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Index

Abdomen

anastomosis , 207–208 bloody operative ﬁ eld , 208 colonic length/mobilization , 206–207 difﬁ cult splenic ﬂ exure , 202–205 fatty mesentery , 209–210 HALS , 202 intraoperative colonoscopy , 210 left-sided resection , 205–206 patient positioning and restraining , 201–202 precautions , 210 preemptive conversion , 207 reoperative surgery , 210 right-sided resection , 205 SRA , 208 traction/countertraction , 202 transverse colon , 205 ureter , 208–209

Abdominoperineal resection (APR)

anesthesia, prophylaxis, and positioning , 133 biologic mesh , 139–140 clinical trials , 131–132 colon mobilization and division , 134 indications , 131 laparoscopic perineal approach , 138–139 myocutaneous ﬂ aps , 139 omentoplasty , 139 ostomy creation , 136 patient selection and preoperative considerations , 132–133 perineal defect, reconstruction , 139 perineal dissection , 137 perioperative management and complications , 140–141 port placement and entry into the abdomen , 133–134 sigmoid colon division , 136

TME , 132, 134–136 Accountable care organizations (ACOs) , 404 Acute colonoscopic perforation , 304–306 Acute perforated diverticulitis , 306 Adhesiolysis and hernia reduction , 191–192 Adhesiolysis, laparoscopic. See Laparoscopic adhesiolysis Air leak test , 116, 117 Airway problems , 243 American College of Chest Physicians (ACCP) , 333 Anastomosis

abdomen , 207–208

bowel extraction and , 68

coloanal , 116, 117

colorectal , 116, 117

creation

colostomy after Hartmann’s procedure , 184

ileostomy with ileorectal anastomosis , 186

laparoscopic rectopexy , 160–161 exteriorization and , 59–60 HALAR , 128 ileocolic resection, CD patients , 341 laparoscopic sigmoidectomy/left colectomy , 78–79

Anastomotic leak , 239–241 Anorectal malformations

LAARP , 367–369 modern open approach , 366

Anorectum division , 150 Antegrade continence enema (ACE) , 369 Appendectomy, laparoscopic. See Laparoscopic appendectomy Appendicitis

acute , 375 clinical presentation and indications , 361 diagnosis , 377 laparoscopic appendectomy , 361–362 pregnant patients , 377

Benign polyps , 298 Bladder , 226 Bleeding , 238–239 Blood vessels , 226–227 Body mass index (BMI)

LAS , 390–391 obese patients, laparoscopic colectomy , 321

Bowel

division , 78–79 extraction and anastomosis , 68 mobilization , 341 obstruction

malignant , 307–308

postoperative small , 307

Cancer, disease pathology , 389–390 Celioscopy , 399 Cholecystitis, acute , 375

insufﬂ ation , 377

C O

Colectomy, laparoscopic. See Laparoscopic colectomy Coloanal anastomosis , 116, 117 Colon anatomy , 43, 46 Colon and mesentery mobilization , 56–57 Colon cancer , 25 Colonic mesenteric vasculature

gastrocolic trunk , 26–27 ileocolic (ICA) , 25, 26

H.M. Ross et al. (eds.), Minimally Invasive Approaches to Colon and Rectal Disease: Technique and Best Practices, DOI 10.1007/978-1-4939-1581-1, © Springer Science+Business Media New York 2015

407

408

Index

Colonic mesenteric vasculature (cont.)

right colic artery (RCA) , 25

superior mesenteric artery (SMA) , 25–27 Colonic mobilization and vessel ligation , 279 Colon mesentery transection , 150–152 Colonoscopic-assisted laparoscopic wall excision , 297 Colon resections, laparoscopic. See Laparoscopic

colon resections Colorectal anastomosis , 116, 117 Colorectal cancer (CRC)

pregnant patients , 376 reoperative surgery , 230

Colorectal perforation

acute colonoscopic perforation , 304–306 acute perforated diverticulitis , 306 postoperative anastomotic perforation , 306–307

