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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_898_Библиотеки_им_академика_М_И_Перельмана.pdf
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- •Foreword
- •Preface
- •Internet Access to Video Clip
- •Acknowledgements
- •Contents
- •Contributors
- •Pulmonary Effects
- •Renal Effects
- •Preoperative Evaluation for Elective Patients
- •Laboratory Testing
- •Cardiac Evaluation
- •Pulmonary Evaluation
- •Special Patient Populations
- •The Elderly
- •Morbidly Obese Patients
- •Emergency Colorectal Surgery Patients
- •Reoperative Surgery
- •Preoperative Management
- •Bowel Preparation
- •Preoperative Fasting
- •Lesion Localization
- •Ostomy Marking
- •Corticosteroids
- •Perioperative Antibiotics
- •Analgesic Considerations
- •Consent
- •Intraoperative Management
- •Patient Monitoring
- •Patient Positioning
- •Venous Thromboembolism (VTE) Prevention
- •Urinary Drainage and Ureteral Stenting
- •Gastric Decompression
- •Availability of Endoscopy
- •Postoperative Care
- •ERAS
- •Summary
- •References
- •1: Perioperative Assessment
- •Physiologic Effects of Laparoscopy
- •Cardiovascular Effects
- •2: Patient Positioning, Instrumentation, and Trocar Placement
- •Key Points
- •Introduction
- •Laparoscopic Instrumentation
- •Trocars
- •Instruments
- •Camera/Laparoscope
- •Graspers
- •Scissors
- •Laparoscopic Staplers
- •Other Laparoscopic Instrumentation
- •Energy Devices
- •Monopolar Energy
- •Bipolar Energy
- •Ultrasonic Energy
- •Hand-Assisted Devices
- •Positioning
- •Padding
- •Gaining Access to the Peritoneal Space
- •Laparoscopic Entry Techniques
- •Veress Needle
- •Direct Trocar Insertion
- •Hasson (Open) Technique
- •Optical Trocar (Video 2.5)
- •Re-operative Surgery and Its Implications
- •Trocar Positioning
- •Hand Assist
- •Pearls and Pitfalls
- •Avoiding Complications
- •Conclusion
- •References
- •3: Surgical Anatomy
- •Introduction
- •Anatomy of Colonic Mesenteric Vasculature
- •Gastrocolic Trunk
- •The Inferior Mesenteric Artery and Its Branches
- •Splenic Flexure
- •Embryologic Surgical Planes
- •The Ureter
- •The Gonadal Vessels
- •Anatomy of the Pelvis
- •Posterior and Lateral Compartments
- •Innervation
- •Anterior and Middle Compartments
- •Right Colectomy
- •Right Colectomy: Common Steps
- •Transverse Colectomy and the Middle Colic Vessels
- •Left Colectomy and Anterior Resection
- •Setup
- •Clinical Anatomy
- •Inferior Mesenteric Vein and Splenic Flexure Mobilization
- •Descending Colectomy
- •Low Anterior Resection
- •Uterine Retraction
- •Perineal Dissection
- •Summary
- •References
- •4: Right Colectomy: Straight Laparoscopic
- •Key Points
- •Introduction
- •Patient Preparation
- •Objectives of the Laparoscopic Procedure
- •Medial Approach
- •Inferior Approach
- •Lateral Approach
- •Superior Approach
- •The Procedure
- •Mobilization of the Colon and Mesentery from the Retroperitoneum
- •Division of the Right Colon Attachments
- •Extended Right Colectomy
- •Exteriorization and Anastomosis
- •Pearls and Pitfalls
- •Conclusion
- •References
- •5: Right Colectomy: Hand-Assist
- •Key Points
- •Introduction
- •Background
- •Operation (Video 5.1)
- •Patient Positioning
- •Port Placement
- •Operative Technique
- •Step 1: Hepatic Flexure Takedown
- •Step 2: Retroperitoneal Dissection and Takedown of Lateral Attachments
- •Step 3: Mobilization of the Ileal Mesentery
- •Step 4: Vessel and Mesentery Division
- •Step 5: Bowel Extraction and Anastomosis
- •Postoperative Care
- •Pearls and Pitfalls
- •Summary
- •References
- •6: Laparoscopic Sigmoidectomy/ Left Colectomy
- •Introduction
- •Indications
- •Contraindications
- •Preoperative Planning
- •Surgery
- •Positioning
- •Technique (Videos 6.1 and 6.2)
- •Port Placement
- •Operative Steps
- •Vascular Isolation and Division
- •Pearls and Pitfalls
- •Retromesenteric Dissection
- •Lateral Dissection
- •Splenic Flexure Mobilization
- •Pearls and Pitfalls
- •Bowel Division, Exteriorization, and Anastomosis
- •Pearls and Pitfalls
- •Positive Leak Test
- •Conclusion
- •Reference
- •7: Hand-Assisted Left Colectomy
- •Background
- •Preoperative Planning
- •Procedure
- •Setup
- •Procedure Steps
- •Hand-Assisted Left Colectomy (Videos 7.1, 7.2, and 7.3)
- •Port Placement
- •Left Colon Dissection
- •Medial-to-Lateral Approach at the IMV
- •Sigmoid Colon Mobilization
