
- •References
- •Glossary
- •11.1 Introduction
- •11.4 Other
- •11.5 Conclusion
- •References
- •12: Re-operation After Robotic Inguinal Hernia Repair
- •12.1 Introduction
- •12.6.1 Open Repair
- •12.6.2 Laparoscopic Repair
- •12.6.3 Robotic Repair
- •12.7 Special Considerations
- •12.8 Conclusions
- •References
- •13: Botulinum Toxin Aided Hernia Repair
- •13.1 Introduction
- •13.3 Existing Clinical Applications
- •13.5.1 Anatomy
- •13.5.2 Our Technique
- •13.6.4 Other Uses
- •13.7 Conclusion
- •References
- •14: Pneumoperitoneum Aided Hernia Repair
- •14.1 Introduction
- •14.1.1 Preoperation Treatment Options
- •14.2 Progressive Preoperative Pneumoperitoneum (PPP)
- •14.2.4 PPP Protocol
- •14.3 Surgical Repair: Minimally Invasive
- •14.5 Conclusion
- •References
- •15.1 Introduction
- •15.2 Patient Selection
- •15.5 Port Placement
- •15.6 Intraoperative Considerations
- •15.7 Conclusion
- •References
- •16.2 Operative Technique
- •16.2.2 Access
- •16.2.3 Port Placement
- •16.2.5 Upper Midline Defects (Lower Dock Setup)
- •16.2.6 Lower Midline Defects (Upper Dock Setup)
- •16.2.7 Side Dock Setup
- •16.2.8 Conclusion
- •17: Robotic IPOM-Plus Repair
- •17.1 Introduction
- •17.2 Definition
- •17.3 Surgical Technique
- •17.3.1 Preoperative Care
- •17.3.2 Patient Positioning
- •17.3.3 Trocar Placement
- •17.3.4 Docking
- •17.3.5 Instrumentation
- •17.3.6 Adhesiolysis
- •17.4 Postoperative Care
- •17.5 Conclusions
- •References
- •18: Transabdominal Preperitoneal (rTAPP) Repair
- •18.1 Introduction
- •18.2 Surgical Anatomy
- •18.4 Patient Selection
- •18.5 Preoperative Evaluation
- •18.6 Equipment
- •18.7 Surgical Technique
- •18.7.2 Trocar Placement, Adhesiolysis, Preperitoneal Dissection
- •18.8 Postoperative Care
- •18.9 Complications
- •18.9.1 Bleeding-Hematoma
- •18.9.2 Seroma
- •18.9.3 Intestinal Injury
- •18.9.4 Chronic Pain
- •18.9.5 Recurrence
- •18.10 Limitations
- •18.11 Conclusion
- •References
- •19.1 Introduction
- •19.2 Background
- •19.3 History
- •19.4 Pre-Operative Workup
- •19.6 Surgical Technique
- •19.6.1 Access
- •19.6.2 Port Placement
- •19.6.3 Dissection/Adhesiolysis
- •19.6.5 Midline Reconstruction
- •19.7 Complications
- •19.9 Discussion
- •19.10 Concluding Remarks
- •References
- •Glossary
- •20: Endoscopic Component Separation Techniques
- •20.1 Endoscopic Component Separation Techniques
- •20.4 Operative Steps
- •20.4.1 Preoperative Preparation
- •20.5 Operative Technique
- •20.5.1 Transfascial Approach
- •20.5.2 Modified Subfascial Approach
- •20.5.3 Endoscopic Subcutaneous CS Approach
- •20.8 Conclusions
- •References
- •21: Robotic Retro-Rectus Repairs
- •21.1 Introduction
- •21.2 Robotic Rives: Retromuscular Repairs
- •21.2.1 Patient Selection
- •21.2.2 General Measures
- •21.2.3 Single Docking: Cranial Approach
- •21.2.4 Double Docking: Lateral Approach
- •21.2.5 Single Docking: Lateral Approach
- •21.3 e-TEP
- •21.3.3 Upper Midline Defect
- •21.3.4 Lower Midline Defects
- •21.3.5 Side-Docking
- •21.4 Conclusion
- •References
- •22: Robotic Transversus Abdominus Release
- •22.1 Introduction
- •22.2 Historical Context
- •22.2.3 The Rives-Stoppa Repair
- •22.2.4 Posterior Component Separation
- •22.2.6 Minimally Invasive Approaches