Colostomy after Hartmann’s procedure

anastomosis creation , 184 distal sigmoid colon resection , 183–184 Hartmann’s pouch and rectum mobilization , 183 port placement , 180–182

proximal colon mobilization , 182–183 Colostomy, laparoscopic. See Laparoscopic colostomy Combined endo-laparoscopic surgery (CELS)

beneﬁ ts , 293

clinical trials , 298

colonoscopic-assisted laparoscopic wall excision , 297

colon polyps , 293

complications , 298

endoscopy , 295

indications , 294

leak test , 297

mobilization , 295, 296

patient setup , 294–295

polypectomy , 296–297

polyp retrieval , 298

port placement , 295

postoperative care , 298

precautions , 298–299

preoperative planning , 294 Constipation , 156, 164. See also Fecal incontinence Conventional open surgery (OS) vs. LAS

clinical trials , 385–386

conversion , 386 Conventional vs. laparoscopic-assisted surgery in colorectal

cancer (CLASICC) trial APR , 131–132 hand-assisted laparoscopic right colectomy , 62 laparoscopic proctectomy , 400

Corticosteroids , 8–9 COST trial

hand-assisted laparoscopic right colectomy , 62 laparoscopic proctectomy , 400

Crohn’s disease (CD)

complex , 339–340 ileocolic resection

anastomosis , 341 bowel mobilization , 341 complex ﬁ stulous cases , 341 extracorporeal manual examination, bowel , 340–341 HALS , 341 mesenteric division , 341 SILC , 341–342 standard ports , 340

indications and contraindications , 337–338

laparoscopic colon resections , 339 laparoscopic proctocolectomy , 144–145 laparoscopic vs. open surgery, ileocolitis , 338–339 literature evidence , 338 minimally invasive (MI) surgery , 337 precautions , 342

da Vinci

system , 275–277 Deep dissection , 331–332 Descending colectomy , 46–47 Difﬁ cult splenic ﬂ exure

abdomen , 202–205

laparoscopic sigmoidectomy/left colectomy , 77–78 Distal sigmoid colon resection , 183–184 Diverticulitis

acute

complicated , 375–376 conservative treatment , 377–378

uncomplicated , 374 disease pathology, outcomes , 388–389 reoperative surgery , 230

Elderly patients, laparoscopy

acid/base effects , 315 aging , 309 cardiovascular and physiologic risk stratiﬁ cation , 310 cardiovascular effects , 316 changes and technical points , 316–317 clinical trials , 311 early studies , 311–312 enhanced recovery protocols , 314 immune system effects , 316 long-term outcomes , 314–315 vs. open outcomes , 312–314 patient factors , 309 pneumoperitoneum physiology , 315 preoperative risk assessment , 310–311 pulmonary effects , 315–316 renal effects , 316 risk factors , 314 vs. young , 312

Emergent laparoscopic colorectal surgery

advantages and disadvantages , 303–304 approach and abdominal entry , 304 bowel obstruction

malignant , 307–308

postoperative small , 307 colorectal perforation

acute colonoscopic perforation , 304–306

acute perforated diverticulitis , 306

postoperative anastomotic perforation , 306–307 precautions , 308

End ileostomy , 95–96 Endoscopy , 295 Enhanced recovery after surgery (ERAS) , 10–11 Enhanced recovery pathways (ERP) , 332 Enterotomy , 237–238 Extended right colectomy , 59 Exteriorization

anastomosis and , 59–60 laparoscopic sigmoidectomy/left colectomy , 78–79

Index

409

Familial adenomatous polyposis (FAP) , 145 Fatty mesentery , 209–210 Fecal incontinence , 369 Fetal monitoring , 376–377

Gas insufﬂ ation, pediatric MIS , 360 Gastrocolic trunk , 26–27 GI NOTES surgery , 264

Hand-assisted laparoscopic right colectomy

bowel extraction and anastomosis , 68 complication and solution , 68 concept , 62–63 COST trial and CLASSIC trial , 62 hepatic ﬂ exure takedown , 66 ileal mesentery mobilization , 66 oncologic colon resection , 63 patient positioning , 63–64 port placement , 64–65 postoperative care , 68 retroperitoneal dissection and lateral attachments , 66 surgeon, camera holder, and monitor , 65 technical difﬁ culty , 61 vessel and mesentery division , 67