- •Medial-to-Lateral Dissection of the IMA
- •Bowel Division and Anastomosis
- •Postoperative Care
- •Complications
- •Pearls and Pitfalls
- •Conclusion
- •References
- •8: Total Abdominal Colectomy: Straight Laparoscopic Approach
- •Key Points
- •Background
- •Preoperative Planning and Decision Making
- •Operation
- •Setup
- •Accessing the Abdomen and Port Placement
- •Operative Steps (Video 8.1)
- •Right Colon
- •Transverse Colon and Hepatic Flexure
- •Sigmoid Colon, Left Colon, and Splenic Flexure
- •Specimen Extraction
- •End Ileostomy
- •Ileorectostomy
- •Postoperative Care
- •Complications
- •Intraoperative
- •Postoperative
- •Outcomes
- •Pearls and Pitfalls
- •Conclusion
- •References
- •9: Total Abdominal Colectomy: Hand- Assisted Approach
- •Introduction
- •Indications
- •Patient Positioning
- •Hand-Access Device Placement
- •Surgical Ports and Energy Devices
- •The “Palm-Down” and “Palm-Up” Techniques
- •Technical Aspects Step-by-Step
- •Step 4. Resection, Specimen Extraction, and/or Anastomosis
- •Special Considerations
- •Summary
- •References
- •10: Operative Details of Laparoscopic Rectal Resection for Cancer
- •Introduction
- •Indications
- •Patient Preparation
- •Operative Technique (Video 10.1)
- •Surgeon, Assistant, and Nurse Positioning
- •Dissection of the Mesocolon and Vascular Pedicle
- •Splenic Flexure and Left Colon Mobilization
- •Pelvic Dissection
- •Division of the Rectum (Video 10.2)
- •Colorectal/Coloanal Anastomosis
- •Pearls and Pitfalls
- •Conclusion
- •References
- •11: Laparoscopic Hand-Assisted Low Anterior Resection
- •Key Points
- •Background
- •Indications
- •Preoperative Planning
- •Patient History and Physical Findings
- •Imaging and Diagnostic Studies
- •Surgical Management
- •Preoperative Planning
- •Positioning
- •Procedure
- •Port Placement and Hand Device
- •Positioning and Alterations During Case
- •Technical Aspects
- •Mobilization
- •Total Mesorectal Excision (TME)
- •Resection
- •Anastomosis
- •Postoperative Care
- •Complications
- •Wound Complications
- •Operative Technical Complications
- •Bleeding
- •Ureter
- •Bowel Injury
- •Outcomes
- •Pearls and Pitfalls
- •Hand-Access Device Placement
- •Visualization
- •Splenic Flexure
- •Pelvic Dissection
- •Conclusion
- •References
- •12: Laparoscopic Abdominoperineal Resection
- •Introduction
- •Indications
- •Outcomes
- •Total Mesorectal Excision (TME)
- •Patient Selection and Preoperative Considerations
- •Operative Technique (Video 12.1)
- •Anesthesia, Prophylaxis, and Positioning
- •Port Placement and Entry into the Abdomen
- •Colon Mobilization and Division of the Superior Hemorrhoidal Vessels
- •Total Mesorectal Excision
- •Division of the Sigmoid Colon and Ostomy Creation
- •Perineal Dissection
- •Alternative Approaches
- •Performing the Perineal Dissection First (“Abdominoperineal Resection”)
- •Laparoscopic Perineal Approach
- •Reconstruction of the Perineal Defect
- •Myocutaneous Flaps
- •Omentoplasty
- •Mesh
- •Perioperative Management and Complications
- •Conclusion
- •References
- •13: Laparoscopic Proctocolectomy
- •Key Points
- •Background
- •Epidemiology and Economics
- •Preoperative Considerations
- •Ulcerative Colitis
- •Crohn’s Disease
- •Familial Adenomatous Polyposis (FAP)
- •Site Marking
- •Stapled IPAA vs. Mucosectomy and Handsewn Anastomosis
- •Patient Positioning
- •Technical Approach
- •Trocar Placement
- •Ordering the Elements of the Procedure
- •Right Colon Mobilization
- •Hepatic Flexure Mobilization
- •Left Colon Mobilization
- •Splenic Flexure Mobilization
- •Rectal Mobilization
- •Division of the Anorectum
- •Transection of Colon Mesentery
- •Ileoanal Pouch Formation and Anastomosis
- •Ileostomy Formation
- •Pearls and Pitfalls
- •Summary
- •References
- •14: Laparoscopic Rectopexy
- •Key Points
- •Introduction
- •Preoperative Planning
- •Procedure
- •Setup
- •Procedure Steps
- •Laparoscopic Rectopexy and Resection
- •Port Placement (Fig. 14.4)
- •Mobilization of the Sigmoid Colon and Rectum
- •Resection of the Redundant Sigmoid Colon
- •Anastomosis Creation
- •Rectopexy
- •Laparoscopic Rectopexy
- •Trocar Placement (Fig. 14.4)
- •Rectum Mobilization
- •Rectopexy
- •Postoperative Care
- •Complications
- •Outcomes
- •Pearls and Pitfalls
- •Summary
- •References
- •15: Minimally Invasive Approach for Stoma Creation
- •Introduction