- •22.2.7 Operative Considerations
- •22.2.8 Patient Selection
- •22.3 Pre-Operative Planning
- •22.4 Technique
- •22.4.3 Trocar Placement
- •22.4.4 Docking
- •22.4.5 Retromuscular Dissection
- •22.4.6 Transversus Abdominis Release
- •22.4.8 Contralateral Dissection
- •22.4.9 Fascial Closure
- •22.4.11 Post-Operative Care
- •22.5 Conclusions
- •References
- •23.1 Introduction
- •23.2 Operating Room Set Up
- •23.3 Surgical Technique
- •23.4 Postoperative Care
- •23.5 Conclusion
- •References
- •24: Lumbar Hernia
- •24.1 Introduction
- •24.1.1 Historical Background
- •24.1.2 Classifications
- •24.1.3 Surgical Anatomy
- •24.1.4 Pathogenesis
- •24.1.5 Clinical Presentation
- •24.2 Preoperative Planning
- •24.3 Operative Technique
- •24.3.1 Open Approach
- •24.3.2 Mimimally Invasive Approach
- •24.3.2.1 Conventional Laparoscopy
- •24.3.2.2 Robotic Assisted
- •24.3.3 Hybrid Approach
- •24.4 Conclusion
- •References
- •25.1 Background
- •25.3 Preoperative Considerations
- •25.4 Operating Room Set Up
- •25.5.2 Transversus Abdominis Release (TAR)
- •25.5.4 Mesh Placement
- •25.6 Postoperative Management of Modified Sugarbaker with TAR
- •25.7 Complications
- •25.8 Traditional Sugarbaker Repair
- •25.8.1 Operating Room Set Up
- •25.9 Postoperative Management
- •25.10 Conclusion
- •References
- •References
- •27.2 Obesity
- •27.3 Malnutrition
- •27.4 Immunosuppression
- •27.5 Age
- •27.6 Special Considerations: Cytoreductive Surgery
- •27.7 Future Thoughts
- •References
- •28.1 Morgagni Hernia
- •28.1.1 Si
- •28.1.2 Xi
- •28.2 Bochdalek Hernia
- •28.2.1 Si
- •28.2.2 Xi
- •28.3 Traumatic Diaphragmatic Hernia
- •28.4 Summary
- •References
- •29: Robotic Assisted Morgagni Hernia Repair
- •29.1 Introduction
- •29.2 Preoperative Evaluation
- •29.3 Patient Selection
- •29.6 Intraoperative Considerations
- •29.7 Recommended Instruments
- •29.8 Postoperative Care
- •29.9 Conclusion
- •References
- •30: Robotic Paraesophageal Hernia Repair
- •30.1 Introduction
- •30.2 Preoperative Evaluation
- •30.2.1 Upper Endoscopy
- •30.2.2 Barium Swallow
- •30.2.3 High Resolution Esophageal Manometry
- •30.2.4 pH Monitoring
- •30.3 Operative Technique
- •30.3.1 Operating Room (OR) Setup
- •30.3.2 Patient Positioning
- •30.3.3 Trocar Placement
- •30.3.4 Docking
- •30.3.5 Visualization
- •30.3.7 Esophageal Lengthening
- •30.3.8 Crural Closure
- •30.3.9 Relaxing Incisions
- •30.3.10 Fundoplication
- •30.3.11 Mesh Reinforcement
- •30.4 Peri-Operative Complications
- •30.4.1 Pneumothorax
- •30.4.2 Vagal Injury
- •30.4.3 Esophageal Perforation
- •30.4.4 Gastric Perforation
- •30.4.5 Bleeding
- •30.4.6 Dysphagia
- •30.4.7 Reflux
- •30.5 Outcomes
- •30.6 Reoperative Considerations
- •30.9 Conclusion
- •References
- •31.1 Introduction
- •31.2 Surgical Indications
- •31.3 Preoperative Evaluation
- •31.4 Surgical Technique
- •31.5 Postoperative Care
- •31.6 Outcomes
- •31.7 Conclusion
- •References
- •32.4 Organ Perforation
- •32.6 Postoperative In-hospital Complications
- •32.7 Late Complications
- •32.8 Conclusion
- •References
- •33: Reoperation After Robotic Diaphragmatic Hernia Repair
- •33.1 Introduction
- •33.6 Open Repair
- •33.7 Laparoscopic Repair
- •33.8 Robotic Repair
- •33.9 Conclusions
- •References
- •Index