Hand-assisted laparoscopic surgery (HALS)

abdomen , 202 ileocolic resection, CD patients , 341 vs. laparoscopic-assisted surgery (LAS) , 386–387 obese patients, laparoscopic colectomy , 327–329 TAC

colonic mobilization, completion of , 106–107 considerations , 109–110 device placement , 104 indications , 103 mesenteric division , 107–108 palm-down and palm-up techniques , 105 partial colonic mobilization, direct vision , 105–106 patient positioning , 104 resection, specimen extraction and anastomosis , 108, 109 surgical ports and energy devices , 104

UC patients

completion proctectomy with IPAA , 348–351 total abdominal colectomy with end ileostomy , 346–348 total proctocolectomy with IPAA , 351–352

Hand-assisted left colectomy

complications , 87 hand-port placement , 82–83 indications , 81 left colon dissection , 83–86 patient setup , 82 postoperative care , 86–87 precautions , 87–88 preoperative planning , 81

Hand-assisted low anterior resection (HALAR)

anastomosis , 128 bleeding , 128 bowel injury , 129 clinical trials , 129 hand-access device placement , 129 indications , 119 mobilization , 122–124

pelvic dissection , 130 port placement and hand device , 121 preoperative planning

imaging and diagnostic studies , 120

patient history and physical ﬁ ndings , 119 resection , 127 splenic ﬂ exure , 129–130 surgical management

patient positioning , 120, 121

preoperative planning , 120 TME , 124–127 Trendelenburg position , 122 ureteral injury , 128 visualization , 129 wound complications , 128

Hand-assist port , 228–229 Hartmann’s procedure , 179, 180 Hasson (open) technique , 22 Healthcare Cost and Utilization Project (HCUP) , 143 Hepatic ﬂ exure mobilization , 148 Hernia repair , 231 Hirschsprung’s disease

clinical presentation and indications , 365 laparoscopic-assisted endorectal pull-through , 365–366

Hybrid approach vs. total robotic approach , 281

Ileal mesentery mobilization , 66 Ileal pouch-anal anastomosis (IPAA)

completion proctectomy , 348–351 stapled IPAA vs. mucosectomy and handsewn anastomosis ,

145–146

total proctocolectomy , 351–352

Ileoanal pouch formation and anastomosis , 152–153 Ileocolic artery (ICA) , 25, 26 Ileocolic resection, CD patients

Ileorectostomy , 96–98 Ileostomy

formation , 153 with ileorectal anastomosis

anastomosis creation , 186

port placement , 184–185

rectal resection , 186

rectum mobilization , 185 laparoscopic ( see Laparoscopic ileostomy)

Imperforate anus. See Anorectal malformations Inferior mesenteric artery (IMA)

blood supply , 27, 28 bowstring effect , 27 embryologic surgical planes , 28–30 gonadal vessels , 30 innervation , 31–32, 34–35, 38–39 pelvis , 30–31 posterior and lateral compartments , 31, 33, 35–37 splenic ﬂ exure , 28, 29 superior rectal artery , 28 ureter , 30–35

410

Index

Inferior mesenteric vein (IMV) , 44–46 I n ﬂ ammatory bowel disease (IBD)

clinical presentation and indications , 362 disease pathology, outcomes , 389 exacerbations

mild , 375

severe , 376 reoperative surgery , 230–231 surgical technique , 362–364

Insufﬂ ation and port placement , 191 International Classiﬁ cation of Diseases (ICD) code , 143 Intraoperative colonoscopy , 210 Ischemic ostomy , 170

J pouch , 250, 257, 259

Keyhole technique , 194–195

LAARP. See Laparoscopic-assisted anorectal pull-through (LAARP) Laparoscopic adhesiolysis , 223 Laparoscopic anatomy. See Surgical anatomy Laparoscopic appendectomy , 361–362 Laparoscopic-assisted anorectal pull-through (LAARP) , 367–369 Laparoscopic-assisted appendicostomy , 369 Laparoscopic-assisted endorectal pull-through , 365–366 Laparoscopic-assisted surgery (LAS)

vs. conventional open surgery (OS)

clinical trials , 385–386

conversion , 386 desirable metrics , 391–392 disease pathology, outcomes

cancer , 389–390

diverticulitis , 388–389

inﬂ ammatory bowel disease (IBD) , 389 vs. HALS , 386–387 patient factors

age , 391

body mass index (BMI) , 390–391 SILS vs. MILS , 387–388 surgeon factors , 391

Laparoscopic colectomy , 381–382 Laparoscopic colon resections , 339 Laparoscopic colorectal surgery

bowel preparation , 7 elderly patients , 6 iatrogenic ureteral injury , 10 obese patients , 6 preoperative evaluation , 5 prevalence , 4