- •Preoperative Planning
- •Operating Room Setup and Patient Positioning
- •Pearls and Pitfalls
- •Summary
- •References
- •16: Laparoscopic Stoma Reversal
- •Key Points
- •Introduction
- •Preoperative Planning
- •Procedure
- •Setup
- •Procedure Steps
- •Laparoscopic Reversal of Colostomy After Hartmann’s Procedure
- •Port Placement
- •Mobilization of the Proximal Colon
- •Mobilization of the Hartmann’s Pouch and Rectum
- •Resection of the Distal Sigmoid Colon
- •Anastomosis Creation
- •Laparoscopic Reversal of Ileostomy with Ileorectal Anastomosis
- •Port Placement
- •Mobilization of the Small Bowel
- •Mobilization of the Rectum
- •Rectal Resection
- •Creation of the Anastomosis
- •Postoperative Care
- •Complications
- •Outcome
- •Pearls and Pitfalls
- •Summary
- •References
- •17: Laparoscopic Parastomal Hernia Repair
- •Key Points
- •Background
- •Preoperative Planning
- •Procedure
- •Setup
- •Procedure Steps
- •Adhesiolysis and Hernia Reduction
- •Mesh Measurement and Preparation
- •Mesh Securement
- •Sugarbaker Technique (Videos 17.1 and 17.2)
- •Keyhole Technique
- •Repairing the Hernia with Stomal Relocation
- •Postoperative Care
- •Complications
- •Outcomes
- •Pearls and Pitfalls
- •Conclusion
- •References
- •18: Overcoming Technical Challenges: The Abdomen
- •Introduction
- •Positioning and Restraining the Patient
- •Traction/Countertraction
- •Hand-Assisted Laparoscopy
- •The Transverse Colon
- •From the Right
- •From the Left
- •Gaining Colonic Length/Mobilization
- •Potpourri
- •Conversion
- •Avoiding the “Twist”
- •Bloody Operative Field
- •Sparing the Sympathetics
- •Finding the Ureter
- •Fatty Mesentery
- •Reoperative Surgery (Prior Colectomy, Vascular Anatomy)
- •Intraoperative Colonoscopy
- •Pearls and Pitfalls
- •Summary
- •References
- •19: Overcoming Technical Challenges: The Pelvis
- •Introduction
- •Medial-to-Lateral Left Colonic Dissection
- •Retroperitoneal Exposure/Critical Anatomy
- •Vascular Pedicle Division/Proximal Colonic Mobilization
- •Inferior Mesenteric Vein Division/Splenic Flexure Mobilization
- •Rectal Mobilization/Bowel Division (Video 19.1)
- •Identifying and Avoiding Damage to the Nerves
- •Lateral and Anterior Mobilization of the Rectum
- •Dealing with the Genitourinary Structures
- •Dividing the Rectum
- •Pelvic Bleeding
- •Pearls and Pitfalls
- •Conclusion
- •References
- •20: Overcoming Technical Challenges: Reoperative Surgery
- •Key Points
- •Introduction
- •General Considerations
- •Preoperative Evaluation
- •Timing of Surgery
- •Gaining Access
- •Identifying Important Anatomy
- •Ureters
- •Bladder
- •Major Blood Vessels
- •Rectum
- •Hand-Assist Port
- •Conversion to Open Procedure
- •Ostomy Reversal
- •Colorectal Cancer
- •Diverticular Disease
- •Prior Hernia Repair
- •Summary
- •References
- •21: Overcoming Technical Challenges: Prevention and Managing Complications
- •Key Points
- •Introduction
- •Trocar Insertion
- •Enterotomy, Serosal, and Thermal Injuries
- •Bleeding: Intra-abdominal and Pelvic
- •Anastomotic Leak
- •Strictures
- •Converting: How and When
- •Pearls and Pitfalls: The Fatty Omentum, Small Bowel, and Maintaining Pneumoperitoneum
- •Omentum
- •Small Bowel
- •Airway Problems
- •Pneumoperitoneum
- •Summary
- •References
- •22: Single-Incision Laparoscopic Approaches to Colorectal Disease
- •Key Points
- •Introduction
- •Indications
- •Preoperative Planning
- •Single-Incision Port Types and Port Placement
- •Right Hemicolectomy (Video 22.1)
- •Operative Technique
- •Single-Port Left Colectomy
- •Surgical Procedure
- •Port at the Umbilicus
- •Suprapubic Location of the Port
- •Single-Port Laparoscopic Total Proctocolectomy with Ileal Pouch Anal Anastomosis Reconstruction Using Standard Laparoscopic Instrumentation (Video 22.3)
- •Preparation and Positioning
- •Colonic Dissection
- •Proctectomy
- •Specimen Extraction
- •Ileoanal Anastomosis
- •Ostomy
- •Postoperative Care
- •Complications
- •Outcomes
- •Pearls and Pitfalls
- •Conclusion
- •References
- •23: Natural Orifice Surgery (NOTES)
- •Key Points
- •Introduction
- •GI NOTES
- •Development of NOTES Transanal Rectosigmoid Resection
- •Phase 1: Preclinical NOTES Developments
- •Phase 3: Initial Clinical Pure NOTES Transanal Resection
- •Pearls and Pitfalls
- •Summary
- •References
- •24: Robotic Surgery
- •Introduction
- •Indications
- •Equipment
- •Robotic System