66
K. A. LeBlanc
Table 4.11 Flat
polypropylene products
2D PPT Std, Microval, Saint-Just- Malmont, France
2D PPT LW, Microval, Saint-Just- Malmont, France
2D PPNT, Microval, Saint-Just- Malmont, France
Basic mesh, Di.pro Medical Devices, Torino, Italy
Basic Evolution mesh, Di.pro Medical Devices, Torino, Italy
Bard mesh, Davol, Inc., Warwick, RI, USA
Bard Soft mesh, Davol, Inc., Warwick, RI, USA
Biomesh P1, Cousin Biotech, Wervicq-Sud, France
Bulev UL, Di.pro Medical Devices, Torino, Italy
Bulev B5050, Di.pro Medical Devices, Torino, Italy
DynaMesh PP-Standard, FEG Textiltechnik mbH, Aachen,
Germany
DynaMesh PP- Light, FEG Textiltechnik mbH, Aachen,
Germany
EasyProthes, TransEasy Medical Tech.Co.Ltd., Beijing, China
Hermesh 3,4,5,6,7,8, HerniaMesh, S.R.L., Torino, Italy
Optilene, B.Braun Melsungen AG, Melsungen, Germany
Optilene LP, B.Braun Melsungen AG, Melsungen, Germany
Optilene Mesh Elastic, B.Braun Melsungen AG, Melsungen,
Germany
Parietene Flat Sheet, Medtronic, Minneapolis, MN, USA
Parietene Lightweight, Medtronic, Minneapolis, MN, USA
Premilene, B.Braun Melsungen AG, Melsungen, Germany
Premium, Cousin Biotech, Wervicq- Sud, France
Prolene, Ethicon Inc., Somerville, NJ, USA
Prolene Soft Mesh, Ethicon Inc., Somerville, NJ, USA
Prolite, Atrium Medical Corporation, Hudson, NH, USA
Repol Angimesh 0,1,8,9, Angiologica, S.Martino Sicc., Italy
SMX, THT Bio-Science, Montpelier, France
SMH2, THT Bio-Science, Montpelier, France
SMH, THT Bio-Science, Montpelier, France
Surgimesh WN, Aspide Medical, St. Etienne, France
Surgipro Monolamented, Covidien plc, Dublin, Ireland
Surgipro Multilamented, Covidien plc, Dublin, Ireland
Surgipro Open Weave, Covidien plc, Dublin, Ireland
TiLENE, GfE Medizintechnik, Nuremburg, Germany
TiLENE Blue, GfE Medizintechnik, Nuremburg, Germany
TiMESH, GfE Medizintechnik, Nuremburg, Germany
TiO
Mesh, Bayreuth, Germany
2
VitaMesh– Getinge Group, Wayne, NJ
VitaMesh Blue– Getinge Group, Wayne, NJ
former is heavy weight while the latter is medium weight and possesses larger pore
sizes. The 2D PPNT is a non-woven PP material that is available in three different
weights and thicknesses (Fig.4.10). These meshes are congured in a variety of
shapes and sizes as shown.
Basic mesh is a lightweight mesh (Fig.4.11). Di.pro has developed an ultra light-
weight version that is called Basic Evolution mesh (Fig. 4.12). Bard Mesh is