Laparoscopic colostomy , 174–176 Laparoscopic ileostomy , 171–174 Laparoscopic perineal approach , 138–139 Laparoscopic proctocolectomy

epidemiology and economics , 143–144 preoperative considerations

Crohn’s disease , 144–145

familial adenomatous polyposis (FAP) , 145

patient positioning , 146

site marking , 145

stapled IPAA vs. mucosectomy and handsewn

anastomosis , 145–146

ulcerative colitis , 144

technical approach

anorectum division , 150 colon mesentery transection , 150–152 hepatic ﬂ exure mobilization , 148 ileoanal pouch formation and anastomosis , 152–153 ileostomy formation , 153 left colon mobilization , 148 precautions , 153 rectal mobilization , 149–150 right colon mobilization , 147–148 splenic ﬂ exure mobilization , 148–149 trocar placement , 146–147

Laparoscopic rectal resection, cancer

colorectal/coloanal anastomosis , 116, 117 indications , 111 mesocolon and vascular pedicle dissection , 112–113 operative technique , 112 patient preparation , 111–112 pelvic dissection , 114–116 rectum division , 116 splenic ﬂ exure and left colon mobilization , 113–114 surgeon, assistant, and nurse positioning , 112 TME , 111

Laparoscopic rectopexy

anastomosis creation , 160–161 clinical trials , 166 complications , 165–166 indications , 156 patient setup , 157 port placement , 157–158 postoperative care , 165 precautions , 166–167 preoperative planning , 156–157 rectum mobilization , 164 redundant sigmoid colon, resection , 159–160 sigmoid colon and rectum mobilization , 158–159 transabdominal/transperineal approach , 155 trocar placement , 162, 164

Laparoscopic sigmoidectomy/left colectomy

bowel division, exteriorization, and anastomosis , 78–79 contraindications , 71–72 difﬁ cult splenic ﬂ exure , 77–78 indications , 71 lateral dissection , 77 left ureter identiﬁ cation, difﬁ culty , 76 operative steps , 74 port placement , 72–74 positioning , 72 positive leak test , 79–80 preoperative planning , 72 retromesenteric dissection , 76–77 splenic ﬂ exure mobilization , 77 surgery , 72

vascular isolation and division , 74–76 Laparoscopic splenic ﬂ exure mobilization , 280 Laparoscopic visualization , 295, 317 Laparoscopy

APR ( see Abdominoperineal resection (APR))

beneﬁ ts of , 4–5

conversions , 241–242

elderly patients ( see Elderly patients, laparoscopy)

HALAR ( see Hand-assisted low anterior resection (HALAR))

Index

411

instrumentation

bipolar energy , 19–20 camera/laparoscope , 16–17 energy devices , 19 graspers , 17–18 hand-assisted devices , 20 insufﬂ ator , 17 monopolar energy , 19 scissors , 18 staplers , 18–19 trocars , 15–16

ultrasonic energy , 20 objectives , 55 PH repair ( see Parastomal hernia (PH) repair) physiologic effects of , 3 stoma reversal ( see Stoma reversal, laparoscopic)

Lateral approach, right colectomy , 56 Lateral-to-medial mobilization , 38–41 Leak test , 297 Left colectomy

anterior resection and

descending colectomy , 46–47

inferior mesenteric vein and splenic ﬂ exure

mobilization , 44–46 low anterior resection , 47–48 perineal dissection , 49 uterine retraction , 48–49

robotic surgery

laparoscopic splenic ﬂ exure mobilization , 280 medial-to-lateral dissection, left colon , 280 port placement , 279 positioning , 279 total mesorectal dissection , 280–281