- •Camera
- •Instruments
- •Positioning
- •Port Placement
- •Right Colectomy
- •Positioning
- •Port Placement
- •Procedure
- •Left Colectomy/Low Anterior Resection
- •Positioning
- •Colonic Mobilization and Vessel Ligation
- •Total Mesorectal Excision (Hybrid Approach)
- •Port Placement
- •Left Colectomy
- •Low Anterior Resection
- •Procedure
- •Total Mesorectal Dissection
- •Hybrid Approach vs. Total Robotic Approach
- •Pearls and Pitfalls
- •References
- •25: Transanal Minimally Invasive Surgery (TAMIS): Operative Technique, Pitfalls, and Tips
- •Key Points
- •Introduction
- •Indications for TAMIS
- •Preoperative Work-Up
- •Technique (Videos 25.1 and 25.2)
- •Pearls and Pitfalls
- •Conclusion
- •References
- •26: Combined Endo-Laparoscopic Surgery (CELS)
- •Background
- •Indications
- •Preoperative Planning
- •Procedure (Video 26.1)
- •Setup
- •Procedure Steps
- •Endoscopy
- •Port Placement
- •Mobilization
- •Polypectomy
- •Colonoscopic-Assisted Laparoscopic Wall Excision
- •Leak Test
- •Polyp Retrieval
- •Postoperative Care
- •Complications
- •Outcomes
- •Pearls and Pitfalls
- •Conclusion
- •References
- •27: Emergent Laparoscopic Colorectal Surgery
- •Introduction
- •Advantages and Disadvantages of Emergent Laparoscopic Colorectal Surgery
- •Approach and Abdominal Entry
- •Indications
- •Colorectal Perforation
- •Acute Colonoscopic Perforation
- •Procedure Steps
- •Acute Perforated Diverticulitis
- •Procedure Steps
- •Postoperative Anastomotic Perforation
- •Procedure Steps
- •Bowel Obstruction
- •Postoperative Small Bowel Obstruction
- •Procedure Steps (Video 27.4)
- •Malignant Obstruction
- •Procedure Steps
- •Pearls and Pitfalls
- •References
- •28: Laparoscopy in the Elderly Patient
- •Key Points
- •Introduction
- •Evaluation for Surgery
- •Preoperative Risk Assessment
- •Laparoscopy in the Elderly: What Are the Outcomes?
- •Early Studies
- •Comparisons of Laparoscopic Outcomes in the Young vs. Elderly
- •Comparisons of Laparoscopic vs. Open Outcomes in the Elderly
- •Laparoscopic Colorectal Surgery in the Elderly: Enhanced Recovery Protocols
- •What Are the Long-Term Outcomes?
- •Operating Room Considerations
- •Physiology of Pneumoperitoneum
- •Acid/Base Effects
- •Pulmonary Effects
- •Cardiovascular Effects
- •Renal Effects
- •Immune System Effects
- •Laparoscopic Surgery in the Elderly: Changes and Technical Points
- •Conclusions
- •References
- •29: Laparoscopic Colectomy in the Obese Patient
- •Key Points
- •Introduction
- •Technical Considerations
- •Alterations of Anatomy and the Technical Challenge of the Obese Patient
- •Ergonomic Issues in Laparoscopic Colectomy in the Obese Patient
- •Learning Curve for Laparoscopic Colectomy in the Obese Patient
- •Operative Details (Table 29.2)
- •Positioning and Securing the Obese Patient
- •Ureteral Stent Insertion: Selective Use
- •Ports and Exposure Techniques
- •Hand-Assisted Laparoscopic Colectomy (HALS)
- •Dissection and Mobilization
- •The Omentum
- •Wound Extraction Site
- •Pelvic Operations
- •Essential Technical Adjustments
- •Strategy for Deep Dissection
- •Wound Management
- •Postoperative Care and Enhanced Recovery Pathways (ERP)
- •Venous Thromboembolism (VTE) Prophylaxis
- •Outcomes of Laparoscopic Colectomy in the Obese Patient
- •Pearls and Pitfalls
- •Conclusion
- •References
- •30: Minimally Invasive Surgery in Crohn’s Disease Patients
- •Key Points
- •Introduction
- •Indications and Contraindications
- •Evidence in the Literature
- •Laparoscopic vs. Open Surgery for Ileocolitis
- •Laparoscopic Colon Resections
- •Complex Crohn’s Disease
- •Technical Considerations
- •Basic Surgical Techniques for Ileocolic Resection
- •Number of Ports
- •Running the Bowel (Video 30.1)
- •Mobilization of the Bowel
- •Mesenteric Division
- •Anastomosis
- •Complex Fistulous Cases (Video 30.2)
- •Hand-Assisted Laparoscopic Surgery (HALS)
- •Single-Incision Laparoscopic Colectomy (SILC)
- •Pearls and Pitfalls
- •Conclusion
- •References
- •31: Minimally Invasive Surgery in Ulcerative Colitis Patients
- •Key Points
- •Background
- •HALS and Conventional Laparoscopic Surgery
- •Total Abdominal Colectomy with End Ileostomy
- •Step 1: Positioning of the Patient, Placement of Trocars, and Abdomen Exploration
- •Step 2: Mobilization of the Intra-Abdominal Colon
- •Completion Proctectomy with IPAA