4 Prosthetic Materials forRobot-Assisted Hernia Repair
Fig. 4.10 2D PPNT
Fig. 4.11 Basic
67
probably the oldest at sheet of heavy weight polypropylene in existence, having
been brought to market in the early 1960s (Fig.4.13). It is still in use today and like
many of these prostheses, a lightweight and more macroporous version has been
developed, the Bard Soft Mesh (Fig.4.14). Biomesh P1 (Fig.4.15) is the standard
weight material compared to the Premium (Fig.4.16). It is available for extraperitoneal placement in various shapes and sizes for laparoscopic inguinal and ventral
hernia repairs. Bulev B and Bulev UL are somewhat similar to the Basic and Basic
Evolution meshes discussed above (Figs.4.17 and 4.18). The weights of the Bulev
2
products are 48gm/m
and 39gm/m2 respectively. They are different in that they
possess blue lines to differentiate them from the other meshes and aid in positioning
of the product.

68
Fig. 4.12 Basic evolution
Fig. 4.13 Bard mesh
K. A. LeBlanc
DynaMesh comes in two weights; Dynamesh PP—Standard (Fig.4.19, right) is
twice the weight of the Dynamesh PP—Light (Fig.4.19, left) product. Easy Prothes
is available as a heavy weight material (90g/m2), two medium products (70g/m2
and 60g/m2), and a lightweight version (40g/m2). Figures4.20 and 4.21 compare
the medium and lightweight versions. The Hermesh 3–8 have a huge variety of sizes
and graduated weights from heaviest (3) to lightest (8) and sizes (Fig.4.22).
Optilene products are all lightweight materials that vary from the heaviest by that
2
name (60gm/m
) to the Elastic (48gm/m2) and the lighter LP (36gm/m2). The

4 Prosthetic Materials forRobot-Assisted Hernia Repair
Fig. 4.14 Bard Soft mesh
69
Fig. 4.15 Biomesh P1

70
Fig. 4.16 Premium mesh
Fig. 4.17 Bulev B
K. A. LeBlanc
Fig. 4.18 Bulev UL

4 Prosthetic Materials forRobot-Assisted Hernia Repair
Fig. 4.19 DynaMesh light
and standard
Fig. 4.20 Easy prothes
mediumweight
71
Fig. 4.21 Easy prothes
lightweight
Elastic version has unequal pore sizes (3.6×2.8mm) to allow for multidirectional
elasticity (Figs.4.23, 4.24, and 4.25). Parietene Flat Sheet and Parietene Lightweight
products are monolament at sheet products (Fig.4.26). Premilene is the heaviest
2
weight (82gm/m
) product in the Braun at mesh product line (Fig.4.27). Premium
mesh is a lightweight product similar to the Biomesh P1 described above (Fig.4.15)
this is congured into various sizes and shapes for use in open or laparoscopic

72
Fig. 4.22 Hermesh 3-8
K. A. LeBlanc
Fig. 4.23 Optilene
inguinal and extraperitoneal ventral hernia repair (Fig. 4.16). Prolene is also a
heavier weight mesh material and it is one of the older products available (Fig.4.28).
Prolene Soft Mesh is the lighter weight version that has larger pores than the original
mesh and blue lines through the product (Fig.4.29). Prolite was one of the earliest
meshes that were initially introduced as a lighter weight material (Fig.4.30). Today,
it is considered a mid-weight mesh. Prolite Ultra possesses even less weight of
mesh than Prolite (Fig.4.31).

4 Prosthetic Materials forRobot-Assisted Hernia Repair
Fig. 4.24 Optilene elastic
Fig. 4.25 Optilene LP
73
Fig. 4.26 Parietene at
sheet (All rights reserved;
used with permission of
Medtronic)

74
Fig. 4.27 Premilene
Fig. 4.28 Prolene (Image
courtesy of Ethicon, Inc.)
K. A. LeBlanc
Fig. 4.29 Prolene soft
mesh (Image courtesy of
Ethicon, Inc.)

4 Prosthetic Materials forRobot-Assisted Hernia Repair
Fig. 4.30 ProLite
75
Fig. 4.31 ProLite ultra
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