Left colon

dissection , 83–86 mobilization , 148

Low anterior resection

left colectomy and anterior resection , 47–48 robotic surgery

laparoscopic splenic ﬂ exure mobilization , 280 medial-to-lateral dissection, left colon , 280 port placement , 279–280 positioning , 279 total mesorectal dissection , 280–281

Lufttamponade therapy , 399 Lumbar sympathetic nerve plexus , 101 Lysis of adhesions , 227–228

Malignant obstruction , 307–308 Medial approach

right colectomy , 55 sigmoid colon mobilization , 71

Medial-to-lateral mobilization

dissection, left colon , 280

mobilization , 35–38, 40–41 Mesenteric division , 341 Mesh securement, PH repair

keyhole technique , 194–195

Sugarbaker technique , 193–194 Mesocolon and vascular pedicle dissection , 112–113 Minimally invasive colectomy

equipment , 401

laparoscopy and natural oriﬁ ce surgery , 401–402 Multi-incision laparoscopic surgery (MILS) , 387–388 Myocutaneous ﬂ aps, APR , 139

Natural oriﬁ ce specimen extraction (NOSE) , 264–265 Natural oriﬁ ce translumenal endoscopic surgery (NOTES)

GI NOTES , 264 initial clinical developments , 266–267 initial clinical pure transanal resection , 269 NOSE , 264–265 POEM , 264 precautions , 270 preclinical developments , 266 surgical paradigm , 263 taxonomy and abbreviations , 264 transanal rectosigmoid resection , 265–266 transanal TME (taTME) procedural steps , 267–269

Nerve damage , 218–219

Obese patients, laparoscopic colectomy

anatomy and technical challenge , 323–324 body mass index (BMI) , 321 clinical trials , 333–334 deﬁ nition, obesity , 321 dissection and mobilization , 329 ergonomic issues , 324 HALS , 327–329 learning curve , 324–325 omentum , 330 pelvic operations

deep dissection , 331–332 essential technical adjustments , 331 postoperative care and enhanced recovery pathways

(ERP) , 332 venous thromboembolism (VTE) prophylaxis , 332–333 wound management , 332

ports and exposure techniques , 326–327 positioning and securing , 325 precautions , 334 preoperative considerations , 322–323 prevalence , 322 technical considerations , 322 ureteral stent insertion , 325–326 visceral abdominal fat (VAT) , 321 waist-to-hip ratio (WHR) , 321

wound extraction site , 330–331 Omentoplasty , 139 Omentum , 242–243, 330 Oncologic colon resection , 63 Open stoma reversals , 186, 187 Ostomy

creation, APR , 136

marking , 7–8

reversal, reoperative surgery , 229–230

Palm-down and palm-up techniques , 105 Parastomal hernia (PH) repair

adhesiolysis and hernia reduction , 191–192

clinical trials , 196

complications , 195–196

incidence , 189

insufﬂ ation and port placement , 191

mesh measurement and preparation , 192–193

mesh securement

keyhole technique , 194–195 Sugarbaker technique , 193–194

412

Index

Parastomal hernia (PH) repair (cont.)

patient setup , 191 postoperative care , 195 precautions , 196–197 preoperative planning , 190 risk factors , 189 stoma creation , 170 stomal relocation , 195 Sugarbaker technique , 189

Patient factors, LAS

age , 391

body mass index (BMI) , 390–391 Patient Protection and Affordable Care Act (PPACA) , 403–404 Pediatric minimally invasive surgery (MIS)

anorectal malformations/imperforate anus

laparoscopic-assisted anorectal pull-through (LAARP) ,

367–369

modern open approach , 366

appendicitis

clinical presentation and indications , 361

laparoscopic appendectomy , 361–362 fecal incontinence , 369 gas insufﬂ ation , 360 Hirschsprung’s disease

clinical presentation and indications , 365

laparoscopic-assisted endorectal pull-through , 365–366 history , 357–358 inﬂ ammatory bowel disease (IBD)

clinical presentation and indications , 362

surgical technique , 362–364 laparoscopic instrumentation , 360–361 patient selection and positioning , 358–359 trocar selection and insertion technique , 359–360

Pelvic dissection

HALAR , 130 laparoscopic rectal resection , 114–116

Pelvis

accessing the abdomen/port conﬁ guration , 213–214 bleeding , 220 genitourinary structures , 219 inferior mesenteric vein division/splenic ﬂ exure mobilization ,