- •Step 1: Positioning of the Patient, Placement of Trocars, and Exploration
- •Step 2: Mobilization of the Small Bowel Mesentery
- •Step 3: Pelvic Dissection
- •Step 4: Construction of the Ileoanal Pouch
- •Total Proctocolectomy with IPAA
- •Step 1: Positioning of the Patient, Placement of Trocars, and Abdomen Exploration
- •Step 2: Mobilization of the Intra-Abdominal Colon
- •Step 3: Pelvic Dissection
- •Step 4: Construction of the Ileoanal Pouch
- •Single-Incision Laparoscopic Surgery (SILS)
- •First Stage: Total Abdominal Colectomy with End Ileostomy
- •Step 1: Positioning of the Patient, Placement of Trocars, and Abdomen Exploration
- •Step 2: Right Colon Dissection
- •Step 3: Hepatic Flexure and Transverse Colon Dissection
- •Step 4: Splenic Flexure and Left Colon Dissection
- •Step 5: Rectosigmoid Junction Section and Specimen Exteriorization
- •Second Stage: Proctectomy and IPAA
- •Surgical Approach to Ulcerative Colitis: Conventional Laparoscopy vs. HALS vs. SILS vs. Open Surgery
- •Surgical Strategy
- •Rectal Cancer and Ulcerative Colitis
- •Pearls and Pitfalls
- •Conclusion
- •References
- •32: Minimally Invasive Approaches to Colon and Rectal Diseases: Technique and Best Practices—Pediatrics
- •Key Points
- •Introduction
- •History of Pediatric Minimally Invasive Surgery
- •Patient Selection and Positioning
- •Trocar Selection and Insertion Technique
- •Pearls and Pitfalls
- •Pediatric Laparoscopic Instrumentation
- •Appendicitis
- •Clinical Presentation and Indications
- •Surgical Technique: Laparoscopic Appendectomy
- •Pearls and Pitfalls
- •Clinical Presentation and Indications
- •Surgical Technique
- •Pearls and Pitfalls
- •Hirschsprung’s Disease
- •Clinical Presentation and Indications
- •Surgical Technique: Laparoscopic-Assisted Endorectal Pull-Through
- •Pearls and Pitfalls
- •Anorectal Malformations or Imperforate Anus
- •Surgical Technique: Laparoscopic-Assisted Anorectal Pull-Through (LAARP)
- •Pearls and Pitfalls
- •Fecal Incontinence
- •Surgical Technique: Laparoscopic-Assisted Appendicostomy
- •Pearls and Pitfalls
- •Summary
- •References
- •33: Laparoscopy in Pregnant Patients
- •Key Points
- •Introduction
- •Overview of Changes in Physiology and Anatomy During Pregnancy
- •Indications for Laparoscopy
- •What Can Wait?
- •Small Bowel Obstruction (Early)
- •Acute Uncomplicated Diverticulitis
- •What Can’t Wait?
- •Acute Appendicitis
- •Acute Cholecystitis and Symptomatic Cholelithiasis
- •Small Bowel Obstruction (Late, Complete)
- •Acute Complicated Diverticulitis
- •Peritonitis
- •Colorectal Cancer (Video 33.1)
- •Patient Positioning
- •Fetal Monitoring
- •Instrumentation
- •Trocar Placement
- •Tips and Tricks
- •Pain
- •Appendicitis
- •Diverticulitis
- •IBD/Pouches
- •Technical Tips
- •What Do or Should We Do Differently in Pregnancy?
- •Useful Tricks in the Belly and Dealing with the Uterus
- •References
- •34: Economics of Laparoscopic Colectomy
- •Key Points
- •Introduction
- •Advantages of Laparoscopic Colectomy
- •Conclusion
- •References
- •35: Outcomes of Laparoscopic Surgery
- •Key Points
- •Background
- •Conventional Open Surgery (OS) Versus Laparoscopic-Assisted Surgery (LAS)
- •Outcomes
- •Conversion
- •Laparoscopic-Assisted Surgery (LAS) Versus Hand-Assisted Laparoscopic Surgery (HALS)
- •Summary
- •Single Versus Multiport Laparoscopic Surgery
- •Summary
- •Outcomes Based on Disease Pathology
- •Diverticulitis
- •Cancer
- •Patient Factors
- •Body Mass Index (BMI)
- •Surgeon Factors
- •Desirable Metrics
- •Conclusion
- •References
- •36: Future Directions in Minimally Invasive Surgery
- •Key Points
- •Introduction
- •Expanding the Role of Minimally Invasive Colectomy
- •Equipment
- •Robotics
- •Perioperative Care
- •Healthcare Reform
- •Pearls and Pitfalls
- •Conclusion
- •References
- •Index

x
I would fi rst like to thank our outstanding Developmental Editor, Elektra McDermott, for her
extraordinary efforts in overseeing this edition and ensuring its timely completion and thoroughness. I personally would like to thank my fellow editors for their tremendous vision and
hard work throughout this entire process, as well as all of my mentors in colorectal surgery for
guiding me and giving me such incredible opportunities. Finally, and most importantly, thank
you to Michele and Marianna for supporting and encouraging me throughout this endeavor.