217–218 lateral and anterior mobilization, rectum , 219 medial-to-lateral left colonic dissection , 214 nerve damage , 218–219 precautions , 220 rectal mobilization/bowel division , 218 rectum division , 220 retroperitoneal exposure/critical anatomy , 214–216 vascular pedicle division/proximal colonic mobilization , 216–217

Perineal approach, laparoscopic. See Laparoscopic perineal approach Perineal defect, reconstruction , 139 Perineal dissection

APR , 137 left colectomy and anterior resection , 49

Perioperative assessment

cardiovascular effects , 3–4 elderly patients , 6 elective patients, evaluation

cardiac , 5–6 laboratory testing , 5

pulmonary , 6 emergency colorectal surgery patients , 6 ERAS , 10–11 intraoperative management

endoscopy availability , 10

gastric decompression , 10 patient monitoring , 9 patient positioning , 9–10 urinary drainage and ureteral stenting , 10 VTE prevention , 10

laparoscopy

beneﬁ ts of , 4–5 physiologic effects of , 3

patient management

analgesic considerations , 9 antibiotics , 9 bowel preparation , 7 corticosteroids , 8–9 fasting , 7 informed consent , 9 lesion localization , 7

ostomy marking , 7–8 pulmonary effects , 4 renal effects , 4 reoperative surgery , 7

Peritoneal space

avoiding complications , 23 direct trocar insertion , 22 hand assist , 23 Hasson (open) technique , 22 laparoscopic entry techniques , 21 optical trocar , 22 reoperative surgery , 22 trocar positioning , 22 Veress needle , 21–22

Peritonitis , 376 Per-oral endoscopic myotomy (POEM) , 264 Pneumoperitoneum

elderly patients , 315 obese patients , 243–244

Polypectomy , 296–297 Polyp retrieval, CELS , 298 Port placement

colostomy after Hartmann’s procedure , 180–182 combined endo-laparoscopic surgery (CELS) , 295 ileostomy with ileorectal anastomosis , 184–185

Positive leak test , 79–80 Postoperative anastomotic perforation , 306–307 Postoperative ileus (POI) , 403 Postoperative small bowel obstruction , 307 Pregnancy

acute cholecystitis and symptomatic cholelithiasis , 375 acute diverticulitis

complicated , 375–376

conservative treatment , 377–378

uncomplicated , 374 appendicitis

acute , 375

diagnosis , 377

insufﬂ ation , 377

colorectal cancer (CRC) , 376 fetal monitoring , 376–377 IBD exacerbations

mild , 375

severe , 376 indications , 374 instrumentation , 377 pain , 377 patient positioning , 376 peritonitis , 376 physiology and anatomy, changes , 373–374

Index

413

small bowel obstruction

early , 374

late and complete , 375 technical tips , 378 trocar placement , 377

Procidentia. See Laparoscopic rectopexy Proctectomy with IPAA

HALS , 348–351 single-incision laparoscopic surgery (SILS) , 353

Proctocolectomy, laparoscopic. See Laparoscopic proctocolectomy Proximal colon mobilization , 182–183

Rectal prolapse. See Laparoscopic rectopexy Rectal resection , 186. See also Laparoscopic rectal resection, cancer Rectopexy, laparoscopic. See Laparoscopic rectopexy Rectum

division , 116, 220 mobilization , 149–150, 164, 185 reoperative surgery , 227

Recurrence rates , 155, 156 Redundant sigmoid colon, resection , 159–160 Reoperative surgery

abdomen , 210 anatomy , 225–226 bladder , 226 blood vessels , 226–227 colorectal cancer , 230 complications , 221 conversion rate , 221, 222 conversion to open procedure , 229 diverticular disease , 230 enterotomy rates , 222 gaining access , 225 hand-assist port , 228–229 IBD , 230–231 laparoscopic adhesiolysis , 223 lysis of adhesions , 227–228 minimally invasive colorectal case , 222–223 ostomy reversal , 229–230 perioperative assessment , 7 peritoneal space , 22 preoperative evaluation , 223–225 prior hernia repair , 231 rectum , 227 timing of surgery , 224 ureter , 226