Scott R. Steele, MD
Acknowledgements

Contents
Part I Preoperative
1 Perioperative Assessment ....................................................................................... 3
Charlotte Kvasnovsky and Andrea Chao Bafford
2 Patient Positioning, Instrumentation, and Trocar Placement ............................ 15
Mehraneh Dorna Jafari, Michael J. Stamos, and Steven Mills
3 Surgical Anatomy .................................................................................................... 25
Todd D. Francone and Ron G. Landmann
Part II Procedures
4 Right Colectomy: Straight Laparoscopic ............................................................. 53
Steven Robert Hunt
5 Right Colectomy: Hand-Assist ............................................................................... 61
Kirk A. Ludwig and Timothy Ridolfi
6 Laparoscopic Sigmoidectomy/Left Colectomy ..................................................... 71
Toyooki Sonoda
7 Hand-Assisted Left Colectomy .............................................................................. 81
Steven Lee-Kong and Daniel L. Feingold
8 Total Abdominal Colectomy: Straight Laparoscopic Approach ........................ 89
Amanda V. Hayman and Eric J. Dozois
9 Total Abdominal Colectomy: Hand- Assisted Approach ..................................... 103
Kiyokazu Nakajima, Tsunekazu Mizushima, and Riichiro Nezu
10 Operative Details of Laparoscopic Rectal Resection for Cancer ........................ 111
Martin R. Weiser
11 Laparoscopic Hand-Assisted Low Anterior Resection ........................................ 119
Govind Nandakumar and Sang W. Lee
12 Laparoscopic Abdominoperineal Resection ......................................................... 131
Jennifer S. Davids and Justin A. Maykel
13 Laparoscopic Proctocolectomy .............................................................................. 143
David A. Etzioni and Tonia M. Young-Fadok
14 Laparoscopic Rectopexy ......................................................................................... 155
Mia DeBarros and Scott R. Steele
15 Minimally Invasive Approach for Stoma Creation .............................................. 169
Seth I. Felder, Zuri Murrell, and Phillip Fleshner
xi

xii
16 Laparoscopic Stoma Reversal ................................................................................ 179
Emre Gorgun
17 Laparoscopic Parastomal Hernia Repair ............................................................. 189
Joshua A. Tyler and Matthew G. Mutch
Part III Technical Challenges and Tips
18 Overcoming Technical Challenges: The Abdomen .............................................. 201
Eric K. Johnson
19 Overcoming Technical Challenges: The Pelvis ..................................................... 213
M. Shane McNevin
20 Overcoming Technical Challenges: Reoperative Surgery ................................... 221
Brian R. Englum, M. Benjamin Hopkins, and John Migaly
21 Overcoming Technical Challenges:
Prevention and Managing Complications ............................................................. 235
Bradley R. Davis
Part IV New Horizons
22 Single-Incision Laparoscopic Approaches to Colorectal Disease ....................... 249
Virgilio George
Contents
23 Natural Orifice Surgery (NOTES)......................................................................... 263
Mark H. Whiteford
24 Robotic Surgery ...................................................................................................... 273
Mehraneh Dorna Jafari, David E. Rivadeneira, and Alessio Pigazzi
25 Transanal Minimally Invasive Surgery (TAMIS):
Operative Technique, Pitfalls, and Tips ................................................................ 283
Francisco Quinteros, Kumaran Thiruppathy, and Matthew R. Albert
26 Combined Endo-Laparoscopic Surgery (CELS) ................................................. 293
Kelly A. Garrett and Sang W. Lee
Part V Special Situations
27 Emergent Laparoscopic Colorectal Surgery ........................................................ 303
Rodrigo Pedraza and Eric M. Haas
28 Laparoscopy in the Elderly Patient ....................................................................... 309
Joshua I. S. Bleier and Brian R. Kann
29 Laparoscopic Colectomy in the Obese Patient ..................................................... 321
Arida Siripong and H. David Vargas
30 Minimally Invasive Surgery in Crohn’s Disease Patients .................................... 337
Chang Sik Yu
31 Minimally Invasive Surgery in Ulcerative Colitis Patients ................................. 345
Marco E. Allaix and Alessandro Fichera
32 Minimally Invasive Approaches to Colon and Rectal Diseases:
Technique and Best Practices—Pediatrics ............................................................ 357
Eric J. Krebill and Daniel J. Robertson

Contents
xiii
33 Laparoscopy in Pregnant Patients ......................................................................... 373
Melissa M. Alvarez-Downing and David J. Maron
34 Economics of Laparoscopic Colectomy................................................................. 381
Anthony J. Senagore
35 Outcomes of Laparoscopic Surgery ...................................................................... 385
Jennifer Leahy and Rocco Ricciardi
Part VI Conclusions
36 Future Directions in Minimally Invasive Surgery ................................................ 399
Howard M. Ross and Matthew Miller Philp
Index ................................................................................................................................. 407


Contributors
Matthew R. Albert, MD, FACS, FASCRS Department of Colorectal Surgery, Center for
Colon and Rectal Surgery , Orlando , FL , USA
Marco E. Allaix, MD Department of Surgery , University of Pritzker School of Medicine
Chicago , Chicago , IL , USA
Melissa M. Alvarez-Downing, MD Department of Colorectal Surgery , Cleveland Clinic
Florida , Weston , FL , USA
Andrea Chao Bafford, MD, FACS Section of Colon and Rectal Surgery, Division of General
and Oncologic Surgery, Department of Surgery , University of Maryland School of Medicine ,
Baltimore , MD , USA
Joshua I. S. Bleier, MD, FACS, FASCRS Division of Colon and Rectal Surgery, Pennsylvania
Hospital , University of Pennsylvania , Philadelphia , PA , USA
Jennifer S. Davids, MD Division of Colorectal Surgery of Colon and Rectal Surgery ,
University of Massachusetts Memorial Hospital Center , Worcester , MA , USA
Bradley R. Davis, MD Department of Surgery , University of Cincinnati Medical Center ,
Cincinnati , OH , USA
Mia DeBarros, MD Department of Surgery , Madigan Army Medical Center , Fort Lewis , WA ,
USA
Eric J. Dozois, MD Division of Colon & Rectal Surgery, Department of Surgery , Mayo
Clinic , Rochester , MN , USA
Brian R. Englum, MD Department of Surgery , Duke University Medical Center , Durham ,
NC , USA
David A. Etzioni, MD, MSHS Division of Colon and Rectal Surgery , Mayo Clinic College
of Medicine , Phoenix , AZ , USA
Daniel L. Feingold, MD Department of Surgery , New York Presbyterian Hospital,
Columbia University , New York , NY , USA
Seth I. Felder, MD Department of Colon and Rectal Surgery, Cedars-Sinai Medical Center ,
Los Angeles , CA , USA
Alessandro Fichera, MD Department of Surgery , University of Washington Medical
Center , Seattle , WA , USA
Phillip Fleshner, MD Department of Colon and Rectal Surgery , Cedars-Sinai Medical Center ,
Los Angeles , CA , USA
Todd D. Francone, MD, MPH Department of Colon and Rectal Surgery, Lahey Health and
Medical Center, Lahey Hospital and Medical Center , Tufts University Medical Center ,
Burlington , MA , USA
xv

xvi
Kelly A. Garrett, MD, FACS, FASCRS Section of Colon and Rectal Surgery, Department of
General Surgery, New York Presbyterian Hospital , Weill Cornell Medical College , New York ,
NY , USA
Virgilio George, MD Associate Professor of Surgery, Indiana University School of Medicine,
Department of Surgery , Richard L. Roudebush VA Medical, Center , Indianapolis , IN , USA
Emre Gorgun, MD, FACS Department of Colon and Rectal Surgery, Digestive Disease
Institute , Cleveland Clinic , Cleveland , OH , USA
Eric M. Haas, MD, FACS, FASCRS Division of Minimally Invasive Colon and Rectal
Surgery, Department of Surgery , The University of Texas Medical School at Houston , Houston ,
TX , USA
Amanda V. Hayman, MD, MPH Division of Colon & Rectal Surgery, Department of
Surgery , Mayo Clinic , Rochester , MN , USA
M. Benjamin Hopkins, MD. Department of Surgery , Duke Raleigh Hospital , Raleigh , NC , USA
Steven Robert Hunt, MD Department of Surgery , Barnes-Jewish Hospital , St. Louis , MO ,
USA
Mehraneh Dorna Jafari, MD Department of Surgery, University of California , Irvine School
of Medicine , Orange , CA , USA
Eric K. Johnson, MD, FACS, FASCRS Associate Professor of Surgery , Uniformed Services
University of the Health Sciences and Madigan Army Medical Center , Joint Base LewisMcChord , WA , USA
Contributors
Brian R. Kann, MD, FACS, FASCRS Division of Colon and Rectal Surgery , Pennsylvania
Hospital, University of Pennsylvania , Philadelphia , PA , USA
Eric J. Krebill, MD Department of General Surgery Residency , Michigan State University ,
Grand Rapids , MI , USA
Charlotte Kvasnovsky, MD, MPH Department of Colorectal Surgery, King’s College
Hospital , University of Maryland School of Medicine , Baltimore , MD , USA
Ron G. Landmann, MD, FACS, FASCRS Department of Colon and Rectal Surgery , Mayo
Clinic , Jacksonville , FL , USA
Jennifer Leahy, BA, MS Department of Colon and Rectal Surgery , Lahey Clinic , Burlington ,
MA , USA
Sang W. Lee, MD, FACS, FASCRS Division of Colon and Rectal Surgery, Department of
Surgery , Weill-Cornell Medical College, New York Presbyterian Hospital , New York ,
NY , USA