Resection

HALAR , 127 redundant sigmoid colon , 159–160

Restorative proctocolectomy , 131 Retromesenteric dissection , 76–77 Retroperitoneal exposure , 214–216 Right colectomy

clinical anatomy , 54–55 colon and mesentery mobilization , 56–57 complication and solution , 60 extended right colectomy , 59 exteriorization and anastomosis , 59–60 identiﬁ cation and division, vascular pedicles , 58 inferior approach , 55–56 lateral approach , 56 lateral-to-medial mobilization , 38–41 lesser sac , 41, 42 medial approach , 55

medial-to-lateral mobilization , 35–38, 40–41 objectives, laparoscopic procedure , 55 patient preparation , 53 patient setup , 53–54 procedure , 56 right colon attachments, division , 58–59 robotic surgery

patient positioning , 278 port placement , 278 procedure , 278–279

superior approach , 56 Right colic artery (RCA) , 25 Right colon mobilization , 147–148 Robotics

assisted laparoscopy , 382–383

assisted surgery

drawbacks , 403 dual console equipment , 402–403

Robotic surgery

camera , 276

da Vinci

system , 275–277 disadvantages , 274 equipment , 275, 276 hybrid approach vs. total robotic approach , 281 indications , 275 instruments , 277 left colectomy/low anterior resection

laparoscopic splenic ﬂ exure mobilization , 280 medial-to-lateral dissection, left colon , 280 port placement , 279–280

total mesorectal dissection , 280–281 patient positioning , 277 port placement , 277–278 precautions , 281 procedure , 273, 274 right colectomy

patient positioning , 278

port placement , 278

procedure , 278–279

Sigmoid colon

division , 136 rectum mobilization and , 158–159

Sigmoidectomy, laparoscopic. See Laparoscopic sigmoidectomy Single-incision laparoscopic colectomy (SILC) , 341–342 Single-incision laparoscopic surgery (SILS)

vs. multi-incision laparoscopic surgery (MILS) , 387–388 UC patients

proctectomy with IPAA , 353

total abdominal colectomy with end ileostomy , 352–353

Single-incision laparoscopy

clinical trials , 261 complications , 260–261 indications , 249–250 left colectomy

port at the umbilicus , 254–256

suprapubic location , 256–257

surgical procedure , 253 port types and port placement , 250 postoperative care , 260 precautions , 261 preoperative planning , 250 right hemicolectomy , 250–253 single-port surgery , 249

414

Index

Single-incision laparoscopy (cont.)

total proctocolectomy with ileal pouch anal anastomosis

reconstruction colonic dissection , 258–259 ileoanal anastomosis , 259 ostomy , 259–260 patient positioning , 258 preparation and positioning , 258 proctectomy , 259 single-port multi-trocar access system placement , 258 specimen extraction , 259

Single-port colectomy , 382–383 Small bowel obstruction

early , 374 late and complete , 375 postoperative , 307

Splenic ﬂ exure

HALAR , 129–130 mobilization

laparoscopic proctocolectomy , 148–149 left colectomy and anterior resection , 44–46, 77 left colon and , 113–114

Stapled IPAA vs. mucosectomy and handsewn

anastomosis , 145–146

Stoma creation

indications , 169 ischemic ostomy , 170 laparoscopic colostomy , 174–176 laparoscopic ileostomy , 171–174 mesenteric length , 176 operating room setup and patient positioning , 171 parastomal hernia , 170 precautions , 176

preoperative planning , 170 Stomal relocation , 195 Stoma reversal, laparoscopic

colostomy after Hartmann’s procedure

anastomosis creation , 184 distal sigmoid colon resection , 183–184 Hartmann’s pouch and rectum mobilization , 183 port placement , 180–182

proximal colon mobilization , 182–183 complications , 186–187 Hartmann’s procedure , 179, 180 ileostomy with ileorectal anastomosis

anastomosis creation , 186

port placement , 184–185

rectal resection , 186

rectum mobilization , 185 outcome , 187–188 patient setup , 180 postoperative care , 186 precautions , 188 preoperative planning , 179–180