Steven Lee-Kong, MD Department of Surgery , New York Presbyterian Hospital, Columbia
University , New York , NY , USA
Kirk A. Ludwig, MD Division of Colorectal Surgery, Department of Surgery , Medical
College of Wisconsin , Milwaukee , WI , USA
David J. Maron, MD, MBA Department of Colorectal Surgery , Cleveland Clinic Florida ,
Weston , FL , USA
Justin A. Maykel, MD Division of Colorectal Surgery of Colon and Rectal Surgery ,
University of Massachusetts Memorial Hospital Center , Worcester , MA , USA
M. Shane McNevin, MD Sacred Heart Hospital , Spokane , WA , USA

Contributors
xvii
John Migaly, MD Department of Surgery , Duke University Medical Center , Durham , NC ,
U S A
Steven Mills, MD Department of Surgery, Division of Colorectal Surgery , University of
California, Irvine School of Medicine , Orange , CA , USA
Jeffrey Milsom, MD Center for Advanced Digestive Care, New York Presbyterian Hospital/
Cornell , Weill Cornell Medical College , New York , NY , USA
Tsunekazu Mizushima, MD, PhD Department of Gastroenterological Surgery , Osaka
University Graduate School of Medicine , Suita , Osaka , Japan
Zuri Murrell, MD Department of Colon and Rectal Surgery , Cedars-Sinai Medical Center ,
Los Angeles , CA , USA
Mathew G. Mutch, MD, FACS, FASCRS Section of Colon and Rectal Surgery, BarnesJewish Hospital , Washington University of Medicine , St. Louis , MO , USA
Kiyokazu Nakajima, MD, FACS Department of Gastroenterological Surgery , Osaka
University Graduate School of Medicine, Suita , Osaka , Japan
Govind Nandakumar, MD Division of Colon and Rectal Surgery, Department of Surgery ,
Weill Cornell Medical School , New York , NY , USA
Riichiro Nezu, MD, PhD Department of Surgery , Nishinomiya Municipal Central Hospital ,
Nishinomiya , Hyogo , Japan
Rodrigo Pedraza, MD Division of Minimally Invasive Colon and Rectal Surgery, Department
of Surgery , The University of Texas Medical School at Houston , Houston , TX , USA
Matthew Miller Philp, MD Division of Colon and Rectal Surgery, Department of Surgery ,
Temple University Hospital , Philadelphia , PA , USA
Alessio Pigazzi, MD, PhD Colorectal Surgery, University of California, Irvine Medical
Center , Orange , CA , USA
Francisco Quinteros, MD Department of Colorectal Surgery , Center for Colon and Rectal
Surgery , Orlando , FL , USA
Rocco Ricciardi, MD, MPH Department of Colon and Rectal Surgery , Lahey Clinic ,
Burlington , MA , USA
Timothy Ridolfi , MD Division of Colorectal Surgery, Department of Surgery , Medical
College of Wisconsin , Milwaukee , WI , USA
David E. Rivadeneira, MD, MBA, FACS, FASCRS North Shore-LIJ Health System,
Huntington Hospital, Hofstra University School of Medicine , Huntington , NY , USA
Daniel J. Robertson, MD Department of Pediatric Surgery , Helen Devos Children’s Hospital ,
Grand Rapids , MI , USA
Howard M. Ross, MD, FACS, FASCRS Division of Colon and Rectal Surgery, Department
of Surgery , Temple University Health System , Philadelphia , PA , USA
Anthony J. Senagore, MD, MS, MBA Department of Surgery , Central Michigan University,
School of Medicine , Saginaw , MI , USA
Arida Siripong, MD Department of Colon and Rectal Surgery , Ochsner Clinic , New Orleans ,
LA , USA
Toyooki Sonoda, MD Section of Colon and Rectal Surgery, New York Presbyterian Hospital ,
Weill College of Cornell University , New York , NY , USA

xviii
Michael J. Stamos, MD Department of Surgery, Division of Colorectal Surgery , University
of California, Irvine School of Medicine , Orange , CA , USA
Scott R. Steele, MD, FACS, FASCRS University of Washington , Seattle , WA , USA
Department of Surgery, Madigan Army Medical Center , Fort Lewis , WA , USA
Kumaran Thiruppathy, FRCS, MBBS, MPhil, BSc Department of Colorectal Surgery,
Center for Colon and Rectal Surgery , Florida Hospital Orlando , Orlando , FL , USA
Department of Colorectal Surgery, Colchester General Hospital, UK
Joshua A. Tyler, MD Chief, Colon and Rectal Surgery , Department of General Surgery
Keesler Medical Center , MS , USA
H. David Vargas, MD, FACS, FASCRS Department of Colon and Rectal Surgery , Ochsner
Clinic , New Orleans , LA , USA
Martin R. Weiser, MD Department of Surgery, Memorial Sloan Kettering Cancer Center ,
Cornell Weill Medical College, Cornell University , New York , NY , USA
Mark H. Whiteford, MD, FACS, FASCRS Gastrointestinal and Minimally Invasive Surgery
Division , The Oregon Clinic , Portland , OR , USA
Providence Cancer Center, Portland, OR, USA
Oregon Health & Science University, Portland, OR, USA
Tonia M. Young-Fadok, MD, MS, FACS, FASCRS Division of Colon and Rectal Surgery ,
Mayo Clinic College of Medicine , Phoenix , AZ , USA
Contributors
Chang Sik Yu, M.D, PhD Department of Colon & Rectal Surgery , Asan Medical Center,
University of Ulsan College of Medicine , Seoul , South Korea

P a r t I
Preoperative
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