Straight laparoscopy. See Total abdominal colectomy (TAC) Strictures , 241 Sugarbaker technique , 189, 193–194 Superior hemorrhoidal vessels , 134 Superior mesenteric artery (SMA) , 25–27 Superior rectal artery (SRA) , 208 Surgeon factors, LAS , 391 Surgical anatomy

colonic mesenteric vasculature

gastrocolic trunk , 26–27

ileocolic (ICA) , 25, 26

right colic artery (RCA) , 25

superior mesenteric artery (SMA) , 25–27

inferior mesenteric artery (IMA)

left colectomy and anterior resection

descending colectomy , 46–47 inferior mesenteric vein and splenic ﬂ exure mobilization ,

44–46 low anterior resection , 47–48 perineal dissection , 49 uterine retraction , 48–49

right colectomy

lateral-to-medial mobilization , 38–41 lesser sac , 41, 42 medial-to-lateral mobilization , 35–38, 40–41

transverse colectomy and middle colic vessels , 42–43 Surgical innovation , 399 Symptomatic cholelithiasis , 375

Thermal injury , 237–238 Total abdominal colectomy (TAC)

abdomen and port placement , 90–91

clinical trials , 100

end ileostomy , 95–96

hand-assisted ( see Hand-assisted laparoscopic surgery (HALS))

ileorectostomy , 96–98

intraoperative complications , 99

patient setup , 90

postoperative care , 98

postoperative complications , 99

precautions , 100

preoperative planning and decision making , 89–90

right colon , 91

sigmoid colon, left colon, and splenic ﬂ exure , 93–94

specimen extraction , 94–95

surgical indications , 89

transverse colon and hepatic ﬂ exure , 91–93 Total abdominal colectomy with end ileostomy

HALS , 346–348

single-incision laparoscopic surgery (SILS) , 352–353 Total lung capacity (TLC) , 373–374 Total mesorectal dissection , 280–281 Total mesorectal excision (TME)

APR , 132, 134–136

HALAR , 124–127

laparoscopic rectal resection , 111

left colectomy , 279 Total proctocolectomy

ileal pouch anal anastomosis reconstruction

colonic dissection , 258–259 ileoanal anastomosis , 259 ostomy , 259–260 patient positioning , 258 preparation and positioning , 258 proctectomy , 259 single-port multi-trocar access system placement , 258 specimen extraction , 259

IPAA , 351–352

Index

415

Transabdominal approach , 155 Transanal endoscopic microsurgery (TEMS) , 283 Transanal minimally invasive surgery (TAMIS)

indications , 284 precautions , 289–290 preoperative work-up , 284–285 technique , 285–289

TEMS , 283 Transanal rectosigmoid resection , 265–266 Transanal TME (taTME) , 267–269 Transperineal approach , 155 Transverse colectomy and middle colic vessels , 42–43 Transverse colon

abdomen , 205

hepatic ﬂ exure and , 91–93 Trendelenburg position, HALAR , 122 Trocar placement

laparoscopic proctocolectomy , 146–147

laparoscopic rectopexy , 162, 164

pregnant patients , 377

prevention and management , 235–237

Ulcerative colitis (UC) patients

conventional laparoscopy vs. HALS vs. SILS vs. open

surgery , 353

HALS and conventional laparoscopic surgery

completion proctectomy with IPAA , 348–351 total abdominal colectomy with end ileostomy , 346–348 total proctocolectomy with IPAA , 351–352

laparoscopic proctocolectomy , 144 operative methods , 345 precautions , 355 rectal cancer and , 354–355 SILS

proctectomy with IPAA , 353

total abdominal colectomy with end ileostomy , 352–353 surgical strategy , 354 treatment , 346

Ureter

abdomen , 208–209 reoperative surgery , 226

Ureteral stenting , 10 Urinary drainage , 10 Uterine retraction , 48–49

Vascular injury , 236 Vascular pedicles , 58 Venous thromboembolism (VTE)

prevention , 10 prophylaxis, obese patients , 332–333

Veress needle, peritoneal space , 21–22 Vessel and mesentery division , 67 Visceral abdominal fat (VAT) , 321

Waist-to-hip ratio (WHR) , 321 Wound extraction site , 330–331

<<< < Предыдущая 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 4041 / 4141

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